Parent Child Interaction Therapy (PCIT)
Helping families with young children with behavior difficulties.
Lauren is a 6-year-old 1st grader whose parents expressed concerns about her impulsivity and daily temper outbursts. Both parents described significant stress managing Lauren’s behavior. They sought help managing Lauren’s outbursts and getting her to complete day-to-day tasks with less stress and frustration for everyone involved.
Nicky is a 4-year-old preschooler whose mother expressed concern about his difficulty listening and following through on adults’ directives. Nicky’s mother was very concerned about the effect Nicky’s difficulties were having on his behavior at home and on his learning.
Children are born with different temperaments; some are easy going and some have more difficulty adjusting to the rhythms of everyday life. Parents may find that their common sense child-rearing practices that may have worked with another child with an easy temperament may not work with a child with behavior problems. The result is increasing frustration and tension between parent and child. Parent-Child Interaction Therapy (PCIT) which aims to improve parent-child relationships and child behavior by working with both parents and children together has been found to be extremely helpful. To learn more about this program AOK spoke with Melanie Fernandez, Ph.D. (Clinical Psychologist, Institute for ADHD and Behavior Disorders)
What are the aims of PCIT?
The program is an empirically supported treatment for children between the ages of 2 and 7 years old with disruptive behavior disorders and their families. PCIT gives equal attention to the parent-child relationship and to parents’ behavior management skills. The goals of the program are to enhance parent-child interactions, improve child behavior, and empower parents to use consistent, predictable, effective parenting strategies.
What is unique about PCIT?
This program is based on teaching and practicing positive parenting skills in a supportive environment. What makes the program unique is that, unlike most therapies in which skills are taught in the office and then the family goes home to practice, in PCIT the practice with the child is done in the presence of the therapist.
What actually happens during PCIT sessions?
PCIT consists of weekly, hour-long sessions, over a period which typically lasts from 12 to 20 weeks, with both teaching and coaching sessions. Teaching sessions involve introduction, modeling, and role-playing of very specific skills; teaching is followed by coaching. Coaching sessions involve review of home practice and live coaching of parent-child interactions. Through a one-way mirror and a transmitter worn in the parent’s ear, the therapist gives live, ongoing coaching, advice and encouragement while the parent interacts with the child. These new skills are practiced, reviewed and mastered in the office. Home practice sessions of 5 to l5 minutes a day are a critical part of the treatment.
What do parents learn in the sessions?
Parents learn to increase their rates of positive attention when their child’s behavior is appropriate and to use differential attention to reduce minor negative behaviors. Parents also learn a specific time-out procedure to use when their child does not comply with a command or demonstrates other previously agreed-upon disruptive behaviors (e.g., back talking, hitting a sibling).
How does the PCIT program involve both parents and children in the treatment?
PCIT is structured in two phases: the Child-Directed Interaction and Parent-Directed Interaction phases. At the beginning of each phase, a teaching session with parents and without the child is held to introduce the skills that will be the focus of that phase. Remaining sessions, or “coaching” sessions, include the child and involve live practice with the parent and child, with coding and coaching of skills by the clinician.
How is progress determined?
Before beginning each session, parents are asked to complete a behavior rating scale – the Eyberg Child Behavior Inventory, or ECBI. This scale provides data on the frequency of their child’s disruptive behavior and how bothersome the behaviors are for parents. Parents must master specific criteria to progress from the Child-Directed Interaction phase to the Parent-Directed Interaction phase (from CDI to PDI and from PDI to graduation.) Skills are coded, tracked, and reviewed with families each week to inform them of their progress. Families graduate from PCIT after demonstrating CDI and PDI mastery, reporting their child’s disruptive behavior to be similar to typical child behavior, as measured on the ECBI, and expressing confidence in their ability to manage their child’s behavior in real-life settings.
Do mental health professionals require special training, and where is it available?
According to the recently disseminated PCIT Treatment Guidelines, to be PCIT-trained, one must have
• a master’s degree or higher in the mental health field
• must be actively working with children and families
• must be licensed in his/her field or working under the supervision of a licensed clinician
• must be at an agency that provides appropriate space and equipment for PCIT
• must be at an agency that serves the appropriate populations within the age-range for PCIT
What treatment is available at the CSC?
The PCIT program at NYU has been developing over the past 10 years under the direction of Dr. Steven Kurtz, Clinical Director of the Institute for ADHD and Behavior Disorders and Coordinator of CSC’s PCIT program. Dr. Kurtz has participated in PCIT training with Sheila Eyberg, developer of PCIT, and Cheryl McNeil, a prominent PCIT researcher and clinician. Dr. Fernandez, a PCIT supervisor and clinician, studied under Dr. Eyberg at the University of Florida.
At CSC, PCIT is available on multidisciplinary training teams that include advanced psychology graduate students, post-doctoral fellows, psychologists, and psychiatrists. PCIT is also available with individual clinicians. PCIT clinicians are supervised by psychologists approved as PCIT trainers according to the Training Guidelines.
The classroom adaptation of PCIT, Teacher-Child Interaction Therapy (TCIT) is being evaluated in two community guidance clinics in Bronx, NY and is also available clinically through the CSC. The CSC also offers training in PCIT every summer, with the opportunity for continued supervision and clinical experience on PCIT teams.
How did PCIT originate?
PCIT was developed by Dr. Sheila Eyberg in the 1970s at the Oregon Health Sciences University. Dr. Eyberg is now a Distinguished Professor at the University of Florida, where she continues to study PCIT (www.pcit.org).
Is research being conducted on the effectiveness of PCIT?
Over 30 published studies have documented the positive effects of PCIT. Specifically, studies have documented the superiority of PCIT to waitlist controls and to parent group didactic training. PCIT has also been identified as among Best Practice treatments for maltreated young children.
Outcome studies of PCIT have demonstrated important changes in parent-child interactional patterns. In addition, findings have repeatedly shown significant changes on parent ratings and observational measures of children’s behavior problems. With PCIT, parents demonstrate increases in physical proximity and prosocial verbalizations towards their child, such as praise and reflective listening, and reductions in sarcastic and critical statements. Outcome studies have also demonstrated significant changes on parents’ self-report measures of depressive symptoms, personal distress, and parenting locus of control. After PCIT, children demonstrate significant improvements in compliance and reductions in other disruptive behaviors, such as whining. The effects of PCIT have also been shown to generalize to untreated siblings.
Have the effects been examined long-term?
Research suggests that gains made in PCIT are largely maintained at least 6 years after treatment completion.
After PCIT, Lauren’s parents expressed relief that they no longer had to battle Lauren to complete routine activities, and they were thrilled that her chronic interrupting had improved. Both parents also described significantly less stress managing Lauren’s behavior and were pleased that they could begin going out to dinner again with Lauren present.
After PCIT, Nicky’s mother indicated that she no longer needed to nag or yell at Nicky for him to listen. She commented that the best compliment on their progress was from her own mother who, after visiting from out of town, was amazed at the improvements in Nicky’s and his mother’s relationship and in Nicky’s behavior. Nicky’s teacher also observed improvements in Nicky’s listening at school.
Date Published: May 27, 2009
