Overview of Parent Child Interaction Therapy (PCIT)

Parent Child Interaction Therapy (PCIT) is an evidence-based treatment for children 2 to 7 years of age with social, emotional, and behavioral challenges.  Over the past 4 decades, PCIT has documented success addressing a wide variety of emotional and behavioral difficulties, including:

• Physical & Verbal Aggression
• Destruction of Property
• Noncompliance / Defiance
• Hyperactivity / Inattention
• Emotional Dysregulation
• Difficulties with Attachment

Duration of Treatment

Parent Child Interaction Therapy sessions typically occur once per week.  The average number of sessions to complete PCIT is 14 (typical range is 10 to 20 sessions).  Importantly, PCIT is a mastery-based treatment that continues until the caregiver has demonstrated specific skills, and the child’s behavior has improved to within normal limits.

PCIT is Delivered in Two Phases

During the first phase of treatment (Child-Directed Interaction), children are encouraged to lead a play activity while their caregivers observe and comment on their child’s positive behaviors (and ignore inappropriate behaviors).  The primary goal of the first phase of PCIT (the Child-Directed Interaction) is to strengthen positive caregiver-child relationships.  Benefits of the first phase of PCIT include:

• Increased feelings of security, safety, and attachment with caregiver(s)
• Increased attention span
• Increased self-esteem
• Increased pro-social behaviors (sharing, taking turns)
• Decreased frequency, severity, and/or duration of tantrums
• Decreased hyperactivity
• Decreased negative attention-seeking behaviors (whining, bossiness)
• Decreased caregiver frustration

In the second phase of the intervention (Parent-Directed Interaction), caregivers learn how to deliver clear, direct commands to reward child compliance, and utilize effective strategies for child noncompliance.  The primary goal of the second phase of PCIT (the Parent-Directed Interaction) is to change ineffective caregiver-child interaction patterns.  Benefits of the second phase of PCIT include:

• Increased compliance with adult (caregivers, teachers) requests
• Increased caregiver confidence (and decreased stress)
• Improved behavior at home, and in public
• Decreased frequency, severity, and/or duration of aggressive behavior
• Decreased frequency of destructive behavior
• Decreased defiance

Live Coaching of Skills

A hallmark of Parent Child Interaction Therapy is the use of constructive, positive, live coaching of caregivers.  Therapists typically coach from an observation room with a one-way mirror into the playroom, using a “bug-in-the-ear” system for communicating to the caregivers as they play with their child.  However, live coaching of skills can be conducted within the same room.  In fact, live coaching can also be done within the client’s home.

Live coaching of caregiver skills has five advantages over the more traditional methods of caregiver training (e.g., parenting groups, modeling, rehearsal):

1. Immediate, positive feedback by the coach can prompt, shape, and reinforce the caregiver’s appropriate skill usage.
2. Live coaching allows the therapist to adapt the skills being taught to manage specific behavior problems as they arise.
3. Direct coaching provides a unique opportunity for therapists to quickly correct errors so caregivers do not repeatedly practice incorrect techniques.
4. Direct observation and coaching decreases the need to rely on caregiver self-reports of skill utilization at home.
5. As caregivers become more adept at using the newly trained skills, the therapist can fade out prompts.