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Parent Child
Interaction
Therapy

What is Parent Child Interaction Therapy?

Young girl ignoring her mother prior to participating in PCIT treatment.

Parent Child Interaction Therapy - also known as PCIT - is a specialized treatment program designed for caregivers and their young children (2 to 7 years old) who are experiencing social, behavioral, and/or emotional difficulties.

 

PCIT has been found to help children who have any of the following:

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  • Frequent temper tantrums

  • Defiance - refusing to follow directions

  • Verbal and/or physical aggression

  • Destruction of toys and/or family belongings

  • Backtalk or sassing adults

  • Whining or crying for no apparent reason

  • Constantly seeking attention

  • Hyperactivity

  • Interrupting others

  • Short attention span

  • Difficulty with behaviors at school, preschool, and/or daycare

Deciding if PCIT is a Good Fit for your Family

Seeking therapy services for your child is a major decision. Families who participate in PCIT services often report the following during initial sessions:

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  • Feeling overwhelmed by their child

  • Feeling frustrated or angry with their child

  • Feeling like their child is out of control

  • Feelings of embarrassment, especially in public places

  • Feeling lost because current behavior management strategies are not working

  • A desire to learn skills or tools to deal with behavior challenges

Mother and son laughing during homework for PCIT therapy.
Father and daughter playing instruments during Special Time of PCIT.

What are the Benefits of PCIT?

During the first phase of PCIT (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). 

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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 PCIT (Parent-Directed Interaction), caregivers learn how to deliver clear, direct commands to reward child compliance, and utilize effective strategies for child noncompliance.  

 

Benefits of the second phase of PCIT include:

  • Increased compliance with caregiver requests

  • Decreased frequency, severity, and/or duration of aggressive behavior

  • Decreased frequency of destructive behavior

  • Improved behavior at home, and in public

  • Increased caregiver confidence

  • Decreased caregiver stress

PCIT Therapy Structure 

PCIT therapy is implemented in two phases: (1) the Child-Directed Interaction Phase (CDI) where parents develop child-centered interaction skills to enhance the parent-child relationship; and (2) the Parent-Directed Interaction Phase (PDI) where caregivers learn additional behavior management skills. PCIT gives equal attention to the enhancement of the parent-child relationship, and the development of caregivers' behavior management skills.

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During the first phase of PCIT therapy (the Child-Directed Interaction Phase), the golden rule is for the caregivers to "follow the child's lead." Children are encouraged to lead the play activity while their caregivers follow along using the PRIDE skills. The CDI Phase of PCIT aims to enhance the parent-child relationship by maximizing positive communication, attention, and imitation during child-led play. 

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In the second phase of PCIT therapy (the Parent-Directed Interaction Phase), caregivers learn to use effective commands and implement additional behavior management strategies for any remaining challenging behaviors (e.g., aggression, destruction). The overall goal for PDI is to create a supportive home environment by helping caregivers become consistent, predictable, and follow through with behavior management skills. 

Mom and son playing with blocks during PCIT therapy.
Mother and daughter smiling and painting during Parent Child Interaction Therapy.

PCIT Therapy Format

Parent Child Interaction Therapy services should only be delivered by mental health professionals who have been formally trained in PCIT. The average length of PCIT treatment is 14-16 weeks, with PCIT services most frequently delivered once per week (60-minute weekly sessions).

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Traditionally, Parent Child Interaction Therapy has been conducted in a mental health clinic using both a clinic room and observation room (and the PCIT therapist conducts services behind a one-way mirror). However, PCIT services have evolved and now trained therapists can deliver PCIT therapy using a wide range of formats, including but not limited to: (a) in-room coaching in a clinic or hospital; (b) home-based services; and (c) telehealth (commonly referred to as iPCIT).

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Each phase of PCIT (CDI Phase & PDI Phase) begins with a didactic, "Teach Session" where PCIT therapists meet only with the child's caregiver(s). During PCIT Teach Sessions, the skills that will be used in each phase are taught, modeled, and role-played with the caregiver(s). Teach sessions are followed by "PCIT Coaching Sessions" where the therapists use scaffolding, prompting, reinforcement, and selective attention to shape a caregiver’s utilization of PCIT skills. To help caregivers become proficient in PCIT skills (and to increase the generalization of PCIT skills outside of sessions), parents are coached in real-time while they are playing with their child. Live coaching of behavior management strategies is a hallmark of PCIT (see below for more detailed information on coaching in PCIT).

PCIT Coaching

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 PCIT skills can be conducted within the same room. In fact, live coaching can also be done within the client’s home or via telehealth (often referred to as iPCIT).

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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.

Psychologist coaching an Oklahoma family during PCIT therapy.

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