Parent-Child Interaction Therapy

Parent-Child Interaction Therapy (PCIT) is an intervention for children (ages 2-12 years) and their parents or caregivers that focuses on decreasing externalized child behavior problems (e.g., defiance, aggression), increasing positive parent behaviors, and improving the quality of the parent-child relationship. It teaches parents traditional play-therapy skills to improve parent-child interactions and problem-solving skills to manage new problem behaviors. Parents are taught and practice communication skills and behavior management with their children in a playroom while coached by therapists. Most parenting programs for abusive parents treat parents separately from their children and use an instructive approach, but PCIT treats parents with their children. Skills are behaviorally defined, directly coached, and practiced in parent-child sessions. Parents are shown directly how to implement specific behavioral skills with their children. Therapists observe parent-child interactions through a one-way mirror and coach the parent using a radio earphone. Live coaching and monitoring of skill acquisition are cornerstones of PCIT.

The PCIT intervention is composed of three phases. The first phase consists of orientation sessions focused on increasing parent motivation for active participation. Following the motivational enhancement orientation module, parents begin a course of approximately 12 PCIT sessions that consists of two more phases. In the child-direct interaction phase, parents allow their child to lead the play activity while they describe, imitate, and praise the child’s appropriate behavior and ignore inappropriate behavior. In the parent-directed interaction phase, parents direct children’s activity by using clear, positively stated direct commands and consistent consequences for their children’s behavior (praise or time-outs). The goal is to enhance relationships while improving compliance.

The length of treatment can vary, but the standard treatment consists of 12 one-half hour weekly sessions, with a one-hour booster session one month after treatment ends.

Blueprints certification is based on three studies: (1) Nixon et al. (2003); (2) Matos et al. (2009); and (3) Chaffin et al. (2011). Nixon et al. (2003) conducted an experimental study with preschool-aged children exhibiting behavioral difficulties. Researchers randomly assigned 63 families to three groups: 1) the standard PCIT (n = 22), 2) the abbreviated PCIT (n = 23 families), and 3) a waitlist control group (n = 18 families). Findings showed both a standard 12-session treatment and an abbreviated 5-session treatment similarly reduced posttest measures of behavior problems among preschool children with oppositional defiant disorder. In addition, parents benefitted from the treatment in developing a stronger sense of competence and control in their childrearing.

Matos et al. (2009) conducted a randomized control trial involving 32 families with a child (ages 4-6 years) exhibiting hyperactivity and behavior problems in which families were randomly assigned to treatment (n = 20) or a waitlist control condition (n = 12). Results indicated significantly greater improvement for the treatment group compared to the control group on posttest measures relating to hyperactivity, aggression, disruptive behavior, and positive parental practices.

Chaffin et al. (2011) evaluated PCIT using a randomized control design involving parents referred to the program by a child welfare agency for neglect and/or physical abuse. Randomization occurred in two steps, first for the orientation conditions and then for the therapy conditions. The first randomization assigned 192 parents to either a self-motivation orientation condition or a usual orientation condition. The self-motivation orientation involved meetings without the children and included activities to highlight the benefits of the program; the usual orientation was primarily informational and educational. The second randomization assigned the 153 parents remaining after the orientation to a PCIT condition or a service-as-usual condition. The PCIT condition followed program guidelines to promote positive interaction between both parent and child; the service-as-usual sessions provided information to the parent on child development, reasonable expectations, compassionate parenting, and the value of empathy. The sequential randomization thus defined four conditions: 1) self-motivation orientation and PCIT; 2) usual orientation and PCIT; 3) self-motivation orientation and service-as-usual; and 4) usual orientation and service-as-usual (i.e., control). The design allowed for the analysis to disentangle the benefits of the orientation from the benefits of the therapy.

The PCIT program included six orientation sessions and 12 parenting sessions. Assessments occurred at baseline, after the six-session orientation, and after the 12 sessions of the parenting program. The length of the intervention varied across subjects, making it difficult to pinpoint a specific end, but the median time from baseline to collection of post-treatment data was 247 days. The period of follow-up differed as well, but the median was 2.5 years.

Study outcomes revealed the package of PCIT combined with a self-motivational orientation significantly reduced the incidence of recidivism among a sample of parents referred to child welfare for child abuse.

In terms of cost-benefit analysis, Washington State Institute for Public Policy (December 2018) reports $15.97 in measured benefits per $1 spent in implementing Parent-Child Interaction Therapy (PCIT) for families in the child welfare system, and $0.57 per $1 spent in implementing PCIT for children with disruptive behavior.

References:

Chaffin, M., Funderburk, B., Bard, D., Valle, L. A., & Gurwitch, R. (2011). A combined motivation and Parent-Child Interaction Therapy package reduces child welfare recidivism in a randomized dismantling field trial. Journal of Consulting and Clinical Psychology, 79(1), 84-95.

Matos, M., Bauermeister, J. J., & Bernal, G. (2009). Parent-Child Interaction Therapy for Puerto Rican preschool children with ADHD and behavior problems: A pilot efficacy study. Family Process, 48(2), 232-252.

Nixon, R. D. V., Sweeney, L., Erickson, D. B., & Touyz, S. W. (2003). Parent-Child Interaction Therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71(2), 251-260.