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The DA Guide to PCIT

Parent-Child Interaction Therapy (PCIT) is a family-oriented therapy which trains parents, or immediate carers, how to interrelate in a positive way with their children. It is considered to be one of the most effective and widely used therapies.

PCIT: What is it?

PCIT is a therapy where the parents are instructed as to how to respond in the most beneficial way to their child. It encourages communication and positive interactions. It aims to create a loving, caring environment in which the child can develop in a healthy way. It helps to transform the child’s negative behaviors into positive ones through learned and repeated responses from the parents.  PCIT can help to develop a stronger family relationship and to increase parent-child bonds.

PCIT Theory

PCIT is one of the behavioral therapies based on the Behaviorism theories.

How Does PCIT Suggest the Mind Works?

In all behavioral therapies, the premise is that behavior is learned and so can be unlearned. This is done by encouraging and praising positive behavior and ignoring or punishing-in an acceptable learned manner-negative behavior. The child learns to associate good behavior with feeling good from receiving praise and attention, and unacceptable behavior with feeling bad from being ignored. He learns to desist in doing the things which get him ignored and doing the things which get him attention.

How Does PCIT Cause Change?

PCIT causes change by modifying behavior by praising good behavior and punishing bad. Both the praise and the punishment are learned techniques which follow simple rules and are always repeated in the same way. Parents learn the necessary skills to encourage the child to develop positive behaviors and to reduce negative behavior. PCIT also brings about positive changes in the relationship between the parent and child which in itself can improve behavior.

What Happens in a PCIT Session?

The therapy is usually broken down into two stages.  Firstly, enhancing the parent-child relationship, and then, establishing discipline that the child complies with.

Initially, the therapist will talk with the parents alone, to discover what the child’s problems are, and what behavior they wish to modify. She will explain to them the principals and techniques that they will be learning. The therapist will then get the parents to play with the child who is allowed to take control of the session and to select the toys to use from those that are available. The therapist will observe through a one-way mirror from an adjoining room and can guide the parents as to how to employ the skills they have learned about, using a small earpiece.

During this first stage, the parents will be encouraged to use these five skills that they have learned.

Praise, where the child receives praise when (s)he is behaving in an appropriate manner.

Reflection, where the parents repeat back the child’s words to them and expand on them to increase and promote communication.

Imitation, where the parents copy the child’s behavior as a sign of approval and acceptance.

Description, where the parents describe what the child is doing to help to increase the child’s vocabulary and so his communication skills, and to demonstrate to the child that they are interested in and paying attention to what he is doing.

Enjoyment, where the parents express their enthusiasm for what the child is doing.

These skills are commonly referred to by the acronym PRIDE.

During this stage of the therapy, parents are asked to ignore any unacceptable behaviors as long as it is not harmful or really serious. They will also be asked to not use negative words such as,” no, don’t or can’t, “and to never respond to the child in a sarcastic or critical way. The aim is to improve the relationship and to promote positive communication, so parents are taught how to speak to their child in a clear, concise and respectful manner. It is the parents, by using the new skills that they have been taught, who learn new ways to deal with different or difficult situations. This change in their response is what provokes the changes in the child’s behavior. Often, both children and parents become frustrated and tense leading to confrontations. Sometimes, parents unwittingly praise negative behavior in order to end a conflictive situation. At this time, parents will learn the skills to help them to diminish the negative aspects of their relationship with their child while at the same time promoting positive ones.

Often, significant improvements in the child’s behavior can be achieved during this stage.  Parents are encouraged to practice their new skills until they feel comfortable employing them so that in the home situation they will naturally react in the same manner and so maintain a steady improvement in the relationship and behavior of the child. Parents are often given “homework,” to practice particular skills.

In the next stage, called, discipline and compliance, the parents learn new techniques which allow them to correctly discipline the child so that his behavior improves. Now, the parent takes control of the sessions and directs the actions of the child. Parents are encouraged to speak clearly in an easy to understand manner when asking the child to do something. They are taught how to make their request clearer by being very specific as to what they want the child to do and asking them to do it in a calm, respectful way.  If the child complies with what he is asked to de he receives praise, specifically directed at whatever instructions he has followed. For example, if the parent wants the child to put their toys away, they would say. “Please put your toys away where they belong.” If the child does as requested, the reward would be, “Thank you for putting your toys away in the right places.”

If the child does not do as asked, then the parent must issue a clear warning, such as “Put your toys away or you will take a time-out.” The request must be made in a calm and firm way. If the child still will not comply then the time-out procedure is used. If the time-out is warned it must be completed if the child does not obey. The time-out procedure is a chill-out time where the child can reflect on his behavior. It also prevents a confrontation and can help parents to remain calm. Parents are taught how to initiate and follow through on the time-out procedure.

If the child does not do as requested, the parent must lead him calmly and without shouting or disrespect to the designated time-out chair. Here, the child must sit without talking to anyone or playing with anything. If the child tries to leave, he must be returned there firmly and without speaking. Initially, establishing the routine will take practice, but soon both parents and children will learn how the technique works. And, it is very effective. Even if agitated the child calms down in the quiet, unstimulating situation, and a timeout session should only be ended when the child is in a quiet, calm state. After a few minutes, usually one minute for each year of age of the child, the request should again be made. If the child complies praise is given, if he refuses, then the time-out must be repeated until he does as he has been asked.

Time-out works because children do not like to be ignored and they quickly become bored and want to return to a normal situation. Always following the same routine, means that the child learns what is going to happen if he does not do as he is told and so is more likely to do as asked so as not to go to time out.

Throughout all the sessions, the therapist keeps a record of the behaviors that are targeted to be changed and sometimes a video recording may be made. In this way, the therapist can evaluate the progress of the child in the changes in behavior, as well as the progress of the parents in using the techniques that they have learned. The therapist gives immediate feedback to the parents, so they understand how the techniques they have used are being effective. Sessions usually last one hour and are held weekly. The length of the course depends on the progress of both the child and the parents, but the average course of therapy is for fourteen weeks

Techniques Used in PCIT

Play, using specially selected toys and materials is the setting for the therapy to take place.

A one-way mirror is used to observe and record what is happening in the parent-child relationship during play.

An ear-bug allows the therapist to give live coaching to the parents so that they put into practice correctly the techniques that they have learned.

Positive reinforcement of acceptable behavior.

Modification of undesirable behavior by clear communication calmly repeating the same request, and the correct use of the time-out procedure.

Does PCIT Work?

Yes, PCIT does work, and the therapy is most effective in children with ages between two and seven. Many studies have been performed which show just how effective this therapy is at improving behavior, enhancing family bonds, and reducing stress in both the child and the parents. Additionally, children who have had PCIT have greater self-esteem and improved social, play, and organizational skills. They are calmer, feel safer, and communicate better. Meanwhile, the parents feel more confident and less stressed about dealing with any behavioral issues, both at home and in public.

What Kinds of Concerns is PCIT Best For?

PCIT is often used with children who have experienced some form of abuse or who are at risk. It is particularly useful for adoptive or foster families to develop a positive relationship with the child.

Any child who has behavioral issues such as anger, short-temper, violence, intolerance, aggression, defiance and non-compliance, and who exhibit unacceptable behavior, like temper tantrums, shouting, hitting, or biting, can all be helped by PCIT.

How Are PCIT Specialists Trained?

PCIT therapists must hold at least a master’s degree in the field of mental health and be a licensed mental health provider.  They receive an intense 40-hours of training in the theory and techniques of the therapy with a qualified trainer. They then gain experience under close supervision and observation until they demonstrate a high level of proficiency in all aspects of the therapy. Once certified, therapists must renew their certification every two years and continue to receive education in the therapy. PCIT International offers different courses and training programs.

Concerns/Limitations of PCIT

PCIT is not effective in situations where the parents have little contact with the children. The success of the therapy depends upon the progressive learning process experienced by both the parent and child in a day-to-day situation and the constant repetition of the leaned reinforcement techniques.  PCIT may also not be appropriate for parents with severe mental health conditions, who are substance abusers, or sexual or physical abusers. The therapy also has limited success with parents with speech or hearing disabilities.

Important Practitioners in PCIT

PCIT was developed by Dr. Sheila M Eyberg, Ph.D during the early 1970s while completing her post-doctorate in child psychology. She used the behavioral program of Constance Hanf, and the developmental research of Diana Baumrind as the core for her therapy, which is based on attachment theory and social learning theory.

Other important people who contributed to the development of PCIT include Robin Gurwitch, Cheryl McNeil, Anthony Urquiza, Beverly Funderburk, and Toni Hembree-Kigin.

How to Find a Therapist

Your health provider will be able to recommend qualified PCIT therapists in your area.

What Should I be Looking for in an LMHP?

Make sure that the therapist is properly certified, and the credentials are up to date. Look for someone whom you feel comfortable with, as building up a trusting relationship with the therapist is very important.

Questions to Ask a Potential Therapist

How long do the sessions last?

How often will we come to therapy?

Do one or both parents need to come?

How many sessions will we need before we see an improvement in our child’s behavior?

Find a Therapist Now

You can find a qualified PCIT Therapist in your area by visiting this page of the PCIT International website  http://www.pcit.org/find-a-provider.html or sending an email to [email protected] or through their contact page at http://www.pcit.org/contact.html

PCIT is an effective therapy that is widely used around the world with excellent results. It has helped many families to achieve a more harmonious and productive relationship and has positively modified the behaviors of both parents and children to the benefit of both.

Resources

http://www.pcit.org/

https://www.goodtherapy.org/learn-about-therapy/types/parent-child-interaction-therapy

https://pcit.ucdavis.edu/about-us/

http://www.cebc4cw.org/program/parent-child-interaction-therapy/detaile

https://www.cdc.gov/parents/essentials/timeout/steps.html

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