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PCIT is an early family intervention therapy for children aged 2-7 that has extensive evidence for treating externalizing behaviors such as impulsivity, difficulty focusing, whining, screaming, hitting, defiance, tantrums, throwing objects and running from parents. Yes, the tough stuff. PCIT teaches caregivers effective strategies to manage the behaviors. What you should also know:
PCIT has proven effective for reducing core symptoms of ADHD and oppositional defiant disorder (ODD) but a diagnosis is not required for treatment (Phillips et al, 2024).
Recent research also supports progress with reducing disruptive and avoidant behaviors in anxious children.
Parent Child Interaction Therapy (PCIT) has the following desired outcomes:
Increased feelings of security, safety, and attachment to the primary caregiver
Increased self-esteem
Increased pro-social behaviors such as sharing and taking turns
Decreased frequency, severity, and or duration of tantrums
Decreased activity levels/increased attention span
Decreased negative attention seeking behaviors such as whining and bossiness.
Decreased parental frustration
What to Expect During Treatment
PCIT is conducted through ‘coaching’ sessions during which the parent and the child are in a playroom while the therapist is in an observation room watching the interaction through a one-way mirror or a live video feed. The therapist communicates with the parent through a bug-in-the-ear device providing in-the-moment coaching on skills to manage the child’s behavior. This interaction can also be implemented with the therapist in the same room. Most of the play encounters are positively reinforcing for both child and caregiver.
There are two didactic sessions the child does not attend so the parent may focus on learning the new skills. These didactic sessions introduce the two treatment phases of PCIT. The first phase focuses on establishing a warmer relationship between the parent and child. Many caregivers begin treatment reporting they rarely have ‘enjoyable’ and rewarding time with their children. Parents take the lead in establishing this dynamic in the relationship through learning and applying skills proven to help children feel calm, secure in their relationships with their parents and good about themselves. Following the didactic session the remaining sessions involve the child playing with the parent while the parent engages using these new skills. The therapist follows along and coaches.
The second phase of treatment begins with the didactic to equip the parent to manage the most challenging of the child’s behaviors. The caregivers begin implementing these new skills in a “special play time” activity that occurs in the clinic and at home. The therapist coaches the skills to encourage the parent to remain calm, confident, and consistent in their approach to discipline. The parent learns to use the proven strategies to help the child accept limits, comply with directions, respect house rules, and demonstrate appropriate behavior in public.
Why is it the “Gold Standard” of parent/child training programs?
PCIT differs from other parent training programs that take a didactic approach as it is more of a coaching and supportive approach. Skills are taught ‘live’ in the moment of the child’s behavior by the therapist/coach. Parents are initially taught relationship enhancement or discipline skills that they are going to be practicing in session and at home with their child. The PCIT clinician encourages in-between session contact to encourage consistency and to offer parents emotional support. The clinician may go to the home or escort the family on a public outing to help support the use of the new skills. It is also a regular practice of the PCIT provider to offer support in the child’s school setting if needed. This includes supportive contact with the teacher by phone or in person visits to the school. When needed, skills can be taught in the school setting.
How long does treatment last?
With consistent 60-minute session weekly attendance and homework completion, PCIT can be completed within 12-20 sessions. Treatment is not time-limited but is considered complete when the parent has become proficient in both sets of skills and rates their child’s behavior within normal limits on a behavior rating scale such as the Eyberg Child Behavior Checklist.
What other populations can PCIT help?
Parent Child Interaction Therapy has been proven to be effective in helping parents who come from abusive backgrounds or are at risk of using abusive discipline techniques. Teaching parents positive and non-violent ways to interact with their children, PCIT can help break the cycle of abuse and create a healthier parent-child relationship. Parents learn the tools and skills necessary to provide their children with a safe and loving environment. Research shows that parents and caregivers completing PCIT typically show more positive parenting attitudes and demonstrate improvements in the ways that they listen to, talk to, and interact with their children (McNeil & Hembree-Kigin, 2010), use less corporal punishment and physically coercive means to control their children (Chaffin et al., 2011).
The latest research is encouraging for the use of PCIT with children with autism and co-occurring disruptive behavior (MacNeil, Quetsch, & Anderson, 2019). Children on the autism spectrum receiving PCIT gain improvements in social awareness, adaptability, positive affect, atypicality and functional communication.
Parents Frequently Asked Questions
Where Can I find a PCIT provider?
Ask your primary care physician or check the PCIT.Org website. It is strongly recommended that you choose a certified PCIT clinician. PCIT is a specialized treatment that requires the clinician/provider to undergo and successfully complete intense training. This training includes supervision through several cases and takes two years to complete. Certification is not mandatory for a clinician to be able to provide treatment although, the provider needs to be fully licensed mental health provider.
How is PCIT different from other treatments we’ve tried?
Many behavior parent training programs teach similar skills. PCIT differs from the others because it:
Emphasizes in-session parent practice of the skills
Parents receive live coaching and feedback related to the skills
Parents are required to master specific parenting skills
PCIT is not session-limited
Graduation is based on parent demonstration of mastery of skills
Parents rate children’s behavior problems as within normal limits before treatment graduation.
PCIT combines elements of play therapy into the treatment but it is the parent that uses the skills and not the therapist. Traditional play therapy can be very efficacious to treat all kinds of presenting concerns however, it is not as helpful with improving the relationship between the parent and child. Children under the age of 7 with externalizing disruptive behaviors can be helped with traditional CBT if the parent is consistently involved in that process. Children need regular practice of new skills to make them more effective during times of struggle, a challenge for parents to maintain consistently. The structure of PCIT supports parents more effectively than traditional CBT in being consistent, predictable, and following through.
Who Should Attend the Sessions with the Child?
In a two-caregiver household it is encouraged for both parents to participate in each session. However, PCIT can be successful with only one parent attending regularly. In this case it is important that the non-attending parent does the skills practice at home. Many families find it helpful if both parents attend the two didactic sessions together when one of those parents will not be able to attend the subsequent coaching sessions. PCIT is completely appropriate for single caregiver households.
What if Time Out has never worked for us?
Time out is taught as part of the second phase of PCIT. The clinician will talk through any concerns during the intake process. It is effective for the following reasons:
When parents set age-appropriate limits, it helps children to learn positive behavior. Used correctly, time-out is a safe, effective way to help children to regulate their behavior.
Time-out teaches children that even when they misbehave, parents will treat them respectfully and consistently
When used correctly, time-out teaches children to follow directions and be compliant more often and more quickly.
It needs to be age appropriate, not an escape from doing tasks, short in length, boring and in a safe environment.
What is the referral process?
The referral process is the same as any other therapy. This is likely to depend on the insurance provider and whether the service is going to be provided by a Licensed Clinician in private practice vs. in a mental health clinic or agency. The service can be billed as individual therapy or family therapy depending on the provider/agency guidelines.
Angie Engelke, MA, LPC
Engelke Counseling
RESOURCES:
Phillips S.T., Druskin L.R., Mychailynszyn M.P.,Victory E.,Aman E.,McNeil C.B. The Efficacy of Parent Child Interaction Therapy (PCIT) for Youth with Attention Deficit/Hyperactvity Disorder (ADHD): A Meta-Analysis. Child Psychiatry Hum Dev.2024 Mar 5.
Owen, C.,McNeil C.B.. Parent Child Interaction Therapy for Children on the Autism Spectrum; Research, Training, and Clinical Considerations. West Virginia Universtiy. Presented at the PCIT International Convention 2019.
McNeil, C.B., Quetsch, L.B., & Anderson, C.M. (Eds)(2019). Handbook of parent-child
Interaction therapy for children on the autism spectrum. New York: Springer.
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