Parent Child Interaction Therapy (PCIT)
Parent Child Interaction Therapy (PCIT)
By Jodie Crump and Bill Eddy
© 2014 High Conflict Institute
Introduction by Bill Eddy: New Ways for Families, developed as a project of High Conflict Institute, draws upon recent research and principles drawn from evidence-based therapies, including Parent-Child Interaction Therapy (PCIT), Child-Inclusive Mediation, Dialectical Behavior Therapy (DBT), and Cognitive-Behavioral Therapy (CBT). Recent research indicates that many people with difficult and abusive personalities can change with 1) lots of structure; 2) small skills taught in small steps; 3) focus on future behavior, and 4) lots of validation from everyone working with them. Research also shows that working with parents and children together is more effective than working with them individually.
This article explains PCIT from a therapists’ perspective who works extensively with the therapy, and discusses the use of PCIT in New Ways for Families. We appreciate Jodie Crump sharing her knowledge with us and our readers. Jodie is a Parent Child Interaction Therapist with Uniting Care Community, Queensland, Australia.
Parent Child Interaction Therapy
Parent Child Interaction Therapy (PCIT) is an intensive parenting program developed in the 1970’s by Sheila Eyberg for parents, caregivers and foster carers caring for children with serious behaviours. Based on Baumrind’s developmental theory of parenting, PCIT has an emphasis on enhancing the quality of the parent/child relationship through nurturing, clear communication and limit setting. Through play, the parent’s are taught specific skills and approaches to nurture the relationship with their child and change parent/child interaction patterns.
The PCIT program can take a minimum of 12 weeks to complete and is divided between two phases; Child Directed Interaction (CDI) and Parent Directed Interaction (PDI).
Each phase can run for approximately 6 sessions but this may vary. Support sessions are given as requested and an information session is conducted before moving on to each phase.
Phase 1 - Child Directed Interaction
The CDI phase is similar to play therapy in that parents follow the child’s lead in play with the goal of strengthening that relationship. In each session the parent is coached through an audio ear piece and observed through a one way mirror.
Parents are coached and supported each session to use the P.R.I.D.E skills:
• Praising the child (for positive behaviours – playing gently with the toys, packing the toys away). Giving labelled praises – very specific praise.
Instead of saying ‘well done” but rather to say “I really noticed how you took your time to get the puzzle pieces to fit together or/ it’s great that you put the blocks away without being asked”.
• Reflecting what the child is saying. This helps parents to enhance reflective listening skills and also improve the child’s language and vocabulary.
• Imitating the child’s play. This is especially useful for parents who do not know how to play with their child. It does not come naturally to everyone.
• Describing what the child is doing (e.g. ‘you are building a tower with the blocks”). This keeps the focus on the child and can be helpful when the child is not talking but keeps the interaction positive and connection continued.
• Enthusiasm – Showing enthusiasm towards the child in the play setting.
Phase 2– Parent Directed Interaction
The second phase of PCIT is the PDI phase where parents learn to use specific behaviour management techniques as they play with their child. Also in this phase, parents are coached and supported to B.E D.I.R.E.C.T with instructions:
- Be specific – “Please put the toys in the blue bucket”
- Every instruction stated positively - “Please pack up the toys”.
- Developmentally appropriate
- Individual rather than compound - one instruction at a time
- Respectful and polite
- Essential instructions only
- Choices when appropriate
- Tone of voice neutral
Parents are coached to give labelled praises when the child has followed instructions. “Great job packing up all the cars”
Parents are encouraged to practise the skills at home on a daily basis. This is referred to as Special playtime which enhances the effectiveness of PCIT and allows for the transfer of skills and knowledge from the centre to the home.
The PCIT Professional Experience of Jodie Crump:
- Parents reporting noticeable positive changes in the parent/child interaction, patterns of relating and/or behaviours.
- A reduction in the number of families requesting a need to participate in the PDI phase of PCIT.
- Witnessing changes in the family dynamics where parent/ child have opportunity to connect/ reconnect through child led play and patterns of relating are positively changed.
- Children are more focussed on what they are doing when they have more of their parent’s undivided attention. They spend more time trying to complete tasks or put things together rather than giving up after a few minutes. This is also from feedback from parent’s who regularly practise the skills at home.
The skills developed in PCIT combined with the daily home practice enhance the relationship between parent and child. PCIT has continued to benefit the families I work with even when a behaviour disorder diagnosis has been made and more specific behaviour management strategies, intense support for family and the child’s school has been provided.
Through PCIT, parents have the opportunity to learn reflective listening skills, reduce critical comments at their child, connect to their child through play and have more positive interactions with their child. When I am able to witness the joy between parent and child when they are connecting through play (sometimes even without words) I am reminded, as a professional, and a parent myself, to never underestimate the importance and value of the relationship with each child.
New Ways for Families with PCIT
By Bill Eddy
Parent-Child Interaction Therapy (PCIT) is a method of treating child abuse for parents of children ages 2 – 7 years old. Much of this work is done with parents whose children have been removed from their homes by child protective services workers because of maltreatment. In a relatively short period of time, these parents are able to regain custody of their children in their own homes.
In this therapy, the therapist guides the parent and child together in their interactions, teaching and reinforcing positive behaviors. This is done primarily with the therapist behind a two-way mirror in an observation room, who speaks into a microphone which communicates with a blue tooth “bug-in-the-ear” receiver worn by the parent while the parent interacts with the child in a playroom. The theory behind this approach is that working with parents alone or children alone will not stop an abusive cycle. Instead, it is necessary to work on the parent-child interaction, coaching them together to focus on positive behaviors and reduce negative behaviors.
PCIT uses a family systems approach and has had substantial success over the past 15 years, as supported by numerous studies. It was developed at the University of California Davis Children’s Hospital, Davis, California. Over 50 mental health treatment agencies provide this method nationwide and internationally.
New Ways Parent-Child Counseling (Step 2 of New Ways for Families Counselling method) is based on a similar concept of focusing on parent-child interaction, rather than the prevailing Family Court method with high-conflict divorce families – namely giving the child a separate child therapist and giving one or both parents their own individual therapists. It is necessary to address this interaction; otherwise an abusive parent-child relationship will be strongly resistant to change. While the New Ways Parent-Child Counseling is shorter (only 3 sessions with each parent) and geared to children of all ages, it is believed that the 6 weeks of prior Individual Parent Counseling will help it be successful, as most high-conflict parents have not had their children removed from their care by child protective services.
We are beginning to see the results of New Ways for Families in a report released in 2013 by Medicine Hat Family Services in Alberta, Canada. Read the report at this link http://newways4families.com/images/pdfs/Medicine%20Hat%20Family%20Services_Executive%20Summary.pdf. The case study found that 42% of clients improved their parenting cooperation in areas such as willingness to accommodate changes in visiting arrangements, to act as a resource to the former spouse in raising the children, and improved day to day decision making about the children. 52% of parents noted improved cooperation on major decisions about the children. In 22% of cases, parents increased their involvement with the children. Outcomes for children included less acting out behaviours (57%); less symptoms of stress such as headaches, stomachaches; difficulty sleeping (54%); improved school performance (45%); and more interest in seeing the non-custodial parent (33%).
Read more about New Ways for Families.
Jodie Crump is a Parent Child Interactive Therapist at Uniting Care Community in Queensland, Australia. She works with families to provide early childhood education, support and skills to enhance family relationships between parents/caregivers and children. Her passion lies in early intervention, sharing with families recent research, strategies and approaches that will support them to further develop their skills and knowledge to strengthen parent/child relationships and connection.
Bill Eddy, LCSW, Esq. is a Licensed Clinical Social Worker and Certified Family Law Specialist. He is the President of the High Conflict Institute and the Senior Family Mediator of the National Conflict Resolution Center based in San Diego, CA. He is the author of several books, including: The Future of Family Court: Structure, Skills and Less Stress and Managing High Conflict People series. He is also the developer of the New Ways for Families program, which is being operated in four Family Court systems in the United States and Canada; the developer of the New Ways for Mediation method of structuring and engaging high-conflict clients in using simple skills during the mediation to make their own decisions out of court; and the co-developer of the PatternViewer method of organizing and presenting patterns of high-conflict behavior.