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Parent-Child Interaction Therapy (PCIT)

Topic Areas
Scientific Rating
Child Welfare Relevance
Disruptive Behavior Treatment (Child & Adolescent)
1  — Well-Supported by Research Evidence
Medium
Parent Training Programs that Address Behavior Problems in Children and Adolescents
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Children ages 2.0 - 7.0 years old with behavior and parent-child relationship problems; may be conducted with parents, foster parents, or other caretakers

For children/adolescents ages: 2 – 7

For parents/caregivers of children ages: 2 – 7

Program Overview

Parent-Child Interaction Therapy (PCIT) is a dyadic behavioral intervention for children (ages 2.0–7.0 years) and their parents or caregivers that focuses on decreasing externalizing child behavior problems (e.g., defiance, aggression), increasing child social skills and cooperation, and improving the parent-child attachment relationship. It teaches parents traditional play-therapy skills to use as social reinforcers of positive child behavior and traditional behavior management skills to decrease negative child behavior. Parents are taught and practice these skills with their child in a playroom while coached by a therapist. The coaching provides parents with immediate feedback on their use of the new parenting skills, which enables them to apply the skills correctly and master them rapidly. PCIT is time-unlimited; families remain in treatment until parents have demonstrated mastery of the treatment skills and rate their child's behavior as within normal limits on a standardized measure of child behavior. Therefore treatment length varies but averages about 14 weeks, with hour-long weekly sessions.

Program Goals

The goals of the Child-Directed Interaction part of Parent-Child Interaction Therapy (PCIT) are:

  • Build close relationships between parents and their children using positive attention strategies
  • Help children feel safe and calm by fostering warmth and security between parents and their children
  • Increase children's organizational and play skills
  • Decrease children's frustration and anger
  • Educate parent about ways to teach child without frustration for parent and child
  • Enhance children's self-esteem
  • Improve children's social skills such as sharing and cooperation
  • Teach parents how to communicate with young children who have limited attention spans

The goals of Parent-Directed Interaction part of Parent-Child Interaction Therapy (PCIT) are:

  • Teach parent specific discipline techniques that help children to listen to instructions and follow directions
  • Decrease problematic child behaviors by teaching parents to be consistent and predictable
  • Help parents develop confidence in managing their children's behaviors at home and in public

Logic Model

The program representative did not provide information about a Logic Model for Parent-Child Interaction Therapy (PCIT).

Essential Components

The essential components of Parent-Child Interaction Therapy (PCIT) include:

  • Child Directed Interaction (CDI):
    • Parent-child dyads attend treatment sessions together and the parent learns to follow the child's lead in play.
    • The parent is taught how to decrease the negative aspects of their relationship with their child and to develop positive communication.
    • The parent is taught and coached to use CDI skills. These skills help the parents give positive attention to the child following positive (e.g. non-negative) behavior and ignore negative behavior.
    • By learning CDI skills, the parent is taught:
      • To give labeled praise following positive child behavior.
      • To reflect or paraphrase the child's appropriate talk.
      • To use behavioral descriptions to describe the child's positive behavior.
      • To avoid using commands, questions, or criticism because these verbalizations are intrusive and often give attention to negative behavior.
    • The parent is observed and coached through a one-way mirror at each treatment session.
    • After the first session, at least half of each session is spent coaching the parent in CDI skills utilizing a 'bug in the ear'—a wireless communications set consisting of a head set with microphone that the therapist wears and an ear receiver that the parent wears.
    • The parent's CDI skills are observed and recorded during the first five minutes of each session to assess progress and to guide skills learned through coaching during session.
    • Behaviors are tracked and charted on a graph at each session to provide the parent with immediate feedback regarding progress in positive interactions and the achievement of skill mastery.
    • The parent is provided with homework between sessions to enhance skills learned in the session.
    • Dyads do not proceed to the Parent Directed Interaction (PDI) until the parent demonstrates mastery of the CDI.
  • Parent Directed Interaction (PDI):
    • Parent-child dyads attend treatment sessions together and the parent learns skills to lead the child's behavior effectively.
    • The parent is taught how to direct the child's behavior when it is important that the child obey their instruction.
    • The parent is observed and coached through a one-way mirror at each treatment session.
    • After the first session, at least half of each session is spent coaching the parent in PDI utilizing a 'bug in the ear'—a wireless communications set consisting of a head set with microphone that the therapist wears and an ear receiver that the parent wears.
    • Parent's PDI skills are observed and recorded during the first five minutes of each session to assess progress and guide the coaching of the session.
    • The parent learns to incorporate the effective instructions and commands (e.g. commands that are direct, specific, positively stated, polite, given one at a time, given only when essential, and accompanied by a reason that either immediately precedes the command or accompanies the praise for compliance) learned during the CDI component.
    • The parent learns to follow through on direct commands by giving labeled praise after every time the child obeys and beginning a time-out procedure after every time the child disobeys.
    • The parent learns a time-out procedure to use in the event that the child disobeys a direct command. The parent begins by issuing a warning, which will lead to the time-out chair, and then to the time-out room if the child continues disobeying.
    • The parent is coached to use the PDI algorithm, which gives the child an opportunity to obey and stop the time-out procedure at each step.
    • Behaviors are tracked and charted on a graph at each session to provide the parent with immediate feedback regarding progress in their PDI skills.
    • Once the parent demonstrates mastery of the procedures, she/he is given homework that gradually increases the intensity of the situations as the child learns to obey.
    • Treatment does not end until the parent meets pre-set mastery criteria for both phases of treatment and the child's behavior is within normal limits on a parent-report measure of disruptive behavior at home.
  • PCIT can be delivered in a group format as well. When done so, small groups of 3 or 4 families in 90-minute sessions are recommended. This will allow adequate time for individual coaching of each parent-child dyad while other parents observe, code, and provide feedback in each session. For additional information, please check the PCIT website homepage at www.pcit.org and select "PCIT Integrity Checklists and Materials."

Program Delivery

Child/Adolescent Services

Parent-Child Interaction Therapy (PCIT) directly provides services to children/adolescents and addresses the following:

  • Noncompliance, aggression, rule breaking, disruptive behavior, dysfunctional attachment with parent, internalizing symptoms

Parent/Caregiver Services

Parent-Child Interaction Therapy (PCIT) directly provides services to parents/caregivers and addresses the following:

  • Ineffective parenting styles (e.g., permissive parenting, authoritarian parenting, and overly harsh parenting)

Recommended Intensity:

One or two 1-hour sessions per week with the therapist

Recommended Duration:

The average number of sessions is 14, but varies from 10 to 20 sessions. Treatment continues until the parent masters the interaction skills to pre-set criteria and the child's behavior has improved to within normal limits.

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider

Homework

Parent-Child Interaction Therapy (PCIT) includes a homework component:

During the first phase of treatment, homework consists of a daily 5-minute parent-child play interaction (called child-directed interaction, or CDI) in which the parent practices the relationship enhancement skills.

Languages

Parent-Child Interaction Therapy (PCIT) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Two connected rooms with a one-way mirror on the adjoining wall (one room for client, other room for coach) or another method for the therapist to unobtrusively observe the parent.
  • A wireless communications set consisting of a head set with microphone and an ear receiver (i.e., "bug in the ear")
  • A VCR and television monitor to tape record sessions for supervision, training, and research purposes

Manuals and Training

Prerequisite/Minimum Provider Qualifications

A firm understanding of behavioral principles and adequate prior training in cognitive-behavior therapy, child behavior therapy, and therapy process skills (e.g., facilitative listening) is required. For training in this treatment protocol outside an established graduate clinical training program, the equivalent of a master's degree and licensure as a mental health provider is required.

It is recommended that the 40 hours of intensive skills training be followed by completion of two supervised cases prior to independent practice. For within program supervisors, it is recommended that they complete a minimum of 4 prior cases and complete a within program trainer training.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

On-site and off-site

Number of days/hours:

5 days for a total of 40 hours; follow-up consultation through the completion of two cases

Implementation Information

Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Parent-Child Interaction Therapy (PCIT).

Fidelity Measures

There are fidelity measures for Parent-Child Interaction Therapy (PCIT) as listed below:

The basic clinical fidelity tools are included as part of the standard PCIT protocols which can be found at www.pcit.org. More detailed research measures of therapist competency and fidelity have been developed for studying skill acquisition and fidelity and are available upon request from Beverly-funderburk@ouhsc.edu.

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Parent-Child Interaction Therapy (PCIT).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Parent-Child Interaction Therapy (PCIT).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Safety and Child/Family Well-Being

Shuhman, E. M., Foote, R. C., Eyberg, S. M., Boggs, S., & Algina, J. (1998). Efficacy of Parent Child Interaction Therapy: Interim report of a randomized trial with short term maintenance. Journal of Clinical Child Psychology, 27(1), 34–45. https://doi.org/10.1207/s15374424jccp2701_4

Type of Study: Randomized controlled trial
Number of Participants: 64

Population:

  • Age — 3–6 years; Parents: 30–36 years
  • Race/Ethnicity — Children: 77% Caucasian, 14% African American, and 9% Hispanic, Asian, or Mixed Race; Parents: Not specified
  • Gender — Children: 38% Male; Parents: Not specified
  • Status — Participants were families of children referred to a clinic for conduct disorder.

Location/Institution: Florida

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of Parent-Child Interaction Therapy (PCIT) with families with children referred for conduct disorder. Participants were randomly assigned either to receive PCIT immediately or to a wait-list control. Measures utilized include the Dyadic Parent Child Interaction Coding System (DPICS-II), the Eyberg Child Behavior Inventory (ECBI) for the child, the Parental Locus of Control Scale (PLOC), the Beck Depression Inventory (BDI), Parenting Stress Inventory (PSI), and the Dyadic Adjustment Scale (DAS). Results indicate that at follow-up, the intervention group showed higher levels of praise and lower levels of criticism in interactions with children than the control group. Children's compliance also increased in the observed interaction and their ECBI scores improved significantly. Parental stress scores and Locus of Control scores shifted to normal levels in the PCIT group, while those for the control group remained at clinical levels. Although comparisons could not be made with the control group at 4-month follow-up, all gains made by PCIT treatment families were maintained. Limitations include that this sample of families had no significant levels of marital distress or depression at baseline and were recruited from a group that actively sought treatment for their children, therefore results might not generalize to other populations; the high attrition rate; concerns about generalizability due to participants being offered free and unlimited treatment; and length of follow-up.

Length of controlled postintervention follow-up: 4 months.

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 Community and Clinical Psychology, 71(2), 251–260. https://doi.org/10.1037/0022-006X.71.2.251

Type of Study: Randomized controlled trial
Number of Participants: 54 families

Population:

  • Age — Children: 3–5 years; Parents: 33–37 years
  • Race/Ethnicity — Majority Caucasian, 1 Australian Koori, 1 Australian Chinese, and 1 Australian Indian
  • Gender — Children: 52 Male and 19 Female; Parents: Not specified
  • Status — Participants were families seeking treatment for problematic behaviors of their child.

Location/Institution: Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare families receiving standard Parent-Child Interaction Therapy (PCIT) with an abbreviated version of PCIT using a combination of videotapes, telephone consultations and face-to-face sessions and with a no treatment wait-list control group. Participants were randomly assigned to either standard PCIT, abbreviated PCIT, or to a no treatment waitlist control group. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) , the ECBI, the Child Behavior Checklist (externalizing subscale), the Home Situations Questionnaire (HSQ), the Parenting Stress Inventory (PSI), the Parent Sense of Competence Scale (PSOC), the Parent Locus of Control Scale (PLOC), the Parenting Scale (PS), and the Dyadic Parent-Interaction Coding Systems-II (DPICS-II). Results indicate that at the end of treatment, mothers in both PCIT conditions reported less oppositional and conduct problem behavior than did control group participants. Mothers in the standard PCIT condition reported less severe problems than those in the other two groups. Fathers in the abbreviated PCIT group reported less oppositional behavior. Limitations include possible treatment bias, families may not have had sufficient therapy time before contact was terminated, and length of follow-up.

Length of controlled postintervention follow-up: 6 months.

Chaffin, M., Silovsky, J. F., Funderburk, B., Valle, L. A., Brestan, E. V., Balachova, T., Jackson, S., Lensgraf, J., & Bonner, B. L. (2004). Parent-Child Interaction Therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72(3), 500–510. https://doi.org/10.1037/0022-006X.72.3.500

Type of Study: Randomized controlled trial
Number of Participants: 110

Population:

  • Age — Children: 4–12 years; Parents: Mean=32 years
  • Race/Ethnicity — Children: Not specified; Parents: 52% White, 40% African American, 4% Hispanic/Latino, 2% Other, 1% Asian, and 1% Native American
  • Gender — Children: Not specified; Parents: 65% Female
  • Status — Participants were parents and children entering the child welfare system for a new confirmed physical abuse report.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy and sufficiency of Parent-Child Interaction Therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Participants were randomly assigned to a control group receiving standard services, a PCIT intervention group, or to a PCIT enhanced group which also included extra services targeting parental depression, substance abuse, and family violence problems. Measures utilized include the Child Behavior Checklist (CBCL), the Child Abuse Potential Inventory (CAP), the Child Neglect Index (CNI), the Abuse Dimensions Inventory (ADI), the Dyadic Parent-Child Interaction Coding System (DPICS-II), the Beck Depression Inventory (BDI), and the Diagnostic Interview Schedule (DIS) Alcohol and Drug Modules and Antisocial Personality Disorder Module, which were modified to be administered as self-reports. Results indicate that the PCIT alone group had significantly fewer re-reports of abuse over the follow-up period than did the control condition and also fewer reports than the enhanced PCIT condition, although this difference did not reach significance. Reductions in negative parent behavior, measured by the DPICS-II, were significant for both PCIT groups compared to the control condition. Positive behaviors were high in all groups and did not differ. Limitations include the inability to control for the differences in service environment conditions; the multi-component nature of the study, making it difficult to dismantle relative enhancements of PCIT and self-motivation; the application of PCIT as a parent intervention, not a child intervention; not all children had pre-treatment behavior problems; and because this study used PCIT as a parent intervention, it cannot be compared to other PCIT studies that targeted children.

Length of controlled postintervention follow-up: Approximately 2 years.

Bagner, D. M., & Eyberg, S. M. (2007). Parent-Child Interaction Therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 36(3), 418–429. https://doi.org/10.1080/15374410701448448

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — Children: 3–6 years; Parents: 35–38 years
  • Race/Ethnicity — Children: 67% Caucasian, 17% African American, 13% Biracial, and 3% Hispanic; Parents: Not specified
  • Gender — Children: 77% Male and 23% Female; Parents: 100% Female
  • Status — Participants were mothers with children who had been diagnosed with oppositional defiant disorder (ODD) and mental retardation (MR) referred by pediatric healthcare professionals, teachers, or self-referred.

Location/Institution: Florida

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of Parent-Child Interaction Training (PCIT) for treating disruptive behaviors of young children (ages 3–6) with mental retardation (MR) and comorbid oppositional defiant disorder (ODD). Participants were randomly assigned to either the PCIT treatment condition or to a wait-list control group. Measures utilized include the Child Behavior Checklist (CBCL), Eyberg Child Behavior Inventory (ECBI), the Parenting Stress Inventory (PSI), and the Dyadic Parent-Child Interaction Coding System (DPICS). Results indicate that parents in the treatment group improved significantly on the parenting skills taught by the program and that the percentage of compliant behaviors shown by the children also increased significantly in comparison to the control group. Treatment group children's externalizing behaviors decreased, their total score on the CBCL improved, and fewer disruptive behaviors were reported on the ECBI. However, groups did not differ on maternal distress on the ECBI or on the PSI Parenting Stress and Parent-Child Dysfunctional Interaction subscales, although, on the Difficult Child subscale, treatment mothers reported fewer problem behaviors. Limitations include differential attrition, lack of generalizability due to parents being primarily mothers, and lack of follow-up.

Length of controlled postintervention follow-up: None.

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. https://doi.org/10.1037/a0021227

Type of Study: Randomized controlled trial
Number of Participants: 192 parents

Population:

  • Age — 20–57 years
  • Race/Ethnicity — 60% Caucasian, 19% African American, 9% Native American, 7% Hispanic, and 6% Other
  • Gender — 75% Female and 25% Male
  • Status — Participants were maltreating biological parents, stepparents, or primary caregivers who were referred for parenting services at a small, inner city, nonprofit, community-based agency operating a parenting program under contract with the single state child welfare system.

Location/Institution: Oklahoma

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the effectiveness of Parent-Child Interaction Therapy (PCIT) in a field agency rather than in a laboratory setting, and to dismantle the self- motivational orientation (SM) Group vs. services as usual (SAU) orientation and PCIT vs. SAU parenting component effects. Participants were randomized following a 2 X 2 sequentially randomized experimental design and were randomized first to orientation condition (SM Group vs. SAU) and then to a parenting condition (PCIT vs. SAU). Measures utilized include self-report questionnaires administered via audio-assisted computerized self-interview (ACASI) using touch-screen computers, observational coding of parent-child interactions, administrative data from the state child welfare database, the Readiness for Parenting Change Scale (REDI), Child Abuse Potential Inventory (CAP), Dyadic Parent–Child Interaction Coding System (DPICS-II), Child and Parent-Directed Interaction (CDI and PDI), and the P.R.I.D.E. skills. Results indicate that previous laboratory results can be replicated in a field implementation setting, and among parents with chronic and severe child welfare histories, supporting a synergistic SM+PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized. Limitations include the lack of a no-treatment control group, the results were obtained at a single agency with a small number of part-time clinicians which may affect generalization to other settings, and a lower level of fidelity control than in a laboratory trial that may reduce internal validity.

Length of controlled postintervention follow-up: Approximately 2 years.

Leung, C., Tsang, S., Sin, T. C., & Choi, S. Y. (2015). The efficacy of Parent-Child Interaction Therapy with Chinese families randomized controlled trial. Research on Social Work Practice, 25(1), 117–128. https://doi.org/10.1177/1049731513519827

Type of Study: Randomized controlled trial
Number of Participants: 111

Population:

  • Age — Children: 3–7 years, Adults: 35–40 years
  • Race/Ethnicity — Children: 100% Chinese; Adults: 100% Chinese
  • Gender — Children: 74% Male; Adults: 87% Female and 13% Male
  • Status — Participants were from nine social service centers offering Parent-Child Interaction Therapy.

Location/Institution: Hong Kong, China

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of Parent-Child Interaction Therapy (PCIT) in Hong Kong Chinese families using a randomized controlled trial design. Participants were randomly assigned to one of two conditions, PCIT or wait-list control. The wait-list control group participants were offered PCIT after the intervention group had completed treatment. Measures utilized include a demographic questionnaire, the Parenting Stress Index (PSI), Depression, Anxiety, and Stress Scale (DASS21), the Eyberg Child Behavior Inventory (ECBI), and Dyadic Parent–Child Interaction Coding System—Third edition (DPICS-III). Results indicate there was a significant decrease in child behavior problems, parenting stress, negative emotions, negative parenting practices, and an increase in positive parenting practices in the intervention group compared with the control group. Limitations include the small sample size, length of follow-up, concerns about lack of generalizability to other populations and that it may not be representative of the population in Hong Kong.

Length of controlled postintervention follow-up: 3 months.

Additional References

Eyberg, S .M., Funderburk, B. W., Hembree-Kigin, T., McNeil, C. B., Querido, J., & Hood, K .K. (2001). Parent-child interaction therapy with behavior problem children: One- and two-year maintenance of treatment effects in the family. Child & Family Behavior Therapy, 23(4), 1-20. https://doi.org/10.1300/J019v23n04_01

Hood, K. K., & Eyberg, S. M. (2003). Outcomes of parent-child interaction therapy: Mothers' reports on maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32(3), 419-429. https://doi.org/10.1207/S15374424JCCP3203_10

Contact Information

Agency/Affiliation: PCIT International
Website: www.pcit.org
Email:

Date Research Evidence Last Reviewed by CEBC: October 2023

Date Program Content Last Reviewed by Program Staff: September 2013

Date Program Originally Loaded onto CEBC: March 2006