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Parent-Child Interaction Therapy (PCIT)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Parent-Child Interaction Therapy (PCIT) program has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent), Infant and Toddler Mental Health (0-3) and Parent Training.

  • Types of Maltreatment: Physical Abuse, Emotional Abuse
  • Target Population: Children ages 3-6 with behavior and parent-child relationship problems. May be conducted with parents, foster parents, or other caretakers. Adaptation available for physically abusive parents with children ages 4-12.

PCIT was developed for families with young children experiencing behavioral and emotional problems. Therapists coach parents during interactions with their child to teach new parenting skills. These skills are designed to strengthen the parent-child bond; decrease harsh and ineffective discipline control tactics; improve child social skills and cooperation; and reduce child negative or maladaptive behaviors. PCIT is a treatment for disruptive behavior in children and is a recommended treatment for physically abusive parents.

Essential Components

Parent-Child Interaction Therapy (PCIT) consists of two components:

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.

For additional information please check the PCIT website homepage and select "PCIT Integrity Checklists and Materials."

Child Component

Parent-Child Interaction Therapy (PCIT) was designed with a child component that addresses the following presenting problems and symptoms:

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

Age range: 3 – 6

Developmental Delays:

This program was developed for children with developmental delays, and has been tested for children with developmental delays.

Relevant research studies:

Bagner, D. M., & Eyberg, S. M. (2005). Parent-child interaction therapy with comorbid conduct disorders and developmental disabilities. In Gurwitch, R. (Chair). New initiatives in parent-child interaction therapy. Symposium presented at the annual meeting of the American Psychological Association. Washington, D.C.

Parent / Caregiver Component

Parent-Child Interaction Therapy (PCIT) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

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

Group Format

Parent-Child Interaction Therapy (PCIT) was not designed to be conducted in a group setting; but has been tested for use in a group setting.

Recommended group size:

When delivered in a group format, 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 sessio

Testing References:

Gurwitch, R. H., Cook, V., Grim, M., & Funderburk, B. W. (2005). Parent-child interaction therapy: Group format. Paper presented at: American Psychological Association; Washington, D.C.

Niec, L. N., Hemme, J. M., Yopp, J. M., & Brestan, E. V. (2005). Parent-Child Interaction Therapy: The Rewards and Challenges of a Group Format. Cognitive & Behavioral Practice. Win 2005; 12(1), 113-125.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Outpatient Clinic

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)
  • 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

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 35-40 hours of intensive skills training be followed by completion of four supervised cases prior to independent practice. For supervisors, serving as primary therapist on a minimum of 10 prior cases is recommended.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
  • Dr. Sheila Eyberg
    phone: (352) 273-6145
Training is obtained:

On-site.

Number of days/hours:

5 days for a total of 40 hours at the University of Florida.

Additional Resources:

There currently are additional qualified resources for training:

University of Oklahoma Health Science Center:

  • Dr. Beverly Funderburk
  • Dr. Melanie Nelson
  • Dr. Delores Bigfoot
  • Dr. Robin Gurwitch

UC Davis Medical Center, Davis, CA:

Implementation Information

Since Parent-Child Interaction Therapy (PCIT) is highly rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Assessments

To be given to organizations or providers in order to measure organizational or individual readiness:

There are no pre-implementation assessments to evaluate readiness.

Implementation Tools — for the program (e.g., implementation guides or manuals)

  • There is a set of materials that can be found at www.pcit.org. These include the basic PCIT protocol, sets of Powerpoint slides, and a protocol for trainers. The basic PCIT protocol on the website is suitable for PCIT applied to children with disruptive behavior problems, foster children, and as a parenting program for child welfare parents.
  • A modified PCIT protocol for child welfare parents of older children (7-12) and additional training manual materials, as used in the Oklahoma PCIT abuse trials, are available on request from Beverly Funderburk at Beverly-funderburk@ouhsc.edu.

Fidelity Measures

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.

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. Please see the Scientific Rating Scale for more information.

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

Show relevant research...

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.

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

Population:

  • Age range — 3-6
  • Race/Ethnicity — 77% Caucasian, 14% African American, 9% Hispanic, Asian or mixed race.
  • Gender — Not Specified
  • Status — Families of children referred to a clinic for conduct disorder.

Location / Institution: Florida

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Families with children referred for conduct disorder were randomly assigned either to receive Parent-Child Interaction Therapy (PCIT) or to a wait-list control. Observations were made of parents and children interacting at baseline using the Dyadic Parent Child Interaction Coding System (DPICS-II). Parents also completed the Eyberg Child Behavior Inventory (ECBI) for the child and the Parental Locus of Control Scale (PLOC), the Beck Depression Inventory (BDI), Parenting Stress Inventory (PSI), and the Dyadic Adjustment Scale (DAS), which measures quality of adjustment between marital pairs. 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 signficiantly. 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. The authors note 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 and so results might not generalize to other populations.

Length of post-intervention 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.

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

Population:

  • Age range — Children 3-5
  • Race/Ethnicity — Majority Caucasian, 3 families other
  • Gender — Not Specified
  • Status — Self-referred

Location / Institution: Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study compared families receiving standard Parent-Child Interaction Therapy (PCIT) with an abbreviated version using a combination of videotapes, telephone consultations and face-to-face sessions and with a wait-list control group. To be included, the child had to measure in the clinical range on Eyberg Child Behavior Inventory (ECBI), meet criteria for oppositional defiant disorder (ODD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and have displayed disruptive behaviors for 6 months. Mothers and Fathers completed the ECBI, the Child Behavior Checklist (externalizing subscale), and the Home Situations Questionnaire (HSQ) to report children's problem behaviors. Parenting was assessed using the Parenting Stress Inventory (PSI), the Parent Sense of Competence Scale (PSOC), the Parent Locus of Control Scale (PLOC), and the Parenting Scale (PS), which measures use of dysfunctional forms of discipline. Observations were also conducted on parent-child interactions in a clinical setting, using the Dyadic Parent-Interaction Coding Systems-II (DPICS-II). 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.

Length of post-intervention 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. (2004). Parent-Child Interaction Therapy with physically abusive parents: Efficacy for reducing further abuse reports. Journal of Consulting and Clinical Psychology, 72(3), 500-510.

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

Population:

  • Age range — Children between 4 and 12
  • Race/Ethnicity — 52% White, 40% African American, 4% Hispanic/Latino, 1% Asian, 1% Native American, 2% Other.
  • Gender — Not Specified
  • Status — Parents and children entering the child welfare system for a new confirmed physical abuse report.

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Parents and children 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. Parents received 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. The CNI and ADI were completed by consultation with the child welfare workers or reviewing written material on cases. Parents reported on their children's behavior using the Child Behavior Checklist (CBCL). Results showed 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. Positive behaviors were high in all groups and did not differ.

Length of post-intervention follow-up: Median 850 days.

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

Type of Study: Randomized controlled trial
Number of Participants: 30 mothers and their children

Population:

  • Age range — 3- to 6-year old children
  • Race/Ethnicity — Treatment: 67% Caucasian, 17% African American, 13% biracial, 3% Hispanic.
  • Gender — Not Specified
  • Status — Referred by pediatric healthcare professionals, teachers, or self-referred.

Location / Institution: Florida

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Mothers with children who had been diagnosed with oppositional defiant disorder (ODD) and mental retardation (MR) were randomly assigned to either the Parent-Child Interaction Training (PCIT) treatment condition or to a wait-list control group. Child and Parent functioning was assessed using the Child Behavior Checklist (CBCL), Eyberg Child Behavior Inventory (ECBI), the Parenting Stress Inventory (PSI), and the Dyadic Parent-Child Interaction Coding System (DPICS). The DPICS measures the quality of parent-child interaction during standard situations. Result showed that parents in the treatment group improved significantly on the parenting skill taught by the program and 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.

Length of post-intervention follow-up: None.

Chaffin, M., Funderburk, B., Bard, D., Valle, L.A., & Gurwitch, R. (in press). A motivation-PCIT package reduces child welfare recidivism in a randomized dismantling field trial. Journal of Consulting and Clinical Psychology.

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

Population:

  • Age range — 20-57 years
  • Race/Ethnicity — 60% Caucasian, 19% African American, 9% Native American, 7% Hispanic, and 6% Other
  • Gender — 75% female, 25% male
  • Status — Maltreating biological parents, step-parents or primary caregivers referred for parenting services at a small, inner city, non-profit, community-based agency operating a parenting program under contract with the single state child welfare system. 66% had all children removed to foster care at baseline.

Location / Institution: Oklahoma

Summary: (To include comparison groups, outcomes, measures, notable limitations)
(Note: Same sample as Chaffin, M. et al. (2009).) Objectives were to test effectiveness in a field agency rather than in a laboratory setting, and to dismantle the SM Group vs. services as usual (SAU) orientation and Parent-Child Interaction Therapy (PCIT) vs. SAU parenting component effects. Assessment information was drawn from three sources—self-report questionnaires administered via audio-assisted computerized self-interview (ACASI) using touch-screen computers, observational coding of parent-child interactions, and administrative data from the state child welfare database. Measures used included 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 P.R.I.D.E. skills. Following a 2 X 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM Group vs. SAU) and then to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment related differences in timing and frequency of children returned home. Findings demonstrated 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 included lack of a no-treatment control group, results were obtained at a single agency with a small number of part-time clinicians that may affect generalization to other settings, and a lower level of fidelity control than in a laboratory trial may reduce internal validity.

Length of post-intervention follow-up: Median unadjusted follow-up time: 904 days. Median risk deprivation-adjusted follow-up time: 730 days.

References

Show references...
Research Articles

Boggs, S. R., Eyberg, S. M., Edwards, D., Rayfield, A., Jacobs, J., Bagner, D., & Hood, K. (2004). Outcomes of parent-child interaction therapy: A comparison of dropouts and treatment completers one to three years after treatment. Child & Family Behavior Therapy, 26(4), 1-22

Chaffin, M. et.al. (2004). Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500-510.

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, 1-20.

Harwood, M., & Eyberg, S. M. (2004). Effect of therapist process variables on treatment outcome for parent-child interaction therapy. Journal of Clinical Child and Adolescent Psychology, 33, 601-612.

Harwood, M. D., & Eyberg, S. M. (in press). Child-Directed Interaction: Prediction of change in impaired mother-child functioning. Journal of Abnormal Child Psychology.

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, 419-429.

Nixon, R. D. V., Sweeny, 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, 251-260.

Schuhmann, E., Foote, R., Eyberg, S. M., Boggs, S., & Algina, J. (1998). Parent-child interaction therapy: Interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology, 27, 34-45.

Werba, B., Eyberg, S. M., Boggs, S. R., & Algina, J. (in press). Predicting the outcome of parent-child interaction therapy: Success and Attrition. Behavior Modification.

Descriptive Articles

Bagner, D., & Eyberg, S. M. (2003). Father involvement in parent training: When does it matter? Journal of Clinical Child and Adolescent Psychology, 32, 599-605.

Bell, S., Boggs, S. R., & Eyberg, S. M. (2003). Positive attention. In W. O'Donohue, J. D. Fisher, & S. C. Hayes (Eds.). Empirically supported techniques of cognitive behavior therapy: A step-by-step guide for clinicians. New York: Wiley.

Brinkmeyer, M., & Eyberg, S. M. (2003). Parent-child interaction therapy for oppositional children. In A. E. Kazdin & J. R. Weisz (Eds.). Evidence-based psychotherapies for children and adolescents (pp. 204-223). New York: Guilford.

Eyberg, S. M. (2005). Tailoring and adapting parent-child interaction therapy for new populations. Education and Treatment of Children, 28, 197-201.

Urquiza, A. J., & McNeil, C. B. (1996) Parent-child interaction therapy: An intensive dyadic intervention for physically abusive families. Child Maltreatment, 1(2), 132-141.

Contact Information

Name: Sheila M. Eyberg, PhD
Agency/Affiliation: University of Florida
Department: Department of Clinical & Health Psychology
Website: www.pcit.org
Email:
Phone: (352) 273-6145
Fax: (352) 273-6156
Address: Gainesville, FL

Date Reviewed: December 2009 (originally reviewed in March 2006)