Parent-Child Interaction Therapy (PCIT)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Parent-Child Interaction Therapy (PCIT) has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent) and Parent Training Programs that Address Behavior Problems in Children and Adolescents.

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

Brief Description

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

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."

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)

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) 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

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.

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:
Training is obtained:

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

Since Parent-Child Interaction Therapy (PCIT) is 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 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

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 program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. 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 — Children: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 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 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. 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. Limitations include attrition, generalizability due to participants being offered free and unlimited treatment, and length of follow-up.

Length of 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.

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, 3 families other
  • Gender — Children: 52 Boys and 19 Girls, Parents: Not specified
  • Status — Participants were families seeking treatment for problematic behaviors of their child.

Location/Institution: Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study compared families receiving standard Parent-Child Intraction 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. Limitations include possible treatment bias, families may not have had sufficient therapy time before contact was terminated and length of follow-up.

Length of postintervention follow-up: 6 months.

*Chaffin, M., Silovsky, J. F., Funderburk, B., Valle, L. A., Brestan, E. V., Balachova, T., … 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 — Children: 4-12 years Parents: Mean=32 years
  • Race/Ethnicity — Children: Not specified, Parents: 52% White, 40% African American, 4% Hispanic/Latino, 1% Asian, 1% Native American, and 2% Other
  • 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 comparison groups, outcomes, measures, notable limitations)
Parents and children were randomly assigned to a control group receiving standard services, a Parent-Child Interaction Therapy (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. Limitations include the size of changes in child behavior found in this study should not be compared with those found in studies of behavior problem children due to inclusion of older children in PCIT treatment program and study findings were interventions were multicomponent in nature.

Length of 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.

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

Population:

  • Age — Children: 3-6 years; Parent: 35-38 years
  • Race/Ethnicity — Children: 67% Caucasian, 17% African American, 13% biracial, and 3% Hispanic; Parent: Not specified
  • Gender — Children: 77% Boys, 23% Girls; Parent: 100% Female
  • Status — Participants were 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. Limitations include attrition, generalizability due to parents being primarily mothers and lack of follow-up.

Length of postintervention follow-up: None.

*Chaffin, M., Funderburk, B., Bard, D., Valle, L.A., & Gurwitch, R. (2011). A motivation-PCIT package reduces child welfare recidivism in a randomized dismantling field trial. Journal of Consulting and Clinical Psychology, 79(1), 84-95.

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, step-parents 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. 66% had all children removed to foster care at baseline.

Location/Institution: Oklahoma

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the 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 postintervention follow-up: Median unadjusted follow-up time: 904 days. Median risk deprivation-adjusted follow-up time: 730 days.

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.

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 comparison groups, outcomes, measures, notable limitations)
This study aimed to examine the efficacy of the Parent-Child Interaction Therapy (PCIT) in Hong Kong Chinese families, using 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 used included a demographic questionnaire, 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 indicated significant decrease in child behavior problems, parenting stress, negative emotions, negative parenting practices, and increase in positive parenting practices in the intervention group, compared with the control group. Limitations included small sample size, length of follow-up, may not be generalizable to other populations as well as may not be representative of the Hong Kong population.

Length of postintervention follow-up: 3 months.

The following studies were not included in rating PCIT on the Scientific Rating Scale...

Mersky, J. P., Topitzes, J., Grant-Savela, S. D., Brondino, M. J., & McNeil, C. B. (2014). Adapting Parent-Child Interaction Therapy to foster care outcomes from a randomized trial. Research on Social Work Practice. Advance online publication. doi: 10.1177/1049731514543023

This study presents initial results from an ongoing randomized trial of a Parent-Child Interaction Therapy (PCIT) model that was designed to improve the accessibility and convenience of services for foster families. Participants were randomly assigned to one of three conditions—brief PCIT, extended PCIT, or wait-list control. The brief and extended groups received 2 days of PCIT group-based training and 8 weeks of telephone consultation. The extended PCIT group received an additional group-based booster training plus 6 more weeks of consultation. Wait-list controls received services as a usual. Measures used included a demographic questionnaire, Child Behavior Checklist (CBCL) and the Eyberg Child Behavior Inventory (ECBI). Results indicate compared to foster parents receiving usual services, foster parents who also received group-based PCIT training plus individual phone consultation reported a greater decrease in their foster children’s externalizing and internalizing symptoms over time. On average, children in the PCIT conditions transitioned from clinically significant scores to a normal range of functioning while control children remained in the clinical or borderline clinical range by the study’s end. Limitations included reliability on self-reported measures, length of follow-up, small sample size, and generalizability may be restricted to children in stable placements with licensed, nonrelative foster parents. Note: This study does not utilize PCIT in the traditional way of individual dyadic parent training so it was not used in the rating process.

References

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, 84-95.

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.

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.

Contact Information

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

Date Research Evidence Last Reviewed by CEBC: July 2017

Date Program Content Last Reviewed by Program Staff: September 2013

Date Program Originally Loaded onto CEBC: March 2006