Parent Child Interaction Therapy (PCIT)

1
Parent ChildInteraction Therapy(PCIT)
The Future of School Psychology Task Force on
Family-School Partnerships Kathryn Woods,
Stephanie Bieltz, and Amanda Clinton
2
Definition

• PCIT is a short-term, empirically
• validated intervention that is designed
• for families with young children.
• This form of treatment may be used for
• externalizing and internalizing problems
• and a broad range of behavioral, emotional, and
• developmental problems exhibited in childhood.
• See PCIT Handout 1 for More Information

3
Rationale for a Multi-Tiered Approach to
Family-School Partnerships

• Family-school partnerships provide a context for
  families and educators to collaboratively
  identify and prioritize concerns across a
  continuum of opportunities and intensities
• Prevention and intervention efforts and supports
  are delivered toward a universal and targeted
  audience
• A multi-tiered approach enables families and
  educators to provide services based on a
  students responsiveness to previous preventions,
  interventions, and supports
• See PCIT Handout 2 for More Information

4
Explanation for a Multi-Tiered Approach to
Family-School Partnerships

• Provides various levels of family-school supports
  based on a students identified need and
  responsiveness to previous efforts
• Universal Family-school collaboration provided
  to support all students and families (e.g., 4 As,
  Parent-School Collaboration, Parent Involvement,
  Parent Education)
• Targeted Family-school collaboration provided
  to support identified students and families
  unresponsive to previous universal efforts (e.g.,
  Parent Education and Intervention, Parent
  Consultation)
• Intensive Family-school collaboration provided
  to students and families unresponsive to previous
  targeted efforts (e.g., Parent Consultation
  conjoint behavioral consultation and Parent
  Intervention)

5
The Multi-Tiered Approach to Family-School
Partnerships
Tier 3 Intensive, Individual Interventions Indivi
dualized supports for families and students
unresponsive to the first two tiers (e.g., Parent
Consultation conjoint behavioral consultation
and Family Intervention)
Tier 3 1-7
Tier 2 Targeted Group Interventions Specific
preventions and remedial interventions for
targeted groups of families and students
identified as at risk and unresponsive to the
first tier (e.g., Parent Training and
Intervention, Parent Consultation)
Tier 2 5-15
Tier 1 Universal Interventions Engaging all
families as collaborative partners (e.g., 4 As,
Family-School Collaboration, Parent Involvement,
Parent Education)
Tier 1 80-90
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Rationale for Using PCIT

• Early intervention is critical to prevent
  negative developmental trajectories and outcomes
• Unlike other techniques used to improve child
  behavior, PCIT emphasizes a comprehensive
  treatment approach that is focused on increasing
  positive behavior, decreasing negative behavior,
  and improving the parent-child relationship
  (McDiarmid Bagner, 2005)
• Parent-child relationships are at the heart of
  many intervention efforts and intervention
  efforts that focus on improving this relationship
  enable families to interact with their children
  and achieve satisfying relationships and positive
  outcomes for children and their families for
  years to come (Epps Jackson, 2000)
• See Overview Module for More Information on
• Partnering with Families

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PCIT Research

• Research examining the effectiveness of PCIT has
  found
• Statistically and clinically significant
  improvements in child disruptive behaviors and
  noncompliance
• Treatment effects that generalize to home,
  daycare, preschool, early elementary classroom
  settings, and untreated siblings
• Significant improvements in parent reported
  activity and stress levels, child internalizing
  problems, and self-esteem
• High degree of participant satisfaction
• Clinically significant improvements maintained at
  one and two-year follow-up evaluations
• See PCIT Implementation Guidelines for Factors
  that
• Influence the Effectiveness of PCIT

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Treatment Goals

• Goals for treatment include
• An improvement in the quality of the parent-child
  relationship
• An increase in parenting skills
• An increase in child prosocial behaviors
• A decrease in child behavior problems
• A decrease in parenting stress
• (Hembree-Kigin McNeil, 1995)

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Steps in PCIT

• Step 1 Pretreatment Assessment of Child
  and Family Functioning and
  Feedback
• Step 2 Teaching Behavioral Play Therapy
  Skills
• Step 3 Coaching Behavioral Play Therapy
  
• Skills
• Step 4 Teaching Discipline Skills

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Steps in PCIT cont.

• Step 5 Coaching Discipline Skills
• Step 6 Posttreatment Assessment of
  Child and Family Functioning and
  Feedback
• Step 7 Boosters
• (Information on steps and session
  content gathered from Hembree-Kigin McNeil,
  1995)

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Session 1 - Intake

• Average Length 1-2 Sessions
• Process
• Information is gathered on concerns,
  developmental history, family functioning, and
  family stressors
• Formal testing is conducted which will serve as a
  baseline measure of a childs behavior and
  parenting skills
• Therapist observes and may videotape how the
  parent and child interact with one another
• Feedback on these interactions will be provided
  during the next session
• See PCIT Implementation Guidelines for
• More Information on PCIT Sessions

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Session 1 Intake

• Process cont.
• Information is also collected regarding the
  familys experience using time-out
• Time-out is described in later sessions so it is
  important to inform the family that the time-out
  that will be described is different from the one
  that may have been used unsuccessfully in the
  past
• Feedback regarding assessment results and
  treatment planning is provided
• Preliminary feedback on observations is discussed
  along with results from formal testing
• Parents are asked why they believe their child is
  experiencing problems
• Therapist tries to reduce any feelings of guilt
  the parents may have for their childs behavior
  problems while also encouraging them to take
  responsibility for successfully resolving them

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Available Resources

• Assessment tools that may be used during intake
• Parent Report Measures
• Child Behavior Checklist Parent Form
• Eyberg Child Behavior Inventory
• Parenting Stress Index
• Social Skills Rating System
• Conners Parent Rating Scale Revised
• Vineland Adaptive Behavior Scales
• Childhood Autism Rating Scale
• Minnesota Multiphasic Personality Inventory 2
• Beck Depression Inventory
• See PCIT Handout 3 for References

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Available Resources cont.

• Assessment tools that may be used during intake
• Teacher Report Measures
• Sutter-Eyberg Student Behavior Inventory
• Child Behavior Checklist
• Social Skills Rating System
• Conners Teacher Rating Scale
• Child Report Measures
• Harter Pictoral Scale of Perceived Competence and
  Social Acceptance for Young Children
• Peabody Picture Vocabulary Test Revised
• See PCIT Handout 3 for
  References

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Session 2 Teaching BehavioralPlay Therapy

• Average Length 1 Session
• Process
• Goals of behavioral play therapy are described
• Rationale for the use of brief daily home play
  therapy sessions is presented
• Do and Dont skills of behavioral play
  therapy are described
• Use of strategic attention and selective ignoring
  are discussed
• All skills are modeled together
• Parents are coached as they role-play skills
• Logistics of play therapy at home are discussed

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Session 2 Teaching Behavioral Play Therapy

• Goals of Behavioral Play Therapy
• Goals based on presenting concerns
• Important to convey that playtime is a
  therapeutic intervention and not just playing
  with the child
• Daily Home Play Therapy Practice
• To be done for at least 5 minutes everyday with
  the child leading the activity
• Play therapy should not be viewed as a privilege
  that the child can earn or lose
• Playtime is often more important on days when the
  child has misbehaved

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Session 2 Teaching Behavioral Play Therapy

• Do Skills (DRIP)
• Describe appropriate behavior
• Reflect appropriate verbalizations
• Imitate appropriate play
• Praise prosocial behavior
• Dont Skills
• Give commands or make requests
• Ask questions
• Criticize or correct in a negative way

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Session 2 Teaching Behavioral Play Therapy

• Using Strategic Attention
• Involves using the Do skills of behavioral play
  therapy
• Used to reward the behaviors adults would like to
  see the child display more often
• First, identify the behaviors or qualities that
  the parent sees as desirable and prosocial even
  if infrequent at first
• Parents may want to think of the behaviors they
  would like to see their child display as opposed
  to their inappropriate behaviors
• Once behaviors are identified, parents are to
  lookout for targeted behavior
• Catch the child being good
• Parents are encouraged to use strategic attention
  and praise appropriate behavior as much as
  possible throughout the day

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Session 2 Teaching Behavioral Play Therapy

• Using Selective Ignoring
• Parents are to identify behaviors or qualities
  they would like to see diminished
• In order for ignoring to be effective the child
  must be doing the problem behavior to get a
  reaction or attention from the parent
• Therapist then helps the parents analyze whether
  or not their attention rewards the child for
  engaging in each of the behaviors and whether the
  removal of attention should be expected to impact
  the behavior
• Important for parents to understand that a
  behavior that is ignored will get worse before it
  gets better
• Parents should determine if they can tolerate
  having the behavior get worse before it gets
  better
• Parents must also understand that once they begin
  to ignore a behavior they must continue to ignore
  the behavior until it stops occurring

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Session 2 Teaching Behavioral Play Therapy

• Modeling Skills Together
• The therapist may model the skills with the
  parent pretending to be the child or show a
  videotaped segment of a parent with a child who
  presented with similar problems
• After demonstrating the combined skills the
  parent performs a role-play
• The therapist should encourage parents to perform
  the Do skills and may suggest specific phrases
  for the parent to repeat
• Purpose is to show the parent how it feels to do
  the skills and what it is like to have someone
  providing frequent feedback on their performance

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Session 2 Teaching Behavioral Play Therapy

• Considerations
• Behavioral play therapy is particularly helpful
  for one-parent families
• These parents may often feel stressed and
  overburdened and this playtime provides them with
  positive interactions and time with their
  children
• Two-parent families should consider alternating
  days in which each parent engages in play therapy
  with the child
• Parents can also do play therapy at home with all
  of their children between the age of 2 and 7
• Before leaving the session, parents should know
  when and where they will conduct play therapy in
  their home
• Should be done in a place that is quiet, private,
  and free of distractions and should occur at
  about the same time everyday
• Parents are reminded to practice for 5 minutes a
  day and are given a recording sheet to note
  whether or not they practiced and any
  difficulties or problems that came up during
  playtime

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Session 3 Coaching Behavioral Play Therapy
Skills

• Average Length 2 4 Sessions
• Process
• Check-in and review homework
• Recording of play therapy skills
• Coaching of play therapy skills
• Feedback on progress and homework assignment
• Individual time with child (optional)

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Session 3 Coaching Behavioral Play Therapy
Skills

• Observing Behavioral Play Therapy Skills
• The parent and child play together for five
  minutes and the therapist records the parents
  progress on a chart that is updated on a weekly
  basis
• Progress is compared to mastery criteria
• Criteria is based on concept of overlearning
  principles taught by therapists

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Session 3 Coaching Behavioral Play Therapy
Skills

• Coaching the Do and Dont Skills Tips for
  Therapists
• Make coaching brief and precise
• Should take the form of labeled praise, gentle
  correction, directives, and observations
• Coach after nearly every parent verbalization
• Give more praise than correction
• Coach easier skills first
• Incorporate observations into feedback
• Make use of humor
• Move from more directive to less directive
  coaching

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Session 3 Coaching Behavioral Play Therapy
Skills

• Qualitative Aspects of Parent-Child Interactions
• Physical closeness and touching
• Eye contact, facial expressions, vocal qualities
• Turn-taking, sharing, polite manners
• Developmentally sensitive teaching
• Task persistence

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Session 4 Teaching Discipline Skills

• Average Length 1 Session
• Process
• Explain use of compliance exercises
• Discuss how to give effective directions
• Discuss how to determine if child has obeyed
• Discuss consequences for obeying
• Discuss consequences for disobeying
• Present backups for time-out
• Coach parents as they role-play discipline skills

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Session 4 Teaching Discipline Skills

• Importance of Compliance Exercises
• Parents are informed of the importance of
  consistency, predictability, and follow-through
• Parents are taught to view all misbehavior as
  falling into two categories noncompliance and
  disruptiveness
• Noncompliance refusing to do what one is told
• Disruptiveness doing things that one is told
  not to do

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Session 4 Teaching Discipline Skills

• Importance of Compliance Exercises cont.
• Best way to teach compliance is through practice
• By receiving a great deal of enthusiastic praise
  for small accomplishments, the child views
  minding in a more positive light and the habit of
  defying simple requests is weakened
• Once compliance is improved within these
  exercises parents are coached in more real-life
  situations such as getting their child to come in
  from outside

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Session 4 Teaching Discipline Skills

• Determining Compliance
• Even with well-stated commands it is sometimes
  difficult to determine if a child has obeyed
• The following situations should be discussed with
  the parent to determine if the child complied
  with the parents direction
• Doing something slightly different from the
  parents request
• Dawdling
• Playing Deaf
• Partially complying
• Minding with a bad attitude
• Undoing

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Session 4 Teaching Discipline Skills

• Consequences for Obeying
• Parents are taught to praise their child as
  specifically as possible when their child
  complies with a request
• Labeled praise such as Thanks for minding, I
  like it when you do what I ask, or Good
  following instructions!
• When enthusiastic labeled praises are given for
  listening children begin to view compliance in a
  more positive light
• In addition to labeled praise, the parent should
  mention that they are happy that the child did
  not have to go to time-out

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Session 4 Teaching Discipline Skills

• Consequences for Disobeying
• If a child does not follow a parents command,
  parents are instructed to not repeat the command,
  but make a two-choices statement
• Parents hold up two fingers and says in a neutral
  tone of voice, You have two choices. You can
  put Mr. Potato Head back in the box or go to
  time-out.
• It is critical that a parent never provides a
  two-choices statement without being prepared to
  follow through with time-out
• After giving the statement, parents are taught to
  watch closely to determine whether their child
  has complied
• If so, enthusiastic praise is given
• If not, the parent should proceed with time-out

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Session 4 Teaching Discipline Skills

• Time-Out
• Parent should escort child to time-out and then
  explain that the child is to sit in the chair
  until they can get off
• The time-out chair should be in a specific,
  boring location that is free from distractions
  or attention from others
• Time-out is over after the child has spent three
  minutes in time-out chair
• More time may be added if child misbehaves in
  time-out chair

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Session 4 Teaching Discipline Skills

• Backups for time-out
• Isolation in another room
• Restriction of privileges
• Ways to handle time-out escape
• Stand by time-out chair
• Place hand on childs shoulder as they sit in
  time-out
• Repeatedly place child back in time-out chair
• Add additional time for time-out escapes
• Explain to child that time-out does not begin
  until they sit appropriately
• Parents role-play discipline skills
• Time-out procedures are reviewed
• Parents should not use time-out until after the
  next session with additional coaching by the
  therapist

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Session 5 Coaching Discipline Skills

• Average Length 4-6 Sessions
• Process
• Rehearse time-out with family
• Coach discipline skills
• Combine play therapy and discipline skills
• Coach time-out

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Session 5 Coaching Discipline Skills

• Guidelines for Coaching Discipline Skills
• Give one instruction at a time
• Use positively stated instructions
• Coach both verbal and nonverbal communication
• Praise parental compliance
• Offer support and reassurance
• Use relaxation training strategies

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Session 6 Posttreatment Assessment of Child
and Family

• Average Length 1 2 Sessions
• Process
• Therapist and family review therapy progress
• Discuss strategies for addressing any remaining
  problems
• Decide on a schedule for maintenance or booster
  sessions

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Session 6 Posttreatment Assessment of Child
and Family

• Measures that were administered before treatment
  are repeated
• Changes on formal measures and videotaped
  interactions of the family from pretreatment to
  posttreatment are reviewed
• Problem-solving skills are reviewed with the
  parents so that they can apply their new
  parenting strategies to a variety of problems
  that may come up
• Parents are asked to identify at least one
  remaining concern and formulate a plan to address
  this concern

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CASE EXAMPLE
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Background

• Tommy is a 5-year, 3 month-old English-speaking
  African-American male who demonstrates behavioral
  difficulties including talking back to adults,
  ignoring directions, and hitting other children
  when frustrated
• He is the child of an older single mother and has
  two siblings in their early twenties

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Step 1 Pretreatment Assessment

• Interview
• Mrs. Smith, Tommy, and Tommys siblings attend
  the session
• First, the limits of confidentiality are
  explained to the family
• During a semi-structured interview, Mrs. Smith
  describes Tommys developmental history, which is
  significant for slight language delays. She
  shares that the family is under considerable
  stress given her long work days, the absence of
  Tommys father, and the need to rely on her adult
  children to care for Tommy after preschool

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Step 1 Pretreatment Assessment, cont.

• Interview, cont.
• During the interview, Tommy is permitted to play
  with toys in the room. He is observed by the
  therapist to select plastic dinosaurs which he
  has run in the air and often strikes against
  one another with loud crashing sounds
• As Tommy becomes increasingly louder and more
  active, Mrs. Smith responds to his behavior by
  yelling, Stop! Similar techniques are employed
  by Tommys elder sister, while his brother
  ignores Tommy
• The therapist is careful to encourage Mrs. Smith
  to feel comfortable managing her sons behavior
  as best she can and does not intervene

42
Step 2 Formal Assessment

• Formal Assessment
• Tommy is observed for a few minutes while the
  therapist speaks to his mother about the
  questionnaires she will complete
• Next, formal assessment is conducted
• Tommy is administered the Peabody Picture
  Vocabulary Test due to reported concerns about
  his language development
• While Tommy is being evaluated, Mrs. Smith
  responds to the items on a series of behavioral
  checklists, including the Child Behavior
  Checklist Parent Form, Eyberg Child Behavior
  Inventory, and Parenting Stress Index, in order
  to establish baseline information

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Step 2 Teaching Behavioral Play Therapy

• Teaching Play Therapy
• Mrs. Smith receives information about the goals
  of play therapy
• Mrs. Smith learns that the interventions are
  designed to improve her relationship with her son
  while reducing Tommys aggression and anger and
  increasing his self-esteem
• Daily home therapy is explained to her as being
  done for at least 5 minutes each day and that the
  child should lead the activity
• She expresses understanding, along with doubts,
  that this 5 minute play activity must take place
  even on days when Tommy has been non-compliant
  because it can break the negative cycle of
  behavioral non-compliance

44
Step 2 Teaching Behavioral Play Therapy, cont.

• Teaching Play Therapy, cont.
• The therapist explains the acronym DRIP to Mrs.
  Smith.
• Mrs. Smith practices with the therapist, starting
  out by saying, You play with the dolls. The
  therapist reminds her it is important to
  describe, reflect, imitate, and praise. Mrs.
  Smith then says, as the therapist picks up a car
  and starts to play with it, You picked a red car
  and you are driving it along the street.

45
Step 2 Teaching Behavioral Play Therapy, cont.

• Teaching Play Therapy, cont.
• When Mrs. Smith demonstrates a solid grasp of the
  use of DRIP techniques through role plays with
  the therapist, she and the therapist make plans
  for follow-up play sessions at home
• Mrs. Smith decides that the most convenient place
  and time to practice behavioral play therapy will
  be just after dinner each day. She plans to play
  with Tommy in his room, since it is a relatively
  quiet location

46
Step 3 Coaching Behavioral Play Therapy

• Coaching Play Therapy
• Mrs. Smith shares her record of play therapy
  sessions
• She demonstrates that she engaged in play therapy
  5 of the 7 days between sessions
• Her efforts and consistency are praised by the
  therapist

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Step 3 Coaching Behavioral Play Therapy

• Coaching Play Therapy, cont.
• Next, Mrs. Smith and Tommy play together for 5
  minutes in a therapy room while the therapist
  observes behind a one-way mirror
• Mrs. Smith is reminded to praise Tommy when he
  shares his toy with her and to avoid asking
  questions and giving commands

48
Step 3 Coaching Behavioral Play Therapy, cont.

• Coaching Play Therapy, cont.
• Mrs. Smith shares her record of play therapy
  sessions indicating that she engaged in play
  therapy 6 of the 7 days between sessions
• During this 2nd session, focused on coaching
  behavioral play therapy, Mrs. Smith is encouraged
  to ignore behaviors that continue to be of
  concern to her. Specifically, when Tommy grabs
  toys away from her or bangs them together, she
  attends to another toy and does not say anything
• As soon as Tommy realizes that his mother is not
  attending to his acting out, he offers to share
  with her. Mrs. Smith reflects on this behavior
  and praises him

49
Step 3 Coaching Behavioral Play Therapy,
cont.

• Coaching Play Therapy, cont.
• Mrs. Smith shares that she engaged in play
  therapy 4 of the 7 days between sessions
• During this session, qualitative aspects of PCIT
  are the focus
• Mrs. Smith is encouraged to make eye contact with
  Tommy and sit close to him or give him a hug when
  he engages in appropriate behaviors, especially
  when he persists on a task that is difficult for
  him
• Tommy responded to attention from his mother by
  continuing to engage in appropriate behaviors

50
Step 4 Teaching Discipline Skills

• Teaching Discipline
• This session explains to Mrs. Smith how to
  effectively implement consequences for Tommys
  inappropriate behavior
• The therapist focuses on increasing Tommys
  compliance during play by helping Mrs. Smith give
  effective directions to Tommy
• When they are not followed, Mrs. Smith
  identifies and responds to non-compliant behavior

51
Step 4 Teaching Discipline Skills

• Teaching Discipline, cont.
• Mrs. Smith gives Tommy two choices, to follow her
  command or go to time-out
• Mrs. Smith practices giving direct commands and
  the use of time-out in the therapists office

52
Step 5 Coaching Discipline Skills

• Coaching Discipline
• Mrs. Smith is taught to increase Tommys
  compliance with her requests by setting small
  goals toward a skill that she knows Tommy can
  learn
• Mrs. Smith picks building a house with blocks,
  since she knows Tommy can do it. She begins by
  giving Tommy a single simple instruction, Tommy,
  put the red blocks at the bottom of the house
• When he does so, she smiles broadly, gives him a
  pat on the back and says, Good listening! You
  put the red blocks at the bottom of the house

53
Step 5 Coaching Discipline Skills

• Coaching Discipline, cont.
• Mrs. Smith continues to give commands in simple
  language
• When Tommy is noncompliant, Mrs. Smith holds up
  two fingers and calmly but firmly says, Tommy,
  you have two choices. You can put the roof on
  the house or go to time-out
• Tommy stands with his arms folded looking at his
  mother then throws a block
• Mrs. Smith gets up and escorts Tommy to time-out.
  He will not go with her so she gently picks him
  up and sets him in the pre-determined time-out
  area for 3 minutes

54
Step 5 Coaching Discipline Skills

• Coaching Discipline, cont.
• When time-out is over, Mrs. Smith repeats the
  original command in which Tommy was noncompliant
• Mrs. Smith says, Tommy, put the cardboard on top
  for a roof. Tommy does nothing
• Mrs. Smith holds up two fingers and says, Tommy,
  you have two choices. You can put the chimney on
  the roof on the house or go to time-out.
• Tommy hesitates, and then puts the chimney on the
  roof of the house, which causes it to collapse
• Mrs. Smith praises Tommy for showing he was
  listening by putting chimney on the house

55
Step 5 Coaching Discipline Skills

• Coaching Discipline, cont.
• Mrs. Smith and Tommy play in an appropriate
  manner without further events during this session
• Tommy obeys commands that his mother makes in an
  appropriate fashion and time-out is not required

56
Step 6 Posttreatment Assessment

• Posttreatment Assessment
• The measures utilized in the initial assessment
  are re-administered in order to provide
  comparative results to Mrs. Smith
• Results indicate that Tommy demonstrates
  significantly less aggression during play and
  more appropriate methods for seeking his mothers
  attention. Areas of progress are discussed and
  comparison scenes on videotape are shown to
  demonstrate Tommys improvements
• Tommys remaining difficulties of a short
  attention span and limited coping skills for
  challenges are discussed
• Mrs. Smith indicates a willingness to continue to
  work on gradually increasing Tommys play
  sessions to help with his attention span. She
  also discusses ways in which she can provide
  additional praise that might influence greater
  coping during play therapy sessions at home

57
Step 6 Posttreatment Assessment

• Posttreatment Assessment, cont.
• Maintenance sessions are scheduled once a month
  with Mrs. Smith and Tommy
• At each session, the therapist and Mrs. Smith
  discuss present concerns and ways to address them
• Mrs. Smith and Tommy spend time interacting with
  one another while the therapist provides feedback
  and reinforcement as needed
• A future booster session is scheduled for 3
  months after their last meeting

58
Future Directions

• Determine what specific context or individual
  variables lead to greater treatment effectiveness
• Identify groups most likely to benefit from
  treatment to ensure that services are provided to
  those who will most likely benefit
• Identify groups who have shown to be less
  responsive to treatment to identify groups in
  need of further study and how to modify PCIT
  procedures to better serve these groups
• Examine effects in real-world clinics without
  intense supervision to improve treatment
  protocols and dissemination
• Examine outcomes for families that do not
  complete training
• (Herschell, Calzada, Eyberg, McNeil, 2002)

59
Future Directions

• Examine the range of comorbid disorders (e.g.
  internalizing disorders, chronic pediatric
  illness, developmental disorders) that may be
  affected by PCIT
• Explore the extent to which PCIT can be adapted
• Investigate effectiveness of PCIT among diverse
  populations in terms of ethnicity and cultural
  factors
• Determine ways in which treatment should be
  tailored to maximize gains in minority groups
• Examine what therapist behaviors contribute to
  improved treatment outcomes
• (Herschell, Calzada, Eyberg, McNeil, 2002)

60
Future Directions

• Identify families at-risk for drop out and
  factors that may promote their adherence to
  treatment
• Determine the level of training necessary to
  produce therapeutic gains
• Evaluate alternate ways to deliver treatment to
  ensure accurate implementation so critical
  treatment components are not altered
• Examine long-term maintenance of treatment
  effects
• Predictors of long-term treatment outcomes
• (Herschell, Calzada, Eyberg, McNeil, 2002)

61
References

• Bates, S. L. (2005). Evidence-based family-school
  interventions with preschool children. School
  Psychology Quarterly, 20, 352-370.
• Epps, S. Jackson, B. (2000). Empowered
  families, successful children Early
• intervention programs that work. American
  Psychological Association.
• Hembree-Kigin, T.L. McNeil, C.B. (1995).
  Parent-Child Interaction Therapy. New York
  Plenum Press.
• Herschell, A. D., Calzada, E. J., Eyberg, S. M.,
  McNeil, C. B. (2002). Parent child interaction
  therapy New directions in research. Cognitive
  and Behavioral Practice, 9, 9-16.
• Jacob-Timm, S. Hartshorne, T. S. (1998). Ethics
  and law for school psychologists (3rd ed.). New
  York Wiley Sons.
• McDiarmid, M. D. Bagner, D. M. (2005).
  Parent-child interaction therapy for children
  with disruptive behavior and developmental
  disabilities. Education and Treatment of
  Children, 28, 130-141.