Parent Child Interaction Therapy (PCIT) Implementation Guidelines

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Parent Child Interaction Therapy
(PCIT)Implementation Guidelines
The Future of School Psychology Task Force on
Family-School Partnerships Kathryn Woods,
Stephanie Bieltz, and Amanda Clinton
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Factors Influencing the Effectiveness of PCIT

• Parents
• Average or High IQ
• Strong Motivation
• Child
• Ages between 2 and 7
• Good Receptive Language Skills
• Family
• Good Marital Adjustment
• Extended Family Support

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Presenting Problems That May Be Addressed Using
PCIT

• Noncompliance
• Verbal Aggression
• Physical Aggression
• Hyperactivity
• Stealing
• Lying
• Destructive Behavior
• Self-Injurious Behavior
• Whining

• Classroom Conduct Problems
• Low Self-Esteem
• Sad Mood
• Perfectionism
• Developmental Delays
• Anxiety
• Postdivorce Adjustment
• Bonding in Blended Families

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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

• Children are encouraged to play in the room
  during the interview. Parents are told that the
  therapist will be watching during this time and
  the parents are to manage the childs behavior as
  they would normally
• Therapists are paying attention to how the child
  plays independently, strategies the child uses to
  get the parents attention, parental responsivity
  to child overtures, parental limit-setting,
  warmth of parent-child interactions, and evidence
  of clinging and/or separation anxiety
• Therapists do not intervene during this time but
  encourage the parents to manage the childs
  behavior as best they can

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Session 1 - Intake

• When conducting observations, it is advantageous
  to collect information in the childs school
  setting to get a more complete view of the child
• It is also helpful to conduct observations on
  separate days at different time periods
• If PCIT is recommended, course of treatment is
  described to the family, emphasizing the ways in
  which PCIT can address the specific concerns
  brought to them in treatment and any additional
  concerns that may have been brought up
• Goal is to get parents excited about treatment
  and establish expectations that PCIT will require
  active involvement on their part
• An overview of PCIT is described with emphasis on
  the behavioral play therapy and discipline
  components

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Session 2 Teaching Behavioral Play Therapy
Rule Reason Examples
Describe appropriate behavior Allows child to lead Shows child youre interested Teaches concepts Holds childs attention Thats a red block Youre making a tower You drew a smiley face The doll looks happy
Reflect appropriate talk Doesnt control the conversation Shows child youre listening Improves childs speech Demonstrates acceptance and understanding Child I made a star Parent Yes, you made a star Child I like to play with this castle Parent This is a fun castle to play with
Imitate appropriate play Lets child lead Shows child you are involved Approves childs choice of play Child Im putting baby to bed Parent Ill put sister to bed too Child Im making a sun in the sky Parent Ill put a sun in my picture too
Praise appropriate behavior Causes the behavior to increase Lets child know what you like Increases self-esteem Adds warmth to relationship Terrific counting! I like the way you are playing so quietly You have great ideas for this game Thank you for showing the colors to me
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Session 2 Teaching Behavioral Play Therapy
Rule Reason Examples
Dont give commands Doesnt allow child to lead Can cause unpleasantness Child obedience will be taught later Will you hand me that paper? Could you tell me your ABCs? Look at this Please tie your shoe
Dont ask questions Leads the conversation instead of following Many are commands or require an answer Makes it seem like you arent listening to the child Thats a blue one, right? What color is this? Are you having fun? You want to play with the blocks?
Dont criticize Doesnt work to decrease bad behaviors Often increases the criticized behaviors May lower the childs self-esteem Creates an unpleasant interaction Youre being naughty I dont like it when you talk back No, honey thats not right Dont scribble on your paper
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Behavioral Targets for Strategic Attention and
Selective Ignoring

• Strategically Attend to
• Polite manners
• Gentle play
• Staying seated at a table
• Talking softly
• Helping, being nice to people
• Sharing toys
• Trying even when it is hard

• Selectively Ignore
• Bossiness, demandingness
• Banging toy on table
• Leaving seat during play
• Whining
• Yelling
• Grabbing toys away
• Giving up in frustration

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Session 2 Teaching Behavioral Play Therapy

• Playtime Homework Sheet

Date Yes No Any problems that came up

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
(Did you practice play therapy for five minutes?)
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Session 3 Coaching Behavioral Play Therapy
Skills

• Criteria for Mastery of Behavioral Play Therapy
  Skills
• During five-minute play session
• Give 25 to 50 descriptions plus reflections
• Reflect nearly all appropriate child
  verbalizations
• Give 15 or more praises, at least 8 of which are
  labeled praises
• Ignore all negative, attention-seeking behaviors
• No critical statements
• No commands
• No questions

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Session 4 Teaching Discipline Skills

• Parents will teach their child to mind by
  establishing small minding goals
• While playing with toys, the parent gives the
  child easy to follow instructions (e.g., put the
  eyes on Mr. Potato Head, place a block on top of
  another)
• The child receives praise and the opportunity to
  continue playing if they follow instructions and
  a negative consequence if they do not follow
  instructions
• As small compliance goals are reached the child
  is provided with more challenging tasks (e.g.,
  doing things that they dont want to do,
  performing a boring or less interesting task)

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Session 4 Teaching Discipline Skills

• Giving Effective Instructions

Make commands direct, not indirect Be polite and respectful, while still being direct Use explanations sparingly
Make commands single and small, not compound Save direct commands for things youre sure the child can do Always provide a consequence for obedience and disobedience
State commands positively, tell child what to do, instead of what not to do Dont give too many direct commands Use a neutral tone of voice, instead of pleading or yelling
Make commands specific, not vague Use choice commands with older preschoolers
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Session 4 Teaching Discipline Skills

• Key points to time-out
• Avoid talking to the child on the way to time-out
  and any other verbalizations and other forms of
  attention while the child is in time-out
• Time-out does not end until the original
  instruction is obeyed
• If child refuses to comply with original
  direction they will return to time-out
• If child complies with the original direction
  after going through time-out it is best for the
  parent to simply acknowledge that the child
  complied with the initial request and avoid
  praising the child

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Session 5 Coaching Discipline Skills

• Combining play therapy and discipline skills
• After child has been praised for obeying first
  command, parents are instructed to return to play
  therapy and avoid giving further instructions for
  a few minutes
• This play therapy serves to reinforce child for
  compliance, decrease anger from being required to
  mind, and helps parents remain calm
• Every three to five minutes another instruction
  is provided
• The parent is gradually given more responsibility
  throughout the session and the demands placed on
  the child are gradually increased

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Session 6 Posttreatment Assessment of Child
and Family

• To enhance long-term maintenance of parenting
  skills and child behavioral improvements a
  schedule of booster sessions is developed
• Number and frequency of sessions depends on
  presence of family stressors, degree of family
  and community support for using PCIT skills,
  cognitive ability and psychological functioning
  of parent, level of posttreatment skills mastery,
  and parental dependency on the therapist
• Usually recommended that families participate in
  1 month, 3 month, 6 month, and 1 year booster
  sessions