Parent-Child Interaction Therapy

PCIT is designed for children ages 2-7 with “disruptive” behaviors, such as tantrums, whining, defiance, hitting, saying unkind things, etc. PCIT is also effective for anxious or depressed children. PCIT kids typically have very big feelings, which sometimes come out as very big behaviors! When children have big feelings and big behaviors, caregivers are impacted too! PCIT is ideal for caregivers who feel frustrated, hurt, disconnected, worried, or embarrassed about their child's behavior.

PCIT requires consistent attendance by the child and the same caregiver each week, although multiple caregivers are able to participate if desired. For children with multiple caregivers, it is recommended that all of the caregivers (e.g., nannies, grandparents) attend the skill teaching sessions, which occur two to three times during treatment. This empowers the whole caregiving team to be consistent, which helps the child improve and build their self-regulation skills more rapidly.

PCIT is completed across two treatment phases. The first phase of treatment focuses on establishing warmth in a caregiver's relationship with their child through learning and applying skills proven to help children feel calm, secure in their relationships with their parents, and good about themselves.  

Desired outcomes of the first phase of treatment in PCIT include:

• Decreased frequency, severity, and/or duration of tantrums

• Decreased activity levels

• Decreased negative attention-seeking behaviors (e.g., whining, throwing objects, and bossiness)

• Decreased caregiver frustration

• Increased feelings of security, safety, and attachment to the caregiver

• Increased attention span

• Increased self-esteem and self-regulation

• Increased pro-social behaviors (e.g., sharing and taking turns)

The second phase of treatment will equip caregivers to manage the most challenging of their child's behaviors while remaining confident, calm, and consistent in their approach to discipline. In this phase, caregivers will learn proven strategies to help their child accept boundaries/limits, comply with directions, respect house rules, and demonstrate appropriate behavior in public.

Desired outcomes of the second phase of treatment in PCIT include:

• Decreased frequency, severity, and/or duration of aggressive behavior

• Decreased frequency of destructive behavior (e.g., breaking toys on purpose)

• Decreased defiance

• Increased child self-esteem and self-regulation

• Increased compliance with adult requests

• Increased respect for house rules

• Improved behavior in public

• Increased caregiver calmness and confidence during boundary-setting

With consistent attendance and homework completion, PCIT can be completed within 12-20 sessions, though treatment is not time-limited. Treatment is considered complete when caregiver's have mastered both sets of skills in each phase of PCIT and rate their child's behavior within the age-expected range on a behavior rating scale.

Most families see a shift in a child's emotional and behavioral regulation abilities within the first couple of coaching sessions. In fact, some families find they meet their goals and treatment success following mastery of skills practiced during the first phase of PCIT and might prematurely terminate PCIT services before starting or while completing the second phase.

The most direct answer to this is “it depends!” A common course of PCIT varies between 12-20 sessions. Coaching sessions average 45-60 minutes, while the intake and skill review/teaching sessions are approximately 90 minutes. Some families move more quickly through the treatment if the particular child responds fast and the caregivers practice daily. Every caregiver is different, and every child is unique, which is why PCIT is flexibly short-term, but not time-limited. Treatment is considered complete when caregiver's have mastered both sets of skills in each phase of PCIT and rate their child's behavior within the age-expected range on a behavior rating scale.

The length of treatment is influenced by the following factors:

• Family's regular weekly session attendance 

• The extent that caregivers engage in quality homework practice in between sessions

• The rate that caregivers display mastery of PCIT skills in session

• The intensity of the child's behaviors at the start of treatment

• The rate at which caregivers report reductions in their child's challenging or difficult behavior(s)

• The extent that the child has other emotional or developmental concerns

• The fulfillment of a specific treatment or case plan if referred by child protective services

Some children do show defiance during early PCIT sessions; however, many children are on their best behavior during PCIT! While this can frustrate caregivers because they deal with a very different child at home, it is actually not a bad thing for treatment. PCIT works just as well for the children who are on their best behavior because we are able to use the specialized therapy skills incorporated by PCIT to "catch them being good" and give the child tons of positive attention to those enjoyable interactions. As a bonus, it shows what a child is capable of when the circumstances and motivations are right!

During the second phase of PCIT, which teaches consistent discipline language and techniques, the therapist will introduce more challenging situations, such as turn-taking, clean-up tasks, caregivers choosing the less fun toy option despite the child wanting a different toy, etc. In general, these situations allow for opportunities for live coaching of caregiving techniques during noncompliance, tantrums, and/or defiance. Following practice and mastery of these skills through play, there is then the potential for community-based sessions in the second phase of treatment to further generalize the skills, including the child's coping and regulation abilities, to other settings.

Proactive Child Care's virtual PCIT services are available to all California residents! In order for virtual sessions to be effective, caregivers must have a phone, laptop, and/or tablet with wired or bluetooth headset/earpiece, and an internet connection fast enough for video chat. 

Intake and skill review/teaching sessions can occur in-home or virtually. A private space to review skills is needed as well as the opportunity to scope out where PCIT caregiver-child play will occur.