Parent-Child Interaction Therapy: Meaning And Application

Parent-child interaction therapy (PCIT) is a behavioral parent training approach that was introduced in the 1970s to treat young children with externalizing behavior problems. The approach is still used today for younger children and adolescents (generally ages 2–7). In PCIT, parents are trained to take responsibility for their child's behavior as well as for themselves. This is accomplished by teaching parents to modify their parenting style in positive ways and working with children on these changes over time. This can improve a child's ability to cope with adversities and develop positive behaviors, especially with respect to problem-solving, remaining calm while interacting with others, and developing social skills.

What is Parent-Child Interaction Therapy?

Parent-child interaction therapy (PCIT) is a family-centered strategy to treat disruptive behavior in children 2 to 7 years old. It has also been used to treat abused and at-risk children 2 to 12 years old. All caregivers, whether they are biological parents, adoptive parents, foster parents, or family members, can benefit from this therapy. Parents learn techniques during PCIT that will improve the parent-child bond and encourage youngsters to behave well. They communicate with their kid and receive guidance from the PCIT therapist in order to accomplish this aim. According to research, PCIT helps parents learn more effective parenting practices, which in turn helps kids behave better, strengthen their bonds with their parents, and lower the chance of child abuse.

Many of the complicated issues that might lead to poor parenting or parent-child interactions are addressed by PCIT. Abuse-prone parents frequently engage negatively with their kids, employ harsh, inconsistent, and inefficient forms of discipline, and place an excessive emphasis on punishment. Children in these households may be momentarily cooperative as a result of the periodic severe discipline, but they eventually learn to be rebellious or noncompliant owing to inconsistent limit setting, which can result in a negative feedback loop for both the parent and the kid. This downward spiral of bad habits can get so bad that it results in severe physical abuse and punishment. PCIT assists by promoting healthy connections between parents and children and by educating parents on how to use fair and nonviolent punishment methods when their kids misbehave. Children exhibit more good behaviors as a result of these stronger interactions and connections.

What are the Theoretical Foundations of PCIT?

According to attachment theory, a kid who experiences sensitive and responsive parenting throughout infancy and toddlerhood will grow up with a cognitive-affective working model that assumes the parent will take care of their needs. Therefore, young children are more likely to establish a reliable working model of their interactions with others and more effective emotional regulation if their parents are more warm, attentive, and sensitive to their signals. Pre-schoolers with externalizing behavior who are referred to clinics are more likely than non-referred children to experience distress during parent separations and to exhibit behavioral signs of insecure attachment.

In order to restructure the parent-child interaction and give the kid a stable bond, CDI focuses on attachment theory. Parents are given knowledge and abilities that promote kindness and supportive interpersonal patterns. This stage of treatment acknowledges that parents can have a particularly significant impact on their child's behavior in the first few years of preschool because children are more receptive to parental attention and less vulnerable to peer pressure, teacher influence, or developmental autonomy than they are in later years.

What are the Key Components of PCIT?

PCIT is commonly offered in 10–20 weekly sessions, with 15 sessions being the norm. Each session lasts around one to one and a half hours. On occasion, more therapy sessions are offered as necessary. Child-directed interaction (CDI), which focuses on improving relationships, and parent-directed interaction (PDI), which focuses on effective punishment tactics, are the two phases of the PCIT curriculum. Each phase normally starts with a parent-only session to introduce the strategy, then the therapist trains the parent in a series of sessions to help them develop the targeted skills while interacting with the kid.

While many other therapy strategies concentrate on either parents or kids, PCIT aims to alter both parents' and kids' behavior at the same time. Parents receive training to better handle their children's behavioral or emotional problems as well as to learn how to model positive actions that youngsters can imitate. PCIT also uses live coaching, in which the therapist converses with the parent using a tiny wireless earpiece while generally watching the parent-child interactions from behind a one-way mirror.

Phase 1: Child-Directed Interaction

This stage focuses on creating a solid and caring attachment between the parent and kid. During CDI sessions, the parent participates in a play scenario under the guidance of the therapist. Parents are especially urged to employ the abilities denoted by the acronym PRIDE −

  • Praise − To promote the conduct and help the kid feel good about their relationship with the parent, provide particular praise for the child's acceptable behavior (for example, "Good job picking up your crayons!").

  • Reflection − To demonstrate that the parent is paying attention and to promote better communication, repeat and expand on what the youngster says.

  • Imitation − Imitate the kid's actions to express approbation and to assist the youngster to learn how to play with others.

  • Description − Describe the child's activity to show attention and develop reciprocal play skills (e.g., "You're constructing a tower out of blocks.

  • Enjoyment − Be active and sincere during the play interaction.

Phase II: Parent-Directed Interaction

During PDI, the therapist instructs the parent on how to give their kid precise instructions and how to apply fair penalties for both compliance and disobedience. The parent is instructed to offer labelled or targeted praise when the kid complies with the directive (for example, "Thank you for doing what I requested"). However, if a youngster disobeys, the parent needs to start the timeout process. Beginning with a warning and a clear option of action (e.g., "If you don't put your toys away, you will have to sit in timeout"), the parent initiates the timeout method. If required, the parent may put the youngster in a chair for a 3-minute timeout. Parents are given daily homework to practice the skills outside of the session, much like with CDI.

Considerations When Using PCIT with Child Welfare Populations

It includes −

  • Therapeutic focus − The emphasis of therapy frequently turns from changing kid behavior to changing parent conduct when the treatment involves a caregiver who was the abuser. In certain situations, a diagnosis of a behavioral disorder may be made without the child's actions necessarily falling within the clinical range.

  • Age − PCIT with these families can be modified to accommodate children up to age 12 because the focus of the therapy is often on the parent rather than the kid in situations involving a parent who is a perpetrator. Adjusting the forms of discipline that are addressed with the parents and increasing the child's involvement in discussing treatment objectives and plans are two examples of age-related adjustments.

  • Skills practice − Regular work practice is a crucial part of PCIT and may not be possible for parents whose kids are in out-of-home situations. The newly acquired abilities of the parents may deteriorate before the kid comes home if the youngster stays in out-of-home care after the course of therapy. A noncustodial parent must have access to the kid at least three times a week in addition to the PCIT treatment sessions in order to participate in the program.

  • Parent engagement − Engagement may be difficult given that many families involved in child welfare may be using programs against their will. In addition, some parents could have mixed feelings or hesitations regarding the services the child welfare system suggests. A caregiver's ability to attend therapy may also be hindered by logistical issues like transportation or conflicting requests from the child protection system or other agencies.


PCIT seems to be effective for parents and children who are in therapy because of disruptive behavior, negative peer relationships, and parent-child discord. In some cases, it may reduce behavior problems. Treatment gains have been found to be relatively stable after the sessions have ended, but more studies need to be conducted to confirm these findings.