Parent Child Interaction Therapy (PCIT) Implementation Guidelines The Future of School Psychology Task Force on Family-School Partnerships Kathryn Woods,

Parent Child Parent Child Interaction Interaction

Therapy Therapy (PCIT)(PCIT)

Implementation Implementation GuidelinesGuidelines The Future of School

Psychology Task Force on Family-School Partnerships

Kathryn Woods, Stephanie Bieltz, and Amanda Clinton

Factors Influencing the Factors Influencing the Effectiveness of PCITEffectiveness of PCIT

Parents:Parents: Average or High IQAverage or High IQ Strong MotivationStrong Motivation

Child:Child: Ages between 2 and 7Ages between 2 and 7 Good Receptive Language SkillsGood Receptive Language Skills

Family:Family: Good Marital AdjustmentGood Marital Adjustment Extended Family SupportExtended Family Support

Presenting Problems Presenting Problems That May Be Addressed That May Be Addressed

Using PCITUsing PCIT NoncomplianceNoncompliance Verbal AggressionVerbal Aggression Physical AggressionPhysical Aggression HyperactivityHyperactivity StealingStealing LyingLying Destructive Destructive

BehaviorBehavior Self-Injurious Self-Injurious

BehaviorBehavior WhiningWhining

Classroom Conduct Classroom Conduct ProblemsProblems

Low Self-EsteemLow Self-Esteem Sad MoodSad Mood PerfectionismPerfectionism Developmental DelaysDevelopmental Delays AnxietyAnxiety Postdivorce Postdivorce

AdjustmentAdjustment Bonding in Blended Bonding in Blended

FamiliesFamilies

Steps in PCITSteps in PCIT

Step 1Step 1: Pretreatment Assessment : Pretreatment Assessment of Child of Child and Family and Family Functioning and Functioning and FeedbackFeedback

Step 2Step 2: Teaching Behavioral Play : Teaching Behavioral Play Therapy Therapy Skills Skills

Step 3Step 3: Coaching Behavioral Play : Coaching Behavioral Play Therapy Therapy Skills Skills

Step 4Step 4: Teaching Discipline Skills: Teaching Discipline Skills

Steps in PCIT cont.Steps in PCIT cont.

Step 5Step 5: Coaching Discipline Skills : Coaching Discipline Skills Step 6Step 6: Posttreatment Assessment : Posttreatment Assessment

of of Child and Family Child and Family Functioning and Functioning and Feedback Feedback

Step 7Step 7: Boosters: Boosters

(Information on steps and session content gathered from Hembree-(Information on steps and session content gathered from Hembree-Kigin & McNeil, 1995)Kigin & McNeil, 1995)

Session #1 - IntakeSession #1 - Intake Children are encouraged to play in the room Children are encouraged to play in the room

during the interview. Parents are told that the during the interview. Parents are told that the therapist will be watching during this time and therapist will be watching during this time and the parents are to manage the child’s behavior the parents are to manage the child’s behavior as they would normallyas they would normally

Therapists are paying attention to how the child Therapists are paying attention to how the child plays independently, strategies the child uses to plays independently, strategies the child uses to get the parent’s attention, parental responsivity get the parent’s attention, parental responsivity to child overtures, parental limit-setting, to child overtures, parental limit-setting, warmth of parent-child interactions, and warmth of parent-child interactions, and evidence of clinging and/or separation anxietyevidence of clinging and/or separation anxiety

Therapists do not intervene during this time Therapists do not intervene during this time but encourage the parents to manage the but encourage the parents to manage the child’s behavior as best they canchild’s behavior as best they can

Session #1 - IntakeSession #1 - Intake When conducting observations, it is advantageous When conducting observations, it is advantageous

to collect information in the child’s school setting to collect information in the child’s school setting to get a more complete view of the childto get a more complete view of the child It is also helpful to conduct observations on separate days It is also helpful to conduct observations on separate days

at different time periodsat different time periods If PCIT is recommended, course of treatment is If PCIT is recommended, course of treatment is

described to the family, emphasizing the ways in described to the family, emphasizing the ways in which PCIT can address the specific concerns which PCIT can address the specific concerns brought to them in treatment and any additional brought to them in treatment and any additional concerns that may have been brought upconcerns that may have been brought up

Goal is to get parents excited about treatment and Goal is to get parents excited about treatment and establish expectations that PCIT will require active establish expectations that PCIT will require active involvement on their partinvolvement on their part

An overview of PCIT is described with emphasis on the An overview of PCIT is described with emphasis on the behavioral play therapy and discipline componentsbehavioral play therapy and discipline components

Session #2 – Session #2 – Teaching Behavioral Play Teaching Behavioral Play

TherapyTherapyRule Reason Examples

Describe appropriate behavior

Allows child to leadShows child you’re interestedTeaches conceptsHolds child’s attention

That’s a red blockYou’re making a towerYou drew a smiley faceThe doll looks happy

Reflect appropriate talk Doesn’t control the conversationShows child you’re listeningImproves child’s speechDemonstrates acceptance and understanding

Child: I made a starParent: Yes, you made a starChild: I like to play with this castleParent: This is a fun castle to play with

Imitate appropriate play Lets child leadShows child you are involvedApproves child’s choice of play

Child: I’m putting baby to bedParent: I’ll put sister to bed tooChild: I’m making a sun in the skyParent: I’ll put a sun in my picture too

Praise appropriate behavior Causes the behavior to increaseLets child know what you likeIncreases self-esteemAdds warmth to relationship

Terrific counting!I like the way you are playing so quietlyYou have great ideas for this gameThank you for showing the colors to me


TherapyTherapyRule Reason Examples

Don’t give commands Doesn’t allow child to leadCan cause unpleasantnessChild obedience will be taught later

Will you hand me that paper?Could you tell me your ABCs?Look at thisPlease tie your shoe

Don’t ask questions Leads the conversation instead of followingMany are commands or require an answerMakes it seem like you aren’t listening to the child

That’s a blue one, right?What color is this?Are you having fun?You want to play with the blocks?

Don’t criticize Doesn’t work to decrease bad behaviorsOften increases the criticized behaviorsMay lower the child’s self-esteemCreates an unpleasant interaction

You’re being naughtyI don’t like it when you talk backNo, honey that’s not rightDon’t scribble on your paper

Behavioral Targets for Behavioral Targets for Strategic Attention and Strategic Attention and

Selective IgnoringSelective Ignoring Strategically Attend Strategically Attend

toto:: Polite mannersPolite manners Gentle playGentle play Staying seated at a Staying seated at a

tabletable Talking softlyTalking softly Helping, being nice Helping, being nice

to peopleto people Sharing toysSharing toys Trying even when it Trying even when it

is hardis hard

Selectively Ignore:Selectively Ignore: Bossiness, Bossiness,

demandingnessdemandingness Banging toy on Banging toy on

tabletable Leaving seat during Leaving seat during

playplay WhiningWhining YellingYelling Grabbing toys awayGrabbing toys away Giving up in Giving up in

frustrationfrustration


TherapyTherapyPlaytime Homework SheetPlaytime Homework Sheet

DateDate YesYes NoNo Any problems Any problems that came upthat came up

MondayMonday

TuesdayTuesday

WednesdayWednesday

ThursdayThursday

FridayFriday

SaturdaySaturday

SundaySunday

(Did you practice play therapy for five minutes?)

Session #3 –Session #3 – Coaching Behavioral Play Coaching Behavioral Play

Therapy SkillsTherapy SkillsCriteria for Mastery of Criteria for Mastery of

Behavioral Play Therapy SkillsBehavioral Play Therapy Skills

During five-minute play session:During five-minute play session: Give 25 to 50 descriptions plus reflectionsGive 25 to 50 descriptions plus reflections Reflect nearly all appropriate child verbalizationsReflect nearly all appropriate child verbalizations Give 15 or more praises, at least 8 of which are Give 15 or more praises, at least 8 of which are

labeled praiseslabeled praises Ignore all negative, attention-seeking behaviorsIgnore all negative, attention-seeking behaviors No critical statementsNo critical statements No commandsNo commands No questionsNo questions

Session #4 – Session #4 – Teaching Discipline SkillsTeaching Discipline Skills

Parents will teach their child to mind by Parents will teach their child to mind by establishing small minding goalsestablishing small minding goals While playing with toys, the parent gives the child While playing with toys, the parent gives the child

easy to follow instructions (e.g., put the eyes on easy to follow instructions (e.g., put the eyes on Mr. Potato Head, place a block on top of another)Mr. Potato Head, place a block on top of another)

The child receives praise and the opportunity to The child receives praise and the opportunity to continue playing if they follow instructions and a continue playing if they follow instructions and a negative consequence if they do not follow negative consequence if they do not follow instructionsinstructions

As small compliance goals are reached the As small compliance goals are reached the child is provided with more challenging tasks child is provided with more challenging tasks (e.g., doing things that they don’t want to do, (e.g., doing things that they don’t want to do, performing a boring or less interesting task)performing a boring or less interesting task)


Giving Effective InstructionsGiving Effective Instructions

Make commands Make commands direct, not indirectdirect, not indirect

Be polite and Be polite and respectful, while respectful, while still being directstill being direct

Use explanations Use explanations sparinglysparingly

Make commands Make commands single and small, not single and small, not compoundcompound

Save direct Save direct commands for commands for things you’re sure things you’re sure the child can dothe child can do

Always provide a Always provide a consequence for consequence for obedience and obedience and disobediencedisobedience

State commands State commands positively, tell child positively, tell child what to do, instead what to do, instead of what not to do of what not to do

Don’t give too many Don’t give too many direct commandsdirect commands

Use a neutral tone Use a neutral tone of voice, instead of of voice, instead of pleading or yellingpleading or yelling

Make commands Make commands specific, not vaguespecific, not vague

Use choice Use choice commands with commands with older preschoolersolder preschoolers


Key points to time-outKey points to time-out Avoid talking to the child on the way to Avoid talking to the child on the way to

time-out and any other verbalizations and time-out and any other verbalizations and other forms of attention while the child is other forms of attention while the child is in time-outin time-out

Time-out does not end until the original Time-out does not end until the original instruction is obeyedinstruction is obeyed

If child refuses to comply with original If child refuses to comply with original direction they will return to time-outdirection they will return to time-out

If child complies with the original direction If child complies with the original direction after going through time-out it is best for the after going through time-out it is best for the parent to simply acknowledge that the child parent to simply acknowledge that the child complied with the initial request and avoid complied with the initial request and avoid praising the childpraising the child

Session #5 – Session #5 – Coaching Discipline SkillsCoaching Discipline Skills

Combining play therapy and discipline Combining play therapy and discipline skillsskills After child has been praised for obeying first After child has been praised for obeying first

command, parents are instructed to return to command, parents are instructed to return to play therapy and avoid giving further play therapy and avoid giving further instructions for a few minutesinstructions for a few minutes

This play therapy serves to reinforce child for This play therapy serves to reinforce child for compliance, decrease anger from being compliance, decrease anger from being required to mind, and helps parents remain required to mind, and helps parents remain calmcalm

Every three to five minutes another Every three to five minutes another instruction is providedinstruction is provided

The parent is gradually given more The parent is gradually given more responsibility throughout the session and the responsibility throughout the session and the demands placed on the child are gradually demands placed on the child are gradually increasedincreased

Session #6 – Session #6 – Posttreatment Assessment Posttreatment Assessment

of of Child and FamilyChild and Family

To enhance long-term maintenance of To enhance long-term maintenance of parenting skills and child behavioral parenting skills and child behavioral improvements a schedule of booster improvements a schedule of booster sessions is developedsessions is developed Number and frequency of sessions depends on Number and frequency of sessions depends on

presence of family stressors, degree of family presence of family stressors, degree of family and community support for using PCIT skills, and community support for using PCIT skills, cognitive ability and psychological cognitive ability and psychological functioning of parent, level of posttreatment functioning of parent, level of posttreatment skills mastery, and parental dependency on skills mastery, and parental dependency on the therapistthe therapist

Usually recommended that families Usually recommended that families participate in 1 month, 3 month, 6 month, and participate in 1 month, 3 month, 6 month, and 1 year booster sessions1 year booster sessions

Documents

Parent Child Interaction Therapy (PCIT) Implementation Guidelines The Future of School Psychology Task Force on Family-School Partnerships Kathryn Woods,