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What is Parent-Child Interaction Therapy, Anyways?

Parent-Child Interaction Therapy as a Therapeutic Approach

There are lots of different therapists, with lots of different approaches to managing lots of different problems in childhood, from social skills, to anger management, to anxiety and depression, to issues of abuse and neglect. Different approaches to therapy have different levels of research backing their effectiveness for different childhood problems. Not all therapeutic approaches are right for all problems or for all children or families. If you are searching for a therapist to help you manage your child's challenges, do your homework and make sure you know what type of therapy is the most effective, and what types of therapy that different Counsellors or Psychologists provide. Although this might take a bit of time in the beginning, it's well worth the effort to ensure your child is receiving the best support possible. Don't be afraid to discuss this with your therapist, either. Any good therapist will be more than willing to explain their approach, the reasoning and research behind it, and the benefits as well as the challenges or drawbacks of that particular approach. Parent-child interaction therapy (or PCIT, for short) is one approach to therapy, which specifically addresses the problems of behavioural difficulties in young children, and challenging parent-child relationships.

Not all Parent-Child Interaction Therapy is Created Equal...

Although many therapists claim to offer "parent-child interaction therapy" in their Canadian practices, the vast majority are simply referring to the fact that they work on the parent-child relationship, or with parents and children together. They have not necessarily actually been trained and certified in providing Parent-Child Interaction Therapy or practice this therapy in ways that are consistent with the research on PCIT. Make sure, if you are specifically seeking out PCIT, that you ask your therapist if he or she has been trained and certified in this particular therapeutic modality. If not, you may wish to gain more clarity around what approach it is that they do offer, and how they work with you and/or your child to address your child's presenting concerns.

The Parent-Child Interaction Therapy Process

In its very basic form, PCIT is a play-based therapeutic approach to addressing disruptive behaviour problems in children ages 2-7 years old. To help you gain a better understanding of what PCIT is, it is important to understand that there is a specific approach and process to PCIT which all PCIT-trained and certified practitioners must follow in order to maintain the efficacy of this therapeutic approach. PCIT consists of an initial intake and observation assessment, in order to ensure that this approach to therapy is appropriate for you and your child, and assessments of progress is carefully collected at each and every session, to ensure that your child and families' individual needs are being addressed appropriately at every step along the therapeutic process. After goodness of fit is ensured, the child and the child's caregiver(s) will work through two consecutive phases of treatment.

Phase 1: Child-Directed Interaction

The first phase of therapy involves child-directed play interactions, and serves as an underlying basis for progression to the next phase of treatment. During this phase of treatment, parents learn the basic principles of differential reinforcement - that is, effective ways of demonstrating positive attention to the behaviours they wish to see more of, and ignoring or redirecting the behaviours they wish to decrease. Children lead play activities in the therapeutic setting, and parents practice the skills they have learned, with the assistance of the therapist who coaches them throughout each session. During this phase, there is an increase in positive interactions and the parent-child relationship is enhanced, resulting in a reduction in the frequency and intensity of behaviour problems. Once parents have mastered the skills in the CDI phase, they move on to the second phase of treatment.

Phase 2: Parent-Directed Interaction

The second phase of therapy involves parent-directed interactions. With the mastery of skills aimed at improving attachment and enhancing relationship of the parent and child, they are ready to move on to the more challenging skills of improving compliance and follow through. During this second phase of treatment, parents learn how to effectively give commands so that their child will listen and follow expectations, rules, and directions. Parents also learn effective ways of dealing with their child's noncompliance and misbehaviour. Parents lead play activities in the therapeutic setting, and practice the skills they have learned with the assistance of the therapist. The therapist assists parents throughout each session by offering insight and direct instruction and support implementing the skills in the moment. During this phase, parents become increasingly effective in their ability to effectively and consistently give commands and follow through with expectations. By the time parents meet mastery of this phase, not only is their child's misbehaviour reduced to that of a typical child, but parents are significantly more effective and confident in managing their child's misbehaviour when it does happen.

Length and Effectiveness of Parent-Child Interaction Therapy

PCIT takes, on average, 14 sessions to complete, and because the parent is learning the skills and implementing them directly with the child in the treatment process, results not only benefit the child in treatment, but parents also report significant improvements within their relationships to the other children within the home as well. PCIT has been found to be a particularly effective approach for treating children with ODD, ADHD, separation anxiety, and as a preventative measure, and results are similar across several diverse cultural groups. Furthermore, treatment results carry over to the classroom, and research looking at whether results remained long-term, found that even 6 years after treatment, the children who participated in PCIT to completion still had behaviours within the normal range. PCIT is not a new trend, or the latest program, but rather, has been backed by several research studies dating back to the 1980's, and is still a very popular and effective approach to managing children's behaviour problems to date, and is used by therapists across the globe. Unfortunately, for whatever reason, Canadians seem to be behind the ball in this therapeutic approach. If you are living in or around Medicine Hat, and would like to discuss whether Parent-Child Interaction Therapy is right for your child and your family, please see more on the PCIT services I offer. Or, if you would like more information on PCIT in general, please visit the PCIT website.