What is Parent-Child Interaction Therapy (PCIT)?

Parents and their children may not always agree, but letting things get out of hand can result in a strained future relationship. Parents can help children unlearn destructive behaviors through parent-child interaction therapy while strengthening their relationships.

In this article, you’ll learn how parent-child interaction therapy works, what issues it can help address, and how to find the best PCIT therapist for your family.

What is Parent-Child Interaction Therapy?

Parent-child interaction therapy (PCIT) is an evidence-based, short-term program to improve relationships between parents and children. While a child therapist is present during the session, they typically observe interactions between parents and children without direct intervention. After the session, therapists provide parents with their observations and recommendations.

President and CEO of PCIT International, Dr. Sheila Eyberg, developed PCIT in the 1970s based on attachment theory research, parenting practices research, and social learning theory.

What Issues Can PCIT Help Address?

PCIT aims to address behavioral issues in young children. For example, it can reduce tantrums, hyperactivity symptoms, and undesired behaviors using various techniques [*].

This therapy also helps address parental frustration, assisting parents to become more patient and confident in guiding their children through stressful times.

PCIT can also address the following issues:

• Emotional dysregulation
• Low frustration tolerance and bad temper
• Being spiteful, vindictive, or unkind toward others
• Difficulties playing quietly, taking turns, or focusing on activities
• Rebellion or defiance
• Inability to be accountable for mistakes

Children who may benefit the most from PCIT are often diagnosed with the following conditions:

• Attention-deficit hyperactivity disorder (ADHD)
• Anxiety disorders
• Oppositional defiant disorder (ODD)
• Autism spectrum disorder (ASD)
• Disruptive behavior disorders (DBDs)
  

What Ages Benefit the Most from PCIT?

PCIT is most applicable to two age groups:

• Younger children between 2 and 7
• Older children between 7 and 11

The approach will depend on the child’s maturity level and the issues that need addressing. PCIT for younger children usually addresses issues like defiance, aggression, and the inability to follow the rules, whereas PCIT for older children adapts these techniques for a later developmental stage.

If your child is much older than 11, PCIT may not be the best option for them, as it relies on play-based techniques.

Older kids above 12 may require more sophisticated strategies, such as cognitive-behavioral therapy (CBT), which helps children develop insights into their thoughts and behaviors, or behavioral and emotional skills training (BEST), which is an intensive program in a group format.

What are the Two Phases of PCIT?

Because PCIT is a progressive treatment, it occurs in two stages. 

Child-Directed Interaction (CDI)

The first phase of PCIT involves child-directed interaction (CDI), in which parents and children focus on positive communication through PRIDE [*]. PRIDE entails the following therapeutic features:

• Praising the child for good behaviors and qualities
• Reflecting on what the child expressed during the session
• Imitating the child’s behavior
• Describing the child’s recent behaviors
• Enjoying the process

During the CDI phase, therapists encourage parents to use positive language and avoid negative talk during play.

CDI aims to implement positive parenting strategies, improve social skills, and increase self-esteem.

Parent-Directed Interaction (PDI)

As children and parents master their skills from CDI, they move on to parent-directed interaction (PDI). This phase of PCIT teaches children to behave better and obey reasonable requests from their parents.

Therapists will provide parents with tips and techniques for remaining calm when their children display unruly behavior and guide them through corrections. Parents will also learn to determine the appropriate consequences for misbehavior while keeping their children motivated.

PDI aims to increase a child’s general compliance, reduce problematic behaviors, and improve a parent’s confidence in their parenting skills.

How Long Does PCIT Take to Work?

PCIT sessions occur weekly and take 14 to 20 coaching sessions to complete [*]. How quickly (or slowly) PCIT becomes effective depends on the parent’s commitment level and how often they practice skills they learn from sessions.

Parents and children “graduate” from PCIT when they master CDI and PDI skills and when children demonstrate “normal” behavior. Therapists should be confident that parents can continue to use PCIT skills in real-life situations over the long term.

How Effective is Parent-Child Interaction Therapy?

Research shows that PCIT can be incredibly effective in correcting disruptive behaviors and treating emotional issues in children [*]. PCIT has also delivered positive outcomes in child welfare settings, as some therapists have applied it to foster homes and domestic violence shelters.

Since being adapted for different age groups and family backgrounds, PCIT has also become practical for non-parental caregivers. However, it’s essential to note that PCIT research is limited, so you should study your options in-depth before diving straight into therapy.

What to Look for in a Parent-Child Interaction Therapist

PCIT International has a comprehensive directory of certified PCIT therapists—this is the best place to look when finding a specialist. Through PCIT International, parents and caregivers can connect with therapists based on their geographic location and specific needs. You can still have PCIT sessions through telehealth options if you don't live near a provider.

So, you’ve matched up with a PCIT therapist—how do you know they’re good at what they do? A reliable PCIT therapist should have the following characteristics:

• Vast communication skills. Children may struggle to communicate verbally, especially at a young age, so a good PCIT therapist should understand non-verbal communication. They must know how to adapt their therapeutic styles according to a child’s responses and body language.
• Resilience. Like parents, PCIT therapists should be flexible and know how best to adjust to a child’s learning curve and specific behaviors. They should be comfortable pivoting when children display specific behavioral challenges.
• The right amount of playfulness. For PCIT to be effective, it should be fun! A good PCIT therapist understands that play is part of the “language of children.” Encouraging play can increase dopamine levels and help children with emotion regulation, which both play a significant role in the healing journey.
  

The Bottom Line

Overall, parent-child interaction therapy is an excellent tool for reducing atypical behaviors in children and helping parents improve their caregiving skills. However, mastering CDI and PDI takes time, so be patient and stay committed!

In the meantime, we encourage parents to explore our collection of worksheets to find activities to improve their child’s healthy habits and emotional management.

Sources:

1. Zimmer-Gembeck MJ, Kerin JL, Webb HJ, et al. “Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy.” Behavior Therapy, 2018.
2. Sehli A, Helou M, Sultan MA. “The Efficacy of Parent-Child Interaction Therapy (PCIT) in Children with Attention Problems, Hyperactivity, and Impulsivity in Dubai.” Case Reports in Psychiatry, 2021.
3. Thomas R, Abell B, Webb HJ, Elbina Avdagic, Zimmer-Gembeck MJ. “Parent-Child Interaction Therapy: A Meta-analysis.” PEDIATRICS, 2017.
4. Lieneman C, Brabson L, Highlander A, Wallace N, McNeil C. “Parent-Child Interaction Therapy: current perspectives.” Psychology Research and Behavior Management, 2017.