Parent-Child Interaction Therapy (PCIT)
Do you have a young child who is struggling? Are you noticing your stress level rising, as your child is facing more and more difficulty dealing with big emotions and challenging behaviors? If you feel like you've tried everything but nothing seems to work, Parent-Child Interaction Therapy (often called PCIT), might be the solution you're looking for. In this blog post, we'll explore what this therapy is, how it works, and what makes it so effective at improving behavior and family relationships. If you're ready to learn about an evidence-based option recommended by pediatricians, psychologists, and child therapists, keep reading.
What is Parent-Child Interaction Therapy (PCIT)?
Parent-Child Interaction Therapy (PCIT) is an evidence-based therapeutic intervention geared towards children approximately two through seven years old and their parents. The model involves parent education and coaching as well as one-on-one play between caregivers and their children. It has been practiced for decades and draws on several established theories, such as attachment theory, behavioral theory, and social learning theory. PCIT has two phases. The first phase emphasizes parents learning particular skills to positively engage their children, fostering trust and healthy communication. The second focuses on consistency and fairness to set children up for success in following directions. In both phases, therapists provide supportive, live coaching so that parents can receive immediate feedback about whatever is happening during the play. This therapy can be done in a traditional office setting, or through telehealth.
What does PCIT help with?
Therapists use PCIT to support families with a wide range of goals. It can be used to address concerns in children like:
Aggression (physical or verbal)
Poor impulse control
Fighting with siblings or peers
PCIT can also help with relational or communication challenges between parents and children, and may be appropriate for children who are experiencing trauma symptoms due a major life change or stressor. Although an
existing diagnosis is not necessary, Kurtz Psychology explains that many children in PCIT have been diagnosed with ADHD, ODD, disruptive behavior disorders, and anxiety disorders.
What are the benefits of PCIT?
While managing behavior challenges is perhaps the most common reason that caregivers seek PCIT, the therapy ultimately strengthens the parent-child relationship, which is beneficial for far more than just difficult behaviors. In PCIT, parents learn numerous positive parenting skills and receive real-time feedback from a therapist. The consistency, predictability, and warm interactions that PCIT offers families can increase emotional regulation in both parents and children. PCIT can help children adjust to big changes, and build their self-confidence. Upon completing PCIT, children are likely to demonstrate greater skill in listening, following directions, cooperating with others, controlling impulses, and expressing themselves in healthy ways. PCIT has also been shown to improve kids’ vocabularies and social-emotional skills, which can help them succeed not only in family functioning, but also in friendships and at school. Parents who complete PCIT with their children report less stress, which in turn can improve the entire family’s wellbeing.
How does PCIT work?
In PCIT, caregivers learn specific parenting skills from a therapist that are known to enhance the parent-child relationship and secure attachment. The skills also set children up for success with following directions and trusting their caregivers to hold fair, but firm boundaries. Every skill that parents implement has a therapeutic purpose both for themselves, and for their child’s wellbeing. Parents practice the skills they’re taught in session as they play with their child, while their therapist observes and provides feedback and coaching. During this time, children are able to take the lead, be creative, and express themselves through both play and verbal exchanges with their caregiver. A brief part of the session is typically coded by the therapist, so that they and the family can track progress from week to week. Additionally, parents will complete a questionnaire at each session, so that their therapist can understand how their child is doing, and what changes are taking place. Between sessions, parents have one-on-one play time with their child to continue building their familiarity with the skills, and to create a routine at home that is predictable and consistent.
Is PCIT play therapy?
PCIT involves a significant amount of play time, as play is an important way that young children learn, build relationships, and express themselves. There are multiple forms of play therapy, but when people refer to this modality, they are typically referring to a model that involves non-directive play and sessions that mostly take place with a therapist and a child. PCIT involves more structured sessions, and most of the session is spent with parents and children interacting, with the therapist interacting primarily with caregivers. Some licensed mental health professionals may be certified in PCIT, while others are registered play therapists (RPTs), and some have training in each modality. Both designations require therapists to have a master’s degree or higher and a license in their respective field.
What makes PCIT different from other kinds of therapy for kids and family?
Many therapy modalities exist to support children and families, however, not all of them center the caregiver-child relationship as the therapeutic means of change, and few were designed specifically with young children in mind. PCIT combines non-directive and directive elements, meaning that while much of the therapy sessions involve freeform play that encourages children to express themselves and explore safely, there are also elements, such as live parent coaching, that are more structured.
Why did my pediatrician, friend, etc. recommend PCIT?
Someone in your life may have recommended PCIT if you have a child that falls into the ideal age range for PCIT, which is about 2-7 years old. They might have suggested PCIT if your family is navigating a significant life change or stressor, such as a new baby in the home, or your preschooler transitioning to kindergarten. Or, you may have indicated that you’re looking for support with a challenging behavior your child has been demonstrating, such such as tantrums, bedtime resistance, aggression, or arguing. Because of the robust evidence that PCIT results are significant and reliable, your pediatrician or personal therapist may have been more likely to recommend it than options with less research behind them.
Will my child be a good fit for PCIT?
The best way to determine if you and your child are a fit for PCIT is to speak to a therapist. They may consult with you by phone before making an appointment, or have you complete an intake process to learn more about your situation and needs. Typically, PCIT is for children in the 2-7 age range, but adaptations of PCIT are sometimes available for older children.
What if my child has a unique need, like a neurodevelopmental disorder?
Many children with a diagnosis of autism spectrum disorder (ASD), intellectual disability, or communication difficulties are able to participate in and benefit significantly from PCIT. Of course, every child and family has different strengths and needs. Speaking to a therapist about your goals and your child’s functioning in various areas will allow them to determine an appropriate therapy modality and treatment plan.
I’m sold! What do I need to participate?
The most important thing you will need is motivation! Families involved in PCIT typically attend one weekly session, with a few minutes of one-on-one play time each day between sessions. Depending on your other time commitments and the location of your therapist, this may be a challenge. Keep in mind that you could actually end up gaining time back in your day, if you are no longer managing lengthy tantrums or arguments with your child.
Your daily playtime will require toys that allow for open-ended, creative, and safe play. Your therapist can make specific recommendations based on your specific goals, concerns, and the toys you have at home. Typically, parents have plenty of toys at home that meet the PCIT guidelines. Some recommended toys include blocks, magnetic tiles, stuffed animals, play food, train sets, and toy farms.
If you are participating in PCIT via telehealth, you will likely need headphones that allow you to play comfortably and move freely while hearing your therapist’s coaching. Therapists offering PCIT in an office setting will likely have equipment for you.
My child already receives speech therapy or occupational therapy (OT), can they still try PCIT?
The short answer is absolutely yes! Sometimes, a certain method suggested by one provider won’t match up completely with the method from another one. That is okay! They may serve different purposes and be needed in different contexts.
Share with any/all of your child’s providers what therapies you are involved in, and consider having them communicate directly with each other so that their efforts can be aligned. Talk to your providers about what documentation you need for them to be able to communicate with each other. They will be able to support your family best if they are informed.
How do I find someone who offers PCIT?
You can refer to the map on the PCIT International website that shows where certified PCIT therapists are located. Some therapists practice PCIT with various levels of training, but have not completed the full certification process.
What does it mean for someone to be certified in PCIT?
If a therapist is PCIT certified, this means that they have gone through a series of steps to ensure that the way they conduct sessions is aligned with the official PCIT manual and principles, meeting particular standards to be as effective as possible for families. These steps include extensive didactic training, having PCIT sessions observed by a trainer, receiving personalized feedback from their assigned trainer, coaching at least two families from the first PCIT session all the way through the graduation session, and passing PCIT International’s certification exam. A therapist cannot claim to be certified until all of these steps are completed, so note that you can find therapists with years of experience in PCIT who are well on their way to certification, just not totally done yet!
What is the evidence behind PCIT?
Decades of research has consistently demonstrated that PCIT has measurable, positive effects on those that complete treatment. Studies have been conducted all over the world, exploring PCIT’s impact on families with different cultures, identities, languages of origin, values, and goals. Hundreds of articles on PCIT have been published, but a few key findings can be found at the links below.
Parent-Child Interaction Therapy: Current Perspectives (National Library of Medicine)
Parent-Child Interaction Therapy for Disruptive Behaviour Disorders: A Meta-analysis (Child Youth Care Forum)
Additionally, the University of California - Davis has assembled its own resource page of PCIT research.