Professional help is often sought by parents who are experiencing difficulty managing their young children’s externalizing behaviors such as extreme tantrums and aggression1. In many behavior management programs, the parents are trained as behavior therapists for their own children2.
One well-established child behavior therapy approach has been to work with parents in groups. As part of the training, parents typically receive lectures, discussions, and reading assignments. They observe their children’s behavior at home, record it, and then present their findings to the therapists.
This group treatment approach encourages mutual sharing and feedback in a non-threatening environment and utilizes professional time efficiently. However, researchers often found little or no difference in outcomes using this type of treatment program.
In 1969, Hanf presented a new type of parenting training that consisted of two stages, labeled the Child’s Game and Parent’s Game3.
Instead of working in groups, this model of intervention involved working directly with parent-child pairs, modeling in practice, and providing immediate feedback to parents.
To assess treatment effects adequately, this training includes parent-reports as well as therapist observation4.
Since then, this model of behavioral intervention has been widely used to treat behavior problems in children. It was also modified to be used in treating a broad range of childhood disorders such as defiant disorder and conduct disorder5.
In the 1970s, Sheila Eyberg adapted this model into Parent-Child Interaction Therapy (PCIT) for families with children showing disruptive behaviors6.
What is PCIT therapy
Parent-child interaction therapy is a behavioral parent training that uses a two-stage approach – parent-directed interaction and child-directed interaction. Based on social learning and attachment theories, it aims to reduce externalizing behaviors in children by improving parenting skills and the quality of parent-child interaction.
How does PCIT work
There are two sequential stages in PCIT: child-directed interaction (CDI) and parent-directed interaction (PDI). In each stage, parents receive teaching sessions to learn relevant skills, followed by coaching sessions.
During the teaching sessions, the therapist shows the parent how to interact with their child by using descriptions and modeling.
Coaching sessions involve the therapist observing the parent-child dyad in the playroom and coaching the parent to respond positively, consistently, and predictably to the child’s behavior. The parent is also provided with immediate feedback and assistance in improving interaction skills.
Child-directed interaction CDI
During the child-directed interaction, the parent practices positive communication skills in order to restore positive feelings and foster close parent-child relationships.
In this phase of treatment, parents follow their children’s lead. They learn to reinforce their child’s positive behavior by giving them positive attention and ignoring their minor negative behavior.
To reinforce positive and appropriate behavior, the parent is taught the PRIDE skills – Praise, Reflection, Imitation, Description, and Enthusiasm.
In addition, they learn to avoid leading or intrusive behavior such as commands, questions, criticisms, sarcasm, and negative physical behavior during interactions with children7.
Parent-directed interaction PDI
During parent-directed interaction, the parent learns to increase prosocial behavior and decrease inappropriate behavior in children that are too harmful to be ignored.
The parent plays the role of a behavior therapist by leading the child’s activity. They learn to give clear and effective instructions by providing consistent consequences, such as praise for compliance and time out for non-compliance.
The parent is further asked to practice in the daily 5-minute parent-child play interaction8.
Is it effective
Studies show that parent-child interaction training results in a marked decrease in child behavior problems and negative parent behavior. The lives of children and families are improved as a result.
In addition to fewer home problems, parents reported a more positive attitude toward their children. They expressed high satisfaction with the parenting training program, believing their child’s behavior had improved directly as a result of it.
In the dyadic parent training, observation and immediate feedback worked better than self-reporting in group settings and feedback on self-reporting.
The positive changes in parent behavior and reduction in negative parenting practices also contributed to children retaining their prosocial behaviors.
Additionally, the parents were more satisfied (and reinforced) with relatively short treatment sessions in which they and their children received exclusive personal attention than they would with longer therapist contact in a less personally relevant group setting.
Overall, researchers found robust declines in children’s externalizing behavior and self-reported parenting stress. Outcomes of parent-child interaction therapy included more positive interaction and better relationships between parents and children compared with traditional behavior therapy9.
- 1.Thomas R, Abell B, Webb HJ, Avdagic E, Zimmer-Gembeck MJ. Parent-Child Interaction Therapy: A Meta-analysis. Pediatrics. Published online September 1, 2017. doi:10.1542/peds.2017-0352
- 2.Berkowitz BP, Graziano AM. Training parents as behavior therapists: A review. Behaviour Research and Therapy. Published online November 1972:297-317. doi:10.1016/0005-7967(72)90054-x
- 3.Hanf C. A two stage program for modifying maternal controlling during mother-child (MC) interaction. Presented at: Western Psychological Association Meeting; 1969; Vancouver, BC.
- 4.O’Dell S. Training parents in behavior modification: A review. Psychological Bulletin. Published online 1974:418-433. doi:10.1037/h0036545
- 5.Forehand R, King HE. Noncompliant Children. Behav Modif. Published online January 1977:93-108. doi:10.1177/014544557711006
- 6.Eyberg SM, Robinson EA. Parent‐child interaction training: Effects on family functioning. Journal of Clinical Child Psychology. Published online June 1982:130-137. doi:10.1080/15374418209533076
- 7.Funderburk BW, Eyberg S. Parent–child interaction therapy. History of psychotherapy: Continuity and change (2nd ed).:415-420. doi:10.1037/12353-021
- 8.Eyberg SM, Matarazzo RG. Training parents as therapists: A comparison between individual parent-child interaction training and parent group didactic training. J Clin Psychol. Published online April 1980:492-499. doi:10.1002/jclp.6120360218
- 9.Leung C, Tsang S, Sin TCS, Choi S yan. The Efficacy of Parent–Child Interaction Therapy With Chinese Families. Research on Social Work Practice. Published online January 16, 2014:117-128. doi:10.1177/1049731513519827
- 10.Schuhmann EM, Foote RC, Eyberg SM, Boggs SR, Algina J. Efficacy of Parent-Child Interaction Therapy: Interim Report of a Randomized Trial with Short-Term Maintenance. Journal of Clinical Child Psychology. Published online March 1998:34-45. doi:10.1207/s15374424jccp2701_4