parent-child interaction therapy courtney ingalls, ms university of florida
TRANSCRIPT
Parent-Child Interaction Therapy
Courtney Ingalls, MS
University of Florida
Parent-Child Interaction Therapy (PCIT)
• Designed for young children (3-6) and their parents/caretakers
• Work with parents and child together
• Live coaching of skills• Emphasis on restructuring parent-
child interaction patterns
What families might benefit from PCIT?
• Children with conduct problem behavior
• Preschool age (3-6)• At least one parent able to attend
weekly sessions with child• Parent(s) willing to practice skills
at home
Child-Directed Interaction
Parent-Directed Interaction
Parents follow
Play therapy skills Differential attention Increase warmth of
parent-child relationship
Parents lead
Limit-settingConsistency Predictability Follow through
Structure of PCIT• Assessment
– Measures that guide treatment• Parent Report
• Observation
Parent Negative Behavior
• Critical Talk
• Smart Talk
• Yell
• Physical Negative
Child Negative Behavior
• Critical Talk
• Smart Talk
• Yell
• Physical Negative
• Whine
• Non-Compliance
Child: (Hits parent) physical negativeParent: You’re mean critical talkChild: AHHHHHHHH yell
DPICSDyadic Parent-Child Interaction Coding
System
Structure of PCIT• Assessment
– Measures that guide treatment
• Teaching sessions– Presentation of skills
– Modeling and role-playing
• Coaching sessions– Check in
– Therapist codes and coaches
– Assign homework
How does coaching work?
• Parent wears a Bug-in-the-Ear receiver while playing with child in playroom (therapist can coach while in the room with the parent)
•Therapist coaches specific skills
•Spouses take turns playing and observing
What families might benefit from PCIT?
• Children with conduct problem behavior
• Preschool age (3-6)• At least one parent able to
attend weekly sessions with child
• Parent(s) willing to practice skills at home
Effectiveness of PCIT
Effect Size Interpretations
• Small = 0.20 - 0.40• Medium = 0.40 - 0.60• Large = 0.60 - 0.80• Very large = 0.80 – 1.00• Astronomical = >
1.00
Child Problem Behavior
and 2-Year Effect Size
178
104112
121
80
100
120
140
160
180
200
Pre Post 1 Year 2 Year
Inte
nsi
ty S
core
2.32
Eyberg et al.
Eyberg Child Behavior InventoryWeekly Intensity Score
90
100
110
120
130
140
150
160
170
1 3 5 7 9 11 13 15 17 19 21 23 25
Dropouts (n = 36)
All combined(n = 99)
Normative mean
Clinicalcutoff
Criterionto end treatment
Completers (n = 63)
Child Complianceand 2 Year Effect Size
50
60
70
80
90
100
Pre Post 1 Year 2 Year
Per
cen
t
.85
Eyberg et al.
School Observation Coding System Compliance
40
50
60
70
80
90
100
Pre Post 12 Mo 18 Mo
Per
cen
t o
f C
om
man
ds
Ob
eyed
Funderburk et al., 1998
Child Deviant Behavior Composite
and 2 Year Effect Size
0
10
20
30
40
50
60
Pre Post 1 Year 2 Year
Fre
qu
ency
in
30
Min
ute
s
.54
Eyberg et al.
DPICS Parent Verbal and Physical
Negative
0
5
10
15
20
25
30
35
40
Pre Post 1 Year 2 Year
Fre
qu
ency
in
30
Min
ute
s
1.11
Eyberg et al.
Child-Directed Interaction
CDI
CDIThe Basic Rule
Follow the Child’s Lead
CDI: The DON’T Rules
• No commands• No questions• No criticism
Direct : Sit here
Indirect : Could you sit here?
• Commands attempt to lead
• Risk negative interaction
No Commands
CDI: The DON’T Rules
Questions ask for an answer
• Often hidden commands
• Take lead from the child
• Can suggest disapproval
• Can suggest not listening
No Questions
CDI: The DON’T Rules
• Examples
You’re a bad girl That doesn’t go that way No Stop Quit Don’t
Points out mistakes rather than correcting them
“That’s wrong” is a criticism
“It goes like this” allows correction without criticism
• Lowers self-esteem
• Creates unpleasant interaction
No CriticismCDI: The DON’T Rules
What’s left?
CDI: The DO Rules The PRIDE Skills
PraiseReflect ImitateDescribeEnthusiasm!
PraiseUnlabeled praise is nonspecific
– Good!
– That's great!
Labeled praise tells child specifically what is good
– Thank you for sitting so quietly.
• Increases the specific behavior
• Increases child's self-esteem
• Increases positive parent-child interaction
CDI: The DO Rules
Reflection
“The moo-moo is in the barn.”“Yes, the cow is in the barn.”
• Allows child to lead the conversation
• Shows that parent is listening
• Shows that parent understands
• Improves and increases child’s speech
Child
Parent
• Repeating or paraphrasing
CDI: The DO Rules
Imitation Doing the same thing the child is doing
Lets the child lead Teaches parent how to “play” Shows approval of child’s activity Teaches child how to play with others
– Sharing– Taking turns
CDI: The DO Rules
Description• Telling the child exactly what he or she
is doing– “You’re drawing a sun.”
• Lets the child lead• Lets child know you are paying
attention and are interested• Shows approval of child’s activity• Models speech• Teaches vocabulary and concepts• Holds child’s attention to the task
CDI: The DO Rules
Enthusiasm• Conveying excitement by voice and gesture
– “Wow!! You finished that SO quickly!”• Lets the child know the parent enjoys being
with the child
• Makes the play more fun for the child (and parent)
• Adds a quality of warmth to the interaction
CDI: The DO Rules
IGNORE annoying, obnoxious IGNORE annoying, obnoxious behaviorbehavior
STOP THE PLAY for STOP THE PLAY for dangerous or destructive dangerous or destructive behaviorbehavior
Child-Directed Child-Directed InteractionInteraction
DON’TDON’T– Give Give
CommandsCommands– Ask QuestionsAsk Questions– CriticizeCriticize
DODO– PraisePraise– ReflectReflect– ImitateImitate– DescribeDescribe EnthusiasmEnthusiasm
“Special time” 5 minutes a day Practice, play, and therapy
Homework
Homework
Good activities:
Toys with no rules
Construction toys
Play sets
Creative Toys
Not-so-good activities:
Board games
Messy activities (like fingerpaint)
Aggressive toys (like guns or action figures)
Pretend-talk toys
COACHING
Why Coach?– Parents think they already do these
things
– Verbal habits are ingrained
– Coaching (therapist feedback) makes parents aware of what they say
– Coaching (child’s feedback) makes parents aware of the immediate effects
– Coaching heightens parent’s attention and motivation
Why Coach?– Coaching provides parent support in
actual difficult situations
– Coaching demonstrates to parents (convinces parents) that change is possible
– Coaching can help parents not to give up
– Coaching is efficient -- makes it possible to address relevant problem areas and not spend time on areas that are not problems
Parent-Directed Interaction
PDI: Effective Commands• Direct (telling, not asking)
• Positive (what to DO, not stop doing)
• Single (one at a time)
• Specific (not vague)
• Age-appropriate
• Given in a normal tone of voice
• Polite and respectful (Please... )
• Explained before given or after obeyed
• Used only when really necessary
The Command ...
Command
No Opportunity
Whoops!(Start over)
Obey
Labeled Praise
Disobey
Back to PlayYEA!
Back to PlayYEA!
Labeled Praise
The Warning ...
Obey Disobey(UH-OH!)
If you don’t [original command], you’ll have to go to the time out chair
The Chair
Are you ready to [obey original command]?
Child stays on chair 3 min plus 5 sec quiet
Or doesn’t(OH-OH!)
ObeyAcknowledge
The Chair
Command
No
BACK TO CHAIR
CHILD GOES TOTIME OUT ROOM1 MIN + QUIET
CHILD GETS OFF CHAIR
CHILD GETS OFF AGAIN
The Backup
ROOM WARNING “You got off the chair before
I said you could.If you get off again,
you’ll go to the Time Out Room .”
Yes
Are you ready to [Obey Original Command]?
Obey
Acknowledge
The First ObeyChild Stays
on Chair 3 Min plus 5 Sec Quiet
No
Praise
Obey
Back to play!!!
Finally!Command
Further Information…
• PCIT website: www.pcit.org– Literature– Measures– Other material
Questions?