Parent Child Interaction Technique PCIT07.ppt

parenting

1. Parent-Child
Interaction Therapy
Courtney Ingalls, MS
University of Florida

2. 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

3. 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

4. Child-Directed
Interaction
Parent-Directed
Interaction
Parents follow
Play therapy skills
Differential attention
Increase warmth of
parent-child relationship
Parents lead
Limit-setting
Consistency
Predictability
Follow through

5. Structure of PCIT
•Assessment
–Measures that guide treatment
•Parent Report
•Observation

6. 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 negative
Parent: You’re mean critical talk
Child: AHHHHHHHH yell
DPICS
Dyadic Parent-Child Interaction Coding System

7. 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

8. How does coaching work?
•Parent wears a Bug-in-the-Ear
receiver while playing with childin
playroom (therapist can coach
while in the room with the
parent)
•Therapist coaches specific skills
•Spouses take turns playing and observing

9. 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

10. Effectiveness of
PCIT

11. 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

12. Child Problem Behavior
and 2-Year Effect Size178
104
112
121
80
100
120
140
160
180
200
Pre Post 1 Year2 Year
Intensity Score
2.32
Eyberg et al.

13. Eyberg Child Behavior Inventory
Weekly Intensity Score90
100
110
120
130
140
150
160
170
135791113151719212325
Dropouts
(n = 36)
All combined
(n = 99)
Normative
mean
Clinical
cutoff
Criterion
to end
treatment
Completers
(n = 63)

14. Child Compliance
and 2 Year Effect Size50
60
70
80
90
100
Pre Post 1 Year 2 Year
Percent
.85
Eyberg et al.

15. School Observation Coding System
Compliance40
50
60
70
80
90
100
Pre Post 12 Mo 18 Mo
Percent of Commands Obeyed
Funderburk et al., 1998

16. Child Deviant Behavior Composite
and 2 Year Effect Size0
10
20
30
40
50
60
Pre Post 1 Year 2 Year
Frequency in 30 Minutes
.54
Eyberg et al.

17. DPICS Parent Verbal
and Physical Negative0
5
10
15
20
25
30
35
40
Pre Post 1 Year 2 Year
Frequency in 30 Minutes
1.11
Eyberg et al.

18. Child-Directed Interaction
CDI

19. CDI
The Basic Rule
Follow the Child’s Lead

20. CDI: The
DON’T Rules
•No commands
•No questions
•No criticism

21. Direct :Sit here
Indirect :Could you sit here?
•Commands attempt to lead
•Risk negative interaction
No Commands
CDI: The
DON’T Rules

22. 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

23. •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 Criticism
CDI: The DON’T Rules

25. CDI: The DO Rules
The PRIDE Skills
Praise
Reflect
Imitate
Describe
Enthusiasm!

26. Praise
Unlabeledpraise is nonspecific
–Good!
–That's great!
Labeledpraise 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

27. 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
•Repeating or paraphrasing
CDI: The DO Rules

28. 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

29. 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

30. 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

31. IGNORE annoying, obnoxious
behavior
STOP THE PLAY for dangerous
or destructive behavior
Child-Directed
Interaction
DON’T
–Give Commands
–Ask Questions
–Criticize
DO
–Praise
–Reflect
–Imitate
–Describe
Enthusiasm

32. “Special time”
5 minutes a day
Practice, play, and therapy
Homework

33. 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

35. COACHING

36. 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

37. Why Coach?
–Coaching providesparent 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

38. Parent-Directed Interaction

39. 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 beforegiven or afterobeyed
•Used only when really necessary

40. The Command ...
Command
No Opportunity
Whoops!
(Start over)
Obey
Labeled
Praise
Disobey
Back to Play
YEA!

41. Back to Play
YEA!
Labeled Praise
The Warning ...
Obey Disobey
(UH-OH!)
If you don’t [original command],
you’ll have to go to the time out chair

42. TheChair

43. Are you ready to
[obey original command]?
Child stays on chair
3 min plus 5 sec quiet
Or doesn’t
(OH-OH!)
Obey
Acknowledge
TheChair
Command
No

44. BACK TO CHAIR
CHILD GOES TO
TIME OUT ROOM
1 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 .”

45. Yes
Are you ready to
[Obey Original Command]?
Obey
Acknowledge
The First Obey
Child Stays
on Chair
3 Min plus 5 Sec Quiet
No

46. Praise
Obey
Back to play!!!
Finally!
Command

47. Further Information…
•PCIT website: www.pcit.org
–Literature
–Measures
–Other material

48. Questions?