1. Parent Child Interaction Therapy (PCIT) Implementation Guidelines The Future of School Psychology Task Force on Family-School Partnerships Kathryn Woods, Stephanie Bieltz, and Amanda Clinton

2. Factors Influencing the Effectiveness of PCIT Parents: Parents: Average or High IQ Average or High IQ Strong Motivation Strong Motivation Child: Child: Ages between 2 and 7 Ages between 2 and 7 Good Receptive Language Skills Good Receptive Language Skills Family: Family: Good Marital Adjustment Good Marital Adjustment Extended Family Support Extended Family Support

3. Presenting Problems That May Be Addressed Using PCIT Noncompliance Noncompliance Verbal Aggression Verbal Aggression Physical Aggression Physical Aggression Hyperactivity Hyperactivity Stealing Stealing Lying Lying Destructive Behavior Destructive Behavior Self-Injurious Behavior Self-Injurious Behavior Whining Whining Classroom Conduct Problems Low Self-Esteem Sad Mood Perfectionism Developmental Delays Anxiety Postdivorce Adjustment Bonding in Blended Families

4. Steps in PCIT Step 1: Pretreatment Assessment of Child and Family Functioning and Feedback Step 1: Pretreatment Assessment of Child and Family Functioning and Feedback Step 2: Teaching Behavioral Play Therapy Skills Step 2: Teaching Behavioral Play Therapy Skills Step 3: Coaching Behavioral Play Therapy Skills Step 3: Coaching Behavioral Play Therapy Skills Step 4: Teaching Discipline Skills Step 4: Teaching Discipline Skills

5. Steps in PCIT cont. Step 5: Coaching Discipline Skills Step 5: Coaching Discipline Skills Step 6: Posttreatment Assessment of Child and Family Functioning and Feedback Step 6: Posttreatment Assessment of Child and Family Functioning and Feedback Step 7: Boosters Step 7: Boosters (Information on steps and session content gathered from Hembree-Kigin & McNeil, 1995)

6. Session #1 - Intake Children are encouraged to play in the room during the interview. Parents are told that the therapist will be watching during this time and the parents are to manage the child’s behavior as they would normally Children are encouraged to play in the room during the interview. Parents are told that the therapist will be watching during this time and the parents are to manage the child’s behavior as they would normally Therapists are paying attention to how the child plays independently, strategies the child uses to get the parent’s attention, parental responsivity to child overtures, parental limit-setting, warmth of parent-child interactions, and evidence of clinging and/or separation anxiety Therapists are paying attention to how the child plays independently, strategies the child uses to get the parent’s attention, parental responsivity to child overtures, parental limit-setting, warmth of parent-child interactions, and evidence of clinging and/or separation anxiety Therapists do not intervene during this time but encourage the parents to manage the child’s behavior as best they can Therapists do not intervene during this time but encourage the parents to manage the child’s behavior as best they can

7. Session #1 - Intake When conducting observations, it is advantageous to collect information in the child’s school setting to get a more complete view of the child When conducting observations, it is advantageous to collect information in the child’s school setting to get a more complete view of the child It is also helpful to conduct observations on separate days at different time periods It is also helpful to conduct observations on separate days at different time periods If PCIT is recommended, course of treatment is described to the family, emphasizing the ways in which PCIT can address the specific concerns brought to them in treatment and any additional concerns that may have been brought up If PCIT is recommended, course of treatment is described to the family, emphasizing the ways in which PCIT can address the specific concerns brought to them in treatment and any additional concerns that may have been brought up Goal is to get parents excited about treatment and establish expectations that PCIT will require active involvement on their part Goal is to get parents excited about treatment and establish expectations that PCIT will require active involvement on their part An overview of PCIT is described with emphasis on the behavioral play therapy and discipline components An overview of PCIT is described with emphasis on the behavioral play therapy and discipline components

8. Session #2 – Teaching Behavioral Play Therapy RuleReasonExamples Describe appropriate behaviorAllows child to lead Shows child you’re interested Teaches concepts Holds child’s attention That’s a red block You’re making a tower You drew a smiley face The doll looks happy Reflect appropriate talkDoesn’t control the conversation Shows child you’re listening Improves child’s speech Demonstrates acceptance and understanding Child: I made a star Parent: Yes, you made a star Child: I like to play with this castle Parent: This is a fun castle to play with Imitate appropriate playLets child lead Shows child you are involved Approves child’s choice of play Child: I’m putting baby to bed Parent: I’ll put sister to bed too Child: I’m making a sun in the sky Parent: I’ll put a sun in my picture too Praise appropriate behaviorCauses the behavior to increase Lets child know what you like Increases self-esteem Adds warmth to relationship Terrific counting! I like the way you are playing so quietly You have great ideas for this game Thank you for showing the colors to me

9. Session #2 – Teaching Behavioral Play Therapy RuleReasonExamples Don’t give commandsDoesn’t allow child to lead Can cause unpleasantness Child obedience will be taught later Will you hand me that paper? Could you tell me your ABCs? Look at this Please tie your shoe Don’t ask questionsLeads the conversation instead of following Many are commands or require an answer Makes it seem like you aren’t listening to the child That’s a blue one, right? What color is this? Are you having fun? You want to play with the blocks? Don’t criticizeDoesn’t work to decrease bad behaviors Often increases the criticized behaviors May lower the child’s self-esteem Creates an unpleasant interaction You’re being naughty I don’t like it when you talk back No, honey that’s not right Don’t scribble on your paper

10. Behavioral Targets for Strategic Attention and Selective Ignoring Strategically Attend to: Strategically Attend to: Polite manners Polite manners Gentle play Gentle play Staying seated at a table Staying seated at a table Talking softly Talking softly Helping, being nice to people Helping, being nice to people Sharing toys Sharing toys Trying even when it is hard Trying even when it is hard Selectively Ignore: Bossiness, demandingness Banging toy on table Leaving seat during play Whining Yelling Grabbing toys away Giving up in frustration

11. Session #2 – Teaching Behavioral Play Therapy Playtime Homework Sheet DateYesNo Any problems that came up Monday Tuesday Wednesday Thursday Friday Saturday Sunday (Did you practice play therapy for five minutes?)

12. Session #3 – Coaching Behavioral Play Therapy Skills Criteria for Mastery of Behavioral Play Therapy Skills During five-minute play session: During five-minute play session: Give 25 to 50 descriptions plus reflections Give 25 to 50 descriptions plus reflections Reflect nearly all appropriate child verbalizations Reflect nearly all appropriate child verbalizations Give 15 or more praises, at least 8 of which are labeled praises Give 15 or more praises, at least 8 of which are labeled praises Ignore all negative, attention-seeking behaviors Ignore all negative, attention-seeking behaviors No critical statements No critical statements No commands No commands No questions No questions

13. Session #4 – Teaching Discipline Skills Parents will teach their child to mind by establishing small minding goals Parents will teach their child to mind by establishing small minding goals While playing with toys, the parent gives the child easy to follow instructions (e.g., put the eyes on Mr. Potato Head, place a block on top of another) While playing with toys, the parent gives the child easy to follow instructions (e.g., put the eyes on Mr. Potato Head, place a block on top of another) The child receives praise and the opportunity to continue playing if they follow instructions and a negative consequence if they do not follow instructions The child receives praise and the opportunity to continue playing if they follow instructions and a negative consequence if they do not follow instructions As small compliance goals are reached the child is provided with more challenging tasks (e.g., doing things that they don’t want to do, performing a boring or less interesting task) As small compliance goals are reached the child is provided with more challenging tasks (e.g., doing things that they don’t want to do, performing a boring or less interesting task)

14. Session #4 – Teaching Discipline Skills Giving Effective Instructions Make commands direct, not indirect Be polite and respectful, while still being direct Use explanations sparingly Make commands single and small, not compound Save direct commands for things you’re sure the child can do Always provide a consequence for obedience and disobedience State commands positively, tell child what to do, instead of what not to do Don’t give too many direct commands Use a neutral tone of voice, instead of pleading or yelling Make commands specific, not vague Use choice commands with older preschoolers

15. Session #4 – Teaching Discipline Skills Key points to time-out Key points to time-out Avoid talking to the child on the way to time-out and any other verbalizations and other forms of attention while the child is in time-out Avoid talking to the child on the way to time-out and any other verbalizations and other forms of attention while the child is in time-out Time-out does not end until the original instruction is obeyed Time-out does not end until the original instruction is obeyed If child refuses to comply with original direction they will return to time-out If child refuses to comply with original direction they will return to time-out If child complies with the original direction after going through time-out it is best for the parent to simply acknowledge that the child complied with the initial request and avoid praising the child If child complies with the original direction after going through time-out it is best for the parent to simply acknowledge that the child complied with the initial request and avoid praising the child

16. Session #5 – Coaching Discipline Skills Combining play therapy and discipline skills Combining play therapy and discipline skills After child has been praised for obeying first command, parents are instructed to return to play therapy and avoid giving further instructions for a few minutes After child has been praised for obeying first command, parents are instructed to return to play therapy and avoid giving further instructions for a few minutes This play therapy serves to reinforce child for compliance, decrease anger from being required to mind, and helps parents remain calm This play therapy serves to reinforce child for compliance, decrease anger from being required to mind, and helps parents remain calm Every three to five minutes another instruction is provided Every three to five minutes another instruction is provided The parent is gradually given more responsibility throughout the session and the demands placed on the child are gradually increased The parent is gradually given more responsibility throughout the session and the demands placed on the child are gradually increased

17. Session #6 – Posttreatment Assessment of Child and Family To enhance long-term maintenance of parenting skills and child behavioral improvements a schedule of booster sessions is developed To enhance long-term maintenance of parenting skills and child behavioral improvements a schedule of booster sessions is developed Number and frequency of sessions depends on presence of family stressors, degree of family and community support for using PCIT skills, cognitive ability and psychological functioning of parent, level of posttreatment skills mastery, and parental dependency on the therapist Number and frequency of sessions depends on presence of family stressors, degree of family and community support for using PCIT skills, cognitive ability and psychological functioning of parent, level of posttreatment skills mastery, and parental dependency on the therapist Usually recommended that families participate in 1 month, 3 month, 6 month, and 1 year booster sessions Usually recommended that families participate in 1 month, 3 month, 6 month, and 1 year booster sessions