PCIT lasts 14-16 weeks, with weekly sessions. Traditionally, sessions are conducted in a mental health clinic using both a clinic room and observation room. More recently, PCIT clinicians can deliver PCIT  in other locations or via telehealth. Treatment gives equal attention to two sequential phases of implementation: 

Child-directed interaction phase (CDI): Parents develop child-centered interaction skills by maximizing positive communication, attention and imitation during child-led play. Parents encourage and follow their child’s lead, using PRIDE skills. 

Parent-directed interaction phase (PDI): Parents (and other caregivers) learn how to be consistent, predictable and reliable, using effective commands and strategies to reduce aggression and destruction—and to build their relationship and create a supportive home environment. 

Each phase begins with a “teach session” for parents to learn the concepts and how to model and role-play. These are followed by “coaching sessions,” to shape the parents use of PCIT skills through prompting, reinforcement and selective attention. 

A hallmark of PCIT is coaching parents in real-time, while they play with their child. Clinicians coach from a room with a one-way mirror, using a “bug-in-the-ear” system for communicating to parents and child in the playroom. This method can be conducted within the same room, the parent’s home or via telehealth.

Advantages of direct observation and live parent coaching:

• • Immediate, positive feedback can prompt, shape and reinforce appropriate skill use.
  • Can adapt to manage specific behavior problems as they arise.
  • Can quickly correct errors to avoid repeatedly use of incorrect techniques.
  • Can decrease need to rely on parent self-reports of skill use at home.
  • Can fade out prompts as parents become more adept at using new skills. 

Scientifically tested in more than 300 research studies, PCIT has proven benefits for children and families, including increases in:

• • Parent attachment and better behavior at home and in public
  • Self-esteem and feelings of security and safety 
  • Attention span and prosocial behaviors (sharing, taking turns) 
  • Compliance with parent and teacher requests
  • Parent confidence 

And decreases in:

• • Frequency, severity and duration of tantrums and/or defiant, aggressive or destructive behavior
  • Hyperactivity and negative attention-seeking behaviors (whining, bossiness)
  • Parent frustration and stress

PCIT-informed treatments are highly structured behavior therapies used to reduce challenging behaviors in children, ages 2-7. These behaviors may result from attention-deficit/hyperactivity disorder (ADHD) or oppositional defiance disorder (ODD) or to help a child with selective mutism engage in verbalizing experiences. Both versions of PCIT are highly effective and, when the intervention starts early, have positive outcomes for a child’s future growth and development.

In the 1970s, psychology professor Sheila Eyberg developed PCIT as a behavioral family approach for treating young children with disruptive behavior problems. Today, it is one of the most scientifically successful, international parent training programs for children.

​Integrating behavioral principles and traditional play therapy, PCIT is based on a two-stage model developed by Constance Hanf. Her pioneering, behavioral parent training treatment aimed to increase the mother’s desirability to the child as a source of social reinforcement and to increase spontaneous mother-child interaction. PCIT also​ incorporates: 

Attachment theory: To facilitate a warm, supportive parent-child relationship toward developing social skills and emotional regulation. 

Social learning theory: To provide differential attention toward addressing behavioral problems, while modeling calm, desired behaviors during parent-child interactions. 

Authoritative parenting practices: To follow consistent child rearing practices, with an appropriate balance between nurturing and limit-setting.  

PCIT teaches play therapy skills to parents and their young children with ADHD or ODD to increase a child’s social skills and cooperation, decrease problem behaviors, improve the parent-child relationship and increase parent confidence. PCIT is typically completed in 12-20 sessions.

More than 150 studies have shown PCIT training to positively affect the behavior of children, with such issues as insecure attachment, aggression, disruptive behaviors, temper and non-compliance. It is conducted in two treatment phases:

1. Child-Directed Interaction (CDI) focuses on establishing a warm parent-child relationship through learning and applying skills that help children feel calm, secure and good about themselves. Parents learn to engage their child in a playroom, while being coached through an earpiece by a therapist behind a one-way mirror or via a live video feed. This “in-the-moment” feedback helps parents correctly apply learned skills and keeps children unaware of the therapist overlooking the play session. Adaptations can be made, both virtually and in person, when the desired technology is not available or accessible. Desired outcomes include:

• • Decreased frequency, severity, duration of tantrums
  • Decreased activity levels
  • Decreased negative attention-seeking behaviors (whining, bossiness)
  • Decreased parental frustration
  • Increased feelings of security, safety, attachment to parent
  • Increased attention span
  • Increased self-esteem
  • Increased pro-social behaviors (sharing, taking turns)

2. Parent-Directed Interaction (PDI) helps parents manage the child’s most challenging behaviors with clear, age-appropriate instructions and consistent consequences, with the goal of increasing compliance from their child. Desired outcomes:

• • Decreased frequency, severity, duration of aggressive behavior
  • Decreased frequency of destructive behavior (breaking toys on purpose)
  • Decreased defiance
  • Increased compliance with adult requests and directions
  • Increased respect for house rules and acceptance of limits
  • Improved appropriate behavior in public
  • Increased parental calmness and confidence in providing positive and negative reinforcement

PCIT-SM aims to improve verbal and non-verbal participation and reduce parental over-accommodation. Research shows impressive outcomes, with gains persisting and generalizing to real-world settings.

Based on the traditional, two-step PCIT model managing disruptive behavior, PCIT-SM also coaches parent and child in live, real-time settings: 

Child-directed interactions (CDI) shapes new interaction patterns to facilitate trust, so children with SM feel supported and temporarily safe from the pressure of speaking. Instead, children receive attention for positive behaviors and for engaging with others, building rapport before moving on to harder steps

Verbal-directed interactions (VDI) shifts from using techniques to manage difficult behavior to verbally directed interactions that help children face their anxieties and tolerate uncomfortable feelings around speaking. Specific techniques remove the opportunity for children to respond nonverbally, while linking their verbal responses with positive reinforcement. 

Read here for more ways to understand the challenges and solutions for children with SM.

CONNECT TO CARE