Parent-Child Interac tion Therapyllct'erl) W " FunAcrburlt and Sheila Elherg

Parenr-Child lnrerr.rction Therrpy (PCIT) was originally devcloped inrlie l9?0s hy Sheila Eybcrg fbr farnilies of children ages 2 to 7.{iagnosed withtlisruptive bchavior disorders. Sincc that tin-re, PCIT has cvolved into a

w idcly r-rsecl, cvir{ence'basr:d tl'catmcnt.PCIT igctu.les tw() sequentiai phnses and requires lu average of I 5 weekly

sessions. Coals of rhe firsr 1',[ase, the Child-Dirccted ]nteractit>n (CDI), are

tr.l irnprovc the qualiq, rrf rhe parcnt-child relatiorrship and strengthen ittten-ti,rn rind reinforcctnetrr fttr ptxitive chiirl hehavior. In tlre Cl)I, parents learn19 fblftlw their child's lead.irr ,lyadic plty and provic{c positive attenlion cora'bined with activc ignrlring of minor mishelrilvior. Thev are taugtrt to use thePRli)E skills--Praise, Re{lcction, lnritatiou, Dcscriptirln, antl Enthusiasnt*to reinfirrce pqsitive, appropriatc behirvir;rs. Pirrents also lcrarn to avtlid lea,.l-

iug gr intrrrsivc bel"rrrviors-c()lutnanl{s, questioniug, criticism, snrcastn' andrlcgarivc physical lrehavio$. This phasc firrms rhc foundi,rtirln ftrr effc'c:tive dis'cipline tnrining in the sectrtr.l pfirrsc, thc Parent.L)irectcd lutcraction (PDI).ln the PDl, parel-rts learn t,r lead therir child's uctivity, iir*^t in dytrdic play sit'sati{)ns apd larer in real.life situirtions whcn ir is itnptlrtilnt rl"rat their childghrey. Thcy lertrn t,, give effcctive itrsrructions anJ ttt fbllow through withcrtnsisleur colueqttences, includirrg lrraise f()r cotnpliuncc atrd a timeout prr:'ceilure f or noncompliance.

One .listinguishirrg fearule o{ PCiT is its intensivc elelivery-directcgirclring of parent-child interactions. Live skills co,rchingof the parentdttr'ing parenr-chiid interrctir"rns is the hallmark of ['CIT. For both the CDI andPL)i phues, rhe principles and skills are introduced in ,rne teaching sessign

rvifh tfic cilregiver(s) altlne. ln suhse.y-rent cclaching sessi()ns, after a htlme'u'<:rk review, therirpists coitch each $tirrent-chiltl dvad in turn' ln clinic'bascdPCIT, co*clring is cltme via a rvireless earphone tlrrough tl one-way tnirror.The trrirrcnt atrd chiH inreract in the tl'rerap) ror)rn rvhile thc tl"rerapist coacheshom an adjacent rrr,.rm bchintl the txre'way mirt'lrt'.

EARI-Y I)EVELOPMENT OF PCIT

PC'llT rvas dcsigned in r:he errri,v 19?0s nt rhe Qregon l{eahh ScienccsUniversity to inregrate rwo irrominent but theorctically .listinct child rreat-mcnts tlf thc clay into tr st;rund intcrventi.ilrt thilt retained imp<.rrtant therapeu'ric elenrents of each. The firsr freatnrenr wils plty thempV in wlrich, a-s clescribedby virginia Axline (194?), the therapisr fbllowccl and reflectecl the child's

t).s)'( ;HoTllERAl') llEsEARCfl (lltN I'liRs AND r;R()tjPs 415

rhe gzrp betrveen rhe prevailing child and hehavior therrrpie.s t:f che time andadded impottantly to the foundation ,"lf PCIT'

Th; urrifying srrucrurc of PCIT rvas forind in the work of CQnstanceHanf (i969), a'ps1,:ch.rl,rgist whO devel*4:eci a hehavioral program fcrr improv'ing complian.* i.,.l*.,*iopmentally,-iisabled children. She trair"red mothersin-two ri"gur, filst to apply diflbrential attention ftr the child's ccroperaf ive

"o,l ur,a.l.iperativc behavi6r, an.l thcn tt> use "cgntrgliing hehavior"-r() give rhecfiild clirecr c.:mmirn.ls and follow thrtlug]r wirh time out ftrrnon.,rmpliance. Shs usccl bug-in-the-e:rr tcchnrllelgy t0 cue ancl reinftlrcethe [rothers' use of the procedr.rres while they playecl with tl"reir children inthe ciinic.

Hanfs pr{}gram pnrvide,.l trh pverarchir}g strtlcture that wirs well suited

at home ro provide the child plrrv thcrapy expericnce every clay. Plactng playtherapl, skiils wirhin a ditlercntiirl atrention paradigrn pnrvide,,l more guid' Io*.. ,o parents fbr timing skill apphcation as well as a more direct bur srill Inoninrusivc method of chitd behavior change. The salne overarching struc' 'rure provi{eci ll connolled nr.earus of cnsuring rhe correct applicatkrn of chikl*ur,*g*rrr"rrt skills and tlre ccltlsislcncy in lirnit'setting that is ussential toauthoritative parenting.

This perior{ r:f initial dcve krpnrenr of thc trealment rogk place in thecontext t>f reai-iife clinical experiences with icw-income fhmiiics iiving inclifficult, stress{ul circunrsiances anci rvithout excltrsionary crifcria. Thetreatment wa.r named PCIT in 1974 tnan applicatictn lo the Aicohol' DrugAbuse, and Mcnt*i Hcairh Adrrinistrarion t.r conchlct a firtrnai piiot studyof irs eftectiveness. To that pt"rint, individuai cases had heerr assessed r:nlywith behavi{)r counts by parents at htltne irni-l therapists in the clinic, andtew standardized measures of rreatmenr plogress and uutcome existed inthe ljield.

The need ro demonsrrate changc formally lecl to the developn-rent ofthree assessment tools; a behrrvioral coding system to A$sess changes inchildren's behavior and pirrents' skiils in rhe clinic-tire Dyadic Parent-Child Inreraction Onding Systern (Eybcrg & I{obinson, 1983; Eyherg,Nels6n, f)uke, &. Boggs, 2005), a patcnt rating scale to monitor and evaluateparents' feporf. 6f behavic'rr charrge ilt tx)me-the Eybetg Child Be'havitrrinu.n.,lry (Eyberg & Ross, 19?8; Eyberg & Pincus, 1999i' irnd a consuntersatistaction measure te assess the lcceptability of treatmcnt to famiiies-the Therapy Attitucle ilventory (Eyherg, 19?4; 1993). The firsc decade c't{

PCIT research inv6lvecl standtrrdizirtg these ipstrutlent.s ar-rd reportingearly results on PCIT efficacy (Eyberg & Matarazzo, 1980; Eyberg &Robinson, l9BZ).

PSYCHOTTIERAPY REr-tARCFJ C:ENTERS .l"N,l) tiROLJPS 4t7

with several htrndred participants, and rhe Sc"c,-rnd Norwegian Conference onParent-Chilcl Interaction Therapy rvas held in October 2007' The itlcreasiugtlemirncl op chitcl mental health practitionefs ?lnd ?lgencies rvorlc{wide ro pro'vic{e eviclencc-hase.l rre?ttmenili f(rr traubled children likely foretclls increasedu$e ancl research for FCIT irr the decades to come'

REFERENCES

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P-sYCl"loTi I ERAPY R ESEI\RL'1"{ CEN'f ERS AND O ROI'.rPS 419