Behavior+Support

Parent‐Child Interaction Therapy WEBSITE: http://pcit.phhp.ufl.edu/ If you would like more information on this practice, contact Greta Coe at greta.l.costate.or.us or 503‐945‐6187 or see below for local providers.

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What is PCIT? Parent-Child Interaction Therapy (PCIT) is an empirically-supported treatment for conduct-disordered young children that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. In PCIT, parents are taught specific skills to establish a nurturing and secure relationship with their child while increasing their child’s prosocial behavior and decreasing negative behavior. This treatment focuses on two basic interactions: Child Directed Interaction (CDI) is similar to play therapy in that parents engage their child in a play situation with the goal of strengthening the parent-child relationship; Parent Directed Interaction (PDI) resembles clinical behavior therapy in that parents learn to use specific behavior management techniques as they play with their child.

The PCIT Story
 Sheila M. Eyberg This article was published in the first issue of “PCIT Pages: The Parent-Child Interaction Therapy Newsletter” in 2004 (vol. 1; pp. 1-2).

Where did it all begin? Perhaps it started in graduate school at the University of Oregon in the late ‘60’s where I was trained in the “new” behavior modification approach to psychotherapy. In most of the clinical psychology world, children’s problems were treated in individual play therapy, but my first training cases involved training parents to change their child’s behaviors. And my mentors were among the first “scientist-practitioners” – although the term wasn’t yet invented. My mentors instilled the notion that a “good therapist” is one who (a) views each treatment plan or procedure as a hypothesis to be tested and, if not (quickly) confirmed, revised based on the new data and tested again until it “works”; and (b) collects data throughout treatment that reflect observable and meaningful change in the presenting problems from the perspective of the family as well as the therapist. Translated into the graduate student’s bottom line, we would be “good therapists” if our cases were successful – defined by the data points on the progress graphs. And It was our responsibility -- not the child or family’s -- to make this happen. These empirical behaviorist principles formed the foundation for the development of PCIT.

The next step in the formation of PCIT happened at Oregon Health Sciences University (OHSU). I was clinical psychology intern in a very traditional (white coats) prestigious (scary) place. I was encouraged to explore the more traditional play therapy approaches to child treatment. Without much earlier training in “how” this was done, I began a period of avid reading. Two authors whose work strongly influenced my thinking -- and my initial play therapy interactions with children -- were Virginia Axline and Bernard Guerney. Axline’s play therapy was dynamic and emphasized acceptance of the child through reflections of the child’s behavior and emotions during play. Therapy was a place where children could feel safe, where they could relax and experience being “okay.” Guerney described a similar play therapy based nondirective psychotherapy. And he extended these ideas to parent training groups in which he taught parents to conduct play therapy sessions with their child at home.

The ideas of these early play therapists, which originated in psychodynamic and client-centered thinking, made sense in play therapy. The children enjoyed the play and seemed to calm down, “self-correct,” and try to please me, but I had several concerns. Their parents were not reporting similar experiences at home. Nor were they reporting changes in their children’s behaviors. (The graphs would not look good…). The therapy hour couldn’t overcome the many other hours in each week filled with powerful negative interactions that kept the child’s negative behaviors in place. At the same time, the children in treatment seemed to bond to me in the way they needed instead to bond to their parents.

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Watching the anger – the absence of warmth and joy in the parent-child interactions -- was striking and very sad. Many of the children had been abused in the past, but even when not physically abusive, the parents’ management of their child’s misbehavior was emotionally hurtful as well as ineffective. The children and parents had become trapped in the “coercive cycle” later described by Gerald Patterson. Even if these parents learned to conduct the play therapy with their child, it would be difficult to sustain such positive interactions in the context of the potent downward spiral of negative disciplinary interactions. <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">While grappling with these issues, I discovered the work of Diana Baumrind. She studies how different parenting styles (authoritarian, permissive, and authoritative) affect children. Her research showed that authoritative parenting leads to the healthiest outcomes for children. The authoritative parenting style combines nurturant and responsive interactions with clear communication and firm limit-setting. This set of parenting behaviors bridged the gap between the behavioral and the more traditional approaches to child therapy -- and added further to the foundation of PCIT.

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">The work of a fourth psychologist, Constance Hanf at OHSU Crippled Children’s Division, contributed the structure to PCIT. Hanf developed a program for mothers and their developmentally disabled children in which she trained mothers to improve child compliance. Her program had two stages: In Stage 1, called Child’s Game, she trained mothers to play with their child using differential social attention – to pay attention to the child’s cooperative behavior and ignore the child’s uncooperative behavior. In Stage 2, called Mother’s Game, she trained the mothers in “controlling behavior” -- to give direct commands, praise the child for obeying, and use time-out for disobeying. She also used a bug-in-the-ear to coach the mothers in these two games! <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Hanf’s program provided a structure that would work for teaching parents play therapy skills – and would allow children to experience play therapy more than one hour a week. This was a way to train parents in the nurturance half of authoritative parenting, a way to increase parent responsiveness and strengthen the parent-child attachment.

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">This overarching structure would also work for teaching child management skills – and the firm limit-setting that is the other half of authoritative parenting. It provided a way to help parents not only set limits but also follow-through – the part that makes limits firm. Therapists could coach and support the parents through the chaos of this change, in guided practice until parents gained confidence in limit-setting on their own. <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">During my next two years of postdoctoral training at OHSU, PCIT took shape. Most of the families referred to our clinic were single-parent mothers with disruptive children living in difficult, stressful circumstances. Thus, PCIT was developed within the context of “real life” clinical experiences, guided by clinical and developmental theory and literature on parenting and behavior change. It was formalized into “PCIT” in 1974 in the process of preparing an application for funding to ADAMHA (Alcohol, Drug Abuse, and Mental Health Administration) to conduct a pilot study of PCIT effectiveness. And it was during this time that my graduate school training played its largest role in the development of PCIT. In Part 2, I describe the assessment base of PCIT and the development of the ECBI, the DPICS, and the TAI.

<span style="color: #800080; font-family: 'Comic Sans MS',cursive; font-size: 200%;">LOCAL PCIT RESOURCES

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">CLACKAMAS COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Clackamas County Community Health Division <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">2051 Kaen Road <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Oregon City <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Wendy Robinson <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: 503‐722‐6502

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">COOS COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Coos County Mental Health <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">1975 McPherson Ave #2 <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">North Bend <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: David Geels <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (541) 756‐2020

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">JACKSON COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Jackson County Mental Health <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">1005 East Main <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Medford <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Maureen Graham <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (541) 774‐7923

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Southern Oregon Child Study and Treatment Center <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">1836 Fremont St <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Ashland <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Tom Gunderson <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (541) 482‐5792

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">JOSEPHINE COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Family Friends Outpatient Program <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">322 NW F St <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Grants Pass <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: George Longden, LCSW <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (541) 476‐4248

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Options for Southern Oregon <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">1215 SW G St <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Grants Pass <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Jeff Krolick <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (541) 476‐2373

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">LINN COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Linn County Mental Health Services <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">PO Box 100 <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Albany <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Sandy Minta, Psy.D. <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (541) 924‐6916

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">MARION COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Easter Seals Oregon Childrenʹs Therapy Center <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">290 Moyer Ln NW <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Salem <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Neda L. Grant, LPC <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (503) 370‐8990

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Marion County Behavioral Health <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">3180 Center Street <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Salem <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Gloria Thetford, RN <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (503) 361‐2675

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">MULTNOMAH COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Kerr Youth & Family Services <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">722 NE 162nd Ave <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Portland <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Stephen Brock <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (503) 408‐5066

<span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Morrison Child and Family Services <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">3205 SE 13th <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Portland <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Linda Magnuson <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (503) 736‐6735

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">TILLAMOOK COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Tillamook Family Counseling Center <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">906 Main Ave <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Tillamook <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Frank Hanna‐Williams, LCSW <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (503) 842‐8201

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">YAMHILL COUNTY <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Yamhill County Health and Human Services Department <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">625 N Evans St <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">McMinnville <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Program Contact: Chris D. Johnson, ACSW <span style="color: #404040; font-family: Arial,Helvetica,sans-serif;">Phone: (503) 434‐7523