Parent-Child Interaction Therapy: A Case Study

The intervention that I chose for this assignment is Parent-Child Interaction Therapy. The intention of article that I examined, as it related to Parent-Child Interaction Therapy, was to “examine Parent-Child Interaction Therapy’s effectiveness for increasing positive parenting skills, reducing children’s behavior problems, reducing parents’ stress, and improving the parent-child relationship with a sample of children typically considered in need of attachment-focused treatment.” (Allen, Timmer, Urquiza, 2014, pg. 334). Parent-Child Interaction Therapy is an intervention “founded on social learning, behavioral, and attachment theories” (Allen, Timmer, Urquiza, 2014, pg. 336). In addition, PCIT is an assessment driven model that uses play therapy

techniques. After the pre-assessment, PCIT is divided into two sections: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI), both sections are typically 7-10 sessions. CDI is the portion of PCIT that uses traditional play therapy techniques such as parents following their child’s lead in play by describing their activities and praising their positive behavior. In the PDI portion, parents are taught how to give clear and concise commands; therefore, increasing the chance of child compliance. In addition to a pre-assessment, there is also a post-assessment. The PCIT is deemed successful and complete when the caregiver can demonstrate, in a 5 minute assessment, that they can give behavior descriptions, effectively reflect content, and praise positive behaviors.
As part of the article, the authors have included a pilot study in which they focused on the effectiveness of PCIT with children deemed appropriate or in need of attachment-focused treatment. The pilot study consisted of “clinic-referred pre-adoptive and adoptive parent-child dyads considered high risk because of the child’s history of maltreatment” (Allen, Timmer, Urquiza, 2014, pg. 337). The study group of the pilot study was fairly diverse: 45% Caucasian, 27% African American, 24% Latino, and 4% other ethnicities. In addition, all children involved in the study had experienced some form of early trauma including maltreatment, interparental violence, physical abuse, neglect, sexual abuse, and prenatal exposure to drugs. Parents started the study by completing standardized measures and a short demographic questionnaire. Some of the measures used to measure different variables included the Child Behavior Checklist, Eyberg Child Behavior Inventory, Parenting Stress Inventory-Short Form, and Dyadic Parent-Child Interaction Coding System. The standardized measures were completed prior to treatment, after the child-directed interaction portion, and immediately post treatment (Allen, Timmer, Urquiza, 2014, pg. 338). Parents were considered graduated when they completed and were able to demonstrate techniques taught in CDI and PDI and when the children successfully responded to their parent’s use of skills to manage behavior.
In order to assess the change in child’s behavior from pre-treatment to post-treatment, the researchers conducted an analysis of scores compiled by the Child Behavior Checklist (CBCL) and Eyberg Child Behavior Inventory (ECBI).

According to the CBCL, there were significant improvements in internalizing, externalizing, and total problems. Furthermore, the ECBI showed significant improvements in the intensity and number of behavior problems that occurred. (Allen, Timmer, Urquiza, 2014). In addition, according to the ECBI pre-test “65% of adoptive parents reported that child behavioral problems in the clinical range” (Allen, Timmer, Urquiza, 2014, pg. 339). Post-treatment, the ECBI indicated that only “26% of children were reported as having clinical levels of behavior problems” (Allen, Timmer, Urquiza, 2014, pg. 339). As well as changes in child behavior, changes in parenting behavior were also measured pre and post PCIT. According to analysis of the Dyadic Parent-Child Interaction Coding System, there were “significant increases in verbalizations communicating positive attention and strong significant decreases in discouraged verbalizations” (Allen, Timmer, Urquiza, 2014, pg. 339). Finally, the last measure analyzed pre and post PCIT was stress related to the parent role. Significant improvements were shown in “parental distress, parent-child dysfunctional relationship, difficult child, and total stress scales” (Allen, Timmer, Urquiza, 2014, pg.

339).
After reading the article on the pilot study of PCIT on children in need of “attachment therapy”, I have a new found understanding of PCIT and its usefulness in social work practice. I was also able to use my knowledge to broaden the benefit of PCIT to children. This study did a good job at explaining how the basis of PCIT is effective at addressing emotional and behavioral needs associated with children who are thought to be in need of an attachment-based approach to treatment. Furthermore, many children who have experienced some sort of trauma also exhibit the same need for interventions that address their behavioral and emotional problems. Therefore, PCIT may also be very useful as a trauma focused intervention for not only adoptive children, but children who have experienced other forms of trauma such as divorce or loss of a caregiver.
In addition, I think that it would be beneficial to caregivers who may have a limited capacity due to reasons such as substance abuse, mental health problems, and intellectual disabilities. Because PCIT requires parent and child interaction and coaching from a trained professional, it is adaptable and a perfect intervention for a caregiver who may need reformatted parented skills due to their limitations. Furthermore, the article talked about the presence of abuse and neglect in the study sample; however, in the results section it talked very little about if PCIT was effective in reducing the risk of child abuse and neglect. I think that in regards to breaking the cycle of abuse in families that PCIT would be very effective. Furthermore, the article stated that PCIT had effectively decreased parental stress which is a known risk factor for child abuse. In addition, PCIT teachers caregivers to effectively discipline; therefore, caregivers will be less likely to engage in corporal punishment which can sometimes cross the line and turn into child abuse.
Although I am a huge supporter of PCIT; I also have some concerns regarding the limitations of PCIT. For example, during PCIT there is a portion where the caregiver has to wear a “bug in the ear” receiver. I would be concerned about how a caregiver with auditory impairments would be able to engage in this part of the intervention. Furthermore, I would also have concerns using this intervention with sexually abusive caregivers. Having children interact with their sexually abusive caregiver in a way that PCIT requires could be more traumatizing for the child than helpful. Moreover, I also had a question concerning the screening for eligible study participants. In the article it stated that if two children both qualified for admission into the study then the younger child was used rather than the older one. The researcher did not provide rationale to this decision making and I was unable to come up with one myself. However, I did possibly that that since PCIT is widely used with younger children then that would be a reason to use the younger sibling. However, this rationale would not take into account siblings that are close in age and both young.
All in all, PCIT is a very valuable therapy that has been proven effective across cultural lines and with a wide variety of clients that may be encountered in the field of social work. PCIT is a unique intervention because its focus is not just the parent or the child, but the parent and child together. Furthermore, PCIT has proven to be trauma sensitive and adaptable to a variety of situations including an emphasis of self motivation, caregivers with mental health and substance abuse issues and abusive caregivers.