Program Goals and Target Population
Parent–Child Interaction Therapy (PCIT) was originally developed to help parents reduce children’s disruptive behaviors (e.g., oppositional and defiant behaviors). PCIT has been adapted for and recently evaluated with families in which there is known physical violence. PCIT targets changing parenting practices and parent–child interactions to help prevent the recurrence of physical abuse in abusive families.
Program Theory and Components
Based on attachment and social learning theories, and incorporating operant behavioral principles, parents engage in a two-phase training that helps them replace maladaptive interactions with their children with more effective practices.
· In phase 1, Child Directed Interaction, parents are first taught and then coached how to enhance their relationship with their child. They are also taught to increase daily positive interactions by using specific praise, noncontrolling reflection during play, and selective attention.
· In phase 2, Parent Directed Interaction, parents learn how to give specific commands and discipline practices, such as using timeout.
With these two phases, parents are first taught the specific skills didactically in individual sessions and are then coached by providers in multiple parent–child conjoint sessions using a one-way mirror and “ear bugs.”
Adaptations for physically abusive parents include participating in a motivational enhancement group before the start of the typical PCIT sessions, listening to testimonials from other successful parent completers, and completing exercises designed to change self-motivational and self-efficacy cognitions. In addition, children participate in a safety and skill-building group that runs concurrently with the parent group. Role-plays are used to further support abusive parents’ identification of children’s age-appropriate behaviors and use of praise. Additional support is given for nonviolent disciplinary strategies.
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Child Behavior Problems
In the 2003 Nixon and colleagues study, both the Parent–Child Interaction Therapy (PCIT) and the abbreviated PCIT condition (ABB) treatment conditions significantly improved the behavior of the children, compared with the waiting list (WL) group, as measured by the parent reporting of child behavior. These gains were maintained at the follow-up. The independent observation showed PCIT children (but not ABB) to be significantly more compliant than WL children.
Parental Behavior, Attitudes, and Discipline
Both treatment conditions reported significantly more satisfaction and control and less reactive discipline than the WL group. This finding was further confirmed through observation of parent–child interactions. Treatment group mothers (PCIT and ABB) gave significantly fewer commands and more praise than the WL group, and maintained these gains at the follow-up. PCIT (but not ABB) mothers gave significantly fewer criticisms than the WL group.
Rereport of Physical Abuse
Of the total sample in the 2004 Chaffin and colleagues study, 34 percent of participants had a future physical abuse report over a median follow-up period of 850 days. Just under half (49 percent) of the standard community group condition participants presented a new report of physical violence. More than one third (36 percent) of the enhanced Parent–Child Interaction Therapy (EPCIT) group presented a rereport of physical abuse, a result that was not significantly different from the comparison condition. However, only 19 percent of the PCIT treatment group presented with a rereport of physical abuse. This was significantly lower than both the comparison and the EPCIT groups. The PCIT treatment led to less than half the reoccurrence rate for physical abuse.
Parent Negative Behaviors
Both the PCIT and EPCIT participants presented significantly reduced parent negative behavior scores from baseline compared with the community group treatment, which showed no improvement at posttreatment. The PCIT treatment was effective in improving negative aspects of parenting that had been present in the sample before the intervention.
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