What Is Parent-Child Interaction Therapy?

Michelle Curtin, DO1Lindsay A. Thompson, MD, MS1

Author Affiliations Article Information

JAMA Pediatr. 2023;177(4):441. doi:10.1001/jamapediatrics.2022.5930

Parent-child interaction therapy (PCIT) is a type of behavior therapy designed to help caretakers of children deal with emotions and behaviors that feel big.

Parenting programs like PCIT are the best treatment available to work on disruptive behaviors, such as not following directions or not cooperating, impulsiveness, rule breaking, arguing back, annoying other people on purpose, being spiteful, and having tantrums or meltdowns. Children with these behaviors may get into trouble with teachers, babysitters, and other grown-ups. They also have a tough time making friends, making it especially important to work on these behaviors early.

PCIT and other parenting programs are different from therapies for grown-ups. In PCIT, the child works directly with their caretaker and a therapist. Together, everyone builds new skills. This is similar to sports when a coach learns new trainings and comes back to the whole team to develop everyone’s skills. The team will have a better season, and the coach can be more confident in their own skills. Working together with PCIT allows children to practice in the therapy office and then continue practicing at home with their caretakers.

Who Can Benefit From PCIT?

PCIT is best for children aged 2 to 7 years who are struggling with any disruptive behaviors, have attention-deficit/hyperactivity disorder (ADHD), or have symptoms that look like ADHD. It is also helpful when a family is dealing with behaviors from their child that make life at home hard or that limit them from going out and doing things in public. Parents or caregivers learn skills that calm their own behaviors and avoid harmful practices like spanking or hitting. PCIT can also help children who are at risk for these challenging behaviors, such as in families with mental health disorders, but are not yet getting into trouble.

What Is PCIT Like?

PCIT uses what they call a bug-in-the-ear system. This is where the therapist, who is usually in a different room watching the therapy session, can coach caretakers to use their skills, try new approaches, and set limits for real-time practice through an earpiece like a Bluetooth headphone.

There are 2 parts to PCIT treatment. The first part works on building better relationships between children and caretakers. Children thrive when they have positive experiences with adults. Children who receive praise and other positive reinforcement increase the behaviors families want to see. The second part works with the challenging behaviors more directly to help children increase their listening skills and complete more tasks asked of them. In this phase, PCIT also helps parents to use effective limit setting. This component teaches how to use consistent consequences.

PCIT takes an average of 12 to 20 hourly sessions, and families finish when they have learned to use all the PCIT skills. Since many therapists have children and caretakers come weekly, PCIT can take at least 3 months. Families also must do their practice homework between sessions to make progress. It takes effort, but therapy does not go on forever! Instead, the child and parent will live more happily in the years to come.

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Article Information

Published Online: February 27, 2023. doi:10.1001/jamapediatrics.2022.5930

Conflict of Interest Disclosures: None reported.