A New Program at the DePaul Community Mental Health Center
Aaron Lyon and Karen S. Budd
Published in Illinos Association for Infant Mental Health News (2005), 41(18), pp. 7-8.
Disruptive behavior disorders (e.g. Oppositional Defiant Disorder, Conduct Disorder) are the most common reason children are referred to mental health services. If left unchecked, these problems rarely remediate spontaneously. Instead, they can proceed along a trajectory of increasing severity. Childhood conduct problems have even been associated with criminality and antisocial behavior in adulthood (Vitelli, 1997). Symptoms of these problems include:
• Frequent aggression or anger
• Destructive behavior
• Temper tantrums
• Refusal to follow rules or adult commands
• Impulsive and hyperactive behavior
Parent-Child Interaction Therapy (PCIT) was developed by Dr. Sheila Eyberg, professor of psychology at the University of Florida, in the 1970s for the treatment of children, aged 2 to 7, who are exhibiting oppositional or conduct disordered behavior. PCIT is a manualized treatment, meaning that the content and sequence of PCIT sessions are clearly delineated by the protocol. Over the following decades, PCIT has been subjected to rigorous empirical study by Dr. Eyberg and her colleagues. Through this research, PCIT has emerged as one of the preeminent manualized treatments for disruptive behavioral disorders in preschool-aged children
(information from many of these studies can be found on the website of Dr. Eyberg’s Child Study Center at the University of Florida – www.pcit.org). As the field of mental health has focused on the empirical basis behind clinical practice methods, PCIT has become increasingly relevant because it is classified as a “well-established” empirically supported treatment.
In PCIT, parents are taught new ways of interacting with their children through the use of natural play situations. Parents are coached by trained therapists, learn new methods to talk to and discipline their children, and receive corrective feedback on their mastery of PCIT skills as they progress through the program’s two successive stages. Parents also practice newly acquired
skills at home during brief, daily play sessions.
Theory of PCIT
PCIT draws from multiple theories of child development and learning in its conceptual framework. These theories include:
• Parenting Styles
• Social Learning
From attachment theory, PCIT embraces the need for a secure base, rooted in warmth and praise. Classic theorists such as John Bowlby (1982) have long touted the importance of parents’ ability to enter into a reciprocal partnership with their children that allows them to be responsive to their children’s emotional needs. These secure parent-child relationships then serve as internal working models that guide relationships into adulthood.
PCIT is also heavily influenced by Diana Baumrind’s (1971) parenting theory, which asserts that an authoritative parenting style exposes children to a balance of warmth and discipline and yields the best long-term psychological and behavioral outcomes. Authoritative parenting is juxtaposed against permissive (warmth without limits/discipline) and authoritarian (discipline without warmth or flexibility) parenting styles, which have frequently demonstrated less adaptive outcomes.
Social learning theory further contributes to PCIT’s theoretical underpinnings. This approach emphasizes contingency management in response to children’s behavior that either increases (through reinforcement) prosocial or decreases (through ignoring or punishment) disruptive behaviors. Therapists teach parents to identify antecedents and consequences of their own and their children’s behavior. During coaching, parents learn to apply management techniques with their children. Simultaneously, therapists shape and reinforce parents’ use of behavior management skills using the same principles.
Application of PCIT
PCIT is an individualized treatment that includes the child and one or (preferably) both parents. PCIT treatment is divided into two major stages, Child-Directed Interaction (CDI) and Parent- Directed Interaction (PDI). Each phase introduces a series of skills and lasts approximately 5-8 sessions. However, treatment completion is not based on the number of sessions, but on skill mastery and the parent’s sense of comfort applying PCIT techniques. Prior to each phase, a session is held with only the parent to teach the skills that will be the focus of upcoming treatment sessions (CDI or PDI). Subsequent sessions involve therapist coaching during parent- child play. During this play, the therapist watches (usually from behind a one-way mirror) and provides immediate feedback to the parent regarding his/her use of the target skills. The entire sequence of PCIT (pre-assessment, CDI, PDI, post-assessment) lasts 12-20 sessions.
Child-Directed Interaction (CDI)
During the first phase of treatment, CDI, the skills taught and practiced focus primarily on strengthening the relationship between the parent and child, building the child’s self-esteem, and increasing the child’s prosocial behavior. During this phase, parents are taught to use traditional play therapy skills while they interact with their children. These (PRIDE) skills include:
• Reflection (of child’s speech)
• Imitation (of child’s behavior)
• Description (of child’s behavior)
Each of the skills serves to communicate to the child that his or her behavior is important and warrants attention. Praise comments are labeled (i.e., made specific to the child’s behavior) in order to provide clear information about what exactly the child did to receive it. Reflection, imitation, and descriptions of behavior all demonstrate that the parent is interested in what the child is doing. Genuine enthusiasm communicates interest and positive affect. During CDI, parents are taught to avoid asking questions, criticizing, or making other attempts to lead the interaction. Disruptive behavior during this phase is addressed by ignoring (within safety limits) or, if necessary, stopping the play. The therapist measures the parent’s progress at mastering PRIDE skills by observing parent-child play (from behind a one-way mirror) and counting the skills displayed during the first five minutes of CDI sessions.
Parent-Directed Interaction (PDI)
Once PRIDE skills are mastered, the second phase, PDI, begins. In this phase, parents are taught behavior management techniques and are guided through use of the techniques to facilitate the child’s compliance with instructions and to decrease disruptive and aggressive behavior. The PDI phase of treatment begins with an introductory session in which the parent is instructed in the use of PDI skills, followed by coaching sessions during parent-child play. The parent continues to use the PRIDE skills while simultaneously learning effective commands (simple, specific statements telling the child what to do rather than what not to do), distinguishing whether compliance has occurred, and applying appropriate consequences for obeying and disobeying. The technique of time out is introduced, which follows a clearly outlined sequence each time it is applied. Like CDI, PDI concludes when the parent displays mastery of the skills taught during that phase.
PCIT at the DePaul CMHC
Although PCIT has been shown to be a successful treatment through empirical study, the populations to which it has been applied have been somewhat limited. The vast majority of studies have used white families treated at a university-based mental health clinic. The Community Mental Health Center (CMHC) at DePaul University in Chicago provides an opportunity to expand PCIT to ethnic minority families from economically disadvantaged backgrounds. It also provides the opportunity to offer these families one of the most promising treatments available.
As of the fall of 2005, PCIT was established as a new program at the DePaul CMHC, which has been providing services to children and families on the near north side of Chicago for over 30 years. Driven by the Vincentian principle of community service, the DePaul CMHC is dedicated to provision of mental health services and community outreach where they are most needed. The catchment area of the DePaul CMHC includes multiple public housing communities in the city of Chicago, and the residents of these communities comprise a significant portion of the CMHC’s client base.
Families eligible for services at the DePaul CMHC include those who reside in or attend school in the Near North, Near Northwest, and Lincoln Park areas of Chicago. Clients from other geographic areas may receive services as staff resources permit. Fees are determined on a sliding scale and Medicaid is accepted.
For more information about PCIT at the DePaul CMHC or to make a referral, contact the DePaul University Community Mental Health Center at (773)325-7780. Interested individuals may also leave a message for the PCIT program at (773)325-7795 or firstname.lastname@example.org.
Baumrind, D. (1971). Current patterns of parental authority. Developmental Psychology
Monograph, Part 2, 4(1), 1-103.
Bowlby, J. (1982). Attachment and loss: Vol 1: Attachment (2nd ed.). New York: Basic Books
Vitelli, R. (1997). Prevalence of childhood conduct and attention-deficit hyperactivity disorders in adult maximum-security inmates. International Journal of Offender Therapy & Comparative Criminology. Vol 40(4), 263-271.