Most moms and dads are not taught how to parent. We are supposed to just know what to do, I suppose. But even if you have a relatively calm and obedient child, moments inevitably arise when you could really use an owner’s manual. Belatedly, I think I’ve found one. Parent-child interaction therapy is a kind of parent training designed to help young children with serious behavior problems. The behaviors in question can range from repeated recalcitrance to violence, and are a feature of diagnoses such as oppositional defiant disorder and conduct disorder, both of which mean that your child’s behavior is pretty problematic. PCIT has also been used to dramatically improve the parenting skills of mothers and fathers in the child welfare system, leading to large reductions in repeated reports of child abuse. (For more on PCIT and its benefits, see “Parent Training Can Improve Kids’ Behavior,” by Ingrid Wickelgren, Scientific American Mind, March/April 2014.)
In my view, however, PCIT offers lessons for everyone faced with the task of raising kids.
In the therapy, a trained practitioner guides live interactions between a parent and child while the two play. The therapist sits behind a pane of one-way glass so that the therapist can see what is going on, but remains hidden to the parent and child. As play proceeds, the therapist talks to the parent through an earbud the parent wears. A typical session lasts about an hour and families require 13 sessions, on average, before they graduate (although some need fewer and others, many more).
These sessions are divided into two parts. In the initial block, parents learn to orchestrate amicable child-directed play—or CDI, for Child Directed Interaction. In this procedure, the child takes the lead and the parent is supposed to respond in prescribed ways. In particular, parent practices so-called PRIDE skills: Praise, Reflect, Imitate, Describe and Enjoy. That is, a parent is told to readily praise good behavior, but ignore annoying or disruptive actions—which is easier said than done if you have ever been a parent. (Dangerous or physically abusive behavior, however, cannot be ignored and has to be stopped.) The idea is to teach the child that he or she will receive attention only for behaving well.
The parent also learns to reflect (repeat or paraphrase) the child’s words, imitate and describe a child’s actions, and express enjoyment. All of this intense engagement helps the child focus and makes him or her feel appreciated. The overall effect is often to calm the child and make him or her feel closer to the parent, which is a good foundation for that relationship and for good behavior. The parent is supposed to avoid criticizing or correcting the child or—in this phase—even telling the child what to do.
Once a parent masters the PRIDE skills, he or she moves on to the second phase of the therapy, called Parent Directed Interaction (PDI). In this phase, the parent gives commands. Failure to comply with a command leads to a warning of a specific punishment—usually sitting in a time-out chair—and then delivery of that punishment. Complying with a request is supposed to be greeted with immediate, labeled praise in which a parent tells the child exactly what the child did right. The consequences of either obedience or disobedience must be consistent, so much so that the wording for the warnings and commands are scripted. So is the exact amount of time the child must sit in a chair, or, if the situation escalates, a time-out room.
Most parents do not need to sign up for therapy sessions to understand the value of the instruction PCIT offers. Putting aside time to build a bond with your child is invaluable. Once you have set aside that time, you need to know how to use it to avoid the interaction dissolving into a fight. Something as simple as keeping your voice even in tone helps. Ignoring minor infractions rather than reacting to them—and thereby inadvertently reinforcing bad behavior in an attention-seeking child—is also an excellent skill to hone. Immediately and specifically doling out praise to a child is beneficial, too, and it may be something that rushed or distracted parents often forget. In addition, I learned to phrase commands as such, and not as questions, which may lead the child to think there is a choice when that was not the intention. Consistent consequences are important, but often a bigger challenge, especially with kids too old to be confined to a chair.
In the audio clip below, psychologist Steven Kurtz of the Child Mind Institute in New York City guides a mother and her six-year-old son through a PCIT session. This particular parent-child pair has advanced to the second phase of training, and in this session, they alternate between child-directed play and parent-delivered commands. Click on the link below to listen to short segments of the session, stitched into one three-minute clip.
Clip from PCIT session
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