Transcript Parent Consultation - University of Nebraska–Lincoln

Parent Child
Interaction Therapy
(PCIT)
Implementation Guidelines
The Future of School Psychology Task
Force on Family-School Partnerships
Kathryn Woods, Stephanie Bieltz, and Amanda
Clinton
Factors Influencing the
Effectiveness of PCIT
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Parents:
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Child:
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Average or High IQ
Strong Motivation
Ages between 2 and 7
Good Receptive Language Skills
Family:
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Good Marital Adjustment
Extended Family Support
Presenting Problems That May
Be Addressed Using PCIT
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Noncompliance
Verbal Aggression
Physical Aggression
Hyperactivity
Stealing
Lying
Destructive Behavior
Self-Injurious Behavior
Whining
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Classroom Conduct
Problems
Low Self-Esteem
Sad Mood
Perfectionism
Developmental Delays
Anxiety
Postdivorce Adjustment
Bonding in Blended
Families
Steps in PCIT
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Step 1: Pretreatment Assessment of Child
and Family Functioning and
Feedback
Step 2: Teaching Behavioral Play Therapy
Skills
Step 3: Coaching Behavioral Play Therapy
Skills
Step 4: Teaching Discipline Skills
Steps in PCIT cont.
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Step 5: Coaching Discipline Skills
Step 6: Posttreatment Assessment of
Child and Family Functioning and
Feedback
Step 7: Boosters
(Information on steps and session content gathered from Hembree-Kigin & McNeil, 1995)
Session #1 - Intake
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Children are encouraged to play in the room during the
interview. Parents are told that the therapist will be
watching during this time and the parents are to manage
the child’s behavior as they would normally
Therapists are paying attention to how the child plays
independently, strategies the child uses to get the parent’s
attention, parental responsivity to child overtures, parental
limit-setting, warmth of parent-child interactions, and
evidence of clinging and/or separation anxiety
Therapists do not intervene during this time but encourage
the parents to manage the child’s behavior as best they can
Session #1 - Intake
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When conducting observations, it is advantageous to
collect information in the child’s school setting to get a
more complete view of the child
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It is also helpful to conduct observations on separate days at
different time periods
If PCIT is recommended, course of treatment is described
to the family, emphasizing the ways in which PCIT can
address the specific concerns brought to them in treatment
and any additional concerns that may have been brought
up
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Goal is to get parents excited about treatment and establish
expectations that PCIT will require active involvement on their
part
An overview of PCIT is described with emphasis on the
behavioral play therapy and discipline components
Session #2 –
Teaching Behavioral Play Therapy
Rule
Reason
Examples
Describe appropriate behavior
Allows child to lead
Shows child you’re interested
Teaches concepts
Holds child’s attention
That’s a red block
You’re making a tower
You drew a smiley face
The doll looks happy
Reflect appropriate talk
Doesn’t control the conversation
Shows child you’re listening
Improves child’s speech
Demonstrates acceptance and
understanding
Child: I made a star
Parent: Yes, you made a star
Child: I like to play with this castle
Parent: This is a fun castle to play with
Imitate appropriate play
Lets child lead
Shows child you are involved
Approves child’s choice of play
Child: I’m putting baby to bed
Parent: I’ll put sister to bed too
Child: I’m making a sun in the sky
Parent: I’ll put a sun in my picture too
Praise appropriate behavior
Causes the behavior to increase
Lets child know what you like
Increases self-esteem
Adds warmth to relationship
Terrific counting!
I like the way you are playing so quietly
You have great ideas for this game
Thank you for showing the colors to
me
Session #2 –
Teaching Behavioral Play Therapy
Rule
Reason
Examples
Don’t give commands
Doesn’t allow child to lead
Can cause unpleasantness
Child obedience will be taught
later
Will you hand me that paper?
Could you tell me your ABCs?
Look at this
Please tie your shoe
Don’t ask questions
Leads the conversation instead of
following
Many are commands or require
an answer
Makes it seem like you aren’t
listening to the child
That’s a blue one, right?
What color is this?
Are you having fun?
You want to play with the blocks?
Don’t criticize
Doesn’t work to decrease bad
behaviors
Often increases the criticized
behaviors
May lower the child’s self-esteem
Creates an unpleasant interaction
You’re being naughty
I don’t like it when you talk back
No, honey that’s not right
Don’t scribble on your paper
Behavioral Targets for Strategic
Attention and Selective Ignoring
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Strategically Attend to:
 Polite manners
 Gentle play
 Staying seated at a table
 Talking softly
 Helping, being nice to
people
 Sharing toys
 Trying even when it is
hard
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Selectively Ignore:
 Bossiness,
demandingness
 Banging toy on table
 Leaving seat during
play
 Whining
 Yelling
 Grabbing toys away
 Giving up in frustration
Session #2 –
Teaching Behavioral Play Therapy
Playtime Homework Sheet
Date
Yes
No
Any problems that
came up
(Did you practice play therapy for five minutes?)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Session #3 –
Coaching Behavioral Play
Therapy Skills
Criteria for Mastery of
Behavioral Play Therapy Skills
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During five-minute play session:
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Give 25 to 50 descriptions plus reflections
Reflect nearly all appropriate child verbalizations
Give 15 or more praises, at least 8 of which are labeled praises
Ignore all negative, attention-seeking behaviors
No critical statements
No commands
No questions
Session #4 –
Teaching Discipline Skills
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Parents will teach their child to mind by
establishing small minding goals
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While playing with toys, the parent gives the child easy
to follow instructions (e.g., put the eyes on Mr. Potato
Head, place a block on top of another)
The child receives praise and the opportunity to
continue playing if they follow instructions and a
negative consequence if they do not follow instructions
As small compliance goals are reached the child is
provided with more challenging tasks (e.g., doing
things that they don’t want to do, performing a
boring or less interesting task)
Session #4 –
Teaching Discipline Skills
Giving Effective Instructions
Make commands direct,
not indirect
Be polite and respectful,
while still being direct
Use explanations sparingly
Make commands single
and small, not compound
Save direct commands for
things you’re sure the child
can do
Always provide a
consequence for obedience
and disobedience
State commands positively,
tell child what to do,
instead of what not to do
Don’t give too many direct
commands
Use a neutral tone of voice,
instead of pleading or
yelling
Make commands specific,
not vague
Use choice commands with
older preschoolers
Session #4 –
Teaching Discipline Skills
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Key points to time-out
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Avoid talking to the child on the way to time-out and
any other verbalizations and other forms of attention
while the child is in time-out
Time-out does not end until the original instruction is
obeyed
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If child refuses to comply with original direction they will
return to time-out
If child complies with the original direction after going through
time-out it is best for the parent to simply acknowledge that the
child complied with the initial request and avoid praising the
child
Session #5 –
Coaching Discipline Skills
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Combining play therapy and discipline skills
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After child has been praised for obeying first command,
parents are instructed to return to play therapy and
avoid giving further instructions for a few minutes
This play therapy serves to reinforce child for
compliance, decrease anger from being required to
mind, and helps parents remain calm
Every three to five minutes another instruction is
provided
The parent is gradually given more responsibility
throughout the session and the demands placed on the
child are gradually increased
Session #6 –
Posttreatment Assessment of
Child and Family
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To enhance long-term maintenance of parenting
skills and child behavioral improvements a
schedule of booster sessions is developed
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Number and frequency of sessions depends on
presence of family stressors, degree of family and
community support for using PCIT skills, cognitive
ability and psychological functioning of parent, level of
posttreatment skills mastery, and parental dependency
on the therapist
Usually recommended that families participate in 1
month, 3 month, 6 month, and 1 year booster sessions