Academic journal article Education & Treatment of Children

Theoretical and Empirical Underpinnings of Parent-Child Interaction Therapy with Child Physical Abuse Populations

Academic journal article Education & Treatment of Children

Theoretical and Empirical Underpinnings of Parent-Child Interaction Therapy with Child Physical Abuse Populations

Article excerpt


Children who experience physical abuse often suffer numerous negative short- and long-term difficulties in comparison to non-abused children. Considerable effort has been invested in developing and identifying treatment interventions to attenuate these negative outcomes. Parent-Child Interaction Therapy (PCIT), originally developed for the treatment of externalizing behavior problems in children aged two to seven years, has also been used to treat child physical abuse populations. The results of emerging treatment outcome studies indicate that PCIT is a promising treatment approach for child physical abuse. This article will review the theoretical rationale for applying PCIT to physically abusive parent-child dyads as well as provide details on the clinical modification made to PCIT for this population. Emerging treatment outcome studies will be critiqued and future research directions will be highlighted.


Despite a decline, almost 3,500 children under the age of 15 continue to die from physical abuse or neglect each year in the industrialized world. In the U.S. alone, where the rate is rising, 27 children die each week from these forms of maltreatment (UNICEF, 2003). The most recent U.S. Department of Health and Human Services Report (2003) indicated that 903,000 U.S. children were victims of abuse or neglect in 2001. Of these, 18.6% of children experienced physical abuse (1) (CPA), which was most often perpetrated by their biological mothers. Considering that these are reported incidents, this likely is an underestimate. In contrast, the Second National Family Violence Survey (Gelles & Straus, 1987) reported that an estimated 6.9 million children were assaulted (e.g., kicked, bit, punched, choked) by their parent at a rate of 110 incidents per 1,000 children during a one-year period.

Children who experience physical abuse suffer numerous negative immediate, short- and long-term difficulties in comparison to non-abused children including: poor school performance, disruptive behavior problems (Eckenrode, Laird, & Doris, 1993), difficulty achieving secure attachments (Crittenden & Ainsworth, 1987), problems with peer relationships (Hoffman-Plotkin & Twentyman, 1984), social withdrawal (Azar & Wolfe, 1998), a higher prevalence of psychopathology (e.g., anxiety, depression) (Blumberg, 1981; Livingston, Lawson, & Jones, 1993; Wolfe & Mosk, 1983), and an increased number of suicide attempts and self mutilations (Green, 1978). CPA is also strongly correlated with committing juvenile and adult crime (Luntz & Widom, 1994; McCord, 1983; Pollock et al., 1990; Widom, 1989).

Research has found that adults who were physically abused as children: a) exhibit a high rate of antisocial behavior (Pollock et al., 1990) such as aggression (Briere & Runtz, 1990), b) experience adult psychopathology (Briere & Runtz, 1988; Wolfe & Alpert, 1991), c) perpetrate maltreatment of children (Egeland, 1988), d) face higher rates of unemployment, low-paying jobs, and increased educational problems (Widom, 1991), and e) experience physical health problems and concerns (Kendall-Tackett, 2004). Additionally, the financial costs of child maltreatment are substantial to the larger community. Each year, a minimum of $460 million is spent in foster placements alone (Daro, 1988).

The negative impact of CPA seems inarguable; however, its etiology remains unclear. Consistent across many child maltreatment experts is the recognition that child physical abuse is a complex, multi-dimensional, and transactional process (Belsky, 1993; Kolko, 2002; Milner & Chilamkurti, 1991). Just as there is no single cause for CPA, there is no single treatment solution. Instead, a range of treatment targets must be addressed within any one intervention.

While the existing outcome studies for treatment of CPA remain sparse (Cohen, Berliner, & Mannarino, 2000; Oates, & Bross, 1995), considerable progress has been made over the past two decades. …

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