Parent-Child Interaction Therapy: Can a Manualized Treatment Be Functional?
McNeil, Cheryl B., Filcheck, Holly A., Greco, Laurie A., Ware, Lisa M., Bernard, Rebecca S., The Behavior Analyst Today
Parent-Child Interaction Therapy (PCIT) is a manualized treatment that contains two separate phases with certain skills (e.g., praise) that are taught to all clients. PCIT has been criticized in the behavior analytic literature for being an approach that is not individualized for each client, that does not use functional assessment, and that does not provide functional alternatives for behaviors. This paper will address each of these criticisms and provide evidence that a manualized treatment can be functional. Specifically, PCIT is an individualized treatment that is consistent with applied behavior analytical principles. For example, PCIT includes informal functional assessment, uses data to guide treatment, teaches functionally equivalent behaviors, and addresses generalization. Moreover, PCIT addresses each of these areas with the parent as well as the child.
Parent-Child Interaction Therapy (PCIT; Eyberg & Boggs, 1989; Hembree-Kigin & McNeil, 1995) is a manualized treatment that is based on behavioral principles (Greco, Sorrell, & McNeil, in press). However, because PCIT is manualized, it has been criticized as being a "packaged approach" that does not allow for individualization using applied behavior analytic techniques (e.g., functional assessment) (James & Scotti, 2000). This paper will address these criticisms using the following structure. First, the therapeutic skills used in PCIT will be discussed. Next, criticisms of PCIT will be examined. Finally, the behavioral strategies and applied behavior analytic features that are included in PCIT will be presented.
Parent Child Interaction Therapy
PCIT (Eyberg, 1988; Eyberg & Boggs, 1989; Hembree-Kigin & McNeil, 1995) is designed for children ages 2 to 7 and is modeled after the Hanf (1969) two-stage operant model for behavior modification of young, noncompliant children. PCIT does not differ greatly from the Hanf model in terms of general structure. For example, both the parent and child participate in treatment, which takes place in the context of behavioral play therapy. During sessions, the therapist observes parent-child interactions from behind a one-way mirror while the parent wears a bug-in-the-ear device, a small ear phone worn by the parent trainee that allows the therapist to communicate discretely via microphone with the parent throughout the session. The therapist is thus able to give the parent immediate feedback on the use of parenting skills. In the absence of bug-in-the-ear technology, sessions also may be conducted with the therapist in the room. When using this method, the therapist is present in the room and does not interact with the child. The therapist provides feedback to the parent, just as would be done when coaching from behind the mirror.
PCIT begins with an intake session in which the therapist obtains important information by conducting a behavioral assessment. The information obtained includes: (a) parent reports of child behavior (e.g., Eyberg Child Behavior Inventory [ECBI; Eyberg & Ross, 1978], Child Behavior Checklist-Parent Report Form [CBCL; Achenbach, 1991]), (b) parent self report of parenting stress (i.e., Parenting Stress Index [PSI; Abidin, 1990]), (c) teacher report of child behavior (e.g., Sutter-Eyberg Student Behavior Inventory [SESBI; Eyberg & Pincus, 1999], Child Behavior Checklist- Teacher Report Form [TRF; Achenbach, 1991]), and (d) behavioral observations of interactions using the Dyadic Parent-Child Interaction Coding System (DPICS; Robinson & Eyberg, 1981). Data continue to be collected throughout treatment. Specifically, observational data are collected during each session to monitor treatment progress. This information is shared with the parents as a means of providing feedback on their acquisition of the skills. If the data suggest that the parents are having difficulty with particular skills, the therapist can then choose to focus on those skills during the coaching session. …