LAGUNA UNIVERSITY

Expert in Contextual Therapies 2022

THERAPY OF
PARENTS – CHILDREN
INTERACTION

Juan Carlos Hernández

Herrera Dr. Psychology Associate
T-1061 [email protected]
 ERAPIODINTERACTION PARENTS – CHILDREN
HISTORY AND EMERGENCE
- Behavioral therapy developed in the 1970s by Sheila Eyberg for
families with children ages 2 to 7 with disruptive behavior problems.

Professor emeritus at the University of

Florida.
Department of psychology
clinical and health.
Multiple research,
publications and workshops.
Director of the website www.pcit.org
- Different influences on the development
of parent-child interaction therapy. Parent-Child Interaction Therapy
(PCIT).

ULL. Expert in Contextual Therapies 2022-2023

 PARENT-CHILD INTERACTION THERAPY
HISTORY AND EMERGENCE
ORIGIN AND INFLUENCES RECEIVED FROM THE PCIT
Origin. Applied behavior analysis. Operant conditioning.
Training of Teach behavior operative to the family to apply them to their
fathers and mothers techniques for children at home. Fathers and mothers like
change agents.
Axline (1947) play therapy Use the game where changes are promoted in the
child through the therapist's skills.
Diana Baumrind Research on the Parents who are sensitive, attentive,
(1966 and 1967) styles communicate clearly, and set limits had boys and
educational girls with healthier behaviors.

constance hanf either

Intervention in Joint work with mothers and children to increase
(1969) Two phases obedience in children with problems. Use of
technology.
Patterson (1982) Theory of Behaviors disruptive maintained by
the parental reinforcement, such as paying attention
coercion or allowing escape from demands.
 PARENT-CHILD INTERACTION THERAPY
WHAT IS IT?
- Behavioral therapy aimed at childhood behavioral problems.
- It is a flexible therapy that can be adapted to each case.
- The term "parents" is used as a generic term for masculine and
feminine, and refers to both fathers and mothers, as well as any
guardian or caregiver. The term "son" is also used as a generic for
masculine and feminine.
- Brief therapy, which has been empirically validated (McNeil, Capage,
Bahl, & Blanc, 1999) and is considered an evidence-based treatment
(Shinn, 2013).
- Fernández Hermida and Pérez Álvarez, (2001) qualify it as a well-
established treatment according to the criteria maintained in the
report of Division 12 of the APA.
 PARENT-CHILD INTERACTION THERAPY

- The PCIT is aimed at:

- Different problems in children's behavior.
- Disobedience, challenges, tantrums, physical and verbal
aggression and breaking of rules ("externalizing" problems).
- Disruptive behavior problems.
- Oppositional defiant disorder.
- Currently, PCIT has been applied to a
multitude of problems: disruptive
behaviors and global developmental
delay, separation anxiety, childhood
depression, cancer, abused children and
prevention of
abuse, in families exposed to
violence, etc.
 PARENT-CHILD INTERACTION THERAPY
- Although there is a standard structure, the therapy is flexible.
- The number of sessions adapts to each family.
- Each family should receive an optimal number of sessions
- There is no limited time.
- The data is used as a guide.
- Possibility of combining PCIT with ACT and FAP.

NECESSARY KNOWLEDGE
Basic behavioral principles
Any therapist who wishes to apply therapy has to know the basic
operating principles that are in the theoretical basis, such as positive
reinforcement, negative reinforcement, stimulus control, positive
punishment, negative punishment, extinction, shaping and
overcorrection.
 PARENT-CHILD INTERACTION THERAPY

Training
Intervention with
positive direct from
parents and child
philosophy, the
or
not judicious interaction
girl at the same
fathers sons
It focuses
on
Characteristic Data usage
to guide the
patterns
interaction
s treatment

Equipment and ofIntervention

the PCIT Sensitivity
space towards
early
specialized aspects of
development
Ferro and Ascanio, (2017)
INTERVENTION WITH PARENTS AND THE CHILD AT THE SAME TIME:
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 CHARACTERISTICS OF PARENT – CHILD INTERACTION THERAPY
Intervene directly on the relationships between parents and children,
training parents to apply therapeutic skills in play therapy taught by
behavioral therapists.

DIRECT TRAINING OF PARENT-CHILD INTERACTION : Immediate

observation and shaping of parents' behavior to change the pattern of
verbal and non-verbal behaviors of the son or daughter. Some
advantages of offering parents immediate feedback while interacting
with their children may include:

- Quick fix before errors become entrenched

during practice time at home.
- Adapt and adjust training to the family as they
problems arise.

- Offer encouragement and support to parents in new skills

Ferro and Ascanio,
(2017)
ULL. Expert in Contextual Therapies 2022-2023
 CHARACTERISTICS OF PARENT – CHILD INTERACTION THERAPY
- Faster learning through successive approaches.
- Have reliable information about what happens during the
interaction.
USING DATA TO GUIDE TREATMENT : Most training sessions begin
with observing parent-child interaction in a play situation. Based on
the data, training is planned and it is determined when they are ready
to move from one phase of therapy to the next.
SENSITIVITY TOWARDS DEVELOPMENTAL ASPECTS : Some parent-
child interaction problems are related to inappropriate autonomy
goals and developmental expectations of the parents themselves. The
games and tasks required must be adapted to the children's level of
development.

Ferro and Ascanio,

(2017)
ULL. Expert in Contextual Therapies 2022-2023
 CHARACTERISTICS OF PARENT – CHILD INTERACTION THERAPY

For example, using very complex instructions for the child or

reinforcing skills that the child performs effortlessly.
EARLY INTERVENTION : Early intervention is critical in behavioral
problems. Intervention in the preschool years may be more effective
by:
- The problems are usually less deep-rooted than in older people.
- Parents of preschool children have more influence, without
competing with the influence of school, friends, etc.
- They have fewer cognitive resources when considering behavioral
interventions that they do not like and are less skeptical when
parents suddenly begin to pay attention to their good behavior.
- Older children may have more impaired interactions with their
parents.

ULL. Expert in Contextual Therapies 2022-2023

 CHARACTERISTICS OF PARENT – CHILD INTERACTION THERAPY
EQUIPMENT AND SPECIALIZED SPACE : Games room and observation
room. one-way glass and an intercom with microphone (an ear
receiver for the parents and a microphone through which the
therapist speaks).

Ferro and Ascanio,

(2017)
 CHARACTERISTICS OF PARENT – CHILD INTERACTION THERAPY
INTERACTION PATTERNS : Focuses on classes of behavior (or
interaction patterns) rather than specific behaviors. PCIT assumes that
disruptive problem behaviors have two functions: to get attention or
stimulation or to escape from demands. For Ferro and Ascanio (2017),
it is useful to teach parents to functionally analyze children's
behaviors and apply consequences based on these analyses. That is,
the CBA functional analysis.

POSITIVE, NOT JUDICIAL PHILOSOPHY . The therapist must apply to

parents the same skills that they will teach them to put into practice
with their children. Be as non-critical and judgmental as possible, and
model how to interact with your child.

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 APPLICATION
S
TWO
PHASES
1s
t
Child-directed interaction 2
(Child-Directed Interaction) n
Parent-led interaction
CDI
(Parent-Directed Interaction)
POI
PHASES SKILLS GOALS
CDI Improve the relationship between
Interaction skills
parents and children
 APPLICATION
POI S
Discipline techniques Increase good behavior
STANDARD STRUCTURE
TEMPORARY
COURSE
 TEMPORARY
COURSE
Pre-evaluation of 1 to 2
sessions
Didactic session
Only parents attend Teaching discipline
CDI skills
Training sessions
POI Observe how they apply the skills
of discipline along with the PRIDE in the
PCIT game Live training
Post-evaluation
1 to 2 sessions They must achieve the objectives for
the end of therapy

1, 3, 6 and 12 month follow-up

Data are collected by administering the
Extra sessions same instruments. Follow-up session
agreement and extras
Ferro and Ascanio,
(2017)
 THE GAME
- This is a part of therapy, not a privilege or reward.
- Employ games that emphasize creativity and the freedom to guide
them.
- Avoid games that involve rules (e.g. board games, cards), those that
may lead to inappropriate behavior, those that are difficult for
interaction (stories, computer games, guns, swords, books) or games
where pretends to be someone else (e.g. superheroes).
- Games like drawing, Legos, making constructions, assembling puzzles,
modeling with plasticine, animal farm, colored pencils, blackboard
and colored chalks, etc.
HOMEWORK
- Fundamental in therapy. Explain it to the family.
- Favors generalization.
- In the CDI the "special playing time", 5 minutes a day.
- In the PDI, in addition to "special play time," parents have to
perform other tasks such as giving orders, administering
consequences for disobedience, etc.
TASKS AT HOME: RECORDS
HOMEWORK
REGISTRATION SHEET
CDI

Child's Name :Date:

Have you practiced Describe the toys used

play therapy and what has happened
for 5 minutes?
 ASSESSMEN
T in different ways, on one day or on two
- The evaluation can be done
different days. Parents attending alone the first day and the second
with their son or daughter.
- Adapt to unforeseen events that may arise.
- Evaluation of the father and mother: clinical interview, request
authorizations (intervene with a minor, recordings, etc.) and
questionnaires.
- Interview : learn about family history and general functioning. Also
ask about aspects that may be useful for therapy. For example, how
they apply time out, what they would like to change, what they like
about the experience of being a parent.
- Questionnaires or inventories : Those considered appropriate.
Depending on family needs.

ULL. Expert in Contextual Therapies 2022-2023

 ASSESSMEN
T (2017), some evaluation instruments
According to Ferro and Ascanio,
used in the PCIT are:
- Eyberg Child Behavior Inventory (Eyberg & Pincus, 1999).
- Sutter-Eyberg Student Behavior Inventory (SESBI; Sutter &
Eyberg, 1984).
- Dyadic Parent-Child Interaction Coding System (DPICS;
Eyberg and Robinson, 1983).
- Child Behavior Checklist (CBCL; Achenbach, 1991, 1992).
- Parenting Stress Index (PSI; Abidin, 1990).
- Revised Edition of the School Observation Coding System (RED-
SOCS; Jacobs et al. 2000)
- Therapy Attitude Inventory (TAI; Eyberg, 1993)
- Child Rearing Inventory (CRI; Brestam, Eyberg, Algina, Bennet-
Johnson, & Boggs, 2003).
 ASSESSMEN
EYBERG INVENTORY OF BEHAVIOR IN CHILDREN
T Is this a
New Seldom Ever Often Always problem for
you? CORRECTION
1. It takes time to get dressed.
2. It takes time to eat.
1
1
2
2
3
3
4
4
5
5
6
6
7
7 h
Yea
Yea
No
No
Total intensity: adds the
3. He behaves badly at the table.
4. Rejects the food they are served.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h
h
Yea
Yea
No
No
frequency. Range from 36 to 252.
5. He doesn't want to do housework.
6. He is slow to get ready for bed.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h
h
Yea
Yea
No
No
Total number of problems: the "SI"s
7. He refuses to go to bed on time.
8. He doesn't obey the house rules.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h
h
Yea
Yea
No
No
are added. Range from 0 to 36.
9. He does not obey until he is threatened with 1 2 3 4 5 6 7 h Yea No

CUT POINTS
punishment. h
10. He is defiant when given an order. 1 2 3 4 5 6 7 Yea No
11. Argue about house rules.
12. He gets angry when he doesn't get his way.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h Yea
h Yea
No
No
Intensity > 124
13. He has tantrums.
14. Responds badly to older people.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h Yea
h Yea
No
No
Frequency > 10
15. Whines. 1 2 3 4 5 6 7 h Yea No
16. Cry easily.
17. Scream.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h Yea
h Yea
No
No
INTERPRETATIONS
18. He hits his parents.
19. Break toys.
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h Yea
h Yea
No
No
Intensity < 124
20. He is not careful with his toys and other
objects.
1 2 3 4 5 6 7 h Yea
h
No Frequency > 10
21. Steal. 1 2 3 4 5 6 7
h
Yea No Low level of parental tolerance
22. Lie. 1 2 3 4 5 6 7 Yea No
23. Annoys other children. 1 2 3 4 5 6 7 h
h
Yea No towards the child's normal
24. Argues with his friends. 1 2 3 4 5 6 7 Yea No
25. Argues with his brothers. 1 2 3 4 5 6 7 h Yea No behavioral problems.
26. He hits on children his age. 1 2 3 4 5 6 7 h Yea No
27. He fights with his brothers. 1 2 3 4 5 6 7 h Yea No
28. He constantly wants to attract attention. 1 2 3 4 5 6 7 h
h
Yea No
Intensity > 124
29. Interrupt.
30. He is easily distracted.
1
1
2
2
3
3
4
4
5
5
6
6
7
7 h
Yea
Yea
No
No Frequency < 10
Overly tolerant parents.
31. Pays attention for a short time. 1 2 3 4 5 6 7 h Yea No
32. He doesn't finish his homework. 1 2 3 4 5 6 7 h Yea No
33. You have difficulty entertaining yourself. 1 2 3 4 5 6 7 h Yea No
34. You have a hard time concentrating on one 1 2 3 4 5 6 7 h Yea No
thing. h Yea
35. He is too active or restless. 1 2
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3 4 5 6 7
h
No
 ASSESSMEN
EYBERG INVENTORY OF STUDENT BEHAVIOR
T
New Seldom Ever Often Always
Is this a
problem for
CORRECTION
you? Intensity total: HE addition
1. Slow to follow rules or instructions
2. Discuss the rules or instructions with the teacher
1
1
2
2
3
3
4
4
5
5
6
6
7
7
Yea
h Yea
No
No the
3. You have difficulty accepting criticism or 1 2 3 4 5 6 7
h

h
Yea No frequency. Range from 36 to 252.
correction
4. He doesn't obey school rules on his own. 1 2 3 4 5 6 7 Yea No Total number of problems: the "SI"s
h Yea
are added. Range from 0 to 36.
5. Does not obey until threatened with punishment 1 2 3 4 5 6 7 No
h
6. He gets angry when he doesn't get his way 1 2 3 4 5 6 7 Yea No
1 2 3 4 5 6 7 h Yea No
7. Acts defiantly when asked to do something
8. He has tantrums 1 2 3 4 5 6 7
h
Yea No
CUT POINTS
9. Responds badly to the teacher 1 2 3 4 5 6 7 h
h
Yea
Yea
No Intensity > 124
10. He complains 1 2 3 4 5 6 7 No
11. Cry 1 2 3 4 5 6 7 h
h
Yea No Frequency > 10
12. Whines 1 2 3 4 5 6 7 Yea No
13. Scream 1 2 3 4 5 6 7 h Yea No
14. Hit the teacher/s 1 2 3 4 5 6 7 h
h
Yea No INTERPRETATIONS
15. He is not careful with books and other objects 1 2 3 4 5 6 7 Yea No
16. Steal 1 2 3 4 5 6 7 h Yea No Intensity < 124
h Yea
Frequency > 10
17. Lie 1 2 3 4 5 6 7 No
18. He makes noises in class 1 2 3 4 5 6 7 h Yea No
h
Low level of tolerance of teachers
19. Responds badly to older people. Break toys 1 2 3 4 5 6 7 Yea No
20. Annoys and/or provokes other students 1 2 3 4 5 6 7 h Yea No
h
21. He is bossy with other students
22. Discuss with other students
1
1
2
2
3
3
4
4
5
5
6
6
7
7 h
Yea
Yea
No
No towards normal student behavior
problems.
23. He sticks with student children 1 2 3 4 5 6 7 h Yea No
24. Wants to get the teacher's attention 1 2 3 4 5 6 7 h Yea No
25. Interrupts the teacher 1 2 3 4 5 6 7 h Yea No
26. Interrupts other students
27. Has difficulty integrating into the group
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h
h
Yea
Yea
No
No
Intensity > 124
28. Has difficulty sharing materials
29. Does not cooperate in group activities
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h
h
Yea
Yea
No
No
Frequency < 10
30. Accuses others of bad behavior
31. He will be easily distracted
1
1
2
2
3
3
4
4
5
5
6
6
7
7
h
h
Yea
Yea
No
No
Excessively tolerant teachers.
32. You have difficulty staying on task 1 2 3 4 5 6 7 h Yea No
33. You get frustrated when faced with tasks that are 1 2 3 4 5 6 7 h Yea No
difficult for you.
34. He doesn't finish his tasks 1 2 3 4 5 6 7 h Yea No
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h
 ASSESSMEN
T
EVALUATION SESSION WHERE PARENTS AND THE CHILD ATTEND
The DPICS method is used to categorize and quantify parents'
verbalizations while playing with their child.
It is proposed to observe three situations of 5 minutes each to which
the parents are exposed separately. The three situations proposed
are: play situation directed by the child, play situation guided by
parents and cleaning situation.

- Child-directed play situation: Parents participate in a game guided

by their child. These data will serve the CDI's objectives. The
instruction can be the following:
“ In this situation, tell （…） that he can play with
whatever he wants. Let him choose the activity he likes
the most. You follow his game ”
 ASSESSMEN
- Parent-directed play situation: Parents guide the game and establish
T
the rules. The data collected will serve the objectives of the PDI. The
instruction can be the following:
“ Now we are going to change the situation. Tell （…） that it
is your turn to choose a game. You must choose an activity.
“Keep playing by your rules ”
Cleaning situation . Parents ask the child to pick up the toys they have
used and put them back, without their help. This task will collect data
that helps set objectives for the PDI phase.
“Tell （…） that it's time to put the toys back. Tell him he
must leave them （…）”
When categorizing verbalizations, a functional analysis must be
carried out, not a topographical one.
Homework : 5 minutes a day of playing with the child begins (stories,
games, etc.)
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 ASSESSMEN
PARENT AND CHILD INTERACTION
T CODING SYSTEM (DPICS)
DYADA PARENT-CHILD CODING SYSTEM (DPICS)
-Evaluation and post-treatment Modified Clinical Record Form

sessions.
-The therapist observes the interaction
Child's name: Father 's /mother's name

Observer: Date:

of the parent and child in the playroom, Treatment session:

and rates the frequency of the

verbalizations (praise,
123456789 10 11 12

descriptions, reflections, questions,

Father Son

orders or criticisms).
Direct order followed by... No chance
Obedience
Disobedience

-The system is divided into three five-

Indirect order followed
by...
No chance
Obedience
Disobedience
minute situations for each parent Description Disruptive behavior...
Ignore

separately. Each parent's skills are Reflection

Praise without label
Reply
Other behaviors
Clinical notes

coded for 15 minutes. Praise with label

Ask
Criticism
1st situation : The child guides theAnother verbalization

game. 2nd Situation : The father or mother guides the game. 3rd
Situation: cleaning.
 PHASES OR COMPONENTS

SKILLS OR TECHNIQUES TAUGHT

PRIDE SKILLS
DIDACTIC SESSIONS

CDI STRATEGIC OR SELECTIVE ATTENTION

SELECTIVELY IGNORE
HOW TO GIVE EFFECTIVE ORDERS
PDI
PRAISE OBEDIENCE
TIME OUT

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 CHILD-DIRECTED PLAY
Child-Directed Play (CDI)

MAIN RULE:
allow the child to lead the game
WHAT NOT TO TO DO
- DO DO
NOT GIVE ORDERS - PRAISE PROSOCIAL BEHAVIOR.
- DO NOT MAKE - DESCRIBE THE APPROPRIATE
REQUESTS BEHAVIOR OF THE CHILD.
- DO NOT ASK - REFLECT
QUESTIONS
- DO NOT CRITICIZE APPROPRIATE VERBALIZATIONS.
- IMITATE APPROPRIATE PLAY.
- SHOW ENTHUSIASM.

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 CHILD-DIRECTED PLAY (CDI)
PRIDE SKILLS
Q R 1 1 d AND
Pride reflect Imitate Describe Be
yourself Enthusiastic
Praise Mirror or Mock Describe the Show
appropriate paraphrase child's behavior enthusiasm
behavior appropriate
speech
The CDI didactic session is intended for the therapist to teach, explain
and model these skills, and the parents have to perform them inside
and outside of the sessions.
Praise : Make verbalizations that express favorable judgments of an
activity, result or attribute of the child. Labeled praise would be that
expression that says exactly what you like about the child. This way of
 CHILD-DIRECTED PLAY (CDI)
proceeding increases praised behaviors, shows approval, gives
warmth to the relationship and allows the child to know what his
parents like.
Some examples: Saying “how well you are sitting”, “how well you are
waiting now”, “you have done a great job coloring those houses”,
“you use the computer well”, “you wait well for your turn”, “thank
you for helping me now, you collaborate well”, “you attend to the task
well”, etc.
Paraphrase or reflect appropriate speech : This skill consists of
immediately repeating the child's verbalization, you can repeat
exactly what the child has said or use synonyms. This skill allows the
child to guide the conversation and feel heard, accepted and
understood by their parents. In addition, it increases verbal
communication and improves the child's language.
Examples: the child says “I put the green cube on top of the blue one”
and the mother repeats “you put the green cube on top of the blue
ULL. Expert in Contextual Therapies 2022-2023
 CHILD-DIRECTED PLAY (CDI)
one.” It is more appropriate, in the case of children aged 6 or 7, to
make the reflection a little more elaborate, not a simple repetition as
in the previous example. For example, more elaborate would be “on
top of the blue cube you have put the green cube, which is smaller”
(Ferro and Ascanio, 2017).

Imitate : It consists of immediately carrying out an activity the same or

similar to what the child is doing or joining the child's game, which
allows the child to lead the child and, at the same time, demonstrate
interest and approval towards what the child is doing. . For example,
the mother makes a drawing similar to the one her son is making, the
child says "I am going to draw a sun in the sky" and the father says "I
am also going to draw, put a sun in my drawing", the father makes the
same playing posture as the child, etc.
Describe the child's behavior : Verbalize phrases that specify and
allude to the child's behavior. It shows that you are paying attention
 CHILD-DIRECTED PLAY (CDI)
to what the child is doing, that they find it interesting and approve of
their play, and also allow the child to lead the game. For example,
saying “you have put the triangle on top of the cube”, “you have
colored the roof with two colors, red and tan”, “you are making a
tower”, “you are sitting on the seat, calmly”, etc.
Show enthusiasm : It consists of appearing attracted, excited, happy
while playing with the child. In different ways; change the tone of
voice to a more animated one “How patient you were doing that
puzzle!”, smile, use eye contact, etc. This skill keeps the child
interested in the game, increases the closeness between parents and
children, and lets the child know that the parents enjoy spending time
with them.

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 CHILD-DIRECTED PLAY (CDI)
Strategic attention and selective ignoring
The child's desirable behavior will be addressed, that is, good
behavior. Instead, problematic or disruptive behaviors will be ignored.

CAUTION: Ignoring will not be carried out if there are risks to the
child's safety. Nor will it be done in the face of dangerous or
destructive behavior.
- Tell the child in advance that you will ignore him or her if the
inappropriate behavior continues.
- Appropriate ignoring can help parents prevent confrontations from
occurring or escalating.
- At the beginning of the application ignoring problematic behavior
may increase.
- Helps the child realize the difference in their reactions to good and
bad behavior
 CHILD-DIRECTED PLAY (CDI)

Selective or strategic attention and ignoring

- Selective Attention is used to deal with behaviors that
DIVERTING RETURN THE
SILENCE THE EYES/FACE/BACK
BACKING
ATTENTIO OUT

are minor, irritating, and inappropriate.

- Ignoring these behaviors is an active way to correct them ! The
technique is used strategically to stop specific behaviors.
- CDI recommends occasionally talking out loud to yourself while
ignoring yourself, describing appropriate behavior. This signals to
the child the behavior you want to see before talking or playing
with him/her again.
 CHILD-DIRECTED PLAY (CDI)
TRAIN STRATEGIC ATTENTION AND SELECTIVE IGNORACY
Appropriate requests
Play correctly Be seated well
Use correct tone of voice
Attend Take care of the material
strategically to… Share
Try it if it's difficult

Demanding demands
Hit the dolls Get up
Cry
Throw the toys
Ignore Play with guns
selectively to… Leave the game
 CHILD-DIRECTED PLAY (CDI)

WAYS TO ACTIVELY IGNORE

Please remain silent.
Look away.
Play with something else.
Do not show any facial expression.
Make your game very fun so that the child wants to play that activity.
Praise or praise another child's appropriate behavior.
Turn your back.
Get up from the table and stand in the corner

Examples
 CHILD-DIRECTED PLAY (CDI)
Child: Protest to the father and pick up the toy.
Parent: Ignores the child's attitude (protest) and praises him for
picking up the toy.
Divert attention:
“I'm going to play with something else, since you have all the
playdough.”
“I'm having a lot of fun, playing with Mr. Potato Head.”
“I'm following the rules, playing calmly with my truck.”
Child: He hits his father.
Father: Leave the game; this cannot be ignored.
Backing out:
“If you hit me again, I will leave the room until you keep your hands to
yourself.”
Taken from www.pcit.org
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 AVOID PERFORMING IN THE CDI
AVOID REASONS EXAMPLES
PERFORMI
NG
Ask questions Lead the conversation, That's blue, right?
rather than follow it. What color is this?
Many times they are indirect You are having fun?
orders, or they require a Do you want to play with the trash can?
response.
It may seem like you are not
listening or disagreeing with
the child.
Give orders Does not allow the child to
lead. Indirect orders
Afterwards, we will focus on Let's draw a castle?
helping the child comply What have you drawn?
with commands. Can you pass me that paper?
Can you tell me the alphabet? direct orders
Put that puzzle piece here.
Look at this.
Fasten your shoe please

ULL. Expert in Contextual Therapies 2022-2023

 AVOID PERFORMING IN THE CDI
AVOID REASONS EXAMPLES
PERFORMI
NG
Make Sometimes it makes the You are behaving badly.
criticisms child do the behavior more I don't like that you talk to me like that.
often. Don't scratch your paper.
The criticized behavior No, love; that is not right.
frequently increases. That drawing looks ugly.
Others Do not use sarcasm
Don't use irony
Avoid using the word “NO”, “Stop…”, “Stop…”

ULL. Expert in Contextual Therapies 2022-2023

 DIDACTIC SESSION IN THE PLAY DIRECTED BY THE
CHILD
The therapist will model the skills.
PCIT uses post-treatment videos from other participants
Training using role-play
Change roles between parents.
Apply skills to parents

Use three different one-minute situations:

1. Good behavior of the child.
2. Good and bad behavior of the child.
3. Worst behavior they predict.

Ask to start with descriptions.

Praise every skill that appears
Ignore errors

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 RECORD OF CDI TRAINING SESSIONS

REGISTRATION SHEET
GDI PROGRESS

Child's name:
Parents name:

Session
Date
Domain
Praise 10
Reflexes 10
Behavior description 10

Questions - 3 P+O+C/S
Orders - 3 P+0+C/S

Criticism/sarcasm - 3 P+0+C/S

ECBI intensity -of 114

ULL. Expert in Contextual Therapies 2022-2023

 PARENT-DIRECTED PLAY
Parent-Directed Play (PDI)
The didactic session in this phase teaches parents to give
effective commands and apply consequences to the child's
obedience and non-obedience in a consistent and systematic
way.
According to Eyberg (1988), there are three steps for the
application of the PDI:
- Give clear and direct, specific orders, adapted to the child's
evolutionary development and one at a time.
- Reinforce obedience to an order through the skills learned
in the previous phase.
- Give a time out if the child does not obey the command.
ULL. Expert in Contextual Therapies 2022-2023
 PARENT-DIRECTED PLAY
Parent-Directed Play (PDI)
Give clear, direct and specific orders: Clear and direct orders are
introduced during the game. Orders will be given positively and in a
neutral tone of voice, brief explanation when necessary and given
when strictly necessary. It is more helpful to say “please put down
the pencil” than to say “please don't paint there.”
- The orders must be direct and you must avoid suggesting the
order or asking something. It is better to say “please sit next to me”
than to say “please, do you want to sit?” It is advisable to give the
commands one at a time, although with older children you can use
two.
- For example, “please turn on the light”, “please sit down”, or two
together “please turn on the light and sit down”. Other commands
would not be recommended, such as “please close the door, turn on
the light, sit down, and pick up the pencil.”
 PARENT-DIRECTED PLAY
Parent-Directed Play (PDI)
Give clear, direct and specific orders
EXPLAINED POSITIVE
DIRECT USE GESTURES
NECESSARY NEUTRAL TONE OF
VOICE
SIMPLE SPECIFIC
RESPECTFUL APPROPRIATE
WITH OPTIONS
Give two options
You have two options. You can put the blocks in the box or you can go
to a TIMEOUT ULL. EXPERT IN CONTEXTUAL THERAPIES 2022

PARENT-DIRECTED PLAY
 Parent-Directed Play (PDI)

Praise obedience : Praise the child every time he is obedient.

This will increase the likelihood of obedience. Each time he
obeys, it will be accompanied by praise, and the rest of the
skills used will be maintained.
- For example, you ask the child to put down the pencil, the
child puts it down and you say “thank you, for putting down
the pencil.” Other possible praise: “thank you for obeying”,
very good, you are very kind”, “great, thank you for doing
it”, etc.
- During parent-directed play all of the above skills will
continue to be used. Praise, mirror, imitate the child,
describe, and enthusiasm.
 TIME OUT AND/OR RESTRICTION OF PRIVILEGES
- It is applied when disobedient and for high intensity disruptive
behaviors (e.g. aggression). It is recommended to sit him in a chair
without receiving attention.
- Duration may vary depending on age.
3 minutes of sitting without attention is
recommended. The last 5 seconds the
child was silent. Some authors use the
criterion of 1 minute per year but it may
be too much with children with more
difficulties.
- In the PDI application, the child will
receive information about the changes, because they will be asked
to obey some order during play time.
- The child will receive information on how the time-out will be
carried out and how to do it.
 TIME OUT AND/OR RESTRICTION OF PRIVILEGES
INFORMATION TO THE CHILD ABOUT TIME OUT
- First, the child is removed from the toys to inform him.
It is explained to him that the playing time will have some changes.
For example: “Today the playing time is going to be different. I will
tell you things that you have to do (…). But this is not a game. It is
important that you listen and be obedient. If you're not, you'll
have to go into time out."
- Parents will explain what a time-out is, sit in the chair, as an
example, and the length of the time-out will be explained.
- You will be informed that it will be the bad behaviors that will
take you to time.
- The child will model sitting in the time-out chair and how to sit.
- Their collaboration in the explanation is reinforced (praise).
 Procedure of the 2 chairs

If he Alternative
escapes

Privilege
Chair time out or variations major or restriction
Time out and restraint (no aggressive risk)
 TIME OUT

AND/OR THE RESTRICTION OF

PRIVILEGES
ULL. Expert in Contextual Therapies 2022-2023
 HOME AND PDI TASK
REGISTRATION SHEET
PEI

Child's Name: Date:

You have practiced

the abilities?
YES NO Time Out_____________Duration____________Notices
MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

Additional comments or issue

 TRAINING SESSIONS OF THE CDI AND THE PDI
- Each teaching session is followed by training sessions.
- The training sessions begin by reviewing the homework from the
previous week, any doubts and problems that arise for parents are
resolved. The following session is explained.
- It continues with observation and skill training.
- According to the DPICS data, each father or mother can train more
one skill or another.
- Ferro and Ascanio, (2017) recommend using the same amount of
training time for both parents, although there are some authors who
dedicate less time to the parent trained last.
- It is recommended that each session starts with a different parent
than the previous session.

ULL. Expert in Contextual Therapies 2022-2023

 TRAINING SESSIONS OF THE CDI AND THE PDI
Approximate time of training sessions in CDI.
5 min. 15 min. 5 min. 10 minutes.
Observation Training Observation Training
CDI. CDI. CDI. CDI.
Father Father Mother Mother

Approximate time of the first training session at PDI.

2 min. 20 min. 2 min. 10 minutes.
Training Training Training Training
CDI. POI. CDI. POI.
Father Father Mother Mother
Approximate time of the second training session at PDI.
5 min. 15 min. 5 min. 10 minutes.
Observation Training Observation Training
CDI. POI. CDI. POI.
Father Father Mother Mother
 TRAINING SESSIONS OF THE CDI AND THE PDI
Approximate time from the third training session in PDI.
5 min. 5 min. 10-15 min.
Observation Observation Training
CDI. POI. POI.
Father Father Father

5-10 min. 5 min. 5 min.

Training Observation Observation
POI. POI. CDI.
Mother Mother Mother
- Individual work with the therapist's child : Applying PRIDE,
positive relationship, reduces resistance, therapist as an ally...
 CRITERIA TO FINISH THE CDI, PDI AND PHASES
TREATMENT

CRITERIA
CDI CRITERIA PDI CRITERIA
FINALS
During the 5 min. of POIs ECBI intensity less
must appear, at least: than 124. Both
During the 5 min. of CDI must appear, parents must have
at least: emotional. 75% met the CDI and PDI
10 Descriptions. of the criteria. Both
10 Reflexes. consequences to parents have skills
10 Labeled compliments. Ignore these orders to manage the
calls for attention through must be correct. child's behavior at
disruptive behavior. If a timeout is home and in public
Imitate the game. Be enthusiastic. applied, it must places.
Less than a total of 3: be applied
4 orders of which 75% must be correctly.
Questions.
Critical Orders.
ULL. Expert in Contextual Therapies 2022-2023
 FACTORS AFFECTING EFFECTIVENESS

PARENTS SONS OR FAMILIES

INCREASE - average or high IQ DAUGHTERS
- Between - Good marital
2 and 7 years
- High motivation - Appropriate adjustment
EFFECTIVENESS - Family support
understanding of
language
DECREASE - Substance Abuse - - Less than 2 and more - Severe marital
Severe than 7 years disagreements -
THE - Generalized Extreme family chaos
Psychopathology
EFFECTIVENESS - Mental development issue.
retardation
- Low motivation

ADAPTATIONS
OF PARENT-CHILD INTERACTION THERAPY
ULL. Expert in Contextual Therapies 2022-2023
PCIT is being applied and adapted to different contexts.
Some examples are:
Adaptations for school.
Adaptations to different problems (anxiety, separation...).
Adaptations for houses.
Adaptations to different populations (under 2 years or over
7 years).
Adaptations of different formats: Abbreviated version,
group version.

ULL. Expert in Contextual Therapies 2022-2023

PARENT-CHILD INTERACTION THERAPY

ULL. Expert in Contextual Therapies 2022-2023