Parent-child interaction therapy heads to
New England
(November 2006 Issue)

Trained in PCIT, (l-r) Dawna Gabowitz, Ph.D., Kristina Konnath, LICSW and Joseph Spinazzola, Ph.D. of The Trauma Center at the Justice Resource Institute, in Brookline, Mass., are the first in the area to offer caregiver workshops and private treatment. (photo by Tom Croke)

By Phyllis Hanlon

In the late 1970s, University of Florida professor Sheila Eyberg created a new method for treating families with small children between the ages of two and six who have behavioral and emotional problems. Parent-child interaction therapy (PCIT), as this treatment is known, originally subsisted within a university setting, but has since branched out to therapeutic centers, particularly on the West coast. As with many trends, PCIT is slowly making its way East.

A combination of behavior and play therapy, family systems and social learning theory, PCIT blends a variety of skills with unique approaches. According to Joseph Spinazzola, Ph.D., executive director of The Trauma Center at the Justice Resource Institute in Brookline, Mass., PCIT in-volves a dyadic response. "The first part is child-directed and the second part is parent-directed," he says. "In the first portion, the parent joins in play with the child on a daily basis. As routine is established, the parent mirrors the child. The second portion shapes behavior such that the child is reinforced for complying with the parental commands."

Fundamentally, the child-directed aspect of PCIT represents attachment-based therapy using play therapy. Non-verbal cues for very young children and alternate methods are used for those non-responsive to parental commands, says Spinazzola. "We teach parents what is age appropriate and focus on the positive."

Dawna Gabowitz, Ph.D., staff clinician at The Trauma Center and project coordinator for the site, notes that the program aims to assist parents attempting to manage children with external behaviors. She adds, "The goal is to help parents integrate skills into everyday interactions. A clinician coaches the parent in the application of skills and tracks the use of those skills. Parents then move to the next level when mastery is achieved and maintained." Throughout the program, parents receive validation, support and reinforcement as they strive to increase the child's willingness to cooperate.

Gabowitz points out that PCIT is often an adjunctive, not a stand-alone, therapy. "You have to make sure that other treatments don't conflict with PCIT. It's important to have good communication between clinicians," she says.

Implementing a PCIT program sometimes presents a "logistical challenge," according to Gabowitz. She says, "Facilities at the current moment find it expensive to fund the technology." In order to maximize PCIT, earpieces, a separate room, monitoring system and one-way mirror are necessary. Clinicians coach from behind one-way mirrors and issue verbal directives through earpieces to parents as they interact with their children.

"Unpredictability and inconsistent attendance pose another challenge," Gabowitz says. Adherence to the 12 to 16 week course ensures a higher success rate. "It's difficult to do [the program] in less than ten weeks. Some families might need 20+ sessions."

Spinazzola notes that The Trauma Center first heard about PCIT through the National Child Traumatic Stress Network and immediately felt the therapy had "definite application to our clients." He, and Gabowitz, together wtih Kristina Konnath, LICSW, of The Trauma Center and also affiliated with the National Center of Family Homelessness, received PCIT training on-site at Cincinnati Children's Hospital Medical Center and are participating in a multi-site PCIT treatment outcome study through the Cincinnati center. Since completing training, the trio has utilized PCIT in several ways. "We offer introductory workshops to caregivers, as well as private PCIT treatment at our Center," says Spinazzola.

According to Konnath, "PCIT is known, but many clinicians are not trained in the therapy. I don't know of other centers in New England that are using PCIT. We're the first trauma center to incorporate PCIT. Our goal is to help increase awareness," she says.

Erica Pearl, Ph.D., works as a trainer at Cincinnati Children's Hospital, one of several PCIT sites across the country. She indicates that some clinicians are self-taught, but recommends that they go through formal training, due to the intense nature of the program. "The workshop model involves 30 hours of classroom work. There are three-day sessions and two-day sessions separated by three to four weeks," she says. The interval between training sessions gives the clinician a chance to begin a case [in his or her agency] and return refreshed. "After three days of training, people are worn out," says Pearl. "The training is very hands-on. Clinicians have to learn the same skills they teach parents. Basically, the clinician has to 'overlearn' to coach the parent."

Originally intended as a therapy for younger children, PCIT has been adapted for use with adoptive and foster parents, physically abusive parents with youngsters from age four to 12, traumatized children, and in residential facilities, according to Pearl.

Mental health professionals with a master's degree in psychology or related field are eligible to undergo the 40 hours of direct training with a four-to-six month period of supervision and consultation. Conference calls, videotapes and distance learning may satisfy the latter requirement. Pearl notes that more than 150 clinicians have been trained in PCIT, ten percent of whom are psychologists.

Lewis P. Lipsitt, Ph.D., professor emeritus at Brown University in Providence, Rhode Island, currently engages in child development research, specifically infant behavior regarding sensory and learning processes. In the classroom, he taught parent-child relationships and aberrations leading to the need for therapy. He says, "The whole idea of seeing two or three patients at one time was the beginning of family therapy." PCIT represents an "embellishment of other parent-child therapies" previously and currently in use. The distinguishing feature of PCIT, according to Lipsitt, is its evidence-based observation and treatment method.

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