Parent-child interaction therapy

1. Introduction

Version followed: standard clinic-based PCIT as defined by PCIT International, i.e. the 2011 PCIT Protocol (Eyberg & Funderburk) plus the DPICS-IV clinical manual (2013/2014), which certified therapists must use. The 2011 Protocol itself (sold by PCIT International) is not drawn on. Its structure and criteria are reconstructed from PCIT International's certification guidelines and time-out position statement, the UC Davis PCIT Training Center manual (Section 1), Funderburk & Eyberg's history chapter, and trainer materials. Where the UC Davis manual or trainers differ from PCIT International, both are named. [source: PCIT International therapist training guidelines; UC Davis PCIT manual §1; Funderburk & Eyberg history]

Parent-Child Interaction Therapy (PCIT) was developed by Sheila Eyberg in the 1970s (University of Florida). It treats disruptive behaviour in children aged about 2–7. It treats the parent and child as a dyad, and the parent is the agent of change. The therapist sits behind a one-way mirror (or on video) and coaches the parent live through an earpiece ('bug-in-the-ear') while the parent plays with the child. [source: Funderburk & Eyberg history; Lieneman et al. 2017]

How change happens: PCIT combines three roots:

traditional play therapy (following and reflecting the child's play to convey acceptance);
behaviour therapy (the parent as change agent, with contingent attention and consequences);
Baumrind's authoritative parenting (nurturance plus clear communication and firm limits).

Its two-stage structure comes from Hanf's 1969 model. In the first phase (Child-Directed Interaction, CDI), the parent's differential attention strengthens the relationship and reinforces positive behaviour. In the second phase (Parent-Directed Interaction, PDI), clear commands with predictable, consistent consequences break coercive cycles and build compliance. Live coaching changes the parent's behaviour in the moment, and coding-based mastery criteria decide when the family moves on. [source: Funderburk & Eyberg history; Rogers BH 2021 slides]

2. Framework

Eligibility (typical agency criteria, not a protocol rule):

Child: aged 2–7, with receptive language above about a 2-year level.
Caregiver: at least one caregiver able to attend every session (two encouraged), with enough contact to practise at least 3 days a week.
Therapist: fluent in the family's language.

Flag these barriers at intake: custody disputes, infrequent visitation, temporary or foster placements, new partners, caregiver physical impairment, active substance use, and concerns about sexual perpetration. [source: Carpenter 2020 slides]

Phase sequence and typical session counts (UC Davis breakdown; PCIT International gives no fixed count):

Phase	Goal	Sessions (UC Davis)	Format	Move-on criterion
Intake / pre-treatment assessment	Diagnosis, baseline, fit	1–2	Interview, pre-measures (ECBI and others), recorded 15-min DPICS observation	Family suitable; goals agreed
CDI Teach	Teach the CDI rationale and skills	1	Caregivers only, didactic with modelling and role-play	Caregiver understands the skills and homework
CDI Coach	Warm relationship; differential attention	6–8 (until mastery)	Dyad, live coaching	CDI mastery in a coded 5-minute interaction (below)
Mid-treatment assessment	Check progress	up to 1	Measures plus coding	—
PDI Teach	Teach effective commands and the discipline sequence	1–2	Caregivers only; role-play (UC Davis uses a 'Mr. Bear' role-play coaching session)	Caregiver can explain and role-play the sequence
PDI Coach	Compliance; generalisation to daily life, house rules, public	6–8 (until mastery)	Dyad, live coaching, home or public visits as needed	PDI mastery plus graduation criteria
Graduation	Post-assessment, maintenance plan	1–2	15-min observation, post-measures, certificate	—

[source: UC Davis PCIT manual §1]

Total length is about 15 weekly sessions on average (Funderburk & Eyberg), 12–15 weeks in agency practice, or about 3 months. Treatment continues until criteria are met rather than stopping after a fixed number of sessions. [source: Funderburk & Eyberg history; Carpenter 2020; Lieneman et al. 2017] [uncertain: 'time-unlimited' is the usual label but was not confirmed in a primary source]

Coaching-session format (UC Davis): about 10 minutes of check-in and homework review; 5 minutes of DPICS coding at the start (5–10 minutes in PDI); about 30 minutes of coaching; then a 5-minute review with homework assigned. With two caregivers, each is coached in turn. Caregivers complete the ECBI at the start of every session. [source: UC Davis PCIT manual §1; Funderburk & Eyberg history; Rogers BH 2021]

Intensive PCIT (I-PCIT): ten 90-minute sessions given daily, 5 days a week over 2 weeks, with PDI Teach on day 1 of week 2. [source: Lieneman et al. 2017]

Phase-move criteria:

CDI mastery (PCIT International 2011): in a 5-minute coded interaction, 10 labelled praises, 10 behavioural descriptions and 10 reflections, with 3 or fewer questions, commands and negative talk combined. Some trainers teach 0 questions, commands or criticisms. [source: PCIT International training guidelines; UC Davis §1; Perez et al. slides] [uncertain: which threshold the 2011 Protocol text prints; PCIT International's guidelines state 3 or fewer]
PDI mastery: at least 75% of the parent's commands are effective (direct, specific, giving the child a chance to comply), and at least 75% are followed through correctly (labelled praise after compliance, warning after non-compliance, time-out done correctly). [source: Perez et al. slides; Rogers BH 2021; UC Davis §1]
Graduation: the caregiver meets PDI mastery, the child's ECBI is in the normal range, and the caregiver feels confident managing behaviour. UC Davis specifies ECBI Intensity below 114, at least 75% effective commands, and completed post-measures (ECBI, PSI, CBCL, TSCYC, TAI) plus a 15-minute observation. [source: UC Davis §1; Carpenter 2020] [uncertain: the exact 2011 Protocol wording of the ECBI criterion]

3. Guiding principles

The dyad is the client and the parent is the change agent. The therapist works through the parent, not on the child directly. [source: Funderburk & Eyberg history]
Relationship before discipline. Time-out is taught only after the parent has mastered the CDI skills, and CDI continues as daily special time throughout PDI. [source: PCIT Intl time-out position statement]
Follow the child's lead in CDI. No leading, teaching or directing during special time; the parent's job is to give attention to what the child chooses. [source: Funderburk & Eyberg history; Rogers BH 2021]
Differential (selective) attention. Give warm, specific attention to positive behaviour; withdraw attention from minor misbehaviour; praise its positive opposite. [source: Carpenter 2020; Perez et al. slides]
Live coaching is the core active ingredient. Coach in the moment rather than give feedback afterwards; in vivo coaching outperformed delayed feedback. [source: Funderburk & Eyberg history; Lieneman et al. 2017]
Coach responsively, not just directively. Praise the parent's good skills more than you correct, and move from directive coaching ('Say…') to less directive coaching as skill grows. Responsive coaching predicted between-session change. [source: UC Davis §1; Lieneman et al. 2017]
Teach the easier skills first. Coach description, reflection and imitation first, then labelled praise and dropping questions and commands. [source: UC Davis §1]
Assessment-driven. Weekly ECBI and 5-minute coding set each session's coaching goals and decide phase moves, rather than the calendar. [source: PCIT International training guidelines; Funderburk & Eyberg history]
Performance-based mastery. Families move on when coded criteria are met, not after a set number of sessions. [source: UC Davis §1]
Predictable, consistent limits. The child always gets the same sequence (command, warning, time-out, return to the command), so the consequence becomes familiar and the child has several chances to comply. [source: PCIT Intl position statement; Perez et al. slides]
The parent, not the child, ends time-out, and the parent never gives in mid-sequence. [source: PCIT Intl position statement; Woodfield et al. 2022]
Safety and calm. The parent keeps the child in view, uses a calm voice and keeps time-out brief. Staff never put the child in time-out; the parent does. [source: PCIT Intl position statement]
Return to warmth afterwards. After discipline, the parent goes back to CDI skills: emotional support and praise for prosocial behaviour. [source: PCIT Intl position statement; Rogers BH 2021]
Model CDI skills yourself with parent and child throughout treatment, at every contact. [source: PCIT International training guidelines]
Teach sessions are with caregivers alone; coaching sessions are with the dyad. [source: Funderburk & Eyberg history]
Daily home practice. Special time at home is what generalises skills; homework completion predicts fewer sessions to reach mastery. [source: Lieneman et al. 2017; UC Davis §1]
Generalise deliberately. Practise commands in play first, then real-life commands, then house rules and public settings. [source: UC Davis §1]
Tailor to development and culture without dropping the core. Examples: more paraphrased reflections for older children; extended family included; nonverbal emphasis where culturally fitting. [source: Lieneman et al. 2017]

4. Intervention inventory

The DPICS and the ECBI are licensed instruments (from the publishers PCIT International and PAR). Their items and code definitions are described below, not reproduced. All 'Example language' is illustrative unless quoted with a citation.

A. Intake and pre-treatment assessment

Purpose: Establish fit, set a baseline and get a coding baseline before teaching anything.
Steps:
1. Run a clinical interview covering the child's development, behaviour, family stressors and maltreatment. Ask specifically what discipline has been tried, including any previous use of time-out (the 2011 Protocol asks about this at intake).
2. Have the caregiver complete the ECBI (required for certified therapists). Recommended extras are the PSI-SF, SESBI-R (school behaviour), BASC or CBCL, and the TAI (satisfaction, at post-treatment). UC Davis adds the TSCYC for trauma symptoms.
3. Record a 15-minute DPICS observation with each caregiver. Coding has three situations: child-led play, parent-led play and clean-up.
4. Screen for the barriers in section 2.
5. Explain the treatment model, including that discipline comes later.
Example language (illustrative): "First we'll spend a few weeks on special playtime, because that makes the later discipline work faster and feel fairer to your child."
Watch for: Unrealistic expectations of quick discipline fixes. Watch also for a caregiver who cannot attend regularly, and for safety or custody issues that need addressing first.

[source: PCIT International training guidelines; Woodfield et al. 2022; UC Davis §1; Carpenter 2020] [uncertain: the three-situation structure of the observation is standard DPICS but the DPICS manual is not drawn on]

B. Weekly assessment: ECBI plus 5-minute DPICS coding

Purpose: Track home behaviour and the parent's skill each session, and set that session's coaching goals.
Steps:
1. The caregiver completes the ECBI in the waiting room or at check-in, and you plot it.
2. Start each coaching session by coding 5 minutes of play without coaching. Tally labelled and unlabelled praise, reflections, behavioural descriptions, questions, commands and negative talk.
3. Enter the tallies on the CDI Progress Record.
4. Pick 1–2 coaching targets: the skill furthest below criterion, or the commonest 'avoid' behaviour.
5. Tell the parent briefly, leading with strengths.
Example language (illustrative): "You had lots of great descriptions today. Let's aim to turn some of those questions into reflections."
Watch for: Coder drift. Certification requires at least 80% agreement with a trainer on a DPICS-IV criterion video.

[source: PCIT International training guidelines; Rogers BH 2021; UC Davis §1]

C. CDI Teach session (caregivers only)

Purpose: Give the rationale and teach the do skills, avoid skills, ignoring and stopping play, before any coaching.
Steps:
1. Explain the goals: a warmer relationship, and more attention for positive behaviour.
2. Teach the CDI rules: follow the child's lead; have fun; no distractions such as phones or TV; one-to-one time.
3. Teach each PRIDE skill (D–H) with a definition, an example and a rationale.
4. Teach the avoid skills (I).
5. Teach active ignoring of minor misbehaviour (J) and stopping play for aggressive or destructive behaviour (K).
6. Model the skills, then role-play: you play the child and the parent practises, with you praising their skills.
7. Set up toys (L) and special-time homework (M).
8. Cover every item on the CDI Teach integrity checklist (fidelity is assessed against it).
Example language (illustrative): "For five minutes a day your child is the boss of the play. Your job is to notice and narrate what they do, not to teach or correct."
Watch for: Parents who start rehearsing questions. Correct gently in the role-play, before the first coached session.

[source: Funderburk & Eyberg history; PCIT International training guidelines; Perez et al. slides; UC Davis §1]

D. Labelled praise (P)

Purpose: Strengthen specific positive behaviours and the child's sense of being valued.
Steps:
1. Notice a positive behaviour.
2. Name it specifically and approvingly, straight away.
3. Prefer labelled to unlabelled praise ('Good job' alone does not count towards criterion).
4. Target behaviours you want more of (the opposites of the problem behaviours), such as gentle hands, sharing, patience or calm voice.
Example language (illustrative): "Thank you for handing me the blue block so gently."
Watch for: Praise that becomes evaluative of products only. Coach praise for prosocial behaviour too.

[source: Funderburk & Eyberg history; Johnson & Henry 2025; UC Davis §1]

E. Reflection (R)

Purpose: Show you are listening, accept the child, and build the child's language.
Steps:
1. Repeat or paraphrase the child's appropriate talk, keeping its meaning; you may add a little.
2. Do not reflect rude or inappropriate talk; ignore it instead.
3. For older children, use more paraphrase and richer vocabulary.
4. For children with speech delay, criteria may be lowered (as in the Perez case).
Example language (illustrative): Child: "The car goes fast." Parent: "Your car is going super fast."
Watch for: A rising intonation, which turns the reflection into a question.

[source: Johnson & Henry 2025; Lieneman et al. 2017; Perez et al. slides]

F. Imitation (I)

Purpose: Show approval of the child's play and teach turn-taking; children tend to imitate back.
Steps:
1. Do what the child is doing with your own toys, alongside them, and say so.
2. Copy only appropriate play.
Example language (illustrative): "I'm going to build a tower like yours."
Watch for: Imitation that drifts into taking over or 'improving' the child's creation.

[source: Johnson & Henry 2025; UC Davis §1]

G. Behavioural description (D)

Purpose: Hold attention on the task, give positive attention, and model language. Descriptions alone outperformed questions for on-task behaviour.
Steps: Narrate the child's ongoing appropriate actions, like a sportscaster: a subject plus an action, said as a statement. Describe only appropriate behaviour.
Example language (illustrative): "You're colouring the sun yellow."
Watch for: Descriptions of the parent's own actions, which do not count, and drift into questions.

[source: Lieneman et al. 2017; Johnson & Henry 2025]

H. Enjoyment or enthusiasm (E)

Purpose: Warmth that makes the attention rewarding.
Steps: Use warm voice tone, smiling, eye contact and appropriate touch, and show genuine interest. Coach qualitative aspects too: warmth, eye contact, vocal tone, persistence and tolerating frustration.
Example language (illustrative): "I love playing trains with you!"
Watch for: Flat affect in a depressed caregiver; see section 5.

[source: UC Davis §1; Funderburk & Eyberg history] [uncertain: the protocol's letter E is given variously as Enjoyment or Enthusiasm across sources]

I. Avoid skills: questions, commands, negative talk

Purpose: Remove leading and intrusive talk, which takes the lead away from the child, and criticism, which gives attention to negatives.
Steps:
1. Teach parents to spot and drop the three avoid behaviours:
  - questions, including 'tag' questions and a rising tone;
  - commands, direct or indirect;
  - negative talk, which covers criticism, sarcasm, 'no', 'don't', 'stop' and 'quit'.
2. Also avoid negative physical behaviour.
3. Coach replacements: turn a question into a reflection or description, and turn a 'don't' into ignoring plus praise of the opposite behaviour.
Example language (illustrative): Coach: "Try that as a statement: 'You're making a red car.'"
Watch for: Indirect commands disguised as suggestions ("Let's put the lid on"). These count as commands.

[source: Funderburk & Eyberg history; Rogers BH 2021; UC Davis §1]

J. Selective attention / active ignoring

Purpose: Stop rewarding minor attention-seeking misbehaviour (whining, sassing, rough but not dangerous play) and break the coercive cycle.
Steps:
1. When the minor misbehaviour starts, immediately withdraw all attention: look away, keep a neutral face, stop talking to the child. Keep playing with your own toy (as in Perez et al.'s 'soft' versus 'hard' ignore distinction).
2. Expect the behaviour to get worse briefly.
3. The instant appropriate behaviour returns, re-engage warmly and give labelled praise for the positive opposite.
4. In coaching, cue the parent through the earpiece when to start ignoring and when to come back with praise.
Example language (illustrative): Coach: "Turn away and play with your own blocks… there, she's sitting nicely. Praise that now."
Watch for: Parents who sigh, glance or comment; any of these gives attention. Never ignore dangerous behaviour.

[source: Perez et al. slides; Carpenter 2020; Rogers BH 2021] [uncertain: definitions of soft and hard ignore are not given in the slides; the in-session steps are synthesis from the selective-attention principle]

K. Stopping play for aggressive or destructive behaviour (CDI phase)

Purpose: Safety, and to make it clear that harmful behaviour ends the special attention. This applies before discipline skills are taught.
Steps:
1. If the child hits, throws or deliberately breaks things, the parent states briefly that playtime is over because of the behaviour and ends special time.
2. The parent stays calm and removes attention.
3. Make another chance available later in the day.
Example language (illustrative): "Special time is over because you hit. We can try again later."
Watch for: Children who learn that aggression ends a play they dislike. If it recurs often, review toys and length, and move towards PDI readiness.

[source: Rogers BH 2021; Perez et al. slides] [uncertain: the exact protocol wording and the later-retry rule; steps 2–3 are synthesis]

L. Toy selection and room set-up

Purpose: Make CDI successful and keep limit-setting to a minimum.
Steps:
1. Provide creative and constructional toys such as blocks, Lego, crayons, toy people and animals.
2. Avoid toys with rules (board games), toys that invite rough or aggressive play, and messy toys that need limits.
3. Match toys to the child's age, development, interests and motor skills.
4. In clinic, the room has a one-way mirror or camera, a coaching earpiece, a small set of selected toys and coding sheets.
Watch for: Siblings and screens in home practice.

[source: Rogers BH 2021; Perez et al. slides; Carpenter 2020]

M. Special time homework (daily CDI practice)

Purpose: Daily practice is how skills generalise, and completion predicts faster mastery.
Steps:
1. Assign 5 minutes a day of CDI play, at a consistent time.
2. Use set toys, with no phones and no siblings.
3. Do not use special time as a reward or take it away as a punishment.
4. The caregiver logs each day on the home record sheet (UC Davis: 'Daily HomeFun Sheet').
5. Review the log at every check-in.
6. Special time continues through PDI and after graduation.
7. Minimum expectation: practice on most days (agencies cite at least 3 days a week).
Example language (illustrative): "Five minutes, every day, even on good days. That's the dose."
Watch for: Logs filled in retrospectively. Ask the parent to describe what happened in the last session.

[source: Rogers BH 2021; Perez et al. slides; UC Davis §1; Lieneman et al. 2017; Carpenter 2020]

N. CDI Coach sessions: live coaching techniques

Purpose: Shape parent skills to mastery in vivo.
Steps:
1. Check in and review homework (about 10 minutes).
2. Code for 5 minutes without coaching, then choose targets.
3. Coach through the earpiece for about 30 minutes. Use brief, frequent comments:
  - labelled praise of the parent's skills (the main tool);
  - prompts or direct suggestions;
  - modelled phrases the parent can repeat;
  - short explanations of why a skill matters;
  - corrective feedback, used sparingly.
4. Sequence the skills: easier ones first (description, reflection, imitation), then labelled praise and dropping questions and commands.
5. Fade from directive to non-directive coaching as the parent improves.
6. Also coach qualitative and child-level targets: polite manners, sharing, persistence, frustration tolerance, and developmentally sensitive teaching.
7. Give a 5-minute review, show the coding result and set homework.
8. Where the child has two caregivers, coach each caregiver in turn.
Example language (illustrative): Coach in the earpiece: "Nice reflection!" / "Describe what he's doing with the truck." / "Great ignoring. Now praise him for sitting."
Watch for: Over-talking. If you talk constantly, parents cannot attend to the child. Let them hear the PCIT skills used on them by you.

[source: UC Davis §1; Funderburk & Eyberg history; Lieneman et al. 2017; PCIT International training guidelines]

O. Mid-treatment assessment / CDI mastery check

Purpose: Decide readiness for PDI.
Steps:
1. In the 5-minute coding at the start of the session, check the CDI criteria (10/10/10, with 3 or fewer questions, commands and negative talk).
2. Repeat the measures if your service uses a mid-point battery.
3. When one caregiver reaches mastery, move that caregiver on. With two caregivers, decide locally whether to wait for both [uncertain].
4. Do not start PDI Teach until mastery is met.
Watch for: Pressure to rush to discipline. Mastery predicts the safety and success of time-out.

[source: UC Davis §1; PCIT Intl position statement]

P. PDI Teach session (caregivers only)

Purpose: Teach effective commands and the full discipline sequence, and rehearse them before the child experiences them.
Steps:
1. Explain the rationale: a predictable sequence gives the child several chances to comply, and consistency cuts how many time-outs are needed over time.
2. Teach the effective-command rules (Q). UC Davis teaches these under the mnemonic 'BE DIRECT'.
3. Teach command → comply → praise (R).
4. Teach the warning, the time-out chair, the chair-escape and back-up procedure, and return to the original command (S–U).
5. Agree the chair and back-up locations in the home.
6. Model the sequence, then role-play it with you as the child (include defiance and escape attempts).
7. Plan how the parent will explain the procedure to the child in developmentally appropriate words. Certified therapists must be able to do this or coach a parent to.
8. Cover every item on the PDI Teach integrity checklist.
Example language (illustrative): "Each command gets the same steps every time: you say it once, clearly, then you wait. Your child will learn the pattern fast if you never skip a step."
Watch for:
- Parents who plan to add extra warnings, explanations or threats.
- Physical-safety worries.
- Any history of harsh physical discipline. Address this explicitly and state that physical punishment is not part of the plan.

[source: PCIT International training guidelines; UC Davis §1; PCIT Intl position statement; Perez et al. slides]

Q. Effective commands

Purpose: Commands the child can understand and follow, which create a clear chance to comply.
Steps: Teach and coach these rules:
1. Direct, not indirect or question-form ("Please hand me the cup", not "Can you…?").
2. Positively stated: say what to do, not what to stop.
3. One command at a time.
4. Specific, not vague ("Put the block in the box", not "Behave").
5. Developmentally appropriate.
6. Given in a neutral, polite tone.
7. Explanations given before the command or after compliance, never as an argument while waiting.
8. Used only when necessary. During PDI coaching, other play stays CDI.
Start with easy, low-stakes commands and move to harder ones at a pace that builds the parent's confidence.
Example language (illustrative): "Please put the red car in the basket."
Watch for:
- Commands the child cannot physically do.
- Commands parents cannot enforce.
- 'Let's…' commands.
- Strings of commands.

[source: Carpenter 2020; Johnson & Henry 2025; Rogers BH 2021; UC Davis §1] [uncertain: the Perez slides list 'no explanation' rather than 'explain before or after'. Most sources give the before-or-after rule, and that version is followed here]

R. Compliance and labelled praise

Purpose: Reinforce minding.
Steps:
1. After the command, wait silently for about 5 seconds. Do not repeat the command, look away or touch the child.
2. If the child begins to comply, give immediate, enthusiastic labelled praise for minding.
3. Return to CDI.
Example language (illustrative): "Thank you for listening and putting the car in the basket!"
Watch for: Parents who repeat the command at second 3. That teaches the child to wait for repetitions.

[source: Rogers BH 2021; Perez et al. slides]

S. Time-out warning

Purpose: One clear chance to avoid the consequence.
Steps:
1. If there is no compliance within about 5 seconds, give a single warning: an if–then statement naming the chair.
2. Wait about 5 seconds again.
3. If the child complies, give labelled praise. If not, start time-out (T).
4. Give no second warning, no counting and no bargaining.
Example language (illustrative): "If you don't put the car in the basket, you'll have to sit on the time-out chair."
Watch for: Warnings that grow into lectures, and threats the parent will not carry out.

[source: Rogers BH 2021; Woodfield et al. 2022; Perez et al. slides]

T. Time-out chair

Purpose: Briefly remove reinforcement after non-compliance in a safe, boring, predictable way.
Steps:
1. State briefly why time-out is happening, naming the non-compliance.
2. The parent takes the child to the designated adult-sized chair, using the least restrictive prompt needed.
3. Tell the child to stay on the chair until the parent says they can get up.
4. The parent stays where the child can be seen and ignores all talk: whining, sassing, negotiating and apologies. The parent does not tell the child to be quiet.
5. Time-out lasts 3 minutes, then until the child has been quiet for 5 seconds (contingent release). The parent decides when it ends.
6. The chair is in a boring, safe, visible spot: not the bedroom, not dark or isolated.
7. Time-out applies to non-compliance with an effective command (and to house-rule breaks, V), not to tantrums or whining as such.
Example language (illustrative): "You didn't put the car away, so you have to sit on the chair."
Watch for:
- The parent talking or giving eye contact.
- The parent ending time-out early or adding minutes.
- Any rough handling: stop and coach calm, safe guidance.

[source: Rogers BH 2021; Perez et al. slides; Woodfield et al. 2022; Johnson & Henry 2025; PCIT Intl position statement]

U. Chair escape: the back-up procedure, and returning to the original command

Purpose: Teach the child to stay on the chair while keeping the parent in control without physical restraint.
Steps (PCIT International 2011 sequence as presented in trainer slides):
1. If the child leaves the chair before time-out ends, the parent gives one warning that leaving again means the back-up space.
2. If the child leaves again, the parent takes the child to the back-up space. It lasts 1 minute, then until 5 seconds of quiet.
3. The child then returns to the chair and does the full chair time-out (3 minutes plus 5 seconds of quiet).
4. After the chair, the parent leads the child back and repeats the original command.
5. If the child complies, the parent gives only a brief neutral acknowledgement ("Fine" in the slides), not enthusiastic praise. The parent then gives a second similar command; compliance with that one earns labelled praise.
6. If the child refuses the original command, the child goes back to the chair and the sequence repeats.
7. Return to CDI warmth afterwards.
Back-up space requirements (position statement): the parent places the child there, the parent can observe or monitor, and it is physically safe. Agencies must check local seclusion rules; some states and agencies restrict staff from placing children in a back-up space. Alternatives: the UC Davis manual lists handouts for alternative back-ups: 'swoop and go', two-choice time-out, removal of privileges, and two-choice removal of privileges. The Woodfield review advises the least restrictive escape response first (for example, repeatedly returning the child to the chair), with a time-out room only for severe cases and with professional support. Spanking and physical restraint are not recommended.
Example language (illustrative): "If you get off the chair again, you'll go to the time-out room."
Watch for:
- Back-up use falls quickly once the child learns to stay on the chair. If it does not, review consistency.
- Safety: no locked doors, nothing dangerous in the space [synthesis].
- If physical struggle escalates, stop and choose a non-physical back-up [synthesis].

[source: Rogers BH 2021; Perez et al. slides; PCIT Intl position statement; UC Davis §1; Woodfield et al. 2022] [uncertain: the step-by-step contents of the UC Davis alternative back-up handouts; the second-command rule is from trainer slides, not the Protocol text]

V. Explaining time-out to the child and role-play ('Mr. Bear')

Purpose: Make sure the child understands the procedure before it is first used, so time-out is predictable.
Steps:
1. In the first PDI Coach session, the parent explains the sequence to the child in simple words.
2. Demonstrate the whole sequence on a stuffed toy: the bear gets a command, a warning, the chair and the back-up.
3. Then practise real 'minding' with easy play commands.
Example language (illustrative): "Mr. Bear didn't listen, so he has to sit on the chair till Mum says he can get up."
Watch for: Children who are frightened by the demonstration. Keep it light and brief.

[source: UC Davis §1; PCIT Intl position statement; PCIT International training guidelines] [uncertain: the bear-demonstration detail is inferred from the UC Davis session name 'PDI coaching with role play (Mr. Bear)'; the script is not drawn on]

W. PDI Coach sessions and graded home practice

Purpose: Achieve PDI mastery and generalise it.
Steps:
1. Each session: check-in and ECBI, then 5–10 minutes of coding (CDI then PDI), then coaching.
2. Coach about 3–4 direct commands in a session, each followed through correctly, while CDI continues between commands.
3. Coach every step of the sequence in real time.
4. Assign homework in stages:
  - commands during special-time play only;
  - then a few real-life commands a day;
  - then commands throughout the day;
  - then house rules and public behaviour.
5. Make home or public visits if needed.
Example language (illustrative): Coach: "Give one command now: 'Please hand me the green block.' … Wait… He did it, praise him for listening."
Watch for: Parents who stop doing special time once PDI starts.

[source: UC Davis §1; Carpenter 2020] [uncertain: the staged homework levels are from PCIT trainer handout titles (Troutman lab)]

X. House rules and automatic time-out

Purpose: Handle aggressive, destructive or impulsive behaviour (hitting, throwing) without needing a command first.
Steps:
1. Choose one or a few standing rules for serious behaviours, phrased with the positive opposite.
2. Explain each rule and its consequence in advance.
3. When the rule is broken: no warning. The parent briefly names the rule and that it means automatic time-out, takes the child to the chair, and gives a direct command to sit quietly until told to get up.
4. The child sits for 3 minutes plus 5 seconds of quiet.
5. The parent asks whether the child is ready to return, and gives a corrective action (for example, gently handing the toy back). The parent waits silently, or points, for compliance.
6. Acknowledge with a simple thank-you.
7. Afterwards, do not discuss the misbehaviour. Praise the positive opposite.
Example language (illustrative): "You hit. That's an automatic time-out."
Watch for:
- Too many rules.
- Rules for minor behaviours, which should be ignored instead.

[source: UC Davis automatic time-out handout; UC Davis §1]

Y. Public behaviour

Purpose: Generalise compliance to shops, restaurants and outings.
Steps:
1. Introduce this late in PDI and practise it to mastery. UC Davis provides a 'Steps for Managing Behavior in Public' handout and allows public visits with the therapist.
2. A typical plan (synthesis, consistent with the PDI sequence):
  - Before entering, state 2–3 positively worded rules.
  - Give frequent labelled praise and descriptions during the outing.
  - Use the same command → warning → time-out sequence with an agreed public time-out spot, such as a bench or a quiet corner.
  - Plan short practice trips at low-stress times first.
Example language (illustrative): "In the shop: stay by the cart and use gentle hands."
Watch for: Parental embarrassment that leads to giving in. Rehearse coping thoughts beforehand.

[source: UC Davis §1] [synthesis for the step detail; the handout contents are not drawn on]

Z. Graduation and maintenance

Purpose: Confirm the criteria are met and protect gains.
Steps:
1. Confirm PDI mastery and the ECBI criterion (normal range; UC Davis: Intensity below 114) and parent confidence.
2. Repeat the 15-minute observation and post-measures (ECBI, PSI, CBCL, TSCYC, TAI per UC Davis).
3. Review the skills and the plan for continued special time and future problems.
4. Give a certificate and a celebration.
5. Offer booster sessions. Refer on, for example to TF-CBT, if needed.
Watch for: Ending on a single good ECBI week. Look for stability across sessions [synthesis].

[source: UC Davis §1; Carpenter 2020; Funderburk & Eyberg history]

AA. Named adaptations and formats (use only with the relevant training)

The sources describe these only briefly. Each has its own manual, which is not drawn on [uncertain on details].

Intensive PCIT (I-PCIT): ten 90-minute daily sessions over 2 weeks (structure in section 2). For families who travel or need speed.
Home-based PCIT, internet-delivered or telehealth PCIT: coaching via video into the home. Real-life behaviour is easier to coach, and lower dropout has been reported. Set up the camera, the earpiece and a toy kit at home [synthesis].
Toddler adaptations:
- Infant Behavior Program: stresses nonverbal praise and repeating the child's vocalisations, with no PDI.
- PCIT-Toddlers (about 12–24/30 months): shorter sessions, a CDI focus, and guided compliance (hand-over-hand) instead of time-out. Time-out is not indicated under age 2.
Older children (about 7 and over):
- more paraphrased reflections and richer vocabulary;
- extended ignoring periods ('big ignore');
- incentive charts;
- removal of privileges instead of the chair.
Autism spectrum: a time-out readiness phase, and a physical-guidance option described as the 'Big Red Stop Button'. Parent-Child Attunement Therapy is a version without time-out.
Anxiety:
- PCIT-SA (separation anxiety, ages 4–8): CDI, then a Bravery-Directed Interaction (BDI) phase, then PDI. BDI covers psychoeducation on the anxiety–avoidance cycle, a bravery ladder with weekly exposures, rewards for brave behaviour and reduced accommodation. Time-out is never used for separation situations.
- CALM (ages 3–8): CDI with low-level exposures, then the DADS steps (Describe the feared situation, Approach with modelling and waiting, Direct command to approach, Selective attention: praise approach, ignore avoidance). Use exposure consent and grading as in any exposure work.
Other variants:
- PCIT-Emotional Development, for early depression or bipolar presentations;
- PCIT with emotion coaching, for ADHD;
- PCIT combined with motivational interviewing, for maltreating parents;
- group PCIT;
- Teacher-Child Interaction Training (TCIT), in classrooms, where teachers reduce rather than eliminate commands.
Cultural and disability adaptations:
- translated materials and interpreters trained in PCIT; Signing Exact English for Deaf families, with visual counting before time-out;
- including extended family;
- extended coding times (for American Indian and Alaska Native families);
- nonverbal emphasis (for Māori families);
- simplified coaching and more frequent sessions for caregivers with ADHD or intellectual disability;
- reduced reflection criteria for children with significant speech delay.

[source: Lieneman et al. 2017; Carpenter 2020; Woodfield et al. 2022; Rogers BH 2021; Perez et al. slides]

AB. Delivering under the PCIT name: certification and fidelity (PCIT International)

Eligibility:
- a master's degree or higher in a mental health field, and either independently licensed or supervised by a licensed provider;
- or a doctoral psychology student past the third year.
Initial training: one of three routes:
- 40 hours face-to-face with a Level II or Global Trainer;
- 10 hours of endorsed online training plus 30 hours face-to-face and a skills review;
- 40 hours with a Level I Trainer, including at least 20 hours of co-therapy or live supervision.
Consultation and cases: contact with a trainer at least twice a month until 2 cases have graduated under the 2011 Protocol criteria, at least one with you as primary therapist.
Skills review: a trainer observes your CDI Teach, PDI Teach, CDI Coach and PDI Coach sessions.
Coding reliability: at least 80% DPICS-IV agreement on a 5-minute criterion video.
Competencies:
- meet the parent CDI criteria yourself in a role-play;
- interpret the CDI Progress Record;
- demonstrate the discipline sequence;
- explain house rules and public behaviour;
- administer, score and interpret the ECBI.
Fidelity: use the 2011 Protocol and the DPICS-IV manual, and cover every item on the session integrity checklists.
Recertification: every 2 years, with 3 hours of approved PCIT continuing education.
Within-agency trainer roles: these exist.

[source: PCIT International training guidelines; Carpenter 2020]

5. Handling problems

Parent stuck in CDI (no mastery after many coach sessions).

Re-read the CDI Progress Record. Usually one skill, most often questions, is holding the parent back.
Coach that single target: "Turn it into a statement" every time it happens.
Praise near-misses, and model phrases the parent can copy word for word.
Check the homework: little home practice predicts more sessions to mastery.
For caregivers with ADHD, intellectual disability or depression: simplify coaching, add sessions, and assess or refer for the caregiver's own treatment. [source: UC Davis §1; Lieneman et al. 2017] [synthesis: single-target coaching]

Homework non-adherence.

Explore the barriers concretely: when, where, siblings, shift work.
Shrink the task to 5 minutes at a fixed anchor point, such as after the bath.
Have the parent show at check-in what they did in the last session.
Praise any practice rather than criticise the gaps.
Agencies require the child to be accessible at least 3 days a week. If custody or visitation prevents this, discuss timing or format, for example I-PCIT. [source: Carpenter 2020; Lieneman et al. 2017] [synthesis]

The child escalates when ignored (extinction burst).

Prepare the parent in the Teach session that behaviour often gets worse before it improves [synthesis].
Coach the parent in the moment to keep ignoring and to be ready to praise the first appropriate behaviour.
If behaviour becomes aggressive or destructive, switch to stopping play in CDI, or to house rules once PDI is in place. [source: Rogers BH 2021; UC Davis automatic time-out handout] [synthesis on the burst]

The parent gives in during time-out, adds lectures, or ends it early.

Coach calmly and continuously through the earpiece ("You're doing it, stay quiet, he's learning").
Remind the parent that ending time-out on the child's terms raises the number of future time-outs.
Rehearse again with role-play.
Normalise distress about crying. [source: PCIT Intl position statement] [synthesis for the coaching phrases]

Repeated chair escapes.

Use the back-up exactly as taught: one warning, then 1 minute plus 5 seconds of quiet, then back to the chair.
Expect back-up use to fade once the child learns.
If agency or state rules restrict a back-up space, or the home has none, use the least restrictive alternatives (returning the child to the chair, removal of privileges, or the UC Davis two-choice or 'swoop and go' options).
Never use spanking, restraint or a locked room. [source: PCIT Intl position statement; Woodfield et al. 2022; UC Davis §1]

Physical struggle, parental anger, maltreatment risk.

Parents, not staff, place children. Coach physical safety and a calm tone.
If a parent becomes rough or threatening, pause the PDI practice, return to CDI, and debrief.
With physically abusive caregivers, PCIT (sometimes combined with motivational interviewing) teaches safe time-out as the replacement for physical punishment.
Follow your child-protection reporting duties if you observe or learn of abuse [synthesis].

[source: PCIT Intl position statement; Lieneman et al. 2017]

Rupture: a parent feels criticised by coaching.

Shift the ratio towards labelled praise of the parent.
Use responsive rather than directive coaching.
Explain the purpose of coding (it tracks skills, not the parent's worth).
Show their progress graph.
Ask how the earpiece feels, and adjust how often and in what tone you comment. [source: UC Davis §1; Lieneman et al. 2017] [synthesis]

Two caregivers who disagree, or one who does not attend.

Encourage both to attend and coach each in turn.
A consistent discipline sequence across households matters more than each parent's style [synthesis].
Where only one caregiver participates, plan how they will talk with the other caregiver about the house rules [synthesis].

[source: Carpenter 2020; Funderburk & Eyberg history]

Trauma history.

PCIT is recommended for children with trauma histories: warmth plus predictable limits.
Track trauma symptoms (UC Davis uses the TSCYC).
Refer for TF-CBT after PCIT if trauma-specific symptoms remain.
Introduce time-out gently and explain it beforehand, so it is predictable [synthesis]. [source: PCIT Intl position statement; UC Davis §1; Carpenter 2020]

Anxious or separation-anxious child. Do not use time-out for separation or fear-related avoidance. Consider PCIT-SA or CALM. [source: Rogers BH 2021]

Very young, developmentally delayed or autistic child.

Under 2: no time-out; use guided compliance instead.
Developmental delay: lower the reflection criteria where speech is delayed, and consider a time-out readiness phase.
Autism: consider ASD-adapted protocols. [source: Woodfield et al. 2022; Perez et al. slides; Lieneman et al. 2017]

Mastery met but ECBI still elevated.

Reassess for ADHD, anxiety, a developmental disorder, trauma, school factors or a caregiver mental-health problem.
Check generalisation: are commands and time-out being used at home, or only in clinic?
Add home or public visits.
Continue PDI coaching rather than graduate. [source: UC Davis §1 (graduation requires the ECBI criterion)] [synthesis on the reassessment list]

Telehealth difficulties.

Fix the camera angle so it shows both of them and the time-out chair.
Test earbuds before each session.
Set up a back-up plan for dropped connections: the parent switches to CDI and waits [synthesis]. [source: Carpenter 2020 (telehealth delivery noted)]

Dropout risk. Engagement suffers when treatment feels long. Use frequent progress graphs, celebrate milestones, and consider I-PCIT [synthesis; Lieneman et al. 2017 for I-PCIT].

Sources

Sources: