Many are often surprised when they hear that I work with children as young as 12-months-old. “Why would a 12-month-old ever need therapy?” they often ask. To this question I reply, “Some toddlers have what we call ‘big emotions’ that they end up expressing in unhelpful ways such as extreme tantrums, whining, screaming or aggression. These behaviors can be very frustrating for parents and can lead to more significant emotional and behavioral issues for the child down the road. So, it is best that parents start treatment early in order to change the trajectory and establish a positive relationship between themselves and their child.”

Even with this answer though, it can be difficult for someone to imagine bringing a toddler in for mental health treatment. It can be difficult to acknowledge that a child this young needs additional support and therefore a lot of parents decide to wait to engage in treatment with the hopes that things will “work themselves out.” Although through maturation some children may move away from these challenging behaviors, there are many for which these patterns of emotional and behavioral dysregulation persist. Therefore, the research completed thus far shows that the positive outcomes of early intervention, specifically through the implementation of PCIT-T, cannot be overlooked.

What is PCIT-T?
Parent-Child Interaction Therapy for Toddlers (PCIT-T) is an evidence-based early intervention program for 12-24 month old children and their caregivers. It focuses on increasing emotional regulation and building self-esteem in toddlers through teaching parents supportive and nurturing parenting practices. Parents learn how to effectively soothe their child when they experience a “big emotion” (e.g., crying, whining or yelling due to frustration or anger) and provide positive attention for their positive behaviors. Parenting skills learned not only lead to increased emotional regulation, but also a secure and trusting parent-child relationship, increased compliance and language development, and decreased parental stress.

Why do parents pursue PCIT-T?
According to research, parents who have participated in PCIT-T have specifically sought treatment due to concerns regarding their child’s behavior such as hitting/biting/scratching themselves and others, screaming, and tantrumming. This, in turn, was leading to parental stress and anxiety and therefore creating a parent-child dynamic that was unhelpful for both the child and parent.

As one can guess, the parent-child relationship is the foundation upon which children learn to engage with others. It is also very dynamic in nature wherein a child’s stress, anger, and anxiety often affects the parent’s mood and vice versa. Therefore, when a somewhat negative dynamic is established neither the parent nor the child are feeling “good” and the child is then also learning maladaptive relationship patterns. Because of this, something needs to be changed for everyone’s benefit.

What specifically needs to be changed in the dynamic?
The goal of parent-child treatment modalities is changing the dynamic from one characterized by negativity to one characterized by positivity. In order for this to occur, research has shown that paying specific attention to and rewarding a child’s positive behavior through the use of positive attention needs to occur.

Oftentimes when dealing with a child with “big emotions,” we tend to pay attention the most to the “tough moments” (e.g., the big tantrums, aggression) which ends up reinforcing these maladaptive patterns. So instead, we need to pay specific attention to the “positive moments,” withdraw our attention when they are seeking it in a negative way, and provide consistent nurturing in a systematic way when they are struggling with a “big emotion.”

What does PCIT-T look like?
PCIT-T focuses on teaching parents the aforementioned skills in a very concrete way. It utilizes both teaching and coaching sessions and parents are given weekly feedback on their skill development. Parents are also taught how to support themselves through recognition and validation of their own feelings, utilizing relaxation strategies when encountering stressful moments with their child, and challenging any maladaptive thinking patterns that are leading to a negativistic views of their own parenting effectiveness.

During teaching sessions, parents meet individually with their therapist to learn specific parenting strategies. These sessions are then followed by coaching sessions during which the therapist coaches the parents in using the skills from behind a one-way mirror using an earpiece. This allows parents to receive immediate feedback on their use of learned parenting skills, helps parents to rapidly learn the correct use of skills, and improves skill generalization to outside of the clinic.
PCIT-T can also be provided via telehealth, which allows the therapist to coach the parent in the home environment. This format can be extremely effective in generalization of the skills, as the parent is being coached right where they will be using the skills the most.

What have been the reported outcomes?
Research done on the effects of PCIT-T that have included parental report indicate a variety of benefits of participating in treatment. These benefits include, but are not limited to the following:

Parent Outcomes:

  • Increased confidence as a parent
  • Parenting skills development – new tools, strategies and techniques for managing challenging behaviors
  • Improvement in the parent-child bond
  • A better understanding of their own and their child’s feelings, desires, wishes, goals and attitudes
  • Decreased parental stress
  • Increased emotional availability

Child Outcomes:

  • Improvements in overall emotional and behavioral functioning – both with externalizing (e.g., aggression, opposition) and internalizing (e.g., sadness, anxiety, withdrawal) problems
  • A secure and stable connection with their parent – which predicts positive social and psychological outcomes across the lifespan

What makes PCIT-T effective?
When parents were asked what elements of PCIT-T they felt were the most helpful, they indicated that they benefited the most from the live coaching and home practice elements of PCIT-T. Regarding the latter, they acknowledged that although consistently practicing the skills at home was difficult, when implemented, it was very effective.

I think we could benefit from PCIT-T. Where can I find more information?
Additional information about PCIT-T at the Manhattan Psychology Group (MPG) can be found at https://manhattanpsychologygroup.com/child-treatment-services/parent-child-interaction-therapy-toddlers-pcit-t-ages-1-2/

References:
Kohlhoff, J., Morgan, S., Briggs, N., Egan, R., & Niec, L. (2020). Parent–child interaction therapy with toddlers in a community‐based setting: Improvements in parenting behavior, emotional availability, child behavior, and attachment. Infant Mental Health Journal, 41(4), 543-562.
Kohlhoff, J., Cibralic, S., & Morgan, S. (2020). A qualitative investigation of consumer experiences of the child directed interaction phase of parent–child interaction therapy with toddlers. Clinical Psychologist, 24(3), 306-314.



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