PCIT and PCIT Adaptations: A Guide for Parents Curious About Parent Child Interaction Therapy
If you’ve ever found yourself exhausted by your child’s meltdowns, second-guessing your parenting choices, or just wishing someone could give you a clear, effective roadmap – you're not alone. Parent Child Interaction Therapy (PCIT) is a powerful, evidence-based approach that helps parents feel more sturdy, connected, and consistent. In this post, we’ll break down exactly what PCIT is, how it works, and why it’s changing the game for families of young children. You’ll also learn my personal philosophy behind PCIT and what to expect in my practice.
What is PCIT?
PCIT stands for Parent Child Interaction Therapy. PCIT was originally developed in the 1970s by psychologist Sheila Eyberg to treat young children ages 2 to 7 years old with moderate to severe behavior problems. Since then, decades of research have supported and expanded the PCIT model, leading to multiple adaptations designed for different age groups and mental health needs (e.g., PCIT-Toddlers, PCIT-Older Child, PCIT-CALM for anxiety, PCIT-ED for mood concerns).
PCIT was developed out of a combination of attachment theory and social learning theory.
Attachment Theory shows that parenting warmth, responsiveness, connection, and consistency lead to more positive child outcomes. In all variations of PCIT, parents are coached how to accomplish this kind of secure relationship with simple and clear skills, especially in the face of challenging child behavior.
Social Learning Theory is all about how children learn their own behavior through watching and experiencing others. Each version of PCIT involves coaching parents to use skills modelling appropriate emotion regulation, consistent expectations and limit-setting, teaching age-appropriate cooperation, and celebrating progress towards learning.
How Does PCIT Work?
From the onboarding process to positive parenting skills coaching to targeted behavior and emotional strategies, PCIT follows a consistent pathway.
1. Getting Started
PCIT Clinical Intake
PCIT begins the way most therapies do, with a comprehensive clinical intake. Your therapist will review your child’s developmental history, current challenges, and what methods you have already tried to help their symptoms. You may also receive surveys or measures to complete about your child’s symptoms and/or to give to your child’s other caregivers and teachers.
Pre-Treatment Play Observation
One of my favorite features of PCIT is the baseline play observation. This valuable tool allows the PCIT therapist to observe you and your child engaging in real-life play situations. Periodically, you’ll be coached to change the play so the therapist can see how your child responds to different scenarios. Each caregiver who is participating in PCIT will be asked to play with the child one-on-one. while the therapist observes and codes the interactions. While you are playing, your therapist will be collecting and coding baseline data on child behavior and parent responses. This helps your therapist see how symptoms show up in real time and tailor the treatment to your family’s communication style and needs.
If you’re doing virtual PCIT, your therapist will guide you in preparing your space and selecting appropriate toys so you can participate fully from home. The therapist’s camera will be turned off during the coded observation to avoid child distraction from play.
2. Child-Directed Interaction (CDI)
The first phase of PCIT, Child-Directed Interaction (CDI), focuses on teaching parents to use a set of positive parenting skills consistently, even in the face of a child’s most challenging behaviors or symptoms. These are the same skills play therapists use to connect with children, and you will learn to offer them to your child every day.
CDI-Teach (Parents-Only Session)
You’ll receive feedback about the play observation and learn all the CDI positive parenting skills. Your therapist will collaborate with you to tailor PCIT to your family’s values and customs, provide examples addressing your child’s specific needs, and role play how to use the skills during challenging moments. You’ll be asked to practice CDI skills 5-10 minutes per day with your child at home and keep track of how it’s going throughout this phase.
CDI-Coach (Live Parent Coaching)
Here is where the magic begins! For the next several sessions, you'll play with your child while wearing headphones, and your therapist will coach you in real-time using live feedback. Leaning on your coach for support and guidance, you will receive immediate responses and try new ways of addressing problems. During the course of CDI coaching, parents typically see reduced parent stress, improvements in child self-esteem, attention, language, and social skills, reductions in behavioral problems, and an increased sense of secure-attachment between parent and child. Your PCIT therapist will share charts and graphs showing your progress over time so you know exactly what areas to focus on during your home practice and how far you’ve come each session.
CDI Graduation: You’ll "graduate" this phase once you reach research-backed skill benchmarks that predict long-term success, even after therapy ends.
3. Parent-Directed Interaction (PDI) or Other Adaptation Modules
The second phase of PCIT depends on your child’s symptoms, progress, and your goals. Some families with more mild concerns complete CDI and feel confident with the results, deciding to end therapy there. In my practice, I use a data-driven review of progress made since starting therapy and combine it with your family’s goals and remaining child symptoms to recommend the next steps. Most families benefit from additional targeted phases, such as:
If Child Behavior Problems Persist: Parent-Directed Interaction (PDI)
Parent Directed Interaction (PDI) is the next phase of classic or standard PCIT, and has the most research support for improving behavior problems in children. In this phase, you will learn how to give effective instructions that help your child cooperate quickly and the first time. You will be coached on rapid-response limit setting and appropriate consequences. There are several variations of PCIT that offer a PDI-like phase, and each uses a different approach depending on the child’s age and developmental abilities (e.g., PCIT-Toddlers, PCIT-Older Child). Throughout PDI, you will apply these skills in increasingly complex real-life situations (e.g., during mealtime, on a public outing, or with siblings).
PDI Graduation: You “graduate PDI” when you demonstrate skills benchmarks — giving mostly effective directions and effective follow-up depending on the child’s cooperation levels.
If Child Anxiety Concerns Remain: PCIT-CALM and the DADS Sequence
If anxiety is the most prominent remaining concern, PCIT-CALM offers a phase called the DADS sequence. During this phase, your PCIT therapist will work with you to identify the factors surrounding your child’s anxiety and build a “fear ladder” to prepare for gradual exposure. You will then learn and be coached on how to support your child in practicing “brave” behaviors and gradually facing those fears, one step at a time.
If Child Depression or Emotional Problems Remain: PCIT-ED and Emotional Development Coaching
If your child’s emotional problems (like guilt, irritability, sadness) remain, PCIT-ED offers a phase called Emotional Development (ED). In this phase, parents are taught and coached on ways to promote a child’s emotional expression and emotion regulation. In my practice, I may also recommend supplementing with other evidence-based techniques from Cognitive Behavior Therapy (CBT), Acceptance and Commitment Therapy (ACT), or Dialectical Behavior Therapy (DBT).
4. Graduating PCIT
You’ll graduate PCIT when you demonstrate proficiency in all phases of skill coaching, when your ratings of your child’s symptoms fall in the normal range, and when you feel comfortable and confident using PCIT skills to manage your child’s behaviors in your day-to-day life. This usually happens within 12 to 20 therapy sessions.
Post-Graduation Options
End Therapy: After graduation, many families have all the skills they need to maintain their child’s therapeutic goals at home without any further therapy.
Booster Sessions: Your therapist will offer you an optional booster session one month after PCIT graduation to reinforce your skills and offer an opportunity to ask questions. Booster sessions are always available to address any re-emerging or new concerns that arise in the future.
Return to or Begin Other Needed Therapies: For children with more complex concerns, graduating PCIT may promote a child’s cooperation abilities enough so that they are better able to engage in other needed therapeutic services, (like toilet training, feeding therapy, or trauma processing).
Frequently Asked Questions About PCIT
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There are different PCIT adaptations available for children from toddlers all the way through age 11. If your child is under 3 or over 7, consider to asking whether your PCIT provider offers adaptations appropriate for your child’s age and developmental abilities. PCIT therapists may specialize in some but not all available PCIT adaptations.
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PCIT sessions typically last 45–60 minutes and are recommended at least weekly. While parents participate the entire time, children usually join the play portion for about 20–40 minutes of the session.
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Most families complete PCIT therapy in 12–20 weekly sessions. Since graduation of the program is based on progress and meeting skill benchmarks, the length of the program can be shorter or longer than this estimate. The most important factor for determining how quickly a family is able to “graduate” the program is consistent attendance and home skills practice. Longer timeframes may occur due to complexity of presentation, external events (e.g., moving, births/deaths in the family, trauma occurring during the course of treatment), or other interruptions of treatment participation.
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For decades, research has shown standard PCIT to be a highly effective and efficient approach to child behavior change. Studies show that graduating PCIT makes much more of a difference in child behavior than other common approaches like play therapy, parenting classes (Triple P, Incredible Years), cognitive behavior therapy (CBT), and even ADHD medication. PCIT even made a greater difference than those models for families who only participated in 4 sessions!
Some of the most impressive PCIT research shows long-lasting effects well after the completion of treatment, reduced parenting stress, child behavior improvements in multiple environments, and even sibling behavior improvements (even if they weren’t involved in the treatment at all!).
More recent research supports PCIT-Toddler’s superior effectiveness over other therapies at increasing secure attachment, improving parent empathy and attunement, and preventing or resolving early onset child emotional and behavioral problems.
Other PCIT adaptations must provide research and effectiveness studies prior to being endorsed by PCIT International. You can find up to date information on PCIT research and effectiveness here.
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Yes! Studies show that online PCIT is just as effective—and sometimes even more so—than in-person sessions. My PCIT practice is fully internet-based, and I prefer it to in-clinic care for a number of reasons. When I observe a child in their home environment, their behavioral patterns and triggers become more apparent more quickly. Through internet-based PCIT, we can do live test-drives of new skills and solutions as they pertain to your exact home layout, toy availability, common interruptions (like siblings or pets), and true-to-life routines (e.g., during meals or bedtime).
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While many child therapists have heard of PCIT, only certified PCIT therapists (or those in training under a certified PCIT trainer) are qualified to offer the full evidence-based program. PCIT certification is a rigorous process that involves over 40 hours of didactic training, learning and demonstrating reliable coding using the PCIT manual, observation and feedback by a certified trainer of several key PCIT sessions to ensure fidelity to the model, and ongoing regular consultation with a trainer until several clients have successfully graduated. PCIT therapists are required to participate in continuing education every 2 years to maintain certification, and frequently consult with the larger PCIT community to hone their expertise. Once PCIT therapists have been certified, they are able to participate in a further learning of PCIT adaptations, and some of those programs require their own rigorous training, observation, and certification processes.
Because PCIT certifications are so time, effort, and investment intensive, certified PCIT therapists can be hard to find. You can verify a therapist’s credentials and find a list of certified PCIT therapists at any of the accrediting bodies’ links below:
Final Thoughts
PCIT is more than just therapy—it’s a parenting transformation. With the right tools and support, you can reduce stress, build a stronger connection with your child, and feel confident navigating even the toughest parenting moments. The gift you give yourself and your child by investing the time and effort into PCIT now can change their trajectory for the long-term, well after treatment is complete.
Begin Online PCIT Therapy in Your Own Home
If you live anywhere in California or any of the 40+ PSYPACT States, virtual PCIT therapy is available to you! As long as you have a device with a camera (e.g., phone, laptop, tablet), a pair of headphones, and internet access, you can start online PCIT with Dr. Sabrina Stutz, PhD, in your own home. Here’s how to get started:
Step 1
Request a Consultation Call
First, you’ll complete my consultation request form that will give you up-to-date information about my practice policies, availability, and wait times.
Step 2
15-Minute Phone Consultation
We’ll schedule a complimentary brief phone call where we learn more about one another and decide if we’re a good match.
Step 3
Begin Virtual PCIT
You’ll get set up in the client portal and book your first session! Together, we’ll walk the journey of restoring harmony in your home.
Download Our PCIT Handout:
Learn more about differences between PCIT and traditional therapy
Share PCIT knowledge with your friends and family
Educate your teachers or healthcare providers about PCIT
Give this to your patients or students when making a PCIT referral
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Dr. Sabrina Stutz, PhD, is passionate about bringing you the most effective, up-to-date, evidence-based child therapy techniques available. With a variety of treatment options for babies, toddlers, preschoolers, school-aged children, adolescents, young adults, and parents, connecting with Dr. Stutz is a great way to strengthen your family bonds and manage challenges across a child’s development. Check out her other virtual child therapy offerings here. And if you have questions or want to connect, feel free to drop us a line. We look forward to hearing from you!