Table Of ContentLarissa N. Niec Editor
Handbook of
Parent-Child
Interaction Therapy
Innovations and Applications for Research and
Practice
Handbook of Parent-Child Interaction
Therapy
Larissa N. Niec
Editor
Handbook
of Parent-Child
Interaction Therapy
Innovations and Applications
for Research and Practice
Editor
Larissa N. Niec
Center for Children, Families, and Communities
Department of Psychology
Central Michigan University
Mount Pleasant, MI, USA
ISBN 978-3-319-97697-6 ISBN 978-3-319-97698-3 (eBook)
https://doi.org/10.1007/978-3-319-97698-3
Library of Congress Control Number: 2018959759
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To the little ones and their parents who are hoping.
And to Sheila, whose lifetime of work will help
generations of families.
Foreword
I was amazed when reading this handbook on parent-child interaction therapy
to discover the progress of clinical innovation in PCIT. As the founder of
PCIT, I found the extent of research examining new and previously untested
innovations truly gratifying. Even 10 years ago, adaptations to PCIT were
largely untested clinical hunches, with potential to water down PCIT or even
rescind its evidence-based status.
Things have certainly changed! This timely handbook comprehensively
presents promising new and inventive applications of PCIT together with the
supporting research for each application—within diverse diagnostic and pop-
ulation samples and within new settings for treatment delivery as well as
large-scale applications of PCIT. As a researcher, I particularly appreciated
the succinct but inclusive literature reviews of the innovative applications of
PCIT. As a clinician, I was excited to read the step-by-step descriptions of the
adaptations for new populations and settings. Chapters describe the specific
changes made to the standard PCIT protocol and the rationale for the change.
Each chapter concludes with a case study illustrating the actual use of the
PCIT adaptation in practice. This handbook also presents updated and new
measures in PCIT as well as issues in current training and dissemination.
As an added bonus, the chapters all contain tidbits of clinical wisdom. The
authors in this volume were carefully selected and are recognized experts in
PCIT and in the applications of PCIT that they describe.
Edited by Dr. Larissa Niec, the organization and composition of this hand-
book is not surprising. In the PCIT world, Dr. Niec stands out as a researcher,
clinician, trainer, and scholar. Her expertise is nationally and internationally
recognized through her federally funded clinical research and writing on
PCIT and her standing as a master trainer and member of the Board of
Directors of PCIT International. There could hardly be a more perfect editor
for this volume.
As might be expected in a handbook emphasizing innovations in PCIT,
fidelity to the standard PCIT protocol is a noteworthy theme throughout this
book. When we conduct PCIT to treat children with disruptive behavior or to
improve parenting skills, we are committed to maintaining fidelity to the
standard model while at the same time, tailoring treatment to match the needs
of the family. Examples of tailoring when delivering standard PCIT would
include changing the introductory content of psychoeducation to be relevant
to the particular disorder being treated or using words or language that more
closely matches the family’s values or understanding. Chapter “Parent-Child
vii
viii Foreword
Interaction Therapy for Families with a History of Child Maltreatment”
provides excellent examples of tailoring treatment for a family referred
because of child maltreatment. Chapter “Cultural Enhancement of PCIT for
American Indian Families: Honoring Children, Making Relatives” illustrates
an exceptionally perceptive approach to tailoring PCIT when treating fami-
lies from culturally diverse populations. Tailoring neither changes the funda-
mental characteristics of PCIT nor does it alter the underlying behavioral
theory. Treatment tailoring would not be expected to improve behavioral
outcomes significantly when compared to standard PCIT, but it augments the
ecological validity of the treatment.
In contrast to tailoring, adaptations of PCIT are evidence-based changes in
fundamental procedures in the protocol. Adaptations are intended for use
with all members of a specific population or group. For example, chapter
“Parent-Child Interaction Therapy for Children with Selective Mutism”
describes an adapted model of PCIT for treating children with early anxiety
disorders. In this adaptation, deletions from the protocol, such as removing
the PDI phase of PCIT, and additions, such as incorporating exposure tasks
into the CDI, are made to improve the outcomes of treatment for child anxiety
disorders, while otherwise following closely the steps of the standard PCIT
model. Adaptations may also change the venues in which treatment is deliv-
ered, such as in-home coaching (chapter “Group PCIT: Increasing Access
and Leveraging Positive Parent Pressure”) or video-conference-based deliv-
ery of PCIT (chapter “Using Technology to Expand the Reach of PCIT”),
to broaden the reach and scope of PCIT. It is essential that adaptations be
supported by well-conducted research. Adaptations should not be recom-
mended or disseminated to others until they have received convincing
scientific evidence showing that the adapted treatment is at least as effective
as the standard protocol in measuring the child’s targeted symptoms.
Adaptations to the measures used in PCIT are also addressed in this hand-
book. The treatments adapted from PCIT may require that PCIT measures
also be adapted to monitor their progress or demonstrate their effectiveness.
For standard PCIT, the DPICS is an essential system for measuring treatment
progress and outcomes. For many interventions adapted from PCIT, the
DPICS will not require changes. Effective parenting and child compliance
are, in particular, almost universal targets of adapted treatments for young
children. For treatments with meaningfully different target goals, adaptations
of the DPICS are easily incorporated into the system. Chapter “Dyadic
Parent-Child Interaction Coding System: An Adaptable Measure of Parent and
Child Behavior During Dyadic Interactions” describes in detail the DPICS
system and the strong evidence of its intercoder reliability, discriminative
validity, and sensitivity to changes resulting from treatment. The flexibility of
the DPICS allows changes that can provide observational assessment of dyadic
interactions in many contexts.
The other measure used to guide PCIT is the ECBI, a measure standardized
in numerous cultures. Many studies have demonstrated the psychometric prop-
erties of the ECBI, including its sensitivity to behavioral changes over quite
short time intervals and its stability, both of which permit repeated weekly
assessments to monitor child behaviors throughout treatment. The items of the
Foreword ix
ECBI also permit assessments of behavior change in both clinical and nonclinical
populations, making it applicable for assessing outcomes in prevention as well
as intervention studies. In chapter “Building Resilience through PCIT:
Assessing Child Adaptive Functioning and Parent-Child Relationship
Quality,” the authors describe new rating scales they have developed to mea-
sure child strengths rather than problem behaviors. They suggest that the new
strength-based measures are important to foster a better understanding of
children’s abilities and that they may play a meaningful role in the evaluation
and tailoring of prevention and intervention programs. These hypotheses will
be important to study.
A second not-surprising theme running through this handbook on PCIT is
the importance of measurement to guide not just treatment progress but also
therapist training in PCIT. PCIT is not an easy treatment to learn. To help
assure fidelity as training moves on from the second- and third-generation
trainers and from individual agencies to large-scale dissemination, the assess-
ment of therapist competence at each step throughout the initial training year
is an ongoing process. Chapter “Assessing Therapist Competence Within the
Context of PCIT Training” describes our current approach to therapist compe-
tence assessment and includes a few preliminary checklists and quizzes with
tested reliability. However, assessment of therapist skill acquisition in many
aspects of PCIT is a subjective judgment by the trainer. One notable exception
is the therapist-parent interaction coding system (TPICS). Published studies
of the TPICS have shown its reliability and preliminary but convincing evi-
dence of predictive validity (chapter “Therapist-Parent Interactions in PCIT:
The Importance of Coach Coding”). PCIT trainers have needed an objective
way to assess therapists’ coaching for many years. It is my opinion that the
quality of coaching in large part determines the outcomes of PCIT. With the
publication of the TPICS, that hypothesis now can be tested. Of note, the
TPICS was developed in the laboratory of the handbook editor Dr. Larissa
Niec. Just as that measure of coaching is likely to move PCIT research for-
ward considerably, so too is this handbook itself. It concludes with a chapter
in which Dr. Niec considers the important next steps for research in PCIT in
order to advance the science of children’s mental health interventions. It is
an essential handbook for clinicians, researchers, instructors, administrators,
and graduate students in mental health broadly. It is certainly will be the go-to
reference for those of us in PCIT.
Sheila Eyberg, PhD
Distinguished Professor Emerita, University of Florida, Gainesville, FL, USA
Founder and President, PCIT International, Inc., Gainesville, FL, USA
Acknowledgments
With deep thanks to the clinicians who ask the questions and the researchers
who test them and to the families for sharing their struggles and successes
with us.
My gratitude also to the leaders of the field who contributed to this book
and to Judy Jones, my editor at Springer, who helped to shape it.
To my amazing team at the Center for Children, Families, and Communities
for all their contributions, large and small.
And with much appreciation to Christy and Aaron, Jo and Kate, and all the
wonderful folks at Ponder Coffee who kept me in coffee and waffles through-
out the writing and editing process.
xi
Contents
Part I Introduction
Parent–Child Interaction Therapy: A Transdiagnostic
Intervention to Enhance Family Functioning � � � � � � � � � � � � � � � � � � 3
Larissa N. Niec
Part II A daptations for New Target Problems
PCIT for Children with Callous- Unemotional Traits � � � � � � � � � � � � 19
Georgette E. Fleming and Eva R. Kimonis
PCIT-Health: An Innovative Intervention for Childhood
Obesity Prevention � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 35
Sarah E. Domoff and Larissa N. Niec
Parent–Child Interaction Therapy for Families with a History
of Child Maltreatment � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45
Allison Cotter, Carisa Wilsie, and Elizabeth Brestan-Knight
Parent–Child Interaction Therapy for Military Families:
Improving Relationships � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 71
Robin H. Gurwitch and Erica Pearl Messer
The Turtle Program: PCIT for Young Children Displaying
Behavioral Inhibition � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 85
Christina M. Danko, Kelly A. O’Brien, Kenneth H. Rubin, and
Andrea Chronis-Tuscano
Parent–Child Interaction Therapy for Children
with Developmental Delay and Related Problems � � � � � � � � � � � � � � � 99
Dainelys Garcia, Loreen Magariño, and Daniel M. Bagner
Parent–Child Interaction Therapy for Children with Selective
Mutism (PCIT-SM) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 113
Allison Cotter, Mitchell Todd, and Elizabeth Brestan-Knight
Adapting PCIT to Treat Anxiety in Young Children:
The PCIT CALM Program � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 129
Jonathan S. Comer, Cristina del Busto, Anthony S. Dick, Jami M.
Furr, and Anthony C. Puliafico
xiii
