Parent-Child Interaction Therapy

Child-Directed Interaction (CDI)

The first phase of PCIT, child-directed interaction (CDI), resembles traditional play therapy approaches. The focus is on strengthening the parent-child attachment, increasing positive parenting, and improving child social skills. CDI is presented first because children tend to become less angry and calmer during the CDI phase and thus accept the discipline component of PDI more readily. In addition, teaching CDI first allows parents to master these skills before implementing them simultaneously with the PDI skills.

During CDI, the parents learn to let the child lead a play situation by using the nondirective PRIDE skills (Praising the child, Reflecting the child's statements, Imitating the child's play, Describing the child behavior, and using Enthusiasm in the play) and refraining from the use of questions, commands, or criticisms. At the same time, they learn to ignore negative child behaviors. Using the PRIDE skills to attend to the child's positive behavior and actively ignoring any undesirable behavior provides a positive form of behavior management called differential social attention. Parents are asked to practice the CDI skills at home during daily 5-minute play sessions with their child. Therapists also review topics such as modeling appropriate behavior for children, the importance of social support, and additional information on behavior management with the parents, and provide supporting handouts.

During CDI coaching sessions, therapists coach by praising the parents' use of the PRIDE skills, making suggestions, and encouraging the parents. The therapists' first goal is to shape the parents' verbal behavior to help them reach the CDI mastery criteria, which are 10 behavioral descriptions, 10 reflective statements, 10 labeled praises, and no more than 3 questions, commands, or criticisms during a 5-minute period. Furthermore, therapists teach parents basic behavioral principles by pointing out the specific effects of their behaviors on the behaviors of their child. It is also through coaching that therapists model and encourage positive attitudes toward the child, reframe parent attributions, and convey appropriate developmental expectations.

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