• By Dartington SRU
  • Posted on Wednesday 23rd May, 2012

PCIT: The birth of an innovation

In a series of stories this week Prevention Action profiles the work of Sheila Eyberg, developer of Parent-Child Interaction Therapy (PCIT) and Distinguished Professor at the University of Florida. Today we tell the birth story of the intervention that became PCIT.In the second part of the series, we will examine how Eyberg’s scientist-practitioner training influenced the nature of PCIT and its related research tools. Finally, the third part looks to the future, with the development of innovative ways to train new generations of PCIT clinicians.“The notion of evidence-based treatment has come on quickly. There is a remarkable difference from 30 years ago,” reflects Sheila Eyberg. Having spent nearly four decades at the cutting edge, developing, testing and refining an evidence-based treatment program, Eyberg is in a good place to comment.Eyberg began developing Parent-Child Interaction Therapy (PCIT) – a treatment program for young children with significant behavioral and emotional difficulties and their parents – in the 1970s. As a young clinical psychologist, inspired by the work of four researchers with very different ideas, she created PCIT from a mix of old practices and new ideas. A marriage of the old and the newEyberg’s first inspiration was the rising star Diana Baumrind. While Eyberg was at graduate school in the late 1960s, Baumrind’s research was challenging the traditional focus on individual play therapy. The idea of parent training – now a mainstay of treatment for child behavior problems – was then novel. “In most of the clinical psychology world, children’s problems were treated in individual play therapy, but my first training cases involved training parents to change their child’s behaviors,” Eyberg explained. Baumrind, who studied the effects that different parenting styles had on children’s development, found that a nurturing and responsive parenting style accompanied by clear communication and firm limit-setting (what she called “authoritative parenting”) led to the healthiest outcomes for children. However, in her first clinical posting at Oregon Health Sciences University (OHSU), Eyberg was encouraged to set aside the novel parent training approach and instead explore the more traditional approach of play therapy.And like a conscientious intern, Eyberg immersed herself in the literature on play therapy. She was inspired by the work of two more researchers: Virginia Axline and Bernard Guerney. Axline argued that play therapy was successful not only because it gives parents and children time to bond, but also because children can vent their emotions through play.“Therapy was a place where children could feel safe, where they could relax and experience being ‘okay’,” Eyberg said. Guerney shared a similar view, and developed a structured training program in which parents, under the observation of a therapist, took part in play sessions with their children in their own homes. Beyond play therapyEyberg used both Axline and Guerney’s methods in her own clinical practice – but the results were mixed. Children’s behavior did improve during therapy sessions, but they still acted out at home between sessions. This is when Eyberg’s earlier training in behavior modification and parent training began to assert its influence.Eyberg hypothesized that the main problem with play therapy was that “the therapy hour couldn’t overcome the many other hours in each week filled with powerful negative interactions that kept the child’s negative behaviors in place.” Play therapy clearly had some short-term benefits, but how could these effects be sustained outside of the therapy session? Eyberg thought a more effective strategy would combine traditional play therapy with the innovations around training parents in a more authoritative parenting style. Parent-child relationships could be strengthened in play therapy – and then parents could learn more effective techniques of managing behavior in parent training sessions. This marriage between the “old” and “new” approaches to child behavior treatment became the foundation of Parent-Child Interaction Therapy. During the next two years of Eyberg’s postdoctoral training at OHSU, the structure of PCIT took shape.The birth of PCITIn structuring PCIT around two phases, Eyberg was inspired by the work of a fourth researcher: Constance Hanf, also at OHSU. Hanf devised an intervention that involved a child-focused stage and a mother-focused stage. Eyberg adopted a similar structure, dividing her intervention into a Child-Directed Interaction (CDI) phase and a Parent-Directed Interaction (PDI) phase. The first phase, CDI, draws on the strengths of play therapy: the child takes the lead while the parent practices giving praise and avoiding criticism. The second adds parent training: parents take the lead in setting expectations and limits. Eyberg also mimicked Hanf’s practice of coaching parents from behind a one-way mirror using a “bug-in-the-ear” device. This support allowed therapists to “coach and support the parents through the chaos of change, until parents gained confidence in applying the new parenting techniques on their own,” Eyberg explained.The intervention was officially named Parent-Child Interaction Therapy in 1974. Since then, studies have shown that PCIT often results in more positive interactions between the parent and child. Parents are better able to be nurturing and set effective limits - both hallmarks of an “authoritative” parenting style - and children themselves engage in better behavior. **********Links:Other stories in this series: PCIT: The scientific method in actionPCIT: What next for the popular intervention?The PCIT Story: http://pcit.phhp.ufl.edu/story.htm

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