• By Dartington SRU
  • Posted on Thursday 24th May, 2012

PCIT: The scientific method in action

In graduate school, psychologist Sheila Eyberg’s mentors instilled the notion that a “good therapist” is one who views each client’s treatment plan as a hypothesis to be tested. And if the hypothesis can’t be quickly confirmed, the therapist revises and tests the treatment plan again and again – until it works. Looking back, Eyberg explained, “When translated into the graduate student’s bottom line, we would be ‘good therapists’ if our cases were successful – defined by the data points on graphs. And it was our responsibility - not the child or family’s - to make this happen.”Eyberg’s training as a “scientist-practitioner” laid the foundation for the inner workings of Parent-Child Interaction Therapy, a treatment program for child behavior problems that Eyberg first developed in the 1970s. Collecting data, testing hypotheses – these apparently mundane, everyday scientific activities help explain PCIT’s success.A solid grounding in the scientific methodIn the first part of this series, PCIT: The birth of an innovation, we explored how PCIT is rooted in theories of child behavior that emphasize the importance of parenting practices. That is, children tend to do best when their parents both nurture them and set boundaries – and PCIT aims to help families move toward this style of “authoritative” parenting. Staying faithful to her scientist-practitioner training, Eyberg established a requirement for PCIT therapists to formally identify change in parents and their children through the collection and analysis of data at the beginning, during and at the end of the course of treatment.The gathering of data as part of this ongoing assessment and hypothesis-testing process is a core component of PCIT. The information contributes to decisions about focus of the treatment and the desired outcomes. The data is used to test the therapist’s hypotheses and inform amendments in treatment plans. What is more, evidence that the child and parents’ situation is improving is required before families can transition from the first phase of the treatment (Child-Directed Interaction) to the second stage (Parent-Directed Interaction). The PCIT treatment is not complete until the child’s behavior is reported to be back within the normal range for children of a similar age and stage of development. Quantifying change: three assessment toolsBut if PCIT was to be based on reliable evidence, therapists had to have a consistent way to assess parents’ and children’s progress. So Eyberg and her colleagues developed several assessment tools. One is a behavioral coding system known as the Dyadic Parent-Child Interaction Coding System (DPICS) that the therapist uses to quantify the changes in children’s behavior and parents’ skills observed during therapy sessions. A second is the Therapy Attitude Inventory (TAI), which explores the family’s perceptions of the acceptability of the treatment and general client satisfaction.And the most widely known is the Eyberg Child Behavior Inventory (ECBI) — a scale that measures parent reports of child conduct problems at home. It measures both the frequency of disruptive behaviors and the extent to which the parent perceives the child’s behavior to be a problem. The ECBI asks parents to report on 36 types of problem behavior, such as “Has temper tantrums”, “Constantly seeks attention” and “Destroys toys and other objects.” Parents rate the frequency with which the behaviors occur using a scale ranging from “never” to “always,” as well as rating the extent to which the behavior is perceived to be a problem with a simple “yes” or “no.” The ECBI (along with the DPICS) is completed every week throughout treatment to highlight areas for PCIT therapists to focus on and to capture changes that might indicate the treatment plan is working.The ECBI is brief, easy to administer, simple to interpret, and sensitive to changes. Because of these characteristics, it is used not only in PCIT but by researchers studying the impact of other interventions on children’s conduct. Some of those studies feature on Prevention Action, such as this one of the Incredible Years intervention. [Incredible Years effects are credible in the long-term]As a result, 40 years on, Eyberg’s early training as a “scientist-practitioner,” and the commitment to evidence embedded in PCIT, has influenced not only the format of this particular intervention, but also the practice of prevention science more broadly. **********Links:Other stories in the series: PCIT: The birth of an innovationPCIT: What next for the popular intervention?PCIT: http://pcit.phhp.ufl.edu/

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