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Description of the Treatment Typical Course of Treatment The Parent-Child Interaction Therapy tends to commence with a pre-treatment evaluation session where interview information is collected on past and current concerns or problems, sample questionnaires are rolled out, and the therapist observes and at same time record the sessions of how the child relates to the parent and vice versa. After the session, the therapist provides feedback concerning the evaluation results. The treatment plan is given to the families either at the end of the pre-treatment evaluation session or in a separate therapy orientation session. The typical course of treatment is given to the family, stressing how Parent-Child Interaction Therapy will address the specific problems that took them to the treatment and any other additional areas of concern that may have cropped out during the assessment session. The Parent-Child Interaction Therapy treatment begins with Child-Directed Interaction. A coaching session is held in which the therapist solely with the parents or caregivers and teaches them the Child-Directed Interaction basics through discussions, role-playing, modeling, including didactic demonstration. In this phase, parents and caregivers are the active participants. They are encouraged to ask as many questions as possible while also giving out their opinions on their own parenting ideas. After the coaching session, the therapist sees the caregiver or the parent and the child for several Child-Directed Interaction skills coaching sessions. The number of sessions depends on how fast parents can grasp the needed skills and the nature of the presenting problems of the target child. Generally, most parents and caregivers are ready to move to the second stage after roughly four coaching sessions. During the coaching sessions, pre-determined skill criteria are employed to help the therapist and the families decide the right time to move ahead to the Parent-Directed Interaction
phase of the Parent-Child Interaction Therapy. Upon mastering and grasping the Child-Directed Interaction criteria, parents tend to have a different session with the therapists where they learn the basics of the Parent-Directed Interaction, popularly known as the discipline and compliance stage. The Parent-Directed Interaction teaching sessions comprise role-playing, discussions, and didactic demonstrations. In the following sessions, the caregivers with their children meet the therapist for several sessions of direct skills coaching. These mentioned above sessions can occur in a clinical setting or a communal setting such as a grocery store. This is done to enhance cross- setting generalization. Upon completion of treatment, there is a graduation session where all the child’s presenting issues tend to be resolved or significantly improved. Upon completion of treatment, parents are given a certificate, and children are given a prize to symbolize their accomplishment. Most parents tend to meet their treatment objectives in the real world after nearly six to seven discipline meetings. After that, a post-treatment assessment session involves a repeat of the measures administered before the initial therapy process. At the end of the post-treatment assessment session, the therapist gives their comment while also receiving pre-and post-treatment enhancements. This session aims to assist caregivers and parents in strengthening their acknowledgment of progresses taking place slowly during the several meetings of treatment. For a number of families, the total number of sessions required to complete the treatment is usually set to twelve. Structure of the Parent-Child Interaction Therapy The original work of Sheila Eyberg described each treatment stage and evaluation meticulously as it incorporated suggestions to use during therapy. Parents and caregivers attended a training session where the therapist explained and told each rule and its outcomes. The
The “Avoid Rules” of the Child-Directed Interaction According to Sheila Eyberg, the Avoid rules assist the caregivers and parents in learning to step back and encourage plus allow their children to lead the play by avoiding commands, criticism, and questions. Commands tend to take away lead from the child and can lead to disagreeableness; suppose the child disobeys the commands. There are two kinds of commands that are taught to the parents to avoid. They are the direct and indirect types of command. Direct types of command are the demands that are made to the child, for instance, "Henry stand up," or "Susan pick the pen." On the other hand, indirect commands tend to be phrased more often as questions. Many caregivers and parents use indirect commands without noticing, such as "Peter, how about you use the blue color," or "Kyle, you might want to sit down to color your page." These forms of commands take away the child's lead and should be avoided during the Child- Directed Interaction phase. The second “Avoid Rule” tends to be the most challenging to parents and caregivers. They are taught to learn to avoid questions. Questions tend to direct communication or conversation instead of following, which tends to take away the child's lead. In most cases, questions lay in the indirect command box. Asking questions will lead to the child concluding that the parent was not paying attention to them or they do not agree with their suggestion or what they are doing. For illustration, "Susan, are you sure you want to play with Mr. Spider's head?" is a leading question that implies that the parent thinks their child should play with a different toy. It suggests disapproval of the original toy the child chose. The last “Avoid Rule” is to “Avoid Criticism and Sarcasm.” Criticism and sarcasm are not encouraged during the Child-Directed Interaction phase and the Parent-Directed Interaction phase. Criticism and sarcasm do not decrease the presenting difficulties, but instead, it increases
undesirable conducts. Children tend to strive for positive attention from their parents or caregivers. Negative attention tends to destroy the self-esteem of the child. Criticism and sarcasm tend to anger or cause frustration to the child, leading to a retaliation. Parents are taught to avoid using words such as idiot, mean, jerk, ugly or dumb. The “Do Rules” of Child-Directed Interaction The “Do Rules” of the Child-Directed Interaction promotes and encourages positive behavior throughout the entire play. There are five do rules that have an acronym for PRIDE. P stands for Praise, R stands for Reflect, I stands Imitate, D stands for Describe, and E stands for Enthusiasm. Praise is the first Do skill of the Child-Directed Interaction. In this coaching session, caregivers and parents are encouraged to provide numerous praises to their children during playtime. There are two exact types of praise taught to parents and caregivers: general (unlabeled) and specific (labeled) praise. General praises convey affection or approval without pinning down the exact thing that the parent liked. Some examples of general praises include, "Nice work John," "Awesome Ashley," "I am proud of you, Peter," and "That's good, Susan." Contrary, specific praises explain to the child the exact thing you as a parent liked about them. General praises can be converted to specific praises, for instance, "Nice work of playing gently John,” “Awesome counting Ashley,” “I am proud of you Peter for being gentle and polite," and "That's a good choice of toy Susan.” Both general and specific praises are suitable for children as they tend to add the friendliness of the child-parent interaction and relationship, particularly praises as they are valuable tools of teaching.
play a significant role in improving the interaction between the child and the parent. When parents and caregivers describe a child's activity, it means the child is kept in the lead. This is advantageous as it will mean the child will have the independence to develop their own ideas and problem-solving skills. Additionally, suppose the caregivers and the parents are commenting and describing their child's play. In that case, it will be a clear sign to the child that their parent has undivided attention to them. The child does not need to yell or bang dolls to attract their parents' response. When a parent has undivided attention, it will boost their kid's self-esteem as it will convey the message that the parent thinks the choice of their kid's activity is fascinating. Additionally, a descriptive statement assists in organizing the child's thoughts and ideas about a play, which increases the duration of time they will be able to attend the activity at hand. The fifth Do skill of the Child-Directed Interaction is Enthusiasm. Parents are encouraged to show delight, enjoyment, and excitement during the play to make the Child-Directed Interaction exciting and, in turn, engage the child. Enthusiasm comprises talking with an animated expression with varied articulation. This will communicate interest and, in turn, make the play fun and interesting for both the child and the parent. Some of the expected outcomes of the Child-Directed Interaction phase include; a decrease in the frequency of hostility, a decrease in parental irritation and frustration, a reduction in negative attention-seeking activities, an increase in the attention duration, an increase in the child self-esteem, and an increase in the child social behaviors. Parent-Directed Interaction phase It is also known as the discipline and compliance Phase. In the Parent-Directed Interaction phase, parents and caregivers continue the skills they learned in the Child-Directed
Interaction phase, but they are taught a new set of skills to lead the play. These new sets of skills include giving verbal directions and applying the practical consequences to the child in a fair manner that they can comprehend clearly. Teaching parents how to give instructions is the central role of compliance in Parent-Directed Interaction. Parents and caregivers need to learn the types of instructions that are likely to provoke obedience in oppositional children. Children with behavior problems tend to respond differently to orders or rather instructions than children with calm behaviors. In this phase, parents and caregivers are taught ways of giving good instructions as they play with the toys brought to them by the therapist. The first step in this phase is for parents to learn to give effective instructions. Parents are encouraged to give direct commands and avoid indirect orders. Parents and caregivers are asked to use not confusing commands rather clear and which their child will do as the parent requested. In short words, parents are to tell their children what they expect them to do instead of asking them if they will comply with the commands. An example of the direct command is, "John put the blue chair in the house." Contrary, an instance of indirect order is, "Susan, will you color the water blue?" Parents are also taught how to make commands single instead of compound. Parents are advised to provide instructions one at a time instead of stringing several together. This will help the child with more chances to experience the positive outcome of obeying. Parents are taught how to state commands positively. They are trained to tell the kid what to do rather than what not to do. Children tend to obey positively framed instructions, which will improve their self-esteem as they get to do the right thing instead of stopping a negative conduct. Additionally, parents are taught to avoid giving unclear commands such as "Come on," "Settle down," but rather make them specific. Here, parents are also encouraged to deliver orders in a neutral tone of voice. The objective of the Parent-Directed Interaction is for children to learn and
behavior groupings include destructive behavior, compliance, and non-compliance, yell and laughing. Eyberg Child Behavior Inventory (ECBI) The Eyberg Child Behavior Inventory is a behavior scale used for tracking children's behavior. The ECBI was made from data that indicated the common problem behaviors reported by the parents of conduct problem children. The Eyberg Child Behavior Inventory includes two scales; Problem and Intensity.
