What Does a PCIT Session Actually Look Like?

If you're considering Parent-Child Interaction Therapy (PCIT), you may understand the basic idea but still wonder what you're actually signing up for.

Will my child sit in front of a computer and talk to a therapist? Am I going to be playing with my child while someone watches me? What exactly is the therapist saying in my ear? What happens if my child has a meltdown, walks away, or simply doesn't cooperate?

PCIT looks different from what many parents picture when they think about therapy for a young child. Your child isn't expected to sit and talk about their feelings with me. Much of our work focuses on you and your child interacting together while I observe and coach you in real time.

Here's what that can look like from the beginning of treatment through the regular coaching sessions that make up most of PCIT.

We Start With the Caregivers

The first PCIT appointment is for caregivers, without your child participating.

Before we start trying to change anything, I want to understand what's actually happening in your family. We'll talk about the behaviors you're concerned about, when they tend to happen, what you've already tried, what seems to make things better or worse, and what you would most like to see change.

This is also where we determine whether PCIT is an appropriate treatment for your child and your family.

We'll talk about what treatment involves and what you'll need for online sessions. That includes practical things like having a computer in an appropriate space, wireless earbuds for coaching, and toys we can use during special playtime.

You don't need to have a perfect therapy setup figured out before we begin. We'll work on that together.

Before I Coach, I Want to See How You and Your Child Already Interact

Early in treatment, I'll observe you and your child playing together before I start actively coaching you.

This isn't a test of whether you're a "good" parent.

I'm paying attention to the interaction that's already happening between you and your child. I want to see the strengths that are already there as well as the areas where learning some new skills may be helpful.

Parents sometimes worry that their child didn't act the way they usually do or that the play didn't accurately represent what happens at home. You can tell me that. I don't need one brief observation to capture every difficulty your family experiences.

The observation gives us information that we can combine with everything you've already told me about your child and your family's day-to-day life.

Then You Learn the Skills Before You're Expected to Use Them

PCIT isn't a situation where I watch you parent and suddenly start telling you everything you should be doing differently.

Before coaching begins, I'll teach you the skills we'll be practicing and explain why we're using them. You'll have an opportunity to ask questions and practice understanding what the skills actually look and sound like.

The first phase of PCIT is called Child-Directed Interaction, or CDI. This is where you'll learn the PRIDE skills and begin practicing a particular kind of play with your child.

The focus is on strengthening your relationship with your child while helping you become very intentional about the kinds of attention you're giving during the interaction.

Then we start practicing together.

What Live Coaching Actually Looks Like

During an online coaching session, you'll be in a designated play space with your child while I'm connected through your computer.

You'll wear a wireless earbud so you can hear me while you're playing. I can see and hear the interaction, but your attention stays primarily on your child rather than on me.

As you play, I'll coach you in real time.

Sometimes that means pointing out something you're already doing well. Sometimes I'll help you notice an opportunity to use one of your skills. I may give you a specific phrase to try with your child or help you adjust something you're saying so that you can practice a skill that hasn't become as natural yet.

I'm also keeping track of the skills you're using so that we're not relying only on whether the interaction feels better. We can actually see how your skills are developing over time.

The coaching is individualized. Different parents have different strengths, and different children bring out different challenges. My job isn't to give every parent the same stream of instructions. It's to pay attention to what is happening between you and your child and help you build the skills you need.

If you're wondering how this translates to telehealth, I explain more about why online PCIT works so well for many families

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It Can Take a Few Sessions to Get Used to Someone Talking in Your Ear

Live coaching can feel a little strange at first.

You're playing with your child, listening to what they're saying, thinking about the skills you've just learned, and also hearing me through an earbud. That's a lot to pay attention to at once.

Sometimes I'll give a parent a specific phrase to try and they won't say it. That's okay. Usually, it isn't because they didn't understand me or don't want to try it. Having someone talk in your ear and then immediately saying something to your child can simply feel unfamiliar.

You do not have to be good at being coached right away.

It often takes a few coaching sessions to get into the groove. As you become more comfortable, we start developing a rhythm. You're able to stay engaged with your child while also taking in my feedback, and the skills themselves begin requiring less thought.

That's part of the learning process.

I Help You Set Up the Environment Too

One benefit of online PCIT is that I get to see the actual space where you're practicing.

Especially when we're first getting started, I'll help you figure out how to make that space work. I may have you move the computer so I have a better view, adjust where you and your child are sitting, move something distracting out of reach, or switch out a toy that isn't working well for special playtime.

If we discover during a session that something about the setup isn't working, we can adjust it.

You're not expected to transform your house into a therapy office or figure out the logistics on your own. We need a space that allows your child to play with you and allows me to see enough of the interaction to coach effectively.

What Happens If My Child Walks Away or Gets Upset?

Real children don't always stay neatly in the space we've prepared for them.

Your child might wander away, become distracted, grab something they aren't supposed to have, get upset when something doesn't go their way, or decide they're suddenly much more interested in something across the room.

That doesn't mean the session has gone wrong.

Those moments give us opportunities to work with what's actually happening. I can coach you through how to respond and how to use the skills you're learning to help bring your child back into the interaction when appropriate.

And if your child happily plays with you for the entire time? That's useful too.

I don't need your child to show me their most difficult behavior in order for PCIT to work. When things are going smoothly, you have an opportunity to practice your new skills without also trying to manage a difficult moment. That's how those skills begin becoming more natural and easier to use when things aren't going smoothly.

What If Two Caregivers Are Participating?

When two caregivers are involved in PCIT, I want both caregivers to have opportunities to learn and practice the skills.

Depending on the family and what is happening at home during the appointment, we can structure coaching so that one caregiver practices with the child and then the caregivers switch.

Sometimes the caregiver who isn't actively playing can remain connected and listen to the coaching while the other caregiver practices. That gives them an opportunity to learn from the feedback their partner is receiving too. Other times, that caregiver may need to manage siblings or something else happening in the household.

We'll figure out what works for your family while making sure both caregivers have opportunities to develop their skills.

PCIT Is More Than What Happens During the Appointment

An important part of PCIT happens between our sessions.

You'll practice special playtime with your child at home. When we meet again, we'll talk about how practice went, including what felt easy, what felt awkward, what got in the way, and what you noticed about your child's behavior.

If practicing between sessions is difficult, that isn't something you need to hide from me.

It's useful information.

Maybe finding five uninterrupted minutes is harder than expected. Maybe your child keeps bringing in toys that make it difficult to use the skills. Maybe one of the PRIDE skills still feels unnatural. Maybe you understand a skill during our session and then can't quite figure out how to use it on your own.

Those are things we can work on together. The goal isn't for you to prove that you can do PCIT perfectly between appointments. The goal is to help the skills become usable in your actual life.

We Don't Rush Through the First Phase

PCIT is different from therapies where you spend a predetermined number of sessions on one topic and then move on because the calendar says it's time.

During CDI, we're working toward you becoming genuinely comfortable and skilled at using what you've learned. I'm tracking your skills during sessions, and we're also paying attention to how things are going at home.

That foundation matters.

We want the relationship-building skills to be well established before moving into the next phase of treatment.

Then We Build on That Foundation

The next phase of PCIT is called Parent-Directed Interaction, or PDI.

This phase builds on the relationship and skills you've already developed and introduces additional strategies for helping your child follow directions and respond to limits.

Just as with CDI, you aren't simply given information and sent home to figure it out. You'll learn what we're doing first, and then you'll have opportunities to practice while I coach you.

By this point, something else has usually changed too: you're no longer brand new to live coaching. You've already spent time learning how to stay connected with your child while hearing feedback through your earbud, trying new language, and adjusting in the moment.

We're adding new skills to a process that has become much more familiar.

The Goal Is for You to Leave PCIT Knowing What to Do

One of the things I value most about PCIT is that parents aren't meant to remain dependent on the therapist.

Throughout treatment, you're practicing the skills yourself. You're seeing how your child responds. You're learning what works, developing confidence, and becoming better able to recognize what to do when a new parenting challenge comes up.

I'm there to teach, observe, coach, help you problem-solve, and give you feedback. But you're the person building the skills.

Ultimately, I want you to reach a point where you don't need someone talking in your ear anymore.

Online PCIT Throughout California

I provide online Parent-Child Interaction Therapy for families throughout California. PCIT is commonly used with young children experiencing behavioral and emotional challenges, and treatment gives parents an active role in helping those patterns change.

If you've been wondering what it would actually feel like to participate in PCIT, hopefully this makes the process a little less mysterious.

You don't need to arrive already knowing how to do the skills. Your child doesn't need to behave a certain way for me. And you don't need to feel comfortable with live coaching the first time we try it.

Those are all things we work on together.

If you're wondering whether PCIT might be a good fit for your child and family, I offer consultations with caregivers throughout California.

Schedule a Consultation