What Is Parent-Child Interaction Therapy (PCIT)?

When a young child is struggling with frequent meltdowns, aggression, anxiety, difficulty following directions, or other behavioral challenges, parents are often given a long list of strategies to try at home. The challenge is that knowing a strategy and knowing how to use it effectively with your own child are two different things.

Parent-Child Interaction Therapy, commonly called PCIT, gives parents an opportunity to learn skills, practice them with their child, and receive immediate support from a trained therapist.

PCIT is an evidence-based therapy designed for young children and their caregivers. It is recommended for use with children between the ages of 2 and 7 who are experiencing behavioral, social, or emotional difficulties.

Unlike many traditional therapy approaches, PCIT combines teaching, live coaching, and practice to help parents build effective skills for supporting their child’s emotional and behavioral development. During structured playtime with their child, parents learn and practice these skills while receiving immediate guidance and feedback from the therapist.

Rather than simply discussing strategies to try later, families build confidence by using the skills together during sessions. With repetition, the skills begin to feel more natural and become easier to use during everyday family life.

The goal of PCIT is to strengthen the parent-child relationship while also improving communication, emotional regulation, cooperation, and behavior.

Why do families choose PCIT?

Parents often seek PCIT because they are tired of trying strategies that only work briefly, work inconsistently, or do not seem to fit their child. Parents also tend to enjoy the structure and clarity within the PCIT protocol. They know there is a beginning and end and know what they need to do to move through the process.

They may feel as though they are constantly correcting behavior, repeating directions, attempting to prevent the next meltdown, or wondering whether they are responding in the “right” way.

PCIT provides a structured path forward. Parents learn specific skills, practice them with support, and receive feedback based on what is happening between them and their child in real time.

PCIT is evidence-based

PCIT is one of the most extensively researched therapies for young children with behavioral difficulties. It was developed by psychologist Dr. Sheila Eyberg in the 1970s and has been studied for several decades. Parent Child Interaction Therapy, Inc. reports that PCIT has been examined in more than 300 published studies and has received the California Evidence-Based Clearinghouse for Child Welfare’s highest research rating.

For parents, this means that PCIT is more than a collection of general parenting suggestions. It is a structured treatment model with clearly defined skills, procedures, and treatment goals.

Parents who would like to examine the evidence more closely can explore the PCIT research library maintained by the organization through which I received my PCIT training.

You learn by doing

Live coaching is one of the defining features of PCIT.

Parents first learn the skills they will use during each phase of treatment. They then practice those skills while interacting with their child as the therapist observes and coaches them in real time.

During online PCIT, the parent typically wears a wireless earbud so they can hear the therapist without the therapist becoming the focus of the interaction. The therapist can point out when a parent is using a skill effectively, help them adjust their response, and support them through more difficult moments.

This immediate feedback helps parents understand not only what the skills are, but also how to use them with their particular child.

Treatment is personalized to your family

Every parent and child enter PCIT with different strengths, challenges, and goals.

During sessions, the therapist observes how parents are currently using the skills and tracks their progress. Parents also complete questionnaires that help monitor changes in the child’s behavior and the family’s experience over time.

The purpose of tracking is not to grade parents. It allows the therapist to see which skills are becoming comfortable, which ones still need practice, and where additional coaching may be helpful.

Practice between sessions is an important part of PCIT. If home practice has been difficult, that becomes something to understand and work through together. The therapist can help identify what is getting in the way and make the practice more manageable. With the help of their PCIT therapist, parents can find a way to make daily practice (done during a 5 minute playtime) a staple at home. Many kids and parents come to look forward to their special playtime.

As treatment continues, parents also learn how to apply the skills to the situations that are most difficult for their family. This might include transitions, sibling conflict, separation, public outings, morning routines, bedtime, frustration, not getting their way, or following directions.

The goal is for parents to leave treatment knowing how to use the skills with current concerns and how to adapt them when new challenges arise later.

What concerns can PCIT help with?

Families do not need to wait until their child has a particular diagnosis before asking whether PCIT may be helpful.

Parents often seek PCIT because of concerns such as:

• Frequent tantrums or meltdowns

• Aggressive or destructive behavior

• Difficulty following directions

• Intense reactions to limits

• Frequent arguing or power struggles

• Hyperactivity or impulsivity

• Difficulty sustaining attention

• Interrupting

• Whining or repeated attention-seeking behaviors

• Difficulty with transitions

• Emotional regulation challenges

• Behavior problems at school, preschool, or daycare

PCIT may also be appropriate for children with ADHD or suspected ADHD, especially when impulsivity, emotional regulation, following directions, or family stress are significant concerns. PCIT research has included young children with ADHD, although a consultation is still important for determining whether the standard PCIT protocol fits an individual child’s needs.

PCIT has also been studied and adapted for children on the autism spectrum who experience behavioral challenges. The treatment does not address autism itself. Instead, it may help parents strengthen communication and connection while responding more effectively to meltdowns, frustration, aggression, or other behavioral concerns. It can also help children regulate, manage, and express their emotions effectively.

For some young children, anxiety shows up through behavior. A child may become controlling, avoidant, clingy, easily frustrated, or highly distressed during separation or transitions. PCIT and PCIT-based adaptations have been studied for childhood anxiety concerns, including separation anxiety. Whether PCIT is the best fit depends on how anxiety is affecting the child and family.

PCIT is also well known for treating significant disruptive or oppositional behavior. Some families may arrive with a diagnosis such as Oppositional Defiant Disorder. Others may simply describe aggression, intense defiance, frequent conflict, or a child who seems unable to cooperate.

I prefer to look beyond the behavior alone. Similar behaviors can be influenced by ADHD, anxiety, autism, developmental differences, stress, or difficulty regulating emotions. Treatment should address the child and family as a whole rather than relying only on a label or diagnosis.

What does PCIT treatment look like?

Although the exact process can vary somewhat by therapist and family, standard PCIT follows a clear structure.

Treatment generally includes an assessment, an observation of parent-child interactions, two treatment phases, and graduation once the family has met the treatment goals.

Some sessions include caregivers only. Most coaching sessions include the child and one caregiver at a time. When two caregivers are participating, they may divide the coaching portion of the appointment so that each caregiver receives an opportunity to practice.

The initial assessment

Treatment begins with a caregiver-only assessment.

This gives parents an opportunity to explain what has been happening, what they have already tried, and which concerns are creating the most difficulty for the family.

The therapist will gather information about the child’s development, behavior, emotional needs, family relationships, daily routines, and any previous treatment. Parents and therapist can then determine whether PCIT appears to be a good fit.

The assessment is also a time to review the structure of treatment, scheduling expectations, home practice, and caregiver participation.

For online PCIT, the therapist will help the family make sure they have the equipment and physical setup needed for coaching. A laptop that can be moved around the room and wireless earbuds with a reliable microphone are very helpful!

The observation session

After the initial assessment, the therapist observes each caregiver interacting with the child during brief, structured play situations.

The therapist provides instructions for each interaction and then observes without coaching. This allows the therapist to understand how the child and caregiver currently respond to one another and to record the interaction skills that are already being used.

The observation is not designed to catch parents doing something wrong. It helps identify strengths as well as areas that may benefit from additional support.

The interaction may not look exactly the way play normally looks at home. Children may notice the computer, feel excited by the setup, or behave somewhat differently because the session is new. Parents will have an opportunity to share what felt typical and what seemed different.

This observation creates a starting point that can be used to personalize treatment and measure progress.

The two phases of PCIT

PCIT is divided into two phases: Child-Directed Interaction and Parent-Directed Interaction. Each phase begins with a caregiver-only teaching session, followed by sessions in which the therapist coaches caregivers while they practice with their child.

Phase One: Child-Directed Interaction

The first phase is called Child-Directed Interaction, or CDI.

During CDI, the child leads a designated playtime while the parent practices a specific set of relationship building skills. The therapist coaches the parent in providing positive attention, following the child’s lead, and communicating in ways that help the child feel noticed, understood, and successful. The therapist will also help the parent navigate any challenging behaviors that arise while still focusing on positive behaviors only.

This phase often feels very positive, but it is more than simply playing together.

Parents learn how different types of attention influence behavior. They practice giving more attention to the behaviors and communication they want to encourage while reducing attention to minor behaviors they do not want to strengthen.

The many purposes of CDI include:

• Strengthening the parent-child relationship

• Increasing positive communication

• Helping children experience positive attention

• Increasing cooperation and confidence

• Supporting emotional regulation

• Reducing negative interaction patterns

• Helping parents feel more effective and connected

The parent practices the skills during a brief daily playtime between sessions. Over time, the principles learned during play begin to influence interactions throughout the rest of the day.

Often, the first phase of PCIT is associated with improvements in positive parent-child interactions and reductions in concerns such as tantrums, hyperactivity, negative attention-seeking, and caregiver frustration.

Some parents initially worry that focusing on positive behavior means ignoring serious concerns or allowing inappropriate behavior. CDI does not require parents to overlook unsafe or significant behavior. It helps families rebalance interactions so that correction is no longer receiving most of the attention.

Families remain in CDI until the parent has demonstrated mastery of the skills and the therapist is seeing evidence that the phase is having its intended effect. Moving forward is based on progress rather than simply completing a predetermined number of sessions.

Phase Two: Parent-Directed Interaction

The second phase is called Parent-Directed Interaction, or PDI.

During PDI, parents continue using the relationship-building skills they learned during CDI while also learning how to give clear, effective directions and respond consistently when their child cooperates or does not cooperate.

This phase helps parents handle situations in which the child needs to follow the parent’s lead.

The goal is to make expectations clear, predictable, and easier for the child to understand. Parents practice giving directions in a way that supports success and learn a consistent follow-through procedure for times when the child becomes defiant.

PDI should build on the relationship and skills established during CDI. The foundation created during the first phase remains important throughout the second.

When a child has significant difficulty moving into PDI, the therapist will consider what may be contributing. In some cases, the family may need additional CDI practice or adjustments based on the child’s developmental and clinical needs.

PCIT should remain thoughtful and responsive to the individual child. The therapist and caregivers work together to determine how the treatment protocol applies to the child rather than assuming that every child will respond in exactly the same way.

How is progress measured?

PCIT is a measurement-based treatment.

During sessions, the therapist observes and records the caregiver’s use of specific interaction skills. Parents will also complete questionnaires that help track the child’s behavior and the family’s experience over time.

These measurements help answer practical questions:

• Are the skills becoming easier for the parent to use?

• Is the child’s behavior changing?

• Are tantrums occurring less often?

• Are they shorter or less intense?

• Is the child recovering more quickly?

• Are parents feeling more confident?

• Are daily routines becoming more manageable?

• Is the parent-child relationship becoming more positive?

Progress is not defined only by whether or not a difficult behavior ever happens again.

Young children will continue to experience frustration, test limits, and have strong emotions. Progress may appear as reduced frequency, shorter duration, lower intensity, faster recovery, or improved confidence in responding.

Tracking these changes allows the therapist and family to make treatment decisions based on what is actually happening rather than relying only on general impressions.

How long does PCIT take?

Many families are told to expect approximately 12 to 16 sessions, with that said, PCIT does not end automatically after a fixed number of appointments.

The length of treatment depends on several factors, including:

• The family’s starting needs

• The child’s developmental and clinical needs

• How consistently the family attends

• How regularly the skills are practiced between sessions (playtime is homework!)

• How quickly caregivers reach skill mastery

• How the child responds to each phase

Some families progress more quickly, while others benefit from additional time.

The purpose of mastery-based treatment is to help parents leave PCIT feeling confident and capable of using the skills independently. Completing treatment should mean more than reaching the end of a calendar.

Can both parents or caregivers participate?

Yes! When multiple caregivers are regularly involved in parenting the child, it is often helpful for each of them to learn and practice the skills.

Some sessions, including the initial assessment and teaching sessions, involve caregivers without the child. Observation and coaching sessions include the child and caregiver.

During online coaching sessions, two caregivers may divide the appointment. One caregiver can participate in play with the child while the other manages siblings or household needs, and then they can switch.

The exact arrangement will depend on the family’s schedule, household, and treatment needs.

Can a child participate in PCIT while receiving another therapy?

In many cases, yes.

A child may already be receiving individual play therapy, occupational therapy, speech therapy, school-based services, medication management, or other support.

PCIT serves a specific purpose: helping caregivers strengthen their relationship with the child and respond more effectively to emotional and behavioral challenges.

Whether treatments should occur at the same time depends on the child’s needs, the goals of each service, and whether the providers can communicate when appropriate. Parents should discuss all current services during the assessment so that treatment can be coordinated thoughtfully.

Why online PCIT?

PCIT was traditionally delivered in a clinic, with the therapist observing through a one way mirror and speaking to the parent through an earpiece. The model can also be delivered with great success through telehealth.

Online PCIT allows the same live coaching process to occur in the family’s home.

Parents practice with their child in the environment where they will use the skills most often. The child can play with familiar toys and remain in a space where they are generally more comfortable.

Online treatment can also reduce transportation demands and difficult transitions to and from an office. For families already managing siblings, work schedules, school, or a child who finds transitions challenging, this can make consistent participation more realistic.

During coaching, I typically turn off my camera, and families can lower the brightness of the computer so that it is just a dark screen. This reduces the likelihood that the child will focus on the video or watch themselves instead of engaging naturally with the parent.

Children do not need to be tricked into participating or kept unaware of treatment. Parents can explain that I help families practice skills for handling big feelings, play, and difficult moments. Some children enjoy saying hello and showing me a favorite toy first before playtime with their parent begins. Others prefer to begin playing right away.

What happens after PCIT?

PCIT ends when the caregivers have mastered the skills, the child’s behavior has improved sufficiently, and the family feels prepared to continue independently.

Graduation is an opportunity to recognize the work the family has done and the changes they have created together.

The skills are designed to continue after treatment ends. Parents can use them with new developmental stages, new routines, sibling concerns, and future behavioral challenges.

Families sometimes notice that the changes extend beyond the child participating in PCIT. Parents may naturally begin using the relationship building and communication skills with siblings, which can improve the overall tone of family interactions.

In my practice, some parents choose to return for occasional parent support sessions after graduation. These appointments may focus on topics outside the formal PCIT protocol, such as routines, chores, reward systems, school concerns, sibling relationships, or new developmental challenges.

Is PCIT right for my family?

PCIT may be a good fit when parents want an active, structured treatment in which they will participate directly.

It can be especially helpful when:

• Your child is young (2-7 years old) and behavioral or emotional challenges are affecting family life.

• You want practical skills rather than therapy that relies mainly on conversation.

• You are willing to practice between sessions.

• You want to improve both your child’s behavior and your relationship.

• You appreciate having clearly defined treatment phases and goals.

• You want individualized coaching rather than only general parenting advice.

PCIT requires time, participation, and regular practice. Parents are not expected to arrive already knowing how to use the skills. Learning them is the purpose of treatment.

A consultation can help determine whether PCIT fits your child’s age, concerns, developmental needs, family circumstances, and current services.

Getting started with online PCIT in California

I provide online PCIT for young children and their caregivers throughout California.

Treatment begins with a caregiver only consultation and assessment. We will discuss what your family has been experiencing, what you have already tried, and what you hope will change. I will also explain the PCIT process and help you determine whether it appears to be the right fit.

PCIT gives parents a structured way to strengthen their relationship with their child while building practical skills for difficult moments. With teaching, live coaching, measurement, and repeated practice, parents have the opportunity to move from feeling uncertain about what to do toward feeling more confident in how they respond.

Wondering whether PCIT is the right fit for your family? I offer online PCIT for families across California. If you'd like to learn more or see whether PCIT is appropriate for your child, you can schedule a free caregiver consultation.

Schedule a free caregiver consultation / Learn more about online PCIT in California