Parent-child interaction therapy (PCIT)

Parent-child interaction therapy (PCIT) is a powerful, family-centered approach that meets challenging behaviors with connection, not just correction. It focuses on building trust, improving communication, and giving caregivers tools they can use right away. If you’re exploring therapy options for your family, this guide will walk you through how PCIT works, who it’s for, and how to find a therapist trained in this unique method.

When a child’s behavior feels overwhelming, it can be hard to know where to start. PCIT offers a different path — one that centers the caregiver-child relationship and gives parents real-time tools to handle tough moments with more confidence. Backed by decades of research, PCIT helps families feel more connected while creating lasting improvements in behavior.

What is PCIT?

Parent-child interaction therapy (PCIT) is a specialized, evidence-based treatment for young children with behavioral challenges, such as frequent tantrums, defiance, aggression, or difficulty following directions. It focuses on strengthening the parent-child relationship and helping caregivers respond calmly and consistently in the moment.

During sessions, a therapist observes a parent and child’s interactions, often from behind a one-way mirror or via video, and offers live coaching through an earpiece. This collaborative approach not only helps reduce difficult behaviors, but also supports a stronger emotional bond between children and their caregivers.

Origins of PCIT

PCIT was developed in the 1970’s by clinical psychologist Dr. Sheila Eyberg. Drawing from behavioral principles, attachment theory, and social learning theory, she created a treatment that blended play-based techniques with on-the-spot coaching.

Unlike traditional talk therapy or cognitive behavioral therapy (CBT), PCIT gives caregivers in-the-moment skills that can be practiced and reinforced at home, helping families experience long-term and sustainable change.

When is PCIT used?

PCIT is typically used with children who exhibit externalizing behaviors. These might include:

• Tantrums or meltdowns
• Noncompliance or defiance
• Aggression (e.g., hitting, biting, throwing)
• Difficulty following directions

Age ranges

PCIT is typically used with children between the ages of 2 and 7. In some cases, it can be adapted for slightly older children who have developmental delays or behavioral concerns more typical of a younger age. Specialized versions of the model exist, such as PCIT-T for toddlers and age-adjusted adaptations for older children.

Flexibility in who participates

While PCIT was not designed as a traditional family or group therapy, it offers some flexibility in how it can be delivered. For example, other key adults, such as a second caregiver or grandparent, may join sessions to gain education and ensure consistency across home environments. Some clinics also offer group-based formats that involve multiple families or include siblings or extended family members to support the child’s progress.

Conditions that PCIT treats

PCIT was originally developed to address challenging behaviors in young children and remains a gold standard treatment and support for conditions like:

• Oppositional defiant disorder (ODD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Anxiety disorders
• Trauma-related symptoms
• Selective mutism
• Challenges commonly faced by children in foster care or those who have experienced early adversity

How does PCIT work?

PCIT is divided into two phases, both of which involve live coaching by a trained therapist:

Child-directed interaction (CDI)

During the CDI phase, parents use play therapy strategies and special communication tools known as PRIDE skills:

• Praise
• Reflect
• Imitate
• Describe
• Enjoy

This first phase helps caregivers build warmth and trust through positive play. Using PRIDE skills, caregivers are encouraged to follow their child’s lead in play.

One important component is “catching your child being good,” such as when they are being gentle, listening, or using kind words. By noticing and praising these positive behaviors, parents help increase how often they occur while gradually reducing unwanted behaviors. This kind of attention supports a child’s self-esteem, improves their attention span, and strengthens positive interactions between the caregiver and child.

Parent-directed interaction (PDI)

In the parent-directed interaction phase, parents receive training on how to communicate with their children, for example, how to give clear, calm instructions and follow through consistently.

This helps children learn that cooperating leads to positive outcomes, while not listening results in predictable, non-emotional consequences. With real-time coaching, parents build strong interaction skills and learn how to guide their child’s behavior in ways that promote healthy child development. Over time, many families see fewer power struggles, greater cooperation, and lasting improvements in their everyday lives.

What to expect during PCIT sessions

Every therapy looks a little different, and PCIT is no exception. This unique, interactive format involves real-time coaching during play sessions, giving parents hands-on support to respond more effectively in the moment. Here’s what to expect when you start.

What a first session might look like

In the first few sessions, the therapist gathers information about things like:

• The child’s typical behavioral patterns
• The parents’ goals
• Any concerns related to attention, attachment, or emotional regulation

This information helps the therapist tailor the treatment to the family’s needs. From there, the core of PCIT is delivered in the two phases outlined above: the child-directed interaction phase and the parent-directed interaction phase.

What a typical session includes

During each session, regardless of the phase, the therapist observes the parent-child interaction through a one-way mirror or video feed and provides live coaching to the caregiver through a small earpiece (often called a “bug-in-the-ear”).

The first phase focuses on strengthening the parent-child relationship through warm, positive play. Parents are taught specific interaction skills — such as giving labeled praise, showing enthusiasm, and following the child’s lead — that help children feel calm, secure, and confident. These sessions are fun for the child and give parents a chance to practice new ways of responding that build connection and reduce power struggles. Parents learn to focus on and reinforce positive behaviors such as sharing, taking turns, listening, and using kind words, while also helping to reduce behavior like tantrums, whining, or bossiness.

The second phase introduces more communication skills for the parent, including structured discipline strategies that help children follow directions, respect rules, and behave appropriately in public or at home. Parents are coached on how to remain calm, confident, and consistent even during challenging moments, using techniques like a time-out when needed. This phase empowers caregivers to set clear expectations while maintaining a supportive and nurturing relationship with their child.

How long does PCIT take to work?

PCIT isn’t open-ended. It’s a short-term treatment designed to bring about meaningful change in a structured timeline.

Short-term vs. long-term use

Parent-child interaction therapy (PCIT) is a goal-oriented treatment typically completed in 12 to 20 sessions. The exact length of treatment depends on the child’s needs and the family’s consistency with session attendance and at-home practice.

Typical session frequency and duration

Sessions typically last about one hour and occur once per week. Families may need more or fewer sessions depending on progress, attendance, and their ability to implement new skills at home.

What progress might look like over time

Many families begin to see meaningful changes like fewer tantrums and better cooperation, within the first several weeks of treatment.

Treatment is considered complete when caregivers demonstrate proficiency in both phases of PCIT (relationship building and discipline) and report their child’s behavior falls within normal limits on a standardized behavioral rating scale.

While uninterrupted treatment is ideal, some flexibility in scheduling is possible as long as progress continues.

Is PCIT effective?

Yes, there are decades of research demonstrating that parent-child interaction therapy (PCIT) is an effective, evidence-based treatment for young children with behavioral challenges. Numerous studies — including randomized controlled trials (RCTs), long-term follow-ups, and meta-analyses — show that PCIT reduces behavioral problems such as aggression, defiance, and tantrums, while also improving parenting confidence and decreasing caregiver stress.

For example, a 2007 meta-analysis of 24 studies found that PCIT improved child behavior and the quality of parent-child interactions. PCIT is also recognized as a “well-supported” intervention by national organizations such as the California Evidence-Based Clearinghouse for Child Welfare and the National Traumatic Stress Network.

PCIT’s effectiveness lies in its unique design:

• Real-time coaching during parent-child interactions
• A two-phase approach that blends relationship-building with consistent discipline
• A focus on mastering skills before treatment ends

This approach helps parents gain confidence and see immediate changes in their child’s behavior, leading to long-term, sustainable improvements.

When it may not be the right fit

PCIT may not be suitable for families who are unable to commit to consistent attendance or who don’t feel comfortable with the live coaching model. It may also be less effective if the child’s primary challenges fall outside of behavior and emotional regulation.

Finding a PCIT therapist

Not all therapists have PCIT training, so it’s important to look for a provider who has these specific skills.

PCIT may be offered by:

• Licensed clinical social workers (LCSWs)
• Licensed marriage and family therapists (LMFTs)
• Psychologists
• Licensed professional counselors (LPCs)
• Mental health counselors (LMHCs)
• And other licensed mental health professionals

Questions to ask before starting

• Are you certified in PCIT?
• How do you tailor sessions to meet my child’s specific needs?
• Do you offer in-person or telehealth PCIT?
• How do you track progress throughout treatment?

Finding a therapist through Grow Therapy

To find a PCIT therapist near you, use Grow Therapy’s therapist finder and select “Parent-Child Interaction Therapy (PCIT)” under the treatment methods filter. You can also filter by location, insurance, and other preferences to find the best fit for your family.

FAQ

1. What does a typical PCIT session look like?

During PCIT, parents and children engage in guided play sessions while the therapist observes, often from behind a one-way mirror or via a live video feed. The parent wears an earpiece so the therapist can provide live coaching in real time. This structure allows the therapist to offer supportive, in-the-moment feedback on how to handle behaviors and build stronger connections.

2. What kinds of skills do parents learn in PCIT?

Parents are coached in a set of tools called PRIDE skills—Praise, Reflect, Imitate, Describe, and Enjoy. These strategies help strengthen the parent-child bond and reinforce positive behaviors. As therapy progresses, parents also learn clear communication and consistent discipline techniques that encourage cooperation and reduce power struggles.

3. How do I know if PCIT is right for my child?

PCIT is generally used for children ages 2 to 7 who are showing frequent tantrums, aggression, defiance, or other disruptive behaviors. It may also be helpful for kids facing anxiety, trauma, or emotional regulation difficulties, especially when paired with a strong parent-child dynamic. If your child’s behaviors are interfering with daily life, PCIT might be a good fit.

4. What makes PCIT different from other types of therapy?

Unlike traditional therapy, PCIT directly involves caregivers as active participants in the sessions. The therapist coaches the parent in real time while observing their interactions with the child. This structure makes it easier for parents to build skills and apply them confidently at home, which often leads to faster, more lasting results.

5. Does PCIT work if only one parent is involved?

Yes, PCIT is designed to be effective with one caregiver, though it can also include multiple adults, like a second parent or grandparent, for consistency at home. If only one adult is actively participating, that caregiver will receive all coaching and practice the PCIT skills directly with the child during sessions.

6. What happens when PCIT is complete?

PCIT typically ends when the parent has mastered both relationship-building and discipline strategies, and the child’s behaviors fall within a typical range on a standardized rating scale. Before ending therapy, your provider may review your progress, talk through what to expect moving forward, and help you create a plan in case challenges come up again later.