Parent-directed interaction
In the PDI phase of treatment, parents learn to
decrease disruptive behavior that is too dangerous to
be ignored, is controlled by reinforcers other than
parents’ attention, or does not extinguish easily.
Parents continue to use the PRIDE skills to reinforce
their child’s positive behavior during PDI, but they
learn also to direct their child’s behavior when
needed. They first learn specific skills for giving
effective commands. As outlined in Table 2, commands
should be direct, specific, age-appropriate,
positively stated, and respectful. Commands also
should be given one at a time and only when
necessary. The reason that it is important for the child
to obey the command should be explained either
before the command is given or after it is obeyed.
These rules make it absolutely clear to both the child
and the parent what is expected and help assure that
the child is able and inclined to obey.
The PDI procedure follows an algorithm that
parents are taught to follow precisely (see Fig 2).
Parents are directed to pay attention only to
whether the child obeys or disobeys the command.
When the child obeys, the parent gives a labeled
praise for the child’s compliance, which includes
an explanation of why the child’s behavior pleases
the parent, and then returns to the PRIDE skills of
CDI until another command is needed. If the child
disobeys, a time-out is initiated that continues until
the child obeys the parent’s original command. This
procedure provides parents with a specific response
for child compliance or noncompliance at
each step, enabling consistency to occur almost
automatically. It also provides a procedure that is
predictable and fair to the child, allowing frequent
opportunities for the child to choose to obey and
end the time-out.
The time-out procedure is initially anxiety-provoking
for parents, though. Children often say
hurtful things or have major temper tantrums in
their attempts to manipulate parents into giving in.
In PCIT, parents practice the PDI the first time
during a treatment session, so that therapists are
able to offer emotional support to enable parents to
follow-through calmly during these very stressful
first experiences with consistent time-out. The PDI
coaching sessions allow therapists to coach parents
in relaxation skills and other anger-control techniques
when indicated.
Parents initially practice the PDI skills at home in
5- to 10-minute daily clean-up sessions following the
5-minute CDI sessions. Gradually, parents extend
their commands to other times of the day and finally
to only those times when obedience is highly
important. After parents have learned to use the basic
PDI algorithm, they may be taught variations of the
basic procedure for specific aggressive behaviors or
misbehaviors in public situations. Throughout treatment,
parents are encouraged to use problemsolving
techniques to apply the PCIT principles they
have learned to specific problem situations. Once
children learn that there are predictable consequences
for breaking the rules, they learn not to test
limits, which helps parents to feel more in control of
their child’s behavior—and their own.