Issues in Clinical Child Psychology SeriesEditor MichaelC.Roberts,UniversityofKansas,Lawrence Forfurthervolumes: http://www.springer.com/series/6082 · Cheryl Bodiford McNeil Toni L. Hembree-Kigin Parent-Child Interaction Therapy Second Edition WithContributions by KarlaAnhalt,ÅseBjørseth, JoaquinBorrego,Yi-ChuenChen,GusDiamond,KimberlyP.Foley, MatthewE.Goldfine,AmyD.Herschell, JoshuaMasse, AshleyB. Tempel,JenniferTiano,StephanieWagner,LisaM.Ware andAnneKristineWormdal 123 CherylBodifordMcNeil ToniL.Hembree-Kigin DepartmentofPsychology EarlyChildhoodMentalHealthServices WestVirginiaUniversity 2500S.PowerRoad 53CampusDrive Suite108,Mesa,AZ85209 Morgantown,WV26506-6040 USA USA [email protected] [email protected] ISSN1574-0471 ISBN978-0-387-88638-1 e-ISBN978-0-387-88639-8 DOI10.1007/978-0-387-88639-8 SpringerNewYorkDordrechtHeidelbergLondon LibraryofCongressControlNumber:2009942276 ©SpringerScience+BusinessMedia,LLC1995,2010 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Usein connectionwithanyformofinformationstorageandretrieval,electronicadaptation,computersoftware, orbysimilarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyare notidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubject toproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoing topress,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityforany errorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,withrespect tothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) ForthedeveloperofParent-ChildInteraction Therapy... ourmentorandfriend, Dr.SheilaM.Eyberg ...andtoourlovingfamilies, whoshareinallofouraccomplishments, my husband Dan, our sons Danny and Will, and MomandDad(C.B.M.) and my husband Tim, our children Molly, Sean, and Patrick,andMom,Dad,Tim,&Jon(T.L.H.) Preface WhyaSecond,ExpandedClinicalEdition? The first edition of this book, Parent-Child Interaction Therapy, was published in 1995 as part of a series called “Issues in Clinical Child Psychology.” As the first book written about PCIT, it was designed to be a readable clinical guidebook describing how to conduct the therapy. At the time the original text was written, PCITwasusedinonlyafewclinicalchildpsychologyresearchlaboratories.Having experiencedgreatsuccesswiththistreatmentapproachinourownclinicalwork,we feltanurgentneedtomakePCITmoreavailabletofamilies.Itwasourhopethatthe treatmentwouldbeembracedbymentalhealthprofessionalsfromavarietyofthe- oreticalorientations.Indeed,thebook–alongwithSheilaEyberg’sprogrammatic researcheffort–sparkedatremendous amount ofinterestandservedasacatalyst formorethanadecadeofrapiddisseminationandempiricalevaluationofPCIT. In 2008, circumstances have changed tremendously. Instead of being available only in university-based clinics in a few states, PCIT is now being provided to familiesacrossthecountryincommunitymentalhealthsettings,privatepractices, hospital-based clinics, and head start programs. In addition to clinical child psy- chologists, providers of PCIT now include social workers, counselors, marriage andfamilytherapists,playtherapists,andothermasters-levelclinicians.Forexam- ple, in California alone, approximately 100 agencies provide PCIT, and there is even a mobile unit delivering PCIT in a 35-foot long Winnebago! In addition to widespreaddeliveryintheUnitedStates,PCITisnowavailableinmanyothercoun- triesincludingNorway,Australia,HongKong,Russia,SouthKorea,England,The Netherlands, Taiwan, and Canada. PCIT’s strong empirical base also has grown tremendouslyresultinginbothacademicandgovernmentalrecognition.PCITcur- rentlyisrecognizedasanevidence-basedprogrambynumerousprofessionalgroups andstateandfederalagenciesincludingtheKauffmanFoundation’sBestPractices Project, Society of Clinical Child and Adolescent Psychology, and the National ChildTraumaticStressNetwork. As a result of the rapid dissemination of PCIT, much more information has been generated regarding both clinical applications and treatment effectiveness. The scope of PCIT has broadened greatly with published reports of its use with a variety of children other than oppositional preschoolers. PCIT has shown vii viii Preface promising results with victims of maltreatment, anxious children, children with ADHD,andthosewithdevelopmentaldisabilities.Thebodyofempiricaldataavail- ableonPCIThasgrownexponentially.Whereasinourfirstbook,wedevotedthree paragraphstodescribingtheoutcomeliterature,theneweditionrequiresafullchap- tertooverviewthewealthofoutcomedatanowavailable.Inthesecondeditionof Parent-ChildInteractionTherapy,ourgoalistocompilethisrichnewclinicaland researchinformationintoareadablesourcebookfortherapistsandresearchers. Organization oftheSecondEdition The second edition is broadly divided into two sections. In Part I, we describe the fundamentals of PCIT as it was developed by Dr. Sheila Eyberg and is described in her 1999 manual entitled, “PCIT: Integrity Checklists and Session Materials.” We strongly recommend that therapists obtain Dr. Eyberg’s manual and use the checklists to guide each therapy session. The treatment integrity checklists and other session materials currently are available for download on Sheila Eyberg’s website(www.pcit.org).Withregardtothefirstsectionofthesecondedition,you will find that this part of the book greatly resembles our original PCIT text, with someimportantmodifications.Notably,wehaveupdatedthetexttoreflectthecur- rentresearch-basedtreatmentprotocolbeingusedinDr.Eyberg’slaboratoryatthe UniversityofFlorida.Forexample,Dr.Eyberg’smasterycriteriahavechangedsince thepublicationoftheoriginalbook.Also,theuseofabackuptime-outroomisnow thestandardforteachingchildrentostayinthetime-outchair.Itiscriticalforboth clinicians and researchers to know about changes to the treatment protocol and to updatetheirownpracticesaccordingly.Itisimportantforclinicianstoknowthatthe changesmadebyDr.Eybergarebasedonsolidempiricalandtheoreticalrationales. Overthepastdecadeofdissemination,wehaveseenmanytherapistsmaketheirown changesinproceduresbasedonpersonalpreferenceandexperience.Inmanycases, theirtherapieshaveevolvedintotreatmentsthatbearlittleresemblancetostandard PCIT.Whenthisoccurs,effectivenessisgenerallydilutedandresearchfindingson PCITarenolongerapplicabletotheworkbeingconductedintheirclinics. With respect to the dangers of therapeutic drift, we find it helpful to consider a boating analogy. Let us imagine that Dr. Eyberg’s research-based protocol is the “mother ship” anchored off the coast of Florida. In order to provide a ther- apy that resembles the evidence-based anchor, it is important for therapists to be knowledgeable about and adhere to the standard protocol. The cumulative effects ofmultiplesmallchangestothetreatmentprotocol(i.e.,lettingoutsomeline)may cause such substantial drift that the therapist ends up off the coast of Mexico pro- vidingaversionofPCITthatlooksalmostnothinglikethe“mothership”protocol anchorednearFlorida.Thedangertolettingoutsomuchlineisthatthenewtreat- ment may not work as well as standard PCIT. Ultimately, widespread drift could undermineoureffortstodisseminatethispotenttreatmenttofamilies.Whenthera- pistsprovideineffectivetreatmentsundertheguiseofPCIT,theyerodeitsstanding as an evidence-based intervention. Therefore, Part I of the book serves as our Preface ix PCIT“anchor”encouragingtherapiststoprovidePCITwiththegreatesttreatment integrity. Part II of the book goes beyond the fundamentals of PCIT to present rich clin- ical examples of how one can expand PCIT to address a spectrum of child and parentconcernsindiversesettings.Forexample,inPartII,wediscusstheapplica- tion of PCIT to special populations other than the preschoolers with oppositional defiant disorder addressed by the standard protocol presented in Part I. We are excitedtosharewithourreadersrecentdevelopmentsintheuseofPCITasapre- vention model with babies and toddlers. We also highlight interesting work being conducted in the adaptation of PCIT to older elementary school age children and siblings. A PCIT protocol has been developed and evaluated for young children withanxietydisorders.Toillustrate,weprovidethereaderwithacaseexampleto demonstratetheadditionofanexposurephasetoPCIT,whichDonnaPincustermed, “bravery-directedinteraction.”Ground-breakingresearchdemonstratingthesuccess of PCIT in reducing future incidents of abusive parenting is presented in this sec- tionofthebook.Weenumeratespecificclinicalguidelinesforworkingwithparents whohaveangercontrolproblemsandtheirchildrenwithtraumahistories.Inaddi- tion,thesecondpartofthebookprovidesclinicianswithhelpfulinsightsandtools for working with culturally diverse and multi-problem families. New approaches are outlined for the use of PCIT in varied settings such as residential treatment facilities, schools, and homes. The book concludes with a discussion of training issuesincludingminimumqualificationsandskillsnecessarytorepresentoneselfas aPCITtherapist. ContributorstotheBook WhenwewereinvitedtowriteParent-ChildInteractionTherapy:SecondEdition, we grappled with whether to write the book entirely ourselves or to make it an editedbookcompilingchapterswrittenbyourPCITcolleagues.Ontheonehand, we have heard from readers that a strength of the original PCIT book was that it was written with a clinical voice. They appreciated that the book incorporated language that we actually use in our interactions with clients. We wanted to pre- serve that practical clinical tone in the expanded edition. On the other hand, we wanted to present cutting edge work that is being conducted with special popula- tions.Insomeinstances,wefeltthatparticularchaptersmightbebetterwrittenby individuals immersed in this specialized work. In the end, we decided to combine the best of both approaches by writing the majority of the book ourselves, while invitingselectexpertstocontributecertainchapters.Wearegratefulforthecontri- butionsofthefollowingcolleagues:KarlaAnhalt,ÅseBjørseth,JoaquinBorrego, Gus Diamond, Kimberly P. Foley, Matthew Goldfine, Amy D. Herschell, Joshua Masse, Ashley Tempel, Jennifer D. Tiano, Stephanie Wagner, Lisa M. Ware, and Anne Kristine Wormdal. Additionally, we want to thank Melanie Nelson for read- ingseveralchaptersfromthisbookandprovidinguswithvaluablefeedbackabout treatmentintegrity.