Child-Directed Interaction

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There are two primary elements of Parent Child Interaction Therapy (PCIT). The  initial element is Child Directed Interaction (CDI). This interaction is intended to strengthen the fundamental relationship between parent and child. The parents have the opportunity to see their child in a situation where the child feels safe and in control where they can pay uninterrupted attention to their child and practice some skills of interaction that help the child to feel that they are valued and appreciated. This should set the stage for the second element called Parent Directed Interaction (PDI).

CDI is meant to be a fairly free time for the child to express themselves it is surprisingly structured. Our therapist has recommended that we get a box filled with toys and activities that can be used for this interaction time. The child is then allowed to choose which toy or activity during each session. Sessions are short enough that the child should only be playing with one type of toy or activity during a given session.

While there are no strict rules about what specific toys or activities should be included there are plenty of guidelines about what types of play should be avoided. Activities which require the establishment of strict boundaries are discouraged lest the boundaries begin to interfere with the child’s play. Games where there are set rules are not recommended for much the same reason. Toys or games which encourage violence or aggressive behavior (guns, and games of cowboys and Indians are examples that were cited in the handouts we were given) are also to be avoided. Some of those things I could have guessed but I would not have thought about avoiding imagination games. While the child should be free to express themselves it is not helpful for these interactions to have the child or the adult pretending to be something other than themselves.

Some of the items that were recommended were games such as Lincoln Logs, erector sets or other building-block types of toys. Around our house we already have Wedgits and train sets.  Also cars or stuffed animals or other small toys can work well. Playdough is one that can work for some kids, allowing for creative play, but it is also one that would not work for other children who might use the playdough in ways that would destroy the effectiveness of the interaction time (like grinding it into the carpet or eating it).

During the interaction parents are supposed to focus on the child and practice a set of “do” skills while avoiding a set of “don’t” skills.

The “do” skills are:

• Behavioral Description – where the parent describes what he child is doing. This is supposed to help the child see that the parent is interested and paying attention.
• Reflection – where the parent repeats or paraphrases things that the child is saying. This again shows the child that the parent is paying attention and that they are being heard.
• Labeled Praise – where the parent states specific things that the child is doing well. Considering that this therapy is with children who tend to spend a lot of time in trouble, this is a good time for them to realize that their parents do not think they are all bad.

The “do” skills can be remembered using the acronym PRIDE: Praise, Reflect, Imitate, Describe, Enthusiasm. Imitate and Enthusiasm are not in the list above but by imitating the child the parent helps to make sure that the child is in charge of what is happening rather that having the child begin following the parent in their play activities. Enthusiasm is meant to remind parents that they need to be upbeat during this interaction rather than simply putting in time and plodding through as if it were some painful homework assignment.

The “don’t” skills are:

• Don’t give commands.
• Don’t ask questions.
• Don’t make critical statements or be sarcastic.

These things tend to take the initiative away from the child and put the parent back in charge – which is not the point of the CDI interaction time. I was surprised to see that asking questions was on the don’t list until it was explained that questions lead the conversations, and they can serve as implicit commands or display disapproval. Of course giving commands and asking questions are appropriate at times but not during the CDI time.

CDI time should be done daily and should generally be independent of the child’s behavior but if the child is acting inappropriately during the CDI time parents have two ways to deal with the inappropriate behavior. Most of the time they should ignore the behavior by not looking at the child or speaking to them about the behavior. As soon as the child does something appropriate the parent should immediately praise the appropriate behavior so that the child is getting attention only for their appropriate actions. If the inappropriate behavior is destructive or aggressive the parents have a second option – they can stop the CDI time and cite the behavior that caused it to end. Note that the parent should not reinstate the playtime even if the child apologizes. They need to see that their destructive or aggressive actions have consequences that will not go away simply because they apologize after the fact.

This has been an essentially clinical description of CDI. In the future I will talk about our particular experience with CDI including obstacles we have faced and outcomes that we have been able to observe as a result of CDI.