Parenting Through the Storm: Practical Tools for Big Emotions and Challenging Behaviors: An Introduction to Parent-Child Interaction Therapy

What Is Parent-Child Interaction Therapy?

Parent-Child Interaction Therapy (PCIT) is a proven program that helps improve the relationship between parents and young children while reducing challenging behaviors. Developed by Dr. Sheila Eyberg and promoted by PCIT International, it is most effective for children between the ages of 2 and 7, especially those who show signs of disruptive behavior, such as ADHD (attention-deficit/hyperactivity disorder) or ODD (oppositional defiant disorder; Sridevi et al. 2017; PCIT International 2025).

A certified PCIT therapist delivers PCIT in two main phases:

1. Child-directed interaction: With guidance from a certified PCIT therapist, parents learn to strengthen their relationship with their child through positive, child-led play.

2. Parent-directed interaction: A certified PCIT therapist guides parents in learning consistent and effective discipline strategies to manage difficult behaviors and improve cooperation.

Through the use of real-time coaching and structured activities, PCIT helps caregivers build communication skills, encourage positive behaviors, and navigate everyday challenges more effectively (Mohamed 2019). Using these methods, PCIT builds a foundation for healthy parent-child relationships based on trust, consistency, and positive interactions.

This publication is meant to raise awareness about PCIT and introduce some of its core ideas and benefits. It is not a replacement for therapy, and families should not attempt to implement PCIT on their own. Instead, the tools and examples shared here are intended to support self-led learning and informed decision-making.

If you’re concerned about your child’s behavior or your parent-child relationship, it’s a good idea to speak with a mental health professional. They can help you explore therapy options, such as working with a certified PCIT therapist, and determine what might be most helpful for your family’s unique needs. It’s also important to know that certain therapy approaches may not be appropriate for all families or situations, which is why professional guidance is strongly recommended.

Core Components of PCIT

PCIT includes two main phases: child-directed interaction and parent-directed interaction. Both phases provide children with positive and clear feedback about their behaviors.

Child-Directed Interaction

The first phase, CDI, focuses on strengthening the parent-child relationship through positive, child-led play (Sridevi et al. 2017). During CDI, parents are trained by a certified PCIT therapist to use PRIDE skills — praise, reflection, imitation, description, and enthusiasm — to support and reinforce positive behaviors.

Objective

Build a positive relationship and encourage good behavior.

Method

Parents engage in child-led play with their child, following these PRIDE guidelines (PCIT International 2025):

• Praise: Offer specific praise for positive behavior. For example, “Great job sharing the toys!”
• Reflection: Repeat or paraphrase what the child says to show understanding. For example, “You built a tall tower!”
• Imitation: Join the child in play by mimicking their actions. For example, stacking blocks together.
• Description: Narrate the child’s actions. For example, “You’re coloring the sun yellow.”
• Enthusiasm: Show genuine excitement and warmth. For example, “Wow, that’s amazing! You’re so creative!”

Benefits of the CDI Phase

For children:

• Increased feelings of security, safety, and attachment with their caregiver(s).
• Improved attention span during play and everyday tasks.
• Increased self-esteem and confidence.
• More prosocial behaviors, such as sharing, taking turns, and cooperating.
• Better emotional regulation: Children are better able to calm themselves and manage frustration.
• Fewer and shorter tantrums.
• Reduced hyperactivity or impulsive behaviors.
• Reduced expressions of distress through behaviors like whining, interrupting, or demanding attention as children learn more effective ways to communicate their needs.

For caregivers:

• Increased confidence in parenting skills.
• Decreased frustration and stress during interactions with the child (Sridevi et al. 2017).

Parent-Directed Interaction

The second phase, PDI, aims to establish consistent discipline and decrease noncompliance (Timmer et al. 2005). In this phase, parents learn to set clear expectations and consequences. Techniques such as delivering clear commands, implementing effective consequences for noncompliance, and conducting behavioral monitoring are emphasized. One key strategy introduced in PDI is the use of time-out — a calm, brief removal of attention or activities that is used to help children reset and learn that certain behaviors are not acceptable. For example, parents might give a straightforward instruction like, “Please put your toys away,” and follow up with a time-out if the child does not comply.

Objective

Establish consistent discipline and decrease noncompliance to create a predictable and supportive home environment. This phase helps caregivers adopt a parenting approach that is both warm and firm.

Method

Parents set clear expectations and consequences using techniques such as:

• Clear commands. Use direct and simple instructions. For example, “Please put your toys away.”
• Effective consequences. Follow through with consistent consequences for noncompliance, such as time-outs or loss of privileges.
• Behavioral monitoring. Track the child’s progress and adapt strategies as needed.

Guidelines for Delivering Effective Commands

1. Direct commands. Direct commands clearly and specifically tell the child what to do, leaving little room for confusion. In contrast, indirect commands may sound like a question or a suggestion, which can make it unclear whether the child is actually expected to follow through.

Examples of direct commands: “Please put your shoes on,” or “Please pick up the toys.” These statements are clear instructions with an expectation for action.

Examples of indirect commands: “Can you put your shoes on?” or “Let’s pick up the toys.” These examples can sound more like a question or a shared activity. A child might interpret them as optional or might not realize the adult is giving a direction.

Using direct language helps children understand exactly what is being asked and reduces the chance of miscommunication.

2. Positively stated commands. Commands should focus on what the child should do, rather than what not to do. Positive phrasing helps the child understand the expected behavior.

Examples: “Please use walking feet,” or “Please put your plate in the sink.”

Avoid: “Stop running,” or “Don’t leave your dishes out.”

3. One at a time. Avoid overwhelming the child with multiple directions at once. Breaking instructions into smaller, single steps is more manageable for young children.

Example: “Please put your backpack away.”

Avoid: “Grab your backpack, put on your shoes, and go to the car.”

4. Specific commands. Be clear about what you want your child to do. Vague commands can lead to confusion or noncompliance.

Examples: “Please stand quietly next to me,” or “Please keep your toys out of the hallway.”

Avoid: “Be good,” or “Don’t make a mess.”

5. Developmentally appropriate commands. Make sure your commands are suited to your child’s age and abilities. Using simple, familiar language helps set them up for success.

Example: “Please draw me a red circle.”

Avoid: “Please draw me a crimson sphere.”

6. Normal tone of voice. Give commands using a calm, neutral tone. Yelling or using harsh tones can make children feel unsafe or resistant.

Examples: “Please give me your homework,” or “Please go to your room.”

Avoid: “Get over here right now!” or “Go to your room this instant!”

7. Explanation or reason. Providing a short reason helps children understand why they are being asked to do something. This builds trust and cooperation.

Examples: “It’s raining outside; please get your umbrella,” or “I need to clean the floor; please pick up your toys.”

Avoid: Giving commands with no explanation, especially when the purpose isn’t obvious.

8. Only when necessary. Use commands when they are truly needed. Too many directives can overwhelm children or cause them to tune out.

Examples: “Please come down from the counter; it’s dangerous,” or “Broken glass is sharp; please stand next to me.”

Avoid: “Bring me the remote,” or “Get me a snack.”

Steps for a PCIT Time-Out

1. Give a clear command. State the desired behavior directly. For example, “Please stop jumping on the couch.”
2. Provide a warning. If noncompliance continues, calmly state that a time-out will follow if the behavior doesn’t change.
3. Implement time-out. If the child persists, guide them to a designated, boring, and safe time-out area. Time out consists of three minutes of the child sitting in the chair with 75% of their body touching the chair. After the time ends, count to five in your head, and the child must be quiet for five seconds before they are permitted to get off the chair.
4. Monitor during time-out. The adult should keep the child within their line of sight to ensure safety, while avoiding interaction or eye contact during the timeout.
5. Signal the end of time-out. After the time-out duration, calmly signal that it’s over.
6. Re-engage with positive interaction. Give the child another opportunity to comply with the original instruction and reinforce positive behavior. If the child goes to time-out for not following the command, after time-out, the child must obey the original command or go back to time-out.

Important Considerations

• Consistency is essential to help children learn expectations.
• Ensure time-out is developmentally appropriate.
• Time-out is not a punishment but a strategy to help the child reset and calm down.
• Before using time-out, it’s important that parents feel confident using praise and child-directed interaction skills. These positive tools help build a strong, trusting relationship with your child and make timeout more effective when it’s needed.

Benefits of the PDI Phase

• Increased compliance with adult requests.
• Improved caregiver confidence and reduced stress.
• Enhanced behavior management at home and in public.
• Decreased frequency and severity of aggressive or destructive behaviors.
• Reduced defiance and oppositional behaviors (Mohamed 2019).

Practicing PCIT Techniques at Home

Parents can practice the following steps to apply PCIT principles in everyday situations. However, it is important to note that these steps are intended as an introduction and do not replace formal Parent-Child Interaction Therapy. For full benefits and guidance, participating in the complete PCIT program is recommended.

• Give clear commands. Keep instructions short and specific to ensure your child understands what is expected.

• Follow through consistently. Calmly and consistently use age-appropriate consequences—such as time-outs, loss of privileges, natural consequences, or a do-over—when your child does not follow directions. Always praise your child immediately when they comply.

Special Time Activities

Schedule “special time”: Dedicate five to 10 minutes daily (a minimum of four times a week) to child-led play, using PRIDE skills to reinforce positive interactions.

• Praise their efforts. For example, “You’re doing a great job stacking those blocks!”

• Reflect their words to show interest and understanding.

• Imitate their actions to foster connection. For example, if your child is pushing a car down a ramp, then you would push your car down the ramp.

• Describe their activities to demonstrate engagement.

• Show enthusiasm to create a positive atmosphere.

Time-Out Practice

Practice the time-out process in a low-stakes situation by clearly stating what behavior will result in a time-out and rehearsing how to guide your child to the time-out space if necessary. After the time-out, reinforce positive behaviors with praise.

1. Identify a quiet area for time-outs.
2. Choose a safe, distraction-free spot such as a kitchen chair, a hallway spot, or a corner of a room. The area should be boring (no toys, screens, or stimulating items) and visible to the caregiver.
3. Avoid holding time-outs in bedrooms (which may send mixed signals) or dark/isolated spaces like closets or garages.
4. Explain the time-out process to your child.
5. Use calm, simple language so your child knows what to expect. For example, “When you’re not following directions, I’ll ask you to sit quietly in the time-out chair for a few minutes to help your body and brain calm down. After a time-out, you’ll get another chance to follow the directions.”
6. Practice calmly implementing time-outs for disruptive behavior, using consistent language and actions.
7. Practice during calm moments to help your child understand the process before it’s needed. This helps reduce fear or resistance when the real situation arises.

Monitoring Progress

PRIDE Skill Tracking

Use a simple chart like the example below (table 1) to track PRIDE skill usage during daily “special time.” One adult (such as a parent, caregiver, or supportive adult) can practice the PRIDE skills, while another person — such as a co-parent, grandparent, friend, or trusted adult — observes and tracks how many times each skill is used during the five-minute session. If possible, switch roles on different days to ensure both practice and observation occur. If no second person is available, adults can self-monitor by using a checklist or by recording short sessions (audio or video, if comfortable) for later reflection. The goal is to use each PRIDE skill at least 10 times within five minutes during playtime to sustain parent-child engagement that can foster healthy relationship development.

Observer Notes

The observer will look for specific behaviors during the five minutes of playtime:

• Praise: Check for explicit praise that identifies positive behavior. Examples include, “I love how gently you are playing with the cars,” or “Great job putting the puzzle pieces together!”
• Reflection: Listen for reflections that accurately repeat the child’s words or ideas, demonstrating engagement. Examples include repeating back phrases like, “Yes, that is a big truck,” or “You’re right, it’s a triangle!”
• Description: Identify comments that describe what the child is doing in real-time without directing them. Examples include narrating actions such as, “You’re stacking the blocks really high,” or “You’re coloring the sun yellow.”

Tip: When possible, switch roles so that each participating adult has the opportunity to practice and observe. Reflecting with the other person afterward can help identify strengths and areas for improvement.

Conclusion

Parent-Child Interaction Therapy gives parents practical tools to improve family dynamics and foster positive behaviors. By practicing PRIDE skills and consistent discipline strategies, parents can strengthen their relationship with their child while effectively addressing challenging behaviors. A unique and essential aspect of PCIT is the clinical coaching provided by a certified PCIT therapist, who guides parents in applying these techniques effectively and tailoring them to their family’s specific needs.

Table 1. PRIDE Skill Tracking Log.

Additional Resources

YouTube Videos

• “Parent-Child Interaction Therapy Demonstration: Earpiece With a Psychotherapist,” The Lukin Center. www.youtube.com/watch?v=oDKV3s3k6b4.
• “Example of Parent Child Interaction Therapy (PCIT) Time Out Procedure with Real 2 Year Old Child,” SelfRegulationLab. www.youtube.com/watch?v=V_sUn2QFWow&pp=ygUUcGFyZW50IGRpcmVjdGVkIFBDSVQ%3D

App

• Pocket PCIT App: Provides interactive guides and real-time coaching tips. Available on iOS and Android.

Books

• “Parent-Child Interaction Therapy,” by Cheryl B. McNeil and Toni L. Hembree-Kigin.
• “The Incredible Years: Trouble-Shooting Guide for Parents of Children Aged 3-8 Years,” by Carolyn Webster-Stratton.

Certified Therapists

• Visit www.pcit.org to locate a certified PCIT therapist near you.

Acknowledgments

This publication was reviewed by the following professionals, whose expertise helped ensure the accuracy, clarity, and relevance of the information presented.

• Kim Thomason, program manager, Early Childhood Education Initiatives, Virginia Tech.
• Paige Riddle, Northwest District, Specialized Agent for Community Health, Virginia Cooperative Extension.
• Angela Scarpa, professor, Psychology, and director, Virginia Tech Autism Clinic and Center for Autism Research.
• Karen Tanner, unit coordinator and senior Extension agent, Family and Consumer Sciences, Virginia Cooperative Extension.

References

Mohamed, N. 2019. Parent-Child Interaction Therapy: A Literature Review on Its Effectiveness for Children With Autism Spectrum Disorder (ASD). Journal of Southeast Asia Psychology 7 (3): 16-40. https://doi.org/10.51200/sapj.v7i3.5238.

PCIT International. “What Is ParentChild Interaction Therapy (PCIT)?” PCIT International, accessed August 8, 2025. https://www.pcit.org/about.

Sridevi, G., D. Rout, and K. Rangaswami. 2017. “Parent-Child Interaction Therapy for ADHD and Related Disorders: An Overview.” International Journal of Scientific and Research Publications 7 (3): 443-448. https://www.semanticscholar.org/paper/f15bca394bb5a2edc8af798f1b00f1302b802307.

Timmer, S. G., A. J. Urquiza, N. M. Zebell, and J. M. McGrath. 2005. “Parent-Child Interaction Therapy: Application to Maltreating Parent-Child Dyads.” Child Abuse & Neglect 29 (7): 825-42. https://www.sciencedirect.com/science/article/pii/S0145213405001444?via%3Dihub.

Wagner, S. M., and C. B. McNeil. 2008. Parent-Child Interaction Therapy for ADHD: A Conceptual Overview and Critical Literature Review. Child & Family Behavior Therapy 30 (3): 231-256. https://doi.org/10.1080/07317100802275546.