Comparing Parent Child Interaction Therapy (PCIT) to Regulation Focused Psychotherapy for Children (RFP-C) with Externalizing Behavior Problems: The Cases of "Jack" and "Oliver"

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This commentary examines the case studies by Brooks et al. (2025) of “Jack” and “Oliver,” two children with externalizing behavior problems. Both cases were drawn from a successful randomized control trial (RCT) using the model of Regulation Focused Psychotherapy for Children (RFP-C), with Jack being a successful case, and Oliver, an unsuccessful case. We first commend Brooks et al. in a number of ways for the contributions their RCT and the cases of Jack and Oliver make to the psychotherapy research literature. At the same time, we raise methodological questions about the selection of Jack and Oliver and the fact that Jack’s pre-test questionnaires were completed by Jack’s mother, while the post-test measures were completed by Jack's father, introducing the unassessed variable of inter-rater reliability. We next compare the psychodynamic, RFP-C theoretical approach with the behavioral theoretical approach we employ–Parent Child Interaction Therapy (PCIT). This comparison includes (a) our suggestion of behavioral alternatives to Brooks et al.’s psychodynamic interpretations of Jack’s and Oliver’s therapeutic interactions; and (b) an alternative case formulation and treatment plan for Jack and Oliver if they were to be seen in PCIT therapy. Regarding the case formulations and the treatment plans, utilization of standard PCIT is illustrated with the case of Oliver. Because Jack presents with many symptoms of anxiety, an adaptation of PCIT (“CALM”) for young children with anxiety is also presented. We suggest that PCIT is able to produce large magnitude improvements that last over time in part due to the use of parents as change agents who employ treatment techniques in their everyday interactions with their children. In addition, PCIT relies on weekly direct coaching as the most potent method for teaching parents therapy skills. This is contrasted with RFP-C’s reliance on two hours per week of therapist child interactions and four total hours of parent education. We conclude with suggestions for incorporating a key feature of PCIT into RFP- C, which may enhance its potency and efficacy.