Parent-child interaction therapy: A promising intervention for abusive families.

Abstract

The field of child maltreatment continues to struggle with methodological difficulties that impede the development and evaluation of empirically supported interventions. Existing treatments vary from parent education to individual child therapy. One promising treatment for abusive families is Parent-Child Interaction Therapy (PCIT), which focuses on the interactions of the parent-child dyad. This intervention has been empirically supported in its use with children with behavior problems and many clinical attributes of PCIT make its use with abusive families appealing (e.g., direct coaching of skills, focus on relationship enhancement, alteration of coercive cycle). PCIT may not address all issues facing abusive families, but it does offer an effective intervention to modify maladaptive parent-child interactions. ********** A substantial amount of research in the area of child maltreatment has been generated within the past 20 years. Investigations into the incidence, prevalence, and consequences of child maltreatment have increased, leading to significant advances in the epidemiological characterization of child maltreatment and its effects (Reece, 2000). Unfortunately, child maltreatment remains challenging to study and to explain. One reason for this lies in the fact that multiple theories have been proposed to explain child maltreatment. Cultural explanations, sociological theories (e.g., Strain Theory), and psychological and biological theories (e.g., Social Leaming Theory) have attempted to clarify child maltreatment, yet no one theory explains all cases. In addition, definitional ambiguities exist in the area of child maltreatment. Different professionals and organizations (e.g., researchers vs. law enforcement officers) have specific definitional criteria that are deemed important; thus, acts are seen differently by different individuals. Other difficulties in the field are related to methodological problems. Most research in the area continues to be retrospective and correlational making it virtually impossible to identify causal relationships. Additionally, samples usually are widely divergent, often incorporating clinical rather than representative samples which limit the generalizability of the results to the general population. As a result of these difficulties, empirically supported treatments for child physical abuse are lacking. One promising treatment for families who have a history of child maltreatment is Parent-Child Interaction Therapy (PCIT; Hembree-Kigin & McNeil, 1995). This manualized treatment has been empirically supported in its use with children with behavior problems and may prove beneficial to abusive families (Herschell, Calzada, Eyberg, & McNeil, 2002). For instance, its emphasis on relationship enhancement within the parent-child dyad and its focus on behavioral management addresses difficulties specific to abusive families. Many additional clinical features of this treatment (e.g., direct coaching of parenting skills) make it a promising intervention for abusive families. In attempting to develop efficacious treatments for child physical abuse, researchers have examined the characteristics of child victims, adult perpetrators, as well as the interactional styles between victims and perpetrators. As a result, a substantial body of literature has amassed in the area of child physical abuse (CPA) and has demonstrated that CPA has deleterious effects on child victims including medical/health and psychological problems, intellectual/academic problems, cognitive/perceptual and attributional problems (e.g., likely to attribute hostile intent to peers' behavior), behavioral dysfunction (e.g., heightened aggression, opposition and defiance), internalizing problems and psychiatric disturbances (e.g., hopelessness, depression, posttraumatic stress disorder), and social/interpersonal competence and relationship problems (e.g., insecure attachments, difficulties in peer relationships; Kolko, 2002; Miller-Perrin & Perrin, 1999). …