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December 26, 2013

How to tame an out-of-control kid

(Continued)

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Most families complete PCIT after 10 to 20 weekly, hour-long sessions. In the first phase of PCIT — called child-directed interaction (CDI) — the parent is taught to notice and praise even the briefest moments of good behavior ("Thank you for sharing your toys!"), while mostly ignoring defiance. In the second phase — called parent-directed interaction (PDI) — the parent is taught to issue calm and concrete commands ("Put the crayons in the box" rather than simply "Clean up your mess") and to respond to noncompliance with predictable, immediate consequences (a warning, followed by escalating timeouts).

The sequence is not accidental: The idea is that the discipline becomes effective — and, ideally, unnecessary — only once the child discovers he can get as much attention for good behavior as for bad. The therapy does not end until the parent has demonstrated — live, with the child — that he or she has mastered the CDI and PDI skills.

Parents maintain the skills at home by establishing a timeout room and having at least five minutes a day of "special time" with their child. That often means playing together with toys and using the relationship-building techniques learned in CDI. If a child misbehaves in public, parents are instructed to find a makeshift timeout area; a stairwell landing or a restroom alcove will do. "Immediate consequences are hands-down the important thing," says Steven Kurtz, a child psychologist who conducts PCIT at the Child Mind Institute.

Once parents graduate from the program, therapists schedule a follow-up phone call a few months later — and, if necessary, a "booster" session. Medicaid and most private insurance cover PCIT as family or individual therapy. Patients without insurance can expect to pay $150 to $200 per session in an area like Washington, according to one local therapist.

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