Child Directed Interaction (CDI) Phase of
Parent Child Interaction Therapy

Overview of the CDI Phase 

Dad smiling and playing a toy guitar with his young daughter

Parent Child Interaction Therapy is implemented in two phases: (1) Child-Directed Interaction (CDI); and (2) Parent-Directed Interaction (PDI). PCIT gives equal attention to the enhancement of the parent-child relationship, and the development of caregivers' behavior management skills.

During the first phase of PCIT treatment (the Child-Directed Interaction Phase), the golden rule is for the caregivers to "follow the child's lead" during the PCIT therapy sessions and during a 5-minute "homework" activity every day. During CDI, children are encouraged to lead the play activity while their caregiver(s) follow along using the PRIDE skills (further described below). The CDI Phase of PCIT aims to enhance the parent-child relationship and attachment by maximizing positive communication, attention, and imitation during child-led play.

 

The Child Directed Interaction Phase of PCIT integrates components of social learning theory, attachment theory, developmental theory, behavioral principles, and traditional play therapy. Attachment theory principles used in PCIT focus on helping the parent facilitate a warm, supportive relationship as a basis for the development of social skills and emotional regulation. From a social learning perspective, PCIT uses differential attention to address behavioral problems, in addition to having the parent model calm, desired behaviors during parent-child interactions. Click here for a more detailed description of the theoretical basis and influences of PCIT.

Benefits of the CDI Phase 

The primary goal of the first phase of Parent Child Interaction Therapy (the Child-Directed Interaction or CDI Phase) is to enhance or strengthen positive caregiver-child relationships.  

Benefits of the CDI Phase of PCIT include:

  • Increased feelings of security, safety, and attachment with caregiver(s)

  • Increased attention span

  • Increased self-esteem

  • Increased prosocial behaviors (sharing, taking turns)

  • Decreased frequency, severity, and/or duration of tantrums

  • Decreased hyperactivity

  • Decreased negative attention-seeking behaviors (whining, bossiness, sassiness).

  • Decreased caregiver frustration

 

The golden rule for caregivers in the Child Directed Interaction Phase is to "follow the child's lead" during the PCIT therapy sessions and during a 5-minute "homework" activity every day. During the CDI Phase of PCIT, children are encouraged to lead the play activity while their caregiver(s) follow along using the PRIDE skills (further described below).

Pregnant mother and father smiling and playing blocks on the floor with their child

What are the PRIDE Skills in PCIT? 

During the first phase of Parent Child Interaction Therapy - the Child-Directed Interaction (CDI) Phase - a primary goal is to strengthen parent-child warmth, security, and attachment. To enhance the parent-child relationship, caregivers learn a specific set of skills called the PRIDE Skills.

The PRIDE skills in PCIT teach caregivers how to give positive attention to appropriate child behaviors to increase the likely of seeing those behaviors in the future. The PRIDE Skills are:

  • Praise (Labeled Praise) - Behavior specific praise of a child's behaviors, product, or attributes

  • Reflection - Actively listening and repeating or paraphrasing a child's comments

  • Imitation - Engaging in similar play and mirroring the child's activity and level of enthusiasm

  • Describe (Behavior Descriptions) - Narrating a child's ongoing play

  • Enjoy - Genuine enjoyment or enthusiasm in the parent-child interaction

A more detailed description of each of the PRIDE skills, including examples can be found below.

The PRIDE skills used in PCIT

Labeled Praise

A colorful graphic with the word _PRAISE_ with a 5-Star Rating

The attachment enhancement skills that caregivers learn to use with their child during the CDI Phase of Parent Child Interaction Therapy are commonly known as the PRIDE skills.

The first, and arguably the most important of the PRIDE skills in PCIT, is the "P" which stands for Praise, or more specifically Labeled Praise. There are two types of praise: (1) Labeled Praise; and (2) Unlabeled Praise. Labeled Praises are specific (e.g., "Thanks for using your inside voice"), whereas Unlabeled Praises are nonspecific or vague (e.g., "Fantastic," "Terrific," "Wonderful," "Great job"). Labeled Praises are more effective because they specific and praise the exact prosocial behavior the child exhibits.

Formal Definition: "Labeled praises (or behavior specific praises) are positive evaluations of a specific attribute, product, or behaviors of a child."

Examples of Labeled Praises:

  • "Thank you for picking up the blocks!"

  • "Good job sharing your toys!"

  • "Great manners!"

Why use Labeled Praises?

  • Increases the likelihood that the behavior described will happen again in the future

  • Increases a child's self-esteem

  • Makes the child AND the caregiver feel good!

Bonus: Labeled Praises should not be limited to children. Adults who know how to effectively use Labeled Praises are often regarded as better bosses, significant others, friends, and/or family members.

Reflections

The second PRIDE skill in PCIT is the "R" which stands for Reflections. Reflections are simply repeating back positive statements made by the child (obviously caregivers should not reflect verbalizations they do not want to reinforce such as swearing).

Formal Definition: "Reflections are phrases or statements made by a caregiver that have the same meaning as the verbalization made by the child." Reflections can directly repeat (or echo) a child's verbalization, or reflections can also paraphrase or elaborate upon a child's verbalization (as long as the caregiver comment does not change the meaning of the child's statement).

Examples of Reflections:

  • Child: "My friend's name is Charlie."

  • Caregiver: "Your friend's name is Charlie." (Direct Repeat)

  • Child: "I like pizza."

  • Caregiver: "You do like pizza with lots of cheese." (Elaboration)

  • Child: "I am going to be Mirabel for Halloween."

  • Caregiver: "Mirabel for Halloween." (Paraphrase)

Why use Reflections?

  • Shows the child that you are actively listening

  • Helps the child understand is important

  • Improves and increases a child's speech and language

Bonus: Reflections are not just important for children. Couples often report communication and active listening as some of the most important components for long-lasting relationships.

For more information on the importance of active listening and the use of reflections, please visit the CDC's Essentials for Parenting Toddlers and Preschoolers website.

Reflections in PCIT

Imitation

Father and son playing cars together on the floor

The third PRIDE skill in PCIT is the "I" which stands for Imitation.  Imitation is quite simply "doing what the child does" (obviously caregivers should not imitate behaviors they do not want to reinforce such as throwing toys at the wall).

Imitation is often playing with the same toys as the child. For example, if the child is coloring, the caregiver also colors. Imitation can either be joint play (e.g., building a castle together) or parallel play (e.g., the caregiver and child are both coloring different pictures).

Formal Definition: "Imitation is a behavior whereby an individual observes and replicates another's behavior."

Examples of Imitation:

  • Child and caregiver are pushing cars on the floor together

  • Child and caregiver are pretending to cook play food together

  • Child and caregiver are building a house with Legos

Why use Imitation?

  • Lets the child lead the play

  • Helps caregivers play at their child's developmental level

  • Makes the play fun for the child

Behavior Descriptions

The fourth PRIDE skill in Parent Child Interaction Therapy is the "D" which stands for Behavior Descriptions. Behavior Descriptions are often referred to as being a sports announcer/commentator and narrating the child's ongoing play  (obviously caregivers should not describe behaviors do not want to reinforce such as kicking Lego pieces all over the floor).

Formal Definition: "Behavior Descriptions are verbalizations or phrases in which the child is the subject of the sentence and the caregiver uses an action verb to describe the child's ongoing or immediately completed behaviors (the action was completed within the last 5 seconds)." Behavior Descriptions can be used to describe observable verbal or nonverbal behaviors. 

Examples of Behavior Descriptions:

  • "You are adding a red Magna-Tile to the top of your house."

  • "You are building a fence to keep the animals safe."

  • "You are pushing your car up the ramp."

Why use Behavior Descriptions?

  • Lets the child lead the play

  • Improves the child's focus (increases attention span) as they play

  • Lets your child know you are paying attention to them

Bonus: Behavior Descriptions are a wonderful skill to use with children who have ADHD, or exhibit ADHD symptoms. When you first start using Behavior Descriptions is to start with the phrase "You are..." and then describe the child's actions (e.g., "You are...coloring the dog's ear black").

A colorful graphic that lists 7 things caregivers can describe in PCIT

Enjoyment (or Enthusiasm)

Mom and daughter giving each other a tight hug and smiling

The final PRIDE skill in PCIT is the "E" which stands for Enjoyment (or Enthusiasm). Enjoyment is being animated and cheerful while interaction with the child during play. 

 

Understandably, children are less likely to play with adults who do not appear happy to be spending time with them. On the other hand, a caregiver who is over-the-top enthusiastic may also be aversive to a child.

Formal Definition: "The state or process of taking pleasure in something."

Why use Enjoyment or Enthusiasm?

  • Increases the warmth of the play

  • Enhances a child's self-esteem

  • Makes the play more entertaining and memorable for the child

CDI Phase of PCIT

Certified PCIT Global Trainers - Katie Smith, LCSW & Dr. Cathy Roring - share CDI stories

Katie Smith, LCSW

Certified PCIT Global Trainer

Katie Smith is a Licensed Clinical Social Worker who is an expert in Parent Child Interaction Therapy and the Executive Training Director at PCIT, Inc.

 

Katie has been PCIT Certified Practitioner for 3 years, and she has been a Certified PCIT Global Trainer for 2 years. 

Katie's primary practice is conducting PCIT, and she specializes in providing services for children and families in the child welfare system.

Click here to learn more about Katie Smith.

Catherine Roring, Ph.D.

Certified PCIT Global Trainer

Dr. Cathy Roring is a Licensed School Psychologist who is an expert in Parent Child Interaction Therapy and an Associate Professor in Psychology at East Central University.

 

Dr. Roring has been delivering PCIT services since 2018, and she has been a Certified PCIT Global Trainer for the past 3 years.

 

Dr. Roring also has a private practice where she offers PCIT and assessment services.

Click here to learn more about Dr. Cathy Roring.

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