Parent Child Interactive Therapy
When it comes to my daughter, we always tell people she’s scared of everything and scared of no one. She’s the most outgoing child you will meet, however she gets so in her head that she makes herself sick, literally.
After struggling to get her through private swim lessons (she was terrified of not being able to be in water she couldn’t stand in) and then vomiting out of fear of fireworks at a soccer game, we finally decided it was time to see a therapist.
The therapist we saw was a massive advocate for Parent Child Interactive Therapy (PCIT). The idea behind this therapy is to create a safe space for you and your child. Think about it this way: when you go to a therapist’s office, that is your safe space to air out your grievances and know there won’t be negative repercussions for talking about how you really feel. The goal of PCIT is to create that same safe space in your own home and ultimately have a system in place that enables you to act as the therapist, diminishing the need for an outside therapist.
I’ll be honest that when this concept was introduced I was rather reluctant. I saw how this would be beneficial in strengthening our bond and building trust, but I didn’t really see how it was going to help with anxiety. Here we are in public and she is spiraling and there’s no pulling her out of it. She’s so anxious she is literally vomiting. How will playing together at home possibly help her not do… this?
Here’s how it works:
During PCIT (we call it “special time”), you are to play with one another (this can be coloring, dolls, blocks, whatever is age appropriate and calm. This should be in a space separate from their play area and is designated specifically for “special time.”
You, the parent, are not allowed to say the words, no, don’t, stop, and can’t.
You cannot give commands (this includes subtle commands like “look at this” or indirect commands like handing them a marker implying that they need to take it).
You cannot ask questions. Be careful of making statements that go up in your inflection making your statement sound like a question (ie: You want the blocks. vs. You want the blocks?) These are called tip-ups.
You are to keep at their pace. If they have 2 markers in their hands, you should have 2 markers in your hand. If they draw a circle, you draw a circle (don’t get ahead of them - they are in the lead).
You are to repeat back to them what you hear. Your child says, “Let’s build a castle.” Your response should be something along the lines of, “You want to build a castle.”
You are to provide labeled praises (instead of saying “good job” you say “Good job sorting all the blue blocks together” or “I like how you didn’t get frustrated and rebuilt your tower”).
You are to state what you are observing them do. For example, “You are building a tall tower.” or “You are drawing a pretty rainbow.”
When trying to help guide play, you can use “I wonder” statements to encourage them to problem solve. For example, your child wants you to build a castle out of blocks because they don’t know how to. Because I’m supposed to keep at their pace, I may say “Hmm… I wonder how I could build a castle. I wonder where I should start… I wonder how I could build a wall…” Provide enough of a pause for your child to make a suggestion and come up with a solution.
Model to your child how to handle certain situations. For example, your child just pretended to get stung by a bee with little toy figurines. You can respond with, “When I get stung by a bee, I like to put some ice on the sting, then get a band aid, and have my mom give me a hug. Then I’m okay and it’s not so bad.” Or, when seeing your child holding the pen wrong, you can say, “I like to hold the pen with my thumb here and my pointer finger here.” This way, you avoid telling them what to do but suggest another way of thinking.
The goals of PCIT are to ensure your child feels heard, feels seen, and walks away feeling confident.
During “special time” I could observe what was on her mind through play and we could work through some scenarios together (being stung by a bee was a reoccurring theme). On top of it all, she enjoyed the connectedness. This is a time she now craves and it only has to be 5-10 minutes if you want (it can also be quite longer).
Because of the labeled praise I gave her, she started to feel proud and capable. When it has come to real world scenarios, I have noticed her applying some of the strategies we’ve discussed. She has started to talk through her owns anxieties and I have seen her become more confident in handling some of those nerves. I have also noticed her articulating to me more when she’s feeling a little nervous or a little scared. This provides us the opportunity to acknowledge right then and there that those feelings are valid and that we can brainstorm some ways to handle those feelings. **Note: do not diminish their fears and anxiety with the statements “you’re okay” or “it’s fine” as it leaves them now feeling unheard and frustrated on top of feeling anxious.
PCIT wasn’t focused on pulling her out of her anxious spiral but has been more of a preventative measure. Like thoughts are fleeting, so are emotions. She got to learn she wasn’t anxious but she was feeling anxious, and that feeling would pass.
The skills we have been practicing during our “special time” have also found their ways into our everyday interactions. I notice I now provide her more labeled praises. For example, when learning to ride her back I make statements like, “I like how you kept pushing even though it got really hard to pedal.” That praise was enough to encourage her to keep trying before she got into a fit of frustration.
These positive interactions have had a ripple effect and not only will they provide her emotional support as she gets older, they are going to help build a relationship that promotes open and honest communication. Eventually our “special time” won’t be focused on play but will be an intentional time to check in and see how school, friends, and life is going and ensuring we stay connected.
I would also like to note that my husband sometimes joins us during “special time” or will run “special time” by himself as well. This way, we are both safe spaces for her and we are both fostering stronger relationships with our daughter. It’s okay to have more than one “therapist” and it’s a good tool to hold us accountable to being present and in the moment rather than buried in our phones or preoccupied with our life’s problems.
