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We’ve had a request to include some clinically-oriented information on the PCIT International website.  

To start with, we are going to include some clinical Q & A features on the blog and then move them to an archive on the webpage.

 Please let us know if you have any other questions that we could address here.

Jocelyn Clegg, MFT, asked  ”I am hoping that someone has some brilliant insight/intervention on how to end a time out session when the child has refused to go to time out, lost three privileges, thrown all toys (which were removed), jumped off of chairs and table (which were removed), hit and kicked mother (who was removed) and then continued to run around room kicking walls, banging doors and screaming for 30 + minutes until finally in exhaustion he sits down and I have mom return the room and say thank you for sitting down, they sit together quietly for short period and session is over.  Original command has never been followed as everything is removed from room and client did not effectively take a time out.”

PCIT Master Trainer,  Dr. Rhea Chase, provided the following answer:

“All the details of PDI can lead to a lot of questions! Children, especially oppositional ones, are masters at finding loopholes, especially when their parents are setting limits on their behavior. The PDI procedure in the standard protocol encourages parents to guide the child to the chair since very few children will go entirely on their own accord! Sometimes all they need is a hand on their shoulder, sometimes the parent has to physically place the child on the chair. It also involves the use of the timeout room/space whenever the child leaves the chair before they are told. The room is only used to teach the child to stay on the chair. So, if the child leaves before they are told, they go to the room for one minute plus five seconds of quiet, and then they are returned to the chair and the 3-minute timeout starts again. The child is always returned to the chair to sit their timeout, so he learns that it’s faster and easier to just stay on the chair. If a family uses the back up space consistently, it is usually not needed very frequently. However, in the beginning of PDI, some children really want to test those limits. They’re used to getting a response for yelling, whining, hitting, etc. so they go through all these behaviors and see what might work, what might get them out of timeout. A colleague of mine had a recent PDI session that illustrated this very well. The child was in the timeout room and was yelling, whining, crying, etc. His mother was doing a great job of ignoring and you could tell the child was frustrated. He said (out loud, and yes, this is a direct quote): “Well, that didn’t work, so I guess I’ll have to try something else!” Both his mother and the therapist had to stifle a laugh, because in that moment, it was so clear what was going on for this little guy. It was a great “aha” moment for mom, as she realized that he usually had been able to get out of different tasks with his crying and yelling. Mom stuck it out – but you can imagine it took a while! Sometimes timeout can last for a long time, especially in early PDI sessions. If it helps, remember this little guy and know that a longer timeout, especially early in PDI, is normal. I like to tell parents that it’s actually a sign that the child is learning the procedure. Children learn by doing, and this is often their way of learning this new discipline sequence.”

Thanks for the interesting clinical Q & A, Jocelyn and Rhea!  Have a great weekend!