Parent-Child Interaction Therapy (PCIT) in Baltimore

Evidence-Based Treatment for Young Children with Behavioral Challenges

If your young child's tantrums, defiance, or aggression are affecting your family's everyday life, you're not alone. Many families with children ages 2 to 7 struggle with disruptive behaviors that create stress, tension, and frustration in the home. You might feel like you've tried everything—timeouts, reward charts, consequences—but nothing seems to work consistently. The behavioral difficulties continue, your parenting stress increases, and the parent-child relationship becomes strained.

Parent-Child Interaction Therapy (PCIT) offers a proven path forward. PCIT is an evidence-based treatment specifically designed for children with disruptive behavior disorders and their families. Unlike traditional play therapy where children meet with a therapist alone, PCIT teaches parents specific skills to manage their child's behavior while strengthening the parent-child relationship. Through live coaching during real interactions with your child, you'll learn practical techniques that work—and you'll see changes in your child's behavior often within the first phase of treatment.

At the Baltimore Therapy Group, our certified PCIT therapist provides this specialized intervention to families throughout the Baltimore area. Whether you're dealing with tantrums, defiance, ADHD-related behavioral concerns, or other disruptive behaviors, PCIT can help your family find calmer, more connected ways of interacting.

What is Parent-Child Interaction Therapy (PCIT)?

Parent-Child Interaction Therapy (PCIT) is an empirically supported intervention for treating disruptive behavior problems in children aged 2 to 7 years. Developed by psychologist Sheila Eyberg in the 1970s, PCIT has become regarded as a gold standard treatment for young children with disruptive behaviors.

What makes PCIT different from other treatments:

Parents are the therapists: Rather than working with your child separately, PCIT training focuses on teaching you—the parent or caregiver—how to change parent-child interaction patterns. You become the agent of change in your child's everyday life.

Live coaching model: During PCIT sessions, therapists observe your interactions through a one-way mirror and provide real-time feedback. This immediate coaching helps you practice new skills effectively.

Structured two-phase approach: PCIT treatment follows two distinct phases—Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI)—each with specific skills and goals.

Measurable progress: Therapists track both parent and child outcomes throughout treatment using objective measures, ensuring that the PCIT process is working for your family.

Evidence-based approach: Research shows that PCIT can lead to improvements in child behavior and parenting skills across diverse populations and cultures. The treatment has been studied internationally and adapted for various age groups, including children with autism spectrum disorder, ADHD, developmental disabilities, and histories of child abuse.

How Does PCIT Work?
Understanding the Two Phases

PCIT involves two phases: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI). Each phase teaches parents specific skills that work together to improve the parent-child relationship and reduce disruptive behaviors.

Phase 1: Child-Directed Interaction (CDI)

The first phase of PCIT focuses on strengthening the emotional bond between parent and child. During the CDI phase, parents learn to follow their child's lead in play, which encourages warm, secure caregiver-child relationships.

The PRIDE skills taught in CDI:

• Praise: Offering specific, positive attention for behaviors you want to see more often ("I love how gently you're playing with those blocks")

• Reflection: Repeating or paraphrasing what your child says to show you're listening ("You built a tall tower!")

• Imitation: Copying what your child is doing to show interest and engagement

• Description: Narrating your child's activities like a sportscaster ("You're putting the red block on top of the blue block")

• Enjoyment: Showing genuine enthusiasm and warmth during play

These foundational positive interaction skills help children feel heard, valued, and connected. As parents learn to engage in child-centered interactions using these specific skills, children typically become more cooperative and less defiant. The CDI skills also help with emotion regulation, as children feel more secure and understood.

What happens in CDI sessions:

During weekly sessions, you'll practice these PCIT skills with your child while your therapist observes. Your therapist provides live coaching—praising when you use skills correctly and gently redirecting when needed. Between sessions, parents practice "Special Time" at home for five minutes daily, reinforcing the skills taught during therapy.

Many families notice changes in their child's behavior during this first phase as the parent-child relationship strengthens and positive communication increases.

Phase 2: Parent-Directed Interaction (PDI)

Once families master the CDI skills and the parent-child relationship has improved, treatment moves to the second phase: Parent-Directed Interaction (PDI). The PDI phase, also called the discipline phase, teaches parents how to give clear instructions and set consistent limits to manage their child's behavior effectively.

What parents learn in PDI:

• Giving effective commands: Using clear, specific, age-appropriate instructions that children can follow

• Following through with consequences: Implementing consistent responses when children comply or don't comply with instructions

• Setting limits: Establishing boundaries in a calm, predictable way

• Managing challenging behaviors: Using time-out effectively and remaining calm during frustration

The PDI skills build on the warmth established in CDI. Because the parent-child relationship is stronger, children are more motivated to cooperate. The PDI phase aims to increase child compliance and decrease disruptive behaviors through positive parenting practices rather than harsh discipline.

What happens in PDI sessions:

Similar to the CDI phase, therapists observe family interactions and provide real-time feedback as you practice giving commands, setting limits, and following through with consequences. The live coaching model allows therapists to help you implement these parenting skills in the moment, correcting mistakes and building your confidence.

What Conditions Does PCIT Treat?

PCIT has been found to be an effective intervention for numerous behavioral and emotional issues. While originally developed for children with oppositional defiance and conduct problems, PCIT is now used for a diverse range of behavioral concerns.

PCIT is particularly beneficial for:

• Children with ADHD who struggle with following instructions, emotion regulation, and impulsivity

• Children with oppositional defiant disorder or conduct problems

• Children at risk for behavioral disorders

• Children who have experienced trauma or child abuse

• Children with anxiety or emotional development challenges

• Children with developmental disabilities

Common behavioral difficulties PCIT addresses:

• Tantrums and emotional outbursts

• Defiance and not following directions

• Physical aggression toward parents, siblings, or peers

• Destructive behaviors

• School refusal or behavioral problems in educational settings

• Difficulty with transitions

• Low self-esteem related to behavioral struggles

PCIT has been adapted to better meet the needs of families from specific cultural groups, children outside of the typical PCIT age range (ages 2-7), clients with comorbid disorders, trauma victims, individuals with disabilities, and those from unique family systems.

Baltimore Therapy Group Accepting New Patients

Meet the Baltimore Therapy Group's PCIT Specialist

rachel greenberg Larson, LCPC
PCIT Certified therapist
Licensed counselor in Baltimore

Rachel works with children, adolescents, and families navigating anxiety, depression, behavioral difficulties, and relationship challenges. As a certified PCIT therapist, she specializes in helping families with young children who are struggling with tantrums, defiance, aggression, and other disruptive behaviors. Rachel brings a strengths-based, calm approach to parent coaching, understanding that behavioral challenges often create stress throughout the entire family system.

Rachel helps parents develop concrete skills through live coaching during PCIT sessions, providing real-time feedback as families practice new interaction patterns. She understands that parenting a child with behavioral difficulties can feel isolating and overwhelming, and she creates a nonjudgmental space where parents can be honest about their struggles while building the confidence and competence to manage challenging behaviors effectively.

What Age is PCIT For?

PCIT is designed for children ages 2 to 7 years. This age range is ideal because:

• Young children are still developing behavioral patterns that can be shaped

• Parent-child interactions have significant impact during these formative years

• Children in this age group respond well to the play-based coaching approach

• Early intervention prevents behavior problems from becoming more entrenched

Adaptations for different age groups:

While the standard PCIT age cutoff is 7 years, adaptations exist for younger and older children:

• Infant Behavior Program: For children under age 2, emphasizing caregivers' use of nonverbal praise and repeating children's vocalizations

• Adaptations for older children: Some certified PCIT therapists modify the approach for children ages 8-12

If your child is outside the typical age range but struggling with similar behavioral concerns, consult with a certified PCIT therapist to discuss whether PCIT or an adapted version might be appropriate.

What Happens in PCIT Sessions?

Initial consultation:

During your first meeting, a certified PCIT therapist will assess your child's needs, explain how PCIT works, and determine if the treatment is a good fit. The therapist will ask about specific behaviors you're concerned about, your child's development, and your family's goals.

Typical PCIT session structure:

PCIT typically consists of 12 to 20 weekly sessions, with the average length of PCIT treatment between 12 to 16 weeks. Each session lasts about one hour and follows this general structure:

• Check-in: Therapists review your homework practice and any challenges you experienced

• Skill practice: You interact with your child using the specific skills (CDI or PDI) while the therapist observes

• Live coaching: Through the bug-in-the-ear system, your therapist provides real-time feedback

• Wrap-up: You discuss what went well, what was challenging, and receive homework for the coming week

The coaching room setup:

During sessions, you and your child are in a playroom or therapy room while your therapist observes through a one-way mirror. This setup allows your therapist to see your interactions clearly without your child being distracted by another adult in the room. The coaching you receive through the earpiece is immediate and specific, helping you implement PCIT skills effectively.

Between-session practice:

Success with PCIT requires daily practice at home. During the CDI phase, families practice five minutes of "Special Time" each day using the PRIDE skills. During the PDI phase, parents practice giving effective commands and following through with consequences in everyday situations.

Graduation criteria:

Families complete PCIT treatment when they've mastered the skills in both phases and when child behavior problems have decreased to within normal ranges. The structured approach ensures that families don't graduate until they're confident managing behaviors independently.

How is PCIT Different from Traditional Play Therapy?

While both PCIT and play therapy involve children and play activities, they differ significantly in approach and goals.

Play therapy typically involves a child meeting individually with a therapist who uses play as a way to help the child process emotions, work through trauma, or develop social skills. The therapist is the primary change agent.

Parent-Child Interaction Therapy (PCIT) focuses on changing parent-child interaction patterns by teaching parents specific parenting skills. Parents become the primary change agents, with the therapist serving as a coach. The emphasis is on observable behaviors and real-time coaching rather than interpretation of play.

Key differences:

• PCIT always includes parents actively participating in sessions

• PCIT uses a structured, manualized approach with measurable outcomes

• PCIT provides live coaching during parent-child interactions

• PCIT typically has a shorter, defined treatment length (12-20 sessions)

• PCIT focuses specifically on behavioral concerns and the parent-child relationship

Both approaches have value, and some children benefit from both PCIT and individual play therapy depending on their needs.

What Can Families Expect from PCIT?

Families who complete PCIT often report significant positive changes in both child behaviors and the parent-child relationship.

Common improvements families see:

Reduced disruptive behaviors: Research shows that families often see a significant reduction in tantrums, defiance, and physical aggression after participating in PCIT. The two phases work together to address both the relationship foundation and behavioral management.

Stronger parent-child bond: The CDI skills help children feel more connected, valued, and understood. Many families report that they enjoy spending time with their child more after learning these positive interaction skills.

Decreased parenting stress: PCIT can lead to reduced parenting stress by increasing parents' confidence and providing effective discipline tools. When parents have specific skills that actually work, the daily struggles decrease significantly.

Improved emotion regulation: As children feel more secure in the parent-child relationship and parents model remaining calm during frustration, children develop better emotion regulation abilities.

Generalization to other settings: The skills parents learn in PCIT sessions transfer to everyday life—at home, in stores, at school, and in other environments. Counselors work with families to practice skills in various situations.

Long-term benefits: PCIT has been shown to produce lasting changes. The parenting practices learned become part of how families interact, preventing future behavior problems.

PCIT Teletherapy:
Receiving Treatment at Home

Teletherapy for Parent-Child Interaction Therapy (PCIT) allows families to receive PCIT services from home. This option has become increasingly popular and research indicates that the effectiveness of teletherapy is comparable to traditional in-person therapy.

How PCIT teletherapy works:

PCIT delivered via teletherapy maintains the same structure and phases as in-person sessions, including Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI). Teletherapy sessions for PCIT utilize live coaching through a wireless earpiece, similar to in-person sessions.

Benefits of PCIT teletherapy:

• Therapists can observe parent-child interactions in their natural environment

• Teletherapy for PCIT can help reduce barriers to treatment, such as transportation issues and scheduling conflicts

• Families practice skills in the actual settings where behaviors occur

• Many families report improvements in child behavior and parenting skills comparable to in-person treatment

Is teletherapy right for your family?

PCIT teletherapy works well for many families, particularly those with transportation challenges, busy schedules, or who live outside the Baltimore area. Your certified PCIT therapist can help you determine whether in-person or teletherapy PCIT services would be most effective for your situation.

Finding a Certified PCIT Therapist in Baltimore

Why certification matters:

Certified PCIT clinicians are the only professionals who should deliver PCIT services to ensure fidelity to the treatment model. PCIT training requires extensive specialized education beyond general therapy training. Therapists must complete specific coursework, supervised practice, and ongoing training through PCIT International.

What to look for in a PCIT therapist:

• Certification through PCIT International

• Experience working with children ages 2-7 and families

• Training in adaptations if your child has special needs (autism spectrum disorder, developmental disabilities, ADHD, trauma history)

• Clear explanation of the PCIT process during initial consultation

• Use of objective measures to track progress

Connecting with PCIT services:

To find a certified PCIT therapist, families can search the Find a Provider directory offered by PCIT International. In Baltimore, families can access PCIT services at specialized clinics, including the Baltimore Therapy Group.

During an initial consultation, a certified PCIT therapist will assess your child's needs and explain the PCIT process, including what to expect during the two phases, how long treatment typically takes, and what will be required of you as a parent.

Is PCIT Right for Your Family?

PCIT may be a good fit if:

• Your child is between ages 2 and 7 (or falls within an adapted age range)

• You're experiencing behavioral difficulties like tantrums, defiance, or aggression

• Previous parenting strategies haven't produced lasting change

• You're willing to commit to weekly sessions and daily practice at home

• You want to improve both your child's behavior and your relationship with them

• Your child's behavioral concerns are affecting family life, school, or relationships

When PCIT might not be the best fit:

PCIT requires active parent participation and daily practice. If a parent has severe mental health concerns that would interfere with learning new skills, these may need to be addressed first. Additionally, if a child has severe developmental disabilities or is outside the typical age range without appropriate adaptations available, other treatments might be more suitable.

Many families wonder about the time commitment. While PCIT typically lasts 12-16 weeks with weekly sessions plus daily practice, most families find that the structured approach and clear progression make the investment worthwhile. The skills you learn become part of your parenting practices for years to come.

Getting Started with PCIT at the
Baltimore Therapy Group

At the Baltimore Therapy Group, we understand how challenging it can be when your child's disruptive behaviors are affecting your family's well-being. Our certified PCIT therapist specializes in helping families with children ages 2 to 7 develop stronger parent-child relationships while reducing behavioral concerns.

Located in Towson, Maryland, we serve families throughout the Baltimore area, including Roland Park, Mt. Washington, Canton, Fells Point, and surrounding communities. We offer both in-person PCIT sessions at our office and teletherapy options for families who prefer receiving services at home.

You're Not a Bad Parent—Your Child's Behavior Isn't Your Fault

PCIT doesn't assume you've been parenting "wrong." Instead, it gives you specific, evidence-based tools that work with your child's particular behavioral challenges. Most families notice that even small changes in how they interact with their child—like the PRIDE skills in the CDI phase—begin to shift the dynamic surprisingly quickly. You'll have a coach guiding you in real-time, correcting course immediately rather than leaving you to figure it out alone. The relief many parents feel once they have concrete techniques that actually produce results is profound.

What PCIT Does Best: The Research Behind Real Results

PCIT has been extensively studied for over 40 years with consistently strong outcomes. Research shows that PCIT produces significant reductions in child behavior problems, with improvements maintained at follow-up periods ranging from several months to six years after treatment. Studies demonstrate that 65-85% of families who complete PCIT see their child's behavior problems move from the clinical to the normal range.

Beyond behavioral improvement, research confirms that PCIT strengthens the parent-child relationship, reduces parenting stress, and increases parents' confidence in their ability to manage their child's behavior. Perhaps most importantly, PCIT has been found effective across diverse populations—different cultures, socioeconomic backgrounds, and family structures—and has been successfully adapted for children with autism spectrum disorder, developmental disabilities, ADHD, and trauma histories.

What we've observed in our work with families is that PCIT is particularly powerful for children whose behaviors haven't responded to other approaches. Parents often tell us they've tried everything—reward charts, time-outs, consequences, reasoning—with inconsistent or short-lived results. PCIT works differently because it addresses the parent-child interaction patterns underlying the behaviors, not just the behaviors themselves. The live coaching component ensures parents learn skills correctly from the start, rather than practicing techniques incorrectly at home without feedback.

What to expect when you reach out:

When you schedule an appointment with our certified PCIT therapist, you'll begin with an initial consultation to assess whether PCIT is the right fit for your family. We'll discuss your child's specific behavioral concerns, answer your questions about the PCIT process, and create a treatment plan tailored to your family's needs.

PCIT has helped many families move from daily struggles with tantrums and defiance to calmer, more connected interactions. With evidence-based treatment and practical skills you can use in everyday life, PCIT offers hope for families ready to make lasting changes.

If you're ready to strengthen your parent-child relationship and address your child's disruptive behaviors with proven techniques, contact the Baltimore Therapy Group today. Our certified PCIT therapist is here to support your family through this evidence-based treatment approach.