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PCIT stands for Parent-Child Interaction Therapy, which is a therapeutic approach designed to improve the parent-child relationship and address a number of behavioral and emotional difficulties in children, including:ptic image

  •  Noncompliance with adult requests
  • Emotional dysregulation
  • Low frustration tolerance
  • Easy loss of temper
  • Difficulty taking turns/interrupting
  • Selective Mutism*

Although in research PCIT has been found to be an effective intervention for a variety of difficulties, many of the core treatment components remain the same across diagnoses. Here is an overall summary of these PCIT components:

  • PCIT is a short-term, evidence-based therapy that focuses on the enhancement of parent-child interactions while teaching parents effective behavior management and social responding techniques. It is typically used with children aged two to seven years who display disruptive behaviors, aggression, or difficulties in social interactions.
  • The structure and components of PCIT consist of two main phases: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI)
  • Child-Directed Interaction (CDI): In this phase, parents engage in play sessions with their child while receiving real-time coaching from a therapist. The therapist observes this interaction either in-person within the playroom or separately through a window or video, depending on what seems most clinically warranted. The therapist then provides feedback and guidance to parents to strengthen positive interactions, improve communication, and enhance the child’s self-esteem.
  • Parent-Directed Interaction (PDI): In this phase, parents learn and practice effective behavior management strategies. The therapist coaches parents on using specific techniques such as clear and consistent commands, praise and rewards for desired behavior, and appropriate consequences for challenging behavior. The focus is on promoting positive discipline, setting limits, and improving the child’s compliance and self-control.

PCIT has been shown to be effective in reducing disruptive behaviors, improving social skills, and strengthening the parent-child bond. It also helps parents develop more confidence and competence in responding to their child’s emotional and behavioral difficulties.


Selective Mutism is an anxiety disorder in which a child is not able to speak in certain settings, such as school or public venues, or to certain people (e.g., extended family, teachers, classmates, strangers). Children with Selective Mutism usually feel intense anxiety about speaking and might fear that others will judge them or reject them if they do speak. As such, they feel unable to speak in certain situations even though they can comfortably speak at other times, such as when they are at home with their parents and siblings. Parents might not realize their child has trouble speaking around others since talking is not a problem at home. About one percent of children suffer from Selective Mutism, and the difficulty usually begins before five years of age. Common symptoms of Selective Mutism include:

  • Being talkative, outgoing, and gregarious at home, but wholly or mostly nonverbal at school, around strangers, or other unfamiliar people or places
  • Appearing frozen with fear, or “shutting down,” when asked to speak outside the home or with strangers (though some children don’t actually look anxious, and might instead appear outwardly calm, just silent in these situations)
  • Using gestures, facial expressions, and nodding to communicate.
    Alternatively, struggling with and avoiding nonverbal communication and interaction with individuals other than their immediate family.
  • Speaking only in a whisper or with an unconventional voice or tone to teachers or peers.

How is treatment different for Selective Mutism?

Selective Mutism treatment for children is best started as early as possible to get better outcomes. Treatment for Selective Mutism involves a combination of approaches, including Parent-Child Interactive Treatment for Selective Mutism (PCIT-SM), behavior therapy (specifically, Exposure Therapy), and contingency management (prompting children using techniques that increase the likelihood of speech and reinforcing successful speaking experiences). PCIT-SM is the research-documented treatment approach developed to help therapists, parents, and teachers working with children to overcome Selective Mutism (SM). PCIT-SM has been tested and found to be effective in both the individual/family format and the intensive group format.

Treatment helps children face situations that make them anxious instead of avoiding them, and it aims to increase the child’s confidence in their ability to speak in anxiety-provoking situations. Treatment involves the child, parents, and, whenever possible, school personnel and teachers. In PCIT-SM the PDI (Parent-Directed Interaction) component of typical PCIT treatment is replaced by VDI (Verbal-Directed Interactions). VDI are direct skills that teach parents the use of guided questioning and positive reinforcement to increase the likelihood of verbalizations. At Anxiety Specialists of Atlanta, several of our clinicians have been trained by and consult regularly with nationally recognized Selective Mutism experts, as well as experts in PCIT, CDI, and VDI skills.


At Anxiety Specialists of Atlanta, our therapists play a critical role in PCIT treatment by providing evidence-based guidance, modeling techniques, and offering support to parents. They help parents build new skills, address ongoing concerns, and ensure the therapy progresses effectively. Clinicians also collaborate with parents to develop an individualized treatment plan and monitor improvements throughout the therapy process.

Using PCIT, our team aims to generalize newly learned skills in therapy to the family’s daily life and various settings. Parents are encouraged by their therapists to practice new techniques at home and in real-life situations. The therapist supports parents in maintaining the gains achieved during therapy and provides strategies to address any new challenges that may arise.

Our goal for your family is to optimize the many positive outcomes that have been shown in PCIT research by improving child behavior, social interactions, parent-child relationship, and overall family functioning.

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