Therapists’ Coaching in Parent-Directed Interaction Predicts Outcomes in Parent-Child Interaction Therapy-Emotion Development

• In Event: The Importance of the Emotional Context: Applications of mindfulness based interventions and concepts in four different settings

Abstract

Introduction: Understanding the “active ingredients” of therapy – the mechanisms that change client symptoms and behavior – is key to enhancing clinician training. Previous work with parent coaching interventions has found that therapists’ frequency of responsive coaching predicts parent behavior change. Most of this work has been conducted with Parent-Child Interaction Therapy (PCIT; Barnett et al., 2014, 2017), and has focused on the first PCIT module, Child-Directed Interaction (CDI). In CDI, therapists coach parents to increase positive parenting skills such as praising children’s behavior. Little research has examined therapist coaching in the Parent-Directed Interaction (PDI) module, in which therapists coach parents to give children effective commands and consequences for noncompliance. This study explored therapists’ PDI coaching in PCIT-Emotion Development, an adaptation of PCIT for early childhood depression which includes abbreviated CDI and PDI modules. Specifically, we compared therapists’ coaching in PDI and CDI, and examined associations between PDI coaching frequency and outcomes.

Methods: Participants included 98 parent-child dyads. Children were 60% male, and were 5.3 years old (SD = 1.1), on average. Children were 83% White, 5% Black, 11% Multi-racial, and 8% Hispanic. All children were diagnosed with depression at baseline, and 51% were diagnosed with comorbid Oppositional Defiant Disorder. Coaching frequency was assessed from 5-minute videos from CDI session 3 and PDI session 9, using the Therapist Parent Interaction Coding System. Child externalizing and depressive symptom outcomes were assessed with the Eyberg Child Behavior Inventory (ECBI) and the Preschool Feelings Checklist at baseline, post-PDI, and post-treatment. Parent outcomes were assessed at baseline, post-PDI, and post-treatment with the Dyadic Parent-Child Interaction Coding System and the Parenting Stress Index.

Results: As shown in Table 1, compared with CDI sessions, therapists used less responsive coaching, t(79) = 5.63, p < .001, and more directive coaching during PDI, t(79) = -8.41, p < .001. As shown in Table 2, controlling for baseline levels of parent behavior or stress, therapists’ responsive coaching frequency during PDI predicted improved parenting skills, β = .34, p = .001, and reduced parent stress, β = -.19, p = .018, at post-treatment. Controlling for baseline ECBI scores, therapists’ responsive coaching during PDI predicted reductions in children’s externalizing behavior after the PDI phase, β = -.19, p = .026, but not at post-treatment, β = -.11, p = .21. Therapists’ responsive coaching did not predict child depressive symptoms after PDI, β = -.10, p = .29, but predicted reduced depressive symptoms at post-treatment, β = -.20, p = .046. Frequency of directive coaching during PDI was not associated with any outcomes.

Conclusions: These results demonstrate the importance of therapist coaching during the PDI module of PCIT in predicting treatment outcomes. To our knowledge this is the first study to link PCIT therapist coaching to children’s externalizing and internalizing outcomes. Although directive coaching is more frequently used during the PDI phase of treatment than in CDI, responsive coaching appears to remain a key active ingredient of treatment. Therapists should be trained to make frequent responsive coaching statements during both CDI and PDI.

Authors

• EB Caron, University of Hartford
  Presenting Author

• Jordan Linde, University of Hartford

• Miya Barnett, University of California, Santa Barbara

• Joan L Luby, Washington University in St. Louis