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Parent-child interaction therapy addresses behavioral problems

Michele Lovehaug, left, and Amy Ochsendorf show their parent-child interaction therapy playroom at Solutions Behavioral Healthcare Professionals in Moorhead. (Michael Vosburg / The Forum)

Social worker Michele Lovehaug likens parent-child interaction therapy to a coach calling plays to the quarterback from the sidelines.

Lovehaug and psychologist Amy Ochsendorf, her colleague at Moorhead's Solutions Behavioral Healthcare Professionals, have been certified to offer PCIT, a confidence-building treatment program for young kids with disruptive emotional or behavioral disorders and their parents.

"What makes PCIT stand out is it's live coaching," Lovehaug says. "You get immediate feedback."

The two attended training in January at the University of Florida and in February began using PCIT with families at Solutions, a nonprofit agency with locations here and in Alexandria, Detroit Lakes and Sauk Centre.

After their initial training, both therapists went through the necessary steps to become certified, and Lovehaug was certified to train other therapists within the agency at the end of September.

Although PCIT has been around for a while, Ochsendorf says it only recently began gaining ground here in the Midwest.

"As of now, we're the only ones in the area that we know of who do PCIT and are certified," she says.

Building confidence

PCIT is designed for kids ages 2½ to 7 with diagnoses such as attention deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder.

Some of the problems Lovehaug and Ochsendorf address are trouble sitting still, trouble focusing, dawdling with tasks, arguing, fighting, and refusing to do as told.

Most kids display these behaviors at some point in time, so how do parents know when they're becoming a concern?

"It's too much when it's interfering with their functioning," Ochsendorf says. "For example, it's disrupting school, so they're not learning like they should be, or it's so disruptive it's impacting their family or peer relationships."

Other kids might label a child as hard to get along with, which could prevent them from forming meaningful friendships.

"The children love PCIT because it builds their self-esteem. They're feeling good about themselves and their relationship with their parents," Ochsendorf says.

Parents benefit by building confidence in their parenting skills and learning how to calmly and effectively handle problematic behaviors.

"They're being supportive of their child; we're being supportive of them," Lovehaug says.

Learning skills

Treatment is divided into two phases: the first focuses on strengthening the parent-child relationship, the second on being consistent and using discipline.

"Oftentimes, you see a lot of significant improvement just in that first phase," Ochsendorf says.

During therapy sessions, parent and child interact in a small playroom equipped with one-way mirrors while the therapist coaches the parent using a wireless earpiece.

"The child then gets the direction from the parent and attaches to the parent," she says.

Though children ask about the earpieces, Lovehaug says once the therapist explains what they're for, they usually forget about it.

"We want them to understand that this is coming from their parent. It's their parent that's providing all this warmth and nurturing to them, not us," she says.

Parents are taught to give clear, specific directions, one task at a time, rather than a list and the option of noncompliance.

"It's 'Put your books in the bookshelf' versus 'Will you put your books away?' " Lovehaug says.

Parents learn to praise their children when they display positive behaviors and to disengage from them when they display negative behaviors.

"Attention, regardless of whether it's positive or negative, reinforces behavior," Lovehaug says.

Timing is key. The therapist coaches the parent when to respond to the child, whether it's with a command, praise, or by removing attention.

PCIT also helps parents manage their child's behavior in public settings, like a grocery store.

"If the parent says it's needed and they agree to it, we go out in the community with them," Ochsendorf says.

Both parents or guardians are encouraged to participate. The therapists have worked with separated families, divorced families, foster families and grandparents.

"We have one parent in here with the child and the other parent behind the mirror, then we split it halfway so both parents are coached equally. Then they can support each other at home, too," Lovehaug says.

Getting results

Though length of treatment varies case to case and depends on how well the child responds, on average, it can take up to 10 to 12 weeks, Lovehaug says.

The therapists track progress using a questionnaire that's filled out after each session. Responses are then scored and graphed.

Lovehaug says in six or seven weeks, they've had children go from throwing several tantrums a day to throwing a tantrum once a week.

PCIT is proven to be most effective for the 2½-to-7 age group because of a cognitive shift that occurs around age 7, Ochsendorf says.

At that age, she says kids' thinking becomes more abstract, they become more "street smart," and they learn how to be more manipulative.

However, Lovehaug says the positive behaviors reinforced with PCIT can continue as the child grows and matures.

"We're trying to help the parents generalize these skills so they become second nature, because when they're done here, we want those changes in behavior to be maintained," she says.

Readers can reach Forum reporter Meredith Holt at (701) 241-5590