Understanding Attrition in Parent–Child Interaction Therapy (PCIT)
Parent–Child Interaction Therapy (PCIT) is a well-established intervention designed to address disruptive behavior in young children. While the therapy is highly effective for those who complete it, a significant number of families do not reach the formal graduation criteria. This has traditionally been viewed as a failure, but recent research suggests a need to reconsider this perspective.
Research Findings: A New Perspective on Early Termination
A study by Lieneman et al. (2019) investigated the impact of PCIT on families who did not complete the full course of therapy. The research involved a large sample of 2,787 children and their families across Oregon, with 1,318 providing usable data. It was found that families who attended at least four sessions but did not graduate still showed significant improvements in child behavior. Specifically, these families demonstrated a medium-to-large effect size (d=0.70) in behavior problem reduction, compared to a very large effect size (d=1.65) for those who completed the therapy.
Implications for Practitioners
For practitioners, these findings highlight the importance of recognizing the value of partial treatment. Even a small dose of PCIT can lead to meaningful improvements, challenging the notion that early termination equates to treatment failure. Here are some strategies practitioners can implement:
- Reframe Success: Shift the focus from strict graduation criteria to recognizing any positive change as a success.
- Flexible Goals: Set flexible treatment goals that accommodate families' unique circumstances and barriers to completion.
- Early Engagement: Focus on engaging families early in the process to maximize the benefits of even a few sessions.
- Address Barriers: Work with families to identify and mitigate barriers to continued participation, such as transportation or scheduling conflicts.
Encouraging Further Research
While the study provides valuable insights, further research is needed to explore how different treatment lengths impact outcomes and to develop strategies to reduce attrition. Practitioners are encouraged to contribute to this growing body of knowledge by documenting their experiences and outcomes with PCIT.
Conclusion
The reconceptualization of "dropouts" in PCIT provides a more nuanced understanding of treatment outcomes. By acknowledging the significant improvements made by early terminators, practitioners can better support families and enhance the effectiveness of PCIT.
To read the original research paper, please follow this link: Reconceptualizing attrition in Parent–Child Interaction Therapy: “dropouts” demonstrate impressive improvements.
