Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

Abstract

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.

The Dissemination of Parent–Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study

“…While Egan and colleagues [ 58 ] recently explored the immediate outcomes of a community-based implementation of PCIT for children with prenatal substance exposure, there is a growing need for thorough and long-term investigations of parent- and child-level PCIT outcomes. Recently, Gurwitch and Warner-Metzger [ 59 ] proposed an adaptation to PCIT that aims to standardize the approach to addressing childhood trauma within the PCIT model. With families highly impacted by the opioid crisis, such as the current sample, it may be beneficial to incorporate the novel Trauma-Directed Interaction into future PCIT dissemination efforts to address trauma related to caregiver opioid use.…”

Utilizing Parent-Child Interaction Therapy with Trauma-Directed Interaction in a Young Male in Out of Home Care Who Had Experienced Trauma

“…Outcomes have generally been positive in relation to parenting stress and parental mental health. Given the rates of traumatic experiences in the general population (Felitti et al, 1998), parents (Maybery et al, 2009), and foster caregivers (Crusto et al, 2010), the bidrectionality of treatment is an important focus (Gurwitch & Warner-Metzger, 2022). Caregiver trauma is not directly addressed by PCIT or any of the other trauma treatments for this population, a missed opportunity given the importance of the safe, predictable, and stable caregiver in a child's recovery from trauma.…”

“…The first relates to providing a consistent and standardized way to adapt PCIT treatment for this cohort of children. This consistency allows for a 'common language' for PCIT providers treating this population as well as the ability to conduct scientific studies that are generalizable with this population (Gurwitch & Warner-Metzger, 2022). Specific treatment goals include helping caregivers to better identify and differentiate between children being "upset" versus being activated by a trauma reminder, identification of trauma activators (for both caregiver and child), and supporting caregivers in understanding to the impact of trauma.…”

“…To standardize the response, caregivers are coached using manualized scripting to connect feelings to the past situation and to ground the dyad to the safety of the current moment. This statement promotes calm and predictability for the child (Gurwitch & Warner-Metzger, 2022). When Finding a "COPE" skill, the caregiver is encouraged to help the child identify "COPE" skills (the skills that are used to manage the child trauma reactions discussed below) and actively engage in practicing the skill together, as needed.…”

“…The "C" in "COPE" is for Color Breathing which is a relaxation technique for small children. It is a developmentally appropriate way to help children to calm and is a standardized way to promote regulation in PCIT treatment ( Gurwitch & Warner-Metzger, 2022). In Open to Feelings, the "O" in "COPE," caregivers and children are taught to expand their emotional vocabulary and improve child communication with caregivers about feelings.…”