Parent-Child Interaction Therapy: What Makes Coaching Work? 

A new study by Scherpbier et al. (2025) explores how therapists support parents in learning and using positive interaction strategies during Parent-Child Interaction Therapy (PCIT). Using 125 video-recorded sessions from 17 Dutch families, the authors applied lag sequential analysis to identify which therapist coaching techniques were most likely to encourage parents to use key interaction skills. The study found that brief, in-the-moment responses—especially labelled praise and reflective descriptions—were strongly linked with parents repeating positive parenting behaviours. These findings highlight how even small shifts in therapist feedback can play a powerful role in helping families build stronger connections.

Why therapist coaching deserves closer attention

PCIT is a widely used, evidence-based intervention for young children with disruptive behaviours (Eyberg & Funderburk, 2011). One of the most distinctive features of PCIT is that therapists coach parents live as they interact with their child. This aims to help them practise and strengthen positive interaction strategies, summarised in the PRIDE acronym: Praise, Reflect, Imitate, Describe, Enjoy.

Coaching falls into two categories:

• Directive: Therapist guides the parent before a skill is used (e.g., modelling how to deliver labelled praise).
• Responsive: Therapist reinforces a skill once it has occurred (e.g., “Great behaviour description!”).

Previous research has shown that coaching can improve parenting outcomes (Barnett et al., 2014; Heymann et al., 2022), although we still have limited insight into the specific language therapists use during sessions, and how their words may influence parent behaviour in the moment. To address this gap, this study set out to explore that process in detail: How do therapist and parent shape each other’s actions during a session? 

Drawing on 125 video-recorded sessions with 17 Dutch families, this study’s novel moment-to-moment lens examines therapist–parent exchanges in real time to pinpoint which coaching moves most immediately prompt parents to apply key skills. This is a key difference from earlier studies that relied on summary outcomes.

PCIT is not just about what skills are taught, but how they are coached in the moment.

What did the study find?

Using lag sequential analysis (a method that tracks behaviour sequences in real time), the researchers identified the therapist strategies most likely to prompt skill use in parents.

Over the first three sessions, therapists used both directive and responsive coaching strategies, with responsive techniques being slightly more common. Among these, labelled praise (e.g., “Beautiful behaviour description!”) and reflective descriptions (e.g., “That was a behaviour description”) appeared especially supportive, as this type of feedback was often followed by parents using the skill again shortly afterwards.

Directive strategies such as modelling (e.g., the therapist says “Thank you for picking up your toys” to demonstrate how to use labelled praise) and prompting (e.g., “Thank you for…”, inviting the parent to complete the phrase) also proved useful. In some instances, they were even more likely than responsive techniques to elicit a specific skill. Although PCIT traditionally emphasises responsive coaching, these findings suggest that timely, more direct input (especially in early sessions) can help parents learn and practise the key strategies they’re expected to use with their child.

The analysis also showed that therapists seldom followed a successful parent behaviour with a directive. Instead, they tended to pause or offer reinforcement. This pattern suggests an effort to maintain the parent’s momentum and consolidate learning, rather than redirecting too quickly.

Well-timed praise and modelling don’t just reinforce parent behaviour, they help build it.

Looking ahead: Implications for training and research

The way therapists speak to parents, meaning what they praise, when they intervene, how they frame what is happening, can make a difference. Especially in the early sessions when parents are unsure, the right kind of encouragement can help enhance skills.

For clinicians, the takeaway is not just “use more praise,” but “be precise”. For example, a generic “good job” isn’t as useful as saying, “Nice job describing what she’s doing.” And for trainers, it’s a reminder that coaching isn’t just about knowing the model, but how you bring it to life in the sessions.

These findings also highlight something broader: the value of modelling through coaching. When therapists use the same strategies they’re encouraging parents to try (like praising, reflecting, or describing clearly), they not only guide the session, but also show parents what those skills look and feel like in practice. That can help parents feel more confident and more likely to use those same approaches with their child.

A deeper understanding of how change occurs within sessions can inform future efforts to support families and improve the effectiveness of PCIT and similar interventions.

Good coaching models the very skills we want parents to pass on.

Conclusions

This study gives us a more detailed understanding of what therapist coaching looks like in practice and what seems to work best. It highlights the importance of therapist language, especially during the moments that shape learning.

It also points to the value of combining responsive and directive strategies, rather than adhering strictly to one. This insight is particularly relevant for those involved in therapist training, session supervision, or real-time parent coaching.

While there is still much to learn, this represents a meaningful step forward. A deeper understanding of how change occurs within sessions can inform efforts to better support families in the moments that matter most.

Understanding how therapist language shapes learning can improve how we train, coach, and support families.

Where next?

Use the interactive programme below to gain an overview of the topic, meet the speaker, test your knowledge, and a whole lot more!

About the speaker

NB this blog has been peer reviewed

References 

Scherpbier, I. C. A., Abrahamse, M. E., Mos, M. N., Lindauer, R. J. L., & Niec, L. N. (2025). Therapist coaching in Parent-Child Interaction Therapy in the Netherlands: An archival lag sequential analysis study. Behavior Modification, 49(3), 271–292. https://doi.org/10.1177/01454455251319731

Barnett, M. L., Niec, L. N., & Acevedo-Polakovich, I. D. (2014). Assessing the key to effective coaching in parent–child interaction therapy: The therapist-parent interaction coding system. Journal of Psychopathology and Behavioral Assessment, 36(2), 211–223. https://doi.org/10.1007/s10862-013-9396-8

Eyberg, S., & Funderburk, B. (2011). Parent-child interaction therapy protocol. PCIT International.

Heymann, P., Heflin, B. H., & Bagner, D. M. (2022). Effect of therapist coaching statements on parenting skills in a brief parenting intervention for infants.

Behavior Modification, 46(4), 691–705. https://doi.org/10.1177/0145445520988140

About the author

Sophie Mizrahi is Content and Events Producer at the Association for Child and Adolescent Mental Health (ACAMH). She holds a BSc in Psychology and a Postgraduate Diploma in Vocational and Career Development from Favaloro University in Buenos Aires, Argentina. Her career spans community-based programmes, where she led initiatives to support individuals, particularly young adults, in navigating transitions and making informed decisions about their personal and professional aspirations. She has also contributed to digital mental health projects and AI startups, with a focus on research and the development of mental health products. Her work consistently centres on expanding access to evidence-based mental health resources for professionals and the wider public.