After Mikey and I met mastery of the first phase of PCIT, the child-led phase, we moved on to the parent-led portion of the program. This was much harder for me to work with in the therapy sessions, but has ended up being very helpful at home.
The idea is that the child must comply with a command. If a parent gives a command and the child does not comply, the child gets a prescribed type of timeout. The process is meant to prepare families for worst-case scenarios, such as giving safety commands in a parking lot or crossing the street. Now, what I liked about my clinician was that she really emphasized the importance of choosing commands wisely.
The thing about PCIT is that it requires strict consistency. Adherence every time! It’s a little exhausting. For me, the tricky part was working on when to give commands, and when to use other ways to get Mikey to do things I’d like him to do. For example, if we were playing and I’d like him to hand me a different color play dough, I can ask him to do so, like a question. He has a choice there, and it’s not really a big deal if he chooses not to help me out with the play dough.
If I’m changing an unexpectedly poopy diaper and run out of wipes, I might command Mikey to go get me the other pack of wipes from the shelf, because that’s more of an emergent situation. At least at my house. We always seem to find ourselves in situations where Alex has poop on his hands. I digress.
Luckily for me, the session where I went in to learn about the parent-led phase of PCIT, my mom was in town and could stay home with the boys. It took about an hour and a half to walk through all the steps of the timeout routine, to talk about what a command really is and some alternatives to giving commands, etc.
The following session, my clinician began by explaining the timeout cycle to Mikey. She used a stuffed bear and had a whole role-play thing. He was able to answer a lot of specific questions about the timeout sequence, so we know he gets it, knows what would lead him to be in timeout, and what happens next if he bolts out of timeout.
One of the trickier things for me to work through in PCIT is giving silence and space for words to sink in and to also acknowledge that my son is smart–smarter than I give him credit for by repeating myself. What I notice sometimes when Mikey is in timeout is that he asks questions for what feels like one hundred years. The program dictates that I’m not supposed to speak to him in timeout. I’m not supposed to engage or empower him by giving reasoning or reminding him of rules we all know he understands perfectly well.
What I didn’t like is that in order for me to practice doing the timeout sequence, we had to manipulate things so that Mikey would disobey so that I’d have to give him a timeout during the session. This was extremely hard for me. It felt icky. I hated it. But I did appreciate having a witness to my technique and getting some feedback as to how I managed the situation.
With the clinician, we developed house rules (gentle hands, tell the truth, no snatching). If Mikey breaks a house rule, he gets a timeout. What we’ve found is that he almost never gets a timeout for disobeying commands. Many, many times per day, he winds up in timeout for hitting his brother or snatching toys.
Often, the timeout is just the break Mikey needed from what was clearly something overstimulating for him. He sits in the chair, calms down, and we all hug and get back to business.
But, sometimes, I can see that the timeout sequence is just exacerbating some frantic energy that’s been brewing in Mikey for hours. This is where I still need help and am glad we have wrap-around services bring clinicians to my house to provide this help. My work now has been what to do to get Mikey doing something else before he hits his brother or how to recognize when he’s about to throw wooden trains across the room.
What Cody and I have learned is that there are things we can do with Mikey to build him up (like the PCIT special play time) so that he’s excited to do things for us when we “command” him to. We’ve also done really well with doing the timeouts in public and using an applied consequence or leaving if the public timeout isn’t working.
Every day, we still struggle with Mikey’s explosive outbursts and breaking house rules. We’ll see how that continues to improve.