Personalised Individual Parent Training (PIPT)
Also known as the Parent-Child Game (PCG), Personalised Individual Parent Training (PIPT) is an intensive parenting program designed to promote a positive attachment relationship between a parent (or carer) and a child by reducing children's oppositional and antisocial behaviour and increasing their prosocial behaviour and compliance. We work collaboratively with families, using our expert knowledge and the parent's understanding of their child. It is based on Social Learning Theory and Attachment Theory principles, and is evidence-based, which means that it has been shown to be effective in multiple trials and settings. It is also recommended by the NICE guidelines. Its effects can be seen fairly quickly, so it is very popular with parents. Take a look at our testimonials page to read more about how PIPT has helped the families we work with.
The aim of PIPT is to help parents “tune in” to their children and increase their sensitive responding to their child’s particular emotions and behaviours. We do this by live coaching with an ear-piece to help parents refine their observational and discriminative skills for different emotional states and behaviours of the child. We then support parents to use this understanding of how their child plays to increase the sociable and cooperative behaviours of the child. We also provide parents with safe and effective ways to manage children’s difficult behaviours, whether mild or extreme, in ways that promote the development of a child’s secure attachment relationship.
NUMBER OF SESSIONS
PIPT consists initially of 8-10 sessions of structured work, although sometimes this can be increased if felt appropriate, and we like to offer a couple of follow up sessions to see how things are changing.
PIPT sessions take place in a room with toys and sofa, equipped with a video suite with a one-way mirror. Parents can hear the therapists speaking to them via a microphone and remote ear-piece from behind the screen, while parent and child enjoy ten minutes of play. We then get together and discuss what went well what was challenging and think of ways together to try out and practice new ideas.
STRUCTURE OF EACH SESSION
Each session is structured in a similar way:
- 10 minutes catch-up: Initially two therapists meet with the parents and discuss the new technique that is the focus of the session, and have a brief update on how the week has been.
- 10 minutes play session: The therapists then leave the room and move behind the screen, and the parent will play with the child for about 10 minutes. One of the therapists will be coaching directly to the parent.
- 40 minutes discussion about how it went, reflection of the process and problem-solving issues: After the play session with one or two parents or other carers, the therapists return to the room, and the child can play with another member of staff The therapists spend the rest of the session with the parents thinking about issues that emerged from the session, and giving practical advice on how to transfer the learning into home. The focus of the discussion is both about the child’s emotions and behaviour and also about the development of the attachment relationship, as well any other factors that might be relevant to this (e.g., the parent’s mood or stresses, questions about certain strategies, etc.). It is a time to think how to make these techniques work for this particular child and family.
Home practice activities are usually discussed towards the end of the session (such as continuing to practice the skill learned in session when at home).
Forehand R & McMahon R (2003) (2nd edition). Helping the non-compliant child: Family based treatment for oppositional behaviour. The Guildford Press, New York.
Tailoring or personalising our treatment to suit individual children's needs has always been the National Adoption and Fostering Clinic’s philosophy. But that doesn't mean giving up on evidence based approaches. It just means knowing how to track the modifications you make to ensure it is working.
We saw an older child in a preadoptive placement, with a complex mix of attachment issues and challenging behaviours most severely seen around separation problems, following on from a history of severe maltreatment and neglect. She didn't fit into any “neat boxes” diagnostically and so neither for an obvious off-the-shelf-treatment. So we made up a new intervention to fit her needs and measured it to see if it worked.
First we did a live coaching program with the parent (Personalised Intensive Parent Training-PIPT) to help her refine her skills to suit this child's complex needs. For example, with PIPT we gave the mother confidence to set limits on the child's violent behaviour around separation in an attachment friendly way that worked for this child [different children need different attachment friendly styles].
Once those skills were in place, we extended the PIPT program to deal with separations, again using live coaching to keep the interactions sensitive and attuned to the child's needs. Actually, it looked rather like the Ainsworth strange situation, the gold standard way to assess attachment security. We filmed the separations and reviewed them to really understand what was going on.
In the graph you can see the first separation was difficult. As usual, we coached mum through it using a tiny, hidden ear piece, from another room. We helped her focus, in the moment, to use the best words to make it successful. It's difficult in the heat of the moment not to get sucked into familiar, unhelpful patterns! The next week the separation was significantly quicker, but in the work we do after the session, reviewing and measuring the video, we identified there were still issues in the interaction. We kept on working for several weeks until the interaction looked stable, after session 4, otherwise there was a possibility that the patterns could have re-emerged once the family went home again.
Various different measures indicated this intervention worked, but the most important is that a placement on the verge of breakdown stabilised and survived.