The day Benetra and Charlton Johnson received the progress note from their son's kindergarten teacher with the phrase "assault on another child," the couple knew their traditional, authoritarian brand of parenting wasn't working for Creighton, who has attention-deficit hyperactivity disorder.
So the Johnson family tried a treatment called parent-child interaction therapy, which after many sessions and much effort helped them become more effective and loving parents and all but ended their son's destructive outbursts.
In this evidence-based therapy, a psychologist watches through a one-way mirror as the parents interact with their child, using a Bluetooth device to offer positive reinforcement and supportive tips on how and when to praise the child, remain silent or discourage bad behavior.
Christina M. Warner-Metzger, a clinical psychologist at the U. of C. Medical Center, who offers the therapy, has seen parents at their wits' end over a child's destructive behavior, sometimes having lost a job because they took too much time off trying to deal with the problem. The therapy has helped these parents get back on track. They learn to nurture their child's positive behavior, she said. The Johnsons, who live in Memphis, Tenn., received therapy from Warner-Metzger for about six months starting in late 2010, when she worked at the University of Tennessee.
"It can be incredibly disruptive for families," said Warner-Metzger. "It really limits the social capability of not just the child but the entire family."
The first few of Warner-Metzger's weekly, hourlong sessions, which target children ages 2 to 6 and last 16 to 20 weeks, entail explanation to parents on the therapy's techniques. From there, she offers guidance to parents on how to interact with a child during play. Then, in subsequent sessions, the parents and child play with Legos and toy kitchen sets and trains, among other things, in a quiet, nondistracting room painted light blue with a big window.
If the child puts the Legos together without incident, the parent offers praise. That shows the child that a parent is paying attention, Warner-Metzger said, and increases the chances that constructive behavior will continue. But if the child starts to play a little rough, she encourages parents to treat the behavior as a minor problem.
"That lets the child know the parent is really focusing in on something good they did and helps decrease some of these negative traps we get struck into," said Warner-Metzger, who is certified as one of the therapy's 18 "master trainers" worldwide, allowing her to train other therapists in the technique.
Later in the therapy, if the child acts out, parents instruct the youngster to spend time away from playing but then come back and follow instructions. Parents also practice the methods at home for five minutes daily. About 70 percent of families that start the therapy complete the program and show significant progress, said Warner-Metzger, whose completion rate is similar to those found in outside research.
"It's a very motivating therapy, not just for providers, but for caregivers," said Warner-Metzger.
The therapy , which was developed in the 1970s by Sheila Eyberg, currently a clinical psychologist and professor at the University of Florida, was initially for kids with disruptive behaviors but has branched out to include children with mood, anxiety and autism spectrum disorders, as well as kids with a history of abuse or neglect.
Karen S. Budd, a professor and director of clinical training at the DePaul University department of psychology, said the therapy is unique in its coaching approach and has been "well-supported by the research."
"Parents get that kind of in vivo experience of interacting, hearing from the therapist what they're doing and usually of a positive, supportive nature, a few little guides, suggestions, reassurances, in ways to help correct some of those patterns," said Budd. "It's a mastery-based model, so parents and children continue in treatment until their changes are at a level that would really be considered to have solved the problem."
The live sessions meant the most to Benetra Johnson, who said she and her husband had used a "dictatorship" style with Creighton, now 9, before the therapy. They have since learned that even a little progress was reason for praise. The warmth and supportive guidance they received from Warner-Metzger was also a motivating factor, Johnson said.
"This therapy brought us together," she said, "bonding with him as a child and as a family, period."