When the Block Tower Falls: How PCIT Helps Families Reconnect
Real-time coaching helps caregivers turn everyday moments into opportunities for connection, confidence, and change.
By 7:40 on a Tuesday morning, one Alaska parent had already been hit twice, not hard, but enough to make an exhausting morning feel even heavier. Her four-year-old was on the hallway floor, overwhelmed by the “wrong” shoes, while the baby cried nearby. Another day had begun with everyone frustrated and no one quite sure how to make things better.
Then the preschool called. The teacher described a bright, funny child who built remarkable block towers, and who also struggled when a tower fell, cleanup began, or another child got too close. The teacher asked a question the family had never heard before: “Have you ever heard of Parent-Child Interaction Therapy?”
Estimated Read Time: 4 minutes
Coaching in the Moment
Parent-Child Interaction Therapy, or PCIT, is an evidence-based practice for young children ages 2 to 7. It can help when anxiety, trauma, or other challenges show up as tantrums, aggression, defiance, or difficulty following directions. The kind of behaviors that can strain family relationships and make daily routines stressful.
At Alaska Behavioral Health, caregivers practice new skills with their child while a therapist observes and coaches them in real time through a headset. In-person sessions are available in Anchorage and sessions can be provided by telehealth statewide.
PCIT has two main components. In the child-directed phase, caregivers learn to strengthen the relationship and encourage positive behavior through focused attention. In the parent-directed phase, families practice giving clear directions and following through consistently so children know what to expect.
A Small Moment That Feels Different
Imagine that same child in the therapy playroom, carefully stacking a blue block on a red one. At first, narrating the play and offering specific praise may feel awkward: “I like how carefully you’re placing the blocks.” But the child notices. His shoulders relax. He places the next block with extra care.
When the tower falls, the familiar storm begins to gather. This time, the caregiver has a calm voice in her ear reminding her to stay present. She reflects what happened and recognizes the child’s effort. Instead of screaming, he pauses and says, “Again.” The tower still fell, but the moment did not fall apart with it.
That is one of PCIT’s strengths: families practice during real interactions, with support available in the moment. Many families begin seeing improvement within a few sessions, although every family’s experience and pace are different.
Learning Something New Together
Parents often arrive worried that seeking help means they have failed. PCIT begins somewhere more useful: with the relationship already there. Therapists ask what the child is like when things are going well: what makes them laugh, what draws them in, and what caregivers most want to protect.
Progress is not always a straight line. There may still be difficult mornings, grocery-store meltdowns, or days when a new boundary is tested. With practice, however, caregivers build a shared set of tools: positive attention, calm and direct instructions, consistent follow-through, and predictable responses that help a young child feel secure.
PCIT is one of the most successful therapies for young children at Alaska Behavioral Health: three-quarters of clients show improvement by the time they finish the therapy.
Building PCIT Capacity in Alaska
Alaska Behavioral Health has provided PCIT since 2018. Recently, a partnership with the Baker Center for Children and Families supported one AKBH clinician in becoming a certified in-house PCIT trainer. That investment gives the organization the internal capacity to prepare future clinicians rather than relying solely on outside training opportunities. It also helps AKBH maintain treatment fidelity, support ongoing workforce development, and sustain access to high-quality PCIT services for children and families across Alaska for years to come.
Interested in PCIT at Alaska Behavioral Health?
New clients can schedule an assessment by calling 907-563-1000. Current Alaska Behavioral Health clients who are interested in PCIT should speak with their clinical team. AKBH bills all insurance, including Medicaid and Medicare, and is in network with Premera Blue Cross Blue Shield.
If daily struggles are getting in the way of connection, your family does not have to figure it out alone. PCIT offers caregivers a chance to learn, practice, and grow alongside their child – one interaction, one play session, and sometimes one block tower at a time.
The family and events described here are fictional and are included to illustrate how PCIT may look in practice. Every family’s experience is different, and results vary.
Meet our PCIT Therapist
Sara Hoedel, LCSW is a clinician in the Little Tykes Therapeutic Services program at Alaska Behavioral Health. She holds a Master of Social Work degree from the University of Alaska Anchorage and provides mental health services to children and families.
Sara is one of 3 certified PCIT therapists in Alaska, and has recently become the only Board-endorsed PCIT trainer in Alaska.
Early Childhood Services at AKBH
Our Little Tykes team uses Parent-Child Interaction Therapy as well as other evidence-based practices to work with young children and their caregivers. Little Tykes operates a half-day therapeutic pre-school program for children in Anchorage.
If you are in crisis, call 988 from any phone in the United States to connect to local resources, or text HOME to 741-741 to connect with a counselor. If you are having a medical or mental health emergency, dial 911 or go to your local ER.
Information in this post and our website is provided for informational/educational purposes only, is not a substitute for professional healthcare, and does not establish any kind of patient-client relationship by your use of this site. In providing this content, including treatment resources, we are in no way representing or warranting that this information is appropriate or effective for your individual needs. If you are struggling with mental or physical health, please contact a qualified healthcare professional or reach out to the national mental health hotline at 988.
