Disruptive behavior problems in children represent a serious, highly prevalent, and costly public health problem (Klein & Mannuzza, 1991). Early intervention is critical to prevent negative developmental trajectories and outcomes. To date, research efforts have yielded a number of efficacious treatments for childhood disruptive behavior. One such intervention is Parent-Child Interaction Therapy (PCIT; Eyberg & Boggs, 1998). Based on Baumrind's construction of authoritative parenting and emphasizing both attachment and social learning theory principles (cf. Foote, Eyberg, & Schuhmann, 1998), PCIT focuses on changing ineffective parent-child interaction patterns. In the first of two phases of treatment, Child-Directed Interaction (CDI), parents engage their child in a play situation. CDI aims to restructure the parent-child relationship and provide the child with a secure attachment to his or her parent. The development of a secure, stable attachment relationship and healthy parent-child interactions are key to the development of a healthy self-concept, optimal emotional/behavioral regulation, and the ability to be empathic to others (see Grossmann, Grossmann, & Zimmermann, 1999; Hobbs, 1982; Kazdin, 1985). Attachment theory asserts that sensitive and responsive parenting leads the infant to develop a cognitive-affective working model that he or she will be responded to when necessary. Thus, young children whose parents show greater warmth, responsiveness, and sensitivity to the child's signals are more likely to develop a secure working model of their relationship and more effective emotional regulation (Ainsworth, Blehar, Waters, & Wall, 1978). Maladaptive attachment is consistently linked to children's aggressive behavior, low social competence, poor coping skills, low self esteem, and poor peer relationships (Coie et al., 1993; Earls, 1980; Jenkins, Bax, & Hart, 1980; Richman, Stevenson, & Graham, 1982; Rutter, 1980).
