Trauma-Focused Cognitive Behavioral Therapy: An Introduction

A family of paper doll cut-outs hovers over the palm of a hand.Trauma-focused cognitive behavioral therapy (TF-CBT) is a short-term,evidence-based practice that is highly effective for children and adolescent survivors of trauma. Trauma can include sexual abuse, physical abuse, neglect, witness to domestic violence, witness to murder or death. Oftentimes these experiences can cause a person to experience posttraumatic stress (PTSD). The symptoms of PTSD include hypervigilance, increased startle response, avoidance around any thoughts or feelings associated with the traumatic event, nightmares, dreams or feelings that the event is reoccurring, as well as acting out or behavior problems. TF-CBT is based on cognitive behavioral therapy interventions and can help an individual gain control over one’s life again.

TF-CBT takes about 13-18 weeks to complete. It begins with psychoeducation. The therapist helps the child and family realize that the symptoms they are experiencing are normal and can be overcome. In the next few phases the therapist teaches the child and family coping techniques such as relaxation, feelings identification and understanding, and the connection between thoughts, feelings, and behaviors. The parents or guardians are encouraged to learn the intervention steps to emphasize the importance of family in the therapy.

Once these concepts are understood, then the child tells the story about the trauma they have experienced. The story may be told over several sessions depending on how the child does with this aspect of the treatment. It is the therapist’s job during this phase to guide and pace the child through the process in a safe manner. This may sound scary at first, but the idea is that an individual will become desensitized to the traumatic event by telling it repetitively over time. In TF-CBT the repetition allows the child to gain acceptance over what happened to him or her. After completing the story, they then share it with their parent or guardian.

The final phase of TF-CBT is to restructure some of the thoughts that come up within the telling of the story that may be irrational or unhelpful. For instance, a common unhelpful thought that may arise is, “it was my fault that this happened.” The therapist will then help the child realize that this is irrational through the use of CBT techniques. It is also important during this time to discuss safety. The child, parent, and therapist can work together to come up with ways to help the child keep himself or herself safe in the future.

TF-CBT can also be used with children and adolescents who experience other psychological difficulties, including obsessive compulsion, separation anxiety, grief, and other mental health conditions.

© Copyright 2009 by Laura Tolle, LMFT, therapist in Palo Alto, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Sue

    Sue

    November 27th, 2009 at 10:44 AM

    I have read quite a lot about trauma-focused CBT in the past and have always come across positive results from it. It really seems like a promising method to treating trauma-inflicted children.

  • Sean

    Sean

    January 20th, 2010 at 3:39 PM

    I’ve been similar due to post traumatic stress syndrome and depression
    I feel great now and getting better
    the best advice for some on who was in my shoes is to tell them to get help
    how to spot them paranoid (edgy)and sad
    spread the love and save a life

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