Trauma-Focused Cognitive Behavioral Therapy

Trauma Focused Cognitive Behavioral Therapy or TF-CBT is an evidence-based treatment model used to guide children and adolescents through recovery of traumatic events. This model involves both individual and joint sessions with the child and caregiver. It combines techniques drawn from cognitive, behavioral and family therapies into one structured method.

Why TF-CBT?

TF-CBT was developed to help children build effective coping skills in order to manage trauma responses and grow in their self-efficacy. It provides the opportunity for them to process their experiences in a safe and supportive environment. Meanwhile, parents and caregivers are provided with tools to improve their communication with and support of their child.

Who is it for?

TF-CBT is most beneficial for children ages 3 to 18 years old from any background, who have endured one or more traumatic life events, such as experiences of or witnesses to…

• Intimate partner violence

• Sexual abuse or assault

• Physical abuse or assault

• Community violence

• Traumatic death of a loved one

• Disaster, war or other hostilities

• Motor vehicle accidents

How does it work?

This model is broken down into 9 components that are explored across roughly 12 to 20 sessions. These can be remembered by the acronym PRACTICE…

P- Psychoeducation and Parenting Skills

R- Relaxation Skills

A- Affect Identification and Regulation

C- Cognitive Coping

T- Trauma Narration and Processing

I- In Vivo Mastery

C- Conjoint Child-Caregiver Sessions

E- Enhancing Safety and Future Development

These components are carried out in 3 main treatment phases:

1. Stabilization and Skill Building (P,R,A,C)

2. Trauma Narration and Processing (T,I)

3. Integration and Consolidation (C,E)

Psychoeducation and Parenting Skills

This section of the process involves discussion and education, with both the caregiver and child, of the impacts trauma has on children, including typical symptoms. Information regarding specific relevant traumas are shared along with prevalence rates, allowing clients a clear and accurate understanding of what they experienced. 

This section also involves teaching parenting skills to the caregiver. The therapist will provide guidance to the caregiver on how to manage and work through behavioral struggles that may show up in their children alongside the healing process.

Relaxation Skills

During this phase of the treatment children and their caregivers are taught various relaxation techniques. These techniques can be employed in and out of sessions to manage strong, upsetting feelings and reactions to trauma related triggers. The caregiver also gains the knowledge on how to co-regulate with  the child in other settings and situations, when the child is unable to regulate themself.

Affect Identification & Regulation

Affect identification consists of teaching children how to accurately identify, label and talk comfortably about different emotions that they experience. Teaching regulation is providing guidance on healthy and developmentally appropriate ways to express these emotions that fit each individual’s needs.

Cognitive Coping

Cognitive coping is a process of reframing the thoughts a client has about their traumatic experience or themselves. It begins with distinguishing between accurate and inaccurate thoughts, as well as helpful and unhelpful thoughts. Children then learn how to understand feelings, thoughts, and behaviors in relation to one another. Lastly, they work on forming more accurate and helpful thoughts, in order to reshape their feelings and reactions to difficult situations.

Trauma Narration and Processing

The trauma narration and processing component involves the creation of an individualized narrative outlining the child’s traumatic experiences. The narrative can be any expression of their story, such as a poem, drawing, song, book, or other expression. This step allows for the processing and desensitization of the trauma. The therapist works at the child’s pace and helps them to employ the relaxation techniques and cognitive coping skills they previously learned, to alleviate any upsetting feelings or thoughts that may arise.

In Vivo Mastery

During In Vivo Mastery the client works on gradual exposure to any harmless triggers that are associated with the incident. Triggers can look like places, objects, sensory experiences, emotions, certain characteristics of people or other things that cause fear in the client, but aren’t actually dangerous. 

Conjoint Child-Caregiver Sessions

In this component, the child will share their trauma narrative with their caregiver. During this process both will work on utilizing their coping skills they’ve been practicing. This conjoint session reinforces the caregiver-child trust, the support of the caregiver and the strengthening of their relationship with one another.

Enhancing Safety and Future Development

Enhancing Safety and Future Development involves both caregiver and child in the formation of a family safety plan. This will include learning some precautions and safety skills that will give confidence to the child and help them prepare for risky situations that may occur in the future.

Written by Noelle Anderson, MSWI

Sources:

Medical University of South Carolina. (2017). A Course for Trauma-Focused Cognitive Behavioral Therapy. TFCBT-Med. https://tfcbt2.musc.edu/en