Most people have memories from childhood that stick with them long into their adult lives. Maybe a certain scent, a song or even a phrase will activate that “déjà vu” sensation that takes us back to those youthful memories that we cannot seem to shake. Unfortunately, for many children throughout the globe, those memories are anything but pleasant. In fact, many children who have experienced trauma are plagued with various forms of psychological distress that have a negative impact on their ability to thrive in their environments, including at home, at school, and among peers.
For this reason, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed by Dr. Judith Cohen, a child and adolescent psychiatrist, along with Drs. Esther Deblinger and Anthony Mannarino, both clinical psychologists. Over the past few decades, this evidence-based form of psychotherapy has helped thousands of children and adolescents who have experienced various forms of trauma. TF-CBT was originally developed to address the psychological needs of children who previously suffered from child abuse and the subsequent Post Traumatic Stress Disorder, depression, anxiety, shame, behavioral problems, age-inappropriate sexual behaviors, and other dysfunctional thoughts, feelings and actions that resulted. It has expanded to address trauma from physical abuse and domestic violence, community violence, traumatic bereavements, and other tragic circumstances and has proved effective in these environments through numerous studies. TF-CBT is helpful not only for the affected children but also for non-offending caregivers.
Typically, this form of treatment is delivered as a combination of individual sessions for the affected child and for the caregivers, as well as joint sessions with the child and caregivers together. The total number of sessions can be as few as 8 and as much as 25, but are on average about 12. Both the children and parents undergo psychoeducation, during which they learn about the impact of trauma and common childhood reactions. Specifically, parents are trained in strategies to manage their children’s behaviors and to communicate effectively with their children. The children and adolescents are also educated on how to care for their personal safety, how to have healthy interpersonal relationships and healthy knowledge of their sexuality, and how to manage future stressors and reminders of their past traumas.
TF-CBT also incorporates a multitude of dynamic approaches, including relaxation techniques, such as focused breathing, visualization of images, and progressive muscle relaxation, which allows one to monitor and control muscle tension. Therapists also help children and caregivers better recognize and express their emotions when they are reminded of past abuse and traumas. The CBT helps the clients understand how their thoughts, feelings, and behaviors relate to one another and teaches them how to correct unhealthy thought processes when faced with triggers. In order to better process the trauma and, in effect, “rewrite” the narrative of trauma, clients participate in exercises in which they recount abusive events verbally, symbolically or in written form, gradually throughout the sessions. Children also learn to control their emotional reactions through a process called in vivo exposure, during which they are gradually exposed to reminders of their trauma, for example, dark basements, and loud noises.
Various kinds of mental health professionals can deliver TF-CBT, including clinical social workers, professional counselors, psychologists, psychiatrists, and clinical counselors. What is most vital is that anyone seeking training in TF-CBT, regardless of their current level of certification, should undergo continuous follow-up supervision and consultation with TF-CBT experts and participation in TF-CBT learning communities and workshops, especially because the field is ever-evolving. Moreover, these training opportunities allow clinicians and other mental health workers to identify and overcome barriers to implementing TF-CBT effectively in their fields.
Many parents and children who are seeking treatment are advised to do so through a caseworker, as they are often knowledgeable on which therapists are well-trained and specialized enough to offer appropriate treatment. This process is especially important, as each case is always unique. If possible, potential therapists should be interviewed by both caseworkers and parents together. Questions during the interview process can include, but certainly are not limited to: those pertaining to the specificity of the therapist’s training (e.g., how recently they were trained and for how long), at what point during the therapy and in what manner the therapist would ask the child to recount their trauma, and which specific techniques the therapist would use with the child. Most importantly, the children, caregivers, and therapist should be patient with themselves and each other in each step of the recovery and should continue to have faith in the process of healing.