A Quick Guide to Trauma Focused Cognitive Behavioral Therapy

By Sharon Fischer, LCSW

Trauma-Focused Cognitive Behavioral Therapy or TF-CBT is a short-term evidence-based practice that is highly effective for children and adolescent survivors of trauma.  Trauma is defined as sexual abuse, physical abuse, neglect, witness to domestic violence, witness to murder or death. Often times these experiences can cause a person to experience Post Traumatic Stress Disorder or PTSD.  The symptoms of this disorder include hyper-vigilance, 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 is based on cognitive-behavioral therapy interventions

TF-CBT takes about 13-18 weeks to complete.  It begins with psycho-education.  The therapist helps the client and family realize that the symptoms they are experiencing are normal and can be overcome.  In the next few phases the therapist teaches the client 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 client does with this aspect of the treatment.  It is the therapist’s job during this phase to guide and pace the client 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 client to gain acceptance over what happened to her.  After completing the story, the client shares it with the 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 client realize that this is irrational through the use of CBT techniques.  It is also important during this time to discuss safety.  The client, parent, and therapist can work together to come up with ways to help the client keep himself safe in the future.

TF-CBT can also be used with children and adolescents whom experience other psychological difficulties including: Obsessive Compulsive Disorder, Separation Anxiety, Grief, and a variety of other anxiety problems.

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