What is trauma-focused cognitive behavior therapy?
Trauma-focused cognitive behavior therapy (TF-CBT) is a short-term type of talking therapy that involves both parent and child. TF-CBT was developed specifically to treat children and teenagers who had experienced trauma. It has a very strong base of evidence supporting its efficacy.
TF-CBT aims to help young people and their and caregivers to (1):
- Learn about trauma
- Learn coping skills and strategies for regulating emotions and reducing stress
- To work through and process the trauma
- Learn how to cope with reminders of the trauma
- Help the young person to develop a sense of safety and security
What TF-CBT can help with
TF-CBT was developed to treat young people with trauma-related symptoms, including post-traumatic stress disorder (PTSD). Trauma symptoms may arise following experiences such as:
- Sexual trauma or abuse
- Physical abuse
- Domestic violence
- Community violence
- Natural disasters
- Other forms of child maltreatment or traumatic loss
With mixed success, TF-CBT has also been used to help prevent and treat mental health issues associated with trauma, such as:
- Behavioral problems (1)
Effectiveness of TF-CBT
Results of available studies suggest that TF-CBT can effectively reduce trauma symptoms (1). For example, a review of the research found that CBT-based therapies, including TF-CBT, reduced trauma symptoms in both children and adolescents (2).
How does TF-CBT work?
TF-CBT draws on cognitive behavior therapy (CBT). It involves identifying and re-examining unhelpful thoughts, feelings and beliefs about traumatic events. Guilt and shame are two common emotions that TF-CBT therapists regularly help with.
Common to many types of therapy for trauma, TF-CBT also uses exposure techniques. The child or adolescent first learns strategies for coping and regulating their emotions. Next, they are slowly and gradually exposed to things that might remind them of the trauma or trigger an emotional reaction. Through this gradual, gentle process, distress reduces over time. The parent is also involved in this process, providing support and helping the child to feel safe.
The therapist also works with the parent individually (typically, this is a parent who has not perpetrated abuse and is supportive of the child) to provide training and help prepare them to support the child during their recovery journey.
Frequency of TF-CBT sessions
The frequency of TF-CBT sessions depends on individual circumstances. Typically, sessions are more frequent at the beginning of therapy, as you learn coping skills and work through the trauma. Towards the end of therapy, sessions become less frequent. The aim of these later sessions is to ensure that improvements are maintained and to troubleshoot any setbacks.
Length of TF-CBT treatment
The length of treatment in TF-CBT is usually between 12 and 16 sessions, but can be up to 25, depending on individual needs. You and your therapist will decide together when the appropriate time is to end therapy.
Structure of TF-CBT sessions
TF-CBT is a structured type of therapy, where sessions tend to last for around 45-50 minutes. Usually, the therapist will spend part of each session with the child individually, and then with the parent individually. There is often also a component of the session involving both the parent and child.
Separate individual sessions are often held with the parent or caregiver for training. This is to help prepare them and ensure that they are able to respond in a caring and supportive way. This is particularly important when the child is sharing trauma-related experiences and reactions.
Typically, the focus of the initial session is clarifying and understanding the problem. This involves the therapist asking lots of questions, and depending on the child, they may ask them to do different tasks to help them understand how they are coping. In later sessions, you’ll work through the elements of therapy, as described below.
- Psychoeducation: The therapist will help you to understand common reactions to trauma, for example.
- Coping skills: This might include learning relaxation exercises or coping statements, to help reduce stress and regulate emotions. It’s important to have these in place before moving on to the next element.
- Gradual exposure: This is a key element of many treatments designed for trauma. Here you are slowly and gradually exposed to things that remind you of the traumatic event, or might trigger difficult emotions. With the therapist’s help, this helps to reduce the distress associated with the trauma over time.
- Processing trauma: Here, the therapist helps to examine thoughts and beliefs related to the trauma. The goal is to work towards developing accurate and helpful thoughts and beliefs, and make sense of what has happened.
- Caregiver training: The therapist might work with the parent to help them to best support the recovery of the young person, through individual sessions or by being present in sessions with the young person.
What happens in a typical TF-CBT session
The content of TF-CBT sessions will vary depending on which element of the therapy is currently being worked on.
Typically, however, a session might begin with an assessment of the young person’s mood and a review of any homework tasks set in the previous session. The therapist will then work on an element of TF-CBT, as described above.
For example, the therapist might work on the exposure and processing by helping the young person to create a narrative about the trauma. This is a gradual exposure and processing exercise that enables the young person to form a coherent story about the trauma or abuse. Creating the narrative can help to reduce distress and change unhelpful thoughts about the trauma.
The parent or caregiver might then join the session so that the young person can share while receiving a supportive and caring response from them. This helps to restore the young person’s feeling of safety.
Before the session ends, the therapist will ensure that the young person is in a safe place to leave the session; that any distress or emotion brought up has been regulated. Homework tasks might be set, such as practicing a relaxation exercise and reflecting on how it affects levels of tension.
What to look for in a TF-CBT therapist
- Look for a mental health professional with a current license; this ensures that your therapist has completed the appropriate level of education to practice. When browsing through therapists on Zencare, you can rest assured that our therapists have already been vetted.
- Look for a therapist who has completed specialized training in TF-CBT. The TF-CBT national therapist certification program provides accredited training that therapists must complete in order to be certified TF-CBT practitioners. It can be helpful to take a look at therapists’ biographies. This is often where they note their experience and specializations.
- Consider working with a therapist who specializes in working with children, such as a child psychologist.
- Prioritize the potential for developing a strong working relationship between the child and parent with the therapist. This trusting relationship, called the “therapeutic alliance” can have a significant impact on the effect of therapy. Young people who have experienced trauma may feel unsafe and see the world as a more dangerous place. Therefore, it’s particularly important to look for a therapist with whom they feel comfortable.
- The best way to gauge how you might feel about your prospective therapist is to ask for a preliminary phone call. Most therapists will be happy to do so. This gives you the opportunity to ask about your therapist’s:
- TF-CBT training
- Experience with working with children who have experienced trauma
- What therapy with them will be like
- Their participation in insurance plans and cost of therapy
It’s a good idea to speak to a few different therapists before making your mind up.
New to therapy? Learn about how to find a therapist here.