Using TF-CBT with Children

Trauma-focused cognitive-behavioral therapy (TF-CBT) is an empirically supported treatment that helps children to overcome trauma related to abuse, violence and grief, such as sexual abuse, physical abuse, and domestic violence. There is extensive outcome data documenting the effectiveness of TF-CBT in reducing PTSD symptoms and shame, decreasing depressive and anxiety symptoms, as well as disruptive and sexualized behaviors.  This treatment includes parents in the process to reduce levels of distress which can improve the quality of the relationship with their child.

TF-CBT goals include:

The goals of TF-CBT are to help clients learn skills to cope with trauma, face trauma and related concerns, as well as progress through life in a safe and positive manner.  In therapy sessions the goals may be:

  • Helping children cope with trauma related distress through use of healthy coping skills
  • Helping children to process their traumatic experiences
  • Assisting non-offending caregivers in responding supportively to children’s distress and helping them cope with their own feelings related to the trauma
  • Improving communication between caregivers and children
  • Reducing children’s behavioral and emotional difficulties
  • Enhancing future safety in order to reduce risk of re-victimization

This therapy is for children ages 3 to 18 who have significant behavioral and emotional difficulties related to traumatic life events. TF-CBT has been used effectively with boys and girls from all socioeconomic backgrounds, who are residing in a variety of settings (e.g., with parents/relatives, adoptive or foster placements, group homes), and who are from diverse ethnic and cultural groups. Treatment typically lasts 12 to 16 sessions.

It is important for a child who has been victimized to “process” or make sense of life and we are here to help.

Why therapy for child after a trauma ?

It can be difficult to cope with the aftermath of a traumatic experience, especially if you’re a child. That;s why therapy can be so important.

Childhood misfortunes make everything more difficult — self-confidence, conflict resolution, being in love, and being successful. A therapist can help identify, fully describe, and respect their journey while teaching coping skills.
Therapy gives kids a way to safely share their feelings, tell their story, and get support. In therapy, kids learn to talk about what they’ve been through. They learn coping and calming skills. They learn to adjust the way they think and feel about the trauma. It can give them the opportunity to face fears in a safe space which translates to decreased negative impact on daily functioning.

While therapy can help a child to process what happened and to understand and cope with the emotions they’re feeling, it can also provide support and guidance for parents who may be struggling to support their child.

If your child has experienced trauma, don’t hesitate to seek out professional help. Therapy can make a big difference in helping your child to heal and to cope with what happened.

Trauma in children

Trauma in children can take many forms.  As much as we try to shield our young ones from traumatic experiences, it can happen.  Understanding the signs and symptoms can provide the information needed to determine if your child needs additional support.  Children of all ages can suffer from traumatic stress after experiencing a violent or dangerous physical, psychological, or emotional experience, and it can overwhelm their ability to cope and heal properly, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Many experiences can trigger an emotional trauma response in kids, per SAMHSA.  Some potentially traumatic stressors include bullying; psychological, physical, or sexual abuse and/or neglect; natural disasters, terrorism, and community and school violence; witnessing or experiencing intimate partner violence; sexual exploitation; accidents; illness or injury; the sudden or violent loss of a loved one; refugee and war experiences; and military-related experiences, such as parental deployment, loss, or injury.

Each child acts or reacts to traumatic stressors differently based on many factors; family history, religious beliefs, gender, age, etc.  Also note, that as a parent, you may not be aware that your child has even experienced a traumatic event.  Just knowing the signs and symptoms of trauma is not enough, it must be taken in context of the child, family and caregiving systems, support, etc.  The symptoms listed in this article can also be unrelated to trauma. 

Trauma experts agree that “the body keeps the score,” which means that when we experience a seriously distressing event, the trauma has a way of weaving its way throughout our bodies, with the after-effects of fear and stress showing up days, weeks, months, and even years later, especially if we don’t actively work on healing.  

Our central nervous system is designed to keep us safe, calm and happy.  If we perceive or experience a major stressor, it can put our bodies into fight, flight or freeze mode, which means our nervous system then focuses on how to manage the threat and maintain feeling safe, calm and happy.  With children, they often cannot escape the threat so their bodies may stay in the fight, flight, freeze mode, leaving them feeling helpless and hopeless.  So even when they are no longer in danger, their brains and bodies remain on high alert, releasing unnecessary stress hormones that can interfere with their ability to pay attention, sleep, or engage with others socially. Some of the common signs of trauma in children include:

Preschool Children

  • Fearing separation from parents or caregivers
  • Crying and/or screaming a lot
  • Eating poorly and losing weight
  • Having nightmares

Elementary School Children

  • Becoming anxious or fearful
  • Feeling guilt or shame
  • Having a hard time concentrating
  • Having difficulty sleeping

Middle and High School Children

  • Feeling depressed or alone
  • Developing eating disorders and self-harming behaviors
  • Beginning to abuse alcohol or drugs
  • Becoming sexually active

Any trauma symptom can be transient or long-term, which is why spotting signs early and supporting your child is of utmost importance, if left unaddressed, can alter the development of the brain and body’s stress response system. 

The main intervention a parent can provide is to notice.  You know your child better than anyone and can distinguish between normal ups and downs and major shifts in their behavior.  If you notice that all of the sudden they are eating less or more than usual, having more nightmares, seem more clingy or scared,  complain of stomach aches,  or moody, aggressive or irritable, take note and inquire..  These signs don’t automatically mean something is wrong,  but it alerts you to seek more information and not ignore the changes.

It is important for your child to feel safe and connected.  Being available and reliable and willing to listen to your child’s experience is an important intervention for your child. . Your child needs to know that you can tolerate their experience, are willing to be supportive and soothing, and they have you to lean on.  

Reaching  out for help and assistance can always start with your child’s school counselor or pediatrician for referrals.  When choosing a therapist, make sure they are trauma-informed and trained to work with children and/or teens.  Seeking your own support as a parent is available as well.  Listening to your child may activate some of your own childhood traumatic experiences.   You will be better able to support your child if you have your own support.

The good news is that trauma can be addressed through therapy and changes to help children feel a sense of safety and stability.  Healing from trauma can occur at any stage of life, early intervention is especially effective — the sooner we can identify and work to heal emotional trauma in childhood, the more likely we are to prevent the long-term repercussions on their physical and mental health.