Trauma-Focused CBT

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):

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:

With mixed success, TF-CBT has also been used to help prevent and treat mental health issues associated with trauma, such as:

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.

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

It’s a good idea to speak to a few different therapists before making your mind up.

Find a TF-CBT near you

Find TF-CBT therapists on Zencare, below. Search by insurance, fees, and location; watch therapist introductory videos; and book free initial calls to find the right therapist for you!

New to therapy? Learn about how to find a therapist here.

Sources

  1. Trauma-Focused Cognitive Behavioral Therapy: Assessing the Evidence
  2. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents