How Does TF-CBT Help Children Move Forward?

Children’s advocacy centers make tremendous efforts to base their work with victimized children on evidence-based practices—those methods that have been proven to work. In the aftermath of abuse, many therapists are using TF-CBT (trauma focused cognitive behavior therapy) to move children and non-offending care givers onto the road to wellness.
This month’s Mental Health Connections, a newsletter from the Southern Regional Children’s Advocacy Center gave a concise summary of TF-CBT that I am including here for those who don’t have a mental health background and are wondering how this works. The information was taken from http://www.nctsn.org/nctsn_assets/pdfs/Q&AChildSexualAbuseTreatmentJC103007.pdf put out by the National Child Traumatic Stress Network.
Wishing you well in all you do!
Elaine

This is based on an interview with Dr. Judith Cohen of NCTSN

Q: What are the elements of effective therapy?

A: Trauma-Focused Cognitive Behavioral Therapy is a structured treatment that takes place over as short a period as twelve weeks. A child and (whenever possible) the child’s parent or supportive caregiver participate. The treatment begins with education. The therapist shares information with the child and caregiver about common reactions and symptoms that may result from sexual abuse. This helps children understand that their reactions and feelings are normal and that treatment can help them. It helps non-abusing parents to accept that the abuse wasn’t their fault or the child’s fault. It’s common for parents to react to their child’s abuse by becoming either too permissive or too protective. The therapist helps them maintain normal routines, household rules, and expectations. If the perpetrator has been one of the parents, the whole structure of the family may have changed, and the remaining parent needs support to be consistent and keep family life as secure as possible.

Another step in the treatment, called affect regulation and relaxation, helps the child to identify his or her negative feelings such as anxiety, jumpiness, and sadness that can occur after a trauma. The therapist gives the child techniques to modulate these feelings and to soothe him or herself. This is important so that the child does not begin to withdraw from life to avoid having these feelings. An-other part of the treatment helps children to analyze the connections between their thoughts, feelings, and behaviors. Children who’ve been sexually abused often feel bad about themselves. They may blame themselves or believe that nothing good will ever happen to them again. We begin by helping children examine their thoughts about everyday events. We then move into exploring their thoughts, beliefs, and feelings about the abuse.

Another part of the therapy is overcoming learned fears. This means unlearning the connection a child has made between the abuse, her negative feelings about it, and trauma reminders, other things and events she’s associated with the experience. Desensitization may be necessary when a child continues to have intense reactions to particular things, places, people, or situations that remind him or her of the trauma. To avoid reactions to these trauma reminders, a child may limit his or her experiences. For example, a child may avoid going into the basement of the house where the abuse occurred because she associates the basement with negative feelings about the abuse. Reactions to trauma reminders may also generalize. A child may begin by being afraid to go into the particular basement where the abuse took place, and gradually become afraid of go-ing into any basement, and then into any room that is downstairs or that in any way resembles a basement. In the case of a child afraid to go into any basement, our treatment would help the child overcome the fear of base-ments by having the child gradually imagine being in a basement without feeling upset. In some cases, the therapist might actually go into the base-ment with the child to be sure she can tolerate the experience.

One of the most significant parts of the treatment is the trauma narrative. The clinician helps the child to tell a coherent account of what happened, how it felt, and what it meant. By putting her memories in order, the child no longer feels haunted by them. The therapist helps identify and correct the child’s distorted ideas and beliefs about the abuse. For example, an adolescent was in treatment for abuse that had occurred when she was five years old and the perpetrator was fifteen. She was still blaming herself for “letting,” the abuse occur. By creating the trauma narrative she realized she had been blaming herself for something she hadn’t had the power to prevent. By telling the story to her therapist, she corrected her own false understanding. The mother had also felt confused about who was to blame. By sharing this story with her mother in a joint therapy ses-sion, the daughter helped her mother to understand what had really happened. The therapy healed not only the young woman but the mother-daughter relationship as well.

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