Trauma–focused Cognitive Behavioural Therapy (TF-CBT) is an approach that is commonly used for treating childhood trauma.
Studies show that TF-CBT is the best evidence based intervention for children that are living with PTSD.
TF-CBT has multiple components: psychoeducation; anxiety management; exposure/trauma narrative and cognitive behavioural therapy.
Psychoeducation is a crucial part of effective treatment. By giving parents psychoeducation about the treatment, their role, and what to expect, it is like having a good foundation to build a sky scraper – without a good foundation, the construction workers would not be able to progress very far.
Some important points that should be discussed during psychoeducation are:
- Psychoeducation involves both the parent and the child. The parent and therapist talk about what are normal responses to trauma, what PTSD looks like, and help the parent make sense of what their child is experiencing, as well as understanding trauma triggers and how or why they elicit negative behaviours. For example, a child that has experienced a car crash on a bridge may be triggered by bridges.
- As a therapist, I find it important to also have a discussion with parents about the therapeutic journey with children. A child’s journey usually is a longer process than an adult’s journey due to taking two to four sessions to build rapport. My other article ‘Building Rapport with Children in Counselling goes into more detail about this topic.
- During the Trauma Narrative stage of the therapeutic journey, negative behaviours may be elicited for the following two days after the session, due to the child starting to take the trauma out of the box and process what has previously happened.
- Treating PTSD in children is often a long journey. For treatment to be most effective, research recommends a minimum of one session a week. This is because two weeks is a long time in a child’s life, and exposure and desensitization may not be effective because it is not challenging the maladaptive beliefs.
Anxiety management strategies are skills that parents can utilise to help manage their child when they get irritable, have tantrums, or avoid trying to go to sleep as a couple examples.
It is also a good way for parents to reflect on themselves, how they cope in these situations, and how they can use their own skills to help them manage those behaviours and not escalating the situation.
In the session with the child, I like to do some emotionally regulating exercises that are age appropriate, so when they are done outside of the therapy room, it is something that they familiar with.
Trauma narrative is about revisiting the trauma: telling the story, the cognitions and the thoughts that go along with it.
One of main symptoms of PTSD is avoidance behaviours because people adapt a belief of: “If I avoid it, don’t think about it and put it in a box in the back of my mind, I’ll be fine”.
However, that’s far from the truth; the trauma box forms cracks and trauma triggers and symptoms come back. By unpacking this trauma box, the trauma can be processed – for example, making sense of it, how it made you feel about yourself, examining the thoughts you have as to why the trauma happened, and learning that neither thinking about the distressing experience nor being upset, is a danger to yourself.
During this stage of TF-CBT, treating children is a bit different to treatment for adults. This is because a child’s way of communicating and expressing their feeling is through play, rather than talking things out. Children may emotionally process trauma through approaches such as exposure therapy, child centred play therapy, sand tray therapy, and expressive therapies such as drawing.
When children are faced with a trauma trigger, such as a sheet that looks like a pathway to a bridge, they will provoke the trauma memory repeatedly for periods of time and their anxiety will decrease. This reduction over repeated confrontations will challenge any unhelpful beliefs they may have, which naturally intertwines with CBT.
Cognitive Behavioural Therapy
Desensitisation and exposure to triggers challenges the beliefs that cause negative emotional and physical reactivity. For example, if a child has PTSD about bridges, the therapist may focus on building rapport for the first couple of sessions, then perhaps roll a ball to each other, then maybe having a sheet and rolling the ball on the sheet to each other and slowly as the sessions go on make steps to making a bridge using cars.
Patience is key, this journey is on the child’s timeline, not ours. During this process, elements of CBT will be intertwined. This is because when one takes the trauma out of the box and starts to examine it, it will bring up thoughts as to why things happened, how it impacts your emotions and behaviours.
Over time, the child’s emotional and physical reactions will start to decrease as a result of desensitisation and challenging unhelpful beliefs.
Author: Larissa Watter, BA Counselling.
Larissa Watter is a Brisbane counsellor, passionate about working with children. She is currently furthering her studies by undertaking a Certificate in Child Centred Play Therapy.
To make an appointment with Larissa Watter try Online Booking. Alternatively, you can call M1 Psychology Loganholme on (07) 3067 9129 or Vision Psychology Wishart on (07) 3088 5422.
- Creamer, Mark. & Australian Centre for Posttraumatic Mental Health. (2004). Treating traumatic stress : conducting imaginal exposure in PTSD : clinicians manual. Heidelberg West, Vic : Australian Centre for Posttraumatic Mental Health