TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY
A PARENT’S GUIDE FOR UNDERSTANDING TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY (TF-CBT)
WHAT IS TF-CBT?
TF-CBT is a special type of therapy that helps children, teens, and their parents deal with the effects of traumatic events.
The goals of treatment are to:
Help the child or teen learn ways to cope with stress from traumatic experiences.
Reduce common problems like sadness, worry, or acting out that can happen after trauma.
TF-CBT is provided to children and teens ages 3 to 18 by a professional trained in this type of therapy. Treatment usually lasts 12 to 16 sessions, which can include:
Individual sessions for the child or teen.
Individual sessions for the parents.
Joint sessions with both parent and child or teen.
WHAT IS TRAUMA?
Trauma is a very upsetting experience that feels too big for a person to handle.
It often brings strong feelings of fear, sadness, or helplessness.
Trauma can come from a single event, like abuse, the loss of a loved one, or an accident. It can also come from ongoing problems, such as neglect, exposure to violence, or living in an unsafe environment.
When a child goes through trauma, it can affect their emotions, their thoughts, and even their body. This can make it harder for them to manage feelings, trust others, or feel safe in the world around them.
Without support, trauma may also impact how they learn, grow, and connect with family and friends.
Research shows that TF-CBT is often more effective than other types of therapy in helping children heal from trauma!
HOW DOES TF-CBT WORK?
The cognitive triangle is a tool used by therapists to show how our thoughts, feelings, and actions are all connected. If we change one part, the others can change too. Even changing just one part can help improve a difficult situation.
THE COGNITIVE TRIANGLE
WHAT DOES THE COGNITIVE TRIANGLE HAVE TO DO WITH TF-CBT?
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) uses the cognitive triangle with children who have experienced traumatic events to notice negative thoughts and learn how they affect their feelings and actions.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) uses the cognitive triangle with children who have experienced traumatic events to notice negative thoughts and learn how they affect their feelings and actions.
BEFORE SUPPORT:
Thought: “What happened was my fault.”
Feeling: Guilt, shame, sadness
Behavior: Avoids talking, pulls away from friends, or lashes out
WITH SUPPORT:
New Thought: “It wasn’t my fault. I am safe now.”
New Behavior: Talking more openly, playing with friends, feeling confident again
New Feeling: Relief, hope, less anxiety
In TF-CBT, the triangle serves as a teaching tool: children (and their parents) see how their thinking patterns influence emotions and actions, and they practice skills to shift the triangle in a healthier direction.
WHY DOES MY CHILD OR TEEN NEED TRAUMA THERAPY?
Children and teens who have experienced trauma can develop strong fears about anything that reminds them of what happened.
This fear may make them avoid talking about the trauma or shy away from reminders of it. They may become more isolated, struggle to express their feelings, or experience emotional numbness or tension.
Even a few of these reactions can make it hard for a child to do well in school, get along with others, or communicate with parents and friends.
If left untreated, these symptoms can interfere with a child’s healthy growth and development.
Some common reactions to trauma include:
Trouble remembering details of the trauma
Difficulty stopping thoughts about the trauma
Feeling emotionally or physically numb
Remembering physical sensations from the trauma
Fidgeting or trouble staying still
Trouble sleeping (nightmares, waking at night, not wanting to sleep alone)
Rapid changes in mood
Trouble concentrating
Feeling sad or depressed
Feeling anxious
Low self-esteem
Difficulty trusting others
Using drugs or alcohol
Wanting to hurt oneself or others
WHAT DO I HAVE TO DO AS A PARENT OR GUARDIAN?
A parent’s participation is very important in TF-CBT. Research shows that children improve faster when their parents are involved.
TF-CBT helps parents by:
Talking about their own feelings and thoughts related to their child’s trauma.
Learning ways to improve parenting skills.
Improving family communication through joint sessions.
Preparing to support their child when the child shares their trauma story in joint sessions.
Processing their own trauma if the parent has experienced trauma, and understanding how it affects their child.
WHAT CAN MY CHILD OR TEEN EXPECT FROM TF-CBT?
During TF-CBT, your child or teen can expect to:
Learn that the trauma was not their fault and that others have survived similar experiences.
Identify feelings and learn ways to manage them.
Learn how to relax and cope with reminders of the trauma.
Notice negative thoughts that cause sadness or worry.
Replace negative thoughts with more helpful ones.
Learn problem-solving skills.
Learn safety skills.
A key goal of treatment is to give the child a safe and supportive space to talk about the trauma. By creating a “trauma narrative,” the child can gradually replace upsetting memories with more helpful thoughts. Over time, reminders of the trauma become less powerful and happen less often.
STEPS OF TF-CBT:
How Kids Heal from Trauma
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The journey begins with education. Therapists will explain what trauma is, how widespread it is, and why it's normal for your child to experience feelings of fear and confusion. This insight helps both you and your child recognize that their reactions are valid and not unusual. You’ll also learn about the structure and goals of the therapy process, setting clear expectations along the way.
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As you navigate this journey, you'll gain practical tools to enhance your parenting. TF-CBT provides strategies for managing your child's behavior constructively, such as celebrating positive behaviors, setting clear boundaries, and establishing consistent routines. These techniques are crucial for rebuilding trust and fostering a stronger relationship with your child.
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Anxiety can be overwhelming, but TF-CBT teaches both you and your child effective relaxation techniques. Together, you'll explore tools like belly breathing, gentle muscle relaxation, and calming imagery. These strategies are designed to reduce stress and help manage intense feelings when they arise.
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After experiencing trauma, children might struggle to identify or express their feelings. TF-CBT will guide you both in recognizing and managing emotions such as sadness, anger, or fear in healthier ways. This process fosters emotional intelligence and resilience.
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Sometimes, negative thinking patterns can take hold. TF-CBT focuses on helping you and your child understand the connection between thoughts, feelings, and actions. You’ll learn how to identify unhelpful thoughts and shift them into more positive and constructive perspectives.
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At a comfortable pace, your child will have the opportunity to share their experiences. This could be through storytelling, art, or music. This safe expression helps process painful memories and gradually reduces their power, enabling emotional growth.
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If your child tends to avoid reminders of their trauma, TF-CBT will support them in facing those fears. Guided by the therapist and your encouragement, your child will be gently introduced to these triggers while employing the calming techniques they've learned, fostering bravery and resilience.
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As therapy progresses, there will be sessions designed for both you and your child to communicate openly about the trauma. These discussions, conducted at a pace that feels safe for both of you, aim to enhance understanding and foster supportive responses that strengthen your bond.
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In the final stages of TF-CBT, you’ll work on strategies to ensure your child feels safe and confident moving forward. This includes teaching boundaries, recognizing trustworthy individuals, and developing assertiveness skills to navigate their world more safely.