What is TF-CBT?
Before talking about Trauma Focused Cognitive Behavioral Therapy, or TF-CBT, we need to talk about trauma. In the last few years trauma has been a word heard a lot more often in the media and in our everyday lives, but what is it really?
When I talk about trauma with kids, I explain it as a scary or upsetting event that “sticks” to us. Trauma can be a lot of different things, like physical or sexual abuse, neglect, witnessing domestic violence, experiencing a natural disaster or bad accident, experiencing community violence, chronic illness, medical procedures, separation from caregivers, and so many other things. When this scary or upsetting thing happens, it sticks to us like an old gross sticker and it takes a lot of effort and energy to make it go away. Have you ever tried to get an old stubborn sticker off something? It’s SO frustrating, time consuming, and feels like no matter how hard we try, there’s always a little bit of residue left to remind us of what was once there. We call that residue a “trauma reminder.”
Our responses to trauma can be very different. Some people might be hyper aware of what is going on around them, they may have nightmares or flashbacks of the scary or upsetting event. Others might feel numb, dissociated, or shut down. Others might experience anxiety and depression, exhibit anger or “behavior challenges.” All of these responses, are our mind and body’s way of trying to keep us safe from the scary or upsetting thing. Sometimes our minds and bodies are reacting to the “sticker residue” rather than the actual event. Our body may think it’s still in danger and it’s doing the best it can to protect us. It may not know the danger isn’t there anymore, but it’s doing what it knows how to do.
The other tricky thing about trauma is that when the scary or upsetting thing happens, it is stored in a very disorganized way in our minds and bodies. Think of those little word magnets that people have on their fridge- when we experience a trauma, it’s like all of those magnets were dumped into a big pile- our minds and bodies react and respond to the scary or upsetting thing, but don’t always know how to make sense or if it, process it, or put it into words. That’s why our responses to trauma can look so different from person to person, and feel confusing for those close to us. TF-CBT helps us organize those word magnets so we can better make sense of what happened to us, and tell our story.
So now that we have a basic understanding of trauma, let’s talk about TF-CBT. TF-CBT is a short term, evidence based treatment for children and teens aged 3-18. TF-CBT is broken down into 8 different components, each one with an important purpose or task.
Here is a VERY brief description of each component:
Psychoeducation and parenting skills: this is where children and parents learn about the specific trauma, and trauma responses- parents also learn different strategies to help manage some behaviors (trauma responses) that may be causing a challenge
Relaxation: this is where children have increased self-awareness of their body’s experience of emotions, and learn coping strategies to manage trauma responses- parents learn coping strategies to co-regulate, and support their child with their new skill set
Affect modulation: this is where children and parents gain increased understanding about feelings and emotions in general, as well as feelings associated with the specified trauma event
Cognitive coping: this is where parents and children learn the connection between thoughts, feelings, and behavior, as well as negative thought patterns associated with the trauma
Trauma narrative: this is where, with the support of a therapist and the use of their new skill set, children un-jumble those metaphorical word magnets and create the story of their trauma
In-vivio exposure: this is where children differentiate real life danger from that old “sticker residue” that shows up in their every day life and causes distress
Conjoint Trauma Narrative: this is where children share their story with a trusted loved one, and the parent has the opportunity to demonstrate support and validate their child’s experience
Enhancing safety: this is where we plan for future safety and children and parents learn about ways to continue managing trauma reminders
After that, children are ready to graduate from TF-CBT with an increased sense of empowerment over their experiences.
As you can see, trauma can impact us in so many different ways, but there is hope in intentional trauma informed care, which is where TF-CBT comes in. If your child has experienced trauma, and has a hard time managing the various ways trauma has impacted them, TF-CBT may be a great step towards healing for your child and family. If you are in the state of Pennsylvania and are interested in TF-CBT for your child, please reach out and set up a free consultation call with me. If you are outside the state of Pennsylvania, but interested in TF-CBT, check out the TF-CBT providers listed here.