Child Abuse Therapy – Trauma Focused Cognitive Behavior Therapy (TF-CBT)

Counselor With Patient Children who have been physically, emotionally, and sexually abused, should attend some sort of therapy or counseling.  Without therapy, they may experience post traumatic stress disorder (PTSD) symptoms such as upsetting memories, bad thoughts, unsettling dreams, emotional numbing, or even physical reactions such as hyperarousal, trouble concentrating, or irritability.

One of the most effective methods of therapy is Trauma Focused Cognitive Behavior Therapy or TF-CBT (TFCBT).  Trauma Focused Cognitive Behavior Theory is based on the theory that traumatic events produce information that is hard for the victim to categorize, process, and fit into their existing scheme.  When a child cannot truly comprehend a traumatic event, the strong emotions that resulted from the traumatic event are left unprocessed.  When the child attempts to process the information, they may either distort the facts to fit within the realm of what they already know or understand, or they may alter their beliefs to fit the unprocessed information into their existing scheme.  Either is bad.  It leads to guilt, shame, self-blame, and a host of other problems.  To counter this, the child must be taught how to deal with the confusing emotions in order to correct maladaptive beliefs.

Trauma Focused Cognitive Behavior Therapy can work in as few as 12 sessions (it’s a short-term therapy method) but could potentially last longer if needed (if for instance, the child has problems establishing a relationship with the therapist).  Trauma Focused Cognitive Behavior Therapy consists of sessions for both the child and the parent because the theory proposes that parents provide much needed skills and support for the child (after all, nobody knows the child as intimately as their parents).

There are several reasons why your current therapist may not utilized TF-CBT methods though.  Therapists who utilize Trauma Focused Cognitive Behavior Therapy must be well trained.  A minimum of a Masters Degree is suggested.  In addition, well established therapists may reject a method such as TF-CBT because they see it as inflexible or restrictive.  In addition, they may see it as a criticism of their current practice.  Or they may simply not have time to train for the method.

TF-CBT’s effectiveness has been easily proven.  That Trauma Focused Cognitive Behavior Therapy results in greater gains in fewer sessions is without argument.  The U.S. Department of Health ranked it the highest out of 24 methods it evaluated.  It also has more proven empirical studies regarding its effectiveness than any other therapy method.  Research studies show that in 12-16 sessions, TF-CBT can resolve PTSD symptoms (such as depression, shame, behavioral difficulties) in about 80% of the children who have been sexually abused.

TF-CBT has several core components:


In this step, the child is taught the impact of trauma, be it physical, sexual, or emotional, and common childhood reactions to abuse.  In addition, safety and prevention skills are taught as are healthy sexuality points.

Trauma Narration and Gradual Exposure Techniques

The child describes the traumatic event.  This progresses gradually until the child is comfortable talking about the traumatic event in detail.  This desensitizes the event and removes the stigma so commonly associated with child abuse.  The end objective is for the child to be able to discuss the traumatic event without any negative feelings.  In effect, they are desensitized to the event.  This is accomplished by letting the child work their way into full disclosure slowly and methodically.  By the end of the treatment, the goal is to enable to child to talk comfortably about their abuse.

Cognitive Reframing

The child must disclose inaccurate feelings about the traumatic event and be taught why those feelings are inaccurate.  For instance, if the child feels self-blame about the event, they must be taught and understand why it the abuse is not their fault.  This is done by teaching what psychologists call the “cognitive triad”, or the relationship between thoughts, feelings, and behaviors.  The child is taught how their thoughts, feelings, and behaviors relate to each other and how the child may control and change those thoughts, feelings, and behaviors to their advantage.

Stress Management Techniques

Learning stress management techniques, such as deep breathing to relieve stress or the ability to control their thoughts, offers several advantages.   Firstly the child learns that they are capable of controlling their automatic physical reactions.  They also learn that techniques such as deep breathing allow the child to relieve stress and turn their thoughts or worries into focused concentration on the act of deep breathing.

Safety Training

Trauma Focused Cognitive Behavior Therapy also teaches children how to avoid being victimized going forward.  The child is taught how to identify “red flags” that may indicate a high risk situation.  The child will be taught who to turn to if they find themselves in a “red flag” situation, the right to say “no”, the difference between appropriate and inappropriate touch, and how to respond to inappropriate touch.

Parental Participation

Parents participate in parallel or in conjunction with the child’s therapy.  Parents are also instructed in child behavior management techniques.  Trauma Focused Cognitive Behavior Theory differs from most other therapy methods in that the parent is deeply involved in the process.  TF-CBT also provides benefits for children that may not have a parent that is able to participate.

Photography by: Stefano Valle

Reviewed: 11/22/10

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