What does “trauma-focused” mean and why should a Child Therapist have a trauma focus?
Trauma is a word that gets tossed around a lot in our culture. Much like colloquial usage of words like crazy, bi-polar, and depression, people adapt words to alternative meanings. However, trauma is a real mental health issue with specific, and at the same time murky, definitions. The word trauma can be specific when it comes to the Diagnosis Statistical Manual’s (DSM-5) definition of trauma. This Manual is used by Therapists to determine if someone meets the criteria of a trauma-related mental health diagnosis. Trauma can at the same time be murky in definition because mental health professionals understand that trauma can take on many different facets depending on both the person and context impacted by the trauma.
We understand that trauma can be a “Big ‘T’ Trauma” like witnessing or being subjected to a horrific crime, accident, or natural disaster. Trauma can also be a “Little ‘t’ trauma” such as a child seeing their parent taken away in an ambulance or having a lucid, scary dream. Ultimately, many post-modern therapists believe it is up to the person who experienced to trauma to determine their depth of traumatization, usually with how they react mentally, physically, and emotionally. Most mental health professionals understand that in 2019, almost every child or person has experienced trauma in some way.
How do we know that so many people have experienced trauma? The Adverse Childhood Experiences (ACE) study has been the most lengthy, well-researched study on trauma, which took place between 1995-1997 and involved over 17,000 adults who responded to a questionnaire about their own adverse childhood experiences on a standardized medical evaluation. The categories on the ACE questionnaire were defined as abuse and household dysfunction. Abuse included psychological, physical, and contact sexual abusive incidents. Household dysfunctional experiences focused on substance use exposure, mental illness, violent treatment of mother/stepmother, and criminal behavior (Centers for Disease Control and Prevention, 2017).
Shockingly, more than half of the 17,000 adults reported at least 1 ACE and one quarter reported 2 or more ACEs. The study linked a greater number of ACEs to a greater risk for chronic health issues, addictions to illegal substances, suicide attempts, mental health issues, cancer, and sexually transmitted diseases. If a child is exposed to traumatic events, they have a higher risk of developing maladaptive coping strategies. People with 6 or more ACEs died nearly 20 years earlier on average than those without ACEs. The ACE study taught us that trauma is internalized, and our bodies handle it somatically or with physical symptoms. Some of these physical symptoms are unhealthy coping skills. Because humans were not made with innate knowledge of how to adapt to traumatic events, we gravitate toward what appears to be a quick fix or band-aid for our wounds. As mental health professionals, beginning with the knowledge that a child, family, or individual has experienced trauma will put us steps ahead of treating the symptoms of trauma that may appear as anxiety, depression, addiction or even a personality disorder. By taking a trauma focused stance, we look at symptoms and concerns that clients bring to us through a lens with the question of “has this been caused by a traumatic experience?” We are then able to understand the impact trauma has on our clients and help them recover from or prevent the development of maladaptive coping strategies by arming them with healthy coping strategies. (Centers for Disease Control and Prevention, 2017)
How does this knowledge about trauma enhance the therapy offered to child and adolescent clients and their families?
Cognitive Behavioral Therapy (CBT) began as behavior modification through classical conditioning or operant conditioning. CBT Theory posits that the activating events (A) do not cause the problem consequence (C) but, rather, the intermediary belief (B) about A causes C. This belief about activating events causing problem consequences ties directly into what we believe about trauma: Traumatic events cause our natural reactions to go haywire and unhealthy coping skills to develop. This is where TF-CBT comes in.
TF-CBT excels in teaching healthy coping skills to children and adolescents. It is a hybrid approach that integrates trauma sensitive interventions, CBT interventions, theory about attachment, developmental brain science, and family therapy. The process of doing TF-CBT is very precise, though the timing can be adapted for individual clients or families. The process begins with psychoeducation about trauma and Post-Traumatic Stress Disorder (PTSD) for both clients and their parents and/or family. Alongside the psychoeducation, TF-CBT therapists provide parental support focusing on how the parent can best continue to parent well and support their child as the child works through TF-CBT. The next phase is teaching relaxation coping skills. Relaxation can be very difficult for a child who has entered the Flight, Fight, or Freeze Mode due to their exposure to trauma. As the child and parents learn new calming coping skills, they are assisted in learning how to express feelings and read affect in others. This segues into cognitive coping strategies to handling triggering events to the trauma, an important skill before beginning to tell the trauma narrative. (Runyon, 2019)
TF-CBT focuses on laying the groundwork for clients being able to write or draw their trauma narrative while utilizing helpful coping skills. This allows children or adolescents to work through their trauma, addressing their lingering fears and reactions in a healing, safe environment. In tandem with their work with a child or adolescent, the TF-CBT certified mental health professional is also working with their parent or caregiver to teach them how to respond to the trauma narrative in a safe, supportive way.
Once the child or adolescent has written or drawn their trauma story, the therapist will help them to master bodily sensations and utilize coping skills while reading, drawing, or sharing their story with their caregiver. As part of the trauma narrative, the therapist will help the caregiver and child team prepare in conjoint sessions how to enhance future safety and development. They will tackle triggers and make plans for utilizing coping skills and safety in future situations.
Perhaps your child or a child you know has experienced trauma.
When would TF-CBT be appropriate?
o If the child has evidence of experiencing a trauma
o if there is a link between the trauma and current difficulties or challenging behaviors
o if they are between the ages of 3-18 when therapy would begin
o if they have some memory of the trauma
o if they have experienced single, multiple, and complex traumas
TF-CBT is not appropriate for children or adolescents who are:
o actively suicidal
o experiencing dangerous acting-out behaviors
o active substance abuse
o foster placement that is very brief and temporary
o no memory of trauma
o ongoing contact with person who abused the child/adolescent
If your child/adolescent has experienced a trauma, reach out to Creative Family Counseling today to schedule an appointment with a Trauma Focused Therapist. Let us teach you how to build a tool-kit of coping skills within yourself and the children for which you care while allowing a space for the child to recover from the traumatic incident with a trained clinician.
Centers for Disease Control and Prevention. (2017, April 18). Adverse Childhood Experience: looking at how ACEs affect our lives and society. Retrieved from VetoViolence.cdc.gov: http://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html
Runyon, D. (2019). Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents. TFCBT, (pp. 7, 11, 12). Lexington.