Psychotherapy: TF-CBT Questions and 100%
Correct Answers.
What is TF-CBT? - ANS evidence-based, conjoint child and parent/caregiver
psychotherapy model for children and adolescents who are experiencing clinically
significant emotional and behavioral difficulties related to traumatic life events they have
experienced. TF-CBT is a relatively brief (typically 12-20 sessions). For ages 3-17 y/o
and their parents.
What are the goals? - ANS enable children and youth who have experienced serious
traumatic events, and their supportive caregivers, 1) to learn effective skills to cope with
trauma-related emotional and behavioral problems, 2) to face and resolve those
problems in a safe and therapeutic way, and 3) to effectively integrate their trauma
experiences and help them move on with their lives in a safe and positive manner.
What are the characteristics of TF-CBT - ANS - structured (not just pt. talking and
directing sessions)?
- trauma focused
- short term
- goal to address trauma related difficulties
- play therapy only sees child, family therapy sees them both together every time. CF-
CBT will see child individually, parent individually, and then together for a few sessions.
What’s the rationale for TF-CBT? - ANS If you develop fear, avoidance or other
problems after trauma, you have to face your difficulties and develop coping
mechanisms for those problems. You also need to realize the connection between your
problems and the trauma in your past. By including a caregiver in the process you have
some support through the different phases
What are the phases? - ANS 1. Stabilization: Comprised of "PRAC" components with
gradual exposure. You start applying new skills to trauma related sexes.
- Gradual exposure: develop skills while building on the connection between the trauma
and the need to develop these skills. The caregiver’s skills are developed throughout as
needed to help manage the child’s behavior.
2. Trauma narrative: "T" component. gradual exposure with caregiver and child
processing their reactions.
- Trauma narrative: Once the skills are built, then a trauma narrative is done (talking
about the trauma) in order to face the experience instead of avoiding it
3. Integration/ Consolidation: includes in Vivo Mastery of trauma reminders, conjoint
sessions, and enhancing future safety and development components ("ICE").
- Integrating: Integrate what you have done to face the trauma and using those skills to
move on.
,Length: 12-25 sessions, the sessions are split evenly between the phases (1/3 each)
Goal: develop resiliency and move on
Note: Gradual exposure and Parenting skills are taught and done throughout all
sessions
Who is TF-CBT for? - ANS 3-18 y/o, all children demographics with any traumatic
experience
Note: if experiencing 4 or more PTSD sexes they will really benefit from TF-CBT. Can
still benefit even after co-morbidities develop (ADHD, ODD, Conduct disorders etc.)
Is a caregiver required for TF-CBT? - ANS No, but it is best if there is one. If one isn't
there, then substantial parts of TX aren't done.
When would TF-CBT not be done? - ANS If a child isn't having trauma related problems
(highly resilient with good support systems) or if there are severe cognitive challenges
(can be used with mild intellectual, cognitive or developmental problems if they can
engage in cognitive therapy) such as autism because they cannot participate in
cognitive therapy.
What problems need to be addressed before starting TF-CBT? - ANS Imminent safety
(active SI, abusive guardian etc.)
Severe disruptive/aggressive behavior problems
Active problematic substance use (infrequent use without interfering in daily functioning
is okay)
Guiding principles of TF-CBT - ANS CRAFTS:
- components based
- respectful of cultural values
- adaptable and flexible
- family focused
- therapeutic relationship is central
- self efficacy is emphasized
How often is the pt. and caregiver seen conjointly? - ANS About half the sessions, in
order to improve the support for the child.
TF-CBT TX components - ANS PRACTICE:
- Psychoeducation/ Parenting skills: instill hope, normalize the trauma and behaviors,
teach skills to help parents with behaviors of child
- Relaxation: skills to help with fear and anxiety
- Affective Identification and Regulation: help understand and regulate negative feelings
(both pt. and caregiver)
- Cognitive coping: explain connections between thoughts, feelings, and behavior.
Develop skills to generate alternative thoughts, important for later cognitive processing.
, - Trauma narration and processing: guide child through trauma story to try and help
manage related thoughts/feelings through gradual exposure (do this in small doses).
- In Vivo Mastery: means "real life", if fears from trauma are to non-dangerous things
(e.g. rooms in house) then exposure activities are done to overcome fears.
- Conjoint Child-Parent Sessions: share trauma with caregiver (beforehand, prep
caregiver to ensure validating experience for child).
- Enhancing Safety and Future Development: enhance family communication and
child’s safety skills to minimize risk for future victimization and enhance self-
competence.
How is the TF-CBT delivery in respect to time spent with the child and caregiver? - ANS
Both are involved in every session. Typically, most sessions you will spend time with the
child individually, parent individually, then together.
How often do you involve gradual exposure? - ANS at every session, however not
constantly throughout the session. Some aspect of the trauma is referred to and
reviewed in every session. Then you teach relaxation skills and apply those skills to
reduce tension while reviewing that aspect. Or during affect identification and regulation
you identify emotions related to that aspect of the trauma and process through those
emotions and try to manage those emotions. Whatever step you are on, you review a
piece of the trauma narrative and involve another component to help process.
Session frequency and length - ANS weekly TX sessions, 60-90 mines each (however,
if not possible, it can also be done in 45-50 minutes and more frequently each wk. [2
sessions/wk.] but never less frequently [1 session/2-3 wks.]).
Found to be effective in 8-25 sessions but typically completed in 12-20 sessions
Note: if caregiver isn't present then it’s not as effective, if not taken as often as it’s
supposed to then it’s not as effective. This is because a significant part is taken out or
you aren't intense enough to build up all the skills we try to teach in TF-CBT (weekly is
needed).
What is TX fidelity? - ANS - skillfully delivered
- as it was designed
- 2 components: adherence and competence
Note: the higher the level of fidelity, the better the outcomes.
Adherence: children with trauma and PTSD sexes, involve caregiver, meet weekly,
follow PRACTICE components, spend 1/3 of sessions on each phase, complete in 12-
20 sessions
Competence: do procedures correctly
Note: you need to measure fidelity and outcomes at beginning, half way, and at end.
Correct Answers.
What is TF-CBT? - ANS evidence-based, conjoint child and parent/caregiver
psychotherapy model for children and adolescents who are experiencing clinically
significant emotional and behavioral difficulties related to traumatic life events they have
experienced. TF-CBT is a relatively brief (typically 12-20 sessions). For ages 3-17 y/o
and their parents.
What are the goals? - ANS enable children and youth who have experienced serious
traumatic events, and their supportive caregivers, 1) to learn effective skills to cope with
trauma-related emotional and behavioral problems, 2) to face and resolve those
problems in a safe and therapeutic way, and 3) to effectively integrate their trauma
experiences and help them move on with their lives in a safe and positive manner.
What are the characteristics of TF-CBT - ANS - structured (not just pt. talking and
directing sessions)?
- trauma focused
- short term
- goal to address trauma related difficulties
- play therapy only sees child, family therapy sees them both together every time. CF-
CBT will see child individually, parent individually, and then together for a few sessions.
What’s the rationale for TF-CBT? - ANS If you develop fear, avoidance or other
problems after trauma, you have to face your difficulties and develop coping
mechanisms for those problems. You also need to realize the connection between your
problems and the trauma in your past. By including a caregiver in the process you have
some support through the different phases
What are the phases? - ANS 1. Stabilization: Comprised of "PRAC" components with
gradual exposure. You start applying new skills to trauma related sexes.
- Gradual exposure: develop skills while building on the connection between the trauma
and the need to develop these skills. The caregiver’s skills are developed throughout as
needed to help manage the child’s behavior.
2. Trauma narrative: "T" component. gradual exposure with caregiver and child
processing their reactions.
- Trauma narrative: Once the skills are built, then a trauma narrative is done (talking
about the trauma) in order to face the experience instead of avoiding it
3. Integration/ Consolidation: includes in Vivo Mastery of trauma reminders, conjoint
sessions, and enhancing future safety and development components ("ICE").
- Integrating: Integrate what you have done to face the trauma and using those skills to
move on.
,Length: 12-25 sessions, the sessions are split evenly between the phases (1/3 each)
Goal: develop resiliency and move on
Note: Gradual exposure and Parenting skills are taught and done throughout all
sessions
Who is TF-CBT for? - ANS 3-18 y/o, all children demographics with any traumatic
experience
Note: if experiencing 4 or more PTSD sexes they will really benefit from TF-CBT. Can
still benefit even after co-morbidities develop (ADHD, ODD, Conduct disorders etc.)
Is a caregiver required for TF-CBT? - ANS No, but it is best if there is one. If one isn't
there, then substantial parts of TX aren't done.
When would TF-CBT not be done? - ANS If a child isn't having trauma related problems
(highly resilient with good support systems) or if there are severe cognitive challenges
(can be used with mild intellectual, cognitive or developmental problems if they can
engage in cognitive therapy) such as autism because they cannot participate in
cognitive therapy.
What problems need to be addressed before starting TF-CBT? - ANS Imminent safety
(active SI, abusive guardian etc.)
Severe disruptive/aggressive behavior problems
Active problematic substance use (infrequent use without interfering in daily functioning
is okay)
Guiding principles of TF-CBT - ANS CRAFTS:
- components based
- respectful of cultural values
- adaptable and flexible
- family focused
- therapeutic relationship is central
- self efficacy is emphasized
How often is the pt. and caregiver seen conjointly? - ANS About half the sessions, in
order to improve the support for the child.
TF-CBT TX components - ANS PRACTICE:
- Psychoeducation/ Parenting skills: instill hope, normalize the trauma and behaviors,
teach skills to help parents with behaviors of child
- Relaxation: skills to help with fear and anxiety
- Affective Identification and Regulation: help understand and regulate negative feelings
(both pt. and caregiver)
- Cognitive coping: explain connections between thoughts, feelings, and behavior.
Develop skills to generate alternative thoughts, important for later cognitive processing.
, - Trauma narration and processing: guide child through trauma story to try and help
manage related thoughts/feelings through gradual exposure (do this in small doses).
- In Vivo Mastery: means "real life", if fears from trauma are to non-dangerous things
(e.g. rooms in house) then exposure activities are done to overcome fears.
- Conjoint Child-Parent Sessions: share trauma with caregiver (beforehand, prep
caregiver to ensure validating experience for child).
- Enhancing Safety and Future Development: enhance family communication and
child’s safety skills to minimize risk for future victimization and enhance self-
competence.
How is the TF-CBT delivery in respect to time spent with the child and caregiver? - ANS
Both are involved in every session. Typically, most sessions you will spend time with the
child individually, parent individually, then together.
How often do you involve gradual exposure? - ANS at every session, however not
constantly throughout the session. Some aspect of the trauma is referred to and
reviewed in every session. Then you teach relaxation skills and apply those skills to
reduce tension while reviewing that aspect. Or during affect identification and regulation
you identify emotions related to that aspect of the trauma and process through those
emotions and try to manage those emotions. Whatever step you are on, you review a
piece of the trauma narrative and involve another component to help process.
Session frequency and length - ANS weekly TX sessions, 60-90 mines each (however,
if not possible, it can also be done in 45-50 minutes and more frequently each wk. [2
sessions/wk.] but never less frequently [1 session/2-3 wks.]).
Found to be effective in 8-25 sessions but typically completed in 12-20 sessions
Note: if caregiver isn't present then it’s not as effective, if not taken as often as it’s
supposed to then it’s not as effective. This is because a significant part is taken out or
you aren't intense enough to build up all the skills we try to teach in TF-CBT (weekly is
needed).
What is TX fidelity? - ANS - skillfully delivered
- as it was designed
- 2 components: adherence and competence
Note: the higher the level of fidelity, the better the outcomes.
Adherence: children with trauma and PTSD sexes, involve caregiver, meet weekly,
follow PRACTICE components, spend 1/3 of sessions on each phase, complete in 12-
20 sessions
Competence: do procedures correctly
Note: you need to measure fidelity and outcomes at beginning, half way, and at end.
