TF-CBT CERT EXAM | WITH COMPLETE QUESTIONS AND ANSWERS
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Alexa is an 8-year-old girl who disclosed sexual abuse by her two older adolescent stepbrothers.
While developing the first part of her trauma narrative, she wrote "I am a bad girl. I think they
messed up my body. I was really dumb because I never told anyone." - (ANSWER)1. Alexa's
statements are examples of:
a) Healthy or functional thoughts.
b) Cognitive distortions.
c) Cognitive realities.
d) Accurate but unhelpful thoughts.
2. How should the therapist proceed? (Alexa case) - (ANSWER)a) Tell Alexa that it is not her
fault and immediately begin to process her statements.
b) Allow Alexa to complete her trauma narrative and then begin cognitive processing of the
trauma narrative, including her statements.
c) Repeat the earlier components, beginning with Psychoeducation as this is a clear example of
the therapy not "sinking in."
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d) Ask Alexa to start the trauma narrative again but this time tell her to only include details about
the sexual abuse, not any statements about herself or any thoughts.
Justin is an 11-year-old boy who witnessed his father brutally attack his mother with a baseball
bat. During the middle of writing his trauma narrative, he wrote that he intervened and attempted
to defend his mother by fighting his father. However, during individual sessions with his mother,
it became apparent that Justin had hidden behind the sofa and cried during the attack. -
(ANSWER)3. How should the therapist proceed?
a) Due to the problems associated with "false memories," confront Justin about the inaccuracy
immediately.
b) Talk to Justin about the difference between the "truth" and a "lie."
c) Recognize that it is not unusual for children to make fantasy or rescue statements; allow Justin
to complete his trauma narrative and gently challenge his statements.
d) Talk with Justin's father to determine whether Justin or his mother is telling the truth; then
share this information with Justin.
In the example above, there is a concern that the father may have access to the home and the
therapist is worried about Justin's safety. The therapist is concerned about following the TF-CBT
model with fidelity and is not sure whether it is okay to implement "Enhancing Safety and Future
Development" without completing the earlier components. - (ANSWER)4. How should the
therapist proceed?
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a) Meet with the child's father and discuss the safety concerns.
b) Do not discuss safety because Justin and his mother would then blame themselves for the
domestic violence.
c) Engage in short-term safety planning with Justin and his mother.
d) Engage Justin in In Vivo Desensitization as his concern about safety is a cognitive distortion.
Monty is a 7-year-old boy who was a victim of sexual abuse for two years by his adoptive
parents. As part of the assessment, he completed the UCLA PTSD Reaction Index and his total
score was in the severe range, including very serious re-experiencing symptoms. When the
therapist discussed the TF-CBT treatment approach with him, including that he would be writing
his story about the sexual abuse, Monty became excited and began to discuss the trauma in great
detail. So, the therapist, encouraged by Monty's willingness to talk, complied with his wishes and
allowed him to create his trauma narrative over the first three treatment sessions. During and
after the completion of the trauma narrative, Monty's behavior began to deteriorate, including
acting-out sexually, soiling himself, refusing to sleep in his own room, and engaging in other
dangerous behaviors that warranted a short-term hospitalization. - (ANSWER)5. What should
the therapist have done instead?
a) Listened to Monty for a few minutes and redirected him; initiated Psychoeducation and
subsequent skills-based components before moving to the trauma narrative.
b) Briefly reviewed the initial four TF-CBT components and started the trauma narrative the next
week.
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c) Nothing. It is imperative to follow a child's cues and wishes rather than a more directive
approach.
d) Skipped the trauma narrative entirely because it is important to do just the opposite of what a
child believes he/she needs.
6. Which component of TF-CBT sometimes needs to be implemented out of order, usually
toward the beginning of treatment? - (ANSWER)a) Trauma Narrative, particularly if a child is
extremely anxious.
b) Conjoint sessions to share the narrative, especially for older teens or foster children who resist
having their foster parents involved in treatment.
c) Cognitive Coping, especially if a child has distortions about the abuse.
d) Psychoeducation; sometimes this component can be left for later in treatment or skipped
altogether.
e) In Vivo Mastery, such as in cases of school avoidance or other highly problematic avoidant
behaviors
Jody is a 6 year-old girl who was attacked by a dog and left with severe scars all over her legs.
Since the dog attack, Jody has experienced severe PTSD symptoms and significant oppositional
behavior problems. Her mother has felt intense guilt as Jody almost died from the attack. She
now cannot say no to anything her daughter wants. The mother also reported that Jody's behavior
is extremely difficult to manage and the mother just cannot take her anywhere. Jody has tantrums