Implementing Trauma‐Focused
Cognitive Behavioral Therapy
for LGBTQ Youth and their
Caregivers
Judith Cohen, M.D.
Anthony Mannarino, Ph.D.
Kelly Wilson, LCSW
Arturo Zinny, LPC, M.A.
Citation: Cohen, JA, Mannarino, AP, Wilson, K & Zinny, A (2018): Trauma‐Focused Cognitive Behavioral
Therapy LGBTQ Implementation Manual. Pittsburgh, PA: Allegheny Health Network.
©2018 JA Cohen, AP Mannarino, K Wilson, & A Zinny: Do not copy or distribute without permission.
, 1
TF‐CBT LGBTQ Implementation Manual Table of Contents
Forward………………………………………………………………………………………………………………………………………………2
Introduction……………………………………………………………………………………………………………………………………. .. 4
Integrating Family Acceptance Project’s (FAP) Family Support Model into TF‐CBT……………….…8
FAP Section: Background Family Acceptance Project……………………………………………….………….…9
Assessment Strategies……………………………………………………………………………………………..……….….10
TF‐CBT Applications for Youth with Complex Trauma……………………………………………….…………..14
FAP Section: Assessment……………………………………………………………………………………………..………17
Enhancing Safety……………………………………………………………………………………………………………………………….20
Psychoeducation……………………………………………………………………………………………………………………………….25 FAP
Section: Psychoeducation………………………………………………..…………………………..…..……….….29 Parenting
Skills……………………………………………………………………………………………………………………….……..….33
Relaxation Skills……………………………………………………………………………………………………………………….……. .. 37
Affective Modulation Skills……………………………………………………………………………………………………….……….39
Cognitive Coping Skills……………………………………………………………………………………………………………….………41
Trauma Narration and Processing……………………………………………………………………………………………….…. ... 44
FAP Section: Parent Response to Trauma Narrative…………………………………………..……..………….48
In vivo Mastery…………………………………………………………………………………………………………………………...……49
Conjoint Sessions…………………………………………………………………………………………………………………………...…51
Enhancing Safety—Continued……………………………………………………………………………………………………..…...53
Summary………………………………………………………………………………………………………………………….……..…..…..54
References…………………………………………………………………………………………………………………………………..…...55
Appendices………………………………………………………………………………………………………………………………….……58
Appendix 1: TF‐CBT Brief PRACTICE Checklist Addendum for LGBTQ Youth………………………………….……59
Appendix 2: Family Acceptance Project ‐ Resources & Materials……………………………………………….……..65
Appendix 3: Family Acceptance Project ‐ Youth Questionnaire………………………………………………….……..67
FAP Youth Support Map………………………………………………..………………………………..…………..… ...... 73
FAP Youth Gender Scale………………………………………………..…………………………………………………..…74
Appendix 4: Family Acceptance Project ‐ Parent Questionnaire ………………………………………………….…...75
FAP Parent Support Map………………………………………………..…………………………………..…...…......….81
FAP Parent Gender Scale………………………………………………..………………………………………….…….…..82
, 2
FORWARD
This manual addresses strategies for implementing an evidence‐based youth trauma treatment—
Trauma‐Focused Cognitive Behavioral Therapy (TF‐CBT)—for trauma‐impacted lesbian, gay, bisexual,
transgender, queer/questioning and gender diverse (LGBTQ) youth. The information in this manual was
developed through a National Child Traumatic Stress Network (NCTSN, www.nctsn.org) Learning
Community, initiated through an NCTSN grant from the Substance Abuse and Mental Health Services
Administration (SAMHSA) to Allegheny General Hospital’s Center for Traumatic Stress in Children and
Adolescents. The Learning Community included 32 members from 12 organizations, listed below.
Clinicians presented TF‐CBT cases during bimonthly calls and provided de‐identified data for assessment,
after which all participants shared resources about TF‐CBT implementation for LGBTQ youth and families
and discussed how the TF‐CBT model should be modified to incorporate sexual orientation and gender
identity issues.
All participants had previously received TF‐CBT basic training, and had a working knowledge of how to
implement the TF‐CBT model for typical treatment cases. The goal of this project was to then apply that
knowledge for traumatized LGBTQ youth and their parents or caretaking adults. Users of this
implementation manual are similarly assumed to have a working knowledge of the basic TF‐CBT
treatment model and principles (Cohen, Mannarino & Deblinger, 2017) and of how the model is
implemented for youth with complex trauma (e.g., Cohen, Mannarino, Kliethermes & Murray, 2012).
We strongly recommend that therapists complete initial web‐based TF‐CBT training (available at
https://tfcbt2.musc.edu), and face‐to‐face TF‐CBT training and consultation calls provided by an
approved TF‐CBT national trainer (https://tfcbt.org/training) prior to implementing the TF‐CBT LGBTQ
applications described in this manual.”
Special thanks and gratitude to Kelly Kinnish, Ph.D. (Georgia Center for Child Advocacy, Atlanta) and
Arturo Zinny, LPC, MA (Healing Hurt People, Drexel University, formerly PACTS, Philadelphia), who
coordinated with participating programs in their respective communities; Kelly Wilson, LCSW (NCTSN
Affiliate member), who generously provided a web‐based platform and technological expertise to the
Learning Community; and Jennifer Grady, MSSW (Duke University National Center for Child Traumatic
Stress), who provided coordination with the National Center for Child Traumatic Stress (NCCTS) and
NCTSN sites throughout the project. We also thank Cathryn Chiesa of the Duke National Center for Child
Traumatic Stress, for conducting a research literature search discussed on page 6. We are very grateful
for the expert review and comments provided by Antonia Barba, LCSW and Andrew Weinberg, LCSW
that greatly improved the manual. We also are very grateful to Antonia Barba, LCSW for creating the
Addendum to the TF‐CBT Brief PRACTICE Checklist that appears as Appendix 1 in this manual.
Finally, we are enormously grateful for and acknowledge the significant contributions of Caitlin Ryan,
Ph.D., ACSW, Director of the Family Acceptance Project® (FAP) at San Francisco State University
(https://familyproject.sfsu.edu), who collaborated with us to integrate FAP’s research findings and
intervention approaches from FAP’s family support model into this implementation manual. We also
want to acknowledge Antonia Barba’s work with Dr. Ryan to align FAP and TF‐CBT’s models to
strengthen families and improve outcomes for LGBTQ youth.
, 3
The following individuals participated in the TF‐CBT LGBTQ Learning Community (listed alphabetically by
program). We thank all of these participants and the trauma‐impacted LGBTQ youth and families who
have received TF‐CBT treatment, from whom we have learned so much and who have made this
Implementation Manual possible.
Allegheny General Hospital, Pittsburgh: Judith Cohen, M.D.; Anthony Mannarino, Ph.D.
Center for Safe and Healthy Children, Atlanta: Jordan Greenbaum, M.D.
Chris 180, Atlanta: Tharyn Grant, LCSW
Devereux Georgia: Mike Cudmore, LPC; Rachel McEwan, LPC; Amy Waldron, LPC
Family Services Rhode Island, Providence: Kayla David, LPC
Family Ties, Atlanta: Tinika Prince, MA, NCC, LAPC
Georgia Center for Child Advocacy: Rebecca Ahmedi, LCP; Jennifer Hossler, MSW; Maggie Huddle,
LMSW; Kelly Kinnish, Ph.D.; Keldric Thomas, Ph.D.; JaKarynn Conyers, LPC
Hall Mercer, Philadelphia: Lauren Cliggitt, MSW, LCSW; Gail Roeshman, LSW, MSW, M.Ed.
Jewish Board of Family and Children’s Services, New York City: Antonia Barba, LCSW; Ellen Blaufox,
LCSW‐R; Erin Mack, LCSW
Joseph J. Peters Institute, Philadelphia: Caitlin Frett, MS
Joy’us Beginnings, Atlanta: Sharnell Myles, PsyD, LPC
Nationwide Children’s Hospital, Columbus: Lourdes Hill, PCC‐S; Kynetta McFarlane, Psy.D.
National Center for Child Traumatic Stress: Jennifer Grady, MSSW
National Child Traumatic Stress Network Affiliate, Madison: Kelly Wilson, LCSW
Persad Center, Pittsburgh: Sandra Soloski, ; Andrew Weinberg, LCSW
Philadelphia Alliance for Child Trauma Services (PACTS): Arturo Zinny, LPC, MA
Rady Children’s Hospital San Diego/Harvey Institute: Al Killen‐Harvey, LCSW
Serving Children and Adults in Need (SCAN‐Inc.), Laredo: Susana Rivera, Ph.D., LPC
The Village, Philadelphia: Paula Wood, MSW, LCSW; Robin Young, MSW, LSW
Cognitive Behavioral Therapy
for LGBTQ Youth and their
Caregivers
Judith Cohen, M.D.
Anthony Mannarino, Ph.D.
Kelly Wilson, LCSW
Arturo Zinny, LPC, M.A.
Citation: Cohen, JA, Mannarino, AP, Wilson, K & Zinny, A (2018): Trauma‐Focused Cognitive Behavioral
Therapy LGBTQ Implementation Manual. Pittsburgh, PA: Allegheny Health Network.
©2018 JA Cohen, AP Mannarino, K Wilson, & A Zinny: Do not copy or distribute without permission.
, 1
TF‐CBT LGBTQ Implementation Manual Table of Contents
Forward………………………………………………………………………………………………………………………………………………2
Introduction……………………………………………………………………………………………………………………………………. .. 4
Integrating Family Acceptance Project’s (FAP) Family Support Model into TF‐CBT……………….…8
FAP Section: Background Family Acceptance Project……………………………………………….………….…9
Assessment Strategies……………………………………………………………………………………………..……….….10
TF‐CBT Applications for Youth with Complex Trauma……………………………………………….…………..14
FAP Section: Assessment……………………………………………………………………………………………..………17
Enhancing Safety……………………………………………………………………………………………………………………………….20
Psychoeducation……………………………………………………………………………………………………………………………….25 FAP
Section: Psychoeducation………………………………………………..…………………………..…..……….….29 Parenting
Skills……………………………………………………………………………………………………………………….……..….33
Relaxation Skills……………………………………………………………………………………………………………………….……. .. 37
Affective Modulation Skills……………………………………………………………………………………………………….……….39
Cognitive Coping Skills……………………………………………………………………………………………………………….………41
Trauma Narration and Processing……………………………………………………………………………………………….…. ... 44
FAP Section: Parent Response to Trauma Narrative…………………………………………..……..………….48
In vivo Mastery…………………………………………………………………………………………………………………………...……49
Conjoint Sessions…………………………………………………………………………………………………………………………...…51
Enhancing Safety—Continued……………………………………………………………………………………………………..…...53
Summary………………………………………………………………………………………………………………………….……..…..…..54
References…………………………………………………………………………………………………………………………………..…...55
Appendices………………………………………………………………………………………………………………………………….……58
Appendix 1: TF‐CBT Brief PRACTICE Checklist Addendum for LGBTQ Youth………………………………….……59
Appendix 2: Family Acceptance Project ‐ Resources & Materials……………………………………………….……..65
Appendix 3: Family Acceptance Project ‐ Youth Questionnaire………………………………………………….……..67
FAP Youth Support Map………………………………………………..………………………………..…………..… ...... 73
FAP Youth Gender Scale………………………………………………..…………………………………………………..…74
Appendix 4: Family Acceptance Project ‐ Parent Questionnaire ………………………………………………….…...75
FAP Parent Support Map………………………………………………..…………………………………..…...…......….81
FAP Parent Gender Scale………………………………………………..………………………………………….…….…..82
, 2
FORWARD
This manual addresses strategies for implementing an evidence‐based youth trauma treatment—
Trauma‐Focused Cognitive Behavioral Therapy (TF‐CBT)—for trauma‐impacted lesbian, gay, bisexual,
transgender, queer/questioning and gender diverse (LGBTQ) youth. The information in this manual was
developed through a National Child Traumatic Stress Network (NCTSN, www.nctsn.org) Learning
Community, initiated through an NCTSN grant from the Substance Abuse and Mental Health Services
Administration (SAMHSA) to Allegheny General Hospital’s Center for Traumatic Stress in Children and
Adolescents. The Learning Community included 32 members from 12 organizations, listed below.
Clinicians presented TF‐CBT cases during bimonthly calls and provided de‐identified data for assessment,
after which all participants shared resources about TF‐CBT implementation for LGBTQ youth and families
and discussed how the TF‐CBT model should be modified to incorporate sexual orientation and gender
identity issues.
All participants had previously received TF‐CBT basic training, and had a working knowledge of how to
implement the TF‐CBT model for typical treatment cases. The goal of this project was to then apply that
knowledge for traumatized LGBTQ youth and their parents or caretaking adults. Users of this
implementation manual are similarly assumed to have a working knowledge of the basic TF‐CBT
treatment model and principles (Cohen, Mannarino & Deblinger, 2017) and of how the model is
implemented for youth with complex trauma (e.g., Cohen, Mannarino, Kliethermes & Murray, 2012).
We strongly recommend that therapists complete initial web‐based TF‐CBT training (available at
https://tfcbt2.musc.edu), and face‐to‐face TF‐CBT training and consultation calls provided by an
approved TF‐CBT national trainer (https://tfcbt.org/training) prior to implementing the TF‐CBT LGBTQ
applications described in this manual.”
Special thanks and gratitude to Kelly Kinnish, Ph.D. (Georgia Center for Child Advocacy, Atlanta) and
Arturo Zinny, LPC, MA (Healing Hurt People, Drexel University, formerly PACTS, Philadelphia), who
coordinated with participating programs in their respective communities; Kelly Wilson, LCSW (NCTSN
Affiliate member), who generously provided a web‐based platform and technological expertise to the
Learning Community; and Jennifer Grady, MSSW (Duke University National Center for Child Traumatic
Stress), who provided coordination with the National Center for Child Traumatic Stress (NCCTS) and
NCTSN sites throughout the project. We also thank Cathryn Chiesa of the Duke National Center for Child
Traumatic Stress, for conducting a research literature search discussed on page 6. We are very grateful
for the expert review and comments provided by Antonia Barba, LCSW and Andrew Weinberg, LCSW
that greatly improved the manual. We also are very grateful to Antonia Barba, LCSW for creating the
Addendum to the TF‐CBT Brief PRACTICE Checklist that appears as Appendix 1 in this manual.
Finally, we are enormously grateful for and acknowledge the significant contributions of Caitlin Ryan,
Ph.D., ACSW, Director of the Family Acceptance Project® (FAP) at San Francisco State University
(https://familyproject.sfsu.edu), who collaborated with us to integrate FAP’s research findings and
intervention approaches from FAP’s family support model into this implementation manual. We also
want to acknowledge Antonia Barba’s work with Dr. Ryan to align FAP and TF‐CBT’s models to
strengthen families and improve outcomes for LGBTQ youth.
, 3
The following individuals participated in the TF‐CBT LGBTQ Learning Community (listed alphabetically by
program). We thank all of these participants and the trauma‐impacted LGBTQ youth and families who
have received TF‐CBT treatment, from whom we have learned so much and who have made this
Implementation Manual possible.
Allegheny General Hospital, Pittsburgh: Judith Cohen, M.D.; Anthony Mannarino, Ph.D.
Center for Safe and Healthy Children, Atlanta: Jordan Greenbaum, M.D.
Chris 180, Atlanta: Tharyn Grant, LCSW
Devereux Georgia: Mike Cudmore, LPC; Rachel McEwan, LPC; Amy Waldron, LPC
Family Services Rhode Island, Providence: Kayla David, LPC
Family Ties, Atlanta: Tinika Prince, MA, NCC, LAPC
Georgia Center for Child Advocacy: Rebecca Ahmedi, LCP; Jennifer Hossler, MSW; Maggie Huddle,
LMSW; Kelly Kinnish, Ph.D.; Keldric Thomas, Ph.D.; JaKarynn Conyers, LPC
Hall Mercer, Philadelphia: Lauren Cliggitt, MSW, LCSW; Gail Roeshman, LSW, MSW, M.Ed.
Jewish Board of Family and Children’s Services, New York City: Antonia Barba, LCSW; Ellen Blaufox,
LCSW‐R; Erin Mack, LCSW
Joseph J. Peters Institute, Philadelphia: Caitlin Frett, MS
Joy’us Beginnings, Atlanta: Sharnell Myles, PsyD, LPC
Nationwide Children’s Hospital, Columbus: Lourdes Hill, PCC‐S; Kynetta McFarlane, Psy.D.
National Center for Child Traumatic Stress: Jennifer Grady, MSSW
National Child Traumatic Stress Network Affiliate, Madison: Kelly Wilson, LCSW
Persad Center, Pittsburgh: Sandra Soloski, ; Andrew Weinberg, LCSW
Philadelphia Alliance for Child Trauma Services (PACTS): Arturo Zinny, LPC, MA
Rady Children’s Hospital San Diego/Harvey Institute: Al Killen‐Harvey, LCSW
Serving Children and Adults in Need (SCAN‐Inc.), Laredo: Susana Rivera, Ph.D., LPC
The Village, Philadelphia: Paula Wood, MSW, LCSW; Robin Young, MSW, LSW
