TF CBT Course

docx

School

Simmons College *

*We aren’t endorsed by this school

Course

509

Subject

Psychology

Date

Jan 9, 2024

Type

docx

Pages

Uploaded by HighnessCapybaraMaster1572

What is TF-CBT?  Is an evidence-based form of psychotherapy for kids and teens who are having clinically significant emotional and behavioral problems because of traumatic events in their lives. It involves both the child and the parent or guardian.  The TF-CBT treatment model is made up of short sessions (12 to 20 sessions on average), and it uses methods and strategies from cognitive, behavioral, family therapy, and humanistic approaches.  Goal: 1. Learn effective skills to cope with trauma-related emotional and behavioral problems, 2) face and resolve those problems in a safe and therapeutic way, 3. Help them move on with their lives in a safe and healthy way by integrating their traumatic events.  TF-CBT is designed to reduce symptoms of PTSD, trauma-related depression, anxiety, and behavior problems, and common trauma related cognitive and emotional problems such as a fear, shame, embarrassment, guilt, and self-blame. Who is TF-CBT for?  Age range around 3-18 yrs.  Children from any racial, ethnic, cultural, or country of origin group living in urban, suburban or rural areas.  Known history of experiencing one or more potential traumatic events.  Has significant symptoms of PTSD (DOES NOT NEED TO MEET THE FULL DIAGNOSTIC CRITERIA)  Other trauma related problems: depression, anxiety, fear, shame, self-blame, behavior problems, sexual behavior problems, or traumatic grief.  Can be successfully with traumatized youth with co-occurring difficulties like ADHS, oppositional defiant disorder (defiant/ disobedient behavior to authority figures), and conduct disorder (serious behavioral and emotional disorder= disruptive and violent behavior and have a hard time following rules).  Having a supportive caregiver is beneficial for TF CBT treatment, if not treatment can be lost. Who is TF-CBT not for?  No prior history of trauma  No trauma related problems  If severe intellectual disabilities like neurocognitive, neurodevelopment, autism, or other problems that make it difficult for someone to benefit from therapy Problems to manage prior to beginning TF-CBT First things to management to have an effective engagement in trauma treatment:  Imminent safety: if a youth is in a dangerous environment that prevents engagement in trauma treatment.  Severe disruptive or aggressive behavioral problems: exhibiting high levels of disruptive or aggressive behavior can make it difficult for treatment.  Active SI: SI should be managed prior to beginning trauma treatment.  Active, problematic substance use: anything that affects a youth’s functioning. Guiding Principles of TF-CBT (CRAFTS)  Components based: Comprised of a set of treatment components, each of which has a specific therapeutic purpose and set of techniques. Work through treatment components in the proper order, utilizing pacing that accommodates to clients needs.  Respectful of cultural values: Respectful of all cultural and values of client families. Procedures and techniques should be adapted as necessary to accommodate cultural norms and values.  Adaptable and Flexible: Components, techniques, and procedures can be adapted to many different clinical settings, situations, and families.  Family Focused: tf-cbt is family treatment. ½ of the treatment involves a supportive caregiver.  Therapeutic relationships is central: developing a strong therapeutic relationship with child and caregiver is critical in tf-cbt and necessary for client engagement.  Self-efficacy is emphasized: TF-CBT helps traumatized children manage, integrate, and move on from their traumas. Doing so boosts self-confidence. TF-CBT should provide children a sense of competence since they are no longer overwhelmed by trauma-related issues and optimism for the future because they can handle other challenges. TF-CBT treatment components (P (P) RACTICE)

 Psychoeducation: educating the child and caregiver about the prevalence of abuse of other traumatic events the child may have experienced, normal reactions to abuse and trauma, and the benefits of treatment.  Parenting Skills: giving parents the tools that will help mange disruptive, aggressive, non compliant behavior; and/or fears, sleep problems, and inappropriate sexual behaviors.  Relaxation: learn a set of relaxation skills to help them manage the physiological symptoms of fear and anxiety.  Affect Identification and Regulation: have difficulties identifying, understanding, expressing, and regulating their feelings, particularly negative feelings. This area helps them address all these needs.  Cognitive Coping: therapist explains the connections between thoughts, feelings, and behavior. By helping them develop skills to generate alternative thoughts that are more accurate or helpful.  Trauma narration and processing: to assist with coping with trauma, they are guided in writing a story about the experiences. Writing the story is sort of like progressive exposure treatment but in a little doses in safe, controlled environment.  In vivo mastery: Some youth have trauma related fears of things that are not actually dangerous (ex: rooms in the house). If they persist exposure activities can be developed to help children overcome these fears.  Conjoin parent-child sessions: sharing the trauma story with a caregiver. A lot of planning is usually needed from the caregiver before sharing the story to make sure that the meetings are helpful and reassuring for the child.  Enhancing safety & future development: enhancing family communication and children’s personal safety skills. TF-CBT Delivery  Parent involvement: parent involvement is crucial for treatment  Gradual exposure: some form of psychological exposure to the traumatic event. Relaxation skills are taught and then incorporated into trauma-related emotions are identifies and discussed.  Session Frequency and Length: weekly sessions of 60-90 mins.  TF-CBT is effective in as few as 8 sessions and occasionally may extend to as many as 25 sessions. Should be completed within 12-20 treatment sessions. Phases of TF-CBT  Stabilization: comprised of the termed the “PRAC” component of TF-CBT, Psychoeducation, relaxation, affective expression and regulation, and cognitive coping.  Trauma Narrative: gradual exposure is a major component  Integration/consolidation: includes the in vivo mastery of trauma reminders, conjoint child parent sessions, and enhancing future safety and development components.

  Settings for treatment: usually in a traditional office but can be effective when conducted in schools, child’s home, foster homes, in residential treatment settings , and even in refugee camps. 1. Psychoeducation a. Usually occurs first in tf-cbt but it can occur anytime as well. b. Children who have been traumatized are often confused; they may not completely understand what has happened; they may feel isolated and alone; they may blame themselves; or they may believe things aren’t accurate because they’ve been deliberately given incorrect information. i. Help children who have been traumatized by providing accurate information. c. Review assessment findings i. Helpful to go over assessment findings about the child’s functioning. This should be done with the parent (without child present) but can be also done with older children and adolescents. Discussion should be less about a diagnosis and more about the child’s behavior has been affected. Important to connect the child’s symptoms to the experience of trauma. d. Provide an overview of treatment i. Some explanation of what’s going to happen is always a good idea. Using developmentally appropriate language, explain that treatment involves learning ways to cope with the symptoms and problems they’ve been experiencing, that their caregiver will be involved in treatment as well, treatment should be concluding in about 3 or 4 months. e. Neutral Narrative/Baseline Trauma Narrative i. NOT REQUIRED BUT helpful to get a baseline of what the child is able to share with you about what has happened to him/her, as well as any feelings s/he might be able to share about it. ii. To make it easier, you can began with a non-trauma “neutral/positive” event (birthday party, soccer game, etc). encourage them to tell you all about it, the event, how they felt when it was occurring.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

iii. Assess the amount of detail provided, the ease with which the child could put events in sequence, and the awareness of thoughts, feelings, and sensations that the child is able to share. iv. After the story praise them and then ask about the trauma, “why you came to see me. Tell me everything about that” may have to prompt kids that say “i don’t know” v. Goal is not to do a deep interview but to see what they child is willing to share how much they will talk to begin the rest of treatment. vi. If reluctant to talk that’s important information. vii. “I want to get to know a little bit about you, and how i want to do that is by you sharing a couple of stories. Tell me about a story about a really good memory you have”. f. General education about abuse and trauma i. Helpful to know about what the kids knows and the type of stress they have been through. ii. You can use a question-and-answer game. Praise for partial correct answers. 1. What is ____ abuse? 2. How often do things like this happen? 3. Why does they type of trauma happen? 4. Why do you think it happened to you? 5. Who is responsible for violent behavior? iii. WHAT DO YOU KNOW CARD GAME. g. Specific information about the traumatic events i. Steady exposure is done by talking about and giving information about the trauma the kid has been through, rather than “bad things” or another euphemism. ii. Appropriate information to talk about for some common types of trauma: 1. Sexual: should include information that’s specific for sexual abuse. This can include information about the various types of sexual abuse, why sexual abuse occurs, who perpetrates sexual abuse, how sexually abused children may feel, sexualized feelings and behaviors and why children often don’t disclose their abuse. a. Ex: sexual abuse often happens because abusers have sexual feeling for children which most people don’t have, that they deliberately choose to sexually abuse a child even though they know that it’s wrong, and that sexual offenders may use tricks or fear to get what they want from children. 2. Physical: may need information on how to tell the difference between appropriate and in appropriate parental discipline. They may also need help understand that psychological abuse (berating, name calling, excessive yelling, ignoring) is commonly a part of physically abusive behavior and that this is not an indication of their worth as a person. 3. Witnessed Violence: Important to provided information so that they don’t blame themselves for ex witnessing parent violence. They need to understand that violence is not an appropriate way to handle disagreements. 4. Other traumatic events: psychoeducation should include any relevant information about the specific events. h. Improving engagement i. Ask questions about the patients and families perspective. Important to know what a family believes about what happens when people ___. ii. Find out what the child or family thinks and knows about mental health treatment. iii. Instill hope. i. Sharing information effectively i. Keep your language simple and direct. ii. Try to avoid using psychological jargon, which does not usually translate well. iii. Consider including family members in treatment planning and psychoeducation activities. iv. Try to using pictures as a way of communicating complex ideas. j. Early childhood

i. Ages 3-4 youngest tf-cbt kids who are eligible, most psychoeducation should be geared towards caregivers. k. Middle childhood i. Use some kind of game or activity to convey the information should be the goal. Don’t come off as teacher-ish. l. Adolescence i. Can use games, conversations, and writing materials m. When things don’t go as planned i. Some youth may have strong negative emotions surrounding psychoeducation and experience a great deal of emotions. Necessary to review the stress management treatment components before continuing with the psychoeducation. n. On the fence about sex (or just plain refusing) i. The first thing you can do is give a strong reason for why these issues are important to talk about. Second, try to figure out why they are worried. Tell the person(s) caring for the child that you will respect their beliefs and values and will only give them knowledge that is age-appropriate and comfortable for them. Involve them in the psychoeducational classes. Of course, if the parent keeps saying no, you will have to accept their choice and gently tell them that this is an important part of their child's recovery. They might be more ready to take part in the psychoeducation process as treatment goes on. o. Don’t watch the clock (or “go with the flow”) i. May find it necessary to repeat some education components at several different points in treatment. p. Quibbles (or lose the battle, but win the war) i. Some children may disagree with the content that you provide to them. Don’t go to battle try to address their questions and concerns. 2. Parenting skills a. Provide psychoeducation to parents i. Caregivers need help understanding that in children trauma increases disruptive, aggressive, and/or noncompliant behavior problems. Help them recognize and reframe their explanations for why their child misbehaviors. b. Teach parents how to use praise i. Teach parents to focus on actively praising their children for desirable behaviors. ii. Praise like: 1. Specific behaviors 2. Label the praise for specific behaviors 3. Provide praise as soon as possible after the desirable behavior occurs 4. Be consistent in your use of praises 5. Avoid complicating your praise with negative add-ons (ex: you did a great job getting your homework done before dinner. Why can’t you do that more often?”) 6. Use an enthusiastic tone when praising the child. c. Teach parents how to combine praise with active ignoring i. Active ignoring refers to the parent choosing not to react to non dangerous, undesirable behavior. ii. How: 1. Avoid responding to the child during the behavior and immediately after it occurs 2. Active ignoring includes avoiding verbal or emotional reactions, eye contact, facial expression, or any other form of communication towards the child 3. Never ignore dangerous or unsafe behavior that could cause injury or worse 4. Try to ignore behavior such as: a. Defiant or angry statements directed at the parent b. Nasty faces, eye rolling, or smirking at the parent c. Mocking, taunting, or mimicking the parent 5. Look for and reward times when the child accepts redirection or negative reponse d. Teach parents how to use time out

i. Time out should occur in a quiet, under stimulating room, and should only last for a few minutes. ii. Time out is best used with children under the age 11-12 e. Differential attention is based on the idea that children will engage in behaviors that are rewarded with praise more than behaviors that are ignored. 3. Relaxation a. Controlled breathing and progressive muscle relaxation are made to manage symptoms like tension when people are feeling anxious or distressed. b. Teaching controlled breathing i. Explain rationale 1. Always explain why you are teaching a skill to a client 2. For controlled breathing its important to share that breathing slowly will help control their level of tension and distress. ii. Demonstrate proper body positioning 1. Child and you should be sitting comfortably in chairs, feet on the floor and arms at your side. Place on hand on your belly, below the rib cage, and the other on your chest. iii. Demonstrate proper breathing technique 1. Practice yourself before you demonstrate it. 2. Hand on chest states relatively still while the hand on your belly rises and falls with your breaths. 3. After a few tries with a few breaths, instruct the child to breathe more slowly on the exhalations that on the inhalations. 4. You can count, or just concentration on breathing out slowly. iv. Introduce relaxing word 1. Have them chose a word to say silently while exhaling. 2. Ex: calm or relax 3. Instruct them to only concentration on breathing and this word. v. Have a child demonstrate c. Teaching Muscle Relaxation i. Explain rationale for progressive muscle relaxation (pmr) to child 1. Explain that when people’s muscles are not relaxed, we may feel tense, sore, or nervous. By relaxing them, we feel calmer and more in control. ii. Make child comfortable 1. Create a relaxing environment. Have the child assume a comfortable body position. Position will vary, but for PMR the best position is lying down or reclining comfortably in a chair. Younger kids who are tensing and relaxing the entire body, standing up with a comfortable chair behind them is also effective. iii. Demonstrate technique and induce relaxation d. Alternative Approaches to Relaxation i. Everyday activities as relaxation 1. Music, reading a book, or watching t.v. ii. Focus-based approaches to relaxation 1. Mindfulness works by helping people focus their attention on the present moment, non-judgmentally accepting thoughts, feelings, and sensations. 2. Yoga and prayers can help refocus their mind on the present moment 3. Guided imagery involves working with clients to identify an image or place where they believe they are safe, calm, and relaxed. e. Applying relaxation strategies i. Whatever relaxation skill you teach to your client you want them to achieve a basic level of competency with the skill before using it when they are stressed. ii. This helps insure caregiver and youth have a tool to cope with trauma related stress and tension. iii. A form can be provided for old children to record these home practices. iv. Discuss when/where the practice exercises will be done, try identifying barriers.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

f. Early childhood i. Using full body, fun activities are recommended ii. Tense/relax exercise like tin solider/rag doll. Or uncooked spaghetti/cooked spaghetti. iii. CBP w/ this age group, the simpler the better; focus on breathing slow and steady g. Middle childhood i. May prefer to use scripted, imaginal scenarios to enhance relaxation h. Adolescence i.

TF CBT Course

Related Documents