What Is Trauma-Focused CBT (TF-CBT) for Children and Teens?

What TF-CBT is

TF-CBT is a form of cognitive behavioral therapy built for young people after trauma. A research review available through the National Library of Medicine describes it as a conjoint treatment, meaning the child and a parent or caregiver are both part of it. In a typical session, the therapist spends part of the time with the child and part with the caregiver.

The model was first designed for posttraumatic stress symptoms linked to sexual abuse. It has since been adapted for other kinds of trauma, including physical abuse, witnessing violence at home or in the community, a traumatic loss and natural disasters.

The word "trauma-focused" can sound intimidating. In practice it means the therapy does not avoid what happened. It makes room for it slowly, after a child has tools to handle big feelings.

Who TF-CBT is for

TF-CBT is intended for children and adolescents who have experienced trauma and are having trauma-related symptoms. Not every child who goes through something frightening needs therapy. The National Institute of Mental Health (NIMH) notes that many reactions fade with time and steady support.

After a traumatic event, children of any age may have nightmares or other sleep problems, physical complaints, trouble concentrating or feelings of guilt. Very young children may cling to caregivers or return to earlier behaviors such as bed-wetting. Older children and teens may have problems at school, pull away from others or seem angry.

NIMH suggests contacting a health care provider if these reactions last for more than a month. These can be signs that a child needs more support, and noticing them is a caring act, not a sign that you have done something wrong.

What happens in TF-CBT

TF-CBT follows a set of components that build on each other. Coping skills are taught before any exposure-based work, so a child is not asked to talk through the hardest parts on day one.

• Learning about trauma: the family learns about common reactions to trauma, so symptoms feel less confusing.
• Relaxation skills: ways to settle the body when stress rises.
• Managing feelings: skills for handling strong emotions.
• Coping with thoughts: thinking skills that help a child cope with distress.
• Trauma narrative: a gradual process in which the child creates their own account of what happened and makes sense of it.
• Facing reminders: being introduced gradually to reminders of the trauma, such as places or people.
• Shared sessions: child and caregiver meet together, and the child may share their story.
• Safety and the future: building skills that support a sense of security and well-being.

The caregiver's role

Caregivers are not on the sidelines in TF-CBT. The review describes parent training and shared child and caregiver sessions as core parts of the model. The therapist meets with the caregiver first to prepare them, so they can respond in a supportive way when their child shares.

Hearing the child's account allows the caregiver to offer support and helps the child correct mistaken beliefs about what happened. The caregiver part can be done with any available supportive caregiver, for example a foster parent, when a parent cannot take part. The caregiver should be someone who was not responsible for the harm.

Outside of therapy, NIMH encourages adults to make sure children are safe, keep routines consistent and let young people express sadness. It also advises against expecting children to be brave or tough, or pressing them to talk before they are ready.

What the research says

A published review of randomized controlled trials rated the level of evidence for TF-CBT as high. It found positive outcomes in reducing symptoms of posttraumatic stress disorder. It was less clear whether TF-CBT reduces behavior problems or symptoms of depression.

The reviewers also named limits. Several of the trials involved the people who developed the model, and some groups of children were left out of the studies. They concluded that TF-CBT is a viable treatment for reducing trauma-related symptoms among some children. That is an honest summary: promising and well studied, and not the right fit for every child.

How we can help

Members of our team are trained in TF-CBT, and everyone on the team is trained in trauma-sensitive care. Our trauma and PTSD therapy page explains the approaches we use, and our child therapy and teen therapy pages describe how we work with young people. The youngest clients we see are 7 years old.

All sessions are by secure video, and clients must be physically in Pennsylvania, West Virginia or Arizona during a session. We match your child with a therapist licensed in your state. You can book a free 15-minute consultation to ask whether TF-CBT or another approach fits your family, and check coverage on our insurance and fees page.

If your child is in crisis or talking about harming themselves, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more options.