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Trauma-Focused Cognitive Behavioral Therapy

After watching her adolescent daughter become extremely irritable, lose interest in her school work and experience difficulty sleeping, a mother learns an adult male relative recently sexually abused her child. Together, they go to a clinician who is trained in trauma-focused cognitive behavioral therapy (TF-CBT) to help the teen heal from this abuse.

TF-CBT is designed for children ages three to 18 who have been exposed to trauma and includes parents or caregivers who did not participate in the abuse (i.e. nonoffending caregivers).

How TF-CBT Works

Three doctors developed TF-CBT 25 years ago while working with children and adolescents who had been sexually abused. TF-CBT sessions may take place in outpatient mental health facilities, hospitals, group homes, schools, community-based settings and family homes.

During the course of 8 to 25 sessions, which are 50 to 90 minutes long, the TF-CBT therapist meets individually and together with the child and nonoffending caregiver. These sessions help the child process traumatic memories, address difficult thoughts and behavioral issues and develop healthy coping and interpersonal skills.

TF-CBT also addresses the shame that many young people feel as a result of trauma and helps them understand that they are not to blame for the harm that occurred. As one of the co-founders of TF-CBT, Anthony Mannarino, says,

“When kids are traumatized, they often believe it’s part of who they are, but it’s our job to show them it’s just something bad that happened to them.”

The caregiver’s sessions involve learning stress management, behavior management, and communication skills that help them support the young person while addressing their own distress associated with the trauma.

TF-CBT’s joint sessions allow the child and caregiver to practice the skills they learned in their individual sessions. For example, the child may share their trauma story, and the parent practices responding in supportive ways to this story and issues related to it.

When to Use TF-CBT

Although it initially was developed to treat children who experienced sexual abuse, research has shown that TF-CBT is effective for a range of trauma experiences such as exposure to community violence or the traumatic loss of a loved one, and for youth from different cultures. TF-CBT also helps with other impacts from trauma, including:

  • Anxiety
  • Depression
  • Behavioral issues, including age-inappropriate sexual behaviors
  • Parenting issues
  • Family distress


TF-CBT may not be the best therapy for youth who had significant behavioral problems prior to the trauma they experienced. Instead, they may need to address these issues first and then pursue TF-CBT.

Because TF-CBT involves talking about the trauma, it also is not appropriate for individuals who experienced trauma as infants and do not remember it. Additionally, TF-CBT is not appropriate if a young person is actively suicidal, as stability is necessary to process the trauma.

TF-CBT is not recommended for youth who are experiencing an actively traumatic situation, such as ongoing domestic violence. In the words of Lucy Berliner, director of the Harborview Center for sexual Assault and Traumatic Stress in Seattle,

“In order for TF-CBT to be most effective, children’s safety needs to be fully addressed and the trauma needs to be behind them.”

TF-CBT and Substance Abuse

Because TF-CBT gradually exposes clients to reminders of the trauma, their urge to use substances to numb the pain may increase during the therapeutic process. An actively using participant may therefore need a modified TF-CBT intervention that changes the pace or order of treatment and/or draws on additional forms of therapy.

Using TF-CBT to Treat Trauma and Addiction in Teens and Young Adults

Sandstone Care has professionals trained in TF-CBT who treat you as a person, not a problem. We offer comprehensive treatment programs for teens and young adults who are struggling with substance abuse, mental illness or a combination of both including teen residential and medical detox.

We have trained professionals ready seven days a week to answer any questions you might have – call us today at (888) 850-1890.

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