Types Of Therapy
Trauma-Focused Cognitive Behavioral Therapy
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a type of psychotherapy that was specifically designed to help children and adolescents who have experienced trauma. Judith Cohen, Esther Deblinger, and Anthony Mannarino developed TD-CPT in the late 1980s and early 1990s.
Development of Trauma-Focused CBT
The development of Trauma Focused Cognitive Behavioral Therapy was informed by research on the impact of trauma on children and the most effective approaches to treating trauma in children. The creators of Trauma Focused Cognitive Behavioral Therapy recognized that children who have experienced trauma often struggle with a range of emotional and behavioral issues, including anxiety, depression, anger, and difficulty trusting others. They also recognized that traditional talk therapy approaches might not be effective for children who have experienced trauma, as these children may struggle to articulate their feelings and experiences verbally.
Because of concerns around expressing their experiences verbally, Cohen and her team developed Trauma Focused Cognitive Behavioral Therapy to be highly structured and incorporated a range of techniques to help children process and cope with traumatic experiences. Trauma Focused Cognitive Behavioral Therapy typically involves a combination of individual therapy sessions with the child, as well as joint sessions with the child and their caregiver. Sessions may involve activities such as drawing or role-playing to help the child process emotions and experiences.
Who benefits from Trauma Focused Cognitive Behavioral Therapy?
Trauma-Focused Cognitive Behavioral Therapy was developed specifically for children and adolescents who have experienced trauma, such as physical abuse, sexual abuse, neglect, or exposure to violence.
TF-CBT typically involves both the child and their caregiver(s) in the treatment process, and it focuses on helping the child develop coping skills and strategies to manage their thoughts, feelings, and behaviors related to the trauma.
While Trauma Focused Cognitive Behavioral Therapy was initially developed for children and adolescents, there is some evidence to suggest that TF-CBT may be effective for adults who have experienced trauma as well. However, the treatment may need to be modified to address the specific needs and experiences of adult survivors of trauma.
It is important to remember that TF-CBT is not appropriate for everyone who has experienced trauma, and as a mental health professional, it is essential to assess whether TF-CBT is a suitable treatment option for an individual's specific needs and circumstances. Additionally, there are other evidence-based treatments for trauma that may be more appropriate for adults or individuals with specific types of trauma or mental health concerns.
Timelines and phases of Trauma-Focused Cognitive Behavioral Therapy
Generally, TF-CBT occurs in 12 to 18 weekly sessions in order to provide parents and children with the skills necessary to work through thoughts, emotions, and reactions related to trauma. In addition, the goal is to improve parenting skills and family communication in order to develop trust, growth, safety, and comfort within the family.
TF-CBT typically follows three stages including stabilization, trauma narrative and processing and integration and consolidation all of which include specific components or techniques.
Trauma-Focused Cognitive Behavioral Therapy techniques
TF-CBT components are described by the acronym PRACTICE and teach the child and the caregiver trauma coping strategies with desensitization and gradual exposure included in every component.
Educates the child and caregiver about trauma, its impact, and how TF-CBT can help.
Teaches the caregiver skills to help support the child's recovery and to manage their own reactions to the child's trauma.
Helps the child learn how to express and regulate their emotions related to the trauma.
Cognitive coping and processing
Teaches the child skills to identify and challenge negative thoughts related to the trauma
Teaches the child relaxation techniques, such as deep breathing and muscle relaxation, to help manage symptoms of anxiety and stress.
Trauma narrative phase
Helps the child tell their story of the traumatic event(s) in a safe and structured way.
In vivo exposure
Gradually and safely exposing the child to situations or stimuli that they have been avoiding because of their trauma.
Brings the child and caregiver together for joint therapy sessions to improve communication and strengthen their relationship.
Enhancing future safety and development
Helps the child and caregiver develop a plan to stay safe in the future and to build positive coping skills to manage stress and adversity.
Source: TF - CBT National Therapist Certification Program
Effectiveness of Trauma-Focused Cognitive Behavioral Therapy
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been shown to be highly effective in treating trauma in children and adolescents. Numerous research studies have demonstrated its effectiveness in reducing symptoms of trauma and improving overall functioning.
One meta-analysis of TF-CBT studies, which was published in the International Journal of offender therapy and comparative criminology in 2022, found that TF-CBT was associated with significant reductions in symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and behavior problems.
Another study published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2013 found that TF-CBT was effective in improving the mental health and functioning of children who had experienced sexual abuse, even those also affected by a war-torn country.
Overall, research indicates that TF-CBT is a highly effective approach to treating trauma in children and adolescents. However, it is important to note that the effectiveness of TF-CBT may vary depending on factors such as the severity and type of trauma, the child's individual needs and circumstances, and the expertise of the therapist.
Potential limitations of Trauma-Focused Cognitive Behavioral Therapy
While Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is considered a highly effective approach to treating trauma in children and adolescents, there are some limitations to consider:
TF-CBT primarily focuses on the child and their internal experiences related to the trauma, and may not address broader environmental factors that may be contributing to the child's distress, such as poverty, family stress, or exposure to ongoing violence. As such, clinicians need to take a broad history to ensure that other environmental struggles don’t need to be addressed with other modalities prior to beginning Trauma-Focused Cognitive Behavioral Therapy.
This therapy is a specialized form of therapy that requires specific training and expertise. Not all clinicians are trained in Trauma-Focused Cognitive Behavioral Therapy, and those who are may have varying levels of experience and skill in delivering the therapy effectively. Training can be long, and some therapists may not have the financial or time resources to complete all training aspects.
TF-CBT is primarily designed for treating children who have experienced a specific type of trauma, such as sexual abuse or physical abuse. It may not be as effective for children who have experienced other types of trauma, such as natural disasters or war.
Additionally, this therapy can be quite time intensive and slow to start seeing progress. Trauma-Focused Cognitive Behavioral Therapy typically involves multiple sessions over a period of several months, which may not be feasible for all families due to scheduling or financial constraints.
TF-CBT training for the therapist
Requirements to become a certified TF-CBT therapist include:
- Holding a Master’s degree or above in a mental health discipline and a license to practice independently in your state.
- Completing the web training for TF-CBT.
- Participating in an approved live two-day training by a qualified TF-CBT trainer.
- Participating in follow-up consultation or supervision twice a month for at least six months or once a month for twelve months. The consultation or supervision must be provided by one of the treatment developers or another qualified trainer of TF-CBT. Alternatively, an individual can choose to participate in a TF-CBT learning collaborative and participate in consultation calls.
- Completing three TF-CBT treatment cases with children or adolescents with at least two of the cases, including active participation of caretakers or another designated third party.
- Using at least one standardized instrument to assess progress with the three cases above.
- Taking and passing TF-CBT Therapist Certification Program Knowledge-Based Test.
For full certification information, check out the certification information at https://tfcbt.org
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Billing for Trauma Focused Cognitive Behavioral Therapy
Licensed mental health professionals who provide Trauma-Focused Cognitive Behavioral Therapy can bill for this service as it is a recognized evidence-based practice and listed in the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP). Many insurance providers cover Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) as a reimbursable service.
When billing for Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), mental health professionals typically use CPT codes 90832, 90834, or 90837, depending upon the appropriate time for individual sessions with the child or the parents alone. Code 90847 should be used during the family sessions of TF-CBT. Of course, always ensure that you thoroughly document what stage of the process you are in and the client’s response to treatment as well.
It is important to note that insurance coverage and reimbursement for Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can vary significantly depending on the individual insurance plan, and mental health professionals should check with the insurance provider to determine whether TF-CBT is a covered service and what the reimbursement rates are.
For more information about Trauma-Focused Cognitive Behavioral Therapy or TF-CBT, the National Therapist Certification Program website is a great place to start. The website provides information about TF-CBT, including the TF-CBT treatment model, training opportunities, and resources for mental health professionals who provide TF-CBT. The website also has a directory of certified TF-CBT therapists.
The American Psychological Association (APA) website has a wealth of informative articles about Trauma-Focused Cognitive Behavioral Therapy and other evidence-based treatments for trauma, as well as resources for mental health professionals and the general public.
Another great resource for those interested in Trauma-Focused Cognitive Behavioral Therapy and similar therapies is The Child Trauma Academy, a nonprofit organization that provides education, training, and consultation on child trauma. Their website has information about TF-CBT and other trauma-focused therapies, as well as resources for parents and caregivers.
Therapists looking to organize their assessment, documentation and treatment plans may consider Theraplatform, a cloud-based, all-in-one EHR, practice management and teletherapy tool that offers documentation, practice management, and billing in a user-friendly and straightforward interface. They also offer a free, 30-day trial with no credit card required and you can cancel at any time.