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TF-CBT: What is it and why is it working?

Heather Brewer is CORRAL’s Licensed Clinical Mental Health Counselor and serves as Kildaire Farm’s Manager of Mental Health Services.

What is TF-CBT?

TF-CBT (Trauma-Focused Cognitive Behavioral Therapy) is an evidence-based intervention designed to help youth and their caregivers overcome the effects of trauma. It is a highly structured intervention using the model of PRACTICE: Psycho-education and Parenting, Relaxation, Affective Modulation, Cognitive Coping, Trauma Narrative, In-Vivo Exposure, Conjoint Parent-Child Sessions, and Enhancing Safety and Development. Youth and caregivers are given pre- and post-assessments to develop specific, measurable objectives that analyze trauma symptoms throughout treatment. Weekly progress monitoring helps to guide the interventions and determine where progress is being made. 

PAt each part of PRACTICE, youth and caregivers are provided with psycho-education on the youth’s specific trauma-related symptoms and how those symptoms impact their world. In addition, caregivers are taught parenting skills to promote the use of interventions learned in treatment into the home as well as support the caregiver’s mental health. Part of the treatment is for youth to teach their caregiver each section of the model, allowing the youth the opportunity to gain confidence in expressing their emotions and being able to openly communicate with their caregiver, who has been taught how to appropriately respond to the youth, in a safe environment. Youth and their caregiver(s) get to engage in activities together that promote healing as they work together learning about the specific trauma and how it impacts their entire world. In return, their communication and relationship improves.  

Why now?

  1. COVID-19, in short! At CORRAL, we typically refer out for TF-CBT because the process is so time-intensive, and we do not always have the resources to engage families in this type of treatment.
  2. Finances: We have some families who do have private insurance, but they still have a co-pay and deductible to be met.  During this pandemic, when so many more stressors are on our families, asking them to pay for even more things out of pocket was not an option. We have connected families with a provider who provides this service free of charge, but due to COVID-19, they had to be put on a waiting list.  When we recognized programming was changing, we saw a huge opportunity to capitalize on this time and take advantage of having more available resources for therapy.

Breakthroughs with CORRAL Girls

In my experience providing TF-CBT, I generally see youth come into treatment as angry, scared, nervous, and/or worried about treatment because they realize they are going to have to face some intense emotions and very real fears, on top of talking to their caregiver about their trauma. However, what I have observed is that because TF-CBT is a gradual exposure intervention, meaning at every session the youth and caregiver are gradually exposed to their specific trauma and trauma-related symptoms, it becomes easier to talk about and process as treatment continues. Youth gain words to what they have been feeling and get to understand why their body responds to different stimuli. In a nutshell, youth are given tools to “be the boss of their body rather than their trauma-symptoms being the boss of them!”

In just a few sessions, I’ve seen a young lady gain the confidence to tell adults in her life how she feels rather than avoiding intense feelings, in particular fears about therapy. I’ve seen connections being made to why specific behaviors are displayed and come to understand how her brain and body have been impacted because of the traumatic experiences rather than simply thinking “this is just how I am”. I’ve seen a family make really challenging goals and hold themselves to high expectations! 

Trust: a key factor to building healthy relationships

I don’t often cry in sessions (literally can count on one hand how many times it’s happened in 10 years) but being able to have a healthy therapeutic alliance can allow for those times where the therapist may experience being tearful. In my opinion, it can be healthy to share that with the client, as it humanizes the therapist. That has happened for me in a few short sessions because I was so overwhelmed with joy at seeing a young lady, who works so hard at avoiding getting close to others because she has been so hurt by people in her life, be able to share her fears. My eyes welled with tears as I shared how proud I was of her because I know the hard work she has done to build healthy relationships with her horse partners and all of the CORRAL adults who consistently have been a part of tutoring and horse time. The time she has spent with her other therapists, to whom I give so much credit for teaching her skills, and here has allowed her the space to gain my trust, especially as we are moving into a new approach of treatment. It has been really amazing to see this young lady gain her voice, put words to what she’s feeling, and build healthy relationships, all of which have helped prepare her for a new journey of unpacking her trauma in a place where she feels safe. What I’ve come to realize is that CORRAL has played such a crucial role in helping build those trusting relationships to where she feels safe and is willing to take the leap of faith to trust us with her story.

Holistic Therapy

Because we utilize a holistic approach and build long-term relationships with our girls and families, it helps us have a better understanding of how our girls engage with their entire world. We get a front-row seat to their lives because we are part of it daily and we get to see how trauma impacts their academics, decision-making process, and relationships! Trauma-Focused Cognitive Behavioral Therapy is another tool in our toolkit that helps our girls and families heal. Plus, our horse partners join in the therapeutic process with TF-CBT, where girls and their caregivers get to practice their skills together with the horses, further building the parent/child bond!

For additional resources, check out CORRAL’s therapy programs here.

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