October is Domestic Violence Awareness Month, a time when we acknowledge the impact of abuse on individuals and families. As a therapist who works with trauma survivors (including many children and teens), I want to shed light on a specialized therapy that gives hope to young people and their families: Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT.
Why Focus on Trauma in Kids?
When we think of trauma, we might picture soldiers or adults after a disaster. But trauma affects children profoundly as well. Kids may experience abuse, neglect, witnessing domestic violence, sudden losses, or other scary events. These experiences can derail a child’s sense of safety and trust in the world. Because children are still developing, trauma can shape their brains and bodies in ways that cause issues like PTSD, anxiety, depression, behavior problems, or difficulty in school and relationships. What breaks my heart is that children often don’t have the words to express what’s wrong – instead, their trauma comes out in nightmares, angry outbursts, withdrawn behavior, or regressed behaviors (like suddenly bedwetting or clinging to caregivers).
As adults, our instinct is to protect kids from remembering painful events. We might hope that if we don’t talk about it, they’ll just “forget” and be fine. Unfortunately, unaddressed trauma tends to linger. It’s like a wound that heals over on the surface but is still infected underneath. That’s where Trauma-Focused CBT comes in – it’s a therapy approach designed specifically to help children and adolescents process trauma safely and heal, with the active support of their caregivers.
What is Trauma-Focused CBT (TF-CBT)?
TF-CBT is essentially a child-tailored adaptation of traditional CBT, with a big emphasis on addressing trauma memories and the emotions tied to them. It was originally developed to help kids who experienced sexual abuse, but over time it’s been adapted for all sorts of childhood trauma and grief. It’s an evidence-based model, meaning a lot of research has shown it works – which is great news in an area as sensitive as child trauma.
A few key components make TF-CBT unique:
Involvement of a Safe Caregiver: In TF-CBT, a non-offending parent or guardian is ideally involved in the therapy process. This is crucial. Kids heal best when they have support at home. The caregiver participates in some sessions, learns how to handle trauma-related behaviors, and provides comfort and encouragement. TF-CBT helps the caregiver process their own feelings about what happened too, and teaches them skills to support the child (for instance, how to listen to the child’s trauma story without showing distress that might alarm the child). It becomes a healing journey for both child and parent, strengthening their bond.
Gradual Exposure: One of the hardest parts of trauma therapy is revisiting the traumatic memory. TF-CBT does this very carefully and gradually. Early on, therapy focuses a lot on skill-building – like teaching the child relaxation techniques, helping them identify and express feelings, and correcting unhelpful thoughts (for example, many kids blame themselves for what happened: “It’s my fault my parents divorced because I was bad.” We work on reframing those false beliefs). Only when the child has some coping skills on board do we gently start “exposure” – meaning slowly talking about or expressing the trauma story.
The Trauma Narrative: This is a hallmark of TF-CBT. When ready, the child is encouraged (never forced) to create a trauma narrative – basically a telling of what happened, in their own words (or pictures, art, writing – whatever form works). This might happen over several sessions, bit by bit. It’s done in a safe, controlled way, with the therapist offering lots of support and using techniques to keep the child from becoming overwhelmed. Why do this at all? Because avoiding the memory gives it power; processing it in a safe environment can significantly reduce its emotional charge. I often explain to parents: it’s like we’re helping the child’s brain properly file the memory away, so it no longer jumps out and scares them at random.
Addressing Trauma Reminders: Kids often develop strong reactions to anything that reminds them of the trauma. For example, a child who heard loud yelling during abuse might panic at anyone raising their voice. Part of TF-CBT is identifying these triggers and gradually helping the child learn to face them or cope with them. We might do little practice exercises (if a vacuum’s noise is a trigger because it happened during an incident, we might work up to hearing that noise in a safe context while using coping skills, until it’s no longer so scary).
Enhancing Future Safety: The “focused” part of TF-CBT also includes practical education. We teach kids skills about staying safe and assertive – basically that what happened was not their fault, and how to respond or get help if they ever feel unsafe again. We also ensure the caregiver is actively protecting the child (if the trauma involved abuse, this often means reinforcing that the perpetrator is not in access to the child and the parent has taken steps to ensure safety). Knowing that steps have been taken to prevent reoccurrence helps kids regain a sense of security.
Why Caregivers are Key:
I want to emphasize the role of parents or foster parents (or whoever the safe adult is). Trauma in children doesn’t happen in a vacuum – it affects the whole family system. Often caregivers have their own guilt (“I couldn’t protect my child”) or they themselves might have trauma that’s triggered by hearing the child’s story. TF-CBT actually includes sessions just with the caregiver to work through these issues. We teach the same coping and cognitive skills to the grown-ups so they can model them. I’ve had moms tell me that learning deep breathing or thought-challenging in “kid therapy” helped them with their own anxiety or trauma triggers – a nice bonus. Ultimately, TF-CBT is about restoring healthy development and trust. We want the child to get back on their developmental track – doing kid things, like focusing in school, playing, making friends – without the trauma hijacking their life. And we want caregivers to feel empowered to support that recovery.
Who is TF-CBT For and Does it Work?
TF-CBT is designed for children roughly ages 3 to 18 who have significant trauma symptoms (though for the very young, therapy involves a lot more play and parent-child work – overlapping with Play Therapy, which we also offer). It can address single-incident trauma (like a one-time car accident) or complex, multiple traumas (like chronic abuse). Research has shown TF-CBT is effective in reducing PTSD symptoms, depression, anxiety, shame, and behavioral problems in kids, often more so than standard therapy without the trauma focus. It’s considered a gold standard for childhood trauma treatment.
It’s important to note that not every child who goes through something scary will need TF-CBT or formal therapy – many kids are quite resilient with support. But if a child is clearly struggling – having frequent trauma reminders, mood swings, developmental regressions, etc. – earlier intervention is better.
Gentle Encouragement to Caregivers: Talking about trauma is tough. Watching your child talk about trauma is extra tough. I often have parents initially say, “I don’t want them to have to think about it; shouldn’t we focus on the positive and move on?” I understand that instinct. But I’ve also seen the relief on a child’s face when their pain is heard and validated. Children are incredibly strong and, with a safe space, they can confront and overcome these experiences. TF-CBT provides that structured safe space. And it doesn’t dwell in darkness all the time – sessions incorporate games, art, and plenty of moments of joy and empowerment. We laugh, we celebrate progress. It’s trauma focused, but also very much child-focused, meaning it uses creativity and even humor when appropriate to engage the child in healing.
If you have a child or know of a child who might be suffering silently from past trauma, consider reaching out to a professional who is trained in trauma-focused therapy. It could be at our practice or another; what matters is that the therapist has specific training for children and trauma. Our kids deserve to grow up unchained from the horrors they’ve endured. With the right help, they truly can. I’ve been amazed time and again at how a hurt, fearful child can transform into a thriving, hopeful one. They carry their scars, yes, but those scars become proof of their strength rather than badges of shame.
A Note on Hope:
Working with traumatized children could sound like a sad job, but to me it’s ultimately hopeful. I get to witness the resilience of a child’s spirit. I see families come closer after hardship, not apart. I see kids learn that what happened to them does not define them – they get to define who they are. For every story of pain that’s shared in my office, I get to see a story of courage being written in parallel. That’s why I do this work.
If you’ve made it this far in reading, thank you – it means you care about understanding and supporting these young survivors. Let’s all remember that behind every statistic of domestic violence or child abuse is a real child, with a heart and a future. With awareness, compassion, and therapies like TF-CBT, we can help turn their nightmares into dreams of a safer tomorrow.
Blog written by:
Lisa Anderson
Owner of A Healing Place