Saturday, May 19, 2012

Understanding Trauma-Focused Cognitive Behavior Therapy

Trisha is a seven-year old African-American female in foster because of neglect and physical and emotional abuse. When I first saw her, she was not in foster care. She was dressed in jeans and a clean shirt. Her hair was puffy and unkempt. She sat up straight in her chair and did not move an inch without her mother's say. She was being seen for physical abuse by her father. Some of her symptoms included stealing food, hoarding food, and lying. She was later removed from her mother's home because of neglect and possible abuse.

When I first saw her with her foster-mother, she seemed like a different child. Her hair was braided and neatly tied in a pony-tail. She was clean and neatly dressed. She was rambunctious and hyperactive. Later sessions would show this out further. Her stealing and hoarding of food became less pronounced, but she was still telling stories. I was treating Trisha for Post-Traumatic Stress Disorder, which we see in soldiers come home from the war. I was using an evidenced-based practice called Trauma-Focused Cognitive Behavioral Therapy, which was developed for children 3-18 years of age. An evidence-based practice means that when this type of therapy is replicated (more than several times) there was vast improvement in symptoms of the clients. It is shown to be an effective type of therapy. This therapy is used for sexual abuse, domestic violence, and physical abuse.

This model of therapy has several components and the most important part is using the parents/ foster parents as part of the treatment. First you assess from the client's point of view, how they have been feeling to see if they have Post-Traumatic Stress Disorder. With young children, you give similar measures to the parents. Once tabulated, you go over with the parent what you found and if they indeed have Post-Traumatic Stress Disorder. The next few sessions are based on educating the child and parent, depending on the type of abuse they suffered, what it is and what it looks like. It is an unfolding process.

You begin treatment by teaching the client coping strategies for when they have distressing thoughts. It begins with relaxation techniques including deep breathing, progressive relaxation, finding their safe place. You have them practice this and teach the parents how to do this.

The next step is getting the client in touch with their feelings. You teach the client about different feelings and get them to relate it to when they felt that way. If they get overwhelmed you have them take a time out and use their relaxation exercises. Then you give them a break and do something fun and work on it next session. You are also teaching them further coping techniques and getting them to think of things that work for them.

Next you are teaching them how feelings, thoughts, and behaviors are all intertwined and how they work together. You are trying to get them to recognize the thoughts they are thinking that fuels the feeling and in turn causes untoward behaviors. We are also teaching them and their parents the cognitive triangle, so that the exercises can be practiced at home.

You are culminating in therapy into the biggest project called the trauma narrative. You have them pick out what was the worst thing about the trauma. They begin to write or draw a story about what was the worst thing for them. This takes several sessions. Each week, they read to you or tell you what they drew or wrote about and they tell a little bit more of the story. You share this with the parents. When the story is complete and they can tell you the story, you ask them to tell the story with their parents. The child gets so used to telling the story that they are no longer afraid of it. If there are several traumas, you can repeat the process.

Only a trained clinician in this method should be treating your child if you suspect or if there has been abuse that is causing a disruption in the child's life. You never undertake these steps yourselves. This article outlines just some of the steps taken in treating a child with Post-Traumatic Stress Disorder. Only a professional can diagnose this and treat it.

If someone you love has been abused, please seek help for them and have them evaluated. Trauma-Focused Behavioral Therapy is only one of many models of treatment out there to treat abuse. There are other models out there which prove just as successful.

No comments:

Post a Comment