TF-CBT - THE TRAUMA NARRATIVE|2023/24 UPDATE|GRADED A+

Treating Trauma and Traumatic Grief in Children & Adolescents - Objectives Continue learning about TF-CBT Cognitive Triangle Creating the Trauma Narrative Cognitive Processing Behavior Management Parent-Child Sessions Explore ways to use TF-CBT with adult clients Cognitive Coping Recognize and understand the difference between -accurate and inaccurate cognitions - helpful and unhelpful cognitions Recognize the distinction and relation among feelings, thoughts, and behavior Generate alternative thoughts that are more accurate or more helpful Attempt to change their feelings and behavior by thinking differently the cognitive triangle thoughts, feelings, behavior Cognitive Triangle Application - Differentiate between thoughts, feelings and behaviors - Generate scenarios to illustrate how thoughts impact feelings and behaviors -Explore how changing a thought impacts the feelings and behaviors Apply the skill to real life Not everyone will be able to differentiate between thoughts and feelings Children under 8 will likely struggle identifying their personal thoughts. Ask what someone else might think Parent Sessions During Cognitive Triangle (common and alternative thoughts) Common Thoughts I can only be happy if my child is happy I can't trust anyone anymore. Being strong for my child means I should never feel upset. Good parents always know the right thing to say to their children Alternative thoughts I can find things to be happy about, is happy to show my child that happiness is possible Most people are good at heart and many are trustworthy. Being strong means doing what you have to do, and I am doing that. Although we try our best, even the best parents sometimes don't know the best thing to say. Creating the Trauma Narrative : purpose Helping to control intrusive and upsetting trauma-related imagery Helping to reduce avoidance of cues, situations, and feelings associated with trauma exposure Identifying unhelpful cognitions about traumatic events Helping the child recognize, anticipate, and prepare for reminders of the trauma. Break apart thoughts, reminders, or discussions of the trauma from overwhelming negative emotions Creating the Trauma Narrative : legal issues Encouraging discussion of the trauma may be perceived as "coaching," "implanting memories," or "tampering with testimony" In TF-CBT, the therapist does not lead children by suggesting details or asking leading questions Creating the Trauma Narrative 1/3 Decide on the best format (poem, book, pictures) Creating the Trauma Narrative Start with a general introduction of the child/person Next (3 Approaches) -start with what happened before the day of the trauma and work forward -start with the day of the trauma -from the present and work backwards Encourage sharing of thoughts and feelings during the event -If feelings are overwhelming, start with thoughts and add emotions later Present/read the narrative Add the worst part of the traumatic event Creating the Trauma Narrative 2/3 Reading through the trauma narrative several times -Identifying thoughts and feelings -Correcting cognitive distortions and errors After several "exposures" the child will typically experience progressively less extreme emotional reactions and physiological reactivity. It is important to help the child -Create a positive and optimistic ending to the narrative - Realize that the traumatic events they experienced are only one part of their lives -Understand that they are not defined only by what happened to them. Creating the Trauma Narrative 3/3 Encourage the children to include in the narrative ways in which they are - How they are different now from when the traumatic events happened and when therapy began -What they have learned from going through the trauma and creating the narrative -Advice they might give to other children who have experienced similar types of trauma Creating the Trauma Narrative : additional points Explain why it's important Prepare parents for the possibility that their child may initially seem more distressed (e.g., have more nightmares, display more "acting out"), but that these behaviors will decrease over time. Prepare parents by asking them to describe their own knowledge about the event, and reactions to learning about it. This will help the parent to learn to tolerate discussion of the narrative with the child. If parents are prepared to respond supportively, it will encourage the child to talk to about issues that arise in the future. Sharing the trauma narrative is an ongoing process. Share parts of the narrative with the parent as it is being developed. Devote parallel parent session to parent reading child's book to improve their ability to listen attentively and be supportive when the child shares it. Cognitive processing 1/3 The creation of the trauma narrative is both -An end in itself, helping the child or adolescent tell his or her story with reduced anxiety and healthier emotions -A starting point for the exploration of how the child thinks and feels about (or "processes") the trauma and its impact. Many issues may remain salient for the child, including: -Shame and/or stigmatization -Feelings of responsibility (either for the trauma itself or for events that occurred subsequent to the discovery of the trauma) -Unhealthy changes in trust of others -Attributions about the offender or trauma -Unhelpful changes in perceptions about the body or safety