Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms

OBJECTIVE: The present study sought to determine whether the 12-session pre- to posttest therapeutic gains that had been found by Deblinger, Lippmann. and Steer (1996) for an initial sample of 100 sexually abused children suffering posttraumatic stress disorder (PTSD) symptoms would be sustained 2 years after treatment. METHOD: These sexually abused children, along with their nonoffending mothers, had been randomly assigned to one of three cognitive-behavioral treatment conditions, child only, mother only, or mother and child, or a community comparison condition, and were followed for 3 months, 6 months, 1 year, and 2 years after treatment. RESULTS: A series of repeated MANCOVAs, controlling for the pre-test scores, indicated that for the three measures of psychopathology that had significantly decreased in the original study (i.e., externalizing behavior problems, depression, and PTSD symptoms), these measures at 3 months, 6 months, 1 year, and 2 years were comparable to the posttest scores. CONCLUSIONS: These findings suggest that the pre- to post-treatment improvements held across the 2-year follow-up period. The clinical and research implications of these findings are discussed.     

Giving a voice to traumatized youth—Experiences with Trauma-Focused Cognitive Behavioral Therapy

The efficacy of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been shown in several randomized controlled trials. However, to our knowledge no one has studied the TF-CBT model from a user's perspective. The objective of this study was to explore traumatized youths’ experiences of receiving TF-CBT. Thirty youths between 11 and 17 years old (M = 15, SD = 1.8) were interviewed using a semi-structured interview guide after they had received TF-CBT as part of an effectiveness trial. The interviews were analyzed according to thematic analysis. The youths’ responses were grouped into four themes: (1) expectations, (2) experiences of talking to the therapist and sharing information, (3) experiences of trauma narrative work, and (4) experiences of change and change processes. Findings showed how an initial fear of talking about traumatic events and not knowing what to expect from therapy was reduced when the youth experienced the therapist as empathetic and knowledgeable. Talking to the therapist was experienced as positive because of the therapist's expertise, neutrality, empathy, and confidentiality. Talking about the trauma was perceived as difficult but also as most helpful. Learning skills for reducing stress was also perceived as helpful. Important change processes were described as resuming normal functioning and getting “back on track,”, or as acquiring new perspectives and “moving forward.” Because TF-CBT is recommended as a first line treatment for traumatized youth and treating posttraumatic stress may entail special challenges, understanding more about how youths experience this mode of treatment contributes to our knowledge base and may help us tailor interventions.     

Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Separation

ObjectivesIn light of the current U.S. family separation crisis, there is growing attention to Childhood Traumatic Separation, defined here as a significant traumatic stress reaction to a familial separation that the child experiences as traumatic. When living in a family setting, Childhood Traumatic Separation may interfere with the child's relationships with the current caregiver(s). Effective treatments for Childhood Traumatic Grief can be modified to address Childhood Traumatic Separation. This article describes current applications of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Childhood Traumatic Separation.MethodsUsing two composite clinical cases, TF-CBT applications for Childhood Traumatic Separation are described. These include: (1) implementing the safety component first; (2) tailoring coping skills to address the uncertainty of Childhood Traumatic Separation; (3) integrating past traumas into trauma narration and processing of the traumatic familial separation; (4) providing Childhood Traumatic Separation-focused components to address challenges of committing to new relationships while retaining connections to the separated parent; and (5) addressing role changes.ResultsThese modifications have been implemented for many youth with Childhood Traumatic Separation and have anecdotally resulted in positive outcomes. Research is needed to document their effectiveness.ConclusionsThe above practical strategies can be incorporated into TF-CBT to effectively treat children with Traumatic Separation.Practical implicationsPractical strategies include starting with safety strategies; tailoring skills components to address the ongoing uncertainty of traumatic separation; integrating past traumas into trauma narration and processing of traumatic separation; providing traumatic separation-focused components to balance the challenges of committing to new relationships with retaining connections to the separation parent; and addressing role changes. Through these strategies therapists can successfully apply TF-CBT for Childhood Traumatic Separation.     

An empirical analysis of behavioral and emotional problems of foster children as related to re-placement in care

Foster care is seen as a temporary service. However, for many children, foster care involves years of long term care. Most professionals feel that if a child must remain in care, the number of foster homes or re-placements the child experiences should be minimized. Evidence suggests that this lack of stability has a detrimental effect on the child's psychosocial development. Even though the research evidence supports the negative impact of re-placement on the foster child, little empirical research has dealt with identification of factors associated with children likely to be re-placed. This article focuses on foster children with behavioral and emotional problems and analyzes the association of these problems with placement stability and continuity. The findings report that children with behavioral and emotional problems are replaced in foster care more often than those children without similar problems.