Trauma-Focused Cognitive Behavioral Therapy with Young ... · Trauma-Focused Cognitive Behavioral...
Transcript of Trauma-Focused Cognitive Behavioral Therapy with Young ... · Trauma-Focused Cognitive Behavioral...
Trauma-Focused Cognitive Behavioral Therapy with Young Children and Their
Families
Alison Hendricks, LCSW Hendricks Consulting
Learning Objectives Participants will:
� Identify key developmental considerations when working with young children who have experienced trauma
� Improve skills in assessing trauma among young children
� Describe PRACTICE interventions for young children
� Identify resources for implementing TF-CBT with young children and their families
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Developmental Considerations in TF-CBT
� Young children � Developmental impact of trauma � Egocentric and magical thinking � Attachment issues � Symptom presentation � Ability to engage in CBT � Creative interventions
� Use of play for engagement and sensory processing of preverbal trauma
� Parent involvement
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Signs of Trauma in Young Children
� Feeling helpless and uncertain
� Fear of being separated from parent/caregiver
� Crying or screaming a lot
� Eating poorly and losing weight
� Regressive behaviors
� Developing new fears
� Nightmares
� Traumatic play
� Developmental delays
� Changes in behavior
� Asking questions about death
� www.nctsn.org
Trauma Assessment with Young Children
• Assessment – developmental level, primary symptoms, caregiver issues
• UCLA PTSD Index – Parent Version
• Child Stress Disorders Checklist
• Ages 2-18, observer report measure of trauma symptoms completed by caregiver or professional
• Sample item: Child startles easily. For example, s/he jumps when hears sudden or loud noises.
• Available at: http://www.nctsnet.org/nctsn_assets/acp/hospital/CSDC.pdf
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Trauma Assessment with Young Children (continued)
• Post-Traumatic Symptom Inventory for Children
• Self-report PTSD symptom measure for children ages 4-8; contact [email protected] to obtain measure
• Sample item: Some children think about really bad things that happened to them. Do you think about really bad things that happened to you? Do you think about these bad things a whole lot like everyday or just sometimes?
• Diagnostic Infant and Preschool Assessment
• Caregiver interview for children 9 months-6 years; self-contained modules for 13 diagnostic categories
• Sample item: Does s/he try to avoid any things or places that might remind him/her of the trauma? I mean, can you tell that s/he is trying to avoid a reminder before s/he becomes upset?
• Available at: http://www.infantinstitute.com/
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Psychoeducation and Parenting Skills with Young
Children and Their Families
• Brave Bart, Red Flag Green Flag, When Mommy Got Hurt, A Safe Place, Good Touch/Bad Touch, What Do You Know? Game, Radio/Talk Show
• Educating parents about impact of trauma on young children and their development is key
• http://www.nctsn.org/resources/audiences/parents-caregivers
• Help caregiver identify and deal with trauma triggers
• Behavioral interventions to address trauma reactions
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Relaxation for Young Children
• Bubbles, pinwheel, belly breathing games
• Robot/rag doll, Hokey Pokey
• Yoga Pretzels
• Belly breathing with Elmo
• Parents to model and help soothe
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Affective Expression and Regulation
• Feelings Charts, Feelings Charades, Feelings Balloons, Color My World/Color Your Heart, books, Candy Land, Sad Mad Glad Game, “If You’re Happy and You Know It,” Weather Report,
• Feelings Basket, Feelings Abacus
• Coping Box, Scavenger Hunt List
• Educate parents on social emotional development, being an emotional container, and teaching/modeling coping skills
• Emotional support and self-care for caregivers
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Cognitive Coping and Processing
• Use brain or heart image to teach about happy, sad, scared, and mad thoughts
• Cognitive triangle
• Worry Brain
• Thoughts and feelings balloons
• Puppets (3 headed dragon)
• Happy song
• “Who made it happen?” game
• Teach parents about common distortions among young children and explore parents’ attributions
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Trauma Narrative Development and Processing
• Baseline narrative
• Use play to demonstrate cleaning out the wound, role of parent
• Bibliotherapy: Brave Bart, Please Tell, No No the Little Seal, When Mommy Got Hurt
• Puppet show, dollhouse, sand tray, dollhouse, picture book
• Feelings abacus, chips, or cones for SUDS ratings
• Eliciting sensory details – Mr. Potato Head
• Use of symbolism
• Fantasy vs. reality
• Trauma processing: responsibility pie, best friend role play, affirmations
• Parent perspective and processing (parent’s and child’s distortions)
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No No The Little Seal: The Gentle Story of a Little Seal who Learns to Stay
Safe, Say No, and Tell
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In Vivo Mastery of Trauma Reminders
• Common avoidance problems in young children: separation anxiety, sleeping, generalized fears
• Identify sensory triggers and develop desensitization plans
• Work with parent to create and implement the plan
• Develop hierarchy with orange cones representing units of distress
• Use of play for desensitization in session
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Conjoint Child Parent Sessions
• Parent preparation
• Incorporate activities and breaks to keep child engaged
• Therapist may need to be more active to assist child in sharing the narrative
• Special rewards
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Enhancing Future Safety and Development
• Role plays, puppet shows
• Red flag green flag people, Let’s Talk about Taking Care of You/A Workbook for Taking Care of Me (CARES Institute)
• Hula hoop boundaries
• My Safe Neighborhood, helpers puzzles
• Caregiver must be engaged in safety planning
Developmental Considerations for Termination
• Educate and prepare parents and child for potential setbacks related to developmental transitions
• Assist child in saying good-bye in developmentally appropriate manner (may use a transitional object)
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Contact Information
Alison Hendricks, LCSW
Hendricks Consulting [email protected]
www.ahendricksconsulting.com
(619)549-7958
Hendricks Consulting