TF-CBT Training Augmented with a Self-Care Focus: Understanding Facilitators and Barriers to Treatment Implementation

Abstract

Clinicians working with youth exposed to trauma may be at increased risk for experiencing elevated levels of stress and symptoms of secondary traumatic stress, which can negatively impact clinician wellbeing and ultimately contribute to reduced access to quality care for clients. An innovative Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training incorporating self-care practices (i.e., Practice What You Preach; PWYP) was developed to help facilitate the implementation of TF-CBT and to enhance clinicians’ coping and decrease stress. The primary purpose of this study was to determine whether the PWYP-augmented training met three Objectives: (1) increase clinicians’ feelings of TF-CBT competency; (2) improve clinicians’ coping abilities/reduce clinicians’ stress; and (3) increase clinicians’ insight into the benefits and/or challenges clients may experience in treatment. An exploratory aim was also developed to identify additional facilitators and barriers of TF-CBT implementation. The written reflections of 86 community-based clinicians who participated in the PWYP-augmented TF-CBT training were examined using qualitative methods. The majority of clinicians indicated increased feelings of competency and improved coping abilities and/or stress levels; almost half mentioned increased insight into clients’ experiences. The most frequently mentioned additional facilitators were related to elements of the TF-CBT treatment model. Anxiety/self-doubt was the barrier most frequently mentioned, though all clinicians who mentioned this barrier indicated it lessened or resolved over the course of the training. Incorporating self-care strategies into trainings may serve as a facilitator for TF-CBT implementation by enhancing the competency and well-being of clinicians. The additional insights into barriers and facilitators can be used to further improve the PWYP initiative and future training and implementation efforts.

Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis

“…Strategies that address low burnout may similarly be important in enhancing feasibility among CHVs given the presence of low burnout as a condition for high feasibility among CHVs. Incorporating self-care into the training of EBTs may be a protective factor against burnout ( Harrison et al, 2023 ). For example, Harrison et al (2023) studied a TF-CBT training in which providers were encouraged to personally use the clinical strategies they would teach their clients (e.g., incorporate new behaviors in their routines and praising others).…”

“…For example, Harrison et al (2023) studied a TF-CBT training in which providers were encouraged to personally use the clinical strategies they would teach their clients (e.g., incorporate new behaviors in their routines and praising others). The emphasis on self-care within an EBT training is likely low cost and can have high impact on providers’ experience providing an EBT ( Harrison et al, 2023 ). Despite the long list of recommendations, it is important to present multiple strategies to counselors and supervisors to tailor the strategies to their context.…”

“…In addition, burnout can lead to less empathy, poor therapeutic alliance, poor communication, and decreased attention in the therapy context ( Salyers et al, 2015 ). On the other hand, decreasing burnout among therapists can increase perceived effectiveness of an intervention as shown in a study of trauma-focused EBT training that incorporates self-care education ( Harrison et al, 2023 ). Therapist fatigue can occur during or after a therapy session and has been shown to negatively impact client outcomes and therapy quality ( Chui & Hill, 2020 ).…”

App-Assisted TF-CBT-Based Intervention as Add-On to Inpatient Treatment Reduces Children’s Post-traumatic Stress Symptoms and Post-traumatic Cognitions

“…PTSD Checklist for DSM-5 (PCL-5) was employed to evaluate children's post-traumatic stress symptoms [82][83][84]. PCL-5 is a 20-item self-report measure that assesses 20 symptoms of PTSD as 6 outlined in the DSM-5, organized into four symptom clusters: 'Intrusion symptoms' (items 1-5), 'Avoidance' (items 6-7), 'Negative alterations in cognition and mood' (items 8-14), and 'Alterations in arousal and reactivity' (items [15][16][17][18][19][20]. Respondents indicate how much they were bothered by a symptom on a 5-point Likert scale ranging from 0 ("not at all") to 4 ("extremely").…”

Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy

“…This approach results in stress reduction for the victim and improved recovery. Additionally, the humanistic approach in the clinician-child relationship is valued and essential for successfully implementing TF-CBT techniques ( 39 , 40 ).…”