Trauma-focused CBT with maltreated children: A clinic-based evaluation of a new treatment manual

Abstract

The effectiveness of a locally developed trauma-focused cognitive behavioural therapy (TF-CBT) program for maltreated children with post-traumatic stress disorder (PTSD) was examined across different therapists in a child protection clinic setting. An earlier phase of the research piloting the program had provided promising results. This second phase involved two studies evaluating the completed TF-CBT manual delivered by (a) the developer and (b) other therapists. A single-case multiple-baseline design was used to demonstrate the controlling effects of the treatment on PTSD symptoms and child coping. Eight 9-13-year-old abused children with PTSD were treated. Positive outcomes support the effectiveness of the TF-CBT program delivered by both the developer and other therapists. The study design and methodology were robust enough to confirm empirically the clinically beneficial effects and potential for this new program. It was also apparent, however, from study limitations, including missing data for some patients, that there are a number of challenges in carrying out such research in a busy child protection service setting with multiply-abused patients. This paper considers implications and ways forward for engaging in empirically supported practice as well as future development and research.

Through the Eyes of the Wounded: A Narrative Analysis of Children’s Sexual Abuse Experiences and Recovery Process

“…Although greater text length is generally associated with older children, the particularly low writing levels in the preadolescent and adolescent groups were noted by the researchers. Other studies have indicated that early childhood trauma can hinder neurocognitive development, resulting in developmental delays, lower intelligence quotient (IQ) scores, and poor school performance (De Bellis, Spratt, & Hooper, 2011;Feather & Ronan, 2009;Sandoval, Scott, & Padilla, 2009). Additional research with a larger sample is needed to confirm the impact of CSA on written expression.…”

“…My life was terrible after what happened" [Participant 10, age 11]). Although each change may have been necessary for increased safety, children may experience further traumatization during this time (Feather & Ronan, 2009). In this study, participants indicated adjustment to their new circumstances.…”

Child Sexual Abuse in the United States: Perspectives on Assessment and Intervention

“…Involvement of the non-offending parent or caregiver improves treatment outcomes for children (Cohen & Mannarino, 2000;Feather & Ronan, 2009) and helps promote positive family relationships (McPherson, Scribano, & Stevens, 2012;Sheinberg & True, 2008). One of the major goals is to increase parents'/caregivers' ability to talk openly about the trauma with their child (Cohen & Mannarino, 2008).…”

“…In cases of CSA, children may be removed from their homes and placed in foster homes or group homes to protect them from abusive parents or caregivers. Whereas the safety of the removed child is ensured in such situations, the removal process itself may further traumatize the child (Feather & Ronan, 2009). …”

“…It is important to note that reactions to the CSA vary depending on the child's developmental stage, and these differences may impact their response to treatment (Feather & Ronan, 2009). The most common and widespread problems effecting children and adolescents who have experienced trauma, including CSA include: "(a) anxiety, (b) depression, (c) anger, (d) cognitive distortions, (e) posttraumatic stress (PTSD), (f) dissociation, (g) identity disturbance, (h) affect dysregulation, (i) interpersonal problems, (j) substance abuse, (k) self-mutilation, (l) bulimia, (m) unsafe or dysfunctional sexual behavior, (n) somatization, (o) aggression, (p) suicidality, and (q) personality disorder" Chatterjee et al, 2006;Deb & Mukherjee, 2009;Reyes & Asbrand, 2005).…”