Trauma-focused CBT

Domain II · Behavioural & cognitive · Cohen, Mannarino, Deblinger

What it is

TF-CBT is a structured, components-based treatment for children and adolescents with trauma-related symptoms (PTSD, plus linked depression, anxiety, behaviour problems), delivered to the child and a non-offending caregiver in parallel individual sessions and then joint sessions. Its theory of…

Format

• Session count and proportionality
• Standard PTSD presentation: 8 to 16 sessions, about one-third per phase. The 2026 PSA manual gives 12 to 16 sessions with about 4 to 6 per phase.

Who practises it, and how they are trained or regulated

• Certification (tfcbt.org National Therapist Certification Program): eligibility review, then TF-CBTWeb 2.0 online course, a 2-day live or 3-day virtual introductory training, at least 12 consultation calls with an approved national trainer, then a knowledge test.
• TF-CBT is a structured, components-based treatment for children and adolescents with trauma-related symptoms (PTSD, plus linked depression, anxiety, behaviour problems), delivered to the child and a non-offending caregiver in parallel individual sessions and then joint sessions. Its theory of change: trauma leaves the child with physiological hyperarousal, dysregulated affect, avoidance of reminders and distorted…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Caregiver guilt or anger lessening enough to stay child-focused.
• Speed of return to the present; use during narrative work when distress spikes.
• Ability to name mixed feelings, especially about the trauma or the person involved.
• Fewer outbursts or shutdowns at home and school; the child spontaneously choosing a skill.
• Ratings that are always 0 or 10 (coach finer distinctions); ratings falling after coping use.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.