Treatment and Recovery

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ProblemFostering Resilience
solving
skills

Mastery
Motivation

Child
Strengths

Selfregulation
skills

(facilitated in
treatment)

Beliefs that
life has
meaning

Positive
beliefs
about the
self

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Treatment
Procedure

Process

Most evidence-based treatment models for PTSD

utilize similar components:

Introduction to treatment/explanation of the

process of therapy
Build emotional cognitive insight, identify feelings,
expand emotional vocabulary
Build affect regulation skills/cognitive coping skills/

relationships with parents/co-regulation

Tell the trauma narrative, identify

attributions/cognitions regarding the trauma
Restructure/reframe the narrative

Restructure negative attributions

Foster mastery in presence of the narrative
Assertive communications, boundaries

They also focus on similar

elements in the process of
treatment:

Alliance
Attachment and
Attunement
Titration/Therapeutic
Window
Esteem, self-worth
Competency/mastery

Closure/consolidation

Finding meaning
Esteem building
Development of future goals

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Trauma Focused CBT: CRAFTS

Cognitive problems
Maladaptive patterns of thinking about self, others, and
situations, including distortions or inaccurate thoughts (e.g.,
self-blame for traumatic events) and unhelpful thoughts (e.g.,
dwelling on the worst possibilities)

Relationship problems
Difficulties getting along with peers; poor problem-solving or
social skills; hypersensitivity in interpersonal interactions;
maladaptive strategies for making friends; impaired
interpersonal trust

Affective problems
Sadness; anxiety; fear; anger; poor ability to tolerate or regulate
negative affective states; inability to self-soothe

Hawley et. al. (2012) TF-CBT Toolkit, MO Therapy Network

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Trauma Focused CBT: CRAFTS

Family problems
Caregiver skill deficits; poor caregiver-child communication;
disturbances in caregiver-child bonding; disruption in family
relationships due to familial abuse or violence

Traumatic behavior problems

Avoidance of trauma reminders; trauma-related, sexualized,
aggressive or oppositional behaviors; unsafe behaviors

Somatic problems
Sleep difficulties; physiological hyperarousal and hypervigilance
toward possible trauma cues; physical tension; somatic
symptoms (e.g., headaches, stomachaches)

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Trauma Focused CBT

CALMs core treatment framework for working with
children is Trauma-Focused Cognitive Behavioral
Therapy (TF-CBT).

Psychoeducation and Parenting Skills

Relaxation
Affective modulation
Cognitive coping and processing
Trauma narrative
In vivo mastery of trauma reminders
Conjoint child-parent sessions
Enhancing future safety and development

P R A C T I C E

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Introduction to treatment/explanation of the process of therapy

Books
Feelings rocket
Balloon metaphor
Alarm Metaphor

P R A C T I C E
Psychoeducation and Parenting skills

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Build insight, identify feelings, expand emotional vocabulary

Draw your feelings body outline

Piles on feelings ID board
Feelings thermometer (control, emotions)
Identify feelings of characters in analogous
books, play
Cognitive triad
Feelings inside and out greeting card
TFD Game
Feelings go fish
P R A C T I C E
Psychoeducation and Parenting skills

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Build relationships with parents/co-regulation

Mirror game
Family line drawing
Nonverbal task activities
Guess my feelings game
Nurturing game

P R A C T I C E
Psychoeducation and Parenting skills

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Praise and Validation

Family Stars
Happy memory kinetic family drawing
Family Superheroes team
Kodak moment s
Hopes and dreams bag

P R A C T I C E
Psychoeducation and Parenting skills

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Parent Management Training

Effective Limit Setting

Active ignoring
Behavioral skills

P R A C T I C E
Psychoeducation and Parenting skills

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Build affect regulation skills

Centering/mindfulness exercise to begin.
Blowing bubbles, tasting/smelling exercise, balance exercise,
etc.

Relaxation

Things that make me calm art activity

Spaghetti arms
Bubble blowing/birthday candles
Calming memory game

P R A C T I C E
Relaxation and Affect Modulation

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Build affect regulation skills

Anchoring/Grounding

Client brings a safe object to session

Safe place activity
Treasure box
5-senses soothing bag
Follow anything a child uses

Savoring activities

Support seeking
Containment/compartmentalization
Lock box activity

P R A C T I C E
Relaxation and Affect Modulation

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Build affect regulation skills

Impulsivity/inhibition

Stop game
Control panel game
Shape game
Jenga/magnatiles/kerplunk/blocks

P R A C T I C E
Relaxation and Affect Modulation

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Cognitive Skills Training

Cognitive Insight
Cognitive Triad
Helpful/harmful thought egg hunt
Talking back to negative thoughts/developing
counters
Whos fault is it? Game

P R A C T I C E
Cognitive Coping and Processing

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Restructuring the Narrative

Garbage bag metaphor
Story-book narrative
First person
Third person
Personal timeline

P R A C T I C E
Trauma Narrative

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Mastery

Movie director
Re-sculpting the scene
Inserting heroes into the narrative
Strengths I have/ways I survived

P R A C T I C E
In Vivo Mastery of Cognitive Reminders

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Co-joint Sessions
Follows development of questions,
parental review and coaching

P R A C T I C E
Cojoint Sessions

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Boundaries/Social Skills

No game
Circles/hula hoops activity
My feelings/their feelings ven drawing
Draw your family as . . .
Family map & legend drawing
Things I like about _______/dont like
continuum
Nonviolent communication/problem solving
skills
P R A C T I C E
Enhancing Future Safety and Development

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Closure/consolidation
Finding meaning
Things I learned about myself
Giving advice to another child

Esteem building

Me collages
Design an award for yourself
Family history
ID local heroes, Im like them because _____

Development of future goals

Future timeline
P R A C T I C E
Enhancing Future Safety and Development

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Vignette
Youre referred a family by child welfare services , compromised of Anna, 26, and her three
children: Maribel (8), Junior (6) and Cassy (27 months). The family is participating in CWSs Voluntary
Family Maintenance Program (VFM), but on initial referral the worker tells you that shes not sure about
this family, and intimates that shes still considering detaining the children.
The family first came attention to the system through a report from Juniors school, where he
has consistently had oppostional/defiant and aggressive behaviors with peers. The school also reported
that he recently pulled the fire alarm and ran into the street in front of the school. This led to his
suspension, the mother fears that he will be expelled. He also struggles academically.
When CWS investigated they discovered that the family was homeless; they were living in
their car after feeling violence from Annas husband, the father of the second two children. She reports
that she continues to be afraid of him, and still receives threatening phone calls from him. Sometimes,
she talks to him and tries to calm him down, but she often becomes angry herself and they begin
arguing.
Upon first meeting the family, you note that Maribel is very quiet, and appears anxious and
inhibited. Anna refers to her as the good one, shes always helpful and compliant. She reports that
sometimes shes concerned about Maribel because she finds her rocking on the toilet in the bathroom
and tearing up toilet paper, she also frequently expresses concerns about seeing her step-father. In the
few months before the family left, she also developed a habit of bathing excessively (asking to take
showers sometimes three times a day). The mother appears frustrated or overwhelmed by her toddler as
well, Cassy engages you quickly following the start of the session, asking to sit on your lap, and
demanding assistance with toys. She signals what she wants with single words and pointing.

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