Engaging in a useful, helpful and supportive therapeutic relationship with children and young people who have experienced trauma is crucial to the success of therapy and to the ongoing wellbeing of the young person. We now know so much about the long term damaging impact that trauma can have, that effective therapy can be our chance to mitigate this impact and change the trajectory for the child.
New research appearing in the Child Abuse & Neglect journal, has looked at the experience of receiving Trauma-Focused Cognitive Behavioural Therapy (TF - CBT) from the perspective of the young people involved in the therapy. There have been several studies that have demonstrated the efficacy of TF-CBT, both with adults and young people. The authors of this study state that they believe that this is the first to really examine the experience of TF-CBT from the a young persons perspective.
"Because therapeutic work with traumatised children who struggle with posttraumatic stress symptoms may entail specific challenges, gaining greater knowledge from the children themselves about what is experienced as difficult or helpful in therapy may bring the field a step closer to helping the many children who suffer from traumatic experiences."
The authors of this study interviewed thirty 11-17 year olds in the weeks after they had completed their treatment. Their traumatic experiences included events such as bullying, sexual abuse and violence within and outside of the family.
Responses were grouped in to four main themes:
- changing expectations (expectations of the therapist, expectations of the process)
- talking to the therapist and sharing information
- working through the trauma narrative
- change and change processes
The study reported that most young people found that engaging in therapy was initially anxiety provoking, but that working with a therapist who was kind, empathetic and knowledgable helped to reduce their anxiety. Primarily this experience of anxiety was around discussing their trauma history with a person they didn't know, which the authors believe may be closely related to the young person experiencing a prior breach of trust with adults and therefor experiencing an increased reluctance to place trust in the therapist. The young people in the study reported that they felt more willing to engage in work around the trauma narrative when the therapist had clearly explained why this was important, was able to work at the child's pace and not push them, and was also able to contain the strong emotions of the child that arose during the trauma narrative.
Young people involved in the study also reported that confidentiality was particularly important for them, but that when issues around their trauma were discussed with their families (with the permission and prior planning of the young person) that this was helpful and appreciated.
Most of the young people involved in the study reported that they experienced change as a result of the therapy and that it had assisted them by reducing the symptoms they experienced as well as to develop new skills to manage any trauma symptoms they may continue to experience.
"Many therapists have found that working with traumatised youths is challenging, and talking about the traumatic events seems to be particularly demanding. However, the data from the present study suggests that youths view working with their trauma stories as one of the most helpful interventions."
Dittmann, I., & Jensen, T.K. Giving a voice to traumatized youth - Experiences with Trauma-Focused Cognitive Behavioral Therapy. Child Abuse & Neglect (2013).