{"id":150085,"date":"2022-09-06T04:45:41","date_gmt":"2022-09-06T08:45:41","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150085"},"modified":"2022-09-05T14:43:52","modified_gmt":"2022-09-05T18:43:52","slug":"trauma-focused-cognitive-behavioral-interventions-trauma-informed-care","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150085","title":{"rendered":"Trauma Focused Cognitive Behavioral Interventions: Trauma Informed Care"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Trauma Focused Cognitive Behavioral Interventions: Trauma Informed Care\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/bTnXa4E9_rs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\n&nbsp;\r\n\r\nthis episode was pre-recorded\r\nas part of a live continuing\u00a0\u00a0 education webinar on-demand, CEUs are\r\nstill available for this presentation\u00a0\u00a0 through all CEUs register at allceus.com\/counselortoolbox I’d like to welcome everybody to today’s\r\npresentation on trauma-focused cognitive\u00a0\u00a0 behavioral therapy part 1 treating trauma and\r\ntraumatic grief in children and adolescents\u00a0\u00a0 in this first part we’re going to define\r\ntrauma-focused CBT and talk about what\u00a0\u00a0 we’re dealing with here because trauma-focused\r\nCBT is a best practice and it is a manualized\u00a0\u00a0 best practice so you’re going to learn about it\r\ntoday but you’re not going to have enough skills\u00a0\u00a0 where you can say you are certified in TF\r\nCBT however I will provide your resources should\u00a0\u00a0 you want to go out and pursue those so we are\r\ngoing to talk about TF CBT as a best practice\u00a0\u00a0 and implementing fidelity but I’m going to\r\nalso take a few detours and as I always\u00a0\u00a0 do and talk about how this might be able be\r\nuseful with adults who have a history of trauma\u00a0\u00a0 in childhood we’ll explore the components\r\nof trauma-focused CBT and their intended\u00a0\u00a0 functions, we’re not going to get through all of\r\nthose today but we’re going to start and we’re\u00a0\u00a0 going to explore ways to use TF CBT with adult\r\nclients so TF CBT works for children who have\u00a0\u00a0 experienced any trauma including multiple traumas\r\nso what we’re talking about is children who\u00a0\u00a0 come to your office who are presenting with\r\ntrauma-related issues it’s effective with\u00a0\u00a0 children from diverse backgrounds and works\r\nin as few as 12 treatment sessions so a lot\u00a0\u00a0 can be accomplished in 12 sessions they’re not\r\nnecessarily weekly sessions they can be spaced\u00a0\u00a0 out a little bit part of it depends on the age\r\nlevel of the child how long ago the trauma was\u00a0\u00a0 any concurrent developmental or mental health\r\nissues that might be present yada yada yada so\u00a0\u00a0 it may be a little bit longer it may be a little\r\na bit shorter in terms of calendar time but you\u00a0\u00a0 can also extend the number of sessions because\r\nsome of these things for example when they start\u00a0\u00a0 talking about cognitive coping differentiating\r\nbetween thoughts and feelings, some children take a while to get the hang of the\r\nthe nuance between the difference between thoughts\u00a0\u00a0 and feelings so you might have to do two or\r\nthree sessions helped them to identify\u00a0\u00a0 feelings and use the feelings thermometer this\r\nhas been used successfully in clinics schools\u00a0\u00a0 homes foster care residential treatment facilities\r\nand inpatient settings so there’s not an environment in which it can’t be used provided\r\nthat there is a supportive caregiver that can be\u00a0\u00a0 of assistance obviously if you’re working with\r\na 10 or 11-year-old or a little bit younger or\u00a0\u00a0 an older adolescent but you know any child who may\r\nneed some support outside of session we don’t want\u00a0\u00a0 to be creating a crisis and then leaving them\r\nkind of defend for themselves between sessions\u00a0\u00a0 without some sort of emotional and cognitive\r\nsupport so there must be a relationship that there is a bond if you will a\r\nthe rapport between the clinician and the caregiver who may not be the biological parent or the caregiver\r\nand the child it does work even if there is no\u00a0\u00a0 parent or caregiver to participate in treatment\r\nhowever again we need to be selective about how we’re using that so if you have a child and\r\nyou’re going to use this particular approach and\u00a0\u00a0 there’s no parent or caregiver to participate\r\nit may be safer to use it in a residential\u00a0\u00a0 setting or an inpatient setting where there is a\r\nclinician somewhere where they can get emotional\u00a0\u00a0 support because as you’ll see when we get into\r\nthe trauma narrative gets intense TF\u00a0\u00a0 CBT is intended for children with a trauma history\r\nwhose primary symptoms or behavioral reactions are\u00a0\u00a0 related to the trauma so if you’ve got someone\r\nwho has an unfortunate childhood but you think\u00a0\u00a0 their behaviors may be more related to the peer group\r\nmaybe more related to conducting disorder or FASD\u00a0\u00a0 or something else that may not be appropriate\r\nbecause what we’re going to look at with TF CBT\u00a0\u00a0 is reducing the PTSD symptoms the hyper-vigilance\r\navoidance behaviors etc as well as improving\u00a0\u00a0 social skills and helping the person identify and\r\ncommunicate their feelings and needs traumatic\u00a0\u00a0 stress reactions can be more than simply symptoms\r\nof PTSD and also present as difficulties with\u00a0\u00a0 affect regulation we’ve talked before about how\r\npeople who are experienced who have experienced\u00a0\u00a0 trauma may develop a situation where they are more\r\nlikely to experience emotional dysregulation the HPA axis kind of tightens up and holds on to the\r\nstress hormones hold on to the stress reaction\u00a0\u00a0 but then when it does perceive a stressor it goes\r\nfrom 0 to 250 there’s no I’m going to get a little\u00a0\u00a0 bit upset it is either nothing or it is a huge\r\nmountain there’s no mole hills there so there\u00a0\u00a0 may be problems with affect regulation there may\r\nbe problems in relationships because of difficulty\u00a0\u00a0 trusting other people because of difficulties with\r\ntheir self-perception and systems of meaning which\u00a0\u00a0 you know we’re getting to in a few minutes but\r\nthe way they conceptualize the world because all\u00a0\u00a0 of a sudden their world was turned upside down\r\nsomatization feelings coming out as physical\u00a0\u00a0 symptoms so headaches body aches more illnesses\r\nmore days where they just don’t feel well and you\u00a0\u00a0 know sometimes they just really don’t feel well\r\nhowever, is it because of a bacteria or a virus\u00a0\u00a0 or is it because of a stress reaction that is\r\nkicking off all kinds of imbalances in hormones\u00a0\u00a0 and neurotransmitters so we want to look at what\r\nthe effect are these traumas having on this youth or\u00a0\u00a0 person and if we address this trauma and if we\r\nhelp help them come to some sort of resolution\u00a0\u00a0 or acceptance of the trauma and integration into\r\ntheir world view of why this trauma happened\u00a0\u00a0 and making meaning from it will help improve\r\nthese areas will help them reduce their hyper-vigilance etc and for many clients the answer is\r\nyes and I talked earlier about the fact that this\u00a0\u00a0 may be useful now it was designed for children\r\nand adolescents but many of the adults I’ve worked\u00a0\u00a0 with are very Alex thymic they are very unable\r\nto identify their emotions their very unable to\u00a0\u00a0 express their feelings sometimes they don’t even\r\nknow where their fear is coming from they’re just\u00a0\u00a0 sort of paralyzed with fear and don’t trust the\r\nworld and they’re angry at everybody and if it\u00a0\u00a0 comes from a traumatic experience then helping\r\nthem explore how that trauma is impacting\u00a0\u00a0 them in the present can be useful in their\r\nrecovery process so these issues that TF CBT may\u00a0\u00a0 help improve aren’t just limited to children and\r\nadolescents they can present in adults who were\u00a0\u00a0 traumatized as children and who didn’t develop\r\nthe skill to effectively deal with the trauma\u00a0\u00a0 components of CBT TF CBT psychoeducation we’re\r\ngoing to start by teaching them what they need\u00a0\u00a0 to know about the trauma we’re going to talk about in\r\ndepth about these so I’m not going to detail them\u00a0\u00a0 very much here parenting skills and if you’re\r\ndealing with an adult oftentimes I will provide\u00a0\u00a0 what I call reap Aron ting skills if your parent\r\nwere here or if your parent would have responded\u00a0\u00a0 how you would have wanted how would they have\r\nresponded how can you do that for yourself\u00a0\u00a0 now because sometimes you don’t have a significant\r\nother or a caregiver with an adult client either\u00a0\u00a0 but we want to help them figure out how to self\r\nnurture if needed relaxation and stress management\u00a0\u00a0 skills because some of the stuff we’re fixing to\r\ntalk about is going to be extremely distressful so\u00a0\u00a0 you have some wiggle room if you will in terms of\r\nwhat skills do you teach here they prescribe some but\u00a0\u00a0 as far as relaxation and stress management affect\r\nexpression and modulation DBT skills seem to fit well into this framework for helping\r\npeople tolerate the distress not act on their\u00a0\u00a0 impulses understand where the emotions are coming\r\nfrom and preventing vulnerabilities and all that\u00a0\u00a0 other stuff that can help them function outside of\r\nsession and when they’re not doing their homework\u00a0\u00a0 help them feel like they’re able to focus on\r\nsomething besides the trauma because we’re\u00a0\u00a0 just kind of ripping the band-aid off that wound\r\nat a certain point and they may have difficulty\u00a0\u00a0 focusing on anything else likewise some children\r\nand adolescents will come to you when that trauma\u00a0\u00a0 is still relatively present and all they can think\r\nabout is that trauma or it regularly comes up for\u00a0\u00a0 them and so we can help them learn skills so\r\nthey can start living more of what they might\u00a0\u00a0 consider a meaningful life that’s not dominated\r\nby memories of this trauma while we’re working\u00a0\u00a0 through the process we want to give them a little hope\r\nthat there’s relief in sight cognitive coping and\u00a0\u00a0 processing are provided next and enhanced by\r\nillustrating the relationships among thoughts\u00a0\u00a0 feelings and behaviors so initially cognitive\r\ncoping skills are taught and then all of this\u00a0\u00a0 is going to be applied later as soon as we\r\nget into the trauma narration helping the\u00a0\u00a0 youth work through narrating the trauma and cope\r\nwith the feelings and thoughts that come up in\u00a0\u00a0 vivo mastery of trauma reminders so any of those\r\ntriggers that are triggering flashbacks that are\u00a0\u00a0 kicking off hyper-vigilant situations we’re going\r\nto address as they come up in the trauma narration\u00a0\u00a0 we’re going to help the person identify what it\r\nis about certain situations that bring up this particular memory and how we master how to do\r\nwe deal with it and then finally conjoint Parent\u00a0\u00a0 Child sessions and these don’t come till the end\r\nall along the parents or the caregivers are\u00a0\u00a0 participating in the process assuming there is a\r\nparent or caregiver and understand learning a\u00a0\u00a0 little bit more about what’s going on but we’ll\r\ntalk about what the clinician does in the parent\u00a0\u00a0 sessions as well as what the clinician does in\r\nthe child sessions as we go through each stage effects of TF CBT reduction in intrusive and\r\nupsetting memory so that’s awesome and you know\u00a0\u00a0 if you think about what’s the function of these\r\nintrusive memories a lot of times it is because\u00a0\u00a0 either they haven’t been integrated into the\r\nperson’s schema of the world and well-being and or\u00a0\u00a0 they still feel unsafe they have some cognitions\r\nthat is telling them they need to be alert they\u00a0\u00a0 need to be aware they’re not safe so helping them\r\nidentify any cognitions and triggers that may be\u00a0\u00a0 causing intrusive and upsetting memories\r\nand addressing those again in the in vivo desensitization avoidance helping people reduce\r\ntheir avoidance of certain situations and certain\u00a0\u00a0 activities so they don’t feel like they are\r\nconfined basically to their prison it helps\u00a0\u00a0 reduce the emotional numbing of a lot of people when they\r\ngo through trauma it’s so overwhelming and they’re\u00a0\u00a0 so afraid if they feel they won’t be able to stop\r\nfeeling so they numb emotionally it’s protective\u00a0\u00a0 it makes sense and as they develop the skills to\r\nhandle this and as they learn they can tolerate\u00a0\u00a0 the distress of the memories of the trauma it\r\nempowers a lot of clients there’s a reduction in\u00a0\u00a0 hyperarousal depression and anxiety behavior\r\nproblems when you’re dealing with adolescents\u00a0\u00a0 or children, especially ones who don’t have the\r\nability to articulate their feelings and their\u00a0\u00a0 thoughts that are underlying these\r\nfeelings and how they relate to the trauma\u00a0\u00a0 I don’t know many adults that can do that so\r\nchildren typically act out physically to either protect themselves or try to get some\r\nsort of protection comfort attention so they\u00a0\u00a0 feel more secure so it’ll help reduce some of\r\nthat as we empower the child to identify what’s\u00a0\u00a0 going on and articulate their needs more effectively\r\ncommunicate with their parent and also deal with\u00a0\u00a0 some of the stuff that’s making them still feel\r\nthreatened or afraid reductions in sexualized\u00a0\u00a0 behaviors trauma-related shame interpersonal\r\ndistrust and again social skills deficits if\u00a0\u00a0 a youth has been dealing with this trauma issue\r\nfor a while, they may have avoided other people\u00a0\u00a0 because they don’t trust other people they’re\r\nafraid of other people haven’t made sense of it\u00a0\u00a0 so they may not have developed the social skills\r\nthat other youth have developed because they have\u00a0\u00a0 been avoidant situations that might trigger\r\nthe trauma memories so who is is inappropriate\u00a0\u00a0 for if the primary issue is defiant or conduct\r\ndisordered it if you don’t believe from a\u00a0\u00a0 clinical standpoint that this is coming from a\r\nthe root of trauma history and addressing trauma\u00a0\u00a0 is probably not going to do it now do these\r\nchildren who are oppositional defiant conduct\u00a0\u00a0 disordered have traumas in their history sure\r\nprobably they do but are those traumas causing\u00a0\u00a0 the behavior or are those traumas sort of\r\nirrelevant and one thing that you’ll find\u00a0\u00a0 is a lot of we’ll talk about it more in a minute\r\na lot of people have multiple traumas but they\u00a0\u00a0 may have resolved certain ones and be okay with\r\nthey but others are still open wounds don’t use\u00a0\u00a0 it if the child is suicidal homicidal or severely\r\ndepressed if a child is in that particular state\u00a0\u00a0 we don’t want to start poking the bear\r\nespecially in an outpatient setting but even in\u00a0\u00a0 residential and even residential with adults I\r\nwas always extraordinarily cautious and hesitant\u00a0\u00a0 to do any sort of trauma work in the first 30 to\r\n60 days I had a client in residential substance\u00a0\u00a0 abuse treatment I mean the first 30 days they’re\r\nstill kind of sobering up there are a lot of impulse\u00a0\u00a0 issues and in the next 30 days there’s usually a\r\na lot of mood issues so I want them to feel like\u00a0\u00a0 they’ve got a handle on things before we start\r\nripping band-aids off open wounds if possible\u00a0\u00a0 and if you’re obviously if you’re dealing with a\r\na child the safety and ethics would just tell you\u00a0\u00a0 when this might not be appropriate additionally\r\nwhen children remain in high-risk situations with\u00a0\u00a0 a continuing possibility of harm such as in\r\nmany cases of physical abuse or exposure to\u00a0\u00a0 domestic violence some aspects of TF CBT may\r\nnot be appropriate for example attempting to\u00a0\u00a0 desensitize to trauma memories is contraindicated\r\nwhen real danger is present I took that\u00a0\u00a0 verbatim from the TF CBT training or one of them\r\nthat is cited in your booklet or your class\u00a0\u00a0 it is important to understand that not all of\r\nthese children are coming or existing living\u00a0\u00a0 in an environment that is healthy and you may\r\nhave a parent who is court-ordered or ordered\u00a0\u00a0 by child welfare to bring the youth to counseling\r\nto address trauma issues but that child is going\u00a0\u00a0 back to a chaotic situation so again it’s going to\r\nbe an ethical decision on your part once you have\u00a0\u00a0 all of the training and you’ve become\r\ncertified and TF CBT it would be an ethical\u00a0\u00a0 decision at that point whether or not to implement\r\nthe program to fidelity and you know we\u00a0\u00a0 want to make sure that the child is cognizant\r\nof any real and present dangerous challenges, they\u00a0\u00a0 always come up, especially when you’re dealing with\r\nfamilies if the carrot parent or caregiver does\u00a0\u00a0 not agree that the trauma occurred and we’ve all\r\ndealt with this whether you deal with adults who\u00a0\u00a0 were traumatized as children and they say nobody\r\nbelieved me when I was a child and I tried to\u00a0\u00a0 get somebody to here or whether you’re dealing\r\nwith a child right now who is with a caregiver\u00a0\u00a0 or removed from a caregiver it doesn’t matter\r\nbut the caregiver was present at the time and\u00a0\u00a0 the caregiver doesn’t believe the trauma occurred\r\nit can be a huge barrier because that caregiver is\u00a0\u00a0 not going to be able to be as supportive if the\r\nThe caregiver agrees the trauma occurred but believes that it is not affecting the child significantly\r\nor thinks that addressing it will make matters\u00a0\u00a0 worse then we can do some education here we can\r\nidentify symptoms that are coming out that are\u00a0\u00a0 present which may be caused by the trauma and we\r\ncan show the research of TF CBT as well as other\u00a0\u00a0 methods if you choose not to use TF CBT but you\r\ncan show the caregiver how addressing this trauma\u00a0\u00a0 can mediate or mitigate some of those symptoms if\r\nthe parent is overwhelmed or highly distressed by\u00a0\u00a0 his or her emotional reactions and is not\r\nable to attend to the child’s experience so if\u00a0\u00a0 the parent feels guilty for what happened or you\r\nknow such as in the cases of domestic violence the\u00a0\u00a0 parent is dealing with their trauma\r\nbecause they are surviving domestic violence they\u00a0\u00a0 may not be able to attend to the issues of the\r\nchild at that point and it’s not a judgment it’s\u00a0\u00a0 just how much energy you have and if you’re\r\ntrying to survive yourself you’re probably not\u00a0\u00a0 going to be able to devote your full attention to\r\njr.\r\n\r\n&nbsp;\r\n\r\nOver here so we need to look at timing if the\u00a0\u00a0 parent is suspicious distrustful or doesn’t\r\nbelieve in the value of therapy again we can\u00a0\u00a0 do some education here rapport building and go\r\nslow if the client and I my experience has been\u00a0\u00a0 this occurs when the client is court-ordered or\r\nordered by child welfare the parent does not trust\u00a0\u00a0 the system and by the fact the system\r\nreferred them to you you’re part of the system\u00a0\u00a0 so start low go slow try to be as compassionate\r\nopen and honest as possible I try with all of my\u00a0\u00a0 clients but especially with my clients who are\r\ninvoluntary I am very open about what’s in my\u00a0\u00a0 records and what I write down because that could\r\ngo to the court which could you know potentially\u00a0\u00a0 reflect upon them you know we talked about what’s\r\ngoing in into the chart I don’t use subjective\u00a0\u00a0 judgment everything’s objective unless we talk\r\nabout something and they say yeah I’ve made\u00a0\u00a0 progress here or I feel like I’m backsliding here\r\nand then we talk about how to how that’s going to\u00a0\u00a0 be put in the notes I don’t lie I don’t cover-up\r\nbut I do want to make them feel more comfortable\u00a0\u00a0 with what’s being written in that magic file that\r\ngets stored away that nobody can see if the parent\u00a0\u00a0 is facing many concrete problems such as housing\r\nbut consume a great deal of energy again if it’s\u00a0\u00a0 a domestic violence issue and they’ve moved out\r\nand they’re living in a homeless shelter or a\u00a0\u00a0 domestic violence shelter the parents may be\r\nexhausted and just not able to fully attend to\u00a0\u00a0 the increased emotional and psychological demands\r\nof the child during this therapy you know they’re\u00a0\u00a0 going to be doing good to help junior through\r\nthe present crisis let alone anything else or\u00a0\u00a0 if the parent is not willing or prepared to\r\nchange parenting practices even though this\u00a0\u00a0 may be important for treatment to succeed and\r\nthere are few and far between situations where\u00a0\u00a0 this may happen one of the situations would be\r\nif you have a parent who is the biological parent and you have a boyfriend or girlfriend\r\nwho is abusing the child and you know that comes\u00a0\u00a0 out and there needs to be some change in the\r\nthe way that children are introduced to new people\u00a0\u00a0 or there may need to be some change in another\r\nsituation and how to indiscipline there are a lot\u00a0\u00a0 of variations that may come up but ultimately\r\nwe need the parent’s full buy-in we need them\u00a0\u00a0 to be willing to work with children on emotions\r\nidentification and cognitive coping and all this\u00a0\u00a0 other stuff which ultimately ends up helping them\r\nmost of the time anyway because I don’t believe\u00a0\u00a0 any of these skills can be harmful to a person at\r\nAt least the initial skills of the trauma narrative if\u00a0\u00a0 it’s done inappropriately or incorrectly can be\r\nvery very harmful but we’ll get there specific\u00a0\u00a0 strategies that can be undertaken through perseverance\r\nin establishing the therapeutic alliance reach\u00a0\u00a0 out to contact and try not to serve as the all-knowing\r\nomniscient person but asking them what they need asking them what changed with jr.\r\n\r\n&nbsp;\r\n\r\nAsking them for\r\nfeedback and suggestions about what helps when\u00a0\u00a0 jr. gets like this and so you can brainstorm put\r\nthe parent in the expert role of being the parent imagines that explore past negative interactions\r\nwith social service agencies or therapy not that\u00a0\u00a0 we can undo that but we can make sure not to\r\nrepeat it and if they start acting disengaged\u00a0\u00a0 we can evaluate the situation and come back and\r\nsay is this reminding you of that prior situation\u00a0\u00a0 or you know are you feeling disempowered again or\r\nwhatever the case may be being fully aware that n\u00a0\u00a0 TF CBT you have two very distinct clients plus a\r\nthe third one is the family so you’ve got a lot\u00a0\u00a0 of different things to juggle if you want to explore\r\nthe parent’s concerns that may make them feel as if they’re not being understood or accepted\r\nthe lead listens to or is respected and that gets a\u00a0\u00a0 little dicey sometimes especially when we start\r\ntalking about cultural sensitivity about belief about why the trauma occurred or a\r\nvariety of other things that we’ll talk about\u00a0\u00a0 it’s important to be able to hear the parent and\r\ncome from a culturally sensitive and culturally\u00a0\u00a0 informed perspective it’s also important if\r\nthe parent feels guilty for some reason you\u00a0\u00a0 know and sometimes they will be cognizant of\r\nany nonverbals or any statements that you make\u00a0\u00a0 that might make them feel that way and if it comes\r\nout or if there’s no other way to say it you know\u00a0\u00a0 talk about any feelings they may have that about\r\nbeing not believed or not respected and how can\u00a0\u00a0 you best facilitate making them feel respected\r\nand accepted and all that stuff explore and help\u00a0\u00a0 them to come overcome barriers to participating\r\nin treatment, if it’s transportation if it’s a\u00a0\u00a0 job if it’s something else there may be some\r\nbrainstorming that’s required and a little bit\u00a0\u00a0 of case management and I recognize that most of us\r\nwhen we work in private practice or agency\u00a0\u00a0 work don’t get any credit for billable hours for\r\ncase management but it has to be done in the best\u00a0\u00a0 interest of the client and emphasize the centrality\r\nof the caregiver’s role in the child’s recovery\u00a0\u00a0 making sure that they understand that this can’t\r\nsucceed without their help by using parent sessions\u00a0\u00a0 to reduce parent caregiver distress and guide them\r\nthrough structured activities that empower them in\u00a0\u00a0 interactions with the child so you’re going to\r\nbring them in each week and you’re going to talk\u00a0\u00a0 to the parent independently about what’s going on\r\nwhat you’re covering how juniors behaving how you can help them help jr.\r\n\r\n&nbsp;\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/6024592\/pexels-photo-6024592.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\nEtc sometimes you need to\r\ndelay joint sessions until the parent or caregiver\u00a0\u00a0 can offer the child support and sometimes that\r\nmeans not even starting treatment really until\u00a0\u00a0 the parent and caregiver parent or caregiver\r\ncan be on board now you can get started with\u00a0\u00a0 psychoeducation emotions identification feelings\r\nidentification and stress management and coping\u00a0\u00a0 skills you know there were not really\r\npoking a bunch of bears so you can probably\u00a0\u00a0 safely get started on that if it’s sometimes it’s\r\ncourt-ordered and they have to start treatment by\u00a0\u00a0 April 1st or something so there are things you can\r\ndo but you may need to delay the actual beginning\u00a0\u00a0 of the trauma narrative until the parent is\r\nable to be available to educate everybody on how\u00a0\u00a0 therapy works and instill in everyone not just\r\nthe parent optima optimist that well optimism\u00a0\u00a0 about the child’s potential for recovery you\r\nknow sometimes they’ve been dealing with this\u00a0\u00a0 child’s acting out behaviors for so long they’re\r\njust like you know we’ve already been to three\u00a0\u00a0 other therapists I don’t know what’s going to\r\nfix it or I’ve done everything I know how to\u00a0\u00a0 do good luck so we can talk about you know a\r\ndifferent approach or we can talk about what\u00a0\u00a0 they’ve done that’s worked for a short period\r\nof time and build on those strengths to instill optimism and hope and empowerment so\r\ninitially, when we talk about psycho-education\u00a0\u00a0 it’s important to provide accurate information\r\nabout the trauma when children are traumatized\u00a0\u00a0 they can be confused and not completely understand\r\nwhat happened they may blame themselves and they\u00a0\u00a0 may hold on to myths because they’ve been misled\r\nand\/or deliberately given incorrect information so\u00a0\u00a0 one of the best ways we can help is to correct\r\nthat information provides information about how\u00a0\u00a0 often this happens and whether you know it’s okay\r\nto do this that or the other psychoeducation\u00a0\u00a0 clarifies inappropriate information children may\r\nhave obtained directly from the perpetrator or\u00a0\u00a0 on their own so the perpetrator may have told them\r\nthat this is how I express love or this is how you\u00a0\u00a0 need to be disciplined because you don’t learn\r\nthis is how I was disciplined whatever it is or\u00a0\u00a0 they could have gotten it on their own they could\r\nhave gotten it from school from the internet or\u00a0\u00a0 just come up with it in their little heads trying\r\nto make sense of what happened psychoeducation\u00a0\u00a0 also helps them identify safety issues the\r\ndifference between safe situations and dangerous\u00a0\u00a0 situations and as we get through this I really\r\nwant you to get away from the notion that TF CBT\u00a0\u00a0 and childhood trauma are only physical and sexual\r\nabuse there are so many other traumas as evidenced\u00a0\u00a0 by the adverse childhood experiences survey that\r\nI want you to wrap your head around that and there\u00a0\u00a0 are things they didn’t cover in the aces such as\r\nbullying and natural disasters so we want to help\u00a0\u00a0 children whatever the trauma is the trauma made\r\nthey feel unsafe so we want to identify safety\u00a0\u00a0 issues if the trauma was a hurricane then we want\r\nto talk about what hurricanes are how often they\u00a0\u00a0 hit what to safety plan etc so every time a\r\nthe thunderstorm comes they don’t freak out and we\u00a0\u00a0 want to use psychoeducation to provide another\r\nway to target faulty or maladaptive beliefs by\u00a0\u00a0 helping to normalize thoughts and feelings about\r\nthe traumatic experience you know it makes sense\u00a0\u00a0 that that was scary and makes sense that\r\nyou’re angry it makes sense that you feel\u00a0\u00a0 this way and we can talk about why that makes\r\nsense and why it makes you feel that way through\u00a0\u00a0 cycle education you’re getting the child to start\r\ntalking about the specific trauma that he or she\u00a0\u00a0 experienced in a less anxiety-provoking way by\r\ntalking in Jen wrong about the type of trauma\u00a0\u00a0 so you’re talking about natural disasters you’re\r\ntalking about plane crashes you’re talking about\u00a0\u00a0 domestic violence so they start learning about\r\nit and then eventually you’re going to move down\u00a0\u00a0 to their experience with it so like I said there\r\nare a ton of different traumas and the ACE study\u00a0\u00a0 even acknowledges that these are just the ten most\r\ncommon ones that they heard however there are many\u00a0\u00a0 many many different traumas and types of trauma\r\nsome of the biggest ones are physical\u00a0\u00a0 and sexual abuse physical neglect emotional abuse\r\nand neglect and the Aces identified mother treated\u00a0\u00a0 violently I would say anyone in the household\r\ntreated violently it’s not just the mother’s substance misuse within the household and that\r\ncan be by the parents or by siblings household\u00a0\u00a0 mental illness parental separation or divorce and\r\nan incarcerated household member so those were\u00a0\u00a0 aces but then like I said there’s also bullying\r\nthe death of a parent or sibling is extremely\u00a0\u00a0 traumatic hurricane tornado natural disaster and\r\nthen I put the fire out separately because sometimes\u00a0\u00a0 fire can be man-made sometimes it can be a wiring\r\nproblem but sometimes it can be Jr was playing with matches now even if jr.\r\n\r\n&nbsp;\r\n\r\nAccidentally started\r\nthe fire does that make it any less traumatic no\u00a0\u00a0 it probably makes it more traumatic because then\r\nthere’s a whole sense of guilt and responsibility\u00a0\u00a0 but it’s still a trauma that has to be dealt\r\nwith so I put a link to the adverse childhood\u00a0\u00a0 experiences website if you want to go look more\r\nabout that but we’re going to move on psycho-education involves specific information about\r\nthe traumatic events the child has experienced\u00a0\u00a0 not the child’s event we’re not going to go\r\ninto police records or something, we’re just\u00a0\u00a0 going to talk about specific information about\r\ndomestic violence or whatever body awareness\u00a0\u00a0 and sex education in cases of physical or sexual\r\nmaltreatment and there are caveats for getting\u00a0\u00a0 parental consent and permission and all that other\r\nstuff and Risk Reduction skills to decrease the\u00a0\u00a0 risk of future traumatization now going back to\r\nthose other things it’s not just about physical\u00a0\u00a0 or sexual abuse so we want to look at what was the\r\nthe risk created by you know how can you reduce your\u00a0\u00a0 risk of being bullied how can you reduce your\r\nrisk of being traumatized in a tornado you\u00a0\u00a0 know you can’t stop the tornado from coming\r\nand they’re everywhere so what do you do and talk about a safety plan the same thing with fire\r\ninformation needs to be tailored to fit a child’s\u00a0\u00a0 particularly particular experiences and level\r\nof knowledge obviously, you’re going to provide\u00a0\u00a0 different information to a seven-year-old than\r\nyou are to a 17-year-old provide caregivers with\u00a0\u00a0 handout materials to reinforce the information\r\ndiscussed in session so this may help educate\u00a0\u00a0 the parents about some of it but it lets them\r\nknow what you talked about and it gets us all\u00a0\u00a0 on the literal same page you’re providing them a\r\nhandout of everything you went over with Junior\u00a0\u00a0 and we want to encourage caregivers to discuss\r\nthis information at home reinforces accurate\u00a0\u00a0 information about how safe or unsafe they\r\nare and obviously, we’re going towards safe\u00a0\u00a0 and reinforced accurate information and develop\r\na safety plan so they feel confident that at\u00a0\u00a0 home they’re going to be taken care of when you\r\nstart psychoeducation you do want to get a sense\u00a0\u00a0 of what the child already knows and you can use\r\na question-and-answer game format in which the\u00a0\u00a0 child gets points for answering questions which I\r\nlove this suggestion so you can ask them if you know\u00a0\u00a0 what is a hurricane or is a tornado and see\r\nif they know and see if they know how much time and much-advanced warning we have for a tornado\r\nversus a hurricane or you know whatever situation\u00a0\u00a0 you’re talking about you see I did a lot of posts\r\nHurricane Katrina counseling in northern Florida\u00a0\u00a0 so that’s one of those things that comes up for\r\nI am talking with children about how likely is\u00a0\u00a0 it that a category 5 hurricane is going to hit\r\nagain but encouraging them to give your aunt’s\u00a0\u00a0 give answers and if they give the wrong answer you\r\nknow it’s great to try now you know try to coach them\u00a0\u00a0 into a correct answer or provide them the correct\r\none but give them credit for at least making an\u00a0\u00a0 effort sample questions might include what is\r\nyou know and put in the type of trauma what is\u00a0\u00a0 bullying how often do you think bullying happens\r\nand why does bullying happen you know those are\u00a0\u00a0 some questions you can ask to just open a dialogue\r\nabout bullying, if this child has been a victim of\u00a0\u00a0 bullying and is and is traumatized so cultural\r\nconsiderations meet the child and family where\u00a0\u00a0 they are by presenting information in a way which\r\nthey can relate it to their belief system and\u00a0\u00a0 you may need to consult with their spiritual\r\nguidance guides leaders whether it be a pastor\u00a0\u00a0 or you know whatever to get some guidance\r\non how to handle certain aspects of whether it was\u00a0\u00a0 the will of God and in the case of sexual abuse\r\nhow to handle the concept of virginity and how to\u00a0\u00a0 handle the concept of bad things happening to bad\r\npeople and whatever else they think is coming\u00a0\u00a0 from or their parents are instilling in them in a\r\nbelief system we want to make sure that we’re not\u00a0\u00a0 necessarily contradicting it and going oh mom dad\r\nand the church is wrong but we also want to help\u00a0\u00a0 them try to integrate this in a way that can help\r\nthey have strong self-esteem so reaching out to\u00a0\u00a0 those spiritual leaders and the family asking what\r\ntheir belief system about certain things can\u00a0\u00a0 be very helpful assess the general beliefs about\r\nthe trauma if something happened or when something\u00a0\u00a0 happens ask the parent or the family that’s there\r\nnot necessarily the child but you want to get a\u00a0\u00a0 sense of what the family stance is on why this\r\nhappened what it means how it’s going to impact\u00a0\u00a0 life hence foreign henceforth and forever more\r\nfocus on the events they perceive as traumatic to the family but most especially the child if the\r\nchild’s going back to the Aces you know maybe\u00a0\u00a0 the parents got divorced but the child doesn’t\r\nsee that as traumatic because there was domestic\u00a0\u00a0 violence ahead of time the domestic violence was\r\ntraumatic the divorce was a relief so wherever the\u00a0\u00a0 child is with each trauma we want to\r\nbe respectful of what they perceive is traumatic\u00a0\u00a0 and tailor the information so the family can be\r\nmore receptive to it as supportive as possible and\u00a0\u00a0 sometimes you need to make sure that the language\r\nyou know make sure the language is not jargony about general views of mental health and mental health\r\ntreatment should also be assessed and addressed in\u00a0\u00a0 the psychoeducation piece not only with the child\r\nbut also with the family, if they are suspicious\u00a0\u00a0 of it don’t understand it think that you’re just\r\ngoing to magically fix Junior we want to demystify\u00a0\u00a0 the process and talk about what is the purpose of\r\nthe assessment what is the purpose of each one of\u00a0\u00a0 these activities and why am I doing this or why\r\nare we doing this as a team and how can it help\u00a0\u00a0 and then we also want to provide information to\r\nD stigmatize and normalize mental health issues\u00a0\u00a0 and seeking treatment some cultures are still\r\nresistant to seeking treatment and I use the term\u00a0\u00a0 cultures broadly because there’s\r\na stigma associated with it so normalizing for\u00a0\u00a0 them how many people go to treatment how common\r\nPTSD is or whatever the situation you’re dealing\u00a0\u00a0 with it doesn’t mean they have to like it but at\r\nAt least it will give them a little bit of a nugget\u00a0\u00a0 to understand that they’re not the only ones if\r\nthey are from a cultural group a minority cultural\u00a0\u00a0 group of some sort you might want to provide\r\ninformation about how common this particular\u00a0\u00a0 issue is in their group I’ve done a lot of work\r\nwith law enforcement and emergency responders\u00a0\u00a0 and they’re kind of their little group so\r\nwe talk about how common depression is among law\u00a0\u00a0 enforcement and emergent emergency responders\r\nspecifically, because they face so much so many\u00a0\u00a0 different stressors than you know Joe Schmo over\r\nhere so it D stigmatizes and normalizes a little\u00a0\u00a0 bit now they still may not talk about it and\r\ngo well hey you know 37% of us have clinical\u00a0\u00a0 depression no that’s probably not going to happen\r\nbut at least in the back of their mind, they can go\u00a0\u00a0 you know what I’m looking around this room and\r\nI can bet that at least one other person’s on\u00a0\u00a0 antidepressants or something and feel a little\r\nless unique and isolated in parent sessions you\u00a0\u00a0 want to provide a rationale and overview of the\r\ntreatment model educates parents about the trauma and talks about the child’s trauma-related symptoms\r\nso we’re going to go over what is hyper-vigilance\u00a0\u00a0 what is the function it why people become\r\nhypervigilant after trauma and what might it\u00a0\u00a0 look like in a child because it presents very\r\ndifferently for different children so we might\u00a0\u00a0 want to give some ideas and say does this sound\r\nlike Johnny or does this sound like Johnny and\u00a0\u00a0 help them understand why these behaviors may\r\nbe coming out we want to talk about how early\u00a0\u00a0 treatment helps prevent long-term problems okay\r\nmaybe the trauma happened three years ago but\u00a0\u00a0 still, it’s better than waiting ten more years and\r\nyou know Johnny’s still not having any Ellucian\u00a0\u00a0 will want to talk about the importance of talking\r\ndirectly about the trauma to help the children\u00a0\u00a0 cope with their experiences and not hedging and\r\nthis will be on a case-by-case basis but the manual\u00a0\u00a0 walks you through handling this discussion with\r\nthe parents about exactly how much detail do I go\u00a0\u00a0 into if Johnny brings it up at home reassure\r\nparents that children will first be taught\u00a0\u00a0 skills to help them cope with their discomfort\r\nand that talking about the trauma will be done\u00a0\u00a0 slowly with a great deal of support so we’re not\r\njust going to plop them down and go okay and tell\u00a0\u00a0 me about the day that all this happened which\r\nis what the child has experienced already if\u00a0\u00a0 it was reported to law enforcement and\/or the child\r\nwelfare they’ve probably had somebody sit down\u00a0\u00a0 and say get right to the nitty-gritty at least\r\nonce or twice and it’s completely dehumanizing\u00a0\u00a0 so we want to reassure parents that we’re not\r\ngoing to do that to the child again will help the\u00a0\u00a0 caregiver understand their role in the child’s\r\ntreatment since this modified since this model\u00a0\u00a0 emphasizes working together as a team so I’m not\r\njust going to be educating you it’s not going to\u00a0\u00a0 be a parallel thing where I go in and I work with\r\nJohnny and then I tell you what I did and then I\u00a0\u00a0 work with Johnny I’m going to work with Johnny\r\nand then we’re going to discuss what Johnny and\u00a0\u00a0 I did in session and I’m going to get input from\r\nyou and we’re going to talk about how you feel\u00a0\u00a0 about it and then I’m going to provide you with tools\r\nso you can help Johnny outside of the session because\u00a0\u00a0 you’re going to be with them for six-and-a-half\r\nother days that I’m not and this can’t work\u00a0\u00a0 if it’s just one hour once a week and we want to\r\nelicit parent input questions and suggestions as\u00a0\u00a0 much as possible because they’ve been living with\r\ntheir kid for you know however many years so they\u00a0\u00a0 probably have an idea about what works and what\r\ndoesn’t so we’ll start with both parents and\u00a0\u00a0 children in their respective sessions helping\r\nthem understand what control breathing is and how\u00a0\u00a0 it helps slow the heart rate and trigger the\r\nwrist and digest sort of reaction in your body\u00a0\u00a0 when your breathing slows your heart naturally\r\nslows because the stress reaction tells your\u00a0\u00a0 brain you’ve got to breathe fast and the heart\r\nrates got to go fast well when you override that\u00a0\u00a0 then you’re kind of overriding the whole system\r\nand we’ll also talk about thought stopping and\u00a0\u00a0 this is especially helpful if the trauma is recent\r\nor and\/or ever-present in the mind of the youth so they\u00a0\u00a0 can say I am NOT going to talk about that right\r\nnow I’m not going to think about that right talk about distraction techniques go back to\r\nyour DBT stuff talks about improving the moment\u00a0\u00a0 and accepts to help the child develop skills to\r\nhandle and work through when those thoughts pop\u00a0\u00a0 up replace unthawed unwanted thoughts with\r\na pleasant one so talk about it in session\u00a0\u00a0 when thoughts like that come up what would you\r\nprefer to think about and then really get into\u00a0\u00a0 the Nitty Gritty the five senses what do you see\r\nsmell hear taste you know help me get into\u00a0\u00a0 that situation or that thought this teaches that\r\nthoughts even unexpected and intrusive ones can be\u00a0\u00a0 controlled so that gives them hope and again we’re\r\nnot exacerbating the thoughts right now we’re not bringing up their particular trauma and\r\nhaving them get into detail we are just helping\u00a0\u00a0 them deal with what’s happening normally on a\r\nday-to-day basis so they feel like they have\u00a0\u00a0 more control for the older kids you can have them\r\npeople log about when this technique is used what\u00a0\u00a0 they were thinking about and how effective the\r\nthought stopping was and then review it and help\u00a0\u00a0 them tune it up if it’s not really effective and\r\ngive them praise for when they use it effectively\u00a0\u00a0 relaxation training persons of Asian or Hispanic\r\norigin tend to express stress in more somatic or\u00a0\u00a0 physical terms so just be aware of that but that\r\ndoesn’t mean that Caucasians don’t relaxation\u00a0\u00a0 training is good for anyone and the medical\r\nschool of South Carolina training recommended that relaxation is stress-free and\r\nworkbook by Davis Schulman and McKay so and\u00a0\u00a0 it is still in publication when deciding how to\r\npresent relaxation techniques are creative have\u00a0\u00a0 the child help you to integrate the elements\r\ninto the technique that makes it more relevant\u00a0\u00a0 to them so, what are you thinking about when you\r\nrelax you know I know I like to go to the woods\u00a0\u00a0 but maybe this kid likes to think about a video\r\ngame or play with their dog whatever it is but helps them make it relevant to them and then have\r\nthey identify other things they do to relax like\u00a0\u00a0 drawing listening to music walking and making a\r\nlist of those things so they can refer to it when\u00a0\u00a0 you’re teaching relaxation training especially if\r\nyou’re doing something like progressive muscular\u00a0\u00a0 relaxation be sensitive to the child’s wishes if\r\nthey don’t wish to close their eyes or lie down which could trigger memories of the trauma we’re\r\nnot going there yet so if they feel vulnerable\u00a0\u00a0 lying down or taking orders like that because\r\nyou can imagine how being told to lie down and\u00a0\u00a0 close their eyes might be a trigger for certain\r\nabuse survivors you know be cognizant of that\u00a0\u00a0 and say you know get into a comfortable position\r\nor how where would you like to sit while we talk\u00a0\u00a0 about this like I said parents can often\r\nbenefit from the relaxation training as well\u00a0\u00a0 so because they’re dealing with their issues\r\nabout the trauma but they’re also dealing with\u00a0\u00a0 trying to figure out how to help Johnny and any\r\nof them deal with any of Johnny’s misbehaviors\u00a0\u00a0 or problematic behaviors then they move on to\r\nfeelings identification so it helps the therapist\u00a0\u00a0 judge the child’s ability to articulate feelings\r\nif you can tell me what makes you happy that’s\u00a0\u00a0 great but if you can’t then you know we need to\r\nwork on figuring out what makes you happy you\u00a0\u00a0 also want to help the child rate the intensity\r\nof the emotion don’t let them stick with happy\u00a0\u00a0 mad sad glad and afraid you know let’s talk about\r\ndifferent emotions and use the emotion chart with little faces on it or you can use the emotion\r\nthermometer so is it a hot emotion or is\u00a0\u00a0 it a cool emotion and helps the child\r\nlearn how to express feelings appropriately\u00a0\u00a0 in different situations I mean sometimes they’re\r\ngoing to be angry but it might not be appropriate\u00a0\u00a0 to you know get up and stomp out of the room or\r\nwhatever however they communicate it so help them\u00a0\u00a0 figure out how to articulate that so they can be\r\nheard and supported some children have difficulty\u00a0\u00a0 discussing or identifying their feelings so\r\nyou might try stepping back and discussing the\u00a0\u00a0 feelings of other children or characters from\r\nbooks or stories so you know think about Puff\u00a0\u00a0 the Magic Dragon if they’ve read that you know\r\nthat dates me a little bit there but you know how\u00a0\u00a0 did the little boy feel and talking about things\r\ndifferent characters and different stories where there are elements of anger and shame and loss and\r\nall of that stuff helps children identify\u00a0\u00a0 how they experience emotions if they seem detached\r\nfrom the experience because sometimes they just\u00a0\u00a0 they’ve shut it off it was just too overwhelming\r\nso we want to talk about you know when you’re\u00a0\u00a0 happy what does that feel like or when you’re\r\nangry what happens what does your body feel\u00a0\u00a0 like when you’re angry and they might be able\r\nto tell you they hear their heartbeat in their\u00a0\u00a0 ears or everything gets all fuzzy or whatever\r\nbut help them start tuning in to how they react\u00a0\u00a0 and connecting that with an emotional word and then\r\nafter all, that’s done they can identify feelings\u00a0\u00a0 they can identify feeling intensity now we want to\r\ndifferentiate between thoughts and feelings many\u00a0\u00a0 children describe thoughts when they’ve been\r\nasked about a feeling so if you ask them how they feel they may say I want to run away so\r\nyou want to say okay well I hear that you want to\u00a0\u00a0 run away so I’m wondering if you are bored and you\r\nyou’re bored and want to get away from it or if\u00a0\u00a0 you’re scared can you tell me a little bit more\r\nabout what it means to you to want to run away during feelings identification the parent\r\nsessions normalize what is going on with their\u00a0\u00a0 child and help the parent understand that some\r\nchildren may be seemingly in constant distress\u00a0\u00a0 or detached from the trauma and that’s okay\r\nwe all react differently to traumas so again\u00a0\u00a0 we’re going to share with the parents what we’re\r\nDo let them know any specific difficulties if\u00a0\u00a0 any juniors have encouraged the parent to praise\r\nthe child for appropriate management of difficult motions and I put in parenthesis successive\r\napproximations because they’re not going to get\u00a0\u00a0 it a hundred percent right every time so if they\r\ntry to effectively manage their emotions even a\u00a0\u00a0 little bit let’s give them praise for that and\r\nthen help them figure out how to do it a little\u00a0\u00a0 bit better the next time so instead of having a\r\ncomplete meltdown maybe they got up and stomped\u00a0\u00a0 out of the room well that’s an improvement so\r\nthen we want to talk about how to shape that\u00a0\u00a0 behavior so it’s a more appropriate communication\r\nif parents have difficulty identifying their\u00a0\u00a0 own emotions provide them with examples so\r\ncontinually ask them questions about how you feel when it’s a rainy day outside and how to do you\r\nfeel when somebody’s supposed to call you and they\u00a0\u00a0 don’t how do you feel when and have about 15 or 20\r\nexamples and you can have them on a piece of paper\u00a0\u00a0 and even give it to the parent to take home for\r\ntheir homework if parents are overcome with\u00a0\u00a0 their own emotions about the trauma validate\r\ntheir feelings and explain how children need to see that their parents can handle talking\r\nabout the trauma so there the children need to see\u00a0\u00a0 the strength and the parents which is what you’re\r\ngoing to work on in parent sessions to make sure\u00a0\u00a0 that the parents have the resolve and the skills\r\nhandle talking about this topic with junior TFC BT can be an effective intervention\r\nfor children or adolescents whose primary\u00a0\u00a0 presenting issue is trauma-related emotional or\r\nbehavioral dysregulation TF CBT is not appropriate\u00a0\u00a0 for clients who are actively suicidal and severely\r\ndepressed or currently abusing substances we want to make sure they’re clean\r\nand sober as much as possible TF CBT starts\u00a0\u00a0 with psychoeducation and then teaches stress\r\nmanagement and coping skills to aid in the\u00a0\u00a0 management of distressing feelings psycho IDI\r\nhelps to clarify the inappropriate information\u00a0\u00a0 children may have and start getting them a little\r\na bit more comfortable talking about the topic in\u00a0\u00a0 general before we start going deeper and\r\nfeelings identification helps participants start\u00a0\u00a0 effectively labeling and communicating their\r\nfeelings so they can receive the support and\u00a0\u00a0 nurturance they need from their caregivers\r\nand their support system if you enjoy this\u00a0\u00a0 podcast please like and subscribe either in your\r\npodcast player or on YouTube you can attend and participate in our live webinars with dr.\r\n\r\n&nbsp;\r\n\r\nSnipes\r\nby subscribing to all CEUs comm slash counselor\u00a0\u00a0 toolbox this episode has been brought to you in\r\npart by all CEUs calm providing 24\/7 multimedia\u00a0\u00a0 continuing education and pre-certification\r\ntraining to counselors therapists and nurses\u00a0\u00a0 since 2006 use coupon code consular toolbox to\r\nget a 20% discount on your order this month.\r\n\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=bTnXa4E9_rs\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\n<a href=\"http:\/\/flywait.4brain.hop.clickbank.net\">Alzheimer’s Dementia Brain Health \u27ab\u27ac \ua19b\u30b7\u27ab I was losing my memory, focus \u2013 and mind! And then\u2026 I got it all back again. Case study: Brian Thompson There\u2019s nothing more terrifying than watching your brain health fail. You can feel it\u2026 but you can\u2019t stop it.<\/a>","protected":false},"excerpt":{"rendered":"<p>&nbsp; this episode was pre-recorded as part of a live continuing\u00a0\u00a0 education webinar on-demand, CEUs are still available for this presentation\u00a0\u00a0 through all CEUs register at allceus.com\/counselortoolbox I’d like to welcome everybody to today’s presentation on trauma-focused cognitive\u00a0\u00a0 behavioral therapy part 1 treating trauma and traumatic grief in children and adolescents\u00a0\u00a0 in this first part &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150085\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Trauma Focused Cognitive Behavioral Interventions: Trauma Informed Care<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150084,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1,781,111,7,122,140,63,72,305],"tags":[59800,38507,34232,38512,37897,37895,35259,38513,38514,42335,59801,38515,37905,38531,37902,38039,38519,37878,38508,59809,59802,38533,42326,38520,37893,42338,37894,38517,42329,37877,37876,59803,38525,38526,37882,42327,38532,38527,37906,59804,59806,59808,38506,35665],"class_list":["post-150085","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anxiety","category-crime-justice","category-diy","category-getting-help","category-lgbt","category-lgbtqq","category-life","category-style","category-unrest-conflicts-war","tag-aca-opd","tag-adacb","tag-addiction","tag-alcohol-and-drug","tag-cadc","tag-cap","tag-cbt","tag-ccapp","tag-ccdc","tag-ccm-ceus","tag-ccmc","tag-ce","tag-ce4less","tag-cebynet","tag-cheap-ceus","tag-cognitive-behavioral","tag-continuing-education","tag-counseling","tag-counselling","tag-donnelly-snipes","tag-dr-dawn-elise-snipes","tag-homestudy","tag-hpcsa","tag-ladac","tag-ladc","tag-ladc-ceus","tag-lcdc","tag-lcsw","tag-lcsw-ceus","tag-lmhc-ceus","tag-lpc-ceus","tag-mcap-ceus","tag-naadac","tag-nbcc","tag-nbcc-ceus","tag-nctrc","tag-online-ceu","tag-online-training","tag-quantum-units","tag-tf-cbt","tag-trauma-focused-cbt","tag-trauma-focused-cognitive-behavioral-therapy","tag-unlimited-ce","tag-ytccon"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2022\/09\/htmlF_IMG_63163d5ac4753.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150085"}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150085"}],"version-history":[{"count":2,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150085\/revisions"}],"predecessor-version":[{"id":150089,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150085\/revisions\/150089"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150084"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150085"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150085"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150085"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}