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A 12 year-old male is brought to your clinic to receive TF-CBT
by his new foster parent who is complying with the CPS case
manager's recommendation/referral. The boy was physically
abused by his biological father, emotionally neglected by his
stepmother, and is unaware of his substance-abusing mother's
whereabouts. The boy appears "shut-down" and is mildly
aggressive in his verbal interactions at his new school with
peers and teachers. He only talks about feeling "mad". -
ANSWERS -27. What will be important to focus on during the
first few weeks of therapy with this boy?
a) Delay using standardized assessment instruments until
trust and rapport are established; this is not likely to occur
until 2-3 months into treatment since he has complex trauma.
b) Provide Psychoeducation and Affective Modulation (e.g.,
encourage him to talk about his "mad" feelings) without
gradual exposure, since referring to trauma experiences early
in treatment with a child who is so emotionally shut down
would interfere with effective engagement.
c) Do not introduce Psychoeducation until he initiates
talking about his trauma experiences as this would likely
worsen his avoidance.
,d) Do not include the new foster parents in treatment, since
they are too new for him to trust; they may be trauma triggers
and incite the boy's anger.
e) Provide Psychoeducation and Affective modulation skills
with gradual exposure and actively engage foster parents in
TF-CBT.
In the first individual TF-CBT session with a 10 year-old girl
named Janie, the therapist learns that "mom cries all the time"
when the abuse is brought up at home so Janie never really
talks about it. She expresses that she does not want to make
mom sad or angry. When you meet with the mother
individually, she expresses that she wants to support her
daughter but she is constantly thinking about what Janie
endured and feels guilty that she did not "pick up on it" before
her daughter disclosed the sexual abuse. - ANSWERS -28.
When a wellmeaning, non-offending parent's emotional
distress (related to the child's abuse history) seems to be
interfering with the child's recovery and preventing the child
from sharing about the abuse in therapy, for fear of triggering
distress in the parent, what is the best next direction in
therapy?
a) Gently suggest to the parent that she should no longer
participate in TF-CBT;
from now on you will just see the child only
in treatment.
b) Provide prolonged intensive exposure to the parent about
the child's abuse
, until the parent is no longer upset
about it.
c) Require the parent go to see an individual therapist as
a condition of
continuing TF-CBT with the child, because the mother's
distress clearly
indicates that she has an unresolved abuse
history of her own.
d) Tell the parent firmly but supportively that she needs to
stop crying all the
time if she is going to really help
her child.
e) Provide supportive psychoeducation about how the
mother's response is
affecting her child and also parental
coping skills.
29. In the situation presented above, is the following True or
False? It may be helpful to prepare the parent to have a joint
session so that she can directly "provide permission" for the
child to talk about the abuse in therapy. It would also be
important for the parent to acknowledge the feelings the child
may have
experienced in the past (e.g., fear, sadness, worry) when the
mother became
upset and/or reacted negatively. -
ANSWERS -true
false