Treating Trauma and Traumatic Grief in Children and Adolescents

273 Pages·2006·5.34 MB·English

by  Judith A. Cohen MD

Treating Trauma and Traumatic Grief
in Children and Adolescents

Treating Trauma
and Traumatic Grief
in Children and Adolescents
(cid:1)
J A. C
UDITH OHEN
A P. M
NTHONY ANNARINO
E D
STHER EBLINGER
THE GUILFORD PRESS
New York London
©2006JudithA.Cohen,AnthonyP.Mannarino,andEstherDeblinger
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LibraryofCongressCataloging-in-PublicationData
Cohen,JudithA.
Treatingtraumaandtraumaticgriefinchildrenandadolescents/JudithA.Cohen,
AnthonyP.Mannarino,EstherDeblinger.
p.cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-1-59385-308-2(hardcover:alk.paper)
ISBN-10:1-59385-308-4(hardcover:alk.paper)
1. Post-traumaticstressdisorderinchildren—Treatment. 2. Post-traumaticstress
disorderinadolescence—Treatment. 3. Psychictraumainchildren—
Treatment. 4. Psychictraumainadolescence—Treatment. 5. Griefinchildren—
Treatment. 6. Griefinadolescence—Treatment. 7. Cognitivetherapyfor
children. 8. Cognitivetherapyforteenagers. I. Mannarino,AnthonyP.
II. Deblinger,Esther. III. Title.
RJ506.P55C662006
618.92′8521—dc22
2006006987
About the Authors
JudithA.Cohen,MD,isaboardcertifiedchildandadolescentpsychiatrist,
MedicalDirectoroftheCenterforTraumaticStressinChildrenandAdoles-
centsatAlleghenyGeneralHospitalinPittsburgh,andProfessorofPsychia-
try at Drexel University College of Medicine. With Anthony P. Mannarino
and Esther Deblinger, she developed and tested trauma-focused cognitive-
behavioral therapy (TF-CBT) for sexually abused and multiply traumatized
children and their nonoffending parents over the past 20 years. Since 1983
Dr.Cohenhasbeenfundedbymorethanadozenfederallysupportedgrants
(including funding from the National Institute of Mental Health, the Sub-
stance Abuse and Mental Health Administration, and the U.S. Department
of Justice) to conduct research related to the assessment and treatment of
traumatizedchildren.ShehasservedontheBoardofDirectorsoftheAmeri-
canProfessionalSocietyontheAbuseofChildrenandreceiveditsOutstand-
ing Professional Award in 2000. She is currently a member of the Board of
Directors of the International Society for Traumatic Stress Studies, and is
Associate Editor of the society’s Journal of Traumatic Stress, as well as the
first author of its published guidelines for treating childhood posttraumatic
stressdisorder.Dr.CohenistheprincipalauthorofthePracticeParameters
for the Assessment and Treatment of Children and Adolescents with Post-
traumaticStressDisorder,publishedbytheAmericanAcademyofChildand
AdolescentPsychiatry,whichawardedherits2004RiegerAwardforScien-
tific Achievement. She has also published and taught extensively on topics
related to the assessment and treatment of childhood trauma.
AnthonyP.Mannarino,PhD,isalicensedclinicalpsychologist,theDirector
oftheCenterforTraumaticStressinChildrenandAdolescentsatAllegheny
GeneralHospitalinPittsburghandProfessorofPsychiatryatDrexelUniver-
v
vi About the Authors
sity College of Medicine. Dr. Mannarino has been a leader in the field of
childtraumaticstressforthepast25years.Hehasbeenawardednumerous
federalgrantsfromtheNationalCenteronChildAbuseandNeglectandthe
NationalInstituteofMentalHealthtoinvestigatetheclinicalcourseoftrau-
matic stress symptoms in children and to develop effective treatment
approaches for traumatized children and their families. He has received
many honors for his work, including the Betty Elmer Outstanding Profes-
sional Award; the Most Outstanding Article Award for papers published in
the journal Child Maltreatment, presented by the American Professional
Society on the Abuse of Children (APSAC); the Model Program Award
from the Substance Abuse and Mental Health Services Administration for
“Cognitive Behavioral Therapy for Child Traumatic Stress”; and the Leg-
acy Award from the Greater Pittsburgh Psychological Association. Dr.
Mannarinorecentlycompleteda2-yeartermasthepresidentofAPSACand
is president-elect of the Section on Child Maltreatment, Division 37, Child,
Youth, and Family Services, of the American Psychological Association.
EstherDeblinger,PhD,isalicensedpsychologistandProfessorofPsychiatry
attheUniversityofMedicineandDentistryofNewJersey(UMDNJ)–School
of Osteopathic Medicine. She is also cofounder and codirector of the
CARES (Child Abuse Research Education and Service) Institute, a member
center of the National Child Traumatic Stress Network. Dr. Deblinger has
been funded by the Foundation of UMDNJ, the National Center on Child
Abuse and Neglect, and the National Institute of Mental Health to con-
duct extensive clinical research examining the mental health impact of
child abuse and the treatment of posttraumatic stress disorder and other
abuse-related difficulties. She has written numerous scientific articles and
book chapters, as well as four books, including Treating Sexually Abused
Children and Their Nonoffending Parents: A Cognitive Behavioral Ap-
proach (with Anne Hope Heflin) and the children’s book Let’s Talk about
Taking Care of You!: An Educational Book about Body Safety (with Lori
Stauffer). Dr. Deblinger is a frequent invited speaker at local, national, and
international conferences; has served two terms on the Board of the Ameri-
canProfessionalSocietyontheAbuseofChildren;andhasbeenrecognized
by Woman’s Day magazine and the New Jersey Office of the Child Advo-
cate, and the Substance Abuse and Mental Health Administration, for her
work in helping children overcome posttraumatic stress and other abuse-
related difficulties. In addition to her administrative, research, and teaching
responsibilities, Dr. Deblinger remains active as a clinician and supervisor.
Preface
This book grew out of our earlier treatment manuals and book (Cohen,
Mannarino,&Deblinger,2003;Cohenetal.,2001;Deblinger&Heflin,
1996), which described the use of trauma-focused cognitive-behavioral
therapy (TF-CBT) for traumatized children, childhood traumatic grief,
and children who experienced sexual abuse, respectively. While this
book reflects our own research findings and incorporates important
ideas from clinical research conducted by Edna Foa as well as others, a
substantial amount has been an outgrowth of our recent collaborative
efforts with community practitioners across the United States.
Over the past 8 years we have been fortunate to receive funding
from the National Institute of Mental Health to conduct several treat-
mentoutcomestudiesatbothofourcenters:theAlleghenyGeneralHos-
pital Center for Traumatic Stress in Children and Adolescents and the
CARES (Child Abuse Research Education and Service) Institute. One of
these projects is now completed; the others are still ongoing. The com-
pleted study was conducted jointly at both centers and included more
than 200 children and their parents. It was the first study to document
the efficacy of TF-CBT for multiply traumatized children (Cohen,
Deblinger, Mannarino, & Steer, 2004). In following up with these chil-
dren a year after treatment was completed, we found that TF-CBT may
be particularly helpful for children who have experienced multiple trau-
mas or who have higher levels of depressive symptoms at the start of
treatment (Deblinger, Mannarino, Cohen, & Steer, 2005). At the same
time, the pilot studies for our childhood traumatic grief (CTG) model
have produced very promising results (Cohen, Mannarino, & Knudsen,
2004; Cohen, Mannarino, & Staron, 2005). Given the strength of these
findings, we believe that it is more important than ever for the TF-CBT
vii
viii Preface
modeltobedisseminatedtocommunitypractitioners,sincetheyarethe
therapists most likely to provide therapy to traumatized children.
Since the events of September 11, 2001, and the establishment
of the National Child Traumatic Stress Initiative (www.nctsnet. org),
funded by the Substance Abuse and Mental Health Services Admin-
istration (SAMHSA), the number of therapists requesting training in
the TF-CBT and CTG treatment models has increased exponentially.
These trainings have not been one-way experiences, however. While
community-basedproviderswerelearningtheTF-CBTmodel,welearned
agreatdealfromthemabouthowthismodelmightbeoptimallyimple-
mented in frontline community settings, particularly with children from
diverse cultural backgrounds and children with challenging clinical pre-
sentations and complex family situations. We have tried to incorporate
muchofwhatwelearnedintothisbook,andwethankalloftheprovid-
ers who shared their wisdom and expertise with us.
Until recently, many therapists have been averse to using treatment
manuals, in part because they might have associated such manuals with
rigid, uncreative types of therapeutic approaches. However, particularly
since TF-CBT was recognized by SAMHSA as a “Model Program” for
the treatment of childhood trauma and the prevention of substance
abuse (www.modelprograms.samhsa.gov), we have been gratified by a
deluge of requests for the TF-CBT and CTG treatment manuals.
The convergence of these three factors—emerging treatment find-
ings regarding the efficacy of TF-CBT for multiply traumatized children
and childhood traumatic grief, the revisions we were making to the
treatment manuals based on valuable feedback from community treat-
ment providers, and the increased demand for our treatment manuals—
ledtoourdecisiontomergethepreviousthreedistinctmanualsintothis
single book. We have divided the book into three sections: the first sec-
tion introduces the concept of TF-CBT, while the second and third sec-
tionsdescribethespecifictrauma-focusedandgrief-focusedcomponents
of this model, respectively. (As noted in the body of the book, however,
itiscommonlythecasewhentreatingtraumaticgriefinclinicalpractice
that the trauma- and grief-focused components are intertwined to some
degree.) We have also developed an easily remembered acronym for
the TF-CBT components, PRACTICE, which is repeated frequently
throughout the book. For each of the PRACTICE and grief-focused
treatment components, we include both child and parent interventions,
as well as cultural, developmental, and troubleshooting features.
Weconcludethebookwithabriefsectionontreatmentreviewand
closure,followedbythreeappendices:Appendix1providesusefulhand-
Preface ix
outs and information sheets; Appendix 2 includes a list of resources for
children, parents, and therapists; and Appendix 3 provides information
on additional training for therapists.
Wehopethatthisbookmeetstheneedsoftherapiststryingtolearn
abouthowtobestimplementtheTF-CBTtreatmentmodel.However,as
with any treatment model, it is rarely sufficient to simply read a book
about how it works. To truly learn about this model, therapists would
benefit by putting it into practice when treating traumatized children. If
youareatreatmentprovider,inadditiontoreadingthebook,youmight
alsoconsidersupplementingitbytakingthefreeTF-CBTonlinetraining
course (available at www.musc.edu/tfcbt) or by attending one of the
manyTF-CBTtrainingsprovidedaroundtheUnitedStates,andthentry
implementing the TF-CBT model in your clinical practice. Learning
about the model from various sources and implementing it in your own
practice are among the best ways to learn how TF-CBT can effectively
treat trauma and traumatic grief in children. We welcome your com-
ments, questions, and feedback about the TF-CBT model and hope to
incorporate them in future revisions.