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Children and teenagers who have experienced trauma deserve specialized support — an approach designed with their unique developmental needs in mind, and one that brings the adults who love them into the healing process. Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT, is exactly that. It is one of the most well-researched trauma treatments available for young people, and it has helped hundreds of thousands of children process traumatic experiences and reclaim a sense of safety, trust, and possibility.

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What it is

TF-CBT is a structured, evidence-based therapy developed specifically for children and adolescents — typically ages 3 to 18 — who are experiencing significant emotional or behavioral difficulties related to trauma. It was developed by Dr. Judith Cohen, Dr. Anthony Mannarino, and Dr. Esther Deblinger, and is supported by decades of rigorous research. A defining feature of TF-CBT is the involvement of a caregiver — most often a parent or guardian — as an active participant in treatment. Caregivers learn the same skills their child is learning, which strengthens the family relationship and gives them the tools to support their child’s healing at home.

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How it works

TF-CBT is organized around a framework of skill-building phases that both the child and caregiver work through — first separately, and then together. The components are often remembered by the acronym PRACTICE.
Both the child and caregiver learn about trauma, its effects, and the treatment process. Understanding that trauma reactions are normal responses to abnormal experiences — not signs of weakness or damage — is itself therapeutic.
Children learn simple, age-appropriate relaxation strategies — deep breathing, progressive muscle relaxation, visualization — to help manage the physical symptoms of trauma, such as tension, hyperarousal, and sleep difficulties.
Affective modulation helps children identify, understand, and manage their emotions. Many trauma survivors have learned to shut down or avoid feelings. This component builds emotional vocabulary and coping tools.
Children learn the connection between thoughts, feelings, and behaviors — a core CBT concept — in age-appropriate ways. This sets the foundation for identifying and challenging unhelpful thoughts related to the trauma.
The child gradually creates a narrative of their traumatic experience — through words, drawings, or other age-appropriate formats — with their therapist’s careful support. This is the heart of TF-CBT. Telling the story in a safe environment allows the trauma memory to be processed rather than avoided, reducing its power over the present.
If the child is avoiding specific places, people, or situations that are reminders of the trauma (but are actually safe), gradual exposure helps them reclaim those parts of their world.
At this stage, the child shares their trauma narrative with their caregiver in a supported, planned session. This sharing reduces shame, strengthens the parent-child relationship, and allows the caregiver to respond in validating, supportive ways.
The final component builds safety skills — helping children recognize unsafe situations, develop personal safety plans, and feel confident in their ability to protect themselves going forward.

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What to expect in sessions

TF-CBT typically runs for 12 to 25 sessions, with the therapist meeting separately with the child and caregiver for portions of each session. The pace is adjusted to the individual child and family.
You will never be asked to relive the trauma in graphic or retraumatizing ways. The trauma narrative is developed gradually and carefully, with the child always in control of the process. The goal is to transform the trauma memory into something that can be told, understood, and integrated — not something that overwhelms.
Sessions with children are engaging and age-appropriate. Therapists use play, art, writing, and other creative means to make the work accessible and even enjoyable, even when the subject matter is difficult. Caregivers meet with the therapist regularly — typically in the same session but in separate portions of the time — to learn the same skills and strategies their child is developing. This parallel process is essential to the treatment’s effectiveness.

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Who it helps

TF-CBT is appropriate for children and adolescents who have experienced:
  • Physical, sexual, or emotional abuse
  • Witnessing domestic violence
  • Sudden loss of a parent or caregiver
  • Natural disasters or accidents
  • Community violence or school violence
  • Medical trauma
It treats a range of trauma-related symptoms including PTSD, depression, anxiety, behavioral problems, and trauma-related shame and guilt.
Research shows TF-CBT is effective across diverse populations and trauma types. It has been studied in children as young as 3 and as old as 18, and has been adapted for use with preschoolers with a specialized protocol.

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At Guzman & Baker

Our therapists who are trained in TF-CBT bring warmth, creativity, and expertise to their work with young people and their families. We understand that bringing your child to therapy can feel daunting, and we are here to support the whole family through the process.
Caregiver involvement is one of the most powerful predictors of positive outcomes in TF-CBT. Your engagement — even when it feels hard — makes a real difference for your child’s healing.
If your child has experienced trauma and you are not sure whether TF-CBT is the right fit, contact us for a consultation. We will take time to understand your family’s situation and help you figure out the best path forward.