Trauma, whether it is caused by a single occurrence, a series of incidents, or a sequence of long-term events, has a varied impact on everyone. However, although some individuals may openly exhibit indicators of trauma, many others will demonstrate resilient responses that do not fulfill diagnostic criteria for the condition. Trauma causes the production of cortisol and adrenaline in the body, which triggers the activation of the body’s normal protective systems of fight, flight, and freeze. Unresolved traumatic events might cause these behaviors to manifest themselves even in non-threatening situations. Trauma, especially when it happens in childhood, has the potential to affect a person’s brain, resulting in prolonged behavioral and physical health problems in the future. When we encounter a traumatic experience or a series of events (such as being molested, getting involved in a car accident, or losing a parent), our bodies react physically in order to cope with the incident or series of events that have occurred (Everstine & Everstine, 2019). To be sure, we don’t always have complete control over our responses. They are influenced by our genetic make-up as well as our coping techniques. One of the response is go through a trauma-related program that is known to treat the specific type of trauma one is suffering from. This is a critical survival tactic since it allows you to respond quickly. This paper presents a deep analysis of how Trauma focused cognitive behavior therapy program (TF-CBTP) is used to treat child molestation trauma.
Overview of the trauma topic
According to Cronje & Vilakazi (2020), child molestation trauma refers to “the extremely unpleasant or upsetting experience of sexually assaulting by a child, which often results in long-term mental and physical harm.” The effects of such events on a child might include feeling overwhelmed, anxious, and/or helpless. Apart from the bodily damage that molestation may do, a child’s reactions to molestation can have prolonged and even generational implications. Physical, psychological, and behavioral consequences of molestation in childhood have been associated with behavioral, psychological and physical repercussions. Although these ramifications may be independent, there is a possibility that they are interrelated. When a child is molested or abused for example, it may stunt his or her brain’s development and cause behaviorism problems such as low self-worth.
Child molestation trauma is extremely common among children who have been sexually assaulted, with one study finding that approximately 65 percent of survivors of childhood sexual assault suffer from high levels of trauma, with 40 percent experiencing symptoms of PTSD. Child molestation trauma may have symptoms such as reliving the traumatic event, avoiding reminders of the trauma, being shocked fast, flashbacks, and having bad views and beliefs. The long-term mental health implications of child molestation may actually shorten the lives of those who have experienced it. A number of studies have shown that adverse childhood experiences, such as child sexual abuse, are associated with significant and long-term health consequences. Adult survivors of trauma are far more likely than children and teenagers to have mental and physical health issues. Among the mental health issues that might arise are depression and anxiety. In the long run, depression is the most prevalent long-term outcome associated with survivors of childhood sexual abuse (Peters et al., 2021). In the majority of cases, when children are sexually abused, they internalize the event(s), resulting in negative self-perceptions that last throughout childhood and into adulthood. Anxiety and depression are two sides of the same coin, and they’re intimately related to one another. Children who have been sexually abused are more prone than other children to have chronic anxiety, panic attacks, and tension, as well as to acquire phobias or fears of various kinds. According to the World Health Organization, research has shown that child survivors of sexual abuse have stress and anxiety levels that are equivalent to those experienced by war veterans. A person’s physical health may be negatively affected by a variety of factors such as substance abuse, obesity, high blood pressure, and diabetes.
For decades, Trauma-focused cognitive behavioral therapy (TF-CBT) has proved effective to help children overcome trauma-related sexual molestation or abuse. It’s designed to minimize negative emotional and behavioral responses to trauma, such as sexual assault and other types of maltreatment, which may result in trauma. Through this program, adults who have been sexually abused as children may learn successful parenting, stress management, behavior control, and communication skills. Trauma caused by child molestation teaches children that the world is scary and that adults may not be able to protect. Such children often get angered easily and find it hard trusting anyone, prompting their parents to become bewildered and upset as a result. By using the Trauma-focused cognitive behavioral therapy program, parents or guardians can learn better ways to read their children’s emotions and respond in a positive manner (Canale et al., 2022). This allows the already traumatized child to get opportunities to relearn that others can be trusted too. Since the program have sections where it focuses on family treatment, traumatized children would benefit substantially from family-centered treatment that includes engaging with their parents on different levels.
Overview of the program
Trauma focused cognitive behavioral therapy uses the Cognitive Behavioral Therapy
(CBT). The theory behind this approach is that one’s cognitions play a critical part in the construction of behavioral and emotional responses to life events, and that this method may be used to measure these reactions. The TF-CBT is based on the concept that our thoughts, emotions, and actions are all connected and that we can’t think without feeling. Our thoughts, in particular, have an influence on our emotions and behaviors. It is possible that negative and unrealistic thoughts would upset us and cause troubles as a result of this. When a person is experiencing psychological pain, their perception of the world becomes skewed, which has a negative impact on their behavior and decisions (Brown, Cohen & Mannarino, 2020). When trauma victims engage in cognitive behavioral therapy, they are taught how to become aware when they are making negative interpretations and the behavioral patterns that are supporting the distorted thinking.
Trauma-focused cognitive behavioral therapy (TF-CBT) is a culturally adapted approach that is appropriate for a broad variety of individuals regardless of their culture or gender. It retains the core principles of classic TF-CBT while also including modules that include cultural considerations throughout the treatment process. Throughout the program, counselors demonstrate their cultural sensitivity in a number of ways. As a starting point, counselors may be attentive to the cultural standard that have had an impact on the participants’ lives. Counselors may also address components of the program that promote cultural sensitivity, allowing them to suggest TF-CBT materials to parents as a way to connect with their children that is compatible with their social and cultural environment (Ovenstad et al., 2020). TF-CBT materials are designed to help parents connect with their children in a culturally responsive way. Additionally, actions such as focus groups with healthcare providers, involving the community in the development process, and making adjustments to intervention materials as needed have all been taken to ensure that interventions implemented in developing and developed countries are culturally appropriate.
Data collection and reporting is a requirement of Trauma focused cognitive behavioral therapy program. Data collection is vital since it serves a variety of purposes. Evidence-based program providers use data collection approaches to guarantee that the programs they provide have the intended impact on the children, adolescents, and/or families who participate in the programs they offer. It also makes it possible to do quality assurance and model fidelity monitoring, which helps to ensure that the program is conducted in accordance with plan. This program makes use of a variety of screening tools, including the Brief Trauma Questionnaire (BTQ), Trauma History Screen (THS), and Combat Exposure Scale (CES). Due to the fact that clients’ trauma histories and accompanying symptoms are often overlooked without screening, practitioners are forced to concentrate their efforts on symptoms and illnesses that may only partly explain client behavior. Individuals who have a history of trauma and who are experiencing trauma-related symptoms may be identified by behavioral health professionals as being at risk of developing more widespread and severe traumatic stress symptoms. A vital phase in the counseling process, screening allows counsellors to obtain information about the traumatic scenario that the client has been exposed to.
Goals of the program
- Helping victims (children) cope with trauma-related pain.
- Increasing the effectiveness of interventions for molested children.
- Improve parental support and parenting abilities.
- Improve parent-child communication and connection.
- Increase child’s capacity to cope with change
- Reduce embarrassment and shame related to child molestation experiences.
Measuring your progress towards a goal allows you to know whether you have made any progress, whether you’ve come to a complete stop, or whether you’ve fallen farther behind. When it comes to TF-CBT, measuring goals is useful in helping counselors make or adjust a plan of action for getting on track. Some of the techniques used to measure the above highlighted goals include monitoring daily experience, preparing ahead, and analyzing victim’s progress to recovery.
Program stages
TF-CBT consists of three major stages of intervention: stabilization, trauma narration and processing, and consolidation/integration. Because continued caregiver participation is a vital component of the program, individual sessions with the same therapist for both the child and the caregiver, are organized as part of the treatment plan. In the first stage, the physician will guide the clients through TF-CBT, necessitate psychoeducation on recovery, and assist them in meaningful healing and growth in the subsequent stages of treatment (Martin et al., 2019). The first section starts with an extremely important step: trauma education. Trauma and the usual reactions to stressful experiences will be reviewed with both the parents and the child during this session. When discussing PTSD and regular behavioral concerns with clients, the therapist will reassure the child that their emotions are normal, understandable, and that their sentiments are valid. This necessitates assurance to both the parents and the child about the likelihood of recovery. A good therapist would agree that, despite the fact that it will be a long road and a great deal of effort, it is possible to restart a fresh life with new and happy memories.
In the second stage, the therapist assists the child through the trauma narrative process. This stage involves narrating the traumatic incident or experience (s). Initially, it may be challenging to begin because the sensations triggered by the trauma may reemerge as the victim recalls the circumstances of the event, but as the process proceeds, they will become less difficult to complete. Starting with the facts — the who, what, when, and where of the meeting – may be good to the child in terms of learning more about himself or herself. They are then free to express their thoughts and feelings regarding the event. After they have become comfortable identifying or expressing their feelings during the session, they may go to the most painful or disturbing elements of their trauma, if they want. Making a thorough account of the event will be difficult, but it is very necessary (Pollio, Neubauer & Deblinger, 2020). Once everything has been completed, the child should write a coherent narrative that includes a concluding paragraph describing how they feel and whether or not they have been extremely affected by the incident, if applicable. Following the completion of the trauma story, the child may choose to share it with the parents.
In stage three (Integration/consolidation) the objectives is to integrate the lessons, enhance relationships, and position the family for success. Molestation reminders are commonplace triggers that may cause a child to have vivid, unpleasant, and debilitating flashbacks of the trauma that he or she has endured. As part of the in-person mastery component, the therapist will work with the child to help him or her overcome his or her dislike to broad reminders while also focusing on capturing specific reminders. During TF-CBT, the therapist may utilize the combined parent-child sessions to assist families in reconnecting and making plans for their child’s future healing and growth. During these sessions, the child may be encouraged to communicate their traumatic experience with their parents, and the two of them may work together to develop their communication skills, both in relation to the trauma and in general. This kind of workshop may also be beneficial in assisting families in building a family safety plan in the case of a future danger or tragedy, among other things.
Practitioner training
The type of training that practitioners receive in order to provide extensive empathy in trauma intervention reflects adherence to key principles that include safety, peer support, trustworthiness, collaboration, transparency, cultural issues and empowerment. During this training, practitioners will learn how to detect the fundamental characteristics of a trauma-informed program and how they may use these characteristics to the patient’s advantage. The training focuses on trauma neurobiology in order to demonstrate how trauma effects the brain, decision-making, and coping in a scientifically sound and easily understandable way. It enables therapists to have a better understanding of the reasons why clients behave in unreasonable or self-destructive ways. In this training, practitioners learn about the relationship between prior experiences of abuse and current or recent suicidal behavior and/or self-injury. A large portion of the training involves asking questions about suicide, addressing dangerous behaviors, building connections, and providing services. Techniques such as grounding, safe coping, and responding empathetically to confessions of suicidal thoughts are among of those that are practiced.
One of the skills needed to achieve biopsychosocial empathy is self-calibration. It has been said that a physician is similar to a musical instrument that must be calibrated, tuned, and adjusted in order to perform correctly. It is necessary for practitioners to perform calibration in order to achieve better health outcomes. This involves developing an acceptable emotional tone, acquiring an accurate history, and distinguishing between what the patient needs and what the patient claims to desire. Self-awareness is the other skill needed to achieve biopsychosocial empathy. A greater sense of self-awareness will enable the physician to have a better understanding of what they are doing in their professional life (Cicek, Yilmaz & Aslanhan, 2019). Because of their enhanced self-awareness, they will have a better understanding of how others around them may respond to their unspoken and expressed actions. The other skill needed is trust. The ability to establish an emotional tone that is conducive to a therapeutic connection is clearly recognized by the professional clinician as a critical competency in the therapeutic relationship. Therefore, all consultations may be rated on the basis of their warmth, optimism, honesty, and sense of humour, among other characteristics. Additionally, the physician must be able to recognize and explain his or her own emotions, as well as create constraints and boundaries as required in order to have a healthy working relationship with his or her patient.
Conclusion
Child molestation is one of the most complicated and puzzling challenges facing society today. While it is hard to ascertain the whole magnitude of the problem, the sheer number of families who have been affected is staggering. Most children are abused by someone they know, whether it’s a member of their own family or close family friend, a religious leader or an adult in authority over the children’s lives. Sexual abuse of minors is a heinous crime against humanity. It has both short- and long-term implications for the victims. Survivors of abuse may have long-term psychological, emotional, and/or bodily consequences as a result of their experience. Therapy programs for victims and their families, on the other hand, may assist in the healing process and teach skills to ensure that the abused child recovers from his or her traumatic experience after the abuse.
References
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Canale, C. A., Hayes, A. M., Yasinski, C., Grasso, D. J., Webb, C., & Deblinger, E. (2022). Caregiver behaviors and child distress in trauma narration and processing sessions of trauma-focused cognitive behavioral therapy (TF-CBT). Behavior Therapy, 53(1), 64-79.
Cicek, E., Yilmaz, A., & Aslanhan, H. (2019). Evaluation of empathy and biopsychosocial approaches of medical faculty assistant doctors. Journal of Education and Health Promotion, 8.
Cronje, J. H., & Vilakazi, M. J. (2020). Secondary traumatic stress in police detective officers dealing with complainants of sexual crimes. South African Journal of Psychology, 50(4), 520-529.
Everstine, D. S., & Everstine, L. (2019). Sexual trauma in children and adolescents: Dynamics & treatment. Routledge.
Martin, C. G., Everett, Y., Skowron, E. A., & Zalewski, M. (2019). The role of caregiver psychopathology in the treatment of childhood trauma with trauma-focused cognitive behavioral therapy: A systematic review. Clinical child and family psychology review, 22(3), 273-289.
Ovenstad, K. S., Ormhaug, S. M., Shirk, S. R., & Jensen, T. K. (2020). Therapists’ behaviors and youths’ therapeutic alliance during trauma-focused cognitive behavioral therapy. Journal of Consulting and Clinical Psychology, 88(4), 350.
Peters, W., Rice, S., Cohen, J., Murray, L., Schley, C., Alvarez-Jimenez, M., & Bendall, S. (2021). Trauma-focused cognitive–behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth. Psychological Trauma: Theory, Research, Practice, and Policy, 13(3), 313.
Pollio, E., Neubauer, F., & Deblinger, E. (2020). Treating Trauma-Related Symptoms in Children and Adolescents. In The Oxford Handbook of Traumatic Stress Disorders, Second Edition.
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