Academic journal article European Journal of Psychotraumatology

Case Report: Manualized Trauma-Focused Cognitive Behavioral Therapy with an Unaccompanied Refugee Minor Girl

Academic journal article European Journal of Psychotraumatology

Case Report: Manualized Trauma-Focused Cognitive Behavioral Therapy with an Unaccompanied Refugee Minor Girl

Article excerpt

Responsible Editor: Jane Herlihy, Centre for the Study of Emotion and Law, UK.

Copyright: © 2016 Johanna Unterhitzenberger and Rita Rosner. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Received: 23 July 2015; Revised: 10 December 2015; Accepted: 15 December 2015; Published: 14 January 2016

Competing interests and funding: There is no conflict of interest in the present study for any of the authors.

*Correspondence to: Johanna Unterhitzenberger, Clinical and Biological Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstrasse 25, DE-85071 Eichstätt, Germany, Email:

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Trauma-focused cognitive behavioral therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006) is an evidence-based treatment manual for children and adolescents with posttraumatic stress disorder (PTSD). In line with treatment guidelines, a recent review (Leenarts, Diehle, Doroleijers, Jansma, & Lindauer, 2013; PTSD after childhood maltreatment) reported manualized TF-CBT to be the best-supported therapy for young people. While TF-CBT may be understood as a treatment approach per se , we are specifically referring to Cohen and colleagues' manual in this paper. Recently, we reported on six unaccompanied refugee minors (URMs) who were treated with TF-CBT (Cohen et al., 2006) showing the feasibility of this approach for the group of URMs (Unterhitzenberger et al., 2015). Still, many clinicians are uncertain about manualized therapies for young refugees. We present this case report to illustrate how this treatment is applied to a URM patient in detail.

TF-CBT (Cohen et al., 2006) is a short-term psychotherapy involving twelve 45-50 min sessions with the child and the same number with a caregiver (usually a parent). The therapy comprises eight modules (acronym: PRACTICE): (1) psychoeducation with child and caregiver, teaching positive parenting skills, (2) relaxation, (3) affective modulation and emotion regulation, (4), cognitive processing, (5) trauma narrative, (6) in vivo exposure (if necessary), (7) conjoint child-caregiver session sharing the narrative, and (8) enhancing future safety (Cohen et al., 2006). TF-CBT is reported to be culturally sensitive in each module and was tested in culturally diverse settings beforehand (e.g., Murray et al., 2015). Murray, Cohen, Ellis and Mannarino (2008) name some components that make TF-CBT applicable in young refugees: its theoretical basis, skills-based approach, and short duration. Also, cultural modifications are possible without changing the treatment manual. Yet, only one study has tested its efficacy for refugee children (Schottelkorb, Doumas, & Garcia, 2012). However, discrepancies from the original manual were numerous (two to four parent sessions, no conjoint sessions), which hinders the evaluation of results.

Although the treatment recommendations for children and adolescents with PTSD are clear, young refugees are just starting to receive attention in traumatic stress research. Reviews of the literature on mental health interventions in this population (Eberle-Sejari, Nocon, & Rosner, 2015; Tyrer & Fazel, 2014) reveal major methodological limitations. Additionally, most treatment protocols have been studied only once. However, a trauma-focused approach seems promising (Eberle-Sejari et al. …

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