Magazine article Clinical Psychiatry News

Establish Clear Goals for Trauma-Focused CBT

Magazine article Clinical Psychiatry News

Establish Clear Goals for Trauma-Focused CBT

Article excerpt

SAN DIEGO -- Before Laura Merchant begins trauma-focused cognitive-behavioral therapy with children and their caregivers, she provides an estimate for them of the number of treatment sessions that will be required for effective intervention.

This approach "has made a huge difference, especially for older teens and parents, when they have a sense that [therapy] won't take forever," said Ms. Merchant, a licensed clinical social worker who is assistant director of the Seattle-based Harborview Center for Sexual Assault and Traumatic Stress. "It gives them a sense of hope."

When developing a treatment plan, she uses her clinical judgment to estimate the number of sessions. "I tell them, 'I think this is something that may take 5 sessions, or 12 sessions,' whatever I think it may be," she said at a conference sponsored by Rady Children's Hospital, San Diego. Then she tells them, "When we get around that time, we're going to see how things are going and see if we need to renegotiate [the number of sessions] one more time."

Establishing a functional outcome or goal with the children and caregivers is an other important part of effective trauma-focused cognitive-behavioral therapy. "My original therapeutic framework was to be very nondirective and very client centered," Ms. Merchant commented. "I still believe we need to be client centered, but I'm also going to hold in my head what the goals are that we've agreed upon, and I'm going to keep track of that information so that when the clients get off track a bit, my job is to kind of rein them back and get refocused and readjusted so that leads to a functional outcome."

She said she favors a treatment approach that focuses on the here and now. "I'm also going to be focusing on [current] thoughts and feelings, and how those thoughts and feelings are impacting behaviors," Ms. …

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