Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is a mental health treatment model designed for children ages 3- 18 who are experiencing difficulties after trauma exposure such as sexual abuse, exposure to violence, or a natural disaster. TF-CBT was developed by Judy Cohen, M.D., Anthony Mannarino, Ph.D. and Esther Deblinger, Ph.D.

TF-CBT is an evidenced-based intervention that is a SAMHSA best practice in the treatment of childhood posttraumatic stress disorder (PTSD). Features of TF-CBT:

  • Treatment is short-term. On average, TF-CBT is completed over 18-24 weekly sessions.
  • TF-CBT is skills–based. Families are taught many skills in sessions, such as relaxation, to reduce trauma-related distress. In order for treatment to be effective, therapists will also ask children and caregivers to practice and use these skills at home and other places where stress may occur.
  • TF-CBT involves the family. Caregivers are actively included in treatment with their child and are key to successful outcomes. Typically, therapists in each TF-CBT session will spend individual time with the child, check in separately with the caregiver, and include combined family time. However, when a child does not have a caregiver who can be involved in treatment, TF-CBT treatment can still be effective in reducing childhood trauma symptoms.
  • Sessions will be structured. TF-CBT therapists will have a planned focus for each session to cover skills and activities known to be important for reducing distress related to trauma.
  • Treatment will be engaging to the family! TF-CBT therapists will strive to be creative and tailor activities to engage children and provide an enjoyable and safe treatment experience.

Frequently Asked Questions

TF-CBT Therapy FAQ

Do all children who are abused or neglected (or in foster care) need TF-CBT?
No. TF-CBT is specifically designed to treat trauma symptoms. What we know is that some children who go through very difficult experiences will not develop trauma symptoms, and would not need TF-CBT. It is recommended that all children who experience trauma participate in an evaluation to determine if trauma symptoms are present in order to plan effective treatment.
What can I expect if I take my child to a TF-CBT Therapists?

Expect therapy to be both hard work and fun. Your therapist will begin by assessing your child for trauma symptoms to determine if TF-CBT is the best treatment. Session time will be structured, although there will always be time for the therapist to check in with you about the past week, he/she will have specific goals and activities to complete with your child (and you) each week. Plan on treatment to last approximately 18-24 weeks. If you are interested in seeking services through The University of Oklahoma Health Sciences Center, please follow this link OUHSC Clinical

What if a child doesn’t want to talk about their past?

Not wanting to talk about difficult or painful memories is very common, and understandable! However, it is often healing to be able to face painful memories and allows a child and family to move forward. In TF-CBT, children gradually progress towards talking about their pasts, while learning important coping skills to manage distress. Children are encouraged to talk about their past only when it can be done in a safe and therapeutic way and the child and family are ready.

What training is required for a therapist who wants to provide TF-CBT?

Several key elements are required for a therapist to truly learn any new treatment model. The generally accepted trainings requirements for TF-CBT are for a therapist to attend the 2-day in-person “Introduction to Trauma-Focused Cognitive-Behavior Therapy” provided by a Master Trainer and to complete at least one TF-CBT case while under consultation with a Master Trainer. Master trainers in the stte of Oklahoma are Susan Schmidt, Ph.D., Elizabeth Risch, Ph.D., Dolores Subia Bigfoot, Ph.D., and Roy Van Tassell, LPC.

How do I know if a therapist can provide TF-CBT?

We have developed a interactive map (here) to aid families in locating a TF-CBT provider. And you can always ask!

What if a child is acting out sexually? Is TF-CBT appropriate?

Maybe. It would depend on the child’s level of trauma symptoms. Treatment is also available for children who have sexually acting out beaviors without trauma symptoms. A thorough evaluation of trauma history, symptoms, and sexual behaviors would allow a clinician to determine what treatment will be most appropriate. Please visit the Children with Sexual Behavior Problems website to learn more. 


TF-CBT is the most well-researched therapy model for treating symptoms of childhood trauma. To date, there are 22 studies showing that TF-CBT is effective in improving child functioning after trauma. Below are important highlights from the research on TF-CBT:

  • TF-CBT reduces symptoms of childhood posttraumatic stress disorder (PTSD). In addition, studies have shown that treatment results in improvements in depression, behavior problems, feelings of shame and guilt, and unhealthy trauma-related beliefs.
  • TF-CBT is appropriate for treating reactions to ALL types of childhood trauma. TF-CBT was initially designed to treat children who had been sexually abused. Research has found TF-CBT to be helpful in treating diverse trauma types, including single-incident traumas (such as accidents or natural disasters) and chronic traumatic experiences (such as child abuse and neglect or witnessing violence).
  • TF-CBT is appropriate for children with multiple traumatic experiences. Children in most TF-CBT research studies have commonly experienced multiple traumatic events and improved significantly from TF-CBT treatment. In fact, it is most commonly children with multiple traumas who are referred for and receive treatment.
  • TF-CBT is effectively used with a variety of family and living situations. Many TF-CBT studies have included children in out-of-home care (e.g., foster placements). Research has also shown TF-CBT can be effectively used in residential treatment facilities. TF-CBT can include biological parents, foster parents, residential support staff, or other trusted adults, with the goal of aiding the child in practicing skills outside of sessions.
  • TF-CBT can successfully reduce acting out behaviors while treating PTSD. Children with trauma histories may present with mild to severe behavior problems, including aggressive behavior toward self or others, sexual behavior problems, and defiance. Caregiver involvement in treatment is key when targeting behavior problems. TF-CBT providers collaborate with caregivers to develop a plan to reduce problem behaviors, and prioritize reduction of potentially harmful behaviors in the treatment plan.