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Treating Complex Trauma in Children and Their Families

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Table of Contents

Acknowledgments About the Authors Chapter 1: Introduction Empirical Support for ITCT Structure of This Book Chapter 2: Effects of Complex Trauma in Children Complex Posttraumatic Events Effects of Complex Trauma Phenomena That May Intensify, Compound, or Complicate Trauma Effects Chapter 3: Central Aspects of ITCT-C Assessment-Driven Treatment Attention to Complex Trauma Issues Early Focus on Immediate Issues Focus on a Positive Working Relationship With the Therapist Customization Attention to Attachment Difficulties Skills Development Titrated Therapeutic Exposure and Exploration of Trauma Memories A Flexible Time Frame Advocacy and Interventions at the System Level Positive Professional Collaborations and Therapist Self-Care Chapter 4: Assessment of Complex Trauma Background and Current Assessment Information Assessment of Trauma Exposure Evaluation of Trauma-Relevant Symptoms Assessment Measures That Can Be Used in ITCT-C Chapter 5: The Assessment-Treatment Flowchart for Children (ATF-C) and the Problems-to-Components Grid for Children (PCG-C) The Assessment-Treatment Flowchart for Children The Problems-to-Components Grid for Children (PCG-C) Chapter 6: Characteristics and Tools of the Therapy Environment The Therapy Office/Agency Environment Session Consistency and Safety Play Therapy Materials and Resources Chapter 7: Relationship Building and Support Expanding the Child's Sense of Identity Therapist Behaviors That Contribute to a Positive Therapeutic Relationship Use of Play and Humor The Role of Attachment History for the Therapist and the Client Family Therapy, Group Therapy, and Advocacy to Enhance the Therapeutic Relationship Advocacy and Case Management Dealing With Difficult Client-Therapist Relationship Challenges A Special Topic: Pet-Assisted Therapy or Sessions Involving Pets Chapter 8: Safety Interventions Impediments to Therapy Reporting Suspected Child Abuse and Neglect Ongoing Monitoring of Safety Issues and Interventions Suicidality and Harmful Behavior Toward Others: Assessment and Interventions Possible Safety Issues During Monitored Visits Safety Within the Therapy Sessions Chapter 9: Psychoeducation General Focus of Psychoeducation Books and Other Materials Used in ITCT-C Other Approaches to Psychoeducation With Children Psychoeducation With Caretakers Chapter 10: Advocacy and Systems Interventions Culture-Specific Advocacy Advocacy for Economically Disadvantaged Clients Advocacy as Therapy Mental Health Advocacy and Support for Caretakers Advocacy With Child Protection and Foster Care Systems Court/Legal Systems Advocacy School Collaborations and Advocacy Chapter 11: Distress Reduction and Affect Regulation Training Acute Distress Reduction Emotional Regulation Capacity Chapter 12: Facilitating Positive Identity Resilience and Its Relationship to Self-Esteem Specific Interventions to Enhance Positive Identity Development, Self-Efficacy, and Assertiveness Chapter 13: Cognitive and Emotional Processing Preconditions for Emotional Processing When Addressing Complex Trauma Cognitive Processing Emotional Processing Chapter 14: Relational/Attachment Processing Specific Client Attachment Styles Avoidant Attachment Resistant/Preoccupied/Ambivalent Attachment Disorganized Attachment Assessment of Attachment Disturbance Relational Processing of Complex Trauma Effects Conclusions Chapter 15: Interventions With Caretakers ITCT-C Caretaker Interventions: Multiple Modalities Individual Psychotherapy With Caretakers Couple's Sessions Conjoint/Dyadic Caretaker-Child Interventions Support, Education, and Parenting Skills The Caretaker Support Group Module Follow-Up Group Chapter 16: Family Therapy Who to Include in Family Therapy Sessions? Cultural Factors to Consider When Should Family Therapy Be Considered? What Improves the Likelihood of Effective Family Therapy? Impacts of Systems Issues on Families Family Therapy Interventions ITCT-C Family Therapy Module for Sessions Chapter 17: School-Based Adaptation of ITCT-C School-Based ITCT-C Interventions The ITCT-C School-Based Group Model Chapter 18: Supervision and Therapist Self-Care Common Reactions and Feelings in Therapists Working in the Trauma Field Supervision and Consultation Team-Building and Support Further Training and Professional Development Personal Therapy Developing a Mindful Perspective Self-Care Appendix References Index

About the Author

Cheryl B. Lanktree, Ph.D. is Project Director of the USC Adolescent Trauma Training Center, National Child Traumatic Stress Network, a Research Assistant Professor of Psychiatry at the University of Southern California, and a licensed clinical psychologist in private practice. The developer of Integrative Treatment of Complex Trauma (ITCT), she has published various articles, chapters, treatment manuals, and books on treating complex trauma in children and adolescents. Her website is John N. Briere, PhD, is Associate Professor of Psychiatry and Psychology at the Keck School of Medicine, University of Southern California, where he consults and teaches in the ER, burn unit, and inpatient psychiatry, and Center Director of the USC Adolescent Trauma Training Center's National Child Traumatic Stress Network. A past president of the International Society for Traumatic Stress Studies, he is recipient of the Robert S. Laufer Memorial Award for Scientific Achievement from ISTSS, and the Award for Outstanding Contributions to the Science of Trauma Psychology from the American Psychological Association's Division 56, and has been designated Highly Cited Researcher (Behavioral Sciences) by the Institute for Scientific Information. He is author of a number of books, articles, and psychological tests in the areas of trauma and interpersonal violence, and has a long-standing interest in the clinical applications of meditation, mindfulness, and compassion. His website is


"A wonderful integrative approach for students to learn how to work with both child who have experience trauma as well as families." -- Becky L. Thomas "Relevant, timely, and essential for all disciplines working to effectively and affectively help children. This book provides the theory underlining how to begin the healing process with children while demonstrating sensitivity and clarity as one proceeds with specific steps towards that healing." -- Naomi Lynch White "An indispensable, practical guide for every therapist working with children and families who have been exposed to complex trauma. The treatment model is truly integrative in incorporating the authors' extensive experience, sophisticated clinical sensitivity, and broad knowledge of the evidence-informed approaches to psychotherapy, and their deep understanding of the challenges facing children and families who are recovering from complex trauma." -- Julian Ford "Once again, the brilliance of the Lanktree and Briere team has been demonstrated. The comprehensive nature and depth of this challenging topic is thoughtfully and creatively illustrated. The cultural/marginalization perspective is unparalleled within the topic of complex trauma. This text is a must read for both my undergraduate and graduate trauma-focused courses." -- Russell T. Jones "This is a must-read for clinicians who help traumatized children and their families. Lanktree and Briere have developed and tested an accessible, integrated, assessment-driven model that recognizes the significant impact of trauma on young children in different social contexts. A valuable alternative to rigidly manualized treatments, this book relies on clinical judgment and customized planning." -- Eliana Gil

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