Parent-Led Therapist-Assisted Treatment for Childhood Trauma: Parents’ and Children’s Perceptions of Trauma Exposure Activities and Changes

Background and Purpose: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment for childhood trauma that is therapist-led and involves parents. Stepped care TF-CBT (SC-TF-CBT) includes Step 1, a parent-led therapist-assisted treatment. A primary component of Step 1 includes 11 parent-child meetings utilizing an empirically informed trauma-focused activity book. Step 2 is standard TF-CBT. While research has explored parents’ and children’s experience of TF-CBT, little is known about parents’ and children’s experience of a parent-led trauma-focused treatment.

The purpose of this qualitative study was to describe parents’ and children’s experiences of processing the trauma narrative (e.g., drawing, discussing, imaginal exposure, and in vivo exposure) as a part of a parent-led therapist-assisted treatment for childhood trauma. A secondary aim was to describe how parents and children viewed the changes that occurred, including changes in the child and changes in the parent-child relationship, from before the parent-led therapist-assisted treatment to post treatment.

Methods: Participants for this study were part of a randomized clinical trial comparing SC-TF-CBT to standard TF-CBT. Only parents (n = 42) and children (n = 40; ages 4-12; 52.5% female) who completed Step 1 and did not receive Step 2 were included. Most children experienced sexual abuse (35.5%), domestic violence (17.5%), or the death of a parent (17.5%). More than half (55%) of children were White; 25% were mixed race; 20% were Black/African American; and 27.5% were Hispanic/LatinX. Interview questions explored hearing/telling the trauma narrative, experiences of parent-child meetings and trauma exposure activities, and changes in the child and parent-child relationship. Data were collected via individual semi-structured interviews conducted during the maintenance phase, six weeks after Step 1. Interviews were transcribed and a six-step reflexive thematic analysis was followed. Themes were developed and compared between parents and children.

Results: Data analysis revealed that parents and children initially experienced difficulty with hearing and telling the trauma narrative, respectively. This process became easier throughout treatment. Completing the exposures was also difficult for parents and children but was a positive experience overall. Most parents indicated that, despite some challenges, the parent-child meetings and trauma exposure activities were doable. Parents and children reported improved child affect, interpersonal communication, and child PTSD symptoms, and that their relationship became closer. Parents noted that they observed their child’s behavior improve and that children were using the learned coping skills. Some parents and children reported no change in their relationship. In general, parents reported that, upon completion of treatment, their children became more like they were before the traumatic event.

Conclusions and Implications: Findings suggest that a parent-led therapist-assisted treatment for children after trauma is a feasible intervention that may be difficult but doable and perceived as resulting in improved child symptoms, communication, parent-child relationship, and coping. To assist with the difficulty of parents and children processing the trauma narrative, social workers should prepare both parents and children for what they can anticipate with Step 1; provide on-going support throughout treatment; and collaborate with parents to tailor the approach if children experience difficulty in the parent-child meetings.