Treating Complex Trauma in Children and Their Families

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 cblanktree.com.John N. Briere, PhD is Professor Emeritus of Psychiatry and the Behavioral Sciences at the Keck School of Medicine, University of Southern California, and is past director of the Psychological Trauma Program at Los Angeles County + USC Medical Center. A past president of the International Society for Traumatic Stress Studies (ISTSS), he is recipient of the Award for Outstanding Contributions to the Science of Trauma Psychology from the American Psychological Association, the Robert S. Laufer Memorial Award for Scientific Achievement from ISTSS, the Presidential Award for Contribution to Methods from the Association for Scientific Advancement in Psychological Injury and Law, and the William N. Friedrich Lecturer: Outstanding Contribution to the Field of Child Psychology from the Mayo Clinic. A long-term student of Buddhist psychology, he has been Remote Faculty at the Institute for Meditation and Psychotherapy since 2013.

• AcknowledgmentsAbout the AuthorsChapter 1: IntroductionEmpirical Support for ITCTStructure of This BookChapter 2: Effects of Complex Trauma in ChildrenComplex Posttraumatic EventsEffects of Complex TraumaPhenomena That May Intensify, Compound, or Complicate Trauma EffectsChapter 3: Central Aspects of ITCT-CAssessment-Driven TreatmentAttention to Complex Trauma IssuesEarly Focus on Immediate IssuesFocus on a Positive Working Relationship With the TherapistCustomizationAttention to Attachment DifficultiesSkills DevelopmentTitrated Therapeutic Exposure and Exploration of Trauma MemoriesA Flexible Time FrameAdvocacy and Interventions at the System LevelPositive Professional Collaborations and Therapist Self-CareChapter 4: Assessment of Complex TraumaBackground and Current Assessment InformationAssessment of Trauma ExposureEvaluation of Trauma-Relevant SymptomsAssessment Measures That Can Be Used in ITCT-CChapter 5: The Assessment-Treatment Flowchart for Children (ATF-C) and the Problems-to-Components Grid for Children (PCG-C)The Assessment-Treatment Flowchart for ChildrenThe Problems-to-Components Grid for Children (PCG-C)Chapter 6: Characteristics and Tools of the Therapy EnvironmentThe Therapy Office/Agency EnvironmentSession Consistency and SafetyPlay Therapy Materials and ResourcesChapter 7: Relationship Building and SupportExpanding the Child’s Sense of IdentityTherapist Behaviors That Contribute to a Positive Therapeutic RelationshipUse of Play and HumorThe Role of Attachment History for the Therapist and the ClientFamily Therapy, Group Therapy, and Advocacy to Enhance the Therapeutic RelationshipAdvocacy and Case ManagementDealing With Difficult Client-Therapist Relationship ChallengesA Special Topic: Pet-Assisted Therapy or Sessions Involving PetsChapter 8: Safety InterventionsImpediments to TherapyReporting Suspected Child Abuse and NeglectOngoing Monitoring of Safety Issues and InterventionsSuicidality and Harmful Behavior Toward Others: Assessment and InterventionsPossible Safety Issues During Monitored VisitsSafety Within the Therapy SessionsChapter 9: PsychoeducationGeneral Focus of PsychoeducationBooks and Other Materials Used in ITCT-COther Approaches to Psychoeducation With ChildrenPsychoeducation With CaretakersChapter 10: Advocacy and Systems InterventionsCulture-Specific AdvocacyAdvocacy for Economically Disadvantaged ClientsAdvocacy as TherapyMental Health Advocacy and Support for CaretakersAdvocacy With Child Protection and Foster Care SystemsCourt/Legal Systems AdvocacySchool Collaborations and AdvocacyChapter 11: Distress Reduction and Affect Regulation TrainingAcute Distress ReductionEmotional Regulation CapacityChapter 12: Facilitating Positive IdentityResilience and Its Relationship to Self-EsteemSpecific Interventions to Enhance Positive Identity Development, Self-Efficacy, and AssertivenessChapter 13: Cognitive and Emotional ProcessingPreconditions for Emotional Processing When Addressing Complex TraumaCognitive ProcessingEmotional ProcessingChapter 14: Relational/Attachment ProcessingSpecific Client Attachment StylesAvoidant AttachmentResistant/Preoccupied/Ambivalent AttachmentDisorganized AttachmentAssessment of Attachment DisturbanceRelational Processing of Complex Trauma EffectsConclusionsChapter 15: Interventions With CaretakersITCT-C Caretaker Interventions: Multiple ModalitiesIndividual Psychotherapy With CaretakersCouple’s SessionsConjoint/Dyadic Caretaker-Child InterventionsSupport, Education, and Parenting SkillsThe Caretaker Support Group ModuleFollow-Up GroupChapter 16: Family TherapyWho to Include in Family Therapy Sessions?Cultural Factors to ConsiderWhen Should Family Therapy Be Considered?What Improves the Likelihood of Effective Family Therapy?Impacts of Systems Issues on FamiliesFamily Therapy InterventionsITCT-C Family Therapy Module for SessionsChapter 17: School-Based Adaptation of ITCT-CSchool-Based ITCT-C InterventionsThe ITCT-C School-Based Group ModelChapter 18: Supervision and Therapist Self-CareCommon Reactions and Feelings in Therapists Working in the Trauma FieldSupervision and ConsultationTeam-Building and SupportFurther Training and Professional DevelopmentPersonal TherapyDeveloping a Mindful PerspectiveSelf-CareAppendixReferencesIndex

"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."