Trauma-Informed CBT for Children & Adolescents: A Clinical Playbook for Integrating Structure with Client-Centered Flexibility

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Faculty

Amy Marschall, PsyD Related seminars and products

Sioux Falls Psychological Services

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Amy Marschall, PsyD, is a psychologist, author, and autistic adult who specializes in evaluating children, teens, and adults for autism, supporting autistic clients, and trauma therapy. She is the author of A Clinician’s Guide to Supporting Autistic Clients, (PESI Publishing, 2024) neurodivergence expert, and speaker. Primarily working with children and adolescents, she is trained in trauma-informed care and cognitive behavioral therapy. In 2017, she became certified in trauma-focused cognitive behavioral therapy. In addition to working with autistic individuals, Dr. Marschall works with survivors of abuse, families in the foster care system, children with incarcerated parents, clients dealing with high-conflict divorce or separation, and those growing up with other chronic stressors and traumas.
 

Speaker Disclosures:
Financial: Amy Marschall is the founder of Resiliency Mental Health and has employment relationships with RMH Therapy, Sioux Falls Psychological Services, Spring Health, ADHD Online, A Change for Better, and Mi World. She is a consultant with VeryWell Mind and receives royalties as a published author. Amy Marschall receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Amy Marschall has no relevant non-financial relationships.

 

 

Objectives

1. Integrate a trauma-informed approach to assessment, treatment planning, and sessions.
2. Employ a collaborative approach to treatment planning, balancing relevant, specific, and time-measurable goals with each client’s articulated goals for their care.
3. Modify therapeutic interventions based on client feedback of their unique needs, preferences, and history.
4. Utilize trauma-informed, evidence-based cognitive behavioural interventions in sessions, including mindfulness activities, breathing exercises, visualizations, metacognition, and psychoeducation.
5. Apply evidence-based cognitive-behavioural techniques while teaching clients to identify what does or does not work for them about each technique, and adjust interventions appropriately in light of client feedback.
6. Assess behavioural issues from a trauma-informed perspective, with an emphasis on identifying and addressing underlying needs rather than consequences or punishments for problem behaviours, and educate parents on how to implement this approach outside of sessions.

Outline

What Trauma Looks Like in Children & Adolescence

• Adverse Childhood Experiences
• Growing up During COVID: A New Stressor
• Preverbal Trauma
• Trauma-Related Emotional and Behavioural Issues

Trauma-Informed Assessment & Treatment Planning

• Developmental trauma interview; ACEs score; Trauma Symptom Checklist
• Assessment is not finite; how to continually assess client safety and therapeutic needs
• Integrating behavioural and emotional goals
• What does it mean to feel “better”?

How to Elevate Your Practice Utilizing CBT and Trauma Informed Techniques

• Actively engaging kids with a child-centred approach
• Balancing the structure of CBT with flexibility/nuance of a trauma-informed lens
• Integrating concrete skill-building into trauma processing work
• Getting to the root cause of each child’s unique trauma needs

A Playbook for Implementing Trauma-Informed CBT (Worksheets, scripts & demonstrations included)

• Preparing clients for trauma work
  • Psychoeducation: deciding what information is helpful and how to present it
  • Identifying the child’s level of anxiety/physiological arousal
  • Teaching children the language around trauma
• Affective Monitoring
  • When feelings are happening – press pause/go with the flow
  • Noticing when emotions start to get bigger – feelings thermometer/feelings spectrum/volcano
  • Mindfulness and body awareness
• Metacognition –
  • Noticing thoughts as they come – watching the clouds/radio station
  • Emotional reaction to those thoughts – naming feelings/emoji feelings
  • Thought stopping activities
• Narrative therapy
  • With specific trauma memories – writing vs dictating poem/children’s book/ narrative story
  • Without specific memories - exploring when they learned about the trauma/ exploring feelings related to the knowledge of the trauma
• Relaxation Techniques that children enjoy
  • Mindful bowling/juggling
  • Guided safe place visualisation
  • Body scan
  • Muscle relaxation
  • Stong like a tree
  • Art therapy
  • Music

Clinical Considerations

• The art of getting caregiver buy-in for participation in treatment
• Balancing honouring the client’s needs and requests with evidence-based practice and treatment goals created by guardians
• Sometimes developmental trauma needs to be re-processed as the child gets older
• Determining/Discerning how much treatment is “enough” for the child’s developmental age/
• stage
• Cultural diversity considerations for trauma work
• Limitations of the research and potential risks

Target Audience

• Psychologists
• Social Workers
• Counselors
• Marriage & Family Therapists
• Speech-Language Pathologists
• Occupational Therapists
• School Administrators
• Physicians
• Teachers/School-Based Personnel