An Attachment-Informed Approach to Trauma-Focused Cognitive Behavioral Therapy

Trauma-focused cognitive behavioral therapy (TF-CBT) is a widely utilized evidence-based practice for treating children exhibiting symptoms of trauma. The model is theoretically grounded in principles of cognitive behavioral therapy (CBT) and incorporates a safe caregiver throughout treatment. TF-CBT's use of a safe parental figure is supported by attachment theory, but the model does not fully address the complex needs of the families frequently served by social service organizations. Through the lens of attachment, the TF-CBT model holds more potential by directly supporting the parent/child bond and enhancing a caregiver's role as a secure base. As the field of neuroscience advances rapidly, new research supports attachment based interventions, and thus, also supports the importance of enhancing the parent child bond in trauma treatment. The purpose of this paper is to highlight ways that attachment theory, if made more explicit in training and education programs, could enhance clinicians' understanding and involvement of the caregiver in TF-CBT, thus making the model more applicable to families who have experienced complex, intergenerational trauma. An overview of literature related to attachment and trauma and the efficacy of TF-CBT will be provided, as well as a case illustration integrating TF-CBT and attachment principles with a highly complex family.