How to help children process, overcome horrific traumas


Unfathomable. Unspeakable.

These are among the terms used to describe children’s extreme traumatic experiences such as severe abuse and neglect. It is often most shocking when these acts are perpetrated by the children’s parents – the very ones that children should be able to depend on for their protection and safety.

Many believe that, in addition to the cumulative and serious nature of repetitive interpersonal traumas themselves, this betrayal of trust will result in irreparable psychological damage. Fortunately, this does not have to be the case. Children are more resilient than we realize; with safety, support, and effective treatment, they can recover from even the most extreme traumas and live healthy, productive lives.

The first priority is for child-serving systems to remove children from severely abusive situations and allow them to live in safe, stable, supportive settings while minimizing traumatic separation from siblings or further disruptions in their living situation. Acute medical problems need to be stabilized, and a thorough mental health assessment should be conducted.

Evidence-based trauma-focused psychotherapy is the first-line treatment for addressing pediatric posttraumatic stress disorder (J Am Acad Child Adolesc Psychiatry. 2010 Apr;49[4]:414-30). Several treatments are currently available. A few examples are trauma-focused cognitive-behavioral therapy, or TF-CBT, for children aged 3-18 years; child-parent psychotherapy (CPP) for children aged 0-6 years; a group school-based model, cognitive behavioral interventions for trauma in schools (CBITS); and Trauma Affect Regulation: Guide for Education and Therapy for teens (TARGET).

Common elements of evidence-based trauma-focused treatments are: 1) nonperpetrating caregivers are included in therapy to enhance support and understanding of the child’s trauma responses, and to address trauma-related behavioral problems; 2) skills are provided to the youth and caregiver for coping with negative trauma-related thoughts, feelings, and behaviors; and 3) children are supported to directly talk about and make meaning of their trauma experiences.

Through trauma-focused treatment, children become able to cope with their traumatic experiences and memories – make sense out of them. These traumas are no longer “unfathomable or “unspeakable,” but rather, manageable memories of bad experiences that the children have had the courage to face and master.

Children can recover from even extreme trauma experiences when they receive effective trauma-focused treatment in the context of a supportive environment. More information about evidence-based treatments is available from the National Child Traumatic Stress Network at

Dr. Judith A. Cohen, a board-certified child psychiatrist, is medical director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh.

Dr. Judith A. Cohen

Dr. Cohen, a board-certified child psychiatrist, is medical director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. She is codeveloper of TF-CBT, described in Treating Trauma and Traumatic Grief in Children and Adolescents and Trauma-Focused CBT for Children and Adolescents: Treatment Applications (New York: Guilford Press, 2012). She receives grant funding from National Institute of Mental Health, the National Institute of Child Health and Human Development, and the Substance Abuse and Mental Health Services Administration. In addition, Dr. Cohen receives royalties from Guilford Press, Oxford Press, UpToDate, and other TF-CBT products. She does not receive industry funding.

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