Treatment Models

Trauma Focused - Cognitive-Behavioral Therapy (TF-CBT), is a psychotherapeutic approach that utilizes CBT techniques to help traumatized children and adolescents cope with the negative consequences of experiencing trauma while increasing positive skills that can foster resiliency. This therapy is not intended to specifically treat substance abuse but given that untreated trauma symptoms increase the likelihood of substance abuse, this approach is important to consider when working with youth who have traumatic histories. This therapy is used for the caretaker, children, and adolescents in a way that decreases the negative behavior pattern and emotional responses that occur as a result of sexual abuse, physical abuse, or other trauma. This form of therapy integrates interventions that are specifically tailored to meet the needs of people experiencing emotional and psychological difficulties as a result of a trauma and combines them with humanistic, cognitive behavioral and familial strategies. Through TF-CBT, both parents and children learn how to process their emotions and thoughts that relate to the traumatic experience. They are given the necessary tools to alleviate overwhelming thoughts that can cause stress, anxiety, and depression and are taught how to manage their emotions in a healthier way. The goal of TF-CBT is to allow both the child and the parent to continue to develop their skills and communication techniques in a healthy manner.

Motivational Interviewing (MI), is a method of treatment focusing on behavioral change and is often used to treat substance abuse. The 4 basic tenets of motivational interviewing are: establishing empathy with the client, developing discrepancy, rolling with resistance, and supporting self-efficacy.

Motivational interviewing helps people to decide they need to change, and to find their own reasons for doing so, rather than their therapist or counselor telling them they need to change. If a client can link their recovery or behavioral change to something they care about, the change is more likely to happen. If a client feels coerced, they may become defensive and decide to rebel against that control but if they have chosen to change, they are much less likely to rebel against themselves. The therapist establishes empathy with the client by putting themselves in the client’s shoes, and helping the client find reasons to change within him or herself.

Motivational interviewing helps clients consider that their way of tackling a problem is not the only way to handle it; therapists explore different plans of attack, and help clients think differently about their problems. The issue of “discrepancy” is explored: the therapist helps clients to compare their lives at present to what they would like their lives to be in the future. The therapist/counselor also encourages clients to look ahead and see what they could gain in their lives through making changes. Since change can be frightening, the motivational interviewer guides the client and teaches him or her to value change.

In motivational interviewing, the therapist/clinician helps clients explore their ambivalence about changing their behavior. Some clinicians view reluctance to change as an abnormal or pathological behavior, especially if the client is refusing to change very destructive behaviors. Motivational interviewing accepts that clients will come to therapy with different levels of reluctance about changing their actions and thoughts. Therapists are discouraged from chastising the client for this reluctance. The level of ambivalence will also depend on how the client came to counseling, if they were forced to come, either by law or by some other force in their life, they may become more reluctant; if they came voluntarily because they themselves has decided to seek treatment, they may be more willing to change.

The motivational interviewer supports the client’s self-efficacy by remembering, and reminding the client, that he or she has the power to make these changes him or herself. The therapist’s role is to help the client make the changes – not to try to make the changes for him or her. It is important for the therapist to remember that even if the client decides not to change, that is the client’s decision, not the therapist’s failing.

Multidimensional Family Therapy (MDFT) is a family-based, comprehensive treatment program focused on adolescent and young adult substance abuse and related behavioral and emotional difficulties. The model is widely recognized as an effective evidence-based treatment for adolescent substance use disorders and delinquency (e.g., Liddle et al 2008; Liddle et al 2009; Rigter et al, 2005; Vaughn & Howard, 2004; Waldron & Turner, 2008). MDFT is theory driven, combining aspects of several theoretical frameworks such as, family systems theory, developmental psychology, and the risk and protective model of adolescent substance abuse. It incorporates key elements of effective adolescent drug treatment, including comprehensive assessment; an integrated treatment approach; family involvement; developmentally appropriate interventions; specialized engagement and retention protocols; attention to qualifications of staff and their ongoing training; gender and cultural competence. MDFT is flexible treatment delivery structure, tailoring treatment to the needs of the youth and family. Delivered across a flexible series of 12 to 16 weekly or twice weekly 60 to 90-minute sessions, MDFT is a manual-driven intervention with specific assessment and treatment modules that target four areas of social interaction: (1) the youth's interpersonal functioning with parents and peers, (2) the parents' parenting practices and level of adult functioning independent of their parenting role, (3) parent-adolescent interactions in therapy sessions, and (4) communication between family members and key social systems (e.g., school, child welfare, mental health, juvenile justice). First implemented in 1985, MDFT has been used in nearly 40 sites in 11 States. Some of the sites have been operating MDFT for over a decade. MDFT has been used with youth from diverse ethnic and socioeconomic backgrounds; in urban, suburban, and rural settings; and in a variety of contexts (e.g., in-home and residential treatment programs, alternative schools, detention centers, hospitals, mental health centers, programs serving court-mandated juveniles).

Seeking Safety is a present-focused therapy to help people attain safety from co-occurring PTSD and substance abuse. The treatment is available as a book, providing both client handouts and guidance for clinicians. The treatment was designed for flexible use. It has been conducted in group and individual format; for women, men, and mixed-gender; using all topics or fewer topics; in a variety of settings (e.g., outpatient, inpatient, residential); and for both substance abuse and dependence. It has also been used with people who have a trauma history, but do not meet criteria for PTSD. Seeking Safety includes modules for Introduction/Case Management, Safety, PTSD: Taking Back Your Power, When Substances Control You, Honesty, Asking for Help, Setting Boundaries in Relationships, Getting Others to Support Your Recovery, Healthy Relationships, Community Resources, Compassion, , Creating Meaning, Discovery, Integrating the Split Self, Recovery Thinking, Taking Good Care of Yourself, Commitment, Respecting Your Time, Coping with Triggers, Self-Nurturing, Red and Green Flags, Detaching from Emotional Pain (Grounding). Life Choices, and Termination.

The key principles of Seeking Safety are:

• Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions)
• Integrated treatment (working on both PTSD and substance abuse at the same time)
• A focus on ideals to counteract the loss of ideals in both PTSD and substance abuse
• Four content areas: cognitive, behavioral, interpersonal, case management
• Attention to clinician processes (helping clinicians work on counter-transference, self-care, and other issues)

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. To date, EMDR therapy has helped millions of people of all ages relieve many types of psychological stress.