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Treating Complex Trauma in Children and Their Families

Treating Complex Trauma in Children and Their Families
An Integrative Approach


January 2016 | 296 pages | SAGE Publications, Inc
“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 ample 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.”

Eliana Gil
Gil Institute for Trauma Recovery and Education

One of the few books on the treatment of psychological trauma in children that provides specific, in-depth individual, group, and family therapy interventions for complex psychological trauma, this practical book focuses on the treatment of 6-12 year-old children and their family members. The authors employ an evidence-based, yet flexible and individualized treatment model, Integrative Treatment of Complex Trauma for Children (ITCT-C), as they address the use of play therapy and other expressive approaches, attachment processing, multi-target titrated exposure, mindfulness techniques, psychoeducation, and affect regulation skill development, as well as interventions with family/caretaker and community systems. The authors emphasize a culturally sensitive and empowering perspective, one that addresses the effects of social marginalization and supports not only recovery, but also posttraumatic growth. Clinical examples and specific tools, such as the Assessment Treatment Flowchart (ATF-C), illustrate how assessment can be used to guide individualized and developmentally-appropriate interventions.

About the Authors
Chapter 1: Introduction
Empirical Support for ITCT

Structure of This Book

Chapter 2: Effects of Complex Trauma in Children
Complex Posttraumatic Events

Effects of Complex Trauma

Phenomena That May Intensify, Compound, or Complicate Trauma Effects

Chapter 3: Central Aspects of ITCT-C
Assessment-Driven Treatment

Attention to Complex Trauma Issues

Early Focus on Immediate Issues

Focus on a Positive Working Relationship With the Therapist


Attention to Attachment Difficulties

Skills Development

Titrated Therapeutic Exposure and Exploration of Trauma Memories

A Flexible Time Frame

Advocacy and Interventions at the System Level

Positive Professional Collaborations and Therapist Self-Care

Chapter 4: Assessment of Complex Trauma
Background and Current Assessment Information

Assessment of Trauma Exposure

Evaluation of Trauma-Relevant Symptoms

Assessment Measures That Can Be Used in ITCT-C

Chapter 5: The Assessment-Treatment Flowchart for Children (ATF-C) and the Problems-to-Components Grid for Children (PCG-C)
The Assessment-Treatment Flowchart for Children

The Problems-to-Components Grid for Children (PCG-C)

Chapter 6: Characteristics and Tools of the Therapy Environment
The Therapy Office/Agency Environment

Session Consistency and Safety

Play Therapy Materials and Resources

Chapter 7: Relationship Building and Support
Expanding the Child’s Sense of Identity

Therapist Behaviors That Contribute to a Positive Therapeutic Relationship

Use of Play and Humor

The Role of Attachment History for the Therapist and the Client

Family Therapy, Group Therapy, and Advocacy to Enhance the Therapeutic Relationship

Advocacy and Case Management

Dealing With Difficult Client-Therapist Relationship Challenges

A Special Topic: Pet-Assisted Therapy or Sessions Involving Pets

Chapter 8: Safety Interventions
Impediments to Therapy

Reporting Suspected Child Abuse and Neglect

Ongoing Monitoring of Safety Issues and Interventions

Suicidality and Harmful Behavior Toward Others: Assessment and Interventions

Possible Safety Issues During Monitored Visits

Safety Within the Therapy Sessions

Chapter 9: Psychoeducation
General Focus of Psychoeducation

Books and Other Materials Used in ITCT-C

Other Approaches to Psychoeducation With Children

Psychoeducation With Caretakers

Chapter 10: Advocacy and Systems Interventions
Culture-Specific Advocacy

Advocacy for Economically Disadvantaged Clients

Advocacy as Therapy

Mental Health Advocacy and Support for Caretakers

Advocacy With Child Protection and Foster Care Systems

Court/Legal Systems Advocacy

School Collaborations and Advocacy

Chapter 11: Distress Reduction and Affect Regulation Training
Acute Distress Reduction

Emotional Regulation Capacity

Chapter 12: Facilitating Positive Identity
Resilience and Its Relationship to Self-Esteem

Specific Interventions to Enhance Positive Identity Development, Self-Efficacy, and Assertiveness

Chapter 13: Cognitive and Emotional Processing
Preconditions for Emotional Processing When Addressing Complex Trauma

Cognitive Processing

Emotional Processing

Chapter 14: Relational/Attachment Processing
Specific Client Attachment Styles

Avoidant Attachment

Resistant/Preoccupied/Ambivalent Attachment

Disorganized Attachment

Assessment of Attachment Disturbance

Relational Processing of Complex Trauma Effects


Chapter 15: Interventions With Caretakers
ITCT-C Caretaker Interventions: Multiple Modalities

Individual Psychotherapy With Caretakers

Couple’s Sessions

Conjoint/Dyadic Caretaker-Child Interventions

Support, Education, and Parenting Skills

The Caretaker Support Group Module

Follow-Up Group

Chapter 16: Family Therapy
Who to Include in Family Therapy Sessions?

Cultural Factors to Consider

When Should Family Therapy Be Considered?

What Improves the Likelihood of Effective Family Therapy?

Impacts of Systems Issues on Families

Family Therapy Interventions

ITCT-C Family Therapy Module for Sessions

Chapter 17: School-Based Adaptation of ITCT-C
School-Based ITCT-C Interventions

The ITCT-C School-Based Group Model

Chapter 18: Supervision and Therapist Self-Care
Common Reactions and Feelings in Therapists Working in the Trauma Field

Supervision and Consultation

Team-Building and Support

Further Training and Professional Development

Personal Therapy

Developing a Mindful Perspective



“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.”  

Eliana Gil
Gil Institute for Trauma Recovery and Education

“Once again, the brilliance of the Lanktree and Briere team has been demonstrated.  The comprehensive nature and depth of this challenging topic is thoughtfully and creatively illustrated.  The cultural/marginalization perspective is unparalleled within the topic of complex trauma. This text is a must read for both my undergraduate and graduate trauma-focused courses.”

Russell T. Jones
Virginia Tech University

“An indispensable, practical guide for every therapist working with children and families who have been exposed to complex trauma. The treatment model is truly integrative in incorporating the authors’ extensive experience, sophisticated clinical sensitivity, and broad knowledge of the evidence-informed approaches to psychotherapy, and their deep understanding of the challenges facing children and families who are recovering from complex trauma.”

Julian Ford
University of Connecticut Health Center

“Relevant, timely, and essential for all disciplines working to effectively and affectively help children.  This book provides the theory underlining how to begin the healing process with children while demonstrating sensitivity and clarity as one proceeds with specific steps towards that healing.”

Naomi Lynch White
The University of Akron

“A wonderful integrative approach for students to learn how to work with both child who have experience trauma as well as families.”

Becky L. Thomas
The University of Akron
Key features


  • The authors’ unique evidence-based treatment model provides therapists with a structured, yet flexible approach to treating complex trauma in children.
  • The book’s individualized, multi-modal, assessment-based approach for complex trauma provides guidelines that help the therapist to identify specific needs for each client, along with appropriate assessment and treatment interventions.
  • A unique chapter on supervision and therapist self-care provides guidelines and information for therapists regarding supervision, management of countertransference, and self-care.
  • Coverage attends to the concerns of socially marginalized children, as well as less deprived children and their families, reflecting the book’s philosophical inclusion of social and cultural issues in trauma treatment. 

Sample Materials & Chapters

Chapter 1

Chapter 13

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