Trauma Focused CBT (TF-CBT)

**Session Details:** 1 November 2024, 10:00 AM, in-person, 50 minutes. Trauma-focused CBT session. **Presenting Concerns:** The patient is experiencing significant symptoms of re-experiencing, including intrusive thoughts and nightmares related to a past traumatic event. She reports frequent avoidance behaviours, such as staying away from places that remind her of the trauma. She also struggles with hyperarousal, feeling constantly on edge and easily startled. She also reports negative cognitions, such as feeling worthless and unlovable. The patient's trauma history involves a single incident of childhood abuse. **Identified Cognitions and Biases:** - "I am not safe." - "I am worthless." - "People will hurt me." - Overgeneralization: Believing that because one person was abusive, all people are dangerous. - Catastrophizing: Assuming the worst possible outcome in every situation. - Self-blame: Blaming herself for the abuse. - "I am a burden." **Emotional and Physiological Responses:** The patient presented with high levels of anxiety and shame. She reported feeling overwhelmed and disconnected from her body at times. - Triggers: Specific locations, anniversaries, and certain types of interactions. - Somatic Markers: Increased heart rate, muscle tension, and stomach upset. **Mental Status / Observations:** - Anxious appearance. - Rapid speech. - Frequent eye contact. - Restlessness. **Therapeutic Process and Techniques:** Psychoeducation was provided regarding the trauma model and the link between thoughts, feelings, and behaviours. Grounding techniques, including deep breathing exercises, were practiced. Cognitive restructuring was used to challenge negative thoughts. Safety planning was discussed. - Grounding techniques: Deep breathing exercises, focusing on the present moment. - Cognitive techniques: Identifying and challenging negative thoughts. - Safety planning: Identifying safe people and places. **Risk and Safety:** - No current suicidal ideation or self-harm urges reported. - Patient reports feeling safe at home. **Patient Strengths and Coping:** - Strong social support from family. - Internal strength: Resilience. - Coping strategies: Talking to friends and family. **Therapist Reflections / Countertransference:** The therapist felt empathy for the patient's suffering and a strong desire to help her heal. The therapist felt some frustration with the patient's avoidance behaviours. - Areas of uncertainty: How to best address the patient's avoidance behaviours. **Plan / Next Steps:** - Homework: Practice deep breathing exercises daily. - Next session: Continue cognitive restructuring and begin exploring trauma narrative. - Coordination of care: Continue with current medication management.