Debunking Common Myths About Trauma-Focused CBT: What Therapists Need to Know
Are We Getting TF-CBT Wrong? Outdated misconceptions that many of us have about TF-CBT could be preventing our clients from accessing one of the most effective trauma treatments available today.
Fast Facts
TF-CBT works for complex trauma, not just single-event experiences
The approach doesn't require clients to relive trauma in vivid detail
TF-CBT is flexible and can be adapted for diverse clients and co-morbid conditions
Recent innovations include digital delivery and culturally-sensitive adaptations
Have you ever had a client express concern about starting trauma-focused CBT (TF-CBT) by saying, "I don’t want to relive my trauma," or ask if it’s only meant for people with a single traumatic experience? If so, you’re not alone.
Many therapists also hesitate to use TF-CBT, unsure whether it’s the right approach for clients with complex trauma, multiple diagnoses, or diverse cultural backgrounds.
Despite decades of research validating TF-CBT as one of the most effective treatments for PTSD, myths and misunderstandings persist. So, what does the latest research really say about TF-CBT? And how can we ensure we’re using this approach in a way that truly benefits our clients?
What Are the Most Common Misconceptions?
"TF-CBT Is Only for Single-Event Trauma" Many believe that TF-CBT works best for individuals who’ve experienced a single traumatic event, such as a car accident or assault. In reality, TF-CBT has been successfully adapted for people with complex trauma histories, including survivors of childhood abuse, domestic violence, and repeated exposure to traumatic events.1
Practical Tip: If a client expresses doubts because they’ve experienced multiple traumas, acknowledge their concerns and explain that TF-CBT can be tailored to address their specific experiences. You might say, “It’s true that everyone’s trauma story is different, and TF-CBT can be adjusted to fit your unique history.”"Clients Must Retell Their Trauma in Detail" Clients (and even some therapists) often think TF-CBT means talking about every traumatic moment in vivid detail. But that’s not the case. In reality, TF-CBT’s trauma processing is designed to be gradual and safe, with a focus on shifting unhelpful beliefs and reducing emotional distress.2
Practical Tip: Many clients worry that trauma-focused therapy means reliving every painful memory. It’s important to explain that the real goal is to help them change how those memories and specific hotspots within these affect them—without diving into every detail."TF-CBT Is Too Rigid and Protocol-Driven" Some view TF-CBT as overly structured or “one-size-fits-all.” While it does follow a framework, TF-CBT allows significant flexibility. Clinicians can modify pacing, incorporate grounding exercises, or borrow strategies from other therapies, like Acceptance and Commitment Therapy (ACT), depending on the client’s needs.3
Practical Tip: Every client moves at their own pace. If someone needs more time to build trust or feel grounded, that’s okay—let their progress set the rhythm. You can say, “This framework is here to guide us, but we’ll take it step by step to match where you are.”. However, for those in organisations that determine a pre-set amount of sessions, this can be challenging, and may be worth discussing with your employer and client."It’s Not Effective for Clients with Co-morbid Conditions" Since PTSD often occurs alongside conditions like depression, anxiety, or substance use disorders, some therapists assume TF-CBT won’t be effective for these clients. However, research shows that TF-CBT not only reduces PTSD symptoms but can also improve comorbid conditions by addressing underlying trauma.4
Practical Tip: Clients sometimes think TF-CBT only targets PTSD symptoms, but it can also help with things like anxiety, depression, or even sleep problems. Let them know it’s designed to address the bigger picture. For example, you might explain, “Because trauma affects many aspects of life, working through it can often relieve symptoms of anxiety, depression, or other difficulties, too.”"TF-CBT Only Works for Certain Demographics" There’s a lingering belief that TF-CBT is primarily suited to Western, highly-educated clients. However, studies have shown its effectiveness across different cultures, languages, and populations—including refugees, children in low-resource settings, and clients from marginalised communities.5
Practical Tip: When you’re working with clients from different cultural backgrounds, take time to understand what healing looks like for them. Maybe that means incorporating storytelling, spirituality, or family support.
Why Misconceptions Matter: How They Shape Therapy Outcomes
Trauma-Focused CBT (TF-CBT) is one of the most effective treatments for trauma, but for the majority of CBT therapists, if we are honest—misconceptions about it can get in the way.
Some therapists assume it’s rigid, that it only works for single-event trauma, or that it doesn’t fit clients with complex issues. And that’s a issue because those myths can stop both clients and clinicians from getting the most out of this powerful approach.
The truth? These misunderstandings can directly impact real people. A client who fears they’ll have to relive their trauma might avoid therapy altogether. Meanwhile, a therapist unsure about using TF-CBT with clients from diverse backgrounds or with complex trauma might hesitate to even try it and stay within other approaches that feel ‘safer’—and those are missed chances for healing.
So how do we fix that? By challenging outdated assumptions, staying curious about new research, and being willing to adapt TF-CBT to meet clients where they are. That’s how we maximise its potential.
Key Reasons to Bust These Myths:
Empowering Clients: Avoiding trauma because it feels too overwhelming is understandable—but it can keep clients stuck. TF-CBT provides a safe, structured way to face that fear, helping clients build resilience and take back control of their lives.
Keeping Up with Research: Many misconceptions come from training that is now out of date or not in line with the latest research. Staying current with research helps therapists feel confident and provide the best care possible.
Feeling competent: Many therapists feel they need additional training on top of their CBT training to work with trauma. The evidence suggests this may not be true, but it is challenging the myths we hold about our training and approach.
What’s Next for TF-CBT?
TF-CBT isn’t standing still. Research is expanding how and where it can be used:
Digital TF-CBT: Online programs are opening doors for people who might not have access to in-person care—whether they live in remote areas or just need a more flexible option.6
Cultural Adaptations: New research is helping therapists make TF-CBT more inclusive, so clients from diverse backgrounds feel seen and supported.7
Neuroscience Breakthroughs: We’re also learning more about how TF-CBT actually changes the brain, giving us deeper insights into why it works so well.8
The bottom line? When we stay open to new ideas and keep adapting TF-CBT to meet clients’ unique needs, it stays dynamic, flexible, and—most importantly—effective. And that’s exactly what clients deserve.
Share Your Thoughts
What strategies have helped you overcome client hesitations about trauma-focused therapy? Share your experiences in the comments below.
Author: Kavya Suresh Kumar for Between Sessions
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Murray H, Grey N, Warnock-Parkes E, et al. Ten misconceptions about trauma-focused CBT for PTSD. (2022). The Cognitive Behaviour Therapist,15:e33. doi:10.1017/S1754470X22000307.
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Fonzo, G. A., Goodkind, M. S., et al. (2021). Neural mechanisms of TF-CBT. Biological Psychiatry, 89(4), 337-345. https://doi.org/10.1016/j.biopsych.2021.04.002.