One of the initial questions that therapists often ask when the youth continues to live with the perpetrator is whether directly discussing the violence in therapy has the potential to pose added risks to the child. For example, if the perpetrator is the father and the child is very young, very emotionally attached to the father and/or the father is so focused on quashing attempts that may lead to the mother and child leaving that he demands to know everything that goes on during the
child’s therapy, the child may tell the father details of what is being discussed during trauma-focused therapy. This may provoke increased violence, including toward the child for describing the father’s abusive behaviors to an “outsider” (i.e., the therapist). Therapists often ask how to balance the potential benefits and risks of TF-CBT in these circumstances. We have found that it is often helpful in these situations to obtain permission from the mother to contact the father via phone to explain the purpose of the treatment. This typically decreases the father’s need to obtain information directly from the child about the content of treatment. When the therapist initiates such contact, openly tells the father about TF-CBT (e.g., describing it in terms of improve the child’s symptoms related to family issues), and offers to speak with the father if he has questions in the future, this often mitigates the father’s need to elicit or coerce information directly from the child on an ongoing basis. Below are three case examples depicting the complex situations where violence continues. The TF-CBT work in these cases focused on the goals of enhancing child safety, recognizing the reality that it is a process toward family-wide safety and living security.