Survey Results
This survey’s purpose is to identify critical dilemmas faced by therapists in therapy with children/families who have experienced developmental traumas such as maltreatment or violence. Your views will help us select the topics for a series of webinars to guide therapists in dealing with these critical dilemmas in therapy sessions. Complete the survey here.
A survey was conducted with all National Child Traumatic Stress Network (NCTSN) centers and affiliates to identify challenges related to developmental trauma that therapists need to be prepared to handle when conducting therapy with children and families. The survey was designed to ask professionals working in or with programs in the NCTSN, and youth/families who serve in an advisory capacity to those programs, for their opinions about the importance of a number of therapeutic challenges that have been identified by faculty of the CTDTD. Respondents were asked to identify additional challenges that they believe should be priorities. The therapeutic challenges that are identified as highest priorities were used as the basis for educational webinars that CTDTD faculty are producing, with the audience as the same professionals and youth/family advisors who complete the survey.
The survey was disseminated by sending an internet link that enables respondents to access it and respond anonymously (using the Qualtrics system). Respondents were invited to serve as “key informants” in which their opinions about the therapeutic challenges will be assessed in greater with open ended questions designed to identify the approaches that they view as most and least helpful when therapists are assisting children and families with each of the challenges that they consider of highest priority. These interviews were done with no link to the respondent’s responses to the survey, and will be conducted by email or other internet modalities. No personal health information identifiers, or personal experiences as a recipient of therapeutic treatment or other services were inquired about. If an interviewee spontaneously provided a personal example, the interviewer recorded the example with no identifying details or identifiers.
To what type(s)/age(s) of clients do you provide trauma therapy/services?
- 357 (66.6%) boys/young men
- 380 (70.9%) girls/young women
- 306 (57.1%) parent/adult caregivers
- 180 (33.6%) trans/other gender children/youth
- 42 (7.8%) None, I am a behavioral health professional but I do not conduct trauma-specific therapy/services
- 34 (6.3%) Other
- 16 (3.0%) None, I am a non-behavioral health professional (MD, RN, PA, attorney, teacher, CPS worker, etc.)
What therapy or related service modalities do you provide or are you interested in?
- 393 (73.3%) Individual child/adolescent therapy
- 317 (59.1%) Conjoint family therapy with caregiver(s) and child(ren)
- 237 (44.2%) Clinical psychosocial assessment/evaluations
- 226 (42.2%) Group child/adolescent therapy
- 216 (40.3%) Dyadic child-caregiver therapy
- 135 (25.2%) Case management
- 55 (10.3%) Residential treatment (child welfare or juvenile justice)
- 37 (6.9%) Forensic psychosocial assessment/evaluations
- 37 (6.9%) Other
- 28 (5.2%) Inpatient/partial hospital milieu treatment
What is your professional training/background? (Select all that apply)
- 273 (50.9%) Licensed MA/MSW-level counselor/therapist
- 71 (13.2%) Licensed doctoral-level psychotherapist
- 48 (9%) Other
- 30 (5.6%) Unlicensed agency-employed therapist/counselor
- 29 (5.4%) Graduate/internship MA/MSW-level therapist trainee
- 11 (2.1%) BA/MA-level case manager
- 9 (1.7%) Front-line BA-level mental health, child welfare, juvenile justice program staff
- 8 (1.5%) Peer-to-peer counselor
- 6 (1.1%) Graduate/internship doctoral-level therapist trainee
- 2 (.4%) BA/MA-level psychometric assessor
Choose the number of years you have been in professional practice
- 169 (31.5%) 0-5
- 102 (19%) 6-10
- 94 (17.5%) 11-19
- 87 (16.2%) 20+
In a therapy session, a child client has severe dissociative reactions. Do you think that therapists know how to handle this type of event?
- 167 (31.2%) YES
- 279 (52.1%) becomes assaultive towards others present
- 241 (45.0%) is completely immobile and unresponsive
- 220 (41%) engages in self-harming behaviors
- 189 (35.3%) re-enacts a sexual assault/abuse incident
- 132 (24.6%) tries to escape or run away as if being entrapped
- 78 (14.6%) tries to escape or hide as if being assaulted
- 62 (11.6%) becomes regressive and acts like a much younger child
- 43 (8%) re-enacts an incident in which s/he witnessed severe violence/death
- 48 (9%) re-enacts a physical assault/abuse incident
- 3 (.6%) Other
In a therapy session, a child client becomes overwhelmed with emotional or physical distress. Do you think that therapists know how to handle this type of event?
- 365 (68.1%) YES
- 280 (52.2%) catatonia/paralysis
- 273 (50.9%) rage/aggression
- 208 (38.8%) passing out/fainting
- 183 (34.1%) extreme physical pain
- 124 (23.1%) vomiting
- 96 (17.9%) difficulty breathing
- 56 (10.4%) hopelessness
- 53 (9.9%) shame/self-loathing
- 24 (4.5%) grief/sobbing
- 24 (4.5%) guilt/self-blame
- 21 (3.92%) anxiety/panic
- 5 (.9%) Other
In a therapy session, a child client is unwilling or unable to participate or to maintain therapeutic boundaries. Do you think that therapists know how to handle this type of event?
- 308 (57.5%) YES
- 344 (64.2%) engages in sexually self-stimulating or exhibitionistic behavior
- 179 (33.4%) impulsively hugs or makes intrusive physical contact with you
- 150 (28%) becomes detached (e.g., hiding under a hoodie) or walks out of the session
- 127 (23.7%) appears completely disinterested in anything except her/his cellphone or other object/toy
- 124 (23.1%) engages in distracting behaviors and won't stop when asked to
- 95 (17.7%) says disrespectful and insulting things to you
- 92 (17.2%) says disrespectful and insulting things to other participants (parents, peers, siblings, etc.)
- 83 (15.5%) says s/he is finished and insists on stopping therapy
- 44 (8.2%) says therapy is unnecessary/unhelpful or harmful
- 3 (.6%) Other
In a therapy session, a child client acts in a way that harms or endangers others in therapy, or discloses doing/intending to do so outside of therapy. Do you think that therapists know how to handle this type of event?
- 261 (48.7%) YES
- 335 (62.5%) assaults someone in the session physically
- 181 ( 33.8%) describes enjoying seeing others suffer physically or emotionally
- 177 (33%) destroys or severely damages property in therapy
- 170 (31.7%) says s/he hears voices telling her/him to harm or kill other person(s)
- 152 (28.4%) describes harming or intending to harm animals
- 101 (18.8%) threatens to assault or harm someone in the session <EVENT31>
- 97 (18.1%) describes assaulting or harming people outside of therapy
- 84 (15.7%) describes intending or threatening to assault or harm people outside of therapy
- 0 (0%) Other
In a therapy session, a child client acts in a way that harms or endangers self in therapy, or discloses doing or intending to do so outside of therapy. Do you think that therapists know how to handle this type of event?
- 312 (58.2%) YES
- 319 (59.5%) engages in self-harming behavior in the therapy session
- 265 (49.4%) says s/he has repeatedly done things or intends to do things so other people will hurt her/him
- 207 (38.6%) says s/he hears voices telling her/him to harm or kill her/himself
- 153 (28.5%) tells you about actually engaging recently in severely risky or reckless behavior
- 142 (26.5%) tells you about plans to engage in severely risky or reckless behavior
- 116 (21.6%) says s/he is going to kill her/himself
- 3 (.6%) Other
In a therapy session, a child client discloses specific immediate fears about a primary caregiver, close friend, or sibling being in severe danger. Do you think that therapists know how to handle this type of event?
- 317 (59.1%) YES
- 273 (50.9%) says s/he is afraid a parent/caregiver is going to kill or seriously harm her/himself
- 204 (38.1%) says s/he is afraid a parent/caregiver is going to be killed or badly harmed by someone
- 160 (29.9%) says s/he is afraid a friend or sibling is going to kill or seriously harm her/himself
- 135 (25.2%) says a parent/caregiver has just committed suicide or died or become terminally ill
- 115 (21.5%) says a parent/caregiver was just attacked and was killed or may never recover
- 113 (21.1%) says s/he is afraid a friend or sibling is going to be killed or badly harmed by someone
- 55 (10.3%) says a friend or sibling has just committed suicide or died or become terminally ill
- 51 (9.5%) says a parent/caregiver was just in a terrible accident and may never recover
- 44 (8.2%) says a parent/caregiver was just arrested, incarcerated, or involuntarily hospitalized
- 34 (6.3%) says a friend/sibling was just attacked and was killed or may never recover
- 16 (3%) says a friend/sibling was just in a terrible accident and may never recover
- 8 (1.5%) says a friend/sibling was just arrested, incarcerated, or involuntarily hospitalized
- 2 (.4%) Other
In a therapy session, a child client discloses severe immediate emotional abuse or exposure to identity-based harassment or threats. Do you think that therapists know how to handle this type of event?
- 268 (50%) YES
- 280 (52.2%) describes a parent/caregiver saying that s/he (the child) deserves to be hurt or to die
- 228 (42.5%) describes a parent/caregiver saying s/he is worthless or should never have been born
- 202 (37.7%) describes being harassed, harmed, or threatened because of her/his race/ethnicity, culture, religion, nationality, or language
- 193 (36%) describes being harassed, harmed, or threatened because of being LGBTQ
- 169 (31.5%) describes an adult repeatedly saying s/he is stupid, disgusting, or always going to fail
- 138 (25.7%) describes being harassed, harmed, or threatened because of being disabled or ill
- 1 (.2%) Other
In a therapy session, a parent/adult caregiver is emotionally abusive or threatening toward a child. Do you think that therapists know how to handle this type of event?
- 235 (43.8%) YES
- 310 (57.8%) verbally emotionally abuses (rejects, belittles, threatens to abandon) a child
- 299 (55.8%) becomes enraged and behaves in a threatening or intimidating manner toward a child
- 248 (46.3%) describes a child as having terrible intentions or being/becoming bad, just like an abuser
- 158 (29.5%) nonverbally regards or reacts to a child with fear or disgust
- 140 (26.1%) lectures a child in a harshly critical and blaming manner
- 3 (.6%) Other
In a therapy session, a parent/adult caregiver is behaviorally and emotionally unresponsive to a child. Do you think that therapists know how to handle this type of event?
- 267 (49.8%) YES
- 248 (46.3%) ignores a child's distress or self-harming behavior
- 197 (36.8%) seems completely uninvolved with or uninterested in a child
- 189 (35.3%) praises and is affectionate toward one child while criticizing and blaming another child
- 178 (33.2%) ignores a child's repeated attempts to make contact verbally or nonverbally
- 151 (28.2%) repeatedly talks about their own distress or distressing experiences
- 123 (22.9%) repeatedly interrupts a child to take over or change the conversation
- 95 (17.7%) seems bored or uninterested whenever a child is speaking
- 1 (.2%) Other
In a therapy session, a parent/adult caregiver becomes severely emotionally or behaviorally dysregulated. Do you think that therapists know how to handle this type of event?
- 203 (37.9%) YES
- 189 (35.3%) re-enacts a personally traumatic experience from her/his own current/past life
- 180 (33.6%) threatens to harm or kill her/himself
- 158 (29.5%) dissociates when a child is describing traumatic event(s)
- 158 (29.5%) threatens to harm or kill someone else
- 154 (28.7%) becomes intensely manic and hyperaroused
- 129 (24.1%) is listening or talking to someone who is not there
- 118 (22%) talks in detail about personally traumatic experience(s) from her own life
- 99 (18.5%) becomes severely confused/disoriented
- 37 (6.9%) becomes overwhelmed with anxiety/panic
- 33 (6.2%) becomes overwhelmed with grief/sobbing
- 13 (2.4%) becomes overwhelmed with guilt
- 1 (.2%) Other
In a therapy session, a parent/adult caregiver engages in therapy-interfering or disruptive behaviors. Do you think that therapists know how to handle this type of event?
- 245 (45.7%) YES
- 289 (53.9%) interacts with a child as if the child is a romantic or sexual partner
- 141 (26.3%) tells a child "you are the only reason I go on living, if it weren't for you I'd have nothing"
- 136 (25.4%) says s/he is giving up on helping a child
- 135 (25.2%) makes intrusive physical contact with or intrudes in the personal space of a child
- 90 (16.8%) verbally or nonverbally pleads for or demands reassurance or comforting from a child
- 87 (16.2%) says therapy is unnecessary/harmful/unhelpful/finished and insists on stopping
- 83 (15.5%) tells a child s/he has to protect and be primary caregiver for him/her/family members
- 80 (14.9%) interacts with a child as if the child is the parent or caregiver
- 79 (14.7%) angrily blames everything on mistakes/actions by other systems (courts, child welfare, etc.)
- 72 (13.4%) says disrespectful or insulting things to the therapist
- 48 (9%) describes being and acts helpless to provide structure or limits for a child
- 1 (.2%) Other