Date of Award

Spring 5-15-2023

Degree Type


Degree Name

Doctor of Social Work (DSW)

First Advisor

Dr. Katherine Ledwith, DSW, LCSW

Second Advisor

Dr. Laura Vega, DSW, LCSW



Caregiver Involvement in Child Trauma Therapy: A Qualitative Study of Trauma Therapists’ Experiences and Perceptions Regarding the Child-Caregiver Relationship

Caroline Menapace Glavin, University of Pennsylvania

Dr. Katherine Ledwith, Dissertation Chair, University of Pennsylvania

Caregivers constitute the most proximal and long-standing relationships in a child’s environment, and the caregiver-child relationship can be an agent of change and a powerful tool following trauma. Research has shown that the nature of a child’s relationships, both before and after trauma, play a critical role in shaping their response (Perry & Szalavitz, 2017). Children’s ability to recover from the negative impacts of traumatic events is deeply influenced by the quality of the child’s attachments and by the caregiver’s ability to sensitively respond to the child’s trauma reactions (Breidenstine et al., 2011). In addition to the understanding that caregivers play a role in recovery, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is established as an effective intervention to reduce posttraumatic stress symptoms for children and adolescents who have experienced trauma. TF-CBT studies show efficacy in reducing posttraumatic stress disorder, internalizing, and externalizing symptoms (Lanktree et al., 2012). TF-CBT emphasizes the importance of caregiver involvement in the child’s treatment but provides limited instructions for therapists to navigate the complexities of involving caregivers in treatment.

This study used semi-structured interviews with 10 trauma therapists in Philadelphia to explore how caregiver support and involvement is incorporated into TF-CBT. Therapist participants were asked about their perspectives, experiences, and strategies related to assessment of caregivers. Therapists also discussed how they work to bolster the child-caregiver relationship once beginning TF-CBT. Key themes emerged from the interviews, including: the importance of caregiver involvement and individualized approaches to that involvement, the lack of a standardized process for assessing caregiver eligibility, the various factors that impact a caregiver’s ability to meaningfully participate in treatment, and the need for additional support and training related to attachment concerns. The findings of this study suggest the need for support within the TF-CBT model to guide clinical decision-making around eligible caregivers. Similarly, the findings suggest that a standardized process for assessing caregiver eligibility would support clinicians to identify factors that negatively impact a caregiver’s ability to meaningfully participate in treatment. Concrete and social needs also impact caregiver’s ability to participate in TF-CBT, which suggests a need for more trauma-focused case management support and services for youth and families in Philadelphia. Finally, participant therapists discussed a need for additional training and support related to managing attachment concerns within the TF-CBT model. Use of these recommendations could lead to increased effectiveness in implementation of TF-CBT, and ultimately more positive outcomes for youth receiving treatment. The youth and families deserve our commitment to continuous reflection and improvement of our training and our models.

Available for download on Friday, May 03, 2024

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