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Supporting traumatised children by training therapists in Sweden

Trauma therapy goes nationwide as CSOs, government and researchers unite

In 2015, Erica Mattelin, a child psychologist at Save the Children Sweden, saw a gap in the services offered to vulnerable children.  

“I worked in a child treatment centre in Stockholm with two other psychologists and we saw that the children’s needs were not being met,” Mattelin recalled. Childhood trauma was beyond the expertise of many therapists and psychiatrists. “People didn’t know if children exhibiting trauma symptoms were the responsibility of child psychiatrists or social services. Children fell through the cracks because nobody saw traumatised kids as their group to serve.”

Exact figures on the prevalence of childhood trauma are not yet available, but numerous indicators suggest the problem is widespread. Some 15% of Swedish children have experienced physical violence from a family member, while a more recent study reported that around 21% have experienced some form of sexual abuse during childhood or adolescence. The link between violence and trauma is indelible: 67% of patients in the Gamlestaden child psychiatric unit in Gothenburg reported exposure to violence both within and outside of the family unit.

To fill the breach, Save the Children Sweden looked to Trauma Focused Cognitive Behavioural Therapy (TF-CBT), a treatment effective both in instances of everyday violence and humanitarian crises. A systematic review of 11 trials found that TF-CBT reduced trauma symptoms and functional impairment among children and adolescents exposed to violence by 37% when delivered to individuals. When delivered in groups, its effectiveness soared to 56%. Studies also show effectiveness whether delivered by trained psychologists or lay workers. 

Since 2015, Save the Children have offered TF-CBT training to around 100 therapists and child psychologists. Despite significant advances in spreading TF-CBT to practitioners, training was often uneven across the country and dependent on the interest of organisations and collaborators.

Now, the project is scaling up with support of the Swedish government through Barnafrid, a national research centre on violence against children at the University of Linköping.

“The aim is to train at least 50 people each year,” explained Moa Mannheimer, Executive Director of Barnafrid. With two intakes, one in the fall and one in spring, therapists are trained extensively in the professional use of TF-CBT over the course of a semester. Intensive day-long training sessions are accompanied by practical work with clients. Regular phone calls assess their progress before the final, day-long sessions, which conclude the semester. 

“The strength of the project is two-fold,” explained Mannheimer. “First is the emphasis it places on involving parents in the process. We know that traumatised children have a lot of behavioural problems, and we know a lot of parents have trauma symptoms themselves.” 

“But the second strength of TF-CBT is the focus on the actual trauma experienced. Sometimes patients and clinicians don’t want to talk about the sexual abuse or the torture they have suffered. In TF-CBT, it is central to the recovery process.”

Barnafrid’s work is explicitly interdisciplinary, combining academic excellence with practitioner experience to pool skills and share insights. According to Mannheimer, “Establishing Barnafrid at the university was crucial to bring the scientific research community and clinicians together.”

The collaborative nature of the approach is breaking new ground in child protection.

“The collaboration between government, private actors and NGOs has been the greatest aspect of this,” Mattelin explained. 

“There are many problems in child psychology that we don’t know how to solve. Trauma isn’t one. We have effective treatments – it’s just a question of making them available. Now, at last, we’re doing that.”

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