Treating Complex Trauma in Children & Teens: The Role of Caretaker Involvement

By: Maureen Bethea, LMFT

When a child has experienced trauma, the healing process doesn’t happen in isolation. While therapy provides a safe, structured space for children to process their experiences, caretakers play an equally essential role in healing. In fact, research consistently shows that therapy outcomes improve when caretakers are actively engaged in the treatment process.

Why Caretaker Involvement Matters

Children rely on their caretakers for safety, regulation, and connection. Trauma often disrupts their access to these core needs, leaving children feeling uncertain about whom they can trust. When caretakers participate in therapy, they help rebuild a foundation of security. This involvement communicates to the child: “You’re not alone. I am here with you in this healing process.”

Caretaker engagement also allows therapists to extend the work done in sessions into the child’s daily life. Skills like grounding, emotion regulation, and healthy communication can be reinforced at home, creating consistency and stability that accelerates progress.

An Important Clinical Decision Point

Deciding when and how to include caretakers in trauma therapy is one of the most important clinical decisions a therapist makes. Some children may benefit from individual time to build trust and safety before involving caretakers. Others may need caretaker participation from the very beginning to strengthen attachment and support regulation. Sometimes the caretakers are part of, or the cause of, traumatic experiences. Therapists need to carefully weigh factors such as the child’s developmental stage, the caretaker’s own history of trauma, and the family dynamics at play. Using a systemic and attachment-trauma informed lens in this clinical decision point is essential for maintaining safety and rapport with the client and their families. 

Making this decision thoughtfully helps ensure that therapy is both safe and effective. When inclusion is timed well, caretaker participation can transform the therapeutic process. The goal is to foster healing not only for the child but often for the family system as a whole.

What Caretaker Participation Looks Like

Caretaker involvement doesn’t always mean that caretakers are sitting in every single session. Depending on the child’s needs and therapeutic goals, it can take many forms:

• Psychoeducation: Teaching caretakers about trauma, its effects on the brain and behavior, and how healing occurs.
  
  
• Modeling regulation: Allowing caretakers to witness you practicing calm responses and coping strategies so caretakers and children can mirror these behaviors.
  
  
• Joint sessions: Inviting caretakers to attend therapy more regularly with the child to build trust, practice communication, or process shared experiences.
  
  
• Support outside sessions: Helping caretakers to create predictable routines, providing them reassurance, and helping them to reinforce therapeutic skills at home.
  
  

Supporting Caretakers in the Process

Caretakers may feel guilt, frustration, or helplessness as they witness the child’s struggles. They may feel shame for the way past behaviors have impacted their children or teens. That’s why many trauma-informed therapists also support caretakers in managing their own stress responses. When caretakers feel resourced and regulated, they are better equipped to offer stability to the child.

The Path to Healing Together

Healing from trauma is rarely a straight line—it’s a journey of small, meaningful steps. When therapists, children, and caretakers work as a team, recovery becomes a shared process rather than a solitary one. By carefully considering caretaker involvement as a clinical decision point, therapists can create a pathway to deeper resilience, stronger relationships, and lasting healing. As we like to highlight at Integrative Resouce Network, healing is relational.

If you’d like to learn more about treating complex trauma in kids and teens, especially including caregivers in the process, please join us on September 12th for our live webinar: Treating Complex Trauma in Children and Teens.