I use Trauma-Focused CBT to help people heal from trauma, PTSD, anxiety, and depression. We work together to process painful experiences, challenge the beliefs trauma planted, and build skills so you can feel safer in your body and relationships. You’ll learn practical tools to manage overwhelming emotions while we address what’s actually driving the pain.
In TF-CBT, I work with you to understand how thoughts, emotions, and behaviors all influence each other. When trauma disrupts that system, it creates patterns that once protected you but now keep you stuck.
Unlike traditional therapy that just talks through feelings, we build practical skills to manage overwhelming emotions while gently processing the memories that still feel too big to hold.
You learn why your reactions make sense, challenge the beliefs trauma planted, and develop tools to feel safer in your own body. We move at whatever pace your nervous system can handle. I never rush you into pain before you’re ready.
I wake up already tense, my chest tight before my feet even hit the floor. Small moments trigger waves of shame, self-doubt, or fear. A missed text, a sharp tone, a simple mistake can spiral into believing I’m not enough. Even moments of calm feel suspicious, like they’re too good to last.
Inside, that critical voice keeps pushing the message that I have to work harder just to be accepted or loved. Relationships feel exhausting, like I’m constantly walking on eggshells, afraid that being fully myself will push people away.
Safety isn’t about erasing the past. It’s about building skills to feel grounded in your body, connected in relationships, and trusting that you are already enough.
Trauma-Focused CBT creates space for this transformation. You learn to recognize patterns that keep you stuck, challenge beliefs that trauma planted, and develop tools to feel safer in your own mind and body.
The goal isn’t to forget what happened. It’s to help you move forward feeling in control, at peace, and at home within yourself.
I understand that trauma is something that affects your thoughts, emotions, behaviors, and physical sensations. To address all the brain-body sensations, we explore how your trauma responses developed, why they made sense at the time, and how to shift patterns that no longer serve you. Rather than forcing you to relive painful experiences, we build skills first, creating a foundation of safety before addressing traumatic memories.
How Trauma-Focused CBT works:
The first session focuses on understanding what brings you to therapy and noticing how trauma shows up in your life. Trauma-Focused CBT moves at the pace your nervous system can handle, never rushing you into processing before you’re ready.
What to expect:
Trauma affects how you see yourself, how you connect with others, and whether your body ever feels safe enough to rest. Trauma-Focused CBT works with all of it, the panic that arrives without warning and the shame that whispers in the background. Together, we will address what you’re experiencing now while also healing the wounds underneath.
Traumatic experiences can create lasting imprints that affect how you move through the world. Flashbacks, hypervigilance, and emotional numbing are the nervous system’s attempts to protect from pain that felt unbearable. We process these memories safely, reducing their emotional charge so they no longer control your present. You learn that remembering doesn’t mean reliving, and healing doesn’t require you to forget.
Anxiety after trauma often stems from a nervous system stuck in survival mode, constantly scanning for danger even when you’re safe. Panic attacks, racing thoughts, and physical tension are signals that your body is trying to protect you from perceived threats. We help you understand these responses, challenge catastrophic thinking patterns, and develop tools to calm your nervous system before panic takes over.
Depression after trauma can feel like the mind and body shutting down to protect from overwhelming pain. Hopelessness, exhaustion, and emotional numbness are ways traumatized parts try to survive when everything feels too heavy. TF-CBT addresses the beliefs trauma created and helps you reconnect with possibilities that depression convinced you didn’t exist.
Self-harm and suicidal thoughts often emerge when emotional pain feels unbearable, and no other coping strategies seem to work. These behaviors are attempts to regulate overwhelming feelings or communicate distress when words feel impossible. We will develop healthier ways to manage intense emotions, process the trauma driving the pain, and build reasons to stay connected to life beyond just surviving.
Emotional dysregulation happens when trauma overwhelms your nervous system’s ability to process feelings in manageable ways. Emotions can surge quickly, feel disproportionate to situations, or swing unpredictably. TF-CBT teaches you to recognize emotional triggers, build the capacity to tolerate distress, and develop skills to regulate your nervous system before emotions flood you completely.
Trauma teaches lies that feel true. “I’m worthless.” “I’m unlovable.” “Something is fundamentally wrong with me.” The inner critic that speaks these words isn’t the enemy; it’s a protective part trying to prevent external judgment by being harsher first. TF-CBT helps identify where these beliefs took root, examine whether they’re actually true, and rebuild self-worth based on reality rather than what trauma convinced someone to believe about themselves.
Trauma shapes how you connect with others, often creating patterns of pushing people away, people-pleasing to avoid abandonment, or staying in relationships that feel unsafe because they’re familiar. TF-CBT helps you understand how early relational wounds affect current partnerships, challenge beliefs like “I can’t trust anyone” or “I always get hurt,” and develop healthier ways of connecting that honor both intimacy and boundaries.
Surviving domestic violence or abuse creates complex trauma that affects your sense of safety, self-worth, and ability to trust. Trauma-Focused CBT helps you process what happened without shame, challenge beliefs that you deserved the abuse or could have prevented it, and rebuild your capacity to recognize healthy relationships. Healing involves understanding that survival strategies that kept you safe during abuse may no longer serve you now.
Trauma-Focused CBT doesn’t rush you into reliving painful memories. The work starts by building a foundation: learning how trauma affects your nervous system, developing skills to manage emotional overwhelm, and creating enough internal safety that processing becomes possible.
Only then does therapy address the traumatic experiences themselves, helping your brain finally complete what it couldn’t process when the trauma first happened. Each phase builds on the last, moving at whatever pace your system needs.
Understanding how trauma affects your brain, body, and relationships is the foundation of healing. Psychoeducation normalizes your reactions, helps you recognize that symptoms make sense given what you’ve survived, and reduces shame about struggles that trauma created.
How this helps:
Before processing trauma, you need tools to manage emotional overwhelm. TF-CBT teaches practical skills to calm your nervous system, stay grounded during distress, and tolerate difficult emotions without resorting to harmful coping strategies.
How this helps:
Trauma creates beliefs that feel true but aren’t accurate. “It was my fault,” “I’m not safe anywhere,” or “I can’t trust anyone” are thoughts that trauma planted. Cognitive processing helps you examine the evidence for these beliefs and develop more balanced, truthful perspectives.
How this helps:
Creating a coherent narrative of what happened helps your brain process fragmented traumatic memories. This doesn’t mean reliving every detail. It means organizing memories in a way that reduces their emotional charge and integrates them into your life story as something that happened in the past, not something still happening now.
How this helps:
Avoidance keeps you safe short-term but reinforces fear long-term. Gradual exposure helps you approach trauma reminders in controlled, manageable ways, proving to your nervous system that you can handle triggers without being overwhelmed. This isn’t about forcing yourself into distress. It’s about reclaiming activities and experiences that trauma took away.
How this helps:
Healing isn’t just about processing the past. It’s about developing skills to handle future stressors without resorting to old trauma responses. TF-CBT helps you prepare for challenges, maintain progress, and trust that setbacks don’t mean you’re back at the beginning.
How this helps:
Trauma affects your mind, body, emotions, and relationships. By integrating Trauma-Focused CBT with other evidence-based approaches, healing addresses every part of your experience, helping you feel stronger, safer, and more connected to yourself and others.
EMDR therapy helps your brain reprocess traumatic memories that TF-CBT cognitive work has prepared you to address. When combined, TF-CBT builds emotional regulation skills while EMDR releases the stored trauma responses in your nervous system.
How this helps:
Internal Family Systems therapy helps you understand the different parts of yourself that developed protective strategies after trauma. When paired with TF-CBT, you gain both practical coping skills and deep self-compassion for the parts carrying pain.
How this helps:
Somatic therapy addresses how trauma lives in your body through tension, shallow breathing, chronic pain, or feeling disconnected. TF-CBT teaches cognitive skills while somatic work helps your body finally feel safe again.
How this helps:
Relational psychodynamic therapy explores how early attachment wounds show up in current relationships. Combined with TF-CBT’s practical tools, you understand both why patterns exist and how to change them.
How this helps:
Clinical hypnosis accesses deeper layers of healing that words can’t always reach. When integrated with TF-CBT, it helps calm the nervous system and process trauma held beneath conscious awareness.
How this helps:
TF-CBT is about more than coping — it’s about helping you feel truly grounded, empowered, and connected again.
Trauma doesn't have to control your life anymore.
I became a therapist because healing transformed my life. For years, I didn’t feel comfortable in my own skin. My emotions felt overwhelming, and I didn’t know how to let people care for me. I questioned my worth and tried to hold everything together, but nothing ever felt good enough.
Healing began when I stopped fighting my feelings and started listening to them. I learned that even the parts of me I wanted to ignore were trying to help, and they needed my help too. As I built trust with myself, I was able to let others in fully, safely, and without shame.
Now I help others do the same. You’re not broken. You’re carrying pain that deserves care. Healing is possible, and you don’t have to do it alone.
Hi, I’m Micah Fleitman, LPC.
I offer Trauma-Focused CBT online throughout Virginia. Serving across Arlington, Richmond, Virginia Beach, and throughout the state. My secure teletherapy makes TF-CBT accessible from wherever you feel comfortable. Online sessions provide the same depth and effectiveness as in-person therapy while offering flexibility that works with your life.
Locations served throughout Virginia:
Trauma-Focused Cognitive Behavioral Therapy recognizes that trauma creates distortions in how you think, feel, and behave. Unlike traditional CBT, TF-CBT specifically addresses trauma’s impact while building skills to manage overwhelming emotions.
The Core Concept of TF-CBT
TF-CBT views trauma as an experience that disrupts your sense of safety, worth, and trust. Symptoms aren’t signs of weakness. There’s evidence that your nervous system is trying to protect you from pain that once felt unbearable.
Key principles:
How TF-CBT Differs from Regular CBT
Traditional CBT focuses on changing thought patterns and behaviors without always addressing underlying trauma. TF-CBT integrates trauma-specific components that honor the complexity of traumatic experiences.
Key differences:
What TF-CBT Includes
TF-CBT follows a structured yet flexible approach that moves through phases of healing.
Core components:
Inside a TF-CBT Therapy Session
Sessions balance skill-building, cognitive work, and trauma processing based on where you are in treatment.
What happens:
A therapist specializing in Trauma-Focused CBT guides you through this process, adjusting pace and focus based on your needs and capacity.
Trauma-Focused CBT is one of the most researched and evidence-supported treatments for PTSD and trauma-related symptoms. Research consistently shows significant symptom reduction and improved functioning.
Research Support for TF-CBT
Studies demonstrate TF-CBT’s effectiveness across diverse populations and trauma types.
Evidence shows:
For Single-Incident Trauma
TF-CBT works particularly well for trauma from specific events like accidents, assaults, or natural disasters.
Why it’s effective:
For Complex Trauma
Complex trauma from ongoing abuse, neglect, or multiple traumatic experiences requires longer, more comprehensive treatment, but TF-CBT remains effective.
When Complex Trauma Needs More Time
Complex trauma affects identity, attachment, and emotional regulation in ways single-incident trauma doesn’t.
What this means:
Challenges TF-CBT Addresses
Complex trauma creates patterns that need careful attention.
TF-CBT helps with:
What Makes TF-CBT Effective
Several factors contribute to TF-CBT’s strong research support.
Why it works:
Limitations to Consider
TF-CBT isn’t magic, and effectiveness depends on several factors.
What affects outcomes:
In my practice, I integrate TF-CBT with EMDR, IFS, and somatic approaches.
Each therapy approach addresses trauma and emotional struggles differently. Understanding these differences helps you choose the treatment that fits your needs and preferences.
TF-CBT vs EMDR
Both treat trauma effectively, but they work through different mechanisms.
How they differ:
How they complement each other:
TF-CBT vs IFS
TF-CBT and IFS have fundamentally different frameworks for understanding trauma.
Core differences:
When to choose which:
TF-CBT vs DBT
DBT and TF-CBT both teach coping skills but have different primary focuses.
Key differences:
Who Benefits from DBT vs TF-CBT
Different presentations call for different approaches.
Consider DBT if:
Consider TF-CBT if:
TF-CBT vs Traditional Talk Therapy
Traditional talk therapy processes emotions verbally and builds insight. TF-CBT is more directive and focused.
How they differ:
What Fully Human Offers
In my practice, I combine Trauma-Focused CBT with EMDR, IFS, somatic therapy, and relational psychodynamic work.
TF-CBT works well for many people with trauma, but certain situations call for different approaches or preparation before starting trauma-focused work.
Who Benefits Most from TF-CBT
TF-CBT is particularly effective for specific presentations and needs.
TF-CBT works well if you:
Conditions TF-CBT Treats Effectively
Research supports TF-CBT for various trauma-related struggles.
Strong evidence for:
ADHD and TF-CBT
ADHD doesn’t preclude TF-CBT, but adjustments may help.
Adaptations that work:
TF-CBT’s structured nature can actually benefit people with ADHD who struggle with unstructured talk therapy.
When Other Approaches May Help
Certain situations benefit from different treatments or preparatory work.
Consider alternatives if:
What About Complex PTSD?
Complex PTSD from prolonged trauma responds to TF-CBT but requires longer treatment and potentially integrated approaches.
What helps complex trauma:
Who Might Not Be Ready for TF-CBT
Readiness matters more than diagnosis. Some people need preparation before trauma-focused work.
You might need stabilization first if:
This doesn’t mean TF-CBT won’t work eventually. It means other interventions should come first to create the stability that trauma processing requires.
What Makes Someone a Good Candidate
Beyond diagnosis, certain qualities support TF-CBT success.
Factors that help:
I assess readiness collaboratively and adjust treatment approach based on where you are. If you’re not ready for full trauma processing, we focus on building skills and safety until you are. Healing happens at your pace, never rushed or forced.
Treatment length varies based on trauma complexity, symptom severity, and how quickly you develop coping skills and process traumatic memories.
Typical Timeline for TF-CBT
Research and clinical experience provide general timeframes, but individual needs vary significantly.
Average duration:
Factors That Affect Treatment Length
Several variables influence how long TF-CBT takes.
Trauma Type and Complexity
Different trauma presentations require different treatment lengths.
Single-incident trauma:
Complex developmental trauma:
Current Symptom Severity
More severe symptoms require more preparation before trauma processing.
Mild to moderate symptoms:
Severe symptoms:
Co-occurring Mental Health Conditions
Additional diagnoses affect the timeline.
Common co-occurring conditions:
The Phases of TF-CBT
Understanding treatment phases helps set realistic expectations.
Phase 1: Safety and Skill-Building
This phase can’t be rushed. It builds the foundation for trauma processing.
Duration: 4-8 sessions typically, longer for complex trauma
What happens:
Phase 2: Trauma Processing
This phase addresses traumatic memories directly once skills are solid.
Duration: Variabledependingds on the number of memories and complexity
What happens:
Phase 3: Consolidation and Relapse Prevention
Final phase strengthens gains and prepares for ongoing life.
Duration: 3-6 sessions
What happens:
When Progress Feels Slow
Some periods of treatment feel stuck, and that’s normal.
Why progress slows:
Slow periods don’t mean failure. They mean your system needs more time, and that’s okay.
Intensive vs Standard Treatment
Some people benefit from intensive treatment formats.
Standard treatment:
Intensive treatment:
In my practice, sessions are typically weekly, with flexibility based on your needs and capacity. Some people benefit from twice-weekly sessions during intensive phases, while others need more time between sessions to process.
Understanding costs and insurance helps you plan for treatment without financial surprises.
Insurance Coverage for TF-CBT
Insurance coverage depends on your specific plan and benefits.
In-Network vs Out-of-Network
Fully Human’s insurance status affects your costs and reimbursement.
Current insurance status:
How Out-of-Network Benefits Work
If your insurance isn’t Anthem/BCBS, you may still receive reimbursement through out-of-network benefits.
The process:
Understanding Your Out-of-Network Benefits
Before starting treatment, call your insurance to verify benefits.
Questions to ask:
Allowable Amount Explained
Insurance plans set an “Allowable Amount” for each service, which affects reimbursement.
How it works:
Help with Insurance Claims
I offer multiple options for submitting claims.
Three options:
Making Treatment Affordable
If costs feel overwhelming, several options exist.
Strategies people use:
Session Structure and Billing
Sessions are 53 minutes, following standard insurance billing practices for maximum reimbursement. This is a private pay practice, with sessions billed weekly.
For complete information about session rates and fees, please visit the FAQs page.
No therapy works perfectly for everyone. Understanding TF-CBT’s limitations helps you make informed decisions.
When TF-CBT Might Not Be the Best Fit
Certain situations call for different approaches or preparatory work.
Active Crisis Requiring Stabilization
TF-CBT is not a crisis intervention model.
When crisis support comes first:
Once stabilized, TF-CBT can be part of comprehensive treatment.
Severe Dissociation Without Adequate Grounding
While TF-CBT helps with dissociation, severe cases need extensive preparation.
Why preparation matters:
Preference for Less Structured Approaches
TF-CBT is directive with homework expectations.
You might prefer other approaches if:
Common Criticisms of CBT-Based Approaches
TF-CBT shares some limitations with traditional CBT.
“CBT Feels Invalidating”
Some people experience CBT as dismissive of their pain.
Why does this happen?
How TF-CBT addresses this:
“CBT Doesn’t Address Root Causes”
Traditional CBT sometimes focuses on symptoms without addressing underlying wounds.
How TF-CBT differs:
What TF-CBT Doesn’t Address Directly
Understanding what TF-CBT doesn’t cover helps identify if supplementary approaches might help.
Attachment Wounds and Relational Patterns
TF-CBT addresses trauma-related relationship struggles but doesn’t focus primarily on attachment.
What this means:
Deep Parts Work
TF-CBT recognizes protective strategies but doesn’t use parts language extensively.
If you need parts work:
Body-Based Trauma Processing
TF-CBT includes psychoeducation about trauma’s physical effects, but isn’t primarily somatic.
For body-focused work:
How I Address These Limitations
In my practice, I combine TF-CBT with EMDR for memory processing, IFS for parts work, somatic therapy for body-based healing, and relational psychodynamic therapy for attachment wounds.
Finding the right trauma therapist requires knowing what to look for and where to search.
What to Look for in a Trauma Therapist
Not all therapists have specialized trauma training, even if they list trauma as a specialty.
Essential qualifications:
Questions to Ask Potential Therapists
Initial consultations help determine fit.
Important questions:
How to Find a Trauma-Focused CBT Therapist Near Me in Virginia
Several resources help locate qualified trauma therapists.
Search strategies:
Virginia-Specific Resources
Virginia has therapists throughout the state, though the concentration varies by region.
Where to find therapists:
Online Therapy Expands Access
Teletherapy makes specialized trauma treatment accessible across Virginia.
Benefits of online therapy:
Is Online TF-CBT as Effective?
Research shows teletherapy works as well as in-person for trauma treatment.
What studies show:
My Approach
I offer trauma treatment online throughout Virginia, integrating TF-CBT with EMDR, IFS, and somatic approaches.
My practice:
Contact information:
What to Expect in Your First Contact
Initial outreach helps determine if a therapist is right for you.
During free consultation:
You’re not committing to treatment by scheduling a consultation. You’re gathering information to make an informed decision about your care.
Book a complimentary 30-Minute Consult
