“Confident and Effective” – A Mixed-Methods Study on Psychotherapists’ Experiences Implementing TF-CBT with Unaccompanied Young Refugees

Background Unaccompanied young refugees (UYRs) are a highly vulnerable population, exhibiting elevated rates of posttraumatic stress disorder (PTSD), depression, and anxiety due to trauma exposure and post-migration stressors. Despite the established efficacy of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for PTSD, there is limited research on its implementation and cultural fit for UYRs.Objective This study examines psychotherapists’ experiences with implementing TF-CBT in the treatment of UYRs within a randomized controlled dissemination trial in Germany.Methods Data were collected as part of the multicenter “BETTER CARE” trial, involving 20 psychotherapists who treated 57 cases of UYRs with TF-CBT. Fidelity was assessed quantitatively through self-reports using the TF-CBT Brief Practice Checklist, while implementation experiences and perceived opportunities were explored through semi-structured interviews. Psychotherapists completed culturally sensitive TF-CBT training and participated in bi-weekly case consultations.Results Treatment fidelity was high, with most core components implemented, except in-vivo exposure and caregiver-related modules. Psychotherapists frequently applied flexible, needs-based strategies, such as addressing the “crisis of the week” and adjusting module sequence. Most UYRs (64.9%) were accompanied by interpreters. Components perceived by psychotherapists as particularly helpful included trauma narrative, psychoeducation, and cognitive coping, whereas relaxation and certain stabilization modules were perceived as less essential or challenging to implement. Psychotherapists reported increased confidence in delivering TF-CBT and willingness to continue using TF-CBT.Conclusions TF-CBT was perceived by psychotherapists as a feasible and acceptable treatment approach for UYRs in routine care. Flexible, needs-based adaptations were considered to facilitate its application in routine care, while structural constraints, such as limited caregiver involvement, may require additional consideration. These findings support the broader dissemination of TF-CBT in diverse, multilingual refugee settings.Trial registration German Clinical Trials Register (http://www.germanctr.de; registration number DRKS00017453, registration date: December 11, 2019).