Phase 1: TF-CBT coping skills for complex traumaOverview—During the initial coping skills phase youth begin to establish a trusting relationship with the therapist and develop safer and more effective self-regulation skills. Under optimal circumstances, participating caregivers also gain understanding of and attunement to youths' complex trauma responses and needs. However, since these changes require youth to shift their longstanding responses for adapting to severe stress, they rarely occur in a linear fashion. Even if the youth's trauma responses are maladaptive or dangerous, they seem to have helped the youth to survive, so giving them up may be terrifying. As a result, youth usually need many attempts of practicing using new self-regulation skills in diverse situations before they begin to use them effectively. Youth may respond very poorly to disappointing early attempts and “give up,” requiring the therapist to repeatedly reengage the youth in attempts to try new self-regulation skills. The youth may repeatedly “test” the therapist for trustworthiness during this process (e.g., a youth may not mention self-injury until the end of a session to see whether the therapist “cares” enough to extend the session). The therapist may be challenged to maintain personal regulation in these situations but doing so is critical to modeling coping skills as well as a fair, predictable, consistent relationship whose rules and boundaries the youth can come to understand and rely upon. Thus, theyouth gradually gains increasing self-regulation while learning to tolerate reasonable levels of frustration within the context of an ongoing supportive relationship.