Table 1. Zambian Counselor Perspectives (N=19).

COVER TERM	Included term summary	Number reporting
TF-CBT is a good program
	The skills counselors learn from TF-CBT are useful in their own life	9
	Structure of the program was useful to the counselor; easy to follow.	7
	The benefits of the program extend beyond patients – to the parents and counselors themselves	7
	TF-CBT builds the relationship between caregiver and child	6
	Involving the caregiver as the support system for the child is an important strength of the model	6
	TF-CBT is empowering	5
	TF-CBT is flexible - you can adapt it to the client	5
	Benefits for the clinicians to be involved in this	5
	The program is practical – both the exercises and the skills taught	4
	People appreciate the program	4
	Helps children get over/come to terms with thoughts and feelings	4
	Good program for sexual abuse	4
Challenges
	Poor attendance at and/or commitment to therapy sessions	15
	TF-CBT duration is too long	9
	Challenges for first-time counselors	6
	Community misconceptions and/or lack of awareness of TF-CBT	5
	Challenging to explain TF-CBT in the local languages	4
	Difficult to talk about sex in our culture	4
Perceived changes in children and families
	The child is more open (to talk about problems/trauma with the caregiver and others)	17
	Overall positive change/growth (attitudes, more trust, sleeps better, learns about feelings and thoughts, goes to school, good hygiene, self-esteem, self-confidence, less angry, more relaxed)	14
	Improved child/caregiver relationship.	11
	Increased support from caregivers	7
	Development of positive/helpful thoughts	7
	Caregiver learns parenting skills	5
	Child socializes more/better	5
	TF-CBT causes change and growth in the child and caregiver	5
	Clients make their own decisions	4
Cultural Adaptations
	There is a need to adjust the activities from the TF-CBT manual to fit the local context	10
	Important to address issues/difficulties regarding use of local languages	9
	It is taboo to talk about sex	8
	Parenting skills were challenging for parents	6
	TF-CBT is working well in Zambia culture	4
	There are differences in parent/child relationship here	4
Training & Supervision
	The practice and supervision groups were helpful and motivating	15
	Training was good – organized, comprehensive, experiential, fun, etc.	9
	Training should be longer	4
Suggestions for Improvement
	Create a physical, permanent center for therapy	9
	Adjust the training in TF-CBT (lengthen, update with materials)	7
	Create awareness of sexual abuse and this treatment in the community	6
	Reduce length of TF-CBT treatment for clients	6
	Improve patient referral system	5
	Improve patient attendance	4
	Provide more funding	4
	Scale up program	4
	Need for programs like this in Zambia	4