4. CLINICAL PRACTICES AND SUMMARY
One of the benefits of STAIR Narrative Therapy is that it provides
intensive work in skills practice in emotional awareness and emotion
regulation. It also pairs up behavioral exercises in social skills with
changing relationship models so that intellectual understanding or
insight can be partnered with real and skilled changes in behavior. The
treatment is flexible so that therapist and client can work together in
the selection of skills that are tailored to the patient. While the SNT
protocol is organized into 16 sessions, the work from each ‘protocol
session’ can be extended as needed over actual session time or therapist
and client can cycle back to old skills and exercises as needed. But, as
is hopefully demonstrated in this case presentation, the working through
of the meaning of the traumas is invaluable to revisions in sense of
self and in relational dynamics. For SGM individuals, SNT provides a
program that recognizes the importance of and helps manage ongoing
minority stressors as well past traumas, leading to increased resilience
and a more positive sense of self.
REFERENCES
Beck, A. T., Steer, R. A., Brown, G. K. (1996). Manual for the
Beck Depression Inventory II. Psychological Corp.
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A.,
Bryant, R. A., Humayun, A., Jones, L. M., Kagee, A., Rousseau, C.,
Somasundaram, D., Suzuki, Y., Wessely, S., van Ommeren, M., & Reed, G.
M. (2017). A review of current evidence regarding the ICD-11 proposals
for diagnosing PTSD and complex PTSD. Clinical Psychology Review ,
58, 1–15. https://doi.org/10.1016/j.cpr.2017.09.001
Charak, R. Cano-Gonzalez, I., Ronzón-Tirado, R., Ford, J.D., Byllesby,
B., Shevlin, M., Karatzias, T., Hyland, P., & Cloire, M (in press).
Factor structure of the International Trauma Questionnaire in trauma
exposed LGBTQ+ adults: Role of accumulating traumatic events and
minority stress heterosexist experiences. Psychological Trauma: Theory,
Research, Practice, and Policy.
Charuvastra, A., & Cloitre, M. (2008). Social bonds and posttraumatic
stress disorder. Annual Review of Psychology , 59 , 301.
Cheavens, J. S., Strunk, D. R., Lazarus, S. A., & Goldstein, L. A.
(2012). The compensation and capitalization models: A test of two
approaches to individualizing the treatment of
depression. Behaviour Research and Therapy , 50 , 699-706.
Cloitre, M., Cohen, L. R., Ortigo,
K. M., Jackson, C., & Koenen, K. C. (2020). Treating survivors of
childhood abuse and interpersonal trauma: STAIR Narrative Therapy (2cd
Edition). Guilford Press.
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker,
A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent
profile analysis. European journal of
psychotraumatology , 4 , 20706.
Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills
training in affective and interpersonal regulation followed by exposure:
A phase-based treatment for PTSD related to childhood abuse.Journal of Consulting and Clinical Psychology , 70 (5),
1067–1074. https://doi.org/10.1037//0022-006x.70.5.1067
Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P.,
Maercker, A., Karatzias, T., & Hyland, P. (2018). The International
Trauma Questionnaire: Development of a self-report measure of ICD-11
PTSD and complex PTSD. Acta Psychiatrica Scandinavica ,138 (6), 536–546. https://doi.org/10.1111/acps.12956
Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry,
S., Jackson, C. L., Gan, W., & Petkova, E. (2010). Treatment for PTSD
related to childhood abuse: A randomized controlled trial.American Journal of Psychiatry , 167 , 915–924.
Cohen, S. (2008). Basic psychometrics for the ISEL 12 item
scale. Pittsburgh, PA: Carnegie Mellon University .
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of
emotion regulation and dysregulation: Development, factor structure, and
initial validation of the difficulties in emotion regulation scale.Journal of Psychopathology and Behavioral Assessment , 26 ,
41–54.
Keeley, J. W., Reed, G. M., Roberts, M. C., Evans, S. C., Robles, R.,
Matsumoto, C., … & Maercker, A. (2016). Disorders specifically
associated with stress: A case-controlled field study for ICD-11 mental
and behavioural disorders. International Journal of Clinical and
Health Psychology , 16 , 109-127.
Livingston, N. A., Berke, D. S., Ruben, M. A., Matza, A. R., &
Shipherd, J. C. (2019). Experiences of trauma, discrimination,
microaggressions, and minority stress among trauma-exposed LGBT
veterans: Unexpected findings and unresolved service
gaps. Psychological Trauma: Theory, Research, Practice, and
Policy , 11 , 695.
Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M.,
van Ommeren, M., Humayun, A., Jones, L. M., Kagee, A., Llosa, A. E.,
Rousseau, C., Somasundaram, D. J., Souza, R., Suzuki, Y., Weissbecker,
I., Wessely, S. C., First, M. B., & Saxena, S. (2013). Proposals for
mental disorders specifically associated with stress in the
International Classification of Diseases-11. Lancet , 381 ,
1683–1685.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in
lesbian, gay, and bisexual populations: Conceptual issues and research
evidence. Psychological Bulletin , 129 , 674–697.
Nickerson, A., Cloitre, M., Bryant, R. A., Schnyder, U., Morina, N., &
Schick, M. (2016). The factor structure of complex posttraumatic stress
disorder in traumatized refugees. European journal of
psychotraumatology , 7 , 33253.
Oprel, D. A., Hoeboer, C. M., Schoorl, M., Kleine, R. A. D., Cloitre,
M., Wigard, I. G., … & van der Does, W. (2021). Effect of prolonged
exposure, intensified prolonged exposure and STAIR+ prolonged exposure
in patients with PTSD related to childhood abuse: a randomized
controlled trial. European Journal of
Psychotraumatology , 12 , 1851511.
Redican, E., Nolan, E., Hyland, P., Cloitre, M., McBride, O., Karatzias,
T., … & Shevlin, M. (2021). A systematic literature review of factor
analytic and mixture models of ICD-11 PTSD and CPTSD using the
International Trauma Questionnaire. Journal of Anxiety
Disorders , 79 , 102381.
Roberts, N. P., Cloitre, M., Bisson, J., & Brewin, C. R. (2019).
International Trauma Interview (ITI) for ICD-11 PTSD and complex PTSD,
test version 3.2 [Unpublished measure].
Roberts, A. L., Austin, S. B., Corliss, H. L., Vandermorris, A. K., &
Koenen, K. C. (2010). Pervasive Trauma Exposure Among US Sexual
Orientation Minority Adults and Risk of Posttraumatic Stress Disorder.American Journal of Public Health , 100 , 2433–2441.
https://doi.org/10.2105/AJPH.2009.168971
Solomon, D.T., Combs, E. M., Allen, K., Roles, S., DiCarlo, S., Reed, O.
& Samantha J. Klaver. (2021). The impact of minority stress and gender
identity on PTSD outcomes in sexual minority survivors of interpersonal
trauma. Psychology & Sexuality, 12 :, 64-78,
Table 1. Michael’s Symptom Scores at Pretreatment and Postreatment