3. OUTCOMES AND PROGNOSIS
A key outcome was that Michael was able to experience and accept many of the feelings that resulted from Drew’s death. During the narration, he is able to experience the terrible grief and the anger he felt towards Drew for abandoning him as a young gay man who was just learning to make his way. Accepting the feelings allows him to explore their meaning and with the therapist’s guidance, have compassion for himself as the confused and hurt young man he was at the time of Drew’s death. Freed of the burden of his grief and anger, he is able to understand that Drew did not choose to leave or abandon him. The “conversation” with Drew at the end of the narration reframes the relationship and points Michael in the direction of becoming more socially engaged as Drew would have wanted for him. Feelings of guilt for surviving are referenced but not addressed in this narration (“I selfishly think about myself because I know that will be me one day…”) and that work may help him understand his need to “find a purpose” and in fact succeed in this task.
The first important intervention in the treatment identified that many of Michael’s problems were the result of his multiple traumas and not an indication of a problematic personality, impaired character or being gay. The diagnosis of CPTSD including his anger, social isolation, emotional numbing his “wordlessness” in naming his feelings were typical consequences of trauma. The presence of symptoms such as nightmares, avoid and heightened fear, all of which confused him now made sense and were organized under the diagnosis. The emotional awareness and regulation exercises accelerated a process of connection to his feelings in an accepting and mature way. They also provided him with choices about how to effectively manage ongoing minority stressors and helped him realize that his ability to manage these stressors differed from those he experienced as a child.
Michael substantially benefited from the skills work included in SNT. He had been living in an emotionally shut down manner and had become literally de-skilled over time. This was also perhaps even more true for his social skills. He had become effective in rejecting others. He felt awkward and at a loss in appropriately engaging with others in both social situations and in the task of developing deep and close relationships. The therapist modelled healthy interactions with Michael in which feelings of both vulnerability and safety were experienced.
Table 1 provides a summary of symptom measures which indicated significant reductions in his Complex PTSD symptoms (ITQ; Cloitre et al., 2018), reduction in depression (BDI-II; Beck et al, 1996) and better emotion regulation (DERS; Gratz & Roemer, 2004) and perceptions and expectations about social support (ISEL; Cohen, 2008). The treatment successfully met the goals of Michael feeling better and improving his social connections. He began engaging with staff at the clinic and with members in his support group in more open and friendly way. The prognosis for Michael is good. He has experienced a radical revision in his self-concept as an angry person with no friends to a person who is struggling with loss, and with discrimination and aggression as a gay man. The challenge is made easier by being in the process of reconnecting with the LGBTQ+ community and recognizing he is accepted there. Challenges that remain are effectively dealing with new traumas and new societal discriminations as they may arise. He also is still figuring out the steps to developing an intimate relationship.