1.3 STAIR Narrative Therapy Process
SNT is a cognitive behavioral therapy that is based in interpersonal and
attachment principles. The treatment was developed following both theory
and evidence that early life trauma disrupts attachment and related
capacities for emotion regulation, positive self-regard and healthy
relationships (see Cloitre et al., 2006). Accumulating research in the
trauma field has strongly indicated that trauma which is the result of
human design (e.g., war, community violence, genocide and other forms of
organized violence), regardless of whether in happened in childhood or
adulthood, is particularly pernicious. Compared to non-interpersonal
traumas, it is associated with higher rates of PTSD and other adverse
effects (e.g., deterioration in social networks) that relate to the
capacity to maintain social bonds at an individual and community level
(Charuvastra & Cloitre, 2008).
As described in the case illustration, the therapeutic allianceis key to recovery as is repeated psychoeducation on the nature of
trauma . The therapist’s feedback and explanations help the client begin
to reframe the nature of their experience from one in which they are to
blame (“How did you let this happen? ”), to something that
happened to them and from which they can recover (“I’m sorry this
happened to you. How can I help ?”) The first two sessions of STAIR
highlight the negative impact of trauma on emotions, self-identity and
relationships. The selection of emotion regulation skills is
based on client preferences, needs and strengths. Research on depression
indicates that the selection of skills that strengthen existing
competencies rather than fill a gap (compensatory) result in greater
decrease in symptoms (Cheavens et al., 2012). This may be because
emphasizing strengths may enhance of mastery and positive self-regard,
both of which are low among trauma-exposed individuals. There are at
least 15 emotion regulation skills available in the protocol (Cloitre et
al., 2020) and typically clients comfortably and effectively adopt from
3 to 6.
The sessions on relationships models borrows directly from Bowlby (see
Cloitre et al., 2020). The relationship models are viewed in a
nonpathological manner. They are described as strategies intended to
maintain connections and ensure survival in particular social or
interpersonal circumstances. Thus, models like “If I don’t share
my feelings, I will be taken care of ” works well for a child with a
distant mother or “Trusting others can get you killed ” ensures
survival in a combat zone. Consistent with attachment theory, SNT
recommends that a client diversify their attachment models for different
relationships and circumstances. It is not necessary to reject or
invalidate old models; they may still be useful if the client returns to
a trauma-genic environment e.g., (an abusive family, combat zones). The
client is encouraged to develop new and alternative schemas that are
relevant to their current environment or even as related to an
aspirational goal (e.g., “I would like to make friends.” ). As
supported in the SNT protocol, several themes can be discussed in the
treatment including, for example, power dynamics, shame, and grief.
Therapist and client can choose to settle in on one or more of these
themes as appropriate.
Last and most importantly, the therapist and client prepare to conduct
narratives of the trauma memories. These sessions can number from 4 to
10 depending on the number of events that the client wants to discuss.
The sessions also include continued use of the emotion regulation and
interpersonal skills learnt during the STAIR phase of the treatment.
This can highlight difference between the “old” traumatized self
represented in the narratives, and the new evolving self emerging from
the STAIR work which is respectful of but different from the person in
the stories.