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.