The Implementation of Narrative Exposure Therapy (NET) for Transgender and Gender Diverse Adolescents and Young Adults

Abstract

Purpose There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma. Methods Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing. Results Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation. Conclusion NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.

Narrative Exposure Therapy for Treating Post-Traumatic Stress Among Transgender Youth of Color With Selective Mutism

“…In this article, we present two case studies to demonstrate strategies to adapt NET with TGNB individuals experiencing PTSD symptoms with comorbid SM for telehealth and in-person settings. We also contribute to the paucity of literature documenting the efficacy of NET with TGNB individuals (Julian et al, 2023;Lange, 2020). These clients were seen within a pilot program, the Trans Community Trauma Treatment Center (TCTTC), in a gender health clinic embedded within a large tertiary care pediatric medical setting in the Southwestern United States.…”

“…Few studies to date have sought to identify specific interventions to support trauma-focused work with TGNB individuals that incorporate a focus on gender-based discrimination and other minority stress (Julian et al, 2023; Lange, 2020), such as non-affirmation and internalized transphobia (Hendricks & Testa, 2012), as sources for traumatic stress. Narrative Exposure Therapy (NET), a brief, trauma-focused treatment, has been identified as an empowering intervention given its “testimonial” approach, acknowledgement of human rights violations, and focus on contextualization of trauma in a non-pathologizing and non-stigmatizing frame (Schauer et al, 2011; Wright et al, 2020).…”

“…Within our clinic, we modified the PTSD-RI-5 based on feedback from clinicians with expertise in TGNB mental health and members of the community. Two additional items reflecting gender-based traumatic experiences (i.e., institutional gender discrimination, interpersonal gender discrimination) were developed and included (Julian et al, 2023). Clients were asked to rate the frequency of their symptoms in the past 30 days keeping in mind their most traumatic event (0 = none of the days, 5 = almost every day).…”

“…While research has documented the effectiveness of NET in reducing trauma-related symptoms for many vulnerable populations, most studies have focused on refugees and displaced persons from non-Western countries (Lely et al, 2019). However, a few studies have begun to apply this intervention to TGNB populations who are disproportionately impacted by trauma (e.g., Julian et al, 2023; Lange, 2020). This case series demonstrates key considerations and modifications for narrative-based treatment to facilitate crucial trauma-focused healing, specifically for TGNB youth.…”

“…This may be aligned with prior research indicating greater prevalence of anxiety, and social anxiety specifically, among transmasculine individuals (Millet et al, 2017), which may increase likelihood of SM especially among those with higher anxiety and potentially with trauma exposure (Vogel et al, 2022; Wong, 2010). In general, modifications related to the intervention are further detailed in another publication (Julian et al, 2023) and are tailored based on the client’s gender identity and experiences of gender-based trauma. Prior research highlights the importance of considering the nuanced experiences of different gender minority identities (e.g., Lefevor et al, 2019).…”