Abstract
Narrative exposure therapy (NET) is an individual therapeutic approach that has an emerging evidence base for children. It was initially trialed with refugee and asylum seeking populations, in low, middle and high-income settings, utilizing either lay or professional therapists. The results of treatment trials for PTSD in refugee children with NET (or the child “KIDNET” adaptation) demonstrates how this is an effective intervention, is scalable and culturally dexterous. This paper describes, in five cases from clinical practice settings, the applicability of NET into broader, routine practice. The cases outlined describe the use of NET with adolescents with: autism spectrum disorders, psychotic symptoms, and intellectual disabilities; histories of forced abduction into child soldiering; complex physical health problems needing multiple interventions; and victims of childhood sexual abuse. The cases are discussed with regards to how the NET lifeline facilitated engagement in treatment, practical adaptations for those with intellectual disabilities and how NET, with its relatively short training for health professionals, can be modified to different contexts and presentations. The importance of improving access to care is discussed to ensure that young people are supported with their most complex and disruptive memories.
Highlights
The sequelae of exposure to extremely distressing events, including the development of post-traumatic stress disorder (PTSD) remain an area of poor service provision across low, middle, and high-income nations, especially for child populations
As a result of increasing interest in this area, we describe here the use of Narrative exposure therapy (NET) and its adaptation to five very different groups of young people with more complex PTSD and share the principles of practice and some of the ways it has been adapted to these situations
This paper has described a number of clinical applications of NET that have been used to treat a range of cases of children with PTSD, some in relatively typical clinical settings and others more unusual
Summary
The sequelae of exposure to extremely distressing events, including the development of post-traumatic stress disorder (PTSD) remain an area of poor service provision across low, middle, and high-income nations, especially for child populations. What was evident early in the treatment was how this young person found social interactions difficult, especially negative interactions with peers This contributed to her experience of multiple traumas involving many negative events, a perception of ongoing bullying and other peer related difficulties—for example in the lifeline session, she placed a large number of stones throughout her life, with many events at school being highlighted. Following completion of NET, he explained that he had not felt secure enough to “open up” at the beginning of the treatment as talking about his PTSD symptoms was more difficult than addressing depression or anxiety, and he needed longer to develop a trusting therapeutic relationship While he had experienced multiple and varied traumatic experiences from age 7 to 16, the visual representation of these as a lifeline helped illustrate how a number of stones related to the same events, the impact of which had not been fully appreciated. NET was a helpful way of processing the traumatic memories associated with major surgery and the lifeline helped to identify which of the many potential experiences were the ones she needed to explore
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