Improving Pregnant and Parenting Adolescents’ Mental Health Using Narrative Exposure Therapy

A young mom with her baby.

Assessing the Feasibility and Acceptability of Narrative Exposure Therapy to Address IPV-Related Mental Health in Parenting and Pregnant Adolescents” (abstract). Ellen M. Volpe, Camille R. Quinn, Kathryn Resch, Valerie Douglas, and Catherine Cerulli. Journal of Family Violence (published online May 2016).

What it’s about: Narrative Exposure Therapy (NET) (PDF, 2.0MB) is an evidence-based, individual therapy that facilitates therapeutic processing of traumatic memories. It has demonstrated potential to prevent and mitigate post-traumatic stress disorder (PTSD) and depression. Young people dealing with traumatic stress related to intimate partner violence (IPV) are at high risk for these conditions. NET involves storytelling using flowers to represent positive events and stones to represent traumatic events in the client’s life. It also includes an optional exercise depicting clients’ lifeline using a ribbon and placing flowers or stones chronologically; this part is optional because it is highly individual and requires close monitoring by the therapist to avoid retraumatization.

Volpe et al. explored the feasibility and acceptability of NET among young people who were pregnant, parenting, or at risk of becoming teen parents, many of whom had a history of dating violence. The researchers conducted five focus groups with a total of 28 youth receiving services from community-based agencies and one focus group of 11 service providers, assessing the participants’ perceptions of NET at several levels of the Socio-Ecological Model.

Why read it: IPV is a common experience for many vulnerable youth, including homeless youth and those who are pregnant, parenting, or at risk of becoming teen parents. While evidence-based programs exist to prevent dating violence , there are few that address and mitigate the mental health effects of experiencing dating violence. NET could fill that gap, and trained service providers could use this study to inform that process or make appropriate referrals.

Biggest takeaways from the research: Overall, both adolescent participants and service providers reported favorable attitudes toward NET and its provision in trusted community agencies. The participants identified several barriers and facilitators to NET engagement at three levels of the Socio-Ecological Model.

1.Individual level: Adolescent participants anticipated that discussing painful memories would bring up undesired emotions. But they also acknowledged that even though engaging in NET might be difficult, it could help them work through emotional issues and experience healing and growth. For example, one participant said, “I think [going through NET is] a good way for you to not have to carry around stuff you think about or old stuff you still grieve about. You kind of talk it out and get past it.” As with any type of exposure therapy, care must be given to prevent retraumatization, and it may depend on the individual whether the therapy is appropriate.

2.Relationship level: The main relationship barrier identified by participants was difficulty trusting a therapist. Yet many adolescent participants reported wanting to have a trusting relationship and increased understanding with a therapist. “Because two heads are better than one, so I feel like if you were to talk to someone about your problems you would get a different perspective on it and see it at a different angle,” one youth shared.

3.Community level: Housing instability in this population was identified as a community barrier to completing the eight to 16 semi-weekly sessions of NET. However, one service provider emphasized the importance of providing the therapy despite this instability, stating, “If we wait for housing, if we wait for all these other things to fall into place before we start addressing the trauma it’s just never gonna happen.” The most commonly mentioned facilitator at this level was having an established, trusting relationship with staff in community organizations.

The study results will inform the researchers’ next steps in pilot testing NET for adolescents with IPV-related PTSD and depression. For example, they plan to ensure that participating youth understand the therapeutic process and session expectations, to facilitate their trust in the therapist and commitment to the therapy. In addition, the researchers plan to have NET training include appropriate ways for the therapist to share with the client, to support a mutually satisfying therapeutic relationship.

Additional references: Learn more about narrative-based trauma interventions, pregnant and parenting youth, and PTSD and depression in our digital library.

NET is partially based on Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Learn more about TF-CBT.

Read about the feasibility of Safe Dates, an evidence-based IPV prevention program, with young moms.

Listen to a podcast about the intergenerational effects of unaddressed maternal PTSD.

Read about the links between witnessing or experiencing violence and developing PTSD and depression among homeless youth.

Publications discussed here do not necessarily reflect the views of the National Clearinghouse on Families and Youth, the Family and Youth Services Bureau, or the Administration for Children and Families.

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