STAIR

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Marylene Cloitre · New York (NYU Child Study Center)

What it is

STAIR (Skills Training in Affective and Interpersonal Regulation), developed by Marylene Cloitre and colleagues (originally at the NYU Child Study Center's Institute for Trauma and Stress), is a structured, cognitive-behavioural skills programme for adults with interpersonal and chronic trauma,…

Format

• Overall structure (2nd edition SNT). Module I, STAIR (about 10 weekly sessions), builds resources; Module II, Narrative Therapy (8 sessions; the client handout says 8–10), processes the past. The STAIR sessions are grouped under three "resources": Hope (session 1), Feelings (sessions 2–5) and…
• STAIR + PE (Oprel et al. 2021): 8 × 60-min STAIR sessions then 8 × 90-min standard PE including in vivo exposure.

Who practises it, and how they are trained or regulated

• Session format. Individual, weekly. Within skills sessions the trainers give a four-step sequence: identify a problem, introduce the skill, practise it in session, client chooses a skill and commits to practise it. Between-session practice is required (daily FMF, worksheets, breathing at least twice daily for about 5 minutes). Session length is not stated in the training slides; in published trials STAIR sessions…
• STAIR/MPE (2002, 2010; 1st ed. 2006): 8 weekly STAIR sessions (4 emotion regulation: labelling feelings, emotion management, distress tolerance, accepting feelings and experiencing positive emotion; 4 interpersonal: revising schemas, assertiveness, awareness of social context, flexibility) then 8 exposure sessions based on prolonged exposure, with in vivo exposure replaced by interpersonal skills practice and a…
• Group STAIR: one facilitator, 5–8 members, 12 sessions in two 6-session cycles (emotion regulation cycle; interpersonal cycle), with the STAIR Coach app as support.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• freezing or shame.
• repair attempts with an unsafe or abusive person.
• shame at "having patterns"; stress that everyone has them.
• intensity that keeps climbing; switch to a body or behaviour skill.
• numbness or alexithymia. Working: more differentiated labels on the FMF.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.