Welcome to STAIRWAYS: The Next Step in Group Treatment for
Borderline Personality Disorder  

What is STAIRWAYS?

STAIRWAYS is the one-year, twice monthly advanced group program
developed for clients with borderline personality disorder who have completed
the 20-week STEPPS program. The letters in the word STAIRWAYS stand for
the skills you will teach in this program: Setting goals; Trying new things;
Anger management; Impulsivity control; Relationship management; Writing a
script; Assertiveness training; Your choices; and Staying on track. We have
also included and expanded The Holiday Season unit from the STEPPS
program (Appendix A), for facilitators who wish to use it. Appendix B contains
A Review of STEPPS Skills which should be copied and given to group
members as they enter the STAIRWAYS program.

Facilitators and group members will recognize some of the skills from
STEPPS, specifically the skills for goal setting, interpersonal relationships, and
impulsive behaviors (called Abuse Avoidance in the STEPPS manual).
Although the names of some of the skills appear to be the same, the materials
are expanded and more detailed, and participants will learn new ways to apply
the skills. The additional skills mentioned above were identified by previous
STEPPS group members as topics they wished to work on. Along with the new
skills being taught, the basic emotion management and behavioral skills in
STEPPS will be reinforced and integrated into the additional skills.  The
Emotional Intensity Continuum and the Skills Monitoring Cards were reviewed
at every STEPPS session. In STAIRWAYS, group members are encouraged to
fill out a continuum for any emotional intensity episodes and to use the skills
cards, but they may not be reviewed regularly at every session. Group
members receive a handout for each session and these are added to their
STAIRWAYS notebooks.

The main benefits of STAIRWAYS come from: 1) identifying how the
additional skills might help overcome some of the problems participants are
still having; 2) reinforcing the skills to manage emotional intensity; and 3)
applying the new skills to specific goals and challenges in their lives, such as
getting a job, taking a class, expanding their social life, etc.  Another way to
characterize the difference between the STEPPS program and STAIRWAYS is
to think of STEPPS as teaching emotion management and behavioral skills to
help those with borderline personality disorder survive; the goal of
STAIRWAYS is to help participants thrive.

STAIRWAYS is not a replacement for individual therapy, but may help group
members identify new topics to explore in greater depth with their individual
therapists. As with STEPPS, we strongly encourage members to take their
STAIRWAYS notebook to their individual sessions to share with their
therapist. They should also be encouraged to continue teaching members of
their reinforcement team the language they can use to help remind participants
to use their skills at times of crisis.  Participants may also wish to share their
goals and ask reinforcement team members to help encourage them as they
work on them.

How is STAIRWAYS Structured?

We suggest twice monthly meetings, for two hours each session. The rationale
for this schedule is to decrease the frequency of meetings and to encourage
group members to seek out other non-therapy activities between meetings.
However, different settings (e.g., residential treatment, day treatment programs,
correctional institutions, etc.) may wish to continue with weekly sessions to
better fit their schedule. As with STEPPS, lessons may be broken down into
shorter components at more frequent intervals, depending on the available time
and level of intellectual functioning of participants. Most STAIRWAYS skills
take multiple sessions to complete.

The STAIRWAYS manual includes a section for facilitator guidelines for each
lesson, including homework assignments and materials needed for that session.
A sample group process note is included with each lesson plan. In addition,
there is a section titled Frequently Used Forms for those worksheets that are
intended to be copied in quantity and used repeatedly throughout the program.

When group members entered STEPPS, the manual began with the Introductory
Lesson and proceeded through the whole sequence; group members also started
at the beginning and completed the 20 weeks together. STAIRWAYS works a
bit differently: the only time you will begin with the Introduction is the first
time you introduce the STAIRWAYS program. After that, new members will
enter a group whenever they finish a STEPPS group (we do suggest that new
members wait until the first session of a new skill, rather than entering “in the
middle” of a skill that has multiple sessions.) Therefore we suggest that
facilitators meet with prospective STAIRWAYS participants before they
actually enter the group and go through the packet of introductory materials
ahead of time. The new members will then stay in the group until they have
completed all 9 skills (24 lessons, or 25 lessons if the optional holiday unit is
included). This means that new people will join the group periodically, and
those who have finished all the skills will leave. After completion of the
program, group leaders can discuss whether additional group therapy,
individual psychotherapy, or some other treatment would be most helpful to the
individual. In some settings, many participants ask to continue attending the
STAIRWAYS program as a way to stay connected with the program and to
continue reinforcing their skills. In some groups, participants ask to be notified
when a particular skill is being taught (e.g., anger control). It is left to group
facilitators to establish policies for their particular settings.

We recommend that facilitators remind an ongoing group ahead of time when
new members will be joining and ask for suggestions to make the newcomers
feel welcome. Some groups have brought simple treats whenever new members
are attending for the first time. It is also helpful to have both old and new group
members introduce themselves and give a brief descriptor (e.g., “I am a
student,” or “I volunteer at the library,” etc.).

Training for STAIRWAYS Facilitators

It is recommended that group leaders, at a minimum, have a master’s degree in
the social sciences with several years of experience in psychotherapy and
counseling, as well as experience with the STEPPS program. If the group is led
by two facilitators, at least one of the facilitators should meet the previously
described level of training; the second facilitator may be less experienced, but
would be able to gain the experience to independently lead a future group. On-
site training workshops are available with ongoing consultation.


Continued
Please scroll down to read the first few pages of the STAIRWAYS
Treatment Manual