Primer on Posttraumatic Growth

An Introduction and Guide

Mary Beth Werdel, Robert J. Wicks

• Publisher: Wiley
• Year: 2012
• ISBN:
  9781118233375
• Edition: 1
• Topic: Psychology
• Subtopic: Post-Traumatic Stress Disorder (PTSD)
• Index: Psychology

"From the inspiring chapter quotes, to relevant historical and current research, to practical clinical directions, Primer on Posttraumatic Growth takes a giant step toward both grounding us and moving us ahead with strong hope for adjustment and growth in the post-trauma/loss world. This is a comprehensive, practical, and readable work that should be at hand for any mental health clinician, pastoral care professional, or student preparing for these professions."
—J. Shep Jeffreys, EdD, FT, author of Helping Grieving People—When Tears Are Not Enough: A Handbook for Care Providers, Second Edition

A guide for helping your clients overcome negative events, based on the latest research on posttraumatic growth

Drawing on the growing empirical and theoretical material on posttraumatic growth—an outgrowth of the positive psychology movement— Primer on Posttraumatic Growth provides insight, depth, and treatment recommendations for both the clinicians who work with those who have experienced dramatic negative events in their lives and for other professionals who support victims of trauma and extreme stress.

This essential primer examines:

• The connections between meaning and growth
• The impact of cognitive processing on posttraumatic growth
• Positive emotion and posttraumatic growth
• Posttraumatic growth and an "open" personality
• The human drive to be in positive and important interpersonal relationships
• Forgiveness: can it be extended towards all areas of posttraumatic growth?
• Posttraumatic growth and religious and spiritual variables
• Wisdom and posttraumatic growth

CHAPTER 1

POSTTRAUMATIC GROWTH: CONCISE HISTORY, DEFINITIONS, AND IMPLICATIONS

Kelly was a successful practicing psychologist who had recently been awarded tenure at her university. She was chair of a certificate program on trauma, a subject for which she received national attention as a result of her work after the September 11, 2001, terrorist attacks in New York, Washington, D.C., and Pennsylvania. Her book on personality disorders had just been published. For her intellect and achievement, she was respected and admired by her colleagues, many of whom over the years had come to call her a friend. And this was merely some of the good in her professional life.

She was also the mother of six children ages 12 years to 10 months. All girls. All beautiful girls. She was the wife of, and best friend to, her husband for 16 years. She was an active member of her children's schools, her church, and her community. She coached soccer. She mentored young girls. She actively lived the healthy life that she preached, jogging regularly, even training for a marathon. She seemed to find a way to touch the lives of the people with whom she interacted with a combination of humor, wit, and grace. In a word, she was special.

Of course, as many of us recognize from both our professional and personal lives, the degree to which we love and are loved does not protect us from stress or trauma. This certainly was true for Kelly and her family.

On a late June afternoon, while at a swim practice with four of her children, the skies started to darken, signaling that a tremendous thunderstorm was moving quickly into the suburb. With obvious concerns for her children's well-being, Kelly packed her children and two of their friends into her minivan to head home. They lived a mere 2.5 miles from the pool. As they made their way home, the winds intensified. The storm was later described as one of the most violent cells of thunderstorms that had been seen in that part of the country in a long while. The wind gusts were estimated to have exceeded 50 miles per hour, which apparently was strong enough to cause a giant branch from a 44-inch-wide red oak tree and the surrounding electrical wires to come crashing down on Kelly's minivan, instantly killing her and one of her children, and trapping one girl alive in the van on top of her dead friend waiting to be rescued. Witnessing the scene, a number of good Samaritans pulled all of the children out of the car, except for one daughter and her trapped friend. It was a terribly horrific scene.

As is the case with many stressful events, just as quickly as the darkness moved in, it lifted from the sky. When word started to spread about the death of such a loved woman and her daughter, that darkness began to pour into the hearts and minds of the people in Kelly's community as they were faced with the reality of such tragic, seemingly incomprehensible deaths of such a special mother, colleague, mentor, and friend, and of such a bright, promising 7-year-old girl.

At the funeral, Kelly and her daughter were laid to rest in the same coffin, her daughter positioned by a funeral home worker on her mother's chest, just as she had been placed 7 years before by a physician after her birth. That Kelly and her daughter died together for some made the death more than doubly tragic. The death of Kelly and her daughter brought more than 3,000 people to the funeral, each one to a different degree carrying their "why" question. Why Kelly? And why her daughter? Why together? Why at that millisecond? Why on that road? Why in that way? Why now?

Why Suffering?

As clinicians we often hear the questions associated with people's suffering. Tragedy is painfully part of the human experience. If we can find any people in our lives who can serve as examples of those who have not experienced any profound stress or trauma (if any do exist), such people are indeed the outliers—for now. We all come to learn that suffering is part of our narrative as people. Some of us who are able to look beyond our inner experiences come to realize that suffering is universal.

As human beings, we can answer some of the questions that surround suffering. We can understand the psychological process of anger, the emotions that underline it, and the factors that have a correlational and causal link to committing violent acts. We can understand the scientific theories of how natural disasters like hurricanes and earthquakes occur. We can explain the physics at work in motor vehicle accidents and in tree limbs crashing to the ground. We can understand the biochemistry of the division and multiplication of cancer cells. We have voices to answer many, though certainly not all, of the how questions of tragedy. But the larger why questions of the existence of such tragic events in our world and in our personal lives are questions that are fundamentally unanswerable by all sciences—soft and hard. Suffering is one of life's ultimate questions (Crews, 1986).

Does Suffering Change Us?

It is rare to find people who have not experienced any profound stress or trauma. As we know that death is inevitable, we know that suffering must also play a part in our human development. Thus, it behooves us to ask, “Do such dark experiences hold the possibility of changing us, and more importantly, if so, then how?” The answer to the first question is a clear and unsurprising “yes.” Long before the 1980s, when Posttraumatic Stress Disorder (PTSD) became a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III; American Psychiatric Association, 1980), we have been systematically studying how stress and trauma have the ability to change us in tremendously negative ways. In every realm of our existence (physical, emotional, social), trauma possesses the ability to have a profound negative impact on the human experience. This has become apparent based on extensive ongoing study of people before, during, and after trauma. The field of psychology has dedicated a great deal of resources to examining the negative outcomes.

From such a perspective, we have been primed to an awareness of the profound negative experiences and consequences of trauma. For Kelly's family and friends this meant continuing with the mundane and the milestones of their lives without the loving support of a mother, wife, sister, educator, mentor, and friend. Because of the attention and focus on the negative aspects of extreme stress and trauma, professionals are able to respond to the negative consequences of suffering in meaningful ways when working with the profound loss experienced by families and friends such as Kelly's. Research and clinical practice has focused on decreasing negative symptoms of stress and trauma, including managing the often profound, significant distress. And thankfully so.

Trauma research that focuses on the negative impacts of trauma will and should continue. Multiple levels of loss and the associated emotional distress are important aspects in the story of suffering, and they deserve great attention. However, it is becoming increasingly evident that while such focus is part of the story of stress and trauma, it is not always the entire story. A return to a premorbid state of functioning cannot always be the goal, and for some people it is not an accurate depiction of their healing process. With these factors in mind, increased attention has started to get counselors in the field to look beyond solely the negative consequences of stress and trauma.

As evidenced in Kelly's community and that of others who have experienced tragedy, sometimes the pain lifts as a new light is permitted to illuminate the darkness. For example, one of the doctoral students who Kelly was mentoring before she died wrote the following:

I had the privilege of knowing Kelly as a professor and mentor for almost six years. As a master's-level student, I enrolled in many of her classes. Then later, as a doctoral student, I became her graduate assistant. Just prior to her death she took on the role of chair of my dissertation committee. I was grateful that she had accepted the role, and it seemed to me that she was enthusiastic about the role as well. She was to help guide me in the biggest and most important educational task ever before me. I felt great ease knowing that she would be present with me through the process. I valued her passion for education, her penchant for quality research, and the way in which she was able to encourage her mentees to produce the highest quality work possible. I could not have imagined working with anyone other than Kelly.

When I heard of Kelly's death I was grief stricken, overwhelmed with the feeling of being alone. My mentor, my guide had left me. I was lost. With time, however, I came to understand something that I may never have come to know if I had not had to struggle to comprehend and make sense of Kelly's death. I realize now that true guides in our life never leave us, not even in death. Kelly was gone prematurely, yes. But her professional and personal qualities that I value so deeply were still alive in me.

And so while she was not present physically during my dissertation process, her spirit, her talent, and her wisdom were still very much accessible to me. Even after her death, she was my guide. My current recognition of who can guide and how a person may guide is a new understanding I hold about life. It is something I understand not only because of Kelly's presence in my life, but because I have had to come to accept her physical absence.

The story of Kelly's mentee reveals that positive changes can be experienced when a relationship is sought with the stress and trauma. Through these difficult and complicated situations, people are allowed or perhaps induced to cultivate certain positive aspects of themselves, others, and the world. This face of trauma is often ignored to the detriment of healing. In fact, we are less versed in the positive aspects of enduring stress and trauma because, until recently, the field has primarily focused its systematic rigor on the negative. Psychologists, counselors, social workers, and others trained in mental health professions were not primed to seek or foster growth but simply sought adaptation in clients; however, this approach began to change in the 1990s.

A History of Growth

In 1995 the term posttraumatic growth (PTG) was coined by clinical psychologists Richard Tedeschi and Lawrence Calhoun of the University of North Carolina Greensboro. Around that time other terms that spoke to a related process also began to emerge in the psychological literature: stress-related growth (Park, Cohen, & Murch, 1996), benefit-finding (Tennen & Affleck, 1998), and adversarial growth (Joseph, 2004; Linley & Joseph, 2004). There are important distinctions in the theories, definitions, conceptualizations, and measurements of each term, which will be highlighted shortly. However, all of the terms capture the idea that value can emerge when cognitive structures undergo the reorganization that results from experiencing stress and trauma (Joseph, 2011). The development of theories of posttraumatic growth is based both on psychological theory and on research that had been taking place for many years when the terms emerged, as well as philosophical and theological underpinnings rooted in centuries-old experiences.

From a psychological perspective, the concept of posttraumatic growth has roots in several different theoretical movements (Tedeschi & Calhoun, 1995): Caplan's Crisis Theory (1961, 1964); Rogers' client-centered theory (1961, 1964); Existential Theory (Frankl, 1963; Yalom 1980); and the Positive Psychology movement. Although ideas on human growth and potential that can result from critical life stress can be seen in other movements as well, these theories appear to have the strongest connections in the field. Each theoretical movement will be explained very briefly, with references provided for deeper exploration of the theoretical roots.

Crisis Theory

Gerald Caplan (1961, 1964) developed Crisis Theory as a result of working at Massachusetts General Hospital in the 1940s with patients who had endured severe life experiences. In his research, Caplan observed that when people experienced a crisis, their normal coping mechanisms were not useful in helping them to manage distress. The lack of an ability to successfully cope with the event led a person to experience a sense of disorganization in regard to their ability to function. In an attempt to discharge inner tensions caused by a sense of disorganization, a person in distress was led to a sort of trial-by-error attempt to end the crisis in a new way (Halpern, 1973). Such trial-by-error attempts suggest that the experience of crisis may promote the realization that one's precrisis set of coping mechanisms can be expanded beyond what one may have previously realized. Caplan's theory highlights that without crisis the need to seek new understandings about the self—namely new ways of coping—would not be identified as necessary. Seeking an expansion of coping resources comes from a place of immediate necessity when the current coping mechanisms can no longer do the job.

Existential Psychology

Posttraumatic growth is rooted in the existential movement. To fully define existential therapy is a contradiction, because it is impossible to completely capture the paradigm (Yalom, 1980). However, in general, existential psychology examines concerns that are rooted in people's existence and the dynamic conflict that arises when a person comes to confront certain realities of the human experience (Yalom, 1980). According to Yalom (1980), one of the leaders in the movement, four ultimate existential concerns result in dynamic intrapersonal conflict:

1. Death: Our desire to live and the nature of our finiteness

2. Freedom: The lack of external structure and the responsibility we have to author our own lives

3. Isolation: Our desire for communion and our intrinsic separateness from others

4. Meaninglessness: Our need for meaning in a world where it may not exist

People tend to reflect on one or more of these four ultimate concerns generally in a few situations: (a) when they are confronted with death; (b) when they have made an irreversible decision; or (c) when they experience a collapse of their meaning-making schema (Yalom, 1980). When a person gains an awareness of any of these four ultimate existential concerns, as can be the case in the wake of stress and trauma, the result is the distressing feeling of anxiety. Depending on the severity and duration of this anxiety, it is believed that people will either move toward positive experiences of growth or negative experiences of psychopathology. Yalom's writings bring to light that, while confrontation with inner conflict can be distressing, facing one or more of the four existential concerns presents an opportunity for a person to create a new sense of meaning in life.

Victor Frankl (1963), a psychiatrist, a survivor of a Nazi concentration camp, and the founder of logotherapy, also wrote about the relationship between experiencing difficult life events and finding a sense of meaning in order to transcend what Frankl considers to be the intrinsic pain of human existence. In Man's Search for Meaning, he writes: “To live is to suffer, to survive is to find meaning in the suffering” (p. 11). Frankl believed that life is essentially meaningless until a person gives it meaning. Central to Frankl's argument is that a person is able to find meaning in every situation that is presented to the human experience, including those that are extremely tragic. According to Frankl (1963), meaning cannot be acquired from another person. Rather, an individual has free will and a responsibility to give life meaning in each moment; for “meaning in life differs from man to man, from moment to moment” (p. 98).

Seen in the two examples of existential writings is the idea that while suffering is an inevitable part of human existence, finding new meaning through confrontation with painful life events is indeed possible, and perhaps even the ultimate goal. Although death, for example, cannot be escaped, it can be confronted, and through an awareness of the confrontation, one may choose to live life differently, with new meaning and purpose not ...

Table of contents

• Cover
• Advanced Reviews for Primer on Posttraumatic Growth: An Introduction and Guide
• Title Page
• Copyright
• Dedication
• Acknowledgments
• Introduction
• Chapter 1: Posttraumatic Growth: Concise History, Definitions, and Implications
• Chapter 2: Posttraumatic Growth: Truth or Myth?
• Chapter 3: Meaning
• Chapter 4: Cognitive Processing
• Chapter 5: Positive Emotions and Growth
• Chapter 6: Personality and Personal Attributes
• Chapter 7: Relationships
• Chapter 8: Forgiveness
• Chapter 9: Faith, Suffering, and Religious Coping
• On the Road to Wisdom: Being a Mindful Companion on the Path to Posttraumatic Growth: An Epilogue
• References
• Subject Index
• Author Index