Exploring thriving in the context of clinical trauma theory: constructivist self development theory - Thriving: Broadening the Paradigm Beyond Illness to Health

Journal of Social Issues, Summer, 1998 by Karen W. Saakvitne, Howard Tennen, Glenn Affleck

The premise that people are capable of transmuting traumatic experience to gain wisdom, personal growth, positive personality changes, or more meaningful and productive lives has been a central theme in centuries of literature (Kingfisher, 1990; Proust, 1927/1932; Shakespeare, 1623/1963), poetry (Dickinson, 1935), and personal narratives (Mansfield, 1927). It is a theme that spans thousands of years of philosophical inquiry (Aeschylus, 1982; Nietzsche, 1990), and that has found its way into recent social commentaries (Lifton, 1993), personal accounts of the Holocaust (Deak, 1997; Todorov, 1997), self-help books (Krauss & Goldfischer, 1988), and newspaper as well as popular literature accounts of traumatic events (Fraser, 1987; Mangan, 1997). In view of two millennia of literary, philosophical, and more recently popular interest in this phenomenon, it would be absurd for social and behavioral scientists to claim the "discovery" of thriving and positive transformation following trauma. As social and behavioral investigators, we are, however, well positioned to evaluate the extent and limits of thriving, its mechanisms, how thriving unfolds over time, who might be most likely to experience such positive transformation, and whether naturally occurring positive changes offer insights for the development of therapeutic efforts. We are also best equipped to offer theoretical frameworks to guide this area of inquiry. Despite the promise of social and psychological inquiry in this area, initial attempts to scrutinize thriving systematically have taken familiar but misguided paths that in our opinion do not adequately address what is most important to our understanding of how adversity can result in positive change.

In this article we describe the limitations, ironies, and what we believe to be flawed strategies in current conceptions and investigations of thriving and crisis-related growth. Acknowledging the challenge inherent in the study of adaptation to trauma, we present a trauma theory, Constructivist Self Development Theory (CSDT; McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995), and demonstrate how this theory can explain both negative changes in the aftermath of a traumatic event and positive changes as a result of adaptation and meaning making. We suggest that CSDT addresses some of the current limitations of the literature on thriving, and conclude with implications for posttraumatic growth in psychotherapy.

The Challenge of Conceptualizing Posttraumatic Adaptation

It is extraordinarily difficult to formulate and measure the complexities of an individual's response to a traumatic event, series of events, or circumstance, at a particular time, place, and social and cultural milieu, and in developmental context. The myriad intrapsychic, behavioral, somatic, interpersonal and subjective responses create both conceptual and methodological quandaries. Further, trauma and people's responses to trauma are embedded in sociocultural contexts often with political and moral overtones. Such complexities are best addressed through the integration of social, personality, and clinical theories of human adaptation and require mindful examination of our underlying assumptions.

As social and behavioral scientists we are asked to explain the behavior of those affected by traumatic life events and to account for individual differences in response to trauma. We are also asked to help those suffering the pain of traumatic stress and loss. Both the challenges and the stakes of these tasks are great. How do we explain the range of responses to similar events, and what it is in the process of responding and adapting to and healing from trauma that leads to posttraumatic growth? How do we make sense of those who seem to thrive following a trauma and those who seem to collapse and barely survive? Traditionally, we have tried to define aspects of the individual to account for these differences (Anthony & Cohler, 1987). Occasionally, we have looked at differences in stressors, or types of traumatic events (Gelinas, 1983). Some have examined the unique interaction of the individual and her or his circumstances (Kauffman, Grunebaum, Cohler, & Gamer, 1979; Linehan, 1993; McCann & Pearlman, 1990; Rutter, 1983; Terr, 1990).

Like others in this issue, we believe that the uniqueness of an individual's response to trauma is determined by the particular meaning ascribed to the trauma, the individual's experience of self, age and developmental stage, biological and psychological resources, interpersonal experiences and expectations, and his or her social, cultural, and economic milieu. The similarities of responses across individuals reflect common values, biology, expectations, and needs that would lead to shared attributions, meaning, and adaptations.

This approach requires a theoretical framework that integrates personality and clinical theory with trauma theory. The way we frame the answers to these questions has enormous implications for survivors of trauma, for social policy, psychotherapy, and cultural beliefs. Our culture fosters denial of the long-term impact of trauma by urging victims to "get over it and get on with it", and by idealizing those who "bite the bullet," and thus does not recognize complex posttraumatic adaptations (Shay, 1994). In fact, it invites an implicit moral judgment on pain and bias toward sublimation and stoicism. Thus, we must be careful not to diminish the experience of the survivor and in effect, "blame the victim" (Ryan, 1971) for his or her own pain, and not to imply that suffering reflects lack of resiliency (Wolin & Wolin, 1993).