Beyond recovery from trauma: implications for clinical practice and research - Thriving: Broadening the Paradigm Beyond Illness to Health

Journal of Social Issues, Summer, 1998 by Lawrence G. Calhoun, Richard G. Tedeschi

The lifetime prevalence of major stressful events is high. In one study of 1,000 adults in four cities in the southeastern United States, for example, 21% of the sample reported a traumatic event (such as a robbery, assault, or traumatic death of a loved one) during the previous year and 69% reported the occurrence of at least one such event in their lifetimes (Norris, 1992). Although the frequencies of reported events vary across studies, "it is clear that exposure to 'traumatic' events is common in the lifetime of individuals, at least in the United States" (Green, 1994, p. 344).

As has been made clear throughout this issue, perceiving and experiencing psychological growth, or thriving, as a result of the struggle with highly stressful events has been recognized clinically for some time (Caplan, 1964). More recent systematic investigations have confirmed the clinical impressions. The phenomenon of perceiving positive self-change originating in the struggle with trauma has been found to occur in a significant proportion of persons as a result of a wide range of disruptive events (O'Leary & Ickovics, 1995; Tedeschi & Calhoun, 1995).

The major focus of this article is on implications of the work on thriving and posttraumatic growth for the working clinician and on areas in need of additional investigation.(1) This article draws implications in four areas: the relation of psychological well-being and thriving, a conceptual framework for the practicing clinician, a discussion of the encouragement of thriving in clients, and suggestions for further research.

Psychological Well-Being and Psychological Thriving

For the individual straggling with a traumatic set of circumstances, perceived growth tends to be reported in three general domains: changes in perception of self, changed relationships with others, and a changed philosophy of life that includes a deeper appreciation for life, along with new life directions and priorities (Tedeschi & Calhoun, 1996; Tedeschi, Park, & Calhoun, 1998). Individuals' self-perceptions can be changed to that of a person vulnerable to difficulties in life (Janoff-Bulman, 1992), but also to that of a person who is self-reliant and capable of coping with difficult challenges (Tedeschi & Calhoun, 1996). Changes are also reported in the individual's relationships with others. These tend to include an experienced increase in interpersonal and emotional closeness with at least some other persons, a perceived increase in one's freedom to express emotions, and an increase in one's reported sympathy and understanding for the suffering of others (Calhoun & Tedeschi, 1989-90). Changes in philosophy of life involve for many persons a change in life priorities, an increased experience of existential wisdom, and a greater interest in and openness to spiritual and religious matters (Park, Cohen, & Murch, 1996; Tedeschi & Calhoun, 1996). These reported changes are regarded by the individual as inherently positive, and they are reported, in some form, by at least some persons experiencing even the most horrible sets of circumstances (McMillen, Zuravin, & Rideout, 1995; Tedeschi & Calhoun, 1995; Veronen & Kilpatrick, 1983).

Not only individuals but also couples and families may experience a change for the better arising from highly demanding sets of circumstances (see Karakashian, this issue, and Bloom, 1998, for a discussion of thriving in large social units). Lehman, Lang, Wortman, and Sorenson (1989) found that 29% of a sample of parents of children who were killed in motor vehicle accidents reported that their marriage had become "somewhat or much better." In addition, 32% of parents indicated that their relationships with their surviving children had improved and become closer in the aftermath of the death of a child or spouse. Among parents whose child had been treated in a neonatal intensive care unit, 70% also reported a strengthening of the marriage as a result of their difficult experience (Affleck & Tennen, 1991).

An important pragmatic question for the clinician is: What difference does growth make with regard to psychological adjustment? If individuals see themselves as better persons, or couples see themselves as closer, what connection, if any, does this perceived change have to overall mental health? As operationalized in the available literature, this question is addressed by looking at the relationships between general measures of psychological well-being or distress, on the one hand, and measures of perceived benefits or growth on the other. The results are not entirely consistent across studies (Park, 1998).

Several studies have suggested at least a modest relationship between self-reported thriving or growth and general measures of psychological adjustment. Taylor, Lichtman, and Wood (1984) reported that women who perceived positive changes as a result of their struggle with breast cancer also had higher levels of overall psychological adjustment. In a sample of persons who had experienced a stroke and of their main caregivers, finding meaning (measured primarily by perceiving benefits) resulting from the straggle with a stroke was reliably predictive of adjustment (Thompson, 1991). In a study of mothers of infants hospitalized with serious health problems (Affleck & Tennen, 1991), perceiving benefits arising from their experience was reliably predictive of better psychological adjustment at follow-up 18 months later. These findings suggest that perceived thriving in the straggle with trauma may have some positive implications for the individual's current and future well-being.