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

Posttraumatic growth is set in motion by the same sets of events that produce psychological distress and that can also place the individual at increased risk for psychological difficulties. The individual experiences what constitutes an event of "seismic" proportions (Calhoun, 1996; Calhoun & Tedeschi, 1998). The circumstances which the individual has had to face must have been capable of at least shaking the foundations of the individual's assumptive world, and in some instances some shattering of fundamental assumptions may occur (Janoff-Bulman, 1992). The traumatic set of circumstances typically causes high degrees of psychological discomfort and a major invalidation, or at least major disruption, of important cognitive elements. The trauma typically leads to a questioning and reevaluation of many important assumptions previously held. And it is in the reevaluation, modification, or rebuilding of one's general assumptions about, and views of, the world that posttraumatic growth may be most readily addressed in the clinical setting. Precisely because of the violation of fundamental assumptions that have provided structure and meaning to life, we see both distress and growth coexisting in persons in the aftermath of trauma. Persons who have struggled with the death of a loved one provide a good example. Such persons' grief is typically characterized by sadness, anxiety, somatic complaints, considerable loneliness, and varying degrees of yearning for the person who has died (Weiss & Richards, 1997). Although for many persons the pain diminishes with time, this is not the case with everyone (Wortman & Silver, 1989). Persons who must face bereavement may also experience significant psychological growth (Calhoun & Tedeschi, 1989-90; Yalom & Lieberman, 1991), but the psychological pain associated with the loss may persist.

Yalom & Lieberman (1991) tell about the impact on a 55-year-old woman of her husband's death. In the struggle with her loss she had experienced and had made a variety of positive changes in her life. She stopped smoking, she began to exercise, she became very much aware of how precious life is, she had experienced a significant change in life priorities, and she began to search for a way to make a difference in the world. At the same time, however, she was frightened by her life's lack of structure, she had strong regrets about how she previously had chosen to live her life, and she had become acutely aware of her own mortality. This woman offers a good example of what clinicians may see in their clients who seek help in dealing with highly stressful events: a mixture of positive changes that typically do not occur in all possible domains of posttraumatic growth, and at the same time, a series of negative experiences that persist in the wake of the difficult circumstances.

The clinician needs to keep in mind that psychological growth, and what clinicians would view as good coping, are not the same, although they may overlap to an extent. For growth to be most likely, the individual needs to have experienced some degree of initial success in coping, particularly when the stressful event has produced highly distressing and perhaps overwhelming emotional distress (Tedeschi & Calhoun, 1995). However, with the removal of all distress through successful coping, the most productive period of growth may come to an end.