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

Elements of Treatment

Individuals who seek treatment because of difficulties precipitated by traumatic events typically have high level of distress and have not yet found the crisis to be manageable. In working with such persons several different elements need to be present in treatment (Herman, 1992; Van Der Kolk, McFarlane, & Weisaeth, 1996). In the earlier phases of treatment, the individual's general psychological state must be stabilized. For this to happen, the individual needs to feel safe and to experience the therapeutic relationship as a secure one. The focus on safety, both physical and psychological, is particularly necessary where the crisis exposes the client to the potential of significant harm, for example, sexual assault, childhood physical abuse, or the presence of a threatening and abusive marital relationship. Additional elements of intervention may need to focus on dealing with the symptoms of intrusion (unwanted images, nightmares, intrusive ruminations about the event) and various forms of conditioned avoidance (fear and avoidance of situations similar to that in which the event occurred), the reestablishment or renewal of meaningful connections to the individual's support system, and the rebuilding and restructuring of the assumptive world. It is in this latter clinical domain that the implications of posttraumatic growth for psychological intervention are most relevant.

Individuals may experience growth by changing schemas, altering personal narratives, and developing a greater degree of what can be called wisdom. In the context of clinical work with persons who have experienced crises, it is important to remember that growth may best be viewed as multidimensional. The individual may experience positive changes in some domains, and no change or negative change in others. These domains are suggested by the factor structure of the Posttraumatic Growth Inventory: New Possibilities, Relating to Others, Personal Strength, Appreciation of Life, and Spiritual Change (Tedeschi & Calhoun, 1996). New Possibilities includes items describing positive new directions in life, e.g., "established a new path for my life"; Relating to Others describes positive change in interpersonal relationships, e.g., a greater "sense of closeness with others"; Personal Strength contains items such as "I discovered I am stronger than I thought I was"; Appreciation for Life contains items reflecting "an appreciation for the value of my own life"; and Spiritual Change is reflected in the item "a better understanding of spiritual matters."

As the person struggles to rebuild or repair the fundamental assumptions that provide a way of ordering one's experience of the world, growth may be most noticeable to the clinician in the process of rebuilding and in the design of the rebuilt assumptive world. Using the metaphor of a seismic event, the clinical worker is likely to observe growth in the process whereby the threatened or demolished structure is redesigned and rebuilt. These are primarily phenomenological events, although thriving can be manifested in changes in behavior too (Tedeschi & Calhoun, 1995).