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 available data on posttraumatic growth indicate clearly that for many individuals positive changes are identified in this existential or spiritual domain (Tedeschi & Calhoun, 1995). To encourage growth in these persons effectively, the clinician not only must feel comfortable dealing with these matters, but also must be capable of actively engaging the person who perceives growth occurring in this arena. Furthermore, the clinician must have the flexibility to tolerate the questioning, doubt, and change in the spiritual and religious realm as the survivor of trauma moves beyond an old belief system to a revised one. The clinician may be working within an evolving belief system and may not have any sense of what the final version may be. The therapist must be willing to act as a "midwife" in this process (Vaughan, Wittine, & Walsh, 1996). This role suggests a supportive expert who respects the survivor's ability to manage the difficult process naturally.

The clinician must be prepared for and willing to support the client's perceptions of thriving. Whether the client discovers or constructs (Neimeyer & Stewart, 1996) positive change, the clinician needs to support the perception of growth when it occurs. Although the issue of positive illusions is a matter that produces academic debate (Colvin & Block, 1994), positive illusions (Taylor & Brown, 1988) can be useful for clients in the process of posttraumatic growth. In some contexts the clinician may need to support a client's perception of growth that may objectively constitute an illusion. From a clinical perspective, it seems desirable to support a client's perception that he or she is now a different and better person, even if the individual has not measurably altered observable behavior. Such behavioral changes may come later, and the clinician can engage the survivor in discussions of how the changes may be shared. In many of the cases we have seen in clinical practice, people who are thriving may have a great motivation to share their hard-won gift with others who unfortunately have been forced by loss to join their community of suffering.

Even if thriving can be engendered by clinical intervention, the clinician should not attempt to rush it. Highly traumatic sets of circumstances produce high levels of psychological distress for most persons who experience them (McCann & Pearlman, 1990; Tedeschi & Calhoun, 1995). For most persons the overwhelming pain and distress produced by highly stressful events must be satisfactorily managed before growth can begin to be experienced and acknowledged. For persons whose trauma has involved exposure to events that directly threatened physical safety, an immediate need is for the intervention to provide a means whereby the client can begin to experience a psychological sense of security from immediate harm (Herman, 1992; Van Der Kolk et al., 1996). And even for persons whose difficulties have not exposed them to danger, for example, parents who are bereaved by the loss of a young child, early clinical work should be focused on helping the individual manage high levels of psychological distress.