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 key issue here is one of the proper timing of the proper intervention. What seems clear for the domain of posttraumatic growth is that for most persons, the clinician should not be looking for nor leading the client to focus on possibilities of growth in the immediate aftermath of a traumatic event. As the individual's coping mechanisms restore some degree of psychological equilibrium and reduce some of the most extreme distress, then the clinician needs to be alert to the possibility of helping the client identify areas of growth. We typically wait until clients make mention of changes themselves, and at first offer only gentle reflections of perceptions first articulated by the survivor.

A semantically minor but clinically important issue is how the clinician chooses to talk about and to help the client articulate the traumatic antecedents, or in the view of many clients, the cause of the individual's experienced growth. We have found, both in the context of clinical work and when we discuss our research work on growth with audiences of laypersons, that it is important to use words that clearly locate the impetus for growth in the arena of struggle with the event, not the event itself. For example, Harold Kushner, who described several elements of growth resulting from his own struggle with loss, was very clear in indicating that there was nothing inherently good in his son's death, and that he would gladly give up this growth in return for his son (Viorst, 1986).

The description we have given of the clinician's role may indicate a rather passive presence during the process of growth. This is true to a great degree, but there are times when firmness and predictability are needed. This is especially true when distress returns, as it does repeatedly during this process (Herman, 1992). The survivor must be reassured that the therapist remains steadfast through the fears and the uncertainties. This is established early on when the clinician shows a willingness to hear horrific details of the trauma itself and even find out more. For example, the clinician may act as an initial viewer of autopsy reports, photographs, court records, or other material that survivors are not ready to consider on their own. The clinician becomes a credible source of safety so that during the time of reconsideration of the fundamentals of life structure and meaning, the survivor is able to endure doubt, experimentation, and the added distress this may bring. The therapist is willing to ask the difficult questions without flinching.

It may be evident that such work demands courage on the part of both the clinician and the survivor. It also should be evident that this is not likely to be brief therapy. We are talking about moving beyond the initial phases of treatments usually recommended for survivors, such as critical incident stress debriefing or crisis intervention. However, we are not describing something superfluous, because distress remains part of the picture, and lives without reconstructed belief systems can seem without direction or purpose, setting the stage for further difficulties in years to come. Therapy that allows survivors of trauma the time to thrive is necessary to consolidate initial coping success.