The papers presented in this edition of the Australasian Journal of Disaster and Traumatic Stress were first presented at the Australasian Society for Traumatic Stress Studies (ASTSS) 2006 conference in Adelaide, in a symposium entitled Posttraumatic Growth: Is there evidence for changing our practice?
Positive changes emerging from adverse experience have been recognised for some time. This post trauma transformation is variously described in the research as finding benefit, stress-related growth, thriving, positive psychological change, adversarial growth, transformational coping and posttraumatic growth. One conceptualisation of positive change from adversity, posttraumatic growth, has become the focus of an increasing body of research in search of greater understanding of the full range of sequelae, both positive and negative, that can emerge from traumatic experience.
Posttraumatic growth has been defined as the experience of positive psychological change, reported by an individual as a result of the struggle with trauma or any extremely stressful event (Tedeschi, Park & Calhoun, 1998; Tedeschi & Calhoun 2004). Implicit in this concept of growth is the assumption that PTG is more than mere survival, or the resistance of damage from a traumatic experience. It implies that the persons levels of adaptation, psychological development, and life awareness, have undergone a transformational change beyond pre-trauma levels.
It is helpful to place PTG within a broader model of trauma response, commonly termed the Salutogenic (or wellness) Model. Salutogenesis which incorporates a range of psychosocial factors involved in health has emerged as a perspective with important implications for understanding responses to traumatic experiences. Typically, research on traumatic experience has focussed on the pathological outcomes of trauma, especially posttraumatic stress disorder and depression. However, the salutogenic model suggests that the outcome of exposure to trauma is not pre-ordained traumatic stress, but that traumatic experience can also have salutary outcomes. Salutogenic approaches focus on the resources and strategies, both personal and collective, which lead to health and wellbeing.
This model has some fundamental differences in focus and process from a pathogenic model - the salutogenic model is concerned with coping as well as stressors (not just coping with stressors). It is concerned with salutary factors as well as risk factors, health as well as vulnerability, and wellness as well as illness. It serves to identify and maximize any salutary effects and possibilities that could arise from the experience of a psychologically challenging traumatic event. Health is related to the presence of wellness and positive functioning not just the presence or absence of illness, unhappiness and suffering. This issue has particular salience in relation to traumatised people.
Trauma therapists routinely encounter individuals who seem to have recovered from traumatic events in so far as they show little evidence of PTSD type symptomatology, yet seem to have lost their sense of self, their relationships are in disarray, their spirituality or meaning-making is in tatters, and their sense of the world and what is possible are, at best, confused. In addition to contributing to understandings of the trauma process, the salutogenic model can provide a framework for facilitating adjustment and healing.
In our practice we deal with individuals, families and other systems (communities and workplaces) that have been profoundly impacted by a wide range of traumatic experiences. We know that recovery from trauma is not simply the amelioration of traumatic symptoms. Trauma changes people. It changes their views of themselves, of others, and of the world. Psychology has characteristically been avoidant of the spiritual, of meaning making. If we focus only on symptom reduction we are ignoring the profound challenge for transformation that trauma often presents. This is not about being pollyanna-ish about trite statements like get over it, or see the positive, or it happened for a reason. This would be patronising, diminishing, minimising and naïve to say the least.
The experience of dealing with negative events, according to Tedeschi & Calhoun (1996), produces three broad salutary groups of outcomes: changes in self-perception; changes in interpersonal relationships; and changes in philosophy of life. In clinical practice I am regularly witness to peoples perceptions of posttraumatic growth. It is not uncommon to hear a person who has endured terrible trauma say Im surprised how strong Ive been, or I dont feel scared any more, of not being able to cope with bad stuff happening. Their sense of change in their interpersonal relationships is reflected in comments like I feel much closer to my partner than I ever did before, or I feel like I can relate to people who are hurting now. Or Im more willing to accept help now, when I need it. Those reporting changes in their philosophy of life report I had always thought that my future was in higher management, but since my son died Im more interested in spending time in the bush or listening to beautiful music than I am climbing the corporate ladder. Or Im not a religious person, but I feel like someone was guiding me through this, or Ive somehow got a greater sense of trust that things will work out (Jackson, 2003).
The papers presented in this edition expand the current body of research into posttraumatic growth. The edition begins with an overview of the research to date, highlighting the significant research advances, as well as the dilemmas and challenges that conceptualisations and measures of posttraumatic growth still presents. Douglas Paton and Karena Burke examine personal and organisational dimensions of post trauma adaptation and growth in police officers. Their paper provides a challenging overview of an increasing body of research on the potential salutary outcomes of trauma, and considers the ways in which individuals mental models can be developed to increase adaptive capacity. Importantly, they point to the importance of the role of systems, in this case the police organisation, in trauma outcomes for both individuals and the organisation. Bronwyn Morris, Jane Shakespeare-Finch and Jennifer Scott present a study of the coping processes of 335 people with cancer diagnosis. Their study highlights broad similarities in coping and growth that have been identified in the literature, and attests to the multidimensional nature of positive post trauma change and coping. Jane Dunkley and her colleagues tread new ground in their examination of first experience of psychosis and the relevance of trauma and posttraumatic growth. This study identifies the experience of psychosis as traumatic, and highlights the limitations of a purely medical model approach to recovery and adaptation. Significantly, it includes a family member of each subject, thus testing a criticism in the literature that reported growth can be illusory. A qualitative study, it provides a plethora of possibilities for further research, including in the important arena of systems and objective change. In the final paper, Catherine So-kum Tang, provides a tantalising examination of, as yet, untested posttraumatic growth outcomes in Asian populations in her study of survivors of the 2004 Southeast Asian tsunamis. The study highlighted the importance of family systems with perceived emotional support from family and being married being salient predictors of both inter and intra personal posttraumatic growth. Despite some procedural difficulties and limitations of this study, the importance of establishing the cognitive frames and inter and intra personal resources that underpin trauma response and adaptation were highlighted.
Since traumatic experience clearly has the potential to elicit positive adaptive responses and personal growth, approaches to post trauma support need to include salutogenic approaches that facilitate awareness and integration of growth factors as well as deal with the negative impact of the traumatic event or loss. Thus, resolution and healing following exposure to traumatic events may be more thoroughly attended to if the tasks of trauma work attend to growth factors as well as the negative impact of the experience. Whist the research considering organisational factors of work environments is encouraging, it is troubling that research into the role of other systems like the family in trauma and PTG outcomes is conspicuous by its absence.
In my practice, I routinely and purposefully incorporate PTG into the therapeutic process. From the outset, I introduce the concept (usually as part of psycho-education on the trauma process), purposefully look for, note and report strengths, adaptive responses and growth using the 5 PTG outcomes as a guide, discuss and encourage strategies for the development of PTG, and regularly check for awareness and progress. But my perception of the value of PTG in therapy is just that a perception. It needs testing. I suggest we also need to examine the role of PTG in the therapeutic alliance, including growth related characteristics of the therapist. What we must do is explore every possible avenue for working with traumatised people to advance their healing. PTG is positive, it is hope giving, and potentially transformative. It is a stark contrast to the struggle of trauma.
Posttraumatic growth needs to be taken seriously. And the need for ongoing research of posttraumatic growth is pressing.
Massey University, New Zealand
May 30, 2007