(originally published in Stress Points, December, 2015)
- Given that most research and practice regarding trauma focuses on alleviating symptoms of PTSD, depression, anxiety and so on, what led you to develop your approach and the subsequent model of PTG?
If we go back to the beginning, [mid 80’s], my colleague Lawrence Calhoun and I were looking at the concept of wisdom. There wasn’t a lot of literature on wisdom and so we started interviewing people who we thought might be wise. Older people, people that had been bereaved and people that had experienced physical disabilities in adulthood but had done extremely well in their lives. We started hearing stories that we later identified as posttraumatic growth. Stories such as “ these events were life changing”. Some people even said that “the event was the best thing that ever happened to them”. We took a quote from one of these people to start the first page of our first book in 1995; “Trauma and Transformation; Growing in the Aftermath of Suffering”.
- Could you talk about your model and explain the process of PTG?
The posttraumatic growth model is highly cognitive, at least on the surface. We take Ronnie Janoff-Bulman’s idea of the shattering of the assumptive world. When people experience a traumatic event, it challenges their core belief system, in that challenge people experience [intrusive] rumination and emotional distress which fuels a need to refigure or rethink the core belief system. With the proper support and resources, people can change the intrusive rumination to a more reflective and deliberate process in which they try to reach a better understanding of their core beliefs. In speaking about core beliefs, this includes beliefs about how controllable the world is and the extent to which people believe they can plan for their life. Individual’s intentions for their life often need to be reconsidered. What kind of world do they live in: is it fair or unfair? What kind of people are around them, are they benevolent or not? These are the core notions that we use to proceed with our lives. The process of posttraumatic growth involves a reconfiguration of the life story or the narrative; the autobiography that we are writing. Based on that revised narrative, people can go out on new missions in life, do new things and devote themselves to activities they consider to be particularly important. Very often, people consider this a life change.
- How is PTG relevant in cross cultural contexts?
Posttraumatic growth has been studied in many different regions and cultures and it does show up, that is there is evidence for it, no matter where you look in the world. I think it is something that is very human, and universal. Although it has been found to be universal, there may be different cultural versions of it. In certain cultures for example spirituality is very important; while in other more secular cultures this change can be rare. Also, types of trauma can be different across cultures, which may, to some degree produce different versions of growth, or lead people to consider different aspects of their core belief system. For example, trauma types that are considered as impersonal, such as natural disasters, or personal, such as victims of crime, might produce different considerations of core beliefs and different kinds of growth.
- How is PTG relevant in extremely severe trauma, for example in refugees who have experienced torture, or women who have experienced sex trafficking?
The surprising thing to me, in some ways, is that even people who have experienced very severe traumatic events can still report growth. Although it can be considered counter intuitive, some people may think that someone who has experienced these really terrible things, that it would destroy them and there would be no positive outcomes, but we do see them! In fact, we have this curvilinear relationship between the degree of trauma or distress and growth. It seems to be that there is an increasing level of growth with increasing trauma, to a point. When people are really overwhelmed they travel beyond the optimal level on the curve, but even then we have an opportunity to approach them, to help them come back up the curve to that optimal level, by giving them appropriate resources and support and the understanding of what’s possible with posttraumatic growth.
- How can therapists and mental health workers apply the PTG model in practice?
Lawrence Calhoun and I released a book  called “Posttraumatic Growth in Clinical Practice” as an aid in clinical practice in this area. We wrote the book as an attempt to nail down very practical examples of how posttraumatic growth can happen with clinical interventions. We developed a five-step model, which involves posttraumatic growth being integrated into standard trauma practice. Using the model, clinicians can use what they already know about responding to trauma survivors, from a perspective where they can essentially expect to see growth opportunities, rather then relying on symptom reduction as their focus. They can think more broadly in terms of the growth possibilities, and the transformative possibilities for people’s lives. The model can help clinicians look for indications that a person has a challenge to their core belief system and start working with those challenges alongside symptom reduction techniques, right from the beginning. The five step model is very easily integrated into trauma practice, and it fits with most interventions, be it cognitive, humanistic or narrative. We draw on all those traditions in posttraumatic growth therapy. this model contains the five factors as seen in the Posttraumatic Growth Inventory (new possibilities, personal strength, relationship change, appreciation for life, and spirituality) You can use these five factors to understand where your client is at in their situation, which one of those five factors they may already be talking about or focusing on. A clinician’s task is to facilitate some more discussion of those factors, to bring them out into the open, deepen the understanding about those factors that they are naturally starting to attend to.
Tedeschi, R.G., & Calhoun, L.G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Sage Publications.
Janoff-Bulman, R. (1989). Assumptive worlds and the stress of traumatic events: Applications of the schema construct. Social Cognition, 7, 111–136.
Shakespeare-Finch, J., & Lurie-Beck, J. (2014). A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder. J Anxiety Disord, 28(2), 223-229.
Calhoun, L.G., & Tedeschi, R.G. (2013). Posttraumatic growth in clinical practice. Routledge.
Weiss, T., & Berger, R. (2010). Posttraumatic growth and culturally competent practice: Lessons learned from around the globe. Hoboken, NJ, US: John Wiley & Sons Inc.