ABSTRACT
A major and sometimes last element in PTG facilitation involves the creation of a narrative that incorporates the traumatic experiences and allows for the recognition of positive changes in the aermath of the trauma. Narrative and constructivist approaches to therapy have become more appreciated in recent years, and represent a way to use the natural storytelling that is involved in all human interaction, including psychotherapy, to aid in healing (Neimeyer, 2006a, 2006b). By working on the narrative, the client comes to appreciate that there are various points of view from which events can be appreciated and understood. ese perspectives represent opportunities to recast a traumatic event and its aermath into constructive stories that can be used in the years ahead, forming a framework for a purposeful and satisfying life post-trauma. In facilitating PTG, it can be useful for the client to incorporate one or more of the ve domains of growth into a life narrative, and to develop a robust set of core beliefs that will allow the trauma survivor to be able to be resilient to future challenges (Jano- Bulman, 2006). Although the focus of survivors is the story of the event and its aermath, the narrative must also reect the pre-trauma life as well. If we are to facilitate PTG, therapists must know what the client is changing from. e narrative is a complete life story, although certain aspects may be the focus. Certainly, one of the aspects of the life story that requires attention is the possibility that the client has suered other major stressors prior to the one for which treatment is sought. Some clients may have had a lifetime of repeated traumatization, and treatment may need to focus on a series of events. e narrative may include how various events are related to each other, with each one playing a role in creating vulnerabilities
and strengths in the client. e ability to link together events into a story that provides a sense of self has been termed autobiographical reasoning (Habermas & Bluck, 2000), and it is an important development during adolescence as identity is formed. is is the familiar concept developed by Erikson (1963). More recently McAdams (2006) has continued in this narrative tradition, and described how negative life events act as a catalyst for generativity in adulthood through redemption sequences that give meaning to suering. It is useful to encourage the process of narrative development by asking clients to create a simple timeline of their lives, locating both positive and negative events that they consider signicant, so that they have a rough outline of a life narrative at the start of therapy. e clinician can then ask them to review the timeline, and in doing so, it can start to become clear how these various events are signicant. Such a review may take a single session or several sessions of therapy. In the review of the life timeline, it oen becomes apparent how dicult events have changed the direction of people’s lives, changed their sense of identity, views of themselves, and of various core beliefs. Clinicians can ask questions to make these changes become clearer to the client, since the person reporting these events may not have considered all their eects. ese questions include, “How did going through this change you?” or “How do you think your life might have been dierent if this hadn’t have happened?” or “How did your life change direction aer this?” It will be important to listen for indications of PTG in these reports, as well as healthy coping and new core beliefs. e revision of the life narrative that can happen in the aermath of tragedy is co-authored by the trauma survivor and the expert companion. e survivor benets from expert companionship in narrative construction because it is hard to appreciate oneself only from an internal point of view. e expert companion notices things the trauma survivor may miss. For example, one of the basic questions the clinician may ask, is “Given how horrible this event was, is there any possibility of anything valuable coming from it?” e clinician may also say “I notice some things that you tend to overlook in yourself.” Trauma survivors are prone to focus on the horror of what they went through, how it has hurt or damaged them, and what they have lost. ey are oen unsure of how to get through their trials, if they will ever heal, and how much discomfort they will need to endure along the way. e narrative must include all aspects of the client’s experience, because growth does not come from denial, but from confronting the existential questions raised, and from sharing these experiences with appropriate others. By considering the entire narrative, survivors of traumatic events become trauma experts, knowledgeable about the details and nuances of trauma. ey also may uncover aspects of themselves that would not have been evident otherwise. As the narrative is reviewed and perhaps revised, it can become apparent that there have been various eras in a person’s life, and perhaps various identities as well. Generally, people manage trauma better when they can recognize that there are dierent aspects to their identity and when one is weak or threatened, another
remains intact (Showers & Ry, 1996). People oen become trauma experts when they struggle to nd their way despite the advice of others. For example, grieving people who are told by others that they must “move on” discover that engaging the grief may be a better way for them, even though it can feel so painful that they wish they could simply, move on. Oen the job of the expert companion is to support the instinctual moves of trauma survivors, helping them see what is right about their perceptions and choices and how much they can count on their own strengths. When the story is told, it may be one where the client is able to see themselves as more assertive and condent. Sometimes it is more dicult for clients to notice the positive aspects of their experiences, and there may need to be more direct methods utilized to help them notice. ese methods may involve diaries or self-monitoring tasks similar to those employed in the “well-being therapy” described by Fava (Fava, 1996; Fava & Ruini, 2003). Sometimes the themes of growth in the survivor’s story are so subtle that the expert companion needs to point them out. is is especially true for clients whose identity involved a sense of invulnerability or great strength. Clients who were like this may desperately wish to return to their former selves, and they may have trouble appreciating the paradox of vulnerability and strength-that people can get stronger by confronting weakness. One client who went through dicult chemotherapy for cancer felt guilty about talking to her husband about it, feeling like she was a complainer, even though he was very supportive. e clinician allowed her to show her vulnerability by suggesting that she could talk all she wanted as long as she did not whine. She had something to avoid, whining, while the rest of the talk became all right with her. Integrating the sense of vulnerability into the life narrative is a characteristic of almost all clinical work with survivors of major life crises. But PTG can involve an appreciation of how acknowledging vulnerability is a subtle strength. In the aermath of major stressors, many people can feel like weaklings or failures because they were not able to prevent the tragic circumstances, they are not able to reverse them, their emotions overwhelm them at times, and they have trouble guring out how to proceed. In the face of all this, subtle strength is endurance, acceptance, expressiveness and support-seekingtendencies that may have previously been seen only as vulnerabilities. In a narrative constructivist approach, clinicians help trauma clients shi the schemas that are used to dene identity, and in particular what it means to be strong. ose who see themselves as vulnerable may be helped to see that survivor status connotes strength. However, it is important not to reconstrue everything as strength. Vulnerability is real, and trauma forces people to face this dicult truth. A clear-eyed vulnerability requires existential courage to live in the face of death (Maddi, 2012). e new life narrative that incorporates this truth may enable the trauma survivor to face their ultimate and inescapable life task, death, more gracefully. In the following case example, we meet Mitchell, a 55-year-old man who had a stroke one year ago. He went through successful rehabilitation, but post-stroke brain scans showed an inoperable aneurysm that could kill him at any moment.
