2020 has been a difficult year. As a practicing psychotherapist for many years, clients come to me to learn how to overcome the impacts of all sorts of negative life experiences. In clinical practice, we refer to this as trauma, or even a formal diagnosis of Post-traumatic Stress Disorder (PTSD). 

Over the past decade of seeing clients, I have never seen as many people suffering from personal hardships and traumas. I also see collective traumas such as financial problems, social isolation, increased relational conflict, illness, and death associated with COVID-19, strained and divided political dynamics that infiltrate one at every turn, and increased racial tensions. 

Most psychotherapists I know are flooded with clients and find it difficult to keep up with individuals whose previous mental health struggles have escalated under these new demands. Now a new host of clients are experiencing mental health problems due to the increased stress and demands of the pandemic. 

Being exposed to traumatic events does make one more vulnerable to post-traumatic stress, but research has shown that the majority of people do not develop PTSD. We can’t assume difficult life experiences will lead to trauma, which reveals there are underlying psychological mechanisms at work that can be utilized to help those in need of support. Each survivor will interpret the event differently and find different meaning from it. 10-15% of individuals who undergo traumatic experiences develop chronic PTSD symptoms, 20-25% experience recovery, while 60% are resilient to a traumatic experience. 

Growth

What does it mean to aspire to grow in the aftermath of traumatic experiences? Dr. Richard Tedeschi, a leading researcher and clinician in the practice of Post-traumatic Growth (PTG) more broadly defines trauma as “a threat to cognitive or psychological integrity – a severe challenge to an individual’s past ways of understanding the world and their place in it, their personal identity.” I don’t know anyone in 2020 who hasn’t experienced some aspect of this more broadly defined type of trauma. 

Resilience is the ability to recover from or resist adversity. Resilience against undermining our core beliefs about the world includes internal beliefs about how good the world is, how safe we feel, how predictable the world is, how much control we have over it, how vulnerable we feel, and our self-esteem. When trauma negatively impacts any of these core beliefs, we have to reconstruct those beliefs to be more resilient against further hardship. Resilience is not the same as post-traumatic growth.

Post-traumatic growth is a transformative response where we develop a new way of being and living beyond our previous level of functioning. Post-traumatic growth doesn’t necessarily cause suffering to cease, but it creates a depth of understanding of ourselves, others, and the world that leads to a more fulfilling life. 

Psychotherapy allows one to write and rewrite the narrative of their lives, themselves, and what they have been through. Traumatic events can catalyze growth, which is at the core foundation of post-traumatic growth therapy.

Post-traumatic growth is both a process and an outcome. The experience of positive changes in oneself is a result of the struggle with traumatic events. As many clients tell me, undergoing trauma therapy is like undergoing chemotherapy. It is not linear, but over time change does occur. Trauma therapy is life-altering, changing the nature of our experience of ourselves and life and results in an existential change. 

Negative thoughts, or cognitions, give way to optimistic possibilities about what life has to offer. Difficulty relating to others, contentious relationship dynamics, and social isolation give way to an increased connection to others in more meaningful ways. Avoidance and numbing towards engagement in life give way to increased involvement and appreciation for life itself and immersing oneself in it. And finally, spiritual growth can be cultivated through suffering. 

While the concepts of post-traumatic growth are relatively new to the practice of psychotherapy, they are found throughout many world spiritual and religious traditions. In Christian tradition, there is the crucifixion and resurrection. In Islam, suffering is found to be an important function in one’s life in preparation for the afterlife. Buddhism posits that suffering must be accepted and embraced to achieve wisdom. Existential psychology focuses on human suffering and can cultivate meaning and how we understand who we are. We need to engage in suffering to develop who we are, which is not the same as happiness. 

Research has shown that post-traumatic growth can impact core beliefs around these core areas:

• Relating to others:

  • I now feel that I can count on people in times of trouble

  • I have a greater sense of closeness to others

  • I am more willing to express my emotions to other people

• New possibilities

  • I am developing new interests in life

  • I am establishing a new direction for my life

  • I am able to do more rewarding things with my life

• Personal strength

  • I have a greater feeling of self-reliance

  • I know I can better handle life challenges in life

• Spiritual change

  • I have a better understanding of spirituality

  • I have greater clarity about the meaning of life

• Appreciation of life

  • I have new priorities about what is important to me

  • I place more value on my own life

If we can constructively think through what traumatic events have happened we can create meaning. We can still have distress, but post-traumatic growth can help distress become meaningful because the changes it produces make life better. Trauma is not good, but what is important is how we deal with the struggle. It is possible to change from a survival mindset to a growth mindset, cultivating psychological fitness. 

Embrace

Post-traumatic Growth (PTG) is an intervention done through the expert companionship model. PTG is utilized in tandem with other empirical supported PTSD therapies. It is cognitive in the sense that it works with thoughts; it is narrative in the sense we are writing the story of what happened, it is constructivists in the sense that we are constructing meaning, and existential in the sense that we are creating meaning. There are five elements in the program: education, regulation, disclosure, story, and service.

1. Education is helping people understand what trauma and PTSD are. Many people with PTSD do not recognize that the distress they experience is PTSD. There is a physiological response to trauma in addition to shattered beliefs about one’s self, others and the world. Reconstructing and repairing the symptoms of PTSD are foundational for post-traumatic growth.
   

2. Emotion regulation occurs during any difficult experience as an adaptive response. When one undergoes a trauma their physiology is altered in response to the trauma, e.g. a rape victim will often dissociate and freeze. Over time these symptoms become disruptive as they persist long after the traumatic event. The sympathetic nervous system will become dysregulated during ongoing stress in living, resulting in a fight or flight response that is no longer useful. It is key to learn skills to bring the nervous system back in balance.

   • It is important to move from a worried mind to reflective rumination. Reflective rumination is the ability to thoughtfully contemplate and think through the trauma rather than worry about it.

   • Managing intrusive thoughts can help lead to greater feelings of control and less emotional dysregulation. This is often done through cognitive-behavioral therapy (CBT) or dialectical-behavioral therapy (DBT).

     • For an example, check out this free website that contains worksheets on managing cognitive distortions through thought records.

     • Mindfulness meditation is helpful in learning to manage intrusive thoughts and ground oneself as well.
       

3. Constructive self-disclosure is the telling of the trauma. In the PTG model, it is especially important to talk through and explore the experience of the aftermath of the trauma. Understanding how the traumatic event has sent one on a different path in life. Focusing on how the trauma served as a turning point and how one can accept what happened. It is important that others you are close to come to understand what you’ve been through as well. In the PTG model, these individuals are referred to as Expert Companions. Who are the expert companions in your life? Identify someone who is safe to disclose to and be open with.
   

4. Creating a trauma narrative when traumas can be disruptions in our life’s narratives. Narratives help individuals understand what is possible in life during the aftermath of a trauma. While working with a therapist, it is important that the therapist highlight:

   • The combination of what terrible things have happened with what growth has occurred. 

   • Post-traumatic growth is based on the concept of paradox: out of loss, there is gain.

   • When you can accept what has happened you will feel a greater sense of control over your life. 

   • Feel the strength in being vulnerable.

   • Feeling gratitude during times of grief. 

   • Living within the paradox of PTSD and post-traumatic growth.
     

5. Developing a mission and being of service is important to people who have experienced growth. Being of service to others helps create and sustain growth. Being of service to others can help manage feelings of guilt and develop an identity as a trauma survivor. Being in service to others can mean different things to different people. 

To learn more about Post-traumatic Growth, visit the Boulder Crest Institute for Posttraumatic Growth or specifically books by Dr. Richard Tedeschi.

Start Your Growth With Us

I know for me personally, 2020 has presented challenges in parenting my children while navigating their education and keeping them safe. Challenges in managing a growing and evolving business in a changing economic and political environment. Challenges in maintaining and developing deeper team cohesion due to remote working and ongoing stressors in the world. Challenges in maintaining connection within extended family dynamics in which already tenuous political divisions created more separation and distance. Challenges with coping with an ongoing fear of getting sick and what would happen to my young children as a single parent if I wasn’t there to care for them. Challenges in maintaining a positive reframe for any set-back when they at times happen in machine gun style out of nowhere. 

Yet I have, through developing psychological fitness over the course of my life, chosen to take each perceived challenge or set-up as an opportunity for growth. This happens somewhat automatically for me now as I let life happen and seek to simultaneously accept the reality of life on life’s terms while looking to see what is now possible out of a new landscape. Looking back, I can say the gains made out of the struggles of 2020 add a depth and meaning to my work, my family, and my life that wasn’t there previously. Trauma and struggle in life are only the starting point. Discover what’s possible. Discover all of the wonders of who you are and what you can create.

At Kimberly Keiser & Associates, while our therapists are trained in evidence-based trauma therapy interventions, including EMDR, IFS, trauma-focused CBT, DBT, and eclectic psychotherapy, we also help cultivate the development of human beings to new levels of functioning through the model of post-traumatic growth.