Loss is a universal experience and the basis of many therapeutic problems. The currently unemployed client, the parents whose son is addicted to opioids, the client whose long-term relationship has broken up, and the client who has received a devastating health diagnosis have a common loss.
As a professional advisor and specialist in grief trauma, I am sensitive to the way loss affects clients' worldviews and emotional struggles. And as a bereaved survivor, I am aware of the unique ways that loss can act as a catalyst for growth. An African proverb captures this feeling when it says: "Smooth sea is not a skilful sailor." But that raises questions: Is growth possible for everyone and how do consultants help clients grow after a traumatic loss?
Post-traumatic growth: what is it?
Post Traumatic Growth (PTG) is an approach that informs our practice as professional advisors. Richard Tedeschi and Lawrence Calhoun, who pioneered PTG research and theory, define it as a positive change that follows the struggle after some kind of traumatic event. The PTG represents changes that occur sooner than during a life crisis. They are usually long-term changes that occur over a longer period of months to years when people cope with crises by developing ways of thinking, feeling, and behaving that are different from those they are targeting had left before the life changing event.
PTG is not the same as personal development or maturity. It can be thought of as something that occurs spontaneously as a result of trying to cope with a challenging life experience from seismic influences. Proof of PTG does not mean that the loss or traumatic event was desired in any way.
Approximately 10% of survivors who lost their lives lost themselves in grief, guilt, and despair for a long period of time. Clients who experience these emotions in connection with an intense longing for who or what has been lost may suffer from complicated grief, which requires a special type of professional treatment (see complicatedgrief.columbia.edu). However, the majority of loss survivors do not get stuck in acute grief and report some degree of growth during recovery from the loss. For many of these survivors, growth can go hand in hand with distress.
Research Summary: What Do We Know?
In 1996, Tedeschi and Calhoun's research led to the Posttraumatic Growth Inventory, a 21-point self-report that yielded five empirically derived PTG markers:
1) Improved relationships with others
2) Higher appreciation for life
3) New opportunities for your own life
4) Greater awareness of personal strengths
5) Changes in Spirituality
These five growth indicators have been reported by a number of survivors, including prisoners of war, veterans with post-traumatic stress disorder, people diagnosed with cancer or other life-threatening diseases, and people who have been paralyzed due to accidents, lost spouses or life partners. Although much of the research was done with people living in the United States, other studies have looked at PTG with people in other countries.
Tedeschi and his co-authors cited the following in their book "Post-Traumatic Growth: Theory, Research and Applications", published in 2018, under the current findings on the PTG:
About 30% to 60% of the survivors report experiences with PTG after a difficult life event.
The PTG is both a process and a result.
PTG is generally a stable phenomenon over time.
PTG is more evident in people who achieve higher scores in terms of extraversion and openness to experience, and is also related to optimism.
There are both universal aspects and culture-specific features of the PTG.
Critics of the PTG point out that the growth reported or perceived by them is not necessarily identical to the actual growth. Some of the contradicting results on PTG seem to be the result of differences in the definition and measurement of growth in different studies.
Growth-promoting practices among loss survivors
Specific interventions and techniques that could facilitate PTG in survivors are less explored, although a predominant feature of a growth-oriented therapeutic approach is working with customer stories or narratives. The following practical strategies can be used to promote the growth of losses.
Creating a safe therapeutic environment. Traumatic loss undermines the feeling of security and puts the survivors in unusual situations. Social support is critical, yet many people feel sad or uncomfortable in the survivors' social networks or make well-meaning comments that offend the survivor. The consultants' first task is to provide a safe container that is comforting and accompanying for survivors of losses. Creating a therapeutic environment in which we listen carefully and hold up the mirror to reflect these clients' experiences will help survivors to feel known.
Use self-care practices. Traumatic loss can disrupt the rhythm of survivor connections. One way to help survivors rebuild bonds is to encourage them to build a new relationship with themselves. We can help our customers recommend effective self-care practices such as exercise and movement, adequate sleep and eating nutritious foods. In the book The Emotional Life of Your Brain, published in 2012, Richard Davidson points out that a lack of consistent self-care practices sabotages our ability to regulate our bodies and emotions. Mindfulness and self-compassion are additional self-help practices that can be used by victims of loss who feel emotionally swamped by anger, guilt or fear. Teaching these clients self-compassion and mindful meditation can help them reconnect with themselves and ultimately with others. These tools also improve customer balance and enable further growth efforts.
Examine customer narratives. An important part of survivor therapy is exploring their stories. PTG is most common among customers who create an adaptive narrative in which they can see themselves as survivors rather than victims. The following elements play an important role in examining customer narratives.
Timelines: At the beginning, customers can create a timeline of their lives with important events that are marked in different ages. Timelines provide important clues to stress factors before and after the loss as well as to the loss event itself. Customers who have been exposed to many stress factors before the loss often have greater difficulties in discovering growth. It is helpful to use strength-related queries when asking customers to check their schedules. For example: “Juanita, I noticed that you had a miscarriage when you were 20 years old. How did you deal with it? What tools did you find that helped you with this loss? "
Indications of growth: Many customers are so tied to the trauma of the event that they can hardly see anything positive in their history. Counselors can be most helpful when they see signs of growth and healing in clients.
For example, James, an African American in his mid-20s, is discouraged because of several losses. The house where he once lived with his grandmother was recently destroyed by a tornado and now she is hospitalized with several injuries. In addition, the business he founded just worked. In his story, James mentions that a local church offered to help rebuild the house, and a nearby dealership was just offering him a job. He says it feels so unusual to let others approach him with offers of support that his opinion about the world and other people is gradually changing. Although he does not identify this as a growth indicator, his advisor points out how James' views about himself, other people and the world are shifting in a new direction.
Cultural context: It is also crucial to deal with customer narratives in a cultural context. Some clients report cultural rather than individual losses when they have been subjected to significant discrimination based on their race, ethnicity, gender, age, ability status, or sexual orientation. It is important for counselors to know how the clients' cultural affiliations affect their lives and how they see the traumatic loss and healing.
James states, for example, that he has had odd jobs since the age of 14 to feed himself and his grandmother, whose only source of income is a small social security check. James admits that he feels more vulnerable as a black man in a predominantly white rural community due to the increased financial strain and recent losses.
Journaling: Consultants can also facilitate customer narratives by promoting the use of journaling as a complementary therapeutic intervention. Therapeutic journaling is a tool developed by James Pennebaker. He says that writing about traumatic events reduces stress and strengthens immune cells. Consistent journaling is most effective, but 15 to 30 minutes of journaling several days a week can be more productive than daily journaling, which Pennebaker says can produce more ruminants than growth. When working with loss survivors, consultants typically instruct these clients to write about their deepest thoughts and feelings about their loss.
Case study: Sharon
Sharon is a 62-year-old woman, whose partner has died of a sudden heart attack for 40 years. Sharon lives in rural Appalachia, where she had lived for many years with her now deceased partner. She has no children and her only brother lives hundreds of miles away. Sharon quit working in a dental office seven years ago to help her partner who had uncontrolled diabetes. She has no real friends and reports that she has rarely been out in the past seven years. She says that she has no acquaintances or memberships in the neighborhood in any social group.
In the first consultations, Sharon sobs and indicates that she has no idea what will happen after she loses her partner. She has a limited income but no real expenses other than rent and utilities. She insists that she doesn't want to go back to work and has enough income to meet her monthly commitments. She presents herself as a kind of loner and describes herself as isolated.
Sharon came to the counseling center at the urging of her brother, but is not sure whether the bereavement counseling can be helpful. Just before she brings her partner back to life, she doesn't know how talking and crying about her loss can make a difference. She has no sleep problems, but feels compelled to leave the house during the day. She drives around randomly and visits local discounters just to have a seat.
Sharon is more interested in counseling when a grief support group is offered and participates in several sessions. In a much livelier state, she returns for individual advice and can even laugh. Sharon has made several friends in the grief support group and reports that the group helped her feel less alone. She is able to create a grief timeline in counseling and can occasionally keep diaries if she is grieved. Over time, she follows up recommendations for joining a local gym and book club in the public library.
After four months of individual counseling, Sharon is interested in volunteering at a local animal shelter and starts weekly. A few months later, she feels like a different person. She is ready to stop attending individual counseling sessions, but will continue to participate in the grief group.
Not all grief survivors experience the growth that Sharon has experienced – or so quickly. Although she continued to miss her partner terribly, her life as a caregiver in the past seven years had prevented her from developing much life satisfaction for herself. Her ability to make friends and social relationships, and her voluntary activities in the shelter gave her a high level of self-efficacy and offered positive opportunities to deal with her partner's absence.
Some people cannot cope with losses as effectively as Sharon. Those who suffer violent losses or are diagnosed with depression, anxiety or substance disorders are more likely to go through a longer recovery period for healing. In addition, many bereaved survivors feel guilty of experiencing some kind of satisfaction as if they were betraying the person who is no longer here.
At the same time, it is not uncommon for grief survivors to reassess and shift their priorities in life, also because their living conditions have changed. For example, Emilee lost her spouse Roberto, a retired military officer who was active in veteran affairs. Roberto had spent his retirement years traveling internationally to support this cause. Emilee had rarely accompanied him because of her fear of terrorism and plane crashes. After Roberto's death, however, Emilee decided to partner with the same veterans' foundation that Roberto worked in and traveled the world. Emilee wanted to preserve her spouse's legacy and share her own gifts with a larger number of people. Loss survivors like Emilee and Sharon, who find ways to give something back or volunteer, are more likely to report growth stories.
Be prepared for growth
There is growth potential when clients uncover meanings from their loss and construct narratives that fit into their worldview and self-esteem. Experienced counselors can act as counselors to help survivors find a sense of what is happening. No survivor should ever be pushed to grow, but a growth-focused advisor could be the missing part that helps clients become more resilient to traumatic losses.
In my own experience as a bereaved survivor after a series of personally devastating losses, awareness of my growth crept up on me. It was like turning a dimmer back on as my gaze and mood moved in a positive direction. I include this because matching growth indices can be one of the best ways to help customers identify growth opportunities and get out of the darkness of a traumatic loss to find light again. As Jon Kabat-Zinn, founder of mindfulness-based stress reduction, said, "You can't stop the waves, but you can learn to surf."
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Sherry Cormier is a licensed therapist, certified bereavement specialist, and a former faculty member at the University of Tennessee and West Virginia University. He is a speaker, trainer and consultant. She is the author of consulting strategies and interventions for professional helpers (ninth edition), senior author of interview and change strategies for helpers (eighth edition) and co-producer (with Cynthia J. Osborn) of more than 100 training videos for Cengage. Her latest book is Sweet Sorrow: Seeking permanent holism after loss and grief. Contact them through their website sherrycormierauthor.com.
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