Tag Archives: Posttraumatic growth

Helping clients grow from loss

By Sherry Cormier February 4, 2020

Loss is a universal experience and an underpinning of many therapeutic issues. The client who has just lost a job, the parents whose son is addicted to opioids, the client whose long-term relationship unraveled, and the client who received a devastating health diagnosis all have loss in common.

As a professional counselor and bereavement trauma specialist, I am sensitized to the ways that loss informs clients’ worldviews and emotional struggles. And as a grief survivor, I am aware of the unique ways in which loss can serve as a catalyst for growth. An African proverb captures this sentiment when it says, “Smooth seas do not make for skillful sailors.” But this raises questions: Is growth possible for everyone, and how do counselors help clients grow after a traumatic loss?

Posttraumatic growth: What is it?

Posttraumatic growth (PTG) is an approach that informs our practice as professional counselors. Richard Tedeschi and Lawrence Calhoun, who pioneered much of the research and theory on PTG, define it as positive change that follows the struggle after some kind of traumatic event. PTG represents change that occurs after a life crisis rather than during it. It usually involves longer-term change that occurs over an extended period of months to years as individuals cope with crisis by developing ways of thinking, feeling and behaving that are different from what they relied on prior to the life-changing event.

PTG is not the same as personal development or maturity. It may be thought of as something that occurs somewhat spontaneously as the result of trying to cope with a challenging life experience of seismic impact. Evidence of PTG does not imply that the loss or traumatic event was somehow desired.

Approximately 10% of loss survivors stay mired in grief, guilt and despair for an extended period of time following their loss. Clients who experience these emotions, coupled with an intense yearning for who or what was lost, might be suffering from complicated grief, which requires a particular kind of professional treatment (see complicatedgrief.columbia.edu). The majority of loss survivors do not get stuck in acute grief, however, and report some measure of growth during recovery from loss. For many of these survivors, growth may coexist with distress.

Research summary: What do we know?

In 1996, Tedeschi and Calhoun’s research resulted in the Posttraumatic Growth Inventory, a 21-item self-report measure that yielded five empirically derived markers of PTG:

1) Improved relationships with others

2) Greater appreciation for life

3) New possibilities for one’s life

4) Greater awareness of personal strengths

5) Changes in spirituality

These five markers of growth have been reported by a variety of survivors, including prisoners of war, veterans with posttraumatic stress disorder, people diagnosed with cancer or other life-threatening illnesses, people who became paralyzed from accidents, and those who have lost spouses or life partners. Although much of the research has been conducted with people living in the United States, other studies have explored PTG with individuals in other countries.

Among current findings on PTG, Tedeschi and his co-authors cited the following in their 2018 book Posttraumatic Growth: Theory, Research, and Applications:

  • About 30% to 60% of survivors report some experience of PTG following a difficult life event.
  • PTG is both a process and an outcome.
  • PTG is generally a stable phenomenon over time.
  • PTG is more evident in those individuals who score higher on measures of extraversion and openness to experience and is also related to optimism.
  • There are both universal aspects and culturally specific characteristics of PTG.

Critics of PTG point out that self-reported or perceived growth is not necessarily the same as actual growth. Some of the conflicting findings on PTG seem to be the result of differences in how growth is defined and measured across studies.

Growth-promoting practices with loss survivors

There has been less research about specific interventions and techniques that might facilitate PTG in survivors, although a predominant feature of a growth-oriented therapeutic approach involves working with client stories or narratives. The following practical strategies can be used to help facilitate growth with loss survivors.

Create a safe therapeutic environment. Traumatic loss erodes a sense of security and thrusts survivors into the middle of unfamiliar circumstances. Social support is crucial, yet many people in survivors’ social networks may be uncomfortable with grief or may offer well-intentioned comments that feel offensive to the survivor. Counselors’ first task is to provide a safe container that is comforting and companionable for loss survivors. Creating a therapeutic environment in which we listen closely and hold up a mirror to reflect these clients’ experiences will help loss survivors feel known.

Use self-care practices. Traumatic loss may disrupt the rhythm of survivors’ connections. One way to help loss survivors reestablish bonds with others is to encourage them to grow a new relationship with themselves. We can help clients do this by recommending effective self-care practices such as movement and exercise, adequate sleep, and the intake of nourishing food. In the 2012 book The Emotional Life of Your Brain, 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-care practices that can be used by loss survivors who feel emotionally flooded with anger, guilt or anxiety. Teaching self-compassion and mindful meditation to these clients can help them reestablish a connection with themselves and, ultimately, with others. These tools also enhance clients’ equilibrium, making further work toward growth possible.

Explore client narratives. An important part of therapy with loss survivors involves exploring their narratives or stories. PTG occurs most often with clients who create an adaptive narrative in which they are able to see themselves as survivors rather than victims. The following items play integral roles in exploring client narratives.

Timelines: Initially, clients can construct a timeline of their lives with significant events marked at various ages. Timelines provide critical clues about pre- and post-loss stressors as well as the loss event itself. Clients who have been subjected to many pre-loss stressors often have more difficulty discovering growth. Using strength-oriented queries when asking clients to review their timelines is useful. For example, “Juanita, I noticed you had a miscarriage when you were 20. How did you cope with that? What tools did you find that helped you through that loss?”

Clues of growth: Many clients are so affixed to the trauma of the event that it’s hard for them to detect anything positive about their story. Counselors can be most helpful by noting clues of growth and healing in clients.

For example, James, an African American in his mid-20s, is discouraged because he has been through multiple losses. The house he once lived in with his grandmother was recently obliterated by a tornado, and now she is in the hospital with multiple injuries. In addition, the business he started just folded. In recounting his narrative, James mentions that a local church has offered to help rebuild the home, and a nearby car dealership just offered him a job. He says having others reach out to him with offers of assistance feels so unfamiliar that it’s starting to change his opinions about the world and other people. Although he doesn’t identify this as an indicator of growth, his counselor does by pointing out ways in which James’ views of himself, other people and the world are shifting in a new direction.

Cultural context: Exploring client narratives within a cultural context is also crucial. Some clients may present narratives of cultural losses rather than individual losses in instances in which they have faced significant discrimination based on their race, ethnicity, gender, age, ability status or sexual orientation. It is important for counselors to be aware of the ways that clients’ cultural affiliations affect their lives and their views of traumatic loss and healing.

For example, James reveals that he has been working odd jobs since he was 14 to support himself and his grandmother, whose only source of income is a small Social Security check. James confides that this elevated level of financial stress and the recent losses he has experienced make him feel more vulnerable as a black man living in a predominantly white rural community.

Journaling: Counselors can also facilitate client narratives by encouraging the use of journaling as an adjunctive therapeutic intervention. Therapeutic journaling is a tool developed by James Pennebaker, who 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 may produce more rumination than growth, according to Pennebaker. When working with survivors of loss, counselors typically instruct these clients to write about their deepest thoughts and feelings regarding their loss.

Case example: Sharon

Sharon is a 62-year-old woman whose live-in partner of 40 years died of a sudden heart attack. Sharon resides in rural Appalachia, where she had lived with her now-deceased partner for many years. She has no children, and her one brother lives hundreds of miles away. Sharon stopped working in a dental office seven years ago to help take of her partner, who had uncontrolled diabetes. She has no real friends and reports that she has rarely been out of the house in the past seven years. She says that she has no neighborhood acquaintances or memberships in any social groups.

In the first several counseling sessions, Sharon sobs and indicates that she has no idea how she will go on after losing her partner. She has limited income but no real expenses other than rent and utilities. She insists that she does not want to return to work and has sufficient income to meet her monthly obligations. She presents herself as something of a loner and describes herself as isolated.

Sharon came to the community counseling center at the urging of her brother, but she is unsure that grief counseling can be helpful to her. Short of bringing her partner back to life, she doesn’t know how talking and crying about her loss will accomplish anything. She is not having trouble sleeping but feels compelled to get out of the house during the day. She drives around randomly and visits local discount stores just to have someplace to go.

Sharon becomes more interested in counseling when a grief support group is offered, and she attends several sessions. She returns to individual counseling in a much more animated state and is even able to laugh. Having made several friends in the grief support group, Sharon reports that the group has helped her feel less alone. She is able to construct a grief timeline in counseling and is amenable to doing occasional journaling when she has bursts of grief. Over time, she pursues recommendations for joining a local gym and a book club at the public library.

Four months into individual counseling, Sharon becomes interested in volunteering at a local animal shelter and starts doing so on a weekly basis. Several months later, she feels like a different person. She says she is ready to stop coming to individual counseling sessions but will continue attending the grief support group.

Not all grief survivors experience the kind of growth that Sharon experienced — or so quickly. Even though she continued to miss her partner terribly, her life as a caregiver for the past seven years had precluded her from developing much life satisfaction for herself. Her ability to make friends and develop social connections and her volunteering activities with the animal shelter gave her a great deal of self-efficacy and provided positive ways to deal with the absence of her partner.

Some people will not cope with loss as effectively as Sharon did. Those who experience losses associated with violence or who have coexisting diagnoses such as depression, anxiety or substance disorders are more likely to go through an extended recovery period for healing. In addition, many grief survivors feel guilty for experiencing any kind of satisfaction, as if it amounts to some kind of betrayal of the person who is no longer here.

At the same time, it is not uncommon for grief survivors to reevaluate and shift their priorities in life, in part because their life circumstances have changed. For example, Emilee lost her spouse Roberto, who was a retired military officer and active in veterans’ affairs. Roberto had spent his retirement years traveling internationally in support of this cause. Emilee had rarely accompanied him because of her fears of terrorism and plane crashes. After Roberto’s death, however, Emilee decided to engage with the same veterans’ foundation that Roberto had been active in and found herself traveling all over the globe. Emilee wanted to preserve her spouse’s legacy and share her own gifts with a larger number of people. Loss survivors such as Emilee and Sharon who find ways to give back or volunteer are more likely to report narratives of growth.

Being attuned to growth

Potential for growth exists when clients uncover meaning from their loss and construct narratives that fit into their worldview and sense of self. Skilled counselors can serve as guides to help survivors make sense of what has happened. No survivor should ever be pushed to grow, but having a counselor attuned to growth may be the missing piece that helps clients become more resilient in the face of traumatic loss.

In my own experience as a grief survivor following a series of personally devastating losses, awareness of my growth sneaked up on me. It was as if a dimmer switch got turned up again as my outlook and mood shifted in a positive direction. I include this because being attuned to indices of growth may be one of the best ways that we can help clients recognize growth possibilities and emerge from the darkness of a traumatic loss to find light again. As Jon Kabat-Zinn, founder of mindfulness-based stress reduction, has 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 trauma specialist, and former faculty member at the University of Tennessee and West Virginia University, as well as being a public speaker, trainer and consultant. She is the author of Counseling Strategies and Interventions for Professional Helpers (ninth edition), senior author of Interviewing and Change Strategies for Helpers (eighth edition), and co-producer (with Cynthia J. Osborn) of more than 100 training videos for Cengage. Her newest book is Sweet Sorrow: Finding Enduring Wholeness After Loss and Grief. Contact her through her website, sherrycormierauthor.com.

 

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Past trauma in counselors-in-training: Help or hindrance?

By Bethany Bray May 20, 2018

Counselors are not immune to trauma — in fact, far from it. Many practitioners say that personal or familial experience with trauma or mental illness actually spurred them to become professional counselors.

The connection between personal experience and the pull to become a counselor is something that is hard to quantify, but “in my personal experience, I encounter it pretty frequently,” says Allison Pow, a licensed professional counselor in North Carolina and adjunct professor at both Wake Forest University and the University of North Carolina at Greensboro. “For a lot of people, past experience draws them into the counseling field, and trauma can play such a pivotal part in someone’s life. It’s a common thing that we see as supervisors and counselor educators.”

Past trauma can be either an impairment or a kind of “benefit” for counselors-in-training, depending on how much the person has worked through and processed the effects of trauma, say Pow and Amber Pope, a licensed mental health counselor and program chair of the clinical mental health counseling program at Hodges University in Fort Myers, Florida.

Counselor educators and other professionals in the field who have close contact with counselors-in-training should keep an eye out for red flags that may indicate that a person’s past trauma is interfering with their growth as a counselor or, in a worst-case scenario, has the potential to cause harm to clients.

“Just because you’ve been through trauma doesn’t mean you can’t become a counselor. You can become a great counselor if [your trauma] is processed correctly,” Pope says.

Pow and Pope co-presented a session, “Wounded healers: How to support counselors-in-training who have experienced trauma,” at the 2017 ACA Conference & Expo in San Francisco. The term “trauma” can encompass a wide variety of experiences, from an acute event to yearslong, developmental trauma, Pow explains.

People who have processed the effects of past trauma — often with the help of a therapist of their own — can become excellent counselors, Pow says. Posttraumatic growth and healing from the experience can foster empathy and strengthen coping skills.

“Going through trauma is a very unique experience [through which] you understand the way your brain works and your body reacts. That is hard for someone to understand who hasn’t gone through that,” Pow explains. “I have had some students who were very resilient because they have been forced to cope [in traumatic situations] in the past.”

“The reason a lot of people become very, very good counselors is their life experience,” Pow adds.

However, people who haven’t fully processed the trauma in their backgrounds can run into trouble as professional counselors. For example, in client sessions, they risk becoming triggered by topics that clients bring up and may be unable to regulate their own emotions or other behaviors in response. These reactions can harm the delicate balance of trust between practitioner and client.

“They may unwittingly be using their role as a counselor to work through their own unprocessed material or to recapitulate an unhealthy power dynamic to feel that they’re in control,” Pow says. “Control is often something that people seek after going through trauma. It may come from a lack of self-awareness.”

 

Red flags

Interactions with classmates and colleagues might be one of the best indicators of whether counselors-in-training have a trauma history that still needs to be worked through. During moments of vulnerability, do they become aggressive or reactive or express other strong emotions? In general, a lack of self-awareness, such as oversharing in class or being unaware of how the people around them are feeling, can be an indicator of unprocessed trauma, says Pow, who has a private practice in Greensboro, North Carolina.

Also watch for attachment issues or signs of avoidance, such as skipping classes or evading one-on-one contact with a professor or authority figures, Pow says. It can also be indicative of a trauma background if students do not generally have themselves together, including missing assignments or being late to class repeatedly, Pope says.

Other indicators can include:

  • Poor boundary keeping: This may manifest as oversharing, attention-seeking or disruptive behavior in the classroom, or an unhealthy preoccupation with relationships with classmates or colleagues.
  • Low self-confidence: Students with unresolved trauma may demonstrate low belief in themselves regardless of past successes. They may feel like they can “never do enough,” Pope explains. These students may lack motivation or even self-sabotage, such as missing a deadline even though they are capable of meeting it.
  • Rigidity in thinking: If students aren’t open to receiving feedback and unwilling to take constructive criticism, it can be a major indicator of past trauma that hasn’t been resolved. This attitude can stem from a black-and-white way of thinking in which the student categorizes things as “all good” or “all bad” with no in between, Pope says.

Everyone has bad days now and then that can set them off. However, if a student is repeatedly unable to regulate their emotions, such as becoming reactive or upset in class, it is a red flag, Pope says.

“When a student is so set in their values or way of thinking that they try and impose it on others, that can stem from trauma. If they can’t become more flexible in their thinking process or relationships with others, then they’re going to have a difficult time with clients,” she explains.

 

When it’s time to intervene

It is beneficial, for any number of reasons, for counselor educators to get to know and connect with the students in their program, Pope says. If a particular student seems to be struggling with challenges that could keep them from becoming a proficient counselor — such as issues related to unresolved trauma — it is better to intervene sooner rather than later.

Be prevention-focused instead of reactionary, Pope suggests. The longer a student continues in a graduate counseling program, the harder it will be to check their behavior or make decisions about their future.

“Don’t let students waste time and money if they’re not going to be a good fit,” she says.

Counselor educators who identify students raising red flags should pull them aside after class or ask them to stop by the counselor educator’s office, Pope advises. The first interaction with the student should be kept informal and light. Let them know that you have noticed some patterns and indicators in their behavior that require some attention, and ask them what supports they need to help them make improvements, she says. If appropriate, other professors or colleagues who know the student can sit in on this initial informal meeting to offer support, Pope says.

Check in with the student frequently during class breaks, supervision meetings and other opportunities. Ask how the student is doing and how they are practicing self-care. This conveys to the student that the professor wants them to succeed and grow, Pope says.

Pope emphasizes that this method should be applied only to counseling students who haven’t committed an egregious offense or intentionally gone against the ACA Code of Ethics. In those cases, a swifter and more formal response is necessary.

If a student does not begin to change their behavior after a first informal meeting, consider meeting with the counselor-in-training again to create a formal written behavior agreement. Spell out which behaviors aren’t acceptable, why those behaviors aren’t acceptable and what they need to do to continue in the counseling program. Be specific and include a timeline of when the expectations must be met, Pope advises.

If the student meets the requirements in the behavior agreement, they should be allowed to continue on with graduate school. If not, suggest that they take a semester or other time off to get the help they need, or leave the program entirely.

“When a student is given feedback and continues in their behavior patterns and doesn’t make any changes, that’s showing me that the student isn’t ready to change or do what they need to do to grow professionally,” Pope says.

Throughout the process, Pope says, she would recommend that the student attend counseling. There is some debate within counselor education as to whether it is ethical to require students to attend personal counseling . In the case of recommending a student to personal counseling, a counselor educator can request the student to provide proof, in the form of written letters from a provider, that they are attending therapy sessions and making progress to demonstrate their willingness to comply with their professors’ recommendation.

“We’re very open, telling students that we [their professors] have all attended or are attending counseling, and that it’s important to be as healthy as you can be, [to] take care of yourself mentally and emotionally,” Pope says.

Although sometimes uncomfortable, this process is also an opportunity for counselor educators to model what a healthy professional relationship should look like, Pope notes. It shows students that you can give critical feedback while caring and maintaining empathy.

“You can give suggestions and guidance while keeping professional boundaries. They may not have had that [example] in their life before,” Pope says.

“In my classes, I make a point of being very transparent with my expectations and predictable. I have a standard of which behaviors I respond to and which I don’t,” Pow agrees. “For a student who has gone through trauma, it’s not our job to be their counselor. But a lot of times their lives haven’t been predictable, and they haven’t had a safe base. We can be that predictable, safe base. We can talk openly about their struggles, getting help and that it’s not a bad thing that you’ve had some challenges in your life.”

 

Gatekeepers and guides

Counselor educators must strike a fine balance between acting as gatekeepers for the profession and serving as mentors and guides for those who need extra support, Pope says.

“When it comes to student trauma and challenges, for me, an ideal situation is when I can have enough conversations with a student so they can come to their own conclusions on whether the field is right for them or not,” Pow says. “Part of effective trauma treatment is creating choice and putting decision-making back into the person’s hands. That may be the choice to take some time off and return to the program. Emphasize where they have agency in things.”

It’s OK for a student to come into a graduate counseling program with unresolved trauma issues. They just have to be willing to work on it, self-process and accept help, Pow says. Students who are open to self-reflection and constructive feedback can experience a tremendous amount of growth, she says. “It’s unreasonable for us to expect, as educators, that people are going to come into these [graduate] programs having processed everything that has happened to them and be completely self-aware,” she affirms.

Processing and rising above trauma builds skills that are the hallmarks of a good counselor, including a strong sense of self-awareness, empathy and sensitivity. Counselors who have successfully processed their past trauma can become models for clients struggling with similar issues, Pope says.

“If you heal from a trauma, you really have to engage with the most vulnerable parts of yourself. It’s a depth that people who haven’t been through trauma may not fully understand,” Pope says. “That’s what creates really great counselors — [to be able to] engage with others at that level of vulnerability and intimacy. Knowing that going through something so challenging, you can become more whole, and in turn become a safe place for others. As a counselor, you’re better able to serve your clients.”

 

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Related reading

  • For more on supporting counselors-in-training through the supervision process, see the feature “Guiding lights” in the June issue of Counseling Today.

 

 

Suggested resources

Want to learn more on this topic? Pow and Pope suggest these titles:

 

 

 

 

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org

 

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

 

‘That I may serve’

By Bethany Bray July 5, 2017

Counselors and counselor educators who have worked with Gerard Lawson describe him as an insightful, genuine and approachable leader who has a gift for listening to others and seeing to the heart of problems to find solutions. At the same time, Lawson, an associate professor of counselor education at Virginia Tech who became the American Counseling Association’s 66th president July 1, is known for having a great sense of humor and not taking himself too seriously.

Nicole R. Hill says she will never forget one particular scene from several years ago when Lawson was president of the Association for Counselor Education and Supervision (ACES), a division of ACA. Lawson walked into his presidential reception at the division’s 2011 annual conference in Nashville, Tennessee, wearing a cowboy-style shirt emblazoned with rhinestones — which he had affixed to the shirt to spell out ACES. To further complete his ensemble, Lawson wore a giant belt buckle, says Hill, who was serving as president-elect of ACES that year.

“I just have this image [of him in that shirt] burned into my mind,” Hill says chuckling. “He really is someone who is willing to put himself out there and has a strong articulated vision for what he thinks needs to happen … but he also just enjoys the humanity side of leadership and professional service. [His approach is], ‘We’re here, we’re working hard and hopefully changing the world, but let’s do it in a way that is celebrating who we are as human beings and we’re just having a good time as well.”

“That’s really how you transform the relationships that you build, those partnerships that you cultivate,” says Hill, who is dean of the College of Education and Human Services at Shippensburg University in Pennsylvania and president-elect of Chi Sigma Iota, the international honor society of counseling.

Lawson is serving a one-year term as ACA’s president through June 30.

 

Learning, listening, leading

Lawson, who is also a past president of the Virginia Counselors Association, says he never intended to get a doctorate in counselor education and supervision. He began his counseling career working in community agencies, child protective services and with youth in the Virginia court system. He says he always thought he would focus on practice work with clients and clinical supervision.

That changed, however, when Lawson took a few classes at the College of William & Mary to

Lawson speaks at ACA’s 2017 Annual Conference & Expo in San Francisco (Photo by Paul Sakuma Photography).

work toward counselor licensure after earning his master’s degree at Longwood College. He was given an opportunity to teach as part of an internship at William & Mary, and Lawson says he “fell in love with it.”

Now, after 15 years as a professor at Virginia Tech, Lawson says one of the things he most enjoys about the job is seeing students grow and find their own voice as counselors. In turn, he says, his students have taught him that there is no one “right” way to be a good counselor.

“They [students] come in wanting to rescue people, wanting to be the one that rides in and saves the day. That’s not really what we do as counselors. We walk along with people, but we don’t ride in and rescue them. That’s one of the things I enjoy watching — how they learn where their strengths are and to walk that path with their clients,” Lawson says. “One of the things that usually happens — for all of us — is that what they think of as their vulnerabilities turn out to be their strengths. That’s always fun to watch, that self-exploration of finding that what’s best for them is best for their clients.

“One of the things that has been the most eye-opening for me over the years is that there is no one way to do this job well. There are all kinds of personalities, backgrounds and belief systems that come into this profession, and they can all become stellar counselors. There are lots of different ways that you can be really good at this. Once you see [students] find their voice, whatever that voice sounds like, that’s when they hit a new gear, and the growth that comes with that is a lot of fun to watch.”

 

Paying it forward

Virginia Tech — as well as Lawson’s tenure there — is inextricably connected to the tragedy of April 16, 2007, when a student killed 32 of his peers and professors in a mass shooting on campus before killing himself. The incident stood as America’s most fatal shooting by a single individual until the Pulse nightclub shooting in Orlando, Florida, in June 2016.

Lawson, then an assistant professor at Virginia Tech, remembers getting involved in response efforts the day of the shooting, as soon as the campuswide lockdown was lifted. At first, he counseled faculty and staff members who needed someone to talk to. In the week that followed, he worked with victims’ families, offering everything from psychological first aid to assistance with the logistics of making funeral arrangements.

Lawson then helped coordinate the campus’ mental health response. When classes resumed at Virginia Tech, there were 600 counselors on campus, he remembers. For three years after the tragedy, Lawson taught half time; the other half of his duties were devoted to recovery efforts on campus. This included facilitating wellness activities for students and workshops for faculty members on how to handle sensitive questions and discussions in the classroom.

“What do you do when your students want to talk about the shooting in class? For counseling faculty, we wouldn’t think twice about that. But for [faculty members] in the engineering program, it might not be second nature for them,” Lawson says. “We talked about reflective listening and other skills, and also how to take care of themselves. In the immediate aftermath, a lot of it was about normalizing what people are experiencing — the fact that they can’t stop thinking about it or have trouble sleeping. That’s normal.”

Lawson remains instrumental in organizing remembrance events — and ensuring that counselors are available — on each anniversary of the shooting. He also helped Virginia Tech develop and initiate a disaster mental health plan, which the campus didn’t have prior to the 2007 tragedy.

Thinking back on the past 10 years and the various ways he has tried to help the Virginia Tech community recover from the tragedy, Lawson puts it simply: There have been opportunities for him to share skills that he is good at — counseling and helping people — and he knew he should take those opportunities.

“Virginia Tech’s motto is ‘that I may serve,’ and that has always been how I approach this work, whether that’s the client who is sitting in front of me, or the community that I’m living in or the university that I work for,” Lawson says. “That’s an important part of how I’ve made sense of this.

“Virginia Tech was so well-supported by the counseling world, and the world more broadly, following the shooting, that I feel like I have an obligation to pay that forward. If there are ways that the skills that I have, the things that I have to offer, are helpful or meaningful, I want to be sure that there are opportunities for me to provide that. That’s a small way to repay the way we were supported. We’ve felt love from every corner of the world. If there are ways that I can help to pay that forward, I think that’s part of the responsibility as well.”

There is no doubt that the tragedy — and Lawson’s ongoing role in the university’s response to it — changed the trajectory of his career and his personal perspective.

“The reality is that if something like that can happen at Virginia Tech, something like that can happen anywhere,” Lawson says. “You have two choices: You can either be paralyzed with fear, or you can realize that you need to live your life. You need to be willing to do the things you want to do, the things that are important to you, and not get drawn in to things that are less important. Make sure you’re using the time that you have wisely and taking advantage of opportunities around you.”

 

In good hands

The many titles and accolades on Lawson’s résumé would suggest that he is a gifted leader, practitioner, educator, counselor supervisor and conference speaker. But those who know Lawson well speak of other attributes: his sense of humility, his approachability, his authenticity.

Bryan Carr, the coordinator for school counseling in the Chesterfield County Public Schools system in Virginia, calls Lawson “a leader by consensus and collaboration.”

Lawson and his wife, Jennifer, at the Mauna Kea Observatory on the Big Island of Hawaii following ACA’s 2014 conference in Honolulu (Courtesy photo).

“The organization [ACA] is in good hands,” says Carr, who worked with Lawson on the boards of the Virginia Counselors Association (VCA) and the VCA Foundation. “He is a good listener. He is not one who needs to be heard. But when he speaks, people listen. … He’s approachable and sincerely out to better whatever group or organization he’s a part of. He’s always able and willing to assist. He sacrifices more of his time and energy than most people will, with a sense of compulsion toward making things better along the way.”

“In stressful situations, he’s able to put things into perspective pretty quickly,” Carr adds. “He’s able to disarm a situation and help with problem-solving.”

Carr worked closely with Lawson roughly five years ago, after Carr’s school district experienced a series of student suicides. The district invited Lawson to help with response efforts. He put in more than a year of intense work, both at the local and state levels, all pro bono, Carr says. Part of the work included creating and rolling out a training model for faculty and staff districtwide to recognize and report the signs of suicide risk.

“We did a lot of soul-searching on how to best approach [the situation],” Carr remembers. “Having his wise counsel and his ability to listen brought perspective to a complex issue. He helped us figure out what we needed. … He was not coming to the table saying, ‘look at what we’ve done’ [related to trauma response at Virginia Tech], but he was an honest broker at the table.”

“[Lawson] is very approachable and compassionate about what he does,” Carr continues. “He has terrific reasoning skills. … It’s easy to talk about an issue and all the complexities about it. He has a real gift to be able to cut to the chase and figure out what options exist and the best option [to choose].”

Hill notes that although Lawson has a relational, approachable style, he “doesn’t hesitate to be bold” if the circumstances call for it. He doesn’t back away from advocating for or taking a stance on issues he feels strongly about, even if his opinion may be unpopular, she says.

“He’s very good at articulating things that are hard but need to be said,” agrees Corrine Sackett, a former student of Lawson’s who is now an assistant professor and coordinator of the clinical mental health counseling program at Clemson University in South Carolina.

Hill and Sackett both cite examples from a few years ago, when Lawson waded into heated conversations that counselors were having surrounding the profession’s shift toward eventually requiring graduation from a counseling program accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) as a pathway to future counselor licensure.

Counselors were debating the issue on the Counselor Education and Supervision Network (CESNET) listserv, and Lawson chose to actively participate in the discussions and share his opinions, even though he was a candidate for ACA president and there was a risk that people would disagree with his views.

“He was very vocal but respectful and laid out his argument clearly,” says Sackett, a licensed marriage and family therapist. Lawson also listened to other posters’ perspectives and tried to see all sides of the issue, she adds.

During the same period, Lawson urged the ACES Executive Board to take a stand on the issue rather than dancing around the controversy, according to Hill. “I saw him really push us forward in a political context,” she says of the board discussions. “He didn’t want to marginalize people or disenfranchise programs, but he was able to look at the big picture and bring people together. I saw him be able to listen and hear other points of view but also set a threshold. He didn’t want to just talk about it on the board. [He said], ‘Let’s come out and say something — put down a vision.’ He was able to take a stand and say, ‘this is what we expect,’ and stand behind it.”

In addition to his leadership ability, Lawson has a gift for connecting with students, says Laura Welfare, an associate professor and program leader of counselor education at Virginia Tech. She has worked with Lawson for 10 years.

“Gerard frequently teaches our practicum and internship courses, and our master’s students are always eager to work with him,” says Welfare, a counselor supervisor and licensed professional counselor. “His calm, collected demeanor in the presence of anxious new counselors, and his knowledgeable responses to their varied concerns, gives them the confidence to embrace new challenges. He is an astute supervisor and helps students trust the counselor development process, during our program and beyond.

“One of Gerard’s gifts as a counselor and counselor educator is his ability to bring out the best in others. He understands individual and systemic issues and connects with others to empower them as they work toward their own goals. He has used his gifts as a counselor, supervisor, educator, consultant and researcher and will be able to bring those strengths to the multifaceted role of ACA president.”

Lawson served as Sackett’s supervisor and doctoral dissertation adviser at Virginia Tech. Counselors who encounter Lawson as a mentor, teacher and leader know that he truly cares about them and their growth, Sackett says.

“I have learned by his example. He has modeled so much for me without even trying to. It took me awhile to find my feet … as a teacher, but I always remembered how I felt cared for by him as a teacher, and that just goes so far,” says Sackett, who is going into her fifth year as a professor at Clemson. “As a student [at Virginia Tech], he and I could say things that would make things better in the long run, but they were hard to say. [He gave] feedback that I didn’t always want to hear, but it was important for my growth. I knew I could say things to him too that could make things better in the long run but were harder [to say] upfront. That’s an important quality in a leader, I think: honesty.”

 

The year ahead

Lawson says he is excited about the year ahead and envisions a presidency marked by advocacy. He has two areas on which he’d like to focus and create presidential task forces to address: 1) counselors performing outreach in their local communities and 2) trauma and disaster mental health counseling and response.

Lawson says the first task force is in response to the discord that has grabbed headlines in recent months, from political divisions to friction between law enforcement and the public. Counselors are skilled in fostering conversations and serving as mediators, but they often don’t think of becoming involved (or don’t know how to become involved) in such a capacity in their local communities, he says. Lawson wants to form a task force to create resources for counselors to become bridge builders and reduce misunderstandings on the local level.

Lawson introduces his dog, Jeff, to the ocean for the first time at Myrtle Beach, South Carolina (Courtesy photo).

“People are feeling disconnected from their neighbors [and] their communities, which results in misunderstandings and isolation,” Lawson says. “If the community wants to have a meeting, counselors are so well-positioned to [facilitate] that but maybe just don’t have the skills or comfort level for that. I’d like to create a task force and toolkit to support counselors throughout that process.”

For the second task force, Lawson will draw from his experience as a trauma responder at Virginia Tech and more than 10 years of volunteering in disaster mental health. ACA already has a solid partnership with the American Red Cross, facilitating training and counselor disaster response across the U.S. But Lawson thinks an opportunity exists for ACA to “fill in the gaps” beyond that partnership whenever traumatic incidents take place that aren’t natural disasters, such as violence or shootings.

“I’d like to position ACA so that we are one of the first things people think of [in trauma situations] and they know we’re a resource,” Lawson says. “We want counselors to be better trained and better prepared. We are all doing trauma work now. It used to be a specialty. Now it’s [everything from] bullying in the schools to interpersonal violence. We need to be prepared to help those folks, regardless of where they’re coming from.”

 

Listener-in-chief

Above all, Hill says she believes Lawson’s time at the helm of ACA will be marked by openness.

“I would encourage our members to reach out, share your perspectives and communicate if there’s an issue you want to address,” she says. “[Lawson] is the kind of leader who is very caring, and I think he’s the kind of leader that would want to hear from you. Reach out and engage.”

 

 

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Meet Gerard Lawson

Certifications and licenses: Licensed professional counselor, certified substance abuse counselor, national certified counselor, approved clinical supervisor, certified trauma professional

Degrees: Ph.D., counselor education and supervision, College of William & Mary; master’s degree in education, community and college counseling, Longwood College; bachelor’s in family and child development (family studies), Virginia Tech

Past leadership positions: Has served as the president of the Virginia Counselors Association, the Association for Counselor Education and Supervision, the Southern Association for Counselor Education and Supervision, and the Virginia Association for Counselor Education and Supervision; co-founder of ACA’s Wellness Interest Network

What you may not know: He loves to kayak and spend time outdoors with his dog, Jeff. He is a big fan of Buffy the Vampire Slayer and the Detroit Tigers. His wife of 23 years, Jennifer, is a professional flutist with the Richmond Symphony.

 

 

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

 

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Salutogenesis: Using clients’ strengths in the treatment of trauma

By Debra G. Hyatt-Burkhart and Eric W. Owens April 25, 2016

Mark was 16 when he found himself in a youth detention facility again. The reasons for his incarceration aren’t necessarily important; he had committed plenty of crimes in his life. His past actions came as no surprise. His father had been incarcerated for the entirety of Mark’s life. His mother was addicted to methamphetamines and often prostituted herself to pay for her addiction. Mark had been physically, emotionally and sexually abused throughout his life. He had also watched as his cousin was shot and killed.

Branding-Images_SalutogenesisMark had been in and out of the Child Protective Services system since the age of 2 and the criminal justice system since he was 12. Mark was often defiant and oppositional when he was in placement or incarcerated. Yet again, Mark’s counselor was asking him why he kept fighting with staff and losing privileges. In a defiant, yet blunt, sad and hopeless way, Mark responded, “There’s nothing anyone can do to me in here that can hurt any worse than what people have done to me out there. They’ve got nothing on me.”

It’s easy to assume the worst from that statement. We can look at Mark’s history of trauma and conclude that he will likely never break the cycle. It’s also easy to assume that “out there” means society and “in here” means prison.

But what if we reframe Mark’s words? What if we step away from our assumptions about trauma and its effects and instead view Mark’s past as a gift of sorts? If Mark points to his chest when he says “there’s nothing anyone can do to me in here …” does this dramatically change our understanding? “In here” can just as easily mean within Mark as outside of him. After surviving everything that had happened to him out there, Mark could certainly survive in here too. Perhaps Mark could find strength from his past and learn from it.

The concept of posttraumatic growth is an important one. If we assume from what Mark said that his path is predetermined, then we are not very well-equipped to help him foster change. From the counselor’s perspective, if the belief is that Mark continually engages in self-defeating behaviors and doesn’t think things can ever change, all we see is resistance to the counseling process. We don’t see the attempts at self-preservation and the potential that Mark has; we see a defiant, angry, wounded young man who doesn’t want his life to be different. But if we look at Mark’s words and behaviors through a different lens, maybe we can help Mark see himself through that lens as well.

Pathology of the profession

Treating trauma has become an increasingly important aspect of the counseling field. Clinicians can quickly point to the symptomology in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and assign a diagnosis of acute stress disorder, posttraumatic stress disorder (PTSD) or reactive attachment disorder. Ongoing research has helped us to make major strides in explaining how the body reacts to trauma and how brain function changes after the experience of a traumatic event. Gone are the days of referring to someone as “shellshocked.”

Now we also recognize that trauma isn’t necessarily the result of a one-time, catastrophic event. Instead, trauma can be cumulative, and mental health professionals have even established labels such as Type I and Type II trauma to help clarify the distinction between catastrophic and ongoing exposures.

However, in a race to count symptoms and assign diagnoses, we may forget that trauma is best defined by the client’s experience. That is, if the client believes that he or she has experienced a traumatic event, then the reality is that the client has experienced a traumatic event.

A larger question may be, what has all of the attention on trauma done to the counseling profession? Rooted in a wellness model that focuses on holism, the profession of counseling attempts to set itself apart from its counterparts in psychology and psychiatry. The notion of professional counseling was, and hopefully still is, to focus on a client’s strengths as a pathway to mental health. Although understanding symptoms and diagnoses is increasingly important in the world of managed care, a diagnosis born of a set of symptoms does not necessarily drive the most effective treatment strategies.

Yet the focus on client strength has become less important in our daily work. When we conduct an intake for a client who has experienced a trauma, what do we look for? It’s common practice to focus on the client’s symptoms and daily struggles, but not as common to delve into the positives the client brings to therapy. The words we use and the questions we ask send critical messages to our clients, especially those whom we are meeting for the first time.

How many pages of most intake forms are devoted to pathology as opposed to strength? When we do ask about client strengths, too often it is not so that we may later return to those strengths in our work, but rather so that we can demonstrate to someone else that we completed the brief section of the intake form that asks about them.

When a client such as Mark tells us his story, too often we immediately make conclusions about his functioning and prognosis. In an effort to avoid “retraumatizing” a client, we may intentionally sidestep important client data. Does our concern about retraumatization translate to an assumption that the client is fragile and must be handled with sympathy or even pity? It seems counterintuitive to assume that Mark is fragile after everything he has survived.

None of this discussion is to imply that trauma isn’t serious and shouldn’t be treated as such. The experiences that our clients bring to therapy are often horrific, and there is simply no other word to describe them. The wellness perspective of professional counseling is rooted in the notion that we must respect the client’s experience and should meet clients where they are. What we are suggesting here is not a “you’re fine, it’s not a big deal” approach to treating trauma. Quite the contrary, appreciating the traumatic experience of the client and empathizing are characteristics critical to successful outcomes.

However, the very forces that have shifted our professional focus toward pathology and symptomology may very well assist us when it comes to moving back to our profession’s roots. Our goal is to move away from pathology and toward solution-focused, strength-based approaches to the treatment of trauma. These approaches not only benefit our clients by respecting autonomy and resilience, but they also benefit our profession by keeping us true to our historic roots.

Salutogenesis

As we attempt to reconcile the horrors of trauma with a model based in wellness, strength and holism, we are brought to the work of medical sociologist Aaron Antonovsky. Antonovsky defined health as more than a dichotomy of sick versus well. Instead, he argued that physical health exists on a continuum, and that wellness is more than simply the absence of illness or disease.

Antonovsky sought to discover why people who are exposed to the same stressors may have very different outcomes related to physical health. Although stress is ubiquitous, Antonovsky noticed that disease is not, and he sought answers as to why that is. In the process, Antonovsky developed the term salutogenesis, which comes from the Latin salus, meaning health, and the Greek genesis, meaning origin.

If salutogenesis is the origin of health, what does this term mean for professional counselors? Simply put, as counselors, it is important for us to examine what it means to be mentally and emotionally healthy. It means that mental health is not merely the absence of mental illness, as defined by the deficient symptomology described in the DSM-5, or, worse, being defined as subsymptomatic due to having an inadequate number or severity of symptoms. Instead, salutogenesis in counseling suggests that mental health exists on a continuum between asymptomatic and diagnosable mental illness. Salutogenesis suggests that mental health is more than simply lacking a diagnosis. Instead, mental health incorporates a holistic vision of the self. It is, in fact, the essence of the counseling profession.

Furthermore, salutogenesis captures the notion that many people may be exposed to the same stressor yet experience different outcomes. Again, stress is ubiquitous, but mental illness is not. Three passengers may be riding in a car that is involved in a severe accident. All three passengers experience the same accident and may have similar physical injuries yet still experience vastly different psychological results. One passenger may experience acute PTSD, whereas another might simply have a nervous reaction when hearing the squeal of tires. The third may become a race car driver without so much as a second thought concerning the accident.

Salutogenesis examines the factors that individuals possess that help them overcome stressors such as traumatic exposures. Furthermore, salutogenesis examines why one person may define an experience as traumatic while another person does not. In this, Antonovsky’s work intersects with that of Urie Bronfenbrenner, who discussed risk and protective factors. Risk factors are those that may disrupt one’s developmental processes; protective factors are those that mitigate risks.

Bronfenbrenner described human development as a process inexorably tied to the influences of the systems in which a person functions. He described far-reaching influences, such as world politics and societal norms, and influences that are close to home, such as family dynamics and peer relationships. Because every person has a different set of systems, every person experiences the interaction between himself or herself and his or her environment in a different way. It is these differences that create our individual perceptions of events and our unique sets of risk and protective factors. As counselor clinicians, the questions become how we can use these unique experiences and characteristics to promote wellness, and how we can help our clients return to wellness should they experience a traumatic event.

A shift toward strength and growth

Antonovsky examined wellness through the notion of “sense of coherence,” which is a construct that helps us connect mental wellness to systemic influences, risk and protective factors, and individuals’ perceptions. Sense of coherence is really about meaning making. It is about the degree to which people believe they have what it takes to understand the world around them (comprehensibility) and possess the resources and skills to meet the challenges of that world (manageability), and that these challenges are worthy of the efforts to surmount them (meaning). When these three factors align from a position of strength, mental wellness is likely.

Let’s return to our example of the three individuals in the car accident. Each person experienced this event in his or her own way, and each made sense of it in a unique manner. Perhaps the person with acute PTSD was unable to manage the stress presented by his injuries or the emotionality of the accident. Maybe another passenger ruminated on concerns that such an accident could happen again and worried that she wouldn’t be able to handle it happening again.

There are no clear answers, but what is evident is that the passengers who experienced ongoing stress reactions were not able to make sense of the event or find the resources within to meet the significant challenges of the experience. These passengers experienced a diminished sense of coherence. But one of the great things about human beings is that we are continually experiencing growth and change. The circumstance of a lack of diminished sense of coherence isn’t necessarily permanent.

As we look at our work with people who have experienced trauma, like the people in the car accident, we can use a focus on sense of coherence to promote a return to wellness. Helping clients gain an understanding of their experiences and assisting them in finding their inherent strengths shifts our work as counselors into a salutogenic approach. We can validate the trauma while putting the experience in a context that allows clients to see their own potential. We can nudge them toward creating an inner narrative that places them in a position of strength and power over their experience. We can focus on changing the “why me?” to “why not me?” We can help clients look at the protective factors and unique strengths they possess that have helped them survive thus far. Because on whatever level, if they are in your office, they have been surviving. When clients can find those strengths, we can help them move beyond surviving to thriving.

Humans are resilient by nature. When we look at the statistics regarding how many of us will experience a traumatic event, the numbers are pretty grim. Using a broad definition of trauma — one that validates that trauma is in the eye of the beholder — nearly all of us are likely to have some traumatic exposure. Yet those who suffer from acute stress reactions as a result of such exposure are generally believed to be less than 20 percent. In other words, recovery and resilience are normative. In fact, a growing body of work is focused on the experience of growth after and as a result of traumatic experiences.

In their work, Richard Tedeschi and Lawrence Calhoun have been exploring the ways in which people grow from negative experiences. We are all likely familiar with someone who has grown from a negative event. Maybe a loved one survived a potentially terminal illness that created in them a mentality of “life is short; carpe diem!” Perhaps an accident promoted awareness that life is fragile and that the most important things are relationships with loved ones.

Tedeschi and Calhoun identified five domains in which such posttraumatic growth is likely to occur:

1) Changes in the perception of the importance of relationships

2) Increases in spirituality

3) An increased sense of self and personal strength

4) A broadening of the sense of possibilities for one’s life

5) Increased appreciation for life

As we look at meaning making, sense of coherence and systemic interactions, it makes sense that these areas would emerge. If we can approach our clients from a salutogenic perspective, we may even be able to promote such growth.

Putting it into practice

So, what does all of this look like when we are working with clients? Again, this should not be confused with a Pollyanna view that everything is great. It is not a dismissal of the negative symptomology or the suffering that a client may be experiencing. Instead it is the process of leaning in to find the client’s strengths that are present even in the midst of despair.

The thing is, clients may not have the slightest inkling that they have any strength left. They may believe that this experience has taken everything from them. It is our job as counselors to find even the tiniest spark of ability and fan that flame until it burns bright enough for them to see it. We explore from a strength-based approach. We ask strength-based questions such as “What was working before? What is going well? What resources do you have? What if a miracle happened? What gives you meaning?” Clients may not have answers in that moment, but we can help them to find answers.

We personally love the question, “What do you ‘groove’ on?” We ask clients what is present in their lives that makes them smile, gives them a lift and helps them find peace, even if those things come in the smallest of measures. We can use that information to connect clients to other strengths upon which they can build, much like stacking blocks. We can promote a feeling in our clients that they are the experts on themselves, and they can help us to promote their positive change. We can empower our clients to believe that they are capable of coping. We can help them draw on both their inner reserves and the external resources that they might be having difficulty accessing.

We aren’t suggesting that a salutogenic approach is easy, nor is it a panacea for all people in all circumstances. As professionals, we know that we must meet our clients where they are. Validation of a client’s experience and careful interventions are always important. Some clients may have a hard time identifying any strengths. They may be so wounded that it would make such an approach a hard sell. What we must do as clinicians is be patient, empathize and continue to provide strength-focused reframes whenever possible. This dance requires sensitivity on the part of practitioners. With a focus on clients’ current needs and an eye toward positive coping, we can help our clients to move forward in their journeys.

We would be remiss if we didn’t discuss the fact that we share the journeys of our clients in very real ways. Any clinician who has worked with these issues has been warned of the dangers of vicarious trauma — the potential that, as clinicians, we can experience disturbance as a result of just listening to the experiences of our clients. The result of such exposure can be as mild as thinking too much about a client or as severe as full-blown PTSD symptoms.

But there is an upside. If we can be disturbed by our clients’ disturbance, then we can also grow from watching our clients grow. Vicarious posttraumatic growth is a burgeoning area of study that suggests we can experience the same kind of fundamental shifts in positive thinking that our clients may undergo just by watching them do it. What a great side effect of a salutogenic approach to our work.

It seems that every day there are terrible, traumatic things reported in the news. There are mass shootings, natural disasters, horrific accidents and incidents of community violence. It seems that each day creates a new Mark. If we were to focus on the pathology of Mark’s experience and the bad in the world, he — and we — may never choose to venture out again.

Mark didn’t choose that path, however. He eventually chose to be a phoenix. He decided to rise up from the ashes of his own experience. It wasn’t an easy process. A great deal of emotional pain was involved. He had to let go of a significant amount of anger and blame. He had to come to understand that all of his experiences, all of his suffering, all of his trauma, did not define him. Mark came to know that all of those things made him tough. They made him compassionate toward others. They made him a survivor who had the skills to fly as high as he wanted to go. Mark chose flight. Watching him fly was beautiful.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Debra G. Hyatt-Burkhart is an assistant professor in the counselor education program at Duquesne University in Pittsburgh. With more than 25 years as a practicing clinician, her work focuses on positive approaches to clinical supervision and treating trauma. Contact her at hyattburkhartd@duq.edu.

Eric W. Owens is an assistant professor and graduate program coordinator at West Chester University of Pennsylvania. He has worked in higher education, K-12 and clinical settings for 20 years. His work focuses on strength-based approaches to trauma treatment and crisis intervention. Contact him at eowens@wcupa.edu.

Letters to the editor: ct@counseling.org

The transformative power of trauma

Jonathan Rollins February 1, 2012

Since 9/11 and the United States’ subsequent wars in Afghanistan and Iraq, many Americans have grown all too familiar with the term posttraumatic stress disorder (PTSD), which was first popularly applied to veterans of the Vietnam War in the 1970s. Today the term shows up regularly in headlines and in magazine articles, in TV news accounts and on websites. Although some mental health professionals protest that posttraumatic stress is not a “disorder” but rather a normal reaction to extraordinary and disturbing events, the term is widely understood to convey that a person’s ability to cope and function has been significantly impaired.

Another trauma-related term developed in the ’90s is much less familiar to the general public and perhaps even to counselors. But given counselors’ focus on wellness and growth, both Lea Flowers and Gerard Lawson believe this term — posttraumatic growth — should be on the tips of their colleagues’ tongues in the counseling profession.

As defined by Richard Tedeschi and Lawrence Calhoun, psychology professors at the University of North Carolina Charlotte who pioneered the development of research and theory concerning posttraumatic growth (PTG) in the ’90s, PTG is a “positive psychological change experienced as the result of the struggle with highly challenging life circumstances.” To meet the criteria for PTG, the transformation the person goes through must be a by-product of the traumatic experience itself. PTG is not simply a “return to baseline functioning,” which more accurately characterizes resilience.

Lawson, president of the Association for Counselor Education and Supervision, a division of the American Counseling Association, says a general awareness of “adversive growth” spans back to World War I, “but the language was always pretty loose, and the research was not there.” He credits Tedeschi and Calhoun with giving form to the concept of PTG but acknowledges that it has taken some time for the concept to catch on, especially in the face of much greater publicity concerning PTSD.

“We need to focus on the client’s growth and not just the disorder as it relates to trauma,” says Lawson, who chairs the ACA Crisis Response Planning Task Force. “This is right in our wheelhouse as counselors. What are the strengths that this person continues to demonstrate despite [his or her] traumatic experience? We need to be deliberate about highlighting those for our clients.”

Flowers, a licensed professional counselor and ACA member who co-directs the Post-Traumatic Growth Research Team at Georgia State University, agrees. “As counselors, we are positioned to really make this concept come alive,” she says. “Posttraumatic growth really fits with our wellness and growth-oriented perspective. [With PTG] you’re not trying to figure out what’s sick and what’s not working but rather how the person coped and was transformed because of [the traumatic event]. It’s less about identifying symptoms and deficits and more about using the process as a root for growth. We will find that this is where counselors can come alive because we’re facilitators of hope and change. We’re trained to do this. That’s not what our cousins in social work and psychology necessarily do.”

Personal experience

Both Flowers and Lawson are strong advocates for counselors applying PTG principles in their trauma work with clients. This is due in large part, they acknowledge, to their personal connections to two of the most traumatic events in recent U.S. history — the devastation wrought by Hurricane Katrina in 2005 and the mass shootings by a student on the campus of Virginia Tech in 2007.

Lawson, an associate professor of counselor education at Virginia Tech, was among the key players on what came to be known as the Mental Health Advisory Group, a collaborative panel that met the day after the mass shootings to develop a strategy for providing mental health support to the entire Virginia Tech community. In the near-term aftermath of the shootings, Lawson recalls, “there was lots of exposure to PTSD, and the focus” — both in the media and within the university community — “was very much on that. But as the situation evolved some, our counseling program decided that we had to advocate for a focus on resilience and posttraumatic growth. We started asking, ‘How do we tell how our campus is doing?’ If you focus on the negative, you’re going to see the negative.”

While Lawson witnessed and helped facilitate PTG on the Virginia Tech campus, Flowers had an even more personal brush with PTG. She was in the final stages of securing her doctorate at the University of New Orleans (UNO) when Hurricane Katrina bore down on the city. Like thousands of others, she was forced to evacuate. Tuning in to coverage of the natural disaster on CNN, she was astonished to see police officers and Coast Guard personnel in a boat, cruising down the street where her home was located.

Flowers stayed with family members and lived in hotels while completing her doctorate at UNO. “I remember defending my dissertation and gutting my house in the same day,” she says. “I lost everything I owned. I lost my whole city. Everything I had was gone except for my dissertation. … What I was experiencing, what my community was experiencing, what my family was experiencing was PTSD.

“But when I started talking to people, I noticed their strength. There was a shift in our life perspective. It was a collective experience. Up until that date [when Hurricane Katrina struck], my datebook had really mattered to me. After Katrina, I was just focused on the present moment. That was a huge transformation for me.”

Flowers recalled that most of the trauma studies and training she had been exposed to previously had been focused from a crisis perspective. Recognizing that she and others she knew had been transformed in positive ways in the wake of a traumatic event, Flowers began searching for an alternative perspective and uncovered information on PTG. “I didn’t find that counselors were gravitating to trauma work, so I was excited when I discovered there was a place in trauma where I could be comfortable. Posttraumatic growth resonated with my training and who I was as a counselor. It still speaks to me today, both as a person and a professional.”

A former assistant professor at Georgia State and clinical supervisor of counselors-in-training, Flowers now owns Chrysalis Counseling and Consulting, a private practice through which she offers consulting services to organizations and professionals and provides growth-oriented counseling services for women. The mission of the practice is explained on its website: “To help facilitate a transformative process for our clients building upon her inner strengths and resilience.”

Domains of change

It is important for counselors to understand the distinction between resilience and PTG, Flowers says. While resilience implies a resistance to the negative impact of trauma, PTG implies a significant and positive change in the person. Another way to put it: “Resilience is how we get through the trauma using our coping skills,” Flowers says. “Posttraumatic growth is how we are transformed because of the trauma.”

She uses the organization Mothers Against Drunk Driving (MADD) and the TV show America’s Most Wanted as recognizable examples of PTG in action. In both instances, parents who experienced the loss of children to tragic and disturbing circumstances were transformed by the experience and took action to create positive change as a result.

Flowers also points to Steve Jobs, the visionary co-founder, chair and CEO of Apple Inc., who in a commencement address at Stanford University in 2005 described getting fired in a public and humiliating way at age 30 from the very company he had helped to build from the ground up.

“I didn’t see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me,” Jobs told the audience. “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

“During the next five years, I started a company named NeXT, another company named Pixar and fell in love with an amazing woman who would become my wife. Pixar went on to create the world’s first computer-animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple’s current renaissance. … I’m pretty sure none of this would have happened if I hadn’t been fired from Apple. It was awful tasting medicine, but I guess the patient needed it.”

“When I read this,” Flowers says, “I thought, ‘This is PTG. This is PTG in a big way.”

At the same time, Flowers cautions that all individuals who experience major life crisis will not necessarily experience PTG, and if they do, it may not show itself in a grand public manner. “Transformation is personal,” she says. “Everyone will not do something with large public impact as a result of posttraumatic growth.” What is important, she adds, is that the transformation is personally meaningful and recognizable to the client, which is where counselors can be of great assistance.

In their research, Tedeschi and Calhoun identified five domains in which positive changes take place in the PTG process:

  • Greater appreciation of life and a changed sense of priorities. This suggests that clients have faced their mortality and no longer take life for granted, Lawson says. Flowers adds that this domain represents a change in philosophy concerning what really matters in life.
  • Greater sense of personal strength. In this domain, clients have discovered they are able to overcome challenges they might not have thought possible before, Lawson says. At heart, Flowers says, this represents a change in perception of self — “If I could get through this, I can get through anything.”
  • Warmer, more intimate relationships with others. This most often manifests itself as an ability to relate to others in a deeper, more meaningful way, Lawson says. Flowers says PTG in this area might also lead to reconciling relationships with others or bonding with another individual or group because of a shared experience.
  • Recognition of new possibilities or paths for one’s life. “They begin to see life with a broader view, perhaps because they learned something about themselves through the traumatic experience,” Lawson says.
  • Spiritual development. Both Lawson and Flowers point out that this domain is not necessarily about an increase in religious behavior, such as attending religious services more frequently, but rather feeling a stronger connection to God or another spiritual power. In many instances, this spiritual development helps those who have gone through a traumatic event to make meaning of the experience or to make meaning in other areas of their life where it had been absent previously.

Windows of opportunity

The possibility that client growth can potentially be cultivated out of a traumatic experience will be a revelation to some counselors. But Lawson says the fresh thinking shouldn’t stop there. “Counselors really need to expand the way they think about traumatic events in general,” he says.

This includes having an understanding that trauma isn’t limited to large-scale natural disasters, terrorist attacks and other instances of mass violence, or war-related experiences. According to the current version of the Diagnostic and Statistical Manual of Mental Disorders, an event can be considered potentially traumatic if 1) “The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” or 2) “The person’s response involved intense fear, helplessness or horror.”

More than 80 percent of people will be exposed to a traumatic event in their lifetime, Lawson says, and most of these events, such as instances of bullying or domestic violence, will never make the news. “The work we do these days as counselors puts us in direct contact more often than we may recognize with clients who have been traumatized,” Lawson says. “Given the numbers of people exposed to trauma, we need to not focus solely on the negative side of the trauma equation.”

In trying to implement the PTG concept in their work with clients, counselors should keep several important points in mind.

First, says Flowers, PTG is not an intervention but rather a way of conceptualizing the client and the treatment plan. “Posttraumatic growth is more of a perspective or a process that you integrate into whatever approach you are using with the client,” she says, adding that it weaves particularly well into existential, narrative and cognitive-based interventions.

Second, PTG is not a given with every client. “Just because there has been a traumatic experience does not mean there will be a growth experience,” Flowers says, “or that there will be a growth experience soon.”

Lawson adds that clients who were closer to healthy functioning before exposure to a traumatic event generally are also better positioned to experience PTG than clients who were already struggling to function before the trauma. This also aligns with the literature regarding which individuals are more susceptible to experiencing PTSD, he says.

Third, PTG should never be forced on or demanded of the client. “In embracing posttraumatic growth in our work, we have to be careful that we don’t come off as Pollyanna when the person just lost their house,” Lawson says. “We have to be sure that we are patient with the process of grieving and allowing clients to work through issues that are completely normal after a traumatic event. We don’t want to rush them to look better, feel better, function better. But at the same time, through the normal course of conversation, we want to highlight ways that the client may be moving [through the five domains of change]. We begin talking about it with the client in terms of, ‘And where will this take you?’”

Although there is no prescribed timetable dictating exactly when to incorporate the PTG concept into treatment with traumatized clients, Lawson says the “immediate noise from the trauma begins to calm down” three to six months after the event. “In that window especially, we begin to look at opportunities for growth,” he says. “We don’t want to be there immediately [after the traumatic event] to pounce on them, but we want to be able to be there to offer support when they need support and before their trauma membrane fills back over. It’s much harder to go back in after the fact.”

“Posttraumatic growth is not something to consider when clients are in crisis,” Flowers adds. “Growth is further down the line for these clients because we first have to help manage the initial crisis, then after things have stabilized, help facilitate them through a more reflective process. … Timing is a huge part of [the PTG process]. Counselors may have terminated their work with these clients when growth finally happens. We may just be there to plant seeds. Likewise, the client’s transformation might be very incremental instead of dramatic.” She also points out that distress from the trauma might continue even as growth is happening, meaning the two are not mutually exclusive.

The role of the counselor

No special training is needed to integrate the PTG process into counseling work, Lawson says, but a certain skill set is required to support PTG properly. “Counselors need to be comfortable doing posttraumatic work and tuned in to the factors for posttraumatic growth,” he says. “You also have to be willing to sit with clients’ grief and loss and capable of identifying their strengths. Then you need to encourage them to answer some questions: How are you going to be able to see the world in a broader way? Where are we going to focus our energy? What are we going to pay attention to?”

Flowers says counselors have been provided with all the basic tools they need in their training programs to integrate PTG into their work, but she suggests looking at growth-oriented models and frameworks to grow more comfortable with the PTG process. “Posttraumatic growth will change your clinical mindset,” she asserts.

According to Flowers, the main role of the counselor is to be a facilitator in the PTG process (rather than trying to be the “creator” of growth), to serve as a companion to the “expert” (the client) and to help the client engage in meaning-making concerning what has happened to him or her.

Using a narrative approach with clients works particularly well in identifying and cultivating PTG, Flowers says, although she adds that counselors must exude patience, empathy and a willingness to meet clients where they are at that moment. “You listen to how they story their experience and stay alert to changes in perception they have had since experiencing the trauma,” she explains. “You want to help them restory their narrative from traumatic and distressing to positive and growth-inducing, but you first have to respect the trauma survivor’s struggle. You may listen to their story and assess that they’re not yet ready to restory their experience. But keep in mind that you’re not the expert — they are. You’re coming along as the expert’s companion. You don’t want to lead the client. That can be almost as damaging as the trauma itself because it can sound like you’re diminishing what happened to them.”

Flowers breaks the narrative approach incorporating a PTG focus into simple-to-understand steps: Listen to the client’s story, reflect the story back to the client using his or her own language and then highlight for the client how he or she has emerged from the traumatic experience and been transformed in a positive way.

“You’re using very basic counseling skills in this process but helping to facilitate hope,” Flowers says. “Our job is to help clients see those areas of transformation when they’re ready and to help them make meaning of whatever is left. We’re trying to move them from a feeling of hopelessness to a feeling of hopefulness.”

Both Flowers and Lawson view PTG as an exciting and beneficial yet relatively undeveloped frontier in trauma work — a frontier that would seem particularly inviting for counselors to explore and, potentially, to break new ground in.

“Right now,” Flowers comments, “there is nothing that says, ‘These are the proper techniques you use for posttraumatic growth.’ I believe counselors are best positioned to perhaps identify or even develop those techniques.”

Lawson concurs. “This philosophy is so consistent with our approach as counselors that the natural next step is for counselors to take the lead in how clients can maximize posttraumatic growth. We need to be the ones to answer the unanswered questions about posttraumatic growth.”

 

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For more information about PTG, contact Gerard Lawson at glawson@vt.edu and Lea Flowers at drleaflowers@gmail.com.

Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.