As the individual comes to recognize some goals as no longer attainable and that some components of the assumptive world can not assimilate the reality of the aftermath of the trauma, it is possible for the individual to begin to formulate new goals and to revise major components of the assumptive world in ways that acknowledge their changed life circumstances. The individual's cognitive engagement with and cognitive processing of trauma may be assisted by the disclosure of that internal process to others in socially supportive environments. At some point, trauma survivors may be able to engage in a sort of meta-cognition or reflection on their own processing of their life events, seeing themselves as having spent time making a major alteration of their understanding of themselves and their lives. This becomes part of the life narrative and includes an appreciation for new, more sophisticated ways of grappling with life events (McAdams, 1993).
Facilitating Posttraumatic Growth
The changes that trauma produces are experiential, not merely intellectual, and that is what makes them so powerful for many trauma survivors. This is the same for posttraumatic growth--there is a compelling affective or experiential flavor to it that is important for the clinician to honor. Therefore, the clinician's role is often subtle in this facilitation. The clinician must be well-attuned to the patient when the patient may be in the process of reconstructing schemas, thinking dialectically, recognizing paradox and generating a revised life narrative. What follows are some general guidelines for this process. More extensive discussion and case examples can be found in Calhoun and Tedeschi (1999).
Attention to elements of posttraumatic growth is compatible with a wide variety of approaches that are currently utilized to help people who are dealing with trauma. Initially, clinicians should address high levels of emotional distress, providing the kind of support that can help make this distress manageable (Tedeschi and Calhoun, 1995). Allowing a distressed patient to regain the ability to cognitively engage the aftermath of the trauma in a rather deliberate fashion will promote the possibility for posttraumatic growth.
Clinicians must feel comfortable and be willing to help their patients process their cognitive engagements with existential or spiritual matters and generally respect and work within the existential framework that patients have developed or are trying to rebuild in the aftermath of a trauma. Further-more, although individual patients may need additional specific interventions designed to alleviate crisis-related psychological symptoms, listening--without necessarily trying to solve--tends to allow patients to process trauma into growth (Calhoun and Tedeschi, 1999). In fact, one way of insuring that clinicians practice this sort of approach is to relate to the trauma survivor's story in a personal manner. Being changed oneself as a result of listening to the story of the trauma and its aftermath communicates the highest degree of respect for the patient and encourages them to see the value in their own experience. This acknowledged value is a short step away from posttraumatic growth.
The immediate aftermath of tragedy is a time during which clinicians must be particularly sensitive to the psychological needs of the patient. Never engage in the insensitive introduction of didactic information or trite comments about growth coming from suffering. This is not to say that systematic treatment programs designed for trauma survivors should not include growth-related components, because these may indeed be helpful (Antoni et al., 2001). A posttraumatic growth perspective can be used even in critical incident stress management (Calhoun and Tedeschi, 2000). However, even as part of a systematic intervention program, matters related to growth are best addressed after the individual has had a sufficient amount of time to adapt to the aftermath of the trauma.
Caveats About Posttraumatic Growth
In order to clarify the clinical perspective on posttraumatic growth, we offer these reminders. First, posttraumatic growth occurs in the context of suffering and significant psychological struggle, and a focus on this growth should not come at the expense of empathy for the pain and suffering of trauma survivors. For most trauma survivors, posttraumatic growth and distress will coexist, and the growth emerges from the struggle with coping, not from the trauma itself. Second, trauma is not necessary for growth. Individuals can mature and develop in meaningful ways without experiencing tragedy or trauma. Third, in no way are we suggesting that trauma is "good." We regard life crises, loss and trauma as undesirable, and our wish would be that nobody would have to experience such life events. Fourth, posttraumatic growth is neither universal nor inevitable. Although a majority of individuals experiencing a wide array of highly challenging life circumstances experience posttraumatic growth, there are also a significant number of people who experience little or no growth in their struggle with trauma. This sort of outcome is quite acceptable--we are not raising the bar on trauma survivors, so that they are to be expected to show posttraumatic growth before being considered recovered.