(p. 72) Session Ten: Posttraumatic Growth
session ten invites you to explore your deep feelings and thoughts about a traumatic experience that continues to bother you. The central positive psychotherapy practice covered in this session is Expressive Writing.
Three Things to Know about Posttraumatic Growth (PTG)
1. What is PTG? Following trauma, some individuals develop posttraumatic stress disorder, a serious condition requiring serious treatment. However, following trauma, many individuals also experience growth, generally known as PTG. Psychotherapy traditionally focuses on trauma and its short- and long-term impact, and this focus is essential because anyone who goes through trauma benefits from support in a safe, confidential, empathic, and caring milieu. Exploring the possibility of growth from trauma—at an appropriate time, without minimizing the pain—is a way that an individual can be helped to deal with the trauma.
2. Benefits of PTG: PTG often accompanies a change of insight into the meaning of life and the importance of relationships. This growth can mitigate negative feelings that are part and parcel of trauma. For example, trauma often leaves us with a strong feeling of loss of control. Knowing that you have lost control in one aspect of life but have grown in another area can lessen the pain of loss of control. Evidence (Jayawickreme & Blackie, 2014; Roepke, 2015) shows that people who experience PTG develop a renewed belief that they can endure and withstand challenges; explore, appreciate, and further cement relationships that stand the test of time; foster a deeper sense of empathy for other people who go through similar kinds of challenges; and develop a deeper, sophisticated, nuanced sense of meaning and purpose in life.
3. PTG is not simple and straightforward: As desirable as it sounds, PTG is not a simple and straightforward consequence. You have probably heard the axiom that time will heal. PTG is not something time will produce; rather, PTG is what you do within that time. PTG does not imply that one can and will withstand all future challenges adaptively. One can still be vulnerable, especially in areas associated with trauma. For example, one can survive cancer and can become resilient in many areas but can still be overwhelmed by relatively minor health problems.
At the start of the session, your clinician may begin with a brief relaxation exercise. To discover some of these practices on your own, go to Appendix A: Relaxation & Mindfulness Practices, which can be found at the end of this workbook.
In-Session Practice: Expressive Writing
Your clinician will be working with you on the in-session practices. Refer to Worksheet. (p. 73)
(p. 74) Reflect & Discuss
Reflect on and discuss the following:
• What was the most difficult part of writing? Do you agree that even though it may have been difficult, it still was worth writing?
• Some reactions to the trauma, adversity, or losses can be so strong that we deliberately avoid associated feelings. Did the writing process help you see this avoidance, if any?
• Did writing help you to visualize growth in terms of your perspective on life?
• Did you experience healing or growth, despite having the lingering pain of the trauma or loss?
• Write about some concrete actions or behaviors you have undertaken, or you plan to do, which signify PTG.
• Did the structure of the writing process help you to see the causal chain of the traumatic experience differently? If so, what different causal links did you discover?
• Do you see your character strengths reflected in your PTG?
In Real Life: Robert Fazio, male, mid 40s, Caucasian
This is the story of Dr. Rashid’s dear friend, Rob Fazio. Rob lost his father during the September 11, 2001, terrorist attacks.
I lost my father at the World Trade Center on Tuesday, September 11th. There is not a day that goes by that I do not wish that he were here with us. The unfortunate reality is that our loved ones are somewhere else right now, and we are here. So what should we do and how can we go on? What I learned about my father after September 11th was that he was a person who reached beyond himself and made a difference in the world. He was a lifeline out of disaster, literally holding the door for others. His heroism, as well as many of other people’s loved ones, is what has inspired me, my family, and friends to try to follow Dad’s example and make a difference in people’s lives. We have already begun to hold the door for others.
When I take the time to reflect upon what allowed me to honor the feelings of losing my dad, it is evident that I strive to live my life the way he lost his. I have a deep passion to put others first, especially in turbulent times. Interestingly enough, the best way to put others first is to first focus on yourself. What I mean by this is that to help others help themselves, you need to be healthy, strong, resilient, and emotionally intelligent. You need to be able to find a way to find the positive aspects in life when it seems that there are none.
I was fortunate to be studying psychology prior to the September 11, 2001, attacks. Throughout my training, as I worked with clients, I always felt strongly about practicing what I preach. When I would work with clients and invite them to practice behaviors and skills related to their emotional intelligence and self-awareness, I would do the same. This approach would provide me with the strength, balance, and energy to manage the fallout from my father’s death as well as to maintain the pursuit of my dreams.
I remember the trip home from Richmond, Virginia, on September 12th. I wasn’t able to get home on the 11th due to the highways, air traffic, and trains being shut down in certain areas. I can recall being on the way home and feeling extreme sadness and concern related to my missing dad.
I learned two things very quickly: I was going to need to be aware of the extreme feelings associated with the trauma of 9/11 and find the strength to rally and look for my dad on the streets of New York City. Personally, I attribute my ability to manage my feelings to my counseling training. The concepts that I had been studying and helping (p. 75) others to learn proved to be a huge resource for me as I cried at night while I thought of the idea that my dad would be gone forever, along with thousands of other Americans, and I hit the streets during the day determined to find him.
After looking for my dad, when I returned to school, to my group therapy class, I struggled with one question, “Is the strength in the crying and showing I am feeling the pain, or is the strength in the not crying and showing that I am okay and will be able to grow through the experience?” Dr. Craig Anderson, Virginia Commonwealth University’s head of the group therapy program, said, “Rob, it is both.” You know what, he was exactly right. To this day I share that story with people to illustrate how important it is to understand your feelings and experience and also to take steps toward self-reliance and strength.
Rob Fazio has spearheaded “Hold the Door,” which is a non-profit organization with the aim to help people learning to grow through loss or adversity (e.g., loss of a loved one to cancer, divorce, or natural disaster). Through hands-on activities, expert speakers, and professionally designed workshops, Hold the Door programs teach participants to become more self-aware and learn practical skills to help them prepare for, live with, and grow through loss and adversity.
Tips to Maintain Your Progress
Discuss the following tips with your clinician to help you maintain your progress:
• Writing about a traumatic event can be extremely challenging. However, keeping the trauma inside—without expressing it in an adaptive manner—can be very harmful for you. Therefore, it is important that before and after the Expressive Writing practice, you remind yourself that your intent is to break the mental block, stop the cycle of thinking about the trauma, and, more importantly, explore if the trauma also brought about any positive changes in you.
• This practice is both individual and interpersonal. The therapeutic groundwork done so far, with the help of your clinician, is critical in preparing you to undertake this PTG endeavor. You will most likely use your strengths of courage, social intelligence, and self-regulation to undertake this work. However, to gain and maintain perspective, especially in interpreting its meaning and potential growth, you will greatly benefit from the continuation of therapeutic support. Confiding your feelings with your clinician, putting such feelings into words, and drawing insights about potential growth is best done in a safe, interpersonal context. We recommend that to maintain the benefits of this practice, you keep engaging in therapy for a while.
• It is also important that you do not force yourself to find growth or expect that surviving a trauma will yield major positive changes in your life. Growth from a trauma, although a more frequent phenomenon than acknowledged and recognized, may take its due time and course to manifest. Rather than searching for a discrete expression of growth, focus more on changes that might have organically occurred within you. For example, after surviving a traumatic event, most individuals report experiencing three things (Roepke, 2015):
• Renewed belief in one’s ability to endure and prevail.
• Improved relationships—in particular, discovering who one’s true friends are and on whom one can really count, and how critical one’s relationships are, compared to material goods.
• Feeling more comfortable with intimacy and feeling a greater sense of compassion for others who suffer.
Periodically reflect if these or similar changes have taken place in you.
• Hass, M. (2015). Bouncing Forward: Transforming Bad Breaks Into Breakthroughs. New York: Simon & Shuster.Find this resource:
• Joseph, S. (2013). What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth. New York: Basic Books.Find this resource:
• Tedeschi, R. G., & Moore, B. A. (2016). The Posttraumatic Growth Workbook: Coming Through Trauma Wiser, Stronger, and More Resilient. Oakland, CA: New Harbinger.Find this resource:
• See Rob Fazio’s story, described earlier in the section “In Real Life”:
• Dr. Randy Pausch’s inspirational speech: The Last Lecture:
• Team Hoy: I Can Only Imagine, the story of Dick and Rick Hoyt, one of the most inspirational father and son teams to race in an Ironman competition:
• Home page of James Pennebaker: Pioneer in processing trauma through writing:
• What doesn’t kill us:
• Mobile apps related to trauma:
• Hold the Door for Others: A 9/11-inspired non-profit organization that offers invaluable free resources for those dealing with trauma, adversity, and bereavement: