Exploring thriving in the context of clinical trauma theory: constructivist self development theory - Thriving: Broadening the Paradigm Beyond Illness to Health

Karen W. Saakvitne

The premise that people are capable of transmuting traumatic experience to gain wisdom, personal growth, positive personality changes, or more meaningful and productive lives has been a central theme in centuries of literature (Kingfisher, 1990; Proust, 1927/1932; Shakespeare, 1623/1963), poetry (Dickinson, 1935), and personal narratives (Mansfield, 1927). It is a theme that spans thousands of years of philosophical inquiry (Aeschylus, 1982; Nietzsche, 1990), and that has found its way into recent social commentaries (Lifton, 1993), personal accounts of the Holocaust (Deak, 1997; Todorov, 1997), self-help books (Krauss & Goldfischer, 1988), and newspaper as well as popular literature accounts of traumatic events (Fraser, 1987; Mangan, 1997). In view of two millennia of literary, philosophical, and more recently popular interest in this phenomenon, it would be absurd for social and behavioral scientists to claim the "discovery" of thriving and positive transformation following trauma. As social and behavioral investigators, we are, however, well positioned to evaluate the extent and limits of thriving, its mechanisms, how thriving unfolds over time, who might be most likely to experience such positive transformation, and whether naturally occurring positive changes offer insights for the development of therapeutic efforts. We are also best equipped to offer theoretical frameworks to guide this area of inquiry. Despite the promise of social and psychological inquiry in this area, initial attempts to scrutinize thriving systematically have taken familiar but misguided paths that in our opinion do not adequately address what is most important to our understanding of how adversity can result in positive change.

In this article we describe the limitations, ironies, and what we believe to be flawed strategies in current conceptions and investigations of thriving and crisis-related growth. Acknowledging the challenge inherent in the study of adaptation to trauma, we present a trauma theory, Constructivist Self Development Theory (CSDT; McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995), and demonstrate how this theory can explain both negative changes in the aftermath of a traumatic event and positive changes as a result of adaptation and meaning making. We suggest that CSDT addresses some of the current limitations of the literature on thriving, and conclude with implications for posttraumatic growth in psychotherapy.

The Challenge of Conceptualizing Posttraumatic Adaptation

It is extraordinarily difficult to formulate and measure the complexities of an individual's response to a traumatic event, series of events, or circumstance, at a particular time, place, and social and cultural milieu, and in developmental context. The myriad intrapsychic, behavioral, somatic, interpersonal and subjective responses create both conceptual and methodological quandaries. Further, trauma and people's responses to trauma are embedded in sociocultural contexts often with political and moral overtones. Such complexities are best addressed through the integration of social, personality, and clinical theories of human adaptation and require mindful examination of our underlying assumptions.

As social and behavioral scientists we are asked to explain the behavior of those affected by traumatic life events and to account for individual differences in response to trauma. We are also asked to help those suffering the pain of traumatic stress and loss. Both the challenges and the stakes of these tasks are great. How do we explain the range of responses to similar events, and what it is in the process of responding and adapting to and healing from trauma that leads to posttraumatic growth? How do we make sense of those who seem to thrive following a trauma and those who seem to collapse and barely survive? Traditionally, we have tried to define aspects of the individual to account for these differences (Anthony & Cohler, 1987). Occasionally, we have looked at differences in stressors, or types of traumatic events (Gelinas, 1983). Some have examined the unique interaction of the individual and her or his circumstances (Kauffman, Grunebaum, Cohler, & Gamer, 1979; Linehan, 1993; McCann & Pearlman, 1990; Rutter, 1983; Terr, 1990).

Like others in this issue, we believe that the uniqueness of an individual's response to trauma is determined by the particular meaning ascribed to the trauma, the individual's experience of self, age and developmental stage, biological and psychological resources, interpersonal experiences and expectations, and his or her social, cultural, and economic milieu. The similarities of responses across individuals reflect common values, biology, expectations, and needs that would lead to shared attributions, meaning, and adaptations.

This approach requires a theoretical framework that integrates personality and clinical theory with trauma theory. The way we frame the answers to these questions has enormous implications for survivors of trauma, for social policy, psychotherapy, and cultural beliefs. Our culture fosters denial of the long-term impact of trauma by urging victims to "get over it and get on with it", and by idealizing those who "bite the bullet," and thus does not recognize complex posttraumatic adaptations (Shay, 1994). In fact, it invites an implicit moral judgment on pain and bias toward sublimation and stoicism. Thus, we must be careful not to diminish the experience of the survivor and in effect, "blame the victim" (Ryan, 1971) for his or her own pain, and not to imply that suffering reflects lack of resiliency (Wolin & Wolin, 1993).

The Complexity of Responses to Trauma

It is widely accepted that trauma is transformative and that in the aftermath of a traumatic event nothing is again the same. We are most familiar with negative aspects of this change: grief and traumatic loss, emotional fragmentation, and psychic devastation. Yet personal narratives, clinical lore, and a growing research base (Grossman & Moore, 1995; Harvey, 1996; Tedeschi & Calhoun, 1995; Tedeschi, Park, & Calhoun, 1998; Wolin & Wolin, 1993) suggest that trauma also leads to other transformations, including the reconstruction of meaning; the renewal of faith, trust, hope, and connection; and the redefinition of self, self-in-relation, and sense of community. After trauma comes adaptation. Those who physically survive trauma begin to recover even as its full horror is still registering. In our biologically mandated struggle to survive, we adapt to seemingly impossible circumstances. Adaptation stems from our attempts to survive and to heal in the midst of our suffering. These adaptations frequently carry both benefits and costs to the individual and to society.

Our conceptual models must be able to incorporate the dialectics of posttraumatic experience and accept apparent opposites that are simultaneously true. Trauma is about devastation and resilience. The most damaged survivor may demonstrate strength that surpasses our expectations. For example, the client who has survived long-term sadistic abuse in childhood by developing dissociated identifies manifests severe psychopathology and emotional vulnerability. At the same time her or his adaptive efforts (i.e., symptoms) reflect considerable resourcefulness and self-protectiveness. It could be argued that such an individual is in some ways more resilient than others. If we measure posttraumatic growth by symptom checklists, or if we assume growth and impairment are opposites, we overlook the many individuals with severe symptoms who also have enormous strengths and who demonstrate the ability to advocate for and nurture others through their writing (DeSalvo, 1989) or through their efforts in the helping professions.

Trauma Theory

Increasingly, there has emerged the need for a theory of self that explicitly addresses the impact of trauma on self-development. An individual's response to trauma is contextualized by the dynamics of perception, cognition, and affective processing, which include the need to create meaning and construct personal narratives (Coles, 1986, 1990; Frankl, 1959; van der Kolk, 1986; van der Kolk & MacFarlane, 1996). Constructivist Self Development Theory (CSDT; McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995) is an integrative personality theory that describes the impact of a traumatic event (or traumatic context) on the development of self. By integrating constructs from psychoanalytic and social learning theories, CSDT describes personality development as the interaction between core self-capacities (related to early relationships, secure attachments, and ego resources) and constructed beliefs and schemas (related to cumulative experiences and the attribution of meaning to those experiences) that shape perception and experience. Thus it is a constructivist theory of personalty development. Because it highlights those aspects of development most likely to be affected by traumatic events, it is also a clinical trauma theory.

The theory outlines the specific components of self most affected by traumatic events. These components of self are also conceptualized as responsive to both conscious and automatic (unconscious) mechanisms of change. Using this theory, one can identify specific aspects of self that will be most affected by trauma. These same aspects are then altered and potentially strengthened as an individual heals from a traumatic event. In this way the theory provides a template for identifying both damage and growth after trauma. CSDT integrates psychoanalytic theory with constructivist thinking (Mahoney, 1981; Mahoney & Lyddon, 1988), social learning theory (Rotter, 1954), and cognitive developmental theory (Piaget, 1971) and emphasizes the influence of the individual's developmental, social, and cultural contexts. It has been developed using clinical and empirical data from a variety of survivor groups.

CSDT understands the individual's adaptation to trauma as an interaction between his or her personality and personal history and the traumatic event and its context, within the social and cultural contexts for the event and its aftermath. The underlying constructivist assumption is that individuals construct and construe their own realities (Epstein, 1985; Mahoney, 1981; Mahoney & Lyddon, 1988). The clinical implication is that the meaning of the traumatic event is in the survivor's experience of it; each individual is affected in his or her own unique way.

The theory emphasizes a developmental perspective, focusing on the individual's early development as central to her or his current way of experiencing and interacting with self and others. It also postulates that experiences of trauma are reinterpreted and reconstructed during subsequent developmental stages. CSDT views the survivor's symptoms as adaptive strategies that develop to manage feelings and thoughts that threaten the integrity and safety of the self.

Constructivist Self Development Theory and the Effects of Trauma

Within Constructivist Self Development Theory, five areas of the self are expected to be affected by traumatic events:

1. Frame of reference: one's usual way of understanding self and world, including spirituality.

2. Self-capacities: defined as the capacity to recognize, tolerate, and integrate affect and maintain a benevolent inner connection with self and others.

3. Ego resources: necessary to meet psychological needs in mature ways; specifically, abilities to be self-observing, and use cognitive and social skills to maintain relationships and protect oneself.

4. Central psychological needs: reflected in disrupted cognitive schemas in five areas: safety, trust, control, esteem, and intimacy.

5. Perceptual and memory system: including biological (neurochemical) adaptations and sensory experience.

These five areas reflect both experiential and cognitive modes of organizing experience. In response to a traumatic life event, the individual must integrate the event and its context and consequences into his or her existing beliefs about self and others. The intensity of the somatic, affective, and interpersonal components of the experience determine the availability of the event for cognitive processing. The more overwhelming or intolerable the experience given one's self-capacities (ability to tolerate affect and maintain a sense of self in connection), the greater the need for dissociative and amnesiac defenses that preclude conscious processing of the event. The event and its implications must be incorporated into one's frame of reference (Who am I now? What do I believe about the world? How do my spiritual beliefs change as a result of this event?) and schemas about central psychological needs (Is the world safe? Whom can I trust? Do I have any control? Whom do I respect now? Do I want to be connected?).

In response to an acute adult trauma, changes are more likely to be short-term and modified over time by the sturdiness of lifelong beliefs. Recurrent traumas in childhood, on the other hand, lead to more stable disruptions of frame of reference and schemas that change only slowly. Beliefs developed in childhood are reinforced when they help the child make sense of his or her experience and protect him or her from unbearable troths. (For example, when it is unbearable to be helpless as a witness and victim of abuse, a child may come to believe, "If I were smarter, I could have protected my mother and me from my father's beatings" and deny the belief that "there was nothing I could have done because I was too small and helpless as a child.") Beliefs that protect someone from something they cannot bear to know or feel are highly resistant to modification and change.

Thus, because of individual differences in identity, worldview, and spirituality, different salience of psychological need areas, and variations in self-capacities and ego resources, as well as different interpersonal and sociocultural contexts, different people respond differently to similar events. For example, when a person with strong needs for control is mugged, she or he focuses on the loss of control and failure to prevent the attack, and may respond with a greater need to control the environment. A person with more salient trust needs focuses on loss of trust in his or her own judgment and greater mistrust of others. Both feel less safe in the world, but how generalized that fear becomes and what steps each takes for self-protection vary.

If the victim of a mugging is also a survivor of childhood violence, he or she integrates the most recent assault with beliefs about himself or herself and the world from the past. She or he may question, "What do I do that makes me the target?" and then may engage in self-recriminations and become confused about whether she or he deserved to be the target of violence. If this focus on culpability precludes a balanced evaluation of the situation (i.e., if it precludes those circumstances over which she or he had little or no control and only includes those circumstances under his or her control), then the construction denies part of the reality of the event and can prevent interpersonal connections that would support healing, appropriate anger, and constructive evaluation of the event and its circumstances, including a review of self-protective or risky choices.

We return below to discussing the applications of this theory to the study of thriving. But first we want to review the current literature on thriving and posttraumatic growth with an eye to some methodological considerations.

The Study of Thriving: Five Familiar Problems

Although the emerging scientific study of thriving is viewed by its proponents as a broadening of the vulnerability and coping paradigms, we are concerned that in fundamental ways investigators of thriving have already begun to replicate the well-entrenched biases of their colleagues who study coping and vulnerability. This unintended repetition, which is both methodological and conceptual, is ironic in that it occurs just as coping theory and research have come under attack for using the methods now mimicked in research on thriving (cf. Folkman, 1997; Somerfield, 1997). We are most concerned with five specific issues: (1) an adherence to nomothetic inquiry, with its focus on variables rather than psychological processes; (2) bypassing descriptive inquiry in favor of more limited, mundane moderator analyses; (3) relying on univariate indicators; (4) failing to distinguish effortful from automatic change; and (5) ignoring the possibility and conceptual implications of abrupt change.(1)

The Legacy of Nomothetic Inquiry

Although thriving theory and research has explicitly rejected the vulnerability model of adaptation to threatening life events (O'Leary & Ickovics, 1995), its investigators have implicitly accepted the nomothetic approach, used so widely in vulnerability and coping research. The nomothetic approach focuses on whether there are relations among variables across individuals, that is, on between-person associations. In the nomothetic tradition we can ask if individuals who are able to derive meaning from their adversity are also more likely to show emotional or behavioral changes consistent with thriving. The nomothetic approach allows us to examine whether individuals who more effectively regulate their emotions soon after a trauma are more likely to thrive in the months and years that follow. These types of questions take the form: "Are those who manifest X more (or less) likely to manifest Y?"

The idiographic approach, on the other hand, permits us to examine relations among variables within a given individual (Allport, 1937). Thus, the individual is the unit of analysis, and the investigational focus is on the relation of variables in the days of that individual's life. The promise of the idiographic approach is its potential to examine unfolding processes over time. Tennen & Affleck (1996) have argued for the benefits of an approach to the vulnerability and thriving literatures that combines the strengths of the idiographic and nomothetic traditions (see Epstein, 1983). This idiographic-nomothetic approach to thriving research requires investigators to ask: Are there relations among thriving-relevant variables within individuals over time that generalize across individuals or that relate to individual differences between individuals? This question allows more complexity and precludes some of the potential damages of reductionistic conclusions.

Thriving is best conceived as a process rather than a static experience or a dichotomous (present or absent) variable. This point of view is shared by most investigators attracted to the concept of thriving. The authors of four articles in this issue (see Carver; Epel, McEwen, & Ickovics; Massey, Cameron, Ouellette, & Fine; and Park) explicitly describe thriving as a process. As processes cannot be understood through "snapshots," even two or three snapshots, they require regular longitudinal monitoring. Nonetheless, investigators in the new field of thriving research have quickly come to accept the snapshot version of scientific inquiry so common in the vulnerability, stress, and coping literatures. If thriving as an area of scientific inquiry is to genuinely broaden our view of psychological responses to adversity, we believe that investigators need to broaden their conceptual and methodological lenses to include intraindividual processes unfolding over time.

A between-person correlation can depart markedly from a within-person correlation, and attempts to answer intraindividual (idiographic) questions with interindividual (nomothetic) approaches are bound to miss the mark. Yet it is precisely intraindividual questions that investigators and clinicians frequently want to answer. Although it certainly is worth knowing if some people with severe and persistent pain from a traumatic injury become more productive at work than they were prior to the injury, it also seems important to know if some or all are more productive during days on which they experience greater pain, or whether a more productive day is followed by (or precedes) a day of greater pain. Depending on our conceptual model, we might posit that a person is thriving when her or his daily productivity is not significantly influenced by changes in pain or distress. Or we might propose that although pain and distress might interfere with work to some extent, an individual who is thriving does not show a positive relation between one day's pain and the next day's productivity.

A focus on intraindividual concurrent and lagged relations transforms variables into processes; such processes cannot be ascertained through between-person associations alone. Tennen and Affleck (1996) have demonstrated that between-person and within-person correlations can differ not only in magnitude but also in direction, and that a statistically significant positive between-person correlation can emerge when not a single individual in the group shows a positive within-person association! Although it is common in the coping literature and more recently in the thriving literature to draw within-person inferences from between-person associations, between- and within-person associations address different questions. We believe that because some of the most interesting and clinically relevant questions in the area of thriving demand within-person analysis, investigators must break from the traditions of vulnerability and coping research to consider thriving as an unfolding intraindividual process.

Ultimately, our research is enriched when we can examine a question from multiple angles. The integration, simultaneous or sequential, of the two approaches offers a wealth of valuable data. However, because the nomothetic approach has dominated, we need to increase research derived from an idiographic framework.

When Explanation Precedes Description

Description is a necessary, though not a sufficient, step in the scientific study of thriving. If thriving is to be something more than a black box construct of "coming out better than you went in," we must concern ourselves with documenting positive changes not only after adversity but also as they occur. One reliable method for describing a phenomenon is to track it in "real time." Such real-time tracking is consistent with the idiographic method and has been used effectively to describe the dynamics of spontaneous benefit finding (Tennen & Affleck, in press) and social comparisons (Tennen & Affleck, 1997) among individuals living with chronic pain, the dynamics of vulnerable self-esteem (Butler & Hokanson, 1994), and individual differences in the emotional concomitants of minor daily illnesses (Larsen & Kasimatis, 1991). It can also be used to describe the dynamics of thriving.

To date, psychological investigators in the field of coping have mostly bypassed descriptive inquiry by using a now predictable methodological kick start: They gather the same list of moderational and mediational "suspects" and examine how these suspects influence psychological adaptation in the face of adversity. Ironically, although we have rejected vulnerability models in recent calls to study thriving (O'Leary & Ickovics, 1995; Tedeschi & Calhoun, 1995) we have accepted the use of moderators - particularly personality moderators - defined in those studies that test these rejected models. Although there may be some benefits to sticking to these "usual suspects" (Tennen & Affleck, in press), there is also the distinct risk of learning only what one already suspects.

One of the usual moderational suspects is crisis-induced personal transformation (O'Leary & Ickovics, 1995; Tedeschi & Calhoun, 1995), and stress-related growth (Park, Cohen, & Murch, 1996) is an internal locus of control. Tedeschi and Calhoun (1995) propose that individuals with an internal locus of control are able to infuse threatening circumstances with the sense of meaning and coherence associated with growth. Along with Moos and Schaefer (1990), Tedeschi and Calhoun also propose that self-efficacy (Bandura, 1982), a sense of coherence (Antonovsky, 1987), and hardiness (Kobasa, 1979) position individuals to extract growth from personal crisis.

Moos and Schaeffer (1990), O'Leary and Ickovics (1995), Tedeschi and Calhoun (1995), Thompson (1985), and Folkman (1997) have hypothesized that dispositional optimism, or the generalized expectancy for positive outcomes (Scheier & Carver, 1985, 1987), may also anticipate growth or thriving following threatening events. Both published findings and a reanalysis of previously published data (Tennen & Affleck, in press) render equivocal the role of dispositional optimism in the experience of personal growth. Although (and perhaps because) the relation between optimism and perceived growth remains uncertain, investigators have not hesitated to propose mechanisms mediating the relation, including active, problem-oriented coping (Tedeschi & Calhoun, 1995) and the reframing of negative experiences in a positive light (O'Leary & Ickovics, 1995).

The latest group of suspects in the search for correlates of thriving is the "Big Five" constellation of second-order personality traits: neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness (McCrae, 1992). McCrae and Costa (1986) found that individuals low in neuroticism, high in extraversion, and high in openness tend to rely to a greater extent on "drawing strength from adversity" as a style of coping with threat. Tennen and Affleck (in press) speculated that the specific benefits attributed to misfortune could match the characteristic approaches to the self, the world, and others associated with these major dimensions of personality. For example, we hypothesized that the negative self-perceptions associated with neuroticism would make it difficult for highly neurotic individuals to find adversity as a source of personal growth. We also suggested that those higher on extraversion, who are more gregarious, cheerful, and seekers of social contact, might be especially likely to cite positive consequences of adversity for social relationships. Finally, we speculated that the individual who is more open to experience - imaginative, emotionally responsive, and intellectually curious - might be particularly likely to meet the challenge of adversity through a philosophical reorientation and a new direction in life plans (cf. Tedeschi & Calhoun, 1996).

We must consider whether the paradigm shift anticipated by advocates of the concept of thriving (O'Leary & Ickovics, 1995) can possibly achieve its goals if we rely on the same personality characteristics to explain individual differences in thriving that have done little to explain individual differences in the vulnerability and coping paradigms. Further, even if this methodological approach were productive, we would be left with the finding that those who are already functioning well are most likely to thrive in a crisis. Individuals who already experience a sense of personal control, are optimistic about the future, are outgoing and open to new experience, are confident in their coping capacities, and view the world as meaningful and crises as manageable are, according to this line of reasoning, most likely to emerge from a crisis or traumatic experience in some way better than they were prior to the experience (Tennen & Affleck, in press).

Yet paragons of mental heath and personal development are not the only ones capable of thriving. Biernacki (1986) has described pessimistic, hopeless, fatalistic individuals who nonetheless managed to experience profound personal growth. Similarly, Miller and C'de Baca (1994) and Lifton (1993) describe individuals who thrived in the face of adversity, yet who were not optimistic, hardy, extroverted, or particularly open to experience, who lacked a sense of coherence and meaning in life, and who appeared to maintain an external control orientation. To avoid the fate of the vulnerability models they critique, investigators seeking a heuristic and productive conceptualization of thriving must also reject the methodological gaffes of those models. To do so, one must step back and describe thriving as it unfolds. In short, the study of individual differences should follow rather than guide an empirically validated description of the thriving process. We rerum to the issue of individual differences in our description of abrupt transformation.

Relying on Univariate Indicators

Thriving and posttraumatic growth research has in its early stages relied exclusively on univariate indicators. Whether thriving has been globally defined as improved mood, a more positive self-concept, or the ability to find benefits in the midst of adversity, investigators have turned to traditional univariate construct indicators. If the concept of thriving is to genuinely change how we understand psychological reactions to significant threatening experiences and losses, our conceptualization and measurement have to be more complex.

As an example, consider how self-esteem might change following trauma. If we measured esteem with a univariate indicator, such as a self-esteem scale, and if we were fortunate enough to have conducted a fully prospective design (which is rare), we might notice that some individuals actually showed an increase in the their self-esteem following trauma, and then might conclude that these individuals were thriving, at least in terms of how they viewed themselves. Others might show a more realistic sense of esteem, relinquishing grandiosity. Now consider a process-oriented, bivariate indicator of self-esteem: the extent to which self-evaluation is sensitive to the slings and arrows of everyday life (Butler & Hokanson, 1994; Kernis, Cornell, Sun, & Berry, 1993). If we measured state self-esteem and events each day for several months and noticed that the same individuals who showed post-trauma increases in their mean level of esteem also showed more distinct drops in esteem on days during which they experienced interpersonal challenges, we might be less inclined to consider their mean self-esteem level as an adequate indicator of thriving. The use of bivariate indicators not only is consistent with a process-oriented view of thriving, but also has the potential to change how we conceptualize thriving.

Thriving: An Effortful or Automatic Process?

Descriptions of personal growth or thriving among individuals in clinical settings and by research participants suggest that such changes may reflect both efforts to change and automatic processes. Some of our research participants have described unintentional revelations about understanding what is important in life. Consider, for example, these reflections of a young father of an acutely ill newborn:

Right after she was born, I remember having a revelation. Here she was, only a week old, and she was teaching us something: how to keep things in their proper perspective, how to understand what's important and what's not. I learned that everything is tentative, that you never learn what life is going to bring. I realized that I shouldn't waste any more time worrying about the little things.

Others have mentioned explicitly that their newfound personal strength required considerable effort. A woman participating in our study of infertility told us:

It has made me a stronger person, and has made me appreciate children so much more. It took determination and hard work to gain this strength, but it was worth the effort.

The distinction between effortful and automatic positive changes in the face of adversity becomes increasingly relevant as clinicians begin to consider the possibility of encouraging psychological thriving in the context of psychotherapy (see Calhoun & Tedeschi, this issue).

Janoff-Bulman (1992) distinguished two cognitive processes that help victims rebuild their assumptive worlds: automatic patterns for processing potentially threatening information and deliberate efforts to reconstruct cherished assumptions. Denial and numbing are examples of automatic processes that help individuals "pace" their cognitive integration of the traumatic experience (see Greenberg, 1995). Trying to reevaluate the trauma as imparting personal strength, wisdom, or other growth-related characteristics is an example of deliberately trying to reinterpret the event so as to maintain cherished assumptions about oneself, the world, and the future. Unlike the process of intentional change, for which there is a considerable theoretical literature (Prochaska, DiClemente, & Norcross, 1992), the characteristics and processes that give rise to revelatory experiences have received scant attention. The processes involved in self-directed, intentional positive change or thriving may be irrelevant to nonintentional change. One possible difference between these forms of growth is that intentional growth may need to unfold over time, whereas revelatory growth, by its very nature, may emerge rather suddenly. To the extent that many psychological defenses are unconscious or automatic, many aspects of psychological adaptation would be automatic. Frankl (1959), Janoff-Bulmann (1992), McCann and Pearlman (1990), and others suggest that the instinctive need to create meaning leads to enduring beliefs about identity and worldview. Other defenses, including denial, intellectualization, projection and reaction formation, stem from unconscious processes and may lead to positive change. We now turn to the poorly understood distinction between gradual and abrupt personal transformation, another aspect of thriving that has received scant attention.

Thriving in the Face of Adversity: Gradual or Abrupt?

Consider this description of personal transformation by one of our research participants living with a painful chronic illness:

Living with this disease has taught me so many precious things that I wouldn't have learned if I were healthy. I guess the most important things it has taught me are to appreciate what life can hold for you every day and to be grateful for the loving relationships in your life. It's taken a long time for me realize this.

The concepts employed in the traditional recovery literature suggest that positive psychological adaptation to trauma, including thriving, unfolds at a gradual pace and tempo. The very notion of"rebuilding" shattered assumptions (Janoff-Bulman, 1992; McCann & Pearlman, 1990) reflects well this sense of gradual change. Individuals "pace their recovery" (Janoff-Bulman, 1992, p. 100) "over the course of coping and adjustment" (p. 110). Some theories of personal change are explicit about its protracted course (Prochaska et al., 1992), and the coping literature has come to equate the term process with something that requires time to unfold.

Yet there exists a rather compelling though unappreciated theoretical and empirical literature beyond (Eldredge & Gould, 1972; Gould & Eldredge, 1977) and within (Franklin, Allison, & Gorman, 1996; Maruyama, 1963) psychological inquiry on dramatic transformations that occur abruptly and through mechanisms not yet fully appreciated. We believe that for individuals in crisis or facing prolonged adversity, these "quantum" changes (Miller & C'deBaca, 1994) may be the most dramatic, and include positive personal changes that cannot be easily incorporated into current conceptions of coping or thriving (Greenberg, 1995). Most of the individuals who reported quantum change in Miller and C'deBaca's study described finding a new sense of meaning in life and a different view of the world. They described equally dramatic changes in their personal goals, which became less achievement-oriented, and a change from the pursuit of pleasure to personal peace and spirituality. Although the retrospective methodology of this study places restraints on interpretation, the overall pattern of findings supports our position that this type of change must be considered as distinct from the incremental change implied by current conceptions of coping and thriving.

Although Miller and C'deBaca (1994) did not measure locus of control, they did ask participants to rate how much they felt in control of their lives before their transformation, after their transformation, and at the time of the interview. Participants reported that they had experienced only a modest degree of control over their lives prior to their transformation. This is in direct contrast to current theorizing described earlier regarding internal locus of control and incremental transformation, but is perfectly consistent with William James's (1902) contention that the "perception of external control" (p. 195) is essential to abrupt personal transformations. Similarly, although formal indicators of optimism were not available, most participants noted that they were at a relatively low point in their lives, suggesting that as a group they were not particularly optimistic about the future. Whereas the theoretical formulations of thriving described earlier associate optimism with positive incremental change following adversity, James suggested that abrupt change is preceded by despair, and Premack (1970) suggested that a sense of humiliation and conscience pangs may trigger abrupt personal changes. Humiliation and conscience pangs, in turn, are more common among field dependent individuals (Lewis, 1971). We find appealing the idea that a personality characteristic like field dependence, which increases the likelihood of distress during times of relative stability, might at stressful times trigger abrupt personal growth. (See Gould, 1993, for an evolutionary counterpart.) Such findings should move investigators in the field of thriving to consider abrupt as well as gradual change and to move beyond the usual suspects as predictors of such change. We now turn our attention to the challenge of conceptualizing adaptation to trauma adequately and offer Constructivist Self Development Theory as a heuristic conceptual framework.

The Application of CSDT to Research on Thriving

CSDT allows us to address many of the limitations of our current conceptualization of and research on thriving and crisis-related growth. We have thus far identified five such limitations. Here we suggest how a clinical trauma theory offers us some solutions.

The need to integrate nomothetic with idiographic inquiry. With its emphasis on the ongoing process of adaptation as it occurs within an individual's context and in response to the individual's salient psychological needs and existing cognitive schemas, CSDT permits idiographic inquiry. It emphasizes both process and context and therefore not only allows but assumes individual differences. This focus on unfolding processes and individual differences offers a theoretical context for idiographic inquiry. Each adaptation shapes future perceptions and adaptations.

Allowing descriptive inquiry as well as moderator analyses. CSDT lends itself to descriptive inquiry as well as analyses of moderator variables. The theory allows a description of adaptive processes and does not offer a priori characteristics of the individual that foster thriving. The impact of traumatic events on the individual is assumed to include the individual's instinctive and deliberate attempts to adapt to the trauma and its circumstances. Although schemas can be assessed empirically (Pearlman, 1994, 1996), the individual's particular identity, worldview, and belief system emerge in the unique constellation of relative disruption. The theory focuses on the whole self as represented in identity and relational beliefs and needs.

Allowing complexity: Multivariate hypotheses. The theory offers a constellation of interrelated factors to describe the individual affected by trauma and thus lends itself to complex assessments of definitions and indications of thriving. Implicit in the multilayered definition of self is the assumption that no aspect of self can be isolated from the others. However, specific relationships, including directional relationships, are not proposed. Although change is not assumed to be unidirectional and negative shifts in beliefs may have positive consequences (e.g., becoming more realistic), the relationships among different beliefs and among different aspects of self are implied but not yet fully articulated (Black & Pearlman, 1997). Although there is much room for further research, we believe the theory lends itself to both univariate and bivariate analyses.

Assessing both automatic and intentional aspects of thriving. The theory assumes the possibility of both effortful and automatic change. On the one hand, it posits automatic adaptation via the cognitive mechanisms of assimilation and accommodation (Piaget, 1971) and the psychological mechanisms of affect and conflict modulation. On the other hand, it assumes conscious examination of adaptations and beliefs and conscious development of alternative skills and beliefs in the service of meaning making and adaptation (survival). The theory assumes that, biologically and psychologically, the individual automatically adapts to survive and maintain a consistent sense of self and world. CSDT outlines the arenas of these automatic changes and posits that, with conscious attention and effort, the individual can modify and alter some aspects of self, specifically beliefs or schemas and specific skills relevant to self-capacities or ego resources.

Allowing for both gradual and abrupt steps toward thriving. The theory assumes both abrupt changes, which occur in response to acute trauma and stress, and extended adaptation, which occurs through processes of adaptation, accommodation and assimilation that follow and proceed through developmental processes. The process of adaptation and change is seen as continuous. The process of healing from trauma (with or without psychotherapy) assumes a conscious examination of meaning and awareness of adaptive strategies and needs.

CSDT and Posttraumatic Growth

As a result of their necessary adaptations and the gradual, epiphanous, or effortful construction of meaning, many survivors of traumatic life events experience posttraumatic growth. CSDT predicts both positive transformative changes and the development of maladaptive beliefs and adaptations (including symptoms of clinical diagnoses).

Contextually, traumatic events can be followed by healing responses (e.g. national community response after natural disaster) or by further traumatizing events (e.g. medical retraumatization; disbelief from authority to whom the survivor turns for protection). These interpersonal or community responses to trauma are important forces that also shape the individual's adaptations and process of meaning making. Thus traumatized individuals draw not only upon their inner resources, but also upon the relational and community resources made available to them.

The CSDT constructs of frame of reference and the five core psychological needs (safety, esteem, intimacy, trust, and control) set the stage for profound changes in schemas or beliefs that form an important aspect of posttraumatic growth. Because CSDT suggests that a core arena for traumatic change is in the individual's frame of reference, a fundamental set of beliefs and perspectives that incorporate identity, worldview and spirituality, the potential for posttraumatic growth, defined as changes in meaning and beliefs, is inherent. Frame of reference forms a lens through which an individual views his or her world. As a person strives to make meaning in the face of traumatic life events, all aspects of his or her frame of reference are likely to be affected. Trauma disrupts and often reshapes this frame, and healing typically involves struggling with basic beliefs about self, world, and spirituality. The components of frame of reference parallel the three arenas generally noted in the literature on posttraumatic growth: changes in self-perception (identity), changes in interpersonal relationships (worldview), and a changed philosophy of life (worldview and spirituality).

As a result of the process of constructing meaning in response to a traumatic event, CSDT posits inevitable changes to identity, worldview, and spirituality. When a traumatic event challenges deeply held conscious or unconscious beliefs about self, others, world, or spirituality, changes to frame of reference are more dramatic. These changes often lead to a sense of disconnection from oneself (identity) as one was in the past. Interestingly, the changes in frame of reference posited by CSDT are consonant with the five arenas of posttraumatic growth described by Tedeschi and Calhoun (1996): new possibilities (identity, worldview, spirituality), relating to others (worldview), personal strength (identity), spiritual change (spirituality), and appreciation of life (spirituality). Work in psychotherapy with survivors of traumatic life events reflects parallel areas of growth. Therapists report that survivor clients develop an expanded sense of possibilities; their relationships change as they develop greater capacity for trust and intimacy; their pride in their own survival and psychic resilience grows as they face the reality of the trauma and recognize their adaptations; their sense of perspective and drive for meaning deepen their spirituality; and their conscious acceptance of power and choice in their lives increase their appreciation of themselves and the potential for pleasure and serenity.

Growth Beyond and Within Psychotherapy

Healing in psychotherapy occurs in the context of the therapeutic relationship, a uniquely bounded intimate relationship. The clinical application of CSDT is in a relational therapy in which the events of the therapy relationship are explicitly noticed and examined. The relationship provides a laboratory within which to develop alternative models of the self in relation to others. Each aspect of the self addressed by CSDT can be enhanced or modified using the therapeutic relationship (Pearlman & Saakvitne, 1995). In the therapeutic relationship, both parties collaborate with a mutual goal and both are influenced by the relationship. This context allows a change in the client's experience of self-in-relation or relational self (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991), which can lead to a change in her or his definition of self (identity).

In CSDT, growth and pain are not mutually exclusive but rather inextricably linked in recovery from trauma and loss. There is no simple dichotomy between those who experience growth from trauma and those who are impaired by trauma. Those who seek psychotherapy to address their pain do not necessarily differ in the degree of distress they experience, nor in their resourcefulness and resilience. It would be inaccurate to assume that traumatized individuals who do not seek counseling are less harmed by trauma, or that those who seek help are more harmed or less able to be positively transformed. Many clients use their trauma experiences to make profound differences in the lives of others while they remain in significant psychological distress. One example is the woman forced to witness the abuse of infants as a child who now works as a pediatric nurse protecting children and helping them speak their pain. Another is the director of a rape crisis center who, through her counseling, has used her own trauma of sexual assault as an impetus to help others heal from their trauma; through her training of volunteers, has helped other survivors find a "survivor mission" (Herman, 1992); and through her advocacy and lobbying efforts, breaks her silence and works to change societal responses to victims of sexual assault.

Posttraumatic growth can occur within the psychotherapeutic process, although psychotherapy is not a prerequisite for such growth. A goal of CSDT-guided therapy is to facilitate the creation of meaning in the face of traumatic loss and help the client focus her or his attention on self and inner processes in a way that increases access to affect and heightens awareness, insight, mindfulness and self-knowledge. The work of insight-oriented psychotherapy emphasizes the process of constructing meaning and creating personal narratives that are expanded to include traumatic events with other aspects of self established over a lifetime.

According to CSDT, posttraumatic growth is theoretically linked to the increased consonance between an individual's understanding of a traumatic event and its personal meaning. Such growth occurs as a client is able to understand her or his current experience - feelings, perceptions, beliefs, and distress - in the context of the past, including past trauma and related adaptations. This process of contextualizing the present in the past and making understandable that which had been labeled crazy, bad, or weak transforms the client's sense of self and allows the construction of a personal narrative and the development of a sense of choice and power in the present. These achievements create opportunities for personal growth. The survivor develops a greater sense of meaning, self-compassion, perspective and insight.

The process of mindful attention to one's underlying beliefs about oneself, others, and the world creates an awareness of choice that may have been impossible before psychotherapy. Growth may be reflected in major shifts in beliefs about self, the world, or spirituality, or in a greater degree of mindfulness, acceptance without resignation, or serenity. With or without psychotherapy, some survivors develop qualities such a wisdom and compassion. These qualities cannot be simply predicted or prescribed according to population. Rather, they are the outcome of the interaction of certain individual's gifts with the challenges they are forced to face. Thus, as researchers we are challenged by the complexity and individuality of survivors' responses to traumatic life events as well as by the daunting task of operationalizing such concepts as personal growth, wisdom, and compassion.

Conclusion

In this article, we have provided a methodological critique of the emerging literature on posttraumatic growth and offered a theory (CSDT) to guide both research and therapeutic efforts. Our description of posttraumatic growth or thriving suggests that in the face of irrefutable knowledge that bad things happen, someone can reclaim hope and faith. This reclaiming through making meaning happens in many ways: internally, spiritually, and in relationships, including therapeutic relationships. The challenge of cross-disciplinary collaboration is central to solving the conceptual and methodological problems we have described. The literature on resilience, posttraumatic growth, and adaptations to trauma is clustered within different and often unrelated literatures in the areas of pediatrics, community psychology, social psychology, health psychology, clinical psychology and trauma.

We hope that Constructivist Self Development Theory, with its emphasis on adaptation, the whole person in his or her context, and on different aspects of the self affected by trauma, can provide a theoretical context to guide integrative research. The goal is to utilize clinical theory to move our social science research beyond the spheres of our respective disciplines as we address questions whose relevance is to the whole person of the survivor and, ultimately, to the world community.

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KAREN W. SAAKVITNE is the Clinical Director of the Traumatic Stress Institute/Center for Adult and Adolescent Psychotherapy LLC in South Windsor, CT. She holds a doctorate in clinical psychology from the University of Michigan and completed a postdoctoral fellowship at the Austen Riggs Center. She has coauthored two books and numerous chapters and articles on clinical theory and technique in psychotherapy with survivors of traumatic life events, with a special focus on the impact of the work on the therapist.

HOWARD TENNEN received his Ph.D. in clinical psychology from the University of Massachusetts. He is Professor of Community Medicine and Psychiatry at the University of Connecticut Health Center. His current research focuses on coping, health and well-being, and adaptation to chronic illness.

GLENN AFFLECK received his Ph.D. in educational psychology from the University of Connecticut and is Professor of Community Medicine and Psychiatry at the University of Connecticut Health Center. His current research focuses on stress, coping, and health and the dynamics of daily life with chronic illness.

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