Post Traumatic Growth

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Journal of Religion & Spirituality In Social Work: Social Thought

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Spirituality and Transcendent Meaning Making: Possibilities for Enhancing Posttraumatic Growth

Jo‐Ann Vis & Heather Marie Boynton

To cite this article: Jo‐Ann Vis & Heather Marie Boynton (2008) Spirituality and Transcendent Meaning Making: Possibilities for Enhancing Posttraumatic Growth, Journal of Religion & Spirituality In Social Work: Social Thought, 27:1-2, 69-86, DOI: 10.1080/15426430802113814

To link to this article: https://doi.org/10.1080/15426430802113814

Published online: 11 Oct 2008.

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Spirituality and Transcendent Meaning Making: Possibilities for Enhancing

Posttraumatic Growth

Jo-Ann Vis Heather Marie Boynton

ABSTRACT. Traditionally, in the field of trauma, the emphasis has been on loss and suffering rather than growth and possibility. While the experience of loss and suffering is true for many trauma survivors, especially during the initial phase of trauma exposure, recent research has demonstrated that sole concentration on these constructs is ineffective in promoting growth and understanding. This article focuses on the benefits of attention to the spiritual aspect in posttraumatic growth and transcendent meaning making. A critical component in assisting individuals to move beyond the immediate impact of trauma is the facilitation of spiritual awareness and accessing spiritual resources. The inclusion of spirituality in the post-trauma processes can provide alternatives for positive reconstruction of worldview, coping, and transcendent meaning making.

KEYWORDS. Trauma, spirituality, transcendence, meaning making, posttraumatic growth, positive coping

Journal of Religion & Spirituality In Social Work: Social Thought, Vol. 27(1-2) 2008 Available online at http://jrssw.haworthpress.com # 2008 by The Haworth Press. All rights reserved.

doi: 10.1080/15426430802113814 69

Dr. Jo-Ann Vis is Assistant Professor at the School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada (E-mail: [email protected] lakeheadu.ca).

Heather Marie Boynton is a MSW candidate at the School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada (E-mail: [email protected]).

Emphasis on behaviors related to suffering and loss post trauma reinforces the perception that traumatic events can only lead to strife and poor coping ability. Immediate distress following a traumatic event is inevitable. It is essential to recognize the loss and tragedy associated with an acute traumatic event; however, acknowledging that the experience can include more than just pain and suffering provides hope and an alternative outcome for trauma survivors. Although spirituality has been alluded to within the trauma literature, its significance and role within trauma management has fallen short of its potential. This article intentionally focuses on the need for explicit inclusion of spirituality and spiritual practices. It is argued that exploration of spirituality is a necessary component in the area of post-trauma management, and social workers can play an important role in facilitating and attending to spirituality. Also, we believe that spirituality is an extension of worldview, coping, and meaning making, and is an essential component in healthy posttrau- matic processing. An examination of emerging research and theory in the area of spirituality supports a rationale for an intervention framework that specifically addresses the components of spirituality within ethics, assessment, and intervention.

A psychological trauma event is often described as an unexpected stress-related event that produces intense feelings of fear, anxiety, or helplessness. McCann and Pearlman (1990) define a trauma event as something that is sudden or non-normative, going beyond the individual’s perceived ability to meet its demands, while also disrupting the individual’s frame of reference and related schemas. The lifetime prevalence of exposure to an acute traumatic event for the average individual is high. For example, in one study of 1,000 adults in four cities in the southeastern United States, 21% of the sample reported a traumatic event such as theft, assault, or traumatic death of a loved one during the previous year. Furthermore, 69% reported the occurrence of at least one such event in their lifetimes (Tedeschi, Park, & Calhoun, 1998).

Research in the area of posttraumatic growth has suggested that the immediate reaction to trauma challenges an individual’s world- view and meaning. It also provides an opportunity through which old and new worldviews can integrate, offering hope and possibility for growth and well-being (Lightsey, 2006; O’Connor, 2002–2003; Smith, 2006). Several authors and researchers in the area of posttraumatic

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recovery agree that individuals who report positive post-trauma outcomes or growth go through a process such as re-appraisal, re- orientation, and re-framing, which offered them an opportunity to re- evaluate their worldviews (Janoff-Bulman, 1992; Park & Ai, 2006; Tedeschi, Park, & Calhoun, 1998). Mattis (2002) confirmed a relationship between religiosity/spirituality, meaning, and interpreta- tions in coping during times of adversity. Furthermore, Cadell, Regehr, and Hemsworth (2003) found that spirituality is part of meaning making and coping and contributes to posttraumatic growth.

The definition of spirituality has been evolving over the past few decades and has ranged from being broad in nature to complex and abstract (Bullis, 1996; Burkhardt & Nagai-Jacobson, 2002; Canda & Furman, 1999; Decker, 1993; Hodge, 2005; O’Connor, Davidson, & Lee, 2003; Smith, 2006). The definition of spirituality proposed by Sheridan (2004) is concise and suggests that spirituality is ‘‘the search for meaning, purpose, and connection with self, others, the universe, and ultimate reality, however one understands it, which may or may not be expressed through religious forms or institutions’’ (p. 10). She distinguishes the difference between spirituality and religion by stating that religion is ‘‘an organized structured set of beliefs and practices shared by a community related to spirituality’’ (p. 10).

SPIRITUALITY, TRANSCENDENT MEANING MAKING, AND POSTTRAUMATIC GROWTH

A review of the literature concerning theoretical approaches in the area of posttraumatic growth reveals three that are closely related. One approach asserts that positive coping develops out of sorting through the impact of a disrupted worldview to incorporate a new view, which includes the trauma experience (Janoff-Bulman, 1992; McCann & Pearlman, 1990). The second approach discusses the use of innate or acquired coping mechanisms within which individuals perceive the trauma as a threat or challenge to their ability to respond accordingly. Some strategies that individuals have used to cope have been positive appraisal, venting of emotions, and religious coping (Park & Ai, 2006). The third approach assumes that meaning formation post trauma provides a context within which an individual

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can reevaluate and understand the event, which includes deriving some positive aspects as a result of the experience (Niemeyer & Stewart, 1996; Tedeschi & Calhoun, 1995; Tedeschi, Park, & Calhoun, 1998). While it can be argued that spirituality is implicitly incorporated within these approaches, it is not easily identified; what is missing is an intentional inclusion of spirituality, which can be an avenue for assessing worldview, determining coping stability, and the development of transcendent meaning formation. Each of these will be discussed next.

Spirituality: An Extension of Worldview

Tedeschi and Calhoun (1995) contend that our basic belief dimensions include a predictable, comprehensible, meaningful, and benevolent world that is comprised of people we can count on. These beliefs allow our world to remain stable and make life meaningful. However, when a traumatic event occurs, it creates immediate distress and disorientation and challenges cognitive perceptions concerning worldview, meaning, and purpose in life (Ai & Park, 2005; Janoff-Bulman 1992; Park & Ai, 2006; Tedeschi, Park, & Calhoun, 1998). The immediate reaction to trauma may include automatic coping strategies, such as avoidance or denial. Eventually, individuals find themselves facing a psychological and/or spiritual dilemma, which requires resolution for effective trauma management. Janoff-Bulman (1992) argues that an individual’s pre-existing world- view is no longer viable post trauma, and, as a result, individuals face an overwhelming coping task. The author suggests that, after a traumatic event, individuals are faced with cognitive and emotional choices that require a re-working of prior views. Individuals are challenged to incorporate prior beliefs about self and the world around them with new information taken from the trauma experience, information that includes negative and threatening realities.

There is general agreement that worldviews are impacted by trauma experiences (Ai & Park, 2005; Park & Ai, 2006; Tedeschi & Calhoun, 1995; Tedeschi, Park, & Calhoun, 1998). How one views the world following a traumatic event is vastly different than how one may have viewed it prior to the trauma. Traumatic events challenge our basic assumptions of the world and ourselves, which makes comprehension of the event difficult to manage. Assumptions about

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self, others, and the world will change as a natural consequence of exposure to an acute traumatic event. These relationships and connections are transformed.

While these arguments are valid and significant, and may include a consideration of spiritual viewpoints, they do not specifically encourage spiritual exploration and its impact on an altered worldview. Concepts such as meaning formation and spirituality are interrelated, complex, and difficult to separate (Clark, 2006; Emblen & Pesut, 2001; Sheridan, 2004). As a result, unexpected, life- altering trauma events, such as a sudden death or threat to well- being, goes beyond the ordinary range of human experience, naturally creating a spiritual or worldview crisis, which requires attention and opportunity for processing.

Spirituality: An Extension of Coping

Tedeschi and Calhoun (1995) state that individuals who rely on religious beliefs or spiritually related concepts might be able to manage a crisis more effectively. They suggest that a ‘‘collaborative style’’ involves an active exchange with a higher power. This exchange helps to manage anxiety and emotions, provides feelings of support, and may assist with problem-solving and self-care. They continue with the perception that, by incorporating an event into the divine, the meaning of it becomes universal and enduring, and is no longer personal; the event is given spiritual significance. Spiritual activities, such as prayer, meditation, or reading spiritual material can offer outlets for emotion and provide comfort.

Schaefer and Moos (1998) identify five personal resources that individuals’ access post trauma: socio-demographic characteristics, optimism, self-confidence and an easygoing disposition, ego-resi- liency, and prior crisis experience. These authors do not identify spiritual aspects within these categories. Others allude to spirituality through regulation of emotion and positive effect, which decreases the arousal affect, and describe concepts such as fate or an ability to understand the situation via metaphysical beliefs (O’Connor, 2002– 2003; Tedeschi, Park, & Calhoun, 1998; Wilson & Agaibi, 2006). While individuals may not readily appear to present spiritual coping resources, these may be masked. In order to fully capture an individual’s full range of coping resources, it is imperative to create space through which potential spiritual resources can be accessed.

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Spirituality: An Extension of Meaning Making

O’Connor (2002–2003) describes meaning making as an individual creating or discovering significance in events with cognitive and emotional components. Meaning can affect responses in the cognitive, behavioral, emotional, and physiological domains. Within a constructivist approach, individuals are seen to co-create personal realities in which a response and participation occurs in reciprocity, which requires cues from the external world. According to Calhoun and Tedeschi (1999), finding meaning in trauma involves two separate tasks. One is to see meaning in the occurrence of the event, and the other entails maintaining a meaningful view of life despite the event. Simply finding meaning is valuable; however, those who accomplish the task of weaving this meaning into their daily lives are able to create a narrative about the traumatic event that goes beyond loss and hopelessness, inviting possibilities for emotional growth.

Park and Ai (2006) discuss global meaning as consisting of beliefs, goals, and subjective feelings. These global beliefs guide explanations and understanding of events. Trauma is a violation or shattering of global meaning. It often raises questions regarding fairness, controllability, comprehensibility, and creates uncertainty about life. Park and Ai (2006) describe the process of meaning making as reappraisal, whereby the individual changes global beliefs and goals in order to integrate the appraised meaning of the event into a global meaning system.

The process of transcendent meaning making goes beyond the basic version of meaning making that implies a cognitive level of understanding of the event and how one is impacted by it. Transcendent meaning making involves a deeper intuitive under- standing of one’s relationship with themselves and their existence in the world (Decker, 1993; Mattis, 2002). Information that is processed during meaning formation post trauma cannot escape spiritual reflection. Some research demonstrates that there is a relationship between spirituality, meanings, and interpretations, and that spiri- tuality is an important aspect of coping and posttraumatic growth (Cadell, Regehr, & Hemsworth, 2003; Mattis, 2002). Park and Ai (2006) note that spirituality has a place in the construction of meaning; however, there is little mention of how purposeful

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facilitation of spirituality can influence the development of positive meaning making and transcendence. Emblen and Pesut (2001) present an argument that transcendent meaning provides ‘‘hope and sustenance for the spirit’’ (p. 45). Transcendent meaning acts as a bridge between despair and hopefulness. In order to assist individuals in finding hope and meaning following times of tragedy and loss, it is necessary to encourage transcendent meaning reflection, with the intention of maximizing the possibility for posttraumatic growth.

Spirituality: An Extension of Posttraumatic Growth

Posttraumatic growth has been defined as ‘‘an individual’s experience of a significant positive change arising from the struggle with a major life crisis’’ (Calhoun, Cann, Tedeschi, & McMillan, 2000, p. 521). Posttraumatic growth from meaning making can range from profound to minute. Park and Ai (2006) relate that some people report reorienting their lives and considering priorities, and others find solace in being more intimate with others, handling stress more successfully, appreciating life more fully, taking risks, and feeling more spiritual.

Smith (2006) outlines that trauma can be a catalyst or a detriment to posttraumatic growth. She explains that trauma and spirituality are interacting domains as a person attempts recovery from trauma. Trauma affects spirituality, and spirituality can shape the journey through trauma. Decker (1993) asserts that the result of a traumatic experience will increase the search for a more meaningful view of existence, which is spiritual development. He sees spiritual develop- ment as a necessary result of trauma. He believes that the individual’s interests need to be addressed for comprehensive effectiveness of clinical treatment.

Reevaluation of one’s worldview, coping ability, and transcendent meaning making following a traumatic event presents an opportunity for individuals to explore questions regarding the meaning of the event as well as the meaning of life after it. Although an individual may not have any control over being exposed to a traumatic event, one does have control over how one makes sense of the event and how one can use this understanding to determine one’s future.

The literature discusses concepts such as altered worldviews, coping, and meaning formation as links to growth and positive outcome post trauma. There is also some discussion regarding the

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importance of spirituality in connection to these links. Ai, Cascio, Santangelo and Evans-Campbell (2005) note that this inter-related- ness is understandable, given that ‘‘the concepts of hope and a search for meaning have occurred in a spiritual context for thousands of years’’ (p. 256). These authors found that positive spiritual connec- tion and spiritual meaning are central to survival, and suggest that searching for purpose or meaning in life is something that is discovered rather than created. These findings support the research of others who propose that religious participation and spiritual activities are connected to posttraumatic growth. Individuals rely on estab- lished religious or spiritual participation to assist them toward growth, or they actively seek out religious involvement or spiritual practices to facilitate growth (Calhoun et al., 2000; Mattis, 2002). Since spirituality is connected to trauma and posttraumatic growth, it deserves to be more prominent within theory and practice.

IMPLICATIONS FOR PRACTICE

Generally speaking, social workers have relied on crisis intervention models as well as other types of trauma management strategies borrowed from psychology and psychiatry (Bell, 1995; Golan, 1978; Mitchell & Everly, 1994; Payne, 1997; Shapiro, 1999). Researchers in this area outline how the training and skill development of social workers are a natural fit for assisting individuals who have been exposed to trauma or crisis events. Bell (1995) highlights several key features that attribute social workers with the ability to offer alternative understandings to trauma effects and intervention. She notes that training in systems and person-in-environment perspectives, skill development in group and crisis intervention models, and an aptitude to empower clients are all vital and contributory skills. Although these skills are significant and pertain to positive influence on growth and coping post trauma, there is also a need to incorporate interventions that explore transcendent meaning making and spirituality.

Garbarino and Bedard (1996) believe that spirituality has a central role in the perception and construction of meaning in people’s lives. They assert that professionals must incorporate and embrace the spiritual dimensions of traumatized persons into interventions. Clark (2006, p. 1) notes, ‘‘the need to attend to the spiritual and religious

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dimensions of a person’s worldview and frame of reference is an axiom of spiritually sensitive practice, but practice models and processes for facilitating this kind of integrative understanding are few.’’ Sheridan (2004) presents a similar argument, noting that social workers should be provided the knowledge, skills, and values required to integrate spirituality into their profession in an ethical, effective, and spiritually sensitive manner. In her study of 204 licensed clinical social workers, she found that 98.5% of the respondents ‘‘helped clients reflect on beliefs about loss or other difficult life situations’’ (p. 14). The study notes that the professionals in this study took it upon themselves to address the issues the client presented. He challenges the profession to provide education and instruction to ensure ‘‘culturally sensitive, holistically oriented’’ practice.

As humans, we seek to find meaning and purpose within our existence. Within the helping professions, there is a need to understand the human condition and the evolution of life. Thompson (1985) argues that perhaps the most important aspect of managing post-trauma effects is connected to ‘‘the need to make sense of the experience: to determine why it happened, who (if anyone) is to be held responsible, and what meaning the event has for one’s life and one’s view of the world’’ (p. 208). We wonder whether individuals can fully determine the answers to any of these questions without some attention to transcendent meaning making. The experience of trauma cannot be simply seen as a cognitive, behavioral, psychological, or sociological encounter. It is also a spiritual experience, if for no other reason than it forces a partial, if not total, reorganization of the value system and worldview of the victims as they process the event (Parlotz, 2002).

Carroll (1998) discusses that spirituality is the essence of our lives. It has to do with fundamental human nature, and the human spirit is seen as the principle of life and vital energy. Schaefer and Moos (1997) present the same position, postulating that both ‘‘religion and spirituality involve a sense of the sacred and the recognition that there exists some power, life force, or divine being that transcends the material world and one’s personal experiences and existence’’ (p. 31). Therefore, it is important for social workers to have knowledge of emerging spiritual themes and understand how these themes can be integrated into theory and practice as it relates to post-trauma intervention.

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One of the most significant factors in assisting an individual with processing or reevaluating their worldview is through relationship with others (Tedeschi & Calhoun, 1995). Janoff-Bulman (1992) suggests that, by talking about the traumatic event, the survivor can revise the experience in ways that can be more manageable. Through the use of language, the individual is challenged to describe the experience and subsequently order it. The author states, ‘‘This need to talk is yet another manifestation of the mind’s motivation to confront, reconsider, and integrate the traumatic experience’’ (p. 108). Canda and Furman (1999) identify six attributes of the concept of spirituality. Two of these specifically relate to meaning and well-being. The authors indicate that searching for meaning and experiencing well-being is not a single solitary experience, but rather a ‘‘developmental process of wholeness in oneself and with others’’ (p. 44). Therefore, spirituality and meaning are not only discovered through private or internal processing, but also through interactive and communal activities.

Traumatic events are reminders of human mortality and vulner- ability. These reminders spark questions and searching for one’s purpose in life. Posttraumatic growth has the potential to emerge from an interactive therapeutic process that incorporates dialogue concerning spirituality, worldview, meaning formation, and effective coping strategies. When one experiences a life-altering event, promoting posttraumatic growth necessitates a spiritual therapeutic discourse. The remaining sections of this article involve an outline for clinical intervention that explicitly includes the subject of spirituality as part of the post-trauma counseling process. The following outline puts the construct of spirituality and transcendent meaning making at the fore, linking these concepts within approach, assessment, rumination, narrative construction, and spiritual self-care.

Approach

Creating an environment within which spirituality can be effectively explored requires a therapeutic approach that embraces exploration, difference, and collaboration. Examining one’s own belief systems and spiritual background is paramount to effective spiritual exploration, and should be a natural first step for social workers engaged in trauma counseling.

Practitioners should position themselves as learners, rather than experts (Clark, 2006). Smith (2006) cautions therapists to not

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overstep their bounds of knowledge and competency in treatment, and therefore therapists are cautioned not to push exploration of spirituality if the client does not desire it. They should dialogically explore and understand the client’s worldview through ‘‘phenomen- ological, inductive, collaborative, and reflective inquiry’’ (p. 2). It is essential to remain in the role of facilitator. Smith (2006) further states that genuineness is a key factor in exploring spiritual beliefs with a client. Sensitivity to cultural and spiritual differences is vital, and these are seen as distinct variables that influence one another: ‘‘each clinician should approach spirituality in trauma treatment with a discerning eye as to what is most appropriate to the client and the therapist’’ (p. 238). Carroll (1998), who views spirituality as a key dimension and the essence of human nature, believes that addressing spirituality with our clients is affirming the wholeness of their being; denying it restricts their potential for wholeness and creative transformation. Since spirituality is understood as highly personal, exploration, assessment, and treatment should involve consent, confidentiality, and sensitivity in the therapeutic relationship.

Assessment

Any effective intervention or counseling experience benefits from a solid assessment of the presenting problem, client resources, and coping ability. The same is equally true for individuals seeking assistance to manage the impact of a traumatic incident. Miller (2003) sees asking spiritual questions as a normal part of the counseling process. Questions may involve spiritual views, experiences, or resources. This questioning provides individuals with an opportunity to begin to move beyond the initial impact of the trauma and move toward interpretation and reevaluation. Hodge (2005) relates that often clients will spontaneously speak about spiritual resources during initial sessions. The practitioner is then open to acknowledge and validate these as strengths and explore their salience in the client’s life. This opens the door to a spiritual assessment and the use of spiritual tools for therapy to distinguish spiritual strengths, which may assist in overcoming difficulties.

Hodge (2005) attempts to find and operationalize spiritual strengths in clients through the use of qualitative tools such as spiritual histories, pictorial spiritual life maps, spiritual genograms, ecomaps, and ecograms. These approaches are based on a

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constructivist approach and use post-modern theory emphasizing the strengths of the client. These tools could be used as a concrete and visual technique of eliciting and exploring spiritual crises, themes, or issues related to the trauma experience. The use of spiritual histories may help clients tell their stories and more clearly illuminate beliefs or worldviews that are in conflict or have been shattered through the traumatic event. Life maps, similar to lifelines, allow a non-verbal concrete method of communication, which may stimulate a verbal dialogue connecting the spiritual aspect to the trauma. Spiritual genograms produce tangible and graphic depictions of complex intergenerational spiritual interactions and relationships through time. These could prove helpful in generating a pictorial depiction of how the spiritual component and trauma may be interconnected. Spiritual ecomaps focus on the client’s current spiritual relationships and highlight spiritual assets that could be useful in supporting the client through the trauma process. Spiritual ecograms combine the assessment of strengths in the present space and also access information that exists across time and could …