Posttraumatic Growth in Relation to Domestic Violence Treatment
Posttraumatic Growth: From Victim
to Survivor to Thriver
Presenters:
Dr. Ron J. Llewelyn
Danette Larsen AMHC-I
Danette Larsen’s affiliations:
Lifestone Counseling
Dr. Llewelyn’s affiliations:
University of Phoenix, Valley Mental Health & The Center for Christian Therapy
Objectives
Learn about the theory,
research and utilization of
Posttraumatic Growth in
our everyday and
therapeutic interactions
with offenders and
survivors.
Be able to identify the
obstacles that limit a
person’s ability to become a
thriving individual.
Walk away with specific
methods to help those
effected by domestic abuse
The Corrective Therapeutic Experience
Is Everyone A Therapist?
Domestic Abuse
Domestic Abuse
As used in this chapter:
(1) "Cohabitant" has the same meaning as in Section 78B-7-102.
(2) "Department" means the Department of Public Safety.
(3) "Divorced" means an individual who has obtained a divorce under Title 30, Chapter 3, Divorce.
(4) "Domestic violence" means any criminal offense involving violence or physical harm or threat of violence or physical harm,
or any attempt, conspiracy, or solicitation to commit a criminal offense involving violence or physical harm, when
committed by one cohabitant against another. "Domestic violence" also means commission or attempt to commit, any of the
following offenses by one cohabitant against another:
(a) aggravated assault, as described in Section 76-5-103;
(b) assault, as described in Section 76-5-102;
(c) criminal homicide, as described in Section 76-5-201;
(d) harassment, as described in Section 76-5-106;
(e) electronic communication harassment, as described in Section 76-9-201;
(f) kidnapping, child kidnapping, or aggravated kidnapping, as described in Sections 76-5-301, 76-5-301.1, and 76-5-302;
(g) mayhem, as described in Section 76-5-105;
(h) sexual offenses, as described in Title 76, Chapter 5, Part 4, Sexual Offenses, and Section 76-5b-201, Sexual Exploitation of a
Minor;
(i) stalking, as described in Section 76-5-106.5;
(j) unlawful detention or unlawful detention of a minor, as described in Section 76-5-304;
(k) violation of a protective order or ex parte protective order, as described in Section 76-5-108;
(l) any offense against property described in Title 76, Chapter 6, Part 1, Property Destruction, Part 2, Burglary and Criminal
Trespass, or Part 3, Robbery;
(m) possession of a deadly weapon with intent to assault, as described in Section 76-10-507;
(n) discharge of a firearm from a vehicle, near a highway, or in the direction of any person, building, or vehicle, as described in
Section 76-10-508;
(o) disorderly conduct, as defined in Section 76-9-102, if a conviction of disorderly conduct is the result of a plea agreement in
which the defendant was originally charged with any of the domestic violence offenses otherwise described in
this Subsection (4). Conviction of disorderly conduct as a domestic violence offense, in the manner described in this Subsection
(4)(o), does not constitute a misdemeanor crime of domestic violence under 18 U.S.C. Section 921, and is exempt from the
provisions of the federal Firearms Act, 18 U.S.C. Section 921 et seq.; or
(p) child abuse as described in Section 76-5-109.1.
(5) "Jail release agreement" means a written agreement:
(a) specifying and limiting the contact a person arrested for a domestic violence offense may have with an alleged victim or
other specified individuals; and
(b) specifying other conditions of release from jail as required in Subsection 77-36-2.5 (2).
(6) "Jail release court order" means a written court order:
(a) specifying and limiting the contact a person arrested for a domestic violence offense may have with an alleged victim or
other specified individuals; and
(b) specifying other conditions of release from jail as required in Subsection 77-36-2.5(2).
(7) "Marital status" means married and living together, divorced, separated, or not married.
(8) "Married and living together" means a man and a woman whose marriage was solemnized under Section 30-1-4 or 30-1-6
and who are living in the same residence.
(9) "Not married" means any living arrangement other than married and living together, divorced, or separated.
(10) "Pretrial protective order" means a written order:
(a) specifying and limiting the contact a person who has been charged with a domestic violence offense may have with an
alleged victim or other specified individuals; and
(b) specifying other conditions of release pursuant to Subsection 77-36-2.5(3)(c), Subsection 77-36-2.6(3), or Section 77-36-2.7,
pending trial in the criminal case.
(11) "Sentencing protective order" means a written order of the court as part of sentencing in a domestic violence case that
limits the contact a person who has been convicted of a domestic violence offense may have with a victim or other specified
individuals pursuant to Sections 77-36-5 and 77-36-5.1.
(12) "Separated" means a man and a woman who have had their marriage solemnized under Section 30-1-4 or 30-1-6 and who
are not living in the same residence.
(13) "Victim" means a cohabitant who has been subjected to domestic violence.
Amended by Chapter 39, 2012 General Session
http://le.utah.gov/code/TITLE77/77_36.pdf
How do we screen for
domestic abuse?
Domestic Abuse & PTSD II
Psychological Trauma: The sudden
uncontrollable disruption of our
affiliative bonds.
Lindemann 1944
Domestic Abuse & Complex PTSD
•
Perception of self starts to change
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▫
▫
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▫
▫
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•
•
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May rationalize their behavior to others
May rational their behavior to self
May blame self for their behavior
Due to isolation, feels they are the only
one there for them
My become dependent upon them
May perceive them with unrealistic
power.
Perception of Close others & the World
▫
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•
Complex PTSD
Relational
Idealization of the Offender
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•
Lowered or lost confidence
Questioning own decisions
Questions if anyone loves them
Blames self for others leaving
Starts to feel defiled
Starts to feel helpless
Starts to feel hopeless
Feels shame, guilt and blame
Identifies with abuser language
Believes that options are few
Increase sense of insecurity
Increase in emotional states
Turning Against the Self
Due to isolation, may feel abandoned
Others will not understand
May see others as a threat
People have failed to rescue them
Self
Repeated
Trama
Offender
Others
Meaning
Physical-CognitiveEmotional
Somatic
Flashbacks
Dissociation
Affective
Dysregulation
Destruction of the Assumptive World
Janoff-Bulman
Epstein
We are not vulnerable
The World is a Source of Joy
The World is Predictable & Controllable
The World is Controllable
We Merit Self Worth
I am Competent & Good
I Feel Crazy
Strength Based/Wellness Enhancement
Posttraumatic Growth
What Is Posttraumatic Growth?
History of Posttraumatic Growth
Ancient texts
Strens (Hollister 1965)
Salutogenesis (Antonovsky 1979)
Resilience
Thriving (O’Leary & Ickovics, 1995)
The Role of Rumination
A cognitive processing
model
Attempts to understand
Attempts to create meaning
Counter-arguments
PTG not well
operationalized
Simply a coping strategy
Simply Positive Illusions
Posttraumatic Growth
Research Findings
Resiliency Factors
Individual
*Familial
Macro
•
•
•
•
•
• Nurturing
• Stable Home
• *Other
support
• Pro-social
organizations
Temperament
*Intellect
*Self worth
ILOC
Self-efficacy
* Most often reported
Areas of Posttraumatic Growth
Outcomes
Grubaugh & Resick, 2007
Improved self efficacy
Change in how one relates to others
Increased Spirituality
Aware of New Possibilities
Greater Appreciation for Life
Posttraumatic Growth
Research Findings (Limitations)
Operationalization
Measurement
Posttraumatic Growth
Research Findings
PTSD
PTG
• PTG does not = reduced PTSD
• Higher PTSD=Higher PTG
•
•
•
•
Higher amongst the spiritual
Higher amongst the supported
Higher with age
Does not reduce re-victimization
Our Role in Posttraumatic Growth
The Role of Disequilibrium
Primary Premise
“…the
reconstruction
of in
“…This
process
is anchored
meaning
is necessary
the meaning
that one
because
trauma
works
by
attributes to the traumatic
threatening or dismantling
incident
as
well
as
in
how
one
the individuals view of the
viewsself
oneself
andworld.”
the world.”
and the
(Cadell, Regehr & Hemsworth, 2003)
Porchaska
Precontemplation
Preparation
Resiliency
Contemplation
Action
Assessing for Strength Based
Competencies
“…the measurement of those emotional
and behavioral skills, competencies,
and characteristics that create a sense
of personal accomplishment; contribute
to satisfying relationships with family
members, peers, and adults; enhance
one’s ability to deal with adversity and
stress; and promote one’s personal,
social, and academic development.”
(Epstein & Sharma, 1998)
Assessment
Assess for resiliency factors
Assess for previous
successes
Assess for current attitude
Tedeschi and Kilmer 2005
•
•
•
•
•
Listen for evidences of strengths
Interests
Hopes
Give examples of previous struggles
Give examples of what you are good at and what
makes you proud (do they struggle with this,
initial response of the helper is to jump in and
help, which takes away their struggle to find
something).
• “What does that mean about you?”
Strength Based Assessments
• What do you want to accomplish in your life?
• What personal qualities are helping you move forward in this
direction?
• When people say good things about you, what are they likely to say.
• How would you know if things were going good in your life? What
brings genuine pleasure.
• How have you managed to overcome the challenges you faced (give
example).
• What have you learned about yourself and your world during your
struggles. (University of Wisconsin).
• Which of these difficulties have given you special strength, insight,
or skills?
• Who are you? (is this their own identity or the product of negative
introjections)
• Describe yourself (again negative introjective processes).
Corrective Therapeutic Experiences:
An In Depth Look at
Safety, Trust & Boundaries
The Person in Context
“…a multifaceted approach to
intervention is advocated:
targeting multiple potential risk
or protective influences rather
than one or two in isolation
greatly increases the likelihood
of positive outcomes.”
Stage one:
Stabilization
Primarily a personal experience
Education
Physical
Well Being
Self
Soothing
Primarily a social experience
Boundaries
Safety &
Safety
Planning
Trust
The Neurobiology of
the Fight or Flight
Response
Stressful
Event
Thalamus
This occurs
before
information
reaches the
Cortex
Cortex
Amygdala
Locus Coeruleus
Hypothalamus
Sympathetic NS
Pituitary
Adrenal Medulla
Thyroid
Thyroxin
Adrenal Cortex
Cortisol
Adrenaline
Noradrenalin
Adapted from Preston, O’Neal, & Talaga 2010
Neuro-anatomical Factors
Stage One:
Self Soothing
Breathing
Exercise/Activity
Clients discover
and adopt healthier
ways of coping with
stressors.
Guided imagery
Journaling/Writing
Art
Music
Nature
Stage One:
Psychosocial Redevelopment
(Herman, 1992)
Stage One:
Safety, Trust & Boundaries
Trust vs.
Mistrust/Oral
Autonomy
vs. Shame
& Doubt
The Paradox of Growth
Growth and
vulnerability go
hand in hand.
Developmental Models
Trust vs. Mistrust
Autonomy vs. Shame
& Doubt
Oral
Anal
Hope
Willpower
Purpose
Initiative vs. Guilt
Industry vs.
Inferiority
Genital
Competence
Latency
Fidelity
Identity vs. Role
Confusion
Intimacy vs.
Isolation
Love
Phallic
Generativity vs.
Stagnation
Care
Integrity vs. Despair
Wisdom
Homeostatic Mechanism of Attachment
“The attachment system acts as
a kind of homeostatic
mechanism for modulating
anxiety and stress by seeking
out an attachment figure for
security and protection.”
(Bowlby, 1978)
Janssen, C. G. C., Schuengel, C., & Stolk, J. (2002). Understanding challenging behaviour in people with severe and profound intellectual disability: A stress-attachment model. Journal of Intellectual
Disability Research, 46, 445-453.
Enhancing Posttraumatic Growth
through the Corrective Therapeutic
Experience
Repetition Compulsion
“The patient cannot remember the
whole of what is repressed in him, and
what he cannot remember may be
precisely the essential part of it…He
is obliged to repeat the repressed
material as a contemporary
experience instead of remembering it
as something in the past.”
• Sigmund Freud
Trust Vs. Mistrust
(Hope)
First World
Ontogenesis of
Hope
Delay of
Gratification/Abandonment
Trust
vs.
Mistrust
Autonomy
vs Shame
& Doubt
Passing the test…
Transference
The Stance
Transference
Testing
Neutral
Passive to
Active
Transformation
Disinterested
Repetition Compulsion:
Transference Testing
Transference
Testing
•Will you do
it?
Passive To
Active
Transformation
•Can you
handle it?
How To…
Exposure to others
in different stages
of Posttraumatic
Growth as a model.
Transference…
Focus on strengths
in all areas of life.
We control the
temperature…
Autonomy vs. Shame & Doubt
(Will Power)
Self Control without loss of self-esteem
Compulsive compliance
or impulsive defiance
Will Power
Autonomy
vs. Shame
& Doubt
Initiative
vs. Guilt
The Transference Neurosis
An Omnipotent Rescuer
An Unpredictable Abuser
Our desire
to save
Our
agenda
Our Own Issues
Inability to sit
with client
Our
projections
Or reenactments
Overly rigid
boundary
response
Overly
Permeable
boundary
response
We Should…
Herman (1997) pg. 135
Remain “Disinterested”
Remain “Neutral”
How can you tell?
Over engaged
with
or
Doa guest
you find
client?
yourself…?
Rebuilding the Assumptive World
• Recognizing the worth of each individual
• Helping (not forcing) envision a future full of
promise and potential
• Actively empowering guest in their care
• Celebrate changes to each persons’ sense of self
•
Turner, S. & Cox, H (2004) Facilitating post traumatic growth. Health and Quality of Life Outcomes, 2 (34).
Initiative vs. Guilt
(Purpose)
Development of
Superego
Development of
Roles
Finding Purpose & Self
Initiative
Initiative
vs. guilt
Industry
vs.
Inferiority
Industry vs. Inferiority
(Competence)
Take School & Cultural
Role
Development of
inadequacy
Competence
Industry
vs.
Inferiority
Identity
vs.
Identity
Confusion
Identity & Repudiation vs. Identity Confusion
(Fidelity)
Impulse Vs. Compulsive
Restraint
Self-Definition
Fidelity
Identity
vs.
Identity
Confusion
Intimacy
vs.
Isolation
Intimacy & Solidarity vs. Isolation
(Love)
Self Abandonment
“Way of Life”
The Defensive Wall
Intimacy
vs.
Isolation
Generativity
vs. Self
Absorption
Generativity vs. Self-absorption/Stagnation
(Care)
Dependency & Maturity
are Reciprocal
Guiding the Next
Generation
Relation to Stage 3
Generativity
vs. Self
Absorption
Integrity vs.
Despair
Integrity vs. Despair
(Wisdom)
Integrity of
experience
Letting go
Sign of conflict is
doctoring of memories
Generativity
vs. Self
Absorption
Thank You for Your Attendance
For further information contact
Dr. Ron J. Llewelyn at
ron@centerforchristiantherapy.com
Download PowerPoint and Handouts at
www.livingwaterscounselingllc.com