A Review of Loss,Trauma and Resilience: Therapeutic Work With Ambiguous Loss

Book reviewed in this article: Pauline Boss (2006). Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss.     

丧失、创伤及人类复原力

通过文献回顾,探讨丧失、创伤及人类复原力问题,以期促进人们对复原力的理解并为灾难创伤后民众的心理复原提供一些理论根据.研究发现,复原揭示的轨迹不同于恢复过程,面对丧失或潜在创伤时复原力比通常人们想象的更普遍,并且是通过各种不同途径来实现的.     

The Trauma and Complicated Grief of Ambiguous Loss

Ambiguous loss is a newly identified type of loss that occurs when a loved one is physically present, but psychologically absent. Dementia is just one example. Because the lost person is here, but not here, grief is frozen, life is put on hold, and people are traumatized. With no official verification of death, no possibility of closure, and no rituals for support, there is no resolution of grief (Boss 1999). Clergy, especially pastoral counselors, can witness and provide comfort for such uncanny loss because people rely on them for support, not just from the clear loss of death, but from the ambiguous losses, catastrophic and ordinary, that inevitably will occur across the life course.     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.     

The FOCUS Family Resilience Program: An Innovative Family Intervention for Trauma and Loss

This article describes the core principles and components of the FOCUS Program, a brief intervention for families contending with single or multiple trauma or loss events. It has been administered nationally to thousands of military family members since 2008 and has been implemented in a wide range of civilian community, medical, clinical, and school settings. Developed by a team from the UCLA and Harvard Medical Schools, the FOCUS Program provides a structured approach for joining with traditional and nontraditional families, crafting shared goals, and then working with parents, children, and the entire family to build communication, make meaning out of traumatic experiences, and practice specific skills that support family resilience. Through a narrative sharing process, each family member tells his or her story and constructs a timeline that graphically captures the experience and provides a platform for family discussions on points of convergence and divergence. This narrative sharing process is first done with the parents and then the children and then the family as a whole. The aim is to build perspective‐taking skills and mutual understanding, to reduce distortions and misattributions, and to bridge estrangement between family members. Previous studies have confirmed that families participating in this brief program report reductions in distress and symptomatic behaviors for both parents and children and increases in child pro‐social behaviors and family resilient processes.     

Multidimensional Assessment of Trauma Impact,Recovery, and Resilience

Abstract

This paper describes a recent effort to introduce Japanese clinicians to the Japanese language version of the Multidimensional Trauma Recovery and Resiliency (MTRR) measures. The MTRR was translated into Japanese and introduced to a group of Japanese clinicians to gather pilot data on trauma survivors in Japan. Although the sample size limits the generalizability of the results, the findings from a preliminary analysis of 27 cases provide promising results concerning the value of a Japanese version of the MTRR-99. Future psychometric studies of the MTRR-99, parallel to American studies of the English language version of the measure, remain to be conducted. The current investigation opens the door to a series of multicultural studies on trauma impact and resiliency.     

Spirituality and Resilience in Trauma Victims

The way people process stressors is critical in determining whether or not trauma will be experienced. Some clinical and neuroimaging findings suggest that posttraumatic stress disorder patients experience difficulty in synthesizing the traumatic experience in a comprehensive narrative. Religiousness and spirituality are strongly based on a personal quest for understanding of questions about life and meaning. Building narratives based on healthy perspectives may facilitate the integration of traumatic sensorial fragments in a new cognitive synthesis, thus working to decrease post-traumatic symptoms. Given the potential effects of spiritual and religious beliefs on coping with traumatic events, the study of the role of spirituality in fostering resilience in trauma survivors may advance our understanding of human adaptation to trauma.     

Exposure,Resource Loss,and Posttsunami Trauma

This study analyzed whether survivors’ resource loss mediates the effects of exposure on posttsunami trauma. Fourteen months posttsunami, 416 survivors were interviewed from the nine worst-affected habitations of the Nagapattinam district in Tamil Nadu (India). Exposure was measured using a checklist; trauma and resource loss were assessed using inventories. Findings indicate that the indirect effects of tsunami exposure on trauma via resource loss were a more potent predictor than the direct effects of exposure on trauma. Resource loss was a vehicle through which the effects of exposure passed on to posttsunami trauma.     

Infantile Trauma,Therapeutic Impasses and Recovery

Throughout his writings Ferenczi examines the role of the mother–infant relationship in healthy development as well as the difficulties that occur when that relationship is problematic. This paper using Ferenczi and Bion as theoretical background explores the clinical development of impasse in the treatment of hard to reach patients. These patients present special difficulty for analysis because they are not self reflective although they can be addicted to “processing,” which is in lieu of emotional connection. Impasse occurs when the analyst does not detect the mimicry involved in processing. The paper offers the idea of recovery, rather than repair, in that such patients have “gone missing” in infancy. Recovery of lost potential can be found in relationship with the analyst and with significant others.     

Asian Trauma Survivors: Immigration, Identity, Loss, and Recovery

Psychological trauma in Asian American communities has been increasingly visible in recent years. This paper examines the impact of several variables, including migration, interdependence of the Asian family structure, and acculturation on the experience of trauma. Case illustrations are discussed to illustrate the interplay of cultural ideology, family dynamics, and intrapsychic experiences in the lives of many Asian and Asian American trauma survivors. Psychotherapeutic issues are explored from cultural and psychodynamic perspectives.     

Conceptualizing Trauma and Resilience Across Diverse Contexts

Abstract

This paper offers a multicultural understanding of trauma and resilience as experienced in the lives of individuals from diverse cultural and racial backgrounds. The research and clinical literature on resilience has focused largely if not exclusively on individual personality traits and coping styles, and has neglected to explore all possible sources and expressions of resilience in individuals and groups. For many ethnic minorities, traditional notions of resilience, shaped largely by middle class European and North American values, may not capture culturally more familiar modes of positive adaptation to adverse and traumatic experience. This paper explores the concept of resilience as a multidetermined phenomenon, and considers the implications of this perspective for clinical research and intervention with ethnic minorities.     

Trauma and Resilience Among Refugee and Undocumented Immigrant Women

Migration and resettlement processes are often characterized by stressful and traumatic experiences. Immigrants may experience premigration trauma in their countries of origin and trauma during their migration journey. Furthermore, refugee and undocumented immigrant women navigate unique and ongoing stressors postmigration. In this study, the authors used a phenomenological approach to explore refugee and undocumented immigrant women's experiences of trauma and stress and the ways in which they develop resilience to cope with these experiences.     

Loss of Humanness: The Ultimate Trauma

This paper is about chronic illness and its impact on the chronically ill and their loved ones who live through the illness and the eventual death. A new concept is introduced, the concept of "passing": physically ill people may pass as healthy even though they are physically ill. In addition to a discussion about why people choose to pass, two major paradoxes are considered. One concerns the paradox that results from "passing." The paradox is that while the falseness of "passing" keeps the self alive, it also deadens it before death. Specifically, "passing" enables the person with a physical illness to keep his well self alive with others, but results in one feeling dead, disconnected, detached, and inauthentic, before death. The second paradox involves the pressure on the chronically ill person to be heroically agentic in fighting the illness and overcoming it and, also, the pressure for this same person to be totally submissive and compliant with treatment. While in analytic treatment, the ill person can be helped to access authentic emotions and aliveness and to feel the power of authenticity.     

儿童期创伤与有留守经历大学生负性情绪：心理韧性的调节作用

本研究旨在考察有留守经历的大学生儿童期创伤与负性情绪关系,以及心理韧性在其间的调节作用。对391名有留守经历的大学生进行间隔3个月的两次问卷调查。结果:(1)相较于没有儿童期创伤的个体,有儿童期创伤的个体心理韧性更低,抑郁、焦虑、压力水平更高;(2)在控制性别、城乡来源、是否独生、年龄与T1时间点负性情绪的作用后,T1时间点的儿童期创伤、心理韧性均能显著预测T2时间点的负性情绪;(3)低心理韧性水平下,儿童期创伤显著预测留守经历大学生的负性情绪;高心理韧性水平下,预测作用不再显著。表明儿童期创伤是有留守经历的大学生负性情绪的风险因素,心理韧性可以调节儿童期创伤对有留守经历大学生的负性情绪的预测。     

Loss and Resilience in the Time of COVID-19: Meaning Making,Hope, and Transcendence

This article addresses the many complex and traumatic losses wrought by the COVID-19 pandemic. In contrast to individually based, symptom-focused grief work, a resilience-oriented, systemic approach with complex losses contextualizes the distress and mobilizes relational resources to support positive adaptation. Applying a family resilience framework to pandemic-related losses, discussion focuses on the importance of shared belief systems in (1) meaning-making processes; (2) a positive, hopeful outlook and active agency; and (3) transcendent values and spiritual moorings for inspiration, transformation, and positive growth. Practice guidelines are offered to facilitate adaptation and resilience.     

Surviving and Thriving After Trauma and Loss

Abstract

Individuals and their communities experience trauma and loss during times of natural disaster. Using Hurricane Katrina as a context, the authors provide an overview of the phases of disaster coping and discuss the ambiguous losses that can occur during these traumatic and life-changing times. The use of rituals as a creative intervention is introduced to help individuals and families facilitate their grief processes.     

Exposure,Loss, and Support Predicting the Dimensions of Posttsunami Trauma

This study examined whether exposure, resource loss, and social support predicted the posttsunami trauma of PTSD, depression, negative affect, and physical health problems of the 2004 tsunami survivors. Four hundred sixteen survivors were interviewed in Tamil Nadu (India) 14 months posttsunami. Loss of life followed by loss of property and disaster exposure positively predicted the dimensions of trauma. Survivors having lower social status and income received less material and informational support than their equally affected counterparts, which furthered stress and distress. The survivors’ trauma can be arrested, minimizing the exposure and tangible resource loss, and improving the delivery of social support.     

No Ordinary Life: Complex Narratives of Trauma and Resilience in Under-Resourced Communities

This investigation examines the occurrence and impact of chronic adversity for young adults who grew up amidst poverty and community violence. Young adults in such contexts, particularly those who have been involved with the courts, are not commonly conceptualized through the developmental lens of complex trauma but rather described by maladaptive behaviors and risk to society. This grounded theory analysis explored how participants perceive and make meaning of their experiences. Interview data revealed consistent narratives of childhood neglect and psychological maltreatment, chronic loss, intergenerational trauma exposure, and the resulting survival-based adaptation. We identified 3 primary themes across the participant narratives: (a) lack of need fulfillment; paradoxical experience of self, others, and the world; and persistent sense of purpose and meaning. Findings illuminated the complexity of ongoing struggle, adaptation, and resilience in adult survivors. The need for an increased focus in trauma-informed treatment of adults in underresourced communities is discussed.     

Sexual Coercion,Trauma, and Sex Work in Justice-Involved Women with Substance Use Disorders

Sexual victimization is associated with mental health problems, trauma, substance use, and incarceration. We recruited 200 formerly incarcerated women with substance use disorders in Chicago. We examined whether empowerment moderates relationships between trauma symptoms, trading sex, and being forced to have sex. There was a significant 3-way interaction among sexual coercion, trading, and empowerment scores on trauma symptoms. For women who have not traded sex, lower levels of empowerment were associated with a larger difference in trauma symptoms between women who have been coerced or traded sex. For women who had been coerced, lower levels of empowerment were associated with a larger difference in trauma symptomatology between those who have traded sex or not. Promoting empowerment in sexually traumatized women might reduce the harm that results from being victimized. Furthermore, providing interventions that educate women regarding gender and cultural roles could help women avoid situations that result in exploitation.