001

Table of Contents
 
Title Page
Copyright Page
Dedication
Foreword
TRAUMA LESSONS MORE OFTEN THAN TRAUMA LOSSES
About the Editors
About the Contributors
Acknowledgements
Introduction
REFERENCES
 
CHAPTER 1 - The Posttraumatic Growth Model
 
CULTURE AND PTG
SOCIOCULTURAL CONTEXT AND PTG: PROXIMATE INFLUENCES
SOCIOCULTURAL INFLUENCES AND PTG: DISTAL INFLUENCES
THE MODEL OF POSTTRAUMATIC GROWTH
CULTURAL INFLUENCES AND THE PTG MODEL: SPECIFIC CONSIDERATIONS
A CLINICAL FOOTNOTE: THE PROXIMATE CULTURE OF PSYCHOTHERAPY
REFERENCES
 
CHAPTER 2 - Posttraumatic Growth in Israeli Jews
 
MAIN CHARACTERISTICS OF ISRAELI SOCIETY
PTG IN ISRAELI STUDIES
IMPLICATIONS AND FUTURE DIRECTIONS
REFERENCES
 
CHAPTER 3 - Posttraumatic Growth in a Middle Eastern Context
 
NATURE AND MEANING OF PALESTINIAN TRAUMA
ARAB-ISLAMIC CULTURE AND STAMINA
MULTIPLE DOMAINS OF PTG
POSITIVE EXPERIENCE AS SELF-HEALING
DETERMINANTS OF PTG
SUMMARY
REFERENCES
 
CHAPTER 4 - Posttraumatic Growth in the Turkish Population
 
MODERN TURKEY: GEOGRAPHY, HISTORY, RELIGION, CULTURE
TRAUMAS IN TURKISH CONTEXT
EMPIRICAL KNOWLEDGE OF PTG IN TURKEY
A CASE EXAMPLE
IMPLICATIONS
REFERENCES
 
CHAPTER 5 - Thriving in Postwar Kosova
 
THE KOSOVAR CONTEXT
TRAUMA AND GROWTH IN KOSOVA
DISCUSSION
REFERENCES
 
CHAPTER 6 - Trauma and Posttraumatic Growth in Germany
 
THE GERMAN CONTEXT
THE GERMAN POSTTRAUMATIC GROWTH INVENTORY
TRAUMA RESEARCH AND GERMAN POLITICAL HISTORY
PSYCHOTHERAPY AND PTG IN GERMANY
CONTEMPORARY FINDINGS ABOUT PTG AND ITS CORRELATES
THE JANUS-FACE MODEL OF PTG
SUMMARY
REFERENCES
 
CHAPTER 7 - Posttraumatic Growth in the Netherlands
 
TRAUMATIC STRESS: HISTORY, RESEARCH, AND TREATMENT
PTG IN THE NETHERLANDS
SUMMARY
REFERENCES
 
CHAPTER 8 - Posttraumatic Growth in Spain
 
PTG IN SPAIN
SUMMARY
REFERENCES
 
CHAPTER 9 - Posttraumatic Growth in U.S. Latinos
 
LATINO CULTURE
PTG IN LATINO CULTURE
CASE ILLUSTRATION
FACILITATING PTG
REFERENCES
 
CHAPTER 10 - Posttraumatic Growth in Japan
 
THE CULTURAL BACKGROUND OF JAPAN
RESEARCH ON POSITIVE OUTCOMES OF TRAUMATIC EVENTS IN JAPAN
EMPIRICAL STUDIES USING THE PTGI-J
CASE EXAMPLES: POTENTIALLY CULTURE-SPECIFIC PTG
ISSUES IN CONSIDERING PTG FROM A CULTURAL POINT OF VIEW
SUMMARY
REFERENCES
 
CHAPTER 11 - Posttraumatic Growth in Chinese Culture
 
EMPIRICAL STUDIES OF PTG IN THE CHINESE CONTEXT
CLINICAL IMPLICATIONS
SUMMARY
REFERENCES
 
CHAPTER 12 - Posttraumatic Growth in Australian Populations
 
THE AUSTRALIAN CONTEXT
PTG RESEARCH IN AUSTRALIA
QUANTITATIVE ASSESSMENT OF PTG
QUALITATIVE ASSESSMENT OF PTG
IMPLICATIONS FOR CLINICAL PRACTICE
SUMMARY AND FUTURE DIRECTIONS OF PTG RESEARCH IN AUSTRALIA
REFERENCES
 
CHAPTER 13 - Posttraumatic Growth in International Study
 
SOCIOCULTURAL CONTEXT
PTG IN A CHINESE-AUSTRALIAN CONTEXT
PRACTICE IMPLICATIONS
REFERENCES
 
CHAPTER 14 - Posttraumatic Growth Around the Globe
 
REFERENCES
 
Author Index
Subject Index

001

To Ari, Bob, Dan, George,
and Tami who always help us grow
.

Foreword
003

TRAUMA LESSONS MORE OFTEN THAN TRAUMA LOSSES

The emerging concept of PTG is a kind of salve to the hurting soul of the traumatized. Most people have no unwanted consequences of trauma exposure and many gain valuable lessons. This is in contrast to the many years of PTSD research, which focused on the negative consequences. What is emerging in the current century is a growing recognition and appreciation of the resilience of the human spirit, despite the impact of major catastrophes such as the recent bush fires in Victoria, Australia, the Indian Ocean tsunami, the terrorist attacks in New York and Washington, DC, and Hurricane Katrina and the levee failures in the U.S.
Richard Tedeschi and Lawrence Calhoun in 1995 introduced the term PTG as a way of representing reports and later research findings about the beneficial effects of the struggle with traumatic events. This is the latest book to tap the experiences of researchers and practitioners around the world who have found the presence of PTG; that there are gems of good news among the sad and depressing stories of the traumatized. It is to their credit that PTG is now part of the assessments and theories most utilized by those helping the traumatized.
Tzipi Weiss and Roni Berger’s Posttraumatic Growth and Culturally Competent Practice: Lessons Learned from Around the Globe brings welcomed attention to applying PTG to culturally competent practice worldwide. They deliver on their promise imbedded in their title: Lots of lessons within the fourteen chapters.
The first chapter is written by the founding fathers of PTG (Calhoun & Tedeschi) with the help of Arnie Cann. Together they suggest that PTG researchers and practitioners must adopt a more sociocultural/contextual orientation for both measuring and predicting PTG. Their new model suggests that the active ingredient in understanding thriving among the traumatized is, among other things, the critically important indicator of resilience and thriving as the meaning making ingredient that is embedded within survivors’ culture.
The other chapters focus on widely divergent cultures and the application of culturally competent practices related to PTG. They include Israeli Jews, Palestinians, those in Turkey, Kosovo, the Germans, the Dutch, Spaniards, U.S. Latinos, Japanese, Australians, and the Chinese-Australians.
In the final chapter the editors call for research that can further develop the concept of PTG and how best to apply these findings toward promoting thriving and human development. This is easier said than done because PTG is, in essence, a re-framing of reality. When does re-framing become self delusion? To be blunt, when does PTG become a problem of perspective and reality? Some argue that PTG is often a temporary draft of meaning making; that later drafts are far more realistic. What is important, according to fundamental models of human development, is stability, low stress, and if there is stress, ways of returning to the set point. PTG is an indication of a cognitive shift among the traumatized.
Weiss and Berger, throughout their book, remind us that PTG is a representation of the societal values of the culture and the meaning making narratives they stimulate. Thus, for example, the chapter on Spain includes reports of how the collectivistic culture leads to a kind of “communal coping” via participation in political demonstrations. While the chapters show diversity in the structure of PTG across cultures, the cultural factors are the necessary but not sufficient ingredient in accounting for differences that often are affected by the interplay between culture and coping with adversity.
The reader will find that this book not only illustrates the expanding and culturally sensitive nature of PTG, but also the importance of culturally competent practice generally. This volume, through the editors and chapters authors’ contributions, challenges trauma researchers to be more culturally competent in their conceptualizing, planning, carrying out, and reporting the findings of those outside their own culture.
 
Charles R. Figley, PhD
Kurzweg Chair in Disaster Mental Health
Tulane University (New Orleans, USA)

About the Editors
004
Roni Berger, PhD, LCSW, was born and raised in Israel. Dr. Berger holds a BSW, MSW, and PhD from the Hebrew University of Jerusalem and a Diploma in Psychotherapy from Tel Aviv Medical School. She serves as a professor at Adelphi University, a consultant to various professional organizations, and maintains a private practice. Her fields of expertise are immigrants; families, specifically stepfamilies; posttraumatic growth; qualitative research; and group work. She published and presented extensively, nationally and internationally. Previous books include Stepfamilies: A multi-dimensional perspective, Immigrant women tell their stories, and From custodialism to community: Transforming residential settings (with H. W. Polsky). Dr. Berger serves on numerous editorial and advisory boards of professional organizations. Before her immigration to the United States in 1990, she worked in Israel in academia, in direct practice with individuals, families, and groups in the fields of health and mental health. She also held supervisory and administrative positions in diverse social, medical, and educational settings. Dr. Berger has received several awards and grants and served as a Fulbright scholar at the City University of Hong Kong.
 
Tzipi Weiss, DSW, LCSW, is an associate professor at Long Island University’s C.W. Post Department of Social Work and the director of the undergraduate program. She is a boardcertified expert in traumatic stress, an adviser to community organizations, and a clinician in private practice. She studied the biological, psychological, and social aspects of human behavior and received a BA from Tel Aviv University, an MSc from Israel’s Institute of Technology Medical School, an MA from Columbia University and MSW and DSW degrees from Adelphi University. She has worked in mental health agencies serving individuals, families, and groups, specializing in gerontology, psycho-oncology, and bereavement. Her research in the area of stress and coping has focused on posttraumatic growth, psychosocial aspects of breast cancer, and immigration. Dr. Weiss has published book chapters and articles in key professional journals, including Psycho-Oncology, The Journal of Psychosocial Oncology, and the Journal of Social and Clinical Psychology. She has presented in conferences in the United States and abroad.

About the Contributors
005
Aliriza Arënliu, PhD, was born in Kosova and received his doctorate in clinical psychology and psychotherapy at Ludwig Maximilians University in Munich, Germany. He currently serves as a lecturer at the Department of Psychology in the University of Prishtina and as a coordinator of the World Health Organization’s community mental health services in Prishtina, Kosova.
 
Yu Bai (Baiyu) was born and raised in Beijing, China. She holds a BA in biomedical engineering and a MPhil in psychology from Tsinghua University and is a PhD candidate at the University of Hong Kong. Her work has focused on group counseling for Internet-addicted college students. Her current research is on positive psychotherapy for depressed patients. In 2005, she was awarded MPhil dissertation at Tsinghua University, Beijing, China.
 
Arnie Cann, PhD, holds a BS in business administration from Northeastern University and a doctorate in social psychology from Indiana University. He has served as a Professor of Psychology at the University of North Carolina at Charlotte since 1975, where he teaches undergraduate and graduate courses in social psychology and research methods. His research focuses on the intersection of social and health psychology. He has published on topics like posttraumatic growth, the roles of humor and humor styles in coping with stress, and perceptions of individuals facing trauma, as well as gender stereotypes, gender roles, and intimate relationship issues. In collaboration with Lawrence Calhoun, he has conducted workshops on effective uses of humor for individuals in high stress occupations. He has served on regional and national executive committees for organizations promoting social psychology.
 
Lawrence G. Calhoun, PhD, is a professor of psychology at the University of North Carolina at Charlotte and a licensed clinical psychologist. Although his parents were North American, he was born and raised in Brazil but completed both his undergraduate and graduate studies in the United States. His scholarly activities are focused on the responses of persons encountering major life crises, particularly posttraumatic growth. He is co-author or co-editor of numerous books, including Dealing with Crisis (1976), Psychology and Human Reproduction (1980), Trauma and Transformation (1995), Posttraumatic Growth (1998), Facilitating Posttraumatic Growth (1999), Helping Bereaved Parents (2004), and The Handbook of Posttraumatic Growth (2006), and of more than 80 articles published in professional journals.
 
Winifred A. Cunningham is a registered psychologist at Monash University, Australia. She serves as the international student counselor and provides service to facilitate students’ successful adjustment to the university and helps them attain their optimal academic, career, and personal potential. She also coordinates research, resources, education, and training with as well as liaise with staff and relevant outside agencies in developing services and policy relative to international students.
 
Samuel M. Y. Ho, PhD, is an associate professor in the psychology department of the University of Hong Kong. His main areas of expertise are clinical psychology, positive psychotherapy, and resilience after traumatic events, including posttraumatic growth, clinical health psychology, and psychotherapy. Dr. Ho directs the Positive Psychology Laboratory of the psychology department. He has published in health and clinical psychology journals like Psycho-oncology and the Journal of Consulting and Clinical Psychology.
 
Cengiz Kiliç, PhD, graduated from Istanbul University Medical School in 1984 and specialized in psychiatry in Hacettepe University Medical School. He has served as a researcher at the Institute of Psychiatry. He currently serves as a professor of psychiatry at Hacettepe University Medical School in Ankara, where he combines teacher training, clinical work, and research, and as associate editor of the Turkish Journal of Psychiatry. His main foci are anxiety disorders and traumatic stress. After the major earthquakes in 1999, he served as a research and clinical supervisor in an international project led by the University of London Institute of Psychiatry, where he also completed his PhD. He has participated in the national epidemiological Mental Health Profile of Turkey survey and was a member of the International Consortium for Psychiatric Epidemiology.
 
Moshe S. Landsman, PhD, is the director of the Municipal Psychological Services at Arara Al-Nakeb in southern Israel, as well as a lecturer at Kaye Teachers’ College in Beer-Sheva, Israel. From 2001 to 2006, he was the director of the University of Prishtina psychology department project in Kosova, and at the moment works there as a professor in the department of psychology. He has been a social activist for many years, chairing the Israel Mental Health Workers for Peace. He is a member of the Central Committee of the Israel Psychological Association. A father of 7 and grandfather of 20, he is still addicted to the bicycle and the guitar.
 
Avital Laufer, PhD, received her degree in Health Sociology from Bar-Ilan University in Israel. Dr. Laufer serves as a lecturer at the Netanya Academic College and as a researcher at the Adler Research Center at Tel Aviv University. Her scholarship focuses on violence among Israeli youth, the implications of political stressors and terror on Israeli children’s and youth’s mental health and well-being, specifically as it relates to religious and ideological attitudes, as well as ideological criminality and psychological distress among youth involved in resistance to the disengagement plan from the Gaza Strip. She has received several awards, including the Inbar Fund Award for outstanding research in the field of terrorism and an award for dissertation excellence. She has published articles in scientific journals and contributed chapters to books.
 
Andreas Maercker, MD, PhD, was born in Halle/Saale (Germany). He was trained in medicine and psychology at the Universities of Halle and Berlin, and received his PhD in lifespan psychology. He serves as a professor of clinical psychology and psychotherapy at the University of Technology in Dresden, where he directs the posttraumatic stress disorder (PTSD) research and treatment center and as a member of the board of directors of the International Society of Traumatic Stress Studies (ISTSS). He was a research consultant at the World Health Organization Collaborative Group in Geneva, chair and professor of clinical psychology and psychotherapy at the University of Trier and chair and professor of abnormal psychology (psychopathology) as well as director of the Institute’s outpatient clinic services at the University of Zurich. Dr. Maercker has been principal and co-investigator in numerous national and international studies on traumatic stress and clinical gerontopsychology. His research focuses on clinical and epidemiological aspects of stress, the aetio- and pathogenic pathways of mental disorders and PTSD, complicated grief, and disorders of the elderly. Dr. Maercker has published extensively and authored or coauthored numerous books and diagnostic instruments. He is an editor and member of the editorial board of several peer review journals (Psychotherapie im Alter; Trauma und Gewalt - Forschung und Praxisfelder; Verhaltenstherapie).
 
Bronwyn Morris, PhD, is Senior Research Officer at the Cancer Council of Queensland. She received her degree from the School of Psychology at the University of Tasmania in Australia. Her scholarship is focused on health psychology, positive psychology, and the study of psychosocial adaptation to a cancer diagnosis and posttraumatic growth (PTG). Her preliminary work was published in the Journal of Traumatic Stress.
 
Mirjam J. Nijdam is a psychologist at the Center for Psychological Trauma in the Department of Psychiatry of the Academic Medical Center at the University of Amsterdam, the Netherlands, and an instructor in medical and psychology programs. She specialized in the diagnostic assessment and treatment of trauma and posttraumatic stress disorder and studied the comparative efficacy and efficiency of eye movement desensitization and reprocessing therapy (EMDR) and brief eclectic psychotherapy (BEP). She has been working on a project commissioned by the Dutch National Coordinator of Counterterrorism (NCTB) about the psychosocial aspects of close protection.
 
Marijke E. Oostingh, MSc, is a Dutch psychologist involved in a research project at the University Medical Centre at Groningen (UMCG) investigating the effects of late premature birth (32 to 36 weeks) on the neurological, intellectual, and motor development of children. She wrote her master’s thesis on posttraumatic growth in cancer patients and related personality factors. She is currently taking courses to become a remedial teacher and clinician for children with developmental, behavioral and learning problems.
 
Darío Páez was born in Chile, received his PhD from the University of Louvain, Belgium, and is currently a professor of social psychology at the University of Basque Country in Spain. He has published studies on collective memory, social identity, and the well-being of refugees, migrants, and persons who have been exposed to traumatic events, and is currently working on the impact of collective violence on culture and emotional climate and on collective processes of coping with traumatic political events. He has served as an editor and co-editor of special issues of the Spanish Journal of Social Psychology and Journal of Social Issues. He has also been a consultant to NGOs of human rights in Spain, Chile, Guatemala, Peru, Paraguay, and Ecuador. He has conducted workshops on trauma and posttraumatic growth for mental health and international organizations.
 
Grieteke Pool, PhD, was born and raised in the Netherlands. She works as a therapist, supervisor, and researcher at the University Medical Centre at Groningen, focusing on cancer survivors, specifically the trauma and grief related to their diagnosis and treatment, the process experience and meaning making and reported growth. She is involved in research projects concerning the role of attachment style in the process of adaptation after cancer and the development of interventions and building on her clinical experience as a music therapist with psychiatric patients. She teaches the use of nonverbal communication for self-expression and the processing of experiences at the School for Creative Art Therapies, Leeuwarden. She also works with a fund that supports international travel for young people diagnosed with incurable cancer.
 
Raija-Leena Punamäki, PhD, MBA, is a psychologist and professor at the University of Tampere, Finland. She specialized in child development and mental health in conditions of war and military violence. In cooperation with the Gaza Community Mental Health Program in Palestine, her specific topics have been resiliency, symbolic processes like dreaming and playing, family dynamics, and adult attachment in traumatized populations. Her research has focused on the rehabilitation of victims of torture and human rights abuse, the effectiveness of prevention and intervention programs for war-traumatized children, and mother-child interactions in life-endangering conditions. She is an active member of the Finnish Psychologists for Social Responsibility, a board member of the European Society for Traumatic Stress Studies, and the Finnish Academy of Science.
 
Jane Shakespeare-Finch, PhD, is a lecturer in the School of Psychology and Counseling at Queensland University of Technology in Brisbane, Australia. Her primary research interests are posttraumatic growth (PTG) and individual differences (for example, personality). Specifically, using both qualitative and quantitative approaches, she studies the promotion of PTG, psychological health, and resilience in diverse populations such as paramedics, cancer survivors, and African refugees as well as the influence of individual factors such as personality and coping on PTG and the role of organizations in promoting successful adaptation to stress and trauma generated by emergency service work. Dr. Shakespeare-Finch has published book chapters and articles both as sole author and in collaboration with Australian and international scholars, and presented at numerous national and international conferences.
 
Zahava Solomon, PhD, is a professor of psychiatric epidemiology and social work at Tel Aviv University and the head of the Adler Research Center for Child Welfare and Protection. Professor Solomon has served in the Israel Defense Forces as the head of the research branch in the medical corps (lieutenant colonel), as dean of the Bob Shapell Social Work School at Tel Aviv University, and as dean of special programs at Tel Aviv University. Prof. Solomon heads several longitudinal projects on traumatized veterans, ex-POWs, Holocaust survivors and children, adults, and the elderly exposed to terror. Some of these unique prospective studies assess PTSD trajectories over 20 years. Professor Solomon has published 6 books on psychic trauma-related issues, more than 250 articles, and more than 50 book chapters. She has served on the editorial board of the Journal of Traumatic Stress, been a member of the DSM-IV advisory subcommittee for PTSD, and has earned numerous Israeli and international awards and research grants, including the prestigious Laufer Award from the International Society of Traumatic Stress Studies for outstanding scientific achievement in the field of PTSD.
 
Kanako Taku, PhD, received her education in Japan: bachelor of education from Kobe University, master of education from Chiba University, and a doctorate in psychology from Nagoya University. Her work as a clinical psychologist has focused on loss and trauma. She has studied how people change psychologically, cognitively, socially, and spiritually after traumatic or stressful life events. In recent years, her research has focused on the construct of posttraumatic growth. At the University of North Carolina at Charlotte, where she worked from 2005 to 2008 as a research scholar, she co-authored several comparative articles on posttraumatic growth. She is currently examining the manifestation of posttraumatic growth in different sociocultural backgrounds and in different developmental stages.
 
Richard G. Tedeschi, PhD, received his BA in psychology from Syracuse University, his PhD in clinical psychology from Ohio University and completed his clinical psychology internship at the University of North Carolina School of Medicine. Dr. Tedeschi currently serves as a professor of psychology at the University of North Carolina at Charlotte, where he conducts research on trauma and posttraumatic growth, teaches personality and psychotherapy, and supervises graduate practica. He is a licensed psychologist specializing in bereavement and trauma, leads support groups for bereaved parents for a nonprofit organization in Charlotte and maintains a private practice. He has coauthored (with L. G. Calhoun) several books on parental bereavement and on posttraumatic growth, including Helping Bereaved Parents (Brunner-Routledge, 2004), and the Handbook of Posttraumatic Growth (Lawrence Erlbaum Associates, 2006). He has served as a consultant to the American Psychological Association in developing materials on trauma and resilience for psychologists and the public and has appeared in the APA/Discovery Channel documentary on coping with the terrorist attacks of September 11, 2001. He has provided workshops on trauma and posttraumatic growth for police and military groups as well as various universities and professional organizations.
 
Carmelo Vázquez, PhD, is a professor of psychopathology at Complutense University in Madrid, serves on the editorial board of national and international journals, and is a reviewer for international journals. He is the national representative of the European Network for Positive Psychology (ENPP), president of the Spanish Society of Positive Psychology, and has been coordinating the Spanish version of the Positive Psychology web site (www.authentichappiness.org). Over the past 20 years, he has conducted experimental studies on cognitive factors associated with psychopathology as well as research on positive emotions in survivors of natural disasters, terrorist attacks, and other adverse conditions. Dr. Vázquez has published in high-impact journals such as Psychological Bulletin, JPSP, and Clinical Psychology Review. He has served as a Fulbright visiting scholar at Northwestern University at Evanston, Illinois; as an associate editor of the British Journal of Clinical Psychology; as an external adviser to Doctors Without Borders to promote resilience among its staff working in emergency situations; and has received the European Association of Psychological Assessment (EAPA) Annual Award for Early Distinguished Scientific or Professional Contribution to Psychological Assessment. He has also co-authored and co-edited several books (Optimismo Inteligente [Intelligent Optimism, Madrid: Alianza Editorial, 1997; Psicologia Positiva Aplicada [Applied Positive Psychology] Desclee De Brower, 2008; and El Estudio Cientifico del Bienestar: Fundamentos para una Psicologia Positiva [The scientific study of well-being: Fundamentals of positiva psychology] Alianza Editorial, 2009).
 
Birgit Wagner, PhD, is a clinical psychologist and research associate at the Department of Psychopathology and Clinical Interventions at the University of Zurich, Switzerland. She has served as a research associate with the German research program Interapy and as a research associate in the Department of Clinical Psychology and Psychotherapy at the University of Trier, Germany. Her research focuses on the study of PTSD and complicated grief and Internet-based preventive programs to address it. She has facilitated workshops about PTSD, stress, and complicated grief and has published in peer-reviewed journals.
 
Thomas A. Whelan, PhD, is a senior lecturer of developmental psychology, counseling, and abnormal psychology in the School of Psychology, Psychiatry, and Psychological Medicine at Monash University, in Melbourne, Australia. Dr. Whelan’s research interests focus on parenting. He wrote the first research-based Australian book on step-parenting and has published most extensively on parents’ efforts to help children cope with illness and medical procedures. He has presented at national and international conferences.

Acknowledgments
006
Thanks to the following colleagues who reviewed this book and provided feedback:
Matthew Cordova, PhD—Veterans Administration Northern California Health Care System
Patricia A. Frazier, PhD—University of Minnesota
Anita Lightburn, PhD—Fordham University, New York
Marie L. Miville, PhD—Columbia University, New York
Cynthia Cannon Poindexter, PhD—Fordham University, New York
Ty Tashiro, PhD—University of Maryland

Introduction
007
The goal of this book is to introduce the reader to the evolving knowledge about posttraumatic growth (PTG) in cross-cultural contexts. This focus reflects the integration of two recent developments in the professional and clinical understanding of human adaptation to the universal phenomenon of trauma and coping with individual or familial (for example, serious illness and rape) or communal (for example, war and floods) stressor events (Bula Wise, 2007).
The first development is the growing recognition that in addition to the well-documented negative effects, struggling with highly stressful events has the potential for positive consequences and that a significant proportion of trauma survivors also report benefits and growth. Trauma has taken center stage in the global academic and professional arenas during the past decade following terrorist attacks in the United States and several European countries, natural disasters in Southeast Asia, such as the tsunami and earthquakes, and wars in the Middle East, Africa, and Eastern Europe. With the advent of positive psychology and the strength perspective in social work, trauma research and intervention shifted from an exclusive focus on negative consequences to including the potential for positive effects (Bula Wise, 2007; Calhoun & Tedeschi, 2006; Joseph & Linley, 2008). Several models have been developed to explain the latter, including the Life Crises and Personal Growth (Schaefer & Moos, 1992), Transformational Coping (Aldwin, 1994), Resilience and Thriving (O’Leary, Alday, & Ickovics, 1998) and The Organismic Valuing Theory of Growth through Adversity (Joseph & Linley, 2008). Leaders in the field are Tedeschi and Calhoun (1995), who coined the term posttraumatic growth to denote the perception of benefits from the struggle with highly stressful or traumatic events. They developed a conceptual model and offered a measurement instrument, the Posttraumatic Growth Inventory (PTGI), which has since been translated and used in over two dozen countries.
The second development is the increasing appreciation, driven by globalization (Sanchez, Spector, & Cooper, 2006), of the effects of culture on the meaning and manifestation of resilience and coping. A multicultural perspective consequently needs to be employed to attend to both universal (etic) and culture-specific (emic) aspects of traumatic exposure and its aftermath (Hawley & DeHaan 1996; Maddi & Harvey, 2006; Wong & Wong, 2006). The question of general versus unique aspects of PTG poses significant theoretical, methodological, and practice challenges. For example, PTG may mean one thing to a Caucasian Midwesterner in the United States and quite another to a farmer in a remote rural region of China. An ecological perspective offers the most appropriate lens for theoretical and clinical understanding of growth following the encounter with stressful events (Ungar, 2008). Also, reliable and valid culture-relevant instruments to measure PTG are critical to guiding practitioners around the world in their efforts to accompany those exposed to stressor events in the journey to recovery and support their attempts to grow (Weiss & Berger, 2006).
While the effects of culture on meaning making, manifestation, and ways of coping with trauma have been addressed (for example, in the Handbook of multicultural perspectives on stress and coping by Wong & Wong, 2006), the need for a similar compilation of knowledge relative to PTG remained unmet. Pointing to this gap in the trauma literature, Wong, Peker, and Peacock (2006) stated “Given the importance of the sociocultural context in shaping every aspect of the stress and coping process, the next major step in the psychology of effective coping needs to seriously consider culturally related variables” (p. 225). The current book addresses this challenge by spreading the rich and diverse tapestry of PTG knowledge acquired around the globe. Attention is paid to understanding aspects of PTG that hold across cultures as well as its unique nature and manifestations within specific cultures.
Chapters in this book are informed by the overarching approach of evidence-based practice (EBP), which dominates contemporary helping professions (Berger, 2009). EBP is the process of using a balanced combination of knowledge from current, high quality, rigorous empirical evidence with clinical expertise-based judgment regarding its applicability, and, with the consideration of unique preferences, values, and circumstances of a particular client system in the process of developing assessment and interventions (Gossett & Weinman, 2007). Thus, “EBP pushes the practitioner to improve the quality of decisions made by systematically reviewing information from rigorous data-gathering efforts” (McCracken & Marsh, 2008, p. 301).
Fidelity to EBP requires that the practitioner has access to knowledge about populations, issues, and interventions. Thus, contextualized knowledge is of utmost importance (Satterfield et al., 2009) to inform the understanding of trauma reactions and developing growth-fostering interventions that match the unique circumstances of clients. Nevertheless, much of the stress, coping, and resilience research has been decontextualized and the cultural milieu in which the stressful events occurred has often been ignored (Waller, 2001). Wong and Wong (2006) pointed out that “even when context is taken into consideration, cross-cultural comparisons are typically based on concepts and instruments rooted in Euro-American psychology” (p. 5) and informed by Western paradigms. Indeed, the conceptual models for growth from adversity discussed here are all European or U.S.-based. However, Sanchez and colleagues (2006) underscored “the need to ascertain whether psychological theories developed primarily in English-speaking countries can be transferred to other cultural settings” (p. 187). Even within countries such as the United States, the multicultural diversity of the population requires understanding and valuing differences in perception and interpretation of what constitutes adversity as well as in responding to stressor events and being transformed in their aftermath (Boss, 2002). For example, a recent meta-analysis indicated that benefit finding and health outcomes in U.S. cancer survivors were associated with race (Helgeson, Reynolds, & Tomich, 2006).
To provide the most current knowledge about PTG in cultural context, an international group of experts contributed chapters about PTG in the respective cultures in which they work. This resulted in a comprehensive volume that illuminates the nature, meaning, correlates, and clinical implications of PTG across a wide range of sociocultural contexts. In agreement with the principles of EBP, the authors discuss the specific cultural context (that is, knowledge about populations), the characteristics and meaning of stress, crisis, and growth, as well as empirical findings about PTG in the context of this culture (that is, knowledge about issues), and offer implications for practice (that is, knowledge about interventions).
The book includes fourteen chapters. In the first chapter, the original developers of the PTG model, in collaboration with their colleague Arnie Cann, discuss its most up-to-date version. From its inception, the model reflected the understanding that posttraumatic transformation is the product of an interaction between intrinsic personal and environmental factors. Key sociocultural variables were added in the 2006 revision. In Chapter 1, they define culture and discuss its implications for PTG. In Chapters 2 and 3, Laufer and Solomon, and Punamaki report about PTG in the two sides of the Israeli-Palestinian conflict. Chapters 4 and 5 bring reports from the Balkans, where Kilic reviews PTG in Turkey and Arënliu and Landsman present knowledge about PTG in survivors of the war in Kosova. The next cluster of three chapters (6 to 8) review PTG in European contexts including Wagner and Maercker’s work in Germany; Pool, Nijdam, and Oostingh’s report on the Netherlands; and, Vasquaz and Páez’s chapter on Spain. The discussion of PTG in Spain also creates a bridge to Chapter 9, which reviews knowledge about Latinos in the United States. The following cluster (Chapters 10 through 13) highlights PTG in the Asia-Pacific region, specifically Japan, Hong Kong, Australia, and Chinese international students in Australia. The concluding chapter culls the lessons from the discussions of PTG in the various chapters.
Because authors vary in both their cultural context and their professional backgrounds, the focus of some chapters is conceptual, others emphasize empirical findings, and yet others are more clinical in nature. Furthermore, the chapters address diverse universal as well as culture-typical stressor events. This diversity creates an interwoven fabric of multicolored perspectives on PTG in cross-cultural contexts. Equipped with this knowledge, practitioners will be ready to offer informed, differential, and culture-sensitive services to those who survived stressor events in different parts of the world and foster their ability to grow and harvest benefits from their ordeal.

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CHAPTER 1
The Posttraumatic Growth Model
Sociocultural Considerations
 
 
Lawrence G. Calhoun, Arnie Cann, and Richard G. Tedeschi
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The term posttraumatic growth (PTG) first appeared in print in 1995 (Tedeschi & Calhoun, 1995) and it has been defined as the experience of positive change resulting from the struggle with major life crises (Calhoun & Tedeschi, 1999). Although PTG, and related terms such as stress-related growth (Park, Cohen, & Murch, 1996), adversarial growth (Linley & Joseph, 2004), construed or perceived benefits (McMillen, Zuravin, & Rideout, 1995; Tennen, Affleck, Urrows, Higgins, & Mendola, 1992), and thriving (O’Leary & Ickovics, 1995), are relative newcomers, the idea of growth as a potential consequence of grappling with trauma1 is ancient (Tedeschi & Calhoun, 1995).
The assumption that facing and struggling with major difficulties in life can lead to positive changes, sometimes radical transformations, is part of ancient myth, literature, and religion. Influential clinicians and scholars of the twentieth century also suggested this idea (Caplan, 1964; Frankl, 1963; Yalom 1980). This assumption, then, is not something that was recently discovered. However, the systematic quantitative investigation of PTG is recent, made possible by the development of scales specifically designed to measure growth (Joseph, Williams, & Yule, 1993; McMillen & Fisher, 1998; Park et al., 1996; Tedeschi & Calhoun, 1996). These scales were first developed in Western, English-speaking countries, but now their translations and the investigation of PTG using them are found in many countries around the world; this very book provides a strong indication of how much work has now been done. Subsequent chapters examine PTG in a variety of different geographic and cultural contexts, and in this chapter our focus is somewhat theoretical and specific to the model of PTG that we have been developing over the years (Calhoun & Tedeschi, 1998, 2004, 2006; Tedeschi & Calhoun, 1995, 2004) and that we build upon in this chapter. We begin by briefly examining the concept and meaning of the word culture and we then suggest some elements of culture that may be particularly useful for looking at PTG in cultural contexts. We also provide a very brief look at our model of PTG, and then, using key components of our model, we offer some suggestions about how cultural factors may affect the possibility of PTG.

CULTURE AND PTG

The word culture and its variants are widely used in current social and behavioral sciences. It is often left undefined, but used as an explanatory concept for differences in attitudes, thoughts, emotions, and behaviors. There is no single definition of culture that is universally accepted, but the one proposed by Fiske (2002) seems to represent a good, current way of thinking about culture (Stuart, 2004). Culture is a “socially constructed constellation consisting of such things as practices, competencies, ideas, schemas, symbols, values, norms, institutions, goals, constitutive rules, artifacts, and modifications of the physical environment” (Fiske, 2002, p. 85). We assume that “culture is transmitted through . . . environmental influences” (Stuart, 2004, p. 3), with interactions with other people playing a major role (Brown, 2004).
The current accepted wisdom in North America, quite reasonably, is that culture has a significant impact on individuals; with rare exceptions, however, (Matsumoto, 2007) the processes whereby this broader and more general culture has an impact on individuals, couples, or families, are left unspecified. We suggest some factors and processes whereby cultural elements influence the behavior of individuals, particularly in the aftermath of traumatic events, both in present and close as well as in more abstract and removed ways. Several general frameworks have been suggested (Barker, 1965; Bronfenbrenner, 1977) and a variety of different terms have been used to describe the possible impact of broad sociocultural elements on the individual. We use two words to differentiate between levels of cultural influence: proximate and distal. Proximate influences come from real people with whom the individual interacts and distal cultural influences are either geographically removed or transmitted through impersonal media (for example, movies, books, television programs, or podcasts).

SOCIOCULTURAL CONTEXT AND PTG: PROXIMATE INFLUENCES

Individuals are influenced by their subcultures and by proximate influences, and an important one of these are the individual’s primary references groups (Stuart, 2004; Tedeschi & Calhoun, 2004). These are groups of people, either formally or informally organized, to which individuals belong and with whom they interact, for example, close friends, families, teams, gangs, and religious groups. It is beyond the scope of this chapter to specify in detail the processes whereby small groups control and influence their members. However, it seems reasonable to assume that positive or negative social responses (for example, reward and punishment) by the members of the groups, to what an individual says or does, will exert significant influence on that individual.
One major aspect of social responses to persons facing major stressors is the idioms of trauma, distress, coping, and growth. For example, phrases we have heard in some groups of Protestants in the Southeastern United States (these are anecdotal reports, not systematic surveys) are: “There are no coincidences; Everything happens for a reason; God has his reasons.” And we have also heard people say, “God never gives you more than you can handle.” These phrases imply that God has a master plan, and that events, even traumatic ones, are part of a great unfolding design. On the other hand, we have also heard individuals, not part of the Southern Protestant tradition, tell us, “Random shit happens,” indicating that they assume that their misfortune is part of living in a world in which events can be uncontrollable and can have purposeless consequences. Such different ways of speaking about and conceptualizing the crisis event and its aftermath may well be expected to have consequences for how others respond to the individual in crisis, influencing how well the individual copes and also influencing the degree to which PTG is experienced.
Additional proximate sociocultural influences are the social norms and rules (Argyle, Furnham, & Graham, 1981) of the primary references groups, especially those also endorsed by the individual. Following the customs and rules of the group would be expected to meet with social approval and their violation would be expected to meet with disapproval and perhaps elicit specific sanctions from group members (Garfinkel, 1967). In the context of facing major life crises, the primary reference groups’ rules regarding expected coping behavior, views about what helps, and, the desirability of emotional disclosure in general and in relation to growth in particular, would be expected to affect individuals’ responses to trauma.

SOCIOCULTURAL INFLUENCES AND PTG: DISTAL INFLUENCES

There are some intriguingly broad, societal narratives and views that may be relevant to the process of PTG. For example, one such broad narrative, identified as influential in the United States, is the “American experiment narrative” (Smith, 2003, p. 67). It is characterized by a sense of destiny, whereby the United States is called a “shining city on a hill . . . to guide a dark world into a future of prosperity and liberty” (Smith, 2003, pp. 67-68). Another general theme that appears to be present in the broader “American” (that is, U.S.) story, at least for highly generative persons, is what McAdams has called “redemptive life stories” (McAdams, 2006, p. 12). The primary element in this narrative is “ . . . Bad things happen to me, but good outcomes often follow. My suffering is usually redeemed . . . ” (McAdams, 2006, p. 10). Individuals living within the sphere of influence of broad, pervasive narratives are likely to be influenced by them (Smith, 2003). Such narratives may be particularly relevant to persons facing the difficult circumstances of major life stressors.
Posttraumatic Growth Inventory