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A Qualitative Analysis of Psychotherapy with Clients Who Have Experienced Trauma

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A Qualitative Analysis of Psychotherapy with Clients Who Have Experienced Trauma Pepperdine University Pepperdine Digital Commons Theses and Dissertations 2013 Expressions of social support: a qualitative analysis of psychotherapy with clients who have experienced trauma Celine F. Crespi-Hunt Follow this and additional works at: https://digitalcommons.pepperdine.edu/etd Recommended Citation Crespi-Hunt, Celine F., "Expressions of social support: a qualitative analysis of psychotherapy with clients who have experienced trauma" (2013). Theses and Dissertations. 383. https://digitalcommons.pepperdine.edu/etd/383 This Dissertation is brought to you for free and open access by Pepperdine Digital Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Pepperdine Digital Commons. For more information, please contact [email protected] , [email protected]. Pepperdine University Graduate School of Education and Psychology EXPRESSIONS OF SOCIAL SUPPORT: A QUALITATIVE ANALYSIS OF PSYCHOTHERAPY WITH CLIENTS WHO HAVE EXPERIENCED TRAUMA A clinical dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Psychology by Celine F. Crespi-Hunt M.S. July, 2013 Susan Hall, J.D., Ph.D. – Dissertation Chairperson This clinical dissertation, written by Celine F. Crespi-Hunt under the guidance of a Faculty Committee and approved by its members, has been submitted to and accepted by the Graduate Faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY Doctoral Committee: Susan R. Hall, J.D., Ph.D., Chairperson Shelly P. Harrell, Ph.D. John Briere, Ph.D. © Copyright by Celine F. Crespi-Hunt (2013) All Rights Reserved TABLE OF CONTENTS Page LIST OF TABLES…………………………………………………………………. x DEDICATION…………………………………………………………………….. xi ACKNOWLEDGMENTS…………………………………………………………. xii VITA……………………………………………………………………………….. xiv ABSTRACT……………………………………………………………………….. xxviii Chapter I: Literature Review………………………………………………………. 1 Positive Psychology and Trauma………………………………………….. 2 Trauma……………………………………………………………... 5 Trajectories of Trauma…………………………………………….. 16 Negative Trajectories of Trauma………………………….. 17 Emergence of Resilience Research………………………… 20 Defining Resilience………………………………………... 22 Resilience as a Trajectory of Trauma……………………… 24 Understanding Resilience………………………………….. 25 Clinical Implications of Resilience………………………… 26 Growth Models…………………………………………….. 27 Resilience and Post-traumatic Growth…………………… 31 Defining Post-traumatic Growth…………………………. 31 Domains of Change………………………………………... 33 The Post-traumatic Growth Process……………………… 35 Time and Post-traumatic Growth………………………… 41 Post-traumatic Growth Assessment and Correlates……… 42 Clinical Implications and Applications of Post-traumatic Growth………………………………. 46 Social Support and Trauma………………………………………………... 48 Social Support Definitions and Constructs………………………… 50 Social Support Structures………………………………….. 52 Social Support Content…………………………….. 53 Functions of Social Support……………………….. 54 Received Social Support…………………………………… 57 Perceived Social Support…………………………………... 59 Extended Social Support…………………………………... 61 Social Embeddedness……………………………………… 64 Social Support Coping and Needs…………………………. 64 Summary of Social Support Constructs and Structures…… 67 Social Support Models and Post-traumatic Experiences………… 68 Page Personality Model………………………………………….. 69 Network Orientation……………………………………….. 70 Stress-buffering Model…………………………………….. 74 Deterioration Models………………………………………. 75 Erosion Model……………………………………... 76 Deterioration Model……………………………….. 78 Deterioration Deterrence Model…………………… 81 Etiological Models of PTSD that Involve Social Support…. 82 Social Support as a Predictor of PTSD…………….. 82 Appraisals of Trauma……………………………… 84 Social-cognitive Processing………………………... 86 Conservation of Resources………………………… 90 Social Support and Posttraumatic Growth…………………. 92 Self-disclosure……………………………………... 93 Mutual Support…………………………………….. 93 Alternative View of Social Support and PTG……... 94 Summary of Models……………………………………….. 95 Social Support and Psychotherapy with People Who have experienced Trauma………………………………… 97 Clinical Implications of Social Support and Trauma……… 98 Measurement of Social Support in Psychotherapy………… 100 Social Support and Therapy Modalities…………………… 107 Summary of Clinical Implications of Social Support……… 110 Purpose of the Study……………………………………………………….. 111 Chapter II: Methods………………………………………………………………... 112 Research Design…………………………………………………………… 112 Participants………………………………………………………………… 114 Client-Participants…………………………………………………. 114 Client-Participant 1………………………………………… 116 Client-Participant 2………………………………………… 117 Client-Participant 3………………………………………… 118 Client-Participant 4………………………………………… 120 Client-Participant 5………………………………………… 121 Researcher-Participants……………………………………………. 123 Coder 1…………………………………………………….. 123 Coder 2…………………………………………………….. 125 Coder 3…………………………………………………….. 125 Auditor……………………………………………………... 126 Instrumentation……………………………………………………………. 126 Received Support Codes…………………………………………… 127 Perceived Support Codes…………………………………………... 128 v Page Extended Support Codes………………………………………....... 128 Support Needs Codes………………………………………………. 129 Social Support Functions Codes…………………………………… 129 Social Support Content Codes……………………………………... 130 Other Social Support Codes……………………………………….. 130 Procedure…………………………………………………………………... 131 Sample Selection…………………………………………………... 131 Step 1: Obtain a List of Potential Participants……………... 131 Step 2: Narrowing the List Based on Demographic Inclusion Criteria………………………………….. 132 Step 3: Narrowing the List Based on Experiences of Trauma……………………………………………... 132 Step 4: Narrowing Selection Based on Discussions of Trauma……………………………………………... 134 Step 5: Selecting Specific Sessions………………………... 134 Step 6: Narrowing Selection Based on Cultural Diversity… 135 Transcription……………………………………………………….. 136 Coding……………………………………………………………... 136 Human Subjects/Ethical Considerations…………………………... 136 Data Analysis Approach…………………………………………… 138 Step 1: Transcription………………………………………. 138 Step 2: Highlighting………………………………………... 139 Step 3: Coding Selected Text……………………………… 139 Step 4: Submission of Codes to the Auditor……………….. 148 Step 5: Reaching Consensus on the Final Codes…………... 149 Step 6: Evaluation of the Coded Data……………………... 153 Step 7: Presentation of the Findings……………………….. 154 Researcher Bias……………………………………………………. 154 Chapter III: Results………………………………………………………………… 157 Content Analysis…………………………………………………………… 158 Findings Across Participants………………………………………………. 161 Support Content……………………………………………………. 161 Received Support…………………………………………………... 165 Support Functions………………………………………………….. 167 Support Needs……………………………………………………… 170 Other……………………………………………………………….. 171 Extended Support………………………………………………….. 173 Perceived Support………………………………………………….. 174 Findings Within Participants………………………………………………. 176 Client-Participant 1………………………………………………… 177 vi Page Client-Participant 2………………………………………………… 188 Client-Participant 3………………………………………………… 199 Client-Participant 4………………………………………………… 205 Client-Participant 5………………………………………………… 213 Chapter IV: Discussion…………………………………………………………….. 224 Trauma Experiences in the Sample………………………………………... 226 Expressions of Sexual Abuse and Rape…………………………… 227 Expressions of Physical Abuse and Violence……………………… 229 Expressions of Medical Traumas………………………………….. 230 Childhood Trauma…………………………………………………. 231 Social Support Expressions Across and Within Participants……………… 232 Support Content……………………………………………………. 232 Family Content: Primary and Secondary Kin……………… 234 Support Content: Service…………………………………... 236 Support Content: Sexual/Romantic………………………... 238 Friend Content: Other and Primary Friend………………… 239 Support Content: Other…………………………………….. 241 Support Content Not Identified: Affiliative and Mutual Aid…………………………………………….. 242 Received Support…………………………………………………... 244 Received Support Not Otherwise Specified……………….. 245 Positive Received Support…………………………………. 247 Negative Received Support………………………………... 248 Support Functions………………………………………………….. 249 Emotional Versus Other Support Functions……………….. 250 Emotional Support…………………………………. 251 Instrumental Support………………………………. 252 Advice/Informational Support……………………... 253 Social Companionship……………………………... 254 Esteem……………………………………………... 255 Feedback…………………………………………… 256 Support Functions: Not Otherwise Specified……… 257 Support Needs……………………………………………………… 258 Support Needs: To Others…………………………………. 259 Support Needs: From Others………………………………. 260 Support Needs: Not Otherwise Specified………………….. 263 Social Support Not Otherwise Specified…………………………... 264 Relationship Factors……………………………………….. 265 Future Support Activities…………………………………... 268 Past Perceived Support…………………………………….. 268 Past Support That Did Not Occur………………………….. 270 Extended Support………………………………………………….. 270 vii Page Extended Support Not Otherwise Specified……………….. 271 Negative Extended Support………………………………... 272 Positive Extended Support…………………………………. 274 Perceived Support………………………………………………….. 276 Positive Perceived Support………………………………… 277 Negative Perceived Support……………………………….. 281 Perceived Support Not Otherwise Specified………………. 286 Within-participant Discussion of Models of Social Support………………. 286 Network Orientation in Session 2………………………………….. 287 Stress-buffering Model in Session 4……………………………….. 289 Erosion Model in Session 5………………………………………... 290 Social-cognitive Processing Model in Session 3…………………... 294 Conservation of Resources in Session 1…………………………… 296 Observations of PTG Across Sessions…………………………….. 298
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