Exploring the Timing and Depth of Discussions of Traumatic Material and the Stages of Change in Psychotherapy: a Case Study

Pepperdine University Pepperdine Digital Commons Theses and Dissertations 2011 Exploring the timing and depth of discussions of traumatic material and the stages of change in psychotherapy: a case study Lauren A. DesJardins Follow this and additional works at: https://digitalcommons.pepperdine.edu/etd Recommended Citation DesJardins, Lauren A., "Exploring the timing and depth of discussions of traumatic material and the stages of change in psychotherapy: a case study" (2011). Theses and Dissertations. 136. https://digitalcommons.pepperdine.edu/etd/136 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], [email protected]. Running head: DISCUSSIONS OF TRAUMA Pepperdine University Graduate School of Education and Psychology EXPLORING THE TIMING AND DEPTH OF DISCUSSIONS OF TRAUMATIC MATERIAL AND THE STAGES OF CHANGE IN PSYCHOTHERAPY: A CASE STUDY A clinical dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Psychology by Lauren A. DesJardins May, 2011 Susan Hall, J.D., Ph.D. – Dissertation Chairperson This clinical dissertation, written by Lauren A. DesJardins 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 Hall, J.D., Ph.D., Chairperson Thema Bryant-Davis, Ph.D. Janine Shelby, Ph.D. © Copyright by Lauren A. DesJardins (2011) All Rights Reserved TABLE OF CONTENTS DEDICATION vii ACKNOWLEDGMENTS viii VITA ix ABSTRACT xiv Chapter I. Introduction and Literature Review 1 Discussion of Trauma 2 Understanding Trauma 2 Childhood Sexual Abuse and African American Women 3 Workplace Harassment and African American Women 5 Positive Psychology Perspectives on Trauma Outcomes 7 Pillars of Positive Psychology 8 Critiques of Positive Psychology 8 Problematic Trauma Outcomes 11 Positive Trauma Outcomes 13 Discussion of Interpersonal Abuse Trauma 16 Discussion of Child Abuse 17 Negative Effects of Trauma Discussion in Adults 18 Positive Effects of Trauma Discussion in Adults 19 Discussion of Trauma and the Therapeutic Alliance 20 Therapists‘ Reactions to Discussion of Trauma 22 Client‘s Experiences of Discussion of Trauma 23 Transtheoretical Model and the Stages of Change 27 Transtheoretical Model 27 Stages of Change 28 Processes of Change 30 Stages of Change and the Therapeutic Relationship 31 Measuring Stages of Change 33 Purpose of the Current Study and Research Questions 34 Chapter II. Method 35 Research Design 35 Participant 36 Researchers 38 Instrumentation 39 Determining an Experience of an Interpersonal Trauma 40 Determining Stages of Change 40 Determining Depth of Discussion of Interpersonal Trauma 41 Understanding the Context of Therapy 43 Procedures 45 v Sampling Procedure 45 Transcription 45 Coding 45 Human Subjects/Ethical Considerations 47 Data Analysis 48 Chapter III. Results 49 Course of Therapy 50 Session 1 51 Session 6 54 Session 7 56 Session 9 59 Session 12 62 Session 18 65 LIWC Analysis 67 Childhood Sexual Abuse 67 Workplace Psychological Harassment 69 Themes Analysis 73 Self-protection 74 Power and Control 77 Sense of Self 80 Gender Role Struggles 82 Emotional Difficulties 84 Job Dissatisfaction 88 Chapter IV. Discussion 90 Processing of Trauma 91 Trauma Experiences 91 Trauma Discussion 95 Stages of Change 98 Discussion of URICA results 98 Timing of Trauma Discussion 104 Depth of Trauma Discussion 110 Therapist Techniques 121 Methodological Limitations 124 Future Directions 130 Potential Contributions 133 REFERENCES 137 APPENDIX A. Client Information Adult Form 148 APPENDIX B. Intake Evaluation Summary 152 APPENDIX C. Telephone Intake Form 156 APPENDIX D. University of Rhode Island Change Assessment 160 APPENDIX E. Outcome Questionnaire 45.2 162 vi APPENDIX F. Working Alliance Inventory – Client 163 APPENDIX G. Working Alliance Inventory – Therapist 165 APPENDIX H. Brief Multidimensional Measure of Religiousness/Spirituality 167 APPENDIX I. Multidimensional Scale of Perceived Social Support 171 APPENDIX J. Treatment Summary 172 APPENDIX K. Training and Coding Manual 174 APPENDIX L. Themes Key 212 APPENDIX M. Client Consent Form 214 APPENDIX N. Therapist Consent Form 221 APPENDIX O. Researcher Confidentiality Statement – Coder 225 APPENDIX P. Research Assistant Confidentiality Agreement – Transcriber 226 APPENDIX Q. Data Tracking Sheet 228 APPENDIX R. LIWC Averages Sheet 231 APPENDIX S. Themes Tracking Sheet 232 APPENDIX T. Themes Occurrences Sheet 233 APPENDIX U. Stages of Change Diagram 235 vii DEDICATION This dissertation is dedicated to my loving family, for without their love and support I would never have survived this process. My parents, David and Cheryl, have always supported and encouraged me in every endeavor, and graduate school was no different. Without their love, support, and patience I would not have been able to accomplish my goals. Also, my little sister, Alison, has been the voice of reason when I thought I could not make it any further. Her words of encouragement have helped me to believe I can accomplish anything. Both of my grandmothers, Arlene and Celia, have provided me with the support and faith necessary to grow personally and professionally. I want to thank my loving boyfriend, Nicholas, who has supported me through the most critical part of this process. He has been my rock, studying alongside me, and pushing me to work my hardest, but also reminding me to relax. Additionally, this dissertation is dedicated to my caring and supportive friends, both old and new. My sorority sisters, who have continued to support and encourage me, I am thankful that they always understood when I disappeared and ―crawled into a hole.‖ Shireen (my person) and Chanel have been constant voices of warmth, kindness and encouragement throughout graduate school. This would not have been the same wonderful experience without their friendship and I am truly blessed to call them friends. Finally, my wonderful classmates, we truly have the best cohort and I am thankful to have gotten to know each and every one of you. viii ACKNOWLEDGMENTS I would like to acknowledge and thank all of those people who have helped contribute to the development and completion of this dissertation. First and foremost, my lab mates, Karina Campos and Whitney Dicterow. It was their constant support, encouragement and laughter that made the completion of this project possible. Without them by my side, the process would have been a lot less fun! I especially want to say thank you to Dr. Susan Hall, my chairperson. Her brilliance and wonderful guidance have made the dissertation process manageable and exciting. She helped me take a simple idea and transform it into the wonderful project I have had the pleasure to work on. Her dedication to me and my project has been beyond words and I am truly blessed to have had the pleasure of working with her. Additionally, I would like to thank my committee members, Drs. Bryant-Davis and Shelby. Their work and knowledge about the topic of trauma have greatly enhanced my dissertation project and the field of psychology as a whole. I am grateful that they were able to take the time and share their expertise with me. Finally, I would like to acknowledge all of the master‘s students whose hard work and dedication to transcribing the numerous therapy sessions made this possible. I wish them the best of luck in their future endeavors. ix VITA Lauren A. DesJardins Education Pepperdine University, Graduate School of Education & Psychology, Los Angeles, CA Doctoral Degree in Clinical Psychology (PsyD), Expected Graduation Summer 2011 Dissertation Title: Exploring the Timing and Depth of Discussions of Traumatic Material and the Stages of Change in Psychotherapy: A Case Study Clinical Competency Exam: Passed September 2009 Pepperdine University, Graduate School of Education & Psychology, Irvine, CA Master of Arts in Clinical Psychology, Emphasis Marriage and Family Therapy, June 2007 Chapman University, Orange, CA Bachelor of Arts in Psychology, English/Literature Minor, May 2005 Thesis Title: Media, Self-perception, and the Development of Eating Disorders in Adolescents Clinical Experience Metropolitan State Hospital, Norwalk, CA September 2010 – August 2011 Pre-doctoral Psychology Intern (APA Accredited) Rotation 1: Participate as a member of a multi-disciplinary treatment team on a co-ed forensic unit with individuals committed under penal codes 1370 and 1026. Responsible for treatment planning and WRP updates on a small caseload of individuals from the unit. Conduct short-term and long-term individual therapy with patients on the unit with a variety of diagnoses including schizophrenia, schizoaffective disorder, mood disorders, anxiety disorders, personality disorders, and substance abuse disorders. Perform psychological assessments including cognitive screenings, suicide risk assessments, diagnostic clarifications and behavioral guidelines. Co-lead/lead psychoeducational treatment groups with forensic psychiatric inpatients on a variety of topics including court competency, managing symptoms, anger management, cognitive therapy for psychotic symptoms and substance abuse. Participate in weekly individual supervision,

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