Nova Southeastern University NSUWorks Department of Family Therapy Dissertations CAHSS Theses, Dissertations, and Applied and Applied Clinical Projects Clinical Projects 2018 A Grounded Theory Investigation of Adaptations to Adverse Childhood Experiences Jeffrey Michael Friedman Nova Southeastern University, [email protected] Follow this and additional works at: https://nsuworks.nova.edu/shss_dft_etd Part of the Marriage and Family Therapy and Counseling Commons, and the Social and Behavioral Sciences Commons Share Feedback About This Item NSUWorks Citation Jeffrey Michael Friedman. 2018. A Grounded Theory Investigation of Adaptations to Adverse Childhood Experiences. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Arts, Humanities and Social Sciences – Department of Family Therapy. (32) https://nsuworks.nova.edu/shss_dft_etd/32. This Dissertation is brought to you by the CAHSS Theses, Dissertations, and Applied Clinical Projects at NSUWorks. It has been accepted for inclusion in Department of Family Therapy Dissertations and Applied Clinical Projects by an authorized administrator of NSUWorks. For more information, please contact [email protected]. A Grounded Theory Investigation of Adaptations to Adverse Childhood Experiences By Jeffrey M. Friedman A Dissertation Presented to the College of Arts, Humanities, and Social Sciences of Nova Southeastern University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nova Southeastern University November 2018 Copyright Jeffrey M. Friedman April 2018 Nova Southeastern University Graduate School of Humanities and Social Sciences This dissertation proposal was submitted by Jeffrey M. Friedman under the direction of the chair of the dissertation committee listed below. It was presented to the College of Arts, Humanities, and Social Sciences and approved in partial fulfillment for the degree of Doctor of Philosophy in Family Therapy at Nova Southeastern University. Dedication To my mother for being my secure base. To my chair, Dr. Jim Hibel, for being supportive of my work and guiding me through this process. To all traumatized youth adults at home and abroad: “Healing is possible.” To all veterans at home and abroad: “War is trauma,” and the psychological wounds can be much more insidious than the physical wounds. iv ACKNOWLEDGMENTS To Dr. Jim Hibel, my chair: You have contributed to my understanding that one cannot assume to know if an event was traumatic for an individual without directly asking the individual to share his or her lived experience. v TABLE OF CONTENTS ACKNOWLEDGMENTS .................................................................................................. v LIST OF TABLES ........................................................................................................... viii ABSTRACT ....................................................................................................................... ix CHAPTER I: INTRODUCTION ........................................................................................ 1 Purpose and Goals of this Study ............................................................................. 3 CHAPTER II: LITERATURE REVIEW ........................................................................... 6 Trauma .................................................................................................................... 6 Resilience .............................................................................................................. 17 Theory ................................................................................................................... 33 Therapy ................................................................................................................. 37 Abuse .................................................................................................................... 45 Catharsis ................................................................................................................ 48 CHAPTER III: METHODOLOGY .................................................................................. 49 Self of the Researcher ........................................................................................... 49 Data Collection ..................................................................................................... 61 Data Management ................................................................................................. 64 Data Analysis ........................................................................................................ 65 Summary ............................................................................................................... 72 CHAPTER IV: RESEARCH FINDINGS ........................................................................ 74 Participant Demographic Information .................................................................. 74 Trauma Themes and Subthemes ........................................................................... 76 vi Resilience Themes and Subthemes ....................................................................... 83 Summary ............................................................................................................. 107 CHAPTER V: DISCUSSION AND IMPLICATIONS OF THE STUDY ..................... 109 Doubled-Edged Traits ......................................................................................... 111 Trauma Themes and Subthemes ......................................................................... 112 Resilience Themes and Subthemes ..................................................................... 122 Theory ................................................................................................................. 147 Empathy Is Resistance ........................................................................................ 152 Recommendations for Future Research .............................................................. 157 Limitations .......................................................................................................... 165 Conclusions ......................................................................................................... 166 REFERENCES ............................................................................................................... 177 APPENDIX A: PARTICIPANT CONSENT FORM ..................................................... 234 APPENDIX B: BIOGRAPHICAL SKETCH ................................................................. 237 vii LIST OF TABLES Table 1. Participant Demographics ................................................................................... 74 Table 2. Themes and Subthemes ...................................................................................... 75 viii ABSTRACT Adverse childhood experiences (ACEs) include childhood sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect, and household dysfunction. Much has been reported about the detrimental outcomes associated with these experiences. The associated negative outcomes of ACEs can include addiction, suicide, disability, teenage pregnancy, and early death. However, it is well known that many people experience ACEs and do very well. Rather than viewing negative outcomes only as symptoms of trauma and positive outcomes only as signs of resilience, it is possible to consider adaptations. This study focused on how adults adapted to their adverse childhood experiences. Data were collected based on semistructured interviews with nine members of the ACEs Connection Social Network, an online support group. The data were analyzed using a constructivist grounded theory methodology. A grounded theory then emerged from data, supporting the adaptation construct. Keywords: ACEs, trauma, resilience, grounded theory, narrative family therapy, posttraumatic growth, double-storied testimony ix CHAPTER I: INTRODUCTION The term adverse childhood experiences (ACEs) refers to childhood sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect, and household dysfunction. The term household dysfunction applies to environments in which a child under the age of 18 lives with one or no parents or whose parent is treated violently, is a substance or alcohol user, has a mental illness, or is involved with the criminal justice system (Chapman et al., 2004; Felitti et al., 1998). The Adverse Childhood Experiences (ACE) study was developed by two family physicians, Robert Anda and Vincent Felitti (Felitti et al., 1998). Initially, these physicians operated a weight loss clinic (Lynch, Waite, & Davey, 2013). While running the weight loss clinic, Anda and Felitti discovered many of their patients were using obesity as a defense mechanism for protecting against unwanted sexual advances (Lynch, Waite, & Davey, 2013). Participants who had dropped out of the weight loss program reported experiencing sexual or physical abuse during childhood (Anda & Felitti, 2003). In fact, almost all the non-responders to the program had a history of sexual abuse (Anda & Felitti, 2003). Consequently, these significant findings led to the development of the ACE study. The original ACE study was conducted by the Center for Disease Control (CDC); researchers examined adults’ retrospective reports of stressful and traumatic childhood experiences and compared these reports with their current physical and mental