Work-related stress is a leading cause of mental health issues for the employee as well as disruptive to their employer. To manage this, many organisations have policies on work-related stress and provide trauma support, group diffusing or critical incident management as well as offering counselling for affected employees. These interventions may be helpful in alleviating problems of anxiety, post-traumatic stress and depression and lead to a reduction in sickness absence rates.1
However, in this article I propose that workplace support and counselling could go further by taking an explicit positive psychology approach, recognising that traumatic stress in the workplace is not only a problem to be solved but that it can also be a springboard for learning and development for the individual that can benefit the organisation.
Positive psychology at work
Positive psychology is the application of psychological science to the promotion of wellbeing and optimal functioning in individuals, organisations and communities.2,3 Considerable research has now accumulated showing the applications of positive psychology in a diverse range of contexts, including the workplace.4 Forward-looking organisations are turning their attention to what they can do to promote resilience and wellbeing and make the workplace a more efficient and pleasant environment where people can flourish. One area of application that offers great potential for bridging workplace counselling with the positive psychology approach is the new field of research and practice in post-traumatic growth.5,6
Post-traumatic growth
Research studies have shown that after experiencing a traumatic event, people often report three ways in which their psychological functioning increases.6 First, relationships are enhanced in some way. For example, people describe that they come to value their friends and family more, feel an increased sense of compassion for others and a longing for more intimate relationships. Second, people change their views of themselves in some way. For example, developing in wisdom, personal strength and gratitude, perhaps coupled with a greater acceptance of their vulnerabilities and limitations. Third, people describe changes in their life philosophy. For example, finding a fresh appreciation for each new day and re-evaluating their understanding of what really matters in life, becoming less materialistic and more able to live in the present. Such growth does not usually happen in the immediate aftermath of an event, but over time as the person cognitively processes the significance of their experience and accommodates new meanings.6
For an organisation whose employees routinely encounter highly stressful events, such as emergency service personnel, medical and nursing staff, social workers and others engaged in high intensity emotional work, such research is directly applicable. Exposure to the pain, suffering and traumatic experiences of others can lead to stress-related reactions. These reactions are often known as vicarious trauma. They can manifest in changes in systems of meaning, a lack of trust in others, and a disruption of the individual’s self-protective beliefs about safety, control, and predictability. Usually individuals working in such situations develop coping strategies in order to function effectively while engaged in such challenging tasks. Often many attempt to disengage emotionally in order to remain objective.
There may also be direct exposure to traumatic situations for firefighters and police officers, whose work can often involve risk to personal safety. Other workers, such as receptionists and teachers, who are attacked either verbally or physically, may also experience distressing psychological effects. What makes such stressful events traumatic for people is that they challenge the expectations, assumptions and values of the person. The greater the challenge, the more opportunity such events provide for growth and development, and the use of post-traumatic growth to leverage change in the workplace.7
Introducing THRIVE
THRIVE is a structured framework originally developed as a self-help framework6 to provide clients with six signposts for overcoming adversity and moving forward.
THRIVE: six signposts towards post-traumatic growth
Taking stock
Harvesting hope
Re-authoring
Identifying change
Valuing change
Expressing change in action
THRIVE can be adapted by therapists as a six-session educational and personal development programme which can also be used with individuals and groups as a process directive approach. The therapist needs to adopt a non-directive approach to the content, which needs to arise from the client, as we are not experts on what our clients should be feeling, or how they should think. They are their own best experts and we need to respect that and see ourselves as mutual companions alongside them on their journey. Each session begins with an opening from the therapist to introduce the signpost, beyond which they need to be responsive to the client’s direction and able to draw on exercises and techniques as appropriate, unless during the first assessment session it is considered that the client is in need of more intensive therapeutic support for post-traumatic issues.
Session 1: Taking stock
Opening: In this session I want to tell you about some of the common reactions people have following trauma, and help you understand what you have been going through, and check up on how you are right now.
It is important to make sure the client is safe and has the necessary advice and guidance appropriate to their situation. Advice needs to be tailored to the organisational context and delivered in a manner that will be palatable to the individual. This will often involve information on common trauma reactions with the aim of explaining to the person the nature of their stress-related reactions, the likely trajectory of their problems and the potential difficulties if not attended to. At this point it will be appropriate to also explain to the client the THRIVE model and what to expect over the subsequent sessions.
Some clients are overwhelmed by their memories of the traumatic event or locked into a pattern of avoidance behaviours. Often people get stuck in their traumatic memories, or in thoughts of what they did or failed to do, and until they are able to make sense of their memories, and rid themselves of feelings of shame or guilt, they will struggle to move in growthful directions. For this reason, we must be prepared to always work with whatever the traumatic material is. It is important not to rush this. The purpose of signpost 1 is to assess whether the client is able to move on to signpost 2 or whether they would be better advised to stay within ‘Taking stock’ until they are able to reduce their stress to tolerable levels. This may involve stress-reduction techniques, exposure-related exercises, and coping skills training. Once the therapist is confident that the client is no longer suffering from a full-blown post-traumatic stress reaction and they are able to manage any remaining reactions, it is appropriate to move on.
Session 2: Harvesting hope
Opening: Hope is the topic for this session. What do you imagine you’ll be doing in one year? Five years? You might struggle to answer that right now, but today you can begin to think about what you want your future to look like.
The idea of post-traumatic growth changes how we think about the aim of psychological support, which is not only about the alleviation of the problems, but the promotion of greater wellbeing and optimal functioning. There is a need to foster hope for the future. However, it is important that the practitioner does not push the idea of post-traumatic growth as this might cause the client pressure and anxiety as well as disappointment if they do not experience post-traumatic growth. Some people very quickly begin to see positive benefits arising from their experiences, but for others it takes longer. Either way, this is something that has to come from the client him/herself when they are ready. Suggesting to someone who has come through trauma that they ought to see positive benefits in their experiences is likely to push them towards a defensive position where they are hostile to the idea of positive change. At this stage, it is sufficient to help the client to begin to learn to be hopeful about their future. This typically will involve conversations with the client about inspirational stories of people who have overcome similar obstacles, exercises that require them to think through how they have overcome obstacles in their past and to understand that change may require small steps, taken one at a time.
Session 3: Re-authoring
Opening: I want you to focus on how you have made sense of what happened to you and what it means to you. How would you describe yourself if you had to choose between the words ‘victim’, ‘survivor’, or ‘thriver’?
Once hope has been established, the therapist can engage the client in conversation about the importance of finding a new perspective on what is troubling them. Techniques such as expressive writing may be useful where the client is stuck in a particular view, as well as the use of metaphors to make sense of the meaning of the experience. How a person makes sense of their experience, whether they use it constructively or destructively, is ultimately their choice, but the more we are able to stand back and respectively trust people to make their own decisions, the more likely they are to be constructive.
The therapist should aim towards an understanding of the client’s experience as it is for them. Our task is to understand what it was like for them, not what it would have been like for us, or what we think it should be like for them. In trauma therapy people tell us things that many people would find shocking or embarrassing, shameful or disgusting. If we want our clients to be able to feel safe to move in growthful directions, it is important that they feel accepted, no matter what they tell us.
Session 4: Identifying change
Opening: I want you to think about the ways in which you have changed since the event. I will ask you to complete a questionnaire that will give us some clues as to how things are different.
Once clients have begun to examine their experiences from different perspectives and look for new meanings, it is likely that they will have experienced some degree of growth, but it may also be that they are less than fully aware of such changes. As such, the aim of this session is to help clients notice their growth.
The Psychological Well-Being Post-Traumatic Changes Questionnaire (PWB-PTCQ)9 was developed to assess post-traumatic growth as defined by an increase in psychological wellbeing. It is an 18-item self-report tool in which people rate how much they have changed in self-acceptance, autonomy, purpose in life, relationships, sense of mastery, and personal growth. Often these dimensions of change go unnoticed in everyday life but deserve to be flagged up and nurtured. Counsellors will find the tool useful as it allows them to bridge their traditional concerns of psychological suffering with the new positive psychology of growth following adversity.9 The PWB-PTCQ is not used diagnostically but rather to open up a conversation with the client: eg ‘I notice you scored 1 for some of the items and 5 for some others?’
It is important for therapists to recognise that growth emerges from the struggle to make sense of the experience, not from the experience itself. The therapist must be careful not to suggest to clients that the traumatic event itself is to be welcomed as a good thing in their lives, but that it is an inevitable fact now of their lives and it is in their struggle to deal with it that something positive can emerge. Trauma inevitably has both negative and positive aspects, and each needs to be acknowledged. Once some degree of positive change has been noted by the client, it is appropriate to move on to the next session. Otherwise it is necessary to step back to session three and re-engage the client with the significance of the event for them.
Session 5: Valuing change
Opening: Last session we talked about the ways you have changed; today I want us to think about what really matters to you in life.
Typically, growth involves a shift in priorities about what is important and meaningful in life with the implication that older values that were once held in esteem are now less important. This will likely be at least implicit in the client’s understanding, but the task is to make this awareness explicit. As such, it may be useful to engage the client in a positive psychology gratitude exercise, where they are given the opportunity to reflect on what matters most to them.
Session 6: Expressing change in action
Opening: At the last session we talked about what really matters to you; at this session I want you to think about what you can do differently in your life.
The final activity is to coach the client towards setting new goals where they can actively seek to put post-traumatic growth into the external world. This may involve goal setting and making a plan of activity for the following week that involves doing concrete things.
Follow-up
It is recommended that a follow-up session is conducted to enquire about the success of the previous week’s activity and to ask the client to complete a final PWB-PTCQ. Follow-up data are also necessary to begin to provide evidence that THRIVE is helpful to people in overcoming adversity and moving forward.
Closing thoughts
For organisations whose clients experience trauma at work there are already many workplace initiatives to help employees deal with their reactions. Positive psychology offers a new perspective for counsellors where they can begin to think beyond the alleviation of suffering to the promotion of wellbeing. The new science of post-traumatic growth shows that it is possible for many people to experience positive changes in their lives and that as counsellors we can learn to leverage such changes in our clients to their benefit and to the benefit of the organisations that employ them
Stephen Joseph is a Professor in the School of Education at the University of Nottingham where he is convenor of the counselling and psychotherapy cluster. He is an HCPC registered counselling psychologist and is author of What doesn’t kill us: a guide to overcoming adversity and moving forward (Piatkus, 2013). www.profstephenjoseph.com
References
1 McLeod J. Counselling in the workplace: a comprehensive review of the research evidence. (2nd edition). Lutterworth: British Association for Counselling and Psychotherapy; 2007.
2 Seligman MEP. Flourish. New York: Free Press; 2011.
3 Joseph S (ed). Positive psychology in practice: promoting human flourishing in work, health, education and everyday life (2nd edition). Hoboken: Wiley; 2015.
4 Henry J. Applications of positive psychology in organisations. In Joseph S (ed). Positive psychology in practice: promoting human flourishing in work, health, education and everyday life (2nd edition). Hoboken: Wiley; 2015 (pp357–376).
5 Calhoun LG, Tedeschi RG (eds.) Handbook of post-traumatic growth: research and practice. Mahwah, NJ: Lawrence Erlbaum; 2006.
6 Joseph S. What doesn’t kill us: a guide to overcoming adversity and moving forward. London: Piatkus; 2013.
7 Murphy D, Durkin J, Joseph, S. Growth in relationship: a post-medicalised vision for positive transformation. In Tehrani N (ed). Managing trauma in the workplace. London: Routledge; 2010 (pp267–282).
8 Joseph S, Murphy D, Regel S. Post-Traumatic growth in police officers: guidelines for facilitating post-traumatic growth. In Freeman Clevenger SM, Miller L, Moore BA, Freeman A (eds). Behind the badge: a psychological treatment handbook for law enforcement officers. New York: Routledge; 2015 (pp256–268).
9 Joseph S, Maltby J, Wood AM, Stockton H, Hunt N, Regel S. Psychological wellbeing post-trauma changes questionnaire: reliability and validity. Psychological Trauma: Theory, Research, Policy, and Practice 2012; 4(4): (420–428).