Posttraumatic Change: Respecting the Narratives of Victims and Survivors of Violence

Background and Purpose: We know that individuals exposed to violent victimization experience varying degrees of post-traumatic stress (PTS) and other mental health effects following the violent event(s). For decades, trauma researchers have extensively examined posttraumatic stress (PTS) and posttraumatic growth (PTG) independently; however, few studies have examined these concepts as co-occurring entities. The purpose of this study was to explore the ways in which Canadian victims and survivors of violent crime describe and make sense of their posttraumatic experience(s).

Methods: This qualitative study drew on open-ended responses from a mixed methods online survey as well as follow-up interviews with Canadian victims and survivors of violent crime (N = 435). Data collection occurred between January to May 2017. Participants reported experiencing intimate partner violence (35%), sexual violence including childhood sexual abuse (32%), homicide or other violent death of a family member (22%), and other types of violence (e.g., physical assault, attempted murder, threats of violence or kidnapping; 10%) from less than 10 years prior (38%), 10 - 20 years prior (18%), and more than 20 years prior (42%). The mean age of survey participants was 47 years. Following the online survey, in-depth narrative interviews (n = 71) were completed with a subsample of survey participants. Interviews were transcribed verbatim by researchers. Qualitative responses from interview transcripts and survey responses were thematically analyzed using both inductive and deductive approaches. Multiple rounds of coding were conducted; five coders completed initial coding and three additional coders completed a second round of coding verification.

Results: Analyses resulted in multiple themes organized into three broad categories: 1) negative posttraumatic changes, 2) positive posttraumatic changes, and 3) resistance to the language of PTG. Participants who described negative or adverse consequences following their victimization spoke on the loss of current or future relationships, new psychopathologies, and disbelief or disillusionment with hospitals, healthcare agencies, the police, government, or the courts. Some participants described posttraumatic experiences they perceived to be beneficial such as a deepened sense of interpersonal connection, increased autonomy and agency, and increased care and concern for others. These participants highlighted their experiences were not because of the victimization but their response(s) to it. Many participants rejected the idea that one must experience violence in order to grow. Growth or survivor only language was difficult to reconcile for individuals that felt who they were died as a result of the violence. For others, the language of PTG was seen to minimize and mischaracterize their experiences. Still others presented narratives that existed along a continuum of harm and growth.

Conclusion and Implications: Results suggest the importance of approaching the posttraumatic experience with a focus on change; the concept of “posttraumatic change" captures the fluidity of posttraumatic experiences, which is often difficult for victims or survivors to frame with binary language that focuses only on stress or growth. Clinically, we must re-evaluate existing language and labels to be more inclusive and responsive to the needs and experiences of those who experience violent crime.