Women's voices on recovery: A multi-method study of the complexity of recovery from child sexual abuse☆,☆☆
Introduction
Merrill, Thomsen, Sinclair, Gold, and Milner (2001) describe “third generation” studies in the field of child maltreatment that go beyond documenting prevalence and direct links between abuse and negative outcomes to a more complex analysis of intervening mediating and moderating processes. One part of this developing area of research focuses on notions of resilience and recovery to understand variability within groups of survivors. While a growing volume of research on this topic has examined samples of children, less attention has focused on adult survivors (Luthar, Cicchetti, & Becker, 2000). This paper uses longitudinal data from a sample of female survivors of child sexual abuse to examine in an exploratory manner aspects of resilience and well-being across the early adult portion of the lifespan.
A central question in this work has to do with definitions and terminology (e.g., Glantz & Sloboda, 1999). Masten, Best, and Garmezy (1990) described three types of resilience, including individuals who exhibit exemplary outcomes after adversity, those who while not exceptional in their functioning show positive development in the context of adversity, and finally those who may initially show negative consequences of trauma but over time recover adaptive functioning. Some researchers have applied these findings to an understanding of adult survivors of trauma (e.g., Bonanno, 2004, Carver, 1998, Harvey, 1996, Poorman, 2002). Palmer, 1997, Palmer, 1999 challenged models of resilience that reflect a more linear pattern of increasing growth across time. Harvey described a model of resilience composed of several stages or types of resilience and using qualitative data showed how individuals may move back and forth between these levels over time. Her work fits with that of Barringer (1992) who described survivors’ healing process from child sexual abuse not as linear but “as spiral, as a repeated traversing of the issues, layer by layer, piece by piece, sorting and resorting, until the toxicity of the abusive experiences has been released (p. 15).” Luthar et al. (2000) provided a definition to span such complexity. They stated, “resilience refers to a dynamic process encompassing positive adaptation within the context of significant adversity (Luthar et al., 2000, p. 543).” They further note “that positive adaptation despite exposure to adversity involves a developmental progression, such that new vulnerabilities and/or strengths often emerge with changing life circumstances (p. 544).” An important implication of this is that all elements of resilience are not necessarily captured in childhood but should be examined across the lifespan (Grossman, Cook, Kepkep, & Koenen, 1999; Luthar et al., 2000, Palmer, 1997; Stein, Fonagy, Ferguson, & Wisman, 2000). The current study is grounded in this broad definition while focusing on a sample that exemplifies Masten et al.'s third “recovery” category.
Studies of resilience examine factors within the individual and at varying levels of context beyond the individual to both measure and explain resilience (e.g., Waller, 2001). For example, Rutter's (1987) classic discussion of resilient children identified four processes that contribute to resilience including those at the intrapersonal level (e.g., self-esteem and cognitive appraisal) and those that involve interactions with the environment such as how opportunities are presented at life turning points (e.g., support to complete high school or resources to reduce other negative events associated with the trauma or adversity). Kaplan (1999) and Waller (2001) review work on children by Garmezy and others that finds resilience promoted by individual factors like cognitive skills as well as interpersonal relationships including the presence of a supportive adult in a child's life and broader community factors such as sense of community and opportunities for involvement in positive and supportive environments and activities. Extending such discussions to work with adult survivors of abuse, Harvey (1996) described the need for more research on survivors who recover outside of traditional psychotherapy to understand their strengths. Grossman, Cook, Kepkep, and Koenen's work (1999) revealed the powerful roles of psychotherapy, spirituality, connections to others, altruism, and employment in resilient functioning among adult survivors of child sexual abuse. Carver (1998) highlighted the need for further study of how variables such as optimism, coping skills, and social support may be related to growth following traumatic events. Other studies show the impact of variables such as coping, social support, and community ties on mental health (e.g., Hobfoll, Jackson, Hobfoll, Pierce, & Young, 2002; Merrill et al., 2001). The purpose of the current study was to continue to examine such ecological protective factors among adults recovering from childhood trauma.
Such ecological models also inform the definition and measurement of recovery and resilience. These models lead to the conceptualization of resilient outcomes in terms of components at the intrapersonal, interpersonal, and broader community levels (e.g., Harvey, 1996, Harvey et al., 2003; Luthar & Cushing, 1999). What follows from this is the need to conceptualize a resilient outcome as a multi-method measure that examines functioning in a number of different domains (e.g., Harvey, 1996, Harvey et al., 2003; Luthar & Cushing, 1999). Luthar and Cushing (1999), for example, review research using composite measures of functioning across several domains.
Future research to examine these questions should also use a multi-method approach in terms of blending qualitative and quantitative tools. For example, discussions of qualitative research have highlighted its utility as a tool for rich descriptions of phenomena. Such detail and texture are useful both for understanding “the ‘why’ of human behavior” (Banyard & Miller, 1998, p. 498) and for laying the foundation for further quantitative study. Banyard and Miller discuss how qualitative research can complement quantitative findings, helping explore and make sense of more quantitative findings. Given that the majority of research on concepts of resilient functioning has focused on children the rich description offered by qualitative methods and narrative inquiry seemed appropriate for an exploratory understanding of resilience and recovery processes in early adulthood (e.g., Harvey, Mishler, Koenen, & Harney, 2000). Indeed, several qualitative studies of this issue have been recently published and make this point (e.g., DiPalma, 1994, Grossman et al., 1999, Harvey et al., 2000; Morrow & Smith, 1995; Poorman, 2002; Valentine & Feinauer, 1993). Grossman et al. (1999) discuss the limitations of an exclusive reliance on questionnaires and statistics that hide the unique texture of individual lives. They state, “We wanted to give voice to survivors, who have too often been silenced and who have important knowledge to impart to those of us in mental health professions. For these and other reasons, we decided to learn through interviews (p. 23).” The current study sought to build on this earlier work by combining both quantitative and qualitative findings.
The current analyses are exploratory and primarily descriptive. Multiple methods are used to examine aspects of resilience and recovery in the lives of female survivors of child sexual abuse (CSA) across 7 years of early adulthood. First, quantitative changes in measures of resilience over time were examined. To what extent did women stay the same, increase, or decrease in functioning in a variety of spheres across 7 years during early adulthood? Next, the role of re-traumatization as an impediment to ongoing resilience and correlates of growth or increased well-being over time were examined. Finally, because resilient processes in adulthood have not been the focus of much research and require further description, qualitative data from a subset of participants was used to examine survivors’ own narratives about recovery and healing to learn about key aspects of resilience in women's own words.
Section snippets
Participants in the quantitative structured interview (longitudinal data)
The participants in the study were women who were interviewed at three time points as part of a longitudinal study (details of the sample including methods of re-contact and retention have been published in detail elsewhere, Banyard, Williams, & Siegel, 2001; Williams, 1994). For the current analyses, data on the child sexual abuse experience come from the wave 1 interview and documented hospital records. These interviews were conduced in 1973–1975 with girls (aged 10 months to 12 years) and
Resilience as a predictor of functioning
Pearson correlations were used to examine the relationship between resilience scores measured at wave 2 and mental health symptoms self-reported at wave 3 (approximately 7 years later) and reports of re-exposure to trauma between waves 2 and 3 (Table 1). Not surprisingly, higher resilience scores at wave 2 were related to fewer symptoms of a variety of forms of psychological distress and were also a protective factor for less trauma exposure between waves 2 and 3. It should be noted that
Discussion
The current study used multiple methods to examine women's experiences with resilience as adults following a childhood marked by sexual abuse. Quantitative findings showed that resilience was often stable and was protective, associated with reduced risk for such things as re-exposure to trauma. Earlier resilience was also associated with more active and positive later coping and greater life and role satisfaction. Yet change was also possible, with decreased resilience associated with trauma
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An earlier version of this work was presented at the Society for Life History Research on Psychopathology Meeting, 2002, New York.
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This research was supported by National Center on Child Abuse and Neglect (90-CA-1406) “Recovery from Sexual Abuse” and (90-CA-1552) “Adult Memories and Consequences of Child Abuse,” Linda Williams, principal investigator. Qualitative research was supported by a faculty support grant from the University of New Hampshire.