Teresa Barnes dissertation by ICSW

Institute for Clinical Social Work

Christian Psychotherapists’ Faith Beliefs after Traumatic Loss

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By Teresa Barnes

Chicago, Illinois April, 2021

Abstract The purpose of this study is to explore changed aspects of Christian psychotherapists’ faith beliefs as manifested in their professional, personal, and spiritual lives following traumatic loss. The study examines the significance of this loss during their professional careers. After screening for inclusionary criteria, four Christian psychotherapists are recruited and interviewed. Using Interpretative Phenomenological Analysis, the researcher examines the participants’ particular and shared experiences along with their meaning-making before, during, and after their traumatic losses. The findings suggest the following: a) faith beliefs have protective functions in which meaning-making is influenced by the belief that God is omnipotent and provides comfort and protection, b) traumatic losses can cause protective functions to fail, thus rupturing trust and safety and shattering spiritual assumptive worlds, c) transitional experiences can restore lost, ruptured, and shattered aspects of faith beliefs, and d) clinical work and professional identity are further enhanced when traumatic losses are integrated into a more flexible faith belief system. The findings also suggest traumatic losses are differentiated from typical grief experiences and there is significance in maternal roles serving as protective functions when protective functions of faith beliefs are lost. In conclusion, reintegrated faith beliefs following traumatic loss are evidenced by the capacity to hold conflictual feelings without losing faith beliefs.

For my own unwavering belief in a God who continued to hold me through the completion of this project.

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Acknowledgments

I want to thank my dissertation committee, readers, conceptual editor, and the study participants for dedicating their time, effort, and focus to my project. I like to thank John Ridings, Ph.D., my dissertation chair, for mentoring me in my endeavor as an IPA researcher. I like to thank Karen Daiter, Ph.D. for her unwavering commitment towards my transformation from a doctoral student to a clinical scholar. I like to thank Judith Aronson, Ph.D. for her wisdom in showing me how a nonpsychodynamic topic like faith beliefs can be conceptualized into psychodynamic thought. I like to thank Constance Goldberg for availing encouragement throughout this process. I like to thank Karen Bloomberg, Ph.D. who as the first faculty member I worked with when I began my journey at ICSW, participated in seeing the completion of this project. I like to thank my writing mentor and conceptual editor Millie Rey for helping me to express my ideas effectively on paper. Finally, I like to thank the study participants who have contributed to this project in immeasurable ways. TB

Table of Contents

Page Abstract ........................................................................................................................... ii Acknowledgments.......................................................................................................... iv List of Tables .................................................................................................................. x Chapter 1. Introduction ................................................................................................. 1 General Statement of Purpose Significance of the Study for Clinical Social Work Statement of the Problem and Specific Objectives Research Questions Foregrounding 2. Literature Review ..................................................................................... 20 Introduction Significance of Faith Beliefs Psychodynamic Theory and Faith Beliefs Trauma Research The Shattering Object Relations and the Traumatized Adult Qualitative Studies on Christian Adults’ Post-Traumatic Experiences v

Table of Contents – Continued

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3. Methodology .............................................................................................. 59 Introduction Theoretical and Operational Definitions of Major Concepts Statement of Assumptions Epistemological Foundation of Project Rationale for Qualitative Research Design Rationale for the Constructivist View Rationale for Interpretative Phenomenological Analysis Methodology The Research Sample Information Needed to Conduct the Study Research Design Data Collection Method Pilot Interviews Demographic Survey First Interviews Member Checking Second and Third Interviews Data Analysis Ethical Considerations Issues of Trustworthiness vi

Table of Contents – Continued Chapter

Page Credibility Dependability Confirmability Transferability Limitations and Delimitations of the Study The Role and Background of the Researcher

4. Results ........................................................................................................ 97 Introduction Explanation of Narrative Accounts Introduction to Results Introduction to the Sample Summary of Participants Introduction to Super-ordinate and Emergent Themes Summary 5. Findings, Discussion, and Implications ................................................. 147 Introduction Discussion Summation Implications and Recommendations Recommendations Strengths and Limitations of Study Conclusion vii

Table of Contents – Continued

Appendices

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A. Consent for Participation in Study .................................................................... 176 B. Study Questionnaire ............................................................................................ 181 C. Question Topics ................................................................................................... 185 D. Interview Guide ................................................................................................... 187 E. Table of Super-Ordinate Themes and Emergent Themes for Dani B. ........... 190 F. Table of Super-Ordinate Themes and Emergent Themes for Kennedy ........ 197 G. Table of Super-Ordinate Themes and Emergent Themes for Terri .............. 205 H. Table of Super-Ordinate Themes and Emergent Themes for Yakitta .......... 212 I. Master Table of Higher Order Concepts for the Group ................................... 219 J. Letter to Waive Pseudonym (Yakitta) ................................................................ 232 References ................................................................................................................. 234

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List of Tables

Table

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3.1. Excerpt from Transcript Reflecting Subjective Experience ................................. 81 3.2. Excerpt from Original Transcripts of a Shared Belief .......................................... 81 3.3. Excerpt from Transcript ......................................................................................... 84 4.1. Demographic Table ............................................................................................... 99 4.2. Higher Order Concepts: Super-Ordinate Themes and Emergent Themes ........... 116 4.3. Summary of Super-Ordinate Themes/Emergent Themes .................................... 145 5.1. Major Findings of the Study ................................................................................ 148

Chapter 1

Introduction General Statement of Purpose The purpose of this study is to explore the changed aspects of Christian psychotherapists’ faith beliefs after they have experienced traumatic losses. The phenomenon of changed aspects of faith beliefs will be defined as subjective meanings within personal, professional, and spiritual daily experiences in the aftermath of traumatic loss. The phenomena studied will be whether or not faith beliefs are altered as a result of the trauma, and if possible, the manner in which these beliefs are reintegrated following this experience.

Significance of the Study for Clinical Social Work Current literature focuses on the role, or lack thereof, of faith beliefs in the clinical work of psychotherapists. Although psychodynamic research has been conducted on aspects of Christianity, there is scant research on how certain adverse life experiences can impact faith beliefs and the clinical work of Christian psychotherapists. Because this topic has gone relatively unexplored, little is known or understood about the nature of traumatic loss and its effects on the faith beliefs of psychotherapists, especially those who identify themselves as Christians. Understanding this phenomenon assumes significance

because it may shed light on the existing literature that suggests that Christian psychotherapists’ faith beliefs and their clinical work are mutually influenced by each other (Sorenson, 2004). Inevitably, this influences their relationships with their clients and their clients’ experiences of the treatment process (Sorenson, 2004). Because of this significance, it is important to understand the manner in which spiritual orientations in Christian psychotherapists impact their clinical work. This is attributed to two reasons. One of these reasons is an emphasis on how religious faith beliefs provide meaning to life experiences (Park & Folkman, 1997). Referencing Pargament (1997), McConnell, Pargament, Ellison and Flannelly (2006) suggest that “people are guided by an orienting system, a set of beliefs, practices, relationships, and values that shape their way of viewing and approaching the world” (p. 1472). How people approach the world is directly related to their orientation system (Pargament, 1997). Religious belief is one of these systems. In fact, people tend to rely on these systems of belief to seek meaning and comfort during times of trouble (Matthews & Marwit, 2006). “Although research has shown that this is often associated with beneficial outcomes, stressful events can also lead individuals to struggle with their religious beliefs, religious institutions, or relationship with the divine” (McConnell et al., 2006, p. 1470). At the center of this struggle is the dissonance between life experiences, beliefs, and how God is experienced (Wiegand & Weiss, 2006). Despite the fact that research explores these struggles in Christians and nonChristians alike, understanding these struggles in Christian psychotherapists can shed light on how their meaning-making can influence their orientation to the world along with their work with clients. How Christian psychotherapists “respond to the

uncontrollable, myth shaking events of life tells much about the way they view the world and offers much in the way of dynamic information. Such responses can also highlight conflicts around spirituality or spiritual expression with which they are wrestling” (Cornett, 1992, p. 102). In other words, the manner in which traumatic losses impact the orientation systems of Christian psychotherapists can provide insights into their struggles in making sense of their own losses while trying to fit these experiences within their preexisting spiritual identities and faith beliefs. Because psychotherapists are human beings who may encounter their own traumatic losses, they can have similar spiritual struggles like the ones experienced by their clients (Wilson & Jones, 2010). This situation may be particularly salient in the case of Christian psychotherapists as Christian psychotherapists explicitly practice according to a Christian orientation. Since this orientation may support a client’s faith beliefs, attention must also be given to psychotherapists’ feelings about their faith, especially after their own experience of traumatic loss (Van Dover & Pfeiffer, 2007; Blanch, 2007; Magaldi-Dopman, Park-Taylor, Ponterotto, 2011). This is because Christian psychotherapists utilize their faith in their work (Langberg, 2006; Carney, 2007). If these faith belief systems are impacted by traumatic loss and its effects are not consciously explored, this can impact their therapeutic work with clients (Sorenson, 1994, 2004). According to others (Spero, 1985; Sorenson, 1994; Moriarty & Hoffman, 2007), such an exploration is necessary because this awareness will help Christian psychotherapists avoid imposing their beliefs onto their clients and judging their clients’ experiences of God (Sorenson, 2004). Since psychotherapists’ beliefs, biases, and values influence their clients’ representations of God, it is important for them to be aware of how their

perceptions and meaning-making impact the clinical relationship (Sorenson, 2004). Regarding Christian psychotherapists, this phenomenon is particularly noteworthy due to the paucity of literature available on Christian psychotherapists and their clinical work. The second reason for understanding the work of Christian psychotherapists is their role in mental health professions. Given that the field of psychology has a history of neglecting the significance of faith experiences (Hill, Pargament, Hood, McCollough, Swyers, Larson, & Zinnbauer, 2000; Sorenson, 2004; Post, & Wade, 2009), Sorenson (2004) suggests that psychotherapists who are not open to the religious material of clients may imply to clients that their psychotherapists do not believe or validate their experiences. Although Shafranske and Maloney (1990) indicate from their study that clinical psychologists are becoming increasingly receptive to spiritual and religious influences, this number is significantly lower than the general population. This has significant implications. For example, people tend to rely more on their faith-based institutions during their time of need than government or human service organizations (Cnaan, Sinha, & McGrew, 2004). Furthermore, individuals from the general population identifying as Christians tend to prefer Christian psychotherapists who share their world view over their secular counterparts (Sorenson, 2004; Post & Wade, 2009). Sorenson (2004) suggests that this preference may not guarantee an ideal therapeutic match because the amount of spiritual exploration that can occur is contingent on the openness of psychotherapists to allow such an exploration. As part of exploring this material with their clients, psychotherapists who explore their own experiences with spirituality provide a way of understanding how spirituality plays a role in integrating traumatic losses. In examining this unexplored topic in

Christian psychotherapists, Langberg (2006) explains how this integration is a way of thinking for Christian psychotherapists who bear the weight of traumatic losses both for themselves and their clients. According to her, this way of thinking aligns with the biblical notion that Christians are image-bearers. In Christianity, the concept of image-bearing relates to the Christian notion of the Trinity of God (McMinn & Campbell, 2007). In accordance with this concept, Christians are urged to reflect the image of Jesus Christ who embodies an aspect of the Trinity (McMinn & Campbell, 2007; WWCC, 2014/2015). According to Western world Christianity, the Trinity is “God existing in three persons - God the Father, Jesus the Son, and the Holy Spirit” (McMinn & Campbell, 2007, p. 33). As part of the Trinity, Jesus came in the form of a man to accept mankind amid his greatest conflicts and struggles (McMinn & Campbell, 2007). As an act of grace, Jesus sacrificed his life on the cross for the sins of humanity (McMinn & Campbell, 2007). Because of this sacrifice, Jesus Christ exemplifies his perfect love for mankind and provides a model of living for those emulating him in their actions (McMinn & Campbell, 2007). For Christians, being created in the image of God means they bear a likeness to him. In addition, his image is imprinted in Christians’ mannerisms and characteristics (Langberg, 2006; Pressley & Spinazzola, 2015). This also implies that by bearing a likeness to Christ, thus assuming Christ’s identity, Christians adopt the mannerisms of Christ to help govern their behavior (Langberg, 2006). The best way to understand the experience of the image of God is through Jesus Christ (McMinn & Campbell, 2007). Because of this experience, mankind’s identity, behaviors, mannerisms, and purpose are encapsulated in God’s love for humanity

(McMinn & Campbell, 2007). Mankind then has a choice through image-bearing to emulate God’s love and acceptance of humanity by reflecting the nature of God’s love in human relationships (McMinn & Campbell, 2007). It is due to this love and acceptance that man is called to accept others in the same spirit of love and compassion (McMinn & Campbell, 2007). This is bearing the image of God. For Christians, the biblical claim that humans are created in the image of God may be one of the most remarkable things about the Creation story (McMinn & Campbell, 2007). For Christians, possessing this reflection of God means that they are called to represent him and become ambassadors of God’s interests for the world (Hoekema, 1986). Therefore, all of humanity has innate worth and dignity, making all worthy of respect and compassion (McMinn & Campbell, 2007). McMinn and Campbell (2007) opine that this innate worth comes from being created in God’s image and bearing his image to the world. This way of being creates a unique stance for Christian psychotherapists and their work (Langberg, 2006). For Christian psychotherapists, this means that adopting Christ’s identity, behavior, and mannerisms can strengthen their commitment to bearing his image in clinical work (Langberg, 2006). This is because Christian psychotherapists may feel that being called to bear witness to others’ pain deepens their clinical training (Langberg, 2006). This calling means that bearing traumatic losses is understood by Christian psychotherapists as part of being an image-bearer of Christ (Langberg, 2006). The notion of image-bearing is critical in understanding how Christian psychotherapists approach their work and imbue it with meaning. However, the concept of image-bearing can also be applied in non-religious contexts. As a case in point,

Langberg (2006) further considers image-bearing when she suggests that individuals’ histories, relational and otherwise, also leave “imprints” on who they are and how they relate to their world even when these individuals are not religious. Just as bearing the image of Christ leaves imprints on individuals’ mannerisms and behaviors, prerecorded relational experiences from early caregiving (Bollas, 1987) can also leave imprints, impacting identities, mannerisms, behaviors, as well as relationships (Langberg, 2006). According to Langberg (2006), human beings tend to internalize experiences into their personhood, therefore “habitually reflecting” the attributes and nuances of these experiences. Each individual’s past and current experiences leave imprints, marks, residue, or images on that individual. Trauma is one such experience that can leave life-changing imprints. Traumatic loss, as Herman (1992/1997) expounds, leaves in its wake individuals who perpetrate or “habitually reflect” this traumatic experience in their lives. This means that similar to what transpires when a Christian assumes the identity, mannerisms, and behaviors of Christ, Christians may also assume an identity of trauma that manifests in their relationships. Assuming this identity of trauma can cause individuals to experience emotions associated with trauma such as anger, helplessness, and fear, as well as feelings of betrayal and distrust (Herman, 1992/1997; Pressley & Spinazzola, 2015). For Christians, this presents a unique challenge because being Christ’s imagebearers can potentially conflict with being an image-bearer of traumatic loss. This can potentially manifest in their personal and professional relationships, especially for Christians whose identity is grounded in reflecting God’s loving nature in relationships

(McMinn & Campbell, 2007). This conflict may also exist in contradiction to their faith beliefs and the ways in which they respond to certain situations. According to Pressley and Spinazzola (2015), this contradictory coexistence presents a challenge to Christians due to the prevailing assumption that they are not supposed to succumb to emotional struggles or to be angry at God. Experiencing these feelings may be deemed a sign of weakness or an act of sin (Pressley & Spinazzola, 2015). This, in turn, may imprison these individuals in their suffering because they believe they are not allowed to feel and express a range of emotions associated with trauma survivors (Pressley & Spinazzola, 2015). This thinking can also prevent Christian trauma survivors from confronting their ambivalent feelings toward a God whom they may believe allows evil to occur in their lives (Pressley & Spinazzola, 2015). The result can be that these individuals may be inadvertently bearing the image of the traumatic loss more than bearing the image of Christ at any given time. This means that their mannerisms, behavior, and identity may be “habitually reflecting” their traumatic loss instead of their faith in Christ. Christian psychotherapists who experience traumatic loss are further challenged when these struggles are present, but they do not acknowledge its effects on their clinical practice and in their relationship with their clients (Sorenson, 1994, 2004; Pressley & Spinazzola, 2015). Given the idea that all experiences leave imprints, Christian psychotherapists, like other Christians, may be confronted with deciding which experiences they allow to define who they are and what they do (Langberg, 2006). They also may have to confront whether the imprint of traumatic loss can coexist with the imprint of their Christian faith. Because of failure to acknowledge and explore the

impact that these coexisting imprints may have on their thoughts, mannerisms, and behaviors at any given point in time, Christian psychotherapists’ therapeutic responses may be coming from the imprint of traumatic loss, imprint of Christ, or from both simultaneously. Given that Christian psychotherapists’ responses can fluctuate depending on what imprint they emulate (Day, 2008), the manner in which Christian psychotherapists respond to theirs and their clients’ conflicting and coexisting imprints, has clinical implications (Spero, 1985; Sorenson, 1994; Moriarty & Hoffman, 2007). Sorenson (2004) posits that these implications lie in Christian psychotherapists pursuing their own treatment and exploring these conflicts in treatment. There is evidence in the literature concerning the importance of Christian psychotherapists pursuing their own treatment (Sorenson, 2004; Wiggins, 2009), which is why Sorenson (2004) underscores its importance from his study on examining his students’ ability to manage their own conflicting religious experiences while treating their own clients. Sorenson (2004) concludes that Christian psychotherapists who experience their own psychotherapists’ openness to their spiritual conflicts are more prepared to be open when these conflicts arise with their own clients than those who don’t. Although Sorenson’s (2004) study suggests that Christian psychotherapists should engage in their own therapeutic treatment regarding these experiences, according to Langberg (2006) and Wiggins (2009), they should also engage in the practice of fortifying their spiritual identities in Christ. By doing so, Christian psychotherapists will be strengthened to follow the imprint of Christ more consistently in their conduct, relationships, and clinical practice.

10 Although fortifying a spiritual identity in Christ is unlikely to erase the imprint of trauma, it can help Christian psychotherapists tackle it in a better manner (Langberg, 2006). Langberg (2006) and Wiggins (2009) opine that there are different ways for Christian psychotherapists to bear the weight of traumatic losses while reflecting God’s image in professional practice. Langberg (2006) describes her faith practices such as worship, prayer, and Bible study as tools to strengthen her Christian identity and beliefs, thus fortifying her work with clients. Wiggins (2009) suggests that it is beneficial for Christian psychotherapists to be engaged in self-reflection through supervision and their own psychotherapy (Wiggins, 2009). This self-reflection can help elicit spiritual awareness questions (Wiggins, 2009). Wiggins (2009) suggests using strategies such as a spiritual genogram, spiritual autobiography, and guided journaling to help psychotherapists reflect on their faith beliefs and their impact on clinical work.1 These strategies will help psychotherapists “examine their previous positive and/or negative experiences with particular faith beliefs and practices” (p. 12). In addition, the strategies will assist Christian psychotherapists as they attempt to work through and explore the imprints left from their own traumatic losses (Wiggins, 2009). This exploration assumes significance because it is impossible to not feel the effects from the imprint of experiences (Langberg, 2006). Imprints from traumatic and religious experiences exist and compete in the lives of Christians. In fact, Langberg

Similar to the family genogram, the spiritual genogram (Wiggins-Frame, 2000) is used to help psychotherapists track generational religious/spiritual backgrounds that may be still influencing their present beliefs and practices. A spiritual autobiography helps psychotherapists trace earliest memories and experiences of religion and spirituality in their childhood homes and families (Wiggins-Frame, 2000). Guided journaling is a personal documentation of events, feelings, thoughts, and relationships (Wiggins-Frame, 2000).

(2006) suggests that for Christians to live in this world, they will have to be intimately acquainted with darkness, pain, and suffering. In the work of psychotherapy and in their own life, Christian psychotherapists encounter these on a consistent basis (Langberg, 2006). However, based on the Christian story of redemption, Langberg (2006) proposes that although Christ bears the sin and suffering of mankind, he does not ruminate on them. Instead, he reflects healing and wholeness (Langberg, 2006). Therefore, if Christians are to “bear his image,” they too can reflect his power to redeem the marks or imprints left behind by traumatic loss (Langberg, 2006). Although traumatic loss can leave an imprint on individuals and their lives, Langberg (2006) suggests that all experiences, not just traumatic losses, “leave some trace” (Bollas, 1987, p. 3). Langberg’s observation that all experiences affect individuals aligns with object relations theory. Experiences that leave a mark are similar to experiences that “leave their shadow” on individuals (Bollas, 1987). It is noteworthy that Bollas (1987) defines the terms as “the human subject’s recording of his early experiences of the object. This is the shadow of the object as it falls on the ego, leaving some trace of its existence in the adult” (p. 3). As is the case with object relational theories, Bollas (1987) refers to the experience of early caregiving paving the way to an unacknowledged experience that impacts subsequent behavior, mannerisms, identity, and relationships. Although Bollas is referring to the infantile experience, the concept of “leaving a shadow” is similar to the “imprint” of experiences that impacts individuals, especially those who have been traumatized (Bollas, 1987; Langberg, 2006). In fact, Bollas’s (1987) term “object leaving a shadow” is the closest to psychodynamically describing the impact these experiences may have on traumatized individuals.

To date, no psychodynamic literature has examined this aspect of the Christian adult’s experience. In fact, there is no current psychological theory that clearly defines the relationship between image-bearing, traumatic loss, and the Christian experience. The only studies that look at trauma through the lens of Christian individuals are not grounded in psychodynamic theory. However, object relations can facilitate the understanding of these experiences, especially as they relate to traumatic loss.

Statement of the Problem and Specific Objectives The manner in which Christians respond to traumatic losses are as diverse as the individuals themselves. They may subscribe to different meanings at various times and their faith beliefs can change depending on these meanings. Therefore, Christian psychotherapists can be assumed to lean on their religious systems in order to derive meaning from these personal life experiences. Depending on these life experiences, these meanings can be positive and negative. The purpose of the study is to explore faith beliefs of Christian psychotherapists who experienced a traumatic loss during their professional careers. In order to examine the impact of these traumatic losses on their faith beliefs and clinical practices, the study is conducted through the lens of Interpretative Phenomenological Analysis (IPA). This qualitative inquiry addresses the lack of qualitative studies found in the existing literature regarding topics related to this study.

Although numerous studies do quantitatively measure the experiences of God (Sorenson, 1994; Lawrence, 1997; Birky & Ball, 1988; Schaap-Jonker, EurelingsBontekoe, Verhagen, & Zock, 2002; Schaap-Jonker, Eurelings-Bontekoe, Zock, & Jonker, 2008; Bradshaw, Ellison, & Marcum., 2010), only a few qualitative studies explore Christian individuals’ experiences of God. Most notably, there seems to be a gap in research about Christian psychotherapists’ faith beliefs, especially if these beliefs are impacted as a result of a traumatic loss. Because the psychodynamic literature may struggle to address this phenomenon, it is important to review how individuals’ beliefs, or lack thereof, in God are clinically explained in psychodynamic theory. … it is acceptable to view one's positive and negative experiences of God as transference based or the result of varying degrees of fixation or distortion in early stages of development, impaired object-relational functioning, etc. … For Christians, their relationship with God is real and may reveal the uniqueness of interpersonal conflicts or feelings that are based on the real impact of God on human experiences (Spero, 1985, p. 80). The statement above is significant to this study due to the exploration of how traumatic loss impacts faith beliefs in Christian psychotherapists over the course of their professional careers. This is specific to adult onset trauma, which is phenomenologically different from childhood or complex trauma (Boulanger, 2007). The study explores first-person account of Christian psychotherapists’ meaning making regarding the impact of traumatic loss on their belief systems and clinical work. The meanings derived from these subjective accounts are analyzed in order to

understand “their personal lived experiences and relatedness” to their faith beliefs following a traumatic loss (Smith, Flowers, & Larkin, 2009, p. 40).

Research Questions My study aims to answer the following research questions: 1. What is the meaning of faith beliefs for Christian psychotherapists who have experienced traumatic loss in adulthood? 2. How do Christian psychotherapists describe the connection between their own faith beliefs and their clinical practice before and after traumatic losses?

Theoretical and Operational Definitions of Major Concepts In order to help the reader have a clear understanding of the concepts discussed throughout this dissertation, the definitions of the major theoretical and operational concepts as follows. 1.

Christian psychotherapists - Christian psychotherapists are trained as a clinical social workers or other licensed psychotherapists who identify their faith as an important aspect in their clinical work (McMinn, Staley, Webb, & Seegobin, 2010).

2. Integrationists - Integrationists are Christian psychotherapists who merge religious and spiritual understanding with contemporary clinical practice. Many of these individuals belong to the Christian Association for Psychological Studies or CAPS (McMinn, Staley, Webb, & Seegobin, 2010).

By aligning their faith beliefs with psychotherapy, they value the tenets of psychology and Christianity (McMinn & Campbell, 2007). 3. SCP - Christian psychotherapists who belong to the Society of Christian Psychology (SCP), base their work on biblical scripture. Despite their visceral interest in psychology, SCP psychotherapists’ theoretical orientations are derived from biblical psychology and other Christian sources (McMinn et al., 2010). 4. Pastoral Counselor - A pastoral counselor can be a pastor who offers counseling but does not have credentials in mental health (McMinn et al., 2010). However, the profession of pastoral counseling consists of individuals who have credentials in both theology and psychotherapy (McMinn et al., 2010). Pastoral counselors can be members of organizations such as the American Foundation of Religion and Psychiatry (1930s) and the American Association of Pastoral Counselors (AAPC, n.d.) (1963) (McMinn et al., 2010). 5. God - According to Western world Christianity, God, the creator and ruler of the universe, “exists in three persons - God the Father, Jesus the Son, and the Holy Spirit” (McMinn & Campbell, 2007, p. 33; Merriam-Webster Dictionary, n.d.). Imago Dei is human nature reflecting God’s nature in loving relationships, grounding Christian belief on the basis that “human dignity comes from being created in God’s image” (McMinn & Campbell, 2007, p.27). 6. Christian - Acceding to the World Council of Churches (WCC) (2014), the primary identity of Christians lies in the fact that they believe in the resurrection of Christ. The basis of faith adopted by the WCC (2014) speaks of

a “common calling to the glory of the one God, Father, Son and Holy Spirit. We perceive God as a Trinity through God’s actions in history and on the basis of God’s dealings with humanity” (p. 465). 7. Faith belief – This refers to meaning construed as a personal belief in the existence of God whereby God has a plan of salvation and goodwill (Bishop, 2016). This is a firm belief held with conviction (Bishop, 2016). The strength of faith beliefs is grounded in the following: 1) how deeply rooted they are (entrenchment), 2) how they influence cognitions, behaviors, and other attitudes (centrality), and 3) how they are appraised as absolute truth (intensity) (Audi, 2008). Unlike other beliefs, faith beliefs are distinct and do not need to be associated with objective probability (Audi, 2008). 8. Traumatic Loss - Violent impact causing “fragmentation of the self and by efforts to hold together what is already broken (self’s resistance to fragmentation)” (Kauffman, 2002, p. 205) 9. Post-traumatic experiences - The aftermath of trauma comprises individuals’ immediate and long-term responses to traumatic events (Levine, 2014). These responses are largely influenced by the responses from individuals’ social environments such as family, friends, institutions, and racial cultural group affiliations (Volkan, 2000; Levine, 2014). 10. Meaning - “... refers to perceptions of significance” (Park & Folkman, 1997, p. 116). Global meanings are strongly held beliefs and valued goals (Park & Folkman 1997). Situational meaning is the initial appraisal and meaning making of a life event and its relevance to the global meaning (Park &

Folkman, 1997). Both situational and global meanings elucidate ways of construing meaning (Park & Folkman, 1997). 11. Spiritual assumptive world - Attributing spiritual meaning to make sense of one’s life and world, which includes God’s role in one’s life and world (Doka, 2002; Kauffman, 2002).

Statement of Assumptions In this study, I am making the following assumptions: 1. The experience of adult-onset trauma impacts Christian psychotherapists’ faith beliefs which are foundational to their clinical practice. 2. Christian psychotherapists experience some type of faith crisis when they begin to question their beliefs following the traumatic loss, subsequently impacting their identities and clinical practices. 3. Christian psychotherapists change their approach to helping others after experiencing personal traumatic loss. 4. Christian psychotherapists may have difficulty treating traumatized clients if they have unresolved personal traumatic loss. 5. Over time, Christian psychotherapists can recover from the traumatic loss and obtain a renewed understanding of themselves along with the enriched capacity to help clients work through their own experiences of traumatic loss.

Epistemological Foundation of Project For the purposes of this study, my preconceptions can potentially compromise the integrity of the phenomenological tradition of research and need to be articulated. While I seek to explore the subjective meanings of changed faith beliefs, I also approach this project with a constructed belief of my own regarding changed faith beliefs. In studying this phenomenon, I believe that Christian psychotherapists will experience a change in previously held beliefs regarding their relationship with God, their practices of faith, and their professional identities in the aftermath of a traumatic loss. Because of my own personal experience of traumatic loss and the ensuing changes in my belief system, I approach this study with an assumption about the impact of traumatic losses on other Christian psychotherapists. My assumptions can lead to biases which may be challenged when I immerse myself further into the research. These biases can compromise my research if I do not approach the literature with the open mindedness necessary to pursue a phenomenological study. “This is because preconceived notions may not correspond with research-based definitions or practical experience” (Wilkinson & Hanna, 2016, pp. 10-11). The challenge then for me, as a researcher, is to embark on this study with the awareness of my assumptions that may drive my beliefs about this study’s outcome. This is where constructivism and phenomenology intersect. “Constructed knowledge naturally leads to an emphasis on interpretations of experience rather than an exploration of experience itself” (Rasmussen, 1998; Wilkinson & Hanna, 2016, p.

13). Since “self-exploration is an important focal point within a constructivist framework” (p. 13), the practice of identifying my preconceptions and setting them aside (bracketing) helps me acknowledge my bias (Wilkinson & Hanna, 2016). By implementing this process of bracketing, my approach to research can be framed in understanding subjective experiences of meaning from the participants’ perspectives.

Foregrounding Prior to this study, I completed a preliminary study on how Christian therapists’ faith influenced their work. My topic of study was to explore Christian therapists’ self-reflections and perceptions regarding their faith and clinical work. One of the emerging themes revolved around the importance of having a relationship with God instead of a religious experience. Another essential theme that emerged from this study was the sense of identity imparted by a faith-based life. Besides the above themes, relationships and prayer were the central focus in the participants’ psychotherapeutic work, faith communities, and spiritual/religious practices. From that study, I began to formulate ideas on how to implement a study t on faith beliefs as they relate to Christian psychotherapists’ perspectives on adverse life experiences. This interest also came from my own personal experiences of traumatic loss that changed how I experienced my own faith beliefs and clinical practice.

Chapter 2

Literature Introduction This study seeks to address the vicissitudes of traumatic loss on the faith beliefs of Christian psychotherapists because there is no comprehensive research found that examines this topic. This literature review comprises scholarly research covering the following areas: 1) faith beliefs from a psychodynamic perspective, 2) psychoanalytic and contemporary theories of trauma, 3) impact of adult onset traumatic loss on the adult self and religious faith beliefs, and 4) the experiences of faith beliefs in Christian psychotherapists’ the personal and professional lives. Before reviewing these literatures, it is noteworthy to highlight that the terms religion and spirituality are used convertibly in this study, as these terms are commonly used to describe sacred faith experiences (Hill, Pargament, Hood, McCullough, Swyers, Larson, & Zinnbauer, 2000). In this context, sacred experiences refer to reverence to a deity which provides the framework to understand the existence, experience, and practice of faith beliefs. Although religion and spirituality are used within the same framework for this study, these terms have been elucidated as distinct from each other in the literature. The terms became distinct from each other beginning in the 1950s and the use of spirituality gained popularity in the 1980s (Hill et al., 2000; Zinnbauer et al., 1999;

Zinnbauer & Pargament, 2005). This is attributed to the fact that religiousness has been associated with institutionalized church doctrine and practices whereas spirituality has been linked to secular worldview that can extend beyond a connection with God (Shaw, Joseph, & Linley, 2005; de Castella & Graetz Simmonds, 2013). Although some conceptual concerns have been raised regarding the use of these terms (Hill, et al., 2000), for the purposes of this study, the term faith beliefs has both spiritual and religious meanings when describing sacred experiences.

Significance of Faith Beliefs The sacredness of faith beliefs pertains to how faith beliefs are understood and subjectively experienced. Because these beliefs are subjectively experienced, they can play a significant role in how individuals apply meaning making (Pargament, 1997, 2007; Harris, Erbes, Engdahl, Olson, Winskowski, & McMahill, 2008; Gerber, Boals, & Schuettler, 2011). According to Park and Folkman (1997), faith beliefs can help provide meaning in terms of self-worth, causal explanations, stress management, and consequences. Religious faith beliefs impact how people feel about themselves and the world, including how they appraise meanings from stressors (Park & Folkman, 1997). From these appraisals, faith beliefs can influence whether or not events are experienced as minor challenges or psychic threats (Furlong, 1982). For the purposes of this study, psychic threats will be defined as traumatic losses. This study focuses on how individuals experience their faith beliefs in light of these threats.

Psychodynamic Theory and Faith Beliefs The nature by which faith beliefs are subjective and deeply rooted have been a topic of much debate (Audi, 2008). Scholars have opined that since the evidence of these beliefs cannot be proven under scientific inquiry, they must be deemed invalid (Audi, 2008). However, others argue that faith beliefs are legitimate and conceptualize faith beyond intellectual justification (Audi, 2008). Psychoanalysis has tended to associate religious faith belief with pathology or insignificance (Sorenson, 2004). Although psychoanalysis has a history of questioning the validity of religiosity, there is psychodynamic literature that contends that faith beliefs contribute to psychological functioning and to an understanding of the individual’s relationship with significant others (Hoffman et al., 2007). The consensus that individuals’ experiences of God are articulated through and from early relationships with their caregivers is embedded in this literature (Hoffman et al., 2007). Thus, the prevailing research about individuals’ experiences of self are predicated on these early experiences with their caregivers and subsequently, with the Divine (Hoffman et al., 2007). Among the other early psychodynamic inquiries about individuals’ early caregiving and religious faith experiences, is Freud’s (1913/1950; 1927/1961) suggestion that religious faith beliefs are socially created and based on wish fulfillment. According to Freud (1923), individuals’ beliefs in God are based on the Oedipus complex, maintaining the idea that the destroyed and repressed version of the powerful patriarchal father is the representation of God (Freud, 1913/1950). A

23 personal God is the superego containing the longing (guilt and remorse) for the exalted and highly idealized father (Freud, 1923). In Moses and Monotheism, Freud (1939) transforms the idea of an internalized God image into an abstract idea of God. This relegates faith beliefs to a psychic activity motivated by the id, which is ruled by the more powerful ego (Freud, 1939). Ignoring the significance of the maternal relationship and associating the God image with patriarchal law and guilt, Freud’s claim to denounce God’s divinity produces a lasting and significant impact on the conceptual work of psychodynamic scholars (Sorenson, 2004; Moriarity & Hoffman, 2007). However, not all psychoanalysts have reached this consensus. Theorists such as Carl Jung, Alfred Adler, Melanie Klein, Donald Winnicott, Harry Guntrip, Ronald Fairbairn, and Ana Rizzuto contribute to psychodynamic literature challenging Freud’s views on this topic. Distinct from Freud’s view, Carl Jung and Alfred Adler suggest that the God image is part of self-actualization and the self-construct. Carl Jung (1938) believes that the origin of the God image resides in the inner world but unlike Freud, Jung disagrees that it is directly related to the internalized father (Rizzutto, 1979). Jung challenges the self-created and socially-created views of God because he believes that subjective experiences of God extend beyond social creation and social construction.2 Jung views the God image as a self-construct (Jung, 1938). As part of the self-

Hoffman, Knight, Boscoe-Huffman, and Stewart (2007) make a distinction between social creation and social construction by clarifying that Freud’s rendering on the God image being based on projected fantasies and wish fulfillment is socially created. Social construction is based on early caregiving experiences which demonstrates a possibility that the self/God experience does exist. See God image handbook for spiritual counseling and psychotherapy.

archetype, the God image is an aspect of the psyche (Jung, 1938) and cannot be distinguished from the self (Jung, 1938). Adler (1933) explains that individuals’ concepts of God are attempts to strive towards “perfection.” This perfection is mankind’s goal of achieving completeness in the self (Adler, 1933). Because individuals have various concepts of God, some may not opine that their God concepts are close to completeness (Adler, 1933). Others, however, deem that this purest expression of God is the closest to achieving their personal goals of superiority (Adler, 1933). Distinct from viewing faith belief as a wish fulfillment or self-construct, object relational theory has an object dependent view of God, as an internalized image (Rizzutto, 1979). Among the first object relational theorists, Klein (1975) suggests that the God image is a “phantasized” internalized object (Forster & Carvath, 1999). Like other internalized objects, Klein’s (1935, 1946) depressive issues are described as being worked through at varying degrees (Forster & Carvath, 1999). Although Klein makes infrequent references to the religious experience (Forster & Carvath, 1999), she provides psychoanalytic understanding of how a Christian’s response to God can remediate infantile envy (Klein, 1975; Forster & Carvath, 1999). She suggests that possessing gratitude and identification with God, diminishes splitting and facilitates the depressive position (Klein, 1975). Other object relational theorists such as Winnicott, Guntrip, and Fairbairn describe individuals’ experiences of God as a transcendent form of the object relationship. For example, Winnicott (1953) explicates that the God image is developed in the transitional space between infant and mother. It begins with the

attunement and actions of the mother, thus accommodating the needs of her infant (Winnicott, 1953). The infant becomes the creator of his own illusions, creating the representation of God as a transitional object between the inner and outer reality of experiences (Winnicott, 1953). Guntrip (1969) describes that a fully developed object relationship gives insight into an individual's relationship with God. Fairbairn (1927) meanwhile believes that psychic dependence on religion comes from disillusioned experiences attributed to primary object relationships, warranting a need to attach to a supernatural form of support. He is also of the view that individuals’ attachments to the supernatural are byproducts of resolving guilt from repressed Oedipal conflicts (Fairbairn, 1927). Contributions from these individuals and others demonstrate psychoanalytic interest in subjective experiences of God. In her study, Rizzuto (1979) makes the first to attempt to differentiate these subjective experiences by suggesting the “importance of clarifying the conceptual and emotional differences between the God image and God concept” (p.47). She describes God images as relational representations that are internalized persons from early caregiving experiences (Rizzuto, 1979). These representations can produce both positive and negative feelings (Rizzuto, 1979). They are also prone to changes with the integration of new life experiences (Rizzuto, 1979). Rizzuto (1979) provides a segue for studying how these experiences extend beyond childhood and how they can change within the internal world of believers. She concludes that practices and teachings of faith-based traditions may remain unchanged throughout development, but their internal meanings may vary with new experiences (Rizzuto, 1979).

Rizzuto’s emphasis on God representations becomes a target for critique as well as the groundwork for other studies. Critiquing Rizzuto’s lack of emphasis on the importance of the individual-God relationship, Wood (2016) stresses the importance of the individual-God relationship throughout one’s lifetime. According to her, an individual’s relationship with God is necessary for establishing a sense of self (Wood, 2016). Meanwhile, Jones (2007) suggests that Rizzuto does not address the transitional experience of the individual-God relationship, but places excessive emphasis on the transitional object. However, others (Birky & Ball, 1988; Brokaw & Edwards, 1994; McDargh, 1983) have built on her work in examining the emotional experiences of God through an object relational lens. McDargh (1983) offers an insight into how these emotional experiences align with an individual’s faith development, further conceptualizing faith’s role in the development of self. In describing the relational component of faith, McDargh, Fowler, and Meissner contribute to the understanding that faith development and self-development occur simultaneously. McDargh’s (1983) work is true to object relations theory in conceptualizing the meaning of faith: “Faith is that human dynamic of trusting, relying upon, and reposing confidence in, which is 1) foundational to the life-long process of becoming a self, and 2) fulfilled in the progressively enlarged capacity of that self for love and self-commitment” (p. 71). Within this definition, are the recurring developmental tasks of managing and tolerating separateness and closeness in relationships (McDargh, 1983)? On the other hand, Fowler (1981) describes faith as a knowing and an essential component to identity formation. Initially, he does not consider identity formation as part of his definition but discovers its relevance when

individuals’ questions concerning their personal value emerge (McDargh, 1983). Although McDargh credits Fowler’s contribution, he suggests that the questions above extend beyond the implied functions of faith (McDargh, 1983). Addressing his question of value, Meissner (1969) points out that self-actualization is reached when people abandon the finite things that initially appear to be valuable, but eventually only lead to a life of emptiness. Discovering an authentic relationship with God is at the end of futile efforts to find the highest experience of the self (Meissner, 1969).

Self-Sustainment and Faith Beliefs Faith beliefs as transformational experiences. Valuing a relationship with God that solidifies identity and achieves the highest experience of self is echoed in the works of Bollas, Kohut, and Winnicott. All three theorists describe the self in relation to the transcendent experience. Expounding this transcendent experience, Bollas refers to the transformational experience as the highest experience of self. In The Shadow of the Object: Psychoanalysis of the Unthought Known (1987), Bollas (1987) describes how the human encounter with the object is experienced as transformational. Bollas (1987) refers to this transformational experience as the “aesthetic moment.” This occurs when a deep connection is felt with an object, eliciting an undifferentiated selfexperience that is like early psychic life. Notably, this psychic life is not a replica of cognitive memories, but an existential sense that is physiologically and psychologically reminiscent of the transformational bond with the object (Bollas,

1987). In adulthood, anticipating experiences that mimic this early psychic life is frequently revered and deemed sacred (Bollas, 1987). According to Bollas (1987), the aesthetic moments are synonymous with the transformational object because they provide an opportunity for the self to become cohesive. In these moments, instead of feeling alone, the individual attains the highest experience of self, in wholeness and completeness (Bollas, 1987). This phenomenon is manifested in both religious and secular life. It is the search for an object that represents “a metamorphosis of the self,” which can be evidenced by faith beliefs, things, or people (Bolla, 1987). According to Bolla, the self seeks new experiences of transformation that mimics the experiences with an early object (Wood, 2016). For believers, faith beliefs may signify a connection with a divine experience built from early caregiving interactions. Bollas (1987) also suggests that negative early experiences can cause aesthetic moments, which can be negative because individuals may have the same intense connection with negative experiences (Bollas, 1987). Because negative experiences can produce a similar state of existential self-metamorphosis and connection with the object, individuals may repeatedly seek these experiences in their lives (Bollas, 1987; Wood, 2016). Bollas (1987) insists that caregiving experiences precede knowledge of the object. He compares his experience to an infant receiving caregiving from the mother even before knowing her (Bollas, 1987). Relating this to religious faith beliefs, “although concepts of God and theologies may differ, they all represent attempts to articulate the human experience of the sacred, which may, as Bollas (1987) has shown, have its origins in infancy, but which holds the potential for a life-long

dialectic” (Jones, 2016, p. 63). Similar to the imprinting of infants’ caregiving experiences of their mothers prior to possessing knowledge (mental representations) of them, individuals’ relationship with their faith beliefs constitutes the imprints of a life-long God-self connection.

Faith beliefs as selfobject functions. Through a self-psychology lens, Banai, Mikulincer, and Shaver (2005) reference Kohut (1971, 1977, 1984) noting the “development of a cohesive self takes place along three axes: (a) the grandiosity axis, (b) the idealization axis, and (c) the alter ego-connectedness axis. The grandiosity axis refers to maintaining self-esteem, developing healthy goals and ambitions, and committing to meaningful tasks and projects” (p. 225). When mirroring selfobject functions are sufficient, this axis is expressed in individuals’ sense of value, ambitious drives, commitments, assertiveness, and achievements (Kohut, 1978). When idealizing selfobject functions are sufficient, the idealization axis “establishes goals around a system of ideals and values” (p. 225). Strongly held goals, values, and beliefs help facilitate a healthy development of the self (Kohut, 1971). When the needs of twinship are met, “the alter ego-connectedness axis provides a development of individuals’ capacities to communicate affect, to form significant and intimate relationships, and to become part of larger groups and organizations” (Banai et al., 2005, p. 225). When twinship selfobject functions are sufficient, individuals feel a sense of belonging, experiencing a sense of community (Kohut, 1984). According to Kohut (1984), when these selfobject functions are sufficient and provide self-sustainment, individuals tend to be

resilient and internally anchored “during times of stress, failures, rejections, and potentially threatening situations” (Banai et al., 2005, p. 225). Describing the significance of sufficient selfobject functions, Rector (1996) quotes Kohut’s (1984) summary of their impact on psychological functioning: When we feel uplifted by our admiration for a great cultural ideal, for example, the old uplifting experience of being picked up by our strong and admired mother and having been allowed to merge with her greatness, calmness, and security it may be said to form the unconscious undertones of the joy we are experiencing as adults (p. 50). The meanings and functions of faith beliefs are understood by examining the nature through which Kohut describes selfobject functions and transferences (Rector, 1996). The lifelong needs of mirroring, idealizing, and twinship provide insight on the psychological meanings of faith beliefs in the lives of Christian adults (Rector, 1996).

Capacity to have faith beliefs. Winnicott (1953) describes the existence of God being developed in the transitional space between infant and mother as occurring when the mother accommodates her actions to her infant’s needs. The infant becomes the creator of his own illusions, therefore creating the representation of God as a transitional object between the internal and external world. Therefore, Winnicott creates two possible functions of faith beliefs – the transitional space and the holding environment. For Winnicott (1971), much like art, poetry, and music, religious beliefs exist in the

creative realm (Wood, 2016). These are valid experiences of knowing that are not necessarily taught but are built on pre-verbal experiences of a caregiving environment (Wood, 2016). When caregivers provide a good enough holding environment, these experiences are not cognitively retained; instead, physiological and psychological confidence are achieved, thus allowing for the “possibility of belief” (Wood, 2016).

Faith belief as a holding/facilitating environment. This facilitating environment, as Winnicott (1960) explains, is the cornerstone to ego development. He further suggests that the self exists only due to the care received from this environment (1960). Winnicott’s theory of the holding environment can provide insight into understanding how individuals’ faith belief systems can be self-sustaining. Winnicott (1960) explains that the holding stage is a time when the infant and mother are merged, and the former is totally dependent on the latter’s empathic responses. By protecting the infant from “physiological insult,” physical caring and attuning to the infant’s needs, facilitates psychological processes that allow the infant to develop into an independent self (Winnicott, 1960). As this development occurs, the caregiver must be attuned to when to assist the child and when to allow the child to function independently and “signal” the caregiver when assistance is needed. This satisfactory holding environment is significantly relevant to psychological development because it achieves the following: an integrated ego, a psychosomatic existence, and a capacity to build object relationships (Winnicott, 1960).

According to Winnicott (1962), ego functioning exists before a sense of self is established. Its existence and maturation are solely predicated on good enough maternal care (Winnicott, 1962). This maternal care is the adaptive role of the mother to know what the infant needs and respond accordingly. This allows the infant to be the “creator” of his experiences, thus giving the infant “omnipotence” to respond as a subject relating to (“not-me”) objects (p. 56). Supporting the ego functioning of the infant, eventually forms the integrated unit that Winnicott (1962) refers to when he points out that an infant moves from total dependence to independence. The continuity of care leads to the continuity of self (Winnicott, 1962), which is experienced when interactions with a primary caregiver validate and mirror an infant’s existence (Kohut, 1977; Poll & Smith, 2003). For Christians, this can confirm a sense of spiritual identity, continuity with the self, and continuity with God (Poll & Smith, 2003). This is why individuals who possess an integrated ego can tolerate anxiety without disintegration (Winnicott, 1960).

Psychosomatic existence. Winnicott (1960) explains that differentiating between the “me” and “not me” is the hallmark of understanding that the body exists within limiting boundaries. The embodied self consists of the motor, sensory, and functional capacities that help differentiate what is inside and outside of self, thus establishing an inner psychic reality (Winnicott, 1960). This inner psychic reality plays a significant role in religion. The following statement of Winnicott (1960) describes the role that faith beliefs can

play in this aspect of development, thereby positioning the terms of transitional or “intermediate space:” During the holding phase, other processes are initiated; the dawn of intelligence and the beginning of the mind that is distinct from the psyche. From this follows the whole story of secondary processes and of symbolic functioning, and of the organization of personal psychic content, which forms a basis for dreaming and living relationships (p. 45). The “intermediate” experience of feeling held promotes not only the capacity to have faith, but also the capacity to experience loving relationships (Winnicott, 1965).

Object relationships. The capacity to experience relationships outside of the self is what Winnicott (1960) alludes to as a healthy object relationship. This is object constancy, which refers to the capacity to internalize and maintain relational experiences with differentiated objects while tolerating/managing separateness and closeness within the object relationship. This can also occur when there is an internalized object relationship with God (McDargh, 1983). An internalized relationship with God is known to strengthen the self during times of doubt, ambivalence, and uncertainty (McDargh, 1983). Diverging slightly from object relations development, Meissner (1984) explains that faith beliefs are neither solely subjective nor solely objective experiences. Rather, they represent both experiences. The need to be part of a community while maintaining individuality is resolved through the interplay between

subjectively experienced faith beliefs and the objectively experienced relationship with the faith community (Meissner, 1984). Like faith beliefs, traumatic loss is also subjectively experienced providing rationale to study the role that traumatic loss has on faith beliefs, especially because faith beliefs and grief responses vary depending on the individual. For instance, grief responses can vary depending on whether the loss is considered traumatic. According to Kauffman (2002), there are two ways of conceptualizing how a response to traumatic losses can be differentiated from typical grief responses. One way is to examine how the unexpected nature of traumatic loss is described in the literature. Another way is to examine what occurs with individuals’ sense of self and their faith beliefs when their subjective sense of the natural order of the world and God’s role in the world are disrupted, thus dismantling the spiritual assumptive world. These are discussed in the subsequent sections.

Trauma Research Research on the impact of trauma on individuals dates back to the 1800s. Psychological theory offers several explanations on how trauma is manifested in the body (Porges, 1995; Van der Kolk, 2014), relationships (Herman, 1992/1997; Boulanger, 2007; Van der Kolk, 2014), mind (Levine, 2014), and sense of self (Bohleber, 2015). These are elaborated further in the subsequent sections. Although limited psychodynamic literature exists that contributes to understanding the effects of trauma on the body, there are over 20 years of trauma research implicating the importance of understanding how trauma manifests

somatically (Levine, 2014). In fact, there are a number of trauma studies that argue for the necessity of treating the somatic as well as cognitive and emotional effects of trauma (Porges, 1995; Levine & Frederick, 1997; Ogden, Pain, & Fisher, 2006; Van der Kolk, 2014). Considering this research trend, attention to this area of trauma literature is warranted. To provide understanding into how trauma dysregulates the autonomic nervous system, Van der Kolk (2014), Herman (1992/1997), Levine and Frederick (1997), Porges (1995), and others have contributed to trauma research by examining the significance of the role of the human body in holding traumatic experiences. According to Herman (1992/1997), there is relevant data on how the body absorbs traumatic experiences and locks them into repetitive occurrences of hypervigilance, sleep disturbances, and psychosomatic complaints. These experiences are manifested in a hyper-aroused autonomic nervous system (Herman, 1992/1997). A hyperaroused nervous system that is chronically activated without appropriate discharge leads to the freeze, collapse, and dissociative responses (Levine & Frederick, 1997; Ogden, Pain, & Fisher, 2006). Van der Kolk (2014) refer to these states as embodiment of trauma. This occurs when communication between the limbic system (emotional brain) and the rational brain (frontal lobes) breaks down, causing visceral reactions in the lungs, heart, and stomach (van der Kolk, 2014). These visceral reactions are what Porges (1995) describes in his polyvagal theory. Notably, the polyvagal theory explains the intimate communication occurring between the brain, heart, and gut (polyvagal nerve) during traumatic experiences (Porges, 1995). The polyvagal nerve plays a critical role in regulating and expressing

emotions in humans and animals alike (van der Kolk, 2014). In trauma, the polyvagal nerve facilitates the fight/flight response, priming distressed individuals to seek escape and social support (Porges, 1995). Ian Pavlov’s (1927) studies on dogs demonstrate this response by discovering what occurs when the innate efforts of the nervous system to escape trauma and seek safety are thwarted. The inability to act upon these innate responses places traumatized individuals into a state of what Pavlov refers to as inescapable shock (Pavlov, 1927). In examining the nature of seeking the safety of comforting relationships, Porges’s (1995) theory elaborates on the observations made by Pavlov 70 years ago.

Relationships. According to Porges (1995), individuals are primed to seek comfort in relationships. Thus, relationships and social connections become important factors in understanding post-traumatic experiences (Boulanger, 2007). In trauma, individuals who are neither able to escape nor are able to seek safety and comfort in others, inevitably experience difficulties relating to others following the traumatic experience (Porges, 1995). Van der Kolk (2014) argues that feeling safe produces reciprocity in relationships and creativity in the mind. In other words, humans can have the emotional and mental capacity to be attuned in relationships, while also being able to create, “plan, play, and learn.” (van der Kolk, 2014, p. 76). When trauma occurs, especially within the context of a relationship, the capacity to maintain safety in relationships is damaged (Porges & Phillips, 2015). This helps to explain Herman’s (1992/1997) view about the significance of relationships:

Traumatic events call into question basic human relationships. They breach the attachments of family, friendship, love, and community. They shatter the construction of the self that is formed and sustained in relation to others. They undermine the belief systems that give meaning to human experience. They violate the victim’s faith in a natural or divine order and cast the victim into a state of existential crisis (Herman, 1992/1997, p. 51). Because relationships fortify self-experiences, traumatized individuals who become alienated from relationships, struggle with maintaining self-agency and selfsustainment (Herman, 1992/1997). As a result, their previous assumptions and beliefs about themselves in relation to the natural and supernatural world have been irrevocably altered (Herman, 1992/1997). The altering of previously held assumptions and beliefs become the center of exploration owing to their impact on individuals’ psyches and sense of self. Understanding the impact of early trauma on one’s self experience is widely discussed in the extant literature. However, few psychodynamic studies have been conducted to examine the impact of adult onset trauma on the sense of self. Unlike childhood trauma, adult onset trauma presents phenomenological differences on how adults process post-traumatic experiences (Boulanger, 2007). Because trauma causes an existential crisis in the self, disturbances in individuals’ beliefs about themselves, God, and the world can occur (Herman, 1992/1997). In this context, psychoanalytic theory can help provide insight into these dynamics as it pertains to traumatic loss and the self. Conceptualizing faith beliefs as part of the self, this study seeks to examine the

changes that occur in individuals’ faith beliefs due to traumatic loss, most notably the unexpected nature of traumatic loss.

The impact of the unexpected nature of traumatic loss on the psyche. One of the most notable references to help describe the unexpected nature of traumatic loss emerged through the literary work of Nobel Prize winning American novelist, William Faulkner (1897-1962). In his novel, Sound and Fury (1929), Faulkner interweaves his own trauma narrative into the narratives of his characters, thus creatively describing trauma as “the unprepared psyche under assault” (Weinstein, 2010, p. 60). This description provides a way to acknowledge how ill-prepared individuals find it difficult to combat the impact of unexpected tragedies. Thus, what was left in its wake were individuals suffering from the result of this type of psychic assault. Therefore, when the unprepared psyche experiences a loss, it is traumatic. Unlike typical grief responses, Herman (1992/1997) suggests that “traumatic losses rupture the ordinary sequence of generations and defy the ordinary social conventions of bereavement. Since so many of the losses are invisible or unrecognized, the customary rituals of mourning provide little consolation (p. 188).” Herman’s (1992/1997) definition speaks directly to the unexpected nature of traumatic loss because there can be no mentalization of the traumatic loss when a psyche is unprepared (Levine, 2014). Put differently, when there is no way to anticipate and conceptualize a potential loss, it remains beyond the social discourse of grieving (Boulanger, 2007). Resultantly, those who suffer with this type of loss become isolated in their psychological experience.

Kauffman (2002) suggests that it is the psychological experience that differentiates traumatic loss from non-traumatic loss. Describing this experience as a “violent fragmentation of the self,” Kauffman suggests that the psychological experience in traumatic loss “consists of the impact (being violated, which fragments the self) and the self’s resistance or cohesion” (p. 205). Put succinctly, it signifies a desperate attempt from the self to prevent fragmentation while simultaneously experiencing fragmentation (Kauffman, 2002). The “violent” urgency that the self displays in trying to maintain cohesion and to seek “repair” in the face of “shattering” pieces, is at the core of traumatic loss (Kauffman, 2002, p. 205). Understanding traumatic loss is thus inextricably linked to understanding what aspects of the self are shattered in its wake.

The Shattering Object Relations and the Traumatized Adult Aspects of the self that are shattered in adults through a traumatic loss can be conceptualized by examining its effects on the adult ego, faith beliefs, and the assumptive world. The best way to conceptualize these effects is through object relations theory. This begins with an inquiry on how the empathic process is shattered in the face of massive traumatization, such as those experienced by the survivors of the Holocaust (Bohleber, 2015). During this empathic collapse, the communication between the self and internal good objects breaks down, causing feelings of extreme hopelessness and loneliness (Bohleber, 2015). The loss of internalized good objects and the inability to trust the goodness in others lead to a loss of the protective shield that a good object provides (Boulanger, 2007; Bohleber, 2015). What remains is the internal dialogue of persecuting bad objects (Bohleber, 2015). The destruction of a once internalized good

object indicates how devastating this type of traumatic loss is on the self: “a catastrophic loneliness and a surrender and annihilation of the self and its agency, imbued with hate, fear, shame, and despair” (p. 4). As Bohleber (2015) explains, extremely traumatized individuals experience not only the breakdown of the internal object relationship, but also the “safe and protective communication between the self and object representations” (p. 3). There is a split between the traumatic experience and the self’s internal communication (Bohleber, 2015). Due to this study on Holocaust victims, object relations theory helps shape understanding about adult onset traumatic loss on the sense of self. Bohleber’s emphasis on adult onset trauma does not negate the effects of other types of traumatic experiences. According to Bohleber (2015), the degree to which trauma impacts individuals on a massive scale is primarily dependent on what occurs within individuals’ object worlds, especially when there is no mentalization for what has happened to them. When an experience becomes a “foreign” entity that is not integrated into the self-narrative, it becomes difficult to derive meaning from it, thus remaining unintegrated (Fonagy, Gergely, Jurist, & Target, 2002; Bohleber, 2015). Unintegrated experiences can best be explained by focusing on what occurs in individuals' object worlds following traumatic losses. Because of their relevance to this study, attention will be given to the impact that splitting, impingements, and catastrophic dissociation have on individuals’ faith beliefs. The ensuing split when unintegrated experiences are cut off from the internal dialogue can provide dynamic information on the role that faith beliefs play in object relations, specifically the extent to which they remain intact during and after a traumatic experience. Splitting and

catastrophic dissociation are manifestations of what occurs when experiences cannot be integrated (Klein, 1935, 1946; Winnicott, 1965; Boulanger, 2007). Chronic impingements are reactions from insufficient environments that inevitably result in permanent states of “unintegration” (Winnicott, 1965). In adults, chronic unintegration is catastrophic because of its dissociative effect on relationships.

Splitting. Ferenczi (1932) articulates the effects of splitting that are later expanded on by Bion, Klein, and Winnicott (Bokanowski, 2004). Ferenczi (1932) describes the concept of splitting by observing and experiencing two opposing psychic states of his patients in the aftermath of traumatic experiences: From now on the ‘individuum’, superﬁcially regarded, consists of the following parts: a) uppermost, a capable, active human being with a precisely – perhaps a little too precisely – regulated mechanism; (b) behind this, a being that does not wish to have anything more to do with life; (c) behind this murdered ego, the ashes of earlier mental sufferings, which are rekindled every night by the ﬁre of suffering; (d) this suffering itself as a separate mass of affect, without content and unconscious, the remains of the actual person. (Ferenczi, 1932, p. 10) Thus, Ferenczi (1932) explains that the traumatic memories continue to exist in the psyche despite the fact that they cannot be mentalized or located. Therefore, these unintegrated memories are trapped and can only be expressed through physical manifestations commonly seen in hysteria (i.e. trances) (Bokanowski, 2004). This

leads to a personality split between the “psychotic” and the “non-psychotic” mind (Bokanowski, 2004). Put succinctly, the unintegrated split off aspects of the traumatic experience functions separately from the capable aspect of the psyche (Ferenczi, 1932). The coexistence of these two minds wards off the agony and anxiety associated with the inability to mentalize the traumatic experiences (Ferenczi, 1932; Bokanowski, 2004). In such cases, recovery commences when traumatized individuals are able to verbalize these experiences, making mentalization and integration possible (Ferenczi, 1932; Bokanowski, 2004). The research of Ferenczi (1932) work in studying mental processes of a split psyche leaves a trail of psychoanalytic inquiry into projective identification, “minute splitting” (attack on linking), disintegration/annihilation, transference, internal and relational affect responses, and the facilitating environment (Bokanowski, 2004). For instance, Klein’s (1946) work expands on the fear of disintegration whereby the splitting of the ego causes the disavowed parts to be projected onto external objects (i.e. bad breast). Bion (1956, 1984) alludes to the shattered mind as a result of death impulses overwhelming the ego. This causes fragmentation, disavowal of reality, and the presence of emotionally charged transferential material in the treatment relationship (Bion, 1957, 1984). Thus, Ferenczi’s contributions precipitate the beginning of the British object relations school, maintaining that one’s sense of self originates from emotional experiences deriving from early relationships (Bokanowski, 2004).

Impingement: When the self no longer feels held. Impingements are described as a lack of body care and emotional attunement from early caregiving experiences (Winnicott, 1962). Ferenczi (1932) foreshadows Winnicott’s theory on the facilitating environment, emphasizing the important role that affirming relationships play in self-regulation, particularly in the face of traumatic experiences. According to Winnicott (1960), splitting is a consequence of failures in the holding environment during a time when self-development is predicated on nurturing care from the caregiver. Winnicott’s (1962) theory also explains changes in the self-experience when this environment fails to be “good enough.” Winnicott (1962) describes that a “good enough” environment produces a continuity of being that results from repeated experiences of caring. Continuity of being validates the self’s existence (Winnicott, 1962). In the absence of this care, the sense of self is built on reactions to environmental impingements (Winnicott, 1962). When repeated impingements occur, they allow the emergence of what Winnicott (1962) refers to as “unthinkable anxieties.” According to Winnicott (1962), unthinkable anxieties manifest as “going to pieces, falling forever, having no relationship to the body, and having no orientation” (p.66). Unthinkable anxiety is differentiated from disintegration. Disintegration is described as a defense of omnipotence (Winnicott, 1962) and prevents the “unintegration” of self in the face of the impingements (Winnicott, 1962, p. 61). Winnicott (1962) suggests that in the absence of maternal holding, this psychic turmoil occurring inside the infant is not relegated to environmental holding. However, it is this omnipotent aspect of the experience produced by the infant that

makes disintegration more identifiable and treatable than disorders related to unthinkable anxiety (Winnicott, 1962). This study explored a psychoanalytic description of the traumatic experience as an “impingement” on faith beliefs. It can describe the tendency for faith beliefs to sustain the self despite the unintegrated experience of trauma. In his essay written in1963, Winnicott suggests that a core part of one’s personality is associated with the true self. Despite the occurrence of splitting, this core aspect of self exists independently from “perceived objects and external reality” (p. 187). In other words, there is a part of the self that does not engage in internal communication between the self and object representations (Bohleber, 2015). Winnicott (1963) refers to this “unknown” and “unfound” aspect of individuals as an “incommunicado element, and this is sacred and most worthy of preservation” (p. 187). The traumatic experience can intrude into this core aspect of the self. Considering empathic failures and subsequent traumatic experiences, Winnicott (1963) suggests that the altering the core true aspects of the self are the precursors to primitive defenses and symptomology. The defense is the hiding and protecting of this core part.

Catastrophic dissociation. Trauma alters the core true aspects of the self because it reawakens all the primitive anxieties of love, hate, and ambivalence in infancy (Bohleber, 2015). Earlier omnipotent experiences of feeling at fault may be evoked (Bohleber, 2015). The fantasized fears that are laid dormant in the unconscious become real in the face of real experiences of annihilation and despair (Bohleber, 2015). This provides the

backdrop to understanding the traumatic loss experiences of adults described by Boulanger (2007). Drawing from psychoanalytic theories, Boulanger (2007) describes why adult onset trauma should be differentiated from developmental or complex trauma. Adult onset trauma is not relegated to psychically internal processes such as earlier conflicts (Freudian), early caregiving experiences (object relations), and self-compensating psychological functions (self-psychology) (Boulanger, 2007). Traumatic loss is an external event that shatters and disrupts the developed individual’s sense of self (Boulanger, 2007), as evidenced by unique experiences of helplessness, dissociation, and isolation (Boulanger, 2007). Differentiating from an infant’s experience of anxiety and helplessness, Boulanger (2007) suggests that the helplessness experienced by an adult is a result of terror. Adopting Anna Freud’s (1967) view that infantile “primitive” trauma and adult onset (catastrophic) trauma are different psychic experiences, Boulanger (2007) suggests the following: Phenomenologically, Anna Freud argues that the experience of helplessness may be the same, but we should bear in mind that the difference between the infant’s undifferentiated state and the adult’s ego is that the adult ego is shattered and cannot be reassembled as it was originally. (p. 23) This terror emerges when adults are confronted with the realization that their fates are inescapable (Boulanger, 2007). As a result, their developed ego functions mobilize defenses and adult victims go into psychological and physical immobilization (Boulanger, 2007). Boulanger (2007) refers to this as catastrophic dissociation.

Catastrophic dissociation occurring in adult massive trauma survivors protects from the terror, but it does not protect from the memory of the dissociation (Boulanger, 2007). This implies that adults are left isolated and confused, describing their posttraumatic experiences as the following: losing their souls, feeling a sense of deadness, and feeling different from others (Boulanger, 2007). Boulanger (2007) describes losing the capacity to recognize the pre-trauma self as the catastrophic dissociative experience in adulthood: Although details of the trauma may be discounted or distorted, stripped of their affective charge and their significance denied - the sense of a collapsed self, a mortal self first encountered during the catastrophe, permeates every aspect of the adult trauma survivors conscious and unconscious life; it is manifest in each self-state. (p. 69) Boulanger’s description of catastrophic dissociation is what occurs when an already established sense of self is shattered. Thus, the shattered self becomes an “imprint” from the traumatic experience impacting individuals’ sense of identities, thoughts, emotions, mannerisms, and behaviors (Langberg, 2006). This experience of a shattered self is between physical death and psychic death (Boulanger, 2007). Boulanger (2007) suggests that psychic death has also been described by others as “anomic terror” (Berger & Luckmann, 1966), “annihilation anxiety” (Klein, 1932), “disintegration anxiety” (Kohut, 1984), and “infinite dying” (Langer, 1991). The death of “humanness” that Kohut (1984) describes denotes the psychic death that puts adult trauma victims face-to-face with the destruction of the internal communication with oneself (subjectivity), which is the mortal self (Felman &

Laub, 1992; Boulanger, 2007). It produces a sense of emptiness that has no meaning and symbolization (Boulanger, 2007). Although physical death has not occurred, Boulanger (2007) explains that adult trauma survivors who experience catastrophic dissociation are alienated from the world of the living due to the intimate awareness of this mortality. From an object relations perspective, this awareness of mortality represents the destruction of the self that is feared in infancy. Klein (1932) describes this fear as “annihilation anxiety.” In the development of a normal infant, the psyche responds to this anxiety by constructing defenses to minimize the existence of the perceived threat (denial) and to assume responsibility for the threat (omnipotence) (Klein, 1975). In adults who have experienced traumatic loss in the past, these infantile defenses are mobilized, but distorted. They confront their inability to assume control over their fates and to deny the impact of the traumatic loss, thereby leaving the adult psyche at the brink of annihilation (Klein, 1932; Boulanger, 2007; Boehlber, 2015).

Theory of traumatic loss: Shattering of the assumptive world. Like Boulanger (2007) and Boehleber (2015), Kauffman (2002) provides additional insight into what causes the self to shatter to pieces after a traumatic loss. In his theory of traumatic loss, Kaufman (2002) suggests that the self tends to fragment in the wake of shattered assumptive world. It is pertinent to note that a shattered assumptive world is a loss of value beliefs that make up individuals’ understanding of their world and its natural order (Kauffman, 2002). A significant

aspect of traumatic loss is the shattering of one’s assumptive world (Kauffman, 2002). Parkes (1971, 1988) originally introduced the concept of the assumptive world as a way of understanding change in psychosocial reality (Kauffman, 2002). He elucidated the assumptive world as “the only world we know and it includes everything we know or think we know. It includes our interpretation of the past and our expectations of the future…” (Parkes, 1971, p. 102). “It is the ordering principle for the psychological or psychosocial construction of the human world.” (Kauffman, 2002, p. 2). In other words, this assumptive world is the psychological structure that contains and organizes psychosocial reality, providing the individuals with a sense that the world functions in an orderly manner. The assumptive world is a way to conserve this reality (Parkes, 1971, 1988; Kauffman, 2002), which is why its shattering is the loss of everything that is known and understood about the world (Janoff-Bulman, 1992). Considering object relations theory, Kauffman (2002) suggests that when individuals’ assumptive worlds are shattered, they lose their capacity to assume omnipotence. These assumptions are also based on the self’s construct of the world as good and orderly. Accordingly, the assumptive world becomes the protector of what is good and orderly about the world (Kauffman, 2002). Therefore, when a traumatic loss occurs and the assumptive world is shattered, this speaks to the failure of the omnipotent self (Kauffman, 2002). This failure of the omnipotent self leaves the self without benefit of their value beliefs because the “traumatic loss overwhelms and floods the self with negative assumptions, assumptions deviant from the protective

norm of the good” (Kauffman, 2002, p. 206). That is, the self no longer feels safe and protected within its assumptions (Kauffman, 2002). Kauffman’s (2002) statement aligns with the views of Bohleber’s (2015) that in cases of mass traumatization, the internalized good object is destroyed, only leaving persecuting objects. The self can no longer be a reliable interpreter of its experiences (Bohleber, 2015). Instead of being insulated by its own good assumptions about the world, the self is left vulnerable to the shame associated with the failure to protect itself. The failure to have the capacity to protect one’s own assumptions, leaves individuals riddled with anxiety (Kauffman, 2002). This is because the failure of the assumptive world to protect, causes a loss of safety, thus threatening the self with the fear of annihilation (Kauffman, 2002). Rooted in infancy (Klein, 1932; Winnicott, 1960; Kauffman, 2002), fear of annihilation originates from the anxiety of a crumbling self when there is no safety or containment after a traumatic loss. When a traumatic loss occurs, there is no sense of safety for the self. Kauffman (2002, p.208) describes this loss of safety as part of the “basic woundedness.” This basic woundedness, as Kauffman (2002) describes: Has to do with a loss of power, such as loss of power to assume a safe world. The psychodynamics of loss of the assumptive world, of loss of the power to assume safety, has to do with the power of infantile omnipotence to provide sufficient protection. (p. 208). When individuals feel that they have no control of their lives or what happens to them, it can cause self-deficits rooted in annihilation anxiety (Klein, 1932) and a self that is “going to pieces” (Winnicott, 1962, p.57). This is because there is no

experience of safety in the world or individuals’ assumptions about the world (Kauffman, 2002). According to Janoff-Bulman (1992) and Kauffman (2002), this loss of safety encapsulates a shattered assumptive world that not only impacts their sense of self, but also their faith beliefs.

Faith Beliefs and the Shattered Spiritual Assumptive World Because individuals’ faith beliefs are closely linked to their identities (Day, 2008), the spiritual assumptive world can be considered a psychological structure that creates a sense of self. Individuals’ spiritual assumptive worlds consist of assumptions based on faith beliefs (Doka, 2002), which in turn, help individuals make meaning of God, their relationship with God, and God’s influence in the world (Doka, 2002). When traumatic loss occurs, it disrupts these beliefs, leaving individuals grasping for spiritual meaning (Doka, 2002). Because reconstructing spiritual meaning becomes paramount in how individuals recover from their traumatic losses, discussing how individuals recover from a shattered spiritual assumptive world is worth examining. Part of rebuilding a spiritual assumptive world includes a reassessment of previously held beliefs (Doka, 2002). When individuals begin to question their faith beliefs as a result of traumatic loss, Doka (2002) describes their questioning as “struggling with their spiritual assumptive worlds” (p.51). According to Doka (2002), this struggle can manifest in losing spiritual meaning, redefining spiritual meaning, or adjusting spiritual meaning. These processes are described in the following four outcomes:

•

Reaffirmation of previous beliefs

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Inability to find meaning in existing or new beliefs

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Redefined beliefs from previous beliefs

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Deepened beliefs resulting from change of existing beliefs Reaffirmation of previous beliefs occurs when previously held beliefs are

reaffirmed. Individuals resolving their traumatic losses align with their general or global assumptions about the world (Rando, 1993; Doka, 2002). When beliefs are not reaffirmed, faith beliefs can lose meaning. In such cases, according to Doka (2002), individuals lack the ability to find meaning in existing or new beliefs. This can be the most devastating of the outcomes because this loss of meaning can lead to a loss of everything they believe, thus leaving individuals in despair (Doka, 2002; Harris et al., 2013). In contrast to losing meaning, individuals’ faith beliefs can be redefined or deepened. Individuals either leave their existing religious faith beliefs to pursue new ones or modify their existing faith beliefs (Doka, 2002). The experience of change in these beliefs can deepen their faith beliefs and strengthen their psychological structure. According to Kauffman (2002), strengthened psychological structures anchor and regulate individuals (Kauffman, 2002). An expansive examination on how traumatic loss, as a significant part of trauma research, helps to inform about the impact of this loss on individuals’ psychological structures, specifically their faith beliefs. The manner in which this experience of change in faith beliefs may contribute to strengthening these psychological structures, will be examined in this study.

The role that faith beliefs play in strengthening individuals following traumatic experiences exists in current literature. For this reason, attention is now drawn to the existing studies concerning the post-traumatic experiences of Christians. A review of these studies helps to substantiate the purpose of this research because it highlights the significance of having more qualitative studies that examine individuals’ faith beliefs following traumatic losses.

Qualitative Studies on Christian Adults’ Post-Traumatic Experiences Existing research examines the impact of traumatic loss on individuals’ beliefs about themselves and God. Although this literature exists, other areas of research have been unexplored pertaining to this topic. The first unexplored area is qualitative inquiry. Majority of the studies available on post traumatic experiences, faith beliefs, and the self, the majority of them are quantitative. According to the literature, quantitative studies limit the exploration of topics such as these, thereby making qualitative studies more necessary (Hoffman et al., 2007). There is also a shortage of qualitative studies on the post traumatic experiences of Christians’ and Christian psychotherapists. Most available studies are quantitative and very few focus on Christians’ post traumatic experiences. There is less focus on the post traumatic experiences of Christian psychotherapists. Studies (McCann & Pearlman, 1990; Schauben & Frazier, 1995; Williams & Sommer, 1995) that come close to exploring psychotherapists’ experiences of trauma address the vicarious trauma incurred while working with traumatized clients. A study by Wilson and Jones (2010) is the only one that

addresses the personal trauma of a psychotherapist. This study focuses on the participant’s responses from working with traumatized clients and her own treatment for past trauma but overlooks her spiritual orientation and the impact of trauma on her faith beliefs. This lack of reference to spirituality illuminates another unexplored area in the literature. Because there is no study examining the Christian psychotherapist’s post traumatic experience, some studies provide a glimpse into how current qualitative literature describes adult post traumatic experience in Christians. The available qualitative studies on the impact of post traumatic experiences on Christian adults’ faith beliefs reveal the variant participant responses following a traumatic event. A limited number of qualitative studies show that Christian individuals are frequently more focused in their faith practices following traumatic experiences (Carmil & Breznitz, 1991; Valentine & Feinauer, 1993; Etherington, 1995; Hall, 2003; Bryant-Davis & Wong, 2013). Other qualitative studies (Finkelhor, Hotaling, Lewis, & Smith, 1989; Astin, Lawrence, & Foy, 1993; Kane, Cheston, & Greer, 1993; McLaughlin, 1994; Rosetti, 1995; Isely, Isely, Freiburger, & McMackin, 2008) suggest that some individuals struggle with maintaining their faith beliefs after trauma. Other studies (Flynn, 2008; de Castella & Simmonds, 2013; Blythe, 2017) provide data indicating individuals perceived support from their faith communities determines the nature of their posttraumatic experiences. This occurs when these individuals associate negative responses from church members as synonymous to God’s response, thus exacerbating the experience of shame and isolation associated with the trauma, causing these individuals to leave their churches and their faith (Blythe, 2017).

54 Some individuals who lose faith in the church maintain their beliefs in God (Flynn, 2008). Studies demonstrate that Christians can struggle in their faith beliefs during traumatic and posttraumatic experiences (Pargament, Desai, & McConnell, 2006). For example, in September 2017, the Betrayal Trauma Recovery Podcast (Blythe, 2017) aired an interview with pastoral sexual addiction specialist, Lisa Taylor. In this interview, Taylor talks about the experiences of spiritual crises in Christian wives of husbands with porn addictions. Taylor addresses the betrayal these women feel in the face of rejection by their husbands, their church communities, and by God. Consistent with research, she states that these women experience a “spiritual crisis” when they begin to doubt, question, and distrust their faith beliefs. Describing this experience as an aspect of betrayal trauma,3 these women lose trust in institutionalized religion and leave their faith communities for a period of time. She concludes that the women do return to their faith communities after reorganizing their spiritual priorities and renewing their relationship with God. What the literature reveals about the posttraumatic experiences of Christians is that spiritual distress is associated with the meaning making process (Williams, Jerome, White, & Fisher, 2006). Posttraumatic growth is achieved when spiritual distress is remedied (Harris, Currier, & Park, 2013). It is evidenced by the way in which individuals use their traumatic experiences to strengthen their faith beliefs and to re-adjust their values, beliefs, and goals toward effective outcomes (Calhoun, Cann, Tedeschi & McMillan, 2000; Harris et al., 2013). Harris et al. (2013) provides an

Gobin and Freyd (2013) specify that betrayal trauma is a manifestation of what occurs when as a result of early interpersonal trauma, individuals lose the capacity to make healthy social decisions. Betrayal trauma theory suggests that trauma survivors are at increased risk for having distorted perceptions regarding trusting others, often leading to intimacy difficulties and further victimization.

example of posttraumatic growth whereby a spiritual crisis can facilitate positive outcomes, such as a deepening of faith beliefs and renewed life purpose (Harris et al., 2013). In other studies, Williams, Jerome, White, and Fisher (2006), Flynn (2008), and de Castella’s and Graetz Simmonds (2013) examine how Christian women use their religious faith beliefs to help them make meaning following trauma. Williams et al., (2006) compared Christian women to women from Jewish and other religious backgrounds. Bypassing ritualized practices of religion, all the women report feeling closer to God and others (Williams et al., 2006). The Jewish and Christian women report that they use their faith beliefs to produce affirming self-statements (Williams et al., 2006) These self-statements enable them to apply new meanings to their traumatic experiences, thus promoting posttraumatic growth (Williams et al., 2006). More Christian women than Jewish women report they learn to accept suffering as part of necessary growth (Williams et al., 2006). The women from de Castella and Graetz Simmonds’s (2013) study report struggling with periods of stagnation associated with doubts, anger, and “spiritual aridity,” frequently leading to secondary trauma in which the women feel a disconnection from God and others (de Castella & Graetz Simmonds, 2013). This, in turn, is precipitated by the lack of understanding from their church communities, resulting in disillusionment (de Castella & Graetz Simmonds, 2013; Blythe, 2017). In situations like these, participants claim that the disconnection from their churches makes them seek God on a personal level, often surpassing the social motivations for church attendance (de Castella & Graetz Simmonds, 2013). Similar results are found

in Flynn’s (2008) study of women who are victims of adult sexual abuse. Despite their disillusionment with their faith communities, participants report that they are able to reconnect to their spirituality through relationships with significant people in their lives. Williams et al. (2006) and de Castella and Graetz Simmonds (2013) suggest that one of the limitations in their studies is the relatively unknown data that may exist from Christians who do not cope well with traumatic experiences. The authors (Williams et al., 2006; de Castella and Graetz Simmonds, 2013) do not define what “not coping well” signifies in their studies. Because the researchers (Williams et al., 2006; and de Castella and Graetz Simmonds, 2013) do not explore the circumstances that make posttraumatic growth not only challenging, but nearly impossible, it leaves an area of study unaddressed. Some studies have addressed these struggles. Fontana and Rosenheck (2004) and Ogden, Harris, Erbes, Engdahl, Olson, Winkowski, & McMahill (2011) suggest that struggles in coping following a traumatic experience may be associated with weakened faith beliefs and difficulties in meaning making. For example, individuals may pursue other ways of meaning making when religious faith beliefs fail them (Ogden et al., 2011; Harris, Park, & Currier, 2013). For Christians, struggles in meaning making may cause them to “lose their faith” (Harris et al., 2013, p. 10). “Findings such as these indicate that when an individual can no longer maintain a previously stable faith system in the process of making meaning of trauma, there is the possibility of a complex set of trauma-related losses” (p. 10). A significant aspect of these related losses is when the spiritual assumptive world is shattered, thus raising

questions about their confidence in God’s protection (Doka, 2002). Pertaining to Christian psychotherapists, this has been overlooked in literature, making this exploration one of the central components for further research (Fontana & Rosenheck, 2004; Wortmann, Park, & Edmondson, 2011; Harris et al., 2013). Christian Psychotherapists’ Experiences of their Faith Beliefs and Clinical Work There are a small number of qualitative studies that address how faith beliefs of Christian psychotherapists impact their therapeutic approaches (Magaldi-Dopman, Park-Taylor, & Ponterotto, 2011). In this regard, Carney (2007) and Magaldi et al. (2011) specifically explore how mental health professionals utilize their spirituality and faith beliefs in clinical practice. In particular, Magaldi et al. (2011) examines how diverse religious/spiritual orientations of psychologists impact the psychotherapeutic process. All psychologists report countertransference reactions which include feeling overwhelmed (Magaldi et al., 2011). They realize their lack of preparedness and training in addressing spiritual issues in treatment, especially if the psychologists and their clients have different spiritual orientations (Magaldi et al., 2011). Carney’s (2007) exploration of female psychotherapists’ spirituality finds that they believe in the importance of exploring spirituality in clinical practice. Carney (2007) concludes that a sacred connection to the therapeutic process, the community, and overall relationships help these psychotherapists connect to their spirituality. She finds that her subjects’ self-awareness regarding their identities and spiritual beliefs are important in identifying and supporting clients’ spirituality (Carney, 2007). It is important that psychotherapists acknowledge the impact of their own traumatic experiences on their spiritual and psychological wellbeing (Wilson & Jones,

2010). Wilson and Jones (2010) suggest that psychotherapists can find ways to manage their own post-traumatic stress by seeking their own therapy. “Because psychotherapists and other mental health professionals are not immune to victimization, the alarmingly high rate of victimization implies that many therapists may be trauma survivors themselves” (Wilson & Jones, 2010, p. 442). Wilson and Jones (2010) address the sense of helplessness that may occur in psychotherapists who feel embarrassment and shame for experiencing the same symptoms that they treat in their clients but lacking the capacity to help themselves. They also suggest that it is important for psychotherapists to explore how their faith and spirituality can help them manage post-traumatic stress. This has important implications for Christian psychotherapists and the work they do. This study will contribute a beginning exploration of the impact of traumatic loss on Christian psychotherapists’ faith beliefs and clinical practice.

Summary This literature review sheds light on the impact of traumatic loss on faith beliefs. It provides a psychodynamic perspective of how faith beliefs can contribute to a sense of self. This is accomplished by describing faith beliefs as transformational experiences, selfobject functions, and holding environments. This literature review also contributes understanding about how traumatic loss affects individuals’ sense of self as it pertains to feeling safe within their faith beliefs.

Chapter 3

Methodology Introduction The purpose of this study is to explore changed aspects of Christian psychotherapists’ faith beliefs as a result of a traumatic loss. The phenomenon of the impact of traumatic loss on faith beliefs manifests as subjective meanings within personal, professional, and spiritual daily living. The overall goal is to examine the particular and shared experiences of meaning making in Christian psychotherapists who have experienced traumatic losses. The phenomena studied is whether faith beliefs are altered or lost as a result of the traumatic loss, and if possible, how these beliefs are reintegrated following this traumatic loss. Exploration is delineated in the following questions: a) What is the meaning of faith beliefs for Christian psychotherapists after experiencing a personal traumatic loss in adulthood? b) How do Christian psychotherapists describe the connection between their own faith beliefs and their clinical practice before and after traumatic losses? As I prepared to collect data for this study, I reviewed existing literature on the phenomenon proposed in Chapter 1. An overview on faith beliefs and adult onset traumatic loss was examined through a psychodynamic lens. Additional works of literature included studies about Christians’ post-traumatic experiences. I also

examined qualitative studies that address the experiences of Christian psychotherapists’ faith beliefs. The review of these studies also included the manner in which beliefs and spiritual identities impact clinical practice. I concluded the review by emphasizing this study’s contribution to the literature.

Rationale for Qualitative Research Design Attempting to measure implicit factors such as faith beliefs and other subjective experiences of God, presents a challenge to quantitative research. This is because it is difficult to determine confounding factors such as traumatic loss and cultural experiences, making the process of determining causal relationships difficult (Hoffman et al., 2007). This is also because quantitative studies seek to determine causality and correlations through scientific measurement (i.e. surveys). This does not provide the opportunity to gain in-depth understanding of individual experiences. When measuring subjective experiences of God, scholars (Gibson, 2007; Hoffman et al., 2007; Granqvist & Kirkpatrick, 2013; Hall & Fujikawa, 2013) suggest that it is important to increase the frequency of qualitative measures. This is especially true when multidimensional human phenomena are being studied, such as subjective meanings of changed faith beliefs and experiences of traumatic loss (Carroll, 2001). A qualitative approach is appropriate for this study because, according to Moustakas (1994): a), it examines the wholeness of experience - integrating the parts to the whole and the whole to its parts, b) the research questions are a reflection of the researcher’s personal interest and involvement, c) experience describes how human behavior is

understood and investigated, d) it receives data through first person accounts, and e) it seeks to explore subjective meanings of experiences.

Rationale for the Constructivist View Within the framework of constructivism, this study demonstrates the multiple perspectives of Christian psychotherapists. This contributes to the understanding about the subjective experiences of faith beliefs following traumatic loss. My approach to this study is to explore these perspectives and not attempt to determine objective truths. This means that truth and meaning are subjectively constructed according to the individuals (Wilkinson & Hanna, 2016). Subjective meanings are the fundamental aspects of phenomenology (Wilkinson & Hanna, 2016). Constructivism is also grounded in “the notion that knowledge is constructed and that understanding is built on pre-established beliefs, suppositions, and experiences of meaning” (Ultanir, 2012; Wilkinson & Hanna, 2016, p. 4). Because meaning is constructed subjectively, this type of research is applicable to qualitative study. However, it is not impervious to potential bias by me, the researcher. The next section explains my rationale for choosing Interpretative Phenomenological Analysis (IPA) as the method for this study.

Rationale for Interpretative Phenomenological Analysis Methodology Interpretative Phenomenological Analysis (IPA) is a type of qualitative inquiry that draws from several philosophical ideas (Smith et al., 2009). IPA draws from these ideas to create its own unique way of making sense of lived experiences. As a case in

point, it borrows from the phenomenological in that it is interested in the meaning and interpretation of a lived experience (Van Manen, 1997). Beyond this, IPA focuses on the analysis of significant events. The purpose is to understand how a significant event affects the everyday lived experience of an individual (Smith et al., 2009). The significant event is the focus because all the “experiential life parts” of the event hold common meaning (Dilthey, 1976; Smith et al., 2009). These experiential life parts comprises everyday relational, work, and recreational experiences that do not hold a common meaning before the event. This common meaning connects these experiences together, thus making them experiential (Smith et al., 2009). Experiential in this sense is “understood to be an in-relation-to phenomenon” in which individuals can “offer a personally unique perspective on their relationship to, or involvement in, the phenomenon” (p. 29). For example, individuals’ traumatic losses can be encapsulated by how they apply common meaning to their daily experiences of relationships, work, and recreational activities associated with the traumatic losses. Thus, the experiential aspect of these experiences is how individuals make meaning of their traumatic losses in relation to their work, relationships, and hobbies (Smith et al., 2009). IPA provides an in-depth analysis conducted through interpreting interview data, bracketing preconceptions, and focusing on the particular (Smith et al., 2009). Interpretation involves engaging with the text the experiences of the individual, thereby addressing the inevitable biases that can emerge in qualitative research (Smith et al., 2009). Borrowing from hermeneutic phenomenology, IPA addresses the issue of

researcher bias by subscribing to the double hermeneutic and the hermeneutic circle (Smith et al., 2009). The hermeneutic circle addresses these biases by focusing on the researcher’s preconceptions and biases about the study and its outcome (Smith et al., 2009). The researcher’s forestructures prior to encountering the data, are the researcher’s preconceptions and biases about the study and its outcome (Smith et al., 2009). Bracketing is used to define the researcher’s efforts to put aside these forestructures (Smith et al., 2009). IPA’s approach to addressing the need to bracket is not only from the perspective of an ongoing process, but is also a way to assimilate the new data coming from the first-person accounts (Smith et al., 2009). By engaging in what participants are saying, the researcher’s preconceptions are confronted with new information (Smith et al., 2009). Assimilating the new data facilitates a way to make sense of the whole and its parts (Smith et al., 2009). “Here the whole is the researcher’s ongoing biography, and the part is the encounter with a new participant, as part of a new research project” (p. 35). It is this whole that represents the researcher’s old preconceptions and assumptions about the data combined with the new project which is the result of assimilating the new information that the participant provides. According to IPA, this encounter with the new information makes it possible to bracket (Smith et al., 2009). Because the double hermeneutic addresses bias by demonstrating focus on the data, attentiveness to the interview data is fundamental to IPA (Smith et al., 2009). Attentiveness to the interview data makes the double hermeneutic an important part of the analysis because it entails more than the activity of thoroughly examining the data,

also encompassing the intent and personal significance of what is being said (Smith et al., 2009). Smith et al. (2009) describes the use of the double hermeneutic in IPA as a dual endeavor in which both the researcher and the participant attempt to make sense of how the participant makes sense of their life experiences. Furthermore, the researcher engages the participants on a level that is personable, with the attitude that there is a shared humanness in which experiences resonate between the researcher and participants (Smith et al., 2009). The next chapter provides evidence of how the double hermeneutic is utilized as I explain my interpretation of the data. The manner in which data is interpreted explains why IPA possesses similarities and differences with other phenomenological studies. One notable difference is its focus on the particular. Otherwise known as idiography, this level of engagement between researcher and participant, is a cornerstone to IPA’s commitment to the particular (Smith et al., 2009). Attentive and detailed focus on the idiographic experience, is IPA’s aim in achieving in-depth analysis (Smith et al., 2009). Focusing on the particular is what makes IPA unique and what makes it distinct from other phenomenological studies. Focusing on the subjective experience is what makes IPA like other phenomenological studies. It is this subjectivity that encapsulates IPA, making it an appropriate method for this study. IPA’s focus on how the subjective aligns with the consensus in the literature confirms that faith beliefs and traumatic experiences are subjective and unique to everyone (Audi, 2008; Levine, 2014). The goal of IPA is to understand the subjective and unique experiences of Christian psychotherapists who have experienced traumatic loss (Smith et al., 2009).

The Research Sample Because an important part of IPA is emphasis on detail, it tends to work well with small sample sizes (Smith et al., 2009). In addition to my two pilot interviewees, this study selected a sample of four Christian psychotherapists. As part of the inclusionary criteria, these were individuals who have experienced traumatic loss while practicing psychotherapy. My interest in this particular experience, lends itself to the small sample size that IPA suggests. This type of purposeful sampling is called “criterion” sampling (Creswell, 1988). Additional criteria for this study are Christian psychotherapists who have been practicing for a minimum of five years, who have at least a master’s degree in the field, and who hold a certification and/or license in the field. Given that this study focuses on psychotherapeutic practice, it excludes biblical and pastoral counselors because they don’t utilize psychotherapeutic techniques. I approached the recruiting process by starting my inquiry in the following four ways: posting an inquiry in the Psychology Today database, recruiting members from the Springs Counseling Community Facebook closed group, contacting Christian organizations such as CAPS (Christian Association for Psychological Studies), and asking potential participants for additional referrals (snowballing). Despite making two attempts to a CAPS contact in Denver, there were no respondents from this recruiting inquiry. Psychology Today database and Springs Counseling Community Facebook group yielded generous responses from psychotherapists wanting to talk about their traumatic experiences. Four Christian female psychotherapists were selected as my sample because of their expressed interest in talking about their experiences with adult onset traumatic loss.

Information Needed to Conduct the Study As part of the data collection for the study, two pilot interviews were conducted prior to collecting data from my sample. Conducting these interviews helped me to assess the appropriateness of the interview questions, to gain familiarity with the interview process, and to formulate an interview schedule. Information obtained from the pilot interviews was used to revise my questions and allowed me the opportunity to hone my interviewing skills for my sample. The four participants who made up my sample participated in semi-structured interviews. During the in-depth interviews, participants were asked questions from the Interview Guide (Appendix D) in order to describe the ways in which they made sense of the traumas they experienced and how they related these meanings to faith beliefs. Accessing the responses that yielded ‘rich’ data reflecting their authentic experiences, “gave the participants an opportunity to tell their stories, to speak freely and reflectively, developing ideas, and expressing concerns at some length Smith et al., (2009, p. 56). “Therefore, ‘rich’ data is evidenced by participants’ engagement into fuller and deeper disclosure” (Smith et al., 2009, p. 56).

Research Design I took the following steps to carry out the research: 1. I performed two pilot interviews with Christian psychotherapists who had experienced a personal trauma during their professional careers. 2. Next, I used purposive, or criterion sampling to recruit participants. I posted an inquiry in the Psychology Today database and Springs Counseling Facebook

group that asked Christian psychotherapists whether they were interested in talking about their traumatic experiences and the impact on their faith and clinical practices. Those who were interested contacted me by email or Facebook. I responded back via email or private instant messenger to obtain their contact information. All contacted participants were informed of the study’s purpose. 3. Via phone, I contacted the participants who expressed interest in the study to review the study questionnaire (Appendix B), also explaining the informed consent form (Appendix A) to participants who met the criteria. Participants were given an opportunity to ask questions and to demonstrate that they understood the consent form and the needs/purpose of the study. The needs of the study included their willingness to be audiotaped. Because unwillingness to be audiotaped was part of the exclusionary criteria, all participants were willing to be audiotaped. 4. After the participants demonstrated their understanding of the study’s purpose and their rights, they were emailed the consent form. In the informed consent, they were asked whether they were willing and able to participate in a maximum of three audio recorded interviews, each lasting approximately 60 minutes. I asked them to confirm if they were willing to participate in member checking procedures between interviews. None of the participants asked to see the interview topics (Appendix C) prior to the interviews. I asked them to provide me with a pseudonym at the time which was paired with a three-digit number (i.e. 001, 002, 003) and used in all forms of data collection, including

interviews and data tables. This three-digit numbers made it possible to maintain the privacy and confidentiality of the participants. 5. Participants returned the signed copy of the informed consent form at the time of the interview. I conducted the first interviews in person using the semistructured interview guide (Appendix D). 6. The interview audio recordings were sent to a professional transcriptionist (Rev) for transcription. Once the professional transcriptionist returned the transcriptions and they were checked for accuracy, I further checked for accuracy (member check) with my participants. 7. After completing the member checking, I initially coded the transcripts from the first interviews and then coded using NVivo qualitative data analysis software within and between participants. 8. I scheduled and conducted second and third interviews. 9. Similarly, I transcribed and coded interview data responses from the second and third interviews within and between participants. 10. After the interviews were completed, it was determined that no more in-depth exploration was needed for the study. Additional candidates were not considered. This was determined by reaching saturation with the initial four participants. I proceeded to write the final chapters, including the results and discussion.

Data Collection Method In this study, triangulation was used to establish the confirmability and trustworthiness of the data and to increase in-depth understanding of unexplored and complex phenomena (Hussein, 2009). Triangulation provided credibility to the data, thus capturing accurate accounts of participants’ narratives (Creswell & Miller, 2000). Theoretical and analysis triangulation were the types of triangulation used in this study (Hussein, 2009). Theoretical triangulation entails the use of over one theory to understand the data (Hussein, 2009). In this study, I chose to look through the lenses of Winnicott (object relations), Bollas (object relations), and Kohut (self-psychology) to understand how the participants imbued meanings from their faith beliefs. I used Kauffman’s (2002) and Boulanger’s (2007) work to help me make sense of how they made sense of their experiences of adult onset trauma. Analysis triangulation involves the use of more than one process to analyze the data by reviewing the professional transcription, checking and revising for accuracy (Hussein, 2009). By member checking, I made sure that the data analysis from me and the professional transcriptionist stayed true to the subjective experiences of the participants. I also used the NVivo software to assist me in theme development once I performed the initial coding manually. Although using triangulation will help ensure trustworthiness, in my efforts to increase the trustworthiness of my research, I took adequate precautions to avoid the pitfalls in the data collection and analysis process outlined by Easton, McComish, and Greenberg (2000). To avoid the pitfalls of using faulty recording equipment, I

checked the recorder and practiced recording my own voice on a manual digital recorder in order to ensure the quality and effectiveness of the recording. Additionally, I obtained a secondary recording app through fingerprint recognition and/or password on my mobile device. I fully charged both devices with chargers within reach just in case a loss of power occurred (Easton et al., 2000). Moreover, I stored extra batteries for the digital recorder in my bag for later retrieval, if necessary. I contacted participants by phone or private instant messenger to set up interviews at times and places that were convenient for them. I collaborated with them on a location where the interview would not be disrupted by phones and other occurrences in the work or home environment. I also practiced with my own voice to determine how close the recorder needed to be positioned so as to derive utmost clarity from the interviewees (Easton et al., 2000). I took these steps as part of my commitment to being accommodating, detailoriented, and patient so as to improve the equality of data (Easton et al., 2000). I accomplished this by accommodating participants’ schedules and their preferences on the interview location. My attention to detail helped me check for mistyped or missing words in the transcripts. This alleviated the problems of misinterpreting meanings and changing expressed by the participants (Easton et al., 2000). I avoided this error by rechecking the transcriptions from the professional transcriber. Participants were contacted a week after the interviews to clarify any parts of the transcription that may have been missed or remained unclear. Clarifying parts of the transcription resulted in adding another hour per interview because participants became more candid about

their responses during member checking. Because of the time given to the member checking, this project yielded valuable information about the data and the participants.

Pilot Interviews The pilot interviews helped become more adept with the interview process. I performed two interviews with Christian psychotherapists to help refine my skills prior to interviewing my research sample, as well as to become familiar with the tenets of IPA research. The interviewees assisted me in identifying questions that may need to be revised and/or clarified. To familiarize myself with the tenets of IPA research, I prepared for the pilot interviews by initially recording and documenting my answers to the interview questions. Reflecting on the findings that emerged during the recording, listening, and documenting, I approached the pilot interviews with a single-minded goal to hone the practice of bracketing my answers. Knowing my answers to these questions beforehand, lessened the occurrence of answering the questions in my head as I attempted to listen to the interviewees. As my answers popped in my head during the interviews, I made a note of them and then recorded and processed my thoughts in my research journal afterwards. As a result, my distractibility lessened, allowing me to listen to the order of the questions being asked. During the first interviews, the second question asked to provide a definition of trauma inadvertently led the participants to discussing the definition as it related to their trauma stories. Realizing that the order of this question did not align with the suggestion of Smith et al. (2009) regarding “funneling” interview questions from

general to specific, I found that this question was asked too early during the interviews, which prevented me from exploring their self-experiences prior to traumatic loss. As a result, I had difficulty going back to questions about their lives prior to the traumatic loss. This was because participants often became engrossed in their narratives about their ‘self-experiences’ during and post trauma. Going back to their pre-trauma experiences felt out of sequence because their narratives lacked fluidity. After reviewing these responses from the first pilot interviewee, I discovered with the help of my chair, that I did not address the pre-trauma experience in an adequate manner, thus leaving out a big portion of the interview. During the second pilot interview, I became more alert in my questioning, ensuring that I asked all the questions. The second pilot interview also helped me to realize that I needed to become clearer about stating the inclusionary and exclusionary criteria. Until the interview, it did not become clear that the pilot interviewee’s traumatic event occurred before she began practicing psychotherapy. After this interview, I began to sharpen my screening criteria, emphasizing in subsequent screenings that the traumatic event must have occurred during the time when individuals were practicing psychotherapy. I learned two things from doing my pilot interviews. One, I prepared to do the work of carefully screening individuals meeting all the inclusionary criteria. Two, I rearranged my questions so that any questions about trauma were not asked until questions about faith beliefs, professional practice, and self-experiences pre-trauma were fully explored. As a result, the narratives took on their fluid quality that was indicative of IPA interviews (Smith et al., 2009).

Demographic Survey The 15 item Questionnaire (See Appendix B) was developed, keeping in mind the fluidity that was characteristic of IPA interviewing. The questionnaire identified potential participants for inclusion based on their answers relating to their Christian orientation, experiences of trauma, and the time their traumatic experiences occurred. This questionnaire also identified demographics and inclusion/exclusion criteria such as a history of childhood trauma. Theoretical orientation, years in practice, education, race, and gender were also some of the specific areas that were identified. History of childhood trauma became the most notable exclusionary criteria. Five out of the fourteen Christian psychotherapists who responded to my Psychology Today database and Springs Counseling Facebook group, were excluded from the study because of their history of childhood trauma, including one out of the two men who responded. The second male who expressed interest in the study was excluded because his adult trauma occurred before he began practicing psychotherapy. Of the nine remaining, five did not respond when I attempted to set up interview times. I contacted the remaining four individuals who responded to my study invitation by email. I later talked to them by phone at their convenience, reviewing the inclusionary criteria and describing the study to them. I briefly reviewed the informed consent form with them. After determining that the interested individuals fitted the inclusion criteria and stated their willingness to participate in the study, I sent them the informed consent form (Appendix A) via email.

First Interviews Given that the informed consent process and questionnaires were reviewed during the phone screening interviews, I obtained signed copies at the time that the first 60-minute interviews were performed. In case any of the participants inquired about the interview questions beforehand, I prepared to share general topics (Appendix C) via email from the semi-structured interview guide (Appendix D). I followed Jochen Glaser’s blog post on ResearchGate.net that suggested the following protocol regarding sending interview questions prior to the interview: If you send the exact questions beforehand, you don't really know anymore whose answers you get, and how these answers emerged. I provide topics only when asked. In my research this rarely happens because people get a brief description of the research when I make first contact, which in most cases proves to be sufficient. When I'm asked for questions, I comply because it puts the interviewee at ease. However, I never provide the exact questions. I use a list of major topics instead. (https://www.researchgate.net/post/Should_you_provide_questions_in_advanc e_of_an_interview) Since none of the participants inquired about the research questions before the first scheduled interviews, I discussed the interview process and time commitment upon setting up the first interviews. In addition, I reiterated that I needed their permission to use an audio recorder as part of my efforts to avoid the distraction of note taking. By using the recorder, I could immerse myself in the data following the interviews.

Besides informing the participants about the requirements for the interviews, I told them about the steps I took to ensure their confidentiality and the integrity of the data they shared with me. First, I ensured that the digital audio recordings and transcriptions were stored in files labeled under their pseudonyms in a password protected and encrypted flash drive. To further protect the participants’ privacy, I intermittently disconnected from internet access while I was working on the data. The interviews were transcribed by a professional transcriptionist company (Rev) who, signed an agreement regarding participant confidentiality (See Appendices) prior to transcribing. To ensure data accuracy, I initiated member checking following the interview and transcription. Prior to member checking as dictated by IPA guidelines, I conducted 60-minute semi-structured interviews to obtain my data. I allowed the participants to choose locations that were not only most comfortable to them, but also that decreased interruptions and distractions (Smith et al., 2009). Despite this effort, two of the participant interviews were interrupted by uncontrollable distractions, but both of them were diligent about addressing the sources of these distractions, allowing the interviews to resume uninterrupted. The interviews were conducted by using the primary questions in the semistructured interview guide (Appendix D). It covered the following topics: subjective meaning of faith beliefs, the influence of spiritual/religious beliefs on clinical practice, the influence of traumatic experiences on faith beliefs, spiritual/religious practices, & clinical practice, and social supports. In consonance with the IPA guidelines, the questions sought to explore the personal experiences, understandings, and meanings of

Christian psychotherapists’ faith beliefs following traumatic experiences (Smith et al., 2009). This was done to ensure my focus was on their voice and not mine. I began with questions that were open ended and expansive, helping participants describe their experiences at length (Smith et al., 2009). Although I used an interview schedule that reflected the topics above (Creswell, 1998; Smith et al., 2009), I was open to participants leading me into unanticipated areas which might lead to additional interview questions. Unanticipated areas occurred with all the participants because of the natural flow of the interview and how comfortable they seemed while sharing their experiences. As encouraged by Smith et al., (2009), rapport was established between me and the participants. As a result, they seemed to be comfortable elaborating on their experience. Establishing rapport with the participants came easily for me because I shared common ground with the participants as a Christian psychotherapist and mother. This rapport also helped me perform member checking because the participants seemed eager to clarify any data that seemed unclear.

Member Checking To ensure data accuracy and examine my bias, during the member checking participants were typically given the opportunity to review, error check, and question the data to determine if more accuracy and clarity were needed. According to Rubin and Babbie (2008) and Creswell (1998), member checking was done to ensure data accuracy and examine researcher bias. Although this is a well-recognized evaluative

process (Rubin & Babbie, 2008), Larkin and Thompson (2012) suggest that this may not be appropriate for IPA. Member-checking may be appropriate for single case designs, where the interpretation offered can be traced back to one person’s account. For designs with multiple participants, the combined effects of amalgamation of accounts, interpretation by the researcher and the passage of time, can make memberchecking counter-productive. It is often preferable to use sample validation (people eligible to participate, but who did not), peer validation (fellow researchers) or audit (p. 112). Despite Larkin and Thompson’s (2012) suggestion against the use of member checking, I decided to use member checking for the following reasons. One, I was ensuring accuracy by reviewing parts of the interview with the participants to validate the transcriptions. Two, because validity in member checking was predicated on the time between the interviews and accuracy checks (Larkin & Thompson, 2012; Burnard et al., 2008), I initiated member checking following the interviews and transcriptions, accomplishing this in one to two weeks of each interview with the majority of the participants. Upon the completion of member checking, participants were then scheduled for the second and third interviews.

Second and Third Interviews Second interviews were 60 minutes in length and occurred after the completion of first interview transcripts and member checking procedures. The same process was followed after second interviews. Whereas the first interviews were focused on faith

beliefs and clinical practices before the traumatic experiences, the second interviews focused primarily on participants’ subjective experiences during their trauma. Data obtained included, but was not limited to descriptions about the impact of their traumatic loss on their emotional responses, thoughts, and relationships. As Smith et al. (2009) suggested, I structured the questions during the second interviews so that the participants’ answers moved from general to specific and in depth. The duration of third interviews was also 60 minutes. After completion of the second interview transcripts and member checking, the questions in the third interview asked clients about their post-traumatic experiences. During those interviews, I listened for specific experiences that related to the impact of trauma on their faith beliefs and clinical work. This included their reflections on their faith beliefs, faith practices, spiritual identities, relationships, and clinical practices following trauma. After collecting the participants’ responses, I analyzed their responses using NVivo 12 Plus for Windows © software. Because of its ability to effectively support qualitative research, NVivo was used to help organize, analyze, and find insights in the data collected for the study. In the next section, I will describe how I performed data analysis in alignment with IPA guidelines (Smith et al., 2009).

Data Analysis Prior to performing analysis, I attempted to set aside my preconceived ideas based on my own experiences. In keeping with IPA guidelines (Smith et al., 2009), I bracketed my preconceived ideas, bias, and forestructures by reviewing not just my answers to the interview questions, but also my emotional reactions from the interview

data. As I reflected on my own impressions from the interviews, I took notes about my emotional reactions to the content and the participants, emerging themes in participants’ descriptions, and potential metaphors and/or imagery that emerged from the data (Larkin et al., 2012). Larkin and Thompson (2012) describes this process of free coding as a way to document my initial ideas, and “identify and consider the influence of my own preconceptions” (p. 106). These notes were considered as part of my overall process of reflexive journaling which will be ongoing throughout the dissertation process (Larkin et al., 2012). Bracketing personal biases and preconceptions are not the only central tasks in IPA. Other central foci in IPA research were identifying the significance, meaning, and the double hermeneutic. The double hermeneutic approach was a collaborative effort between the participants and me that was undertaken to interpret what the participants were interpreting about their lived experiences (Smith et al., 2009). “The process for reaching this point in IPA was iterative and inductive, cycling and recycling through the strategies described below” (p. 105).

Step 1: Read and re-read. The first step in IPA was getting immersed in the participants’ accounts (Smith et al., 2009). This was done by repetitively reading the original transcripts, looking for shifts in the discussion from broad to specific, and from general to detailed. I began my analysis by listening to the audio recording while writing my reflections in my journal. In line with the suggestion of Smith et al. (2009), I listened to the recording again while reading the transcript. As I went through the transcript, I highlighted

certain words that resonated with me. I examined each transcript line by line and coded at the level of individual sentences or groups of sentences by highlighting words or word groupings that could be coded. Additionally, I bolded certain words that seemed to emphasize significant meaning for each individual participant (See Table 3.1). This practice allowed me to notice unique findings from individual participants that were not part of the findings associated with the participants’ shared experiences. These unique findings were identified as “outliers” in the data which were “different or contrary to the main findings, or simply unique to some or even one respondent” (Burnard et al., 2008, p. 431). These identifying outliers were embedded in the constructivist approach whereby themes were examined through multiple subjective perspectives (Creswell & Miller, 2000). In other words, I approached and understood the data by looking at the data from a subjective stance (Wilkinson & Hanna, 2016). This meant that instead of looking for objective truth, I attempted to understand the data through subjective preconceptions (Wilkinson & Hanna, 2016). Their perceptions about their traumatic losses were organized around their subjective experiences (Wilkinson & Hanna, 2016). Because the constructivist approach and IPA both focused on the subjective experience, findings demonstrated subjective perspectives that were also unique to the rest of the findings aligned with these approaches.

81 Table 3.1. Excerpt from Transcript Reflecting Subjective Experience He touched his hip... and forever after Jacob had a limp. Right? However, he did get the blessing. Jacob lived with that limp forever more. I [am] going back to cripple, I think that if somebody is crippled, it affects every part of their life. It affects every single thing. Every single task in it that it can affect. Their self-image, their idea of who they are and it seeps. It can seep into every single part of their life. I think that fear was crippling to me.”

Looking for shared experiences through subjective perspectives was also an approach that aligned with IPA. I performed this by thoroughly searching for meaning through the data by repeatedly looking for comparisons, thereby allowing emerging themes to become more accessible (Burnard et al., 2008). For example, Table 3.2 illustrated this as individual participants expressed a common belief that they had about a spiritual enemy.

Table 3.2. Excerpt from Original Transcripts of a Shared Belief Participant 1:

Participant 2:

Participant 3:

“The Enemy doesn’t

“…that it has been eight

“... because I know it

want us to grow closer to

years of the Enemy

was the Enemy [saying],

God.”

intricately sitting back

‘You miss this, you

and waiting to weave

didn't do that or this.”

these lies…

Tables 3.1 and 3.2 both helped me to document all steps of data collection and analysis. As part of this standard practice, I sought supervision regarding the areas that I may have over-interpreted, which, in turn, could compromise the authenticity of the participants’ accounts (Larkin & Thompson, 2012). Because Smith et al. (2009) suggested that this was a common error, I attempted to avoid making this error by reviewing the data with the participants during member checking, bracketing my interpretations so as to attend to their subjective experiences.

Step 2: Initial noting. The second step was to explore participants’ descriptions, language use (linguistic), and meanings (conceptual). This process actually began in step one when I made comments on the highlighted and bolded words while re-reading them. Merging steps one and two, according to Smith et al. (2009), was common at this stage of the analysis. As they elucidated their experiences, I made initial comments on how the participants related their feelings, thoughts and experiences to significant areas of concern. Smith et al. (2009) defined this type of coding as “taking things at face value” (p. 84). Coding the language use or, as Smith et al. (2009) referred to as making linguistic comments, were descriptions that facilitated a deeper exploration of how participants attributed meanings to significant events. For example, in Table 3.1, the participant described her fear as crippling, which indicated how she attributed significance to this experience. Unique to this participant was her use of biblical scripture as a metaphor to describe fear’s impact on her.

Using conceptual coding, I moved from her particular experience to the shared and common experience among the participants. According to Smith et al. (2009), this type of coding adds depth to the analysis by enabling the researcher to reflect on my own experiences and interpretations. In this case, sharing a Christian faith with this participant meant that I shared her beliefs about a spiritual enemy who wanted to obliterate all the good things in her life. Reflecting on my own beliefs about this aspect, it deepened the analysis when I identified this common belief between the participants. This had the makings of an emerging theme. In Table 3.2, the theme is illustrated as participants describe a common experience of being pursued by a common enemy. Besides performing these tasks of analysis, I used additional ways that Smith et al. (2009) suggested in exploratory noting: “free associating from the participants” texts were writing down whatever came into my mind when reading certain sentences and words” (p. 91). This resonated with me due to the fluidity free association provides. The other way I performed the analysis was writing my notes in bold and in all caps, emphasizing why I thought the words I highlighted had significance (Smith et al., 2009).

Step 3: Developing emergent themes. The third step was identifying emerging themes from the notes discussed in the previous paragraph. As a byproduct of the hermeneutic circle, I reduced the detailed transcripts by examining patterns within each transcript, also determining possible relationships and mutuality between the parts (transcripts and notes) and the whole

(comprehensive analysis). This shift in analysis, as Smith et al. (2009) points out, is the process of grouping parts of the original transcripts and chronologically abstracting emerging themes from my notes. Identifying themes is to phrase or state “the psychological essence of the piece and contain enough particularity to be grounded and enough abstraction to be conceptual” (Smith et al., 2009, p. 92). This meant that individual subjective accounts were considered while allowing common meanings from their individual experiences to emerge in the data. They represented a collaborative effort of both participants and me the researcher, to capture not only the description of experiences, but also the interpretation of meaning (Smith et al., 2009). As depicted in Table 3.3, some of these emerging themes from one of the participants are noted in the left margins, with each of the transcripts comprising three vertical columns labeled Emergent Themes, Original Transcript, and Exploratory Comments.

Table 3.3. Excerpt from Transcript Left Margin

Original Transcript

Right Margin

Emergent Themes

Interview

Descriptive, Linguistic, Conceptual Comments

God’s a genie

I was probably more in

Request from God, Request is

just the request mode.

what she can get from God only, relationship not mature-infantile faith

Being client &

There’s people,

Therapists in their own

therapist

therapists in therapy,

treatment, therapists are people

it's like, I know it but

too, speaks to the unique

you know, I need

perspective of therapists being

someone to like say it

clients themselves

back to me… Unbearable layers

Yes, I handed it to the

Interactions with hospital staff

ER nurse that took care

about deceased baby, taking care

of me, and they said

of her means that her baby

that they would be

would be taken care of, trust in

taking it back to the PA

hospital staff to care for her and

that was in charge of

baby

us. Issue with trust

I feel like some of this

Lacks trust in self, distrust in self

wouldn't be so much of

is associated with a feeling,

an issue if I trusted

related to core belief about self

myself.

post-trauma

Step 4: Searching for connections across emergent themes. The fourth step in data analysis was to look at how all the themes were similar and different. Emergent themes that were similar were placed together, those that were different were placed separately. The emergent themes were clustered and given

a label according to similar characteristics. The labels were the super-ordinate themes that validated the emergent themes derived from the participants’ accounts. Those which were not thoroughly substantiated are discarded (Loveland, 2016). I performed this task by reviewing the list of nodes in NVivo and then created parent nodes for my super-ordinate themes, before grouping the related emergent themes under them as children nodes. A table representing the structure and development of the superordinate themes as well as the emergent themes were downloaded from NVivo and included in the appendices. Parent nodes or super-ordinate themes were created by reviewing the emerging themes and noting both the repetition and frequency of the participants’ descriptions. According to Smith et al. (2009), the frequency of these themes is referred to as numeration. Grouping these emerging themes or child nodes were what Smith et al. (2009) described as putting the “like and like” together or abstraction (p. 96). Another way that I looked at patterns between themes was locating the child nodes that later developed into super-ordinate themes. Smith et al. (2009) referred to this pattern of similarity as subsumption. For example, one of the participants talked extensively about her role as a mother. This was noteworthy because of the manner in which she elucidated the importance of her maternal role. Initially considered a child node, maternal role and meaning of motherhood became a super-ordinate theme because the participant described how significant her maternal role was in how she processed and coped with her traumatic loss. Her frequent descriptions of these experiences of motherhood provided substantial support for making The Experiences of Mothering into a super-ordinate theme.

In further examining The Experiences of Mothering, I found other emerging themes in the transcripts that were associated with this super-ordinate theme. For example, the same participant talked about her desires to be mothered. This added further depth to the analysis because although she did describe her role as the protective strong mother, she also expressed her need to be mothered and protected.

Step 5: Moving to the next case. All preceding steps (1-4) were repeated for each participant and their corresponding super-ordinate; emergent themes were color coded and arranged as “sets” in NVivo. Sets were a form of grouping in NVivo. Subsequently, these sets were arranged as individual tables for each participant (See Appendices). This was because I wanted to represent each participant’s experience “on its own terms, to do justice to its own individuality [and so as to] allow for new themes to emerge” (Smith et al., 2009, p. 100). “This was in keeping with IPA’s idiographic perspective and the model’s attempts to understand an individual's unique experience of the phenomenon as it unfolded” (Loveland, 2016, p. 97). In this context, keeping an idiographic perspective entailed focusing on the unique experience of each individual participant (Smith et al., 2009).

Step 6: Looking for patterns across cases. During the final stage of IPA data analysis, I explored patterns across and between cases. I performed this by printing all the tables representing the themes associated with each participant. After placing each printed table “on a large open

surface, I then examined similarities and differences between the participants” (Smith et al., 2009, p. 101). At this stage, I looked for the “dual quality” of IPA research: identifying the particular and unique aspects of participants’ experiences while also examining the shared overall meaning between them (Smith et al., 2009, p. 101). Using scissors, I cut the super-ordinate and emergent themes apart to relabel and rearrange them to create a master table of themes (Smith et al., 2009). These themes were clustered under color-coded postcards which were labeled higher order concepts (Smith et al., 2009), illustrating “ways in which participants represented unique idiosyncratic instances but also shared higher order qualities” (p. 101). A master table of these higher order concepts demonstrated the shared themes of the participants while demonstrating each participant’s individual perspectives (Smith et al., 2009) (See Appendices).

Ethical Considerations The Christian psychotherapists in this study were volunteer participants. Although these psychotherapists had experience in treating trauma, the nature of their reported experiences of personal traumatic loss made them vulnerable to emotional and psychological risks. Therefore, all participants received and completed an informed consent document (Appendix A) before commencing data collection. I honored their confidentiality and ensured their rights as human subjects involved in this study. The participants were informed of their right to end participation in the study at any time.

I ensured that these steps were taken so that my professional conduct during this research study could reflect the research and professional guidelines outlined in The Code of Ethics of the National Association of Social Workers (NASW) (2017). The NASW Code of Ethics that guided my professional conduct were Privacy and Confidentiality (1.07) and Evaluation and Research (5.02). All participants’ anonymity, confidential information, data, and backup copies were rigorously maintained in password protected digital files. Honoring the participants’ confidentiality, I ensured that their data would be protected. After completing data collection, I stored hard copies of the data in a locked file to be destroyed after five years. The professional transcriber I hired for this study signed a confidentiality agreement before they had access to the raw and unedited data. This confidentiality agreement can be found in the appendices. Participants were told that the study results would be published as a dissertation and may also be possibly published in journal articles or presented at conferences. To ensure their privacy, they were told that all data shared were presented in either summary form or disguised in such a way that it cannot identify them. Besides ensuring their privacy, the other NASW Code of Ethics that guided my conduct in this study was Commitment to Clients (1.01) and Competence (1.04). I kept in mind that the interview process could elicit strong emotional responses in the participants due to the sensitive nature of traumatic loss. The participants were told that at any point during the research, if they communicated significant emotional distress, they would be asked if they would like to either stop answering questions, reschedule an interview, or drop out of the study. If necessary, I would take the

professional responsibility of referring them to mental health professionals in the community for additional support. In weighing the possibility of what could occur when topics like traumatic loss were discussed, I determined that the benefits of this study outweighed the risks, because the purpose of this study is to inform the social work community about the significance of how faith beliefs and traumatic loss impact the professional self and the clinical relationship. This was demonstrated by the participants’ accounts. Recognizing that disclosure about my own experiences of traumatic loss could facilitate rapport with the participants, I did not want our shared experiences to potentially interfere with their responses (Smith et al., 2009). Therefore, I initially identified myself to the participants as a social work Ph.D. student at ICSW who was exploring Christian psychotherapists’ changed aspects of faith beliefs following traumatic loss. Due to the potential of bias and the nature of my own traumatic experience, I chose not to disclose details about my own traumatic experience during my professional career. Ryan, Coughlan, and Cronin (2007) suggested that having this kind of subjectivity could not only present bias, but also affect the trustworthiness of the study.

Issues of Trustworthiness Evaluating validity in qualitative research creates unique problems concerning trustworthiness. This s because the subjectivity of these kinds of studies as well as researcher bias may affect the findings (Ryan et al., 2007). According to Ryan et al. (2007), it is important to approach validity with rigorous effort. “Rigor is the means of

demonstrating the plausibility, credibility, and integrity of the qualitative research process” (p. 742). This means the process is substantiated by documenting each step of the research and the reasons for taking the documented steps. It also means that I am aware of my potential bias while committing to maintain accuracy of participants’ accounts. To ensure the trustworthiness of my study, I implemented rigor in documentation, procedure, and ethics (Ryan, Coughlan, & Cronin, 2007). I demonstrated rigor in documentation when I ensured that the steps of the research process, the question being studied, recommendations for future research, and implications for both practice and theory were aligned with the purpose of the study (Ryan et al., 2007). Procedural rigor involved precise and comprehensive data collection methods that included reflection and critique, thereby monitoring “my bias and misinterpretations” (p.743). I applied ethical rigor when I made sure that the confidentiality and the rights of participants were addressed (Ryan et al., 2007). Besides protecting the study from bias, other aspects of rigor such as credibility, dependability, confirmability, and transferability are discussed below.

Credibility To increase the credibility of my study, I answered the interview questions by journaling my experiences prior to interviewing the participants. This helped me become aware of any preconceived ideas or perceptions I had while approaching the data. I subsequently ‘bracketed’ these responses. I also invited the participants to take part in the “consultation, reading, and discussion of data and research findings” (Ryan

et al., 2007, p.743). This was part of the member checking that was explained earlier in this chapter.

Dependability By performing effective member checking, I ensured that findings were consistent with their accounts. Dependability is another word for consistency. Dependability in this study meant I made sure that another researcher could trace the stages of the research and reach similar conclusions based on the findings (Ryan et al., 2007). I documented each stage of the process and provided substantiated data for decisions I made throughout the study. Per IPA guidelines, all aspects of the interpretation process were recorded in my research journal and could be validated by others by evaluating aspects of the analysis such as individual, across-case, and between-case analyses (Smith et al., 2009). These practices were incorporated in order to accurately and credibly reflect participant experiences and subsequent research findings (Loveland, 2016).

Confirmability Confirmability was the evidence from the documented research data that allowed me to arrive at conclusions about the study (Ryan et al., 2007). I provided this evidence by allowing my free coding, reflexive and research journals, transcriptions, and theme table to substantiate my findings. These findings were documented in Chapter 4. Chapter 5 addressed my conclusions from the substantiated findings.

Transferability Transferability referred to “whether the findings could apply to “other contexts and readers could apply the findings to their own experiences” (Ryan et al., 2007, p. 743). The nature of this study suggested that exploring the aspects of faith beliefs of Christian psychotherapists following traumatic loss did not make it applicable to other contexts. This is because the faith experiences that may face Christian psychotherapists were unique to them and their approaches to their work. Although Christians from other professional backgrounds may experience personal traumatic losses, their approaches to their work were outside of the clinical parameters that were characteristic of Christian psychotherapists.

Limitations and Delimitations of the Study My biases and limited experience in IPA were the primary limitations of the study. I addressed my biases by implementing bracketing procedures, using a reflexive journal, and consulting with my dissertation committee. To hone my interview skills, I performed two pilot interviews. This was done to develop a style of questioning that facilitated a deeper and profound process for the participants. By the time I began the second interviews, I had developed a comfort level with the participants. However, this method is not impervious to some limitations. First, IPA’s focus on the particular subjective experience of a particular population limited general claims regarding experiences. This meant that conclusions could not be made on the general population. Second, IPA was a new research so applying the criteria for valid

and quality IPA research was still developing at the time of this study (Smith et al., 2009). Thus, applying the criteria for valid and quality IPA research was still developing at the time of this study. Despite these limitations, IPA’s guidelines pertaining to quality research were followed. These guidelines included setting boundaries around the research such as determining inclusion and exclusion criteria in this study (Simon & Goes, 2013). These guidelines, which also included choosing a sample size, participants, and research topic, will be discussed in greater detail below. IPA is an idiographic approach emphasizing the details of a phenomenon (Smith et al., 2009). This is best done with small sample sizes because of the “detailed case by case analysis on the unique perceptions and understandings of each participant” (p. 49). Thus, by having small sample sizes, attention is given to individual accounts that capture participants’ particular subjective experiences. Per IPA, I interviewed four Christian psychotherapists. My goal was to obtain meaningful data indicative of this small sample size (Smith et al., 2009). Homogeneity is also indicative of a small sample size. In my study, I was interested in interviewing a specific segment of the population who experienced traumatic phenomena. Christian psychotherapists who experienced traumatic loss made up a homogeneous sample because of the shared experience of loss, professional background, and faith. Owing to this specificity, inclusion/exclusion criteria were included in the questionnaire given prior to engaging in the informed consent process. Obtaining a homogeneous sample, according to IPA standards, enabled me to examine

similarities and differences within a group of Christian psychotherapists who experienced traumatic losses (Smith et al., 2009). As mentioned in the previous paragraph, inclusion and exclusion criteria were identified for potential participants in this study. For instance, pastoral and biblical counselors were excluded from the study. First, the majority of pastors who provide counseling at their churches take only a limited number of classes related to counseling (McMinn et al., 2010). Second, pastoral counselors who are considered part of the profession of pastoral counseling have a dual degree in ministry and in psychotherapy (McMinn et al., 2010). This implies that their understanding comes from a theological and psychological perspective (McMinn et al., 2010). Third, biblical counselors solely base their psychological understanding of biblical text, frequently dismissing the significance of psychological theories (Johnson, 2007). Because this was not a theological study, choosing psychotherapists who were trained in psychological theory and whose practices were based on psychological approaches were paramount to this study. In addition to pastoral and biblical counselors, Christian psychotherapists were excluded if they suffered trauma in childhood. This is attributed to the literature substantiating that individuals who are survivors of childhood trauma have different self-experiences than those who experience adult onset trauma (Boulanger, 2007). In order to ensure their inclusion in this study, it was important participants to have been Christian psychotherapists who had experienced adult onset trauma during their careers.

The Role and Background of the Researcher Because I am a Christian psychotherapist who has experienced personal traumatic loss, this makes me have “insider status” (Smith et al., 2009). Additionally, given that I belong to the group that I will be studying, I have tried to list and bracket these biases in my assumptions section to the best of my ability. As mentioned in the previous section, my reflexive journal would further assist in my efforts to hone in on participants’ experiences and not my own.

Chapter 4

Results Explanation of Narrative Accounts In order for the narrative accounts to adequately address the lived experiences of the participants, the following steps are taken to facilitate better reading of this chapter. For example, filler words such as ‘like,’ ‘um,’ ‘uh,’ ‘you know,’ ‘I mean,’ ‘so,’ etc. are removed from the excerpts. The participants’ use of proper nouns are replaced by pseudonyms or acronyms. In addition, I provide a descriptive narrative account of the major themes that are identified and discussed in the results chapter (Chapter 4) of this study.

Introduction to Results This chapter discusses the experience of changed faith beliefs of Christian psychotherapists who have experienced traumatic losses. The Christian psychotherapists (N=4) participating in this study are discussed through their demographic information as well as their faith narratives and trauma stories. The focus is on the unique aspects of each participant using the guidelines of interpretative phenomenological analysis. After discussing these unique aspects, this chapter concludes with highlighting the shared meaning among the participants when they talk about the significance of

their faith beliefs and their traumatic losses. These shared meanings are delineated in the following super-ordinate themes: Core Faith Beliefs, Traumatic Loss & The Subjective Experience, Sources of Comfort, and The Changed Experience. The superordinate themes along with their supporting emergent themes lead to the key findings that are discussed in Chapter 5. Notably, these themes emerge from the accounts of the participants who make up the sample in this study. They are introduced in the following section.

Introduction to the Sample The four participants who met the inclusionary criteria for the study were female Christian psychotherapists practicing in Colorado. Their expressed interest in sharing their traumatic losses was another reason why they were selected. All four participants agreed to participate in three audio recorded in-person interviews to talk about these experiences. A total of 12 interviews were completed.

Demographic information. While all four participants are females, they are not a homogenous group. Their ages range from 30 to 55 years old with an average age of 42 years old. All participants are married with children. Except for one participant who has adult children, the children of the other participants range from two to nine years old. Participants vary in terms of their theoretical orientations and licensure/certifications. Years of practice range from eight to ten years, with an average of eight years in practice. Table 4.1 provides this demographic information in detail.

99 Table 4.1: Demographic Table Name Age

Dani

Kennedy

Terri

Yakitta

Avg

Race

Caucasian

African American

Gender

Female

Years in Practice

7.5

License/ Certification

Registered LMFT Psychotherapist

Registered LPC/Cert. in Psychotherapist/ Christian CAC II Counseling

Clinical Orientation

Person Narrative Centered Emotion Family Systems Focused Therapy

Cognitive Behavior Therapy

The participants: Faith narratives, trauma stories, & unique aspects. This study seeks to understand how the participants’ traumatic losses have impacted their faith beliefs. It also seeks to understand how the participants describe the traumatic loss that has changed their faith beliefs and sense of self. The participants’ accounts make it possible for the reader to understand the subjective and unique experience of each participant. These descriptions are titled faith narratives and trauma stories. The purpose of providing the faith narratives and trauma stories is to highlight each participant’s unique faith experience as well as some detail of their trauma narrative. Faith beliefs provide a framework for understanding their experience, their meaning making, and the subsequent integration of the traumatic loss. In describing

8.3

NA NA

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these experiences, unique aspects of their narrative styles and personalities emerge in the interviews. The next section highlights each participant’s faith narrative and trauma story. The uniqueness of their narrative styles is discussed at the end of each description of their trauma stories.

Dani B’s faith narrative: ‘God spoke to me.’ Although she was not raised in a religious home, Dani was drawn to Christianity in college. Dani B. shared how those early days of her Christianity were bittersweet because she had to defend her beliefs early in her faith journey: I came to Christ in college. I had an early crisis of faith because I was studying psychology. I was going to a very fundamental church who believed everything psychology was of the Devil. I took that to the Lord and said, “What do you want me to do with this?” He just made it very clear… He said, ‘This will open doors that I want you to go through.’ I said, “Okay. I’m doing this.” Dani B. seemed to grow confident, believing that she could hear from God through prayer. Relying on what she believed God said to her, her faith beliefs intensified, seemingly becoming a holding environment that successfully sustained and guided her in every aspect of her life. Later, she acknowledged that her personal faith beliefs clashed with traditional Christian beliefs: I think I was a lot more black and white when I was younger...…but there’s a lot of gray between… a college friend shared that she was gay. It was hard to hear that she was struggling with it… God spoke to me about being in her life

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to show love and nothing else matters… not my job to judge and condemn. My job is to share God’s love and truth, although I know that it [homosexuality] is not God’s will for his people. Dani B. became reliant on her faith beliefs because they not only gave her the confidence to choose a career in psychology, but also seem to symbolize an internalizing relationship she believed was loving and safe. Because of this internalized relationship, she could hold onto her experiences of feeling loved and safe on her own and was able to emulate this love towards others. This capacity to hold these experiences as her own proved to be significant to Dani B. when she had to face a traumatic loss.

Dani B’s trauma story: ‘Nothing is keeping me protected from this.’ The traumatic loss that changed Dani B. was the death of her best friend’s son, during the time period she described as ‘the year of loss.’ Dani B. explained this traumatic loss as embedded in multiple other losses. These losses contextualized how she experienced the death of her friend’s son, who died unexpectedly from leukemiarelated complications. Despite the other losses, Dani B. described the death of her friend’s four- year-old son as a different kind of loss because it brought her face to face with her fears of losing her own children: Ever since I was pregnant with my son, the one fear that I’ve had, the one thing that I’ve begged God was, “Please don’t take my children. I think I could handle just about anything else, but please…” has been my biggest fear… if I got to actually have kids, I might lose them.

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Because this fear existed years before she had children, Dani B.’s reaction to her friend’s son’s death connected to her fear of losing her own children. Given that this was her worst fear, seeing this happen to someone who was close to her, made this fear a traumatic experience in itself. “When Evan died, that really brought that fear just right here, to my face. If it can happen to my friend, my friend’s child, it could happen… nothing is really keeping me protected from this,” she said. Dani B.’s trauma is that no matter what she did to protect her children, she could not prevent the possibility of losing them. The fear that she could not protect them, and that God would not prevent a loss from occurring, invaded her behaviors and thoughts. These fears manifested when Evan died because she realized that despite a parent’s best efforts, children die. In spite of her best efforts, her faith beliefs could not protect her and her children. Facing the realization that her belief in God’s omnipotence failed to protect her, Dani B. had to come to terms with a traumatic loss that threatened her trust that her faith beliefs would keep her loved ones safe.

Unique aspects about Dani B’s interview. Dani B. uses a creative interplay of biblical scripture, spiritual metaphor, and life application as her unique narrative style. Because she frequently uses biblical references and scriptures to describe experiences, she demonstrates in-depth religious understanding in her narrative and analysis. One example of this is how she describes surrendering her fears about losing her children. This act of surrender shows her ability to trust her faith beliefs and accept that she might still face losses or difficulties. “He doesn’t guarantee that he’s going to give us all of our desires. He gives us what

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we need... and will I be okay with that? Just coming to acceptance…,” she said. This trust seemed to indicate Dani B.’s move towards reintegrating her faith beliefs in God. Learning to tolerate love and frustration within an environment of safety means that relying on her faith beliefs does not always provide her with the comfort of unconditional safety.

Kennedy’s faith narrative: ‘It was the foundation.’ Like Dani B., Kennedy relied on the safety of her faith beliefs prior to her traumatic loss. She was raised in the church and her faith beliefs were reinforced by the church and her family. Kennedy describes her faith as central and foundational to her identity. This identity however, has changed and evolved over time. Describing her faith beliefs as stages of development, Kennedy considers her early faith experiences as infantile: I’m a pastor’s kid, so I was raised in the church. It was the foundation. Faith was central and always there, but not tested yet. … been a lot of different instances in my life where the Lord has shown himself, both faithful and present in my life. Kennedy described her faith was childlike that prior to her traumatic loss. Kennedy used God as a ‘Genie’ because she believed God could magically protect her. Being taught about faith and experiencing the benefit of these teachings, Kennedy’s faith beliefs provided her with an experience of safety and stability, creating a holding space for her. Looking back, she acknowledged that this type of faith belief in God

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was not mature. She began to recognize this when relying on her faith beliefs did not guarantee that God’s protection would prevent bad things from happening. This became apparent when Kennedy’s traumatic loss tested her faith and she struggled to reconstruct an experience of safety. She realized she needed to integrate the capacity to tolerate threats and conflicted thoughts and feelings. “I know I have to trust you [God] because I know these things can happen… I struggle with trusting myself and how I can trust God in me when I don’t fully understand. That’s been an interesting dichotomy…,” she said. As she sought to achieve this integration and reconstruct meaning in the world around her, Kennedy realized that she had to learn how to hold onto herself and her faith beliefs when bad things happened. Kennedy struggled to hold on to her faith beliefs when she lost her pregnancy. Suffering through the traumatic loss of her pregnancy while still believing that God could meet her needs, hallmarked a change in her faith. Her idealized faith belief that God would protect her from loss coincided with her anger towards him when this belief did not protect her from the anguishing pain of pregnancy loss. Through this loss of idealization, Kennedy was challenged on how to hold onto her belief in God. Allowing idealization and anger to co-exist as part of her faith beliefs implied that Kennedy had to accept traumatic loss as part of her faith in a God who could still sustain her when bad things happened.

Kennedy’s trauma story: ‘I can’t trust these people.’ Kennedy questioned the belief that God could sustain her when she experienced the loss of her first pregnancy eight years earlier, around the time she

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began her clinical practice. Kennedy suffered a miscarriage at eighteen weeks’ gestation. Her negative responses to the hospital staff began after a failed attempt to locate the fetus via a vaginal ultrasound after which Kennedy was sent home where she later miscarried. I was in the shower... the baby had come out. ... I literally saw it just sliding across the shower floor. I screamed at the top of my lungs, “My baby!” over and over and over. I don’t even know how many times. While dealing with the horror of miscarrying, Kennedy had to reconcile with the unanswered questions about her baby’s gender and the cause of her baby’s demise. These critical questions would never be answered because the hospital staff mistook the baby for hospital refuse and disposed of the child. The baby was at the hospital because her husband had picked up the baby and taken it to the hospital for testing. The couple needed to understand what had happened, but the hospital disposed of the baby before they could get any answers. The traumatic loss was exacerbated by what Kennedy and her husband experienced as the hospital personnel’s careless responses to them. She expected the hospital staff to take care of her baby and also to take care of her. Kennedy acknowledged this was what she expected from other people in her life. “I can’t do it on my own, or I guess I do rely on other people to be my True North ... was never okay with just being me,” she said. Because she relied on others to be her ‘True North,’ Kennedy struggled to develop the internal capacity and strength to rely on herself. The necessity to rely on herself when the hospital failed to take care of her caused Kennedy to face the anxiety of keeping herself intact. Not having support when she needed it the most caused

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Kennedy to feel utterly alone and abandoned by the individuals whom she trusted to take care of her. This betrayal of trust resulted in a crisis of self where Kennedy was left vulnerable to experiencing the anxieties associated with losing trust in the comfort and safety of others. “... That was what was traumatic for me for a while... feeling as though I can’t trust these people who are supposed to be medical professionals,” she said. According to Kennedy, part of her traumatic loss was that she lost trust in the medical professionals. Kennedy felt like she could not rely on them because she did not feel like the hospital staff treated her like she mattered. This was significant because Kennedy had to return to the hospital because of excessive hemorrhaging. Unable to feel cared for during a time when she almost lost her life seemed to encapsulate another layer of Kennedy’s traumatic experience: I remember being so cold because there was no blood left. ... for some reason, that sticks, as just a showing of how close I was to potentially dying. … Not so much the fear of death, but the realization of how close I was to dying. Kennedy was impelled to reconcile the discarding of her baby as well as almost dying because of excessive hemorrhaging. Much like what had happened to her baby, Kennedy also felt discarded. Feeling like the hospital staff failed to protect her in her time of crisis, she became ‘trash’ like her baby. This failure of protection from the hospital staff mirrored the internal conflict Kennedy confronted when she was unable to rely on her faith beliefs to sustain her. This conflict was palpable in Kennedy’s narrative.

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Unique aspects about Kennedy’s interview. Kennedy describes her narrative in scenes, adding depth to the data analysis. These scenes manifest the raw subjective experience she felt about not being ‘taking care of’ by her own faith beliefs and the medical professionals. Similar to the failure of her faith beliefs to prevent tragedy from occurring in her life, Kennedy’s belief in the competence of the hospital staff failed to provide her the safety she needed and expected. The parallel between these experiences was that Kennedy’s internal world was constructed with her expectations that others were protective, comforting, and safe. When her reliance on her belief in God and the hospital staff failed to provide any of that, the threat to her sense of self became as imminent as the threat of physical death. Facing this potential outcome without having the ‘fear of death’ meant she came to the realization that she could not rely on herself, others, or on her internal world to feel intact and safe. This failure to feel safe encapsulates one of the essential aspects of Kennedy’s traumatic loss experience.

Terri’s faith narrative: ‘Today’s a new day.’ Like Kennedy, Terri depended on others to help solidify her early faith beliefs. Terri was raised in an Italian-American family whose faith beliefs were rooted in the Catholic church. Her mother’s family were Baptists, but Terri’s commitment to Catholicism came from her father’s family. Although she attended church since she was a young child, Terri believed that God reached out to her when she was approximately 12 years of age. She remembers it being a difficult time in her family’s

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life. This was because two cousins who came to live with them, were causing constant conflict among family members. She also began to lose interest in attending Catholic church around this time. Terri’s loss of interest coincided with the constant conflict in her home. Her departure from church seemingly indicated her loss of a sense of safety in the faith beliefs that once grounded Terri. These beliefs seemed to be centered on church attendance and religion. Amidst these tumultuous feelings, Terri described how God used the song Morning Has Broken to reach out to her during a time when she felt other religious rituals could not provide enough holding for her. There was a lot of turmoil in the house due to her [female cousin] moving in with us. … She would often play a song that resonated with me. The song brought me peace at the time. No matter how bad yesterday, tomorrow is a new day: Morning Has Broken. This is why I liked the song... how God reached out to me: ‘Rather you come to church or not, I am here.’ This song helped solidify Terri’s belief in God’s presence in her life during a time when she needed comfort. This belief also provided an experience of continuity for her because she believed that God’s presence brought her comfort at a young age. It was an anchor for her during a time when her world seemed uncertain and sustained her during her 10 years of church nonattendance. After this period of nonattendance, at the age of 22, Terri was inspired to go back to church with the same song that comforted her when she was 12 years old. I was 22 and literally was eight months pregnant with my first daughter. I woke up [saying], “Oh my God, I have to go to church!” … Heard the song

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as I walked in the church after ten years of not going… Morning Has Broken...today is a new day no matter what happens. Went to church and never stopped going. This song provided a transitional space for Terri as she relied on this song to comfort her, assuring her of God’s presence. Hearing the song upon returning to the church for the first time in ten years, Terri was reassured in her belief that God never left her despite her nonattendance. This reassurance made it possible for Terri to recognize her desire to return and renew her commitment to her faith beliefs. Her commitment to her faith beliefs became valuable to her when she experienced the abrupt traumatic loss of her stepson.

Terri’s trauma story: ‘... five weeks before 19th birthday.’ Terri’s traumatic loss was the murder of her 18-year-old stepson four years earlier, when she was 52. She suspected her stepson was shot by a friend in a gangrelated murder. Commenting on his bad life choices and subsequent estrangement from the family, Terri describes the details surrounding the event: He actually got shot and killed at his own house. He was out in the garage partying. There was beer and pot. There was a gun. How it ended up going down was they were passing the gun around. His friend claims that he thought the gun was empty. Literally pointed the gun and shot my stepson, point blank right through his eye. … Then he died. … five weeks before his 19th birthday. Terri gave the impression she believed her stepson’s death could have been a revenge shooting given his involvement with gangs and a misunderstanding that

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occurred surrounding the death of a rival gang member. Terry was unsure whether the shooting of her stepson was an accident. She attempted to reconcile her feelings about the circumstances surrounding his death through repeated comments throughout her narrative about her strength.

Unique aspects about Terri’s narrative style. Terri’s narrative style emerges in how she responds during the interview and how she describes her response to traumatic loss. Throughout her interview, Terri responds to certain emotionally triggering content with laughs as well as tears. When she talks about feelings associated with traumatic loss, she frequently indicated that she did not let herself or others feel down or ‘wallow’ in their emotions. For example, Terri describes her response shortly following her stepson’s death: … Life still has to go on… took some bereavement leave, but not a whole lot. … have to compartmentalize... see clients, charting, errands, pay bills. I do what I need to do to be okay... don’t give up and do life. Terri did not allow herself to grieve for a significant amount of time; instead, she worked hard to ‘compartmentalize’ and ‘carry on with life,’ allowing Terri to disavow the concomitant feelings of sadness and depression. Based on her account, Terri’s feelings seem too intolerable to manage on her own. Therefore, she relies on what she believes God shows her to reinforce her belief that she is a strong person. I’ve had multiple reminders… signs and wonders [what she believes God shows her] about how strong of a person I am. It gives me a sense of pride. It

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is more positive for others to see you as strong as opposed to weak or broken. … I thought about it and believe it. Believing that her strength is a positive attribute that others needed to see, it is important to Terri not to appear weak in times of trouble. Terri’s faith beliefs are unintegrated in that she cannot hold onto her belief in God’s sustaining strength in the face of experiencing these overwhelming emotions. She therefore immerses herself in caregiving activities in response to her grieving instead of allowing herself to ‘wallow.’ Still, Terri recognized the importance of reflecting on her responses to traumatic loss as she mentioned the timing of the interview, marking the four-year anniversary to the day of her stepson’s death. We both reached a consensus on how uncanny the timing was and how it was a good time for her to reflect on this traumatic loss. This reflection led to a related discussion after the completion of the interviews. Terri mentioned that her daughter’s current illness made her reflect on the way she processed her stepson’s death, noting her reluctance to process and talk about certain feelings. Terri’s reluctance to process these profound feelings was apparent throughout her narrative.

Yakitta’s faith narrative: ‘I grew up in it.’ What was apparent throughout Yakitta’s narrative was the connection between her faith beliefs and identity. Similar to Kennedy and Terri, Yakitta was raised in the church. She described how her religious upbringing fostered a sense of identity that remained with her to this day. “I was one of those kids Sunday through Saturday, we were in church. Whether it was meetings, a board meeting, Bible studies, Sunday school, I grew up in it,” she said. Yakitta’s journey to embody her faith beliefs began

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with her family. Familial faith beliefs helped to solidify Yakitta’s spiritual identity, which seemed to remain intact despite her decision to leave the church while she was in the military. Yakitta referred to her days in the military as existing outside the realm of the safety that her faith beliefs provided at one point in time. Acknowledging her poor choices, she described that ‘everything was going wrong’ during this time in her life. Reaching out to her family, she was convinced to go back to the church. Upon her return to church, Yakitta began to rely on the beliefs that provided her the provisional experience she had in her childhood.

Yakitta’s trauma story: ‘The tell-tale signs.’ Yakitta’s reliance on her faith beliefs was tested after the suicide of her 14year-old client a year and half earlier. This occurred two weeks after he was released from the hospital and three days after his last session with her. He was sitting in the office and he was like, ‘Miss Kitta, we’re doing this, I’m feeling good.’ When you look back, those were all the tell-tale signs. That was on a Wednesday. Monday I got the call from the grandfather that he hung himself. After receiving this news and days after his wake, Yakitta described her shock when she saw his picture as a memoriam on the church billboard. “What the church has now started doing is putting the picture up of the individual. I almost ran off the road in a shock and surprise... disbelief... I had to pass that every day at work,” she said.

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Ill-prepared to handle this type of traumatic loss, Yakitta could not reconcile her feelings about her client’s death while dealing with the shock of seeing his memoriam daily on the church billboard. This reinforced her traumatic loss, making the pressure to persevere more difficult for her. As this became increasingly difficult, Yakitta became more desperate to seek solace from her faith beliefs that provided her comfort in the past.

Unique aspects of Yakitta’s narrative style. The most unique aspect of my experience with Yakitta was reviewing the interview questionnaire with her. I asked Yakitta what pseudonym she preferred and she requested that if permissible, her real name be used. Upon receiving approval, we proceeded after she submitted documentation stating her request (See Appendices). Yakitta was candid in explaining why she wanted her real name to be used in the study. She said it was her story to tell and she did not want her story to be associated with another name. During Yakitta’s interviews, it became apparent that the use of her real name was attached to the significance of her traumatic loss. She did not know anyone who had a client who committed suicide and identified as being one of very few psychotherapists whose treatment relationship with a client ended this way. Feeling alone in this traumatic experience, Yakitta wanted her real name to be connected to her story. Besides using her real name, Yakitta’s experience of aloneness became an emerging theme throughout the interview and in the analysis. She described this experience not only at her job, but also within her field:

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… [it] was that isolated situation that I couldn’t go to somebody… it’s a difference when you can look at someone, talk to someone, and they know or they had their experience. That’s the part where I don’t have anybody. Yakitta describes being different from other psychotherapists as a result of her client’s suicide because she has nobody who understands what this type of traumatic loss does to the confidence of a psychotherapist. Yakitta is also unique in how she integrates her faith identity and practices into her work. She describes in detail how she integrates the practice of ‘anointing’ or blessing her office as a preparation for seeing her clients, even before she lost her 14-year-old client to suicide: I have it in my drawer right there and before every session, I walk around and I anoint from the door back to the door, around, so, it’s already kind of setting the tone of, “Let your [God’s] presence be here, let it stay here.” Although Yakitta integrates this practice into her work, she does not fully rely upon her faith beliefs. Instead, she uses her grandmother’s oil as a transitional object to assure her of God's presence with her in her office. Yakitta’s belief in the power of anointing her office and praying prior to her sessions, empowers her to do therapeutic work with her clients.

Summary of Participants Like Yakitta, the other participants also believe that their faith beliefs and faith practices empower them to do therapeutic work with their clients. Besides this commonality, all share faith beliefs and all but one of the participants have histories of being raised in the church, attributing their faith upbringing to their sense of self and

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identity. Based on their accounts, the participants’ faith narratives demonstrate an internalized object relationship with God, which is represented by their faith beliefs. Their narratives are delineated into the following themes discussed below.

Introduction to Super-Ordinate and Emergent Themes The four super-ordinate themes (higher order concepts) emerging from the data are: Core Faith Beliefs, Traumatic Loss & The Subjective Experience, Sources of Comfort, and The Changed Experience. Table 4.2 illustrates these themes below.

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Table 4.2: Higher Order Concepts: Super-Ordinate Themes and Emergent Themes

Emergent theme 1

Emergent theme 2

Emergent theme 3

Emergent theme 4

Super-ordinate Theme 1.

Superordinate Theme 2.

Super-ordinate Theme 3.

Super-ordinate Theme 4.

Core Faith Beliefs

Traumatic Loss & The Subjective Experience A different kind of loss ‘Gone too soon’

Sources of Comfort

The Changed Experience

Use of faith practices ‘Being held’

The value of experience ‘Catalyst for all this future growth’

Experiences of mothering - ‘Keep it together’

Therapeutic interventions ‘A safe place to finish’

Relying on internal relationship with God over religion - ‘Me walking with Him.’ Psychotherapy as a spiritual calling - ‘What I am supposed to do’ Good and evil coexists - ‘The Devil’s hand was in it.’

Struggles associated with the traumatic loss - ‘Constant questioning’

Renewed spiritual meaning ‘God knows what He’s doing’ Witnessing the Changes made strength of as a result of others’ faith traumatic beliefs and experience - A faith practices ‘little bit more - ‘Went away aware’ different’ Commitment to faith beliefs - ‘Could never walk away’

These themes represent the participants’ shared experiences describing their meaning making as it pertains to the function of their faith beliefs before, during, and after their traumatic losses. The themes are grouped in terms of the manner in which the participants make sense of how their faith beliefs function to provide them with a sense of safety, protection, and comfort. These themes also highlight how by relying on these functions, the participants use their faith practices, psychotherapeutic

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interventions, and affirming relationships to integrate their traumatic losses into renewed spiritual meaning and posttraumatic growth. This integration is seen in how they describe their clinical practices in the aftermath of their traumatic losses. The four super-ordinate themes and their supporting emergent themes are discussed in detail below.

Super-Ordinate Theme I: Core Faith Beliefs Super-ordinate theme one, Core Faith Beliefs, does not address trauma specifically. Instead, it indicates how the participants’ faith beliefs provide holding experiences for these subjects. This is described below in the following emergent themes: Relying on internal relationship with God over religion - ‘Me walking with Him,’ Psychotherapy as a spiritual calling - ‘What I am supposed to do,’ and Good and evil co-exists - ‘The Devil’s hand was in it.’

Emergent theme 1: Relying on internal relationship with God over religion - ‘Me walking with Him.’ All the participants believe they have an emotionally intimate relationship with God who is all-knowing and powerful. Going beyond adherence to religious rules and traditions, their faiths and beliefs represent what they believe is loving, good and safe. This experience of safety provides a connection that fosters the participants’ belief that they can trust God to guide and direct their lives.

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● It’s not about the rules. ... It is about choices. He does have rules such as the Ten Commandments, but within the relationship, there are suggestions. (Dani B.) ● It’s not the legalistic view of religion. It is a relationship between me and the Lord. He guides and directs through his love. I believe that everything is through the lens of his love and how great that is. (Kennedy) ● Just having faith means I could sit right here and talk to God. I don’t have to go to church. I don’t have to think of something to confess… He’s guiding every single step I take and my decisions. (Terri) ● ... My relationship and intimacy with God... hear his voice and recognize his voice... me walking with him. Certainty and assurance… (Yakitta) This intimate relationship with God represents an internalized good object that provides a foundation for their faith beliefs. Having a relationship with God is a foundational belief, manifesting in how the participants conduct their lives with family, work, and recreation. They all elaborate on how this lifestyle shaped their perceptions of their role as psychotherapists.

Emergent theme 2: Psychotherapy as a spiritual calling - ‘What I’m supposed to do.’ The participants’ faith beliefs are based on an internalized relationship with God; this relationship is instrumental in how they reflect on their roles as psychotherapists. They believe that they are not psychotherapists solely because of their training, but because of their choice to follow a spiritual calling to be psychotherapists.

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● When we see our calling and our role for what it is, there’s freedom. Recognizing that it is not my job to save others or judge them. I don’t have that responsibility... Just doing what God called me to do. (Dani B.) ● I’m your vessel. What it [providing psychotherapy] is that I’m called to do. (Kennedy) ● ...But I really feel like that’s [providing psychotherapy] what I’m supposed to do. (Terri) ● With it being ministry and feeling that I’m called to this… This is what I believe I’m called to do. (Yakitta) Because the participants firmly believe in their calling as Christian psychotherapists, each speaks to a sacredness associated with their profession. Empowered to follow their faith beliefs in God’s work, they carry their experience of God with them. ● I can carry Christ into that room, into that situation. … I invite God in by praying for discernment for his words and his truth. When it drops in my head, I check with the client. If it resonates, it is God. (Dani B.) ● I think I always had this concept of believing that the Lord brought me the right clients. The Lord brought me who I was supposed to see, and in turn, who was supposed to see me. (Kennedy) ● I believe in her [client’s] faith… I think I just recognized her [client’s] need to lean on her faith maybe more strongly… meet people where they are. (Terri)

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● I’m praying… I’m always asking the Holy Spirit, ‘If someone presents something, let me make sure I say something or do something that causes no harm.’ (Yakitta) Their reliance on faith beliefs denotes a way of being held in their clinical work, thus giving the participants confidence in their role as psychotherapists and the work their clients are doing. This confidence gets jeopardized in the face of traumatic loss for two out of the four participants who begin to question their beliefs of being spiritually called to practice psychotherapy. ● ... I fail at being the person that I want to be or who everyone thinks that I am. … (my) calling, … testimony, and …. [my] influence is shot. (Kennedy) ● … this [providing psychotherapy] is ministry for me… what I believe I’m called to do. When that [client’s suicide] happened, those things were all questioned. (Yakitta) These questions led to doubts that began to affect their trust in God’s purpose for their lives. Trust is discussed in terms of how they rely on their beliefs in God to combat what they believe is the ‘Enemy’s’ influence. Their belief in the coexistence of good and evil is discussed in the next emergent theme. Emergent theme 3: Good and evil coexist - ‘The Devil’s hand was in it’ The participants have a spectrum of responses based on what they believe about the presence of evil in their lives. Referring to this evil as a spiritual enemy, allows the participants to reconcile with the notion that bad things can occur in a world

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that they believe is governed by a loving God. Relying on this belief enables the participants to split what is loving and good from what is bad and evil. ● … spiritual aspect of that, [the Enemy] doesn’t want us to be close and growing closer to God. The Enemy doesn’t want that. (Dani B.) ● ... had to hold onto this idea that the Enemy can’t steal… can’t rob you of your destiny. He can just make you quit before you get there. (Kennedy). ● There’s things and then just some other things that just felt like the Devil’s hand was in it there [previous job]. (Terri) ● [My colleagues] don’t even understand the spiritual attack and how the Enemy wanted to take him [her client] out... (Yakitta). When referring to the presence of evil, all their responses suggest that just as their beliefs about a real God who wants only the best for them, there is also a widespread belief about a real Devil who wants to destroy what they believe God has given them. Kennedy and Yakitta specifically attribute their questions and doubts following their traumatic losses to a spiritual enemy determined to destroy their belief in the spiritual calling that God has for their lives. ● ... the Enemy intricately sitting back and waiting to weave these lies. From that, to ultimately trying to tarnish what it is that I’m called to do. (Kennedy)

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● …because I know it was the Enemy [saying], ‘You missed this. You didn’t do that or this.’ Is this [psychotherapy] what I am supposed to do? (Yakitta) This belief in a spiritual enemy is the reason why they doubt their professional competence. The statements made by Kennedy and Yakitta suggest that they attribute their self-doubts concerning their spiritual calling to a belief in evil that is shared by all the participants. The participants’ statements suggest that they all share the following belief: in order for God to remain the good object, they have to attribute evil occurrences onto a spiritual enemy. This suggests that having conflictual feelings about their beliefs towards God can only be reconciled by attributing this conflict to a spiritual ‘enemy.’ Prior to their loss, they had to separate what they believed was good, loving, and safe from what they believed was evil and threatening. Their sense of protection stemmed from a reliance that following their faith belief would protect them. For the participants, this process manifested through their experiences of traumatic loss. The participants talk about these experiences in the next super-ordinate theme describing their experiences of their traumatic loss.

Super-Ordinate Theme II: Traumatic Loss and the Subjective Experience All four participants elucidate their losses as experiences affecting every aspect of their lives. Although they describe traumatic loss in a similar way, different factors lead them to respond to their individual experiences of traumatic loss. These factors are identified as the following emergent themes: 1) A different kind of loss - ‘Gone too

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soon,’ 2) Experiences of mothering - ‘Keep it together,’ and 3) Struggles associated with the loss of protection - ‘Constant questioning.’ These emergent themes are discussed in greater detail below.

Emergent theme 1: A different kind of loss - ‘Gone too soon.’ All four participants report that their responses to their traumatic losses are different from typical grief due to the incomprehensible nature of their traumatic losses. The participants attribute the incomprehensible aspect of these traumatic losses to the age of the person whom they lost, thus implying a death of a future and potential: ● ... Gone too soon… It’s the loss of your child, the loss of all the expectations. You just have all of these hopes and dreams and expectations in that child, and then it’s gone. That’s probably the huge, the biggest difference. You don’t expect children to die. (Dani B.) ● Because we never looked [for the gender when the baby came out in the shower], now we’ll never know gender, which we could’ve known. We’ll never know anything. (Kennedy) ● It was five weeks before his 19th birthday...an unexpected death... but he was young. Opportunity for relationship is gone. I definitely felt regret that I wouldn’t be able to be part of his future life. (Terri) ● I couldn’t wrap my head around a 14-year-old [committing suicide].’ This is such a young boy with so much potential and so much life. (Yakitta)

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For the participants, grieving a lost future and potential are the essential features of what distinguishes grief from a traumatic loss. Grappling with traumatic losses they could not understand, the participants talked about the unique challenges associated with the death of a future. When Dani B. said that ‘you don’t expect children to die,’ she meant that the death of a four-year-old was an experience that could not be logically reconciled with because it disrupts the anticipated order of life. On the other hand, Kennedy struggles to logically come to terms with the loss of a baby she never knew. When she talks about losing the chance to know her baby’s gender, she says she also has lost the opportunity to give her baby a name. “I think what makes it hard is that it’s this nameless, genderless baby. This baby never… a part of our family system… That makes me sad,” she said. Kennedy’s sadness associated with losing a ‘nameless, genderless baby’ implies that her baby is deprived of experiencing a continuity of self, meaning that her baby is deprived of having an identity within her family. Terri describes a similar loss when she talks about the lost future of her stepson. “Opportunity that he lives a happy life is gone. There won’t be any children, grandchildren from him,” she said. Losing the potential of seeing her stepson’s future children is a significant part of her traumatic loss because they represent the dreams and hopes she had for her stepson’s future which she will never see. Meanwhile, Yakitta’s grief was associated with the lost future life of her client that caused by his decision to commit suicide. Believing that her client had ‘so much potential and life,’ it was difficult for Yakitta to reconcile with the idea that he would choose to end it. “… how to grieve for a client who makes the choice to die. Different

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than my grandmother who was 100 who passed away or an accident. This was that you made a decision…,” she said. Her grandmother, who died of old age and of natural causes, aligns with Yakitta’s understanding of death. However, her client’s death at age 14 caused by suicide disrupts this understanding, thereby making the loss of his future more traumatic than the death of a family member with whom she shares a closer relationship. It is notable that besides experiencing the loss of a future, the majority of the participants talked about how being mothers at the time of their losses impacted how they grieved. Experiences of Mothering - ‘Keep it together’ became the second emergent theme and is discussed in more detail below.

Emergent theme 2: Experiences of mothering - ‘Keep it together.’ All four participants talk about their experience of motherhood as it relates to their losses. Three of the four participants pointed out that they did not have time for their own grieving because of their maternal roles, while the fourth participant talked about how her grief framed her experience of mothering. ● ... Soon as you walk in the door the kids are saying, ‘Mom, Mom.’ … pushed it down and back. Felt it all in the car. Had to put it all in when I got home. (Dani B.) ● Trying to be on top of everything for the kids. … I try to make sure it [her parenting] doesn’t slip through the cracks. There is a piece with the parenting..., [Thinking to herself] “You failed. You started out parenting by failing.” (Kennedy)

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● Being the mom… going into caregiver mode… had a lot of focus on my husband to make sure that he is okay. I would cry away from him so that I could come back and take care of him. (Terri) ● I didn’t really have time to sit in my emotions and let myself grieve. What I tell others to do, I didn’t have time to do myself… being a wife and mother… couldn’t let my feelings flow how they needed to. (Yakitta) The participants shared a sense of responsibility to their families that manifested as a maternal response, impacting how they processed their grief. Despite not having children at the time of her loss, she carried the responsibility to not fail her subsequent children. Kennedy believes she is a failure as a mother because her first experience resulted in the loss of her first child. The responsibility for the care of her subsequent children becomes an effort to compensate for her initial sense of inadequacy which makes her feel unworthy of receiving her ‘children’s love.’ “… it doesn’t matter how you reframe it… gonna be a piece that… carry… failure or inadequacy... I am incapable and therefore, I’m unworthy of my children’s love,” she said. This indictment of her self-worth, has caused her to carry every potential parenting struggle as a defective aspect of her parenting. Because she had not fully come to terms with making meaning of her faith beliefs in light of this defective aspect, she believed that she was being punished because of this ‘incapability.’ Kennedy also believes that God is withholding good things from her because of her unworthiness. “I believe in your promises, Lord, for everyone except me…because I

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have this deep down belief that… I am unworthy,” she said. Kennedy struggles with not allowing her caregiving to ‘slip through the cracks’ on a continual basis, working to protect her children from her perceived parenting failures. This sense of responsibility to protect those that she cares about is shared by the other participants. Already mothers, the other participants sought to protect their family from their grief by seeking time alone following their traumatic losses. ● I wanted to have that time for myself. … my space to grieve. Protectiveness that came out toward… [husband and children]. When it is just me, I am completely focused on my grief. (Dani B.) ● It [grieving] would just happen when I’m… driving alone... safer… because of being alone - yell obscenities. ... Wanted to protect him [my husband] from that [my anger]… this wouldn’t be useful [for him]…I was getting it [her anger]... away from him… (Terri) ● ... would take showers and I would just cry… that was a place where I could go and I can be vulnerable. I don’t have to keep it together for anybody… I could just be. (Yakitta) Caring for others while trying to manage their own grief responses led the participants to prioritize the needs of their families over their own. Explicating this as ‘protectiveness,’ most of the participants took time alone for themselves to grieve. By doing this, they could attend to their own needs so they were able to ‘come back’ and be present to care for their loved ones. For two participants, attending to their need to grieve, at times, interfered with their ability to attend to maternal demands. For Dani B., this was a challenge. “…

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grieving a child that was lost, and yet, wanting to make the most of any… moments I had with my children, but the grief wouldn’t let me do that,” she said. Correspondingly, Yakitta conceded that this was a challenge for her as well. “I was drained, depleted… taking care of [my] children, had to go through the motions while trying to process [my grief]. It’s tiring,” she said. These two participants’ statements suggest a significant relationship between their ability to attend to maternal demands and their ability to attend to their own need to grieve. When all four participants talked about the weightiness of their grief, they acknowledged their need to manage overwhelming thoughts and feelings. This struggle to make sense of what has happened to them, the third emergent theme, Struggles associated with loss of protection - ‘Constant questioning’, is discussed in the below section.

Emergent theme 3: Struggles associated with the loss of protection ‘Constant questioning.’ All four participants share their struggles in experiencing their intense feelings of fear, shock, anger, confusion, and doubt following their traumatic losses. ● Just had this fear, I would say crippling fear… struggled with depression in a way that I really never had before… the brain fog... (Dani B.) ● I remember being so angry. … Realizing that things happen… so it adds to the disappointment… this constant questioning… (Kennedy) ● This sucks (laughs). … there’s this sense of loss, sadness. (Terri)

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● It’s tiring. I was frustrated. All of those emotions that go with why. (Yakitta) This barrage of emotions caused the participants to struggle with questions and other thoughts that bombarded them following their traumatic losses, thus underscoring a shared struggle. For Dani B., of all the other deaths she endured that year, the traumatic loss of her friend’s young child, was the most significant. This was because the fear of losing her own children haunted her most of her adult life. “The one fear that I’ve had, the one thing that I’ve begged God was, “Please don’t take my children,” she said. After being confronted with this fear, she could not trust in the protection that her commitment to her faith beliefs provided her. Realizing ‘nothing could protect her’ from losing her children meant nothing could protect her from annihilation. Losing this perceived protection and the safety in her faith beliefs reflected Dani B.’s struggle to hold on to what she believed was good and would keep her safe. Part of this struggle included experiencing her faith beliefs differently than what she had known. Dani B. had to reconcile with this failure of her beliefs. The ensuing depression reflected her struggle to reconcile with these experiences. Kennedy also had to reconcile with a lost trust in God’s omnipotence to protect her. She describes this loss as her disappointment in God. “Not only disappointment, but I can’t ever get back. Death is final… reconciling with whether he is a deity that doesn’t care,” she said. Having been raised with beliefs to trust in God in all circumstances, Kennedy believed that God let her down. This loss of confidence that a good God could allow traumatic loss to occur in her life impacted her faith beliefs.

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Terri described her loss of hope was the biggest impact on her faith beliefs. She struggled in trying to reconcile that her traumatic loss was final, revealing that a large aspect of it was a lost opportunity. Terri struggled with the thought of never restoring her relationship with her stepson, describing it as the death of hope when her stepson was killed. “… having hope slammed like that. When that kind of hope is gone, similar to miscarriages - hope slammed away, so abruptly,” she said. Terri’s analogy about the death of her hope with having a miscarriage sheds light on what Kennedy felt. “… losing a child, not only disappointment, but I can’t ever get back [a chance to have a future relationship]… more of the pessimistic, glass half empty…,” she said. The abruptness that they both describe in their experiences of loss seems to hallmark the feeling of lost potential of a future relationship amongst all the participants. Pain from these abrupt losses highlights the struggles associated with their traumatic losses, encapsulating the experience of no longer feeling protected by their faith beliefs.

Responding to this loss of protection is also reflected in

Yakitta’s experience as she grieved the traumatic loss of her young client to suicide. “I was all over the place. I wasn’t showing up to appointments… couldn’t pray,” she said. As Yakitta struggled to make sense of her traumatic loss, her reliance on her faith beliefs and practices which comforted her in the past were no longer effective. This occurred among all participants, another theme emerging from this study. The shared emergent themes above encapsulate the initial responses by all of the participants following their traumatic losses. Upon further examining their subjective accounts, the next super-ordinate theme, Sources of Comfort, emerges

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because it is significantly related to the participants’ efforts to seek resources outside of themselves to help them make sense of their traumatic losses. This super-ordinate theme is discussed in the next section.

Super-Ordinate Theme III: Sources of Comfort Following their traumatic losses, all four participants accessed various resources such as their faith practices, pursuing therapeutic options, and relying on the spiritual strength of others. Accessing these external resources not only gave them succor, but also enabled them to manage their conflictual feelings and thoughts associated with their traumatic losses. They talked about a deepening of their commitment toward their faith beliefs as a result of accepting these traumatic losses. The following emergent themes illustrate how the participants describe this process: 1) Use of faith practices - ‘Being held,’ 2) Therapeutic interventions - ‘a safe place to finish,’ 3) Witnessing the strength of others’ faith beliefs and faith practices - ‘went away different,’ and 4) Commitment to faith beliefs - ‘could never walk away.’ These are further elaborated below.

Emergent theme 1: Use of faith practices - ‘Being held.’ When sharing their experiences on the manner in which they managed their thoughts and feelings about their traumatic losses, the participants talked about how they looked for guidance from God and their faith beliefs. This came in the form of prayer, worship songs, and biblical scripture which they used as ways to help them interpret their experiences and seek comfort.

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●

When I journal, a lot of times that’s how I’m praying… He’ll quiet my heart. He’ll give me a scripture. … I start out the handwriting jagged … by the end, it’s calm. Being at peace... questions not answered but his calm. I’m being held. (Dani B.)

●

Believing that I would be Job [referencing scripture about a biblical character].... believed that God was going to multiply [like he did for Job]. Believing that… He wasn’t going to leave me there. (Kennedy)

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That song [Morning Has Broken]… That whole spirit of that song was renewed in me… Makes me consider what God is doing and what God wants me to do. (Terri)

●

… the song that... has been in my spirit… on my way to work and worshiping… I poured my heart out and… letting God’s presence wash over… let the worries, baggage of day be washed away. (Yakitta)

All the participants talked about how utilizing their faith practices gave them comfort and guidance. The words in scripture and in worship songs offered ways to interpret and manage experiences that were too overwhelming to contain on their own. These faith practices made it possible for them to find comfort and make meaning of these experiences. Despite their struggles, the participants channeled their confusion, anger, sadness, and doubt to ultimately deepen their commitment to their faith beliefs. Through prayer, worship music, and biblical scripture, they found guidance. Similarly, through these faith beliefs, they achieved calmness and clarity where there was once confusion.

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In addition to their faith beliefs, the participants also sought guidance through various forms of therapeutic interventions. Similar to their faith practices, the participants used these interventions as ways to help them manage their thoughts and feelings associated with their losses. The participants describe their use of therapeutic interventions in the next emergent theme.

Emergent theme 2: Therapeutic interventions - ‘Safe place to finish.’ All four participants saw their own therapists and/or utilized their own psychotherapeutic techniques to manage thoughts and feelings that overwhelmed them. ● ... self-regulation skills that I knew… helping me… That’s part of why I started seeing a counselor the middle of last year. I still need a safe place to finish, as much as you can finish. (Dani B.) ● That’s why going to therapy is helpful, just that person to normalize [what her therapist says], ‘You’re not crazy, everything’s fine… being a mom’s hard,’ and those types of things. (Kennedy) ● But even now I regularly access my therapist peeps. (Terri) ● Cognitive behavioral therapy has always worked for me… That’s what I did, the reframing and challenging my thoughts… stopping intrusive thoughts because there was a lot of replay. (Yakitta) The participants shared how combining psychotherapeutic supports with their faith practices helped them manage their thoughts and feelings pertaining to their traumatic losses. By reintegrating their traumatic loss experiences as part of their faith beliefs, they all explained the benefits of accessing this support.

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Dani B. mentioned that she needed a ‘safe place to finish,’ and that her therapeutic relationship provided her the space to begin integrating her traumatic losses. The other participants talked about similar experiences. By affirming that these feelings and thoughts were normal, therapeutic spaces provided them with the capacity to bear witness and validate experience. Psychotherapeutic support was part of their attempt to seek comfort and to make meaning from their traumatic losses. The participants also used psychotherapeutic support as a way to help them engage in the work of ‘finishing,’ ‘normalizing,’ and ‘reframing’ their traumatic losses. These words denote examples of how the participants began the work of meaning making, which provided the participants with ways to help them make sense of their traumatic losses, eventually leading to a place of acceptance despite these tragedies. The participants also talked about how individuals in their lives helped them to hold their experiences of traumatic loss. This is discussed in the next emergent theme.

Emergent theme 3: Witnessing the strength of others’ faith beliefs and faith practices - ‘went away different.’ The participants talked about using the models provided by individuals who practiced using faith beliefs and faith practices during difficult times. ● This has always been my fear, and watching you [friends]... being here in the celebration of T’s life, if that were to happen [to me], I’ll be okay. ... that was... a really powerful thing. (Dan B.) ● … my clinical director at [my workplace] told me this idea of… where Jesus says, ‘I came to give them life to the full.’ ... I’m [saying], “… Yay!

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It’s sunshine and rainbows… like euphoria.” [My clinical director asks], ‘How do you know what fullness is unless you’ve seen this side [the bad]?’ … It blew my mind... (Kennedy) ● [When she was twelve] There was a lot of turmoil in the house due to her [female cousin] moving in with us. She would often play a song [Morning Has Broken] that resonated with me. The song brought me peace at the time. (Terri) ● … she [prayer partner from her prayer group] put her hands on me and just prayed. Was so healing… the weightiness shifted…Because of how she prayed and allowing God to use her with even the same words [as I] used. God answered her prayer… (Yakitta) Witnessing these models, the participants used how others integrated faith beliefs, channelized their commitment to faith practices, and bore witness to their pain. By using these external resources to help them hold their experiences and come to terms with their traumatic losses, the participants ultimately began to expand their capacity to internalize their faith beliefs. As a result, participants began to see their traumatic losses from a renewed perspective. ● I think God did what he does. He just spoke to that fear in me and helped me recognize it a different way. [Speaking to God]... “and I still don’t want you to take my children, but I’ll be okay if you did.” (Dani B.) ● That’s been challenging me… because “Okay Lord, you’ve shown me this fullness. I wanted to believe that this fullness wasn’t really there. That it wasn’t needed for growth…” (Kennedy)

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● Those words [to the song] are always with me. I believe every day is a new day. I got through yesterday, I’m gonna get through today. (Terri) ● It [her prayer] aligned to my heart when I was praying… finding closure in what happened - [She was praying that] I need to understand but it will be okay if I don't understand, [she] even [used] the same verbiage. … [I] went away different… (Yakitta) Obtaining renewed perspectives meant that the participants began to have a more integrated experience with their faith beliefs. This was evidenced by how the participants were able to talk about holding their traumatic loss experiences and their faith beliefs. They talked about their willingness to submit and declare their commitment to their faith beliefs despite their traumatic losses. This commitment to their faith beliefs became the next emergent theme discussed in detail below.

Emergent theme 4: Commitment to faith beliefs - ‘could never walk away.’ The participants came to rely on their faith beliefs to reestablish a sense of safety and comfort, which helped them make sense of God and their world. Their traumatic losses forced them to examine if their faith beliefs could still hold them when their sense of safety and comfort were lost. Through their faith practices and the help of others, the participants began to make sense of, accept these losses, and reintegrate their faith beliefs. When the participants talked about their faith beliefs getting ‘stronger,’ their commitment to their faith beliefs included realizing that these beliefs did not guarantee protection from tragedy, but continued to be symbolic of their internalized relationship with God.

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● … my faith in who I know God to be… gotten stronger. It’s that reinforcement of, [What she believes God is saying], ‘No matter what you go through, I am there.’ I knew that to different degrees up until that point but it’s reinforced even more. (Dani B.) ● I still struggle… because I could never walk away from my faith… I believe you’re there and I believe that you’re… deity and authority. I could never walk away and be an atheist...you’re there. (Kennedy) ● … they [faith beliefs] became more relevant… strong faith that has gotten me through [the loss]… I think that my faith beliefs just became more to the forefront and I believe they’ve stayed there. (Terri) ● … in those times when I was upset because I didn’t understand and I didn’t get it, I could’ve walked away completely from God… didn’t know what that would look like... my relationship with God is all that I know. I can’t imagine. (Yakitta) When the participants talk about their unwavering commitment to their faith beliefs, they demonstrate that they do not lose God as a good object. In particular, Dani B. demonstrates this when she talks about believing that she carries the presence of God with her which seems to ‘reinforce’ what she believes about him. This experience of constancy and safety is what enables her to remain committed to her faith beliefs. Like Dani B., Kennedy and Yakitta also believe that they carry the presence of God in them. Due to her reliance on this experience of constancy, Kennedy believes that this internalized relationship can keep her intact in the midst of her struggle to

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come to terms with her anger. “… [I] probably [was] the most outwardly angry I’ve been at the Lord… I really try to keep that in check…like talking to a parent – personal intimacy but there is a respect,” she said. Kennedy believes that her internalized relationship with God is the authority, resembling ‘a parent’ who governs her responses even when she is angry at God. Using her belief as authority, she keeps her anger from bordering on what she believes is disrespectful. Like Kennedy, Yakitta also uses her faith belief to direct her, in which she believes that God is the authority in her life. Even in her anger, she cannot allow herself to walk away from these faith beliefs. This is because though they do not help her understand the ‘why’ behind her traumatic loss, her faith beliefs continue to represent what she believes as safe and comforting. Despite her questions, she relies on this internalized belief system because it is ‘all that she knows,’ and keeps her intact. Terri also demonstrates how her faith beliefs represent what is safe and comforting. She describes a shift in the manner in which she uses her faith beliefs before and after the death of her stepson: I was more cautious before so that I wouldn’t maybe turn someone off or make them wanna shut down… as therapists we don’t… push our beliefs onto someone else. … but now it seems, I’m more open. If it comes up, I’m more willing to share that. Unlike the rest of the participants who mentioned feeling confident in relying on their faith beliefs, Terri initially, did not rely on her faith beliefs the same way.

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After her stepson’s death, she relied more heavily on them, giving her the freedom to share her faith beliefs with her clients. Terri also talked about her faith beliefs becoming more ‘relevant,’ allowing internalization to become possible. As participants internalize their new understandings of God, their faith beliefs are reintegrated into their senses of self. The participants talk about being changed as they reintegrated their faith beliefs into new meanings. These changes are discussed in the next super-ordinate theme.

Super-Ordinate Theme IV: The Changed Experience All four participants report experiencing a change in one or more areas of their lives following their traumatic losses. All four participants spoke about how their perspectives following the traumatic losses are imbued with a renewed sense of spiritual meaning. These accounts are delineated in the following emergent themes: 1) The value of experience - ‘catalyst for all this future growth,’ 2) Renewed spiritual meaning - ‘God knows what He’s doing,’ and 3) Changes made as a result of traumatic experience - ‘a little bit more aware.’ These emergent themes are discussed below.

Emergent theme 1: The value of experience - ‘catalyst for all this future growth.’ All four participants talk about how they gain insight from their traumatic experiences. With this insight, all participants elaborate on how their losses have helped them grow in certain aspects of their lives.

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● … but having not gone through what I had, I don’t feel that I would be able to give… that space... to really go there… into the messiness of the grief…[now] just increased confidence in that I don’t have to do it all. I don’t have to have the answers. (Dani B.) ● I feel like that’s [the miscarriage] really shaped my whole 20s… right after the miscarriage… It was this catalyst for all this future growth. (Kennedy) ● I think it’s more of an awakening of the strength for me… perseverance, tolerance, and increased amount of joy. (Terri) ● I now had experience or I now had something to bring to the table… I now had the experience and the knowledge… (Yakitta) Their traumatic losses helped to deepen their understanding about the potential value in suffering. For the participants, suffering meant losing and no longer feeling held by their faith beliefs. Their suffering, which was attributed to their traumatic losses, threatened their experiences of feeling held by their faith beliefs. Because these faith beliefs were the cornerstone to their sense of self, the fear of annihilation became real in the face of traumatic loss. As noted previously, through the use of their faith practices, therapeutic interventions, and help from affirming others, the participants can internalize these experiences in a way that helps solidify aspects of themselves that are under the threat of falling apart. Feeling more intact, the participants began to make meaning from these experiences, challenging their old ways of thinking about God. This helped renew spiritual meaning for them and became the next emergent theme.

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Emergent theme 2: Renewed spiritual meaning - ‘God knows what He’s doing.’ The participants’ faith beliefs become reintegrated when they change the meaning of their protective functions. With the reintegration with these faith beliefs, they demonstrate the participants’ increasing capacity to understand and accept disappointment and frustration as well as regain trust in God. ● … it’s not a promise that I’m not gonna lose my children. It’s a promise that [believes God is saying to her] … ‘I know what’s best for you… I’m still God over all of it and if that were to happen, I will carry you through.’ … That fear does not have a hold on me anymore. (Dani B.) ● … [Directed at God] “I believe you’re there… but are you really truly as omnipotent as you say? Do you really care about all these things that are happening?” I, of course, worked through that… I do genuinely believe he does [care]. (Kennedy) ● … sometimes, you need a reminder. There’s that saying, “God doesn’t give you more than you can handle.” … I am so strong, I think I can lift a Buick (laughs). (Terri) ● ... because this happened doesn’t mean prayers aren’t being answered. There’s a bigger plan… God knows what he’s doing. [Directed at herself], “Don’t try to take on his role.” (Yakitta) The participants began to solidify their trust in the safety and comfort of God who ‘knows what he’s doing’ while also reconciling that their experiences of safety do not necessarily include protection from tragedies and uncertainties. Dani B.’s once

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persecutory fears about God taking her children diminished as she begins to internalize her faith belief that he will ‘carry her through.’ Therefore, she is beginning to tolerate her conflictual feelings and still trust her faith belief that God is still a good and safe object. Like Dani B., in an effort to reconcile that their belief in God does not protect them from tragedy, both Kennedy and Yakitta came to terms with their doubts and questions. For Kennedy, this means that despite her traumatic loss, she develops a belief that God still cares. For Yakitta, by trusting in God’s omnipotence as opposed to her own, her feelings of anger, frustration, and disappointment do not destroy their internalized relationship. These feelings seem mitigated by the reassuring faith belief that God has a ‘bigger plan’ and he ‘knows what he is doing.’ Like Dani B., both Kennedy and Yakitta demonstrate through their accounts that their faith beliefs continue to represent an experience of safety and comfort. Terri is comforted by her belief that God trusts her with the ability to remain intact during difficulties. By stating that she ‘can lift a Buick’ she relies on this attribute as a way to describe her ability to handle life’s tragedies. Instead of questioning the why behind her traumatic loss, Terri seems to use her ‘awakening of strength,’ as a ‘reminder’ of what she believes God entrusts to her. Introjecting these faith beliefs, they become a way of strengthening aspects of herself. Because of their internal relationship with God, the participants are able to use their faith beliefs to integrate their traumatic losses, thus infusing spiritual meaning to their experiences. As a result, the participants facilitate changes in how they relate to others and how they approach their clinical work. These changes are articulated in the

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last emergent theme titled, Changes Made as a Result of the Traumatic Experience - ‘a little bit more aware.’

Emergent theme 3: Changes Made as a Result of the Traumatic Experience - ‘a little bit more aware.’ Experiencing change after a traumatic loss is a common thread among the four participants. This experience of change manifests in the manner in which approach their clinical work. Additionally, change is manifested in how they relate to others, God, and themselves following their traumatic losses. ● … But having not gone through what I had, I don’t feel that I would be able to give... space to do all of that… safe... to really be real and honest. I am a person that you can just lay it all out. There’s no judgment. (Dani B.) ● There’s almost that loss of innocence… changing who I am. … I feel like that has made me a little bit more aware of the world and I do believe that there is a healthy goodness to that. (Kennedy) ● … realigning priorities. … I stayed firm to that. I was... proud of myself. I learned how to say no and not feel guilty about it. (Terri) ● … [clinically] being more in tune, more aware, and really asking those questions that people don’t wanna ask… Being able to ask those straightforward questions and addressing them versus making it nice. (Yakitta) All of the participants’ narratives seemed to culminate in a resolve that their personal and professional practices have changed as aspects of their faith beliefs began to

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solidify. Dani B. mentions that she now has the ‘space’ for all ‘the messiness of grief.’ Kennedy is beginning to recognize the ‘healthy goodness’ in seeing the world a different way after her loss. As Terri becomes more confident expressing her faith beliefs, she also begins to demonstrate confidence in being able to set boundaries for herself. Yakitta demonstrates by becoming more confident with suicidal clients because she is not afraid to ask uncomfortable questions. Yakitta’s confident resolve is what resonates among the other participants. Besides re-establishing an internalized experience of safety and comfort for them, their faith beliefs helped them use their traumatic losses to shape an understanding of how they can learn and grow from change and loss. As a result, the participants demonstrated a renewed confidence in their approach to clinical practice and their faith beliefs.

Summary Chapter 4 describes the super-ordinate and emergent themes derived from the four Christian psychotherapists who have chosen to participate in this study. In Table 4.1, the super-ordinate themes and emergent themes are identified based on the common emphasis placed on how the participants describe certain details of their accounts and responses concerning the meaning of their faith beliefs. The results reflect the varying levels of integration of these beliefs as the participants attempt to grapple with unexpected traumatic losses. This assumes significance when it comes to providing understanding on the extent the participants relied on these beliefs when they experienced traumatic losses and more specifically, to what degree they used these faith beliefs to acquire new meaning considering these traumatic losses. Table

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4.3 provides a summary of the results which are discussed as major findings in this study. Table 4.3 Summary of Super-Ordinate Themes/Emergent Themes Super-ordinate theme: Emergent theme Core Faith Beliefs: Relying on internal relationship with God over religion - ‘Me walking with him’ Core Faith Beliefs: Psychotherapy as a spiritual calling ‘What I’m supposed to do’

Core Faith Beliefs: Good and evil coexist -‘The Devil’s hand was in it’ Traumatic Loss & the Subjective Experience: A different kind of loss ‘Gone too soon’ Traumatic Loss & the Subjective Experience: Experiences of mothering ‘Keep it together’

Key Findings God represents an internalized good object that provides a foundation for participants’ faith beliefs.

Their reliance on the belief that they are spiritually called to be psychotherapists is a way of being held in their clinical work, thus giving the participants confidence in their role as psychotherapists and the work their clients are doing. The participants split what they believe is good and safe from what is bad and evil as a way to explain negative experiences in their lives. The unexpected nature of the participants’ traumatic losses was the death of a future relationship. The participants share a sense of responsibility to their families manifesting as a maternal response to protect them from their grief.

Traumatic Loss & the Subjective Experience - Struggles associated with the loss of protection - ‘Constant questioning’

Pain from abrupt loss manifests as intense feelings of fear, shock, anger, confusion, and doubt associated with the participants losing the protection of their faith beliefs.

Sources of Comfort: Use of faith practices - ‘Being held’

Because of their use of faith practices, the participants are able to manage feelings that are too overwhelming to contain on their own. Seeking therapeutic support provides the participants with a holding environment to help them manage their thoughts and make sense of their tragedies, leading them to acceptance. Internalizing how others model their use of faith beliefs, participants begin to reinterpret their experiences and accept their losses, developing the capacity to internalize their faith beliefs. Demonstrating a reintegration of their faith beliefs makes the participants realize that these beliefs do not guarantee protection from tragedy but continue to

Sources of Comfort: Therapeutic interventions - ‘a safe place to finish’

Sources of Comfort: Witnessing the strength of others’ faith beliefs and faith practices - ‘went away different’ Sources of Comfort: Commitment to faith beliefs - ‘could never walk away’

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The Changed Experience: The value of experience - ‘catalyst for all this future growth’

The Changed Experience: Renewed spiritual meaning - ‘God knows what he’s doing’ The Changed Experience: Changes made as a result of traumatic experience - ‘a little bit more aware’

remain symbolic of what is safe and good - their internalized relationship with God. Experiencing losses seems to help the participants’ understand about the potential value in suffering, enabling them to use their faith beliefs to begin to apply renewed spiritual meaning to their lives. The participants are able to use their reintegrated faith beliefs to help integrate their loss, thus finding renewed spiritual meaning to what has happened to them. The participants’ narratives culminate in a resolve that their personal and professional practices are changed as aspects of their faith beliefs begin to solidify. This changes how they relate to others and approach their clinical work.

This study identities four key findings. In Core Faith Beliefs, the findings describe the participants’ faith beliefs prior to their traumatic losses. These faith beliefs represented their internal relationship with God, making this the basis for their other core beliefs. These beliefs provide a holding environment for them. In Traumatic Loss and Subjective Experience, the findings elucidate how the unexpected and traumatic loss of young life threatens the stability of these beliefs, causing the participants to question and doubt God. Their maternal functions protected them when they no longer felt comforted in their beliefs, also safeguarding their loved ones from overwhelming grief. In Sources of Comfort, the findings suggest that the participants sought external resources to help them manage and hold these transitional experiences. Reliance on these resources contributed to the Changed Experience, allowing the participants to begin reintegrating their faith beliefs into a more flexible belief system , renewing spiritual meaning, and integrating their traumatic losses into their clinical work.

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Chapter 5

Findings, Discussion, and Implications Introduction This chapter discusses the findings derived from the super-ordinate and emergent themes identified in Chapter 4. The findings also address the research questions: a) What is the meaning of faith beliefs for Christian psychotherapists after they have experienced traumatic loss in adulthood? b) How do Christian psychotherapists describe the connection between their faith beliefs and clinical practice before and after traumatic losses? Highlights from these findings are briefly outlined and then discussed through a psychodynamic lens. This chapter concludes by addressing strengths, limitations, implications, and recommendations. The major findings address essential features of traumatic loss that are common to all the participants. These major findings are outlined in Table 5.1:

148 Table 5.1: Major Findings of the Study MAJOR FINDINGS Major Finding 1

The Protective Functions of Faith Beliefs

Major Finding 2

The Protective Functions of Mothering

Major Finding 3

The Protective Functions Shattered

Major Finding 4

Sources of Comfort as Transitional Experiences

Major Finding 5

Renewed Faith Beliefs

Each of these findings will be discussed in more detail below.

Major finding 1: The protective functions of faith beliefs God as an internalized object. As Christian psychotherapists, all of the participants had existing faith beliefs before their traumatic losses. They described these faith beliefs as feeling God was with them, representing an internalized relationship with God primarily formed through early relationships and/or religious teachings within the Christian tradition. These experiences taught them to believe in a loving God who was ‘the foundation’ to a sense of self, identity, and purpose. Their willingness to follow these faith beliefs provided direction, comfort, and protection. Trusting in the reliability of their faith beliefs, the participants used these good enough experiences to identify God as an internalized good object (Winnicott, 1953, 1960, 1971). Feeling supported through

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their Christian faith, the participants felt shielded from traumatic loss. Although traumatic loss threatened the stability of this internalized relationship, the participants discovered they could still trust the reliability of their Christian faith beliefs to feel safe, supporting them in their personal lives and clinical practice.

Faith beliefs as holding experiences. The participants talked about relying on these faith beliefs prior to their traumatic losses during previous times of struggles. During these challenging times, they talked about how their faith beliefs comforted and held them, inferring that their faith beliefs kept them intact. Faith beliefs provided the continued “environmental provision” elaborated by Winnicott (1960, p.43) when he discussed the significant role holding environments played in allowing the self to remain intact during times of threat. As part of their Christian faith, the participants expected their beliefs to withstand and protect them from such threats as traumatic loss. Because of this continued provision of protection, the participants could trust in the protection of these faith beliefs.

Faith beliefs as created experiences of comfort and safety. As their faith beliefs became strengthened by a sense of God’s provision of a safe holding environment, they believed God ‘made the decisions’ and ‘guided and directed’ their lives. Because they could trust their faith beliefs, they developed assumptions and experiences based on these beliefs concerning their expectations of

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God. One of these expectations was that if they followed these beliefs, God would protect them when faced with anything that could fracture their sense of self. Belief in God’s protection was built on Christian teachings about the certainty of God’s omnipotence. These teachings were reinforced by the participants’ life experiences, securing their sense of safety in their world and in their Christianity. During times of previous losses, this protection served to shield them from annihilation or the anxiety of a self “falling to bits” Klein (1946, p. 101), thereby keeping them intact. When a traumatic loss occurred in their lives, the participants’ sense of self fell apart, rupturing their sense of safety and trust in their faith beliefs. It is also noteworthy that Christian identities played a significant role in how they experienced this rupture because they began to question their belief in God’s omnipotence and protection.

Major finding 2: The protective functions of mothering. As Christian mothers, their maternal identities also played a significant role in the manner in which they experienced this rupture. This emerged as a notable and unexpected finding because as was the case with their Christian faith beliefs, the participants used and/or relied on their maternal roles keeping them intact while they managed overwhelming feelings in others. This enabled them to tolerate their own feelings when they did not feel safe in their faith beliefs. Protecting loved ones from overwhelming feelings, the participants found themselves trying to simultaneously manage maternal responsibilities while grieving. This proclivity to protect those

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around them often meant the participants could not grieve while attending to these responsibilities, causing them to seek time alone to grieve away from their families. Keeping their grief responses from their families is similar to Winnicott’s (1949) reference to mothers who went through extraordinary efforts to keep destructive feelings to themselves with a view to maintaining or protecting the caretaking relationship. Bearing these destructive feelings, the participants sought time in solitude, thus sparing their loved ones from these feelings. When the participants did seek time alone, they could separate from their maternal roles. In addition, separating their maternal roles from their grief exhibited their difficulty in holding these two experiences at the same time. Attending to their own needs allowed them the space to be present with these feelings without fearing their adverse impact on their loved ones. Away from their maternal roles, the participants were Christians grieving alone, questioning their faith beliefs. They experienced their feelings without fearing that these feelings would destroy those around them. Their traumatic losses shattered their assumptions about what they believed was orderly, safe, and good in the world. This realization, in turn, made them hold on to their maternal capacities to maintain the order and safety they desperately sought. This was attributed to the fact that they could not trust that God could protect them or their loved ones, throwing them into an existential crisis of questioning their Christian beliefs in God’s omnipotence. This also caused them to question other aspects of their faith beliefs such as their hope and their spiritual calling. Expressing this anguish while still believing that God was with them

152 demonstrated that although their trust and prior spiritual assumptions about God’s protection were shattered, they did not destroy their faith in God.

Major finding 3: The protective functions shattered. Loss of a future relationship. One of the essential features of traumatic loss for these Christian mothers was losing the opportunity to have a future relationship with the deceased.

One of the

participants mentioned this in her account when she compared this type of loss to a miscarriage. Although there was only one participant whose traumatic loss was triggered by a miscarriage, the psychological meaning underpinning the abrupt loss of young life was shared among all of the participants. This abrupt loss meant that any hope for a future relationship was severed. Psychologically similar to women who miscarried, the participants’ mourning signified the irreconcilable finality associated with their traumatic losses. Jones (2015) referred to this finality as a “psychological miscarriage.” When one of the participants explicated losing expectations for a future relationship, she mentioned that her ‘hope was slammed.’ The rest of the participants shared this sentiment in light of losing individuals who were young, because these deaths shattered their previously held assumptions about how the world worked. The shattering of previously held assumptions illustrated what was at the core of losing the protective function of Christian faith beliefs. This caused their beliefs to shaken and lose their meaning. Unable to make sense of these traumatic losses, these

153 Christian psychotherapists who were mothers were forced to depend on their maternal roles to help them regain the previous equilibrium they experienced prior to their traumatic losses.

Shattering of the spiritual assumptive world. Prior to their traumatic losses, the participants’ faith beliefs were based on Christian faith experiences that helped them to form meaning about God’s omnipotent presence in the world, thereby creating a framework of understanding. Doka (2002) referred to this type of experience as a spiritual assumptive world. Their spiritual assumptive worldview constructed the belief that when death occurred naturally, grief responses could be managed by relying on faith beliefs as a holding environment, which, in turn, helped them make meaning and provide comfort. This was evident in the comments made by all four participants when they shared their experiences of previous losses of elderly loved ones. These individuals were often remembered as living a full life before they succumbed to disease and/or illness. Although they grieved these losses, they talked about accepting death as an expected ‘life event that would have happened at some point.’ Because these deaths were in alignment with their spiritual assumptive worlds, the participants’ faith beliefs continued to hold them, providing protection so the participants’ senses of self could remain intact. This assumptive meaning of their faith beliefs was shattered when they experienced an unexpected and seemingly incomprehensible death. The participants’ difficulty coming to terms with losing individuals of a young age and the loss of a future potential relationship resulted in the participants no longer feeling ‘shielded’ by

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God. As they no longer felt protected in their spiritual assumptions and their faith beliefs, these faith beliefs lost meaning (Bishop, 2016). As a result, the participants began to question and doubt their reliance upon God. Similar to what Aronson (2008) found, “in some cases, individuals can begin to question the validity of their faith beliefs” (p. 93). After experiencing traumatic losses, these participants’ faith beliefs were shaken because their trust in God’s provision for them was shattered. Because their Christian faith beliefs were founded on the promise of God’s protection, the shattering occurred when the participants could not rely on the ‘validity’ of God’s promise.

Major finding 4: The sources of comfort as transitional experiences. Despite their questioning, participants sought comfort through both practicing their Christian faith rituals and relying on the faith beliefs of others. These external supports provided the comfort the participants had previously experienced through their faith beliefs, despite an uncertainty regarding the capacity of their internal relationship with God to contain their experience. As part of their Christian culture, participants found comfort and safety in reciting prayer, meditating on words from biblical scriptures and worship music, also using others as examples for modeling their

155 faith beliefs. In addition, they relied upon the presence of others to provide comfort and make meaning through intercessory prayer, clinical supervision, and psychotherapy. These transitional phenomena4 resulted in the participants integrating their external experiences internally. This was because these experiences helped to affirm and strengthen participants, allowing them to hold onto their beliefs despite losing their protective functions. Consequently, they became ‘stronger’ in their faith because they could still trust God despite the absence of these protective functions. This led the participants to begin accepting their traumatic losses while retaining their beliefs in God as a reliable internalized good object.

Major finding 5: Renewed faith beliefs. Recovering the shattered. As a result of their traumatic losses, participants’ spiritual assumptive worlds were shattered, rupturing their sense of comfort, safety, and trust in their faith beliefs. They still believed in God, but conceded that this shattering left them feeling ‘all over the place’ and less secure. Following her traumatic loss, one of the participants mentioned that she struggled to pray despite her belief in God. Theoretically, this aligned with Aronson’s (2008) point that certain aspects remain “conscious” (p.98), although there were times when they “were not accessible to them” (Aronson, 2008, p.

Winnicott (1953, 1971) relegates religious experiences as transitional, part of the “intermediate” areas of experience, existing between internal and external reality and buffering the ego from the anxiety of separation from the internalized object. Within this realm, these transitional experiences can exist throughout adult life (Winnicott, 1953), with renewed reliance on these experiences following traumatic loss. For the participants, these transitional experiences provide significant support for how they are able to tolerate ambivalence.

156 98). Unlike Aronson’s (2008) findings, these participants were Christians whose “conscious” aspects were their Christian identities. Participants began to rebuild these assumptive beliefs by seeking external resources. In particular, their willingness to “engage in the process” (Aronson, 2008, p. 99), facilitated this type of renewal. Reviving trust in their faith beliefs supports “the result of actual experience” (Aronson, 2008, p. 99) embodied in their personal relationships and their approach to their clinical work. For the participants, relying upon transitional objects and experiences helped to renew their belief that God could sustain them during difficulties. Transitional experiences demonstrating integrated faith beliefs were modeled by other Christians’ commitment to their beliefs despite experiencing tragedy and traumatic loss. Observing how these individuals practiced their faith beliefs despite seemingly being unprotected from tragedies, comforted the participants and renewed their faith. The participants internalized others’ commitment to believe and they “rediscovered” comfort and safety that existed by having an internalized relationship with their God. “Rediscovering” can be accomplished “through objects or in other people” p. (Aronson, 2008, p. 98). They could begin to make peace with their traumatic losses by renewing their faith beliefs through Christian faith rituals/practices such as intercessory prayer, worship, and scripture. Referring back to Winnicott’s (1953, 1971) transitional phenomena, the participants’ use of these resources enabled them to tolerate the shattering of their sense of safety and “rediscover” their faith beliefs.

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Rebuilding a shattered spiritual assumptive world. Rediscovering their faith beliefs through Christian faith practices was necessary for the participants to rebuild their spiritual assumptive world. Their reliance on these experiences helped them to begin to resolve the inconsistencies in what they believed about God and how their traumatic losses impacted their spiritual assumptive world (Doka, 2002). The participants described rediscovering their faith beliefs as embracing the “unknowableness of God” (Doka, 2002, p. 52). They talked about making peace with not understanding the reasons for their traumatic losses, but their trust was restored as they realized that they could still feel protected through their faith beliefs. Participants regained a sense of safety from the belief that God would be with them even though protection was not guaranteed. These findings align with Kauffman’s (2002) and Doka’s (2002) views that the only way to rebuild a spiritual assumptive world that is shattered, is within the confines of a safe relationship. For these Christian psychotherapists, feeling safe to trust God’s “unknowableness” came through faith rituals/practices and other transitional processes that reaffirmed their internal relationship with God. This was exemplified in the manner in which participants integrated their traumatic losses as opportunities to change how they conducted their personal and professional lives. The participants reinforced their attachments to individuals who could bear witness to their pain, thereby augmenting their own capacities to bear witness to the pain of others in personal and clinical interactions. Because they were Christian psychotherapists, reintegration began when the participants could describe a relational experience of God that was indicative of healthy object relations, i.e. a

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relationship that could simultaneously experience God as comforting and disappointing. This resulted in more flexibility in their faith beliefs and how God functioned in their lives.

Discussion The major findings describe the changes that occurred from the traumatic loss experiences of Christian psychotherapists. This discussion highlights how the findings address the research questions.

Research Question 1: What is the meaning of faith beliefs for Christian psychotherapists after they have experienced traumatic loss in adulthood? Believing in God’s goodness in the face of traumatic loss. These Christian psychotherapists struggled to find meaning in their faith beliefs following a traumatic loss. As their faith beliefs failed, they had to dispel the conflict that threatened their internal good relationship with God. As Christians, they were taught to believe that evil existed as a direct opposition to what they believed was good. Their feelings of anger, fear, and confusion and doubt were insulated from their beliefs in God as good and safe. In order to preserve this goodness and safety, the participants needed to project the destructiveness of these feelings onto a spiritual ‘enemy,’ threatening to destroy their internalized relationship with God. In their efforts to separate evil from good, this split managed their inability to hold these two contrasting experiences. This, in turn, led them to attribute their destructive feelings toward evil in order to maintain their faith beliefs.

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Amidst their grief, the participants struggled to maintain their faith beliefs while managing maternal responses. Fearing their grief will destroy them and/or their families, the participants immersed themselves into their caretaking, thereby restraining their grief. Their maternal roles served as a defense in which the participants went into ‘protector mode,’ attempting to shield their loved ones from their intolerable feelings of loss and shielding themselves from the anxiety they felt when they no longer trusted that their beliefs in God could protect them. This maternal protective function was reinforced when they sought solitude, so that they could privately struggle to reconcile their ambivalence about their faith beliefs without having to function within their maternal roles. For two participants, the demands of their grief prevented them from effectively performing their maternal roles, highlighting the need that was shared among all the participants. All of the participants were preoccupied with protecting their loved ones from the intolerable feelings that they feared would destroy those they loved. When the participants sought time alone, they did not have to fear this destruction while attending to their own needs to grieve. On the contrary, the participants sought healthy ways to integrate their grief with their faith beliefs away from their maternal functioning. As Christian psychotherapists who could grieve alone with their faith beliefs, they were enabled to reintegrate their Christian faith system. With a view to tolerating their ambivalence and manage their grief, they sought outside support to help them internalize their faith beliefs. Using resources outside of themselves, participants began to recreate safety more objectively and facilitated ego strength that reflected their ability to tolerate

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ambivalence, resulting in a deepening of their faith beliefs. Safety included accepting that God’s actions did not always align with their prior assumptions. This was demonstrated in the majority of their responses although one participant continued to struggle to achieve this level of acceptance. Maintaining her Christian identity, she repeatedly made comments about still struggling to trust her belief that God would protect her and keep her safe. Threatening to overtake her sense of self, Kennedy’s faith beliefs fluctuated in and out of integrative states. As Christians, the participants had to learn to tolerate the coexistence of good and evil as part of this integration. This was paramount to managing their ambivalent feelings towards a loving God who did not protect.

Loving a God who does not protect. The participants’ traumatic losses ruptured their ability to rely on the belief God would protect them. The participants lost their idealization of God impacting their faith beliefs, which had a less nuanced reliance upon how God functioned in their lives. As Christian psychotherapists, accepting this loss nudged all the participants toward achieving the capacity to tolerate ambiguity in their faith beliefs. The participants tolerated their conflictual feelings towards God without their feared punishment or abandonment by God. They also survived these feelings while retaining their relationship with God. The participants’ capacity to tolerate the anger, guilt, and fear associated with losing God as an idealized object, marked a significant step toward reintegrating their faith beliefs. Because their beliefs in God survived their rage

161 and disappointment, the participants’ faith beliefs were also able to survive their doubt and questioning. Based on their Christian worldview, the participants’ belief in a God who could survive their destructive feelings was paramount to their belief in the story of salvation (Forster & Carvath, 1999; McMinn et al., 2007). The survival of the participants’ faith beliefs was evident in their reliance on their transitional experiences which helped them internalize and reinforce their belief that their God was still there to protect them despite their conflictual thoughts and feelings. Through these transitional experiences, the participants also strengthened their commitment to their faith beliefs, which provided new meaning for them. God was not destroyed and continued to be the center of their faith beliefs about was good and safe. As participants reconciled that God remained good and loving despite the occurrence of tragic events, their faith beliefs were reintegrated. Having experienced reconciliation5 (Klein, 1946), the participants began to further integrate between their faith beliefs and their clinical practice. The meaning of the participants’ faith beliefs following traumatic loss is recognizing their capacity to accept that God’s protection does not always prevent tragedy from occurring. Tolerance for this ambivalence varied among the participants, illustrating that to these Christian psychotherapists, integrative states of faith beliefs is an ongoing process. What is learned from the participants is that this integration can lead to renewed faith beliefs which are strengthened by internalizing others’ models of faith.

Klein (1946) describes that reconciliation to the good object occurs when the infant, out of guilt, seeks to repair the ruptured experience (as a result of hateful, destructive feelings) with the mother. When these efforts are rewarded with the loving presence of the mother, the infant can experience this internalized relationship as safe because of the increased capacity to tolerate frustration and disappointment with the mother while still experiencing her as loving. This analogy explains the participants' internalization of their faith in God.

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This can lead to strengthened faith beliefs in God. These strengthened faith beliefs can be instrumental in how Christian psychotherapists begin integrating these faith beliefs into their clinical work.

Research Question 2: How do Christian psychotherapists describe the connection between their faith beliefs and clinical practice before and after traumatic losses? Prior to experiencing traumatic losses, the participants described Christianity as central to their identity whereby they relied on their faith beliefs to provide comfort and direction. Due to their assurance in the belief that God knew what was best for them, the participants’ major life decisions such as marriage partners, careers, and child rearing practices were based upon these beliefs. These faith beliefs deepened through their reliance on transitional objects and transitional phenomena manifesting through prayer, bible reading, and religious office decor. Through these experiences, they were able to feel God’s presence, comforting them, and grounding them in their Christian identities while empowering them in their clinical work. Following their traumatic losses, all four participants increased their capacity to hold onto their Christian and professional identities as their capacity to contain conflictual feelings increased. This increased capacity modeled ego strength for their clients, as during their traumatic losses, they had relied upon those who modeled faith beliefs through faith practices. Having managed their inner conflicts and fears through these transitional processes of faith practices, participants eventually learned that these conflicts actually strengthened their faith rather than weakening it. Within their

163 clinical practices, this allowed them to have greater ability to tolerate a broad range of feelings with their clients without trying to ‘fix’ them.

Summation In summary, this study sought to explore Christian psychotherapists’ changed faith beliefs following a traumatic loss. The findings revealed that the participants’ traumatic losses were hallmarked by the unexpected death of the young. Losing a young life was tragic in its own right, but for these Christian psychotherapists, impact on their maternal experience intensified these traumatic losses. As the participants were functioning in their maternal roles, these deaths signified the death of a future relationship, thus rupturing the participants’ belief systems. The participants’ understanding about how God functioned was based on their Christian worldview, giving them a sense of order. When this sense of order was shattered, it disrupted their understanding of not only the world but also their faith belief. This ruptured their trust and they no longer felt protected by these beliefs or their spiritual assumptions. They questioned not only God, but also themselves. This period of questioning revealed that their experiences of traumatic losses involved more than the abrupt loss of a potential future relationship. Their sense of safety was also shattered, causing them to lose the assurance that by following their belief in God, God would protect them. Losing access to these structures that helped them remain intact, the participants experienced an existential crisis deepening the traumatic loss. Because these Christian psychotherapists were also mothers, they struggled with managing the demands of caretaking while simultaneously facing this existential

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crisis. At times, performing their maternal roles helped minimize the impact of their traumatic losses and other times it created strain because of the participants’ need to grieve while protecting their loved ones from their vulnerability. This tension caused all of the participants to put in efforts to manage their grief away from their families. In order to protect their loved ones from bearing the brunt of their overwhelming and traumatic responses to these losses they needed to split off the demands of caretaking. The participants sought support from others and their examples of using their faith beliefs to bear these overwhelming experiences. They were strengthened by observing how others held onto their faith beliefs and spiritual meaning following traumatic losses. By considering the examples of others, they used these strengths, holding and utilizing others’ faith beliefs for themselves. Through continued reliance on these transitional experiences, the participants regained strength in their commitment to their faith rituals practiced in their Christian culture. This solidified trust in their faith beliefs and confidence in their approach to clinical practice.

Implications and Recommendations From the participants, we have learned that tolerating a range of feelings while managing internal conflict with faith beliefs is a significant aspect to how these Christian psychotherapists reintegrate their faith beliefs following traumatic losses. This is best explored by examining of the sample of Christian psychotherapists who begin to accept these losses as part of their faith beliefs. This is elaborated in the following sections.

165 Theoretical implications. The participants’ changed faith beliefs following traumatic loss can be best conceptualized as their increased capacity to hold both experiences. Despite having aspects of these beliefs shatter or rupture, the participants have shown they can hold onto their beliefs despite the shattering. This was the change that elaborated upon when the participants talked about accepting their traumatic losses as part of their faith beliefs. This implies that through acceptance, Christian psychotherapists, can recognize their weakened faith beliefs can become a pathway to healing and professional growth. For the participants, their healing and growth are reflected in how they are able to tolerate loving and trusting a God who does not guarantee protection, thereby integrating their experience of the object relationship. This is reflected in how the participants demonstrate acceptance of their traumatic losses, integrate their experience of God as an internalized object, and sharpen their approach to clinical treatment.

Acceptance of traumatic loss. For the participants, accepting traumatic loss meant accepting not only the loss of the young, but also the loss of the protection of their faith beliefs. Because these losses shook their belief in God’s omnipotence, the participants could not rely on these faith beliefs alone to protect them. Through transitional experiences such as meditating on prayer and scripture, listening to worship music, and emulating the faith beliefs and faith practices of others,’ the participants found the comfort and safety they had previously experienced from their faith beliefs. These transitional experiences

166 helped them begin to reintegrate their weakened faith beliefs and rebuild their shattered spiritual assumptive worlds. The participants’ reliance on external resources to support their faith beliefs remains an integral part of their religious experience. The participants described how they used religious decor, praying oil, intercessory prayer, and psychotherapeutic techniques as holding experiences when they did not feel held by their faith beliefs. This was attributed to the significance of these transitional experiences to hold them in their shattered spaces where their faith beliefs felt distant from them. These transitional experiences ‘held’ their beliefs for them, creating a space where the parts of their shaken faith beliefs could feel near again. Amidst these transitional experiences, they could hold their beliefs in a way that they could not hold onto alone. Their reliance on their faith practices and others to hold their beliefs as they grieve their traumatic losses is central to how these Christian psychotherapists began to restore safety, spiritual meaning, and trust following traumatic losses. Christian psychotherapists’ faith beliefs are affirmed and their internal relationship with God remains intact through this continued reliance.

Integrated experiences of God as an internalized good object. Relying on the strength of others’ faith beliefs and their faith practices, the participants could begin to accept their traumatic losses and reinforce their commitment to their faith beliefs. This commitment was grounded in the renewed belief that God was there and cared for them, even if God did not prevent traumatic loss from occurring in their lives. The participants demonstrated that their experience

167 of God is new in that it is “less polarized, more holistic… which ambivalent feelings, both love and hate, can be held toward one and the same object” (Carvath, 2007, p. 12). Their capacity to accomplish this is reflected in their reintegrated faith beliefs. Certain aspects of their faith beliefs were more integrated than others. Unintegrated states6 were evidenced by how the participants continually conceptualized evil through splitting and how they continued to rely on transitional experiences. On the other hand, integrated states were observed in how they confidently talked about their restored trust in God following their traumatic losses. For Christian psychotherapists, this means that they can experience periods of feeling unintegrated in their faith beliefs. This was reflected in how the participants projected their anger, fear, and confusion onto their beliefs in a spiritual ‘enemy’ who wanted them to doubt God and turn away from their faith beliefs. This split was their incapacity to simultaneously hold onto their beliefs and their feelings. Acknowledging the presence of this conflict, their beliefs were not destroyed but strengthened because of the “overpowering,” life-giving, and “loving impulses” stemming from relocating the good object (Forster & Carvath, 1999, p. 211). Although this battle between these impulses may persist throughout their lives, the participants could hold onto the good object, affirming their faith beliefs in a loving God.

Like Winnicott’s description of transitional experiences, Klein (1935, 1946) did not consider integration as a stage in development, signifying stagnancy and finality, but oscillated between unintegrated and integrated states. These developmental positions, when applied to faith beliefs suggest that they are fluid, continually moving between different phases of integration throughout the life cycle. For the participants, recognizing this fluidity signifies their movement toward increasing integrative states.

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Approach to clinical treatment. Feeling reconciled to a good and safe internalized object, all four participants express increased trust in their faith beliefs, exhibiting confidence in their professional personas and treatment modalities. From the participants, it can be inferred that Christian psychotherapists can transform how they approach clinical practice following their traumatic losses. Going through their own struggle to renew their faith beliefs makes them more empathic in their work with their clients. Because the participants’ capacity to tolerate ambivalence is fundamental to how they make meaning from their faith beliefs following traumatic losses, it is possible to understand Christian faith beliefs as reflecting different phases of integration. Unlike Meissner’s (1969) notion that faith development follows a linear course, the findings of this study suggests that faith beliefs can change and are nonlinear and fluid, which is in consonance with Aronson’s (2008) findings on the experiences of prayer. For certain Christian psychotherapists, life experiences such as traumatic losses can facilitate a constant state of changing and evolving of faith beliefs. Their capacity to acknowledge and accept these changes without losing all of their faith beliefs is an ongoing endeavor. Holding on to these beliefs while also managing clinical and maternal roles in the face of traumatic loss, points to the following clinical implications that warrant further discussion.

169 Clinical Implications for Social Work This study’s findings inform us about Christian psychotherapists who struggle with making meaning from traumatic losses. From what was learned by the participants, these perspectives can be examined in the following ways: 1) recognizing the potential shattering of a spiritual assumptive world as an essential feature of traumatic loss in Christians, 2) acknowledging the role of hate/ambivalence while grieving for Christian psychotherapists who are also mothers, and 3) considering the psychotherapists’ use of their faith beliefs as holding experiences for Christian clients who have lost aspects of their faith beliefs as a result of traumatic loss. There is clinical significance in identifying what has been shattered as a result of traumatic loss. From the participants, we learn traumatic loss can shatter Christians’ trust as well as their sense of safety in their faith beliefs. Traumatic loss can also shatter their spiritual assumptive world, causing them to question the credibility of their faith beliefs. Although traumatic loss can be associated with one’s shattered assumptive world, this may look different for some Christians, because their assumptions are grounded in their beliefs about God’s omnipotence. Christians may be confronted with additional losses related to their spiritual assumptive world, such as failed expectations about the protection of faith beliefs. From the participants, we learn that some Christian psychotherapists examine their thoughts and feelings associated with the shattering of their spiritual assumptive worlds. For a couple of the participants, this included emerging feelings of blame toward themselves and God when confronting their traumatic losses. Within a safe relational context, certain Christian clients need to be given the freedom to explore and express feelings

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concerning trust, safety, blame, and helplessness in the face of annihilation. This freedom can allow for mourning that was not possible and a path to rebuilding a spiritual assumptive world shattered due to traumatic loss. When psychotherapists can model survival in the midst of intolerable conflict, they can help their clients begin to tolerate their ambivalence along with responding with care for their loved ones. This modeling can also help them reconcile their love for a God whom they believed has failed them. A significant aspect of mourning for these Christian psychotherapists includes managing their internal conflicts arising from traumatic loss. These findings reflect the participants’ struggles are associated with trying to manage conflictual feelings toward their loved ones and their faith beliefs, indicative of their inability to simultaneously contain anger, fear, and confusion with feelings of love, trust, and safety. This means that some Christian mothers who seek treatment may fear their significant relationships will be threatened if they allow these feelings to coexist. In this regard, therapy can provide a good opportunity for Christian mothers who are clients to begin integrating these feelings by witnessing their therapist’s ability to survive intolerable conflicts emerging in the treatment relationship. Safety can then be established and these clients can begin to internalize the capacity to hold onto others while tolerating conflictual feelings. As mentioned in Chapter 1, awareness around these issues is essential because it can help Christian psychotherapists seeking their own treatment bear the strain of tolerating their ambivalence. Because the findings reflect that these feelings do not necessarily go away, it is noteworthy that they can at least be addressed and managed within a safe space. By establishing safety in their own treatment, they can keep

171 themselves intact as they reconstruct meaning and recover from traumatic loss (Winnicott, 1953, 1965; Herman, 1992/1997; Kauffman, 2002). Although this is true for all psychotherapists, Christian psychotherapists can also use their reintegrated faith beliefs as a way to reconstruct meaning after their spiritual assumptive worlds have shattered. Participants’ experience of reconstructing meaning made them more supportive in their work with clients who also questioned their faith beliefs after a shattering of their assumptive world. Like other psychotherapists, Christian psychotherapists use the therapeutic relationship as a model to help clients who struggle with regaining safety and meaning after a traumatic loss. As the therapeutic space becomes a holding environment, Christian psychotherapists who rely on and use their faith beliefs have additional means to achieving this beyond the maternal and psychotherapeutic relationship. Given that certain Christian psychotherapists opine that they are spiritually called to be ‘representatives for Christ,’ their reliance on their faith beliefs can serve as another type of holding environment for their Christian clients.

Because the participants are psychotherapists who also happened to be mothers, reliance entails dual significance. Like most mothers and psychotherapists, these participants are continually balancing their needs with the needs of those around them. While responding to the spiritual call to care for others as Christians, the participants may face additional challenges in balancing these needs. This presents further implications for research because of how competing caretaking roles impact Christian psychotherapists who are also mothers.

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Recommendations The mother Christian psychotherapist. As Christian psychotherapists who are called to do this work, there are the multiple caretaking roles of mother, therapist, and Christian. For example, mothers are frequently conflicted between sacrificing themselves for the sake of their children and seeking to meet their own needs (Winnicott, 1949; Mayer, 2012). Christians are expected to care for others as Christ cared for others (WWCC, 2014). Psychotherapists are inclined and expected to care for others as part of their professional responsibilities (Adams, 2014). However, there is scant research about the role Christian faith beliefs play in how Christian psychotherapists who are also mothers practice balance their caretaking roles with their own needs for care. This includes research on psychotherapists who are mothers and practice while relying on their Christian faith beliefs to manage their responses from traumatic loss. These areas are worthy of further exploration because of the caregiving demands confronted by mothers who are also Christian psychotherapists. Although mothers and psychotherapists are generally inclined to take care of others, this study found that the participants are inclined to respond to caretaking as Christians. As Christian psychotherapists, they are further inclined to respond to caretaking due to the commitment to their spiritual calling as psychotherapists. Using their faith beliefs to fulfill their calling means, they believe that they are fulfilling God’s purpose. When the strain of caretaking emerges in this context, further research may be warranted on how this strain is reconciled when Christian psychotherapists are

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confronted with managing their ambivalent feelings toward caretaking with their commitment to honor what they believe God has called them to do. The findings also suggested they had ambivalent feelings about caretaking and their spiritual calling during the occurrence of traumatic loss. While fulfilling her caretaking role as a psychotherapist, losing her client to suicide caused one of the participants to question her spiritual calling and even consider leaving her profession. This indicated her inability to tolerate failing at what she believed she was spiritually called to do, which was to ‘save’ him. Failing to save her client from suicide implied that she could not protect him. Failure to protect while caretaking presents another area of future research because it brings to question the impact on psychotherapists’ maternal and spiritual roles when those who are cared for are not protected from destruction.

Strengths and Limitations of Study Acknowledging the socio-cultural context in which the participants’ accounts are given is part of the data collection process because the nature of IPA is to honor the unique and particular aspects of the participants (Smith et al., 2009). In doing so, I engaged myself in their world as I interacted with them. As a result, the study yielded rich data, allowing me to identify the unique aspects of each participant’s interview/narrative style which emerged differently with each individual participant. As identified in Chapter 1, my focus was to clarify the need for the study. I did this by identifying the limited research that was available about psychotherapists’ traumatic experiences and how there was even less literature on Christian

174 psychotherapists’ traumatic experiences, especially as it related to their faith beliefs. Identifying this gap in research and determining how this gap could impact the profession of psychotherapy and clinical social work points on the importance of this study. Committing to valuable research, I must acknowledge its limitations. First, owing to my own experiences of traumatic loss and how my loss has informed my clinical practice, I realized that despite my attempts to bracket my responses and reactions to the data, I still held bias toward the participants’ responses. Second, the sample of participants was also limited to a small geographic area. As a result, it was difficult to determine whether there could be variances of responses depending on whether the participants lived and practiced in a large metropolitan city as opposed to a smaller city. Third, this study may not be generalizable to all Christian psychotherapists who had traumatic losses due to the small sample size. With the exception of one participant who was an African American participant, the small sample size meant that there was no full representation of culture, ethnicity, and race. Given that the recommended approach to IPA research is to seek a purposive sample which aims at ensuring homogeneity around a particular experience, exploring the impact of traumatic losses on the faith beliefs of Christian psychotherapists achieves its purpose. Although homogeneity is maintained through focusing on a particular experience, efforts to recruit Christian psychotherapists who varied in race, culture, and gender was not achieved. This was because potential participants were recruited on a voluntary basis and I did not have control over who responded. Therefore, the participants who responded were all women. Although this was not the

175 study’s intended purpose, the accounts from a group of women who chose to become participants provided this study with unanticipated findings that can inform future research.

Conclusion What makes Christian psychotherapists distinct from non-Christian psychotherapists is how significant the role of faith beliefs play in how Christian psychotherapists experience the meaning and resolution of traumatic loss. This study’s findings suggest that evidence of positive posttraumatic adjustment may lie in the effective integration of traumatic losses with reintegrated faith beliefs. For Christian psychotherapists, developing the capacity to tolerate traumatic loss without abandoning their faith beliefs becomes possible through continued reliance on outside resources. These resources were instrumental in helping the participants rediscover meaning as they rebuilt their shattered spiritual assumptive worlds, reconciling God as a good object. The participants regained their trust in the belief that God could hold them in the midst of threatening feelings, thoughts, and circumstances. Using their faith beliefs as their holding environment, the participants could provide their clients with holding spaces. Creating experiences of safety while tolerating conflicting feelings within themselves signaled the process of integration that occurred among the participants. Through this integration, a professional confidence emerged in these individuals, with seemingly unapologetic and unwavering faith beliefs.

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Appendix A Informed Consent

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Leave box empty - For office use only

Institute for Clinical Social Work Research Information and Consent for Participation in Social Behavioral Research An Exploration of Aspects of Changed Faith Beliefs in Christian Psychotherapists’ Post-Traumatic Experiences

I, , acting for myself, agree to take part in the research entitled An Exploration of Aspects of Changed Faith Beliefs in Christian Psychotherapists’ Post-Traumatic Experiences. This work will be carried out by Teresa Barnes under the supervision of Dr. John Ridings. This work is conducted under the auspices of the Institute for Clinical Social Work; At Robert Morris Center, 401 South State Street; Suite 822, Chicago, IL 60605; (312) 935-4232, info@icsw.edu. Purpose The purpose of this study is to understand the changed aspects of faith beliefs of Christian psychotherapists following a traumatic experience. The goal of this study is to capture the essence of what these changes mean in terms of faith practice and clinical practice. By exploring this phenomenon, the hope is to illuminate the significance of how Christian psychotherapists’ post-traumatic experiences informs their beliefs about themselves, their clinical practice approaches, and their faith practices.

178 This study will contribute to the mental health field for three reasons. First, there is limited research on Christian psychotherapists’ faith beliefs and their impact on clinical work. Second, how Christian psychotherapists experience, perceive, and live their faith beliefs has clinical implications. Although supporting a client’s religious material is proven to contribute to health maintenance and recovery, attention can also be given to the psychotherapists’ beliefs and feelings about their faith, especially after their own experience of trauma (Van Dover & Pfeiffer, 2007; Blanch, 2007; MagaldiDopman, Park-Taylor, Ponterotto, 2011). Furthermore, it will be worthwhile to examine how these events change their approach to professional practice. According to others (Sorenson, 1994; Moriarty & Hoffman, 2007), this exploration is necessary. Since Christian psychotherapists’ beliefs, biases, and values influence their clients’ representations of God, it is important for them to be aware of how their perceptions and meaning making impacts the clinical relationship (Sorenson, 1994). Third, Christian psychotherapists play an important role in mental health. For example, people tend to rely more on their faith based institutions during their time of need than government or human service organizations (Cnaan, Sinha, & McGrew, 2004). When deciding to pursue psychotherapy, Christian clients tend to prefer Christian psychotherapists who share their worldview over their secular counterparts (Post & Wade, 2009). Procedures used in the study and duration First, participants will be contacted to schedule an interview at a time and place that is convenient for them. Next, participants will be asked to read the consent form or have it read to them. The researcher will ask them questions to ascertain their knowledge of the consent form and ensure informed consent. The participant will then participate in an hour interview. Subsequently, the researcher will transcribe the interview and analyze it before scheduling another interview with the participant. Up to two followup interviews may be scheduled after the initial interview. In the last interview, the researcher will share the results of the study that have been acquired to by that point in the study. This final interview will also utilize a member check in which the interviewer will solicit informant feedback to ensure the credibility, validity, and accuracy of the information collected as well as the conclusions drawn from the information provided. Participants will be paid $20 at the completion of the final interview. Benefits The purpose of this study is to inform Christian psychotherapists about how faith beliefs and trauma impact the professional self and the clinical relationship. Hopefully, this will benefit participants’ self-reflections regarding their approaches to clinical work and their relationship with their clients.

179 Costs There are no costs to you for participating in this research study. Possible Risks and/or Side Effects This research has the following risks: You may find that discussing your feelings, thoughts, and beliefs about your traumatic experience may illicit distressing emotions. If this happens, you may skip any questions that you don’t want to answer, take a break, or end the interview. Loss of confidentiality may be another concern. The information you share will only be used by the researcher. However, to ensure that the research is conducted ethically, data will be reviewed by dissertation committee and professional transcriptionist. Necessary steps will be taken to ensure you confidentiality. You will be assigned an identification number and your name will be removed from the survey. The list connecting your name with the identification number will be stored separately from the survey data. It will be destroyed once we have completed data collection. Privacy and Confidentiality The only people who will know that you are a research subject are members of the research team. No information about you, or provided by you during the research, will be disclosed to others without your written permission, except: - if it is necessary to protect your rights or welfare (for example, if you are injured and need emergency care, or when the ICSW Institutional Review Board monitors the research or consent process); or - if required by law, for example, if you indicate plans to harm yourself or others. When the results of the research are published or discussed in conferences, no information will be included that would reveal your identity. Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. Only the researcher and professional transcriptionist will have access to the interview transcripts. Only the researcher will have access to the computer data files. In order to protect your confidentiality, we will not write your name on the interviews. Instead, we will assign you an identification number (e.g. 001, 002). We will store the interview transcripts and audio data in a locked briefcase separate from any papers that have your name on them. The list that connects your name and identification number will be kept in a password protected computer file. This file will be destroyed after the completion of data collection. All interview transcripts will be destroyed five years after the results of the study are published. Electronic data will be kept in a

180 password-protected file on a password-protected computer. After five years, the password-protected file will be destroyed. Subject Assurances The following is the format that should be followed in creating the assurances: By signing this consent form, I agree to take part in this study. I have not given up any of my rights (my child’s rights) or released this institution from responsibility for carelessness. I may cancel my consent and refuse to continue in this study (or take my child out of this study) at any time without penalty or loss of benefits. My relationship with the staff of the ICSW will not be affected in any way, now or in the future, if I (or my child) refuse to take part, or if I begin the study and then withdraw. If I have any questions about the research methods, I can contact Teresa Barnes, at this phone number 719-425-9366(day), 719-425-9366(evening). Email: tbarlow@icsw.edu or 21stcenturymom.tb@gmail.com If I have any questions about my rights – or my child’s rights – as a research subject, I may contact Dr. John Ridings, Chair of Institutional Review Board; ICSW; At Robert Morris Center, 401 South State Street; Suite 822, Chicago, IL 60605; irbchair@icsw.edu.

Signatures I have read this consent form and I agree to take part in this study as it is explained in this consent form.

Signature of Participant

Date

I certify that I have explained the research to and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward.

Signature of Researcher Revised 14 Oct, 2015

Date

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Appendix B Study Questionnaire

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Thank you for agreeing to participate in this study! Please complete the questionnaire below and return it via email, or snail mail, based on your preference. If you have any questions while filling this out, please email me at 21stcenturymom.tb@gmail.com. This questionnaire must be completed and returned before your first interview can be scheduled. Please note that the information in this questionnaire is confidential and will only be used under the auspices of this research study. This questionnaire consists of 15 questions in two sections. In the 15 questions, please circle the answer that best represents your response, or fill in the blank. Section I:

1. Since you became a therapist, have you experienced a personal trauma? Yes - continue No - the subject is excluded from the study 2. Did you have childhood experiences of trauma? Yes - the subject is excluded from the study No - continue 3. If you answered Yes to question 1, would you be willing to discuss this trauma as part of this research project or with this researcher? Yes - continue No - the subject is excluded from the study 4. Are you a Christian? Yes - continue No - the subject is excluded from the study 5. What is your certification and/or license? (if none, put none): ________________ 6. Are you a Christian psychotherapist or psychologist for whom Christian faith beliefs are foundational to your clinical practice? Yes - continue No - the subject is excluded from the study

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7. This study will include the collection of verbal data from you through a series of interviews. Do you agree to allow me to audio record your responses? Yes - continue No - the subject is excluded from the study 8. How many years have you been a Christian psychotherapist of psychologist? __________number of years. 9. Please indicate the pseudonym you would like to be addressed by during data collection: ___________________________. 10. Please indicate the theoretical orientation you most identify with: ___ Attachment theory ___ Classical Drive theory ___ Ego psychology ___ Object relations theory ___ Relational psychology ___ Self-psychology ___ Other: _____________________ Section II: 11. What is your gender? ___________________ 12. What year were you born? ___________ 13. What is your race? ___________ 14. What is your ethnicity? _______________ 15. What is the highest level of formal education you have completed? ___ No schooling completed ___ Nursery school to 8th grade ___ Some high school, no diploma ___ High school graduate, diploma or the equivalent (for example: GED) ___ Some college credit, no degree ___ Trade/technical/vocational training ___ Associate degree ___ Bachelor’s degree ___ Master’s degree ___ Professional degree ___ Doctorate degree ___ Other: _________________________________

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Thank you for completing this questionnaire! Your time and participation are very much appreciated.

Teresa Barnes 8686 Quinn Pt. Colorado Springs, CO 80924 719-425-9366 21stcenturymom.tb@gmail.com

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Appendix C Question Topics

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1. Subjective meaning of faith beliefs before and after traumatic experience(s) 2. The influence of spiritual/religious faith beliefs on your clinical practice before and after traumatic experience(s) 3. The influence of traumatic experiences on faith beliefs, spiritual/religious practices, and clinical practice.

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Appendix D Interview Guide

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Initial Open-Ended Questions: 1st Interviews (prior to trauma) Opening Question: Can you tell me why you agreed to participate in this study? 1. In your own words, how do you define a) faith b) Christianity? 2. To the best of your ability, describe your faith beliefs and practices prior to the traumatic experience(s)? 3. How did your faith beliefs influence your therapeutic practice approach prior to the traumatic experience(s)? 4.

In your own words, how do you define trauma?

5. To qualify for this study, you had to experience a personal trauma. Can you tell me about the personal trauma(s) that qualified you for this study? ● When did the trauma take place? What time of day? What time of year? Was it a single or multiple occurrence trauma? ● Can you remember any specific details about the trauma that stick with you? More Specific Open-Ended Questions: 2nd Interviews (during the trauma) 1. How would you describe your relationship with God during your traumatic experience? 2. What do you remember about the thoughts and feelings you experienced during this time? How did you manage them and what helped? 3. In what ways did you feel that you had control over your recovery recovered? 4. In what ways have/were others supportive during the traumatic experience(s)? 5. In what ways have others been non-supportive? Ending Open-Ended Questions: 3rd Interviews (after the trauma)

189

1. How have your faith practices, faith beliefs, and professional practices changed in light of your traumatic experience(s)? 2. Please describe how your faith beliefs currently influence your therapeutic practice approach? Did anything noticeably change post trauma? 3. What have you recovered and/or discovered about yourself, your faith beliefs, and your professional identity since your traumatic experience(s)? 4. Describe your relationships with others post trauma. 5. How significant has your faith community been to your recovery?

190

Appendix E Table of Super-Ordinate Themes and Themes for Dani B.

191

Themes

NVivo Reference

Key Words

Core Faith Beliefs An all-knowing attentive God

Files\\Dani B 002 3rd Interview 12-18-18

“I'm still God over all- all of it.”

Reference 2 Hearing from God

Files\\Dani B 002 1st Interview 11-17-18 Reference 1

Christianity as relationship not religion

Files\\Dani B 002 1st Interview 11-17-18

God’s healing presence during difficulties

Files\\Dani B 002 1st Interview 11-17-18

When God’s presence

Files\\Dani B 002 2nd Interview 12-3-18

doesn’t heal

Reference 1

Reference 2,3, 5

Reference 1 Being authentic

Files\\Dani B 002 2nd Interview 12-3-18 Reference 1

Immersing in his word…seeking and desiring God’s will…really in prayerclose to “sweating blood”… “laying before Him”… aligning with his word It's not about the rules… guidelines to live by- keep us and protect us

But God was still there… walked with Christ, and never failed me… has walked me through For help, for comfort, and for answers, doesn't always guarantee

have no problem shaking my fists at him

192

Surrendering to God’s will

Files\\Dani B 002 1st Interview 11-17-18 Reference 1, 2

There’s freedom in Christ

Files\\Dani B 002 3rd Interview 12-18-18 Reference 2

There is a real enemy

Files\\Dani B 002 3rd Interview 12-18-18

Living with longing…putting desire on altar…truly laying it down I don't have to do it all… don't have to have the answers, just let God

The enemy doesn’t want us to grow closer to God

Reference 1

Being God’s representative in the profession of mental health Building relationships is priority over ministry

Files\\Dani B 002 1st Interview 11-17-18 – Reference 1

Building rapport, must know that you care, God’s truth

Divine appointments

Files\\Dani B 002 1st Interview 11-17-18 – Reference 1

Christian clients, sharing beliefs

Inviting God into the treatment setting

Files\\Dani B 002 1st Interview 11-17-18-

Prayer before session, God’s presence, promoting emotional safety

Reference 1

193

Year of loss Expected vs. unexpected loss

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1

Don’t expect children to die

Characteristics of traumatic loss

Files\\Dani B 002 3rd Interview 12-18-18 – Reference 1

The unexpected, not prepared

Fighting the battle

Files\\Dani B 002 3rd Interview 12-18-18 – Reference 1,2

Fight on our hands, won battle because of who the Lord is

Shattering of the spiritual assumptive world

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1,2

Grieving future expectations & dreams

Files\\Dani B 002 1st Interview 11-17-18 – Reference 1,2,3

Begging - please don’t take away my childrenbiggest fear, demonic fear

The self-experience of trauma The fear narrative

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1,2,3 This could happen to me

Files\\Dani B 002 1st Interview 11-17-18 – Reference 3 Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1

Death of children…this can happen to anybody, even me

194

Impact on parenting

Files\\Dani B 002 1st Interview 11-17-18 – Reference 1

Face to face with crippling fear, overprotectiveness

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1 Relinquishing control <Files\\Dani B 002 3rd Interview 12-1818 – Reference 1 The questioning

Kids at school & sense of control gone, details of day unknown

Files\\Dani B 002 2nd Interview 12-3-18 – References 1,2,3,4

Why?, the anger, God is faithful

emotional caretaker

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1,2,3,4,5

Protective nature…how is he going to handle this? Overwhelms easily, barely function, going to crumble

Self-reliance acceptance that others couldn’t meet

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1,3,6,8

her needs

Files\\Dani B 002 3rd Interview 12-18-18 – Reference 1,2,3

Not giving me what I need, disappointment, push it aside to caretaker, take care of own emotions

Essence of motherhood Being husband’s

195

Sacrificing her time to grieve to meet the needs of family

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1,2

Grieving alone…didn’t want to come home & enter real life…pushing down & back, protect them from the reality, couldn’t fall apart yet

Finding her own space to grieve

Files\\Dani B 002 2nd Interview 12-3-18 – Reference 1

“Need to journal, be out in nature, needing to be with God”

<Files\\Dani B 002 2nd Interview 12-318> -Reference 1,2,3,4,5

Journaling is prayingpour out inside turmoil, emotional upheaval

Files\\Dani B 002 1st Interview 11-17-18> Reference 1

Assumptive world shattered-Jesus on cross, good comes out of bad – God’s plan for salvation,

<Files\\Dani B 002 3rd Interview 12-1818> Reference 12,19,33,34

Commitment, trust, honesty…be and feel without rejection

Faith practices Prayer & faith practices for coping

Use of the secular & spiritual as metaphors of loss and faith experiences

Safe relationships What safety means

196

When someone just gets it

<Files\\Dani B 002 2nd Interview 12-318> Reference 1

Supportive, understanding, came alongside me, there to listen

Unwavering trust in husband and God

<Files\\Dani B 002 3rd Interview 12-1818> Reference 2

Always do what he said he was going to do

Better, not bitter

<Files\\Dani B 002 2nd Interview 12-318> Reference 3

Wouldn’t change outcome…I am who I am because of it

The therapeutic space…a safe place

<Files\\Dani B 002 3rd Interview 12-1818> Reference 1,4,6,7,9

Being present, giving others space to be real and to be honest, containing for them

Coming to terms with traumatic loss

<Files\\Dani B 002 1st Interview 11-17-18> Reference 1,2

Healing from watching you grieve…you are okay so I’m okay

Post trauma – value of experience

197

Appendix F Table of Super-Ordinate Themes and Themes for Kennedy

198

THEMES

NVIVO REFERENCE

KEY WORDS

Journey of faith development Teachings about God & experiences of God

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,2

Parents & church taught… adopting own beliefs… questioning… align experience with teachings

God was a like a genie

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,2

Lord save me… survival… not refined by fire

Synonymous to therapist development

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,2,3,4,5

Infantile… under developed therapist

Unwavering faith despite the questioning & anger

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2

Questioning everything, anger… could never walk way

<Files\\Kennedy 003 First Interview 11-29-18> Reference 2

The professional self Inviting God into the work

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1

I’m your vessel

199

God sends clients as divine plan

Being client & therapist

<Files\\Kennedy 003 First Interview 11-2918> Reference 1

Whom I am supposed to see

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2, 4,5,6,7

Say it back to me…I’ve been there… I understand, disclosure

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference1,2,3

Faith is central…linked to identity…unacceptabl e parts of me…can’t do it on my own

Journey of identity development Formation of identity

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,2 Trauma’s imprint on identity

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 3

Can I trust who God created me to be?

Lasting core truths

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2,8,9

Incapable, failure, fraud

The demonic strategy

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 13

Lies from the enemy… destroy calling… distraction, can’t rob or pluck

<Files\\Kennedy 003 First Interview 11-2918> Reference 1

200

Defining trauma A foreknowing

<Files\\Kennedy 003 First Interview 11-2918> Reference 2 <Files\\Kennedy 003 First Interview 11-2918> Reference 1,2

Sensed something’s wrong…body preparing mind, Lord uses music

Anxiety’s role

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 1,3

Anticipator, assuming the worst

Feeling dehumanized

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 2

Not being taking care of…loss of dignity… trying to stay alive

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 4 Secondary loss

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 1,2,3,4

Gender unknown

The body & mortal self

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,6

Outside of my body…close to dying

The memories that stick to this day

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,2,3

Deafening silence… too much trust, failure

201

The unbearable layers

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 1,2,3

Couldn’t have a baby…process of dying

Anger & grave disappointment

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 3

Know you can, so why didn’t you?

Disillusionment about subsequent pregnancies

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 2,7

Unresolved, trigger, anxiety

Fluctuating faith

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 1

Faithful, unworthy, disappointment

A personal betrayal

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2 Issue with trust

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 5

Trust who I am in you…don’t trust self

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2

What the body is supposed to do…worst case scenario

Healing comes in layers Cognitive behavioral therapy

202

Eye movement desensitization and reprocessing (EMDR)

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 1,2

Healing began but still festering

Making peace

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 2,3

Nothing I can do about it…grandma & baby in heaven

Gesture of protection

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 3

He carried & protected, my rock

Reminders of failing

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2,3,4

Coddling means I am not normal...focus on failure

Power of remembrance

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 4,9

Went through together…he gets it…didn’t forget

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 3

Middle ground – seeing his goodness in the bad

Shared meaning & experience with others

Reflections on the post traumatic experience Biggest change is the biggest struggle living in the grays

203

Fear and trust coexist - loss of innocence

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2

A lot of questioning…not in control, anxiety happens

The assumptive world

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1

Shouldn’t be me…world is crappy place

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2,4

Black & white thinking

Co-existence of the core truths from trauma and core faith beliefs

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2,4

Am incapable & unworthy of love…God’s promises are not for me

Living with unmet

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 7,8

Paid my dues…entitlement & disappointment

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 3

Not in control…at the mercy of the process…biggest trigger

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 4

Means control

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2

Accepting good with bad

has changed - veil is lifted Result of religion over relationship

expectations

The need to control something

Compartmentali zing The fight

204

Birthing pains

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 6

This huge thing...be prepared

Growing out, not up

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1

Not linear

Cost of ministry

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2

So tired, don’t want to

Experiences of hospital admin & staff

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 2,4,8

Attunement, taking care vs. not being taken seriously

No one cares

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 1,2

Will do nothing to save…pull it together because no one cares

Society just wants to throw it away

<Files\\Kennedy 003 2nd Interview 12-2218> Reference 2,5

Don’t see trauma, minimizing

The world needs to stop and validate what

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2,4

Insides exploding, need to hold on to loss…means survival

A dismissive society

happened to me

205

Appendix G Table of Super-Ordinate Themes and Themes for Terri

206

THEMES

NVIVO REFERENCE

KEY WORDS

An attentive God who has an overall plan God communicates his plan through prayer

<Files\\Terri 001 2nd Interview> Reference 2

This is what I am supposed to do next

God communicates through signs & nature

<Files\\Terri 001 2nd Interview> Reference 1,2

Get up early, mountains, sense of humor

Things happen for a reason

<Files\\Terri 001 2nd Interview> Reference 2

Lines them up…prepped with this...mysterious ways

<Files\\Terri 001 3rd Interview 11-29-18> Reference 1 Trust in God above self & natural world

<Files\\Terri 001 First Interview> Reference 1,2,3

Need a clear sign…sit, quiet, huge part

The God nudge

<Files\\Terri 001 First Interview> Reference 6,7

A feeling…what I am supposed to do

Personal meaning of Christianity

207

God’s intervention & provision

<Files\\Terri 001 First Interview> Reference 1,2,3,4,5

Meant to meet…meant to be

Multiple facets of Christianity

<Files\\Terri 001 First Interview> Reference 2,4,6,8

Basic tenets- be nice, help, man’s interpretation, acceptance, monogamy, many molds

Religion is man made

<Files\\Terri 001 3rd Interview 11-29-18> Reference 2,3

Grew up Catholic… escaped cult…worship unnatural

Being a psychotherapist is a spiritual calling

<Files\\Terri 001 First Interview> Reference 4

Sorrows of others… not money focused

Professional self before trauma

<Files\\Terri 001 First Interview> Reference 1,4

Less likely to say I was Christian… my education

Professional self during trauma

<Files\\Terri 001 2nd Interview> Reference 2,3

Worried, reminders, it’s about me… not about me

Faith beliefs & the professional self

Traumatic loss- an undefined experience

208

Like grief

<Files\\Terri 001 2nd Interview> Reference 1,7

Intertwined, overlap, stupor, fog

Unlike grief

<Files\\Terri 001 First Interview> Reference 8,11

A change, extreme, unexpected, shock to system

Opportunity gone

<Files\\Terri 001 2nd Interview> Reference 6

Relationship loss… opportunity to have happy life gone

Complexness with forever husband

<Files\\Terri 001 3rd Interview 11-29-18> Reference 1,5,6

Weekly date… not take for granted… make the time

Experiences of supportive others

<Files\\Terri 001 2nd Interview> Reference 3,4

Check in, protect, someone to take care of me

Loss of connection with church community

<Files\\Terri 001 2nd Interview> Reference 2

Church too big… didn’t fit in… turned me away

Relational estrangement from stepson

<Files\\Terri 001 2nd Interview> Reference 1

Stab in the heart… time lost

Significance of relationships

Essence of motherhood

209

Needing to be mothered

<Files\\Terri 001 First Interview> Reference 1,2

Hard times…need my mommy

The caregiver

<Files\\Terri 001 2nd Interview> Reference 3

Cry away from him…then take care of him…am Italian…cook

<Files\\Terri 001 First Interview> Reference 1 The helper

<Files\\Terri 001 2nd Interview>Reference 2,3

Clean, cook, helping others… help self

<Files\\Terri 001 First Interview> Reference 3 The protector

<Files\\Terri 001 2nd Interview> Reference 1

Mom…protect a little more

The stepmother

<Files\\Terri 001 2nd Interview> Reference 1,2

Bonus mom

The strong one

<Files\\Terri 001 3rd Interview 11-29-18> Reference 1

Helped people…lift a Buick

<Files\\Terri 001 2nd Interview> Reference 1

Love to give, no one to give it to...not part of future life

Feelings & thoughts associated with event Death of hope

210

Don’t have to worry anymore

<Files\\Terri 001 2nd Interview> Reference 1

Typical mother concern…only son…finally have a son

The anger

<Files\\Terri 001 2nd Interview> Reference 12,13

Natural emotion…being alone...protect from

What depression means

<Files\\Terri 001 2nd Interview> Reference 1

Sink down & get stuck…need to do to be okay…don’t give up

Praise & worship songs

<Files\\Terri 001 2nd Interview> Reference 1

Those words are always with me…morning has broken, like the first morning…

Small & attainable goals

<Files\\Terri 001 3rd Interview 11-29-18> Reference 2,5

Focus on what’s done

Caring for others

<Files\\Terri 001 2nd Interview> Reference 1

Caregiver mode…what do I need to do?

Mechanisms of coping

<Files\\Terri 001 First Interview> Reference 1 Attitude

<Files\\Terri 001 3rd Interview 11-29-18> Reference 1,3

Thankful, focus on the positive

211

Being playful

<Files\\Terri 001 2nd Interview> Reference 1

Grandkids…great distraction

Prayerful

<Files\\Terri 001 2nd Interview> Reference 1

Sporadic…coping skill

Changed life priorities

<Files\\Terri 001 3rd Interview 11-29-18> Reference 1,7,13,14

Self-first… more time with family. let it be…faith in forefront

212

Appendix H Table of Super-Ordinate Themes and Themes for Yakitta

213

THEMES

NVIVO REFERENCE

KEY WORDS

Faith beliefs are a lifestyle Wearing the mantle

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1,2

Christian – preaching, teaching always

Foundation to self

<Files\\Yakitta 004 First Interview 11-3018> Reference 5

Innate, who I am

Profession is ministry

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 2

Called to this…have niche to say the right things to help

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 4 Sacred space – God’s presence in treatment

Clients are divinely assigned

Leaving bags

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1,6

Anoint the room…be available & present

<Files\\Yakitta 004 First Interview 11-3018> Reference 7

Desire faith practices in treatment plan

<Files\\Yakitta 004 First Interview 11-3018> Reference 4

Treatment metaphor – release, let go

214

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1

All that I know, can’t turn away

Feelings, behaviors, & thoughts

<Files\\Yakitta 004 First Interview 11-3018> Reference 2

All over the place, missing appointments

The questioning/doubting

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1

Am I good at what I do? couldn’t save the day

Unshakable commitment to faith practices

The subjective experience of trauma

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 3

The emotions that go with why

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1

Confused, drained, frustrated

No time & place to grieve

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1,3

No time for self, no time to grieve…life still continued

The aloneness of trauma

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1

Isolated, nobody understood

215

The prayer struggle

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1,2

Needing direction, can’t pray…woulda, coulda, shoulda

Spiritual attack

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1

Looking back, it was the enemy, enemy wanted to take him out

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1 <Files\\Yakitta 004 3rd Interview 12-1718> Reference 3

Don’t know where to put it

Family & friends

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1,6,7,8

Just sat with me…had to learn what to do…say what I need…didn’t get stuck

Supervisor

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 5,7,

Met me where I was…shielded me

Colleagues

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1

Not empathizing…want to be nosy

Trying to make sense of what makes no sense

Presence of significant others

216

Evolution of personal & professional boundaries The outsider

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 4,5,6

Only black female…his therapist…still hugged me

Emotional baggage

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 2

Over & beyond…that’s not mine

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1 How to grieve

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 2,3

Family, stranger, client…where to put this in?

Clinical experience is real & tangible

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 2<Files\\Yakitta 004 3rd Interview 12-1718> Reference 6,9,15

Now have the experience & knowledge…proactive , two-fold, hypervigilant

It’s not about me

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1,3

Tunnel vision… it’s mine…only so much I can do

Reflections on the post traumatic experience

217

Resolution to the why

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1

Not gonna understand God…acceptance

Re-evaluation

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 8,26

Step away from it…can leave this…so much potential

Trauma as catalyst for change

<Files\\Yakitta 004 First Interview 11-3018> Reference 1

My time to move

What helped

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1,6

CBT – reframing, made a choice

Power of intercessory

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 4,6,8

Hands on me…prayed, refreshing, clarity…standing in agreement…uninterru pted presence of God

Worship is freedom

<Files\\Yakitta 004 3rd Interview 12-1718> Reference 1

Pour heart out in worship

Cognitive Behavior

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1,3

Reframing & challenging thoughts

prayer & sacredness of the altar call

Therapy

What sticks the most

218

Hostile working environment

The wake

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 3

Bombarding questions…business, nonchalant…drew more into myself

<Files\\Yakitta 004 2nd Interview 12-1218> Reference 1,10,11

He had the same shirt…family coming together…nice time

219

Appendix I Master Table of Higher Order Concepts for the Group

220

A. Trauma & The Subjective Experience Reference Differentiation of grief – the unexpected Terri: It's a shock to the system. Um, when my father unexpectedly died in 2007; it's a shock to the system, but I don't necessarily consider it a trauma. Not as deep of a trauma. Um, grief and great loss, absolutely.

Files\\Teri 001 First Interview>

Dani B: And, you just have all of these hopes and dreams and expectations in that child, and then it's gone. It’s all gone. You don’t expect children to die.

Files\\Dani B 002 2nd Interview 123-18 >Reference 1

Kennedy: Not thinking about it, not anticipating it, but it's right now in this moment. So the disbelief it'd probably be the biggest one, cause I had never really, um, being such an anticipator in my life, I had never had really expected that, so it was like, How's this the one thing that I didn't, you know, think through.

<Files\\Kennedy 003 2nd Interview 12-22-8> Reference 2

Yakitta: …how to grieve for a client who makes the choice to die. Different than grandmother who was 100 who passed away or an accident. This was that you made a decision a solution. What compartment do I put this in…Never had this…never experienced it.

<Files\\Yakitta 004 3rd Interview 12-17-18> Reference 4

Experiences of mothering

Reference 8

221

Terri: And there are times, um ... There are ... Oh ... (cries) There are times in life you still want your mom. You know, like when something bad happens. I don't know, my mother and I cry. I guess, I guess some of me, now that I'm thinking about it, I wanted to protect her a little more, especially because there was so many unknowns.

Dani B: And she just was not able to provide, um, nurturing care…She just, she couldn't. She just didn't have it in her. I learned very early as a child, to go to her for emotional comfort was just not gonna happen. And not only was it not gonna happen, but I would be rejected. I-I didn't want to tell my husband, 'cause I-I didn't, I didn't know how he would handle that... push it down and back, felt it all in car, had to put it all in when I got home.

Files\\Terri 001 First Interview>Refere nce 1 Files\\Terri 001 2nd Interview>Refere nce 1 Files\\Dani B 002 3rd Interview 1218-18> Reference 1 Files\\Dani B 002 2nd Interview 123-18>Reference 1

Kennedy: Um, there is this also, I don't- I don't feel like I carry it as much, but there is a piece as well, with the parenting of, um, you failed. Like, um- like you started out parenting by failing.

<Files\\Kennedy 003 3rd Interview 1-1919>Reference 21

Yakitta: My mom would get into bed with me and we would just, you know, we would talk and she will let me cry.

Files\\Yakitta 004 2nd Interview 12-12-18> Reference 1

Didn’t have time to sit in my emotions and let myself grieve. What I tell others to do, I didn’t have time to do myself – 2 other jobs, wife and mother, could let my feeling flow how they needed to It was boom, boom, boom.

<Files\\Yakitta 004 2nd Interview 12-12-18> Reference 10

222

Struggles associated with the traumatic loss Terri: I was never mad at God for this happening, but I was mad at, at Nicholas. Um, and I didn't really want my husband to see that…and I wanted to protect him from that.

Files\\Terri 001 2nd Interview> Reference 12

Dani B: but it also brought me face to face with that fear…And, um, I did see that in my parenting. I saw you know, that over protectiveness… and this misperception that if I'm with my kids all the time I can keep them from all harm and danger.

Files\\Dani B 002 2nd Interview 123-18>Reference 1

Kennedy: probably that disappointment, once again, where it's like, such, such grave disappointment that it's like. Not only disappointment, but I can’t ever get back. Death is final not like finding a new job… reconciling that he is deity that doesn’t care, if this is your definition of good then I am pretty confused.

<Files\\Kennedy 003 2nd Interview 12-2218>Reference 3

Yakitta: Because nobody had experienced it…so they didn't know. I didn't have, I didn't have that with anybody. You know, to sit in front of me and talk to.

Files\\Yakitta 004 2nd Interview 12-12-18> Reference 1,2

B. Core Faith Beliefs

Valuing relationship with God over religion Terri: This is how I see worship as opposed to “this is what I am supposed to.” …having faith means I could sit right here and talk to God. I don't have to go to church. I don't have to think of something to confess.

<Files\\Terri 001 3rd Interview 1129-18> Reference 3

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Dani B: You know, it's not about the rules. Certainly, God gives us guidelines to live by- it is about choices. He does have rules such as 10 commandments, but within the relationship, there are suggestions.

Files\\Dani B 002 1st Interview 1117-18

Kennedy: I mean like, probably the most, um, outwardly angry I've been at the Lord, like I really try to keep that in check. It can border on disrespectful talk like family but not your buddy. Like talk to parent – personal intimacy but there is a respect. Like I know, we're allowed to come to him.

<Files\\Kennedy 003 First Interview 11-2918> Reference 2

Yakitta: speaking for me, you know, in those times when I was upset cause I didn't understand and I didn't get it, I could've walked away completely-didn’t know what that looked like, my relationship with God is all that I know. I can’t imagine.

<Files\\Yakitta 004 3rd Interview 12-1718>Reference 1

Reference 1

Being a psychotherapist is a spiritual calling Terri: I believe those words were like given to me to let people know yeah, I- I didn't go into this business to get rich off of the sorrows of others, you know, and whatnot.

<Files\\Terri 001 First Interview> Reference 4

Dani B: He just made it very clear, and again I was a very young Christian, he said, "This will open doors that I want you to go through." It was just that knowledge- Seeking and desiring God’s will. I was really in prayer-close to “sweating blood” and “laying before Him” aligning with his word…And I said, "Okay. I'm-I'm doing this."

<Files\\Dani B 002 1st Interview 11-1718>Reference 1

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Kennedy: I’m your vessel. What it is that I'm called to do? And I've really had to hold onto this idea that the enemy can't steal- the enemy can't rob you of your destiny, he can just make you quit before you get there.

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,10,11

Yakitta: Um, I trust God um with this and believe for me that this is ministry and it's not necessarily this is my job; yes, it's my job, but it's ministry. So with it being ministry and feeling that I'm called to this…

<Files\\Yakitta 004 2nd Interview 12-12-18> Reference 1,2

Belief in the existence of a real enemy Terri: There are things ... And then, just some other things that just felt like, I don't know ... The devil's hand was in it there. Um, okay it's time- it's time to go.

<Files\\Terri 001 First Interview> Reference 1

Dani B: The enemy doesn’t want us to grow closer to God.

Files\\Dani B 002 3rd Interview 1218-18 Reference 1

Kennedy: …that it has been eight years of the enemy intricately sitting back and waiting to weave these lies to ultimately try to tarnish what it is that I'm called to do.

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 7-10

Yakitta: And sometimes for me, I'm like, stop because I know it was the Enemy, any kind of, you miss this, you didn't do that or this.

<Files\\Yakitta 004 3rd Interview 12-17-18> Reference 1

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C. Forms of Coping/What Helped

Prayer, worship songs and biblical scripture used for coping Terri: So then, it was renewed, that whole spirit of that song was renewed in me. So then, I felt like getting up, okay I'm gonna make it through this day.

<Files\\Terri 001 2nd Interview> Reference 1

Dani B: …scripture of Jesus being in the boat in storm – holding onto him was very solid and stationary but don’t understand why you did this, don’t know what this means for me and what will keep it happening to me. My emotions were all over the place. Sometimes, I could rest in him and other times, on top of rollercoaster hanging for dear life.

<Files\\Dani B 002 2nd Interview 12-3-18> Reference 1

Kennedy: I listened to…it was a Hills song called My Hope…where my help comes from, you're my strength, my song. My trust is in the name of the lord. I sing of your praise, you are faithful. And I remember, in that moment, I had this sense of something's not right…and music is a huge part of my life, too. Music speaks to me. The lord uses music in a lot of ways.

<Files\\Kennedy 003 First Interview 11-2918> Reference 1,2

Yakitta: …woke up with, um, the, the song that had kind of ... has been in my spirit, um, is this is the Day. So, the version that I ... there's the old kind of hymnal of it, but there's a Fred Hammond version of it, um, that just on my way to work and worshiping. Sitting in the car where I am so in tuned that pull over and cry. The Spirit shows up and the atmosphere changes – setting the tone of my day with how I start it…can’t stay in pity party too long…always mindful of it.

<Files\\Yakitta 004 First Interview 11-3018> Reference 1,2

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Therapeutic Interventions Terri: But yeah, I mean even now I regularly access my, my therapist peeps, you know?

<Files\\Terri 001 2nd Interview> Reference 22

Dani B: I started seeing a counselor, um, the middle of last year was just I- I still, you know, need a safe place to kind of finish, you know... as much as you can finish.

<Files\\Dani B 002 2nd Interview 12-3-18> Reference 1

Kennedy: EMDR helped… I can't really describe EMDR very well to you, as far as like what it was; I said it just really felt like it wasn't as triggering anymore. I think that that EMDR was a big that was the turning point probably.

<Files\\Kennedy 003 2nd Interview 12-22-18> Reference 5,6

Yakitta: So, I love CBT. CBT has always, cognitive behavioral therapy has always worked for me.

<Files\\Yakitta 004 2nd Interview 12-12-18> Reference 2

Surrendering to God’s plan/will – making peace Terri: Um, and again, I know- I said this before. I believe things happen for a reason.

<Files\\Terri 001 2nd Interview> Reference 1

227

Dani B: …you know the worst time in their life, when they're seeing him, their Messiah, their savior on the cross had to happen for all the good to happen after, it was still part of God's plan…and, that's, that's powerful and it’s truth, and it’s scripture you know? It’s something we know, it’s something we celebrate as Christians. It’s the hallmark of our Christian faith.

<Files\\Dani B 002 1st Interview 11-17-18> Reference 1,2

Kennedy: Right after the miscarriage, all of this. It's like that was just this catalyst for all this future growth. And saying like, okay, you're here for a purpose to teach me something.

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1,2

Yakitta: …not gonna know everything. God does what he does. If I'm saying that I trust and believe that God is doing what He knows He's going to do, then I have to align with that.

<Files\\Yakitta 004 3rd Interview 12-1718>Reference 2,3

D. Response from Others

Supportive comments and actions from others Terri: Because I had a lot of focus on the husband to make sure that he is okay. With Dr. P., I could focus on myself more...someone to take care of me.

<Files\\Terri 001 2nd Interview> Reference 4

Dani B: And she was- was wonderful. She was, you know, very- very supportive, very understanding…I mean, she just ... she really came alongside me.

<Files\\Dani B 002 2nd Interview 12-3-18> Reference 1

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Kennedy: My dad…every year, he'll say, like, "I didn't forget." Um, my sister bought me a necklace of the August birthstone…and, um, got me a book, a devotional called, um, Grieving the Child I Never Knew. I think the biggest thing in trauma is, like, tell me this was a big deal…validate that this was a big deal…those little things. It was, okay, this was a big deal to me, and you telling- and you doing this, or giving me this, acknowledges that you see that.

<Files\\Kennedy 003 First Interview 11-2918> Reference 2,3

Yakitta: So my mother was here, um, my sister that lives here who very close, my husband, um, and so they all just kind of let me be, but didn't let me get stuck.

<Files\\Yakitta 004 2nd Interview 12-12-18> Reference 8

Unsupportive comments and actions from others Terri: So, there were people that we may have hear from initially. Oh I'm so sorry, condolences. And then that's all nice, and they may have also made statements, you know, if you need anything. But then don't hear from them.

<Files\\Terri 001 2nd Interview>Refere nce 30

Dani B: So he died in- in May, and then Tyler died in October. August 1st, my son's birthday I over… my mom and I talked. And then, I overheard her trashing me. …and- and I really just was like, okay I can't do this right now…and just pulled away. It wasn't like you know, you're toxic and I'm not talking to you anymore. It was just like, I, you're not safe.

<Files\\Dani B 002 3rd Interview 12-18-18> Reference 1

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Kennedy: What bothers me is that any competent hospital would not let a woman at 18 weeks just leave without a DNC. I mean that, that's what bothers me. … and that was what was kind of traumatic for me for a while was feeling as though I can't trust these people who are supposed to be medical professionals.

<Files\\Kennedy 003 2nd Interview 12-2218>Reference 6

Yakitta: We're in this huge room; they're sitting around this whole panel of people and they're just bombarding with questions or talking amongst themselves about how dysfunctional and it was bound to happen. …drew more into myself, you know, with that, because I was like, I don't want to talk to you. I don't want to tell y'all anything.

<Files\\Yakitta 004 2nd Interview 12-12-18> Reference 3

E. The Changed Experience

Value of experience Terri: I think it's more of, um, more of an awakening of the strength for me.

<Files\\Terri 001 3rd Interview 1129-18> Reference 2

Dani B: And then, you know if you go into, you know your fifth, sixth battle, you know you're- you're not like, "Yay I'm going into battle." But you- you have some experience under your belt.

<Files\\Dani B 002 3rd Interview 12-18-18> Reference 1

Kennedy: It's not so much triggering, it's just like, hey, you need to face that… so I'm able to kind of put it back burner. When I work with those women, it's more of like, I get it, I understand.

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 2,3

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Yakitta: I literally now had the experience and the knowledge to say; this is what it looks like…but, I now had experience, or I now had something to bring to the table…

<Files\\Yakitta 004 3rd Interview 12-17-18> Reference 1

Shattering of an assumptive world Terri: "up in smoke". "He was cremated so literally up in smoke (she laughs)." Funny now... that in itself is traumatic… having hope slammed like that. When that kind of hope is gone, similar to miscarriages - hope slammed away, so abruptly. Receiving news of someone passing who is young.

<Files\\Terri 001 2nd Interview> Reference 2

Dani B: You know, you have that child and you just kind of automatically look to the future…you just have all of these hopes and dreams and expectations and it’s all gone. You don't expect children to die.

<Files\\Dani B 002 2nd Interview 12-3-18> Reference 1,2

Kennedy: I feel like anytime that veil is lifted again, of like, the world is a crappy place…didn’t have concept of it yet…God was life line. It's like re-triggering to me.

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 1

Yakitta: So I just kinda was like, "Lord, I am going to need you to help me with this because I couldn't wrap my head around a 14 year old."

<Files\\Yakitta 004 2nd Interview 12-12-18> Reference 12

Changes made as a result of the traumatic experience

231

Terri: I learned how to say no and not feel guilty about it. Felt guilty before, I really should, they need my help. But if I don’t fill my cup, nothing to give.

<Files\\Terri 001 3rd Interview 1129-18> Reference 24

Dani B: But- but having not gone through what I had, um, I don't feel that I would be able to give her that space to do all of that. Um, for people to know that- that you're safe. You know? …to- to really be real and honest…just increased confidence in that I don't have to do it all. I don't have to have the answers. I have to be there. I have to be present. I have to show up. And, um, let God.

<Files\\Dani B 002 3rd Interview 12-18-18> Reference 10-13

Kennedy: I'm having to embrace the gray and the Lord's kind of like requiring me to do that…part of growth process. Need to do for some reason to be better wife, mother, therapist and I hate it. So I'm trying to find that in the goodness, The very thing that sent for your destruction's actually gonna be sent for your deliverance

<Files\\Kennedy 003 3rd Interview 1-19-19> Reference 21,22

Yakitta: I'll never work with adolescents, so I just needed some time, um, to step away from it. And then come back to it, probably just a different way. Taking break from severe clients to brief work with families – it really gave me the time to reflect to see if I really wanted to do… I had to let myself go through that grieving process naturally and professionally…

<Files\\Yakitta 004 3rd Interview 12-17-18> Reference 7

232

Appendix J Letter to Waive Pseudonym (Yakitta)

233 To Whom It May Concern,

I have had the pleasure of being able to support Teresa Barnes complete the necessary requirements of her Doctoral Program. During this time, I specifically requested that my true name: Yakitta Renfroe be used in her research vs a pseudonym.

I believe that my name is critical to the authenticity of my testimony, my life, and my story; and because of that I again request that my name be used.

If there are any questions or concerns, please do not hesitate to contact me via cellphone: 609442-9722.

Yakitta Renfroe, MA., LPC New Beginnings Therapy & Healing, LLC 3210 E. Woodmen Rd Suite 110 Colorado Springs, CO 80920 Owner/Psychotherapist Call/text: 719-428-6024 Email: yakitta@newbeginningsth.com

234

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