Why Some People Take Breakups Harder Than Others

Why Some People Take Breakups Harder Than Others: Part of it depends on whether they believe personality is fixed or constantly changing.

http://www.theatlantic.com/health/archive/2016/01/romantic-rejection-and-the-self-deprecation-trap/424842/

  

An interesting article! This is why it frustrates me to see people who are stuck and constantly ruminating on their past – can’t forgive, can't let go, can’t move on, therefore can’t grow and can’t change, leading to a vicious cycle further reinforcing the belief that the personality is fixed and therefore remaining stuck, hopeless, and depressed, which further repels other people away leading to further experiences of rejection.

In one study, people were asked to reflect on a time when they were rejected in a romantic context, and then write about the question: What did you take away from this rejection? For some people, their answers made it clear that the rejection had come to define them—they assumed that their former partners had discovered something truly undesirable about them. For example, one person wrote: “Things were going well when all of a sudden he stopped talking to me. I have no idea why, but I think he saw that I was too clingy and this scared him away.” “Why wasn’t I good enough?” or “Is there something wrong with me?”

But the loss of a partner can make it easy to fall into the self-deprecation trap. Research by the psychologist Arthur Aron and his colleagues shows that when people are in close relationships, their self becomes intertwined with their partner’s self. In other words, we begin to think of a romantic partner as a part of ourselves—confusing our traits with their traits, our memories with their memories, and our identity with their identity. In a measure designed to capture the closeness of a relationship, Aron’s team ask people to consider themselves as one circle, their partner as another, and indicate the extent to which the two overlap.

If rejection seems to reveal a new, negative truth about a person, it becomes a heavier, more painful burden. When rejection is intimately liked to self-concept, people are also more likely to experience a fear of it. People reported becoming more guarded with new partners and “putting up walls.” One study participant wrote: “I feel like I constantly withhold myself in possible future relationships in fear of being rejected again.” The belief that rejection revealed a flaw prompted people to worry that this defect would resurface in other relationships.

In some cases, rejection also seemed to fundamentally change people’s outlook on romantic partnerships, leaving them with pessimistic views about the fundamental nature of relationships. As one person wrote: “To me, this rejection was like opening Pandora’s Box, and concepts like love and trust became fantasies that never really existed.”

So what makes for a healthy breakup, one in which the person moves on with minimal emotional damage? In the author's study, some people drew much weaker connections between rejection and the self, describing rejection as an arbitrary and unpredictable force rather than the result of some personal flaw. One person wrote, “Sometimes girls are not interested. It’s nothing to do with yourself, it’s just that they’re not interested.” Another noted how rejection wasn’t a reflection of worth: “I learned that two people can both be quality individuals, but that doesn’t mean they belong together.” Other people saw the rejection as a universal experience: “Everyone gets rejected. It’s just part of life.”

Yet another group of people saw the breakup as an opportunity for growth, often citing specific skills they had been able to learn from rejection. Communication was a recurrent theme: People described how a rejection had helped them understand the importance of clear expectations, how to identify differences in goals, and how to express what they wanted out of a relationship. Other participants wrote that breakups had helped them to accept that they couldn’t control the thoughts and actions of others, or to learn how to forgive.

Pastoral care for PTSD

Abstract:The pastoral care situation I will be analysing is on Posttraumatic Stress Disorder (PTSD) in a survivor from a man-made mass casualty incident. The physical aspects associated with PTSD include a hyperarousal state and substance abuse as an attempt to self-medicate. Emotionally, one goes through the grief process, which involves negative emotions such as anger, guilt and depression. There can also be excessive fearfulness. On the spiritual level, there is disruption of the relationship with God and with people. Therefore the pastor needs to foster spiritual wholeness through attending to both the parishioner and the Holy Spirit. Biblical/theological concepts to aid the pastoral care process include instigating faith, hope and love through rebiographing the parishioner’s narrative using examples such as the story of Joseph, the prophets in the Hebrew Scriptures, and Job’s sufferings. Humans can never understand why God does what he does; we can only trust in faith that somehow innocent suffering fits into a larger plan of His.

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The pastoral care situation I will be analysing is on Posttraumatic Stress Disorder (PTSD) in a survivor from a man-made mass casualty incident. To identify the physical, emotional and spiritual aspects of this situation as well as the pastoral issues arising, we need to know the DSM-V definition of PTSD.[1] Some of the features described in the DSM-V are related to the hyperarousal state one experiences in a fight or flight response to threat where adrenaline and noradrenaline are released.[2] There can also be a freezing response to traumatic threat, where one goes into a state of tonic immobility^[3], has an altered sense of time, reduced sensation of pain, absence of terror or horror.[4] Once the fight or flight has been successful, cortisol will halt the alarm reaction. In PTSD the body do not release enough cortisol to halt the alarm reaction so one remains chronically hyperaroused even after the threat has passed. In PTSD there is distortion to the hippocampus, the area of the brain associated with memory processing that gives events a beginning, a middle, and an end. One of the features of PTSD is a sense that the trauma has not ended. The activity of the hippocampus often becomes suppressed during traumatic threat,[5] and in PTSD it remains continuously suppressed and shrunken.[6] This is the likely mechanism of the “flashback” symptom of PTSD. The traumatic event seem to float free in time, rather than occupying its locus in one’s past, often intrudes into the present perception as if it were occurring now.[7] Functional studies also show a significant decrease in the activity of the Broca’s area which is related to translation of personal experiences into a communicable language.[8]

The physical problems of PTSD are inseparable from the emotional problems. Intrusive symptoms restrict the person’s ability to function as reminders of the trauma they suffered may appear suddenly, causing instant panic.[9] Eventually, one can become so overcome by fear that they become extremely restricted, fearing to be with others or to go out of his/her home.[10] Dissociation, which seems to be the most severe consequence in PTSD, involves a splitting in awareness to save the self from suffering[11], where the numbing of emotions experienced in the freeze response persists.^[12] The difficulty PTSD individuals experience in synthesizing and assimilating a traumatic event to produce a structured narrative[13] can create communication difficulties leading to impairments in interpersonal relationships and social functioning. Other psychological comorbidities are common: Approximately 80% of sufferers have another disorder such as depression, substance misuse, or anxiety.[14] Patterns involving self-pity, abandonment, self-victimization and self-depreciation may intensify the negative emotions related to a traumatic memory and exacerbate psychological suffering.[15] In fact, one goes through the various stages of the grief process. [16] Hopelessness is a word often used by PTSD individuals to express their emotional state.[17] Studies suggest that an increase in hope and decrease in despair and hopelessness may be critically important factors for better health and longevity.[18] A sudden, violent, or preventable physical death is traumatic for those left behind[19], so individuals with PTSD may describe painful guilt feelings about surviving when others did not or about things they had to do to survive.[20]^,[21] There can also be a sense of anger and unforgiveness.^[22]

Trauma changes our assumptions of identity, safety, and relationship with the world.[23] One loses a sense of innocence and trust. They saw the world as dangerous, feeling perpetually vulnerable.[24] In despair, one may ask, “What kind of God would allow this to happen?”, “What kind of world is this?”[25], and “Why me?” When the God I have cried out to for help seems to fail me, the loneliness is devastating.[26] Spiritually, there can be a severed sense of connection with God.[27] Even when the survivors thank God for mercy, there is always a question that haunts^[28]: what of those who were not saved? Did God choose for them to die for a purpose?^[29] The need to find a reason for injury or survival is a defensive strategy. If only there is a reason, or a mistake can be identified and judgment made, the reality of lost control and powerlessness can be avoided.^[30] The victims might go to their clergy for help with these spiritual questions.[31] The traumatic wound touches us as a whole: mind, body, and spirit[32], therefore healing from trauma is as multi-dimensional as the wound itself.[33] Biblical psychology is clearly holistic psychology because the body, soul, spirit are not separate entities.^[34] Transforming trauma is impossible without spirituality: a belief in something more than what is currently seen or understood.[35] Spiritual issues include: “How do we pray or feel ourselves in God’s presence when one of the fundamental elements of trauma is that trust has been ruptured?”, “How do we make a reconnection with the God and meet God in a transforming way?”[36]

Positive religious coping, religious openness, readiness to face existential questions, religious participation, and intrinsic religiousness are typically associated with posttraumatic growth[37] as well as improved health outcomes.[38] Johnson and Friedman[39] describe “spiritual emergence” as the personal integration of spiritual and transpersonal experiences “to achieve expanded consciousness and maturity”. Whatever the source of trauma, healing takes shape in the act of breaking out of isolation and connecting with other people and the deeper meanings of human experience.[40] Pastors are the only counselling professionals who routinely have training in systematic theology, biblical studies, ethics, and church history^[41], hence uniquely equipped to foster spiritual wholeness.^[42] The role of the pastor is to listen, focus, and direct the process while attending to both the parishioner and the Holy Spirit.^[43] Pastors are also able to help their parishioner connect to support systems through faith communities[44] that can provide love and support.^[45] Pastors should never feel that they are responsible for meeting all the needs of those who seek their help. Instead, they carry the role of a broker, bringing those who consult them into contact with the healing resources of the body and life of Christ.^[46] There is a high personal cost associated with the provision of counselling^[47], so Benner proposes the establishment of a time-limited relationship five counselling sessions.^[48] Terminating the counselling relationship can sometimes get tricky.^[49] Setting a limit discourages the formation of dependent relationships and encourages people to continue to work on their problems.^[50]

Theologically it is very important to address the issue of hope because hopelessness and depression are common in people with PTSD. Despair, apathy and shame are three attitudes where, once internalised and well established, poses a powerful threat to the maintenance of a hopeful attitude toward life.^[51] Therefore one needs to try and modify their narrative of the traumatic event.^[52] One possible meaning of repentance is that one’s sinful past is blotted out, like an erased debt. Another is that one’s sinful past is rectified. The story of Joseph is a biblical example of rebiographing[53], whereby he turned his brothers’ act of betrayal into a “useful event for humanity”, a viable method of reframing because it is grounded in the boundless mercy of God, who is able to take sinful actions that we or others committed in the past and make them something better than we would ever have imagined. Therefore, rebiographing makes the past as open and possibility-filled as the future.^[54] Victor Frankl was a psychiatrist whose work was deeply influenced by his experience in a concentration camp. He pointed out that human beings have a fundamental need to believe in the future, not just a hope for one’s individual future but an embrace of future possibilities for humanity. If that belief is lost, it is impossible to live well in the present.^[55]

The most powerful hunger for God is known in the feeling of seeming absence.^[56] The seeming loss of God is, in actuality, a passage into a deeper relationship with the God. The loss of the image of a protective God carries with it the experience of presence in the midst of the human reality of suffering.^[57] When the prophets of the Hebrew Scriptures expressed profound grief for the losses of their people, it invokes the memory of God’s fidelity and opens up the possibility for a new way of understanding and living. Grief acknowledges that a link has been severed: living into that truth frees the soul to believe again in the future and to imagine a new possibility.^[58] The book of Job demonstrates that no one is exempt from suffering, even a saint like Job, who in the face of natural evil displayed signs of social withdrawal and complained against God. It does not explore why there is suffering but rather the question of how a person can respond in the midst of suffering^[59]. Job’s friends thought they were wise but they were doing more harm to Job when they tried to explain everything away through human wisdom and self-confidence. It is not debate but the comfort of the close human community that helps. These sufferings lead Job to a “face to face” encounter God whereby he indicated his complete submission to the Lord (Job 42:5-6)^[60], and instigated a profound formation of Job into the genuinely humble wise man of great faith who serves God simply because God is worth of such service.^[61] The greatest act of faith for those encountering grief is to stand in its presence and make no attempts to explain it away.^[62] Humans can never understand why God does what he does; we can only trust in faith that somehow innocent suffering fits into a larger plan of His. Such faith in God begins to free one from grief so that other imaginative possibilities start revealing itself, including hope for the future and the desire to love again.

Person’s situation	PTSD in a survivor from a man-made mass casualty incident.
Major needs for the person	Physical: l   Reduce anxiety/hyperarousal symptoms, eg. irritable behaviour, reckless behaviour, hypervigilance, exaggerated startle response, poor concentration, and sleep disturbance. l   Reduce intrusion symptoms, eg. recurrent intrusive memories, dreams, flashbacks l   Get off any addictions Emotional: Guide the person through the grief process. l   Reduce negative emotions (anger, guilt) l   Reduce numbing/depression (the inability to experience positive emotions). l   Lead the fearful individual into trusting again. Relational: l   Restore intimate relationship with God l   Restore interpersonal relationships. Social: l   Enhance integration into community and social functioning Spiritual: l   Forgive self and others through the change of narratives l   Strengthen faith in God l   Reinstigate hope in those who lost a sense of innocence and trust l   Regain the ability to love again
Support Network (who are all the providers of care in this person’s life? What role do they have?)	Family/relatives: provide love and support, need indepth understanding of PTSD due to proximate contact. Friends: provide love and support. Pastor: foster spiritual wholeness[1] through listening, focusing, and directing the process while attending to both the parishioner and the Holy Spirit.[2] Help their parishioner connect to support systems through faith communities.[3] Enhancing parishioner’s awareness of God’s grace and faithful presence.[4] Congregation: provide love and support.[5] Health Professionals: GP is usually the first place to start. Subsequently, community psychiatric nurse, psychologist, or psychiatrist might be involved.[6]
Major Overall Objectives for Pastoral Care Plan	Foster spiritual wholeness[7]
Length of plan and how it will be reviewed (how long will this plan be used, how will it be assessed for effectiveness?)	Set five-sessions first because those who need more sessions should be referred to someone who is appropriately qualified.[8] The exception to this rule is a situation which a parishioner is facing a significant crisis at the end of the five sessions, and there are no other available resources to provide the necessary support.[9]

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[1] David G. Benner, Strategic Pastoral Counselling: A Short-Term Structured Model (Grand Rapids: Baker Academic, 2003), 33.

[2] Benner, Strategic Pastoral Counselling, 51.

[3] Judith A. Sigmund, “Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder,” Journal of Religion & Health 42 (2003): 222.

[4] Benner, Strategic Pastoral Counselling, 40.

[5] Benner, Strategic Pastoral Counselling, 35.

[6] “Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children,” last modified March 2005, https://www.ranzcp.org/Mental-health-advice/guides-for-the-public/PTSD-Public.aspx. To treat with counselling, psychotherapy, and/or antidepressants.

[7] Benner, Strategic Pastoral Counselling, 33.

[8] Benner, Strategic Pastoral Counselling, 54. Setting a limit discourages the formation of dependent relationships and encourages people to continue to work on their problems. There is no assumption that strategic pastoral counselling fixes people for life.

[9] Benner, Strategic Pastoral Counselling, 102.

Pastoral Care Plan – specific steps
Identified problem or issue	Specific Objectives/goals	Specific Skills or Activities that will be utilised	Support Providers	Specific Resources that will be used
Anxiety/hyperarousal symptoms. Intrusion symptoms. Addictions.	Reduce these physical symptoms and stop harmful “self-medication” methods such as substance abuse.	Teaching: The person and his family/carers need to be educated so they understand the condition and its symptoms. He needs to be fully informed about all available treatment options. Training: The person needs to be trained to perform relaxation techniques, incorporating healthy lifestyle, and ways of staying off addictions.	GP: initial assessment and referral. Psychologist/Psychiatrist: treat through psychotherapy or medications. Family: understand and cope in living with a PTSD individual. Pastor, congregation, friends: be understanding when these physical symptoms arise.	Website for self and carer education about PTSD:[1] https://www.ranzcp.org/Mental-health-advice/guides-for-the-public/PTSD-Public.aspx Specialist referral services: http://www.sjog.org.au/hospitals/richmond_hospital/hospital_services/post-traumatic_stress_disorder.aspx Psychotherapy: CBT or EMDR. Antidepressant medication might be needed.
Negative emotions: anger, guilt. Numbing/depression: the inability to experience positive emotions.	Forgive self and others through the change of narratives. Regain the ability for positive emotions such love and joy.	Listening skills: one needs to be a good listener to detect the anger and guilt, which can be hidden. Genuineness: people don’t always voluntarily express negative emotions unless it’s somebody they trust. Empathy: to be a good listener, one has to be empathetic. The person feels safer about telling their story. Encouragement: use the Scriptures to shift the focus to the love and promises of God.	Family, friends, pastor, congregation: give the person time and space to heal, don’t take his negative emotions personally. Intercession prayer. Heath professionals: listen, counsel, provide psychotherapy or medications as needed.	Pastoral guidance through Scriptures:  One possible meaning of repentance is that one’s sinful past is blotted out, like an erased debt. Another is that one’s sinful past is rectified. The story of Joseph is a biblical example of rebiographing.[2] Psychotherapy: Past-focused approaches include exposure therapy and psychodynamic recall therapies.[3] Antidepressant might be needed.
Lead the fearful individual into trusting again. Restore intimate relationship with God.	Instigate hope in those who lost a sense of innocence and trust. Strengthen faith hence trust in God, thereby re-instigating faith, hope, love.	Genuineness: the person need to encounter enough genuine people to be able to trust again. Listening skills: to both the parishioner and the Holy Spirit. Teaching: using Scriptural examples to teach about faith, hope, love, and God.	Pastor: to listen, focus, and direct the process while attending to both the parishioner and the Holy Spirit.[4] Family, friends, congregation: spiritual time together.	Pastoral guidance through Scriptures: “…faith, hope and love. But the greatest of these is love (1Corinthians 13:13)”. The prophets of the Hebrew Scriptures and Job’s story as illustrations.
Restore interpersonal relationships. Enhance integration into community and social functioning.	To trust and love others again. Restore meaning and purpose in life and find a vocation that fulfill these.	Recognition of abilities: to identify suitable vocations and community activities. Training: for interpersonal skills and the vocation of interest. Teaching: biblical wisdom applicable to interpersonal relationships and social functioning. Encouragement: be patient as the process can be slow and frustrating.	Pastor: Setting a limit discourages the formation of dependent relationships and encourages people to continue to work on their problems.[5] Psychologist: provide interpersonal skills training.	Pastor: help parishioners connect to support systems through faith communities during and after treatment.[6] Psychotherapy: Interpersonal skills training. Setting your goals: http://www.stickk.com/

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[1] “Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children,” last modified March 2005, https://www.ranzcp.org/Mental-health-advice/guides-for-the-public/PTSD-Public.aspx

[2] Donald Capps, Agents of Hope: A pastoral psychology (Minneapolis: Fortress Press, 1995),  173.

[3] Elizabeth M. Ventura, “Strategies and Techniques for Counseling Survivors of Trauma.” In Trauma Counselling: Theories and Interventions, ed. Lisa Lopez Levers, (New York: Springer Publishing Company, 2012),  506.

[4] Benner, Strategic Pastoral Counselling, 51.

[5] Benner, Strategic Pastoral Counselling, 54.

[6] Sigmund, “Spirituality and Trauma,” 222.

Pastoral Care Plan – biblical, theological and theoretical foundations
Biblical, theological or theoretical perspectives/evidence (that are relevant to this situation and the care plan that has been developed)	Ways that this perspective/evidence informs the pastoral carer (link your response to specific problems, objectives, skills or resources in your plan)
Psychotherapies have been considered the mainstream treatment for PTSD cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR).[1] When there’s sufficient benefit from psychological intervention alone[2], medications have been shown to be helpful in the management of core symptoms of PTSD.[3]	These physical symptoms need to be managed and are not signs of spiritual weakness.[4]
Joseph turned his brothers’ act of betrayal into a “useful event for humanity”, a viable method of reframing because it is grounded in the boundless mercy of God, who is able to take sinful actions that we or others committed in the past and make them something better than we would ever have imagined.[5]	Help the person re-narrate his story.
When the prophets of the Hebrew Scriptures expressed profound grief for the losses of their people, it invokes the memory of God’s fidelity and opens up the possibility for a new way of understanding and living.[6] From Job we see humans can never understand why God does what he does; we can only trust in faith that somehow innocent suffering fits into a larger plan of His. This faith allows other imaginative possibilities start revealing itself, including hope for the future and the desire to love again.	Do not try to explain everything away theologically. Let the Holy Spirit lead the process.
Human beings have a fundamental need to believe in the future, not just a hope for one’s individual future but an embrace of future possibilities for humanity. If that belief is lost, it is impossible to live well in the present.[7]	Carry the role of a broker, bringing those who consult them into contact with the healing resources of the body and life of Christ.[8]

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[1] S. Seedat, D. J. Stein, and P.D. Carey, “Post-traumatic stress disorder in women: Epidemiological and treatment issues,” CNS Drugs 19 (2005): 411.

[2] National Health and Medical Research Council, The Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder (Melbourne: Australian Centre for Posttraumatic Mental Health, 2013), 14.

[3] John R. Tomko, “Neurobiological Effects of Trauma and Psychopharmacotherapy,” in Trauma Counselling: Theories and Interventions, ed. Lisa Lopez Levers, (New York: Springer Publishing Company, 2012), 63. The first line medication is the SSRI class of antidepressants.

[4] Teresa Rhodes McGee, Transforming Trauma: A Path toward Wholeness (Maryknoll: New York, 2005), 36. Making peace with memory requires respecting the reactions and processes at work in the face of trauma as in service of life, not proof of hysteria or some type of failure.

[5] Capps, Agents of Hope, 175. Therefore, rebiographing makes the past as open and possibility-filled as the future.

[6] McGee, Transforming Trauma, 89. Grief acknowledges that a link has been severed: living into that truth frees the soul to believe again in the future and to imagine a new possibility.

[7] McGee, Transforming Trauma, 87.

[8] Benner, Strategic Pastoral Counselling, 35.

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[1] “American Psychiatric Association DSM-5 Development,” DSM-5, accessed September 23, 2015, http://www.dsm5.org/ 1) Exposure to a traumatic event where there is exposure to actual or threatened death, serious injury, or sexual violence. 2) Presence of one or more of the following associated with the traumatic event, beginning after the traumatic event occurred: Recurrent, involuntary, and intrusive distressing memories or dreams of the traumatic event. Dissociative reactions, eg. Flashbacks, in which the individual feels or acts as if the traumatic event was recurring. Intense or prolonged psychological distress or marked physiological reactions at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event. 3) A persistent avoidance of stimuli associated with the traumatic event. 4) Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the traumatic event has occurred, eg. Dissociative amnesia, blame self or others, negative emotional state, markedly diminished interest in significant activities, and persistent inability to experience positive emotions. 5) Marked alterations in arousal and reactivity associated with the traumatic event, eg. Irritable behaviour, reckless behaviour, hypervigilance, exaggerated startle response, poor concentration, and sleep disturbance. 6) Duration >one month. 7) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

[2] Babette Rothschild, The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment (New York: W. W. Norton & Company, 2000), 8. Arousal is mediated by the limbic system, the part of the brain which regulates survival behaviours and emotional expression. The limbic system responds to threat by activating the sympathetic branch of the autonomic nervous system (SNS) and the release of corticotrophin-releasing hormone. This in turn activates the release of adrenaline and noradrenaline to mobilise the body for fight or flight.

[3] Rothschild, The Body Remembers, 9.

[4] Rothschild, The Body Remembers, 13.

[5] Rothschild, The Body Remembers, 12.

[6] Julio F. P. Peres, et al. “Spirituality and Resilience in Trauma Victims,” Journal of Religion & Health 46 (2007): 345.

[7] Rothschild, The Body Remembers, 12.

[8] Peres, et al. “Spirituality and Resilience in Trauma Victims,” 345.

[9] Rothschild, The Body Remembers, 13.

[10] Rothschild, The Body Remembers, 14.

[11] Rothschild, The Body Remembers, 13.

[12] McGee, Transforming Trauma, 33.

[13] Peres, et al. “Spirituality and Resilience in Trauma Victims,” 345.

[14] National Health and Medical Research Council, The Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder, 11.

[15] Peres, et al. “Spirituality and Resilience in Trauma Victims,” 346.

[16] McGee, Transforming Trauma, 76. The most familiar model for the stages of grief include: denial, anger, bargaining, depression, and acceptance. The cycle does not progress neatly and is a process.

[17] C.D. Scher, & P.A. Resick, “Hopelessness as a risk factor for post-traumatic stress disorder symptoms among interpersonal violence survivors,” Cognitive behaviour therapy 34(2005): 99.

[18] L.D. Kubzansky, et al. “Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the Normative Aging Study,” Psychosomatic Medicine 63 (2001): 910. A more optimistic explanatory style, or viewing the glass as half-full, lowers the risk of coronary heart disease in older men.

[19] McGee, Transforming Trauma, 13.

[20] Hani Raoul Khouzam, and Perla Kissmeyer, “Antidepressant Treatment, Posttraumatic Stress Disorder, Survivor Guilt, and Spiritual Awakening,” Journal of Traumatic Stress 10 (1997): 691.

[21] McGee, Transforming Trauma, 28.

[22] Sigmund, “Spirituality and Trauma,” 225.

[23] McGee, Transforming Trauma, xiii.

[24] Sigmund, “Spirituality and Trauma,” 223.

[25] Sigmund, “Spirituality and Trauma,” 223.

[26] McGee, Transforming Trauma, 14.

[27] McGee, Transforming Trauma, xii.

[28] McGee, Transforming Trauma, 79.

[29] McGee, Transforming Trauma, 80.

[30] McGee, Transforming Trauma, 80.

[31] Judith A. Sigmund, “Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder,” Journal of Religion & Health 42 (2003): 222.

[32] McGee, Transforming Trauma, xii.

[33] McGee, Transforming Trauma, 16.

[34] Benner, Strategic Pastoral Counselling, 55.

[35] McGee, Transforming Trauma, 17.

[36] McGee, Transforming Trauma, 18.

[37] Peres, et al. “Spirituality and Resilience in Trauma Victims,” 347.

[38] Judith A. Sigmund, “Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder,” Journal of Religion & Health 42 (2003): 222.

[39] C. Johnson, and H. Friedman, “Enlightened or delusional?: Differentiating religious, spiritual, and transpersonal experiences from psychopathology,” Journal of Humanistic Psychology 48 (2008): 514.

[40] McGee, Transforming Trauma, xiii.

[41] Benner, Strategic Pastoral Counselling, 32.

[42] Benner, Strategic Pastoral Counselling, 33.

[43] Benner, Strategic Pastoral Counselling, 51.

[44] Judith A. Sigmund, “Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder,” Journal of Religion & Health 42 (2003): 222.

[45] Benner, Strategic Pastoral Counselling, 35.

[46] Benner, Strategic Pastoral Counselling, 35.

[47] Benner, Strategic Pastoral Counselling, 37. Counselling a person who is confused, hurting, angry, or fearful necessarily involves absorbing significant amounts of that person’s distress, but they do represent an essential component of the healing process.

[48] Benner, Strategic Pastoral Counselling, 40. Structured to provide comfort for troubled persons by enhancing their awareness of God’s grace and faithful presence and thereby increasing their ability to live their lives more fully in the light of these realisations.

[49] Benner, Strategic Pastoral Counselling, 102. Because the parishioner may have experienced a kind of acceptance or even emotional intimacy in the counselling experience that is rare or not present in the rest of life. Alternatively, the pastor may be tempted to continue the sessions because they were enjoyable or rewarding.

[50] Benner, Strategic Pastoral Counselling, 54.

[51] Donald Capps, Agents of Hope: A pastoral psychology (Minneapolis: Fortress Press, 1995), 98.

[52] Capps, Agents of Hope, 165. The meaning any event has for us depends upon the frame in which we perceive it. When we change the frame, we change the meaning. Reframing is changing the frame in which a person perceives events in order to change the meaning. When the meaning changes, the person’s responses and behaviours also change.

[53] Capps, Agents of Hope, 173.

[54] Capps, Agents of Hope, 175.

[55] McGee, Transforming Trauma, 87.

[56] McGee, Transforming Trauma, 152.

[57] McGee, Transforming Trauma, 154.

[58] McGee, Transforming Trauma, 89.

[59] Lindsay Wilson, “Job”, In Theological Interpretation of the Old Testament: A Book-by-Book Survey, edited by Kevin J. Vanhoozer, (Grand Rapids: Baker, 2008), 150.

[60] Susan F. Mathews, “All for Nought: My Servant Job”, In The Bible on Suffering: Social and Political Implications, edited by Anthony J. Tambasco, (Paulist Press: New York, 2001), 67.

[61] Craig G. Bartholomew and Ryan P. O’Dowd, Old Testament Wisdom Literature: A Theological Introduction, (Downers Grove: IterVarsity Press, 2011), 153.

[62] McGee, Transforming Trauma, 90.