Date of Award

Spring 5-28-2025

Document Type

Open Access Thesis

Degree Name

Master of Arts (MA)

Department

Clinical Psychology

First Advisor

Heidi M. Levitt

Second Advisor

Evan Auguste

Third Advisor

Abbey S. Eisenhower

Abstract

Posttraumatic stress disorder (PTSD) is prevalent and can be highly complex. Guidance for the treatment of PTSD has typically been based on quantitative meta-analyses of randomized controlled trial findings and has focused on the comparative efficacy of specific treatments, rather than how to deliver treatment. There is a need for clinical guidance that highlights moment-to-moment, in-session psychotherapy processes for psychotherapists working with clients with PTSD. In the current study, I conducted a qualitative meta-analysis, focusing on the qualitative literature investigating clients’ perspectives in order to develop an understanding of the preferences, values, and experiences of clients in individual psychotherapy for PTSD. Thirty-nine studies were included in the meta-analysis. I used critical-constructivist grounded theory to build a hierarchy to represent patterns across included articles’ findings to understand PTSD psychotherapy processes and outcomes. I then conducted a hermeneutic analysis of the hierarchy to generate process-based principles for practice. Results included one core category, six clusters, 15 categories, and 15 principles for practice. Findings indicated that clients progressed through a developmental process of first establishing relational security as well as collaborative treatment. They then gained a sense of groundedness, also learning to turn toward and transform trauma-related reactions. Their expanded capacities facilitated their deep emotional experiencing and meaning reconstruction. This progression represents a staged model encapsulating clients’ central process of developing their agency upon a foundation of therapeutic safety to liberate themselves from trauma and related pain. I discuss the implications of this staged model for practice, training, and research.

Comments

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