Journal articles on the topic 'Interpersonal Reconstructive Therapy'

This paper compares the approaches to Sharon’s case presented in two articles that appear earlier in this module, my paper (Westerman, 2021a), which was based on Interpersonal Defense Theory, and the paper by Critchfield, Dobner-Pereira, and Stucker (2021a), which was based on Interpersonal Reconstructive Therapy (IRT). I begin by considering differences in general between the ways in which these two perspectives approach case formulation. I then turn to comparing the formulations of Sharon’s case based on the two perspectives. Among other things, this part of the paper contrasts IRT’s focus on copy processes and the Gift of Love with Interpersonal Defense Theory’s focus on functionalist processes that involve the temporal organization of the parts of noncoordinating defensive interpersonal patterns. The second half of the paper compares the treatment implications of the two approaches in general terms and as they relate to Sharon’s case in particular. Implications for treatment are discussed regarding both insight-oriented interventions and enacted interventions at the level of therapy relationship processes.

In Interpersonal Reconstructive Therapy (IRT: Benjamin, 2003/2006; 2018) a case formulation is used to tailor interventions to each patient’s unique patterns. Using the IRT lens, psychopathology is understood as reflecting attempts to adapt to current environments using maladaptive rules and values that were learned and internalized in the context of close attachment relationships. IRT identifies precise ways in which early learning shapes present experience. Additionally, the "gift of love" (GOL) hypothesis posits that motivation to repeat maladaptive ways is linked to the wish to receive love and acceptance from specific internalized attachment figures by repeating their ways and values for the patient. The IRT case formulation has been shown to be reliable and valid (Critchfield, Benjamin, Levenick, 2015). The therapy adherence measure is also reliable (Critchfield, Davis, Gunn, Benjamin, 2008) and correlates well with retention as well as reduced symptoms and rehospitalization rates (Karpiak, Critchfield, Benjamin, 2011) among "difficult to treat" patients characterized as having high levels of personality disorder, chronic and severe problems, and prior failed treatment attempts. To illustrate the case formulation process, an IRT formulation is applied to the case of a 28-year-old female patient for whom a poor outcome was documented.

Objectives: This study aimed to determine the effectiveness of affective-reconstructive couple therapy in increasing the trust in close relationships and marital satisfaction of couples with remarriage and divorce experience. Methods: This is a single-case experimental study with a non-concurrent multiple baseline design. Three distressed couples were selected from among couples with remarriage and divorce experience referred to private and government counseling centers in Ahvaz, Iran, based on inclusion/exclusion criteria using purposive sampling method during September-December 2018, They participated at eight sessions of affective-reconstructive couple therapy, once a week each 90 minutes. They completed the Trust in Close Interpersonal Relationships Questionnaire and Marital Satisfaction Scale before and after treatment, and at the follow-up period. The data analysis was conducted by using visual analysis (graph drawing), reliable change index, recovery rate formula (increase rate), and normative comparison methods. Results: Affective-reconstructive couple therapy increased the trust in close relationships and marital satisfaction in couples after treatment and at the follow-up period. Conclusion: Affective-reconstructive couple therapy, due to special attention to the couples’ past relationships and increasing their insight into the causes of distress development in relationship can increase the trust in close relationships and marital satisfaction in remarried couples with divorce experience.

This article is a brief orientation to the current PCSP issue, which presents and compares two contrasting, interpersonal theories—Interpersonal Defense Theory and Interpersonal Reconstructive Therapy—for developing a case formulation and treatment plan for the case of "Sharon," a 28-year, unmarried social worker with no children. At the beginning of Sharon’s therapy, which was part of a randomized clinical trial (RCT), Sharon presented with comorbid anxiety and personality disorders. A major focus of her problems was being stuck between being simultaneously drawn to and repelled by "Jeff," her former finance. In reading this article series, a number of important themes to keep in mind are mentioned, including (a) comparing theoretical similarities and differences between the two theories; (b) the differences in the information selected by each theory from the large database of quantitative and qualitative clinical information in the database generated by the RCT; and (c) the enrichment of theory that occurs when it is applied to an individual case.

This paper sets the stage for subsequent papers in this set of articles, which collectively offer a comparative examination of two approaches to case formulation and treatment by examining the same case from the two theoretical perspectives. One approach is based on Interpersonal Defense Theory (e.g., Westerman, 2018, 2019), the other is Interpersonal Reconstructive Therapy (IRT, Benjamin, 2006, 2018). In this paper, we present the goals of the project and its design, which was novel in some respects. We also introduce the case by presenting basic clinical information about the patient, Sharon (pseudonym), and describing the short-term therapy approach that was employed. The concluding section introduces the subsequent papers in this set, which includes a commentary by Stanley Messer that raises fundamental methodological/philosophy of science issues about comparing the relative merits of different therapy approaches and a reply to that commentary that addresses the important questions it poses.

As part of this project comparing analyses of the case of Sharon based on Interpersonal Defense Theory (e.g., Westerman, 2018, 2019) and Interpersonal Reconstructive Therapy (e.g., Benjamin Critchfield, 2010), this paper considers the case from the vantage point of Interpersonal Defense Theory. The first half of the paper presents the theory’s novel approach to case formulation. It begins by explaining the kind of case formulations the Interpersonal Defense Theory calls for in general and then presents a formulation of Sharon’s case based on the theory, illustrating that formulation with an examination of a transcript of a session excerpt from her therapy. The second half of the paper discusses the theory’s implications for treatment, beginning with a presentation of its treatment implications in general and then turning to its specific implications for Sharon’s case. Overall, the paper shows that the theory sheds new light on how to understand Sharon’s problems, provides a possible explanation for why the treatment, which was based on Brief Adaptive Psychotherapy (Pollack, Flegenheimer, Kaufman, Sadow, 1992), resulted in a poor outcome, and suggests a different therapeutic approach that might have been more successful.

Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

(1) Background: This study aims to apply drama therapy to a counseling group to address the mental health problems of college students in Taiwan due to the increasingly serious psychological problems that have happened in recent times. Based on the healing factors in drama therapy, we applied such therapy activities to four counseling groups composed of 12 high-risk students from Taiwan. (2) Methods: “Questionnaire-based assessment, participant self-assessment and participant attitude assessment” methods were used to evaluate the six mental health indicators of the participants in the evaluation of drama therapy’s effect and the groups’ pre-test and post-test (the first group and the last group). The six indicators were self-awareness, self-expression, interpersonal and communication skills, self-cognitive reconstruction ability, social role ability, and decision-making ability. Data were collected and assessed for the frequencies and percentages of each indicator item. Sets of paired-samples t-tests, independent t-tests, and two-way repeated measures ANOVAs were employed to evaluate the different designs. (3) Results: The results revealed that drama therapy could deliver significantly positive effects for and improve the six mental health indicators of the participants. Males’ self-awareness and decision-making actions were more positively affected than females. (4) Conclusions: The study helps to provide a path of establishing the mental health module of drama therapy in the education sector in Taiwan.

In this article, I respond to the thoughtful commentaries and critiques offered by James Mahalik (2020), Ethan Hoffman and Michael Addis (2020), and Ginelle Wolfe and Ron Levant (2020) on my hybrid case study of "Tommy" (Dewey, 2020), a college freshman exhibiting symptoms of depression, alcohol use concerns, and inflexibly enacted traditional masculinity norms (IE-TMNs) during a time of difficult transitions and loss in his life. These commentaries have reaffirmed many of my beliefs about best practices for working with boys and men in therapy, while also expanding my knowledge of the psychology of men and masculinities (PMM) and introducing me to conceptual frameworks and therapeutic goals not directly explored in my original case study. Additionally, these three commentaries underscored areas of particular importance that I would like to discuss in further detail, including, (a) Hoffman and Addis’s differentiation between reconstructing and deconstructing masculinity as treatment aims when working with boys and men in therapy; (b) the benefits of employing Interpersonal Theory to better conceptualize presenting concerns related to traditional masculinity norms as highlighted by Mahalik; (c) constructive criticism from Wolfe and Levant and from Addis and Hoffman about the need for closer examination of social justice themes that arise when addressing masculinity in treatment; and (d) concerns about the generalizability of the case study raised by all three commentaries.

The pandemic caused by the COVID-19 virus has imposed changes to daily life in every social sphere. The ways in which we interact with each other have had to be reviewed, questioned, and readapted. The term “catastrophe” seems to be adequate to define this historical event, given the drastic, tragic changes experienced in every sphere of society, and particularly evident in daily events and interpersonal relationships. In defining the daily changes brought about by the quarantine situation as a catastrophic situation, we will focus on the shocks to be undergone by the structures of consciousness in their intention toward the world and, from a protentive possibility, their reconstruction after the crisis. For this analysis, the article has been split into five parts: definition of the concept of limit situation, as per Jaspers, with subsequent analysis of two limit situations experienced by individuals in quarantine; suspension of values and correlation between the temporal experience lived during this period and the concept of expectation, as per Minkowski; analysis of this experience, drawing on Blankenburg’s description of “loss of natural evidence”; possibilities of psychic reaction to this catastrophic event; and, finally, how phenomenological therapy can help individuals affected by this situation.

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. 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