Expressions of social support: a qualitative analysis of psychotherapy with clients who have experienced trauma

One commonly accepted protective factor, social support, is hypothesized to be both helpful and harmful following exposure to traumatic events (Bonanno, 2008; Ellis, Nixon, & Williamson, 2009; Lyons, 1991). Although at least 10 theoretical models have been proposed to explain the relationship between social support and post-traumatic responses, existing theories do not adequately capture the multidimensional experience of social support, which is comprised of several constructs and structures (e.g., received and perceived support; support functions and content). Moreover, existing social support theories have not been studied in research related to therapy with traumatized clients. The present study, therefore, examined how clients who experienced trauma expressed social support in psychotherapy. A qualitative content analysis was conducted using a directed coding system developed for this study that was based on the constructs and structures commonly discussed in psychology literature on post-traumatic experiences, namely: (a) received support, (b) perceived support, (c) extended support, (d) social support functions, and (e) social support contents. The current study observed that clients who have experienced trauma are likely to mention social support in sessions but that salient factors related to the benefits and harms associated with social support were discussed less. Although many expressions of social support fell into not otherwise specified categories because the quality or type of support experienced was not clearly stated, inductive analysis identified the following salient factors: support needs, relationship elements, planned future support activities, past perceived support, and past support that did not occur. The study also provided support for some existing models of social support and trauma (i.e., network orientation, stress-buffering, erosion, social-cognitive processing, and COR models). Clinical implications related to social support discussions in individual therapy include the need to examine and potentially change therapists\u27 views of social support. Psychotherapists are encouraged to explore the support relationships identified by clients, as well as the quality and types of support experienced and perceived, in order to understand the role and impact of social support and address the benefits and risks associated with support. Clinicians should also recommend that clients engage in adjunctive mutual aid and affiliative support groups