Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology’s knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological. The author challenges these assumptions by reviewing evidence that resilience represents a distinct trajectory from the process of recovery, that resilience in the face of loss or potential trauma is more common than is often believed, and that there are multiple and sometimes unexpected pathways to resilience. M ost people are exposed to at least one violent or life-threatening situation during the course of their lives (Ozer, Best, Lipsey, & Weiss, 2003). As people progress through the life cycle, they are also increasingly confronted with the deaths of close friends and relatives. Not everyone copes with these potentially disturbing events in the same way. Some people experience acute distress from which they are unable to recover. Others suffer less intensely and for a much shorter period of time. Some people seem to recover quickly but then begin to experience unexpected health problems or difficulties concentrating or enjoying life the way they used to. However, large numbers of people manage to endure the temporary upheaval of loss or potentially traumatic events remarkably well, with no apparent disruption in their ability to function at work or in close relationships, and seem to move on to new challenges with apparent ease. This article is devoted to the latter group and to the question of resilience in the face of loss or potentially traumatic events. The importance of protective psychological factors in the prevention of illness is now well established (Taylor, Kemeny, Reed, Bower, & Gruenewald, 2000). Moreover, developmental psychologists have shown that resilience is common among children growing up in disadvantaged conditions (e.g., Masten, 2001). Unfortunately, because most of the psychological knowledge base regarding the ways adults cope with loss or potential trauma has been derived from individuals who have experienced significant psychological problems or sought treatment, theorists working in this area have often underestimated and misunderstood resilience, viewing it either as a pathological state or as something seen only in rare and exceptionally healthy individuals. In this article, I challenge this view by reviewing evidence that resilience in the face of loss or potential trauma represents a distinct trajectory from that of recovery, that resilience is more common than often believed, and that there are multiple and sometimes unexpected pathways to resilience.

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Loss, Trauma, and Human Resilience Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?

Comparing the Influence of Traumatic and Organizational Stressors on the Psychological Health of Police, Fire, and Ambulance Officers

Resilience, the ability to adapt to adversity and endure job demands, is growing in prominence in the management literature with limited regard to occupational influences. Often examined at the ind...

Resilience: A Review Using a Grounded Integrated Occupational Approach

This article describes the development and testing of the Social Work Self-Efficacy Scale, which assesses social workers’ confidence regarding a broad range of social work tasks. Pre-post data from two cohorts of social work students are presented showing significant positive change in MSW students’ self-efficacy, suggesting a new approach to outcomes assessment in social work education.

https://www.jstor.org/stable/info/23043650

Outcomes of Social Work Education: The Case for Social Work Self-Efficacy

Occupational injuries among emergency medical services personnel.

As the United States experiences substantial growth in its population that is 65 years and older, development of safe housing and compassionate care for seniors is becoming a priority domestic issue. Assisted living is one of the fastest growing types of senior housing in the nation, attracting residents with a perceived combination of security, personal care services, less restrictive homelike environments and emphasis on independence, privacy and personal dignity. As there is limited reference to assisted living in the social work literature, this article selectively reviews the broader literature on the aging U.S. population and their need, assisted living as a senior housing and care option, the characteristics of this approach and the potential for social work practice in this evolving arena.

The coming of age for assisted living care: new options for senior housing and social work practice.

Emotional, cognitive and behavioral stress can negatively affect the performance of fire, rescue and law enforcement personnel responding to emergency situations. Impaired professional performance in these crises not only endangers the incident victims, all involved responders and their families, but potentially the lives and property of entire communities. This article describes the major administrative and clinical leadership of a hospital-based Social Work department in implementing one of the few statewide critical incident stress debriefing teams for emergency service personnel in the United States. It represents a model for program development by other organizations.

Critical incident stress: the role of hospital-based social work in developing a statewide intervention system for first-responders delivering emergency services.

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

Future Trends in Health and Health Care: Implications for Social Work Practice in an Aging Society

Although occupational stress exists in all work situations, the intensity and emotional demands of the health care environment and patient care service delivery in often life-threatening situations place exceptionally high performance expectations and stress on health care providers. Stress associated with dramatic, emotionally overwhelming situations, known as "critical incidents," can overcome professionals' normal coping mechanisms, particularly following the injury or death of colleagues, loss of life after extraordinary and prolonged professional interventions, actual or potential threats to professionals' well-being, or emotionally charged crises such as sudden and pediatric deaths (Mitchell, 1982, 1983, 1986a; Mitchell & Bray, 1990). The effects of critical-incidents stress on health care professionals can pose potentially life-threatening hazards to patients, families, or other staff who rely on the competent delivery of timely, complex, and safe interventions (Graham, 1981; Neale, 1991; Patrick, 1981; Robinson, 1986; Spitzer & Neely, 1992). Symptomatology associated with excessive acute or sustained stress may include cognitive impairments such as diminished memory, decision-making capacity, and attention span; emotional reactions of increased anger, irritability, guilt, fear, paranoia, and depression; and physical problems ranging from fatigue, dizziness, migrane headaches, and high blood pressure to diabetes and cancer. Self-destructive and antisocial behavior may also be triggered (Everly, 1990; Mitchell, 1982, 1983, 1986a; Mitchell & Bray, 1990). Professional intervention that addresses occupational stress of hospital personnel becomes crucial to safeguard quality patient care; to maintain employee health; and to reduce organizational costs associated with malpractice litigation, employee turnover, and use of employee health care benefits because of work-related illnesses or injuries. Such concern has contributed to expanded use of employee assistance programs and other supportive interventions (Blair, 1985; Howard & Szczerbacki, 1988; Kunkler & Whittick, 1991; Matheson, 1990; McCue & Sachs, 1991; Mitchell & Bray, 1990). Hospital-based social work departments have offered employee counseling, stress management education, and team development training (National Society for Hospital Social Work Directors, 1987; Spitzer, 1985). Notwithstanding the important contribution of social work in responding to work-related stress among health care professionals, limited evidence suggests the use of critical-incident stress debriefings (CISDs) as an intervention option in health care settings. This article reviews the individual and institutional effects of critical-incident stress on health care delivery and use of stress education, "defusings," and "debriefings" as effective interventions with health care personnel. The successful efforts of a social work department using these techniques in a major university hospital system are presented as a model for replication in similar settings. CRITICAL STRESS INTERVENTION Substantial evidence exists that stress management programs can ameliorate psychological and behavioral factors that are adversely affected by excessive stress (Everly & Smith, 1987). During the past 15 years, the Mitchell model of CISD has proved to be an effective stress management intervention with emergency professionals (Mitchell, 1985, 1986a; Mitchell & Bray, 1990; Spitzer & Neely, 1992). Nearly 300 CISD teams exist in the United States, offering intervention to fire, paramedic, police, and other emergency first-responder personnel (American Critical Incident Stress Foundation, 1992). CISD teams of specially trained mental health and peer support professionals use defusings and debriefings to provide ventilation of feelings, emotional reassurance, education regarding stress awareness and reduction techniques, consultation, and referral assistance to distressed personnel (Mitchell, 1982, 1983, 1986a; Mitchell & Bray, 1990). …

A Critical-Incident Stress Debriefing Program for Hospital-Based Health Care Personnel

The Hospital Social Work Self-Efficacy Scale (HSWSE) was developed to assess social workers' confidence about their ability to perform hospital social work. The scale was originally tested with master's-level social work students. This partial replication and extension included both students and professional social workers. In addition, we used a new scale to assess construct validity and added another hospital to assess external validity. In general, findings continue to support the use of the HSWSE. In addition, anecdotal evidence suggests that this is an outcome measure that practitioners see as easy to use, specific, and highly relevant.

William J. Spitzer

Papers

The coming of age for assisted living care: new options for senior housing and social work practice.

Critical incident stress: the role of hospital-based social work in developing a statewide intervention system for first-responders delivering emergency services.

Future Trends in Health and Health Care: Implications for Social Work Practice in an Aging Society

A Critical-Incident Stress Debriefing Program for Hospital-Based Health Care Personnel

The Hospital Social Work Self-Efficacy Scale: A Partial Replication and Extension