JOURNAL OF PSYCHOLOGY & THEOLOGY2012, Vol. 40, No. 4, 289-301

Copyright 2012 by Rosemead School of PsychologyBiola University, 0091-6471/410-730

Earthquake in Haiti: Relationshipwith the Sacred in Times of TraumaKari A. O'Grady, Deborah G. Rollison, Timothy S. Hanna, Heidi Schreiber-Pan, Manuel A. RuizLoyola University Maryland

The devastating earthquake in Haiti on January 12,2010 killed over 230,000 people and injured manymore. One year later, 1.2 million people were still livingin tents. Haiti is only one of many places around theglobe that have been struck by community-wide disas-ter in recent years, including the United States' owndevastating tornadoes in Joplin, Missouri and Tusca-loosa, Alabama. Although several studies have demon-strated strong links between spirituality and resilience,the field is only just beginning to break ground on therole of spirituality in large-scale disaster situations(Koenig, 2006).

In this article we briefly review the literature onspirituality and trauma, followed by a description ofthe current study within a relational framework. Thestudy aimed to investigate the impact of the Haitianpeoples relationship with the divine on their psycho-spiritual transformation following the earthquake. Re-sults are considered from a cross-cultural perspective.

Growth Following TraumaA growing body of research suggests that many trau-

matic life events, including natural disasters, precipi-tate positive psychological changes, such as a broad-ened view of life, an increased sense of meaning andpurpose for existence, and an increase in spirituality(Sigmund, 2003). Posttraumatic growth occurs whenindividuals are faced with a traumatic event such as anatural disaster, and consequently positive psychologi-cal effects take place (Tedeschi & Calhoun, 1996). Al-though traumatic life events may produce precarioushealth outcomes for some individuals and devastatingconsequences for communities, research indicates thatposttraumatic growth is possible when appropriate fac-tors are in place (Richards, Smith, Berrett, O'Grady, &Bartz, 2009; Tedeschi & Calhoun, 2004).

The extent to which trauma develops into posttrau-

matic growth or decline is in part mediated by themeaning an individual assigns to the stressful life event(Gole, Hopkins, Tisak, Steel, & Carr, 2008; Feder etal., 2008). According to cognitive adaption theory,positive reinterpretation of a traumatic event serves anadaptive role for experiencing stress-related growth(Karanci & Frkam, 2007; Taylor, Collins, Skokan, &:Aspinwall,1989). When individuals are able to createpositive meaning out of tragedy, they are often able toactivate critical recovery attributes such as a sense ofself-efficacy and a sense of purpose in life.

The study of posttraumatic growth is not only theconsideration of factors that contribute to growth fol-lowing trauma, but it is also the examination of the na-ture of growth outcomes. Previous research has, for in-stance, reported positive correlations between theexperience of trauma and improved social relation-ships, positive changes in beliefs, renewed faith, cohe-siveness in the community, identification of new possi-bilities, newfound talents and strengths, changes inself-image, and transformed comprehension of way oflife (Affleck & Tennen, 1996; Linley c Joseph, 2004;Tedeschi & Calhoun, 1996, 2004). Many individualswho have felt "stuck" in their lives or who have beenunwilling to make important life transitions feel an in-creased desire and strength to do so following a trau-matic life event. From this understanding, communitydisaster may be the impetus towards a psychologicallyhealthier and more satisfying lifestyle for some people.

Trauma impacts most people, not only physically,socially, and psychologically, but also spiritually. Forthose who are engaged in a spiritual life, trauma thatthreatens this aspect of their experience can generate agreat deal of internal distress. "When issues of the soulmay be at stake," many are driven to reconsider their be-lief systems including their views about God or ahigher power (Pargament, Murray-Swank, Magyar, &

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Ano, 2005, p. 247). As individuals reevaluate their be-liefs and values, they are likely to undergo a form ofspiritual transformation. Spiritual transformation canprompt other important life transitions, such as over-coming or assuming addictions, relationship adjust-ments, altered value systems, changes in vocation, anddisruption in typical coping patterns (O'Grady &Bartz, 2011). As spirituality has been shown to havestrong associations with trauma recovery and overallpsychological well-being, the evaluation of both psy-chological and spiritual transformation of trauma vic-tims have important clinical implications (Cole et al.,2008).

Spirituality and TraumaTraumatic events often provoke individuals to re-

examine and incorporate post-trauma meaning intotheir lives. For many individuals, their spirituality orfaith is central to their meaning-making process; this isexpanded when individuals and communities drawupon religious and spiritual practices to help themcope with trauma. Studies have evidenced strong asso-ciations between religious coping, religious practices,religious and spiritual beliefs, spiritual and religiousmeaning making, and resilience (Sigmund, 2003).There seems to be a unique and powerful potentialitywithin the spiritual faith and expression of many indi-viduals who have encountered trauma. Walsh (1999)proposed that the resilient feature within people's spir-ituality is that:

Faith supports the belief that we can overcome adversity.This involves more than simply being religious; studiessuggest that what matters most is being able to give mean-ing to a precarious situation, having faith that there issome greater purpose or force at work, and finding solaceand strength in these oudooks." (p. 38)

Studies do indicate that those who are spiritually in-volved and practice their faith reveal higher levels ofposttraumatic growth than those who are not. In addi-tion, research has found that a strong personal identifi-cation with their faith aids individuals in achievingposttraumatic growth (Cadell, Regehr, & Hemsworth,2003; Kira et al., 2006; Laufer & Soloman, 2006; Shaw,Joseph, & Linley, 2005). Furthermore, studies haveshown that intrinsic religiosity is associated with an in-crease in posttraumatic growth a few months subse-quent to the trauma (Schaefer, Blazer, & Koenig,2008).

There are limited findings about the relationshipbetween spirituality and large-scale community disas-

ters, however, a U.S. survey conducted following 9/11found that relying upon prayer or religious or spiritualfeelings was the second most common way of coping(90%), second only to talking with others (98%; Schus-ter et al., 2001). Perhaps people turn to prayer and spir-itual feelings because spirituality provides a mean-ing system that offers a sense of coherence within thechaos of disaster (Peres, Moreira-Almeida, Nasello, &Koenig, 2007).

Relationship with God and TraumaAten et al. (2008) conducted a qualitative study

that explored God images of survivors of HurricaneKatrina. Among a number of themes, many partici-pants reported that they felt God's presence through-out the disaster, and they also reported feeling thatGod was distant at various times throughout the event.Likewise, Lawson (2010) conducted in-depth inter-views with older African American hurricane sur-vivors. Without exception, all participants reportedthat their faith had helped them cope with the event,and many stated that reliance upon a higher power wasessential for their coping during and following the hur-ricane. Survivors stated that ongoing conversation witha higher power was paramount in their ability to copewith the hurricane and its aftermath. Male survivorswere more prone to attending church, testifying andwitnessing, and thought-blocking. Female survivors,on the other hand, relied more on personal, family, andcommunity resources; moaning and crying; cognitivereframing; and construing positive meaning, the latterof which has been explained as helping by means of "itsre-interpretation of adverse conditions to create an op-timistic world view based on human justice" (Lawson,2010, p. 465).

In a related vein, Bhui, King, Dein, and O'Connor(2008) interviewed 116 individuals from six ethnicgroups in a study exploring ethnicity and religious cop-ing with mental distress. Results indicated that reli-gious coping was most commonly practiced amongBangladeshi Muslims and African Caribbean Chris-tians. Along with other forms of religious coping, par-ticipants reported that talking to God, having a rela-tionship with God, and trusting in God were helpful incoping and generating positive emotional states. Partic-ipants also indicated a sense of acceptance in their ex-periences with trauma because they presumed thatGod was accepting of the event. Additionally, thosewho described a conversational style in their relation-ship with God experienced a greater sense of personalchoice and responsibility. Authors of this study pro-posed that conversing with God or a higher power

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might constitute a form of psychotherapy that fostersresilience in times of distress.

Perceiving that God cares, along with the use ofother religious coping strategies, has been found topredict spiritual transcendence and spiritual transfor-mation for those dealing with stressful life events(Greenway, Phelen, Turnbull, & Milne, 2007). Simi-larly, connection with God and perceiving God asbenevolent were associated with positive appraisals ofterminal illness (Gall, 2000). Siegel and Schrimshaw(2002) reported findings of a study of perceived bene-fits of religious and spiritual coping among older adultsliving with HIV/AIDS. Results indicated that partici-pants experienced a greater sense of vicarious controlthrough their personal relationship with God thathelped them cope with the stress associated with theirillness. Participants also reported alleviation in theirfeelings of despair from the belief that they could leanon God and work with God to solve their problems.Additionally, participants reported feeling strength-ened by allowing God to handle the unresolvable prob-lems of a chronic illness.

Although not all of these studies address commu-nity disaster, they do converge on the importance thata relationship with God may have on those strugglingwith traumatic life events. Relationship with Godseems to mediate important coping strategies that leadto posttraumatic growth and spiritual transformation.

We recognize that many people experience endur-ing negative symptoms as a result of trauma, such asposttraumatic stress symptoms and other serious de-clines in health. The respectable body of researchdemonstrating the potential deleterious effects oftrauma for individuals and communities has advancedour clinical acumen in treating those who have enduredsuch experiences. Likewise, many who have encoun-tered traumatic life events have experienced spiritualand religious crises that are not easily resolved. Somelose their faith in a God who could allow such experi-ences to happen to them or to those they love. From astrengths-based perspective, we hope that investigatingfactors that may contribute to psycho-spiritual growthfollowing traumatic events will lead to greater insightsabout how to lessen some of the harmful effects oftrauma and encourage genuine transformations (Rob-erts, 2005).

The Current StudyThe purpose of this study was to explore the role of

spirituality in the lives of earthquake survivors in Haiti.More specifically we were interested in learning abouthow people's interaction or involvement with the tran-

scendent influenced their ability to experience psycho-logical and spiritual growth following the earthquake.

Posttraumatic Growth and Spiritual TransformationPosttraumatic growth research indicates that

trauma does not necessarily lead to deleterious out-comes alone, but that for many individuals traumaactivates a desire for growth and change (Karanci &Erkam, 2007). For some, the crisis of trauma thruststhem into a state of disequilibrium in which their pre-vious ways of understanding and coping in the worldare no longer sufficient, thus facilitating a process of re-evaluation and re-emergence (Greene, Lee, Trask, ScRheinscheid, 2005; Sigmund, 2003). Likewise, re-search has indicated that when individuals encountertraumatic life events, the spiritual aspects of these indi-viduals' worldviews may become threatened, triggeringa spiritual struggle in which the individuals are thrustinto a position of either conserving or transformingtheir spirituality (Pargament, Murray-Swank, et al.,2005; Pargament, Magyar, Benore, & Mahoney, 2005).Mental health and spirituality are intertwined suchthat a transformation in one's spirituality necessarilytransforms many aspects of one's psychological well-being and vice versa. Research has found that althoughspiritual transformation and posttraumatic growth arediffering constructs, they have strong associations withone another (Sigmund, 2003). Therefore, it can be as-sumed that trauma has the potential to transform peo-ple's spirituality in health-promoting ways. Testing thisassumption has important clinical applications forboth counselors and clergy members who may becalled upon to assume the role of counselor when ac-cess to mental health professionals is limited. Thus, wewere interested in investigating the relationship of anumber of psycho-spiritual variables with both post-traumatic growth and spiritual transformation. Post-traumatic growth is not easily detected immediatelyfollowing a traumatic event; in fact, some longitudinalresearch suggests a timeframe of six months or moreneeds to pass after a loss before meaning-making andpotential benefit-finding can occur (Davis, Nolen-Hoeksema, & Larson, 1998; Park, Cohen, & Murch,1996). Therefore, we opted to conduct our study sixmonths following the earthquake, assuming this timeframe allowed adequate time for individuals to demon-strate posttraumatic growth or decline.

Relational Perspective of Spirituality. The aims ofthe study were to explore the relationship of individu-als' daily interaction with the transcendent and theirpropensity towards psycho-spiritual transformation

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following a large-scale disaster. There have been somestudies that have investigated the relationship betweenposttraumatic growth and religious and spiritual cop-ing, religious virtues, religious social support, religiousbeliefs, and meaning making (Shaw, Joseph, & Linley,2005). However, we were interested in exploring post-traumatic growth and spiritual transformation from arelational perspective. To gain understanding about theimpact of people's relationship with the sacred in timesof trauma, we chose measures that tapped into experi-ences with the transcendent rather than assessment ofspiritual beliefs and behaviors. We selected a scale thatmeasured individuals' substantive thoughts and feel-ings about their perceived interaction with a higherpower in everyday life {Daily Spiritual ExperiencesScale; Underwood & Teresi, 2002). As the majority ofHaitians are theistic (Roman Catholic 80%, Protestant16%, none 1%, other 3%; CIA: The World Factbook,2010), we determined that considering spirituality interms of individual's relationship with "God" was ap-propriate for our population and consistent with theaims of the study.

Subsequently, we wondered if the nature and degreeof individuals' perceived relationship with God wouldaffect whether or not they experienced growth and/orspiritual transformation following disaster trauma.Along with a measure that assessed individuals' per-ceived relationship with transcendence more generally,we also chose a scale that measures individuals' rela-tionship with God specifically {Spiritual Assessment In-ventory; Hall & Edwards, 1996, 2002). We hypothe-sized that those who perceived positive involvementand interaction in their relationship with God wouldexperience psychological growth and spiritual transfor-mation despite the nature and severity of their losses.

Finally, analysis of the Spiritual TransformationScale demonstrated that spiritual transformation andposttraumatic growth were distinct constructs, withsome correlation with one another (Underwood &Teresi, 2002). We were interested in investigating boththe relationship of spiritual transformation with post-traumatic growth as well as considering spiritual trans-formation and posttraumatic growth as distincdy sepa-rate outcome variables. We were also interested inexploring if our sample had encountered specific reli-gious and spiritual experiences during the earthquake,so we included such questions in our design.

Methods

ParticipantsThe participants were adult male and female

Haitians {N = 108) who were living in Haiti at the

time of the earthquake on January 12, 2010. The sam-ple consisted of 64 females and 44 males, with agesranging between 15 and 73, and a mean age of 30.2years. Participants were recruited from Port-au-Prince,Jacmel, and Pitionville, Haiti. All locations surveyedwere impacted by the earthquake. All participants ex-perienced some degree of loss (e.g., loss of family mem-bers, health, job, home, school, vocation, etc.).

ProceduresParticipants were solicited six months after the

earthquake from local church communities, a second-ary school, and a tent communitylocations whereparticipants were receiving assistance to cope with theeffects of the earthquake in their lives. Materials werecompleted in groups of 10-20 volunteers, with a fewexceptions in which volunteers completed the surveypackets individually. As quantitative questionnaire for-mats are mainly a Western-European concept mostparticipants were unfamiliar with a Likert-type scaleformat of sharing their experiences. Prior to filling outthe survey packets, participants were given a brief de-scription of the quantitative survey process, includinginstruction about the process of responding to Likert-type scale questions.

MeasuresFive individual surveys were presented to the partic-

ipant. The first measure. The Daily Spiritual ExperienceScale (DSES; Underwood & Teresi, 2002), is a 16-item, 6-point Likert scale that was designed to measureeveryday, ordinary spiritual experience rather than par-ticular beliefs or behaviors. Some sample items include:"I feel guided by God in the midst of daily activities." "Iexperience a connection to all life." "I feel God's lovefor me, through others."

The Spiritual Assessment Inventory (SAI; Hall &Edwards, 1996,2002) is a relationally based, 54-item, 5-point Likert scale. The SAI is designed to assess two di-mensions of spiritual development: Awareness of Godand Quality of Relationship with God. The measureconsists of five subscales: Awareness (e.g., "I am aware ofGod attending to me in times of need"). Disappoint-ment (e.g., "I feel betrayed by God"), Grandiosity (e.g.,"I seem to be more gifted than most people in discern-ing God's will"). Realistic Acceptance (e.g., "When[God disappoints me] I still have the sense that God willalways be with me"), and Instability (e.g., "My emo-tional connection with God is unstable").

The Inventory Loss scale has three items that assessinjury to self and/or family members, damage to hous-ing, and degree of threat. Additionally, two open-ended items were included in the Inventory Loss por-

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tion of the survey packet: "Please describe your losses,"and "Please describe how the disaster has affected yourspirituality"

The Posttraumatic Growth Inventory Short Form(PTGI-SF; Tedeschi Sc Calhoun, 1996), is a 10-item,6-point psychological assessment Likert scale. ThePTGI is designed to measure positive outcomes re-ported by people who have experienced traumatic lifeevents. Items include questions such as: "I am morelikely to change things that need changing." "I discov-ered that I'm stronger than I thought I was."

The Spiritual Transformation Scale (STS; Cole, etal., 2008) is a 32-item, 6-point Likert scale of spiritualgrowth and transformation. This scale assesses individ-uals' perception of their spiritual movement over time(e.g., "Spirituality has become more important to me.""I more often have a sense of gratitude." "I am morespiritually wounded.").

Eight individual items that assessed spiritual and re-ligious resources and experience were included in thedemographic portion of the survey packet. They werepreceded by a statement of informed consent, and ques-tions about the participants' demographic information.The survey packets, originally in English, were trans-lated into French by a local Haitian fluent in Englishand trained as a translator. The surveys were then re-viewed for accuracy by a French-speaking, U.S. citizen.

Results

Correlates of Spiritual Variables andPosttraumatic Growth

A bivariate correlational analysis was conducted toexplore zero-order correlations among the variables of

interest in our five surveys (DSES, PTGI-SF, STS, fivesubscales of the SAI, and the three Inventory Lossquestions). As illustrated in Table 1, significant cor-relations were found between the total scores forDaily Spiritual Experiences (DSE) and PosttraumaticGrowth (PTGI) {r=.35,p < .001); SAI awareness (r =.32,; < .01); SAI realistic {r = .28,/> < .01); and STS{r = .32,/) < .01). In addition, PTGI was significantlycorrelated with SAI awareness (r = .38, p < .001) andSTS (r = .42, p < .001). Significant correlations werealso indicated between STS and SAI awareness (r =.40,; < .001); and SAI grandiosity (r = .24, ;> > .05).Inventory Loss Total correlated significantly only withone variable, SAI disappointment (r = .26,p < .01). Insummary, high scores in positive and realistic percep-tions and expectations of God's awareness of and in-volvement in their lives correlated positively with post-traumatic growth and spiritual transformation, as did asense of "being special or better than." Those withgreater amounts of loss also had a greater sense of disap-pointment in their relationship with God, and as ex-pected, there was a positive relationship between post-traumatic growth and spiritual transformation.

Gender Differences in Spiritual VariablesOne-way analyses of variance (ANOVAs) were con-

ducted to explore the effects of gender and marital sta-tus. Analyses showed a significant effect for gender onDSE,i'(l, 101) = 5.23,p < .05 [p = .024]; also for STS,/(1,101) = 9.66, p < .01 [p = .002]. No significant re-sults for the effect of marital status for any of the vari-ables emerged. Post hoc analyses using Tukey's post hoccriterion for significance indicated that women scoredsignificantly higher on DSE {M = 68.83, SD = 11.75)

TABLE 1Intercorrelations Between Resource Loss and Religious Variables Related to Posttraumatic Growth (PTG) in HaitianEarthquake Survivors

Measures

1. DSEtotal2. PTGItotal3. SAIawareness4. SAIdisappointment5. SAIgrandiosity6. SAIrealistic7. SAIinstability8. STStotal9. ResourceLossTotal.

Note. N = 108.'p < .05, two-tailed, "p < .01

1 2

1.00 . 35" 1.00

(two-tailed), '"p < .001), adjusted ^ = .109;Step 3: ^ R'^ = .073 (/>< .01), adjusted R2 = .175; Step 4: AR^ = .010 (p = ns), adjusted R^ = .178; Step5: A^ = .020 ip = ns), adjusted R^ = .191; Step 6; A^ = .013 (? = ns), adjusted R' = .197; Step 7: hR^= .004 (p = ns), adjusted R^ = .193. ResourceTotalLoss = sum of Earthquake damage to home + senseof life in danger + injuries to self and/or others; DSEtotal = Daily Spiritual Experiences Scale totalscore; and SAIawareness, SAIdisappointment, SAIgrandiosity, SAIrealistic, and SAIinstability = fivesubscale totals of the Spritual Assessment Inventory (SAI), 'p < .05, two-tailed test, "p < .01, two-tailed test, ' "p < .001, two-tailed test.

Strongly agreed that they have felt God's inspiration more, much energy has been invested in security effortsduring or following the earthquake. since the "rule of law" in Haiti is particularly weak. The

results of our study do not in any way negate the lossDiscussion and suffering, but rather help us understand how some

The 2010 earthquake in Haiti left an unprece- of the people in Haiti were able to rise above thedented amount of destruction in its wake. Two years af- tragedies and experience posttraumatic growth andter the devastating earthquake, people are still in need positive spiritual transformation. The majority of par-of basic necessities such as water, food, and security. ticipants reported that their faith in a higher power in-The hardship of recovery and reconstruction was in- creased following the trauma and that they felt a re-tensified by a persisting cholera epidemic. Further- newed interest in practicing their religion. It was also of

O'GRAOY, ROLLISON, HANNA, SCHREIBER-PAN, and RUIZ 297

interest that the vast majority of participants reportedthat they felt God had inspired them during and fol-lowing the trauma. This is illustrated by a response toan open-ended question in the survey packet: How hasthe earthquake affected your spirituality^ The partici-pant replied by stating, "The earthquake has not af-fected my spirituality; on the contrary, it has rein-forced it. If not for the strong hand and power of God,my son would be dead. My faith increases over time."

Women scored higher on a measure of individuals'substantive thoughts and feelings about their perceivedinteraction with a higher power in everyday life and onoverall spiritual transformation than did their malecounterparts. We did not find significant gender differ-ences in posttraumatic growth, suggesting that bothgenders experienced equal levels of posttraumaticgrowth, but that women tended to grow more spiritu-ally following the trauma. The finding that womentended to experience a greater degree of positive spiri-tual transformation is not surprising given that womentend to score higher on measures of spirituality in gen-eral and endorse more personal experiences with ahigher power (i.e., Skarupski, Fitchett, Evans, & deLeon, C. 2010).

We also found that Spiritual Transformation andPosttraumatic Growth themselves are positively corre-lated, suggesting the key role that spirituality mightplay in transforming a traumatic event from a mo-ment of destructiveness to a moment of challenge andnew perspective. Additionally, people's perceptions ofGod's ongoing involvement in their lives, their view thatGod is aware of and responsive to them, and their senseof "specialness" to God significantly contributed totheir psychological growth and spiritual transforma-tion. This finding suggests that those who feel God isnear them and considers them to be special were able todraw upon these beliefs to propel them through theiradversity in growth-promoting ways. Less surprising,people's perception of God's awareness of them andGod's involvement in their lives contributed towardstheir spiritual transformation following the trauma. It islikely that participants found comfort and a sense of di-rection from a connection with spiritual transcendenceand specifically in a relationship with God (O'Grady &Richards, 2007).

Additionally, since posttraumatic growth includesthe process of meaning-making following traumaticevents, individuals who consider their spirituality asimportant may gain significant support from their spir-itual beliefs. Spirituality is frequently employed to helpmake sense of or to instill meaning in people's suffering.Posttraumatic growth is a process of regaining meaning

following a distressing ordeal ; therefore, for individualswho view spirituality as a central meaning-makingcomponent, a relationship with God may present achannel through which meaning reconstruction cantake place.

In light of the trauma experienced by these Haitianparticipants in the aftermath of the earthquake, we seethat not all people experience positive transformationfollowing disaster. Not surprisingly, those who sufferedgreater amounts of loss reported a greater sense of dis-appointment, frustration, and betrayal in their rela-tionship with God; however, these feelings did notseem to significantly impact their overall psychologicaland spiritual transformation. Some participants in ourstudy indicated that they felt more distant from Godand less spiritual following the trauma of the earth-quake. For instance, one participant stated, "After thedisaster I felt a little hopeless and alone. Traumatizedalso." However, the overall findings of growth, ratherthan decline, found in this population are worth con-sideration; other study populations have not producedsuch optimistic findings (Connor, Davidson, & Li-Ching, 2003; Deal et al., 2012). In interpreting thesefindings it is important to consider the infiuence ofcommunity trauma and recovery in comparison tomore individual or isolated experiences of trauma. Col-lective suffering and recovery may serve as a protectivefactor against trauma events. Likewise, cultural factorsinvolved with the study populations may significantlyinfluence the outcome of traumatic events in the livesof survivors.

Cultural ConsiderationsTo avoid transposing meaning onto the findings of

a population, researchers should be sensitive to cul-tural interpretations that may differ from their own.For instance, our findings about the relationship be-tween posttraumatic growth and grandiosity mayseem surprising initially and deserve further consider-ation. The SAI subscale of Grandiosity is intended tobe a measure of pathology, and diagnostically, the fieldof mental health generally tends to view such narcissis-tic patterns in a negative light. However, some theoret-ical perspectives are inclined to distinguish betweenhealthy and unhealthy narcissism, with the formerserving to bolster the sense of personal identity and toprotect the self against perceived threats (Camassa &Negri, 2009; Knox, 2003).

In light of Haiti's complex history of slavery, op-pression, and revolution, this theme of grandiositymay be reflecting just that. The Haitian people haveexperienced "a 'disavowed' modernity . . . of negation.

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repression, disidentification, and denial" (Drexler,2008, p. 454). At the risk of over-simplifying an intri-cate cultural phenomenon, this finding may be in part aresult of the Haitian people, over time, developing psy-chic defenses to protect themselves against the perpet-ual barrage of personal exclusion by their oppressors.Given the key role that their spiritual and religious ori-entations play in the Haitian people's daily lives (Daut& Richman, 2008; Desmangles, 1979; Richman,2007), it is not surprising that a protective mechanismsuch as spiritual grandiosity would emerge as a signifi-cant mitigating factor of traumatic stress. Moreover,some of the spiritual practices of the Haitian culturefurther lend themselves to an individual's sense of "spe-cial access" to God, thereby buttressing any Westernmeasures of this perceived grandiosity (Johnson,2006). Participants also seemed to garner feelings of"specialness" from being a survivor, as illustrated in thefollowing participant quote.

All that has happened to me has affected my spirituality. Ibelieve that the earth is desperate, and I realize that mylife was not destroyed because I need to finish certaintasks that God has asked me to do.

This sense of grandiosity may help alleviate tendenciestowards survivor's guilt and promote a sense of purposefor one's future.

Participants in our study were African Caribbean,similar to those in the Bhui et al. (2008) study reportedabove. It is interesting to note the consistencies in thefindings about relationship with God and religiouscoping between the two studies. The current study andthe Bhui et al. (2008) study both found that the per-ception of an involved and trusting relationship withGod promoted healthy coping in times of trauma. Theemergence of grandiosity in our study demonstratesthe need to consider study findings in a culturally sensi-tive way, including the importance of fostering an on-going curiosity about the links between cultural pecu-liarities and unique study findings. The similarity inour findings to those of other African Caribbean cul-tures informs the interpretation of the findings and theconsideration of future research directions, and re-minds those researchers studying in the fields of psy-chology and spirituality of the need to gather datafrom diverse populations.

Suggestions for Future StudiesThis brief examination of some of the cultural dy-

namics of the Haitian population reveals the impor-tance of further demographic exploration. In both the

collection and analyses of our data we are aware of pos-sible cultural limitations to our study. The question-naires, although translated into French, are likely tocontain foreign cultural concepts or unfamiliar percep-tions. The Haitian people's very perceptions of "faith"and "spirituality" are undoubtedly nuanced and partic-ular to a culture that may not have the same distinc-tions common in our Western presumptions.

As just one example, we were aware that "roughlyhalf of the [Haitian] population practices voodoo,"most alongside their professed and predominantlyChristian faith (CIA: The World Factbook, 2010). Wechose not to assess the role of voodoo in individual's ex-periences with the earthquake, because many Haitiansfind questions posed by Western researchers abouttheir voodoo practices to be offensive, and as noted,most Haitians who do adhere to voodoo beliefs andpractices also adhere to monotheistic belief systems aswell. Despite the lack of demographic informationabout adherence to this practice for the study popula-tion, it is possible a heritage of voodoo practices influ-enced the way participants responded to the surveyquestions. This possibility could still be consideredwhen attempting to interpret results, if done so in anon-stereotypical and culturally sensitive manner (Pot-ter, 2009).

Future studies hold the potential to explore moreexplicitly these cultural differences, as well as follow upin a longitudinal fashion the dynamic progression ofthe population's posttraumatic growth. Additionally,our study had a small sample size, although comparableto similar studies of disaster populations. We hope ourfindings will be tested in other disaster populationswith larger sample sizes. For instance, replicating thisstudy with survivors of the tornadoes in the U.S. andthe earthquake and tsunami of Japan could provide op-portunities for cross-cultural comparisons. Futurestudies might also include the investigation of the rela-tionships between spirituality and PTSD in commu-nity disaster populations six to eighteen months fol-lowing the disaster.

Further, we believe that quantitative measures havethe potential to impose a framework of meaning that isinconsistent with the cultural background of those un-der investigation. Therefore, qualitative investigationmay be more appropriate for the study of posttrau-matic growth and spiritual transformation in popula-tions unfamiliar with the Western scientific traditionof reporting experiences in a numerical manner, and foraccessing some of the rich data that are not as obtain-able through quantitative approaches. We recommendthat future research be conducted on community

O'GRADY, ROLLISON, HANNA, SCHREIBER-PAN, and RUIZ 299

trauma survivors through culturally sensitive qualita-tive approaches.

Implications for Research and PracticeThe findings from this study support previous re-

search that suggests that trauma can be an impetus forspiritual growth and renewal, and that some peopleperceive and value God's involvement during times oftrauma. Study findings also support our hypothesisthat individuals who perceived positive involvementand interaction in their relationship with God wouldexperience growth and spiritual transformation despitethe nature and severity of their losses.

This study also has important clinical implications.We encourage counselors and psychotherapists to ex-plore clients' relationships with God and the impact ofthis relationship on their tratuna recovery and spiritualtransformation. Based on our study, clients who believethat God is mindful of them and interacts with them inpositive and consistent ways may be more equipped tohandle traumatic life events in psychologically healthyways than those who experience God as more distant.When working with theistic clients, counselors andpsychotherapists should invite clients to discuss theirfeelings and perceptions about God's interaction inclients' lives during past trauma events. If clients ex-press disappointment in God, or distance from Godduring the trauma, psychotherapists may wish to ex-plore these experiences more thoroughly, and when ap-propriate, discuss possible ways to reframe those expe-riences, or to make meaning from those experiencesthat foster more complex and potentially positive per-ceptions of the role of God during difflcult times. Ourstudy findings also support the need for a contextualunderstanding of the spiritual language of the client.Psychotherapists and counselors should be careful notto assume that their understanding of spiritual termsand concepts is the same as their clients, but rather in-vite clients to explicitly define and describe spiritualconstructs from their own cultural perspective.

The broader implications of this study may advancemental health assistance, with attention to spiritualityas a necessary element of relief efforts. These findingsmay also prove helpful in formulating a culturally sensi-tive and collaborative model for training clergy as men-tal health "helpers" in populations where mental healthprofessionals are limited or unavailable.

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Tedeschi, R. G., & Calhoun, L. G. (2004). Postttaumatic gtowdi:Conceptual foundations and empitical evidence. Psychological In-quiry, 15(1), 1-18.Tedeschi, R.G., & Calhoun, L.G. (1996). The Postttaumatic GtowthInventoty; Measuting the positive legacy of ttauma./oaraAuthor InformationO'GRADY, KARI A. PhD. Address: Pastotal Counseling Depatt-ment, 8890 McGaw Road Suite 380N, Columbia, MD 21045.Email: kaogtady@loyola.edu. Title: Assistant Ptofessot, PastoralCounseling Department. Degrees: BS, Btigham Young Univetsity;PhD (Counseling Psychology) Btigham Young Univetsity. Special-izations: integration of spirituality & psychology and counseling/psychothetapy.

O'GRADY, ROLLISON, HANNA, SCHREIBER-PAN, and RUIZ 301

ROLLISON, DEBORAH G. PhD. Address: 1232 WindmUl Ln,Silver Spring, MD 20905 [or use Loyola Address: Pastoral Counsel-ing Department, Loyola University Maryland, 8890 McGaw Rd.,Suite 380, Columbia, MD 21045]. Title: Affiliate Faculty Member,Loyola University Maryland; Pastoral Counselor, Ft. Meade FamilyLife Center and Safe Harbor Christian Counseling. Degrees: PhD,MS (Pastoral Counseling) Loyola University, MD; MA (Manage-ment & Supervision) Central Michigan University; BA, CatholicUniversity of America. Specializations: Applied gratitude, includingas a potential buffer for stress; grief, loss, & bereavement; career tran-sition and counseling; issues of faith & meaning in times of trauma.

HANNA, TIMOTHY S. Email: tshanna@loyola.edu. Title: PhDCandidatePastoral Counseling, Loyola University Maryland. De-

grees: MS (Pastoral CounseUng) Loyola University Maryland; MTS(Theology) Weston Jesuit School of Theology; BA (Psychology)University of South Florida; BS (Microbiology) University ofFlorida. Specializations: none at this time.

SCHREIBER-PAN, HEIDI. Email: hschreiberpan@students.loyola.edu

RUIZ, MANUEL A. Address: 8715 1st. Ave., #429C. Silver Spring,MD 20910-3534. Email: mar@javeriana.edu.co. Title: CounselingProgram Coordinator at the Family Crisis Centet of Prince George'sCounty. Degrees: MA (Pastoral Counseling) Loyola UniversityChicago;BS (Psychology) Pontificia Universidad Javeriana, Bogota,Colombia. Specializations: intimate partner violence (IPV).

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