Project: Flow to Flourish
This was my final paper for the research methods class in Fall 2023. This is a proposal only. I did not conduct the research (as I did in the undergraduate senior project on dreaming).
Flow to Flourish: Optimal Wellbeing in Late Adulthood Women with Trauma History by Libra Kaplan, Expressive Arts Therapy program, CIIS, December 4, 2023.
Flow to Flourish: Optimal Wellbeing in Late Adulthood Women with Trauma History. 3
The Expressive Arts and Late Adulthood Women. 7
Flow to Flourish: Optimal Wellbeing in Late Adulthood Women with Trauma History
Our world is not okay. There is a growing deficit in our collective wellbeing (Dahl et al., 2020; Maté & Maté, 2022). The National Council for Mental Wellbeing (2022) reports that approximately 70% of Americans, or 223.4 million (para. 2), have experienced at least one kind of trauma in their lives. Nearly 64% (para. 4) of U.S. adults have had one adverse childhood experience (ACE), and 17% (para. 4)report four or more; with multiple ACEs occurring more often in women (Swedo et al., 2023). When trauma is a uniting cultural factor, our lens of normal becomes cracked, and we ourselves cannot help but become fractured (Maté & Maté, 2022). The foundational CDC-Kaiser ACE study (Felitti et al., 1998) was published over twenty-five years ago. While it has inspired the current trend of trauma-informed care, ACE awareness is still considered recent knowledge and continues to be integrated into the wider medical fields (Maté & Maté, 2022).
Consequently, late adulthood women who experienced complex childhood trauma may be less likely to understand their experience from a psychological and biological perspective (Kaiser et al., 2022). And yet, some of these women have found unique and creative tools allowing them to heal and flourish. How have they done this, and what does flourishing look like for them? This research will explore the single case study of a 70-year-old woman—my mother—with a history of complex trauma and addiction and her experience of flourishing. This arts-based research will incorporate her art, music, and other creative endeavors as data.
Unpacking the Literature
In this section I introduce the subjects of flourishing and flow, trauma and recovery, and the expressive arts and late adulthood women. Consistent with the current literature, wellbeing and flourishing will be used interchangeably throughout this paper (Dahl et al., 2020; Seligman, 2010). First, we begin with flourishing.
Flourishing and Flow
Flourishing can be understood “as a state in which an individual feels positive emotion toward life and is functioning well psychologically and socially” (Keyes, 2003, p. 294). To flourish is to be in a state of optimal wellbeing where one is not simply surviving but thriving, and able to deal with challenges and adversity and come out stronger than before (Seligman, 2010); Aristotle called this dynamic state of being eudaimonia (Stanford Encyclopedia of Philosophy, 2022). Some researchers have identified components of flourishing in order to measure it. For example, Dahl et al. (2020) posited that it has “four core dimensions of wellbeing: awareness, connection, insight, and purpose” (p.32917); Seligman (2010) identified positive emotion, engagement, relationships, meaning, and accomplishment in his PERMA scale.
People who report high levels of flourishing also report experiencing flow states (Oppland, 2023). Csikszentmihalyi (1990) identified the flow state as an internal experience of complete immersion in an activity or focus, where everything else feels inconsequential, time slows down or disappears, and the activity is done for its own sake (i.e., autotelic). This aspect of everything becoming inconsequential is important to highlight as it suggests liminality—a suspension of day-to-day reality.
Flow appears to be a universal experience occurring “across all classes, genders, ages, and cultures, and it can be experienced during many types of activities” (Oppland, 2023, para. 4). Activities like running, playing chess, writing, gardening, cooking, dancing, swimming, yoga, painting, artmaking, and playing music have all been noted to facilitate flow states (Csikszentmihalyi, 1990; Nash, 2019). In a 2021 study, Burt and Gonzalez described the flow state as an “existential tool” that when accessed consistently, can “increase optimal experience and life enjoyment” (p. 199); they define optimal experience as “a profound sense of happiness that emerges through suffering, self-awareness, and deep embodiment” (p. 201). Suffering is also explained as uncomfortableness, risk-taking, or pushing beyond limitations, due to the persistence that can sometimes be necessary in order to get into this altered state of consciousness.
it occurs when the prefrontal cortex of the brain slows in activity and high-level thinking decreases. Transient hypofrontality is key in attaining flow state, in that studies indicate that the less people think, the more their genuine, true self can emerge, unfettered from societal constraints (Burt & Gonzalez, 2021, p. 198).
I understand this to mean that when we get immersed in an activity that is intrinsically rewarding, the inner critic must be intentionally silenced, and once it is, and the thinking mind recedes, flow becomes possible. This connects to what Csikszentmihalyi (1990) was getting at with ‘everything else becomes inconsequential.’
Something important to note in Burt and Gonzalez’s (2021) study, is that flow states may elicit addiction, frustration, and/or lethargy in certain people. They stated that “during flow, dopamine, anandamide, norepinephrine, serotonin, and endorphins release together and cause a natural high that can be very addicting … clients may become irritated or weary because they are unable to attain flow state continuously” (p. 208). They suggested that when teaching flow, counselors assess and monitor their clients for signs of addiction or frustration. The authors asserted that regardless of these potential risks, flow state is still a viable tool with many potential benefits.
Trauma and Recovery
“Complex trauma describes both children’s exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure” (National Child Traumatic Stress Network, n.d., para. 1). According to addiction and trauma specialist, Dr. Gabor Maté (2023), addiction has its roots in “childhood trauma and in stress and social dislocation endemic to systems of inequality and injustice” (para. 1). The environment that the child grows up in greatly influences their developing brain. In a recent interview, Maté (as cited in Brown, 2019) explained that if toxic stress is present consistently over time, for example, neglect, abuse, and household dysfunction, a prolonged and chronic stress response is triggered. Neural pain-and-reward circuitry gets altered, and certain neurochemicals will not be produced, while others are done so in excess. These chemical imbalances may predispose adults with complex trauma history to engaging in destructive behaviors which reproduce similar dissociative states that were once survival mechanisms in their youth (Maté, 2010; Maté & Maté, 2022; O’Brien, 2020).
Psychotherapist and EMDR facilitator, Adam O’Brien (2020) proposed the ‘Addiction as Dissociation’ model, defining addiction as “a manifestation of untreated dissociation and trauma … addiction and dissociation are the same process and it is the impact of trauma that creates the extremes” (para. 4). From this perspective, addiction and other symptoms of trauma are manifestations of dis-connection and dis-location from the self. This takes the stigma out of addiction when it is understood that addiction is simply on a spectrum of dissociation. Depending on an individual’s personal genetic predispositions and early life experiences, the dissociation can take many forms. The recovery process then at its core, independent of method, becomes a healing journey of re-connecting to one’s authentic self (Brown, 2019; Maté, 2023).
The Expressive Arts and Late Adulthood Women
The expressive arts are a tool for facilitating engagement with the imaginal realm, and this may contribute to post-traumatic growth (i.e., recovery) and flourishing (Grant, 2022). In Attunement in Expressive Art Therapy: Toward an Understanding of Embodied Empathy, Mitchell Kossak (2021), explained that the expressive arts facilitate attunement, which is an “interpersonal rhythmic syncing” (p. 113). Attunement also describes the relational attachment that happens between mother and child, and for those with early childhood adversity, healthy attachment, or attunement, was often absent from their experience with parents and caregivers (Bowlby, 1969). Interestingly, Kossak (2021) said that “attunement has also been referred to as ‘flow’” (p. 4). The flow state may therefore be a unique in-road for locating, connecting, and attuning to the authentic self.
Late adulthood is the developmental period of life from approximately 65 years of age to death (Arnett & Jensen, 2018). A 2022 study by Wang et al. showed that higher exposure to early childhood trauma equates to less flourishing in adulthood, meaning that it may be harder to heal from childhood trauma the older we get. Other studies posit a more hopeful perspective, offering that flourishing in later years, including after addiction, is possible (Keyes, 2015). Additionally, optimal wellbeing in late adulthood and beyond is possible by connecting with nature, keeping an active social life, and having “flow niches”—for instance places where one engages with flow state through immersive personal projects (Roe et al., 2022, p. 1). Narrative therapy has been shown to reduce PTSD symptoms among those in late adulthood (Lely et al., 2022).
There exists a gap in the literature covering late adulthood women who are flourishing after addiction with complex trauma history. This study hopes to address that gap by exploring what flourishing looks like in a single case study within this population.
Intersectionality
The topic of flourishing has been associated with positive psychology, and historically this branch of psychology has been defined by groups who are Western, educated, industrialized, rich, and democratic ([WEIRD], Hendriks, 2019; Jones-Smith, 2021). Strengths-based therapy is a parallel domain to positive psychology, and while it uses similar concepts, it is a “client-centered, culturally responsive, and integrative approach to psychotherapy and counseling” (Jones-Smith, 2021, p. 453). The focus is on a person’s strengths and resources as they are informed by community, culture, and social locations. Using a strengths-based framework allows the participant to provide their personal ways of knowing and understanding of flourishing, independent of measurements typically found in positive psychology questionnaires and assessments, for example, Seligman’s (2010) PERMA scale.
Role of the Researcher
I am a 49-year-old, neurodivergent, White, Jewish, American, cis-gendered female, and I am heterosexual, with middle class socioeconomic status and privilege. Growing up, I experienced multiple childhood adversities. My stance as a researcher is grounded in an epistemology of interpretivism; there are many truths, and we are each creating meaning from our experiences in specific and distinctive ways. I find power in living by an ethic of love (hooks, 2000), and I practice a deep reverence and wonder for the natural world, what John O’Donahue (2018) described as “walking in wonder.” This study is close to my heart, as the participant is my mother.
Procedures
Method
The brackets of this case, for example, time and place, are participant-defined and will be initiated using open-ended inquiry beginning with the question, “When did you first recognize signs of flourishing in your life?” This approach will allow the participant to shape our understanding of their personal experience of flourishing and direct the story holistically.
Participant
My mother is a 70 years-young cis-gendered female who had a childhood filled with complex trauma, and developed a substance use disorder in adulthood that lasted decades. Despite the predictive risks associated with her ACE score of 8, my mother is now flourishing.
Data Collection
Data will be collected from multiple sources including interviews, photos, art, music, textiles, as well as others. The final product will be a short film documentary that uses still images, video, and audio in a collage-like manner. The participant is multi-modal in her creative expression and given this understanding, a film offers the most appropriate container for capturing the variety of data. Additionally, during the collection phase and filming process, I will be recording my own field notes, through journaling, morning pages of free writing including dreams, synchronicities, ideas, and sparks of curiosity.
After funding has been secured, gear rented, and film crew members hired as needed, a timeline would be discussed and confirmed. In order to keep this process holistic, and reduce unnecessary stress, a film crew will only be used in a limited capacity, and only once approved by the participant.
In order to have everything out in the open, I intend to discuss the informed consent on camera. By stating—from the very start—that this is in no way objective, but still valuable, I hope to address ethical concerns about using one’s own parent in research. This is also when I will ask her the initial bracketing question, “When did you first recognize signs of flourishing in your life?” We will discuss some of her ideas and agree on a plan for the film crew if necessary. I will set up a stationary camera in a private room in my mother’s house where she can do confessional storytelling, if she wants. A second camera will be possibly set up in her painting area, where we can conduct interviews together. To capture the most organic depiction of her story, I want the camera presence to recede into the background.
With the initial bracketing question in mind, she could begin setting aside whatever data feels relevant to her story of flourishing, when it began, how she recognizes it, and what that looks like. The filming and data collection will take place over 5–7 days. An additional week would be allotted afterwards for the participant to add (or subtract) anything else she felt was important.
Data Analysis
Analysis will be a three-phase process. Phase one will be done by myself and my film editor, as we view the raw film footage, listen to interviews and audio clips to transcribe them, and look through my collected field notes. We will observe themes that emerge, and then this thematic content will be incorporated into the film. The film will then be edited to a phase one length of 2 hours. In phase two, we will give the film to the participant for review and to offer any changes she may have. Phase three will be the final editing down of the film to 20 minutes.
Ethical Concerns
“Maybe you will want to use me in your research?” asked my mother at the start of this semester. Diving into the topic of flourishing revealed that she represented an under-researched, and therefore, important, population. Although there are no rules prohibiting the use of a close family member, there are ethical concerns. In Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2017), section 8.02 Informed Consent describes in detail how the participant must be fully informed about the study, which includes the purpose of the research, the right to decline and/or withdraw at any time, the consequences of doing so, and limits of confidentiality, which is especially relevant for filming.
There may be potential therapeutic benefits gained by the participant in sharing her story, such as the gratification of helping others, and emotional processing and recognition of achievement. There are potential benefits that I, as the researcher, might receive in bringing this story to a larger audience, specifically career opportunities. There is also the potential that the participant could experience substantial emotional distress during the filming, and this would be a discontinuation criterion. To support the participant, a licensed therapist would be available by phone or Zoom starting on the second day through the last day of production.
Conclusion
The nature of scientific inquiry is to quantify and measure; yet when it comes to wellbeing, empirical measurements may not adequately capture the nuance of the lived experience of flourishing among women with multiple ACEs. Their adulthood years may have been fraught with various means of destructive self-soothing, including addiction (Brown, 2019; Maté, 2012)—for some, against the odds, they have found resiliency and post-traumatic growth.
This research will explore a single case of flourishing in a late adulthood woman with a history of complex trauma and addiction. I have identified a gap in the literature among this population, and more stories are needed to fill this void, and to offer inspiration for this growing demographic (World Health Organization, 2023). There is also a lack of research on flourishing among marginalized groups (Kiknadze & Fowers, 2023). Although my mother is partially WEIRD, she also shares some locations of identity with marginalized and non-dominant groups. Nevertheless, more research is needed to help shape our understanding of cultural variations of flourishing.
Possible outcomes of this work include the following: to conduct more interviews with other late adulthood women with complex trauma history; interview Dr. Gabor Maté and Shawn Ginwright, both of whom are cited throughout this paper; show the short film from this case study at an International Expressive Art Therapist Association (2017) conference; and give a TED talk on the nature of flourishing in this specific population. Another hoped-for outcome is to contribute to the field of expressive art therapy in a way that gives back to the collective and builds community with other flourishing wise women who are using their creativity as healing tools; so, as those of us with trauma history get older, we have examples of flourishing to inspire and guide us.
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