Child Abuse & Neglect 103 (2020) 104430

Contents lists available at ScienceDirect

Child Abuse & Neglect

journal homepage: www.elsevier.com/locate/chiabuneg

Survivors’ lived experiences of posttraumatic growth after

T
institutional childhood abuse: An interpretative phenomenological
analysis
Grace Sheridan*, Alan Carr
School of Psychology, University College Dublin, Ireland

A R T IC LE I N F O ABS TRA CT

Keywords: Background: Institutional childhood abuse (ICA) represents a chronic and severe form of child-
Institutional childhood abuse hood maltreatment and is associated with a host of adverse outcomes. However, there is some
Posttraumatic growth evidence to suggest that survivors can also experience positive psychological change after in-
Adult survivors stitutional childhood abuse and neglect.
Trauma
Objective: To examine the lived experiences of posttraumatic growth (PTG) in adult survivors of
Qualitative
institutional childhood abuse.
Interpretative phenomenological analysis
Participants and setting: Nine survivors of historical institutional abuse in Ireland ranging in age
from 41 to 75 years (M = 60.5).
Method: Semi-structured interviews were conducted to explore survivors’ experiences of positive
change after institutional upbringing. Data were analysed in the tradition of interpretative
phenomenological analysis (IPA).
Results: The analysis yielded two superordinate themes. The first major theme, ‘Survivor Identity’
described participant’s subjective understanding of their survivorship through five subthemes.
The second major theme, ‘Engendering Growth’ comprised seven subthemes which collectively
identified key factors and processes related to positive change and posttraumatic growth after
significant early-life maltreatment.
Conclusions: Findings underscore the importance of supporting survivors to construct a com-
prehensive self-narrative that identifies their personal strengths and growthful experiences,
whilst also acknowledging the continued distress associated with their unique survivorship tra-
jectory.

1. Introduction

1.1. Institutional childhood abuse

Institutional childhood abuse (ICA) is a distinct form of childhood maltreatment in that it is perpetrated by adults working in
community institutions serving children. ICA is also perpetrated by institutionalised peers (Lynch & Minton, 2015) and can occur
across a range of short-term and long-term care settings including religious and nonreligious residential centres and foster care,
schools, churches and recreational facilities. ICA may involve prolonged traumatisation involving physical, sexual and emotional
abuse (Wolfe, Jaffe, Jette, & Poisson, 2003). Dynamics of the abuse context and characteristics of this trauma type are of significance

⁎
Corresponding author at: School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Dublin, Ireland.
E-mail address: grace.sheridan@ucdconnect.ie (G. Sheridan).

https://doi.org/10.1016/j.chiabu.2020.104430
Received 25 August 2019; Received in revised form 10 December 2019; Accepted 18 February 2020
Available online 03 March 2020
0145-2134/ © 2020 Elsevier Ltd. All rights reserved.
G. Sheridan and A. Carr Child Abuse & Neglect 103 (2020) 104430

in considering survivors’ posttraumatic outcomes. Within institutional settings, individuals are in a position of power and trust in
relation to children. Opportunities for abuse disclosure are often inhibited by the use of threats and force and the normalisation of
abusive activities by perpetrators. In turn, this serves to compound the abuse secrecy, victims’ experiences of shame and guilt and
their sense of powerlessness within the abusive system (Blakemore, Herbert, Arney, & Parkinson, 2017). Furthermore, the dearth of
supportive family or social systems to provide a sense of safety and security greatly reduces opportunities for survivors’ emotional
expression and cognitive reorganisation of the experienced traumata.
Historical accounts of ICA have been reported globally in recent decades. Within the Irish context, approximately 170,000 young
people were placed in religiously-affiliated institutions over a 40-year period between 1930 and 1970 (CICA, 2009). This included
placements in industrial or reformatory schools and orphanages. Young girls and women could also be placed in Magdalene laundries
and mother and baby homes, with the former often incarcerating women who were deemed to be transgressing the moral code of
society. The severity and chronicity of the abuse experienced by children and adults in these settings was documented in a report
produced by the Commission to Inquire into Child Abuse in Ireland (CICA, 2009). Unsurprisingly, a host of negative psychological,
social, cognitive and broader life difficulties were reported by 247 adult survivors (Carr et al., 2010; Fitzpatrick et al., 2010).
International studies have found that the overall rate of psychological disorders among survivors of ICA greatly exceeds those found
in normal community samples. In their umbrella review of systematic reviews of outcomes for survivors of severe neglect in under-
resourced childcare institutions (N = 3856), Carr, Duff, and Craddock (2018) found that 84% of adult survivors of ICA had lifetime
mental health problems.

1.2. Posttraumatic growth

Encouragingly, research in this domain has moved away from an exclusive focus on the negative aftermath of traumatic ex-
periences. There is now a burgeoning literature base investigating experiences of positive psychological change after traumatic life
events. Empirical reports of such change include improvements in the areas of self-perception, interpersonal relating and philosophy
of life. These changes are often referred to as posttraumatic growth (PTG). PTG theorists infer that positive post-traumatic changes
occur through a cognitive processing of the traumatic event(s), which in turn fosters a sense of meaning and value in survivors’ lives.
It is inferred that the growth process is initiated by the “shattering” of an individual’s assumptive world as a direct result of the
perceived threat of the trauma experienced (Janoff-Bulman, 1992, 2006). Subsequently, adaptive cognitive processing of the trauma
precedes the rebuilding of a survivor’s assumptive world, which in turn fosters the development of posttraumatic growth. Research on
the phenomenon of PTG has been pioneered by Richard Tedeschi and Lawrence Calhoun. The authors identified five growth con-
structs through factor analytic processes: appreciation of life, increased personal strength, new opportunities, improved relationships
with others and increased spirituality (Tedeschi & Calhoun, 1995). Over the past three decades, a wealth of quantitative and qua-
litative investigations have reported post-traumatic growth after various categories of accidental traumas including natural disasters,
chronic and acute health problems, transportation accidents and other traumatic life experiences (Linley & Joseph, 2004). PTG has
also been investigated in samples of survivors of interpersonal traumas including childhood abuse and neglect (Hartley, Johnco,
Hofmeyr, & Berry, 2016; Kaye-Tzadok & Davidson-Arad, 2016; Lev-Wiesel, Amir, & Besser, 2005; Mohr & Rosén, 2017; Shakespeare-
Finch & de Dassel, 2009; Walker-Williams, van Eeden, & van der Merwe, 2013; Woodward & Joseph, 2003).

1.3. Posttraumatic growth after institutional childhood abuse

To date, there is no empirical literature investigating PTG after institutional childhood abuse. The available research on outcomes
from ICA provides some evidence to suggest that positive change can be experienced among this cohort of trauma survivors.
Investigating the profiles of resilient survivors of ICA in Ireland, Flanagan et al. (2009) found that positive adjustment after ICA was
associated with older age, higher socio-economic status, less experiences of sexual and emotional abuse, less traumatization and
fewer trauma symptoms. A formal report based on findings from the same survivor sample (Carr, 2009), and submitted to the
Commission to Inquire into Child Abuse, highlighted the personal strengths and resources that ICA survivors identified as supportive
to their positive coping including self-reliance, optimism, and occupational functioning. Most recently, Moore, Flynn, and Morgan
(2019) examined the resilience-enhancing factors across the social ecology that promoted mental wellbeing for Irish emigrant
(n = 56) and non-emigrant (n = 46) survivors of clergy-perpetrated ICA in Ireland using a mixed-methods strategy. The authors
found that personal skills and competencies, including problem-focused coping, altruism, and defiance were centrally important
across both groups in promoting resilience. These studies suggest that the potential for positive change after chronic interpersonal
traumatisation exists. However, extrapolation of broad findings on PTG to survivors of institutional childhood abuse may not be
appropriate given the potential impact of the abuse context and abuse characteristics on growth processes. Within the context of
clergy-perpetrated abuse, impairments in spiritual wellbeing and religious coping are commonly reported (Fater & Mullaney, 2000)
and survivors report feelings of anger, betrayal and distrust towards Church doctrines (Blakemore et al., 2017). Marotta-Walters
(2015) suggested that the spiritual and religious beliefs associated with protection from a higher power, as represented by clergy
members, may become distorted as a result of abuse experiences. Investigating correlates of PTG in a sample of 481 male survivors of
CSA, Easton, Coohey, Rhodes, and Moorthy (2013) found that the variable of ‘clergy-perpetrated abuse’, as endorsed by 61.7% of the
sample, was the only abuse characteristic that demonstrated a significant correlation to PTG.

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1.4. The current study

Developing an understanding of how survivors of institutional childhood abuse experience positive change and psychological
growth after chronic and severe childhood maltreatment is of crucial importance. The predominant empirical focus to date on
pathways to pathology and distress after ICA does not inform understandings of psychological growth processes in this survivor
cohort. As such, little is known about what leads to a fulfilling and meaningful life for survivors of ICA. Furthermore, it remains
unclear how characteristics unique to experiences of abuse in institutional residential settings may impact on the development of
PTG. To this end, qualitative approaches offer a valuable framework to explore survivors’ subjective experience of positive post-
trauma adaptation. Therefore, the aim of the present study was to investigate the lived experiences of posttraumatic growth for adult
survivors of institutional childhood abuse in Ireland.

2. Method

2.1. Study design

A qualitative design using Interpretative Phenomenological Analysis (IPA; Smith, Flowers, & Larkin, 2009) was employed in the
current study. IPA is a detailed analysis of personal lived experience which focuses on examining how individuals make meaning of
their personal and social world. In doing so, the approach draws upon fundamental principles of phenomenology, hermeneutics and
idiography (Pietkiewicz & Smith, 2012). Phenomenology is concerned with the study of lived experience and how individuals come
to understand their experiences of the world whereas hermeneutics describes the theory of interpretation and efforts to expose the
intentions and meanings of the individuals who are providing lived experience information on the topic of exploration (Smith et al.,
2009). IPA’s emphasis on idiography means that the researcher focuses on the particular rather than the universal. This analytic
approach seeks to generate rich and detailed descriptions of an individual’s subjective experience of the phenomena under in-
vestigation (Pietkiewicz & Smith, 2012). The sample size for this study was determined in line with recommendations for conducting
IPA research and the documented need for small sample sizes to enable an in-depth, case-by-case analysis of the data.

2.2. Participants

Participants were a mixed-gender sample of nine survivors (Male = 5; Female = 4) of institutional childhood abuse, ranging in
age from 41 to 75 years (M = 60.5). Participants were a poly-victimised sample who had experienced abuse within several institution
types including orphanages, mother and baby homes, industrial schools and Magdalene laundries. Perpetrators of abuse included
clergy members, lay staff employed by the respective religious institutions, family members and other institutionalised peers.
Inclusion criteria for the study were: persons 18 years of age or older who self-identified as a survivor of institutional childhood
abuse. Exclusion criteria for the study were: Persons with active suicidality; persons currently experiencing interpersonal violence;
persons with a diagnosis of cognitive impairment; and poor fluency in spoken English.

2.3. Measures

2.3.1. Demographics and abuse characteristics

A brief demographic questionnaire was developed to obtain information on participant current age, gender, relationship status,
occupational status, age of entry into institution(s), type of residential institution and length of stay in institution (see Table 1).

2.3.2. Suicidal ideation

The Suicide Behaviours Questionnaire-Revised (SBQ-R; Osman, Bagge, Guitierraz, Konick, Kooper, & Barrios 2001) was used to
screen for at-risk suicidal ideation and behaviours. The SBQ-R is a four-item measure that assesses for past and future suicidal

Table 1
Demographic information and abuse characteristics for study sample.
Pseudonym Age Gender Age when entering institution Length of stay Institutional Placement(s)

Ger 63 F 3 years old 13 years Orphanage

James 75 M 3 years old 13 years Industrial school
Aidan 47 M 9 years old 7 years Industrial school
Stephen 69 M Born in institution 5 years; Mother and baby home;
4 years Magdalene laundry
Paul 41 M 13 years old 9 weeks Industrial School
Nora 69 F 3 years 13 years Orphanage
Lucy 57 F Born in institution 13 years; Orphanage;
3 years Magdalene laundry
June 71 F 3 years 13 years Orphanage
Neil 53 M 2 years; 1 year; Orphanage;
12 years 1 year Orphanage

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thoughts and behaviours. A total score (range 3–18) is obtained by summing the scores for each of the 4 items. Scores of 8 or above on
the SBQ-R indicate at-risk suicidal ideation or behaviours. In the current study, all participants scored below risk threshold on the
SBQ-R.

2.4. Procedure

This study was approved by the university research ethics committee. A purposive sampling approach was used. Participants were
recruited through two national survivor organisations. After initial consultation with staff at consenting organisations, staff were
asked to disseminate verbal and written study information to service users who met study eligibility criteria. This procedure enabled
the research team to reduce the risk of excluding participants with literacy difficulties and to determine participants’ capacity to take
part in the research without experiencing a harmful level of stress. Individual meetings were subsequently scheduled with service
users who expressed interest in participation to meet with the first author to discuss study involvement. At the end of these meetings,
an interview date and time was scheduled with eligible individuals who indicated their intent to participate in the research.
Protocols for the management of participant distress and suicide risk were developed and discussed with participants prior to their
interview. Informed consent was obtained from all participants and the first author administered items from the SBQ-R measure
(Osman et al., 2001) to determine risk of suicidal ideation, intent and behaviours. Individual, semi-structured interviews were
employed to elicit rich, detailed and first person accounts of survivor’s experiences of positive change and growth during adulthood.
A semi-structured interview topic guide was used to facilitate exploration of key topic areas. The research team encouraged con-
tribution from staff at the involved support organisations toward the development of the interview schedule. Interviews were con-
ducted on-site at the involved survivor organisations and ranged in length from 30−97 min. Interviews were audio recorded with
permission and transcribed verbatim. Upon conclusion of each interview, participants were debriefed and thanked for their parti-
cipation. Follow-up appointments with service staff at the involved survivor organisations were made available to all participants in
the event that they should experience emotional distress after discussing their post-trauma adaptation and experiences.

2.5. Analysis

Participants’ names and other identifying information were changed to protect confidentiality. Data were analysed according to
the principles of IPA. Analysis was conducted across three broad stages. The first stage involved multiple reading of the raw data and
documenting notes on descriptive and linguistic aspects of the content, as well as detailing initial interpretative comments. The
second stage involved a move toward an increased level of conceptualisation in order to transform notes into emergent themes. Each
interview was analyzed in isolation to allow for as much objectivity and impartiality in developing emergent themes. The final stage
was characterized by the collation of superordinate and subordinate themes and involved looking for convergence and divergence
across emergent themes and clustering them together according to conceptual similarities. Finally, each cluster was headed with a
descriptive label which captured the core meaning of included themes. Verbatim extracts from each participant supported the final
master table of themes.

2.6. Quality, reflexivity and rigour

Throughout the process of analysing data, the research team sought to ensure that the lived experiences of participants were
sensitively reflected and that analytic procedures were transparent, coherent and rigorous. These are regarded as crucial procedures
in demonstrating the quality of qualitative research (Yardley, 2008). The first author had previously received professional training in
qualitative methodology and was familiar with responding to the unique challenges posed by qualitative methods of inquiry. To
enhance member checking (Creswell, 2009), a verbal summary of the interview content was provided to participants at the end of
each individual interview and they were encouraged to amend or augment the researcher’s interpretations throughout the interview
process. For consistency and reliability, a clear audit trail of data collection and analytic processes was recorded. Inter-rater reliability
was assessed on a random selection of annotated transcripts with a second reviewer who independently coded the raw data. Close
agreement was reached on the development of codes and minor discrepancies were resolved through discussion.
In considering influences on reflexivity in the current research programme, the researcher’s own personal characteristics (e.g. age,
gender, educational status) are likely to have impacted the manner in which participants engaged in the research process. The
researcher’s training in the area of Clinical Psychology may have influenced the posing of questions and further probing of parti-
cipants during the individual interviews. The researcher’s attendance at a number of national events and rallies advocating for justice
for survivors of institutional and clergy-perpetrated childhood abuse in Ireland may have had some bearing on the interpretation of
participants’ narratives. Through the maintenance of self-reflexivity, including the use of a reflexive journal, the researcher could
remain cognizant of her personal contributions to the construction of meaning in the study results. Furthermore, the use of a second
reviewer to code the raw data fostered dialogue and led to the construction of complementary, as well as divergent understandings of
the study topic. It also provided a context within which the researcher’s beliefs, values, perspectives and assumptions could be
exposed and challenged.

3. Results

All participants scored below the risk threshold on the SBQ-R measure for suicidal ideation and behaviours. The final analysis of

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Table 2
Superordinate and subordinate themes.
Superordinate themes Subordinate themes

Survivor Identity “People putting me in boxes”

The Shared Identity
The Incomplete Self
The Disavowed Identity
The Transformed Self

Engendering Growth Temporal Change

Cognitive Insights
Improved relatedness: Intrapersonal and Interpersonal Domains
Important Others
Meaningful engagement
Continued Distress
“Weaving and Dodging”

participants’ transcripts yielded 12 themes which were clustered into two superordinate themes: ‘Survivor Identity’ and ‘Engendering
Growth’ (see Table 2 below).

3.1. Superordinate theme: survivor identity

‘Survivor Identity’ describes participants’ personal understanding of what it means to be a survivor of institutional childhood
abuse. This theme highlights the interactions between social stratification, identity loss and rejected aspects of self, shared survivor
experiences and character transformations in the construction of a comprehensive and multi-faceted perception of self.

3.1.1. “People putting me in boxes”

The centrality of social structures, most notably the stigmatising attitudes and behaviours of society toward survivors, was in-
strumental in shaping participants’ sense of self. Nora highlighted the maltreatment of disadvantaged children through the prevalent
and damaging cultural attitudes at that time.
“People still criminalised you, as children. My father dying is not a crime. And that was the reason why we were in care”. (Nora)
June, the eldest participant, referenced the hypocrisy of the actions of “the so-called Christians”; those who failed to demonstrate
kindness and compassion to vulnerable, abused children. She described how society chose to narrate ICA survivorship as shameful
and punishable. Aidan’s use of metaphor, “people putting me in boxes”, highlights the role of social structures in the development of his
early maladaptive self-beliefs.
“I always thought I was bad, was always told I was bad, had to do bad. From a very young age, if you have that belief instilled on you or
imprinted on you, it’s like your DNA…when people are putting you down all the time, you begin to believe that stuff” (Aidan)

3.1.2. The shared survivor identity

Participants’ sense of self was also influenced and shaped by interactions with other survivors and through opportunities to
develop meaningful relationships within a safe group context. These were experienced as relationships of enduring support that
provided constancy, reliability and acceptance of life experiences. Below, Neil notes the powerful force of the ICA group membership
in enabling him to begin to open himself up to others.
“Since I’ve been coming here, I’ve noticed in myself that it’s like taking down a brick wall because I had a constant wall up. I hadn’t met
people who had gone through similar situations. So that kind of made me feel more relaxed” (Neil)
June noted the absence of perceived social hierarchies within these relationships. Her addition that “people are all real with each
other. I think that’s very important” suggested that the shared identity provides a sense of authentic relating and feeling understood. For
Aidan, the positive outcome is twofold; opportunities for reciprocal exchange with other survivors bolstered his positive perceptions
of self and ICA survivorship, whilst also encouraging him to support others in doing so.
“…I like being around other people and not dwelling on the past or talking about the abuse. And by doing that I think it encourages you to
help then” (Aidan)

3.1.3. The incomplete self

Almost every participant touched upon a prevalent sense of missed opportunities and thwarted occupational aspirations due to
educational disadvantage. James reported a sense of “getting left behind” in occupational endeavours and Ger’s sense of loss of
opportunity reflected a commonly reported perception of an unfulfilled aspect of self. Experiences of catastrophic loss during critical
developmental periods were also commonly described. Neil, who at the time of the interview was coming to terms with the recent

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bereavement of a family member, reflected on the developmental consequences of his multiple institutional placements. He described
the perceived loss of being a loved child and noted the longstanding sense of detachment from his family of origin.
“I think I didn’t feel like I was being loved, especially as a kid, being taken away from your mother. I’m still kind of attached to my mother
but with the family and me…I don’t feel like I am part of that family”. (Neil)
Similarly, Nora described the impact of spatial dislocation in early childhood on the later development of family relationships and
overall sense of family cohesiveness. Her experiences, as outlined below, were echoed across several participant narratives and
convey the loss of a family identity due to fragmentation of sibling relationships.
“Not knowing your brothers…and as a result you don’t have a bond, you don’t have any kind of a relationship. And when that bond is
broken, you can’t get it back. It’s very hard to glue that back together.” (Nora)

3.1.4. The disavowed identity

The disavowed identity encapsulates participants’ sense of rejection of their survivorship by others, in addition to their own
disavowed aspects of self. Whereas Aidan noted an overt rejection of his survivor identity by family members, Nora described a more
covert dismissal in the perceived pressure to conceal her identity as an ICA survivor due to societal discomfort with acknowledging
historical institutional abuse experiences.
“Being able to come out and say that you were in care. That is an awful big step for anyone…to say that you were in an institution because
once you mention that word ‘institution’, people didn’t want to ask you anything” (Nora)
Lucy touched upon her difficulties with intimacy and sexual functioning during adulthood. She highlighted her distress in relating
to, and tolerating herself as a sexual being due to the re-emergence of memories of her sexual victimisation and abuse during
childhood. Aidan and Paul, both of whom reported previous experiences of addiction, homelessness and criminality, recalled the
difficulties in accepting the actions of their younger, more vulnerable selves. Their interpretations seemed closely tied to a self-
perception of agency and responsibility for their behaviours; thereby ultimately viewing themselves as perpetrators of immoral
action.
“I’d rather be dead now than to live the way I lived because it wasn’t right, and I wasn’t doing the right things…I’d never be like I was. I
can’t believe some of the things I got up to” (Paul)

3.1.5. The transformed self

The transformed self describes the development of positive self-impressions through the influence of shifting societal attitudes in
addition to survivor perceptions of role transition. Several female participants identified younger generations as promoting a
transformational change through public demonstrations of empathy toward survivors and calls for accountability regarding the
actions of abusive institutions. This deconstruction of stigmatising attitudes helped to facilitate participants’ ownership of their
identity as an ICA survivor. Reflecting on the important factors which had enabled her to find the good and the positive in her life
since childhood, Nora identified the importance of positive self-impressions arising from changing cultural scripts.
“Being told that I wasn’t…what I was perceived to be all my life. That you’d never be any good, that you’d never come to anything, things
like that (Nora)
Stephen, who had recently begun to embrace his survivor identity, described his visit to one of the mother and baby homes in
which he had been placed. His search for meaning in his early life circumstances illustrates a flourishing curiosity to better un-
derstand his identity as an orphan. Other participants highlighted the significance of a role transition in promoting a positive self-
impression. Reflecting on his experiences with the criminal justice system, Paul expanded on this sense of role evolution with his
description of distinct life chapters.
“I always say, the old chapter in my life was called ‘doing life’ [and] the new chapter in my life is called ‘having a life’” (Paul)

3.2. Superordinate theme: engendering growth

‘Engendering Growth’ describes the multiple factors and processes intrinsic to the promotion of positive change for survivors. This
superordinate theme describes the intersection of temporal change, cognitive insights, intrapersonal growth, interpersonal re-
lationships, important others, altruism, co-existing distress and continued coping efforts along survivors’ trajectories of positive
change and personal growth.

3.2.1. Temporal change

This subordinate theme describes the development of positive change and influential factors along survivorship timelines. Young
adulthood was identified as a critical developmental period for survivors due to their initial experience of independence and freedom
from the institutions. For some participants, the physical distance from their childhood trauma was reinforced through emigration
upon release from the institutions. June described the emergence of relational and sexual curiosity during early adulthood and the
importance of these new experiences on her younger, developing self.

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“A new world opened up that you didn’t have back there… seventeen really woke me up…it just woke me up to, when boys would look at
you, you know you’d get that feeling” (June)
Entry into parenthood and grandparenthood further contributed to positive change. Survivors described how their capacity to
develop loving bonds with their own children signified a seminal life achievement. Stephen identified retirement as an important
transition period and noted the availability of new opportunities conducive to his autonomous motivation for self-promotion.
“I’m always probing and asking questions of myself and checking out what’s the benefit of this, to promote myself positively. That has come
in recent times, especially now in my retirement.” (Stephen)
Some participants identified a ‘turning point’ along their survivorship trajectory. This was conceptualised as a notable event or
time period which prompted positive change. Some turning points arose from action-oriented processes such as disclosure of abuse
and formal judicial procedures. For other participants, a turning point emerged due to reaching a state of deep despair or after long-
standing turmoil and emotional pain. Aidan was diagnosed with a severe and life-threatening health condition after years of
homelessness and addiction and recalled having reached the point of being “sick of being sick”.
“One day I was just thinking ‘I want to kill myself’ and I was lying under a tree and then, I just, after that, I thought, ‘right, I have to do
something’ (Aidan)

3.2.2. Cognitive insights

Cognitive insights were a central component of survivors’ growth process. Ger noted that her resilience in childhood was bolstered
by her continued rejection of personal responsibility for the behaviour of abusive others. This sentiment was reflected in almost every
participant’s narration of their adjustment after experiences of childhood abuse and neglect.
“I never owned their bad behaviour. Ever. And I would always say to others [survivors], “as long as you’re owning it, you’re depressed,
you’re feeling sad” (Ger)
Stephen’s ability to draw out individual, positive memories from an overwhelmingly distressing childhood illustrated his capacity
to integrate positive and negative memories in the formation of a cohesive trauma narrative. He noted that positive personality
characteristics and sporting achievements “saved me big time, I was lucky to have that”.
Aidan’s engagement in meaning making processes enabled him to develop a compassionate understanding of his father’s de-
velopmental experiences and the role this may have played in his own experiences of intrafamilial childhood abuse.
“Maybe when I put it back to how he grew up… his Da, he left when he was a kid as well so maybe that’s why he ended up the way he
endedup…[be]cause of that trauma” (Aidan)
The transformational effect of acceptance and resolution of early life abuse further illustrated survivors’ adaptive cognitive
processing of trauma. Inherent to this were experiences of an increased personal strength and self-perceptions of thriving. For June,
her developing capacity to embrace change was central in re-storying her trauma and in identifying growthful aspects of her sur-
vivorship.
“Change is an important thing in our life. Moving on, change…you’re never too late to start thinking different…because at the end of the
day you want to be happy in yourself. And the past happened to me. But the past is gone and positive things came out in my life…So the
other things are small things to me now” (June)

3.2.3. Improved relatedness: Intrapersonal and interpersonal domains

When exploring survivors’ self-perceptions, participants were noted to commonly describe themselves in terms of increased
personal strength (“determined” “assertive”), positive relational qualities (“honest” and “caring”) and positive character traits such as “a
good man”. For Aidan, the development of emotion regulation was central to his experience of improved self-to-self relating. He also
highlighted the importance of learning to tolerate and embrace personal vulnerabilities. Paul noted the importance of self-forgiveness
in cultivating a compassionate attitude toward self and moving forward.
“I don’t have to beat myself up anymore. And I don’t have to be constantly sorry. I have been sorry for all I’ve done wrong. And it’s just time
to move along” (Paul)
Of the total sample, two participants reported the emergence of growth from an enhanced relationship with a higher being during
adulthood. An increased sense of safety was depicted in how these participants described their relationship with God. Paul described
the importance of religious coping and the integration of Christian values into his day-to-day life to support his continued mental
wellbeing. His commitment and deference to an ‘Almighty God’ was central to his perceived role transition and development of a
moral identity. For June, the development of increased spirituality in her later adult years provided her with a source of solace and a
sense of relational security.
“I also have a very strong faith. Listen, I wasn’t there for years and years with that. And I came back all on my own…that’s therapy to me.
And no one can take that away from you, a God”. (June)
However, by and large, most survivors reported a lack of spiritual orientation, spiritual wounding, and the rejection of religious

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practices and ideologies. These participants related their current perspectives on religion to the chronic abuse perpetrated by clergy
staff within religious institutions during their childhood, and to the continued cover up of their abuse experiences by the Catholic
Church.
With regards improved interpersonal relating, survivor’s narratives highlighted that a need for closeness to some individuals was
as important as a need for distance from others. The development of relational management skills including boundary setting,
assertiveness and emotional expression helped survivors to mitigate against the negative influence of toxic or complex relationships.
Ger’s understanding of the detrimental impact of enmeshed relationships within her family of origin enabled her to discontinue
fulfilment of a dual sibling and mother role.
“What I did discover in counselling, which was hugely important to me, was [that] I had to learn to be a sibling and not a mother. And I
found that difficult” (Ger)

3.2.4. Important others

Every participant reported the significance of an ‘important other’ to their experience of positive change after childhood victi-
misation. Friends and partners often assumed a family status due to the notable lack of prosocial adults within family systems during
participants’ childhood years. The formation of participants' own family systems was central to positive adaptation in adulthood. Ger
illustrated the significance of secure attachment experiences within parent-child relationships to her perceptions of thriving as an ICA
survivor.
“When I found times difficult, I would say, I would do it all again. Because I have three fantastic children. And I’ve broken a cycle. Because
my mother was in care, I was in care, and I was never going to let the same thing happen to my children” (Ger)
Counsellors and therapists were often noted to play a significant role in a process of transformational change. Aidan noted that a
trusted and skilled counsellor enabled him to address his developmental trauma and most notably his long-standing fears of rejection
and abandonment. Neil similarly noted the emergence of a revised self-narrative because of his counselling experience. Stephen’s
therapeutic journey was unfolding at the time of the interviews and he identified his counsellor as the only person with whom he
could safely discuss and explore his early life experiences with.
However, other participants reported both underwhelming and unhelpful counselling experiences. Lucy described a somatic re-
experiencing and acute physiological arousal induced by an intrusive counselling approach. June’s experience with a counsellor of
similar age evoked an association with a passive society who failed to protect her as a vulnerable child.
“I only used to go home [from counselling] with fierce, fierce headaches. Bawling me eyes out in the room…I like young people you see.
[This was] an older person who didn’t intervene” (June)

3.2.5. Meaningful engagement

Opportunities to engage in meaningful activities were associated with a sense of achievement and the development of self-worth.
Pathways to education and vocational training, as well as access to creative outlets were noted to be influential during adulthood.
Lucy’s sense of fulfilment through occupational training and subsequent employment in her training area was illustrated in her
descriptions of the great sense of responsibility she experienced with her “first great achievement…first ever achievement really”.
Altruistic behaviours were an important feature across several survivorship trajectories. Participants’ personal growth was both
prompted and expressed by altruistic actions. Some participants played an active role in the process of initial disclosure of institu-
tional childhood abuse at a national level. Nora’s fierce determination is illustrated in her response to the challenges she was
confronted with as she navigated a formal process of seeking justice.
“I said “neither God nor man are going to tell me I’m telling lies”. I don’t care how far I have to go. I’ve made this statement; I’m not backing
down” (Nora)
Aidan noted how caring for vulnerable others in his role as peer support worker helped to ameliorate some of the effects of his
own trauma. Paul’s discomfort with confronting his prior experiences of criminality and addiction was prominent at points
throughout his interview; however, as he reflected on his capacity to support others, he was noted to embrace his multifaceted
identity and perceive his earlier life experiences as a positive force which could ultimately benefit disadvantaged and marginalised
groups.
“I want to be helpful to people. I’d like to be making a difference. You know if you’re helping someone, it makes you feel good too…I’ve had
the trauma, I’ve had near death experiences, I’ve been an alcoholic, I’ve been a drug addict, I’ve been mentally ill, I’ve been homeless, I’ve
been in prison. And I feel that I can identify with all these people. I care about those kinds of people” (Paul)

3.2.6. “Weaving and dodging”

A common pattern of conflict avoidance within interpersonal exchanges was identified in the exploration of participants’ coping
capacities in the aftermath of ICA experiences. Participants noted that these relational strategies developed out of a conditioned fear
response which had manifest in institutional childhood settings. They described an increased sensitivity to threat and vigilance of
danger cues within their social environments. Almost every participant described achieving interpersonal safety through avoidance
or de-escalation of conflict. Neil explained the importance of this emotional reflex in enabling him to evade interactions perceived as

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threatening before he experiences immobilisation or intense physiological arousal.

“When there’s people arguing and I’m stuck in that situation, I feel like my body shakes and I know by my voice I’m ready, and if I don’t
leave this scene now, god knows what would happen” (Neil)
Stephen indicated that anticipation of negative consequences arising from the intended actions of self or others, and avoidance of
vulnerable situations was a crucial coping strategy in his maintenance of personal safety and wellbeing.
“It’s got to do with eh…weaving and dodging…and avoiding…I had to grow up very quickly and mature very quickly to be able to dodge
and avoid conflict. To survive in other words” (Stephen)

3.2.7. Continued distress

Many participants reported experiencing a range of chronic and severe interpersonal traumas during adulthood, including ex-
periences of domestic violence and coercion, marital breakdown and ongoing family conflict. Lucy described her vulnerability upon
leaving the Magdalene Laundry and unknowingly entering a controlling and violent marriage. She likened her experience of marriage
to “being in the institution again, you’d nearly want to ask him permission to go into town”. She subsequently described the emergence of
an increased personal strength ensuing from the challenges she faced in early adulthood.
“I always swore I’d never get married again. I’d never let a man rule me like that again. So, in a way it made me stronger, having
experienced that” (Lucy)
Ger described a co-existence of positive coping and continued distress characterised by post-traumatic re-experiencing symptoms.
“I still wake up, at least 20 times a night in violent situations. Because I have no control over nightmares. My coping skills are fantastic
during the day, but no matter how happy I am going to bed, I just can’t tell you what’s going to trigger it” (Ger)
A litany of distressing and traumatising experiences during a formal redress process was uniformly reported across interviews. For
many survivors, the bereavement of siblings, children and close friends through suicide and addiction further compounded their
sense of interpersonal trauma and loss. Yet, despite their experiences of continued distress, participants demonstrated a remarkable
tenacity in navigating unpredictable, and often harrowing trajectories of survivorship.

4. Discussion

Results suggest that survivorship after institutional childhood abuse involves a complex adaptation to post-traumatic environ-
ments. Such adaptation is characterised by interwoven aspects of positive behavioural changes, perceptions of growth and continued
distress. Survivors described multifaceted identities which had been influenced, to varying degrees, by early histories of institutional
and intrafamilial childhood abuse, as well as later experiences of addiction and homelessness, criminality and re-victimisation during
adulthood. The centrality of social structures in the construction of survivors’ identity was prevalent across participants’ narratives. A
widespread sense of feeling stigmatised and marginalised by societal attitudes transcended participant’s recollections of earlier life
experiences due to institutional upbringing. Some survivors reported that a transformed perception of self during adulthood was
promoted through a change in social attitudes and the ameliorating effect of changing cultural scripts. These findings align with
extant literature on identity development; most notably, the impact of how social structures affect the structure of self (Stryker &
Burke, 2000).
The importance of developing a positive post-trauma identity was a central motif across survivors’ growth narratives and echoes
findings in the PTG literature base. Walker-Williams and Fouché (2015) conducted a qualitative evaluation of their strengths-based
intervention which aimed to facilitate the development of PTG in female CSA survivors. Their results suggested that the development
of a ‘post-trauma thriver identity’, which comprised increased self-acceptance and self-efficacy, enabled survivors to derive salutary
meaning from their abuse experiences. The current findings also highlighted that, in some instances, aspects of survivors’ identity
were rejected by others or disavowed by survivors themselves. When survivors viewed themselves as agents of immoral action, they
described later motivations to re-organise their self-concept around moral cognitions and behaviour which benefited both themselves
and others. Aquino and Reed (2002) suggest that moral identity can be a basis for social identification that people use to construct
their self-definitions. Results from the current study also emphasised the impact of a loss of perceived relational security and sense of
feeling loved within primary caregiving relationships due to the disintegration of the family unit during early childhood. The far-
reaching consequences of early attachment disruption due to institutional upbringing have been reported previously (Carr, 2009,
Carr et al., 2010, 2018).
In the second subordinate theme, participants reported a range of internal and external factors inherent to the development of
perceptions of positive change and growth during adulthood. Important transition periods such as entering adulthood were con-
sistently identified as triggers of influential change. The importance of turning points as they relate to PTG has been reported
previously. Examining the qualitative survey responses of 250 adult male survivors of CSA, Easton, Leone-Sheehan, Sophis, and Willis
(2015) identified seven forms of turning points across three broad categories of significant relationships, insights and new meanings
and action-oriented processes. The authors inferred that turning points may be indicative of a commitment to healing and greater
deliberate processing of abuse experiences.
Participants’ narratives also suggested that cognitive transformations were central in facilitating an adaptive understanding of
early life trauma and in mitigating against later emotional distress in adulthood. Of note, the acknowledgement of perpetrator

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culpability for experiences of victimisation was a positive driving force in the development of survivors’ personal strength. The
empirical literature suggests that the attribution a victim assigns to their abusive experiences influences their interpretation of the
trauma (i.e. self-blame or external blame) and is therefore crucial in determining its impact on the individual. The significance of
external blame attribution to the development of PTG after childhood maltreatment has been highlighted by several previous in-
vestigations (Anderson, Danis, & Havig, 2011; Easton et al., 2015; Hartley et al., 2016; Walker-Williams et al., 2013; Willis, Rhodes,
Dionne-Odom, Lee, & Terreri, 2015).
Expressions of empathy and perspective taking were illustrated across participants’ narratives. Encouragingly, recent research has
also yielded positive findings on the association between childhood trauma and cognitive and emotional empathy. Exploring the link
between childhood trauma and increased trait empathy across non-clinical populations (n = 829), Greenberg, Baron-Cohen,
Rosenberg, Fonagy, and Rentfrow (2018) found that adults who reported having experienced a traumatic event in childhood reported
elevated empathy levels compared to adults who did not experience a traumatic event. Furthermore, the severity of childhood trauma
was positively linked to empathy levels. Several participants also described feeling motivated by their own experiences of margin-
alisation and social exclusion to help others presenting with similar vulnerabilities. Previous investigations have shown that adversity
can be linked to an increase in prosocial behaviour – a phenomenon termed “altruism born of suffering” (Staub & Vollhardt, 2008;
Vollhardt, 2009). A recent systematic review on PTG after experiences of interpersonal violence during adulthood (Elderton, Berry, &
Chan, 2017) found that altruistic action by survivors may indicate behavioural expressions of positive psychological change and
therefore play an important role in growth experiences.
The development of positive self-impressions and enhanced self-to-self relating was commonly conceptualised as an increased
sense of personal strength and was perhaps the most frequent report of positive change across participants’ narratives. The finding
that improved connectedness to others, a sense of belonging, and feeling cared for and loved were central to the facilitation of
improved interpersonal relating echoes consistent findings on the importance of social support in increasing an individual’s capacity
to cope with traumatic events (Mohr & Rosen, 2017; Schaefer, Howell, Schwartz, Bottomley, & Crossnine, 2018; Willis et al., 2015;
Woodward & Joseph, 2003). At a broader level, findings from the current study on growth-promoting factors echo the primary
assumptions underlying Maslow’s (1943) theory of motivation and hierarchy of needs. Participant’s narratives demonstrated that
when their basic needs for safety and shelter were met during adulthood, internal processes of interpersonal growth, self-acceptance
and self-actualisation were encouraged. This suggests that environments which are responsive to survivors’ needs for food, safety,
love and self-esteem can encourage their motivations for self-actualisation.
Mixed findings were yielded on the importance of spiritual growth in the current study. A small minority of participants (n = 2)
reported the significance of increased religious coping or deep spiritualty to their growth experiences. However, most survivors in this
study described difficulties in developing spiritual connectedness due to associations between the religious privilege of abuse per-
petrators and their own abuse experiences. These findings suggest that a childhood history of harsh religious practice, which is
connected to pervasive abusive experiences, can negatively impact the spiritual growth dimension proposed by current PTG fra-
meworks. Exploring the lived experiences of survivors (N = 7) of clergy-perpetrated CSA, Fater and Mullaney (2000) similarly found
that participants associated clergy victimisation with loss of spirituality and distrust of religious organisations.
To some extent, results also support the notion of a co-existence of growth and distress among trauma survivors. Several parti-
cipants described ongoing symptoms indicative of PTSD (American Psychiatric Society; APA, 2013) including intrusive memories,
cognitive and somatic re-experiencing and acute physiological arousal. The prevalence of posttraumatic symptomatology among ICA
survivors has been highlighted internationally (Carr et al., 2018). Most recently, Carr et al. (2019) found that the rate of posttrau-
matic stress disorder (PTSD) was 12 times higher among a sample of Irish ICA survivors (N = 225) when compared to normal
community samples.
Findings also have relevance for theoretical understandings of posttraumatic growth after childhood maltreatment. Results
support the posited significance of adaptive cognitive processing of trauma to the development of positive psychological change, as
outlined in Tedeschi & Calhoun’s (1995, 2004) model of PTG. However, their emphasis on a ‘shattering’ of the victim’s assumptive
world as a fundamental prerequisite for the initiation of growth processes offer a limited framework for understanding developmental
aspects inherent to chronic traumatisation during childhood. In the current study, most survivors were either born into, or entered, an
institution at a very young age. Given the expected low level of cognitive maturity of children when first experiencing in-
stitutionalisation, it is not surprising that survivors did not report experiencing a ‘shattering’ of their assumptive worlds. Rather,
participants’ narratives suggested that maladaptive cognitive biases developed during their early years and were further strengthened
during childhood and adolescence through experiences of maltreatment and institutional upbringing. It seems that the subsequent
assimilation of positive change experiences into their cognitive frameworks in adulthood, as promoted through positive reappraisal
strategies, acceptance of trauma, and cognitive efforts to process the abuse, challenged their trauma-laden belief systems and led to
the accommodation of new information into their survivorship narrative. Therefore, current understandings of PTG (Tedeschi and
Calhoun, 2004), which contextualise trauma experiences within an adult worldview, do not provide a comprehensive formulation of
posttraumatic growth after childhood traumatisation. Previous studies have also noted issues concerning the applicability of the
‘shattered worldview’ process (Janoff-Bulman, 1992, 2006) in the development of growth after childhood trauma (Draucker, 2001;
Hartley et al., 2016; Shakespeare-Finch & de Dassel, 2009).

4.1. Clinical implications

Recovery and growth after institutional abuse is a protracted process and participants highlighted the importance of offering
appropriate, long-term interventions which allow for the development of a secure therapeutic relationship within which survivors can

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safely explore their trauma experiences. Therapists should remain mindful of how dynamics of the ICA context, such as the pun-
ishment of verbal expression, may pose difficulties for survivors in their engagement with a therapeutic process. There may be a
greater need for therapists to scaffold sessions to prevent the emergence of a power dynamic within the therapeutic relationship.
Survivors should be supported in constructing a self-narrative that embraces their individual strengths whilst acknowledging their
continued vulnerabilities. Continued psychological distress, indicative of PTSD symptoms, was commonly reported by participants.
Therefore, although survivors may report growth as a result of processing their trauma, this does not prevent the occurrence of
continued suffering and distress. Therapeutic efforts should provide appropriate evidence-based treatment for co-occurring post-
traumatic symptomatology. Clinicians should also provide survivors with experiences that can restore a sense of physical safety,
reduce their hypervigilance and support them in responding appropriately to danger.
The importance of cognitive transformations, particularly external blame attribution, was universally reported across narratives.
Psychological interventions are also well placed to facilitate improved self-perceptions, cognitive restructuring, personal agency and
an enhanced sense of self-worth. Where appropriate, therapeutic interventions should address sexual anxieties and explore the
development of positive sexual self-schemas in adulthood, particularly for individuals with experiences of CSA who may present with
psychosexual dysfunction. Re-victimisation during adulthood was commonly reported by participants and reflects the vulnerability of
survivors as they enter adulthood. It is crucial that clinicians working with traumatised youth support the development of relational
management strategies including boundary setting, increased assertiveness, and relational safety. Finally, it is important not to
prescribe growth as clients may experience an invalidation of their victimisation or a sense of failure for not having achieved positive
change. Instead, it is recommended that clinicians and counsellors pay attention to growth as it occurs during a client’s therapeutic
process.

4.2. Limitations

Results should be viewed within the context of study limitations. First, a validated measure of posttraumatic growth was not
employed in the current study; therefore, an objective measure of reported PTG could not be obtained. Second, participants re-
presented a specific survivor cohort of abuse survivors with experiences of a particular culture at a particular point in time. Findings
would therefore need to be extrapolated with caution when applying to other ICA survivor samples. The small number of participants
also precludes generalisability of findings. Finally, findings are dependent on the interpretation of participants’ narratives and to
some degree may have been influenced by the subjective experiences and assumptions of the research team.

4.3. Future research

The results of this study outline several important avenues for future research and clinical investigation. From a theoretical
viewpoint, further clarification is required on the impact of cognitive maturational issues in the development of PTG. Results
highlight a crucial need to understand the cumulative effect of early life institutionalisation and patterns of re-victimisation during
adulthood. Related to this is a need for further investigation on the temporal effects of childhood trauma, especially on functioning in
later life. Given that many older adult survivors may require institutional care in the future, there remains an urgent need to
understand their profile of needs and how these may interact with the expected processes of cognitive and physical decline. The
expression of altruistic growth and empathy across participants’ narratives highlights an important research agenda for empirical
investigation on the effects of victimisation and suffering with regards the development of positive change. Finally, and of im-
portance, survivors of institutional abuse in Ireland are an ageing cohort. Additional qualitative studies are needed to capture the
voices of survivors and document their experiences before their stories are no longer available to empirical investigation.

4.4. Conclusion

This is the first known study to explore survivors’ perceptions of posttraumatic growth after institutional childhood abuse. This
research broadens the clinical and research discourse on outcomes after ICA to provide a unique and critical insight into the complex
experience of survivorship after institutional childhood abuse, and how survivors may experience positive change and posttraumatic
growth. Results suggest that this is a process with multiple, interlinking components. Current conceptualisations of post-traumatic
growth offer a limited framework to understand the antecedents of positive psychological change after institutional childhood abuse.
Findings yielded from the current analysis may be useful in guiding therapeutic interventions for survivors of institutional childhood
abuse and neglect.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

None.

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Acknowledgements

The authors want to extend their sincere thanks to all the participants who shared their experiences, thereby making this study
possible. We would also like to thank the staff at the Christine Buckley Centre and Right of Place, Second Chance for their continuous
support and valuable contributions throughout the research process.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Anderson, K., Danis, F., & Havig, K. (2011). Adult daughters of battered women: Recovery and posttraumatic growth following childhood adversity. Families in Society:
The Journal of Contemporary Social Services, 92, 154–160. https://doi.org/10.1606/1044-3894.4092.
Aquino, K., & Reed, A. (2002). The self-importance of moral identity. Journal of Personality and Social Psychology, 83, 1423–1440. https://doi.org/10.1037//0022-
3514.83.6.1423.
Blakemore, T., Herbert, J. L., Arney, F., & Parkinson, S. (2017). The impacts of institutional child sexual abuse: A rapid review of the evidence. Child Abuse & Neglect,
74, 35–48. https://doi.org/10.1016/j.chiabu.2017.08.006.
Carr, A. (2009). The psychological adjustment of adult survivors of institutional abuse in Ireland. Final Report of the Commission to Inquire into Child Abuse, Vol. 5
Retrieved from http://www.childabusecommission.ie/rpt/05‐03A.php.
Carr, A., Dooley, B., Fitzpatrick, M., Flanagan, E., Flanagan-Howard, R., Tierney, K., White, M., Daly, M., & Egan, J. (2010). Adult adjustment of survivors of
institutional child abuse in Ireland. Child Abuse & Neglect, 34, 477–489. https://doi.org/10.1016/j.chiabu.2009.11.003.
Carr, A., Duff, H., & Craddock, F. (2018). A systematic review of reviews of the outcome of severe neglect in underresourced childcare institutions. Trauma, Violence, &
Abuse. https://doi.org/10.1177/1524838018777788 Advance online publication.
Carr, A., Nearchou, F., Duff, H., Ní Mhaoileoin, D., Cullen, K., O’Dowd, A., & Battigelli, L. (2019). Survivors of institutional abuse in long-term child care in Scotland.
Journal of Child Abuse & Neglect, 93, 38–54. https://doi.org/10.1016/j.chiabu.2019.04.018.
Commission to Inquire into Child Abuse (2009). Report of the commission to inquire into child abuseVols. 1–5Dublin: Stationery Office Retrieved from http://www.
childabusecommission.ie.
Creswell, J. W. (2009). Research design: Qualitative and quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage.
Draucker, C. B. (2001). Learning the harsh realities of life: Sexual violence, disillusionment, and meaning. Health Care for Women International, 22, 67–84. https://doi.
org/10.1080/073993301300003081.
Easton, S. D., Coohey, C., Rhodes, A. M., & Moorthy, M. V. (2013). Posttraumatic growth among men with histories of child sexual abuse. Child Maltreatment, 18,
211–220. https://doi.org/10.1177/1077559513503037.
Easton, S. D., Leone-Sheehan, D. M., Sophis, E., & Willis, D. G. (2015). “From that moment on my life changed”: Turning points in the healing process for men
recovering from child sexual abuse. Journal of Child Sexual Abuse, 24, 152–173. https://doi.org/10.1080/10538712.2015.997413.
Elderton, A., Berry, A., & Chan, C. (2017). A systematic review of posttraumatic growth in survivors of interpersonal violence in adulthood. Trauma, Violence & Abuse,
18, 223–236. https://doi.org/10.1177/1524838015611672.
Fater, K., & Mullaney, J. A. (2000). The lived experience of adult male survivors who allege childhood sexual abuse by clergy. Issues in Mental Health Nursing, 21,
281–295. https://doi.org/10.1080/016128400248095.
Fitzpatrick, M., Carr, A., Dooley, B., Flanagan‐Howard, R., Flanagan, E., Tierney, K., & Egan, J. (2010). Profiles of adult survivors of severe sexual, physical and
emotional institutional abuse in Ireland. Child Abuse Review, 19, 387–404. https://doi.org/10.1002/car.1083.
Flanagan, E., Carr, A., Dooley, B. A., Fitzpatrick, M., Flanagan-Howard, R., Shevlin, M., & Egan, J. (2009). Profiles of resilient survivors of institutional abuse in
Ireland. International Journal of Child & Family Welfare, 12, 56–73.
Greenberg, D. M., Baron-Cohen, S., Rosenberg, N., Fonagy, P., & Rentfrow, P. J. (2018). Elevated empathy in adults following childhood trauma. PLoS One, 13(10),
e0203886. https://doi.org/10.1371/journal.pone.0203886.
Hartley, S., Johnco, C., Hofmeyr, M., & Berry, A. (2016). The nature of posttraumatic growth in adult survivors of child sexual abuse. Journal of Child Sexual Abuse, 25,
201–220. https://doi.org/10.1080/10538712.2015.1119773.
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press.
Janoff-Bulman, R. (2006). Schema-change perspectives on posttraumatic growth. In L. G. Calhoun, & R. G. Tedeschi (Eds.). Handbook of posttraumatic growth: Research
and practice (pp. 95–113). Routledge.
Kaye-Tzadok, A., & Davidson-Arad, B. (2016). Posttraumatic growth among women survivors of childhood sexual abuse: Its relation to cognitive strategies, post-
traumatic symptoms, and resilience. Psychological Trauma Theory Research Practice and Policy, 8, 550–559. https://doi.org/10.1037/tra0000103.
Lev-Wiesel, R., Amir, M., & Besser, A. (2005). Posttraumatic growth among survivors of childhood sexual abuse in relation to the perpetrator identity. Journal of Loss &
Trauma, 10, 7–17. https://doi.org/10.1080/15325020490890606.
Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress: Official Publication of the International Society
for Traumatic Stress Studies, 17(1), 11–21. https://doi.org/10.1023/B:JOTS.0000014671.27856.7e.
Lynch, J. L., & Minton, S. J. (2015). Peer abuse and its contexts in industrial schools in Ireland. Journal of Aggression, Conflict and Peace Research, 8, 76–85. https://doi.
org/10.1108/JACPR-11-2015-0199.
Marotta-Walters, S. A. (2015). Spiritual meaning making following clergy- perpetrated abuse. Traumatology, 21, 64–70. https://doi.org/10.1037/trm0000022.
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, 370–396. https://doi.org/10.1037/h0054346.
Mohr, D., & Rosén, L. A. (2017). The impact of protective factors on posttraumatic growth for college student survivors of childhood maltreatment. Journal of
Aggression, Maltreatment & Trauma, 26, 756–771. https://doi.org/10.1080/10926771.2017.1304478.
Moore, J., Flynn, M., & Morgan, M. (2019). Social ecological resilience and mental wellbeing of Irish migrant survivors of clerical institutional childhood abuse. Child
Abuse Review, 28, 52–68. https://doi.org/10.1002/car.2548.
Osman, A., Bagge, C. L., Guitierraz, P. M., Konick, L. C., Kooper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviours Questionnaire-Revised (SBQ-R): Validation with
clinical and nonclinical samples. Assessment, 5, 443–454. https://doi.org/10.1177/107319110100800409.
Pietkiewicz, I., & Smith, J. A. (2012). A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology. Czasopismo Psycholiczne,
18, 361–369. https://doi.org/10.14691/CPPJ.20.1.7.
Schaefer, L. M., Howell, K. H., Schwartz, L. E., Bottomley, J. S., & Crossnine, C. B. (2018). A concurrent examination of protective factors associated with resilience and
posttraumatic growth following childhood victimization. Child Abuse & Neglect, 85, 17–27. https://doi.org/10.1016/j.chiabu.2018.08.019.
Shakespeare-Finch, J., & de Dassel, T. (2009). Exploring posttraumatic outcomes as function of childhood sexual abuse. Journal of Child Sexual Abuse, 18, 623–640.
https://doi.org/10.1080/10538710903317224.
Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis. theory, method & research. London: SAGE.
Staub, E., & Vollhardt, J. (2008). Altruism born of suffering: The roots of caring and helping after victimization and other trauma. American Journal of Orthopsychiatry,
78, 267–280. https://doi.org/10.1037/a0014223.
Stryker, S., & Burke, P. J. (2000). The past, present, and future of an identity theory. Social Psychology Quarterly, 63, 284–297. https://doi.org/10.2307/2695840.
Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage Publicationshttps://doi.org/10.
1037/000626.
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18. https://doi.org/10.
1207/s15327965pli1501_01.

12
G. Sheridan and A. Carr Child Abuse & Neglect 103 (2020) 104430

Vollhardt, J. R. (2009). Altruism born of suffering and prosocial behaviour following adverse life events: A review and conceptualisation. Social Justice Research, 22,
53–97. https://doi.org/10.1007/s11211-009-0088-1.
Walker-Williams, H. J., & Fouché, A. (2015). A strengths-based group intervention for women who experienced child sexual abuse. Research on Social Work Practice, 27,
194–205. https://doi.org/10.1177/1049731515581627.
Walker-Williams, H. J., van Eeden, C., & van der Merwe, K. (2013). Coping behaviour, posttraumatic growth and psychological well-being in women with childhood
sexual abuse. Journal of Psychology in Africa, 23, 259–268. https://doi.org/10.1080/14330237.2013.10820622.
Willis, D., Rhodes, A., Dionne-Odom, J., Lee, K., & Terreri, P. (2015). A hermeneutic-phenomenological understanding of men’s healing from childhood maltreatment.
Journal of Holistic Nursing, 33, 46–57. https://doi.org/10.1177/0898010114552706.
Wolfe, D., Jaffe, P., Jette, J., & Poisson, S. (2003). The impact of child abuse in community institutions and organizations: Advancing professional and scientific
understanding. Clinical Psychology Science and Practice, 10, 179–191. https://doi.org/10.1093/clipsy/bpg021.
Woodward, C., & Joseph, S. (2003). Positive change processes and post‐traumatic growth in people who have experienced childhood abuse: Understanding vehicles of
change. Psychology and Psychotherapy Theory Research and Practice, 76, 267–283. https://doi.org/10.1348/147608303322362497.
Yardley, L. (2008). Demonstrating validity in qualitative psychology. Qualitative Psychology: A practical guide to research methods, 2, 235–251. https://doi.org/10.1080/
17439760.2016.1262624.

13