342 Trauma Processing Reconsidered Using Account-Making.docx

342
Trauma Processing Reconsidered:
Using Account-Making in Quantitative
Research With Male Survivors of
Child Sexual Abuse
SCOTT D. EASTON
Graduate School of Social Work, Boston College, Chestnut
Hill,
Massachusetts, USA
Account-making is a sociopsychological model that describes
the
recovery process after a traumatic event. This study examined
the
theory’s utility in quantitative research using data from a large
sample of men with histories of child sexual abuse ( N = 487).
The
three aims of the study were (a) to describe how account-
making
concepts can be operationalized, (b) to explore the relationship
between account-making and mental health, and (c) to suggest
revisions to the theoretical structure of the model. Results
suggest
that account-making is a useful framework for research with
trauma survivors and may be related to mental health.
Suggestions
for future research are provided.

KEYWORDS trauma processing, account-making, accounts,
child
sexual abuse, male survivors
The study of how survivors process loss and trauma is a
difficult task due, in
part, to the broad range of traumatic events. A recent volume of
this journal,
for example, included articles that focused on stressors as
diverse as
Received 22 March 2012; accepted 26 April 2012.
This study received financial support from the John A. Hartford
Foundation (Geriatric
Social Work Initiative) and support during recruitment from the
following organizations: the
Survivors Network of those Abused by Priests, MaleSurvivor,
1in6.org, and Dr. Jim Hopper. The
author is grateful for the generosity and courage of the men who
participated in this study.
Address correspondence to Scott D. Easton, Graduate School of
Social Work, Boston
College, McGuinn Hall, Room 207, 140 Commonwealth
Avenue, Chestnut Hill, MA 02467,
USA. E-mail: [email protected]
Journal of Loss and Trauma, 18:342–361, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1532-5024 print/1532-5032 online
DOI: 10.1080/15325024.2012.701124
Trauma Processing Reconsidered 343

pregnancy loss, bereavement, natural disasters, cancer, military
service, and
war. Despite differences in specific events, theories attempt to
integrate
common characteristics of the recovery process for survivors
and describe
how survivors process, interpret, create meaning, and adjust
after a traumatic
experience. One sociopsychological theory of trauma
processing, account-
making (Harvey, Orbuch, & Weber, 1990), posits that survivors
progress
through a series of stages in developing a narrative or account
of the event.
The purpose of this article is to assess the viability and utility
of account-
making theory in explaining trauma recovery using data from a
large sample
of men with histories of child sexual abuse (CSA).
LITERATURE REVIEW
Historical Roots of Account-Making
Account-making is a social-psychological model that describes
the adjust-
ment process of people who have encountered a severe stressor,
a traumatic
event, or a significant personal loss (Harvey et al., 1990).
Traumatic events
such as bereavement, natural disasters, or violent crimes often
shatter
commonly held assumptions of normalcy ( Janoff-Bulman &
Berger, 2000)
and increase the risk for psychological illnesses (Updegraff &
Taylor, 2001)

for survivors, including depression, anxiety, and posttraumatic
stress disor-
der. A core assumption of the account-making model is that
people who
have experienced potentially traumatic events can benefit by
developing
accounts to describe, interpret, and create meaning from the
event.
Researchers have defined accounts as “story-like constructions
of events that
include explanations, descriptions … and affective reaction”
(Harvey, Orbuch,
Chwalisz, & Garwood, 1991, p. 516).
The concept of accounts spans several academic disciplines
(e.g.,
cognitive psychology, communication studies, linguistics) but
originated in
the research of sociologists Scott and Lyman. These scholars
conceptualized
accounts as linguistic tools used by individuals to justify or
excuse actions
associated with negative events (Lyman & Scott, 1970; Scott &
Lyman, 1968).
In the mid-1970s, Weiss (1975) applied the concept of accounts
to the study
of individuals undergoing marital separation and found that they
have the
potential to help individuals organize their lives in the
aftermath of relation-
ship loss. To understand how individuals manage blame,
responsibility,
and causality during relationship dissolution, other scholars
incorporated
attribution theory in the formation of accounts (Harvey, Wells,
& Alvarez, 1978;

Orvis, Kelly, & Butler, 1976). More than a decade later, social
psychologists
expanded the definition of accounts beyond a set of attributions
following
a divorce. Harvey et al. (1990) stated, “In more recent writings,
we have continued
to define accounts as people’s explanations presented in story-
like form for
344 S. D. Easton
past actions and events that include characterizations of self and
key others
in plots … thus accounts represent more than simply collections
of disparate
attributions” (p. 192).
Social psychologists also advanced the account-making model
by
examining how people construct accounts after facing a wide
variety of
traumatic and stressful events: Vietnam veterans returning from
combat
(Harvey, Agostinelli, & Weber, 1989), older adults coping with
the death of
a spouse (Weber, Harvey, & Stanley, 1987), and adults who
experienced
sexual assaults (Harvey et al., 1991; Orbuch, Harvey, Davis, &
Merbach,
1994). Although some people begin developing accounts shortly
after the
event occurs, many people delay account construction until long
after the
event. Regardless of when account construction begins, the

cognitive and
affective process of refining an account often takes years to
complete. As a
framework to understand how individuals create meaning from
traumatic
events, accounts share common traits with other frameworks
such as narra-
tives (Gergen & Gergen, 1988), stories (Coles, 1989), and life
schemas
(Thompson & Janigian, 1988). As a process to create meaning
from a trau-
matic event, account-making shares similarities with clinical
interventions
such as narrative therapy (Sommers-Flanagan & Sommers-
Flanagan, 2004),
logotherapy (Frankl, 1984), and structured, written emotional
expression
(Butcher & Buckwalter, 2002).
Stages of the Model
In an attempt to explain how people cope with traumatic events
or severe
stressors, the pioneering research of Horowitz (1986a) led to the
develop-
ment of one of the first stress-processing models. A few years
later, Harvey
et al. (1990) adapted Horowitz’s original model to fit within
the emerging
theory of account-making. The result was a structured account-
making model
that consisted of six stages that follow a traumatic event (see
Figure 1).
In the immediate aftermath of a traumatic event (i.e., outcry
stage), the

survivor often feels shocked, overwhelmed, or numb as the
event may
severely disrupt the sense of normalcy. Horowitz (1986b)
explained that “the
person quickly processes the crude implications of the event,
has an alarm
reaction that interrupts ordinary activities, and expresses
warning signals”
(p. 241), a normal response to a shocking event. During the next
stage
(i.e., denial), the survivor may experience a cluster of cognitive,
affective,
and behavioral symptoms. Because of the intensity of the
emotions
surrounding the event, the survivor “ignores implications of
threats or losses,
forgets important problems, and experiences emotional
numbing, withdrawal
of interest in life, and behavioral constriction” (Horowitz,
1986b, p. 242).
Although some denial symptoms might be adaptive in the short
term, abnormal
denial is characterized by extreme avoidance and
countermeasures such as
excessive use of drugs or thrill-seeking (Horowitz, 1986b).
After the denial stage, the survivor may acknowledge that the
event
occurred and realize that it disrupted his or her sense of safety,
normalcy,
and continuity. In the intrusion stage of the account-making
process, the

survivor may attempt to restore a sense of equilibrium by trying
to interpret
and understand the event (i.e., initial account-making).
However, he or she
may become overpowered by the emotions associated with
recalling the
event and experience repetitive, intrusive thoughts;
hypervigilance; somatic
complaints; and difficulties with concentration. Despite
attempts to make
sense of the stressful event, the survivor may become stuck and
dwell on the
event without reaching new insights or understanding (i.e.,
obsessive review).
During the working through stage of account-making, the
survivor
intensifies processing efforts at both the cognitive and the
affective levels.
Account-making efforts can range from informal activities
consisting of
private reflection (e.g., journal keeping) to more formal
account-making that
involves interpersonal exchanges (e.g., self-help groups).
Survivors may
attempt to share the account with other people (e.g., family
members,
partners, close friends). Harvey et al. (1991) introduced the
term productive
confiding and defined it as an “interaction with other(s) that
involves [others’]
empathic and helpful response and in turn one’s own sense of
greater relief,
acceptance, clarification and direction for further coping” (p.
520). Realizing
that productive confiding does not always occur, Harvey later

added a
confiding component to the account-making model with
bidirectional outcomes
that reflect whether the response to confiding was helpful or
not.
FIGURE 1 Original account-making model.
346 S. D. Easton
After the working through stage, a survivor then progresses to
the
completion stage. At this point, he or she has fully developed a
story to
explain the cause and impact of the precipitating traumatic
event. The
account has been revised several times and now provides the
survivor with
an enhanced feeling of control and validation and a heightened
understand-
ing of the self, others, and the world. During the completion
stages, the
survivor has integrated the traumatic event into his or her life
story and
can discuss it without experiencing distress, thereby increasing
a sense of
mastery over his or her past.
The final stage of the model is identity change. While a
survivor recog-
nizes losses associated with the event, he or she has developed
adequate
coping skills, regained a sense of personal control, and attained
a sense of

self-efficacy. Successful completion of account-making can lead
to improved
mental and physical health. Alternatively, if a survivor is
unable to engage in
the account-making process (or stops in the early or middle
stages), he or
she may develop maladaptive coping patterns (e.g., substance
use), psycho-
somatic problems (e.g., stress, hypertension), or psychological
problems
(e.g., chronic grief, anxiety, depression).
Account-Making and Male Survivors of CSA
In the immediate aftermath of sexual abuse during childhood
(i.e., the outcry
stage), the sexually abused boy may feel panic, hopelessness, or
even
despair, especially because CSA often co-occurs with other
forms of abuse
(Banyard, Williams, & Siegel, 2004; MacMillan et al., 2001;
Molnar, Buka, &
Kessler, 2001). Due to cultural norms, the boy may also feel
shame from not
being able to protect himself from the abuser or from being
abused by
another male (Hunter, 2006). Alternatively, because some boys
do not label
the experience as sexual abuse (Fondacaro, Holt, & Powell,
1999; Holmes &
Slap, 1998) and are manipulated by the abuser through
psychological groom-
ing strategies (Craven, Brown, & Gilchrist, 2006), the outcry
stage for some
boys may involve feelings of confusion or ambivalence.

The next stage of the model—the denial stage—is consistent
with the
numbing theory of psychopathology for people who were
sexually abused
during childhood (Polusny & Follette, 1995). To protect himself
against
feelings of confusion or shame, a sexually abused boy may
minimize the
experience, dissociate from it, or even deny that it occurred
(Holmes, Offen, &
Waller, 1997). Avoidance coping is very common during
childhood for sexually
abused children (Sigmon, Green, Rohan, & Nichols, 1996).
Furthermore, sexually
abused boys face many obstacles to disclosure, often resulting
in “silencing”
that can last well into adulthood (O’Leary & Barber, 2008).
As denial wanes and awareness increases, “the horror of the
abuse
overpowers [CSA] survivors whose emotions had been de-
centered and
blunted to avoid the emotional pain” (Fater & Mullaney, 2000,
p. 288). In the
intrusion stage, male survivors may experience fear associated
with remem-
bering the abuse, dreams, and flashbacks. Lisak (1994) wrote:
“Perhaps the
most common experience of fear described by [male survivors
of CSA] was
of fear associated with intrusions. The intrusions might be

images of events
which then evoked fear reactions, or they might be purely
affective
intrusions—unbidden and sudden experiences of raw fear and
panic” (p. 532).
In addition to fear, the intrusions may evoke feelings of intense
anger (Fater
& Mullaney, 2000; Lisak, 1994), a possible source of
depression, anxiety, or
suicidality.
During the working through stage, male survivors attempt to
under-
stand and create meaning from the sexual abuse through various
activities.
Initially, a survivor might seek out resources and gather
information on CSA
in a confidential or private manner (e.g., self-help books,
Internet sites,
psychotherapy). Other resources include the growing number of
national
survivor organizations (e.g., Male Survivor, 1in6.org, and the
Survivors
Network of those Abused by Priests), support groups, and
online discussion
boards for male survivors. Use of these resources can help
survivors develop
and refine their account of the sexual abuse, create meaning
from the experi-
ence, and contain the negative effects of the trauma. These
activities may
also empower the survivor through an enhanced sense of control
and lead
to identity change (e.g., moving from victim to survivor) and
account
completion.

Empirical Support
To date there is modest empirical support for the benefits of the
account-making
model for mental health. A fundamental assumption of the
account-making
model is that emotional expression—an interpersonal process at
both the
affective and cognitive levels—is beneficial to the
psychological well-being
of the survivor who experiences a traumatic event. This
assumption is
supported by the influential work of Pennebaker (1985, 1989).
Other studies
have examined account-making with various populations (e.g.,
veterans;
Harvey et al., 1989) and found that account-making can have
beneficial
effects for adjustment. Harvey et al. (1991) stated that
“available evidence
suggests that well-developed accounts play a salutary role in
providing
perspective, the will to carry on, hope about the future, and
closure regard-
ing such stressors” (emphasis added) (p. 517).
Few researchers have specifically evaluated the account-making
model
with adults who experienced CSA. In one cross-sectional study
of 26 adults
with histories of nonconsensual sex during childhood (25
females, 1 male),
Harvey et al. (1991) examined how levels of account-making
activities (i.e.,
the extent to which the respondent mentioned activities in

narrative responses)
and the timing of disclosure were related to adjustment. The
researchers
reported that higher levels of account-making activities (e.g.,
journal keeping,
348 S. D. Easton
private reflection, formal therapy) were positively associated
with success-
ful coping and negatively associated with negative emotions
about the
sexual abuse experience. In a similar qualitative study of 28
adults with
histories of CSA (21 females, 7 males), Orbuch et al. (1994)
found that the
extent of account-making activities (i.e., activities such as
journal keeping,
private reflection, and formal therapy) and the completeness of
account-
making (i.e., level of understanding of the sexual abuse) were
related to
coping, close relationships, and emotional state. Orbuch et al.
(1994)
concluded that account-making activities and confiding “may
represent
invaluable acts of meaning in the recovery process of survivors
of
trauma … and may be essential to the will to recover and to
other behav-
ioral steps toward recovery” (p. 263).
By attempting to operationalize and measure components of the
account-making model, these studies (Harvey et al., 1991;

Orbuch et al.,
1994) greatly advanced our understanding of account-making in
general
and, more specifically, its relevance to special populations such
as adult
survivors of CSA. Nonetheless, the researchers acknowledged
several limita-
tions of the studies, including small sample sizes, not
controlling for gender,
self-selection bias, and nonstandardized measures. The current
study is the
first study to apply account-making to a large, nonclinical
sample of male
survivors of CSA using standardized measures of mental health.
The study
had three specific aims: (a) to describe how measures of
account-making
can be operationalized in quantitative research, (b) to explore
the relation-
ship between account-making and mental health for men with
histories of
CSA, and (c) to suggest revisions to the structure of the
account-making
model. The results of the current study will provide directions
for future
research using account-making in understanding how survivors
recover from
traumatic events.
METHOD
This study used a cross-sectional survey design with purposive
sampling
from three national survivor organizations: the Survivors
Network of those
Abused by Priests (SNAP), MaleSurvivor, and 1in6.org. Each

organization
posted a Web site study announcement; SNAP also sent
recruitment emails
to its members. After reading the announcement, potential
participants were
directed to a survey Web site with a welcome message, consent
letter, and
eligibility screening questions. Participants were eligible if they
were male,
18 years of age or older, and had been sexually abused before
the age of 18.
Interested, eligible participants completed an anonymous,
Internet-based
survey during an 8-week period in the summer of 2010.
The study received human subjects approval from the
institutional
review board at a midwestern university. Prior to
implementation, the survey
was pretested in three phases with input from national sexual
abuse and
trauma experts, clinicians, and graduate students in social work.
The final
survey consisted of 137 items, and the current study utilized a
subset of items
from the general survey.
Participants
The final sample consisted of 487 men with histories of CSA
ranging in age

from 19 to 84 years (M = 50.4 years). The level of education
was measured
on a Likert scale ranging from less than a high school diploma
(1) to a
doctorate or professional degree (8). The modal level of
education was 6
(bachelor’s degree). Most participants were Caucasian (90.9%),
living with a
spouse/partner (69.9%), and members of a national survivor
organization
(81.8%). The mean level of total household income was
$60,000–$69,000.
Measures
MENTAL DISTRESS
The measure for mental health problems was the General Mental
Health
Distress Scale (GMDS; Dennis, White, Titus, & Unsicker,
2007), a component
of a comprehensive biopsychosocial assessment, the General
Assessment of
Individual Needs (GAIN; Dennis et al., 2007). The GMDS is a
symptom count
of internal sources of distress that were experienced in the past
12 months.
For this study, the measure included 25 items related to
internalizing disor-
ders (depression, anxiety, somatization, and suicidality).
Participants selected
yes (1) or no (0) for each symptom. The measure was scored by
adding the
number of symptoms that each participant endorsed (range = 0–
25), with
higher scores indicating more psychological distress. The

clinical cut-points
were as follows: low (0–3), moderate (4–6), and high (7–25).
The Cronbach’s
alpha for the index was .904.
ACCOUNT-MAKING VARIABLES
The measures used for account stage, account development, and
other
account-making components will be described below.
Data Analysis
Data were cleaned and imported into a data file in SPSS 19.0.
There were
very little missing data in this study (generally < 3%), and data
appeared to
be missing at random. Diagnostic tests were conducted prior to
inferential
testing to examine potential problems such as influential
outliers, nonlinear-
ity, and multicollinearity. Unless otherwise noted, the results
indicated that
the assumptions were met for statistical tests. In addition to
univariate
350 S. D. Easton
analyses, bivariate tests (i.e., chi-square tests, t tests) and
interitem correla-
tions were conducted.
STAGING WITHIN ACCOUNT-MAKING

Development of Measure
To identify the stage of account-making for each participant,
the researcher
generated items that assessed characteristics of each stage as
described in
previous studies (Harvey et al., 1990). Each item was then
customized to
reflect the specific stressor of CSA. For example, one item that
assessed the
denial stage stated “Because the sexual abuse is hard to deal
with emotion-
ally, I try not to think about it.” During the process of item
construction, the
researcher consulted over a 2-year period (2008–2010) with
experts who
specialized in trauma processing models, account-making
theory, child abuse
and neglect, and clinical practice with men who were sexually
abused during
childhood (MSAC). These consultations evaluated face and
content validity
and reduced the original list of more than 20 items to six items
(see the
appendix): denial stage (Items 1, 2), intrusion stage (Items 3,
4), working
through stage (Item 5), and end stage (Item 6). The initial
outcry stage was
not measured due to the composition of the sample (i.e., mean
age of 50.4
years).
For each item, participants were asked the extent to which they
agreed
with the statement. The response choices were based on a 6-
point Likert

scale ranging from strongly disagree (1) to strongly agree (6).
The responses
were then recoded into dichotomous variables for each of the
four stages:
denial, intrusion, working through, and end. Participants who
agreed (5) or
strongly agreed (6) with the original item were assigned a score
of 1 (yes)
for the stage (no = 0).
Further analysis, however, revealed that the stages were not
mutually
exclusive. Many participants provided responses that classified
them into
multiple stages. For example, 66.5% (n = 314) of the sample
was classified as
being in the working through stage, and 39.6% (n = 187) of the
sample was
classified as being in the end stage (see Table 1). A cross-
tabulation found
that of those who met the criteria for working through, 48.4% (n
= 152) also
met the criteria for the end stage. Thus, the items were not
useful in defini-
tively classifying participants into one of the stages of the
account-making
model.
Results for Mental Health
Although the stages were not mutually exclusive, they did
measure charac-
teristics of the recovery process that may be related to mental
distress. Based

TABLE 1 Results for Account-Making Stages and Relation to
Mental Distress (N = 487).
Stage %
Mental distress
score (SD) Range
Denial
Yes 44.9 13.69 (5.92)** 0–25
No 55.1 11.57 (6.43)
Intrusion
Yes 57.9 14.68 (5.49)** 0–25
No 42.1 9.53 (6.11)
Working through
Yes 66.7 12.98 (6.02)* 0–25
No 33.3 11.68 (6.73)
End
Yes 39.4 11.69 (6.41)* 0–25
No 60.6 13.05 (6.16)
*p < .05; **p < .001.
on account-making theory, it was expected that the early
(denial) and middle
stages (intrusion, working through) would be positively related
to mental
distress and that the end stage would be negatively related to
mental distress.
Independent samples t tests were conducted and found support
for these
relationships (see Table 1). For example, participants who met
criteria for

denial had a higher score on mental distress (M = 13.69, SD =
5.92) than par-
ticipants who did not meet criteria for denial (M = 11.57, SD =
6.43),
t(476) = −3.67, p < .001. Similarly, participants who met the
criteria for the
end stage had a lower score for mental distress (M = 11.69, SD
= 6.41) than
participants who were not in the end stage (M = 13.05, SD =
6.16), t(390) = 2.29,
p < .05.
Implications
Although efforts to classify participants into a single stage of
account-making
with a scale were unsuccessful, the items that assessed
characteristics associ-
ated with each stage of account-making were useful. As
expected, the early
and middle stages of account-making were positively related to
mental
distress, and the end stage was negatively related to mental
distress. The
results of the current study are important because they provide
support for
the association between account-making stages and mental
health using a
standardized, validated measure of mental distress. Researchers
can build on
these findings by developing measures to more accurately
identify the stage
of account development for survivors at a particular point in
time. Studies
with probability samples from the general population would
allow research-

ers to measure the full range of stages. Future studies should
also examine
whether account-making varies depending on factors such as
gender, race/
ethnicity, or socioeconomic background.
352 S. D. Easton
ACCOUNT DEVELOPMENT
Development of Measure
Another goal of this study was to develop a measure of account
develop-
ment and assess its relationship to mental distress among
MSAC. Originally
the researcher generated dozens of items based on dimensions
of account
development cited in previous research with sexual assault
survivors (Harvey
et al., 1991; Orbuch et al., 1994) and conversations with
mental health
practitioners who specialize in treating MSAC. Some of the
dimensions that
were identified included naming the experience as sexual abuse,
assessing
responsibility for the abuse, understanding the response to the
abuse (by the
survivor and his caregivers), and identifying the emotional and
behavioral
impact of the CSA for the survivor. The dimension of naming
the experience
as CSA was not included because it was one of the eligibility
criteria for this

study.
Through consultations with the panel of experts, the original list
of
items was reduced to six measuring three dimensions: assessing
responsibil-
ity (Items 1 and 2), understanding the response to the abuse
(Items 3 and 4),
and understanding the impact of CSA (Items 5 and 6; see the
appendix). For
example, one item measuring responsibility read “The person
who sexually
abused me is responsible for the abuse.” The response choices
for each
item ranged from strongly disagree (1) to strongly agree (6). A
composite
measure—the Account Development Scale—was then created
by adding
scores on the six items (range = 6–36), with higher scores
indicating a more
developed account. All of the items were significantly
correlated with one
another (see Table 2). The Cronbach’s alpha for the scale was
.737.
Results for Mental Health
A Pearson’s product-moment correlation coefficient was
conducted to assess
the relationship between account development and mental
distress. The
results indicated that there was a negative relationship between
scores on
the Account Development Scale and mental distress (r = –.175,
n = 487,
p < .001).

Implications
Previous research has found a positive relationship between
account devel-
opment and coping and adjustment for sexual assault survivors
(Harvey
et al., 1991; Orbuch et al., 1994). These studies collected
qualitative data on
accounts, rated the extent and depth of the narratives, and then
examined
the relationship between account development and adjustment.
The current
study attempted to develop a scale to measure account
development and
353
T
A
B
L
E
2
I
n
te
rn
al
C

o
n
si
st
e
n
ci
e
s
an
d
I
n
te
ri
te
m
C
o
rr
e
la
ti
o
n
s

fo
r
th
e
A
cc
o
u
n
t
D
ev
e
lo
p
m
e
n
t
Sc
al
e
(
N
=
4
4
2

).
F
ac
to
r
1
2
3
4
5
6
C
o
rr
e
ct
e
d
i
te
m
to
ta

l
co
rr
e
la
ti
o
n
C
ro
n
b
ac
h
’s
a
lp
h
a
if
i
te
m
d
e
le

te
d
1
.
A
b
u
se
w
as
n
o
t
m
y
f
au
lt
—
.4
4
4
.7
0
9
2

.
A
b
u
se
r
w
as
r
e
sp
o
n
si
b
le
.5
8
6
—
.4
5
9
.7
1
5

3
.
U
n
d
e
rs
ta
n
d
m
y
r
e
sp
o
n
se
.3
5
1
.3
1
8
—
.5

7
6
.6
6
8
4
.
U
n
d
e
rs
ta
n
d
c
ar
e
g
iv
e
r’
s
re
sp
o
n
se

.2
6
9
.2
0
3
.3
8
6
—
.4
2
2
.7
3
3
5
.
U
n
d
e
rs
ta
n
d
e

m
o
ti
o
n
al
e
ff
e
ct
s
.2
6
7
.2
7
8
.4
9
3
.3
5
1
—
.5
8
0

.6
6
7
6
.
U
n
d
e
rs
ta
n
d
b
e
h
av
io
ra
l
e
ff
e
ct
s
.1
9

7
.2
8
2
.3
5
9
.2
2
9
.5
2
7
—
.4
6
1
.7
0
4
N
ot
e.
A
ll

o
f
th
e
co
rr
el
at
io
n
s
b
et
w
ee
n
i
te
m
s
w
er
e
si

g
n
if
ic
an
t
(p
<
.0
5)
.
354 S. D. Easton
then assess its relationship to mental health using a
standardized, validated
measure of mental distress. The results are consistent with
previous research
and provide support for the beneficial effects of account
development for
mental health. However, not all of the elements of account
development
were included in the Account Development Scale (e.g., naming
the experi-
ence). Future studies should more fully assess the psychometric
properties
of this scale, examine its relationship to mental health using a
probability
sample of sexual abuse survivors in the general population, and
explore
how it may be related to the stage of account development.

REVISIONS TO THE ACCOUNT-MAKING MODEL
Progression
Because survivors of trauma or severe stress may become
emotionally over-
whelmed during initial and intensified account-making efforts,
many
survivors may periodically return to the earlier stages (i.e.,
denial, intrusion).
Rather than following a linear progression through the stages of
the account-
making process, a survivor may go through regression loops to
earlier stages
during the recovery process. In describing the recovery process
during
rehabilitation from mental illness, Anthony (1993) explained
that recovery
often does not feel like a linear process, but rather one filled
with periods of
growth and setbacks. Ridgway (2001) wrote: “Recovery is an
evolving process,
one that sometimes spirals back upon itself, and may result in a
frustrating
return to active disorder after periods of positive functioning”
(p. 339).
To explore this possibility, participants in this study of male
survivors of
CSA were asked to assess their level of agreement with the
following state-
ment: “My progress toward understanding the effects of being
sexually
abused has been filled with temporary setbacks.” The response
choices were

based on a 6-point Likert scale ranging from strongly disagree
(1) to strongly
agree (6). The results for somewhat agree, agree, and strongly
agree were
17.4%, 28.0%, and 34.2%, respectively (see Table 3). Thus,
most participants
agreed with this statement (79.7%; n = 384). Because temporary
setbacks
were common in this sample, these results suggest that account-
making is
not always a linear, sequential process but rather one filled with
periods of
progress and regression. If these findings can be replicated with
other
trauma survivors, a more accurate visual representation of the
account-making
process may include bidirectional arrows or even loops
connecting the
different stages of the model.
Turning Points
Another question surrounding the account-making process is:
What propels
an individual from earlier stages to working through and
eventually
completion? Because MSAC may spend a great deal of time in
the denial and
intrusion stages and experience painful emotions when starting
to think
about or discuss the CSA experience, it is unclear what causes

them to inten-
sify account-making activities during the working through
stage. Some
research has suggested that MSAC may reach a turning point
and make a
conscious decision to deal with the effects of the CSA
experience (Harvey,
Mishler, Koenan, & Harney, 2000; Kia-Keating, Grossman, &
Sorsoli, 2005;
Lamar, 1984). One example of a turning point is that a survivor
may grow
tired of being depressed and commit himself to healing and
developing
more effective coping skills. Another example is that a survivor
may experi-
ence an unexpected or sudden revelation that may help him to
reframe his
CSA experience and commit to improving his health.
To examine this possibility, an item asked participants: “Some
adults
who were sexually abused struggle for years and then reach a
turning point
where they decide to commit to healing and improving their
health. Did you
experience such as turning point?” (no = 0, yes = 1). Overall,
57.7% (n = 276)
of the sample responded affirmatively (see Table 3). Because
the experience
of a turning point may be related to a survivor’s stage in the
account-making
process, a chi-square test of independence was conducted
between turning
point (0 = no, 1 = yes) and end stage (0 = no, 1 = yes). The chi-
square results
were significant, χ2(1, n = 472) = 50.90, p < .001. Interestingly,

77.8% (n = 144)
of the MSAC who were in the end stage reported that they
experienced a
turning point in their recovery, compared to only 44.6% (n =
144) among
participants who were not in the end stage. Thus, the findings
indicate that
TABLE 3 Results for Items for Revising the Account-Making
Model.
Item % Mean (SD) n
Experienced temporary setbacks 482
Strongly disagree 3.7
Disagree 8.1
Somewhat disagree 8.5
Somewhat agree 17.4
Agree 28.0
Strongly agree 34.2
Experienced a turning point
End stage 185
Yes 77.8**
No 22.2
Not in end stage 287
Yes 44.6
No 55.4
Engage in maintenance activities
Entire sample 4.18 (1.6) 482
End stage 4.77 (1.47)** 189
Not in end stage 3.78 (1.58) 289
**p < .001.

356 S. D. Easton
turning points may be an integral part of the account-making
process for
men with histories of CSA. Future research should explore the
possibility of
turning points for survivors of other severe stressors.
Maintenance Activities
Finally, although the model has a stage called completion (and
proponents
use the term completed account), it is unclear whether MSAC
who go through
the account-making process ever actually end their account-
making activi-
ties. Even after reaching the final stages of account-making, it
is possible that
many survivors periodically engage in activities to maintain and
advance
their progress (e.g., participating in annual rituals or memorials,
writing or
journaling, joining online discussion groups, engaging in public
advocacy
efforts related to CSA). These maintenance activities may fulfill
a role similar
to that of booster sessions in clinical treatment (Schlup,
Munsch, Meyer,
Margraf, & Wilhelm, 2009) and prevention programs (Nation
et al., 2003). If
a high percentage of MSAC in the later account-making stages
participate in
such activities, then another stage—ongoing maintenance—
could be added
to the model to reflect the ongoing, dynamic nature of the
account-making.

To examine this possibility, participants were asked the extent
to which
they agreed with the following statement: “I periodically engage
in activities
to maintain my progress in dealing with being sexually abused
(e.g., read
self-help books, attend self-help groups, volunteer).” The
response choices
were based on a 6-point Likert scale ranging from strongly
disagree (1) to
strongly agree (6). The mean score on this item for the entire
sample was
4.18 (SD = 1.6). However, additional analysis showed
differences in scores
for ongoing maintenance that were based on the stage of
account-making,
t(476) = −6.89, p < .001 (see Table 3).
Participants who were in the end stage scored higher on this
measure
(4.77; SD = 1.47) than participants who were not in the end
stage (3.78;
SD = 1.58). These results suggest that ongoing maintenance
activities may be
a common, important practice even in the later stages of the
model for men
with histories of CSA. Thus, account development may never be
“complete”
but more accurately described as an ongoing, continually
dynamic process.
Future research should explore this possibility with other
survivor
populations.
DISCUSSION

The purpose of the current study was to assess the viability and
utility of the
account-making model for understanding the recovery process
for trauma
survivors. Because account-making is an inherently subjective,
constructivist
process, most research studies to date have used qualitative
approaches.
Nonetheless, account-making may also be useful in quantitative
research
with trauma survivors. Although more work is needed to
develop and refine
measures of account stages and account development, the
current study
offers an example of how account-making constructs can be
operationalized.
It is hoped that this study will stimulate discussion of account-
making as a
framework for future research that advances our knowledge of
the recovery
process for survivors of loss and trauma.
A second aim of the study was to explore the relationship
between
account-making and mental health for trauma survivors. Among
a large,
nonclinical sample of men with histories of CSA, account-
making appears to
be related to better mental health at the bivariate level. These
findings are

consistent with previous studies on survivors of sexual assault
that found
that account-making is related to positive adjustment and
coping (Harvey
et al., 1991; Orbuch et al., 1994). The use of a standardized,
validated measure
of mental distress in the current study, however, extends the
empirical
support for account-making. Beyond coping and adjustment,
account-making
may actually be related to a reduction in psychological
symptoms (e.g.,
depression, anxiety, somatization, suicidality). If future
research replicates
these findings with other populations, account-making may have
important
implications for clinical treatment of trauma survivors.
A third aim of the study was to provide suggestions for refining
the
theoretical framework of account-making. The results suggest
that three
concepts—regression loops, turning points, and ongoing
maintenance—may
be important components that should be incorporated into the
model.
Although the results of the current study are suggestive and
based on a
specific subpopulation, it is likely that these concepts may be
applicable to
other trauma populations as well.
Many of the limitations of the data set used in the current study
(e.g.,
cross-sectional design, non-probability sample, retrospective
self-report data)

have been described elsewhere (Easton, 2011). However, in
interpreting the
results, three limitations deserve consideration. First, an aim of
the current
study was to describe how account-making concepts can be
operationalized
for quantitative research (e.g., Account Development Scale).
Although initial
reliability analyses were encouraging, the validity and
reliability of the scale
were not fully established. To develop a standardized measure
of account
development for survivors of CSA, additional research is
needed to assess
the psychometric properties of the scale in more depth. Second,
bivariate
analyses provided support for the relationship between account
stage,
account development, and mental health. Future research can
build on the
findings using advanced statistical models that control for other
variables
related to the CSA severity, disclosure, and demographic
background (e.g.,
age). Multivariate models can also handle interrelationships and
possible
interactions between variables such as account development and
stage of
account-making. Third, an important element of the account-
making
358 S. D. Easton
model—productive confiding (Harvey et al., 1991)—was not

included in the
current study. Other researchers have found that aspects of
disclosure (e.g.,
timing, discussion) were related to long-term mental health for
adult survi-
vors of CSA (e.g., O’Leary, Coohey, & Easton, 2010). Future
studies should
examine the role of disclosure in account-making and account
development
for this population.
Despite these limitations, the results suggest that account-
making is a
useful, viable theoretical framework for understanding recovery
from trauma
or loss. To complement existing qualitative research,
quantitative studies that
incorporate account-making can extend our knowledge base of
trauma
recovery. This is especially important as evidence suggests that
account-
making may promote mental health for trauma survivors.
Additionally, the
incorporation of regression loops, turning points, and ongoing
maintenance
into the model will refine the theory and more accurately
describe the trauma
recovery process.
REFERENCES
Anthony, W. A. (1993). Recovery from mental illness: The
guiding vision of the
mental health service system in the 1990s. Psychosocial
Rehabilitation Journal,
16, 11–23.

Banyard, V., Williams, L., & Siegel, J. (2004). Childhood
sexual abuse: A gender
perspective on context and consequences. Child Maltreatment,
9, 223–238.
Butcher, H. K., & Buckwalter, K. C. (2002). Exasperations as
blessings: Meaning-making
and the caregiving experience. Journal of Aging and Identity, 7,
113–132.
Coles, R. (1989). The call of stories. Boston, MA: Houghton
Mifflin.
Craven, S., Brown, S., & Gilchrist, E. (2006). Sexual grooming
of children: Review of
literature and theoretical considerations. Journal of Sexual
Aggression, 12,
287–299.
Dennis, M. L., White, M. K., Titus, J. C., & Unsicker, J. I.
(2007). Global Appraisal
of Individual Needs (GAIN): Administration guide for the
GAIN and related
measures (Version 5). Bloomington, IL: Chestnut Health
Systems.
Easton, S. D. (2011). Men who were sexually abused during
childhood: An examina-
tion of factors that influence long-term mental health.
Unpublished doctoral
dissertation.
Fater, K., & Mullaney, J. (2000). The lived experience of adult
male survivors who
allege childhood sexual abuse by clergy. Issues in Mental

Health Nursing, 21,
281–295.
Fondacaro, K. M., Holt, J. C., & Powell, T. A. (1999).
Psychological impact of child-
hood sexual abuse on male inmates: The importance of
perception of child
abuse and neglect. Child Abuse & Neglect, 23, 361–369.
Frankl, V. E. (1984). Man’s search for meaning. New York, NY:
Washington Square Press.
Gergen, K. J., & Gergen, M. M. (1988). Narrative and the self
as relationship. In L.
Berkowitz (Ed.), Advances in experimental social psychology
(Vol. 2, pp. 17–56).
Orlando, FL: Academic Press.
Harvey, J. H., Agostinelli, G., & Weber, A. L. (1989). Account-
making and formation
of expectations about close relationships. Review of Personality
and Social
Psychology, 10, 39–62.
Harvey, M. R., Mishler, E. G., Koenen, K., & Harney, P. A.
(2000). In the aftermath of
sexual abuse: Making and remaking meaning in narratives of
trauma and recovery.
Narrative Inquiry, 10, 291–311.
Harvey, J. H., Orbuch, T. L., Chwalisz, K. D., & Garwood, G.
(1991). Coping with

sexual assault: The roles of account-making and confiding.
Journal of Traumatic
Stress, 4, 515–531.
Harvey, J. H., Orbuch, T. L., & Weber, A. L. (1990). A social
psychological model of
account-making in response to severe stress. Journal of
Language and Social
Psychology, 9, 191–207.
Harvey, J. H., Wells, G. L., & Alvarez, M. D. (1978).
Attribution in the context of
conflict and separation in close relationships. In J. H. Harvey,
W. Ickes, & R. F.
Kidd (Eds.), New directions in attributional research, 2 (pp.
235–259). Hillsdale,
NJ: Erlbaum.
Holmes, G. R., Offen, L., & Waller, G. (1997). See no evil, hear
no evil, speak no evil:
Why do relatively few male victims of childhood sexual abuse
receive help for
abuse-related issues in adulthood? Clinical Psychology Review,
17, 69–88.
Holmes, W. C., & Slap, G. B. (1998). Sexual abuse of boys:
Definition, prevalence,
correlates, sequelae, and management. Journal of the American
Medical
Association, 280, 1855–1862.
Horowitz, M. J. (1986a). Stress response syndromes (2nd ed.).
Northvale, NJ: Jason
Aronson.
Horowitz, M. J. (1986b). Stress-response syndromes: A review

of posttraumatic and
adjustment disorders. Hospital and Community Psychiatry, 37,
241–249.
Hunter, S. V. (2006). Understanding the complexity of child
sexual abuse: A review
of the literature with implications for family counseling. The
Family Journal:
Counseling and Therapy for Couples and Families, 14, 349–358.
Janoff-Bulman, R., & Berger, A. R. (2000). The other side of
trauma: Towards a
psychology of appreciation. In J. H. Harvey & E. D. Miller
(Eds.), Loss and
trauma: General and close relationship perspectives (pp. 29–44).
Philadelphia,
PA: Brunner-Routledge.
Kia-Keating, M., Grossman, F. K., & Sorsoli, L. (2005).
Containing and resisting
masculinity: Narratives of renegotiation among resilient male
survivors of
childhood sexual abuse. Psychology of Men and Masculinity, 6,
169–185.
Lamar, D. F. (1984). The experience of being a survivor.
Unpublished doctoral
dissertation.
Lisak, D. (1994). The psychological impact of sexual abuse:
Content analysis of inter-
views with male survivors. Journal of Traumatic Stress, 7, 525–
548.
Lyman, S. M., & Scott, M. B. (1970). A sociology of the
absurd. New York, NY:

Appleton-Century-Crofts.
MacMillan, H., Fleming, J. E., Streiner, D. L., Lin, E., Boyle,
M. H., Jamieson,
E., … Beardslee, W. R. (2001). Childhood abuse and lifetime
psychopathology
in a community sample. American Journal of Psychiatry, 158,
1878–1883.
Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child
sexual abuse and subsequent
psychopathology: Results from the National Comorbidity Study.
American
Journal of Public Health, 91, 753–760.
360 S. D. Easton
Nation, M., Crusto, C., Wandersman, A., Kumpfer, K. L.,
Seybolt, D., Morrissey-Kane,
E., & Davino, K. (2003). What works in prevention? Principles
of effective
prevention programs. American Psychologist, 58, 449–456.
O’Leary, P. J., & Barber, J. G. (2008). Gender differences in
silencing following
childhood sexual abuse. Journal of Child Sexual Abuse, 17,
133–143.
O’Leary, P., Coohey, C., & Easton, S. D. (2010). The effect of
severe child sexual
abuse and disclosure on mental health during adulthood. Journal
of Child
Sexual Abuse, 19, 275–289.

Orbuch, T. L., Harvey, J. H., Davis, S. H., & Merbach, N. J.
(1994). Account-making
and confiding as acts of meaning in response to sexual assault.
Journal of
Family Violence, 9, 249–264.
Orvis, B. R., Kelly, H. H., & Butler, D. (1976). Attributional
conflict in young adults.
In J. H. Harvey, W. Ickes, & R. F. Kidd (Eds.), New directions
in attributional
research (Vol. 1, pp. 353–386). Hillsdale, NJ: Erlbaum.
Pennebaker, J. W. (1985). Traumatic experience and
psychosomatic disease:
Exploring the roles of behavioral inhibition, obsession, and
confiding. Canadian
Psychologist, 26, 82–95.
Pennebaker, J. W. (1989). Confession, inhibition, and disease.
In L. Berkowitz (Ed.),
Advances in experimental social psychology (Vol. 22, pp. 211–
244). San Diego,
CA: Academic Press.
Polusny, M. A., & Follette, V. M. (1995). Long-term correlates
of child sexual abuse:
Theory and review of the empirical literature. Applied and
Preventive Psychology,
4, 143–166.
Schlup, B., Munsch, S., Meyer, A. H., Margraf, J., & Wilhelm,
F. H. (2009). The efficacy
of a short version of a cognitive-behavioral treatment followed
by booster
sessions for binge eating disorder. Behaviour Research and
Therapy, 47,

628–635.
Scott, M. B., & Lyman, S. (1968). Accounts. American
Sociological Review, 33,
46–62.
Sigmon, S., Greene, M., Rohan, K., & Nichols, J. (1996).
Coping and adjustment in
male and female survivors of childhood sexual abuse. Journal of
Child Sexual
Abuse, 5, 57–75.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004).
Counseling and psychother-
apy theories in context and practice. Hoboken, NJ: Wiley.
Thompson, S. C., & Janigian, A. S. (1988). Life schemes: A
framework for understand-
ing the search for meaning. Journal of Social and Clinical
Psychology, 7,
260–280.
Updegraff, J. A., & Taylor, S. E. (2001). From vulnerability to
growth: Positive and
negative effects of stressful life events. In J. H. Harvey & E. D.
Miller (Eds.),
Handbook of loss and trauma (pp. 3–28). New York, NY:
Bruner/Mazel.
Weber, A. L., Harvey, J. H., & Stanley, M. A. (1987). The
nature and motivations of
accounts for failed relationships. In R. Burnett, P. McGhee, &
D. C. Clarke (Eds.),
Accounting for relationships (pp. 114–133). London, England:
Methuen.

Weiss, R. S. (1975). Marital separation. New York, NY: Basic
Books.
Scott D. Easton is an assistant professor in the Department of
Health and Mental
Health at the Boston College Graduate School of Social Work.
His research interests
include mental health, aging, sexual abuse, and trauma
recovery.
APPENDIX: SURVEY ITEMS
Account-Making Stages
1. Because the sexual abuse is hard to deal with emotionally, I
try not to
think about it.
2. Whenever I am reminded of the sexual abuse, I do something
to take my
mind off of it.
3. Even when I don’t want to, I can’t stop thinking about the
sexual abuse.
4. Whenever I think about the sexual abuse, I get overwhelmed
with strong
feelings.
5. I am actively working to understand how the sexual abuse has
affected my
life.

6. At first the sexual abuse was hard to deal with and I tried not
to think
about it. Later, even when I wanted to, I couldn’t stop thinking
about it.
But now I’ve worked through it and understand how the sexual
abuse has
affected my life.
Account Development
1. The sexual abuse was not my fault.
2. The person who sexually abused me is responsible for the
abuse.
3. I understand why I initially responded the way I did to the
abuse.
4. I understand why my caregivers responded the way they did
to the abuse.
5. I understand how the sexual abuse has affected me
emotionally.
6. I understand how some of my negative behaviors are related
to the sexual
abuse.
Copyright of Journal of Loss & Trauma is the property of
Routledge and its content may not be copied or
emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission.
However, users may print, download, or email articles for
individual use.

342 Trauma Processing Reconsidered Using Account-Making.docx

342 Trauma Processing Reconsidered Using Account-Making.docx

Recommended

Recommended

More Related Content

Similar to 342 Trauma Processing Reconsidered Using Account-Making.docx

Similar to 342 Trauma Processing Reconsidered Using Account-Making.docx (18)

More from lorainedeserre

More from lorainedeserre (20)

Recently uploaded

Recently uploaded (20)

342 Trauma Processing Reconsidered Using Account-Making.docx