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Pathways of Resilience and Recovery from Trauma for Cambodian Young People

The majority of trauma and resilience research in Cambodia has focussed on survivors of the Khmer Rouge. This qualitative study set out to discover what protective factors promote resilience in young trauma survivors who are at least one generation removed. A Grounded Theory approach offered a guiding resilience framework that shaped 40 interviews: 26 participants comprised of Cambodian young people (ages 18-30) who had experienced significant early childhood trauma and 14 key informants from the Cambodian Child Protection non-governmental organization sector. Data from the young people was collected through the use of three instruments: semi-structured interviews, a narrative timeline of events and the Connor-Davidson Resilience Scale. These instruments were used to explore factors relating to recovery, resilience and wellbeing among the Cambodian young people. Key informant interviews were conducted to help understand how the Child Protection sector assists recovery from trauma in Cambodia. Analysis of the participants’ oral narratives sought to uncover, understand and explain the phenomena of resilience and factors contributing to their recovery, in a post-Khmer Rouge contemporary Cambodian context. According to the young people, key factors contributing to their recovery included emotional regulation, faith and spirituality, opportunities for education and employment, social connectedness and meaning making. low levels of education available to the population that survived the regime; intergenerational trauma; poverty; and gender-based violence. The findings conceptualised resilience through the participant narratives which illustrated factors underpinning their recovery from trauma. These factors included: social connectedness in childhood; catalysts for change and defining moments; significant relationships post-trauma; meaning making post-trauma; the role of faith and religious communities; healing through helping; opportunities through NGO intervention; and emotional regulation. The majority of the young people demonstrated enormous tenacity for educational and economic advancement. However, their determination to succeed was challenged by the ongoing effects of their early childhood trauma, which often had been compounded by intense community stigmatisation. These effects were evident in the interviews and included: fear; sadness; anger; difficulty trusting others; and struggling with alcohol and substance Despite this, the young people showed great capacity to remarkably well and alternative coping strategies, such as turning to faith for healing. In the of deeply spiritual faith-based practices appeared to have a positive impact on the trauma survivors. Because of this, some found comfort and solace in their faith, which for some pre-existed, for it was newly young people prayer and a little bit of these participants also partially trauma and life to either supernatural individuals felt due external forces. Moreover, they were able to reframe their trauma histories as both meaningful and necessary within this context.


Introduction
The devastating outcomes of the genocide and other atrocities inflicted by the Khmer Rouge (KR) during the 1970s and the subsequent 20 years of international isolation that followed continue to have broader societal implications in Cambodia today (Bockers et al., 2011;Field et al., 2013;Wyatt et al., adult attachments later in life (Alink et al., 2009;Beckett et al., 2006;Collishaw et al., 2007;National Scientific Council on the Developing Child, 2015). Post-trauma, these positive relationships can be protective and reparative. Moreover, despite the widespread Western belief that strength of character and individual grit will triumph over adversity, research demonstrates that it is in fact the relationship with at least one supportive adult that will enable the child to develop effective coping skills (National Scientific Council on the Developing Child, 2015).
The majority of psychological research on the effects of childhood trauma in Cambodia and internationally, whether on children, adolescents or adults, tends to focus on negative outcomes of trauma such as PTSD and mental illness (Agger, 2015;Armes et al., 2019;Bremner, 2006;Kinzie et al., 1998;Steinert et al., 2015). This is in contrast to a growing body of trauma research that focuses on the concept of resilience, or an individual's ability to overcome, as the explanatory mechanism driving recovery from trauma (Antonovsky, 1987;Miles & Thomas, 2007;Overland, 2013;Van de Put & Eisenbruch, 2002). There have been various definitions of resilience; however, most of the work occurs within the Western framework and gaps exist in contextualising resilience in a non-Western environment. Broadly defined, resilience is the capacity to recover from adversity and/or withstand both physical and psychological shock (Masten, 2015). Instead of concentrating on the pathology of trauma, resilience research centres on trauma survivors who appear to have recovered from adversity and "do remarkably well" (Antonovsky, 1987;Overland, 2013). Masten and Cicchetti (2016) propose that resilience is a result of an interconnected system of supports.
They argue that multiple levels interact with each other to shape function and development, the capacity for adaption is dynamic and always changing, change is interconnected, and the systems are interdependent. These complex adaptive systems have profound implications for individuals as they are embedded in families and other systems such as peer groups, culture, community and schools. A central implication is that resilience is far from a singular trait; rather, it arises from interactions involving multiple systems and processes working in tandem simultaneously (Masten, 2018). The resilience of a traumatised child may be dependent on the resources and supports available and the many systems with which the child interacts. Caregivers, foster parents, family members and important mentors and role models are likely to have played a substantial role in this. As the child grows older they are likely to have connected with other resources and relationships outside of their primary caregiving system (Gunnar, 2006). The role of systems in building resilience was adopted in this project's approach, as all of the study participants had received non-governmental organisation (NGO) support post-trauma, which helped them connect with other resources and relationships that underpinned their resilience.
While this body of resilience research has provided context pertaining to risks mitigating and factors facilitating positive outcomes in recovery from trauma, most of the research has been conducted by Western researchers in primarily developed nations (Ungar, 2008). The emphasis here has generally been on individual and relational factors within the West. However, there are multiple variables in addition to individual and relational factors that affect a trauma survivor's recovery-such as culture www.scholink.org/ojs/index.php/assc Advances in Social Science and Culture Vol. 3, No. 3, 2021 83 Published by SCHOLINK INC. and the socio-political environment. Briere and Jordan (2004) argue that external sociocultural factors such as social inequality, poverty and the political environment, as well as inadequate social and community support, are critical factors in influencing recovery from trauma, particularly among those from multicultural backgrounds.
Research indicates that community and cultural context are important factors for trauma survivors so they may build resilience in their lives and find a sense of wellbeing (Betancourt & Khan, 2008;Masten & Obradovic, 2008;Norris et al., 2008). Research suggests that the psychological effects of trauma may be experienced and expressed across cultures in markedly different ways, which need to be addressed during the trauma recovery process (Briere & Jordan, 2004;Overland, 2013;Ungar, 2008 (Wyatt et al., 2018) and they provided some early contextual information on building resilience in Cambodia, which was present in some of their clients. It was through these discussions that stories of survival and recovery of Hagar's young people emerged.
All participants in this study are former clients of Hagar and TLC. Flame was included in this study as they employed a group of ex-Hagar clients. TLC was selected to complement the study population and was included in the research design for diversity of the participants. The young people all shared similarities in terms of having some type of early childhood trauma, which necessitated NGO intervention. The following is an overview of the three Cambodian NGOs from which the young people were recruited. trafficking, slavery and abuse and believes when healing happens, the cycle of trauma stops (Hagar International, 2019). Hagar also provides capacity-building support to NGOs and governmental partners to ensure that survivors are receiving trauma-informed care services, building capacity in each of its program countries (Hagar International, 2019 Through this program and others, TLC seeks to give individuals, families and communities the tools to build their own resilience and to overcome the adversity they face. The goal of this program is to ease their reintegration into their communities when they are released. TLC does this by providing vocational and life skills training and strengthening family connections by facilitating family visits. TLC seeks to ease the difficulties of incarceration by preparing their clients for their lives post-release. TLC does this by helping them build resilience, by ensuring that they are not "broken" at the end of their incarceration and that they are ready to face the challenges of life after prison (Gorter, 2019).

Study Aims and Objectives
This study aims to address an important gap in the current literature regarding Cambodian young people who have experienced significant trauma. The goal was to explore the concept of resilience through the lived experiences of young Cambodians who have been supported by NGOs post-trauma.
The participants of this study were all Cambodian young people who had experienced traumatic events in their childhood, yet appeared to be doing remarkably well. How did they manage this? What has helped them move forward and cope with events of the past? The aim of this study was to understand what factors had enabled their recovery by collecting qualitative data that could help understand their lived experiences.
Accordingly, the research question is as follows: What factors promote resilience and recovery from trauma in Cambodian young people?
In addition to answering this overarching question, the research sought to address the following four objectives: 1) Understand the characteristics of a young person's interpersonal relationships with family, friends and their wider community.
2) Explore young peoples' perception of their own personal effectiveness in their daily lives.
3) Explore young peoples' self-care strategies and capacity to manage stress.

4) Identify strategies NGOs implement to foster wellbeing and resilience among their clients in their
intervention.

Methodology
This researcher is a member of the Australian Association of Social Workers (AASW) and bound by the

Participant Characteristics
The following table of participant characteristics gives an overview of the young people in terms of differences and similarities captured:

Trauma History
Participants had varying trauma histories, from sexual exploitation to labour trafficking, incarceration, poverty, violence and/or abuse.

Education
Most participants from Hagar and Flame had completed university. None of the young people from TLC had completed university and the majority had no more than a primary school education.

Employment
All participants were in some kind of paid employment, varying from construction and manual labour-type roles, to university lecturers and medical professionals.

Affiliations
Although the NGOs do not proselytise, many of the participants from Christian NGOs Hagar and Flame identified as Christian. This resulted in a much higher proportion of Christians partaking in the study than is reflective of Cambodia's religious denomination demographics (Cambodia is a Theravada Buddhist majority nation). TLC is secular and the participants' religious affiliations were predominately Buddhist.

Family of Origin
Over half of participants from Hagar and Flame were orphans and had limited kinship support in their early life. This was in direct contrast to TLC participants who all had at least one parent with whom they were connected.

Qualitative Design
A biographical interpretive method was used in the form of a one-hour interview, supported by a timeline and resilience scale. The Connor-Davidson Resilience Scale is a widely used instrument for measuring resilience and its Khmer translation (Kh-CD-RISC-10) was used for this study. Kh-CD-RISC-10 has been used by researchers in Cambodia investigating the levels of self-reported resilience among Cambodian adolescents (Duong & Hurst, 2016). The Kh-CD-RISC-10 remains the only recognised Khmer version of resilience scales and importantly, was not used as a standalone measure of resilience. Instead, was used to explore the subjective reality of the diverse group of young people in this study.
The use of timelines in narrative research has been used in the study of resilience with marginalised groups of young people to support and situate semi-structured interviewing (Rose, 2007). Narrative timelines build rapport, utilising participants as navigators, allowing for therapeutic moments with positive closure (Kolar et al., 2015). Research has shown that through a visual representation and construction of a participant's life, a researcher can remain focused on the study objectives, moving the interview along to meet time constraints and ensuring marginal emotional distress by redirecting a participant's attention when they appear to be showing signs of distress (Berends, 2011;Kolar et al., 2015;Sheridan et al., 2011). By using a relatively unstructured timeline and keeping the instructions broad, the study remained exploratory, aiming to identify recovery resources and processes among participants. Using this approach highlighted the coping strategies, strengths and ingenuity of the study participants. Open-ended questions were used as prompts during the interview to highlight important events in an individual's life story, as well as visual pictures on the timeline that guided the interview.
Data obtained from the interviews was analysed using the Kh-CD-RISC-10 scale and NVivo v.12.
Coding was then used to break down the core themes during each stage of the analysis. Interactive thematic analysis began when there was enough data to provide accurate descriptions of themes.

Result
The young people interviewed were all affected by complex sociocultural and environmental dynamics, many of which stem from the ongoing challenges faced by Cambodia in the aftermath of the KR regime and societal unrest that followed. These challenges include: low levels of education available to the population that survived the regime; intergenerational trauma; poverty; and gender-based violence.
Key themes in relation to the young people's recovery from trauma began to emerge and intersected with the sociocultural challenges mentioned above. These themes were identified as: early childhood experiences; the shadow of the KR; rural poverty; violence; gender; being orphaned; community  succeed was challenged by the ongoing effects of their early childhood trauma, which often had been compounded by intense community stigmatisation. These effects were evident in the interviews and included: fear; sadness; anger; difficulty trusting others; and struggling with alcohol and substance abuse. Despite this, the young people showed great capacity to do remarkably well and many developed alternative coping strategies, such as turning to faith for healing. In the backdrop of Cambodia's deeply spiritual roots (Harris, 2008), faith-based practices appeared to have a positive impact on the trauma survivors. Because of this, some found comfort and solace in their faith, which for some pre-existed, while for others it was newly found. For the young people of faith, the difficulties and challenges in one's life could be met with prayer and a little bit of "magic." Furthermore, these participants also partially attributed their motivation to overcome past trauma and thrive in life to either being on God's path or supernatural forces. These individuals felt that they were predestined to succeed due to external forces. Moreover, they were able to reframe their trauma histories as both meaningful and necessary within this context.
Additionally, supporting and mentoring other young trauma survivors and the role of faith appeared to have a direct correlation with the success of the young people's ability to overcome adversity.
Leadership roles were found to be a way for the young people to thrive in the face of a society and culture which continually told them that they would never amount to anything because of their trauma histories. Participants with higher education viewed these roles not only as a path to economic security and advancement, but also as a societal status symbol. In fact, they believed their higher education distinguished them from the vast majority of the Cambodian population. They also saw higher education as an attribute that made them positive role models for mentoring young people with trauma histories like themselves. Having education also mitigated these young people's feelings of being stigmatised by their communities, as it both enabled them to feel positively about themselves and also helped them feel that they had something to offer others who looked up to and admired them. Many of these informants spoke of success in terms of financial independence and societal reintegration for their clients, which was often contingent on education and training opportunities offered by the NGOs.

Discussion
The analysis indicated that the young people constructed meaning in their lives using two different yet parallel pathways of recovery. The first pathway was understood through healing through helping others, by which the participants could reframe their lived experiences in meaningful ways. The second pathway was built upon the experience of being a part of a collectivist society and contributing to their family unit. It was through these avenues that a moral framework for personal conduct was shaped, which was further informed by the participants' early significant relationships. Participants had learned life lessons from those they had loved and often lost, which laid a foundational moral rubric and a series of ways of surviving and of relating to people. As the pathways shared common themes, the young people had moral beliefs that they either learned in church or in their Buddhist communities, which had been internalised and practiced.
The findings indicate that Cambodian communities need to support trauma survivors and truly encourage trust and empowerment. The young people in this study were all recovering from early childhood trauma and the pathways they took to build resilience (individualist or collectivist) diverged largely due to important social and community factors. Those experiencing community stigma and/or rejection, such as those who had been orphaned and had lived as street children, most often took the individualist route, as survival coping strategies they learned were centred on their self-reliance. Those who maintained their communities and families of origin took the collectivist route and their resilience was built upon their ability to contribute to their families and the social connectedness they were able to find there as well as in their communities at large. In addition, the findings indicate that underpinning the recovery of participants across both groups was the opportunity for economic empowerment and advancement, which was supported by key relationships these individuals had in their life post-trauma. The similarities and differences between the pathways to recovery from trauma will be discussed in detail in the following sections using an individualist-collectivist framework to differentiate the construction of meaning within the context of the two pathways (Jayawickreme et al., 2012;Nicely, 2019).

Significant Adult (0-2) Trust
All participants had a stable connection with a significant adult before the age of 2, even in instances where there was abuse at the hands of a parent in their early childhood. It was in the next stage of childhood development where a divergence occurred among the groups of young people, which highlights how some young people struggled to trust others post-trauma. Some of the comments made by members of the individualist group suggested that they had learned survival techniques from living on the streets, which spoke to this group's overall self-reliance.
The significance of close relationships for participants early in life was then carried over to later stages in www.scholink.org/ojs/index.php/assc life and was a positive indicator for building resilience. This has been noted in virtually every study on resilience development during the past half-century (Masten, 2015). Accordingly, it is unsurprising as all of the participants across both individualist and collectivist groups had one stable and loving parent or caregiver before the age of 2, were capable of forming trusting relationships later in life after experiencing significant trauma. This helped facilitate their resilience in their recovery, despite the different pathways taken. It is proposed that these early attachments served as the basis for the development of resilience in the young trauma survivors.

Coping with Trauma: Individualist Survival Strategies vs. Collectivist Family/Community Support
Findings indicated that the coping methods of the participants were aided by their having social supports, such as faith, working with others and community resources, all of which helped them develop a sense of belonging through social connectedness. Across both groups, the data showed that the young people's ability to cope was further facilitated by societal advancement opportunities which could provide them with a sense of purpose. Active coping mechanisms described by participants included sharing with someone they trusted and providing self-encouragement. For many of the individualists, helping others in their recovery from adversity was an active coping mechanism used to transform their early childhood trauma into a source of strength and resilience. Passive coping strategies used by many participants included avoidance, patterns of distrust and disengagement.
Distrust of others emerged as a survival mode of interaction for many participants. Recovery from Additionally, many participants found a sense of purpose through mentoring and working with others.
These perceived social supports appeared to aid emotional regulation and active coping mechanisms for many of the young people across both groups. The data indicated that these young people were taught by significant adults around them, such as parents, counsellors and teachers, how to effectively regulate stress and other negative emotions. In instances where the participants lacked strong examples of how to positively cope with stress, these individuals engaged in more destructive coping behaviours, such as alcohol use and substance abuse.
Intergenerational trauma, as well as social and historical factors in Cambodia, create a social legacy of trust issues, which includes the breakdown of community support systems. Cultural context in combination with other environmental factors, is internalised during childhood development and importantly includes trust. As trust is both a cultural and psychological attitude, this is influenced by Cambodia's collective experiences and intergenerational trauma stemming from the KR regime and its aftermath. Patterns of distrust that developed during the war and at the refugee camps during the KR  However, despite many of the young people in both groups being able to mobilise social resources and empower themselves post-trauma, their pathways to recovery were complicated by various expressions of trauma responses in adulthood.

Expressions of Trauma in Adulthood
The findings of this study characterise the journey to recovery as a complex, challenging and continuing process for many survivors. Most of the participants self-reported struggles with emotional regulation and other expressions of trauma, such as coping with alcohol and/or substance abuse. Many participants in the individualist group found comfort and solace in their faith and religious practices as a way of navigating negative emotions and understanding what had happened to them. Some reported intense moments of sadness or acting out in anger, while others struggled with substance abuse.
However, the trauma responses present in some participants did not detract from their overall levels of resilience, suggesting that recovery is not a linear trajectory. Although many of the participants still struggled with coping effectively with their past trauma, they still had managed to find success in many areas of their lives, indicating varying degrees of resilience and illustrating how recovery from trauma is an ongoing process. Notably, none of the participants communicated or reported suffering from the The way the young people in both groups interpreted the meaning of their lived experiences could have given them understandings, interpretations and reasons for behaving in a particular way. Participant narratives were grounded in a system of meaning derived from their lived experiences, with either individualist or collectivist worldviews. The findings indicated that many had constructed meaning from their traumatic experiences through faith, helping others, connection, and sense of belonging to a family of their own.
Two different religious systems for creating meaning emerged from the data, which were essential in informing the participants' individual worldviews. While the collectivist group still maintained family and community bonds and were overwhelmingly Buddhist like their families of origin, the individualist orphans were mostly Christian. Different faith backgrounds translated to a differences in how these individuals found meaning in their worlds post-trauma. The individualist Christian participants tended to interpret their world with a more postmodern belief of freedom and autonomy. This is in contrast to individuals from the mostly Buddhist collectivist group who understood their world through maintaining gainful employment, being present within the context of their family unit and participating in community-oriented religious gatherings and rituals. As by-products of their Cambodian Buddhist communities, these individuals found meaning in life through merit-building activities, many of which involved direct participation in community and religious events and gatherings, which in turn fostered a sense of belonging.
Across both groups, the aspect of meaning appears to have helped some of the young people tolerate their experiences in the midst of trauma. Upon reflection on their traumatic lived experiences, the majority of the young people in the individualist group were able to construct meaning by connecting who they are today with what had happened to them during childhood. Here it should be further noted that unlike the collectivist group, the majority of the individualist group were also highly educated and this could have affected these individuals' ability to verbalise how they created meaning in their lives, in addition to their faith background. Contrastingly, the lesser educated, collectivist, Buddhist participants did not speak about faith in the same way as the individualist Christian participants. Instead, the collectivist group appeared to create meaning through social connection and being a part of their family and community, with many participants emphasising the value they placed on having a family.
This differed for the individualist participants who found meaning through working with others and many of whom found meaning in their personal lives by contextualizing themselves as "being on God's path." Faith was not central for all participants, as one participant from the individualist group reported non-religious or agnostic belief systems. Even so, this participant still spoke about freedom and www.scholink.org/ojs/index.php/assc wanting to take care of their family as their primary motivating factor to move forward from their trauma history.
By establishing safety and support, providing opportunity and education, and working in NGOs helping others has enabled the young people to find meaning in their lived experiences post-trauma. One of the avenues for the young people from the individualist group to find meaning in their lives post-trauma was telling their stories and working with other survivors. Many of these participants spoke of wanting to help others. The findings indicated that being a role model in the community could serve as a source of pride for these individuals. This process of giving back and mentoring youth may have helped these individuals find meaning in their lives. Moreover, it appeared across both groups success in life did not appear to be measured by financial wealth, but through connection to others. Leadership, mentoring and working with/supporting others were mentioned frequently by the individualist group and supporting the family unit was of a high priority for collectivist participants. For most of the participants across both groups, having experienced stigma and disconnection from community throughout their lives, creating their own families and inspiring other young people is the ultimate in meaning making.
The narratives of Cambodian young people and the NGOs that support them, were instrumental in understanding how survivors constructed meaning in their lives post-trauma, which enabled recovery.
Study participants demonstrated their resilience by being able to adapt to life after experiencing trauma despite encountering some personal challenges. The findings illustrated several important underlying factors that supported recovery from trauma including: having positive role models; cultivating the ability to regulate emotions; finding the capacity to understand trauma in the context of meaning making aided by faith; being presented with economic advancement opportunities including education; and forming healthy relationships. All of these complex interactions between the individual and their wider environment, including how they make meaning and understand their surroundings, demonstrated the complexities of recovery from trauma.