A Theoretical Framework for Understanding Recovered Memory Experiences

Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms

OBJECTIVE

As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes.

METHOD

Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment.

RESULTS

After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge.

CONCLUSION

The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

Having permission not to remember: perspectives on interventions for post-traumatic stress disorder in the absence of trauma memory

BACKGROUND

It is possible for people to have post-traumatic stress disorder (PTSD) without memory of the trauma event, such as in drug-facilitated sexual assault. However, there is little evidence available on treatment provision for this population.

OBJECTIVE

This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PTSD without memories (PwM).

METHOD

Interpretative phenomenological analysis was used to explore the lived experience of nine women with PwM, who had sought psychological assessment/therapy. Participants were recruited via social media and completed semi-structured interviews online/via telephone.

RESULTS

Identified themes concerned two broad areas: (i) the challenges of having therapy whilst lacking memories and (ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (vs. unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having 'permission' from therapists not to remember.

CONCLUSIONS

Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients' emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory, thus supporting them to accept that not remembering is 'permitted'.

HIGHLIGHTS

• Having therapy for unremembered trauma involves unique challenges, but aspects of therapy can still be helpful.• Suggested 'dos and don'ts' for therapists include recognising the additional barriers to treatment, focussing on emotions (not memories), and normalising memory loss.

Confession, psychology and the shaping of subjectivity through interviews with victims of female-perpetrated sexual violence

Female-perpetrated sexual abuse (FSA) is often seen as rare and of little consequence. Confessing to being a victim of FSA is infrequent and often met with incredulity. Identifying as such a victim is thus often a response to an incitement to speak in the mode of confession. Interviews producing the possibility for such confessions were conducted with ten self-identified South African FSA victims and then analysed using a Foucauldian approach. In identifying as victims of FSA the participants drew on psychologised, gendered accounts of damage reflected in trauma, revictimisation, memory loss, the cycle of abuse and deviance. An analysis of these accounts demonstrates how confessional sites, such as the (psychological) interview, anchor victim worthiness in damage so that 'non-normative' victims of violence are able to see themselves in sexual violence discourse as forever compromised subjects whose healing requires rethinking the relationship between gender, sexuality, and violence in contemporary South Africa.

Tilting at Windmills: Why Attacks on Repression Are Misguided

In the November 2019 issue of Perspectives, Otgaar et al. argued that the "memory wars" persist and that "the controversial issue of repressed memories is alive and well and may even be on the rise" (p. 1072). Their thesis overlooked the well-established consensus that recovered memories of trauma may be genuine, false, or a mixture of the two and instead focused on a disputed mechanism: unconscious repression. A formal cocitation analysis identified the major publications mentioning repressed memories, but none endorsed a theory of unconscious repression. Studies of beliefs about repressed memories by the general public and other groups do not support Otgaar et al.'s thesis either because these studies did not adequately assess the key ideas defining the theory of repression. Clinical evidence is consistent with recovered memories occurring in many different forms of therapy, including ones that do not use suggestive techniques or rely on the concept of repression. Thus, Otgaar et al. have proposed the existence of a problem for which little objective evidence can be found. Continuing theoretical uncertainties about the mechanisms responsible for forgetting are less important than the general recognition since the 1990s that suggestive therapy and attempts to exhume memories are hazardous and generally inappropriate.

Memory and Forgetting

PURPOSE OF REVIEW

I summarize recent developments in understanding the phenomenology of memory in PTSD, describe the most prominent theoretical models, and outline new forms of treatment aimed at modifying the traumatic memory.

RECENT FINDINGS

Intrusive memories that have the quality of being relived in the present have been highlighted in ICD-11. Debate over whether trauma memories are disorganized has led to a distinction between global narratives that are usually well rehearsed and episodic memories of the most frightening moments when disruptions and fragmentation may occur. Attempts to prevent the initial consolidation of trauma memories have promise in prevention but face practical difficulties. Theoretical developments have led to a number of promising treatments for established PTSD including pre-retrieval propranolol and imagery rescripting. Research has suggested real possibilities to improve the prevention and treatment of PTSD by modifying trauma recall even though the theoretical basis for these interventions remains controversial.

"As Time Went On, I Just Forgot About It": Thematic Analysis of Spontaneous Disclosures of Recovered Memories of Childhood Sexual Abuse

This study was a thematic analysis of transcripts of interviews of child sexual abuse survivors discussing their experiences of recovered memories. This study included 27 English-speaking participants from 3 major Canadian cities: Montreal, Toronto, and Ottawa. Seven participants identified as male and 20 as female. Participants ranged in age from 31 to 69 with a mean age of 47. The educational background of participants ranged from 9th grade to doctoral levels. Out of the sample of 27, 21 participants reported some period of amnesia for their CSA experiences. Three primary global themes emerged in the transcripts of participants describing adult emergent recovered memories: flashbacks, triggers, and denial. Three global themes emerged in the transcripts of participants describing partially discontinuous memories: dreams/nightmares as the "how" of memory recovery, triggers, and active processes of forgetting.

Towards a cognitive and neurobiological model of motivated forgetting

Historically, research on forgetting has been dominated by the assumption that forgetting is passive, reflecting decay, interference, and changes in context. This emphasis arises from the pervasive assumption that forgetting is a negative outcome. Here, we present a functional view of forgetting in which the fate of experience in memory is determined as much by motivational forces that dictate the focus of attention as it is by passive factors. A central tool of motivated forgetting is retrieval suppression, a process whereby people shut down episodic retrieval to control awareness. We review behavioral, neurobiological, and clinical research and show that retrieval suppression leads us to forget suppressed experiences. We discuss key questions necessary to address to develop this model, relationships to other forgetting phenomena, and the implications of this research for understanding recovered memories. This work provides a foundation for understanding how motivational forces influence what we remember of life experience.

Epilogue: continuing points of contention in the recovered memory debate

Four contentious issues in the recovered memory debate are explored. Volume contributors offer differing perspectives on the generalizability of laboratory research, on the role of emotion in memory, on the prevalence of false recoveries, and on the motivations that underlie differences in opinion, especially with regard to whether the debate ought to be framed within a larger sociopolitical context. The recovered memory debate is argued to center on two ethical concerns that happen to be in conflict, equality among groups on one hand and due process protections on the other. Additional movement toward reconciliation is possible with a fair assessment of all available evidence, with a mutual understanding of differing perspectives, and with civil discourse.