Motivated forgetting and misremembering: perspectives from betrayal trauma theory

When Institutions Harm Those Who Depend on Them: A Scoping Review of Institutional Betrayal

The term institutional betrayal (Smith and Freyd, 2014) builds on the conceptual framework of betrayal trauma theory (see Freyd, 1996) to describe the ways that institutions (e.g., universities, workplaces) fail to take appropriate steps to prevent and/or respond appropriately to interpersonal trauma. A nascent literature has begun to describe individual costs associated with institutional betrayal throughout the United States (U.S.), with implications for public policy and institutional practice. A scoping review was conducted to quantify existing study characteristics and key findings to guide research and practice going forward. Multiple academic databases were searched for keywords (i.e., "institutional betrayal" and "organizational betrayal"). Thirty-seven articles met inclusion criteria (i.e., peer-reviewed empirical studies of institutional betrayal) and were included in analyses. Results identified research approaches, populations and settings, and predictor and outcome variables frequently studied in relation to institutional betrayal. This scoping review describes a strong foundation of published studies and provides recommendations for future research, including longitudinal research with diverse individuals across diverse institutional settings. The growing evidence for action has broad implications for research-informed policy and institutional practice.

Neural differentiation of emotional faces as a function of interpersonal violence among adolescent girls

Interpersonal violence (IV) is associated with altered neural threat processing and risk for psychiatric disorder. Representational similarity analysis (RSA) is a multivariate approach examining the extent to which differences between stimuli correspond to differences in multivoxel activation patterns to these stimuli within each ROI. Using RSA, we examine overlap in neural patterns between threat and neutral faces in youth with IV. Participants were female adolescents aged 11-17 who had a history of IV exposure (n = 77) or no history of IV, psychiatric diagnoses, nor psychiatric medications (n = 37). Participants completed a facial emotion processing task during fMRI. Linear mixed models indicated that increasing hippocampal differentiation of fear and neutral faces was associated with increasing IV severity. Increased neural differentiation of these facial stimuli in the left and right hippocampus was associated with increasing physical abuse severity. Increased differentiation by the dACC correlated with increasing physical assault severity. RSA for most ROIs were not significantly associated with univariate activity, except for a positive association between amygdala RSA and activity to fear faces. Differences in statistically significant ROIs for physical assault and physical abuse may highlight distinct effects of trauma type on encoding of threat vs. neutral faces. Null associations between RSA and univariate activation in most ROIs suggest unique contributions of RSA for understanding IV compared to traditional activation. Implications include understanding mechanisms of risk in IV and trauma-specific treatment selection. Future work should replicate these findings in longitudinal studies and identify sensitive periods for neural alterations in RSA.

Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions

Introduction

Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT.

Aim

To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them.

Methods

Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified.

Results

40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics.

Conclusion

This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.

A Systematic Review of Children's Perspectives of Fathers who Perpetrate Intimate Partner Violence

Exposure to intimate partner violence (IPV) between parents or caregivers can result in lifelong mental, physical, and relational challenges for children. Although the impacts of IPV on children are well documented, the aim of this systematic review was to be the first to synthesize the literature on children's perspectives of fathers who have perpetrated IPV. Five electronic databases were searched using a string of search terms relating to the variables of interest. In total, 11,40 records were obtained from the database search. Screening based on a strict inclusion and exclusion criteria yielded 24 qualitative articles addressing the perceptions of children concerning fathers who perpetrate IPV. Research capturing the views of children regarding fathers who perpetrate IPV is scant. The current review highlights that children experience a range of feelings about their perpetrating fathers, including fear, anger, hatred, as well as ambivalence and love toward their father and children often have difficulty integrating contradictory experiences of their fathers' behaviors. Father-child relationships are severely affected by IPV, including their fathers' use of coercive control, even after the parents have separated. Finally, children's experiences of their fathers' attempts at behavior change varied. More research is needed to understand the views of children in this area, with consideration given to children's developmental stage and the type of IPV experienced. Recommendations for research and interventions for children and families are emphasized further within this review.

A meta-analysis of childhood maltreatment in relation to psychopathic traits

Psychopathy is a personality disorder characterized by a mix of traits belonging to four facets: affective (e.g., callous/lack of empathy), interpersonal (e.g., grandiosity), behavioral instability (e.g., impulsivity, poor behavioral controls), and social deviance (e.g., juvenile delinquency, criminal versatility). Several scholars have argued that early childhood maltreatment impacts the development of psychopathy, although views regarding its role in the four facets differ. We conducted a meta-analysis including 47 studies comprising a total of 389 effect sizes and 12,737 participants, to investigate the association between psychopathy and four types of child maltreatment: physical abuse, emotional abuse, neglect, and sexual abuse. We found support for a moderate link between overall psychopathy and childhood physical abuse, emotional abuse, and neglect, as well as overall childhood maltreatment. The link between psychopathy and childhood sexual abuse was small, but still statistically significant. These associations were stronger for the behavioral and antisocial facets than for the affective and interpersonal facets of psychopathy, but nearly all associations were statistically significant. Our findings are consistent with recently developed theories on the role of complex trauma in the development of severe personality disorders. Trauma-focused preventive and therapeutic interventions can provide further tests of the trauma-psychopathy hypothesis.

When solidarity hurts: (Intra)cultural trust, cultural betrayal sexual trauma, and PTSD in culturally diverse minoritized youth transitioning to adulthood

Sexual trauma is associated with PTSD, with perpetrators putting women and girls more at risk than men and boys. Young adulthood is a time where risk of victimization and susceptibility to mental health problems increase. Certain contributors of costly trauma outcomes may be affected by the larger context of societal inequality. Cultural betrayal trauma theory (CBTT) highlights cultural betrayal in within-group trauma in minoritized populations as a dimension of harm that affects outcomes. In CBTT, within-group trauma violates the (intra)cultural trust-solidarity, love, loyalty, connection, responsibility-that is developed between group members to buffer against societal inequality. This violation, termed a cultural betrayal, can contribute to poorer mental health. The purpose of the current study is to address a gap in the CBTT literature by examining the role of (intra)cultural trust on the association between cultural betrayal sexual trauma and symptoms of PTSD among diverse minoritized youth transitioning to adulthood. Participants (N = 173) were diverse minoritized college students, who completed a 30-min online questionnaire at a location of their own choosing. Participants received course credit and could decline to answer any question without penalty. The results reveal that the interaction between cultural betrayal sexual trauma and (intra)cultural trust predicted clinically significant symptoms of PTSD. These findings have implications for increased cultural and contextual specificity in trauma research in minoritized populations, which can aid in the development and implementation of culturally competent interventions for diverse minoritized youth survivors of sexual trauma.

Internalization and Opposition to Stigmatized Social Discourse among Incest Survivors

Despite the high prevalence of incest, survivors are reluctant to disclose its existence for reasons such as shame, guilt and the presence of an accusatory and stigmatizing social discourse. The current mixed methods study examined the internal discourses of 13 incest survivors in Israel, reflected in self-reported internal dialogs which emerged during interviews. The qualitative analysis revealed a dialectical tension between two themes - one reflecting an internalization of the social discourse (manifested as quotes taken from social discourse and uttered by the survivors) and the other an agentic discourse (manifested in utterances either resisting the social discourse or showing an empowering advertence to one's own fulcrum). The quantitative analysis showed that for seven participants the internalized social discourse expressions were most frequent, for five the agentic expressions were most frequent, and that for one the discourses were at equilibrium. The ubiquitous sub-themes manifested in the internalized social discourse were: victimhood (feelings of vulnerability and helplessness), survivorship (meaningless existence, despair and hopelessness), negative self-esteem and self-pathology (perception of the self as having pathological psychological problems), and denial/repression of the abuse. The ubiquitous sub-themes manifested in the agentic discourse were: positive self-image and sense of potency, hope, optimism and positive perception of life, and uprising against the parents and institutions that did not give support. The discussion is based on Butler's concept of vulnerability, which suggests how to address the harms inflicted by incest without erasing aspects of the survivors' agency and growth.

Cultural Betrayal as a Dimension of Traumatic Harm: Violence and PTSS among Ethnic Minority Emerging Adults

According to cultural betrayal trauma theory, within-group violence confers a cultural betrayal that contributes to outcomes, including symptoms of posttraumatic stress disorder (PTSS). Close relationship with the perpetrator, known as high betrayal, also impacts PTSS. The purpose of the current study is to examine cultural betrayal trauma, high betrayal trauma, and PTSS in a sample of diverse ethnic minority emerging adults. Participants (N = 296) completed the one-hour questionnaire online. Hierarchical linear regression analyses revealed that when controlling for gender, ethnicity, and interracial trauma, high betrayal trauma and cultural betrayal trauma were associated with PTSS. Clinical interventions can include assessments of the relationship with and in-group status of the perpetrator(s) in order to guide treatment planning with diverse survivors.

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.

The "3 Es" of trauma-informed care in a federally qualified health center: Traumatic Event- and Experience-related predictors of physical and mental health Effects among female patients

Federally Qualified Health Centers (FQHCs) are a fast-growing source of healthcare for women with intersectional identities, or those most frequently exposed to and negatively impacted by interpersonal trauma. According to the "3 E" conceptualization of trauma, certain Event- and Experience-related characteristics of a trauma predict victims' physical and mental health Effects. The "3 Es" have yet to be studied in female FQHC patients. The current study examined the prevalence of interpersonal trauma and interrelationships among traumatic Event-related factors (e.g., cumulative trauma by victim-perpetrator relationship), Experience-related factors (e.g., betrayal, resilience), and Effects (e.g., somatic symptoms, posttraumatic stress (PTS), anxiety/depression, mistrust, reduced sense of safety) among 138 predominantly Black (89.1%) women receiving care at an FQHC in the southeastern U.S. Roughly 65% of participants (n = 86) endorsed exposure to at least one type of interpersonal trauma. More cumulative trauma was significantly correlated with more somatic, PTS, and anxious/depressive symptoms, and a reduced sense of safety. Experiences of betrayal and/or resilience were better predictors of PTS and anxious/depressive symptoms and lack of safety than Event-related factors. Findings support the need for the implementation of trauma-informed care within community-based health centers. Healthcare providers should consider women's subjective experience of trauma when screening for exposure and providing trauma-sensitive care.

Gendered Sexual Violence: Betrayal Trauma, Dissociation, and PTSD in Diverse College Students

Young adults' transition into college includes risk for onset of mental health problems and sexual violence, particularly for women. Compared to men and boys, women and girls across the lifespan are more likely to be sexually abused, with the perpetrators often being someone close to them. High betrayal trauma is linked to varied mental health outcomes. Despite literature depth, many samples are not ethnically diverse, which results in uncertainty about the generalizability of these findings outside of majority White American populations. The purpose of the current study is to assess gender and high betrayal in sexual violence and mental health outcomes among ethnically diverse college students in the U.S. Participants (N = 368) were ethnically diverse college students attending a public university in the Pacific Northwest, who completed online measures assessing sexual violence and mental health outcomes. When controlling for medium betrayal sexual trauma (perpetrator: unclose other), the associations between high betrayal sexual trauma and dissociation and anxiety, respectively, were moderated by the female gender. The findings point to the utility of relational cultural therapy as a feminist framework that can identify sexism as a contributing factor to young women's increased risk for sexual violence and associated mental health problems.

Exploring an Emerging Measurement Issue in Older Adult Maltreatment: Exploitation of Older Adults' Residences

Despite nationwide housing challenges that might lead to the exploitation of older adults' housing resources, exploitation of older adults' residences has not been a focus of measurement in the rapidly developing field of elder abuse and neglect. Rather, measures of older adult abuse and exploitation used in the research literature emphasize specific property, money, or resources being taken. Two composites are used to illustrate exploitation of older adults' residences by trusted others on whom the older adults depended with potentially serious implications for environmental safety and ultimately the older adults' housing stability. As part of a larger study on older adult maltreatment, police reports were coded for abuse and financial exploitation as well as misuse of the older adult's residence that threatened the older adult's housing security and/or exerted control over the older adult. Nearly one in ten (9.2%) police reports involving older adult victims and known/trusted perpetrators described exploitation of residences. Residence exploitation was separable from financial exploitation and less likely to co-occur with neglect. Considering the importance of housing stability to older adult well-being, consequences of maltreatment by a known/trusted other, and a national housing crisis, we propose that exploitation of older adults' residences warrants further measurement and practice attention. Findings are relevant to advancing theory in older adult maltreatment (e.g., application of white-collar crime versus betrayal trauma and family violence theories).

The Return of the Repressed: The Persistent and Problematic Claims of Long-Forgotten Trauma

Can purely psychological trauma lead to a complete blockage of autobiographical memories? This long-standing question about the existence of repressed memories has been at the heart of one of the most heated debates in modern psychology. These so-called memory wars originated in the 1990s, and many scholars have assumed that they are over. We demonstrate that this assumption is incorrect and that the controversial issue of repressed memories is alive and well and may even be on the rise. We review converging research and data from legal cases indicating that the topic of repressed memories remains active in clinical, legal, and academic settings. We show that the belief in repressed memories occurs on a nontrivial scale (58%) and appears to have increased among clinical psychologists since the 1990s. We also demonstrate that the scientifically controversial concept of dissociative amnesia, which we argue is a substitute term for memory repression, has gained in popularity. Finally, we review work on the adverse side effects of certain psychotherapeutic techniques, some of which may be linked to the recovery of repressed memories. The memory wars have not vanished. They have continued to endure and contribute to potentially damaging consequences in clinical, legal, and academic contexts.

Group dynamics as a predictor of dissociation for Black victims of violence: An exploratory study of cultural betrayal trauma theory

Violence victimization is prevalent in the US and is linked to costly mental health outcomes, including dissociation and posttraumatic stress disorder (PTSD). Black Americans are at increased risk for violence victimization, while additionally enduring racism that impacts mental health. Moreover, discrimination affects outcomes of violence. Cultural betrayal trauma theory (CBTT) is a new framework for examining the impact of within-group violence victimization (termed cultural betrayal trauma) and minority status on outcomes. Furthermore, CBTT examines posttraumatic group dynamics, such as (intra)cultural pressure. As pressure to protect the minority in-group by not disclosing cultural betrayal trauma, (intra)cultural pressure may impact outcomes. The purpose of the exploratory study was to examine the impact of cultural betrayal trauma and (intra)cultural pressure on dissociation and posttraumatic stress symptoms (PTSS). Participants (N = 43) were Black/African American university students who completed online measures assessing violence victimization and outcomes. Linear regression analyses revealed that cultural betrayal trauma predicted PTSS, whereas (intra)cultural pressure predicted dissociation. The current study has implications for examining the impact of group dynamics, such as (intra)cultural pressure, in clinical interventions for Black victims of cultural betrayal trauma. Such cultural competency in mental health care treatment may help reduce mental health disparities.

Reports of recovered memories of childhood abuse in therapy in France

Recovered memories of abuse in therapy are especially controversial if the clients were not aware they were abused before therapy. In the past, such memory recovery has led to legal action, as well as a debate about whether such memories might be repressed, forgotten, or false memories. More than two decades after the height of the controversy, it is unclear to what degree such memories are still recovered today, and to what extent it occurs in France. In our French survey of 1312 participants (M_age = 33; 53% female), 551 reported having done therapy at some point. Of that 551, 33 (6%) indicated they had recovered memories of abuse in therapy that they did not know about before therapy. Sexual abuse was the most commonly reported type that was recovered in therapy (79%). As in past research, discussing the possibility of repressed memories with therapists was associated with reports of recovered memories of abuse. Surprisingly, memory recovery occurred just as much in behavioural and cognitive therapies as it did in therapies focused on trauma. We found recovered memories in a proportion of clients who began therapy recently. Recovered memories in therapy appears to be an ongoing concern in France.

Isn't It All About Victimization? (Intra)cultural Pressure and Cutural Betrayal Trauma in Ethnic Minority College Women

Cultural betrayal trauma theory proposes that intraracial trauma in ethnic minority populations includes a cultural betrayal that contributes to outcomes, such as symptoms of PTSD (posttraumatic stress disorder; posttraumatic stress symptoms [PTSS]), dissociation, and (intra)cultural pressure. Participants (n = 179) were ethnic minority female college students, who completed online questionnaires. The results revealed that when controlling for age, ethnicity, and interracial trauma, intraracial trauma and (intra)cultural pressure affected PTSS and dissociation. There were also indirect effects of cultural betrayal trauma on outcomes through (intra)cultural pressure. The current study can contribute to clinical interventions that address trauma-related mental health in ethnic minority college women.

Memory experts' beliefs about repressed memory

ABSTRACTWhat we believe about how memory works affects the decisions we make in many aspects of life. In Patihis, Ho et al. [Patihis, L., Ho, L. Y., Tingen, I. W., Lilienfeld, S. O., & Loftus, E. F. (2014). Are the "memory wars" over? A scientist-practitioner gap in beliefs about repressed memory. Psychological Science, 25, 519-530.], we documented several group's beliefs on repressed memories and other aspects of how memory works. Here, we present previously unreported data on the beliefs of perhaps the most credible minority in our dataset: memory experts. We provide the statistics and written responses of the beliefs for 17 memory experts. Although memory experts held similarly sceptical beliefs about repressed memory as other research-focused groups, they were significantly more sceptical about repressed memory compared to practitioners, students and the public. Although a minority of memory experts wrote that they maintained an open mind about repressed memories - citing research such as retrieval inhibition - all of the memory experts emphasised the dangers of memory distortion.

Weak evidence for increased motivated forgetting of trauma-related words in dissociated or traumatised individuals in a directed forgetting experiment

Motivated forgetting is the idea that people can block out, or forget, upsetting or traumatic memories, because there is a motivation to do so. Some researchers have cited directed forgetting studies using trauma-related words as evidence for the theory of motivated forgetting of trauma. In the current article subjects used the list method directed forgetting paradigm with both trauma-related words and positive words. After one list of words was presented subjects were directed to forget the words previously learned, and they then received another list of words. Each list was a mix of positive and trauma-related words, and the lists were counterbalanced. Later, subjects recalled as many of the words as they could, including the ones they were told to forget. Based on the theory that motivated forgetting would lead to recall deficits of trauma-related material, we created eight hypotheses. High dissociators, trauma-exposed, sexual trauma-exposed, and high dissociators with trauma-exposure participants were hypothesised to show enhanced forgetting of trauma words. Results indicated only one of eight hypotheses was supported: those higher on dissociation and trauma recalled fewer trauma words in the to-be-forgotten condition, compared to those low on dissociation and trauma. These results provide weak support for differential motivated forgetting.

High Betrayal Child Sexual Abuse and Hallucinations: A Test of an Indirect Effect of Dissociation

Though hallucinations traditionally have been conceptualized as a central feature of psychosis, some hallucinations may be dissociative, with dissociation potentially contributing to hallucinations. Childhood trauma has been linked with dissociation and hallucinations. Betrayal trauma theory distinguishes abusive experiences based on closeness to the perpetrator. In the current study, we examined the indirect effect of dissociation on the relationship between high betrayal child sexual abuse (perpetrated by a close other) and hallucinations. Participants (N = 192) from a northwestern university in the United States completed self-report measures online assessing history of high betrayal child sexual abuse and current dissociation and hallucinations. Bootstrapping analyses indicated a significant indirect effect of high betrayal child sexual abuse on hallucinations through dissociation, 95% Confidence Interval (.16, .66). Through betrayal trauma theory, this study provides a non-pathologizing framework for understanding how dissociation and hallucinations may develop as natural reactions to the harm inherent in child sexual abuse perpetrated by a close other. These findings have clinical implications for relational models of healing for trauma survivors who are distressed by dissociation and hallucinations.

Victim-perpetrator dynamics through the lens of betrayal trauma theory

Interpersonal trauma exposure is linked with a host of seemingly disparate outcomes for victims, such as psychological distress, post-trauma appraisals (e.g., alienation, shame), poor cognitive functioning, expectations of harm in relationships, and revictimization risk. The presence of interpersonal trauma alone may not fully explain this range of outcomes. The current paper applies Betrayal Trauma Theory (BTT), which was originally articulated two decades ago as a framework for understanding memory disruptions following interpersonal trauma, as a framework to understand the diverse outcomes that can occur when interpersonal trauma is perpetrated by a close other. Implications for clinical work and future research are considered.

Collusion, torture, and inequality: Understanding the actions of the American Psychological Association as institutional betrayal

The Hoffman Report (Hoffman et al., 2015) documented devastating information about the American Psychological Association (APA) and the profession of psychology in the United States, prompting a public apology and a formal commitment by APA to correct its mistakes (APA, 2015). In the current article, we utilize betrayal trauma theory (Freyd, 1997), including betrayal blindness (e.g., Freyd, 1996; Tang, 2015) and institutional betrayal (Smith & Freyd, 2014b), to understand and learn from APA's behaviors. We further situate this discussion in the context of inequality, both within APA and in American society generally. We detail how the impact of APA's institutional betrayals extended beyond the organization, its members, and the psychology profession, highlighting the potential for disproportionate harm to minorities, including those who were tortured; Muslims, Middle Easterners, Afghans, and non-Americans who were not tortured; and other minority individuals (Gómez, 2015d). Acknowledging, understanding, and addressing its institutional betrayals offers APA the opportunity to take meaningful corrective and preventive measures. We propose several institutional reparations, including making concrete changes with transparency and conducting self-assessments to inform further needed changes (Freyd & Birrell, 2013). By engaging in institutional courage, APA has the potential to grow into an ethical governing body that fulfills its mission to "advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives" (APA, 2016).

Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care

As the diagnosis and treatment of mental disorders has become increasingly medicalized (Conrad & Slodden, 2013), consideration for the relational nature of trauma has been minimized in the healing process. As psychiatrist R. D. Laing (1971) outlined in his essays, the medical model is an approach to pathology that seeks to find medical treatments for symptoms and syndromes based on categorized diagnoses. We argue that such a model implicitly locates the pathology of trauma within the individual instead of within the person(s) who perpetrated the harm or the social and societal contexts in which it took place. In this article, we argue that this framework is pathologizing insofar as it both prioritizes symptom reduction as the goal of treatment and minimizes the significance of relational harm. After providing a brief overview of betrayal trauma (Freyd, 1996) and the importance of relational processes in healing, we describe standard treatments for betrayal trauma that are grounded in the medical model. In discussing the limitations of this framework, we offer an alternative to the medicalization of trauma-related distress: relational cultural therapy (e.g., Miller & Stiver, 1997). Within this nonpathologizing framework, we highlight the importance of attending to contextual, societal, and cultural influences of trauma as well as how these influences might impact the therapeutic relationship. We then detail extratherapeutic options as additional nonpathologizing avenues for healing, as freedom to choose among a variety of options may be particularly liberating for people who have experienced trauma. Finally, we discuss the complex process of truly healing from betrayal trauma.

"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.

Self-injury and suicidality: the impact of trauma and dissociation

In the growing research literature on nonsuicidal self-injury (NSSI) and suicidality (SA), there are many questions still unresolved about the role played by exposure to traumatic stressors (including but not limited to childhood maltreatment) and posttraumatic disorders (including dissociative features and disorders). In this special issue of the Journal of Trauma & Dissociation, a review article and 4 empirical studies attempt to provide additional insight into the relationship of traumatization and dissociation to NSSI and SA. The review article describes similarities and differences in the relationships that have been empirically documented between trauma exposure and posttraumatic stress or dissociative symptoms with NSSI versus SA and highlights the need for research to identify and test integrative clinical constructs, such as emotion dysregulation, in order to develop systematic risk, assessment, and intervention models. The empirical reports provide illustrative examples of conceptually and clinically integrated research on traumatic stress, dissociation, and NSSI and SA. Their findings offer a more nuanced picture of the potential role of different forms and degrees of dissociation in SA and NSSI and suggest that dissociation and emotion dysregulation may play a mediating role linking childhood maltreatment and adult or adolescent NSSI. In this introduction, we briefly summarize key points from the special issue articles and point out directions that their findings suggest for future research, including incorporating multiple predictors in studies of NSSI and SA, utilizing longitudinal studies to assess the etiology and course of NSSI and SA, and sampling diverse populations.

Recent advances in false memory research

In the last few years, substantial gains have been made in our understanding of human memory errors and the phenomenon of false memory, wherein individuals remember entire events that did not happen at all. Research had established that false memories can be consequential and emotional, that they can last for long periods of time, and that they are not merely the product of demand characteristics or the recovery of extant but hidden memories. These recent advances are discussed as extensions of earlier foundational research.

Factors contributing to ongoing intimate partner abuse: childhood betrayal trauma and dependence on one's perpetrator

Identifying the factors that contribute to ongoing intimate partner abuse (IPA) among survivors of childhood abuse is essential to developing appropriate interventions. The current study assessed prospectively whether childhood betrayal trauma (BT) history and women's potential dependence on their perpetrators (unemployment, number of children below 13) increased women's risk of ongoing victimization, while controlling for trauma-related symptoms (PTSD, depression, dissociation). Women survivors of IPA (N = 190) from an urban U.S. city were recruited based on an IPA incident reported to the police. At the initial interview, women reported on childhood betrayal trauma experiences, their employment status, number of children, and current trauma-related symptoms. Women returned 6 months later and reported on ongoing events of victimization (physical, sexual, psychological aggression, and injury) in their relationships with the initial IPA perpetrator. Results showed that higher levels of childhood BT were associated with ongoing victimization over the course of 6 months. Women's unemployment status predicted greater physical and sexual aggression and injuries. Higher levels of depression and lower levels of PTSD symptoms were also associated with increases in physical, sexual, and psychological aggression, and bodily injury. The findings have important implications for interventions by demonstrating the need to process women's betrayal trauma experiences, target depression symptoms, and increase women's economic opportunities to prevent further victimization.

Revenge and forgiveness or betrayal blindness?

McCullough et al. hypothesize that evolution has selected mechanisms for revenge to deter harms and for forgiveness to preserve valuable relationships. However, in highly dependent relationships, the more adaptive course of action may be to remain unaware of the initial harm rather than risk alienating a needed other. We present a testable model of possible victim responses to interrelational harm.

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.