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Dissociation (amnesia) and remembering abuse anew?


How is it that someone could forget a horrific event or experience? What is happening when something new is remembered about a very old event? Is it possible to forget (lose the capacity to recall) for long periods of time but then later remember?

Continuing my series on memory, abuse, and the controversies of recovered memories [you can read my previous posts: here, here, and here], I now want to address the issue of dissociation, amnesia, and remembering abuse. In those previous posts we have looked at how memory can be degraded by intent (conscious denial or unconscious rejection), by other overwhelming stimuli, or by failure to encode. But, since I have not spent much time on the topic of dissociation and repression, I want to say just a few words about these two ideas–in part because they are frequently used but poorly defined.

What is Dissociation? Is Amnesia a better term?

People define dissociation in a variety of ways but most definitions include some disconnection from present reality–sensations of disconnection from self, others, or time–and exists on a continuum. The most mundane forms happen everyday. You are driving from point A to point B but realize you cannot remember what you saw along the way. While we could describe this as a failure to encode data into memory, we could also describe the process, a disconnecting from what is happening in the present. Some dissociation is even beneficial. If you have ever been in pain but then got a distracting phone call, your pain perceptions probably decreased. You were, in effect, dissociating from the present experience of pain.

Now, when we talk about dissociation from a counseling perspective, we are talking about a more significant disconnection from present experiences, one that often seems to happen outside the conscious control of the person (but may be a practiced habit that happens without mindful decision). Dissociative experiences include feeling unreal, disconnected from the body, unable to engage the present, unable to remember salient portions of pesonal identity, or even, rarely, the presentation of alternate personality states that appear to fight for control of the individual.

You can imagine that if you are in the position of a repeated trauma (such as child sexual abuse by a parent figure) and unable to escape it, you might develop ways of dealing with the pain by disconnecting from the present. As a result, you might find that any time you begin to feel unsafe, you naturally disappear in some minor or major way. What happens during that “disappearance” depends on the individual. For some, they are reliving some other experience (I’m no longer present but reliving a painful event in my life). For others, they report being blank–thinking and feeling absolutely nothing. The most telling sign to a therapist is that the client no longer seems to be present in the room (nonreactive or reacting clearly to something other than is going on in the present). Whatever the form of disconnection, most then experience some level of inability to remember portions of the trauma.

Interestingly, there is some evidence that those who dissociate have greater capacity to self-hypnotize. In addition, McNally describes a study (in Remembering Trauma) that followed a person with psychogenic amnesia who had altered brain function when in amnestic states.

Does dissociation lead to forgetting traumatic data?

Can a person dissociate enough to create a persistent amnesia for a traumatic event? There is evidence that those who experience frequent disconnected states have greater difficulty remembering important details of traumatic events. However, many would say that repression is a better conceptual tool to explain such forgetting. But then, repression is not well-defined either (even Freud himself interchanged repression and suppression when talking about decisional vs. unconscious forms of forgetting). Despite the frequent use of repression in common parlance (and without the Freudian baggage) I would suggest that amnesia or motivated forgetting may be better terms, a bit more descriptive and less connected to psychoanalytic theory.

Whatever you call it, some level of forgetting can happen to those experiencing relentless traumas.

  • a young Jewish woman forced into an internment camp has her infant child ripped from her and killed. After the war, a relative asks the woman about the child and the woman responds, “what baby?” Only much later does she remember having a child or how this child died.
  • A young male cannot remember much about his childhood. When asked about his Uncle (only 5 years older than he), he can only remember a vague uncomfortable feeling. His younger brother recounts this uncle would routinely enter their bedroom at night to sodomize both boys. Only after numerous conversations does the older brother begin to remember abuse details, even beyond those supplied to him by his younger brother.

Forgetting then Remembering anew?

In my 23 years of counseling I have never encountered someone who recovered memories of a trauma after completely blocking all memory (I believe it is theoretically possible but extremely rare). I have, however, had a number of clients recall previously long forgotten or vaguely remembered traumas. Often when they recall events with VASTLY new interpretations, so new that it feels like an entirely new memory even as they admit the memory isn’t new to them. Here’s a real example (with details changed to disguise identity),

Alice, a 52-year-old elementary school principal, enters individual therapy at her husband’s insistence to deal with her irritability at home. She admits she has developed a fantasy of leaving her husband for the new (and younger) president of the school board. She discloses that this fantasy began not long after her husband suffered a work-related accident rendering him partially disabled. During the initial intake Alice denied any history of trauma or abuse. As the therapy progressed, it became evident that Alice connected her personal identity to that of being pursued–something that her husband no longer attempted. In addition, her attempts to flirt with the school board president had been ignored. In a moment of frustration, Alice exclaimed, “I’ve always known that men found me very enticing, ever since I developed [breasts] at an early age. I’ve always had to be so careful around men, especially married men. I knew they wanted me and that made me feel dangerous but desirable. Now, who am I if no one wants me?” Alice’s therapist asked her to recount a bit of her early sexual history and without much delay Alice reported her first sexual experience at age 12 with her 35-year-old, married Sunday School teacher. She recalled her teacher hugging and fondling her breasts while telling her about his failing marriage and the need for the two of them to avoid further sexual temptation. At age 16, she reported that she and a 4o-something father of a child she babysat engaged in a 6 month sexual relationship.  Alice’s counselor indicated some surprise at how Alice described both experiences. She asked Alice how she would describe the same interactions between one of her current 6th grade students and a school teacher. Alice immediately flushed with horror. “Why, it would be child abuse!” Once Alice regained her composure, she explored how she had always remembered herself as the protagonist in both experiences. In that session and over the next several weeks, Alice reported a flood of new memories, mostly about things done or said by the two sexually abusing men and now interpreted to be predatory behavior. On several occasions she reported that it felt like she had never had these memories before even though she recounted that she never forgot the sexual encounters. The new interpretations and labels created the experience of recovering long-lost memories–ones that seemed blocked as long as she was responsible for the trysts but freed in light of her victim interpretation.

In this little vignette I want to illustrate that memories of abuse can be forgotten, whether only small portions or large, and remembered anew. Recalled or recovered memories are frequent as individuals gain the freedom to explore events from different vantage points. A therapist does not need to go on an abuse hunt or attempt to conjure up forgotten memories for this to happen. Merely exploring the narrative of a prior difficult experience can be all the priming a client needs to begin to experience “new” remembering.

But here’s where good therapy differs from unethical therapy: how the therapist responds to or pursues memories may be the determining factor when it comes to the development of false memories of past abuse. In the next post we will take up the ethics of memory work and explore therapist habits that may produce false memories of abuse.

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Is All Counseling Theological?


Why do we have to study theology? I don’t need that to be a good counselor?

These are words I have heard from students studying counseling and/or psychology in both university settings and seminaries. What would you say?

Biblical and theological training in professional programs?

Most Christian institutions offering counseling or psychology graduate programs require some level of theological engagement. Otherwise, why exist? Some do so via specific course work while others embed the theological or biblical material into classic counseling courses. At Biblical, we do both. We require traditional counseling courses such as Marriage & Family, Helping Relationships, Psychopathology, Social & Cultural Foundations, etc. In these courses we explore counseling theory and practice from an evangelical Christian psychology perspective. We also require students to complete courses like, “Counseling & the Biblical Text” and “Counseling & Theology: Cultural Issues” where they engage biblical texts and theological study as they consider how it forms counseling theory/practice and shapes the character of the counselor.

Is all counseling theological?

Yes. And David Powlison in the most recent CCEF NOW magazine (2-4) talks about this very fact. Here are some choice tidbits,

…counselors deal with your story. In fact, they become players in that story. By word and deed, even by their line of questioning, they inevitably offer some form of editing or rescripting, some reinterpretation of your story.

Counseling is inescapably a moral and theological matter. To pretend otherwise is to be naive, deceived, or duplicitous.

…all counseling uncovers and edits personal stories…. All counseling must and does deal with questions of true and false, good and evil, right and wrong, value and stigma, glory and shame, justification and guilt.

All counseling explicitly or implicitly deals with questions of redemption, faith, identity, and meaning.

Thus, if value-free counseling is not possible (the very questions we ask lead clients in one direction or another), then it stands to reason that every counselor ought to explore the theologies (doctrines, interpretations, beliefs, etc.) he or she brings into the counseling room. Who is God? How does God operate? What is the purpose of the Bible? Does it have anything to say about my life, my attitudes, my relationships? What is sin? What is my purpose in life? What does God think about my suffering? And on we could go.

But counseling is NOT theologizing

But lest you think that Christian counselors spend a great deal of time plying clients with the right answers, on sin hunts, or catechising clients, let us remember that exhortation rarely makes for good counseling. In fact, most clients are well aware of their sins–even those who do not call themselves “believers.” And those who have correct theology are not less likely to have trouble in their relationships or less likely to struggle with racing thoughts or depression or less likely to get caught in addictive behavior.

Instead, good christian counseling consists mainly of,

  1. loads of stimulating questions designed not to get the “right” answer but to awaken the client to how they think, act, believe, relate, etc.
  2. Short observations to stimulate more critical understanding of the personal narratives being written, and
  3. Collegial exploration and practice of new narratives, perceptions, and behaviors.

Wait, just what is Christian about these three points? Couldn’t unbelieving counselors agree with this list? Sure they could. What makes these three activities Christian is the submission of both counselor and client to core convictions and practices of Christ followers.

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Forgetting Abuse? Some thoughts on motivated forgetting


Could someone really forget something as horrifying as a rape or sexual abuse? How come some people say they never stop reliving a bad experience while others say they have forgotten and cannot remember what happened? How do we best understand these two, seemingly, opposing reactions?

In a previous post I began a short series on the controversies of repressed and recovered memories. In that post I made a few general comments about the nature of memory. It isn’t a particular structure or substance or even stored as one discrete movie but rather is a whole brain process connected to context, mood, and self/other-perception. Memories do not exist outside of narrative or story (unfortunately for those with traumatic histories, these narratives are usually quite jumbled up making it difficult to tell the story well). In general, stories help us remember and remembering tells a story.

In this post I want to address the matter of forgetting abuse. Is it possible? The short answer is yes. Common to forget all of it? No. Common to forget portions? Yes. And even more common to have the experience of a new memory even without ever having forgotten the abuse (this I will address in the next post). It is possible to forget, to no longer have access to one’s own history. But, the bigger question is “how” and “why” rather than “if”.

Complicating factors

Laboratory studies re: memory cannot replicate the experience of sexual abuse or trauma. Thus, we have some rather weak experiments or post hoc, retrospective studies. What these studies point to is that (a) most people don’t forget entire episodes, (b) some forgetting does happen, and (c) some confabulation or memory error also happens (e.g., eye-witness accounts are more frail than we imagine them to be). But even when we get a good study, we find it hard to apply the information to real life. For example, one retrospective study located a number of child abuse victims decades after their ER visit to a hospital. A goodly number denied ever having been abused. While the study could reveal some form of forgetting, we might also be witnessing lying and/or alternative interpretations.

So, we have to admit at the outset we have a large supply of anecdotes of full forgetting, partial forgetting, and no forgetting, and an equally large supply theories and explanations based in part on experience and low power correlational studies. Now, anecdotes and poorly supported theories aren’t reasons to doubt the reality of forgetting trauma (or the reality of false recovered memories). They are, however, good reminders to be wary of applying some general knowledge as complete answer to any specific case. Each case of forgetting trauma needs to be evaluated on its own merits (more on this when I get to a post on clinical/practical interventions).

One more complication. Adults who reveal child sexual abuse experiences rarely have any corroborating witnesses or forensic evidence. They have their memories and that is about it. Families, offenders, and communities have much to lose to admit such abuse could have happened. Thus, outside therapeutic environments, adults have few opportunities to be heard or believed.

By what mechanism do we forget traumatic experiences

“Normal” forgetting happens in a variety of ways. Each of these may be a partial answer as to why someone might forget something very powerful.

  1. Distraction leading to failure to encode. If you are introduced to someone and immediately forget their name (happens to me ALL the time), it is because the information never got encoded (too distracted by preparing to say my own name??). Distractions may come in the form of attending to something very specific or not attending to anything at all. Some victims of abuse report that their memories are fuzzy because they could only focus on the flower pattern on the wall during the actual abuse.
  2. Other memory intrusion. A previous memory may interfere with the clear encoding of a new memory or a new memory may interfere with the recall of an old memory. Victims of extended abuse often report difficulty in remembering when it started and stopped, who was present, etc., especially when  the perpetrator also provided more normal love and attention. The memories (and their competing narratives) make it hard to remember.
  3. Motivated Forgetting. I like but hesitate to use this term. “Motivated” could sound like “willful” or “intentional.” And while some motivated forgetting is intentional, most just happens outside the conscious experience of the one doing the forgetting. If I have a conflict with my wife and I spend the next 5 hours rehearsing her supposed sins against me, I may have difficulty recalling my own misuse of words. I may not consciously say to myself, “I am going to do this so I won’t be able to remember my angry words to her,” but I am engaging in what I call “motivated forgetting.” Obviously, abuse victims would rather NOT remember what happened to them and would rather maintain a positive view of a loved one who did the abuse. Victims may encourage motivated forgetting through several means (again, without conscious decision): repeating a false narrative (“He didn’t mean to do that and I am at fault.”) created by themselves or others, using conscious decision not to think about an event, dissociating during abuse and then dissociating when not being abused, focusing on another possible threat.

Now, these forms of forgetting may not sound like they would lead to the complete forgetting of an event. And that would be true for the vast majority of abuse victims. But, I think we need to remember that it is possible given enough anecdotes of some who recover memories (apart from suggestion by therapist or others) on their own and that do get corroborated by others. Is it common? No. Can mental health professionals cause false memories? Yes (but that is for another post in this series!).

So, why do some remember minute details of trauma? They rehearse them (whether they want to or not). Why do some forget them? Their memories degrade due to forms of memory loss discussed above. Other factors are also likely: natural capacity to dissociate, age/development of victim, culture where abuse took place (e.g., a one-time event in a rather safe environment will have a different impact than repeated experiences where safety has never been present).

In my next post I want to take a few minutes to discuss dissociation, repression, and the experience of re-remembering child abuse later in life.

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Job opportunity in trauma healing


American Bible Society

American Bible Society (Photo credit: Wikipedia)

The American Bible Society has posted a job in the She’s My Sister and Trauma Healing Institute project. It is probably entry-level but will involve travel and close work with trauma healing projects around the world. The right person will need to be able to run projects, be organized and, of course, have a deep love for Jesus! Attached here is the job description. I know and highly respect Bagudekia and Harriet, the people leading this position.

 

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What is therapeutic presence?


If you go to a counselor, you’d probably prefer that person to be awake versus asleep, to pay attention to you versus check their smart phone, to respond to what you are talking about versus make non sequitur responses. As I’ve noted here before, it is probably better to have a counselor who cares about you than one who has a big bag of techniques–though most of us would prefer our counselors to care AND be competent.

Therapeutic presence is a way of talking about the act of being with our clients in such a way as to build safe, trust-filled relationships where clients can grow and change. I think most people can easily identify failures of therapeutic presence. Try these on for fun:

CLIENT: I’m just so depressed.

THERAPIST: You think you are depressed? Let me tell you about depression. I have a client who just lost job, family, church, home. Now, that is something to be depressed about. You just had a bad day, that’s all.

Or,

CLIENT: I don’t understand why God would take away this job from me.

THERAPIST: Well, theologically speaking, God does things for all sorts of reasons. He sometimes does this to cause us to trust him more, to reveal some sin, to give him glory.

Notice how both responses fail miserably to be either therapeutic or present with the person in the moment of counseling. Not hard to miss, right? So here’s a question: Why do so many of us counselors, even seasoned ones at that, fail the “presence” test?

My answer? When we fail to be present in helpful ways, it reveals a lack of preparation and a lack of attention to purpose.

Shari Geller and Leslie Greenberg (in Therapeutic Presence: A Mindful Approach to Effective Therapy. APA, 2012) define the building blocks of therapeutic presence as

    • how therapists prepare for being present (in personal life and in session)
    • the process (or therapist activities) of being present (aka purposing to be present)
    • the experience of being present

Sound like mumbo-jumbo? Here’s another way of putting it. What does a counselor need to do to be ready to be in tune with their clients? What do they do to stay in tune when with clients, and are they aware of when they are failing to be in tune? (If I am unaware, then I am likely to get out of tune.)

Here are some things counselors ought to be asking themselves:

  • Do I have adequate space to move from my private life to being present with my clients? Do I have enough space between clients? The answer is not always an amount of time, but what we do during the space between.
  • As I prepare for sessions, what am I meditating and praying about? For example, if I pray for clients to be free from something that has them bound up, I could accidentally encourage myself to push for change or to talk about a subject that the client is not able or ready to talk about. I’m all for praying for healing. I just think we have other prayers to pray as well. “Lord, help me to be with the client today and not focused on my own personal goals for them.”
  • Am I staying present with their mood, their cognitions, their silences in such a way that it is as easy to talk about what is happening in the session as it is to talk about what happened in the past or might happen in the future?
  • When I sense a disconnect, am I quick to invite dialogue and learn (vs. avoid or defend/explain away)?

Therapeutic presence isn’t everything. I could be present with someone and no healing might take place. But without therapeutic presence, I will only be a barrier to whatever growth is taking place. When I do it well, I imagine that I might see just a tiny glimpse of how Jesus was with the woman caught in adultery, the Samaritan woman, or with Peter after he had abandoned Jesus.

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2nd Post: Can Your Body Make You Sin?


Over at Biblical Seminary’s Faculty Blog you can read my second of two posts on the topic of bodily weakness, sin, and culpability. I conclude with the realization that there is something more important in this conversation than ascribing blame or parsing fault.

I’m curious about your thoughts. How much does culpability really matter when determining your response to those whose bodies seem to cause them to sin?

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Refusing to report abuse and its consequences


As many Americans know, The Jerry Sandusky trial is well underway. Mr. Sandusky is charged with 52 counts of child sex abuse during his era (and following) as assistant football coach at Penn State University. But equally on trial–at least in the media, the court of public opinion, and most likely civil and criminal courts in the near future–are Penn State officials. Chief among those under scrutiny is former PSU president, Graham Spanier. It appears that Mr. Spanier, along with other important University employees knew of accusations and eyewitness accounts of abuse and failed to report the matter.

I have written here about the reasons why we fail to report. We fail to report because we are protecting our own. We fail to report because we worry about backlash, bad press, and we don’t want to get involved in messy situations. But consider now the consequences of not reporting.

1. Protecting the wrong person or entity. allegedly, one email from Spanier states that he wouldn’t report Sandusky for “humane” reasons. Spanier appears to have made the calculation of negative consequences for reporting Sandusky to law enforcement but failed to do the same calculation for probable victims.

2. Destroying trust for future leaders. Ask the general public how they feel about the trustworthiness of leaders within the Catholic church? Ask if they feel that the church’s response (verbal and in legal settings) has helped improve or continue to erode trust? Sadly, future leaders of organizations (those that failed to report child abuse) likely face unmerited suspicion on the basis of the predecessor’s behaviors. Further, such failure to instill trust does not just impact general trust within a community. Victims who were not protected and helped are much less likely to be willing to report abuse that happens in the future.

3. Increasing PTSD symptoms. Many abuse and interpersonal trauma victims report that something traumatized them even more than the original abuse–the failure of those who knew about the events to do something about it. When those you think should protect you do not, you are more likely to experience PTSD.

4. Having no answer for Matthew 25:31-46. You may remember that this passage tells what will happen on the day of judgment. For those who did not do for the “least of these” (care for, protect, serve), tremendous judgment awaits. Strong words.

41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’

46 “Then they will go away to eternal punishment, but the righteous to eternal life. ”

Strong words indeed.

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If Sixth Graders Ruled the World…


…the world would be run by girls.

Such was the observation of my wife after attending our son’s graduation from elementary school and the 6th grade. I concur. 80% of the awards and recognition for leadership went to girls. Actually, to about 30% of the girls. Mind you, I am not the least bothered by this. It was great to see these young women so active in the life of their school and community.

However, I do have a question: Will their leadership last?

There seems to be a pattern of girls falling back from their high performance in athletics and academia (my general impression and surely not always accurate). Why would there be such a change? Social pressure to focus on looks and boys? Boys catching up development-wise and creating more competition? Or, are we seeing a change in culture that will continue? I’m hoping for this last question to be true. When my wife was in school, there were few opportunities for girls to excel in sports. That has changed. A goodly number of the girls mentioned aspirations of being a professional athlete. When my mother was in school, I doubt many of her classmates aspired to be doctors and lawyers. These days, girls recognize that most professions are wide open to them. So, I hope we are seeing a continued culture change. I’m all for girls wanting to be married and to become mothers (all in DUE time) but I am also worried about how much pressure we place on them regarding looks and body image.

Can you and I do anything about the world of sixth grade girls? Well, let us all endeavor to encourage young women to focus on their intellectual pursuits and god-given callings. And let us cease giving support to those cultural entities (ads, TV, movies, print media, etc.) encouraging young women to equate value with looks.

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Helpful (short) definition of sex trafficking


ImageAt staff meeting today we watched, Not My Life. A film about human trafficking and modern slavery. Narrated by Glenn Close, this documentary explores the cruel inhumanity of trafficking and slavery around the world today. I recommend it for anyone wanting to get a clear picture of the types of trafficking and slavery, whether in Africa, India, Cambodia, Europe, or the United States.

Somewhere in the movie someone defines sex trafficking as supported by,

force, fraud, and coercion

You might think that force and coercion are the same but here is how I hear those words:

force: the physical power to control another person

fraud: deception often makes it possible to get more cooperation without using as much force

coercion: psychological efforts to get someone to do what you want. It is one thing to kidnap someone. It is another to convince them to act in ways that they would never choose to do. Coercion could be physical but sex traffickers rarely stand over their slaves and make them act out with those who buy them–at least after the first times. No, coercion is often psychological. If you don’t do this, I will kill your family. No one will want you now. Force starts the process, coercion keeps the victim entrapped.

Why is this helpful? Because these three items can be found anywhere. It is far too easy to believe that trafficking happens elsewhere or is something that only a monster does. Well, that last phrase is true…but we all know a little about force, manipulation, and deception. These features are found in everyday life.

Want to do something about trafficking? Stand up against force, manipulation (coercion) and deception everywhere you see it–in yourself, in others, in systems.

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Thoughts on closure by Bryan Maier


Is closure after trauma, grief, or some other sort of suffering a realistic goal? If so, how would you know when you arrived?

My colleague, Bryan Maier has a short review post of the book Closure: The Rush to End Grief and What it Costs Us. I think you will find his thoughts compelling to consider.

Sounds like a book we should all read.

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