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False memories, regression and repression in trauma

In BSCAH we teach safe ways of helping people deal with trauma from their past and highlight the danger of regressing someone in hypnosis to a traumatic event. It can be very distressing and very easy to retraumatise someone if you use this approach and it is now unnecessary given the imagery approaches we can now utilise.

Dr Ann Williamson (GP retired) says, ‘In more than 40 years of practice, I have never come across a truly ‘repressed’ memory although many patients have locked trauma memories away in the back of their mind – but they know they are there. Utilising imagery techniques in hypnosis can often very quickly resolve traumatic memory.’

Dr Peter Naish (Psychologist) says, ‘On the subject of false memories, I will give a true story. A young woman accused her father of multiple rapes when she was a girl. Some of the horrific story stretched credulity (one rape location being a well-frequented towpath during broad daylight). Nevertheless, this poor person was without doubt suffering from PTSD. Not only did elements of the story fail to stack up, as more information came to light it transpired that she had consulted a hypnotist – she had been a bit depressed as I recall. It was not long before she was a good deal more than depressed and eventually, she was referred to an NHS psychiatrist. His notes recorded her saying, “I was OK until I did hypnosis.” Notes from the (lay) hypnotherapist indicated that he had “Taken her back to get to the root of the problem.” What she had generated as a result was so horrific and realistic as to cause PTSD. 

When the case came to court, not only did the Expert for the Defence but also the Prosecution Expert gave opinions that this was a very clear example of hypnosis-induced false memory. The father was acquitted, but sadly the daughter has remained estranged from what was once a happy, close-knit family. I saw the complainant in court, but never actually met or spoke to her, although I would be prepared to do so.

In another example I was able (with hypnosis!) to help the victim of hypnosis-induced false memory recognise that her memories had been entirely false. Logically, she had already concluded that they must be (again, not stacking up) but she complained that she could not get the ‘reality’ of the images out of her mind. That’s what we managed to achieve with hypnosis (the reality).

As is well known, long ago the Home Office issued guidance to police forces that they should cease the practice of using hypnosis to ‘refresh’ the memories of witnesses. The reason, of course, was the probability of generating false memories. In this century, Mike Heap and others of us produced a ‘best practice’ document on hypnosis for the British Psychological Society. I will give a couple of quotations:

Hypnosis does not have any special property for enhancing memory in therapy … using hypnosis in this way carries a real risk of producing substantial pseudo-memories … some can be so plausible as to beguile the therapist and client alike into accepting them as accurate. 

And …

For a therapist merely to claim awareness of the problem and to be guarding against it provides insufficient protection against the dangers of false memory. Research has shown that simply to label a situation ‘hypnotic’ will cause people who are attempting to recall their earliest memories to produce [so] many more … as to make it virtually certain that the recalled memories are false.

Repression is a Freudian idea, a hypothesis formulated long ago when psychology was in its infancy, and the bulk of modern research tools and methods were unavailable. It is a questionable concept, but there is evidence that distressing material might remain ‘out of sight’ for long periods. I would point out, however, that sufferers from PTSD would dearly love to repress their memories; instead, these horrors repeatedly thrust themselves unbidden into their consciousness.

Whereas it is not easy to find unequivocal examples of repression, or to generate realistic examples in the laboratory, false memories are two a penny – both in real life and in laboratory analogues. A topical analogy here is the balancing of the dangers and benefits of vaccines. In this vein, the dubious merits of going on a ‘fishing expedition’, to find putative traumatic precursors to current ills, fade into insignificance when compared with the relatively high probability of generating highly damaging pseudo-memories.’

Phyllis Alden (Psychologist) says, ‘My first concern would be whether the patient has any actual memories of a trauma or just believes that there has been one.  This would make a significant difference to treatment approaches.  If the latter is the case, then a therapist doing regression is going on a ‘fishing trip’ which would be very likely to generate false memories.  And could indeed cause the patient a lot of problems.

If the patient does have some memories of a trauma, then any of the trauma treatment techniques we use to work with these actual memories would be appropriate, e.g. screen techniques but there has to be something real to work with.

The other very important message all therapists should be giving is re memories. That unless they can be corroborated, one can’t assume they are real and that vivid imagery does not equate to historic truth.

I have a couple of examples:

I was once asked by a colleague if I would hypnotise his patient who had little memory of life before age 15 and believed she might have suffered trauma.

When I saw her, I explained all the risks and in the end we agreed that it wouldn’t be helpful.  What I did do, was ask my trainee to do a non-directive cognitive interview with her which she did find helpful.  A few things – non-traumatic – surfaced which she did get corroborated.

Another patient who came to me after seeing a lay hypnotist who had regressed her to elicit ‘memories’ of trauma.  She herself questioned this so we looked at the hypnotically elicited images and compared them with what she knew to be ‘real’ memory images and she was able to identify subtle differences in the quality of these, which helped her conviction that they weren’t true.

On another note, CBT properly done is not a paper exercise.  it involves verbal interactions exploring beliefs, thoughts, and feelings. I very rarely ask people to do form filling when dealing with trauma.

Here is an example:

A client of mine had severe PTSD following a relatively minor RTA.

She had terrible flashbacks, nightmares, hyperarousal, and other symptoms and significant travel anxiety.  Her score on the IESR was 80 out of 88.

I was instructed to offer her 16 sessions of CBT and 12 of EMDR.

After some work using breathing and ‘relaxation’ to help stabilise her and help her to feel a bit more in control she was able to start talking about the accident.  The woman driver who had crashed into her had been pregnant and my client’s biggest fear was that the baby would die.  That had haunted her. We elicited some specific thoughts about the baby dying and I asked her if she’d had thoughts like these in relation to her own children. Which it turned out she had had. 

I asked her if anything had ever happened with her own two children when they had been babies or if she had lost a baby.  At first, she said no to all that but then she had recalled that when her son was three months old, he had had meningitis.  At one point, the hospital suggested she call the priest, but she said she had never believed that he would die.  And then it ‘clicked’ for her that her reaction to the RTA was linked to this experience.  No hypnosis, just some simple CBT.  It worked like magic, and I discharged her after only 6 sessions.  

Finally, a cautionary tale of what damage regression can do:

A depressed woman being treated by a psychiatrist with whom I used to work consulted a hypnotherapist who regressed her and elicited a load of traumatic stuff.  She killed herself.

by Ann Williamson, Peter Naish, Phyllis Alden