Transcript Working with Clients with Trauma

Traumatic Memory
How Stress Affects Memory
How to Elicit Stressful Memories
“In any war story, but especially a true one, it’s difficult
to separate what happened from what seemed to
happen. What seems to happen becomes its own
happening and has to be told that way…” When a
booby trap explodes, you close your eyes and duck
and float outside of yourself. When a guy dies…you
look away and then look back for a moment and then
look away again. The pictures get jumbled; you tend
to miss a lot. And then afterward, when you go to
tell about it, there is always that surreal
seemingness, which makes the story seem untrue.
But which in fact represents the hard and exact truth
as it seemed.” (Tim O’Brien, The Things They
Carried)
“Absolute occurrence is irrelevant. A
thing may happen and be a total lie;
another thing may not happen and be
truer than the truth.” (Tim O’Brien)
“In many cases a true war story cannot be
believed. If you believe it, be skeptical. It’s a
question of credibility. Often the crazy stuff is
true and the normal stuff isn’t because the
normal stuff is necessary to make you believe
the truly incredible craziness. In other cases,
you can’t even tell a true war story. Sometimes
it’s just beyond telling.” Tim O’Brien
Outline
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Memory: Active Process
Reaction to stress
Types of memory
Effect of stress on memory
Techniques to enhance reporting
Luanugage Mreomy
• Aoccdrnig to a rscheearch at
Cmabrigde Uinervtisy, it deosn't mttaer
in waht oredr the ltteers in a wrod are,
the olny iprmoetnt tihng is taht the frist
and lsat ltteer be at the rghit pclae. The
rset can be a toatl mses and you can
sitll raed it wouthit porbelm. Tihs is
bcuseae the huamn mnid deos not raed
ervey lteter by istlef, but the wrod as a
wlohe.
The Puzzle of Memory
• First considered an entity (the Engram)
• Now considered a network
– Neural pathways that link perception with
interpretation
– Initial plasticity that shrinks in response to exposure –
– Neuro-network of culture and language
– Individual difference
• Memory entails
– Stimulation of the network (laying down a memory)
– Intra-cerebral network (Interpretation of perception)
– Re-trace of new network (Recall)
The Complexity of the Network
• Number of neurons in cerebral cortex
(adult) about 20,000,000,000)
• Number of synapses (adult) 2,000-5,000
per neuron)
• Glial cells 10,000 for every neuron
From MIT Human Information Processing Project (2005)
http://vadim.www.media.mit.edu/MAS862/Project.html
CREB cyclic amp-response element binding protein
Two forms: activator (Velcro)
or repressor (Teflon)
Kinds of Memory
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Eidetic Memory
– Detailed recollection (Photographic Memory)
– Scene as a whole (“video-recording”)
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Conceptual Memory (Frontal Lobe Interpretation)
– Meaning of events
– Reconstructive to fit concepts
– Errors in direction of beliefs (recall consistent with beliefs)
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Physiological memory
– Sensory recall (olfactory stimulation of memory)
– “Hot zone” memory
– Déjà vu
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False memory (recall of what never occurred; associated with emotion, social desirability)
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Implanted
Suggested
Hysterical
Confabulatory
Cultural memory
(examples: “Thanksgiving Dinner” “Silent Female” phenomena)
– Interpretation according to accepted constructs
– Collective vs. individual memory (Village vs. self)
– Family vs. individual memory
Traumatic Memory
• Most research on
– Post-traumatic not Intra-traumatic Stress
– Disorder not “normal” response
• Most research
– On men, post Viet Nam
– On women, post rape
• Post 911
– Internalized response
• Suspicion
• New perceptions
– World View Shift
• Safe to threatened
• Predictable to “unpredictable” but predictably sinister
Response During Stress
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Survival coping/automatic responding
Dissociation/ “out-of body”; separation
Narrowing of focus all the way to blackout
Exaggeration of personality style
Lack of reflection; intense but limited
attention (the “keyhole” phenomenon)
• Cognitive static and overload
Memory Characteristics After Trauma
• Longer lasting, “packaged” effects: construct vs.
detail (Chinese Poet)
• Mimic PTSD symptoms (without decrease in function)
• Difficult to assess
– Nature of memory – what is remembered
– “Video-camera in the head” aspect of memory more
complicated. (Video present but cannot be parsed
out; like “reading” during a dream)
– “Memory” result of active, on going process of
retrieval and interpretation. (Holocaust memory)
Specific Effects of
Trauma on Memory
• Limit on eidetic recall; although sense that scene is
stored (emotional memory)
• “Blackouts” that include time and detail gaps
• Increased suggestibility but decreased certainty
• Identification (Blend of self and others )
• Consolidation (Concentration of relevant events without regard to time)
• Integration (Reconstructed memory with added meaning)
• The process of using related information and empathy to an event
real.
• Explaining a sensation (shame, horror, etc).
Wisconsin Memory Study
• Ordinary class
• Stress-induced class
– Confederate “Student”
chastised for using
computer in class
– Students asked the
following
– Confederate “Student”
chastised for using
computer in class
– Students asked the
following
• Are computers allowed
to be used in the class?
• Were YOU specifically
told not to use your
computer?
• Are computers allowed
to be used in the class?
• Were YOU specifically
told not to use your
computer?
Results Showing Identification
Low Stress Condition
100
90
80
70
%
60
CR*
50
GradStud
PreLaw
PreMed
Undergrad
40
30
20
10
0
Rule
*Confabulated recall
Self
Results Showing Identification
High Stress Condition
100
90
80
%
CR 70
60
Grad
Prelaw
Premed
Undergrad
50
40
30
20
10
0
Rule
Self
Franz, R.T, et al, 2006
Recollections of Traumatic Events
Decreased Recall
of Detail
Making sense
of the event
Reconstruction
Recall
Eidetic
memory
Reconstruction
COMMUNICATION
Reporting
Common Fallacies
About Accurate Memory
• A video-tape of an event
• We recall major stressful events: “the seared image”
– True for observers; may not be so for victims (“Snap shot memory.”)
– Under threat and stress, memory may decrease
• Consistency correlates with probity
– Inconsistency in detail common as memory unfolds
• “Unpacking the trunk in the attic”
– Certain core memories remain as ideas with a decay of the supporting
data
• True memory is consistent over time
– Memory is an active process that gets reprocessed as experiences
change
– Memories vary with learning, mood, reflection, agenda
• Recollection is the recall of what was
– Memory is active and the process of retelling serves many purposes
Enhancing Precision
in a Narrative Account
• Context of the telling
– Nature of relationship
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Trust
Time
Support/security
Treatment
Permission (to forget, correct, tell truth)
• Order of techniques
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Cathartic: uninterrupted story-telling
Timeline
Chaining
Clustering
Uncovering
Review and memory cues
Cathartic Story Telling
• Develops empathic relationship
– You care and want to know and understand
• “It’s my interview; not yours.” (Anglican Romanian)
• Allows assessment of language facility
– Where are the difficulties
– How verbal, how difficult to follow
• Provides overview of information and a
starting point
Bio-line
• Constructed by attorney
• Later check with client
• Visual aid for checking sequences and
pointing out inconsistencies
– One side life events (births, deaths,
community events, moves, school)
– One side asylum events (arrests, torture)
Chaining
• Chaining
– Triggering from one kind of memory to another
• Set the stage: “Help me to get a picture of this event. Was it
raining that day? What were you wearing? Who was there?
What town?”
• Progression from mundane, non-threatening to stressful
memory
– Help sort out inconsistencies
• “There is so much to remember. I will ask questions about
what I don’t understand; help me to correct any thing I get
wrong.” Use time line to point out the conflicting information.
– Can trigger PTSD response
• “If you feel too upset, let’s stop.” Take lead from client and
support system.
• Consider referral
Clustering
• Segment story by event or time
– Focus on one period of time or one event
– Structured interview with questions that guide
recollection and ask for detail
– Directed the recall
• Segment story by type of events
– Sort out by chaining and bio-line what info
belongs to what
Uncovering
“How to get to the wine cellar.”
• Assigned review of particular period
• Direct client to do homework.
– “Keep paper and pencil nearby and anything you
recall jot down.”
– Drawings
• Mooting
– Creates tension that chains to emotional connection
– Simulates the hearing and provides true rehearsal