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Section 10
Recall in Depression and Posttraumatic Stress Disorder

Question 10 | Test | Table of Contents

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In the last section, we discussed three techniques to help a PTSD client cope with their triggers:  trigger coping questionnaire, writing, and abdominal breathing exercise.

A vital part of the healing process, as you are well aware, is the client’s detailed recall of the traumatic events. 

In this section, we will examine techniques to help your client recall the trauma safely and accurately:  memory prompts, revisiting the scene of the trauma, talking to others, and artistic outlets.   Also, we will discuss self-forgiveness and its relation to the recall process.  In this section, we will examine PTSD resulting from sexual abuse and natural disasters.

4 Techniques to Recall Trauma Safely and Accurately

♦ #1 Memory Prompts
The first technique that I have found useful for client trauma recall is memory prompts.  This includes photographs or journal entries that the client had made around the time of the trauma.  One of the more difficult issues to address is what kind of pictures is least harmful to the client’s healing process. 

For instance, Lydia was abused by her father when she was 11.  Pictures of her abuser might harm Lydia more than help her.  Her therapist Marion left this decision entirely up to Lydia.  Forcing her to look at pictures of her father might send her into shock or extreme flashbacks that could put serious risk to her health.  In this case, Lydia preferred to look at pictures of herself at that age. 

While she studied these photographs, Marion asked Lydia to consider such questions as:  "What was I like then?  What did I feel like?  What was I interested in?  How did I change?" 

To these questions, Lydia answered, "When I was 11, I liked to play soccer.  I was a tomboy and always had my hair in braids or a ponytail, because having it down made me look girly.  I didn’t really know a lot about how people were.  I didn’t know they did things like what my dad did.  In fact, I didn’t even really know what my dad was doing at the time, or whether it was good or bad.  Just that I didn’t like it."  Through memory prompts, clients like Lydia can gain a broader perspective of the type of person they were at the time of the trauma.

♦ #2 Revisiting the Scene of the Trauma
The second technique that I suggest to my clients to aid in their recall is revisiting the scene of the trauma.  By seeing objects involved with the trauma, clients can more easily stimulate their memory.  However, this can be an extremely hazardous journey if the client is not prepared for the reactions he or she may undergo.  If your client is prone to debilitating flashbacks that may incapacitate him or her for days or weeks on end, a visit to the scene of the trauma is strongly advised against. 

Stephen had survived a flood that completely decimated his home and all his belongings.  After a few months of therapy, Stephen expressed to me the wish to go and see the site where his house used to stand.  To prepare Stephen for this shock, I asked him first to vividly recollect his house and write down all the precious objects that were swept away during the flood.  Because Stephen could successfully do this without any risk to his health, I thought it suitable for him to visit the site. 

We talked at length about the emotions he would most probably feel:  regret, nostalgia, longing, helplessness, sadness, and anger.  Once again, because Stephen’s trauma did not involve severe emotional or physical losses, I believed he could confront the scene of the trauma beneficially.  However, I undertake this action with extreme caution and concern for the client’s current emotional stability.

♦ #3 Talking to Others
In addition to memory prompts and revisiting the scene of the trauma, many of my clients have reported successful recall after talking with workers involved with the trauma or simply other survivors.  However, I take the same precautions here as I do when considering whether or not a client could visit the scene of the trauma. 

Would the client be able to deal with additional anger, grief, and possible disappointment at this stage in their healing?  Are they under any current stresses or are feeling vulnerable or overwhelmed for other reasons? 

I find it useful to go over specific goals for clients who wish to make contact with others involved in the trauma.  I generally tell my clients not to expect these individuals to provide them with unconditional love or emotional support.  I also emphasize the importance of keeping the line of questioning neutral, only related to specific details about the events and without emotional investment. 

♦ #4 Artistic Outlets
The fourth technique that my clients have found useful in recalling their trauma is through artistic outlets.  These include writing, painting, music, play acting, storytelling, and any other ways that involve their creative talents. I emphasize that the quality of the artwork is not important but rather the actual act of making the artwork.  

Flor, a PTSD client I treated, used dance to try and recall the emotions that overwhelmed her during her sexual abuse.  At the same time, Flor also found the means to overcome her feelings of shame resulting from her trauma.  Flor stated, "Instead of feeling as though my body was dirty or a thing of evil, dancing helped me feel that I could produce something beautiful." 

♦ #5 Self-Forgiveness
In addition to memory prompts, revisiting the scene of the trauma, talking to others, and artistic outlets, a vital step in the recall process is the client’s willingness to forgive themselves.  By forgiving themselves, clients can let go of feelings of guilt and shame that they experience as a result of their choices and behaviors during the trauma. 

I ask my clients to complete the four step "Self-Forgiveness Examination" to help them identify any feelings of guilt that they still may be harboring.

  1. Looking back over the trauma, for which behaviors, attitudes, and feelings do you still castigate or blame yourself?
  2. What would it take for you to forgive yourself for some of these behaviors, attitudes, and feelings?
  3. Is it possible for you to do whatever you have listed above so that you can forgive yourself?  If so, what is keeping you from pursuing whatever you need in order to make peace with this part of your past?
  4. Is there information you need that you might never be able to obtain before you can forgive yourself?  If so, your options are to try to forgive yourself anyway or to continue to punish yourself.  Who are you helping and what good are you doing in this world by punishing yourself?  Who would you harm if you forgave yourself?

I have also found this self-examination beneficial for clients who are suffering from survivor’s guilt, which we discussed in section 6.

In this section, we discussed techniques to help your client recall the trauma safely and accurately:  memory prompts, revisiting the scene of the trauma, talking to others, and artistic outlets. Also, we discussed self-forgiveness and its relation to the recall process.

In the next section, we will present challenges in helping clients recall their emotions during their trauma: resistant clients, risks, and unresolved grief and anger. 

EMDR beyond PTSD: A Systematic Literature Review

- Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Pérez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A Systematic Literature Review. Frontiers in psychology, 8, 1668. doi:10.3389/fpsyg.2017.01668.

Peer-Reviewed Journal Article References:
Assink, M., van der Put, C. E., Meeuwsen, M. W. C. M., de Jong, N. M., Oort, F. J., Stams, G. J. J. M., & Hoeve, M. (2019). Risk factors for child sexual abuse victimization: A meta-analytic review. Psychological Bulletin, 145(5), 459–489.

Boysen, G. A., & Prieto, L. R. (2018). Trigger warnings in psychology: Psychology teachers’ perspectives and practices. Scholarship of Teaching and Learning in Psychology, 4(1), 16–26.

Callahan, J. L., Maxwell, K., & Janis, B. M. (2019). The role of overgeneral memories in PTSD and implications for treatment. Journal of Psychotherapy Integration, 29(1), 32–41.

Mott, J. M., Galovski, T. E., Walsh, R. M., & Elwood, L. S. (2015). Change in trauma narratives and perceived recall ability over a course of cognitive processing therapy for PTSD. Traumatology, 21(1), 47–54. 

O'Kearney, R., & Parry, L. (2014). Comparative physiological reactivity during script-driven recall in depression and posttraumatic stress disorder. Journal of Abnormal Psychology, 123(3), 523–532.

What are four techniques that could help your client recall the trauma safely and accurately? To select and enter your answer go to Test.

Section 11
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