Coping with Traumatic Memories Of Sexual Abuse
Dr. Karen Engebretsen-Larash: Guest speaker. Even after the abuse has ended, the traumatic memories remain. This conference focuses on how to effectively deal with those traumatic memories. Dr. Engebretsen-Larash specializes in trauma-related disorders.
The people in blue are audience members.
Beginning of Chat Transcript
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com Our topic tonight is "Coping With The Traumatic Memories of Sexual Abuse." Our guest is Dr. Karen Engebretsen-Larash, psychologist and specialist in treating trauma-related disorders.
Dr. Karen: Good evening everyone.
David: Good evening, Dr. Karen, and welcome to HealthyPlace.com. Can you define for us what traumatic memories are?
Dr. Karen: Traumatic memories are any recollections either in the mind or body that the unconscious tries to communicate with the person who has been traumatized. These memories can occur at any time, even long after the sexual abuse has taken place.
David: Why is it that long after experiencing sexual abuse, some people are left with very vivid traumatic sexual abuse memories that are difficult to deal with, much less get rid of?
Dr. Karen: The mind has a way of protecting itself from pending danger and does a pretty good job at protecting the self; but in times of great stress, it is likely for these memories of sexual abuse to increase in frequency which is a signal that the unconscious can no longer continue to suppress this information.
David: Some people say they are "haunted" by memories of traumatic experiences which intrude on and disrupt their daily lives. They often can't get the "pictures" of the trauma out of their heads. How can an individual deal with this in an effective manner?
Dr. Karen: They can, but it generally takes years to work through the aftermath of repeated sexual trauma. In the recent past, I have been working with Dr. William Tollefson who developed the WIIT (Women's Institute for Incorporation Therapy). He developed this technique to remove the "pain" aspect or the "self" figure so that patients can continue doing the uncovering work necessary for healing. Although his focus has been on the inpatient population, he has been making this available on an outpatient basis. In my clinical experience, I am amazed by how much more quickly we can speed up the therapy process following the Incorporation Therapy.
David: Why do some people undergoing extreme stress have continuous memory and others have amnesia for all or part of their experience?
Dr. Karen: That's a good question. We are all born with certain coping strategies and we learn at a very early age what is safe to let others know about us and what is not. Individuals who have "continuous" memories are generally so crippled that they cannot function. Others become extremely creative and develop a system whereby they can access different "parts" (or alters) to cope with the stressful situations. This is the extreme form of PTSD (post-traumatic stress disorder) and can lead to Dissociative Identity Disorder (DID).
David: Dr. Karen, here are some audience questions:
LisaM: I would like to know if remembering parts of the trauma every few months or years is 'normal' or common?
Dr. Karen: Yes, it is common. Certain things can trigger a memory that may not have bothered you in the past.
David: If you can remember the abuse but not the feelings associated with them, only visual memories, how do you get in touch with those feelings?
Dr. Karen: That's a good question. It is likely to believe that you were told that you were not permitted to feel in any way shape or form. However, the visual memories remain and are a signal that the brain is trying to work through this unresolved conflict.
David: Can these traumatic memories also be experienced in physical ways (i.e. tremors, headaches, etc.) as well as, or instead of, psychologically?
Dr. Karen: Absolutely! In fact, if we pay attention to our bodies they will give us all kinds of clues about what's going on in our heads.
angeleyes: Why do the memories seem so unreal or dreamlike? I end up questioning their validity. If they hadn't been verified by other family members, I would not believe me.
Dr. Karen: No one wants to believe that the very person (or persons) they were supposed to trust for their care and safety would betray them. In the mind, that just doesn't make sense. So an elaborate defensive system develops to keep the individual from having to face the horrors of what is happening to them. Please understand, all memory is screened by the brain and as we recall information, it goes through different filters in the brain. It is unlikely that any memory is recalled exactly as the abuse happened, but that is not the point. What is important is that the "self" was damaged in the process and needs to be healed.
Sleepy pair: Is there anything I can do about body memories to make them stop?
Dr. Karen: I always recommend that patients have a complete physical examination to make sure that there is not something medical which needs to be addressed. Once medically cleared, I would recommend that you find a therapist who is able to work with "body memories" to help ease the physical and emotional pain which accompanies these traumatic memories.
David:Is there anything she can do on her own in the meantime?
Dr. Karen: Guided imagery is a wonderful tool. While in a relaxed state, create a safe place in your mind. Visualize the places which are hurting and imagine that a warm healing hand has arrived to heal the wound. Please remember, working through sexual abuse memories can be complicated and you need to develop a good working relationship with a therapist so that they can address the other issues which arise in the course of dealing with these traumatic memories.
dawnblue: Dr. Karen, how do we deal with the nightmares in our own day-to-day lives? I can't even find a therapist in my own area, much less one that is familiar with a new technique. What can we do ourselves to lessen some of the anguish?
Dr. Karen: Good question. Eye Movement Desensitization and Reprocessing (EMDR) is a technique that has been found to be very effective in the short-term. If you go online on the search engines and look up EMDR, I am sure you can find some local clinicians who are practicing this technique. Also, I often recommend books to my patients on a variety of subjects. Several include: "Healing the child Within" by Charles Whitfield and "Victims No Longer" by Mike Lew. If you look in the reference book section of my website, you will find a list of other books which would be helpful for your healing process.
lpickles4mee: What do you suggest someone do if they know it happened, but do not remember anything?
Dr. Karen: I guess I would ask how you "know" it happened if you have no memory of such. Were you told it happened or do you just have a "feeling" it happened? By the way, there are a couple of other good books which may also be of interest. For example, "Memories of Sexual Betrayal: Truth Fantasy, Repression and Dissociation"by R. B. Gartner and "Trauma, Memory and D dissociation" by JD Bremner and CA Marmar.
David: Here's another memory question, Dr. Karen.
Chatty_Cathy: Dr. Karen, is it necessary to try to remember every incident of sexual abuse, or is it enough that once I acknowledge the ways in which I was hurt , I focus on the emotional aspects and work to change how I feel about myself and how I deal with things today. I am not sure I see how remembering every single incident will do anything but hold me back in the past. Thank you.
Dr. Karen: I agree totally. Wallowing in the past is futile at best. What is important is to acknowledge that the abuse occurred and move on. Once you begin to put the pieces of your life back together, you have the possibility of developing a happy, healthy, confident, competent self which can enjoy all the successes life has to offer. Let's face it, recovery is hard work and it is a LIFE LONG process, not a one time event during the therapy process.
David: Given that everyone is different and heals at different levels and rates, do the traumatic memories of sexual abuse ever go away, or is the best one can hope for a reduction in the frequency and intensity of the sexual abuse memories over time?
Dr. Karen: I don't think the objective is to rid the self of the memories. On the contrary, the memories are a gift, a signal that the brain is now ready to get to work and finally work through the trauma. There are different ways to obtain symptom reduction, through meditation, exercise, reading and other self-care tools. There are no easy answers and certainly no quick fixes. Finding a good support group can be a big help. Certainly, the internet has made it possible for individuals to reach out like never before. Find a support group you feel comfortable with and interview several therapists before making a decision about who to work with.
David, in reference to the latter part of your last question, I don't think memories ever go away, but they become less intense over time. Like I mentioned before, I have seen some dramatic results with the Incorporation Technique in working with both male and female abuse survivors.
David: I think that's comforting to know. Here are some more audience questions:
kapodi: I am currently struggling with flashbacks and nightmares. A friend who has been with me during these has said that I seem to go back to infancy in my behaviors and sounds. I remember nothing when these happen, except that they start with a feeling of slow puffball like things coming towards me and slowly speed up to the point where it is out of my control. I cannot find a way to stop the puffballs once they start. My therapist recommended Eye Movement Desensitization and Reprocessing (EMDR). The EMDR therapist could not work with me. What can I do about this?
Dr. Karen: EMDR is not a cure all and it does not work for everyone. It is meant to be a stabilization technique but not a cure. Based on how you describe your symptoms, it is likely that the dissociative process is becoming more intense over time. That is not uncommon when you start to do some really intense therapy. Kapodi, I am not familiar enough with this technique to make any recommendations, however, I will say that seeking alternative therapies can prove to be very beneficial. Remember, we are all unique individuals and there is no single cookie-cutter approach that will work for everyone.
Krittle: Dr Karen, when dealing with the specifics of the abuse and you receive a diagnosis of Multiple Personality Disorder (MPD) or Dissociative Identity Disorder (DID) how do you defend your diagnosis with the "church goers" and their belief that you are just possessed and need religious intervention? Thanks for your time. :-)
Dr. Karen: That's an excellent question! In fact, I am working with a DID (Dissociative Identity Disorder) patient who was told she was evil and a "bad seed" and a priest attempted to "exorcise" her. Obviously, it did not work. The Incorporation Therapy accomplished what prayer alone cannot. Please understand, I am very respectful of people's belief systems regardless of religious affiliation. In fact, as part of the Incorporation, it is necessary for individuals to access their God or higher power in order to incorporate.
theotherboo: Do you feel that there is a time frame, a certain length of time, that someone should be seeing a therapist?
Dr. Karen: That's a good question too. Most psychoanalysts would say at least 4-5 years on the couch is necessary, and since I was trained along those lines and am an analyst myself, would have said the same thing. However, since we live in an age where insurance benefits are almost non-existent anymore, I have looked for more creative ways to speed up the process. Like I mentioned earlier, there are many wonderful book references on my website which provide a wealth of information. Of course, bibliotherapy has nothing to do with psychoanalysis, but it gives additional support to the process.
StarsGirl9: Is there any way to deal with flashbacks while in the middle of the day, say, if something is triggering them at work?
Dr. Karen: One of the techniques I teach my patients is to fix your eyes on a focal point, put your feet on the ground and take three deep breaths and focus on something pleasant. Another thing I require my patients to do is write a list of 50 positive affirmations and recite this list FIVE times a day in front of a mirror for 6 months. An example of a positive affirmation would be: I am creative for me, or I am intelligent for me, I am sober and focused for me, I am talented for me, I am loving to me for me, etc. It is important that NO negative statements are part of this list. The objective is to reprogram the negative abuser values with new values, which are unique and special for you. Remember, one bad apple can spoil a whole bunch and one negative comment can ruin all the 49 positive affirmations.
David: Sometimes, Dr. Karen, the intensity and constant reappearance of the traumatic memories and feelings associated with the sexual abuse can be very tough to live with. With that in mind, here's the next question:
angeleyes: What is the best course of action when one is suicidal? What do you do with your patients?
Dr. Karen: I have been fortunate enough to have established a good enough relationship with patients early on, so when they become suicidal, I make them contract that they will call instead of follow through. Since I am in private practice, I make it a policy to be available by phone when necessary and expect patients to reach out when in crisis. This provides a great opportunity for them to learn how to trust. Don't be afraid to ask your therapist what their policy is about emergency phone contacts. The bottom line is (in good humor of course) I tell them, " I value working with you but I can't work with a corpse." This is hard work and we can wade through this difficult time if you're committed to the process. I also tell them, "you have survived this long. Your life is a gift. God isn't done with you yet." Folks, recovery is hard work and there are no easy answers. Having been a victim of ANY kind of trauma is a tragedy and it takes time to work through the issues.
David: I noticed some first-time visitors in the audience tonight. Welcome to HealthyPlace.com and I hope you will continue to come back. Here's the link to the HealthyPlace.com Abuse Issues Community. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.
I want to thank Dr. Karen for joining us tonight. It's been very informative and I hope everyone found it helpful.
Again, thank you for coming and staying late to answer questions, Dr. Karen. And I want to thank everyone in the audience for coming and participating. I hope you found it helpful.
Dr. Karen: I was honored to participate. God bless.
Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.