Memory, a Psychotherapeutic Perspective

by Mary de Courcy

Abstract. This paper was given in Autumn 2005 as part of a post-graduate seminar in the Humanities Institute, UCD. It considers memory from a psychotherapeutic perspective, and focuses on body memory. In order to protect client confidentiality, it draws on observations of composite rather than individual clients.

Introduction.

One way of considering the whole of a person is to regard the him or her as being made up of five selves; the cognitive, the physical, the emotional, the spiritual and the sexual selves. Each is separate, yet intimately connected. If one or more of these selves is out of balance, then the entire system is affected. The balance of the selves which is necessary for healthy living is unique to each individual. No two people have the same needs, desires or wants. No two share identical patterns of internal harmony. So each person must find his or her own route towards achieving balance. For some it may be competitive or recreational sport. For others it may be religious practice or meditation. Creative writing or  participation in music making may help others to achieve inner calm. But for many commitment to a psychotherapeutic relationship may be the most beneficial way to release long-held burdens in order to engage fully with the the joy of being alive.

In many instances a person beginning psychotherapy will speak of bodily symptoms and strange thought processes. Often their way of feeling out of sorts, or out of balance will manifest itself through disturbed sleep patterns, repetitive nightmares or obsessive thoughts. Sometimes a client will experience body symptoms like skin irritations or sores, repeated upper respiratory difficulties or stomach ailments like irritable bowel syndrome or colon spasms. An examination by the client’s GP will ascertain if these conditions need medical or psychiatric intervention.  In instances where the person is referred to psychotherapy, the causes are generally psychosomatic. In other words these are somatic or body conditions brought about by psychic distress. So while a person may not be aware of the causes of the distress, he is aware of feeling unwell in his body and his mind. Thus it is suggested that, at the outset, the physical and cognitive selves are out of balance. Emotional distress is generally apparent and in most instances the spiritual and sexual aspects of the whole are also out of syncopation.

The Composite Client.

A typical situation of a new client referred to psychotherapy from a GP might be as follows. Lizzie, a 33 year old single woman, employed, lives in her own apartment far from the area in which she was raised. She complains of stomach pains, heart palpitations and is frequently beset by new outcrops of facial spots.  She sleeps poorly and is constantly distracted at work. At weekends she binge drinks and this is often accompanied by drink induced sexual behaviours. She buys self-help books but seldom gets past the first chapter. Her workplace has referred her to her GP who has said she is suffering from anxiety. He has suggested psychotherapy as a first option, rather than antidepressants and sleeping tablets.  To this she has somewhat dubiously agreed.

By considering the five aspects of the self, it is apparent that for Lizzie, all five are out of balance. Although she presented with physical symptoms, it is clear that her emotional, sexual and cognitive selves are imbalanced. As the spiritual self is intimately connected to the whole, it can be reasonably assumed that it too is imbalanced. Interestingly in some cases,  the spiritual self is not readily identified with by the client. This is because many people confuse spirituality with religious belief or practise rather than as a way of being. In many instances a client like Lizzie will blame her ailments on the lack of an intimate relationship or on poor working conditions. While these may indeed be factors, often a root cause of her difficulties is a poor relationship with herself. Out of this can come loneliness, a low sense of self-worth  and a depressed attitude towards her life and future.

Memory

As humans we have both conscious and unconscious memory. At a conscious level we are aware of our surroundings. We retain short-term and long-term information and we use our cognition to solve problems with which we are faced daily. In general we are unaware of our unconscious memory. The stored information remains effectively hidden from our cognition. This is as it may seem, however the truth is quite different. Unconsciously stored information is given to our consciousness frequently. Yielded through dreams, slips of the tongue and somatic distress, the knowledge of our past is available to us. While happy events from the past do not trouble us but contribute to an internal balance between the selves, traumatic or disturbing incidents from our past will linger in the unconscious memory. The information is held but it may be difficult to access. It bubbles to the surface of consciousness through obsessive thoughts. It reveals itself through repeated failed relationship patterns. Disturbed sleep patterns and nightmares may impair a person’s ability to work effectively during the day. Complaints of the skin, throat and stomach can render the person physically unwell and he or she may develop a very poor self image. Substance abuse and random sexual behaviour may be sought as an escape from that which simmers beneath.

In psychotherapy body symptoms are readily observed by the psychotherapist. Twitches, throat-clearing, choking sounds, indirect or too direct gaze, repeated hand movements, all are the body’s way of communicating. While it may not be appropriate in the early stages of the relationship to comment, the psychotherapist will be aware that the body of the client is talking and has much to say. Body memory, that is information stored in the unconscious and conveyed through the body, has no chronology. Yet it holds all the person’s life experiences. This includes life in utero, the birth journey and all the ante-natal experiences of the infant. It holds the experiences of attachment and separation. Memories which the conscious mind found too painful to remember are held in the unconscious as body memory. The body has no cognition. It cannot place a particular past event at a precise age in the person’s life. It remembers incidents as if they were in the present. The 33 year old body of Lizzie talks as if she were eighteen months, or five, or thirteen years old. It hold the information that she needs in order to make sense of and move forward in her life. Thus it can be seen that one of the tasks of psychotherapy is to release unconsciously held memory into consciousness. Then the hope is that the information can be understood and dealt with by the client.

Trauma.

Every day, the media informs us of traumatic events at home and abroad. Human catastrophes arising from collison with natural forces like tidal waves, earthquakes and flooding abound. Disasters resulting from human error like car crashes, fires and accidents are too frequent. Less familiar are abductions, murders and death through negligence. Daily we must contend with such information. Yet unless tragedy directly affects us, we turn away and continue our own lives. This is not an uncaring response. It is a healthy way to avoid being overwhelmed or psychically flooded by the external world.

Yet within us we can hold traumatic events, the details of which are cognitively long forgotten. Separation at birth from the mother whose heart and pulse we listened to for nine months. The quiet sobbing of a three year old who lies in the dark and feels forgotten. The seven year old who stands alone in the school yard longing to join in the gang. The thirteen year old who wants to be like everyone else and who feels so different. The abused child who remained silent and pretended to the outside world that home was a good place to be. Each of these has suffered trauma. Each has tried to cope in order to survive. And for many the establishment of internal defence mechanisms is the only way to cope.

Research suggests that the memory of a single traumatic event remains in the conscious mind. A person, regardless of age, who is involved in a single car crash will generally remember with startling clarity the events of the scene. A child who is beaten on one occasion by an irate parent will usually remember the situation with precision. In contrast multiple traumatic events and the person’s experience of them are held unconsciously.  For instance a person subjected to ongoing humiliation perhaps from physical, emotional or sexual abuse, will seldom consciously remember more than sketchy details. This may result from the formation of intense defence mechanisms like dissociation, severe splitting, psychosis and paranoia. It may result in attempts to release the internal pain through self harm. Addictive behaviours may also be caused by the person trying to suppress painful lurking memories. Whether the addiction is to food, substances, sex or gambling, the person tries to control the environment which has traumatized him or her so deeply. He doesn’t want to feel in his body, it’s too distressing. She doesn’t want to remember. He wants to feel good, or nothing at all. The bottle is her best friend. It will always be there, it will never betray him or her.

Many people who have been abused tend to minimize the abuse. They often split the abuser into a good or bad person and fiercely protect their internalised image of the good person.  The trauma and the resultant defence mechanisms may be the cause of some mental illnesses like schizophrenia, obsessive compulsive disorder and manic depression.

The Client.

Returning to Lizzie our composite client, it is quite evident that she holds much at an unconscious level. Her anxiety, body symptoms and inability to focus cognitively suggest deeply held trauma. It is also clear that she is quite alone with few, if any, close relationships. Her weekends are drink-fuelled, numbing her to the possiblity of allowing close connections with others. She is distrustful and wary, yet yearns for nurturance and companionship. The key to unlocking body held trauma is the relationship between the psychotherapist and the client. In Lizzie’s case, issues of trust, dependancy, attachment and separation are evident. It may be difficult for her to speak. She may be evasive and defensive in her verbal responses, denying and minimizing the extent of her problem. She may be highly resistant, sabotaging the psychotherapeutic relationship by breaking boundaries; for instance forgetting appointments or arriving late or too early.  The work of the psychotherapist is to provide safety and a holding space for Lizzie in which she can begin to learn to trust, a space into which she can begin to release memories which have held her captive for so long.

Influences.

A person’s response to trauma is influenced by his or her cultural, familial, religious and societal background. The exposure to Irish female dress codes, Irish advertising and billboards, and Irish colloquialisms may be quite shocking to an Islamic, scarved young Saudi Arabian woman. A Middle Eastern homosexual youth living and participating in the gay scene in Dublin, could return back to Dublin from a visit to his family home, in a fearful traumatized state following an introduction to his intended bride in an arranged marriage. A young South American, expelled with her family for political reasons, arrives in a Scandanavian country. Her family’s strong Latin Catholicism, her father’s harsh discipline and her difference in skin colour and language compound her sense of alienation. She travels further, searching for a sense of belonging and identity, but is never permitted to return to the country of her roots.

Our early environment can significantly affect what we perceive to be traumatic and how we experience that trauma. Cultural difference, societal mores, gender roles, trans-generational memory, each has an impact of our conscious and unconscious responses to external stimuli. If the childhood environment, perpetuated by parental attitudes is generally adaptable, accepting and quite solid, the person can develop a resiliance towards traumatic incidents. He will be shocked, may suffer from night-terrors, and may display symptoms of body distress. But he will recover. Another may be rocked by devastating images, but she will steady herself and courageously face an unknown future.

If however a child’s upbringing was severely harsh and intolerant, or was uncaring and negligent, his or her responses to what is perceived to be traumatic may have a lifelong impact. It will colour his relationships with the world, with others and crucially with himself. Her memory may be fragmented, unable to cope with remembered flashes of cruelty. He may yearn for stability, but not recognise it. She may tremble from glimpses of devastating loss, but not know what it is she has lost. He make seek attention through grandiose displays. Or he may retreat into a mute world, able only to relate to a computer screen and anonymous chatrooms. To remember is re-traumatizing.  It is too painful. It is easier to block out the mental memories through addictions, or through severe psychological defences.

But the body remembers. The body knows what the person has experienced. It knows what happened. Even in cases of severe dissociation when the senses of sight and sound, of taste and touch have left, the child continues to smell. The sense of smell remains to bear witness. Decades later when all cognitive memory of the abuse has been erased, that smell can trigger the whole horror. Ugly scenes flash into the mind and the person is again the small child crouched in terror.

Lizzie

Let us briefly place Lizzie in a societal context. Raised in a small rural setting, with a strict Catholic upbringing by well-intentioned, hard-working parents, she now lives in an anonymous, large, apartment complex on the fringe of the city. That she would achieve a university education was the aspiration of her parents, both of whom were early school leavers. Lizzie no longer practises the religion of her parents yet she is haunted by the concepts of sin, evil and shame. She is embarrassed by the financial and educational poverty of her childhood yet she is unable to embrace the middle class attributes afforded to her. She is rooted yet adrift. Her sense of belonging is lost. And ownership of her identity is beyond her grasp.

Lizzie needs to be anchored. She needs to be attached. She needs to feel that someone cares, that someone can see her, that someone can accept her in all her fraility, shame and sorrow. She needs to know that someone can see through her disguises, through the drinking, the overt sexual displays. She needs someone to walk with her, back along childhood paths. Someone who will not direct her, but will sit with her while she weeps. She needs to know what it would be like to feel safe. She needs to know what it would be like to get furiously angry and not be rejected. It may be several years before Lizzie can trust her psychotherapist. It may be many years after that before she can begin the journey towards remembering. The memories are held in her body.  But until she’s ready, her psychotherapist will sit with her and wait.

The Work

Whether the psychoptherapist works from a cognitive, psychodynamic, Gestalt or object relations approach, or from an integrative perspective, Rogerian person centred theories underpin the relationship between the psychotherapist and the client. Building a climate of trust and safe holding may be difficult, frequently sabotaged and will take time.The client’s loyalty to her internalised objects may provide the greatest obstacle to change. The fear of challenging the internalised authority and belief system of her parents, or the risk of addressing an internalised, rigidly held societal system may cause the client to jeopardise the psychotherapeutic relationship. The non-judgmental stance of the therapist may be regarded with deep suspicion. The client may employ primitive or well developed defence mechanisms to manipulate and test the therapist. Seductive poses, glowering silences and attacking outbursts may test the therapist’s commitment and boundaries. Ambivalent parenting may have resulted in internalised trauma held somatically. The body armouring may be familiar, even reassuring to the client. The possibility of losing this survival mechanism may be terrifying.

Yet the client feels alone, frightened and often lost. Some part of her knows that the therapist accepts her as she is. Perhaps it is this knowledge that encourages her to return week after week, year after year.

Conclusion

Development of the therapist’s internal supervisor is most effective when employed both cognitively and somatically. Similarly countertransference recognition and interpretation at both levels will strenghten the therapist’s understanding of the client’s internal world. By following the ebbs and flows of the somatic dynamics in the therapist’s own body, it is possible to observe unconsciously held information being yielded by the body of the client. In time balance can be restored to the five aspects of the self. Resiliance can replace fragmentation. The light and hope of the psychotherapeutic relationship can illuminate the deepest internal shadows.

Mary de Courcy is a psychotherapist in private practice, serves on the Governing Body of IAHIP and is on the editorial board of Inside Out.

Further Reading.

Corry, M. and Tubridy, A. (2001) Going Mad. Dublin: Newleaf

Dirie, W. (2001) Desert Flower. NewYork:Virago

Levi, P. (1979) If this is a man. London: Abacus

Lynch, T. (2001) Beyond Prozac. Dublin: Marino

Mallon, P. (1996) Multiple Selves Multiple Voices. UK:Virago

Nolan, I.S. and Nolan, P. (2002) Object Relations and Integrative Psychotherapy. London: Whurr

Picoult, J. (2000) Plain Truth. London: Hodder and Stoughton

Terr, L. (1990) Too Scared to Cry. New York: Basic Books