Workshop 2: Wednesday 15th July 2020
Relived, Re-remembered, Reconstructed:
Working with Complexity in PTSD Memories and Non-memories
Sharif El-Leithy, Traumatic Stress Service, London
Murray, University of Oxford
While CT-PTSD is a powerful empirically-supported treatment, there are many
ways in which working with memories can become complicated. This can
include when the patient finds it hard to recall, tolerate or articulate
the traumatic memories. Equally, clinicians can struggle to know how to use
memory-focused strategies when symptoms seem not to relate to specific
memories, or may not reflect actual events. This can become particularly
challenging when working with "non-memories" that include hallucinated or
imagined material, "flash-forwards", and worst-case scenarios.
This workshop will bring together cognitive models of PTSD and memory with advanced
therapeutic techniques, to help clinicians formulate and adapt for complexity when
working with traumatic memories and associated imagery. Case illustrations will
be used, including those reflecting PTSD that has developed following the COVID-19
pandemic, such as patients who have survived the illness and intensive care unit
admissions, healthcare workers, and traumatic bereavement in those who have lost
a loved one.
Areas we will cover include:
- Clinical update on models of memory in PTSD, and the range of
intrusive re-experiencing phenomena found in PTSD, including "non-memories"
- Memory activation issues including managing in-session flashbacks
and affect without recollection.
- Timelining and target selection when working with multiple, fused and representational
- Using "map the gap" to address fragmentation and recall problems
including memory gaps, psychogenic and organic amnesia.
- Issues about what is "real" - intrusive memories of hallucinated
and imagined events.
- How to use memory-focused techniques with non-memories including
out-of-body memories, constructed traumatic imagery, and "flash-forward"
- Relevant examples from clients experiencing PTSD related to the COVID-19 pandemic, such as constructed memories of loved ones dying, and hallucinations experienced in ICU.
The workshop will help clinicians identify, formulate and adapt for a range
of complexity when working with traumatic memories and intrusive
non-memories in PTSD. Participants will acquire the following skills:
- Identifying the wide range of PTSD re-experiencing and imagery
phenomena that can confer complexity.
- Understanding how traumatic memories are reconstructed through
remembering, creating a pathogenic current memory that may not reflect
reality but feels nonetheless real.
- Adapting CT-PTSD to effectively target, activate and update
traumatic memories that challenge the patient and/or clinician with some
- Formulating and working with non-memories in PTSD treatment.
Dr Sharif El-Leithy is Consultant Clinical Psychologist at the
Traumatic Stress Service in South-West London. He was a member of the
NICE (2018) PTSD guideline update committee. Dr Hannah Murray is a
Research Clinical Psychologist at the Oxford Centre for Anxiety
Disorders and Trauma, University of Oxford. She is currently involved
in developing and evaluating internet-based therapies for PTSD. Between
them they have 30 years of experience in working with PTSD using
cognitive therapy. They supervise, teach and research widely in the
Ehlers, A. (2015). Understanding and treating unwanted trauma memories in
posttraumatic stress disorder. Zeitschrift für Psychologie/Journal of
Rubin, D. C., Berntsen, D., & Bohni, M. K. (2008). A memory-based model
of posttraumatic stress disorder: evaluating basic assumptions underlying
the PTSD diagnosis. Psychological review, 115(4), 985..
Oulton, J. M., Strange, D., Nixon, R. D. V., & Takarangi, M. K. T.
(2018). PTSD and the role of spontaneous elaborative "nonmemories".
Psychology of Consciousness: Theory, Research, and Practice, 5(4), 398-413
Wednesday 15th July 2020