Finally, the case has been made for two memory systems (Bornstein, 1995; Hellawell & Brewin, 2002) in which “ordinary” memories of trauma fall within the common cognitive psychology formulations of memory as constructions and not literal video libraries. PTSD memories, and particularly flashback type, however, are quite literal in their right brain registers (Hellawell & Brewin, 2002, and cited in Brewin, 2003, p. 101).
In particular Damasio notes that “knowledge which exists in memory under dispositional representation form … can be made accessible to consciousness in non-language versions” (p. 166; emphasis added), and that these representations “can fire others if linked strongly by circuit design (in the brain) or they can generate a movement by activating motor cortex” (p. 105; emphasis added). Discussion That two therapists could be present for all hypnosis sessions is unusual.
Geographical location, a manageable financial arrangement for the patient and therapists, scheduling, and compatibility of personal styles and competence were all, perhaps anomalously, achievable. While this arrangement allowed for greater safety in the transition and subsequent complementarity between therapies, we speculate that the presence of the regular therapist in this case was a great benefit but not a necessary condition for responsiveness in the patient or effectiveness of hypnosis. This is not to minimize the effect of this combination, however.
That both therapists were male, with the long-term therapist closer in age to the patient and the hypnotherapist about 10 years older, reasonably relied on the safety derived from the supportive attending of the original therapist in rapidly establishing the positive transference with the new therapist. Second is the matter of comfort and propriety. There is inherently a significant qualitative difference in a person’s talking about what happened-even with very intense affect and even with reporting body reactions in site-specific trauma locations-and displaying what happened.
It is vulnerability and visibility quite unusual in this work. We assert that for those patients who display an aptitude and energy for thus engaging the choreography of trauma, that the abbreviated emblematic movements described here are the protocol of choice. All that is necessary, at least from the perspective of this case, is enough to suggest a meaning in the activity. This perhaps allies with clinical and literature contentions that not every incident within a history of trauma needs to be accessed and processed for effective healing (Dolan, 1991).
Further, it is especially important to consider the care, expertise, and consultation suitable to this problem and modality. For example, discussing with the patient particularly after the initial sessions how she felt about these experiences and the form they were taking cannot be overstressed. Such discussion and processing included attending to comfort level, felt sense of usefulness of the work, and especially that she experienced herself as in charge and a respected consultant as treatment proceeded. This debriefing and ratification of experience and utility occurred after each session.