EMDR Therapy Quarterly

Understanding whether patient and therapist personal beliefs align with science is critical information for all EMDR practitioners. Beliefs matter. In clinical settings, unscientifically supported or controversial memory beliefs may cause harm. An example of such a belief is the notion of unconscious repression. This is potentially harmful (Lambert & Lilienfeld, 2007; Lilienfeld, 2007; Loftus & Davis, 2006). Yet many laypersons and clinicians believe in the existence of an unconscious protective mechanism called repression (Otgaar et al., 2019; Otgaar et al., 2021; Patihis, 2014; Pendergrast, 1995; 2021).

Some EMDR members may regard this psychoanalytical concept as a scientific truth; however, cognitive scientists disagree. The notion conflicts with mainstream scientific understanding of memory function for traumatic experiences (McNally, 2003). Moreover, decades of scientific research have failed to find scientific evidence for this concept. Recent research on EMDR practitioners’ beliefs indicate they too may believe in repression (Houben et al., 2021).

Presenting information that conflicts with or challenges a status quo bias within the close confines of an annual conference is challenging. Pamela Radcliffe’s recent presentation in York, did just this. A former practicing barrister (in family and criminal law) and current PhD candidate, Pamela presented a talk titled “The science of memory in the Twenty-First Century” and shared recent research findings on lay people and EMDR practitioners’ beliefs about memory function. Her study findings aligned with other recent research on the persistence of this controversial belief (Patihis et al., 2014; Houben et al., 2021).   

Pamela talked about the belief in repression being a zombie idea (Otgaar, presentation in Mainz, September 2023). This is a belief that will not die despite lack of evidence (Krugman, 2013) and partly because it is so rooted and reinforced in our western culture.

Pamela informed the audience that, as of yet, no scientific proof of repression has been found. At best, it is a controversial notion. This came as a bombshell to many in the audience who, in fact, believe unconscious repression is a scientifically supported phenomenon. Moreover, of special interest was a recent Dutch study of EMDR practitioners. In this study, the participants held strong beliefs about both unconscious repression and accurate therapeutic retrieval (Houben et al., 2021). Her own research (presented at a conference but not yet published) showed a significant number of EMDR therapists believing the same thing, despite the majority also believing that trauma memory is reconstructive. It is difficult for me to acknowledge that both beliefs can be held at the same time.

To be clear, ‘unconscious repression’ is a psychoanalytical hypothesis (rooted in Freud) for which scientific evidence is absent. Moreover, it contradicts the science of memory function for adverse experiences.The argument for the non-existence of evidence for repressed memories is supported by the following:

• Traumatic memories are recalled only too well in the first instance, and voluntary efforts to suppress trauma memories are effortful and frequently unsuccessful. The trauma memories that resurface are often amplified in their reconstruction (McNally, 2003; Melchert & Parker, 1997).
• There is an absence of any neuroscientific evidence for dissociative amnesia or repression (Otgaar et al., 2023).
• This belief runs counter to the science of memory (McNally, 2003, 2009). It has never been mentioned in any edition of the DSM. Given that the DSM has systematically pathologised most of what we might call normal human experience, this in itself is surprising.
• Alternative explanations and evidence are offered for the phenomenon of recovered memories. For example, McNally & Geraerts (2009) propose that “recalling childhood sexual abuse after many years is not the same thing as having recalled a previously repressed memory of trauma.”
• How can it be proved that the absence of a memory is a memory? In science, we look for falsifiability to test a hypothesis, and this idea simply does not stand up to the test.

Dissociative amnesia is probably a synonym for repression, and many memory scientists are concerned because the notion is “scientifically fraught” (Otgaar et al., 2019), even though this is a recognised disorder (DSM-5TR, 2002 (300.12 p.298)).

It echoes the ‘unconscious repression theory’ in all but name, and Otgaar argues that there are more plausible scientific explanations for so-called recovered (dissociated) memories.

It would be fair to say that trauma-dissociation researchers and clinicians tend to disagree with memory scientists.

Why the concern?

Despite the absence of evidence, this potentially harmful belief is deeply embedded in society, and this is important because our clients may hold this belief, even if we as therapists do not, and it may induce distorted or false memories. Some people might believe that if they hunt for hidden trauma memories through therapy, they might uncover something that can explain their current distress, which can therefore be healed.

If EMDR practitioners believe in controversial notions of memory such as repression, accurate retrieval, permanence or dissociative amnesia, there is an increased risk of distorted (spontaneous, false or inaccurate) memory induction and the risk of harming our clients. Indeed, Shapiro, in her 2017 book (Shapiro, 2017), in the section on appropriate goals for therapy (p.293) cautions EMDR clinicians “not to retrieve or interpret forgotten memories of abuse, even if the client wishes to do so.”

She goes on to advise practitioners “to be aware of the limitations and distortions of memory”… and to “specifically refrain from asking for details or interpreting events.”

Memory is “vulnerable to error and illusion” (Schacter, 2022) and through her writing, we can see that Shapiro was clearly aware of this and wanted to guard against “the possibility of contaminating memories or creating false impressions.”

Although Shapiro does not state her position on repression itself, she is clearly advising practitioners against interpreting seemingly recovered memories during therapy. Her reference to ‘forgotten memories’ is also important and leads to another point. EMDR practitioners may be misinterpreting forgotten memories as ‘recovered, repressed’ memories. Research shows that people do forget memories they could originally recall. This is not the same as amnesia or repression. Also, given the reconstructive nature of memory, these recovered forgotten memories may also be inaccurate and distorted, as Shapiro points out.

The memory wars

Shapiro was possibly influenced by the fallout from the so-called Memory Wars (Crews, 1995; Lynn et al., 2023) of the 80s and 90s, where probably thousands of individuals were seriously harmed by the belief of therapists in unconscious repression and the active practice of recovered memory therapy (which has since been discredited). Experts on both sides of the scientific debate (typically cognitive scientists versus clinicians/psychiatrists) gave witness testimony (in civil and criminal trials) explaining the scientific controversy surrounding repressed-recovered memories. Claimants and complainants’ testimony relied on the claimed accuracy of formerly repressed memories accurately recovered with therapeutic assistance. The therapy was founded on the idea that hidden (repressed) memories could be therapeutically retrieved. The courts overwhelmingly rejected unconscious repression and accurate therapeutic retrieval. Much harm was caused to vulnerable patients and falsely accused individuals due to sincerely held but inaccurate beliefs about memory function.

As clinicians and researchers, it is important to recognise that we are on a continual learning curve and that we have a responsibility to keep abreast of current developments in research. This is in line with the EMDR Association UK’s strategic objective of “developing the knowledge, skills and professionalism of its members.”

We must be open to learning about how memory works and modify our beliefs to better serve our clients. I was dismayed at the closed and defensive response to Pamela’s thoughtful and, yes, provocative presentation, even by the moderator. A much more workable response, in line with our commitment to continuous professional development, might have been, ‘That’s interesting; I did not know that; I need to find out more.’

This is the exact attitude adopted by Pamela about twenty years ago when first instructed in cases featuring historic memory reports. At that time, her knowledge of memory relied on common sense. To better serve justice, Pamela read the scientific literature. We would do well to do the same to better serve our clients.

Acknowledgements

My thanks to Pamela Radcliffe for taking the time to read and comment on the draft of this article.

Beverly Coghlan is the Editor of ETQ.