A third type of trauma is characterized by malevolent abuse (Gelinas,1988). This type of trauma has a particularly significant impact on the NMS since the victim cannot rationalize or form any type of understanding of the experience. It is also the basis of a more complex relationship in the victim’s HMS and NMS memory systems and is notoriously difficult to treat.

1. After witnessing a traumatic event, such as a serious accident and the consequences that follow, when people try to recall and relate the event to another person, they often get pieces out of sequence. This is because, as they were processing the event, the amygdala was firing off with different intensities, causing the segments of memory to be discontinuous and stored in different areas. Upon recall, the HMS tries to piece the segments back together, but it can easily get the segments out of order.

2. The second most common error in recalling a traumatic incident is leaving a part out of the recalled scenario. An important part of the experience cannot be recalled, often a part that had a more intense charge as the event was witnessed. Again, this is explained by the discontinuous storage of different parts of the memory. In reconstructing the event, the HMS fails to retrieve a piece that is particularly charged and thus stored away from other parts of the memory.

3. The third kind of error involves a misperception about what was witnessed. This is not a storage problem, but an encoding problem. The stress of trauma opens us to a number of perceptual distortions. In addition, perception always involves filters, sometimes called cognitive schemas or paradigms—preconceived ways of understanding the world and characteristic ways of distorting it. When there is a difference between what we perceive and what we believe, this "cognitive dissonance" frequently results in an interpretation that fits our world view more closely than it fits the experience.

Depending on the nature of the trauma and several other factors described below, a client’s defense mechanisms may be more or less structured, complex, and effective in diverting energy away from the "hurt spot." But if therapy is to help a client resolve the effects of trauma, the opposite must occur. The energy must travel down the fragmented memory segment, the anxiety tolerated, the "hurt spot" activated, and the resultant memories and emotions processed. Then the fragmented memory segment and the affect it holds can be integrated rather than defended against. In short, the gap must be bridged. This may be accomplished in any number of ways, with some being more efficient and more effective than others.

road that never gets to the desired destination. Nonetheless, talk is the medium of the therapeutic relationship, and Carl Rogers’ (1951) emphasis on empathic listening, unconditional positive regard, and acceptance remains essential in building trust, regardless of the clinical approach.

Behaviorally-oriented psychotherapy uses exposure and desensitization, where the traumatic situation and related events are enacted or imagined in hopes of desensitizing the person. In the terms we have been using, desensitization occurs when the gap in the memory trace is bridged and the traumatic memory segment is discharged of its emotional valance. This can, however, be a long and painful process.

Hypnotherapists (e.g., Brown & Fromm, 1986) have had success inducing trance states to help patients recall traumatic memories. The heightened internal awareness generated by hypnosis allows memory fragments that could not be accessed to become available, and this can be done in a gentle and controlled manner due to the phenomenon of "trance logic." The impact of the memory can, for instance, be modulated by keeping the patient behind a hypnotically-induced protective shield or by viewing the event from a distance. These methods reduce and control the affective discharge that accessing the traumatic segment of memory may cause. While hypnosis can increase the amount a person remembers, it does not necessarily increase the accuracy of memory (Brown, Scheflin & Hammond, 1998).

Rapid cures for the symptoms of single-incident trauma have frequently been reported in the literature of EMDR and energy psychology. However, regardless of the approach used, or its power, in instances involving multiple trauma, where the Neocortical Memory System plays a more decisive role and the memory structures are more complex, the same safeguards that more conventional therapies use with people who have been severely damaged need to be in place.

Therapists find themselves in challenging times when working with victims of psychological trauma. We have never been called upon to treat more trauma or more severe trauma; at the same time, never before have we had such potent tools for rising to these challenges. Much of the information presented here builds on the work of others (See Horowitz, 1999; van der Kolk, 1987, 1996; van der Kolk et al, 1996; Stickgold, 1998; LeDoux, 1992, 1996), and the model, while speculative, is consistent with a growing body of research on the neurobiology of trauma. For me, however, the significance of the model is its explanatory power. When I use this model to think through or revise a treatment plan, or to explain to patients why they are experiencing what they are experiencing, or to help a patient understand the treatment approach being administered, or to engender hope in a new patient who has been suffering for years despite various failed treatment attempts, patients get better. That is the reason for the model, and it is the reason I am pleased to have had this opportunity to share it with you.