When survivors of sexual abuse share their stories, they sometimes describe forgetting or repressing memories of their abuse for years, even decades, before the memories resurface, usually in the form of painful flashbacks.

In an effort to understand why this happens, we spoke with Rick Hohfeler, Psy.D., a licensed psychologist in Milwaukee who has worked in the trauma field for 33 years. He currently serves inmates at the Department of Corrections at the Milwaukee Secure Detention Facility, teaches courses on trauma and dissociation at the Wisconsin School of Professional Psychology, and is a member of the board of directors for the International Society for the Study of Trauma and Dissociation.

This phenomenon of forgetting painful memories is formally known as “dissociation.” It’s most common in people who experience trauma as children, though it can happen to adults as well. It’s not actually “forgetting,” because the brain does hold those memories, Hohfeler says. But the brain processes this information differently than other, ordinary experiences. “There are many different systems in the brain that remember things, and they remember them in different ways,” Hohfeler says.

What’s happening in the brain in dissociation?

“When you recall a traumatic memory, it is as though your somatic, or bodily, self is recalling something that your reflective mind is not,” he explains. Ordinary experiences are processed into normal reflective memories in the brain’s left hemisphere, which is responsible for language and logic and gives us words and ideas to make sense of our experiences.

Researchers who study memory sometimes use functional MRI to see which areas of the brain light up during particular types of memories. They’ve observed that when people experience flashbacks of a traumatic event, such as sexual abuse, the left hemisphere shuts down, Hohfeler explains. This suggests that they do not have language or other “symbolizing” tools to process the experience. But the right hemisphere, which processes feelings and bodily sensations, “lights up like a Christmas tree,” he says. “This is the body’s way of remembering something, and all five senses are incorporated.”

Hohfeler notes that dissociation often takes place in situations in which a victim experiences “relational betrayal,” or is harmed by someone that they love and trust and depend on, such as a parent or family friend. In the cases of clergy abuse, the abuser often represents God, Hohfeler says. The betrayal is so hard to comprehend—how can a parent or a God who loves me hurt me?— that the victim will dissociate, and file the memory away deep in the subconscious.

What causes victim-survivors to remember again?

“Many times it happens because we experience something that is reminiscent of the trauma,” Hohfeler says. Survivors might see their perpetrator, smell a related aroma, or hear a sound that they connect with the abuse, all of which can cause intrusive memories or flashbacks. “When triggered, the memories can come back sometimes in very fragmented ways,” which can be scary and disturbing for victims, Hohfeler says.

Can psychotherapy help people who experience flashbacks of sexual abuse?

The field of trauma therapy has grown over the last few decades, and therapists now have many ways to help people having flashbacks. “We have lots of tools to use to try to contain and process flashbacks, but it takes a good, strong relationship with your therapist to achieve it,” Hohfeler says.  He cautions that this type of work often takes time (longer than a month or two), and it’s important to find a therapist with expertise in trauma and dissociation.  Hohfeler suggests starting at the website for the International Society for Trauma and Dissociation, which has a “Find a Therapist” tool.

What do you say to skeptics who distrust the idea of dissociation or don’t believe that memories can resurface?

There is some disagreement among psychologists about dissociation. But Hohfeler says he sees traumatized and dissociative people on a weekly basis in his work in the prison. He acknowledges that a person could claim, falsely, that they experienced childhood trauma (and Hohfeler says there are certain behaviors in patients that make him question a patient’s account). But after more that 30 years of doing this work, “this is very rare, in my experience,” he says.

He adds that research shows that victims don’t forget traumatic “sensory-motor memories” the way they might forget details of a birthday party or what they had for lunch last week. “Sensory-motor memory is very resistant to decay,” Hohfeler says. “There’s plenty of research to verify that.”

Is it possible for people who dissociate after sexual abuse to heal?

Hohfeler offers hope: “Yes, it’s very treatable. You have to be patient with it, and you need a therapist that knows what they’re doing,” he says. “But it’s very treatable.” —Erin O’Donnell, Editor, Awake Blog