Does trauma-focused psychotherapy alter pre-existing memories? A survey of German psychotherapists

Little is known about how pre-existing trauma memories change under trauma-focused therapy. We surveyed 224 German therapists trained in trauma therapy regarding observed memory changes, therapeutic practices, and beliefs about trauma and memory. Most reported using trauma-focused interventions primarily for PTSD, although some reported using them to complete fragmented memories (49%) or recover inaccessible memories (19%). Most agreed that traumatic experiences are usually remembered, but some endorsed scientifically questionable beliefs about inaccessibility or recovery being a therapeutic goal. Many reported observing memory changes (82%), and among these, a substantial proportion reported the emergence of new traumatic memories (81%), although such experiences were relatively uncommon overall (12% reported them as occurring "often" or "very often"). Memory changes usually involved emotional meaning, narrative expression, and retrospective reappraisal. Problematic changes, such as alterations in temporal-spatial context (39%) and substantial changes in core event details (18%), were less frequent. Reports of recovered memories, but not of changes in existing memories, were associated with potentially problematic beliefs and attempts to complete or recover memories, and such patterns were more common among psychodynamic therapists than among cognitive-behavioural therapists. Taken together, these findings add to the complex picture of how trauma-focused interventions may affect memory and diverge from laboratory evidence generally indicating no effects on memory. They highlight the importance of evidence-informed training on trauma, memory, and suggestibility, as well as longitudinal research on trauma memory changes during therapy.