3.Dawn Hughes — Direct/Cross (Part 1)

DAWN HUGHES: Good morning.

DAWN HUGHES: I'm a clinical and forensic psychologist.

DAWN HUGHES: So clinical psychology is basically the study of human behavior of both normal and abnormal human behavior. Clinical psychologists assess and treat and evaluate individuals who are having difficulties in their life, from problems of living to major psychiatric and mental disorders. Psychologists can also teach and conduct research as well.

DAWN HUGHES: Forensic psychology is just the application of the science and principles of clinical psychology to a particular legal question.

DAWN HUGHES: Yes. I received my bachelor's of arts degree in psychology at Hamilton College, which is upstate New York. I received my Master's of science and my doctorate degree in clinical psychology at Nova Southeastern University, which is in Florida. I had to do my full-year intensive internship to obtain the Ph.D. and that was at Yale University in their school of medicine in the department of psychiatry, and there I had two full-year rotations. Instead of breaking it up, I had a one full-year rotation at a substance abuse treatment unit run by Yale, and then the other one was at the West Haven Mental Health Clinic, where we treated individuals with more severe and persistent mental illness. After that, I came back to New York and had to complete my postdoctoral fellowship in order to amass a number of hours to get licensed in the State of New York, and that was at Weill Cornell Medical College on the east side, and there I worked in the department of psychiatry as well in the anxiety and traumatic stress program.

DAWN HUGHES: So I'm currently in independent practice in New York City.

DAWN HUGHES: So I look at it as three main areas. One area is the clinical area, where I treat individuals in therapy. I have an active clinical practice, two, two and a half days a week, where individuals are coming to me to deal with their problems that they have, struggling with the traumatic effects of the victimization or abuse or violence that they experienced. The other part I do is the forensic psychology part, so something that I'm doing here today. I also assess individuals who are involved in criminal or civil matters and write reports for the court and confer with attorneys on cases, and then sometimes I testify in court. And then the third part of what I do is, I'm on the faculty at Weill Cornell. I'm a clinical assistant professor in the department of psychiatry there and that means I'm supervising an extern, I'm participating in the teaching program, and I'm doing other type of academic things. This is called a voluntary position, which is what academic medical institutions do, which means you don't get paid for that, but you give your time back. So that's one of the things I do. And then the other part of that third bucket is, I'm engaged in our professional organizations, in the American Psychological Association and the trauma division specifically, and spend time because I'm on the board doing things with that organization as well, which also is not a paid position.

DAWN HUGHES: That entails people coming to my office for individual psychotherapy. Most of them, but not all, but a good majority of them have had some kind of violence or abuse in their lives, either having been sexually assaulted, having been a victim --

DAWN HUGHES: Yes, your Honor.

DAWN HUGHES: That's correct.

DAWN HUGHES: That entails conducting sometimes comprehensive psychological assessments of individuals who are involved in criminal or civil matters.

DAWN HUGHES: So the teaching part is, I teach an ethics seminar for the incoming interns. I teach ad hoc seminars for the interns. I do supervision of an extern who is in the military families program who is treating some of our military members. I supervise him. And I field the ethics calls and trauma or violence calls from our faculty when they need consultation.

DAWN HUGHES: Yes. So, as I mentioned, I'm a member of the American Psychological Association, and that's the largest body of psychologists, and, because it's so big, it's broken down into different divisions. And one of the divisions is the division of trauma psychology, and that division was founded in 2007. I was one of the founding members advocating for APA to have this division. I served in many leadership roles, and I'm just rotating off as the past president of that organization. I also am part of trauma organizations, the International Society for Traumatic Stress Studies, the International Society for Trauma and Dissociation. I'm a member of a New York State Psychological Association, the Anxiety Disorders of America Association, and a local women's mental health consortium which is based here in New York City.

DAWN HUGHES: I specialize in interpersonal violence and traumatic stress.

DAWN HUGHES: So interpersonal violence --

DAWN HUGHES: Yes, I am.

DAWN HUGHES: Traumatic stress is the psychological outcome, one psychological outcome that someone can have from sustaining a traumatic event, such as domestic violence, rape, sexual assault --

DAWN HUGHES: Yes, I do.

DAWN HUGHES: I think it's close to 30 years now.

DAWN HUGHES: Probably thousands at this point.

DAWN HUGHES: Yes, I am.

DAWN HUGHES: That means that I have amassed the highest degree of board certification that psychologists can have, meaning that you have demonstrated a certain competency and excellence in the field of forensic psychology.

DAWN HUGHES: Yes, I am.

DAWN HUGHES: Sure. I'm licensed in New York, in New Jersey, in Connecticut and in North Carolina.

DAWN HUGHES: Yes, I have.

DAWN HUGHES: I think it's approximately 60, 65 times in court.

DAWN HUGHES: Sure. In New York, in New Jersey, in Pennsylvania, in Connecticut, in Virginia, and I think in the federal court in the Southern District here and the Eastern District and then the Northern District of New York.

DAWN HUGHES: No.

DAWN HUGHES: On a very brief level, yes.

DAWN HUGHES: I do not.

DAWN HUGHES: I have not.

DAWN HUGHES: I have not.

DAWN HUGHES: I have not.

DAWN HUGHES: Because it's my understanding that under the law I'm not permitted to do so.

DAWN HUGHES: Yes.

DAWN HUGHES: No, I haven't.

DAWN HUGHES: That's correct.

DAWN HUGHES: So my role here today is to provide expert witness testimony as a blind expert. That means I don't know anything about the case or the players or the witnesses, and to provide the ladies and gentlemen of the jury of some things that we know in the field about domestic violence, rape, sexual assault, and traumatic stress.

DAWN HUGHES: I'm really going to address four main topics. One of them is how do individuals, how do we understand why individuals stay in relationships mired with domestic violence. The second is how do individuals cope when they are in those relationships. The third is what are the -- the patterns of disclosure, how do victims finally tell about the abuse. And then the fourth category is what do we know about memory for traumatic events.

DAWN HUGHES: Sure. Domestic violence is commonly defined as a pattern of behavior that functions to instill fear and to control. It is using multiple abusive behaviors, such as --

DAWN HUGHES: Yes, that's correct.

DAWN HUGHES: No, not at all.

DAWN HUGHES: Yes, I have.

DAWN HUGHES: I have.

DAWN HUGHES: Yes, I have.

DAWN HUGHES: Yes, I am.

DAWN HUGHES: $600 an hour.

DAWN HUGHES: I think it's $6,000 for the day.

DAWN HUGHES: No, not at all.

DAWN HUGHES: Yes, they do. And it's important to understand that they don't remain in the relationships because they are unconcerned about the violence. They don't remain because they want to be abused. No victim wants to be abused, and anyone can be abused: Strong people, people who have vulnerabilities, smart people, people who have other difficulties and deficiencies, and we know that domestic violence crosses race, ethnicity, sex, gender.

DAWN HUGHES: Yes, your Honor.

DAWN HUGHES: So it's very common.

DAWN HUGHES: Yes. So there is three main categories that the research has looked at. This is a question that has been explored extensively over the last 40, 50 years. And the three main kind of areas are: One, they stay in the relationship because it's not just about hitting. It's about using a lot of different abusive behaviors that make a victim feel entrapped in the relationship and those abusive behaviors, it can be physical violence, but it's also psychological abuse, emotional abuse, economic abuse, surveillance behaviors, and all of those behaviors conspire together to keep the victim trapped in the relationship and make it feel like they can't leave. Secondly, we know that in these types of relationships there is almost always love and attention and attraction and companionship, and it's those positive feelings that when they get paired with the violence and the abuse make it very difficult for the victim to see their way out. It creates an intense psychological bond, an attachment with their abuser that makes it difficult for them to leave. And the third bucket, the third reason we know why individuals have a hard time leaving the relationship is because of the psychological consequences from the abuse itself. We know in the psychiatric and psychological literature that exposure to repeated acts of violence and sexual assaults results in significant psychological disorders and symptoms, and that makes it difficult for individuals to have higher order planning to leave.

DAWN HUGHES: Sure. In order to leave a very complex, difficult situation, it's hard for us to break up with someone under the best of circumstances, and then when you have all this violence and abuse, you're just trying to kind of live day-to-day in this micro way of trying to avoid being hit, avoid being yelled at, avoid being hurt, and that interferes with all these other resources. We need to think about how am I going to get out of this relationship.

DAWN HUGHES: Right. Because it's about the power and control that the abuser has over the victim, and the hitting is just one tool that the abuser used. The abuser uses other tools such as the psychological abuse --

DAWN HUGHES: So when we are hit, harmed, beat up, the normal human emotion that gets arisen is fear, we feel scared, and it's very hard to take that fear away once you've been hit. So what happens is the victim, the brain organizes around that fear, and that fear is now organized around the relationship. So they're always sort of walking on eggshells trying not to do something to get hit. Once again, the resources are now being devoted to, how do I stay safe in this relationship and not over here, how do I do all these things I need to do to get out.

DAWN HUGHES: So fear is also a very debilitating emotion. When you feel anxiety, sort of butterflies in your stomach, that's the low-level fear. When you feel like oh, my gosh, I'm going to die on this roller coaster, that's the high-level fear. So if you're in high-level arousal and high-level fear, you're not really able to start thinking about these other big-deal things on your plate that you have to do, like leaving an abusive relationship.

DAWN HUGHES: It doesn't have to happen all the time. We know that once someone has shown us not only the ability, but the willingness to use violence against us, that link has been set, like our brains don't forget, we know that it can be forthcoming. And then with the other types of behaviors, the threats, the control, and the putdowns, that can solidify and reinforce that threat even without using more physical violence.

DAWN HUGHES: So psychological abuse is about threatening future violence and about controlling your victim. So when you are doing things that the abuser doesn't want you to do, there are negative consequences for that. That could be a physically violent act or that can be other acts. So the physical, psychological violence looks like intimidation, like threats, like throwing things, like telling you where you can go and what you can do.

DAWN HUGHES: So because psychological abuse is so controlling, it makes the victim feel entrapped in that relationship. It makes her feel frayed because of the threats she can't get out, it makes her feel intimidated to make choices to get out because of that fear.

DAWN HUGHES: It has a tremendous amount of psychological distress when you're always trying to figure out what abusive behavior is coming at me and at which time, this proverbial feeling of walking on eggshells and not know what's coming next.

DAWN HUGHES: So psychological distress is symptoms of depression, symptoms of anxiety, symptoms of PTSD where you're constantly being reminded of the acts that came before and you're really sort of on an equilibrium trying to keep yourself physically and psychologically safe, and not able to be thinking about how am I going to get out of this relationship.

DAWN HUGHES: Yes, because sexual abuse is so inherently damaging, it's a very private harm, and it very much debilitates a person's psychological functioning. Sexual abuse is one of the highest types of traumatic stressors that we know can result in PTSD and is often met with a high degree of psychological distress. So if you're in significant psychological distress in the relationship, you're walking around injured and harmed. It's important to understand that sexual abuse doesn't only mean --

DAWN HUGHES: Because they experience a tremendous amount of shame, humiliation, degradation, they don't want to talk about it, they don't even want to think about it in their own brain, they don't want to hear it come out of their own mouth, and they need significant help and resources in order to get out of that relationship. And if it's something you can't even talk about, these unspeakable acts, it prevents them from getting that help to get out of the relationship.

DAWN HUGHES: So, simply, emotional abuse is when we belittle, demean, and put down our partner. What that does, the result is that our partner begins to feel like a low sense of self, a low sense of esteem, not feeling like they're worthy, feeling like a piece of crap. When you feel so low about yourself, you're moving into depressive symptoms. When we have depressive symptoms, we really don't have the motivation to do other things that maybe could be helpful for us and we're still back to trying to prevent further physical violence or further psychological harm.

DAWN HUGHES: Because if you can't talk about what's happening in the relationship, you can't get help, and who's going to talk about these very humiliating degrading sexual things your partner does to you when that's not supposed to happen in an intimate relationship.

DAWN HUGHES: So that's very important. We look, we say we need psychological resources to leave --

DAWN HUGHES: So if you don't have access to tangible resources, money or an apartment, you are left with a feeling of where am I going to go, am I stuck here, and that makes it very difficult to leave.

DAWN HUGHES: So they're all interacting, they're not all happening at once, they're not all happening simultaneously, sometimes they do, sometimes they don't, and that keeps the victim on a very unstable footing because they never know what's coming at them. So if you are unstable and you don't know how and when this person is going to abuse you, you're feeling more psychological consequences, you're feeling more trapped, and you're unable to extricate yourself from that dynamic.

DAWN HUGHES: No, they don't.

DAWN HUGHES: Because some -- we look at the magnitude of what the behaviors are. Some of the behaviors are quite severe. So if you have severe physical violence and severe sexual assault, that can be enough, even if we don't have emotional abuse or psychological abuse. But the more abusive behaviors we have, the greater the degree of likelihood that it's difficult for that individual to leave that relationship.

DAWN HUGHES: So it's very important. We know that more trauma is never a good thing. So the more you're exposed to traumatic events and acts of violence and sexual violence, that deteriorates, again, the psychological functioning of the individual. So we look at those measures, we look at the severity of the acts, how severe is what's happening — in our field we say what's the magnitude of that stressor — we look at the frequency, how often is it happening, and then we look at the duration, over what period of time. When those things are high, we're seeing that, you know, a victim who was, you know, functioning to low capacity because they're so distressed and are feeling more and more entrapped and hopeless and helpless in this relationship.

DAWN HUGHES: Sure. So because of -- as I said before, these relationships start with love and companionship and kindness, and the victim wants that, they want that back. So when that is shown to the victim, that becomes very reinforcing. And we see this often, it's called the honeymoon phase, that after that particular assaultive episode that the abuser becomes contrite, becomes apologetic, gives promises to change, maybe gives -- so now they're sort of showering their victim with all this love and care. That's what she or he only wanted. So now you have this very difficult situation where you're trying to live with the person who's abusing you, but I want that good person back, and that creates not only psychological confusion, but also a psychological attachment to the individual, which sometimes we call as a trauma bond.

DAWN HUGHES: So A trauma bond is when somebody leads the partner or somebody is attached to the partner, and somebody loves the partner in spite of the violence and the abuse. We know when we pair violence and abuse with times of good, it creates that very strong bond. We know that from just general psychological principles of intermittent reinforcement. Things that are intermittently reinforced have greater stability and behavior, they have a better ability to change behavior. So when you're getting unpredictable abuse and unpredictable love, that creates this intermittent cycle. It's like a slot machine, you press the button, you press the button, you're going to lose most of the time, but when you hit it, that's the feeling that you want and you keep going back because you want that good feeling, they want that good partner that they got, fell in love with, and that becomes an immense trauma bond. The other important part of the trauma bond is, you know, usually because these acts are so private and they're so humiliating, the only person -- not the only, but the person who the victim often turns to is the abuser because that's the person who knows what's happened and who they can talk to about it. So if that's the person that you go to for that support, that's that need, that's that attachment, and that creates a very powerful bond, and it's very difficult with all the other abusive behaviors to extricate and leave an abusive relationship.

DAWN HUGHES: Well, first, it makes her unable to leave or makes them unable to leave, it makes them more attached to their partner, more willing to sort of go back and give it a try again, but it also has a sense of hopelessness and a sense of meaninglessness because you're feeling that sort of you, as your individual person, you know, does not have the same agency as your partner.

DAWN HUGHES: Yes.

DAWN HUGHES: So love bombing is a term that's used now in the popular media. How we understand it in the literature is that honeymoon phase that I talked about, that when a victim is trying to extricate herself, extricate themselves from the relationship or leave the relationship, the perpetrator, the abuser, you know, showers them with love and affection and attention and, you know, presents and gifts, and this is really a tactic to bring that trust and dependence back and get that victim back in the relationship.

DAWN HUGHES: No, it happens over time. We know from the research that it takes multiple attempts to leave an abusive relationship. There's reconciliation and then there's leaving again, and it can take multiple attempts.

DAWN HUGHES: So at the time that they're attempting to leave, that is usually met with intense fear on the victim. They are afraid of retaliation, they have been with a partner who has abused them, who has hurt them, who has shown them that they're willing to use serious forms of violence against them, and they're afraid of more retaliation and more danger. And that is not unwarranted. We know from our very robust --

DAWN HUGHES: Yes, they do. There's this pattern of returning and reconciliation and trying to leave again.

DAWN HUGHES: So they return for the love, they return for the companionship, they return for the good version of their partner that they still do love, and sometimes they return because the abuse is continuing, and if the abuse is continuing when they left and they're still being harassed and followed and surveilled and controlled, I might as well be back in the relationship because it's not working here, I'm not free.

DAWN HUGHES: Sure. Coping mechanisms, that's just a psychological term of how we deal with stressors in our lives, and coping strategies that we have examined are specific to what do individuals do when they are in an abusive relationship. We know they do a lot of things, but we want to see what they do. When we look at that, we look at sort of formal coping mechanisms, informal, and then personal strategies that they use.

DAWN HUGHES: So formal strategies are using outside help. It may be going to the police, filing a protection order, getting medical help, going to a shelter, you know, it's going to somebody who has the kind of authority to take a report, it can be, you know, going to a Title IX officer in a university setting or going to an HR professional in a workplace setting. It's somebody who has the authority to take that report. The problem is it's the least likely used strategy --

DAWN HUGHES: So the informal strategies are the ones where we're trying to get the abuser to stop the abusive behavior by talking to family or friends, or talking to trying to get their friends to talk to him or their family to talk to him or trying to get them to go to church or go to counseling, and it's also talking to family and friends to try to get much needed support for the victim of how am I going to continue to deal with this mess.

DAWN HUGHES: So the personal strategies are what the victim uses within the relationship. So it's not trying to get out of the relationship, but what do I do that I'm in it. These are trying to talk to your partner to try to stop the violence, talk about what's going on, trying to get counseling or help, trying to plead and negotiate for different kind of behaviors, trying to placate and give compliance to make your partner okay, sometimes it's physically fighting back. It's all of these different strategies that a victim is doing but within the relationship, within the confines of the relationship.

DAWN HUGHES: The personal strategies are the most common that they're trying to use within the relationship, trying to work it out with your partner.

DAWN HUGHES: Because of the trauma bond, because of the feeling entrapped that you can't leave, because of the psychological consequences that you're being burdened with, and you still, you don't want to lose your partner, you still want to try to preserve the love of that partner and you have this hope for change, which comes from the honeymoon phase and that cycle. So you're trying to do everything you can with that partner within that relationship to make this violence stop.

DAWN HUGHES: No, they don't. They have to be very attuned to their partner's moods and how they're feeling and what particular, you know, anger, eruption or abusive behavior they may use at a certain time. So they use a lot of different strategies depending on the demands of what their partner brings into the room. I mean, it's important to know that as the abuse gets more severe, so do the coping strategies. So they don't use less, they use more. So they're doing a lot of things, it's just not stopping the violence.

DAWN HUGHES: When we placate and appease our abuser, what we're trying to do is soothe the abuser, we're trying to make an abusive episode not happen. We may be apologizing unnecessarily, we might be going along with things that we don't want to do, and that's back to what I talked to you about before, the contingency. Once someone has demonstrated that they can use serious forms of violence against you, you know, that contingency has set, that link is set. So the victim is really trying to do all of those things to not get hurt, to not get hit, and sometimes placating and complying strategies are a good strategy to use.

DAWN HUGHES: It usually appears in all facets of the relationship, and it's, you know, if you can't say no to little things --

DAWN HUGHES: Yes, I am.

DAWN HUGHES: Yes.

DAWN HUGHES: So passive self-defense ways that a victim might try to protect themselves when they are being assaulted, it may be blocking punches, it may be throwing a pillow or throwing at someone to get them to stop, it may be curling up in a ball on the floor, and it may be trying to do something as the least provoking as possible to get the violent episode to stop.

DAWN HUGHES: So active self-defense are when victims are actively fighting back. They may hit back, they may punch back, they may push back, they may throw objects, they may yell back in a way to, you know, have some way of standing up for themselves, even though, in many cases, that usually results in more severe injury to themselves.

DAWN HUGHES: Because if we're talking about a generally -- a heterosexual relationship of a man and a woman, just the size and strength disparity between a man and a woman, a man can do more damage --

DAWN HUGHES: Yes. And like we said before, they're really trying to mirror the strategies to what their abuser is bringing into the room. Victims get very hypervigilant to their abuser's moods, they're really trying to scan and track how they are presenting and how they are a certain day, and that's how they decide what strategies to use. Remember, I said they're using a lot of strategies, they just don't work.

DAWN HUGHES: Yes.

DAWN HUGHES: Sure. So, in addition to the strategies to working within the relationship and toward the abuser, they have to do things to deal with all that psychological and traumatic stress that I talked about. When you're in the relationship, one of the things that they use is avoidance strategy. They try to not think about it, not feel it, not talk about it, they try to push it down and direct at forgetting, I'm going to push this in the back of my mind, I'm going to compartmentalize it somewhere. Sometimes there's the disassociation that happens in all these episodes. So it's all the way of sort of protecting themselves from the onslaught of the psychological consequences of the abuse while still being able to maintain the status quo and stay in the relationship.

DAWN HUGHES: Avoidance is not dealing with something, right, not trying to think, not trying to feel, not trying to talk about something. So it's about pushing under the rug and I'll deal with it later.

DAWN HUGHES: Minimization is a way of distancing yourself from the reality of what's going on. Sometimes victims do that to themselves by saying, you know, maybe they didn't mean it or maybe they were drunk or maybe they were angry, had a stressful day at work, it's a way of kind of lessening the responsibility of what happened to them. And again, that's a way that they can try to find some kind of semblance of normalcy and stay in the relationship. And sometimes when they minimize the problem, as we know, that that also increases the risk for more danger.

DAWN HUGHES: Well, it has short-term effectiveness, it's not a long-term strategy, but it helps them get through the day. It helps them get from one assaultive episode to the next.

DAWN HUGHES: So, unlike those other strategies, disassociation is more of an involuntary coping mechanism. Our brain does that for us automatically. What it is, it's a change in our conscious awareness, it's about zoning out, spacing out, looking at a spot on the ceiling, feeling that you're leaving your body, and it's a way really that your brain protects yourself from very serious psychological injury and physical injury. And with disassociation, because you're not attending and you're not focusing, that often leads to impairments in memory.

DAWN HUGHES: Because memory is dependent on our focusing and attention and applying significance to things, and when we're disassociating, we're having -- technically it's called an alteration in consciousness, we're having a change in our conscious awareness, we're not attending, so we're not encoding that information.

DAWN HUGHES: Yes, it's a very common coping mechanism. Like I said before, we see a high degree of co-occurrence between trauma-based disorders and substance use disorders. And substances allow us to numb our pain. Most people know that. The problem with trauma survivors is they do it to -- for a very trauma-specific function, to get rid of the memories and the thoughts about what has happened to them in the past and the fear of what's happening to them in the future, to get rid of all those anxiety and fear-based feelings that they're having because they're living in a state of fear. And then survivors and victims also use it as a preventive measure. We see a lot of survivors, if they've had a fight with their partner the day before, before they get home, I'm going to take drugs, I'm going to drink because I know what's going to happen when I get home. As I told you, they're very attuned to their partner's moods. They may take it sort of preventively to ward off other physical and psychological pain that's going to come. And sometimes they do it to not feel and to not remember. Sometimes they know that that may interfere with their memory and they don't want to remember these things. The problem is that substance use, the cycle --

DAWN HUGHES: Yes, and often they do. That's back to the trauma bond. Often, they still have positive and loving feelings toward their abuser, even after they've left for years, there's still a part of them that loves that initial person that they fell in love with.

DAWN HUGHES: So it's not common that victims do that. Many victims will wait months, even years before telling about what happened to them. And the term that we use in the literature is called delayed disclosure because of that.

DAWN HUGHES: Some of the top reasons are fear of not being believed, fear of the negative consequences that are going to come from the disclosure, fear that other people are going to look negatively on you, they're going to shame you, they're going to blame you, say those questions like, oh, well, why didn't you just leave. They fear -- they have sort of internal still that shame and that embarrassment, so they have to overcome that internalized shame and self-blame in order to tell. Sometimes they've had previous traumatic experiences, and if those, you know, didn't go well in a disclosure, they might not disclose again or they may feel that somehow, why does this keep happening to me, I can't tell anyone about it. They fear the change in probably their economic situation, if they have those financial controls, they fear being publicly identified, and they fear that the change in the network, the change in the relationship. But usually, even when we leave the relationship, we have friends and family, and all of those people then, you know, are going to go away, and they fear losing that, as well.

DAWN HUGHES: So one of the robust findings is that the closer the relationship to the perpetrator, the less likely you're going to disclose. So that means if you've had a stranger rape or assault, you're more likely to disclose that as opposed to somebody who's an acquaintance or somebody who's a partner.

DAWN HUGHES: So what it does is just amplify, amplify the power and control differential between the abuser and the victim. It's very difficult for a victim to disclose in the best of circumstances. And somebody can have celebria power because they're the principal of a school, and it can change many different things. So if you're going against someone who has wealth and access and privilege, you're beginning to think who is going to protect me, who is going to believe me, how am I going to come out of this. They don't feel very safe in that disclosure in those situations.

DAWN HUGHES: Usually it's when they're in a safe environment. Clearly, they're not being bombarded with abuse anymore, that can be a factor; they could have left the relationship, that could be a factor; they could have had some psychological help. Having a way to put words to what they went through and to understand their experience of, you know, how did I get here, how was I not able to say no, how was I abused for so long. And sometimes there are societal reasons, the way, you know, things change in the public or in society where you feel like you're not so alone and it's okay, it's okay for me to talk about this now.

DAWN HUGHES: They're most likely going to talk to a trusted friend or confidant, it's usually a mother, a sister, a best friend, someone who they think really can support them through this process.

DAWN HUGHES: It's typically piecemeal, it's not a binary, I disclosed, I didn't disclose. Usually, it unfolds over time, especially if we have a long duration of a type of a domestic violence situation. And different bits come out with different people in different contexts. So we know that and even I know that of evaluating hundreds of thousands of individuals, I'm not going to get all the information in one sitting, that wouldn't be realistic and we may not need that. Also, what inhibits the disclosures is that when they're talking about it, all of those trauma feelings are being evoked, all of that is coming up. So they're sitting there really trying to manage that internal traumatic stress and psychological distress each time they're talking about it. So they may sort of approach, talk a little, and then have to back up because it's just too painful.

DAWN HUGHES: I mean, it can affect disclosure in a very serious way. If you've been threatened, if you tell, something bad will happen to you, and this person has already demonstrated that they can use serious forms of physical violence or sexual assault against you, you believe them. So you may have to sort of wait to disclose to you have other safety measures in place you have for yourself, whatever those may be.

DAWN HUGHES: So we talk about they use minimizing language, they don't want to talk about the details of what happened, they talk around it. They don't want to label themselves as a victim, they don't want to label their abuser as abuser, and they don't want to talk about graphic details. So that's sort of the piecemeal process that happens for individuals where it's a little bit of a distancing of all of the psychological harm that they're feeling when they have to talk very detailed and specific about the abuse.

DAWN HUGHES: Really, because it's just too painful, it's really too painful to admit that back to somebody who loved me did this to me, and they are still in self-blame. Self-blame takes a long time to go away and shame takes a long time to go away. Like, why did it take me so long to get out of here. They don't understand it, like the higher order of conceptualization I'm providing here today, that takes years of therapy for them to really understand the elements of control on entrapment that they were in.

DAWN HUGHES: They use hedging language. Sometimes they won't say the name of the perpetrator, sometimes they'll say -- even patients in my practice, they'll say, you know when that thing happened or the incident. They won't say the rape, the sexual assault. They'll use anything they can to sort of distance themselves from the reality of the horrors that they went through.

DAWN HUGHES: Sure. So we know that trauma impacts memory, we know that on one hand we can have a vivid bright memory sort of burned into our brain, but at the same time have lack of details and fragments for that same trauma. We know that trauma memories can be forgotten or not recalled and recalled at a later time. And we know that this cuts across trauma groups. This is not just domestic violence survivors, it's not just sexual assault survivors, we again see this in combat veterans, in child sex abuse victims, in our law enforcement. So whenever we have different trauma groups, we can see this type of interrupted memory.

DAWN HUGHES: So, in general, it's because of the neurobiology of stress, right, that narrows attention and that narrows attention in trauma. What we know is what victims remember is the core gist of what happened — I was sexually assaulted, I was in a car accident, I was in the battle field. People don't forget that. Then we go to those central details. Those are also pretty robust, people don't usually forget them. The problem is it's whatever the person assigns significance to at the moment. So that's not up to us, that's up to their brain. It may be if they're being assaulted, the smell of alcohol on their perpetrator's breath, it may be focusing on the chipping paint on the ceiling, right, that's what they decided to assign significance for the real reason of keeping themselves safe. And those details also tend to be robust and tend to be remembered. It's the peripheral details which we say is everything else was not assigned significance, that doesn't get encoded because it doesn't have any value for the victim. It may have value, we might want to know those details, but it didn't get encoded because it didn't have significance for the victim.

DAWN HUGHES: So central details are usually sensory things, a sight, a smell, a feeling, an emotion, and those are the type of details that get remembered.

DAWN HUGHES: Those are things that are just surrounding the other things that don't get established significance. We sort of say they're in the bucket of everything else that's not significant.

DAWN HUGHES: That is absolutely unique to each individual and their unique brains. Your brain is trying to function to keep you safe. We say your brain's working, it's doing what it's supposed to do. So we can't, out here, determine what's significant for you or what's significant for the next person. That's a very unique thing for each person in each situation that they're in.

DAWN HUGHES: It's mostly unconscious. Certainly the central detail of a person can say, make a deliberate attempt, I'm going to look at those drapes, and sometimes they just find that's what they're doing. So there can be some voluntariness in the central details.

DAWN HUGHES: No, it's not always the case, and sometimes victims don't know why I was focusing on the drapes.

DAWN HUGHES: So fragmented just means because the narrowing of the attention that not all memories are getting in about the event that happened to you. So that's why it's not complete. And there's no evidence to suggest that because it's not complete, what we do know isn't reliable. So the fragmented memories can be just as reliable, they're just not as expansive and they're just not as complete, they're missing details.

DAWN HUGHES: So these are the things that the victim is doing after these assaultive episodes, right, they're trying to push it down, not think about it, not talk about it, and pushing it further in the recesses of their brain. This is a common thing that we see with trauma survivors. It's recognized as part of the PTSD diagnosis. What they do is they're deliberately trying not to remember, and that can interfere with your recall of the information, not the storage which we did before, but that can interfere with the recall of the information.

DAWN HUGHES: Right, they're trying not to remember because it's too painful to remember. The only difference -- you said disassociation, that's involuntary. So these other things I just talked to you about, the directed forgetting, the compartmentalization, that's voluntary, the disassociation is not voluntary. That's when your brain is sort of taking you someplace else to not feel and to not remember. So that's the difference between those.

DAWN HUGHES: Because if you're not attending and you're not focusing, it's not getting encoded.

DAWN HUGHES: Yes, a memory has to be encoded for us to remember it, yes.

DAWN HUGHES: So we know that when we have chronic situations, again, like domestic violence, like our combat veterans, not everything is going to get in, events are going to blend together. And that's because of, again, that high stress neurobiology of repeated traumatic events and also just the general principles of memory of repeated events. We know that, could you remember each time you had a slice of pizza at your favorite pizza place, I can't. You know, you can't remember every single time you've walked in this courtroom and the precise details of what happened at every time. The repeated events that we do commonly are not all going to get recalled. Unfortunately, in situations of domestic violence, there are these repeated events, there is this routine of all of this abuse happened. So these abusive episodes are blending together.

DAWN HUGHES: It looks like someone can say, I know I got punched a bunch of times, but I can't tell you when that was. I know I was kicked and I was in a ball in a closet, I know that happened a couple times, but I can't tell you when, I can't place it in a timeline. And sometimes it's those external markers where individuals are able to place it in a timeline of this happened on my birthday or this happened on the beach vacation where they have a marker and they can go, yeah, I remember that happened there. But all of the other similar type of behaviors that have been happening to them, they are not usually able to bring out each and every one.

DAWN HUGHES: Yes, they are.

DAWN HUGHES: That's, like I said, like a birthday or anniversary or it was a snowstorm, right, there's something that sort of connects the memory to something else, which makes it much more likely to be recalled.

DAWN HUGHES: That's correct.

DAWN HUGHES: No, because like we just said, they don't lose the core gist of what happened to them, that they were being abused or they were being sexually assaulted. That is pretty solid, that does not go away.

DAWN HUGHES: Yes, they do. All memories can be recalled. That's sort of the hallmark of trauma memories in post traumatic stress disorder that the trauma doesn't stay in the background forever, eventually it comes up into the forefront and the person is left in having to deal with it. That's usually met with a tremendous amount of psychological distress and being sort of bombarded with images and thoughts of the traumatic experience and having a tremendous amount of anxiety and hypervigilance and sadness and all types of disequilibrium when that memory comes back.

DAWN HUGHES: Sometimes, when the memory comes back, we feel as though it's happening now. So that hypervigilance, which means you're scanning for danger, you're being on alert, even though you're out of the relationship, the brain is not so sure you are, so it's bringing those same characteristics back, and you're usually hypervigilant and afraid and watching things, even though you're not in that situation anymore.

DAWN HUGHES: I mean, a lot of times they describe them, frankly, like I think I'm going crazy. That's a lot of times how people enter into ERs or enter into the VA or enter into my office. They don't really understand how they can't put these memories back in the box like they were, you know, a couple of days ago. Once you sort of open that crack, they're out there and individuals have to deal with them and use them. But it's very distressing for people and it's very upsetting and they have a lot of psychological difficulty with that process.

DAWN HUGHES: So that's our recall, our retrieval of memories and they're cued by context and cues. Sometimes the context elements are a place or a feeling, and sometimes the triggering cues are back to our senses, a smell, a sight, a sound, and sometimes it's a combination of those that bring a memory back up into the forefront. And that's also, you know, happens to trauma memories. But also general principles of memory, again, you go home for Thanksgiving and you're at your family table with your siblings and the same dynamics, someone laughs in a certain way or someone yells in a certain way, that likely is going to trigger a memory from before. That's just how memory retrieval and recall works. That's something that happens with trauma victims, as well. They may smell the smell of alcohol, they may see someone dressed in a certain way, someone walk in a certain way, and the brain will register that as something of danger and open up those memories.

DAWN HUGHES: I mean, they can be triggered at any time. Sometimes they're triggered all the time since the episodes have happened and ended and sometimes we have what we call later recall. We know that that can happen, as well, that because of all of those defenses where someone's trying to put them in the back of their head, that they can later recall these memories. We know this, again, in the PTSD diagnostic criteria, we have it, it's called delayed expression of PTSD, and that is the manual that we've used in the psychological and psychiatric communities for decades now. There's no evidence either, especially we know this with our war veterans our combat veterans as well as our assault victims, that later retrieve memory is any less accurate than if someone had it -- they might not have all the details because it's a later retrieved, but there's no evidence that it's less accurate.

DAWN HUGHES: I believe so. I think I was licensed in 1997.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Yes, I do.

DAWN HUGHES: Yes, I do.

DAWN HUGHES: Yes, I do.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Among other things, yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: I don't know if I would say any detail can be important. You're trying to ascertain which facts are and which aren't.

DAWN HUGHES: Sure.

DAWN HUGHES: Yes, we are.

DAWN HUGHES: Well, we have general categories of how we understand people, general categories of psychiatric disorders that we do know, you know, present in a certain way.

DAWN HUGHES: Yeah, I'm certainly not divorced from my education, training, and experience about certain other areas of study when I'm doing that, of course.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: I do.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Sure.

DAWN HUGHES: Correct.

DAWN HUGHES: Yes.

DAWN HUGHES: It's not a clinic. It's a private office where I treat people in psychotherapy.

DAWN HUGHES: Because I'm conducting clinical work.

DAWN HUGHES: Yes.

DAWN HUGHES: Correct.

DAWN HUGHES: That's correct.

DAWN HUGHES: That's correct.

DAWN HUGHES: Correct.

DAWN HUGHES: That's not why I'm listening intently. I'm listening intently to really understand the person in front of me and what ails them and what the difficulties are.

DAWN HUGHES: Of course.

DAWN HUGHES: Yes.

DAWN HUGHES: I pay attention to detail because I want to do a comprehensive evaluation, and I know that that work is going to be looked at other people.

DAWN HUGHES: You have to explain what you mean.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Depending on the relevance of that data, sure.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Yes.

DAWN HUGHES: Correct.

DAWN HUGHES: I think you're making it a little more simplistic. I just don't listen. I'm conducting a clinical interview, a semistructured clinical interview and administrating psychological tests, so it's not like I'm listening like I would be listening with a psychotherapy patient. It's a different methodology.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct. As we said, determined on their relevance.

DAWN HUGHES: Yes.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Yes.

DAWN HUGHES: That's correct.

DAWN HUGHES: Trained to do a comprehensive forensic assessment, yes.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Yes.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: To make sure they have reliability and validity, yes.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: The trauma symptom inventory.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct. But it's a way of analyzing and looking at a whole host of symptoms that individuals may have.

DAWN HUGHES: I rely on multiple methods. What we say, a forensic evaluation is a multi-method, multi-hypothesis driven model. So I'm relying on all of these methods to arrive at my conclusion.

DAWN HUGHES: I agree.

DAWN HUGHES: To get a sense of that individual, yes.

DAWN HUGHES: I am.

DAWN HUGHES: That's not a correct definition.

DAWN HUGHES: Malingering is just the fabricating of emotional or psychological symptoms. It's not related to the facts of their case.

DAWN HUGHES: They can.

DAWN HUGHES: You wouldn't take the test alone. You're looking for the confluence of the data points, the clinical interview, the testing, the external data, and you're looking how it all holds together to render an opinion.

DAWN HUGHES: Correct.

DAWN HUGHES: Correct.

DAWN HUGHES: Validity scales, yes.

DAWN HUGHES: Yes.

DAWN HUGHES: Validity scale.

DAWN HUGHES: The validity scales are really to look at the response style of the individual. The two tests that you mentioned also are used clinically, and we use them in a clinical practice as well. So it does look at things like exaggeration, but it also looks at things, minimization and defensiveness and not wanting to report symptoms. So we see that as well.

DAWN HUGHES: Not that necessarily you're ashamed of but that you don't want to address, like I talked about before. So sometimes we see individuals who are minimizing their distress.

DAWN HUGHES: OK.

DAWN HUGHES: Thank you.