As reproduced in the FMSF Newsletter of Feb. 1994, Vol. 3 No. 2
STATEMENT ON MEMORIES OF SEXUAL ABUSE
This statement was approved by the Board of Trustees of the American Psychiatric Association on December 12, 1993.
This Statement is in response to the growing concern regarding memories of sexual abuse. The rise in reports of documented cases of child sexual abuse has been accompanied by a rise in reports of sexual abuse that cannot be documented. Members of the public, as well as members of mental health and other professions, have debated the validity of some memories of sexual abuse, as well as some of the therapeutic techniques which have been used. The American Psychiatric Association has been concerned that the passionate debates about these issues have obscured the recognition of a body of scientific evidence that underlies widespread agreement among psychiatrists regarding psychiatric treatment in this area. We are especially concerned that the public confusion and dismay over this issue and the possibility of false accusations not discredit the reports of patients who have indeed been traumatized by actual previous abuse. While much more needs to be known, this Statement summarizes information about this topic that is important for psychiatrists in their work with patients for whom sexual abuse is an issue.
Sexual abuse of children and adolescents leads to severe negative consequences. Child sexual abuse is a risk factor for many classes of psychiatric disorders, including anxiety disorders, affective disorders, dissociative disorders and personality disorders.
Children and adolescents may be abused by family members, including parents and siblings, and by individuals outside of their families, including adults in trusted positions (e.g., teachers, clergy, camp counselors). Abusers come from all walks of life. There is no uniform "profile" or other method to accurately distinguish those who have sexually abused children from those who have not. Children and adolescents who have been abused cope with the trauma by using a variety of psychological mechanisms. In some instances, these coping mechanisms result in a lack of conscious awareness of the abuse for varying periods of time. Conscious thoughts and feelings stemming from the abuse may emerge at a later date.
It is not known how to distinguish, with complete accuracy, memories based on true events from those derived from other sources. The following observations have been made:
1. Human memory is a complex process about which there is a substantial base of scientific knowledge. Memory can be divided into four stages: input (encoding), storage, retrieval, and recounting. All of these processes can be influenced by a variety of factors, including developmental stage, expectations and knowledge base prior to an event; stress and bodily sensations experienced during an event; post-event questioning; and the experience and context of the recounting of the event. In addition, the retrieval and recounting of a memory can modify the form of the memory, which may influence the content and the conviction about the veracity of the memory in the future. Scientific knowledge is not yet precise enough to predict how a certain experience or factor will influence a memory in a given person.
2. Implicit and explicit memory are two different forms of memory that have been identified. Explicit memory (also termed declarative memory) refers to the ability to consciously recall facts or events. Implicit memory (also termed procedural memory) refers to behavioral knowledge of an experience without conscious recall. A child who demonstrates knowledge of a skill (e.g., bicycle riding without recalling how he/she learned it, or an adult who has an affective reaction to an event without understanding the basis for that reaction (e.g., a combat veteran who panics when he hears the sound of a helicopter, but cannot remember that he was in a helicopter crash which killed his best friend) are demonstrating implicit memories in the absence of explicit recall. This distinction between explicit and implicit memory is fundamental because they have been shown to be supported by different brain systems, and because their differentiation and identification may have important clinical implications.
3. Some individuals who have experienced documented traumatic events may nevertheless include some false or inconsistent elements in their reports. In addition, hesitancy in making a report, and recanting following the report can occur in victims of documented abuse. Therefore, these seemingly contradictory findings do not exclude the possibility that the report is based on a true event.
4. Memories can be significantly influenced by questioning, especially in young children. Memories also can be significantly influenced by a trusted person (e.g., therapist, parent involved in a custody dispute) who suggests abuse as an explanation for symptoms/problems, despite initial lack of memory of such abuse. It has also been shown that repeated questioning may lead individuals to report "memories" of events that never occurred.
It is not known what proportion of adults who report memories of sexual abuse were actually abused. Many individuals who recover memories of abuse have been able to find corroborating information about their memories. However, no such information can be found, or is possible to obtain, in some situations. While aspects of the alleged abuse situation, as well as the context in which the memories emerge, can contribute to the assessment, there is no completely accurate way of determining the validity of reports in the absence of corroborating information.
Psychiatrists are often consulted in situations in which memories of sexual abuse are critical issues. Psychiatrists may be involved in a variety of capacities, including as the treating clinician for the alleged victim, for the alleged abuser, or for other family member(s) as a school consultant; or in a forensic capacity.
Basic clinical and ethical principles should guide the psychiatrist’s work in this difficult area. These include the need for role clarity. It is essential that the psychiatrist and the other involved parties understand and agree on the psychiatrist’s role.
Psychiatrists should maintain an empathic, non-judgmental, neutral stance towards reported memories of sexual abuse. As in the treatment of all patients, care must be taken to avoid prejudging the cause of the patient’s difficulties, or the veracity of the patient’s reports. A strong prior belief by the psychiatrist that sexual abuse, or other factors, are or are not the cause of the patient’s problems is likely to interfere with appropriate assessment and treatment. Many individuals who have, experienced sexual abuse have a history of not being believed by their parents, or others in whom they have put their trust. Expression of disbelief is likely to cause the patient further pain and decrease his/her willingness to seek needed psychiatric treatment. Similarly, clinicians should not exert pressure on patients to believe in events that may not have occurred, or to prematurely disrupt important relationships or make other important decisions based on these speculations. Clinicians who have not had the training necessary to evaluate and treat patients with a broad range of psychiatric disorders are at risk of causing harm by providing inadequate care for the patient’s psychiatric problems and by increasing the patient’s resistance to obtaining and responding to appropriate treatment in the future. In addition, special knowledge and experience are necessary to properly evaluate and/or treat patients who report the emergence of memories during the use of specialized interview techniques (e.g., the use of hypnosis or amytal), or during the course of litigation.
The treatment plan should be based on a complete psychiatric assessment, and should address the full range of the patient’s clinical needs. In addition to specific treatments for any primary psychiatric condition, the patient may need help recognizing and integrating data that informs and defines the issues related to the memories of abuse. As in the treatment of patients with any psychiatric disorder, it may be important to caution the patient against making major life decisions during the acute phase of treatment. During the acute and later phases of treatment, the issues of breaking off relationships with important attachment figures, of pursuing legal actions, and of making public disclosures may need to be addressed. The psychiatrist should help the patient assess the likely impact (including emotional) of such decisions, given the patient’s overall clinical and social situation. Some patients will be left with unclear memories of abuse and no corroborating information. Psychiatric treatment may help these patients adapt to the uncertainty regarding such emotionally important issues.
The intensity of public interest and debate about these topics should not influence psychiatrists to abandon their commitment to basic principles of ethical practice, delineated in The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry.
The following concerns are of particular relevance:
The APA will continue to monitor developments in this area in an effort to help psychiatrists provide the best possible care for their patients.
As reproduced in the FMSF Newsletter, July 1994, Vol. 3 No. 7
AMERICAN MEDICAL ASSOCIATION
June 16, 1994
REPORT OF THE COUNCIL ON SCIENTIFIC AFFAIRS
CSA Report 5-A-94
Subject: Memories of Childhood Abuse
Presented by: Yank D. Coble, Jr, MD, Chair
Referred to: Reference Committee D, Peter W. Carmel, MD, Chair
The adoption of Substitute Resolution 504, A-93, created new policy on memory enhancement methods used in cases of possible childhood sexual abuse. The policy states "The AMA considers the technique of ‘memory enhancement’ in the area of childhood sexual abuse to be fraught with problems of potential misapplication (AMA Policy Compendium, Policy 515.978). The resolution also directed the Council on Scientific Affairs to investigate the issues surrounding memory enhancement. This report addresses those and related issues.
The resolution was adopted in response to concerns about the growing number of cases in which adults make accusations of having been abused as children based solely on memories developed in therapy. In many cases, the accusations are made against the parents of the accuser, although others, such as members of the clergy, teachers and camp counselors, have been targets of allegations. Questions have been raised about the veracity of such reported memories, one’s ability to recall such memories, the techniques used to recover these memories, and the role of the therapist in developing the memories.
The general issues have come to be referred to under the umbrella term "repressed memories" or "recovered memories." Both terms refer to those memories reported as new recollections, with no previous memories of the event or circumstances surrounding the event, although some "fragments" of the event may have existed. Considerable controversy has arisen in the therapeutic community over the issue, and experts from varied professional backgrounds can be found on all sides of the issue. At one extreme are those who argue that such repressed memories do not occur, that they are false memories, created memories, or implanted memories, while the other extreme strongly supports not only the concept of repressed memories but the possibility of recovering such memories in therapy. Other professionals believe that some memories may be false and others may be true.
Most controversial are those "memories" that surface only in therapy and those from either infancy or late childhood (including adolescence). Concern about and interest in repressed memories is widespread, and the topic is covered in both the professional literature and the lay press. Word of the AMA’s interest in the issue resulted in well over 100 letters asking the AMA to address the needs of falsely accused individuals.
The Board of Trustees of the American Psychiatric Association (APA) recently issued a statement "in response to the growing concern regarding memories of sexual abuse." In part, the statement says:
It is not known what proportion of adults who report memories of sexual abuse were actually abused. Many individuals who recover memories of abuse have been able to find corroborating information about their memories. However, no such information can be found, or is possible to obtain, in some situations. While aspects of the alleged abuse situation, as well as the context in which the memories emerge, can contribute to the assessment, there is no completely accurate way of determining the validity of reports in the absence of corroborating information.(Statement of the APA Board of Trustees, adopted December 12, 1993)
Related AMA Policy
The AMA has numerous policies related to child abuse, including sexual abuse, and about violence in general. Two policy statements are of particular importance. Policy 515.976, adopted at the 1993 Annual Meeting, encourages physicians to be alert to the mental health consequences of interpersonal and family violence. Council on Scientific Affairs Report B (A-93), which developed this policy, thoroughly discussed these consequences, including possible long-term adverse effects. There is considerable evidence that victims of child abuse are found in mental health treatment settings in large numbers. (1)
Also relevant is Policy 80.996, adopted in 1984, which discusses the use of hypnosis in refreshing recollection. The entire policy states:
The AMA believes that (1) With witnesses and victims, the use of hypnosis should be limited to the investigative process. Specific safeguards should be employed to protect the welfare of the subject and the public, and to provide the kind of record that is essential to evaluate the additional material obtained during and after hypnosis; (2) A psychological assessment of the subject’s state of mind should be carried out prior to the induction of hypnosis in an investigative context, and informed consent should be obtained; (3) Hypnosis should be conducted by a skilled psychiatrist or psychologist, who is aware of the legal implications of the use of hypnosis for investigative purposes; a complete taped and/or precise written record of the clinician’s prior knowledge of the case must be made; complete videotape recordings of the pre-hypnotic evaluation and history, the hypnotic session, and the post-hypnotic interview, showing both the subject and the hypnotist, should be obtained; (4) Ideally, only the subject and the psychiatrist or psychologist should be present; (5) Some test suggestions of known difficulty should be given to provide information about the subject’s ability to respond to hypnosis; (6) The subject’s response to the termination of hypnosis and the post-hypnotic discussion of the experience of hypnosis are of major importance in discussing the subject’s response; (7) Medical responsibility or the health and welfare of the subject cannot be abrogated by the investigative intent of hypnosis; and (8) Continued research should be encouraged.
This policy was developed as part of CSA Report K (I-84), which addressed several aspects of hypnosis and memory. The report concluded that new information is often reported under hypnosis, and that while the information may be accurate, it may also include confabulations and pseudomemories. Moreover, the Council concluded that hypnosis- induced recollections actually appear to be less reliable than non- hypnotic recall. That statement remains an accurate summary of the empirical literature.
Neither the AMA nor the Council has studied other aspects of memory enhancement, such as amytal or age regression. A forthcoming review of amytal concludes that it has no legitimate use in recovered-memory cases. (2) Rigorous scientific assessments of other methods of memory enhancement are not available.
To some extent, current concerns about repressed memories can be traced to the lawsuits filed by accusers, particularly those filed against parents. Numerous such lawsuits have been filed by accusers, and it is of course difficult to disprove accusations regarding events that are alleged to have taken place many years or even decades earlier. Over the past few years, a number of states have adopted laws that have affected such litigation. Illinois, for example, has just extended the time allowed in which to file a suit; previously lawsuits could not be filed after the accuser had attained the age of 30. On the other hand, California has recently adopted laws under which a plaintiff cannot prevail in the absence of evidence beyond the recovered memories.
From a therapeutic perspective, such lawsuits might be deemed valuable in helping an abuse victim retake or reassert control of his or her life. Restoring control to the victim is a widely recognized part of therapy. (1) At the same time, public policy may require standards of proof that must be met before allowing suits based on recovered memories to be filed or result in judgments against the accused.
Of particular interest in this issue is the role of the therapist in developing new memories. It is well established for example that a trusted person such as a therapist can influence an individual’s reports, which would include memories of abuse. Indeed, as the issue of repressed memories has grown, there have been reports of therapists advising patients that their symptoms are indicative -- not merely suggestive -- of having been abused, even when the patient denies having been abused. (3) Other research has shown that repeated questioning may lead individuals to report events that in fact never occurred. Unfortunately, the dynamics that underlie an individual’s suggestibility are only beginning to be understood.
Notwithstanding these findings, other research indicates that some survivors of abuse do not remember, at least temporarily, having been abused. While some research relies on self-identified survivors of abuse and consequently begs the question of repressed memories (see for example Briere and Conte (4), other research is based on cases in which childhood sexual abuse was documented. Williams , (5) for example, reports that more than one-third of women in a group of known victims failed to report victimization 17 years later; most of those who did not report the abuse appear to have been"amnesic for the abuse." (p 20) There are other instances in which recovered memories proved to be correct.
In short, empirical evidence can be cited for both sides of the argument. While virtually all would agree that memories are malleable and not necessarily fully accurate, there is no consensus about the extent or sources of this malleability. The issue is far from settled, and under such circumstances, therapists should exercise care in treating their patients, maintaining an empathic and supportive posture. Due diligence for and reference to the Principles of Medical Ethics, or other similar statements in the case of non-physician therapists, should be given high priority. In some cases, a second opinion should be considered.
Conclusions and Recommendations
The AMA has a long history of concern about the extent and effects of child abuse. Child abuse, particularly child sexual abuse, is under recognized and all too often its existence is denied. Its effects can be profound and long-lasting. (6) The Council on Scientific Affairs recommends that the following statements be adopted and that the remainder of this report be filed:
1. Herman J.L. Trauma and Recovery, New York: Basic Books; 1992.
2. Piper A Jr. "Truth Serum" and "Recovered Memories" of sexual abuse: A review of the evidence. J Psychiatry and Law. In press.
3. Loftus E.F.. The reality of repressed memories.
4. Briere J, Conte J. Self-reported amnesia for abuse in adults molested as children. J Traumatic Stress. 1993; 6(1)21-31.
5. Williams L.M.. Adult Memories of childhood abuse: Preliminary findings from a longitudinal study. The APSAC Advisor. 1992; 5(3):19-21.
6. Council on Scientific Affairs. Mental health consequences of interpersonal and family violence. Implications for the practitioner. CSA Report B (A-93).
As reproduced in the FMSF Newsletter, Jan. 1995, Vol. 4 No. 1
THE AUSTRALIAN PSYCHOLOGICAL SOCIETY LIMITED
APPROVED BY BOARD OF DIRECTORS, 1 OCTOBER 1994
Guidelines Relating to The Reporting of Recovered Memories
The Australian Psychological Society has expertise in scientific, clinical and ethical aspects of the practice of psychology. These Guidelines Relating to the Reporting of Recovered Memories draw essentially on these competencies. The Australian Psychological Society acknowledges that the broader social context affects the credence given to the interpretation of recovered memories when independent corroboration is not available or possible. Central elements of this social context include gender, age, social class, ethnic and cultural identity. Although this wider context is beyond the scope of these Guidelines, the Australian Psychological Society recognizes that comment and debate on these issues is important.
B) CODE OF PROFESSIONAL CONDUCT
These Guidelines should be read in conjunction with the Australian Psychological Society Code of Professional Conduct, which sets forth principles of professional conduct designed to safeguard
The General Principles of the Code are:
Psychologists remain personally responsible for the professional decisions they take
Psychologists shall bring to and maintain appropriate skills and learning in their areas of professional practice
The welfare of clients, students, research participants and the public, and the integrity of the profession, shall take precedence over a Psychologist’s self interest and over the interests of the psychologist’s employer and colleagues.
C) GUIDELINES RELATING TO RECOVERED MEMORIES
These Guidelines set forth information and recommendations designed to safeguard clients and psychologists who are dealing with reports of recovered memories. These Guidelines acknowledge, however, that those who are associated with the events of therapy (Psychologist, client, and others) must take ultimate responsibility for their own actions.
I. Scientific Issues
Memory is a constructive and reconstructive process. What is remembered about an event is shaped by what was observed of that event, by conditions prevailing during attempts to remember, and by events occurring between the observation and the attempted remembering. Memories can be altered, deleted, and created by events that occur during and after the time of encoding, and during the period of storage, and during any attempts at retrieval.
Memory is integral to many approaches to therapy. Repression and dissociation are processes central to some theories and approaches to therapy. According to these theories and approaches, memories of traumatic events may be blocked out unconsciously and this leads to a person having no memory of the events. However, memories of these traumatic events may become accessible at some later time. Although some clinical observations support the notion of repressed memories, empirical research on memory generally does not. Moreover, scientific evidence does not allow global statements to be made about a definite relationship between trauma and memory.
"Memories" that are reported either spontaneously or following the use of special procedures in therapy may be accurate, inaccurate, fabricated, or a mixture of these. The presence or absence of detail in a memory report does not necessarily mean that it is accurate or inaccurate. The level of belief in memory or the emotion associated with the memory does not necessarily relate directly to the accuracy of the memory. The available scientific and clinical evidence does not allow accurate, inaccurate, and fabricated memories to be distinguished in the absence of independent corroboration.
It is established by scientific evidence that sexual and/or physical abuse against children and adults is typically destructive of mental health, self esteem, and personal relationships. It is also the case that people who suffer these experiences may use various psychological mechanisms to reduce the psychological severity of the painful events in an attempt to help them cope with the experience and its consequences.
Just as psychologists should be familiar with this evidence, so should they recognize that reports of abuse long after the events are reported to have occurred are difficult to prove or disprove in the majority of cases. Independent corroboration of the statements of those who make or deny such allegations is typically difficult, if not impossible. Accordingly, psychologists should exercise special care in dealing with clients, their family members, and the wider community when allegations of past abuse are made.
II. Clinical Issues
Psychologists should evaluate critically their assumptions or biases about attempts to recover memories of trauma-related events. Equally, psychologists should assist clients to understand any assumptions that they have about repressed or recovered memories. Assumptions that adult problems may or may not be associated with repressed memories from childhood can not be addressed by existing scientific evidence.
Psychologists should be alert to the ways in which they may unintentionally overlook or minimize reports of experiences of abuse or other events that may have had a significant impact on a client. They should also be alert to the ways that they can shape the reported memories of clients through the expectations they convey, the comments they make, the questions they ask, and the responses they give. Psychologists should be alert that clients are susceptible to subtle suggestions and reinforcements, whether those communications are intended or unintended. Therefore, psychologists should record intact memories at the beginning of therapy, and be aware of any possible effects from outside the therapeutic setting (e.g., self-help groups, popular books, films, television programs).
Psychologists should be alert not to dismiss memories that may be based in fact. Equally they should be alert to the role that they may play in creating or shaping false memories. At all times, psychologists should be empathic and supportive of the reports of clients while also ensuring that clients do not jump to conclusions about the truth or falsity of their recollections of the past. They should also ensure that alternative causes of any problems that are reported are explored. Psychologists should recognize that the context of therapy is important as is the content.
Psychologists should not avoid asking clients about the possibility of sexual or other abusive occurrences in their past, if such a question is relevant to the problem being treated. However, psychologists should be cautious in interpreting the response that is given. Psychologists should not assume the accuracy or inaccuracy of any report of recovered memory.
Psychologists should recognize that the needs and well-being of clients are their essential focus and they should design their therapeutic interventions accordingly. Relatedly, psychologists should recognize that therapeutic interventions may have an indirect impact on people other than the client they are treating. They should seek to meet the needs of clients who report memories of abuse, and should do this quite apart from the truth or falsity of those reports. Psychologists should be cautious about conveying statements about the accuracy of memory reports given by clients. In particular, psychologists should understand clearly the difference between narrative truth and historical truth, and the relevance of this difference inside the therapy context and outside that context. Memory reports as part of a personal narrative can be helpful in therapy independent of the accuracy of those reports. But, to be accepted as accurate in another setting (e.g., court of law), those reports will need to be shown to be accurate.
III. Ethical Issues
Psychologists treating clients who report recovered memories of abuse are expected to observe the Principles set out in the Code of Professional Conduct of the Australian Psychological Society, and in the Code of Professional Conduct of the Psychologists Registrations Boards in States in which they are registered as psychologists. Specifically, psychologists should obtain informed consent at the beginning of therapy in relation to the therapeutic procedures and process.
Psychologists should explore with any client who reports recovering a memory of abuse that it may be an accurate memory of an actual event, may be an altered or distorted memory of an actual event, or may be a false memory of an event that did not happen. Psychologists should explore with the client the meaning and implications of the memory for the client, rather than focus solely on the content of the reported memory. Psychologists should explore with the client ways of determining the accuracy of the memory, if appropriate.
Psychologists should be alert particularly to the need to maintain appropriate skills and learning in this area, and should be aware of the relevant scientific evidence and clinical standards of practice. When appropriate they should refer the client to a colleague who is especially skilled and experienced in dealing with issues in this area. Psychologists should guard against accepting approaches to abuse and therapy that are not based in scientific evidence and appropriate clinical standards.
Psychologists should be alert also to the personal responsibility they hold for the foreseeable consequence of their actions.
IV. Legal Issues
Psychologists should in no way tolerate, or be seen to tolerate, childhood or adult sexual abuse, or abuse of any kind. They should ensure that their psychological services are used appropriately in this regard, and should be alert to problems of deciding whether allegations of abuse are true or false. They should be alert especially to the different demands and processes of the therapeutic and legal contexts in dealing with such allegations.
Psychologists should be aware that some approaches and writings concerning abuse and recovered memories urge people who report recovered memories to pursue legal action of various types. Given that the accuracy of memories cannot be determined without corroboration, psychologists should use caution in responding to questions from clients about pursuing legal action.
Psychologists should be aware that their knowledge, skills, and practices may come under close scrutiny by various public and private agencies if they are treating clients who report recovering memories of abuse. Psychologists should ensure that comprehensive records are maintained about their sessions with clients who report recovering such memories.
V. Research Issues
Psychologists should be aware that research is needed to understand more about trauma-related memory, techniques to enhance memory, and techniques to deal effectively with childhood sexual abuse. Psychologists should support and contribute to research on these, and related, issues whenever possible.
These guidelines have been adapted from:
McConkey, K.M., & Sheehan, P.W. (in press). Hypnosis, memory, and behaviour in the forensic setting. New York: Guilford Press.
Kevin M. McConkey, School of Psychology
University of New South Wales, Sydney, NSW 2052, Australia,
Can a memory be forgotten and then remembered? Can a ‘memory’ be suggested and then remembered as true?
These questions lie at the heart of the memory of childhood abuse issue. Experts in the field of memory and trauma can provide some answers, but clearly more study and research are needed. What we do know is that both memory researchers and clinicians who work with trauma victims agree that both phenomena occur. However, experienced clinical psychologists state that the phenomenon of a recovered memory is rare (e.g., one experienced practitioner reported having a recovered memory arise only once in 20 years of practice). Also, although laboratory studies have shown that memory is often inaccurate and can be influenced by outside factors, memory research usually takes place either in a laboratory or some everyday setting. For ethical and humanitarian reasons, memory researchers do not subject people to a traumatic event in order to test their memory of it. Because the issue has not been directly studied, we can not know whether a memory of a traumatic event is encoded and stored differently from a memory of a nontraumatic event.
Some clinicians theorize that children understand and respond to trauma differently from adults. Some furthermore believe that childhood trauma may lead to problems in memory storage and retrieval. These clinicians believe that dissociation is a likely explanation for a memory that was forgotten and later recalled. Dissociation means that a memory is not actually lost, but is for some time unavailable for retrieval. That is, it’s in memory storage, but cannot for some period of time actually be recalled.
Some clinicians believe that severe forms of child sexual abuse are especially conducive to negative disturbances of memory such as dissociation or delayed memory. Many clinicians who work with trauma victims believe that this dissociation is a person’s way of sheltering himself or herself from the pain of the memory. Many researchers argue, however, that there is little or no empirical support for such a theory.
What’s the bottom line?
First, it’s important to state that there is a consensus among memory researchers and clinicians that most people who were sexually abused as children remember all or part of what happened to them although they may not fully understand or disclose it. Concerning the issue of a recovered versus a pseudomemory, like many questions in science, the final answer is yet to be known. But most leaders in the field agree that although it is a rare occurrence, a memory of early childhood abuse that has been forgotten can be emembered later. However, these leaders also agree that it is possible to construct convincing pseudomemories for events that never occurred. The mechanism(s) by which both of these phenomena happen are not well understood and, at this point it is impossible, without other corroborative evidence, to distinguish a true memory from a false one.
What further research is needed?
The controversy over the validity of memories of childhood abuse has raised many critical issues for the psychological community. Many questions are at this point unanswered. This controversy has demonstrated that there are areas of research which should be pursued; among them are the following:
Much of this research will profit from collaborative efforts among psychologists who specialize in memory research and those clinicians who specialize in working with trauma and abuse victims.
If there is so much controversy about childhood memories of abuse, should I still seek help from a mental health provider if I believe I have such a memory?
Yes. The issue of repressed or suggested memories has been overreported and sensationalized by the news media. Media and entertainment portrayals of the memory issue have succeeded in presenting the least likely scenario (that of a total amnesia of a childhood event) as the most likely occurrence. The reality is that most people who are victims of childhood sexual abuse remember all or part of what happened to them. Also true is the fact that thousands of people see a psychologist every day and are helped to deal with such things as issues of personal adjustment, depression, substance abuse and problems in relationships. The issues of childhood abuse or questionable memory retrieval techniques never enter into the equation in the great majority of therapy relationships.
What should I know about choosing a psychotherapist to help me deal with a childhood memory or any other issue?
The American Psychological Association has released to the public the following advice to consider when seeking psychotherapy services.
First, know that there is no single set of symptoms which automatically indicates that a person was a victim of childhood abuse. There have been media reports of therapists who state that people (particularly women) with a particular set of problems or symptoms must have been victims of childhood sexual abuse. There is no scientific evidence that supports this conclusion.
Second, all questions concerning possible recovered memories of childhood abuse should be considered from an unbiased position. A therapist should not approach recovered memories with the preconceived notion that abuse must have happened or that abuse could not possibly have happened.
Third, when considering current problems, be wary of those therapists who offer an instant childhood abuse explanation, and those who dismiss claims or reports of sexual abuse without any exploration.
Fourth, when seeking psychotherapy, you are advised to see a licensed practitioner with training and experience in the issue for which you seek treatment. Ask the therapist about the kinds of treatment techniques he or she uses and how they could help you.
How can I expect a competent psychotherapist to react to a recovered memory?
What credentials should I look for when selecting a mental health provider?
You should choose a mental health professional as carefully as you would choose a physical health provider. For example, licensed psychologists have earned an undergraduate degree and have completed 5-7 years of graduate study culminating in a doctoral degree and including a one-year, full-time internship. All psychologists are required to be licensed or certified by the state in which they practice and many states require that they keep their training current by completing continuing education classes every year. Members of the American Psychological Association are also bound by a strict code of ethical standards.
Once the provider’s competency has been established, his or her experience dealing with the issues you want help with is important. Also important is your level of comfort with the provider. Psychotherapy is a cooperative effort between therapist and patient, so a high level of personal trust and comfort is necessary. However, you should be concerned if your therapist reports to you that a large number of his or her patients recover memories of childhood abuse while in treatment.
There are a number of good ways to get a referral to a mental health professional. Your state psychological association will be able to provide you with referrals to psychologists in your community. Many state associations are located in their state capital. Also, because so many physical ailments have psychological components, most family physicians have a working relationship with a psychologist. Ask your doctor about a referral. Your church or synagogue and school guidance program or university counseling centers also usually maintain lists of providers in the community. APA also has published a brochure of advice about the selection of a mental health provider entitled How to Choose a Psychologist.
Editor’s note: This document is being released at the direction of the APA Board of Directors. It is based on numerous reports and documents, including, but not limited to, the work of the APA Working Group on the Investigation of Memories of Childhood Abuse.
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Prepared by: The NASW National Council on the Practice of Clinical Social Work
Serious ethical and legal issues have arisen in the clinical literature, courtrooms, and legislatures around the country with regard to the recovering of memories of childhood sexual abuse during the process of treatment. This statement is an effort on the part of the National Association of Social Workers (NASW) National Council on the Practice of Clinical Social Work to provide guidance for clinical social workers as they proceed with the evaluation and treatment of their clients. This guidance is based on the foundation that the clinical social worker’s decisions should be clinically sound, ethically based, and legally sanctioned.
The validity of some recovered memories of sexual abuse has been the cause of passionate debate among mental health professionals, attorneys, and the public. In addition to the questions of validity of undocumented reports of sexual abuse and the therapeutic techniques used to elicit these memories have been placed under scrutiny. We will not enter the debate on whether traumatic events are forgotten or how accurately people report their memories. There is ongoing and developing research on memory, including the repressed memory phenomenon. Clinical social workers should be continuously acquainting themselves with this literature. Our concern is for the clients who believe they have been traumatized by childhood sexual abuse as well as the people who believe they have been falsely accused of being a sexual abuser. This statement addresses and reiterates the basic clinical and ethical principles and standards that NASW and the social work profession have followed, applied to the assessment and treatment of clients for whom the possibility of childhood sexual abuse may be present.
Establishing and maintaining the appropriate therapeutic relationship is the responsibility of the clinical social worker, not the client. The clinical social worker should:
The clinical social worker’s role is to be empathetic, neutral, and non-judgmental. Awareness of one’s own attitudes toward repressed memories is crucial. Attitudes of enthusiastic belief or disbelief can and will have an effect on the treatment process. Any predisposition with regard to whether the client’s symptoms are related to particular events or circumstances may render the assessment and treatment inappropriate and ineffective. The therapist’s responsibility is to maintain the focus of treatment on symptom reduction or elimination and to enhance the ability of the client to function appropriately and comfortably in his or her daily life.
Evaluation and Treatment
A treatment plan should be developed based on a complete psychosocial and diagnostic assessment. Issues related to the client’s total clinical picture including symptoms and level of functioning need to be carefully evaluated. All likely medical causes for the client’s symptoms need to be identified by referring the client to the appropriate medical personnel before diagnostic conclusions are drawn. Other adjunct services should be made available to the client as needed.
Clinical social workers should explore with the client who reports recovering a memory of childhood abuse the meaning and implication of the memory for the client, rather than focusing solely on the content or veracity of the report. The client who reports recovering a memory of sexual abuse must be informed that it may be an accurate memory of an actual event, an altered or distorted memory of an actual event, or the recounting of an event that did not happen.
The use of therapeutic techniques such as recovered memory groups, guided imagery, and hypnosis for treatment purposes should be limited to clinical social workers with special training, experience, and certification in these modalities.
Clinical social workers need to maintain appropriate skills and knowledge in the area of trauma and memory. They must keep abreast of the evolving relevant scientific examination of the issues and developments in standards of clinical practice. Clinical social workers conducting psychotherapy with clients who have been abused should have adequate training and emonstrated competence and use appropriate and skilled supervision or consultation.
Social workers must maintain an awareness of the effect the treatment may have on people other than the client. Clinical social workers must exercise great caution regarding a client’s expressed desire to confront an alleged abuser. The clinical social worker must remain neutral and objective. Although the client has a right to self-determination, the social worker should help the client think through the goals and possible positive and negative outcomes of a confrontation. If a client intends to pursue confrontation the social worker should help the client consider an approach that will maximize the likelihood of a satisfactory result. For example, if clinically indicated, a neutral mediator may be used.
If a client requests the social worker to be present at a meeting with the alleged abuser to discuss the abuse, and if the social worker determines this to be therapeutically indicated and consistent with the treatment plan; the social worker is advised to consider seeking clinical and legal consultation prior to agreeing to such a meeting. It should be understood that if the social worker is present for such a meeting, it will be difficult to argue that this session is not part of the treatment plan. A meeting of this nature may not be essential for a positive treatment outcome, therefore, careful consideration should be made before the client, the alleged abuser and the social worker are placed in a potentially volatile and emotionally charged situation. The purpose of the session should be clarified and all parties should agree to participate. Written consent based on full notice should be obtained from all participating parties before the meeting takes place.
Records should be maintained that reflect the clinical activity with the client from the initial appointment to termination of treatment. The recorded information should be objective and clinically relevant. The documentation should reflect the process related to assessment and ongoing treatment and should document facts and descriptions about what takes place in the therapeutic setting. It should reflect how the memories surfaced and how the client arrived at the conclusion that he or she was the victim of childhood sexual abuse. The social worker must remember that the record is a treatment tool and potentially a legal document.
Clinical social workers should be knowledgeable of state and federal laws regarding disclosure, reporting of abuse, privileged communications, and release of records. Both the obligations and/or lack of protections for the client or social worker may pose clinical and ethical challenges for the social worker. Some circumstances may stimulate requests by clients or other parties for access to the records.
Clinical social workers who practice in the area of recovered memories should be mindful that this is a high-risk area of practice in an environment of intense controversy. Individuals who report childhood sexual abuse and trauma must receive expert care. The clinician must carefully evaluate theories and techniques used in the care of this very vulnerable client group. The application of sound clinical judgment in the midst of conflicting beliefs and evolving knowledge is the best course to follow on behalf of both the client and the social worker. The clinical social worker needs to conscientiously adhere to principles such as currency of knowledge, comprehensive treatment planning, use of consultation, maintenance of clear boundaries, and careful documentation as described in the NASW Code of Ethics and NASW Standards for the Practice of Clinical Social Work.
References and Suggested Readings
American Medical Association Report of the Council of Scientific Affairs. (1994). Memories of childhood abuse. Washington, DC: Author.
American Psychiatric Association. (1993). Statement on memories of sexual abuse. Washington, DC: Author.
American Psychiatric Association. (1994, April). Fact sheet on memories of sexual abuse. Washington, DC: Author.
American Psychological Association. (1994). Working group on investigation of memories of childhood abuse. Interim report. Washington, DC: Author.
Australian Psychological Society Limited Board of Directors. (1994). Guidelines relating to the reporting of recovered memories. Carlton, South Victoria: Author.
Barlas, S. (1995, March). Psychiatrist unraveling memories of abuse walk on tenuous ground. Psychiatric Times, p. 44.
Bolker, J. (1995). Forgetting ourselves. Readings, 10, 12-15.
British Psychological Society. (1995). Report of the working party of the British Psychological Society on recovered memories. (Available from the British Psychological Society, St. Andrew House 48, Princess Road, East Leicester LE 1 7DR United Kingdom).
Butler, K. (1995a). Caught in the cross fire. Family Therapy Networker, 19, 24-79.
Butler, K. (1995b). Like herding cats. Family Therapy Networker, 19, 35.
Butler, K. (1995c). Marshaling the media. Family Therapy Networker, 19, 36.
Canadian Psychiatric Association. (1996). Position statement on adult recovered memories of childhood sexual abuse. Ottawa, Canada: Author.
Cornell, W. F. (1995). A plea for a measure of ambiguity. Readings, 10, 4-10.
Gardner, R. A. (1995). Protocols for the sex-abuse evaluation. Kreskill, NJ: Creative Therapeutics.
Garry, M., & Loftus, E. F. (1994). Pseudomemories without hypnosis. International Journal of Clinical and Experimental Hypnosis, 13, 363-378.
Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
International Society for the Study of Dissociation. (1994). Guidelines for treating dissociative identity disorders (multiple personality disorder) in adults. Skokie, IL: Author.
McHugh, P. R. (1992). Psychiatric misadventures. American Scholar, 61, 497-510.
McHugh, P. R. (1994). Psychotherapy awry. American Scholar, 63, 17-30.
National Association of Social Workers. (1989). NASW standards for the practice of clinical social work. Washington, DC: Author.
National Association of Social Workers. (1991). NASW guidelines on the private practice of clinical social work. Washington, DC: Author.
National Association of Social Workers. (1994a). NASW code of ethics. Washington, DC: Author.
National Association of Social Workers. (1994b, August). Recovered memories. Need for action (Report to the NASW National Council on the Practice of Clinical Social Work). Washington, DC: Author.
Peterson, M. R. (1992). At personal risk. Boundary violations in professional-client relationships. New York: W. W. Norton.
text adapted from the FMSF Newsletter, Feb. 1995 Vol. 4 No. 2
In January 1995, the British Psychological Society issued the report on which it had been working for the previous 18 months. We urge readers to obtain the full report as it is a testament to the thinking and compromises by clinicians and scientists on the issue of recovered memories. We print the Executive Summary and Guidelines for Therapists. To obtain the full copy, enclose a cheque for $20 (twenty dollars). British Psychological Society, St. Andrew House, 48, Princess Road East, Leicester LE1 7DR, United Kingdom. The report will be sent by return airmail.
RECOVERED MEMORIES: THE REPORT OF THE WORKING PARTY OF THE BRITISH PSYCHOLOGICAL SOCIETY
JANUARY 12, 1995
The working party was charged with reporting on the scientific evidence relevant to the current debate concerning Recovered Memories of Trauma and with commenting on the issues surrounding this topic. We have reviewed the scientific literature, carried out a survey of relevant members of the British Psychological Society, and scrutinized the records of the British False Memory Society. On this basis we came to the following conclusions:
Complete or partial memory loss is a frequently reported consequence of experiencing certain kinds of psychological traumas including childhood sexual abuse. These memories are sometimes fully or partially recovered after a gap of many years.
Memories may be recovered within or independent of therapy. Memory recovery is reported by highly experienced and well qualified therapists who are well aware of the dangers of inappropriate suggestion and interpretation.
In general, the clarity and detail of event memories depends on a number of factors, including the age at which the event occurred. Although clear memories are likely to be broadly accurate,they may contain significant errors. It seems likely that recovered memories have the same properties.
Sustained pressure or persuasion by an authority figure could lead to the retrieval or elaboration of memories of events that never actually happened. The possibility of therapists creating in their clients false memories of having been sexually abused in childhood warrants careful consideration, and guidelines for therapists are suggested here to minimize the risk of this happening. There is no reliable evidence at present that this is a widespread phenomenon in the UK.
In a recent review of the literature on recovered memories, Lindsay and Read commented that "the ground for debate has shifted from the question of the possibility of therapy-induced false beliefs to the question of the prevalence of therapy-induced false beliefs". We agree with this comment but add to it that the ground for debate has also shifted from the question of the possibility of recovery of memory from total amnesia to the question of the prevalence of recovery of memory from total amnesia.
Guidelines for therapists
The following guidelines are intended to apply to a range of psychological therapies.
1. It may be necessary clinically for the therapist to be open to the emergence of memories of trauma which are not immediately available to the client’s consciousness.
2. It is important for the therapist to be alert to the dangers of suggestion.
3. While it is important always to take the client seriously, the therapist should avoid drawing premature conclusions about the truth of a recovered memory.
4. The therapist needs to tolerate uncertainty and ambiguity regarding the client’s early experience.
5. Whilst it may be part of the therapists’ work to help their clients to think about their early experiences, they should avoid imposing their own conclusions about what took place in childhood.
6. The therapist should be alert to a range of possibilities, for example that a recovered memory may be literally true, metaphorically true or may derive from fantasy or dream material.
7. If the role of the professional is to obtain evidence that is reliable in forensic terms, they need to restrict themselves to procedures that enhance reliability (e.g. use of the Cognitive Interview and avoidance of hypnosis or suggestion and leading questions).
8. CSA should not be diagnosed on the basis of presenting symptoms such as eating disorder alone. There is a high probability of false positives, as there are other possible explanations for psychological problems.
The members of the Working Party were:
John Morton - MRC Cognitive Development Unit, London (chair);
Bernice Andrews - Royal Holloway University of London;
Debra Bekerian - MRC Applied Psychology Unit, Cambridge;
Chris Brewin - Royal Holloway University of London;
Graham Davies - Leicester University;
Phil Mollon - Dept of Psychiatry, Lister Hospital, Stevenage.
Formally adopted by the Management Committee
Alec McGuire,Chair, BAC Research & Evaluation Committee British Association for Counselling, "Research Study I," p.1-27 (1997)
1 Regent Place, Rugby, Warwickshire CV21 2PJ
Implications for Practice The conclusions of this study have implications for practitioners. The possibility of false memories occurring needs to be taken into account by all who are involved in counselling where the client may have been abused as a child.
It is good practice for counsellors to familiarise themselves with the issues relating to the nature of memory generally.
Practitioners should not use methods which are deliberately intended to induce memories of abuse. Such methods run considerable risks of eliciting false rather than actual memories.
It is not good practice to diagnose that sexual abuse occurred to a client on the basis of reported symptoms unaccompanied by clear pre-existing memories. In general, counsellors should be careful not to say anything to a client which suggests that abuse may have occurred. The impetus for discussions of abuse as a possibility should come from the client.
When clients retrieve memories of abuse spontaneously during the counselling process, counsellors should proceed with caution. Nothing should be done which might encourage the client to elaborate beyond what has actually been recalled. Counsellors should be aware that the details of memories are not always reliable.
Having said that, counsellors should also bear in mind that the majority of memories of abuse are clear and reliable, and they should not be afraid to work with the many issues that childhood sexual abuse arouses for the client. In these matters, it is paramount for the counsellor to discuss the issues with their supervisor.
Text adapted from the FMSF Newsletter, April 1996, Vol. 5 No. 4
FINAL REPORT FROM THE AMERICAN PSYCHOLOGICAL ASSOCIATION WORKING GROUP ON THE INVESTIGATION OF MEMORIES OF CHILDHOOD ABUSE NOW AVAILABLE FMSF Staff
The Final Report of the APA Working Group on the Investigation of Memories of Childhood Abuse is now available through the American Psychological Association. (Contact: Paul Donnelly at APA (202-336-6055), email: email@example.com, 750 1st NE, Washington, DC 20002.) The report and commentaries on the report have been published in Psychology, Public Policy, and Law, December 1998, Vol. 4, Number 4.
This Final Report is a remarkable document and it is "must" reading by anyone who is interested in the methodology and the research base of both sides of the repressed memory debate. The report opens with the final conclusions of the Working Group:
The Working Group concluded that they differed markedly on the following issues of the conception of memory:
This is followed in tennis-match fashion by the arguments and research evidence of each group in the following sections:
SYMPTOMATIC CLIENTS AND MEMORIES OF CHILDHOOD ABUSE: WHAT THE TRAUMA AND CHILD SEXUAL ABUSE LITERATURE TELLS US (Alpert, Brown, Courtois)
REPLY TO THE ALPERT, BROWN AND COURTOIS DOCUMENT: THE SCIENCE OF MEMORY AND THE PRACTICE OF PSYCHOTHERAPY (Ornstein, Ceci, Loftus)
THE POLITICS OF MEMORY: A RESPONSE TO ORNSTEIN, CECI AND LOFTUS (Alpert, Brown, Courtois)
ADULT RECOLLECTIONS OF CHILDHOOD ABUSE: COGNITIVE AND DEVELOPMENTAL PERSPECTIVES (Ornstein, Ceci, Loftus)
RESPONSE TO "ADULT RECOLLECTIONS OF CHILDHOOD ABUSE: COGNITIVE AND DEVELOPMENTAL PERSPECTIVES" (Alpert, Brown, Courtois)
MORE ON THE REPRESSED MEMORY DEBATE: A REJOINDER TO ALPERT, BROWN AND COURTOIS (Ornstein, Ceci, Loftus).
Position Statement on Adult Recovered Memories of Childhood Sexual Abuse, 1996
As reproduced in the FMSF Newsletter, Sept. 1996 Vol. 5 No. 8
JUNE, 1996 POSITION STATEMENT
The Canadian Journal of Psychiatry Vol 41, No 5 305-306
ADULT RECOVERED MEMORIES OF CHILDHOOD SEXUAL ABUSE
Stella Blackshaw, MD, FRCPC, Praful Chandarana, MBChB, ABPN, FRCPC, Yvon Garneau, MD, FRCPC, Harold Merskey, DM, FRCPC, Rebeka Moscarello, MD, FRCPC
This paper was prepared by the Education Council of the Canadian Psychiatric Association, chaired by Dr. Yvon Garneau, and approved by the Board of Directors of the Canadian Psychiatric Association on March 25, 1996.
Sexual abuse of children is a serious and common problem in our society, although exact estimates of its frequency are understandably difficult to obtain. Sexual abuse involves both girls and boys, but all population studies concur in finding that girls are more frequently affected. Broad definitions of sexual abuse include incidents of exhibitionism and touching nongenital areas of the body. More narrow definitions are confined to incidents of unwanted genital touching or penetration by significantly older persons. Until recently, attention to these problems was limited, and their scope was not recognized.
Sexual abuse, like other types of abuse or trauma, is now considered to be a nonspecific risk factor for many psychiatric conditions. These include disorders of anxiety, mood, dissociation, personality, and substance abuse. Although many sexually abused persons do not become psychiatric patients, studies of inpatient and outpatient psychiatric populations have found a higher than expected incidence of a history of sexual abuse. The psychiatric profession is acutely aware of the need for the prevention of sexual abuse and the treatment of victims.
There are many survivors of childhood sexual abuse. This position statement does not refer to survivors of childhood sexual abuse with continuous memories of their ill-treatment, nor does it deal with individuals who have recovered memories that have been corroborated. Serious concern exists about uncorroborated memories recovered in the course of therapy that is narrowly focussed on the enhancement of memory of what is hypothesized to be repressed sexual abuse. Differences of opinion have emerged about the frequency and the veracity of such recovered memories of sexual abuse, which have also been referred to as part of a "false memory syndrome." A further important concern is that poorly trained or misguided therapists have been urging patients, as a specific part of their therapy, to confront and accuse the alleged perpetrators of the abuse once they have been identified. As a consequence of this type of therapy, members of the patient’s family are most often identified and accused. When recovered memories are found to be false, family relationships are unnecessarily and often permanently disrupted. Furthermore, such therapists have been sued for malpractice.
In well-conducted psychotherapy, the focus is on the patient’s perceived experience, and a search for proof of the veracity of memories has not been customary. However, when others are publicly accused, especially if legal action is undertaken, the veracity of memory becomes a fundamental issue. The issue then is whether or not recollections of earlier events can be relied upon when they appear after an interval of time (usually years) during which they were not available in consciousness until questions, pressure to recall, suggestions of abuse, or "memory recovery techniques" like hypnosis or narcoanalysis were employed. It is argued that these memories are less reliable than memories that have always been available in consciousness.
Developmental psychology casts doubt upon the reliability of recovered memories from early childhood. The older the child at the time of the event, the more reliable is the memory. Cognitive psychology further finds that memory is an active process of reconstruction that is susceptible to fluctuating external events and to internal effort or drives. If memories of events have not been revisited and cognitively rehearsed in the interval between the occurrence of the events and attention being paid to them some years later, it is not clear that such memories can endure, be accessible, or be reliable.
The controversy over recovered memory has been compounded by certain therapists who use a list of symptoms that are said to indicate the likelihood of individuals having been abused. Common symptoms such as depression, anxiety, anorexia or overeating, poorly explained pains, and other bodily complaints have all been used as proof of alleged sexual abuse. There is no support for such propositions. Psychotherapy based on these assumptions may lead to deleterious effects. Increases in self-injury and suicide attempts have been reported in some patients given recovered memory treatment.
In response to this controversy, at least four separate bodies have issued statements. These include the American Psychiatric Association (December 12, 1993), the Australian Psychological Society Ltd. (Board of Directors, October 1, 1994), the American Psychological Association (November 11, 1994), and the American Medical Association (1994 Annual Meeting). All of these statements recognize and emphasize the seriousness of childhood sexual abuse and of false accusations of childhood sexual abuse. The American Medical Association took the view that it is not yet known how to distinguish true memories from imagined events and that few cases in which adults make accusations of childhood sexual abuse based on recovered memories can be proved or disproved.
The present position statement of the Canadian Psychiatric Association offers brief advice to all members involved in circumstances where recovered memories of sexual abuse play a role. This advice is set out in the form of conclusions and recommendations.
Conclusions and Recommendations
Sexual abuse at any age is deplorable and unacceptable and should always be given serious attention. All spontaneous reports should be treated with respect and concern and be carefully explored. Psychiatrists must continue to treat patients who report the recollection of childhood sexual abuse, accepting the current limitations of knowledge concerning memory, and maintain an empathic, nonjudgemental, neutral stance.
Lasting serious effects of trauma at an early age very probably occur, but children who have been sexually abused in early childhood may be too young to accurately identify the event as abusive and to form a permanent explicit memory. Thus, without intervening cognitive rehearsal of memory, such experiences may not be reliably recalled in adult life.
Reports of recovered memories of sexual abuse may be true, but great caution should be exercised before acceptance in the absence of solid corroboration. Psychiatrists should be aware that excessive emphasis on recovering memories may lead to misdirection of the treatment process and unduly delay appropriate therapeutic measures. Routine inquiry into past and present experiences of all types of abuse should remain a regular part of psychiatric assessment. Psychiatrists should take particular care, however, to avoid inappropriate use of leading questions, hypnosis, narcoanalysis, or other memory enhancement techniques directed at the production of hypothesized hidden or lost material. This does not preclude traditional supportive psychotherapeutic techniques, based on strengthening coping mechanisms, cognitive psychotherapy, behaviour therapy, or neutrally managed exploratory psychodynamic or psychoanalytic treatment. ?Since there are no well-defined symptoms or groups of symptoms that are specific to any type of abuse, symptoms that are said to be typical should not be used as evidence thereof.
Reports of recovered memories that incriminate others should be handled with particular care. In clinical practice, an ethical psychiatrist should refrain from taking any side with respect to their use in accusations directed against the family or friends of the patient or against any third party. Confrontation with alleged perpetrators solely for the supposed curative effect of expressing anger should not be encouraged. There is no reliable evidence that such actions are therapeutic. On the contrary, this type of approach may alienate relatives and cause a breakdown of family support. Psychiatrists should continue to protect the best interests of their patients and of their supportive relationships.
Further education and research in the specific areas of childhood sexual abuse and memory are strongly recommended.
As reproduced in the FMSF Newsletter, Nov. 1997, Vol. 6 No. 10
REPORTED RECOVERED MEMORIES OF CHILD SEXUAL ABUSE
RECOMMENDATIONS FOR GOOD PRACTICE AND IMPLICATIONS FOR TRAINING, CONTINUING PROFESSIONAL DEVELOPMENT AND RESEARCH
Royal College of Psychiatrists’ Working Group on Reported Recovered Memories of Child Sexual Abuse: Professor Sydney Brandon (Chair), Dr Janet Boakes, Dr Danya Glaser, Professor Richard Green, Dr James MacKeith and Dr Peter Whewell. Approved by Council, 24 June 1997. Embargoed until 1st October 1997. The College Psychiatric Bulletin (1997), 21, 663-665. Reprinted with permission.
The College recognises the severity and significance of child sexual abuse and the suffering experienced both at the time of the abuse and in adult life. The difference between incestuous fathers and paedophiles is less distinct than was previously thought. Those who sexually abuse children share many characteristics including verbal denial even in the face of clear evidence, recidivism, secrecy, minimisation, rationalisation and justification of their actions among others. These are often maintained even after criminal conviction.
Nevertheless, the growth of litigation against alleged perpetrators and therapists and the risk of bringing the profession into disrepute makes it necessary to alert psychiatrists to the possibility of ‘false memories’. In this context a ‘recovered memory’ is one in which traumatic events have been totally forgotten until ‘released’ or recovered in therapy or as a result of some other trigger or experience. A ‘false memory’ is one which is not based on events which have occurred.
Memories are constantly forgotten and recovered, but we are here concerned with the alleged forgetting and recovery of memories of prolonged and repeated child sexual abuse, typically from childhood into adolescence. Concern about recovered memories which have no factual basis should be concentrated on those cases where patients report having had no memory whatsoever of abuse which continued over many years. In the United States concern about such recovered memories led to the use of the term False Memory Syndrome which, though misleading, has now gained wide usage.
Memory is a complex field of study which has generated an enormous literature and a plethora of theories. The evidence shows that memories of events which did not in fact occur may develop and be held with total conviction. Such memories commonly develop under the influence of individuals or situations which encourage the development of strong beliefs. They have often been described as arising within therapy, sometimes involving psychiatrists or other mental health workers, as well as psychotherapists.
Although the following recommendations are particularly concerned with the use of specific memory recovery techniques, it is important to emphasise that distortion of memory may occur in any therapeutic situation. Psychiatrists need to be aware of the techniques employed by other members of their team, including semi-autonomous practitioners. Any professionals, including senior psychiatrists, working with cases of sexual abuse or recovered memories should have access to expert advice and the opportunity for regular peer supervision.
Recommendations for good practice
The welfare of the patient is the first concern of the psychiatrist. Concern for the needs of family members and others may also be necessary, within the constraints imposed by the need for confidentiality
In children and adolescents, symptoms and behaviour patterns may alert the clinician to the possibility of current sexual abuse, but these are no more than indicators for suspicion. Previous sexual abuse in the absence of memories of these events cannot be diagnosed through a checklist of symptoms.
Psychiatrists are advised to avoid engaging in any ‘memory recovery techniques’ which are based upon the expectation of past sexual abuse of which the patient has no memory. Such ‘memory recovery techniques’ may include drug-mediated interviews, hypnosis, regression therapies, guided imagery, ‘body memories’, literal dream interpretation and journaling. There is no evidence that the use of consciousness-altering techniques, such as drug-mediated interviews or hypnosis, can reveal or accurately elaborate factual information about any past experiences including childhood sexual abuse. Techniques of regression therapy including ‘age regression’ and hypnotic regression are of unproven effectiveness.
Forceful or persuasive interviewing techniques are not acceptable in psychiatric practice. Doctors should be aware that patients are susceptible to subtle suggestions and reinforcements whether these communications are intended or unintended.
The psychiatrist should normally explore his or her doubts with the patient about the accuracy of recovered memories of previously totally forgotten sexual abuse. This may be particularly important if the patient intends to take action outside the therapeutic situation. Memories, however emotionally intense and significant to the individual, do not necessarily reflect actual events.
Adult patients reporting previously forgotten abuse may wish to confront the alleged abuser. Such action should not be mandated by the psychiatrist and likewise it is rarely appropriate to discourage or even to forbid the patient from having contact with the alleged abuser or family members. The psychiatrist should help the patient to think through the possible consequences of confrontation with the alleged abuser. In these circumstances it is appropriate to encourage the search for corroboration.
Psychiatrists should resist vigorously any move towards the compulsory reporting of all allegations or suspicions by adults of sexual abuse during childhood. Mandatory reporting is entirely appropriate where children or adolescents spontaneously report current or recent abuse. Hints at the possibility or suspicion of current sexual abuse always need to be carefully evaluated and investigated.
It may be legitimate not to question the validity of a recovered memory while it remains within the privacy of the consulting room, though there is a risk in colluding with, and creating, a life history based upon a false belief. Action taken outside the consulting room, including revealing the accusations to any third party, must depend upon circumstances and upon the wishes of the patient.
Although there are doubts about the validity of diagnoses of dissociated identity disorder (formerly multiple personality disorder) it is asserted by some that this condition is frequently associated with a history of childhood sexual abuse. There seems little doubt that some cases of multiple personality are iatrongenically determined and psychiatrists should be careful to ensure that they do not directly encourage patients to develop ‘alters’ in whom they may invest aspects of their personality, fantasies or current problems. Any spontaneous presentation of dissociative identity disorder should be sympathetically considered but should not be made the subject of undue attention, nor should the patient be encouraged to develop further ‘multiples’. Psychiatrists should be particularly aware of the unreliability of memories reported in these cases. Since there is no settled view on the validity of these diagnostic concepts there is a case for the preparation of a consensus statement which would need to be based upon a substantial literature review.
Implications for training and research
Postgraduate psychiatric trainees should have:
Continuing professional development
Psychiatrists may not have made themselves aware of the developments in the understanding of memory, suggestion or of child sexual abuse and its possible consequences for adult psychotherapy. Continuing professional development should therefore ensure that, through courses and authoritative reviews, psychiatrists are kept up to date on these topics.
It is appropriate that all psychiatrists should have a general understanding of child abuse and its consequences. The skills required for the assessment or therapy of the abused and their families require additional training and experience. All psychiatrists should be open to new knowledge and ready to modify their beliefs and practices accordingly. Psychiatry as a profession should know the limits of its knowledge and experience.
Further research is required into the nature and validity of such concepts as repression, dissociation and the psycho-neuro-physiology of traumatic memories of all kinds. More precise definition of child sexual abuse, accurate recording of its type and duration, of the relationship between the victim and the perpetrator and the age of commencement and duration of the abuse are required for further studies. These studies need to examine the relationship between different varieties and severities of child sexual abuse and later adult psychopathology and to consider the influence of early experience in general, including the effects of physical and emotional abuse.
The College Psychiatric Bulletin (1997), 21, 663-665
Adopted by Executive Council on May 17, 1995
"In summary, given the meager and conflicting scientific data regarding the validity of reported recovered memory of sexual abuse, the Michigan Psychological Association at this time does not support the modification of any existing statutes of limitations in respect to civil and criminal complaints stemming fro m such reported recovered memory. Given the nature of the scientific evidence to date, there is substantial potential for harm in treating claims of recovered memories of sexual abuse presumptively valid. We must await the accumulation of pertinent and scientifically valid research on this issue before recommending th e routine or uncritical acceptance of recovered memory in the absence of corroborative evidence."
Michigan Psychologist, 20 (5) (Sept./Oct., 1995) p. 13.
Childhood Trauma Remembered: A Report on the Current Scientific Knowledge Base and its Applications
ISTSS, 60 Revere Drive, Suite 500, Northbrook, IL 60062, June 1997.
"While there is some evidence that recovered memories of childhood abuse can be as accurate as never-forgotten memories of childhood abuse, there is also evidence that memory is reconstructive and imperfect, that people can make very glaring errors in memory, that people are suggestible under some circumstances to social influence or persuasion when reporting memories for past events and that at least under some circumstances inaccurate memories can be strongly believed and convincingly described. While traumatic memories may be different than ordinary memories, we currently do not have conclusive scientific consensus on this issue. Likewise, it is not currently known how traumatic memories are forgotten or later recovered. These are all fundamental questions that have stimulated a great deal of important research on the memory process in general and on traumatic memories in particular." p. 23.
Professional and Scientific Advisory Board of the False Memory Syndrome Foundation
From the FMSF Newsletter, July/August 1998 Vol 7 No 6
May 17, 1998
Because of the continuing misuse of trust, power, and authority in some forms of mental health treatment, and because of our sense of social responsibility to the victims of these treatments, we, the assembled members of the Scientific and Professional Advisory Board of the False Memory Syndrome Foundation, unanimously agree to the following:
Despite growing awareness of these concerns in public and professional circles, no major United States mental health professional association has acted decisively to prevent its members from contributing to this public health problem.
Therefore, we recommend the following goals for the Foundation:
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