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Ethical Boundary Considerations and Repressed Memories of Sexual Abuse
4 CEUs Ethical Boundary Considerations and Repressed Memories of Sexual Abuse

Section 11
Repressed False Memory of Sexual Abuse:
Boundaries in the Therapeutic Relationship

Ethics CEU Question 11 | Ethics CEU Answer Booklet | Table of Contents | Boundaries CEU Courses
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

In earlier years, therapists routinely underreported and underestimated their patients' traumas of sexual molestation (Crews 1994, p. 54). The pendulum has now swung the other way. Crews states that according to Mark Pendergrast, almost one-fifth of the 255,000 practicing psychotherapists are prepared to actively encourage their patients to consider that they may have been molested (Crews 1994, p. 54). In a letter to the New York Review of Books, Theresa Reid, Executive Director of the American Professional Society on the Abuse of Children in Chicago, faults those therapists who are not prepared to do so (Reid 1995, p. 42). Zoland C. Summit asserts that half of all women were sexually abused in childhood but many do not remember the abuse (Summit 1992). Frederick Crews puts the number of "victims" of abuse at a million patients since 1988 and suggests that "when one explanation for mental distress rockets to prominence so quickly, we ought to ask whether we are looking at a medical breakthrough or a fad" (Crews 1994, P. 54).

True incidents of abuse range from verbal and emotional to physical and sexual. Memories of such abuses frequently are accurate. Some can be corroborated. But along with the explosion of reported memories of incidents of abuse, there is a parallel explosion in the numbers of therapists set to convince their patients that they had to have experienced trauma because they show its symptoms or fit a profile. Some mental health providers form their "conclusions" on the very first or second visit of the patient. Carol Tavns writes:

The problem is not with the advice they the authors of The Courage to Heal)offer to victims, but with their efforts to create victims-to expand the market that can then be treated with therapy and self-help books. To do this, survival books all hew to a formula based on an uncritical acceptance of certain premises about the nature of memory and trauma. They offer simple answers at a time when research psychologists are posing hard questions. (1993, p. 16)

The fundamental question here is whether eating disorders, for example, are really the fingerprints of abuse. Wendy Maltz and Beverly Holman give a long list of other physical and psychological problems that they believe are symptomatic of molestation (Malta and Holman 1990). In fact, just about anything qualifies, including headaches, anxiety, sexual disfunction, relationship difficulties, abusive behaviors, eating disorders, loneliness, and depression. On the evidence of such symptoms, we may all have been molested as children. For therapists who believe this, every undifferentiated complaint leads inexorably to the universal cause of all such complaints: sexual molestation. Wakefield and Underwager (1991, p. 2, citing Grand, Alpert, Safer, and Milden) stress "that the role of the therapist is to help the patient become convinced of the historical reality of the abuse, even when there is no verification (that there was an abuse and the patient herself doubts that the memory is real." Bass and Davis state that "if you think you were abused and your life shows the symptoms, then you were" and "if you don't remember your abuse you are not alone. Many women don't have memories, and some never get memories. This doesn't mean they were not abused" (Bass and Davis 1988, p. 81). In other words: if you do not recall being abused, this too is a symptom of your abuse. Everything can be a symptom for those who believe that everyone is a victim of abuse. "Forget fighting with Harold and the kids, having a bad job or no job, worrying about money. Healing is defined as your realization that you were a victim of sexual abuse and that it explains everything wrong in your life" (Tavris 1993, p. 17). This, I believe, is what explains the approach of the counselor in the Ramona case.

Many therapists advocate the use of invasive, intrusive, or aggressive techniques to convince patients that they were abused. In group therapy, it is common to see continuing encouragement, of increasingly strident and bizarre dimensions for the discovery of memories. Hypnosis, drugs, direct questioning, and other techniques all form part of such an approach. The next stage in the treatment is to encourage expression of rage, including litigation. If rage is present, can Lorena Bobbitt be far behind? (Letters 1995, p. 45, citing Bass and Davis 1988).

False memories can be implanted through misinformation, especially from a trusted person. Immersion in newspaper accounts can supply details that then become part of the "memory." Outside intervention can convince people to "remember." Memory can be manipulated: by suggestion; by hypnosis; by sodium amytal; by other drugs. Under hypnosis and drugs, persons subject to suggestion confabulate to please the person asking the question. It is for this reason that hypnotically altered testimony is inadmissible in many states and subject to strict controls in others. A decade ago, the AMA went on record as opposing the use of hypnotically altered recall in court. In December 1993, the APA reported that "[t]he rise in reports of documented cases of sexual abuse has been accompanied by a rise in reports of sexual abuse that cannot be documented" (APA Statement 1993, p. 1). In each case, the dangers of creating, inducing, or altering memories may outweigh the benefits. It is difficult to be precise about such "cost- benefit" analysis, because there are no convincing statistical data about the interplay between reliance on recovered memories and improvement in patients' health.

Memory can also be created. Researchers have succeeded in inducing false memories under controlled conditions. In one exercise, Loftus displayed to a target group an accident scene including an intersection with a building located there. Some time later she questioned the group about the intersection, inserting invented data in her question: "Did you see the car pass the red barn before reaching the intersection?" The red barn was her invention. A month later, she asked the group to describe the scene of the accident. Almost 25 percent of the target group recalled seeing the fictitious red barn. The question had become a "memory" and the targets believed that their memories were unitary and true. They were neither, only the result of two layers of information, acquired at different times and subtly fused into a coherent whole.

Similar experiments have successfully created false "memories" of being lost at a mall, when the question was presented by trusted members of the family "reminding" the target of the event, it did not take long to convince the target to the point of an enthusiastic elaboration of details. People have been caused to remember incidents from previous lives, future lives, or life with aliens.

While some believe that memory of truly traumatic events cannot be implanted, others contend that the creation of memories is not limited to inconsequential or nontraumatic matters, Hyman and coworkers implanted memories of emotional events such as false recall of overnight hospitalization and embarrassing acts such as spilling punch on the bride's mother at a wedding (Hyman et al. 1995). This study may not be sufficient to determine whether memories of more traumatic events can be implanted. More importantly, memories may be merely a code word for the effect of rationalizing one's present-day problems.

If fusing memories is achievable in a random experiment, consider the effect of repeated suggestions. Brainwashing is not limited to cults and intelligence agencies. All "true believers" engage in it. Many converts see their conversions as free, volitional choices. Sometimes they benefit by the conversions, and sometimes they are destroyed by them.

Memories can be forgotten. Can they be repressed? The notion that the mind is able to defend the self from emotionally overwhelming events is enticing. It seems more natural, however, to respond to a terrible experience by being unable to forget it. There is little if any empirical proof of the accuracy of long-term repressed memories to warrant admissibility in court. In each case, it would depend on how the witness presents him- or herself. Holmes concludes after reviewing sixty years of research and finding no controlled laboratory support for the concept of repression "that any use of the concept be preceded by a warning: Warning. The concept of repression has not been validated with experimental research and its use may be hazardous to the accurate interpretation of clinical behavior" (Holmes 1990, p. 97). Loftus and Ketcham have examined dozens of treatises on memory and found almost no discussion of repression, although discussions of amnesia have been plentiful (Loftus and Ketchem 1994, p. 49). Recently, Lindsay and Read (1994, p. 281) concluded that "it is possible that some adult survivors would not remember the abuse events, and that memories might be recovered given appropriate care."

Can parts of memory be repressed, or a whole incident, or a lifetime of incidents? Can they be exhumed without signs of aging or decay in the original material? As Loftus and Ketcham (1994, p. 52) write: "We had captured a butterfly of an idea, pinned it to the wall, and analyzed it to death. No wonder some of us were wondering why it wouldn't fly." The existence of robustly "repressed memories" of the kind claimed in Ramona is simply not verifiable absent solid corroboration.

It is not necessary for us to reach the conclusion that repressed memories do not exist in order to require exact and convincing corroboration of memory recovery in cases like Ramona. Legally, it should not be enough for Holly (or her therapist) to testify to a sudden recall, unless it is objectively likely that the recall is genuine. Thus, in the case of Cardinal Bernardin, the recovered memory was bogus and was recanted. But in the case of Ross Cheit, who recalled a memory of being abused by a boys' chorus camp administrator twenty years earlier, a taped admission by the former camp administrator corroborated the event and sufficed to bring a sizeable jury verdict, regardless of how the memory of the abuse was recovered (Butler 1994, p. A2).

If the charge of sexual molestation is not fixed as to the precise time and place, it is difficult to defend against it. A simple alibi could defeat a false memory claim, but one cannot establish an alibi when the charge is both stale and vague as to time. George Ganaway, a professor of psychiatry at Emory University, observes:

Reconstructed memories may incorporate fantasy, distortion, displacement, condensation, symbolism, and other mental mechanisms that make their factual reliability highly questionable. When suggestibility, hypnotizability, and fantasy-proneness are added to the equation, the result is a potential for such a potpourri of facts, fantasy, distortion, and confabulation as to confound even the most astute investigator attempting to separate the wheat from the chaff. [Cited by Loftus and Ketcham 1994, pp. 84-85]

It is this uncertainty that makes reconstructed memories risky in court.
- Loftus, Elizabeth & Katherine Ketcham, The Myth of Repressed Memory, University of Chicago Press: Chicago, 2005.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #4
The preceding section contained information aboutthe creation of false memory. Write three case study examples regarding how you might use the content of this section in your practice.

Along with the explosion of reported memories of incidents of abuse, there is a parallel explosion in the numbers of what? Record the letter of the correct answer the Ethics CEU Answer Booklet.

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Table of Contents

The article above contains foundational information. Articles below contain optional updates.
Ethics Alive! Respect in Social Work Advocacy
We explore the nature of respect in social work advocacy. Social workers demonstrate respect to individual clients by honoring their right to self-determination. Advocacy often involves persuason and trying to change beliefs and behaviors of others.
Ethics Alive! To Record or Not To Record: The Ethics of Documentation
How much and what should social workers document? Allan Barsky outlines the ethics of social work documentation.
Ethics Alive! Coping With Multiple Codes of Ethics as a Social Worker
Which codes “must” social workers abide by? Which codes “should” social workers abide by? And if there are conflicts between two or more codes by which you are abiding, which code takes “precedence”?
Respect: Ethical Imperative or Skills for Success?
Many of us think about respect in terms of how we engage with clients. Honoring clients’ dignity is not the whole story, however, with social work codes of ethics also highlighting the importance of showing respect to colleagues.
Ethics Alive! Social Work With Client Friends and Family: Avoiding Collateral Damage
The first standard in the NASW Code of Ethics advises social workers that their primary ethical obligation is to clients. The Code is silent on what obligations, if any, social workers owe to clients’ family members, friends, and other collaterals.

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