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PTSD & other Traumas: Ethical Issues in Using Recall
PTSD & other Traumas: Ethical Issues in Using Recall

Section 2
Track #2 - Hypnosis & Tools for Avoiding the Cycle of Confabulation

Question 2 | Answer Booklet | Table of Contents | PTSD
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

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On the last track, we discussed the ethical risks of countertransference and an efficient way to avoid it through supervision related to #1. unconscious assumptions, #2. inappropriate prescribing methods, and #3. APA code of ethics.

On this track... we will discuss four ethically questionable possible results of hypnosis. 1. clients create memories; 2. distort existing memories; 3. incorporate cues from leading therapist questions; and 4. incorporate therapist beliefs. We will also examine the path the client might take to resolve their supposed sexual abuse.

According to Professor Alan Scheflin in a talk given at the International Society for the Study of Dissociation (ISSD) and International Society for Traumatic Stress Studies (ISTSS) conferences in Montreal, there was a $10.6 million lawsuit settled out-of-court in Chicago for a therapist who treated Dissociative Identity Disorder, also more recently, the U.S. government has brought criminal charges against Judith Peterson, a Texas psychologist who treats dissociative clients. The charges allege that Dr. Peterson, trauma therapist, intentionally created and diagnosed DID and intentionally implanted false memories in her patients in order to keep the patients in the hospital longer, thereby providing fraudulent therapy for traumas that did not occur.

Let us examine the technique of hypnotism to recover repressed memories and its ethical implications. This concept was briefly touched upon in the home study course. Ethical Dilemmas in the Use of Client's Repressed Memories. Since there is much controversy about the possibility of hypnosis actually generating or creating, rather than merely recovering memories of sexual abuse the Institute felt this area may need additional specific attention.

Share on Facebook#1 Defining Hypnotism
As you probably know, hypnotism is one of the most popular and well-known methods in recovering repressed memories. How do you define hypnosis? Clark Hull and A. M. Weitzenhoffer defined hypnosis as "a state of enhanced suggestibility." It should be noted at this point that the Comprehensive Textbook of Psychiatry states: "An overwhelming body of research indicates that hypnosis does not increase accurate memory, but does increase the person's willingness to repost or change previously uncertain memories with strong conviction."

Furthermore, the hypnotized client, according to the Textbook,
1. "has a pronounced tendency to confabulate or create in those areas where there is little or no recollection.
2. the client distorts memories to enable these memories to become more congruent with currently held beliefs…and fantasies.
3. The client also incorporates cues from leading questions by the therapist as factual memories.
4. Finally, there is a high likelihood that the beliefs of the therapist will somehow be communicated to the patient in hypnosis, and incorporated into what the patient believes to be memories, often with strong conviction."

In summary according to the Comprehensive Textbook of Psychiatry clients create memories; distort existing memories; incorporate cues from leading therapist questions; and incorporate therapist beliefs. Wow, what an ethical landmine this is. Do you agree?

Share on Facebook #2 Hypnotism and the Distortions of Memory
Based on the above information from the Comprehensive Textbook of Psychiatry, "there appears to be a high likelihood that the beliefs of the therapist will somehow be communicated to the patient in hypnosis." What do you think? You may be thinking "I don't use hypnotism in my sessions", but what about deep relaxation or guided visualizations? Could you be implanting false memories or confabulations in your client's mind and raising the ethical issue of client self-determination?

According to psychologist Robert Baker, "confabulation or false memories shows up without fail in nearly every context in which hypnosis is employed." Granted this is a pretty all-encompassing statement. Where do you stand on Baker's idea that, "confabulation or false memories shows up without fail in nearly every context in which hypnosis is employed?"

However, other researchers observe that, "It is difficult to disregard totally the wealth of anecdotal reports praising the virtues of hypnotic memory enhancement". It may be possible to utilize hypnosis in enhancing real memories, but the risk of also enhancing fantasies is always present and is an ethical question.

Share on Facebook #3 A Client Requests Hypnotism
So should a therapist completely deny a client's request to be hypnotized because of its ethical risks? To consider this, one might take into account the client's right to self-determination, as mentioned earlier, and consider carefully this dilemma. Standard 1.02 in the NASW Code of Ethics maintains that "Social Workers respect and promote the rights of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' rights to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others." In short, self-determination is an essential feeling of control and one that the therapist does not violate unless there are other ethical risks involved such as a risk of self-harm.

Here in lies the rub…during memory-recovery hypnosis, the therapist takes an active role in trying to find the memory he or she believes exists somewhere in the client's subconscious. By purposefully attempting to pull out memories that might not even be there, the therapist severely compromises established ethics of over-influential treatment.

Share on Facebook Cycle of Confabulation
How does the cycle begin? How does a therapist through hypnosis implant false memories? How is it that the client came to the hypnotist in the first place? The following is an excerpt from an interview with a therapist regarding the therapist's opinion of a typical progression of events for sexual abuse discovery. As I am reading this to you, see if you agree with me, that the missing step is exploring other alternatives besides sexual abuse:

--Q. There seems to be a lot of stories of women having been sexually abused as children. They have repressed the memories and now it's coming out.
--A. I work so much with that.
--Q. How does it start?
--A. The progression is that often there is some kind of an addictive behavior. The client has forgotten all the sexual abuse and all they know is that they can't stop eating and throwing up or they are addicted to alcohol. Let's take the bulimics. Bulimia, somehow, is clearly linked to sexual abuse.

A young girl finds that she's eating and throwing up, so the first step is to go to OA, Overeaters Anonymous. So she goes to OA and she gets abstinent which is the word they use for eating what you are supposed to eat.

And then she starts hearing about therapy and how some of the people are in therapy and they are doing inner child work. Then she comes to a therapist like me and at this point the sexual abuse is all blocked out but little by little we get to the abuse. But they don't come in knowing about the abuse.

Do you agree with this therapist that, "Bulimia, somehow, is clearly linked to sexual abuse." I don't. But that's just the opinion of one person.

On this track... we discussed four ethically questionable possible results of hypnosis. 1. clients create memories; 2. distort existing memories; 3. incorporate cues from leading therapist questions; and 4. incorporate therapist beliefs. We also examined the path the client might take to resolve their supposed sexual abuse.

On the next track, we will discuss facilitated communication and its possible ethical misuse related to the trauma of sexual abuse.

QUESTION 2
According to the Comprehensive Textbook of Psychiatry what are four possible results of hypnosis which may raise ethical questions regarding confabulation of sexual abuse? To select and enter your answer go to Answer Booklet.

 
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