Ethical Boundary Considerations and Repressed Memories of Sexual Abuse

In the last section, we examined the various sides of the controversy regarding repressed memories.

In this section, we will discuss cognitive dissonance created in the therapist when predisposed ideas are challenged and eight key characteristics that red-flag your co-dependent clients to be predisposed to therapist implantation of ideas of sexual abuse.

♦ The Introduction of Cognitive Dissonance
When a person's core belief has been challenged, as you know, a great internal conflict in the mind of the client occurs, known as cognitive dissonance. How does cognitive dissonance relate to repressed memories of sexual abuse? When two different opinions are presented, the client must choose one. In the case of repressed memory, authority figures, such as the child's parents or therapists, play a major role.

If one opinion advocate, as Festinger states, is "seen as an expert or very knowledgeable about such matters, the dissonance between knowledge of his contrary opinion and one's own opinions will be greater." I am sure you probably have observed this in your therapy sessions with your client. Festinger adds, "The person will actively avoid situations and information which would likely increase the dissonance."

In therapy, this may result in the client cutting him or herself off from friends and family that express any doubts. By maintaining a very close-minded approach, the client isolates themselves in a reality that might be false and unhealthy for their growth.

♦ Therapist Predisposition
Let's switch the focus for a moment, away from pseudo-memories or predisposition of our clients, to therapist predisposition. How susceptible are therapists to pseudo-memories? For example, how quick are therapists to assign diseases for which there is little evidence? Let's look at an experiment by a Stanford psychology and law professor D. L. Rosenhan. Rosenhan sent eight subjects to be admitted to 12 in-patient psychiatric wards around the United States where, during admission, they complained of hearing voices that said words such as "empty," "hollow," and "thud."

In reality, the subjects were students and other ordinary healthy volunteers from the community. As soon as they were admitted, they totally ceased simulating any symptoms of schizophrenia whatsoever. However, Rosenhan noted, "The pseudo-patient spoke to patients and staff as he might ordinarily speak. However, because there is commonly little to do on a psychiatric ward, he attempted to engage others in conversation. When asked by staff how he was feeling, he indicated that he was fine."

By the end of the experiment, none of the healthy people were detected by psychiatrists. Eventually, each was released with a diagnosis of "schizophrenia in remission." Some were kept in the hospital anywhere from a week to almost two months.

The student and volunteer subjects wrote down their observations of the therapists and patients. Amazingly, in each case it was only the other patients in the hospital that detected the pseudo-patients and not the staff. The other patients would make statements like, "You're not crazy. You're a journalist or a professor. You're checking up on the hospital."

The real patients, just by normal, everyday observation, could see without any pre-accepted theory that the subjects were perfectly healthy. However, those psychiatrists, even though they kept close observation of subject's behavior, could not see that they were devoid of mental defect.

Regarding sexually abused clients, once the therapist is predisposed to the idea of sexual abuse, perhaps by a wife seeking custody, the therapist may tend to pursue the line of thought regarding sexual abuse, just as the therapists on the in-patient unit were predisposed to see the healthy subject as being schizophrenic because of their admission criteria.

♦ Ethical Minute of Contemplation
Take a few minutes. In short, take a long ethical minute of contemplation and consider what factors cause you to be predisposed or have a tendency to develop certain attitudes, feelings, and perhaps diagnoses under the right circumstances.
-- Can you recall a patient's or client's name where you received information from other family, school records, or parents that predisposed you to be looking for sexual abuse?
-- Could you have asked leading, probing questions in that interview that possibly could have implanted false memories in your client?
-- What was your diagnosis?
-- And what were the factors that contributed to that diagnosis?
-- Let's go back now to the point of cognitive dissonance. As you know, many clients are people-pleasers. Could you have created in your client a conflict between what you are expecting them to say in the session, and what really happened?
-- Ask yourself if your client may be unconsciously getting on the band wagon. Have they mentioned watching Oprah, Jerry Springer, or Dr. Phil?

Sophia, age 47, suggested to her therapist of three months that she believed she might have been abused as a young girl and had repressed the memories. When asked how she had come by this realization, she stated, "Well, I saw this episode of Oprah where all these women had repressed the memory of their childhood abuse. They described the symptoms they'd had before their discovery, and, oh my god, it was exactly what I was going through!"

Her therapist was skeptical, because the symptoms Sophia described were not the ones she had been exhibiting months before. Before treating Sophia, her therapist had compiled an 8 point checklist of examples of a client that is over-eager to find a cure for their behaviors and therefore jump at any influence, for example, alleged child abuse.

♦ 8 Point Checklist
As you read this checklist, you will find many of your clients have exhibited these behaviors. However, if the overall context is a custody suit, or jail-time for the abuser, you might use this checklist as merely food for thought. A client who may be predisposed to therapist implantation of false memories might exhibit the following codependent type characteristics:

-- 1. Try to please others instead of themselves,
-- 2. Abandon their routine to respond to or do something for somebody else,
-- 3. Believe deep inside other people are somehow responsible for them,
-- 4. Feel angry, victimized, unappreciated, or used,
-- 5. Finding themselves saying yes when meaning no,
-- 6. Believe other people are making them crazy
-- 7. Believe they don't deserve good things and happiness
-- 8. Wish other people, including their therapist, would like and love them

Such descriptions fit Sophia, and her therapist soon realized that any kind of diagnostic implication from him would unduly influence Sophia into trying to fit into her symptoms to the disorder. As a result, the therapist focused the sessions on Sophia with little input from himself.

After several sessions of gently refusing to answer leading questions, Sophia began to open up more about her life rather than focus on treating herself. The ethical thin grey line is not very clear here. Ask yourself, at what point are you leading the client into false memories of sexual abuse? On the other hand, at what point are you ignoring and invalidating their needs?

In this section, we discussed predisposing the therapist and a codependent checklist.

In the next section, we will examine the influence of New Age Mentality on repressed memories of possible sexual abuse as it relates to intuition, imagination, and hearsay.
Reviewed 2023

Peer-Reviewed Journal Article References:
Levy, N., Harmon-Jones, C., & Harmon-Jones, E. (2018). Dissonance and discomfort: Does a simple cognitive inconsistency evoke a negative affective state? Motivation Science, 4(2), 95–108. 

Murphy, J., Shevlin, M., Houston, J., & Adamson, G. (2012). Sexual abuse, paranoia, and psychosis: A population-based mediation analysis. Traumatology, 18(1), 37–44.

Nahleen, S., Nixon, R. D. V., & Takarangi, M. K. T. (2019). Memory consistency for sexual assault events. Psychology of Consciousness: Theory, Research, and Practice. Advance online publication. 

Smith, R. D., Holmberg, J., & Cornish, J. E. (2019). Psychotherapy in the #MeToo era: Ethical issues. Psychotherapy, 56(4), 483–490.

Voisin, D., & Fointiat, V. (2013). Reduction in cognitive dissonance according to normative standards in the induced compliance paradigm. Social Psychology, 44(3), 191–195.

Ethics CEU QUESTION 4
Does your client, who states he or she has been sexually abused, exhibit a predisposition towards, perhaps, codependence? To select and enter your answer go to Ethics CEU Test.