Robert Todd Carroll
repressed memory therapy (a.k.a. trauma-search therapy)
Repressed memory therapy (RMT) is a type of psychotherapy which assumes that problems such as bulimia, depression, sexual inhibition, insomnia, excessive anxiety, etc., are due to unconsciously repressed memories of childhood sexual abuse. RMT assumes that a healthy psychological state can only be restored by recovering and facing these memories.
RMT uses a variety of methods--including hypnosis, visualization, group therapy, and trance writing--to assist the patient in 'remembering' the traumatic event. The methods are very successful in getting patients to "remember" many things of which they were unaware before therapy. The "memories" include not just memories of being sexually abused as children, but of some very bizarre things such as being abducted by aliens for sexual experimentation or breeding, being forced to participate in satanic rituals, and being traumatized in a past life. Despite the success of RMT at recovering such horrible "memories" that had apparently been completely forgotten--or perhaps because of it--skeptical critics have charged that the therapists are creating the horrible memories through suggestion and active encouragement. Some RMT advocates and sexual abuse victims have countercharged that the critics are child abusers and demons. Rather than leading to vigorous challenges met by setting up rigorous studies of memory, repressed memory, false memory, therapies, etc., the controversy has led to a war zone of polemical literature.
What do the scientists and professional organizations say?
There is little scientific evidence supporting the notions that (a) childhood sexual abuse always causes psychological problems in adults; or that (b) memories of childhood sexual abuse are unconsciously repressed; or that (c) recovering repressed memories of abuse leads to significant improvement in one's psychological health and stability. The Royal College of Psychiatrists in Britain has officially banned its members from using therapies designed to recover repressed memories of child abuse. The British Psychological Society, on the other hand, does not ban its members from such therapy, but in a 1995 report urged them to "avoid drawing premature conclusions about memories recovered during therapy." The report noted that a patient's recovered memory may be metaphorical or emanate from dreams or fantasies. The report also denied that there is any evidence suggesting that therapists are widely creating false memories of abuse in their patients.
In the U.S.A., The American Psychological Association's Working Group on the Investigation of Memories of Childhood Abuse also issued a report in 1995. The report notes that recovered memory is rare. It also states 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....At this point," according to the APA, "it is impossible, without other corroborative evidence, to distinguish a true memory from a false one." Thus, says the APA report, a "competent psychotherapist is likely to acknowledge that current knowledge does not allow the definite conclusion that a memory is real or false without other corroborating evidence."Yet, many RMT therapists consider it unnecessary to attempt to find corroborative evidence for the abuse their patients remember while in therapy.
What do the RMT advocates say?
Many of the more prominent RMT advocates use a check list approach to diagnose repressed memories of childhood sexual abuse as the cause of a patient's problems, despite the fact that "there is no single set of symptoms which automatically indicates that a person was a victim of childhood abuse" (APA report). Yet, works on child abuse promoting such a notion have been very popular among therapists and talk show hosts featuring Ellen Bass, Laura Davis, Wendy Maltz, Beverly Holman, Beverly Engel, Mary Jane Williams and E. Sue Blume. Through communal reinforcement many empirically unsupported notions, including the claim that about half of all women have been sexually abused, get treated as a 'fact' by many people. Dr. Carol Tavris writes
One significant difference between this group of experts and, say, a group of physicists is that the child abuse experts have achieved their status as authorities not by scientific training but by either (a) experience [they were victims of child abuse or they treat victims of child abuse in their capacity as social workers], or (b) they wrote a book on child abuse. The child abuse experts aren't trained in scientific research, which, notes Tavris, "is not a comment on their ability to write or to do therapy, but which does seem to be one reason for their scientific illiteracy."
Here are a few of the unproved, unscientifically researched notions that are being bandied about by these child abuse experts: (1) If you doubt that you were abused as a child or think that it might be your imagination, this is a sign of "post-incest syndrome" [Blume]. (2) If you can't remember any specific instances of being abused, but still have a feeling that something abusive happened to you, "it probably did" [Bass and Davis]. (3) When a person can't remember his or her childhood or has very fuzzy memories "incest must always be considered a possibility" [Maltz and Holman]. And, (4) "If you have any suspicion at all, if you have any memory, no matter how vague, it probably really happened. It is far more likely that you are blocking the memories, denying it happened" [Engel].
Just what kind of techniques do therapists use in RMT? Before discussing these techniques, it should be noted that very few recovered memories of childhood sexual abuse first occur spontaneously. When they do, they are almost always more likely to be corroborated by evidence than those evoked in RMT therapy. In fact, in some cases, corroborative evidence serves as the retrieval cue for the repressed memory. RMT, however, seems to be able to produce recovered memories of sexual abuse in most of its clients. To those practicing RMT, this is proof of its power and effectiveness. To skeptical critics this is warning sign: are the memories confabulations which are the result of prodding, suggestive therapy?
Two techniques frequently used in RMT are hypnosis and trance writing. Both of these techniques are risky for fishing for repressed memories. Hypnosis is risky because it is easy to lead and encourage the patient by suggestive or leading questions. Trance writing, on the other hand, has never been proven to have any therapeutic value (Schacter, 1996, 271).
Another technique is group therapy, which can be turned into a place for communal reinforcement of delusions if the therapist is not careful. People in the group can encourage others to share their bizarre tales without fear of ridicule. The group might not originate the repressed memory, but they might facilitate the birth and nourish the growth of horrendous fantasies.
The case of Diana Halbrook provides evidence of a therapist assisting in the creation of a false memory. In a trance writing session, she had written that her father had molested her. This was shocking news to her! She went into group therapy and heard bizarre tales of satanic ritual sacrifices. Soon the same kinds of bizarre events appeared in her trance writings, including the recovered memory that she'd killed a baby.
Halbrook got out of the therapy, characterized by Schacter as "toxic," and no longer believes the outlandish memories. Schacter comments that "the most reasonable interpretation is that the events [recovered in therapy] do not have any basis in reality."
Another technique used in RMT is guided imagery or visualization. Sherri Hines describes how her therapist used this method to help her retrieve a memory of being abused by her father:
Hines came to believe she was molested by her father and became so depressed she attempted suicide. She is now out of therapy and believes the memories were false and created in therapy.
Are RMT therapists creating false memories of abuse?
"The Memory Wars" is the apt title of Daniel Schacter's chapter on repressed memory in his 1996 book Searching for Memory. To enter the controversy over repressed memory and the psychotherapies used to "recover" memories of childhood sexual abuse is to enter a war zone. On the one side--The Recovered Memory side--are those who maintain that patients with certain kinds of physical and mental disorders have repressed memories of childhood sexual abuse which must be recovered during therapy. The other side--The False Memory side--maintain that the memories recovered in therapy are not recollections of actual childhood sexual abuse but are constructed memories built out of materials suggested to the patient or implanted by the therapist during therapy.
On the recovered memory side are Lenore Terr, Laura Brown, Kenneth Pope, Laura Davis and Ellen Bass among others. On the False Memory side are Elizabeth Loftus, Carol Tavris, Richard Ofshe and the False Memory Syndrome Foundation, among others. Opponents in this war are not seen as colleagues in quest of the same truth, but as demons, villains or frauds. Schacter seems to tiptoe on glass as he presents what is known, not known, guessed at, etc., in this area. His conclusions seem pretty weak, if not contradictory, given the evidence he presents (272).
On the other hand, Schacter presents strong evidence from controlled research that memories can be created, and he makes a strong argument that repression, the conceptual basis for RMT, has little scientific support. This concept has widespread acceptance in the psychological and psychiatric communities--as does the related theory of dissociation--but scientific studies demonstrating such mechanisms are lacking. Those in the RMT movement begin with the assumption that the demonstration of any of a number of symptoms is evidence of childhood sexual abuse. Many of the symptoms would not necessarily indicate any deep psychological problems, much less a traumatic source. Many could be symptomatic of a number of disorders having no basis in sexual trauma. Therapists who assume their patients have been sexually molested, and assume that any memories they have, no matter how fantastic or delusional, are either accurate memories of abuse or symbolic of abuse, do not need to plant memories in their patients to find that they've been abused. The therapists have determined a priori that whatever mental artifacts they uncover will lead the way to childhood sexual abuse as the cause of their patient's problems.
Despite the strong circumstantial case that has been built to support the claim that techniques such as hypnosis, trance writing, guided imagery and group therapy are creating horrible memories in patients, Schacter maintains that "there is no hard evidence that these techniques are specifically responsible for the creation of pseudomemories in therapy" (Schacter, 1996, 272). His claim depends on what is meant by "hard evidence" and "pseudomemory." If he means that controlled studies have not been done which support this hypothesis, then he's right. Such studies will never be done because it would be unconscionable to intentionally abuse children. But if he means that there has not been a single case where the evidence and logic would indicate to a reasonable person, using standards no higher than that required of a juror in a criminal trial, that a therapist has been a significant causal factor in the production of a false memory, then he is mistaken. Schacter himself, in the case of Diana Halbrook described above, provides evidence of a therapist assisting in the creation of a false memory.
Studies by Marcia Johnson et. al. have shown that the ability to distinguish memory from imagination depends on the recall of source information (Schacter, 1996, 116). Thus recovered memories of abuse might be very vivid and accurate in many details, but incorrect about the source of the memory. For example, in the case of Diana Halbrook it is very probable that the source of her satanic ritual memories is to be found in her group therapy.
Psychologist Joseph de Rivera claims that in RMT "rather than help the patient separate truth from fantasy, the therapist encourages the patient to 'remember' more about the alleged trauma. And when the patient has an image--a dream or a feeling that something may have happened--the therapist is encouraged, praises the patient's efforts and assures him or her that it really did happen." This kind of therapy, he says, "confuses the differences between real and fantasized abuse and encourages destruction of families" (de Rivera, 1993).
The False Memory Syndrome Foundation claims to have hundreds of such cases on file. Several cases have gone to court and therapists have been found liable for the harm caused by planting false memories. Despite the claims of hundreds of successful expeditions to recover lost memories by RMT therapists, some judges will not accept memories recovered in therapy as evidence. Judge William J. Groff of New Jersey wrote in case he heard in 1995 that
It is true that another New Jersey judge, Linda Dalianas, did allow such testimony in a later case but she also stated that
In California, where a recovered memory not only was allowed but served as the basis for a murder conviction, the case was eventually overturned because of failure to reveal to the jury that the source of nearly every detail remembered about the murder could have been readily accessible newspaper accounts. It was also revealed that the person who claimed she had had a spontaneous flashback of the crime, lied about that, as well as about having recovered some, if not all, of her memories during hypnotherapy.
In short, RMT has not proved its case. On the other hand, the evidence is overwhelming that RMT therapists have been significant causal factors in the creation of false memories of abuse in people who have come to them for help.
memories of abuse as symbolic
One thing the RMT group has accomplished in these Memory Wars is to divert attention from the questionable mechanism of repression and their predetermined, unscientific methods of interpreting symbolic meanings of recollections, to the issue of whether or not the RMT therapists are planting memories in their patients. This was not intentional, but the result of a number of lawsuits against RMT therapists by former patients, all of whom recanted the memories of childhood abuse uncovered in therapy and blamed their therapists for ruining their lives by planting false memories of abuse in their minds. But the issue over whether or not a particular memory has or has not been planted by a particular therapist is mainly of importance because the alleged memories are of horrible things and they are very disruptive and destructive of peoples' lives. If therapists were planting all kinds of good memories in patients' minds helping them enjoy more satisfying lives and relationships, it is doubtful that there would be such an uproar.
Some of the memories recovered in RMT are extraordinarily bizarre, so bizarre that one would think that a reasonable person could hardly take them at face value. Memories of past lives, of being abducted into alien spaceships for sexual experiments, and of grotesque satanic rituals have been "recovered" time and time again in RMT. But RMT therapists are not put off by such "recollections." They either take them at face value (as John Mack does of his alien abduction patients and others do when interrogating children). Or they take them as "artifacts" of the mind, which therapists must analyze as if they were archaeologists who must infer the real truth from the artifacts. Or they take fantastic memories as symbolic of real experiences.
Laura Brown, for example, a Seattle psychologist in the forefront of RMT says that fantastic memories are "perhaps coded or symbolic versions of what really happened." What really happened, she's sure, was sexual abuse in childhood. "Who knows what pedophiles have done that gets reported out later as satanic rituals and cannibalistic orgies?" asks Dr. Brown (Hallinan, 1997).
In the past, Brown has criticized the False Memory Syndrome Foundation for being unscientific, but her emphasis on the symbolic nature of fantastic memories has little scientific credibility itself. Where is the scientific evidence that a fantastic memory can be distinguished from a delusion? How do we distinguish memories of real cannibalism from symbolic memories? We usually know what a crucifix or a swastika symbolizes, but what does eating an infant symbolize? Symbols might be ambiguous. How can we be sure that a memory is a symbol of child abuse and not of adult abuse by co-workers, or by other children who tormented the patient years ago, or by the therapist him- or herself? How can we be sure it is not a symbol of self-abuse? How can we be sure it's a symbol of any kind of abuse at all? What would distinguish a symbol of abuse from a symbol of fear of abuse? For that matter, what would distinguish a symbolic representation of fear of being abused from one representing fear of abusing someone else in the present, or a regret of having abused someone else in the past? The dangers and imminent probabilities of misinterpretation of symbolic memories should be obvious, especially when it is not always that clear that a memory really is a symbolic expression at all.
Are we to accept without question the notion that any memory, true or false, reflects some truth, objective or subjective, which only the trained therapist can determine? That seems to be the view of some RMT advocates. If so, we're being asked to accept mysticism instead of science. How could one possibly disprove the claim that a memory which is incredible on its face is a symbolic message? Can anyone imagine any empirical test for this notion? If the issue were simply whether or not a memory is accurate, there would be some hope of establishing in some cases that the probability is that the memory is true or that it is false. But if the issue is whether or not a memory has a meaning, that point will probably soon be granted, since we don't like to think of ourselves as doing anything without there being some reason for it.
How do we determine the real reason for a confabulation? Don't therapists and those of us who interpret memories or dreams become storytellers ourselves? As storytellers, isn't it reasonable to assume that our stories may not be literally true, but are symbolic and must be interpreted by another storyteller, ad infinitum? Perhaps "repression" is not to be taken literally, but symbolically. Perhaps each therapist must develop a subjective truth for concepts such as "repression" and "therapy." But if this is so, then therapy is a dangerous weapon to be feared by everybody rather than a blessing to be sought by those with psychological problems. History is replete with examples of what happens when any group of authorities do not have to answer to empirical evidence but are free to define truth as they see fit. None of the examples has a happy ending. Why should it be otherwise with therapy?
a false dilemma
It would be a grave mistake to think that the issue is simply to determine whether or not an alleged recovered memory is either an accurate memory of abuse suffered as a child or a false memory planted by a therapist. The memory could be either, but it could also be a confabulation. Whether taken symbolically or literally, the source of the memory could be mistaken. The source could be something one picked up in conversation, while reading or watching television, in a classroom or a movie theater. The source could even be a sermon. A patient may recover a memory in therapy of her minister sexually abusing her. She may have been sexually abused by someone, but it may not have been the minister. She may have heard him sermonize on the evils of abuse about the same time she was abused and her memory may be accurate in detail but inaccurate about the source of her abuse. On the other hand, she may not have been abused at all. Her memory may express a fear of being abused and the source may be a story she heard on a talk show. For all we know for certain about such cases, her memory might reflect a wish, rather than a fear. She may not wish to be abused, but she may have a powerful wish to be on the Oprah Winfrey show. She may simply have a powerful wish to be attended to and such a memory would certainly get her a lot of attention. She may have an unconscious wish to harm her accuser and in the current social milieu nothing might seem more harmful than to have abused a child. How a therapist, without corroboration, could be certain that a recovered memory is accurate or symbolic, and if symbolic, that he or she knows for certain what the memory represents, is not a matter of science but of mysticism. It is not harmless mysticism, either; for families are destroyed by these accusations.
Baker, Robert A. Hidden Memories: Voices and Visions From Within (Buffalo, N.Y. : Prometheus Books, 1992.) $14.36
de Rivera, Joseph. "'Trauma searches' plant the seed of imagined misery," The Sacramento Bee, May 18, 1993.
Hallinan, Joseph T. "Money for repressed memories repressed," Sacramento Bee, Jan. 12, 1997, Forum.
Johnson, M.K. et. al. "Source Monitoring," Psychological Bulletin, 114, 3-28.
Loftus, Elizabeth. The Myth of Repressed Memory (New York: St. Martin's, 1994). $11.16
Ofshe, Richard and Ethan Watters. Making Monsters: False Memories, Psychotherapy, and Sexual Hysteria (New York: Scribner's, 1994). $11.96
Schacter, Daniel L., editor, Memory Distortion: How Minds, Brains, and Societies Reconstruct the Past (harvard University Press, 1997). $17.95
Schacter, Daniel L. Searching for Memory - the brain, the mind, and the past (New York: Basic Books, 1996). $11.20
Tavris, Carol. "Hysteria and the incest-survivor machine," Sacramento Bee, Forum section, January 17, 1993.
Wakefield, Hollida and Ralph Underwager. Return of the Furies - An Investigation into Recovered Memory Therapy (Peru, Illinois: Open Court Publishing Co., 1994). $19.95
Robert Todd Carroll