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CHALLENGE TO PSYCHOTHERAPY:

An Open Letter to Psychotherapists Concerning Clinical Practice
As Seen through the Lens of the "Recovered" or "False Memory" Debate.

Spencer Harris Morfit
Westford, MA

Address correspondence to the author at 24 Monadnock Drive, Westford, MA 01886; or send email to smorfit@shore.net
From the Journal of Sex Education and Therapy, Vol. 20, No.4. 1994, pp. 234-245
© 1994 American Association of Sex Educators, Counselors & Therapists

Reproduced with the permission of the author.

I am a journalist who has followed the debate over so-called "recovered" or "false" memories for approximately five years. Though I am not a psychotherapist, I have read extensively in the field for 35 years, had hours of candid conversations with practicing professionals and experienced therapy first-hand as a consumer. More importantly, I am a critical thinker who has a passionate concern for the ethical responsibilities of any professional who advises others on the conduct of their lives - especially if those others (as is usually the case) arrive in the consulting room in a vulnerable state . . . especially if the treatment holds out the notion that "cure" is dependent upon the placement of an unearned trust in the expertise of the therapist. The responses of professionals to the "recovered" or "false" memory phenomenon are often defensive in character and do not join the issues raised by thoughtful observers - at least not fully and completely. The net result is to underestimate the threat this phenomenon poses to the credibility of clinical psychotherapy. To understand why, let’s take a critical look at the most common arguments lodged against those who even dare to raise the issue of false memory.


No. 1: That those who give credence to the issue of false memory are perpetrators or part of a backlash against psychotherapy or feminism and that those who believe in the existence of a false memory syndrome trivialize real sexual abuse, i.e. are "in denial"

This is a political argument since it does not join the issues and seeks only to disqualify all opponents from the get-go, not to mention that it pathologizes people the speaker usually doesn’t know. It is an evasion of the main issue, which is "Are the memories true?" Such arguments do not acknowledge that there have been cases in which the innocence of the accused has been conclusively established. Perhaps the most dramatic of these is the Wade Case (1) in San Diego, which led the Grand Jury to order a massive reevaluation of San Diego County’s procedures for handling abuse charges. In other cases alternative explanations (usually having to do with contamination by directive and suggestive "therapists" or "evaluators") have been more demonstrably plausible than the original claims. The McMartin case, which was the longest and most expensive in California history but resulted in no convictions, and the recently withdrawn case of Steven Cook against Cardinal Bernadin are cases in point.

In addition, hundreds of attempts to substantiate specific criminal claims of alleged "ritual sexual abuse" by purportedly large, centuries-old, wellorganized, multigenerational Satanic cults have turned up no corroborating evidence despite the insistent conviction of therapists and their clients. Law enforcement officials (2), research psychologists (3) and psychotherapists (4) have provided alternative hypotheses. A recent three-year study of Satanic abuse allegations conducted in Britain by the Department of Health came to the same conclusions. (5)

The crux of the controversy is whether the claims are true or not. Unfortunately, most therapists who are treating alleged survivors make no effort to corroborate their clients’ claims of abuse and therefore have no basis for determining the truth of those claims, much less the means to test their own hypotheses.

These clinicians often believe that the existence of certain symptoms is "evidence" of abuse, or they argue that the consistency of the client’s story is "evidence" of its veracity. However there is no evidence at present that sexual abuse necessarily causes a definable set of symptoms or any specific symptom, nor is there evidence to suggest that such symptoms are related exclusively to a history of sexual abuse.

With regard to consistency, most accounts of "repressed" sexual abuse follow a pattern of being vague and incredible to the client at first, but become increasingly more detailed and consistent with each telling, especially when reinforced by an attentive and probing therapist. At what point in the development of the sex abuse scenario is "consistency" determined? Moreover, as forensic experience with lie detector tests has shown, consistency is not a measure of truth, it is only a measure of conviction.

In a similar vein, I have heard therapists say, "Feelings are facts." Feelings are information, but they are not facts. Anyone who routinely confuses the two would probably be diagnosed as a psychotic.

The argument that the only people who give the "false memory" phenomenon any weight are ignorant about therapy is simply not true. There are highly-credentialed professionals who understand how therapy works, acknowledge that real abuse occurs, and who treat abuse survivors but who nevertheless agree there are enough cases of false accusations to warrant some serious attention.

We should also pay attention to the fact that false memory cases often follow a pattern that is characteristic of hysteria. Specifically, such cases are not always randomly distributed throughout the population. The majority seem to come with suspicious regularity from the offices of certain therapists, certain mental health care facilities, and from certain religious groups.

The alliance between some therapy and a radical, "politically correct," feminism is a strong one and an interesting one - so much so that some have claimed that "Feminism has an agenda and therapy is the means to carry it out." For instance, Judith Herman, M.D., a psychiatrist who has made a name working with alleged abuse victims, gave the prestigious Guttmacher Address at the Spring, 1994, annual convention of the American Psychiatric Association in Philadelphia. She used the occasion to say that those who question the memories of alleged survivors are the equivalent to people who deny the Holocaust and she ended her presentation by projecting a slide of demonstrators holding placards that said, "Women Unite!"6 Herman has repeatedly rejected invitations by the False Memory Syndrome Foundation [FMSF] to interview its accused members. We need more rigor, not more politics here, which is why this relationship between therapy and feminism is increasingly being explored in critiques of feminism... and therapy.

False memory accusations are significant for the injustices they represent and for what they reveal about clinical practice, not for their numbers. According to one recent survey, there were between 700,000 and 750,000 reported cases of child abuse of all kinds in the U.S. in 1993. By contrast, the FMSF is the major organization dedicated to the support of those who consider themselves falsely accused. Since its founding two years ago, the FMSF claims approximately 13,000 members. Though this is a significant number, it is small compared to the number of cases that are probably based on external corroboration. In other words, there appears to be a majority of abuse cases in which the false memory defense is not even applicable. Contrary to reports, the FMSF fully acknowledges this. The problem is that regardless of the number of cases in which the false memory defense is applicable, each of these is a potential case of malpractice (since the therapists do not distinguish between a client who is delusional or hysterical - or even malicious (7) - and one who is a legitimate victim) and a possibly serious breach of justice for the falsely accused. In addition, each case exposes clinical practice to careful public scrutiny. All of these points have been at issue in the landmark Ramona trial in Napa, California, which recently set a precedent for third parties to sue therapists for damages suffered as a result of questionable or even discredited treatments.


No. 2: That the false memory concept should not be allowed as a defense because it can be used to protect abusers

The trouble with this argument is that it operates from several faulty assumptions:

The beauty and danger of logic is that it is a two-edged sword. Accept the premise that "The false memory defense should never be used because it might protect an abuser," and, by the same reasoning one could as well say, "No one should ever go into therapy because it does harm in some cases."

It has long been recognized that you "cannot prove a negative." That is, if something does not exist or never happened, it leaves no traces, no evidence that it does not exist. The best defense one can mount in such a case is to provide alternative hypotheses. This is why the burden of proof has to lie upon the shoulders of the accuser. Although the false memory concept may conceivably and regrettably protect an abuser, the conviction of an innocent person is equally horrendous. We cannot ignore the right of the accused to a higher standard of proof than an uncorroborated memory backed only by the "expert opinion" of a therapist who may be using questionable or even discredited methods.


No. 3: That the false memory phenomenon is an aberration and the result of work by poorly trained therapists

This contention seems to be an attempt to marginalize concern over false memories. Although the false memory phenomenon may not be the rule, it is an extreme but logical extension of broadly accepted therapeutic concepts (such as the "unconscious" and "repression") and techniques (such as hypnosis and visualization.)

Also, although, as said earlier, false accusations come from certain professionals and facilities in suspect concentration and many of the therapists have questionable credentials, some of these therapists have advanced degrees from prestigious universities and are affiliated with big-name hospitals. These professionals provide leadership on the believe-the-victim side of the argument. For example, it is a Harvard-affiliated psychiatrist, Dr. John Mack, who is presently touting a belief in abductions and sex abuse by aliens from outer space. What is so telling about cases like this is that while Dr. Mack’s claims are an embarrassment to many of his colleagues, the profession has difficulty regulating such occurrences because it cannot do so without also calling into question basic tenets of clinical psychology - questions to which good answers are not readily available.


No. 4: That memories retrieved under clinical conditions are necessarily reliable

This is the most fully covered aspect of the false memory debate and I will not belabor the point, which has most authoritatively and articulately been argued by such researchers as Elizabeth Loftus (3) and Richard Ofshe, among others. Suffice to say that researchers who specialize in memory have found no evidence to support the idea that memories are retrieved intact through therapy. Instead, they have uncovered much to suggest that such memories can be contaminated (especially over time and through suggestion, including extra-therapeutic contamination by talk shows and the media), and have even experimentally implanted false memories in subjects using techniques common to therapy. Further research into such matters continues apace.


No.5: That repressed memories of abuse cause specific psychological symptoms and that retrieval of memories is necessary to effect a "cure"

Different people can suffer the same trauma or abuse. Some will emerge with symptoms and others won’t, as has long been known. Some studies conclude that more people emerge without symptoms than do, though there are some indications that prolonged abuse may cause symptoms more predictably. According to research, however, victims of repeated or prolonged abuse rarely forget the abuse, though they may not recall a specific incident. The truth is that:

Questions about how all this works have caused some professionals to revise their theories about memories. Thus, for instance, we have the concept of "the model scene" a.k.a. "the organizing therapeutic metaphor" [please notice the choice of the word "metaphor."] According to some psychodynamic theory, the model scene is an event which may or may not have happened as reported by the client, and which may or may not have been traumatic in and of itself. It nevertheless represents a characteristic pattern of interaction which then becomes the focus of the therapeutic work, thus the "organizing therapeutic metaphor," i.e. something that is far more important for its symbolism than for its truth.

Of course, this theory begs a number of questions:

Professionals are not in agreement on any of this.

Work that focuses on the retrieval of memories may even be harmful and not just for the falsely accused. Dr. George K. Ganaway, who is affiliated with Emory University and Director of the Ridgeview Center for Dissociative Disorders in Smyrna, Georgia, is a classically trained psychiatrist, who has encountered the false memory phenomenon through his work with dissociative disorders. In a recent paper titled "Dissociative Disorders and Psychodynamic Theory: Trauma Versus Conflict and Deficit," (8) Ganaway talks about clients who arrive at his clinic with diagnoses of posttraumatic stress disorder and multiple personality disorder, two diagnoses often associated with sexual abuse. Ganaway states,

From the standpoint of helping to improve the mental status and level of function of these patients, continuing to focus on meeting and mapping layers of alleged personalities and encouraging the continued uncovering of ever-expanding alleged traumas at this point proves to be about as useful as rearranging the deck chairs on the Titanic. Instead, the emphasis necessarily is placed on supportive "grounding" techniques, as we call them, including reality orientation, clarification of appropriate boundaries, firm structure, and strict limits on acting-out behaviors.

As for the idea that insight (through removal of repression) is curative, there is no evidence to support this traditional belief and most professionals no longer totally believe this. More traditional therapies do no better - and often do worse - in the outcome studies than other methods that do not concern themselves with memory directly. All this raises a number of uncomfortable questions that the profession has not addressed adequately, much less answered:


No. 6: That the client must be believed for healing to occur

Some therapists now successfully treat clients without necessarily believing them. Many, including Ganaway, take a neutral stance toward memories. And as the false memory phenomenon has shown, there are many who have been "curing" a client of some symptoms while allowing or even encouraging them to hold questionable or sometimes demonstrably false beliefs. It is reasonable to ask if the therapist is not engaging in a form of iatrogenic symptom substitution, for instance healthy functioning at the cost of delusional thinking (assuming that these two can be separated and maintained independently of one another.., a premise that needs examination.) Ideas have consequences and when ideas have consequences, the truth matters.


No.7: That cut-off from the family of origin is necessary or even good for the client and/or that suing a parent might be healing

This is an odd notion, since it makes the justice system an extension of therapy. Nevertheless, there are circumstances in which avoiding "toxic" people is prudent. But breaking apart and families and suing on the basis of suspect claims is a serious business. In any case...


No.8: That the "false memory syndrome" is not a "syndrome" since the people who named it are not qualified to use the term "syndrome"

This argument is political (a turf battle), irrelevant to the issues and does not excuse the speaker from joining them. Call it the "recovered memory phenomenon" if you like, or the "repressed memory debate" or any other term on which you can negotiate agreement, though the Journal of American Psychiatry (9), I notice, now refers to the "the false memory syndrome" without apology or quotation marks. No issue is off limits to inquiry by intelligent, informed people.

The rest of my points are less directly related to the false memory debate and deal, instead, with the lack of critical thinking that surrounds this issue and others in contemporary psychotherapy.


No. 9: That "the truth is always somewhere in the middle"

This is an idea therapists often state. It is one that makes truth a function of compromise and consensus, rather than of rigor and empiricism. This is a political argument, rather than an epistemological one. This is an idea that is faulty at its base, since it is, indeed, possible to get consensus on a false assumption, as anyone who understands such events as the Salem Witch Trials would acknowledge. In an address to the Spring 1994 Family Therapy Network Conference in Washington, D.C., Michael Yapko made the statement that "Black and white thinking is always a cognitive distortion," [Was this not black and white thinking?]. Black and white thinking may, indeed be a cognitive distortion. So might, "The truth is always in the middle." Sometimes one thing is demonstrably more true than another.

For the most part, the persistent and rigorous thinker will, by testing different ideas against each other over time, learn that one principle is more demonstrably true than another in a given situation. This is quite different from plotting a point in the middle of a range and declaring it correct by virtue of its location. This is a line of argument that assumes that no ideas are invalid or discardable, only more or less extreme. As a consequence, it is a premise that is very tolerant of errors.

It is on the basis of such applied rigor over time that most professions claiming any scientific validity justify their authority and continuously refine their practices. Where is the history of such testing in the story of psychotherapy? One would expect to see a history of winnowing and refining, that is, a narrowing of choices. Instead we see an ever-increasing proliferation of treatments, diagnoses and psychotherapeutic fads.

Moreover, it is just this kind of rigorous thinking that most helps people (clients or therapists) to grow towards wisdom and integrity. Yet it is just this kind of thinking that no few therapists could categorically call "resistance" if their clients used it to challenge the ideas the therapist is recommending to them.


No. 10: That all truth is relative, or difficult - if not impossible - to establish

One might ask, "Is that so? Is the truth that all truths are relative also a truth that is relative?" I will concede there is a smart-ass quality to this sentence construction, but think about it anyway.

Suppose you really take this position as a therapist? If you are really serious and consistent about this, if all "realities" are equally valid, then on what basis would you ever be able to confront a client with cognitive distortions, such as projection, etc? How would you help to strengthen a marriage if the two partners disagree and there is no way to argue compellingly that one way of seeing things or one solution (including an alternative offered by the therapist) is more functional than another? Or should "different relative realities" in and of themselves be immediate grounds for a divorce? In which case, why bother with therapy?

This is the real zinger: if as professionals, clinicians have neither regard nor concern for the truth or its closest approximation, on what do they base their claim to any expertise at all? On what basis does one attempt to objectively assess, correct (if necessary), or recalibrate the application of his or her professional skills? On what basis can a therapist claim any expertise that would be credible to any rigorous thinker.., or to a courtroom, for instance?

I am not alone in raising this issue. Right now, for instance, there is a move to re-examine the insanity plea. The argument is being made that the insanity defense is meaningless, since psychotherapists can always be hired to represent both sides of the question. "Expert" testimony in courtrooms is questionable in lots of cases.

I acknowledge that the task is a big one and a difficult one. Nor do I expect that the yield would be immediate. Still it is a worthwhile, if not to say necessary task. The degree of difficulty should not excuse the profession from making the attempt. It may be some time before we can expect empiricism, but it should not be too much to ask for rationality. Rationality, will, in fact, inform the quality of research.


No. 11: "But therapy helps people."

People can help other people. I have no quarrel with that premise. Since none of us is completely objective about either ourselves or our situations there has always been a need and role for the wise friend or sage counselor and some therapists may play this role admirably well. I am less convinced that such help necessarily requires all the therapeutic arcana and manipulation that abounds, and I am acutely uncomfortable with people who march under the banner of science and behave more like shamans. Before therapists can take credit for such "help," other questions must be answered. Questions like:

Most immediately important, therapy also has a real potential to harm. Perhaps the most striking contribution of the false memory debate is that it throws up a lavender light on the dark side of psychotherapy - and there is one, despite all good intentions on the part of professionals. It creates a climate within which the critics of psychotherapy will find a stronger voice and a larger audience. That is already happening.

These questions are not new. Nor are they restricted to the false memory phenomenon, though the false memory debate is bringing them into sharper focus than other current issues in psychotherapy. Follow the false memory debate, for instance, and it is not long before you find that a percentage of the clients who report florid memories of sexual abuse are diagnosed at one time or another as having multiple personality disorder (MDP), that MPD is itself a controversial diagnosis. Indeed, the entire Diagnostic and Statistical Manual of the American Psychiatric Association, the Bible of psychotherapeutic diagnosis, is controversial. (10) Follow the false memory debate and you begin to see a disorganized profession with little agreement on what it is dealing with, what it is trying to accomplish, or how to go about it.

Overarching all these issues is the same crucial question: On what basis do clinicians lay their claim to professional authority? This is no small matter when you consider that there was an increase of between 275% (10) and 352% (11) in the number of clinical professionals practicing in the U.S. over a fifteen year period from 1975-1990. There was, of course, a concomitant increase in the number of people seeking psychotherapy as well a the percentage of the GNP spent on therapeutic services. Figures vary on these also, but are equally dramatic and they are very much behind the movement towards managed care.

What are we to make of the lack of dialogue between clinicians and researchers, the proliferation of fad-driven "schools" of psychotherapy (estimates range between and 225 and 700+ different schools, depending upon how you count), the fact that one patient can be given seven different diagnoses by seven different therapists, and that professionals routinely disagree in the courtroom? Why, in other words, should we be placing our marriages, families and futures in the hands of therapists? And please do not trot out the sheepskins. The question is: "On what knowledge base do all these certifications rest?"

To survive and prosper as a profession, psychotherapy must begin to provide real answers to these questions. There may be real answers but to ignore the questions is no longer acceptable. And it is certainly out of line to pathologize the intelligent person who raises them as being "resistant," or "lacking in basic trust," "in denial," or... pick your favorite diagnosis.

There may be a baby in this bathwater, but the water is so murky it’s hard to say.

For those who believe they have been falsely accused, the "false memory" phenomenon is an issue of personal justice. For the attentive onlooker, it is that and much more. The fact is that the age of uncritical acceptance of psychotherapy is coming to an end, not just because of the false memory debate, but because of all the unanswered questions it exposes. More of us will be more reluctant to surrender all independent thought - or any unquestioned authority - to our therapists.., especially if our therapists seem to have surrendered all conscious thought before us.

I was in a neighborhood pub talking to a construction worker the night the Ramona verdict came in and was announced on the television. My companion pushed back his baseball cap and, waving his frosted glass, pointed in the direction of the television screen. "Boy!" he said, "You have really have to think twice before you put yourselves in the hands of those people." I am possibly more long-winded and piercingly articulate than my friend, but no more inherently rational or concerned. It’s does-the-Emperor-have-any-clothes time for the therapeutic professions. And that is a much bigger issue than the "False Memory Syndrome."


NOTES

1. The 1991-1992 San Diego County Grand Jury, Case 0/Alicia Wade, Report No. 6, A Report of the Grand Jury, June 2.3, 1992. County of San Diego, 1420 Kettner Boulevard, Suite 310, San Diego, CA 92101-2432.
2. Lanning, Kenneth V. (1992, January). An Investigator’s Guide to Allegations of "Ritual" Child Abuse. Quantico, Virginia: The National Center for the Analysis of Violent Crime, FBI Academy.
3. Loftus, Elizabeth. (May, 1993). "The Reality of Repressed Memories," The American Psychologist, 48(5), 518-537. This article probably represents the best summary of Loftus’s work to date, though all of her work sheds light upon this subject.
4. Ganaway, George K. M.D. (August, 1991). "Alternative Hypotheses Regarding Satanic Ritual Abuse Memories," presented at the 1991 Convention of the American Psychological Association, See especially pp. 12-16. For reprints write: Dr. George K. Ganaway, M.D., 5064 Roswell Road, Suite D-201 Atlanta, Georgia 30342.
5. Waterhouse, Rosie. (April 24,1994). "Government inquiry decides satanic abuse does not exist," Independent, and LaFontaine, J.S., "The Extent and Nature of Organized and Ritual Abuse: Research Findings," The Department of Health, HMSO, Dd 297832 C25 5/94 9698, Crown Copyright, 1994, The United Kingdom.
6. Bowden, Mark, "Repressed Memory Syndrome Splits Psychiatrists" Philadelphia Inquirer, May 23, 1994.
7. I often hear objections to raising the possibility of maliciousness. I could be persuaded to change the word "malicious" if someone would provide me with another to as adequately describe the widely-reported case of the eight-year-old Chicago schoolgirl who took offense at a substitute teacher and paid several of her classmates $1.00 each to falsely accused him of sexual abuse. Also, it has long been known that false memory cases arise in custody battles in divorces.
8. Ganaway, George K., M.D. (April 17, 1993). "Dissociative Disorders and Psychodynamic Theory: Trauma Versus Conflict and Deficit," a paper presented as part of a symposium, "Perspectives on Recovered Memories" held at the conference, Memory and Reality, Emerging Crisis, Valley Forge, Pennsylvania. For reprints write: Dr. George K. Ganaway, M.D., 5064 Roswell Road, Suite D-201, Atlanta, Georgia 30342.
9. For example, see American Journal of Psychiatry, 151(5), May, 1994, p.734.
10. Kirk, Stuart, &Herb Kutchins, The selling of DSM: The rhetoric of science in psychiatry, Aldine de Gruyter, New York, 1992, p. 8.
11. Figure derived from others provided by Dr. Michael Freedman, Director of the Institute for Behavioral Health Care, San Francisco, in the Institute's Press Kit.

Reproduced with the permission of the author.

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