Frontline tackles recovered memory therapy.
ANN NORRIS WENT TO see Laguna Beach psychologist Doug Sawin in 1988. She had recently graduated from college with a degree in music and suffered from insomnia and drank alcohol to sleep. But it was her relationship with her mother, Judy, that troubled her most. After Ann’s triumphant college graduation vocal recital, Judy hadn’t even congratulated her. Two days later, Judy had called and angrily attacked Ann over the phone until Ann cried.
It was the kind of issue that a good family or individual therapist might have addressed by building on Ann’s obvious strengths, teaching her to contain and manage her feelings, and coaching her to develop a better relationship with her mother. But Sawin instead focussed intensely on the past. Ann soon had memories of her father sexually abusing her, and later of elaborate cultic abuse, which her three siblings didn’t come close to corroborating. She was hospitalized after attempting suicide, and Sawin bluntly told her father, Al, over the phone, of Ann’s charges Al collapsed in tears.
Over the years, Ann drew closer to Sawin while her relations with her family and her own mental state grew more troubled. She was diagnosed with Multiple Personality Disorder and, with Sawin’s support, sued her parents and grandparents for $20 million. She spent six years in therapy with Sawin She now describes psychiatric hospitals where she still stays periodically because she cuts and burns herself as her “institutional mothers.” She has not spoken to her true mother in six years. And she no longer sings.
It doesn’t take a PhD in psychology or a seat on a state licensing board to see that Ann is worse off than when she entered therapy. Millions of nontherapists undoubtedly made just such an assessment when Ann, her therapist and her family told their stories before millions of prime-time viewers on “Divided Memories,” a four-hour PBS Frontline documentary screened in early May.
In her wide-ranging investigation of therapy, sexual abuse and memory, producer Ofra Bikel used as her primary subject families divided by recovered memories of abuse. She also managed to persuade nearly half a dozen therapists to do therapy while her camera was running. It was a remarkable event, in which all of America was invited behind the one-way mirror to see therapy in action in the midst of its most divisive controversy and to judge it for themselves.
And what therapy they saw Clients weeping over flashbacks of their incestuous fathers, sobbing as they sat on carpets in their therapists’ arms, remembering past lives in hypnotic trances and having “cellular memories” exorcised by masseurs The clients in the documentary seem to have replaced their blood families with therapists and fellow clients. Few of the therapists hold out much hope that women who’ve been sexually abused can heal, or that they can work out healthier relationships with their families. As California therapist Joanne Stillwagon put it, “Ninety percent of the time, if it’s incest, the family is going to turn against you. So these survivors begin to be your family.”
And what about the validity of recovered memories? Bikel plays neither detective nor researcher, but her choice of interview subjects for the Frontline program shows that she thinks therapists should be far more skeptical. One client in Boston says that, based on her dreams and her therapist’s assessment, she accused her father of abuse and then retracted after her therapist met her father and decided she’d made a mistake. A hypnotherapist states that one of her clients recalls being stuck in the fallopian tube.
“What is going on in the name of recovered memory across the country is almost scandalous,” says producer Bikel. “Therapists say this is just a fringe phenomenon, but the fringe is longer than the cloth. Something must be done. Therapists can’t just ignore it.”
Therapists’ reactions to the documentary ranged from embarrassment to outrage to approval. “I was ashamed for my profession,” says one Washington, D.C. , psychologist. Harvard psychiatrist and trauma researcher Bessel van der Kolk, who was interviewed on the show, wrote to Bikel to say she had ignored scientific research validating traumatic amnesia and held trauma victims up to ridicule Christine Courtois, psychologist and author of Healing the Incest Wound, says that the documentary used bizarre practices to discredit work done in the clinical mainstream. “The therapy they showed was far outside the norm,” she says. “What they do is not being advocated by trauma experts I’ve never heard anyone talk about being lost in the fallopian tube.”
And former Miss America Marilyn Van Derbur the country’s most well-known “recovered memory” survivor says, “It was irresponsible to use my image and not acknowledge that although I did repress my memories, my sister Gwen did not repress hers, my mother has publicly acknowledged the incest, and my two middle sisters also validate there was incest in the family.”
But Atlanta family therapist and psychiatrist Frank Pittman, who contends that practically all delayed recall of childhood sexual abuse is iatrogenic, said the documentary was an enormous relief. “Finally, somebody is catching on,” he says. “I think repressed and recovered memory is a giant hoax that has had an absolutely disastrous effect on the mental health field and our credibility. It’s an expression of our terrible distrust of families and of how enamored we are with the concept of victimhood.”
Whatever the literal truth of their family histories, the therapy victims interviewed seemed to have unwittingly replicated in therapy the abuse they say they suffered in childhood. Now it was their therapists, rather than their parents, who told them what was real, who to love and how to behave. And in the name of healing, therapists like Sawin had focussed them on childhood pain and ruptured family bonds.
The damaging therapeutic relationships shown on the Frontline documentary appear to be the end result of many causes, including a tragic meeting of vulnerable clients with impaired and incompetent therapists. But they also help illuminate the lack of certainty, training and consensus that bedevils the entire sexual trauma field. Science has produced no litmus test for the accuracy of disputed memories and little outcome research has been done on trauma therapy. The professional associations, balkanized by the issue, have no clinical guidelines. Most therapists have little or no graduate-level training in family systems, trauma or suggestibility and they need all three. To muddy the waters even further, no studies have been done to determine whether therapy clients or their accused parents suffer more “false memory.”
Another part of the answer, most leaders in the trauma field concede, is that some genuine abuse victims are experiencing damaging therapy The sad truth is that people victimized in childhood are vulnerable to therapeutic revictimization. According to van der Kolk, survivors of physical or sexual abuse, for complex reasons, can be unskilled at discerning danger or at protecting themselves from further abuse Stanford University psychiatrist David Spiegel notes that many people who made it through sexually or physically traumatic childhoods have learned to please authority figures. They are used to abusive caretakers; they may fail to notice when therapy makes them worse or they may adopt unfounded suggestions as their own experience.
Studies have shown that sexual abuse survivors run significantly higher-than-average risks of rape, domestic violence or other revictimization, including sexual exploitation by therapists. And family therapist Dusty Miller warns that victims of trauma often compulsively re-enact the trauma and may agree or even insist on reliving past hurts, often before they have even established a relationship with a therapist.
In the past five years, leading clinicians have increasingly questioned an earlier belief that traumatized people must re-experience or “abreact” every traumatic incident to heal. “There is no excuse for people to experience retraumatization within the context of therapy,” writes narrative therapist Michael White in Re-Authoring Lives. “Distress, yes Retraumatization, no.”
Cambridge family therapist Jill Harkaway adds that clients need to re-own feelings gradually, while at the same time learning to soothe themselves and to manage distress rather than acting it out. One hospital in-patient unit in her area, says Harkaway, “encourages people to get in touch with their inner child and to re-experience their trauma. Women go to sexual abuse groups on the unit carrying their teddy bears. And they get worse. There’s a lot of bad therapy not the majority, but more than I would like.”
Harvard psychiatrist James Chu, who heads the Dissociative Disorders Unit at McLean Hospital, concurs. “It’s important for therapists to say that it’s not going to be helpful to lie in a dark bedroom and let your mind go wild,” he says. “People get caught in endless abreaction. Some therapists are forgetting that the point of therapy is not to relive everything awful. It’s for people to be able to understand their lives in an intelligible, personal narrative, to engage in supportive relationships, and to cope with the world.”
Psychiatrist Judith Herman, author of Trauma and Recovery, warned attendees at a San Francisco trauma conference last fall to make sure that clients create stable lives before they look at traumatic pasts Christine Courtois hands out a list of 16 cautionary guidelines for working with clients who suspect they were abused or have symptoms of trauma but no memories of it She recommends taking a detailed history at the start of therapy, including questions about sexual abuse and other childhood trauma. At the same time, she cautions against asking leading questions, suggesting abuse or referring clients who have no memories to self-help groups for survivors. “Do not assume that a client who cannot remember much from childhood is repressing,” she writes. “Be open to the possibility that other childhood events and trauma might account for a patient’s symptoms.”
But is the message getting across to those who most need to hear it? Not if Frontline is any indication. Those whose disastrous work was showcased spoke with frightening self-assurance. “I believe you have to go back, re-experience that emotional trauma, feel it in your body, acknowledge it and give it expression,” says therapist Doug Sawin confidently, apparently unaware of the effect of six years of such an approach on his client Ann Norris.
Given such blindness, it’s not surprising that members of the False Memory Syndrome Foundation want strict state and federal legislation to forbid insurance reimbursement for any “scientifically unproven” therapy. “Memory retrieval” techniques, they say, are so dangerous and suggestive that they should be banned, like breast implants or the Dalkon shield.
But given the paucity of outcome research on trauma therapy, such legislation may solve some problems while creating others. Many promising approaches including narrative therapy, brief therapy and EMDR are underResearched and could be prematurely abandoned. And banning “memory retrieval” techniques, rather than educating therapists about suggestion, retraumatization and family systems, may be overkill. Therapy techniques, after all, are not simply tools, but human skills, part of a context of relationship poison for some clients and medicine for others. Asking a client to look at family photographs or draw or write in a journal to remember her childhood can be helpful or harmful, depending on the circumstances.
“You can’t legislate that only certain approaches can be used,” warns psychologist Laura Brown, a member of the American Psychological Association’s working group on childhood memories of trauma. “When cognitive-behaviorism was first put forward 20 years ago, psychoanalysts thought it was dangerous and would only create symptom substitution,” Brown says. Both the American Psychiatric Association and the American Psychological Association oppose the legislation.
But what can be done short of legislation? The mental health field, like all professions, is notoriously poor at regulating itself Boston family therapist Michael Elkin proposes guidelines that would require both therapists and clients to get an outside consultation before clients take actions that affect others, like filing for divorce or making an incest accusation. Some therapists suggest that state licensing boards set up family mediation services, or allow parents and others to bring third-party complaints. And many clinicians agree that clients wander into therapy with far too little information to make informed consents.
“The pain of it all is that there’s so much sincerity, but it’s a crapshoot for the client,” says psychologist Francine Shapiro, the originator of EMDR itself attacked by those who think it is underresearched and oversold. She recommends cross-disciplinary task forces, organized by the major professional associations, to evaluate and structure outcome research and write up informed consent documents for clients. “We’re walking a fine line here,” Shapiro says “How do you protect the intuitive clinician and innovator and at the same time protect clients from someone who is incredibly sincere but incompetent?”
Given the profession’s polarization, it’s unlikely that clinical guidelines will be established soon. In the meantime, Ann Norris and other clients shown on Frontline are poignant reminders of how much power people place in therapists’ hands In the privacy of the therapy hour, few external forces protect a client, leaving both parties dependent on the client’s common sense, and the therapist’s sanity, training, supervision and ethics. When things go well, the power of therapeutic influence and suggestion can help people make positive changes in their lives. But therapeutic power is a two-edged sword And when vulnerability meets incompetence, clients can be cut by the other side of the blade.
In the past 40 years, public school teachers and administrators have witnessed a dramatic change in the nature of discipline problems in the classroom, cafeteria and corridors of America’s schools. According to comparative data from the Fullerton, California, Police Department and California Department of Education, the most common discipline problem likely to land a student in detention during the 1950s was talking, followed by chewing gum, running in the halls, getting out of turn in line, wearing improper clothing and not putting paper in the wastebasket. Such transgressions sound quaint to today’s teachers: in the 1990s, the most common discipline problem is alcohol abuse, followed by drug abuse, teen pregnancy, suicide, rape, robbery and assault.
©Katy Butler. All Rights Reserved. Not to be reprinted without permission.