Psychotherapy Networker Caught in the crossfire cont'd

Caught in the Crossfire, Continued:

It was what science historian Thomas Kuhn, author of The Structure of Scientific Revolutions, might call a "paradigm shift" a time when old models can no longer explain new data and are being abandoned. And it had all the messiness that such shifts often entail. Some therapists believed every memory of satanic ritual abuse as gospel, passed around their own invented statistics, misused hypnosis, overdiagnosed, and drew heavily on self-help literature, autobiography, and pop psychology, borrowing checklists, insights and simplistic dogmas from the addiction-recovery movement. If the influence of past abuse had gone unrecognized by the old paradigm, those involved in the new paradigm would focus on it to the exclusion of the present. If it had been kept secret, they would blurt it out everywhere. If earlier therapists had tacitly colluded with abusing fathers and mothers, they would now champion the daughters and sons.

These were the excesses. At the same time, careful researchers, clinicians and theorists, some connected with major universities, were developing new psychotherapies and psychologies of trauma based not on speculation but on listening to victims who finally felt free to speak. Included in this group are psychiatrists Judith Herman and Bessel van der Kolk of Harvard; psychiatrist Lenore Terr of the University of California's medical school in San Francisco, who studied children traumatized by the Chowchilla kidnapping; psychologist Francine Shapiro, the inventor of a treatment for trauma called Eye Movement Desensitization and Reprocessing (EMDR); and psychologist Christine Courtois of Washington, D.C., author of Healing the Incest Wound. Their focus was not on false memory, but real trauma that disturbing skeleton that kept walking unbidden out of the cultural closet.

Some of them worked not only with incest survivors but with Vietnam veterans, Holocaust survivors and victims of political torture, street crime and rape. All of these clients in their momentary or repeated experience of utter helplessness that is the essence of victimhood had lost faith in a benign universe and had their trust in human nature shattered. They were troubled by numbing, flashbacks, intrusive thoughts and feelings, blanks in their memories, and repetitive nightmares.

Herman argues that a more accurate metaphor for what troubled these women and men was not disease, but injury. Van der Kolk suggested to psychoanalytically oriented therapists that disowned childhood realities, not disowned childhood fantasies, had shaped such people. Neurobiologists found that a single instance of overwhelming terror could permanently alter brain chemistry and affect the encoding of memory.

This loose constellation of theorists began to grope toward a theoretical model of trauma and memory that they called "dissociation" in which memory was not so much buried (or as Freud would have it, "repressed,") as disowned and compartmentalized, accessible only in certain feeling-states, and not integrated into a coherent sense of self. Based on what clients told them, they posited the existence of many, almost contradictory types of trauma-distorted memory of vivid flashbacks and memory blanks as well as images recalled in fragments, like shards of a shattered mosaic. As they and their clients experimented, they theorized that healing required not only retelling the incest story, but re-owning the experience as well.

This makeshift new paradigm which believed womens' stories, took the effects of abuse seriously, and theorized that childhood sexual abuse shared commonalities with other traumas but also differed in its utter secrecy transformed some womens' lives.

Dorianne Laux, who is now 42 and a writing teacher at the University of Oregon, went into therapy at a free clinic in San Diego in the late 1960s, shortly after being released from a psychiatric hospital. She curtly told her new therapist that her stepfather had beaten and sexually abused her from as early as she could remember until she was 17, but she wouldn't say much more about it. Her psychiatrist made it clear that he took the abuse seriously, but for the next three years, the two of them talked around the subject and even joked about it, while concentrating on stabilizing Laux's present life.

Then she gave him a few real details, began to cry for the first time ever in therapy, walked out of the session and didn't come back. Four or five years later, in the mid-1970s, she gave birth to a daughter and it nearly overwhelmed her. She had flashbacks and nightmares. She couldn't finish a course at the community college. She couldn't sleep and sometimes couldn't shower or leave the house until she'd played solitaire and won.

She went back to her old psychiatrist, knowing that this time she would have to face, and speak about, what had been done to her. Her psychiatrist saw her twice a week, for $5 a session, for the next five years. It helped, Laux says, that he had worked with Vietnam veterans, and was Jewish himself, with an awareness of the Holocaust. Somehow, she says, he recognized the impact of the abuse, and yet saw her as an undamaged human being. And this time she talked about incest to him and to others.

"In the past, if an intrusive thought or nightmare would happen, I would try to stuff it down, pretend it didn't exist, and try to deflect the pain, which often involved hurting someone else," she says. "This time around, I would immediately call a friend, write it in my journal, and think about other times I'd had the same thought."

She never confronted her stepfather. But she confronted her mother for not protecting her, and once she went over to her mother's house and destroyed all the bathroom fixtures in a rage. Some nights she found herself doubled up with stomach pains and unable to sleep. But over the next five years, she became able to finish college classes. She could sleep alone at night. She raised her daughter well. After selling magazine subscriptions, frying donuts, being on welfare, and working as a waitress, she got a B A. from Mills College in Oakland, California. Her latest collection of poetry, What We Carry, has been nominated for the 1995 National Book Critics Award.

"I still have angry feelings," she says, "But I have other fish to fry. I know what the world is capable of, and I still enjoy being here. For me, this is a kind of peace.

"If I can do it, other people can do it. But it can only be done if we talk about it. I sat for seven years and talked about it. That's a short time to take out of a life to rectify 17 years of damage."

Laux learned what human beings have long known and research has recently confirmed: that people do better when their traumas are shared whether in war stories, the AIDS quilt, funerals, talks over coffee, or in the communal rituals of mourning that take place in village societies after mining accidents or storms that devastate fishing fleets. Those who are tacitly told that there was something shameful about their trauma, and that they should hide it Vietnam veterans and incest survivors for example often do much worse, which is why the Vietnam Veterans Memorial is more than architecture.

"Trauma is isolating. It usually happens when you're alone, and it creates feelings of negative uniqueness," says Laura Brown. "Silence added to trauma is a deadly combination. Part of the recovery process is to have a witness to your experience. You need to speak and to know that someone will listen and not cast you out because you have been the target of trauma."

And so the incest secret, once so tightly contained, began to leak out into the culture. And as it did, it generated troubling, anomalous data that did not fit into previous research paradigms about the workings of ordinary memory, or for that matter, common sense. A substantial minority of their clients, Herman and others said, entered therapy with no specific memories of repeated childhood sexual abuse and later recovered them. In 1987, she published a research paper saying that out of 53 therapy clients 20 of whom began therapy with "severe amnesia" for childhood abuse 74 percent had been able to find some sort of corroboration, such as an admission or apology, pornographic photographs or the recollection of siblings who said they, too, had been abused. Those who began without memories, Herman says, had the same rates of corroboration as those who always remembered.

It was these reports of delayed recall that formed the basis of the FMSF's charges of superstition and pseudoscience. Therapists, the accused parents and some research psychologists argued, were creating abuse memories the way a frightened child makes a monster out of a bedside lamp in the semi-darkness. The FMSF and the trauma clinicians looked at the same data and saw different images.

They were like people staring at a trick painting from Victorian England and forming different gestalts one group seeing a glamorous lady holding up a looking-glass, the other seeing the equally valid image of a skull. And for the rest of the culture, weary of the national incest psychodrama and confused by listening to distinguished psychiatrists from Harvard saying diametrically opposing things, it was though all standards of certainty and scientific truth had dissolved.

FACING CHILD MOLESTATION HAS created paralyzing conflicts for our culture. Many of our most deeply held illusions are challenged. Who wants to suspect the Norman Rockwell couple down the block? Or to think that not suspecting them may place their children in jeopardy? Who wants to look at a class of kindergartners and think about who has already been abused, and who will be?

And how can we serve as a healing witness to a woman suffering from memories of childhood abuse without somehow judging her father, whose side of the story we don't know? And when there are more survivors of child sexual abuse than victims of schizophrenia and the Cambodian and Jewish holocausts combined, why do we assume she is more likely to have invented her story?

And what about the adults who abuse? Should we think of them as sick people needing help? What is the line between compassion and idiot compassion? Or should we apply the criminal justice model, even the power imbalance, throw them in jail at least overnight, and make it clear that child sexual abuse has consequences just like sexual harassment, date rape and knocking over the local 7-Eleven?

Should we combine social sanctions and compassionate treatment, as we do with alcoholics when a judge hands out a stiff drunk driving sentence and also requires AA.?

All of society's unanswered questions and undone tasks have somehow become therapy's responsibility. Much to the distress of some of the first feminists to go public with their incest stories, incest survivors have become an therapeutic and literary market, not a social movement. "Incest is not a disease, it's an injury. It's a social problem, like drunk driving," says Louise Armstrong, author of Kiss Daddy Goodnight and Rocking the Cradle of Sexual Politics. "Drunk driving certainly produced the maimed and wounded and the grieviously bereft, but the solution was not to drag them endlessly across the TV screen. It was to organize Mothers Against Drunk Driving and act for social change."

When survivors do act, things can change. Two years ago, some parents in Mill Valley, California, discovered that their middle school's volunteer soccer coach had molested more than a score of their daughters. A similar complaint had been made five years earlier by two single mothers, but nothing was done for "lack of evidence." The man continued to teach soccer, have his daughter's friends over for the night, and to molest them.

This time, however, the parents organized, pressured the sheriffs department, spoke to the media, and showed up in court. They chose as their spokeswoman, Cathy Youngling, who could appear on television and in newspapers without compromising the privacy of any of the children because her own daughter had not been victimized. Youngling, who had been sexually abused by a doctor when she was 12, felt that by acting, she was helping to make sure that her own children would be better protected than she had been.

This time, the investigation was not dropped. The man eventually confessed to a single count of abuse for each of the children who made official reports, and he got a long prison sentence. A joint therapy group was formed for the children. A long prison sentence may seem like an ambiguous achievement, especially now that "three strikes" legislation is expected to solve all social ills. But considering the previous alternative no sentence at all and no effort to protect children it is an advance. The community acknowledged what had been done, supported their children and one another, and stopped one particular man from abusing children.

THIS KIND OF CULTURAL discussion, of course, is cold comfort to the accused parents of the FMSF. Their personal anguish is no less keen because it results sometimes from the ambiguities of their own family histories, or from therapy trying to do the work of social action, or from the haphazard errors of a constellation of social workers, psychologists and psychiatrists working in overlapping and sometimes mutually contradictory ways.

Disasters, they feel, have shattered their families and they want to know why. Complex, intimate, lifelong blood relationships have come to a point of breakdown and they hold therapy sometimes only a couple of sessions of it responsible. For any parent, innocent or guilty, whose daughter won't speak to them or has sued them, a single botched therapy case is one too many.

They do not see the issue as a few incompetent therapists using poor techniques to generate disastrous results with highly suggestible clients. They see an epidemic. They blame a single, well-defined therapeutic technique that they call "memory retrieval therapy," which they say shouldn't be used ever, by anybody, with anybody.

Pamela Freyd, the director of the False Memory Syndrome Foundation, defines "memory retrieval therapy" as "the notion that the presenting problems are not at issue but that some kind of trauma that you don't remember caused the problem, and searching for that. The techniques brought to our attention include hypnosis, sodium amytal, guided imagery, dream interpretations, body massages, participation in survivor groups to help somebody find memories, the reading of self-help books, journaling and looking at childhood photographs."

Despite recent research showing that a significant minority of people report amnesia for childhood sexual abuse, the Foundation considers it "highly unlikely" for memories of repeated abuse to be lost from consciousness and later reliably retrieved. Therapists who assume otherwise, it implies, are unscientific.

Noting that 16,000 parents have called the Foundation to say they were falsely accused, Freyd says that any commercial product that garnered 16,000 complaints would be removed from the market. "Supposing somebody discovered a drug that would cure cancer but they found out that it killed or maimed another percentage, wouldn't you sue the makers of the drug?" she asks. "Recovered memory therapy may help some people, but the risks involved seem awfully great, and those risks are showing up in lawsuits."

Freyd and other parents believe that this kind of therapy not their own and their offspring's actions has destroyed their relationships and their offspring as well. "If somebody came into your house and shot your child, it would probably be justifiable homicide if you did something, and that's how these parents feel," says Freyd. "When you get between parents and children, you can expect things to happen."

To this, psychologist Laura Brown responds, "There is no such thing as 'recovered memory therapy or 'memory retrieval therapy.' These terms were made up, just as 'false memory syndrome' was made up. It's used in a broad way to describe any therapy the Foundation doesn't like. The people who are receiving these services aren't, for the most part, complaining. We don't have 16,000 reports of a patient dying. We have 16,000 complaints about therapy made by people who weren't there. Those who were there are mostly happy with what they got and angry that it's being criticized."

Brown concedes that "there are some very characterologically disturbed people who have bad boundaries from what they read and hear, and can develop new symptoms based on what they've been reading." But, she says, "that's a risk we always take. We have the First Amendment, and people can read and write what they want. And if they don't read The Courage to Heal, they can read the same ideas in fiction in a novel like A Thousand Acres, by Jane Smiley.

And, adds Brown, who works with a number of gay men and lesbians who have been forced to separate from families who cannot accept their sexuality, "Adults have the right to decide what defines their family. Some adults want to include their biological family, and some do not and that often has nothing to do with whether they recover memories," she says. "In my mind, what constitutes good therapy is what helps the person receiving it to function optimally. Sometimes this involves creating separation from family, and sometimes it involves getting closer." The FMSF's parents, however, say the debate is not about ideology, or the messy details of their families' lives, or the reality of genuine sexual abuse or the free choices of their adult children. The debate, they say, is about therapeutic suggestibility and the science of memory. Some of them hold that memory somewhat like gravity functions in a single predictable way, according to rules discoverable by strict scientific research on ordinary people under ordinary levels of stress. Such studies have shown, they say, that repeated events are more likely to be remembered; that memory is far more malleable than most people think; and that some people, especially children, can be convinced to report mildly traumatic events that never happened.

But therapists who have worked successfully with such families caution against framing these families' conflicts as a reductionistic dispute over whether daddy did it. Social worker Mary Jo Barrett, who has recently formed "the family dialog project" to mediate between members of families torn by abuse allegations, has so far worked with the families of 150 adults who have accused family members of sexual abuse. In about half of those families, the abuse was admitted right away, and therapy proceeded on that basis. Of the remaining 75 families, about two-thirds have come to agree upon what Barrett calls a "third reality" in which daughters felt abused and humiliated even though they remember no physical touching.

In these cases, Barrett tells both sides that she cannot convince one side to confess or the other to retract. Instead, she explores what it would take for them to share Passover, or Christmas, or a wedding, despite radically different views of the past.

"I don't define success as finding out the truth," says Barrett. "I maintain I can never find out the truth. But I try to get them off the idea that the only options are to find out the truth or to sue. Instead, we try to work out some form of relationship in which there is safety, clear boundaries, and respect."

In one family, a mother and her accusing daughter had not spoken in two years, and after six sessions managed to negotiate a relationship that allowed the mother to see her grandchild. In another family, the father, an engineer, was on the brink of suing his daughter's therapist after he'd been summoned to a confrontation and read a long list of charges of incestuous acts. Today, neither daughter nor father are close, and the daughter still believes her father abused her, but they can share family gatherings like Christmas together.

"All through my career I've seen cases where the person wasn't sure," says Barrett. "They say things like, 'I think something weird happened, I have these terrible nightmares, I see my brothers hands and I go beserk. But I have no memory and no corroborating evidence.' My style of treatment has never been to assume that it actually happened. How would I ever know?

"I have a client who remembers only that her father would come in her bed at night if she couldn't sleep. She remembers him getting in and out of her bed. Nothing else. She entered therapy with many different symptoms and can't read an article about sexual abuse without getting upset. Her father walked around in his underwear, there were Playboy magazines all over the house, and he used to say things to her like, Tour boobs look great.'"

"I say to her all the time, 'You got enough,' and she does. It doesn't have to have been anything more than that."

Sometimes, Barrett says, fathers don't remember some of the sexual violations their daughters accuse them of but remember other things, far worse, that the daughters have apparently forgotten. Sometimes fathers begin therapy saying they don't know what their daughters are talking about, and then recover lost memories of their own.

Jack, for example, a retired Chicago salesman, came to see Barrett after a grown daughter accused him, saying she only wanted to hear from him in writing. He called a lawyer. His second wife was sure he was a victim of False Memory Syndrome. When the daughter did not reply to a letter asking her to join family therapy, Barrett arranged sessions with other adult children who were also estranged.

In sessions alone and with his wife, Jack talked about a long secret affair during his first marriage, and his loneliness and heavy drinking. He talked about how badly he'd wanted to be a geologist when he was young and how he had sobbed the day he realized he would have to become a salesman instead. In his fourth or fifth individual session, he told Barrett he remembered being unable to sleep, going into his daughter's bedroom when she was about 15 and masturbating. He says, "I may have taken my daughter's hand to touch my penis, during her sleep. Or supposed sleep."

What had made it possible for him to remember and admit? "Mary Jo put me at ease," he says. "She said, 'I don't know you, I don't know what you did if you did do anything, and even if you did it doesn't make you a bad guy.'"

He has since told his second wife, who has promised to stay with him as long as he stays in therapy. And with Barrett he is continuing to repair his relationships with his other children. He explores what might have triggered his behavior, and waits for his daughter to write again. "What would have caused me to get out of bed, go in the girls' room . . . ?" he asks, his voice trailing off. "Because at least I did that."

Other therapists have reported in direct contradiction to Pamela Freyd's position that recovered memories are rarely corroborated fathers who admit, and apologize for, things their daughters recall after years of forgetting.

In Virginia, therapist Marche Isabella, who was a defendant in California's Ramona malpractice case, had been seeing a couple for 18 months in marital therapy when their daughter phoned home and told her mother that she had remembered being sexually abused for several pre-teen years.

"Do you remember that?" Isabella asked the father, and he said yes.

Isabella thanked him for being honest, and told him that he had a responsibility to his daughter to acknowledge what had happened, and to offer to pay for therapy, or medication or other help. The father called his daughter that night and apologized. For the next year, he sent her money, but she chose to have little contact. Now she feels comfortable enough to take part in family holidays again. "This kind of thing doesn't have to destroy the family," Isabella says. "But both people have to be honest and work on the issue."

Laura Brown has two women clients who recovered some memories in therapy and whose fathers apologized to them after a period of family separation. "Both fathers said, 'I didn't know this would hurt you and stay with you,' which my clients found enraging. But they also said, 'I'm sorry and I do love you,' and that was comforting," Brown says. "It helped create a sense of peace and closure. And when their fathers put aside their own interests and their needs to protect themselves, and said, Yes, I did something that harmed you and I'm sorry' in those moments each of these women felt like she had a father."

Families in which incest is charged are messy, intricate places, and things rarely work out with the sentimentality of a movie-of-the-week. Most therapists settle for modest victories, negotiated painstakingly over time, seeing members in individual therapy as well as treating couples and other family dyads. Many fathers never acknowledge, and therapists are left with the work of salvaging a healthy adult rather than reconstituting a family. In other cases, nobody falls down on his knees and begs forgiveness, but relationships can be re-negotiated, and future generations protected.

Depending on how one looks at it, these cases represent either small potatoes or a minor miracles. But they may be all that can be expected now, in a culture groping its way through a journey between denial and resolution. Families where incest has taken place and families in which nonexistent incest is charged are not happy places. They are messier still when poisonous secrets leak from the bodies and minds of women who have held them for decades as their families and their cultures have asked them to do. Before 1970, bystanders beheld a cultural mirage of pristine families and innocent, untroubled children. It soothed us to see it, but it had its costs. Those who held the secret for us sometimes paid with their lives: in suicide, prostitution, drug and alcohol use, the sexual abuse of later generations, "borderline" behavior, madness, sexual disfunction, unhappiness and alienation. Virginia Woolf, Anne Sexton, and Marilyn Monroe all of whom said they were sexually abused as children, all of whom were treated for mental illness gave the world their creativity and committed suicide. Oprah Winfrey, Maya Angelou and Dorianne Laux, who came of age when they could speak freely and be believed, have not.

In the last decade, incest survivors have effectively told the culture they will no longer keep things looking neat and clean for the rest of us. Society can hold therapists responsible for the resulting mess and expect them to clean it all up, but it probably won't turn back the clock.

Therapists have often oversold themselves as miracle workers, as ministers, as substitutes for political and community life. But they are none of these things. Nor are they policemen, judges, community organizers, detectives, or psychics gifted with second sight. If they pretend to do work that a culture must do for itself, they will be scapegoated when they fail. And fail they must. The rest of society, weary though it may be of incest stories, risks something far more serious accepting the illusion that an epidemic of delayed incest revelations can be explained away as the result of bad therapy alone. It may be easier for the culture to focus its outrage on therapy than to face the larger issue its failure to protect children, both yesterday's and today's, from real abuse. But not facing this more difficult truth may mean giving in to the ultimate seduction of victim-hood: the comforting illusion that whatever is wrong, someone else is responsible, and someone else is to blame.