Repressed Memory Therapy

...on critical examination, the scientific evidence for repression crumbles. --Harrison G Pope

In Freud's theory of "repression" the mind automatically banishes traumatic events from memory to prevent overwhelming anxiety. Freud further theorized that repressed memories cause "neurosis," which could be cured if the memories were made conscious. While all this is taught in introductory psychology courses and has been taken by novelists and screenwriters to be a truism, Freud's repression theory has never been verified by rigorous scientific proof. --John Hockmann
Repressed memory therapy (RMT) is a type of psychotherapy that 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 be restored only by recovering and facing these repressed memories of sexual abuse.
Any amount of sexual abuse of children is intolerable. Let me remind the reader that this article is about a particular type of therapy, not an article about sexual abuse. There are many people who suffer physical and psychological damage as a result of having been abused and many of these have been helped by good therapists. As Esther Giller notes: "More disturbance is associated with more severe abuse" and some research indicates that "at least 40% of all psychiatric inpatients have histories of sexual abuse in childhood" (Giller n.d.).  Nevertheless, there is little scientific evidence supporting the notion that childhood sexual abuse almost always causes psychological problems in adults:
Research shows that about 1/3 of sexually abused children have no symptoms and a large proportion that do become symptomatic are able to recover. Fewer than 1/5 of adults who were abused in childhood show serious psychological disturbance. (Giller n.d.;  Mullen and Fleming 1998;  see also the American Psychological Association's Understanding Child Sexual Abuse.)
There is also little scientific evidence supporting the notions that memories of childhood sexual abuse are unconsciously repressed or that 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 childhood 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, a charge levied by members of the False Memory Syndrome Foundation.
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." 

the RMT checklist

Many of the more prominent RMT advocates use a checklist 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). Works on child abuse promoting such a notion have been very popular among therapists and talk show hosts featuring Ellen Bass, Laura Davis (The Courage to Heal), 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 facts by many people. Dr. Carol Tavris writes
In what can only be called an incestuous arrangement, the authors of these books all rely on one another's work as supporting evidence for their own; they all endorse and recommend one another's books to their readers. If one of them comes up with a concocted statistic--such as "more than half of all women are survivors of childhood sexual trauma"--the numbers are traded like baseball cards, reprinted in every book and eventually enshrined as fact. Thus the cycle of misinformation, faulty statistics and invalidated assertions maintains itself (Tavris).
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]. (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].
As a point of reference, the U.S. Bureau of Justice Statistics reports that a survey done of female state prison inmates in 1996-97 found that some 36 percent said they had been sexually or physically abused at age 17 or younger. The terms 'sexual abuse' and 'physical abuse' were not clearly defined; however, one-third reported they had been raped before incarceration. By comparison, 16 studies of child abuse in the general population found that from 12 percent to 17 percent reported they had been "abused" as children.
Furthermore, people who have experienced traumatic events usually do not forget them.* Severely traumatic experiences are typically forgotten only if (a) the person is rendered unconscious at the time of the trauma; (b) the person is brain damaged before or by the trauma; or (c) the person is too young to make the necessary neural connections needed for long-term memory. Memories are not stored in some mysterious dark cellar, but in a complex network of neural connections involving several parts of the brain. Memories are lost because neural connections are lost, not because some homunculus stores them in the basement of the mind and lets them haunt the people upstairs in the room where clear consciousness dwells.

memory and repression

Before discussing the methods and techniques of RMT, it should be noted that very few recovered memories of childhood sexual abuse first occur spontaneously. When they do, they are usually 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: the memories are confabulations suggested by prodding, suggestive therapy.
Daniel Schacter notes that the scientific evidence for repression is weak. Even weaker is the evidence that specific disorders are caused by repression. He notes the case of a rape victim who could not remember the rape, which took place on a brick pathway. The words 'brick' and 'path' kept popping into her mind, but she did not connect them to the rape. And she became very upset when taken back to the scene of the rape, though she didn't remember what had happened there (Schacter 1996, 232). One could posit that the victim really does have a full-fledged memory of the rape, but she has repressed it. Hypnosis could help bring forth this repressed memory. However, hypnosis or other methods starting with this assumption are risky as well as unfounded. The concept of implicit memory, i.e., memory without awareness, which is due to the fact that some neural connections have been made during a trauma, but not enough for a full-fledged recollection, could explain this rape victim's incomplete memory without assuming that she was recording memories while she was unconscious. The concept of implicit memory explains everything that is known about memory without making assumptions about what is not known.
Furthermore, even if traumatic memories are repressed sometimes, they are probably done so consciously and deliberately. Many of us choose not to dwell on unpleasant experiences and make a determined effort to wipe them from our memories as far as possible. We hardly desire some hypnotist or therapist to dredge up memories of experiences we've chosen to forget. In short, limited amnesia is best explained neurologically, not metaphysically. We forget things either because we never encoded them strongly enough in the first place or because neural connections have been destroyed or because we choose to forget them.

RMT techniques

RMT uses a variety of methods--including hypnosis, visualization, group therapy, and trance writing--to assist the patient in 'remembering' the traumatic event. Hypnosis is risky because it is easy to lead and encourage the patient by suggestive or leading questions. Trance writing has never been proven to have any therapeutic value (Schacter 1996, 271). Group therapy, on the other hand, can become communal reinforcement of delusions, if the therapist is not careful. People in the group can encourage others to share 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.
Using guided imagery or visualization in therapy can also be dangerous. Sherri Hines describes how her therapist used this method to help her retrieve a memory of being abused by her father:
My father would give me a bath and he used to draw on the mirror, draw on the steam, and he would draw cartoon characters. And that was the seed for a memory; we would start with that.
And [my therapist] would tell me, 'You're in the bathtub. Your dad is there. He's drawing in the mirror. What is he drawing?' Then he'd say, 'OK, now your father's coming over toward you in the bathtub. He's reaching out to touch you. Where is he touching you?' And that's how the memories were created (Hallinan 1997).
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.
The case of Diana Halbrook also brings into question the reliability of RMT methods. In a trance writing session, Halbrook 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.
Because Diana Halbrook's ritual abuse memories seems so outlandish, her doubts about the reality of these and her other recovered recollections continued to grow. But these doubts met resistance from the people in her support group and her therapist. "I continually questioned the memories, doubted them, but when I questioned the therapist, he would yell at me, tell me I wasn't giving my 'little girl within' the benefit of the doubt. Tell me that I was in denial. I didn't know what to believe. But I trusted him" (Schacter 1996, 269).
Halbrook got out of the therapy, characterized by Daniel 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."
Each of the various methods described above has been 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, or being traumatized in a past life.
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
...the phenomenon of memory repression, and the process of therapy used in these cases to recover the memories, have not gained acceptance in the field of psychology, and are not scientifically reliable (quoted in Schacter 1996, 267).
It is true that another New Jersey judge, Linda Dalianas, did allow such testimony in a later case but she also stated that
...[t]he Court will not allow expert evidence regarding either the process or the plausibility of 'recovering' an allegedly repressed memory, because the experts have not offered any data either supporting or refuting any theory of how or whether a 'lost' memory might be recovered (Schacter 1996, 267).
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 whether she had recovered her memories of the crime during hypnotherapy.

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).
First, there is no conclusive scientific evidence from controlled research that false memories of sexual abuse can be created--nor will such evidence ever exist, because of ethical considerations. Second, there is likewise no definitive scientific evidence showing that therapy per se or specific suggestive techniques are alone responsible for the creation of inaccurate memories. Third, several separate strands, when considered together, support the conclusion that some therapists have helped to create illusory recollections of sexual abuse....
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.
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.

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 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 a particular memory has 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. But RMT therapists are not put off by bizarre "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 is 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 are 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 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 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." 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?