Janet’s theory which explains cognitively how dissociation occurs, without necessarily proposing an intentional process.
For further elaboration of these comments, see Cardena, E. (1994). The domain of dissociation. In S. J. Lynn & J. W. Rhue (Eds.) Dissociation: Clinical and Theoretical Perspectives. New York: Guilford Press
Frankel, Fred H. (1994, October). On patients remembering abuse when it in fact may not have occurred. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
The concept of hidden memories has supported the profession of psychotherapy for a century. This process can only occur if there is a mechanism to support it. Bowers says, if memory is not reliably accurate, it is not reliably inaccurate either.
“Ideas passing as descriptions lead us to equate the tentative with [the factual.]” – Gould.
Three studies purporting to establish repression: 1. Briere & Comte sampled 450 adults who reported abuse. They asked, “Was there ever a time when you couldn’t remember the forced experience?” How does respondent understand the question? Clients were all in therapy. 2. Herman and Schatzow (1989) “verification of abuse” study. 53 Ss in a survivor’s group. Reports percentages who had no or little recall. Authors don’t acknowledge that the group discussion and the attitude of therapist may have shaped the response. It is also not clear how many Ss who claimed to have “verified” their accounts were among those who had severe amnesia for the event. They could be Ss who had never lost the memory in the first place. 3. Williams interviewed women who earlier were in Emergency Rooms because of abuse being suspected. 38% did not report childhood abuse when questioned, and author concluded it was due to repression. Significant numbers of adults cannot remember things even past the age of 5.
Problem with wording of questions. Some of the women interviewed might have preferred not to report the event. This was not investigated in the study.
Loftus, Elizabeth; Polonsky, Sara; Fullilove, Mindy Thompson (1994). Memories of childhood sexual abuse: Remembering and repressing. Psychology of Women Quarterly, 18, 67-84.
Women involved in out-patient treatment for substance abuse were interviewed to examine their recollections of childhood sexual abuse. Overall, 54% of the 105 women reported a history of childhood sexual abuse. Of these, the majority (81%) remembered all or part of the abuse their whole lives; 19% reported they forgot the abuse for a period of time, and later the memory returned. Women who remembered the abuse their whole lives reported a clearer memory, with a more detailed picture. They also reported greater intensity of feelings at the time the abuse happened. Women who remembered the abuse their whole lives did not differ from others in terms of the violence of the abuse or whether the violence was incestuous. These data bear on current discussions concerning the extent to which repression is a common way of coping with childhood sexual abuse trauma, and also bear on some widely held beliefs about the correlates of repression.
NOTES
In previous research, it was reported that violent or incestuous abuse is particularly susceptible to repression. This study differs from previous investigations in the definition of violence. In the present study, ‘violence’ is defined as any act involving vaginal, oral, or anal sex. Earlier research defined ‘violence’ as involving sexual assault with physical injury or fear of death.
Depending on the definition of repression, a sizeable minority (31% or almost 1/5) of this sample forgot their earlier abuse for a period of time. The authors state that this suggests there is little ‘robust repression’ in this sample. They cannot rule out the possibility that some women who were abused still, to this day, do not recall the experience; or that some who continue to have memory loss based on organic causes, including blackouts.
The authors suggest that future research in this area use more specific questions, including assessing whether Subjects respond to statements like: “There was a time when I would not have been able to remember the abuse, even if I had been directly asked about it,” or “There was a time when I would not have been able to report the abuse because I had no idea that it had even happened to me.” Also, when Subjects report that a memory had emerged after a period in which they had no recall, the Experimenter should enquire about how and when the recovered memory occurred.
The authors conclude that remembering abuse is more common than forgetting it.
Marmar, Charles (1994, October). Peritraumatic dissociation and PTSD. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
Following trauma there is a tendency to more dissociation and vulnerability. We completed 3 recent studies. In 1991 Spiegel and Cardena presented review that found: 1. Early childhood abuse is associated with profound dissociation. 2. Repeated abuse is more important and profound than single abuse for producing dissociation. 3. Dissociation in childhood and perhaps in adulthood has been viewed as an adaptive attempt to cope, to take distance in time, place, and person; does that confirm long term adaptation, or is it a risk factor? 4. Dissociation is not limited to childhood trauma; it occurs in adults exposed to overwhelming trauma. 5. In adults with PTSD, there is an increase in hypnotizability, which is interesting because most Axis I disorders are associated with reduced hypnotizability.
Peritraumatic dissociation is defined as an immediate dissociative response to trauma. We developed a scale that robustly captures the phenomena. The scale has both self report and rater versions.
Authors used this measure in many studies: combat trauma, accident trauma, victims of terrorism. The scale predicts who will be a PTSD patient 5 months later, even after controlling for initial response in first week (how many symptoms they had) and for the degree of trauma.
Study 1 (Am. J. Psychiatry, June 1994)
Studied 251 male Vietnam Theater Veterans, mean age 41 at time of study. Had high combat exposure and high risk for PTSD. Rater version of
Peritraumatic Dissociative Experiences Questionnaire was used. There was a lot of variability in response, but one underlying dimension resulted from the factor analysis (and this factor accounts for 40- 50% of the variance).
Author hypothesized that those who have a greater response to trauma will have more problems later, and would predict stress symptoms but not necessarily psychopathology. The score correlates highly with: Mississippi Scale for PTSD .51; Horowitz’s scales; Impact of Events Scale (Intrusion .53, Avoidance .60); MMPI derived PTSD .42; Dissociative Experiences Scale (recall of time of event) .41; and War Zone Stress Exposure .48.
MMPI-2 clinical scales had almost no correlation with this scale (using partial r’s, and controlling for MMPI-2 PTSD scores).
Prediction of PTSD case classification from this scale, after taking into consideration other predictors: War Zone Stress War Zone Stress, DES War Zone Stress, DES, PDEQ-RV Kappa is .63
You know much more about who will be a case taking into consideration the DES and DEQ than just knowing the amount of stress. Peritraumatic stress is strongly associated with PTSD but not with psychopathology.
Study 2
Replicated Study 1 using 77 female veterans. Females Ss were more highly educated, older, more likely to be in a health profession role (trauma was working with death and dying, exposure to sex abuse and harassment, given even less support than the males). Yet women have had a better course of recovery, though rates were the same (30% developed PTSD after return from war).
Correlation with Impact of Event Scale (Intrusion .41 and Avoidance .40), but correlations with MMPI-2 are low (and with other PTSD scales are lower than with the males). Hierarchical multiple regression models show R squared doesn’t increase with DES but does with PDEQ to Intrusion (less so to Avoidance).
This study replicates the same pattern, with peritraumatic dissociation strongly related to PTSD symptoms years later, and not to general psychopathology, even after accounting for the nature of the stress and for the degree of dissociation.
Study 3
-trusion (less so to Avoidance).
This study replicates the same pattern, with peritraumatic dissociation strongly related to PTSD symptoms years later, and not to general psychopathology, even after accounting for the nature of the stress and for the degree of dissociation.
Study 3
After the 1989 Loma Prieta earthquake in Northern California we studied emergency services personnel involved in the collapse of a freeway in Oakland. 1000 rescue workers were involved. The workers (police, fire personnel, paramedics, CALTRANS road workers) involved one I-880 cohort and a replication cohort, with two control groups (smaller scale incidents like attending a child drowned in swimming pool, removing someone from a wrecked auto). In all 3 samples, 90% were male.
What characteristics of the person or their exposure account for which workers go on to cope and which will later have PTSD symptoms? Predictors: IES-I IES-A IES-H M-PTSD SCL-GSI.
Variables most associated with problems 1.5 to 3 years afterward were years of experience, exposure, adjustment (measured by the Hogan Personality Inventory measure of adjustment), social support, DES, and PDEQ. Regression analyses used the best predictors first: forced exposure, adjustment, years experience, locus of control, social support. For Intrusion scores there were modest but significant increments by the DES and PDEQ; for avoidance scores, there were very significant contributions (.072 and .078).
There is a robust relationship between the DES and PDEQ and how much hyperarousal there is afterward (.104 and .110 %). DES measures a trait, PDEQ measures a state; yet the latter continues to contribute even after accounting for variance by the DES.
The PDEQ also has been found to predict among rape victims who will have PTSD. This was replicated in different cultures and different language groups.
FUTURE DIRECTIONS. Authors plan to examine people with moderate to high exposure after the L.A. earthquake. They gathered personality and coping style data on the rescue workers to answer the question: what characterizes those who are more vulnerable to dissociative tendencies during trauma?
There are treatment implications: given that those who develop the most profound response are the ones who will have more PTSD later, what are the implications?
Uncovering the trauma that caused the PTSD is often associated with re- dissociation There is a question of how this should be managed.
The authors will attempt to see if they can predict in advance if a person would dissociate if exposed. Do those who dissociate have more childhood abusive environments? Hypothesis: there may be an interaction of childhood trauma and combat trauma that produces PTSD.
Nash, Michael R. (1994). Memory distortion and sexual trauma: The problem of false negatives and false positives. International Journal of Clinical and Experimental Hypnosis, 42 (4), 346-362.
Logically, two broad types of mnemonic errors are possible when adult psychotherapy or hypnosis patients reflect on whether they were sexually abused or not as a child. They may believe that they were not abused when in fact they were (false negative error), or they may believe they were abused when in fact they were not (false positive error). The author briefly reviews the empirical evidence for the occurrence of each of these types of errors, and illustrates each with a clinical case. Further, in considering the incidence, importance, and clinical implications of these errors, the author contends that clinical efficacy in no way assures that a false negative or a false positive has been avoided. A plea is made for theorists and researchers to acknowledge that both categories of errors can occur and to conduct future clinical and laboratory research accordingly.
of these errors, the author contends that clinical efficacy in no way assures that a false negative or a false positive has been avoided. A plea is made for theorists and researchers to acknowledge that both categories of errors can occur and to conduct future clinical and laboratory research accordingly.
Spiegel, David (1994, October). Acute stress disorder and dissociation in DSM-IV. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
Starting with the theme on hysteria introduced by Frankel (1994), and Cardena (1994) on trance disorder [Spiegel notes that] in the West our problem is of individuality, so fragmentation of personality is our disorder. There is cultural content in the delusions of schizophrenia, and cultural content in dissociative disorders. We have further evidence of trauma being involved in dissociation. Trauma is the experience of being made into an object, and the core problem is helplessness (not anxiety or fear), and discontinuity in experience. Dissociation permits people to retain control of their minds when they have lost control of their bodies. The discontinuity of dissociation reflects the discontinuity of experience.
Spiegel, David (1994, October). On patients not remembering abuse when it in fact may have occurred. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
False memories and false non-memories may be two sides of the same coin. What is the evidence for repression?
If people are abducted by extraterrestrials, why don’t they just keep them? [Joke!] It seems counter-intuitive that people would forget important, arousing things that happen.
The three main components of hypnosis (suggestibility, absorption, and dissociation) are also aspects of memory: 1. Absorption relates to encoding (narrowing attention); also happens during traumatic events (Loftus’ “gun memory” which is so clear, while they don’t encode what gunman’s face looks like). 2. Dissociation relates to memory storage (compartmentalization of information). Traumatized people have symptoms of dissociation, depersonalization. If you are in an unusual mental state, you may watch the event; the memory is stored without the usual network of associations. 3. Suggestibility relates to retrieval. The way questions are asked influences one’s response. But hypnosis is not an infinite influencer; the main damage to memory contributed by hypnosis is “confident errors” (McConkey).
We did research one week after the Loma Prieta earthquake, and found significant cognitive alterations, memory alterations, etc. In our sample, 1/4 of the people felt detached from their body or from the ground right after the earthquake.
Memory alterations were compared with data from other studies after other traumas. Difficulties with memory occurred in 29% of our sample.
The disorganization of memory can follow even just witnessing trauma (e.g. the recent slaying of 8 people in the law office in San Francisco) And people who witnessed the execution of Harris. They were in no danger themselves, yet the level of dissociative symptoms were as high in the former.
The Briere & Cone and Herman & Shatzow studies are based on self report of earlier trauma, and that is a problem in research. But Williams’ study does have the age of people when they were abused as children; see her article in Journal of Consulting and Clinical Psychology.
COMMENTS FROM THE AUDIENCE:
Dabney Ewin: Sex abuse trauma differs from earthquakes because the abuser says, “If you tell anybody I’ll kill you.” This is like a post hypnotic suggestion, which is carried out compulsively when given to the victim during fear.
Dale: How to we account for the vigor in the attempts of each side to convince the other. The people who have been real victims of sexual abuse need to be able to talk with the people who are victims of False Memory Syndrome. The impact on a family is just as traumatic as the sexual abuse itself.
1993
Alden, Phyllis A. (1993, October). Hypnosis in the treatment of posttraumatic stress. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
NOTES
[Author is at Grimsby Hospital in England.] Discussion of practical aspects of treatment of PTSD. Work began with Janoff-Bulman (1985) and Epstein (1990) focuses on cognitive appraisal. Affect and meaning are shunted into unconsciousness. She observes that when patients report intrusions, there are pieces missing from the memory: they recall the horror but not the positive part.
Used the following technique: Ask patient to get comfortable and imagine being in a theater; then go to a projection room where she can control all parameters; then watch herself watching a pleasant film; then the scene; then return to a seat in the theater and watch the upsetting film, freezing it; when uncomfortable, describe associations; then return to projection room where she watched film of what she imagined might have occurred–the image behind the image, that holds the affect; then going back to image and playing it through, with more comfort; then leave the theater and go into the film, into the screen, to go through the scene. Then asked patient to get back the intrusive image and go through it, which she did with comfort.
With another patient she introduced the “current” person into the image to reassure her that everything would be all right–i.e. she would survive. This is called “double dissociation method.”
She also has the patient tell people in the scene what they should have done, or express anger verbally toward them, etc. Or she might have them make the intrusive imagery less threatening or amusing by introducing other imagery.
Cardena, Etzel (1993, October). Trance and possession as dissociative disorders: How exotic are they?. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
Joke: “What happened to the possessed patient who didn’t pay his exorcist?” Answer: “He got repossessed.”
Began with a quotation of Lagerkvist’s book describing possession of a Sybil in Greek temple. Possession is part of religious experience worldwide, that he is not discussing here.
The revised diagnostic manual, ICD-10, has included “dissociative trance disorders.” To diagnose this one must have either trance (narrowing awareness or focusing and stereotyped movements, behaviors) or possession trance (replacement of sense of personal identity by a new identity, with stereotyped culturally-determined behaviors or movements that are experienced as being controlled by the possessing agent), *and* full or partial amnesia for the event. Cardena emphasizes it doesn’t need to be full amnesia.
To be diagnosed as dissociative trance disorder, the trance or possession state observed cannot be a normal part of a broadly accepted cultural or religious practice, and it must produce distress or maladjustment.
These are the most common type of dissociative disorders in non-Western cultures, e.g. 90% in India. So this diagnosis in India is not “atypical.” “Non-Western” applies to 80% of the World and 1/3 of the USA population. DSM is trying to expand cultural relevance.
Also, even in the Western culture Allison and others have published cases of dissociative trance disorder, and others have described trance disorders:
Spiegel & Spiegel’s Grade 5 personality is vulnerable to dissociative disorder. Hartman’s chronic nightmare patients have “boundary thinness” (i.e. they are not clear if they are awake or asleep, lack separation from themselves and others). Lynn & Rhue’s fantasy prone individuals, 22% of people, are vulnerable to maladjustment.
Cardena’s recommended change in diagnosis of dissociation is critiqued in Transcultural Psychiatric Research Review (1992). Criticisms of the new diagnosis, published int that journal, are: 1. Culture-bound syndromes cut across Western diagnostic boundaries. 2. The diagnosis may be insensitive to the cultural context in which phenomena occur (e.g. distress may lead a person to participate in a cult of affliction) and it may require anthropological sophistication of diagnosticians or consultation with someone who has that knowledge. 2a. It may disregard considerations such as who has the power to “authorize” the phenomenon, under what circumstances, etc. [That would be true with any diagnosis however.] 3.Dissociative Trance Disorder may assume greater within and across-culture uniformity for the conditions than is warranted. 4. It may give validity to metaphysical explanations for spirit possession. [But in psychiatry we often use terms that don’t take into consideration validating metaphysical explanations, e.g. “phantom limb” pain. 5. The medical model that underlies DSM is inappropriate for ontological considerations on the nature of the self. [But those with this diagnosis give us some understanding, not what the ultimate nature of the self and consciousness are. Diagnoses are pragmatic ways of dealing with problems.}
At the present time, the diagnosis of Dissociative Trance Disorder is included in the Appendix of DSM-IV.
For further elaboration of this material, see Cardena, E. (1992). Trance and possession as dissociative disorders. Transcultural Psychiatric Research Review, 29, 283- 297.
London, Ray William (1993, October). Refreshed adult memories: Abuse survivor or therapeutic victim?. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
The author addresses four areas: 1. public policy 2. psychological issues 3. legal issues (evidence) 4. how to properly deal with it
A definition of sexual abuse is being applied to behaviors that for years were not considered out of bounds (e.g. entering a bathroom where someone else is). Furthermore, using the word “survivor” for abused people equates patients with survivors of concentration camps, who do not present with repressed memories typically. National incidence of child abuse remains unclear estimates are 6 to 60% of females. In Florida, only 13% of cases reported are confirmed.
Some therapists who specialize in this area in surveys indicate that they have false beliefs regarding memory and effects of trauma.
[These represent only partial notes on a lengthy and substantial paper.]
Rhue, Judith W.; Lynn, Steven Jay (1993, October). Dissociation, childhood sexual abuse, and fantasy. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. We are reporting on part of an ongoing study, with results still being analyzed. We are looking at imagination, fantasy, and dissociation in abused and non-abused children. This focuses on the relationship between dissociation and fantasy and imagination.
For Janet, dissociation was the primary defense against trauma. [Quotes D. Spiegel also.] There is a body of research on trauma associated with the development of dissociation. 1. NIH found 97% of multiple personality patients reported trauma in childhood; 83% were sexually abused; 75% were repeatedly physically abused; 68% had both types of abuse. 2. Bliss – studied 70 MPDs and found same results. 3. Ross, Norton, and Noosney [?name] – found same results 4. Coombs & Milstein – same
The incidence of retrospective reports of abuse is much lower in other types of patients.
So, what is going on during child abuse? We wanted to look at children experiencing or who recently experienced abuse. Also looked at a children’s scale of dissociation symptoms and validated other studies.
We studied 39 children referred to Ohio University College of Osteopathic Medicine; 12 had primary problem as sexual abuse (8 of whom were female). Non-abused Ss were either behavioral or adjustment disorders. 8 reported severe physical abuse. Parents concurred in presence of abuse. Physical abuse consisted of broken bones, burns, etc. Average age 9-10.
Ss were given the Beck Depression Scale, Children’s Fantasy Inventory, Meyers’ Children’s Creative Imagination Scale, Children’s Perception Alteration Scale, Figure Drawings, WISC-R, and 2-3 other measures. Research assistants administering the scales didn’t know the children’s diagnoses.
We found no support for the hypothesis that sexual abuse in childhood is associated with imagination, fantasy, or dissociative tendencies–not surprising considering that only 4 Ss were abused by their father or stepfather, 2/3 of Ss had fondling as the most severe abuse they had experienced; only 2 had intercourse; 2/3 were abused only 1-3 times. Sexual abuse that is not violent, severe, prolonged, or perpetrated by a parent may not lead to the same problems.
In a sample of women whose assaults were rape, only 25% reported it as rape.
On other hand, physical punishment was more reliably associated with dissociation (.47), imagination and fantasy in absorption scale (.41-.51 with question about using imagination to block awareness of punishment). Physical punishment was associated with increased dissociation.
Sample size is small and the trend is in the predicted direction, so later results may be significant.
Conclusion: measures of fantasy, dissociation, and imagination were correlated. Children’s Perception Alteration Scale and the measures of fantasy and imagination were validated. Diverse measures of fantasy were highly correlated with one another.
We need a non-abused sample to add to this research.
The clinical sample had a higher dissociation score than Evers, Sanders, and Shostick’s cutting score. We use 60 as a cutting score (for an abused sample) while they used 55.
COMMENTS FROM THE AUDIENCE:
Jack Watkins: the sexual abuse for the most part was not painful. Answer by Rhue: The group of sexual abuse cases includes very wide varieties of experiences; we need to examine that in our research. Also, trauma and the perception of trauma is an individual matter.
Etzel Cardena: We presented a paper at APA in which sexual abuse was a predictor of psychogenic seizures, and most important, the duration of the abuse.
Phyllis Alden: In a recent study in Germany, it was length of time for the abuse that predicted [dissociative symptoms?].
Spiegel, David; Koopman, Cheryl; Classen, Catherine; Freinkel, Andrew (1993, October). Dissociation, trauma, and DSM-IV Acute Stress Disorder. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
This represents a progress report on the research in our laboratory, which is different from traditional approaches that link childhood trauma to current problems. We say if there is a link between dissociation and trauma, one should find the symptoms in people who have trauma.
Earthquake Research:
They examined data from Loma Prieta earthquake; Stanford had $164 million damage. Oct 1989. [Presents data that he has presented before.] There was a drop in dissociative symptoms over 4 months. McFarlane found that numbing was the best predictor of later PTSD symptoms, and we find that too.
Most trauma researchers have focused on anxiety because that is what they are interested in; they have ignored dissociative experiences, because such symptoms are designed not to be noticed.
Andrew Frankel and Cheryl Koopman studied 15 journalists who saw Robert Alton Harris’ execution–volunteers who reported on the execution, to whom the event did not personally threaten. 40% reported depersonalization experiences, 2/3 felt detached or estranged from others, 27% had problems remembering everyday activities, etc. Dissociative symptoms were especially high in TV journalists, lowest in radio journalists, and in the middle range in newspaper reporters.
Oakland Fire Research:
Koopman & Classen looked at immediate psychopathology and later problems. They studied people of low, medium, and high exposure as defined by distance from the fire, which related strongly to both dissociative and anxiety symptoms.
There were strong relationships between the Mississippi PTSD scale scores and anxiety and dissociative symptoms (.50 and .59 respectively). People who reported recent life stress in the intervening period had higher PTSD and dissociative symptoms. The combination of initial dissociation and subsequent stress was additive in their relationships to PTSD.
People who had higher dissociation scores tended to do higher risk things (e.g., cross police barriers). This may explain how clinicians see patients who appear to get themselves re-victimized.
Law Office Shooting Research:
We followed up on the 1993 shooting of 14 people (8 fatally) in a law office in San Francisco. Survivors filled out dissociation questionnaires in the office (N = 36). They had high scores on the Impact of Event Intrusion Scale. The more they thought they or colleagues were in danger, the higher their scores on anxiety and dissociation measures and on Impact of Event scale.
Dissociation Definition:
These studies led to a project, with Etzel Cardena, in trying to revise DSM-IIIR, which doesn’t capture the symptoms [of post traumatic dissociation]. In DSM-IV there will be the diagnosis of 308.3 Acute Stress Disorder, characterized as: A. Same as DSMIIIR, except it doesn’t require that the trauma be “unusual” B. Requires 3 of 5 dissociative symptoms. C, D, and E are classic dissociative symptoms F, G, and H are delimiting factors (e.g., causes significant impairment, length of time, not due to other factor).
Also, the multiple personality disorder (MPD) diagnosis has been changed to Dissociative Identity Disorder. The problem for these patients is not in having more than one personality, but not having one _functioning_ personality.
Watkins, Helen H. (1993). Ego-State therapy: An overview. American Journal of Clinical Hypnosis, 35, 232-240.
Ego-state therapy is a psychodynamic approach in which techniques of group and family therapy are employed to resolve conflicts between the various “ego states” that constitute a “family of self” within a single individual. Although covert ego states do not normally become overt except in true multiple personality, they are hypnotically activated and made accessible for contact and communication with the therapist. Any of the behavioral, cognitive, analytic, or humanistic techniques may then be employed in a kind of internal diplomacy. Some 20 years experience with this approach has demonstrated that complex psychodynamic problems can often be resolved in a relatively short time compared to more traditional analytic therapies.
1992
Claridge, Karen (1992). Reconstructing memories of abuse: A theory-based approach. Psychotherapy, 29, 243-252.
The recovery of traumatic memories is an important part of therapy with survivors of abuse. This article describes a conceptual framework for memory reconstruction based on Horowitz’ (1986) theory of stress response syndromes. The client’s history of intrusive symptoms provides a way to anticipate the nature of the trauma, even when no memory of it exists. Ongoing intrusive symptoms are used to retrieve memory fragments, and their emotional impact is used to build the client’s emotional tolerance. Emphasis is placed on preparing for memories by identifying what the client will need when the memories return, building coping skills, and beginning to restructure cognitions at the “what if” stage of remembering. Case material is used to illustrate.
Darken, Rachel (1992). Hypnosis in the treatment of survivors of sexual abuse. Australian Journal of Clinical and Experimental Hypnosis, 20, 105-110.
This paper outlines the problems of child sexual abuse and its long-term sequelae, often reaching down generations. In psychotherapy with survivors of childhood sexual abuse, hypnosis offers a flexible treatment modality and the paper focuses particularly on the use of hypnosis and self-hypnosis for the “reparenting” element of psychotherapy.
Faller, Kathleen Couborn (1992, Summer). Can therapy induce false allegations of sexual abuse?. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 3-6.
NOTES: “Concern about the impact of therapy on children’s accounts of sexual abuse should be understood in the context of two phenomena: (1) the adult need to deny that children are sexually abused, and (2) adult identification with the alleged abuser. These phenomena operate at both individual and societal levels” (p. 3).
“Research related to impact of stressful situations on children’s ability to recall provides mixed results, some studies finding children are less accurate if the event is traumatic (Peters, 1991) and others finding they are not (Goodman, Reed, & Hepps, 1985).
“Research reveals that it is rare for children to falsely allege that they have been touched in their private parts. In one study, a substantial proportion of children who experienced genital and anal touch during a physical examination by a doctor did not volunteer this information when asked general questions about the examination. The majority of children in the study revealed genital and anal touch only when they were asked specific questions like, “Did the doctor touch you there?” (Saywitz, Goodman, Nicholas, & Moan, 1991)” (pp. 3-4).
“Clarke-Stewart and her colleagues (1989) have demonstrated that children’s interpretation of ambiguous events can be manipulated and altered by an authority figure who insists upon a particular interpretation (see also Lindberg, 1991)” (p.4).
“In sum, the research suggests that older children are likely to provide more complete unassisted disclosure than younger children. Younger children may need more memory cues in the form of specific questions than older children. Therapists are much more likely to find false negatives than false positives. Finally, therapists should be aware of the possibility the child may identify the wrong person. … Generally, however, the research indicates that concern about the contaminating effects of therapy on children’s recollections of sexual abuse is exaggerated” (pp. 4-5).
“Research indicates that the proportion of fabricated reports may be higher in the divorce scenario than in other contexts (Faller, 1990; Jones & Seig, 1988). Studies suggest most false reports are made by adults, not children (Jones & McGraw, 1987; Jones & Seig, 1988)” (p. 5).
“Clinical research (Sorenson & Snow, 1991) and experience (Faller, 1988) indicate that for most children, revealing sexual abuse is a process which occurs over time. A typical pattern is one in which children begin with the least overwhelming experience and gradually disclose more and more as their accounts are accepted and believed” (p. 5).
“[In conclusion]… therapists should be aware of the findings from research on children’s memory and suggestibility. This research indicates that there are vulnerabilities which should be taken into account during therapy” (p. 6).
Murrey, Gregory J.; Cross, Herb J.; Whipple, Jim (1992). Hypnotically created pseudomemories: Further investigation into the ‘memory distortion or response bias’ question. Journal of Abnormal Psychology, 101 (1), 75-77.
In order to study whether pseudomemories represent actual memory distortions or are a result of response bias, 60 highly hypnotizable subjects and subjects from the general population were divided into 4 experimental groups and were tested for pseudomemory manifestation after receiving a false suggestion. Of the 4 groups of subjects, 3 were offered a monetary reward as a motivation to distinguish false suggestion from the actual occurrence. Pseudomemory manifestation was found to be significantly higher among subjects not offered a reward than among subjects who were offered such a reward. The implications of these findings are discussed.
NOTES
The article contains a review of the literature through 1989. The study tested the hypothesis that when it is important to distinguish fantasy from reality in a hypnosis experiment, subjects can do so–a position presented by Spanos and McLean (1986). They used a verifiable event to test for pseudomemory production, as in research published by McCann and Sheehan (1988). Subjects were 30 high hypnotizable and 30 unselected students.
Subjects were shown a videotape of a mock robbery scene. The next week, Groups A, B, and C heard audiotapes “to enhance memory,” but in addition to motivating statements about “trying to remember” certain details, the tapes included misleading information (e.g. “Remember the color of the hat the robber was wearing” when in fact there was no hat on the robber). Subjects in these groups were ‘influenced.’
“Both highly hypnotizable subject groups (Groups A and B) listened to the audiotape after being administered a 10-min hypnotic induction procedure (modified from that of Barber, 1969). Subject Group C listened to the audiotape without hypnosis. The control group, Group D, did not listen to the audiotape and was, therefore, classified as ‘uninfluenced.'”
A week later subjects responded to multiple-choice and yes-no or true-false questions about the robbery scene. The yes-no question about whether the robber was wearing a hat served as the dependent variable, a measure of pseudomemory. “To motivate subjects to report the truth rather than to follow any perceived expectations of the experimental of social context, we offered subjects in Groups B, C, and D a monetary reward if they achieved the most correct answers on the quiz (according to the videotape). The reward was offered just before administration of the quiz to ensure that no collusion between the subjects could occur. Group A was not offered any such reward” (p. 76).
“The number of subjects in Group A (hypnotized, influenced, no reward) who reported the false information at posttest (12) was significantly greater then that of Group B (hypnotized, influenced, offered reward…. However, the difference in incidence of pseudomemory between Group B and the control group, Group D (not hypnotized, uninfluenced, offered reward), was nonsignificant” (p. 76).
Table 1 Incidence of Pseudomemory Per Group ——————————————————————————————- False suggestion Group A Group B Group C Group D
result (n=15) (n=15) (n=15) (n=15) ——————————————————————————————-
Accepted 12 6 7 3
Rejected 3 9 8 12 —————————————————————————————— Note. Group A = hypnotized, influenced, not offered reward.
Group B = hypnotized, influenced, offered reward.
Group C = not hypnotized, influenced, offered reward.
Group D = not hypnotized, not influenced, offered reward.
In the Discussion, the authors wrote, “Because the only variable among these groups was the reward, a reasonable conclusion from the findings is that pseudomemories manifested by the subjects were (for the most part) not actual memory distortions. Presumably, the reward provided the subjects in Group B an incentive to ‘report the truth’ and a disincentive to give biased reports on the basis of the perceived expectations of the social or experimental context. Thus these data suggest that pseudomemory effects or the occurrence of the pseudomemory phenomenon among highly hypnotizable subjects can be minimized by providing a motivation to subjects to give unbiased reports.
“A major implication of these findings is that researchers should control for response bias resulting from perceived social demands or from leading test designs when they conduct pseudomemory research. Of further concern is the fact that a number of researchers contend that hypnotic interrogation of eye-witnesses can greatly facilitate the creation of pseudomemories (Levitt, 1990; Loftus, 1979; Orne, 1979; Putnam, 1979), and therefore hypnosis either should not be allowed in the courtroom or should be strictly controlled. Yet in light of our findings, response bias may be a confound in pseudomemory research, and thus researchers need to be cautious when making inferences to specific situations from data obtained in an experimental setting.
“Despite the existence of a confound of (unmeasured) differences in hypnotizability between the two groups, there was no significant difference between Group B and the control group (Group D). This suggests that if response bias is controlled for, there may not be significant differences in manifestation of pseudomemories between highly hypnotizable subjects and subjects representative of the general population. However, further research is needed in order to address this question” (pp. 76-77).
Ofshe, Richard J. (1992). Inadvertent hypnosis during interrogation: False confession due to dissociative state; mis-identified multiple personality and the satanic cult hypothesis. International Journal of Clinical and Experimental Hypnosis, 40, 125-156.
Induction of a dissociative state followed by suggestion during interrogation caused a suspect to develop pseudo-memories of raping his daughters and of participation in a baby-murdering Satanic cult. The pseudo-memories coupled with influence from authority figures convinced him of his guilt for 6 months. During this time, the suspect, the witnesses, and all the evidence in the case were studied. No evidence supported an inference of guilt and substantial evidence supported the conclusion that no crime had been committed. An experiment demonstrated the suspect’s extreme suggestibility. The conclusion reached was that the cult did not exist and the suspect’s confessions were coerced- internalized confessions. During the investigation, 2 psychologists diagnosed the suspect as suffering from a dissociative disorder similar to multiple personality. Both psychologists were predisposed to find Satanic cult activity. Each concluded that the disorder was due to “programming” by the non-existent Satanic cult.
Perry, Nancy W. (1992, Summer). How children remember and why they forget. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 1-2; 13-16.
‘My memory is the thing I forget with.’ (a child’s definition, cited in Grossberg, 1985, p. 60)” (p. 1).
“Unlike the simpler forms of memory retrieval, free recall is strongly age-related… the recall skills of preschool children develop gradually” (p. 2). “…in some cases, younger children can provide _more_ accurate information than adults (Lindberg, 1991). For example, if an event is particularly salient (as sometimes happens in cases of trauma), recall may be exceptionally good (Brainerd & Ornstein, 1991; Lindberg, 1991)” (p. 13).
“Children have limited ability to use memory strategies. For this reason, children often know more than they can freely recall” (p. 13).
“The use of _rehearsal_ as a memory strategy is almost automatic for adults. … Ten-year-olds also commonly use rehearsal to aid memory. Young children, however, have not mastered rehearsal (Harris & Liebert, 1991).
“Another memory strategy is imagery, which involves (1) mentally picturing a person, place, or object, or (2) visually associating two or more things that are to be remembered. Children develop imagery much later than other memory strategies. Indeed, some people never learn this memory strategy (Flavell, 1977)” (p. 13).