Repressed and Recovered Memories: Implications for our field

By David S. Prescott, LICSW

Many professionals (and the lay public) came of age at a time when it was believed that traumatized people commonly repressed all memories of having been abused. It made sense at the time: If the abuse was bad enough, the mind could just completely block it from memory. The mind is an amazing thing, right? The motivations were certainly positive, with the idea that bringing abuse to light could help people to live better lives. Those who lived through those times will recall that these recovered memories often occurred against a backdrop of maxims such as “always believe the victim” without questioning the methods by which people came to believe themselves to have been victimized.

Not long after these efforts, researchers came along and produced findings that were nowhere near that simple. Elizabeth Loftus has become a champion of explaining the myriad vagaries of memory, while Scott Lilienfeld has documented a number of ways that false memories have caused life-altering harm. In a conference presentation on hypnosis in therapy attended by the first author, Michael Yapko once described the recovered memory movement as a near-death experience for hypnotherapy. Havoc ensured, often referred to as the “memory wars”. Since those days, it has been increasingly clear that people might not remember every detail of their traumatic past, but research simply hasn’t confirmed the complete repression/blockage of memory that has driven so many therapeutic interventions.

Within the past month, Henry Otgaar, Mark Howe, Lawrence Patihis and their colleagues (including Scott O. Lilienfeld and Elizabeth Loftus) have just published a paper on the current status of “recovering” memories of trauma that clients had long repressed. A pre-publication version can be downloaded here. The findings are sobering. From the abstract:

We show that the belief in repressed memories occurs on a non-trivial-scale (58%) and appears to have increased among clinical psychologists since the 1990s. We also demonstrate that the scientifically controversial concept of dissociative amnesia, which we argue is a substitute term for memory repression, has gained in popularity. Finally, we review work on the adverse side effects of certain psychotherapeutic techniques, some of which may be linked to the recovery of repressed memories. The memory wars have not vanished: They have continued to endure and contribute to potentially damaging consequences in clinical, legal, and academic contexts.

To be clear, the authors are referring to repressed memories as the “complete blockage” of memories related to trauma. There’s no question that our minds can distance us from painful memories, but the standard response to trauma is more likely to be the inability to forget about it. There is any number of implications that follow.

First, there is a question about the sequelae of adversity and trauma as experienced at different ages. Under what conditions does it become unhelpful to explore past experiences? Examples from recent publications provide points to consider. A recent BBC article explored the concerns of clients in treatment having to describe their abuse of others in excruciating detail. A recent book describes, also in detail, the role of recovered memories in the infamous Jerry Sandusky case, and the harmful effects of treatment administered with the assumption that it was helping. Whether one is exploring what one has done or had done to them, it is vital to recall that treatment poorly delivered is not a benevolent event; any problem professional can make better they can almost certainly also make worse.

Second, whether treating abuse or preventing further harm, it can be easy to minimize the vulnerability and suggestibility of clients in treatment. Research into coerced false confessions is just one example of how powerful professionals can be, and how easily they can manipulate the people in their care. Can therapists seeking to uncover past events be certain that they are not involved in similar processes?

It maybe worthwhile for professionals to return periodically to the codes of ethics of their professions in order to consider the risks and benefits of the programming they deliver and to reconsider to what extent they have the truly informed consent of their clients. Likewise, there remains a question of what the least restrictive alternative is: Do programs that compel complete accountability inadvertently create new risks or cause new forms of harm that our field hasn’t yet explored?

Ultimately, with all of the sequelae from trauma and adversity in evidence in the lives of so many clients, it seems there is a question of why we don’t spend more time looking forward at constructing a better life and less time over-emphasizing the deconstruction of the past. Important to emphasizes is that many programs are working today to get this balance right, and many resources exist for providing treatment for abuse and aggression that minimize the potential risks. The findings of Otgaar et al described above are not entirely new. However, they do point to the ongoing necessity to consider our actions. It seems that while therapeutic fads come and go, we still face obstacles to understanding and helping our clients.

ATSA Engagement event 2019

Over the last five years as part of its annual conference ATSA a public engagement event on the issue of sexual abuse and how we can engage communities in preventing it as well as responding to it; this year is no exception! The engagement event at this year’s ATSA conference will take place at the Hyatt Regency in Downtown Atlanta on the 7^th November 2019 from 15.00 – 17.00 hours.

To register:  www.Eventbrite.com/e/understanding-and-responding-tosexual-abuse-tackets-68137201203

The aim of the event is to engage professionals who have safeguarding as part of their jobs, but that it’s not their main role, and therefore would not be attending the ATSA conference. These professionals would include, but are not limited to, teachers, nurses, health care professionals, social carers, foster carers, youth workers, members of charities and NGO’s or people who would with vulnerable groups. The event will consist of 4 talks, each approximately 15 minutes, followed by a question and answers session with the panel and a networking event with representatives from the conference, members of ATSA as well as GASTA (The Georgia chapter of ATSA). This year’s topics and speakers include;

Ann Snyder, MMS, is the Public Affairs Coordinator for ATSA. She has more than 20 years of experience in media relations and crisis communications. She will discuss ways to develop effective messaging, address controversial issues, use questions from the media and public as educational opportunities, and help ensure your organization's message is heard. Ann Synder

Hayley Entrekin, EdD, LPC, ATSAF, CPCS is the ATSA Georgia Chapter (GATSA) president. She works as the Clinical Director at Haralson Behavioral Health Services, which is a rural county mental health agency. She is also the owner of Response & Prevention Counseling, where she is an evaluator of juveniles who have been charged with a sexual offense and teaches children safety empowerment strategies as a radKIDS instructor. Hayley will be briefly discussing where Georgia professionals can seek help: From prevention to acute/emergency situations to how to find/coordinate services for those that have a history of sexually harmful behaviors. 

Tyffani Monford Dent, PsyD is a licensed psychologist and the Clinical Director at a residential treatment center in Ohio. Dr. Dent has served as a consultant and trainer under various federal and state grants in the areas of working with juveniles who have engaged in problematic sexual behavior, supporting survivors of sexual abuse, family reunification after sexual abuse, sexual violence in juvenile correctional systems, and prevention/response to campus sexual assault. She will be addressing her work on both sides of the aisle of sexual violence and the importance of the collaboration between those who work with survivors and those who work with those who cause them harm.

Jocelyn Cooper is the Georgia and East Coast Outreach Coordinator for The Younique Foundation. The Foundation's mission is to heal the one and protect the many from sexual abuse. She will be highlighting a few best practices that can serve as tools to empower everyone to lead the discussion on prevention and healing in their respective circles of influence.

Kieran McCartan, PhD, is a Professor of Criminology from the University of the West of England in the United Kingdom and a member of the ATSA Board of Directors. Kieran will be discussing the causes of sexual abuse, focusing on the many reasons why a person will commit a sexual offence and how we can by better understanding these reasons, effectively prevent and respond to sexual abuse. Kieran's presentation will focus on sexual abuse from a  health, social and developmental perspective, rather than just looking at the issue from a criminal justice one.

We look forward to meeting you at the event.

Halloween and sexual abuse prevention: The mythical “Halloween effect”

A statement from the Association for the Treatment of Sexual Abusers.

As October arrives and families begin preparing for Halloween, it is always a priority to ensure children’s safety during this holiday. It is important to learn the facts and know the risks to your child during this festive time. A heightened risk of being sexually abused is NOT one of the dangers children face at Halloween.

The simple fact is that there are no significant increases in sex crimes on or around Halloween. There is no “Halloween effect.” There is no change in the rate of sexual crimes by non-family members during Halloween. That was true both before and after communities enacted laws to restrict the activities of registrants during Halloween.

The crimes that do increase around Halloween are vandalism and property destruction, as well as theft, assault, and burglary. In addition, according to the Centers for Disease Control, children are four times more likely to be killed by a pedestrian/motor-vehicle accident on Halloween than on any other day of the year.

Fully 93% of sexual assaults on children are perpetrated by someone known to, and trusted by, the child and the child’s family. But due to the myths regarding child sexual abuse that focus on “stranger danger,” communities and lawmakers often endorse policies that do little to prevent sexual abuse and instead unnecessarily stretch limited law enforcement resources.

Jurisdictions that ban individuals on sex offender registries from participating in any Halloween activities, require registrants to post signs in their yards during Halloween, or round up registrants for the duration of trick-or-treating do not make children safer. Instead, these approaches create a false sense of safety while using law enforcement resources that could be better spent protecting children against the higher risk they do face during Halloween – injury or death from motor vehicles.

Child sexual abuse is a serious public health issue that faces all communities. Although the prevalence of child sexual abuse can be difficult to determine due to under-reporting, researchers estimate that one in four girls and one in six boys will be victims of sexual abuse before age 18.

For concerned parents, the best way to protect children from sexual abuse is to know the facts about sexual offending and take precautions based on facts, not fears. Parents can visit www.atsa.com to learn more about sexual abuse and prevention.

For more research and analysis on this topic please see a previous blog by Jill Levenson called “Halloween & Sex Crime: Myth vs. Reality” – Kieran

NOTA Annual Conference 2019

By Kieran McCartan, PhD., & David Prescott, LISCW

This is a reprint of a NOTA Blog - Kieran

The annual NOTA conference took place from the 18^th – 20^th September in Belfast. NOTA, the National Organisation for the Treatment of Abuse, is a long-time partner to ATSA. This year’s conference was a real mix of research, practice, and engagement with over 300 colleagues from across the UK, Ireland and internationally in attendance (with attendees and speakers from a range of countries including the USA, Gibraltar, Norway, Ireland, and from all four countries of the UK). The conference focused on abuse within and across systems, with even Brexit getting a mention. In this blog we are going to take you on a whistle-stop tour of the event.

The 2019 plenaries combined research, practice and innovate approaches from a very broad group of speakers. The Conference started on Wednesday with Professor Teresa Gannon presenting the findings of her recent meta-analysis, which included this year's HMPPS report, on the effectiveness of treatment programs for men convicted of a sexual offense. The headlines from Professor Gannon’s presentation was that treatment does have a positive effect on behavior change, including recidivism, compared to none and that the role of consistent, well trained and engaged providers is important. Following on from this we had a “conversation with Karl Hanson” whereby Professor Don Grubin discussed with Karl a combination of pre-submitted audience questions and his own thoughts. The topics ranged from risk assessment, treatment, risk management and professional practice; it was an insightful alternative to a traditional keynote that allowed participants to gain more of an insight into Karl’s work and thinking. The Thursday started with a keynote from Professor Anne-McAlinden on peer-to-peer abuse, based on NOTA research committee funded work (a good a reminder of the annual research grant scheme that was also launched at the conference), which indicated that we need to potentially reconceptualize risk in the context that young people live and doing so would enable us to prevent as well as respond to sexual abuse better. The was followed by a trio of Ireland based practice initiatives which were focused on children who committed sexual harm and/or engagement with their families (Carol Carson talking about AIM 3; Rhonda Turner talking about the work of the National Inter Agency Prevention Program; and Gareth McGibbon talking about the development of the Capacity & Ability to Supervise and Protect Framework [CASP]), all of which demonstrated best practice and a series of tools that conference attendees could take home with them. The final day of the conference opened with Professor Erick Janssen discussing research on sex, emotion and risk, followed by a roundtable of police experts (from England, Ireland, Wales, Scotland, Northern & Gibraltar) on the potential impact of Brexit on cross border co-operation and data sharing. The roundtable was fascinating and raised several questions about the impact of a no-deal Brexit and the issues that changing data sharing agreements would have on risk management, background checks, and deportation. The conference closed with a powerful and very relevant piece by the Geese theatre group examining the interactions of abuse within the family system and how it spills into other closely aligned systems (school, sport and the community). 

The conference had 40 parallel sessions with over 50 speakers across the Wednesday and Thursday afternoon, spanning a full range of topics and speakers (of which this is just a flavor) including, integration of people who have sexually offended back into the community (Public Protection Arrangements Northern Ireland), people who have committed sexual abuse as service users and hearing their views (Kieran McCartan, David Prescott; Lynn Saunders; Karen Martin), trauma-informed care (Catherine Gallagher, Maggie Tai Rakena); youth who sexually harm (Carol Carson; treatment (David Briggs; Adam Deming; TUSLA; AIM project Eleanor Woodford & Ben Evans; Gallagher; Geraldine Akerman); sibling sexual abuse (Jacqueline Page; Melissa Maltar, Nancy Falls): 3 sessions dedicated to research and another on important issues for practitioners in critically engaging with research by the research committee. The workshops were a good mix of research, evaluation, practical working, professional learning, and knowledge exchange.

In addition to the traditional conference activities NOTA 2019 also had an engagement event that was open to all co-organised with Public Protection Arrangements Northern Ireland and took place away from the conference site. We advertised the engagement event to professionals who have safeguarding as part of their jobs, but that safeguarding is not their main role (and therefore would not be attending the NOTA conference) including, teachers, foster carers, members of charities and NGO’s, etc. We had 60 participants sign up to attend the event, all of whom attended.  The session heard from national (DSI Paula Hamilton, Julie Smyth & Kieran McCartan) and international (Eileen Finnegan & Maia Christopher) speakers about the etiology, prevention and risk management of people convicted of sexual offenses in the community.

NOTA 2019 saw Professor Simon Hackett step down as Chair of NOTA and Professor Sarah Brown take over the role. Unfortunately, Simon could not be in Belfast with us but his contribution to the organization was applauded in his absence and he was thanked for all his hard work. Also, NOTA 2019 was Gail McGregor’s last conference as conference chair and she too was thanked for all her hard work.

  

NOTA 2019 fitted a massive amount of material in across three days, which left us informed, refreshed and looking forward to next year’s meeting in Leeds.

The purpose and outcomes of treatment

By David S. Prescott, LICSW, & Kieran McCartan, Ph.D.

As we prepare for this year’s NOTA conference, we have been again discussing many of the controversies of our field, among these are the effectiveness of the work that we do. An important 2017 article by Karl Hanson and his colleagues is among the most recent to indicate that truly low risk/need people very often require no abuse-specific treatment at all. We certainly agree and continue to urge considerable thought in this area, as we did in 2017. However, it’s important to distinguish abuse-specific treatment from other mental health services that can help people lead a more fulfilling lifestyle in which offending is undesirable and unnecessary. One concern we have in the subsequent discussions is that it may become easy to confuse “doesn’t need treatment aimed at reducing his risk” with “doesn’t need treatment, period.” This leads to broader questions about what our goals are when providing treatment.

Criminal justice policy and practice, internationally, typically indicates that something should be done with people convicted of an offence, including sexual offences, parallel to their punishment/incarceration. These programs, including treatment and other interventions, are usually pro-social, educational and designed to help people integrate back into society and desist from future offending. However, it might behoove each us to ask ourselves honestly what our motivations are in believing in the effectiveness or ineffectiveness of abuse-specific treatment. Is it that we believe that an individual should receive treatment because it is the best outcome for them or is it because we feel that we are providing treatment to someone because something needs to be in response to their problematic behavior and treatment is the path of least resistance in the public as well as the political domain? Do we believe in treatment because we believe that people can change or because we want to be seen to be doing something and that treatment is an acceptable outcome? To what extent do we view treatment, and the accountability it brings, as part of required punishment and/or justice for the people who have been convicted of a sexual offence? Therefore, what is the purpose of treatment, especially “mandated” treatment?

Different readers will have different responses to the questions above. Much debate in our field has emerged from findings such as those by Schmucker and Lösel in 2015. That study found re-offense rates of 10.1 and 13.7 percent for treated and undertreated people convicted of sex crimes respectively. Although this represented a relative reduction of 26.3 percent, the numbers are clearly not what anyone would like them to be. Nonetheless, other studies have found that people who abuse very often believe that treatment is important and can be helpful. How should we understand all these findings?

A recent article in the New Yorker addressed problems in understanding statistics. Within the article, the author took note of a now-classic study:

Take a clinical trial on aspirin run by the Oxford medical epidemiologist Richard Peto in 1988. Aspirin interferes with the formation of blood clots, and can be used to prevent them in the arteries of the heart or the brain. Peto’s team wanted to know whether aspirin increased your chances of survival if it was administered in the middle of a heart attack.

"Their trial involved 17,187 people and showed a remarkable effect. In the group that was given a placebo, 1,016 patients died; of those who had taken the aspirin, only 804 died. Aspirin didn’t work for everyone, but it was unlikely that so many people would have survived if the drug did nothing. The numbers passed the threshold; the team concluded that the aspirin was working.

The story of these findings is a reminder that our findings are best understood when placed into a broader context. Obviously, there are differences between baby aspirin (where the benefits will nearly always outweigh the risks) and treatment for sexual abuse (where some clients have faced consequences from their treatment disclosures despite attempts to protect their rights against self-incrimination). Nonetheless, the numbers themselves remind us that even a small level of impact in sexual violence can produce dramatic improvements in the quality of life of both those who have abused and the people who won’t be abused thanks to our interventions. Marshall and McGuire compared various kinds of treatment in 2003, and in their conclusions suggested that “using a harm reduction index to estimate effect sizes for treatment with sexual offenders would produce more meaningful results.”

Although treatment for people convicted of a sexual offence is rooted in language around reducing reoffending, this may not be the only outcome we should consider. We must remember this! Treatment for people convicted of a sexual offence does not stop offending behavior, it provides individuals with the skills to understand and manage their behavior better. Treatment is a process and not an outcome! Hence, we need a “what works”, individualized approach that is orientated towards the client, what they need, what they respond too and what will help them change their lifestyle.

Whatever the finer points may be, we keep returning to what the research shows:

·     Across time, place, and setting, people can benefit from talking to professionals to get on track and stay on track with their lives.

·      Punishment-only responses have not worked in any of the large-scale analyses that have taken place (e.g., Smith, Goggin, & Gendreau, 2002)

·       Treatment for sexual aggression can help to reduce re-offense and build better lives

·   For those returning to the community, treatment combined with supervision can increase its effectiveness

·        As others have observed, the safest person who has abused is:

o   Stable

o   Occupied with work or education

o   Accountable to others in his or her life

o   Has Plans for the future

o   And has everything to lose by doing it again

As we move into conference season, with the NOTA and ATSA annual conferences occurring over the next couple of months, we can continue these discussions and consider how our policies can most effectively put these principles into action.