Controversies in the issue of "false memory syndrome" have been drawing extensive attention of the media and the public, as well as mental helath professionals, since the foundation of False Memory Syndrome Foundation (FMSF) in 1992. Involving the legal, political, scientific, and emotional issues of our society, the phenomenon of "false memory syndrome" has created the suitable target of the media in the chaos of information; that is, therapists. In this papaer, I will discuss the false memory phenomenon from the both sides' points of view: FMSF and those who criticize the foundation. Then, the possible causes for the development of false memory and suggestions for therapists are discussed. However, since the biggest controversy of this issue lies in the question whether memory can be repressed, the issue of repressed memory is discussed first.
Since Freud first explored the unconscious level of mind and its role in relation to childhood truma, the concept of repression has come to be widely known among those who study human mind (12). Although Freud used the word "repression" to refer to the defense from internal conflicts in a form of motivated banishment of materials from consciousness, today it is often used interchangeably with dissociation(6 9). Dissociation is a disruption in the unity and continuity of consciousness, identity, memory, or perception of the environment. A child who are exposed to repeated sexual abuses experiences dissociation as a cognitive skill to mentally escape from repeated physical pains and sufferings by sexual abuse (6). In fact, as the experience of sexual abuse prolongs over the extended point of time, the process of dissociation a child learned becomes automatic and unconscious and it is common among child sexual abuse (CSA) survivors to suffer from dissociative symptoms long after the abuse ahs been terminated (6). A review of researches show that CSA survivors sometimes lose their memory of abuse and some of them recover the memory after a certain period of time (6 12 7). Some of the researches even present corroborative evidence of CSA occurrence in order to validate the subjects' memory of abuse.
While the concept of repressed memory is mainly supported by psychoanalysists, however, it is not free from criticism. The biggest counterargument of repressed memory deals with a research methodology. Since most studies for represesd memory depend exclusively on subjects' retrospective self-report without the objective evidence, the validity of their subjects' responses is in question (2). Furthermore, many argue that subjects who report that they had time when they forgot the occurrence of CSA may in fact have not forgotten it but only have not thought about it (6 12 7). Deliberate avoidance of painful events may lead subjects to respond as having forgotten the events. In response to the criticism, Mollon (1996) argues that it seems difficult for CSA survivors in our society not to think about it because of the repeated information by today's media about CSA and survivors' trauma. According to Mollon, another avidene why the participants of the survey actually had recovered memory and not just have not thought about it is that some of them sought psychological help because they begun to recover some of the memories. If they have not lost memories of abuse at all, there is no reason why they suffer remembering it. In sum, even though there are some criticisms about it, the concept and occurrence of repressed and later-recovred memories seem to be generally in consensus among mental health professionals (10).
This is not to say, however, that every incident of recovered memory is actually based on the fact. It is very difficult to estimate and predict how much portion of their memory is true. Actually, there is no way or no criteria to distinguish false memory from memory of the actual event without external verification (15 7 10). This inability to discriminate false memory from true one, combined with relatively easy implantation of false memory udner certain circumstances (6 7 10 5), led to the foundation of False Memory Syndrome Foundation.
False Memory Syndrome Foundation (FMSF) was first founded by Pamela and Peter Freyd in March 1992 to help parents who were wrongly accused of CSA by their children. Those children claim to have recovered their memories of CSA but, according to FMSF, these memories are actually false. Pamela and Peter Freyd were themselves the parents who had been accused of CSA by their daughter, which they claim to be false, and they believed that the wrongly accused parents need help because they suffer from alienation and isolation from their children and other relatives and unreasonable stigma as a consequence of the accusation (14).
FMSF is now comprised of the parents of more than 4,000 families in similar circumstances. Their official goals include:
(1) to publicize the existence and prevalence of "false memory syndrome,"
(2) to provide information about the condition in which this syndrome is likely to happen,
(3) to help victims of this syndrome,
(4) to provide the victims with legal assistance, and
(5) to promote scientific research about this phenomenon (6).
Even though some people take an extreme side of FMSF claiming that CSA rates are overestimated and that even when CSA happens, the influence of CSA on psychological health of an individual is not significant (14), the general core claims of FMSF are not to de-emphasize the impact and harm of CSA but, instead, emphasize the malpractice of mental health practitioners, especially, therapists.
"False memory syndrome" can be defined as a condition in which a person strongly believes that he or she has a memory of traumatic experience, such as child sexual abuse which, in fact, have not occurred (6 15). FMSF claims that false memory can be "implanted" into people's mind through therapy, especially misleading questions and suggestion by a therapist. Specifically, memory can be distorted when people are exposed to a repetition of false information and insistent suggestion in therapy, sometimes combined with memory recovery techniques such as hypnosis (6 7 10). Enns and McNeilly (1995) argues, through their extensive review of memory research, that people's suggestibility in a therapy may increase when:
(1) false information is repeated and provided by authoritative sources, such as therapists and psychiatrists,
(2) false information seems plausible rather than implausible,
(3) there is a significant temporal gap between the time when they try to recall and event and the time when the event might have happened, and
(4) a therapist uses direct questions (yes/no questions) rather than indirect (free recall).
While Enns and McNeilly (1995) also conclude that the subjects in memory researches tend to have false memories about the details of an event rather than the central features of it, there are also research findings which show that personal experiences of sexual abuse or other traumatic events do not influence the rates or content of false memories (7). People, regardless of their true memory or experience, have possibility of developing false memories that are as vivid, internally coherent, and detailed as true memories under the right circumstances (7). This creation of completely false memory is possible because memory is not the exact re-experience of the past events but rather, it is a reconstruction of them (1 10).
Reconstruction of Memory: Our memory is influenced, from the beginning when we encode materials into memory, by our beliefs, wishes, expectations, feelings, perceptions, and inferences (1). The materials encoded are broken up into pieces when they are put into storage of memory under certain labels. Remembering is a reconstruction of these pieces that are retrieved based on the labels we put at the time of encoding. Our memory can be false because at encoding we may have had wrong labels attached to the certain pieces of memory or we may retrieve wrong pieces of memory under the similar labels as we try to remember. Therefore, developing false memories of CSA or any other event does not involve any mysterious or grandiose task as people may imagine. It may simply be reconstruction of wrong pieces of memory together, coming up with a single traumatic event when actually the memory is based on multiple events at different time and locations with different people (6).
However, the point here is not whether people may have false memory, since there is general consensus today that memory can sometimes be wrong, but how the role of therapy and a therapist fits into the development of CSA false memory.
Hypnosis: Hypnosis is one of the therapeutic techniques that may be used by a tehrapist, psychiatrist, or other mental health practitioners. People tend to experience higher level of suggestibility during being hypnotized (6) and FMSF claims that many people are implanted false memories by a therapist during hypnosis. In fact, evidence shows that the use of hypnosis and other memory recovery techniques, such as drug-assisted interview, has a higher risk of creating or distorting memories of clients (3 10). When a therapist uses hypnosis with suggestions or leading questions, those who are hypnotized may create completely false memory or conflate memories with their beliefs or emotions and thus distorting them and believe even more strongly that the memories gained through hypnosis are trues. Hypnosis certainly increases the client's conviction that the receovered memories are true, but it does not increase the accuracy of the recovered memory (6 3 10).
Also, some other therapeutical techniques such as guided-imaginary can induce the hypnotic-like state and memories gained through thte techniques are also very likely to be distroted (6). Therefore, we can safely say that the use of hypnosis as a mean of recovering accurate memories runs a risk of creating, or "implanting" as FMSF puts it, false memory.
Role of a Therapist: The use of suggestions, leading questions, hypnosis, and other memory recovery techniques all can be problematic in terms of creating false memory, especially when combined with a therapist's enthusiasm and pressure toward a client to recover repressed or simply forgotten memories. Some therapists either intentionally or unintentionally pressure their clients to recover memories and insist that remembering forgotten events will lead them to cure (15 5). However, there is no proof that recovery of memory is necessary for curing patients (10). For example, a research conducted by Spiegal shows no difference in patients' outcomes between therapy that focuses on past traumatic experiences and therapy that focuses on current functioning of the patients (Spiegal, 1994 cited in 7).
Also, as a therapist repeatedly encourages a client to recover memories, a client may create false memories of CSA to please his or her therapist (15). deRivera (2000) conducted a survey among 56 retractors (those who recovered memory of CSA and later come to the conclusion that the recovered memory was false) in FMSF and found that 77% of the participants responded that when they described how they had been abuseed, they received more attention from their therapists than when they talked about other things. Need for attention and approval from a therapist may well motivate clietns to come up with false memories of CSA.
Therapists' emphasis on and sometimes almost obsession with recovery of memory of their clients is derived from their inference of CSA occurrence as a cause of various symptoms. FMSF argues that since Freud started to study the influence of sexual experience on psychopathology, the importance of sexuality has been overemphasized by therapists regarding various psychological problems of their clietns (7). Even though we should not underestimate the impact of CSA on later behavioral and psychological problems of CSA survivors, it is a too simplistic way of thinking to conclude that all of those who have psychological problems experienced CSA. Therapists who pressure thier clients to "remember" CSA may simply be trying to satisfy their need for certainty (6).
As they attribute too many current symptoms to CSA history of thier clients, some therapists even try to convince their clients who reject the occurrence of CSA that they are in the state of denial, being aftaid of admitting the truth (6 15). Also, in too many cases, the feeling and belief of clients that CSA has occurred are seen as an evidence of the actual occurrence of CSA without any other proof.
Criticisms of FMSF
Although the foundation oand activities of FMSF drew and attention of many mental health practitioners as well as the public to the problems of mal-practiced therapy, it is still a fact that many whjo suffer from psychological problems, especially phobic, depressive, anxiety, and eating disorders, and borderline, sntisocial, and dissociative personality disorders, have CSA history (14). Studies showt hat 50 to 60% of psychiatric inpatients, 40 to 60% of outpatients, and 70% of all psychiatric emergency room patients report childhood physical or sexual abuse or both (cited in 14).
From a political point of view, underestimating and ignoring the harm of CSA on individual's state of mind is devaluing women who have less power in our society (6 2). The leaders and followers of the feminism movement argue that those who are accused of CSA are heard and paid attention by the media and the public more than victims and the victims are blamed as making an excuse and being irresponsible for their problems by accusing their parents (6 2).
Also, criticisms arose from mental health professionals that the media and the public are making an overgenralization of some mal-practicing therapists to the whole mental health professionals (4 3). Therapists who work with their clients with an abuse histopry are all seen as mal-practitioners who use memory recovery techniques such as hypnosis. People who recover memory of CSA during the course of therapy are automatically seen as creating or being implanted false memory (4). This overgeneralization is not an accurate picture of current mental health practices and may bring a problem, losing hte trust and credibility of the public toward practitioners.
Some mental health professionals also find it problematical that FMSF consider hypnosis as harmful regardless of hte purpose and content of it or the way it is practiced. If practiced in a poper way by the experts, and if the purpose of it is not to recover accurate memories, hypnosis can be one of the effective therapeutic techniques (10). Hypnosis can be effective with CSA survivors in increasing subjective well-being, managing problematic behaviors, engagin in self-soothing activities, coping with and decreasing painful traumatic symptoms, and redefining identities in positive way (6).
These criticisms are, however, directed toward extreme supporters of FMSF, who blame all the therapists and therapies and who ignore the harmful impact of CSA. General consensus among mental health professionals is that false memory of abuse can be created and sometimes, udner certain condition, that is what actually happens (10). Being awaew of the possibility that their clients may develop false memory, most therapists keep skepticism, hearing clients' stories of recovered CSA memory (14 8).
Gore-Felton et al. (2000) and Tobachnick, Barbara, and Pope (1997) conducted separate studeis of therapists' responses and judgments to CSA memories. Both studeis show taht most therapists do not make and immediate judment that CSA did or did not happen only through therapy. Their response to vignette (two studeis sued different vignette) was that abuse may or may not have happened, indicating that they do not hold extreme view toward the prevalence of CSA. In addition, the studies also show that the memory of abuse that happened at older age is considered more valid and accurate by most therapists than the memory of abuse happened at younger age. The outcome of these studies show that most therapists are aware of the prevalence of false memorya nd cautious about believing, enhancing, or implanting false memory into their clients.
Causes of False Memory
False memory can be developed due to several factors. The reason why some clients develop false memory differs depending on an individual and on a situation, and an individual may have several factors contributing to the development of one false memory. Since it is almost impossbile to screen all memories for distinction between false and true memories, most proposed causes ofr the development of false memory are merely theoretical. However, there is one study conducted by deRivera (2000) which assessed why false memory occurred, surveying 56 restractors. The study shows imporatnt results assessing why the actual retractors think they developed false memories of CSA, but the results may not be appropriate for generalization because restractors may not represent the whole population of those who develop false memories. More importantly, the sample is gathered through FMSF and all retractors were, at the time of survey, members of FMSF. It is not hard to imagine that they probably possess unique characteristics and they are in ceratin situations that differ from retractors whoa re not members of FMSF. Given the limitation of the study, however, the results are worth considering.
Forty one percent of the participatns responded to the survy that they had developed false memory because they lost control over themeslves in therapy. Their therapists had constantly insisted them to recover memories in order to become well, taking control of the sessions over them. Also, they were paid more attention when they talked about CSA and felt they need to talk more about it to get approval from their therapists. THe boundary violation, such as "being encouraged to call between sessions, advised as to how to make important dicisions," and "being taken to dinenr" (5), was common and they became dependent on their therapists.
Eighteen percent of the participants responded that they had developed false memory because they needed reasonable explanations why they felst and behaved as they did. THey felt relief when they "remembered" CSA experieicne because they were finally free from uncertainty where their symptoms had came from. Also, they usually had a suspicion of having been sexually abused as a achild before starting a therapy. THeir therapists did not insist the occurrence of CSA, but they either suggested or supported the idea of being sexually abused as a child.
Four percent of the participants thought the cause of developing false memory was being udner the pressure, sometimes unconsciously, to play a role of CSA survivors, especailly when they were place in a survivor group. Many of them had a suspicion of CSA experience prior to the therapy, but their therapists were not involved in the developmetn of false memory. These results give us the implications of better practice of therapists, which are discussed in the next section. In addition, 38% of the participatns indicated either multiple causes (27%) or no correct causes in the survey (11%).
Other possible causes for the developmetnal false memory include psychoanalytic concepts of false memory, sucha s Oedipal complex and desire and fear to be independent, and a promise of cure (6 14 15). The psychoanalytic approach suggests that the unresolved and long-suppressed sexual desire of a woman toward her father appears as an anger toward him and the anger leads her to unconsciously come up with the false memory of being sexually abused as a child (6 14). Also, internal conflict of an individual that she desires independence from ther parents but feels guilt and fear in doing so may lead her to develop false memory (6 14). A woman who is psychologically dependent on her parents, especially mother, finds her therapist as an ideal mother figure who shows her sympathy and affection and, encouraged and supported by the therapist, she starts late rebellion toward her parents by accusing htem of CSA that had never happened. These possible causes for the development of false memory are highly psychoanalytic and have a plenty room for criticism from scientfiic and feministic points of view.
Guidelines for Therapists
In order to reduce the risk of developing false memory, therapists must be awasre of the danger of inducing false memory occurrence and always pay enough caution not to. There are several guidelines for therapists to follow.
First, therapists have to practice in the area of competence (8). They should not use any therapeutic technique which they are not familiar with and they did not receive the extensive training for. In the case where they find themselves not so confident or where they think they need more knowledge in making clinical judgment about clients' diagnosis or tratment plans, they have to ask for a professional consultation or refer theri clients to other professionals in the area (8). In order to practice with confidence, they also need to be familiar with current argument regarding flase memory and researches and theories about memory, child abuse, effectiveness and the use of therapeutic techniques and interventions, and other psychological mechanisms in general (6 7). This suggests the imporatnce and effectiveness of a scientist-practitioner model of mental health professions.
Second, therapists need to focus on the current functioning of their clients, rather than recovering their past memories (6 11 10 5). They have to know and constantly remind themselves and their clients that the purpose of receovering memory is not to find out the actual historical events that happened to their clients, but rahter, to face their past in turms of hteir emotion in order to become able to handle current problems for the future life. Recovery of memory is not the purpose of therapy or an absolutely necessary step for cure. THerefore, therapists should not insist their clients to remember every piece of forgotten memories or use suggestion (6 11 15 5). Moreover, they should be aware that CSA cannot be inferred from any set of symptoms (6 15 7). Even in the case where CSA actually ocurred, it is not a diagnosis and therapists should focus ont he current symptoms and malfunctionis of their clients that results from the experience, rather than their past itself.
In addition, therapists must bear uncertainty and ambiguity of their clients' memory and help their clients to do so (6 3 10). Desire and a feeling of need for certain reasons and causes of curent problems may lead their clietns' unconcsious development of false memory.
Third, therapists need to be cautious about intervention their clients receive. The use of hypnosis must be handled with complete assessment, monitoring, and carefulness (6 11). Suggestibility of clients increases during hypnosis and false memory is especially likely to develop during hypnosis. Therefore, hypnosis should not be used for the purpose of memory recovery and only therapists who received advanced training and supervised practice may use it in a session. It is possible in some states that people who have been hypnotized during therapy lose their rights to stand in courts as witness (3), so informed consent must be obtained before the practice of hypnosis.
Clients must not be placed in a survivor group until there is a reasonable evidence that they have actually been sexually abused as a child because being int he group may produce pressure for them to play a role of a survivor (6 11 5). Before deciding a use of group intervention and which group the patient is going to be in, pretherapy screening must be conducted to assess the stage of the client's recovery. Group leaders need to be clear about the purposes, rules, boundary issues, structures and procedures of the group. Therapists also need to consider the use of other intervention and therapeutic techniques that have a lower possibility of producing false memory (7 11 10).
Another advise for therapists is to assess clients' CSA history during assessment period as a routine inquiry into their past (6 7). Fear of using suggestions and consequently implanting false memory into clients must not prevent therapists form asking about clients' CSA histories because in the case where it had actually happened, a lack of the knowledge of CSA occurrence is to miss very important information about the clients.
Respecting and promoting clients' autonomy in therapy is very important and absolutely necessary (6 10 5). Therapists must respect clients' decisions about the occurrence or non-occurrence of CSA and should not insist either opinion of therapists themselves. Boundary in the relationships betwen therapists and clients must be kept stricly and therapists should not elicit dependency of clients on them.
Finally, therapists must be aware of the possibility that their own biases and their personal beliefs, such as a belief about the prevalence of CSA, may influence their professional clinical judgment (6 11 5 8). For objective competence and effectiveness of therapy and legal purposes, processes of assessment, making a diagnosis, interventions, and the use of therapeutic techniques must be carefully and completely documented (15 8).
Regarding the issue of false memory, either side of FMSF and criticisms against the foundation does not appear to produce a solution for this controversy. The extreme sides of this issue, claiming that all recovered memories are false or true, may lead mental health professionals, their clients, and the public to confusion and a lack of understanding. The solutions to this problem may lie on the middle ground between the opponents, which suggests that remembering accurate or inaccurate memories is a matter of degree. More imporatnt and productive solution is to investigate the characterisitics of therapists and clients which may increase a risk of false memory occurrence and the situations in which therapeutic techniques and itnerventions may develop false memory.
As we do not yet know that exact mechanisms of human memory and development of false memory, what we have to do now to prevent false memory from occurring is to do what we can do. IT is absolutely the obligation of therapists and other mental health professionals to be aware of this issue and keep up with the current scientific arguments, as well as informing and education their clietns and the public of the development of false memory.