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Suggestion in the Therapeutic Setting
Along with a clinician's belief and their client's acceptance of the theory of repression, the context of therapy is a causal factor in the creation of ritual abuse memories. As explained in Origins of the Ritual Abuse Scare, the therapeutic environment is geared toward accepting any memories of abuse as geniune, regardless of the tentative nature of some memories, or a client's expressions of doubt.
In addition, there is usually no attempt made to verify reported abuse, because this is seen as irrelevant to the healing process. These conditions promote confirmatory biases, whereby the therapist who suspects sexual abuse, may look for symptoms in the client that are consistent with that belief, without seriously consdering other explanations.
In therapy, and probably in society, sexual abuse is regarded as the deeper cause of many psychological disturbances, and is given a great deal of attention. Those working to uncover the victims of sexual abuse are often on an almost moralistic crusade, and assume a certain nobility as defenders of the helpless. Their heartfelt goal may be to help their client face past abuse and come to terms with it, but in the process they may merely convince their client that they are a victim of something that never occured.
When sexual abuse is suspected, many therapists will concentrate on the client's retrieval of these abuse memories. It is thought that, left unfaced, traumatic memories will exert a negative influence on the client that threatens their well-being, (Claridge, 1992) However, the popularity of the concept of repression has led to some patients being asked by their therapists to recall sexual abuse where no memories exist already. In such cases, the client is unaware that they ever were abused. Their recollections of childhood may be happy and normal, but on the basis of the therapist's diagnosis they are urged to at least consider the possibility of abuse.
Although the practice of diagnosing abuse on the basis of symptoms rather than actual memories may seem sensible to those who believe in repression, real and lasting harm can be done if the diagnosis is wrong. It has been shown that merely imagining a childhood event increases one's confidence that the event occured (Garry, Manning, Loftus, & Sherman, 1996). These findings suggest that therapists should be very cautious before recommending that their client try to imagine an abusive childhood event (as some do), where memories do not already exist. Doing so could lead to the unintended effect of creating belief in an event that never occured. It is not unlikely that this effect could occur even without the imagination instruction of the therapist. The therapist's expressed certainty that an individual was abused could lead that person to become preoccupied with possible sexual abuse scenarios, thereby conjuring visual images of abuse that may later increase confidence.
Memory Retrieval Techniques
As will be explained, memory retrieval techniques create source confusion, so that the client who expects to retrieve repressed memories may mistake dreams, fantasies, imaginings and what has been seen and heard for real memories of their own trauma. Claridge (1992) suggests that the process of memory reconstruction only take place after the client expresses a desire to remember the diagnosed abuse. In other words, the client is already willing to believe that they were abused, and expects to find memories consistent with that belief. Once a client is ready to remember abuse, they may undergo a course of "memory work". This may include controversial techniques such as age regression, past life regression, guided imagery, and bibliotherapy, in which the client is encouraged to read books about memory recovery and ritual abuse. Other popular techniques are journal therapy, dream interpretation, hypnosis, and the use of published ritual abuse symptom checklists (Bottoms & Davis, 1997).
All of these methods, and particularly hypnosis and age regression, have been implicated in the creation of ritual abuse memories. For instance, Coons (1994) found that among patients at a dissociative disorders clinic who allegedly were ritual abuse victims, 48% had elicited their memories through hypnosis, 34% through dreamwork, and 28% through regressive therapies. Unfortunately, the use of controversial memory retrieval techniques is common amongst certain therapists.
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