Working with adult clients who may have experienced childhood abuse: Recommendations for assessment and practice.

Abstract

The delayed memory debate has generated many questions about therapeutic practices that are likely to be beneficial and detrimental to clients. This article proposes components of optimal practice for working with adult clients who may have been abused as children. The recommendations are organized around the following themes: (a) competence, (b) assessment and treatment planning, (c) psychotherapy process and technique, (d) memory issues, (e) and ethics. The authors emphasize the importance of a collaborative therapeutic relationship and urge clinicians to proceed cautiously when encountering treatment issues for which scientific knowledge and consensus are still evolving. In the wake of the delayed memory debate, the therapeutic procedures of clinicians have been exposed to increased scrutiny, and some authors have concluded that therapists are often unprepared to respond effectively to clients' concerns or are responsible for leading clients to believe that they have been abused when there is no basis for such a conclusion (e.g., Lindsay & Read, 1994; Loftus, 1993; Poole, Lindsay, Memon, & Bull, 1995). Several recent articles have addressed therapeutic CAROLYN ZERBE ENNS received her PhD from the University of California at Santa Barbara in 1987. She is a member of the psychology faculty at Cornell College and a part-time psychologist at the University of Iowa Counseling Service. She recently chaired the Task Force on Memories of Childhood Sexual Abuse that was sponsored by the Division 17 (Counseling Psychology) Section on Women. JEAN CAMPBELL received her PhD in counseling psychology from Florida State University in 1971. She is in independent practice in San Diego, CA, and specializes in the treatment of trauma and abuse victims, including domestic violence survivors and adult survivors of sexual abuse. She initiated work on the recommendations presented in this article. CHRISTINE A. COUKTOIS is a psychologist in independent practice in Washington, DC, and is co-founder and clinical director of the CENTER: Posttraumatic Disorders Program, the Psychiatric Institute of Washington, DC. She specializes in the treatment of posttraumatic conditions and disorders, sexual abuse and assault, and, recently, delayed memory issues and practice guidelines. MICHAEL C. GOTTLIEB, PhD, practices independently in Dallas, TX. He is an American Board of Professional Psychologists Diplomat (Family) and an American Psychological Association (APA) Fellow. His research focuses on applied ethics. KAREN P. LESE received her PhD from Virginia Commonwealth University in 1992. She is coordinator of practicum training at the Texas Tech University Counseling Center. Her research interests include psychological trauma and gender issues. practices from the standpoint of risk management and the legal concerns that practitioners may face (e.g., Frank, 1996; Knapp & VandeCreek, 1996). This article adds to the emerging literature on psychotherapy practice with clients who may have experienced abuse by proposing practices that we believe will s...

Bridging the gap between posttraumatic stress disorder research and clinical practice: The example of exposure therapy.

“…On the contrary, because there is empirical evidence supporting their efficacy, ESTs ought to be considered first-line treatments. Until systematic evaluations of psychiatric comorbid conditions (e.g., substance abuse, dissociation) or life problems are conducted, practitioners are advised not to automatically exclude use of recommended practices but to proceed, instead, with caution (Enns et al, 1998). However, there are some empirical data suggesting that CBTs that are effective with PTSD related to adult sexual and nonsexual assault are as effective in reducing PTSD and depression associated with childhood sexual abuse (Cahill, Yadin, et al, 2003).…”

Imagery and Altered States in the Treatment of Child Abuse Survivors: A Commentary on Therapist Influence

“…Hypnosis facilitates recall of false as well as accurate material (Cardeña, Maldonado, van der Hart, & Speigel, 2000), and, as noted above, guided imagery increases the incidence of memory confabulation in certain contexts and for certain individuals (e.g., Paddock et al, 1999). In the past decade researchers have underlined the implications of these findings for clinical practice, and a professional consensus is now emerging that therapists (a) should educate clients about the fallibility of memory; (b) should not endorse the accuracy of uncorroborated trauma memories; (c) should not suggest to clients, subtly or overtly, that they have unrecovered memories; (d) should allow clients, as a general rule, to take the lead in presenting memories; and (e) should use special techniques such as hypnosis and guided imagery for memory retrieval or enhancement cautiously and nondirectively, if at all (Alpert et al, 1998;Briere, 1996;Courtois, 1999;Enns et al, 1998; International Society for the Study of Dissociation, 1997; Knapp & VandeCreek, 1997;Pope & Brown, 1996).…”

Focus on Division 17’s Committee on Women/Section for the Advancement of Women (SAW) 1970-2030

“…This task force was instrumental in the publication by Enns, McNeilly, Corkery, and Gilbert (1995), which was the lead article in a major contribution to TCP on the delayed memory debate. A few years later, Enns et al (1998) published an article presenting guidelines for counselors and therapists who work with female clients who have experienced childhood sexual abuse. The guidelines are organized around the issues of competence, assessment and treatment planning, and psychotherapy issues.…”