Pseudomemories: the standard of science and the standard of care in trauma treatment

Dissociation as a Function of Child Abuse and Fantasy Proneness in a Substance Abuse Population

To our knowledge, no research has empirically assessed the relationships among dissociation, child abuse, and fantasy proneness in a single study. The present study assessed 1229 male substance abuse patients at a VA Medical Center on dissociation (measured by the Dissociative Experiences Scale, DES), child abuse (measured by the Child Abuse and Trauma scale, CAT), and fantasy proneness (assessed by the Inventory of Childhood Memories and Imaginings, ICMI). A regression analysis was used to predict dissociation with the five CAT subscales and fantasy proneness. The five CAT subscales accounted for 12 percent of the variance when predicting the DES from only the five CAT subscales. However, 22 percent of the variance was accounted for when using both the ICMI and the CAT subscales. Cross-validation regression analysis yielded very similar results. Regression analyses suggested that fantasy proneness is as important as sexual abuse in predicting dissociation. These results may shed light on the recent controversy concerning “repressed memories,” as well as understanding the development of dissociative disorders and differences between borderline personality disorder and the dissociative disorders.

Hypnosis in the Treatment of Dissociative Identity Disorder and Allied States: An Overview and Case Study

Hypnosis played a prominent role in the first successful treatment of the condition now known as dissociative identity disorder (DID) by Antoine Despine in the 1830s, and continues to be employed in its treatment in the twenty-first century. Despite its venerable history as a therapeutic modality for this condition, controversy has often compromised the acceptance of hypnosis by the healing professions. In this article, it will be argued that given the nature of hypnosis and that hypnotizability, a genetically mediated capacity, is high in dissociative disorder populations, it is inevitable that hypnosis will play a role in the treatment of DID patients, whether this is acknowledged or not. Thereafter, the roles hypnotically facilitated techniques might play will be reviewed, and the application of several of these techniques in the treatment of a DID patient will be illustrated.

On the history of dissociative identity disorders in Germany: the doctor Justinus Kerner and the girl from Orlach, or possession as an "exchange of the self"

The history of hypnosis is closely linked to the theme of possession; one such link is that the forerunner of hypnosis, animal magnetism, replaced exorcism in 1775 when Franz Anton Mesmer testified against Father Johann Joseph Gassner's exorcism. Modern authors have noted remarkable similarities between states of possession and dissociation. The treatment of possession by animal magnetism and exorcism represents the special romantic-magnetic therapy of the German medical doctor Justinus Kerner in the early 19th century. This article describes the man, his methods, and his thinking and presents one of his most famous case studies, the girl from Orlach, which, by today's standards, was a true case of dissociative identity disorder (DID). This article describes how contemporary principles of treatment were used and controversial issues about the nature and causes of DID were discussed 175 years ago.

Collaborative remembering of emotional events: the case of Rabin's assassination

Individual and collaborative remembering of the assassination of Israel's Prime Minister, Itzhak Rabin, were compared. In line with previous laboratory findings on memory of neutral stimuli, it was hypothesised that collaborative remembering (three individuals reaching a common response) and nominal remembering (three individual responses pooled together) of the assassination would be more accurate than individual remembering. A total of 146 participants responded (115 individually and 120 in groups of three) to open-ended and multiple-choice questionnaires (among them, 89 responded twice with a week of intertest interval) about Rabin's assassination and the events that preceded and followed it. Data analysis showed that the collaborative responses to the open-ended questionnaire contained more details (both accurate and inaccurate) than the individual responses, and that the responses to the multiple-choice questionnaire were more accurate than the individual responses. However, the collaborative responses contained fewer details (both accurate and inaccurate) than the nominal responses. Responses to the two questionnaires were more accurate on the retest when they followed collaborative rather than individual responses on the original test. The inferiority of the collaborative relative to the nominal remembering was attributed to collaborative inhibition, whereas the positive effect of collaborative remembering on performance on the retest was attributed to the contribution of contextual cues.

Implications of the Memory Controversy for Clinical PracticeAn Overview of Treatment Recommendations and Guidelines

The controversy surrounding delayed and recovered memories of incest/child sexual abuse has had a profound impact on clinical practice. This article first provides an overview of the positions taken by both sides in the dispute, the “false memory” proponents and the traumatic stress proponents. It then presents the major findings of several of the professional task forces charged with reviewing the controversy and arriving at recommendations for research, clinical practice, and forensic practice regarding delayed recall of memories for sexual abuse. The current status of scientific and clinical knowledge is discussed, especially in terms of its implications for therapists and clinical practice. Nineteen recommendations and practice guidelines are presented for therapists working with individuals who report or suspect childhood sexual abuse on the basis of continuous and/or recovered memory.

The plasticity of early memory reports: social pressure, hypnotizability, compliance, and interrogative suggestibility

Early autobiographical memory reports by adults were very sensitive to social influence in a leading interview. The mean age of initial earliest memory report was 3.7 years. When participants were instructed to close their eyes, visualize, and focus on their 2nd birthday, 59% reported a birthday memory. After repeated probes for earlier memories, 78% of subjects reported memories at or prior to 24 months of age, and 33% reported memories within the first 12 months of age. The mean age of the final earliest memory reported was 1.6 years. Participants rated their memory reports as accurate and did not recant them when given an opportunity. The age of earliest memory reports in the suggestive interview correlated negatively with measures of compliance, hypnotizability, and interrogative suggestibility.

Hypnotic Recall: A Positive Criterion in the Differential Diagnosis Between Epileptic and Pseudoepileptic Seizures

PURPOSE

Because the diagnosis of pseudoepileptic seizures (PESs) is mostly made by excluding epilepsy, availability of a positive criterion for PESs is of great importance. This study was aimed at the validation of a diagnostic technique that intends to provide in such a positive criterion.

METHODS

In 17 patients with epileptic seizures (ESs) and 20 patients with PESs, a hypnotic procedure was performed by an investigator blind to other data to recover amnesia for the ictus. If recall was obtained, the experimental diagnosis PES was given; if not, ES was diagnosed. The experimental diagnoses were compared with the clinical, EEG-confirmed diagnoses. Hypnotizability was measured to determine the relation between the outcome of the test and hypnotizability of the patients.

RESULTS

Recall for the ictus was obtained in 17 patients. Each of these had a clinical diagnosis of PES. Seventeen patients with "no recall" had a clinical diagnosis of ES, and three patients had PESs. This result yields a specificity of 100% and a sensitivity of 85% for the recall technique. Hypnotizability was significantly higher in patients with PESs than in patients with ESs. In some "low hypnotizables," recall was obtained, and in some "high hypnotizables," no recall was obtained.

CONCLUSIONS

A positive recall test indicates PES. A sub-group of patients with PESs is characterized by a high level of hypnotizability. Hypnotizability is not crucial for outcome of the recall test. High hypnotic abilities are especially found in disorders in which it is supposed that "dissociation" is involved. It can be speculated that PES may be one of the dissociative phenomena.

Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.

Memories of sexual abuse: Janet's critique of Freud, a balanced approach

Since the late nineteenth century explanations of sexual trauma have invoked unconscious mental mechanisms of forgetting. Memories have been seen as submerged only to be therapeutically recovered. Explanations and related therapies have tended to be either hotly advocated or decried, not the least were those of Janet and Freud. Once again there is a vigorous debate surrounding the status of recovered memories. This paper was undertaken to contribute to reasoned and balanced dialogue by exploring an historical dimension. There is a renaissance of interest in the oeuvre of Janet. In this article Janetian sources are examined in which he criticised Freud's views on sexual trauma and elaborated his own position, a position which is yet significant today.

THE GUDJONSSON SUGGESTIBILITY SCALE (GSS): FURTHER DATA ON ITS RELIABILITY, VALIDITY, AND METACOGNITION CORRELATES

This article presents two studies in which the psychometric properties and validity of the Gudjonsson Suggestibility Scale (GSS) were further investigated. Results of the first study (N = 40) indicate that the GSS has reasonable internal consistency. Additionally, a modest, but significant test-retest stability was found for the GSS. As to the association between suggestibility and self-reported cognitive efficiency (i.e., metacognition measures), scores on the Yield dimension of the GSS were positively and significantly related to scores on the Dissociation Experiences Scale (DES), but not to scores on the Cognitive Failures Questionnaire (CFQ). In a second, experimental study (N = 53), evidence was found for the predictive validity of the GSS. In that study, subjects saw a slide series and were then confronted with leading questions about the critical (emotional) slide. In addition, they completed the Yield scale of the GSS. A small but significant correlation was found between subjects' Yield scores on the GSS and their susceptibility to leading questions about the slide series.

False attribution of suggestibility to explain recovered memory of childhood sexual abuse following extended amnesia

Suggestibility is central to arguments proffered by critics of recovered memory of childhood sexual abuse who believe that memories involving amnesia are false creations of treatment. The present study represents the first direct investigation of suggestibility among patients who report recovered memory. Suggestibility was measured in 44 patients who recovered memories and in a 31 patient comparison group without a history of sexual trauma using the Gudjonsson Suggestibility Scale. Results indicated that patients who recover memories were remarkably less suggestible than the clinical field has been led to believe by advocates of false memory. As a group, they scored low on suggestibility. Recovered Memory patients yielded to suggested prompts an average of 6.7 times per case. This compares to an average of 10.6 in the Psychiatric comparison group. Paradoxically, patients without a history of sex abuse were more at risk for altering memory to suggestive prompts. These findings appreciably challenge advocated theories of suggested memory.

Illusory safeguards: legitimizing distortion in recall with guidelines for forensic hypnosis--two case reports

Two amnesic automobile accident victims remembered the information needed for their ongoing lawsuits during hypnosis. Meeting the recording requirements of the Hurd safeguards led to the admission of hypnotically influenced testimony in court in one case, whereas failure to record led to exclusion in the other. In both cases, closed-head trauma almost certainly prevented long-term memory consolidation. Thus adherence to guidelines for forensic hypnosis legitimized distortions in recall instead of preventing them. Hypnosis used to facilitate hypermnesia alters expectations about what can be remembered, makes memory more vulnerable to postevent information, and increases confidence without a corresponding increase in accuracy. Distortion of recall is an inherent problem with the use of hypnosis and hypnotic-like procedures and cannot be adequately prevented by any set of guidelines.

On the interaction of hypnotizability and negative affect in chronic pain. Implications for the somatization of trauma

The high risk model of threat perception predicts that high hypnotizability is a risk factor for trauma-related somatization. It is hypothesized that high hypnotizability can increase experimentally induced threat or negative affect, as measured by skin conductance level, in a linear or dose-response manner. This hypothesized interaction of hypnotic ability and negative affect was found in a consecutive series of 118 adult patients with chronic pain symptoms. Larger increases in skin conductance levels during cognitive threat were significantly related to higher levels of hypnotizability. In addition, individuals with high hypnotizability retained higher skin conductance levels than individuals with low hypnotizability after stress. The clinical implications of the interaction of hypnotizability and negative affect during threat perception and delayed recovery from threat perception are discussed in terms of cognitive mechanisms in the etiology and therapy of trauma-related dissociative disorders.

Assessing outcome in psychoanalysis and long-term dynamic psychotherapy

The efficacy of psychoanalysis and long-term psychotherapy remains a fundamentally unresolved issue for lack of methodologically sound studies. This article reviews the shortcomings of prior long-term treatment research, and presents a rationale and justification of the importance of more rigorous outcome studies. An emphasis on process research is premature when efficacy remains uncertain. The modern reconceptualization of psychotherapy in terms of hermeneutic theory is discussed in relation to the empirical model. Although historically the hermeneutic perspective has served to repudiate positivism, the hermeneutic and empirical (but not positivistic) approaches to understanding information actually share common priorities. The clearest of these is that the process is ultimately evaluated and validated by the produced effect. It is argued that the recasting of psychoanalytic technique and theory according to aesthetic and pragmatic principles is not inconsistent with contemporary outcome research paradigms so long as the professed treatment objective is clearly specified in verifiable terms. The specific methodologic problems involved in extending the successful short-term psychotherapy research model to psychoanalysis are discussed. An overview of the major components of the Columbia feasibility study currently underway is presented. Finally, a number of assessment domains-for which reliable and validated instruments exist-that are thought to be relevant to outcome are reviewed.