Specifying Unacceptable Behavior

Is there really the possibility of specifying such ''out of bounds'' behavior? Does it occur? Or does ''anything go?'' There is a possibility, it does occur, and anything does not go. Such behavior clearly violates standards of psychotherapy—whether the standards are based on our views of ethics or of effectiveness. For example, psychology research shows memory to be ''reconstructive'' and hence prone to errors that ''make sense'' of what happened, considered either by itself or in broader contexts such as one's ''life story.'' Further, there has never been any research evidence for the concept of ''repression.'' That absence does not mean it is impossible for someone to ''recover a repressed memory,'' or that such reconstructed memories are necessarily historically inaccurate. What it does mean is that as professionals practicing their trade—which means applying psychological knowl

Standards for Psychotherapy edge as we now know it—therapists should not be involved in attempting to do something that current research evidence indicates can easily create illusion, and needless suffering.

Nevertheless some are. For example, in a survey of licensed U.S. doctoral-level psychologists randomly sampled from the National Register of Health Service Providers in Psychology by Poole, Lindsay, Memon, and Bull in 1995,70% indicated thatthey used various techniques (e.g., hypnosis, interpretation of dreams) to ''help'' clients recover memories of child sexual abuse; moreover, combining the sample from the register with a British sample from the Register of Chartered Clinical Psychologist, the authors conclude: ''Across samples, 25% of the respondents reported a constellation of beliefs and practices suggestive of focus on memory recovery, and these psychologists reported relatively high rates of memory recovery in their clients'' (pg. 426). The study asked about the use of eight techniques that cognitive psychologists have found to involve bias and create errors. Hypnosis, age regression, dream interpretation, guided imagery related to abuse situations, instructions to give free reign to the imagination, use of family photographs as memory cues, instructions for remembering/journaling, andin-terpreting physical symptoms. Remarkably, with the exception of the last three techniques, the proportion of survey respondents who reported using them was overshadowed by similar or higher proportions of respondents who ''disapproved'' of using them.

In addition, failure to disapprove of interpreting physical symptoms as evidence of unusual events can be traced to a failure to understand the base rate problem in interpreting diagnostic signs—a failure that has been decried ever since Meehl and Rosen first discussed it in detail in 1955, but which is remarkably robust—as experimental studies in the area of behavioral decision making indicate that people equate inverse probabilities without equating simple ones, even in the face of evidence that these simple probabilities are quite discrepant. It takes one step to move from the definition of a conditional probability to the ratio rule, which states that P(a given b)/P(b given a) = P (a)/P(b). For example, the probability of being a hard drug user given one smokes pot divided by the probability of smoking pot given one is a hard drug user is exactly equal to the simple probability of being a hard drug user divided by the probability of smoking pot. Exactly. To maintain that because (it is believed that) a very low base rate event (e.g., being brought up in a satanic cult, an event that may have probability zero) can imply high base rate distress (e.g., poor self-image and an eating disorder) it therefore follows that the distress implies the event is just flat-out irrational. Doing so violates the standard of practice proposed, which is that it be based on empirical knowledge interpreted in a rational manner.

Unfortunately, however, the debate about recovered repressed memories has degenerated into claims and counter claims about whether they can exist, or the—totally unknown—frequency with which they are accurate or invented, rather than around the question of whether attempting to recover them is justified by what is known. In fact it is not; the real question is whether doing so is ''out of bounds'' behavior, and given we do know a lot about the reconstructive nature of memory, but very little about whether memory of trauma differs from other memories —and if so in exactly what way—such recovery must be categorized as out of bounds, that is, practice that violates standards.

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