Guidelines for the Treatment of Adults Abused or Possibly Abused as Children (with Attention to Issues of Delayed/recovered Memory)
Courtois, Christine A., American Journal of Psychotherapy
These guidelines** provide practicing clinicians with information regarding psychotherapy with adults who (1) disclose an abuse history (physical, sexual, emotional) at the beginning of therapy; (2) do not disclose abuse despite having knowledge and memory about such events in their past,; (3) report new (delayed or recovered) memories of abuse during the course of therapy; and/or (4) suspect past abuse but have no clear memories of having been abused. The more common clinical scenario involves an individual who has retained memory for past abuse but recalls additional events or details during therapy. The less common scenario is for an individual to have totally absent memory of abuse and to later develop highly detailed memory. Practitioners should expect a range of memory presentations and must work to neither suggest nor suppress abuse-related issues that arise in the course of therapy.
Treatment of abuse-related psychological effects follows the established principles of practice for generic psychotherapy; yet, specialized knowledge and skills are required to address the complex issues that often are involved. These guidelines outline general principles for posttrauma treatment of abuse, along with cautions and recommendations for working with delayed/recovered memories when they emerge during the course of therapy. This document is not intended to be overly prescriptive nor does it constitute a formal standard of care; rather, it summarizes the present consensus among experts in postabuse and posttrauma treatment regarding ethical and competent practice and takes into consideration critiques and suggestions offered by memory researchers. Furthermore, these guidelines can be modified as needed for different mental health disciplines, theoretical orientations, and cultural considerations. They are expected to evolve as additional clinical information and research data become available on a number of topics pertinent to this treatment (e.g., posttraumatic response, the psychobiology of trauma, memory for traumatic versus nontraumatic events, dissociation, etc.). For this reason, practitioners are advised to keep abreast of developing and newly published research and literature relevant to this treatment and this population.
I. GENERAL TREATMENT ISSUES AND RECOMMENDATIONS
1. Practice within the established code of ethics and practice standards
First and foremost, the mental health practitioner is advised to abide by the ethical code and standards of practice for his/her discipline. As of yet, no formal practice standards have been adopted for posttrauma treatment (in general or for postabuse and delayed/recovered memory issues). Professional organizations are only currently devising principles, recommendations, and statements as precursors to the development of standards of practice; consequently, clinicians must exercise caution and sensitivity when working with these issues. Interim guidelines and policy statements are now available from the following professional organizations: American Medical Association, American Psychiatric Association Board of Trustees, American Psychological Association (Working Group on the Investigation of Memories of Childhood Abuse and Board of Directors), American Psychological Association Division 17 (Counseling Psychology) Section on Women, American Professional Society on the Abuse of Children (guidelines under development), American Society of Clinical Hypnosis, Australian Psychological Association, British Psychological Society Working Party on Recovered Memory, Canadian Psychiatric Association, and The International Society for the Study of Dissociation. Most can be ordered through the respective association's public affairs or publications departments.
2. Develop specialized knowledge and competence
The mental health practitioner who works with abuse-related cases has responsibility for developing specialized knowledge in issues of abuse, trauma, memory, and posttrauma treatment as well as developing competence in this treatment. …