Evaluation and Treatment of Adults with the Possibility of Recovered Memories of Childhood Sexual Abuse
Prepared by: The NASW National Council on the Practice of Clinical Social Work
Serious ethical and legal issues have arisen in the clinical literature,
courtrooms, and legislatures around the country with regard to the recovering of
memories of childhood sexual abuse during the process of treatment. This
statement is an effort on the part of the National Association of Social Workers
(NASW) National Council on the Practice of Clinical Social Work to provide
guidance for clinical social workers as they proceed with the evaluation and
treatment of their clients. This guidance is based on the foundation that the
clinical social worker's decisions should be clinically sound, ethically
based, and legally sanctioned.
The validity of some recovered memories of sexual abuse has been the cause of
passionate debate among mental health professionals, attorneys, and the public.
In addition to the questions of validity of undocumented reports of sexual abuse
and the therapeutic techniques used to elicit these memories have been placed
under scrutiny. We will not enter the debate on whether traumatic events are
forgotten or how accurately people report their memories. There is ongoing and
developing research on memory, including the repressed memory phenomenon.
Clinical social workers should be continuously acquainting themselves with this
literature. Our concern is for the clients who believe they have been
traumatized by childhood sexual abuse as well as the people who believe they
have been falsely accused of being a sexual abuser. This statement addresses
and reiterates the basic clinical and ethical principles and standards that NASW
and the social work profession have followed, applied to the assessment and
treatment of clients for whom the possibility of childhood sexual abuse may be
Establishing and maintaining the appropriate therapeutic relationship is the
responsibility of the clinical social worker, not the client. The clinical
social worker should:
- establish and maintain an appropriate therapeutic relationship with careful
attention to boundary management
- recognize that the client may be influenced by the opinions, conjecture, or
suggestions of the therapist
- not minimize the power and influence he or she has on a client's impressions
- guard against engaging in self-disclosure and premature interpretations
during the treatment process
- guard against using leading questions to recover memories
- be cognizant that disclosure of forgotten experience is a part of the
process but not the goal of therapy
- respect the client's right to self-determination.
The clinical social worker's role is to be empathetic, neutral, and
non-judgmental. Awareness of one's own attitudes toward repressed memories is
crucial. Attitudes of enthusiastic belief or disbelief can and will have an
effect on the treatment process. Any predisposition with regard to whether the
client's symptoms are related to particular events or circumstances may render
the assessment and treatment inappropriate and ineffective. The therapist's
responsibility is to maintain the focus of treatment on symptom reduction or
elimination and to enhance the ability of the client to function appropriately
and comfortably in his or her daily life.
Evaluation and Treatment
A treatment plan should be developed based on a complete psychosocial and
diagnostic assessment. Issues related to the client's total clinical picture
including symptoms and level of functioning need to be carefully evaluated. All
likely medical causes for the client's symptoms need to be identified by
referring the client to the appropriate medical personnel before diagnostic
conclusions are drawn. Other adjunct services should be made available to the
client as needed.
Clinical social workers should explore with the client who reports recovering
a memory of childhood abuse the meaning and implication of the memory for the
client, rather than focusing solely on the content or veracity of the report.
The client who reports recovering a memory of sexual abuse must be informed that
it may be an accurate memory of an actual event, an altered or distorted memory
of an actual event, or the recounting of an event that did not happen.
The use of therapeutic techniques such as recovered memory groups, guided
imagery, and hypnosis for treatment purposes should be limited to clinical
social workers with special training, experience, and certification in these
Clinical social workers need to maintain appropriate skills and knowledge in
the area of trauma and memory. They must keep abreast of the evolving relevant
scientific examination of the issues and developments in standards of clinical
practice. Clinical social workers conducting psychotherapy with clients who have
been abused should have adequate training and demonstrated competence and use
appropriate and skilled supervision or consultation.
Social workers must maintain an awareness of the effect the treatment may
have on people other than the client. Clinical social workers must exercise
great caution regarding a client's expressed desire to confront an alleged
abuser. The clinical social worker must remain neutral and objective. Although
the client has a right to self-determination, the social worker should help the
client think through the goals and possible positive and negative outcomes of a
confrontation. If a client intends to pursue confrontation the social worker
should help the client consider an approach that will maximize the likelihood of
a satisfactory result. For example, if clinically indicated, a neutral mediator
may be used.
If a client requests the social worker to be present at a meeting with the
alleged abuser to discuss the abuse, and if the social worker determines this to
be therapeutically indicated and consistent with the treatment plan; the social
worker is advised to consider seeking clinical and legal consultation prior to
agreeing to such a meeting. It should be understood that if the social worker is
present for such a meeting, it will be difficult to argue that this session is
not part of the treatment plan. A meeting of this nature may not be essential
for a positive treatment outcome, therefore, careful consideration should be
made before the client, the alleged abuser and the social worker are placed in a
potentially volatile and emotionally charged situation. The purpose of the
session should be clarified and all parties should agree to participate. Written
consent based on full notice should be obtained from all participating parties
before the meeting takes place.
Records should be maintained that reflect the clinical activity with the
client from the initial appointment to termination of treatment. The recorded
information should be objective and clinically relevant. The documentation
should reflect the process related to assessment and ongoing treatment and
should document facts and descriptions about what takes place in the therapeutic
setting. It should reflect how the memories surfaced and how the client arrived
at the conclusion that he or she was the victim of childhood sexual abuse. The
social worker must remember that the record is a treatment tool and potentially
a legal document.
Clinical social workers should be knowledgeable of state and federal laws
regarding disclosure, reporting of abuse, privileged communications, and release
of records. Both the obligations and/or lack of protections for the client or
social worker may pose clinical and ethical challenges for the social worker.
Some circumstances may stimulate requests by clients or other parties for access
to the records.
Clinical social workers who practice in the area of recovered
memories should be mindful that this is a high-risk area of practice in an
environment of intense controversy. Individuals who report childhood sexual
abuse and trauma must receive expert care. The clinician must carefully evaluate
theories and techniques used in the care of this very vulnerable client group.
The application of sound clinical judgment in the midst of conflicting beliefs
and evolving knowledge is the best course to follow on behalf of both the client
and the social worker. The clinical social worker needs to conscientiously
adhere to principles such as currency of knowledge, comprehensive treatment
planning, use of consultation, maintenance of clear boundaries, and careful
documentation as described in the NASW Code of Ethics and NASW
Standards for the Practice of Clinical Social Work. ð
NASW National Council on the Practice of Clinical Social
Mary Jo Monahan, ACSW, LCSW,Chair
Patricia M. DeLorme, MSW,
ACSW, LICSW, Immediate Past Chair
Veronica Coleman, ACSW, LCSW, National
Jeannie Krause-Taylor, ACSW, LCSW
Kathryn Koos-Lee, ACSW
References and Suggested Readings
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American Psychiatric Association. (1993). Statement on memories of sexual
abuse. Washington, DC: Author.
American Psychiatric Association. (1994, April). Fact sheet on memories of
sexual abuse. Washington, DC: Author.
American Psychological Association. (1994). Working group on investigation
of memories of childhood abuse. Interim report. Washington, DC: Author.
Australian Psychological Society Limited Board of Directors. (1994).
Guidelines relating to the reporting of recovered memories. Carlton,
South Victoria: Author.
Barlas, S. (1995, March). Psychiatrist unraveling memories of abuse walk on
tenuous ground. Psychiatric Times, p. 44.
Bolker, J. (1995). Forgetting ourselves. Readings, 10, 12-15.
British Psychological Society. (1995). Report of the working party of the
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Butler, K. (1995a). Caught in the cross fire. Family Therapy Networker,
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Butler, K. (1995c). Marshaling the media. Family Therapy Networker, 19,
Canadian Psychiatric Association. (1996). Position statement on adult
recovered memories of childhood sexual abuse. Ottawa, Canada: Author.
Cornell, W. F. (1995). A plea for a measure of ambiguity. Readings, 10,
Gardner, R. A. (1995). Protocols for the sex-abuse evaluation.
Kreskill, NJ: Creative Therapeutics.
Garry, M., & Loftus, E. F. (1994). Pseudomemories without hypnosis.
International Journal of Clinical and Experimental Hypnosis, 13,
Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
International Society for the Study of Dissociation. (1994). Guidelines
for treating dissociative identity disorders (multiple personality disorder) in
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McHugh, P. R. (1992). Psychiatric misadventures. American Scholar, 61,
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National Association of Social Workers. (1989). NASW standards for the
practice of clinical social work. Washington, DC: Author.
National Association of Social Workers. (1991). NASW guidelines on the
private practice of clinical social work. Washington, DC: Author.
National Association of Social Workers. (1994a). NASW code of ethics.
Washington, DC: Author.
National Association of Social Workers. (1994b, August). Recovered
memories. Need for action (Report to the NASW National Council on the
Practice of Clinical Social Work). Washington, DC: Author.
Peterson, M. R. (1992). At personal risk. Boundary violations in
professional-client relationships. New York: W. W. Norton.