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Issues in Psychotherapy
What are Repressed Memories?
• Holly and Gary Ramona
– Holly’s bulimia and accusation
– Gary’s lawsuit
• Dad awarded $500,000.00 from
therapist!
Freud and Repression
• Unpleasant thoughts,
experiences,
memories get pushed
way down into
unconsciousness
• These repressed
items sneak out
through slips of the
tongue, symbolic
behaviors, or
psychologically
abnormal behaviors
Validity & Frequency
• Clinical cases have been substantiated
• Different researchers found that 18%,
32%, and 59% of adult clients with a
history of sexual abuse said that they
had forgotten or recently uncovered
repressed memories of sexual abuse
Elizabeth Loftus
• Increased
occurrence in 1990s
has been partly
blamed on the
practices of some
therapists
The Therapist’s Role
• Therapists’ defense repressed memories
blocked, takes
deliberate suggestion
and effort to release
them
Can False Memories be
Implanted?
• Loftus contacted
families of students,
had they ever been
lost.
• Those who had not
were subjects in an
experiment.
Lost in a Mall Experiment,
Loftus, 1996
• Ss. told story that at
about 5 years of
age, they were lost
in a mall, complete
with details of the
local mall from
where they lived at
age 5.
Lost in a Mall Experiment,
Loftus, 1996
• Ss. are asked questions about having been
lost in the mall.
• 75% of what they remember were true facts
about the mall, etc.
• 25% of what they remember is totally created
based on what they had been told, falsely,
had happened to them.
• A significant minority of people (in research)
will believe the created memories actually did
occur, even when presented with explanation.
Do photos enhance the
creation of false memories?
• Garry and Gerrie, 2005
• Instead of narratives of
being “lost in a mall”,
Ss. are shown 4 photos,
three are real childhood
pictures, but the fourth
is a ‘doctored’ photo of
them and at least one
other family member
taking a hot-air-balloon
ride.
Do photos enhance the
creation of false memories?
• Ss. reviewed each photo three
times over a maximum of 2
weeks,
• 50% remembered something
about the ride
• Descriptions were rich in
detail
• When told the photo was a
fake, many were genuinely
surprised
Which is more effective at creating
false memories, photos or narratives?
• Garry and Wade, 2005 combined the “lost in
a mall” and “hot-air-balloon” experiments
– Half of the Ss. saw a doctored photo of them in a
balloon, the other half read a detailed story about
their balloon ride
– When interviewed about their memory of the ride,
50% of photo-viewers claimed it happened, but
80% of narrative-readers believed it had
happened!
Why are made-up stories
better than doctored photos?
• photo forced a concrete
visual memory
• narrative allowed them to
generate their own details,
expending more mental
involvement, and thus
making it more likely to
believe our own story
(invented though it may be).
A clinical case of false
memories
• Dr. Diane Humenansky sued by a patient for
medical malpractice
– Client came in with Generalized Anxiety Disorder
– 10 months later, Humenansky diagnosed Dissociative
Identity Disorder with over 100 alter personalities
– Patient awarded $2,671,000.00
• $2 mill for pain/suffering, $461,000 for future damages,
husband awarded $210,000 for loss of partnership
– A second patient came forward, sued and received
$2,500,00.00
Loftus investigates
techniques of rogue doctors
• Therapist and patient
accounts
• Sworn statements
• Taped sessions
• Artifacts - books & articles
doctor is reading/writing, etc.
• Undercover patients
• Surveys of therapists about
techniques commonly used
• 75% did not use
questionable techniques
Humenansky used. . .
•
•
•
•
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Hypnosis
Sodium amytal (truth serum)
Group therapy (memory poker)
Age regression
Guided imagery related to abuse situations
So, does therapy work?
• What, and how, to
measure?
– Compare different
styles of therapy
– How do we measure
improvement?
• Is psychotherapy
more effective than
no treatment at all?
– “Spontaneous
remission”
• Improvement for people in
weekly psychotherapy and
people who did not receive
psychotherapy.
• After 8 weekly sessions more
than 50% receiving therapy
were significantly improved
compared to 4% of those not
receiving therapy
• Clearly, psychotherapy
accelerates both the rate and
the degree of improvement for
those experiencing
psychological problems.
SOURCE: McNeilly & Howard, 1991.
More Evidence of
Psychotherapy’s Effectiveness
• PET scans of Obsessive Compulsive
Disorder patients’ brains before and
after 10 weeks of psychotherapy
– Scans showed changes in the actual
structure and functioning of their brains
similar to the changes that accompany
patients who receive only drug therapy
Burlingame & Barlow, 1988
• Eight experimental
therapy groups met for
15 weekly sessions
– 4 groups run by
therapists
– 4 groups run by
nonprofessionals
• 6 months out - nonexpert group had
deteriorated, pros did
not!
What about relapse rates?
• Comparing those
who received:
1. a placebo drug treatment;
2. a placebo and counseling;
3. drugs and counseling;
4. drugs only.
Is one form of
psychotherapy better?
• Answer 1: No -- in general there is little or no
difference in the effectiveness of different empirically
supported psychotherapies
• Answer 2: Yes -- in some cases one type of therapy
is more effective than another for treating a particular
problem
– E.g.,
• Depression -– cognitive therapy
• Panic disorder, OCD, phobias
– cognitive, behaviorist, CBT > insight oriented therapies
• Disorders with severe psychotic symptoms (e.g.,
schizophrenia)
– insight oriented therapies < other therapies
Daily Affirmations
Jessica's Affirmations
Stuart Smalley
Eclecticism
• A good match between person and type of therapy
is important
• Current trend in psychotherapy is Eclecticism-pragmatic and integrated use of techniques from
different psychotherapies.
• Today therapists identify themselves as eclectic
more than any other orientation
• Eclectic psychotherapists carefully tailor the therapy
approach to the problems and characteristics of the
person seeking help.
What makes psychotherapy
effective?
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A strong therapeutic relationship
Personal characteristics of the therapist
Personal characteristics of the client
External circumstances
– Family
– Finances
– Employer & co-workers