Evaluating Adult Litigants Who Allege Injuries from Sexual Abuse: Clinical Assessment Methods for Traumatic MemoriesMartha L. Rogers*ABSTRACT: The assessment of adults alleging injuries from sexual
abuse as children is difficult and complex. Three areas of concern are
whether the claimant is a bona fide patient or is in treatment for
significant reasons other than pain and dysfunction, whether the memories
of the alleged abuse are more or less continuous, and whether the report
of abuse was spontaneously obtained or was the product of therapy or
extra-therapeutic influences. Methods which may prove useful in
evaluating such clients include the Early Memories Procedure, the TSC-40
Scale, The Impact of Event Scale, and the application of Statement
Validity Analysis to the narrative accounts of the abuse. Factors
hypothesized to be relevant in differentiating between valid and invalid
claims are discussed. In recent years, the filing of civil damage suits has been seen as an increasingly frequent remedy for adult victims of childhood sexual molestation, especially in the current legal climate with changes in statutes regarding time limitations. This option was summarized in commentary published in the Journal of Interpersonal Violence (Berliner, 1989; Barbarieri, 1989; Dawson, 1989). Some of these claims may prove valid and the victims are deserving of financial compensation to provide treatment and meet other needs. The problem is, of course, separating out nonlegitimate claims. The facticity of the alleged abuse and the extent of damage attributable to such abuse must be addressed in comprehensive assessment of these cases. As noted by Weissman (1991), "The examiner's task of
separating proximate from nonproximate factors ... becomes more complex
with the passage of time" (p. 418). This problem is quite complex
when we are talking about child sexual abuse and assessment for
litigation occurring 10 to 20 or more years later. To evaluate these
claims appropriately, an understanding of the range of presentations of past child sexual abuse may provide a
useful perspective. Some Varieties of Adult Abuse Reports in Therapy The following types of adult clients claiming sexual abuse as children are examples from my own experience which were chosen to show the range of possibilities. They come from psychotherapy clients only as well as those who were litigants. Some details have been altered to protect their identities and in some cases the details reflect a composite from several clients of a similar type. Some experience in treatment of cases not involving litigation is necessary to assess effectively those who sue. I see approximately equal numbers of cases for the plaintiff and defense sides. However, whether or not litigation has already begun, I first make a careful assessment to determine if I can reach an opinion as to the alleged injuries. These are sometimes cases the attorney has asked me to evaluate before filing any legal action. The adult who reports childhood sexual abuse in psychotherapy may present in one of several ways. Some of the case composites reflect individuals who were treated prior to changes in the law that would have permitted filing of suits many years after the injuries; whether all of these individuals would have pursued legal action in the current climate is unknown. Some are more recent and certainly the clients had the option to sue but elected not to do so for various reasons. Many of these appear to reflect legitimate claims against a perpetrator. Many people enter psychotherapy with a history of having been abused, which they have always remembered. These individuals typically do not claim to have forgotten what happened to them or to have substantial periods of not remembering. What may be more common, however, is an extensive period of time in which they attempted to set the traumatic experience(s) aside. Sometimes this was possible because during certain life phases they were not dealing with current issues in their lives that necessarily evoked recall of the past trauma. Young people who have unresolved trauma from childhood molestation may not realize that serious problems in living are occurring until they attempt to negotiate particular developmental tasks, such as getting into their first serious love relationship. These clients may then experience uncomfortable feelings that were avoided earlier. Some enter psychotherapy with a partial awareness that the past molestation is behind their current difficulties. Others may be stumbling through life until other issues force them to address their own past molestation. There may be crises that develop with the parents of the now adult abuse victims, which they feel ill-equipped to handle because of the past. Severe enmeshment may make it hard to break away. They have trouble feeling, thinking, and behaving separately from a parent. They may be unable to develop intimate relationships with a spouse, or have continuing conflicts with a spouse. When they become parents, they may be very obsessive and
overconcerned about the safety of their children. They fear the same
thing happening to their own children. They may have problems sharing
parenting with the spouse, who is not trusted not to harm the
children. Sexual problems with the spouse may occur from the beginning
or increase at later stages in the marriage. Severe conflict with the
spouse may be inevitable. A number of these marriages fail, and some
of the wives seem to be at high risk for alleging molestation against
the former spouse during divorce actions. Case Example: Ms. A Ms. A had been molested from early childhood to age 15, when she finally disclosed. Her father was criminally charged, and ultimately he admitted to some of the incidents, was convicted and served time in prison. At the time the abuse first came to light, Ms. A was offered psychotherapy and she attended a few sessions. However, she was not at all enthusiastic or comfortable with the process, and elected to drop out. Part of her attitude had been shaped by the family, where internalized attitudes negative to disclosure outside the family were strongly inculcated by the father, and besides that, therapists were stupid anyway. Despite the abuse, she had internalized these attitudes and felt negative about treatment. Her general demeanor and style for many years was to hide any sort of inadequacy from others as well as herself, but a corollary premise was that no one could be trusted to know who she was. Appearance of adequacy was more important than adequacy itself. After marrying and having children, she and her husband were
having serious problems because of interference from the client's
family of origin. When Ms. A made a decision to maintain more distance from her family, she
became aware of the dynamics that had prevented her from relating to
anyone outside her family of origin, and had kept the abuse issues
covered up for many years. It was then that she realized her need for
treatment for the first time. Case Example: Mr. B Mr. B, who had always known he was molested hundreds of times over a several year period by a religious brother who taught him at a boarding school, never disclosed to anyone until after his own child was molested by a relative. There were very serious, lifelong problems with intimacy and functioning sexually with his wife, as well as profound problems in relating to his children as a parent. But he had stumbled along in life until things began to unravel. He then entered psychotherapy to work on these difficulties. His accounts about his own past abuse were highly detailed, with a myriad of peripheral details. There is another group of people who enter psychotherapy for
reasons other than a direct concern about past abuse or trauma. These
individuals may be having problems in living that they themselves may
not correlate with past molestation. When therapeutic methods are not
invasive or intrusive, and there is no expectation that abuse memories
will be produced, their spontaneous recall of abuse is less likely to
have been contaminated by the therapeutic approach. Case Example: Mr. C In psychotherapy with a 45-year-old man, Mr. C, a lifelong pedophile, explorations into his past were more broad. The client was not directed to search for specific kinds of memories. Early in the treatment, he was asked if he had any recall of having been abused in any fashion, and his response was no. No intrusive or educative techniques were used to explore further the possibility of abuse or to lead to an expectation that he must have been abused. Although he was in court-ordered treatment, there did not appear to be any advantage for him to produce memories of past abuse. His own case had been fully adjudicated, he had entered a plea, and he was convicted of child molestation. However, about a year into therapy, in the context of recalling what life was like for him as a young child during World War II, while his father was away from home, he reported two incidents of sexual abuse which he apparently remembered outside of therapy. One involved a trip he took on a train with his mother at age five, when he had to go to the bathroom. In the men's bathroom on the train, a man who was wearing a military uniform reportedly orally copulated him. Another involved an adolescent maternal aunt, who was his babysitter off and on, and he had the impression he might have been molested more than one time, but could not pull back specifics of separate episodes. It appears the recall of these incidents was relatively spontaneous, and evoked by discussion of surrounding events in the same time frame as the molestations. There are others who enter therapy with serious problems who may
have some inkling or suspicion of having been abused, but who lack
certainty of what has transpired. Depending on the skills and patience
of the therapist, they may learn more about what may have actually
happened. Case Example: Ms. D A college student, Ms. D, was several months into therapy by an intern when she began experiencing intense panic and suicidal ideation in conjunction with what appeared to be flashes of memory fragments of sexual abuse involving her father. Interpersonally, she was an individual with intense, manipulative, borderline qualities, and she had entered therapy primarily because of conflicts and failures in interpersonal relationships; there were components of acting in and acting out during the therapy. At one point, she became assaultive toward the therapist and damaged the therapy room. As her panic escalated, more fragments of memory about possible abuse seemed to surface. The nature of some of the memory fragments appeared possibly to reflect historical events. There was no use of intrusive methods in evoking these reports, as one of the main therapeutic tasks at that point was to help her contain and regain control. In one incident, for example, she experienced herself as on the floor and looking up at cobwebs under the bed in her bedroom while being molested. Because there were concerns about her increasing loss of behavioral controls with intrusive recollections surfacing, she was hospitalized. During the first week of hospitalization, some staff at the hospital completely discounted the client's accounts, seeing her as a personality disorder with borderline and antisocial features. The intern felt that she had somehow been hoodwinked by the client and that she was doing poor therapeutic work with her. Because of the nature of some of the memories, I suggested to the intern that I didn't think the possibility of actual molestation could yet be discounted, but I advised that she simply continue on with treatment, not overfocusing on the sexual abuse issue, but helping the client regain control. The client's father came to visit her at the hospital, and in the course of conversation admitted to her that he had, in fact, molested her a number of times when she was very young. Upon becoming aware of her severe suicidal ideation, the father had become quite guilt-ridden and came forward. The client experienced great relief, and was able to make significant strides in dealing both with her present relational difficulties and the impact of the past. Some individuals enter therapy for reasons other than awareness or concerns over abuse and are experiencing serious and usually long-term difficulties that they have been unable to explain to themselves. In part, therapy can provide a way for a person to tell his or her story. For some, a midlife awareness of failure at particular life tasks, such as finding a meaningful job or maintaining satisfying friendships and intimate relationships, leads them to treatment. If the assumptions, methods, and skills of the therapist are adequate to this task, the client may indeed discover a means of getting back on track, In many of these cases, molestation may have been a significant
factor in their difficulties, while in some it may have been a less
overwhelming component of what went wrong. Case Example: Ms. E Ms. E had multiple stresses throughout her childhood which contributed to her current problems. These included having moved from household to household in the wake of her parents' divorce, her mother's alcoholism, her father's remarriage to a woman who was not accepting of a stepmother role, and being placed in foster care with her grandparents, an aunt and uncle, and others when her parents were unable to function as parents. These were much more important in the overall scheme of what happened to her than her childhood sexual abuse. She was molested over the space of a year from ages 12 to 13 by one of her mother's boyfriends. This was devastating but her own view is that things couldn't have been much worse before this happened, but it was only one of the traumas she had to work through. When she began treatment, she hadn't thought about it for many years, but when asked whether she had forgotten about it or just shoved it aside, she concluded she had only shoved it aside because there had been so many other problems that had to be dealt with first. If the therapist naively assumes that one must unearth a single "cause" for pervasive and longstanding unhappiness, following which the person will then be expected to magically improve, there is a risk that inappropriate therapeutic techniques and conclusions will follow. While abuse is a major problem in our society, there are some therapists whose training has been narrow and based on assumptions that may be inadequate to conceptualize fully the difficulties of their clients. Their background in diagnosis and treatment may be quite limited, but they may have gone to workshops on multiple personality disorder (MPD), satanic ritual abuse (SRA), or child abuse, and then made diagnostic judgments for which they do not have adequate foundation, perspective or context. I suspect some of these therapists are overdiagnosing dissociative disorders, and also are heavily involved in the excavation of so-called repressed memories. Looking at the initial data of Wakefield & Underwager (1992), of families of clients who have made accusations of such abuse, those who were aware of the background of the therapists reported that they were comprised of 57% "counselors" or social workers. This appears consistent with research of Bucky and Dalenberg (1992) in which a sample of mental health professionals from San Diego County were polled regarding the frequency with which they have seen dissociative or SRA symptomatology and the extent of MPD or SRA in their case loads. Master's level professionals who also attended training seminars on MPD or SRA appeared markedly more prone to make these kinds of diagnoses. Neither of these studies reflected random samples of data; Wakefield and Underwager's sample comes from parents who claim to have been falsely accused by their adult children and Bucky and Dalenberg's reflects the 10% of mental health professionals who took the trouble to answer a questionnaire about child sexual and satanic ritual abuse. But both studies suggest that it would be fruitful to investigate whether the level of professionals, and their background and training in diagnosis, correlate with the frequency with which these diagnoses are being made. This is an issue that needs to be more systematically explored. There is a great risk with some counselors and practitioners of participating in creating what Loftus (1989) has termed "... a sincere but misguided memory" (p. 155). Many people who enter therapy may thus become aware of how abuse
affected their own development, this awareness increasing during the
course of therapy. Also, the assumptions or methods of the therapist
may play a significant role in eliciting memories that may have been
substantially modified by the therapeutic process. Some of these
clients need justification provided by the therapist, others need an
explanation of a derailed life, and parents can therefore be blamed
for the person's troubles. In the extreme, the client's need for
justification for all of life's failures, and the therapist's need to
find a cause can result in misdiagnosis of past child abuse. Treatment
then is geared toward the reinforcement of such belief. Case Example: Ms. F Ms. F had a long-term history of serious personal, interpersonal,
and occupational difficulties dating from childhood. She had come
from a family in which there had been severe neglect and abuse involving her siblings as well as Ms.
F. She had been receiving alimony for a significant period of time,
and a week before her benefits were to terminate, she presented
herself for psychotherapy at a clinic, citing long-term stressors
including family conflicts, financial difficulties, and several
chronic medical problems. She also stated that she wanted to explore
possible memories of having been abused by a cousin with whom she had
lived for a time as a child. Early on, she was placed in group therapy
with other sexual abuse survivors. Case Example: Ms. BD Ms. BD (Rogers, 1992a), a woman in her mid-forties with three failed marriages, and a couple of advanced degrees, had never been occupationally or financially stable or secure, went to a therapist who rapidly diagnosed MPD and SRA. There was no work-up for dissociative disorder or other problems completed. The therapist seemed to have had certain preferred symptoms which he viewed as indicative of MPD and child abuse, but no systematic evaluation was ever done until the litigation was already underway. Therapeutic techniques included a form of self-induced trance, joint sessions with family members, and group therapy with other survivors. BD also became involved in graduate studies in counseling, attending classes and seminars in MPD, as well as reading some of the major texts and journals about MPD. In a few weeks' time, her younger sister and her daughter were
also diagnosed similarly after they were taken in for therapy.
They
accused the elderly mother and deceased father of being part of a
satanic ritual abuse ring and having brutally abused them throughout
their childhoods. Her father had died a year or so before, and he
had usually been very generous financially, but her mother
reportedly less so. With his death and then the demise of her last
marriage, she was in crisis. The therapist was a master's level
licensed therapist with a doctorate in ministerial studies whose
primary practice seemed to be MPD and SRA. He alleged that he had
over fifty SRA victims being seen in his several clinics by his
interns. Case Example: Ms. G Ms. G was seen at the request of a plaintiff attorney in order to assess her claim of recovered memories of abuse involving both parents, two brothers, and several other persons including some females. Ms. G had entered therapy stating that she had read materials about abuse victims which included a list of symptoms purported to he suggestive of past sexual abuse in childhood. There were several such symptoms which she felt she had. As the therapy progressed, numerous memories of alleged abuse
surfaced, but it did not appear that the therapy had been the major
impetus to her claims; rather, she had several friends who were
"survivors," and she read voraciously various self-help books such as
The Courage to Heal: A
Guide for Women Survivors of Child Sexual Abuse ( Reviewing some of the books she had read early in her therapy
process, or even before she had begun therapy, one would have to
hypothesize a learning of how to develop a memory. Whether she had
been abused or not was quite uncertain, as the alleged memories
differed considerably from what is typically seen in how incest
develops across time. Operationalizing Factors That May Be Associated with Valid or Invalid Claims of Past Abuse: A Decision Tree As stated by Wakefield and Underwager (1992), there is little available on an empirical basis to aid in the assessment of the validity of abuse claims by an adult when the alleged trauma occurred many years previously. Based on past experience, however, there are some common sense clues and areas worthy of consideration until the needed research can be conducted. There are three areas of concern:
A hypothetical "decision tree" (Appendix A) based on past experience and limited research may provide a starting place for attempting to operationalize and test criteria associated with valid or invalid complaints. The definitions may need to be refined, and should not be used in a rigid fashion. The judgments made may have to include features not addressed by this working model. It is far from certain that all relevant variables that should be taken into account have yet been identified. It should be noted that I haven't seen clients in litigation in all of the potential categories hypothesized here. In reviewing the examples given above, clients A, B, C, D, E, and BD were deemed to have been bona fide therapy clients. Their therapy preceded any consideration of litigation, and it was only after it became apparent that treatment was going to be long and complex that litigation was contemplated. It should be noted, however, that in the case of BD, litigation had apparently been recommended by the therapist and the decision was made very early in the treatment to pursue a legal case. Clients A and B were evaluated at the request of their plaintiff attorneys who wished an assessment prior to making a decision about entering litigation. In both of these cases, it was my judgment that the molestations had occurred and that the individuals had suffered significant pain and impairment in functioning which was attributable to the injuries. Neither of the individuals claimed any significant memory loss. Both claimed they had not been aware earlier of the extent of their damage and impairment due to the molestations. Client A's father had admitted to at least some of the molestations. There was a criminal conviction in the case. After undertaking therapy, Ms. A asked her father to assist her with treatment expenses, but she reportedly did not receive a positive, workable response from him. She subsequently decided to file a legal action. Client B contacted some of his former peers in his church and school and quickly learned that there were several others who had also been molested. Some of those who admitted having been abused did not want to enter into any litigation as they did not want their history to become public information. The defendant in this case admitted to having molested six different boys. An informal resolution of the case was attempted prior to filing legal action. Client G was also evaluated at the request of her plaintiff attorney, and she appeared to reflect a personality disorder. It was uncertain as to whether entering therapy was bona fide or not. Her alleged symptoms did not match her personality testing. There were marked influences from reading which occurred before, during, and aside from therapy, as well as heavy involvement in survivor support systems. More and more detailed accounts emerged over time. Clients C, D, arid E were not litigants at any time to my knowledge. There was no external corroboration for the recovered memories of Client C. There were several non-essential details and good contextual aspects to the reports. No advantage accrued to his legal status for having remembered the abuse. Although Client C appeared to progress for a time in his court-ordered treatment, he later terminated treatment and moved away to another state when his parole period ended. He seemed to have taken up a similar lifestyle as before which would likely result in a risk for future offenses. Client D's father acknowledged that she had been abused and took responsibility for paying for her treatment. She at first considered but then did not elect to file suit. Client F was not deemed a bona fide therapy client when evaluated on behalf of defense. It appeared that she had entered into therapy in close time proximity to her other financial resources being depleted, and that she raised the issue of litigation very early in treatment. She had a past history of manipulating others for meeting her financial needs. There was also a past history of probable malingering in a prior legal action. She had claimed that she was too disabled to work in a prior divorce action. Her psychological testing was grossly exaggerated and invalid. She claimed that she might have had some limited awareness of having been abused prior to entering psychotherapy, but that she needed treatment in order to make certain that it was true. There were major discrepancies in her accounts of the abuse over time. The litigated abuse accounts were far more sparse than other abusive memories reported. She did not seem to "recover" any further memories about the cousin other than the ones alleged in the litigation. The cousin she sued admitted having had sexual contact with her while they were both minors, alleging that the contacts were consensual, but denied the forceful sodomies of which he was accused. The defendant was probably the only person in the extended family who had significant financial assets. The plaintiff was highly resentful of his success. She clearly was a disturbed individual for whom it was difficult to assess just how much damage was attributable to the sexual contacts with the defendant because of her unreliable response patterns. Client BD was a plaintiff in a lawsuit but I did not not directly examine her. Her original motives for going into psychotherapy were probably genuine, but the nature and quality of the assessment and treatment she received were inadequate and were contaminating influences. At a very early stage in therapy, her counselor likely suggested litigation to her and she sought out legal representation. She also was influenced by the popular media and by educative participation in seminars and classes about MPD and SRA. She claimed that she had no memory whatsoever of the alleged abuse prior to discovery through psychotherapy. Her defendant mother was evaluated extensively and did not appear to have any notable characteristics consistent with a parent who had been abusive (Rogers, 1991). BD and her two co-plaintiffs were indirectly assessed through a review of their trial testimony which was videotaped in full (Rogers, 1992a). Their narratives about abuse were bizarre in the essential details of the accounts, with few or no non-essential or peripheral details that did not add to the allegations. SRA is a rapidly developing area regarding which available research and clinical experience has exploded recently, but for which there is very limited substantiation at this time (Rogers, 1992b). It was unclear to me whether client G was a bona fide therapy client. The major sources of influence in developing and elaborating her memories which had reportedly preceded the time she first started treatment seemed to have been extra-therapeutic. Psychological testing did not suggest the presence of repressive or dissociative features or any clear distress, but rather was more consistent with an individual suffering from a personality disorder. It was my opinion that litigation was not appropriate in this case. By the time most lawsuits are filed, the plaintiff has probably gone over the alleged memories any number of times and ways, depending on how they surfaced in the first place. In my experience with plaintiffs with verifiable traumas, there has not been a claim by either adults or children that the events were forgotten or repressed. Some bona fide chronic PTSD victims of traumas aside from sexual abuse have avoided psychotherapy, even though it became apparent in the course of conducting defense-requested IME exams that their symptoms and dysfunction were severe. Their symptomatology had to be practically dragged out of them on examination. In several civil cases I have seen where the complaint was child sexual abuse, typically 10 to 20 years earlier, the plaintiffs stated that the events were always remembered but they didn't realize the impact or damage they had suffered. I have seen no litigation cases that I considered legitimate where the abuse was allegedly not recalled until going into therapy, although I have seen several people in psychotherapy only where the abuse seemed to surface during the psychotherapy process without use of any intrusive techniques or extratherapeutic influences that could have explained the reports. Some of these would have been legitimate suits. Thus, it is likely that there will be legitimate cases in which
memories were either recovered or had been just shoved aside for years
and years. Those which appeared to be valid typically did not utilize
hypnosis, "body" work or experiential work leading to
emotional regression, repeated probing, or directed reading about
abuse and were not placed in group treatment until the abuse had
already been fully detailed and documented. These individuals did not
typically sue. What Are Some Promising Methods For Assessing Adult Litigants Claiming Child Sexual Abuse Injuries? In any litigation, evaluations of plaintiffs should be extremely thorough. When I am examining on behalf of a plaintiff, my goal is to do as thorough a job as I would if retained by the defense to ascertain whether in fact the case is a valid one and/or what the problems of the case may be. Too often, the plaintiff examinations I have reviewed as a defense-retained psychologist were thin, insubstantial, or even "bought." Some defense exam findings are also unfair and give short shrift to people who have been hurt. Methods that provide the litigant the most complete opportunity to tell the story will also provide data that may identify those who have exaggerated, fabricated, and malingered abuse complaints. A thorough examination should include reviewing all documents on the individual that might be relevant to their claims, e.g., school, employment, medical, psychiatric, legal, military records. Any deposition testimony of the parties, other relatives, treating personnel, or others may be relevant. Personal documents of any kind kept by the litigant that might be pertinent, e.g., diaries or journals, personal correspondence, photographs, audiotapes of phone calls are important. It is helpful to review these materials prior to actually examining the individual. The examination should include a detailed life history, including accounts of the alleged abuse, and psychological testing. My normal procedures call for at least one full day to conduct such examinations. In case of plaintiffs, I may spend more time. In case of defense examinations, there are usually efforts to limit the time to one or two hours and to eliminate psychological testing. I resist these efforts and will not allow them to control these parameters, because these cases cannot be adequately assessed in a limited time span. If at all possible, obtain collateral interviews with relatives or others who may provide important information that may tend to confirm or disconfirm the claims. I will not detail the basics of such an evaluative process here in the interest of time and space. Weissman (1984, 1985, 1990, 1991) has provided excellent conceptualizations of the problems inherent in personal injury assessments. What has been described thus far would be fundamental to any examination. I routinely make use of a laptop computer during any exam, which allows me to make virtually verbatim notes of both my questions and the litigant's answers. I may audiotape or videotape the exam in some cases, sometimes at the request of the litigant's attorney. In assessing sexual abuse cases, it is recommended that the examination be at least audiotaped. The following are some techniques that I have been using recently
which have promise both as research and clinical evaluative procedures
in legal cases involving alleged past sexual traumas: The Early Memories Procedure (EMP) (Arnold R. Bruhn, 1989, 1990, 1992a, 1992b) Bruhn's technique was developed based on studies of earliest autobiographical memories, and takes the stance that what is remembered reflects a product of changing perceptions and experiences across time. It is based on a theory of personality known as cognitive-perceptual theory, which focuses on the needs, perceptions, expectations and unresolved issues in early memories. This approach treats early memories (EMS) as "... fantasies about the past that reveal present concerns" (Bruhn, 1992a, p. 1). Bruhn states that from one standpoint, most EMS are not memories at all and he estimates that, in his experience, 95% of the memories are experienced as an outside observer and are probably largely fantasy reconstructions rather than actual recollections. But Bruhn has also collected some actual cases that were verified as having actually occurred dating from the first two years of life. He discusses at length some of the features seen in cases that suggest actual recall as opposed to later reconstruction (See Appendix B for a description of his observations and those of Loftus.) Bruhn's technique can be carried out in one of two ways, one being through a verbal administration and another by providing the client with a test booklet to take home and complete. I have routinely begun to use both procedures with clients where alleged traumatic events are an issue, whether reflecting so-called "recovered" memories or not. The advantage of using both methods is that the verbal administration catches the respondent by surprise, where he or she must respond immediately, and it is fairly economical in terms of examination time. In my experience, approximately one hour will be used in the verbal administration. The advantage of the follow-up written format is that more information will be generated at a later time which can then be compared to the earlier data. The written format will not uncommonly require six or more hours on the part of the client. In some legal cases where I have evaluated on behalf of the defense, the plaintiffs have either not been willing to later complete the written format, or have been advised by their attorneys not to do so. Where I have evaluated for the plaintiff, I have had no difficulty in obtaining compliance, even though it is time-consuming and although as Bruhn warns, this is often an uncomfortable procedure for clients. Instructions to clients are to think back to their earliest memories of specific events in childhood, choosing events actually remembered, not those they have heard from others. They are also asked to make sure it is a "... specific one time event ('I remember one time ...') and not a recurring event ('I always used to ...')" (Bruhn, 1989, page 2). Hence, the instructions attempt to direct the respondent to avoid so-called script memories or those derived from external sources. Clients are asked to first report the earliest memory from childhood. This is then followed by inquiry about what early memory comes next, which may be chronologically the next early memory "... or simply another early memory that comes to mind" (Bruhn, 1989, p.3). A total of six early memories are obtained. After reporting the memory, clients are asked to report the part of the memory they experience as the clearest part, what the strongest feeling is associated with the memory and what action or thought this is connected with, what they would change about the memory if anything, and the approximate age at the time of the memory. After completing the six memories, clients provided some Likert rating scales to assess the affective tone and clearness of each memory. They are then asked to assess which of the six memories is most significant and why it is important. They are also asked why it is that these particular memories are recalled from all childhood experiences. In administering the Early Memory Procedure, the responses should be tape recorded, or some type of verbatim transcription should be used. I use a laptop computer in interviews, finding that it is much less distracting than handwritten notes, allowing me to maintain eye contact, to keep on talking with the client, and at the same time to get down virtually a verbatim record both of what was asked and what was said. This is also very quick, whereas taking handwritten notes takes much more examination time besides being less complete. Having verbatim records is essential to some of the analyses that are later applied to the data. Subsequent to the above, a second section is comprised of asking for a series of specific memories associated with various situations and people, e.g., first school memory, first punishment memory, first sibling memory, first family memory, a memory of mother, a memory of father, a memory of someone you admired, happiest memory, a traumatic memory, a memory of a parental fight or argument, a memory of a parent or other relative involving alcohol or drugs, an incident that made you feel ashamed, a memory of being physically or emotionally abused, a memory of an inappropriate sexual experience, and a fantasy memory. The respondents are then asked to pick one of these memories and interpret it the best way that they know how, considering why that particular incident was selected. Bruhn treats the data derived from his technique as a projective personality measure, and, in my experience, it is probably the most rich level of data one can obtain, providing more detailed idiographic and multi-leveled understanding of clients, how they reached their current view of themselves and their world. In addition, one ends up with a discrete set of self-reports, some of which or some aspects of which may prove verifiable. In some cases, such as reports involving parents, siblings or other family members, some of the episodes may have actually been witnessed. In others, there may be records from other sources that can authenticate at least aspects of the experience. Another potential use of these data is to provide a baseline set of narratives which can be studied and compared to particular events of interest, such as alleged abusive or traumatic events for which compensation is being sought. Thus, clients serve as their own "control" and the nature and quality of these narratives can be compared across time. Based on what we know about the nature of children's memory and
their ability to recall and narrate past events, one might hypothesize
that events that are selected by the respondent within a given time
frame have particular meaning and relevance to that individual, and
the nature and quality of details would be relatively consistent.
Memories purported to come from age three would be expected to contain
fewer details than memories coming from age twelve. TSC-4O Scale The TSC-40 (Elliott, 1990; Elliott & Briere, 1992) is a research scale which is a more recent version of the earlier TSC-33 Scale (Briere & Runtz, 1989), designed to assess the aftermath of child sexual abuse in women. There are some score ranges and comparisons available between individuals who report that they were molested versus those who report that they were not. The respondent is asked to report which of a list of 40 items have occurred and to what extent over the past two months. The instrument instructions could be modified, and the litigant asked to estimate recall of these difficulties in the past year, or in the time frame immediately after the traumas, etc. To my knowledge it has not been used with males, and studies have not been completed with males. There are no items in the scale that would necessarily be different for males that have been molested. There are some control items that allow an assessment of the degree to which an individual may tend to overreport. When using this scale, one should follow up with interviewing to
obtain input as to why the client responded as she did. If the
individual checks that she has frequently experienced flashbacks, for example, one should inquire
into the circumstances of such experiences, where, when, and the
specific nature of the images. Meek (1990) has noted that "laundry
lists" of expected symptomatology for PTSD have become widely
available and accessible to litigants, but genuine symptoms will
typically be attached to individualized, idiosyncratic meaning. In my
experience, when a number of such unusual details are present to which
the individual is able to describe highly situational cues that are
associated with individualistic components of past traumas, they are
less likely to have been made up or to have been acquired from others.
Meek states: "Acute PTSD symptoms, related to the avoidance and
re-experiencing of the trauma, are often unaffected by psychological
sophistication that may be subsequently acquired by the victim from
advocates, counselors, or lawyers" (p.143). Impact of Event Scale (IES) [Horowitz, Wilner, & Alverez, 1979; Horowitz, Wilner, Kaltreider, & Alverez, 1980) The IES is another research scale that has been studied in PTSD populations more broadly than just past sexual abuse which may have resulted in post traumatic symptomatology. But it has also been studied in various samples of past molestation cases as well. The IES and the TSC were both utilized in a study of the effects of brother/sister incest (Laviola, 1992). The IES deals with defensive coping tactics in cases of PTSD, seeking to assess the extent to which the victim may report continued intrusive recall versus his or her ability to avoid such experiences. As stated for the use of the TSC, the time frames in which the
client is asked to report past symptomatology can be altered, and in
the case of the IES, one would expect to find a diminishment of
intrusive symptomatology and ability to avoid stress would increase
over time, with the former typically more predominant in the time
frames right after the trauma. However, one would want to assess
whether avoidant mechanisms are being overused as this is associated
with poorer adult psychological adjustment (Leitenberg, Greenwald,
& Cado, 1992). As with the TSC, one would want to inquire as to
why respondents answered as they did, as the idiographic aspects of
response will help delineate persons who are answering because they
have somewhere learned that one is supposed to have these symptoms
versus being able to place the symptoms in context of actual life
experiences. Obtaining Narrative Accounts of Instant Alleged Abuse and Application of Statement Validity Analysis (SVA) and Other Clinical Procedures In cases of sexual abuse in litigation with relatives, it is rare that we are talking about a single episode; most often, there are many different instances of abuse alleged. When a case is in litigation, the chances are that the alleged victim has told and retold the major incidents so many times that the accounts may have become similar to some fabricated accounts in being linear, and often devoid of details. Although linguists have investigated this issue of features of narrative that might provide insight into the differences between historical narratives, literary narratives, and narratives which are invented but attempting to pass as historical, they have concluded that in all narratives there are rhetorical and interpretive motivations. In Europe, a system of content analysis of narratives to assess the likely credibility of the witness was developed in the late 1940s and 1950s known as Statement Reality Analysis (SRA). Udo Undeutsch, a Professor at the University of Cologne was the primary proponent of this method, by which a transcript of an interview could be analyzed for presence or absence of certain content and structural features. The method became widely used and accepted in Europe (Undeutsch, 1982). Its basic premise, known as the Undeutsch Hypothesis, was that an account based on actual experience will differ in structure, organization, and content compared to one based upon fabrication or influence of others in shaping an account. Similar and related methods were also developed by Arne Trankell in Stockholm (Trankell, 1972, 1982). Trankell actually published an early account in English in our own Journal of Abnormal and Social Psychology (1958), but at that time interest in child sexual abuse had not emerged in the U.S., and this work was not even noticed. In the mid-1980s, Undeutsch began to teach his methods to Americans. There began to be collaboration between some of the German researchers and those in the U.S. to distill the available research and experience with SRA into a more systematized methodology which could then be operationalized and validated (Steller & Köhnken, 1989). The more recent systematized version became known as Statement Validity Analysis (SVA). An interview must be conducted in which the role of the interviewer is to obtain useful information without suggestion, contamination, or persuasion. The interview is then tape-recorded, transcribed and subjected to Criteria-based Content Analysis (CBCA). Two North American researchers, John Yuille in Canada and David Raskin in Utah, as well as those in Germany such as Max Steller began conducting studies including both analog and field studies (c.f., Cutshall & Yuille, 1989; Yuille & Cutshall, 1989; Steller, 1988; Wegener, 1988; Raskin & Yuille, 1989; Raskin & Steller, 1989; Esplin, Houed, & Raskin, 1988; Raskin & Esplin, 1991a). Raskin and his colleagues also began providing workshops to teach these methods to interested professionals in law enforcement, social work, and the mental health fields. Current research efforts are geared toward attempting to validate the method with children, although traditionally it has also been used with adult subjects. Part of the power of the method with children is that they do not typically have such a repertoire of past sexual experiences from which to draw in telling an event, and thus it is much more difficult for them to fabricate an account. With adults, one can more easily relate a real event but change the players and it may be very difficult to discriminate a true account from a fabricated one. Nevertheless, Cutshall & Yuille (1989) have hypothesized from some of their research that in telling an untrue account, the story teller may have such a job keeping up with the most relevant details needed to convince the listener that less necessary or more peripheral details which are normally present in abundance may tend to drop out. This is not always so, however, in my experience, which will be described further below. At this stage in development, SVA is best conceptualized as one more clinical tool that may provide some assistance in identifying narrative accounts that seem to be discrepant from the examinee's overall style and capacities. It is my belief that it may provide one more avenue from which to look at data that are being studied on several different levels in the process of an examination. It cannot be considered a method that will stand alone in assessing these cases (Raskin & Esplin, 1991a & 1991b; Wells & Loftus, 1991; McGough, 1991). Rather, it can add to traditional clinical approaches of developmental analysis or sequence analysis where one carefully studies any changes in the statement across time. In legal settings, one may challenge or impeach a witness based on prior statements, and SVA provides one more avenue for studying such changes. One way of using SVA and other clinical analysis methods would be to study some of the data from a verbally administered EMP or from other questions about past experiences in interview. Those memory episodes which do not involve abuse, or those which involve abuse episodes aside from those being litigated can serve as a baseline of the client's narrative capacities, style, and level of detailing. One advantage would be that some of the episodes narrated with EMP may be subject to external validation from other witnesses. When the client has reported memories of events being litigated, these accounts can also be compared to accounts given by the Plaintiff at earlier times. Based on SVA methodology, one might expect some peripheral details to be added or to drop out between one account and another, but the major elements would be expected to remain more constant. The older the individual at the time of the alleged incident, the more details one should expect. Details recovered from a very young age should be consistent with the perspective of a person who is very young, without the cognitive labeling of events in the manner of an older person. There will be detailing consistent with other surrounding events of the same time frame. As events are recovered from age 10 or 11 on up, where cognitive capabilities become close to those in adults, one would expect the accounts to be more detailed but still consistent with the capabilities of a young person, and consistent in quality and detailing with other surrounding events in the same time frame. In any abuse victim where there may be questions as to the credibility or validity, it is useful to build a time line of statements from the earliest known to the most recent and to study the changes across time. In cases of mistaken or fabricated allegations, typically there will be some major changes across time (Rogers, 1990). Another advantage to the use of the EMP is that it is highly likely
the examiner will solicit some abuse incident episodes or additional
aspects of the incidents that the examinee has not related to others
previously. In cases where one particular event has been retold many
times, it may be very difficult to ascertain whether or not one is
dealing with an actual incident, as many of the peripheral details may
drop out. If one can tap aspects of the experience that have not been
previously gone over many times, one has a better chance of assessing
the validity of the complaint Factors Helpful in Differentiating Between Valid and Invalid Claims Although many of the cases where I have used these methods are still in litigation and their actual accounts from the EMP and SVA methods would be far too identifying to discuss here, there are some generalities that I can provide about what I have seen thus far:
I would concur with Wakefield and Underwager (1992) that in some cases involving exaggeration, shaping, or fabrication, the progression across time is from innocuous behaviors to more and more intrusive or improbable behaviors. This has often been the case in child cases where allegations were mistaken. But whether that is always the specific progression in adults is uncertain. I believe it depends on the type of litigation, the goals of the person who is fabricating, the kind of feedback he or she is receiving across different interviews and contexts, the length of time passing between statements, and the external sources of influence on the statements. Some plaintiffs who are fabricating appear to actually forget what they said before and later to make substantially different statements. In many personal injury cases, I suspect that the plaintiffs often are not receiving negative feedback for their claims or being challenged in any way, as they tend to come in contact with an examiner selected by the defense only one time, and in these situations one may not necessarily see the gradual increase in severity and improbability. Rather, the statements about abuse tend to remain more vague and undefined as contrasted to other memories in the same time frames which may be much more detailed. In cases not involving personal injury litigation, but those involving fabricated criminal charges, there may be more awareness of challenge against the adolescent or adult victim who then seemed to need to "up the ante." I have seen two criminal cases where an alleged adolescent victim was reinterviewed multiple times by different people, where the following patterns were observed: a. The alleged victim makes completely contradictory statements within days of one another when interviewed by different personnel; b. As one event becomes closely scrutinized by interviewers, the victim may begin to add other alleged incidents, often making them much more forceful and/or further and further back in time with fewer and fewer details, so that they become very sparse and stereotypic (Rogers, 1990). This seems to be motivated by the wish to make an allegation that will stick as far as legal charges for which the defendant has no hope of defending himself. As a hypothetical/created example, the victim first alleges detailed accounts of being molested by the father in a recent time frame where there were several other people around, or at times for which the father had a solid alibi. The nature of the allegations may be more ambiguous or less serious in these initial disclosures. But, as these incidents are more closely scrutinized in interviews and do not seem to hold up so well, she may then allege more serious, forceful episodes in earlier and earlier time frames. Certain details then are repeated and become more stereotypic. One adolescent kept bringing up dark "blackout" curtains, which first appeared in a motel setting, but then was repeated for incidents that allegedly occurred in her father's home or in the homes of several friends. Her earlier, more detailed accounts gave way to extremely stereotypic, repetitive allegations with virtually no nonessential or peripheral details. She alleged incidents occurring at a motel, at her father's home, and at homes of several friends whom they visited overnight over a week vacation period where others slept in the same room with her and saw nothing. Another adolescent told of an incident early in the investigation in which she innocently ran naked through the sprinklers at age five or six, following which her father dried her off. She adamantly denied on repeated interviews that anything abusive had occurred at that time. But over time this incident changed to the point that she was allegedly raped. She first alleged she had not had intercourse with the suspect before she was 12, but then the age began to inch downward and the allegations began to become much more forceful. c. Additional perpetrators may be added as the case progresses. In some cases, the adding of additional, and progressively less likely alleged perpetrators has been striking. In a case of one 12-year-old, she first accused her natural father, then two paternal uncles, her maternal grandfather, and a maternal step-uncle. Each of the subsequent allegations seemed to be related to her mother's "falling out" with one and then another family member.
Since in this case (Rogers, 1991, 1992a) defense had no discovery or
IME exams performed prior to trial, they went into the trial
"blind." The tactic used was to have the plaintiffs
elaborate as fully as possible their allegations, hopefully pushing
them well beyond what they may have rehearsed with their attorney —
which worked well in this case. They became testy, defensive,
and rationalizing in regard to their answers even though' the defense
approach was totally non-confrontative, but simply trying to get them to elaborate events in fine detail.
These individuals also came
up with incidents they allegedly remembered from infancy, which are
highly unlikely to be based on actual memory. Conclusions Clinical methods that would allow one to collect systematic data about a range of past memories from individual bona fide non-litigating therapy clients and litigants in therapy could provide forensic examiners with better tools to differentiate valid from invalid claims of injuries. If such a set of methods and techniques could be agreed upon by clinical/forensic practitioners and academic memory researchers, a data bank could be established from which clinical and memory researchers could draw for further study. The available methodologies are, at this point, more subjective and unsatisfying from a research standpoint, placing the psychologist testifying in these types of cases in a difficult position as far as building an objective basis for opinions that will be fair to litigants on both sides. If criteria that may prove to help discriminate valid from invalid cases could be further developed and tested, some of the subjectivity could be reduced. There are several methods with sound clinical research already behind them that hold promise for forensic applications. Methods used need to allow the litigants every opportunity to tell their story and, at the same time, provide the means for assessing their credibility, reliability, and validity to the greatest extent possible. Determining how different population groups approaching the assessment tasks with varying motivations will be important in future research. Another avenue for research and also for dealing with the present needs in evaluating these cases for litigation is allowing respondents to serve as their own baseline across time. This will help provide a greater degree of objectivity in assessing accounts of abuse. In some cases, the differences in accounts across time are so striking that jury members exercising common sense will be able to easily see them if such data are obtained and presented. In other cases, the examiner may well have to say, "I don't know what happened." One then may have to rely on one's overall understanding of the functioning in the litigant in light of the total circumstances to make judgments. As noted by Loftus (1992), we have no certain means of knowing who is telling the truth in such cases. It should be clearly evident that, regardless of which side one has
been requested to perform these evaluations, that the law has raced
ahead of our actual scientific capabilities in cases of so-called
"recovered memories." The needed research has not yet been accomplished and many
practitioners are operating on the basis of clinical lore and popular
but inadequate and faulty conceptualizations of how human memory works.
The methods described herein can only be regarded as a means of
attempting to collect data in some kind of standardized approach to
reduce some of the subjectivity. The fact patterns of the alleged abuse
will then have to be studied in light of known perpetrator patterns and
the situation in which the allegations actually came to light, as
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Assessment ( APPENDIX A: Decision Tree Regarding Factors Hypothesized to be Associated with Valid or Invalid Complaints by Adult Litigants of Childhood Sexual Abuse APPENDIX B: Features of Historical Memory According to Loftus and Bruhn
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