Open Court Publishing Company This excellent book is a powerful and detailed indictment of "recovered memory" "therapy," which is not therapy (in the sense of healing) and is not memory (in the sense of historically accurate recall). Moreover, it has no basis in anything that could remotely be termed "science." As Wakefield and Underwager point out toward the conclusion of one of the strongest chapters in the book (Chapter 12): "The only answer given by proponents of recovered memories to the question 'How do you know?' [that memory is historically accurate] is a presentation of anecdotes, case studies, and personal, subjective feeling. It is wrong to cite a testimonial or case study as support for a particular theory or therapy. Those who do so mislead the public if they don't point out that such evidence is open to a wide range of alternative explanations and can be highly misleading. ... To the best of our knowledge no proponents of claims of recovered memories even attempt to answer the question whether or not they do better than chance. We know of no scientific quantified data supporting any of the techniques passed off as therapeutic and healing" (pp. 361-362). The same blunt approach is found throughout. The section quoted above, for example, is followed by the single sentence paragraph: "Recovered memory therapy as it is practiced is unethical and constitutes malpractice" (p. 362). In the prologue of the book, the authors cite an incident in which Underwager, as a young Lutheran pastor, noticed a 7 -year-old girl who "looked a bit shabby" at a parochial school he had started in the fall of 1952. "Denise began to spend the time interacting with him. During morning recess on a day in early January, she said, 'my Daddy screws me.' At that time there was no child protection system. The police were not interested. That afternoon he took Denise to her home, pointed his finger at the father and said, 'you are the man!', Nathan's words to King David confronting him with his adultery with Bathsheba." After "the father was confronted by the Elders in meetings," Underwager spent time counseling the families and 10 years later Denise reported to him that "there was never any further sexual abuse by her father and that he was happy she was doing so well" (pp. 2-3). That story exemplifies the personal style of the authors. They point, they confront — and then give generally good advice to those caught in the riptide created by the reality of child sexual abuse clashing with the totally invalidated claims of those who (sincerely) believe they can diagnose or recover memories, for example, by observing clients' high base rate symptoms that can result from a variety of problems, and by urging these clients to engage in activities such as hypnosis, guided imagery, and joining "survivors groups" — activities that have been demonstrated to yield high rates of false belief and delusion. The direct tone in presenting conclusions is complemented by very careful scholarship throughout this book. The conclusions are well-founded. T he authors have gone to great lengths to present in detail not only the research that should lead to the rejection of recovered memory therapy, but the belief of proponents as well. In fact, the authors do such a good and responsible job of presenting the arguments of those supporting recovered memory therapy that these arguments become almost plausible. How widespread is the problem the authors address? At the time the book was written, its prevalence could be estimated only on the basis of convenience samples, such as those of Smith and Yapko. Later, however, a much more systematic poll of therapists has been conducted by Poole, Lindsay, Memon, and Bull (1995). These authors randomly sampled licensed U.S. doctoral psychotherapists from the National Register of Health Service Providers in Psychology and British psychologists from the Register and asked them to check any technique "that you have used in the past 2 years to help clients remember childhood sexual abuse." (The first version of the questionnaire simply asked "check any techniques that you have used with abuse victims in the past 2 years," with highly similar results.) They listed "8 techniques that are considered suggestive by many cognitive psychologists" (an understatement). Only 39% of those surveyed returned the questionnaire, but 71% of those responding indicated that they had used one of these techniques and 25% indicated that they had used two or more. The latter group reported working with a total of 3,542 adult female clients in the previous two years. The United States sample consisted of 3.75% of those in the National Register. If we make the hyper-conservative assumption that no one not responding to the questionnaire uses two or more of these techniques, we obtain an estimate of 94,453 women who have seen therapists in the United States the previous two years who used two or more. On the assumption that non-responders are equivalent to responders, that estimate is 242,188. But there are only 16,000 psychotherapists in the National Register and an estimated 250,000 spread out throughout the United States. Those in the Register tend to be the best trained. Assuming that others are at least as fond of these coercive techniques as those who are well trained, the previous assumptions yield a lower bound of 1,475,833 for the last two years. (This reviewer finds this figure quite "unbelievable," but all the reader must do is divide 3,542 by .0375 and then multiply by 250/16 to obtain it.) Wakefield and Underwager are absolutely correct in their assessment that recovered memory therapy is widespread. The only chapter of the book I find questionable is the one in which the authors offer advice for distinguishing between true versus false memories ("When Memories Are Real," Chapter 11). Suddenly, a great many statements concerning the authors' own "beliefs," "skepticism," and "assessment" of what is more or less "unlikely" appear. They offer "hypotheses and suggestions by ourselves, Martha Roger, and Richard Gardner" for distinguishing between historically accurate versus historically inaccurate memories, but then conclude that these hypotheses and suggestions should all be "provisional since there's little research as yet on the criteria differentiating real from false allegations of childhood abuse" (p. 340). Why present these ideas all? The authors are criticizing others who present such ideas without any empirical verification, and their ideas have none as well. Admittedly, empirical verification of hypotheses for distinguishing between past historical fact versus fantasy concerning sexual abuse is extremely difficult to obtain. But it is the recovered memory therapists who claim that therefore criteria established in all other contexts are irrelevant, and that therefore their own hypothesized criteria should be given some credence. A "we don't know" conclusion would be more consistent with criticism of the recovered memory approach than is one of presenting unverified "hypotheses and suggestions." This inconsistency does not, however, damage the very next chapter, which may be the most powerful in the book. While it is titled "Good and Bad Therapists: How to Tell the Difference," it really concerns the ethics of recovered memory therapy. After quoting Striker and Meehl and McFall that persisting in approaches despite clear negative evidence is simply unethical, Wakefield and Underwager address one of the most serious claims of recovered memory therapists (pp. 364-365): "Some of the recovered memory therapists argue that it is a therapeutic necessity to believe the patient even if the memories are not real. They claim that it has therapeutic benefit and helps clients when the therapist believes their story. There are no quantified data to support this claim and the idea is wrong and foolish. It rests on the assumption that error can be beneficial. We believe that error can never, in the long run, contribute to healing nor to a better life. Science can be about lots of things but one thing it is never about is encouraging error" (followed by examples such as insulin shock therapy, prefrontal lobotomies, and curing schizophrenia by pulling out all the teeth). The whole book is, in fact, oriented toward what the authors see as a struggle between empiricism and rationality versus the error of pure intuition and emotionality, which here has resulted in the return of the Furies. I am not certain whether this framework enhances or detracts from the book: For example (p. 19): "Today in the United States freedom is abandoned and individual rights surrendered for fear of crime and rage that drugs. Violence is met with greater violence and harsher and more draconian punitiveness. Gender warfare breaks out in wild and bizarre attacks and convoluted reasoning produces wholesale blaming of entire categories of persons, for example: all men are rapists; all women are emotional and hysterical. Whining and complaining replace courage, self-reliance and personal responsibility. Random acts of violence shatter the veneer of order. Victimization supersedes virtue and political correctness covers rudeness and ill-mannered behaviors unthinkable 20 years ago." The trend is certainly there. Moreover, Wakefield and Underwager are — in this reviewer's opinion — correct when they state that "the great mass of human anguish and pain is not caused by some mysterious cosmic force, as Luke Skywalker encounters in Darth Vader, but rather by plain, simple, garden variety human stupidity" (p. 21). I further agree that the rational and critical approach to life — as exemplified by science — is not natural as emotional acceptance of authority and selfserving ideology1 (although I see more of a need to integrate emotion and reason than to juxtapose them). The problem with this framework, however, is that it initially presents recovered memory therapy as just one instance of "the return of the Furies," while in fact the bulk of the book concerns recovered memory therapy per se; moreover, there is simply not enough space to substantiate the general assertion about rationality, vindictiveness, and emotionality. I can not do justice to the whole book in this brief review. I recommend it highly. I also recommend that it not be chewed entirely at one setting. The Wakefield and Underwager bluntness in stating their opinion combined with the details of their reporting of the scientific literature make it a book that is difficult to read quickly. Moreover, there are the anecdotes. The authors use them quite responsibly to illustrate points rather than to form a basis for generalization. Many, however, (for example the attorneys' report in Chapter 7) are simultaneously heartwrenching and infuriating. Like the rest of this challenging book, they can not be read quickly. All of it, however, deserves to be read and studied by all concerned with this "therapy.
1 "Scientific thinking, which is analytic and objective, goes against
the grain of traditional human thinking, which is associative and
subjective. Far from being a natural part of human development, science
arose from unique historical factors." Alan Cromer, Uncommon Sense: The
Heretical Nature of Science ( ReferencesPoole, D. A., Lindsay, D. S., Memon, A., & Bull, R. (1995). Psychotherapy and the recovery of memories of childhood sexual abuse: U.S. and British practitioners' opinions, practices, and experiences. Journal of Consulting and Clinical Psychology, 63, 426-437. Reviewed by Robyn M. Dawes. Carnegie Mellon University. This review is reprinted with permission from the FMS Foundation Newsletter, January, 1995.
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