This article, "Suggestions of abuse [Book review of Suggestions of abuse: True and false memories of childhood sexual trauma]" originally appeared in Advances in Medical Psychotherapy & Psychodiagnosis, 9, (1997), pp. 208-210.

Michael D. Yapko

Suggestions of Abuse: True and False Memories of Childhood Sexual Trauma

Simon & Schuster, 1994, 271 pages, hardcover, $22.00. ISBN: 0-671-87431-4

Psychologist/hypnotherapist/family therapist/author Michael Yapko's latest work may be the first to attempt a balanced inquiry into one of the greatest controversies in contemporary psychotherapy: "repressed" vs. "false" memories of childhood trauma. In the process, he has written an important but flawed book. Suggestions of Abuse seems to be two books: (1) a relatively scholarly, down-to-earth, and balanced work that raises many serious questions, and (2) a polemic that periodically degenerates into tirades against ambiguously-defined "bad therapists" (which seem to be the majority of us).

The first two chapters introduce and then review his own research on therapists' attitudes about hypnosis and memory (repressed and otherwise). Even taking into account the methodological imprecision of Yapko's instrument and sampling procedures, the results of his study give cause for concern: Far too many therapists are unfamiliar with scientific research on hypnosis and memory--yet psychotherapists are often accepted, by both lay people and the courts, as "experts" in both fields. Yapko makes a strong case for challenging pseudoscientific beliefs about "truth serums," "body memories" and the accuracy of hypnotic regressions. Yapko's chapter on memory is concise and easy for professional and lay audiences alike to follow and understand. He is at his conceptual best when explaining how therapist expectations and countertransference issues can subtly influence some clients to question the validity of their pretherapy memories, and then resolve those doubts by accepting the possibility of "repressed abuse" being at the root of their symptoms.

Perhaps Yapko was trying too hard not to alienate accused families and their allies (the False Memory Syndrome Foundation chief among them). While making liberal use of clinical anecdotes supportive of false memories, he does not balance these out with a similar number of clinical anecdotes of repressed memories (although he does indicate they exist). Similarly, he takes great pain (and many paragraphs) to critique research supportive of repressed memories, while only briefly mentioning without elaboration the possibility of flaws in the research that has claimed to have discredited repression.

For a book that initially tries to rely heavily on objectivity and science, Yapko does not clearly distinguish between science and polemic. When being argumentative and opinionated, his primary target is psychotherapy. He criticizes therapists for "adding new perspective to old experiences...[in which] a 'loving a protective mother' may become 'co-dependent.' (They used to just be 'Mom and Dad.')" He notes that "while the number of therapists in the country has roughly doubled in the last decade, the mental health of the country has not improved accordingly." (p. 88) Personally, I am perplexed by people who seem to suffer from distorted conscious memory as they pine for "the good old days" (of Jim Crow and lynchings, of rampant child exploitation by industry, of flagrant oppression of women, of institutionally-sanctioned humiliation and persecution of addicts and the mentally ill--not to mention the Holocaust). I do not accept as a fact that the "general mental health" of the world or this country was "better" prior to the second half of this century.

Similarly, Yapko takes a stand that seems to agree with the revisionist notion that we live in an era in which America is becoming the "land of victims." "Few people want to say, 'I guess I'm just a loser.' It is much easier to say, 'It's Mom and Dad's fault.'" (p. 145) I have not found this to be the case at all with abused clients; unfortunately, my patients have had no trouble calling themselves "losers." They tend to be extremely protective of their parents and families, even when there is plenty of objective evidence of chronic and extreme abuse. In my clinical experience, sexual abuse survivors too often fail to see themselves as victims, and are overly critical and harsh with themselves (i.e., they victimize themselves). I wonder if Yapko is confusing media hype and television talk shows with sociology.

Yapko also claims that "since psychotherapy started to become more widely accepted and available...therapists have intensely emphasized personal fulfillment, personal happiness...[with the underlying message of] you don't have to live up to anyone else's expectations...you don't have to honor commitments that later become inconvenient, you don't have to do things you find unpleasant..." (p. 139). He speculates that "the cultural climate invites [false memories of abuse] by encouraging individuals to believe they are entitled to whatever they want, however unrealistic and irresponsible." Therapists encourage clients "to lay the blame elsewhere when [they] are disappointed." (p. 142) I have not encountered many therapists who confuse "personal fulfillment" with irresponsibility in this manner; if anything, the therapists I have encountered are strong proponents of the cognitive therapy paradigm that exhorts clients to be responsible for their beliefs, feelings, and behaviors. I have a similar problem with Yapko's unrelenting attack on the "recovery movement," often by quoting media-guru John Bradshaw. Again, Yapko's experiences do not match my own. People at meetings of Alcoholics Anonymous talk at length about their own foibles, not their parents.'

Fortunately, Yapko does balance this tirade with the admonition that "parents can get caught in a similar trap." (p. 146) Still, Yapko criticizes therapists for making premature generalizations from incomplete data (in the first two chapters of his book), but then often demonstrates the same tendency. A story in Time magazine (with which Yapko begins a section entitled "America: The Land of Victims") hardly constitutes scientific data.

The final chapters in Suggestions of Abuse are better constructed, but incomplete. His advice to survivors and accused family members is fairly sound, and the sections on "If you are the spouse of the accused" and "If the accuser is your sibling" are well thought-out. To the accused family members, he clearly states that "[if] you instigated or participated in acts directly or indirectly involving abuse, the painful but moral response is to admit it. ...Admitting that abuse occurred is often an opportunity for the offender to make important life changes." (p. 183) On the other hand, on the next page he states "the important thing is to keep the lines of communication open between all family members..." (p. 184) When the accused perpetrator continues to deny abuse in the face of overwhelming evidence, ongoing communication can be traumatic for the survivor, and trigger dangerously self-destructive behaviors. Yapko also warns bona fide survivors against getting "stuck" in their pain, but does not mention the equally important (and given the current managed care environment) problem of "moving on" too fast. Among my clients, I have seen far more premature attempts at "putting the past behind me" than chronic wallowings in pain and self-pity.

Chapter 7 ("How Can You Be Sure?") is important, and raises some good points. I especially agree with Yapko's criticism of therapists who universally prescribe confronting alleged perpetrators. While confrontation may be necessary at some point, I have not found it helpful at all to encourage it according to some "formula." On the other hand, I found Yapko's sections on "The Need to Know" and "Is Knowing Necessary?" to be insensitive to survivors. The survivors I have worked with have been tortured souls who have often felt crazy for a great deal of their lives. Often, they have been misdiagnosed (e.g., Borderline Personality Disorder), mismedicated, and mistreated. They want validation, and they want it desperately--and not just out of some trivial or neurotic curiosity. On the other hand, Yapko is right when he asserts that very often we can never know, and that the goal of therapy often must be "to learn to live with the uncertainty and get better anyway." (p. 169)

Yapko gives short shrift to the extremely important issue of choosing a competent therapist. In the section on "Choosing a Therapist" he advises people to seek referrals from AAMFT, which "can be especially helpful in providing a local family therapist who is sensitive to these [abuse] issues." In my experience, I have not found AAMFT members to be, as a whole, any better or any worse than other qualified therapists on abuse issues. Yapko leaves out other possible referral sources (and there are many), including the American Society of Clinical Hypnosis, the Society for Clinical & Experimental Hypnosis, the Family Psychology and Psychological Hypnosis divisions of APA, and the ABMP. ASCH in particular has taken a highly balanced view on the repressed memory issue, and certified members of ASCH are now being required to obtain specific training in this area. On the other hand, Yapko fails to provide warnings about lay hypnotists, non-credentialed "recovery therapists," and addictions counselors with no formal psychotherapy training who are practicing unethically beyond their limits.

All told, Suggestions of Abuse is an extremely important book for anyone working with trauma and abuse. The importance of Yapko's message in the first three and final two chapters of this book outweighs some of its pedantic flaws.