Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

Learning Task #5
Addressing Forgotten and Recovered Memories of Child Sexual Abuse
Irene Estay
Amanda Medland
August 14, 2013

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

Addressing Forgotten and Recovered Memories of Child Sexual Abuse

The issue of Child Sexual Abuse is no light conversational piece and often times one that
harbours many strong feelings for both victims and non-victims alike. Sexual abuse occurs when
an older individual involves a younger child in order to gain sexual satisfaction (Woods, n.d.).
This can occur in various ways, and can involve contact or non-contact with the offender.
Contact with a child may involve kissing, touching in sexual ways both to and from the offender,
forcing sexual acts (oral or penetration) on the child or forcing the child to perform sexual acts.
Non-contact sexual abuse may consist of showing private areas, showing or creating
pornography, or making sexual comments towards the child (Woods, n.d.). Despite the rise in
awareness of Child Sexual Abuse over the years, it seems as if many underestimate the
occurrence of this crime. As reported by the Canadian Centre for Justice Statistics (2010) there
were 13,600 reported cases of child sexual assaults in 2008, and of those, 75% of the offenders
were adults known to the child (Calgary Communities Against Sexual Abuse, n.d.). It is believed
that there are a substantial number of unreported cases of Child Sexual Abuse as the child may
be afraid to tell, is not listened to or is unaware that the actions imposed upon them are
inappropriate (American Academy of Child and Adolescent Psychiatry, 2012). In addition,
victims of sexual abuse often hide their feelings, blame themselves, keep the secret, and
rationalize the abuse by telling themselves it was not that bad, or it won't happen again (Woods,
n.d.). As a result, some children will develop symptoms similar to Post-Traumatic Stress
Disorder (PTSD), depression or anxiety, along with a gamut of other psychological, social and
behavioural issues. For the children who do not disclose, often they are not able to appropriately
process and may turn to drugs or alcohol in order to self-medicate, whereas with the children
who disclose the abuse, there is hope they can receive effective counselling in order to

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

psychologically process the violations that occurred (Deblinger, 2009). For those who are
qualified to provide counselling, there are large discrepancies around the topic of repressed or
recovered memories in regards to Child Sexual Abuse. Some people believe that it is logical for
victims of Child Sexual Abuse to repress an act so vile, while others disagree, stating that
memories may not be repressed but rather misunderstood in the context of the situation.
The concept of repressed memories operates on the idea that individuals who experience
traumatic events, such as sexual assault, restrict the related memories to an extent that they do
not remember the event, therefore keeping them from having to deal with the psychological
effects (American Psychological Association, n.d.). In a study of 495 individuals of the Danish
general population, almost 70% of those believed that the idea of forgotten child sexual abuse
was possible or very possible (Rubin & Berntsen, 2007). The idea of repression, also known as
dissociation, is that the memory of a specific event still remains, although it is unavailable for
recall for a length of time, whether short or long (American Psychological Association, n.d.).
This is believed to serve a purpose which typically centers on an individuals ability or inability
to cope at that particular time. Freyd (1996) believes that because often the abuser is a familiar
person, and the child may rely on the adult (for food, shelter, affection), the child must block out
memories of the abuse in order to retain the relationship that enables the childs basic needs to be
met. Although many professionals accept that the idea of repressed memories is a plausible one,
there is acknowledgement in the infrequent occurrence of repression of memories to the extent
that the individual can no longer remember the event (American Psychological Association,
n.d.). It is also recognized that for those who identify with repressed memories, it is possible to
construct convincing pseudomemories for events that never occurred or for memories to be
influenced by other factors (American Psychological Association, n.d.). Others believe that there

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

is not substantial credible evidence to support the concept of repression due to excessively
horrific or violent abuse, so the debate between the concepts of repressed memories continues
(Loftus & Polage, 1999).
The idea of forgetting or underestimating the severity of actions is another standpoint on
how victims of Child Sexual Abuse organize their memories. McNally et al. (2006) provided a
compelling statement that not thinking about something for a long time is not the same thing as
amnesiathe inability to remember. There are many reasons why a person would not think
about their abuse, but it does not tend to make it inaccessible in their memory. It is possible that
for some, the sexual abuse was not seen as traumatic, and therefore does not hold a heavy weight
in a persons thoughts. Loftus and Polage (1999) state that a key reason why children may not be
traumatized by Child Sexual Abuse is they did not understand at the time of the event that it was
sexual abuse and only later reframed their experience as one of abuse. This does not mean that
the act itself was not unethical but it changes the thought processes about the sexual abuse in the
moment to one that is not categorized as traumatic. It has been found that when individuals of
Child Sexual Abuse were recalling memories of forgotten assault, there was more psychological
trauma resulting from the recollection and realization than when the sexual abuse occurred
originally (McNally et al., 2006). Clancy (2009) goes as far to say that classification of Child
Sexual Abuse as traumatic may be an interference in the victims recovery, as many therapists
approach abuse similarly to post-traumatic stress disorder, which may not be the best treatment
pathway.
Whether individuals are capable of repressing memories, forgetting them or
underestimating the severity of the actions, the issue still remains that Child Sexual Abuse occurs
and Psychologists are sought out to assist the affected in mentally processing and coping with the

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

aftermath. Care needs to be taken for professionals engaging in therapy with victims of Child
Sexual Abuse when the concept of repressed or forgotten memories is broached. Wilsnack, S.,
Wonderlich, Kristianson, Vogeltanz-Holm, and Wilsnack, R. (2002) surveyed 711 women from
the United States in regards to forgetting and remembering child sexual assault. Of these, it was
found that only 1.8% of those who claimed to feel abused had recovered memories with the
assistance of professionals. This suggests that although therapists have an important role,
assisting recall is not prevalent. The role of the counsellor will differ depending on each
individual case, as no two are alike. It is possible that some children not to need intensive
therapy but rather an opportunity to talk through what occurred, creating a safe environment with
the family to talk about feelings surrounding the abuse (Deblinger, 2009). Other individuals may
experience blame or guilt and create cognitive distortions about the abuse that would be best
addressed with more focused Cognitive Behaviour Therapy (CBT). Another alternative for those
who processed the sexual abuse as extremely traumatic may benefit from CBT addressing the
PTSD they may experience.
For obvious ethical reasons, research involving potentially traumatic events (such as
Child Sexual Abuse) is not purposely inflicted on subjects in order to gain more controlled
research and insight into the connection between memory and trauma (American Psychological
Association, n.d.). With the array of research in favor and against repressed or forgotten
memories as well as the most ethical and effective therapy options to treat the effects of Child
Sexual Abuse, Psychologists need to pay extra care to the code of ethics of which they abide by
in order to provide the best possible care.
Relevant Ethical Principles

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

As per the Canadian Code of Ethics for Psychologists there are several ethical principles
and values that become exceptionally important when working with individuals who have been
victims of Child Sexual Abuse.
Dignity of Persons
Of utmost importance is the Respect for the Dignity of Persons. Clients who have been
affected by sexual abuse are particularly vulnerable, and display a spectrum of emotions. The
main goal is to protect and assist in the welfare of clients while sub sequentially avoid doing
harm (Canadian Psychological Association, I.1, I.2). It will also be essential that the psychologist
communicates in a way that respects the client and displays dignity in both oral and written
communication (CPA, I.3) It is also important to be hyper aware of any communication that
could be taken as judgemental or accusatory, as many victims of Child Sexual Assault may
harbour feelings of guilt or self-judgement. Lastly in regards to dignity of persons, it is also
critical that the client have the opportunity to participate in decisions regarding their therapy as
much as is possible (CPA, I.16). If clients do not feel as if they have a degree of control when
visiting their psychologist, the likelihood of openness and honesty (with the psychologist and
self) has the potential to diminish, causing the client to close down.
Responsible Caring
The Principle of Responsible Caring comes next when adhering to the weighted order of
principles. As such, it is crucial that psychologists avoid doing harm, carry out activities that will
benefit the clients, and maintain competence in doing so (CAP, II.2, II.6). When competence is
not established, best care can be provided by either consulting or referring to another
professional with adequate skillset (CAP, II.8). As victims of Child Sexual Assault can range
from young children to adults who have been living with the aftermath, so-in exists professionals

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

that specialize in addressing the needs of both old and young. When working with children, it is
also important to look at the entire family dynamics and how your involvement will assist, rather
than harm the child and whether the family is able to assist in the process (CAP II.13). Especially
with a client who has been sexually abused, it is important to weight the risks and benefits of any
research or interventions that may invoke pain, discomfort, or harm (CAP II.16). The recovery of
memories or the acknowledgement of the severity of childhood events in itself has the potential
for mental harm to clients, so this needs to be taken into account. It is also crucial that
psychologists refuse to help families or carry out activities that would cause excess
psychological harm, and termination of activities must occur if there appears to be more than a
minimal risk, or if there appears to be more harm than good (CAP, II.38, II.37). Throughout the
entire process, close attention must be paid towards the psychologists own experiences, beliefs,
attitudes, etc. as they can potentially influence the psychologists actions towards the client or the
services provided (CAP, II.10).
Integrity in Relationships
Lastly, Integrity in Relationships identifies that psychologists must ensure that despite
personal experiences and individual differences, objectivity and un-biasedness must remain with
services provided to clients (CAP, III.10).
Potential Dilemma #1
The ethical values identifies that analyzing risks and benefits when an intervention or
may pose some level of pain or hurt. For individuals who wish to explore the concept of
repressed memories, where is the line between helpful and harmful?
Case Example: A 19 year old woman, Mia, with self-reported depression is seeking therapy. She
claims that she saw a show on repressed memories and thought it was something that would

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

explain why I feel so messed up all the time. She believes that she needs to uncover her
memories in order to work through whatever may have happened to her. She lived with her
parents until the age of 6 at which time she was apprehended and placed in foster case. There is
little information about her apprehension but it is believed it was because of some type of abuse.
Mia does not remember much about her childhood with her biological parents.
Resolution of Dilemma #1
When working with clients, it is always important that respect is given to the client and any
others involved. Despite any ideas that may be presented (credible or not credible) it will be
essential that Mia is made to feel as if her ideas are heard and acknowledged. That is not to say
that I must follow through with all suggestions that she brings forward, but to allow her to openly
share without discrimination. As stated above: The main goal is to protect and assist in the
welfare of clients while sub sequentially avoiding harm (CPA, I.1, I.2). In this case it will be
especially important to weigh the relations between what is harmful and helpful for Mia in
regards to therapy.
Option 1: No Treatment
As per the code, it is our duty to identify and inform the client of the risks associated with nonaction. We would need to consider what the effect of no treatment would be for Mia. As she has
presented with a concern which may or may not be present (Child Sexual Assault) we must
consider how this will affect her if she were not involved in services. At the current moment, she
is not able to recall any past history of abuse, and is looking for a reason for her mental problems
as an adult. Mia has identified that she has been experiencing depressing and other messed up
feelings, which must also be taken into consideration. As a psychologist, if you refuse to assist

Running head: ADDRESSING MEMORIES OF CHILD SEXUAL ABUSE

her in therapy on the basis that there is no evidence for repressed memories, then she also will
not receive treatment for her other symptoms.
Option 2: Therapy to address her repressed memories
The first thing to consider is the professional research conducted that supports or discredits the
concept of therapy to address repressed memories. As indicated above, the concept that repressed
memories occur is one that many research participants view as possible, but the reality is that the
prevalence of therapy induced recovery is substantially low (Wilsnack et al., 2002). As Mias
awareness of repressed memories was sparked by a television show and an unknown past rather
than evidence of memories surfacing, it would be crucial to decide if it would be more harmful
than helpful to try to dig up memories that are not prevalent. If Mia was sexually abused as a
child, studies have shown that the recovery and acknowledgement of such information can often
be more traumatic that the occurrence of the abuse initially, as Mia will have a greater
understanding of what happened (Loftus & Polage, 1999). In her current state, which is already
identified as struggling, will Mia be capable of processing and working through a traumatic
experience such as abuse if it surfaces? It may also be of interest to address whether Mia is really
wanting to know about her past, or is only looking for relief of her current symptoms and
believes that uncovering past information is the way to do so. If there was to be therapy to
attempt to uncover her repressed memories, it would be important that the psychologist did not
steer Mia toward any particular conclusions, and allow her memory to evolve as naturally as
possible (APA, n.d.). I would also need to identify whether, in this scenario I as a psychologist
would be capable of providing competent therapy in regards to repressed memories. Having
never experienced an individual for who this was a concern, I have little to no awareness of

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treatment plans for such an individual. If Mia is only looking for relief of her mental health
symptoms, then it may be of beneficial to consider another therapy option.
Option 3: Therapy to address her secondary symptoms
The final option I see acceptable for Mia would be to address her secondary symptoms of selfreported depression and get greater insight into her mental health. As little is known about Mia at
this point, there may be other factors that are playing into her current state that have little to do
with her biological families impact. Little is known about her biological parents so it would be
difficult to tell if mental health issues run in her family, but with the symptoms she presents it is
very possible to address those without a family background. Trauma focused CBT has been used
with adult victims of rape or sexual assault who display symptoms of PTSD (Lev-Wiesel, 2008).
CBT can be identified as a treatment that guides the client in changing their thoughts (typically
negative or maladaptive) which will directly change their emotional state and behaviour. It can
involve a number of approaches and techniques to assist in modifying the thoughts and influence
change. CBT alone, not taking into account any trauma that may have occurred, has significant
research supporting its effectiveness for depression. Page and Hooke (2012) conducted a study of
which 300 inpatients were involved in a modified (shortened) CBT program in order to decrease
depressive symptoms. Not only was the trial of CBT effective, but the results were comparative
to studies which were conducted over an extended period of time. Along with depression, CBT
has been shown to have positive effects on numerous other concerns such as anxiety and
addictions. As the techniques and skills learned in therapy can be generalized to many other
presenting issues, Mia will be provided with a toolbox of resources that she can apply to any
aspect of her life in the future. CBT can also be tailored for each client in order to be most
effective and to focus on the issues of concern. Regardless of the fact that Mias past history of

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abuse is unknown, treatment that is client-specific and focuses on the clients secondary problems
has been shown as the most beneficial (Hetzel-Riggin, Brausch & Montgomery, 2007).
In conclusion, I would feel the best option for Mia would be to provide therapy
addressing her secondary symptoms. This would be due to the lack of validity on therapy
regarding repressed memories, and the inadequate evidence that she may have been exposed to
sexual assault as a child. As per the American Psychological Association (n.d.), a competent
psychotherapist will attempt to stick to the facts as are reported, which in this case is evidence
of depression and/or other mental health problems. This will create a starting point for addressing
concerns with Mia in relation to where she is in the current moment, and allow her to work
through the struggles at present. Focusing on her mental health currently does not mean that we
dismiss the idea that Mia may have been abused as a child and subsequently forgot. In the event
that Mia begins to remember parts of her past, this will be something that can be addressed as it
presents. If Mia shows evidence of recovering memories, it would be something that would
warrant additional consultation in order to proceed with the best possible care.
Potential Dilemma #2
Working with children presents with multiple challenges, especially if there is
considerable evidence that a child is at or has been harmed. Of utmost importance is to ensure
the childs immediate safety. Secondary, when providing support for children, one must
acknowledge that not all children develop at the same speed. Special attention must be paid to a
childs age, developmental level and understanding when determining which type of support may
have the most benefit and cause the least amount of harm.
Case Example: A 7 year old girl named Anika is brought into the office. Her parents explain that
they also provide guardianship to Anikas uncle (Marty) who has a developmental disability.

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They explain that they have reason to suspect that when left unsupervised Marty may have
touched Anika in appropriately. Marty has been temporarily relocated until clarification can be
made. Anika seems vaguely aware that something has happened, but has been asking why Marty
left and when he is coming back. The parents want to determine if their suspicions are correct
and to what extent Marty has violated their child.
Resolution of Dilemma #2
First and foremost it is important to identify if there has been legal involvement and how they
view the parents desire for therapy to discern what has happened. As the parents suspect that
abuse has occurred to their child, it is imminent that the police are notified and appropriate legal
actions are taken. This may have implications on therapy as the police may encourage disclosure
or reports from Anika, and they often times will conduct an investigation of their own. It is
possible that if therapy occurs before the authorities are allowed to precede that disclosure and
statements may be altered. Also with suspicion of Marty as a potential abuser, it is paramount
that he has not been relocated to an area where he may again have unsupervised access to other
children. Once any legal issues are approached, then the psychologist is faced with the dilemma
of what would be of highest benefit to Anika while posing the fewest risks. This creates several
pathways to identify and weigh as options.
Option 1: No Therapy
A main question to consider would be, since Anika has very little insight into what has happened:
would it be more harmful for her to engage in therapy, identifying and bringing attention to the
fact that an atrocious thing has happened to her? In a meta-analysis of treatment outcome,
Hetzel-Riggin, Brausch, & Montgomery (2007) identified that involvement in treatment
presented with more positive outcomes than no treatment, and treatment is frequently sought

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even for children who appear to be asymptomatic. Even though at the moment Anika appears not
to have been affected, complete ignorance of this issue would be unethical as it leaves her
vulnerable for reoccurrence of this type of abuse in the future.
Option 2: Therapy
Therapy for individuals who have experienced sexual assault can exist in a range of formats,
depending on the needs of the individual and the symptoms they present with. For most sexual
abuse therapy, there is at minimum one of four basic goals that are approached: symptom relief,
de-stigmatization, increase in self-esteem, and preventing future abuse (Lev-Wiesel, 2008). The
therapeutic route that is taken may vary from client to client, but typically at least one of the four
mentioned goals is of concern when an individual seeks therapy for such a matter. Despite the
sexual abuse, there are some children who may show higher levels of resiliency, thus needing
less treatment, and others who show little resiliency and who inevitably will require much more
intense therapy to overcome the abuse (Hetzel-Riggin, Brausch & Montgomery, 2007).
Option 2a: Cognitive Behavioural Therapy (CBT)
The first option for therapy is CBT which can be specialized to be trauma focused. This typically
involves the children reliving aspects of the abuse gradually in order to process, comprehend and
work through what occurred. This is paired with parenting education on how to work with their
child through the process with behaviour management techniques (Green, 2008). CBT has been
found to be most effective for children experiencing behaviour problems as a result of the abuse,
as well as those who are psychological distress (Hetzel-Riggin, Brausch & Montgomery, 2007).
One concern with CBT with young children is that they may not be
emotionally or developmentally equipped to engage in treatment
interventions that require substantial verbal and cognitive output (Green,

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2008). Especially for a child who seems to be very unsure of what has
happened, it would be difficult for her to engage in a therapy that relies on
exposure and verbal exploration of the event.
Option 2b: Play Therapy
The second option for therapy I would need to consider would be Play Therapy. Play Therapy is
designed to meet children where they are developmentally in order to address the concerns for
therapy in a way that is more sensitive to the needs of children. Often this includes play based
activities or artistic outlets in order to work through their concerns (Green, 2008). This allows
children to participate in gradual exposure to therapy and their abuse, and creates a safe nonjudgemental environment to explore the issues the child presents with (Green, 2008). For
children who have concerns with social functioning, play therapy appears to be the most
effective treatment (Hetzel-Riggin, Brausch & Montgomery, 2007). Due to the age of Anika and
the fact that she seems unaware or unsure about what has happened to her, it could be of benefit
to approach therapy for potential sexual assault in a safe, more neutral vessel rather than with
typical psychotherapy.
In conclusion, after weighing the options, it believed that Anika would best benefit from
Play Therapy to address what has happened to her in an age appropriate way without inducing
additional stressors but by creating a supportive environment for which she can express herself
and create an understanding of what has happened. This also means that since I am not versed in
the scope of play therapy that I would need to make a referral to a professional who specialized
in this in order to provide the best care for Anika. Lastly, in addition to individual therapy for the
victim, a second option for therapy involves the family, sometimes inclusive of the abuser as
well (Lev-Wiesel, 2008). It would be suggested that primarily, Anikas parents engage in family

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therapy to ensure that all are able to move forward past this incident. Anikas parents may also
harbour guilt surrounding the incident and their exposure of their daughter to a potentially
dangerous adult, and this will need to be addressed. Marty will also be encouraged to have
therapy surrounding his actions (regardless of legal implications) and depending on the cognitive
level of Marty, in the future he may be encouraged to attend the family therapy as well once he
has shown success in individual therapy.
Personal Values and Potential Conflict
As a current family support worker, I occasionally spend time supervising adults who
have either alleged or convicted accounts of sexual assault. This is an area that is difficult for me,
but ranges on a spectrum in my ability to stay neutral towards the adult, as I am sure is the case
for many. I believe that I have an easier ability to remain unbiased towards perpetrators who are
able to admit what they have done as wrong in comparison with those who appear are not able to
identify their wrongdoings or seem unwilling to change. Also, for those who are not aware of the
differences between right and wrong actions due to medical or cognitive issues, I am able to
approach with less judgement and other negative feelings more easily.
I am also very aware of myself as being a strong empathizer, and I am aware that if I
pursue a career path that centres more strongly around counselling psychology, this will be
something I will need to be hyper aware of. It is possible that if the more heartbreaking cases,
such as neglect or physical, emotional, and sexual abuse, were interspersed with clients with
mental health issues or less emotionally affecting cases, that I would not become too
overwhelmed. Although if I were in a situation where there were several clients who I felt
emotionally sensitive towards their cases, I would need to make sever efforts to ensure that my
own mental health was not neglected in order to provide the best care. It would be important that

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I would have another professional to consult with to ensure I was providing the best care, and to
validate my proposed treatment options. I also believe that it would be paramount to implement
to the best of my ability, timelines for which I would allow myself to be active in thinking of
each case. Without this I believe it would be easy to allow thoughts to override other parts of my
life. Being actively aware and thought stopping outside of designated hours would help to keep a
fresh mind and prevent burn out when presented with cases that I may view as traumatic.
Lastly, I believe that working with children who have experienced abuse would be much
more difficult than adults who experienced it as children but are seeking help to overcome issues
as a result. As women, we typically have a predisposition to want to protect children and may
want to save them from whatever negative influences they have had in their lives. In fact I
would be assisting them in bettering themselves with whatever issues brought them to me as a
professional, so the hope is that this would allow me to help them in the long run without feeling
the need to save them from their lives.

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References
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Canadian Psychological Association. (2000). Canadian code of ethics for psychologists (3rd ed.).
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Clancy, S.A. (2009). The trauma myth. New York: Basic Books.
Deblinger, E. (2009).Questions and answers about child sexual abuse. The National Child
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Freyd, J. J. (1996). Betrayal Trauma: The Logic of forgetting childhood abuse. Cambridge, MA:
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Goodman, G.S., Ghetti, S., Quas, J.A., Edelstein R.S., Alexander, K.W., Redlich, A.D., Jones,
D.P. (2003). A prospective study of memory for child sexual abuse: New findings
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modalities. Children and Youth services Review 30, 665-673.
Loftus, E. F, & Polage D.C. (1999). Repressed Memories: When are they real? How are they
false? Forensic Psychology, 22(1), 61-70.
McNally, R.J., Perlman, C.A., Ristuccia, C.S., & Clancy, S.A. (2006). Clinical characteristics of
adults reporting repressed, recovered Psychology, 74, or continuous memories of
childhood sexual abuse. Journal of Consulting and Clinical Psychology, 74 (2), 237-242.
Page, A.C., & Hooke, G.R. (2012). Effectiveness of cognitive-behavioral therapy modified for
inpatients with depression. ISRN Psychiatry, 461265-7.
Rubin, D.C., & Berntsen D. (2007). People believe it is plausible to have forgotten memories of
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(2002). Self-reports of forgetting and remembering childhood sexual abuse in a nationally
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Woods, A. (n.d.). Understanding and overcoming child sexual abuse. Canadian Living. Retrieved
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_sexual_abuse.php.