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Ethical Boundary Considerations and Repressed Memories of Sexual Abuse
On the last track, we discussed how false memories may be generated and several ethical dilemmas to keep in mind when you suspect a client may be under the influence of a false memory.
On this track, we will examine ethical dilemmas that occur when determining whether or not a client has fabricated a memory.
5 Ethical Dilemmas
Dilemma #1 - Fallacies of the Client
One such client, Marie age 33, was the first to suggest she might have been molested as a child. Marie went through three therapists, who all were convinced of her childhood abuse. Marie recalled wanting to bite down and clench her teeth. Soon her entire body was reacting: first, a few of her limbs would go numb, and soon she felt a heavy weight on her chest. One of her therapists diagnosed her as going through post traumatic stress disorder.
Interestingly enough, before feeling these symptoms of depression and bodily reactions, Marie had experienced a miscarriage. However, once the idea that sexual abuse was introduced, the possibility that the miscarriage was responsible for her post-traumatic stress took a secondary emphasis and repressed childhood sexual abuse was immediately focused upon.
Think of a client you are currently treating and the directional role you take in your sessions. Could you be violating an ethical boundary by being too directive?
Dilemma #2 - Misconceptions about Functions of the Brain
Bartlett, a memory researcher, states that the widely held view of this kind must be discarded. He states that remembering is "an imaginative reconstruction, or construction, built out of the relation of our attitude toward a whole active mass of organized past reactions or experience." When considered this way, the idea that all memories are infallibly recorded is disproved.
Dilemma #3 - Recovered Memories Highly Colored by Emotions
Dilemma #4 - Memories Can be Changed by Current Beliefs
In order to give life purpose, it is possible to reshape the past to fit to currently held beliefs. So could it be possible that your clients, who have the idea of sexual abuse in their head, could shape their memories to fit identified maladaptive behaviors? In this way, they can explain their symptoms with relatively little invasive therapy. A quick solution means sparing oneself the hardship of more therapy.
So the ethical tightrope to walk here is how can you manifest client self-determination in a session given the information above regarding client's possible faulty, unwavering beliefs; the belief that the brain remembers every experience; manipulations your client's may have experienced by outside stimuli; as well as your client's conscious or unconscious efforts to rewrite their past based on their current attitudes and opinions. It's sort of like trying to build a house on quicksand with no stable supports and very shifting conditions.
Have you ever had the compulsion if even just for an instant to terminate a client whom you feel has been blatantly and intentionally misrepresenting facts during the session?
Dilemma #5 - Consulting with Colleagues
As you are most probably aware, by terminating the client you may be violating the client-therapist bond by not doing all in your power to repair the relationship. Professional codes of ethics states, "The therapist should take reasonable steps to avoid abandoning clients who are still in need of services. The therapist should withdraw services with caustion only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects." It goes without saying, if you should abandon the client prematurely, this could result in a relapse in symptoms. This could also lead to allegations of abandonment.
On this track, we discussed dilemmas in determining whether or not a client has fabricated a memory, as well as seven ethical points to consider when terminating a client.
On the next track, we will examine the various sides of the argument regarding repressive memories.
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