Working with adult clients who may have experienced childhood abuse: Recommendations for assessment and practice.

Abstract

Karen P. LeseTexas Tech University Counseling CenterMary S. Gilbert and Linda ForrestMichigan State UniversityThe delayed memory debate has generated many questions about therapeutic practices that are likelyto be beneficial and detrimental to clients. This article proposes components of optimal practice forworking with adult clients who may have been abused as children. The recommendations are orga-nized around the following themes: (a) competence, (b) assessment and treatment planning, (c)psychotherapy process and technique, (d) memory issues, (e) and ethics. The authors emphasize theimportance of a collaborative therapeutic relationship and urge clinicians to proceed cautiously whenencountering treatment issues for which scientific knowledge and consensus are still evolving.In the wake of the delayed memory debate, the therapeuticprocedures of clinicians have been exposed to increased scru-tiny, and some authors have concluded that therapists are oftenunprepared to respond effectively to clients' concerns or areresponsible for leading clients to believe that they have beenabused when there is no basis for such a conclusion (e.g., Lind-say & Read, 1994; Loftus, 1993; Poole, Lindsay, Memon, BKnapp & VandeCreek, 1996). This article adds to the emergingliterature on psychotherapy practice with clients who may haveexperienced abuse by proposing practices that we believe willsupport the best interests of clients. Our intent is to avoid (a)MARY S. GILBERT received her PhD in counseling psychology fromMichigan State University and is currently working as a psychologistfor the Michigan State University Counseling Center. Among her researchand treatment interests are various women's and feminists' issues, episte-mology, and issues of diversity.LINDA FORREST received her PhD from the University of Washington in1979. She is a faculty member associated with the counseling psychologyprogram at Michigan State University. She is the past chair of the Divi-sion 17 Committee on Women and the Task Force on Memories ofChildhood Sexual Abuse. She is the current vice chair of the APACommittee on Women in Psychology.CHRISTINE A. COURTOIS AND JEAN CAMPBELL are the joint second authorsof this article.SPECIAL THANKS TO Christine A. Courtois for generously sharing hertreatment guidelines for delayed-recovered memories (Courtois, 1997b)as a partial foundation for the perspectives presented in this article andfor leadership in the development of abuse-trauma theory and treatment.We gratefully acknowledge the contributions of many individuals whoprovided feedback and suggestions, including Bianca Bernstein, LauraBrown, Judy Ellickson, Ruth Fassinger, Kathy Hotelling, Kathy Miller,Karen Pfost, Ken Pope, Tina Stern, Marolyn Wells, and Betty Yarns.We also express appreciation to the APA Division 17 Section on Womenfor its support during this project.CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Car-olyn Zerbe Enns, Psychology Department, Cornell College, 600 FirstStreet West, Mount Vemon, Iowa 52314-1098. Electronic mail may besent to [e-mail].