Review: Try to Remember


A shortened version of this review was posted at Amazon.com  

Dr. McHugh was busy being Department Chair of Psychiatry at Johns Hopkins. When asked to help with a court case he declined. The asserted false memory based accusations in the case were too ludicrous and absurd to be true. Cages with children being abused by large machines in their cellar? The couple did not even have a cellar! He was certain the legal team could do without him. Later that year Judge Elizabeth Dolan of Massachusetts found that elderly innocent couple guilty and had them arrested. Dr. McHugh was shocked and saddened. He then changed his course and thousands of innocent people were able, based on his expert testimony illuminating the travesty of "recovered memory" based accusations, to avoid prison. The struggle took 20 years. This book is his personal account of what happened in the 1980's-90's when he helped prevent misinformed zealots, suggestive clients, ambitious prosecutors and manipulative therapists from imprisoning innocent people and destroying families.

    The book largely recounts Dr. McHugh's professional struggle against fads that impacted psychotherapy.   The repressed memory (or recovered memory) therapies caused parents and relatives to be accused of horrendous sexual abuse of children by adults claiming to remember abuse.  It appeared that a large number of these recollections were false and that evidence in support of the claims were weak or non-existent.  He states (on page 38)
          "And yet it [repressed/recovered memory movement] was a terrible mistake.  It 
           would injure many families and damage public confidence in psychiatry.  If I,
           the Psychiatrist in Chief of the John's Hopkins Hospital couldn't tackle this
           misdirection who could - or might dare- try?  The issue seemed clear: 
           If not me who?  If not now, when?"
Dr. McHugh attempted to communicate with therapists and colleagues and was stunned to find that they used these techniques or allowed these techniques to be used in their institutions.  He joined with other informed therapists, memory experts, lawyers and professionals to confront this movement based on errant understandings of the human biological, neural and social systems.  He began a formal association with the False Memory Foundation dedicated to understanding the true nature of human memory.
     During his career as a psychiatrist he encouraged and witnessed a transition in the field from one based on Freudian Analysis explaining all the struggles and ills of the mentally ill and emotionally challenged to one that recognized the impact of physiological and social influences.  
    One offshoot of this approach to therapy (recovered memory therapy) were those who suffered from emotional challenges and mental illness emerged in the 1980's and 90's.  This expression of the Freudian approach claimed that events could have a high impact on life and yet not be consciously remembered.  Until a therapist trained in "recovering these memories" worked with the client to "remember them" the client would continue to suffer numerous ills.  Once the "repressed memories of sexual abuse" were uncovered the client would then begin the process of healing.  The problem with this approach was that it increased dependency on the therapist, often split families, resulted in less productive lives and produced pseudomemories that were treated as actual memories.  Often times the memories, which we both horrid and false, harmed family members, shattered the professional lives of those falsely accused, alienated family members and often put innocent people in jail.   All this happened at the hands of professionals and Dr. McHugh was one of the sane voices that spoke up to challenge therapist practitioners and colleagues.  The book details his personal experiences with the heartache and challenges that errant approach generated.
     He identifies another offshoot or fad of the Freudian Mannerists being "post traumatic stress disorder".  The error he sees (as he did in the recovered memory fad earlier) is similar.  Assigning high impact to single events and then focusing on that event as the cause of numerous ills and with that recognition the "victim" can assign responsibility to an external agent and then pursue a life free from this event.  In contrast Dr. McHugh sees the role of the counselor or therapist as one in which the client is guided away from from unproductive and or counterproductive behavior that influence everyday life decisions a person must face. 
     The last 2 chapters are, in my opinion, the best of all the chapters.  During his years as a Chair of two different Psychiatric Departments at reputable universities he oversaw the emergence of Psychiatry from a practice of interpreted dreams and seeing memories as the key to healing to one that recognized the physiological impact that could be treated with medication and equipping the client in therapy that encouraged the growth of cognitive skills to help the person deal with day to day life decisions more effectively.    In this vision of counseling the "cause" is not addressed but instead new ways of thinking are encouraged about those everyday life decisions.
     Dr. McHugh points out that those in psychosis, a highly suggestible state that yields delusions and even hallucinations, is amazingly responsive to the latest versions of medication and combined with cognitive therapy can drastically improve the conditions of the mentally ill.  The mentally ill no longer are required to generate "memories" as their vulnerability to delusions and hallucinations is reduced with medication.   The new inductive role for the therapist is one that coaches the client in more productive ways to engage the challenges in life 
     This is a fabulous read for those who have mentally ill family members or those victimized by memory based therapies (still rampant today).  Those in the legal professions, law enforcement or social workers who must deal with accusations by mentally ill people that are highly functioning (but still vulnerable to delusions) who can make very "credible accusations" that are in fact false will be better equipped to make sound decisions about the quality of those accusations. This book gives me hope for Psychiatry.

========================================
INTERESTING QUOTES from 
"Try to Remember:  Psychiatry's Clash over Meaning, Memory and the Mind"

"What is wrong with psychiatry?"
      "One must wonder why psychiatrists learn so little from the these misdirections, because they all follow the same pattern: seeing in human mental disorders things that do no exist, building treatment programs that are doomed, and the unapologetically retreating from these claims and therapies to await some other apparition to recapture the professions's loyalty and attention."
                                                                                                       pg 1
Front row seat...
     "I was someone with a front row seat in American academic psychiatry, who witnessed the injuries to people it [recovered or repressed memories] exacted, and who in protesting against it, came upon--as I had before--the power of this discipline to protect itself from criticism....In this book I describe the calamitous course of the recovered memory movement in psychiatric practice and how the theories on which it was based proved invalid and pernicious."
                                                                                                         pg 2
"A final hope"
     "I have a final hope--that the description of just how psychiatrists ought to act and what they must avoid may dispel the aura of mystery and inscrutability that has emanated form the field for decades [Psychiatry].  This mystique played a role in sustaining the misdirection by putting the ideas beyond criticism as experts on the 'mysteries of the mind'. "
                                                                                                         pg 4
Manneristic Freudians....
       "many of the conceptual presumptions of psychoanalysis about how the mind works had become idiomatic among therapists.  Ideas such as the conflict ridden unconscious, sex and sexuality as the source of these conflicts and repression hiding life's truths from the patients were the currency of service in psychotherapeutic clinics.
      These Freudian presumptions were easily co-opted and simply given new contents to serve the times.  And so what I've called the Manneristic Freudians were born.  They picked up Sybil, multiple personality, and the shameful buried traumas from Cornelia Wilbur.  They threw in repression, symptom formation and psychic defenses.  They ended up explaining mental disorders in a way that seemed fashionable and linked to tradition.  Such a diagnostic regimen demanded little more than a high level of suspicion and a low level of skepticism.
                                                                                                       pg 21
Surprise....
     "....some years after I had settled into my position at Hopkins [Chair of Psychiatry at John Hopkins School of Medicine], I was surprised by the "recovered memory" idea that was to rip tragically and malevolently at the social and emotional fabric of many American families.  For me it indicated psychiatry's sudden and unexpected reversion to the deductive explanations of mental disorders that I had at that time admittedly written off....
      ...I was surprised- at the weight this movement carried with influential psychiatric authorities such as department directors, educators, and journal editors despite the absence of any empirical support for the premise on which the practice depended.
                                                                                                       pg 33
Abandon idea that Psychiatrists know a great deal....
     "I encourage everyone to abandon the idea that psychiatrists know a great deal. I thought we should realize that we were working in a rather rudimentary medical discipline, one that has few natural correctives such as autopsy room or the laboratory to reveal its errors or restrain misguided enthusiasms.  We should look closely at what we are claiming in order that that we might abandon what impedes and seize upon what advances our enterprises."
                                                                                                       pg 40
Changing the Psychiatric Department he led...

     "By ceding dominance to imagination and insubstantial theories, we [psychiatric profession] had surrendered responsibility and overlooked the advances that were emerging from contemporary psychology, pharmacology, and neuroscience - programs of progress I pointed out that we ourselves might enrich.
                                                                                                       pg 43
Mountains of evidence on trauma and memory...
     "Mountains of evidence had demonstrated that shocking and frightening traumatic experiences are difficult to forget rather than difficult to remember."
Sympathy trumping evidence in making accusations...
     "Thus I could see that the concepts supporting the recovered memory movement were uninformed and that much of the psychiatric tolerance being shown to it [recovered memory therapy] rested on sympathy for the alleged child victims and not upon any evidence of its [recovered memory] validity."
                                                                                                       pg 46
Doctors influence...
     "doctors now realize that mentally disturbed people can easily take up what their doctors believe - especially if told that these ideas will help them recover."
                                                                                                       pg 61
Dubious features of recovered memory therapy...
     "First and foremost, the trauma was usually assumed and not confirmed...." 
                                                                                                       pg 62
 illogical elements in this theory-driven practice..
     "whenever psychiatrists commit to a single cause for mental symptoms...This error of reasoning works on the assumption that if a particular event (A) can cause or provoke a situation (B), one can assume that A MUST have preceded it. 
       The error lies in an unacknowledged and demonstrated presumption that A and only A can produce B.  Many other events (C, D, E, ect.), different and distinct from A, could perhaps produce B and because of the fallacy in reasoning, be overlooked, discounted, or even remain unsought in encountering B."      
                                                                                                       pg 63
"All denials were rejected and all failures in the quest construed as resistance.  The patients (as part of the treatment) could have no contact with those members of the family who might have been part of the (claimed) abuse. Likewise they were forbidden contact with any other persons...who might challenge the diagnosis and sustain the resistance to its implications"
                                                                                                       pg 63-4
"flashbacks and dreams were certainly no reliable evidence of trauma - sexual or otherwise.   These were reflections primarily of what was on the minds of the patient and were, as psychotherapists knew well, influenced by what the patients were talking about"
                                                                                                       pg 64
"dreams are not evidence of an experienced event. They are evidence of the fears (and preoccupations with victimization)"
                                                                                                       pg 65
"only the weapons of investigative psychologists could decisively end this memory war.  They would have to confront the recovered memory faction with facts it was ignoring, such as how memories are built and retrieved, how circumstances mold beliefs, and how hypnosis can mislead."
                                                                                                       pg 65
False Memory Syndrome defined...
     "We all have memories that are inaccurate...the syndrome may be diagnosed when the memory is so deeply ingrained that it orients the individual's entire personality and lifestyle, in turn disrupting all sorts of other adaptive behavior.  False Memory Syndrome is especially destructive because the person assiduously avoids confrontation with any evidence that might challenge memory."
                                                                                                       pg 68
Clients with False Memory Syndrome...
     "Only the most strong minded and experienced of examiners can resist this pressure for affirmation....
      They resent being questioned about inconsistencies...
      The explain away evidence of past affection and gratitude for the parents they are now vilifying--expressions found in letters, cards, diaries and the like by referring to the  'blindness of repression' at the time those expressions were made....
       They are quite simply fanatical about their opinions and they insist that all their present difficulties in life derive from the effect of those remembered abuses....
        It is pointless to ague with them, as doing so terminates the meeting...
                                                                                                       p 70
Battles over False Memory Syndrome...
     "In the battles over false memory syndrome, none of us was claiming that child abuse does not happen.  We were claiming that accusations of child abuse derived form suggestive psychotherapy had to  have more support than the plausibility of the therapists or the compelling stamp of emotional displays."
                                                                                                       pg 73
Reluctant Court Expert...
     "The torment of the Souzas (innocent couple  placed under house arrest for abuse that never occurred - Dr. McHugh declined to help them because it was obvious to him that the accusations were too incredible to be believed) and how I, in my naivete and preoccupations had left them to the mercies of an unmindful Massachusetts jurist- stirred my conscience and prodded me into courtroom work."
                                                                                                       pg 76
Couple reduced to begging from a stranger...
     "The woman who had been sitting in the car approached me.  She was his wife Judee.  'you have to understand, we're in despair,' she said. 'He could got to jail for 20 years. He's already lost his job, our other two children have been removed from our home, and allover claims that are not true and we can't fight'
      It was a grim moment.: this modest couple reduced to begging on a stranger's doorstep...[later after reviewing legal documents] On the basis of these details, I decided that I would take the case."
                                                                                                       pg 77
 Client abused by therapist...
     "Instead of recognizing and treating Donna's depression, Meryers (Donna's therapist) introduced her to false ideas about her father and incest and them encouraged her to buy into those beliefs by promising her recovery."
Disregard for family reports...
     "As I later testified, the doctors disregard of the family reports meant that all their diagnostic opinions - traumatic sexual abuse, repressed memories, satanic ritual abuse, MPD - rested no on objective evidence but on speculative theories built around displays of a distressed young woman - displays they (hospital staff) themselves encouraged."
                                                                                                       pg 83
Danny White Case Wins...
     "The case went to jury and after 8 hours they returned to day the were hopelessly deadlocked. Eleven members voted to acquit but one holdout, a man, later told the newspaper reporter he couldn't believe Donna could possibly 'make it up'.  The judge dismissed the case, and the holdout juror called Donna for a date."
                                                                                                       pg 84
Case gets attention...
      "The Donna Smith Case ....became the first in a number of cases where the practices of Manneristic Freudians were held up as dangerous and misguided."
                                                                                                       pg 85
Danger in the concept of repression...
     "I emphasized how socially dangerous the concept of repression was in that no one could be safe from prosecution if it was employed without confirming evidence."
                                                                                                       pg 97
Victory in New Hampshire Court...
     "After Hungerford and Morahan (1997), accused abusers in recovered memory cases could ask for and have a reasonable expectation of receiving an evidentiary hearing challenging the validity of repressed memories..."
                                                                                                       pg 100
Believe...
     " 'Believe the victim' and 'Believe the therapist' tended to be slogans that were running hand in hand and unchallenged because they matched what people suspected. No one was looking dispassionately at the facts or the treatment methods."
                                                                                                       pg 104
Culture of suspicion...
     "There was more here than a foolish therapist to explain,  Something in the culture itself - some devotion to suspicion over trust, had led ordinarily careful people to abandon judgement and join in what amounted to a persecution.."
                                                                                                       pg 107
What the doctors did not do...
     "Consider what these doctors (therapists or psychiatrists) didn't do.  They failed to take a full psychiatric history from the patients, but instead rested their diagnostic opinions on a list of symptoms that theory taught were 'diagnostic of previous child abuse.'  They launched emotionally evocative cathartic therapies without ever seeking outside informants, such as family members who could describe the patients' characteristics, capacities and vulnerabilities." 
                                                                                                       pg 119-20
We see things differently...
     "Adolf Meyer, who was the prominent American teacher of psychiatry in the first half of the twentieth century, held that all psychological symptoms and disorders in one way or another are to be seen as emerging form the life as lived.  Although we see things differently today, given that we recognize how some diseases of the mind such as schizophrenia and bipolar disorder disrupt the course of the mental life rather than 'emerge' from it, we continue to hold that symptoms are always shaped by personality and life experience. Hence we teach the need for biographical assessment of every patient."
                                                                                                       pg 128
CHAPTER 8 Getting to know Patients

Psychiatrists who clarify purposes do better...
     "Psychiatrists who clarify their purposes and their methods to patients tend to do better than those who don't....psychiatric evaluations, resting on dialogue between doctor and patient, depend on the patients trust and cooperation.  Role induction offers patients early in the encounter the opportunity to engage in 'give and take' or feedback in which the psychiatrist can answer questions, relieve anxiety, dispel any mystery or false impressions and encourage a willingness to proceed.  During role induction, doctors can explain and patients can ask about the process of evaluation or therapy, what if any dangers can come with it, and what is ultimately involved.
                                                                                                       pg 129
Emotions and therapist in the way...
     "I mentioned that she was so distressed that her emotions were in the way.  I recommended that she cease seeing her present therapist ('at least for a time') and that she work with a female psychiatrist who would be both sympathetic and open to her views but who would concentrate on helping her workout what stood in her way now rather than digging into her past."
                                                                                                       pg 131
A first step...
     "As a first step, we separate the patient form any therapist who is seeing her, encouraging her memories, or eliciting her alter personalities.  This requires some negotiation, and often the best way to accomplish it is to persuade the patient to enter the hospital for a week and to direct treatment toward some specific pressing problem...Such an approach interupts the sustaining and provoking attention that comes form talking about 'alters'."
                                                                                                       pg 133
Behaviors Ignored...
      If the patient displays any of the dissociative phenomena such as multiple personalities, fugues, or periods of amnesia, these behaviors are ignored by the staff. And if the patient objects, she is coaxed back on track by being told that these 'dissociative episodes' are transient remnants of her prior illness and now that recovery is under way, she shouldn't                                                                                                        pg 133-4
Actual abuse probable examined...
     "If the patient says that the abuse happened when she was of school age, that the abuser was well known to her, that the abuse was a private affair and produced trouble for her at the time and that she has wondered ever since whether to bring forth her complaints or simply 'forget ' about them, then diagnosticians should feel confident that they're dealing with someone reporting an actual event...."
       If the patient says that she actually always knew of the abuse but had either minimized its importance or put it out of her mind until recently...diagnosticians would surely feel more confident that they were dealing with someone has remembered an actual event.  They would contrast this story with one in which the patient reports that she developed her memory when she was in therapy with a therapist who drew her attention to the possibility of abuse right from the start and use hypnotic inductions or repetitive trances  to 'recover her memory'...
      As for the confirmation of memory: If the patient brings witnesses or confessions from the perpetrator about the abuse and demonstrates just how disrupted her life was for some time during the period of abuse, again diagnosticians would feel more confident that they're dealing someone who is reporting a memory of an actual event...."
                                                                                                       pg 137
Malpractice Claims...
     "Malpractice claims would come to a stop, because many of the malpractice claims rest upon the fact the hospital records show only the effort to confirm a preconception...with such records many judges and juries conclude that the therapists were not thinking about their diagnostic responsibility. And when the patient retracts and complains about mistreatment the sense that the therapist was promoting a belief rather than acting dispassionately in the patients interest will advance."
                                                                                                       pg 138
Summary of chapter on clients...                                                                                                         "If those who practice in these disciplines draw a curtain of mystery over their methods, approaches, aims and outcomes, then not only are they doing their patients and the public a great disservice, but they and their associates will often lose their way and come to grief - as happened with practitioners of 'recovered memory' therapy..."                 
                                                                                                       pg 139
CHAPTER 9 Making Sense of the DSM
      Note:  The DSM is a Diagnostic and Statistical Manual of Mental Disorders is a manual used by mental health professionals, researchers and insurance companies

     "In fact, all psychiatrists now realize that in order to get a diagnosis into DSM, what is needed is a political ticket and a 'claims ticket' - i.e., a sizeable group of psychaitrists to lobby the APA for a diagnosis [the political ticket] all of whom agree on the set of defining symptoms [that 'claims' ticket]"
                                                                                                       pg 148
     "I describe this outcome [the DSM] as a paradoxical and unintended consequence of a political effort at resolving controversy and promoting progress within psychiatry.  The attempt to make clinical diagnosis reliable with symptoms-based field guide produced much good.  It advanced research and improved consultations and communications over many psychiatric disorders.  But it provided an entree for many deceptive claims...
     This flaw in the system will persist until the field guide method of diagnosis is psychiatry is supplanted by a systematic one.  Hurry the day I say.
                                                                                                       pg 149
CHAPTER 10 What is meant by Hysteria?
     Note: Researcher Debbie Nathan uncovered using interviews and written records that the Sybil story was a fraud perpetrated by Dr. Wilbur for the purpose of making money and with the cooperation of  the patient (S.. Mason).  The book "Sybil Exposed" was written in 2011.  The points about hysteria made in this book hold true if the Sybil story was genuine or a fraud.  The author of this book believes the claims of the "Sybil" were possibly exaggerated, somewhat dubious and (if true) a uses it as a classic example of an individual (Shirley Mason the client) with hysteria induced and nurtured by Dr. Wilbur.  It may have been hysteria on the part of the client and unwittingly nurtured by Dr. Wilbur but at some point, even after becoming aware that it was likely hysteria Dr. Wilbur continued with the publication and movie support.
     "Dr. Spiegel, looking back at the publication of Sybil, commented on how it started 'a whole new cult, a whole new wave of hysteria restated in a new way...basically it's hysterical response to hysteria.'  He believed that MPD (multiple personality diagnosis) therapists were 'taking highly malleable, suggestible persons and molding them into acting out a thesis that they are putting upon them.' "
                                                                                                       pg 152
     "What precipitates hysterical behaviors?  Occasionally, a dramatic, emotionally laden event such as a family crisis or a report of the death of an honored public figure...can provoke the onset of hysterical paralysis, muteness, or fugue in a highly suggestible person. More often, hysterical conditions emerge in patients seeking care and support for some mixture of discouragement or demoralization tied to their temperament and life circumstances....People vulnerable to hysteria are often emotionally if not chronologically immature and have regularly and habitually exaggerated or dramatized their feelings.  They are also highly hypnotizable, as Herbert Spiegel has stated."
                                                                                                       pg 156
     "It is remarkable (even breathtaking) to realize that despite all the changes to theory and practice that Freudian psychoanalysis underwent over the following decades, this basic idea - one heals by remembering - has never been questioned.  It remains today as a fundamental concept behind the....MPD [multiple personality disorder] and recovered memory craze.
     What do these...(historical) examples of hysteria have in common?...
     First , the subjects in all these outbreaks of hysteria were true believers - they believed they were bewitched, mesmerized, or seizure prone...
      Second, the patients beliefs derived from conceptions of reality held by others and particularly influenced by others (authority figures) doctors and divines of Salem...
      Third, the belief generated behaviors spread among subjects and grew in intensity with each individual
      Fourth, the more attention paid to the behavior, the more the behavior was seen, the less attention paid the less it was seen...
                                                                                                       pg 167-8     
     "Thanks to remarkable advances in memory science during the last decade, we can dismiss the purported psychological mechanism - call it 'repression' 'dissociation' or whatever.  The work of Elizabeth Loftus, Richard Ofshe, and Richard McNally established both that testimony based on recovered memories can not be trusted without corroboration and that the human mind has no specific tendency to drive trauma from recall."
      As Richard McNally states unequivocally
           'The notion that the mind protects itself by repressing or dissociating memories of trauma, rendering them inaccessible to awareness, is a piece of psychiatric folklore devoid of empirical support.' "
                                                                                                       pg 179
MPD craze not PTSD craze...
    "Distressed feelings, nightmares, agitation ad the like are products with many different sources.  Than can accompany a wide variety of psychiatric disorders, and they accompany all of the emotions of adjustment.  In fact they will occur whenever distressing ideas are being generated.  This explains they seeking to 'recover memories' of childhood abuse will often evoke distressing emotional reactions in patients that then are often confused as PTSD responses to the memories themselves.
   And so the burning question to ask of the trauma centers replacing the old "multiple personality centers" is whether they are inducing such emotional distress (and calling it PTSD) when seeking to "recover" trauma memories, just as previously they induced MPD when seeking to "recover" sexual abuse memories.  Given that techniques such as hypnosis and suggestive probing of recall are still being employed, good reason exists for asking that question."
                                                                                                       pg 200
Do I really need psychotherapy?
     "Even if we put inventions about memory to one side, anyone considering psychotherapy should ask questions as: Do I really need psychological influence or can I resolve these matters myself?...
     First, understand what psychotherapy cannot do.  As the treatment rests upon talk, it cannot cure a disease of the brain that disables its mental faculties or powers...
     Second, psychotherapy will not change innate or constitutional psychological features.  It cannot add a single point to someones IQ, transform and extrovert to an introvert or vice versa....
    Third, a sizeable proportion of patients, as many at two out of three, who are referred for psychotherapy because of anxiety or depressive symptoms would if left alone, spontaneously recover...
    Fourth, the good news is that several investigators, understanding how they had to demonstrate that treatment improved on spontaneous recover, successfully developed better psychotherapeutic procedures...They did so usually by challenging the Freudian therapies that were at that time dominant.
     Lewin's emphasis on the here and now in therapy provoked Frank reservations about traditional Freudian emphasis on the role of abiding unconscious conflicts derived from childhood as the root cause of mental disorders."
                                                                                                       pg 208                    
"Frank's research into psychotherapy ultimately helped many psychiatrists committed to empirical work abandon the Freudian idea(s) that the cause of mental distress comes from some universal conflict fundamental to human development and generated early in life though interactions of selfish infant and the socializing forces of family.  Most patients are demoralized, as Levin taught, by what they are confronting in the present.  Habits of thought derived from their past and from aspects of their psychological constitution can amplify the problems and retard their solutions, but those factors are less important than the proximate contemporary challenges they face.
    Although Frank could not demonstrate that therapists committed to any particular theory or school of psychotherapy were more effective than any others he did not 3 characteristics common to all therapies...
    First, effective psychotherapists emphasize and display certain attributes of status in their behavioral style, dress, and titles that help patients view them as having power and authority to heal them....Such accouterments as wearing white coats, displaying diplomas on walls, carrying title of doctor or professor...
     Second, effective psychotherapy usually includes some effort at promoting some emotional arousal in the patients.  The efforts may  take the subtle form of evoking hope in a better future, a comforting sense that help will be available even if matters worsen, or feeling of trust and devotion to the therapist.
     Third, effective therapists eventually offer suggestions for action or for responding to circumstances....The suggestions - however delivered - encourage the patients to act upon and alter their situations and so begin to gain at least some feeling of control over their circumstances and take the first steps toward mastery....
     All effective psychotherapies use these three elements in one way or another, differing only in emphasis..."
                                                                                                                                         pg 211-2           
Anther option in therapy...
    "...cognitive behavioral therapy, is by its nature goal directed. It is intentionally tied to the patient's symptoms and own sense of what's lost or missing and needs to be restored.  This treatment usually demonstrates in a direct fashion, just how demoralized feelings and products of maladaptive assumptions, false images of the world, and behavioral reflexes that need to be challenged and replaced if one hopes to regain and sustain a sense of mastery and control of one's life. And, perhaps crucially, it emphasizes how much mental health and happiness is one's own responsibility.
                                                                                                                                            pg 210
Recommended therapy if needed...
     "I recommend that Cognitive Based Therapy be the preferred form of psychotherapy: it has the best record of success, it works in a most natural way, and interactions between the therapist and patient are direct and coherent.
     By contrast my faith, what trust I had in conflict psychotherapy has been shaken by the false memory disaster and not restored by the emergence of 'traumatologists' and a 'traumatic memory' specialty.
                                                                                                                                            pg 225
Final Words...
     "And as for patients, if they can be helped to comprehend what psychiatrists know and how they know it, they will reject practices built on mysteries and unwarranted suspicions and happily turn to treatment methods with lucid promises and proven benefits."
                                                                                                                                    pg 235



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*** WARNING ***
If you are seeking help for personal struggles and a therapist, counselor or friend says that "recovering childhood memories can help you get better" then IMMEDIATELY get up from your chair (or off the couch), run to the door, open it and flee. Hundreds of thousands have lost families, years of productive living and squandered immense wealth with tragedy inducing therapy that produces horrid false memories, splinters families, isolates the client and is documented to cause decline in mental health.

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WHY I BECAME INTERESTED IN THIS BOOK
Our adult child in postpartum depression and medicated with antidepressants sought help while living 2000 miles away. Someone "helped" her using memory based therapy either through a therapist or friends using "do it yourself therapy books". She became one of hundreds of thousands victimized by a method well known to produce false or pseudo memories (American Psychological Association). Experts have established how false memories are maintained once nurtured and we hope that friends are helping free our daughter from the shackles of false memories. Unfortunately the accuser and the friends around her may nurture and reinforce false memories for a variety of reasons. Those medicated and entranced, as our daughter was, often have the most detailed and horrid fantasies mistaken for memories. It will take incredible emotional strength, a mind cleared of medication, fully functioning intellect, immense humility and great courage for our daughter to return. Many such victims never do but we remain steadfast in our hope. In spite of the bizarre and false accusations we love our daughter and her family. We will never give up on reconciliation.

OUR DAUGHTER BEFORE TREATMENT
MEMORY EXPERTS COMMENT
DARK AGES OF MENTAL HEALTH TREATMENT

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