“Do you believe me?” – Therapeutic neutrality in a post #MeToo and #TimesUp era

Memory trilogy: Part 3 of 3

The final of the memory trilogy explores complexities in navigating historical memories of child sexual abuse in psychotherapy with adult victim-survivors.

In the five years since the #MeToo and #TimesUp movements, a chorus of victim’s voices has broken the silence and cover-ups surrounding sexual harassment and assault. The alleged perpetrators were predominantly but not only men, typically in positions of power over the victim’s employment and career. Many of the accused claimed allegations were false and that their careers and reputations have been ruined unjustly.

Journalist Louise Milligan’s Four Corners series “Inside the Canberra Bubble” (2020) and “Bursting the Canberra Bubble” (2021) exposed allegations of sexual misconduct in federal parliament. Ex-Liberal staffer Brittany Higgins disclosed an alleged rape inside Parliament House by a fellow staffer. Rachelle Miller, former media advisor to then-Minister for Education, Alan Tudge, accused him of  bullying and assault. A historical rape allegation was made against then- Attorney General, Christian Porter. Parliamentary investigations were held into Ms Higgin’s and Ms Miller’s allegations. The Australian Human Rights Commission held an inquiry into workplace culture in federal parliament who reported in November 2021, only a few months after the Commission released the findings of the National Inquiry into Sexual Harassment in Australian Workplaces.

An independent inquiry in 2020 into allegations of sexual harassment by three female associates against former High Court Judge, Hon. Dyson Heydon, AC, QC, found he had sexually harassed the women. The High Court apologised to the women.  In February 2022, represented by Maurice Blackburn’s Principal of employment and industrial relations law, Josh Bornstein, the women secured a landmark settlement from the Commonwealth. The current Attorney General, Michaela Cash apologised to the women.

Activist Saxon Mullins, the complainant in what became Australia’s most controversial rape trial, spearheaded changes to consent law in New South Wales. The Affirmative Consent Bill, commencing in mid-2022, states consent must be communicated not assumed. Journalist Nina Funnell’s, #LetHerSpeak campaign of which Grace Tame, Australian of the Year 2021, became a prominent public face, was launched in November 2018. The campaign resulted in changes to gag laws in Tasmania, the Northern Territory and Victoria, allowing victims of sex crimes to be publicly identified if they choose to do so. In 2021, Chanel Contos launched an Instagram poll which received a staggering 6,700 testimonies from teenage girls about sexual assault and rape by their male peers. The outcome of her activism has resulted in consent education becoming mandatory in all Australian schools commencing next year.

Speaking out is crucial to raising awareness and is extraordinarily courageous. The personal toll on activists’ mental health and wellbeing is significant. The obvious connection between creating an environment where victim-survivors feel encouraged and supported to speak out is believing their stories – which leads into a tricky space. Depending on the role that a professional has with a victim-survivor, there is often a need to sensitively navigate believing, supporting, opinion, fact, and ethical practice.

A disclosure by an adult about sexual abuse as a child, sexual assault, harassment, or domestic abuse should always be met with compassion and empathy: listen to what they tell you, don’t rush the conversation or push for more information than the person is ready to disclose, and check what supports they have or may need. These are basic humane responses when someone is distressed, even if the distress isn’t overtly apparent. In addition to these responses, different professionals will have considerations related to their specific role. Disclosures of sexual abuse by children will be discussed under ‘When it is important not to be neutral’.

A journalist might seek corroboration of the person’s story such as text messages, email, voice-mail, photos or witnesses to their allegations. Can the person provide dates, times, and places where the alleged event(s) occurred? It will be important to examine details to make sure that the story holds up when it is inevitably before the court of public opinion (and, possibly, a defamation suit). It is not a police investigation (although it may lead to one) but a journalist and their publisher need the story to hold up to scrutiny.

A human resources manager must firstly prioritise the employee’s wellbeing and safety, including providing information about their Employee Assistance Program. A formal process to investigate the allegations might follow, whether handled inside or outside the organisation. Such situations can give rise to a tension or a conflict of interest between protecting the employee and protecting the reputation of the organisation or alleged perpetrator.

A lawyer, whether the matter is criminal, family, civil or a mediation, will advise on law related to the allegations and legal process. Assessing the evidence and any additional information will assist in advising the best way to proceed. Such an assessment will include looking for any discrepancies or inaccuracies that the defense might attempt to capitalise upon to discredit the allegations and the client.

In counselling and psychotherapy, there are other considerations. Sexual assault and domestic abuse services operate from the premise clients are telling the truth. This is appropriate for services responding to predominantly women and children in crisis. In 2019, the Centre Against Sexual Violence Inc., Queensland developed a campaign for Sexual Violence Awareness Month titled #WeBelieveYou. The statement behind the campaign theme said:

“We believe you” addresses a pervasive cultural attitude in not believing survivors when they disclose their experience of sexual violence. Many survivors have attempted to find justice through reporting and have not been believed. Many women choose not to report or disclose to friends and family due to unhelpful messages from their communities, friends and family, the police and the justice system.”

The 2017, Community Attitudes Towards Violence Against Women survey found that four in ten Australians mistrust women’s reports of sexual assault (Minter, K., Carlisle, E., & Coumarelos, C. 2021). The Royal Commission into Institutional Responses to Child Sexual Abuse report reported that 57% of witnesses said they did not disclose the abuse until they were an adult (Royal Commission, 2017). Reasons for delayed disclosure are complex. Children cite fear of not being believed and feelings of shame and self-blame. There is often fear of upsetting family members and wanting to protect the offender (McElvaney, Greene, & Hogan, 2014). Other reasons include fear of being responsible for family breakdown, loyalty and strong emotional bonds with the perpetrator (Lyon & Ahern, 2011; Smallbone, Marshall, & Wortley, 2008). Most children who disclose are not believed! So it makes sense not to disclose. Disclosure is often a bad decision  (Swingle et al., 2016).

False memory counter-attacks on victim-survivors’ allegations of abuse were explored in False Memory: A short history  and Trauma And Memory: What We Know, What We Don’t Know And What We Know But Don’t Know We Know .The Royal Commission and related research highlight the prejudices, discrimination or disbelief many victim-survivors experience. Louise Milligan’s book, Witness: An investigation into the brutal cost of seeking justice (2020), highlights the retraumatisation of victim-survivors through the legal system and alarmingly low rates of convictions in rape and historical child sexual abuse cases. However, #WeBelieveYou or #BelieveHer statements, while well-intentioned, risk reducing complex issues into a false dichotomy of belief and disbelief.

Journalist Helen Lewis, writes, “Believe women” was intended to capture an undeniable truth: Sexual harassment and sexual assault are so endemic in society that they make the coronavirus look like a rare tropical disease” (Lewis, The Atlantic, 14 May 2020). She quotes fellow journalist, Megan Garber, “Believe women” has evolved into “Believe all women,” or “Automatically believe women.” This absolutism is wrong, unhelpful, and impossible to defend. The slogan should have been “Don’t dismiss women,” “Give women a fair hearing,” (Lewis, The Atlantic, 14 May 2020).

Multiple issues are involved. The first is the safety of all victim-survivors. The second is access to services. The third is trauma informed justice. Movements bring about change and tend to create a backlash as seen with the False Memory Syndrome Foundation. Explored here is the potential impact on therapy, the therapeutic process, and the therapeutic relationship, particularly when working with adults who disclose historical childhood sexual abuse.

Some people report continuous recall or partial recall of abuse. However, others may have no recollections of child abuse, or only sporadic access to those memories. They may seek professional help for other life reasons, or in the aftermath of a traumatic event, only to begin remembering child abuse in the context of therapy. Neither continuous nor discontinuous recall of child abuse is unusual. Nor is discontinuous memory suggestive of a lack of accuracy.

Trauma And Memory: What We Know, What We Don’t Know And What We Know But Don’t Know We Know explored how traumatic memory, which by its nature involves memory encoded in a highly emotional and physiologically aroused state, can be both more accurate than normal memory and at other times more impaired than normal memory (Brewin, 2011). For victims of traumatic experiences, both children and adults, events can be vividly imprinted, encoded and retrieved in the form of flashbacks, a symptom of post-traumatic stress disorder (van der Kolk, 2014) and can also be forgotten, through the mechanisms of repression or dissociation (Ross & Halpern, 2009). Studies have also shown that, in situations of extreme stress or anxiety, a person’s eyewitness memory may be negatively impacted for some types of information about the event (Deffenbacher, Bornstein, Penrod, & McGorty, 2004). Memory for peripheral details may be affected while memory for central details can be accurate (Waring, Payne, Schacter, & Kensinger, 2010).

People can have diverse beliefs about the veracity of their memories of child abuse, regardless of whether the memories have always been intact or have surfaced years after the events. Some clients are convinced of the truth and accuracy of their memories. Others are racked with doubt, erring on the side of disbelief. This response makes sense. Who would want to face the horror of abuse at the hands of a family member or trusted caregiver? Instead, people often search for some other cause or reason for the images, physical sensations, or intense emotional reactions they experience (flashbacks), including a preference for believing they are ‘crazy’ or the memories were ‘just a dream’. Oscillation between asserting and recanting these recollections of abuse is not uncommon.

At some point during therapy, a client may seek from the therapist, directly or indirectly, validation of their memories. This is the “Do you believe me?” question. Other questions may relate to the therapist’s history, such as whether they have been sexually abused. These questions and curiosity about the therapist are understandable. They often come up at a time of great confusion, uncertainty, and vulnerability. The client may be seeking something or someone to hold onto – “Do you really understand me? “Can you help me?”.

Some therapists choose to be open about personal experiences and positions, such as religion, sexual abuse, domestic abuse, addiction, sexual orientation, or gender identity. Sometimes this information is on the therapist’s website to assist potential clients in deciding whether they may be a good fit. Consultation with people who have lived experience of a particular issue is crucial in developing policy and designing services.  Lived experience can enhance and deepen a therapist’s understanding of clients with similar experiences. Self-disclosure is not necessary for this to be the case. Other therapists choose to keep a clear boundary around personal information and disclosures. Both approaches are valid and may influence the transference and countertransference dynamic in different ways.

It is often useful to pre-empt the “Do you believe me?” question by informing clients at the outset of therapy about the principle of therapeutic neutrality. Doing so can assist in averting misunderstandings and the potential for the client to externalise inner conflicts and ambivalence about memories through polarising with the therapist.

The word neutrality, in the context of therapy, which by its nature is a deeply connected relationship, sounds counterintuitive. Neutrality sounds emotionless, conjuring a lack of empathy at best and indifference at worst. Therapeutic neutrality is neither. It describes supporting the client through ambivalence, conflicts and intense emotions about memories and the alleged perpetrator with compassion and sensitivity, while at the same time not confirming or denying the veracity of the client’s memories. During this process, a therapist may develop a feeling, intuition or opinion about whether these memories are real or otherwise. However, when adopting the stance of therapeutic neutrality, the therapist does not allow their own feelings or beliefs to interfere with the client’s process of grappling with their conflicts and ambivalence. In other words, therapeutic neutrality allows the therapist to support the client to address their problems, without becoming part of the client’s problem.

Most adults who report a history of abuse do not have independent definitive corroboration, such as a conviction, records of abuse in hospital or school reports, or verification from a witness.  Taking the position of believing or not believing a client’s memories, where there is no corroboration, sets the client up for greater conflict. For example, if the therapist says they do believe the client, it takes away the possibility for the client to disbelieve, which is an important avenue that they need left open as they work through painful and conflicting feelings. If the therapist disbelieves the client, they will feel unsupported, not validated, and limited in their ability to explore all the conflicts and issues that they need to deal with, whatever the truth of their experience may be (Ross & Halpern, 2009).

Where there is no corroboration (and even when there is), as discussed in parts one and two of this series, it is possible that the client’s memories may not be accurate in part or totality. The client needs to explore what is coming up for them and what it means. If the therapist takes a position of believing or not believing, this process is hindered.

Where there is no corroboration of a client’s accusations, the therapist can never be certain about what did or did not happen. There will be exceptions. For example, a client during a period of psychosis claimed that she knew that there were tunnels underneath my office building and that she had seen me exit the building through these tunnels to meet with secret service agents in a nearby park. Another client, with dissociative identity disorder, had a part (alter) that held a memory of giving birth to piglets.

It is important not to dismiss such claims as merely delusional and therefore, meaningless. The therapist may choose, depending on their knowledge of the client, to remain ‘neutral’. It may be equally valid in some instances for the therapist to state that in their opinion these events didn’t occur (in the first instance) or couldn’t have occurred (in the second instance) while acknowledging and empathising with the distress these beliefs were causing. Whichever approach the therapist takes, such material can be explored (once the psychosis has subsided) in the same way other memories and issues that are brought to therapy are explored.

There are other considerations in addition to believing or disbelieving memories of abuse. It is important to not take at face value the reports of clients that abuse stopped at a certain age, or that abuse is not currently happening. Reports of ongoing incestuous abuse into adulthood are not uncommon (Middleton, W. 2013). I worked with a client where abuse was ongoing by family members into her forties but was denied for many years because she felt ashamed and feared I would blame her. Clients may claim abuse stopped at a particular age, when it did not, due to issues related to memory and/or understandable defenses against facing an intolerable reality. Similar sensitivity and care must be taken around comments or statements about the alleged perpetrator given unresolved ambivalent attachment and locus of control shift dynamics. Where there is the possibility of a legal case, being mindful of the potential for defense lawyers accusing the therapist of suggestion and implanting false memories must also be considered.

False negatives, statements that “I was not abused” when the person was are more common than false positives, “I was abused” when the person wasn’t. Some people may assert that what they experienced “wasn’t abuse” or that “it wasn’t harmful” or that they “liked it”. These beliefs may also be understood as conflicts related to unresolved ambivalent attachment to the perpetrator and locus of control shift which require a neutral stance by the therapist as the client grapples with the reality of the betrayal.

While it may appear to be supportive and empathic, stating an unequivocal belief in memories or other assertions may lead to greater conflict for the client. However, there may be times, with some clients, when a therapist makes a clinical judgement that sharing their opinion could be helpful. There is no formula. Good therapy is a recipe of knowledge, experience, instinct, creativity, navigating transference and countertransference dynamics and the therapeutic relationship. All of which are imprecise ingredients that cannot be measured and replicated from client to client.

At the point a client raises a known or suspected history of abuse, it is important to explain to them what they are likely to experience in therapy while working with such issues. Information about the nature of memory, some of the difficulties they may encounter, and the principle of therapeutic neutrality are helpful to educate clients. Providing information does not mean that clients will necessarily welcome therapeutic neutrality. The client may express anger, frustration and feeling that the therapist is not supporting or validating them. A neutral stance can be misinterpreted as saying, “I don’t believe you”.

There are ways to affirm and validate clients that do not rely on confirming the veracity of their memories, such as acknowledging that something has clearly caused their distress. Therapists can explain the nature of traumatic memory; for instance, that it is common for people with a history of abuse to not remember events clearly or at all, while the body may remember in the form of images, sensory experiences, strong unexplained emotional responses (flashbacks). Psychoeducation about the role of addictions and self-harming behaviour in managing inner distress arising from trauma can reassure the client that you don’t think they are ‘just making things up’ or are ‘crazy’. Therapeutic neutrality is not about believing, disbelieving or doubting. It involves working with whatever arises in the session with compassion and empathy, ‘as if’ the memories are true, holding the client’s confusion and ambivalence while they explore their meaning.

Ethical and compassionate therapeutic practice also involves making clear statements that abuse of any kind is never OK and is never the fault of the client. If an adult client reports knowledge of the abuse of a child occurring in the present or a child discloses abuse, therapists are required to follow their professional guidelines regarding mandatory reporting. If a client is currently in an abusive situation, it is important to state that what is happening is not OK, and that you are concerned for their current wellbeing and safety. Working with a client on how to increase safety is crucial. Clients are rarely ready to immediately exit an abusive relationship or cease contact with a perpetrator who is still abusing them. However, it is vital that a therapist states clearly their concerns about safety, and that safety needs to be a primary focus of therapy. Therapists also need to respond when a client makes threats of violence toward another person that they believe could be acted upon, and when suicide is assessed to be an imminent risk.

There are many approaches to therapy, positions about self-disclosure and opinions around affirming client’s memories and beliefs. All positions can be valid depending on the therapist’s role, training, organisation, and personality. Sexual violence is a highly emotive issue, as it should be. As a society we should be shocked, horrified, and outraged. However, when an issue is emotive it also can quickly become polarising.

#WeBelieveHer, #WeBeliveYou, #BelieveWomen and various iterations of these hashtags come from a good place. They attempt to counter the structures and institutions that have silenced, dismissed, and disbelieved victim-survivors for generations. In confronting and challenging these systems, we need to be careful of not creating another problem for victim-survivors (or innocent alleged perpetrators), not only in therapy but potentially in the courtroom or around the mediation table.

Therapeutic neutrality involves a commitment to stand by the client regardless of the ‘truth’ value of their memories and beliefs. It is a statement that the client matters and that the therapist will stand by them and support them either way. Oftentimes, it is a client’s first experience of unconditional positive regard.

Compassion and empathy are central to effective therapy. Offering encouragement, praise, and humour where appropriate are the golden threads that weave together the intricate and complex tapestry of a strong therapeutic relationship. While knowledge and skill in working with trauma provide the foundations for effective therapy, the therapeutic relationship is the crucible where healing takes place.

Guest Editor: Associate Professor Michael Salter, School of Social Sciences, University of New South Wales

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