By Asbjørn Dyrendal (published 03.02.2007)
Necessarily then, some of the research from the skeptical camp has been devoted to similar issues. Other research has had the context of the development of narratives about SRA more in focus. Since claims have originated both from adults and interviews with children, both adult patients and children, particularly child interviews, have been investigated. Finally, as some of the very few known Satanists in contact with the therapeutic environment have been youth delinquents, some of the psychological research has been devoted to these. Most are simple case studies.
Satanic Ritual Abuse as Construct
Some critical voices from inside the community of therapists have identified possible contaminants, in that group therapy settings, networks of patients, and mass media portrayals give access to detailed descriptions of what Satanists allegedly do. This may to a certain extent have shaped expectations and confound attempts at finding independent corroborations (e.g. Braun, in Ofshe & Watters 1994:249). Believers usually find a way around possible criticism, but other research has been focused on checking some basics of the claims, and their relations to people and situations.
A central aspect of many claims is that elements in stories about ritual abuse are not merely vaguely similar, they are just about identitical. Research on children and adults' narratives about ritual abuse in the United States, and children's narratives in Great Britain puts this assumption to the test.
In Great Britain, the anthropologist Jean La Fontaine investigated 84 allegations of ritual abuse that had been reported to child protection services and/or the judicial system. With regard to a perceived identical nature of alleged rituals in which abuse had been said to take place, she demonstrates conclusively that this “uniformity” was constructed by the strategy of summarizing testimonies in reports, and were not present in the narratives offered by the children (La Fontaine 1998:78ff, 149ff.). The alleged rituals seeming similarity is a result of decontextualized statements presented together: "picking out the common features of a large number of cases described rather briefly, gives a spurious impression of uniformity" (ibid.:78).
Is this finding replicated for SRA elsewhere?
First, we need to note that La Fontaine has had close access to data rich in detail, and of a kind not readily available to other skeptical researchers. Therefore, it is not strictly correct to speak of replication, since the analyses are made from other kinds of sources that are not as close to the processes of making accusations about SRA.
To the degree we may talk about similar findings, however, we find that there are some interesting ones. For instance, Bottoms et.al. report that from a list of prototypical SRA-experiences, respondents among clinicians checked off some case features much more often than others (Bottoms et.al. 1996:9f.). The most common allegations checked were forced sex, cult member, and repeated practices, while the "least common features of ritualistic cases were abuse related to the breeding of infants for ritual sacrifice, abuse involving cannibalism, child pornography, and amnesic periods or preoccupation with dates" (ibid.:10). Moreover, adults were much more likely to report all or many of the features most associated with the stereotype of SRA (ibid.:10f.). While not a strict replication, this is a clear indication that claims to the effect that ritual abuse narratives are everywhere identical, are wrong.
Who, then, are the therapists diagnosing Satanic Ritual Abuse as the cause of their patients’ troubles?
Therapists and therapy
The therapists who found their patients to be victims of SRA often belonged to a subculture within the therapeutic community, where focus on dissociation and multiple personalities were more important than among other clinicians.
This small minority among therapists were involved in the vast majority of ritual abuse allegations with a therapy background (Victor 1993; Goodman et.al. 1994; cf. Bottoms et.al. 1996; Bottoms & Davis 1997:120-125; Spanos 1996:244ff.). Nevertheless, many elements of the ideas, and some of the practices that seem to have been important in creating SRA-narratives were common among therapists of all kinds: belief in the concept of repression (Yapko 1994: 231ff.; Bottoms & Davis 1997: 121), a view of memory as analogous to a video-tape or computer (Loftus &amp; Ketcham 1994; Pendergrast 1996), and that hypnosis could be an important tool in unearthing forgotten abuse (Yapko 1994:234ff., Lynn 1998). This view of memory and memory recovery has been largely dismissed among the community of cognitive psychologists (e.g. Loftus & Ketcham 1992; 1994; Schacter 1995; 1996; Kihlstrom 1998; Payne & Blackwell 1998).
Many therapists who saw patients claiming to suffer after-effects of SRA did not claim repressed and recovered memories. The largest investigation to date found that a majority of reports came from a non-recovered memory setting (Goodman et.al. 1994: Table 23; Qin et.al. 1998:268). Recovered memory settings accounted for more tales that conformed to the SRA prototype, with more features present (cannibalism, sacrifice, satanic rituals, early onset of abuse etc.) (Goodman et.al. 1994: Table 20, 21).
The second of these findings conforms to a host of more anecdotal reports and impressions throughout the literature of both believers and skeptics (Ofshe & Watters 1994; Showalter 1997; Wakefield & Underwager 1994; Feldman 1993; Sakheim & Devine 1992; Sinason 1994; Ross 1995), while the first seems to contradict the same. The demand of clear reports from the therapist about the patients' periodic amnesia and "clear language in response to other survey questions to indicate that memory had been lost" (Goodman et.al. 1994:68; cf. Qin et.al. 1998:268f.) may account for some of this discrepancy. The difference between the focus on memory in "ordinary" psychotherapy and what has been dubbed "repressed memory therapy" may not be as strong as some would like to think. Nevertheless, the finding of Goodman et.al. seems to indicate that the popular stereotype of SRA-narratives as deriving wholly or mostly from extreme types of therapy and therapists with special views on memory, trauma and personality may be misleading.
The status of what skeptics call "strong repression" is in severe discredit with cognitive psychology. Research psychologists tend to be skeptical of the concept, but clinical psychologists tend to accept it more readily (e.g. Pope & Hudson 1998; Holmes 1998; Reisner 1998; Crews et.al. 1995). Moreover, there seems to be considerable confusion among believers in repression as to what the term should mean. On the other hand, it is not quite clear that there could be evidence for 'strong repression' the way it is often conceptualized. Where one party sees repression, the other may see motivated forgetting or a host of other, more specific mechanisms at work (cf. Wakefield & Underwager 1994).
Another diagnosis often associated with SRA is what was “multiple personality disorder” (MPD) before 1994 and “dissociate identity disorder” (DID) after 1994 and DSM IV. The diagnosis and diagnostic criteria was still current in both DSM IV and ICD 10. However, the alleged disease has received harsh criticism (e.g. Spanos 1996; Hacking 1995; 1998; 1999; Acocella 1999), and the diagnosis has fallen sharply in popularity (Acocella 1999).
One of the reasons for the decline in popularity of MPD diagnosis is, allegedly, the strong connection to allegations of SRA in highly profiled cases leading to litigation (Acocella 1999). MPD/DID seems to be highly related to ideas about repression, as "68% percent of clients in repressed memory cases supposedly qualified for an MPD diagnosis" (Qin et. al. 1998:272; cf. Wakefield & Underwager 1994; Spanos 1996; Lynn & Rhue 1994).
A related concept to MPD and SRA is that of "programming". Those who have believed that SRA caused MPD seem to often have believed that forgetfulness, strange behaviors (denying allegations, suicidal ideation and behavior etc.) and other "symptoms" were the result of some sort of sophisticated "mind control" (e.g. Ross 1995). There has been no evidence of such techniques or even their possibility forthcoming from research (e.g. Hacking 1995). Similarly, the idea that the body in some way "stores memories" (a.k.a. "body memory) so that a sufficiently perceptive therapist may reconstruct historical truth from the patient's bodily "symptoms" (i.e. behavior) has found no sympathy in research (Wakefield &amp; Underwager 1994; Watters & Ofshe 1999).
The educational background of the therapists who participated in creating SRA ranged from Ph.D. psychologists, to M.D. psychiatrists, MSW social workers to "licensed therapists" without any formal training. Do any of these stand out with relation to cases of SRA found?
Bucky and Dalenberg (1992) found no such relation in their analysis of 433 respondents in San Diego. With regard to training, Bucky and Dalenberg report a positive correlation between attending special ritual abuse/multiple personality seminars and cases seen clinically, but question whether the correlation is not the effect of previous interest.
This interpretation is seen as possible also by Bottoms et.al. (1996:26), but for at least some of their respondents, interpretation of symptoms as SRA-related were explicitly seen in conjunction with topics addressed at ritual abuse seminars. Thus, the most probable interpretation of the positive correlation between seminars and finding ritual abuse in patients seems to be the content of these training seminars (Bottoms et.al. 1996:31; cf. Mulhern 1991; 1992; Victor 1993).
With regard to cases seen clinically, Bucky and Dalenberg as well as Bottoms et.al. replicate the finding that a small minority reports the majority of cases (Bucky & Dalenberg 1992; Bottoms et.al. 1996:26f.; Bottoms & Davis 1997:114; Victor 1993). Bucky and Dalenberg reported additionally that these were often practitioners who had specialized in sexual abuse (op.cit.:237).
Overwhelmingly, therapists who saw patients reporting ritual abuse, believed the accounts to be true (Goodman et.al. 1994:6; Bottoms et.al. 1996:22ff.). Moreover, they believed them to be true in spite of the lack of corroborative evidence (Goodman et.al. 1994:79; Qin et.al. 272ff.). Research by Bottoms et. al. found no relation between the strength of evidence and the confidence of belief in the patients' reports (Bottoms et. al. 1996:22, 24f.). Rather, belief was positively correlated to the bizarreness of claims (Goodman et.al. 1994:78f.).
There seems to be no study of the difference in age groups when it comes to believing ritual abuse allegations among therapists and child protection workers. This situation should be remedied, as there might be interesting data with regard to how different roles may influence belief or skepticism.
A study of police officers, highly select because they were all already subscribers to File 18 Newsletter, described by its publisher as a fundamentalist, anti-Satanist publication for police officers, showed that parents of young children were more likely to give credence to stories about Satanism and child molestation than others (Crouch & Damphousse 1991). One might suspect a similar bias among other groups, according to age and parental status, but this interesting note has yet to be replicated.
Victor (1994:323f.) noted the growth in Christian psychotherapy and counseling as one of the factors behind growing numbers of patients' claiming to have been ritually abused. He claimed that:
Therapists with an ideological Christian bent are particularly receptive to belief in the satanic cult legend and find indications of satanic ritual abuse in their most deeply disturbed patients. (ibid.:324)
He cited no evidence in support of this claim. Later research, however, seems to confirm his opinion. McMinn and Wade (1995) found only one important distinction between 497 Christian therapists and 100 APA psychologists who returned a questionnaire on DID, sexual abuse and SRA: Christian therapists were more likely to diagnose ritual abuse. However, the difference was only slight. The difference may perhaps be accounted for by Victor's theory of how SRA-claims are symbolically consistent with the underlying demonology of conservative Christians (Victor 1994; 1998a).
His model (applied to radical feminism) may perhaps also account for a more tentative finding, that "gender may also be a relevant therapist factor" (Bottoms & Davis 1997:124). While citing no figures, Bottoms and Davis nonetheless claim that "our research reveals that women therapists are somewhat more likely than men to believe in repressed memory and in the reality of ritualistic abuse" (ibid.; cf. Haaken 1997:232-244).
Ritual Abuse Patients and Satanic Survivors
There is, relatively speaking, little information about the population of people who have been identified by themselves or their therapists as victims of ritual abuse. Many of those identified seem to be contained within the category of MPD/DID patients, and are not easily divisible from that larger group. Even less seems to be known about "satanic survivors" to the degree that group is not co-extensive with the former. We know with certainty that some highly profiled cases of "survivors" have not been in therapy, others have, but far from all in MPD-therapy. Divorced from these considerations is another group, more verifiably self-identified adolescent Satanists who have been subjected to hospitalization or incarceration and thus met with psychological treatment and research. What are the results of research thus far?
Being a victim of SRA seems to have two very clear characteristic: 1) it is a gendered problem, and; 2) it is "discovered" in the context of therapy (Goodman et.al. 1994; Bottoms & Davis 1997:118f.; Victor 1993; Wakefield & Underwager 1994). The patients claiming SRA narratives as their own were predominantly females; "Across our surveys, the vast majority of self-designated survivors of ritual abuse were women" (Bottoms & Davis 1997:119). While there have been some reports of adult survivor groups containing a relatively large number of males, the main guesstimates have women outnumbering men at around 9 to 1 (e.g. Bottoms & Davis 1997:119). These figures seem, however, to be based more on best estimates rather than research. Patient's reports about victimization by Satanists typically include many more male victims than are found among self-designated survivors or in populations of abused children or adults (Bottoms et.al. 1996:16).
Tales of ritual abuse have been found to be related to the social setting of therapy. This may to some extent be an artifact of research gathering information from therapy, but few seem generally to have presented with the story of ritual abuse (Goodman et.al. 1994:35f.). Sherrill Mulhern reports that "[m]emories of satanic blood rituals only emerge after a patient has been involved in the process of recovering memories for an extended period of time (Mulhern 1994:279; cf. Young et.al. 1991). Bottoms and Davis report that "[i]n 95% of ritual abuse cases reported to us, the allegations were first disclosed in therapy"(1997:120). We shall return to hypotheses accounting for this below.
What brought these women into contact with a therapist? If we exclude cultural factors (cf. Watters & Ofshe 1999), therapists reported that the "most common presenting symptoms included depression, suicidal ideation, and excessive fears and phobias (Goodman et.al. 1994:35). The diagnoses from DSM III – and later DSM III-R – that were employed, showed an extremely high percentage of Multiple Personality Disorder (MPD). Up to half the patients were diagnosed with MPD. For adult survivors alone, the percentage could be even higher (Goodman et.al. 1994:37).
It is not clear how this finding relates to more general findings of MPD, namely that they are supposed to have had a long prehistory of treatments and diagnoses. A seven year treatment mean and a host of serious diagnoses has been alleged:
"According to various patient surveys, almost 90 percent of them are depressed, 61 percent have made serious suicide attempts, 57 percent have a history of drug abuse, and 12 percent have criminal records (Acocella 1999:62; cf. Putnam 1989:141).
Similarly, Coons’ (1994) retrospective chart analysis failed to find significant differences between 29 patients alleging SRA and the other patients presenting at the Dissociative Disorders unit. These findings stand in stark contrast to many highly profiled SRA cases where the patients are cast as mostly normal before therapy (cf. Dyrendal 2003:260-275. However, some other research findings fail to accommodate the SRA patients’ profile to that of MPD patients in general. Goodman et.al. found that other serious diagnoses were rare, and substance abuse or anxiety was low (1994:36) before therapy.
There may then be difficulties in drawing conclusions about SRA patients relative to the MPD population in general with regard to prior problems. However, gender proportions in MPD-diagnosis and SRA-allegations seem to be similar: "Nine out of ten patients who have been diagnosed with multiple personality disorder are women" (Hacking 1995:69; cf. Coons 1994:1376). This "gender gap" is often accounted for by saying that men who would qualify for dissociative disorders diagnosis end up in jail; women in therapy.
At what age do people report having been victims of SRA? Different interpretations of the question yield different answers. As we remember, the reports and memories of SRA surface most often during the process of therapy, and most often in so-called recovered memory therapy. Interpreted in this manner, the reports come into being at much the same time of life as diagnoses of MPD, when the women "survivors" are in their thirties (cf. Acocella 1999:62). If one looks at the claims with regard to the age of onset of abuse, however,
Victims in adult survivor cases were younger when the alleged abuse began but older when the abuse ended than victims in child cases, suggesting that abuse in adult survivor cases typically lasted longer than abuse in child cases. (Goodman et.al. 1994:33)
In all ways, claims from professed adult survivors of SRA were more extreme than other kinds of claims.
With regard to the family and religious background of alleged SRA-victims, there seem to be little data. Anecdotal information from the United States put the typical adult survivor somewhere in the (all-encompassing) middle class of therapy users, with a relatively undramatic family history (e.g. Ofshe & Watters 1994). With alleged child-victims, the story may be somewhat different (e.g. Nathan & Snedeker 1995; La Fontaine 1994; 1998). Cases seen in relation with kindergarten panics are more likely to suggest middle- to upper-income families, but other claims of "child sex rings" which include Satanism, may strike much lower on the social scale. La Fontaine's finding for Great Britain seem to suggest that SRA-interpretations mostly came from foster parents or social workers, and were used on children from very poor homes and a long history of neglect, physical, and/or sexual abuse in order to explain their extreme behaviors (La Fontaine 1998).
With regard to religion, one may extrapolate somewhat from other tentative conclusions, and say that if 1) allegations are made during therapy, and; 2) a larger percentage of these are conservative Christian therapists, then; 3) the patients seeking out explicitly Christian counselors are most likely from a similar background themselves. The history of SRA, the role of "satanic survivors" from deliverance ministries (Warnke et.al. 1972; Irvine 1974; Ellis 2000), case histories and anecdotal evidence (e.g. Wright 1994; Trott 1995a,b; Pendergrast 1995) strengthen this nonetheless very tentative conclusion. The research of Goodman, Bottoms, Shaver, and Qin at times raises this question. They are without clear conclusions other than the same tentative guesstimate (Bottoms & Davis 1997:119f.), which is also shared by MPD therapist Colin Ross (1995): Women from conservative Christian backgrounds are overrepresented in the population of patients developing SRA narratives, just as they are among self-proclaimed satanic survivors.
If SRA narratives are mostly constructed from therapy, there is the additional question of whether patients improve from their therapy. Skeptic's narratives would have therapy making patients worse, rather than better. Is there any clear data supporting or denying this?
There is a wealth of anecdotes supplying examples of patients who, if we take the accounts seriously, moved from mildly troubled to extremely troubled during the course of therapy. According to the stories, they only got better when therapy was discontinued, which was usually because their insurance ran out.
Some of these stories are well documented from later trials against their therapists (cf. Ofshe & Watters 1994; Pendergrast 1996). What is not yet available, however, are reports making clear beyond doubt that these reports are representative of patients who have been treated for alleged reactions to SRA.
From the literature of therapists, however, it is clear that the kind of therapeutic impulses described in such tales are widely used among therapists who believe in SRA (Fraser 1997; Sakheim & Devine 1992; Sinason 1994; Ross 1995; Feldman 1993; cf. Bottoms & Davis 1997; Goodman et.al. 1994). The same literature often reports on substantive successes in treating such patients, but these reports are typically of the same "case-study" format, and where this is not the case, numbers are vague. Reports on treatment outcomes of patients who report SRA vary widely with regard to their reports of helpfulness, and I have found none that analyses differential treatment outcomes.
However, Loftus (1997) reports on two studies, neither of which I have been able to access as yet.
The first of these is a study of 40 people who have retracted accusations about Satanic Ritual Abuse (Lief & Fetkwicz 1995). The authors conclude that “[e]normous harm is being done to these patients and to their families” (in Loftus 1997:28). The conclusion seems supported by the findings of the other study, conducted for the State of Washington’s Crime Victims Compensation Program. The study was primarily focused on recovered memory therapy, but of the 30 people randomly selected (from 183 claimants), 29 reported SRA. How did the patients fare – bearing in mind that this may not be a direct effect of the treatment?
Before the memories, only 3 (10%) had attempted or thought of suicide; after memories, 20 (67%) were suicidal. Before memories, only 2 (7%) had been hospitalized; after memories, it was 11 (37%). Before memories, only one woman (3%) had engaged in self-mutilation; after memories, 8 (27%) had mutilated themselves. […]
Most of the patients had been employed before entering therapy (25/30 = 80%), many of them in the health-care industry (15/30). After three years of therapy, only 3 of 30 (10%) were still employed. Of the 30, 23 (77%) were married before therapy. Within three years of this time, 11/23 (48%) were separated or divorced. Seven (of 30 = 27%) lost custody of minor children … All 30 were estranged from their extended families. (Loftus 1997:29).
As stated above, there are both personal statements and studies from the believer camp, which allege strong, positive effects from treatments. I have yet found none addressing SRA-patients quantitatively.
If one could faithfully turn to the literature of MPD/DID with which SRA often was associated, one might access larger studies with numbers that are better grounded (e.g. Kluft 1986:47), but this field is similarly contested, and opinions about the helpfulness of diagnosis and therapy vary as much (cf. Acocella 1999; Hacking 1995; 1999).
Adult Patients: Iatrogenesis?
If therapy is the common factor in the vast majority of cases of alleged SRA, and the majority of these patients had no memories of SRA before entering therapy, one might consider the question whether these alleged memories of SRA were not created during therapy.
This point of view has been very common in skeptic's narratives as they have been presented in print and electronic media. What is the evidence that such is or is not the case?
The evidence against the hypothesis of SRA-narratives being iatrogenic may be neatly summed up with reference to the report of George Ganaway (1989) and others (Young & Young 1997: 71) that a minority of patients who report SRA actually reported such experiences already when presenting for therapy. While these patients' reports seem to be consonant with other accounts about SRA in that they similarly claim a period of repression, the source for these ideas cannot be the therapeutic situation itself, except in cases where the patients have been referred from believer therapists.
We then need to account for both SRA stories that have their background in therapy, and whether such "memories" are induced by the therapeutic situation, as well as for stories that do not originate from therapy. These two groups of stories seemingly converge in the direction of a more nuanced picture of the genesis of SRA-narratives, with the latter group contributing much of the alternative understanding to simple iatrogenesis as an explanation.
In an otherwise very sympathetic article to the claims of alleged survivors of SRA, Walter and Linda Young nevertheless propose that some who read the burgeoning literature of survivor stories are susceptible to source amnesia with regard to the content of their alleged memories of ritual abuse (1997:71). Thus, the available literature on ritual abuse, "the burgeoning literature of survivor stories" (ibid.), may be integrated in someone's memory as "their own experience".
This hypothesis has been widely framed in different literature, noticing seeming effects of popular literature and mass medial presentations on claims (e.g. Peebles 1995; Klass 1988; Victor 1993; Robbins 1999). Young and Young note the particular effect of outside information on hypnotizable subjects, an effect noted earlier by Mulhern (1991; 1994), with the added note that alleged SRA survivors often act just as they would according to theories that they are fantasy prone, highly hypnotizable subjects. The same has often been noted by therapists using hypnosis, both of dissociative patients in general, and of MPD and SRA patients specifically (cf. Hacking 1995).
There exists, then, claims that suggest a subsection of the population, those characterized as "fantasy prone," are particularly vulnerable to claiming diagnoses popular in current media for their troubled lives (cf. Showalter 1997). Mechanisms proposed to account for this involves fantasy, suggestion, hypnosis, social contagion, and regression therapy (Coons 1994:1376). The common denominator of all elements is that of the alleged victim's high-level imaginative involvement with available stories about victimization, with some or other social factors stimulating the confounding of fantasy with memory, thus constructing "believed-in-imaginings" (cf. de Rivera & Sarbin 1997).
For this to explain patients presenting SRA stories before therapy, there needs to be available sufficient details for someone to form more or less full-blown SRA-narratives on their own in the general population (i.e. outside clinics). Overviews of reports of SRA show this to hold true (e.g. Bottoms & Davis 1997:127; Coons 1994; Victor 1994; La Fontaine 1998; Hill 1999).
Coons (1994:1377) found that a model of social contagion was supported in his population of 358 patients, 29 of whom reported SRA, with reports typically originating after popular media had made the typical motifs of claims known to a wider public, and often after local "workshops" had made them locally relevant. However, this effect was still joined with that of therapy, with memories "elicited through hypnosis with 14 (48%) patients, dreamwork with 10 (34%) patients, and regressive therapies with 8 (28%) patients" (ibid.).
I have found no available studies on SRA-"survivors" who have not participated in therapy – such may not only be few, but are obviously harder to come by – but there is a general theory proposed for people who claim culturally available scripts as their own story:
Patients who present themselves to therapists as victims of SRA do so through the process of "ostension," a term coined by folklore scholars. The process of ostension involves appropriating a social script from a widely communicated folklore narrative, or rumor story or mass media report, and using it for one's own behavior. (Victor 1998b:207)
This kind of behavior is known from several kinds of social behavior. Folklorist Bill Ellis (1992) has termed the claim of being victim of SRA "proto-ostension": Acting out the story of SRA in the role of "victim."
According to this kind of theory, culturally available scripts may be appropriated by people outside any particular setting. While this body of research suggests that while some "kinds" of people may have been more influenced than others by such information, the kinds of influence working on highly suggestible people are also at work for the general population in how beliefs about ourselves are constructed and validated: Self-understanding is narrative and makes use of culturally available scripts, and beliefs are validated or contested in social space (cf. Sarbin 1998a,b). Research by Lynn and Stafford shows culturally available scripts of SRA and DID to be both widely disseminated and interrelated (in Lynn et.al. 1998: 130f.).
Theories that contest a "brainwashing" theory of iatrogenesis see all these sources of influence as combining in the micro-social space of therapy. In therapy, writes Jeffrey Victor (1998b:207), the "social interaction between psychotherapists and their patients involves a mutual negotiation of a shared definition of the situation, as is true in any face-to-face interaction." Since they share the same kinds of culturally available explanations of suffering in general, therapists and patients may cooperate towards a shared understanding of the particular patient's
Moreover, clients and therapists generally share certain ("folk") notions about troubled lives as showing evidence of childhood trauma (e.g. Watters & Ofshe 1999; Csordas 1994). They also seem to share certain notions of that therapy is “about” such things as "resolution" of current troubles through a "working through" memories of what has gone before, and that the size of current problems point to the size of previous trauma. The hypothesized process is neatly summed up by Steven Jay Lynn and his team:
suffering (Victor 1998b:210f.; de Rivera 1998a).
Clients consult therapists because there is much that is going on in their lives that they cannot understand, explain, or contend with. The presence of serious psychopathology that cannot be explained by organic or physiological accounts raises the question of what in the person's past is sufficient to account for it. The Stafford and Lynn (1997) findings imply that individuals invoke a representative heuristic such that they believe that serious psychopathology requires traumatic antecedents sufficient to explain the disordered behavior or puzzling experiences. In situations where individuals cannot recall specific aspects of their past that could explain or account for current problems, they might assume that they have repressed memories of abuse and trauma, and, therefore, they may be particularly amenable to suggestive procedures or explanations from authority figures that trauma can account for current difficulties. (Lynn et.al. 1998:131)
This account is supported by a subset of the population studied by de Rivera (1998a:172) who labels this the "self-narrative account," where people's sense-making of their current predicament is supported by therapists. Rather than being forced on the patient, the SRA narrative develops from the patient's need to understand, and the therapist helps develop it by supporting the patient and giving the space to develop the narrative.
This does not mean that therapists and patients are necessarily on the same level of influence, or that all patients are similarly susceptive, or that the procedures used in therapy are on equal levels with regard to effecting agreement. Although the specifics of the situation may vary, therapists are mostly seen as more responsible for the end result by those claiming iatrogenic factors for SRA-narratives (Ofshe & Watters 1994; Wakefield & Underwager 1994; Dineen 1997; Pendergrast 1996).
That this latter point of view should be accorded importance is shown by the unanimous finding that the vast majority of SRA-narratives come not only out of therapy, but from a small minority of therapists (e.g. Goodman et.al. 1994; Victor 1993). While some patients may be transferred, as examples show, to those seen as "experts" once they develop "memories" consistent with SRA, this can only account for a minority of the cases. Lynn et. al. agrees with other researchers in highlighting "suggestive procedures" as more influential in constructing shared understandings of SRA narratives as historically true (cf. Bottoms & Davis 1997; Ofshe & Watters 1994; Wakefield & Underwager 1994; Dineen 1997; Pendergrast 1996; Ross 1995). Moreover, the same therapists believing in and practicing clusters of such "suggestive procedures" shared with most of their colleagues the belief that skepticism of claims or "testing alternative hypotheses" to "memories" being historically true, was "therapeutically contraindicated" (Bottoms & Davis 1997:123).
This means that a large percentage, although not precisely known, of those therapists whose patients told SRA narratives, 1) practiced suggestive therapies, 2) believed their patients, and even when this was not so, 3) often affirmed the patient's "memories" and thus gave authoritative support enabling imaginative practice to be labeled memory. Due to the nature of therapy, these "memories" were often continually rehearsed and developed, with attendant "abreaction" lending added credibility to these imaginings by raising and rehearsing appropriate emotion (fear, anger, nausea, sorrow etc.) (Kenny 1998).
Abreaction and elicitation of "memories" have documentably been supported in therapy by techniques such as hypnosis, strong medication, group therapy, guided visualization, "anger work," isolation from disbelievers etc. etc. On occasion many of these techniques seem to have been in use for the same group of patients (Pendergrast 1996; Wakefield & Underwager 1994; Ofshe & Watters 1994).
While these may be the extreme examples, rather than the typical cases, they indicate that the hypothesis of a strong iatrogenic component (along the lines of "mind control") cannot be wholly dismissed. The documentation in certain cases brought before the court (e.g. Burgus vs. Braun; Susan Q. Smith vs. John v. Public) is strong enough to suggest this. However, in the population examined by de Rivera, only 50% opted for the "mind control" account as covering their own experience in therapy, whereas self-narrative, role-enactment, and combinations accounted for the others (de Rivera 1998a:173). As this research was done on retractors associated with the False Memory Syndrome Foundation, it may suggest that self-narrative and role enactment are even more likely to account for the tales of non-retractors.
With regard to the claims about iatrogenesis, then, there is no simple solution. Cultural factors, social psychological factors and factors specific to therapy interact to different degrees, and influence self-understanding and self-narratives differently. In the latter part of the 1990s there seemed to be general agreement between believers and skeptics of SRA that iatrogenic factors could be at work, and that self-narratives and memories developed/"recovered" in therapy could be influenced and shaped by therapy (e.g. Ross 1995; Gross 1997; Glass 1993; Showalter 1997; Goodman et.al. 1994; Bottoms & Davis 1997). However, there is insufficient evidence that this realization have resulted in therapists revaluing their belief in patients' stories, with many of the believers-turned-"semi-skeptics" hedging their bets (e.g. Young &amp; Young 1997; Ross 1995).
One of the main bodies of psychological research on SRA has been made with regard to children's disclosures of "ritualistic abuse" (one of the main euphemisms for SRA, sometimes enlarged to incorporate what Goodman et.al. terms "religious abuse" (1994)). I shall report only briefly on a very few of the findings here. Although there are geographical differences (USA, Great Britain etc.), and they are at times important differences, I am not going to detail them here.
Children's testimony of SRA were, superficially similar to that of adults, mostly related to a therapeutic setting, often initiated because of prior suspicions of gross neglect, physical mistreatment, and/or sexual abuse (La Fontaine 1994; 1998; Goodman et.al. 1994). They were, however, not as overwhelmingly related to a therapy setting as is reported for adults. Neither were the stories about SRA reported by children identical to those told by adults. Children's stories typically contained less of the prototypical features of SRA than the adults’ tales (Bottoms et.al. 1996:27).
Anecdotal evidence would have most American cases taking place in relation to suspicions of abuse in kindergarten settings. Bottoms, Shaver, and Goodman (1996:17f.) could find no evidence that this impression held true for child SRA-reports. Outside the United States, this connection became even more tenuous, with no such relation found in the United Kingdom (La Fontaine 1994; 1998) and only scattered reports from elsewhere (Hill 1999).
In therapy very few children reported SRA at once, with disclosures occurring only after some time. Gonzalez et.al. (1995) report that most children disclosed within a month. This opens for similar concerns as those with regard to adults, that "disclosure" of ritual abuse means that information about SRA was given and the role of SRA-victim conferred through therapy.
In this regard, an important difference between adults and children was that many more children are reported as having first "disclosed to authorities, family members, neighbors, or other nontherapist professionals" (Bottoms et.al. 1996:20). Case reports to some extent may minimize the impact of this finding. There are indications that this "disclosure" was the result of long periods of intense questioning and leading questions, inside as well as outside of therapy. There is also some confusion about which elements came from the adult and which from the child (La Fontaine 1994; 1998; Ceci & Bruck 1995; Nathan & Snedeker 1995).
Among the influences leading children to develop false accounts of SRA have been interviewer bias, repeated, leading questioning, stereotype induction, peer pressure, the emotional tone of the interview, and the effect of adults holding high status doing the interview (Ceci & Bruck 1995).
Bottoms et. al. (1996) also report a further complication brought up by one respondent: "Physical and sexual abuse were disclosed during a social services investigation, but the satanic (ritualistic) abuse was disclosed in treatment" (1996:19).
This brings up another issue suggested by some (e.g. Ganaway 1989), that some true accounts of sexual and physical abuse may be overlaid with misleading accounts of SRA. The research of Jean La Fontaine on British children support this for her population. Although she found no evidence of ritual abuse, there were clear indications and/or evidence for neglect, abuse and sexual abuse of many of the children (La Fontaine 1998).
Transference values of the La Fontaine study may or may not be high. There are no similar studies with similarly privileged access to detailed records of investigation. Even most of the records related to particular cases before the court – especially after the McMartin trials – seem often not to have much detailed information about the development of the narrative. The general finding for the study conducted by Bottoms et.al. was that there was more corroborative evidence for abuse than for ritualistic elements (1996:27). "The evidence for ritualistic elements of the abuse was generally weak, however, even in the child cases," (ibid.) and much more so than for comparative reports about physical and sexual abuse.
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 One point where many agree, is in denying allegations of vast conspiracies of Satanists murdering hundreds of thousands of children over a few years. Although several important "believers" hold this belief, many others do not. It is, however, rare for these, more selective believers in SRA to give any systematic account of why the cases they hold credible are more so than other allegations. Since they give the same reasons for believing singular cases or classes of cases as others do for constructing conspiracy theories, it may in practice amount to much the same thing. (Others deny belief in vast conspiracy theories, while committing to claims which rely on conspiracy (e.g. tunnels of McMartin).
 Detailed accounts of many of these trials and cases may be found in the False Memory Foundation newsletters from 1994 on. The web page of FMSF, http://www.fmsf-online.org also features detailed testimony from one of the few criminal proceedings raised against MPD-practitioners.
 E.g. of the value of "taking the patient seriously" and going ahead with what has for some been the default treatment of memory recovery combined with abreaction vs. ignoring the alleged memories (cf. Kluft 1997).
 I have been unable to obtain this article, or indeed any article from the short-lived journal Dissociation, and am referring to it from consensual reporting about content in the literature (e.g. Victor 1993; Acocella 1999). (To call library services unhelpful in this regard would be an understatement.)
 Which among a host of other bad ideas promotes such pseudoscientific therapies as Eye Movement Desensitization Reprocessing, a then current "miracle"-cure for a host of troubles.
 For a sophisticated and nuanced critique of the notion that hypnotizability shows itself as a stable trait, see the research by Nicholas Spanos (e.g. 1996). Most of the literature, however, continues to insist that hypnotizability is a stable trait and that "hypnosis" is a particular state of consciousness (e.g. McConkey 1998). I have seen no convincing research to either effect, and some devastating critique of both notions (i.e. Spanos 1996; Spanos & Chaves 1989; Lynn & Rhue 1992).
 The primary reference here is an unpublished manuscript. Results referred from a later paper by Lynn.
 I am here following the line of reasoning found in investigations of those who exits new religious movements, where association with "anti-cult" groups seems to assist developing a self-image as the victim of "mind control" (e.g. Beckford 1985). There are other ways of reasoning which may lead to different conclusions.
 Although Ross has since repudiated SRA generally, he continues with belief in the same methods, and similar tales of conspiracy, only now it is seemingly focused on CIA "mind-control" experiments (Ross 1997).