-Caveat Lector- from: http://www.ipt-forensics.com/journal/ <A HREF="http://www.ipt-forensics.com/journal/">Institute for Psychological Therapies - "Issues </A> ----- The 'Rationalist' outlook. Om K ----- Issues In Child Abuse Accusations Issues In Child Abuse Accusations (ISSN 1043-8823) is a multidisciplinary journal presenting scholarship from disciplines such as law, law enforcement, psychology, psychiatry, sociology, social work, medicine, history, and theology. Its goal is to advance our care for children through pointing to the mistakes of the rush to solve the problem of child abuse, sharing demonstrated facts about the reality of abuse, and discussing new ways for professionals to respond to accusations, victims, perpetrators and those accused. Issues In Child Abuse Accusations has been in publication since 1989. Copies of all back issues are currently available for purchase at a cost $15.00 domestic and $20.00 foreign (U.S. Dollars). Subscriptions are $50.00 per year domestic and $70.00 per year foreign (U.S. Dollars). To order copies or subscribe, mail a check or money order payable to: Institute for Psychological Therapies 13200 Cannon City Blvd. Northfield, MN 55057-4405 At the present time, telephone or credit card orders are unavailable. Tables of Contents for Back issues (by year): 1989 | 1990 | 1991 | 1992 | 1993 | 1994 | 1995 | 1996 | 1997 | 1998 Copyright ©1989-1999 by the Institute for Psychological Therapies. This page last revised on May 25, 1999. ===== from: http://www.ipt-forensics.com/journal/volume10/j10_8.htm <A HREF="http://www.ipt-forensics.com/journal/volume10/j10_8.htm">IPT Journal - "The Social and Cultural Context </A> ----- The Social and Cultural Context of Satanic Ritual Abuse Allegations Susan P. Robbins ABSTRACT: This article explores the multiple, interrelated, and converging social and cultural forces in American society that gave rise to the allegations of widespread satanic ritual abuse that first emerged in the 1980s and eventually peaked in the 1990s. It also examines the factors that sustained both public and professional belief in ritual abuse and suggests that it is the confluence of a variety of factors within the larger societal context that created a climate in which ritual abuse allegations flourished. Beginning in the early 1980s, stories of well-organized satanic cults began to emerge in police reports of horrifying crimes. Not surprisingly, these accounts became increasingly widespread as they also came to be well-publicized by the media. A multigenerational, underground cult network was allegedly orchestrating gruesome satanic rituals that routinely included child sexual abuse, ritualistic torture, mutilation, and human sacrifice (Bromley, 1991; Nathan & Snedeker, 1995). Both media and police reports were based on hand-hand accounts of childhood ritual abuse from adults in psychotherapy who claimed that they had "recovered" previously repressed memories, and from young children in day care who allegedly suffered satanic abuse while in the care of Satanist teachers and caretakers (Jenkins, 1992; Jenkins & Maier-Katkin, 1991; Mulhern, 1991; Nathan & Snedeker, 1995; Victor, 1993). Although these accounts of satanic ritual abuse (SRA) varied to some degree, most shared common themes and were based on anecdotal descriptions of early childhood sexual abuse at the hands of parents or caretakers. Recovered memories of SRA most typically included brainwashing, being drugged, sexually abused, and being forced to watch or participate in satanic rituals, drinking human blood, and ritual murder. Such early ritual initiation was supposedly preparation for an eventual role as a "breeder" who delivered infants to the satanic cult solely for the purpose of ritual sacrifice. Children in day care who made accusations of SRA against their teachers and caretakers gave accounts of ongoing, and often daily sexual abuse that typically included violent rape, and vaginal and anal mutilation with sharp objects. Such acts allegedly took place during normal day care hours and included the presence of magic rooms, tunnels, clowns, jungle animals, animal mutilation, and flying. Allegations such as these were often accepted as factual accounts, despite the fantastic nature of the stories and the lack of evidence to support such claims. It was believed, after all, that children would not lie about sexual abuse and that adults could not invent such realistic and consistent memories of horrific abuse. This article examines the multiple, interrelated, and converging social and cultural forces in American society that gave rise to such SRA allegations and explores the factors that sustained both public and professional belief in widespread ritual abuse. Previous literature in this area has described the influence of specific social factors and trends in the growing therapeutic enterprise (Mulhern, 1991; Nathan & Snedeker, 1995; Pendergrast, 1996; Smith, 1995; Victor, 1993; Wakefield & Underwager, 1994), but none has fully examined the convergence of historical, social, cultural, professional, and ideological forces and their combined influence on the subsequent reporting of and belief in SRA. The Modern Satanic Cult Legend As Shermer (1997) has pointed out, the recent concern and panic about satanic ritual abuse is a modern version of the medieval witch crazes. In such crazes, the intermeshing of psychological and social conditions become coupled with a feedback loop that feeds on people's fears and drives legends and rumor panics in such a way that they come to have a life of their own. Although a variety of commonalities between historical witch crazes and modern SRA accusations have been noted in the literature, some of the most salient similarities include: 1) the prevalence of allegations of sex or sexual abuse; 2) mere accusations become equated with factual guilt; 3) the denial of guilt is seen as proof of guilt; 4) single claims of victimization lead to an outbreak of similar claims; and 5) as the accused begin to fight back, the pendulum begins to swing the other way as the accusers sometimes become the accused, and the falsity of the accusations is demonstrated by skeptics (Shermer, 1997). The role of various stakeholders, discussed in more detail below, plays an important part in the escalation of rumor panics and, as Victor (1993) has demonstrated, the modern SRA legend is not dissimilar to other rumor-driven panics that have been promulgated and further legitimized by self-proclaimed authority figures. Very significantly, legends of this sort have great mass appeal because they provide simple explanations for disturbing phenomena in society. Central to the modern SRA legend are fears about evil acts perpetuated on children that include kidnapping, murder, molestation, child slavery, child pornography, and child sacrifice for satanic purposes (Richardson, Best & Bromley, 1991). While such fears may be rooted, in part, in real dangers, they have been found to be widely over-exaggerated and exacerbated by questionable public statistics that warn of a host of dangers to children. Underlying such fears is a primary concern regarding the sexual abuse of children. Despite the fact that sexual abuse of children is a very real and tragic social problem, public concern about child abuse and CSA was not mobilized until these were publicly defined as a problem that cut across social class boundaries (see Costin, Karger & Stoesz, 1996; Hacking, 1995; Pelton, 1981). Although the data have consistently and clearly indicated that violence, child abuse, and CSA are strongly over-represented among the poor, the myth of classlessness and the subsequent acceptance of child abuse as a middle-class problem was a key factor in the spread of our current concept of CSA. In addition to separating the problem of abuse from the less appealing issue of violence associated with persistent poverty, the new mythology of abuse became extremely profitable for the growing industries of psychotherapy and law. It also increased the likelihood that legislation would be passed and funded to provide services that were not linked directly to conditions of poverty (Costin, Karger & Stoesz, 1996; Pelton, 1981). It is within this social and cultural context that allegations of CSA and SRA in day care settings first arose in the early 1980s. Although satanic cult rumors predated this by more than a decade, the first ritual child abuse allegations and arrests occurred in 1983 in the famous McMartin Preschool case (Victor, 1993). According to Nathan (1991), by mid-1984 reports of ritual child abuse skyrocketed and, by 1987, over 100 such cases had been validated by child protection agencies and police, despite the total lack of admissible evidence in many cases. In response to such allegations, criminal evidence statutes were reformed to make it easier to prosecute such cases and a new cadre of police, mental health, and child welfare "specialists" claiming expertise in SRA developed new methods to elicit SRA affirmations and discourage denial and recantation. As these new and questionable methods were taught to other professionals through a series of training seminars and specialty conferences, the epidemic of accusations of ritual abuse in day care settings began to grow as well. The Demonization of Cults Concern about satanic cults and satanic crime, however, was predated by a growing widespread alarm about religious cults since they first emerged in the United States in the late 1960s and early 1970s. The media gave special attention to a variety of relatively new, small, non-traditional religious groups that proliferated during this time period (Beckford, 1985; Robbins, 1992). The popular use of the term "cult" generally carries with it extremely pejorative connotations, and such groups are viewed as essentially deviant and controversial due to their unconventional beliefs and lifestyles, and often totalistic separatism from mainstream society (Beckford, 1985; Robbins, 1992; Shupe & Bromley, 1991). By the mid 1970s, stereotypes of cults as being "dangerous," "extreme," and "destructive" began to emerge, and anti-cult sentiment was further solidified with the 1978 mass suicide/murder of the followers of charismatic leader Reverend Jim Jones in Jonestown, Guyana. From this point on cults were seen as groups that were brainwashed into submission and labeled as being authoritarian, totalistic, dangerous, destructive, fanatic, and violent (Victor, 1993). Despite a growing body of empirical research that questioned the validity of this stereotype and demonstrated that most new religious groups are, instead, characterized by an impressive diversity, these ideas became central to the negative conception of satanic cults as well (Beckford, 1985; Robbins, 1995a, 19 97; Victor, 1993). Satanic Cults and the New "Crime Wave" By the late 1980s societal concern turned to reports of a new "crime wave" that connected violent crimes to occult practices and satanic worship (see Larson, 1989; Raschke, 1990; Schwarz & Empey, 1988). Satanism became linked to the use of ritualistic magic and animal sacrifice in religions with African and Hispanic origins such as Voodoo, Santeria, and Brujeria (Kahaner, 1988). Growing reports of cult-related child sexual abuse (CSA) and recovered memories of SRA added fuel to the increasing hysteria about coercion and brainwashing within satanic cults and previously unrevealed and unthinkable forms of horrific cultic crime. Despite the growing hysteria, studies have consistently shown that there is no reliable empirical evidence to support allegations of widespread, organized, multigenerational satanic crime (Blimling, 1991; Bromley, 1991; Jenkins, 1992; Lyons, 1988; Melton, 1986a; Richardson et al., 1991; Victor, 1993). Numerous and extensive police and FBI investigations have concluded that there is no definitive physical evidence that such cultic crime exists (see Bromley, 1991; Lanning, 1989a, 1989b; Lyons, 1988; Victor, 1993). Contemporary Satanism, on the other hand, does exist, and is manifested primarily in two forms: 1) open satanic groups and churches that pose no public threat; and 2) small ephemeral groups of self-proclaimed Satanists, composed primarily of teenagers and young adults (Melton, 1986b). In addition to these groups, individuals who have no group affiliations may be involved in their own version of satanic worship. Both individuals and groups of self-proclaimed satanists are frequently involved in violent crimes such as murder and rape, as well as crimes involving drug trafficking. The causal link between organized satanic worship and the crimes committed by these individuals is, at best, tenuous (see Lyons, 1988; Ofshe, 1986; Victor, 1993). Although there is no evidence to support the claims of widespread satanic crime, proponents of satanic conspiracy theory continue to pose an argument that is virtually irrefutable (Bromley, 1991). The lack of evidence is cited as "proof" of the successful clandestine operation of the cult. Thus, according to Victor (1993), "sensational claims" of cult survivors have come to be transformed into irrefutable "truths." Anti-Cult Organizations The rise of new religious cults in the 1960s and 70s led to the formation of anti-cult groups that were initially composed of parents who were concerned about losing their children to destructive cults (Robbins, 1992; Shupe & Bromley, 1991; Victor, 1993). By the 1980s, anti-cult groups achieved greater organizational stability, and were able to draw media attention to their cause. Central to their allegations was the idea that cult members were victims of brainwashing that was achieved through the use of drugs, hypnotism, and other forms of coercive mind control (Shupe & Bromley, 1991). As the anti-cult movement became more sophisticated, they forged an alliance with sympathetic social workers, psychologists, psychiatrists, social scientists, lawyers, and police. Professional newsletters, journals, monographs, and seminars on destructive cultism quickly proliferated and gave greater credibility to the idea that cult members were victims of mind control. As reports of satanic crime and SRA began to surface in the 1980s, parallel coalitions emerged to confront what they believed to be the new and growing threat of satanic cults. Similar to the dissemination of earlier allegations of cultic mind control, claims of a satanic conspiracy, CSA, ritualistic abuse, and kidnapping were quickly spread through conferences and literature for police and mental health counselors, through fundamentalist articles, books, and radio programs. Eventually, sensationalistic stories of SRA made their way into the mainstream media (Bromley, 1991; Crouch & Damphouse, 1991; Jenkins, 1992; Victor, 1993). The Influence of the Media The news media have played an important role in the general public's perception of and belief in satanic cults and cultic crime. The tendency of the media to report sensationalistic stories about SRA and cultic crime greatly contributed to a widespread belief in the reality of ritualistic abuse (Richardson et al., 1991; Victor, 1993). Newspaper and magazine reports on satanic cults relied heavily on officials and cult "experts" who portray all forms of Satanism and cult membership as dangerous and destructive. During the 1980s, terrifying accounts of SRA and cult victimization were commonly featured on national television talk-show programs such as "Geraldo" and "Oprah Winfrey" (Richardson et al., 1991; Rowe & Cavender, 1991; Victor, 1993). Divergent views, though aired, were frequently overshadowed by horrific stories of a satanic conspiracy, mind control, ritualistic torture and sexual abuse. Not surprisingly, divergent views were often seen by the general public as less credible than firsthand accounts of abuse and torture. Quite simply, it was incomprehensible to think that anyone would lie about such events. Common portrayals of Satanism by anti-cult groups and alleged SRA survivors included diverse practices such as kidnapping, ritual sexual abuse, sacrifice of children, cannibalism, blood drinking, and animal mutilations. Perhaps most significantly, when unfounded allegations about such crimes and practices were proven to be untrue, they received sparse media attention. Thus, uncritical and sensationalized reporting have helped shape, support, and perpetuate the public's belief in SRA and cultic crime (Robbins, 1995a, 1997). The Recovered Memory Movement Because many of the reports of SRA were based on memories recovered in the course of therapy, one of the significant factors in the spread of SRA stories was the rediscovery and embracing of Freudian theory by professionals and paraprofessionals in the field of mental health (Robbins, 1995b). Freud originally believed that repressed memories of early childhood seduction were responsible for much of the psychopathology that he encountered in his psychoanalytic practice. He later revised his position and, although he continued to believe in his patients' conscious and spontaneously reported memories of abuse, he came to doubt the veracity of unconscious memories of early infantile seduction, which he concluded, "were only phantasies which my patients had made up or which I myself had perhaps forced on them" (Freud cited in Demause, 1991, p. 126). Thus, in accordance with Freud's revision of his early theory, psychoanalysts and therapists trained in neo-Freudian thought were taught that patient reports of seduction and sexual abuse were incestuous wishes rather than memories of actual events (Masson, 1990). By the mid-to-late 1970s, feminist researchers and therapists began to document the reality of CSA and brought it to the forefront as a public issue. Recognition of the reality of CSA was long overdue because most mental health professionals ignored, minimized, or avoided the topic of sexual abuse for a variety of social, cultural, and professional reasons (Craine, Henson, Colliver, & MacLean, 1988; Jacobson, Koehler, & Jones-Brown, 1987; Nathan & Snedeker, 1995; Post et al., 1980; Rose, Peabody, & Stratigeas, 1991). Given the prevalence of abuse found in clinical populations, the failure to inquire about or respond to reports of sexual abuse was, indeed, a serious omission (Robbins, 1995b). As neo-Freudian thought began to be displaced by biological psychiatry and family systems approaches (among others) in the early-to-mid 1980s, influential psychoanalysts began to revive Freud's early theory of childhood seduction. Expanding on Freud's early theory and British psychoanalyst Fairbairn's object-relations revision of repressed sexual trauma (1952), Swiss psychoanalyst, Alice Miller (1981, 1983, 1984) was among the first to popularize what has now become the common conception of repressed childhood trauma at the hands of one's parents. Further building on the tragic reality of incest and the revived concept of repressed sexual trauma, psychiatrist Judith Herman's book Father-Daughter Incest provided early impetus for the formation of incest survivor therapy groups in the Boston area (Webster, 1995). Perhaps even more influential was the work of psychoanalyst Jeffrey Masson, the former projects director of the Freud archives. In his now famous book The Assault on Truth: Freud's Suppression of the Seduction Theory (1984), Masson proposed that for personal, political, and professionally expedient reasons, Freud abandoned his theory about the importance of incest in the development of hysteria. As Pendergrast (1996, p. 423) noted, Masson's work has served as "one of the cornerstones of the Incest Survivor movement." The revival of Freudian seduction theory led the way for what would soon become a largely uncritical acceptance of uncorroborated accounts of repressed memories of repeated sexual abuse and recovered memories of SRA. Addiction, Denial, and the Self-Help Movement The expansion of recovered memory ideology was aided by a new and growing social and cultural phenomenon that emerged in the 1980s: the growth in the size and scope of self-help groups based on the twelve step model of Alcoholics Anonymous (AA). The escalation of "zero tolerance" in the War on Drugs and the concomitant push for widespread identification and treatment of substance abuse was eagerly embraced by the media. Estimated and fabricated figures that warned of the growing prevalence of alcoholism and illegal drug use became commonplace (Baum, 1996; Peele, 1989). The resulting growth in the substance abuse treatment industry was aided by media campaigns that included testimonials by well-known people such as Kitty Dukakis, Betty Ford, and Elizabeth Taylor, whose stories were aimed at convincing people to get help for their addictions. Thus, as Peele (1989) has pointed out, addiction not only became destigmatized, but addicts were turned into role models. As drug treatment programs came to rely heavily on AA ideology and group treatment methods, the AA credo of twelve step recovery became a national dogma (Peele, 1989). Ironically, even though AA had enjoyed some degree of popularity since its inception in the 1930s, the ideology of self-help recovery in the 1980s began to shift some of the ideas that were central to AA. Instead of people seeking help because they knew that they were having problems with alcohol, alcoholics were now seen as being in denial about their illness (Peele, 1989). As the idea of denial became popularized, the ever-expanding concept of "addiction" and twelve step recovery began to spread to a wide variety of other behaviors such as eating, gambling, sex, love, and relationships. Groups like Al-Anon and Alateen that were initially set up to provide support and guidance for non-alcoholic family members, now began to portray wives, husbands, parents, and children of the alcoholic as themselves having a disease. Alcoholism and drug addiction were no longer seen as an illness of the individual alcoholic or addict, but of the entire family system. Denial was defined as "part of the disease for both the alcoholic and his family" (Woititz, 1976). With denial at the core, the newly popularized concepts of "co-dependency" and the "dysfunctional family" gave rise to a burgeoning self-help industry in which all of life's problems were defined as a previously undiagnosed disease, rooted in childhood family dysfunction, over which the sufferers had little, if any, control. Pop Psychology, Feminist Theory, and Survivor Ideology The addiction self-help movement provided fertile ground for the expansion of theories and ideology to support the growing view of families, and society as a whole, as being diseased and dysfunctional. Rather than examining some of the very real and social and economic stressors that accompanied the quickly changing and unstable job market, fluctuating economy, profound changes in family structure, changing social roles, and the increasing demands on women, many of whom now found it necessary to join the labor market as well as be responsible for child care, the disease model turned our attention inward and backward. Newly self-appointed "experts" in addiction and dysfunction turned to the prototypical Freudian model of individual pathological functioning based on alleged parenting deficiencies in early childhood (Kaminer, 1993; Pendergrast, 1996; Smith, 1995). Popularized versions of Freudian-based object-relations theory emerged as one of the primary theoretical explanations of adult dysfunction (see Smith, 1995; Wood, 1987). Although early American feminists criticized Freudian theory for its distinctively anti-female assumptions, later feminist thought embraced a revised form of psychoanalytic theory that accepted many of Freud's fundamental assumptions about the nature of the unconscious and the importance of early childhood experiences in the formation of adult personality (see Chodorow, 1978). While rejecting the idea of female inferiority that was pivotal to Freud's work, both psychoanalytic feminism and an emerging body of radical feminist writing portrayed male domination (i.e. the patriarchy) as the root of women's oppression and the primary cause of psychological disorders. Violence against women (physical, sexual, and psychological) was seen as a primary force through which women were denied control over their lives and choices. The recovered memory movement readily embraced the idea of male violence, particularly that of repressed CSA at the hands of fathers, step-fathers, and other male authority figures. Women (overwhelmingly white and middle class) who sought counseling for alcohol and drug problems, depression, eating disorders, and a variety of other conditions were told by their therapists that they were abuse victims because they showed the "symptoms" of CSA, despite the fact that most had no conscious memories of such childhood violence. Many were encouraged to "abreact," or recover and relive the repressed memories, and to join ongoing incest survivor self-help groups to aid in their "recovery." More recently, a newer "third wave" of feminism has produced scathing critiques about feminist theory and practice that is rooted in the concept of victimization (see Kaminer, 1995; Robbins, Chatterjee, & Canda, 1998). Requiring women to assume the role of the "victim," a person who is perpetually in recovery, has been criticized for being disempowering as well as being a suppression of women's rights to sexual, psychological, and economic freedom. Nonetheless, "victim feminism," as it has been dubbed, was an integral part of the recovery culture that emerged in the 1980s. The Recovery Culture and the Rise of SRA In the context of a variety of self-help recovery groups, women came to adopt the view of themselves as co-dependent, dysfunctional and "diseased," and they came to accept their therapist's and recovery group's definitions of the cause and nature of their problems. Among the burgeoning self-help recovery literature on addictions, codependency, sexual abuse, and family dysfunction, the publication of a pivotal book, The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse ()(), advanced the purely ideological position that "if you think you were abused, and your life shows the symptoms, then you were" (Bass & Davis, 1994.) Written by two women with no formal training in psychology or counseling, this book became the veritable bible of the sexual abuse survivor movement. With victimization now elevated to an even higher and more desirable status, women were told, and many came to believe, that they could not trust themselves, their self-knowledge, or their actual memories. Ironically, this new therapeutic ideology, allegedly rooted in feminist thought and concern for women, actually replicated the oppressive patriarchal model of therapy in which the patient's self-knowledge was inferior to the therapist's expertise. Newly "recovered" memories of CSA were sometimes accompanied by even more horrific accounts of childhood abuse that included torture, abuse, and murder in satanic cults. Although some of these stories first surfaced in the early 1980s (Nathan, 1991), they became quickly fueled and spread by the popular media, and an uncritical belief on the part of a small cohort of therapists that their patients' accounts reflected real memories of cult abuse. In this context, SRA survivor stories became a primary focus of therapy. New and often barbaric techniques to invoke abreaction were taught at professional seminars and were justified by the idea that SRA survivors suffered Multiple Personality Disorder (later renamed Dissociative Identity Disorder) that was reinforced by sadistic satanic cult brainwashing. As SRA and MPD became inextricably linked with one another, stories of satanic abuse gained credibility through their association with a psychiatric diagnosis. Through its inclusion in the primary manual used to diagnose psychiatric disorders, the aura of medical acceptance validated the treatment of satanic possession and abuse, despite the fact that there was no verifiable evidence that any such abuse had occurred. Skeptics were always critical of this diagnosis and were quick to label MPD an "iatrogenic" disorder, a disorder that is actually caused by the treatment itself. Although SRA claims are now being examined with a more critical eye by the media and most therapists, the diagnosis of MPD/DID continues to be linked to dissociated childhood trauma. Many therapists are now approaching such cases more cautiously, however, due to the fact that a large number of people have now recanted their SRA "memories," questioned their diagnosis of MPD/DID, and some have won very high profile lawsuits against their therapists for implanting memories of SRA and CSA that never occurred. In addition, professional organizations that regulate mental health counseling have now issued statements or guidelines warning about the use of hypnosis and other therapeutic methods aimed at the recovery of repressed memories (Pendergrast, 1996). Summary The numerous social and cultural forces that gave rise to the widespread belief in SRA coalesced at a time in which American society was undergoing significant transformation. New societal fears about cults, child pornography, rising crime, family instability, and a growing concern for children's safety, all contributed to the belief in the ritual abuse of children. Fueled by media sensationalism, these apprehensions and concerns became further enhanced by a growing self-help movement and counseling industry based on defining life's problems in terms of addictions and one's status as a victim. This was then coupled with the renewed ideological belief that present day problems stem from early childhood trauma and family dysfunction. This paved the way, in part, for the rise of an increasingly profitable therapeutic enterprise built on people's fears and dissatisfaction. Although many of these forces were interactive and intricately built upon one another, they must also be placed within the larger social context of the day in which real and unsettling changes in the industrial economy were accompanied by economic insecurity, changing family forms, and increasing anxiety about family stability and sex roles. It is the confluence of these multiple factors that made the climate ripe for a rumor panic about a satanic conspiracy that led otherwise reasonable people to believe in fantastic and unfounded accounts of satanic ritual abuse. References Author Info Susan P. Robbins is Associate Professor and Associate Dean for Academic Affairs at the University of Houston, Graduate School of Social Work, Houston, TX 77204-4492. [Back to Volume 10] Copyright ©1989-1999 by the Institute for Psychological Therapies. 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