Professional Psychology: Research and Practice 1998, Vol. 29, No. 3, 245-256 Copyright 1998 by the American Psychological Association, Inc. 0735-7028/98/S3.00 Working With Adult Clients Who May Have Experienced Childhood Abuse: Recommendations for Assessment and Practice Carolyn Zerbe Enns Cornell College Jean Campbell San Diego, CA Christine A. Courtois The Psychiatric Institute of Washington, DC Michael C. Gottlieb Dallas, TX Karen P. Lese Texas Tech University Counseling Center Mary S. Gilbert and Linda Forrest Michigan State University The delayed memory debate has generated many questions about therapeutic practices that are likely to be beneficial and detrimental to clients. This article proposes components of optimal practice for working with adult clients who may have been abused as children. The recommendations are orga- nized around the following themes: (a) competence, (b) assessment and treatment planning, (c) psychotherapy process and technique, (d) memory issues, (e) and ethics. The authors emphasize the importance of a collaborative therapeutic relationship and urge clinicians to proceed cautiously when encountering treatment issues for which scientific knowledge and consensus are still evolving. In the wake of the delayed memory debate, the therapeutic procedures of clinicians have been exposed to increased scru- tiny, and some authors have concluded that therapists are often unprepared to respond effectively to clients' concerns or are responsible for leading clients to believe that they have been abused when there is no basis for such a conclusion (e.g., Lind- say & Read, 1994; Loftus, 1993; Poole, Lindsay, Memon, & Bull, 1995). Several recent articles have addressed therapeutic CAROLYN ZERBE ENNS received her PhD from the University of Califor- nia at Santa Barbara in 1987. She is a member of the psychology faculty at Cornell College and a part-time psychologist at the University of Iowa Counseling Service. She recently chaired the Task Force on Memories of Childhood Sexual Abuse that was sponsored by the Division 17 (Counseling Psychology) Section on Women. JEAN CAMPBELL received her PhD in counseling psychology from Florida State University in 1971. She is in independent practice in San Diego, CA, and specializes in the treatment of trauma and abuse victims, includ- ing domestic violence survivors and adult survivors of sexual abuse. She initiated work on the recommendations presented in this article. CHRISTINE A. COUKTOIS is a psychologist in independent practice in Washington, DC, and is co-founder and clinical director of the CENTER: Posttraumatic Disorders Program, the Psychiatric Institute of Washing- ton, DC. She specializes in the treatment of posttraumatic conditions and disorders, sexual abuse and assault, and, recently, delayed memory issues and practice guidelines. MICHAEL C. GOTTLIEB, PhD, practices independently in Dallas, TX. He is an American Board of Professional Psychologists Diplomat (Family) and an American Psychological Association (APA) Fellow. His research focuses on applied ethics. KAREN P. LESE received her PhD from Virginia Commonwealth Univer- sity in 1992. She is coordinator of practicum training at the Texas Tech University Counseling Center. Her research interests include psychologi- cal trauma and gender issues. practices from the standpoint of risk management and the legal concerns that practitioners may face (e.g., Frank, 1996; Knapp & VandeCreek, 1996). This article adds to the emerging literature on psychotherapy practice with clients who may have experienced abuse by proposing practices that we believe will support the best interests of clients. Our intent is to avoid (a) MARY S. GILBERT received her PhD in counseling psychology from Michigan State University and is currently working as a psychologist for the Michigan State University Counseling Center. Among her research and treatment interests are various women's and feminists' issues, episte- mology, and issues of diversity. LINDA FORREST received her PhD from the University of Washington in 1979. She is a faculty member associated with the counseling psychology program at Michigan State University. She is the past chair of the Divi- sion 17 Committee on Women and the Task Force on Memories of Childhood Sexual Abuse. She is the current vice chair of the APA Committee on Women in Psychology. CHRISTINE A. COURTOIS AND JEAN CAMPBELL are the joint second authors of this article. SPECIAL THANKS TO Christine A. Courtois for generously sharing her treatment guidelines for delayed-recovered memories (Courtois, 1997b) as a partial foundation for the perspectives presented in this article and for leadership in the development of abuse-trauma theory and treatment. We gratefully acknowledge the contributions of many individuals who provided feedback and suggestions, including Bianca Bernstein, Laura Brown, Judy Ellickson, Ruth Fassinger, Kathy Hotelling, Kathy Miller, Karen Pfost, Ken Pope, Tina Stern, Marolyn Wells, and Betty Yarns. We also express appreciation to the APA Division 17 Section on Women for its support during this project. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Car- olyn Zerbe Enns, Psychology Department, Cornell College, 600 First Street West, Mount Vemon, Iowa 52314-1098. Electronic mail may be sent to enns@cornell-iowa.edu. 245