I write this column (using “he” throughout, for simplicity purposes) to suggest some useful ideas for vetting a prospective provider who does not come recommended through a reliable source (or through Donna Anderson’s growing new LoveFraud referral base).
How can you begin to assess a relatively unknown provider for his competence to address your experiences with a suspected sociopath specifically, exploiter in general, or otherwise personality-disturbed individual?
Let me start by suggesting that a provider who claims to be educated about sociopathy really isn’t if he lacks an equally fluent understanding of narcissistic and borderline personality disorder.
The reason I say this is that, under certain circumstances, all three disorders can look very much alike; but more importantly, if you are involved with someone who has any one of these disorders, you are at heightened risk of being personally violated and abused.
So, while they are distinct from each other (although common elements of narcissism and sociopathy remain intriguing), I’m suggesting that all three disorders greatly increase the probable, if not certain, occurrence of interpersonal violation.
In the course of this discussion, I’m going to assume that you may be involved with someone (or have been involved with someone) whom you suspect (or know) to be, for instance, sociopathic and/or abusive? Otherwise you wouldn’t be seeking assurances that a particular provider has knowledge and/or expertise of the disorder(s) in question.
I also make the assumption that LoveFraud members or visitors wanting to find a knowledgeable resource on sociopathy (who do not find assistance through Donna’s new referral resource) come with a nice advantage—by virtue of their involvement with LoveFraud, they are already extra knowledgeable on the subject. This equips them to be astute evaluators of a prospective resource.
So let’s get down to business.
You will need, no surprise, to ask questions; questions that can gauge the provider’s competency to appreciate the gravity of a situation in which a sociopathic (or some other exploitative dynamic) is, or has been, present.
And you will want good, expressive answers to your questions, not dismissive ones.
The first, vital task is to assess the provider’s receptivity to your interest in his clinical experience. This point needs emphasis: You are entitled to evaluate the provider’s clinical experience and expertise as it pertains to your circumstances.
I stress: You are completely, utterly entitled to assess the provider’s professional experience, skills, and interest on matters relevant to your personal circumstances and self-interest.
Remember, this is not about protecting the provider; it’s about protecting yourself.
As such, this speaks to a bigger issue: You are setting yourself up if you do not protect yourself, and so you protect yourself by owning your right to a completely respectful, receptive invitation to evaluate the provider’s scope of interest and competence with a given client population, or in a particular clinical area. Anything less than a genuine, undefensive invitation from the provider to proceed with your questions should immediately disqualify him from consideration.
So for instance, you might begin with something like, “You know, it’s very important to me, given my circumstances, to be working with someone I can feel confident has a really good knowledge of _________. Would you mind if I asked you several questions along those lines, for my own personal comfort?” (There are many ways to break the ice, this is just one example.)
Remember: A provider who fails, at this point, to invite you to proceed, undefensively, has disqualified himself. Thus, if he responds impatiently, arrogantly, angrily, curtly, condescendingly, as if offended or put-off, or in any other way inadequately, he is wrong for you. You must move on, because you deserve better.
Assuming you’ve gotten the proper encouragement to proceed, I offer below a list of questions (hardly comprehensive) which, depending on your circumstances, can elicit meaningful information. The idea (quite obviously) isn’t to ask all of these questions, but to pursue several that are most applicable to your situation.
This list is by no means complete; rather, it’s at best a starting point, if only to get your own wheels rolling to come up with even better questions! Note that some of the questions probe for knowledge, others for personal views and biases, and others for experience. The asterisked questions can sometimes elicit responses that will enable you to quickly eliminate potential resources.
· How familiar are you with sociopathy?
· How familiar are you with psychopathy?
· Do you distinguish sociopathy and psychopathy, or are we using these terms to mean the same thing?
· Do you distinguish antisocial personality disorder from sociopathy or psychopathy?
· How many cases have you worked involving sociopathy?
· Can I ask how you came to work with these individuals?
· What is your treatment philosophy regarding sociopathically disturbed individuals?
· I’m curious how you view sociopathy? I know that many people have different ideas about sociopaths. Can you tell me your view of what characterizes the sociopath?
· How do you distinguish, if at all, the sociopath from the narcissistic personality?
· What’s been your experience working with borderline personality disturbance?
· In your experience, what are similarities and differences between borderline, narcissistic and sociopathically disordered individuals?
· How much experience have you had working with abusive individuals?
· Can you tell me a little about the history of your interest, and experience working, with abusive personalities?
· *How effective and appropriate, in your experience, are anger management referrals for abusive personalities?
· How much interest, and experience, have you had working with victims of abuse?
· What is your view of what constitutes abuse in a relationship?
· What are your goals in working with someone who is in, or has been damaged by, an abusive relationship?
· *Are there circumstances where someone might be driven, legitimately, to abuse someone else?
· Do you mind if I ask you whose work or writings on abusive relationships and abusive personalities has most influenced your views?
· Do you mind if I ask you whose work on the subject of psychopathy (or sociopathy) has most influenced your ideas?
· *Are you familiar with Robert Hare’s work?
· *Have you successfully treated sociopaths?
· My partner, if you meet him, will tell you that I’m a sociopath”¦how will you know which of us, if either, is the sociopath?
· Are you familiar with any psychological instruments that assess for psychopathy, and if so, do you use them?
· *Under what conditions, if any, would you be hesitant to do couples therapy?
· What goals do you have, generally, when working with a borderline personality?
· What goals do you have, generally, when working with a narcissistic personality?
· What is your understanding of the central feature(s) of sociopathy?
· What is your understanding of the central feature(s) of the narcissist?
· Would you be willing to read something I’d give you if I felt it could help you understand the precidament/situation/personality I’m dealing with?
· When you believe you are dealing clinically with a sociopathic individual, what is your clinical goal?
The answers to your questions
As I’ve strongly suggested, the provider’s responses, first of all, should convey interest in, and respect for, your questions. Your first assessment, then, is less of the provider’s expertise and knowledge, than his or her attitude to your questions.
As a matter of fact, a primary purpose of your questions is to assess the attitude of the provider. In other words, if the provider isn’t temperamentally suited to appreciate the complexity of your concerns, he or she can have all the knowledge in the world and be pretty much worthless.
You’ll want honest answers. Genuine answers. Not pretenses to expertise where there isn’t any. You’ll want a provider who is willing to say, “That’s an interesting question. I might even need to think about that a bit more.”
I offer randomly some rough examples (from countless possibilities) of what might be deemed encouraging responses to some of these questions:
“To be honest, no”¦I haven’t worked with what I’d call a high volume of ________; but I do feel comfortable with my understanding of this clinical issue, and I’d like to be of help to you.”
“I consider myself to be clinically literate on this subject, but I’m happy to become even more enlightened and would welcome anything you have to share with me to get me up to speed.”
“I wouldn’t say that I have a particular interest working with _______, but I do like working with and helping those who have been victimized by ________(s).”
“I suppose I’d regard ______as a very central feature of _______. Also ______.”
“I don’t really make a distinction between antisocial personality and the sociopath? As a matter of fact, I wasn’t even aware of such a distinction? But I’m curious about that? Am I missing something?”
“I’ve worked a great deal with victims of abuse and enjoy working with this client population.”
“I’m not familiar with that issue, to be honest” (depending on the circumstances, this doesn’t necessarily have to be a disqualification).
“I can’t say that I’ve had great success working with narcissistic personalities”¦but I’ll work with anyone who voluntarily seeks my help genuinely.”
“I’m not sure if I satisfied you with my response?”
These hypothetical replies have in common a thoughtful, humble, curious quality. The confident provider will feel relaxed, undefensive, and unpressured to produce brilliant, comprehensive answers beyond his or her scope of expertise.
At the same time, you are looking for evidence of expertise that will leave you feeling comfortable that this is someone who can effectively, sensitively advocate for your interests.
Some responses, as noted, can quickly reveal a provider’s serious limitations.
For instance, the response to the question, Have you successfully treated any sociopaths?, “Yes”¦I’ve worked with many sociopaths and treated several very successfully,” is a great time-saver. You just say, “Thanks very much, I’ve really appreciated your time,” and then have a good laugh on your way out.
That’s because true sociopathy, as the LoveFraud community well knows, is a refractory
condition, unamenable to meaningful modification.
Regarding the Hare question: in cases where a provider claims to be experienced with the subject of sociopathy, I might find it dubious (although not necessarily instantly disqualifying) that he or she would have no knowledge of Robert Hare, who is such a notable figure in psychopathy research.
Similarly, the response to the question, Under what conditions would you be hesitant to do couples therapy?, “Umm”¦.I can’t really think of any?,” would suggest a potentially serious defect in the provider’s clinical knowledge and/or judgement. That’s because couples therapy is ill-advised under several circumstances, among them when serious abuse is occuring in a relationship, or when one or both partners is sociopathically oriented. (And naturally, non-genuine motivation to work on the relationship would be another contraindication.)
Further, a provider who suggests that, yes, a referral for anger management is probably the best intervention you can offer an abusive personality betrays a likely ignorance of the dynamics of the abuser, who has much more than merely an anger problem.
And it’s self-evident that a provider who can find a basis to justify abuse under any circumstance is probably confusing abuse with, perhaps, self-defense—a failure of understanding that ought to send you running for the hills.
Bear in mind there is no one right way to answer many of these questions; in many cases, there are multiple good (and good-enough) answers which also allow for differences in clinical approaches and orientations.
I offer below additional examples (also random, hypothetical) of the kinds of responses that might reflect a reassuring level of clinical expertise:
“What do I see as the central feature of sociopathy? I see the sociopath as someone who is extremely, chronically manipulative and deceptive. Someone who lacks empathy in a very gross way for the victims of his or her exploitation.”
“I see what you mean”¦.you can have a borderline personality disorder doing something, say, really vengeful that might look very sociopathic, but the motive for the aggression would be different. The borderline personality might be motivated by rage, panic, or desperation over, say, abandonment issues, whereas the sociopath? He or she may be movitated by”¦the impulse?”¦pure greed”¦or even the fun of it?”
“If I have good reason to believe I’m dealing with a sociopath, my main goal becomes evaluating his or her risk to others”¦depending, of course, on the circumstances of the referral and case.”
“If I’m working with someone with borderline personality, I’m looking to help that individual, among other things, learn how to better regulate his or her emotions, which may be very dysregulated and for that reason a source of much distress.”
“If I’m working with a narcissistic personality disorder, I’m looking, over time, to help that individual, if possible, examine his demands and expectations of others—his inflated sense of entitlement—more thoughtfully; and also examine the ways that he routinely handles, or mishandles, his disappointment in others.”
“When I’m working with abusive individuals my goal is to confront their excuses and rationalizations for their violating behaviors.”
“When I’m working with victims of abuse I may have several goals, including safety concerns; also exploring how the client finds herself in an abusive relationship, and the factors that make it difficult for her (or him) to leave that relationship.”
“How will I know which of you is the sociopath? I think in any clinical situation, you rely on a number of factors in formulating possible diagnoses, including your instincts, your experience of the individuals, the client’s history (as furnished by the client and others), other relevant, available, supporting documentation; and any adjunctive testing and evaluations that can narrow down, if necessary, a suspected diagnosis more accurately? And so there’s no guarantee that I’ll get it right, but I’m pretty confident of my chances.”
In sum, you’ll want assurances that the provider, at a minimum, can recognize the central aspects of sociopathy (or the disorder in question); he or she should appreciate the futility of pursuing treatment with the sociopath, especially in a private practice setting; but most importantly, the provider should be able to convey a good clinical grasp of, and history of work with, abusive personalities and their victims.
You will know, intuitively, whether the provider’s responses indicate an adequate level of thoughtfulness and knowledge.
And remember, your initial assessment doesn’t end when you choose to begin a working relationship with a particular provider, anymore than you cease evaluating the individual with whom you enter a personal relationship. Your evaluation should be ongoing, and your continued investment in the relationship, whether with a professional resource, or intimate partner, should be based on a continuing evaluation of him or her as worthy of your time and trust.
You can say at any point along the way, This person is not right for me. Just because I sized this person/provider up initially (with necessarily incomplete information) as worth my initial investment, doesn’t mean I can’t modify my assessment of him or her at any time, thanks to my making good use of additional, more complete information!
I hope this offers some guidance for conceptualizing an approach to the evaluation of a relatively unknown prospective provider. I am glad to continue this discussion based on feedback.
(This article is copyrighted (c) 2009 by Steve Becker, LCSW.)
Excellent list of questions and information in this post. Thank you, Steve!
This article would be helpful on the main LoveFraud site.
Steve: Good article, good list, a couple of red flags, though. In a hypothetical question you said, “When I’m working with victims of abuse I may have several goals, including . . . how the client finds herself in an abusive relationship . . . .” This disregards the fact that a “highly socialized” psychopath may have targeted the victim, and the victim did not have any real clues to the truth. Imagine how a therapist would say to a victim of Bernie Madoff, “So, how did you contribute to the relationship that allowed Bernie to fleece you for $100 million?”
One major challenge for recovering victims is getting over the self blame. This particular tack doesn’t help in the process.
The other flag is: “You will know, intuitively, whether the provider’s responses indicate an adequate level of thoughtfulness and knowledge.” No, not if the con artist was pretty good at the lies. They can fool anyone, even highly intuitive animals. It’s because they present the lie so effectively as the truth that we are fooled and blindsided.
Have been reading this blog for months now, as I was the victem of a narcissist. Am very much healed by it (LoveFraud), and think this site has truely been a life-changing experience. I almost feel like I know many of you personally, and owe you all so much.
I am a trained and practicing diagnostician in psychometrics. I have spent years studying psychopathy and its symptoms. I could talk for hours on the differences between Borderlines, Narcissists and Anti-Socials. I thought that this made me “safe” – my special knowledge.
Well, I can tell you than nothing immunised me from the reality of NPD. All the intellectual understanding in the world doesnt help when you are human, and fall ‘in love’. All the ‘clinical expertise’ available doesnt give you the first inking of what it FEELS LIKE to be emotionally raped.
So I have to disagree with Steve completely. All those questions are useless in my experience. The only way your therapist will ever really “get it” is if they themselves have personally been emotionally involved with a personality disorder. No amount of study really prepares you. And working with them doesnt make any difference either. You can treat people with Cancer, and still not really know what it feels like to be terminally ill.
Grant: Yes. Yes. Yes.
When I went to the judge for a restraining order, he asked, “Well, were you raped?” I was speechless. What else was it when the entire 18 months had been a calculated con?
I’m glad you’re here. You have a unique perspective as an intellectually sophisticated professional in the field, who has had the close encounter with the emotional freight train. Thank you for your honesty.
DEar Grant,
Welcome to the “LF club” but sorry you had to “join”—-I definitely see your point about knowing how a Cancer patient feels, BUT I will say that while you may not know how the FEEL because you haven’t had that experience, you can find out what their NEEDS ARE and you can help them and support them in their healing process (even if that includes dying).
Hospice is one of the greatest, most supportive groups in the world, and they haven’t experienced death personally either, but they definitely understand what the patients are going through in the way of grieving. While I agree it would be NICE if a professional could have been through the experience, I disagree that they hve had to have had cancer in order to be able to support and help the cancer patient.
I disagree that they have had to die to support a dying patient.
ONe of the grief counselors I heard give a 3 day conference on the “presencing” of just being there in an empathetic posture so that the patient can ask for and get what they need from just your very presence.
This is simplistic, but I’m sure you have known people who would come into the home of someone who had died and say to their widow or widower “I know how you feel.” NO YOU DON’T KNOW HOW I FEEL. I had that happen to me, and though I have TAUGHT classes in grieving and I knew what their intentions were it PISSED ME OFF IMMEDIATELY.
In an AA meeting one drunk can say to another one “I know how you feel” and they probably DO. People here can tell me they KNOW how I feel when I am down, and I am NOT offended cause I figure they have a pretty darned good idea. Maybe not exactly, but CLOSE ENOUGH FOR GOVERNMENT WORK.
If the person who had come to me and said “I know how you feel” after my husband died, I would have been less offended if they had been a widow or widower, but still they didn’t KNOW HOW I FELT because they hadn’t seen their husband suddenly burned to death, or stood there thinking that their son was still in the burning inferno of an airplane. At that moment there was NO ONE IN THE WORLD who knew how I felt unless maybe it was a widow/er from 9/11. Plus, my nerves were SO RAW, I WAS IN SUCH SHOCK I wan’t processing much. Just basic overwhelming denial, shock and pain. NUMB.
Having been on the local volunteer fire department we have pulled horribly burned bodies out of houses, aircraft and cars, and I was empathetic with the person’s loved ones, comforting and supportive, but you are right I did NOT KNOW first hand how they felt. I do know first hand how they felt now. But still, I had enough training and enough knowledge in the workings of the grief process I was able to be supportive of them wihtout having had the experience first hand (at that time.) Now I can be BETTER.
You are right too about our professional knowledge, training, etc. not being a protection from us falling into the WEB of one of them. I can’t count the mental health professionals from MD, PhD and therapists who are on here. It seems I would think that there is a GREATER number of “us” than would be expected in a random selection of victims.
I know with myself, I was ARROGANT and felt safe. I worked with the women and children doing pro bono family clinic medical care. I felt superior to these women who frequently went back to the man who had beaten and beaten them. I WOULD NEVER have let a man punch me around and go back to him. BUT I let my son, I let my mother and others abuse me. Just not my husband. LOL No, I was too arrogant for my own good, and thought I could “fix” others. That’s what they paid me for was “fixing others”—-“physician, heal thy self.” (or in my case Nurse Practitioner, heal thy self)
And of course afterwards I beat myself up unmercifully for “being so stupid, you should have known better” and that has been a hard “row to hoe” in my healing, to forgive myself for “being so stupid.”
Anyway, glad you are here, Grant, and glad that our musings have helped you along the healing road. Keep on posting.
Hi everyone, and thanks for the feedback.
Grant, in response to your comments: It is not possible, I agree, to intellectually assess whether a prospective therapist is going to “get your particular experience.” On the other hand, I maintain that it is possible, and wise in fact, to query a prospective clinician about their interest and experience working with special clinical problems. Regardless of their purported experience (even if it’s objectively vast), there will need to be a genuine chemistry and understanding that will transcend any volume of clinical education. However, one would be reasonable to begin, I think, with some assurances that a prospective clinician has, at the very least, had some meaningful clinical exposure to, in addition to interest in, one’s particular circumstances. I also disagree with you when you emphasize that unless a clinician has personally experienced the client’s precisely traumatic emotional experience, this precludes him or her from being potentially helpful in many possible ways. I disagree with you strongly about that. I do not think that it’s essential for a clinician to have been married, for instance, to a psychopath, or to have lived with a borderline or narcissistic personality, to work potentially very effectively with those who have been damaged in such relationships. I think that this is an erroneous, very limited view. My own view is that we can sometimes be very helpful to others (by “we,” I mean potentially anyone) without having necessarily precisely experienced what another has experienced. I think your analogy to oncologists is equally flawed: there are many exceedingly empathic oncologists (who themselves have not had cancer) who are well-equipped to navigate cancer patients through the medical and emotional travails of the experience. And there are many cancer patients who have been further helped, emotionally, by therapists who themselves have never, blessedly, had terminal cancer. So while I appreciate on one hand your point(s), on the other I think your categorical dismissal of providers having anything to offer suffering clients unless they–the providers–have suffered intimately and personally exactly what their clients have suffered is pretty rigid and rather dismissive. Regarding the questions I specifically proposed as potentially useful, I don’t begrudge you your view of their usefulness. Their purpose, to restate probably unnecessarily, isn’t to ratify with any certainty that this or that provider will be right for this or that client, but rather to suggest possible ways of establishing just how comfortable (and yes, experienced) a given provider might be vis a vis addressing and exploring particular clinical issues (eg., sociopathy). I disagree strongly with your assertion that to make such an initial assessment is useless, and moreso with your assertion that only providers who have “lived” the experience can be helpful. According to your logic, perhaps only a clinician who is a sociopath can fully and completely relate to the experience of sociopathy; or perhaps only a borderline therapist, in the final analysis, is equipped to treat (and sufficiently understand) the client who has been damaged by a borderline partner? How far do you take this?
Steve, I know your response post was directed to GRant, but I would also like to chime in again, I agree with your response completely, except for the last two sentences which I think are a bit extreme. (tongue in cheek?)
REading between the lines, I am suspecting that maybe Grant had an unpleasant and untheraputic experience with a therapist as well. I have also had such experiences in the past.
Actually in the phase of my career when I was treating patients in an ourpatient psych clinic (managing both their medication and doing therapy) I was a GREAT therapist for THEM, but I was a pi$$ poor practitioner of my own advice!
I worked well with them, and they with me and I had some successes with patients that previously had not made any or very little progress in many years of therapy…in fact, I got the patients that everyone there had dealt with unsuccessfully (the joys of being the lastest hired!) and I got some great accolades for my success with these patients (didn’t cure them but at least got them on a good track) got them compliant with their medications etc. Helped families quit enabling them, but didn’t take care of my own problems at ALL.
All I can do now about that time in my life is to shake my head at myself and do better now.
Dear Steve
While you may think my views are ‘flawed’ and ”rigid’, all I was really trying to convey to others is that even being trained in the field of psychology, even being skilled in diagnostics, doesnt help you deal with the experience of abuse any better. There have been many posts on here bemoaning the insensitivity of therapists and counsellors. What I wanted to say is that it is not that these people are ignorant, or poorly trained, it is that they, like most normal people, dont really understand how these relationships pan out. Sure, they know that antisocials are “interpersonally exploitative”, but they dont properly consider just how that works in the context of intimacy. They dont really recognise how strengths are used AGAINST you, how love can be FAKED, how your deepest hopes are sought out, hyped up, and then consciously thwarted. They dont get the ins and outs of it all.
What that leads to is ultimately a “time to move on” attitude. And I cant say I blame them. I knew there were disturbed people out there in the world, but being well brought up, I also didnt know. I knew intellectually, but I didnt ‘know’ emotionally. And I think that, fortunately for them, most people dont know, and hopefully never will.
OxDover. Thank you. I work sometimes at a drug rehab clinic, and all the group sessions include a counsellor who is themselves a rehabilitated addict, as well as a psychologist. Because one of the first things an addict will always say to a psychologist is “what do you know” or “you dont know what it is like”. And in most cases they will be right. Doesnt make the psychologist a “bad” therapist.
I suppose that it would be hard to find any therapist who readily admits to having been conned in love. Not the kind of thing anyone, especially a mental health person, readily shouts from the rooftops ! But it is my deep conviction that unless a therapist has been through this personally, they are going to struggle to understand it, no matter how many degrees of years in the field they may have.
Thank for your welcome. It is so nice to actually engage with you all, after months of passive reading.
Steve,
I want to add my thanks to you for writing that list. It would have been helpful for me to have when I was seeking help during after my relationship.
I particularly liked your questions about their experience in dealing with abusive personalities, and victims of abuse.
Along with everyone else here, I found it incredibly difficult to find resources for healing from this relationship. I wasn’t looking for a therapist because I wanted to manage my own recovery. But even in finding literature — and I was prepared to read professional-level material — I was frustrated.
There seems to be no professional training for this. And no particular school of therapy training that lends itself to this recovery, except possibly PSTD work. Or work on childhood abuse issues. But in both those cases, the causative factor or perpetrator are usually in the past, often far in the past. In most of our cases, they are in the immediate past or not out of the picture at all.
I explored everything I could find that even looked like this, and I found a lot of material that helped me synthesize a personal model for healing. But I am having a hard time believing that, given the likelihood of a significant encounter with a sociopath in anyone’s life, there is not some formal training for emotional recovery in this area.
Do you know of anything?
KH and Grant: I’ve also found that same lack of literature addressing the needs of the victims in the process of healing.
First, it helped me when I had a name for the “freight train” that hit me. That at least let me know that it wasn’t just a “bad relationship, but . . . you know . . . there are two sides to every story.” That at least validated my own horror when I realized that NOTHING I’d taken for truth was even close to the truth.
But after that, I’ve found very little practical help. The self-blame, obsessive replaying and re-examination of events, the profound despair, the hyperactive startle reflex, the inability to concentrate . . . talk therapy just doesn’t address this.
I like the suggestion that the best therapist to help a victim through the process is truly someone who was married or otherwise involved with an S/P. So, are we all going back to school? Those of us who don’t already have our credentials?