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.)
In pharmaceuticals, there is what is known as a “paradoxical reaction.” My grandmother responded to morphine by becoming energized and feeling pain more acutely. The more pain and anxiety she felt, the more morphine the doctor administered.
The more I say, “I didn’t ask for it! I didn’t see it coming!” the more I hear, “What is your role in creating this?” And that goes back to the self-blame for what I did NOT ever envision or have an inkling of understanding. That sort of therapy is like upping the morphine dosage when my grandmother hadn’t slept in several days.
Rune I would like to comment on a few things you said:
People don’t understand if I say that I realized I was living with someone who had chosen to destroy my work and all my resources, and that at the last, when I looked into his eyes, I thought I saw Ted Bundy.
“People” don’t understand. This statement is said by people who have gone through all sorts of different experiences. It does not just apply to people who have been victims of psychopaths. I had a person recently make that same statement to me except she was talking about how people do not understand clergy sexual abuse and what she went through. No one understands it in the way you do because only you have gone through it.
What if I don’t have a name for it? The therapist is supposed to figure these things out, right? But as I understand, the training is that they deal with “the person in the room,” and they don’t try to diagnose the other people in that person’s life.
Abuse, pain, suffering, hurt, and trauma. These are all names that often fit. And Rune you can not diagnose someone you have not met and evaluated and that is a good thing because those psychopaths that do end up in the office would have therapists believing all sorts of things about other people.
With victims of those who are psychopathic/sociopathic, the issue is radically different. The disordered person is NOT in the room. If the therapist cannot even begin to understand that the real disorder might be the “elephant in the corner,” then the therapist will never get to a place to facilitate healing. It will all be about teaching the victim to repress and, “get over it.”
I disagree. It is not radically different and this is the “special” thing I was talking about. All abuse is a special case. The abuser may not be in the room but that is true of other abuse issues as well. Everything from domestic violence to child abuse to rape and more. I do not know of any licensed counselors that teach people to repress and “get over it”. And while the “disordered” person may not be in the room the hurt person is.
I guess we disagree because I do not believe that we are dealing with a spectrum of special cases other than the fact that all cases of abuse are special and unique unto themselves. A non-psychopath can deliberately select and traumatize a fellow human being, over a period of time, while pretending to be their most loving, trustworthy advocate and then smash it all apart just as easily as a psychopath can.
Pain, trauma, and the experience is unique to every person who went through it. There is no one size fits all training that can cover that.
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 have to wonder what kind of therapy/therapist you found because the counselors I know that work with abuse issues all deal with those issues you listed. In fact that list sounds like it could belong to numerous people (ranging from domestic violence to sexual assault to abuse/neglect to assault to accidents) I have seen over the years, some victims of psychopaths and some not.
Hi All
Thanks for the comments
I have found, in telling my friends, most of whom are therapists, that they empathize, but tended to feel that it was just a relationship that didnt work out, and that I was being stubborn in not being able to just suck it up and move on. I think that what makes this so different from a plane crash is that normal break-ups occur, and normal relationships end, and that is the template that people work from. They dont realise, therapists included, that this was in no way normal.
I think all of us also fail here. We ask ourselves “whats wrong with me”. Why is this so hard, why cant I move on. And our therapists ask the exact same questions !
I see lots of psychopaths at work. Peadophiles mostly. Yes, I can assess them. No, I cant understand why they find kids attractive. And, truth be told, I dont really want to.
This does not make me a poor assessor, however. It may make me a poor therapist if I chose to work with them in therapy. So I dont.
If you asked all the therapists where I work “Can you treat a Borderline?”, they would say Yes. Could they really? I have my doubts. Sure, they have the theory, they have experience, but I can bet you none have ever been intimate with one.
I dont think you need to have been a victim of a Sociopath to be a therapist to one – I want to make that clear. I do think, though, that as a victem, you would make a much, much, much better therapist ! And if I could choose, I,d choose the victem therapist over the non-victem any day of the week. No contest.
Libelle
I also tend to find that I am often, after 10 years work, still confronted with new, unusual genetic syndromes, most of which I have never heard of before. I still assess them, however, and learn from each one. There will always be a first time, that is how we learn. Im certainly not saying I need to have the syndrome myself in order to treat it. That would be plainly ridiculous. But I will also never have first hand knowledge of what it is really like either.
So I think it may be too harsh to expect a therapist to have inside out knowledge of the pathology at hand, and it often falls to the patient to educate the doctor ! Even this, however, will have its limits.
If you can sucessfully describe to your therapist what exactly has happened to you, how it happened, and how it felt, your battle is really already more than half won.
I agree with BloggerT in that there are many good therapists experienced with working with women (or men) who were in abusive relationships or victims of trauma. I know many of them. I know therapists who specialize in trauma who are gifted at helping people recover from such.
I think the problem is not specifically the therapist’s ability to work with traumatized patients, but rather the therapist’s ability to recognize that a relationship with a sociopath is just that – a relationship with a sociopath. And that it was traumatic. I think unless you walk into a therapist’s office and say “I was in an abusive relationship and I may have PTSD and I would like your help recovering from that” a therapist experienced with trauma would be helpful.
However, the sense I get is that when most individuals like us seek out therapy – we are in a stage where we are very confused about what happened, still in a fog, still don’t remember a lot of the stuff we have repressed, and go to a therapist’s office to help things get sorted out. We suspect we are crazy, we all suspect that something was wrong with him (or her).
The problem here is that most therapist’s do not assume that the person is someone who is the victim of a sociopath. Why would they? Odds are against it. The therapist then does, explore with the whether or not she is, in fact, “crazy.” And this can be further traumatizing to the patient.
In short – I think if you walked into a trauma specialists office, or any one, really who is a good therapist, and said that you were a victim or a relationship with a sociopath, you’d get good care.
But I bet the vast majority of us do not recognize that when we are seeking help. We are not nearly that far along in the journey. We are confused, in a fog, questioning ourselves….and bring that muddled picture into a therapist’s office. And the therapist, unless they can recognize that you are a victim of a sociopath relationship, will take a while to get there with you. And in the process we feel like someone else is joining us in looking at us as the crazy person (possibly). And that is not what they need.
The story with my therapist was different. I had been seeing her for a number of years. She watched me go into the relationship, go through it, come out. I showed her some of his emails. She said to me at more than one point “He is okay. This is a guy who is okay.” She now believes, fully, he is a sociopath. But I had to convince her. And it really wasn’t until he was stalking me that she started to believe. And this woman knows me as honest. In fact, she had complimented me in the past on how honest I was, how willing I was to look critically at myself. She had said “you are much more intererested in the truth than looking good.”
I think the problem is not that therapists can’t work with victims of abusive relationships, but that they don’t recognize these women (and men) as victims of abusive relationships. Unless the patient clearly states such – and usually, when they seek out treatment, they are too confused and distressed to know enough to do so.
I just read all the blogs….and many people, in addition to BloggerT state that there are many therapists experienced in dealing with trauma who would be helpful.
This is all true. However, I think that going through our experience is a unique kind of trauma – as going through vietnam is different than being raped. I have worked with both populations. Both had PTSD – but there experience was very different. It wasn’t until I worked with vets for a while, that I became very good with them and understood (as much as someone who isn’t a vet could) about their trauma and was really qualified to help. Same thing with rape victims. You can have book smarts, and even training (ivy league or State U – it doesn’t matterr), but its not until you’ve been in a room, and heard the stories that you get it. And I think almost all specialists in trauma would agree with this. Certainly the psychologists and psychiatrists I worked with. It would be arrogant to think otherwise.
I go back to my main point in my last post. The problem is not finding a therapist who can treat trauma – most of them can. And there are thousands, tens of thousands, who specialize in treating trauma and victims of abusive relationships. I agree with Steve, BloggerT, and every one else who pointed that out. You are right.
However, when most of us seek out treatment we can not state our trauma. We cannot say “I’m a rape victim” “I’m a survivor of desert storm” or “I’m a survivor of hurricane katrina.” We walk into a therapist’s office confused, crazy, questioning ourselves, and not knowing what the hell it is we have been through. And the problem is that most therapists won’t look at one of us and think “Ah, this looks like someone who has been a victim of a relationship with a sociopath.” Unless we can state that clearly, and unless we have bruises and restraining orders to show, a therapist won’t know it. Most won’t assume it – and are not sensitive in dealing with us – and may even make us feel worse in the process.
Dear Grant. I just wanted to point out that having first hand experience does not make one being a better therapist. At the moment, psychopaths and sociopaths seem to be “a la mode” with the press because of the financial crisis. (I think i is just a bit late…)
“If you can sucessfully describe to your therapist what exactly has happened to you, how it happened, and how it felt, your battle is really already more than half won.”
I am with HH: we are not so able to describe, at least I do not think I was able; it was my sister who actually SAW the P and me often together and HEARD what he told me and her and she was in close encounter, but she told me only after I have dumped him after 7 moths of “being together” to look up “Psychopath”. And she has been in two relationships with P’s!
I am sure in therapy I would have bragged about MY faults and my shortcommings as I always seek mistakes first in myself. I am not sure whether the therapist would have gotten through all this to conclude “”x-“partner=”Psychopath”.
You can only recognize what you already know. Therefore I personally find the questions very good as we can’t tell from the outside what expertise a shrink or psychologist has.
Being HERE on this very website is already a BIG step forward in the healing. We have found the solution to our problem and now we are dealing with it. As soon as WE get to the answer (WHAT the NAME of the train was that hit us), no matter who told us, we are at once expert in this particular field as we have already made a big step in healing and getting out of the fog.
NOT KNOWING is the hardest part. How to get to know the truth? Know the P/N/S-word and CONNECT it with OUR horrible experience? Maybe it would be helpful if we could state how we learned that we were victims of a P/S/N? How we got to know about this site?
Healing Heart: What’s wrong with therapists having a check list available for all patients to complete as they arrive in the outer office. Other physicians have a check list for their new patients to fill out, why not therapist.
Doesn’t take an Einstein to figure simple procedures out.
As soon as I found out what my EX was about, I immediately made an appointment with my OBGYN. As soon as I arrived in to his office, he wasn’t available to see me but another physician was scheduled for my appointment. She made me fill out a brand new check off list … and many of the questions on the chart was about a “partner’s” abuse. So naturally, still in shock, I checked off the boxes that applied to me. After my exam … this physician sent me for every STD test imaginable.
Peace.
libelle: I don’t know where anyone else lives in this country… but the state I live in is very well versed in what anti-social personalities are all about. The first psychiatrist I went to (to get my bosses and my Senator off my back …because I refused to see the Employee’s Assistance Program therapists) was more than knowledgeable about any type of anti-social personality. The 2nd therapist I went to (at my sister’s request after I found out the truth about my EX (actually her insistence because she had several free sessions owed her through her job) knew about anti-social personalities and admitted to me, she read articles, saw movies/shows pertaining to my situation but she personally never met anyone who actually went through what I endured. Never the less, she was compassionate and competent… and now (due to me) is more than well initiated into dealing with PTSD due to anti-social personalities involvement with their patients.
I really should write the woman and tell her that I’m OK … a little up date and refer this site to her … if she doesn’t know about it already.
Peace.
Wini – What would the checklist say? I think the point is that when most of us walk into a therapist’s office we don’t know what is wrong. We are terribly confused. A checklist wouldn’t be that useful and would feel pretty insensitive and cold (in fact, I know this to be the case)
There is nothing inherently “wrong” with therapists. Many are excellent, most are good – and most (though certainly not all) who go into field are caring souls. There isn’t enough education about survivors of relationships with sociopaths. And the survivors, like us, are just beginning to connect.
If it wasn’t for the internet, I bet most of us would be very isolated with our problem and still not understand what the hell had happened. Most of us were ultimately educated and connected through the internet. And even with the internet, still 95% stay isolated. Think about it – if 4% of the population are sociopaths…and they tend to have 4-5 lovers a year (probably an underestimate), there should be millions and millions of victims. But what are there – one hundred people on this site? A few thousand on the S and N survivor sites altogether? Most of us suffer silently.
It’s much easier for physicians to have a “checklist” of physical problems. And even with that – their hit rate is pretty mediocre. Most people I know don’t sing praises to the medical care they’ve received. My gyn. was also excellent, like yours. But it was a clear issue. I walked in and said “my partner had unprotected sex with multiple people.” So I got tested for everything. Simple. She didn’t have to sort through anything, figure out anything. She was excellent because I could tell her precisely what happened. And I asked to be tested for everything. There was no challenging or confusing picture to sort through.
My therapist, on the other hand, got a very confused and often changing account of what was happening in my life.
There are millions of emotional problems that people can have. A checklist isn’t possible. And even with a checklist that said “Are you in an abusive relationship” most people wouldn’t know how to answer that properly at the time they are seeking treatment.