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.)
“We do not see thiings as they are . . .” That comment is in the same category as “what’s wrong with you that you got into that relationship.”
No it is not nor was it intended to come across that way though it seems that is how it came across.
My abuse was subte, if abuse can ever be subtle. There was no violence, no theft. But it did more damage than a plane crash. I couldnt point to bruises, or bank-statements. All I had to go on was an endless series of defeating experiences that, when examined individually, may be explained away, but when seen in their totality, revealed a picture of devestation.
I found it very hard to explain to others what exactly it was that had happened, but I knew that it wasnt normal, and I knew it wasnt something I had in any way willed onto myself, or deserved.
I had my suspiscions about my abuser. I wasnt sure whether it was NPD, or ASPD, or NPD with antisocial features. The lable was important, because at that stage I still thought that if I knew for sure what it was, I could turn it around on them. Well, we all know where that goes.
Where the lable was in fact very useful was in finding the correct resources so I could interact with other victims of the same kind of abuse I had suffered. I didnt want a group of victems of mood disordered people, or a Borderlins support group. I wanted to be with people who had been through the exact same loop as me.
And I found that here. After reading just a few of your stories, I knew right off that I was in EXACTLY the right place. Sure, there are individual differences, but they are all variations on the same theme.
And so, I extrapolate that with regards wanting a therapist that can fully grasp, and work with that theme. And who better than one who has been abused.
I have just finished reading the book titled “The Gaslight Effect”, after hearing about it here, of course. Dont know how many of you have read it, but it is written by a psychologist who acknowleges having been gaslighted herself in her previous marriage. This, of course, led to her interest in the subject, and to her writing a very good and helpful book on the subject.
PS HH I think your posts are great.
WINI, I really don’t know what you are talking about. To what do you take offense? The “blame” part of being victimized? Who is blaming the victim? What have I written here, or elsewhere, that suggests that I blame victims of exploitation?
Every post I’ve written on LoveFraud has been written with the intent of protecting victims of exploitation and offering my own personal insights about exploiters (to the end of possibly helping others evade their predations). If you are referring to my columns regarding “red flags” and better “radar detection,” I’m really sorry that what you’ve taken from them is a blaming perspective. I think the vast majority of feedback on my posts has reflected the intent of my posts.
Thank you, BLOGGER T, for noting this in a subsequent response.
All of this comes down, again, to a combination of the right therapist for the particular client. We all have our criteria of what we seek, and most value, in a helper. And we don’t all have identical criteria. And it’s our job, as we seek the right helper, to apply the same high standards that, hopefully, we apply in the course of exploring our personal relationships. And if a therapist doesn’t get it, just as if a new partner increasingly reveals incapacities to appreciate our experience, we cut bait and seek a more fulfilling relationship experience.
It is silly to bemoan how particular therapists are just thick and incapable of recognizing that you are, or have been, involved with an abusive individual. As soon as you experience his or her ignorance, insensitivity, or invalidation, it’s time to be proactive and find a therapist who will get it, who will see it. Failing to replace a therapist who invalidates your experience isn’t much different than failing to replace a partner who invalidates your experience.
And no, WINI, I’m not “blaming” you or anyone here–I’m speaking, I think, to a pretty important concept whose actualization (as hard as it can be to attain) is self-empowering and can help short-circuit patterns of settling into relationships with invalidating (if not abusive) personalities.
Speaking of validation, BLOGGER T, again…thanks for yours.
Steve Becker
Grant, I get it. Here’s an example of “abuse”: exhausted, depleted, my muscles tied in knots, I gratefully accepted someone’s offer of a day at a spa — something he’d gotten in trade, and this was someone I had sponsored in a business effort, so I had a financial investment in him already. However, I knew that if I took the spa gift, I would never hear the end of it from the S/P. So I suggested that the S/P be included in the spa day. Fine, no problem.
The S/P eagerly soaked up every treatment: steam, mud bath, electronic wave therapy, massage. He was as excited as a kid in a toy store. When the massage therapist worked on me, however, the therapist became very concerned: he felt a tightness and twisting in my back that explained the increasing numbness I’d been experiencing in my hands. He warned that without several sessions, this was a progressive and permanently debilitating situation. He also warned that after a session, I would not be able to drive, but that he would be able to do several helpful sessions within the next week before he left for a three-month trip. It was obvious that the S/P and I were “together,” so the therapist carefully explained this to the S/P, getting his agreement to bring me back the next day for another session. (The fees were also nominal: his suggestion seemed motivated by genuine concern, not by an effort to get more work.)
The S/P solemnly agreed to help. He put on such an earnest face, and absolutely promised that he would have me back the following afternoon. As we drove back home, the S/P was on the phone organizing attendance for a bunch of people at a multilevel marketing meeting the following evening. He would ensure that everyone got to the meeting and he would be there as well. (Notice that the S/P wasn’t actually doing the work of setting up a meeting or putting on a meeting, but cruising on someone else’s effort.) When he got off the phone, I asked, in shock, “What about my session with the therapist?” “Oh, you can drive yourself,” he said.
Out of the context of the understanding of a sociopath, that story sounds relatively benign. It’s only when you see an accumulation of those incidents — many little ones in a day, many big ones over the weeks and months — that you see the abuse, and when you know what you’re looking at, it glows like a fungus under black light.
Thank God I knew enough about the nature of an S/P when the battered women counselor dropped her wrongheaded and dangerous advice that I was able to re-start my own breathing and RUN!!! Thank God I didn’t have to wonder if “maybe she’s right, maybe I should just talk to him . . .”
Steve, dont you think that no matter what issue you go to a therapist for, if they dont get it, they are no good for you. If you go for depression, and they say “cheer up”, you give them the boot.
Many therapists say they can treat victims of abuse. And they can. Can they treat victims of Narcissistic partners too ? Is it the same thing ? Not as sure.
HH: I’m almost two years away from the S/P, but the devastation he caused has contributed to a continuation of a downward slide. The daily trauma of living in circumstances that continue to worsen doesn’t really allow for recovery.
Intellectually, I understand what has happened. Fortunately I never went through a time of yearning for him, because I instantly “got” the horror of his inhumanity when he dropped the mask. However, my livelihood was destroyed, and now that whole area of business is in wreckage because of the national and international economic situation. I face a need to redefine my skill set into a new employment situation at the same time that the job market is devastated, and my own psyche is still in deep trauma. If I knew how to take a socket set, buy new spark plugs and wires, and give myself a psychological tuneup, I’d do it in a minute. I have no tools to deal with the profound waves of despair, and unfortunately the despair is well-justified in the circumstances.
Where am I in the healing process? Maybe quite a distance down the highway, but broken down and stuck on the shoulder.
Rune…….You wrote..”(Notice that the S/P wasn’t actually doing the work of setting up a meeting or putting on a meeting, but cruising on someone else’s effort.)
This flew off the page for me because it is something I have always noticed particularly in Ns who might be low level S/P types too. —–>”….cruising on someone else’s effort” is a is significant red flag I have noticed. I’ve seen this over and over……..they frequently have an entourage or have access to one and they are able to get those individuals to do everything for them. It is not something to which they are entitled because of their position or job demands, but it’s something they are able to orchestrate and perpetuate by means of manipulative tactics. Good point!
Eye: That knack could be a huge advantage if a true leader was trying to get something done with little obvious capital. But then the activity would be goal-directed, and probably offer some benefit to the community. You might like my last comment under Liane’s blog today.
Some of my confusion about the S/P was that I kept thinking he had some organized intention under his actions, and he DIDN’T! At least not any that made sense to me.
Hi Rune. Sorry to hear it. I think the economic crisis would have caused problems anyway, P or no P ? Sounds like, though, you have encountered one major problem, before having had the time to heal the first one. Not a nice place to be !
Found my work extermely difficult to manage through my personal crisis. Sometimes, driving home, Id have to stop my car on the side of the road, and just get out of it quick. Like an intense need for space, like I couldnt breathe, or was going to be sick.
I found though, that I was less tolerant of on-going frustrations at work, and started, issue by issue, to resolve them, some of which involved very old issues. I needed to feel a greater sense of control at work, because personally things were totally out of control.
Caused a few upsets, and eventually left the practice to start a whole new venture. Was very hard, and financially tough, but it absorbed all my energy, leaving less time to ruminate about my N. Was also a way of extracting something positive from an otherwise totally negative experience.
I think that if you can survive an experience like you have had, you can overcome anything. Was certainly the hardest thing Ive ever done in my life.
Isnt the term “Narcissistic Saterlight” wonderful. Oh, I was born to be your Narcissistic saterlight, so never mind about my needs and dreams.