When Therapy Enables Abuse

Rev. Sheri Heller, LCSW

Photo by Mika Baumeister on Unsplash

Life is not fair. Fifty-fifty propositions are illusory. There are always power differentials and shortcomings. Ideals of perfection are a pipe dream. Ideologies always get corrupted. It’s crucial to tolerate these shortcomings. Doing so puts our human trials and tribulations in perspective.

Acceptance of ‘what is’ assists us with sensibly distinguishing what can or cannot be accommodated, tolerated and bargained with. From this place we can cultivate stringent standards and conditions that are critical to mental health.

That said, when I learned that my client’s couples therapist upholds the naive notion that all relational assaults are dynamically caused by both partners and are to be rectified through mutual responsibility, my blood boiled. Suggesting that every viscious outburst and betrayal was legitimately ignited by some arbitrary provocation, sent the message that no mater how egregious the harm, somehow culpability was always shared. Such archaic notions view marital rape a misnomer and women and children as property. Ironically the couple at hand are lesbians. Clearly antiquated oppressive views infiltrate all stratum of society.

In clinical circles, where therapists are relied upon to model and uphold healthy accountability and realistically assess behavioral ownership, the absence of discerning relational ethics is especially disturbing. One therapist colleague of mine chalks it up to incompetence. I tend to view it as a refusal to accept human evil and deal with the backlash of assigning blame where it truly belongs. Maybe it’s simply to keep a paycheck coming or a twisted need to be a savior capable of fixing any debacle that prevents the promoting of dealbreakers and when necessary, detaching with an ax.

Whatever the reasons, when a therapist enables, mitigates or justifies abuse the clients’ instinctual awareness of wrongdoing is not only denied, it is reframed as intolerant, an exaggeration, and ultimately, the client’s fault. For those who are too vulnerable, traumatized and confused to ‘run for the hills’ from these stilted therapeutic interventions, a cycle of shame and subjugation is set in motion. In short, abuse is enabled. At worst this sort of thinking fails to detect possible lethality.

Harway and Hansen (1993) conducted a research study examining mental health providers’ ability to accurately perceive violence within couples presenting for therapy and to intervene in a manner in which to reduce the risk of danger to couples. They discovered that 40% of the therapists sampled failed to perceive intimate partner violence (IPV) and virtually no therapists (4%) intervened to reduce the risk of lethality.

When this study was replicated by Desreen Raphael Dudley, Kathy McCloskey, and Debora A. Kustron in 2019 the results signified somewhat of an auspicious shift. Twenty percent of therapists predicted an increase in conflict, compared to 4% in the original sample. However, almost no therapists accurately predicted lethality in either study. On the up side marked improvement from the Harway and colleagues’ study was evidenced by 81% of mental health professionals suggesting crisis intervention as a therapeutic approach.

These findings have precarious implications. Although improvement is indicated, the absence of foresight and the failure to recognize signs of non-negotiable abuse within the therapeutic context persists. It should be common sense across the board that clinical intervention is superfluous when a client is contending with entrapment, but it’s not. Instead, much of the time the downplaying of physical, sexual, psychological or emotional abuse by a psychotherapist, further traumatizes the victim. Moreover, suggesting that provocation is always a catalyst to violent aggression, places the emphasis on the victims problematic behavior and away from the reckless, impulsive behavior of the abuser.

When physical and emotional safety are primary concerns, advocacy and access to necessary resources is the priority.

Preventing repeated victimization necessitates countering abuse-related dynamics by affirming the victim’s basic right to be treated with respect and to have the freedom to make personal choices without fear of sabotage or retaliation. It may require the therapist to address the possibility of severing a relationship that cannot be salvaged and the need to enlist the aid of legal services and safe homes.

The rationalizing of abuse suggests a resistance to coming to grips with the brutal truth that sometimes danger and betrayal is random and not contained. People can be hair triggers, prone to acts of violence at a moments notice. That is scary to face. It’s preferable to believe life is stable and predictable, that anything can be repaired and remedied as long as all parties own up. Yet when the adage ‘it takes two to tango’ doesn’t apply, ironing out difficulties aren’t the answer. In fact, radical measures may be called for.

For clinicians to responsibly engage with the reality of abuse they need to be willing to confront threatening circumstances and dispense with a position of neutrality. This might entail grappling with the precariousness of the victim and looming fears of backlash. Taking definitive measures that preclude diplomacy and civil discourse may mean opposing standard therapeutic directives of unconditional positive regard.

If a therapist is not comfortable with modeling this stance of moral authority, they will proceed with processing detrimental incidents of intimate partner or child abuse, as benign conflicts involving shared liability. Although it is not an easy task, it is incumbent on clinicians to facilitate a shift from a trauma response to that of empowerment. To achieve this end therapist’s must brave that which causes distress and consciously bring into the therapeutic framework ironclad protocols and consequences pertaining to managing abuse. Not doing so unwittingly makes them instruments of harm.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY

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