What counselors need to know when treating survivors of intimate partner abuse

When seeking therapy, some victims of intimate partner abuse or intimate partner terrorism are told that they “chose to be abused” or are “codependent.” But most survivors do not knowingly or willingly enter into relationships in which they are exploited, dominated and preyed upon. According to new research by Lovefraud.com, counselors who blame victims, either directly or indirectly, for becoming entangled in abusive relationships may be delivering therapy that does more harm than good. Counselors who understand the characteristics and behaviors of abusive partners, on the other hand, are often able to establish more productive therapeutic relationships.

Counseling Intimate Partner Abuse Survivors: Effective and Ineffective Interventions, a research paper by the Lovefraud team of Liane J. Leedom, MD, Donna Andersen, Mary Ann Glynn, LCSW, and Meredith Barone, is published in the October issue of the Journal of Counseling and Development. The peer-reviewed paper is based on research conducted with Lovefraud readers about their experiences seeking therapy in the context of abusive relationships.

The authors were surprised to discover survivors reporting that their counselors blamed victims of intimate partner abuse, by suggesting they chose to be abused, or were codependent. A search of the literature revealed that clinicians may blame victims because of two attribution errors.

• The fundamental attribution error is the tendency to explain someone’s behavior based on internal factors, like personality or disposition, and underestimate the influence of external factors.
• The just-world hypothesis is the need to see the world as orderly and morally fair, where noble actions are rewarded and evil is punished.

The authors write:

“These errors reduce empathy for abuse victims. In making the fundamental attribution error, clinicians over attribute the cause of abuse to victim personality traits and underestimate both the responsibility of the abusive partner and the dynamics of the abusive relationship. Clinicians’ belief in the just-world hypothesis causes them to act as though intimate partner abuse victims ‘get what they deserve.'”

Research based on 578 survey responses

Lovefraud sponsored an online Therapy Satisfaction Survey, which drew 578 respondents. This paper analyzes a subgroup of 104 respondents (including both women and men), selected because of their answers to specific questions, including whether or not they felt the counselor blamed victims for being abused or for their choice of partner.

The survey collected data on why respondents sought therapy. The reasons were:

• Anxiety — 3%
• Depression — 15%
• PTSD — 4%
• Stress — 6%
• “All of these” — 55%
• Other — 17%

Respondents were also asked what types of abuse they endured. They reported:

• Physical abuse — 45%
• Emotional abuse — 99%
• Psychological abuse — 99%
• Sexual abuse — 62%
• Financial abuse — 77%

Respondent views of their therapy

The survey included both quantitative and qualitative questions, and asked about helpful and unhelpful responses by their counselors. The survey also assessed the quality of the helping alliance between counselors and survey participants.

Participants were divided into five groups, according to the themes of their comments.

• Accountable group (n=42) — Counselors held participants accountable for their choices, and participants acknowledged the benefits of that.
• Chose group (n=20) — Counselors said or implied that participants chose, with awareness, the abusive relationship and/or the abuser.
• Codependent group (n=24) — Counselors told participants that they were codependent, love addicts or exhibited traits related to codependency.
• Childhood group (n=12) — Counselors attributed the abusive relationship to the participant’s childhood trauma.
• Vulnerable group (n=6) — Counselors identified other participant vulnerabilities that led to the abusive relationship.

Counselors in the accountable group were affirming, validating and nonjudgmental. They believed the participants and acknowledged their partners’ pathology. They provided education about personality disorders and abuse, and warned about danger. These counselors had the lowest blame ratings from survey respondents, and developed strong helping alliances.

By contrast, participants in the chose group were told by counselors that they chose the abusive partner and remained in the relationship because they failed to set boundaries, accepted abuse, or had a prior history of abuse. These participants felt blamed, misunderstood and invalidated. They attributed the therapists’ statements to a lack of knowledge about personality disorders and the characteristics of abusers. Helping alliance scores for counselors in the chose group were significantly lower than the accountable group.

Of the 24 survey respondents in the codependent group, four found the concept of codependency to be valuable, and gave high helping alliance scores. But 20 participants rejected the clinician’s views regarding codependency and found them to be critical. These participants rated the therapeutic alliance as poor.

Counselors who attributed the abusive relationship to childhood trauma or another vulnerability were viewed positively. The helping alliance scores for the childhood and vulnerable groups were significantly higher than the chose or codependent groups.

The authors summarized their findings as follows:

“Counselors who were knowledgeable about partner characteristics and the abuse experience provided information and effectively assisted participants in navigating difficult choices. … Counselors who blamed victims for their partner choice and attributed difficulty with separation to codependency or survivor personality traits alienated clients, as did counselors who directly or indirectly stated that clients chose to be abused or knowingly chose their abusive partner. The poor therapeutic alliance was, in turn, associated with unhelpful therapy and participants feeling harmed by the therapy.”

Literature on the abuse experience

After discovering that so many survey respondents were being blamed for being in abusive relationships, or told that they were codependent, the authors asked the question, “Why?” To find an answer, the lead author, Dr. Liane Leedom, who is the world’s leading expert on psychopathy in the family, conducted a review of the scientific literature on victim-centered explanations for abuse.

In the clinical literature, two theories attributed the abuse experience to the victim’s personality deficiencies and behavior:

Self-defeating personality disorder — Women were drawn to and chose situations in which they would suffer. This was related to the psychoanalytic concept of repetition compulsion, which hypothesized that people compulsively exposed themselves to situations similar to a previous trauma that they experienced.

Codependency — This concept actually originated in the realm of alcohol abuse, to explain how family members of alcoholics were affected by the disorder. It’s now defined as a behavioral condition in a relationship where one person enables another person’s addiction, poor mental health, immaturity, irresponsibility or under-achievement.

Both of these theories have been rejected. Self-defeating personality disorder was temporarily included in the appendix of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM), and then dropped. Codependency was never included in the DSM, and to this day, it is not an official recognized diagnosis.

But despite the fact that these diagnoses are not recognized in the DSM, clinicians still appear to be relying on them when attributing blame to victims.

Traumatic bonding

In 1992, Judith Herman developed the concept of complex PTSD. She explained that repeated trauma, over time, creates a form of post-traumatic stress disorder that alters the victim’s consciousness, perceptions, relations with others and systems of meaning.

In 1993, Donald G. Dutton and Sally L. Painter theorized that abuse victims suffered from traumatic bonding. They said that power imbalances between the two people, and intermittent good-bad treatment, caused the victim to become attached to the abuser.

Research also shows that childhood trauma increased the risk for intimate partner abuse.

These explanations mean that victims are not stuck in abusive relationships because of self-defeating personality disorder or repetition compulsion. Rather, they are suffering from PTSD, depression and impaired judgment due to their current or prior trauma. Furthermore, victims’ submissive and caregiving responses are not codependency — they are normal human reactions to trauma. Enhanced caregiving and social engagement, called tend-and-befriend, is a biological response to stress and threats, especially among women.

The importance of understanding disorder

The key to helpful therapy, according to the survey respondents, was for counselors to know and understand the impact of exploitative and manipulative personality disorders, including antisocial personality disorder/psychopathy, on family members and others. Here’s how some respondents explained their experiences with their counselors:

“She locked the doors after he finally stormed out. Asked if he was always like this? I said usually worse. She said he was a sociopath with narcissistic tendency… and to run not walk away from him.”

“My ex refused to continue therapy, and the therapist told me she believed he was a narcissist and/or sociopath and that I needed to leave him, I was not safe and he would not change. … She ‘got it’ but the first therapist I went to did not, and told me I needed to trust him more and that it seemed like he really loved me.”

“She just thought I was a, ‘woman who loved too much’ and recommended I read that book. I knew that was not the issue.”

“I would have preferred for her to tell me that the man was a psychopath, that there are many people out walking the streets who should really be locked up in institutions. I would have preferred a very pragmatic approach rather than delving so deeply into my childhood. She should have told me that the man was crazy. You cannot rationalize with a crazy person; you cannot fix a crazy person; a crazy person is dangerous; associating with such a person is a little bit like committing slow suicide. I FEEL VERY STRONGLY ABOUT THE CRAZY PERSON IDENTIFICATION! It makes everything crystal clear.”

The views of respondents regarding the importance of understanding personality disorders were reflected in the helping alliance scores.

• Counselors in the accountable group were judged most knowledgeable regarding the interpersonal behavior of partners with ASPD/psychopathy, and the therapy they provided was rated as most helpful.
• Counselors in the chose group appeared to lack knowledge of the interpersonal impact of ASPD/psychopathy and were rated as most blaming. The helping alliance was weak and the therapy they provided was rated as not helpful.

Recommendations for counselors

In this paper, the authors reiterated the recommendations of other researchers for counselors treating clients who are in, or escaping from, abusive intimate relationships:

• Become familiar with the tactics of abusive partners and the nature of psychological abuse.
• Become familiar with the dynamics of abusive relationships.
• Complete a thorough diagnostic evaluation, screening for symptoms of PTSD, depression and anxiety.
• Take a detailed history of the relationship, including functional changes and coping strategies.
• Validate that the survivor is the expert on his or her own life, and has the wisdom and strength to overcome this challenge.
• Teach symptom management skills.
• Avoid making statements that survivors may interpret as blaming.
• If a survivor discloses feeling blamed, thank him or her and work through the problem that led to the therapeutic rupture.

Survivors of intimate partner abuse have had their lives and dreams shattered. Each person faces tremendous challenges in rebuilding his or her life and sense of self, and wants nonjudgmental, validating support. These survivors deserve counselors who are knowledgeable about typical perpetrator characteristics, and understand the abuse experience.

Therapists: How to learn more

If you’re a therapist and you want to learn more, read the full paper. Click the title below to access it.

Journal of Counseling and Development

If you counsel survivors of interpersonal abuse or interpersonal terrorism, these research findings directly impact your work. Two of the paper’s authors, Liane J. Leedom, M.D., and Donna Andersen, explain the findings further, and how counselors should use this information, in the following Lovefraud Continuing Education program:

Webinar: Counseling Intimate Partner Abuse Survivors: Effective and Ineffective Interventions.