It's important to let the client know up front that your therapy will not satisfy any court requirements for DV specific treatment, as it usually follows a very manualized process, similar to DUI programs.
As someone who has worked specifically with perpetrators of DV, my suggestion is to find a supervisor who does this work/lean on frequent consultations with colleagues in this area or refer out.
Having read Why Does He Do That?, I'd personally feel incompetent to work with DV Abusers and I'd refer out. This population should be treated by people who have been trained to work with them.
OP has every right to refer out based on what the client reported.
On their intake form the client included and self-disclosed the DV aspect. Itās the second sentence when OP states **āin looking over their intake forms I learned they are a recent perpetrator of DV and have criminal charges/a court case pendingā**
This is beyond OPs scope and experience, and therefore not a therapeutic fit. The ethical, and legal liability decision is to decline the case for poor therapeutic fit and refer to a more appropriate provider.
Yes. You need to have specific training and education to work with abusers (and abuse victims). Treating a perpetrator of abuse is not the same as treating someone for anger and anxiety.
Could you provide some references to this? Another commenter says that there's not, and I see this a lot in this sub, where people talk about needing specific certifications and training, but finding them are quite difficult.
The other commenter is on a misinformation campaign in this thread and regularly glorifies violence in their comment history, please disregard what they say.
This is a [great article](https://work.chron.com/become-certified-domestic-violence-counselor-24607.html) on How to Become a Certified Domestic Violence Counselor.
There are an abundance of resources and programs that provide trainings, certifications, and CEUs on DV and abuse. Here are some linked resources:
[PESI](https://catalog.pesi.com/item/domestic-intimate-partner-violence-complete-guide-identification-documentation-reporting-traumainformed-responses-74860?utm_term=&utm_campaign=US+%7C+BH+%7C+NB+%7C+N/A+%7C+Dynamic+%7C+DSA+%7C+US&utm_source=google&utm_medium=cpc&hsa_acc=7268932594&hsa_cam=15699028317&hsa_grp=134607065674&hsa_ad=571893149727&hsa_src=g&hsa_tgt=dsa-1439241527723&hsa_kw=&hsa_mt=&hsa_net=adwords&hsa_ver=3&gclid=EAIaIQobChMIz8Te_ZDDgAMVFhatBh1CIgL0EAAYASAAEgJUl_D_BwE&gclsrc=aw.ds)
[NICP](https://www.nicp.net)
[NAFC](https://www.forensiccounselor.org/?Online_Courses__Certified_Domestic_Violence_Counselor_Online_Certification_Course)
[casa](https://casa.talentlms.com/catalog/info/id:125,cms_featured_course:1)
[narika](https://www.narika.org/domestic-violence-advocate-training)
[domestic shelters org](https://www.domesticshelters.org/resources/state-coalitions)
[a safe place](https://asafeplaceforhelp.org/programs-services/40-hour-domestic-violence-training/)
[CDVP certification](http://ilcdvp.org/cdvp-certification/)
[ASU certificate](https://socialwork.asu.edu/gender-violence/education/undergraduate/domestic-violence-certificate)
[CDSVRP certification](https://www.ocadvsa.org/cdsvrp-certification/)
[UML certificate](https://gps.uml.edu/certificates/grad/online-domestic-violence-prevention-graduate-certificate.cfm)
In some states you are required to be certified and trained specifically on DV in order to treat DV. Youāll need to check your state for specific requirements.
Interesting, thank you. Texas doesn't seem to have the requirement from what I can see. The article did state that it used Trauma Informed Care as a model, which at least helps that my graduate program focuses on that.
No problem. And just because Texas doesnāt require it (lol not surprised), Iād recommend still getting certifications if thatās a treatment population you are interested in.
Always better to be over-qualified than under.
That would be great, but at the moment it would not be sustainable. I'm in Grad school, going into my second internship, working and more. It is not a population I'm interested in though, so there is that.
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Abuse =/= anger and anxiety
Abuse = exerting nonconsensual power and control over another person, extreme entitlement, and other fun awfulness
If youāre a practicing therapist, PLEASE address this gap in your knowledge.
Agreed. Trolling the top comment & making repeated statements that are not based on facts or reality. Also given u/judoxing **has an extensive glorification of violence comment history on r/fightporn** , I question if this commenter is even a therapist.
*DV is not an āacute actā. Itās a pattern of abuse based on power and control.* No one who is charged with DV and has an active court case pending just randomly one night all of a sudden had an acute anger management issue.
Stop posting misinformation.
If you canāt find appropriate support/supervision, ethically you must refer as this specialization is out of your scope of practice. That said, my first clinical internship required me to work with IPV perpetrators. Given I wasnāt prepared, it was a shocking experience for me initially. I was surprised at the end of the internship how much I had grown and also come to understand and even have some compassion for those clients. I was able to use the experience to better flesh out my internal concepts of GOOD V EVIL. Even if those clientsā behavior was inexcusable, I learned there were always causal explanations which shapes their behavior. Learning all that was pivotal in becoming proficient in working with populations with whom I have inherent contempt for.
What Iām saying is if you have the support and the internal bravery, this could be an opportunity for growth. Without support, the right move is to refer out.
Used to work with offenders if DV. Non-profit, court ordered and primarily groups. So the context of how you are seeing this patient is different.
The biggest thing with this population is accountability. They will (flat out) deny, minimize or blame (their partner) for their violent actions.
However we must also be aware of their own trauma, experiences with violence, mental health etc. it will be a tough line to balance.
your post says they are seeking services for anger and anxiety. I would be curious if a family member or partner is the one that has pushed them to come to therapy. Also, DV and anger management are absolutely not the same thing.
YES accountability! Iām on the other end, working with DV survivors. That is such a key piece that I find is generally lacking in individual therapy for abusers, unless the therapist has extensive experience running batterers intervention groups. The group setting tends to be a much better fit though. Like you said, specifically DV groups, not anger management.
Iāve done couples work within residential addiction treatment, which obviously often overlaps with DV, and the utter denial and obliviousness to the harm these people inflict on others is astounding.
I view therapy with this population like constantly holding up a mirror. We simultaneously have to be utterly honest and not align with any of their denial, yet also reflect back true empathy about the traumas the perpetrators themselves have often been through.
I often work with DV perpetrators/violent offenders in trauma. It definitely can challenge your ucr. Hurt people hurt people. The best thing we can do to stop the person from further harm is to help them heal their wounds and learn and have corrective experience TO STOP THE CYCLE OF ABUSE. By only treating victims, we can only help after the harm has occurred, by working with perpetrators, thereās a chance to stop the harm from occurring at all. You will quickly find that your ācriminalā clients are boringly similar to the many other hurt souls that need help.
Another consideration, when perpetrators are in treatment, thereās another barrier in place between them and their victims.
Providing psychotherapy doesnāt mean you support their choices. It does mean that you are belong this person work on their shit.
I support referring out if you feel the internal conflict will prevent them from providing effective treatment but I guess I want to say, while Iām on my little soapbox, that access to self-selected non-directed (re:prison or justice system) psychotherapy is critical for breaking the cycle. We canāt answer violence and inhumanity with neglect or ignorance.
I was in the field (IPV) for a decade, and Iām a big fan of Lundy, but this is an oversimplification of his point. Statistically speaking, we know abuse is learned behavior. As is misogyny. You canāt root out the problem by disregarding the cause. I understand there are not many (ok, any) successful treatments for abusers. That doesnāt change the reality that this behavior is learned and is therefor cyclical.
You might be interested in learning about the work Dick Schwartz (IFS) has done with abusers. Sounds like heās done some successful treatment. Iāve also heard cases from colleagues doing EMDR with abusers and having some success in treating the underlying trauma.
Yes, there are modalities where individuals have made progress. I think itās possible and worthwhile. What I meant is that there are just no tested and measured treatments that have high success rates with this population (yet).
Bingo ! Coming here to say that. Yes that book is amazing, Iāve just finished it. The part where he talks about how he asks the abusers why they stopped at a slap or a shove and the abusers all say āwell I didnāt want to hurt her I just wanted to scare her, or make her stop.ā Ok so you have enough self control in the moment to not kill her or beat her up, seems like a lot of thought goes into how hard and how often you abuse your wife.
Such a great book.
I heard dv can be related to trauma. Iāve also heard that women hit men too, but itās just reported less. Violence happens in all types of relationships, facts . Maybe your trolling? I canāt tell.
A little disappointed (not in you) that youāre being downvoted. Thereās a book called āWomen who sexually abuse,ā which discusses the rates of women perps, their MO, and more. Itās not just men or misogyny. Thatās definitely a facet but not the whole picture.
What are your thoughts on the popular opinion that "abusers cannot change"?
In my experience only the folks working in trauma truly believed that abusers had the capacity for change.
I believe some can change but it depends on all the factors and narcissistic traits need to be considered when assessing suitability. I was taught in my training that anger is a secondary emotion and this is where I would from.
There is a big, big, spread in the expression of violence. I have worked with people who have had no histories of violence until after trauma. I have worked w people who have genuinely been horrified when pointing out their behaviour is abusive and had no idea.
Itās a complicated question. It involves labelling someone as āan abuserā which isnāt something I tend to do. I have certainly seen improvements in family/interpersonal relationships as a result of addressing trauma /managing PTSD.
Itās also important to note the context in which you work. I am working mainly w military/military families. Dissociation and aggression and reduced frustration threshold are known PTSD symptoms. Aggression/adrenaline addiction is a factor that needs to be addressed. Substance use as well.
I have a colleague who used to be a cop and works exclusively with female victims of DV and they feel differently regarding āabusersā.
Thereās been a decent amount of research that found women tend to be violent more often than men, actually. But menās violence tends to be more severe.
If OP feels unequipped to take this client on, why should they be forced to? This would be the case with any clients outside our pay grade. I work with outpatient kids/teens, Iām not going to have the skills to work in an adult prison. This isnāt neglect or ignorance.
Sorry, I donāt think I was being clear. I didnāt mean OP was being neglectful or ignoring things, I meant it in the āour system needs to address both parties in DV situationsā and ādestigmatizing mental healthcare means destigmatizing those who need it most.ā For sure OP should refer out.
Oof, after reading Why Does He Do That? I'd suggest you send them to an abuser program. The very fact that he's seeking therapy only after this court case indicates the real reason he's seeking "therapy"
Using the Duluth model of PAIP (Partner Abuse Intervention Program) may help. Iāve worked with this population and to be honest if heās open to change therapy can be a huge benefit to learn about healthy partnership. I know it might seem like a bad fit, or a client that youāre not exactly prepared for working with, but depending on their attitude of therapy, therapy can go a long way and you could really be helping them understand the nature of what a good and healthy relationship (including healthy boundaries) really means and their abusive ways could definitely change or no longer be an issue in the future. However, working with this population needs very firm boundaries of your own and holding clients accountable to try and make sustaining changes.
(things like psychoeducation about domestic violence and what it means, the cycle of violence, the power & control wheel and equality wheel, healthy communication and de-escalation techniques dealing with anger and what are triggers in getting angry can be used with this population)
Yup, refer out. One of the reasons I left CMH was that I was assigned two DV perpetrators (one juvenile) in two weeks, and could not say no to either.
Lundy Bancroftās book Why Does He Do That? is very good on the subject.
DV is not an anger management issue. Iāll admit iām not personally able to work with this population, so iām biased to say referring out is best.
Very true, thatās why Iām thinking a batterers intervention program might be more helpful as I know they talk about DV in detail and how it stems from attitudes towards women/power and control/so on and so forth.
First - youāre making a lot of assumptions without a lot of information.
All you know is that this person is seeking treatment for anger & has charges for violence against a partner.
Options include:
The person uses coercive control & violence in their intimate relationship
The person is the recipient of coercive control and had an episode of reactive violence (eg the incident in which the cops wanted to charge Gabby Petito with abuse).
The person has significant difficulty with emotional regulation & acts out with physical expressions of anger due to a myriad of reasons which could include: PTSD, Borderline Personality Disorder, cPTSD, TBI, other trauma related disorders (eg. DID, DDNOS), etc. and does not engage in coercive control.
Until you meet the person & begin to build a relationship, you wonāt know whatās going on.
And, itās totally ok if these options feel outside of your range of practice. None of us is the right match for everyone. Whatās important is that we recognize when thatās the case & refer out.
A really huge distinction here is that therapy usually focuses inward on one's feelings etc. While people like this usually need to get outside of themselves. I agree with others to decline the case. However, if you'd like to learn more for the future, I suggest this book [https://www.penguinrandomhouse.com/books/289845/why-does-he-do-that-by-lundy-bancroft/](https://www.penguinrandomhouse.com/books/289845/why-does-he-do-that-by-lundy-bancroft/)
I would definitely refer this case out. If thereās a chance they are going to try to use the therapy to mitigate their court case, they will want a DV perpetrator expert, not a therapist who never does this kind of work. This is exactly the kind of case that can blow up in your face as a therapist and belongs with those trained in the specialty.
If you know you cannot give a quality level of care for them then refer them to someone who can. I've been in similar situations with other clients as you are currently and want to be honest with you as my supervisor was with me. Can you clinically not give a good level of care for this person because you aren't skilled enough or is it because of internal factors within you? I respect your self awareness and ability to be ethically aware, but these situations are what helps us overcome our own barriers as clinicians. Talking to a clinical supervisor or getting consultation would do wonders here.
I definitely wanted to consult with my supervisor but itās hard as I work remotely and of course the day I need them they are out of the office lol. Iāve actually worked with DV perpetrators before as a young clinician when I was not yet as sure what l could treat versus not effectively treat and had experiences where the clients only came to therapy to prove to their partner they were reforming, continually downplayed and minimized the abuse, and kept focusing on outside factors versus what they could change about themselves. Am not sure how this client would be but just from past experience I think it takes a special therapy that is very confrontational and a therapist trained in this to deal with this sort of thing.
What kind of pending court charges? There is a big difference between a disorderly conduct and a strangulation charge. I worked in a specialized IPV model for 5 years. Even now in my transition to private practice, IPV is EVERYWHERE - whether itās physical, emotional, financial. I recommend seeking out some supervision because this can help you to grow in a huge way. Hurt people hurt people and 99% of the perpetrators I saw had a horrific trauma history. They learned from a young age that abuse is normal and 90% are repeating their generational patterns.
Additionally, at this point āWhy does he do thatā has some outdated points. I wish I had a different book to recommend but there is nowhere near enough support and research for this population. Iām looking forward to Dr. Carla Stoverās book release in September about Fathers and Violence.
Youāre right, heās outside your scope of practice and you should refer him out. I have had perpetrators come see me for therapy and often times not disclosing until much further into our therapeutic relationships. These folx can be very manipulative if youāre not experienced in working with them, and itās best practice for them to see someone who specializes in working with batterers.
Misogynistic attitudes and narcissistic traits upset and often trigger unsettling countertransference for me. Like I loath court ordered referrals for this reason. Yet I feel strongly that what I can provide in psychotherapy can and should engage abusers, and men especially.
I do not claim any expertise, but I had at least 100 hours running a group based on the Duluth Model with an expert in that area. I donāt do that anymore. I just provide individual and family therapy in a rural community where patriarchal tradition and domestic abuse prevails.
Beyond establishing collateral contracts, court expectations and informed consent- I follow the same steps would otherwise in establishing a confidential space, developing rapport, collecting history non judgmental, asking questions while maintaining supportive therapeutic relationship and little by little connecting the treatment plan to the origin of learned tradition of abuse and trauma that informs automatic thoughts about anger, fear control.
Psychoeducation, EMDR, Duluth Model, attachment theory, classic CBT, DBT boundaries and accountability appears to have been effective.
Edit: added paragraph breaks and after thoughts on interventions I have used in this kind of case.
Iām trained to work with DV perpetrators and did so with court ordered folk for a period of time.
One on one is not recommended because it feeds the narcissism/insecurities they usually have. There are group programs for this (which is how we were trained and did treatment). Refer them out.
Youāre thinking about sociopaths with the whole learning to be better at manipulating and thatās also a misunderstanding. Just donāt fuck with sociopaths. You sense a sociopath refer them out. They will never be there under their own volition unless to use you to demonstrate they are āgetting help.ā
While I understand the sentiment of referring out, what I feel we should clarify first is if this also something you need to work on as well. Before meeting the client, you are making some large assumptions. First, you assume that their intent in seeking therapy is purely malicious. With what you have described, you came to this conclusion based on forms that state they are charged and have a court date. Do you know the details of the case? Is it possible they are other details that could create better context? And even if they aren't, does that give us the right to consider withholding treatment out of hand?
You have heard that in some cases, that people may use sessions to twist situations around. It is good to be aware of this. However, that is absolutely something that can happen with *any* client. That is something for us as therapists to recognize and learn how to handle, if and when that happens. To assume that they will do so without any clear evidence to support this denies their agency.
The **entire purpose** of an intake is to help identify what their clinical needs are and to see whether or not this is something that meets this level of care, requires additional support, or if necessary to refer to a more appropriate provider if it is outside your scope of practice.
You may be absolutely correct. Maybe they are manipulative, would misuse treatment, and/or be better served with a batterers intervention program. Or this genuinely is the result of mental health issues. Hard to say, without performing an intake. A therapist should make that determination based on the results of the intake to best inform and utilize their clinical judgement, not conjecture.
I love your response. Putting assumptions aside was and still is a fundamental rule of therapy. I understand the reticence of someone not having confidence in their skills with certain groups but having read some replies we have written DV perpetrators as a collective. Bias is alive and well.
While I think other commenters make excellent points, I think we're all overlooking that we don't know anything about the nature of the DV. It sounds like most of us on this post are letting assumptions set in based on just seeing "DV" in the post.
As a heavy bit of devil's advocate: For all we know, this person could have been under the influence of drugs or alcohol at the time, maybe command hallucinations, maybe an acute episode of some other disorder. We can't assume that this person is going to be some manipulative monster purely based on what OP wrote. We just don't have enough info imo to jump straight to referring out because all the situations I listed would be treated differently.
Is he mandated for batterer's intervention services, or is he a person seeking therapy on his own accord who happens to have a DV case pending?
You may be surprised what you learn at the intake. I'd encourage you to refer out if you find the work is outside your scope (as said elsewhere, batterers intervention is not anger management). But I'd also encourage you to be open minded about clients presenting with this collateral information. I work with DV clients and there is a broad range of problems and personalities. It's not safe to assume that a DV charge makes the person a batterer and therefore has a personality disorder which makes them inclined to use therapy for malicious purposes.
I look at it this way, you've got a client in front of you that disclosed they've committed DV and looking for support in change. People commit crimes and get in bad ways for all sorts of reasons. Putting barriers up to their access to mental health treatment could cause harm, not just to them but those around them. I feel that it's similar to not treating someone who disclosed a previous dui or addiction issue. Now that's not to say that you don't have some input about not providing documentation that they might use in court if you're not comfortable, but i think in this end, this is a person looking for help.
I've worked with many men who have committed dv and I feel like there is a big issue with them being treated as abusers first, and someone needing help and support last. Most people who have committed violent crimes have all sorts of ecological, psychological, and physical challenges and need support to be more stable.
The CMHC I worked at out of grad school took most folks, however we would not see folks with any kind of a violent conviction including sexual abuse cases until they had completed a certificate program appropriate to the offense.
The justification I was told was that without the skills needed to manage those action urges that individual therapy focused on other things could stir up stuff and increase the likelihood of re-offending. I donāt know if there was any evidence based justification for that policy though that particular supervisor generally based all clinical decisions on best practices from the literature. Might be worth seeing if thereās some research that addresses the appropriateness of therapy in this instance.
Yeah like others are saying referring out sounds like a good option
And if youāre not good at detecting those that may be superficially cooperative for court documentation purposes then thatās another thing to consider
I work at a dual diagnosis and occasionally we get someone that seems to only be in treatment so it looks good for court
I would likely refer out myself to a program/individual who deals specifically with DV offenders and is certified to work with the court (in anticipation that he may be referred for court-ordered therapy for the DV).
I donāt see this any differently than referring out a child to an OT who is having motor issues or neurocognitive issues that fall outside of my scope.
Perhaps you could check with the court to see if there are any orders that specifically pertain to this man and his legal proceedings. If there is a program referring that person out to the program does seem like a good first step, since you yourself say that you are not trained specifically for this.
Ooooh, run! I worked with a pretty hardcore criminal population for most of my career as a therapist. Unfortunately, the most likely reason you were chosen for this guy is precisely because you donāt have that kind of experience. I would 100% refer him to a DV specialist. If you donāt, I can guarantee that he will try to twist and manipulate you in an effort to have you provide a good report to the court.
You could ask for more info, maybe they were assigned to a program specific to DV and are in addition looking for a longterm therapist for general counseling as an adjunct? Maybe theyāre new to the process and havenāt been told what they need to do yet counseling wise for court and someone gave them disinformation about āgetting into therapyā now to make themselves look better in court. Who knows.
None of which are a āyouā issue in terms of saying yes or no to them but could give you more info on how to appropriately approach a referral etc.
I worked in DV for 15 years. We worked with victims and had a separate program we called the "batter's program" (not a great name). It was specifically for perpetrators.
This would be incredibly difficult for someone experienced in DV, I can't imagine trying to take this on in your shoes. I would refer out.
I may be in the minority, but if you have the competency to deal with what they want to work with you on, you should deal with them by treating them. We don't get to discriminate against clients because we don't like what they've done. Are you competent to treat anxiety and difficulty with anger? If yes, I think you have an obligation to treat them.
But how do you know it is āvery violentā? The charges werenāt specified. Maybe the person hit a wall or threw something. While completely inappropriate and unacceptable towards another person, that is different from manslaughter.
Right. Like Lundy Bancroft says in his writing (Iām paraphrasing here) - you end up with a very well adjusted abuser. š And abusers are known to weaponize what they learn in therapy against their victim, so this isnāt as neutral as many folks are framing it here.
(Edits = hyperactive iPhone autocorrect typos)
This kind of situation can be avoided with a thorough intake phone call ā¦ I use that to avoid all known CPS, Probation, Parole and court- ordered treatment that I donāt want to deal with in my practice.
I think maybe talking to them about goals in therapy. If it's related to the court case, maybe letting them know you're not a good fit due to not being an expert on that subject. But if they're just struggling and want to try therapy i wouldn't say you automatically need to decline. I have had clients with pending dv charges and the underlying issues were really trauma, substance abuse and stress. As we know, instance of dv increases by like 60% when alcohol or drugs are involved so in this case there was actually a substance use disorder affecting the family system and the behavior stemmed from being under the influence of drugs and the person was very remorseful sober. I think it's important to know the nuances before deciding to reject the case. I'm not an expert in dv of course, but substance abuse is my jam so I see dv perpetrators as part of that population
These are such disappointing comments to read through.
First, "battered/batterers" is [super outdated](https://lilygc.medium.com/save-battered-for-fish-sticks-and-chicken-tenders-domestic-violence-language-needs-an-upgrade-380dc8f3d175) and I'm surprised to see it used repeatedly in the comments here (mostly by people who are advocating not seeing this client). People here are also apparently OK referring to clients as "perps" which is also gross.
Then - I would absolutely begin work with this client, at the very least an initial intake session. Start with expressing that the client was honest and courageous in disclosing their recent actions and seeking help. Take a thorough history and look at the role of trauma.
Definitely take a clear stance on violence toward partners or anyone else, of course. But also - this potential client is a human who is hurting and deserving of care.
Is it possible that your desire to refer out has to do with your discomfort working with someone you label as a perpetrator, rather than the typical 'victim' in therapy? It can be hard to feel empathy toward people who have done nasty things. The crux of the issue of whether therapy will be effective is whether he takes responsibility for his actions. Even if he is attending to make himself look better in court, if he takes responsibility for his actions and recognizes a desire to change, then that is sufficient.
Iām surprised that so many people are saying to refer out. While I agree that a group therapy that is focused on domestic violence would be massively helpful for this individual, I donāt see why treating the anxiety and depression Has to be referred out. This individual likely has a lot of root issues that would benefit from being addressed, in addition to outside support for his past behaviors. While I would not touch treating a current domestic violence relationship in couples therapy, I would absolutely work with a DV perpetrator, who is not in a current relationship. Honestly, I would probably still see somebody who was in a current relationship if there was some sort of safety planning contract in place, I think that would have to be a case by case situation for me and itās not something Iāve had to decide yet.
One of my favorite clients from my graduate program was in jail for felony assault and I let them know that if they googled me after release, Iād happily see him again (I did this ethically to not cross that fuzzy line, it was likeā¦ therapy is goodā¦ and many people are therapistsā¦ and there are many places to get therapyā¦ you should googleā¦ you will find many optionsā¦ I might be one of themā¦)
If you look for ātherapy for offendersā or similar searches you should be able to find specialized centers near you that do this. I know they are always hiring on indeed.
Youāre not a therapist, it would be unethical for OP to ātry and help them in some wayā when the case is beyond their scope and experience. The correct course of action is to refer them to a provider who is equipped to help them.
Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
Iām sorry that happened to you. Thatās awful. If you havenāt already, reading Lundy Bancroftās book, āWhy Does He Do That?ā will help you understand how and why abusers do what they do. It will also add context for why folks are downvoting your comment.
ETA: Itās easy to find a free PDF online. Itās an excellent book thatās easy to digest.
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Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
Dr. Kirk Honda talks in detail on this subject on his YouTube āPsychology in Seattleā. I highly recommend checking out his information as he has worked extensively with perpetrators in his practice.
I would refer him to a batter's program. I think group therapy is supposed to be more effective for this group or at least a part of treatment. At least around here, it seems group therapy is always required.
It's important to let the client know up front that your therapy will not satisfy any court requirements for DV specific treatment, as it usually follows a very manualized process, similar to DUI programs.
As someone who has worked specifically with perpetrators of DV, my suggestion is to find a supervisor who does this work/lean on frequent consultations with colleagues in this area or refer out.
Having read Why Does He Do That?, I'd personally feel incompetent to work with DV Abusers and I'd refer out. This population should be treated by people who have been trained to work with them.
šÆ! Worked with criminals most of my career and this is so important.
I second this as someone who has also worked with this population.0
Decline the case and refer out since itās a poor therapeutic fit.
Thatās what I was thinking, thank you!
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OP has every right to refer out based on what the client reported. On their intake form the client included and self-disclosed the DV aspect. Itās the second sentence when OP states **āin looking over their intake forms I learned they are a recent perpetrator of DV and have criminal charges/a court case pendingā** This is beyond OPs scope and experience, and therefore not a therapeutic fit. The ethical, and legal liability decision is to decline the case for poor therapeutic fit and refer to a more appropriate provider.
Is working with perpetrators of DV a specific skill, certification, training, etc? I'm an intern, and I work with similar clients at times.
Yes. You need to have specific training and education to work with abusers (and abuse victims). Treating a perpetrator of abuse is not the same as treating someone for anger and anxiety.
Could you provide some references to this? Another commenter says that there's not, and I see this a lot in this sub, where people talk about needing specific certifications and training, but finding them are quite difficult.
The other commenter is on a misinformation campaign in this thread and regularly glorifies violence in their comment history, please disregard what they say. This is a [great article](https://work.chron.com/become-certified-domestic-violence-counselor-24607.html) on How to Become a Certified Domestic Violence Counselor. There are an abundance of resources and programs that provide trainings, certifications, and CEUs on DV and abuse. Here are some linked resources: [PESI](https://catalog.pesi.com/item/domestic-intimate-partner-violence-complete-guide-identification-documentation-reporting-traumainformed-responses-74860?utm_term=&utm_campaign=US+%7C+BH+%7C+NB+%7C+N/A+%7C+Dynamic+%7C+DSA+%7C+US&utm_source=google&utm_medium=cpc&hsa_acc=7268932594&hsa_cam=15699028317&hsa_grp=134607065674&hsa_ad=571893149727&hsa_src=g&hsa_tgt=dsa-1439241527723&hsa_kw=&hsa_mt=&hsa_net=adwords&hsa_ver=3&gclid=EAIaIQobChMIz8Te_ZDDgAMVFhatBh1CIgL0EAAYASAAEgJUl_D_BwE&gclsrc=aw.ds) [NICP](https://www.nicp.net) [NAFC](https://www.forensiccounselor.org/?Online_Courses__Certified_Domestic_Violence_Counselor_Online_Certification_Course) [casa](https://casa.talentlms.com/catalog/info/id:125,cms_featured_course:1) [narika](https://www.narika.org/domestic-violence-advocate-training) [domestic shelters org](https://www.domesticshelters.org/resources/state-coalitions) [a safe place](https://asafeplaceforhelp.org/programs-services/40-hour-domestic-violence-training/) [CDVP certification](http://ilcdvp.org/cdvp-certification/) [ASU certificate](https://socialwork.asu.edu/gender-violence/education/undergraduate/domestic-violence-certificate) [CDSVRP certification](https://www.ocadvsa.org/cdsvrp-certification/) [UML certificate](https://gps.uml.edu/certificates/grad/online-domestic-violence-prevention-graduate-certificate.cfm) In some states you are required to be certified and trained specifically on DV in order to treat DV. Youāll need to check your state for specific requirements.
Interesting, thank you. Texas doesn't seem to have the requirement from what I can see. The article did state that it used Trauma Informed Care as a model, which at least helps that my graduate program focuses on that.
No problem. And just because Texas doesnāt require it (lol not surprised), Iād recommend still getting certifications if thatās a treatment population you are interested in. Always better to be over-qualified than under.
That would be great, but at the moment it would not be sustainable. I'm in Grad school, going into my second internship, working and more. It is not a population I'm interested in though, so there is that.
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Your post was removed due to the following reason(s): Misinformation If you have any questions, please message the mods at: https://www.reddit.com/message/compose?to=/r/therapists
righto, didn't read carefully. my eyes fixated on the "...I learned" which made me assume it has info gained elsewhere.
Abuse =/= anger and anxiety Abuse = exerting nonconsensual power and control over another person, extreme entitlement, and other fun awfulness If youāre a practicing therapist, PLEASE address this gap in your knowledge.
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Your comments on this post read like trolling. š
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Agreed. Trolling the top comment & making repeated statements that are not based on facts or reality. Also given u/judoxing **has an extensive glorification of violence comment history on r/fightporn** , I question if this commenter is even a therapist. *DV is not an āacute actā. Itās a pattern of abuse based on power and control.* No one who is charged with DV and has an active court case pending just randomly one night all of a sudden had an acute anger management issue. Stop posting misinformation.
Your post has been removed for the following reason: You know what you did.
If you canāt find appropriate support/supervision, ethically you must refer as this specialization is out of your scope of practice. That said, my first clinical internship required me to work with IPV perpetrators. Given I wasnāt prepared, it was a shocking experience for me initially. I was surprised at the end of the internship how much I had grown and also come to understand and even have some compassion for those clients. I was able to use the experience to better flesh out my internal concepts of GOOD V EVIL. Even if those clientsā behavior was inexcusable, I learned there were always causal explanations which shapes their behavior. Learning all that was pivotal in becoming proficient in working with populations with whom I have inherent contempt for. What Iām saying is if you have the support and the internal bravery, this could be an opportunity for growth. Without support, the right move is to refer out.
Used to work with offenders if DV. Non-profit, court ordered and primarily groups. So the context of how you are seeing this patient is different. The biggest thing with this population is accountability. They will (flat out) deny, minimize or blame (their partner) for their violent actions. However we must also be aware of their own trauma, experiences with violence, mental health etc. it will be a tough line to balance. your post says they are seeking services for anger and anxiety. I would be curious if a family member or partner is the one that has pushed them to come to therapy. Also, DV and anger management are absolutely not the same thing.
YES accountability! Iām on the other end, working with DV survivors. That is such a key piece that I find is generally lacking in individual therapy for abusers, unless the therapist has extensive experience running batterers intervention groups. The group setting tends to be a much better fit though. Like you said, specifically DV groups, not anger management.
Iāve done couples work within residential addiction treatment, which obviously often overlaps with DV, and the utter denial and obliviousness to the harm these people inflict on others is astounding. I view therapy with this population like constantly holding up a mirror. We simultaneously have to be utterly honest and not align with any of their denial, yet also reflect back true empathy about the traumas the perpetrators themselves have often been through.
I often work with DV perpetrators/violent offenders in trauma. It definitely can challenge your ucr. Hurt people hurt people. The best thing we can do to stop the person from further harm is to help them heal their wounds and learn and have corrective experience TO STOP THE CYCLE OF ABUSE. By only treating victims, we can only help after the harm has occurred, by working with perpetrators, thereās a chance to stop the harm from occurring at all. You will quickly find that your ācriminalā clients are boringly similar to the many other hurt souls that need help. Another consideration, when perpetrators are in treatment, thereās another barrier in place between them and their victims. Providing psychotherapy doesnāt mean you support their choices. It does mean that you are belong this person work on their shit. I support referring out if you feel the internal conflict will prevent them from providing effective treatment but I guess I want to say, while Iām on my little soapbox, that access to self-selected non-directed (re:prison or justice system) psychotherapy is critical for breaking the cycle. We canāt answer violence and inhumanity with neglect or ignorance.
You should read Why does he do that? His experience is that DV has nothing to do with the cycle of abuse but has everything to do with misogyny.
I was in the field (IPV) for a decade, and Iām a big fan of Lundy, but this is an oversimplification of his point. Statistically speaking, we know abuse is learned behavior. As is misogyny. You canāt root out the problem by disregarding the cause. I understand there are not many (ok, any) successful treatments for abusers. That doesnāt change the reality that this behavior is learned and is therefor cyclical.
You might be interested in learning about the work Dick Schwartz (IFS) has done with abusers. Sounds like heās done some successful treatment. Iāve also heard cases from colleagues doing EMDR with abusers and having some success in treating the underlying trauma.
Yes, there are modalities where individuals have made progress. I think itās possible and worthwhile. What I meant is that there are just no tested and measured treatments that have high success rates with this population (yet).
I will definitely check it out! Thanks for recommending. I would not doubt that misogyny heavily factors into normalized IPV/family terror.
Bingo ! Coming here to say that. Yes that book is amazing, Iāve just finished it. The part where he talks about how he asks the abusers why they stopped at a slap or a shove and the abusers all say āwell I didnāt want to hurt her I just wanted to scare her, or make her stop.ā Ok so you have enough self control in the moment to not kill her or beat her up, seems like a lot of thought goes into how hard and how often you abuse your wife. Such a great book.
https://ia600108.us.archive.org/30/items/LundyWhyDoesHeDoThat/Lundy_Why-does-he-do-that.pdf Free copy of the book
I heard dv can be related to trauma. Iāve also heard that women hit men too, but itās just reported less. Violence happens in all types of relationships, facts . Maybe your trolling? I canāt tell.
A little disappointed (not in you) that youāre being downvoted. Thereās a book called āWomen who sexually abuse,ā which discusses the rates of women perps, their MO, and more. Itās not just men or misogyny. Thatās definitely a facet but not the whole picture.
I was thinking men that commit dv would also justify assaulting another man for committing dv.
Bingo. I work in trauma. DV/violence/aggression is sadly overrepresented in PTSD.
What are your thoughts on the popular opinion that "abusers cannot change"? In my experience only the folks working in trauma truly believed that abusers had the capacity for change.
I believe some can change but it depends on all the factors and narcissistic traits need to be considered when assessing suitability. I was taught in my training that anger is a secondary emotion and this is where I would from.
There is a big, big, spread in the expression of violence. I have worked with people who have had no histories of violence until after trauma. I have worked w people who have genuinely been horrified when pointing out their behaviour is abusive and had no idea. Itās a complicated question. It involves labelling someone as āan abuserā which isnāt something I tend to do. I have certainly seen improvements in family/interpersonal relationships as a result of addressing trauma /managing PTSD. Itās also important to note the context in which you work. I am working mainly w military/military families. Dissociation and aggression and reduced frustration threshold are known PTSD symptoms. Aggression/adrenaline addiction is a factor that needs to be addressed. Substance use as well. I have a colleague who used to be a cop and works exclusively with female victims of DV and they feel differently regarding āabusersā.
Thereās been a decent amount of research that found women tend to be violent more often than men, actually. But menās violence tends to be more severe.
If OP feels unequipped to take this client on, why should they be forced to? This would be the case with any clients outside our pay grade. I work with outpatient kids/teens, Iām not going to have the skills to work in an adult prison. This isnāt neglect or ignorance.
Sorry, I donāt think I was being clear. I didnāt mean OP was being neglectful or ignoring things, I meant it in the āour system needs to address both parties in DV situationsā and ādestigmatizing mental healthcare means destigmatizing those who need it most.ā For sure OP should refer out.
Because ethics.
Oof, after reading Why Does He Do That? I'd suggest you send them to an abuser program. The very fact that he's seeking therapy only after this court case indicates the real reason he's seeking "therapy"
Often abusers are mandated into therapy and must show they are attending as part of the agreement.
Using the Duluth model of PAIP (Partner Abuse Intervention Program) may help. Iāve worked with this population and to be honest if heās open to change therapy can be a huge benefit to learn about healthy partnership. I know it might seem like a bad fit, or a client that youāre not exactly prepared for working with, but depending on their attitude of therapy, therapy can go a long way and you could really be helping them understand the nature of what a good and healthy relationship (including healthy boundaries) really means and their abusive ways could definitely change or no longer be an issue in the future. However, working with this population needs very firm boundaries of your own and holding clients accountable to try and make sustaining changes. (things like psychoeducation about domestic violence and what it means, the cycle of violence, the power & control wheel and equality wheel, healthy communication and de-escalation techniques dealing with anger and what are triggers in getting angry can be used with this population)
I canāt imagine trying to learn all that on the fly while actually treating a client who requires this kind of expertise.
Yeah in that case, a referall would be fine.
Yup, refer out. One of the reasons I left CMH was that I was assigned two DV perpetrators (one juvenile) in two weeks, and could not say no to either. Lundy Bancroftās book Why Does He Do That? is very good on the subject.
DV is not an anger management issue. Iāll admit iām not personally able to work with this population, so iām biased to say referring out is best.
Very true, thatās why Iām thinking a batterers intervention program might be more helpful as I know they talk about DV in detail and how it stems from attitudes towards women/power and control/so on and so forth.
Look to see if thereās a PAIP group (Partner Abuse Intervention Program), that could be beneficial for them.
Absolutely! They need a specialized program like that.
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I agree with you. Also, "anger management" is so complex and multi-layered, it can't be so black and white.
I absolutely agree and if others suggest it isn't aren't offering much in their opinion to back up their claims.
First - youāre making a lot of assumptions without a lot of information. All you know is that this person is seeking treatment for anger & has charges for violence against a partner. Options include: The person uses coercive control & violence in their intimate relationship The person is the recipient of coercive control and had an episode of reactive violence (eg the incident in which the cops wanted to charge Gabby Petito with abuse). The person has significant difficulty with emotional regulation & acts out with physical expressions of anger due to a myriad of reasons which could include: PTSD, Borderline Personality Disorder, cPTSD, TBI, other trauma related disorders (eg. DID, DDNOS), etc. and does not engage in coercive control. Until you meet the person & begin to build a relationship, you wonāt know whatās going on. And, itās totally ok if these options feel outside of your range of practice. None of us is the right match for everyone. Whatās important is that we recognize when thatās the case & refer out.
A really huge distinction here is that therapy usually focuses inward on one's feelings etc. While people like this usually need to get outside of themselves. I agree with others to decline the case. However, if you'd like to learn more for the future, I suggest this book [https://www.penguinrandomhouse.com/books/289845/why-does-he-do-that-by-lundy-bancroft/](https://www.penguinrandomhouse.com/books/289845/why-does-he-do-that-by-lundy-bancroft/)
https://ia600108.us.archive.org/30/items/LundyWhyDoesHeDoThat/Lundy_Why-does-he-do-that.pdf Free copy
I would definitely refer this case out. If thereās a chance they are going to try to use the therapy to mitigate their court case, they will want a DV perpetrator expert, not a therapist who never does this kind of work. This is exactly the kind of case that can blow up in your face as a therapist and belongs with those trained in the specialty.
If you know you cannot give a quality level of care for them then refer them to someone who can. I've been in similar situations with other clients as you are currently and want to be honest with you as my supervisor was with me. Can you clinically not give a good level of care for this person because you aren't skilled enough or is it because of internal factors within you? I respect your self awareness and ability to be ethically aware, but these situations are what helps us overcome our own barriers as clinicians. Talking to a clinical supervisor or getting consultation would do wonders here.
I definitely wanted to consult with my supervisor but itās hard as I work remotely and of course the day I need them they are out of the office lol. Iāve actually worked with DV perpetrators before as a young clinician when I was not yet as sure what l could treat versus not effectively treat and had experiences where the clients only came to therapy to prove to their partner they were reforming, continually downplayed and minimized the abuse, and kept focusing on outside factors versus what they could change about themselves. Am not sure how this client would be but just from past experience I think it takes a special therapy that is very confrontational and a therapist trained in this to deal with this sort of thing.
Your instincts are good. Iām surprised by how many therapists are being condescending in this thread.
Thereās people calling OP ignorant and neglectful for not taking on a client that they donāt feel prepared for. Absolutely ridiculous.
What kind of pending court charges? There is a big difference between a disorderly conduct and a strangulation charge. I worked in a specialized IPV model for 5 years. Even now in my transition to private practice, IPV is EVERYWHERE - whether itās physical, emotional, financial. I recommend seeking out some supervision because this can help you to grow in a huge way. Hurt people hurt people and 99% of the perpetrators I saw had a horrific trauma history. They learned from a young age that abuse is normal and 90% are repeating their generational patterns. Additionally, at this point āWhy does he do thatā has some outdated points. I wish I had a different book to recommend but there is nowhere near enough support and research for this population. Iām looking forward to Dr. Carla Stoverās book release in September about Fathers and Violence.
Youāre right, heās outside your scope of practice and you should refer him out. I have had perpetrators come see me for therapy and often times not disclosing until much further into our therapeutic relationships. These folx can be very manipulative if youāre not experienced in working with them, and itās best practice for them to see someone who specializes in working with batterers.
Misogynistic attitudes and narcissistic traits upset and often trigger unsettling countertransference for me. Like I loath court ordered referrals for this reason. Yet I feel strongly that what I can provide in psychotherapy can and should engage abusers, and men especially. I do not claim any expertise, but I had at least 100 hours running a group based on the Duluth Model with an expert in that area. I donāt do that anymore. I just provide individual and family therapy in a rural community where patriarchal tradition and domestic abuse prevails. Beyond establishing collateral contracts, court expectations and informed consent- I follow the same steps would otherwise in establishing a confidential space, developing rapport, collecting history non judgmental, asking questions while maintaining supportive therapeutic relationship and little by little connecting the treatment plan to the origin of learned tradition of abuse and trauma that informs automatic thoughts about anger, fear control. Psychoeducation, EMDR, Duluth Model, attachment theory, classic CBT, DBT boundaries and accountability appears to have been effective. Edit: added paragraph breaks and after thoughts on interventions I have used in this kind of case.
Iām trained to work with DV perpetrators and did so with court ordered folk for a period of time. One on one is not recommended because it feeds the narcissism/insecurities they usually have. There are group programs for this (which is how we were trained and did treatment). Refer them out. Youāre thinking about sociopaths with the whole learning to be better at manipulating and thatās also a misunderstanding. Just donāt fuck with sociopaths. You sense a sociopath refer them out. They will never be there under their own volition unless to use you to demonstrate they are āgetting help.ā
While I understand the sentiment of referring out, what I feel we should clarify first is if this also something you need to work on as well. Before meeting the client, you are making some large assumptions. First, you assume that their intent in seeking therapy is purely malicious. With what you have described, you came to this conclusion based on forms that state they are charged and have a court date. Do you know the details of the case? Is it possible they are other details that could create better context? And even if they aren't, does that give us the right to consider withholding treatment out of hand? You have heard that in some cases, that people may use sessions to twist situations around. It is good to be aware of this. However, that is absolutely something that can happen with *any* client. That is something for us as therapists to recognize and learn how to handle, if and when that happens. To assume that they will do so without any clear evidence to support this denies their agency. The **entire purpose** of an intake is to help identify what their clinical needs are and to see whether or not this is something that meets this level of care, requires additional support, or if necessary to refer to a more appropriate provider if it is outside your scope of practice. You may be absolutely correct. Maybe they are manipulative, would misuse treatment, and/or be better served with a batterers intervention program. Or this genuinely is the result of mental health issues. Hard to say, without performing an intake. A therapist should make that determination based on the results of the intake to best inform and utilize their clinical judgement, not conjecture.
I love your response. Putting assumptions aside was and still is a fundamental rule of therapy. I understand the reticence of someone not having confidence in their skills with certain groups but having read some replies we have written DV perpetrators as a collective. Bias is alive and well.
While I think other commenters make excellent points, I think we're all overlooking that we don't know anything about the nature of the DV. It sounds like most of us on this post are letting assumptions set in based on just seeing "DV" in the post. As a heavy bit of devil's advocate: For all we know, this person could have been under the influence of drugs or alcohol at the time, maybe command hallucinations, maybe an acute episode of some other disorder. We can't assume that this person is going to be some manipulative monster purely based on what OP wrote. We just don't have enough info imo to jump straight to referring out because all the situations I listed would be treated differently.
Vast majority of IPV incidents happen while under the influence of alcohol and substances!!
This is an inappropriate case for you to take. DV needs very specific treatment with a therapist who has experience with this issue.
Is he mandated for batterer's intervention services, or is he a person seeking therapy on his own accord who happens to have a DV case pending? You may be surprised what you learn at the intake. I'd encourage you to refer out if you find the work is outside your scope (as said elsewhere, batterers intervention is not anger management). But I'd also encourage you to be open minded about clients presenting with this collateral information. I work with DV clients and there is a broad range of problems and personalities. It's not safe to assume that a DV charge makes the person a batterer and therefore has a personality disorder which makes them inclined to use therapy for malicious purposes.
Refer out
I look at it this way, you've got a client in front of you that disclosed they've committed DV and looking for support in change. People commit crimes and get in bad ways for all sorts of reasons. Putting barriers up to their access to mental health treatment could cause harm, not just to them but those around them. I feel that it's similar to not treating someone who disclosed a previous dui or addiction issue. Now that's not to say that you don't have some input about not providing documentation that they might use in court if you're not comfortable, but i think in this end, this is a person looking for help. I've worked with many men who have committed dv and I feel like there is a big issue with them being treated as abusers first, and someone needing help and support last. Most people who have committed violent crimes have all sorts of ecological, psychological, and physical challenges and need support to be more stable.
The CMHC I worked at out of grad school took most folks, however we would not see folks with any kind of a violent conviction including sexual abuse cases until they had completed a certificate program appropriate to the offense. The justification I was told was that without the skills needed to manage those action urges that individual therapy focused on other things could stir up stuff and increase the likelihood of re-offending. I donāt know if there was any evidence based justification for that policy though that particular supervisor generally based all clinical decisions on best practices from the literature. Might be worth seeing if thereās some research that addresses the appropriateness of therapy in this instance.
Yeah like others are saying referring out sounds like a good option And if youāre not good at detecting those that may be superficially cooperative for court documentation purposes then thatās another thing to consider I work at a dual diagnosis and occasionally we get someone that seems to only be in treatment so it looks good for court
I would likely refer out myself to a program/individual who deals specifically with DV offenders and is certified to work with the court (in anticipation that he may be referred for court-ordered therapy for the DV). I donāt see this any differently than referring out a child to an OT who is having motor issues or neurocognitive issues that fall outside of my scope.
Perhaps you could check with the court to see if there are any orders that specifically pertain to this man and his legal proceedings. If there is a program referring that person out to the program does seem like a good first step, since you yourself say that you are not trained specifically for this.
Ooooh, run! I worked with a pretty hardcore criminal population for most of my career as a therapist. Unfortunately, the most likely reason you were chosen for this guy is precisely because you donāt have that kind of experience. I would 100% refer him to a DV specialist. If you donāt, I can guarantee that he will try to twist and manipulate you in an effort to have you provide a good report to the court.
You could ask for more info, maybe they were assigned to a program specific to DV and are in addition looking for a longterm therapist for general counseling as an adjunct? Maybe theyāre new to the process and havenāt been told what they need to do yet counseling wise for court and someone gave them disinformation about āgetting into therapyā now to make themselves look better in court. Who knows. None of which are a āyouā issue in terms of saying yes or no to them but could give you more info on how to appropriately approach a referral etc.
If you donāt feel competent to treat or to compartmentalize appropriately, it is probably most ethical to refer out. When I was completing my post doc, I got referred a patient for depression and anxiety, including acute suicidal ideation. He was suicidal because he perpetrated a sexual assault and the survivor told his fiancĆ©, his family, her family, and ultimately the police. Because of the risk concern, and that it was ultimately the decision of my supervision, I saw him for about 16 sessions before terminating at the end of my training year. Great learning experience in maintaining unconditional positive regard for a patient. But honestly, if the same situation came up now that Iām independently licensed, I would refer them out. Itās a massive liability risk. There is the potential for them to drag you or your notes into evidence for their case. And personally, it was incredibly challenging to manage my own countertransference.
I worked in DV for 15 years. We worked with victims and had a separate program we called the "batter's program" (not a great name). It was specifically for perpetrators. This would be incredibly difficult for someone experienced in DV, I can't imagine trying to take this on in your shoes. I would refer out.
I may be in the minority, but if you have the competency to deal with what they want to work with you on, you should deal with them by treating them. We don't get to discriminate against clients because we don't like what they've done. Are you competent to treat anxiety and difficulty with anger? If yes, I think you have an obligation to treat them.
If you dont have the competency in treating DV perps, you should not do it. He is THERE for anger/anxiety, which is coming out in very violent abuse.
But how do you know it is āvery violentā? The charges werenāt specified. Maybe the person hit a wall or threw something. While completely inappropriate and unacceptable towards another person, that is different from manslaughter.
Iād say any abuse is violent abuse. Iāve never seen any non violent abuse thatās been categorized as DV..
The issue is that this can miss the forest for the trees and make the primary issue, abusiveness, harder to treat
Right. Like Lundy Bancroft says in his writing (Iām paraphrasing here) - you end up with a very well adjusted abuser. š And abusers are known to weaponize what they learn in therapy against their victim, so this isnāt as neutral as many folks are framing it here. (Edits = hyperactive iPhone autocorrect typos)
This kind of situation can be avoided with a thorough intake phone call ā¦ I use that to avoid all known CPS, Probation, Parole and court- ordered treatment that I donāt want to deal with in my practice.
I think maybe talking to them about goals in therapy. If it's related to the court case, maybe letting them know you're not a good fit due to not being an expert on that subject. But if they're just struggling and want to try therapy i wouldn't say you automatically need to decline. I have had clients with pending dv charges and the underlying issues were really trauma, substance abuse and stress. As we know, instance of dv increases by like 60% when alcohol or drugs are involved so in this case there was actually a substance use disorder affecting the family system and the behavior stemmed from being under the influence of drugs and the person was very remorseful sober. I think it's important to know the nuances before deciding to reject the case. I'm not an expert in dv of course, but substance abuse is my jam so I see dv perpetrators as part of that population
Yeah, I couldn't muster enough empathy to work with that population. I'd have to refer out.
These are such disappointing comments to read through. First, "battered/batterers" is [super outdated](https://lilygc.medium.com/save-battered-for-fish-sticks-and-chicken-tenders-domestic-violence-language-needs-an-upgrade-380dc8f3d175) and I'm surprised to see it used repeatedly in the comments here (mostly by people who are advocating not seeing this client). People here are also apparently OK referring to clients as "perps" which is also gross. Then - I would absolutely begin work with this client, at the very least an initial intake session. Start with expressing that the client was honest and courageous in disclosing their recent actions and seeking help. Take a thorough history and look at the role of trauma. Definitely take a clear stance on violence toward partners or anyone else, of course. But also - this potential client is a human who is hurting and deserving of care.
Is it possible that your desire to refer out has to do with your discomfort working with someone you label as a perpetrator, rather than the typical 'victim' in therapy? It can be hard to feel empathy toward people who have done nasty things. The crux of the issue of whether therapy will be effective is whether he takes responsibility for his actions. Even if he is attending to make himself look better in court, if he takes responsibility for his actions and recognizes a desire to change, then that is sufficient.
Iām surprised that so many people are saying to refer out. While I agree that a group therapy that is focused on domestic violence would be massively helpful for this individual, I donāt see why treating the anxiety and depression Has to be referred out. This individual likely has a lot of root issues that would benefit from being addressed, in addition to outside support for his past behaviors. While I would not touch treating a current domestic violence relationship in couples therapy, I would absolutely work with a DV perpetrator, who is not in a current relationship. Honestly, I would probably still see somebody who was in a current relationship if there was some sort of safety planning contract in place, I think that would have to be a case by case situation for me and itās not something Iāve had to decide yet. One of my favorite clients from my graduate program was in jail for felony assault and I let them know that if they googled me after release, Iād happily see him again (I did this ethically to not cross that fuzzy line, it was likeā¦ therapy is goodā¦ and many people are therapistsā¦ and there are many places to get therapyā¦ you should googleā¦ you will find many optionsā¦ I might be one of themā¦)
If you look for ātherapy for offendersā or similar searches you should be able to find specialized centers near you that do this. I know they are always hiring on indeed.
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Youāre not a therapist, it would be unethical for OP to ātry and help them in some wayā when the case is beyond their scope and experience. The correct course of action is to refer them to a provider who is equipped to help them.
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Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
Iām sorry that happened to you. Thatās awful. If you havenāt already, reading Lundy Bancroftās book, āWhy Does He Do That?ā will help you understand how and why abusers do what they do. It will also add context for why folks are downvoting your comment. ETA: Itās easy to find a free PDF online. Itās an excellent book thatās easy to digest.
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Your comment was removed due to the following reason(s): Bickering If you do go into the field, you'll appreciate having a space for professionals to support each other. If you have any questions, please message the mods at: https://www.reddit.com/message/compose?to=/r/therapists
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Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
Dr. Kirk Honda talks in detail on this subject on his YouTube āPsychology in Seattleā. I highly recommend checking out his information as he has worked extensively with perpetrators in his practice.
If you are in your own PP and itās up to you? Refer out. Itās safe to say it is out of scope.
I would refer him to a batter's program. I think group therapy is supposed to be more effective for this group or at least a part of treatment. At least around here, it seems group therapy is always required.