I write this column (using “he” throughout, for simplicity purposes) to suggest some useful ideas for vetting a prospective provider who does not come recommended through a reliable source (or through Donna Anderson’s growing new LoveFraud referral base).
How can you begin to assess a relatively unknown provider for his competence to address your experiences with a suspected sociopath specifically, exploiter in general, or otherwise personality-disturbed individual?
Let me start by suggesting that a provider who claims to be educated about sociopathy really isn’t if he lacks an equally fluent understanding of narcissistic and borderline personality disorder.
The reason I say this is that, under certain circumstances, all three disorders can look very much alike; but more importantly, if you are involved with someone who has any one of these disorders, you are at heightened risk of being personally violated and abused.
So, while they are distinct from each other (although common elements of narcissism and sociopathy remain intriguing), I’m suggesting that all three disorders greatly increase the probable, if not certain, occurrence of interpersonal violation.
In the course of this discussion, I’m going to assume that you may be involved with someone (or have been involved with someone) whom you suspect (or know) to be, for instance, sociopathic and/or abusive? Otherwise you wouldn’t be seeking assurances that a particular provider has knowledge and/or expertise of the disorder(s) in question.
I also make the assumption that LoveFraud members or visitors wanting to find a knowledgeable resource on sociopathy (who do not find assistance through Donna’s new referral resource) come with a nice advantage—by virtue of their involvement with LoveFraud, they are already extra knowledgeable on the subject. This equips them to be astute evaluators of a prospective resource.
So let’s get down to business.
You will need, no surprise, to ask questions; questions that can gauge the provider’s competency to appreciate the gravity of a situation in which a sociopathic (or some other exploitative dynamic) is, or has been, present.
And you will want good, expressive answers to your questions, not dismissive ones.
The first, vital task is to assess the provider’s receptivity to your interest in his clinical experience. This point needs emphasis: You are entitled to evaluate the provider’s clinical experience and expertise as it pertains to your circumstances.
I stress: You are completely, utterly entitled to assess the provider’s professional experience, skills, and interest on matters relevant to your personal circumstances and self-interest.
Remember, this is not about protecting the provider; it’s about protecting yourself.
As such, this speaks to a bigger issue: You are setting yourself up if you do not protect yourself, and so you protect yourself by owning your right to a completely respectful, receptive invitation to evaluate the provider’s scope of interest and competence with a given client population, or in a particular clinical area. Anything less than a genuine, undefensive invitation from the provider to proceed with your questions should immediately disqualify him from consideration.
So for instance, you might begin with something like, “You know, it’s very important to me, given my circumstances, to be working with someone I can feel confident has a really good knowledge of _________. Would you mind if I asked you several questions along those lines, for my own personal comfort?” (There are many ways to break the ice, this is just one example.)
Remember: A provider who fails, at this point, to invite you to proceed, undefensively, has disqualified himself. Thus, if he responds impatiently, arrogantly, angrily, curtly, condescendingly, as if offended or put-off, or in any other way inadequately, he is wrong for you. You must move on, because you deserve better.
Assuming you’ve gotten the proper encouragement to proceed, I offer below a list of questions (hardly comprehensive) which, depending on your circumstances, can elicit meaningful information. The idea (quite obviously) isn’t to ask all of these questions, but to pursue several that are most applicable to your situation.
This list is by no means complete; rather, it’s at best a starting point, if only to get your own wheels rolling to come up with even better questions! Note that some of the questions probe for knowledge, others for personal views and biases, and others for experience. The asterisked questions can sometimes elicit responses that will enable you to quickly eliminate potential resources.
· How familiar are you with sociopathy?
· How familiar are you with psychopathy?
· Do you distinguish sociopathy and psychopathy, or are we using these terms to mean the same thing?
· Do you distinguish antisocial personality disorder from sociopathy or psychopathy?
· How many cases have you worked involving sociopathy?
· Can I ask how you came to work with these individuals?
· What is your treatment philosophy regarding sociopathically disturbed individuals?
· I’m curious how you view sociopathy? I know that many people have different ideas about sociopaths. Can you tell me your view of what characterizes the sociopath?
· How do you distinguish, if at all, the sociopath from the narcissistic personality?
· What’s been your experience working with borderline personality disturbance?
· In your experience, what are similarities and differences between borderline, narcissistic and sociopathically disordered individuals?
· How much experience have you had working with abusive individuals?
· Can you tell me a little about the history of your interest, and experience working, with abusive personalities?
· *How effective and appropriate, in your experience, are anger management referrals for abusive personalities?
· How much interest, and experience, have you had working with victims of abuse?
· What is your view of what constitutes abuse in a relationship?
· What are your goals in working with someone who is in, or has been damaged by, an abusive relationship?
· *Are there circumstances where someone might be driven, legitimately, to abuse someone else?
· Do you mind if I ask you whose work or writings on abusive relationships and abusive personalities has most influenced your views?
· Do you mind if I ask you whose work on the subject of psychopathy (or sociopathy) has most influenced your ideas?
· *Are you familiar with Robert Hare’s work?
· *Have you successfully treated sociopaths?
· My partner, if you meet him, will tell you that I’m a sociopath…how will you know which of us, if either, is the sociopath?
· Are you familiar with any psychological instruments that assess for psychopathy, and if so, do you use them?
· *Under what conditions, if any, would you be hesitant to do couples therapy?
· What goals do you have, generally, when working with a borderline personality?
· What goals do you have, generally, when working with a narcissistic personality?
· What is your understanding of the central feature(s) of sociopathy?
· What is your understanding of the central feature(s) of the narcissist?
· Would you be willing to read something I’d give you if I felt it could help you understand the precidament/situation/personality I’m dealing with?
· When you believe you are dealing clinically with a sociopathic individual, what is your clinical goal?
The answers to your questions
As I’ve strongly suggested, the provider’s responses, first of all, should convey interest in, and respect for, your questions. Your first assessment, then, is less of the provider’s expertise and knowledge, than his or her attitude to your questions.
As a matter of fact, a primary purpose of your questions is to assess the attitude of the provider. In other words, if the provider isn’t temperamentally suited to appreciate the complexity of your concerns, he or she can have all the knowledge in the world and be pretty much worthless.
You’ll want honest answers. Genuine answers. Not pretenses to expertise where there isn’t any. You’ll want a provider who is willing to say, “That’s an interesting question. I might even need to think about that a bit more.”
I offer randomly some rough examples (from countless possibilities) of what might be deemed encouraging responses to some of these questions:
“To be honest, no…I haven’t worked with what I’d call a high volume of ________; but I do feel comfortable with my understanding of this clinical issue, and I’d like to be of help to you.”
“I consider myself to be clinically literate on this subject, but I’m happy to become even more enlightened and would welcome anything you have to share with me to get me up to speed.”
“I wouldn’t say that I have a particular interest working with _______, but I do like working with and helping those who have been victimized by ________(s).”
“I suppose I’d regard ______as a very central feature of _______. Also ______.”
“I don’t really make a distinction between antisocial personality and the sociopath? As a matter of fact, I wasn’t even aware of such a distinction? But I’m curious about that? Am I missing something?”
“I’ve worked a great deal with victims of abuse and enjoy working with this client population.”
“I’m not familiar with that issue, to be honest” (depending on the circumstances, this doesn’t necessarily have to be a disqualification).
“I can’t say that I’ve had great success working with narcissistic personalities…but I’ll work with anyone who voluntarily seeks my help genuinely.”
“I’m not sure if I satisfied you with my response?”
These hypothetical replies have in common a thoughtful, humble, curious quality. The confident provider will feel relaxed, undefensive, and unpressured to produce brilliant, comprehensive answers beyond his or her scope of expertise.
At the same time, you are looking for evidence of expertise that will leave you feeling comfortable that this is someone who can effectively, sensitively advocate for your interests.
Some responses, as noted, can quickly reveal a provider’s serious limitations.
For instance, the response to the question, Have you successfully treated any sociopaths?, “Yes…I’ve worked with many sociopaths and treated several very successfully,” is a great time-saver. You just say, “Thanks very much, I’ve really appreciated your time,” and then have a good laugh on your way out.
That’s because true sociopathy, as the LoveFraud community well knows, is a refractory
condition, unamenable to meaningful modification.
Regarding the Hare question: in cases where a provider claims to be experienced with the subject of sociopathy, I might find it dubious (although not necessarily instantly disqualifying) that he or she would have no knowledge of Robert Hare, who is such a notable figure in psychopathy research.
Similarly, the response to the question, Under what conditions would you be hesitant to do couples therapy?, “Umm….I can’t really think of any?,” would suggest a potentially serious defect in the provider’s clinical knowledge and/or judgement. That’s because couples therapy is ill-advised under several circumstances, among them when serious abuse is occuring in a relationship, or when one or both partners is sociopathically oriented. (And naturally, non-genuine motivation to work on the relationship would be another contraindication.)
Further, a provider who suggests that, yes, a referral for anger management is probably the best intervention you can offer an abusive personality betrays a likely ignorance of the dynamics of the abuser, who has much more than merely an anger problem.
And it’s self-evident that a provider who can find a basis to justify abuse under any circumstance is probably confusing abuse with, perhaps, self-defense—a failure of understanding that ought to send you running for the hills.
Bear in mind there is no one right way to answer many of these questions; in many cases, there are multiple good (and good-enough) answers which also allow for differences in clinical approaches and orientations.
I offer below additional examples (also random, hypothetical) of the kinds of responses that might reflect a reassuring level of clinical expertise:
“What do I see as the central feature of sociopathy? I see the sociopath as someone who is extremely, chronically manipulative and deceptive. Someone who lacks empathy in a very gross way for the victims of his or her exploitation.”
“I see what you mean….you can have a borderline personality disorder doing something, say, really vengeful that might look very sociopathic, but the motive for the aggression would be different. The borderline personality might be motivated by rage, panic, or desperation over, say, abandonment issues, whereas the sociopath? He or she may be movitated by…the impulse?…pure greed…or even the fun of it?”
“If I have good reason to believe I’m dealing with a sociopath, my main goal becomes evaluating his or her risk to others…depending, of course, on the circumstances of the referral and case.”
“If I’m working with someone with borderline personality, I’m looking to help that individual, among other things, learn how to better regulate his or her emotions, which may be very dysregulated and for that reason a source of much distress.”
“If I’m working with a narcissistic personality disorder, I’m looking, over time, to help that individual, if possible, examine his demands and expectations of others—his inflated sense of entitlement—more thoughtfully; and also examine the ways that he routinely handles, or mishandles, his disappointment in others.”
“When I’m working with abusive individuals my goal is to confront their excuses and rationalizations for their violating behaviors.”
“When I’m working with victims of abuse I may have several goals, including safety concerns; also exploring how the client finds herself in an abusive relationship, and the factors that make it difficult for her (or him) to leave that relationship.”
“How will I know which of you is the sociopath? I think in any clinical situation, you rely on a number of factors in formulating possible diagnoses, including your instincts, your experience of the individuals, the client’s history (as furnished by the client and others), other relevant, available, supporting documentation; and any adjunctive testing and evaluations that can narrow down, if necessary, a suspected diagnosis more accurately? And so there’s no guarantee that I’ll get it right, but I’m pretty confident of my chances.”
In sum, you’ll want assurances that the provider, at a minimum, can recognize the central aspects of sociopathy (or the disorder in question); he or she should appreciate the futility of pursuing treatment with the sociopath, especially in a private practice setting; but most importantly, the provider should be able to convey a good clinical grasp of, and history of work with, abusive personalities and their victims.
You will know, intuitively, whether the provider’s responses indicate an adequate level of thoughtfulness and knowledge.
And remember, your initial assessment doesn’t end when you choose to begin a working relationship with a particular provider, anymore than you cease evaluating the individual with whom you enter a personal relationship. Your evaluation should be ongoing, and your continued investment in the relationship, whether with a professional resource, or intimate partner, should be based on a continuing evaluation of him or her as worthy of your time and trust.
You can say at any point along the way, This person is not right for me. Just because I sized this person/provider up initially (with necessarily incomplete information) as worth my initial investment, doesn’t mean I can’t modify my assessment of him or her at any time, thanks to my making good use of additional, more complete information!
I hope this offers some guidance for conceptualizing an approach to the evaluation of a relatively unknown prospective provider. I am glad to continue this discussion based on feedback.
(This article is copyrighted (c) 2009 by Steve Becker, LCSW.)