Domestic Abuse: Where Are All the Therapists?

by Carol Lambert, MSW

Those who experience psychological abuse from an intimate partner often suffer from mental health problems as a result. In order to get treatment, they consult therapists and other mental health professionals. But the majority of mental health professionals don’t have enough knowledge of psychological domestic abuse to provide treatment that these individuals would find truly helpful—perhaps because psychological abuse is much more difficult to detect than physical abuse.

A 2013 study of mental health professionals was conducted on the premise that a large percentage of “psychiatric service users experience domestic violence, yet most cases remain undetected by clinicians.” The aim of the study was to “assess mental health professionals’ knowledge, attitudes and preparedness to respond to domestic violence." The results showed:

  • Only 15% of mental health professionals asked clients about domestic violence.

  • Upon disclosure (either self-initiated or from being asked by the therapist) only 27% of therapists provided helpful information.

  • Most professionals (60%) felt they lacked sufficient knowledge of helpful support services for their clients.

The study concludes that mental health professionals need more training to address domestic abuse—both physical and psychological—with their clients.

The following statistics show why. There are many in the US experiencing domestic violence and its effects, so there is a real need for mental health treatment.

Coercive Tactics and Hidden Injuries

Intimate partner abuse is about one partner gaining power and control over the other. The coercive tactics used by an intimate partner to accomplish this make up psychological abuse that in turn cause hidden injuries including depression, anxiety, and low self-esteem that often can be the presenting symptoms in psychotherapy. Psychological abuse requires therapists to have background knowledge of it to truly help their clients to recognize the coercive tactics embedded in their intimate partner’s behavior that affects their mental health—a critical first step in their recovery.

Psychological abuse is made up of coercive tactics that, in time, can mount to a loss of one’s identity. Of the many coercive tactics that I address in my groups for women with controlling partners, the following two are common and devastating to the targeted person:

Monopolization of perception (or gaslighting) is when a partner makes his thoughts, feelings, and perception the overriding reality for the couple or family. This is done by withholding information, distorting the truth, lying, or changing reality—often with accusations toward the other partner that they’re distorting, lying, not remembering correctly, etc. The hidden injury in this tactic is that over time this causes self-doubt and the erosion of trust in one’s own perception that leads to being all the more vulnerable to the coercive partner. Anxiety and depression are only some of the resulting conditions.

Devaluation and humiliation is coercive behavior that’s intended to degrade another by ridiculing the partner’s character and sense of self that include name-calling and putdowns. In my experience, these attacks are often directed at the individual’s strengths since her strengths can threaten the success of the coercive control. It’s not surprising that over time, there is an increase in shame and a loss of self-esteem. Once this occurs, there’s a greater propensity to blame oneself for the problems in the relationship, including the abuse that the sufferer endures. In the end, the cost of resistance can seem more damaging to one’s self-esteem than giving in to the abuser’s demands.

In intimate relationships, these coercive tactics are among many that can cause serious mental health conditions including depression, anxiety, low self-esteem, dissociation, post-traumatic stress disorder, and low self-efficacy—the sense that one can make a difference in one’s life.

A Call to Action for Therapists

In the United States, physical domestic violence is criminalized—it’s apparent and easy to recognize—but psychological abuse remains unaddressed by the criminal justice system, probably because it’s much harder to detect. Additionally, psychological abuse is known to be a precursor to physical violence so the more we can help detect it, the more lives can be helped and saved. Psychological abuse is not yet formally criminalized by law in the US, which makes the role that therapists play in helping individuals heal and protect themselves that much more vital.

How Therapists Are Key in Helping Those Who Are Experiencing Abuse

  1. They can help those who are currently in psychologically or physically abusive intimate relationships find the right mental health treatments. These are often critical for individuals to gain the strength to decide whether to leave their relationship. Assistance can also include helping find legal aid.

  2. They can assist those who are exiting or have exited abusive relationships, and provide recovery from the traumatic effects of the abuse. With domestic abuse, physical injuries heal in a matter of months, but psychological effects from abuse can linger for years and hinder self-esteem and identity (see 2015 study in Women’s Health Issues Journal).

How Therapists Can Inform Themselves About Domestic Abuse

You can start to familiarize yourself with psychological domestic abuse and the resources available for it by visiting online resources and looking up books. The first resource listed below is an excellent option to offer a client who's at risk for physical violence.



Carol Lambert, MSW, is a psychotherapist and domestic violence expert with three decades of clinical experience helping individuals and groups, and a career-long commitment to women’s psychological health. She is the author of Women with Controlling Partners, which came out December 2016.



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