Individuals may seek out the help of a therapist for a myriad of reasons. Regardless of the purpose behind their visit, a patient’s drive for being there doesn’t always end up matching what a provider uncovers. People are rarely single-faceted in their challenges when they first meet their therapist, and it can take time to discover every layer contributing to a person’s mental health challenges.

It is the provider’s job to help the client navigate these facets at their own pace to understand themselves and improve their mental health. This can be an extremely challenging path to course as it is also your job to protect the trust that exists between you and your clients.

As therapists, you may sometimes uncover something about a patient that they have yet to uncover about themselves or are not yet willing to admit to you. A common example of this is with patients experiencing emotional or physical abuse in their personal life.

It is vital for providers to recognize and understand the signs and patterns of abuse, understand why patients may hide them from you, and what to do once you know.

5 Ways to Spot the Signs of Abuse in Therapy:

  1. Defending the Abuser – Regardless of the type of abuse, clients may recall the behavior of their partner that could be considered abusive and are fast to defend them. They may brush off the severity of the situation, justify it, or blame themselves.
  2. Physical Signs – Bruises, marks, or signs of pain. When asked about these injuries, clients may be hesitant to give a reason or have an elaborate/unlikely cause for them.
  3. Withdrawing From Other Relationships/Clinging to Abuser – If a client is showing signs of removing themselves from other relationships and clinging to no one other than their abuser.
  4. Mental Illness – Depression, anxiety, PTSD, and others are linked to experiences of abuse.
  5. Engaging in Harmful/Risky Behaviors – Substance use, self-harm, etc.

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Why Do Patients Avoid Talking About Abuse in Therapy?

Once you have spotted the signs, you are likely ready to dive right in and start helping your client navigate their way out of their situation, but that isn’t the best way to approach this.

Protection – Clients hide their abuse for many reasons, but it can be related to protection. Abusers may threaten victims should they try and share what is happening to them. Other times, victims feel like they are protecting others by limiting the abuse to just themselves.

They’re Not Ready – While this concept seems outlandish to many of those who have not experienced abuse, it’s true. Therapists always need to be willing to move at their client’s pace, not their own. If your client isn’t ready to talk about their abuse, you should not bring it up.

They Don’t Know – Not everyone realizes that they are experiencing abuse. If your client is under the impression that their situation is normal, then hearing that they’re being abused is going to be a shock.

They’re Unsure How To – Talking about something that feels as large as your abuse can be intimidating to bring up – even in therapy. Clients might not be sure how to start the conversation on something so huge to them.

Fear – Of course, there is usually a mountain of fear surrounding bringing up one’s abuse to someone, let alone a person you don’t know very well. Sometimes clients need to know that they can trust you before they’re willing to bring it up. Sometimes they don’t know what will happen to their life once they do, so they refrain from it. Sometimes they fear they’ll be judged for dealing with their abuser for so long, so they keep quiet. Fear is a huge immobilizer.

How Do You Talk to Patients About Their Abuse?

If your client isn’t quick to disclose their abuse on their own, but you are recognizing the signs of its existence, you have options.

  1. Go Slow – First, you need to remember that this is a fragile situation, and it needs to be handled with grace and care.
  2. Build Trust – Take as much time as your client needs to build trust in your therapeutic relationship with you so that they feel comfortable sharing information that is tough for them to bring forward.
  3. Take Notes – If you uncover any signs of abuse during sessions, make sure to document them in session notes. This will allow you to monitor the signs throughout the therapy process and keep a close eye on clients who you deem to be at risk. Software like TheraNest can help you digitally create session notes that are easy to create and reference later.
  4. Don’t Lead – Let the client steer the ship. Remember that you are not there to decide where they need to go, but to help them navigate what they feel is impacting them the most. Hopefully, they will trust you and feel comfortable enough to talk about their abuse. This can be challenging when you feel like you know how to help them.
  5. Look for Natural Opportunities – While a client may not come straight out and say, “I’m being abused,” they may disclose an abusive experience to you. This could be something small, but it is a great opportunity to get them to expand on their relationship with their abuser and is a great sign that they are trusting you with this information. Make sure to just listen because they still haven’t admitted to abuse at this point. Once they’re finished sharing, you can ask them if they feel comfortable sharing more, or if this type of dynamic is something that occurs often in their relationship with that person. This can be a gateway into talking to clients about their abuse moving forward. If the client doesn’t wish to continue, respect that and move on to something else until they’re ready again.  
  6. Once Trust Has Been Built – Once trust has been built, and you and your client have discussed their abuser on more than one occasion, you may start to notice your client opening up about the negative aspects of their relationship with that person. This may be a good time to start discussing the signs and definitions of abuse, and how that may apply to them in this situation. It is up to you as the therapist to determine whether you think your client is prepared to hear this and should not bring it up before they are.

Abuse is something that every therapist can encounter, regardless of their client’s initial reason for seeking out care. It’s vital to know the signs, why clients avoid it, and how to talk about it with them once you’ve identified it. If you have a client that is experiencing abuse, make sure to connect them with the right resources. National Domestic Violence Hotline: 800-799-7233

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