What Therapists Really Do When Patients Tell Them About Domestic Abuse

Photo: Hilary Bronwyn Gayle/Courtesy of HBO.
In a show full of affairs, bullies, and revenge, it's a little surprising that so much attention is being paid to Big Little Lies' therapy scenes. But it's because they're just that good.
As others have pointed out, those scenes are both extremely compelling and accurate. It's admittedly a bit jarring to watch couples therapist Amanda Reisman (Robin Weigert) confront Celeste Wright (Nicole Kidman) so directly about her husband's abusive behavior, bluntly telling her at one point, "We should come up with a plan for the next time he hits you." But as uncomfortable as those moments might seem, that directness is sometimes a necessary part of a therapist's job.
And Celeste's visible discomfort is pretty true to life as well. "They’re doing a good job of showing her shock and bristling at the therapist," says Michael Brustein, PhD, an NYC-based clinical psychologist specializing in couples therapy. "That really speaks to the dynamics of what somebody who's been through abuse would go through [in therapy]."
That's because the first step to helping a patient who may be with an abusive partner is guiding them to recognize the reality of their relationship on their own, Dr. Brustein says. But that's not always an easy process. "It might be hard for a patient to acknowledge abuse because they don’t want to see themselves as someone who is with an abuser," he explains. Accepting that you're in an abusive relationship often comes with feelings of guilt and shame for getting into it and not getting out sooner. At the same time though, "it's powerful to own that," Dr. Brustein says. (Side note: Domestic abuse can happen to anyone, it's not survivors' fault, and asking for help is hard — but very much worth doing.)
At one point, Celeste questions Dr. Reisman's decision to start seeing her individually. Although that's not necessarily something a couples therapist will do on a regular basis, Dr. Brustein says it happens more often than you'd think. It's particularly common in the early assessment phase when the therapist is getting to know you and your partner, or later on if only one of you needs to learn, say, anger management skills. And, certainly, when abuse is suspected, your therapist might suggest that individual appointments would be better.
Celeste's case is also complicated by the fact that her husband (Perry, played by Alexander Skarsgard) can be a good father. But abusive relationships aren't necessarily abusive all the time. So her initial reaction to her therapist's bluntness is entirely understandable, as is Dr. Reisman's need to consistently bring the discussion back to abuse. Normally, if a patient appears to be in an abusive relationship, "I would try to get exact details of what happened in the [abusive] interactions, reflect them back to the patient, and ask how she felt about it," Dr. Brustein says. With enough details, and hearing the therapist say them back to her, "My hope would be that the patient would say, 'Oh, this is abusive.'"
But he says it's definitely not unusual for a patient to be resistant to that approach. "If that fails or they were unable to refer to it as [abuse]," he says, "it would be appropriate to directly call it what it is." And if the therapist found out that children were also being abused in the relationship, Dr. Brustein says he would be required by law to report it.
Once the therapist and patient are on the same page, though, they can start to come up with a plan to help the patient get out of the relationship safely. At that point, Dr. Brustein says the patient's financial resources and level of support from friends and family need to be taken into account — as does the abusive partner's potential reaction. If there's reason to believe the partner might become violent, for instance, "you want to just get out without confronting them, so you have to do it kind of in secret," he says.
As for Dr. Reisman's suggestions that Celeste take pictures of her injuries and confide in a friend to document the abuse, Dr. Brustein says that makes total sense.
However, it's good to remember that everyone's therapy is different, Dr. Brustein says. So what you might experience might not be exactly what we see Celeste going through. But if you're in any way concerned about your relationship or your partner, talking with a professional counselor can help you find clarity and stay safe — and we're glad such a popular show is helping to demystify that process.
If you are experiencing domestic violence, please call the National Domestic Violence Hotline at 1-800-799-7233 or TTY 1-800-787-3224 for confidential support.

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