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Therapist Self-Care Compassion Fatigue & Secondary Traumatic Stress
Domestic Violence continuing education addiction counselor CEUs

Section 13
Therapist Stress Related to
Coerced Referrals

CEU Question 13 | CE Test | Table of Contents | Domestic Violence
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

Whereas reluctant referrals simply drop out of therapy, coerced referrals are more likely to continue to attend. Faced with serious consequences such as loss of their children or criminal charges if they fail to comply with an order for therapy, these parents, like Anna Ryan, feel they have no real choice but to attend. Nevertheless, they are often unwilling to discuss their situations openly. Although the coercion they experience ensures their physical presence in the room, it also overshadows any potential motivation to address individual or family issues, as these parents revealed:

“The judge said that I had to return to court myself on July 30th, which I did, and I was allowed to have my son back if, this is where it stinks, if I would have counseling for 2 years through some little upstart named Teresa. She’s 26. I don’t know what she’s done in the way of training. She’s not at all sympathetic, or empathic, or what­ever the word is.”

“How did I end up coming here? This is what I have to prove, see? They’re making me. I’ve got a choice. Either come here and see Ken and do all these sorts of things or they take the kids away. That’s the choice!”

“He just said he would see us again and we would have to come Ito therapy, otherwise ‘there are ways of making you come’ if you don’t want to come!”

Parents who are coerced referrals to therapy perceive therapy to be an extension of the CP Department and therapists, therefore, as untrustworthy. They expect that the therapist is allied with the CP Worker against them, an expectation that exists even when CP Workers and therapists describe themselves as in conflict with each other. Issues concerning confidentiality of information and the possibility of renotification often loom large for both therapists and parents.

Therapists describe coerced referrals as unmotivated and resistant, and may conclude that by ordering the family to therapy, the CP Department is shifting the burden of responsibility for the child’s safety to the therapist. Therapists know all too well that therapy is not a magical solution, particularly for those clients who have no interest or desire to be there. As one therapist described it:

“I’m afraid that we take on a family into therapy prematurely and the court doesn’t have full information. All the information they have is that the family is in therapy, and they write it off. I think there is a general feeling that therapy is magic and fixes everything up. It’s just the buck-passing process that concerns me. In some cases it can be a very risky situation.”

It is difficult and stressful, on the one hand, to have unmotivated clients, and on the other, to feel significant responsibility to “come up with the goods.” Therapists want clients who “want to be there” and who show some interest or desire to talk about their difficulties. This expectation, however, feeds into the evolving difficulties between therapists and parents, as one mother described:

“They [therapists] expect things of you; they shouldn’t expect things of you. For a start, they shouldn’t expect you to be happy or anything like that when obviously the situation—they expect you to be cooperative ... they expect you to be willing to be there when they know darned well you’re not.. . before you even walk in there, before they’ve even seen you, they must know you’re not going to be quite as cooperative, you know? Well, there you go, why do they expect you to be cooperative and willing?”

In the case of coerced referrals, there is sufficient leverage to ensure the parents’ physical presence in the room. But the transition from physical presence to open and active involvement in the process of therapy is difficult and often just does not happen. Parents remain in a defensive position and see little to gain in changing their behavior. Without a sense of choice, without the ability to define the problem in their own terms or have their definition of their relationship between themselves and the Department stick, these parents do the only thing left to do while preserving a sense of their own integrity: They resist. This resistance is sometimes subtle and sometimes overt, but always it is with such tenacity that child abuse cases are infamous among therapists for their difficulty.

And so we are left with the question “Why?” Why do parents find the situation so threatening that they resist us with such tenacity despite our genuine and often altruistic desire to help them? Why do they resist us so much more than other clients? The answers to these question are complex and multilayered, but in the next chapter, we will deal with the reason the parents themselves most often give: They see therapists as aligned with CP Workers and they feel blamed, stigmatized, and oppressed by their experiences of Department intervention. When parents have been referred from the Department to therapy, the background context that informs the parents’ relationship with the therapist is their prior and ongoing relationship with the Department. This was the case with Anna Ryan, whose story of coercion into therapy began this chapter.


Personal Reflection Exercise #6
The preceding section contained information about coerced referrals to therapy. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Aviram, A., Westra, H. A., Constantino, M. J., & Antony, M. M. (2016). Responsive management of early resistance in cognitive–behavioral therapy for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 84(9), 783–794.

Ayanian, A. H., Tausch, N., Acar, Y. G., Chayinska, M., Cheung, W.-Y., & Lukyanova, Y. (2021). Resistance in repressiveontexts: A comprehensive test of psychological predictors. Journal of Personality and Social Psychology, 120(4), 912–939.

Nissen-Lie, H. A., Orlinsky, D. E., & Rønnestad, M. H. (2021). The emotionally burdened psychotherapist: Personal and situational risk factors. Professional Psychology: Research and Practice. Advance online publication.

Urmanche, A. A., Oliveira, J. T., Gonçalves, M. M., Eubanks, C. F., & Muran, J. C. (2019). Ambivalence, resistance, and alliance ruptures in psychotherapy: It’s complicated. Psychoanalytic Psychology, 36(2), 139–147.

Online Continuing Education QUESTION 13
What court viewpoint contributed to MacKinnon’s stress regarding coerced referrals? Record the letter of the correct answer the CE Test.

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