REPRINTED BY PERMISSION from The Annals of The American Psychotherapy Association, 2001, vol. 4, No. 5, pp.15-17.
Do not be fooled into thinking the percent of battering victims (about 16%) in this country is small. Stripped of the obfuscation of statistics, that comes to between two and four million (Medical Education Group Learning Systems, 1997) and 8.7 million women a year (Feld & Straus, 1990) resulting in “more injuries to women victims than accidents, muggings, and cancer deaths combined” (Valentine, Roberts, & Burgess, 1998, p. 29).
Twenty-five percent of abused women try to commit suicide
Twenty-five percent of abused women try to commit suicide (MEGLS). Eighty percent of male batterers aggress against parents, children, pets, and outsiders. Arrests and convictions for other violent behavior of these men is significantly higher than for the general population (Walker, 1984). Domestic violence kills police too, at the rate of 25% of all slain on duty (Guerney, Waldo, & Firestone, 1987). Violence also has a medical cost: over 50 million dollars (Hart, 1993).
The costs in people hurt or killed and dollars spent are actually not the worst aspect of violence. In the long run, its most pernicious element is that it takes place within families–the precise location where people expect a safe harbor from harm, and, even worse, it is intergenerationally transmitted (Straus, Gelles, & Steinmetz, 1980). Conservative estimates of the number of children whose parents assault them while beating each other ranges between 1.4 and 1.7 million (Hotaling, Straus, & Lincoln, 1990). Unfortunately for child victims, not only are they the likely recipients of their father’s anger at their mother, but women’s likelihood to aggress against their children increases when living with their abusers (Leeder, 1994); according to Walker (1984), “eight times as many [women] may use physical violence against the children when with the batterer as with the nonbatterer” (p. 29). Sibling violence is directly proportional to the amount and severity of spouse and child abuse (Hotaling et al.). Whereas 15% of nonabused children severely assault siblings, 76% of “repeatedly abused” children “repeatedly and severely assaulted a sibling” in direct proportion to the abuse they receive from parents (Straus 1990, p. 407). Only one child in four hundred of nonviolent parents strikes that parent, but half of abused children do so, and it is to a degree that would be considered aggravated assault were parents to press charges (Straus et al., 1980).
Given the intensity of the problem, one would think that therapists have rolled up their sleeves to grapple with it. Not so. It frequently slips by the most gifted therapists–and for good reason. Perpetrators like to look good and certainly won’t tell. Besides, they must minimize its significance in their own eyes in order to face themselves every day. Victims, terrified to tell, would not bring it up in therapy sessions. Screening tools like Murray Straus’ Conflict Tactics Scale (Gelles & Straus, 1988) and Sonkin, Martin, and Walker’s (1985) anger and violence inventories should be routinely filled out as part of the intake process. But what if your agency does not want to make this addition? What if you are in the middle of working with a couple and it would not seem natural to administer an intake form at this point? Here are some red flags that may cue you in to investigate further:
- The presence of a gun is a major risk factor.
- Excessive alcohol use is a risk factor
- Abusive parents of either member of the couple raise the risk of current abuse.
- Dashed expectations. Adult survivors of childhood abuse are often attracted to one another because their common history implies that the partner somehow “knows” their pain and-leaps of logic notwithstanding-can heal it. Needless to say, that is not the case, and intense disappointment in the partner can be a red flag for current or future abuse.
- Inability to separate love and violence. Because parents who abuse their children frequently show them love in other ways, children may actually not believe the two are separable. O.J. Simpson reveals such a confounding, quoted in a Florida newspaper: “‘Let’s say I committed this crime. Even if I did do this, it would have to have been because I loved her very much, right?'” (Yup, 1998, January 7, p. 2A).
- Inability to reason with one another. Abusers are highly sensitive to what they perceive of as criticism. Even mild suggestions like, “Why not ask Jake for a job?” remind the perpetrator of his lack of that job. When discussions between partners seem to disintegrate into accusations and counter-accusations a severe abuse history is most likely lurking in the shadows and current abuse may be going on as well.
- Trouble remembering childhood. There is a lot of argument in the mental health community about repressed memories, but if casual questions about childhood draw zeros from memory banks, one could cautiously consider the possibility of past abuse.
- Woman-bashing. Asking a man about his friendships and what he talks about socially can reveal wife-bashing disguised as joking. Men who do this are often abusing or getting ready to.
- Absence of a cycle-of-violence does not imply absence of violence. According to Walker (1984) “In 65% of all cases (including three battering incidents for each woman who reported three) there was evidence of a tension-building phase prior to the battering. In 58% of all cases there was evidence of loving contrition afterward” (pp. 96-97). BUT “Over time, these proportions changed drastically. By the last incident, 71% of battering incidents were preceded by tension building but only 42% were followed by loving contrition” (p. 97). In her sample, 58% DID NOT have any loving contrition cycle.
Given that you may be saddled with an abusive couple, what is the most ethical position to take? On the one hand, therapists should not practice above their skill level. On the other hand, shelter referrals can be deadly. For example, most women referred to shelters do not go; only 2% of severely beaten women go to a shelter (Gelles & Straus, 1988). The shelter philosophy is to encourage leaving abusive partners, but that may be lethal advice. When an abused wife leaves her husband, the probability of homicide, suicide or both goes up and lasts for two years afterward (Hart, 1993; McHugh, 1993; Walker, 1993). Even if she leaves in safety and begins a new life, the untreated abuser quickly finds a new girlfriend to chase away his loneliness and fear of feeling empty. Activists in the field call this “cycling through” (Hansen & Harway, 1993; see also Gondolf, 1993). Empirical data support this: Batterers remarry more often than ex-wives (Walker, 1984).
Referring the man may not be a better choice than referring the woman. Upon discovering violence, you may have some difficulty getting a man into a batterer program; the completion rate is less than 2% (Gardiner & McGrath, 1995). Conjoint treatment is not without risk either. Ignoring the violence sends the message that it is unimportant (Flaskas & Humphreys, 1993; Leeder, 1994); attempting to address it directly by getting information from the victim can lead to her revictimization once the couple gets home. Even asking the abuser about the abuse can bring up such painful feelings for him that he again takes it out on his spouse at home (Gondolf, 1993). Attempts to have her defy his control through assertiveness training can lead to his redoubled efforts to reassert himself (Walker, 1993).
Proponents of conjoint therapy argue that the risk is there with or without the therapy if the couple stays together and increases after divorce or separation (Walker, 1993). Furthermore, the wishes of a couple that present together should be respected; to insist on asking the wife to leave repeats the very paternalism that we would not want husbands to have (Magill, 1989; Register, 1993). Given that the couple may want to stay together and want to continue therapy and given that you do not know a more skilled therapist in this area, the most ethical-and safest-position to take might be to continue couples counseling (Cook & Franz-Cook, 1984; Doan, Gutsche, & Hatfield, 1992; Hansen, & Goldenberg, 1993; Lane & Russell, 1989; Leeder, 1994; Lloyd, 1990; Singer, 1997)
With the cautions listed above clearly in mind, I would offer the following guidelines for therapy: - Obtain peer supervision.
- Learn more than you ever wanted to know about this topic. A great beginning is Jenkins’ Invitations to Responsibility (1990).
- It would be natural for you to wish to create a protective psychological distance between yourself and your clients. However, because your clients’ behavior comes out of their trauma and wounds, you must be genuine in this relationship if you ever were. Therefore, it is most important to not create an authoritative, judgmental, or sit-back-smoking-your-pipe distance from the perpetrator or the victim. You must reach for the humanity in the people facing you, and you must do it with gentleness, kindness, and respect.
- Avoiding criticism no matter how outlandish the excuses may be. Rather, continuing in this gentle manner, proceed to the next step, described below.
The key to success in working with abusive people is remembering that they have also been victims and are still hurting. By deeply connecting with their humanity combined with gentle challenges, you can get them to formulate their own goals. By praising small steps forward and continuing to challenge, you will even see change.
References
Cook, D. R., & Franz-Cook, A. (1984). A systemic approach to wife battering. Journal of Marital and Family Therapy, 10, 83-94.
Doan, R., Gutsche, S., & Hatfield, P. (1992). Overlapping conversations about men, women, power, and violence: A conference experience. Journal of Strategic and Systemic Therapies, 11(3), 20-30.
Feld, S. L., & Straus, M. A. (1990). Escalation and desistance from wife assault in marriage. In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in 8,145 families (pp. 489-505). New Brunswick: Transaction Publishers.
Gardiner, S., & McGrath, F. (1995). Wife assault: A systemic approach that minimizes risk and maximizes responsibility. Journal of Systemic Therapies, 14, 20-32.
Gelles, R. J., & Straus, M. A. (1988). Intimate violence. New York: Simon & Schuster.
Gondolf, E. W. (1993). Treating the batterer. In M. Hansen & M. Harway (Eds.), Battering and family therapy: A feminist perspective (pp. 105-118), Newbury Park, CA: Sage.
Guerney, B. G., Waldo, M., & Firestone, L. (1987). Wife-battering: A theoretical construct and case report. American Journal of Family Therapy, 15, 34-43.
Hansen, M., & Goldenberg, I. (1993). Conjoint therapy with violent couples: Some valid considerations. In M. Hansen & M. Harway (Eds.), Battering and family therapy: A feminist perspective (pp. 82-92). Newbury Park, CA: Sage.
Hansen, M., & Harway, M. (Eds.). (1993). Battering and family therapy: A feminist perspective. Newbury Park, CA: Sage.
Hart, B. J. (1993). The legal road to freedom. In M. Hansen & M. Harway (Eds.), Battering and family therapy: A feminist perspective (pp. 13-28), Newbury Park, CA: Sage.
Hotaling, G. T., Straus, M. A., & Lincoln, A. J. (1990). Intrafamily violence and crime and violence outside the family. In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in 8,145 families (pp. 431-470). New Brunswick: Transaction Publishers.
Jenkins, A. (1990). Invitations to responsibility: The therapeutic engagement of men who are violent and abusive. Adelaide, South Australia: Dulwich Centre.
Lane, G., & Russell, T. (1989). Second-order systemic work with violent couples. In. P. L. Caesar & L. K. Hamberger (Eds.), Treating men who batter: Theory, practice, and programs (pp. 134-162). New York: Springer.
Leeder, E. (1994). Treating abuse in families: A feminist and community approach. New York: Springer.
Levy, T, & Orlans, M. (2000, October 24). Attachment disorder. Workshop presentation at the American Psychotherapy Association Conference, Las Vegas, NV.
Lloyd, S. A. (1990). Asking the right questions about the future of marital violence research. In D. J. Besharov (Ed.), Family violence: Research and public policy issues (pp. 93-107). Washington, DC: AEI. McHugh, M. (1993). Studying battered women and batterers: Feminist perspectives on methodology. In M. Hansen & M. Harway (Eds.), Battering and family therapy: A feminist perspective (pp. 54-68).). Newbury Park, CA: Sage.
Medical Education Group Learning Systems (MEGLS) (March, 1997). Domestic violence: 1 hour: An interactive program designed to satisfy the mandatory domestic violence educational requirement for license renewal and initial licensure, approved by the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling for all licensed professionals. (Available from MEGLS, 1833 Boulevard Suite 609, Jacksonville, FL 32206)
Singer, M. (1997). Saving face: Applying a systemic approach to domestic violence. Journal of Systemic Therapies, 16, 229-245.
Sonkin, D. J., Martin, D., & Walker, L. E. A. (1985). The male batterer. New York: Springer.
Straus, M. A. (1990). Ordinary violence, child abuse, and wife beating: What do they have in common? In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in 8,145 families (pp. 403-423). New Brunswick: Transaction Publishers.
Straus, M. A., Gelles, R. J., & Steinmetz, S. K. (1980). Behind Closed Doors: Violence in the American Family. Garden City, NY: Anchor. Walker, L. E. (1984). The battered woman syndrome. New York: Springer. Walker, L. E. A. (1993). Legal self-defense for battered women. In M. Hansen & M. Harway (Eds.), Battering and family therapy: A feminist perspective (pp. 200-216). Newbury Park, CA: Sage.
Yup, what goes around . . . (1998, January 7). The Herald, p. 2A.
Hello Dr Deb…
It is very nice to be able to read your articles…All together.
You do have a strong insight into the heart of abusers (sufferers).
I wanted to let you know that the AA program is actually a way to learn yourself about your bad parts (necessary to change and to be able to accept them), but also of your good parts! Balance is the key… Too much self-hatred is not encouraged… we are all a mix of both as you said … and knowing both parts of yourself helps you to love yourself…
It is a little short as an explication… but I am doing the AlAlanon program, and the 4th step is very much about knowing yourself…the good and the bad… like everybody else!
You are correct! I hope you will take a look at my own “take” on the 12 steps — the first 6 are in this blog and the next 6 are on my You Tube channel, DrDeb Empowers.