HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals

TYPES OF DOMESTIC VIOLENCE AND FAMILY SYSTEMS THERAPY: INITIAL OBSERVATIONS AND CONSIDERATIONS

  • Eufrosyni SpaneaPsychologist, Consultation Centre Athens for family violence. General Secretariat for Gender Equality. Greek Ministry of Interior, Graduate of Systemic Family and Couple Psychotherapy Training Course, University Mental Health Research Institute, Athens, Greece.
  • Intimate partner violence
  • Typologies
  • Couple therapy

Periklis Antoniou Photo

Abstract

Α frequent feminist critique towards couple therapy is that placing a violent man and his victim in close quarters and inviting them to address contentious issues in their relationship has the potential to revictimize the woman physically and psychologically and to provide the offender with a platform for self-justification. But at the same time, an individual intervention lacks the lived experience of many of these couples and their extraordinarily intense, mutual reactivity. In this still unresolved controversy over whether interventions should be addressed only to victims or also to couples, help may be found in the distinction proposed by Johnson of four major patterns of partner violence. The presentation describes cases from the Family Therapy Unit of Eginition Hospital, in order to examine the difficulties that arise in systemic treatment of partner violence, and to assess whether a typology like the above is helpful for an adequate and safe intervention.

Key-Words: Couple therapy, Intimate partner violence, Typologies

As family therapists we frequently have to work with couples in which there is intense violence. In fact, studies have demonstrated that between 36% and 58% of couples who seek regular outpatient treatment have experienced male-to-female physical assault in the past year and between 37% and 57% have experienced female-to-male physical assault  (Jose & O’Leary, 2009).

Is couple therapy the preferable treatment for these couples? According to the feminist approach, which dominates interventions in domestic violence in the western world, the answer is a resounding NO (see e.g. Avis, 1992, Bograd, 1984, Dobash and Dobash, 1979). In criticizing couple therapy, feminist critics explain that the emphasis of systemic reasoning on the circular nature of interactions overlooks the dominant role of inequality of power in relationships (man-woman, adult-child). This oversight might jeopardize the safety of the woman, since it is possible that the discussion in therapy of a burning issue might be followed by physical and/or psychological revictimization. Furthermore, accepting the victimizer in therapy together with the victim might provide the offender with a platform for self-justification.

On the other hand, personal intervention deprives the therapist of a first-hand observation of the intense interactions of the couple. Also, very often the spouses declare that they want to continue their relationship, feel intense emotions and are so absorbed in each other that they demand to see a therapist as a couple. These couples have to face the challenges and bear the burdens of a family, such as managing finances and raising children. Though ineffective, violence can be used as a way of coping with stressors and interpersonal problems. Conjoint therapy may help the couple to discover new and more functional ways of interaction and problem management (Nandini, 2016).

Couple therapy enables the therapist to understand the setting in which violence and imposition of power unfold and to intervene in vivo. It is one thing to tell the husband to detect when he becomes angry and leave before becoming violent, and a totally different thing to be in the room together with the couple, ask the husband when he begins to feel the first indications of tension and fear and, when those are detected, say “This is the moment you should say to yourself, 'It's time to go”. (Goldner, 1988, 2013).

A systemic approach may help the couple to recognize the inequalities in power between the partners and help develop a more equitable model of interaction. Also, the recognition of the transgenerational transmission of violence, a common finding in the literature (see Dutton 1998), can help both partners to understand their present behaviors in the light of the attitudes, the expectations and the gender role stereotypes that they acquired in their families of origin. Rather than providing justification for the perpetrator’s actions, systemic approach can be employed to encourage the man to accept full responsibility for his behavior and empower the woman to take control over her safety and emotional well-being (Goldner, 1988, 2013, Nandini, 2016, Stith et al. 2012).

Recent research has come to recognize that the criticism regarding dangerousness is unfounded; both women and men valued more similar aspects of the couple therapy than expected, especially the presence of two gender co-therapists, and reported feeling safer, especially emotionally, after participating in couple therapy for domestic violence (Lechtenberg et al. 2015, as reported by Vall et al,. 2016). In a relatively recent review of various forms of couple therapy for domestic violence, Stith and her coworkers (2012) pointed out that despite the misgivings of clinicians and social services, systemic interventions in couples can safely reduce the frequency of physical and psychological domestic violence without increasing the danger to the victims.

On the other hand, psychoeducational interventions on perpetrators do not appear to be very successful (Babcock et al. 2004; Stith et al. 2004; Stith et al., 2003), since they are plagued by a high incidence of dropouts and relapse of violence. This lack of efficiency has been attributed by the sociologist Johnson (2000) to the fact that domestic violence is addressed as a single phenomenon and the possibility of diverse types and patterns of violence in couples is not recognized. Indeed, during the last decades a growing body of empirical research has convincingly demonstrated the existence of different types or patterns of intimate partner violence (Friend et al., 2011; Holtzworth-Munroe et al., 1994; Johnson, 1995; Johnson & Ferraro, 2000; Kelly et al., 2008). One of the best-known typologies in the literature is the one proposed by Johnson et al (Johnson, 1995; Leone et al, 2004). This typology was based on the observation of broader patterns of CONTROL in the relationship; these patterns are based on the motives of the partners. Johnson tried to interpret the contradictory findings of domestic violence studies from the feminist and the family therapy perspective by distinguishing two different types of couple violence: Common Couple Violence/Situational Violence and Intimate Terrorism; the latter corresponds to the stereotype of an abusive relationship. Johnson (1995), having enough findings, claimed that feminist studies, which usually recruit subjects from women’s shelters, court-mandated treatment programs, police reports and emergency rooms, find different percentages and outcomes of physical domestic violence than large-scale survey research using community or national samples. According to Johnson, this happens because the populations studied are characterized by different types of violence; the type of violence that is encountered more frequently in the general population is the one he names  Common Couple Violence/Situational Violence .This consists in confrontations between partners who do not succeed in managing their disputes adequately, so that those disputes escalate to “mild” violence, with the sporadic appearance of more serious incidents. Here violence does not aim at total domination of the partner but is temporary and springs from a stressful situation that creates emotional stress, to which one or both partners react violently. This violence is usually mutual, infrequent and doesn’t tend to escalate with the passage of time. This is the most usual form of violence in couples, although not the kind of violence that people think about when they hear about domestic violence. On the other hand,  Intimate Terrorism  is the type of intimate partner violence encountered most frequently in agency settings such as law enforcement, courts, shelters, and hospitals. This comprises patterns of violence and other behaviors that have domination as their goal. In this type, violence is more frequent, escalates to serious violent episodes and persists over time. The overwhelming majority of perpetrators exhibit sexist or patriarchal attitudes; the perpetrators also often exhibit borderline or antisocial traits (which is why this type of violence is also known as characterological violence).

More recently, Johnson (2008) extended his typology to encompass two more types of domestic violence. (1) Violent Resistant Couples: One partner is violent and controlling, whereas the other partner is violent but not controlling. Violence is employed for self-protection from persistent victimization by a perpetrator. Therapists who fail to assess the setting and the intention may mislabel self-protective behaviors as acts of abuse. (2) Mutual Violence Control: Here, both partners are controlling and violent in a situation that could be viewed as two intimate terrorists battling for control. This type seems to be the most rare, and we know little about it.

That’s why, says Johnson, programs of intervention in domestic violence fail: because the therapy offered to everyone is actually appropriate only for a minority of perpetrators, those with the patriarchal profile. For couples who fall into the category of situational violence, couple therapy would be much more appropriate and safe (Simpson et al. 2008; Stith et al. 2004, 2012). In cases of Intimate Terrorism or when the husband is also violent outside the family, some researchers stress that couple therapy should be avoided because it probably puts the wife at risk (Holtzworth-Munroe, 2001).

Stith et al (2012) and Vall et al (2016) propose four main conditions that should be fulfilled in order for family therapy to be applied to couples that experience domestic violence: (1) When there is low-to-moderate violence (the psychological abuse must be infrequent and mild); (2) when both partners voluntarily agree to participate in therapy and wish to remain together; (3) when both partners want to end the violence; and (4) when the violence is reciprocal.

In order to confirm whether this typology is helpful in clinical practice, we studied three couples which had visited the Family Therapy Unit of Eginition Hospital and had completed one cycle (more than 10 sessions) of systemic couple therapy.

First couple (couple A): The husband, 47 yo, is a private sector employee, whereas the wife, 42 yo, works on and off. They have five children. The eldest son is 23 yo and the youngest is 3,5 yo. The couple was wed in the final stage of pregnancy of the wife, just before their first child was born, while the husband’s father objected to the marriage. The couple had problems in their relationship from the beginning of the marriage. The wife complains about extramarital relations of the husband. During the last five years there have been intense episodes of battering, some of them in front of the children. In a recent episode the wife demanded the involuntary psychiatric examination of the husband. He was diagnosed with intermittent explosive disorder and medication was administered. The violent episodes continued. The husband has left the home twice, in the context of planned divorce, but both times he eventually returned. They had visited a family therapist before, but they quit treatment after the sixth session, after an episode of abuse. The wife appears intensely attached to the husband and asks him for commitment and care.

Second couple (couple B): The husband, 55 yo, works as a builder. The wife, an immigrant, 46yo, does the housework. They have three children, aged 15, 13 and 11. The couple got married due to pregnancy. In this couple, violence has existed since the beginning of the relationship, it was initially intense and highly dangerous (threats with a knife), was precipitated by trivial matters (e.g. the potatoes not being oiled), took place in front of the children and was accompanied by jealousy and characterological suspiciousness on the part of the husband. There is also financial violence, with the husband ruining every effort of the wife to find a job and earn her own money. Physical violence has been reduced in recent years, whereas verbal violence remains rampant. The wife appears fatigued and emotionally distant from the husband.

Third couple (couple C): The husband, 55 yo, works as a security employee, whereas the wife, 40 yo, has graduated from the university, is an immigrant and stopped working after the marriage. They have a daughter under 2 yo. They met through the internet and were married in a few months. The husband appears cognitively challenged, is socially withdrawn, has intense fears of death (his own or the baby’s) and is suspicious. He didn’t finish school and quit his studies in a technical school because he found it difficult. He has so far changed many jobs. The wife appears more cognitively adept, does not express her emotions and expresses intense financial demands towards the husband. After the birth of the child there have been intense confrontations, a few of which have escalated to physical violence, which appears to be mutual. The problem is centered on verbal abuse and in the spouses’ difficulty in resolving their disputes.

Ιn the two first couples violence was intense and frequent and  there was a history of episodes of violence that had led to injury of the wife. In the third couple the violence was sporadic and mutual. All three husbands appear to have characterological problems (irascibility, suspiciousness). Our observations can be summarized as follows:

The distinction made in the aforementioned typology between impulsive violence, which arises in the context of a conflict, and premeditated (instrumental) violence, which aims at domination over the other partner, appears quite simplistic. In the third couple, which according to Johnson’s typology would be characterized as a couple with situational violence, there were several behaviors of domination over the wife (e.g. checking the cell phone, blocking access to Facebook and the internet), whereas in the first two couples there were also episodes of violence which appeared to stem from frustration and anger of the one partner over a specific incident and not from the desire to control the other partner.

The finding that appeared consistently in all three couples was that incidents of violence and aggressive behavior appeared to arise in the context of an organization of communication dominated by antagonism and intense entanglement.

The dominant and most explicit characteristic of couples with violence is the presence of an intense and combative competition.

(When the therapist noted that the relationship is combative and asked whether they ever consider a truce, the wife in couple B answered:

“It is as if the war has been declared to have ended, but people are still getting killed at the borders…”)

Communication in these couples resembles what is called a “zero-sum game” in game theory. For the one to be vindicated, the other has to be condemned. For the one to win, the other has to lose. That’s why the admonitions to the couple towards a collaborative way of thinking appear to be disregarded. This dichotomous and rigid structure is reflected in the language used by the couple.

“I can’t apologize to her because it is like admitting that I am a fool. It is absurd. It’s like saying that I am a fool and you did everything right… when I reach that point and blow up, it means that I see clearly what is right and I get mad… will we accept the wrong as right?”

“She is not Einstein — and I am not a fool…” (husband B)

The female partner is described as an enemy figure, as a modern Pandora, who may externally behave politely but deep inside she has the spirit of a swindler and a ravenous appetite. What she really wants is to exploit the husband financially and ultimately to suck him dry. Hence, all three husbands in the couples under study described their wives as spendthrifts, who only wasted their money and drove them to bankruptcy.

“At that time we also had a big financial problem. D didn’t work, yet she spent money all the time, which made my blood boil. It wasn’t fair, me working 15 to 16 hours a day and the expenses flooding in… At a certain point I just couldn’t bear it…” (husband A).

“I worked from 5:30 am to 5:30 pm. My hand was numb and my back sore. I struggled every day, the taxes poured in, she was watching TV and then you say it’s all my fault… All day on the sofa fiddling with the remote control… all she wants is to irritate and humiliate you…” (husband B)

“She’s lazy, I tell you… she has only a child to occupy herself with … she does nothing… I am the sucker who takes care of everything and she appreciates nothing, never” (husband C).

Keeping in their mind the idea that they are alone against a hostile world, the aforementioned husbands cloak themselves in self-pity and illusory indignation, which only fuels their anger even further.

Even disagreements that would go unnoticed in other couples (e.g. whether the child will eat the egg white or not, in the third couple) can fuel a conflict, which usually begins with intense criticism, derogatory comments, screams and threats and sometimes escalates to physical violence. Things that are part and parcel of living in a family, such as having to deal with a child’s illness, prompt blaming and conflict.

“You took our child to your church and it got the flu. I will cut you to pieces and send you back to the country you came from…” (husband C).

“You are nuts… Our child got the flu at your workplace where you took it, your colleague’s children were ill”. (wife C).

Elements of family life which in nonviolent couples promote intimacy and care, such as sexuality, knowledge of the partner’s sensitivities and bringing up children, are exploited by violent couples in their conflicts. Sex, for example,  is experienced as a violation of the partner’s body or will: (Husband B: “She is like a piece of wood… I always make the first move (in sex)”… “C thinks that with sex everything’s gonna be all right… while we don’t communicate”, “C wants to satisfy his need, he doesn’t want me” (wife C). In the same way, the partners expect the children to side with them. [“The bad thing is that we do it all in front of the children… I tell her to stop but she doesn’t” (husband A)…. “I would like the children to protect me but they stay in their room…” (wife A).

Apart from being frequent, disputes in violent couples are also characterized by mutual negativity. Each partner tends to retaliate, verbally or physically. It is interesting that wives who are subjected to violence and would be expected to be more timorous still continue their negative behavior when the violence begins.

“Listen to me well, the evil that you are doing to me I can also do to you” (wife B to her husband).

“You tell me she’s afraid of me. Then why doesn’t she stop when we quarrel? I tell her to stop and she doesn’t. She goes blah blah blah… she really doesn’t give me a break… she doesn’t stop… she doesn’t’ stop… I send her away and she comes back and keeps stinging at me… I just couldn’t bear it, I flew off the handle and slapped her… then she scratched my face… so I grabbed her by the hair to force her to stop…” (husband A describes a violent episode).

In general terms, these couples appear to lack “"a withdrawal ritual” (Jacobson & Gottman, 1998). All couples, both happy and unhappy ones, experience disputes; however there is a red line they don’t cross. They cease fire before the conflict escalates. Some compromise, others leave the scene of conflict. In the couples under study, the onset of violence was unpredictable and the wife didn’t retreat; when she sensed the danger, it was already too late.

The intensity and combativeness of conflict appears to be a defining characteristic of violent couples. We think that the therapist ought to assess from the beginning the type and frequency of violence, verbal and physical, as indicators of the degree of destructiveness in the couple, as well as their changes over time. Does aggression tend to monopolize the couple’s communication or is it the exception in an otherwise loving relationship? Do petulance and combativeness appear in specific areas of conflict or are there violent outbreaks over insignificant matters? Is aggression also directed towards other persons outside the family, even towards the therapist?

The therapist also has to assess whether the aggressor assumes responsibility for his aggression. Does the perpetrator tend to minimize, deny or distort his responsibility for the violence? Does he view violence as a loss of control or as something for which he blames not himself, but the victim?

“She spoke to me in such I way that I got angry and raised my hand… it was just a continuation of her verbal violence” (husband A)

“Listen to me for a moment. I am a human being, not a cupboard. Sometimes I get nervous, I get mad, I see red and I may kill her sometime… What I do (physical violence) is just a result of these unjustifiable actions of hers” (husband B).

It is also important to assess the ability of the partners to contemplate with insight the reasons of their aggressiveness. Can they see their contribution in the development of violence? Can they see how the difficulties and their discontent in their relationship have led them to replace love and respect with aggression?

Recent research (Vall et al, 2016) suggests that an important prognostic factor in couple treatment for domestic violence is a common narrative regarding the violent episodes, whether they agree that there was a violent episode and on how it happened.

However, despite the low marital satisfaction and the aggression, what characterized all three couples was a strong desire, a yearning, a craving related to a nostalgic and idealized conception of love. Both partners desperately desire a change in the behavior of the other partner and depend on them. All three couples, especially the first, were characterized by intense entanglement and frequent sex. Cecchin has pointed out the intense passion that may exist in violent couples:

“As therapists with a particular love for a systemic orientation, one observation that we have found useful is that in many cases involving violence, there is a strong undercurrent of sexual passion – a prevailing theme that we encountered during the course of working with many court-referred violent families. We became interested in the idea that in many instances passion somehow holds couples together, even though there is severe violence in the relationship” (Cecchin, Land and Ray, p. 15-16).

One who doesn’t heed this craving that appears to hold the couple together won’t be able to understand this perplexing phenomenon called domestic violence and the contradictory messages about the status of the relationship that therapists receive. Hence in the first couple we encounter the following paradoxical phenomenon: after an episode of violence, the wife calls the therapists with anger and despair asking for help, and in the next session the selfsame wife demands her partner’s love and accuses him of infidelity. In the second and third couple, the selfsame husband who has been deriding and scorning his wife appears devastated before the prospect of divorce. Behind this dangerous war-game there is an intense craving for union and life. It might be useful in clinical practice for the therapist to investigate the desires, the dreams, the passion that holds those people together, to the point that their lives, their mental health and the mental health of their children are put at risk.

It appears that the aforementioned characteristics (antagonism, intense dependence) do not show up exclusively in these couples but only more intensely compared to other, nonviolent couples. In other words, the problems of violent couples may be extreme variants of ways of relating and communicating that other couples experience sporadically.

According to Virginia Goldner, a psychoanalyst, family therapist and feminist who has worked therapeutically for years with violent couples:

“The more I immersed myself in the issues presented by abusive couples, the more I felt that these issues are not the special province of “sick” people in “bad” relationships but rather are hyperbolic versions of the emotionally charged conflicts around dependency, autonomy, and separation that all couples negotiate. Indeed, recent research on adult attachment supports my early clinical intuition. Showing how these standard conflicts can be mapped onto an attachment paradigm, researchers are now also suggesting that attachment issues are especially acute and unresolved in abusive and violent relationships”

( Goldner, 2004, σ. 350)

The question remains: Can family therapy help couples who are bound in a Gordian knot of rigid, extreme and ambivalent communication? How can they be released from this fateful dance? Considering the course of these three couples in therapy, we observed that systemic couple therapy helps both partners to think and to verbalize their aggressive acting-outs. Indeed, in the first couple, where physical violence was present, as therapy progressed the violence decreased and eventually stopped. However, what is most interesting is that through the therapeutic process the couples started to consider and evaluate their mutual intense desire. Both the responsibility of the perpetrator and his thirst for recognition by his partner were pointed out. Apart from its other goals, therapy also helped both partners to realize that what they demanded from each other was impossible. They couldn’t satisfy their needs. The mirroring of this desire and the realization by the wife that she wouldn’t be satisfied, the dismantling of the romantic dream, led two of the wives to decide to leave the relationship and seek employment, whereas in the remaining couple the partners started to consider divorce openly and concretely.

Relationships that involve violence, where partners are so despaired and enraged, pose a great challenge to systemic therapy. We think that the evaluation of destructiveness and passion in the relationship, of the “trauma of love”, enriches our clinical practice more than the alternative of one-sided evaluation of the intention to control.

The dimension of safety, how one can intervene in such a relationship and help the husband to fear love less and the wife to experience love safely, remains an open subject for further investigation. Therapy should probably be tailored to the specific characteristics of each couple, on the basis of a careful evaluation that prioritizes safety.

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ARTICLE 6/ ISSUE 11, October 2017

Transgenerational Transmission of Psychopathology: from Understanding to Treatment

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