Physical Abuse: Screening and Treatment, Part 2

by Debby Schwarz Hirschhorn, PhD

(Page 2 of 2)

• 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.

About the Author

Dr. Deb is a specialist in both marriage counseling and abuse and trauma with