Spouse / Partner Abuse > Chapter 2, Part A - Assessment

Chapter 2, Part A: Assessment

II. Assessment

Destroying possessions or treasured objects, hitting walls, breaking doors, abusing and/or killing one's pets are acts of psychological domestic violence. (CAADV, 2005)

Women who appear for physical abuse may additionally have been victims of psychological and sexual abuse. Optimally, social workers should assess for psychological and sexual abuse and, should they be present, attend to the consequences of these types of abuse in interventions with battered women. Focus on physical abuse alone may not be sufficient in helping women with violence and safety (Macy, Nurius, Kernic and Holt, 2005) This is part of the reason why assessment of spousal/partner abuse is complicated, involving multi-levels of assessment. The first task is to determine if and what types of abuse are taking place. Second, the professional healthcare provider needs to understand the emotional and psychological issues that are involved in abusive relationships. This includes the psyche/profile of the abuser, the victim and the relationship. Third, the cycle of violence needs to be understood, taking into account how these cycles spiral into more serious violence. Assessment also needs to be understood in regards to cultural factors and the characteristics of those who seek services.

A. Detection: Is there abuse?

I'd get worked up waiting. I believe it was just a matter of luck. Maybe this time a nurse would look at me and know. A doctor would look past his nose. He'd ask the questions. He'd ask the right question, and I would answer it and it would be over. Charlo was always with me. He was always there. Behind the curtain was the only time I was alone. His shadow on the curtain. A few minutes. One question. One question. I'd answer; I'd tell them everything if they'd ask......Ask me."
Roddy Doyle, 1996 (as found in Fisher et al., 2005)


Victims, for reasons addressed below, are often hesitant to disclose when they are in an abusive relationship. They often do not say directly, "my partner is abusing me." For this reason the professional healthcare provider needs to know the red flags/signs of abuse in order to determine if abuse is a factor in why the individual is seeking help. These red flags are behavioral, and manifested in present and historical physical symptoms. The following is from University of Michigan, Health System, Red Flags of Abuse, Domestic Violence (2005) from http://www.med.umich.edu/abusehurts/dvflags.htm . It identifies the behavioral symptoms, physical spousal/partner abuse.

Behavioral symptoms that would trigger a cause for concern include:

1. Patient's behavior

  • Discrepancy between physical findings and verbal report of injury.
  • Vagueness about cause of injury, for example, "bruise easily."
  • Evasive when questioned about injury.
  • Delay between time of injury and seeking treatment
  • Non-compliance with medical advice, especially when non-compliance is life threatening.

2. Patient and partner relationship

  • Expressed or observed fear of partner
  • Reluctance to speak in presence of partner
  • Overly protective or controlling partner
  • Intense irrational jealously or possessiveness expressed by partner or reported by patient
  • Inappropriate behavior by partner (lack of concern, over concern, threatening demeanor, reluctance to leave partner)


3. Possible indirect indicators

  • Depression
  • Addictions to preblockedion medications, alcohol, and/or illegal drugs
  • Symptoms of post traumatic stress disorder, for example, exaggerated startle response, nightmares, sudden panic attacks, emotional numbness, and statements about expecting to die in the near future
  • Suicide attempts
  • Isolation from friends and family-only ties seem to be with partner
  • Work absenteeism/lateness
  • Indirectly brings up the subject of abuse.
  • Many patients may make statements like "I am depressed" or "I am stressed" and these statements should alert the practitioner to ask further questions about the origin of the stress or depression.
  • Directly brings up the subject of abuse.


Physical symptoms that are red flags for abuse:

  • Chronic pain and /or areas of tenderness especially at the extremities Bruises, welts, edema or scars, particularly in the genital and anal areas and the breasts
  • Swelling of eyes
  • Split lip
  • Unconjunctival hemorrhage
  • Signs of choking on throat
  • Intra-abdominal injury
  • Shoulder dislocation
  • Chronic pelvic pain, particularly without obvious somatic pathology
  • Chronic headaches
  • Chronic GI problem
  • Sexual assault


Historical Physical Indicators of Domestic Violence include:

  • Pattern of emergency room treatment for injuries
  • Bruises in various stages of healing
  • Past fractures in various stages of healing, especially of facial bones, spiral fractures of radius or ulna, fracture of ribs with no reasonable story for the mechanism of the injury
  • Limited motion of an extremity
  • Past injuries while pregnant
  • Spontaneous abortions/series of miscarriages
  • Closed head injury


Whereas the physical symptoms of abuse are easier to view, it takes the skillful provider to notice and assess the behavioral indicators. Through exploratory questions the providers can encourage the victim to discuss their abuse more openly. Suggested ways to frame questions regarding abuse include: "I'm concerned that your (symptoms, injury) may have been caused by someone hurting you. Has someone been hurting you?" or "Sometimes when I see an injury like yours, it's because somebody hit them - did that happen to you?" (UMICH, 2005)

These questions are effective because the provider is showing care and concern for the victim while simultaneously inquiring about the possibility of the abuse. Suggested questions regarding suspicions in a relationship can be presented this way:

"Sometimes when people tell me they are stressed, it has something to do with a relationship they are in. I am wondering if there might be something bothering you in your relationship with your boyfriend?" "Tell me what happens when you don't agree with your partner." "Has your partner ever hit you or physically hurt you?" (UMICH, 2005)

Again, the provider is showing empathy by inquiring about the causes of the patient's stress, and then inquiring as to the possibility of its cause being some type of violence. When red flags or symptoms do appear, it is important for the provider to follow up on these by asking questions in a similar manner. The tones of the questions are not attacking but show care and concern. The framing of these questions are important in order to find out if there is spousal/partner abuse present. Adults can often hide the effects of abuse. Healthcare providers have not been taught with as much attention to identifying adult victims of abuse whereas child abuse awareness and the red flags of it are more widely known. Providers have been trained to be vigilant in the detection and reporting of child abuse. With the prevalence and danger of spouse/partner abuse it is essential for providers to have a similar awareness regarding the abuse of intimate partners.


B. Profile of the Abuser, the Victim, and the Relationship

Domestic violence is a pattern of coercive behavior [perpetrators use] to control their partners, involving a physical assault or the threat of physical assault. (UMICH, 2005)

What are the characteristics of the abuser?

Abusers do not look different than others, do not speak different than others and in fact, do not appear different than anybody else. They may appear as very kind and friendly in public, even as someone who is enjoyable and fun to be around. In public they may also be loving to their spouse and family, and often only display their temper behind closed doors. There is no single deblockedion of an abuser, other than that they are usually male. Frequently the abuser has low-self esteem. It is important to remember that abuse is not an accident. Rather, it is an intentional act that cannot be blamed on alcohol or drug use. (Eicher, 2004) As mentioned, the abuser is responsible for the choices they make.

The abuser often uses the abuse as a way to exert power and control over another. Abusers use the abuse to get what they want. They often minimize the abuse, or blame the victim, and have a history of having been abused themselves. The abuser may feel remorse for the abusive episode, and may believe that they will not do it again, however, the assault usually continues to escalate in severity and frequency. (CAGO, 2002).

Socioeconomic indicators associated with the abuser include men who are African American, young, divorced or separated and living in rented housing. (Rennison and Welchans, 2000)

Society's Response to the Abuser

Society's response to the abuser has evolved over the years to a greater level of criminal accountability. That is not to say there is not some debate about the subject.In her book Insult to Injury: Rethinking Our Response to Intimate Abuse, Mills (2004) asserts that sending abusers to jail is not productive to changing the cycle of violence, but that they need guidance and counseling instead. This assertion resulted in the following response to the book by C. Douglas Kern, a former special prosecutor for violence against women in Clark County, Ohio.

TRUE story, from Insult to Injury: A man beats and rapes his wife; later, he holds a loaded gun to her head in front of her small children. His guilt is indisputable. Total punishment: six months of incarceration, followed by a term of probation. Now, complete the following statement. "The six months of incarceration was a travesty because ..." (a) "the sentence was absurdly short; serious crimes require serious punishment" or (b) "the sentence was absurdly long; the victim wanted counseling for the offender, not punishment, so incarceration was unduly harsh."

Did you choose (a)? Linda Mills, a professor of social work at New York University, says (b). Her book, Insult to Injury, rejects the mandatory-arrest-and-prosecution policies for domestic violence that now apply in nearly every jurisdiction in the United States. Under the regime that Mills proposes, men who torment their spouses and domestic partners can elude real punishment almost indefinitely, as victims will have the power to help them avoid arrest and prosecution.

Under the status quo, Mills complains, it is prosecutors, not victims, who make the decisions in the criminal-justice system. Policies that are tilted toward prosecution fail to acknowledge that women themselves perpetuate domestic violence by abusing children; and, of course, the system is biased against the poor, the black, and the disenfranchised. This is vintage left-wing criminology, with the flavor notes unique to the memorable 1967 harvest: Crime is never a choice, society is to blame, and punishment is merely avoiding the problem.

In lieu of punishment, Mills advocates Intimate Abuse Circles. May I propose that no aspect of crime has ever been or will ever be solved by the use of anything involving the words "Intimate" and "Circles?" Forget jail; now you can be "punished" with the punishment no criminal dreads: hours of harmless blather. Mills wants experts to meet with abusers, abusees, and their family and friends to discuss abuse problems. And whereas mandatory prosecution is "playing God," "human transformation should be the heart and soul of the Intimate Abuse Circle." Human transformation shall be achieved through the healing benediction of words, words, words.

Will ill-socialized men feel anything but contempt toward covens of experts yammering about "communication"? Such efforts will indeed earn the contempt of the more inarticulate abusers, most of whom are no strangers to the lectures of well-meaning professionals with degrees in social work. And the crafty, manipulative abusers will learn from these Intimate Circles a new lexicon of buzzwords and catchphrases with which to dazzle judges and probation officers at future sentencing hearings.

Mills is correct on one point: Current policies ignore the wishes of most domestic-violence victims. For this, I believe, we should be thankful. You can beat these victims senseless; you can scar them for life; you can torture them for days and reduce their children to whimpering nothings, and still the stories won't change: "I can't live without a man in my life"; "I need his paycheck because I just can't work a job"; "I know he'll change with some counseling"; "It's all my fault." To give these pathetic delusions any credence "empowers" no one. When Mills airily characterizes the lies and excuses of domestic violence as "narratives," she condescends to abusers and abusees more completely than criminal laws ever could.

Criminal laws assign victims and abusers responsibility for their actions and for the truth and falsehood of their words. To Mills, words--and, for that matter, criminal laws--are just tools with which to promote or deny psychological adjustment. At no time does Mills reflect any awareness that spousal abusers should be punished because they are spousal abusers. And yet she advocates mandatory jail (yes, mandatory, thus contradicting the whole point of the book) for men who act violently after enduring her precious Intimate Abuse Circles. To Mills, ignoring the wisdom of the experts seems to be a far more serious crime than attacking others.

Words often substitute for reality in Insult to Injury. For example, Mills argues that women are just as abusive in relationships as men are. How? Mills expands the definition of "intimate abuse" to encompass physical and emotional abuse. And since every wife-beater can grumble some complaint about emotional abuse, then--presto!--women are as abusive as men. To Mills, words are violence, and words can dispel violence. Harry Potter's magic incantations should be so effective.

Insult to Injury is surprisingly old-fashioned. It sanitizes every hoary cliche about domestic violence that ever dripped from the lips of the sleaziest defense lawyer and the right of women to degrade themselves in the manner of their choosing is a right that every wife-beater will cheerfully defend.

Oh, and as for the monster who served six months? His sentence was so short because the victim found a prosecutor who agreed with Linda Mills. His probation was a failure. He never stopped blaming the victim for his crimes.

Such is the world Linda Mills apparently wants for you and your daughters. Reject it.

What do you think?

Characteristics of an abusive relationship

Abusive relationships are often somewhat of an enigma to people. It would seem obvious that if somebody is being abusive, that the victim would leave and/or press charges against the abuser. One question that is frequently asked is why the victim does not leave. The answer to this question is often complicated as the setting of abusive relationships are presented in a variety of circumstances.

The characteristics of abusive relationships form barriers to assessment. The victim is reluctant to disclose to the provider out of fear of the consequences. So the provider must be aware of the red flags and symptoms of partner abuse. The provider also needs to create an open and honest therapeutic environment. When a victim feels they can be safe in disclosing information, that it can make a difference, or that there is somebody who cares, they will be more likely to disclose the abuse.

These relationships maintain complicated physical and emotional issues that are tied into intimate and cohabitational relationships. These issues contribute to abuse being underreported. For example, a woman who has children, with little schooling or work experience realizes that if she leaves the abusive mate, it places her, and her children in poverty with no home, no money, and little hope. At least there is food and shelter residing with the abusive mate. The victim in this case may not leave because of the prohibitive feelings of guilt for taking the children away from their father, especially if the father is not "physically" abusive to the children.

There are also cultural and religious factors that may impact the definition of the relationship and play a role in the victim's decision to stay in the relationship. As shown in the cycle of violence, the abuser will make promises to change, and the victim wants to believe it is true so much that they will stay, even if those promises have been broken repeatedly in the past. (CAGO, 2002).

In studying the relationships involving domestic violence in the United States, Straus (1994) seemed to find somewhat conflicting data regarding male dominant societies and prevalence of abuse. On the one hand, he states that "the findings were consistent with the feminist theory that holds that the prevalence of wife assault is a function of the male dominant nature of the society. " On the other hand they found that the social disorganization and control theories of deviance, which hold that crime and other deviant behavior are more likely to occur in a society in which the disruption of traditional social patterns weakens the attachment of individuals to the moral standards of society. Also, income inequality was not found to be related to the rate of wife assault. Thus, no support was found for the proposition based on conflict theory that any type of social inequality increases the risk of violence.

The following is an interesting and informative look at the anatomy of the abusive relationship and suggests the possibility of, not excusing, but understanding the abuser in the formulation of treatment.




Inside the heart of marital violence

by Hara Estroff Marano (1993)

"This much I will tell you," one of its proprietors, psychologist Neil Jacobson, Ph.D., had said conspiratorially months before, "anger has nothing to do with it." He was talking about domestic violence--specifically, the latest "hard" evidence from this laboratory, where he is recording every physiologic flicker of violently distressed couples as they light into topics that, at other times and places, generally lead to blows.

In the scheme of things, this is not a politically correct thing to do (focusing on the couple relationship is seen by some as implying that women somehow collaborate in their own abuse). It is possibly even a dangerous thing to do. But it appears to contradict the little anyone really knows about spouse abuse--that anger is to batterers what acrylics are to painters.

It is hard to believe that this dreary little room is one of the major fronts in a revolution now unfolding in thinking about and looking at why men batter the women they love. It is part of a seismic shift in the whole field of psychology--a new awareness that all behavior unfolds in a specific context, and it is necessary to understand the context in order to understand the behavior.

For decades, the puzzle of spouse abuse has been summed up in the question, "Why do they stay?" As if that were all there is to it--the manufacture of victims of a gender hierarchy that encourages men to demonstrate their dominance. But the question is misogynistic; it fails to grapple with a very obvious fact: that between batterer and batteree there is a relationship, and a very powerful one. It has a dynamic that stubbornly defies what is well known at the nation's 1,300 shelters for abused women: the vast majority of battered women return to their abusers. If intellectual curiosity is not enough of a reason, then certainly protecting women requires that their marriages finally be probed.

Researchers and clinicians (many of them hard-core feminists) now peering into the very heart of domestic violence find, even to their own surprise, that it is far more complex, and far less dark, than most had imagined. In a turnabout that might just as well serve as a symbol of all else that is now being learned, the crucial question turns out not to be "Why do they (the women) stay? Rather, it is what makes them (the men) so vulnerable, so dependent?"

Violence may indeed reflect patriarchy run amok and men may indeed use violence to exert power and control over women. But there's a dirty little secret in the world of domestic violence: It almost always arises from feelings of powerlessness. Men experience their own use of force as a loss of control. Abusers do not enjoy being abusive.

"These men give women too much power--to take care of all their needs, to solve their loneliness, for example. They expect women to be their psychic nurses," reports family therapist Virginia Goldner, Ph.D. This is just one of the many paradoxes one must now entertain about domestic violence to see it clearly.

In the whole new picture of domestic violence that is emerging, spouse abuse looks a lot like a very strange onion--the product of many forces operating and interacting at many levels between an individual and his environment. There are intimations of influences at the biological level, including disturbances in the activity of the neurotransmitter serotonin, high levels of testosterone production prompting men to aggression, possibly frank brain damage from head injury. There are elements that work at the cognitive level, like a propensity to misread social cues and attribute hostile intent to others. There are defects in interpersonal skills, like a lack of ability to deescalate the conflict that is inevitable in relationships. There are intrapsychic deficits--a hypersensitivity to abandonment, inability to control negative emotions, and poor impulse control. And, of course, there are general cultural contributors like the traditional role structure of marriage. Just when one thing is true at one level, its opposite appears to be true at another.

Among the many provocative findings shaping a new, more holistic view of domestic violence:

* Apart from the coercion, the relationship between batterer and partner has a positive side. It is typically a highly romantic and deeply loving relationship. Both are drawn by the fantasy and reality of having found acceptance for the first time in their lives and feel their relationship is "special," a unique haven from an outside world. "They are Hansel and Gretel," says Goldner, a faculty member at New York's Ackerman Institute for Family Therapy.

* Not every interaction, not even every argument, in an abusive marriage is violent. Some issues turn out to be uniquely troublesome in these relationships. Violent men seem to have deficits in processing social information in specific situations--typically, they negatively misinterpret their wives' behavior when, for example, she pays attention to anyone else. Such situations induce an inner panic because they hint at rejection.

"These men are very dependent on their wives," explains Amy Holtzworth-Munroe, Ph.D., a psychologist at Indiana University. "They constantly want their wives' attention. If they sense signs of rejection, they experience it as a real threat. Violence is related to jealousy and security of attachment. If they think their partners might leave, they become violent."

* But all batterers are not alike. For Neil Jacobson, family psychologist and behaviorist, studies in which he conducts blow-by-blow analyses of arguments turn up at least one "very scary" group of men--about 20 percent of batterers--for whom violence does not seem to be the result of rage at all. He calls them "autonomic athletes." Unlike other other people, and unlike the majority of batterers, they do not show any signs of nervous system arousal in situations of conflict--their heart rates go down even when engaging in the clashes that give rise to abuse.

"There is a disconnection between their physiology and their behavior--they are inwardly calm but outwardly contemptuous, belligerent, demeaning, verbally abusive. This dissociation of physiology from emotion is extraordinary--no one's ever seen such a thing before. We think it may be a clue to the disorder of battering. It may be due to some traumatic experience in early childhood. Most of these men all witnessed high levels of violence among their parents."

* Without deflecting responsibility for male violence, it is possible that batterers are also somehow biologically different. "I started from a straight feminist perspective," reports family therapist Gillian Walker, M.S.W., also at the Ackerman Institute. "I've had to broaden the lens as I go. I'm struck by how many of these men are learning-disabled. Or how often they had their heads pounded into the ground as kids."

One psychologist finds that head injury increases by sixfold the likelihood a man is to physically abuse his partner. It is the most significant predictor there is.

* The stereotype of battered wives as fragile, passive, placating, docile, and self-deprecating does not do justice to their actual role in relationships. Women prove to be the more functional members of these couples. What's more, during confrontations, they reciprocate anger and contempt tit for tat and don't back down. They do not act as if they fear being beaten later. But no matter what they try, once the violence starts, nothing they do can stop it. "The wives are beaten," says Seattle's Jacobson, "but not beaten into submission."

* Most women in battering relationships are themselves violent, a fact that has proved very politically troublesome to victims' advocates. But Jacobson's studies provide powerful proof that their violence occurs only in response to their partners' attacks. Fear turns out to be the telltale emotion. "Only the husband's violence produces fear in a partner," reports Jacobson. "He has the unique capability to subjugate his partner by battering. That's why I can't believe in husband abuse."

It's hard to make sense of statistics about domestic violence. Advocates of all stripes lob statistics that verge on the hysterical--it is increasing, it always increases, and violence always escalates in a relationship: Today's pushes are tomorrow's punches. However, the need to stop domestic violence is not diminished by what the research community accepts as fact: The incidence of domestic violence is not increasing. It has always been high; only an idealized view of the family has prevented us from seeing it until recently. There is no central reporting mechanism on spouse abuse, but two respectable national surveys suggest it decreased slightly between 1975 and 1985.

No matter how long domestic abuse has thrived behind closed doors--and it thrives on isolation and privacy as well as on patriarchal attitudes, rigid gender arrangements, acceptance of aggression in other contexts, economic hardship, and other potent stressors--it is increasingly less tolerated today. Rising public and professional interest could make it a watershed issue in American society. It could wind up as the proving ground for a new way of thinking about many complex social problems, where we accept, finally, that major problems almost always have a social context but that doesn't mean they have a social cause. As Virginia Goldner and colleagues at the Ackerman Institute are proving, it is indeed possible to explain, even treat, abusive behavior while regarding it as inexcusable and holding perpetrators fully responsible for their actions.

Goldner and Gillian Walker inhabit a very sharp edge in psychotherapy. They are developing a "feminist/systemic approach to the conjoint therapy of battering." In other words, they believe battering can best be stopped by seeing couples and helping them reconstruct the relationship--without letting batterers get away with a damn thing. The emphasis is on feminist and conjoint, because in traditional feminist circles, the two are incompatible. In fact, in some states where advocates have had a strong hand in shaping legislation-- California, Colorado, Massachusetts among them--conjoint therapy is illegal for spouse abuse.

They jumped in because there are many battered women who want to keep the relationship, albeit without the violence. "How can the victims of violence who have elected conjoint treatment speak and enjoy justice when perpetrators' truths are judged equal?" as systemic thinking requires, Goldner asks. But she's a respected feminist who, after much soul-searching, rejected the polarities of either/or thinking about domestic violence in favor of "the more difficult, but more hopeful, stance of both/and." She has reconciled herself to "recognizing the value of competing and contradictory perspectives." As any good family therapist knows--as does any honest married soul--all relationships inherently involve competing perspectives.

Goldner's absolute requirement is that abuse must stop before therapy can begin, and the men must take complete responsibility for the battering--something they are always trying to foist off on their partners.

Goldner and Walker begin by telling a couple, "We are experts in working with this problem and in determining who this therapy is suitable for. We are saying, by implication, 'We're not yet in the role of therapists, we're consultants, evaluating you to see whether you're suitable to be our clients.' This isn't a trick; we devised it as a way to avoid getting involved in unsuitable cases. But it unexpectedly proved a powerful therapeutic tool. Couples know we're the court of last resort, we're experienced, and we're as good as it gets. They fell they are on trial. They want to pass the test."

The test is that the violence must stop, unconditionally, and there must be a bond, a loving side to the relationship. Of course they secure the woman's safety, which may mean having her live for a time at a shelter.

"What distinguishes my work is that I am looking at key features of the romantic relationship between violent men and their partners. It is an open secret that partners go back to each other. The women can't really explain why they stay with someone who hurts them," says Goldner--until the therapists point out that there is also a loving side to the relationship. This is itself an important step in the therapy; it strips away the shame women feel about being in an abusive relationship. That, in turn, helps restore a woman's dignity, and nullifies the binding power of what has been experienced until now as a secret alliance. The woman is then free to begin fighting for new terms in the relationship.

Others have described a honeymoon phase after the violence, a redemptive moment both partners experience as a bond. But Goldner feels the partners are drawn more by the fantasy and reality of having found acceptance. "Each feels the other knows them more profoundly and accepts them better than anyone before."

That, of course, is a commentary on what went on before. "Almost all the men we've treated come from families where there was physical violence. The women don't necessarily come from violent households but from families where they were unmothered. The unmothered girl and the abused boy are two lost souls who don't trust the world outside. The paradox is they only feel safe together." This romanticism works until real life enters. Say, he wants sex and she doesn't.

In their therapy, Goldner and Walker have developed a line of relentless questioning from multiple angles that separates the "many strands of meaning, memory, and feeling" that they find "packed" into the explosive moment. "When a man says 'I just saw black' or 'I felt a fire in my veins,' the specific conflicts are unavailable to him. But they are there."

Repeated inquiries about his life story capture the violence in slow motion. This technique gets the men to see not only that they have made a choice to hit, but they are full of conflicts that center on deep ambivalences about gender roles. These men are themselves victims of "gendered premises of masculinity." They are engaged in constant denial of "feminine" vulnerabilities they try to hide even from themselves.

"Indeed," Goldner has written, "in remembering the escalation that precedes the violent moment, the men often describe an internal struggle between unmanly feelings and macho feelings occurring in rapid-fire alternation." Only by unpacking a man's globalized experience of rage, unraveling the sequence of steps that end in violence, can be begin to see the issues that ignite his fury and begin to take charge of his reactivity.

"We see that some large vulnerability activates them into the abusive rage. There is a deep disturbance in the person, and he believes it is the female's job to soothe him, to keep him at bay. He sees her job as to make him feel powerful, to attend to him, to meet all his needs, when he wants. If not, that's when there is violence.

"These men hate it when their wives go out with friends. Anything that separates her from him means he has to deal with the large, empty space in his interior. We insist that she has to have a life of her own and that he will survive. We pull them apart psychologically. We address his psychological experience, that she has too much power, too much power to hurt him. We'll tell him, 'You're relying too much on her. You need to take care of yourself. As long as you give her the power to solve your loneliness, you're giving her too much power and you'll hit her. You must solve that alone."

Seven years into the Gender and Violence Project, Goldner and Co. think they've got a form of therapy down pat that reliably gets the violence to stop yet gives couples what they want--each other, but not at the cost of their selves. They see a couple three or four times on a consultation basis, in which time the violence is teased apart until the men can grasp what they have done--and what they have done to their partner. Then the couples are seen about six times in a treatment mode. Of all the couples they have seen (they have worked intensively with about 30) there has been only one instance of hitting that occurred after treatment started. "And that was during a six-week hiatus in treatment over the holidays," Goldner is quick to point out.

But there are questions whether this therapy model is usable by others. Goldner has an unmistakable presence that may help deter violence in the couples she treats. Still, she is now trying to teach what she does to another set of therapists. If she succeeds, "We will be able to send this therapy out to other mental-health centers."

While Goldner's work is dazzling insightful, to say nothing of intellectually demanding, researchers leap to suggest the possibility of flaws in her observations. She doesn't use comparison groups; as a result, elements that appear to be linked to violence could in fact be due to extreme marital distress, a typical feature of violent relationships.

Indiana's Amy Holtzworth-Munroe is also looking closely, though scientifically scrupulously, at the men in violent couples. She measures them against two comparison groups--one of men in couples who report similar levels of conflict and distress but do not resort to violence, and one of happy couples. Still, there is remarkable resonance in the findings.

Whatever else leads a man to violence, it operates only in certain specific situations, says the Indiana psychologist. In her research, she asks men what they would say or do in response to certain problematic marital situations presented by audiotape. These test the skills people use to decode social information and generate appropriate responses.

A competent response is "one that would solve the current problem and make problems of the same type less likely in the future." Like negotiating mutually agreeable compromises and explaining thoughts and feelings. Threatening statements or behaviors, name-calling, and sarcasm lead the list of "incompetent" responses.

Only the maritally violent men provide incompetent responses to situations involving jealousy--"at a social gathering, your wife is talking to another man and they are smiling and laughing." Or "you receive a phone call from a man who asks for your wife, says he is her friend, but will not leave a name or number."

In such situations, violent men consistently misinterpret their wife's actions as having been done with hostile intent. This is an extraordinarily important piece of information to have, not just because it points to a distinguishing flaw in these men. But because attributing hostile intent to a wife's behavior--to anyone's behavior--gives men a way to justify violence. It becomes the grease for the machinery by which they try to shift blame: "She was trying to hurt me/provoke me...."

The violent men also do not generate competent responses in situations that represent rejection or abandonment from the wife--a vignette, say, in which she is not interested in her husband's sexual advances or wants to spend time with friends. Nor do they do well in situations where a wife challenges or embarrasses her husband--she questions his judgment or wants him to cancel plans with friends.

"The data show that violent men repeatedly go into abusive relationships," says Holtzworth-Munroe. "That's not so true for the women. The husband is the problem. What we're finding is that we have to fix these men at the individual level as well as at the societal and couple level. These men do not have the social skills to participate in the culture."

She has proof their problems carry over to non-marital situations as well. When the maritally violent men listen to vignettes of assorted non-marital situations--involving bosses, coworkers, and friends--the same deficits in social skills show up. "They have a general deficit, although the marital situations are more arousing."

Holtzworth-Munroe sees the rejection--jealousy issue as one of the keys to domestic violence. "These men appear to be more dependent on their wives. If they sense signs of rejection, they experience it as a real threat. We are now applying measures of attachment. Violent men are more preoccupied with the marital relationship than other men. They have a narrower focus on their wife. They have few outside friends. They especially rely on their wives for comfort. If they think she might leave, they become violent.

"My work implies that these men have screwed-up relationships with their own parents. They lack the ability to trust, something that comes out of secure early attachment" to a parent or other responsive caregiver. As a result, they fear loss, misinterpret neutral situations as threatening, see hostile intent when it doesn't exist.

There is a certain urgency to itemizing those situations that put men at greatest risk for violent responses. "We need to know where to focus our energy," says Holtzworth-Munroe. "It's clear from the evidence that most treatments don't help. Probably they are applied too late, after violence is a set behavioral pattern. Once violence is used, it becomes reinforced--because it works. The men get what they want, though they may feel bad about doing it."

Neil Jacobson's study of the marriages in which domestic violence takes place is entirely without precedent. It is the first study to include people with severe levels of physical violence, numbering 57 such couples. It also employs two comparison groups: 32 couples who have never used physical violence but whose marriages are equally unhappy, and 22 couples who are happily married.

What's more, he is looking directly at the couples during their arguments. He has then attempt to work out two problems they identify as troublesome. They do this for an intense 15 minutes while tethered to the aforementioned electric chairs by wires that monitor their physiology. Overhead videocameras record every word, every nuance of facial affect, voice tone, posture, and gesture.

Marital violence, Jacobson finds, is not just an extreme form of argument. It's something of a different genre altogether. The batterers look different from other men. They do things other men don't do. In arguments they are highly emotionally aggressive--they are belligerent, contemptuous, demeaning. They lack any empathy for their partners. And in some ways, their wives are different, too.

Just as the Eskimos allegedly have 28 words for "snow," Jacobson feels that "anger" doesn't do justice to this emotion. "Anger is common in unhappy couples. We find there are specific facets of anger and they differentiate the violent from the nonviolent."

In his atlas of anger, there's garden-variety anger, a pure expression of affect with no attempt to control, as in "That really pisses me off!" There's belligerence, a taunting attempt to produce a negative response in another: "What are you gonna do about my drinking?! You don't like it, huh? Well, what are you gonna do about it?" There's contempt, full of demeaning and insulting remarks. There's disgust. And critical disapproval. There's demandingness and control, with hostile affect and tone.

"Anger is shared by both partners in violent relationships," says Jacobson. "Even the provocative types of anger. They taunt. They demean. They hurl contempt at each other even in nonviolent arguments."

The wives of domestic violence, for their part, are very, very feisty. Once an argument is started, they don't back down. They greet negative statements with negative responses--what psychologists call negative reciprocity. Like their husbands, they don't deescalate an argument if one gets started. "These women don't look anything like the passive trauma victims others have described," Jacobson reported at the recent convention of the American Psychological Association. "This is a more flattering portrait of the victims of wife abuse. They look courageous."

That, however, is the view from outside. Internally, things are not always what they seem, Jacobson discovered in a series of studies conducted with John M. Gottman, Ph.D. The wives of violent men are highly aroused physiologically. Their heart rate shoots up, just as one would expect of someone engaged in angry conflict. But, much to Jacobson's surprise, among the violent men, heart rates actually go down during discussion of conflicts.

In the normal response to conflict, the autonomic nervous system is activated. The cardiovascular system turns on. Heart rate goes up. In a subgroup of the violent men--12 of 57--there is an extraordinary divergence between behavior and physiology. Behaviorally, they are full of anger--belligerent, dominating, verbally abusive. But internally they are exceedingly calm. Those who are the most calm physiologically are the most belligerent and contemptuous, and the most abusive verbally. They are also most likely to be violent outside the marriage as well as in it; many have arrest records. And they are most likely to have a family history of violence.

These men are not sensation-seeking, engaging in explosive behavior to get aroused; they are not under-aroused to begin with. "They are gaining autonomic control before striking in an emotionally aggressive manner," says Jacobson. "They are like pythons. These men are scary."

Jacobson regards the disconnection between the physiological and emotional as a clue to a core defect in batters. "It may be due to the early trauma of being around a violent environment. That could occur through some early, emotionally traumatic experience, or it could be a consequence of being violent. Or it may be the result of head trauma." At the hands of people whose loving is supposed to be protective.

Jacobson has spotlighted a way that violence--violence: a behavior!--can ricochet from generation to generation as assertively as a rogue gene. It's possible that these men are so deeply, irrevocably, wounded, changed by experience, that they are even beyond the help of therapy. "Not every problem that exists is appropriate for psychotherapy," notes Jacobson.

The deceleration in heart rate in the face of a stressful situation also suggests that for some men, violence may not be a problem of impulse control at all, which is the traditional view. Rather, Jacobson speculates that the batterers are deliberately, manipulatively controlling what goes on in the marital interaction. "The only other known state in which there is a deceleration in heart rate is focused attention. These men look like they are being very attentive and focused."

In domestic violence, says Jacobson, "Women are fighting for survival and men are fighting for control."

Equally startling to Jacobson was the discovery that heart rate went down, too, among a subgroup of men in distressed but nonviolent marriages. These men, however, were also more emotionally aggressive than the other nonviolent men. "We suspect that there may be some continuity from verbal to physical abuse. It looks like we're tapping into an underlying substrate of aggression that may predict who becomes violent over time."

Two-year follow-up evaluations should reveal whether the nonviolent dissociators become physically violent with time, as the psychologist predicts.

It is an axiom of family relations that women are the barometers of relationship distress. Normally in unhappy marriages, couples develop a communication pattern in which the woman tries to engage her partner while he retreats. She is seeking change. In this demand/withdraw pattern, the demand role signifies dissatisfaction. In violent relationships, there is a switch of roles and the husband shares the dissatisfied role. When wives are the dissatisfied partner, they get angry. When husbands are dissatisfied, the implications are different. They get violent.

How is it that the portrait Jacobson paints of battered wives-feisty, angry, returning negative statements, and extremely aroused internally--can differ so sharply from the conventional one of women silenced into a pathetic state of helplessness as a result of posttraumatic stress?

Jacobson also sees helplessness among battered wives but thinks it reflects their emotional responsiveness. "Usually you see people who are angry or psychologically distressed. These women are angry and distressed. They are verbally and emotionally aggressive. But they are also defensive, frightened, and sad. All their negative affects are heightened simultaneously." The helplessness these women feel, he believes, comes as a result of physical trauma and the threat of trauma, and it is manifested by the activation of all of their negative emotions at the same time; it's confusing and debilitating. Plus the fact that once violence starts, nothing they do, even withdrawing, stops the physical abuse. In fact, attempts to withdraw may even provoke an escalation of the violence.

When psychologist Alan Rosenbaum, Ph.D., arrived several years ago at the University of Massachusetts Medical Center to run the domestic violence research and treatment program, he was required to take a medical history in all abuse cases. Before long, he noticed a distinct pattern. Among a surprising number of the cases of marital injury he was recording an early history of head injury.

Rosenbaum looked at 31 consecutive admissions to the marital violence program. In 19 of them--61 percent--there was in fact a history of significant head injury: loss of consciousness, a diagnosed concussion, or post-concussion symptoms.

That was enough to warrant a grant for a more rigorous study. When the results were tabulated, abusive men were significantly more likely to have had head injury--53 percent, versus 25 percent among nonviolent men from unhappy marriages and 16 percent in the happily married.

"Head injury increases the chance of marital aggression by a factor of six. That makes it the most significant predictor of marital violence that there is," Rosenbaum says. He's now following the fate of two groups of men--one with a history of head injury, the other with orthopedic injury, And he'll be measuring the incidence of marital violence in both groups over the next two years.

At the same time, Rosenbaum is exploring the possibility that, among domestically violent men, there is some defect in the regulation of the brain chemical serotonin. A nuerotransmitter widely dispersed in the brain, serotonin is though to influence much of mental life. There is evidence to suggest that high levels of serotonin correlate with dominant behavior, while low serotonin levels are implicated in anxiety, general aggression, as well as impulsive behavior.

Psychologist Roland Maiuro, Ph.D., of the University of Washington, head of one of country's leading domestic violence clinics, has been giving batterers a drug known to influence serotonin-sensitive paths--Paxil, first cousin of Prozac. "It seems to enhance the resiliency of these men," Maiuro reports. "They're less reactive. When confronted with the same 'provocations,' they're not activating as much. But they still need to work on cognitive and behavioral repertories. As we say, there are no skills in pills."

A controlled study of the effect of Paxil on domestically violent men is about to get under way.

"Right now, this is not a very politically correct model of domestic violence," Rosenbaum offers. "But I'm not suggesting that marital violence is caused by biologic factors. We have to look at causes at several levels and see whether there are factors that make some men unable to regulate their impulses, that increase the likelihood of an aggressive response to any kind of negative stimulus, such as stress.

"Marital aggression is very complex. We can't say there is one factor. No one factor applies to 100 percent of men. People become aggressive for a variety of reasons. These are some."

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Question No.3. Physical symptoms that are red flags indicating possible intimate partner abuse include:

a. Chronic pain
b. Swelling of the eyes
c. Split lip
d. Signs of choking on the throat
e. All of the above

Question No.4. The abuser in a relationship:

a. Is easily detectable
b. Is just as often female as male
c. Often uses abuse as a way to exert control over another
d. Is usually a wealthy old man who owns his home

Question No.5. Victims of spousal/partner abuse:

a. Are at fault for the abuse
b. Find it easy to leave the abusive relationship
c. Are mostly women
d. Usually think pretty highly of themselves

 
Spouse / Partner Abuse > Chapter 2, Part A - Assessment
Page Last Modified On: June 19, 2015, 10:40 PM