Domestic violence in heterosexual relationships is a serious issue, with 20% of women reporting they have been assaulted by their partners, and this is true among married adult women as well as dating college women (IPARV, 2002). Stats are that 3 in 10 couples walking the street have had a violent episode at some point in the relationship, but 1 in 2 couples in your office have had an incident of violence. Worse, Williamson (2000) reports that two-thirds of couples seeking therapy did not report domestic violence until asked, and that 40% to 75% of the children of abusers, in addition to witnessing parental abuse, suffer child abuse themselves. Holtzworth-Munroe and colleagues cite Quigley as finding that 76% of violent first-year husbands were violent during the second or third year of the marriage as well, with higher numbers for more severe violence.

Therapists often don’t know what to do. Harway et al (1997) found 40% of clinicians did not recognize signs of violence in a vignette, and another 15% recognized it but did not suggest any intervention to deal with it. Cursing and name calling alone do not predict violence, as about 77% of nonclinical couples do this, as do 93% of clinical couples. Holtzworth-Munroe and colleagues recommend using a standard instrument, like the Conflict Tactics Scale (CTS or CTS2) to assess violence.

Types of Domestic Violence

Not all domestic violence is the same though, as differences in frequency, severity, purpose, and outcome are all significant. Johnson and Ferraro (2000) argue there are five types of violent relationships:

• Common Couple Violence – within the context of a single issue, there is one or at most two incidents of violence, and it is not used as part of a pattern of behavior to control the partner. This is similar to the “family-only” batterer, or someone who is not violent outside the home and is the least likely to be sexually and emotionally abusive. Johnson and Ferraro report this kind of batterer is about evenly split between males (56%) and females (44%), and some studies showing that in younger samples women may use more aggression than men. However, women still tend to suffer more serious injuries compared to men.
• Intimate Terrorism – as one tactic in a general pattern of control and manipulation, violence may be used, perhaps only in one or two settings, and may be relatively “low severity.” Nonetheless, it still involves emotional abuse, and men who show this pattern of abuse are more likely to kill their partners. This is similar to a “generally-violent-antisocial” batterer, and what Jacobson and Gottman (1998) called the “cobra” type of batterer. This kind is more likely to use violence as a way to control; while they may appear extremely distressed, the appearance of almost uncontrollable rage is an act, one tool of many to intimidate and control others. Such batterers are more likely to engage in carefully planned and more violent revenge if the relationship ends, and are thus much more dangerous to their victims.
• Violent Resistance – where one partner becomes controlling or frightening, the other partner may respond with violence in self-defense. Johnson and Ferraro do not call this pattern of violence self-defense, however, noting that courts and lawyers understand it to be whatever is defined by State law. This kind of violence occurs in response to a perceived threat, and is not part of a pattern of control and manipulation.
• Mutual Violent Control – this kind of violence may be what is thought of as mutual combat, or two parties using violence to control each other, a kind of intimate terrorism. Johnson and Ferraro note that even in these cases, however, some gender differences remain. In 31% of these couples, the male initiated more violence, as opposed to 8% for the female.
• Dysphoric-Borderline Violence – this kind of batterer is a entails a needy, dependent, and emotionally overwhelmed person who resorts to violence in frustration. Jacobson and Gottman (1998) called this the “pitbull” type of batterer, feeling extreme emotional and physical arousal and distress. Renzetti (1992) also classified 68% of the abuse in her lesbian samples as due to dependency needs. This kind of abuser is more likely to show obvious emotional adjustment problems and distress, such as depression, fears of abandonment, and great emotional dependence on the victim.

Theories Regarding the Causes of Abuse

There are a number of factors typically associated with predicting domestic violence:

• History of Aggressive Behavior – past behavior is the best predictor of future behavior
• History of Abuse/Witnessing Abuse as a Child
• SES – unemployed and low SES men have a high risk, and this increases if the partner is employed or has a higher SES at the same time; lower education is also associated with domestic violence
• Isolation and Lack of Resources – this is tied to SES but is a separate factor on its own
• Mental Illness – this can include ASP, but also alcoholism/drug abuse, or neurological problems
• Age – couples under 30 have the highest risk
• Cohabitation – unmarried couples have higher rates of violence

On alcoholism, Murphy and O’Farrell (1994) found 66% of alcoholics reported relationship violence, versus 20% of controls. Some have found that 25% – 46% of the specific incidents of abuse are tied to alcohol consumption, but the range may result because some aren’t clear about consumption versus intoxication, which seems associated with about 23% of specific incidents of violence (Pernanen, 1991).

The general models explaining domestic violence focus on intrapersonal, interpersonal, and social causes. However, Merrill (1996) offers a three-phase gender-neutral model, which avoids a heterosexist bias:

• First, there is learning to abuse. Learning to resort to violence comes from three factors:
• instruction by others to act in violent or threatening ways
• modeling of violent or controlling behavior, and
• reward of controlling and threatening behavior
• These factors could lead to modeling, and even teaching that the batterer is entitled to use violence. The reward for violent behavior can be directly experience or observed (Social Learning Theory). The “flip side of the coin” may also come into play; if police are called to a violent disturbance and do nothing, the batterer learns that outside intervention is nothing to be concerned about or feared.
• Second, after learning to be violent, they must have the opportunity to abuse. Two factors provide the opportunity: power and isolation. Power may stem from sexism/heterosexism, prejudice, income differences, health and HIV status… Isolation of the victim means that 1) the abuser is less likely to be caught, 2) conflict can easily escalate, and 3) depression and resignation to the violence are more likely.
• Third, given learning and opportunity, the abuser must choose to abuse. Poor communication skills, impulse control weakened by substances, and distorted ideas about gender and the permissibility of violence could all lead to the choice to be violent.

Assessment

Assessment of “red flags” includes:

• a history of unexplained or poorly explained injuries at various stages of healing
• a pattern of unexplained failure to meet obligations, such as keeping appointments for parent-teacher meeting
• signs of traumatic stress such as depression, insomnia, nightmares, and anxiety
• reluctance to provide details about the home life and the family’s problems
• the appearance of strong dependence on the partner to make decisions
• alcohol/substance abuse in the partner

When asked about violence, “yes” means “yes”, but “no” can mean:

• “No, there never has been any issue with violence or abuse”
• “No, there hasn’t been any violence in a long time”
• “No, there isn’t any violence (but that doesn’t mean I’m not fearful of it happening)”
• “No, there isn’t any violence (but that doesn’t mean there will never be any)”
• “No, I’m not going to admit to any violence until I know you better and trust you”
• “No, I’m not going to admit to any violence while the abuser is here”

Thus, the setting is important, which is why Gottman recommends seeing couples together and separately. Further, closed or direct questions without a “lead in” are likely to lead to a “No” answer.

As for what is asked, a number of authors (see for example, Williamson, 2000) offer several topic areas and several kinds of questions worth asking. Questioning should begin with less threatening questions about issues in the stability, satisfaction, and general functioning of the relationship, which are easier to admit to and discuss. Questioning turns to direct inquiries about violence only after this “lead in” approach allows the client to feel more comfortable and safe disclosing any violence.

Questions to Ask in the Assessment of Violence

Introductory Questions

• How are things at home? Have they always been that way?
• Are you afraid of anyone at home?
• Are there any problems in your relationship? Has it always been so?
• How serious are these problems? How long have they lasted?
• How often do you argue?
• What kinds of things do you argue about?
• What’s the worst argument you’ve ever had?
• Have things ever gotten physical between the two of you when you’re arguing?

Psychological Violence

• Do you feel criticized or controlled by your partner?
• Does you partner interrupt you, swear at you, yell at you, or minimize your contribution to the relationship?
• Does your partner interfere in your work, school, or other relationships?
• (For gays and lesbians) Has your partner ever threatened to “out” you?
• Does your partner seem jealous of you, or accuse you of being unfaithful?
• Does your partner track your time, control your money, or make you explain all of your actions or spending to him or her?
• How does your partner handle anger? Do you ever feel intimidated or frightened by your partner?
• Has your partner ever threatened to hurt loved ones, or threatened to hurt himself/herself?
• Has your partner ever threatened to hurt you?
• Have you talked to anyone about this?
• Have you ever tried to leave your partner? What happened?
• Has your partner ever threatened you if you tried to leave him or her?
• Has your partner ever stalked you?

Property Violence

• Does your partner throw things, break things, or kick or punch things when angry?
• Does your partner threaten to or purposely destroy things of yours, perhaps that have sentimental value or that you worked hard to afford?
• Has your partner ever locked you out of your home?

Physical Violence

• Has your partner ever put his or her hands on you in anger?
• Has your partner ever tried to prevent you from leaving the home?
• Has your partner ever grabbed or slapped you? Ever left a bruise by holding you?
• Has your partner ever pushed or shoved you? Did this lead to injuries?
• Has your partner ever tried to cut, choke, punch, or burn you?
• Has your partner ever cut, choked, punched, or burned you?
• Has your partner ever threatened you with a weapon?
• Has your partner ever been arrested for assault or violence of any kind?
• Have you ever been unable or unwilling to leave the home after a fight?
• Have you ever been unable to get out of bed after a fight?
• Have you ever needed medical care after a fight? What kinds of injuries have you sustained?
• Have you ever sought medical services after a fight?
• Has your partner ever withheld medication or prevented you from seeking medical services?
• Have you ever sought services such as a battered women’s shelter or support group?
• Does your partner have access to weapons, like hunting knives or guns?
• How long has the violence gone on? Has it always been this bad? How bad do you think it could get?

Sexual Violence

• Has your partner ever forced you to have sex when you did not want to?
• Has your partner ever pressured you to have “make up” sex after a fight, when you were unwilling or wanted to be alone?
• Has your partner ever had affairs and bragged about them to you?
• Has your partner ever pressured you to engage in sexual activities you felt were humiliating, frightening, or painful?
• Have you ever been worried about contracting HIV from your partner? Has your partner forced you to engage in unprotected sex?
• Has your partner ever threatened to hurt you if you did not agree to have sex when and how he or she wanted?
• Has your partner ever physically restrained or injured you during sex?
• Have you ever sought services such as rape crises counseling?

Substance Abuse

• Does your partner drink or use drugs too much?
• Does your partner have a problem controlling his or her temper soon after using substances?
• Does your partner become frightening, controlling, or more hostile soon after using substances?
• Does your partner have a problem controlling his or her temper the day after using substances?
• Does your partner become frightening, controlling, or more hostile the day after using substances?
• Has your partner been physically or sexually violent after using substances?
• Has your partner ever forced you to use substances?
• Have you ever sought services for codependence or substance abuse?

Child Abuse

• Do your children witness serious arguments between you and your partner?
• Do your children seem scared, upset, angry after these arguments?
• How much violence have the children witnessed? How do they understand it?
• Do the children try to intervene to stop it?
• Does your partner threaten to hurt your children?
• Has your partner prevented you from doing something to care for your children, such as shopping, keeping medical appointments, or contacting a child’s teachers?
• Has your partner physically or sexually abused your children? Have you been fearful he or she would?
• Have the children told anyone?
• Have the children needed medical attention as a result of your partner? What kinds of injuries did they sustain?
• Has your partner ever withheld medication or prevented you from seeking medical services for the children?

Williamson points out that a child abuse report to State authorities may be necessary after this kind of interviewing, and that an assessment of the batterer’s likely response and the victim’s safety is probably needed.

Batterer Assessment

• How do you think your partner will react to a report against him or her?
• Is there anywhere you can stay while the report is being investigated? What will happen if your partner seeks you out there?
• Do you need to take your children with you?
• Do you have a safety plan?
• Does your partner suffer from emotional problems like severe depression or rage?
• Has your partner ever threatened to kill himself or herself? Has your partner ever threatened to kill you?
• Does your partner have access to a weapon?
• Has your partner ever threatened to harm you if you left the relationship? What did he or she threaten and can they carry out this threat?