Assessing for Domestic Violence

Richard Niolon, Ph.D.
Other Links

Causes of Domestic Violence

Cycle of Violence

Intro To Domestic Violence

Mutual Combat

Why Don't They Just Leave?

Safety Plans


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 violenceuntil asked. They also found that 40% to 75% of the children of abusers, in addition to witnessing parental abuse, suffer child abuse themselves. McDonald et al. (2006) found the chances of couple violence are greater when there are children in the home, and estimated that 15.5 million children live in families experiencing violence.

Holtzworth-Munroe and colleagues cite Quigley as finding that 76% of violent first-year husbands carried this violence into the second or third year of the marriage, with higher carryover for more severe violence. McDonald et al. (2006) found that in their in-home interviews with over 1,600 cohabitating and married couples obtained through probability sampling across the US, 21% reported an act of violence in the last year against one of the partners, with 14% of the men and 18% of the women in the sample initiating some violence against their partner.

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.

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 usemore 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 inself-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 asmutual 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 aboutconsumption versusintoxication, 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 islearning 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

The factors above could lead to modeling, and even teaching that the batterer isentitled 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 theopportunity 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 mustchoose 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 of "red flags" include:

  • 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 feel intimidated/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 were there?
  • Have you ever sought medical services after a fight?
  • Has your partner ever withheld medication or prevented you from seeking treatment?
  • 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 after using substances?
  • Does your partner have a problem controlling his or her temper the day after?
  • Does your partner become frightening, controlling, or more hostile the day after?
  • 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/sexually abused the children? Have you been fearful of this?
  • 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 may be necessary, 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?

Mutual Combat
The questions most people ask with regard to mutual combat relate to who is considered "the batterer" and who is considered "the victim". While this is a complex issue, it actually can be managed with some brief interviewing and basic observation. Marrujo and Kreger (1996) offer that interviewing should include:

  • how fights start and how often they occur,
  • who sustains the more serious injuries,
  • who has motives stemming from revenge, jealousy, or control,
  • who feels the least responsibility for the violence,
  • who has anger-control problems outside the home

This basic information can make clear the roles the partners in the relationship play. Marrujo and Kreger (1996) and Fox (1999) offer a number of points from their research of battering in gay and lesbian relationships:

Batterers Mutual Combatants Victims

High Jealousy and Control

Some Jealousy and Selective Control

Little Jealousy or Control

High Intrusion into Partner Activities

Selective Intrusion into Partner Activities

Little Intrusion if any into Partner Activities

High Anger and Rage, and Anger Problems Outside the Home

Minor Problems with Anger and Anger Outside the Home

Anger Turned Inward (Depression) and No Problems with Anger Outside the Home

Feelings of Entitlement

Some Entitlement

No Entitlement

Feelings of Blamelessness and Adequacy

Accepts Some Responsibility but not All Responsibility

Accepts All Responsibility and Feels Inadequate

Clarity on the Details of the Fight, and Claims of Victimization

Some Clarity

Mostly Confusion on How Matters Escalated, Unsure about Victimization

More Likely to "Cross The Line" First and Initiate the Fight

May or May not Initiate

Unlikely to Initiate, Violent only in Self-Defense

Holtzworth-Munroe and colleagues offer treatment is more likely to work when:

  • victimizers are amenable to social skills and anger management training
  • violent men recognize the power base of their violence
  • social support that disapproves of violence can be introduced to the system to decrease the isolation
  • stressful life events can be managed more directly
  • emotional issues such as jealousy and substance dependence can be treated

There is considerable debate about the appropriateness of couples counseling. Island and Letellier (1991) go so far as to say it's never appropriate, as it:

  • reinforces the batterer's efforts to "make up," making it harder for the victim to freely choose to leave
  • may redefine one person's choice to be violent as "a couple problem"
  • requires careful decision-making regarding client safety outside of the therapy office
  • prevents accurate monitoring of abuse potential, as the victim is likely to be afraid to report honestly
  • could lead to violence if therapy stirrs up issues or if the victim reports the abuser's actions honestly
  • stirs deep feelings and possible transference in therapists to punish batterers and protect victims

Some argue that, under specific circumstances, it might be possible. Holtzworth-Munroe and colleagues note that there is no data supporting that couples treatment is more effective than individual therapy, but no evidence to support that it is less effective. Studies seem to show equivalent outcomes.

Individual therapy for batterers, however, has low rates of success. Edelson and Grusznski (1989) conducted anintense treatment program and found that at a five month follow-up, 67% of batterers were reported non-violent by their female partners.However, 43% of them made threats of violence. Thus, in actuality, only 24% of the men could be considered "success cases," who did not become violent or threaten violence toward their partner. Gondolf's (1997) 70% success rate is similar.

Holtzworth-Munroe and colleagues (1995) offer that couples therapy:

  • gives the therapist a more accurate picture of the violence, since it is not based solely on the abuser's report
  • allows for the same techniques and information to be given to both partners, including education about domestic violence, personal responsibility, and warning signs
  • can focus on better communication patterns to prevent the batterer losing self-control
  • provides a "safe place" to discuss difficult and anxiety-provoking topics

Prerequisites for potentially successful couples treatment would include:

  • the violence did not fit a pattern of abuse and control
  • the violence only happened once, perhaps twice (separated by a long interval)
  • the batterer takes full responsibility and is willing to seek treatment
  • the batterer is willing to comply with "safety check-ins" and reports by the victim without the batterer present
  • there is a clear set of terms under which therapy would be ended (such as a "relapse" into any violence)

Holtzworth-Munroe and colleagues offer that the research does not help us determine which mildly violent couples will become seriously violent, and so we have to assume that all will. In this case, you need:

  • a "no violence" contract that specifically states there is to be no violence between the parties, and that should they become violent, they must report this to the therapist within one day
  • part of the "no violence" contract would also include no threats of violence
  • the batterer is required to begin work on their own issue (individual therapy, anger management classes, group therapy, relaxation therapy, etc… )
  • there is a safety plan in place for the victim, which spells out under what circumstances he or she will leave the home, which is secret from the batterer
  • there is a safety plan for the batterer, which spells out triggers or physiological signs he or she can attend to, "calming activities" to soothe anger, and a contact person for support who is aware of the violence
  • a "no threats" contract that specifically states neither partner will make threats to end the relationship; this would not preclude leaving, but the decision to leave for good would be reported at a therapy session
  • a "no discussion" list of topics, minimizing "crazy buttons" or issues that are too volatile for the couple to discuss outside of session

    Why Don't They Just Leave?
    Some may ask why people in violent relationships do not just leave the relationship.

    First, one response would be that there are many reasons why leaving may not be so simple during the relationship. For about half, the violence did not begin until a year into the relationship (O'Leary and colleagues, 1989; Merrill and Wolfe, 2000). Thus, many victims did not realize it would be the start of an abusive pattern, felt that they had invested strongly in the relationship and owed it to their partner to "stick it out" (31%), and maintained hope that their partner could change (75%). This same sense of obligation is why many spouses stay together despite illness, substance abuse, and affairs. For gay men, this sometimes is tied to HIV status. Of HIV+ victims, 60% were doubtful of their ability to leave the abuser and care for themselves, while 50% of HIV- victims with HIV+ abusers felt guilty about leaving the abuser (Merrill and Wolfe, 2000).

    Further, part of "The Cycle of Violence" entails an abusive episode, followed by regret and guilt on the part of the abuser and a "honeymoon" period. Thus, many victims see true regret and guilt on the part of the batterer with promises to change, and actually see some change for a short time, and thus agree to stay in the relationship because of this.

    For other victims, financial dependence, fears of violence, or fears the abuser will, in desperation, harm or kill himself are common. For others, the abuser has significantly isolated them from family and friends, leaving them with little support to leave the relationship.

    Second, another response is that mostdo leave. Herbert and colleagues (1991) found that two-thirds of their sample did leave. Similarly, Merill and Wolfe (2000) found that 90% of their gay victim sample left, with 46% leaving a 2+ year relationship, and 77% of them leaving an abuser they lived with. Of note, 60% reported making three or more "significant attempts" to leave before being able to escape. 58% rated the continued harassment of their ex as moderate to severe.

    This is consistent with straight relationships. Riggs et al (2000) report that the United States Department of Justice reported that statistics from 1998 indicated that incidents of abuse against women werethree times higher after the divorce from an abuser. Davis and Frieze (2000) reported that 62% of young adults had experienced some stalking by an ex-partner. They note that physical/psychological and substance abuse were strongly associated with stalking, and women were twice as likely to report being afraid of the stalker. Tjaden and Thoennes (1998) found 68% of stalked women feltless safe after the breakup, 45% began carrying a weapon, and 81% were physically assaulted and 31% sexually assaulted.

    Safety Plans
    A Safety Plan is a plan for a victim in the event that he or she decided to leave the abuser quickly. Sometimes the victim may have little warning of an opportunity to do so and need to act quickly, or may decide at once that his or her life is in danger and they need to escape immediately. Safety plans can be elaborate or simple, and include some of the following:

    • a specific plan for how to get out of the home (a window, a door, a fire escape…)
    • packed bags, each with needed things like
      • a set of keys to the home, car, and workplace
      • money
      • copies of pay stubs, bills, and other financial documents
      • clothes and toiletries
      • a green card, visa, or other immigration papers if applicable
      • Social Security card
      • identification such as a driver's license or passport
      • phone numbers for friends, police, and a shelter or agency that can help
      • a set of checks or an ATM card, and a copy of a monthly checking account statement
      • any legal documents like an order of protection or restraining order
      • medical records
    • one bag is hidden somewhere the batterer is unlikely to find, and the other is saved by a friend in case the victim has to leave with no warning
    • if there are children, two similar bags packed for them with a favored toy or stuffed animal; one is stored where the batterer is unlikely to find it, and the other is saved by a friend
    • if there are children, a copy of birth certificates and school records
    • any medications or copies of needed prescriptions
    • a neighbor who will "watch out" for anything suspicious in the home
    • a family member or friend who will respond a given way (for example, by calling the police) when the victim uses a preset "catch phrase" (for example, "What ever happened with your aunt's divorce?")
    • two places to go in the event the victim has to leave immediately

    Once a week, review the safety plan so it is deeply ingrained in the victim's memory.