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
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

Psychological Violence

Property Violence

Physical Violence

Sexual Violence

Substance Abuse

Child Abuse

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