Domestic violence in straight, as well as gay and lesbian, couples is a serious problem. Treatment options vary, but those who would treat violent couples should consider three things.
Knowledge of the Domestic Violence Literature
The therapist must have a solid knowledge base about the dynamics of domestic violence. This knowledge base would include an understanding of:
- the assessment of specific risk factors for violence, as well as recognition of changing risk factors depending upon the couple's stage in "The Cycle of Violence"
- the importance of focusing on physical safety of the victim in treatment and periodic "safety check-ins" to assure the situation remains safe for the victim
- the power differences between batterer and victim, both those that are "acquired" as well as those that are "inherent"
Treatment providers should know the local community resources available or lacking, as well as both the general and local hardships involved in seeking legal aid.
This kind of work is likely to require an examination of any personal biases for the treatment provider. Such biases may be obvious or subtle, as in encouraging victims to fight back and defend themselves, or minimizing the risk for harm and injury. Providers should examine any history of violence in their own families and lives, and be willing to wrestle with left-over issues they could have. The work is demanding in and of itself, and so the provider's resiliency and self-care skills should be examined too.
Debate Regarding Couples Counseling
There is considerable debate about the appropriateness of couples counseling with violent couples, be they straight, gay, or lesbian.
Island and Letellier (1991) go so far as to say that couple's counseling is never appropriate. This view makes some sense. Clinicians working with violent couples struggle with a number of concerns, including that couples therapy:
- reinforces the batterer's efforts to "make up," possibly making it harder for the victim to freely choose to stay or leave the relationship
- 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 if the potential is high
- could cause more violence after therapy has stirred troublesome issues and conversations or if the victim reports the abuser's actions honestly
- is demanding, as work with abusers stirs deep feelings and possible transference in therapists to punish batterers and protect victims
Some argue that under specific circumstances, couples therapy might be possible. Holtzworth-Munroe and colleagues (1995) note that there is no data supporting that this approach to treatment is more effective than individual therapy. However, there is no evidence that this approach is less effective than individual treatment. Individual therapy for batterers, however, has low rates of success. For example, Edelson and Grusznski (1989) conducted an intense treatment program including educational self-help groups, therapeutic groups, and individual therapy for heterosexual batterers and found that at a five month post-treatment follow-up, 67% of batterers were reported to have been non-violent by their female partners. However, 43% of the men were reported to have 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) study similarly showed that verbal abuse continued after treatment for 70% of abusive men.
Holtzworth-Munroe and colleagues (1995) offer that couples therapy would offer several benefits over individual treatment, including that couples therapy:
- gives the therapist a more accurate picture of the violence, since it is not based solely on the abuser's report, which is likely to be minimized
- allows for the same techniques and information to be given to both partners, including education about domestic violence and personal responsibility for one's actions and safety, as well as attention to warning signs that the abuser is at risk to lose control over his anger
- can focus on better communication patterns that could help prevent risky situations in which the batterer is prone to lose self-control
- provides a "safe place" to discuss difficult and anxiety-provoking topics
- 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 for the abuse and is willing to seek treatment to gain better control of his actions
- the batterer is willing to comply with "safety check-ins" and reports by the victim, which typically should be conducted without the batterer present
- a clear set of terms under which therapy would be ended (such as a "relapse" into any violence, or the use of manipulative efforts to control)
- 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 may be required to begin work on his own of some kind (individual therapy, anger management classes, group therapy, etc ) to begin to address his anger problems, perhaps including attention to physiological signs, relaxation therapy, etc
- there is a safety plan in place for the victim, which spells out under what circumstances he will leave the home; the therapist should meet individually with him to spell out a safe place to go (e.g., a friend or family member who knows the relationship has been violent), and this place should remain secret from the batterer
- there is a safety plan for the batterer, which spells out triggers or physiological signs he can use to warn himself that he is loosing control of his temper, "calming activities" he can engage in to soothe his anger, and a contact person he can go to for support and honest feedback who is aware of the violence in the relationship
- a "no threats" contract that specifically states neither partner will make threats to end the relationship; this would not preclude leaving the home, but it would stipulate that any decision to leave would be reported at a therapy session
- a "no discussion" list of topics; these would include "crazy buttons" or issues that are too volatile for the couple to discuss outside of session, and an agreement for both partners not to discuss these outside of session, and what to do if the other brings up these issues
Of note, work with domestic violence cases is never easy. Some research (Edelson & Grusznski, 1989) shows that even under the most intensive treatment conditions (individual, educational, and group therapy), physical abuse may end in a large number of cases, but many abusers continue to be manipulative, controlling, and threatening in their relationships, and thus therapeutic gains are limited. When there are no or limited resources specifically targeting gays in violent relationships in the community, it is possible that even fewer gains can be made.