Defining Psychological Maltreatment in Domestic Violence
Perpetrator Treatment Programs: Multiple Perspectives

Daniel Jay Sonkin, Ph.D.

Under submission to the Journal of Emotional Abuse

Abstract

When treating perpetrators of domestic violence it is crucial that service providers clearly define what constitutes domestic violence. Although most advocates and professionals agree that violence manifests in three general forms, physical, sexual and psychological, there still lacks agreement as to what exact behaviors constitute psychological violence. This paper discusses the problems of conceptualizing psychological violence and describes several conceptual models. A integrative approach to defining psychological violence is proposed that takes into account broadness of definition, frequency and the likelihood of causing trauma in the victim. This models is discussed with regard to it's application to clinical treatment of domestic violence offenders, particularly in court-mandated populations.

When treating perpetrators of domestic violence it is crucial that service providers clearly define what constitutes violence (Sonkin, 1995). In any mental health treatment, clear treatment goals are necessary to successful outcomes. Not only is it important for the therapists and clients to identify what behaviors are needing change, but it is also important for the criminal justice personnel be to be clear with regard to what constitutes successful and unsuccessful participation in court mandated treatment (Ganley, 1987, Sonkin, 1987). Clear and consistent definitions are also, however, relevant to the issue of program evaluation (Dutton, 1995; Gondolf, 1987)) as well as public awareness campaigns (Soler, 1987). How can we dialogue about something that may be defined differently by different people? This article will discuss the various definitions put forth today by researchers and clinicians and explore how to best use these definitions to enhance batterer treatment.

It has been over twenty years since the first publications describing the problem of domestic violence and still much confusion exists regarding the definitions of violence. Although most professionals agree that violence manifests in three general forms, physical, sexual and psychological (Sonkin, 1985; Stordeur and Stille, 1989; Dutton, 1988, rev. 1995), there still lacks agreement as to what exact behaviors would be included in a comprehensive definition of domestic violence. Numerous clinical and research instruments (Straus, 1979; Hudson, and McIntosh, 1981; Walker, 1984; Tolman, 1989; Stets and Pirog-Good, 1990; Marshall, 1992; Shepard and Campbell, 1992; Sonkin, 1995b) have been developed to assess for all forms of violence but agreement as to what specific acts should be included in a comprehensive definition is far from resolved. In general, with physical, sexual or psychological maltreatment, it is with the most extreme acts that we find the most agreement and with the less extreme, more subtle, acts we are likely to find the most disagreement.

Definitions of Physical, Sexual and Psychological Violence

For the most part, there is fairly consistent agreement as to what behaviors are included in the physical violence category. These acts would include a range from the less lethal acts of grabbing and pushing to the more lethal acts of choking, punching and assaults with weapons (Sonkin, 1995). Frequently, inexperienced service providers ignore the low levels of physical violence focusing exclusively on the more demonstrative acts, such as punching, choking etc. (Sonkin, 1995).

Greater disagreements begin to appear when defining sexual violence. Most professionals would agree that any non-consensual sexual activity (rape, oral copulation, sodomy, etc.) would be included in this category. However, according to some state laws, consent is only one element to proving sexual assault. In some jurisdictions, physical force has also to be proven (Walker, 1994) to obtain a criminal conviction. However, many battered women consent to sexual activity for fear of escalating physical and psychological violence and therefore physical force is not necessary for the perpetrator to obtain partner complicity. Therefore, the behavior itself (sexual intercourse, for example) may not be sufficient to determine whether or not an act of sexual violence has occurred.

Sexual violence has been defined by advocates more broadly than the criminal justice model (Russell, 1982). For example, continual complaining or criticism may be interpreted as sexual coercion. Additionally, the subjective experience of "feeling" coerced may be a result of antecedent threats made by the perpetrator, or actual acts of physical or sexual violence, which may contribute to the belief that the victim has no choice even though it may look to the unknowing observer as if she does have a choice (Bochnak, 1981). When considering these realities, the issue of consent itself becomes open to interpretation.

Where inconsistency in definition is the greatest is in the area of non-physical violence. Even the terminology varies from professional to professional. Terms such as emotional abuse, psychological maltreatment, verbal abuse, mental abuse, emotional maltreatment and psychological violence are commonly used to describe non-physical aggression. Some view these terms as synonymous whereas others may make differentiations between forms. For example, emotional abuse may be defined as those behaviors that both partners may exhibit and are likely to include name-calling, negative judgments or attributions or actions (such as yelling) that result in causing the other person psychological pain or discomfort. Psychological violence, on the other hand, may be characterized as carrying an implied threat of physical violence, or attempt to intimidate or control the other person. Whether this distinction between psychological violence and emotional abuse is real or arbitrary, the fact still remains that, in a rudimentary way, these distinctions are an attempt to begin to differentiate the concept of psychological violence from marital discord (Burman, Margolin and John, 1993).

The Psychological Maltreatment of Children

Researchers in the field of child maltreatment have been examining the issue of psychological maltreatment for many years because it has been viewed as the unifying factor that connects the cognitive, affective and interpersonal problems that result from physical and sexual abuse and neglect (Brassard, Germain and Hart, 1987; Hart and Brassard, 1987). There is a growing body of literature that supports the claim that psychological maltreatment is just as damaging as physical or sexual abuse or neglect (Egeland and Erickson, 1987). In operationalizing psychological maltreatment for the purpose of empirical studies, researchers have struggled with the advantages and disadvantages of broad versus narrow definitions of psychological maltreatment. Broad definitions of psychological abuse recognize its manifestations in both obvious and subtle forms. Broad definitions also help to clearly illustrate the pervasiveness of this type of abuse and the gray boundary between abusive and non-abusive behaviors. Broad definitions make the connection between social and cultural factors and their influence on the experience of the individual or family. On the other hand, these broad definitions of psychological abuse may often disregard important individual and cultural differences creating standards of conduct defined by a few but compared to many. The greatest drawback to broad definitions of psychological abuse is that the definition may be so vague or general that it makes the majority of parents vulnerable to being identified as abusers. This also gives the subtle or direct impression that these borderline cases will eventually become full-fledged cases of abuse, even though there is no definitive research that supports this theory.

Narrow definitions tend to restrict the list of actions constituting psychological maltreatment to the more blatant and more easily agreed-upon behaviors that constitute psychological abuse. By their less-inclusive nature, these definitions are less vulnerable to the problems of the broader definitions. However, these more-narrow definitions often ignore the subtle forms of abuse that may be equally injurious as, or predictive of, the more serious forms. Narrow definitions may also fail to identify social forms of psychological abuse such as racism and sexism.

An interesting, and perhaps applicable, development in the child abuse field is the change from focusing solely on the act but rather examining the act in relationship to the effect on the child (Hart and Brassard, 1987). In other words, what may be considered by one child as abusive, may not be the case for another. Similarly, what one adult would consider abusive behavior, such as yelling, another adult may consider unpleasant but not abusive and yet a third adult may consider fair game. Child abuse researchers are also considering as to whether it is a particular act abuse that is problematic or whether is it a pervasive pattern of behaviors that are detrimental and therefore abuse. Is there an accumulation of psychological effects over time, making a person more vulnerable to psychological injury and less able to defend against psychological attacks on the self (Van der Kolk, 1987). For example, one person who is call a derogatory name may not experience this as abuse, but the same person who criticized on a daily basis for many years may feel devastated by the slightest criticism. With child victims, the stage of development plays an important role in what constitutes psychological maltreatment and its subsequent effects. Particular acts of abuse may have a more devastating effect on a younger child than an adolescent (Rosenberg, 1994). Considerable research has supported that early psychological maltreatment may have profound and lasting effects on children, leading them to experience many of the same problems as those who have been physically and sexually abused (Egeland and Erickson, 1987). Developmental issues play less of a significant role with adult victims of psychological abuse. However, adults who are victims of repeated trauma may experience a diminishing of internal psychological defenses and resources necessary to fend off the negative effects of abuse over time (Walker, 1994).

Another issue in accurately defining child psychological maltreatment has to do with the issue of intent. It has been suggested that a victim's past experiences may either exacerbate or diminish the effects of the abuse (Brassard, Germain, and Hart, 1987). For example, a person whose self-esteem has been damaged by past acts of violence may define some acts as more abusive than an objective outsider would. Even some individuals who have greater psychological resources may experience a particular negative comment or abusive action in a detrimental manner. Lastly, the argument has also been made by child abuse experts that if the resulting injury or impact of the abusive act defines whether or not a particular behavior is child abuse, and we know that all victims of physical, sexual, and psychological maltreatment and neglect results in some emotional injury, then it is reasonable to assume that psychological abuse is the underpinning of all forms of abuse (Navarre, 1987). In other words, a child who is hit is just as likely to receive the message that he or she is unworthy as a child who is not hit but explicitly told that he or she is unworthy. Therefore, following this logic, psychological violence may be the underpinning of all forms of domestic violence - an argument already posited by researchers in the field of domestic violence (Stets and Pirog-Good, 1990; Vissing, Straus, Gelles and Harrop, 1991). Additionally, some advocates in the field (Pense and Paymar, Michael, 1993). suggest that all forms of violence (physical, sexual and psychological) are used to wield power and control over others and therefore distinctions between the different forms of abuse are not necessary.

Methods and Definitions

The Conflict Tactics Scale

Considerable efforts have been made in the domestic violence field to define psychological maltreatment (Straus, 1979; Hudson, and McIntosh, 1981; Walker, 1984; Tolman, 1989; Stets and Pirog-Good, 1990; Vissing, Straus, Gelles and Harrop, 1991; Shepard and Campbell, 1992; Marshall, 1994; Sonkin, 1995b). Like physical and sexual violence, psychologically violent acts can range from the overt (threats to kill) to the subtle (criticism).

The most widely used instrument, the Conflict Tactics Scale, developed by Straus, was designed to measure behaviors ranging from passive (sulking or withdrawing) to hostile (insulting and swearing) to threatening to overt physical violence. The verbal/symbolic aggression items on the scale were (Vissing, Straus, Gelles and Harrop, 1991):

Insulted or swore at the other one
Sulking or refusing to talk to the one
Stomped out of the room or house (or yard)
Did or said something to spite the other one
Threatening to hit or throw something at the other one
Threw or smashed or hit or kicked something

Although this tool has been criticized for it's poorly conceived and constructed items and ignoring the context of violence, it was the first systematic attempt to quantify psychological violence within in families. It's greatest limitation, for the purpose of this discussion, is it's lack of inclusion of other behaviors that are commonly defined as psychological maltreatment.

Amnesty International Definition

Lenore Walker (1994) has proposed utilizing the definition of psychological violence or terrorism provided by Amnesty International (the human rights watch group) because it closely resembles the ways that male batterers control and intimidate their partners. This definition includes the following behavior patterns.

Isolation of victim
Induced debility-producing exhaustion
Monopolization of perceptions, including obsessiveness and possessiveness
Threats, such as death to self, victim, family or friends, or sham executions
Degradation, including humiliation, denial of victim's power, and verbal name-calling
Drug or alcohol administration
Altered states of consciousness produced by a hypnotic state
Occasional indulgences that keep hope alive that the abuse will cease

Following are some examples of such actions as they might occur in cases of domestic violence.

_ Examples of isolation would include not letting her socialize with friends or family members, forcing her to stay at home or not letting her leave the house without his presence, moving away from all her support systems, such as friends or family members.

Induced debility-producing exhaustion would include keeping her up all night during a fight, waking her up to argue with her or abuse her physically or sexually, making her do all the work at home, forcing her into a servant role, keeping her pregnant, or not allowing her to have support in taking care of the children.

Monopolization of perceptions includes pathological jealousy, having to know where she is all the time and who she is with, accusing her of being with other men, looking at other men, or wanting to be with other men, following her, controlling finances so she cannot leave him, stalking her after a separation or divorce, or refusing to obey restraining orders.

Threats to kill her, kill others, or kill himself are common forms of psychological abuse that are intended to control her and get what he wants.

Verbal degradation is another common behavior that men use to cope with their fears, control their partners, and deal with their own sense of worthlessness. Comparable to physical abuse, the verbal name-calling has as much, or sometimes more, impact on the victim in that it serves to damage the victim's sense of self-worth, resulting in feelings of powerlessness. She feels she must give up her own values, her point of view and feelings, in order to keep him from becoming physically violent.

Drug or alcohol administration is common in many battering relationships. Many male batterers encourage their partner to use alcohol or drugs, some force her use of chemicals, and many battered women simply do so as a means of coping with their depression or anxiety about their situation. Women with preexisting chemical abuse problems often gravitate towards partners with similar problems. Frequently, violence is a prominent aspect of these relationships.

Altered states of consciousness is a term that often refers to the batterer's attempt to invalidate his partner's perceptions. Many men try to convince their partner that she is crazy or is hearing or seeing things that did not happen, or that she can't live without him. The motion picture Gaslight quite effectively illustrates this dynamic.

The occasional indulgences that we often hear are typified by the statement, "I promise dear, I'll never do it again." In psychological violence, this is followed with loving behavior, such as gift-giving, sensitivity, and tolerance for a short period of time before the old behavior sets in again.

This definition provides a comprehensive description of psychological violence but is more narrow than other definitions (Pense and Paymar, 1993; Shepard and Campbell, 1992). The Amnesty International definition describes the more severe forms of psychological violence without including what may be termed maladaptive or negative interpersonal problem-solving behaviors. However, many of these criteria are also susceptible to interpretation and therefore may be criticized for not being clearly and consistently definable.

The Psychological Violence Towards Women Inventory

The Psychological Violence towards Women Inventory, developed by Richard Tolman (1989), is one of the first psychometric-type tests that has been developed for specifically measuring psychological violence by male batterers. Tolman developed items from his experience as well as numerous other inventories and conceptualizations of psychological violence (Straus, 1979; Hudson and McIntosh, 1981; Patrick-Hoffman, 1982). Fifty eight items were eventually selected for the study. The items clustered into six general categories:

Attacking her personhood, demeaning, belittling, undermining self-worth
Defining her reality, getting her to question her own perceptions and judgments
Controlling her contact with outside world and support systems
Demanding subservience, complying with rigid sex-role expectations within the family
Withholding positive reinforcers within the relationship
Threatening nonphysical punishment for noncompliance with requests; status and emotional regulation

After analyzing the fifty-eight-statement questionnaire using responses of both battered women and male batterers, Tolman found that statements fell into one of two categories: domination/isolation (which included isolation from resources, demands for subservience, and rigid observance of traditional sex roles) and emotional/verbal (which included verbal attacks, behavior that demeans the woman, and withholding of emotional resources).

The obvious clinical advantage to this measurement tool, it the ability of the clinician to more accurately assess the types of psychological maltreatment occurring in a relationship. It provides for some consistency between clients with regard to both definitions and specific behaviors. Although this form may not include the broadest definition, such as that used by the Duluth model, it is not as narrow as the criminal justice model. Most importantly, it seems to take the Amnesty International model and change it from "terrorist" language into "relationship-appropriate" language, even though some may argue that many batterers behave in ways that may be considered terroristic. Lastly, no matter what arguments that could be made about methodological short-comings, this tool can be very useful in a clinical setting by assisting the practitioner in identifying psychological violence in a structured and clearly articulated fashion.

The Abusive Behavior Inventory: The Duluth Model

Educational, curriculm-based programs, such as the Domestic Containment Program in Duluth, Minnesota (Pense and Paymar, 1993), have used the most inclusive definition of what may be described as psychological violence. This definition of psychological abuse is one of the most inclusive or broadest in that it includes the types of behaviors that have traditionally been viewed as dysfunctional or maladaptive but not "violent". This definition stems from the ideology of the Duluth program. The problem of battering is understood from a sociopolitical perspective, rather than a psychological perspective (Paymar, 1993). The focus in their program is on the exploitation of women through men's use of techniques (physical, sexual, and psychological violence) that upset the balance of power between men and women. They view the main purpose for men's violence against women to be an effort to maintain control and power rather than a result of psychological deficiencies (Stets and Pirog-Good, 1990). The crucial difference between the profeminist approach to treating male batterers and other psychological approaches is that the profeminist approach focuses on the sexist attitudes that are precipitant of violence rather than the psychological causes. Additionally, profeminist programs tend to minimize the differences between batterers and non batterers, and hence the broader definition of psychological violence, allowing the men to look at the ways in which all men devalue women and assert their male privilege. Heavy emphasis is placed on the man examining how his behavior has affected his partner or family, and ways that he can make them safe from his violence. Although this perspective has been questioned from both a practical and philosophical standpoint (see Dutton, 1994 for an excellent review of this issue), many programs around the country use this philosophy as a basis for their treatment of male batterers.

The power and control wheel is used in their groups to help men identify their coercive behaviors that may lead to physical or sexual violence if their attempts to get what they want is frustrated. The behaviors listed in the power and control is are viewed as being no different than physical or sexual violence in that they serve the same function - to control and dominate their partners. Using this model, programs using the Duluth Model will work with any man who demonstrates these behaviors and therefore are labeled abusive. One outcome of using this model is to define some men as batterers or abusers who in the past may have been labeled as domineering, authoritative, unfair fighters, or chauvinistic. Their power and control wheel describes eight forms of psychological violence consisting of specific behaviors.

_ Using coercion and threats (making and/or carrying out threats to do something to hurt her, threatening to leave her, to commit suicide, or to report her to welfare, making her drop charges, making her do illegal things)

Using economic power (preventing her from getting or keeping a job, making her ask for money, giving her an allowance, taking her money, not letting her know about or have access to family income)

Using male privilege (treating her like a servant, making all the big decisions, acting like the master of the castle, being the one to define men and women's roles)

Using children (making her feel guilty about the children, using the children to relay messages, using visitation to harass her, threatening to take away the children)

Minimizing, denying, and blaming (making light of the abuse and not taking her concerns about it seriously, saying the abuse didn't happen, shifting responsibility for abusive behavior, saying she caused it)

Using isolation (controlling what she does, who she sees and talks to, what she reads and where she goes, limiting her outside involvement, using jealousy to justify actions)

Using emotional abuse (putting her down, making her feel bad about herself, calling her names, making her think she's crazy, playing mind games, humiliating her, making her feel guilty)

Using intimidation (making her afraid by using looks, actions, gestures, smashing things, destroying her property, abusing pets, displaying weapons)

Based on this model, Shepard and Campbell (1992) developed the Abusive Behavior Inventory, a thirty item instrument that uses a five point Likert scale to measure the frequency of abusive behaviors during a six month period. This scale is based on the Duluth feminist perspective that views physical abuse and a means to maintain power and control over victims and that psychologically abusive behaviors reinforce this dynamic (Shepard and Campbell, 1992). This scale is similar to the Conflict Tactic Scale in that it includes both physical and psychological violence (here the authors refer to the power and control wheel descriptors as psychological violence). The authors differentiate their scale from the Conflict Tactics Scale in that it includes sexual abuse, other forms of psychological abuse not included in the Conflict Tactics Scale and, most importantly, it is not framed within the context of conflict, but rather abuse. This scale is useful for both the assessment and treatment process. The scale can be administered to the client and his/her partner during the assessment process so as to complete a violence history. It can be useful to assess for minimization and denial by comparing answers to the questions. During treatment, a similar check list could be filled out each week by group participants to determine if their violent behaviors persist.

The Penal Code and Psychological Violence

Use of the criminal penal code is one way of formulating a more clear, reliable and useful definition of psychological violence (Deerings California Penal Code, 1995). In most states a threat to hurt or batter is called assault. Simple assault may be a verbal act but is most commonly accompanied by a physical gesture, such as threatening with a fist or an object. Aggravated assault is usually a threat to kill as indicated by the use of a weapon, such as a knife or a gun. Threats to kill or terrorizing threats are also described in the penal code. Therefore, if we were to use the law as the criterion for defining psychological violence, then any threat to hurt or kill would be a part of this definition.

Additionally, stalking would be an important part of this definition (Sonkin, 1994a/b). Stalking includes any attempt on the perpetrator's behalf to follow, watch, harass, terrorize, or otherwise contact his partner against her desires. These contacts include in-person, telephone or mail contact, or communications through other persons. Stalking also includes any specific threats to kill or otherwise harm her, as well as veiled threats to kill or harm. Stalking may also include mailing cards or other cryptic messages, breaking windows or vandalizing her property including the car, taking away her mail, leaving things, such as flowers, on her doorstep or at work, watching her from afar, hang-ups on the telephone, or any other kinds of harassing behaviors.

In California, a recent law was passed broadening the definition of stalking, which allowed police greater discretion in making arrests of stalkers. This new law defines stalking as willful, malicious, and repeated following or harassing of another person, and making a credible threat with the intent to place that person in reasonable fear for his or her safety, or the safety of his or her immediate family. According to California law, harassing means a knowing and willful course of conduct directed at the specific person which seriously alarms, annoys, torments, or terrorizes the person and which serves no legitimate purpose. Credible threat, according to this new law, means a verbal or written threat, or a threat implied by a pattern of conduct made with the intent and the apparent ability to carry out the threat, so as to cause the person who is the target of the threat to reasonably fear for his or her safety or the safety of his or her family. Course of conduct is defined in the new law as meaning a pattern of conduct composed of a series of acts over a period of time, however short, evidencing a continuity of purpose.

The use of the penal code can be a good start in developing a working definition of psychological violence. Many of the men referred for treatment are court-ordered, and as a condition of probation or diversion are required to sign a statement indicating that they will abide by the court mandate as well as obey all laws (Ganley, 1987). If the client threatens or assaults his partner, then he has broken the law and therefore is in violation of his probation or diversion. When this type of behavior is reported by the treatment program the criminal justice system is likely to respond, as opposed to the mere reporting of an argument where the man called his wife a derogatory name.

On the other hand, the obvious problem with using the penal code is its narrow and restrictive definition of psychological violence. Mental degradation, for example, can over time be experienced as painful and traumatic as a physical threat of violence. Not addressing this fact in counseling gives the message that any behavior is acceptable as long as it is not illegal.

Integrating definitions

Given the differing definitions of psychological violence, how does one decide which definition is appropriate for their intervention program? One may integrate these definitions by conceptualizing psychological violence on a number of continuums. One continuum could reflect the severity (or likeliness of causing psychological harm to the victim) of the specific acts. For example, on this continuum one would place the most terrorizing types of psychological violence on one end (such as threats to kill and stalking), the more common and less terrorizing acts in the middle (such as extreme controlling behaviors or verbal abuse) and the least intrusive or damaging and most common acts at the other end (such as using male privilege).

Another continuum of psychological violence would describe the acts solely on a frequency basis, the idea being that the more frequent the abuse the more likely it will cause psychological trauma. This method would depend heavily on a way of quantifying specific acts of psychological violence. The author has developed a comprehensive Domestic Violence Inventory (Sonkin, 1995b) HyperCard stack for the Macintosh environment where the acts of physical and sexual violence and threats of violence are specifically quantified (once, twice, 3-5 times, etc.) and the acts of psychological violence are described more generally (never, rarely, occasionally, or frequently). In developing this tool, I found that clients found it difficult to quantify psychological violent behaviors. This may result from two reasons. First, some forms of psychological violence occur too often to actually quantify. Second, some terms may be too easily interpreted and therefore lack specificity. For example, take the category of mental degradation. What words constitute mental cruelty? Some victims have told me that it wasn't what he said, but how he said it. Generally, rarely is defined as happening once or twice. Occasionally is defined as happening more than once or twice or periodically throughout the length of the relationship. Frequently is defined as happening on a regular basis. Although these terms are subject to great variability, depending on the clients subjective experience, however, asking does give the clinician an overall sense of the types and frequency of psychological violence.

Another continuum may be one of inclusiveness where at one end is the most narrow definition of psychological violence (the legal definition), at the other the end is the most inclusive definition (Tolman, 1989; Shepard and Campbell, 1992) and in the middle a definition that captures both the narrow definition and specific pieces of the most inclusive definition (Amnesty International).

If we could develop a way of defining psychological violence that both takes into account the many subtle and obvious manifestations (inclusiveness), the effects on the victim (severity) and the number (frequency) of acts this would make good clinical sense given the psychological variability in the population of male batterers as well as the circumstances of the treatment referral (self or court referred). Below is a proposed model that takes into account, severity, legality and frequency.

Psychological Violence Inventory

Category 1: High risk of psychological trauma - Criminal behavior

Threats to hurt or batter
Never Once Twice 3-5 Times 6-10 Times 11-20 Times > 20 times Don't Know

Threats with weapons
Never Once Twice 3-5 Times 6-10 Times 11-20 Times > 20 times Don't Know

Threats to kill or terrorizing threats
Never Once Twice 3-5 Times 6-10 Times 11-20 Times > 20 times Don't Know

Stalking
Never Once Twice 3-5 Times 6-10 Times 11-20 Times > 20 times Don't Know

Category 2: Moderate risk of psychological trauma - Intimidating behavior

Isolation of victim (separation from social support systems)
Never - Rare - Occasional - Frequent - Don't Know

Induced debility-producing exhaustion (preventing sleep, rest and personal time)
Never - Rare - Occasional - Frequent - Don't Know

Monopolization of perceptions, including obsessiveness and possessiveness
Never - Rare - Occasional - Frequent - Don't Know

Mental Degradation, including humiliation,denial of victim's power, verbal name-calling
Never - Rare - Occasional - Frequent - Don't Know

Forced drug or alcohol administration
Never - Rare - Occasional - Frequent - Don't Know

Using intimidation (making violent gestures, smashing things, destroying her property, abusing pets)
Never - Rare - Occasional - Frequent - Don't Know

Category 3: Lower risk of psychological trauma - Dysfunctional behaviors

Traditional role expectations
Never - Rare - Occasional - Frequent - Don't Know

Using children during arguments
Never - Rare - Occasional - Frequent - Don't Know

Minimizing, denying, and blaming
Never - Rare - Occasional - Frequent - Don't Know

Altered states of consciousness/denying her reality
Never - Rare - Occasional - Frequent - Don't Know

Withholding positive reinforcers
Never - Rare - Occasional - Frequent - Don't Know

Threatening nonphysical punishment for noncompliance with requests, emotional distancing
Never - Rare - Occasional - Frequent - Don't Know

The above proposed inventory illustrates how the earlier definitions of psychological violence can be integrated in a way that both appreciates the variability, the degree of trauma, and legality issues. In a treatment program, the number of clients who will be flagged as re-offending will depend on which category one uses and for what purposes. The first category, the most exclusive definition, are those acts that would likely cause severe psychological trauma too the victim and are illegal behaviors. Hopefully, this category would involve the smallest number of clients. The second category are those acts that are likely to cause significant trauma, particularly when occurring at a high frequency. This category would involve a greater number of clients than the first category because these acts are typical of many battering situations. The third category are those acts likely to cause emotional distress but are not traumatic, per se, like the other two categories. This third category of psychological violence would be evident in the greatest number of clients in that many of these behaviors are likely to occur throughout treatment with or without the therapist's knowledge. The extremes of this continuum are clearly evident. Too exclusive a definition does not fully appreciate the various ways the clients are perpetrating psychological violence, whereas a too inclusive a definition brings so many behaviors into the definition that most clients would be considered re-offenders on a weekly basis. Conceptualizing psychological violence in this way can be extremely useful for both the clinician and the client.

Where this model is most useful is when needing to address the issue of client re-offenses during the course of court-mandated treatment. It is clear that when client perpetrates physical or sexual violence while in treatment, that the clinician must act swiftly and decisively when intervening therapeutically. For many programs re-offenses of these forms of violence may call for immediate expulsion from the program, or for the criminal justice client, a referral to probation or the courts. Depending on the type of psychological violence perpetrated, the response by the clinician may range from a simple discussion of the problem to the dire consequence of termination from the program. Therefore, it is important for clinicians to clarify when developing program structure as to how this type of violence will be addressed. For example, it could clearly stated at the onset of treatment that any threats or stalking (Category 1) would be immediately reported to probation (for court-mandated clients) or could be grounds for termination from the program. Psychological violence that falls short of criminal behavior but is nevertheless likely to be experienced as traumatic (Category 2) could be considered when deciding treatment plans, interventions or additional treatment and may be reported to probation depending on the frequency of the acts. Finally, the most common acts of psychological violence (Category 3) may be considered goals of treatment but their presence are not necessarily an indication that treatment is failing to produce desirable results. In this way the most egregious and most harmful acts of psychological violence are noted and addressed by service providers while at the same time clients are not faced initially with the seemly insurmountable task of changing deeply ingrained behavior patterns.

Given the various definitions of psychological violence, it is doubtful that any victims of physical or sexual violence have escaped being exposed to one or number of acts of psychological violence. In fact, the psychological violence that always accompanies physical and sexual violence may be the cause of the psychological trauma experienced by the victim (Stets and Pirog-Good, 1990; Vissing, Straus, Gelles and Harrop, 1991). Because of the chronic nature of domestic violence, most victims are experiencing these acts with sufficient intensity, frequency, and duration that they are having lasting negative effects (Dutton, 1992; Vitanza, S.; Vogel, L.C.M. and Marshall, L L., 1995). Therefore, it is both the serious acts and frequent acts of psychological violence that clinicians need to aggressively address in treatment, while at the same time work with clients to change the less traumatic forms of psychological abuse.. Obviously, while each category of psychological violence described above is distinct in principle, in practice there is a great deal of overlap within each client's life, therefore the clinician is challenged to address multiple level of abuse at any one time.

In Summary

It is clear from the literature that although there are still many important differences between the various definitions of psychological maltreatment, there is also a great deal of agreement between definitional approaches. What is still unanswered is what short and long term effects the various types of psychological have on victims. Similarly, it is still unclear as to how to differentiate psychological violence from other behaviors that contribute to marital discord. Therefore, counselors are encouraged to cautiously use a definition of psychological maltreatment and refrain from making claims as to it's effects without the support of empirical data. Additionally, it is also particularly important to exercise caution when working with court-mandated clients and handling crises. Because psychological abuse is likely to regularly occur with male batterers in treatment, it is suggested that counselors clarify with probation, the courts, and clients themselves what acts of psychological abuse will be considered a "re-offense" and therefore reported to the court (or probation). Similarly, it is suggested that counselors clarify from the beginning of treatment what types of psychological violence will be used as a basis of violating client confidentiality in exercising their duty to protect and/or initiate an involuntary hospitalization. In these situations, it is recommend that counselors use the more narrow, crime-specific definitions of psychological violence (threats, harassing, stalking, etc.) and reserve the broader elements of the definition (name-calling, using male privilege, etc.) for the long-term goals of treatment.

References

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