The Violence History

In determining suitability, motivation and developing a formalized treatment plan for a particular client, clinicians should obtain a thorough description of the physical, sexual and psychological violence perpetrated by the client recently as well as in the past. Abusers commonly minimize the frequency and severity of their violent behavior even with the best of interviewers; therefore particular techniques should be employed in order ascertain the most complete history as possible.

Typically, a violence history will begin with the clinician asking the client to describe the most recent incident of physical violence.This may be before the clinician provides the client with a definition of physical, sexual or psychological violence.The purpose of this procedure is so the clinician can first determine from the client’s point of view what behaviors are problematic or may be considered violence.Typically, there is considerable omission of details due to denial, minimization, shame or lack of memory due to decreases in higher cognitive processes during highly impulsive dysphoric states.Whatever the reason, it is important for the therapist to slowly encourage the client to disclose greater details, so that he/she can begin to examine the behavior that led to the referral in the first place.

In some jurisdictions, therapists may receive copies of the police report or a summary of the offense in a probation report, prior to interviewing the client. Having this information ahead of time, can allow the therapist to confront the client on his/her minimization and denial of the violence.However, this level of confrontation could also be problematic when conducted too early in the treatment process.With some clients who are experiencing high levels of shame regarding their violence, this type of confrontation may result in a cost in the development of a therapeutic alliance.The client may experience the therapist as critical and judgmental and react either by overt hostility or passive avoidance.On the other hand, with clients who can handle a more confrontational style, the development of trust with the therapist will be predicated on the therapist confronting the client immediately upon the first signs of minimization or denial.

Once the therapist has a relatively complete picture of the incident that led to the referral, or has decided the client has disclosed all he/she is going to disclose at this time, the therapist may begin obtaining a violence history.At this time, the therapist may want to offer the client a more complete definition of what is meant by physical, sexual and psychological violence. Having these definitions written for the client may help him/her recall specific incidents of violence.In the Forms, is a brief description for the client.

The therapist may continue obtaining the violence history by asking a number of open-ended questions such as:

Tell me about another incident of physical violence in the past year.
Tell me about the worse or most violent incident that stands for you.
Tell me about the incident that frightened you or your partner the most.
Tell me about the first incident you remember.
Based on our definition of sexual violence, are there any incidents that stand out in your mind?
Based on our definition of psychological violence, are there any incidents that stand out in your mind?

Therapists may want to encourage the client to be more specific by asking for clarification of details by asking questions such as:

You say that you came home and lost it.What do you mean by losing it?
You say that you grabbed her and it was over.How did you grab her?Where did you grab her?
You say you don’t remember anything.Tell me about what you do remember.For example, what was the last thing you remember before you lost your memory?What was the first thing you remember when you regained your memory?
You said that you pushed her and then you left.How did you push her?What happened to her?What kinds of things were you saying when you were pushing her?
After you punched her, what did you do next?What did you do after that? And after that?
What injuries occurred as a result of that incident?
How did your partner react emotionally to your violence?
What did you and your partner do afterwards?

The therapist is encouraged to take detailed notes in the client’s own words describing the specific incidents of violence. During this part of the interview it is also important to elicit the client’s thoughts and feelings about their violence.For example:

What were you feeling when you had your hands around her neck?
What thoughts did you have when you were tearing up her clothes?
How does it feel now to talk about the violence?
What do you think about your violence?
How does your partner feel about your violence?
What does your partner think about your violence?
What impact has your violence had on your relationship?
What impact has your violence had on your children?

At some point in the interview you may want to administer one or a number of inventories assessing the range and degree of past violence.The Spouse Abuse History Form, included in the Forms is one such form.It is useful as a structured format for assessing the range of violent behaviors perpetrated in the past as well as their frequency of occurrence.Utilizing such a tool can be educational for the client as well, whose definition of violence may be limited to the more severe forms and therefore insensitive to the more subtle, less lethal, forms of violence that may occur on a more frequent basis in relationships.

In programs that work with partners, a similar interview can be very effective to determine the degree of minimization and denial with the client, as well as being an opportunity to offer the partner referrals for counseling and other assistance.When interviewing partners, who are not considered clients or patients, it is important to procure the appropriate authorizations to release information (see Authorization to Release Information - Partner in Forms).The Spouse Abuse History Form may be utilized with victims as well. It is also very helpful to consult with all current and past medical and mental health professionals. Because aggression and violence are often chronic problems, these contacts could yield useful information about the client’s history of violence as well as help clinicians accurately assess the client’s current potential for future violence.

Psychological/Non-Physical Violence Assessment

When treating perpetrators of domestic violence it is crucial that service providers clearly define what constitutes violence.It is generally accepted that clear treatment goals are necessary to successful treatment outcomes.Not only is it important for the therapists and clients to identify what behaviors need change, but also it is important for the criminal justice personnel to be clear with regard to what constitutes successful and unsuccessful participation in court mandated treatment.Clear and consistent definitions are also, however, relevant to the issue of program evaluation as well as public awareness campaigns.How can we dialogue about something that may be defined differently by different people?

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, there still lacks agreement as to what exact behaviors would be included in a comprehensive definition of domestic violence.Numerous clinical and research instruments 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.

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. Frequently, inexperienced service providers ignore the low levels of physical violence focusing exclusively on the more demonstrative acts, such as punching, choking etc.

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 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.

Advocates have defined sexual violence more broadly than the criminal justice model.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.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 or dysfunctional behaviors.

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.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.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.In other words, what may be considered by one child as abusive or traumatic 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?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. 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. 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.

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. 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.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.Additionally, some advocates in the field 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.

The Conflict Tactics Scale

Considerable efforts have been made in the domestic violence field to define psychological maltreatment.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:

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 its lack of inclusion of other behaviors that are commonly defined as psychological maltreatment.

Amnesty International Definition

Lenore Walker 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

This definition provides a comprehensive description of psychological violence but is narrower than other definitions. 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, is one of the first psychometric-type tests that have 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.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 consistently 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 Power and Control Wheel

Educational, curriculum-based programs, such as the Domestic Containment Program in Duluth, Minnesota, have included the most inclusive behaviors of what may be described as non-physical abuse. Their definition of power and control behaviors 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.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.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 non-physical abusive behaviors, allowing the men to look at the ways in which all men control and 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, 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 their needs met 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 non-physical power wielding and controlling 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 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 as a means to maintain power and control over victims and that psychologically abusive behaviors reinforce this dynamic. 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 checklist could be filled out each week by group participants to determine if their violent behaviors persist.

The Penal Code and Non-Physical Violence

Use of the criminal penal code is one way of formulating a more clear, reliable and useful definition of psychological violence. 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.Violating restraining or stayaway orders would also be included in this definition.

Additionally, stalking would be an important part of this definition (see section on stalking in this workshop). 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. 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 the treatment program reports this type of behavior 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.

Clinical Issues

Given the differing definitions of psychological violence, how do clinicians decide which definition is appropriate for their intervention program?At a minimum, programs should utilize the criminal justice definition to determine what acts will be reported to probation. These acts are illegal and as such should be immediately reported to probation.Many probation departments require clients to sign a contract that prohibits their breaking the law while on probation.Therefore, these behaviors clearly fall within the purview of this agreement.However, it is clear from the research that other conduct that is not illegal can be extremely problematic and indicative of a pattern of behavior that, if it doesn’t lead to physical violence, can be very traumatic to those toward whom it is directed.Therefore, a broader definition may necessary to thoroughly address the manifestations of the psychological disorders that lead to violence.

The Amnesty International definition described earlier consists of a range of behavioral categories that are easily operationalized by the clinician and the client.The Spouse Abuse History Form included in the Forms covers a wide range of behaviors that would constitute psychological violence.The clinician can easily identify these behaviors, however it is stressed that the motivation for these acts may be considerably different from client to client.Nevertheless, the tracking of these behaviors, as well as the physical violence, will help the therapist assess progress in treatment.

The checklist below, from the Spouse Abuse History Form, is a combination of the criminal justice and the Amnesty International definitions.Another category, Property and Pets, has been added since both types of violence have been correlated with physical violence.Obviously, while each category of psychological violence described is distinct in principle, in practice there is a great deal of overlap within each category and within each client’s life; therefore the clinician is challenged to address multiple categories of abuse at any one time.

The “Threats” category contains all the acts included in the criminal justice category.The therapist will hopefully not be dealing with this type of situation with clients as often as with the other categories.However, when threats occur the therapist must take them very seriously, especially when one considers the potential consequences to the client, the one(s) to whom the threats are directed, as well as the professional liability for the therapist.Therefore therapists should report these incidents immediately to probation.Threats may also be indicative of the client's inability to control his/her behavior and therefore additional interventions may be needed to prevent the threatened person from harm.Therapists should consider those interventions that are often utilized with dangerous clients, including increased sessions, medication, adjunctive treatment referrals, termination of treatment, and voluntary or involuntary hospitalizations.Therapists should also be cognizant of their reporting duties as dictated by law in their jurisdiction.

The other categories in the checklist are those acts that are likely to cause significant trauma, particularly when occurring at a moderate and high frequency.Therapists are not likely to hear about these acts unless they specifically listen for themes in the client's material, ask the client directly or ask the partner during the follow-up procedures.Some of these behaviors are likely to occur throughout treatment without the therapist’s knowledge, particularly those that are less traumatic per se (for example: lying, manipulating, promise to stop the abuse, etc.).But nevertheless, discussing these forms of abuse provide the therapist and the client with the opportunity to deepen the clinical work and thereby increase the opportunity for change.Discussing a re-offense, no matter what form it takes and what the consequences are is an opportunity for psychological growth.

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, when developing program structure, to clarify how this type of violence will be addressed.For example, therapists could clearly state at the onset of treatment that any threats or stalking (*’d items) would be immediately reported to probation.Psychological violence that falls short of criminal behavior but is nevertheless assessed by the clinician to be potentially traumatic could result in rethinking the treatment plan and interventions.Additional treatment may be required (such as adjunctive individual therapy, substance abuse therapy or a psychiatric evaluation).These acts may be reported to probation depending on their frequency or severity.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.

Because psychological violence always accompanies physical and sexual violence, and may be the primary cause of the psychological trauma experienced by the victim, it is important to address psychological abuse from the beginning of treatment. However there is another reason to address psychological violence when working with this population.Because of its chronic nature in domestically violent relationships, it provides therapists with a barometer, if you will, of how the treatment is progressing.An overemphasis on physical violence may give the client the impression that as long as there is no physical abuse, everything is okay. Nothing can be further from the truth.Physical violence is just one of many maladaptive coping mechanisms that these individuals utilize to manage the struggles of intimate relationships.Therefore, clients must understand that in order to really address the issues of violence, they must make a fundamental change within themselves.Psychological abuse provides the clinician with the opportunity to assess how well they are doing in assisting the client with that fundamental change.

Psychological violence, like physical abuse, may be conceptualized as a psychological defense mechanism triggered by overwhelming anxiety or other distressing emotions.The client protects and soothes the “self” or “ego” through these defense mechanisms.The types of defense mechanism the client utilities may vary from situation to situation.Ego psychology views defenses in a hierarchical way, from early/psychotic defenses, to immature, to neurotic and finally to mature.Psychological abuse in any of its forms may be categorized in one of the first three levels.For example, many abusers utilize the early defense of projection, where they attribute unacceptable thought, feelings or impulses to another.For example, when they accuse their partner of wanting to leave they are projecting their own insecurity and fear of loss onto their partner.This type of defense can have a profoundly negative effect on the person to whom it is directed.Impulsive acting out (an immature defense) in the form of using psychoactive substances, stalking and such, are mechanisms abusers use to avoid dealing with the emotional tension (for example, depression or trauma related affect) that results from not acting on those impulses.Regression (also an immature defense), retreating to an earlier level of psychological functioning, typically appears when the person is faced with a developmental challenge that cannot be mastered or when environmental stressors create high levels of anxiety.This defense is often triggered when a client is challenged to manage separation anxiety when there is a literal separation or when a partner is seeking greater autonomy in the context of the relationship.Neurotic defenses of repression (forgetting), reaction formation (transforming the unacceptable into the acceptable) and displacement (having unacceptable feelings toward one person and redirecting them toward another) are also common neurotic defenses employed by perpetrators.In fact, a good deal of the treatment is geared toward remembering that which is shameful, frightening or otherwise upsetting, acknowledging those feelings and expressing them in an appropriate fashion.

Object relations theorists describe other defenses such as splitting (good and bad aspects of the self or others are experienced separately), introjection (internalizing aspects of others), projective identification (similar to projection except that the projector does not want to lose the projected part completely), idealization and devaluation.These defenses, like the ones described above, are used (albeit unconsciously) to keep painful and unacceptable feelings out of consciousness, whether they be neediness, weakness, insecurity, envy, desire, rage or hate, just to name a few.

Of course, the goal here is not to stop using defense mechanisms.We all need and use defenses at one time or another to cope with difficult situations.However, it’s the chronic use of one or a few primitive defenses that is where trouble can arise.This is the case with many perpetrators of domestic violence.They often rely on less mature defenses to regulate intense, emotionally distressing reactions to interpersonal stress.Most of these clients do not have higher-level defenses at their disposal.Mature defenses, including sublimation (transforming asocial impulses into socially acceptably constructive behaviors) and humor (being humorous without offending listeners), can be an adaptive means to regulating dysphoric affect.Even the less mature defenses can be useful at times, as long as the individual does not rely solely on them in a habitual manner.The key here, as with most things, is flexibility and choice.

Working with psychologically abusive patterns in relationships, particularly those less aggressive forms that occur more regularly, can be an opportunity for therapists to work on the developmental and character issues that give rise to their use.By assisting clients through the therapeutic encounter to learn and utilize more adaptive responses to interpersonal stress, therapists will help clients to become better prepared to deal with the windstorms of life, whether they occur in their intimate relationships, friendships, family interactions or at work.