Effectiveness of couples therapy for Domestic Violence

by Michael Carolla, LMFT

Articles & Essays
Despite its controversy, carefully conceptualized and delivered couples treatment appears to be at least as effective as traditional treatment for domestic violence, and preliminary data suggests that it does not place women at greater risk for injury. Marriage and family therapists have an important part to play in continuing to develop and test innovative ways of helping couples end violence and improve their relationships – an endeavor that promises to improve the quality of the partner’s lives as well as those of their children. (Stith, Rosen, McCollum, Journal of marriage and family therapy, July 2003)

Recent, as well as ongoing research indicates the advocacy of couples counseling as an effective treatment for high conflict as well as domestically violent couples. While this is controversial, if we are able to look past the politics, it certainly fits with clinical experience as well as with theoretical models of systemic influences on family dynamics. The overwhelming research showing that women initiate violence as often as men, as well as studies that show that lesbian couples experience domestic violence at the same rate as heterosexual couples would indicate that a more inclusive approach is indicated. While not ignoring the fact that women are harmed at a rate 7 times that of men when violence does occur, if we address the issues of couples violence from a systemic model we are much more likely to effectively address the full range and scope of the problem. Current approaches to couple violence address all incidences of partner violence as male initiated, motivated by a desire for power and control. While it cannot be denied that great harm is done in too many instances of intimate partner violence, the majority of couple violence takes place at a lower level of mutual combatency. We risk not addressing the problem by not addressing the full continuum of the problem honestly and effectively. That said, systemic therapeutic interventions can help families and individuals gain better insight to their contributions to dysfunctional family patterns.

Research suggests that three subtypes of batterers exist (i.e., family only, dysphoric/borderline, and generally violent/antisocial). Many working in the field have been frustrated by the limited scope of treatment options. The family only batterer, without apparent psychopathy is most likely to benefit from couple therapy. (the majority of domestic violence cases). When we include the facts regarding reciprocal violence, it makes much more sense to include both parties in the counseling especially considering that a women is much more likely to be physically injured in an exchange.

When assessment shows that there has been couple/family abuse or that it is likely that high marital discord will lead to couple violence, regular couple treatment approaches must be modified. It must first be emphasized that systemic approaches to family therapy never condone or excuse violent, threatening, or abusive behavior. It is always emphasized that one is responsible for ones behavior regardless of external influences or events. Many therapist working with violent or potentially violent relationships include most, if not all the following protocols in the therapeutic process.

  • A separate interview of both clients. Both must indicate their desire to participate in couples therapy and that they are not afraid to express their concerns to their partner.
  • Initially the primary focus of therapy is on eliminating all forms of abuse (physical, emotional, verbal) for all members of the family.
  • Components for skill building in taking responsibility for one’s own behavior and recognizing when anger is escalating, de-escalating, and time outs.
  • Teach negotiated time out skills to both partners. Many of the men in our DV groups report trying to take time outs to de-escalate their own anger only to be angrily confronted by their partner and prevented from leaving.
  • Clear safety plans are discussed and easily implemented if needed for safety of all family members.
  • The therapist’s primary responsibility is the safety of all family members. This will remain at the forefront until safety of all family members is assured.
  • The therapist must be skilled at moderating his/her own reactions to intense moments in the session, able to monitor his or her own counter transference and possible gender biases.
  • It is necessary for the therapist to take an active role in the therapy. Not afraid to confront either partner. The therapist must be skilled in establishing a safe and comfortable structure, taking the lead in the theraputic process. The therapist must also able to recognize subtle attempts at manipulating the therapist to take sides.

What has struck me is that the usual couple therapy approaches are most often ineffective. Family violence rarely improves by just teaching better communication skills and “I” statements. Most, both men and women, have some investment and/or secondary gain in the maintenance of the high conflict. Often this is an avoidance of intimacy. Violence can be a form of passivity, a way of not actively addressing issues of intimacy. Instead we need to focus on helping our clients to focus on changing the dysfunctional patterns of interaction that keep them trapped in the abuse. Help them recognize why they hold onto the conflict rather than stop. Help them learn the role they play in perpetuating the pattern, recognize their own triggers activated by their partners interactions with them, and what to do about each. I recognize the controversy involved in advocating this approach. However, most involved in the DV system recognize that current approaches are woefully inadequate in addressing the broad range and scope of family violence. When we treat all DV case from a Power and control, Borderline or generally violent/antisocial point of view we miss the opportunity to use our skills effectively in the vast majority of these cases. Our profession is in a unique position to be able to address what is most often a systemic problem with sound clinical practices.

In working with this population it has been my experience that almost all genuinely desire and are willing to do their part for relationships without abuse or violence. I have been impressed by their willingness to accept responsibility for their roles in the dynamics. I have also been encouraged by the willingness of most men to accept the lead role in stopping any violence in the house when taught the skills to do so. Quite often I meet with the men before hand and coach them on the process and how I want them to participate and respond to make this work. I have rarely been disappointed in their willingness to take my lead. I have found that with most couples violence is not about “power and control” but instead about not knowing how to handle the out of control feelings of overwhelm that can occur during an escalating conflict. Once taught the skills, most are able to prevent the escalation that can lead to the violence.

Michael Carolla LMFT, is executive director of Touchstone Counseling in Pleasant Hill, CA. In addition to his regular practice seeing couples and families, he runs a 52 week domestic violence treatment intervention program, and conducts regular workshops on working with high conflict couples.