Journal of Couple & Relationship Therapy
ISSN: 1533-2691 (Print) 1533-2683 (Online) Journal homepage: http://www.tandfonline.com/loi/wcrt20
Contemporary MFT Theories and Intimate Partner Violence: A Review of Systemic Treatments Megan Oka & Jason B. Whiting To cite this article: Megan Oka & Jason B. Whiting (2011) Contemporary MFT Theories and Intimate Partner Violence: A Review of Systemic Treatments, Journal of Couple & Relationship Therapy, 10:1, 34-52, DOI: 10.1080/15332691.2011.539173 To link to this article: http://dx.doi.org/10.1080/15332691.2011.539173
Published online: 22 Jan 2011.
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Date: 08 October 2015, At: 06:59
Journal of Couple & Relationship Therapy, 10:34–52, 2011 Copyright © Taylor & Francis Group, LLC ISSN: 1533-2691 print / 1533-2683 online DOI: 10.1080/15332691.2011.539173
Contemporary MFT Theories and Intimate Partner Violence: A Review of Systemic Treatments MEGAN OKA Marriage and Family Therapy Program, Brigham Young University, Provo, Utah, USA
JASON B. WHITING Downloaded by [186.67.71.43] at 06:59 08 October 2015
Marriage and Family Therapy Program, Texas Tech University, Lubbock, Texas, USA
As specialists in couples’ dynamics, marriage and family therapists will inevitably be faced with issues of violence in the clients they serve. However, there has been criticism of treating partner violence systemically, and it is not clear whether MFT theories adequately conceptualize and treat violence. This article examines current issues that MFTs should be aware of when violence is an issue with clients. Also, we critique how four contemporary family therapy theories view and/or treat couple violence, both conjointly and individually. Specific implications for therapists who work from these current models are presented, as are suggestions for future research. KEYWORDS violence, theory, narrative, solution-focused, couples
INTRODUCTION Although awareness of the scope of intimate partner violence has been increasing in recent years, it is still unclear if marriage and family therapists (MFTs) are well suited or qualified to assess for and address issues of violence. On one hand, MFTs are relationship specialists who understand escalation, anger, blame, context, and patterns. On the other hand, as systems thinkers, MFTs have been accused of neglecting personal responsibility as it relates to perpetration of violence (Bograd & Mederos, 1999). It has also been suggested that MFTs are more interested in relationship preservation (at all costs) than they are in safety and necessary relationship dissolution. Further, there is question as to how well MFTs address power and gender Address correspondence to Megan Oka, Marriage and Family Therapy Program, Brigham Young University, 274 TLRB, Provo, UT 84602, USA. E-mail: megan
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differences, or if they miss crucial violence dynamics because of limited training in violence (Jory, 2004; Knudson-Martin & Mahoney, 2009). Despite the criticisms, there is reason to hope that MFTs are becoming more prepared to help individuals and couples identify, reduce, and eliminate violence (Dersch, Harris, & Rappleyea, 2006). Although there are many important issues relevant to MFTs and violence, this article briefly examines appropriate approaches to treatment and assessment for MFTs working with violence. Then we will review how several current MFT theories address violence.
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Traditional Violence Treatments Treating violence in a family or couple context has long been controversial. The traditional paradigm for treating violent couples has been to separate them and assign the male offender to a batterer intervention program while female victims are sent to a support group (Gondolf, 1995). Many states discourage or prohibit funding of programs that offer conjoint therapy as the primary mode of treatment (Healey, Smith, & O’Sullivan, 1998). Batterer intervention programs (BIPs) are typically psychoeducational groups for violent men who are taught anger management skills, gender equality, and responsibility (Feldman & Whiting, 2009). The rationale behind treating men in male-only groups is that violent couples should not be seen together for safety reasons, and perpetrators of violence have separate issues to work through than victims of violence. However, these groups sometimes have unintended consequences. Batterers who work together may empathize with one another and reinforce or generate new abusive behaviors (Augusta-Scot & Dankwort, 2002). Also, batterer intervention groups have shown varying levels of success in treating the problem, with recidivism and dropout very common (Babcock, Green, & Robie, 2004). Another challenge with most BIPs is that these groups assume that all violent men are the same, meaning that all violent men fit the profile of batterer, and that the violence is one-sided.
Recent Issues in Violence Treatment In recent years, researchers have identified different kinds of violent men and different kinds of violent relationships (e.g., Johnson, 2008; HoltzworthMunroe, Meehan, Herron, & Stuart, 1999). These findings suggest that different types of violence warrant different types of treatments. For example, Holtzworth-Munroe and Stuart (1994) found that violent men tend to present from one of three types: antisocial, dysphoric/borderline, and family only. These scholars suggest that certain types of violent men (family only) can be treated successfully, while others cannot. Similarly, Johnson’s research (1995, 2008) has generated different typologies of violent couples, which align with Holtzworth-Munroe’s typologies of
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violent men. Of the four types of couples, two are most often found in research and practice. Intimate terrorists are those commonly thought of as batterers. Intimate terrorism tends to be one-sided violence, characterized by coercive control and escalation of violence. Intimate terrorists are usually either dependent or antisocial in orientation, and are similar to HoltzworthMunroe’s dysphoric-borderline and antisocial types. These types should not be treated in couples’ therapy. Intimate terrorists are often violent partners of women in shelters. Situational couple violence is characterized by mutuality of violence and lack of control or domination by one partner. It is commonly found in research on violence in community samples. While still potentially serious, this type of violence is less likely to result in injury and might be characterized by poor self-regulation skills and escalation (Johnson, 2008). Less common are violent resistance and mutual violent control. Violent resistance refers to the partner of an intimate terrorist (usually female) who may react to violence with violence but not in a controlling way. Mutual violent control occurs when both partners are violent and controlling. This typology comprises a very small portion of violent couples. This typology is becoming more commonly accepted in research and practice settings and corresponds well to existing research on violence (e.g., Gottman et al., 1995; Holtzworth-Munroe and Stuart, 1994). Knowing the various types of violence has important implications for practice (e.g., Greene & Bogo, 2002). In assessing for violence, several factors are important to consider. First, it is helpful to realize that violence is very common but often hidden. Bograd and Mederos (1999) found that even in a therapeutic situation, most couples do not disclose violence unless asked specifically about it. Additionally, most therapists only talk about violence with a couple who is presenting for issues of violence, and therapists vary widely in their screening processes of violent couples (Todahl, Linville, Chou, & Maher-Cosenza, 2008). However, research shows that 53% of couples in therapy have been violent at one time or another, suggesting that therapists in general need to be more assertive when assessing for violence (O’Leary, Vivian, & Malone, 1992). There exist helpful guidelines on assessing for violence in MFT (e.g., Bograd & Mederos, 1999; Greene & Bogo, 2002; Jory, 2004), and these assessment findings will help determine what decisions clinicians should make. For example, it may be the best practice to separate couples into standard perpetrator/victim groups when intimate terrorism is found. However, for milder types of violence (e.g., situational couple), it may be appropriate to treat couples conjointly (e.g., Greene & Bogo, 2002; Stith, McCollum, Rosen, Locke, & Goldberg, 2005). Couple treatments may be helpful for some types of violence, since many couples experiencing violence do not want to separate but do want the escalation and violence to stop (Stith et al., 2005). Also, situational couple violence may be seen as the result of mutual provocation, and conjoint treatment can help violent men and women recognize things
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that trigger their violence, take responsibility for their actions, and leave provocative situations (Goldner, 1998). In order for couple work to be feasible, several factors must be present. First, both spouses must agree to participate in therapy, and the violent member must take full responsibility for any violence (or if the violence is mutual, the male is willing to acknowledge his greater threat or physical power). In addition, the violence should have been minor and infrequent, and not based on intimidation or control. The therapist should ensure that there are no risk factors for lethality and that there is no fear of retaliation on the part of one partner following therapy (Bograd & Mederos, 1999). If a therapist has carefully assessed for violence risk when working with individuals or couples in therapy, then they need to consider how their theoretical approach may fit for use when violence issues are present. We will now look at systemic treatment of violent couples from several contemporary family therapy theories, including collaborative language, narrative, solution-focused, and emotionally focused therapy theories. We will discuss the philosophies of treating violent couples for each of these theories, as well as recent studies on the effectiveness of using these models to treat violent couples. We will conclude by talking about future directions for the field of couple therapy in the treatment of couple violence.
CONTEMPORARY FAMILY THERAPY THEORIES AND TREATMENT OF VIOLENCE Many of the critiques of treating violence systemically list traditional or early MFT theories that are closely tied to systemic assumptions (e.g., Structural, Bowen Family Systems Theory, or Strategic—see for example, Hare-Mustin et al., 1999). While there are legitimate concerns about treating violence with traditional assumptions, we were interested to know how newer (contemporary) theories address issues related to violence. Contemporary theories of family therapy are often more sensitive to culture, gender, power, or societal influences than were early MFT theories. Many contemporary theories are founded in postmodern philosophy, which emphasizes creating meaning through language construction and relationships. In addition, most contemporary theorists espouse the belief that the relationship between a therapist and his/her clients should be collaborative, rather than hierarchical. Most contemporary theories are strength-based, focusing on what clients do well, rather than what is going wrong. These issues are relevant when considering violence in treatment. In this review we critique four contemporary approaches that have become well accepted in the last two decades: narrative, collaborative language, solution-focused, and emotionally focused therapy. The first three of these
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theories are founded in postmodern assumptions (Nichols & Schwartz, 2007). Emotionally focused therapy is not considered a postmodern theory, and it is founded on systems philosophy. However, it was included in this review because it espouses some postmodern tenets, such as de-pathologizing clients and validating marginalized narratives that are important considerations in treating violent couples (Johnson & Denton, 2002). Also, it is a newer model that specifically addresses the issue of violence in a way that early models did not. One initial question we had in reviewing these contemporary, collaborative treatments was how they handle collusion in therapy. In other words, how can one maintain a collaborative, respectful stance with someone who very well may be distorting what is happening in the relationship? Research has shown that those in violent relationships tend to minimize, deny, or lie about the amount of violence in the relationship, as well as their roles and responsibilities (Logan, Walker, Jordan, & Leukefeld, 2006; Whiting, 2008). Many therapists get recruited into believing the distorted picture that is presented, and many abusers are very persuasive, charming, and manipulative (Goldner, 1998; Jory, 2004). While this may always be a challenge, and probably needs to be reviewed on a case-by-case basis, it is worth reminding therapists that this point needs special attention when working with those who present with issues of violence. In our review of these theories, we attempt to identify how each of these approaches might deal with distortion and avoid colluding with clients.
Narrative Therapy Narrative therapy relies heavily on social constructionist assumptions about how humans create meanings in their lives through interaction and language. Rather than the therapist possessing the ultimate knowledge of truth, truth is seen as co-created between therapist and client. A critique of narrative therapy has been its departure from systems theory (Minuchin, 1998). Indeed, narrative therapists believe that viewing clients in systemic terms promotes the “therapist as expert” position, which devalues the knowledge and richness of the client’s experience. In addition, narrative therapists see systemic thinking as reinforcing the idea that problems are inherent in the family system. Given that, it is not surprising that much of the literature on narrative therapy and violence focuses on an individual or group therapy approach (Augusta-Scot & Dankwort, 2002; Draucker, 1998; Jenkins, 1990). These scholars have highlighted some of the strengths of narrative therapy in dealing with violence in individuals. For example, narrative therapy celebrates the “unique outcomes” of survival and resilience that may occur within a dominant narrative of suffering and victimization in women who have been battered. Also, by externalizing problems, women who have been battered recognize that they are not victims as they recognize that the abuse
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is outside of them and not a part of their identities (Draucker, 1998). Further, narrative therapy does not pathologize women’s responses to male violence, the way problem-focused therapies tend to. Augusta-Scot and Dankwort (2002) contrast a narrative approach to batterer intervention programs with the traditional psychoeducational model of batterer intervention programs. While psychoeducational groups tend to focus on power, patriarchy, and anger management, narrative groups allow batterers to talk about their own narratives of injustice. At the same time, a narrative group also works within a pro-feminist structure that highlights cultural constructions of gender and oppression. While narrative therapy allows for men to talk about the injustices they feel they have suffered, this storytelling is used as a way to invite individuals to place their choices in context, not to excuse them (Jenkins, 1990). A narrative approach does not focus on coercing batterers to admit to violence or telling men they are wrong when they view their partners as deserving violence. The narrative group challenges men to take a look at their violence and how it has affected their lives and their relationships. Group facilitators work to externalize these stories as part of a construction based on destructive cultural norms, such as those involving patriarchy and male entitlement, as well as destructive beliefs enforced by their families of origin. In these groups, men recognize the relationship between their destructive cultural/familial beliefs and their violence. Their violence is reframed as injustice similar to what they have experienced in their own lives from their families and society. This externalization helps men to realize that their experiences with injustice have fostered in them a desire for equality, and it reframes stopping relationship violence as a way to take a stand against injustice. Jenkins (1990) describes a narrative therapy–based program for men who are violent. He advocates a theory of restraint—that men generally tend to relate respectfully, sensitively, and nonviolently unless restrained from doing so by harmful traditions, habits, and beliefs. His program involves inviting men who behave violently to address their violence and to argue for a non-violent relationship. Therapists invite men to examine how misguided efforts to achieve desired goals for relationships have led to violence that has escalated over time. Men externalize patriarchal beliefs that act as restraints, and they acknowledge times when they have not been restrained by these beliefs. The therapist offers “irresistible” invitations to challenge restraints. Such invitations may take the form of “Can you handle a marriage in which you control your own violence, or do you need [your partner] to try to control it for you by keeping her mouth shut/walking on eggshells around you?” (Jenkins, 1990, p. 88). The man is then invited to consider his readiness to take new action, plan new action, and discover evidence of new action in his life. Jenkins makes it clear that individual therapy for violence is appropriate until the man takes responsibility for his violence. Couple work with this
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model is similar to individual work, as it invites both partners to challenge their restraints related to violence. The woman is invited to examine her restraints from accepting responsibility for her own actions and declining responsibility for her partner’s actions. She is invited to externalize cultural and family influences that have kept her from taking responsibility for herself. While monitoring safety of partners, the therapist invites the couple to translate their ideas into actions and to anticipate obstacles. Couples are counseled to avoid premature trust, and the man is invited to be sensitive and understanding to his partner’s experience. Jenkins warns of couples who report no violence by avoiding conflict. When a man has taken responsibility for his feelings and has not engaged in violence for some time, a therapist may challenge him to face up to conflicts in a nonviolent manner. Partners are invited to strike a balance in terms of responsibility of maintaining the relationship. In addition, partners are encouraged to achieve a healthy balance between autonomy and togetherness in their relationship. In an ethnographic study of therapists, O’Connor, Davis, Meakes, Pickering, and Schuman (2004) found that half of therapists interviewed about their experiences as narrative therapists had concerns about treating violence. Therapists reported feeling themselves switching from a postmodern perspective (viewing the multiple realities of the situation) to a modernist perspective (seeing violence as a matter of right and wrong). In their discussion of this theme, the authors note that this may be a problem of beginning narrative therapists. However, they also note that more research should be done on narrative therapy and family violence. Specifically, studies should explore the issues to consider when deciding if postmodern theories like narrative are appropriate in working with family violence.
Collaborative Language Collaborative language therapy is a postmodern theory that places emphasis on the way people explain their lives through their stories (Anderson & Gehart, 2007). It assumes that humans each create their own meanings for the language that they use and that couples have to make a deliberate effort to understand one another. A collaborative language therapist works to create a space where people can talk to one another and understand the meanings the other makes of their world. The therapist is not a casual observer of the couple’s process. Rather, he/she works actively with clients to produce solutions to their problems. In this type of therapy, a therapist cannot superimpose his or her view of what a violent couple looks like. Terms like “battering,” “perpetrator,” and “victim” may be seen as limiting. Such categories or labels may restrict clients’ views of themselves to only these labels. Levin (2007) detailed a study using collaborative language therapy with women who were battered. Levin uses the language “women who have been
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battered” to delineate between the client and her problem. Using qualitative methods, this study focused on themes that are not commonly addressed in quantitative studies. Such themes included feeling guilty for provoking her partner and the feeling that she did not want to leave. Such themes have systemic implications, even in the context of a relationship characterized as battering. In discussing clinical implications, Levin lists positive and negative reasons to treat violent couples from a collaborative approach. Levin addresses the notion that violent couples may distort or minimize the amount or the role of violence in their relationship. She also points out the fear that couples who discuss conflict in therapy may get inflamed in session, causing them to be violent at home. In defense of treating violent couples in therapy, Levin points out that couples who are turned away for couple therapy because they are violent may not seek treatment elsewhere. One of the themes of Levin’s research is that women who have been battered do not feel that others hear them in their community. She points out that a therapist’s failure to treat a violent couple seeking couple therapy may be another instance in which this couple does not feel heard. Levin then offers some considerations for treating a couple from a collaborative language lens. First, the therapist must determine how invested each member of the couple is in therapy. In addition, the therapist must assess how willing the couple is to discuss the violence. A couple’s willingness to discuss violence in therapy indicates that they are acknowledging it as a problem, which may indicate that the couple has begun the change process. Collaborative language therapists create an environment for couples to tell their stories—even if these stories are stories of violence. Working with a couple systemically means that the therapist works to emphasize both sides of the story and to help both partners be a contributing influence in telling and modifying the story in the therapeutic process. Another aspect of the collaborative relationship in this type of therapy is the openness of the therapist. A collaborative therapist may be explicit about what research and clinical experiences suggest about violence, including escalation, the connection between violence and alcohol, and women having a hard time leaving abusive relationships. However, a collaborative therapist would take a not-knowing stance, asking the couple for their opinions about these findings, and, in particular, about their own experiences, rather than assuming an expert role. The therapist would ask for the couple’s input on how to handle violence if it occurs during the course of therapy so that intervention continues to be collaboration between the therapist and the couple. Often, violent couples are wary of legal and other authority figures. By maintaining a collaborative stance, the therapist may be able to approach violent clients as a peer interested in helping them, rather than as an authority figure ready to punish them.
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Solution-Focused Brief Therapy Solution-focused brief therapy (SFBT) grew out of early systemic theories and claims to be a systemic theory. However, SFBT is seen as a more pragmatic alternative to traditional family therapy theory and is also considered a postmodern theory due to its assumptions about the power of language to create reality (de Shazer et al., 2007). Unlike traditional systemic theories, SFBT focuses on solutions rather than the problems. SFBT also focuses on the future, in which the problems are solved, rather than the past, in which the problems were created. In SFBT, the therapist decides who in the system to treat based on who comes to therapy, in the postmodern tradition of not imposing a therapist’s reality on the clients. Further, SFBT is systemic because the solutions explored in therapy are inherently interactive. In addition, SFBT maintains the systems theory tenet that if change occurs in one part of the system, it will radiate out into other parts of the system. SFBT has been used to treat both those who have perpetrated couple violence and those who have had violence perpetrated against them. According to SFBT’s assumptions, a therapist could work with an individual member of a violent couple, and that could change the violent dynamic of the couple (Milner & Singleton, 2008; Lee, Sebold, & Uken, 2007). By working with one partner to change his/her individual behavior, whether or not he/she is violent, it will change the pattern of interaction in his/her relationship. Like other postmodern theories, solution-focused therapy tries not to pathologize couples coming in for any issue, including violence. Stith et al. (2005) have developed a solution-focused model of couple therapy with domestic violence. They suggest that it is insufficient to only work with individuals in traditional violence treatments. In their view, changing one partner’s violence is not likely to change the couple violence if it is mutual. They also acknowledge that batterer intervention programs do not address relationship difficulties that may be contributing to violence. The authors also argue that failing or refusing to provide services for both partners may be destructive should the partner who is being abused choose to stay in the relationship. Stith et al. (2005) outline this approach in the domestic violence focused couples therapy model (DVFCT). Therapists can use this model of therapy as a means of assessment as well as treatment. The authors reiterate that only 6% of women who seek treatment identify violence as a problem during intake. However, during a violence assessment, 53% admit that there has been violence in the relationship. This finding supports others who suggest that people in violent relationships may choose not see the violence as a problem or may minimize the scope of the violence due to fear of consequences from their partners or because it is shaming (see also Jory, 2004; Whiting & Oka, 2009). Even though they operate within an SFBT framework, Stith et al. (2002) still promote practical steps of assessment, including having therapists conduct interviews about the violence with each of the partners
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individually and having couples fill out violence assessment instruments (e.g., the Conflict Tactics Scale) in separate rooms. The therapist ensures that both partners have voluntarily consented to therapy and that there has been no severe violence, such as injury or hospitalization. In keeping with research on batterers, the therapist also assesses to make sure that neither partner has been violent outside the home. Finally, therapists have the couple sign a no-violence contract. In the Stith et al. model, prior to beginning treatment, couples complete 6 weeks of anger management courses in gender-specific groups. These groups focus on accountability and responsibility for anger and violence, and they give facilitators of the groups the opportunity to encourage individual therapy if they deem it necessary. In outlining the program’s theoretical basis for treatment, the authors make the distinction between primary and secondary theoretical orientations. This means that while the authors adhere primarily to SFBT tenets in their work with violent couples, they are not philosophical purists. Here, the authors seem to be acknowledging the difficulties encountered by beginning narrative therapists (O’Connor et al., 2004), that it is difficult to maintain postmodern stances of social construction and collaboration when dealing with a subject like violence. They acknowledge that while their primary theoretical orientation is SFBT, they must rely on other pragmatic orientations when tenets of SFBT do not fit with treating violent couples, such as when safety is threatened. The authors highlight the strengths-based appreciative stance as a principle from SFBT that they retain when working with violent couples, meaning that clients are competent and bring their own strengths and resources into therapy. Other SFBT interventions include helping clients create detailed descriptions of solutions to help clients reach their goals and to collaboratively identify changes that have already happened in the client’s lives. Therapists also describe their clients’ lives as fluid to help them recognize already-existing solutions. In addition, the goals that clients set for themselves structure treatment, rather than goals imposed on the couple by the therapist. For this model to be successful the couple must be intrinsically motivated to end violence in their relationship—the therapist will not impose that goal on the couple, even if he/she discovers violence is present in the relationship. For this reason, the assessment phase is critical for working with violent couples to determine their commitment to ending violence in their relationships. However, an SFBT therapist recognizes that there is no one way to treat a problem and that each couple can and should find their own path to a solution. After addressing the tenets of SFBT that the DVFCT program adopts, the authors discuss constraints that may prevent a therapist from using SFBT in treating violent couples. These constraints include the recurrence of violence, and lack of progress if the perpetrators do not understand how much pain and suffering has been caused by their violence. In working
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with violent couples, the authors acknowledge that therapists must be more directive and instructive than an SFBT therapist would normally be. In addressing pain and anger related to violence, the authors acknowledge that it may seem to run counter to SFBT’s focus on future events and strengths. However, they cite de Shazer and Isebaert (2003) on the importance of “honoring the problem,” pointing out that clients who feel like their pain is not being acknowledged can feel marginalized and unheard. In order to help her partner understand her suffering, a woman may present her story with emotion not typically accessed in SFBT. However, helping the couple discuss and validate one another’s pain will help the couple get to a place where they are able to take a more solution-oriented view. The therapist can then use more solution-focused questions like, “What will your partner be doing the next week that will tell you that he now really understands the effect the abuse had on you?” (de Shazer and Isebaert, 2003, p. 422). The authors also address problems associated with relapse in violence as well as other problematic behavior. As SFBT therapists, the authors address the discouragement clients are prone to feel when they have relapsed, and the fear that things will never change. From an SFBT perspective, it is important to ask strengths-based questions and to look for exceptions to the problems. The therapist may ask questions related to the couples’ ability to limit the relapse. However, when therapists are dealing with violence, the primary concern must be for the safety of the couple. Therapists may interview the partners individually to determine if conjoint sessions should continue and to determine a safety plan. Last, the primary aggressor may be frustrated with his/her partner’s lack of trust. While the therapist and the couple should expect that the trust will happen as a result of the steps the couple is taking to manage their anger and become nonviolent, they must also recognize that trust may not happen quickly or easily. The aggressor is encouraged to be sensitive to his/her partner’s experience. The therapist, again, uses strengths-based questions to help the aggressor talk about how he can be more understanding, for instance, “How can you show her that you are prepared to be patient?” or, “How will you resist the urge to demand her to trust you prematurely?” (Stith et al., p. 424).
Emotionally Focused Therapy Emotionally focused therapy (EFT) combines experiential therapy with systems and attachment theories. EFT therapists ask their clients to be emotionally vulnerable with one another in order to strengthen or repair attachment bonds. Part of EFT’s success with couples comes from how it changes the focus to primary emotions such as sorrow and fear instead of secondary emotions such as anger. By treating the primary emotions, therapists help couples stop their anger from escalating, which, in turn, may help situationally
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violent couples avoid getting to the point of using violence against one another. EFT has been empirically studied in many situations (Wood, Crane, Schaalje, & Law, 2005). However, the founders make explicit their philosophy of working with violent couples, stating that it is not an appropriate model of therapy for violent couples. Johnson gives theoretical rationale for why this is so:
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EFT is not used . . . where there is ongoing abuse and violence in a relationship, or where there is evidence that the exposure of vulnerability will place a partner at risk, as in the case of a highly verbally abusive husband who in the session unrelentingly demeans his partner, mocking her when she speaks of her suicidal depression (Johnson, 2004, p. 114).
It may be that this is referring to only the more severe types of violence, as we will discuss later. There is EFT scholarship that suggests that are aspects of this approach that address violence. For example, studies on EFT with trauma survivors (Woolley & Johnson, 2005) have led researchers to draw connections between trauma and violence. The authors state that working with couples where trauma has occurred, in either childhood or adulthood, is different from working with other couples. Traumatized couples tend to have more distress and more difficulty regulating their emotions. They have a harder time turning to one another for comfort. Consequently, couples may find themselves resorting to violence or substance abuse in an effort to cope with their emotions. Woolley and Johnson highlight the need for psychoeducation regarding trauma. However, they do not address what to do with couples where violence has taken place as a result of trauma. Susan Johnson clarified this in an address to the Texas Association of Marriage and Family Therapy (2009) by distinguishing between violence and abuse: In her definition, abuse occurs in a relationship when one partner feels he/she has no voice, or when one partner is scared of or dominated by the other partner. Johnson made it clear that EFT should not be used with couples where control and fear are part of the relationship. In the absence of this, violence is treated in the context of EFT like any other relational problem. Johnson’s definition of abuse in this context mirrors intimate terrorism and supports the notion that conjoint therapy should not be done with intimate terrorist couples but may be applicable with situationally violent ones. Jarry and Paivio (2006) describe how EFT could be used with individuals in the treatment of anger and aggression. The authors make a case for couple therapy in this context, citing the therapeutic environment as a safe place for couples to express emotions without fear of angry outbursts. They place strong emphasis on the therapist’s ability to validate clients as a means to deescalate anger. In addition, they write about couples continuing reparative work outside the therapy session. In this way, the authors put a lot of trust in a couple’s ability to be vulnerable with one another, and in the experiential
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elements of therapy to enable the continuation of the secure environment of the therapy room in the couple’s home. Paivio and Carriere (2007) describe spousal abuse as “instrumental anger” and discuss how to treat instrumental anger using EFT. Instrumental anger is used to control others. They point out that individuals who use anger and aggression to get their desires accomplished often lack awareness of feelings other than anger. To intervene with instrumentally angry people, the authors suggest confronting them, helping them to access their needs, and then teaching them more adaptive strategies to accomplish their goals and desires. Implicit emotion coaching involves the therapist’s responses that help direct clients to access and label their emotions. Emotion awareness training borrows from dialectical behavior therapy (Linehan, 1993).
DISCUSSION The treatment of intimate partner violence is a subject that is complex and fraught with challenges. However, as discussed, there are times when family therapy theories may be appropriate to work with individuals or couples who have experienced violence. We will summarize some of the main clinical and research implications for each theory that has been discussed.
Narrative Therapy Few studies have focused specifically on narrative therapy with violent couples. However, Freedman and Combs (2002) assert that narrative therapy is as applicable to “couples struggling to reclaim their relationship from violence and abuse,” as it is for couples presenting for other types of couples therapy (p. 322). Again, this may suggest an application for couples where both members are willing to own their role in the violence and are willing to resist the invitation to blame the other. Jenkins’ discussion of narrative therapy with violent couples outlines a protocol in which couples are encouraged to do just that. O’Connor et al. (2004) in their study of beginning therapists indicate that, while beginning therapists may not understand how to treat violent couples using narrative therapy, as their understanding of and training in narrative therapy increases, these insecurities will be overcome. However, the authors do not cite any studies in which therapists have done this, or give any guidelines as to how this is to be done, especially when safety is in question. Following the assertion by Freedman and Combs (2002), it may be presumed that a narrative therapist would work with a violent couple the same way he/she would work with any other couple, by listening, questioning, externalizing the problem, and looking for unique outcomes. However, future research could include studies following up on
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the O’Connor et al. study, focusing on how therapists with more experience treat violence, as well as how they feel about their abilities to do so.
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Collaborative Language Therapy Like the DVFCT model, Levin’s (2007) model of treating couples using collaborative language therapy stipulates that couples not be violent during therapy. Levin agrees with the DVFCT model that the therapist not impose his/her solutions on the couple. Rather than imposing a safety plan at the outset of therapy, the therapist collaborates with the couple to determine what the couple will do if they relapse into violence during therapy. In this way, Levin sidesteps the problem of the therapist imposing his/her reality on the couple in an order to keep them safe. Levin does not address issues of control or power in the context of an intimate relationship. This may be important for therapists working with couples whose relationships are characterized by battering or intimate terrorism. The reality that the couple presents may be distorted (Whiting, 2008), which would complicate the couple’s ability to collaborate with the therapist to solve their problems. Future research or expanse of this particular model of treatment could include addressing these issues of control or power.
Solution-Focused Brief Therapy Stith et al. (2002) discuss where they see SFBT as inadequate for working with couples, particularly when the therapist needs to set boundaries about violence. One of the ways in which DVFCT does this is by requiring an anger management course, which has both psychoeducational and group therapy qualities. While it may be seen as a critique of this model that it cannot remain theoretically consistent when working with specific populations, it can also be seen as a strength that the authors are not so rigid in their theoretical beliefs that they have lost sight of the importance of safety in working with violent couples. It can also be seen as a strength in that the authors acknowledge the departure from the theory and articulate justification for their departure. In working with violent couples, it is important for clinicians to prioritize the safety of the couples above allegiance to a particular model. In addition, the authors detail the process of “honoring the problem,” which may mean delving into the emotions of the partner who feels hurt and betrayed by the violence, and helping the other partner acknowledge and validate the hurt. While this was a concept developed by de Shazer, it seems on the surface to be a departure from the traditional SFBT model, which focuses on the future rather than past pain, as well as the problem rather than the solution. However, SFBT is based on pragmatism, rather than on theory. De Shazer et al.’s (2007) concern for making sure the client’s pain does not go unacknowledged indicates an understanding that if the client
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feels unheard and invalidated by the therapist or his/her partner, therapy has little chance of progressing, and clients will have a harder time focusing on future solutions.
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Emotionally Focused Therapy Johnson (2004) addresses the issue of violence explicitly by saying that EFT is not suitable for couples that continue to be violent during treatment because the process of EFT can leave an abused partner vulnerable to being mocked and demeaned. Johnson’s initial summation of violence fails to take into account the possibility that violence may be systemic, although her later work (2009) makes provision for systemic treatment of violence. However, the question of safety in working with couples, for either the couple or the therapist is not answered in EFT literature. While Paivio and Carriere (2007) addresses the use of EFT with anger and aggression, it is never discussed as a treatment for violent couples. It is viewed as an individual problem, rather than a problem of mutual escalation. Despite the fact that Paivio and Carriere’s (2007) works do not mention it, the methods Paivio uses could easily be applied in a couple setting, using principles of EFT to teach couples how to de-escalate their conflict before it becomes violent. Although there appears to be limited research on using EFT with violent couples, certain tenets of EFT seem to lend themselves well to working with situationally violent couples. EFT has its theoretical basis in attachment theory in that it states that couples get angry and lash out at one another because their attachments to one another have been injured. These attachments to one another constitute a basic biological need. Holtzworth-Munroe and Clements (2007) explained partner violence in terms of attachment, theorizing that people whose attachment needs are unmet may react with high levels of anger and violence. In other words, the violent partner may feel the threat of abandonment or separation from his/her partner and protest it with violence (Dutton, 1995). It may be helpful for clinicians working with violent couples to view the violence as a response to an attachment threat, and to address attachment needs in therapy. Further research with EFT could include research on its effectiveness at cessation of situational couple violence.
Summary and Cautions There are a few things which the various theories seem to support in working with violence. All imply that they are concerned with the safety of both partners. All presuppose that, while the violence may be mutual, the man is likely to be a more serious aggressor, if only because of his size and strength (Johnson, 1995). All stipulate that in order to work with violent couples, the violence must be infrequent and minor, with no severe injuries
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or hospitalization. All theories recognize that both partners must be willing to participate in therapy and be willing to change. Not all the literature reviewed adequately described a specific procedure for treating couples. However, the studies that did acknowledged the importance of safety and the process of working safety into theory, or the justification for putting aside the theory for the sake of safety. This review was not without limitations. To limit the scope of the study, only a few contemporary theories were reviewed. The only theories that were included in the study were those that either described treatment of violent couples or gave rationale for not treating violent couples. There were some contemporary theories, such as internal family systems theory that were not represented at all, as well as integrative approaches (O’Leary & Vega, 2005) that were not reviewed in order to keep the article focused. Some have addressed violence in more detail (e.g., SFBT) and were therefore given more attention in the body of the article. In addition, while several literature searches were conducted to find all studies related to these four contemporary theories, there is a possibility that other studies exist that were not reviewed here.
Future Directions With the exception of DVFCT, none of the contemporary theories reviewed have empirically validated their models for working with violent couples. Further research should include both the development and the empirical validation of specific models of treatment, including quasi-experimental studies. For example, the principles discussed in narrative approaches for treating violence (e.g., Jenkins, 1990) could be further refined into a more specific, manualized treatment, progressing through specific types of assessments and interventions. These treatments could then be implemented in quasicontrolled settings and applied with various types of populations. However, the size and scope of such studies may make them difficult to accomplish without funding and resources. Other types of research could add evidence to the application of these theories, including interviews or focus groups with clients who have experienced such treatment, or with therapists who provided them. Case studies detailing treatment of violent couples using specific theoretical models would also be useful to help clinicians understand how one might approach these issues from a specific model (e.g., White, 1988). This review has implications for MFT training programs. Supervisors who work with therapists in training need to be aware of violence indicators and help supervisees do the same. The decision whether to treat couples where violence is an issue that should be addressed in training programs, regardless of the models being used. This review may help therapists better understand how to assess for violence, the parameters for seeing violent couples conjointly, and how to be faithful to a model while doing so. Given
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the scope and severity of the problem of violence in intimate partnerships, it is important for MFTs of all theoretical orientations to be prepared to address this issue when it arises in the therapy room.
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