Wife abuse versus marital violence: Different terminologies, explanations, and solutions

Clrnicol Psych&~ Reuim, Vol. 13, pp. 59-73, 1993 Printed in the USA. All rights reserved.

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WIFE ABUSE VERSUS MARITAL VIOLENCE: DIFFERENT TERMINOLOGIES, EXPLANATIONS, AND SOLUTIONS Gay/a Mat-go/in University

of Southern

California

Bonnie Burman School of Social Welfare University of California, Los Angeles

ABSTRACT. The article examines feminist, social-learning and farnib therapy approach to wife abuse. Explanations for abusive behavior as well as treatment strategies are related to whether one&cuses on the societal rwrms that legitimize farnib violence and permit wife abuse, churacteristtis of the individual batterers, or the interpersonal relalionships that serve as the contextjr the violence. Resulting interventions are either individually oriented and directed to batterers or victims, or else couple-j&used and coruermd with thefamib. The article reviews this theoretical controversy, summarizes in@mation on explanatory factors for w;fe abuse, and describes both gender-specific and conjoint treatment options. Similar&s and differences between th theoretkal perspectives are explored, as well as ways in which each approach can inform and benefit the other. The goal is to heighten awaret2RTsof the problem of ~$2 abuse, as distinct from o&r marital problems in terms of legal, medical, ethl;lal, and treatment ramifications.

While there is a growing awareness that violence in marriage is a major social problem, there is little consensus regarding the conceptualization and treatment of this problem. Therapeutic models that focus on violence stem from feminist as well as social-learning analyses of the problem, and lead to gender-specific treatments. Conjoint therapeutic models for couples identified as violent somewhat reflect feminist and social-learning analyses,

but also incorporate

interactional

explanations

and focus more on the couple

unit. Many violent couples, however, are seen in traditional modes of marital and family therapy that, although quite concerned with the general topic of conflict, say remarkably little about the specific problem of violence. If violence is viewed simply as one extreme

Correspondence partment

should be addressed

of Psychology

- SGM

to Gayla

Margolin,

930, Los Angeles,

59

University

CA 90089- 1061,

of Southern

California,

De-

60

form of conflict,

G. Margolin and B. Bwman

the qualitative

differences

between violence

and other forms of conflict

may be overlooked. As contrasted with other forms of conflict, violence potentially leads to injury, if not death; introduces fear into intimate relationships; involves unlawful behaviors; and undermines the fundamental foundations of the relationship. This article is written to explore the role of the marital therapist in the identification and treatment of violence, most notably husband-to-wife violence. Our goal is to heighten awareness of this problem as distinct from other marital treatment ramifications.

problems

in terms of legal, medical,

ethical,

and

The marital therapist faces particular challenges and competing priorities when dealing with violence. As we explore later, the most common treatments have been designed for either the victim or the perpetrator individually. Because of the very good reasons for these gender-specific treatments, the clinician working with the couple or the whole family, who is committed to the well-being of all family members, faces difficult decisions. Is it appropriate ever to treat wife battering in the context of conjoint therapy, or should all such cases be referred

to gender-specific

treatments?

Does the goal of stopping the vio-

lence, and the life-saving ramifications of that goal, supersede any other treatment goal? Is the problem of wife abuse so philosophically and topographically distinct from other marital problems that one must dismiss systemic explanations of behavior? Are minor forms of aggression (pushing, grabbing, shoving) part of the same phenomenon as severe forms of battery? Is it possible to be an advocate for both spouses? Is helping the family to stay together an appropriate intervention goal? Is there a moral obligation to help a battered woman consider the option of leaving the marriage? Feminist approaches to wife battering focus on power and gender as the fundamental issues, and base their analysis on the patriarchal social context, the unequal distribution of power, and the culturally based patterns of male-female relations (Adams, 1988; Dobash & Dobash, 1979; Pressman, 1989). The underlying question in feminist literature is why men in general use physical force against their partners

and what functions

this serves for

a given society in a specific historical context (e.g., Bograd, 1988; Pagelow, 1981; Walker, 1984). The goal is to restructure the societal context that tacitly supports violence against women and maintains a hierarchical power structure. Actions by the women’s movement have focused on articulating the differences between victim and aggressor and directing assistance to wives as victims. Women are encouraged to empower themselves as individuals, which often involves extricating themselves from the abusive relationship. The social learning analysis focuses on observational learning and reinforcement of the perpetrator’s performance within a social context (Ganley, 1989). The batterer learns when, where, and against whom to aggress, and also learns that aggression is functional. The reinforcing properties of violence are both internal (e.g., the reduction of bodily tension) and external (compliance in the victim) (Saunders, 1989). Interpersonal determinants such as family-of-origin, peer group, and current family relationship are important to this analysis. The family therapy movement is grounded on ideas that clash with both the above analyses, but particularly the feminist approach. Commonly held beliefs in family therapy include the following: The family, not the individual, should be diagnosed and treated as a single unit; behaviors are examined for their communicative meanings; and problems are best understood through circular rather than linear explanations (Nichols, 1984). Each spouse’s actions in a marriage are viewed largely as a function of the consequences provided for those actions by the partner. A repeating and enduring pattern, such as violence, is viewed like other behaviors, as an interactional sequence maintained by both partners or as a homeostatic mechanism preserving the equilibrium of the system. As a

WzyeAbuse Versus Marital Violem

result, responsibility conceptual

for individual

distinction

between

actions is dispersed

victim and aggression

61

among family members disappears

(Bograd,

and the

1984;

Press-

man & Rothery, 1989). The various names given to the phenomenon of abuse reflect the schism in the way this problem is conceptualized and the types of interventions that are offered. As noted by Dobash and Dobash (1990), the problem we have been discussing has been given a number male violence,

marital

idea about the nature

of different names: violence

violence,

spouse assault,

of the problem,

its likely causes,

being addressed

is violence

clear by naming

it wife or woman abuse.

an equal

occurrence

by men against

and importance

should be named marital

violence

against women,

domestic

violence.

wife or woman abuse,

Each conveys a different

and possible

solutions.

their wives or cohabitants,

If it is violence

of women

or spouse abuse.

between

who are violent

marital

If the issue

that should be made partners,

implying

to their male partners,

it

(p. 109)

such as spouse abuse orfamily violence obscure the dimensions of gender and power that are fundamental to understanding wife abuse (Bograd, 1988; Schechter, 1982). Data on the frequency of violence in marriage also lend confusion to this phenomenon. Two large-scale national surveys, collected at a lo-year interval, report that approximately Terms

one in six couples experienced acts of physical aggression during the previous year, and one in four experienced an incident of abuse over the course of their marriage (Straus & Gelles, 1986; Straus, Gelles, & Steinmetz, 1980). These surveys show approximately equal amounts of husband-to-wife and wife-to-husband aggression and that, among all relationships containing violence, 49% show violence by both spouses. These quantitative research methods, which count up individual acts of violence without regard to the severity of injury or the issue of self-defense, have been held up to significant criticism for obscuring the greater danger posed to women than to men (Margolin, 1987; Saunders, 1986; Yllo, 1988). Moreover, there is evidence that clinical samples cannot be understood through the national survey. According to Straus (1990), shelter samples average more than one assault per week, as compared to the abused women in the national survey who average six assaults per year. Straus concludes that the experiences of the most severely assaulted women are not reflected in the national survey due to reluctance by both the male and female partners to be interviewed. It is argued here that husbands’ violence, more than wives’ violence, is likely to be dangerous, controlling, and frightening, and needs to be the main focus of concern. Due to differences in size and strength, the potential to inflict physical harm is greater for a male than a female, with the relatively infrequent exception of using weapons, which are equally dangerous in the hands of males or females (Saunders, 1988). Overall, women experience more physical injury than do their husbands. For example, there is a history consistent with possible battering in 25% of female emergency department trauma patients (Stark, Flitcraft, & Frazier, 1979). Stets and Straus (1990) report that 3% of physically victimized women needed medical attention as compared to only 0.4% of physically victimized men. Out of 93 couples seeking marital therapy, 14% of wives experiencing physical aggression sustained broken teeth, broken bones, or injuries to sensory organs, whereas only 1% of husbands experienced such injuries (Cascardi, Langhinrichsen, & Vivian, 1991). In terms of legally reportable assaults, the U.S. Justice Department (1983, cited in “Wife Abuse: The Facts,” 1984) reported that 95% of all assaults on spouses are committed by men. In light of the greater physical, economic, and psychological consequences due to assaults by husbands, as compared to wives, our discussion below focuses on the husband as aggressor and the wife as victim.

62

G. Maqolin

and B. Buman

Violence in marriage is a topic that we, as marital therapists, Given the frequency of this problem in nonreferred samples,

must concern ourselves. we assume that a large

proportion of couples seeking therapy may be violent. In support of this, O’Leary, Vivian, and Malone (1992) found that while only 1.5% of men and 6% of women spontaneously report violence, 46% of husbands and 44% of wives acknowledge violence in response to direct questions. This article summarizes what is known about batterers and victims and what treatment options are available. Although the problem of wife abuse might be identified in the context of marital therapy, we do not assume that couples therapy is the treatment of choice. On the other hand, we do not automatically rule out the possibility of couples treatment as a possible treatment option. Our goal is to show that gender-specific and couple treatments, although quite divergent in underlying assumptions, are not necessarily

mutually exclusive.

EXPLANATORY It is increasingly

common

to conceptualize

FACTORS husband-to-wife

violence

as multideter-

mined- that is, having its origins in the individual, the family, and the culture (Dutton, 1988; Ganley, 1989; Straus, 1976). While it is generally agreed that one of the reasons men batter is because of societal norms that legitimize family violence and permit men’s domination over women, this still does not explain why some men use violence while others do not. In general, researchers distinguish battering from nonbattering violent from nonviolent

have attempted to identify characteristics men, battered from nonbattered women,

that and

couples.

Male Batterers In the most comprehensive review of this literature, Hotaling and Sugarman (1986) evaluated the evidence for a variety of characteristics that have been mentioned as possible risk factors associated with marital violence. While some factors may not have received support simply because they had not been investigated sufficiently, eight factors were identified as “consistent risk markers” for battering men. To be a consistent risk marker, a variable had to have been examined in at least three studies, and a significant relationship in the predicted direction had to have been found in 70% of these studies. According to this criterion, batterers are more likely to be sexually aggressive toward their partners, to abuse their children, to have witnessed violence as a child, and to abuse alcohol. Batterers also have significantly lower incomes, lower occupational status, less education, and express less assertiveness. While some of the risk factors are concurrent variables of aggression (e.g., sexual aggression toward spouse), others may be related to etiology (e.g., witnessing violence between one’s parents as a child). In addition to the eight risk factors noted by Hotaling and Sugarman (1986), other variables found to correlate with battering are low self-esteem (Neidig, Friedman, & Collins, 1986), discrepancies between male’s conservative attitudes and female’s liberal attitudes (Alexander, Moore, & Alexander, 1991), stress (Rouse, 1988), and personality disorders (Hastings & Hamberger, 1988). Other interesting directions being pursued are the association between head injury and behavior (Rosenbaum, 1991) and the attributions that men make for their abusive behavior (Holtzworth-Munroe, 1988). Although cutting across all social classes, marital violence seems to be more likely in lower socioeconomic groups (Sugarman & Hotaling, 1989). This may represent a selection bias, however, as batterers in higher socioeconomic groups may use private, as opposed to public facilities,

Wife Abuse Versus Marital Violence

63

and thus may be less likely to be identified. Alternatively, a higher rate of marital violence may reflect the greater degree of environmental stress experienced by people in lower socioeconomic groups (Hamberger & Hastings, 1988). R ace does not appear to be related to the prevalence of marital violence when demographic (age, urbanicity) and socioeconomic factors are controlled (Cazenave & Straus, 1979; Straus & Smith, 1990). In general, the empirical literature does not answer the question of why some men batter and others do not. While a number of correlates have been found, etiological explanations remain elusive (Murphy & O’Leary, 1989). Since all of the data have been collected retrospectively, some of the correlates may be the result of being a batterer (Russell, 1988). Even reports of violence in the family of origin may be subject to distortion in the light of the respondent’s own current violent behavior (Widom, 1989). Moreover, some of the variables that have been identified correlate with one another (e.g., income and occupation) and may not be related to marital violence except through third variable connections Battered

(e.g.,

stressful environments)

(Sugarman

& Hotaling,

1989).

Women

The important

question

to ask regarding

battered

women is: What are the consequences

of repeated assaults and victimization ? Confirming previous studies with small samples, Gelles and Harrop’s (1989) random sampling of over 3,000 women found that significant psychological distress (depression, stress, and somatic complaints) is associated with being a victim of marital violence, and that the distress increases with the severity of the violence. Moreover, psychological distress is significantly related to marital violence even after controlling for marital conflict, total family income, and health and age of the woman. No psychological or behavioral pattern predicts for being a battered woman. The only consistent risk marker found for battered women is witnessing violence during one’s childhood (Hotaling & Sugarman, 1986), although this too varies according to the sample studied (e.g., Doumas, Margolin, &John, 1992; Rosenbaum & O’Leary, 1981). Walker’s explanations for this finding are that witnessing violence between one’s parents may lead women to be more tolerant of violence within intimate relationships (Walker & Browne, 1985) or may socialize women to believe that nothing they do will alter the spouse’s battering (Walker, 1988). Another question that has received attention is what constrains some women from leaving abusive relationships (Bograd, 1988). Evidence indicates that a combination of economic vulnerability and high commitment to the relationship predicts whether a woman remains in or returns to an abusive relationship (Strube, 1988; Strube & Barbour, 1983). Gondolf (1988) additionally found that women were more likely to return when their partners were in counseling. He warns that treatment staff have a responsibility to inform the women of the limitations of their partner’s treatment, since this treatment may provide women with a false sense of security and/or the hope that the men will change. In general, it appears that we need to study the social context of women’s lives to understand the sequelae of battering and the reasons for not leaving abusive relationships. Battering Couples Data from dating couples and early marrieds suggest that violence is a pattern that can begin early in marriage. Approximately one quarter to one third of dating couples experience violence (Arias, Samios, & O’Leary, 1987; Riggs, O’Leary, & Breslin, 1990). Factors associated with violent dating relationships are violence in family-of-origin, personality

64

G. Margolinand B. Burman

characteristics, inability to problem-solve, major life events, relationship problems, and expectations that violence will produce positive consequences (Breslin, Riggs, O’Leary, & Arias, 1990; Riggs et al., 1990). O’Leary and his colleagues found there were significant reductions in physical aggression for women from premarriage to 18 or 30 months postmarriage, but similar reductions were not found for men (O’Leary et al., 1989). These couples tended either to minimize the violence or to attribute it to factors external to the spouse, such as alcohol or stress. In an attempt to identify cause and effect, Murphy and O’Leary (1989) found that psychological aggression predicted to the first instances of physical aggression at either 6- or 12-month follow-ups, but that marital dissatisfaction seemed to be a result rather than a precursor of physical aggression. Thus, for some people, violence initially occurs in the context of a satisfactory relationship, but over time the violence breeds relationship dissatisfaction. The study of violent couples also involves the direct examination

of couples’ conflictual

discussions to understand how anger develops, maintains, or dissipates over time. Margolin, John, and Gleberman (1988) f ound that husbands in physically aggressive relationships, compared to husbands in nonviolent, high conflict relationships, were characterized by subtle negative

behaviors

such as more negative

voice qualities

and more nonverbal

signs of irritation and dismissal. Examining the same couples in their own homes, Margolin, Burman, and John (1989) found that, over the discussion, physically aggressive couples, compared to high conflict, nonviolent couples, did less problem-solving, more patronizing, and more attacking. Physically aggressive husbands displayed defensive behaviors throughout the interactions and became increasingly withdrawing and despairing as the conflict progressed. Two studies that used sequential analysis to compare the interaction patterns of physically aggressive couples to high conflict, nonviolent couples (Burman, John, & Margolin, 1992; Burman, Margolin, &John, in press) found that the behaviors of physically aggressive spouses were highly contingent upon the behaviors of their partners. Once one spouse exhibited angry or contemptuous affect, the other spouse was likely to reciprocate that behavior, and this pattern continued longer and more consistently for physically aggressive than for other couples. The couple data reviewed in this section are based on intact

physically

aggressive

couples, who are likely to differ from the subjects drawn from more extreme populations such as women’s shelters or men’s court-mandated treatment programs. The data suggest that couples who resort to physical violence differ from nonviolent couples on interactional dimensions in addition to their use of violence. While these interactional variables may be one of the multiple factors contributing to violence, the violence is a consequence of an individual’s choice to use aggression at a given point in time. No finding regarding an interaction

pattern could, in any way, challenge the responsibility

of the person exhibiting

the aggression.

Summary Research primarily has addressed individual and family variables, leading to the identilication of factors associated with an increased risk of violence. Although any particular research effort generally addresses only one explanatory factor, it is necessary to explore interactions among these variables to further understand wife abuse (Brennan, 1985). Generally speaking, researchers and service providers in this field have functioned pendently of one another. Nonetheless, available treatment models, particularly batterers, reflect many of the same themes as the research on explanatory factors.

indewith

Wz+ Abuse Versus Marital Violence

TREATMENT Treatments

can be differentiated

educational

and psychotherapeutic

Battered

OPTIONS

as to whether they are gender-specific-that programs,

batterers and victim assistance programs namely, conjoint treatments for couples. Victim A&

65

as well as judicial

for battered

women;

is, psycho-

interventions

for male

or non-gender-specific

-

tance

Women’s Shelters. The shelter movement

began in the 1970s to meet the safety

needs of women who were physically abused and to provide a supportive, nonjudgmental atmosphere geared toward fostering independence and optimizing each woman’s strength and abilities (Fleming, 1979). Although some of what shelters provide can be found elsewhere, they offer two very important and unique functions: (a) concealment of the victim so that the batterer cannot confront her or use continued violence to force a return home, and (b) a community of women who have suffered similar injustices and role models in the staff, who, in many cases, also had been abused but surmounted ..:c+:-:,o+:A, /R,x...l,,, J?_ h,f,..,,, lOQ~.\ C,,,:G, oh-l+a,r ~,,..;a,, ;,,l..,-l, rh;lcl r-,-a. “ILLII,II~LILI”II \uvwnr;, Lx, I”LLL”ILI) 1 -‘“J,. “p,LlllL OIILILLI JLl Y *L.c.? IIIL.IUUL L1IUU MX‘L, obtaining

welfare; employment

or financial

assistance;

accompaniment

their -;A :, CALU111

to welfare offices

and social security offices; assistance in getting housing; and survival-skill development, such as money management, parenting, nutrition, and driving. Shelters vary in the extent to which they are horizontally organized and run as collective households or are hierarchically organized and run on a social service model (McDonald, 1989). The peer counseling dimension can be particularly useful in the initial crisis phase to provide validation and friendship, to provide advocacy with legal and medical agencies, and to educate the woman regarding the sociopolitical reasons for battering. Professional social services and psychotherapy can be useful later on to help the woman address longterm effects of battering, such as depression or posttraumatic stress, and to explore ways to form new reiationships (Cooper-White, i990). In general, the need for shelters far exceeds their availability.

It is estimated

that nearly

40% of battered women and children were turned away from emergency housing due to lack of space in 1987, despite the existence of 935 shelters, 550 safe homes, and 303 nonresidential programs (U.S. Department of Health and Human Services, 1991). It further has been estimated that only about 3% of all battered women ever are seen in shelters, due in part to the unavailability of facilities as well as the need for more culturally appropriate

outreach

services for ethnic minorities

(Cooper-White,

1990).

Medical and legal Policies. Medical personnel in the emergency room often are the first to see a woman injured from battering and, as such, can play a crucial role in the course of her intervention.

Medical practice has been criticized for failure to appropriately

diagnose

abuse and for use of contraindicated medications that might hamper the victim’s alertness or increase her risk for suicide (Kurz & Stark, 1988). In 1985, the Surgeon General convened a task force that called for specific medical protocols for spouse abuse identification and intervention, as well as a full range of services for victims and their children (U.S. Department of Health and Human Services, 1986). As of 1992, there was a recommendation to routinely incorporate screening for violence with all female patients (Council on Scientific Affairs, American Medical Association, 1992). Changes in the legal system also reflect a greater emphasis on victims’ rights programs and victim advocate services. Specific legal actions include issuance of protective or restraining orders, providing coun-

G. Margolinand B. Burman

66

se1 for victims, expedited hearings, and using videotaped rather than live testimony (Fagan, 1990). In sum, battered women need services that offer support and emotional connections as well as specific and concrete information about their options. Helping agents can assist the woman in identifying her choices and prioritizing her decisions, help her to cope with problems of daily living, and work with her around the emotional and social sequelae of the abuse.

Interventions ludicial

for Male Batterers

System. In the mid-80s

a change occurred

in police responses

to domestic

vio-

lence, primarily ushered in by the Attorney General’s Task Force on Violence (1984), which stated that “the legal response to family violence must be guided primarily by the nature of the abusive act, not the relationship between the victim and the abuser.” For the first time in history, family violence no longer was sanctioned through silence, but was treated as seriously as violence between two strangers. The primary change in police action was a mandatory arrest policy for batterers. A landmark study by Sherman and Berk (1984) in Minneapolis of individuals apprehended

assessed the effects of arrest plus jailing on the future violence for domestic assault. At a &month follow-up, rates of repeated

violence were lower for offenders randomly assigned to arrest plus immediate but brief jail time than for offenders randomly assigned to the nonarrest alternatives of mediation or asking the man to leave the house for 8 hours. Arrest and immediate release was not assessed, since that alternative could be dangerous if the perpetrator returned to the victim in the height of his anger. Based on the results of this study, at least 15 states plus the District of Columbia passed mandatory arrest laws, either for violations of a restraining order or for probable cause of an assault misdemeanor. The Justice Department then commissioned replication studies in six cities to verify Sherman Huizinga,

and Berk’s (1984) and Elliott (1990)

findings. Reporting on the study in Omaha, Dunford, concluded that arrest, by itself, does not appear to deter

subsequent violence any more than does separation or mediation. Results from 1,200 cases in Milwaukee revealed that arrest reduces the immediate threat of being battered, but these results then attenuate. Interestingly, there was a differential response over time based on employment status. Arrests increased the rate of violence by 44% among unemployed suspects and reduced it by 16% in employed suspects (“New Study of Domestic Violence,” 1991). Given the far reaching implications of the original Sherman study, results from these additional studies are likely to influence further the justice department’s policies on wife abuse (Sherman

& Cohn,

1990).

Psychoeducational Approaches. Treatment programs for men have existed since 1985, having been initiated through three sources (Gondolf, 1985; Roberts, 1984). First, there are a number of self-help groups, established in response to the women’s movement and the accompanying men’s liberation movement. These programs often are run on a peer counseling format, thereby avoiding the stigma experienced by some men when seeking traditional mental health services. Second, some of the women’s shelters have started adjunct programs for the abusers. These programs reflect an expanded role of shelters in dealing with both sides of the battering relationship, although generally not both spouses of the same couple. Third, well-established community mental health service agencies have begun offering programs for batterers. While having the advantage of coordinating

WzyeAbuse Versus Marital Violence

67

with other mental health services, such as alcohol treatments, these programs than the others on sociopolitical issues surrounding violence. The primary goal across these programs is to stop violent behavior. The

focus less programs

emphasize that the batterer must take responsibility for abuse, that abuse must and can be stopped, and that there are alternatives to abuse (Gondolf, 1989). Confrontation is widely used to convey these messages. Due to the batterer’s tendency to minimize or deny his violent behavior, it is crucial to confront him with the reality of what he is doing and how it affects his life and the lives of others (Ganley, 1981). The widely used cognitive behavioral treatments, based on social-learning explanations of abuse, include pointing out the damaging behaviors emotional

and ultimately self-defeating consequences of violence and teaching alternative 1989). Relaxation training, systematic desensitizations, and skills (Saunders, awareness training, and assertion skills, for example, provide these men with

alternative behaviors that are incompatible with violence. In addition to the primary goal of stopping violence,

many treatment

programs

also

have secondary goals reflecting a more general resocialization process through procedures such as exploration of sex roles, antisexist education, and a redefinition of manhood. A third goal is improving relationships skills through communication training, empathy building, and cooperative decision-making. Treatments for men generally are offered in a group format to break down the social isolation of these men through a shared educational and emotional experience, to let them discover that their problems are not unique, and to give them the opportunity to help others as well as to receive help. Despite the far-reaching goals of some programs, the major criteria for judging success has been the degree to which violence is reduced subsequent to treatment. Edelson’s (1990) review of group treatments for batterers revealed nonviolence levels of 59 % to 75 % as reported by victims at follow-up. These data are inconclusive, however, since there are different definitions of nonviolence, follow-up lengths are limited, and few studies have used relevant comparison groups. Decreased violence may be a function of limited access to the victim, particularly if the couple has separated. Furthermore, measures of violence do not take account of “indirect abuse” such as noncooperation, isolation, and control, which also contribute to sustaining terror in the victim (Gondolf, 1987). Anger control procedures evaluations

alone have been shown to be insufficient in treating batterers. Follow-up by Gondolf and Russell (1986) indicate that anger control methods may be

associated with less physical abuse but intensified

psychological

abuse.

Couples’ Therapy Couples’ therapy, as an intervention mode for spousal abuse, has been the source of much controversy and debate. The philosophy of conjoint approaches is that the presence of both the abuser and the abused expedites the goal of ending violence. These treatments vary, however, along the dimension of accountability. In some models the male batterer has total and ultimate responsibility for the violence. Even if the wife engages in physically aggressive acts, the husband’s superior strength requires that he take responsibility. Other models reflect more of a systems perspective in which battering is seen as one aspect of an ongoing dysfunctional interactional pattern. With this perspective, both the husband and wife are seen as victims. In general, the couples’ approaches walk a fine balance between holding an individual responsible for violent acts but generally being concerned less with individual blame, and more likely attributing causality to situational and relationship factors (Neidig & Friedman, 1984). The more highly structured couple treatment programs incorporate treatment compo-

68

G. Margolin and B. Burman

nents quite similar to those of the cognitive-behavioral men’s groups, with somewhat greater emphasis on communication training, decision-making, and enhancing intimacy (Deschner,

1984;

Mantooth,

Geffner,

Franks,

& Patrick,

1987;

Neidig

& Friedman,

1984). Therapy often is offered in a group to reduce the isolation that characterizes these couples by allowing them to experience a larger network of support. While most of these programs could be adopted and modified to work with couples separately, it is unknown to what extent such procedures are followed in individual couple therapy. As summarized by Margolin, Sibner, and Gleberman (1988), the unique contribution of couples’ therapy is the opportunity to identify and change repeating interactional cycles that serve as the context for abuse. The husband can learn to monitor the emotions and anger-arousing cognitions that accompany his abuse. He also can develop a way to communicate with his wife if he has a pressing need for physical and emotional distance. In the interests of self-protection, the wife also can learn to monitor subtle cues that signal the husband’s escalation of anger and her fearfulness. These early cues can be used to trigger coping responses, such as leaving the situation, rather than terrorized, self-blaming, or combative reactions. Helping a woman change her behavior to protect herself and escape an abusive partner does not imply that she provokes the violence. In fact, giving the woman some responsibility for her own safety may begin the process of her own empowerment (Magill, 1989). Geffner and his colleagues (Mantooth et al., 1987) list the following additional advantages of conjoint therapy: (a) The spouses are taught the same educational materials simultaneously; (b) they have a safe environment to express their feelings; (c) the counselors can get both spouses to agree to save highly emotional issues for the session; (d) the counselors gain a more accurate picture of what is happening; (e) neither spouse has to wonder what the other has said and no one party is likely to try to use new techniques or information whole family can occur. There

are a number

to manipulate

of arguments

the other;

against conjoint

and (f) structural

changes

for the

therapy, however. The heart of the

feminist criticism is that conjoint counseling gives ambiguous and contradictory messages to the abuser about how much responsibility he should take for ending his violence (Adams, 1988; Bograd, 1984; Ganley, 1981). Even if the woman is not held accountable for the abuse, her presence in treatment makes her part of the solution. When the woman’s precipitating behavior becomes part of the discussion, the definition of the problem is shared; as such, the man no longer has sole responsibility for behaving in a nonviolent manner. Moreover, in conjoint therapy, the battering behavior may not be identified as the primary treatment issue but as a symptom of a larger problem in the relationship. Adams (1988) concludes, “The result of this misnaming of the problem is that the batterer is given the message that his nonviolence is negotiabledepending on his ability or motivation to better himself, develop insight, or improve his (or his wife’s) communication skills. The tacit message is that he will likely continue to grab, shake, slap, and kick his wife until he makes changes in these other areas” (p. 177). In addition to dispersing accountability for the violence, conjoint therapy is criticized for giving subtle messages regarding the continuation of the relationship. With the spouses together, it is difficult to assess adequately whether or not each spouse wishes to remain in the marriage (Rosenbaum & O’Leary, 1986). Rosenbaum and Maiuro (1989) suggest a sequential approach, first treating aggression as the man’s problem while the woman makes decisions about remaining in the marriage, and then, if the relationship continues, offering conjoint therapy. Gondolf (1989) similarly suggests that different approaches may be more appropriate for men at different points in their change process, with couples’

WzyeAbuse Versus Marital Violence

counseling change.

being offered

only after a batterer

SUMMARY

has accomplished

69

substantial

individual

AND RECOMMENDATIONS

Can the different approaches to therapy inform one another? The family systems approach can benefit by adapting philosophies and strategies from the gender-specific approaches. If conjoint therapy is being offered to a couple, that therapy must be different from traditional couple therapies. First, violence must be given special status as the primary problem and treated independently without linking it in explanation or solution to other problems. Second, there must be flexibility to see spouses individually in order to evaluate the viability of the marriage, to obtain honest reports on whether the violence has ceased, to deal with individual issues, and to discuss alternative forms of treatment (Magill, 1989). Third, explanations of abuse need to go beyond family interaction patterns and examine abuse as a reflection of cultural norms and institutionalized inequities regarding malefemale roles. The stratification of society along the dimension of gender has had signilicant influence on our clients and on their relationships, as well as on the development of our therapeutic practices. We are not saying that any one client should be held responsible for society’s injustices, that those injustices can be corrected through the treatment of a particular client, or that societal influences overshadow the individual’s choice to be violent. Nonetheless, it is important, with all couples, to recognize the different frames of reference that males and females typically bring to their relationship and to examine the effects of sexist attitudes. What the family systems approach has to offer the gender-specific approaches is an appreciation and concern for the family unit. Given that many couples will remain together despite the abuse, there is reason to understand the family context in which the batterer and the victim reside. Moreover, certain interventions may be more effective if the wife is an informed and cooperating participant. When time-out is explained directly to the wife by the therapist, rather than translated through the husband, there generally is better cooperation with the procedure by both partners (Rosenbaum & Maiuro, 1989). In addition to exploring the relationships within the family, it may be important to examine how the family as a system interacts with the larger community. These families often have been described as socially isolated and without an adequate support network. Despite the obvious differences between gender-specific and couple-therapeutic approaches, there also are important similarities. First, as part of any intervention into marital violence, safety is the primary concern. Although some victims are acutely aware of the danger they face, others downplay their own risk. Violence always has the potential to be dangerous and, as such, should be taken seriously by the therapist. All treatment modes emphasize the importance of careful assessment of the violence, including the specific types of acts committed, the extent of injuries over time, the availability of weapons, threats to kill, and generalizability of violence to other family members, particularly the children. A strategy common to all therapies is the formulation of a safety plan that identifies ways for the partners to disengage from one another so that violence is precluded by virtue of the fact that there is no access. To give weight to the importance of this, the therapist often requires written acceptance of a noviolence policy, including prespecified contingencies to deter violations. Safety planning does not stop with the initiation of a no-violence contract, but requires continued monitoring through the treatment.

70

G. Margolin and B. Burmm

A second similarity across these therapies is that they are not value-free. Any treatment that has the termination of violence as its goal is founded on the basic premise that “abusiveness is unacceptable? In dealing with other types of problems, a therapist might attempt to be value-free, accepting a client’s definition as to what is problematic and nonproblematic. However, given society’s long history of condoning violence, failure to confront such behavior can be interpreted as tolerance, if not acceptance, of violence. Rather than rely on the abused woman to complain about her husband’s violence, particularly if the husband is present, the therapist must assess and challenge this behavior. A final commonality across these different approaches is that each type of therapy may bring inadvertent risks. In addition to inadequate information about the effectiveness of these treatments, there is informal evidence that, in some instances, treatment might exacerbate the problem. It is not unusual, for example, for a battered woman to report that her honesty in a family therapy session was followed by violent retaliation at home (Adams, 1988; Bograd, 1984). Batterers who hold their partners responsible for placing them in a therapeutic situation that they find uncomfortable may harass the partner in response (Hart, 1988). Certainly there has been a concern that judicial action initiated by the wife might increase the risk of subsequent conflict (Dunford et al., 1990). While these issues deserve attention in any large-scale program evaluations, they also should be examined on an individual case basis. In conclusion, because of the societal context associated with all problems of family violence, interventions need to be focused at the level of primary prevention. Thus far, the majority

of our funding and efforts have been directed to programs

that assist victims and

reform perpetrators. Even though the criminal justice and health care systems are becoming more informed and better able to identify this problem, and therapeutic interventions have been developed to treat the problem, there is little indication that the incidence of wife abuse has been reduced. Reductions in the incidence of marital violence will occur only as we are able to raise generations of nonviolent people through education and social change. The burden of saying no to violence has been shouldered by activists in the women’s movement and a small group of concerned professionals; it is time for psychologists to demonstrate a greater commitment responsible clinical treatments.

to ending wife abuse through social action and

article has been funded by NIMH Grant ROl 36595-08. The authors wish to thank Marya Mogk as well as two anonymous reviewers for their suggestions and editorial assistance on a previous draft of this manuscript.

Ackrwwledgemmts-This

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