Journal of Marital and Family Therapy

Oct ober 2002,Vol. 28, No. 4,455-466

THE DIFFERENT FACES OF INTIMATE VIOLENCE:
IMPLICATIONS FOR ASSESSMENT AND TREATMENT
Kelly Greene
Peel Childrens Centre, Mississauga, Ontario, Canada
Marion Bog0
University of Toronto, Toronto, Ontario, Canada
Current research about violence in intimate relationships suggests that at least two qualitatively
distinct types of violence exist. This new knowledge challenges the dominant conceptualization of
intimate violence as solely a manifestation of patriarchal male dominance. Following a review of
the research and analysis of illustrative clinical examples, a conceptual framework is presented
that assists couple therapists in answering three salient questions: What type of violence am I most
likely to be working with? How can I assess the diferences between types of violence? And how
might Iproceed with treatment for diferent types of violence?
The conceptualization of violence in intimate relationships and of appropriate interventions in the field
of family therapy has reflected dominant paradigms at a particular stage in the history of the field. Earlier,
influenced by systems theory, the field failed to detect that abuse was present, or blamed the victim by
holding the woman equally responsible for male perpetrated violence. Since adopting a feminist critique and
a gender analysis, the dominant conceptualization has emphasized male power and domination over women,
rooted in patriarchy and gender-role socialization. Interventions have focused on ensuring the safety of the
woman, treating male batterers separately, and avoiding couples therapy as inappropriate and unsafe (Avis,
1992; Bograd, 1992; Kaufman, 1992). Only recently have there been published reports that provide
alternative perspectives and interventions and suggest the need for careful and thoughtful consideration of
the utility and safety of conjoint treatment (Almeida & Durkin, 1999; Bograd & Mederos, 1999; Goldner,
1999; Greenspun, 2000; Holtzworth-Munroe, Beatty, & Anglin, 1995; Jory & Anderson, 2000).
The first author, committed to feminist approaches to woman abuse and with extensive experience
working in shelters for abused women, became increasingly aware of the limits of the dominant conceptu-
alization of intimate violence when she moved on to work with a community-based population of couples
where there was violence in the relationship. There appeared to be a striking difference between the type of
violence seen in this community-based population as compared to the shelter population. Intervention
approaches, however, were based on a generic, universal conceptualization of intimate violence as primarily
a manifestation of male domination. Recent research on batterer typology (Holtzworth-Munroe, Meehan,
Herron, Rehman, & Stuart, 2000; Waltz, Babcock, Jacobson, & Gottman, 2000) and studies comparing the
differences between clinical and community samples (Archer, 2000; Johnson, 1995) renders this nondiffer-
entiated view problematic. This research suggests that at least two qualitatively distinct types of intimate
violence exist, one type involving male power and control, and the other involving mutual conflict between
partners (Johnson & Ferraro, 2000). Unfortunately, even the newer couple intervention models do not
Kelly Greene, Peel Childrens Centre, Mibsissauga, Ontario, Canada; Marion Bogo, Faculty of Social Work, University of
Correspondence concerning this article should be addressed to Kelly Greene, Peel Childrens Centre, 85A Aventura Court,
Toronto, Toronto, Ontario, Canada.
Mississauga, Ontario L5T 2Y6, Canada. E-mail: kelly.greene@utoronto.ca
October 2002 JOURNAL OF MARITAL AND FAMILY THERAPY 455
distinguish between types of violence. Current assessment and intervention practices that focus almost
exclusively on patriarchal male violence against women may not reflect an understanding of the lived
experiences of many couples and ultimately may deny them the type of help they seek. The current and
compelling research about violence in intimate relationships enables therapists to develop a more complex
and individualized understanding of violent couples. This article provides concepts and accompanying
assessment guidelines to discriminate between these different types of violent couples.
AN ALTERNATIVE CONCEPTUALIZATION OF INTIMATE VIOLENCE
The domestic violence literature includes disparate and controversial findings. On the one hand, studies
of community samples find generally low levels of violence perpetrated by both males and females. On the
other hand, studies of clinical samples drawn from courts, hospitals, and shelters find severe violence mainly
perpetrated by men (Archer, 2000; Johnson, 1995). Feminist researchers have studied primarily clinical
samples and conclude that intimate violence is the result of patriarchy and, thus, is primarily perpetrated by
men as a means to maintain power and control (Dobash & Dobash, 1979; Pagelow, 1984). Family conflict
researchers have studied mainly representative community samples and conclude that intimate violence
between partners results from individual, relational, and societal variables that tend to be more gender
neutral (Berkowitz, 1993; Straus & Smith, 1990). These two different perspectives have led to a long-
standing debate about the veracity of each position. Until recently we have had no other way of
conceptualizing violence that is inclusive, rather than exclusive, of different ideological positions, empirical
findings, and clinical experiences.
Johnsons ( 1 995) ground-breaking analysis, in which he compared and contrasted representative
community samples with clinical samples selected for the presence of male violence, suggested that the
dramatic differences in gender patterns of violence arise from the fact that researchers are actually studying
different phenomena. He proposed that domestic violence is not a singular phenomenon; rather there are
qualitatively distinct patterns of intimate violence that he named patriarchal terrorism (Johnson, 1995, p.
284) and common couple violence (p. 285). Patriarchal terrorism represents a pattern in which there is
systematic use of both violent and nonviolent actions to achieve general control over ones partner. Violence
is merely one tactic of many used to gain absolute control in the relationship. Compared to common couple
violence, patriarchal terrorism is more likely to escalate over time, have a higher frequency of violent
incidents, cause serious injury, and involve the unilateral use of violence by one perpetrator (predominately
men in heterosexual relationships). Common couple violence, unlike patriarchal terrorism, is not charac-
terized by a pervasive pattern of control. Rather, violence is an intermittent response to a specific argument
or conflict. Control is thus limited to a specific situation. Common couple violence is more likely to be
mutual, is not as likely to escalate over time, does not occur as frequently, and is less likely to involve severe
violence (Johnson, 1995; Johnson & Ferraro, 2000).
Although the term common couple violence has now become more widely used since Johnson coined
the phrase in 1995, common should not imply that this type of violence is more benign or acceptable. Any
conflict that escalates to the point where physical aggression is used can put couples in danger. Fortunately,
because of the influence of feminism, the tendency for family therapists to disregard violence as a principal
target of treatment has decreased (OLeary & Murphy, 1999). The field of family therapy has recognized
that ignoring violence is both unethical and unhelpful when working with violent couples. Treatment
requires special skills and knowledge about this issue. Thus, the term common couple violence is meant
strictly to denote a type of violence that is distinct and qualitatively different from patriarchal terrorism.
Clinicians should be aware of and assess the risks throughout treatment, regardless of their initial assessment
of the type of violence.
The majority of studies on couple violence have largely used samples involving only severely violent
men. Conclusions and conceptualizations about violence and appropriate clinical interventions have been
generalized from these samples to all couples in which there is aggression (Johnson & Ferraro, 2000).
Comparably little research has involved couples voluntarily seeking conjoint treatment for intimate violence
456 JOURNAL OF MARITAL AND FAMILY THERAPY October 2002
(Brown & OLeary, 1997). Despite growing evidence of differences between these populations, distinctions
have yet to be included in assessment. To select differential interventions that are responsive to the couples
needs and experiences, couple therapists need to answer three questions: What type of violence am I most
likely to be working with? How can I assess the differences between types of violence? How might I
proceed with treatment for different types of violence?
WHAT TYPE OF VIOLENCE ARE COUPLE THERAPISTS MOST LIKELY TO SEE?
Studies suggest that couple therapists in the community are most likely to see common couple violence
in couples presenting with some form of physical aggression in their relationship. The majority of couples
(50%-65%) who seek couples therapy report some level of physical aggression, yet 90% of these couples
do not perceive physical aggression as a major relationship problem (Ehrensaft & Vivian, 1996; OLeary,
Vivian, & Malone, 1992). The most common forms of violence are grabbing, slapping, pushing, and
throwing things at one another (OLeary & Murphy, 1999). Comparing self-referred men in intact
relationships with men court mandated into treatment, the former engage in less physical aggression, are
less likely to deny their physical aggression, and may be more motivated to change their behavior (Brown
& 0 Leary, 1997). Studies of couples treated conjointly in domestic-violence-focused treatment programs
with clear exclusion and inclusion criteria found that very few women reported being fearful of remaining
with their husbands or of participating in conjoint treatment. These women were placed at no further risk of
abuse than women receiving treatment separately from their spouses (Brannen & Rubin, 1996; Dunford,
2000; OLeary, Heyman, & Neidig, 1999).
Archer (2000) in a meta-analysis compared samples selected for male violence (from battered
womens shelters) with community samples to assess whether couple violence looked different across these
populations. Very high levels of male aggression were reported in shelter samples, whereas in community
samples women were slightly more physically aggressive. Archer (2000) also examined studies of couples
undergoing treatment for marital problems and found that men were slightly more likely than women to be
physically aggressive. However, in contrast to shelter samples, the level of male aggression was much lower.
This suggests that couples receiving counseling, even for problems specifically related to male violence, do
not have nearly the same kind of imbalance in physical aggression as might be found in couples in which
the woman has sought shelter from abuse.
Although other typologies for differentiating male batterers have been proposed, research on female
perpetrators is much less extensive. Holtzworth-Munroe and Stuart (1994) proposed three types of male
batterers: Family-only, dysphorichorderline, and generally violent/antisocial. Batterers can be identified
along three descriptive dimensions: Severity/frequency of violence, generality of violence, and
psychopathology or personality disorders, as well as risk factors correlated with the development of violent
behavior (such as witnessing violence in the family of origin). Dysphorichorderline and generally
violenthtisocial batterers engage in moderate to severe levels of violence and the later are most likely to
be involved in criminal behavior and use violence both within and outside the home. The
dysphorichorderline tend to confine their violence to the intimate relationship. Family-only batterers
engage in the least amount of violence, show little or no psychopathology, and have very low levels of risk
factors. Empirical testing of the model has supported this batterer typology (Hamberger, Lohr, Bonge, &
Tolin, 1996; Holtzworth-Munroe, et al., 2000; Tweed & Dutton, 1998; Waltz, et al., 2000).
Two recent studies compared couples from the community (Holtworth-Munroe, et al., 2000; Waltz, et
al., 2000) with maritally distressed but nonviolent couples and found a striking resemblance between the
family-only batterers and the nonviolent men. In these studies, the two did not differ significantly on a wide
variety of measures hypothesized to be correlated with violent behavior (e.g., psychopathology, violence in
the family of origin, attachment style, dependency, jealousy, impulsivity, social skills, attitudes toward
violence, and attitudes toward women). In contrast, both the generally violent/antisocial batterer and the
dysphorichorderline batterer differed significantly from nonviolent men on most of these measures. During
a conflict discussion with spouses in a laboratory no differences in behavior between family-only batterers
and nonviolent men were found. However, the other types of batterers displayed higher levels of contempt
October 2002 JOURNAL OF MARITAL AND FAMILY THERAPY 457
and negative behavior toward their spouse during problem discussions.
Jacobson and Gottman (1998) identified two types of batterers, whom they labeled, pitbulls and cobras.
These two batterers resemble the dysphorichorderline and generally violent/antisocial batterers, respec-
tively (Holtzworth-Munroe et al., 2000). Although Jacoboson and Gottman focused their study on severely
violent men, they also discovered what they called a low-level violent group of couples, which they
followed with the expectation of tracking the development of violence from minor to more severe forms.
Unexpectedly, however, this group almost never escalated their use of violence, and are described by
Jacobson and Gottman as a stable group of couples who periodically have arguments that escalate into
pushing and shoving, but never reach the point where we would call the men batterers (p.25). This
description coincides with Johnsons (1995 j description of common couple violence.
Utilizing the same data set as Jacobson and Gottman (1998), Waltz, et al. (2000) tested the proposed
typology set forth by Holtzworth-Munroe and Stuart (1994), with the inclusion of this low-level violent
group. They found that 83% of the men from Jacobson and Gottmans (1998) low-level violent group of
couples were classified as family-only type batterers, whereas 89% of batterers classified as generally
violent/antisocial came from Jacobson and Gottmans sample of couples where there was severe husband-
to-wife violence. This research appears to support Johnson and Ferraros (2000) observation that types of
violence among couples appears to be associated with types of perpetrators.
In summary, the studies reviewed suggest that couple therapists working with voluntary couples in the
community are most likely to see common couple violence and family-only type perpetrators. The family-
only type differs from other types of perpetrators, yet closely resembles nonviolent men in distressed
relationships. Although studies indicate that a certain type of violence may predominate in a specific
population, these distinctions are not absolute (Archer, 2000). Thus, it is imperative that couple therapists
have the knowledge and skill to identify the differences between patriarchal terrorism and common couple
violence in order to provide individualized and effective interventions.
ASSESSMENT FOR DIFFERENT TYPES OF VIOLENCE
When working with couples, therapists need to first screen for violence and complete a safety
assessment, Bograd and Mederos (1999) offer a comprehensive assessment procedure that is helpful in
detecting violence and examining risk factors. Many advocates in the domestic violence field have stressed
the importance of safety planning and ongoing evaluation of the potential for lethal violence as fundamental
components of assessment and treatment (Aldarondo & Straus, 1994; Bograd & Mederos 1999; Cervantes,
1993).
Feminist scholars have helped illuminate the obvious and subtle ways that gender-based power differ-
entials are evidenced in intimate relationships between women and men, and especially where there is
violence. This perspective is likely to be the most useful lens to bring to the initial assessment of couples
where aggression is present. All couples, however, whether violent or nonviolent, have conflicts involving
power and control issues (Jacobson & Gottman, 1998). The extent to which this power and control is attrib-
utable to gender inequalities, however, can vary greatly from couple to couple. The research summarized
earlier in this article on common couple violence and the many couples we have seen in clinical practice
obliges us to broaden our lenses when trying to understand aggression where gender inequities may not be
the primary motivation. That is, the desire to control as an expression of male domination does not appear
to be universally present in cases of common couple violence.
An assessment of violent couples needs to include an analysis of whether the violence represents
patriarchal terrorism or common couple violence. This assessment is complex as it involves more than
identifying who is using physical aggression. For example, Jacobson and Gottman (1998) found that wives
of severely violent men often fought back both verbally and physically against their spouses. However these
researchers did not consider the wives use of physical aggression as battering since they found that only the
men successfully used violence as a method to control their partners and only the women were afraid. Fear
and control differentiated the mens and womens use of violence. Jacobson and Gottman (1998) particularly
stressed the element of fear as a defining characteristic of these relationships: Without fear, there is no
458 JOURNAL OF MARITAL AND FAMILY THERAPY October 2002
control. For us, fear became a barometer of control (p. 82). Similarly, Johnsons (1995) distinction between
common couple violence and patriarchal terrorism is largely based on motivation to control.
Therefore, we propose that in order to distinguish types of violence an assessment needs to consider
four factors: Range of control tactics (e.g., does the perpetrator use emotional abuse, isolation, threats,
degradation, and withdrawal of access to resources?); motivation for the use of violence (e.g,, is the
perpetrators intent to instill fear and thereby establish control over their partner, to essentially put her in
her place or is it an intermittent response to a specific argument or conflict without the intent to exert
general control over the other?); impact from the physical aggression (e.g,, is employment, social networks,
physical or mental health being affected?); partners subjective experience (e.g., is one partner afraid of the
other?). The following two case studies (we are satisfied that the information is presented in a way that will
not compromise confidentiality) from our clinical practice illustrate how assessing these four key factors can
help distinguish a pattern of patriarchal terrorism from common couple violence.
CASE STUDIES
Patriarchal Terrorism
Mary and Bob are a White, Catholic couple in their early 30s with one 7-year-old son. Bob is a software
computer programmer and Mary previously worked as an executive secretary. During an initial therapy
session Bob and Mary disclosed that some physical aggression was occumng in their relationship. The
therapist decided to see each partner individually to assess safety issues more fully and to determine the type
of intimate violence.
In the individual interview Mary explained that when she married Bob she thought they were meant
for each other. She was attracted to the fact that Bob had a good job, wanted to support her, and was
intensely loyal and committed to her. However, over time, Bob became more and more jealous and
controlling, often refusing to let her visit family and friends. At work he would call her at least 20 times a
day, and if she were not at her desk, he would accuse her of having affairs with her male coworkers. Bob
also started becoming physically aggressive about 2 years ago, occasionally shoving, pushing and slapping
her. He would often pick a fight with her just before she left for work. One day Bob told her that she looked
like a whore in the skirt she was wearing and when she refused to change, he blocked the door and would
not let her leave the house. When she tried to push him out of the way, he struck her across the face. This
caused her to miss an important meeting, and she was fired. Since then, her relationship with Bob has deteri-
orated. He sold her car, started putting his checks in a separate bank account, and refused to give her any
money. He insisted on doing all the shopping, because she spent too much money. Mary has thought about
getting another job, but Bob wants her at home, and besides she feels so anxious and depressed that she does
not think she could hold down a job.
When asked to describe the most recent incident of violence, Mary said that last week she was ill and
unable to prepare dinner before Bob arrived home. Bob started accusing her of spending her day screwing
other men. Mary then yelled at him that if he wanted dinner sooner, he could make it himself. The next thing
Mary remembers is being thrown up against the wall while Bob shouted in her face, You had better make
my dinner right now you lazy fucking bitch! He then spit in her face. Mary said that she is frightened when
Bob flies into these rages and never quite knows what will set him off next. She is afraid that if they do
not get help for their marriage he may really lose it on me one day. Mary is also concerned about her son
witnessing some of these arguments and that he is becoming more withdrawn.
In an individual session Bob expressed concern that he and Mary fight too much. He said that he loved
her, did not want her to leave him, and was willing to do almost anything for her. He then proceeded to talk
about all the things that he does for her, in particular, financially supporting her so that she can stay home
and do nothing all day. He reported being baffled that given everything he does for her, she is not more
grateful. Bob felt that he did not ask for much in return-just a clean house and dinner ready for him when
he comes home. When asked about a recent fight, Bob talked about a day last week when Mary was doing
who knows what and had not even bothered to get dinner ready. On top of this, she snapped at him and
told him to make it for himself. Bob said that he grabbed her by the arms to get her attention. He believes
October 2002 JOURNAL OF MARITAL AND FAMILY THERAPY 459
that sometimes Mary needs reminders like this to treat him with more respect. When asked if Mary is ever
afraid of him during these times, he laughed and said, I wish she were, then maybe she would listen to me
more often.
Common Couple Violence
Tracey and Steve are a second generation East Indian couple in their late 30s. They live in a midsized
city and both are teachers. Tracey and Steve reported having heated arguments, which have escalated to
the point where they have pushed and shoved each other. Following standard safety protocol, the couple was
then interviewed separately. Both Tracey and Steve identified that their marriage was under a great deal of
stress because of their inability to conceive a child. Steve felt that Tracey was stuck on the idea of
continuing to try to have children, whereas he wanted to move on to explore different options, such as
adoption. Tracey felt that Steve had given up on them and was no longer emotionally supportive. They
reported that in the last year they had been arguing more than ever. Several times these arguments had
involved physical aggression-slamming doors, throwing things, and occasionally pushing or slapping each
other. Tracey said that it can be either one of them who starts an argument and both of them seem to be
unable to stop it from getting out of hand.
When asked to describe their most recent incident of violence, Tracey and Steve gave similar accounts
of the same incident. Two weeks ago, Tracey learned that the fertility treatment was not successful. Tracey
described the devastation she felt when she found out that their last attempt to conceive a child had failed.
She recalls at the time feeling that she just did not have the words to talk to Steve about this, and remembers
feeling really angry. She said that she went into the kitchen to make coffee in the morning, and out of
frustration, started slamming cupboard doors when she could not find the filters. When Steve came
downstairs, Tracey said all she could think was What do you care anyway?; when he insisted they talk,
she told him to fuck off. Steve said that he was outraged, as this loss affected him just as much as it did
her. He then told Tracey to stop being such a selfish bitch, at which point she pushed him and stormed out
of the room. Steve tried to stop her from leaving by grabbing her arm. Tracey said that when he tried to stop
her from leaving, she slapped him across the face. It was at that point that both of them realized things had
gone too far.
Both Tracey and Steve feel that they were equally responsible for the conflicts and were ashamed of
their behavior. They want to learn how to control their temper and resolve conflicts more constructively.
When Tracey was asked if there were ever times she was afraid of Steve, she said No, I know that Steve
would never intend to hurt me. She was afraid, however, that if their fighting continued this way, their
marriage might be at risk. Steve did not indicate any fear of Tracey harming him, but, like Tracey,
emphasized that the fighting was undermining the positive aspects of their marriage. Tracey and Steve were
hoping that couples therapy would help them move on in a direction that was mutually agreeable and
satisfying to both of them. They were keenly aware that the decision regarding whether to stop or pursue
more fertility treatments involved heavy financial and emotional commitments. After several years of trying
to conceive, the couple was now faced with severe financial difficulties after spending most of their savings
on fertility treatments. As both of them have similar incomes, Tracey and Steve have a good understanding
of their financial needs and participated together in financial planning. They reported having always made
important decisions together and valuing each others opinion. They wanted to find a way that each of them
could feel good about their future choices, but were feeling helpless over how to make this happen.
Analysis of Cases
To uncover the patterns distinct to patriarchal terrorism and common couple violence four key
variables-range of control tactics, motivation, impact, and partners subjective experiences-need to be
assessed. In Mary and Bobs relationship, there is a wide range of control tactics being used by Bob beyond
physical aggression. Mary discloses that Bob calls her degrading names, has denied her access to money
and transportation, isolates her by cutting her off from friends, family, and work, uses intimidating and
degrading gestures such as spitting in her face, and exhibits highly jealous and possessive behaviors. For
Bob, physical aggression is but one part of his arsenal of weapons aimed at humiliating and subjugating his
460 JOURNAL OF MARITAL AND FAMILY THERAPY October 2002
wife, Mary. Bobs motivation for the use of violence can be understood as his attempt to assert general
control over his partners thoughts, feelings, and behavior. Acts of physical aggression are used to keep
Mary in line; they are reminders from Bob that she must follow his rules. There is also an unpredictable
nature to his violence, which keeps Mary off guard and overly focused on trying to modify her behavior to
avoid further abuse.
Tracey and Steve in contrast, have marital issues that lead to conflict involving physical aggression, but
there is no attempt to exert control outside of this specific context. Tracey and Steves use of physical
aggression arises in the context of a specific argument about an emotionally charged issue, in which they
react by physically lashing out at each other. Unlike Bob, Tracey and Steve do not engage in a wide range
of both violent and nonviolent behaviors that would indicate a general pattern of control. Tracey and Steve
report the experience of violence as being about anger and frustration, but not about fear or the intent to
instill fear in the other partner. Both acknowledge the aggression, admit that it is shameful, and want to
change their behavior. There is no motivation to use aggressive acts as a means to establish widespread
control over their partners life.
Although Tracey and Steve both feel at a loss when it comes to stopping these arguments from getting
out of hand, these feelings of powerlessness do not profoundly affect other areas of their lives. Tracey and
Steve continue to work full time, pursue hobbies, visit friends and family, and do not show signs of any
mental health issues. Mary, in contrast, reports being depressed and anxious and does not feel capable of
sustaining employment. These effects are consistent with the trauma literature, which has found that female
victims of intimate violence suffer from negative psychological effects, such as posttraumatic stress
disorder, depression, lowered self-esteem, in addition to social and economic disadvantages (Holtzworth-
Munroe, Smutzler, & Sandin, 1997; Walker, 2000). Consequences beyond physical injury must be
considered when assessing impact. For example, in terms of actual physical injury, both Tracey and Mary
have sustained only minor injuries. However, when the psychological, social, and economic consequences
are considered, a different picture emerges for these two couples.
Tracey and Mary also describe the experience surrounding the physical aggression very differently.
Mary experiences Bobs physical aggression as frightening, and she is afraid that he may cause her serious
harm in the future. Tracey and Steve, in contrast, do not experience the aggression as frightening or intimi-
dating. It is important to stress the need to understand the subjective experience of violence for each partner,
as the presence of fear and intimidation appears to be a key distinguishing feature between patriarchal
terrorism and common couple violence. The literature on domestic violence has emphasized that some
women and men may minimize or deny both violence and their fear in the relationship (Bograd & Mederos,
1999; Holtzworth-Munroe et al., 1995). As mentioned previously, it is imperative for therapists to screen for
violence continually and assess risk factors to understand fully the context and safety issues involved. At the
same time, dismissing couples views of the main problems in their relationship and denying their
experiences could ultimately alienate couples and may be one possible reason for their terminating
treatment. Acknowledging and incorporating each partners understanding and view of the relationship
problems may yield valuable information in distinguishing types of violence and strengthen the therapeutic
bond necessary for effective treatment.
When the above four factors are considered together-range of control tactics, motivation, impact, and
subjective experience-the differences in these two cases become apparent. In each case, a distinct type of
violence is occurring; Bob and Marys case represents patriarchal terrorism, whereas Tracey and Steves
case corresponds with a pattern of common couple violence. Couple therapists are often faced with helping
couples experiencing different types of violence, such as in the two cases presented. A thorough assessment
of these four factors can help therapists distinguish types of violence so that effective treatment planning can
take place for each case.
DTFFERENTIATED TREATMENT STRATEGIES
There has been much discussion and controversy about how family therapists intervene in domestic
violence cases. The debate in the field concerns whether or not couples therapy is an appropriate and
October 2002 JOURNAL OF MARITAL AND FAMILY THERAPY 46 1
effective treatment modality. The consensus has generally been to avoid couples therapy in domestic
violence cases and to provide gender-specific treatment primarily through separate mens and womens
groups (OLeary, et al., 1999; Wileman, 2000). The wisdom of this approach, however, has been challenged
by empirical research. Reviews of batterer treatment outcome studies have not been favorable, calling into
question whether mens treatment groups are truly effective or not (Dunford, 2000; Hamberger & Hastings,
1993; Rosenfeld, 1992). Furthermore, several recent studies directly comparing conjoint treatment with
gender specific treatment have found no significant differences in treatment effectiveness, including the risk
of further violence (Brannen & Rubin, 1996; Dunford 2000; OLeary, et al., 1999).
Dunfords (2000) comparative study is particularly compelling in that it avoided many of the method-
ological flaws characteristic of previous studies. Dunford employed a randomized no-treatment control
group design involving a large sample of 861 U.S. Navy couples in which husbands were reported as having
physically assaulted their wives. Each case was randomly assigned to one of four different treatment
conditions: A mens group, a conjoint group, a rigorous monitoring group, and a no-treatment control group.
Interventions for the mens and conjoint groups consisted of weekly sessions for 6 months, followed by six
monthly meetings. A number of standardized assessment tools were used to measure continued abuse, and
both wives and husbands reports were used. At a 1-year follow-up, Dunford found that there were no
statistical differences between any of the four treatment groups-including the control group-on measures
of continued abuse. In other words, treatment had no effect on reducing continued abuse.
Dunford (2000), along with other researchers (Holtzworth-Munroe, et al., 2000; Saunders, 1996; Waltz
et al., 2000) have suggested that treating physically aggressive men as one homogenous group, rather than
tailoring interventions according to the different motivations and needs of physically aggressive men, could
be responsible for the ineffectiveness of treatment. Dunford urges us to give full and preferential attention
to the possibility that one-size-fits-all approaches to treatment may not meet the needs of these couples (p.
475). Examining the effectiveness of distinguishing between couples in different types of violent
relationships and tailoring treatment interventions accordingly is a promising area for future clinical
exploration and empirical research.
As empirical research has failed to show that any one of the current treatment approaches are superior
to another, the debate about how to intervene in domestic violence cases has largely centered on ideological
differences. These differences originate from two overarching dominant perspectives-feminist and
systemic. These two perspectives conceptualize intimate violence very differently. Almost every step in the
assessment and treatment approach is, in turn, affected by this conceptualization.
Comparison of Feminist and Systemic Approaches to Treatment
From a feminist perspective, domestic violence is a problem of male domination and control of women.
rooted in patriarchy. Interventions have targeted structural change and coordinated community responses,
particularly the implementation of criminal sanctions. Regarding treatment, male batterer groups are seen as
an opportunity to challenge mens sexist beliefs regarding their entitlement to exert power and control over
women (Pence & Paymar, 1993). As mentioned above, this view has been the most influential in informing
treatment approaches, as evidenced by the fact that batterers groups are the most common form of treatment
(OLeary, et al., 1999; Wileman, 2000). The systemic perspective, in contrast, assumes circular causality for
problems and thus views intimate violence as a relationship issue, with both partners contributing to the
escalation of conflicts. Spouse-abuse treatment programs based on this approach are rare, as systems
theories have been extensively criticized for revictimizing women and putting them at greater risk
(Holtzworth-Munroe, et al., 1995).
However, given the research reviewed above, there may be more than one type of violence, and each
theoretical perspective and intervention approach may be more appropriate for a specific kind of violence.
The debate regarding appropriate and inappropriate approaches has polarized the field casting some
methods as wrong and diverted us from addressing which type of treatment is most effective with which
type of violence.
For example, Heyman and Niedigs (1997) Physical Aggression Couples Treatment model (PACT)
462 JOURNAL OF MARITAL AND F m I L Y THERAPY October 2002
appears to be well-suited to address common couple violence as illustrated in the case of Tracey and Steve.
This is not standard marital therapy; it specifically aims to eliminate violent behaviors by focusing on both
identifying and managing anger, and increasing competence in relationship skills. The program consists of
14 sessions, with the first half devoted to helping spouses identify and manage their anger. It is believed that
this is a necessary prerequisite to focusing on couple issues. Based on systemic principles, both partners are
encouraged to examine and take responsibility for their own role in escalating the conflict. Relationship
issues, such as communication, jealousy, negotiation, and recognizing underlying feelings are also dealt
with in order to decrease conflicts that may lead to violence. The concept that abusive behavior is a
desperate, self-defeating attempt to effect relationship change is used to help couples develop more
constructive, healthy ways of improving their relationship and ending the violence.
Although this model may be very useful for common couple violence, one can see its limitations and
hence that it is inappropriate to use it to address a pattern of patriarchal terrorism, as in the case of Mary and
Bob. For example, the idea that both partners are responsible for escalating the violence is clearly not the
case for Mary and Bob. In fact, Mary feels she has no control over the situation and lives in fear that Bob
may really lose it one day. Essentially, Bobs use of both physical and nonphysical methods has
established general control in the relationship. To encourage Mary to accept personal responsibility for the
violence by asking questions such as What do you think you did that made the situation worse? (Heyman
& Niedig, 1997, p. 594, italics in original) would be blaming the victim by not acknowledging the severe
power imbalance in the relationship. Similarly, primarily focusing on issues of anger management would
shift the focus away from Bobs systematic use of violence. In this case, a model with an explicit focus on
male power and control would be more appropriate.
In contrast, using the dominant feminist approach that focuses on violence as predominately an issue
of male power and control would be inappropriate for cases of common couple violence such as Tracey and
Steve. It is unlikely that Tracey and Steve would experience such a definition of their issues as accurate. In
a study of voluntary participants assigned to either a conjoint or gender-specific spouse-abuse treatment,
Brown, OLeary, and Feldbau (1997) found that the reason cited most frequently by couples for dropping
out of treatment was that treatment did not fit with their needs. More specifically, the majority of these
couples said that they dropped out of treatment because a program focusing on aggression did not address
enough of their own individual marital issues. It is interesting to note that the majority of participants in the
conjoint group (based on the PACT model) had dropped out before the sessions that focused on relationship
issues, such as communication. The excessively high drop-out rate in spouse-abuse treatment programs, as
compared to standard marital therapy, warrants consideration of whether these programs are meeting the
needs of these couples (Brown, et al., 1997). This research suggests that perhaps, in cases of common couple
violence, intervention should maintain a dual and simultaneous focus on both anger management and
relationship building. Gottmans (1999) research has also highlighted the importance of addressing issues
beyond conflict, such as strengthening the marital bond.
Integrative Models
Although some models derived from certain perspectives (systemic or feminist) seem to fit better
with certain types of violence, there is a growing recognition in the family therapy field of the need to
integrate different theoretical perspectives and practice models for effective practice. Johnson and Lebow
(2000) see the trend toward integration as a sign of a maturing field that general principles and
interventions become delineated and applied in varying formats and contexts (p. 32). Lebow (1997)
believes that integrative approaches have the potential to offer greater flexibility, an increased repertoire of
interventions, higher treatment efficacy, and greater acceptability among clients. The latter is particularly
important in domestic violence cases, given that many clinicians have noted that women and men often want
to be seen together (Goldner, 1999; Lipchik & Kubicki, 1996; Shamai, 1996). Shamai (1996) has noted how
the categorical dismissal of systemic principles in the treatment of domestic violence, may be akin to
throwing the baby out with the bath water, (p.202) and serves to detract from efforts to develop a more
effective, broader range of interventions.
Goldner and her colleagues at the Ackerman Institute (Goldner 1998, 1999; Goldner, Penn, Sheinberg,
October 2002 JOURNAL OF MARITAL AND FMI LY THERAPY 463
&Walker, 1990) have spent the last 10 years developing an integrative treatment model for intimate violence
where systemic and feminist perspectives inform and enrich one another. They have articulated how each of
these perspectives in isolation from the other serves as an insufficient explanatory framework, and highlight
the need to move from an either/or orientation to a both/and position. Over the years, a complex and sophis-
ticated multisystemic approach to treatment consisting of several different approaches-feminist,
systemic, psychodynamic, narrative, neurobiological and behavioral approaches-have been integrated
under the guiding principle that one level of description or explanation does not have to exclude another
(Greenspun, 2000).
Equipped with a sound theoretical basis for addressing intimate violence in a couple format, feminist
family therapists have continued to develop couple approaches that are sensitive to issues of power and
gender (Almeida & Durkin, 1999; Bograd & Mederos, 1999; Greenspun, 2000; Jory & Anderson, 2000;
Lipchik & Kubicki, 1996; Shamai, 1996). Utilizing these treatment models with couples such as Mary and
Bob could prove very effective, as they target the power and control issues involved in Bobs use of violence
and seek to hold him accountable for the violence, while exploring the relational dynamics, which may
contribute to the escalation of violence and leave Mary vulnerable to further abuse. Moreover, by working
within a relational context, the couples wish to be seen as a couple is respected.
The advent of integrated couple approaches to address intimate violence for couples such as Mary and
Bob represents progress in the family therapy field. These models, however, do not distinguish between
different types of violence. An exception is Jory, Anderson, and Greer (1997) who clearly state that their
approach addresses male domination while recognizing that other types of violence may exist which need
different approaches. Because most integrated models conceptualize intimate violence as patriarchal
terrorism, they may be less useful for cases of common couple violence, such as Tracey and Steve. The
tendency to define all violence as a form of patriarchal terrorism, combined with the relative paucity of
research on common couple violence, appears to have resulted in comparably fewer integrated treatment
models to draw on to address common couple violence. A better understanding of the dynamics of common
couple violence is needed to enable the development of more sophisticated, integrative approaches.
For example, it has been well documented by feminist researchers that gender is a central organizing
principle for both individuals and couple relationships and therefore must be an integral feature in family
therapy (Goldner, 1985; Hare-Mustin, 1986). The fact that a model such as PACT is gender free is a
limitation requiring the introduction of a feminist analysis. Vatcher and Bog0 (2001) point out that many
couples presenting for therapy today are struggling precisely with issues of shifting, contradictory gender
roles. Tracey and Steve are no exception. In Traceys view, stopping fertility treatments would forever mark
her as a failure because she would not truly have fulfilled the role of mother in the way she had
envisioned. To Tracey, this felt like a death sentence. Tracey reported that Steves insistence to stop the
fertility treatments and look at other options such as adoption felt at times like he was the one delivering that
final death blow. Tracey said that it often felt like Steve was the enemy that she had to fight against. Steve,
in contrast, talked about feeling defective because he had not been man enough to impregnate his wife.
Many of their friends were having children and he found that the men would often compare how long it took
for them to get their wives pregnant. In Steves mind, Traceys desire to continue trying to conceive only
served to prolong his feelings of shame and inadequacy and during conflict, he often found himself telling
her to just shut up and let the issue go. Clearly a feminist analysis of how gender-based societal expectations
produce strong emotions in each partner would be critical to addressing these issues. More research,
analysis, and understanding of how intersecting factors, such as gender, class, race, and ethnicity operate in
cases of common couple violence is urgently needed.
CONCLUSION
The history of family therapy is tarnished by our inability to detect and adequately respond to women
who were being brutalized by their male partners. On this issue, there can be no debate. However, the fields
attempt to rectify earlier mistakes may have neglected recognizing the presence of other forms of intimate
464 JOURNAL OF MARITAL AND FAMILY THERAPY October 2002
violence. This article has used current empirical research and illustrative clinical examples to support a
conceptual framework for guiding assessment and treatment intervention. Couple therapists who work with
intimate violence are searching for opportunities and approaches that offer more flexibility in meeting the
individualized needs of couples. A broader lens that takes into account the different faces of intimate
violence may expand the alternatives for assessing and treating these couples.
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