Dynamics and Risk Factors in Partner Violence: Chapter Summary

Chapter Summary by
Glenda Kaufman Kantor and Jana L. Jasinski
from an article of the same title by:
Partner Violence: A Comprehensive Review of 20 Years of Research
Edited by Jana L. Jasinski and Linda M. Williams (1998) Made available by Sage Publications http://www.sagepub.com

Summary
This chapter examined current research on the dynamics and patterns of family violence, the types of abuse, and the major risk markers for intimate assaults and emphasized implications of these findings for assessment. Major findings included the following:

1. The forms and patterns of family violence are not the same for all families experiencing violent conflict. Patterns of common couple violence are more prevalent among general population samples, and patterns of severe, "terroristic" violence are more typical of clinical samples.
2. The cycle of violence associated with the battered woman syndrome may be typical only of the more severe form of intimate violence.
3. Common interaction dynamics include violence as a response to loss of control, unmet dependency needs, fears, anxiety, frustrations, and threats to self-esteem. Extreme, severe, and intermittent episodes of rage (with no apparent stimulus) may be associated with particular disorders of the personality.
4. Aggression by women, though studied less than aggression by men, differs in regard to the greater incidence of physical and psychological injuries experienced by female victims compared with male victims. Women also appear at greater risk for a system of victimization that includes physical, sexual, emotional, and economic forms of abuse.
5. Recent typologies of male batters distinguish three types of martially violent men: family only, dysphoric/borderline, and generally violent/antisocial.
6. Major risk markers for intimate violence include violence in the family of origin; socioeconomic factors; personality variables such as low self-esteem; substance abuse; biology; and situation factors related to life course.
7. Many risk markers in the family of origin are interwoven and can be passed on to future generations. These include exposure to abuse, alcoholism, and hostile/depressed personality-style parents.
8. Aggression does not inevitably follow from alcohol intoxication, but alcohol is the drug most consistently related to intimate assaults. Alcohol facilitates aggression in many ways, including pharmacological effects that interfere with reasoning, perceptions, calculations of the consequences of behavior and perceptions of threat.
9. A potential biological component to intimate violence is suggested by findings of organically based correlates, including head injury, attention deficit disorder, and differences in heart rate reactivity among different types of violent men.
10. An analysis of life course risk markers found that rates of intimate violence are increased during courtship and early marriage, pregnancy, separation, and divorce. Elders are also at risk for abuse by caretakers, although these rates are lower than for other forms of family violence.
11. The risks for spousal homicide are greatest when the spouse is also violent outside the family, rapes the partner, kills or abuses pets, severely injures the partner, and/or threatens to kill the partner.
    

Implications for Practice and Policy: What Professionals Can Do
Screening for Victimization and Assessment of Risk

Some risk markers for partner violence can be identified by professionals who might come into contact with individuals or couples involved in violent relationships. Physical signs of abuse, such as bruises or other questionable injuries, should be noted and inquired about. In addition, general questions about marital satisfaction and quality can also be asked in a nonjudgmental and non-victim-blaming manner. Questions about violence, both current and in the family of origin, should become part of the documented family history because they indicate elevated risk. The mental health practitioner should also routinely ask questions such as the following:

· Is anyone in your family hitting you?
· Does your partner threaten you? your life?
· Does your partner prevent you from leaving the home, from getting a job, or from returning to school?
· What happens when your partner does not get his or her way?
· Does your partner threaten to hurt you when you disagree with him or her?
· Does your partner destroy things that you care about (e.g., your family photographs, your clothes, your pets)?
· Are you forced to engage in sex that makes you feel uncomfortable?
· Do you have to have intercourse after a fight to "make up"?
· Does your partner watch your every move? call home 10 times a day? accuse you of having affairs with everyone? (Schecter, 1987)

Other risk markers that should be assessed include excessive alcohol/illicit drug use by one or both partners and the presence of life stressors, such as a change in employment status (e.g., more responsibility at work, reduction in work load, reassignment to another job), pregnancy, and problems with children. Affirmative responses to threats of violence and of death, and destruction of property and pets are signs of potentially lethal violence. Immediate intervention may be necessary in such cases. In a group therapy session, professionals should watch for the relationship dynamics of the couple and guard against one partner controlling the other. Signs to watch for include one partner constantly speaking for the other and demand by one partner to always be present when discussing the relationship. If possible, partners should be interviewed separately to allow each to feel free to speak openly about their relationship.

Professionals who deal with pregnant women are in a unique position to screen for marital violence and to initiate intervention if needed because pregnant women must come in periodically for checkups (Sampselle, Petersen, Murtland, & Oakley, 1992). During these visits, professionals can note any physical signs of abuse, such as bruises, as well as ask questions regarding abuse as part of both an oral and a written history (Campbell et al., 1993). Research evidence suggests that this process should involve more than one question regarding abuse. For example, Helton (1986) found that, of 68 self-identified battered women, 78% checked no to the first abuse-focused question in a written history. Because many batterers may attend doctor visits with their partners, written questions or a private interview may be a more appropriate mechanism for assessing risk for abuse (Campbell, Pugh, Campbell, & Visscher, 1995).

A particularly risky period for women in violent relationships occurs when they try to leave (Ellis, 1987; Feld & Straus, 1990). In particular, risks for lethal violence may be greatest when individuals try to leave relationships (Browne, 1987; Wilbanks, 1983; Wilson & Daly, 1993). Professionals who counsel victims of partner violence should watch for signs of escalating abuse, including more frequent and severe episodes of violence, and should be aware of any threats of violence or use of weapons. Such behavior may indicate an increased risk for lethal violence.

The ability of therapists to recognize the risk markers for lethal violence is extremely important. Some evidence, however, suggests that more training is needed in this area. Hansen, Harway, and Cervantes (1991), for example, found that, in a sample primarily composed of family therapists who were presented with case studies containing evidence of violence, almost one half did not address this violence as a problem.

Assessment of Male Partners. Counselors of abusive men suggest that specific questions are needed to assess the extent of violent behavior (Emerge, n.d.). Guidelines developed by counselors from Emerge, the first program in the United States for treating male batterers, suggest the need for concrete questions such as, What happens when you lose your temper? Did you become violent? What about grabbing or shaking? Have you hit her? When you hit her, was it a slap or a punch? They also suggest that violence needs to be defined to the men as any actions that force a partner to do things that she does not wish to do or that make her afraid. Therefore, questions should be posed about whether he ever threatened her, took away her car keys, threw things in her presence, damaged her property, or punched walls or doors. He should also be asked about when the violence occurred and against whom it was directed. Aldarondo (in press) cautions about the need to use language carefully. Because men often do not consider pushing and shoving to be violent behavior, the therapist should avoid using the term violent. Many of the behavioral items mentioned above are already included in the Conflict Tactics Scale (CTS; Straus, 1990); clinicians may wish to use or adapt this most frequently used assessment tool for couple violence or the recently revised version of the CTS (Straus & Hamby, 1996). Counselors should ask direct questions about the man's violence to help him take responsibility for his actions, as well as to understand the nature and extent of the abuse.

Implications for Intervention, Policy, and Research
The information presented on the different types of abuse points to the need for varying interventions. The most important distinction is whether the abuse patterns fit the common couple dynamic or the terroristic dynamic. The limitations of traditional family systems therapy, couples therapy, or even psycho-educational approaches are all too evident when the abuser fits the terrorist profile (Walker, 1995).

The research on psychological characteristics, alcohol abuse patterns, and biological risk markers points to the need for both a variety of assessments, as well as a variety of approaches to intervention. Because more severe and injurious abuse is likely to be associated with numerous psychological problems and with alcohol or other drug abuse problems, specialized clinical skills are required. It should not be assumed that a program focused mainly on " anger management" is sufficient to end the more serious types of intimate violence or, for that matter, that substance-abuse-focused treatment alone is sufficient. Sobriety may not be enough to end the assaults by all batterers. At the same time, there is a need for more and better research on effective treatment and other deterrence strategies.

The Vivian and Langhinsichsen-Rohling (1994) study, in particular, points to the need to characterize offender-victim relationships. The findings of this research, while documenting the rarity of women as the sole "batterers," also showed that victimization of either spouse, even by low levels of aggression, significantly increased psychological distress. The study authors went on to suggest that instances in which victimizations are truly mutual and mild may be amenable to couples therapy. Research that addresses the specific issue of marital aggression is still needed. In cases of asymmetrical aggression (one perpetrator or one primary aggressor), gender-specific treatment of individual partners is advisable.

Our review of the research found scant systematic examination of victim characteristics, risk markers, or research on victim-specific interventions. This gap in the research suggests that more information on victims is needed. Women who have experienced abuse, particularly severe or long-term abuse, may need assistance in understanding and processing their experience so that they can move ahead with their lives (Walker, 1995). There is also a need to assess whether the welfare of victims has improved or declined longitudinally (McCord, 1992). Research to date has rarely considered the well-being of women in the follow-up. Clinical evidence based on reports of battered women service providers, however, suggests that the safety mechanisms and psychological counseling provided in battered women's shelters are central to women's recovery (Walker, 1995).

We identified particular gaps in the literature in regard to batterer-specific and victim-specific interventions and victim risk markers. At the same time, the discussions of this chapter drew on almost three decades of research that clinicians can use to enhance their practice with clients at risk for intimate violence. The strengths of our knowledge base as detailed above include improved ability to identify offenders that pose an ongoing risk; improved understanding of the psychodynamics of violent relationships; better understanding of gender similarities and difference in the forms that partner violence takes; and gains in knowledge about how to break the cycle of abuse.

References
Aldarondo, E. (in press). Perpetrators of domestic violence. In A. Bellack & M. Hersen (Eds.), Comprehensive clinical psychology. New York: Pergamon.

Browne, A. (1987). When battered women kill. New York: Macmillan Free Press.

Campbell, J.C., Oliver, C., & Bullock, L. (1993). Why battering during pregnancy? AWHONNS Clinical Issues in Perinatal and Women's Health Nursing, 4(3), 343-349.

Campbell, J.C., Pugh, L.C., Campbell, D., & Visscher, M. (1995). The influence of abuse on pregnancy intention. Women's Health Issues, 5(4), 214-223.

Ellis, D. (1987). Postseparation woman abuse: The contribution of lawyers as "barracudas," "advocates," and "counsellors." International Journal of Law and Psychiatry, 10, 401-410.

Emerge. (n.d.). Guidelines for talking to abusive husbands. Cambridge, MA.

Feld, S.L., & Straus, M.A. (1990). Escalation and desistance from wife assault in marriage. In M.A. Straus & R.J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in 8,145 families (pp. 489-505). New Brunswick, NJ: Transaction.

Hansen, M., Harway, M., & Cervantes, N. (1991). Therapists' perceptions of severity in cases of family violence. Violence and Victims, 6(3), 225-235.

Helton, A.M. (1986). The pregnant battered woman. Response to Victimization of Women and Children, 9(1), 22-23.

McCord, J. (1992). Deterrence of domestic violence: A critical review of the research. Journal of Research in Crime and Delinquency, 29(2), 229-239.

Sampselle, C.M., Petersen, B.A., Murtland, T.L. & Oakley, D.J. (1992). Prevalence of abuse among pregnant women choosing certified nurse-midwife or physician providers. Journal of Nurse-Midwifery, 37 (4), 269-273.

Schecter, S. (1987). Empowering interventions with battered women. In S. Schecter (Ed.), Guidelines for mental health professionals (pp. 9-13). Washington, DC: National Coalition Against Domestic Violence.

Straus, M.A. (1990). New scoring methods for violence and new norms for the Conflict Tactics Scale. In M.A. Straus & R.J. Gelles (Eds.), Physical violence in American Families: Risk factors and adaptations to violence in 8,148 families. New Brunswick, NJ: Transaction Publishers.

Straus, MA, Hamby, SL, Boney-McCoy, S. & Sugarman, DB (1996). The revised conflict tactics scales (CTS2): development and preliminary psychometric data. Journal of family issues, 17 (3), 283-316.

Vivian, D. & Langhinrichsen-Rohling, J. (1994). Are bi-directionally violent couples mutually victimized? A gender-sensitive comparison. Violence and Victims, 9 (2), 107-124.

Walker, E. A., Gelfand, A. N., Gelfand, M. D., Koss, M.P. & Katon, W. J. (1995). Medical and psychiatric symptoms in female gastroenterology clinic patients with histories of sexual victimization. General Hospital Psychiatry, 17, 85-92.

Wilbanks, W. (1983). The female homicide offender in Dade County, Florida. Criminal Justice Review, 8, 9-14.

Wilson, M., Daly, M. & Wright, C. (1993). Uxorcide in Canada: Demographic risk patterns. Canadian Journal of Criminology, 35, 265-291.