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Family Violence

Health Promotion Disease Prevention

Instructor: Gregory M. Chase, MS Emergency Medicine, MSHED, PA-C, RN

Dynamics of Partner Violence, Community Health Introductory Program: Principles of Instructional Design

Author: Gregory M. Chase, MS, MSHED, PA-C, RN.
Dr. David Sellen, PhD precepting

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.