The recognition of domestic violence as a serious social problem is an achievement of second wave feminism originating in the late 1960s. Feminist activists provided safety and shelter for women and children escaping violence, and located the roots of domestic violence in gender inequality in social relationships. This formulation challenged the existing medical model which located the causes of domestic violence within the pathology of individual men and women. In Australia today, there is wide recognition of the deleterious impact family violence has on society as a whole, culminating most recently with the Rudd Government's development of a national action plan aimed to reduce violence towards women (FaHCSIA, 2009). A Victorian Government initiative to develop a common family violence risk assessment framework lists psychologists alongside GPs, social workers and police as key frontline professionals equipped to assess and intervene in family violence cases. From a policy and practice perspective, it is clear that psychologists need to respond effectively to family violence.
What is family violence and what are the effects?
Family violence is complex and can occur in a range of circumstances and family settings. The context of the family violence case can be disarming and even heartbreaking. The distressing effect on women, children and men is often long term, spanning generations. Moreover, it is likely that we have all been impacted by family violence in some form in our lives. Family violence is any violent or abusive behaviour that is repeated, controlling, threatening and coercive, and includes physical and sexual assaults and a range of fear inducing tactics including intimidation, direct or in direct threats, emotional and psychological torment, economic control, property damage and social isolation. By far the most common form of family violence, intimate partner violence (IPV), is from male intimate partner to female and consequentially to children. Women and children who have experienced violence have poorer health outcomes, and are more likely to utilise mental health services. Since IPV is perpetuated by shame, secrecy and fear of retribution it may often remain hidden in a standard clinical assessment.
Various government policy documents on IPV list the following statistics:
- IPV is the leading contributor to death, disability and illness in women between the ages of 15 to 45, more than obesity, smoking and heart disease.
- Violence against women is estimated to cost the Australian economy $13.6 billion per annum.
- Although family violence is widely underreported, one in five women report being sexually assaulted and one in three women report physical assault by an intimate partner.
- One in four children has witnessed domestic violence.
Explanations for intimate partner violence
The pyschosocial perspective has much to offer our understanding of IPV. The male who uses violence is psychologically more likely to have an Axis I or II diagnosis, to have a history of intergenerational violence and be a substance user. These factors are also related to poorer outcomes and recidivism in perpetrator treatment programs. From a socio-cultural perspective, is it noted that violence is perpetuated by social deprivation and marginalisation, as apparent in higher incidences of violence in Indigenous communities and higher rates of IPV-related murder among immigrant and refugee women. Perhaps the most important, and certainly most prevailing, social theory is feminist theory, which sees violence as an inevitable result of women's subordination in a patriarchal world where men are conditioned to dominate and women are objectified. IPV from this vantage point is essentially seen as a man's attempt to maintain power and control over women in an intimate relationship.
Assessing typologies of intimate partner violence
There is some controversy as to whether or not typologies of IPV exist. An argument against the identification of typologies is supported by the knowledge that all violence is damaging and has a tendency to escalate over time. A classification system can tend to organise some forms of violence as less problematic than others. Psychologists working with clients where IPV is present can hold a moral or ethical position which states that all violence is a social and political issue and that all forms of violence are unacceptable, whilst also recognising that psychological assessment of typology may in fact be useful in developing appropriate treatments.
Jacobson and Gottman (1998) in their in vivo studies of couples found that three male IPV typologies may exist. The ‘cobra' is described as anti-social, hedonistic, impulsive and invested in power and gendered roles. In this presentation, the man is noted to remain ‘cool' in his arousal when violent. These men are also more violent generally and will only appear in the service system when mandated. There is evidence that suggests that these men are best suited to the criminal justice system and should not be treated within a voluntary therapeutic process.
The second type is referred to as the ‘pitbull', a man who is often equally as violent as the ‘cobra' but is more likely to be emotionally dependent, easily aroused, controlling and angry. This man is usually only violent in intimate relationships with strong abandonment fears, which makes him high-risk if his partner leaves. This man is also difficult to work with in isolation and is best suited to working within a service system that offers a range of family and/or correctional-based interventions.
The last grouping is the ‘family violence only' which is seen as a reactive and situationally responsive group of men who act violently in response to conflict and negative internal cues. These men tend not to use psychological and sexual abuse and are not as invested in relationship power and control.
Holtzworth-Munroe and Stuart (1994) also noted three similar clusters of male IPV. Their groupings were: anti-social generally violent; dysphoric-borderline; and family only. Hamberger et al. (1996), from their research, again confirmed three main IPV types: anti-social; passive-aggressive; and non-pathological.
Additional support for these typologies comes from work done by Johnson (1995) who found through sampling the general population a classification of what he termed ‘common couples violence' - a violence that may not escalate, is not always gendered and remains in response to conflict. This was distinguished from ‘intimate or patriarchal terrorism', a form of IPV which can be aligned to the antisocial or dysphoric-borderline typology where the use of violence is embedded in control of the woman. The simplest diagnostic indicator here is the level of fear reported by the woman. The phenomenon of ‘walking on egg shells' is a strong indicator of intimate terrorism.
Moreover, Jacobsen and Gottman's research showed that no matter how careful the woman was to avoid escalation, in relationships that are indicative of intimate terrorism, the man's violence would remain unpredictable and would escalate without any external triggering.
Assessing risk and treatment options
A psychologist's training in standard risk assessment is an adequate starting point for assessing dangerousness. In addition, it is vital to ascertain the woman's report of her own level of fear or safety and the degree of responsibility taken by the man. When a man shirks responsibility through blaming, justifying, minimising or denying his violence, and is unable to access empathy or shame and sadness about his behaviour, he is more likely to continue his use of violence.
Other known risk factors for violence that may be readily assessed in a standard clinical interview are:
- Poor mental health
- Substance use
- Gendered and rigid beliefs
- History of violence in family of origin
- Recent life stressor leading to social isolation, e.g. separation or unemployment
- Threats to self or other including breaches of intervention order
- Access to weapons.
In working with IPV the clear aim is to stop the violence and enable safety for the whole family. If the IPV has been reported, the psychologist must ascertain the terms of any family violence intervention order or AVO currently in place. In making an initial IPV assessment, the safety of the family is paramount, which may mean the intervention needs to include some form of reporting alongside referral to specialist services. There is no evidence to support couples counselling as a useful intervention in IPV until safety has been completely restored. Appropriate referral pathways include child protection, legal aid, male behaviour change programs, local outreach and counselling support and refuges for women and children, and CALD and Indigenous specialist services. Knowing and utilising the State-based family violence service system is a vital adjunct to the work.
Limited confidentiality
Any psychological intervention for family violence must be structured around an agreement of limited confidentiality which basically states that all occurrences of violence, no matter how small, must be spoken about. Without this agreement, the psychologist will risk collusion with violence and thus perpetuation of violence. When the man agrees to this condition of working, he is taking a step closer to taking responsibility and getting off the ‘cycle of violence' (see Figure 1). Recognising that violence exists in secrecy and fear, the woman is relieved that the obligation of managing his violence is no longer hers alone. With limited confidentiality also comes the right to discontinue service. The psychologist may need to terminate treatment with clients when a situation has been reported that warrants police intervention or there has been an escalation in risk. It is important to frame this as a safety measure within the work and as modelling that the perpetration of violence in the home is actually a crime.
