12. Types and Patterns - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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The therapist normally deals with couples where psychological or emotional aggression that subjectively to clearly cross over to abuse.  Therapy seeks to set the boundary so psychological and emotional assertion is individually and interpersonally safe and healthy- and the relationship functional.  This can be complicated and difficult therapy as the therapist deals with both partners' emotional reactivity that may result in abusive verbal sallies.  The therapist must always be alert to such boundary violations, and particularly wary when there is potential for physical danger.  Intimate partner violence or domestic violence perpetrators or batterers go beyond psychological or emotional abuse- much less psychological or emotional assertiveness and aggression.  Dirk is psychologically and emotionally assertive, aggressive, and at times, abusive to Madeline.  Is he at risk to become physically abusive as well?  Has he already become physically abusive?  The therapist can assess Dirk with this summary of batterers' characteristics offered by Jacobson and Gottman (1998).

Batterers share a common profile: they are unpredictable, unable to be influenced by their wives, and impossible to prevent from battering once an argument has begun.

Batterers women are neither passive nor submissive; sometimes they are as angry as the batterers.  But women almost never batter men.

Batterers can be classified into two distinct types, men whose temper slowly simmers until it suddenly erupts into violence, and those who strike out immediately.  This difference has important implications for women leaving abusive relationships.

Emotional abuse plays a vital role in battering, undermining a woman's confidence.

Domestic violence can decrease on its own—but it almost never stops.

Battered women do leave at high rates, despite the increased danger they face when leaving the relationship (page 62).

Attachment insecurity, limited social information processing skills, and poor verbal fluency correlate to increased propensity to intimate partner abuse for an important subgroup of partners.  Attachment insecurity appears to be at the core of insecure attachment style and intrapersonal and interpersonal issues, which lend to a destructive progression of anxiety, anger, aggression, and abuse.  Recognizing the signs of earlier stages and behaviors in the progression may enable the therapist to prevent further harm.  Either as distinct forms or as being on a continuum of severity and danger, it can be useful to distinguish variations of assertive behaviors toward a partner that crosses interpersonal boundaries.  The therapist should "…assume that spouses who move from psychological and interpersonal aggression (e.g., intimidation, humiliation, and threats of violence) to mild physical violence are at-risk for inflicting more severe acts… A couple is diagnosed 'at-risk' when at least one of two criteria are met: (1) a pattern of aggressive arguments, coercion and conflict characterized by humiliating, intimidating, and/or physically threatening statements or behavior, and (2) a pattern of using "mild" forms of violence characterized by throwing objects, pushing, and physical restraining"  (Perez and Rasmussen, 1997, page 231).

When the behavior goes beyond emotional or psychological aggression and abuse, to physical actions, two forms of domestic violence can be identified.  One form would be physical aggression such as blocking or otherwise restraining movement, including leaving a room or house, grabbing or pushing.  These more mild or moderate physical behaviors do not involve striking the partner and are not necessarily intended to cause pain or injury.  The second form is much more severe physical assault that causes injury such as hitting, kicking, or choking.  Using any object, whether clearly designed for inflicting injury (e.g., guns or knives) or common personal or household items (e.g., belts, rulers, tools, or sports equipment) constitutes the use of weapons.  This is clearly more dangerous and likely to cause injury and death.  Threatening harm to the partner with such weapons or items can be included in this more severe category.  Or at least, it should be considered as transitioning from a more mild to more dangerous abuse.  Unfortunately for assessment and intervention, "Conditions and processes by which batterers move between pre-abuse, mild, and severe forms of violence remains unclear" (page 230).

Nevertheless, the therapist must strive to be aware of how and why an individual progresses from psychological aggression to verbal psychological abuse to mild to severe domestic violence.  Not all individuals progress in the same manner, but there is an identifiable profile of perpetrators who "…metabolize anger in a kind of a slow burn: it gradually increases but never lets up.  We call them 'Pit Bulls' because they grow more and more aggressive until they finally attack.  These men, we have found constitute about 80 percent of batterers.  Pit Bulls have unrelenting contempt for women, and yet are extremely dependent on them.  This creates a unique dynamic in their behavior" (Jacobson and Gottman, 1998, page 64-65).  The therapist should listen carefully to Dirk's tone as he describes Madeline.  If he does not express in a manner that indicates clear respect for her, but instead speaks of her with disgust or derision, it may indicate contempt.  Contempt expressed at the partner is a form of psychological abuse.  It insults the quality of the person rather than complain about the behavior of the person.  As such, it may be the early stage of aggression/abuse that may descend into physical abuse over time in the relationship.  Or, it may be indicative of the "slow burn" that precede and lead up to the physical assault.

Attachment insecurity is seen as the underlying problem for the Pit Bull.  Some request from the partner activates insecurity.  For example, Madeline might ask Dirk to not work so much and be around the home more often.  "In many unhappy marriages, when one partner (usually the woman) requests change, the other one (usually the man) resists change, and eventually the woman's requests become demands, and the man's avoidance becomes withdrawal.  But Pit Bulls often both demand and withdraw… Through… scrutiny and… constant demands, Pit Bulls establish control.  Control is important to these men because they genuinely feel that they will be abandoned if they do not maintain constant vigilance over their wives.  One particularly sinister form of control they use is known as 'gaslighting.'  This technique—which gets its name from the film Gaslight, in which Charles Boyer convinces Ingrid Bergman she is going insane—involves a systematic denial of the wife's experience of reality… This technique of denying the woman's reality can be so effective that, when used in combination with methods to isolate the woman from other people, it causes battered women to doubt their own sanity.  This is the ultimate form of abuse: to gain control of the victim's mind" (Jacobson and Gottman, 1998, page 64-65).

The therapist needs to be alert to how someone such as Dirk responds to Madeline's descriptions of the history of the relationship and what happens in the home.  Some individuals, especially those with narcissistic tendencies have a cognitive or memory distortion that maintains the grandiose or "good guy" self-image.  Such individuals interject frequent "corrections" about what "really happened" or outright denials and alternate realities that contradict the partner.  If persistent and effective, a partner such as Madeline starts to have doubts about her memories.  She might get confused and become tentative about her experiences.  This is another example of how treatment or interventions are simultaneously assessment and diagnosis.  The therapist may ask Dirk to comment on Madeline's experiences in their relationship.  Dirk may show more or less empathy, have a different or nuanced perspective that sheds light on either or both their motivations, compare her to other important attachment figures, give some personal history, or otherwise contribute to better understanding of their dynamics or demonstrate their functionality.  Any of these and other responses may facilitate the progress of therapy.  On the other hand, denial of Madeline's experiences or more psychological aggression against her (that is, subverting or avoiding the therapist's therapeutic intent) may hone more accurate diagnosis about Dirk.

The therapist should also carefully observe Dirk's affective state.  While emotional arousal including anger may be indicative of issues in the relationship and complicate therapy, flat affect may be more alarming.  If an individual feels misunderstood or misrepresented by his or her partner, normal reactions include a variety of emotional arousal: disappointment, hurt, sadness, anxiety, and anger.  The individual may breathe deeply, shut eyes, reflexively gesture facially or bodily, or otherwise attempt to calm or restrain his or her emotional arousal.  Observation of Dirk doing this would provide further diagnostic information and guide further interventions.  However in contrast to observable emotional arousal from relationship conflict or partner criticism, while there may be greater verbal aggression with some batters "…there is a decrease in heart rate.  Like the cobra who becomes still and focused before striking its victim at over 100 miles an hour, these men calm themselves internally and focus their attention while striking swiftly at their wives with vicious verbal aggression… The 'Cobras'—who constituted about 20 percent of our sample—were more likely to have used or threatened to use a knife or a gun on their wives, and were more severely violent than the other batterers.  Only three percent of Pit Bulls had a history of extramarital violence, while 44 percent of Cobras did.  And while about 33 percent of Pit Bulls qualified for a diagnosis of 'antisocial personality disorder'—which includes a long history of impulsive criminal behavior, childhood episodes of lying, stealing, fire setting, and cruelty to animals—fully 90 percent of the Cobras met the criteria.  Finally, even though both groups abused alcohol at high rates, Cobras were more likely to be dependent on illegal drugs, such as cocaine and heroin, and were much less emotionally attached to their wives… Another main difference between Cobras and Pit Bulls is that Cobras came from more chaotic family backgrounds.  In our study, 78 percent of the Cobras came from violent families, compared to 51 percent of Pit Bulls.  (In the population at large, 20-25 percent of children grow up in violent homes.)" (Jacobson and Gottman, 1998, page 65, 81).

The therapist should be clear and overt asking about incidents of violence.  The couple may answer honestly that there is not current or has there been recent violence.  However, after the experience of abuse and control established, continued manipulation and domination can be sustained without frequent or constant physical abuse.  Emotional or psychological abuse with occasional physical abuse is sometimes sufficient to keep the victim aware of what can happen again upon provocation.  The victim remains intimidated without ongoing abuse.  "Cobras' violence was so severe that it may have been easier for them than for the Pit Bulls to maintain control through emotional abuse alone."  While there is more mental illness, drug addiction, emotional abuse, and severe violence in couples with a Cobra abuser, it is not unusual for the wives to stay in the relationship.  Although almost half of "Pit Bull marriages dissolved within two years, by the five year follow-up point, only 25 percent of women married to Cobras had left them; these women not only recognized the danger of trying to leave them, but often were quite attached to them… she described her childhood as a 'war zone' where her father would one day be absent and disengaged, and then suddenly became physically abusive toward… mother and all of the kids (Jacobson and Gottman, 1998, page 81).  This suggests some compelling reasons or models to stay with the abusive partner.

FAMILY, CULTURAL, AND GENDER MODELS
As with most issues, there is a wide range of potential factors contributing to how the individual manages conflict.  With regard to men, it is often proposed that aggression between parents causes them as children to internalize poor-conflict management.  "One of the most established risk factors for violence in couple relationships is violence in the family of origin (Burgess, Hartman, & McCormack, 1987; Mihalic & Elliot, 1997; Stets & Straus, 1990; Stith & Farley, 1993; Straus et al., 1980; Widom, 1989).  More specifically, men who report witnessing violence between their parents have a substantially higher risk of being violent themselves (Hotaling & Sugarman, 1986; Mihalic & Elliot, 1997; Riggs, O'Leary, & Breslin, 1990; Stets & Straus, 1990; Stith & Farley, 1993; Straus et al., 1980; Widom, 1989).  Parent-to-child violence sometimes has been found to increase the risk of men being violent (Stets & Straus, 1990: Straus et al., 1980)… Rosenbaum and O'Leary (1981) reported that 82% of men who reported witnessing violence between their parents also reported being victims of violence by their parents… family-of-origin parental violence was found to elevate risk of adult male relationship violence substantially more than parent-to-child violence (Kalmuiss, 1984)" (Halford et al., 2000, page 220).

Boys who observe a lot of conflict between their parents are more prone to externalize negative behaviors such as aggression and conduct disorder.  On the other hand, in response to observing conflict girls are more prone to internalize with anxiety and depression.  In couples where the male had been exposed to high parental conflict, they tended to show comparable negative behaviors seen in boys similarly exposed.  Women who were exposed to high parental conflict had frequent negative thoughts about themselves and infrequent positive thoughts about partners.  This may be seen as reflective of the depression and anxiety of girls who observed high parental conflict (Halford et al., 2000, page 230).  The relative commonality of conflict along with psychological aggression and abuse can desensitize the individual to it.  Although uncomfortable at best, everyone in the family also gets used to the negative behavior and becomes less assertive resisting aggression or abuse.  "Cappell and Heiner (1990) suggest that a vulnerability to abuse may be intergenerationally transmitted and may involve such strategies as learning to tolerate and/or provoke violence, gravitating toward aggressive partners, or not learning productive strategies for avoiding conflict" (Henderson, 2005, page 227).  The therapist should explore both Madeline and Dirk's families-of-origin for the patterns of conflict among family members.  In particular, the therapist should be alert to family models of assertiveness that become aggressive and of aggression becoming abusive.  The therapist can ask each partner how his or her parents "argued," "fought," or "did anger."  Either or both partners may be unaware he or she has been desensitized to committing and/or accepting abuse based on parental or family models.

The family models for children their gender expectations and roles, communication processes, and conflict resolution.  While there are individual variations in how children will emulate or adapt family models, the family foundation is the default setting that they as adults will work from.  In a similar dynamic, society and culture provides models for families and the leaders of the family- the parents.  While individual family interpretations of the social and cultural models for assertiveness and aggression will also vary, such models are the default for the family to emulate or adapt.  Dirk or Madeline's ethnicity or other potentially distinctive cultural experience may have significant expectations around what is appropriate for assertiveness, aggression, and conflict along with gender roles.  Such models may accentuate or mitigate mainstream influences, family dynamics, and individual tendencies and attitudes.  They may decrease or increase the likelihood of what American mainstream society considers abusive and American laws define as domestic violence.

The therapist should examine for cultural models that emphasize a traditional family system in which males are highly valued, and expected as patriarchs to govern the family.  In addition to traditional cultural models, the therapist should be alert to recent historical experiences that may further accentuate cultural tendencies.  For example, Kim and Sung (2000) address the experience of Korean-Americans who bear the recent experience of immigration.  Immigration causes stress on the individual and the family that can lead to further problems and harmful reactions.  "As minority members of their adopted society, many of them experience occupational and economic stresses caused by multiple difficulties including language barrier, inadequate prior education, discrimination, inability to adjust to the mainstream culture, and downward mobility.  With their patriarchal family structure and socio-structural stressors, they are likely to have an increased risk of conjugal violence between marital partners (Straus and Gelles, 1990; Farrington, 1980).  In fact, according to the Los Angeles Police Department (LAPD), one-half of the reported spouse abuse cases among Asian Americans in Los Angeles came from Korean American families (Chosen Ilbo, 1992).  About 35% of the abused Asian women in shelters were Korean Americans.  Most of them had been in the United States for less than 10 years.  Nearly 2,000 spouse abuse cases among these families were reported annually to the LAPD.  This number is twice as high as that for Chinese Americans and Japanese Americans.  Around 740 of the Korean abusers had been arrested for assault (Chosen Ilbo, 1990).  The number of Korean American spouse abuse cases reported to the LAPD increased by 10% between April 1991 and March 1992 (Chosun Ilbo, 1991,1992)" (page 332).

The therapist needs to determine how "Korean" or "Jewish" or "Greek" an individual may be.  This should be expanded to determining how much a guy, a gal, an engineer, a homemaker, an immigrant, a teen, an elder, and so on an individual may function like some cultural model.  Knowledge about social and cultural norms for any community, including common shared experiences for any given group must always be checked against the reality and experiences of the individual in front of the therapist.  While academic, professional research, and therapeutic experience may show important patterns among large groups of individuals with shared origins or history, academic, professional, and therapeutic stereotypes remain stereotypes.  Aspects of Korean or Jewish or Greek models may not be relevant to an individual with such background.  Dirk may not be a typical guy.  Madeline may not be a typical homemaker or mother.  Moreover, the therapist would need to identify how the individual's internalizing and expression of a cultural model may be significantly idiosyncratic with various idiosyncratic influences.  Stereotypes can be useful for initial assessment and especially, as a guide for more detailed exploration.  Stereotypes conversely can be harmful if it precludes actual examination of unique individuals, couples, or families.

A pattern of various stresses or pressures can coalesce for individuals and groups that increase vulnerability to domestic violence.  The therapist would need to explore if and how much the pattern is relevant.  For example, "Hispanic adolescent females may be more likely to experience intimate partner violence compared to other ethnic groups not only because of their socioeconomic status but because they may be more vulnerable to psychosocial distress specific to this group identified as Hispanic stress (Cervantes & Castro, 1985; Cervantes, Padilla, and Salgado de Snyder, 1991; Salgado de Snyder, Cervantes & Padilla, 1990).  Such stressors often are associated with linguistic and language differences, changing personal and family values, changing expectations, socioeconomic status, immigrant status, acculturation and perceived or real discrimination.  Adolescent females experiencing these stress characteristics may be at a greater risk of involvement in intimate partner violence. (Petersen and Valdez,2004, page 69)… Five psychometric valid dimensions of the Hispanic Stress Inventory have been identified: (1) Marital Stress, (2) Family/Cultural Stress, (3) Immigration Stress, (4) Parental Stress, and (5) Occupational/Economic Stress (Cervantes & Castro, 1985; Cervantes et al., 1991; Salgado de Snyder et al., 1990)" (Petersen and Valdez, 2004, page 72).  There may be important amalgamations of these stresses for a Hispanic individual or for a couple that include one or more Hispanic partners.  At the same time, these stresses are not unique to Hispanic individuals.  One or more of the dimensions that comprise the Hispanic Stress Inventory may be also relevant to non-Hispanic individuals with or without significant cultural nuances.

Adolescent females in general, as indicated by Petersen and Valdez in examining Hispanic adolescents can be more vulnerable to domestic violence.  Vulnerable to the same risk factors as Hispanic adults, when they also become teen parents, they may be "at particularly high risk for couple violence, in part, because (a) the event of premature parenthood can be extremely stressful (Williams et al., 2006) and (b) adolescent parents are more likely than adult parents to have a history of psychological difficulties (Miller-Johnson, Winn, Coie, Malone, & Lochman, 2004; Miller-Johnson et al., 1999).  Moreover, there is some research indicating that the rate of dating violence among adolescent couples is higher than the rate of interpartner violence among adult couples (Hickman, Jaycox, & Aronoff, 2004)" (Moore, et.al., 2007,page 553).  Insecure attachment issues would have had little time for positive resolution by adolescence with hormonally enhanced first attempts at "adult" intimacy.  Adolescent romantic idealism and less mature ability for emotional self-regulation predict all manner of intrapsychic and interpersonal challenges.  Greater propensity to commit intimate partner violence and to accept it would be predictable.

Adult perpetuators and victims of domestic violence may be characterized as emotionally functioning as immature dysfunctional adolescents.  It would be logical that actual adolescents could have greater vulnerability to similar unhealthy dynamics.  The general public often considers adolescent couples as immature and volatile and assigns them relatively low social status.  A part of their functional immaturity, however may be due to their often limited economic resources.  Financial limitations bring pressure on the relationship across the age span.  The therapist should be aware of socio-economic experiences for different populations.  Class difference experiences should be considered.  Psychotherapy tends to be utilized and experienced differently according to clients' socio-economic backgrounds.  For example, although it may appear that Dirk and Madeline are a professional middle class couple, one or both may be first generation middle class and have significant embedded working class values from their families of origin.  Therapy may be viewed more cynically by working or lower class individuals, while more accepted and used by middle to upper class individuals.  Availability of providers for therapy may vary according to insurance coverage or third-party-payer benefits with the more affluent individuals affording greater care and options.  In addition, the therapist should be aware of how mental health interventions have been used as a form of institutional oppression to economically disadvantaged or marginalized populations.  Lower or working class individuals may be suspicious of therapy and the therapist.

The therapist should be vigilant about his or her assumptions regarding gender roles in the couple that might have significant variations within certain populations.  For example, "According to Staples (1988), there is tension in the Black male and Black female relationship because of the lack of opportunities available for Black males to succeed in the traditional good provider role.  Also, the greater independence of Black women makes it even more difficult for men to engage in traditional role behaviors, what Elliotlin (1984) terms 'incompatible role enactments,' Ball and Robbins (1986) found, in fact, that being married was a stressor for Black men and was actually related to lower levels of well-being" (Kesner et al., 1997, page 224-25).  Whereas stress for an African-American male over his economic potency is accentuated by racial history, another man may have very comparable stress depending on his personal experience.  It is up to the therapist to evaluate each person individual experience through examining his or her personally relevant factors.  Therapeutic rapport may increase if the therapist reveals the "secret" shame of marginal economic equity for a male partner.  It may significantly increase for an African-American male partner if respectfully presented.

Certain individuals may feel they have fewer non-family options for dealing with domestic violence due to being marginalized in one or more ways.  "This reflects, in part, a scarcity of social services available to low income women and adolescents in the communities in which they reside (Arcia, Keyes, Gallagher & Herrick, 1993; Dembo et al., 1998).  Nonetheless, compared to other groups, Hispanic family-based networks may consider incidents of intimate partner violence less damaging to the structure of the family rather than exposing problems, possibly leading to family break-up.  This may be related to the cultural domain of familismo among Hispanics. Furthermore, Amaro, Fried, Cabrak and Zuckerman (1990) argue that Hispanic and other minority women may value more of a connectiveness to men that makes them more tolerant of this type of behavior" (Petersen and Valdez, 2004, page 82).  The therapist should examine values regarding how self-contained the family is supposed to be.  To some degree or another, many families besides Hispanic families emphasize the sanctity of the family.  They perceive bringing attention, including the attention of professionals and government authorities to be a violation of family loyalty.  This is often an implicit unacknowledged but deeply held value.

The therapist may be able to discover the ethic regarding held secrecy within the family from the outside by exploring the process of how the partners came to therapy.  Rather than assuming that couple therapy is a logical resource for the partners, the therapist should explore what boundaries were crossed or inhibitions were set aside for the couple to instigate therapy.  "How do you feel about using couple therapy?  Is this easy for you to do?"  "How is it to talk family stuff to someone outside the family?"  "Would your parents have used couple therapy?"  "What happened to finally bring you to therapy?"  "Was there something new and different or is this about something that's been going on for a long time?  What was it?"  "How come you're here now and not earlier?"  Questions such as these can be addressed to each partner since one may have a different value than the other.  The therapist should consider if one partner or the other has explicitly placed some topics off limits.  Domestic violence along with alcohol or drug abuse and sexual abuse (past or current) are among potential topics that have been forbidden to mention in front of the therapist.

DOMESTIC VIOLENCE AND HOMOSEXUAL COUPLES
"Recent research suggests that the intimate partner abuse epidemic pertains to more than just women and heterosexual couples.  Instead, intimate partner abuse occurs at similar and perhaps even higher frequencies in the gay, lesbian, bi-sexual, and transgender (GLBT) community (Balsam 2001; Burke and Follingstad 1999; Hamberger 1996; McLaughlin and Rozee 2001; Miller et al. 2000; Poorman 2001; Renzetti 1996; Ristock 2001; Seelau et al. 2003; Walsh 1996).  In fact, Peterman and Dixon (2003) report that intimate partner abuse is the third largest problem facing gay men today, 'second only to substance abuse and AIDS' (p. 40).  Despite this, few empirical articles have focused on the phenomenon of same-sex partner abuse" (Brown, 2008, page 457).  Secrecy and shame can exist and shared in many families, but have additional nuances, variations, and increased intensity in certain populations.  The therapist should be aware of such possibilities particularly among individuals from historically marginalized, disenfranchised, and oppressed populations.  Ethnic, racial, and religious groups are not the only communities to be aware of and attentive towards.

The therapist needs to be aware of the possibility of domestic violence among individuals of any definable population and any relevant similarities, distinctions, or nuances.  Domestic violence in gay and lesbian couples often has similar roots as those in heterosexual couples.  "Babcock et al. (2000) found that during laboratory arguments between partners, men who were distressed and preoccupied responded with violence when their wives withdrew from the conflict.  The link between violence perpetration and attachment anxiety also has been observed in a sample of gay men.  Landolt and Dutton (1997) found that psychological and, to a lesser extent, physical abuse in male same-sex relationships was negatively associated with secure attachment and positively associated with fearful and preoccupied attachment.  These results suggest that attachment anxiety may be a trigger for perpetration of violence, at least in men" (Henderson et al., 2005, page 221).

Heterosexual or homosexual males thus can share relatively similar attachment issues that can lead to anxiety and potentially, domestic violence.  Domestic violence clearly can occur and does occur in homosexual relationships.  However, historical social rejection of homosexual relationships may create nuanced or additional pressures on the couple.  Homosexual partners may share secrecy and shame issues from their families-of-origin and cultural background identical to individuals in heterosexual couples.  In the homosexual relationship, however there is an additional issue of asserting same gender relationships while going against the heterosexual norm.  To have asserted ones homosexuality and right and need to be in an intimate partner relationship, sometimes in the face of family ostracizing and social scorn and then, to suffer from intimate partner violence can be deeply shameful.  Some individuals are neither out with their homosexuality or with their homosexual partnerships.  Those secrets thus become layered with holding the secret of being a victim of domestic violence.  Seeking help can be significantly more difficult.

An interesting but false assumption about certain characteristics among lesbian relationships directs theoretical and therapeutic focus regarding a mythological tendency for domestic violence.  Balsam and Szymanki (2005) assessed the degree that "butch/femme identity is related to domestic violence aggression and victimization.  The hypothesis that butch women would be more likely to perpetrate and femme women would be more likely to be victimized was not supported in the majority of our analyses.  This finding is not surprising, given that clinical and theoretical writings on this topic have disputed the stereotyped notion of perpetrators and victims in lesbian communities.  It is important to interpret this finding with caution, given that a single item was used to assess the butch/femme construct.  Nevertheless, the stereotype that masculinity is associated with aggression and femininity with victimization may not hold true in women's same-sex relationships" (Balsam and Szymanski, 2005, page 266).  Masculinity or stereotypical masculine traits and behavior may not therefore cause greater propensity for domestic violence per se.  Both men and women, whether straight or gay who exhibit stereotypical and culturally accepted masculine characteristics such as assertiveness and aggression can do so without crossing over to psychological abuse or further to domestic violence.  By the same token, both men and women, whether straight or gay who exhibit stereotypical and culturally accepted feminine characteristics such as emotionality and nurturing would therefore be able to do so without becoming victims of abuse.  Femininity or stereotypical feminine traits and behavior may not therefore cause greater vulnerability to suffer intimate partner violence per se.  However, stereotypical gender traits and roles may further intensify dysfunctionally and violently when attachment insecurity or sociopathy psychically drive the individual.

Homosexual individuals may also absorb a homophobic or heterosexist version of minority stress.  Balsam and Szymanski (2005) reported, "the extent to which participants endorsed internalized homophobic beliefs and the number of self-reported experiences of discrimination showed some correlation with lifetime domestic violence variables, although these relationships were generally modest.  Internalized homophobia was associated with lifetime victimization by a female partner.  It may be that women who have been treated badly by a lesbian or bisexual partner hold more negative beliefs about lesbian and bisexual women in general.  Conversely, women who have internalized more negative beliefs about themselves as lesbian or bisexual women may be more likely to remain in abusive relationships because they may harbor beliefs that they deserve the abuse" (page 266).  Internalized negative self-beliefs can create vulnerability for abuse in any individual from any historically disenfranchised or marginalized group.  Such groups include women, youth/teens, persons of color, LGBTQ individuals, the poor, migrants, immigrants, the physically disabled, the mentally handicapped, religious minorities, and so on.  The therapist should examine if the victimized partner- Madeline for example, may have internalized negative identity values not only from family experiences, but also from societal stereotyping or historical oppression.

Since minority stress designates a group of people as inferior, lesbians are doubly stressed as women and as sexual minorities.  Lesbians of color are triply stressed.  Economic disadvantage, lack of education, disabilities, and religious minority status are additional minority stresses.  The therapist should consider all potential minority stress issues rather than assume they are adequately managed, or that there is only the single minority stress of sexual orientation.  "Exploring the connection between issues of minority stress and partner abuse among the GLBT population can help and produce more effective treatment and help articulate how issues of minority stress and homophobia affect every aspect of this violence, the abused partner, the abuser, and the helping resources…it becomes evident that the "multiple layers of victimization in the lives of many battered GBLT(s) compound the experience of trauma and its impact on mental health and well-being."  Although it is argued that a person may leave the abusive relationship, they cannot 'leave a homophobic society and culture' (Balsam 2001, p.31). Reaching out for help can become very difficult for GLBT victims of intimate partner abuse since they need to trust they will not be discriminated against, which is often not what past experience has taught them" (Brown, 2008, page 459).

In examining domestic violence among individuals from relatively unfamiliar (personally or professionally) groups, the therapist may find characteristics or dynamics that are both distinctive and shared with those he or she has greater experience with.  For example, if familiar and experienced with domestic violence among heterosexual couples, there will be both unique and similar dynamics among homosexual couples.  "Fortunata (1999) looked at the lesbian experience of domestic violence, comparing the personality and psychological characteristics of violent lesbians with non-violent lesbians.  Her study explored violence in relation to family history of violence, substance misuse history, life stressors, perception of power imbalance in the relationship, personality features, jealousy and dependency.  She found that violence correlated with everything except dependency and perception of power.  She also found that the personality and psychological characteristics of women who batter women in stable relationships (of more than five years) were similar to those of heterosexual male perpetrators" (d'Ardenne and Balakrishn, 2001, page 232).  Issues with dependency, power and control, reactivity, and personality disorders including antisocial personality disorder are at least as relevant to gay and lesbian couples as contributors to domestic violence.  However, the social status of membership in any marginalized group potentially impacts domestic violence as it affects many if not all areas of life.  As a couple of color or a bi-racial couple in a white dominant society, as an economically stressed couple, as a couple from a religious minority, or as a gay or lesbian couple in a hetero-dominant society specific potential issues may be important.

"Perhaps the most influential difference in same-sex partner abuse is living as an oppressed minority in a heterosexist and homophobic society.  Weinberg (1972) coined the term 'homophobia' to refer to the 'irrational emotional reaction of fear, disgust, anger, discomfort, and aversion to homosexuals' (p. 145).  This emotional reaction can be manifested both internally and externally causing added elements of stress (minority stress) to an abuse situation (Byrne 1996).  The consequences of heterosexism also contribute to the added problem of gender role socialization in determining who can and cannot be a victim of partner abuse; creating inexperience and the lack of GLBT friendly helping/legal agencies, and limiting the legal protection that is available to those suffering from same-sex partner abuse" (Brown, 2008, page 458).  The therapist should examine each partner's identity as a homosexual person and his or her process of coming to own personal sexuality.  In particular, how secure and open an individual identifies self and to others may affect his or her willingness to reveal or discuss partner abuse.  If there remains ambiguity, shame, and secretiveness about ones sexuality, committing or being the victim of domestic violence cannot be easily revealed to others.  Having struggled to assert attraction to same gender partners against recriminations, rejection, and condemnation from family members, friends and peers, and society in general, it can become virtually impossible to admit choosing a partner who is gay or lesbian… and abusive.

Societal oppression complicates and accentuates partner oppression or any other problematic relationship stresses.  Gay men who report being victimized in their relationships also reported more internalized homophobia, while there was not relationship found in perpetrators aggression and internalized homophobia (Kelley and Robertson, 2008, page 480).  This seems to imply internalized homophobia creates a greater vulnerability to becoming victimized or perhaps, to be targeted, while not increasing aggression.  "...the relationship between internalized homophobia and recent domestic violence was fully mediated by relationship quality.  Thus, our data is consistent with minority stress theory suggesting that internalized oppression results in poorer relationship quality (e.g., Brown, 1995) and with research on heterosexuals suggesting that poorer relationship quality leads to domestic violence (Stith et al., 2004)" (Balsam and Szymanski, 2005, page 266).

In homosexual couples, there can be "the added threat of social isolation on a grand level. That is, while they experience all of the same threats as heterosexual victims (lack of friends and support), they also can experience being 'outed' by their partner.  Their partner may threaten to reveal the victim's sexual orientation to employers, friends, and family members, which can lead to greater isolation and perhaps even job termination.  Similarly, the abusive partner may threaten to limit the other partner's involvement in the gay community, or discourage them from reporting because doing so will shame the gay community (Balsam and Szymanski 2005; Miller et al. 2000; Peterman and Dixon 2003).  Understanding these differences is crucial to understanding, treating and preventing violence in GLBT partnerships.  According to Disempowerment Theory, individuals who feel inadequate and/or lack self-efficiency are at a greater risk of using unconventional means of power assertion, including substance abuse and violence (Mckenry et al. 2006)" (Brown, 2008, page 458).  The abusive partner may be more driven by his or her desire to maintain power and domination or be so intensely emotionally reactive than any loyalty to same-sex idealism or commitment.  Rather than holding or presenting their homosexual relationship affirmatively against social homophobia heterosexism, his or her partner's and the couple's homosexuality becomes another tool or expression for manipulation or reactivity.

To manipulate or control gender expression, sexual behavior, and perceived gay aesthetics, gay men frequently use relational aggression.  Relational aggression is also common with female or girl-to-girl bullying.  "'For example, one participant offered, 'In general I would say gay men gossip most about promiscuity, followed by financial issues, then how they dress, their appearance, how they present themselves socially.'  Also, several participants referenced malicious rumors concerning sexually transmitted infections, HIV status, sexual performance, and sexual behavior/promiscuity.  One participant stated, 'You hear stuff about being promiscuous and STD's.  Or is he big?  Is he small?  Was he good in bed?  Usually said in a way to make you not want to associate with the person.'  Interestingly, numerous participants also reported disclosure of another's homosexual orientation or 'outing' as a common form of relational aggression.  Revealing one's sexual orientation to others, such as coworkers or family members, is something not usually harmful in straight relationships.  Thus, outing is a form of relational aggression/victimization that appears to be exclusive to gay individuals" (Kelley and Robertson, 2008, page 480-81).  Outing may be exclusive to gay individuals but attacking the other's reputation and relationship, also common among females is a general strategy for control and/or status.

Neither heterosexuality nor homosexuality offers any automatic immunity for other psychosocial issues including emotional disturbance or antisocial personality disorder.  Gender stereotypes can assert that women are victims and men are the perpetrators, which is based on a heterosexual dyad that is not relevant to a lesbian or gay couple.  Biologically based theories that assert that men are more prone to aggression and violence than women imply that domestic violence among lesbian couples would not exist.  It would also seem to imply that gay couples with two male partners would be rift with aggression and violence.  A counter-stereotype may however assert that the gay partners are so feminized as to not have any male-typical aggressive or violent tendencies.  "As such, it is often expected that same-sex couples would not experience this form of violence because the power differential that exists in heterosexual is not present… Likewise, power dynamics are down-played since power and control are traditionally defined in the context of a man versus a woman.  Nonetheless, literature has illustrated that the use of power and control is a commonality among batterers regardless of gender and sexual orientation (Balsam and Szymanski 2005; McLaughlin and Rozee 2001).  Power is based on social dynamics between the couple aside from gender, such as relative personal power, socioeconomic status, and level of education, disabilities, and race (McLaughlin and Rozee 2001; Walsh 1996)" (Brown, 2008, page 460).

The therapist should be aware of group dynamics or unique issues within particular populations that may be incorporated into some strategy for assertion, aggression, or abuse.  Considering how specific challenges and issues for homosexual individuals in heterosexual communities are used to manipulate or dominant others suggests for example, that undocumented individuals would be vulnerable to being "outed" to naturalization or other authorities.  A person "passing" as an individual from another race would similarly be at risk for manipulation, as would someone who crosses socio-economic class lines secretively.  By any means necessary becomes by any means available if the need to control, dominate, or abuse is strong enough despite the means being otherwise a shared socio-cultural-economic disenfranchised status.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
office: (510) 582-5788
fax: (510) 889-6553
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