25. It Depends - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Anger, assertion, aggression, and abuse are common characteristics in couples and in couple therapy.  Conflict, control, and sliding to becoming out of control are essential challenges and issues in relationships.  The therapist must be aware that couple therapy dealing with the continuum of assertion, aggression, and abuse may reveal minor to severe emotional or psychological abuse.  Severe emotional or psychological abuse may be precursors or surface verbal and non-physical manifestations of physical violence.  Couple therapy may unexpectedly shift because of domestic violence issues.  Although, domestic violence may not be the therapist's intention or focus in couple therapy, he or she must be knowledgeable about treatment for domestic violence.  Theoretical prohibitions against and cautions about conducting couple therapy for domestic violence need to be carefully considered by the therapist.  Domestic violence work becomes inherently different from "normal" couple therapy because of danger and safety issues.  However, domestic violence couple therapy and "normal" couple therapy share many issues and principles.  Much if not all of the issues endemic to domestic violence are the regular focus of couple therapy: attachment, power and control, stress, gender roles, cycles of dysfunction, emotional reactivity, anger, depression, anxiety, alcohol use, and so forth.  Partners moreover often come for couple therapy specifically because anger, assertion, and aggression had slid or threatened to slide across the relationship contract boundary to emotional abuse.  Emotional aggression and abuse if poorly addressed may become so aggravating to ignite domestic violence and/or relationship termination.  The therapist may be need to help the couple effectively manage and curtail emotional abuse to prevent the couple from degenerating to physical abuse.

Despite tremendous frustration some partners never or rarely become emotionally abusive with each other.  For them, they stay within safe boundaries on the continuum of assertion and aggression without straying into abusive behavior.  They have conflict, deal with emotions and stay in control, and seldom if ever get out of control.  If they do lose control, they are able to stabilize relatively quickly and efficiently.  Since emotional abuse is rare or quickly addressed and effectively restrained well short of becoming physical, there is no need for couple therapy to prevent domestic violence.  For other partners, it is the first episode of emotional abuse or physical confrontation- perhaps, being restrained or a push or a slap (not physically traumatic) that has upset the couple for them to instigate couple therapy.  For the couple and many therapists, referral to domestic violence treatment in this case would seem unnecessary and an over-reaction.  Referral to domestic violence treatment including labeling one partner (in straight relationships, the male usually) turns them away as they seek help for other issues.  The goals of domestic violence treatment: safety for the abused and prevention of re-abuse may not be the imminent concern for the couple.  The partners may be safe and stable with secure boundaries against physical altercations, and wish to focus on dealing with their underlying dynamics.  Entering couple therapy is the partners' admission and ownership of their ineffective relational dynamics and already a commitment to prevent any or further physical interactions and reduce or eliminate emotional abuse.

The therapist must be prepared when a couple in therapy reveals emotional abuse or physical confrontations or clearly identifiable past or current domestic violence.  The therapist is not conducting couple therapy to treat domestic violence, but now domestic violence treatment must be a part of couple therapy.  In fact, the physical or sexual abuse becomes the major or only focus of therapy- at least, until violence has stopped, security ensured, and relapse prevented.  Continuation of couple therapy implies that couple therapy is appropriate and can be effective.  Continuation of couple therapy implicitly asserts that the abused partner is safe enough and can be protected sufficiently against further violence with therapeutic interventions.  Continuation implies that the abusive or violent prone individual is and can stay in sufficient control not to assault the partner again.  While the confidence, arrogance, or ignorance of the therapist may sometimes result in ineffective therapy for many other foci of therapy, with domestic violence ineffectual work can be dangerous and perhaps, fatal.  At the end of the day… at the end of the session, the therapist has to use all his or her knowledge of anger issues, assertion, aggression, and abuse, of relationship dynamics, of intrapsychic issues, of intimate partner violence, of domestic violence treatment, and the scope and limitations of couple therapy to make a wise choice first whether to conduct couple therapy.  Intrinsic to this decision is whether the violence comes from various forms of emotionally reactive issues more receptive to therapy.  The decision to attempt couple therapy may change if the violence is instrumental, and a result of the individual's sociopathic issues.  The therapist must consider that the partner is in greater danger, the sociopathic individual is less receptive and available for change, the equitable quality of the couple's relationship significantly skewed, and the goals for partners out of sync.  The therapist must recognize and accept limited realistic outcomes if choosing to conduct therapy.

Asserting and keeping a hard boundary of never conducting couple therapy if there is domestic violence or a sociopathic member precludes these therapist challenges.  Assessment stops upon the identification of physical abuse and the therapist risks practicing dogma rather than theoretically sound therapy.  There is no relief from the therapist’s temptation to avoid difficult assessment with dangerous consequences to abused individuals other than avoidance.  Is avoiding working with couples where there is emotional abuse or the potential or reality of physical or sexual partner violence ethically or therapeutically responsible?  The therapist may reject the couple and/or the abused partner who need his or her skills.  Assertion that had become aggressive is now crossing over to be emotionally and psychologically abusive.  Issues of control have turned into toxic conflict and they have gotten out of control.  The therapist is called to reverse this progression and to keep it from getting worse.  Or, verbal emotional abuse has slipped to the partners' horror into an incident or several incidents of physical contact.  The therapist is asked to help the partners be the couple they want and need to be, rather than infected with domestic violence.
What to do?  As is often the case in therapy and with therapeutic decisions, it depends!  And the specific therapist has to work that out with the specific clients or couple and their specific circumstances, characteristics, and history.  "I don't do that," is an inaccurate depiction that inappropriately distinguishes domestic violence work and principles from the normal work of couple therapy.  "That" is essentially the same work, albeit with significant differences and nuances.  What differences and nuances?  It depends!  How to conduct therapy based on similarities, differences, and nuances?  It still depends!  Figuring out what depends is the skillful assessment and diagnostic work of therapy.  There is no simple answer or standard therapeutic protocol- no "one size fits all" therapy, but there are relevant principles to guide therapeutic investigation leading to interventions and strategies.  What of Dirk and Madeline, the primary example of partners for this book?

Dirk and Madeline did need a lot of work on their anger issues.  They needed to learn how to be being appropriately assertive or aggressive.  Throughout therapy, the therapist kept assessing the couple and each partner
for his or her intensity of anger,

how anger was expressed in the relationship,

how each partner assert him or herself

how does each partner aggresses

does either partner go step across the boundary of abuse

when and how does each partner become emotionally or psychologically abusive

and if, how, and why the abuse or behavior become domestic violence.

if aggression in the relationship was "mostly verbal" and "never really got physical," what did that mean about when the aggression was more than verbal

if the aggression "never really got physical" when it "sorta got physical

for the degree of entitlement to violate or cross boundaries leading to abuse

Therapy helped each partner stay in control through being more mindful and self-aware when crossing from assertiveness to aggression.  Appropriate assertive communication and behavior was taught.  The partners were essentially trained how to “fight,” meaning how to assert oneself, confront, have conflict, judiciously aggress, and seek connection and understanding with respect and without abuse.  Each partner worked at being more aware of approaching the boundary between aggression to abuse.  Since Dirk and Madeline's original vague comments left unclear if and how they might get out of control in their conflicts.  The couple therapy continually checked and analyzed their pattern of conflict for erosion and progression- that is, of being or losing control.  The therapist continually confronted any denials, minimizing, or diversions.  The couple therapy reassessed regularly the scope and depth of aggression, especially abuse.

Dirk and Madeline both had core issues that revolved around or activated emotional and psychological aggression and abuse.  Therapy investigated how such core issues developed from the family-of-origin, trauma, social and cultural models, and other key formative experiences.  To the degree that one or the other’s core issues were embedded characterological issues including personality disorders, therapy of necessity shifted focus to the personality disorders.  Personality disorders are not important elements or influences in a relationship.  They are so profoundly powerful that they fundamentally define and structure ones relationship with anyone dysfunctionally.  Depending on the type of personality disorder, therapy shifted strategically to deal with the disorders compelling anxiety, pain, trauma, and needs.  Or, in the case of paranoid personality disorder or antisocial personality disorder, therapy fundamental goals changed from healing, intimacy, connection, and growth to boundaries, consequences, security, and safety to an extent beyond the other issues complicating couple’s relationships.  That happened with Zane and Jessica because of Zane’s paranoia.  Domestic violence research cautions about applying the goals of treatment with reactionary perpetrators to instrumental perpetrators who are more antisocial or sociopathic.  Safety, safety, and safety define treatment.  Growth and change aspirations for the sociopath may be completely useless, and worse place the other partner in danger.

What of another pair of partners?  What about Elliot and Clarissa?  She is paranoid like Zane, but there may be some important differences that make her potentially more amenable to therapy and to change.  What to do?  After and with all the conceptual considerations, the therapist's clinical judgment with these or any other couple has to be final arbiter for action.  It depends on what?  The therapist must always depend on his or her clinical judgment gained through in session experience and senses in combination with knowledge, education, training, and prior experiences.  There is nothing easy about this type of work.  If it is easy relatively speaking, then the partners almost assuredly do not have personality disorders or strong emotional reactivity, trauma, or other profoundly impacting issues calcified in their personalities.  Would a therapist seek out this book or similar books?  It depends!  If dealing with “easy” couples, then not particularly necessary.  If dealing with couple’s chaos or therapeutic frustration, then maybe!

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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