Professional Documents
Culture Documents
21
http://dx.doi.org/10.1037/12329-002
Couples Therapy for Domestic Violence: Finding Safe Solutions, by S. M. Stith,
E. E. McCollum, and K. H. Rosen
Copyright © 2011 American Psychological Association. All rights reserved.
abuse and therefore would have left the abuse untreated. More recent research
is somewhat more encouraging. Schacht, Dimidjian, George, and Berns (2009)
surveyed 620 couples therapists and found that 53% reported conducting
universal screening—that is, they screened all couples treated in the past year
for the presence of domestic violence. However, their approaches to screen-
ing left much to be desired. Most respondents did not consistently interview
both partners separately, and more than three fourths did not use written
questionnaires during the screening process. We hope that this chapter helps
couples therapists understand the recommended procedures for assessing for
Copyright American Psychological Association. Not for further distribution.
reported that both he and his partner pushed, grabbed, and kicked each
other said,
If you’re looking for people, like violent people, man, we are not it!
You know a few little kicks and stuff here and there, with no more than
people do when they are playing. We are not violent. We don’t do one
another when we are fighting and stuff.
Later he said, “Psychologically I beat her, but I don’t beat her physically.” It
seemed clear from the reports of many of our clients, that they did not believe
that the aggressive acts they reported constituted violence; therefore, it is
important that therapists ask about specific acts rather than about “violence.”
Although each client is unique, some questions the therapist might ask
include:
䡲 “What happens when you and your partner argue?”
䡲 “Do you ever feel unsafe at home?”
䡲 “Have you ever been physically hurt or felt threatened?”
䡲 “Have you ever been or are you currently concerned about
harming your partner?”
䡲 “Have you ever felt afraid of your partner?”
䡲 “Has your partner ever:
䡲 pushed, grabbed, slapped, choked or kicked you?
䡲 forced you to have sex or made you do sexual things you didn’t
want to?
䡲 Threatened to hurt you, your children, or someone close to you?
䡲 Stalked, followed, or monitored you?”
We use the AUDIT (Babor et al., 2001) and the DAST–10 (Skinner,
1982) to screen for substance abuse. We admit clients scoring in Zones 1
(score of 0–7) and 2 (score of 8–15) on the AUDIT. Similarly, we admit
Copyright American Psychological Association. Not for further distribution.
DEPRESSION SCREENING
RELATIONSHIP SATISFACTION
EXCLUSION CRITERIA
very high level of violence. Therefore, we could not directly address the high
level of violence without endangering the wife. We would be concerned that
if we directly address with the husband the violence that she reported to
us privately, he may become angry about her report, and she may be at risk
of further violence. When clients report very high levels of violence on the
CTS2 or there are serious discrepancies between husband and wife reports of
violence received or perpetrated, we meet with each partner to discuss their
reports. We do not tell one partner what the other partner reported, but we
spend time asking them to help us understand what they reported and encour-
age them to tell us whether there were other incidents that they had not
reported. A typical interview with a partner who reported perpetrating a small
act of minor aggression when their partner reported being victimized by
severe aggression might go like this:
Therapist: I noticed on your survey you indicated that you have shoved
your partner more than once last year. Can you help me
understand what happened?
After the client explains what happened, the therapist might ask if the client
thought their partner was afraid. The therapist might also ask the client to
talk about the most recent incident when anything physical occurred. Next,
the therapist might ask about the most serious incident. With the partner, the
interview might go like this:
Therapist: I noticed on your survey you indicated that your partner
choked you and shoved you against the wall last year. Can
you help me understand what happened?
After the client explains what happened, the therapist might ask if the client
was fearful when the incident happened. The therapist would also ask whether
the client thought his or her partner would mention these incidents on the sur-
vey and how the participant might think the partner would respond if the ther-
apist talked with him or her about the incident. It would also be important to
find out whether the client felt safe talking about the incident with the part-
ner in session.
therapy, and if either person fears that being honest with the partner could
lead to increased violence, couples therapy is not appropriate. We gave Mary
numbers for the local battered women’s shelter, worked with her to develop a
safety plan (described in more depth in a later chapter), and gave her resources
for individual therapy, if she decided to seek help for herself. We also told her
of our plan for a joint meeting with her husband. At that time, we told both
partners that we decided that they did not meet the criteria for being in our
project. We said that we believed that they each had individual issues they
needed to address before beginning couples treatment and encouraged them
both to seek individual therapy. We gave them appropriate referrals.
In another case, both partners may report independently that the hus-
band choked the wife. Both may also report that this incident was what led
them to know they needed help. In that case, we may decide to allow them
to begin treatment. If we find both partners are in agreement that a high level
of severe violence has occurred, we interview each of them separately to
determine whether changes have occurred that may make the home safer. For
example, we have had clients with a history of severe violence participate in
our program after the offender has completed a batterer program or substance
abuse program. Because our program has many safety procedures and ongoing
screening, we have found that using an arbitrary exclusion screening criteria
is not necessary. However, in general, we exclude clients if
䡲 either partner is fearful that the other could get violent in
response to anything said in conjoint therapy.
䡲 there is a significant discrepancy between partners in response
to the CTS2, that is, if one partner reports receiving consider-
ably more serious abuse than the other partner reports perpe-
trating, especially if she or he does not feel safe talking about
the discrepancy.
䡲 either partner has a serious untreated substance abuse problem
or is not able to attend treatment without using. He or she would
probably be referred to a substance abuse program before being
accepted into our program.