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10/25/2015
1
Chris Huffine, Psy.D.
Allies in Change
October 24, 2015
Anger/abuse issues as analogous to
substance abuse is...
10/25/2015
2
Unhealthy conflict
 Bad or unhealthy conflictrefers to disagreements or
problems where ineffective communica...
10/25/2015
3
What is abusive behavior?
 Most obviously it is physical abuse. Physical abuse
includes:
 Hitting, kicking,...
10/25/2015
4
What is abusive behavior?
 Economic
 Sexual
 Most typicallywe think of rape or child sexual abuse
when we ...
10/25/2015
5
It’s NOT about the physical abuse
 For most victims, even of severe physical abuse, the
emotional abuse was ...
10/25/2015
6
A pattern of abuse . . .
 A pattern of abuse is what shifts the relationship
dynamic from Common Couples Vio...
10/25/2015
7
37
Pathological conflict
 This pro-abuse belief system is its own distinct
problem
 Abusive behavior is alw...
10/25/2015
8
Intentional listening/thinking
 Listening with an agenda/intent
 Goal is to convince the other, to “win” th...
10/25/2015
9
DV screening outcomes
 Typically there will be one of three outcomes from the
screening:
 1. There is defin...
10/25/2015
10
12 reasons why couples counseling is not
appropriate when domestic violence in
present
 7. Upsetting the ho...
10/25/2015
11
Talking with the abuser
 Again, no one right way of doing this, but here are
some things I typically try to...
10/25/2015
12
After the first session . . .
 Keep in mind that you are not doing true couples
therapy (per the reasons gi...
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Pathological Conflict in Couples

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2015 Oregon Counseling Association Conference presentation by Chris Huffine, PsyD, executive Director of the treatment organization Allies in Change.

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Pathological Conflict in Couples

  1. 1. 10/25/2015 1 Chris Huffine, Psy.D. Allies in Change October 24, 2015 Anger/abuse issues as analogous to substance abuse issues  While it is NOT an addiction, anger/abuse issues and how they need to be addressed parallel, in many ways, substanceabuse issues and how to identify and address them (and how NOT to identify/address them)  To start, just as, for many years, the mental health field did a poor job of identifying and addressing substance abuse issues, it does a poor job of identifying and addressing the presenceof domesticviolence Prevalence of domestic violence among therapy clients  One in four women will be physically assaulted by a romantic partner  More than a third of all individual female clients with a severe mental illness have experienced at least one act of physical abuse from an intimate partner in the past year (Goodman et al., 2001)  Victims of domestic violenceare more likely than non- victims to utilize mental health services  It is estimated that between 50-70% of all couples seeking out couples counseling have experienced physical aggression in the relationship (Cascardi et al 1992; O’Leary et al 1992) Prevalence of domestic violence among therapy clients  Physically abused women report twice as many days of feeling sad and depressed as non-abused women (Oregon Domestic Violence Needs Assessment 1998)  Abused women are likely to have nearly twice as many contacts with health care providers (Oregon Domestic Violence Needs Assessment 1998)  Abused women often turn to mental health professionals for support (Oregon Domestic Violence Needs Assessment 1998)  One study found that among couples identified by mental health providers as “non-violent”, 55% of the men reported having engaged in physical abuse towards their partner (Holtzworth-Munroe et al 1992)  Another study found that 40% of practitioners who read a vignette of an actual violent family failed to address the issue of violence, even when it was clearly identified (Hansen et al 1991; Harway & Hansen, 1993)  The goal of this workshop is to clarify how the presenceof domesticviolence qualitatively changes how a couples therapist should work with a couple just as the presence of an active substance abuse problem should do the same Healthy conflict  While many of us do not like conflict of any kind, the specific concern is the presence of unhealthy conflict  Healthy conflict refers to disagreements or discrepancies where the couple makes effective use of a variety of communication skills to resolve or address the issue  Healthy conflict leads to greater intimacy and closeness  While it may be uncomfortable, people typically feel better, closer, happier at the end  Even healthy conflict can be difficult for some because people fear it will be unhealthy and lead to unhappiness, hurt, and distance, among other things
  2. 2. 10/25/2015 2 Unhealthy conflict  Bad or unhealthy conflictrefers to disagreements or problems where ineffective communication and problem solving skills are used  It leads to hurt feelings, distance, a loss of love, and further problems, including, if it is intensive and long enough, threatening the relationship  This can be due to a variety of reasons—lack of knowledge of communication skills/tools, ineffective management of emotions, family of origin issues, etc.  A variety of differentcouples counseling approaches have been developed to deal with these unhealthy conflicts (e.g., CBT, Emotion Focused, Imago, etc.) Unhealthy conflict  Sometimes theconflict may primarily be due to the issues in one person (e.g., substanceabuse, depression, childhood trauma)  When that is the case it is common and appropriate for the couplescounselor to recommend, or even require, that at least one of the two pursue individual or alternative counseling to address that issue  In some cases, that individual doing work on their own, alone, may significantly improve the quality of conflict in the relationship  Unfortunately, domestic violence is often not adequately identified or conceptualized as an individual issue rather than as a couples issue Unhealthy conflict  Everybody has it at times  Often each person plays a role in it (“It takes two to Tango”)  Couples counseling helps the couple work through that conflict, utilizing a variety of tools/philosophical frames (e.g., family of origin, communication skills, emotional expressivity/reactivity, etc.)  A basic, often unstated, presumption of virtually every couples counseling paradigm is that the couple is presumed to be more/less collaborative  This is qualitatively different than pathological conflict Pathological conflict  Pathological conflict refers to on-going conflict that is primarily driven by (at least) one individual’s distorted view of the relationship and leads to that individual having on-going patterns of abuse and control of their partner— aka domestic violence  Because it is driven by the belief system of that individual, it does not matter what the partner does, the abusive and controlling behavior will continue until that individual’s belief system changes  Most, if not all, forms of couples counseling do a poor job of identifying and addressing this belief system  Regardless, this is primarilywork that needs to be done outside of the couples counseling session No one’s perfect  The problem is not about any single abusive act. Most of us can probablygive an example or two of when we have acted poorly in the moment.  In those cases we apologize and/or recommit not to doing those kinds of things and we generally don’t  There is no need for any additional intervention because it stops on its own  The real concern and problem is when it happens over and over again, forming a pattern  The analogy—anyonecan have a moment of drinking too much, but that doesn’t mean there needs to be an intervention, only when it continues to be a problem Definition of Domestic Violence  A pattern of coercive behavior used by one person to control and subordinate another in an intimate relationship
  3. 3. 10/25/2015 3 What is abusive behavior?  Most obviously it is physical abuse. Physical abuse includes:  Hitting, kicking, slapping, pushing, shoving, pinching, poking, choking, pulling hair, etc.  It also includes being physically controlling:  Grabbing, holding, restraining, blocking your way, moving you against your will  ANY of sort of UNWANTED physical contact is considered physical abuse EVEN if it doesn’t cause an injury or pain What is abusive behavior?  There are many other kinds of abusive behavior:  Verbal  Name calling, put downs, tearing apart with words, swearing, yelling  Psychological  Non verbal behavior that creates fear/intimidation including looks, stares, facial expressions, gestures, the silent treatment, etc.  There are also more subtle forms of psychological abuse such as radiating intensity Radiating Intensity  “Radiating intensity” describes a state of emotional distress in which the man is not acting overtly abusive, however he is quietly distressed/unhappy  There is often subtle blaming of the family for his distress  Alternatively, it may be conveyed that they need to be wary and to not “set him off”  That distress is conveyed by subtle behavioral cues that result in his family being anxious and on edge around him  As a result, the family is often on eggshells Radiating Intensity  This is different than simply being grumpy or being in a bad mood  In its benign form others typicallydon’t feel particularly anxious and aren’t concerned about the person “losing it”  Radiating intensity is quite toxic and wearing on other family members. It’s akin to an odorless, colorless toxic gas that gradually poisons those exposed to it. What is abusive behavior?  Property  This is often psychologicallyabusive by witnessing acts of aggression against objects, even if the object isn’t damaged  Economic Examples of Economic Abuse  Withholding money  Micromanaging the money  Making large secret payments  Hiding money  Making unilateral financial decisions  Imposing your financial values  Withholding economic information  Giving an allowance  Setting a budget without the other’s agreement  Keeping items in just one name  Limiting access to finances or financial information  Making her turn over her paycheck  Lying about finances
  4. 4. 10/25/2015 4 What is abusive behavior?  Economic  Sexual  Most typicallywe think of rape or child sexual abuse when we hear this phrase  It includes any kind of unwanted sexual contactor sexual harassment Examples of sexual abuse  Pressuring a sexual partner into being sexual when they don’t want to be  Badgering for sex  Making her suffer for saying “no” (e.g. whining, pouting, complaining)  Using guilt and othercontrol tactics to get sex  Willfully withholding sex to punish  Making her do undesired sexual activities  Affairs  Any sexual behavior that does not include non- coerced informed consent Relational neglect  Neglect is a more subtle form of mistreatment  It isn’t about doing things to a partner, it’s about NOT doing things with a partner, specifically the things that help keep a relationship healthy and loving  Just as there is child abuse and child neglect, both of which can be quite damaging, there is also relational neglect. And, just as child abuse and neglect can go together, so can relational abuse and neglect can go hand in hand. Relational neglect  One common form of neglect, rampant in abusive relationships, is the non-acknowledgement of the bad behavior  Accountable acknowledgement can significantly mitigate the damage of the abuse  Typically abusive individuals don’t do this, instead they deny the abuse, rationalize, minimize, justify, ignore, or blame the other  This non-acknowledgement significantly aggravates the impact of the abuse, akin to scraping a knee but not attending to it  It’s like leaving a scraped knee unattended—it’s much more likely to become infected and cause problems Relational neglect  Relational neglect includes things like:  not acknowledging a partner  not thinking about them, particularly how they are different from the other  not considering their input or preferences  The partner presumes everyone sees the world through their eyes, that their perspective is the only one, that their concerns and needs are the only ones that are important  Other words for this include narcissism, grandiosity, and egotism It’s NOT about the physical abuse  Even in the worst abusive relationships there is going to be far more non-physical than physical abuse  Many abusive relationships have little to no physical abuse  Because most of our laws are against physical abuse this means that most domestic violence is not illegal  This means that most domesticallyviolent families can’t be intervened with via the police and courts  Part of the reason rates of DV are dropping is that abusive individuals are no longer giving themselves permission to be physically (i.e., illegally) abuse while continuing or even escalating the verbal, psychological, and economicabuse
  5. 5. 10/25/2015 5 It’s NOT about the physical abuse  For most victims, even of severe physical abuse, the emotional abuse was still worse  “Sticks and Stones may break my bones, but words will break my heart”  “The physical abuse made me hate him, the emotional abuse made me hate myself.”  The “active ingredient” of physical abuse is not the abuse, but the meaning of the abuse It’s NOT about the physical abuse  Most abusive behavior is intended to be controlling Definition of Domestic Violence  A pattern of coercive behavior used by one person to control and subordinate another in an intimate relationship To be controlling of another is: To make them act or think in a certain way, without them freely choosing to do so To interfere with their freedom and liberty to make their own choices To coercively or manipulatively reduce another person’s options Controlling behaviors  All of us are occasionally controlling (raindrop)  What is particularly damaging are on-going patterns of controlling behavior (rainstorm)  While most abusive behaviors are intrinsically abusive, most controlling behaviors are not  Anything can be twisted into a controlling behavior  Anger is not a cause of abuse, but more typically a symptom, resulting from the frustration when controlling behaviors aren’t working  See the hand-out for many more examples
  6. 6. 10/25/2015 6 A pattern of abuse . . .  A pattern of abuse is what shifts the relationship dynamic from Common Couples Violence to domestic violence  Once a pattern is formed an environment is created  The “Bully Effect”--even technically non-abusive behavior is experienced by the family as being abusive  This leads to an exponential increase in the amount of abuse experienced by the family  It isn’t just the abuse itself, it’s the anticipation of it, the aftermath of it  Typically the reason why the abuse continues to occur is due to an underlying belief system The roots of abusive behavior  On-going abusive behavior is driven by the belief systems/world views of the abuser, the most common of which is “power over” Reality I: Power over  Win-lose/One winner  One right answer/one truth  Either my needs or your needs me or you  Assumption of scarcity  Hierarchical  External focus  Blame  Abuse and control are used  Competitive: Others are viewed as opponents, competitors Reality II: Personal Power  Mutual respect is practiced  Win-win/Many winners  Many right answers/many truths  We can all get our needs met/me and you  Assumption of abundance  Internal focus  Cooperative  Others are viewed as allies “Let me explain what I mean by power. That is a word whose meaning has become twisted in your world. When you say power, people become afraid, they think of the police and tax collectors and someone having power over them. That is not what I mean by power. Power, in my way, is the spirit of medicine energy that flows through all beings. Power is strength and the ability to see yourself through your own eyes and not through the eyes of another. It is being able to place a circle of power at your own feet and not take power from someone else’s circle. True power is love.” -Agnes Whistling Elk The roots of abusive behavior  Stopping abusive has to focus not just on stopping behaviors, but on changing underlying belief systems  If the beliefs aren’t changed, new abusive behaviors will appear even if old ones are stopped
  7. 7. 10/25/2015 7 37 Pathological conflict  This pro-abuse belief system is its own distinct problem  Abusive behavior is always a choice and the responsibilityof the person doing it  This is analogous to the widely accepted understanding that addictions are their own issue, separateand distinct from other issues  While other issues can aggravateor mitigate the abusive behavior, they are typically not the cause (just as other issues can aggravateor mitigate substance abuse, but don’t cause it) Pathological conflict  While each person may have a role in non- pathological conflict, pathological conflict is solely due to the person being abusive  Just as the alcoholic is solely responsible for his/her sobriety, so, too, is the person with the “powerover” belief system solely responsible for changing it  Note that unhealthy conflict is different (and broader) than pathological conflict—whileall pathological conflict is unhealthy, not all unhealthy conflict is pathological Couples counseling  Just as traditional couples counseling will be minimally effective if someone is an active alcoholic, it will also not be particularly effective as long as someone continues to have a “power over” stance in the relationship  It is vital that the “powerover” stance be addressed independently of the couples work and preferably prior to the coupleswork  Couples counseling is likely to be far more effective once the “powerover” stance has been addressed Screening for conflict in couples Pathological Non-pathological  Patterned abuse & control  Power over stance  Combative  No abuse/isolated acts of abuse & control  Personal power stance  Collaborative Screening for conflict in couples Pathological Non-pathological  Patterned abuse & control  Power over stance  Combative  Intentional  No/isolated acts of abuse & control  Personal power stance  Collaborative  Informational
  8. 8. 10/25/2015 8 Intentional listening/thinking  Listening with an agenda/intent  Goal is to convince the other, to “win” the argument  Characterized by rhetorical and/or leading questions  Argumentative  Examples: debaters, courtroom attorneys 43 Informational listening/thinking  Listening with an open mind  Goal is to understand the other while acknowledging oneself  Characterized by open, genuine questions, follow-up and clarifying questions  Seeking to understand  Examples: reporters, detectives 44 Screening for conflict in couples Pathological Non-pathological  Patterned abuse & control  Power over stance  Combative  Intentional  External focus  Low accountability  Causes fear/suffering/ intimidation  No/isolated acts of abuse & control  Personal power stance  Collaborative  Informational  Internal focus  Personal accountability  No sustained fear/suffering/ intimidation Screening for domestic violence  Screen in the first session with all couples, make it clear that this is routine/automatic  Make sure to screen the possible victim and abuser separately and alone  Start with the potential victim (or the female by default) Screening for domestic violence  Ask if there is any additional information to be shared  Ask each if there are any concerns about anger or abuse  Be willing to use other euphemisms such as “conflicts”, “anger”, or “communication problems”, or other language the individual may have used earlier  Ask about victimization and perpetration  Follow-up with asking about specific behaviors based on categories of abuse (e.g., physical, verbal, psychological, economic). Inquireabout frequencies  Also follow up on specific incidents or issues mentioned earlier Screening for domestic violence  Inquire about the impact--the extent the victim feels afraid, intimidated, on eggshells, or otherwise compromised by the behavior  Ask to what extent the other is controlling  Ask to what extent the relationship feels collaborative  Ask what percentageof the relationship problems are due to the anger/abuse-the higher the percentage (esp. > 50%) the more it’s really about DV
  9. 9. 10/25/2015 9 DV screening outcomes  Typically there will be one of three outcomes from the screening:  1. There is definitely not DV present (negative)  2. There definitely is DV present (positive)  3. It’s not clear—some indications, but not definite or decisive (mixed/ambiguous) If the screening is negative . . .  If there is definitely not DV present then proceed with typical couples counseling  Once in a great while it will later becomeevident that neither person was fully disclosive and there is DV present If the screening is ambiguous/mixed . . .  Proceed with regularcouples counseling while continuing to monitor the dynamics between the two of them  Play particularattention to when there is conflict and the possible abuser doesn’t get his/her way  Look forcontrolling behaviors  Look for intimidation/fear from the possiblevictim  Look fora power over stance  To what extent is the possibleabuser truly open to influence (Gottman concept)? If the screening is ambiguous/mixed . . .  Typically, continued monitoring should lead to clarity over the next 6-10 sessions  There will either be an emerging pattern of abuse and control that is undermining the coupleswork or it will become increasingly evident that there is not a power dynamic and you can proceed with regularcouples work If the screening is positive . . .  You will be challenged to do your best work  It starts by no longer using traditional couples counseling with the couple  Just as you wouldn’t try to primarily address one individual’s substanceabuse issues with couples counseling, it is not appropriateand may even be unethical to use traditional couples counseling interventionswhen there is domestic violence present 12 reasons why couples counseling is not appropriate when domestic violence in present  1. More likely to be seen as 50-50  2. Victim blaming  3. Abuse goes unaddressed  4. No direct confrontation of abuse  5. Information withheld out of fear  6. Abuser feels scapegoated if abuse is the focus
  10. 10. 10/25/2015 10 12 reasons why couples counseling is not appropriate when domestic violence in present  7. Upsetting the homeostasis  8. Too much risky disclosure  9. Abuse needs to end first  10. Collusion with abuser’s denial  11. No DV assessment  12. Keeps the victim in the relationship longer The challenge of working with abusive behavior in a couple  In my experience I am challenged to do my best, most intuitive, and most nuanced work when intervening with a couple around issues of abuse and control  I need to find the perfect balance of pacing and leading  If I take too strong a lead, become too confrontative, I risk losing the couple or alienating one or both of them. Resistance is likely to flare up.  If I pace too much, I risk colluding with the abusive dynamic and/or making it even worse The challenge of working with abusive behavior in a couple  I need to do what I can to join with the abuser without supporting their abuse  I also need to validate the victim’s experiencewithout “taking theirr side”  I need to understand that I am no longer doing couples counseling, I am doing a couples intervention, even if it takes multiple sessions Talking with the victim  If there is DV present it is important to talk with the victim privately, either during the screening or at some other time  There is, of course, no one right way to talk with the victim, but here are things I typically cover . . .  Identify that it is an abusive relationship, elaborate if necessary  Indicate that the abusive behavior is 100% the responsibilityof the person doing it  For this reason (among others), couples counseling is not the most appropriate intervention. The abuser needs to be in a specialized group or, at least, initially meeting individually with someone knowledgeable about DV Talking with the victim  Even if the abuser gets specialized services, there is no guarantee, that the abuse will stop or get better  Encourage the victim to seek out individual therapy (or a group) to address the dynamics of being in an abusive relationship  Suggest that the victim read more about domestic violence. The two best books out there (written for heterosexual female victims, but good for others, too):  The Verbally Abusive Relationship by Patricia Evans  Why Does He Do That? by Lundy Bancroft Talking with the victim  Ask the victim to what extent you can disclose to her/his partner what she/he has shared with you  Ask the victim to what extent her/his partner is willing to acknowledge that he/she has abuse and control issues  Encourage her/him to be as vocal/assertive as she/he can be about his/her abuse as it happens, naming the behavior rather than labeling it  Identify any other ways to get leverage/address the issue with him/her  Inform her/him that it will be necessary to align with the abuser in order to help him/her move to acknowledgement and for the victim to understand that it is a strategic move
  11. 11. 10/25/2015 11 Talking with the abuser  Again, no one right way of doing this, but here are some things I typically try to do . . .  To what extent are they able to acknowledge their bad behavior? The more they do, the more promising  How do they rate what percentage their behavior is responsible for the problems? The higher the percentage, the more promising  To what extent might they be willing to work on themselves? The more they are willing to, the more promising If the abuser acknowledges significant difficulties . . .  Suggest that it might be more productive and effective if they just focus on themselves by doing individual work (or, even better, a group, if they’re that open)  It is vital that they be referred to someone highly knowledgeableabout domesticviolence  Talk about how by removing their abuse it will be easier to focus on other issues—anger/abusedistracts away from other issues  Consider stopping thecouples work or significantly reducing it If the abuser acknowledges some difficulties . . .  Remind them that the only part they can truly control is their part  They need to focus 100% on their percent, even if it’s only 5%  Identify the helplessness they likely feel when they are more externally, rather than internally, focused If the abuser acknowledges some difficulties . . .  Plant seeds, suggest that if they continue to struggle with their issues they should consider individual (or group) work  Continue to point out their role as it emerges and wait for the right time to more strongly encourage them to do their own work  One of the best times to do a stronger intervention is after a significantcrisis in the relationship If the abuser acknowledges no difficulties . . .  Look foropportunities to do more education around abuse, control, powerover, and Gottman concepts  The work of John Gottman, while not explicitly labeled as such, focuses heavily on abusive behavior (e.g., defensiveness, contempt, criticism, stone-walling, etc.)  Work to help them start to see their role in all of this, especiallyas it continues to occurrepeatedly If the abuser acknowledges no difficulties . . .  Ultimately if they remain firm in their denial, shift your focus to empowering the victim and validating the victim’s experience (which means it will start to look like you’re increasingly “taking their side”)  Point out the repeated failures of the interventions and express concerns aboutcontinuing with the couples work and whether it’s even a viable relationship
  12. 12. 10/25/2015 12 After the first session . . .  Keep in mind that you are not doing true couples therapy (per the reasons given above), but instead a couples intervention  Sprinkle in educational pieces, as appropriate, about what is abuse, what are controlling behaviors, power over/personal power, etc.  Educate about Gottman conceptsof the 4 horsemen (criticism, contempt, stonewalling, defensiveness)  Educate about other relevant Gottman concepts (e.g., accepting influence, emotional bank account, bids) After the first session . . .  No matter what other interventions you do, inevitably the power orientation/pathological conflict beliefs will spring up and undermine those  As that happens, point it out  As it forms a pattern, point it out  As it is primarily being done by the abuser, point it out  Consistently, persistently increase the strength of your recommendation that the abuser do their own work on these issues  Be willing to shift from being the couples therapist to being one of their individual therapists, preferably the abuser’s Traditional Anger Management  Problem: Difficulties managing and expressing anger  Goal: To de-escalate internally and externallyand more appropriatelyexpress anger  Means: Increased self- awareness, internal de- escalation and external use of behavioral skills  Problem: A person is displaying abusive behavior  Goal: To stop the abusive behavior and change the underlying beliefs  Means: Addressing underlying attitudes and beliefs, teaching alternative skills Violence Intervention Recommended Readings  Michele Harway & Marsali Hansen (2004) Spouse Abuse: Assessing & Treating Battered Women, Batterers, & Their Children  Carol Jordan et al (2004) Intimate PartnerViolence: A Clinical Training Guide for Mental Health Professionals  Terrence Real (1997) I Don’t Want To Talk About It: Overcoming the Secret Legacyof Male Depression  Patricia Evans (2010) The Verbally Abusive Relationship  Lundy Bancroft (2002) Why Does He Do That?: Inside the Minds of Angry and Controlling Men Chris Huffine, Psy.D. Allies in Change 1675 SW Marlow Ave, Suite 110 Portland, OR 97225 (503) 297-7979 www.alliesinchange.org chuffine@pacifier.com

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