Working Alliance (WA) describes the relationship between a client and therapist and the underlying bond formed during the therapeutic process.  The majority of researchers believe that a strong WA is essential to a positive treatment outcome. Ethnic and racial differences between clients and therapists can impair the working alliance and therefore influence the outcome as well. “Members of racial/ethnic minority groups may experience greater challenges in establishing a trusting therapeutic relationship due to perceived or actual cultural differences or cultural biases,” said Sherry Muterspaugh Walling of the Department of Psychology at Fresno Pacific University.

Because half of the therapists in the United States are Caucasian or of European decent, Walling believes this presents an obstacle, especially for men seeking treatment for violent crimes. “White therapists working with clients who are members of racial/ethnic minority groups may symbolize past experiences of mistreatment or discrimination or experiences of racism within the criminal justice system,” said Walling, lead author of a recent study that evaluated WA in interracial client-therapist settings. “The current study seeks to address this important research need by examining therapist and client reports of working alliance (WA) by client race/ethnicity across four time points during a 16-week cognitive– behavioral treatment program for male perpetrators of intimate partner violence (IPV).”

The participants included 107 male offenders, half of whom were Caucasian. The other half was Hispanic, American Indian, Asian American or African American. Walling discovered that the Caucasian clients who met with white therapists experienced an increase in WA over the 16 weeks. However, the minority participants did not. “The interaction between client race/ethnicity and WA was also a significant predictor of treatment outcome at 6-month follow-up,” said Walling. “The current findings point to the importance of race/ethnicity in the development of the therapist– client relationship.” She added, “Further exploration into the mechanisms underlying these differences is essential to enhance the effectiveness and quality of treatment programs for partner-violent men.”

Reference:
Walling, S. M., Suvak, M. K., Howard, J. M., Taft, C. T., & Murphy, C. M. (2011, December 19). Race/Ethnicity as a Predictor of Change in Working Alliance During Cognitive Behavioral Therapy for Intimate Partner Violence Perpetrators. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0025751

In psychiatric emergency settings, the standard treatment for aggressive or agitated behavior during psychosis is an injection of Haldol (haloperidol). A dosage of 5 to 10 mg is typically effective at putting a restless patient to sleep in a relatively short period. Aggressive patients are worrisome because they can do harm to themselves or others. An agitated person in the middle of a psychotic episode is not going to respond to the ordinary line of treatments. In some emergency settings, attending physicians choose to combine Haldol with a strong antihistamine such as Phenergan (promethazine). This practice is not recommended by international guidelines; however, researchers believed that the practical experience of emergency room doctors might have revealed a better, safer treatment option for agitated patients.

A group of international researchers conducted a study at a Brazilian hospital comparing the effectiveness of certain approaches to managing aggression and restlessness in patients admitted to a psychiatric emergency room. When an admitted patient qualified for participation in the study, they were randomly administered either Haldol alone or Haldol in tandem with Phenergan. A total of 316 people participated before the trial was stopped. One-hundred and sixty received the combination treatment, while the other 156 received only Haldol. Doctors and nurses observed and recorded how much time passed between administration of drugs and sedation, as well as any adverse side effects.

The trial ended early because data monitors quickly saw the results. Haldol by itself is neither as safe nor effective as when used together with an antihistamine like Phenergan. First, full sedation took much longer with Haldol alone. The longer patients remain agitated, the greater the danger they represent. In addition, one of the more troubling side effects of Haldol is dystonia—painful spasms of large muscle groups. Antihistamines seem to counter this effect, although the exact mechanism isn’t well understood. Because of these dangers, the study was halted when only halfway complete.

Despite the fact that the Brazilian study was left unfinished, the results are still significant. The researchers strongly recommend that psychiatric emergency wards institute administration of Haldol plus Phenergan as standard procedure for aggressive patients. This combination helps increase the safety of both patients and those charged with caring for them.

References

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Haloperidol. Retrieved February 29, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000604/
  2. Huf, G., Coutinho, E., Adams, C. (2007). Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ. 335(7625):869. Published online 2007 October 22. doi: 10.1136/bmj.39339.448819.AE

 

GoodTherapy | When Girls Are BulliesDo you remember your first bully—the girl who called you fat, mocked your choice in clothes, or spread false rumors about you? Of course you do. It’s like a first kiss, a first drink, the first time you drove a car. Only this is a memory you wish you could forget. You may not recall her exact words, but you remember the girl, the time, the place. Did you ever wonder why she did it, what provoked her meanness, how she got to wield so much power?

Bullying is an intentional act of aggression in which the perpetrator belittles, controls, intimidates or harms another person. Attacks are often unprovoked, and exploit an individual’s vulnerabilities or weakness. Although male bullying is typically straightforward, often involving physical aggression or blatantly hostile taunts, female bullying may be more subtle, and therefore, harder to detect. For girls, bullying can be a means of gaining popularity, jockeying for power among peers, or asserting control. Since it is more covert, teachers and parents may overlook clues, or assume the behavior is just a normal part of social interactions.

Some forms that bullying can take include:

So, why do girls resort to bullying? Reasons vary, but usually include a need for control, attention, and approval, or an outlet for anger. Girls who bully may appear threatening and commit hurtful acts, but they often harbor underlying insecurities that fuel their behaviors. Some feel lonely, inadequate, and fearful, and bully to feel powerful or hide their insecurity. Some attack first before they are attacked by others. Some are angry about problems at home and lash out at peers. Occasionally, girls who bully learn these behaviors at home due to family members who are abusive or because of a hostile neighborhood environment. Popularity is no safeguard, since often the girls who bully are those who seem to have it all. Frequently, the pretty, popular, athletic girls are the ringleaders who foster a culture of bullying, even though they may have already acquired power in the social hierarchies of their schools.

The process of bullying can develop slowly over time. Girls who are popular and charismatic may attract others into their circle of friends and make them feel special. They may then try to control these girls, expect favors, or demand that the new girls bully others as well. By controlling a group of peers, bullies achieve power in numbers and go on to terrorize teens they believe are a threat. Individual victims can be targeted at random, but are often selected because of jealousy, noticeable differences, refusal to conform to the group, or a weakness that can be exploited. Bullying also can be sparked by a sudden turn of events in a friendship, where the bully feels threatened and angry, and decides that she must retaliate.

While punches are not thrown, bullying can leave a devastating mark on its victim and engender long-lasting pain and suffering. Girls are particularly vulnerable because of how much they value friendships. Victims can become depressed, anxious, insecure, and feel they are to blame. Obsessive preoccupation with perceived flaws, physical appearance, conformity, and adhering to the bully’s rules of conduct can follow. Conversely, some girls who are bullied become isolated, withdrawn, and even drop out of school. In rare instances, victims can become so depressed and hopeless that they consider suicide as their only option.

Victims often remain silent due to embarrassment, self-blame, or fear of retaliation, so incidents of bullying may go unnoticed. Investigate whether bullying is occurring if your loved one, friend, or student is showing any of the following signs: mood swings, sudden withdrawal from friends, refusal to attend school or social events, sleep problems, academic difficulties, physical complaints, weight loss or gain, or frequent crying.

If you suspect that someone you know is being bullied, it is important to offer support. Reassure the victim that the bullying will end eventually, and that you will help her identify strategies for addressing the problem. One size does not fit all, so a variety of strategies and interventions should be considered depending on the specific situation. Useful websites with anti-bullying tips are listed below. Sometimes getting advice from a therapist or guidance counselor can help. Girls who bully also benefit from counseling, where they can learn to take responsibility for their behaviors and identify appropriate outlets for their anger and need for control.

Prevention is essential, and needs to come from both the family and community. Parents need to discuss bullying with their children, even before it occurs. Teaching girls how to respond to potentially difficult situations, before a problem develops, is critical. Helping young girls improve their self-esteem by developing strong academic, athletic or extracurricular interests, and finding friends who share similar interests (so that social standing is not as critical), may minimize their vulnerability to falling victim. Schools should offer anti-bullying initiatives, including training for staff, programs for students, and counseling services when necessary. When parents, schools, and the community promote an environment where bullying is unacceptable, perhaps fewer girls (and boys) will have to encounter that first bully.

Anti-Bullying Resources and Information:

 

Being the target of bullying can cause a child to internalize and experience a decrease in self-worth. Many children who are victims of bullying become isolated and withdrawn, and often have a limited social circle of friends. “Because many of the correlates and predictors of peer victimization are common in children with ADHD, it is not surprising that children with ADHD are at elevated risk for peer victimization,” said Stephanie L. Cardoos of the Department of Psychology at the University of California, Berkeley. “Although more is known about risk factors for victimization than about protective factors, one well-established protective factor for those at risk of victimization is friendship.” Cardoos and her colleague Stephen P. Hinshaw recently conducted a study to determine what affect friendship would have on bullying. “The overall purpose is to understand factors that may both predict and protect  against peer victimization in girls with ADHD, with a particular focus on friendship as a protective factor,” said Cardoos.

The researchers examined data from 228 girls between the ages of 6 and 12, half of whom had ADHD. The girls were evaluated by counselors at several points during a five week summer camp program and the girls listed who they considered to be their friends and which girls they did and did not like. The team found that all of the girls who were bullied exhibited similar symptoms, regardless of whether they had ADHD or not. “Our core finding was that the presence of a mutual friendship moderated the association between each behavioral risk factor and victimization, such that the presence of at least one friend reduced risk of victimization,” said Cardoos. “The current findings suggest that even for those who may be at elevated risk for deleterious peer effects, such as girls with ADHD, peers can play an important protective role.” She added, “If friends protect by intervening directly in challenging peer situations, it will be important for at-risk children to develop a friend in their natural peer group. In contrast, if friends are most important in increasing self-esteem, interventions outside of the natural peer group may be equally protective.”

Reference:
Cardoos, Stephanie L., and Stephen P. Hinshaw. “Friendship as Protection from Peer Victimization for Girls with and without ADHD.” Journal of Abnormal Child Psychology 39.3 (2011): 1035-045. Print.

Steroid use is believed to cause rage, commonly referred to as “Roid Rage.” But a new study suggests that the anger resulting from increased levels of testosterone may actually merely be a means to an end. “The link between aggression and testosterone has sparked the interest of many kinds of people, from a fan wondering whether anabolic steroids might be responsible for his favorite athlete’s wild antics to the scientist hypothesizing about the biological processes involved in violence,” said Carly K. Peterson and Eddie Harmon-Jones, researchers from Texas A&M University and authors of the study. “Instead, researchers now believe that testosterone plays a role in a broader picture involving power and dominance as opposed to aggression per se. That is, testosterone may facilitate behaviors aimed at obtaining and maintaining power and dominance. It is possible testosterone relates to aggression only because aggression can be one of many ways that people attempt to exert control over others.”

The researchers enlisted 43 students for their study and took saliva samples at the beginning of the study to measure cortisol and testosterone levels. The students were given a neutral activity for 5 minutes, followed by a stressful, competitive virtual game. They were led to believe they were competing with other people and the game was designed so that the students were included during the play for half of the game, and completely ostracized for the other half, causing them to experience heightened emotional arousal. At the end of the game, the students measured their emotions. Within fifteen minutes of the game ending, the team collected a second saliva sample. The results revealed that anger was the only emotion that was linked to increases in testosterone. The team believes that the participants needed to be included and dominate the game as a result of higher levels of testosterone. They added, “Although we believe that a motivation to regain control may assist in explaining the observed correlation between self-reported anger and testosterone, future research is necessary to elucidate the precise mechanisms underlying the link between anger and testosterone.”

Reference:
Peterson, C. K., & Harmon-Jones, E. (2011, September 12). Anger and Testosterone: Evidence That Situationally-Induced Anger Relates to Situationally-Induced Testosterone. Emotion. Advance online publication. doi: 10.1037/a0025300

GoodTherapy | Shadow Work: Transforming Emotional Suffering into Freedom If you read last month’s blog, Creativity vs Shadow, you will remember a brief mention of Deepak and Gotham Chopra’s book, The Seven Spiritual Laws of Superheroes. In the book Chopra identified shadow as a “force of the unconscious that can be destructive, divisive and/or self-sabotaging if it remains unconscious”. Shadow is difficult to recognize because left to it’s own devices it remains unconscious. Shadow is a zapping energy that lurks in the area of emotional suffering caused to oneself or to another. The concept can be broadly applied to families, groups, religions, governments, countries, etc. if we consider them bodies of energy.

It is often easy to recognize someone else’s shadow energy because it is not unconscious to us. It is recognizable it in the behavior of someone who is ‘acting out’ or conversely, someone who appears emotionless. Pointing out someone’s shadow is often met with resistance because shadow is tenacious. It develops as a coping mechanism over time. It pulls vital energy to it to enforce its stronghold.

Shadow is often the very issue that brings someone into therapy, although they may not recognize that aspect of themselves when they begin therapy. They come to therapy because they are suffering in some way and are looking for relief. Often therapy provides relief by helping people to understand their part in their own suffering and to develop new strategies to cope with their emotions.

Art therapy is a powerful tool for helping to get in touch with shadow. Art therapy brings images out from the unconscious to the surface where they can be experienced and felt through the senses and processed verbally. Creative arts therapies can include painting, drawing, collage, movement, sound, video, performance art, writing, dreams, digital media: such as dating profiles, pornography choices, avatars, gaming environments, etc.

Therapists often try to help clients to transform their emotional suffering (shadow) into well-being (freedom) through awareness and change of behaviors that do not ultimately serve their goals. Many of the blogs here on Good Therapy.org provide examples of shadow work. For example: Darren Haber, MFT, Addictions & Compulsions Topic Expert Contributor wrote about The Abused Husband a topic that is gravely under-reported. In Haber’s scenario, the most obvious example of shadow resides with the abuser. The abuser often does not know how s/he gets caught in the cycle of abuse that often escalates and can become very dangerous. The abused person on the other hand, not only suffers the abusers wrath but s/he is not able to understand how to stop the cycle of abuse by recognizing their complicity in it. I realize that my statement may jar strong reaction. Abuse is a dynamic between people. Darren Haber’s blog also contains a subtle example of shadow in the Abused Husband scenario. It resides with the onlooker who “even pumped her fist happily as she watched the woman slapping her partner.” Shadow is present in any violent act, or superficial judgment against another. In this example the onlooker’s shadow was triggered. It is particularly difficult to unravel a dynamic of abuse when it involves people whose lives are closely bonded.

Shadow is the part of the self that most humans get glimpses of but ignore or deny in favor of a self-perception that is ‘inflated’ or in some cases ‘deflated’ by ego. Neither ego inflation nor ego deflation can be sustained without some form of destructive result. For example: Jim Hutt, Ph.D., Family Problems Topic Expert Contributor too Good Therapy.org recently wrote in his blog, Resentful Compliance vs Commitment about a relationship where one person is “resentfully compliant” by doing what their partner wants, while they are “resentful about doing it”. Resentment falls to shadow. The resentful person may say to themselves, “oh, it doesn’t matter that my partner is getting their way again, it’s no big deal”, (ego deflation) when in actuality, resentment grows into a big deal because their true feelings are denied. The result can often be passive-aggressive behavior. The other partner may think that there is nothing wrong with being persistent and that getting their way is a sign of strength (ego inflation). Oftentimes that ego inflation comes out of a profound fear and vulnerability. Most of the time, without realizing how they are complicit in the toxic environment of the relationship both parties continue to project their emotions out onto the other.

In therapy, the therapist encounters shadow in the painful experiences that their clients share. The therapist and client build a safe relationship where shadow can be explored. Shadow is very difficult work because of resistance. The outcome of examining oneself and facing what has happened in one’s life, however, gives a person freedom to create change and use the wealth of energy that was tied up in shadow.

cruelty woman shouting megaphoneWhy do people we care for sometimes engage in cruel behavior? What can we do about it?

Alfred Adler believed the ultimate goal for all human beings is to belong and feel connected to others. Unfortunately, when a person doesn’t find connection with others through kindness and good deeds, they become discouraged and feel inferior to others.

Adler said no one can tolerate these inferiority feelings, and so they over compensate by striving for superiority. One way to strive for superiority is to become a bully. Bullies who band together with other bullies in order to strengthen their sense of belonging are called gangs, terrorists, mafias, and racists.

Understanding Cruelty

Learning theory explains cruel behavior as being modeled. If a child is treated with emotional or physical abuse, the child learns to act that way: “monkey see, monkey do.” So a person, the child who has experienced being treated cruelly, learns to be cruel.

Still another reason for cruel behavior may be mental illness. There are some mental illnesses that manifest themselves with angry outbursts, violence, a lack of empathy, or difficulty understanding the impact of one’s behavior on others. There are also medical conditions, like brain injuries or Tourette’s syndrome, which can feature aggressive outbursts as a symptom.

There are a number of other theories that can explain cruelty, including genetic inheritance. Darwin thought behavior is related to survival, so violence could be seen as adaptive to our very survival—or violence may in the end be the reason humans ultimately fail to survive.

Responding to Cruelty

We can’t change another person’s actions, but we can change our own reactions. Here are some typical reactions to cruelty:

• Retaliation
• Anger and outrage
• Defensiveness
• Fear
• Avoidance
• Passive-aggressiveness
• Self-blame
• “Walking on eggshells”
• Lowered self-esteem
• Attempts to please

These are natural responses, but they never work to stop cruelty. In fact, any of the above reactions can make cruelty intensify. So what can we do to stop cruelty?

We can do as Rudolf Dreikurs said and “separate the deed from the doer.” A person who engages in cruelty engages in unacceptable behavior, but that does not mean the person is unacceptable. That does not mean we chastise, admonish, and punish the person. If we believe in Adler’s theory that all people have a thirst to belong, we can make an effort to accept the person while not accepting cruel behavior. We learn to be more inclusive and forgiving .

We have to feel good about ourselves when we hear cruel things. If we like ourselves enough, there’s no need to get defensive when nasty things are said. We can react as if it’s untrue nonsense that doesn’t deserve an ounce of our negative energy. If someone tells me my hair is pink, which it is not, I don’t have to argue. I may make a joke of it or say, “Thank you, pink is my favorite color!”

We have to take a stand against cruelty. No one deserves to be treated cruelly. It takes two people to fight and only one to stop it. Be the person to stop the nastiness. Refuse to fight. Say “I’m not going to fight with you,” and physically remove yourself.

We must tell ourselves over and over and over again, “I deserve to be treated kindly.”

Does knowing the source of the cruelty help stop the nastiness? I’m not sure. What I do know is that if we want cruel people to stop their behavior, we have to look within and change our own reactions to this heartlessness.

Why do so many men sabotage relationships and careers? Current cultural stereotypes of men range from bumbling incompetence to aggressive, macho insensitivity. I’ve worked with men in therapy and personal growth workshops for over 25 years, and I’ve identified a type of adult man I call the LATE Men, Lost, Angry Teens, and they are often stuck in an adolescent level of development – literally, LATE to grow into full adult functioning.

We all have four primary internal parts: An Inner Child, a Teenager, an Inner Critic, and a loving, responsible Adult. The Teenager seeks independence, identity, and acceptance with peers. Teens may also become rebellious, angry, confused and withdrawn. Adjustment problems are more likely to occur in distressed or dysfunctional families, where adolescents do not receive the guidance, emotional support, and other resources necessary for healthy maturation and individuation. (more…)

GoodTherapy | The Basics of Bullying and How to Stop It“All cruelty springs from weakness.” —Seneca, 4BC-AD65

There are those who say that bullying is behind all forms of violence, conflict, persecution, abuse, harassment, discrimination, and prejudice.

The death of Phoebe Prince in 2010, a 15-year-old Massachusetts girl who hanged herself after being harassed by a group of students from her school, puts a spotlight on bullying among teenagers. And in fact, there have been many notable cases of teen bullying, on and off the Internet (i.e., cyber-taunting on Facebook) that come to mind when we think of bullies.

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However, it isn’t just children and teenagers who bully. Although it may not be as obvious, or as easily identifiable, adult bullying may be more widespread. “Independent research suggests that bullying is happening to around 1 in 4 people” (from “Life After Adult Bullying”). Bullying impacts many of us, regardless of our age.

What Is Bullying?

Bullying is defined as “an act of repeated aggressive behavior in order to intentionally hurt another person, physically or mentally” (Wikipedia). It is characterized as behaving in a manner to gain power over another person. And it is a form of abuse. I would suggest that if you rephrase the descriptive action from “repeated aggressive behavior” to “taking frustrations out” on those who are weaker or different, bullying becomes a much more commonplace and identifiable act. In fact, it is pervasive.

There are different types of bullies and different environments in which they proliferate. There are verbal bullies, physical bullies, serial bullies, gang bullies, cyber bullies, subordinate bullies, unwitting bullies, work bullies, sadistic bullies, and psychotic and sociopathic bullies. There are bullies at work, at home, in schools, in governments, in religious organizations, on the Internet, and in social cliques.

What Kind of People Bully?

Usually people with low self-esteem and a certain amount of unconscious resentment (envy, jealously) that pushes the bully to project their own feelings of inadequacy onto you while denying that anything is wrong with them. Not all bullies are serial bullies. Sometimes the average person loses it under pressure and takes out their feelings in a bullying manner. But regardless of how or why it is happening to you, it is not acceptable.

What all bullies have in common is the use of power to satisfy one’s own psychological shortcomings. Each time a bully moves against someone weaker, he/she feels better about themselves for an instant. But because that feeling doesn’t last, they do it again and again. Sometimes the bully appears to lack insight into their own behavior (unwitting bully), but more often the bully does know yet elects to ignore the moral and ethical considerations by which the majority of people are bound. The rules don’t apply to them. Or they have projected so much self-hatred on the other that they truly believe that those they are bullying deserve exactly what they are getting.

Why Are There So Many Bullies in Society?

One of the reasons bullying is so prevalent is because most bullies commit non-arrestable offenses. And so bullying becomes unconsciously acceptable. It’s an outlet–a way to express–frustration and/or rage.

There are adult bullies we can easily identify. Hitler was a bully; racists are bullies. Parents and older siblings have been known to bully. Certainly, gang members bully. But what about those who threaten, shame, or intimidate you into doing things you don’t really want to do? It happens to most of us, and when it does, we are being bullied. Even when it comes from a person or institution that you love, respect, admire–your government, your church, your significant other, a family member, a professional colleague.

Sometimes there is a fine line between harmless coercion and harmful bullying. But you can feel the difference. You know when you are truly ambivalent and open to being talked into something versus when you are being pressed against your better instincts, wishes, or values. And if you are being bullied by more than one person (i.e. an organization or group), it is even more difficult to stand up for yourself.

More insidious and pernicious is the type of bullying that has less to do about forcing you to do something and more to do with “putting you in your place”–minimizing or even destroying you in order to make someone else feel better about themselves. People do this consciously or unconsciously because of a hole inside of themselves that they try and fill by being better than someone else. It gives them a sense of power and authority in the world that they may not otherwise experience. It is a way to externalize their own feelings of insecurity, inferiority, and/or rage by putting those feelings on someone else and then attacking them.

Some bullying is so subtle that you really believe the bully. They make you feel unsure of yourself; bad about yourself. They can even do it in the guise of friendship or love. It becomes more of a mind game than an outright violation. But it is bullying just the same. We will not be able to rid the world of bullies, but we can learn how to stand up to them.

How Do You Stand Up for Yourself to Stop Bullying?

First and foremost, recognize what is happening and remember that it is the bully who has the problem, not you. Unless they are physically threatening you, bullies are “paper tigers.” If you stand up to them calmly and confront their behavior rationally while asserting your rights, they will back down. If you call them out on their actions, they usually have no place to go–especially if others are witness to these actions.

You don’t have to attack a bully; you simply have to calmly and self-assuredly stand up for yourself. You don’t want to give them reason to escalate by engaging in a heated or emotional manner. You may be thinking that this sounds easier than it would actually be. So start slowly. If you can’t immediately stand up to a bully, at least don’t play into their behavior by trying to appease them.

Let the bully know by your reaction that you are not cowed and quietly walk away. Think about what you want to say and either talk to them later or wait until the next time they behave that way and then call them out on it. Bullies don’t have any real power once they realize that you won’t engage in their game. Once you have exposed them; they will fade away.

Woman is reflected in mirror while sitting on her bed thinkingRecent estimates put the annual number of intimate partner violence (IPV) incidents in the United States at around 8 million. That is, 8 million men and women in the U.S. experience partner violence each year. Over the course of a lifetime, about 30% of all U.S. women and 20% of all U.S. men will experience physical, sexual, or psychological abuse by an intimate partner, and those are just the reported cases. But of course, adults are not the only ones affected; during the course of a year, there are an estimated 3.3 to 10 million children exposed to violence between their parents or caregivers. Partner abuse costs the U.S. nearly $6 billion annually. Most of that is for medical and mental health treatment, but more than $700 million is for lost productivity in the workplace.

Who are these people who wreak so much havoc on their partners, their children, their workplaces, and their communities? There is a stereotype of what an abuser looks and acts like. He is male, usually blue collar, possibly unemployed, who drinks a lot and wears a particular fashion of undershirt. He is hyper-masculine and beefy, a forbidding presence. He demands that his wife have dinner on the table by six, that she keep up the house and children to his satisfaction and that she never question his authority.

The reality is that partner abuse occurs in all social and economic classes, races, ethnic groups, educational levels, religions, and without regard to physical and mental abilities. Women as well as men use it. It occurs between married and unmarried heterosexuals, gay men, and lesbians. A person who abuses their partner physically, psychologically, or emotionally is just as likely to be a corporate attorney as a forklift operator; a hair stylist as a software engineer; a schoolteacher as a deacon in the church. You can’t pick one out of a line-up. Central casting got it wrong.

So to answer the question why do partners abuse? Is not as simple as some would believe. There is an entire school of thought that states that IPV perpetrators are almost exclusively male and their motive for the abuse is to assert male dominance and maintain power and control over their female partners. This school of thought has gained a great deal of traction in courtrooms and legislative bodies all across the U.S., and while the proponents of this view have shed much welcome light on a horrible problem for many American families, it does not tell the whole story nor address the entire problem.

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The Nature of Partner Abuse

Though emphasis of the criminal justice system has historically been focused toward male-on-female “battering” as a microcosmic representation of the broader patriarchal society, more recent literature on IPV reveals that there are different and distinct violent or abusive dynamics that occur between intimate partners. In each of these distinct dynamics, researchers identify different “types” of IPV. And in the most common type, it is next to impossible to differentiate a “perpetrator” from a “victim”.

The most frequently occurring type of partner violence is what has come to be known as “Situational Couple Violence”. Different researchers estimate that anywhere from forty to seventy percent of relationships include this type of IPV. With situational couple violence, there is not usually an ongoing pattern of violent behavior, but rather the violence erupts from a specific conflictual encounter in which both partners act out with verbal and/or physical aggression. In these relationships, verbal and emotional abuse may be common. Women and men are equally likely to initiate this type of partner abuse.

Another type of IPV is identified as “violent resistance,” which may or may not be an act of self-defense against a physical assault. For example, one of the partners may resort to a physical act of aggression in response to the other partner’s emotional or verbal abuse, or in response to repeated jealous accusations. This type of partner violence is often in response to a partner who practices the next identified type of IPV.

“Intimate terrorism” is IPV in which there is a clear perpetrator and victim. Researchers estimate that anywhere from four to eleven percent of partner abuse involves this type of IPV. In intimate terrorism, the violence is part of a process by which one person establishes and maintains control and domination over his or her partner over the long term, rather than one independent act. The abuse may begin in subtle ways and escalate over time, beginning with criticism, verbal abuse and possessiveness, moving on to emotional and economic abuse, and, eventually, physical attacks that may become more frequent and severe. This type of IPV is what most of us think of when we hear the term “domestic violence.” According to crime statistics, men more often commit it, though women can be implicated in this type of pattern as well.

The final type of IPV is the least common. In “Mutual Violent Control,” both partners are entrenched in a pattern resembling two intimate terrorists battling each other for power and control. The violent acts may be a way to exert control, to relieve built-up tension, to take revenge or to avoid intimacy.

In each of these different types, occurrences of physical violence may be chronic, sporadic, or may be an isolated incident. Physical assaults may actually be only the “tip of the iceberg” in an abusive relationship. There is often an undercurrent of ongoing verbal, emotional or other types of abuse that has been present – perhaps for years – before a physical eruption occurs. Interestingly, many partners who have been subjected to verbal and emotional abuse, in addition to physical, say they feel the verbal and emotional abuse do the most damage.

Why Do They Do It?

Given these different types of IPV, it is apparent that partner abuse can occur in completely different contexts and with different motivations. To say that all partner abuse is about men having power and control over women is grossly misleading. Literature on partner abuse suggests that there are many contributing factors — neurological, psychological, interpersonal, situational, and cultural that lead an individual to engage in this type of behavior within their intimate relationships. For example, many incidents of IPV occur while the abuser is under the influence of alcohol, but most people are able to consume alcohol without assaulting their partners.

Some mental disorders are linked to incidents of IPV, and statistically, personality disorders, anxiety, addictions, bipolar disorder, or PTSD may complicate an individual’s ability to deal with interpersonal discord, but to identify mental illness as a cause of IPV is to do a great disservice to the many people struggling with these conditions who do not commit violent acts.

IPV is, in many cases, learned or witnessed in the family of origin. One study estimates that children who witness IPV between their parents are three times more likely to become adult abusers than children who are not exposed to it. Researcher Donald Dutton and others have produced a number of studies showing that the more severe cases of IPV seem to be a result of years of early developmental influences from the family of origin, including witnessing violence, shaming, abandonment, and exposure to trauma (e.g., witnessing partner violence is a type of trauma especially damaging to children). Both genders are susceptible to these influences. The common thread in developmental theories of IPV would seem to be a close link to issues of attachment.

Family of origin IPV is a fairly consistent predictor, but clearly not everyone whose parent was an abuser grows up to be one. Oftentimes, partner abuse is a “choice of last resort” for persons who experience anger or frustration in their relationship, yet lack the skills to express or manage these feelings in a constructive way. Few of us grew up with a model of what a healthy relationship looks like; most of us struggle with stresses and hardships and just do the best we can figuring it out as we go. When relationship conflict arises, we do what our parents did: ignore it, avoid it, deny it, use “the silent treatment,” raise our voices, cry, use put-downs, swear, call names, accuse, blame, walk out, slam doors, throw things, drink, get high, punch a wall, point a finger, raise a fist, hit, slap, punch, kick – you get the idea. Most times, we do exactly as our parents did. It is not uncommon for someone in treatment for abusing their partner to lament, “I’ve done what I promised I would never do – I’ve become just like my father or mother.”

The argument can be made that every relationship has problems and conflict but most people don’t resort to violence. That is very true, and research bears this out.

Abuse of any kind is always a choice. It is not caused by a poor intimate relationship, job frustration, financial crisis, sexual problems, troublesome in-laws, or child-rearing difficulties, although these factors may be present and contribute stress. It doesn’t happen because a person is provoked, drunk, has “rage issues,” bipolar disorder or “impulse control” problems. Substance abuse or psychopathology does not diminish responsibility for IPV. There is no behavior on the part of the victim that causes or excuses abuse. The person who uses violence, coercion or control must bear the responsibility for his or her choice of action.

IPV is a learned behavior; it is learned in the family and broader society (peers, community, mass media). Because it is learned, it can be “unlearned” and replaced with healthy ways of interacting.

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