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

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. 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. 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. 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. 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. 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. 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. 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. 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. 10/25/2015
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. 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. 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