Counselling Case Study: Domestic Violence
The client, Gary, called to make his first appointment and said he was persuaded by “a mate” to attend counselling to control his anger. In short Gary was a perpetrator of physical abuse against his intimate female partner, Julie, who is 22 years of age. The couple have no children but his partner has recently expressed a desire to have a child with him.
The client is 28 years old and a labourer by occupation. He has only had casual/ contractual employment and has been subject to periods of unemployment, the longest being three months. At the time of beginning counselling Gary was unemployed and renting with his partner in a shared house with another couple.
Brief outline of the counselling techniques used in the session
The counselling approach chosen is based on the findings in a report by authors Richards, J; MacLachlan, A; Scott, W; & Gregory, R. (2003) – Identification of Characteristics and Patterns of Male Domestic Partner Abusers.
Psycho-educational techniques became prominent early in partner abuse treatment, and remain ubiquitous today. Psycho-educational programs typically include educational instruction around power and control issues, gender role attitude restructuring and anger management.
Participants also learn how to manage hostility and aggressive impulses (Arias & O’Leary, 1988). In current psycho-educational programs, the focus is on altering the attitudes of abusers by teaching new options, strategies and skills. Abusers are also expected to become responsible for their abuse, anger and violent behaviour. (Richards et al 2001-2 p. 10)
As reported by Hamburger (1997 cited Richards et al, 2001. p.10) “cognitive behaviour therapy (CBT), like psycho-educational intervention, is well suited to treating men who abuse their partners”. The aim of CBT is to place responsibility for cessation of domestic violence with the perpetrator. CBT approaches also provide systematic, empirically based methods to facilitate specific behaviour change and cognitive re-structuring. This all adds up to CBT being a logical choice in counselling Gary.
The introductory session revealed that Gary had also been under pressure from his partner’s family to attend counselling or face retaliation. There was also a serious warning from his partner that she would leave him if he did not seek help to change his behaviour and stop his displays of physical abuse in the home.
It was obvious that Gary felt intimidated and irate by the ‘threats’ yet he did admit to behaving with “mild physical and verbal abuse” towards his intimate partner. Incidents of this abuse include slapping and pushing her, shouting insults to her face, and delivering embarrassing comments about her in public.
Gary’s history revealed that he had previous relationships, without children, that ended as a result of his violent and abusive behaviour. According to Gary no serious harm has been dealt to his current partner; he has not been officially charged by police for assault. He claims that his abusive behaviour is restricted to behind closed doors or only in the home.
The structure of the CBT sessions, were adapted from a cognitive behavioral therapy group for abusive partners (for details see Taft, Murphy, King, Musser, & DeDeyn, 2003). In this case study, sessions were divided into four sequential blocks of two sessions. Each session sought firstly to assess and develop Gary’s motivation to change and subsequently to offer him self-management strategies to help him deal with his anger issues.
In the first block the client was guided to explore his motivation to change and commitment to a nonviolent relationship; assessing his readiness to change in the first session could provide a predictor of positive outcomes. [For an overview of Motivational Interviewing (MI) refer to Resnicow, Dilorio, Soet, Borrelli, Hecht, & Ernst, (2002). For a discussion on predicting a perpetrator’s readiness to change refer to Scott & Wolfe (2003).]
The second block was devoted to teaching crisis management techniques, such as time out, to avert violent behaviour during difficult relationship situations.
The third block involved assisting the client to formulate his own self-management plan to deal with his anger and stress, including self monitoring of anger cues, rational restructuring of anger-producing thoughts, and applied relaxation exercises.
The fourth block has the client working on learning positive relationship skills as an alternative to coercion and aggression, including communication and assertiveness skills.
This plan is flexible and I have allowed two additional sessions for wrapping up, reviewing changes made, and articulating goals and plans for continued personal work.
Session One: Motivational Interviewing Style
The tone and mood setting for the first session follows the motivational interviewing (MI) style closely (Miller & Rollnick, 1991 cited Resnicow et al 2002).
The basic tenets of MI are closely related to Carl Rogers person-centred counselling being:
- a supportive climate where the client can feel comfortable expressing both positive and negative aspects of his current behaviour.
- where the client is encouraged to talk more than the counsellor
- initially the role of the counsellor is to engage in reflective listening without attempting to confront denial, irrational or maladaptive beliefs, or try to convince or persuade.
- primarily invites the client to think about and verbally express his own responses for and against change, how his current behaviour may conflict or be an obstacle to achieving immediate and long term goals.
- an opportunity to use a neutral tone to address discrepancies in client knowledge, beliefs or behaviours without promoting defensiveness
As Gary’s counsellor I had to make sure that I resisted providing information or advice until he had first presented his own understanding of his ‘life’s frame of reference’, including any ideas he thought possible for changing his behaviour.[In the following transcript counsellor is abbreviated to C and Gary to G.]
C: Well Gary, where would you like to begin?
G: (Shifting in his seat) Well… I have been made to come here by my girlfriend, Julie, and her family.
G: They say I’m a violent person because of what I do when I get agro with Julie. (Looking away, breaking eye contact)… All I do is shout at her, then she goes whingeing to her family and they all gang up on me.
C: What else happens?
G: (Raising his voice, leaning forward and gripping the armrests.) I really got agro because she complained to her parents. If she’d just copped it… then things wouldn’t have got out-of-hand. C: Just copped it?
G: She’s always on at me to get a better job, to be like her sister’s boyfriend. Day in, day out she’s nag, nag, nag… I never seem to do anything right. I can’t help it if there are no good jobs out there… Look at these hands (standing, then sitting down, holding out his hands, his voice rising). Do they look like the hands of someone who doesn’t know what hard work is?
C: I see what you mean Gary.
G: I wish to hell other people would see that I’m not a bludger, I can match any man in doing a bloody hard day’s work. I had to work hard… no one ever cared about Poor Old Gary! (slumping in his chair, head bowed, punching left fist into right hand).
C: What are you telling yourself Gary?
G: (shouting) You tell me!
C: I’ve only known you 15 minutes.
G: Well, (getting up and walking towards door) aren’t you going to try and stop me?
C: No, it’s up to you.
G continues walking around the room, his body tense, anger and frustration in his face; C watches him in silence. After a few minutes Gary show signs of calming down and returns to his chair.
C: What are you telling yourself here?
G: I have been in and out of relationships with women… why… I love Julie… she is the best girl so far. why do I get so angry with her?
C: It is good to hear you using “I” statements.
G: What do you mean?
C: It tells me that you are accepting responsibility for your own behaviour.
G: It might sound like that to you but I see it differently. She doesn’t know when to shut up!
C: How could you behave differently to avoid getting angry?
G: I thought you’d say that.
C: Gary, I can only help you if you want to change.
C suggested they take a short break during which Gary could think about things on his own.
On resuming C began to provide feedback on what Gary had said.
C: It seems that Julie is very unhappy with your behaviour and she is asking you to change it. You love Julie and want the relationship to last and not turn out like others you have had in the past. While your anger is directed against Julie and generally in private, your behaviour is now beginning to attract possible retaliation from Julie’s family. Does that describe the situation?
G: Yeah, that’s right
C: Can you help me understand what you mean when you say you love Julie and want the relationship to last?
G: I guess I don’t want a repeat of those times when I felt lonely. I have been alone enough times and I don’t want the hassles of starting another relationship. I want some continuity in my life and Julie is the one.
C: So you fear being on your own again?
G:(After a long pause) So?
C: So what has controlling your violence got to do with being here?
G: If I want to remain an important part of Julie’s life I need to treat her differently… If I want to feel…(hesitates before closing his mouth tightly and turning his head away)
C remains silent, waiting for him to continue, there is a long pause.
G: I hate it when I get like this
C: Like what?
G: I want to go now.
C: You know you can leave anytime.
G: You’re trying to get me to admit that I’m in the wrong, that it’s all my fault when we argue.
C says nothing.
G: I do all I can to be what she wants me to be, but she always finds me lacking… I get angry and hit her… I shout at her and put her down.I want her to feel as bad as she makes me feel.
C: OK, Gary I’m asking you to try and hold on to that feeling of wanting to hit back. Let it slowly build but stop when you sense you are about to lose control.
G tenses his upper torso, raises his right arm as if to strike out then shouts: You bitch! You never give me the same approval you hand out to others!
C: Stay in control. Hold back from striking. Listen to me Gary, listen to my voice. Repeat after me. I… HAVE… A… CHOICE!
G: I… HAVE… A… CHOICE!
C: I… CHOOSE… TO… REMAIN… CALM (my voice level drops and slows down when saying the word calm).
G: I… CHOOSE… TO… REMAIN… CALM C: We repeat this sequence until Gary’s temper and anger subsides.
(Now in a calm voice) “I have a choice and I choose to remain calm” – Gary repeats these words a number of times and then stops and stares into space, C remains silent, watching him.
G: Do you think that will work for me the next time I get agro?
C: Together we can start to make a difference.
G: I need a break.
During the short interlude I took time out to consider what I had learned about Gary. I sensed that he might fit the typology of a male batterer who according to Holtzworth-Munroe & Gregory (1994 p. 492) is a family-only batterer rather than someone likely to be violent in the wider social context. He may have high security and belonging needs, and low self-esteem. A lack of social and assertiveness skills may also contribute to his abusive behaviour.
C: Gary, we’re nearing the end of this session, is there anything else you want to talk about?
G: I can’t think of anything.
C: I know it’s not easy for you to control your anger, but you managed to do so.
G: I lost it a bit.
C: Can you tell me what it felt like when you “lost it”?
G: Well, I sure was not happy with myself…I had time to think about it during the break when I went outside… and… after I calmed down I was still shaking a bit… … I do want to fix it.
C: Have you any ideas about how you would like to fix it?
G: No, not really
C: Would you like to consider some possible ideas?
C: Let me begin by saying that I have confidence in your ability to change. I’m going to suggest some material for you to read on your own. Find somewhere comfortable you enjoy, away from the environment that you find yourself being violent in. It’s a book which describes some better ways to deal with those times when you and Julie lock horns and you respond with the violence and anger that harms her and your relationship. It includes chapters on communication and assertiveness skills, how to express yourself better and how to manage anger. What do you say?
G: I think I can manage that…but what can I do now to stop myself from flying off the handle.
C: You have already found one way to cope.
G: I have?
C: Time out, just like we did during this session. Move out of the difficult situation, calm down and then you will find it much easier to try to deal with what is making you angry.
G: So until I see you again, I make a conscious decision to take time out whenever I feel I am getting angry?
C: It will not be that easy in the beginning but with practice it will get easier and each time you succeed you will be reinforced by feeling of being in control; a sense of empowerment in making a conscious choice to stop your anger building before it gets out of control. Maybe, when Julie sees you are trying to change she may also change some of her styles of communication. Gary, it is very important that you tell yourself when you immediately sense your anger rising: I…HAVE…A…CHOICE… AND… I…CHOOSE..TO REMAIN…CALM.
G: I have a choice and I choose to be calm… I have a choice and I choose to be calm.
C: Then when you have removed yourself from the situation that’s making you agro, I want you to try the relaxation exercises I taught you. If you don’t want to do the exercises, you can do something physical that you enjoy – walking fast, jogging, cycling perhaps.
G: OK, I’ll try.
C: Something else you might consider which might help is to write down when you get angry, what the triggers are, what happens just before. If we can start to identify what is making you angry, it will be easier to find ways to manage it.
G: I hope it will not happen as much. but I get your drift. Thanks for your help.
The session ended with Gary feeling positive about doing the homework tasks he had been set and confident about using the mediating response he had learned. In future sessions we would look at role playing to practice better communication and relationship skills.
Author: Paul Hodge
- Bard, J. A. (1980). Rational Emotive Therapy. Illinois: Research Press. Holtzworth-Munro, A., & Stuart, G. L. (1994). Typologies of male batterers: three subtypes and the difference among them. Psychological Bulletin 116(3), 476-497.
- Johnson, D. W. (1993). Reaching out: Interpersonal effectiveness and self-actualization (5th Ed.). Boston: Allyn & Bacon.
- Resnicow, K., Dilorio, C., Soet, J., Borrelli, B., Hecht, J., & Ernst, D. (2002). Motivational interviewing in health promotion: It sounds like something is changing. Health Psychology, 21(5), 444-451.
- Richards, J., MacLachlan, A., Scott, W., & Gregory, R. (2003). Final report: identification of characteristics and patterns of male domestic partner abusers. Canberra: Criminology Research Council. Retrieved July 28, 2005 from http://www.aic.gov.au/crc/reports/200001-04.pdf.
- Scott, K. L., & Wolfe, D. A. (2003). Readiness to change as a predictor of outcome in batterer treatment. Journal of Consulting and Clinical Psychology, 71(54), 879-889.
- Taft, T., Murphy, C. M., King, D. W., Musser, P. H., & DeDeyn, J. M. (2003) Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men. Journal of Consulting and Clinical Psychology 71(4), 812-820.