Your Abuser in Therapy

By: Dr. Sam Vaknin

Emotional, Verbal, and Psychological Abuse, Domestic and Family Violence and Spousal Abuse

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Your abuser "agrees" (is forced) to attend therapy. But are the sessions worth the effort? What is the success rate of various treatment modalities in modifying the abuser's conduct, let alone in "healing" or "curing" him? Is psychotherapy the panacea it is often made out to be – or a nostrum, as many victims of abuse claim? And why is it applied only after the fact – and not as a preventive measure?

Courts regularly send offenders to be treated as a condition for reducing their sentences. Yet, most of the programs are laughably short (between 6 to 32 weeks) and involve group therapy – which is useless with abusers who are also narcissists or psychopaths.

Rather than cure him, such workshops seek to "educate" and "reform" the culprit, often by introducing him to the victim's point of view. This is supposed to inculcate in the offender empathy and to rid the habitual batterer of the residues of patriarchal prejudice and control freakery. Abusers are encouraged to examine gender roles in modern society and, by implication, ask themselves if battering one's spouse was proof of virility.

Anger management – made famous by the eponymous film – is a relatively late newcomer, though currently it is all the rage. Offenders are taught to identify the hidden – and real – causes of their rage and learn techniques to control or channel it.

But batterers are not a homogeneous lot. Sending all of them to the same type of treatment is bound to end up in recidivism. Neither are judges qualified to decide whether a specific abuser requires treatment or can benefit from it. The variety is so great that it is safe to say that – although they share the same misbehavior patterns – no two abusers are alike.

In their article, "A Comparison of Impulsive and Instrumental Subgroups of Batterers", Roger Tweed and Donald Dutton of the Department of Psychology of the University of British Columbia, rely on the current typology of offenders which classifies them as:

"... Overcontrolled-dependent, impulsive-borderline (also called 'dysphoric-borderline' – SV) and instrumental-antisocial. The overcontrolled-dependent differ qualitatively from the other two expressive or 'undercontrolled' groups in that their violence is, by definition, less frequent and they exhibit less florid psychopathology. (Holtzworth-Munroe & Stuart 1994, Hamberger & hastings 1985) ...  Hamberger & Hastings (1985,1986) factor analyzed the Millon Clinical Multiaxial Inventory for batterers, yielding three factors which they labeled 'schizoid/borderline' (cf. Impulsive), 'narcissistic/antisocial' (instrumental), and 'passive/dependent/compulsive' (overcontrolled)... Men, high only on the impulsive factor, were described as withdrawn, asocial, moody, hypersensitive to perceived slights, volatile and over-reactive, calm and controlled one moment and extremely angry and oppressive the next – a type of 'Jekyll and Hyde' personality. The associated DSM-III diagnosis was Borderline Personality. Men high only on the instrumental factor exhibited narcissistic entitlement and psychopathic manipulativeness. Hesitation by others to respond to their demands produced threats and aggression ..."

But there are other, equally enlightening, typologies (mentioned by the authors). Saunders suggested 13 dimensions of abuser psychology, clustered in three behavior patterns: Family Only, Emotionally Volatile, and Generally Violent. Consider these disparities: one quarter of his sample – those victimized in childhood – showed no signs of depression or anger! At the other end of the spectrum, one of every six abusers was violent only in the confines of the family and suffered from high levels of dysphoria and rage.

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Impulsive batterers abuse only their family members. Their favorite forms of mistreatment are sexual and psychological. They are dysphoric, emotionally labile, asocial, and, usually, substance abusers. Instrumental abusers are violent both at home and outside it – but only when they want to get something done. They are goal-orientated, avoid intimacy, and treat people as objects or instruments of gratification.

Still, as Dutton pointed out in a series of acclaimed studies, the "abusive personality" is characterized by a low level of organization, abandonment anxiety (even when it is denied by the abuser), elevated levels of anger, and trauma symptoms.

It is clear that each abuser requires individual psychotherapy, tailored to his specific needs – on top of the usual group therapy and marital (or couple) therapy. At the very least, every offender should be required to undergo these tests to provide a complete picture of his personality and the roots of his unbridled aggression:

1.     The Relationship Styles Questionnaire (RSQ)

2.     Millon Clinical Multiaxial Inventory-III (MCMI-III)

3.     Conflict Tactics Scale (CTS)

4.     Multidimensional Anger Inventory (MAI)

5.     Borderline Personality Organization Scale (BPO)

6.     The Narcissistic Personality Inventory (NPI)

These tests are the topic of our next article.

Continue ...


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