Intimate partner abuse

I’ve been reading Lundy Bancroft‘s book ‘Why Does He Do That? about the causes and management of domestic abuse, which takes down many pervasive myths. For me, reading it as a health care professional, these were the main points:

  • Typical abusers do not, despite what is commonly believed, abuse because of overwhelming inner pain or anger management problems. They abuse because they have outsize senses of entitlement and a lack of empathy to the problems their actions cause for their partners.
  • Abusers get a surprising amount of benefit from their abuse. Obviously, if they get a kick out of control-freakery then that in itself can be satisfying; however, even if this isn’t the case, they can get themselves set up in a situation where no-one in the family dares to challenge them or expect them to pull their weight with day-to-day work, and where they can count on getting their way in any disagreement because the other family members are too scared to stand up to them.
  • If someone confesses to you that they have been abused, the best way to react is by treating them in the opposite way to the way the abuser treats them. Since abusers treat their victims as incompetent and unable to make decisions and try to convince them not to trust their perceptions, let an abuse victim know that you trust her to know what is going on and to make the best possible decisions for her situation. Obviously, support the victim as much as possible; just don’t fall into the trap of lecturing a victim on what they should be doing. If a victim feels leaving will make things worse, trust them.
  • Psychotherapy does not help abusers and may well make them worse, because it encourages them to focus on their feelings rather than their beliefs and behaviour, which is precisely the cause of the problem in the first place.
  • Similarly, couples’ therapy can backfire badly because the therapists are so used to a paradigm in which both partners contribute to issues in the marriage and where problem-solving involves both partners needing to make compromises. In an abuse situation, this can feed abusers’ beliefs that they only abuse their partners because their partners make them so angry, and allow them to reinforce this to their partners. Also, of course, revealing abuse to a counsellor can be very unsafe and trigger an episode of severe abuse in itself.
  • The only abuse programmes known to be of some help are long-term programmes (up to a year or two) providing confrontation as well as education, coupled with clear adverse consequences for the abuser (court-imposed penalties and/or the woman leaving him for an extended period of time or permanently). Even the best of programmes are successful in only a minority of cases, because they rely on the abusers’ ability to want to change, which is in short supply given the many benefits abusers get from their abuse and the justifications they are used to using to themselves.
  • Trying to persuade or plead with an abuser to change will not work. Confrontation and consequences are the only things that stand a chance. An abuser not faced with these may get as far as joining an abuse programme, but won’t stay the distance.
  • A good abuse programme will focus on the victim – both on supporting her and on checking her perceptions of whether the abuser is changing. (Abusers, not surprisingly, can be extremely successful at talking the talk during the programme, without actually walking the walk at home. Conversely, sometimes abusers who seem very dismissive during the sessions can actually make deep and lasting changes at home, so there is hope.) The woman should be considered the primary client.
  • There are various signs that an abuser is/is not changing, but the most reliable one is whether the abuser’s partner feels that he is. The partner’s perceptions of the matter should always be trusted.
  • If an abuser gets critical of his partner for not believing that he’s changed, that’s a red flag. Abusers cannot change unless they accept not only what they have done and the consequences to the partner, but also the effect that this will have on the relationship in terms of long-term damage to trust.
  • When looking at whether an abuser has changed, don’t look at whether he’s being nice (abusers are typically great at doing ‘nice’ temporarily) but at whether he’s become respectful and non-coercive.
  • Giving up abuse is like giving up smoking – cutting down doesn’t help. An abuser who has made only partial changes and plateaued will eventually slide back into being fully abusive, because his core justifications and beliefs (that his partner deserved the abuse, that it’s his right to abuse his partner) are still unchanged below the surface.
Advertisements

About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Abuse, Credits 2014. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s