Your Abuser in Therapy

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 batters 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.

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)

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 the following tests to provide a complete picture of his personality and the roots of his unbridled aggression.

In the court-mandated evaluation phase, you should insist to first find out whether your abuser suffers from mental health disorders. These may well be the - sometimes treatable - roots of his abusive conduct. A qualified mental health diagnostician can determine whether someone suffers from a personality disorder only following lengthy tests and personal interviews.

The predictive power of these tests - often based on literature and scales of traits constructed by scholars - has been hotly disputed. Still, they are far preferable to subjective impressions of the diagnostician which are often amenable to manipulation.

By far the most authoritative and widely used instrument is the Millon Clinical Multiaxial Inventory-III (MCMI-III) - a potent test for personality disorders and attendant anxiety and depression. The third edition was formulated in 1996 by Theodore Millon and Roger Davis and includes 175 items. As many abusers show narcissistic traits, it is advisable to universally administer to them the Narcissistic Personality Inventory (NPI) as well.

Many abusers have a borderline (primitive) organization of personality. It is, therefore, diagnostically helpful to subject them to the Borderline Personality Organization Scale (BPO). Designed in 1985, it sorts the responses of respondents into 30 relevant scales. It indicates the existence of identity diffusion, primitive defenses, and deficient reality testing.

To these one may add the Personality Diagnostic Questionnaire-IV, the Coolidge Axis II Inventory, the Personality Assessment Inventory (1992), the excellent, literature-based, Dimensional assessment of Personality Pathology, and the comprehensive Schedule of Nonadaptive and Adaptive Personality and Wisconsin Personality Disorders Inventory.

Having established whether your abuser suffers from a personality impairment, it is mandatory to understand the way he functions in relationships, copes with intimacy, and responds with abuse to triggers.

The Relationship Styles Questionnaire (RSQ) (1994) contains 30 self-reported items and identifies distinct attachment styles (secure, fearful, preoccupied, and dismissing). The Conflict Tactics Scale (CTS) (1979) is a standardized scale of the frequency and intensity of conflict resolution tactics - especially abusive stratagems - used by members of a dyad (couple).

The Multidimensional Anger Inventory (MAI) (1986) assesses the frequency of angry responses, their duration, magnitude, mode of expression, hostile outlook, and anger-provoking triggers.

Yet, even a complete battery of tests, administered by experienced professionals sometimes fails to identify abusers and their personality disorders. Offenders are uncanny in their ability to deceive their evaluators.