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When should couple therapy be the choice of intervention?

Crime statistics show an egregious level of domestic violence by men against women. In many instances, the violence and psychological abuse is severe and frequent, with little or no sense of remorse for the harm inflicted. The abusive situation may be exacerbated because the male perpetrator misuses alcohol and/or illicit drugs, has mental health problems and is also violent outside of the family home. As previously emphasised, couple therapy is strongly contraindicated in such cases.

However, findings also reveal that domestic violence operates on a broad continuum of seriousness, with homicide lying at one extreme and pushing and shoving at the other. Moreover, an increasing body of research presents a picture of relationship violence that is reciprocal and bidirectional in nature. This finding obtains in both opposite-sex and same-sex relationships. Commonly, the violence is infrequent, confined within the family and relatively “minor”. Whatever the form, violence and abuse are wholly unacceptable: the acts may differ in magnitude, but not in essence. The issue of escalation also needs to be kept in mind in assessing the risk of physical injury and psychological harm.

The decision whether or not to work therapeutically with a couple whose intimate relationship is characterised by violence and abuse should be informed by an assessment of risk, by relevant research findings, and by the couple’s particular needs and socio-cultural context. The detrimental impact on any children of the family should also be assessed. I think it good practice to see the couple together for an initial meeting followed by a separate interview of both partners. This may facilitate disclosure of violence and abuse. It also provides the opportunity to take each partner’s attachment history, explore their experiences of abuse and psychological trauma, and to assess the general emotional and sexual quality of the relationship and their respective adult attachment styles. In cases where the couple disclose a low level of violence and abuse, and both partners indicate their desire to freely participate in couple therapy with the initial goal of eliminating all forms of abuse, it makes good clinical sense to work on the relationship conjointly, not least because the woman is much more likely to be physically injured in a violent exchange.

How, then, can attachment theory help us to understand the contradictory relationship between violence and abuse on the one hand and love and intimacy on the other? Why do so many people hurt the ones they love?

Adult attachment can be represented by two underlying dimensions reflecting the degree to which an individual feels uncomfortable in intimate relationships or fears abandonment from the partner. These dimensions are labelled ‘Discomfort with Closeness’ and ‘Anxiety over Abandonment’. Adults with a dismissing attachment style report more Discomfort with Closeness, whereas those with a preoccupied attachment style report higher levels of Anxiety over Abandonment. Researchers have presented evidence showing that couple violence is related to the regulation of intimacy and the maintenance of proximity within the relationship.

Whereas a secure partner may provide a buffering effect for the behaviour of an insecure individual, the pairing of two insecure individuals may prove a highly volatile combination, especially if one partner is fearful of abandonment and the other is uncomfortable with intimacy. This not uncommon combination of adult attachment styles may be especially fraught and combustible because of the conflicting needs for intimacy involved. In particular, a person who is anxious over abandonment may find the withdrawal and emotional distance of a partner who is uncomfortable with closeness extremely anxiety-provoking. As the preoccupied partner escalates the appeal to have dependency needs met, this escalates the dismissing partner’s defensive response of distancing, which leads to subsequent pursuer-distancer escalations. When the closeness/distance struggle cannot be negotiated to suit both partners’ intimacy needs, the conflict, fuelled by chronic fear and distress, may escalate out of control and erupt into violence.

Dismissing individuals, then, tend to deactivate their attachment system and withdraw from conflict situations, presenting as overly independent and self-reliant. By contrast, preoccupied people are chronically hyper-vigilant and anxious about rejection and abandonment. They have such excessive needs for support and reassurance that they are inevitably frustrated in not having these needs met. They may become increasingly demanding and potentially violent when their attachment needs are not fulfilled. Indeed, research has identified an association between couple violence and withdrawal from conflict, with violence being used to protest the distance and prevent the partner from leaving the scene of conflict. Therapeutic approaches that are unfamiliar with such attachment dynamics often employ ‘time out’ as a safety strategy. However, unless carefully thought through and managed, the ‘time out’ strategy may unwittingly escalate the conflict, being misconstrued as a defensive withdrawal, and thus place one or other partner at greater risk of a violent assault.

From the foregoing, it may be seen that instead of focusing on perpetrators and victims in isolation, a relational or systemic approach informed by attachment theory and research examines the interaction between the partners’ adult attachment styles. This shifts the focus from the individual to the dyad and to a discussion of the relational context in which the violent behaviour develops and is maintained. Links may also be drawn to the way in which the current conflict is activating dissociated archaic self-other mental models associated with early attachment trauma. Individuals whose attachment histories have made them especially susceptible to anxiety, rejection, separation and loss may be most likely to perceive ambiguous behaviour by a partner as rejecting and unsupportive. This is likely to be subjectively experienced as posing an imminent threat to their security and integrity as a psychological self. Sexual jealousy and fears of rejection and abandonment are common triggers of violent incidents in intimate relationships, with the violence functioning in a wholly maladaptive way to regulate intimacy and maintain proximity to the loved one whose loss is so desperately feared.

Couple violence, then, is a complex phenomenon and has both relational and individual origins. Understanding the traumas and adult attachment styles that people bring to their intimate relationships in the context of their early attachment histories may help us to assess whether or not, and under what specific circumstances, couple violence is more likely to occur. Violence, as a relationship trauma, corrodes and violates the couple’s love bond and compromises the capacity of the relationship to serve as a secure base and safe haven for either partner. Following a comprehensive assessment of risk, the employment of an attachment-based couple therapy may enhance the partners’ understanding of their mutual needs for security, love and closeness. The overarching goals are for the couple to end the violence and abuse, soften their blaming attitudes, repair any relationship traumas, and communicate their hurts and needs in an emotionally engaged and direct way. Optimally, the therapeutic process will help the couple to function more effectively as a source of security for one another, thereby decreasing the likelihood of violence and abuse in the future.

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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Written by Paul Renn

I am a relational psychoanalytic psychotherapist and author in private practice in central and south west London (see below in 'Extra Information' for details of my practice addresses). I am accredited by the United Kingdom Council for Psychotherapy (UKCP). I work with individuals, offer couples counselling and also supervise counsellors and psychotherapists. I also work as a life coach.… Read more

Written by Paul Renn

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