Contrasting Perspectives on the Use of Couples Therapy in Instances of Relational Violence

It was established on the first day of our two-day Domestic Violence workshop that couples therapy is contraindicated for patients where intimate partner violence is present, but we didn’t have time to go into depth as to why this is. In order to understand this, we must start but remembering the primary purpose of psychotherapy is to treat mental illness. As outlined in the DSM since the 3rd edition, the current definition of mental illness or mental disorder in the DSM-5-TR is defined as “a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2022). One could perhaps conceptualize the abuse of a domestic partner as a problem of emotional regulation and/or behavior, but in my research, holes in this perspective were illuminated. Couples therapy in particular is meant to treat relational dissatisfaction, but as will be discussed later, in couples where abuse is occurring, treating couples may not only be ineffectual but could even be damaging to the person in the dyad who is being abused.

Another important point of consideration is that the definition of abuse is often subjective. The APA dictionary defines it as, “interactions in which one person behaves in a cruel, violent, demeaning, or invasive manner toward another person or an animal. The term most commonly implies physical mistreatment but also encompasses sexual and psychological (emotional) mistreatment.” (American Psychological Association, n.d.) Specifically when we are discussing intimate partner violence, it’s worth noting that we are talking about patterns of abuse, and that the abuse is specifically designed to effectuate control of another person or persons by the abuser (as discussed in the next section). This differentiates it from violence occurring outside a domestic partnership, as well as bilateral and rare instances of mutual aggression that does not result in injury for either party (which I will discuss later in this paper).

As I often do when exploring a new research topic, I like to start with the public facing literature to conceptualize the topic and then use scientific journal articles to either substantiate or refute it. One of the most popular books on the subject of domestic violence is Why Does He Do That? Inside the minds of angry and controlling men. (Bancroft, 2003). The book is written by Lundy Bancroft, a man who at the time had been running groups for men who had self-reported abusing their partners and then later were court-mandated for that reason. I first heard of the book in a casual discussion with a friend who was finishing her Masters in Psychology at USC at the time. Despite the fact that Bancroft is not himself a psychologist, and the text is written for a popular audience, it had still been assigned to her as reading in a clinical, graduate-level course. I was surprised by this at the time, thinking that she would be reading more empirically researched works. But in looking for such a text myself when writing this paper, I also came up short. It’s a bit of a catch-22 that the major criticism of Bancroft’s work is that it is not scientifically researched; and yet no real book on the why of domestic violence that is written from a psychological or psychotherapeutic standpoint and backed up with quantitative research exists that I could find.

Bancroft’s main argument in his book, qualitatively linked to his background in working with abusive men, is that abuse is not a mental illness and therefore cannot be treated by psychotherapy. Although many in the public assume that someone’s abusive behavior is a result of mental illness (check tik tok and the enormous popularity of so-called ‘narcissistic abuse’ content), Bancroft refutes this using what we in the field refer to as trait vs. state (Geiser et al., 2017). In this concept, the latter is a temporary experience or episode that may symptomatically resemble a mental illness, for example a period of sadness following the death of a loved one; as opposed to the former, which indicates a stable or mostly static pattern, such as major depressive disorder, which because of its enduring nature would be considered a mental illness. Bancroft conceptualizes that because the abusive partner only treats certain people (i.e., his partner) abusively, his behavior cannot be seen as a personality trait, and therefore cannot be conceptualized as a mental illness. The abusive partner, for example, may fly off the handle in a rage in response to a request by his partner, but he is able to stay calm when his boss makes requests of him, for example. This indicates that his abusive behavior is not a disorder beyond his ability to control, but is strategically, or at the very least, deliberately employed. The true narcissist, who has personality disorder characterized by an unsubstantiated entitlement to special treatment and a lack of empathy for others (American Psychiatric Association, 2022), behaves narcissistically with everyone, not just his partner. Bancroft emphatically states that, “no psychological test can distinguish an abusive man from a respectful one” (Bancroft, 2003, p. 216), meaning that though abusive behavior may present alongside mental illness, being abusive in itself is not itself a mental health diagnosis. Therefore, from Bancroft’s perspective, we cannot treat abusive behavior with mental health treatments such as psychotherapy.

Despite Bancroft’s contention, not all agree with his perspective, and they substantiate their perspective by delineating more specifically the ‘types’ of intimate partner violence that Bancroft views singularly. One such scholar is Michael P. Johnson, a professor emeritus of sociology and women’s studies at Pennsylvania State University. He conceptualizes different classifications of violence that include, in descending severity: Intimate Terrorism, Violent Resistance, and Situational Couple Violence (Johnson, 2012). While the first type concerns violence as a method of control (its description is most in alignment with Bancroft’s description of abuse), and the second type is a response to the first, Johnson posits that a third type of intimate partner violence exists that is not related to control. Instead, Situation Couple Violence is usually in response to a specific circumstance, typically the same things that bring most couples into relational therapy: money, child rearing, relationship status, or substance abuse issues. Johnson suggests that this specific type of intimate partner violence’s “root cause lies in chronic sources of stress and conflict in the couple’s life… sometimes it lies in the psychological problems of one member of the couple, such as alcohol abuse problems or anger management problems. At times the problem has less to do with one individual and more to do with how the couple communicates.” (Johnson, 2012, pp. 60-61) This differs greatly from Johnson’s conceptualization of Domestic Terrorism, which like Bancroft’s conceptualization of abuse, is a strategy of control. Instead, SPV occurs because partners do not have the skills of conflict management, communication, or anger management.

As therapists, whether or not we can be helpful to a couple is worth weighing against the potential harms caused by treatment, in accordance with our oath of nonmaleficence. In the instance of SPV, while psychoeducation is within our wheelhouse, it is up to the therapist’s discretion to decide if they are capable of teaching these skills. It’s worth noting that there are people who specialize in groups that teach anger management and communication skills, which may be a better fit for these clients than psychotherapy, if that is truly what they need to improve. Perhaps the therapist could keep seeing the couple concurrently, or after that skill-based treatment was completed. Though Situational Couple Violence is less likely than Intimate Terrorism to result in severe physical or psychological injury, the risk of homicide and/or post-traumatic stress syndrome are still significantly higher than in non-violent couples (Johnson 2012, pp. 43-47). For this reason it is important for therapists to honestly evaluate their abilities and refer out to specialists in this area where appropriate.

Although it was made clear in class that therapy is contraindicated in instances of intimate partner violence, the fact remains that many therapists continue to treat couples where violence is present. A popular textbook for graduate level psychology students, Clinical Handbook of Couple Therapy, which is assigned for our required class on that subject at Antioch, has an entire chapter devoted to the treatment of so-called “partner aggression” (Leblow & Snyder, 2023). The chapter makes a clear distinction, similar to Johnson, that there is a scale among types of intimate partner violence, though they separate it as either mild-to-moderate or moderate-to severe partner aggression (the former being a slap or push, and the latter resulting in injury). The authors argue that in instances of moderate-to-severe violence, “conjoint interventions” should be forgone (Leblow & Snyder, 2023, p. 8). However, the authors take issue with the “gender-specific treatment groups” that Bancroft suggests as best referrals for male perpetrators of intimate partner violence, stating that they “have shown limited effectiveness, with high recidivism”. Instead, they argue that by not working with the couple specifically, the violent partner misses out on learning dyad-specific tools to better handle conflict in the forum in which they occur: the relationship of the couple (Leblow & Snyder, 2023, p. 392).

The problem with this perspective is two fold: first, it assumes that the self-reports of clients are accurate, when in the case of IPV we should assume the opposite. Perpetrators of intimate partner violence, despite their justifications, generally know that their behavior is frowned upon. As a result, they may be incentivised to downplay the severity of their abuse. Additionally, victims fear retaliation from their abusers should they disclose the abuse. This fear of retaliation makes the victim of abuse likely to downplay or minimize what is happening in their self-report, at least until they are certain they can trust the therapist. A level of hesitation or non-disclosure from clients in general is to be expected in the beginning of a therapeutic relationship, as rapport and trust in the therapist are built over time. However, in the case of intimate partner violence, time is one of our most important interventions, as violence tends to escalate over time (Boxall & Lawler, 2021).

If therapists cannot always rely on client self-report, how then can they effectively discern which couples are appropriate for treatment? The answer lies in proper screening. Screening questionnaires designed to assess for the presence of intimate partner violence include: HITS, The WAST/WAST-SF, The PVS, The AAS (for pregnant women specifically) (Rabin et al., 2009). These scripts were originally developed for use in healthcare settings (Paterno & Draughon, 2016). Screenings should be brief and conducted with each partner separately (Hogan, J. N., 2022). They can be implemented formally or informally. If the data resulting from the clinician’s chosen assessment indicates the presence of more than mild aggression, best practice is to terminate couples therapy and refer clients to individual therapy instead. If assessments are not indicative of intimate partner violence, and yet an instance of more than mild violence occurs over the course of therapy, it is suggested the clinician “conducts a supplemental crisis management session focused on preventing further violence.” (Leblow & Snyder, 2023, p. 395) If a second instance of violence occurs, the therapist should then terminate couples therapy. As is part of our due diligence, if a clinician must terminate therapy, it is best practice to ensure clients leave with referrals. In the case of intimate partner violence, it would be best to meet with each party individually to discuss referrals and termination to prevent possible retaliation.

Beyond Bancroft’s conceptualization that therapy is ineffective in instances of abusive behavior (which stems from his background in non-therapeutic settings), in the field of psychotherapy it is also understood that therapy may be an inappropriate treatment when IPV is present. This is because the nature of abuse is in opposition to the goals of couples therapy, which include: negotiation, mutual empathy and responsibility for problems, and fostering attachment (Leblow & Snyder, 2023, p. 7). The underlying assumptions of these goals are equality, respect, and a level of safety for both parties. In the case of intimate terrorism, the equality and respect necessary for negotiation and empathy is simply not present. One must be careful as well to attempt to guide partners to understand where they are both responsible for conflict in instances of abuse, as this could actually be victim blaming. “The tried-and-true counseling method of talking through clients’ life scenarios, behaviors and choices while asking questions such as “What could you have done differently?” or “What would you want to change if this happens again?” can be hurtful because a counselor may inadvertently be placing the responsibility for the abuse on the victim instead of on the abuser” (Bray, 2019). Additionally, the goal of ‘fostering attachment’ in couples therapy could be very harmful for victims of abuse. It would be more helpful instead to assist victims with safety planning, building self-esteem, and directing toward social resources. Couples therapy works best when the client is the relationship between the two individuals present. If a relationship is overshadowed by control and abuse, as in the case of intimate terrorism or moderate-to-severe aggression; couples therapy can be harmful.

That being said, it is still extremely important for therapists to be educated on intimate partner violence, should it arise in their casework. This is not only because of the potential for harm caused to the clients should they not get appropriate treatment, but also because statistically, “partner aggression is more common among couples who seek therapy” (Lebow & Snyder, 2023, pp. 391–412). One study showed that half of the couples seeking relational therapy reported physical violence and over two-thirds reported psychological violence. Its important for early career clinicians to understand that couples therapy is not only contraindicated for clients whose relationships exhibit signs of moderate-to-severe abuse, but that couples who are navigating IPV are more likely to seek relational therapy. In order to prepare for this, therapists must use good screening tools, have contingency plans for what to do should abuse or violence present during treatment, and have well-thought out referrals and resources for clients who are inappropriate for couples treatment.

In researching this topic I noticed a few things came up for me, mainly how systemic patriarchy is woven into the field of psychotherapy and creates blind spots when it comes to the best course of action for treating intimate partner violence. I was especially horrified by the suggestion that couples should stay in relational therapy because the abuser can only improve if they get to practice skills in a relational format (Lebow & Snyder, 2023). To be frank, I don’t think victims owe their abusers a forum in which they can get well, especially when statistically, the victim’s life is at stake. When we look at the gender discrepancies in who dies from intimate partner violence (Smith, 2022), it is overwhelmingly women being abused by a male partner. The idea that statistically women owe men healing is offensive to me, especially when we can’t even as a society agree that the state owes women safety from abuse, as evidenced by the fact that reporting the abuse of adult women is not mandated by mental health professionals. This double standard speaks to an unchecked bias that women are obligated to serve healing, support, and help men; as if men are ultimately the main characters in therapy, society, and the world. I reject this completely. As a clinician, if I must choose, I would prefer to give the world an alive woman than a redeemed man, and I think it’s absolutely wild that that’s a contentious take. In general, this speaks to a larger conflict between my two primary sources: Bancroft, who is against therapy as a treatment of abuse and conceptualizes all relational violence as abuse; versus Leblow & Snyder, who suggest that intimate partner violence is a spectrum, and that couples therapy is appropriate and even preferable to other treatments in the case of what they call ‘low-level bidirectional IPV’ (where violence does not escalate beyond pushing and slapping and is equally enacted by both partners). I am not certain I agree. My reason is simply in the data: even if the violence is truly bidirectional, in a heterosexual couple, the woman is still much more likely to be killed. Therefore, in continuing to see the couple, instead of referring out to more appropriate and specialized resources, the clinician is ultimately deciding that she is willing to risk her female client’s life in order to serve the couple– and from my perspective I struggle to see how this isn’t an androcentric or even misogynistic choice. I think it’s incredibly important to check to see how our own gender biases come up when we’re doing couples work, specifically who is expected to help make their partner better, and whose life and wellness is prioritized. As for myself, I write this paper from a very privileged place of having not yet been placed in the position of deciding what is best for my clients both as a couple and as individuals. I am quite certain that as a future clinical who is interested in working with couples I will be confronted with this with some regularity. I do believe that there is some nuance beyond Bancroft’s perspective, but I anticipate that in the vast majority of cases, given my Restorative Practices background, my interest will be in helping the victim, rather than the couple– which indicates the case is unsuitable for couples therapy.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).

American Psychological Association. (n.d.). Abuse. In APA dictionary of psychology. Retrieved February 1st, 2026, from https://dictionary.apa.org/abuse

Bancroft, Lundy. (2003). Why Does He Do That? Inside the minds of angry and controlling men. New York. Berkley Books

Bray, Bethany. (June 2019). Addressing Intimate Partner Violence with Clients. Counseling Today. https://www.counseling.org/publications/counseling-today-magazine/article-archive/article/legacy/addressing-intimate-partner-violence-with-clients

Geiser, C., Götz, T., Preckel, F., & Freund, P. A. (2017). States and Traits: Theories, models, and assessment. European Journal of Psychological Assessment, 33(4), 219–223. https://doi.org/10.1027/1015-5759/a000413

Hayley Boxall, Hayley & Lawler, Siobhan. (2021). How Does Domestic Violence Escalate Over Time? Trends & Issues in Crime and Criminal Justice, 626. 1836-2206. https://www.aic.gov.au/sites/default/files/2021-04/ti626_how _does_domestic_violence_escalate_over_time.pdf

Hogan, Jasara N. (2022) Conducting Couple Therapy via Telehealth: Special considerations for virtual success. Journal of Health Service Psychology. (48). 89–96. https://doi.org/10.1007/s42843-022-00060-x

Johnson, M. P. (2012). A Typology of Domestic Violence: Intimate terrorism, violent resistance, and situational couple violence. Upne. (Johnson 2012)

Leblow, J. L., & Snyder, D. K. (Eds.) (2023). Clinical Handbook of Couple Therapy (6th ed.). The Guilford Press. (Leblow & Snyder, 2023)

Paterno, M. T., & Draughon, J. E. (2016). Screening for Intimate Partner Violence. Journal of midwifery & women’s health, 61(3), 370–375. https://doi.org/10.1111/jmwh.12443

Rabin, R. F., Jennings, J. M., Campbell, J. C., & Bair-Merritt, M. H. (2009). Intimate partner violence screening tools: a systematic review. American journal of preventive medicine, 36(5), 439–445.e4. https://doi.org/10.1016/j.amepre.2009.01.024

Smith, Erica L. Department of Justice. (2022). Female Murder Victims and Victim-Offender Relationship, 2021. Bureau of Justice Statistics. https://bjs.ojp.gov/female-murder-victims-and-victim-offender-relationship-2021#the-percentage-of-females-murdered-by-an-intimate-partner-was-5