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Ask the Mental Health Expert Archives 2001-2004

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Anger Management

Q. Aside from anger management and removing oneself from the situation, what treatment would you recommend for all parties involved in domestic abuse (abuser and victims)?

A. That's a very difficult question, since each case must be dealt with on an individualized basis. Making the wrong intervention based on a cookie cutter approach to domestic abuse can sometimes do more harm than good, and put the abused individual in greater danger. As one group of authors puts it, "Recommendations for joint counselling or marriage guidance for the couple are usually not appropriate" (Mazza et al, Med J Aust 200 Nov 20;173:532-5). This runs contrary to our usual mental health model, in which therapy is nearly always thought to be helpful.

On the other hand, some recent work using behavioral couples therapy (BCT) for alcoholism and drug abuse has found that this approach reduces not only substance abuse, but also domestic violence (O'Farrell et al, J Subst Abuse Treat 2000; 18:51-54). BCT involves seeing the substance-abusing patient with the spouse to arrange a daily sobriety contract. BCT also teaches communication skills, which may help both parties get their needs met without violence.

This research points out that attacking the problem of substance abuse is often one important aspect of reducing domestic violence. However, BCT presumes that neither member of the couple is in immediate danger of severe physical abuse--which is clearly not always the case. In such extreme cases, the victim must usually be removed to a safe house or sheltered setting, which the abuser cannot locate. In milder cases, in which verbal abuse is the main form of mistreatment, I do believe that anger management training is worth considering.

Also, in some cases, the abuser has a treatable psychiatric disorder that is contributing to the problem. For example, undiagnosed or untreated manic episodes in a bipolar individual can sometimes lead to domestic violence, particularly if the bipolar individual is also abusing alcohol or illicit drugs. This does not mean that treating the bipolar disorder is the final answer to the domestic abuse, but it may be a necessary part of treatment. Similarly, in cases where the victim of the abuse is acting out psychopathology due to an underlying personality disorder, I believe that individual psychotherapy may be helpful--but I don't have studies to back this up. (Adult children of alcoholics often fit into this pattern, in my experience).

Finally, when children are among the abused parties, they, too may need individual treatment to address posttraumatic symptoms, depression, behavioral or school problems, etc. For more information on preventing and managing domestic abuse, I suggest you contact the National Resource Center on Domestic Violence in Harrisburg, PA (800-537-2238)

May 2001

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