Intimate Partner Violence (IPV) Assessment and Treatment

Women in Violent Relationships: Assessment, Risk, and Treatment

Family Violence SOW 4141

Dr. Patricia Temes, PhD, LCSW-QS

Learning Objectives

• Define Intimate Partner Violence

• Understand impact

• Differentiate types

• Conduct screening

• Identify risk/protective factors

• Apply safe treatment

Defining Intimate Partner Violence (IPV)

• Types of IPV • Physical violence • Sexual violence • Emotional abuse • Threats/coercion • Occurs in intimate relationships

Hidden Nature of IPV • Clients seek help for symptoms • Depression, anxiety, pain • Do not identify IPV • Clinicians must assess actively

Impact of IPV

• Mental: depression, PTSD

• Physical: chronic pain

• Self-worth, identity

• Impact on children

Decision to Leave

Often impacted by:

• Financial barriers

• Fear of retaliation

• Children concerns

• Emotional attachment

Prevalence

• 1 in 4 women are affected

• It is underreported

• It is often undetected

Counselor Role

• A professional can help by:

• Screening early

• Assessing the risks

• Using effective tools and interventions

• Ensuring safety

• Respecting autonomy

IPV Not One-Size

• Women can be victims or aggressors

• Patterns vary

• Tailored treatment needed

Johnson Typology

• Intimate Terrorism • Violent Resistance • Mutual Violent Control • Situational Violence

Overview of Johnson’s Typology • Developed by Michael Johnson (2008) • Organizes IPV based on:

– Power and control dynamics – Patterns of behavior (not just isolated incidents)

Core Principle: Not all intimate partner violence is the same—context, motivation, and control matter

Intimate Terrorism (Coercive

Controlling Violence)

Definition

• A pattern of violence where:

– One partner is both violent and controlling

– The other partner is not violent and is often fearful

• Violence is embedded in a broader system of:

– Domination

– Control

– Psychological manipulation

Intimate Terrorism (Coercive

Controlling Violence) cont.

• Key Characteristics

• Ongoing pattern (not isolated incidents)

• Includes:

– Physical abuse

– Emotional abuse

– Psychological control

– Isolation tactics

• Victim experiences:

– Fear

– Loss of autonomy

– Dependency

Intimate Terrorism (Coercive

Controlling Violence) cont.

Control Tactics May Include: • Monitoring movements • Financial control • Isolation from family/friends • Threats and intimidation • Gaslighting

Clinical Presentation Victim may:

– Appear anxious, fearful, or hypervigilant

– Minimize abuse – Feel trapped or unable to leave

Intimate Terrorism (Coercive

Controlling Violence) cont.

Prevalence & Context

• Most commonly:

– Male perpetrator → female victim

• Often portrayed in:

– Media

– Legal cases

– Shelters and crisis services

Important:

• Although highly visible, this type is less common than others

Intimate Terrorism (Coercive

Controlling Violence) cont.

Clinical Implications

• High risk for:

– Severe injury

– Lethality

• Requires:

– Immediate safety planning

– Individual treatment (NOT conjoint therapy)

• Focus on:

– Protection

– Empowerment

– Resource connection

Violent Resistance

Definition

Occurs when:

– A victim uses violence in response to ongoing abuse

– Violence is defensive rather than controlling

Violent Resistance

cont.

Key Characteristics

• Reactive rather than proactive

• Motivated by:

– Self-protection

– Survival

• Not part of a broader pattern of control

Violent Resistance cont.

Clinical Considerations: • High risk of misinterpretation: • Victim may be incorrectly labeled as:

– “Aggressor” – “Mutually abusive”

Assessment Focus On: • Identify:

– Who holds power and control – Context of violent incidents

• Explore: – Fear levels – Patterns over time

Violent Resistance cont.

Clinical Implications

• Avoid:

– Victim-blaming

• Provide:

– Trauma-informed care

– Safety planning

• Validate:

– Survival strategies

Mutual Violent Control Definition

• Both partners:

– Are violent

– Attempt to control each other

Key Characteristics

• Reciprocal aggression

• High conflict

• Power struggle dynamic

Mutual Violent Control cont.

Clinical Presentation

• Relationship marked by:

– Instability

– Escalation cycles

– Mutual fear and hostility

Mutual Violent Control cont.

Clinical Implications

• Requires:

– Careful, structured assessment

High risk situation:

– Violence may escalate quickly

• Often NOT appropriate for conjoint therapy without stabilization

Situational Couple

Violence

Definition

• Violence occurs:

– During conflict escalation

– NOT driven by ongoing control

Key Characteristics

• Episodic rather than chronic

• Triggered by:

– Arguments

– Poor communication

– Stress

Situational Couple

Violence cont.

Behavior Pattern

• Either partner may engage in violence

• Does NOT involve:

– Systematic domination

– Ongoing fear-based control

Prevalence

• Most common form of IPV

• Research indicates:

• Bidirectional violence is more common than one-sided violence

Situational Couple

Violence cont.

Clinical Presentation

• Clients may report:

– “We just argue and it gets out of control”

• Less fear compared to intimate terrorism

Clinical Implications

• May be appropriate for:

– Couples therapy (with caution)

• Focus areas:

– Communication skills

– Conflict resolution – Emotional regulation

Cross-Cutting Clinical Insights

Importance of Context • Same behavior ≠ same meaning • Must assess:

– Pattern – Intent – Control dynamics

Bidirectional Violence • Research shows:

– Many relationships involve mutual aggression

• However: – Mutual aggression ≠ equal power

One-Size- Fits-All Approach is Ineffective

Traditional models: – Focus only on male perpetrators Johnson’s typology highlights: – Need for tailored interventions

Application for Clinical Practice • Assessment Questions • Who is afraid of whom? • Is there a pattern of control? • What triggers the violence? • Is violence reactive or controlling?

Treatment Matching

Type Recommended Approach

Intimate Terrorism Safety planning, individual therapy

Violent Resistance Trauma-informed care, validation

Mutual Violent Control Intensive assessment, caution

Situational Violence Couples therapy (if safe)

Treatment

Safety Planning • Emergency contacts • Exit plans

Conjoint Therapy • Only if safe • Assess both partners

Avoid Conjoint Therapy if: • Fear present • High risk

Risks

Risk Factors • Substance abuse • Weapons • Mental illness

Socioeconomic Risks • Poverty • Unemployment • Early parenthood

Developmental Risks • Childhood abuse • Exposure to IPV

Protective Factors

• Support

• Housing

• Employment

Strengths-Based

• Focus on resilience, self esteem, self confidence

Modern Approach

Interventions should include:

• Trauma-informed

• Individualized

Treatment Goals should address:

• Ending violence

• Increasing safety

Priorities should focus on:

• Safety first

• Accurate assessment

Ethics • Confidentiality vs safety

• No victim blaming

Reference Kopala, M., & Keitel, M. (Eds.). (2017). Handbook of counseling women (2nd ed.). SAGE Publications.

Women in Violent Relationships: Assessment, Risk, and Treatment

Family Violence SOW 4141

Dr. Patricia Temes, PhD, LCSW-QS

Learning Objectives

• Define Intimate Partner Violence

• Understand impact

• Differentiate types

• Conduct screening

• Identify risk/protective factors

• Apply safe treatment

Defining Intimate Partner Violence (IPV)

• Types of IPV • Physical violence • Sexual violence • Emotional abuse • Threats/coercion • Occurs in intimate relationships

Hidden Nature of IPV • Clients seek help for symptoms • Depression, anxiety, pain • Do not identify IPV • Clinicians must assess actively

Impact of IPV

• Mental: depression, PTSD

• Physical: chronic pain

• Self-worth, identity

• Impact on children

Decision to Leave

Often impacted by:

• Financial barriers

• Fear of retaliation

• Children concerns

• Emotional attachment

Prevalence

• 1 in 4 women are affected

• It is underreported

• It is often undetected

Counselor Role

• A professional can help by:

• Screening early

• Assessing the risks

• Using effective tools and interventions

• Ensuring safety

• Respecting autonomy

IPV Not One-Size

• Women can be victims or aggressors

• Patterns vary

• Tailored treatment needed

Johnson Typology

• Intimate Terrorism • Violent Resistance • Mutual Violent Control • Situational Violence

Overview of Johnson’s Typology • Developed by Michael Johnson (2008) • Organizes IPV based on:

– Power and control dynamics – Patterns of behavior (not just isolated incidents)

Core Principle: Not all intimate partner violence is the same—context, motivation, and control matter

Intimate Terrorism (Coercive

Controlling Violence)

Definition

• A pattern of violence where:

– One partner is both violent and controlling

– The other partner is not violent and is often fearful

• Violence is embedded in a broader system of:

– Domination

– Control

– Psychological manipulation

Intimate Terrorism (Coercive

Controlling Violence) cont.

• Key Characteristics

• Ongoing pattern (not isolated incidents)

• Includes:

– Physical abuse

– Emotional abuse

– Psychological control

– Isolation tactics

• Victim experiences:

– Fear

– Loss of autonomy

– Dependency

Intimate Terrorism (Coercive

Controlling Violence) cont.

Control Tactics May Include: • Monitoring movements • Financial control • Isolation from family/friends • Threats and intimidation • Gaslighting

Clinical Presentation Victim may:

– Appear anxious, fearful, or hypervigilant

– Minimize abuse – Feel trapped or unable to leave

Intimate Terrorism (Coercive

Controlling Violence) cont.

Prevalence & Context

• Most commonly:

– Male perpetrator → female victim

• Often portrayed in:

– Media

– Legal cases

– Shelters and crisis services

Important:

• Although highly visible, this type is less common than others

Intimate Terrorism (Coercive

Controlling Violence) cont.

Clinical Implications

• High risk for:

– Severe injury

– Lethality

• Requires:

– Immediate safety planning

– Individual treatment (NOT conjoint therapy)

• Focus on:

– Protection

– Empowerment

– Resource connection

Violent Resistance

Definition

Occurs when:

– A victim uses violence in response to ongoing abuse

– Violence is defensive rather than controlling

Violent Resistance

cont.

Key Characteristics

• Reactive rather than proactive

• Motivated by:

– Self-protection

– Survival

• Not part of a broader pattern of control

Violent Resistance cont.

Clinical Considerations: • High risk of misinterpretation: • Victim may be incorrectly labeled as:

– “Aggressor” – “Mutually abusive”

Assessment Focus On: • Identify:

– Who holds power and control – Context of violent incidents

• Explore: – Fear levels – Patterns over time

Violent Resistance cont.

Clinical Implications

• Avoid:

– Victim-blaming

• Provide:

– Trauma-informed care

– Safety planning

• Validate:

– Survival strategies

Mutual Violent Control Definition

• Both partners:

– Are violent

– Attempt to control each other

Key Characteristics

• Reciprocal aggression

• High conflict

• Power struggle dynamic

Mutual Violent Control cont.

Clinical Presentation

• Relationship marked by:

– Instability

– Escalation cycles

– Mutual fear and hostility

Mutual Violent Control cont.

Clinical Implications

• Requires:

– Careful, structured assessment

High risk situation:

– Violence may escalate quickly

• Often NOT appropriate for conjoint therapy without stabilization

Situational Couple

Violence

Definition

• Violence occurs:

– During conflict escalation

– NOT driven by ongoing control

Key Characteristics

• Episodic rather than chronic

• Triggered by:

– Arguments

– Poor communication

– Stress

Situational Couple

Violence cont.

Behavior Pattern

• Either partner may engage in violence

• Does NOT involve:

– Systematic domination

– Ongoing fear-based control

Prevalence

• Most common form of IPV

• Research indicates:

• Bidirectional violence is more common than one-sided violence

Situational Couple

Violence cont.

Clinical Presentation

• Clients may report:

– “We just argue and it gets out of control”

• Less fear compared to intimate terrorism

Clinical Implications

• May be appropriate for:

– Couples therapy (with caution)

• Focus areas:

– Communication skills

– Conflict resolution – Emotional regulation

Cross-Cutting Clinical Insights

Importance of Context • Same behavior ≠ same meaning • Must assess:

– Pattern – Intent – Control dynamics

Bidirectional Violence • Research shows:

– Many relationships involve mutual aggression

• However: – Mutual aggression ≠ equal power

One-Size- Fits-All Approach is Ineffective

Traditional models: – Focus only on male perpetrators Johnson’s typology highlights: – Need for tailored interventions

Application for Clinical Practice • Assessment Questions • Who is afraid of whom? • Is there a pattern of control? • What triggers the violence? • Is violence reactive or controlling?

Treatment Matching

Type Recommended Approach

Intimate Terrorism Safety planning, individual therapy

Violent Resistance Trauma-informed care, validation

Mutual Violent Control Intensive assessment, caution

Situational Violence Couples therapy (if safe)

Treatment

Safety Planning • Emergency contacts • Exit plans

Conjoint Therapy • Only if safe • Assess both partners

Avoid Conjoint Therapy if: • Fear present • High risk

Risks

Risk Factors • Substance abuse • Weapons • Mental illness

Socioeconomic Risks • Poverty • Unemployment • Early parenthood

Developmental Risks • Childhood abuse • Exposure to IPV

Protective Factors

• Support

• Housing

• Employment

Strengths-Based

• Focus on resilience, self esteem, self confidence

Modern Approach

Interventions should include:

• Trauma-informed

• Individualized

Treatment Goals should address:

• Ending violence

• Increasing safety

Priorities should focus on:

• Safety first

• Accurate assessment

Ethics • Confidentiality vs safety

• No victim blaming

Reference Kopala, M., & Keitel, M. (Eds.). (2017). Handbook of counseling women (2nd ed.). SAGE Publications.