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Treating Relationship Power and Aggression
Definition: Verbal abuse is the mistreatment of others involving the expression of aggression through vocalization. Both those at whom these vocalizations are directed and those who experience them vicariously may be considered victims of verbal abuse. It is likely that the adult who is verbally abusive as well as the adult who is the recipient of verbal abuse was abused as a child. Verbal abuse may be combined with physical abuse and may take a variety of forms on a continuum from mild, such as subtle teasing, veiled criticism or sarcasm through severe, such as vocal expressions of uncontrolled rage. It is important to note that the definition of verbal abuse will vary with the cultural context and community environment in which the behaviors occur.
Clinical Example: Although 42 at the time he began in psychotherapy treatment with me, Charles was still the frightened boy in the childhood pictures he brought to show me. He is a small man who had muscular tension so great that he looked as though he could shatter. His facial expression was fixed and emotionless. To look into his eyes was to see fear.
From an early age, Charles learned to remain in a disassociated state to cope with his constantly angry, verbally abusive father and clinging, controlling mother. Unable to develop independently and authentically, instead, he developed a keeness of mind to stay one step ahead of the unpredictability at home and to shape himself around expectations he estimated his parents and others had of him. From an early age, Charles used intellect and achievement as coping, which led to academic success and later to professional success as a respected attorney. Although successful, Charles had been plagued since childhood with sleep difficulties, anxiety, depression, disabling headaches and outbursts of rage.
Charles accommodating style made him a favorite of adults growing up, and he reports that throughout his life many have considered him a great co-worker and a good friend. Unfortunately, at the same time, he viewed himself as a monster child; unlovable, ugly and evil. Charles has been married twice, to volatile and aggressive women to whom he tended to cling, although they experienced him as passive, remote and emotionally unavailable. He initially came to treatment as his first marriage was ending.
Although Charles history is rather dramatic, his treatment has been quite successful. He no longer becomes depressed, he rarely has headaches, sleep difficulties or emotional outbursts. His anxiety is greatly decreased, and Charles now knows himself, values himself and has more trust in the world, all of which support him in expressing himself and in making deeper relationships. Now in the later stages of individual psychotherapy, and with his second wife also in individual treatment, we are beginning to talk about beginning couples work.
The Psychotherapy of Verbal Abuse in Relationships: Over the years, I have found that the treatment of verbal abuse is most effective in the controlled relational environment interactions among several major aspects of functioning. These aspects include personality development, psychological defenses, emotional regulation, cognitive style regarding the self, others and life, and communication skills. Toward the later stages of individual treatment, couples therapy or family therapy can provide opportunities to explore current relationships in the care and safety of the therapeutic relationship.
The positive therapeutic relationship is the foundation of the treatment of abuse and is discussed below. It is followed by specific areas of focus for individual psychotherapy, beginning with a case example for each section, and followed by description and suggestions for intervention.
Cautions for the Therapist: I cant believe how much I hate you sometimes, William often yells at me during our sessions. The therapy with verbal abusers or their victims can be challenging and may hold potential hazards for the therapist. Perhaps the greatest pitfalls include feeling hurt by or angry at our patients and reacting aggressively toward them. Although the reactions we have as therapists inform us about how are patients are feeling or have been treated, as well as guide us in formulating interventions, it can be difficult to contain our reactions when working with issues of verbal abuse. This may be a particular vulnerability for those of us who have experiences with abuse in our personal histories.
Areas of Attention in the Treatment of Verbal Abuse
Regulation. I cant believe how angry I was at her. Before I knew
it, I was screaming at her and pounding my fists on the floor. Its just
not me to act like that. I really scared her, Janet confessed to me regarding
her reaction to her daughter. Although affected by individual constitution, emotional
regulation forms from the outside in, as adults help children to learn to manage
strong emotions and aggression. Powerful learning also occurs vicariously through
the observations of the emotional regulation of others. Without positive opportunities
for learning, lack of self-control, for example of ones vocalizations can
result in abusive behavior.
Style. Jimmy justified an experience of rage that occurred while shopping
recently at a department store. People just dont care. The clerks
actions were saying to me, you are nothing. I sure put her in her
place. Patients who have been mistreated are likely to have a poor self-esteem,
a negative view of relationships, and a pessimistic view of life. They are likely
to create situations in which they continue to be mistreated, or they take the
role of the aggressor and mistreat others.
Skills. You need a new suit, your hair looks terrible, and you have
bad breath. This was the greeting Maya gave to her husband when he entered
my office to join her for a recent couples therapy session. We learn communication
through how others communicate with us. Frequently, I have directed at me, in
individual work or overhear in a couple, ways of communicating that are sure to
create relationship difficulties. Note that sometimes the words arent so
much the issue as the way something is said, such as in the voice tone, or nonverbal
accompaniments to what is said.
Final Thoughts: Working with verbal abusers and victims of verbal abuse can be challenging. The combination of primitive defenses, early personality development, difficulty with emotional regulation, negativity and pessimism in thought, and poor communication skills can leave a therapist feeling pained and frustrated. Hence, it is crucial that, in the process of caring for our patients, that we also remember to do the things for ourselves that support our own well-being.
Anne C. Fisher, PhD ADTR, is a licensed clinical psychologist and a registered dance/movement therapist in private practice in Washington, DC. For the past 20 years, she has had a general psychotherapy private practice involving the long-term treatment of adults individually and in couples.
Throughout her practice, Dr. Fisher has successfully treated many patients who have been abused, as well as those who have been involved in abusive relationships. Her work with such relationships in couples therapy is comprehensive and integrative, involving attention to developmental, psychodynamic, cognitive, behavioral, communicational, including nonverbal, aspects of the individuals involved and how those aspects interact in the couple relationship. In this work, emphasis is placed on the therapeutic relationship as vehicle for self-exploration, for healing past relational traumas, for developing new relationship skills and as a model for positive relating.
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