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Introduction - Crazy for Loving You?: The Psychotherapy of Verbal Abuse in Relationships
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.
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.
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.
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
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.
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
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.
Therapist Presence: When
I began working with you, it was like I had kept myself in a box my whole life.
I was finally able to do what I had never been able to do before -- open myself
and trust. Timothy said this to me during a session, as he reflected upon
how different he now feels within himself and in his relationships. A therapist
can be a gifted theoretician and technician, but there is nothing more crucial
to successful psychotherapy than the therapeutic relationships we make with our
patients. This is of particular importance when psychological difficulties form
as a result of relational damage. In an atmosphere of acceptance, respect and
kindness, self-exploration and healing regarding relationship can occur. It is
the relationship with us that our patients will use as a new model for current
and future relationships.
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
Development. Nina was exasperated as she sobbed to me, I was so angry
at him for staying out all night with his friends. I yelled at him until I lost
my voice. At one point, I said, Im addicted to you like a drug. I
just cant take it anymore, but I dont know how to stop.
Abuse halts the natural momentum toward psychological development. Patients may
be left without a basic sense of safety, or struggling to meet dependency and/or
personal power needs. Personality disorders may result. Of course, living in these
developmental stages have profound effects on the quality of relationships, putting
a person at risk to become abusive or to become a victim of abuse.
Assessing your patients personality development and using your assessment
to create developmentally appropriate interactions to provide a second chance
for normal development.
2. Looking with your patient at the patients
developmental functioning and exploring the effects of developmental strengths
and limitations on current relationships, using emerging situations within or
outside the therapy for learning.
Psychological Defenses. Powerful,
primitive defenses develop automatically and unconsciously to cope with abusive
treatment. A basic sense of safety may be damaged, leaving a person in a constantly
anxious state of emergency. Self-awareness is impaired by defenses that create
a disassociation from self. Suppression of emotion and physiological functioning
may result in depression. Of course, feelings of threat and lack of awareness
of self can set the stage for abusive behavior or becoming a victim of abuse.
1. Observing defensive states as they are reported
or as they emerge in the sessions, and exploring their functions.
your patient toward non-emergency states and increased self-awareness. Imagery,
breathing awareness, relaxation and body movement are excellent interventions
for this. Simultaneous observations and interpretation of defenses as they emerge
is key to moving defenses.
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.
1. Helping your patients
to become aware of difficulties in self-regulation through situations that emerge
within and outside your sessions.
2. Teaching your patient techniques
for self-regulation, such as distinguishing between inner states and behavior,
practicing silence, walking away from an upset, quieting strong feelings and reactions
through relaxation and channeling strong emotions to positive activity.
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.
your patient to notice and to record in detail thoughts about the self, others,
and life, and teaching your patient to interrupt, through self-talk, erroneous
or excessively negative thoughts.
2. Collaborating with your patient to
create new, more balanced ways of thinking about the self, others, and life.
3. Encouraging the practice of these new patterns through positive self-talk.
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.
1. Supporting awareness
of communication by observing and reflecting content to your patient, as well
as non-language aspects of communication.
2. Modeling for your patient
polite, respectful communication, and encouraging your patient to practice it
with you in the sessions and with others outside the sessions.
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.
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.
What is the foundation of the treatment of abuse? To select and enter your answer go to .