Abusive Relationship Therapy: Is It Helpful?

Couples therapy can be effective when both partners are:

• committed to improving and reflecting on dysfunctional behaviors
• exhibit empathy, understanding, and willingness to change negative behaviors and communication patterns
• are willing to overcome obstacles in the relationship to make the relationship work

But “The Clinical Handbook of Couples Therapy, 5th edition” notes that couples therapy isn’t usually suitable for:

• abusive relationships with severe or frequent physical violence or psychological aggression
• relationships with a high degree of fear of retaliation and a chance of abuse for what’s disclosed in therapy
• relationships where the person who’s abusive has a high degree of narcissistic traits or antisocial personality disorder (ASPD) and a lack of empathy that may impede their progress in therapy, depending on the type of therapy used
• relationships where the person who’s aggressive has an ongoing substance use problem that’s left untreated

In these cases, couples counseling may result in an escalation of abuse and retaliation.

The person experiencing abuse may not feel safe disclosing the full extent of the abuse, and the person who’s abusive may be unwilling to make efforts to change.

Physical abuse includes a wide variety of physically aggressive acts of violence — including shoving, hitting, punching, slapping, strangling, or physically restraining the other person.

When assessing for evidence of intimate partner violence, a couples therapist may ask directly about the use of physical, sexual, and emotionally abusive methods.

This assessment can begin with questions about how the couple navigates conflicts and arguments, including whether arguments ever get out of control and how each partner expresses anger or frustration.

Safety concerns may also be addressed by asking about weapons or the presence of children who may be harmed.

Specific terms may be used to ask whether partners have ever hit, shoved, or pushed one another.

Questionnaires such as the Couple Questionnaire or the Conflict Tactics scales may be used so that someone who prefers writing down their experiences also has a chance to disclose them without as much discomfort.

If the level of violence in the relationship is considered to be a hindrance to therapy, the partner who’s abusive may be referred to a gender-specific domestic violence treatment program, while the person being abused is referred to a place that will provide them with supportive and legal services.

Some couples therapists may decide that the abuse in the relationship can be addressed if the level of abuse is low and the partner who’s abusive is committed to improving. If that’s the case, a “safety contract” may be set up to establish boundaries in the relationship and continue with therapy sessions.

Dr. Michele Waldron, a certified sex and couples therapist in Massachusetts, assesses the chance of violence when deciding whether to continue with couples therapy.

“For high risk cases, the first priority is establishing safety as much as possible,” she says. “The most extreme is the survivor leaving the house or advocating for police involvement. Otherwise, establishing rules of engagement and healthy boundaries between them is the next priority.”

Waldron often uses dialectical behavioral therapy (DBT) to help couples establish better emotional regulation and distress tolerance skills.

For couples therapy to work, Waldron emphasizes that both people must acknowledge an issue and be motivated to change. Waldron also uses safety planning and establishes “rules of engagement” to guide victims to recognize potential escalation, enforce boundaries, and enhance self-protection.

Dr. Lee Phillips, a certified sex and couples therapist in New York, says, “I assess the level of abuse. If a client is experiencing emotional abuse, there’s always a chance of physical abuse. In this case, safety planning is critical.”

When cases of emotional abuse are milder and less frequent, some skills can be learned depending on the willingness of the person who’s abusive. Phillips uses supportive therapy to enhance shared empathy and cognitive behavioral therapy (CBT) to challenge negative and anxious thoughts.

If the person who’s abusive grew up in a dysfunctional family, Phillips may use attachment theory to help increase awareness of where these behaviors were first learned.

“For emotional abuse, a treatment plan may contain an agreement with both partners agreeing to identify thoughts and feelings that trigger discord in their marriage,” Phillips says. “I may have each partner use reflective listening where they can mirror back what the other partner is saying, have them validate each other, and have them show empathy.”

Phillips cautions that severe emotional abuse can be difficult to manage.

He finds that many people who are abusive tend to end the therapy prematurely themselves, especially, he says, if they have narcissistic personality disorder (NPD) or ASPD.

“Often [they] will terminate because they’re called out on the abuse,” he says. “[They] may be terrified of therapy for this reason.”

Melanie Preston, a licensed mental health therapist in Indiana, asserts that verbal abuse isn’t always obvious, and couples may believe their ways of communicating are typical.

She usually asks couples how much knowledge they have about each other’s family of origin and helps them to recognize any adverse childhood experiences that may still be affecting their present-day behavior.

“It’s usually at this point that the couple is able to begin identifying the behavior as verbally abusive in nature,” Preston says. “Sometimes the [offender] is willing to learn new techniques to communicate, as there is the realization that ‘just because I witnessed it being done this way, doesn’t mean I have to continue the same behavioral pattern.’ Other times, the [offender] is unwilling to admit fault.”

In either case, Preston sees each partner individually for a “personal deep dive into the behavioral pattern.”

But if she senses that the person experiencing the abuse may be in danger due to information shared in individual sessions, Preston says, “I will terminate service with the person who’s abusive and assist the survivor in establishing a safety plan.”

If the person who’s abusive is willing to improve, Preston guides them to slowly unlearn negative behaviors by offering emotional regulation tools that help control their physiological state and offers additional sessions per week or anger management if needed.

According to Dr. Liz Jenkins, a licensed marriage and family therapist in Texas, a pattern of controlling a partner doesn’t always start out as abusive. It can begin innocuously, with one partner appeasing the other to avoid “potential hot spots of conflict.”

This control dynamic, she says, can be a result of a survival skill of conflict avoidance and escalation avoidance learned in childhood. As the control and isolation escalate, the survivor’s role may change to them being “their partner’s mood manager.”

The solution, she writes, is to recognize the triggers and examine the “elaborate planning that goes into managing their partner’s happiness.”

She uses therapy to guide couples to better understand the origins of their need for control while also offering individual sessions with each person and confidential individual assessments of potential abuse.

“My approach depends on the dynamics of the couple, the degree of abuse, and the willingness or readiness of each person to step into change,” she says.

She helps couples break down old habits and curb knee-jerk responses while celebrating their wins. But if the abuse appears to be escalating, she’ll terminate therapy.

“I’ll absolutely stop couples work if the abuse seems to be triggering escalations,” she says. “Physical and emotional safety is continually monitored, and all initial sessions cover my confidentiality, mandated reporting requirements, and expectations.”

Jeanae Hopgood, a licensed marriage and family therapist in Pennsylvania, who has worked mainly with couples who have had trouble with financial abuse, recognizes the importance of unlearning early patterns of coercion and control.

Depending on the dynamic, she says that couples therapy for financial abuse may include exploring belief systems and family-of-origin histories to better understand what each individual in the relationship comes to “believe about how two or more people are supposed to interact with one another.”

But Hopgood cautions that working with couples around this type of abuse requires a “buy-in” from all parties, mutual recognition of the problem, and a willingness to seek solutions.

“Even if the partners don’t agree on the language of abuse, they need to agree on the dynamic between them being harmful or causing friction within the relationship,” Hopgood says.

Celeste Labadie, a licensed marriage and family therapist from Colorado, agrees that financial abuse can be a learned behavior. She believes that participating in individual therapy first to explore those unresolved patterns of behavior before attending couples therapy is crucial.

In cases of sexual abuse, Hopgood uses both joint and individual assessments of the couple to gather additional information.

“In the separate sessions, I’m able to discern additional information about family history, as well as any unwanted touch, safety concerns, and problematic power dynamics that can be difficult to discuss in a couples session,” she says.

This helps her get the shared and individual views of the problematic dynamics.

Sexual abuse tends to thrive in secrecy, so it’s unlikely that couples experiencing this in their relationships would seek out couples therapy, Labadie says. “The person instigating the abuse wouldn’t want to be found out or pressured to look at their behaviors.”

Research from 2014 suggests that intimate partner violence disproportionately affects women, which means some abuse can also hold elements of patriarchal domination — when females are specifically degraded and devalued by exploiting their subordinate position in society.

Jason Polk, a licensed clinical social worker and owner of Colorado Relationship Recovery, notes that there’s usually some form of patriarchal dominance in many relationships. He uses relational life therapy (RLT), created by Terry Real, to guide couples through healthy communication skills.

This form of therapy also addresses what RLT therapy calls “psychological patriarchy,” where a partner with traditionally “masculine traits” such as assertiveness and invulnerability holds contempt for the partner with more “feminine traits” such as accommodation and vulnerability.

RLT works to help partners with masculine traits show more vulnerability while helping those with feminine traits be more assertive.

In working with any dysfunctional patterns arising from the family of origin, Polk says that the key is to remind the person who’s abusive of “what they will lose if they don’t stop as well as what they can gain.”

He then works with the couple on building better relational skills so that neither partner is in a “one-up grandiosity” position or a “one-down toxic shame” position.

Couples counseling can be helpful and effective when both people are committed to learning new skills and overcoming destructive relationship patterns and have the empathy to better understand one another.

But couples counseling is generally not recommended when the level of abuse is severe or the traits and behaviors of one person interferes with therapy.

Although couples therapists vary in their approach, many use individual and joint sessions to perform risk assessments and determine whether to continue with couples therapy in cases of abuse.

Couples may instead be referred to individual treatment, as couples therapy may actually escalate abuse in some cases. Safety planning with the survivor is especially crucial in severe cases.

Therapies such as dialectical behavior therapy (DBT), supportive therapy, and cognitive behavioral therapy (CBT) may be used depending on the unique patterns present in the relationship.