Crisis and Violence

As the closure wears on, the collective nerves of many families will be increasingly frayed. Part of our role as therapists is to approach the possibility that there may be incidents of violent behavior in some of the families we are treating. We can divide this topic into two sections:

Families who have experienced violence in the past:

               These are our most vulnerable families. It is always best to have a calm and “neutral” approach to violence. Neutrality is not an ethical matter. We do not condone violence. But neither do we “condemn” anything. Neutrality means our ability to UNDERSTAND violence as a part of human experience. We can never treat anything we refuse to understand. Nor can a therapist afford a stance of distance from any human experience of her clients. This means we need to recognize and accept whatever we can identify in OURSELVES that comes closest to violent experience.

               We ask of ourselves to be able to look honestly at the possibility that there may well be violent behaviors in the families we are treating during this time. We ask of ourselves to be able to inquire about violence the same way that we inquire about depression or anxiety: a form of human suffering. For these families, an open discourse about the possibility of violence allows the family to communicate honestly about this aspect of their experience.

               If there have been unfortunate violent expressions during these times, we ask of ourselves to understand the divergent experiences of the family member who has been violent and the experience of the members who have been the victim of the violence. First and foremost, we ask whether there remains a danger of repeated expressions of violence. Our first task is to help the family to REGULATE itself to prevent further violence. This may include changes in time and in space that separate “perpetrator” and “victim.” In an escalating situation we may wish to involve social services to assist in these pragmatic changes. This is a matter for emergency supervision.

               We cannot afford to make our clients afraid of us. That is why our interest in understanding the violence as an unfortunate but human experience for the entire family is foremost. If we can help the violent party and his victim to understand each other we add an intersubjective aspect which is the most reliable and deepest contribution to regulation, if we can get there. No one strikes a loved one whose painful experience is present in his heart. For our fragile families who suffer lower differentiation and are challenged to create a safe regulation, we offer the possibility of mentalizing about violence and creating alternatives.

Families who have no history of past violence:

               Here we must recognize the tragic aspect of a family who first experiences violence during these unusually stressful times. We have a complex role to play. We want to explore how the dysregulation that led to the violence took place. We want to help change the patterns in time and space to create a safer regulatory function. But we also want to preserve the family’s self-respect, self-confidence, and HOPE. We risk harming the family if our inquiry or intervention leads to a self-image as a “violent” family.

               To this extent our approach is similar to that with a child who hears from his parents, “How does a bright and capable child like yourself end up hitting?” After all, we wish to help the family to move past the tragic expression of violence, not to identify with it. You can see how the “neutrality” of seeing the human side of violence, as long as it does not present immediate further danger, allows the family to internalize the pain and regret and become a partner in further prevention. As you all know, once a child regrets something he has done, yelling at him weakens his conscience by treating him as incapable of conscience. We put it this way: Acting as an external conscience weakens the internalization of conscience. It is the same with families. The important issue is how the family approaches the violence. How we approach it is a means, the ends is how the family moves.

 What to do with a given family at a given time is something to sort out with your supervisors. Here I have tried to formulate the questions that will come up in supervision. I am encouraging you first and foremost not to be afraid to look at violence squarely in the face – and, as always, in the mirror.

I am sharing some of our senior staff’s comments for your information. This way you can see how the conversation evolves on this issue.

Comment 1:

I enjoyed this article – it’s humane, reader-friendly, concise, and gives a therapeutic meta- approach to a subject which can freak out even the most seasoned therapist. Certainly the counter-transferential piece is critical. This is a necessary article and one of the few therapeutic ones I’ve seen lately.

Along with this, a few comments.

I have a problem with the word “neutrality”, even if it is in quotes. It’s not clear to me what that means and what it would mean to a new therapist. Dealing with abuse necessitates finding some empathic foothold with the abuser and joining him/her in understanding his pain and difficulty. However, I don’t believe therapy can be effective if the abuse is on-going. As therapists we can’t in any way condone or minimize aggressive and hurtful behavior. I would aim at externalizing the abusive BEHAVIOR (a la Michael White) which is less judgmental of the abusing person, but does take a stand against violence.

Understanding the family dynamic which leads up to the abuse is very important and central to the therapy. Even here, though, therapists have to be super-careful and exact because a potential exists for a paradoxical outcome whereby the victim might feel blamed (eg. if I didn’t get Dad upset, he wouldn’t have erupted at me). Therefore I think it’s crucial to analyze the family interaction with all members, where the overarching value is that abuse is not an option. I don’t see this as the therapist taking away the abuser’s conscience rather as joining forces with all family members to figure out how to act conscientiously. Ultimately, I believe that the expectation that family members are non-abusive is super-ego enhancing. Hopefully the combination of family distress, empathic understanding of all sides, and a therapeutic contract which takes into consideration the whole family dynamic would achieve both regulation and a family “conscience”.