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In clinical work with couples, spousal violence is a
complex issue that is often underreported or concealed,
as spouses consult more often for their problems with
regard to managing conflict. However, escalating conflicts
are an important precursor of violence within couples.
Clinicians need to properly assess the presence, frequency
and forms of violence (e.g., psychological, physical and
sexual) and the severity of violent behaviours within
couples before embarking on interventions with the
spouses. This paper provides an overview of the scientific
work on the prevalence, reciprocity and risk factors of
spousal violence, in addition to providing avenues for
assessment and directions for treatment in the context of
violence.
Statistical portrait
Many epidemiological inquiries and studies have attempted to
develop a statistical portrait of male and female psychological,
physical and sexual spousal violence in the general population.
Desmarais and her collaborators (2012a,b) examined studies on the
prevalence of spousal violence published between 2000 and 2011
and observed that 22% of adults (female = 23%, male = 19%)
reported having experienced physical violence in an intimate rela-
tionship, whereas 25% (female = 28%, male = 22%) reported having
perpetrated physical violence against a romantic partner. Spousal
violence is a complex and persistent phenomenon with high rates
of recidivism (around 67%; Feld & Straus, 1990).
In the United States, nearly one in two Americans
(male = 48.8%, female = 48.4%) say they have been victims of
psychological violence during their lifetime, while one-third of
women (35.6%) and one-quarter of men (28.5%) reported that they
had experienced physical or sexual violence (Black et al., 2011).
According to Statistics Canada (2013), violence between intimate
partners accounts for 20% of violent crimes reported by the police;
the vast majority of victims (80%) are women. The 2004
General Social Survey on victimization, which included 653,000
women and 546,000 men, revealed that approximately 7% of Cana-
dian women and 6% of Canadian men living as a couple reported
having been victims of some form of physical or sexual violence
(from mere threats of hitting the partner to sexual abuse) by their
spouse in the five years preceding the survey (Statistics Canada,
2005). Quebec ranked slightly below the Canadian average, with
5% of men and 6% of women saying that they had been victims
of spousal violence. Rates of spousal violence in the general
This paper presents some concepts about spousal
violence, in terms of prevalence, reciprocit y and risk
factors. Criteria are suggested to facilitate assessment of
the intensity of violence within couples. Recommendations
are proposed concerning the relevance of treating violent
acts in couple’s therapy.
Keywords: spousal violence, reciprocal violence,
dangerousness, assessment, treatment
8
Integrating Science and Practice VOL. 3 NO. 2 NOVEMBER 2013
www.ordrepsy.qc.ca/scienceandpractice
Spousal violence:
Useful parameters
for assessment and
intervention
Yvan Lussier, Ph. D.
Psychologist and
Professor of Psychology
Université du Québec
à Trois-Rivières
yvan.lussier@uqtr.ca
Audrey Brassard, Ph.D.
Psychologist and Professor of Psychology,
Université de Sherbrooke
Natacha Godbout, Ph.D.
Psychologist and Professor of Sexology,
Université du Québec à Montréal
Stéphane Sabourin, Ph.D.
Psychologist and Professor of Psychology,
Université Laval
John Wright, Ph.D.
Psychologist, Emeritus Professor,
Université de Montréal
Don Dutton, Ph.D.
Psychologist and Professor of Psychology,
University of British Columbia
Integrating Science and Practice VOL. 3 NO. 2 NOVEMBER 2013
www.ordrepsy.qc.ca/scienceandpractice
population appear to be similar for men
and women. It is important to point out,
however, that women are victims of more
severe and violent incidents and report
more psychological consequences and
injuries than men (Statistics Canada, 2005).
In studies among represen-
tative samples of couples in Quebec,
Godbout and her collaborators (2009)
evaluated different forms of violence and
observed that 27% of couples (female =
31%, male = 23%) reported having
exhibited at least one physically violent
behaviour towards their partner in the
past year. The rates rose to 83% for psycho-
logical violence, with a mere 17% of cou-
ples reporting the absence of violent
behaviours in their relationship. In addi-
tion, 17% of men and 7% of women had
been sexually violent towards their partner
at least once during the same period
(Lafontaine & Lussier, 2005). This form of
violence is more widespread in young
adults; 46% of women aged 18 to 25 said
they had suffered sexual violence at least
once in the past year (Lussier, Lemelin,
& Lafontaine, 2002).
Clearly, there are marked
disparities in the estimates of violence ob-
tained in the different studies. The nature
of the study (epidemiological, clinical,
samples of cases going to court, samples
of volunteers), the manner in which the
study is presented to participants (study
on conflicts or study on crime, crime vic-
tims, personal safety), the very definition
of violence and its operationalization (type
and number of questions), and the sam-
ples’ characteristics (age, presence of chil-
dren, etc.) are important factors that may
contribute to such variations. For example,
retrospective studies reveal that there is an
increase in violence in terms of frequency,
intensity and severity in many couples
over the years of living together
(Holtzworth-Munroe, Beak Beaty, & Anglin,
1995). Despite the variations, the studies
clearly demonstrate that violence is a real
issue that undermines the quality of cou-
ple relationships and carries substantial
social costs. Spousal violence, whether
physical or psychological, is linked to many
consequences. Some researchers highlight
the particularly damaging effects of
psychological violence, not only because
it occurs more frequently (e.g., Marshall,
1992; Walker, 1984) but also because it
often precedes physical violence (O’Leary
et al., 2007) and is perpetrated by both
men and women (Ehrensaft et al., 2009).
Reciprocal violence
Bidirectional spousal violence is consid-
ered the most frequent form of violence
in intimate relationships, whether in the
general population or in clinical popula-
tions (Langhinrichsen-Rohling et al., 2012).
Because of this, it is important to consider
the dyadic mechanisms that help foster or
sustain spousal violence, owing particu-
larly to their deleterious effects on
spouses, on the relationship and on
children who may be witnesses, and the
risks of escalation associated with spousal
violence.
Current data indicate that
clinicians need to incorporate bidirectional
violence assessment protocols and con-
sider the relational dynamic, communica-
tion patterns, emotional regulation
strategies, romantic partner selection
processes, conflict management styles,
and both partners’ internal experiences in
order to provide effective prevention and
intervention services. Indeed, studies on
the spousal interaction in violent couples
indicate a “negative reciprocity” where
each spouse tends to retaliate and
contributes to exacerbating the negative
communication, leading to an escalation
of the gravity of negative verbal ex-
changes that typically precede the perpe-
tration of physical violence (e.g., Margolin
& Gordis, 2003). Researchers also observe
a pairing between partners who use
violence (see Serbin et al., 2004), which
results not only in reciprocal violence but
is also associated with a risk of escalating
violence leading to police intervention
(Capaldi et al., 2007). In examining both
members of the couple, studies thus high-
light the dynamic influence of spouses.
The two-way nature of
spousal violence does not necessarily
imply a symmetry between the forms of
violent acts that are committed, nor the
resulting effects. Studies indicate that men
tend to use more severe violence, are at
less risk of injury, and experience less fear
towards their spouse’s violent behaviours
(e.g., Langhinrichsen-Rohling et al., 1995).
Likewise, according to a national survey,
women are more likely to report being vic-
tims of “intimate terrorism,” characterized
by the use of severe violence and a control
dynamic to subjugate the romantic part-
ner (4% as compared to 2% of men;
Laroche, 2005). Couples who perpetrate
bidirectional violence should be referred
quickly to assistance and protection serv-
ices. According to the study by Gray and
Foshee (1997), adolescent couples charac-
terized by mutual violence sustain and
perpetrate more spousal violence and
their risk of injury is greater, as compared
to couples characterized by unidirectional
violence.
In short, current data indi-
cate that clinicians need to pay special at-
tention to the intra and interpersonal
mechanisms underlying spousal violence,
regardless of the type. Moreover, by
9
viewing the couple as an interdependent
unit of intervention, whenever possible,
the range of personal and relational
dynamics underlying the violence and
relationship dissatisfaction can be ob-
served and targeted in order to offer
adapted services.
Quebec and international work
on predictors of spousal violence
Whether violence is unidirectional or
bidirectional, Quebec and international
researchers study the risk factors or predic-
tors of spousal violence. Their work serves
to identify the individuals most likely to
resort to acts of violence, but also to target
mechanisms leading to violence that can
be the focus of therapeutic work. In that
regard, Hamberger and Holtzworth-
Munroe (2009) report that a diagnosis of
mental disorder in one of the partners is a
factor that increases the risk of perpetrat-
ing spousal violence. Reviews of the litera-
ture on the subject further reveal that
certain sociodemographic factors are
linked to a greater risk of violence (e.g., low
income, young age, unemployment), but
that violence can be found in all social
classes (Holtzworth-Munroe, Smutzler,
& Bates, 1997). Other works have pointed
to the role of childhood exposure to vio-
lence (Godbout et al., 2009) and childhood
sexual abuse (Brassard et al., 2013) as pre-
cursors to violent behaviours in adult
romantic relationships. Attachment inse-
curity (Fournier, Brassard, & Shaver, 2011;
Lafontaine & Lussier, 2005), low empathy
(Péloquin, Lafontaine, & Brassard, 2011),
jealousy (O’Leary et al., 2007), anger regu-
lation difficulties (Brassard et al., 2013;
Lafontaine & Lussier, 2005), dysfunctional
communication patterns where one
spouse makes demands while the other
withdraws (Fournier, Brassard, & Shaver,
2011), and relationship dissatisfaction
(Lawrence & Bradbury, 2007) also appear
to be factors that predict recourse to acts
of violence against an intimate partner.
More and more models are being pro-
posed where multiple factors are included
simultaneously. For example, Godbout
and her collaborators (2009) have high-
lighted the link between childhood expo-
sure to violence and the use of spousal
violence, via the development of cognitive
attachment patterns marked by discom-
fort with intimacy (violence used as an
escape mechanism) and abandonment
anxiety (violence used as a pursuit strat-
egy). Brassard and her colleagues (2013)
have tested a model where childhood
sexual abuse is associated with the use of
spousal violence in men via abandonment
anxiety and difficulty regulating anger.
Assessment of spousal violence
Before arranging an initial meeting with a
couple, it is recommended to screen for
the presence of violence in the couple over
the phone. Most clinicians do not com-
plete such screening. This preliminary
screening does not replace direct inquiry
with the victim, and a more thorough
systematic assessment should follow
during initial meetings (Lussier, Wright,
Lafontaine, Brassard, & Epstein, 2008).
For safety’s sake, it is prefer-
able that a detailed investigation of severe
current violence be performed in both
spouses, during one-on-one meetings
with each partner because (1) spouses
may not admit to or may underplay the
nature or intensity of the violent acts
because of denial or fear of retaliation, and
(2) the victim may have a false impression
of safety during sessions and denouncing
acts of violence may result in retaliation
before a violence prevention program can
get underway. It is further recommended
that the word “violence” not be used
during the initial couple session, but rather
that questions be asked regarding behav-
iours during conflicts (Epstein & Baucom,
2002). As Table 1 suggests, the procedure
for investigating violence as advocated
by Lussier and his collaborators (2008)
implies a style of inquiry that is direct, yet
respectful of each individual. Self-report
questionnaires can also be used to validate
the presence of violent behaviours, both
perpetrated and sustained (e.g., conflict
resolution strategies scale; Lussier, 1997)
and motivations for the use of violence
(e.g., Lafontaine, Péloquin, Brassard, &
Gaudreau, 2013). They must be adminis-
tered on an individual basis.
Decision-making model for choice
of couple’s therapy
The decision-making model proposed
by Lussier et al. (2008) is based on clinical
and empirical knowledge (e.g., Stith &
McCollum, 2009) and seeks to help clini-
cians take the right clinical action during
the assessment phase as regards the rele-
vance of couple’s therapy (CT) to treat
violence in one or both partners, or indi-
vidual therapy (IT) to treat the abuser’s
violent behaviours or the victim’s behav-
iours. The model considers five forms of
violence on a continuum of dangerous-
ness (see Table 2). Psychological violence
and physical violence are both taken into
consideration, while sexual violence is
included in one of those two forms of
violence.
The process leading to the
recommendation or not of CT (right
column) is based on the clinician’s strong
familiarity with: (a) risk factors of danger-
ousness; (b) various clinical options avail-
able in cases of dangerous spousal
violence; and (c) the pros and cons of cou-
ple’s therapy in cases of dangerous spousal
violence. Like Stith and McCollum (2009),
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TABLE 1
Assessment of violence during initial contact with spouses.
1. What happens when you are angry?
2. Do you and your spouse raise your voices or shout?
3. Do you scream abuse or insults at each other?
4. Do you or your spouse do something at the height of the argument that you
regret later?
5. When your arguments escalate, has either of you ever thrown objects or hit
something?
6. When your conflicts escalate, has either of you ever pushed or shoved the other or
done anything else of a physical nature?
who use a variety of criteria to determine
the relevance of couple’s therapy, the
decision-making process considers 24 fac-
tors identified by Lussier and his collabo-
rators (2008). The factors need to be
assessed minutely (see Table 3). To assess
the intensity of a factor, a four-point scale
is proposed (0 = absence of behaviour,
1 = minor presence, 2 = moderate pres-
ence, 3 = strong presence). The first six
factors directly concern the dangerous-
ness of the acts of physical violence. It is
important to remember that the presence
of just one of the first six factors is suffi-
cient reason to contraindicate CT, as they
are indicators of dangerous or potentially
dangerous violence. In those cases,
individual treatment of each spouse is
recommended. Once that treatment is
completed successfully by each partner
(which corresponds to type 4 violence in
Table 2), couple’s therapy can be recom-
11
TABLE 2
Continuum of violence and recommendation for couple’s therapy.
TYPE OF VIOLENCE
1. Psychological violence, without physical
violence
• minor psychological violence
• severe psychological violence
2. Sporadic psychological violence and
physical violence in the past
3. Current but minor physical violence
4. Severe physical violence in the past,
but no longer active
5. Dangerous or potentially dangerous
current physical violence
Recommended
Recommended on condition
Recommended on condition
Recommended on condition
Recommended on condition
Not recommended
COUPLES THERAPY
mended on condition that there are few
factors in Table 3 (factors 7 to 24) of
moderate to strong intensity.
Throwing or breaking ob-
jects or hitting something (factor 7) is a
strong indicator of potential physical
violence. Violence is present, but it has not
reached the victim physically yet. The acts
are threatening and can be potentially
dangerous. The abuser’s ability for self-
control needs to be assessed to determine
whether CT is recommended: a score
of 3 indicates a poor ability and is a
contraindication to CT. If factor 7 is of
moderate intensity and is accompanied by
severe psychological violence, CT is not
recommended. In couples that exhibit
minor and infrequent psychological
violence or report one or a few sporadic
episodes of physical violence in the past,
CT would be appropriate (Cascardi &
O'Leary, 1992). If factors 8 to 24 are absent
or obtain low scores (score = 1), spousal
problems generally lie within the range of
communication and problem-solving skills
where intervention is possible so that the
violence does not degenerate into more
severe violence. Severe psychological
violence can also be treated in CT. How-
ever, if a victim reports an intense fear with
respect to his/her spouse (factor 17) or ex-
treme psychological vulnerability (factor
18), it is preferable that IT be recom-
mended before initiating CT. Likewise, if
the scores are low (score = 1), but more
than five risk factors are present, IT is
recommended before CT. The presence of
deficient relational skills, judgment or
intelligence (factor 23) needs to be care-
fully assessed to determine the relevance
of treatment. All in all, the intensity and the
number of factors presented in Table 3
influence whether CT is appropriate for the
treatment of spousal violence.
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TABLE 3
Factors associated with dangerous spousal violence (Lussier et al., 2008).
RISK FACTORS OF DANGEROUSNESS
1. Injury caused to spouse on more than two occasions in the past 12 months
2. Injury to children on more than two occasions in the past 12 months
3. Reprisals or threats of injury, suicide and/or homicide
4. Sadistic behaviours (e.g., torture, burns, deprivation of food or sleep)
5. Use of a weapon to threaten or injure, or use of martial arts to threaten or injure
6. Rape or forced sexual relations
7. Throwing or breaking objects or hitting something (e.g., wall or table)
8. Criticism, insults or bullying
9. Possessive behaviours, domination or control by coercion
10. Substance abuse (alcohol and/or drugs)
11. Interventions by persons from outside the couple during incidents of spousal violence
12. Police record or police intervention for violence inside or outside the home
13. Spousal dependence, jealousy or obsession
14. Borderline personality (inability to trust one’s spouse because of paranoid thoughts or
pathological jealousy)
15. Antisocial personality (impulsiveness, manipulation, crime, history of cruelty to animals)
16. Non-acceptance of responsibility for violent behaviours, lack of remorse for harm
caused, or lack of motivation to change
17. Feelings of fear in victim with regard to abuser, fear of being killed, or personal blame
for spouse’s violence
18. Psychological vulnerability of victim (e.g., low self-esteem, lack of self-assertiveness,
submission, acquired resignation, post-traumatic stress disorder)
19. Multiple family stressors (e.g., poverty, job loss, blended family, sick child)
20. Poor social support network
21. Social environment that encourages violence
22. Past history of childhood maltreatment
23. Deficient relational skills, judgment or intelligence
24. Clinician does not feel safe
Finally, factor 24 was intro-
duced because clinicians in contact with
spousal violence can experience or feel
concerns for their personal safety.
Extremely little documentation exists on
that subject. According to Lussier et al.
(2008), violent men with an antisocial or
borderline personality may use that type
of threat, especially with female therapists
(e.g., “when people push my buttons, they
know I can get nasty”). Such threats must
never be taken lightly. For that reason,
familiarity with the various elements of the
diagnostic protocol is important, not only
for the well-being of the spouses, but for
that of caseworkers as well. If clinicians are
fearful for their safety, they best not pursue
couple’s therapy and should refer the
violent spouse to a specialized treatment
centre or work in co-therapy (mixed dyad;
Lussier et al., 2008).
These few multi-dimen-
sional avenues for the assessment of
spousal violence can be used both by
therapists working with couples as well as
by clinicians who intervene with clients
in individual therapy. When intervening in
the area of spousal violence, we recom-
mend that clinicians proceed with caution.
Solid training is necessary. The interven-
tion models need to consider the multiple
developmental, personological, interac-
tional and cultural factors that predispose,
precipitate and maintain violence within
couples.
13
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