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 Section 9 Cognitive Therapy for Partner Violence
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 In 
  the previous section, we talked about 5 urban legends or myths you might consider 
  reviewing with your client concerning their beliefs about abuse. 
 In this section, we will explore reframing these beliefs;  the use of the three concepts of 
  recognize and remember, RET, and BAD Questions.
 
 How invested is your client in 
  viewing a situation from the point of view of myths created by their "Great 
  Catch"? We will look at how the power invested in the "Great Catch" 
  enables him to "Reconstruct Reality," which erodes your client's self-image through blame.
 In 
  a session, have you found the introduction of the topic of the control a 
  partner exhibits over another can be a difficult one to discuss? During 
  these sessions I have found the receiver of the abuse realizes the negative impact 
  that their Great Catch relationship is having on them.  As 
  you know, many clients blame themselves for their situation. They buy into their 
  partner's script, that her defects are the root of all evil and the cause of his 
  or their problems as a couple. What makes your abused client stay in a relationship that 
    is controlling and abusive? What role does blame play in whether or not she stays? 
    What do you think? ♦  Eroding of Self-ImageAs 
  you already know, the eroding of self-image is a primary factor in the creation 
  and perpetuating of an abusive relationship. This destruction is achieved mostly 
  through blaming the individual being abused. This blaming, in turn, creates a 
  chain reaction,  in which she feels responsible for the abuse.  This feeling of 
  responsibility for the abuse makes her feel compelled to stay in the relationship.
 
 Here's an example of this blaming chain reaction which goes from feeling responsible 
  to resulting in feeling compelled to stay. Rhonda, a 41-year-old schoolteacher 
    with 2 children, expressed that in her 20 years of marriage, Jeffrey often made 
  her feel like she was a bad wife who couldn't do anything for herself.
 Rhonda 
  burst into tears after two sessions, "Jeffrey knows how to really push my 
  buttons, in a big way. He always makes me feel at fault for all of our problems! 
  Even if I did everything perfectly, he still manages to find something wrong. 
  He yells at me and says 'If you didn't make such crappy food I would feel motivated 
  to go to work more.' But even if I make the best meal, he'll turn around and then 
  accuse me of making meals that are too good so that he gains weight and feels 
  too lazy to go to work. I feel like a complete failure. I hate myself."  In 
  spite of Jeffery's blaming behavior, Rhonda felt she had the "Great Catch" 
  which was evident as she described how things were in the beginning of her marriage 
  by saying, "In the first couple years of our marriage before our first child, 
  I felt fortunate to have Jeffrey. Even the wedding photographer described him 
  as looking like a model. My brother described Jeffrey as 
  the best I could do
Jeffery's a really great guy."  ♦ Reconstructing the Reality Clearly 
    Jeffrey is reconstructing the reality of his not going to work and making Rhonda 
    his scapegoat. Thus, tool #1 of the abuser is reconstructing reality
by blaming. 
    Jeffery's blaming is eroding Rhonda's self-esteem.
 What 
  would be your next step with Rhonda in this session? Here's what I did. I decided 
  to Reconstruct the Reality of Rhonda's self-blame based upon her narrative and 
  explore the meaning that it held for her.  ♦ 2 
  R's: Recognize and RememberI Reconstructed the Reality of Rhonda's 
    self blame by using a 2 R method of questioning, which encouraged her ability to 
    construct her truth independent of Jeffrey's version of the truth.
 The 
  2 R's are recognize and remember. Rhonda began to first recognize and then remember 
  the power that she had before she met Jeffery. Do you need to point out the 2 
  R's of recognize and remember that occurred at the beginning of your clients' 
  transformation into being desperate dependent
into awareness? I 
  have found, by helping the client to discover a new narrative as they recognize 
  and remember the abuse, it often introduces her to opportunities for making new 
  choices. Here's how I helped Rhonda develop this new narrative using the 2 R's 
  of recognize and remember. The purpose was to reverse the erosion of her self-esteem 
  caused by Jeffrey's reconstruction of reality.  I asked Rhonda, "Have you ever thought about your relationship with Jeffrey 
  from the point of view of who's in control? It sounds like Jeffrey constructs 
  the story, or his version of reality was pretty much  accepted by you. Is 
  that right?" After Rhonda remembered specific situations this seemed to fit. 
  I could see she was beginning to emotionally buy into, or connect with and recognize 
  this as a line of reasoning that seemed to fit and be true for her. Ask yourself 
  are the 2 R's of recognize and remember a concept you might introduce into your next 
  training session with your Rhonda? ♦ Rational-Emotive TherapyTechnique 
  two to reframe client beliefs, in addition to the two R's remember and recognize, 
  is RET.
 I find borrowing from Albert Ellis' Rational-Emotive Therapy, RET, 
  approach here beneficial. I encouraged Rhonda, as I had Ellis' RET basics in mind, 
  to make a distinction between what is an objective fact versus what was her subjective 
    interpretation of her and Jeffrey's behavior. I stated in so many words, "It 
  sounds like you and Jeffrey have created an environment where Jeffrey's negative 
  behavior is either justified or it is tolerated by you. By justifying and tolerating, 
  this allows your relationship to continue as it has."
 The 
  tricky part here, for me is, while saying this to Rhonda, in my RET work with 
  her I felt I needed to steer her away from self-blame, but in addition steer her 
  away from making Jeffrey out to be the total scapegoat.  ♦  The Triangular TightropeSo 
  the therapeutic triangular tightrope I felt I needed to walk in distinguishing 
  objective fact from subjective interpretations, was this:
  #1 Helping Rhonda to become aware that by justifying and tolerating Jeffrey's 
  behavior she was perpetuating the problem.   #2 in the triangle was to, at the same time, steer her away from self-blame, 
  which she was an expert at. Sound familiar with some your clients?  #3 in the triangle I had to walk therapeutically was to steer her away from externalizing the problem and making Jeffrey the total bad guy and scapegoat.  ♦ B-A-D 
  QuestionsIn addition to the 2R's of remember and recognize and 
    Ellis' RET concepts of objective fact versus subjective interpretations, was the 
    use of the B-A-D questions reframing Rhonda's beliefs.
 I 
  used the following three questions, over the period of several sessions, to help 
  Rhonda walk this three sided triangular therapeutic tightrope. BAD stands for the 
  key words bear, acceptable, and deserve. #1. 
  The B stands for bear. I asked Rhonda, "Do you think that you can 
  bear this type of treatment for the rest of your life?"  #2. 
  The A stands for acceptable. I asked Rhonda, "You stated earlier, 
  Jeffery is not behaving the way that a man in love with you and committed to his wife behaves. Is that acceptable to you?" #3. 
  The D stands for deserve. I then stated, "You stated there have been 
  good times between the two of you, but that's not what I'm hearing about. You 
  sound unhappy. Do you think you deserve happiness?" I 
  gave Rhonda the opportunity to come to her own conclusions as each BAD question 
  was explored over a series of sessions.  Notice, 
  I phrased these questions so that the focus was not on Jeffrey's behavior but 
  rather on Rhonda's responses, and on Rhonda's choices that she made based on her 
  perception of the reality of the situation. Rhonda realized that she was spending 
  more energy than she wanted to be anticipating Jeffrey's needs. She began speaking 
  up to establish boundaries regarding his angry outburst. Rhonda finally insisted 
  firmly that Jeffery get help. Rhonda 
  explained at the end of one of our final sessions, "Nothing raises 
  my feelings about myself like my successes. Maybe it's just a small thing, but 
  I now feel proud to be a teacher, and see that feeling lazy because I don't take 
  a second job is not how I feel anymore. This was Jeffery's version of the truth. 
  I feel the cure for my horrible feeling of powerlessness is to be aware of my 
  power in my relationship with Jeffrey." In 
  this section, we explored reframing you clients beliefs by the three interventions 
  of the 2 R's of recognize and remember; RET objective facts versus subjective 
  interpretations, and B-A-D Questions. In 
  order to facilitate your client's awareness of the power he or she has lost or 
  holds in a relationship, in the next two sections we will talk about how to increase 
  your client's awareness of rationalizations they have for staying in their relationship.Reviewed 2023
 
  Peer-Reviewed Journal Article References:Allard, C. B., Norman, S. B., Thorp, S. R., Browne, K. C., & Stein, M. B. (2018). Mid-treatment reduction in trauma-related guilt predicts PTSD and functioning following cognitive trauma therapy for survivors of intimate partner violence. Journal of Interpersonal Violence, 33(23), 3610–3629.
 
 Cotti, C., Foster, J., Haley, M. R., & Rawski, S. L. (2020). Duluth versus cognitive behavioral therapy: A natural field experiment on intimate partner violence diversion programs. Journal of Experimental Psychology: Applied, 26(2), 384–395.
 
 Galovski, T. E., Werner, K. B., Weaver, T. L., Morris, K. L., Dondanville, K. A., Nanney, J., Wamser-Nanney, R., McGlinchey, G., Fortier, C. B., & Iverson, K. M. (2021). Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence. Psychological Trauma: Theory, Research, Practice, and Policy.
 
 Iverson, K. M., Gradus, J. L., Resick, P. A., Suvak, M. K., Smith, K. F., & Monson, C. M. (2011). Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors. Journal of Consulting and Clinical Psychology, 79(2), 193–202.
 Lambert, J. E., Benight, C. C., Wong, T., & Johnson, L. E. (2013). Cognitive bias in the interpretation of physiological sensations, coping self-efficacy, and psychological distress after intimate partner violence. Psychological Trauma: Theory, Research, Practice, and Policy, 5(5), 494–500.
 QUESTION 9Walling, S. M., Suvak, M. K., Howard, J. M., Taft, C. T., & Murphy, C. M. (2012). Race/ethnicity as a predictor of change in working alliance during cognitive behavioral therapy for intimate partner violence perpetrators. Psychotherapy, 49(2), 180–189.
 
To reconstruct the reality of self-blame experienced by your client, what are the key words to use to recall the B-A-D questions in a session with a client? To select and enter your answer go to . 
 
 
 
 
 
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