Abuse is the basis of many counselor visits. The occurrence of abuse underlies many maladaptive schema which manifest themselves in the rest of the individuals relationships. Women engaged in abusive relationships are at the same time terrified for their safety at the hands of their abuser and of reporting the abuse for a myriad of reasons. Whether it’s protecting their “love” or fear of the “consequences” of revealing the abuse, a good counselor will be able to spot signs of abuse in patients otherwise uncomfortable talking about it.
Abuse can occur in several forms, be it, emotional or physical, further compounding the difficulty in screening. The main detriment to learning about the truth of abuse in a relationship for the counselor is that the abused does not say that she’s being abused, or otherwise hiding it. Hiding things from the counselor is something that obviously hinders accurate history taking and diagnosis. But how can the counselor learn to read a patient and inform his inquiries?
Another difficulty in learning about abuse is that information is filtered with only counseling the one patient. It is important when understanding a patient to understand the biopsychosocial context they live in (Engel, 1977). This may involve speaking to friends, family, or colleagues. Perhaps the patients best friend may be more willing to inform about abuse than the individual.
The current literature speaks of abuse happening in a cycle. Different commentators have made circles of various complexity but they all amount to the following four phases: 1) Tension building phase, 2) An acting out phase, 3)Reconciliation/Honeymoon phase and 4) a calm phase. Understanding the phases in which abuse occurs can help the counselor make an informed hypothesis about what is happening.
A trained practitioner will be able to spot the symptoms of anxiety that might come with the tension building phase. Abuse is most likely to be discovered in the acting out phase. In the Reconciliation/Honeymoon phase the patient will likely try their hardest to conceal the abuse, and in the calm phase they may be lulled into a false security by its evident smoothening.
It is important to understand that abused dependents often fall into some early maladaptive schema as described by Young in 1990. If early maladaptive schema can be detected and surveyed than it may be possible to recognize patterns that individuals might fall into when they happen to be in a particular stage of the cycle (Young, 1990). A trained counselor might have also recognized the warning signs regarding the relationship when hearing about adventures and misadventures. For instance according to Gray in 2012, as early as 2009, Huguely’s propensity for irrational violence was known when he attacked his team mate over rumors. This attack bully mode that can be seen in dangerous people is common (Young, 1990).
It is never easy to detect abuse if the abused feels a need to keep their abuse secret. Elaborate tricks will be played, many appointments cancelled, and flimsy excuses all may be extended to attempt to deceive the interviewer of abuse. The abuse cycle and the various times that abuse may become more evident in different phases of the cycle, and acute ears to pick up queues from the client evident of any maladaptive schema may lead to timely aid of the abused.
Engel, G. L. The Need for a New Medical Model: A Challenge for Biomedicine.
Science. 8 April 1977: 129-136. Viewed on Jstor.
Gray, M. (2012). The murder of Yeardley Love and trial of George Huguely V: A
timeline. Time Magazine. http://newsfeed.time.com/2012/02/23/the-murder-of-yeardley-love-and-trial-of-george-huguely-v-a-timeline
Young, J. E.(1990). Cognitive therapy for personality disorders: A schema-focused
approach. Sarasota, FL: Practitioner’s Resource Series