Introduction & Pre-Test
Welcome to the Course
This computerized training module is designed to increase your knowledge about domestic violence so that you can be more effective in helping families in their homes throughout your profession.
In this course, we’ll explore the following topics:
- The prevalence of abuse.
- The effects of abuse on women, children, and society.
- The forms and signs of domestic violence, including physical, emotional and sexual.
- The patterns of abuse that typically exist in intimate partner relationships.
- How to assess for abuse.
- How to help families dealing with domestic violence develop a safety plan.
- Safety plans that will help you as a home therapist.
In this module, the female pronoun is used to refer to the victim and the male pronoun is used to refer to the abuser for the sake of convenience.
This module will guide your exploration and increase your knowledge about families and domestic violence and enable you to become more effective in working with the family on domestic violence issues. The objective of the module is to accomplish the following:
- Explore the scope of families and domestic violence in HBFT.
- Establish a common ground of terminology.
- Develop a unified framework for exploring domestic violence throughout the process of home therapy.
- Examine examples of effective strategies and techniques to therapeutically address domestic violence.
- Apply the unified framework to a family vignette.
Scope of the Issue
Domestic violence is one of the many crises facing families today. It destroys the social, economic, mental and physical well being of men, women, children and the family as a whole. Although many responses are targeted primarily toward adult victims of abuse, attention is now being given to children who witness domestic violence. Studies show that 10 to 20 percent of children are at risk for exposure to domestic violence. This has led to more attention being given to children who witness domestic violence, as opposed to responses primarily being targeted at adult victims of abuse. In fact, there are adults and children in 30 to 60 percent of families experiencing domestic violence (Edleson, 1999).
Prevalence of Domestic Abuse
According to the US Department of Justice (2005), family violence accounted for 33% of all violent crimes recorded by police in 18 states and the District of Columbia in 2000. The majority of family violence offenders (93%) in state prisons in 1997 were male. Of these more than 207,000 family violence crimes, about half (53%, or 110,000) were crimes between spouses.
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Establishing a Common Ground
What is Domestic Violence?
Definitions of Domestic Violence
There are many varying definitions of families and domestic violence. To many researchers, for example, men and women are equally violent in their relationships and some consider family violence to be gendered. According to the US Department of Justice (2005), “family violence includes all types of violent crime committed by an offender who is related to the victim either biologically or legally through marriage or adoption. A crime is considered family violence if the victim was the offender’s current or former spouse; parent or adoptive parent; current or former stepparent; legal guardian; biological or adoptive child; current or former stepchild; sibling; current or former step sibling; grandchild; current or former step- or adoptive-grandchild; grandparent; current or former step- or adoptive-grandparent; in-law; or other relative (aunt, uncle, nephew)”.
Domestic violence therefore “includes one form of family violence — spouse violence —and one form of nonfamily violence —intimate partner violence” (Department of Justice, 2005).
Miller and Knutsen (2007) in developing the Family Abuse or Violence Framework define family violence as episodes that are “usually repeated but always purposeful social behaviors or omissions that tend to be motivated by inappropriate intentions to control or dominate family members or situations that affect family relationships”.
Types of Domestic Violence
As noted in the previous section, domestic violence occurs between family members or relational intimates within the family. There are many types of domestic violence; however, this module will focus on these four: intimate partner violence, child abuse, dating violence, violence between same sex couples.
Intimate Partner Violence
Intimate partner violence is the most common type of domestic violence and many studies describe it as any behavior within an intimate relationship that causes physical, psychological or sexual harm (Hegarty, Taft, & Feder, 2008).
- Socio Cultural Perspective of Intimate Partner Violence:
The definition and interpretation of intimate partner violence is characterized by a social context that has been shaped by diverse dimensions such as gender, class and culture (Connell, 1987). It is therefore uncommon for victims of intimate partner abuse to perceive the abuse from one of these dimensions which reinforce power inequities between men and women (Yick, 2007). For instance, in certain cultures, husbands are legally permitted to beat or kill their wives in response to infidelity (Connell, 1987), whereas social norms in other cultures perceive intimate partner abuse as a personal and private issue which must be dealt with by the partners involved in the violence.
Socioeconomic status also plays a role in understanding intimate partner violence. By contrast, women who are economically independent have more options and are freer to see certain situations as intolerable than those living in poverty (Liang, Goodman, Tummala-Narra & Weintraub, 2005). A vignette from, Liang, Goodman, Tummala-Narra & Weintraub, (2005) will be presented in a subsequent section to illustrate how culture, class, gender and other sociocultural dimensions of women’s experiences influence their decisions to seek help.
The definition of child abuse has been debated over for the past four decades, reflecting different perspectives and opinion on the acts of abuse. One of the early definitions includes any nonaccidental injury to a child resulting from actions (or non-actions) of the parents (Helfer & Kempe, 1974 as cited in Frieze, 2005). Other scholars such as Garbarino (1989) have argued that for an action to be labeled as abuse, the parent must intentionally harm the child physically, emotionally, or by neglect. Child abuse also includes all the types of domestic violence that will be discussed in later sections. Studies show that physical abuse toward children is often associated with more general patterns of violence within couples (Krishnakumar & Buehler, 2000). Thus men who batter their wives may also abuse their children in one way or another. The victims (women) can also take out their frustrations by using violence against their children (Perilla, Frndak, Lillard, & East, 2003).
Miller and Knudsen (2007) define dating as “the formation of intimate and exclusive relationships that launch the process of courtship which is intended to culminate in marriage or cohabitation”. The American Psychological Association (APA) reports that dating violence generally leads to marital violence. Thirty-one percent of teen girls who report being forced to have sex identify their boyfriends as perpetrators (APA, 2004 as cited in Miller & Knudsen (2007). Dating violence includes all forms of domestic violence such as acts of physical, emotional, and sexual abuse that occur when couples begin going out. . The following points emphasized by Miller and Knudsen (2007) are worth noting:
- Girls and young women tend to be the victims of the more serious forms of physical violence and sexual violence. Boys and young men are as likely as girls and young women to experience verbal and emotional or psychological abuse within dating relationships.
- Substance abuse increases the likelihood of perpetrating dating violence.
- Balance of power within the relationship can affect the risk of experiencing dating violence.
- Social, structural and cultural factors, such as the concentration of poverty in urban neighborhoods and the acculturation of ethnic group members, are better predictors of dating violence than are personal characteristics.
Violence Between Same Sex Couples
Because same sex relationships are less common than heterosexual relationships, there are fewer data on violence in these relationships. However McClennen, Summers, & Daley (2002) estimate that there is violence in 25% to 50% of lesbian couples. Many couples in same-sex relationships admit they remain in their relationship with the hope that their violent partners will change, similar to couples in heterosexual relationships. A study by Tjaden, Theones, and Allison (1999 cited in Frieze, 2005), compared same sex couples with heterosexual couples and found that men living with a same sex partner were more likely to have been assaulted by their partners than were men living with women (15% versus 8%). For women, 11% of those living with a same sex partner were assaulted by their partners as compared to 20% of those living with men. Thus, gay partners may experience more violence than lesbian couples.
Forms of Domestic Violence
There are 3 major forms of domestic abuse:
Physical Abuse- Any nonsexual physical assault on the victim.
Emotional/Psychological Abuse- A behavior intended to frighten, control, or disparage a partner.
Sexual Abuse- Includes acts that force the partner to have nonconsensual sexual relations. Force includes applying undue pressure, threatening violence, threatening to leave the relationship, or using direct physical coercion.
Keep in mind that each form of abuse is on a continuum (as shown in the Domestic Violence Threshold Schematic) from mild to severe based on the offender’s behavior. Even so, any act of abuse can cause harm to the victim and can shift the power balance in the relationship. Also, remember that acts from all three forms of abuse can occur in a relationship, either at the same time or at different times.
Besides physical, emotional and sexual abuse, there is also economic or financial abuse where an abuser may hurt a victim and other family members by:
- Controlling their finances
- Withholding money or credit cards
- Withholding basic necessities (food, clothes, medications, shelter)
- Giving them an allowance
- Stealing or taking the victim(s) money
- Making the victim(s) account for every penny spent
- Exploiting the assets of the victim(s) for personal gain
- Preventing the victim(s) from working or choosing their own career
- Sabotaging the job of the victim(s)(constantly calling them)
Myths and Truth about Abuse
The following myths and facts about why domestic violence occurs have been adapted from the Maine Coalition to End Domestic Violence (2008):
- Myth-The abuser is out of control
Truth- the abuser is in control. The abuser decides who to abuse, when and where, the parts of the body to abuse and the length and severity of the episode. The abuser may remove rings or a belt as a signal or threaten the victim what he or she is going to do.
- Myth- Abuser has poor anger control.
- Truth- Many abusers admit to calmly planning violent incidents and most batterers are able to control their emotions when on the job, with friends, in court or when dealing with the police.
- Myth- Abusers experience stress.
- Truth-Abusers do not experience more stress than non abusers do. They choose to deal with their stress violently. Abusers usually believe they have the right to control and get their way.
- Myth- Abusers have low self esteem.
- Truth- Abusers do not differ from non abusers in their level of self esteem. The difference lies in the abusers belief system regarding women and children. The problem is the permission abusers give themselves to control and hurt other people.
- Myth- Domestic violence is caused by substance abuse of the perpetrator.
- Truth- Getting sober and into a program does not stop the abuse or the violence and being an alcoholic may be used to sidestep responsibility for abusive behavior. Substance abuse is another way for an abuser not to be held responsible. Getting sober is in fact the first step to dealing with issues of power and control. Studies show that frequent alcohol and drug use is not associated with domestic violence and sexual assault (Schewe, Riger, Howard, stags, & Mason, 2006).
- Myth- Abusers have a history of abuse from childhood.
- Truth- Many abusers were abused as children, but some choose not to abuse.
- Myth- Abusers abuse due to poor communication skills.
- Truth- This is a form of victim-blaming. Abusers demand that their needs be met before the needs of all others. Even when victims meet the needs of abusers, they continue to abuse.
- Myth- Abusers need to learn non-violence.
- Truth- Abusers know non violence. The problem is not their inability to resolve conflict in a non- violent manner, but their unwillingness to do so.
What Does Domestic Abuse Look Like?
Domestic abuse is used to gain and maintain control over a victim. Abusers usually use dominance, humiliation, isolation, threats, intimidation, denial and blame to exert power over their victims.
Dominance- In a home setting, you will recognize that the abuser is in charge of the relationship. He/she treats the victim(s) as his/her possession, telling them what to and what not to do. The abuser may make decisions and give specific instructions to the victim and the family as whole. The victim(s) is/are expected to obey every instruction without questioning.
Example: Rob expected his wife Ann to be obedient and passive all the time. When torturing Ann’s cat, Rob would demand her to swallow a large amount of sleeping pills if she wanted him to stop. This resulted in Ann spending many hours during the day and night sleeping because of the pills (Sev’er, 2002).
Humiliation- The abuser usually humiliates the victim and makes her feel defective and bad about herself in every way. If a victim believes she is worthless and that no one else will want her, she is less likely to leave. Usually insults, name calling, and shaming are some of the weapons that an abuser employs to make the victim feel powerless and erode her self esteem.
Example: Emanuel constantly insulted Lorie. He made brutally hurtful remarks about the lack of youthfulness in her hair, skin, breasts, belly, and practically every other part of her body. Lorie said that he often made her feel “like the dirt under his shoes.” Eventually Lorie felt that Emanuel was doing her a favor by being her husband because she felt that she was not worthy of anyone’s love. (Sev’er, 2002).
Isolation- You will notice in a home setting that the victim usually does not have contacts with her friends and the rest of her family because the abuser cuts the victim off from her family, friends and the outside world just to increase dependence on him. The victim may have to seek permission to do anything, to go anywhere, or to see anyone. (Maine Coalition to End Domestic Violence [MCEDV], 2005; Pence & Paymar, 1993).
Example: Rob wanted to isolate Ann from her family so he had them move many times (always farther away from her family). He treated Ann’s family rudely and insulted them when they visited. Rob also monitored Ann’s telephone calls, by not allowing Ann to speak to her family when they called. He eventually convinced her that her family was intruding on their privacy, and Ann began to believe him and started pushing her family members away (Sev’er, 2002).
Threats- Abusers commonly use threats to keep their victims from leaving or to scare them into dropping charges. For example, an abuser may threaten to hurt or kill the victim, her children, other family members, or even pets. He may also threaten to commit suicide, file false charges against the victim, or report her to child services.
Example: Amber’s husband Guy would threaten her by saying “If you are not with me, I’ll mark an X on your face.” Amber knew that he would carve her face up or even shoot her in the head. Guy’s threats terrified her enough to stay with him; until she found the courage to run away (Sev’er, 2002).
Intimidation- An abuser may employ different intimidation tactics to scare a victim into submission. Examples of the tactics include making threatening looks or gestures, smashing things in front of the victim, destroying victim’s property, hurting victims’ pets, or putting weapons on display. In fact, the clear message the abuser is communicating is that if the victim does not obey, there will be violent consequences.
Example: After many years of being told she was stupid by her husband, Laurette decided to take some classes at a local college. Her husband Sam was infuriated when he found out. He burned her books and all of her notes (Sev’er, 2002).
Denial and Blame- Abusers are often very good at making excuses. For instance, they may blame their violent behaviors on a bad childhood, a bad day and even on the victims. The abuser will usually shift the responsibility onto the victim saying that his violence and abuse is the victim’s fault. In certain circumstances the abuser may minimize the abuse or even deny that it ever occurred.
Example: Larry’s wife, Sue, would easily get angry with him for things like not cleaning his plate, not putting the toilet seat down, or simply watching T.V. When Sue got angry she would hit Larry with a wooden chair leg and verbally put him down. After Sue would react this way to Larry, she would apologize and explain to him that she only hurt him because she loved him. Sue would also tell Larry that she was just having a bad day and she could not help the way she acted.
Effects of Domestic Violence
The societal costs stemming from domestic violence, whether in tax dollars or human suffering, cannot be overstated. Domestic violence generates billions of dollars in costs per year in areas such as:
- Child welfare system: 25.4 billion
- Hospitalization/treatment of injuries: 6.6 billion
- Mental health care: 1.1 billion
- Law enforcement interventions: 33.3 billion
(Prevent Child Abuse Iowa website, http://www.pcaiowa.org/child_abuse_costs.html)
The Adverse Childhood Experiences (ACE) study (1999) reported that children who suffer maltreatment and/or are exposed to dysfunction in the home have an increased risk of smoking, obesity, depression, alcoholism, illicit drug use, heart disease, and hepatitis. The new report estimates the costs of this long-term health and mental health care at $67.8 million. The most costly long-term effects are those associated with lost productivity to society from adult survivors of child abuse, who are disproportionately affected by unemployment and underemployment later in life. The report estimates the cost of lost productivity at $33 billion annually.
Effects of Domestic Violence on Women
When considering the effects of domestic violence on women, it is important to examine the common forms of abuse. These include physical, sexual, emotional, and psychological abuse. Some research also includes stalking behavior as a form of intimate partner violence.
Physical assault in a relationship is rarely a one-time event and, therefore, is an ongoing trauma for the victim. It is important for clinicians to understand that when the physical violence is no longer present, the victim may continue to experience emotional abuse or trauma.
The second form of intimate partner violence is sexual violence and abuse involving nonconsenting sexual encounters. Victims may report feeling pressured or coerced into sexual activity with the partner. It is also important for the clinician to be aware that when sexual violence is present in a relationship, spousal rape will be ongoing and the victim is often retraumatized.
The effects of domestic violence on women are far-reaching into all aspects of life. Some effects include, but are not limited to:
Physical Effects: Physical injury, death, dehydration, eating disorders, poverty, malnutrition, sexual dysfunction, chronic pain, self-injury, suicide attempts.
Mental/Emotional Effects: Depression/mental disorders, panic attacks, anxiety, emotional “over-reactions” to stimuli. In addition common psychological effects of domestic violence include:
- Fear and terror
- Low self-esteem
- Difficulty concentrating
- Difficulty with trust and intimacy
- Sexual difficulties
- Problems with memory
- Cognitive confusion
- Anger and irritability
- Shame and embarrassment
- Health concerns
- Increased startle response and physiological arousal
- Numbing and avoidance
(Report of the American Psychological Association’s Presidential Task Force on Domestic Violence and the Family, 1996).
Riggs (1992) discusses the connection between the crime of domestic violence with other violent crimes against a person. Intimate partner violence is as psychologically traumatizing as assaults perpetrated on a victim by a stranger. It is important to understand that even one assault can result in psychological trauma for the victim. Repeated victimization will result in greater psychological impairment (Jordan, et. al. 2004).
Effects of Domestic Violence on Children
Domestic violence affects all of those involved and the youngest of children are no exception. Existing research has demonstrated clear associations between exposure to violence and emotional and behavioral problems in infants and toddlers. Infants and toddlers who witness violence in their homes or in their communities show excessive irritability, immature behavior, sleep disturbances, emotional distress, fears of being alone, and regression in toileting and language.
Exposure to trauma, especially violence in the family, interferes with a child's normal development of trust and later exploratory behaviors, therefore hampering their development of autonomy. Osofsky, Cohen, and Drell (1995) have noted the presence of symptoms in these young children are very similar to post- traumatic stress disorder in adults, including repeated reexperiencing of the traumatic event, avoidance, numbing of responsiveness, and increased arousal. Sometimes the experience can have long-lasting emotional, behavioral, cognitive, spiritual, and physical effects.
School-age children exposed to violence are more likely to show increases in sleep disturbances and are less likely to explore, play freely or to show motivation to master their environment. They often have difficulty paying attention and concentrating because they are distracted by intrusive thoughts. In addition, school-age children are likely to understand more about the intentionality of the violence and worry about what they could have done to prevent or stop it.
Studies conducted by the National Research Council (1993) as well as Cicchetti and Toth (1997) show that as children get older, those who have been abused and neglected are more likely to perform poorly in school, to commit crimes, and to experience emotional, sexual, and alcohol/substance abuse related problems. Also, adolescents exposed to violence, particularly those exposed to chronic community violence throughout their lives, tend to show high levels of aggression and acting out, accompanied by anxiety, behavioral problems, school problems, truancy, and revenge seeking. (Osofsky, 2006).
Other research (Margolin & Gordis, 2004), on the other hand, shows that children's responses to witnessing adult domestic violence vary considerably depending on the child's age and gender, the level of violence in the home, the degree of the child's exposure, whether or not the child is abused, and the presence of other risks and protective factors. Some children have such resilience that they are able to cope with the chaos of a violent home in constructive ways. While children are affected by violence in their lives, not all experience long-term negative consequences.
Social Effects of Domestic Violence
Domestic violence creates strained relationships with family and friends. When family and friends are unable to understand the impact this has on the victim’s psyche, they may also not understand the victims’ difficulty in leaving the relationship. Family and friends may become frustrated with the victim’s decision to remain in a violent relationship. They may limit time with the victim or become increasingly irritated with the victim and may blame the victim for assaults, telling them “if you left like I told you to, this wouldn’t happen.”
Domestic violence can severely impair a parent's ability to nurture the development of their children. Mothers who are abused may be depressed or preoccupied with the violence. They may be emotionally withdrawn or numb, irritable, or have feelings of hopelessness. The result can be a parent who is less emotionally available to their children or unable to care for their children's basic needs. Battering fathers are less affectionate, less available, and less rational in dealing with their children. Studies even suggest, “battered women may use more punitive child-rearing strategies or exhibit aggression toward their children” (Newton, 2001).
Patterns of Domestic Violence
It is commonly termed common couple violence and is defined as intimate partner violence that is not embedded in such a general pattern of controlling behaviors. It is thought to be usually less injurious and severe, with physical violence more often used by both members. Its particular causes may vary from couple to couple and across different incidents of violence experienced by the same couple, but there is no relationship-wide pattern of controlling behaviors.
This pattern of intimate partner violence is not rooted in a general pattern of control but occurs when specific conflict situations escalate to violence (Johnson & Leone, 2005). It occurs as a result of occasional conflicts motivated by reactivity (out of control outbursts), retaliation (“you hurt me, I will hurt you back”) and communication (“I want him to know that I am really hurt”). This pattern of abuse is very common and occurs frequently.
The physical effects are less severe and so victims do not often seek help. The victim does not usually feel afraid of the abuser but the abuse diminishes the trust and respect in the relationship. Children growing up in homes with situational couple violence may have the same consequences as those witnessing other violence.
Intimate terrorism is defined by the attempt to dominate one’s partner and to exert general control over the relationship, domination that is manifested in the use of a wide range of power and control tactics, including violence. The best known description is probably that which is embodied in Pence and Paymar’s (1993), Power and Control Wheel, which includes the following nonviolent control tactics:
- emotional abuse
- using children as weapons
- using male privilege
- economic abuse
The core idea of these theories of coercive control is that even the nonviolent control tactics take on a violent meaning that they would not have in the absence of their connection with violence (Johnson & Leone, 2005). With this pattern of abuse, the victim usually suffers severe injuries and feels demoralized, afraid, incapacitated and trapped in the relationship.
The consequences for women who experience intimate terrorism are different from those who experience situational couple violence. Women subjected to intimate terrorism are attacked more frequently and experience violence that is less likely to stop. They are more likely to be injured, to exhibit more of the symptoms of posttraumatic stress syndrome, to use painkillers (perhaps also tranquilizers and antidepressants), and to miss work. Furthermore, they are more likely to leave their husbands, and when they leave, to seek their own residence or escape to locations that ensure safety (Johnson & Leone, 2005).
Differences and Similarities Between the Patterns of Abuse
The violent acts involved in both situational couple violence and intimate terrorism can range from relatively innocuous behavior, such as pushing and shoving, to life-threatening attacks or homicide, and both types of violent relationships can involve anything from infrequent, isolated incidents to regular assaults.
In the case of frequent situational couple violence, for example, the relationship may involve areas of conflict that continue to be unresolved and one or more partners who regularly choose to resort to violence in the context of those conflicts.
In the case of infrequent intimate terrorism, one assault may be enough to establish a level of fear that allows the intimate terrorist to exert control almost exclusively by means of nonviolent tactics.
The two types of violence are not defined by the nature or frequency of violent acts but solely in terms of the relationship-level control context in which they are embedded. Intimate terrorism is violence that is embedded in a general pattern of control; situational couple violence is not (Johnson & Leone, 2005).
Intimate terrorism is hypothesized to be characterized by more frequent and injurious physical violence that escalates over time and is almost exclusively perpetrated by men against women, with the female partner using violence only in self-defense if she uses it at all. Intimate terrorism is thought to be more characteristic of clinical, emergency department, criminal justice (at least in the past), and domestic violence shelter populations, whereas situational couple violence is thought to be more common at the population level (Frye, Manganello, Campbell, Walton-Moss, & Wilt, 2006).
Forming a Unified Framework
Domestic Violence Wheels
- Power and Control Wheel
- Cycle of Domestic Violence
- Child Witnessing Domestic Violence Wheel
Power and Control Wheel
Domestic Violence Wheels
Cycle of Domestic Violence
Phase 1- Tension Building (escalation)
In this phase there is increased tension, anger, threatening, blaming and arguing between family members caused by anything from a bad day at work to a major life crisis. The tension may last a day, week, month or years and it becomes more frequent as the cycle repeats. Sometimes this situation may be enough to frighten the victim into submission. Tension builds as the frequency and severity of abusive incidents escalates. The abuser at this phase is afraid of losing control of the victim while the victim fears the imminent violence of an acute battering incident.
Phase 2- Battering Incident (abusive episode)
This second phase occurs so that the abuser can gain power and control. In this phase the abuser loses the desire or ability to control his/her anger and violence and the tension becomes unbearable. It may include physical contact or verbal abuse. The abuser starts hitting, slapping, kicking, and choking the victim. The victim becomes hurt and scared, and the abuser may feel ashamed, guilty and humiliated.
Phase 3- Honeymoon Stage (dramatic reconciliation)
In this phase the abuser may be extremely loving and apologetic. The abuser may give gifts to the victim(s), say sorry and promise that the abuse will never happen again. He may feel guilt, but will minimize the event by claiming that it was the woman's fault that she was hit. At this point the abuser may be most open to help at the start of this phase because typically, he is remorseful and wishes to please (keep) the partner.
At the peak of this stage both the abuser and the victim may deny or distort what has occurred. Stith, McCollum, & Rosen, (2007) posits that it is usually difficult to leave an abusive relationship after the explosion, because victims of abuse often say the honeymoon stage is, “the best time of our marriage” and “during this time, I know how much he really needs and loves me.” Both the victim and the abuser are convinced that each abusive episode is isolated and that the incidents are unrelated to each other. Without intervention, the violence becomes more serious and eventually the third stage of apology and denial will no longer exist (Walker, 2000).
Then, the cycle begins again. The reality is that the violence is unlikely to stop until the victim seeks help. The victim(s) believe the abuser‘s promise that “it will never happen again,” but in most cases it does. The violence reoccurs, and intensifies each time. When working with families at home, it is important to help the victims to understand that these phases often help them make sense of their experience. Identifying that the victim truly is not to blame for the violence that she has suffered and emphasizing that the abuser is the one responsible will help the victim to make informed decisions to leave or seek help before the next explosion. Note also that many victims do not go through all the phases in the cycle.
Child Witnessing Domestic Violence
Child Witnessing Domestic Violence Wheel
Children who witness violence are at high risk for being abused. There is a significant correlation between intimate partner abuse and abuse of children (Miller & Knudsen 2007; Walker, 2000). Reports by battered mothers show that 87% of children witness the abuse (Walker, 2000). While there are some inconsistencies in the evidence, the research shows that children living with domestic abuse have much higher rates of depression and anxiety (McCloskey , Figueredo, & Koss, 1995), trauma symptoms (Graham-Bermann & Levendosky, 1998), and behavioral and cognitive problems (O'Keefe, 1995) than children and young people not living with these issues. Rossman (2001) posits that,“"Exposure at any age can create disruptions that can interfere with the accomplishment of developmental tasks, and early exposure may create more severe disruptions by affecting the subsequent chain of developmental tasks” ( p. 58). Barbara Corry (1994) identifies some of the impacts of witnessing domestic violence as:
- Battering causes damage and distress to the fetus
- Battering adversely affects infants and toddlers
- Older children see and hear the violence
- Battering means emotional abandonment
- A battering home means living in constant fear
- Violence creates constant anxiety
- A violent home means feeling powerless
- Battering creates low self-esteem
- Family violence results in behavioral problems
- Battered children take on adult roles prematurely
- Children of abuse learn how to abuse others
- Battered children learn to harm themselves
- Abused children learn extreme behavior
- Children of violence do not learn boundaries
Evidence-based research (Margolin & Gordis, 2004) show that some children fare well in spite of witnessing or living with domestic violence. Sometimes this is referred to as ‘resilience’. Issues such as age and severity may be intervening variables. For instance, longitudinal studies in the US suggest that for children under 8, witnessing abuse towards their primary care giver is deeply traumatic (Humphreys & Houghton, 2008). Psychological tests indicate children found this more disturbing than the effects of direct physical maltreatment (Humphreys & Houghton, 2008). Other research shows that problems for children can compound over time as they live with the multiple problems associated with the negative effects of domestic violence.
Laing (2001) draws attention to the incomplete state of our knowledge of protective contexts for children. Higher rates of distress shown across a range of clinical measures should not be conflated with the impression that all children show these elevated levels of emotional distress and behavioral disturbances. Thus, as highlighted by Magen (1999), ‘correlation is not causation’ (p. 130). Research (Wolfe, Zak, Wilson & Jaffe, 1986) shows that children will usually recover their competence and behavioral functioning once they are in a more safe and secure environment. With support, children have even proved to be effective social and political actors in securing resources for similarly affected children and young people (Houghton, 2006). With that being said, it is essential to provide the necessary support and resources to the family as well as the child(ren) to deal positively with the situation.
Using Strategies and Techniques
Working with the Entire Family
Home based family therapists often see the victim and the perpetrator as well as the children. Responding appropriately to domestic violence in the family should be part of good home-based family therapy. When necessary, provide continuous and long-term non-judgmental care and support to families.
Previous sections have indicated that there is a close association between partners involved in violence and child abuse. It is, therefore, important to consider the following:
- Consider the impact of abuse on the children from the adult’s point of view
- Provide confidential support and referral for the children and let them know that they do not have to blame themselves
- Verify the children’s safety and support and provide aids for parents to ensure the safety of their children
- Studies show that children respond differently to domestic violence (Spears, 2000). Home-based family therapists should be wary of the assumption that witnessing domestic violence immediately requires child protection services. However, in cases where parents have not been able to improve the safety of their children, it is imperative to report the situation to Child Protection Services.
When working with couples in the home, therapists should always seek permission from the victim before confronting the perpetrator. Joint counseling should be offered when necessary. Recommendations from a panel of experts (Hegarty, Taft, & Feder, 2008) suggest that: moving from general questions such as, “how are things at home?” to specific questions such as “how does your wife /partner/children respond when you shout or hit them?” is helpful.
Always acknowledge the courage of the victim if she discloses the violence and offer support if she is willing to work with you. If you are not comfortable working with the family or couple refer them to another therapist who will help them.
(Stages of Change Theory)
The Stage of Change Theory was developed by Prochaska and DiClemente (1982) to conceptualize a variety of problem behaviors. The five stages of change include:
These five stages can be applied to domestic violence. Studies show that most women in abusive relationships are at different stage of change with respect to the abuse (Zink, Elder, Jacobson & Klostermann, 2004). The different stages require different techniques for working with each stage (Zink, Elder, Jacobson & Klostermann, 2004).
*Adapted from Prochaska & DiClemente's Transtheoretical Model
HBFTs should remember that the victim may sometimes be unwilling or unable to take immediate action although they are experiencing abuse. Unlike other behavior changes such as quitting smoking, which may be an individual struggle to change, the process with domestic abuse is influenced by a variety of internal and external factors which may affect the victims’ choices. Zink, Elder, Jacobson and Klostermann (2004) found that factors including finances and education, the abuser and the victim’s attachment versus perceived threat or degree of harm, and the children, appeared to have either helped or hindered participants’ prior efforts to create safety. However, understanding the stages of change will provide you with additional tools to assist victims and their families to take important steps toward needed action. The stages of change model shows that for most victims, the conviction to take action may occur gradually, with the victim moving from disinterest, fear, or unwillingness to taking action to seeking help and taking action.
Assessing for Domestic Violence
Myth: Abuse victims will usually volunteer information about the abuse without having to be asked.
Truth: Most abuse victims are hesitant to share about the abuse and will only offer information if they feel safe and if they are asked.
- If you suspect abuse, ask the victim about the abuse when her/his partner is not nearby. First ask non-threatening questions about the relationship, and gradually become more specific. Example: “When you and your partner disagree, how does it go? Does anyone ever get hurt? Who gets hurt? What happens? Have there ever been times when your partner has pushed, slapped, or hit you?”
- When you have determined that abuse is occurring, you will need to assess the degree of danger and lethality for the victim.
- Lethality risk factors
- “Are you afraid of your partner?”
- “Has the abuse become more frequent or more severe recently?”
- “Has your partner used or threatened to use weapons?”
- “Has your partner ever threatened to kill you?”
- Pattern and history of the abuse (NASW, 2008)
- “How long has the violence been going on?”
- “Has your partner forced or harmed you sexually?”
- “Describe a typical violent episode.”
- “What was the most recent incident? The most severe?”
- Violence outside of the home or assault on other family members (NASW, 2008):
- “Has your partner ever been violent toward someone outside of the home?”
- “Has your partner harmed your family, friends, or pets? (e.g. pushed, slapped, hit, kicked)”
- Substance use/abuse
- “How often does your partner drink or use substances?”
- “How much does your partner typically have to drink at one time?”
- Degree of isolation and access to resources (NASW, 2008):
- “Do you have friends or family nearby whom you could go to for support?”
- “Does your partner limit or monitor your contact with your friends or family?”
- “What resources have you used, or tried in the past?”
- Lethality risk factors
- If spousal abuse is occurring, it is important to assess for the abuse or neglect of the children. If you suspect that the children are being abused or neglected because of the violence in the home, explain to the client that you are mandated to report the situation.
- During the process of mandated reporting you can
- Explain that you will continue to support and visit the family through the process.
- Explain how the process works in the state.
- Say, “As a mandated reporter I have to report any incidents of abuse to protect you and your family.”
- Say, “This can be a positive thing for your family because now it is out in the open, you can get some help.”
- During the process of mandated reporting you can
Developing a Safety Plan
This is some information that can be helpful for the HBFT to address safety issues with the family and in the home.
Family Safety Plan
As an HBFT, you have a responsibility to work with the victim and to develop a safety plan.
- Provide the family with all of the necessary information they need to be safe in their home
- Make sure the family knows what to do at each phase of the cycle:
- Before the violence
- During the violence
- When preparing to leave and what to take with them when leaving.
The Personalized Safety Plan from Creative Communications Group (2007) and Domestic Violence Safety Tips and a Spanish version of the domestic violence safety tips Consejos de Seguridad en situaciones de Violencia Domestica from American Bar Association (2007) will help you in assisting the family develop a safety plan. (A link to the Safety Plan and Safety Tips can be found in the resources section at the bottom of this page)
Safety Plan for the Therapist
As a home-based therapist, you may encounter a situation that puts you in danger, especially when working with couples experiencing domestic violence. According to Rey (1996), client violence against social workers has increased. In Rey’s (1996) study of the level of violence social workers experience at work, 23% of them had been physically assaulted by a client during his/her career. In another study conducted by Newhill (1996), the author evaluated the prevalence, nature, impact, and risk factors associated with client violence toward social workers. Seventy-eight percent of participants in Newhill’s (1996) study felt that client violence was an important issue for the profession and fifty-two percent worried about their own safety while working with clients. Eighty-three percent of the social workers had been threatened by a client and 40% had experienced an attempted or actual physical attack (Newhill, 1996).
With that being said, we feel that it is critical for you to stay safe as a clinician working with domestic abuse clients in the home. Below is a table listing the Eight Stages of Escalation (Phily Loss of Control Services, 2006). To help elaborate on the eight stages, we have incorporated de-escalation tips from Brasic & Fogelman (1999) article on Clinician Safety. You will find the eight stages with de-escalation tips on the following page.
Eight Stages of Escalation
Although the interventions may be helpful in a violent situation, please remember to keep yourself and other family members safe by taking precautions before visiting the clients in their home. Rey (1996) suggests bringing a co-worker with you on a home visit if you feel a particular risk of danger. Before going on a home visit, you should always inform your supervisor of your destination, route, time of departure and expected return to the office.
Lastly, below is a list of physical signs that a client is likely to display before assaulting you (Brasic & Fogleman, 1999):
- Clenched jaw
- Demanding immediate attention
- Flared nostrils
- Flushed face
- Hands clenched or gripping
- Intoxication with alcohol or drugs
- Loud or shouting
- Pacing, sudden movements, or restlessness
- Slamming objects or pushing furniture
- Widened eyes or staring eyes
Applying the Framework & Post-Test
Yin’s Family Vignette
Yin is a 38-year-old woman who relocated with her husband and two children from Thailand to the United States. Both she and her husband experienced a difficult adjustment to living in the United States. Despite his attempts to secure a job in his uncle's business, Yin's husband was unable to find a job that fit with his interests and skills. He, therefore, worked as a custodian in a school, became increasingly depressed, and began drinking alcohol excessively. Yin worked as a waitress in a restaurant and the children attended school. Yin and her husband at times discussed possibly moving back to Thailand particularly when they notice people at work or at their children's school make derogatory comments about their Asian accent and their immigration status.
Approximately one year after their arrival to the United States, Yin's husband began to hit her and verbally abuse her. The frequency of the abuse increased with her husband's alcohol abuse. The children witnessed these incidents almost routinely and felt helpless to protect themselves and their mother. Yin made several attempts to talk to her husband about his behavior. However, he kept none of his promises to stop hitting her. Yin thought about leaving her husband, but worried about the future of her status as an immigrant, and the ability of her children to obtain a green card if she left him. The idea that she could return to Thailand without her husband also felt overwhelming, as she worried about how she would "fit in" to her community in Thailand as a single or divorced mother. After a few months, Yin revealed the abuse to her parents in Thailand. Although they expressed their sadness and concern for her, they were not able to think of ways to help her. She then spoke with members of her husband's family about the violence. They responded to her by stating, "It is your duty to take care of him. He is sick, and he needs your help. Think about the children. They need their father to get better." Eventually, constrained by practical difficulties, and influenced by family, cultural, and gender-role expectations, Yin came to see the abuse as the inevitable consequence of her husband's stress and culture shock, in other words, “it is not her husband's fault." Rather than defining her situation as unacceptable, she normalized her particular experience, and defined it as her "cross to bear for the family's sake.”
Applying the Framework with the Yin Family
It is important to consider the cultural factors present when helping Yin to deal with the domestic violence issues she has presented. As the vignette indicates, she feels ““stuck”” and her extended family has indicated they believe she should stand with her husband. He is frustrated with his inability to adjust to the disappointments life in the US has presented and she should be sensitive to this. In considering the Stage of Change model, at one point Yin reached the Contemplative stage of change and sought guidance from both her family and her husband’s family. Their message has moved her to normalize her experiences and therefore she becomes less ready (able) to make any steps toward change.
- Based on the Transtheoretical Model, what should the therapist do to assist Yin?
- What strategies would you implement to help Yin move forward in the stages of change?
- Contemplative stage strategies?
- Preparation stage strategies?
- Action stage strategies?
Throughout this work it will be important to reflect on the Power and Control Wheel as well as the Cycle of Violence. It seems there would be a relationship between Yin’s ability to move forward in creating change and where she is at any given time in the cycle of violence.
- At what point in the Cycle of Violence would Yin be most receptive to information about domestic violence?
- At what point in the Cycle of Violence would Yin be most likely to move within the Stage of Change model?
It is imperative that the therapist focus on safety first. As Yin is gaining support from the therapist to make change she is also experiencing this information as contrary to her cultural beliefs and the guidance of her family. Respecting the influence of her culture and her need to satisfy her extended family obligations is essential to maintaining an ongoing therapeutic relationship. Consistent attention to the integration of the Transtheoretical Model, Cycle of Violence and Power and Control Wheel dynamics will assist the therapist in aiding Yin and her family in the difficult work of dealing with domestic violence.
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