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By Sage DeBeixedon, Ph.D. and Ofer Zur, Ph.D.
Table of Contents:
Chapter I: Detection of Violence within Intimate Partnership
Chapter II: Assessment of Violence within Intimate Partnership
Chapter III: Intervention Strategies
Chapter IV: Partner Violence in Ethnic Minority Families
Chapter V: Intimate Partner Violence in Lesbian, Gay, Bisexual & Transgender Relationships
Chapter VI: A Cultural Perspective and Systems Theory Applied to Domestic Violence
Chapter VII: Code of Ethics and Domestic Violence
Chapter VIII: California Law and Domestic Violence
Chapter IX: References
CHAPTER I:
DETECTION OF VIOLENCE WITHIN INTIMATE PARTNERSHIPS
It is the same, no matter how we name it. All of these are terms that describe the introduction and/or maintenance of violence between people who have developed an intimate or love relationship. Whether that violence is physical, emotional, psychological or sexual is irrelevant; the outcome is the same-that which started as an intimate, safe space between two parties becomes hostile, coercive and dangerous for one or both involved.
Scope of the Problem
Research suggests that one in three women will be abused in her lifetime (de Beixedon, 1995; Planned Parenthood of Southeastern Pennsylvania, 1992; Tjaden & Thoennes, 2000; Domestic Violence Statistics, 2011). The number soars to one in two women when you incorporate the silent who speak only to close friends- or who never tell.
Imagine sitting in a restaurant full of women and realizing that half the women in that facility have or will be victimized. Or, closer to home, imagine taking this course in a meeting room at the local Sheraton. As you sit through the course, let your eyes take in the female colleagues filling the seats around you. At least half of those female peers that you observe have or will experience domestic violence.
Of the women who are abused, more than half are victimized prior to age 18 (de Beixedon, 1995; Tjaden & Thoennes, 2000). Nearly 1 in 5 female teens reported threatened violence or self-harm by a boyfriend if girls indicated that they were leaving the relationship (Domestic Violence Statistics, 2011). Statistics cultivated between 2009 and 2010 suggest that an adult female is assaulted or battered every nine seconds in the United States (Domestic Violence Statistics, 2011). Those statistics parlay into approximately 5.3 million episodes per year of intimate partner victimization (Bonds, DE et al, 2006; CDC, 2011). Of those that are abused, about 17% report physical and/or sexual abuse by their partner during a pregnancy, and of spousal abuse victims, approximately four women are murdered each day in the United States by their intimate partners.
The focus in the research has been on the women who are abused in their relationships (Bureau of Justice Statistics Selected Findings, 1994; Domestic Violence Statistics, 2011). This in no way suggests that men cannot be victimized. It simply recognizes that women are violated far more often than men, and thus that phenomenon has been studied to a much greater extent (American Bar Association, 2003; Tjaden & Thoennes, 2000). With the advent of the Women’s Movement, the installation of Battered Women’s shelters, improved screening protocols in healthcare facilities and the increased legal protection of women in violent relationships, awareness and reporting of domestic violence against women has increased significantly (Children’s Safety Network, 1992; Walker, 2000). This has allowed for a more accurate statistic or accounting with regards to the number of women victimized each year.
However, because men are less likely to identify or report incidents of domestic violence when they have been victimized, our understanding of the scope and incidence involving male victims is minimal at best (Fontes, 1998; Kimmel 2002; NCAVP, 1998). Even at that, the research suggests that one in seven men will be sexually abused in his lifetime (Lew, 1990). More recent research posits that if greater inquiry were made on the origin of men’s injuries, accounts of domestic violence against men would increase by 200%. That computes roughly to one in four men being victimized by those they have come to know and trust (de Beixedon, 1995). The information posted by the Centers of Disease Control suggests that men are reporting nearly 2.9 million episodes of victimization by a partner per year (CDC, 2011).
Taken together the costs associated with intimate partner violence for medical care, mental health services, and lost productivity (e.g., time away from work) was an estimated $5.8 billion in 1995. Updated to 2003 dollars, costs have reached more than $8.3 billion (CDC, 2011). According to research, domestic violence victims lose nearly 8 million days of paid work per year in the US alone – the equivalent of 32,000 full-time jobs (Domestic Violence Statistics, 2011).
Demographics of Intimate Partner Violence
People tend to think that domestic violence doesn’t happen to folks like them. “That only happens to other people,” is a common thought. But, violence happens to people just like us, no matter who we are. Domestic violence is experienced by those in every age group, race, ethnicity, culture, social class and sexual orientation (Alpert & Albright, 2000; Bureau of Justice Statistics Special Report, 1995; DiLoreto, S., 2001). And, whether the parties involved are married and living in the same home, or just dating more casually, violence knows no boundaries. Intimate partner violence is an equal opportunity phenomenon.
There are factors that increase the likelihood of violence in an intimate relationship. It seems that if a person is heterosexual, young, unmarried, female and of lower socioeconomic status, chances of being victimized are higher (McCauley, et al., 1995).
Factors Impacting Intimate Partner Violence
There are two elements that significantly impact the incidence of domestic violence: characteristics specific to male perpetrators and relational qualities of domestically violent couplings.
Characteristics of Male Batterers
These ideas stem from the early works of Bowlby (1969, 1973, 1980) and Ainsworth (1978) who found that infants possessed specific attachment styles. Experiments involved separating infants from their mother, and observing the reactions of infants, both directly following the separation and upon reunification. Researchers identified a group of infants that experienced significant anxiety upon separation from their mothers but who also displayed ambivalent feelings when reunited with their mothers. These ambivalent feelings were reflected in their angry attempts to avoid their mothers, while simultaneously desiring reunion with her.
Sonkin & Dutton (2003) point out that when this insecure attachment is later played out in adult relationships, the “dysfunctional anger” acts to propel the desired female away from the man, rather than drawing her in and eliminating the likelihood that she will quell his ever-increasing anxiety. As a result, his rage grows exponentially and violence is the ultimate result (Dutton, et al., in press; Sonkin & Dutton, 2003).
However, just because the batterer experiences chronic anger does not suggest that he acts violently towards everyone. Within the domestically violent relationship, batterers exhibit both expressive and instrumental violence towards their partners and children. Expressive violence is that behavior which reflects feelings which are experienced as negative, and from which the perpetrator wants relief. Instrumental violence is that behavior which the batterer uses to achieve a long-term objective (e.g. compliance, long-term submission, or some other goal) (Dutton, et al., in press; Holtzworth-Munroe, et al., 1997; Hotaling, et al., 1986; Tolman, et al., 1990).
Male batterers are certainly not all the same, even though there appear to be some common characteristics associated with batterers. For even more accurate detection of male batterers many authors have described specific typologies of batterers.
Typologies of Batterers
Those men who abuse their intimate partners are commonly divided into three groups: the Family-only batterer, Dysphoric/Borderline batterer and the Generally Violent/Antisocial batterer. Prior to reviewing these categories, it is important to distinguish the motivations for violence within these sub-groups.
Motivation for Violence
Johnson (1995) described two types of spousal abuse: “patriarchal terrorism” and “common couple violence”. Patriarchal terrorism is what is commonly thought of as spousal abuse. These batterers are most often men who assert intense and frequent anger towards their partners in the effort to dominate and control them. Those who use patriarchal terrorism not only use physical assault, but also employ threats, intimidation, sexual abuse, emotional and psychological abuse, verbal violence, economic control and social isolation in order to subordinate their domestic partners.
In contrast to patriarchal terrorism common couple violence is employed equally by men and women. This kind of violence reflects a response to the hassles experienced in the every day life of the relationship. It is less likely to reflect an effort of one partner to control the other, but more likely to be one partner’s desire to control a situation that the person experiences as out of control. This form of domestic violence is an expression of frustration rather than rage.
Wexler (1999) further denotes the difference between these two forms of intimate partner violence as physical aggression vs. battering. While common couple violence includes acts of physical aggression, this form of violence does not necessarily incorporate any other efforts to control the partner. In battering relationships all acts of violence are accompanied by some form of psychological abuse used to further control the partner.
Abuser Subtypes
Holtzworth-Munroe and Stuart (1994) identified three types of batterers within the domestic violence literature: Type I, Type II and Type III.
The Type I batterer employs instrumental violence and, surprisingly, does not perceive himself as significantly more violent than the next person (his anger is ego-syntonic). These batterers have been described within the research as “vagal reactors”, “cobras” and “psychopaths” (Hare, 1993; Jacobson & Gottman, 1998b; Wexler, 1999). These men, when tested for physiologic signals, are unlike other batterers. While other batterers experience an increase in heart rate and blood pressure in response to their ever-increasing frustration, these Type I “cobras” can remain still and vigilantly focused on their prey before, during and after they strike, no matter what the reaction of the victim.
Relational Qualities
In addition to the qualities and characteristics specific to the male batterer, there are also relational qualities and factors that increase the likelihood that a relationship will become violent. These include:
Walker (2000) describes the impact of this tension in her fundamental theory introduced in 1979: the Walker Cycle Theory of Violence. She describes a three-phase cycle of violence in battering relationships in which tension mounts (Tension Building), is released (Acute Battering Incident) and is resolved or suppressed (Loving-Contrition). Unfortunately, the tension in battering relationships can only be suppressed for so long before it increases and surpasses available coping strategies and must be released again.
In addition to the physical isolation of an intimate partner, a batterer may isolate his victim from requisite resources, such as medical and legal assistance, to name just a few. (Aldarando, et al., 1996; CDC/NCIPC, 2003; Hotaling, et al., 1990; Sugarman, et al., 1989).
CHAPTER II:
ASSESSMENT OF VIOLENCE WITHIN INTIMATE PARTNERSHIPS
As clinicians, learning about the detection of domestic violence may better enable us to recognize batterers. However, sometimes we don’t have the luxury of foresight or the power to alert potential victims. More often than not, when the client presents for treatment, the violence has already occurred. As such, it is imperative that we have the skills to appropriately address and comprehensively assess the domestic violence at hand.
The Silent Phenomenon
As has been indicated thus far, domestic violence is often a silent phenomenon. Batterers rarely share with others that they have become violent in their relationships for fear that they will be “caught” and prosecuted, but also because they do not want to lose the respect of friends and family. Victims remain silent, not only as a result of threat by the perpetrator (“You tell and I’ll hurt you worse”), but because of their own feelings of guilt and shame (“I should’ve done something to make him stop”). Victims may learn to protect their perpetrators as they become less and less capable of recognizing the need for the batterer to become accountable. And, the longer the violence continues, the more the victim will begin to see herself as responsible for the violence (de Beixedon, 1995).
Many couples remain in denial about the state of their relationship. They do not recognize the extraordinarily negative impact of the violence in their relationship, as they become habituated to the cycle. Perpetrators do not want to see themselves as “bad guys”, so they use denial and minimization to alter their perception of how they are treating their partners. They may see violence as common in relationships and consider it “normal”, especially if they have witnessed violence in their families of origin. Batterers learn to justify their violent behavior (“I just wanted her to listen!”) and to rationalize away the pain they cause to their victims.
In a similar vein, victims often use denial to hide from their own realities. To see oneself as occasionally being slapped is somehow different than to see oneself as the victim of spousal abuse (Alpert & Albright, 2000). Victims minimize their injuries and the various impacts of the violence on their lives, often as a way to avoid further action. If a victim sees the violence as just “an occasional shove”, it is far easier to remain in the relationship than to recognize the pervasive negative ramifications of the domestic violence and leave. Leaving a violent relationship requires far more than a set of car keys: it requires patience, self-esteem, planning, resources and tremendous courage (Walker, 2000).
Framing Statements, Methods of Questioning and Detecting Domestic Violence
Because intimate partner violence is often a silent, underestimated phenomenon, it is imperative that clinicians learn to screen for violence, even when it isn’t readily apparent. When they studied this issue, Freund et al. (1996) discovered that women who weren’t asked, didn’t tell for the most part. When specific questions about domestic violence were excluded from their comprehensive health-history questionnaire, none of the 178 female patients disclosed a history of abuse. However, the violent truth was revealed for an eighth of the participants when a single question about domestic violence was added to the questionnaire.
Alpert and Albright (2000) encourage physicians to use their RADAR mnemonic when meeting with female patients:
R: Remember to ask
A: Ask directly
D: Document findings
A: Assess safety
R: Review options
Victims of violence may “fly below the RADAR” and present for other reasons. However, when injuries are assessed with domestic violence in mind, often patterns appear that help to identify the violence behind the maladies. Patterns may be as obvious as particular types of injuries (bruising restricted to anatomy which is usually covered by clothing) or may be more subtle, as specific responses to medical and dental exams (e.g. often victims of sexual abuse have an exaggerated gag response to dental probing or become dissociative during gynecological exams) (de Beixedon, 1995). Alpert and Albright (2000) remind physicians to screen all patients for relational violence, as women do not have the monopoly on victimization.
Framing Statements
In order to screen for domestic violence most effectively, it is important to conduct clinical interviews in private. This may require creativity in the event that a violent partner has become highly controlling. For instance, a perpetrator who learns that his spouse has a medical appointment may cancel it for fear that abuse will be identified. And, even if the appointment is kept, the abusive partner may accompany the victim, making private discussion much more difficult. Alpert and Albright (2000) caution physicians not to allow the partner or anyone else known to the patient to be present during even a routine screening in order to limit the risk of exposure to the patient. They offer one creative solution should the perpetrator tag along for a medical visit: ask the patient to provide a urine specimen while at the office, and make sure to send a nurse along for the procedure. When the two are in the privacy of the bathroom, the nurse can identify the concerns for domestic violence and conduct at least an initial, brief screening in private.
“Framing statements” allow the clinician to explain to the patient why she is being asked about the issue. Framing statements do the following:
Direct and Indirect Questions
Framing statements help set the stage for the screening. When it is evident that a patient is willing to talk further about these issues, the clinician may want to use direct or indirect questions, depending on the patient and the situation.
Indirect questions elicit information in a very subtle way. For instance, a clinician might say, “Conflict is a part of every relationship. How do you and your spouse handle things when they come up? When you argue, do things ever get physical?” S/he might also ask, “How are things going at home? How are you feeling about your spouse? How is he treating you?”
When responses to indirect questions raise suspicion of domestic violence, the clinician can follow up with more direct questions, such as, “Has your partner ever hurt you physically, sexually or emotionally? Has he ever threatened to harm you or your children or pets?” Alpert & Albright (2000) remind the physician to use more specific terms in this type of questioning, rather than using “value laden” labels (e.g., abuse, batter) that may deter patients from disclosing further. Terms like “hit”, “slap” or “shove” are less difficult for the patient to deny than “batter”.
The clinician may choose a gentler though direct approach if s/he determines that the patient may feel unsure or guilty about exposing the abuse. That inquiry might be, “Sometimes I see women who have been hurt in their relationships but don’t feel like they can talk about it openly. I’d like to be the kind of person that you could talk to about anything, no matter what it is. Has anything happened to you that left you feeling as if you couldn’t talk about it?”
The Person, the Victim
Many of us are not in a position to be assessing physical evidence from our clients following an episode of domestic violence, but it is imperative that all caregivers and clinicians are capable of identifying the physical, emotional, behavioral and psychological sequelae of domestic violence.
Physical Evidence
It would be ever so helpful if batterers just wanted to be caught and left easily identifiable marks and injuries on their victims. However, in most cases of chronic violence batterers learn to cover their tracks and harm their victims in ways that are less obvious to the outside observer. Sometimes a well-trained and thorough physician is the only source of data that would otherwise remain hidden. The medical examination may be a tremendously useful tool in cases such as these.
Physical Examination
Acute injuries
The most common areas of assault during domestic violence are the torso, breasts, abdomen and genitals. While obvious injury (harm to an area not generally hidden by clothing) is rare, it is a red flag of increasing levels of violence (the batterer is becoming less cautious). Injuries that are bilateral, have been repeated on numerous occasions or are in different stages of healing suggest chronic abuse. In addition, when a patient has waited for an injury to heal (or partially heal) before seeing a physician, this may also be suggestive of abuse. Further, evidence of chronic pain or injury, significant psychological distress, evidence of rape or sexual assault and any injury in a pregnant woman may all be indicators for violence in an intimate relationship.
Physical Aftermath of Abuse
Beyond the acute injuries often associated with domestic violence, there are many physical effects which appear later. Many of these can be detected during clinical interview and physical exam.Physical symptoms:* Chronic fatigue* Insomnia, Hypersomnia, restless sleep* Chronic headaches* Chronic abdominal pain, irritable bowel syndrome* Other sources of chronic pain* Musculoskeletal complaints* Pelvic pain* Recurrent sexually transmitted diseases and/or frequent gynecologic problems
Clinical Interview
Behavioral and psychological sequelae of domestic violence
Other signs may be more subtle and may be diagnosed as primary problems. If a physician or clinician is not screening for intimate partner violence, it is possible that the association between these behavioral and psychological concerns and domestic violence might not be identified. Other common sequelae of violence in the home include:
Behavioral and Psychological Symptoms:
Anxiety, panic, Post-Traumatic Stress Disorder and Dissociative Identity Disorder
Drug and alcohol abuse or dependence
Eating disorders
Depression
Dissociation
Hypervigilance
Somatization
Suicidal ideation or suicide attempts
When Abuse Is Discovered: Planning, Documentation & Confidentiality
When a clinician is really listening to a client, has used framing statements, has asked follow-up questions and is certain that the client has been victimized by an intimate partner, a number of goals must be achieved.
First, it is imperative that the clinician further develops the rapport and therapeutic relationship with the client. As things become more complex (especially if the client decides to end her relationship with her batterer), the client will need to rely on the relationship with her support team in order to act. This will require a strong bond and clear communication with her clinician.
Documentation, Treatment and Intervention
Documentation
Detailed Interviewing
As soon as the clinician identifies evidence of domestic violence s/he needs to gather specific data about the abuse for documentation, treatment and intervention purposes. Some common questions that the clinician might ask to begin this process include:
It is also important for the clinician to determine if there is a history of domestic violence or whether the abuse has newly begun. The pattern of violence not only effects the type and duration of treatment needed, but may also determine the victim’s willingness to end or leave the violent relationship. Walker (2000) discovered that if women experienced increasing levels of violence in their relationships and were asked to graph these episodes, they were more likely to leave the battering relationship than those who were left to deny and minimize the increasing gravity of their situations.
Some of the questions that may help identify the pattern and severity of the intimate partner violence include:
Chart Notes
Clear, concise, non-judgmental statements about the events that have occurred, the subsequent injuries and any sequelae must be placed in the medical chart. Not only is it good clinical practice, but also may be required later for treatment and adjudication purposes.
Sketches & Photos
The clinician may use freehand sketches, line drawings or photographs to document the injuries in order to supplemental the narrative description of the domestic violence. If the clinician chooses to photograph the client’s injuries, s/he needs to obtain written consent from the client to do so.
Alpert and Albright (2000) remind physicians of the most effective ways to use photography to document this kind of evidence. They advise physicians to:
Confidentiality
As with all medical records, the confidentiality of a client’s information is a high priority. However, in cases of intimate partner violence, even greater caution must be taken. Because batterers can be particularly controlling and manipulative, they may find ways to access clinical data. For example, a batterer may visit his spouse in the hospital following an episode of violence and read the patient chart hanging from the end of the hospital bed. Should the record contain inflammatory descriptions, the threat to the patient’s safety may rise exponentially.
Further, in the event that the client decides to adjudicate her batterer, clinical records will most likely be subpoenaed. Chart notes should be clear, concise and also keep the client’s best interest in mind at all times.
The Violent Relationship:
When screening for domestic violence, it is likely that the clinician will assess the physical evidence and will seek to identify any behavioral and psychological sequelae, but s/he might not think to assess the client’s relationship for symptoms of intimate partner violence. As has been described before, relationships in which one or both partners become violent often show telltale signs.
Common Relational Symptoms include:
The cycle:
In addition to some of the common relational “symptoms”, most violent relationships follow a cycle.
Lenore Walker (2000) is one of the foremost experts in the area of domestic violence. Her groundbreaking research with battered women shed light on the silent phenomena and impacted victims, families and support teams.
Walker’s research identified an important pattern that has been named Walker’s Cycle Theory of Violence. As noted earlier, this cycle is based on tension-reduction and incorporates three components: 1) tension building, 2) acute battering and 3) loving-contrition.
During the tension-building phase, the conflict and tension gradually rises, accompanied by minor verbal and physical assaults. The victim does all that she can to reduce the stress and strain in the relationship, and the fact that she is moderately successful leads her to believe that she has some control over the events which occur in the partnership. Unfortunately, the tension eventually escalates to a point at which the batterer can no longer tolerate his internal state, and he seeks to divest this tension by acting violently.
The acute battering phase may incorporate any and all forms of violence and will last until the batterer feels adequately divested of his internal discomfort. If the intimate partner violence is repeated many times, the victim may become able to predict the point of inevitability: the point from which the violence will happen without direct intervention. Due to the anxiety associated with awaiting this point of inevitability, the victim may actually provoke her partner in order to “get the abuse over with”. This is another way in which the victim may gain an inaccurate sense of control within the relationship. According to Walker’s research, women in violent relationships actually score higher on items which measure locus of control, seeing themselves as controlling events and elements in their environments far more often than women in non-violent relationships!
The third and final phase is the “loving-contrition” phase, also known as the “honeymoon” phase. This phase is marked by the batterer’s remorse, acts of kindness and warmth and the absence of tension in the relationship. Even if the batterer is not outwardly affectionate, as long as he is not abusive, the victim may experience this phase as sufficient reinforcement to remain in the relationship. In the event that the batterer does not show signs of remorse nor returns to baseline behavior or attitude, it is an indication of increased lethality.
Walker suggests that the assessment of relational violence can be facilitated if the victim is asked to graph the episodes of violence in her relationship. Walker often asks that victims graph the first and second incidents of violence, as well as the most recent episode. According to the research, the act of graphing the violence enables the victim to better recognize the cycle of violence occurring in the relationship where the woman may have been unwilling to see it before. Walker also notes that by asking for specific details about the incidents, the denial maintained by the victim is broken and the gravity of the situation comes into bold relief.
Risk Assessment and Safety Planning:
Knowing that an intimate partnership is enduring violence is one thing, recognizing how lethal and dangerous that behavior has become is another thing entirely. Alpert and Albright (2000b) provide specific suggestions for physicians attempting to assess risk in violent relationships and to assist their victim-patients with safety planning.
As noted previously, one of the most imperative steps in assisting victims of domestic violence is to continue to build rapport and security. Following the assessment of the relationship itself, the clinician must begin the work of patient advocacy.
Patient Advocacy
Advocacy combines education with the identification of options. The clinician must first help the victim understand that the violence is not her fault, and that the behavior of the batterer is inappropriate and inexcusable. The clinician may wish to share information about how the cycle of violence plays out in relationships and its impacts on the primary victim, as well as on children or others present. The clinicians may also want to identify data and statistics about others who have been abused. The primary goal of the clinician is to enable the victim to feel less isolated and more empowered. It is also important that the clinician identify resources and options for the victim. While the victim may be aware of resources available, she may not have considered these as viable solutions to her own situation before this time.
Assessing Risk
As Walker (2000) points out, a victim’s perception of the violence in her relationship has a huge impact on whether or not she remains in the partnership. Often, before the victim is asked to graph the violence in her relationship, she will vastly underestimate the level and frequency of the violence. Alpert and Albright (2000b) validate this notion and remind that victims typically minimize and deny the violence in their relationships due to shame, embarrassment and even fear that the perpetrator will discover their “awareness” of the violence.
In order for victims to more accurately appraise the danger in their intimate partnerships, clinicians must assess for specific indicators of escalating risk, such as:
Some of the Risk Assessment questions that Alpert and Albright (2000b) encourage physicians to use to further evaluate risk in intimate partnerships include:
Developing a Safety Plan
No matter how strongly a clinician may feel about the need for a victim to exit a violent relationship, the clinician can’t make that decision for the victim. Enabling the victim to gain confidence, strength, information and options is essential for facilitating the empowerment required to exit the dangerous relationship. However, as the victim gains the strength and awareness needed for this transition, her support team can assist her in developing plans for short- and long-term safety. Some of the questions that Alpert & Albright (2000b) suggest for use in safety planning include:
It’s as if perpetrators have a sixth sense when they are about to lose access to the targets of their tension-reducing rage. When a victim takes control of her life and begins to plan for departure from the violent relationship, the perpetrator seems to gain a heightened awareness, increasing the danger for the victim. As such, it is imperative that the victim have a way to communicate with supportive others to enact her safety plan, as it might become an emergent plan rather than a deliberate one.
If the victim is able to do so safely and without being discovered, it is important that she compile a few items to take with her when she leaves the relationship. These include:
In the event that the victim’s departure from the relationship becomes more likely, the clinician should also encourage her to speak with additional trained personnel, such as shelter staff, police, attorney, mental health care providers and victim/witness personnel.
CHAPTER III:
INTERVENTION STRATEGIES
Treating batterers means helping them go through a process as they relinquish their violent behaviors. Usually these steps include:
Of course, all interventions must be devised for the batterer and his/her situation.
Prosecution & Mandated Intervention
Arrest
There is mixed research on the effectiveness of arrest as a deterrent to violence (Dunford, Huizinga, & Elliott, 1990; Hirschel, Hutchinson & Dean, 1992; Sherman & Berk, 1984; Sherman, et al, 1991). Some studies suggest that arrest can be an effective “intervention” for intimate partner violence, while other studies do not replicate that finding. Factors which may impact the effectiveness of arrest as a deterrent to further violence include length of time in police custody, experience while in custody and characteristics of the individual arrested.
Prosecution
There are even fewer studies which examine the effect of prosecution by a victim or the District Attorney. Some studies suggest that there are no preventative effects, while other studies suggest that there may be some positive effect on perpetrators with histories of less severe violence (Fagan, Friedman & Fagan, 1989: Wexler & Lewis, 1984.
Court-ordered Batterer Intervention Programs
Most Batterer Treatment programs seek to rehabilitate perpetrators of intimate partner violence through a class-like structure which combines education and psychotherapy.
Through the Feminist model, batterers are encouraged to view women and children as separate entities to be cherished and nurtured rather than to be objectified and used. This model engages batterers to view their female spouses as equals and partners.
Family-based Systems Theory encourages the development of communication and assertiveness skills, so that all members of the family can be heard and respected. The interventions are designed to improve the health of the family so that reunification is possible.
Finally, the addition of the intrapsychic psychological theories examines individual attributes and characteristics that may impact the function of the batterer in the relationship. These interventions are designed to enable the batterer to gain self-awareness, cognitive skills and broader coping skills for managing intolerable internal states without violent reaction.
While many programs combine tenets and interventions associated with all these theories, there is no research to prove that one model is better than any other.
Evolution of Treatment Approaches: Client-Centered, Self Psychology and Dynamic Approaches
There are many different therapeutic approaches to intimate partner violence and batterer recovery. Wexler (1999) does a wonderful job of summarizing the similarities and differences amongst these models. Some of that summary is paraphrased below:
In the beginning: The Duluth Model
The most common model in use in Batterer Treatment programs is the “Duluth” model, which seeks to re-educate batterers about healthy power and control in relationships. This Feminist model suggests that the socially- and culturally-approved power imbalance between men and women eventually results in the violent behavior of men who abuse their power, privilege and entitlement in their relationships with women.
Prior to the development of the Duluth Model, treatment programs had taken a more relational approach-viewing the violence in the partnership as the result of relational dysfunction, pressures on the perpetrator and psychological issues of the victim which kept her prisoner in the violent relationship. In treatment approaches in existence prior to the development of the Duluth Model, responsibility for the violence could land equally on the victim as it could on the batterer. By utilizing the Duluth Model, perpetrators were confronted with their denial and minimization of the violence they wreaked, their inappropriate rationalizations and their externalization of blame for the relational violence. Unfortunately, the benefits of these models have been diminished by some delivery “flaws”: often, programs based on the Duluth model are highly confrontational and judgmental. Men are perceived as powerful aggressors and “bidirectional” violence in the relationship is discounted. Further, these kinds of programs place primary importance on “accountability”, rather than on skill building and family reunification.
Movement Towards Psychotherapeutic Approaches
With the benefits of the Duluth model came some clinical shortcomings: men were required to confess their guilt and take complete responsibility for their intimate partner violence. While this approach might be a healthy change from denial and minimization, these mandates were made in the absence of therapeutic rapport or the safety of therapy. This shame-based technique further alienated many men who could have been positively affected by affiliative techniques.
Weiss and Sampson (1986) discovered that greater impact came from therapists who could offer their batterer clients some experience of acceptance, even in light of their past violent behavior. Along the same lines, Murphy and Baxter (1997) found that more empathic therapists are also generally more effective than highly confrontational ones. Finally, both research and common sense point to the value of changing the set: if men are asserting control over women in order to feel powerful and masculine (because they are internally experiencing inadequacy), what is the impact of having therapists treat them the same way?
Approaches which focus on modeling the desired behavior (treating all people as equals who deserve decent and humane interaction) tend to breed the healthiest response. Those interventions which seek to subjugate and demean the client perpetuate that same aggressive behavior in their relationships. Dutton’s (1998) research validates this: batterers who are confronted and shamed for their behavior come to experience the treatment setting as just another shame-based experience and respond to it with increased anger, rationalization of violence and projection of blame.
Client-Centered Approaches
The Client-Centered approaches all favor skill-building and an empathic regard for the experience of the batterer. They do not excuse the violent behavior in any way but simply examine the issues from a different perspective and with a caring style. These approaches can be utilized in pure form or can be integrated with other approaches.
One strategy that can be used easily to promote change in the batterer and models the desired behavior is referred to as “pacing and leading”. While Erickson designed this strategy to be used in hypnosis, it is also highly effective in non-hypnotic behavioral change (Wexler, 1999). The therapist first builds rapport with the client, uses passive and active listening skills to really understand the emotional experience of the batterer and then offers a “leading” statement to subtly suggest the most appropriate behavioral action in situations like that described. The batterer gains a sense of acceptance by the therapist and comes to understand not only the kind of behavior that is desirable, but also hears how to change his behavior to achieve better interpersonal results.
Self-Psychology Approaches
Like the Client-Centered therapies, those approaches that incorporate the basic tenets of Self-Psychology can be quite useful in treating batterers. Self-Psychology is based on the concept that all children come into the world with the propensity for becoming whole. In order to achieve this goal three elements are required: children must be “mirrored” or nurtured sufficiently by their caregivers, they must have adequate role models and they must experience “bonding”-typically gleaned from interaction with siblings and peers.
The “self” develops and evolves by coming to know that one is good and special because 1) one exists (gained from mirroring experiences with the “selfobject” or primary caregiver), 2) one exists in the presence of someone great (“basking in the glow” of an idealized parent, leaving the child feeling special because the parent is perceived as special) and 3) those feelings are reflected in the general population or “group” (gained from interactions with siblings-the “us against them” phenomenon).
As Dutton et al (in press) and Wexler (1999) point out, those who batter often describe less than perfect experiences with their early caregivers and reflect inadequate selves. When the batterer enters an intimate relationship, he desires to finally experience the love, adoration and nurture so needed from his caregivers (and did not receive). When he is able to experience that mirroring, he becomes the best man he can be. When his partner reflects back less than perfect mirroring (often because of inappropriate behavior by the batterer), he becomes the worst of himself.
Holtzworth-Munroe and Hutchinson (1993) noted that when the batterer experiences his partner as rejecting or critical, he begins to cognitively distort her intentions. These “misattributions” result in the batterer assuming that his partner is trying to hurt him, evoking narcissistic injury and ultimate violent reaction.
When batterers enter treatment paradigms designed with a Self-Psychological approach, they can finally receive the mirroring they have so desired. Through the mature “twinship” experience with a therapist, as well as with other program members, they learn to relate as men, flawed but equal men. They more easily accept the education being offered through new perspectives and skill-building exercises within a safe and respectful environment.
Psychodynamic Approaches
Saunders (Browne, et al., 1997, Saunders, 1996) designed a treatment model that emphasized recognition and process of the impacts of old emotional wounds on current relational function. Saunders theorized that men who experienced themselves as unable to adequately express their feelings and old hurts learned to rely on their female partners to do this expression. Over time, these men came to resent this emotive dependency, resulting in eventual ambivalence and angry outbursts at their partners. Through his research, Saunders discovered that when these angry, emotionally dependent batterers were treated with a psychodynamic approach, they responded far better than those who were treated with the more traditional cognitive behavioral approaches.
The Compassion Workshop
One of the group treatment programs that is considered highly effective is the Compassion Workshop designed by Stosny (1995). Like some of the other models reviewed here, its premise is that men struggle with attachment as well as with the regulation and expression of their emotions.
Within this workshop men are led through a series of exercises that incorporate experiential, video and homework components in order to generate increased compassion for the wounded self (that they probably don’t recognize) and to promote better self-cohesion. The cornerstone technique of the Compassion Workshop is Stosny’s HEALS method. By practicing the following steps on a regular basis, the men experience healing and true power:
Solution-Focused Approaches
Models based on Solution-Focused therapy (O’Hanlon & Weiner-Davis, 1989) combine the humanistic perspective, systems, theory, and social constructivisim to promote strength and skill-building in the batterer. The treatment encourages batterers to avoid perception of themselves as pathological or diabolical and towards recognition of their lack of skills for managing feelings and situations. Some of the questions used in this model that enable the batterer to redefine his self-perception include:
This kind of treatment can be used in individual psychotherapy with batterers and can also be used in the group setting. Review work by Lee et. al. (1997) to learn more about how these concepts can successfully be incorporated into the group therapy paradigm.
Treatment of Assaultive Men from an Attachment Perspective
Sonkin and Dutton (2003) have applied the basic tenets of attachment theory to psychotherapeutic treatment of batterers resulting in a unique treatment paradigm. Using clinical steps based on Bowlby’s (1988) work, Sonkin and Dutton’s approach enables violent men to gain awareness of their ambivalent feelings, better modulate their anxiety and avoid enlisting the rage response when perceiving rejection or abandonment by an intimate partner. The five clinical tasks to be achieved in treatment include:
Sonkin and Dutton (2003) remind that because batterers may have a variety of attachment styles, it is important to be able to assess status and style in order to provide appropriate treatment (all attachment styles are not created or treated equally).
CHAPTER IV:
PARTNER VIOLENCE IN ETHNIC MINORITY FAMILIES
As stated previously, intimate partner violence knows no boundaries. It cuts across age, gender, culture, SES, sexual orientation and ethnicity. Even though all groups experience relational violence, there are factors which contribute uniquely to intimate partner violence among ethnic minorities. These include poverty and discrimination. These factors, as well as others, may contribute to frequency of violence and impact the help-seeking behavior of the victim (West, 2003; Bressler, 2008).
Minorities Studied
African Americans
African Americans are the third-largest ethnic group in the United States, comprising about 13 percent of the total population, at 38.9 million. It is believed that the majority of African Americans originally entered the United States via the slave trade. As a result, they endured the forced separation of their families, physical abuse, prohibition of indigenous language and culture. While this ethnic minority has improved its plight significantly, they still have not achieved economic, employment and educational parity with Anglican Americans. Even in the face of these adversities, African American families “have developed cultural strengths and coping strategies including, adaptability of family roles; strong kinship bonds; emphasis on work, education, and achievement; religious values; and a humanistic belief system that stresses concern for others and spontaneous interactions” (West, 2003, p. 79).
Latinos and Mexican-Americans
According to the 2010 Census, the Hispanic population grew by 43 percent during the last decade, reaching 50.5 million by 2010. The more than 15-million-person growth in this ethnic group accounted for more than half of the nation’s overall growth through the decade. This ethnic minority now constitutes approximately 16% of the US population. This group is comprised of immigrants from Mexico, Puerto Rico and Cuba.
Mexican Americans make up 60% of this ethnic group. While many migrated here from Mexico, the original population was indigenous to this land and was conquered during the Mexican-American War. The Californios and Angelinos were the original inhabitants of what are now known as California and Los Angeles.
In similar fashion Puerto Ricans lost their indigenous rights during the Spanish-American War. Approximately 50 years ago, Puerto Ricans began to immigrate to the U.S. to escape unemployment and poverty. Today, Puerto Ricans comprise 15% of the Latino population.
Immigrants from Cuba make up 5% of the Latino minority. Those who arrived between 1959 and 1965 were considered political refugees (because Cuba is a communist country) and were primarily White, educated professionals. By the 1980s U.S. laws and economic status had changed, and the influx of Cuban immigrants was experienced with quite a different attitude (Ginorio, Gutierrez, & Cause, 1995; Portes & Truelove, 1987).
The difference in migration histories and patterns contributes to variations within this ethnic population. For instance Cuban-Americans tend to be older and more economically advantaged than other subsets of the Latino population.
Asian Americans
The Asian/Pacific Island Americans represent 5% (14.7 million) of the total U.S. population (https://www.uspolicy.be/headline/hispanics-are-largest-minority-group-united-states). This ethnic group is comprised primarily of 1) those from mainland Asiatic cultures (Chinese, Vietnamese, Japanese and Koreans), 2) those from Southeast Asia (Filipinos, Indonesians, Malaysians, Cambodians and Laotians) and 3) those from the Pacific Islands (Hawaii, Samoa and Guam).
Like the subgroups which comprise the Latino population, Asian-Americans differ greatly by immigration and generational status. A large percentage of the first subgroup (mainland Asians) immigrated many generations ago, increasing their level of acculturation and adoption of American norms and behaviors. They have also achieved relatively high levels of educational and economic success (Okamura, et al., 1995). In contrast, more recent immigrants to the U.S. are considerably more impoverished and face greater language barriers, lack of education, unsafe neighborhoods and anti-Asian violence. Despite their diverse backgrounds, as a group, Asian-Americans emphasize family loyalty, responsibility, respect and cooperation (Chen & True, 1994; Stevenson, 1992).
Native Americans
Of the groups studied, the smallest ethnic minority in the U.S. is the indigenous Native American population. These 2 million Native Americans represent over 500 different tribes and account for 0.8% of the total U.S. population. Historically, almost every tribe was forced to relinquish their homelands and move to assigned reservations. Like the Africans, they were pressured to assimilate into the Anglican-American society.
This group experiences extraordinarily high unemployment rates, great poverty, significant prevalence of alcoholism and high “early” mortality (Bachman, 1992; Indian Health Service, 1989; LaFromboise, et al., 1994; LaFromboise, Choney, James, & Running Wolf, 1995). Despite these incredible challenges, many Native American families maintain their traditional values and customs (e.g. reverence of elders, cooperation and group cohesion) (Wasinger, 1993).
Incidence of Partner Violence
The most accurate representation of intimate partner violence likely comes from large national probability samples rather than community or non-representative samples. As such, this is the data that will be primarily reviewed.
African Americans. According to the large national probability samples, there is a higher rate of partner assault among African-Americans compared to Anglican-Americans. The First National Family Violence Survey indicates that Black husbands are violent with their wives at a rate four times higher than Caucasian husbands, and Black wives assault their husbands twice as often as do Caucasian wives (West, 2003; Straus, et al., 1980; Hampton & Gelles, 1994; Straus & Gelles, 1986; Hampton, et al., 1989).
Latino and Mexican-Americans. Data from two national surveys produced conflicting results: while one study indicated that couples from the Latino minority were less violent than their Anglican-American counterparts, another study suggested that there was a higher rate of violence among Latino couples. In order to avoid these apparent research flaws, Kaufman Kantor and colleagues (1994) conducted person-to-person bilingual interviews with respondents in a national probability sample. When the subsets of the Latino minority were considered by subgroup, large ethnic group differences emerged: Puerto Rican spouses were approximately twice as likely as Anglican husbands and ten times more likely than Cuban husbands to be violent with their wives (West, 2003).
Asian Americans. West (2003) reports that no nationally representative surveys have been conducted with those in the Asian-American ethnic minority. In addition, studies that have been conducted produced mixed results, though there appears to be a preponderance of relational violence in this minority group as well.
Native Americans. Estimates of intimate partner violence within Native American couples range from 50% (Wolk, 1982) to 80% (Chapin, 1990), though most of the data comes from anecdotal reports (e.g. (Allen, 1986) and small samples (Verlarde-Castillo, 1992). Results from the National Family Violence Survey (Straus & Gelles, 1990) noted that Native American couples were significantly more violent than their Anglican counterparts (Bachman, 1992; West, 2003; Bressler, 2008).
While the research suggests that minority groups have a higher prevalence of intimate partner violence than Anglican Americans, ethnic minorities are not inherently more violent than Anglican Americans. They are more likely to be overrepresented in demographic categories (lack of opportunity, higher unemployment, lower SES, prevalence of alcoholism) that are at greater risk for physical violence (Asbury, 1993; Cazenave & Straus, 1990; Kaufman Kantor, et al., 1994; Straus, et al., 1980). West (2003) points out that “in many cases, racial differences in rates of partner violence disappear when age, lower social class, and husband’s occupational and employment status are taken into account (Cazenave & Straus, 1990; Straus & Gelles, 1990). The remaining ethnic differences can often be explained by level of acculturation, alcohol abuse, particularly husband’s binge drinking, and normative approval of violence” (p.83). Additionally, during an interview (Bressler, 2008), Michael Johnson suggested that the research about domestic violence in minority groups may be misleading. Not only are these groups not inherently more violent, but they likely do not constitute a larger percentage of “intimate terrorists.” However, there may be higher frequency of common couple or situational violence amongst those in minority groups, though even this statistic could be flawed as it only takes a single incident of common couple violence in a relationship to warrant the statistic.
Demographic Factors
Age. Younger age, specifically being under age 30, is a strong predictor of partner violence (Straus & Smith, 1990; Suitor, Pillemer & Straus, 1990).
Social class. Cazenave and Straus (1990) found that when SES is held stable, the prevalence of intimate partner violence in African-American couples is no higher than that in Caucasian couples. Higher rates of domestic violence among Black couples were only identified in the $6,000-$11,999 annual income range (unfortunately the largest percentage of African-American couples were in this income category). Similar results appeared for partner violence in the Latino minority. Less research was available on Native American and Asian American couples, though it is believed that this factor impacts couples in these ethnic minorities in the same way that it impacts other minority groups.
Husband’s occupational and employment status. African-American men employed in blue collar occupations as well as those who were unemployed reported more violence than their Black professional counterparts (Cazenave & Straus, 1990; Hampton & Gelles, 1994). Husband’s unemployment demonstrated the strongest effect when statistics for Latino couples were compared with those of Caucasian couples (Kaufman Kantor, et al., 1994). These kinds of associations have not been studied adequately for the Asian American and Native American ethnic groups.
Cultural Factors
As much as we would like to believe that poverty and unemployment are the strongest reasons for heightened frequency of domestic violence in ethnic minority couples, some surveys suggest this is not the case. When these factors were held stable in one study, Black men were still more violent than their Caucasian counterparts (Cazenave & Straus, 1990).
Other factors associated with increased intimate partner violence are being evaluated. Perceived stress, for example, may be the culprit for the higher prevalence of violence in Native American couples (Bachman, 1992; West, 2003). And, just as Dutton and his colleagues (in press) found, alcohol abuse and normative approval of violence likely significantly impact intimate partner violence in ethnic minority groups (Kaufman Kantor & Straus, 1987). Level of acculturation may have some impact on domestic violence in ethnic minorities though research on this factor has produced mixed results for the Asian American minority (Jasinski, 1996; Okamura, et al., 1995). Among those in the Latino minority, being born in the U.S. was associated with increased risk for domestic violence (Kaufman et al., 1994; Sorenson & Telles, 1991).
Therapeutic Implications
For help-seeking behavior: There are several factors which may impede the help-seeking behavior of battered minority women, including cultural and institutional barriers (Rodriguez & O’Donnell, 1995; Paranjape, A; Tucker, A: Mckenzie-Mack, L; Thompson, N; and Kaslow, N. (2007)). Anecdotal data suggests that Latinas seek and utilize fewer resources than do African-American and Caucasian women (Gondolf, et al, 1988; O’Keefe, 1994).
It is possible that cultural beliefs may inhibit help-seeking behavior, though acculturation level, language skills, educational attainment and socioeconomic status may also impact which beliefs are held strongly and how significantly help-seeking behavior is affected as a result. For example, Kanuha (1994) found that more acculturated, educated, second and third generation Latina and Asian battered women may be more familiar with and accepting of mental health services.
Some of the institutional barriers that are postulated to have an impact on the help-seeking behavior of ethnic minorities include the lack of translators, limited number of bi-cultural/bi-lingual professionals, inadequate reading materials in client native languages and limited number of ethnically-sensitive treatment programs (West, 2003). Other factors which may impede help-seeking behavior include geographic distance of resources from the home, prohibitive fees and inconvenient hours of operation. Additionally, Paranjape, A; Tucker, A: Mckenzie-Mack, L; Thompson, N; and Kaslow, N. (2007) suggest that for older African American women, there may be a lack of trust in the system itself to actually do anything. Their research indicates that this group is more likely to manage their experiences of interpersonal violence personally, rather than by utilizing external resources.
For culturally appropriate assessment:
In addition to all the data that is gathered in any assessment, West (2003) reminds that therapists should also seek information in the following categories for their ethnically diverse clients:
Any effective treatment program must always consider the specific culture, beliefs and traditions of the population being addressed.
CHAPTER V:
INTIMATE PARTNER VIOLENCE IN LESBIAN, GAY, BISEXUAL AND TRANSGENDER RELATIONSHIPS
Despite stereotypes to the contrary, results from the Second Annual Domestic Violence Report conducted by the National Coalition of Anti-Violence Programs (NCAVP) suggest that intimate partner violence is prevalent in about 30% of lesbian, gay, bisexual and transgender couples, comparable to the data on heterosexual couples (Brand & Kidd, 1986; Koss, 1990; Harms, 1995; Lockhart, White, Causby & Isaac, 1994). This percentage has increased over the years, indicating greater recognition and reporting in this community. However, research also suggest that the incidence of relational violence in this population is still underreported for a variety of reasons.
Impact of cultural beliefs
Like the cultural beliefs that may inhibit help-seeking behavior and promote denial in ethnically diverse populations, the notion that intimate partner violence only occurs between men and women may perpetuate violence in lesbian, gay, bisexual and transgender couples. The same factors which may engage heterosexual victims to remain in domestically violent relationships are at work in lesbian, gay, bisexual and transgender partnerships: victims do not recognize or label themselves as such, perceive love as prevailing over the violence, accept blame and responsibility for the relational violence, attribute the violence to situational factors and maintain belief that things in the relationship will change for the better with time.
Impact of substance abuse
As Dutton and his colleagues (in press) discovered with heterosexual couples, substance abuse is also significantly associated with intimate partner violence.
Impact of community size and density
Due to the smaller community size and density of the population, lesbian, gay, bisexual and transgender victims may not seek assistance for fear that others in their community will find out. And, even if the victim is courageous enough to seek assistance in his/her own community, sufficiently sensitive treatment unique to this population may not be available. In fact, the NCAVP survey found that only half of the centers that reported data provided services for victims of intimate partner violence.
If the lesbian, gay, bisexual and transgender victim seeks assistance outside his/her community, s/he may be met by the prejudices of heterosexual police, shelter staff, counselors and clergy.
Availability of Protective Orders and Legal Remedies
Legal options were originally designed for women abused by men. Over time, some of the laws were revised to incorporate a gender-neutral framework, though most were not sufficiently rewritten to enable lesbian, gay, bisexual and transgender victims to receive the same legal options offered to heterosexual victims.
While every state and the District of Columbia has legally addressed the issue of domestic violence in some way, not all states have addressed the issue of intimate partner violence within the lesbian, gay, bisexual and transgender community.
Orders of protection enable a judge to limit, prohibit or direct the behavior of the batterer. They afford quick, simple solutions for the batterer who reabuses his/her victim: violation of the protective order is generally a criminal offense (in most states) and police are given the authority to immediately arrest the perpetrator if s/he is found to be harming the victim. Protective orders also safeguard the victim’s home and place of employment. A protective order may also restrict use, transfer, sale or concealment of jointly owned property, such as cars, checkbooks or keys, and may engage the perpetrator to provide financial assistance to the victim.
Unfortunately, not all states enable lesbian, gay, bisexual and transgender victims to apply for protective orders because they exclude those who have been abused by members of the same sex. In approximately ten states orders are unavailable to lesbian, gay, bisexual and transgender victims. In about two-thirds of the states (and in the District of Columbia) a victim of same-sex intimate partner violence should be able to obtain an order of protection because the laws in these jurisdictions are written in gender-neutral language. In four states orders of protection have been made specifically available to lesbian, gay, bisexual and transgender victims. Other legal remedies may be available but all with limitations.
CHAPTER VI:
A CULTURAL PERSPECTIVE AND SYSTEMS THEORY APPLIED TO DOMESTIC VIOLENCE
Many cultures and societies throughout the history of human kind have accepted and tolerated the abuse of women (Amnesty International, 2003; Gelles & Straus, 1988; Herman, 1992; Onoh, 2001; Zollicoffer-Brown, 2003). We are now in an era where this tolerance is beginning to diminish, albeit slowly. Political, social and cultural awareness is growing. Laws are changing. Training for health care and law enforcement personnel is mandated. Additionally, we have observed an increase in resources, such as shelters, educational formats and legal aid, that are all aimed at providing victims, primarily women, better protection from partners that are violent (Massachusetts Citizens for Children, 2001; Swall-Yarrington, 2002; Walker, 2000; Wilder Research Center, 2003). While a significant amount of progress has been achieved, there is still a long way to go towards adequate protection for victims and the prevention of domestic violence. This section will identify some of the obstacles to such progress. It identifies several cultural and political forces that seem to further impede protection of battered women. It also suggests that the application of Systems Theory to domestic violence is likely to increase the effectiveness of prevention and treatment programs.
Gelles & Straus (1988) identify accurately that the primary reason so many men continue to batter women is because “they can” (p. 20). “They can” primarily because for too long society has tolerated it and the legal system, systematically, has ignored it (National Task Force On Violence Against Women, 1996.). Most abusive men do not strike their bosses, their colleagues, friends or strangers, which means that they are able to exercise control over their behavior if they choose to or if they consider the consequences of their behavior (Holtzworth-Munroe & Stuart, 1994; Johnson, 1995; Wexler, 1999; Zollicoffer-Brown, 2003). O. J. Simpson would have been arrested if he had beaten his friend Al Cowlings, a policeman, or for that matter any stranger, but he was not arrested for beating his wife in the privacy of their home. Reflecting on the prevalence of domestic abuse, Gelles and Straus (1988) poignantly write: “Violence in the home is not the exception we fear; it is all too often the rule we live by” (p. 20). The family has always been considered to be one of our most important institutions and particularly in post-industrial cultures. It ideally provides its members with such fundamental needs as safety, food, affection, intimacy and socialization. However, conflict in families is inevitable and is all too often pervasive. Unlike the belief perpetuated by the media that violence against women is committed by strangers, women are more likely to be physically assaulted, beaten and killed in their own homes at the hands of a loved one, than in some other place or by a stranger (American Bar Association, 2003; DiLoreto, 2001; Gelles & Straus, 1988).
In one remote tribe in East Africa, whenever battering occurs, all the women from all the adjoining huts encircle the hut where the battering is taking place and loudly bang pots and pans. The banging does not stop until the abuse stops. In almost all cases, in light of such a powerful communal protest, the abuse stops immediately. Most western cultures, with their emphasis on individualism, privacy, autonomy and separation, have lost this sense of a village and the capacity to communally protect each other (de Beixedon, 1995; North Dakota Council on Abused Women’s Services, 2003; Rural Womyn Zone, 2002). As a result, domestic abuse of wives and children is prevalent.
In addition to the dominant values of isolation, privacy and separation, two main attitudes seem to impede our effectiveness in dealing with victimization in general and intimate partner violence in particular: both of these attitudes are based on blame.
Blaming the victim or assuming the victim deserved the abuse has been the primary mode of dealing with domestic violence for many centuries. As a response to the enormous injustice of these attitudes, more recently, some fractions of the feminist movement and others have taken a new approach, viewing men and “patriarchal culture” as primarily responsible for all forms of violence, whether as soldiers on the battlefield, politicians in government or husbands perpetrating domestic violence (Hughes, 1993; Zur, 1994; Zur & Glendinnning, 1987). As a result of the latter approach and the outcry for justice, laws have changed, law enforcement personnel have been getting better training, shelters have opened and therapists have gained an enormous amount of information about batterers and how to treat them. Male batterers often face incarceration, restraining orders and mandatory psychological treatment.
It is easy to understand why the pendulum has swung from blaming women and other victims to blaming men or the patriarchal cultures (Zur, 1994). The political, social and legal progress resulting from this shift in attitudes has been apparent, as women are more protected than ever before from domestic violence. However, this swing has also resulted in suppressing two important and potentially helpful areas of inquiry that have been deemed by some as victim blaming and, therefore, politically incorrect. One of these areas is the investigation of the complex and intricate relationship between perpetrators and victims and the complementary and often mutually dependent roles that they assume in the dynamics of intimate partner violence. The second taboo area, which is even less politically correct, is the general exploration of what role, if any, victims may play in their own battering. Battered women’s personalities, demographics and other characteristics have been studied (Alpert & Albright, 2000; McCauley, et al., 1995; Walker, 2000), but their contributions to domestic instability have not (Zur, 1994). The pressure for political correctness results in avoidance of any investigation that may even remotely look like victim-blaming. Thus, the responsibility for intimate abuse has been laid almost exclusively at the male batterer’s feet. One of the most common queries by batterers in treatment is, “Why doesn’t my partner have to be here? How can we change our relationship if I am the only one here? ” And, while the feminist model would have had therapists confront these batterers with their avoidance of responsibility for the violence, the question is still a good one. Dynamic interactions require at least two, to tango. At some point, victims need to address their role in the violence (even if it is assuming responsibility for not promoting stronger boundaries within the relationship or, as hard as it may be, recognizing the need to depart from the relationship earlier).
Any analysis which assumes that victims, in general, and women, in particular, may make choices which contribute to their misfortune, or that they are neither the only victims nor totally innocent, is seen, primarily by some parts of the feminist movement, as blaming the victim, betraying women and allying with patriarchal society and sexist men (Caplan & Hall-McCorquodale, 1985; Cook & Frantz-Cook, 1984; Herman, 1992; Ryan, 1971; Sundberg, Barbaree, & Marshall, 1991; Yollo & Bogard, 1988). The ironic result is that we know very little about how women may contribute to their own misfortune and consequently we are limited in the ways we can empower women further.
In spite of the political pressures, a handful of writers have confronted the taboos around exploring the roles and responsibilities of victims. A few of those who have courageously penned their thoughts include: Charles Sykes (1992), author of the widely acclaimed A Nation of Victims; Alan Dershowitz (1994), the famous Harvard attorney and author of The Abuse Excuse; Tana Dineen (1996), disillusioned psychologist and author of Manufacturing Victims; Kaminer (1992) who titled her book I’m dysfunctional, you’re dysfunctional; Carol Tavris (1993) whose article, “Beware the incest survivor machine,” was published in the N. Y. Times; And Ofer Zur (1994), who wrote the article “Rethinking Don’t blame the victim”.
All have described how we have become a nation of victims, where everyone is leapfrogging over each other and competing for the status of victim, where vast numbers of people define themselves as victims or the survivors of some sort of holocaust. What started as support for a most important civil right and the feminist movement has partly evolved into what has been called by sociologist Amitai Etzioni (1987) the “Rights industry,” “Rights movement” or “Victim industry”. Shelby Steel (1992) similarly analyzed the victims’ ideology and how tragically it has affected African Americans’ identity and their relationships with white Americans.
The basic assumption of the legal system is similar to our culture’s general approach to victims and responsibility. It is an approach that assumes that in violent relationships one party is guilty while the other one is innocent. The physically hurt party-the victim-is usually seen as totally innocent. Surprisingly, even the therapeutic community has bought into this politically correct notion (Dineen, 1996; Kaminer, 1992; Sykes, 1992). For the most part therapists have failed to employ Systems Theory, such as presented in Bateson (1979) and Laszlo (1976), or family therapy (Goldenberg & Goldenberg, 1999; Nichols & Schwartz, 2000) principles of complementarity in domestic violence. As a result, the therapists’ effectiveness is significantly reduced, as they tend to judge rather than understand the complex dynamics of violence in systems.
While in some cases the responsibility is clearly one-sided, in many other violent situations, including domestic violence, it is not that simple. Zur (1994) proposed classification of victims according to their relative degree of responsibility and power to predict, control or affect situations.
The following five categories evaluate the degree of guilt or responsibility, ranging from total innocence to total responsibility:
The prohibition against exploring and understanding how some victims are not 100% innocent but in fact contribute to their own misfortune, results in further victimization and suffering. By helping victims understand their part in the dynamic of intimate partner violence, they can change their affective, cognitive or behavioral patterns so victimization is less likely to reoccur. A few communities across the nation are gaining awareness of these dynamics and the need to treat the family system, and they are implementing dual treatment programs: batterers attend a 52-week Anger Management program and victims attend their own 52-week Empowerment and Accountability program.
Mental health workers are fully aware of the wide array of self-destructive behaviors, such as playing Russian Roulette or the chicken game, drunk driving, smoking, drug abuse, obsessive gambling, self-mutilation and, of course, suicide. They are aware that some individuals are more prone to repeatedly getting into trouble or being frequently victimized in one way or another. Despite this awareness, an understanding of how women contribute to their own victimization is not highly developed. As a result, female victims often do not get the help they need and deserve so they can change, heal and, most importantly, stop the violence. Relieving all women, or any victim, of any and all responsibility to predict or prevent their victimization is to reduce them to helplessness and, in fact, re-victimizes them. The focus of the legal system on punishing and healing the batterers is one example of this approach. Male batterers have a wide range of programs available to them to help them change their violent ways. Often they must attend such programs if they want to avoid serving jail or prison time. On the other hand, women who are viewed as innocent victims by the legal system, do not have any mandate to attend therapy or any other program. Battered women’s shelters and a few other programs have served as an important resource not only for physical security but also for psychological support and healing.
Unlike the Alanon programs that recognize the complementary role of the alcoholic and the co-alcoholic, the domestic violence legal and psychological interventions have shied away from such understanding and instead focus on placing blame.
Research has shown that both battering men and battered women have had significantly more exposure to battering and abusive relationships in their homes during childhood than the rest of the population (Gelles & Straus, 1988; Hotaling & Sugarman, 1986; Matthews, 1999; Rosenbaum & O’Leary, 1981; Straus, et al., 1980; Viano, 1990). Research has also shown that many batterers and battered women have been involved in more than a single battering relationship in their adult life (de Beixedon, 1995; Dutton, 1988. as cited in Zollicoffer-Brown, 2003). These disturbing patterns suggest that the batterers and battered do not choose their partners randomly. This leads us to the painful conclusion that once the boundaries between love, care and violence have been blurred in sexual and physical childhood abuse, both victims and victimizers may re-enact this blurring of boundaries by repeatedly engaging in violent intimate relationships (Dutton, 1996; Hotaling & Sugarman, 1986).
In general, many victims, including victims of domestic violence, suffer from low self-esteem and a sense of guilt. They develop a faulty cognition that they are solely responsible for what happened to them. Of course, batterers are known to put the blame on the victims and often the cultural messages and the media tend to support this. Dershowitz (1994), Dineen (1996), Etzioni (1987), Kaminer (1992), Sykes (1992) and Zur (1994) have described an additional dynamic which takes place with some victims. This is the dynamic of secondary gain. These authors have articulated how the stance of many victims in our culture involves a complete lack of any responsibility for anything that happens to them and, therefore, a concomitant lack of accountability. These authors describe the fundamental stance of the victim as being neither responsible nor accountable for his/her misfortune, being morally right and forever entitled to sympathy.
Many abused or violated victims are truly and completely innocent, such as the molested child. However, most interpersonal violence involves some knowledge, familiarity or intimacy between victims and victimizers (Gelles & Straus, 1988; Wolfgang & Ferracuti, 1967). The familiarity and intimacy found between victims and victimizers in most violent incidents is always an element in domestic violence. Those who are involved in domestic violence are by definition intimately and sexually involved. This implies a certain level of mutuality and complementarity of roles in these systems. As consenting adults, the battered and batterer have freely chosen each other as intimate partners. They often make this choice, fully aware of the other’s history of domestic violence. The fact that both batterers and battered often repeat the pattern of choosing similar partners tells us that neither one is completely innocent or guilty. Relying on this understanding, sending the batterer to jail for battering, while very appropriate, may not be of any long-term help to the battered party. Women, who are usually the victims, may feel some sense of vindication when their abusive partner is thrown in jail (as he undoubtedly should be), but this may not help them become aware of their responsibility for choosing him in the first place or for staying with him after the first few violent episodes. Even worse, it does not help them make healthier decisions in regard to future intimate partners. As a result, victimization and re-victimization is perpetuated and sufferings are prolonged, often leading to tragedy.
The view of women as innocent victims in domestic violence cases takes place in the context of a culture of victims enforced primarily by the pressure for political correctness, attorneys and psychotherapists. In her book, Manufacturing Victims (1996), Tana Dineen details how the victim industry has been fueled by psychotherapists and outlines the direct economic and professional benefits that psychotherapists derive from perpetuating the idea of victimology via the prevalent use of the PTSD diagnosis. Violence begets violence. Similarly, blame begets blame. Blaming men or women keeps the blame game alive and keeps the race for victim status alive. An individual or group can win the battle, become the victim of the year and yet lose the war or even their lives. Victims’ insistence on assigning blame, coupled with the lack of accountability are the very reasons that victims continue to get hurt, injured and abused. It is apparent that the blame approach is neither effective in resolving the problems of violence, nor in protecting the victim from further victimization, nor protecting future generations from continuing the cycle of abuse.
An alternative approach to blame can be found in Systems Theory (Bateson, 1979; Laszlo, 1976). Applied to victimization and domestic violence, it is concerned with the ways the dynamics of victimization develop and are sustained, how batterers escalate towards violence and what may enable them to shift toward non-violent resolution. Who is right or who is to be blamed is not the primary emphasis of this approach. Instead, it offers ways to understand the mutual contribution of all the participants and ways to intervene and, hopefully, stop the patterns of violence.
In applying systems analysis to victimization and domestic violence, the following assumptions arise:
Applying systems analysis to clinical work with domestic violence (where the husband is the batterer):
As has been discussed extensively elsewhere (American Bar Association, 2003; Beth Israel Deaconness Medical Center, 2001; CHARMECK, 2002; Walker, 2000), leaving the relationship is not always a simple or very doable option for a woman with children and without economic means.
Only with the understanding of the above components and the use of Systems Theory, often in conjunction with other theoretical orientations, are therapists likely to intervene effectively. Systems Theory is a way to understand the system and does not necessary imply or mandate couples therapy. In fact, for safety reasons, couples therapy is counter-indicated in situations where violence is still taking place (Holtzworth-Munroe & Hutchinson, 1993; Walker, 2000).Whether the therapist works with individuals or the whole system, the most immediate task is to prevent any imminent violence. The long-term goal must be to help the patient, whether batterer or battered, to assume a new role and new behavior. The ultimate task of therapy is to help all participants live their lives violence-free, meaningfully and with greater dignity.
In cases where the therapist is working individually with the victim, s/he has to walk the fine line between empathy and collusion. Without blaming, the therapist’s goal is to move victims from blame to responsibility, from helplessness to accountability and from hopelessness to empowerment (Zur, 1994). Victims should never take total responsibility for their suffering; however, they must develop an understanding of how they contribute to their own victimization. While acquiring a cohesive sense of self, victims must be helped to feel better about themselves, raise their self-esteem and work through the legacy of their childhood abuse. Therapy must enable batterers and battered to break the dangerous and painful link between love and abuse while helping them realize that they deserve respect and dignity like any other human being. When therapists work individually with batterers, they must make sure that the batterers do not use the approach proposed by Systems Theory to justify their actions or to minimize their responsibilities.
By understanding types, origins and modes of operation of victims and victimizers, battered and batterers alike will be able to recognize, prevent and intervene in violent systems. For this to happen, blame must be replaced by responsibility. Victims must realize that they have a part to play in what happens to them and that they have choices to act differently or leave. Without doubt, batterers must assume full responsibility for their violent behavior. The healing process should empower both batterers and battered to become conscious and responsible contributors to the unfolding of their lives, which can then become dignified and meaningful and above all free of violence.
CHAPTER VII:
ETHICS CODES RELEVANT TO SPOUSAL AND PARTNER ABUSE:
The American Psychological Association (APA) Code of Ethics, the California Association of Marriage and Family Therapists (CAMFT) Code of Ethics, the National Association of Social Workers (NASW) Code of Ethics and American Counseling Association (ACA), while not having sections that focus on domestic violence, all have a number of similar sections that are relevant to domestic violence. In this section we flag some of the sections from all three codes, as they are highly pertinent to domestic violence.
Ethical decision process
Psychotherapists who are working with domestic violence should carefully review and possess knowledge of the Codes of Ethics and of the applicable state laws. Therapists must be acutely aware of the volatility, danger, violence and potential lethality that is inherent in domestic violence systems. Accordingly, they should minimize the potential for danger and harm by being well trained, informed of local resources, knowledgeable about assessment and detection, educated about techniques, interventions and prevention, and should work only within their scope of practice. Special attention should be given to issues of culture, age, personality, drug abuse, class, gender and sexual orientation concerns. Additionally, therapists must be aware of the complexities involved around the issues of confidentiality in domestic violence cases. Therapists should avoid victim blaming, and it is essential that they seek legal, ethical and/or clinical expert consultation and supervision in complex or potentially dangerous situations.
The Codes of Ethics are available online at:
CHAPTER VIII:
CALIFORNIA LEGAL CODES ASSOCIATED WITH INTIMATE PARTNER VIOLENCE
CA PENAL CODE. SECTION 11160-11163.6 11160. (a) Any health practitioner employed in a health facility, clinic, physician’s office, local or state public health department, or a clinic or other type of facility operated by a local or state public health department who, in his or her professional capacity or within the scope of his or her employment, provides medical services for a physical condition to a patient whom he or she knows or reasonably suspects is a person described as follows, shall immediately make a report in accordance with subdivision.
Sections relevant to psychotherapy and counseling in the California Business and Professional Code:
For complete regulations online:
CHAPTER IX:
RESOURCES
References