274 -Domestic Violence and Mental Health

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Domestic Violence and Mental Health
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Executive Director: AllCEUs Counselor Continuing Education
Podcast Host: Counselor Toolbox, Addiction Counselor Exam Review & Happiness Isn’t Brain Surgery

Objectives
• Overview of the prevalence of IPV/DV
• Overview of the mental health professional guidelines.
• Assessment of those who batter: limits of confidentiality
• Treatment Program approaches and goals
• Partner contacts
• Characteristics of those who batter
• Characteristics of victims
• Impact of DV on mental health
• Treatment issues for victims
• Impact of DV on children
• What can help children
• Buffers against DV

Statistics
• 1 in 4 women and 1 in 7 men have been victims of severe physical violence by an intimate partner in their lifetime. https://ncadv.org/statistics
• 19.3 million women and 5.1 million men in the United States have been stalked in their lifetime.
• 63% of males as opposed to 15% of females had a deadly weapon used against them in a domestic violence incident.
• In the year 2000, 440 men were killed by their intimate partner. Since then, 4% of male murder victims come from domestic violence incidents.
Male Victims of DV
• Men find it hard to see themselves as victims. They tend to feel that battering is associated with women and not men.
• Men who are bisexual or gay may believe that they deserve the abuse because of their sexual orientation.
• Male victims find it hard to seek help because
• Help is mainly gender based
• According to the National Coalition of Domestic Violence in 2003 and 2004 the state of Tennessee provided shelter to 11 men but was unable to find shelters for 192 men
• They feel that they do not have the right to seek help because they have become part of the problem by defending themselves

Where Do We Find Victims and Abusers?
• Mandated treatment for batterers from the courts
• Self referral for domestic violence counseling
• In the context of therapy for other concerns (e.g., alcohol or other drug abuse, marital conflict, anger problems, depression, academic or conduct problems of children who witness domestic violence, etc.)
• Over fifty percent of clients presenting alcohol or other drug problems also experience domestic violence.
• Over fifty percent of those presenting for help with domestic violence also struggle with substance abuse.

Important Note
• Statistically, women are more likely to be killed by their partners when their partners threaten suicide than when their partners threaten homicide. However, confidentiality laws do not provide for the warning of battered women whose partners contemplate suicide.
• Therefore, treatment programs may wish to specify an exception to confidentiality in the program contract for “all threats of harm to self and others.”
Concurrent Addiction and DV Treatment
• Some domestic violence programs require chemically-dependent batterers to participate in drug treatment programs concurrently.
• Many of the treatment issues are the same (e.g., denial, minimization, projection of blame, etc.)
• Batterers often blame their use of violence on psychoactive substances
• Batterers often blame their partners for “forcing” them into treatment
• Violence may become more frequent once the “batterer” is sober
• Integrated treatment allows for an examination of the relationship between substance use and violence
• Victims remain at higher risk of being abused while their partners go without DV treatment
• Postponing DV treatment may imply that stopping the violence is not as important as some other issue such as substance abuse.

What About Couples Counseling
• Clinicians should question the appropriateness/safety of couples counseling if any of the following conditions exist:
• Physical violence within the last several months
• Either partner is afraid of the other
• Either partner is afraid of reprisal for expressing feelings, needs, concerns, etc.
• Either partner does not believe that the other can express feelings other than anger or jealousy
• Either partner does not experience a sense of self-control over the choice to be violent or abusive
• Either partner feels or seems unable to freely choose how to think, behave, etc. due to partner’s efforts to control, manipulate or coerce.

COMMON CHARACTERISTICS BATTERERS

• Sense of entitlement
• Feels like a victim
• Witnessed abuse as a child/May have been abused
• Difficulty controlling (experiencing) anger
• Possessive – Suspicious
• Drug and alcohol concerns
• Denial, minimization, projection of responsibility
• Intimacy problems
• Assertiveness problems
COMMON CHARACTERISTICS BATTERERS

• Low self-concept
• Few social supports
• Sees self and partner as “one”
• May have military/police background
• Traditional views of marriage – Not always abusive
• Perceives violence as a means of control
Scope of Batterer Treatment
• Ceasing physical and other forms of abuse
• Understanding oppression (power and control issues)
• Learning about effective male/female socialization and issues of entitlement
• Developing emotional awareness
• Developing victim empathy
• Understanding the impact of violence on child witnesses
• Developing mutual respect and trust
• Developing honesty and accountability
• Developing control plans (e.g., time outs) to ensure safety
Scope of Batterer Treatment
• Identifying cues for violence
• Learning techniques for responsible parenting
• Developing social supports
• Taking social action to promote a nonviolent/nonoppressive community
• Communicating needs nonabusively
• Taking responsibility for managing one’s own stress
Batterer Group Treatment
• Advantages of this approach over individual or couples treatment include:
• The opportunity for group members to challenge each other’s attitudes and beliefs while mutually supporting efforts to change
• Group members feel less isolated and hopeless
• Group members have the opportunity to develop friendships based on equality rather than on power and control.

Batterer’s Group Treatment
• Group the discussions are aimed at
• Ending all forms of abuse toward his/her partner and family
• Increasing awareness of how he/she behaves toward others.
• Stopping denial that it is a serious life threatening problem.
• Stop blaming partner for any of his/her abusive behavior.
• Redefining abuse and recognize the real damage that it does to him/her and others.
• Assessing the damage done and become responsible to those he/she has abused.
• Becoming more flexible and tolerant toward sex-role expectations for both men and women.
Batterer’s Group Treatment
• Group the discussions are aimed at …
• Breaking out of isolation from family, friends, society and own non-violent, nurturing self.
• Recognizing and better managing the stress.
• Stopping blaming stress (or poor management of it) for violence.
• Support others who have been abusive in their efforts to change
• Face up to any conflict in relationships by learning to become non-violent, nurturing and assertive.
• End any threat of retaliation toward his/her partner because of her/his efforts to be protected from violence
Contacting the Victim During Treatment
• Some programs make periodic contact with their clients’ partners. Following is a list of the most frequently cited reasons for such contact:
• To gather information about the extent and nature of violence and other forms of abuse
• To encourage the client to disclose information about abusive behavior
• To hold the client accountable for the abuse
• To disseminate information to the client’s partner about:
• Goals and limitations of the program
• Information about local victims’ services
• Characteristics of those who batter.
Contacting the Victim During Treatment
• Other programs do not make such contacts believing that the risks outweigh the benefits. They often cite the following contraindications:
• Partner contacts imply that the victim is responsible to track or change the “batterer;” this should not be his/her job
• She/he may be punished for disclosing
• The clinician may not be able to hide knowledge from a suspicious “batterer” when honoring a request not to share information with the batterer
• The partner contact sends a message of distrust which may erode the working alliance with the “batterer”
• The report may not be accurate due to fear of reprisal
• The counselor may not need information from the victim to educate the batterer about how to be nonabusive
Characteristics of Victims
• Unexplained injuries
• Frequently “sick”
• Fears intimate partner
• Feels that she/he does not deserve better
• Blames self for the abuse
• Accepts responsibility for her/his partner’s actions
• Accepts responsibility for maintaining the relationship in spite of his/her actions
• Spends much energy trying not to anger the abuser
• Is secretive about the problems in the relationship
Characteristics of Victims
• Isolates from family and friends
• Continually hopes things will get better
• Feels guilty, depressed, angry, and worthless due to the batterer’s actions
• Has to constantly account for every action to the jealous partner
• Children either cling or are disrespectful
Treatment of Victims
• Safety and empowerment are the two most widely-cited goals of treatment for victims of domestic violence.
• Consult with the local domestic violence council to learn how to safely empower
• Clinicians should be careful not to overpathologize battered partners.
• What appears to be maladaptive functioning in a nonviolent relationship (e.g., “co-dependent traits”) may be a survival strategy for a battered partner
• “Co-dependency counseling” may also blame the client for being battered in the first place, since the relationship is “co-created.”
• Be clear that although it takes two to be in a relationship, it takes only one to be violent. And only the violent person is responsible for that violence.
• Some victims are abandoned by their church when separating from abusers, since some religious doctrines prohibit separation or divorce regardless of the severity of abuse.

Losses Associated with DV
• Sense of safety
• Ability to trust
• Relationship with the abuser
• Relationships with other people
• Isolation
• Abandonment
• Hope for what love will be
• Time
• Finances
• Self-Esteem
• From what the abuser said
• For not leaving/protecting children
• Physical (abilities, appearance)

How do I know when he’s changed?

• Have the violence and threats stopped?
• Are you afraid when you are with him/her?
• Is he/she able to be angry without becoming verbally or physically abusive?
• Are you able to express anger without being attacked?
• Are you able to make decisions about your own life without fear of retaliation?
• Is he/she able to hear and respect what you are saying even though he/she may not agree?
• Can he/she negotiate with you without being attacking or controlling?
• Can he/she respect your right to say no?
• Is he/she able to let you know what he/she is feeling most of the time?
• Is he/she able to express feelings other than anger?
• Does he/she blame you for his/her anger, frustrations, and violence?
• Does he/she respect your right to be different and to make your own decisions?

Domestic Violence and Mental Health
• 54% to 84% of battered women suffer from PTSD
• 38% to 75% experience anxiety
• 63% to 77% of battered women experience depression
• Substance Abuse
• Between 3.3 million and 10 million children witness domestic violence annually (American Bar Association, 2009)
Impact of DV on Children
• Witnessing can mean SEEING or HEARING the violence.
• OBSERVING the aftermath of physical abuse such as blood, bruises, tears, torn clothing, and broken items.
• AWARENESS of the tension in the home such as their parent’s fearfulness when the abuser’s car pulls into the driveway.
• Children who are exposed to battering become fearful and anxious.
• They never know what will trigger the abuse, and therefore, they never feel safe.
• They are always worried for themselves, their parent, their pets and their siblings.
• They may feel worthless and powerless
Impact on Children cont..
• Emotional reactions of fear, guilt, shame, sadness, depression, and anger (at both the abuser for the violence and at the victim for being unable to prevent the violence).
• Sleep disturbances
• Stomachaches
• Headaches
• Bedwetting
• Loss of ability to concentrate
• Acting out
• Withdrawal
• Anxiousness to please

Impact on Children cont..
• Short attention span
• Developmental delays in speech, motor or cognitive skills.
• Use violence to express themselves displaying increased aggression with peers or mother.
• Self-injury
• Seeing the victim treated with enormous disrespect, teaches children that they can disrespect their partner the way the abuser does.
• Witnessing domestic violence is the single best predictor of juvenile delinquency and adult criminality
• Children who witness abuse have an increased risk of being abused.

Impact of DV on Children
• Children have tantrums because they are overwhelmed by their feelings and don’t know any other way to “let go.”
• Children and teenagers may be aggressive as they struggle to feel in control of things instead of helpless.
• When they live with domestic violence, they may try to resist your authority as a parent and test the limits of your rules in order to feel independent and strong.

Buffers Against Effects of DV in Kids
• Mental health
• Social support
• Positive parenting skills
• Good self-esteem
• Ability to regulate emotions
• Treatment of trauma symptoms
• A safe and secure home environment
• Adults who will listen and believe them
• A sense of routine and normalcy

https://www.researchgate.net/publication/284803972_Edleson_Revisited_Reviewing_Children%27s_Witnessing_of_Domestic_Violence_15_Years_Later [accessed Jun 04 2018].
Helpful Messages for Kids

• Violence isn’t OK.
• It isn’t your fault.
• I will do everything I can to help you be safe.
• It’s not your job to fix what is wrong in the family.
• I want you to tell me how you feel.
• It’s important, and I can handle it.
• It’s OK to have mixed feelings about either or both of us (your parents).

What You Can Do

• Set clear and regular routines at home. They make daily life more predictable, especially for younger children.
• Think carefully about which behaviors you might safely ignore and which are unacceptable. The ones you ignore will usually decrease over time.
• Praise your child for the positive things she does.
• Do not try to reason with your child when you are in the middle of a struggle with her.
• Offer your child choices. Say that she may do what you ask, talk about why she is upset, or go to her room to calm down.
• Explain that it is your job to set limits and make decisions.
• Make the consequences of behavior clear and always follow through.
• If you see your child mimicking abuse during play, use the moment to talk about his feelings and worries. For example, say “It seems like you’re thinking about what happened between Mommy and Daddy.”

Summary
• Domestic violence impacts approximately 1 in 3 women and 1 in 4 men
• Group treatment for batterers is the best approach
• Batterers may have low self-esteem, abandonment anxiety and issues with emotional dysregulation
• Domestic violence can lead to anxiety, PTSD, depression, substance abuse and self injurious behaviors in victims and their children.
• Some of the best buffers against the impact of domestic violence include: Social support, healthy self-esteem, mental health, effective parenting skills and effective coping skills.

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