Transcript EAP and Domestic Violence - Cecille del Gallego, LCSW

Domestic Violence
Deepening Our Understanding as EAP Consultants
Cecille del Gallego, LCSW, CEAP
June 22, 2011
Domestic Violence
Training Objectives:
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Refresh and build upon current knowledge of
domestic violence
Identify the different typologies of domestic
violence
Acquire alternative assessment and intervention
techniques
Be reminded of the importance of self-care and
managing transference and counter-transference
Domestic Violence
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“A pattern of behavior where one partner coerces, dominates, and
isolates the other to maintain power and control over their partner.”
(National Coalition of Anti-Violence Programs 2008, p.5)
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“It is an epidemic affecting individuals in every community, regardless
of age, economic status, race, religion, nationality or educational
background.”
(The Public Policy Office of the National Coalition Against Domestic Violence, NCADV)
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Domestic violence can result in “physical injury, psychological
trauma, and sometimes death. The consequences of domestic
violence can cross generations and truly last a lifetime.”
(The Public Policy Office of the National Coalition Against Domestic Violence, NCADV)
Prevalence and Statistics
WOMEN
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1 in 4 women will experience domestic violence in her lifetime
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An estimated 1.3 million women are victims of physical assault by an intimate partner each year
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85% of domestic violence victims are women
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Historically, females have been most often victimized by someone they knew
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Females who are 20-24 years of age are at the greatest risk of non-fatal intimate partner violence
(The Public Policy Office of the National Coalition Against Domestic Violence, NCADV)
Prevalence and Statistics
HOMICIDE
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Almost one-third of female homicide victims are killed by an intimate partner
In 70-80% of intimate partner homicides, no matter which partner was killed, the
man physically abused the woman before the murder
RESTRAINING ORDERS
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Approximately 20% of the 1.5 million people who experience intimate partner
violence annually obtain civil protection orders
Approximately one-half of the orders obtained by women were violated
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Domestic violence is one of the most chronically underreported crimes
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(The Public Policy Office of the National Coalition Against Domestic Violence, NCADV)
MEN AS VICTIMS
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300,000 and 835,000 victims each year
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Higher rates of domestic violence with male partners
(same-sex) compared to men who are with female
partners
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Reluctant to report to you fear of ridicule, fear that they
will be blamed for the abuse, embarrassment
(National Healthy Marriage Resource Center Fact Sheet)
Same-Sex DV
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Prevalence = 25 - 33%
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Between 50,000 and 100,000 Lesbian women are battered each year
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500,000 Gay men are battered each year
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Same-sex victims receive fewer protections
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Same-sex batterers use forms of abuse similar to those of heterosexual
batterers. They have an additional weapon in the threat of "outing" their
partner to family, friends, employers or community.
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Many of these shelters routinely deny services to same-sex victims
(University of Wisconsin-Stout, 2010)
ECONOMIC & PUBLIC HEALTH IMPACT
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Over 18.5 million mental health care visits each
year
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Cost exceeds $5.8 billion each year
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Victims lost almost 8 million days of paid work
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There are 16,800 homicides, $2.2 million
medically treated injuries
(The Public Policy Office of the National Coalition Against Domestic Violence, NCADV)
DOMESTIC VIOLENCE
STATE LAWS
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States differ on the type of relationship that qualifies under
domestic violence laws.
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Most states require the perpetrator and victim to be current or
former spouses, living together, or have a child in common A
significant number of states include current or former dating
relationships in domestic violence laws.
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Some states exclude same-sex relationships in their domestic
violence laws.
(The Public Policy Office of the National Coalition Against Domestic Violence, NCADV)
Domestic Violence
TYPES OF ABUSE
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Physical
Emotional/Verbal/Mental
Sexual
Financial
Spiritual
Cultural
POWER AND CONTROL Domestic Violence Intervention Project - Duluth, Minnesota
(dvcc.delaware.gov)
DOMESTIC VIOLENCE
TWO SCHOOLS OF THOUGHT
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Intimate Partner Terrorism
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Situational (Common) Couple Violence
(Johnson 2008; 2005; 2000; 1995) - derived from RTI “The STOP Program” 2011)
Intimate Partner Terrorism (IPT)
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Rooted in Feminist Theory of Power and Control
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Views Patriarchy as cause of DV
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Primary abuser is usually male
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DV as a Gender issue
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Female violence only seen as in the context of self-defense
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Victims usually fit the ‘Shelter clientele’
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Coercive control – general pattern of abuse
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Fear = Motivation
Situational Couple Violence (Common)
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Rooted in Family Conflict Theory
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Violence is viewed as a result of family systems, psychological issues
and psychopathology
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Men and women seen as equally capable of violence
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Pattern of violence is not generalized
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Violence as a cathartic, reactive response vs psychological control or
deliberate instilling of fear
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Fear for life or safety is usually absent
Perpetrator Typologies
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Generally Violent Anti-Social
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Family-Only
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Low-Level Antisocial
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Emotionally Dysphoric/Borderline
(Holtzworth-Munroe 2000 - derived from RTI “The STOP Program”, 2011)
Generally Violent Anti-Social
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Generalized pattern of violence
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Abuse tends to be severe, highly injurious and can be
lethal
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Usually Personality Disordered – AXIS II’s –
Psychopaths, Sociopaths
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“Under-Attached”
Family-Only
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Violence is not generalized
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Abuse is generally less severe
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Little or no evidence of Psychopathology
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“Poor partner-specific communication skills”
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High on “Impression Management”
Low-Level Anti-Social
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Mix between Generally Violent Anti-Social and Family-Only
Emotionally Dysphoric/Borderline
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Violence is seen as an impulse reaction to express distress
and intense anger
Perceive relationship conflicts as threats of abandonment
Lack the skills to self-regulate
Anxiety-based rage
As a child - parental rejection, abuse, abandonment/loss
Emotionally volatile
Still tend to be violent only with their family
More socially isolated or socially incompetent
“Over-attached”
GENDER DIFFERENCES
MEN
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More serious physical abuse
More sexual coercion
More coercive control behaviors
More stalking behaviors
(Derived from RTI “The STOP Program”, 2011)
GENDER DIFFERENCES
WOMEN
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Use equal levels of emotional and verbal abuse
More moderate physical violence
(throwing something, pushing, shoving)
ABUSE IS MOTIVATED BY
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Self-defense
Fear
Defense of Children
Retribution
To gain control/assert authority
To express feelings
(Derived from RTI “The STOP Program”,2011)
DOMESTIC VIOLENCE
ASSESSMENT
and
INTERVENTION
VICTIMS
STAGES OF CHANGE
1.
Pre-Contemplation - Lacks any perceived need for change
2.
Contemplation -
Ambivalence and Inaction
3.
Preparation -
Balance of pros and cons begins to tip in the direction
of change
1.
Action -
Putting the plan into action
2.
Maintenance -
The Aftermath
(Prochasksa, DiClemente & Norcross, 1992 - Derived from RTI “The STOP Program”, 2011)
Why Do Victims Stay?
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Fear
Hope
Denial
Shame
Children
Family, religious and cultural values
Lack of awareness of services
Lack of resources
Lack of support
Poor Self-esteem
Poor Self-efficacy
Medical, BH issues (e.g. depression, anxiety, PTSD)
Past trauma or abuse – normalization of violence/abuse
DELETE ME PLEASE
Why Do Victims Stay?
“But I still love him/her”
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“Thoughts about” ex-partner
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“Urges” to reconcile with ex-partner
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Ongoing emotional attachment to the abuser
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Normalizing the recovery and grief process
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Need to Re-define definition of Love and Healthy Relationships
Self-Esteem
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Oversimplifies the issue
Self-esteem is part of the problem – both for the victim AND the
abuser
The victim’s responsibility is to examine her own “stuff” as it
relates to mate selection and tolerance for abuse
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Protect or Nurture self-esteem
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Reinforce Strengths
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Build on Resiliency
Cognitive Dissonance
Theory developed in 1957 by Leon Festinger
“The feeling of uncomfortable tension which comes from holding two conflicting thoughts
in the mind at the same time”
Sandra Brown (2009)
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“Having two relationships going on at the same time”
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“The inability to hold a consistent view of [the abuser] is wonderful or horrible
Cognitive Dissonance
Examples:
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I am a smart, strong woman.
I feel worthless and helpless.
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I believe children should feel safe, loved and protected.
I continue to stay with my husband even though he physically abuses
our children.
Domestic Violence
“Intimacy and psychopathology rather then gender
alone generates relationship violence. It is because
of intimacy that straight and gay rates of abuse are
similarly high; the impact of attachment and related
anxieties produce anger and abuse.”
(Dutton, 2005 – derived from RTI “The STOP Program 2011”)
EAP CONSULTANT ROLE
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Risk Assessment
Crisis Intervention
Triage
Supportive “Counseling”
Consultative Role
Psycho-education
Develop Safety Plan
Connect to Resources
Connect to EAP Counselor
Mobilize Support – friends, family, workplace
Advocacy
Follow-up
HARM REDUCTION
“Harm reduction is a set of practical strategies that reduce
negative consequences of drug use, incorporating a
spectrum of strategies from safer use, to managed use to
abstinence.
Harm reduction strategies meet drug users "where they're
at”, addressing conditions of use along with the use
itself.”
(Source: www.harmreduction.org)
HARM REDUCTION
“Redefined in terms of domestic violence, harm reduction
is a set of practical strategies that reduce negative
consequences of certain survival, [defense] and coping
mechanisms survivors use.”
(Adapted from Eminism.org)
Harm Reduction Principles
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Accepts, for better and for worse, that survivors learn to cope in whatever
ways that reduce their pain and increase their sense of control, including
those traditionally viewed as "unhealthy" [or dysfunctional].
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Understands each method of coping as a complex, multi-faceted
phenomenon that encompasses a continuum of behaviors from recklessly
extreme to no action, and acknowledges that some ways of coping are
clearly safer than others.
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Establishes quality of life and well-being--not necessarily cessation of all
activities deemed unhealthy or unsafe--as the criteria for successful
interventions and policies.
Harm Reduction Principles
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Calls for the non-judgmental, non-coercive provision of services and
resources to victims
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Ensures that survivors themselves--both those receiving services
currently and those who have in the past--have a real voice in the
creation of programs and policies designed to serve them.
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Affirms victims as the primary agents of reducing the harms of their
various coping methods as well as the authorities on their own
experiences; empowers victims to share information and support each
other.
Harm Reduction Principles
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Recognizes that the realities of poverty, class, racism, social isolation,
past trauma, discrimination and other social inequalities affect both
victims’ vulnerability to and capacity for effectively dealing with the effects
and aftermath of the abuse.
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Does not attempt to minimize or ignore the real and tragic harm and
danger associated with certain coping methods survivors may employ.
(Adapted from Eminism.org)
WHAT YOU CAN SAY:
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“I am afraid for your safety”
“I’m afraid for the safety of your children”
“It usually only gets worse”
“I’m/We are here for you”
“You don’t deserve to be abused”
“What, if anything, would you like to change?”
“What might be most helpful to you right now?”
“Where are you at with this relationship?”
“What would you like to do?”
DIVERSITY
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Sexual orientation
Race/ethnicity
Religion
Class
Economic status
Social standing
Education
Profession
Disability
Marital status
Parental status
DIVERSITY
Be mindful of issues related to:
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Language
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Access issues
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Appropriateness of Resource Referrals
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Cultural Values specific or unique to the client
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DIVERSITY
Guidelines
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Do not pathologize cultural values or communications styles that may be unique to
the client
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The unspoken question “Do you really understand me?”
(Wexler, 2011)
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Respect diversity issues but do not let this be used as an excuse when assessing
and intervening with clients
(Wexler, 2011)
TRANSFERENCE
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Normal Dynamic
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Therapeutically Valuable
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Keeps us sharp and “in check”
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Remind us to respect individual styles of coping
COUNTER-TRANSFERENCE
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Normal dynamic
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Therapeutically Valuable
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Therapeutically Damaging
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Two-fold process between Self-Awareness
and Self-Care
COUNTER-TRANSFERENCE
SELF-AWARENESS
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Be aware of your own trauma histories
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Examine your own biases and assumptions about DV, victims and
perpetrators
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Examine your own Competency Gaps
COUNTER-TRANSFERENCE
SELF-CARE
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Consult
De-brief
Seek Support
Take a break
Know your threshold and set limits
Do your best then “let go” of the outcome
Set realistic expectations
Personal Self-Care
TAKE-AWAYS:
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No “one size fits all” approach to DV
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Victims and Perpetrators are not an Homogenous group
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There is a Continuum of Violence (Perpetrators)
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There is a Continuum of Responses and Coping Styles (Victims)
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Harm Reduction vs. “Abstinence”
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Stages of Change
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Be mindful of Diversity issues
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Recognize Transference and Counter-transference Dynamics
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Self-Care as a lifestyle
EQUALITY WHEEL
Domestic Violence Intervention Project - Duluth, Minnesota (dvcc.delaware.gov)