Transcript Working With Children Exposed to Family Violence

Personality Factors Associated with
Domestic Abuse:
The Importance of Perspective
Angelique Jenney,
M.S.W.(PhD Candidate)
Director,
Family Violence Services
OVERVIEW OF THE PRESENTATION
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Why is this issue important?
Impact of abuse/trauma on
Interpersonal Relationships Importance of Perspective
Challenges to Practice
Prevalence of Domestic Abuse in the
Population
Domestic Violence:
 29% of women ever married, or living in a common law
relationship have been physically or sexually assaulted by their
intimate partners at some point in their relationship (Statistics
Canada 2000)
 It is estimated that about half a million children are exposed to
domestic violence EVERY YEAR in Canada (Dauvergne, &
Johnson, 2001)
Co-ocurrence of Other Forms of Trauma with Domestic Abuse:
 Experiences of War, Immigration
 Historical childhood abuse (physical, sexual, emotional/neglect)
Why Where You Come From is
Important: History/Context
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The quality of the environment directly influences the
quality of caregiving - which is how we all learn to
modulate stress
This care then ‘influences the development of the brain
and in particular, alters the development of particular
genes (largely responsible for stress/danger response).
“Under conditions of poverty, animals that are most
likely to survive are those who have an exaggerated
stress response”
(Meaney, as cited in Begley, 2007 p.175)
Understanding Individuals who have
Experienced/Perpetrated Domestic Abuse
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Experiences
Thoughts/
Feelings
Behaviours
Needs
Effects of Experiencing Domestic Abuse
and the Impact on Behaviours
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hyper-arousal, numbing of emotions, and avoiding traumatic stimulus
aggression or withdrawal
disruption in sleep patterns, eating, lowered self-esteem, and feelings of
helplessness and hopelessness
Depressive and anxiety disorders
Physical health problems (chronic pain etc. and symptomology with no
apparent biological/physical cause)
Cognitive distortions (making sense of the unthinkable)
patterns of dysfunctional relationships (disorganized attachment/traumatic
bonding) ‘dread to repeat vs need to repeat’
“We inhabit our histories, and our histories inhabit us”
-Angela Davis
Trauma, the Environment and
Development
A Lesson from the natural world…
Nature vs Nurture:
The Case of the Water Flea
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No predator - remains
unarmed
Odor of predator - the
same genetic clone
grows armour - MOVE
that one to the nopredator aquarium armour recedes!
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Female water flea who
has been exposed and
then placed in predatorfree zone - lays eggs offspring are fully
armoured
Nature vs Nuture:
The Case of the Lab Rat
Handled vs Unhandled
 More exploratory
 Less fearful
 Less reactive to stress when
adults
The reason? Handling increased
Maternal Licking Behaviours!
High Lickers:
 Mellow, well-adjusted rodenthood
 Grew up to be HLs
Low Lickers:
 Fearful, stressed-out
 Grew up to be LLs
Switch them up? LLs HLs
HLs  LLs
Oh The Possibilities!
Ironically….
Survival of the fittest
(or most stressed out in this case)
 Stress hormones offer a certain amount of protection in
threatening environments - not all behaviours are
maladaptive (e.g. hyper-vigilance could be protective)
 Problems begin when stress response is prolonged
without a break (not just in our clients - ourselves)
 Homeostasis (body resilience)
Caution: People Are More Complex
Than Rats (thank goodness!)
Opportunities for conditions to be
mediated by social supports.
Trauma and the Brain:
the science behind behaviours
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Experience changes the brain
Trauma is encoded in the language in which it occurs
What fires together - wires together (understanding the power to
repeat)
Different parts of the brain process emotion - in words and feelings
- if that process is separated - problematic (this is what EMDR
attempts to address)
Memory is an interpersonal process
Insight doesn’t necessarily lead to change
Trauma and the Brain:
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Direct connection between trauma, prolonged
stress response, and resulting disrupted
neurodevelopment….
Leading to social, emotional and cognitive
problems….
Which may then lead to ..health risk
behaviours (smoking, substance abuse
etc.)…difficulties with affect regulation and
subsequently relationships.
Discourse around Trauma
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Mind Over Matter sends the message that your mind
doesn’t matter to me….
A Hidden Injury - not hidden for those living with it
What may be seen as a problem, bad habit, or selfdestructive behaviour may actually be a coping
mechanism or adopted solution for an unknown
traumatic life experience
Never assume that the trauma you are intervening with
is the most influential event in the person’s life
Our expectations should not do harm to families
Challenges to Recovery
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Inability to make connection between symptoms and
previous experiences (actions/behaviours) - so change
is problematic!
Unwillingness/inability to talk about or remember
traumatic experiences
Getting worse before getting better is not that
attractive!
Feeling defensive/protective of family - potential that
victimization is ongoing
(adapted from Perry, 2003)
Maintaining focus of intervention
within context of abuse/trauma
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Recognition of the issues, needs and expectations of
the patient-doctor relationship
Reality checking and grounding in the present
Recognition of strengths and limitations of both doctor
and patient
Recognizing and responding to evocative emotions
Helping patients access resources/material supports to
meet tangible needs
Using skills in engagement as well as goal setting
REPEAT, REPEAT, REPEAT (this issue took years to become
entrenched, we must think about longer term intervention)
VOLUNTEERS???
Importance of Perspective
Appreciating/managing diversity:
 cultural differences in the expression of emotion
 Differences in thoughts/beliefs about relationships
particularly about marriage, parenting and child
development
 recognizing, surviving and working through
miscommunication
Recognizing Diversity
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Individual differences contribute to the human
experience - including the likelihood of getting
the full benefit of community resources
Stresses inherent in poverty bring out
personality differences and accentuate their
implications for receptivity to helping
relationships
Individual differences tend to be especially
apparent under conditions of difficulty.
How do people manage trauma?
Engagement and the Importance of
Relationships
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Quality of personal relationship or working alliance
between doctor and patient is central to engagement
levels
Client’s relationship history may affect his or her ability
to engage effectively
Personality is linked to the quality of individual’s
interpersonal experiences and expectations
strong relational base will be protective factor in the
event of difficult decision making (challenging risk
behaviours and reporting to authorities)
Acts of Resistance or Survival?
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Challenging the legitimacy of professional claims or
expertise
Non-compliance with physician’s direction
Concealing practices such as contact with abuser
(possibly to present herself as compliant)
Actively avoiding services
Ambiguity between wanting help and resisting scrutiny
(McIntosh, 1987; Bloor & McIntosh, 1990)
Engagement:
Finding the Connections
The need for empathic connection - the only way to get
through difficult areas - find a way to understand and care
Build on:
 Use the knowledge base of child development and
infant research: (attunement, joining, yielding, tracking)
 Harm Reduction Compromise (e.g. leaving may be more
frightening than staying; so support staying with a solid safety
plan)
What You Can Do:
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Have posters/pamphlets (educational/service related)
about domestic violence in your waiting room (research
shows it increases patient comfort with disclosure (Ahmad, 2009)
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Know the people in your neighbourhood (pass the baton)
Never underestimate the power of listening and
acceptance (change takes time; you want them to keep telling you)
Intervene when you must (child welfare, police)
Follow-Up (the last time I saw you…how are things now?)
Keep it in perspective (windows of opportunity)
What to Avoid:
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Assuming patients will get the help they need from
someone/somewhere else (health care providers are often
the first point of contact and sometimes the only point)
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Prescribe a bitter pill (if you know they won’t take it)
Not having a back up plan (These patients WILL catch you off
guard - consider it like any other medical issue - suggest a follow up visit)
If all else fails:
“I’m glad you told me”
Key Provincial Resources:
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Assaulted Women’s Helpline (24 hr crisis line)
Toronto:
416.863.0511
Toll-Free: 1.866.863.0511
http://www.awhl.org/
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Shelternet (access to shelters and on-line safety plan)
http://www.shelternet.ca/en/
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Kids HelpPhone (24 hr crisis line)
1-800-668-6868
http://www.kidshelpphone.ca/
LANDSCAPES EXERCISE
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WHICH OF THE FOLLOWING LANDSCAPES
DO YOU PREFER?
How Important You Are
A Final Note:
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Research shows that the most high-risk
individuals in regards to domestic abuse particularly men and women who later become
involved in domestic homicides have only one
common intervention entry point:
The Healthcare System.