Example Of Essay On Domestic And Intimate Partner Violence: Impact, Assessments, And Interventions
Domestic violence is a social ill that knows no boundaries. Worldwide, men and women of all ages, sexual orientations, ethnicities, and social and economic backgrounds are at risk for domestic violence (Garg & Kaur, 2008, p. 73). While many think of domestic violence as a man physically abusing his wife or girlfriend, the true nature of domestic violence (DV), also commonly known as intimate partner violence (IPV), is much broader and more complex. Domestic violence refers to the exertion and misuse of power by one adult over another adult within an intimate relationship, and includes not just the perpetration of occasional or chronic physical violence but also of psychological, social, economic, financial, and/or sexual abuse, and is directly or indirectly perpetrated against not just the partner, but all who live in its shadow, including children (Garg & Kaur, 2008, p. 73).
While there are many commonalities between individual abusive relationships, differing types of abuse occur at varying levels within each relationship. Psychological or emotional abuse includes name calling, belittling, inflicting humiliation, and threatening to harm victim or the victim’s loved ones (Garg & Kaur, 2008, p. 7). Economic abuse includes restricting, controlling, or withholding a victim’s access to income or resources, as well as forbidding them or sabotaging their efforts to gain or maintain employment, and is debilitating to victims of DV/IPV - according to Garg and Kaur, economic dependence is the primary reason female victims remain in abusive relationships (2008, p. 8). Sexual abuse is commonly defined as rape, pressure to perform sex acts the victim is uncomfortable with, and any other unwanted or unwelcome sexual contact, and also occurs frequently within abusive relationships (Garg & Kaur, 2008, p. 7).
Most outside of an abusive relationship, such as friends and family, find it difficult to understand why a victim would stay and subject themselves to ongoing abuse. Well intentioned friends and family members, and even providers untrained in addressing DV/IPV, may encourage the victim to ‘just leave,’ and establish ultimatums or condemn the victim if she fails to do so. In fact, a woman’s risk for serious injury or death at the hands of an abuser is highest when a victim attempts to leave or pursue legal or criminal action against an abuser (Payne & Wermeling, 2009, p. 3) The decision to leave an abusive relationship is not one guided solely by emotion but also by the victim’s calculated assessment of personal risk (Plunkett & Seeley, 2013, p. 15). Criticism or judgment of a victim’s character, strength, or inherent capacity to make appropriate decisions for oneself is detrimental to the recovery of the victim or survivor; these behaviors disempower and discourage the individual, rather than empower and encourage them to take action and safely terminate an abusive relationship (Plunkett & Seeley, 2013, p. 5).
Victims of domestic violence face increased risk of physical injury as well as psychiatric symptoms and disorders such as depression, anxiety, post-traumatic stress disorder (PTSD), self-harm, and suicidal ideation and suicide attempts (Johnson & Zlotnick, 2009, p.2). According to Baker, Boyle, Campbell, Dienemann, Resnick & Wiederhorn, 61% of women diagnosed with major depression reported experiencing DV/IPC at some point, making them twice as likely as the general population to suffer depression (2000). Due to the chronic nature of DV/IPV and the difficulty faced by victims attempting to terminate abusive relationships, PTSD is the most prevalent psychiatric disorder affecting victims and survivors of DV/IPV (Johnson and Zlotnick, 2009, p. 1). Compounding the psychological effects of trauma experienced by survivors of DV/IPV is an increased likelihood that the victim is also experiencing significant stress related to housing and financial instability secondary to the economic abuse perpetrated by the abuser (Johnson and Zlotnick, 2009, p. 3).
While some victims of domestic violence experience a cessation in psychological symptoms once they have removed themselves from the abusive relationship, many survivors suffer ongoing psychiatric symptoms related to the abuse for months or even years following the abuse and require psychiatric and social interventions, especially in the case of those victims experiencing symptoms of PTSD (Rivera, Sullivan, & Warshaw, 2013 (1), p. 2). Due to a lack of routine screening for DV/IPV and failure on the part of many medical and mental health providers to inquire about abuse even if a woman does not voluntarily disclose it, many behaviors exhibited by women who are experiencing ongoing abuse or remain at risk are often pathologized as psychiatric symptoms rather than being recognized as adaptive responses to their situation (Rivera et. al (1), 2013, p. 3). Hypervigilance may serve to keep a victim safer in a volatile and chronically violent home, while psychological numbing and dissociation may be a victim’s effort, conscious or unconscious, at psychological preservation (Rivera et. al, 2013 (1), p. 3). Before diagnosing a victim or survivor of DV/IPV with a psychiatric disorder such as PTSD, it is critical to determine the victim’s actual and perceived safety to ensure that psychiatric symptoms are not in fact a protective or self-preservative response to ongoing abuse or the risk of ongoing abuse (Plunkett & Seeley, 2013, p. 19).
Well-intentioned but inadequately trained providers of medical and mental health services may not only fail to meet the unique needs of victims due to a lack of understanding about the complex nature of DV/IPV, but may even unintentionally disempower victims and re-traumatize them during the course of intervention, leading to frustration, further loss of hope, and high drop-out rates among individuals who direly need support (Plunkett and Seeley, 2013, p. 2). Plunkett and Seeley (2013) gathered anecdotal evidence and case studies from skilled providers of DV/IPV services to identify the seven most common negative experiences victims and survivors report when seeking support within the medical and mental health system. These include (1) a failure to recognize the signs of domestic violence or respond to victim’s sharing of incidents of DV/IPV; (2) failing to assign blame for violence solely on the perpetrator due to (3) a lack of understanding about DV/IPV in general; (4) failure to address victim’s concerns and needs regarding their personal safety; (5) failure to collaborate with other professionals providing support to the victim, despite consent being granted; (6) pressuring the victim into taking steps towards certain outcomes (separation, legal action) against the victim’s better judgment; and (7) a pathologization of the victim’s psychological response to ongoing violence (p. 4-5). The prevalence of these complaints illustrates the need for expansive education and training in appropriate assessment and intervention techniques for those working with victims and survivors of DV/IPV that are sensitive to their needs, fears, and concerns.
There are a number of assessments designed for or tested on victims and survivors of domestic violence. Most of these assessments are considered “risk assessments,” and focus not on the symptoms the victim is experiencing but on gathering information from the victim to determine how dangerous the abuser is, to ensure that victims receive the support necessary to ensure their safety. It is imperative that any psychological assessment include an evaluation of a victim or survivor’s risk of ongoing harm from their abuser to ensure that client-driven safety planning occurs so that the victim or survivor can focus on recovery (AHRQ, 2004, p. 1-4).
The Domestic Violence Survivor Assessment (DVSA) was developed by researchers from Agency for Healthcare Research and Quality (AHRQ), United Family Services of Maryland, and the House of Ruth of Baltimore Maryland to guide interventions as well as improve and measure outcomes for female survivors of DV/IPV (2004, p. 3-4). The DVSA was developed using the Transtheoretical Model of Change and Landenberger’s Theory of Domestic Violence Recovery and measures a woman’s perception of herself within the context of 11 issues identified as common experiences among female survivors of DV/IPV, including five issues related to her relationship with the abuser and six issues concerning her as an individual (AHRQ, 2004, p. 4). By interpreting data gathered during client interviews according to the DVSA matrix, the DVSA enables clinicians to identify the survivor’s readiness to address or resolve each of the 11 issues and can help providers to meet survivors where they are in terms of readiness to leave an abusive relationship and progress towards psychological recovery (AHRQ, 2004, p. 4). According to a study performed by Dienemann, Glass, Hanson and Lunsford (2007), the DVSA is found to be a reliable and valid tool for assessing survivors of DV (p. 921).
The Trauma Symptom Inventory (TSI) is a tool used to assess acute and chronic symptoms of posttraumatic stress, and has been tested on victims of DV/IPV for efficacy. The TSI is a self-assessment checklist that victims or survivors complete which measures an individual's PTSD symptoms across a variety of domains (Briere, 1996) and assists clinicians in assessing the scope and severity of PTSD symptoms.. The TSI has been used by various researchers in the assessment of trauma in female victims of DV/IPV, including Dillworth, Kaysen, Larimer, Resick, Simpson, & Waldrop (2007), who utilized the TSI to measure trauma symptoms among female alcoholic victims of DV/IPV; Dillworth and colleagues cite research from Briere, Elliot, Harris, and Cotman (1995) that validates its efficacy with this population through empirical study (p. 7).
Unlike most DV/IPV assessment and intervention tools, which focus on interrupting the cycle and perpetuation of abuse through the victim or survivor, the Spousal Assault Risk Assessment Guide (SARA) was developed, based on empirical research, to assess the risk and severity of intimate partner violence through interview and evaluation of the perpetrator of the abuse, as well as to guide interventions for abusers (Northcott, 2012, p. 21). The SARA is designed for implementation by mental health clinicians and is used to guide treatment plans and psychosocial intervention strategies for abusers to reduce the risk of reoffending (Northcott, 2012, p. 21). The SARA has been extensively tested, proven to have good validity and reliability, and is currently in use in 15 countries worldwide (Northcott, 2012, p. 21).
According to Hughes and Loring (2000), the underlying priority of interventions aimed at victims and survivors of DV/IPV should be to reconstruct the victim’s sense of self, increase their ability to assess their own level of risk, and empower them to develop the skills needed to seek and secure resources and social support (p. 28). Despite the vast number of men and women who experience DV/IPV annually, there is a lack of empirical, evidence-based interventions available that take into consideration the psychological effects of chronic versus acute violence as well as the myriad of social and economic struggles concurrently faced by women seeking DV/IPV-related services (Hughes & Loring, 2000, p. 28-29). Many interventions designed for those suffering from PTSD are aimed at victims of acute violence or trauma, rather than those exposed to chronic and/or ongoing trauma; because the PTSD symptoms that victims of DV/IPV exhibit are often a manifestation of fear over the threat of ongoing victimization, as opposed to a re-experiencing of past trauma induced by a psychological trigger, intervention techniques originally designed for acute (single event) trauma, such as exposure therapy, have been found to be detrimental rather than beneficial to the recovery of DV/IPV survivors (Johnson & Zlotnick, 2009, p. 3). Many women seeking services for DV/IPV are in community shelters and thus also experiencing a variety of stressors such as housing insecurity, potential loss of parental custody, poverty, and etc. Victims and survivors of DV/IPC who re-experience trauma as a result of exposure therapy may decompensate to a point where they are unable to constructively address these critical issues while in shelter, significantly impairing their ability to focus on full recovery (Johnson & Zlotnick, 2009, p.3).
Helping to Overcome PTSD through Empowerment (HOPE) is a shelter-based cognitive-behavioral therapy (CBT) program developed by researchers in response to a lack of intervention tools appropriate for use with individuals suffering from PTSD secondary to DV/IPV (Johnson & Zlotnick, p. 3). The focus of therapists implementing the HOPE program is to prioritize survivor safety and empower women to develop the skills they need to follow through on their choices, attain their personal goals, and build their capacity to manage ongoing grief and posttraumatic stress symptoms (Rivera et. al (2), 2013, p. 4). HOPE is delivered over the course of 8 weeks and, guided by Herman’s multi-stage model of recovery, helps to guide victims and survivors through three stages of recovery from DV/IPV: “re-establishing safety and self-care; remembering and mourning; and self-connection,” and does not include any exposure-based treatment (Rivera et. al (2), 2013, p. 4). Preliminary studies indicate that HOPE participants were less likely to return to experience abuse within the 6 months following their exit from shelter, and demonstrated decreases in severity of depression symptoms; the greatest shortcoming of the HOPE program is that it is offered in-shelter, and many participants may not be in shelter for the full duration of the program (Rivera et. al (2), 2013, p. 5).
The unique and complex nature of DV/IPV and its psychological effects on victims and survivors are still poorly understood by the medical and mental health community at large. While relevant research into the traumatic experience of victims and survivors has come a long way in recent years, there is significant room for improvement in terms of the availability of empirically sound, evidence-based assessment and intervention techniques. Until those become available, practitioners should continue to make efforts to incorporate trauma-focused principles into their work to ensure the best possible outcomes for those affected by DV/IPV.
Resource List for Victims of DV/IPV
The National Domestic Violence Hotline (thehotline.org) (1-800-799-SAFE): The NDVH is a free hotline available 24 hours a day, 7 days a week, that provides confidential support, crisis intervention, advocacy, and information regarding community services to victims of DV/IPV.
National Coalition Against Domestic Violence (NCADV.org): The NCADV provides links to national DV/IPV hotlines as well as a database of shelter programs, counseling, and support services available through different organizations nationwide.
clicktoempower.org: Clicktoempower.org was created through a partnership between the Allstate Foundation and the National Network to End Domestic Violence, Inc. According to their website, clicktoempower.org offers online financial empowerment curriculum for victims of DV/IPV to “provide victims with the financial knowledge, skills, and resources they need to get safe, stay safe, and thrive.”
Womenslaw.org: “Providing legal information and support to victims of domestic violence and sexual assault.” Womenslaw.org provides access to hundreds of articles educating victims of DV/IPV about abuse, and how to create a personal safety-plan. Womenslaw.rg also contains a wealth of information regarding women’s rights in the legal system, including laws and statutes in place to protect them as well as a database of shelter programs lawyers and legal assistance available by state.
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