Practice Guidelines: Partner Violence

What is Intimate Partner/Domestic Violence?

Although legal definitions vary by state, intimate partner violence, or domestic violence, may include physical assault (e.g., kicking, punching, restraining), sexual assault (e.g., forced sexual activity, physical assault during sexual activity), and/or emotional abuse (e.g., verbal abuse, isolation, threats, intimidation). In addition to engaging in abusive behavior toward the partner, perpetrators of domestic violence may also abuse the children in the home, or use them to further torment the victim (e.g., threaten to hurt the children if the victim does not comply with some demand, force the children to hurt the victim).

Contributed by

Joanne Davis, Ph.D.
and
Ernestine Briggs, Ph.D.

National Crime Victims Research and Treatment Center, MUSC


What is Intimate Partner/Domestic Violence?
How Common is Intimate Partner/Domestic Violence?

Intervention
Crisis Intervention
Documentation
Assess Emotional/Psychological Functioning
Individul Treatment
Referrals
Ethical Issues
References
How Common is Intimate Partner/Domestic Violence?

According to the 1996 Bureau of Justice Statistics (BJS), women were the victims of approximately 840,000 violent crimes perpetrated by intimates. In the BJS report, violent crimes include murders, rapes, robberies, or assaults committed by spouses, ex-spouses, boyfriends, or girlfriends. Women are at significantly greater risk for violence by an intimate. In fact, women were the victims of 3 out of every 4 murders and 85% of nonlethal violent crimes perpetrated by an intimate. Men are more likely to be victimized by strangers or acquaintances than by intimate partners or family members (Bachman, 1994).

Intervention


The information provided below is intended to be a basic guideline of treatment strategies to use and issues to consider when working with victims of domestic violence. The guidelines are organized into two sections. The first section focuses on crisis intervention and includes guidelines for assisting victims in need of immediate assistance, either because a violent incident has just occurred or because a situation is escalating. The second section focuses on treating the psychological effects of experiencing a traumatic event.

Crisis Intervention
Safety planning: General safety strategies
The first issue to consider when working with victims of domestic violence is the safety of the victim and, if appropriate, the safety of the children. A popular method to use is the personalized safety plan. Safety plans may be verbal agreements or a written plan (Hart, & Stuehling, 1992), personalized to fit your client. With either method, it is important to discuss general safety skills, strategies to use during a violent encounter, and those to use as the client prepares to leave her/his partner. Once established, it is important to review the safety plan regularly in case of changes in the client’s circumstances and to help her remember these important steps. As appropriate, the worker can also help the client modify the plan to for use in the workplace and in school.

Individuals should have a list of important phone numbers with them at all times, as well as change for phone calls. Some important numbers include: police department, domestic violence hotline, domestic violence shelters, schools, friends, and family. They can also make a list of important things to take with them if they decide to leave their partner. These items may include: identification papers, birth certificates, bank books, credit cards, medical records, social security cards, medications, and other important papers. These documents should be kept together in a location that can be quickly and easily accessed. Many police departments have victim advocates who may be a source of support and information regarding legal issues and/or resources in the community. The individual may want to contact a victim advocate to assist in her safety planning. Understanding the cues of an escalating dangerous situation is very important (Dutton, 1992). It is important for any person working with the victim to provide information regarding cues to look for in her/his situation or partners’ behavior. Safety planning: Preparing to escape a violent encounter As the situation during a violent encounter is likely to be chaotic and emotionally charged, it is important that the client prepare strategies in advance to help her escape the situation. Just as we instruct children on escape routes from the home in case of a fire, the client would benefit from identifying all possible avenues of escape from her residence and practice using these routes. Escape routes may be particularly important to review and practice with children. Car keys and the client’s purse should always be placed where they can be quickly located. Children should know how to dial emergency numbers and provide their address. Clients need a safe place to go if they have to leave the house. This may be the residence of a family member, friend, domestic violence shelter, hotel, or police station. The victim may want to leave extra clothes for her/himself and the children in case they need to escape quickly. She/he may want to establish a signal or code word or phrase to be used to alert neighbors or children the need to initiate the safety plan (Hamby, 1998). The most important part of preparing to leave a violent situation is to plan ahead and establish an explicit plan of where to go and how to get there. Safety planning: Preparing to leave the offender Leaving a violent partner is often the most dangerous period in the relationship. If the individual decides to leave the relationship, it is important that she carefully plan the steps to take. Workers can provide information regarding the increased risk to women when they attempt to leave their partner and help them to problem-solve and plan for this event. If they have an established safety plan, much of the preparation will already be done, including putting money, extra sets of keys, extra clothes for her/himself and the children, and important documents in a safe place. This may be with a trusted friend or family member. Opening their own bank account, if possible, will be of assistance should they need to stay away from their residence for a period of time. They should know the steps to take to get a restraining order or order of protection. Further, they may want to inform the police of the situation and their plans to leave. Safety planning: Safety in the victims’ residenceAdditional safety strategies are necessary when the client has successfully left the relationship and secured her/his own residence. Hart and Stuehling (1992) suggest changing locks, installing security systems, purchasing rope ladders & smoke detectors, informing local police about standing protection orders, and making sure teachers, neighbors and friends know who has permission to pick up the children.

Documentation

In preparation for the possibility that charges are brought against the offender, it is important to have a paper trail documenting the abuse. Not only is this important for the victim to do, but also those individuals working with her/him. Things to include in your documentation include: The nature and circumstances of the assault(s)
Location, nature, and severity of any physical injuries (mental health professionals should assist the client with scheduling an appointment with a physician)
Property damage
History of the relationship and violence in the relationship (the history should include the first incident, the most recent incident, and the most severe incident)
The individual’s functioning and response following previous assaults (if appropriate)
Abuse of children in the home (of course, if it is discovered that children in the home have been abused, a report to Child Protective Services will have to be made) Assess Emotional/Psychological Functioning

During a time of crisis, a comprehensive assessment is vital to ensure the client receives appropriate services and referrals and, if necessary, immediate intervention. Areas to assess include: Mental status
Suicidality
Homicidality
Current risk for violence
Treatment history
Trauma history
Symptoms of common post-trauma difficulties including depression, anxiety, posttraumatic stress disorder, panic disorder, and substance use. Social support may be critical to assist the individual in coping with the violent relationship and its ramifications, thus it may be helpful to identify the clients’ social resources including family, friends, colleagues, religious/spiritual groups and activities.

A few assessment tools have been developed to assess for violence in relationships. As listed in Kantor and Jasinski (1998): Conflict Tactics Scale (Straus, 1990)
Revised Conflict Tactics Scale (Straus & Hamby, 1996)
Abusive Behavior Inventory (Sheppard & Campbell, 1992)
Aggression Scale (Snyder & Snow, 1995)
Danger Assessment Instrument (Campbell, 1995)
Spouse Specific Aggression Scale (O’Leary & Curley, 1986). Individul Treatment

Treatment intervention with victims of domestic violence should include psychoeducation on the dynamics of and risk factors for violent relationships. Information is typically provided on (Walker, 1994): The cycle of violence (e.g., the honeymoon phase, growing tension, explosion of violence; escalation in the severity and frequency of violence over time) with the caveat that not all relationships demonstrate the same patterns of violence
Use of power and control in abusive dating relationships (e.g., isolation, jealousy and possessiveness)
Characteristics of batterers
Myths about domestic violence
Common psychological and emotional sequelae of experiencing a traumatic event Identifying, challenging, and altering distorted cognitions and beliefs may be beneficial in treatment with DV clients. Douglas and Strom (1988, cited in Webb, 1992) identified three categories of distorted beliefs that abused women often develop. Prior beliefs that may have increased the client’s vulnerability to becoming involved with an abusive partner (i.e., women are inferior to men)
Beliefs that develop through the abusive experiences (i.e., he wouldn’t hit me if I were a better partner)
Beliefs that result from the aftermath of the violence (i.e., I’m a wreck - I can’t make it on my own) Many domestic violence clients may benefit from skills training. Due to their experience in a violent relationship, they may have developed ways of relating with others that minimize conflict, and may not be in the best interest of the client. Skill acquisition may include assertiveness training, communication skills, decision making, and problem solving skills.

Depending upon the results of the evaluation, other treatments may be integrated into the treatment plan to target specific symptoms including depression and posttraumatic stress disorder.

Group therapy and couples therapy may be alternatives to or adjuncts with individual therapy. Group therapy may be helpful in ameliorating feelings of guilt and shame, practicing social skills, developing trust in others. The type of groups offered may range from support groups to trauma-focused treatment groups.

Unfortunately, the efficacy of treatments designed for victims of domestic violence is essentially unknown (Kantor & Jasinski, 1998). Very few outcome studies have been conducted using domestic violence victims as participants. A great need exists for more case studies, group designs, and longitudinal investigations to determine whether the interventions being administered are appropriate and effective in increasing safety and decreasing post-trauma symptoms.

Referrals

At the onset of treatment and throughout the course of treatment, it is important that the worker assess the need to refer the client to other providers for additional assistance. Possible referral sources include: Local domestic violence center
Family physician
Law enforcement agencies
Legal assistance
Victim assistance programs and organizations
Support groups
Therapist to assess children’s need for treatment or services Ethical Issues

Clinicians and researchers working with victims of domestic violence and their children must be prepared to address several ethical dilemmas that are becoming more common as reporting laws and policies continue to evolve. The duty to report, for example, poses a particular challenge to workers assessing child abuse within this population. Although reporting laws vary considerably, clinicians and researchers should be aware of the limitations of confidentiality and the local statutes governing their duty to report (Azar, 1992). In some jurisdictions, for example, researchers may be exempt from the duty to report.

Maltreatment definitions may also vary by location, for example, in some jurisdictions exposing children to domestic violence is considered a form of emotional abuse. Other jurisdictions may pursue a finding for failure to protect. Although providing a safe environment for the child is of primary importance, practitioners should be aware of the complex array of issues that the child victim (e.g., disclosure of maltreatment, removal from the home), adult victim (e.g., separation/divorce, financial difficulties, limited ability to trust others), and worker may have to negotiate (breaking confidentiality, impediments to building rapport). In sum, practitioners that may uncover disclosures of maltreatment need to be prepared to respond professionally and ethically.

References

Azar, S.T. (1992). Legal issues in the assessment of family violence involving children. In R.T. Ammerman, Hersen, M., et al. (Eds.), Assessment of family violence: A clinical and legal sourcebook (pp. 47-70). New York, NY: John Wiley & Sons.

Bachmann, R., & Saltzman, L.E. (1994). Violence against women: A national crime victimization survey report (No. NCJ 154348). Washington, DC: U.S. Department of Justice.

Campbell, J.C. (1995). Prediction of homicide of and by women. In J.C. Campbell (Ed.), Assessing dangerousness: Violence by sexual offenders, batterers, and child abusers (pp. 96-113). Thousand Oaks, CA: Sage.

Dutton, M.A. (1992). Empowering and healing the battered woman: A model for assessment and intervention. New York: Springer.

Hamby, S.L. (1998). Partner violence: Prevention and intervention. In J.L. Jasinski & L.M. Williams (Eds.), Partner violence: A comprehensive review of 20 years of research (210-258). Thousand Oaks, CA: Sage Publications, Inc.

Hart, B., & Stuehling, J. (1992), Personalized Safety Plan, Pennsylvania Coalition Against Domestic Violence (PCADV), 524 McKnight Street, Reading, PA 19601. Available online: http://www.mincava.umn.edu/hart/persona.htm

Kantor, G.K., & Jasinski, J.L. (1998). Dynamics and risk factors in partner violence. In J.L. Jasinski & L.M. Williams (Eds.), Partner violence: A comprehensive review of 20 years of research (1-43). Thousand Oaks, CA: Sage Publications, Inc.

O’Leary, K.D., & Curley, A.D. (1986). Assertion and family violence: Correlates of abuse. Journal of Marital and Family Therapy, 12, 281-289.

Sheppard, M.E., & Campbell, J.A. (1992). The Abusive Behavior Inventory: A measure of psychological and physical abuse. Journal of Interpersonal Violence, 7, 291-305.

Snyder, D.K., & Snow, A. (1995). Evaluating couples’ aggression in marital therapy. Paper presented at a meeting of the American Psychological Association, New York.

Straus, M.A. (1990). New scoring methods for violence and new norms for the Conflict Tactics Scales. In M.A. Straus & R.J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in

8, 145 families (Appendix B, pp. 535-559). New Brunswick, NJ: Transaction.

Straus, M.A., Hamby, S.L., Sugarman, D.B., & Boney-McCoy, S. (1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17 (3), 283-316.

Walker, L.E.A. (1994). Abused women and survivor therapy. Washington, DC: American Psychological Association.

Webb, W. (1992). Treatment issues and cognitive behavior techniques with battered women. Journal of Family Violence, 7 (3), 205-217.



This paper was authored by Joanne Davis, Ph.D. & Ernestine Briggs, Ph.D.
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