Diverse Faces of Domestic Violence, Research Paper Example

Intimate partner violence is associated with a plethora of ills, ranging from negative socioeconomic outcomes to PTSD and depression, amongst others. Professional and institutional responses to intimate partner violence encompass much-needed material, financial, and psychological support, from domestic violence shelters for battered women to therapeutic counseling, and much else besides. There are many issues and barriers in the field of domestic violence prevention and treatment for survivors, and helping professionals in a wide range of disciplines must be aware of specific issues as well as general issues. Professional responses to intimate partner violence encompass a wide range of institutions and capacities, but all have an important part to play in helping victims to rebuild their lives and find new ways of empowered, positive, healthful living.

A sound place to begin is with the question of identifying victims of intimate partner violence. This question is indeed seminal to much of the following work, and to our enterprise here, inasmuch as it encapsulates that central problem, obtaining in so many cases of intimate partner violence: the unwillingness of the victim to speak out. It is for this reason, as Spangaro, Zwi, Poulos, and Man (2010) explained, that screening for signs of intimate partner violence is of such great importance in the clinical setting of health services (pp. 671-672). Health services provide a context in which intimate partner violence can be identified, but—more is the pity—so often goes unidentified (pp. 671-672). Indeed, some 20% of women who have been victimized by intimate partner violence disclose it to precisely no one (p. 672). And yet, the literature indicates that of those women murdered by their partners, many, a great many, “have used health services in the 12 months prior to death” (p. 671).

Clearly, there is a missed opportunity here. In the context in question, in New South Wales, the effort was made to implement a questions-based screening, containing items that ask women to disclose incidents of intimate partner violence; information about domestic violence was also supplied (Spangaro et al., 2010, p. 672). And the findings were revealing: as the authors explained, “the final sample size was 122 women who screened positive and 241 who screened negative” (pp. 674-675). And of the 120 who screened positive for intimate partner violence, some fifty-six per cent (67) gave attestation that in truth, “this was the first time they had been asked at a health service about being hurt by a partner” (p. 675). And a full 23% of the positive-screened group actually reported that in fact, “the screening was the first time they had told anyone about being hurt by their partner” (p. 675). What this indicates, clearly and unequivocally, is a very great need for professional, institutional responses to be active in helping victims of intimate partner violence from detection onward. It is not enough for professional, institutional responses to be active once victims are identified: helping professionals must be actively engaged in helping to identify victims of intimate partner violence, breaking the silence.

The correlation between domestic violence, particularly intimate partner violence, and all manner of physical and social ills is well-attested: in addition to health consequences that might readily be described as “acute and chronic”, intimate partner violence is associated quite often with high incidences of “poverty, unemployment, housing instability, and homelessness” (Eisenman et al., 2009, p. 112). Indeed, the social needs of the victims of intimate partner violence are often intertwined with their legal needs and with their health needs, making the provision of services for health and safety of the greatest and most paramount concern for helping them (p. 112).

There are, of course, some populations that are especially at risk: women, and Latina women in particular, especially during pregnancy and in the course of the perinatal period (Eisenman et al., 2009, pp. 111-112). Language barriers and, at least in some cases, immigration status, are both significant concerns with the Latino population, in addition to more ecumenical risk factors such as low income, unemployment and other signal characteristics of low socioeconomic status (pp. 112-113). Accordingly, the participants in the study by Eisenman et al. were “predominantly foreign born (76.2%) and unemployed (55.6%)” as well as having earned “less than $20,000 in the past year (60.6%)” (p. 115).

What Eisenman et al. (2009) found was of significant interest for understanding which social and legal services are needed by victims of intimate partner violence. In particular, women who had recently experienced intimate partner violence reported a desire for legal services, certainly a greater need than women who had not experienced intimate partner violence (p. 115). Similarly, there was a greater need for social services amongst the victims of intimate partner violence as well (p. 115). Immigration assistance, job assistance, and other social and legal services were all requested by women who had experienced intimate partner violence at higher rates than their counterparts who had not experienced such abuse (pp. 116-118). What this indicates is a very real need to maintain foundational links between clinics providing services to victims of intimate partner violence, and agencies providing community services of a social and/or legal nature (p. 118).

Ethnicity and “race” are far more significant to intimate partner violence than one might think: as Próspero and Kim (2009) explained, cultural differences affect the willingness of people in general to seek help for any given issue, to say nothing of victims of intimate partner violence seeking help for their situations (p. 78). The literature indicates a certain predilection of African-Americans to avoid asking for help on the basis of the stigma of doing so, as well as a greater reliance on spiritual and religious approaches than their European-American counterparts (p. 78). The literature also indicates a tendency of Asian Americans to be quite reserved about seeking mental health services of any kind, and to be quite reserved on the subject of any form of mental distress (p. 79).

Unsurprisingly, then, Próspero and Kim (2009) found that intimate partner violence and other kinds of coercion were correlated with higher levels of mental health symptoms according to racial/ethnic grouping (p. 81). The interesting thing, however, was the following: “the correlations between coercion and mental health symptoms were stronger among the minority respondents” (p. 81). What the authors found was that in fact, minority (non-white) participants who reported having used mental health services were more likely to have experienced intimate partner violence victimization, and higher levels of coercion in such victimization (p. 82). Thus, the ramifications of this study are not hard to see: in order to better serve the needs of a diverse clientele, it is essential for professionals to exercise cultural sensitivity, and tailor their responses to their clients according to culture-specific standards of correct behavior. By learning to recognize the different ways in which different groups ask for help or avoid doing so, professionals can further their own potential to help (pp. 86-87).

In a similar vein, Anderson and Aviles (2006) explained that accessing mental health services can be especially difficult for non-white women/women of color (pp. 129-130). Racial discrimination is still a reality for women of color, as with men of color, and in the context of intimate partner violence it is one that affects the degree to which therapists are likely to treat their presenting case as legitimate (p. 130). As the authors explained: “Often, violence against Black women is not considered as serious as the violence committed against White victims”, which makes it all the more difficult for African-American women to disclose incidences of domestic violence (p. 130).

Stereotypes about the Black community which paint it as a particularly violent cross-section of American society, together with distrust of institutions accumulated through long and bitter experience, all contribute to make it especially difficult for African-American women to have their voices heard and gainsay justice and empowerment in order to make new lives for themselves (Anderson & Aviles, 2006, p. 130). Unsurprisingly, then, for African-American and Hispanic American women who have been the victims of intimate partner violence, finding institutional services that are culturally appropriate is often an especial challenge (p. 131). Indeed, institutions are often geared towards middle-class, European-American women who are not immigrants (p. 131).

For the helping professional, the best remedy is due diligence: health professionals, such as physicians and other practitioners, need to be alert and aware of signs of intimate partner violence, and of culture-specific communication standards and issues (Anderson & Aviles, 2006, p. 131). From there, professionals can play an integral role in supplying important information in order to help women who have been the victims of intimate partner violence access much-needed resources. To a considerable degree, barriers of culture and (where applicable) language can be overcome with the right knowledge and awareness (p. 131).

According to Harding and Helweg-Larsen (2009), a key predictor of the re-occurrence of intimate partner violence is the perceptions of the victim (p. 76). In fact, the literature indicates that “women’s perceptions of likelihood of future violence” are even more accurate than “risk factors alone and as well as two risk assessment instruments” (p. 76). Because of this, it is important to answer the following two questions: firstly, does the ability to accurately predict abuse correlate with an intent to leave the abusive partner? And secondly, how can this information be used to better the cause of interventions to help victims of intimate partner violence? (pp. 75-77).

What Harding and Helweg-Larsen (2009) found was that first of all, 37 of the women in the study (66.1%) had left their abusers previously, and thus had prior experience staying at a shelter (pp. 80-81). These more experienced women portrayed the prospect of continuing the relationship with their abusers as a greater risk than did the women for whom this was their first stay in a shelter (p. 81). Those women who had called the police “at least once in the past year due to a violent episode” also reported higher levels of perceived risk in continuing their relationships with their abusers (p. 81). Severe sexual coercion was another predictor of these perceptions, though not other measures of coercion (p. 82).

Harding and Helweg-Larsen (2009) also established that women who viewed the prospect of continuing their relationships as more risky were less likely to do so: in other words, women who viewed their abusers as more dangerous were more likely to seek to avoid harm by ending the relationship (p. 82). This is indeed a significant finding, one that casts light upon the first question asked above. As regards the second question, the findings suggest some significant ramifications for policy and interventions: inasmuch as women who perceive their abusers as particularly dangerous are more likely to leave them, perhaps professionals should focus on helping victims of intimate partner violence to understand the true dangers that abusive partners can pose, where necessary (pp. 82-83).

The first major professional, institutional response to intimate partner violence was the women’s shelter movement, which grew out of the broader women’s movement dating back to the latter half of the 19^th century (Barner & Carey, 2011, p. 236). From the 1960s on, the women’s shelter movement was able to successfully implement the creation of shelters to help victims of intimate partner violence (p. 236). This movement has continued to grow, and remains one of the most important sources of aid for women, in particular, who have suffered intimate partner violence (pp. 236-237).

In the 1980s, the societal, cultural and political push to oppose intimate partner violence extended to attempting to reform the perpetrators of domestic violence with the Duluth model, of the Duluth Domestic Abuse Intervention Project (DAIP) (Barner & Carey, 2011, p. 237). The great advantage of the Duluth model was its multi-institutional character: the ways in which it drew upon the capacities of different agencies, from law enforcement and criminal justice to the domestic violence shelters and the human service agencies (p. 237). The essential framework here is the idea that the problem with perpetrators is that they subscribe to patriarchal and violent thinking, which can be addressed and changed with the proper therapy (p. 237). The Duluth model has been criticized for its overly-ideological and idealistic approach, particularly in light of the well-known tendencies of some batterers to simply lie and feign sincere change in order to placate the authorities, and the tendencies of others to simply grow more defiant. In any event, though it is an interesting landmark in the history of institutional, professional responses to domestic violence, since the Duluth model is focused on the perpetrators it is of less relevance to our purposes here.

Shelters for battered women remain a very important strategy for providing assistance to victims of intimate partner violence, perhaps the single most important: they serve as effective safe-houses and hiding places for women who are fleeing abusive partners (Haj-Yahia & Cohen, 2009, p. 95). Domestic violence shelters provide a number of different types of services to victims of domestic violence, ranging from their function as safe-houses to enrichment programs that can facilitate survivors’ attempts to rebuild their lives and seek fresh options beyond the abusive situations they have escaped from (p. 95). Shelters have also been described as laboratories for social change: preparing women to overcome their pasts in a more egalitarian, democratic framework (p. 96).

From the above, it follows quite naturally that the experience of women who have survived intimate partner violence and spent time in shelters is of considerable interest in evaluating the efficacy and impact of shelters (Haj-Yahia & Cohen, 2009, p. 96). Although some literature has found many positive impacts of shelter life for women who are survivors of intimate partner violence, including substantial empowerment and self-esteem effects, it is also true that the literature has evinced certain tensions between social workers and the women at the shelters (p. 96). More specifically, the performance of certain tasks by social works has been implicated as a significant source of disappointment for women at the shelters. Conversely and concomitantly, the social workers have their own share of disappointments in the women who stay at the shelters (p. 96).

What Haj-Yahia and Cohen (2009) found was that the women saw the shelter as a “total institution”: they found it a coercive environment, one that forced them into a position of dependence upon each other, while binding them with an assortment of “rules, regulations, and obligations”, all under the supervision of the staff personnel (p. 98). Privacy was a key concern, inasmuch as all of the women had to share facilities, in addition to receiving intensive care from the staff (p. 98). Moreover, in the setting of the shelter, the women reported that they had no sense of privacy, since they were in a therapeutic, communal institution (p. 98).

However, the impressions were hardly all negative: in fact, they were more mixed (Haj-Yahia & Cohen, 2009, p. 99). For example, one resident found the rules, regulations, and prohibitions easy enough to abide by, indeed almost trifling, and the experience of the shelter she found quite empowering and stimulating (p. 99). For this resident, the shelter was, quite literally, “a panacea for her problems” (p. 99). Nor was she alone, for another resident described the shelter in similar terms: encouraging, even familial, and with duties that were clear and not at all onerous (p. 99). However, many other residents were far more ambivalent, finding the rules coercive, the conditions crowded and noisy, and the lack of privacy burdensome at least (p. 99). For one woman who was a survivor of rape, the cleanliness inspections of her room were an unwelcome invasion of her privacy, even a triggering event (p. 99). Another woman likened the shelter to “a closed boarding house, a school, or a jail”, with a hierarchy and an authoritarian style of management (p. 99).

Accessibility is a major concern for the efficacy of domestic violence agencies in helping the victims of intimate partner violence. A key part of accessibility, of course, is geography. As Hetling and Zhang (2010) explained, much of the literature indicates that there is a complex relationship between poverty and domestic violence, indicating a more significant need for domestic violence agencies to have a presence in rural areas (p. 1144). This relationship between poverty and domestic violence is complex, but it is still significant (p. 1144). Poverty may serve as a risk factor for intimate partner violence, inasmuch as women of lower socioeconomic status, in particular, are often more disadvantaged in terms of economic options and social support networks (p. 1144). For other women, intimate partner violence may lead to an impoverished socioeconomic situation, inasmuch as some women who escape situations of intimate partner violence are left without recourse to alternate financial resources (p. 1145).

In light of all of this, the importance of domestic violence shelters, psychotherapeutic counseling, and public monetary assistance becomes the more manifest (Hetling & Zhang, 2010, p. 1145). Survivors of intimate partner violence often depend on these services to help them make the transition to a new life, free of the abusive influence of their former relationships. Of course, this is why accessibility is so important, since survivors of intimate partner violence need to be able to access the agencies in question geographically (p. 1145). The services in question range from emergency shelters, first founded in the 1970s on a wave of grassroots activism in favor of providing aid and assistance to female victims of intimate partner violence and to their children, with a cardinal emphasis on immediate safety (p. 1147). Over the course of forty years, the movement for providing social services to intimate partner violence survivors has broadened its aims with the model of empowering the victims in order to help them become survivors, even as the movement itself has gained capacity and professional centralization and organization in an institutional context (p. 1147).

Accordingly, Hetling and Zhang (2010) investigated not only the connection between poverty and intimate partner violence, but also the issues of spatial proximity of domestic violence programs to areas wherein incidents of intimate partner violence occurred (p. 1145). First of all, they found a correlation between poverty and intimate partner violence, particularly in the more urban parts of the state in which they did their research, Connecticut (p. 1153). The authors also found a correlation between the particular cities and towns wherein domestic violence agencies were located, and higher rates of “general crime, domestic violence incidence, and domestic violence assaults” (p. 1155). These findings demonstrate two important things: firstly, that poverty is indeed correlated with intimate partner violence, and secondly, they demonstrate the importance of correlating the spatial placement of domestic violence agencies with those areas that are most needful of their services (p. 1157).

Significant problems with accessibility of services and resources can be ameliorated through the use of information technology, particularly the internet (Westbrook, 2007, p. 420). This information support can provide a crucial link to much-needed information on services, particularly in settings such as public libraries (p. 421). Public libraries can serve as important hubs and dispensaries of information, connecting victims of intimate partner violence to the outside world, particularly those agencies that might be able to help them (p. 423). The study itself involved emailing requests for information to librarians, on the behalf of fictional women (p. 424). Specifically, the researchers asked the librarians to supply them with an email address and a phone number “for a local safe house for battered women” (p. 424).

As Westbrook (2007) explained, there are indications that much progress remains to be made (p. 424). Out of 151 libraries, a full 28% had an automatic, immediate confirmation of the message’s receipt, while some 58% did not acknowledge it at all (p. 424). The other libraries either “acknowledged later in the day or a delivery failure notice was received” (p. 424). The bigger question, of course, was whether or not the libraries sent an answer to the question asked of them by the researchers. In all, 27 out of the 151 libraries sent no answer to the question at all (p. 424). In all, some 124 did reply, and the results were relatively encouraging here: a rapid response rate, with 50 libraries answering the message that very day and 62 answering the message on the next day (p. 424).

The information the libraries provided was of mixed character and quality: a mere two of the 124 responding libraries provided both a phone number and an email address; however, a full 74% of the libraries “did provide at least two means of contact” (Westbrook, 2007, p. 425). Some librarians overlooked the fact that the request was for an email address, and responded by explaining that they could not release a physical address for a safe house (p. 425). All in all, the findings of this study readily indicate both a great deal of good, and a great deal that needs to be improved in the responses of public library staff to requests for information on domestic violence shelters. However, the study also confirmed the essential importance of public libraries as signal providers of knowledge to victims of intimate partner violence, important hubs of information that can play a critical role in helping victims of intimate partner violence to rebuild their lives, away from abusive partners (pp. 425-426).

Another possibility for using information technology to provide important services to the victims of intimate partner violence is the “telehealth” approach: the use of telecommunication technology to provide victims of intimate partner violence with advanced practice nursing services (Mattson, Shearer, & Long, 2002, p. 466). This approach was recommended in the context of endeavors to serve individuals living in urban areas who might not be able to access such services by other, more traditional means (p. 466). In this context, the participants were women living in domestic violence shelters in Maricopa County, Arizona, in a context wherein the logistics of providing advanced practice nursing services were becoming increasingly unfeasible (p. 466).

The approach proved to be popular with the participants, and very successful (Mattson et al., 2002, p. 467). The participants had positive experiences with, and impressions of, nurse practitioners (NPs). Many were not internet-savvy, but they proved willing enough to learn with instructions and guidance (p. 467). In particular, the interventions were identified as an effective way to help the victims to deal with physical and psychological stress as a direct result of their situation and circumstances (p. 468). The model was found to be quite feasible, particularly with proper training of the participants to use the computers and the internet in order to communicate with their nurse practitioners (p. 468).

For benefits workers, those social workers who seek above all to minister to the needs of victims of intimate partner violence, training is of the most essential importance. After all, as Payne and Triplett (2009) explained, benefits workers provide domestic violence victims with such important assistance as short-term financial aid, “job training, access to health care, and assistance in obtaining a job” (p. 243). Accordingly, it is of fundamental importance that benefits workers be properly trained, in order to more effectively meet the needs of survivors of intimate partner violence: they need to understand, in particular, “the cycle of violence, the intergenerational transmission of violence, and the reaction of various government agencies that could play a role in breaking the cycle” (p. 243).

Understanding all of these things begins, for the social worker, with the ability to identify victims of intimate partner violence (Payne & Triplett, 2009, p. 244). Social workers who can successfully identify victims of intimate partner violence are in a much better position to help initiate, and play an active and constructive role in directing, the process of meeting their needs (p. 244). This is especially important, again, amongst benefits workers, since they have the most contact with victims of intimate partner violence and do the most to help them to overcome their situations and rebuild their lives (p. 244).

Conceptually, the cycle of violence is a relatively simple idea: violence occurs in a pattern of phases in any intimate partner violent abuse situation (Payne & Triplett, 2009, p. 244). What this means is that the risk of the abusive partner harming the victim at any given time ebbs and flows—though predictably, the abuse always recurs (p. 244). The concept of the intergenerational transmission of violence is that children in households characterized by intimate partner abuse will grow up having internalized it (p. 244). As a consequence, from childhood on, such children are likely to use violence in their interactions with others outside the home (p. 244). Finally, a wide range of government agencies can play crucial roles in breaking the cycle: everything from the criminal justice approach to the social support of a variety of groups in local communities (p. 244).

With knowledge, then, benefits workers can become effective agents in this process of change. In many cases, benefits workers can expect to encounter women who have been the victims of intimate partner violence through the system of public assistance (Payne & Triplett, 2009, p. 245). The research evidence, according to Payne and Triplett, indicates that rates of victimization are much higher amongst those receiving public assistance than amongst the general population (p. 245). Once benefits workers have identified victims of intimate partner violence, they need to ensure that they receive the assistance they need. There are at least six key factors that motivate victims of intimate partner violence to seek out public assistance: firstly, as a remedy for their feelings of powerlessness, with attendant socioeconomic, psychological and emotional outcomes; secondly, pertaining to particular, special needs in the field of employment, or vocational concerns; thirdly, in order to secure new accommodations; fourthly, for a variety of physical and mental health care needs; fifthly, due to concerns for the wellbeing of their offspring, particularly psychological well-being, and sixthly, financial assistance, inasmuch as there are significant, albeit complex, ties between intimate partner violence and poverty (pp. 245-246).

Concerning the findings of Payne and Triplett (2009), one notable trend amongst benefits supervisors surveyed was the position that their subordinates, the benefits workers, knew “less than they needed to know about domestic violence for virtually all of the items [on which they were surveyed]” (p. 247). This is indeed disconcerting, but a curious thing is that other supervisors did aver that in fact, their subordinates had a greater body of knowledge than they required for certain subjects (p. 247). Cases in point here included “testifying in court, working with the courts, working with the police, theoretical perspectives and domestic violence,” and so on (p. 247). And thirdly, it is indeed a curious thing that the non-benefits supervisors rated the knowledge competencies of their subordinates above those of the benefits supervisors, indicating a substantial asymmetry indeed between the perceptions of benefits supervisors and those of non-benefits supervisors (p. 247).

What conclusions, then, may be drawn from all of this? How much knowledge do benefits workers truly possess about intimate partner violence? The indications are that in fact, on a number of different topics, benefits workers do not seem to know enough with regards to intimate partner violence (Payne & Triplett, 2009, pp. 249-250). Payne and Triplett found that they were less competent than other social workers with regards to knowledge on a variety of topics pertaining to intimate partner violence (p. 250). Moreover, benefits workers were also found to be less well-trained than other social workers (p. 250). The ramifications of this study indicate a significant need for better training of benefits workers, in order to ensure the more that the needs of victims of intimate partner violence are attended to (p. 250).

As seen previously, domestic violence shelters play a very important role in helping survivors of intimate partner violence to rebuild their lives. A key problem identified from domestic violence shelters, however, is that victims of IPV often return to their abusive partners, often on more than one occasion before finally making a break for good (Hughes & Rasmussen, 2010, p. 303). The reasons for this are potentially numerous, ranging as they do from financial dependence to “misperception of what is best for children, fear of worse abuse, and ambivalence” (p. 303).

In light of these conflicted and often confused feelings, as well as the fears, one promising technique for helping victims of intimate partner violence is motivational interviewing (MI) (Hughes & Rasmussen, 2010, p. 303). In concept, MI is relatively simple: the theoretical basis is the idea that behavioral change transpires in categorical increments, with each stage “moving the person to higher levels of motivational readiness for change” (p. 303). Thus, in essence the idea is that motivation is something that happens through increasing stages of readiness: as the individual increasingly entertains the motivating thought or belief, it gains traction in their mind, making them more and more likely to engage in that behavior (p. 303).

Hughes and Rasmussen (2010) evaluated the impact of motivational interviewing on survivors of intimate partner violence in domestic violence shelters. The comparisons between the control group and the intervention or experimental group were striking indeed. Common amongst the control group was the experience of having been isolated (p. 308). This feeling of isolation was total, inasmuch as the abusers had isolated their victims from friends and family (p. 308). The situation of those with dependent children was especially difficult, making it harder for them to leave their abusers (p. 308). Continued feelings of insecurity and fear were common, as were indications that the participants looked forward to the prospect of better lives for themselves as well as for their children (pp. 308-309). And much to their credit, the participants in the control group were all capable of ascertaining that in fact, certain beliefs that they had held about themselves had had the effect of contributing to the ability of their abusers to victimize them (p. 309).

For the intervention group, Hughes and Rasmussen (2010) found, self-esteem and confidence ran higher (p. 312). These participants evinced “a strong self-concept and inner strength and determination” (p. 312). The participants sometimes singled out determination as one of the things that had changed in them since entering the program (p. 312). One participant stated that she believed that the program had helped her to dispel much of the feelings of fear and anxiety that she had experienced previously, enabling her to take better advantage of her own native determination and self-confidence (p. 312). Participants reported feelings of greater competence and confidence in their abilities to succeed, as well as recognition of the ways in which they had undermined themselves and made themselves vulnerable to their abusers in the past (p. 312).

Understanding intimate partner violence survivors’ needs and experiences with accessing health and social services is certainly of considerable importance for ascertaining the efficacy of professional responses (Robinson & Spilsbury, 2008, p. 16). In a systematic review, Robinson and Spilsbury found that one concern of the victims of intimate partner violence was that the issue of domestic violence be addressed by health professionals in clinical settings on a routine basis, and in a proactive manner (p. 20). The reasoning is simple: by so doing, survivors of intimate partner violence indicated, health professionals could make it easier for victims of intimate partner violence to disclose that they are in fact victims, and therefore in need of assistance (p. 20).

One complaint of some IPV victims was that although counselors were helpful with regards to disclosure issues, other health professionals were not (Robinson & Spilsbury, 2008, p. 20). Moreover, the authors found that many victims of IPV did not feel that the environment offered by the healthcare setting was the best place to discuss matters pertinent to domestic violence (p. 20). One key finding was that victims were not averse to “the idea of being asked about domestic violence by a doctor or nurse”: in fact, they were quite welcoming of it (p. 20). Trust, it was found, was a key ingredient: victims indicated that if they could trust their healthcare professionals, then they would have an easier time opening up in order to discuss matters of domestic violence (p. 20).

A major need of many victims of intimate partner violence is psychotherapy and other mental health services, in order to deal with such deep-seated psychological traumas as post-traumatic stress disorder (PTSD) (Johnson, Perez, & Zlotnick, 2011, p. 542). Domestic violence shelters are an important context for dealing with the problems of PTSD, the more because PTSD’s tendency to numb its victims may lead to some of them returning to their abusive partners (p. 542). Psychotherapy is a very important strategy for combating the chronic traumas experienced by victims of intimate partner violence, including the effects of PTSD (pp. 542-543).

Johnson et al. (2011) evaluated the efficacy of a new cognitive behavioral psychotherapy, Helping to Overcome PTSD through Empowerment (HOPE) (p. 543). The HOPE model is a powerful, but conceptually quite simple and elegant, perspective: the first stage involves “establishing safety”, in order to help the victims of intimate partner violence to feel secure, and that their immediate needs have been attended to (p. 543). This step is of foundational importance before the therapy can proceed, because the need for safety must be answered before any productive work towards ameliorating the deep-seated traumas can begin (p. 543).

The second step in the HOPE model consists of “remembrance and mourning” (Johnson et al., 2011, p. 543). This step is an integral part of the work of recovery: the patient’s safety needs addressed, the psychotherapist can help the patient to remember what has been lost and mourn it properly. This is very essential for achieving emotional and psychological closure with the events of the relationship, in order to help the patient move on (p. 543). Thirdly, the last step is one of reconnection: helping the patient to reconnect to life, and rebuild their life in a positive and healthful way (p. 543).

Many of the results of the study conducted by Johnson et al. (2011) were very promising indeed. The retentions in the program were very high, and so was patient adherence to the treatment regime (pp. 546-547). The authors did find significant treatment effects of HOPE for such PTSD factors as emotional numbing systems (pp. 547-548). Less satisfactory, however, was the fact that the study found “no significant treatment effects for re-experiencing, effortful avoidance, or arousal symptoms” (p. 548). There were also reductions in depression, and in incidences of re-abuse by partners, which may well be attributed to higher empowerment scores for the participants involved in HOPE (pp. 548-549). All in all, the authors ascertained that HOPE was indeed a promising course of treatment, albeit one in need of substantial modification in order to improve its efficacy for the victims of intimate partner violence (p. 549).

Another study, by Iverson et al. (2011) also evaluated the use of cognitive-behavioral therapy for PTSD and depressive symptoms amongst survivors of intimate partner violence (pp. 193-194). As these authors explained, both PTSD and depression are tremendous problems for victims of intimate partner violence, occurring in this population at staggering rates: 31%-84.4% and 48%, respectively (p. 193). The literature has also evinced no mean correlation between PTSD and/or depression and re-victimization of survivors of intimate partner violence, while decreased symptoms of both conditions seem to be correlated with lower incidences of intimate partner violence (p. 194).

Iverson et al. (2011) tested the effects of a kind of cognitive behavioral therapy known as cognitive processing therapy (CPT), a therapeutic intervention which has been correlated with quite significant reductions in both PTSD and depressive symptomatology (p. 194). Significant patterns of change were found in the symptomatology of both conditions: both were reduced, in clear correlation with each other (pp. 197-198). Indeed, the changes were quite significant, and evinced significantly better mental, emotional, and psychological health (p. 198). What this suggests is that victims of intimate partner violence have a great need for effective mental health interventions, in order to secure their mental, emotional and psychological well-being. This is certainly important for helping them to avoid being victimized again, although of course the perpetrator must also be held to account (p. 198). What is clearest, however, and it is by far the most important thing, is that cognitive behavioral therapy is an effective way to help victims of intimate partner violence to win their struggles and overcome the deep-seated psychological issues relating to the abuse (p. 198).

The competencies and knowledge of helping professionals are of the most foundational importance in helping victims of intimate partner violence. IPV victims are often deeply traumatized, and many are afflicted with such disorders as PTSD and depression. They have material and financial needs, too, often quite desperate ones. And, too, one issue is that some victims of IPV are willing to give abusive perpetrators another chance—in circumstances where this is often, if not always, very questionable.

In confronting these myriad challenges, helping professionals from social workers to physicians all have important roles to play, ranging from detecting incidences of intimate partner violence through health services screenings, to providing financial assistance and job training, to helping victims become survivors through cognitive behavioral therapy and other interventions of proven efficacy. Professionals must be aware of cultural, economic, and personal barriers to asking for or even receiving help, and work around or through them. By so doing, professionals can contribute to efficacious professional and institutional responses to the problem of intimate partner violence, for the greater benefit of the victims and in the interest of helping them to start new and far more empowered lives.

References

Anderson, T. R., & Aviles, A. M. (2006). Diverse faces of domestic violence. ABNF Journal, 17(4), pp. 129-132. Retrieved from http://www.search.ebscohost.com/

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