Spouse / Partner Abuse > Chapter 2, Part B - Assessment cont'd

Chapter 2, Part B: Assessment cont'd

II. Assessment

A Brief Editorial Comment

I heard recently that around 90% of research done in the areas of mental health are studies relating to problems and negative themes i.e.: why are people depressed, what contributes to delinquency, what causes domestic violence.In that spirit, I wanted to add a brief note about what makes a relationship positive. I believe, and have observed, that the unselfishness, caring and respect that a couple has for one another, or lack thereof, are stronger measures for the prevalence of spousal abuse and marital happiness in general. In every culture can be found couples who do have that love and respect for each other, where the concern for the care and comfort of one’s spouse is elevated above concern for self. Certainly societies, cultures and families that teach and promote these principles will have a much higher satisfaction in their intimate and important relationships. Maltreatment and abuse cannot co-exist with such caring. Conversely, those societies, cultures, sub-cultures, and families who teach their members, through various means, opposing principles such as self above spouse, disrespect of gender, and devaluation of roles, create an increased prevalence of maltreatment and abuse, along with general dissatisfaction. I believe any relationship treatment should include these basic principles.

Characteristics of Victims
There is no typical profile of domestic violence victims, but they are usually female (some 85 percent are women). Young, old, single, married, professional, unemployed, rich or poor — all may be potential victims of domestic violence. The problem of domestic violence occurs throughout society and affects all socioeconomic, cultural and ethnic groups. Children in abusive homes are also victims of domestic violence, even if they are not physically abused themselves. Witnessing violence in the home causes emotional suffering and many corresponding problems for children, including increased anxiety, aggressive behavior, depression and a lack of self-esteem. Youngsters who grow up in hostile or abusive environments are much more likely to demonstrate violent behavior as adolescents than children who are raised in nonviolent homes. Exposure to violence as a way of life may also result in their becoming involved in abusive relationships as adults. (CAGO, 2002).

Assailants are accountable for their actions. The behaviors of the victim do not justify abuse, and it is not their fault they are being abused. It is also important to note that when we identify "characteristics," they are general in nature. There are still many victims that would fall outside of these general characteristics. With the understanding that research will not provide all of the answers, studies are helpful to build frameworks which the healthcare provider can draw from in treatment.

As mentioned before, domestic violence happens with those who are famous and those who aren’t. Although there does not exist a specific profile of victims, there are characteristics common that can help determine risk, prevention and intervention. These characteristics include a history of being abused, low-self esteem, and fear of being alone in addition to other socioeconomic and cultural factors.

The history of being abused is often cited as an indicator of future abuse. Studies show that a woman who has a history of being physically or sexually abused both as a child and in adolescence, is at greater risk to suffer abuse in college than those who were only abused as a child or as an adolescent. If the abuse only occurred in childhood, the woman was not at any greater risk to suffer abuse in college. Only if that abuse carried through to adolescence was the risk greater. (NCJRS, 2004)

Emotions and psychology play a large part in spousal/partner abuse. Victims often suffer from low-self esteem. Victims may believe they either deserve the abuse or that there is nothing they can do about it. Often times, there is a feeling of powerlessness. Abusers exert power over the victim through violence and threats, to create and carry on feelings of worthlessness, first verbally and then violently. Because the abuser often expresses remorse after episodes of abuse, and makes promises not to do it again, the victim gives the abuser another chance, a cycle which repeatedly becomes more violent.

The victim may also have an overwhelming fear of being alone. They may not have confidence that they would be able to find another relationship, or if they did, that it would be much different. Ultimately the abuse creates levels of psychological stress including anxiety, depression, loss of control and lack of emotional ties (NCJRS, 2004).

Cultural and socioeconomic issues are also associated with being victims of spousal/partner abuse. These include being divorced or separated, lower income earners, living in rental housing, living in an urban area, being young, and being African American. (Rennison and Welchans, 2000)

Men May Also be Victims
The issue of “battered husbands'' is much less well known than that of women being subjected to domestic abuse. Steve Dennett, 47, a provider of services to both abused men and women said: “What people don't realize is that it's not just men that abuse, and it's not just women that are victims.'' Surveys have shown that as many as 9% of men against 13% per cent of women had been subject to domestic violence, sexual victimization or stalking in the 12 months prior to interview ("Grant for Abused Husbands; Plan for Refuge to Help Sufferers," 2004)

Profiles of Female Victims who Seek Help
Knowing what causes women to seek domestic violence services can be of assistance in the assessment and intervention of the abuse. Macy, Nurius, Kernic, and Holt (2005) studied these characteristics in regards to seeking legal, biopsychosocial and economic services, providing a profile of women and the abuse suffered that contribute to them seeking help.

If most women in violent relationships are not seeking domestic violence services, where are they going for help? What are their needs? What can we learn from violence exposure, biopsychosocial, and demographic factors to better anticipate their needs across diverse services? Women generally cope with partner violence through informal means as long as possible (Coker, Derrick, Lumpkin, Aldrich, & Oldendick, 2000).As a result, battered women who seek formal services from agencies and providers may have long-standing needs and severe problems (Hutchison & Hirschel, 1998).

On one hand, they may need formal services to manage the difficulties in escaping or ending the abuse. On the other hand, disclosing the abuse or trying to protect themselves and their children may increase their danger. This danger can come in the form of escalated or more insidious abuse, interference with work or schooling, damaged social relations, impairment of the woman's parenting, or danger to children's well-being (Wolf, Ly, Hobart, & Kernic, 2003). So the decision of seeking help is not always clear cut to the victim. Until they do it, they cannot always determine if it will do more harm than good. Mush of it depends on multiple factors about the victim and the abuse itself.

Macy et al’s study was to help determine how battered women's needs, characteristics, and resources are associated with help seeking across a spectrum of formal human services: domestic violence, legal, health care, public assistance, counseling, substance abuse, and religious or spiritual.

In their study, 85% of participants reported having engaged in some type and level of service help seeking. Most women sought legal help (66%), with more than one-third of the women reporting contact with domestic violence (38%), economic (32%), and counseling services (31%)

The characteristics of those more likely to seek services included those who experienced significantly higher rates of partner violence, greater threats, and greater biopsychosocial needs, including higher levels of depression and negative social relationships and lower levels of physical health functioning.

Some Implications for Assessment and Interventions

In conjunction with earlier research that shows that battered women seek help for a range of life problems without calling attention to the violence in their lives (Henning & Klesges, 2002), these findings suggest the importance of practitioners across the broad spectrum of human services anticipating and screening for the needs of battered women who obtain their services. This information attests to the opportunity to intervene, especially with women with less severe histories for whom escalation may be prevented.

The investigation results have two overarching implications for social work assessment and intervention. First, battered women's needs correspond with help seeking. Their needs, however, are not always presented with reference to the violence in their lives, and the majority do not reach domestic violence specialists. Battered women may seek economic and substance abuse services, for example, without ever reporting violence unless social workers ask about psychological, physical, and sexual violence.

Social workers in all service settings should screen women for violence; otherwise critical intervention opportunities will be missed. Second, battered women who seek help for partner violence likely have a myriad of biopsychosocial difficulties resulting from the violence (Riger et al., 2002). The battered women contacting domestic violence services in this investigation were likely to be seriously depressed, have impaired physical functioning as well as injuries, and have few social relationships and activities that were positive and more that were negative. Practitioners who primarily provide domestic violence services should connect battered women with a range of supports and services to address co-occurring needs. Although violence cessation and safety planning are important intervention targets for these women, co-occurring biopsychosocial difficulties must be addressed concurrently.

Women do not usually seek services at the first sign of abuse. Help is sought as the duration and the severity of the violence increases (Brown, 1997) in addition to when women feel deeply threatened by their partners and they have noticeable difficulties in their everyday lives because of the violence.. Women contacting domestic violence providers often have a range of needs and this contact facilitates connection with other service providers, likely through assessment and referral. (Sullivan, Basta, Tan, & Davidson, 1992)

The biospsychosocial factors leading to women seeking help are often complex. These factors include increased psychological distress, low social support and poor physical functioning. To facilitate safety for battered women, service providers must assess and address this range of biopsychosocial needs, because these problems may impede a woman's ability to carry out a safety plan.

( Macy, Nurius, Kernic, and Holt 2005)

A Victim No More

The following illustrates the case of one woman’s travel from abuse:

Vickii Coffey, 39, says she was one of the large number of Black victims. Coffey, who married her childhood sweetheart when she was 19, says her dream marriage turned into a nightmare of violence that often resulted in her hospitalization. Eventually, she says, she turned the violence inward, blaming herself for her plight. After eight years, Coffey filed for divorce, saying among other things, that she feared for the life of her two small sons, one of whom, she says, tried to protect her from the abuse.

Today, almost 13 years later, Vickii Coffey is the executive director of Greenhouse, Chicago's oldest and largest shelter for battered women and their children. Now happily married, she fights to keep the doors of her shelter open-as well as the minds of an unsympathetic public which often can't understand why battered women remain with their abusers. "The question I get all the time is, 'Why would a woman stay there and take something like that? What's her problem?'" says Coffey who now counsels women on their options to violence. "That is victim blaming. There are many factors that prevent her from leaving."

The rewards - and the risks - of facing the problem of domestic abuse are considerable. Take, for example, the last chapter of Vickii Coffey's ordeal. Three years after leaving her ex-husband, Vickii was on a train heading for the University of Illinois At Chicago, where she was earning a degree in criminal justice. As she thought about how the degree would enable her to better support her two children, she saw her ex-husband sitting a few seats away. Vickii decided to say hello, and at first, the conversation was polite. She gave him an update on how their children had grown and how she had provided for them over the years. But Vickii says he became upset when he saw how well she was doing and started belittling her again.

To his surprise, Vickii objected to his remarks and loudly demanded her long overdue respect. As the crowded train sped along its tracks, and passengers cheered her on, Vickii told him she didn't intend to be mistreated anymore.

"When I got off that train, I felt like people were celebrating my independence, and I was too," recalls Coffey, who speaks of the liberating experience often. "I knew at that point, it was all over. I would never let anyone abuse me again." (Barber, 1990)

C. The Domestic Violence Power Wheel

Abuse is never a one time event (Eicher, 2004)

The different ways in which an abusive man exerts power and control over a women is well illustrated in this Wheel developed by the Domestic Abuse Intervention Project from Duluth, Minnesota.

It should be noted that this wheel was developed in research of male on female violence exclusively.This wheel is not meant to be used regarding gender neutral violence nor woman on man violence. Many parts of this wheel are found in the following cycle of violence that occurs in spousal/partner abuse.

D. The Cycle of Violence

A summary of the cycle of violence is provided by the Oakland County Coordinating Council Against Domestic Violence and adapted from the original concept from Walker, Lenore. The Battered Woman. New York: Harper and Row, 1979 (Eicher, 2004).

There are stages in the cycle of violence that, without intervention, keep repeating itself with greater escalation of abuse. The first stage of the cycle, which is the most likely beginning, is called Tension Building. During this time the abuser starts to get angry at things more often. Communication between the couple breaks down and the victim feels a need to try and keep the abuser calm to the point where the victim feels like she is “walking on egg shells.” The tension becomes intense and then the abusive incident occurs.

The Abusive Incident or episode may be physical, sexual or emotional. This is the climax of the cycle and where the actual abuse occurs. After the incident comes the stage of Making Up. During this stage the abuser may apologize for the abuse, promise it will never happen again, blame the victim for causing the abuse, or claim that it either did not take place or minimize it.

After the making up stage is a period of calm. This is characterized by the abuser acting like the abuse never took place; promises made during the making up may be kept. The victim may become hopeful that the abuse is over and the abuser may give gifts to the victim. At some point the tensions begin to build again continuing another round in cycle of violence resulting in a more severe abusive incident than the last. The abuse may occur frequently or infrequently, but in most cases it tends to increase in severity and frequency (Eicher, 2004)

A more detailed illustration of the cycle of violence is provided by the California Attorney General’s Office (2002). This detailed account helps explain some of the emotions involved in the abusive relationship including reasons why the victim stays in the relationship and the severe danger in doing so.

What happens during the cycle can help to explain why some women feel so guilty and ashamed of their partner’s violence toward them. It also explains why they may find it difficult to leave, even when their lives are in danger. The cycle of violence involves a tension-building phase, a violent incident and a period of loving closeness or reconciliation.

The Tension-building Phase

The first phase in the cycle of violence is characterized by tension between the batterer and victim. While stress is a normal factor in life and in all relationships, some people, for a variety of reasons, react to it violently. During the tension building phase, the woman senses her partner’s increasing agitation. She may or may not know what is wrong. Her partner lashes out at her in anger, challenging her, saying she is stupid, incompetent and unconcerned about his welfare. The woman typically accepts this blame and tries hard not to make any "mistakes" or say something that may upset her partner. She takes responsibility for making him feel better, setting herself up to feel guilty when he eventually explodes in spite of her best efforts to please him.

During the increasing tension, the woman rarely becomes angry, even at the most unreasonable demands. Instead, she internalizes her anger and suffers depression, anxiety and a sense of helplessness. She may even have physical symptoms related to her emotional distress such as headaches, upset stomach, insomnia or fatigue. These problems increase her sense of worthlessness, loss of control and vulnerability to her partner’s criticisms. The woman may deny her fear and minimize the seriousness of the threat, believing she can control the situation. Even if she acknowledges the danger, she may be reluctant to seek help. She feels ashamed of her failure to please her partner, and she believes that if other people knew about the violence, they would blame her.

As the tension increases, so do minor episodes of violence such as pinching, tripping, slapping or shoving. The batterer knows his behavior is inappropriate, and he fears the woman will leave him. That fear of rejection and loss increases his rage at his partner and his need to control her. During this phase, the couple’s children are also affected. They may feel tense, afraid, angry or confused. They may side with one or the other parent, hide, deny what is happening, or try to distract their parents.

The Violent Episode

The tension-building phase ends in an explosion of violence. The incident that sets off the man’s violent behavior is often trivial or unknown, leaving the woman feeling desperately confused and helpless. During the episode, the batterer is out of control and often unaware of how much injury he is inflicting. The woman may or may not fight back. She often tries to escape the violence; she may call for help. If she cannot escape the beating, she may make herself feel as if it is happening in a dream. She may not be aware of how badly she is being hurt.

Children may be harmed as well. Those who witness the violence may feel frightened or trapped. They may watch helplessly or hide; they may even attempt to stop the fighting or try to help the victim. Children caught in the cross fire of domestic violence can become unintended victims of serious injuries when objects are thrown or weapons are used. Also, youngsters who hear, but do not see the violence, may suffer emotional trauma.

Following the battering, the victim may be in a state of physical and psychological shock. She may be passive and withdrawn or hysterical and incoherent. She may be unaware of the seriousness of her injuries and resist getting treatment. The batterer discounts the episode and usually underestimates the harm he has inflicted. He may refuse to summon medical help, even if the woman’s injuries are life-threatening.

The Loving Reconciliation

The loving reconciliation, also called the "honeymoon" or "remorseful" phase, begins a few hours to several days after the violent episode. Both the man and the woman have a profound sense of relief that "it’s over." While the woman may be initially angry at her partner, he begins an intense campaign to "win her back." Just as his tension and violence were overdone, his apologies, gifts and gestures of love may also be excessive; he may shower his partner with love and praise that temporarily helps repair her shattered self-esteem.

It is very difficult for her to leave him during this period, since he is meeting her desperate need to see herself as a competent and lovable woman. In addition, the woman’s feelings of power and romantic ideals are nurtured. She believes this gentle, loving person is her "real" man. If she can only find the key, she can control him and prevent further violent episodes. No matter how often the violence has happened before, somehow this episode seems different; this time, it will never happen again.

During the loving reconciliation, a strong bond develops between the couple, isolating them both from reality and from anyone who tries to intervene in their destructive relationship. Friends or family who have supported the woman and urged her to get out of the violent situation may now be seen as "enemies" trying to separate the loving couple. Meanwhile, children living in the home during this period may express feelings of embarrassment, humiliation, relief, guilt or anger. They may try to please their parents or attempt to distract themselves to forget the stress of the battering incident.

The loving reconciliation is a time of intense pleasure and reassurance for the couple that convinces them there is nothing wrong with their relationship. Their isolation discourages them from seeking assistance, and when the violence happens again, the woman may find that she has fewer places to turn for support. Psychologists have found that any behavior followed by a positive reward happens more and more frequently. Thus, the loving reconciliation becomes a kind of reward for the violence. The more often periods of uncomfortable tension end in violent explosions followed by loving closeness, the less likely the couple will be to develop alternatives for handling stress. And it is this cycle that must be broken in order to end the violence." (CAGO 2002)

The Unbroken Cycle: When abuse turns into Homicide

Where the last violent episode left off the next begins. If the cycle of violence is not broken the continuous spiraling of the abuse to more frequent and more severe incidents may result in homicide. Particularly, women who are threatened or assaulted with a gun are 20 times more likely to be murdered. Those that are threatened to be murdered by an intimate partner are 15 times more likely to be murdered than other women. The following link has further information regarding risk factors for homicide, in addition to a Danger Assessment to help determine the level of danger the victim is in. http://ncjrs.org/pdffiles1/jr000250e.pdf

A 2004 study showed a correlation between homicide and previous, serious abuse. The study found that "44% of women, murdered by their partner, had visited an emergency department within 2 years of the homicide, 93% of whom had at least one injury visit." ( www.cdc.gov/ncipc/factsheets/ipvfacts.htm).

It is important for the healthcare practitioner to use this information to educate their clients about the level of danger they may be in.

Question No.6. Healthcare professionals should only focus on the issues of violence with victims of spousal-partner abuse:True/False?

a. True
b. False

Question No.7. Battered women contacting domestic violence services were likely to:

a. Be seriously depressed
b. Have impaired physical functioning as well as injuries
c. Have fewer positive social relationships and activities
d. All of the above

Question No.13. The cycle of violence usually occurs in this sequence:

a. Tension Building – Violent Episode – Reconciliation
b. Violent Episode-Tension Building-Reconciliation
c. Reconciliation – Violent Episode – Tension Building

Question No.14. Without intervention the cycle of violence will:

Eventually exhaust itself with continuously decreasing violence
Spiral into more frequent and severe episodes of violence
Become extinct

Question No.15. After an abusive incident the victim can be confident that the abuser will keep their promise to never abuse the victim again:

a. True
b. False
Spouse / Partner Abuse > Chapter 2, Part B - Assessment cont'd
Page Last Modified On: June 19, 2015, 10:45 PM