Spouse / Partner Abuse > Chapter 4, Part B - Intervention Strategies cont'd

Chapter 4, Part B: Intervention Strategies cont'd

In Shelter Treatment Plan

Roberts suggest a 7 to 8 sessions for in-shelter treatment. In the first session, along with the necessary assessments, the therapist needs to establish rapport, build trust, evaluate the risks of further danger and help create an escape plan. As the first few session move on a safety plan is formed that included very clear behavioral tasks that victim can follow should another incident occur, or then it is about to occur.

Coming into the shelter the victim is going to be terrified and overwhelmed.While validating the victims fears, helping the client through cognitive interventions to see that she and the children are safe, and to focus on the immediate problems will help decrease these feelings and help her see tings more objectively .

The social worker also needs to assess for the necessity of medical care, psychiatric care or entry into a drug and alcohol treatment. Assessing levels of depression and the presence of suicidal ideation are also immediate needs.Roberts suggests that the safety plan be verbally reviewed after each session and the plan focus on how the victim can escape and where she can go for help.Also introduce in the first sessions and continued on through treatment are teaching the victim about the causes and effects of battering, legal services and treatment programs for batterers.

Having been battered and isolated victims often feel powerless, thus, empowering the victim is important. This includes validating experiences, exploring options, building on the client’s strengths and respecting her right to self-determination.During the treatment process the clinician must emphasize that the abuse was not the victim’s fault and state such things as: The abuse is criminal and wrong; many times leaving an abuser is the only way to end the abuse; a family staying together simply to be together is not always best (Follingstad et al., 1991; Schecter, 1987).During these messages the clinician need to be sure to allow space for the victim to get a sense of her own strength.

Early on in treatment, at least during the early/middle phase of treatment, the clinician and the client should decide on goals and objectives. Specific approaches in the middles phase of treatment includes using cognitive-behavioral principles to help the victim repair illogical thought pattern that may have developed from the abusive relationship. Some of these illogical beliefs can be that violence, intimacy and love all part of the same thing. Another faulty idea the victim may have is that if they just behave well, they can create a stress free world for the abuse so they do not become angry (Walker, 1984). As already mentioned, victims of abuse often have the irrational thought that the abuse was her fault, or that violence is a normal part of a relationship and that she cannot leave the abusive situation.

One of the objectives during this phase is to help the victim get the help she needs from various organizations and government benefits.Broadening resources will give the client a greater sense of empowerment. The client’s self esteem and feelings of empowerment will also increase when treatment focuses on the client’s strengths and develop assertiveness in tackling the treatment objectives.Other cognitive-behavioral techniques of treatment include modeling, thought stopping, reframing, stress inoculation and cognitive restructuring.

The following steps are useful in cognitive restructuring:

  • Assist clients to accept that their statements and beliefs affect their emotional reactions to life’s events.
  • Assist clients to identify dysfunctional beliefs and patterns of thoughts that underlie their problems.
  • Assist clients to identify situations that engender dysfunctional cognitions.
  • Assist clients to substitute functional self-statements in place of self defeating cognitions.
  • Assist clients to reward themselves for successful coping efforts.
(Cormier and Cormier 1979)

It is also very useful for the client to attend a group with other victims of spousal abuse.A group to use as a reference, who have shared experiences, and are working through them, are often much more powerful and meaningful than sitting with a clinician.There is a high level of understanding, and the victim will often give greater deference to what is said by members of the group as she can relate to them regarding many of their shared experiences, fears, thoughts and feelings.

As with any treatment, during the last phases in a shelter the client and clinician should review together the progress the client has made towards the goals that have been set.The safety plan should be reviewed to ensure that the client is clear about the plan, resource that help promote hope and independence should be understood, and the plan of continuing to work on the goals set during treatment. The victim may return to live with the abuser, which is her right, however that does not mean that treatment has failed. With a safety plan, enhanced resources, greater empowerment, and more logical thought processing, the client takes with her new tools that can improve and may even save her life.

C. Further Treatment Issues

After making sure that the victim is safe, a licensed clinical practitioner can help manage the emotional and psychological issues of the abuse.The reasons that a victim often stays in an abusive relationship: the fear of being alone, lack of resources for food, clothing and shelter, transportation issues and lack of emotional support….all of these fears now directly confront the victims. The victim might also be faced with others not believing them, criticizing them for leaving, and further threats of violence from the batterer.

All these issues come at a time when they feel most vulnerable, unsure of themselves, and unsure of their future. Their coping skills are stretched to their limits.This is where the professional healthcare provider can make a big difference.

Prioritize and Set Goals

By first prioritizing needs, setting goals, and breaking the goals up in manageable tasks the victim will start to feel hope and confidence in the future and their own abilities.The provider needs to maintain a delicate balance of respecting the victims wishes, and not creating a dependence by doing everything for them. It is important for the victim to feel they are capable of doing things for themselves, that they are worthwhile and strong.Their strength should be reinforced.Leaving a relationship under uncertainties takes a lot of strength.Setting goals and taking action on each task needs to be reinforced with praise.The provider not only acts as their counselor but as their #1 fan.

Goals and Tasks might be laid out this way, depending on the circumstances of the individual

Safety and Basic Needs:Help the victim find a safe place for themselves and their children.This has already been discussed in the safety plan.This will provide the initial essentials of food, clothing and shelter.

Work and Daycare:Helping the victim find a way to provide for themselves and their children is a primary confidence builder.This might entail assessing skills and interests, and also developing job finding and interviewing skills.In addition, helping them develop a budget and savings system in order to find more permanent and independent housing is important.Another task is to help the victim find safe and affordable child care.

Emotional and Psychological Issues:As the victim takes the road to independence, many of the other symptoms; helplessness, depression, and anxiety will be lessened.Throughout the process it is important for the provider to assess and treat those issues that the victim presents. If there are children involved, they will also need counseling services to work through the tragedy of the violence they have either observed or heard in their home.Helping the children identify those feelings, reaffirming their own value and validating their feelings are important.Children may feel guilty for either having angry feelings towards their father (if he is the batterer), or feeling guilty and confused about missing him.Helping the children identify and manage these feelings is important.They also need to recognize how their mother is working to make things better and, as much as possible, be able to take part in that.

Legal and Court Issues:Often times the batterer will be prosecuted for the violence against the victim. This will require the testimony of the victim. Being in the courtroom with the batterer who has intimidated and controlled the victim can be a very difficult experience.The provider can help the victim through this with desensitization exercises, validating feelings, praising her for her strength and courage, and helping her see past her present difficult circumstances to the future she is building for herself.

Dating and Intimacy:There is a tendency for those who have been abused to be subconsciously attracted to batterers. Helping the victim be patient and identify characteristics of a batterer can help them avoid another abusive relationship. The victim may fear the idea of having relationships again, and this needs to be respected. At the same time, empowering the client to recognize the red flags a batterer will present as dating proceeds, and helping them feel more confident in their own independence, will improve the chances of them finding a new and satisfying relationship.

Other Social Relationships:The victims should also build up their social resources.This can be done through support groups, church groups and other social activities.Broadening normal social supports is an important step in the victim becoming less dependent on the counselor.

Generally, the approach to treatment for battered women outside of a shelter is similar to that of a client in a shelter. However, a woman who enters a shelter will probably present with a more severe immediate crisis and have fewer resources available than that of a battered individual who comes in to an office or to a group.It is also very possible that a client will have already received some treatment in a shelter and is now looking for a further expansion of treatment and support.

In treating battered women for mental health issues Roberts (1996) recommends that the treatment be guided by the following principles:

  • Intervention goals should be appropriate to the needs of the client and reflect her right to self-determination.
  • Assessment and treatment protocols should be developed that best meet the identified needs of battered women, and clinicians should employ empirically proven and psychometrically sound methods and measures that permit the objective assessment of a client's unique constellation of presenting problems, as well as the effectiveness of clinical interventions.
  • A contextual perspective must guide assessment and intervention.
  • Clinicians must engage in on-going monitoring of their own attitudes, feelings, and behaviors.
  • The impact of clinical interventions must be evaluated.
  • Clinicians must develop and use a conceptual framework to guide assessment and treatment
One of those frameworks is that of a cognitive-behavioral approach in short term individual therapy and in group. Groups provide the opportunity for reality testing, for the client to “bounce” views and ideas off of others, and to receive candid feedback regarding their behaviors.The therapist should emphasize educating the client and help to enhance the clients decision-making skills.Just as in a shelter, the therapist should assess for and if it is present, treat the depressive symptom of the client.

Possible depressive symptoms assessed are laid out in the DSM-IV-TR (2000) under the diagnosis of Major Depressive Episode:

  • Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

    Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
    • depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
    • markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
    • significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
    • insomnia or hypersomnia nearly every day
    • psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    • fatigue or loss of energy nearly every day
    • feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
    • diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
    • recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
  • The symptoms do not meet criteria for a Mixed Episode (see p.171).
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  • The symptoms are not better accounted for by Bereavement i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Cognitive-behavioral therapy has been found by many of those who treat victims of spousal abuse as an effective treatment, including for those who show symptoms of depression.The depressive symptoms are most likely impacted by the trauma of being abused, but may also be further ingrained as a result of poor self-esteem, feelings of hopelessness and helplessness that often are a result of depression.Using many of the same techniques and approaches mentioned regarding shelter care treatment are appropriate for out-of-shelter treatment.

VI. Conclusion

This course addressed the issues of Spousal/Partner Abuse.The need and manners in which abuse can be detected and assessed, the cultural factors of abuse, same-gender dynamics and intervention strategies, along with this wonderfully brief, conclusive, yet deblockedive paragraph, have all been included in this course.The following is a partial list of the many resources available to victims of spousal/partner abuse and those that provide services for them.
Question No.20. Intervention strategies for spousal/partner abuse include all of the following except:

a. Developing a safety plan
b. Broadening resources
c. Prioritizing and setting goals
d. Blaming the victim for the abuse

Spouse / Partner Abuse > Chapter 4, Part B - Intervention Strategies cont'd
Page Last Modified On: June 19, 2015, 10:48 PM