Responding to Family Violence

A Comprehensive, Research-Based Guide for Therapists

Christine E. Murray, Kelly N. Graves

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415885607
• eBook ISBN:
  9781136207181
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The comprehensive theory- and research-based guidelines provided in this text help answer the personal and professional questions therapists have as they provide competent clinical treatment to clients who have experienced family violence. It presents academic, scholarly, and statistical terms in an accessible and user-friendly way, with useful take-away points for practitioners such as clarifying contradictory findings, summarizing major research-based implications and guidelines, and addressing the unique clinical challenges faced by mental health professionals. Both professionals and students in graduate-level mental health training programs will find the presentation of information and exercises highly useful, and will appreciate the breadth of topics covered: intimate partner violence, battering, child maltreatment and adult survivors, co-occurring substance abuse, the abuse of vulnerable populations, cultural issues, prevention, and self-care. Professionals and students alike will find that, with this book, they can help their clients overcome the significant traumas and challenges they face to let their strength and resilience shine through.

1
Overview of a Research-Informed Approach to Responding to Family Violence

Family violence is one of the most common, and yet challenging, issues that therapists encounter for two central reasons. First, clients who have experienced past or current family violence are very common in the clinical field and typically have very complicated backgrounds and are in need of multiple forms of support. In a recent survey of 347 marriage and family therapists, for example, nearly all participants—98.6%—indicated that they had worked with clients who were in domestic violence situations (Blasko, Winek, & Bieschke, 2007). Second, the existing research demonstrates that it is an issue for which many practicing therapists are ill-prepared to address (Gauthier & Levendosky, 1996). Many therapists are undertrained in family violence issues (Wingfield & Blocker, 1998), although this area of practice requires specialized training in order for therapists to be competent to address it (Wingfield & Blocker, 1998).

According to Hamberger and Ambuel (1997), therapist training in intimate partner violence (IPV) has lagged far behind the training that physicians in training typically receive in medical school. This historical perspective is notable in light of a more recent survey of medical students in the United States, in which the researchers (Frank et al., 2006) found that over 90% of the students i nd icated t h at t hey h ad received some t r a i n i ng i n add re s si ng I PV. However, on ly about 20% of these students said that the training they had received was extensive. Additional survey research with mental health professionals provides additional support to the notion that many therapists are ill-prepared for addressing family violence issues in their clinical practice. In a recent doctoral dissertation study, Bozorg-Omid (2007) conducted a survey of members of the American Mental Health Counselors Association (AMCHA). Bozorg-Omit demonstrated that although 90% of the survey respondents had received some training in family violence issues, about one-half of these did not receive that training in their formal graduate education. Moreover, nearly 80% of the participants described their graduate school training in family violence issues as inadequate.

In addition to lacking formal training and education in family violence issues, there has been a lack of accessible sources to guide therapists in their clinical practice. Although numerous high quality books on family violence exist, our observations have been that, to date, most of the existing books focus either only on some forms of family violence, primarily on general background information (and not clinical applications) about family violence, and/or are not grounded on the most current research-based information found within the scholarly literature on family violence. As such, therapists seeking information on family violence have lacked the availability of a comprehensive, in-depth clinical consideration of these issues, and especially such a consideration that is grounded in research. Our aim in writing this book was to develop such a resource for practicing therapists and therapists-in-training. This book is designed to familiarize readers with the dynamics of multiple forms of family violence—including IPV, child maltreatment, and abuse in special populations such as elders and individuals with disabilities. Beyond the “basics” of these dynamics, clinical guidelines are presented for assessment and intervention.

Defining Family Violence

In this book, we define family violence as any form of maltreatment—including physical, sexual, and emotional (inclusive of both verbal and psychological abuse), as well as neglect—perpetrated or witnessed by one or more members of a family and/or intimate relationship upon one or more other members of that family or relationship.

Clinical Challenges Associated with Family Violence

Multiple clinical challenges may arise for therapists when working with clients impacted by family violence. These include the complexity of family violence cases, clarifying the role of the therapist within the family violence response system, partnering with community resources within the family response system, seeking research-based guidelines for clinical practice, and managing the self-care challenges that arise when addressing family violence.

The Complexity of Family Violence Cases

Family violence can be a challenge to address based on the complex dynamics involved. In addition to basic survival and safety needs of themselves and other family members, clients often experience extensive traumatic stress responses that impact their cognitive and social functioning (e.g., Daignault & Hébert, 2009; Helfrich, Fujiura, & Rutkowsky-Kmitta, 2008; Reinhard, Wolf, & Cozolino, 2010). Very often, clients participating in therapy for family violence reveal additional experiences and histories of other forms of violence, such as childhood trauma. This intergenerational transmission of family violence has been documented in the research literature (Tracy & Johnson, 2006). Beyond familial experiences, clients’ cultural backgrounds and other social forces may contribute to the continuation of their violent experiences ( Jenkins, 1996; Jenkins, Hampton, & Gullotta, 1996). Complex, poly-victimization experiences may render it more challenging for clients to become removed from circumstances contributing to their victimization or to overcome and stop their perpetration of abuse.

Family Violence Response Systems

Family violence is not just a phenomenon that impacts mental health, and several other systems are involved in preventing, responding to, and treating family violence issues. Thus, therapists must be aware of local resources that clients can seek as additional sources of support to help them achieve safety and make progress toward their treatment goals. In this book, readers will learn about what we describe as the family violence response systems that are typically in place in local communities that address various forms of family violence. A family violence response system is defined as a coordinated, multidisciplinary, community response team that provides information, support, crisis and safety planning assistance, and resources to individuals impacted by family violence. Family violence response systems may include legal and criminal justice systems, healthcare systems, social service agencies, natural support and peer support groups, and a variety of other systems that may include schools, workplaces, and religious institutions. Many clients impacted by family violence already will be involved in various aspects of these response systems, and, in fact, these systems may be the reason that clients find their ways to their therapists’ offi ces, as in cases when abuse perpetrators are court-mandated to attend treatment. Still, it is imperative that the therapist connect with these key community resources to ensure a strong support system is in place for the clients that they are working with throughout the therapeutic process.

Understanding the multiple layers of clients’ involvement in family violence response systems presents a unique challenge for therapists. Consider, for example, a family in which a child witnessed his father perpetrating severe IPV against his mother, and this was reported to the local Child Protective Services (CPS) unit. The child’s father was arrested and referred to a court diversion batterer intervention program. The child’s mother sustained physical injuries in the violent episode that required her to seek medical attention. She also began to seek victim advocacy services from a program for battered women in the community, as well as psychotherapy from a community mental health agency. The child was assigned a caseworker through CPS, personnel from his school were notified of the situation, and he also began to receive outpatient counseling through the same mental health agency as his mother. Certainly, the therapist for this child will interface with many aspects of the family violence response systems with which the family is involved. Knowing when and how to do so appropriately can become quite a challenge for therapists.

When working with clients impacted by family violence, therapists may be challenged to go beyond the functions they typically associate with conducting psychotherapy. For example, consistent with pr inciples of trauma-informed care, attending to basic survival and safety needs take priority over exploring clients’ emotional and psychological functioning. Furthermore, therapists also are challenged to help their clients navigate these response systems and assume a “case management” function. Therapists must inform and empower clients to understand the unique role that they play within these systems and how clients’ work done with their therapists may be related to other aspects of these systems. For example, batterers who have been court-mandated to attend batterer intervention programs should be fully informed as to how participation and progress in the program will impact any legal sanctions they may face. Likewise, when multiple components of response systems are involved in clients’ lives, there may be additional exceptions to confidentiality that could impact the process of therapy.

Seeking Research-Based Guidance for Practice

Although a substantial body of research exists that addresses the study of family violence, the translation of this research to practice often is not achieved. As will be discussed later in this chapter, a series of recent studies aimed at understanding and developing potential solutions to addressing the gap between family violence research and practice was conducted (Murray & Smith, 2009; Murray, Smith, & Avent, 2010; Murray & Welch, 2010). Through these studies, several factors were identified that hinder the application of research to practice in the area. First and foremost, many therapists lack access to useful research. The high cost of academic journals puts research out of reach for many community-based therapists. Second, many busy therapists simply do not have the time or energy needed to locate, read, and interpret individual research studies, particularly given that academic language used in published research studies is often diffi cult to decipher among non-research professionals. Third, much of the existing research on family violence lacks clearly defined practical relevance. Therapists have obser ved that many researchers lack a clinical background that would sensitize them to the needs of therapists, and while the findings are helpful, researchers often fail to consider or report the clinical relevance of their studies. Furthermore, research is notorious for producing contradictory findings, which causes confusion for therapists in determining the best course of action to take when working with specific clients. The practical implications of a particular research study can indeed be diffi cult to identify, and many researchers fail to make these implications clear. Thus, to date, many therapists have been limited in their ability to access and benefit from research-based information to help guide them in their clinical work.

Personal Challenges Associated with Working with Family Violence

Finally, any therapist who has worked with clients impacted by family violence likely can attest to the immense personal challenges that are often brought to the forefront when working with such complex, evocative, and potentially saddening or anger-provoking cases. Despite their extensive clinical training and experience, therapists are first and foremost human, and therefore they are not immune from being challenged emotionally and even spiritually by the dynamics involved in family violence. In recognition of the personally challenging nature of working clinically with family violence issues, this book contains a chapter dedicated to the issue of self-care for therapists. Readers may find it useful to read that chapter first, especial ly if they anticipate that they wil l have a diffi cult time managing their emotional and personal responses to learning more about the various forms of family violence.

The Context of Ethics

All therapists are bound by the professional ethical guidelines associated with their respective credentials and organizational memberships. This book assumes that readers are familiar with basic ethical principles and decision-making guidelines pertinent to their areas of practice. Throughout this book, readers will find case studies in several chapters that illustrate the most pertinent ethical issues they may face when working with clients impacted by family violence. Our discussion of these issues through case studies is grounded in the ethical codes of various related professional organizations, including the American Association for Marriage and Family Therapy (AAMFT; 2001), the American Counseling Association (ACA; 2005), the American Psychological Association (APA; 2002), and the National Association of Social Workers (NASW; 2008). Although each of these codes has its own unique nuances, they are united in their shared foundations in promoting client welfare. Therefore, although the specific standards addressing particular ethical challenges within each code vary, we focus throughout this book on addressing the general themes that can guide therapists in their work with clients impacted by family violence.

The context of safety and lethality issues surrounding the various forms of family violence gives rise to unique ethical challenges for therapists. First, as will be stated throughout this book in many different ways, client safety is the primary consideration for therapists when working with clients who have experienced family violence. As Maslow’s (1954) hierarchy of needs demonstrates, safety is the foundation upon which all subsequent layers are built, including the therapeutic process. This also is consistent with the principles of trauma-informed care, which highlight that safety also must be addressed as the first order of business in the therapeutic process before trauma healing can begin. When applied to family violence-related ethical dilemmas, safety considerations must be the lens through which all alternative courses of action are evaluated. Therapists must be aware that abusive behaviors can present actual threats to the physical, emotional, and psychological well-being of victims and the family members around them (e.g., children), and, in some cases, lives may be at stake. Thus, therapists may face therapeutic and ethical dilemmas when working with victims and/or perpetrators of family violence. Safety must therefore be at the forefront of ethical decision-making processes as they relate to family violence situations.

Ethical issues associated with family violence also are unique in their intersection with legal issues. As will be addressed throughout this book, many forms of family violence are crimes. Therefore, therapists must be informed as to all relevant local, state, and federal laws (e.g., related to mandatory reporting of child abuse, the filing of protective orders, and standards for batterer intervention programs). As such, therapists must ensure that the outcomes of the ethical decisions they make are in accordance with all relevant laws and regulations.

The Research Basis for This Book

One of our major goals in writing this book was to build upon the existing body of research on family violence and to translate that information into useable clinical guidelines for therapists. A focus of our research has been on what we have termed the “domestic violence research-practice gap” (Murray & Smith, 2009; Murray et al., 2010). We define this term as a disconnection between existing research findings and common service delivery practices in … domestic violence prevention and intervention (Murray & Smith, 2009, p. 4). Although the focus of this book is in the area of family violence, gaps between research and practice are quite common in the mental health professions (Murray, 2009). Our observation is that the research-practice gap in this area is somewhat unique given the historical and professional context, in which there is evidence that there has been a history of tension and antagonism between some groups of researchers and service providers (Gondolf, Yllö, & Campbell, 1997; Hamberger, 2001; Murray & Smith, 2009; Riger, 1999; Williams, 2004). As such, building links between research and practice was an important objective of this...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• Foreword
• Preface
• Acknowledgments
• About the Authors
• 1 Overview of a Research-Informed Approach to Responding to Family Violence
• Part I
• Part II
• Part III
• Part IV
• References
• Index