Working With Violence

Policies and Practices in Risk Assessment and Management

Judith Milner, Steve Myers

• Publisher: Bloomsbury Academic
• Year: 2007
• Print ISBN:
  9781403943071
• Edition: 1
• eBook ISBN:
  9781350313743
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Assessing and managing violence places a heavy burden on practitioners in social work, criminal justice and health care settings. Milner and Myers examine current explanatory theories of violence and how these influence assessment and intervention. Using case studies and a variety of agency documents, the strengths and weaknesses of these approaches are weighed up and a framework is presented to help workers looking to effect positive change.

CHAPTER 1

Introduction

Our starting point in writing this book is that everyone who works with people in whatever capacity will at some time have to respond to violence; whether this is a young child telling a nurse of an abusive experience, an adult with learning disabilities telling their carer about experiencing harassment, a young woman explaining to her social worker that she has aggressive feelings towards her baby, a boy who has sexually abused his sister talking to their youth offending team worker, or a frail older man in hospital who tells the community care manager he does not want to go home because his wife physically assaults him. You will come across these situations as a student on placement or as a qualified practitioner working with people, and responding to violence is an increasingly common element within social and health education and training programmes. When you turn to a book for guidance on how to deal effectively with these complex manifestations of violence, you will quickly discover that the literature divides unhelpfully into two distinct types. First, there are a number of books telling you how to work with people who are violent (mainly men and mainly groupwork). Second, there is a vast literature on how to respond to the victims of violence (mainly female and individual counselling). You will probably find that the situation you are dealing with is far more complicated; for example the young woman who has aggressive feelings towards her baby may well tell you that she has been a victim of abuse too. Similarly the older man who is physically abused by his wife may turn out to have been financially and emotionally abusive to her for most of their lives. Also with older people their expression of violence and/or their acceptance of violence towards them will have been mediated through culturally informed attitudes. Older people have not necessarily been informed by feminist thinking on the courses of male violence.

Professional practice is also informed by agency policies and practices, which in turn may change regularly in response to the large number of government consultation papers, guidance and legislation. Not only does government policy change frequently, but it varies from government department to department. For example, in the United Kingdom the Home Office has much to say on male violence, favouring a cognitive behavioural explanation and treatment. At the same time whilst cognitive behavioural programmes are recommended for male offenders within the community and prison, it largely ignores organized violent crime although it is increasingly expecting people who work with people to be able to rescue and rehabilitate those who are the victims of sex trafficking. On the other hand the Department for Education and Science has very much more to say about victims, especially children, favouring psychotherapeutic explanation and treatment. What dominates in this approach to violence is a commitment to reducing the domestic violence inflicted by men on women and reducing the emotional and physical harm to children. Despite a common interest in domestic violence across government departments, government guidance reflects different ways of intervening with victims and offenders.

These sources of guidance can often prove inadequate for dealing even with what are quite common situations. For example, a family where the man is violent to his wife but no-one wishes him to be removed from the home, a family where both the man and the woman fight each other physically and emotionally, or a less traditional family where one woman regularly beats up her female partner. In this book we acknowledge that violence in relationships is almost always complex and that there is no single way of dealing with it. We are aware, however, how tangled it becomes when a worker attempts to combine two totally different approaches to one situation. For example, what is the rationale for deciding that an adult who is violent requires a brief cognitive behavioural programme to correct their distorted thinking, whilst the victim requires psychodynamic intervention over a long period of time to repair the emotional damage?

Using one single (probably familiar) domestic violence scenario throughout the book we explore a range of interventions, detailing the theoretical basis on which they have been developed and critically analyse their effectiveness in different situations. At the end of each chapter are brief examples of government and agency guidance that have been developed from the theory and intervention outlined. Our intention in this is to make clear where an intervention originates (the theories and research findings), how selective use has been made of this material in the development of people’s working hypotheses about violence, and the actual interventions themselves and where they can most effectively be used. We illustrate them with a single case example but the reader will be able to examine examples from their own practice. The examples of government guidance, agency policy and examples of practice at the end of each chapter allow the reader to reflect on how they have been influenced by the theories outlined. We aspire to making the links between social policy and practice more transparent.

We hope that this book will be useful both to students trying to make sense of different ways of working with violence in different placements and to experienced practitioners who find that their multi-disciplinary colleagues hold different allegiances to different interventions (and whose agency policies are informed and regulated by their respective government departments which in themselves take often contradictory theoretical treatment positions). We also provide ideas for informing your practice in reducing risk and promoting the safety of the people you work with.

In Chapter 1 we emphasize the complexities of violence, outlining the social, cultural and political context in which it is constructed and identifying the key drivers of current explanations of, and responses to, violence. We look at the role of the media in influencing perceptions of the prevalence and severity of violence, contrasting this with official statistics and political statements. We then outline government policies and strategies, highlighting the very real contradictions, complexities and confusions that exist despite the confidence with which government guidance promulgates specific ways of working, promoting them as effective, evidence-based and straightforward. We then address some of the consequences for workers attempting to reduce risk and promote safety within these narrow frameworks.

In Chapter 2 we explore some of the key issues in the assessment of violence, including the notion of ‘risk’ and the different ways in which assessment can be constructed. The models and protocols commonly used to assess violence are critically analysed in terms of their limitations and strengths. Clinical and actuarial approaches are explored, questioning the usefulness of dynamic and static risk factors. The consequences of increasingly sophisticated ways of identifying people who may be ‘risky’ at the expense of developing effective risk-reduction approaches is also explored, particularly the dangers of pathologizing those subjected to them and how this undermines the traditional values of social care.

Chapter 3 introduces the earliest and most enduring approach to working with violence in social and health care. There are three main components: how interpersonal violence is understood in terms of a response to grief and loss (attachment theory); how the theory informs risk assessment; and the implications for prevention and intervention. As attachment theory evolved from psychoanalytic theory and practice this is briefly described. The research evidence supporting attachment theory as an explanation for interpersonal violence is presented. The clinical implications of attachments for the prediction of violence and the assessment of risk are explored using the examples of child, sibling, peer, spouse and elder abuse and the practice implications are critically explored.

Chapter 4 explores a currently favoured approach to working with violence (particularly offenders), that is cognitive behavioural therapy. We outline how the theory explains violent behaviour; how it is used in the prediction and assessment of violence and the various forms it takes in managing violent behaviour. This theory has become an increasingly influential one in the development of policies, protocols and practices to tackle violence and has made claims to be the most effective intervention. We explore the evidence base for this.

Chapter 5 focuses on Feminist explanations of violence, particularly how men’s violence to known women and their children is understood in terms of patriarchy; how this theory influences risk assessments; and the implications for prevention and intervention. The various forms of feminism are briefly introduced and the huge impact of ‘second-wave’ feminism on professional practice and government policy and guidance is explored. The limitations of this theory as an explanation for all family violence is also discussed, with reference to elder abuse, same-sex violence, female sexual abuse, and female-on-male violence.

Chapter 6 looks at the changing expectations of mental health services in responding to and managing violence and the potential for violence with people, especially those who also use drugs. How this has been influenced by political and media representations of violence associated with those who have mental health problems is outlined, and legislative initiatives are critically analysed. The effectiveness of traditional classification and treatment paradigms are considered within the demands made on mental health services to deal with both offenders and victims within both hospital and community-based programmes.

Chapter 7 introduces Solution Focused approaches which are emerging ways of working with violence. Unlike the more established approaches, it does not attempt to explain and categorize violent behaviour, on the grounds that it is not necessary to understand a problem to arrive at its solution. The basic principles and techniques of solution focused practice are described, followed by a detailed discussion of assessment and intervention using a signs of safety approach. Outcome research is detailed, plus examples of how solution focused practice ‘works’ in a variety of service provider settings.

Chapter 8 introduces another emerging approach to working with violence, Narrative Therapy. Although it shares certain commonalities with solution focused approaches, it is more explicitly influenced by postmodern theorizing and deconstructs the problem in order to understand, assess and reduce risk. It takes a more explicitly ‘political’ stance through the recognition of power relations within society and how these impact on people’s behaviour and potential for change. The theoretical principles and practices are described and its usefulness in working with violence is critically evaluated.

Using the case example, Chapter 9 brings together the various approaches outlined previously, assessing their potential effectiveness within a criminal justice policy which emphasizes the safety of victims and the control and management of offenders. The limitations and pitfalls of government policy, including the What Works agenda, are also summarized.

Case example: Mark, Kelly, Billy and Luke

This example has been constructed from our experiences of working across a range of violences and (of course) is neither clear-cut nor discretely drawn, as most lives are complicated, messy and cross professional boundaries.

Mark (28 years) and Kelly (24 years) have been referred to a Domestic Violence Programme by their health visitor following an incident when Mark took a hammer to the front door which Kelly had locked behind him when he stormed out of the house during an argument. Kelly was very frightened and rang her father. He arrived and had a noisy altercation with Mark which led to her father telling Mark that he was not good enough for her and to get out of her life. Mark and Kelly were reunited the next day. She has acco...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• List of Figures
• Acknowledgements
• 1. Introduction
• 2. Assessing Violence
• 3. Grief and Loss: Psychodynamic Approaches
• 4. ‘Wrong-Thinking’: Cognitive Behavioural Approaches
• 5. Challenging Men, Supporting Women: Feminist Approaches
• 6. ‘Mad and Bad’: Mentally Disordered Offenders
• 7. Safety Building: Solution-Focused Approaches
• 8. Deconstructing Problems: Narrative Approaches
• 9. Conclusion: Towards Effective Practices with Violence
• Bibliography
• Index of Authors
• Index of Subjects