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Intimate Partner Violence: Raising Our Awareness as Clinicians

healthcare and social problems concept - womans hands holding puAs clinicians, we want to prevent trauma by raising awareness of dating violence and sexual assault prevention. Most people don’t know how terribly common sexual assault is, or what to do about it.

Intimate partner violence may be even more prevalent than sexual assault. Reports show that one in five women have experienced sexual assault. But nearly one in five women have experienced severe physical violence from an intimate partner, says the National Domestic Violence Hotline. One in three women have experienced some form of intimate partner violence, according to the National Coalition Against Domestic Violence (NCADV).

Stopping intimate partner violence presents its own set of challenges. Domestic violence often involves a co-dependent relationship and two people with histories of trauma.

But it only takes one well-informed, well-prepared adult in the lives of victims to make the difference between someone staying trapped and getting help.

No Typical Profile

Abusers and victims come from all social groups, ethnic groups and professions. Most victims are female between 18-24, but victims also include men.

Domestic violence is about power. Any physical violence in a relationship is harmful and unhealthy. It can happen when one person is having trouble managing their own stress and aims to cope by controlling their partner through force and fear.  The offender uses threats and actual physical or emotional harm to exert control.

Victims often feel responsible for the emotions of their partner. A victim may think that the violence is ‘not his fault’ or ‘he didn’t mean it.’  They endure abuse, hoping that their partner will change. Victims often feel powerless, unable to stand up for themselves, hopeless, worthless and beyond help.  None of this is true.

Many couples who experience intimate partner violence witnessed violent relationships as children. It may be hard for either person to imagine a relationship working another way.

What Needs to Change; Recommended Treatment

average, it takes a victim seven times to leave a relationship that remains abusive, before moving on for good. Why does this happen?
Most people — including the victim — want to believe their partner won’t hurt them again.  They may make statements like:

“Well, he didn’t mean to do that.”

“Well, he apologized.”

“She promised not to do it again.”

An important question must be asked:  What has changed so that it doesn’t happen again? Something more needs to happen than an apology, an excuse or a promise.

Each person needs help. The recommendation from most professionals who deal with domestic violence — including me —  is against therapy as a couple. Rather, we recommend that partners work through individual therapy until there is some growth or change to make it safe enough for therapy to happen together.

Violent behavior is a choice. “It is not caused by drugs or alcohol (although these things can make abuse worse) or by anything the victim did to ‘provoke’ the abuser,” says the Office for the Prevention of Domestic Violence in New York. “Abuse is not caused by a bad day or ‘buttons that got pushed’…. Abuse is always a choice. And it’s never the victim’s fault.”

An important goal of therapy is to help the abuser develop healthy ways to regulate emotions and therefore, make different choices.

The victim of abuse also needs to develop abilities for self-awareness and self-care. Therapy is a vital opportunity to experience what it means to feel safe and fully respected in a relationship. This goal is one of the most important  of the therapeutic relationship between the survivor of abuse and the therapist.

The Importance of Recognizing the Risks to Children

It’s important to talk about what happens children in violent households.  It has a devastating impact on the emotional, physical and neurologic development of children and the consequences are lifelong.

The extent of exposure to violence during childhood in the United States is staggering.  “At least a third of American children have witnessed violence between their parents. Most have witnessed multiple instances,” reports the Child Witness to Violence Project.

This fact isn’t just about kids being in the other room.  They hear it. They see it. It’s somewhat common for children to try to break it up, when they can be physically harmed.   We are still learning about the neurological and emotional damage caused by trauma experienced during childhood.

One landmark study, known as the Adverse Childhood Experiences (ACE) Study by the Centers for Disease Control and Prevention and Kaiser Permanente asked 17,000 adults about their exposure to trauma up to age 18. It included questions about witnessing a mother or stepmother treated violently.

The study also followed health conditions among participants long term.  It revealed the lifelong consequences of trauma.

“Children with toxic stress live much of their lives in fight, flight or fright (freeze) mode,” writes Jane Ellen Stevens, founder of Aces Too High.

They respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults. Some kids do all three.

With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamine, inappropriate sex, high-risk sports, and/or work and over-achievement.

Children of domestic violence live with toxic levels of terror every day, and grow up seeing the world through a lens distorted by trauma. As adults, too many trauma survivors repeat the unhealthy violent relationship model they grew up with. This behavior puts future generations at risk for continuing the cycle of intimate partner violence.

How to Stop the Cycle of Intimate Partner Violence

Some couples get help because they become aware of the impact on their children.  Others get help because someone intervenes.

A child’s stress from violence at home is known to emerge in behavior problems, lower school performance and mistrust of adults.  Often the life-altering change comes through the child because an important caring adult notices something, and becomes appropriately informed.

For example, a school counselor can play a life-changing role for a child or adolescent impacted by intimate partner violence. The counselor may be able to engage with a student who appears exhausted, and can ask “Why are you so tired?” A good counselor will keep asking to understand the situation and guide next steps such as: maintaining a safe place to talk, thinking through a safety plan, knowing where to get help, deciding what to do in an emergency.

What Can Friends and Family Members Do?

The most important thing is to be there and offer support. It does not help to criticize or berate the violent partner. This reaction usually prompts the victim to become more protective of their partner, and more isolated, and you become one less person to turn to.

When you’re with a friend you fear is in an abusive relationship, being supportive means  listening, offering assistance and a compassionate point of view:

  • “I am so sorry this is happening to you. It sounds so incredibly stressful.”
  • “It must be so scary when he loses control. I am so glad you told me.”
  • “I can’t imagine how hard this must be for you. You must be so worried. I’m here any time you want to talk.”

Your friend may not be ready to hear: “I will take you to a therapist.  I will find a therapist for you.”  Family members and close friends cannot usually “rescue” an adult with an abusive partner.

Helping is a matter of being informed so you can point the person to the right resources. Where are the shelters? Who can they go to? What is the hotline number? Where can they safely make the phone call?

In the city of Alexandria, where I work, there is a support network not just for the victim, but for family members and caring friends who want to help.  See More Resources below.

If someone you care about opens up and tells you their awful secret of abuse, the next step is just to be supportive.  “I’m here, you can talk to me.” Building a culture of support for victims of abuse, and their children, is vitally important to reducing rates of domestic violence.

Most victims don’t ask for help, whether they have experienced domestic violence or sexual assault, because they feel ashamed. They believe it’s their fault. The difference we can make comes in the form of support. We can help when we are able to reach out with a message of reassurance and compassion that the abuse is not their fault, and that there are resources to guide and protect them.

It’s important to offer calm reassurance that they are not alone. By listening, acknowledging their experience without judging and being informed and available, you can be the bridge between the despair they know and the support they need.

More Resources

Articles

Dating Violence: Being Better Prepared to End Abuse by Robyn E. Brickel, MA, LMFT

Sexual Assault: What It Looks Like, How to Prevent It and Help Survivors Recover by Robyn E. Brickel, MA, LMFT

 Why Domestic Violence Occurs and How to Stop It by Lisa Firestone, PhD

 

National Hotline

National Domestic Violence Hotline: 800-799-7233

Advocacy and Education

Saving Promise works for public awareness and prevention to reduce the number of individuals and families that are impacted by intimate partner violence

No More, a public awareness campaign to end domestic violence and sexual assault

One Love

Resources for Teens

Break The Cycle:

A national organization to empower youth to end dating abuse and manage emotions.

Love is Respect

A website, hotline, chat line and text-based support to get help for yourself or someone else. A partnership between Break the Cycle and the National Dating Abuse Helpline.

One Love Foundation

Founded in 2010 to honor Yeardley Love, a UVA senior and lacrosse player who was beaten to death by her ex-boyfriend. It reaches out to young people across the country to raise awareness about the warning signs of abuse.

Youth.gov: Victim and Survivor Resources

Includes hotline phone numbers, and links to help those in abusive relationships, and promote prevention.

Smartphone Applications

Circle of 6

iPhone and Android app designed to give college students a fast private way to reach six friends they choose.

Love Is Not Abuse

iPhone app designed for parents, to help them recognize signs of relationship abuse through technology, cell phone messages, and social networking. It helps parents understand the nature and impact of digital dating abuse, and links parents and teens to resources for help, and the Love Is Not Abuse curriculum for teens.

My Plan App

Offered by the One Love Foundation, this app helps a person determine if a relationship is unsafe and create an action plan to leave safely.

For Family and Friends of Abuse Victims

Love Is Respect Safety Planning

An interactive guide for family, friends and someone experiencing abuse, to help them find safety and know how to act in different scenarios.

In Alexandria Virginia

Alexandria Domestic Violence Program 703-746-4911 – Excellent resources for family and victims of abuse.

 

Intimate Partner Violence: Raising Our Awareness as Clinicians