Domestic Violencel Ceu Course for lmft, social workers, counselors

"Upon completion of this program, the healthcare professional will be able to:”

1. Describe the assessment tools used with victims of partner abuse.
2. Describe intervention strategies at various stages of domestic violence treatment.
3. Find access to available community resources.
4. Determine what cultural factors may be involved in assessment and treatment planning of domestic violence cases.
5. Describe the dynamics and resistances from those experiencing same sex violence.

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Domestic Violence is defined as violence or mistreatment an individual may experience at the hands of a marital, common-law, former or same-sex partner. The abuse may happen during a relationship or after it has ended. There are many different forms of abuse, below is a list of the types of abuse. A victim can experience more than one kind of abuse at a time.

Physical abuse may include the use of physical force that can include injuries, including beating, hitting, pushing, choking, and kicking. Physical abuse can include threats and/or assault with a weapon. Other forms of physical abuse may include confinement or restraint.

Sexual abuse and exploitation includes all forms of sexual assault including rape, coercion and sexual exploitation. Forcing someone to participate in unwanted or unsafe or degrading sexual activity, without that persons consent is abusive and against the law.

Emotional abuse includes verbal attacks, such, social isolation, intimidation or exploitation to dominate another person. Stalking including threats to a person or their family is abusive behavior.

Economic or financial abuse includes withholding money that is necessary to buy food or medical treatment or preventing a partner from working while withholding money. These are also forms of economic abuse.

Spiritual abuse includes using a person's religious or spiritual beliefs to manipulate, dominate or control them. It may include preventing someone from engaging in spiritual or religious practices, or ridiculing their beliefs.

The victim appears to be afraid of their partner’s temper. The victim is compliant because they are afraid of what their partner might do? The victim makes decisions based on how they expect the abuser to react. The victim avoids expressing their feeling and opinions to avoid setting off the abuser. The victim feels ashamed of and responsible for the partner’s abusive behavior. The victim describes an obsessive fixation placed upon them and may be accused of having an affair with another person. The victim reports being kicked out of the home without means to care for themselves or their children. The victim reports that they have been cut off from all financial matters and has to go without finances to care for the family.

Most interventions employ a mixture of theories in their curriculums, the most common of which is a psychoeducational model that encourages profeminist attitude change while building interpersonal skills using cognitive-behavioral techniques. Three categories of theories of domestic violence dominate the field. Each locates the cause of domestic violence differently, and each theory leads practitioners to employ different approaches to batterer intervention:

Society and Culture - Social and cultural theories attribute the problem to social structure and cultural norms and values that endorse or tolerate the use of violence by men against women partners. The feminist model of intervention educates men concerning the impact of these social and cultural norms and attempts to resocialize them by emphasizing nonviolence and equality in relationships.

Batterer intervention programs were started in the 1970s when feminists and others brought public attention to the problem of domestic violence and grassroots services began to be established in response. The feminist perspective has influenced most batterer intervention programs.

Central to the perspective is a gender analysis of power, which holds that domestic violence mirrors the patriarchal organization of society. In this view, violence is one means of maintaining male power in the family. Feminist programs, which attempt to raise consciousness about society’s sex-role conditioning and how it constrains men’s behavior, present a model of egalitarian relationships based on trust instead of fear.

Support for the feminist analysis comes from the observation that most batterers, when “provoked” by someone more powerful than they, are able to control their anger and avoid resorting to violence. Further support comes from research showing that batterers are less secure in their masculinity than non-batterers.

The Family - Family-based theories of domestic violence focus on the structure of the family, interpersonal interactions within the family, and the social isolation of families. The family systems model of intervention focuses on developing healthy communication skills with a goal of family preservation and may use couples therapy, a treatment approach prohibited by 20 State standards and guidelines regulating batterer intervention (to protect the safety of the victim).

Couples counseling, an intervention based on family systems theory, is controversial because of its failure to assign blame for the abuse to one person and to identify a victim. Couples counseling is also considered dangerous to the victim because it encourages the victim to discuss openly issues that may spark later retaliation by the batterer.

This model regards the problem behaviors of individuals as a manifestation of a dysfunctional family, with each family member contributing to the problem. Both partners may contribute to the escalation of conflict, with each striving to dominate the other. In this view, either partner may resort to violence. Intervention involves improving communication and conflict resolution skills, which both partners can develop. It focuses on solving the problem rather than identifying the causes.

The Individual - Psychological theories attribute domestic violence to personality disorders, the batterer’s social environment during childhood, biological disposition, or attachment disorders. Psychotherapeutic interventions target individual problems and/or build cognitive skills to help the batterer control violent behaviors.

Attachment theory -a form of social learning theory, focuses on the interaction of caregivers with their children and the impact of that first attachment on an individual’s ability to establish safe and healthy relationships later in life. Batterer interventions based on this theory attempt to facilitate secure attachments between batterers and loved ones (intimate partners, children, and parents).

Psychodynamic approaches target the underlying psychological cause of the violence, while cognitive behavioral approaches teach batterers new patterns of nonviolent thinking and behavior. These perspectives, which focus on the individual, hold that personality disorders or early traumatic life experiences predispose some people to violence. Being physically abusive is seen as symptomatic of an underlying emotional problem, which may be traced to parental abuse, rejection, and failure to meet a child’s dependence needs.

From this perspective, two forms of batterer intervention—individual and group psychodynamic therapy and cognitive-behavioral group therapy— have evolved. The former involves uncovering the batterer’s unconscious problem and resolving it consciously. Although a recent study revealed that the approach retained a higher percentage of men in treatment than did a feminist/cognitive-behavioral intervention, critics fault psychodynamic therapy for not explaining what can be done to stop the behavior, allowing the behavior to continue until the underlying problem is solved, and ignoring the cultural acceptability of male dominance.

The cognitive-behavioral approach focuses on the conscious rather than the unconscious and the present rather than the past to help batterers function better by modifying how they think and behave. The approach is compatible with a criminal justice response, simply addressing the violent acts and attempting to change them, without trying to solve larger issues of social inequality or delve into deep-seated psychological problems. Feminists fault the approach for failing to explain why many batterers are not violent in other relationships.

Critics claim the feminist perspective overemphasizes sociocultural factors to the exclusion of traits in the individual, such as growing up abused. In their view, feminist theory predicts that allmen will be abusive. Other criticisms hold that feminist educational interventions are too confrontational and as a result self-defeating because they alienate batterers, increase their hostility, and make them less likely to enter treatment. Another concern, revealed in some evaluations, is that the education central to the feminist program may transmit information but not deter violent behavior.

It is important for criminal justice professionals to understand the assumptions and goals of service providers whose interventions have divergent theoretical bases, because not all intervention approaches employ techniques that are equally compatible with the goals of the criminal justice system—protecting the victim as well as rehabilitating the offender.

Both feminist educational and cognitive-behavioral interventions can be compatible with the goals of the criminal justice system—protecting the victim as well as rehabilitating the offender. However, feminist educational programs offer some advantages. By contrast, family systems interventions conflict with criminal justice goals by failing to identify a victim and a perpetrator, an identification the law requires.

The origins of domestic violence are the subject of active debate among victim advocates, social workers, researchers, and psychologists concerned with batterer intervention. More than in most fields, the theoretical debate affects practice. Over the last two decades, a number of practitioners representing divergent theoretical camps have begun to move toward a more integrated “multidimensional” model of batterer intervention in order to better address the complexity of a problem that has psychological, interpersonal, social, cultural, and legal aspects.

In practice, few batterer programs represent a “pure” expression of one theory of domestic violence; the majority of programs combine elements of different theoretical models. As a result, when discussing program theory with batterer intervention providers, criminal justice professionals need to understand not only the primary theory the program espouses but also the program's content, because programs may identify with one theory but draw on or two more theories in their work.

Experts caution criminal justice agencies against accepting an eclectic curriculum uncritically: program components borrowed from different theoretical perspectives should be thoughtfully chosen to create a coherent approach, not a scattershot attempt hoping to hit some technique that works.

The primary intervention strategy for spousal and partner abuse is to insure the safety of the victim and children. The confidentiality of the victim is to be maintained unless it conflicts with the safety of the children.

Many people who work with violent families have noted a pattern or cycle of violence. While there is no uniformity on how long a phase lasts, there seems to be a pattern, however: the tension building phase, the explosion or acute battering incident, and the calm, loving respite. There are also other models of domestic violence dynamics.

In phase one, the tension builds. In this phase the abuser becomes increasingly edgy. The victim, noticing this behavior, may try to calm or appease the abuser in ways that have worked in the past. There may be minor outbursts of violence for which the abuser may quickly apologize using such words as "I'm really sorry that I hit you, but if you only had (or hadn't) done . . ." Usually the victim forgives and assumes the guilt for these incidents. The victim will rarely become angry because she fears that her anger would serve to escalate the violence. The abuser is aware of his inappropriate behavior even if he doesn't acknowledge it. This serves to make him even more fearful that she will leave him. He attempts to keep her captive by being more abusive, possessive and controlling. His ability to defend these assaults or to placate his victim become less effective. The tension builds to a point where an assaultive explosion is inevitable.

Phase two is the shortest and most violent part of the cycle. It may begin with the abuser attempting to teach the victim a lesson, not with the intent of doing her physical injury, although this is the result of his unrestrained rage. At the end of the episode the abuser cannot fully understand or remember what has occurred.* Although the victim will often let her anger out during this phase, she does not usually fight back because she believes that to do so will only bring her more abuse and injury. Although most victims are seriously beaten at the end of this phase, they consider themselves "lucky" for surviving and will often placate the abuser by denying the extent of their injuries.

Phase three is a period of calm.** Some victims, sensing that phase two is in-evitable, will "encourage" its appearance and completion because they know that once the violence of phase two is over, phase three brings the "reward" of a kind, caring, if not contrite, partner. The abuser is usually sorry for his behavior even if he does not acknowledge this. He promises never to do it again and the victim wants to believe him. He may even become especially helpful and compromising in his behavior. Just prior to this phase a victim may have sought outside help, perhaps in connection with treatment for injuries. The appearance of her idealized, loving husband during this phase provides her with a glimpse of what she hopes for -- that people who truly love one another can overcome all odds. The apparent calm and bliss of phase three often undercuts a victim's interest in seeking and utilizing help. The cycle of violence inevitably continues as phase one behavior unfortunately reappears.

Not all violent situations follow this pattern. Some abusers have been known to wake their victims up with physical assaults. In some cases, violence occurs only sporadically while other abusers engage in violent behavior of some form on a consistent or daily basis.

"He would bring me flowers and gifts the very next day after beatin' me... I used to love the day after until things were getting worse and worse." He would say he was sorry and promise to change, but then about one month later he would go right back to kicking and punching. He even grabbed my throat once!"

"I don't want to hit her, but she keeps nagging me. It is just like she wants me to hit her."
"The man is the head of the wife. I have the right to do what I have to do to keep things in order."
"Hitting actually helps both of us. It relieves all the tension I've built up, and it makes her behave. She treats me better and I treat her better after we've had a little fight."
"All I ever have to do is yell at her. I don't hit. I'm not a wife beater. She does what I tell her, and as long as she does I will never hit her."
"I just do what my Dad did, and they had a good marriage."
"If I was married to somebody else, this wouldn't happen. I'm not that kind of person."
"It must be okay. Last time we had a fight she went and saw her pastor and he sent her home."
"All I know is what I see on T.V. and what I see is people fighting and the stronger person winning."
"The military taught me that this life is the survival of the fittest. I'm a survivor and I ain't going to be dominated by any women."
"I think secretly she likes it. I think she does it because she likes it when we make up."
"Look, I've a responsibility to my family. I go out and make a living and she stays home and takes care of the kids. If she isn't going to pull her own weight I'm not going to let her get away with it. They wouldn't let me get away with it at work. Anyway, the guys at work think it is all right to hit once in a while if the wife really needs it. It's just part of marriage."
"I love my wife. If I didn't love my wife I wouldn't hit her, I'd just leave."

Batterers are counseled by helping professionals or voluntarily seek assistance from social service agencies with considerably less frequency than victims of battering. Much of the assistance they obtain is court-ordered and consequently sporadically received. As a result, much of the data on batterers comes from information provided by victims and from court-ordered programs.

Not all batterers are alike, but they often share some common characteristics. Batterers appear to:

have intense, dependent relationships with their victims;
have low self-esteem;
believe all the myths about domestic violence;
be traditionalists, believe in male supremacy and stereotyped masculine sex roles;
have poor impulse control or explosive tempers;
have limited tolerance for frustration and severe reactions to stress;
often present a dual-personality -- loving or violent;
have difficulty acknowledging or describing feelings;
deny and minimize their violent behavior;
not believe their violent behavior should have negative consequences;
be extremely jealous, possessive, controlling and fear they will be abandoned;
be depressed and vulnerable to drug and alcohol abuse.

Why do men batter and continue to batter? Most of the men in batterers' programs have been violent throughout their relationship with their victims. Most often, these men have learned to use violence as a way of managing everyday stress and frustration. They may not use violence at work, because they know that they would be fired. They have unrealistic expectations of themselves and their partners. At the same time, they have low self-esteem. Thus, they are extremely dependent on their partners for their sense of self-worth and for a sense of control over their lives.

Because of this dependency they are often extremely jealous and possessive of their partners. In some cases, the fearful rage that can result has impelled an abuser to murder his partner rather than let her leave him.

Abusers may not like their violence, but they know of no other options. Because most of them cannot accept what they are doing, they will minimize, deny and even lie about their abuse.

"My husband and I are both attractive people and for the most part respected and well liked. We have three children and live in a middle class home with all the comforts one could possibly want."
"For the most part of married life, I have been periodically beaten by my husband. What do I mean by 'beaten'? I mean those times when parts of my body have been hit violently and repeatedly, causing painful bruises, swellings, bleeding wounds, unconsciousness, or any combination of those things."
"I have had glasses thrown at me. I have been kicked in the abdomen when I was visibly pregnant. I have been kicked off the bed and hit while laying on the floor -- while I was pregnant. I have been punched and kicked in the head, chest, face and abdomen on numerous occasions."
"I have been slapped for saying something about politics, having a different view about religion, for swearing, for crying, for wanting to have intercourse."
"I have been threatened when I wouldn't do something I was told to do. I have been threatened when he's had a bad day -- when he's had a good day."
"I was never able to drive after one of these beatings, so I could not even get myself to a hospital for care. I could never have left my young children alone and I certainly could not have left them alone even when I could have driven."
"My husband on a few occasions did call a day or so later to provide me with an excuse which I could use for returning to work, the grocery store, the dentist appointment, and so on. I used the excuses -- a car accident, oral surgery, things like that."
"Everyone I have gone to for help has somehow wanted to blame me and vindicate my husband. I can see it there between the words and at the end of sentences. The clergyman, the doctors, the counselor, the police -- every one of them has found a way to vindicate my husband."
"I've learned also that the doctors, the police, the clergy and friends will excuse my husband for distorting my face, but won't forgive me for looking bruised and broken."

While battered women are different from one another in circumstances and characteristics and vary as much as non-battered women from one another, there are some characteristics that appear to be common to victims of domestic violence. And these characteristics often correspond to the needs of their violent abusers. Victims appear to:

believe all the myths about domestic violence;
be traditionalists about home, family unity and female sex roles;
accept responsibility for the batterer's behavior;
have low self-esteem;
feel guilt, self-blame and self-hatred and deny legitimacy of their own feelings and needs;
show martyr-like endurance and passive acceptance;
hold unrealistic hopes that change is imminent;
become increasingly socially isolated;
act compliant, helpless and powerless in order to appease the offender;
define themselves in terms of other people's needs;
have a high risk for drug and alcohol addictions;
exhibit stress disorders, depression and psychosomatic complaints.

For some women, physical punishment in their childhood was rare or mild, but their homes were controlled, traditional and authoritarian. Other women experienced violence in their childhood homes and appear to expect it in their homes and relationships. Both groups of women cling to the hope that it will never happen again and that the batterer's promise to stop is true.

Battered women often hold fiercely to conventional views of marriage and sex-stereotypical roles. They believe they are responsible for their husband's well being. They make excuses for his behavior. They believe it is a woman's responsibility to insure the peace and success of the family. These women think they can change their partner's behavior by acting more loving or being better wives themselves. They believe they can save their partners. Violence for many has been interpreted as "their cross to bear."

Women also stay because they are socially and economically dependent on their abusing partner.

Some women with children often stay because they cannot imagine how the children will be fed and clothed without the income from their spouse. Others believe that a violent father is better than no father at all. Some women have been told that the family must stay together at all costs.

These reasons combine into what been has called "learned helplessness." The victim becomes passive and submissive because she believes that she has no control over the relationship's violence or her own children's safety.

"I kept on staying with him because I thought all marriages required the wife to suffer." "I did not know I deserved better. I saw my mom get beat and figured what makes me special?"

Domestic violence may be kept from relatives, neighbors, clergy and others, but the children of violent partners know what is happening. In one home there may not be any physical violence against a child whose adult caretakers have an abusive relationship, while in another home there may be physical abuse of the child as well. Either way, a child who lives in a house where domestic violence occurs is a victim all the same.

A home that is characterized by physical, emotional, sexual or property abuse is a frightening, debilitating and unhealthy place. The children in such a home are often unable to be children. They worry about protecting their parents. They are concerned that they not become an additional source of stress or problem, and fear for their own safety and security. They have the burden of carrying around a tremendous family secret.

Children from violent homes often suffer from depression. Some become isolated. Many do not want to bring friends home because of the shame and unpredictability of violence. They may spend much time away from home and get into trouble for truancy, petty crimes or disturbances. Children from violent homes often experience nightmares, sleep disturbances and nighttime bed wetting. A child's ability to handle his or her school work the next day is often adversely affected. Domestic violence incidents often occur during late evening hours, just at the time a child is getting ready for bed, and often wakes them up with shouts and noise.

Children from violent homes often feel responsible for everything bad that happens to themselves or to their parents. If they were neater, quieter, helped more or were smarter in school, maybe the violence would stop.

Domestic violence can also have psychological effects including depression, anxiety, Post Traumatic Stress Disorder (PTSD) and suicide. Victims may also feel anxious, helpless, afraid, demoralised, ashamed and angry and may experience panic attacks. Battered Women Syndrome (BWS) is a psychological condition that is characterized by psychological, emotional and behavioral deficits arising from chronic and persistent violence. The central features of BWS include ‘learned helplessness’, passivity and paralysis. In relation to domestic violence, common features associated with PTSD include anxiety, fear, experiencing flashbacks or persistently reexperiencing the event, nightmares, sleeplessness, exaggerated startle responses, difficulty in concentrating, feelings of shame, despair and hopelessness. There is little doubt that psychiatric illness, particularly PTSD, depression and anxiety is greater among people who have experienced domestic violence compared to those who have not.”

The goal of treatment is to make the victim and perpetrator recognize that Domestic violence is unacceptable behavior. Every human has the right is to live free from intimidation, abuse and violence. The abuser is 100% responsible for his abusive behavior. Domestic violence is not the fault of the victim. No one ever deserves to be abused no matter what is said or done. Violence towards a partner is intentional behavior. Abusers can change their behavior. It is within their control and they can choose to stop. Making changes is not easy. Sufficient motivation is required for change to occur.

When a victim first comes to see you she almost always needs information. It is important to discuss with the victims what their options are and help them to find a way to be safe.

In beginning domestic violence sessions, an advocate or counselor should put safety of the victim first. Developing a safety plan with a client can mean the difference between her getting out of a dangerous situation and her being abused again. Additionally, beginning domestic violence sessions should focus on educating the client on the dynamics of abuse. Teaching clients the dynamics of abuse helps minimize the client's feelings of isolation and helps them to start to look at the abuse in the relationship as something that is not their fault.

Currently, because of the predominance of individual and socio-cultural factors in understanding the etiology of domestic violence, most treatment programs for domestic violence offenders are based on a cognitive behavioral approach. The focus of understanding has been on individual and/or socio-cultural pathologies. Group approaches are also based on the assumption that domestic violence offenders have deficits in knowledge or skills that are necessary for avoiding battering. Building on such assumptions is a treatment orientation which holds that the behaviors of domestic violence offenders can and need to be changed through a re-educational process.

Consequently, the core components of these treatment programs generally include direct education about violence, anger management, conflict containment, communication training, and stress management and raising awareness of patriarchal power and control. The resulting psycho-educational programs usually focus on confronting participants so they will recognize and admit their violent behaviors, take full responsibility for their problems, learn new ways to manage their anger, and communicate effectively with their spouse.

Particularly if the abuse has been happening over a long period of time, the victim is likely to feel depressed, insecure and lacking in confidence and self-esteem. She may be extremely afraid of the situation, and that fear may include a fear of talking to anyone about what has been taking place. Women who experience domestic violence often try to explain it to themselves, and others, by seeing it as their responsibility or fault, and the response of others to their situation may have reinforced this view. Before asking direct questions, it may help to begin with some indirect ones to help in establishing a relationship with the patient and developing empathy, for example:

• Is everything alright at home?
• Are you being looked after properly/is your partner taking care of you?
• Do you get along well with your partner?

The following questions are intended as prompts; it will not always be necessary or appropriate to ask all of these. In particular, the questions tend to focus on evidence of physical assault and injury, but many women who routinely access health care services and who are experiencing domestic violence, will not have physical evidence of injuries at the time.

“I am sorry if someone has already asked you about this, and I don’t wish to cause you any harm, but we know that throughout the country 1 in 4 women experiences violence at home at some time during their life. I noticed that you have a number of bruises/cuts/burns (as appropriate)”

4 Have you ever been in a relationship where you have been hit or hurt in some way?

6 Does your partner often lose their temper with you? If he/she does, what happens?

8 Does your partner get jealous of you seeing friends, talking to other people or going out? If so, what happens?

9 Your partner seems very concerned and anxious about you. Sometimes people react like that when they feel guilty, was he responsible for your injuries?

10 Does your partner use drugs or alcohol excessively? If so, how does he behave at this time?

A major therapeutic hurdle when working with offenders is the issue of motivation. Most domestic violence offenders are involuntary, court-mandated clients who are not self motivated to receive treatment. Many practitioners who work with court mandated domestic violence offenders are only too familiar with defensiveness, commonly manifested in constant evasiveness, silence, phony agreement, and vociferous counterarguments when participants are confronted with their problems of violence. Many participants stop attending the program altogether.

According to one survey, nearly half of the treatment programs faced dropout rates of over 50% of the men accepted at intake.

In addition, some professionals have begun to raise doubts about how a focus on deficits, blame, and confrontation can be conducive to stopping violence or initiating positive changes in offenders. Because blaming is one of the main strategies used by offenders to intimidate victims and to justify their own abusive acts, using confrontation and assigning blame in treatment may re-create a similar and non-helpful dynamic in abusive relationships. The effectiveness of a deficit perspective or a blaming stance in treatment is dubious if one looks at the characteristics of domestic violence offenders.

The most consistent risk markers for violent males have been identified as having experienced and/ or witnessed parental violence, frequent alcohol use, low assertiveness, and low self-esteem. As a result, a high percentage of domestic violence offenders are likely to be insecure individuals at the margins of society who victimize others to boost their own low self-esteem. Studies on personality further indicate that many domestic violence offenders fit the profile of narcissistic or borderline personality disorder.

Women and children constitute approximately two-thirds of all legal immigrants in the United States. Increasing evidence indicates that there are large numbers of immigrant women trapped and isolated in violent relationships, afraid to turn to anyone for help. A survey conducted by the Coalition for Immigrant Rights revealed that 34% of Latinas and 25% of Filipinas surveyed had experienced domestic violence either in their country of origin, in the U.S., or both.
Battered immigrant women encounter obstacles that can be attributed to language, culture, citizenship status, or lack of access to services.

In addition to the physical violence, a battered immigrant woman may experience:

ISOLATION: The abusing partner often keeps his victim isolated from family and friends - and from anyone who speaks her language. He also may not allow her to learn English.

THREATS: The mate may threaten to report her to the Immigration and Naturalization Service (INS) to have them deported. Or he may threaten to withdraw the petition to legalize her immigration status.

INTIMIDATION: He may hide or destroy important papers (such as her passport, identification card, Green card, health insurance card). He also may destroy the only property she has from her country of origin, including important mementos.

ECONOMIC ABUSE: He may report her to the INS if she works "under the table" -- or threaten to do so. He may not let her obtain job training or schooling so she can become financially independent.

EMOTIONAL ABUSE: The abusive spouse may lie about her immigration status. He may write lies about her to her family and friends. He may call her racist names.

CHILDREN USED: He may threaten to take her children away from the United States, or to report her children to the INS. Or he may threaten to hurt them.

LANGUAGE BARRIERS: When a battered immigrant woman tries to get assistance from a domestic violence agency, she may not be able to use the help that is offered because it is not in her language and no one is available to translate.

CULTURAL ISSUES: Services provided by domestic violence programs may not address relevant cultural issues, so the agency may propose ideas that are not culturally appropriate or may not be able to offer her the right kind of assistance.

LACK OF ACCESS TO SERVICES: Domestic violence agencies may not understand immigration laws and issues, and therefore be unable to help her solve her problems. Immigration agencies or attorneys may not recognize the signs of domestic violence, or know how to help

In 2001, women experienced an estimated 588,490 rape, sexual assault, robbery, aggravated assaults and simple assault victimizations at the hands of an intimate, down from 1.1 million in 1993. In 1993, men were victims of about 160,000 violent crimes, and in 2001 men were victims of about 103,220 violent crimes by an intimate partner.

Intimate violence is primarily a crime against women. In 1998, females were the victims of 72% of intimate murders and the victims of about 85% of non-lethal intimate violence.

Women age 16-24 experienced the highest per capita rates of intimate violence (19.6 victimizations per 1000 women.

Intimates (current and former spouses, boyfriends and girlfriends) were identified victims as the perpetrators of about 1% of all workplace violent crimes.

Two-thirds of victims who suffered violence by an intimate reported that alcohol had been a factor. Among spousal victims 3 out of 4 incidents were reported to have involved an offender who had been drinking. By contrast, an estimated 31% of stranger victimizations where the victim could determine the absence or presence of alcohol as perceived to be alcohol-related.

For about 1 in 5 violent victimizations involving perceived alcohol use by the offender, victims also reported they believed the offender to have been using drugs as well.

Women age 35-49 were the most vulnerable to intimate murder, while females age 16-24 were the most vulnerable to nonfatal violence.

Males were more likely to be victimized by a stranger, and females were more likely to be violently victimized by a friend, an acquaintance, or an intimate.

Family members were most likely to murder a young child -- About one in five child murders was committed by a family member -- while a friend or acquaintance was most likely to murder an older child age 15 to 17.

The National Domestic Violence Hotline has received more than 700,000 calls for assistance since February 1996.

Nearly one-third of American women (31 percent) report being physically or sexually abused by a husband or boyfriend at some point in their lives.

It is estimated that 503,485 women are stalked by an intimate partner each year in the United States.

Each year 4 million women are physically abused by their husbands or live-in partners each year.

Studies show that child abuse occurs in 30-60% of family violence cases that involve families with children.

In 92% of all domestic violence incidents, crimes are committed by men against women.

A child’s exposure to the father abusing the mother is the strongest risk factor for transmitting violent behavior from one generation to the next.

Domestic violence can affect children in many ways. Young people may witness terrible acts of violence against their parents or caregivers. Some children may never see the violence, but they may feel the tension, hear the fighting, and see the injuries left behind. Young people may be physically injured themselves if they try to intervene to stop the violence. Children may be asked to call the police or to keep a family secret. No matter the details of a family’s situation, children and young people bear the burden of domestic violence, too.

Children react in many different ways to violence in their homes. Individual children may respond differently even within the same family. Some children may become violent themselves, while others may withdraw. Some may "act out" at home or at school, while others constantly try to act like the perfect child.

Although domestic violence impacts children tremendously, it is only recently that domestic violence has been taken into account when determining child custody in families where domestic violence has occurred. The laws regarding child custody in families with domestic violence histories are still different from state to state. Even when a violent relationship has ended, the abuser may continue to have contact with the children. It is important to plan for the safety of the children and adults in the family at all times.

Children of abused moms have more internalizing problems, externalizing problems and behavior problems.

In a national survey of more than 6,000 American families, 50 percent of the men who frequently assaulted their wives also frequently abused their children. Slightly more than half of female victims of intimate violence live in households with children under age 12. Studies suggest that between 3.3 and 10 million children witness some form of domestic violence annually.

Marital rape is the term used to describe nonconsensual sexual acts between a woman/man and her husband/wife, ex-husband/wife, or intimate long-term partner. These sexual acts can include: intercourse, anal or oral sex, forced sexual behavior with other individuals, and other unwanted, painful, and humiliating sexual activities. It is rape if one partner uses force, threats, or intimidation to get the other to submit to sexual acts.

It is important to note that, although battered women are more at risk for marital rape than their non-battered counterparts, some men will rape their wives and never beat them and vice versa. These issues may be inter-linked or seemingly unrelated. Don’t make assumptions about their victimization based on partial facts.

This involves forced sex combined with beatings. This type of sexual assault is primarily motivated by anger towards the victim. The sexual abuse is either part of the entire physical abuse incident or is a result of the husband later asking his wife to prove she forgives him for the beating by having sex with him.

- The husband uses only as much force as necessary to coerce his wife into sexual activity. This type of sexual assault is primarily motivated by the need for power over the victim. In his mind, he is merely asserting his right to have sex with "his" wife on demand. This is the most common type of marital rape.

The husband’s sexual interests run toward the strange and perverse, and he is willing (or even has a preference) to use force to carry these activities out. This is the least common, yet arguably the most physically damaging, type of marital rape.

It is illegal in all 50 states for a husband to rape his wife. Some states, including Texas, have gender-neutral laws which apply to both spouses

Seventy-eight percent of stalking victims are women.
Eighty percent of women who are stalked by former husbands are physically assaulted by that partner and 30 percent are sexually assaulted by that partner.

To begin talking about this issue we need to educate ourselves and others about the true dynamics of same-gender battering. Battering has long been one of the lesbian, gay, bisexual and transgender community's best kept secrets. In some ways, violence in same-gender relationships resembles violence in heterosexual relationships:

Violence can be physical, sexual, emotional, psychological or verbal. ·

The purpose of abuse is to get and maintain control and power over one's intimate partner. ·

The abused may feel isolated, terrified, and debilitated by the violence.

Abuse does not happen all the time, it often occurs in a cyclical fashion. Unpredictable attacks are a part of the tyranny. ·

The victim/survivor may feel as if s/he cannot do anything right. ·

Domestic violence can be lethal. ·

The myth persists that abuse is a relationship problem and may be mutual.

A sense of entitlement exists among perpetrators; they believe that they have the right to empower themselves by disempowering others. ·

Abuse in the home severely impacts the children living in that home, whether or not they are the direct recipient of the abuse. ·

Substance abuse may make domestic violence more dangerous and damaging.

In other ways, however, violence in same-gender relationships differs from violence in heterosexual relationships:

Lesbians and gay men who have been abused have much more difficulty finding support. The isolation, that already accompanies same sex relationships in a prejudice society, is compounded and made worse by domestic violence. The silence about domestic violence among homosexual people further isolates the victim/survivor as well as the perpetrator. Utilizing existing services may be tantamount to "coming out" which is a major life decision. ·

The battered women's movement avoids the fact that women can be as violent and dangerous as men. It is assumed that two men or two women in a fight constitutes a fight between equals. Gay men often reject the idea that they can be victims within their own community. Gay men and lesbian women approach most shelters, social service agencies, and providers with great caution. Their fear of further victimization through minimizing or disregarding their circumstance remains, along with the fear of rejection and degradation. In all likelihood both the survivor and the abuser may lose their privacy, be "outed" or become the subject of gossip.

criminal court, where the state will prosecute the abuser (possible crimes include abuse of intimate partner, violation of a protection order, elder abuse, murder, rape, assault, kidnapping, false imprisonment, property destruction, vandalism, trespassing, stalking, unlawful possession or concealment of a weapon, intimidating a witness, and many others)

civil court, where you might address violation of a protection order or sue for money damages (possible civil lawsuits include sexual harassment, personal injury)

divorce, or family, court (family violence directly affects divorce proceedings and can be a factor in limiting or prohibiting the abuser’s rights to child custody or visitation privileges) Domestic violence might also involve child abuse and neglect and might impact on other areas of law, such as public benefits, immigration status, etc.

The fastest form of legal help is to get a Court Order of Protection. A Court Order of Protection is an official legal notice, enforceable in court that requires the abuser to stop the violence and abuse. Relief available under a Court Order of Protection can be tailored to specific needs and can address concerns. It can order the abuser to stay away from the victim and can prevent him from contacting the victim by phone, mail, e-mail, fax, or through third parties. It can force the abuser to move out of your home and give the victim exclusive use of the car.

The court may award temporary custody of children to the victim, along with child support, spousal support, and the continuation of insurance coverage. The police can arrest and jail the abuser for violating the order.

To get a Court Order of Protection: Call the local state’s or district attorney or tell the police you want to get one. They will tell you who to contact. The victim will have to go to court. In court, the judge needs to be convinced that the victim has been threatened with violence or that they have suffered abuse. Witnesses, including police officers, can help the case.

Depending on state law and how the court applies it, physical evidence is also helpful, but not essential. Physical evidence could include signs of physical abuse such as bruises, photos of physical damage to property (the table that was smashed, the hole punched in the wall), or objects used in an assault (the ashtray thrown, the knife brandished).

The order should focus on your specific safety needs. If the victim has children and is concerned for their safety, they must specifically request custody and visitation restrictions or “no contact” orders. They must call the police every time the order is violated. They should make lots of copies and carry a copy everywhere, especially if it has custody or visitation provisions.

A protection order is one tool that can help gain independence and stop the abuser from hurting the victim and children. They should contact a domestic violence advocate and a qualified attorney in your area to discuss ways of ensuring the safety of themselves and their children, which can include getting a protection order.

There are thousands of staff and volunteers in communities across the country who assist, support, and serve victims of domestic violence. Often these professionals provide a lifeline to women and children who desperately need assistance and direction but are confused by the dynamics of their victimization, the thought of leaving a violent environment, and, in some cases, entering into the criminal justice system.

Multiple responsibilities are associated with assisting victims of domestic violence:

Responding to crisis calls from victims through twenty-four-hour hotlines.

Accompanying or following law enforcement officials who respond to domestic violence incidents.

Providing safety and shelter to battered women and their children.

Providing follow-on services to increase the number of victims who file charges or seek protection through the civil or criminal courts.

Advising victims about their legal rights throughout the criminal justice system. Advising victims about information and resources relevant to protection and security, divorce, custody, and visitation.

Helping victims develop "safety plans."

Providing information and assistance to victims who leave battering environments, including temporary and long-term housing, employment training (or re-training) and placement, and child care.

Providing assistance in financial matters, including child support, restitution, victim compensation, and financial planning.

Upon request, acting as liaison between the victim and the criminal justice system.

Providing peer counseling.

Providing support groups.

Providing information and referrals to community resource agencies, including public assistance, child protective agencies, public and mental health agencies, social services, and schools.

Providing training to law enforcement, criminal justice, social service, mental health, and other allied professionals about the dynamics of domestic violence and the specific rights and needs of domestic violence victims.

Working to establish or strengthen a coordinated community response to domestic violence and its victims.

Generating greatly needed public awareness about domestic violence and its effects on victims, witnesses, communities, and society in general.

Working to affect changes in laws, agency policies, protocols, and programs that enhance rights and services for victims of domestic violence.

The power to transform people attributed to alcohol and drugs has a basis in personal experience. Anyone who has ever been intoxicated on alcohol or other drugs understands how this works. In fact, the transformative capacity of substances may come to be expected by those who use them. If someone is motivated to feel more powerful, more social, more talkative, more attractive, more sexy, or more aggressive, and if they expect their substance of choice will facilitate this transformation, more often than not, the substance complies. If a man experiences a need to appear powerful or to dominate others, and if he attributes this capacity to alcohol (or to any other drug), he is far more likely to experience himself as powerful after drinking or drugging. For men who experience themselves as powerless, one motivation for drinking or drugging is to increase their experience of personal power (McClelland, 1975).A power model of alcohol and domestic violence views alcohol abuse and woman abuse as rooted in men’s drive for power over others (Gondolf, 1995).

One particular aspect of drinking behavior, drunkenness, may be an important means of controlling a partner’s behavior by increasing her level of fear (Hutchison, 1999). The increased unpredictability of a man’s behavior while drunk or stoned, observed over time, increases the chances that a woman will behave according to a man’s wishes because of fear for her safety. Observing the effects of his drunkenness reinforces the alcohol-control connection, increasing the likelihood it will be repeated. By themselves, none of these theories explain the high rate of co-occurrence or the dynamics of substance abuse and partner abuse. In time, other theories will be developed that better capture the variation in violent behavior linked to substance abuse. At present, we must be constantly seeking what facts exist in order to inform our practice and policy when these two problems do co-occur. High levels of blood alcohol increase the likelihood of cognitive distortion. A man’s aggression while drinking depends on Bennett, Williams his perceiving his target as aggressive (Leonard & Jacob, 1988). Domestic aggression is more likely at high levels of blood alcohol because the drinker, due to cognitive distortion and to beliefs about women’s aggression, is more likely to misperceive his partner’s behavior as aggressive, abandoning, or overwhelming (Barnett, Fagan, 1993).

Alcohol is not necessary, however, for a man to misperceive his partner as aggressive; any number of conditions, historical and current, could facilitate such misperception. Through experience and acculturation, we develop expectations for the effects of alcohol use. We may believe alcohol makes us sexier, stronger, more social, or more aggressive (Goldman, Brown, & Christiansen, 1987). Lang and et al. (1975) found that male laboratory participants who believed they had drank alcohol displayed higher levels of aggression, independent of whether they were given alcohol. There are possible errors in such experiments, but within the limitations of the science, these experiments suggest that a man’s belief about the effects of alcohol on his aggression is as important as the chemical effects of alcohol. In summary, the link between substance use, substance abuse, and men’s abuse of their intimate partners is far too complex to understand with simple cause-effect language. Use and abuse of chemicals are important considerations in preventing violence against women by men but no more important than the personal and cultural beliefs that support the link between substance and violence. Nor can we be sure on any but a case-by-case basis whether substance abuse precedes or follows men’s violent behavior; overall, both sequences occur, along with situations where there is no relationship at all between substance and violence.

There are many reasons for screening and assessment, but the most important reasons are to increase intervention effectiveness, to improve victim safety, and to increase the opportunities for recovery. Assessment usually occurs at an initial interview, but it may occur during the ongoing delivery of services, at termination, or during follow up or after care. With co-occurrence rates on the order of 50% in populations that come to the attention of health, justice, and social service workers, identification and management of substance abusers and domestic violence victims are critical. In such settings, screening service recipients is necessary. Brief observation, testing, interviewing, or using existing records may indicate the presence of domestic violence, substance abuse, or both. More often than not, the presence of one form of abuse predicts the other form of abuse. Failure to screen batterers and victims for substance abuse in domestic violence agencies or failure to screen all clients for domestic violence in substance abuse agencies is poor practice.

Batterers in batterer programs and substance abusers in treatment comprise a special subgroup, because, more often than not, if one problem is present, the other problem is present as well. However, the response of these two fields of practice to the cross problem has been uneven. Screening batterers for substance abuse is common; less common is screening substance abusers for domestic violence. Historically, substance abuse agencies have paid more attention to violence in the family of origin as a causal link to current dysfunction and less attention to ongoing violence in the lives of men and women in treatment. With the development of criteria for placement of substance abusers in treatment, such as those developed by the American Society of Addiction

Medicine (ASAM) (2001), we now have formal mechanisms for including domestic violence intervention in a substance abuse treatment program. Domestic violence can be incorporated in substance abuse treatment plans under Dimension 5: the potential for relapse. Two other ASAM dimensions also provide convenient places for integrating domestic violence issues in substance abuse treatment plans: emotional/behavioral issues (Dimension 3) and recovery environment (Dimension 6). Based on the prevalence of domestic violence by and to substance abusers, its presence in a written treatment plan should be an issue in an agency’s quality assurance process. Although batterer programs have been more assertive in screening for and intervening with substance abuse, one question that has periodically plagued batterer programs is whether to exclude men from a batterer program if they refuse to get substance abuse treatment when such treatment is clearly indicated. In our opinion, the answer to that question in most cases is no.

Victim safety is the primary consideration in screening for violence by men in treatment for substance abuse treatment. Men screened for domestic violence in substance abuse programs (and in all programs other than domestic violence programs) must be informed that all men in the program are screened for domestic violence. The reason is simple: Men who batter may assume that if they are asked about domestic violence in a setting where they would not expect to be screened (e.g., substance abuse, health care, social service) they are being asked the questions because their female partner has informed the staff of the violence. Screening men without informing them that everyone will be screened is, therefore, a risk to the safety of battered women. Other “Safety 101” issues about which substance abuse agencies may need education are the following: (a) If contact with the female partner is part of screening or assessment, never document the substance of the contact in the man’s chart, and (b) once domestic violence has been identified, there should be, under all but the most conscientious conditions, no subsequent family or conjoint interviews. Our recommendations for those conscientious conditions are discussed elsewhere (Bennett & Williams, 1999).

One of the most crucial skills a victim advocate must possess is the ability to validate the victim's feelings, experiences, and fears. Many domestic violence victims do not view themselves as victims, and fail to realize that domestic violence is a crime perpetrated against many other women.

Victim-centered advocacy involves engaging in a risk analysis with the client based on her perceptions. An advocate needs to find out what a client perceives as risks, and how the advocate can most effectively use this information to advance the woman's plans and priorities. The advocate and the woman may be working at cross-purposes, either deliberately, because they have different goals, or inadvertently, because the advocate does not know enough to ask about the client's concerns.

Victim-centered advocacy involves a three-step process: (1) help the client identify what she perceives as batterer-generated risks and what the effect of staying or leaving may be on those risks; (2) help the client identify life-generated risks and identify how the abuser may manipulate these risks to further his control; and (3) assess the client's past and current safety plans.

The first step involves identification of batterer-generated risks. These include risk of physical injury; risk of psychological harm (including concerns regarding her mental health, drug and alcohol abuse, and suicidal ideation); child-related risks; financial risks; risks to family and friends, including the possible loss of relationship with them; and risks involving arrest and legal status. Gathering this information involves approaching each woman as a unique individual whose concerns may vary from those of other victims; listening effectively; and understanding that a woman's perspective will change as the process unfolds.

The second step in identification of batterer-generated risks is to listen effectively. This involves creating a safe place in which the woman can speak openly. Only then can an assessment of risk factors be made. This approach is quite different from the approach taken by an advocate who says "I only have twenty minutes to spend with the client so I make sure I spend the time describing what services are available to her."

This approach to advocacy does not explore whether any of these services are relevant to the particular woman. In addition, this approach does little or nothing to establish trust with the client. Without a relationship of trust, the client is less likely to contact the advocate again. Establishing trust begins by listening to her story and hearing her concerns and questions.

Battered women analyze the risks to themselves and their children on an ongoing basis. What she fears as the biggest risk will likely change as his tactics change and as she receives information that allows her to reassess her previous concerns. Unfortunately, advocacy often stops at assessment of the physical risks, which is only one of her fears.

An advocate can also assist the client to identify life-generated risks. These include such issues as: finances; home location; physical and mental health; discrimination based on race, ethnicity, gender, sexual orientation, age, disability or other form of bias; and inadequate response from major social institutions including the legal and/or health system and workplace. Beyond identification of the concerns, real or perceived, the client expresses about such life-generated risks, the advocate also needs to assist the client in discussing the methods by which the batterer may manipulate these risks to reinforce his power and control.

Once the batterer-generated and life-generated risks are discovered, the advocate can begin the process of giving the client complete and accurate information to dispel any concerns or explain options to address the concern. The advocate can also begin the process of allowing the woman to engage in decision making and safety planning. As women weigh the risks and their options, the decision they face is more complex than simply whether to stay or to leave. Even if the woman does stay in the relationship, it does not mean she accepts the violence. It cannot be overemphasized that leaving the relationship provides neither a guarantee of her safety nor a guarantee that other risks will be reduced, despite social beliefs to that effect.

Studies show that women typically try many strategies to deal with the abuse. Researchers find the process of change is slow for most battered women, with an average of leaving five times before permanently leaving, and an average length of eight years to leave permanently. As noted earlier, studies also show women who left suffered more abuse than those who stayed.

After identifying the risks, the goal is to help the victim to create a safety plan that addresses the batterer-generated and life-generated risks. Such a plan includes protection strategies, staying strategies, and leaving strategies.

Guidelines for validation of domestic violence victims include the following:

Learn and practice effective communication skills, including verbal and nonverbal techniques.

When interviewing the battered woman, do not ask for verification of her story from second parties.

Assess the complete history of violence, including the current battering incident as well as the first and worst incidents.

When conducting this assessment, ask the woman directly to describe the violent acts and how she felt when and after they occurred as well as how she feels now. Do not avoid speaking directly about the violence. Provide encouragement and support to the victim for sharing her feelings and experiences.

Empathize with the victim and validate her feelings, stressing the criminal nature of the violence, and the fact that the victim is not to blame.

Universalize the crime of domestic violence, pointing out the scope and prevalence of such crimes that cut across socioeconomic, racial, cultural, and geographic lines.

Provide information and referrals for continued support and assistance, including local, state, and national resources.

Develop a plan for follow-up contact, support, and assistance from you, your agency, or allied community service or criminal justice agencies.

Affirm the fact that the victim is not alone and that there are people and programs available to assist and support her.

If and when a victim is able to leave her battering environment, it is essential that she has a "safety plan" to increase her opportunity for a successful departure. Advance planning is crucial. Start by assessing the battered-generated and life-generated risks with her. Based on this information, concerns and actions may need to include the following:

Does she have family and friends with whom she can stay?

Would she find a protective or restraining order helpful?

Can a victim advocate safely contact her at home? What should the advocate do if the batterer answers the phone?

Does she know how to contact emergency assistance (i.e., 911)?

If she believes the violence might begin or escalate, can she leave for a few days?

Does she know how to contact a shelter? (If she doesn't, provide her with information for future use.)

Does she have a neighbor she can contact or with whom she can work out a signal for assistance when violence erupts or appears inevitable?

If she has a car, can she hide a set of keys?

Can she pack an extra set of clothes for herself and the children, and store them--along with an extra set of house and car keys--with a neighbor or friend?

Can she leave extra cash, checkbook, or savings account book hidden or with a friend for emergency access?

Can she collect and store originals or copies of important records such as birth certificates, social security cards, drivers' license, financial records (such as banking and other financial accounts, mortgage or rent receipts, the title to the car, etc.), and medical records for herself and her children?

Does she have a concrete plan for where she should go and how she can get there regardless of when she leaves?

Does she have a disability that requires assistance or a specialized safety plan?

Does she want access to counseling for her children or herself?

Are there any other concerns that need to be addressed?