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Book Reference

James, R. K. & Gilliland, B.E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.

Introduction The pervasiveness of domestic violence is IDJI so great that it cuts across social, economic, reli- gious, ethnic, cultural, racial , and geographical boundaries (Ahrens et al., 2010; Arai, 2004; Archambeau et al., 2010; Browne & Herbert, 1997; Hague & Sardinha, 2010; Haj-Yahia, 2003; Hotaling & Sugarman, 1986, 1990; Kasturirangan & Williams, 2003; Lee, 2002; Levinson, 1989; Maziak & Asfar, 2003; Murdaugh et al., 2004; Robinson, 2003 ; Santiago, 2002; Sev'er, 1997; Weitzman, 2000; West, Kaufman Kantor, & Jasinski, 1998; Witko , Martinez, & Milda, 2006; Yoshioka et al., 2003 ; Zanipatin et al., 2005). Indeed, a review of the Amer- ican Psychological Association abstracts reveals that almost every country the National Geographic covers has had a study done on domestic violence. Culture plays a large part in what is defined as domestic violence or if it even exists . Further, if we define culture in terms of the social locations that Laura Brown (2008) speaks so eloquently to, we need to look at being pregnant (Suglia et al., 2010), homeless (Yeater et al., 2011), HIV positive, or a sex worker (prostitute) (Ulibarri et al. , 2010) as some of the many locations that lead to physical violence between intimates (Bryant-Davis, 2010).

Certainly, physical abuse in domestic situations is not limited to husband-and-wife relationships. In- deed, single, separated, and divorced women are ac- tually at greater risk for battering than are married women (Stark & Flitcraft, 1987). Furthermore, bat- tering is not confined to heterosexual relationships: lesbians, gays, and bisexuals also batter one another (Kanuha, 2005; Peterman & Dixon, 2003; Randle & Graham, 2011; Ricks , Vaughan, & Dziegielewski, 2002;

286

Stanley et al., 2006; West, 1998). Men are also assaulted by women (Langhinrichsen-Roling, Neidig, & Thorn, 1995; Randle & Graham, 2011; Stets & Straus, 1990· Straus & Gelles, 1990; Wiehe, 1998). Therefore, it should be clearly understood that the concepts

::iscussed in this chapter apply to all partners or ?eople involved in any established current or former ;:ohabiting relationship. To further amplify the cross- 5enional aspects of battering, the politically correct :erm has now become intimate partner violence 'IPV) to encompass all types of couples. Because

o men form the major target group of severe domes- ic violence, however, this chapter focuses mainly on ::risis intervention with women who are involved in iomestic violence and the men who batter them.

The terms battering, abuse, and assault are often :.!Sed interchangeably in the literature. In this chap- :er, battering indicates any form of physical violence ?er petrated by one person on another and typically -ncludes a life-threatening history of injuries and _ sychosocial problems that entrap a person in a :elationship. Abuse is a more general term that =-..1. d icates that physical violence is only one weapon in an armory of coercive weapons. Abuse denotes the un- equ al power relationship within which the assault oc- curs and further suggests that a presumption of trust .:ias been violated. Assaultive behavior can include aot only harmful acts against a person but also both \-erbal and behavioral threats to significant others, p ers, or property. Domestic violence subsumes any ac r of assault by a social partner or relative, regardless of marital status (Stark & Flitcraft, 1988).

The Incidence of Partner Violence T h e history of spouse beating in Western society goes as far back as the patriarchal system does. Whereas an assault on or rape of another man's wife caused and srill causes immediate and severe legal punishment and moral outrage, abuse by a man of his own wife is q uite another story (Pleck, 1987). Common law in the Un ited States early acknowledged the right of a man co chastise his wife for misbehavior without being p rosecuted for doing so (Bradley v. State of Mississippi, 1824). Indeed, the law's attitude toward wife beating co the current day is aptly summarized in the case of rhe State of North Carolina v. Oliver in 1874. The court ruled that "if no permanent injury has been inflicted, ir is better to draw the curtains, shut out the public eye, and leave the parties to forgive and forget." The im plications of such " blind" justice are ominous.

There is no more anxiety-provoking call for a police officer than a domestic disturbance call. Fu rthermore, domestic disturbance calls far out- n u mber other types of police calls in which the pos- sib ility of violence, injury, and death exists to both

CHAPTER TEN Partner Violence • 2 8 7

civilians and police (Benjamin & Walz, 1983). In the last comprehensive survey on domestic violence, it was estimated that about 1.5 million women and 830,000 men were victims of intimate violence in the United States (Tjaden & Thoennes, 2000). The Centers for Disease Control's report on homicides in the United States from 1981 to 1998 found that approximately one in three murders were intimate partner homicides (Centers for Disease Control, 2001). The good news is that these rates are appar- ently decreasing (Agency for Healthcare Research and Quality, 2010); however, those most likely to suffer IPV are, like many of you reading this book, women in their 20s to early 30s. A summary of all violent crimes reported that around 500,000 were perpetrated by intimates in 2002, down from the 1.1 million reported to authorities in 1993 (Bureau of Justice Statistics, 2003). Incidence studies report that 25% to 44% of women and about 7.6% to 13.8% of men in the United States have experienced a violent incident with a partner during their adult lifetime (Black et al. , 2011; Thompson et al. , 2006; Tjaden & Thoennes, 1998a). The foregoing figures should be viewed as very conservative estimates. Other es- timates place the number of domestic violence incidents at anywhere from 4 to 8 .7 million! World- wide, it is estimated that between 8% and 67% of women are physically assaulted in their lifetime, with most countries reporting lifetime prevalence rates of 20 % (Aldarondo & Castro-Fernandez, 2011). These latest figures probably underestimate the magnitude of the problem, for several reasons: cul- tural norms tolerate and in some instances condone familyviolence; confidentiality keeps violence a family secret; poor and non-English-speaking women are underreported; women who are institutionaliz ed or hospitali zed are often not included; elderly, gay, and lesbian incidents of violence are often not reported; and gender roles based on power differentials that are still sanctioned keep a number of domestic violence cases out of the legal system (Browne & Herbert, 1997; Lee, 2002; Pence & Shepard, 1999; Ricks, Vaughan, & Dziegielewski, 2002; Santiago, 2002; Wiehe, 1998). If there is possibly a worse number in these statistics, it is that an estimated 15.5 million children live in families where violence has occurred and about 7 million have witnessed severe violence (McDonald et al. , 2006). What that kind of problem-solving behavior models for children and begets in adult- hood should give you an idea why this type of crisis has been so intractable.

288 • PART TWO Handling Specific Crises: Going Into the Trenches

One of the major reasons much domestic violence is not reported is that the medical system fails to do so (Hampton, Vandergriff-Avery, & Kim, 1999; Roberts & Roberts, 2002). The American Medical Association, the American College of Obstetricians and Gynecologists, the Institute of Medicine, the U.S. Preventive Services Task Force, and the American Nurses Association all recommend counseling and screening for domestic violence, and the Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women (Boes & McDermott, 2002; Miller et al., 2015). Using a trauma screen to determine how the physical injury has occurred, researchers found that the sin- gle most common cause of a female injury brought to medical attention was abuse. In emergency room settings, an estimated 20% to 35% of female pa- tients seek treatment for domestic violence, and in family practices, between 25% and 40% of women report abuse . However, only 2% to 10% of battered women are commonly identified as such by physi- cians (Hamberger, 1994). The failure of health care professionals to adequately detect partner violence stems from a fear of offending patients, lack of train- ing and knowledge, inability to cure the problem, lack of time, and lack of insurance coverage (Tilden et al. , 1994). This failing should not be too surprising be- cause little emphasis on domestic violence has been given in medical schools or nurses' training (Sassetti, 1993). Compounding the problem are state reporting laws that are not nearly as stringent as child abuse laws in requiring health care professionals to report injuries from suspected partner violence (Chalk & King, 1998, p. 173). However, during the 1990s the American Medical Association started an education campaign for its members and started teaching them how to ask appropriate questions to women who ap- peared to be battered. More recent data suggest that women are more likely to report abuse if they seek out treatment and are asked appropriate questions in an empathic and supportive manner. The problem is that it is still unclear how many women do not seek out treatment (Walker, 2000, p . 31).

Another culprit in the helping professions is the clergy. Many clerics who deal with family violence have a great deal of difficulty with the issue, and a number were found to place the blame on the woman (Wood & McHugh, 1994). However, other human services workers should not feel smug. Research in- dicates that they, too, may have biases against and stereotypes about ; bused women that interfere with

and hinder treatment (Ross & Glesson, 1991). But it is noteworthy that although crisis workers are no t contacted as often by abused women as other profes- sionals are, they were reported to be the most helpful (Hamilton & Coates, 1993).

Emerging Approaches to Partner Violence Despite the long history of partner abuse, only l!.!JI since 1974 has there been a consistent and planne d systematic approach to the problem. Erin Pizzey's book Scream Quietly or the Neighbors Will Hear (1974) was responsible for the start of the first women's shelter in England. Subsequently, in the Unit ed States, the National Organization for Women, along with grassroots organizations such as the Massachusetts Coalition of Battered Women Service Groups , has come to the forefront in developing funding sources, shelters, support groups, organizing and training manuals, and legislation for battered women . Such increased public awareness and the efforts offeminist and other citizens' groups resulted in the formatio n of the National Coalition Against Domestic Violence to promote a national power base for battered women (Capps, 1982). This group has exerted a good deal of social and legislative pressure to combat the problem of domestic violence. The Domestic Abuse Inter- vention Project in Duluth, Minnesota, has become internationally known as the Duluth model for its in- tegrated approach to the problem (Pence & Shepard, 1999). The Duluth model has become internationally known because of its massive and sustained effort to get every agency that comes in contact with a bat- tering incident- from 911 dispatch that receives the first call to the last judge, probation officer, or ther- apist who signs off on the batterer as finished with intervention-involved in a systematic and integrated manner so that no battered person or batterer fall s through the cracks (Home of the Duluth Model, 2011).

Thus, over the last 30 years, the country's approach to domestic violence has changed dramatically. First, there has been a shift in police procedures, increased prosecution of partner violence, and enhanced legal protection through tougher protective orders and warrantless arrest. In many cities and states, a police call to a domestic dispute in which battering is in- volved now results in a mandatory arrest; and if con- victed, the batterer is mandated by the court to either participate in counseling and a batterer intervention program (BIP) or go to jail (Goodman & Epstein, 2011;

? ence & Shepard, 1999; Shupe, Stacey, & Hazlewood, :987). Second, as a result of lobbying efforts by ac- ;ivists, state legislatures have enacted protection laws with teeth in them that allow judges to tailor-make orders of protections suited to individual cases (Good- :nan & Epstein, 2011). Third, countywide coordinated ommunity responses on the order of the Duluth

m odel have been formed (Goodman & Epstein, 2011). ? ourth, domestic violence units have been formed in ?Olice departments, probation and parole offices, states attorneys' offices, and domestic violence courts, which all coordinate efforts to reduce domestic violence Chalk & King, 1998, p. 172; Pence & Shepard, 1999).

A growing number of women have entered academia in the past 30 years, particularly in the social sciences. Their research on family violence, gender roles , and m ale dominance has resulted in social activism that ~as debunked the "safe haven" notion of the family Qasinski & Williams, 1998, pp. vi-vii). The Violence Against Women Act of 1994 provided $1.2 billion for the improvement of services and community support fo r domestic violence victims, the criminal justice system's response to violent crimes against women, safety for women in public transit and public parks, assistance to victims of sexual assault, and support fo r a variety of educational, health, and database services. This bill was reauthorized in 2000 with an increase of$3 .3 billion over 5 years to community ser- \·ices to aid survivors of domestic violence, sexual as- sault, and stalking. It was reauthorized again in 2005 and has received continuous funding. An overview of its many activities can be found at the website of t he Department ofJustice's Office ofViolence Against Women (www.ovw.usdoj.gov).

Media attention about the severity of the problem has raised public consciousness. Television documen- -aries, newspaper articles, and media coverage have a nracted attention, changed public perspectives, and removed some of the cloak of secrecy from domestic ,-iolence. Stories such as those of Francine Hughes subject of the movie The Burning Bed), who suffered

p rolonged and severe beatings by her husband and wh o finally killed him by pouring kerosene around his be d and setting it on fire, have had an impact on the courts by challenging legal precedents and assump- rions about homicide and self-defense (Edwards, 1989). Indeed, psychologist Lenore Walker's (1989) bo ok Terrifying Love is a chilling and eye-opening account of her experiences as an expert witness in m urder trials of battering victims who have killed their assailants. The result has been the recognition of

CHAPTER TEN Partner Violence • 2 8 9

a history of abuse called the battered wife syndrome (PTSD -like symptoms due to battering) (Walker, 2000, pp. 160 - 161) as a valid part of a legal defense for battered women who kill their husbands (Chalk & King, 1998, pp. 171- 172).

Once arrested, batterers are required to go through a variety of different educational programs to teach them not to batter (Geffner & Rosenbaum, 2002; Mederos, 1999; Rosenbaum & Kunkel, 2009; Sonkin & Dutton, 2003). Treating batterers has become a big- time business. For example, as of 2006 there were 450 registered batterer programs (BIPs), serving more than 25,000 batterers in California alone (California State Auditor, 2006). All states now have laws on the books that make IPV a crime and domestic violence courts that may mandate sentences ranging from jail time to BIPs (Rosenbaum & Kunkel, 2009).

Although no national register of BIPs exists, Price and Rosenbaum's (2007) survey found 1,750 programs nationwide. That is undoubtedly low because it didn't take into account many of the private programs that exist in addition to those run by local community agencies. It is safe to say that hundreds of thousands of men and women have now gone through some kind ofBIP in the United States. In Tennessee, batterers are required to pay for their group treatment from a certified leader. But the phi- losophy and treatment approaches of these programs vary a great deal, and by no means is there a common, unitary approach.

In their 10-year follow-up studyoffamilyviolence in 1985, Straus and Gelles (1986) found an overall decline in husband-to-wife violence of 6.6% and a decrease in severe husband-to-wife violence (battering) of 26.6%. Overall violence reduction has continued to the pres- ent, which would lead one to believe that the massive effort by the judiciary, law enforcement, education, social services, and media attention has started to have an impact. However, what was perplexing in their study was that wife-to -husband violence had in- creased to a rate higher than that of husband-to-wife violence. Other studies support this increase, par- ticularly when courtship is involved (Carrado et al., 1996; Fiebert & Gonzalez, 1997; Morse, 1995). In fact, a number of more recent reports have found compa- rable levels of female-versus male-initiated violence (Bowen, 2009; Dutton, 2007; Hines & Douglas, 2011; Randle & Graham, 2011). Needless to say, the veteran feminists who were in the forefront of the fight to get domestic violence out into the light of public scrutiny have hotly disputed these findings.

290 • PART TWO Handling Specific Crises: Going Into the Trenches

Clearly, a great deal of violence by women against men is retaliatory, or in self-defense, as opposed to male batterers' attempts to terrorize, control, or intimidate. Also, when women are the victims of as- sault, it usually means more serious injury than when the opposite occurs. Furthermore, no research places men in the same systematic victimization status of women who are literally terrorized into attempt- ing to escape the relationship (Kaufman Kantor & Jasinski, 1998, pp. 9-10). The apparent statistical de- crease in women reporting domestic violence is puz- zling given that the number of shelters for abused women has grown from none in 1975 to more than 2,000 shelters in 2002 (Roberts, 2002), and those shelters are constantly beyond capacity and must turn people away.

Dynamics of Partner Violence Psychosocial and Cultural Dynamics The overarching dynamic that has held sway lmJ over the battering of women is the belief in male su- premacy. This belief is the natural result of a long- term sexist, paternalistic social order that rewards aggressive behavior in men but expects women to be passive and submissive (Benjamin & Walz, 1983, p. 65; Pence & Shepard, 1999). This stereotypical and dated view has produced a volatile mix of personality dynamics between the "traditional" male and the female. The flash point of such a mix occurs when the man who lives the traditional male image of chief breadwinner and director of the family perceives himself as losing power in the conjugal relationship .

The question of power is the fuse that ignites this explosive mixture. In this view, the woman's position is to obey, conciliate, perform traditional domestic duties, and, in general, be subservient. Any attempt to establish herself in her own right is likely to be met with punishment for overstepping her bounds (Benjamin & Walz, 1983, pp. 74-77; Pence & Shepard, 1999). Violence, though, is not something that devel- ops only in families. It involves a complex interplay of social, cultural, and psychological factors, and to say that a patriarchal system alone is responsible for battering would seem to fall far short of the mark (Dutton, 1995, pp. 27-62).

The fact is that a great many men who have pa- triarchal attitudes go through their entire married lives without assaulting their wives , and the sociopo - litical beliefs of abusers don' t discriminate them from nonabusers (Hotaling & Sugarman, 1986; Straus &

Gelles, 1986). So is there one true theory of the abu- sive/ assaultive personality that leads to partner vio- lence? The answer to that question is a resounding "No!"-although most of the following theories have their rabid supporters who would vehemently dis- agree with that statement. The following theories en- capsulate past and present thinking about the causes of battering.

Attachment/Traumatic Bonding Theory. Disruptions of attachment in early life arouse intense anger, grief, sorrow, and anxiety in the child and dimin- ish the child's ability to form mutual and trusting relationships as an adult. High correlations appear among spousal violence, the number of separation- and-loss events abusers and their families of origin experienced, and the erratic caregiving patterns of batterers' parents. Thus, men whose parents were un- reliable, abusive, needy, or otherwise unequal to the task of child rearing may be very sensitive to fears of abandonment and enmeshment. The partner may contribute to these fears by her own fears of aban- donment. Each partner creates ways to control the other to avoid being abandoned. One of those ways is through violence. Traumatic bonding may explain why some women stay with or return to their abusive partners (Bowlby, 1980; Brewster, 2002; Sonkin & Dutton, 2003).

Coercive Control. Morgan (1982) used the term con- jugal or intimate terrorism to describe a tactic akin to brainwashing and political terrorism, whereby violence or the threat of violence is used to break the victim's resistance and bend her to the will of the terrorist (batterer). Typical brainwashing and terror- ist tools such as social and physical isolation, torture, sleep deprivation, malnourishment, dictating the use of the victim's time, bondage, false confessions, and denouncing and belittling the victim to signifi- cant others are all standard operating procedures of abusers to enhance the victim's dependency on them. Johnson (1995) identifies this type of batterer as indeed a terrorist, representative of the type that women who seek out shelters describe. Women who are battered by these men have more injuries, take more painkillers, have more PTSD symptoms, are attacked more frequently, and are less likely to have the violence stop (Johnson & Leone, 2005) . This pathological male is very different from the general population of situational batterers and is extremely dangerous .

Cu ltural Reinforcement. Sociological theories cover a wide gamut of specific theories that are psychoso- cially and culturally bound. These theories find the roo ts of violence in institutions ranging from the culture at large down to the family unit. Societal at- titudes about the legitimate use of violence to achieve pe rsonal ends have their roots in a tradition of per- ceived "national interest." As a nation, we promote and glorify the controlled use of aggression for protec- tion, law and order, self-defense, and national interest Benjamin & Walz, 1983, pp. 64 - 66). Force is a major ~esource in maintaining the existing social structure and projecting national presence. This notion has be en extended to the family by at least implicit per- :nission of the state. For the state, the family is the basic disciplinary agent-family over individual, male over female, adult over child. Control is direct, con- ti nuous, personalized, and an efficient way of keeping intact the past social order of the state (Capps, 1982).

Exchange Theory. Exchange theory (Gelles & Cornell, 1985) is a variant of a learning theory approach . It pro poses that batterers hit people because they can (Carden, 1994). As long as the costs for being violent d o not outweigh the rewards, violence will invariably be used as a method of control (Hampton, Vander- g riff-Avery, & Kim, 1999). Particularly when social control agents such as the police, criminal charges, im prisonment, loss of status, and loss of income are not used as negative sanctions that increase the cost of the behavior, batterers will continue to batter. Gen- de r inequality in physical size, financial resources, and social status allows batterers to become violent without fear of retribution. Although there may be loss of status in the larger society for being a child or wife beater, t here are certain subcultures in which aggressive and violent behaviors are proof of being a "real man." Finally, exacting "costs" from a partner to pay for her or his supposed "sins and transgressions" is itself satisfying to the batterer (Gelles & Cornell, 1985, pp. 120-125).

Feminist Theory. Feminist theory views social phe- nomena as determined by the sexist, patriarchal st ructure of our society and battering as merely one outcome of a structure that allows rape, incest, prostitution, foot binding, and a host of other sex- ist restrictions to keep women in servile positions (Schechter, 1982; Stark & Flitcraft, 1988). Feminists believe that women have not achieved the politi- ca l, economic, and social independence that would

CHAPTER TEN Partner Violence • 2 91

empower them to leave abusive relationships (Bograd, 1992; Dobash & Dobash, 1992; Pagelow, 1992). They do not believe that a woman has any culpability in promoting or maintaining a violent relationship be- cause the perpetrator alone commits the act; he alone is morally and legally responsible for it and should be the one to suffer the consequences (Avis, 1992; Bograd, 1992). A strict feminist view categorically separates woman battering from other forms of in- trafamily violence, or at the most sees the other forms of family violence as a by-product of how women are brutalized (Okun, 1986). The feminist view also holds that until women are seen as other than subservient, compliant victims , little will change. Feminists criti- cize the mass media for romanticizing violence, male dominance, and female submissiveness (Dines, 1992; Jarvie, 1991). Feminist theory calls for a complete restructuring of society to eradicate the power differ- ential that males enjoy that allows them to batter.

lntraindividual Theory. There is evidence that psycho- pathology and neurophysiological disorders may play a greater part in some perpetrators of battering than was previously thought. Personality disorders, atten- tion deficit disorder, psychosis, internal head trauma, and substance abuse have been identified as possible contributing factors that lead to aggression and rage reactions (Browne & Herbert, 1997, p. 61; Dutton, 1994, 1995, pp. 26-29; Jasinski & Williams, 1998, p. 42; Stuart et al., 2006). Both male and female ado- lescents with psychiatric disorders are at greater risk for becoming involved in abusive adult relationships (Ehrensaft, Moffitt, & Caspi, 2006).

Learned Helplessness/Battered Woman Syndrome. Learning theory approaches operate on the principle that both perpetration and acceptance of physical and psychological abuse are conditioned and learned behavior. A great deal of research indicates a strong relationship between being abused by parents and/ or witnessing interparental violence as a child and being violent toward a partner as an adult (Astin et al., 1995; Barnett & Hamberger, 1992; Jouriles & Norwood, 1995). Foremost among these theories is Lenore Walker's (1984, 1989, 2000) theory oflearned helplessness, which she adapted from animal studies conducted on random, noncontingent punishment.

Applied to battering in particular, the theory pro- poses that battered women stay in abusive relation- ships because they have been conditioned to believe they cannot predict their own safety and that nothing

292 • PART TWO Handling Specific Crises: Going Into the Trenches

they or anyone else does will alter their terrible cir- cumstances. Over time, through continuous condi- tioning, a battered woman syndrome emerges that causes the woman to lose hope and feel completely incapable of dealing with the situation (Brewster, 2002).

Walker (1984, 1989, 2000) proposed a number of factors in childhood and adulthood that are building blocks for learned helplessness . Childhood factors include witnessing or experiencing battering, sexual abuse or molestation, health problems or chronic ill- ness, stereotypical sex roles, and rigid tradition. Such experiences teach the child that external, autocratic, and often whimsical forces dictate outcomes. In adulthood, factors that are instigated by the batterer include an emergent pattern of violence, sexual abuse, jealousy, overpossessiveness, intrusiveness and isola- tion, threat of harm, observed violence toward other people, animals, or things, and alcohol or drug abuse. Given these conditions, the vi.cti.m cannot escape the noncontingent punishment and thus los es any effec- tiveness in being able to control what happens to her (Walker, 2000, pp. 10 - 12).

The term helplessness has caused a great deal of furor from feminists because they see this pejorative term as casting women in a victim role with few re- sources or little empowerment. However, according to Walker (1989), women are not helpless in the standard sense of the term. What learned helplessness means is that battered women choose behavioral responses that have the highest predictability of causing them the least harm in the known situation (pp. 50-52), or what Gondolf and Fisher (1988) call the survivor hypothesis, wherein women become very active and resourceful in protecting themselves and their chil- dren (Browne, 1997). Because of the extreme and often lethal violence that occurs when these women attempt to leave, and the lack of social support for making any attempt, it is understandable that a "Bet- ter the devil I know! " philosophy predominates for many abused women.

Masochism. Psychoanalytic theory, which has held masochism to be the primary motivating factor in abusive relationships, is now mostly obsolete in the therapeutic community. There is no empirical re- search to substantiate the notion that erotic enjoy- ment of pain through battering is a trait found in abused women (Okun, 1986; Stark & Flitcraft, 1988). That being said, one has to wonder why Fifty Shades of Gray was a best-selling book and movie if there isn't at least a grain of t r:uth in what the Freudians extolled. From a feminist point of view, this theory held sway

for a long time because the male-dominated field of psychiatry found it a convenient pigeonhole for a troublesome problem. Until interest in the problem was generated in the 1970s, little research was pre- sented to refute the idea.

Nested Ecological Theory. Because no single factor theory has effectively explained the battering phe- nomenon, an integrated, multifactor approach may be the best way to understand the complexities of battering (Brewster, 2002). Dutton (1985 , 1995) pro- posed an ecological theory that integrates many of the foregoing theo ries. Four layers of variables oper- ate within the ecosystem. First is a core of individual experience composed of intrapersona) psychological factors such as shame, denial, and hostility. Second is a family system layer, in which the individual experi- ences such negative actions as abandonment, neglect, and. abuse. Third. is a community/ peer layer, which in- culcates fundamental religious training, alcohol and drug use, and rigid gender role socialization. Finally, in a larger societal context, the individual is exposed to sociopolitical gender inequities, media portrayal of subjugat ion and violence against women, and racial/ethnic prejudices. As a result, it is not just one but many factors that operate within the individual, in interpersonal relationships, and throughout the larger social environment that are communicated and synthesized to make battering a viable option (Hampton, Vandergriff-Avery, & Kim, 1999).

Psychological Entrapm ent. Psychological entrapmem proposes that the woman does not leave the relation- ship because she feels she has too much time, energy, and emotion invested in it (Brewster, 2002), or she would feel shame if her terrible secret were found out (Buchbinder & Eisikovits, 2003). She engages in wish- ful thinking that some miracle will occur or that she can somehow change the significant other and a non- violent, intimate, and loving relationship will emerge. For some women, the shame of their battering and the failed relationship is so great that they will d o anything to keep it from public view.

Sociobiology. Sociobiology proposes that evolution- ary adaptation requires aggression for survival. Thus there is the inherited tendency to aggress agains t someone who threatens the chances of survival and deductively, procreation of the species. If the forego- ing is true, then it would be reasonable to expect that males would aggress against other real or imagine d males who were trying to take away the female . The

question then arises: Why would the male assault the object he wishes to possess instead of other intrud- ing males? The sociobiologists have no clear answer w this question (Dutton, 1995, pp. 29 - 34).

Stockholm Syndrome. (For a complete description of chis syndrome, see online Chapter 19, Crisis/ Hostage

egotiation.) Akin to being held hostage, the woman is completely isolated and subjugated by her abuser, and her survival is entirely dependent on his whims, desires, or purposes. Because she is shown occasional ki ndness and is completely isolated from other sup- po rt systems, she develops a strong emotional bond with the abuser (Brewster, 2002).

System Theory. System theory posits that battering is not a ttributable to the st andard victim-abuser di- chotomy. Rather, conjugal violence and battering relationship are more appropriate terms to depict battering as part of a violence-prone system. The vio - lence is a maladaptive but efficient way to keep the system in homeostasis. Through learning history and rigidly polarized roles for both parties, the system is able to maintain itself (Wiehe, 1998, pp. 87-90).

Although each of the preceding theoretical stances has merit, to this point none has proven able w completely explain the phenomenon of batter- in g. Certainly, there is much to be said for a feminist perspective couched in paternalistic sociocultural re rms. If it had not been for the feminist movement's willingness to take on battering as a social issue, it would probably still be "behind drawn shades." There is also clear evidence that at least one factor contrib- uting to our bulging prison population is that certain pe ople will attempt to get away with anything they can with little regard for the cost to others, as long as they believe they can escape the consequences of their actions. Similarly, evidence exists that legions of people with personality disorders would think noth- ing of manipulating anyone in any manner to sat- is fy their insatiable narcissistic or dependency needs . T here is a lso clear evidence from a national perspec- tive that Teddy Roosevelt's admonition "Speak softly and carry a big stick! " is extremely effective and has u ickled down to the family unit. It doesn't take a doc- m rate in sociology to figure out that ecological and cultural variations may h ave profound effects on the k ind and incidence of partner violence. Finally, it is hard to argue against the contention that the found- ing fathers ' belief that "a man's home is his castle" has m uch to do with society's refusal to intervene in the sacrosanct realm of the home.

CHAPTER TEN Part~er Violence • 293

Psychological Factors Psychologically, both parties to a battering IC.tW situation may have certain identifiable characteristics. You should clearly understand that these are not just separate and individual ingredients, but complex forces that interrelate with one another and thus increase the odds of IPV. As an example, Bornstein (2006) has provided an in-depth examination of how emotional dependency in males and economic de- pendency in females, when combined, become an extremely dangerous mix that can lead to violence.

Men in a battering relationship may:*

1. Demonstrate excessive dependency and possessive- ness toward their women-although they deny it.

2. Be unable to express any emotion except anger and generally have poor communication skills where emotional issues are concerned.

3. Have unrealistic expectations of their sp ouses and idealize marriage or the relationship far beyond what realistically may be expected.

4. Have a lack of self-contro l and, paradoxically, set up rigid family boundaries for everyone else.

5. Be alcohol or drug abusers . 6. Have been abused as children or saw their moth-

ers abused. 7. Deny and minimize problems, particularly batter-

ing, that they generate in families . 8. Emotionally cycle from hostility, aggressiveness, and

cruelty when they do not get their way, to charm, manipulation, and seductiveness when they do .

9. Be characterized as jealous, denying, impulsive, self-deprecating, depressive, demanding, aggres- sive, and violent.

10. Feel a lack of comparative power to the woman in economic status, decision making, and communication skills.

Women in a battering relationship may:t

1. Have a lack of self-esteem as a result of being told over and over that they are stupid , incompetent, and otherwise inadequate.

2. Experience a lack of control and little confidence in their ability to take any meaningful steps to improve their marriage.

*This list was derived from Babcock et al., 1993; Barnetc et al., 1980; Bornstein, 2006; Ehrensaft et al., 2003; Finkelhor et al., 1983; Gelles & Cornell, 1985; Okun, 1986; Schumacher, Pals-Stewart, & Leonard, 2003; Shupe, Stacey, & Hazlewood, 1987; Walker, 1984, 1989, 2000. t:rhis list was derived from Benjamin & Walz, 1983; Bornstein, 2006; Eh rensaft et al., 2003; Finkelhor et al., 1983; Gelles & Cornell, 1985; H age, 2006; Ibrahim & Herr, 1987; Okun, 1986; Roberts , 2002; Walker, 1984, 1989, 2000 .

294 • PART TWO Handling Specific Crises: Going Into the Trenches

3. Have experienced a history of abuse that leads them to accept their role as victim, or saw their mothers abused and accepted it as their lot.

4. Be so ashamed that they hide their physical and emotional wounds and become socially and emo- tionally isolated.

5. Lack personal, physical, educational, and financial resources that would allow them to get out of the battering situation.

6. Be extremely dependent and willing to suffer grievous insult and injury to have their needs met.

7. Have an idealized view of what a relationship should be and somehow feel they can "fix" or "change" the man.

8. Not have good communication skills, particularly in regard to asserting their rights and feelings.

9. Have learned stereotyped sex roles and thus feel guilty if they do not adhere to a rigid patriarchal system.

10. Be unable to differentiate between sex and love and believe that love is manifested through intense sexual relationships.

In one way or another, all the concepts just enumer- ated have to do with power, and all point back to this basic enculturated dynamic. If men acted on impulse or some other drive, they would beat up their bosses, secretaries, friends, or neighbors as often as they do their mates and children. Although some sociopaths might fit this category of indiscriminate violence, they are in the minority (Gondolf, 1985; Hastings & Hamberger, 1988; Holtzworth-Munroe & Stuart, 1994). Only in a conjugal relationship do many men generally believe in and exercise their ability to coerce, abuse, and beat women and children (Hart, 1980).

Stressors If power is the fuse , then stress is the match i(uW that lights the fuse. As the idealized image of the relationship breaks down and environmental stresses build up, couples become engaged in an ever-increas- ing spiral of violent interaction (Barnett et al., 1980). Although they are not generic to all battering, a list of factors that seem to appear over and over in domes tic vi- olence follow (Barnett et al. , 1980, pp. 7- 9; Benjamin & Walz, 1983; Bograd, 2005; Brown, James, & Taylor, 2010; Finkelhor et al., 1983; Gelles & Cornell, 1985; Halbsgut, 2011;Jasinski & Williams, 1998; Koverola& Panchanadeswaran, 2004; Okun, 1986; Parker et al., 1993; Stuart et al., 2006; Walker, 1984, p. 51). These fac- tors may be introduced by the batterer to control the .

situation, may occur as a product of the relationship itself, or may be environmentally introduced fro m outside the relationship.

1. Geographic isolation. Because of geographic loca- tion, the victim has no friends nearby who can provide a support system. A farm woman who cannot drive is an example of the worst case- literally being marooned and held captive by an abusive husband.

2. Social isolation. Because of extreme emotional de- pendence, the woman expects all needs to be met by her partner and has no significant others t o turn to when she is assaulted.

3. Economic stress. When a woman is unemployed or underemployed, has inadequate. housing, is pres- sured by creditors, and cannot feed and clothe her children by herself, she becomes human chattel to her abusive partner.

4. Medical problems. Long-term, chronic medical problems for either spouse or children exact tre- mendous financial and emotional costs.

5. Inadequate parenting skills. A lack of knowledge of parenting skills and conflict over parental roles can lead to situations that start as minor disciplinary problems and escalate into violence in the family.

6. Pregnancy. Ranging from heralding an unwanted child through creating anxiety over providing for the new baby to arousing jealousy over a wife's at- tention to a newborn, pregnancy is an especially acute crisis point for potential abuse.

7. Family dysfunction. A veritable kaleidoscope of problems causes dysfunction in the family. Some of these problems are related to age and number of children, presence of stepchildren, loyalty con- flicts, death, desertion, and career change.

8. Alcohol and drug abuse. Chemical dependence serious enough to cause economic chaos and severe emo- tional disturbance characterizes addictive families and has spin-offs that commonly include spouse abuse. The insidious problem with alcohol and drugs is that they are often used as an excuse for behavior (battering) that is normally prohibited by societal norms and standards. Interestingly, there appears to be a significant relationship, at least in Australia, between the number and prox- imity ofliquor stores and the incidence of domes- tic violence (Livingston, 2011).

9. Educational and/ or vocational disparity. When a female in a relationship has higher educational attainment or higher vocational status than the male, this may raise questions of adequacy and

responsibility with both parties. Furthermore, if the man is unemployed and the woman is em- ployed, the man has a great deal of time to brood on his inability to function as the head of house- hold, which males already suffering from feelings of inadequacy may find extremely demeaning. The role of occupational therapy in domestic violence has become important enough that a book has been devoted to that connection (Helfrich, 2001).

10. Age. One of the most consistent risk factors of bat- tering is age. Approximately 20% of men in the age range of 18 to 25 and 17% of men in the age range of 26 to 35 have committed at least one act of vio- lence in the past year.

1 1. Disenfranchisement. Seeking help from the authori- ties for battering may be very aversive to persons of color, same-sex orientation, minority status, immigrant status, and other marginalized groups because of their previous negative experiences or fear of retribution from the system.

12. Rejection. The barterer's perception of rejection is an antecedent to abuse. Men with a family of origin where rejection occurred become extremely sensitive to any behavior construed as rejection. Their response is likely to be aggressive .

13. Threat to masculinity. Some men who perceive them- selves as less masculine see their use of battering as affirming their masculinity in comparison to males who have good self-concepts who do not batter.

Myths About Battering The following myths encapsulate numerous IC.N arguments used by those who would submerge, cam- o uflage, and diminish battering (Gelles & Cornell, 1985; Hampton, Vandergriff-Avery, & Kim, 1999; M assachusetts Coalition of Battered Women Service Groups, 1981; Okun, 1986; Roberts, 2002; Stark & Flitcraft, 1988; Straus, Gelles, & Steinmetz, 1980; Weitzman, 2000).

1. "Battered women overstate the case." Any person who has contusions, lacerations, and broken bones is not overstating anything. In any other instance, such outcomes are referred to as assault and battery.

2. "Battered women provoke the beating. " Although some women may be classified as the stereotypical "nag," there can certainly be many significant oth- ers in a man's life who fit into the "nag" category who are not beaten.

3. "Battered women are masochists." If such women did have masochistic tendencies, they would find a vari- ety of ways to suffer pain, not just an abusive mate.

CHAPTER TEN Partner Violence • 295

4. "Battering is a private, family matter." When beaten women are disenfranchised from their homes and the children of battering relationships learn the pathological roles a battering father models, batter- ing transcends the home and becomes society's prob- lem. All 50 states now have warrantless arrest policies for battering. Battering is anything but private.

5. "Alcohol abuse is the prime reason for wife abuse." Al- though alcohol plays a part in many cases of abuse and is present and used by both men and women who engage in violent relationships, it may be only an excuse for, and not the cause of, violent behavior. There are many violent relationships where alcohol is not present.

6. "Battering occurs only in problem families." The dy- namic representation of stress factors that assail families shows that any family, at any given point, may be classified as " problem."

7. "Only low-income and working-class families experience violence. " Members of those socioeconomic classes do come to the attention of the police and welfare agencies to a much greater degree than middle- or upper-class members, but statistics from shelters, police calls, and crisis line calls indicate that bat- tering has no class boundaries.

8. "The battering cannot be that bad or she would not stay." The host of personal factors that tie a woman to the relationship militate heavily against simply picking up and leaving.

9. "A husband has patriarchal rights." What a man does in his own family is not his own business when the emotional overflow of what he does spills over into the community. No amount or kind of justification from the Bible or any other authority- be it person, institution, or book-can excuse spouse abuse.

10. "The beaten spouse exaggerates the problem to exact revenge." Reporting a beating-whether commit- ted by a total stranger or one's spouse-is no exag- geration. If revenge were the motive, there would be a host of ways of going about it that would be far less traumatic than calling or showing up at an abuse shelter.

11. "Women are too sensitive, especially when they are pregnant. " If a person is too sensitive because she objects to being kicked in the stomach or vagina, thrown down a flight of stairs, or hit in the face with a lamp, then we would suppose that everyone is overly sensitive.

12. "Battering is rare. " The statistics reported in this chapter clearly indicate otherwise. Family violence is endemic in society.

296 • PART TWO Hand ling Specific Crises: Going Into the Trenches

13. "Battering is confined to mentally disturbed or 'sick' people. " It appears that less than 10% of family violence is caused by mental illness. Although continued physical and psychological abuse may cause many victims to suffer serious emotional distress and posttraumatic stress disorder, they did not enter the relationship "sick." Further- more, most perpetrators are not mentally ill by any DSM -5 (American Psychiatric Association, 2013) definition.

14. "Violence and love cannot coexist. " Strange as it may seem, members of violent families may still love one another. This paradoxical aspect is most prob- lematic because children in such families grow up believing you hit the people you love.

15. "Elder abuse between intimates is neither prevalent nor dangerous. " Because of the debilitating factors that come with aging, the potential for physical abuse becomes greater and more lethal as partners become more frustrated, angry, and depressed over the declining physical and mental capabilities of both themselves and their partners.

Profiling the Batterer Researchers have examined multiple per- l(tiM sonality and behavioral typologies of batterers. Dutton (1995) , Fowler and Western (2011), Gondolf (1985), Hastings and Hamberger (1988), Holtzworth- Munroe and Stuart (1994), Holzworth-Munroe and associates (1999, 2003), and Saunders (1992) have all developed typologies of batterers based on clusters of demographic, personality, and abuse vari- ables. Holtzworth-Munroe and Stuart (1994) and Holtzworth-Munroe and associates (1999, 2003) have compiled three major groupings-family only, dys - phoric (anxious)/ borderline, and generally violent/ antisocial-and a fourth subgroup, low-level anti- social. Characteristics of the family only batterer include high dependency, impulsivity, poor commu- nication skills, and family-of-origin violence. The dysphoric/borderline batterer has a history of parental rejection and child abuse, delinquent acts, poor communication and social skills, violence-as- a-solution ideation, extreme fears of abandonment, and low remorse. The low-level antisocial batterer has antisocial behavior and moderate levels of domes- tic and general violence. Fowler and Western's (2011) typologies conform closely to the foregoing types with psychopathic, hostile/ controlling, and border- line/ dependent. Tfile generally violent/antisocial

batterer has all the foregoing characteristics, but to a much more profound degree and probably falls into what Jasinski and Williams (1998, p. 1) call the ter- roristic batterer. Such people are extremely aggres- sive and impulsive, and view violence as appropriate to any provocation inside or outside the home.

The family only batterers are the largest group, and their behavior is consistent with Walker's (1979) cycle of violence. Its members are likely to be contrite and apologetic after battering incidents. Gondolf (1985) reports this group type to be most prevalent, with a 52% occurrence rate. The dysphoric/ borderline and antisocial types are typical of how women who flee to shelters describe their batterers. They are the most dangerous and according to Gohdolf make up about 41% and 7% of batterers, respectively. Differ- ences in these groups in regard to their level of violence appear to remain somewhat stable over time, and they do not appear to move from one group to the other (Cavanaugh & Gelles, 2005). Thankfully, not all marital violence escalates nor does it evolve to more dangerous personality types (Holtzworth-Munroe et al. , 2003).

There is a good deal of debate over the use of pro- filing because of the diversity of typologies in bat- tering populations. However, Gibbons, Collins, and Reid (2011) used the Millon Clinical Multiaxial In- ventory with a sample of 177 batterers and found that 54% fell into a personality disorder category and 37% could be characterized as having severe pathol- ogy. Taking the foregoing typologies together with an assessment device like the Millon, consider that Eke and associates (2011) found that of their sample of men who had murdered or attempted to murde r an intimate partner, 42% had previously committed crimes, 18% had a psychiatric history, and 15% had both. These individuals were given the Ontario Do- mestic Assault Risk Assessment. Their mean score was in the 80th percentile of "at risk" for domestic violence. The researchers concluded that the use of validated risk assessment data for batterers and indi- cators of pathology and/ or criminal behavior would increase the ability to predict who would violently assault an intimate partner and hopefully aid in intervention and prevention of homicidal acts to- ward intimate partners. Loinaz (2014) used the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) to classify offenders and predict recidi- vism. His study on incarcerated batterers in Spain found high predictive validity with both the non- pathological group and the antisocial/pathological

group. He further found that the antisocial patholog- ical group had about a 2 to 1 recidivism rate. We be- lieve some fine-tuning of these instruments, applied ro all batterers, would be of some worth in determin- in g their degree of potential lethality and guiding judicial disposition as to what kind of intervention they should receive.

The Cycle of Violence Barnett and associates (1980) schemati- i(ef:M cally represented the phases leading to the explo- sion of violence in the family. Walker's (1984) cycle theory of violence-(1) tension building, (2) battering a nd abuse, (3) contrition and loving respite-closely parallels these phases, and her research supports the theory (p. 95).

Phase I. Tranquility prevails. The relationship may have been characterized as calm to this point, with no previous violent incidents, or a period of calm may follow an earlier violent episode.

Phase II. Tension starts to build. A variety of stresses impinge on the relationship. They may come in combination or singly from the common group already mentioned. However, there is no reduc- tion of tension, and the situation grows more strained.

Phase III. A violent episode occurs. The episode may range from harsh words to a severe beating. At this phase, communication has broken down, and the situation is out of control.

Phase IV The relationship takes on crisis proportions. A variety of options becomes available. A. The abuser becomes remorseful and asks for-

giveness. Sooner or later the victim forgives the abuser, and calm is restored.

B. The abuser is not remorseful and feels his control over the situation has been estab- lished. The victim gives in and relinquishes control, and calm is restored.

C. The victim takes new action. Within this option are two possibilities: the abuser ne- gotiates the situation, and, given that the negotiation is agreeable to the victim, calm is restored; or the abuser rejects the new action and a crisis state continues.

It is at this last point, in which no possibility of resolution exists, that the victim is most likely to seek help by contacting an abuse center. Walker found that as the battering continues, the loving contrition phase diminishes and battering becomes more prevalent

CHAPTER TEN Partner Violence • 297

(2000, p. 128). If effective assessment and interven- tion do not occur when the violence emerges (Phase III), the likelihood that the violence will recur and will be of greater intensity is dramatically increased (Bar- nett et al., 1980, p. 34). Dutton (1995, pp. 126-139) has demonstrated that this cycle closely fits that of the borderline personality disorder type of abuser.

Not all battering relationships fit the cycle of violence. Battering between partners may be a once-in-a-lifetime affair. But many women have reported being constantly terrorized and assaulted with no intermittent periods of relief (Dutton & Starzomski, 1993). These are most probably the victims of the antisocial, psychopathic type of batterer, who sees little need for contrition or remorse in his dealing with a partner-or anybody else, for that matter.

Realities for Abused Women Why, then, do women stay in an abusive IC.PM relationship? For those who have no experience with violence in a relationship, it is an easy thing to say, "Throw the bum out!" or "I wouldn't tolerate that. I'd call the cops and have him arrested!" or "Forget you, nobody does that to me, I'm leaving!" In actu- ality, most women who are in battering relationships do leave, and this in itself is a courageous act because it is one of the most dangerous things a woman can do . The batterer tends to do poorly on his own and would often rather kill or die than be separated from the woman, because he is more terrified of abandon- ment than violence or punishment (Walker, 1989, p. 65). It is remarkable that a number of women do leave, given their clear understanding that lives hang in the balance-their own, those of their children, and even the barterer's.

The same question could be asked of men. Why do they stay? Henning and Connor-Smith (2011) ex- amined more than 1,000 men who had been adju- dicated for battering their partners. More than half said they were planning on staying in the relation- ship. Their reasons included being older, caring about their children, attributing less blame to the female for the alleged offenses and their arrest, and coming from a family where they saw the same thing as chil- dren and regretted modeling their parents' assaul- tive behavior. Ominously, the researchers also found that some men who were continuing the relationship had low relationship satisfaction predictors: having children, expressing hostile attitudes toward women, being jealous, blaming the victim for the arrest, and describing the victim as being aggressive.

298 • PART TWO Handling Specific Crises: Going Into the Trenches

Most women leave a battering relationship an average of three to six times, but do so with varying degrees of permanency (Dobash & Dobash, 1979; Walker, 1979). The following reasons for staying in the relationship have been gleaned from a number of researchers (Benjamin & Walz, 1983; Bograd, 2005; Koverola & Panchanadeswaran, 2004; Okun, 1986; Pagelow, 1981; Walker, 1979, 1984, 1989, 2000), and these realities have nothing to do with the myths listed previously.

1. The woman has a fear of reprisal or of aggravating the attacks even more .

2. Even though the situation may be intolerable for the woman, her children do have food, clothing, and shelter.

3. The woman would suffer shame, embarrassment, humiliation, and even ridicule ifher secret got out.

4. Her self-concept is so strongly dependent on the relationship and perceived social approval that leaving would be very destructive to her.

5. Early affection and prior love in the relationship persist and, by staying, the woman hopes to sal- vage them.

6. If financially well off, the woman is unable to forgo a reduction in her financial freedom.

7. In the cyclic nature of abuse, her mate may not be terrible 24 hours a day, 7 days a week. The victim may tend to forget the batterings and remember only the good times.

8. Early role models of an abusive parent may lead her to beli eve that relationships exist in no other way.

9. The woman may hold religious values that strongly militate against separation, divorce, or anything less than filial subjugation to the man's wishes.

10. The woman may be undereducated, have small children to raise, and have no job skills.

11. She may be kept so socially, physically, geographi- cally, and financially isolated that she has no re- sources of any kind to help her get out.

12. She may be so badly injured that she is unable physically to leave.

13. She may believe the man's promise to reform. 14. She may be concerned for children who are still

at home. 15. Love or sorrow at the mate's professed inability to

exist without her may impel her to stay. 16. Because of previous negative experiences with the

authorities, she may believe she has no options.

17. Due to language barriers or immigration status, she may be unable to communicate her abuse, or she may be afraid to seek help.

Secondary victimization may result by label- ing battered women as hysterical, depressed, schizo- phrenic, alcoholic, or child neglecters and abusers. Such labeling may provide professionals with "rea- sons" to do things to battered women ranging from overmedication with psychotropic drugs to sending them to jail and removing their children from the home. Any one of the revictimizations by well-meaning or not-so-well-meaning institutions undermine s assertiveness and reinforces submissiveness and com- pliance, which in turn increases vul_nerability to abuse (Stark & Flitcraft, 1988; Walker, 1989). It is little won- der that a woman making her first call to an abuse center may be taking only an initial step in a series that sometimes goes on for years b efore she can make a complete break from the battering relationship.

Intervention Strategies In the past 35 years the raising of consciousness that domestic violence is epidemic and that it extracts tre- mendous financial and emotional costs from society has caused an exponential rise in attempts at inter- vention. To that end, intervention strategies for bat- tering are different from other types of crises, becaus e they target both victim and victimizer.

Assessment Assessment in battering and domestic i(t)[ej violence is complex and is subject to controversy and many unanswered questions in regard to its precursors, onset, and outcomes for both victims and victimizers. Assessment is also problematic because of the trans crisis nature of battering. Both batterers and those who are battered do not present themselves in a "steady state" that is amenable to stable and consistent measurement.

Personality Measures. Assessment of battered women by personality measures is somewhat confounding and contradictory to what one might logically expect. One never really knows whether the personality fac- tors found in battered women were present before they were battered or are the res ult of the victimiza- tion (Gelles & Cornell, 1985, p. 71). However, Walker (1989, p. 105) reports that as the battering progres- sively becomes worse, Minnesota Multiphasic Person- ality Inventory (MMPI) profiles change notably.

The question arises: Are there particular attri- butes, traits, or psychological profiles that will in- dicate those women who are potential victims of batterers? In an extensive review of characteristics of battered women, Hotaling and Sugarman (1986) fo und only one characteristic-having witnessed or been a victim of personal violence as a child-as a co nsistent characteristic. When they reviewed the re- sp onses of 699 women who participated in the first

ational Violence Study, the researchers could not fi nd even that characteristic (Hotaling & Sugarman, 1990). Thus, there appears to be little empirical evi- dence that there are any consistent predisposing fac - rn rs that predict who will and who will not become a victim of abuse.

The Attitude Towards Women Scale (Spence & Helmreich, 1972) measures the traditionality of a woman's attitude about her role as well as her per- ception of significant others' views of women. Walker fo und that battered women viewed their father's per- ception of a woman's role much more traditionally th an did a nonbattered control group (2000, p. 105).

The Battered Woman Scale (Schwartz & Mattley, 1993) is used to measure traits that arise as a result o f experiences in battering relationships. Overall, battered women present many of the symptoms of posttraumatic stress disorder and can be placed for d iagnostic purposes within the PTSD category of the D SM-5 (American Psychiatric Association, 2013; As- ti n, Lawrence, & Foy, 1993). Weaver (1998) found in her study of women who had been either sexually or physically abused as children, raped as adults, or bat- te red that only battering was a common marker for PTSD. Thompson and associates (1999) found that suicide, PTSD symptomology, and physical part- ne r abuse go hand in hand. Women incarcerated for k illing or seriously assaulting their partners also show increased levels of PTSD symptomology (Hat- tendorf, Ottens, & Lomax, 1999; O'Keefe, 1998). In- de ed, Walker (1989, pp. 48-49) proposes the battered woman syndrome as a subcategory of PTSD. There- fo re, if PTSD symptoms are present, then partner vio- le nce should always be suspected.

Clinical Interview. Probably the best assessment de- vice for partner abuse is a clinical interview. Any fam- ily history taking should include questions about hitting, threats, controlling, destruction of property or pets, forced sex, alcohol and drug use, and the part- ner's hypervigilance and paranoia about the client's actions (Jasinski & Williams, 1998, p. 37).

CHAPTER TEN Partner Violence • 2 9 9

Walker (1984, p. 122) also has one ·major rule of as- sessment that supersedes all others and to which your authors strongly subscribe: When a woman calls or comes in to report a battering, believe her and start intervention immediately. It is a safe bet that whenever a battered woman seeks help, she is not carrying out the act as some impetuous, hysterical, spur-of-the-moment way to get back at her mate. Battered women refer them- selves only after their problems have become exceed- ingly serious.

Walker (1984, p. 26) found that only 14% of bat- tered women surveyed would seek help after a first in- cident, 22% would seek help after a second incident, and 49% would seek help only after a series of inci- dents had taken place. Given the length of time that passes and the degree of severity of the crisis that is typically reached before help is sought, triage assess- ment of the battered woman should look first and foremost to her safety and the safety of significant others, such as her children. We can assume that a battered woman making an initial call to a crisis line will be at the extremely high end of the assessment scale. She will be behaviorally out of control because of the beating she has just had. She will be affectively out of control because of the trauma she has just suf- fered and the threat of more to come. Cognitively, she may be just holding together and may not be far from dissociating from the terrible reality of her situation.

Sadly, many in the helping professions still con- fuse the effects of domestic abuse with symptoms of other diagnoses. It is extremely important to be aware of these masking symptoms. Compared to women who are not abused, battered women are 5 times more likely to attempt suicide, 15 times more likely to abuse alcohol, 9 times more likely to abuse drugs, 6 times more likely to report child abuse, and 3 times more likely to be diagnosed as psychotic or depressed. It is little wonder that these women experience low self-esteem (Aguilar & Nightingale, 1994).

Crisis workers typically encounter battering vic- tims in the following four settings: in hospital emer- gency rooms and other medical care settings, on telephone crisis lines, in police follow-up operations on domestic violence calls at crisis centers, and at shel- ters (discussed later in this chapter). The operational strategy in all of these settings should be twofold. First and foremost: Ask! Ask if the person has been battered, even if the presenting problem appears to have little to do with battering. Chang and associates (2005) advise that workers give a reason for why they are asking about IPV, to reduce women's suspicions

300 • PART TWO Handling Specific Crises : Going Into the Trenches

and minimize stigma, and that they provide informa- tion, support, safety, and access to resources whether or not the woman discloses IPV. By doing so, workers are not seen as trying to diagnose a pathological con- dition, but communicate compassion, provide valu- able information, and open the door for women to self.disclose IPV and consider seeking services.

That show of concern creates increased levels of trust when questions about battering are asked in an empathic manner, confidentiality is discussed, and nonjudgmental and supportive responses and concern for the person's safety are made with of- fers to provide help, even ifIPV is not the basic issue that brings the woman into counseling (Battaglia, Finley, & Liebschutz, 2003). The smorgasbord of symptoms presented in this chapter all come out of battering. While there may be other reasons , one of the biggest mistakes a worker can make is to not empathically query a person about battering and validating their experiences (Day, 2009; Spangaro, Zwi, & Poulos, 2011). When a woman is validated by an external source that she is being battered and that it is unacceptable, that act is a major contribu- tor to her taking action to remove herself from the battering (Day, 2009). Congruent with validation is her sense of support from community resources in providing her with information and supporting her in making the myriad decisions that range from ca- reer and geographic moves to religious and moral qualms she has over leaving (McLeod, Hays, & Chang, 2010).

Medical Settings. Contrary to recommendation af- ter recommendation by a variety of medical groups, including the surgeon general of the United States, abuse assessment is still not routine in hospital ERs, maternity wards, obstetrics, and family practices (Boes & McDermott, 2002). Many battered women will not acknowledge abuse no matter how empathic and supportive the medical worker is . Therefore, when physical abuse is suspected, the worker should state that this is just a routine part of any medical examination and that the supportive service infor- mation the woman is about to get is also routinely provided. In that way, the woman is given control of the situation, is given support by the worker, and her autonomy is respected (Hamberger, 1994). No one else should be present in the interview for the sake of the patient's safety. The worker needs to ask specific and direct questions while walking a tightrope of not being confron.tational or antagonistic.

The following questions are abridged from Snyder's (1994) and Hamberger's (1994) protocols for hospital emergency room staff

CW: Lots of times people get into arguments, and they get physical with one another. I'm wondering if some of your bruises occurred that way? When you and your husband or boyfriend argue, does he get angry? Do you feel afraid? I'm wondering ifhe ever loses his temper with the children, and when you step in he loses it with you and maybe winds up hitting you . How does he act with you if he's been drinking or u s- ing drugs? Sometimes when people get jealous they overreact and get physical. Did this happen with him? Have you ever been with someone who tried to really control you by hitting you or threatening to hurt you? Are you in one of those relationships now?

By raising the issue of arguing, the worker n or- malizes the situation and opens the door for the cli- ent to talk about the reasons that brought her to the medical facility. By asking about her fears , the worker validates her affective and cognitive bases regarding the situation. These and other questions move fro m general relationship issues to what Hamberger (199 4) calls "funneling" to more behavioral specifics abo ut the abuse, such as number and severity of incidents types of weapons used, and who did the battering.

Juanita: Well ... I sorta got hit with a broom handle.

CW: (empathically but assertively) A broom handle has to be attached to somebody's hand. Whose hand was it? Is he the man who brought you here?

Specific information about what she can do and what the hospital can do should be given if the pa- tient admits she has been physically abused. Medical staff should be well acquainted with local and state laws governing abuse so they can know what legal obligations they have and what can be done to kee p the woman safe. Very specific step-by-step protocols should be formulated and made available to all staff, along with inservice education on domestic violence and its signs. Brasseur (1994) abstracted a typical pro- tocol from Chicago's Rush-Presbyterian-St. Luke's Medical Center to be followed once a battered woman has been identified:

1. Assign a primary nurse. 2. Notify appropriate support services within the

hospital. 3. Give a complete physical exam, along with a neu-

rological exam and X-rays.

Document statements about who caused the liljUfleS.

- Make a body map of old and new injuries. 6. Depending on the jurisdiction, make a call to the

police, identify the assailant, and have him arrested, if possible.

- Take photographs of the victim's injuries. Inform the patient ofher right to access her medical files and how to do it.

9. Discuss with the woman a posthospital plan that will include shelter or other referral, safety plans if she is not leaving the abusive situation, and community support services.

When a protocol such as the foregoing is followed, :tlentification rates of victims of partner violence go 2p (McLeer & Anwar, 1989; Olson et al., 1996; Tilden ii: Shepard, 1987).

ri sis Lines. Of all the dilemmas a crisis telephone worker faces, battering is one of the worst. Women :nay present emotions that range from icily detached :o hysterical to white-hot anger. No matter what the woman's emotional response, the worker's job is to try o help the woman cope with the immediate situation Roberts & Roberts, 2002). That immediate situa-

tion may include the batterer being present while the woman makes the call. The woman may call a crisis line instead of the police in hopes that the police will n ot have to become involved but the publication of the abuse to an outside agency will make the batterer stop.

At times the woman may ask the worker to talk ro the batterer. In almost all cases that is not a wise choice. The woman should be asked if she is in danger and needs police assistance. The focus is on the caller and the caller's safety, not attempting to defuse the batterer. If the batterer truly wants to be defused, then he may call the crisis line. Although the threat of further injury or death to the woman may be extremely high, unless the crisis worker feels danger is imminent and can get the woman to give her name and address so that a 911 call can be made, the best t he crisis worker can do is offer short-term assistance to help ease physical pain and calm the emotional state of the client. Duty to warn certainly takes pre- cedence over confidentiality, but deciding whether t he danger is sufficiently imminent and lethal to ne- cessitate a call to the police is tricky and has future ramifications. Even then the crisis worker may have raging internal debates about what to do. If the client is helped to a safe place, will that only enrage her mate

CHAPTER TEN Partner Violence • 301

even more? Is the woman really ready to make such a move? What assets does the battered woman have so that she can leave? What are her debits? That is why the worker should carefully go over each area, making sure that all pertinent information and all possibili- ties of available action have been carefully considered. No other type of crisis presents as critical a need for comprehensive yet fast assessment.

It is also worth remembering that if the worker calls back a week later, the client may be going through a "honeymoon phase" and may seem not to have a care in the world, only to turn around later at the next battering and beseech the crisis worker to help her. These situations, oscillating from extreme need one day to little if any need the next, can make workers cynical and uncaring if they do not carefully manage their stress levels. Yet such ambivalence is more typical than not as clients slowly come to grips with the risks and realities of leaving the situation or quite possibly facing death there.

Components of Intervention As a call comes in to the abuse center and the IC.ill crisis worker picks up the phone, the assessment pro- cess begins with active listening. The crisis worker im- mediately has to be concerned with a variety of roles. The worker must be not only a good listener but also supportive, facilitative , and concerned with the call- er's safety and must act as an advocate (Barnett et al., 1980, p. 44).

Listening. Facilitative listening and responding are crucial. The victim must know that the crisis worker understands and accepts her present situation in a nonjudgmental, non-value-laden way. Only then will the battered woman be able to open up and share her feelings about her predicament (Heppner, 1978). The crisis worker also immediately reflects that she under- stands the difficulty and urgency of the situation by positively reinforcing the battered woman for calling and taking a first step toward resolving her problem.

CW: You did the right thing by calling. No matter how bad it seems and what terrible things have happened, you've made a big step on the road to straightening it out. We're here to help, and we'll stick with it as long as it takes.

Juanita: I ... I ... don't know. It's gone on so long. I feel so ashamed. I don't know what to do! It's so confusing.

3 02 • PART TWO Hand ling Specific Crises: Going In to the Trenches

CW: I understand how you feel and how difficult it was to make this call. The hurt, the fear, the uncertainty of it all. So start anywhere you want. We won't do anything unless you decide it's best for you. Right now, I want to listen to what you have to say. I'll listen for as long as it takes , so take your time and tell me what's happened.

Supporting. The caller is given both explicit and im - plicit permission to ventilate. The free flow of the victim's anger, hurt, fear, guilt, and other debilitat- ing feelings may take from a few minutes to 2 hours to an extended period of months. Supportiveness means empathizing but not sympathizing with the victim. A sense of lack of social support is one of the major factors for battered women (Perrin et al., 1996), and this lack may be particularly severe for immigrants with different cultural backgrounds (Sev'er, 1997, pp. 3-5). Many victims are only par- tially mobile, and any action steps they take may be months away from happening. Thus, supporting a victim does not mean intervention on a one -shot ba- sis. The crisis worker may have to exert an excruciat- ing amount of patience over a long period of time as the victim slowly moves toward making a decision to take action. No matter how bad the victim's situ- ation looks to the worker, only the victim herself can decide when she is ready to take action to allevi- ate her traumatic circumstances (Dagastino, 1984).

CW: OK! I understand it's a hard decision to make- getting out. Your marriage has had some good times, and you'd really like to hang onto that part of it, even though the beatings are happening more often. You say you want some time to think about it. That's OK! It's your decision, and we'll help whenever you need us.

Breaking away from a battering relationship is a slow developmental process. The crisis worker can- not move the victim any faster than she is willing to go. The worker must be acutely aware of being ma- nipulated into becoming sympathetic to the victim's needs and attempting to "fix" things for her. Many times the victim will project anger onto the police, a minister, or other significant persons. At some point the victim needs to see that displacement and shift- ing of responsibility to others are not going to solve the problem. The crisis worker must be aware of this possibility and not get trapped into proposing exter- nal remedies . •

The victim is actually demonstrating what Hep- pner (1978) calls the wishing and hoping syndrome. The victim wishes the situation would change, that her spouse would treat her the way he used to, and hop es the crisis worker can effect a change in her husband. However, cessation of battering by the abuser rarely happens without legal or therapeutic interventio n (Dagastino, 1984). Under no circumstances should the crisis worker attempt to rescue the victim by talk- ing to the batterer. It is dangerous and takes respon- sibility and autonomy away from the victim. Instead, the conversation should be redirected away from what can be done to "fix" the batterer and toward what the victim is now able to do .

CW: Although I hear you wanting me to come and straighten your husband out and make things the way they were, I can' t do that. I wish I could, but I'm not a marriage counselor. If you think marriage counseling would work, I can give you some names of people who do that. What I can d o is help you make some decisions about what you want to do right now.

A t ypical response to the crisis worker's refusal to fix the problem is anger.

Juanita: You're no damn help at all. You're just as bad as the rest. You're a horrible counselor. I'm gonna have to go back to him, and he'll kill me, just because you wouldn't do anything.

Because abuse workers do not want to lose clients, such ploys often rub a raw nerve in the workers and propel them to do something they may later regret. The crisis worker should realize that when a victim doubts the worker's ability, she is also doubting her own ability. She is probably looking for a way to re- sume the relationship and may be displacing her own incompetence to make changes by blaming the worker (Dagastino, 1984). The best response the crisis worker can make is not to be confrontive but to be empathic, realizing that right now the woman is looking for a way to go back to her mate.

CW: I'm sorry you're angry with me because I won't talk to your husband. I realize the frustration you feel. Yet I'm also not like the others who'll tell you how to act and what to do. I want you to know I'd be happy to work on a plan of action you want to take.

The excerpt typifies the response of a crisis worker who is being supportive yet not taking over for the victim. Usually abuse victims have not been

i:idependent to any degree and quickly fall back into a d ependent state. If the crisis worker keeps foremost ill mind that the woman he or she is now talking to is ultimately going to have to be her own defender and ? rotector, then the crisis worker is not likely to fall into a sympathy trap. The crisis worker who becomes angry or engages in denouncing or criticizing the hus- :'.:>and is making a fundamental mistake. The worker :nay provoke the victim to defend the violent batterer and to attack the crisis worker (Dagastino, 1984).

Facilitating To facilitate the movement of a victim to ac tion takes a great deal of tenacity and patience. Typi- cally the crisis worker will have to deal with feelings of dependency, ambivalence, and depression, which are all clear-cut signs of the client's immobility. Overarch- ing these immobilizing feelings is the learned helpless- :::iess referred to earlier. To generate movement in the victim, the crisis worker strongly reinforces the victim's a t tempts at rational decision making, self-control, and statements of personal power (Heppner, 1978).

CW: You said that you couldn't do anything, but that's not true. You called here, didn't you? When you first started talking, you were crying uncontrollably, and now you're speaking in a rather level, controlled voice. I also notice a lot of "I" statements, which say to me you're starting to take responsibility. Maybe you don't know it, but those are all signs that you're starting to feel some personal power for the first time in a long while, and I think that's great!

Ambivalence about the situation is predominant in most women who seek help from abuse centers. Ambivalence is particularly strong with regard to the m an who, after beating the woman, apologizes, show- ers her with gifts, and tells her what she wants to hear a nd what society leads her to believe (Conroy, 1982). To deal with this ambivalent state, the crisis worker cycles between asking open-ended questions and re- fle cting and clarifying the victim's feelings as an ef- fe ctive means of helping the victim begin to examine previously denied feelings and thoughts.

CW: What were you thinking and feeling while he was beating you?

Juanita: It was like I was standing off to the side watching a movie of this. It was like this can't re - ally be happening, especially to me.

CW: So that's how you cope with it. Kind of separat- ing yourself from the beating, as if it's happening to someone else.

CHAPTER TEN Partner Violence • 303

Juanita: Yes, I guess I've done it that way for a long time. I'd go crazy otherwise.

CW: What is your understanding of why you're being battered?

Juanita: I don't know. I guess I'm just not a good wife.

CW: You're not living up to his expectations, then. How about your own?

Juanita: I'm not sure. I mean, I've never thought of that. It's always been what he wants.

CW: How do you cope with the beating other than just kind of separating yourself from the situation when it happens?

Juanita: I try to do what he wants , but when it starts to build-the tension- I just try to stay out of his way and be nice, although I know sooner or later I'm gonna get it. I dread the waiting. Actually sometimes I push the issue just to get it over with. I know he'll always apologize afterward and treat me nice.

CW: So you do what he wishes even though you know the bottom line is a beating. Yet because of the anxiety you may even push things to get it over with. Seems like you're willing to pay a steep price to get his love back.

Juanita: When you say that, I can't believe I'm letting this happen to me. What a fool . .. a stupid fool!

CW: Then you feel foolish about paying that price. What's keeping you in the relationship?

Juanita: God! I don't know. Love! Honor! Obey! The kids. The good times . Martyrdom. I don't have a job, and I'm pregnant again. I've got to get out. He'll wind up killing me.

Using open-ended questions, restatement, and re- flection, the crisis worker relentlessly hammers at the victim's faulty and illogical perception of the abusive situation. Only by looking and listening through the victim's eyes and ears can the crisis worker form an ac- curate perception of what steps to take and how the crisis worker will operate on the nondirective-to-direc- tive continuum of intervention. Women who have been abused also have in common the feeling of depression. Invariably, once a victim has related the details of the as- sault, her affect becomes flat. Depression has taken over. Beneath the depression is a volcano of residual anger that is trying to find an outlet. The crisis worker's job is to help move the victim out of her depressed state and let the angry feelings out (Dagastino, 1984). This is the first step toward taking action.

304 • PART TWO Handling Specific Crises: Going Into the Trenches

CW: As you relate the details, it sounds like you're re- porting it but not living it. I wonder if that's a typi- cal way you hold it in ... control it.

Juanita: I guess ... ifI really thought about it, I'd kill the SOB . How could the bastard do this to me?

CW: How does it feel to let some of those angry feel- ings out?

Juanita: Scary! I'm really scared I would kill him if I got the chance.

CW: That is a legitimate feeling after what you've been through, but that won't get you where you want to go. Let's take a look at some of the alterna- tives between killing and being killed.

In summarizing the facilitation of the victim's movement from an immobile to a mobile state, the Massachusetts Coalition of Battered Women Service Groups (1981, pp. 25, 67) has made the following rec- ommendations for crisis workers.

l. Be real. Don't hide behind a role. You are what you are. To pretend to be something else makes the crisis worker false and discredited in the eyes of the victim.

2. Set limits. The crisis worker is not Superman or Superwoman. Owning feelings of puzzlement, anger, stupidity, tiredness, and so forth allows the crisis worker to stay on top of the game. If the worker is tired, is taking on a lot of anger, and can- not work it through with the victim, the worker should own the feelings, ask for time out, and get out of the situation until the problem can be gone over with a fellow professional and a fresh start can be made .

3. Give the victim space and time to "freak out." Remem- ber that the victim is experiencing a flood of emo- tions that have been building over a long period of time. Knowing that anger is one step on the way to becoming her own person can be reassuring and empowering to the victim. Give her time to venti- late before settling down to a plan of action.

4. Allow the victim to go through the pain, but stay with her. Your first response may be to become a psycho- logical crutch because the victim is so fragile that she cannot hold together. The crisis worker who remembers that the victim has been down a long road of pain and is just now beginning to expe- rience that pain will realize that the victim pos- sesses a lot of staying power. Belief in the victim's ability to get out of the mess she is in is of overrid- ing importance.

5. Maintain eye and ear contact. Both nonverbal and verbal responses of the victim are important; th ey tell the crisis worker whether what the victim is saying is congruent with what she is doing. Read- ing nonverbal responses may be difficult over the phone, but the worker needs to be aware of into- nations, pauses, and sighs. How something is said may be as important as what is said. Also, what is not said may be as important as what is said.

6. Be respectful and nonjudgmental. The victim's actions must be carefully separated from the victim he r- self. What the victim does may seem asinine; that does not mean the victim is an ass. That is espe- cially true of the religious and moral issues that go with leaving.

7. Restate and reflect the victim's thoughts and feelings. As simple as this sounds, it is often extremely dif- ficult. There is no greater therapeutic help than manifesting these skills.

8. Set priorities together. Two heads are better than one. This is why the crisis worker is there. If the victim could handle the problem alone, she would. Like- wise, the abuse worker is not in business to run the victim's life for her.

9. Look at options. Brainstorming can uncover a vari- ety of previously hidden ideas and actions.

10. Stay away from "whys." Asking why a person does something like staying in a battering relation- ship often leads the victim, rightly or wrongly, to assume she is being judged. When a victim feel s she is being judged, she is apt to respon d in defensive ways that do little to help her or h er situation.

11. Give the victim time to experience catharsis, but do not let her get stuck in self-pity. The client needs to ac- complish movement, and the crisis worker needs to move gently from nurturing emotional release to helping the client start to make plans, however small, concerning her own predicament.

12. Get back to the victim. Even if the battered woman says, "I guess I can make it now," get her phone number and call a few days later to make sure she is getting along all right. Many abused women are so embarrassed by their plight and their own self- assessed stupidity that they cannot bring them- selves to make another call and admit they have failed again. (Note: It is important to determine when the abuser will not be home. Furthermore, it is important to determine whether the phone has caller ID or call-back features so the victim's safety will not be compromised.)

13. Peer supervision and feedback are essential for domestic abuse workers. The intensity of partner abuse is such that few, if any, crisis workers can remain totally objective all the time. Cross-supervision by trusted coprofessionals keeps the worker on track, reduces personal stress, and helps avoid burnout.

Ensuring Safety. The crisis worker 's first job is to de termine how critical the situation is (Roberts & Roberts, 2002; Walker, 1984, p . 122). Is this a cri- si s call where danger is imminent or the woman j us t needs a chance to cathart? All the listening and responding skills known to humanity are of little us e if the victim has multiple fractures or if her sig- n ificant other has threatened to come back and kill h er. The crisis worker calmly and cautiously makes a n assessment of how bad the situation is. Does the victim need and want medical attention, shelter, a place to send her children, a way out of the house if h er husband returns?

All these questions are posed in a measured, de- liberate way to avoid adding to the panic the victim already feels. Although the situation may be critical a nd the best alternative may be for the victim to come d irectly to the shelter, the crisis worker has to remem- b er that the woman cannot be forced into making that choice. This does not mean, however, that the worker cannot make such a recommendation.

CW: From what you've said, it sounds like the situ- ation is pretty bad. Bad enough that you might consider leaving and coming to the shelter. Do you feel as if you or your children are in danger now? Is he there now? Do you want me to call the police? Do you need medical attention?

Because of a fear of the unknown, the victim may b alk at this alternative (Dagastino, 1984). Patiently, th e crisis worker ex plains the role and function of the shelter, answers any questions the victim has , a nd tries to allay her fears. If, after all this , the victim is still unwilling to make a decision, the worker does n ot push the issue. In initially reporting the batter- ing, victims often appear to feel that it is an isolated incident and not abuse . They refuse to see it on an ever-escalating continuum. They delude themselves with the belief that "He really does love me, and if I'm a better person, it ' ll never happen again." As the crisis worker intervenes, he or she shou ld be aware th at such incidents are not isolated. Indeed, there is a consistent pattern leading up to the climax of battering (Walker, 1984, p. 24) . The crisis worker

CHAPTER TEN Partner Violence • 3 0 5

endeavors to lay that pattern out so that the victim sees it not as isolated but as continuous and predict- able . Seeing the pattern is particularly important when the victim is not sure whether to leave or stay. Walker proposes that instead of speaking about the cycle of violence, the worker should lay out the es- calating behavior in graphical form. Having the woman draw a graph of the ever-e scalating violence and the shorter periods of tranquility can be an eye - opening event that allows her to decide to get out (Walker, 2000, pp. 136 - 137).

CW: As you tell me about it, I hear a sort of pattern. For about a week he gets surly, starts criticizing the way the house looks, the way you look, the food you cook, and your control over the kids. Those criti- cisms start out mild but become more severe, until you finally have had eno ugh and say something to the effect that he ought to take more responsibility if he doesn't like things. That winds up with your getting beat up. I wonder if you can look back and see how the situation has repeated itself Just take a pencil and piece of paper and make a graph back for the past couple of months . Put down the length of time when there has been peace and tranquil- ity. Then put down how many hours or days the tension builds and he gets psychologically abusive, then put down when the fights star t and how long they go on before he comes back and says he's sorry.

Juanita: Well, I don't know. I really think it was dif- ferent this time. I mean this was the first time I needed emergency treatment. He was really sorry afterward. (draws out graph) Well, maybe it is get- ting worse. He seems to be getting madder faster.

CW: OK. So you see! What's different is that the pat- tern seems to be repeating itself more frequently, and it's getting more intense.

Juanita: Damn! I do see! I just don't know, though .

Often the client may be very immobile and may not even hear the question, so the worker may need to pose it again (Dagastino, 1984).

CW: When did he say he'd be back, and what'd he say he'd do?

Juanita: I just don't know whether to take it anymore. I love him, but I'm really scared.

CW: OK, I understand you are afraid, but I need to know how much time we've got and what threats he made.

By gently guiding the victim back to immediate and pressing issues, the crisis worker keeps the session

3 0 6 • PART TWO Handlin g Specific Crises: Going In to the Trenches

on track but does not deny the emotional hurt and confusion the victim is experiencing.

By the time the battered woman becomes desperate enough to make the call for help, she does not have time to be analyzed. What she needs is some behav- ioral action-oriented techniques she can use on a short-term basis (Walker, 1979, pp. 75-77). Just hav- ing a plan allows the victim to regain some compo- sure and feel she has obtained some control over the situation. The whole focus of the conversation is to prepare her to get through that one day. At this time, the worker does not worry about tomorrow or any other time. Tomorrow, the worker may call the victim and talk about the next day. If the worker attempts to deal with future events that extend beyond a week, the victim gets lost (Dagastino, 1984).

Because of the flood of critical needs the victim faces , the worker must realistically judge which needs may require immediate action and which ones can be deferred. To help make sense of the heavy flow of information, the crisis worker writes down what the victim tells her so that she can quickly identify and set priorities on the very practical concerns that are pressing at the victim.

Logs that are preprinted and pose a structured set of questions and information ensure that crisis line workers cover critical needs of battered women and provide them with consistent information (Dagastino, 1984; Roberts & Roberts, 2005). Immedi- ate actions and follow-up actions need to be covered and checked. Issues such as getting enough money for the children's lunch the next day may be just as important as taking care of a broken nose, and the worker will need to remember this. By calmly, clearly, and concisely feeding back to the victim her written summary, the crisis worker takes the victim step by step through a review of her most critical needs. By dissecting the crisis in this manner, the worker assures the victim that her problems can be broken down and managed (Dagastino, 1984).

CW: Here are all the things I hear happening to you right now. No wonder you're feeling paralyzed; anyone in that situation would feel the same. You've said you have no job, the children don't want to leave, and that he might kill you. You also indicated that it was against your faith to get a divorce, and particularly coming from Colombia there are some really strong cultural prohibitions. That's a load. Let's take them one at a time and sort through each problem and put them back together. ,

A careful examination of the woman's fears about these problems, what priorities need to be set on them, and the options she has in dealing with them is ex- tremely important. Until the abused woman can con- front such fears openly, she cannot begin developing strategies to deal with her problems (Heppner, 1978).

CW: You're afraid to leave because you feel sure h e will come after you when he comes back, and you're not sure what he might do, so that causes tension to build. Yet I really believe if we make a plan right now you'll feel better, even if you don't have to use it.

If the victim states that she does not know what to do, the crisis worker immediately looks at the two basic alternatives-staying and leaving. What has she done before? How is this time different, if at all, from the times before? If so, what different action needs to be taken now? A key ingredient is determining the level of danger at home. Is the abuser really go- ing to act out, or is the fear of his acting out propel- ling the woman into making the call? To learn what has happened before, the crisis worker asks que s- tions such as "When he 's gone out and gotten drunk before, what has he done? " "What have you done? " From the answers, the crisis worker gains a realistic assessment of the danger level of the situation. If the victim is unwilling to leave the house, then the cri- sis worker role-plays the scene of the drunken abuse r returning home.

Assuming the role of the abuser, the worker goes through, in a systematic way, each situation of poten- tial confrontation and then discusses the potential positive and negative outcomes of the victim's at- tempt to handle the confrontation (Dagastino, 1984).

CW: (in role) Hey, honey, come in the bedroom, I need you real bad.

Juanita: (typical response) I can't stand having sex with you when you are drunk .

CW: (as self) Now, look at how you responded to that. When you shut him off like that, he gets angry, right? What could you do or say differently? How could you change things? How about turning the tables so he had no desire for you at all? What would happen if you had a facial on and your hair up in curlers and had on a frowzy housecoat? Al- though that might not make you very alluring, would that turn him off?

By looking at options and posing alternative ways of behaving, the worker attempts to provide coping

:...>ch niques that may defuse the crisis. By the time :.::e worker is done, the victim is feeding back a plan, ~-0int by point, either for staying in the house or for ::10ving out. Having an escape plan is critical (Walker, :984, p. 122).

CW· All right! You've figured out how to get out of the house. You'll keep the back door open. You've given the kids a note to go over to the neighbors. You've got our number, and you know you can get to your car, parked out back, and get to a phone booth and call us.

As indicated in Chapter 6, Telephone and Online Crisis Counseling, computers and electronic technol- ogy play a larger and larger role in the lives of young ;o.du lts. Therefore, the following study would seem to · ave some potentially important ramifications for -o u nger women who are battered and have access to ;;. co mputer. A computer program that has been field- ;:es ted with a group of battered women currently re - siding in a shelter holds promise for both keeping "Tomen who are abused safer and encouraging them ;:o risk leaving (Glasser et al., 2010). This English/ Spanish program was tested on women who had ex- ?erienced severe threats to their safety. It provides :eedback about risk for lethal violence, options for safety, assistance with setting priorities, and a safety plan personalized to the user. From their scores on che Danger Assessment component, 69% of the sub- ~ects discovered that they were in extreme danger. After using the safety decision aid, the women felt more supported in their decision to leave and had less d ecisional conflict about doing so .

In summary, both short- and long-term safety de- pends on helping abused women take action steps rather than remaining immobilized. For many vic- ti ms, it may not be a question of returning to a precri- sis equilibrium. The equilibrium was never there in the fi rst place. Therefore, for many women, taking first, tentative steps toward action is likely to be extremely frightening, confusing, and full of trepidation.

The following points seem worthwhile for crisis workers to know and understand in helping abused women make such decisions and take action (Mas- sachusetts Coalition of Battered Women Service Groups, 1981, pp. 25, 67).

1. Help women think and act on their situation by providing legitimate reinforcement for their efforts.

2. Help women figure out what they want by pro- viding a sounding board for examining ideas and alternatives.

CHAPTER TEN Partner Violence • 3 0 7

3. Help women identify feelings that prevent them from making decisions.

4. Be honest. The worker cannot tell a person what to do bur can clearly state from her own life how the situation would affect her.

5. Help women to things for themselves, but do not let them become dependent on the worker.

6. Know and offer resources from which battered women can get specific kinds of assistance: Spell out who, what, where, when, and how.

7. Help women gain a sense of self-confidence and ability to take care of themselves.

8. Be challenging. Support women, but do not be afraid to push them toward a decision-making point.

9. Be open to choices. Each woman has control over her life; the crisis worker must not attempt to as- sume control for clients.

10. Hear and understand what women have to say, particularly if it does not run parallel to the work- er's own beliefs, attitudes, and outlooks.

11. Build on the commonalities that women, partic- ularly battered women, share, but recognize the worth of the individual differences of each person.

12. Assess lethality. "I' m fed up and whipped" may really mean "I'm ready to commit suicide."

The following crisis worker's response to a bat- tered woman, who after 2 hours of talking on the tele- phone still could not make up her mind about what to do, aptly illustrates the application of the 12 points just made.

CW: I understand your mixed feelings of wanting to stay and wanting to leave; also the constant fear you live with while waiting for the next time, maybe even wishing it would happen quickly so the tension will ease off. But my guess is that ten- sion reduction only occurs for a short period and then starts to build all over again. I also under- stand that you feel like you're locked into this, but there are some alternatives, which we have gone over. I want you to pick at least one of those, whichever seems best for you, and do it. I won't take no for an answer. Do something that will make you feel better right now. Go take a hot bath if that'll help, and don't spare the bath oil. I think it would be safer for you to come to the shelter right now, but if you don't really feel you can do that, I understand. However, if you feel the ten- sion start to rise and feel like you just can't take it anymore, I want you to promise to call back here.

308 • PART TWO Handling Specific Crises: Going Into the Trenches

I won't take no for an answer. I'll call you tomor- row afternoon to see how things are going. What would be a good time?

Advocacy. Because battered women have been iso- lated for much of their live s, they generally have little knowledge of alternatives open to them. This is especially true with respect to their rights and op - tions with both legal and welfare systems. Providing court advocates who understand the laws and how to weave through bureaucratic obstacles and how to cut through the red tape that often interferes with someone seeking help from the system is of para- mount importance. Weaving one 's way through the state employment and welfare system to obtain fi- nancial aid and job training requires support and advocacy (Shepard, 1999). The worker needs to have an excellent networking system to tap into and get immediate help for a variety of problems these women will face.

Transcrisis Perspective. All the preceding inter- vention procedures cannot be accomplished in a 20 -minute phone call. Even minor crises may require two or three calls to get the client stabilized, in touch with her feelings, and into some semblance of prea- buse equilibrium. The crisis worker is not providing a short-term elixir that merely calms the victim and then blithely sends her on her way. What is being pro- vided is a blend that not only deals with the immedi- ate crisis but also has a long-term application. Many battered women need to go through a complete reedu- cation process about who they are and what they can do. This process should not be hurried even if it takes a year to accomplish this goal.

Indeed, the transcrisis of the battered woman does not end when she gets off the phone and decides to come to the center or go to the shelter. The initiat- ing interview or hotline call is only the first part of the crisis resolution. Other crises will continue to plague the victim. Ibrahim and Herr's (1987) work with bat- tered women who were involved in a group counseling format that concentrated on vocational exploration and economic independence is an excellent example of a transcrisis point. When these women reached the stage of vocational implementation, ready actually to go out into the world of work and test their skills, they experienced all kinds of threatening and anxious feelings and became immobile and paralyzed. The women needed 15 two -hour sessions of intensive sup - port by the grbup leaders to work through this stage!

Shelters A center and a shelter are generally two dif- l(t)fj ferent entities within a domestic abuse program. The center deals with t elephone and on-site, short-term crisis intervention and counseling. The shelter is a longer-term facility where women and their familie s can stay for short or extended periods of time. A com- prehensive program will have both a center and a shelter and will be staffed around the clock with a 24-hour hotline and an open door policy for walk-ins (Barnett et al. , 1980). Shelters generally provide two other im- portant ingredients, individual counseling and pee r support (Hampton, Vandergriff-Avery, & Kim, 1999). There will be tie-ins to other social services agencies: police, free or sliding-scale legal services, hospitals , medical staff and mental health facilities , mobile crisis teams that provide transportation for abuse victims, and direct links to emergency housing facilities with follow-up services (Benjamin & Walz, 1983, p. 83) .

The typical shelter is linked to the abuse center and is well publicized, but for security reasons its location may not be made public. For the same rea- son, it will be well patrolled by the police and will be secure. Staffed by both professionals and volun- teers, it will have adequate cooking, sleeping, bath, and child and infant care facilities for a number of families and funds for clothing, food, and transpor- tation (Langley & Levy, 1977). It should also provide a variety of counseling services to help women ven- tilate feelings , explore alternatives, and make imme- diate plans for what they will do next (Benjamin & Walz, 1983, p. 84). It should also have comprehensive services for children (Roberts & Roberts, 2005). This ideal shelter is a rarity due to lack of funds, although in the authors' home state of Tennessee, a portio n of every marriage license fee goes toward supporr of shelters.

Counseling Women at Shelters Women who enter the shelter fit into two categories: those who are unsure about leaving the battering re- lationship and those who have made a definite com- mitment to leave it (Dagastino, 1984). Women who fall into the first category need to be monitored on an hour-by-hour basis and are the more critical of the two categories. The crisis worker maintains constant contact with these women and reinforces them fo r having had the courage to come to the shelter.

CW: I'm glad you made it. I know it took a lot of courage.

CW: (10 minutes later) Getting settled in? Come on with me. There are some other women I would like you to meet.

CW: (2 hours later) How are things going? Got the kids settled in? They're great-looking children. Want to have a cup of coffee and talk?

Vacillation between going back and staying is ;:haracteristic of these women. The longer the women sray at the shelter, the greater the probability is dl at they will not return to their mates (Hilbert & :filbert, 1984). However, until women can recover ;:heir self-esteem and come to understand that they a re not the cause of the abuse, they are at risk to leave and go back (Schutte et al., 1986). The worker does ;:io t try to force women to stay at the shelter but does -ry to get them to take some psychological "time- o ut" to review their situation in a more objective way D agastino, 1984). The foregoing is particularly true

o f women who have suffered childhood sexual abuse, who are far more likely to return to the batterer be- cause of their emotional attachment (Griffing et al., 20 05). Knowing this kind of information is critical to worker intervention and keeping women from leaving before they have a chance to start gaining back their self-esteem.

Juanita: I'm all mixed up. I don't know if I'm wrong or not. I'm Catholic, and I'm Hispanic. Women in my family just don't walk out of a marriage. The church and my family both say we just need to work things out, but I really think he'll kill me.

CW: Let's assume you're taking a 1-day vacation, so you can get some rest before you go back and deal with it. It's fine if you want to go back home, but do this much for me-just take it easy for a while. I can see that you're physically all right and not hurt, and I'm relieved. This is a great t ime to talk about what you can do if you do or don't go back.

The shelter worker checks repeatedly with the new a rrival and reinforces her decision to come. She con- veys her concern for the victim and, with the help of other women in the shelter, sees that the victim and her family are settled. The focus is on the here and now. Durillg the first few hours of the victim's separa- tion from her abuser, the worker will probably have to be very directive. Few women at this time have the ego strength to stand on their own, and most need an abundance of support and help. The objective is to keep the victim moving, thinking, and acting so that she is preoccupied and does not have time to let

CHAPTER TEN Partner Vio lence • 309

fear, guilt, or any other debilitating and anxiety-rid- den emotions overcome her. Domestic chores such as cleaning and cooking seem to be particularly help- ful in this regard. In all instances, the worker should be carefully attuned to the victim's needs . Some may find help sitting, talking, or crying with a worker or a group of other women. Others may be so exhausted that they need to go to bed and sleep. Whatever the victim needs, the worker should be adaptable to those needs and flexible enough to change as circumstances demand (Dagastino, 1984).

Shelter Dynamics. A variety of positive dynamics occur at shelters. There is substantial support from other women who have experienced the same kind of trauma. This support enables victims to begin gain- ing the courage to face people, recovering their lost self-esteem, and learning that the beatings were not their fault (Schechter, 1982, pp. 55-60).

Wife abuse shelters are not vacation spas where one's every whim is catered to. Although an abun- dance of caring and sharing occurs, women who live in shelters are encouraged to start trusting themselves to make decisions. Part of the decision-making pro- cess includes determining what is best for the shelter. This is not an easy task . Limits have to be set with re- spect to pets, children, cooking, and so on (Schechter, 1982, pp. 63-64). Women get bored, boss each other around, miss their men, miss sex (pp. 55-60), and have problems relating to people from different eth- nic and racial backgrounds and sociocultural milieus (Massachusetts Coalition of Battered Women Service Groups, 1981, p. 28).

Shelter user: Getting used to a shelter is overwhelm- ing. You like it, but you don't want to be there, 'cause it isn't home. You've got to put together all your psychological know-how in getting along with different types of people. Wondering if you're going to make it, especially when you see all the pain and confusion and don't know whether it's yours or theirs or what, and hoping nobody finds out you're here. Trying to be understood and feel- ing like you are a blabbermouth here when you couldn't talk at home. Trying to look forward and all the time wanting to forget . .. wanting to forget ... wanting to forget (Schechter, 1982, pp. 59 - 60).

At a shelter, everything is not always as it seems. Many women who come to the shelter are extremely dependent and exceptionally adept at manipulating the workers there (Walker, 1984, p. 126). A statement

310 • PART TWO Handling Specific Crises: Going Into the Trenches

like "You really understand-you've made my whole life better" is reinforcing to the worker but may actu- ally be manipulation. The woman is using the house and the worker as a security blanket and is not mak- ing any progress toward getting out on her own (Da- gastino, 1984). The wise shelter worker comes to see the manipulation for what it is, a refusal to take re- sponsibility for oneself and a shift from dependency on an abusive partner to dependency on a caring shel- ter worker (Weincourt, 1985). Gently but firmly, the worker extinguishes such behavior.

CW: I appreciate what you said, and I appreciate your wanting to cook my dinner and all the other things you want to do for me . Yet I believe your time and mine could be better spent working on getting you set up in an apartment and looking for a job.

Grief. Besides being dependent, many abused women go through a grief process. Sorrow and depression, guilt and self-blame, and decision-making difficulty are all hallmarks of the grieving process. What would be viewed as normal in a woman who suffered the death of a spouse may be viewed as pathological in an abused woman. However, these responses are just as legitimate for an abused woman who is trying to come to terms with the loss of a significant relation- ship, shared parental responsibilities, and a clearly defined role as a wife (Campbell, 1989).

There are a lot of yes, buts as workers start to con- front abused women with making a new future . As victims shift from a depersonalize d view of their situation to depression over it, the process can be extremely frightening to a shelter worker unless she knows that this, too, is another step in the transcrisis that battered women go through (Dagastino, 1984). The woman's grief often puzzles those trying to help her. Many human services workers may be threatened by these feelings and deny the woman's need to mourn by concentrating on dealing with concrete aspects of the woman's dilemma, such as providing food, cloth- ing, and housing.

Her grief can be understood, however, if one asks the question "For what is she mourning?" In most cases, she has defined herself in terms of her relation- ship with the batterer, and if that relationship ends, she feels as if she has lost everything-including her sense of self (Turner & Shapiro, 1986). She clings quite tightly to the dreams she has for the relationship- including the expectations with which she entered

into it. When the relationship ends, she must come to terms with the fact that these dreams will never materialize. Therefore, she is not grieving so much for what was , but for what she hoped could have b een (Spanno, 1990). A crisis worker can and should val i- date that the woman's loss is very real and that she has a legitimate right to mourn and experience the feelings she has over the loss (Russell & Uhlemann 1994). At this point, the counseling process is little different from grief due to death of a loved one (se e Chapter 12, Personal Loss: Bereavement and Grief) .

Juanita: I wanted this to work so much. We could have had it so good, but I couldn't take him beat- ing on me and the kids too. What went wrong with that good-looking, happy couple in this picture? He was so handsome and so good to me in the be- ginning. Then it just slowly went to hell, and now this . (Weeps while slowly turning over in her hands a wedding picture that she brought with her to the shelter.)

CW: It's really hard to say good-bye to all those things that were and might have been. It must hurt even more than the beatings to know that all those hopes and dreams won't come to pass.

Juanita: It tears my heart out, but I know I did the right thing. Sooner or later he would have killed me or the kids in one of his rages. It's so weird! I still love that SOB.

CW: The grief you're feeling is as real as if a clos e friend or a relative had died. Perhaps even more tragic because when this relationship died, a part of you died with it, Juanita. The part of you who struggled out of the barrio, went to college, got an education, made a success of herself, married the perfect man, and then had all those expectations dashed because of the way he treated you and the children.

Juanita: I can't let that stop me. Nothing else did. I made the right decision coming here. I also made the right decision getting a warrant on him. Maybe that last act of love will get him the help he needs or the jolt he needs to wake him up so he doesn't do it to somebody else.

CW: As you say that, I see so much determination coming through the tears. I also see a new, differ- ent, stronger person as you say those farewells , as tough as they are.

A woman who has been involved in an abusive re- lationship needs to grieve and to have her grief vali- dated. The crisis worker does this while reinforcing

chat although there is now an altered future, it has p o tential to be a good one. It is through this process lh at the battered woman can come to see the relation- ship for what it really was-abusive. The crisis worker will make a very bad therapeutic mistake if she ex- ? ects the woman to rejoice. If she is expected to be ha ppy for leaving and is discouraged from feeling her sense ofloss and expressing it, she may never confront -h e truth about the relationship. The end result may well be a return to the partner or one just like him Spanno, 1990).

Depression. Depression comes in many guises . Many women who come into the shelter sleep much of the rime. On first appearance, they may seem to be lazy. Actually, they may be going through a stage of try- in g to regroup their psychic energy. The worker's task b ecomes one of trying to help them move past their inactivity, but not by pressuring them or taking them on a guilt trip (Massachusetts Coalition of Battered Women Service Groups, 1981, p. 27).

CW: I've noticed you pretty much sticking to your room and sleeping a lot. I was a little concerned and was wondering how you were feeling. I wonder if you've had a chance to talk to anyone about how you feel since you got here.

Juanita: I feel so guilty. It seems like I have slept ever since I've gotten here, and the other women have been so good to take care of the kids. I'm not really like this. I just don't seem to have any get-up-and-go. I'm really sorry to be so much trouble .

CW: What you are doing is exactly what you should be doing, getting your energy back. You burned up a tremendous amount of it making the decision to get out and get here. The other women have felt the same way, so they understand. In a few days you'll do the same for somebody else. If you want to talk, we're here . If you want to rest, that's just fine too . The main thing is you're safe, and that's what's important right now.

Terror. For many women, a stress-related syndrome similar to agoraphobia arises after they have been in rh e shelter for a while (Massachusetts Coalition of Battered Women Service Groups , 1981, p. 27). They m ay have extreme and unexplainable attacks of ter- ro r that are touched off by seemingly innocuous inci- d ents. These incidents greatly restrict their activities a n d new freedom. Fear of their mates , fear of their p redicament, fear of their separation from a definable

CHAPTER TEN Partner Violence • 311

past, and fear of an undefinable future can all cause the onset of terror. Under no circumstances should the shelter worker allow it to continue. Victims must be encouraged and helped step by step to pull them- selves away from the security blanket of the shelter and out into the real world.

Such progress may take place in very small, slow steps, but the steps must be taken. As women take these steps, they receive very specific, positive reinforcement for what they have accomplished, enabling them not to fall back into learned helplessness but instead to take responsibility for their behavior (Weincourt, 1985). Invariably, victims will not be able to see that they have done much of anything, or they tend to diminish their successes. For women who are faced with leaving a relationship with no means of support, structural change in their economic en- vironment is imperative. Independent housing, job training and opportunities, affordable child care, and social support services are critical. Programs such as the Job Readiness program that is run in a number of Kentucky shelters provide job training to make women employable (Websdale & Johnson, 2005). However, such preparation may bring on its own de- velopmental crises as these women venture into new, unfamiliar territory.

CW: I know you're still scared to death to go down and talk to them at Federal Express about that job. It's a big step, but a week ago you couldn't walk down to the grocery store, and now you're doing that fine . So let's take it a step at a time. Look at what you overcame. We can go through the job inter- view, play it a step at a time, talk about those steps right here where it's safe, and give you a chance to really become confident about going down there.

Those Who Have Decided to Leave. The second cat- egory of women who come to the shelter are in for a long haul and are not going back to the battering situation. For women who are in for the duration, the crisis worker deals with immediate specifics such as finding a place to live, financial aid, and child care. Emotional support has a low priority because these women are so busy that all they want and need is very practical advice and help . These women are very dif- ferent from those experiencing acute crisis because they are highly motivated to change their lives. They are much easier to work with, because they have made a decision to get out of their domestic pressure cooker (Dagastino, 1984).

312 • PART TWO Handling Specific Crises: Going Into the Trenches

Follow-Up Once women leave the shelter, they should IC.id be provided with follow-up care (Tutty & Rothery, 2002). As immediate demands are' relieved, the emo- tional impact of their decision should be dealt with over the long term. These women are urged to go for counseling with the idea that no one can be beaten even once without suffering some psychological damage. It is not uncommon for a woman to be so busy getting her act together that her emotional reac- tions are delayed. The victim may be out on her own, well established, and watching television at the time that she experiences a sudden emotional breakdown. The crisis worker apprises the victim of what to ex- pect in the way of emotional aftershocks. Such re- sidual psychological trauma seems to be particularly characteristic of women who initially appear to be very much in control (Dagastino, 1984).

CW: Even though you feel like you've made the break from your husband, don't be surprised if later on you get depressed and really feel like you need and miss him. That's to be expected. We know that, and we're here to help then too!

Indeed, in the worst of scenarios, the victim may become lonely, forget about the terrible abuse she suf- fered in the past, invite her ex-mate over for dinner, and get beaten up again. Or because of urging from children or the ex-p artner, she may feel pressured into reuniting (Tutty & Rothery, 2002). Therefore, in fol- lowing up with the victim, the crisis worker should understand that there may be relapses and that the victim may fall into old ways of behaving. Or, the vic- tim having made the break, the batterer may seek her out for revenge . Thus, crisis workers not only may have to check up on their clients but also may have to be indirect about it, so the women do not become dependent on them (Dagastino, 1984).

CW: Hello, Juanita.just called to see if you've been able to make that appointment for counseling at the Human Services Clinic. I know it's hard to get in there at times and thought if you hadn't, I could call the clinic, and we'd have one of the people here drive you down and help you get started.

The crisis worker continues to be a support system until the victim is well connected to a long-term sup- port source (McLeod, Hays, & Chang, 2010), and only then does the crisis worker fade from the victim's life. Long-term support is particularly critical for abused women. Research indicates that women who leave the

shelter and strike out on their own continue to u n - dergo emotional changes for at least 6 months after leaving. Therefore, support and advocacy are critical during this time frame. Those who have a suppon group and advocates who help them access services do significantly better in reaching their goals than do women who lack such services (Sullivan et al., 1994). Support services also build self-esteem, increase locus of control, reduce stress, and enhance feelings of b e- longingness and support (Tu tty, Bidgood, & Rothery, 1993). Follow-up and support are particularly impor- tant for women who have little education, few job skills, and minimal financial support (Webersinn Hollinger, & Delamatre, 1991).

Do the shelter experience and its follow-up services significantly alter a woman's chance of not becoming involved in an abusive relationship again? The data are not clear on this issue. Research indicates that the greater the number of times a woman leaves an abu- sive relationship, the more likely she is to leave per- manently (Schutte, Malouff, & Doyle, 1988). Going to a shelter without benefit of follow-up and othe r support services may actually increase violence (Berk, Newton, & Berk, 1986). Finally, because shelters tend to be based on Western forms of feminism, ethnic minorities with different cultural backgrounds re- port difficulties in adapting to a shelter environment (Hamby, 1998, p. 238). Clearly, entering a shelter is a major step and not one to be taken lightly. While en- tering a shelter may be necessary, based on the forego- ing it is not necessarily sufficient by itself and is but a first step on a long road (Tutty & Rothery, 2002).

Intervention With Children There has been a tendency in the battered j(t)[j women's movement to look at children as "secondary" victims (Lehmann & Rabenstein, 2002; Peled, 1997). They are not. Remember that there are an estimated 7 million children who have been exposed to vio- lent abusive conditions in the United States alone (McDonald et al. , 2006). First and foremost , children often receive physical abuse along with their moth- ers (McMahon, Neville-Sorvilles, & Schubert, 1999). Statistics on family violence identify that at least half the homes that suffer domestic violence have chi l- dren under 12 years of age living in them (Greenfield, Rand, & Craven, 1998). Children are often lost in the shuffle of domestic violence, but that violence has a direct impact on their lives both in the present and in the future (Wolak & Finkelhor, 1998, pp. 73 - 111).

Lehmann and Rabenstein's (2002) review of re- search outcomes on children who have witnessed

omestic violence indicates a variety of behavioral and emotional problems that range from academic difficulties to approval of violence as a problem- solving method. In adulthood those same children are likely to experience poor interpersonal relation- sh ips, use and accept violence as a way to solve prob- :ems, have chronic depression and low self-esteem, and engage in criminal behavior. In that light, crisis workers need to be as concerned for children as they are for the women who are immersed in battering relationships .

Of primary concern is the safety of the children, so a lethality assessment should be conducted to de- ermine where the children should reside and who

wi ll supervise them during visitation and other oc- cas ions on which the perpetrator may be present. For children who are old enough to take action on their own, a safety plan should entail how to deter- m ine whether the situation is becoming lethal, how co get away from the perpetrator, and where they ca n go to be safe. If they are in a shelter, they need to

n ow how to keep the location a secret not only from the perpetrator but also from other relatives and ac- q u aintances. If there is evidence of abuse toward the ch ildren, which is highly likely in partner violence, t h en the crisis worker is mandated to refer the case co a state welfare agency (Wolak & Finkelhor, 1998, pp. 100-101).

Children who have witnessed partner violence or have just fled or been removed from a home can bene- fit from immediate crisis counseling to stave off typi- cal PTSD symptoms (Lehmann & Rabenstein, 2002) t h at can follow them into adulthood (Anderson, D anis, & Havig, 2011). (See the sections on children in Chapter 7, Posttraumatic St ress Disorder, and Chapter 9, Sexual Assault, for more detailed assess- m ent and intervention strategies.) Specific immediate intervention with a trained crisis worker should first d o a safety assessment, then allow children to recount t h e events and their feelings about them, correct neg- a tive misattributions about self-blame, and work t h rough overwhelming negative feelings (Wolak & Finkelhor, 1998, p. 101). Specific problem-solving strategies need to be developed in which the child's a ffect is normalized and she or he learns how to a nticipate and deal with uncomfortable emotions (Lehmann & Rabenstein, 2002).

There is probably no age too early to start therapy fo r children who come from abusive home settings .

CHAPTER TEN Partner Violence • 313

Roberts and Roberts (2005) report that the Jersey Battered Women's Service in Morristown, New Jersey, has developed coloring books that are used during initial contact with the children. The books encour- age children to identify feelings, provide assurance of safety, give them information to understand what is happening in their families, provide information to help the children adapt to the shelter setting, and begin to assess the children's needs and concerns.

Therapeutic work done conjointly with caregivers is critical. First, a parental interview should be con- ducted with the battered parent to determine safety issues, developmental history of the child, a history of the traumatic exposure, what current symptoms are being manifested, and how well the child is han- dling separation issues , and to provide psychoeduca- tion about children's symptoms as well as hope that things will improve (Weinreb & Groves, 2007). Doug- las (1991) used conjoint therapy with mother and child, employing attachment theory to help toddlers ages 15 to 36 months work through traumatic batter- ing events they had witnessed. Hughes's (1982) brief intervention strategy includes intervention with chil- dren, mothers, schools, and shelter staff members. Her model is comprehensive in that it provides indi- vidual counseling; initiates group meetings for peers, siblings, and family ; teaches parenting skills to moth- ers; establishes a liaison with school personnel; and trains shelter staff members in child advocacy and child development issues.

Malchiodi (2008 , p. 254) recommends art and play therapy as a primary therapeutic mode because many children will not want to talk about the violence they have witnessed. Further, children will have dif- ficulty because of their immature cognitive develop- ment in verbalizing the complex issues that undergird domestic violence (Weinreb & Groves , 2007).Treat- ment goals for children and the victimi zed parent in- clude (Malchiodi, 2008; Weinreb & Groves, 2007):

1. Creating an alliance with the parent to help the child heal.

2. Providing psychoeducation to both parent and child about the trauma and therapy.

3. Restoring the parent's self-esteem and confidence to parent.

4. Establishing a safe therapeutic environment for the child to express thoughts and feelings.

5. Relieving the child's symptoms, including diffi- culty with living transitions, sleeping, nightmares, and other trauma symptoms.

314 • PART TWO Handling Specific Crises: Going Into the Trenches

6. Reestablishing the child's previous level of cogni- tive functioning and strong attachment with the caregiver.

7. Reassurance that what has happened is not the child's fault and the child is not guilty of anything.

8. Helping the child express thoughts and feelings and regain cognitive and emotional regulation.

9. Providing stress reduction strategies to aid in stopping emotional dysregulation.

Weinreb and Groves (2007) provide an excellent example of why using play therapy is effective with children coming out of domestic violence situations. In this instance a 7-year-old girl had witnessed severe beatings of her mother by her father. She was intro- duced to therapy by being brought into a play ther- apy room and invited to play. She used drawing and playing with figurines that represented her violent environment to work through a constellation of con- flicted feelings about the traumatic events and sepa- ration of the family. She expressed that she was afraid of, yet missed, her father, which are all too common ambivalent feelings about the offending parent. Try- ing to verbalize these ambivalent, conflicted feelings and integrate them is extremely difficult for an ele- mentary school age child. Working th em out through play and anchoring them with drawings , models , and other concrete representations isn't.

Many times group work (Malchiodi, 2008, pp. 252-263) may be used with children; benefits in- clude decreasing isolation, bonding with other vic- tims, and seeing others moving forward from the trauma of the domestic violence they experienced. Malchiodi (2008 , pp. 258-261) has adapted Her- man's (1992) three-phase trauma recovery model to her groups, which generally meet for 90 minutes for up to 12 sessions. Phase 1 is about establishing safety rules, confidentiality, personal space, and boundar- ies, which may be put on a colorful poster and signed by the children as part of their behavioral contract. The group engages in activities such as making feel- ing thermometers; reading about Brave Bart, the traumatized cat who gets into a group of other trau- matized cats; creating safety hands with "safe" adult names and phone numbers on it; learning relaxation and yoga activities; and free drawing and play time . Phase 2 is about telling the trauma story and includes activities such as creating collages of being powerless and powerful, making "how hands can hurt" post- ers, drawing a picture of "your family," reading thera- peutic storybooks, engaging in relaxation and stress

reduction act1vlt1es, practicmg scaling techniques with feeling thermometers, learning simple cognitive- behavioral techniques to reduce negative thinking, and free play and art time. The final phase has to d o with returning to the community and reconnecting with significant adults in the child's life who are cen- tral to his or her emotional recovery. These caregivers are asked to participate in the final two sessions. Chi l- dren can share their artwork and have parents engage in reconstructing artwork, cooperatively creating or adding to safety hands to reinforce the child's sense of security and creating past, present, and future col- lages to show where they have been, where they are now, and the hopeful future they are moving toward.

Outcomes for the children should include the fol- lowing (Malchiodi, 2008, p. 261):

1. Increased knowledge of the emotional and physi- cal effects of family violence

2. Understanding that violence in the family is not okay and it is not their fault

3. A reduction in stress-related or PTSD symptoms; increased ability to self-regulate emotions

4. Decreased negative self-talk 5. Improved ability to identify feelings , and the abil-

ity to communicate those to peers and adults 6. Increased sense of social support 7. Stronger connection with the nonabusive parent 8. Resilience to cope with future crises

Finally, many children are still involved with both parents , and long-term monitoring and inter- vention are needed. The Duluth Family Visitation Center operates on the premise that this will occur and that parent training is critical for both parents so that children will not be used as messengers, ne- gotiators, or witnesses to further verbal or physical abuse. As such, the Center staff members attempt to remain neutral and to act as advocates for the chil- dren with both pa.rents by providing a safe place to exchange children, helping parents develop good parenting relationships with their children, and pro- viding valid information to courts regarding custody and visitation rights (McMahon, Neville-Sorvilles, & Schubert, 1999).

Courtship Violence To believe that only women who are part- i(tiij ners in a conjugal relationship are victims of vio- lence is to be badly mistaken. Studies on courtship violence estimate that it occurs in anywhere from

22% to 67% of courtship relationships and cuts across college, high school, and nonschool dating popula- tions (Burcky, Reuterman, & Kopsky, 1988; Henton et al., 1983; Makepeace, 1983). A conservative esti- m ate is that violence occurs in approximately 25% of courtship relationships. As simplistic as the follow- ing may sound as a predictor of violence, Bergman (1992) found that number of dating partners and d ating frequency had the highest positive correlation a nd that grade point average had the highest negative co rrelation. As one might expect, adolescents who come out of violent families carry their experiences into their dating behavior (Foshee et al., 2015; Kauki- n en et al., 2015; Laporte et al., 2011). All of the fore - going researchers found that indeed family of origin violence is a risk factor in dating and aggression. Fe - m ales who had been victimized by either parent were a t greater risk for revictimization but not increased aggression. High-risk males reported being aggres - sive toward girlfriends, particularly if they had been h arshly disciplined by their fathers. For both males a nd females, but particularly for girls, the extent of their aggression toward their parents predicted their aggression toward partners (Laporte et al., 2011).

If you then also consider living in violent neigh- borhoods and attending violent schools, dating violence is just part of the culture (Black et al., 2015; }l"iolon et al., 2015). However, as old fashioned as this sounds, East and Hokoda (2015) found that moth- ers' early strictness, close monitoring, and conserva- tive sexual attitudes predicted a lower likelihood of subsequent dating violence in low-income Latinas . 'os and African Americans. So it appears that what goes o n within the family can buffer environmental effects.

Perhaps, even more ominous, in a study of high school students by Burcky, Reuterman, and Kopsky 1988), dating violence affected girls as young as 12.

These researchers also found that assaultive behav- :or was not just shoving and pushing. Among those experiencing dating violence, 37.5% reported that the m inimum assaultive behavior was being punched, and approximately 9% reported having been as- saulted with a gun or knife! It is noteworthy, and may ?resage the future of these relationships, that the ?ercentage of violent incidents reported closely par- allels that found in samples of married couples and :h at this violence is reciprocal in nature (Jasinski & Wi lliams, 1998, p. 30; Straus & Gelles, 1986; Straus, Gelles, & Steinmetz, 1980). What is truly astounding is that, in a study by Henton and associates (1983), 25% of victims and 30% of offenders interviewed

CHAPTER TEN Partner Violence • 315

interpreted violence in courtship as a sign of love! Research study after research study indicate that vio- lence invariably escalates the longer people are in an abusive relationship. Further, each subsequent year that women experienced violence as adolescents in- creases their risk for revictimization compared with those who did not have that experience. Across all years, women who are physically assaulted are sig- nificantly more likely to be sexually assaulted in that same year (Smith, White, & Holland, 2003). To think that people will give up violent behavior for "love" or any other reason is to think wrong. Worse, to think that one has the power to get a partner to give up an addictive behavior such as battering is patently false!

In that regard, the best directive your authors can offer to anyone who is physically assaulted even once in a dating relationship is , no matter how great the love, how great the good times, how great the sex, how many flowers , apologies , and promises to change are given after an initial assault, get out of the relationship now! No battered woman we have met set out with the intention to go with or marry someone who would beat her. However, by letting such behav- ior occur early in courtship, many battered women unwittingly set the stage for some terrible conse- quences of their early tolerance.

And if you have assaulted someone in a dating re- lationship, get help now! "Assaulted" doesn't necessar- ily mean that you put the person in the hospital. It may have been a series of hard shakes, a shove or two, or a slap in the heat of an argument or a moment of jealousy. Although you can easily rationalize this be - havior away, the chances are good that this behavior will increase in the future. Besides the harm you do to someone you profess to love, the changes in the law and increased judicial sensitivity to battering mean that you will probably spend some time in jail if you are convicted of an assault on your girlfriend or boy- friend. If your school counseling center doesn't con- duct anger management groups, there are therapists who do. The section on treating batterers will give you an idea of what you need to look for in a therapist.

Stalking Epidemiological studies of stalking preva- i(tiiji lence range from 8% to 16% of women and 2% to 7% of men who will be stalked during their lives (Dressing, Kuehner, & Gass, 2006; Tjaden & Thoennes, 1998b, 2000), with the National Intimate Partner and Sex- ual Violence Survey pegging the stalking rate at 15.2% for women and 5.7% for men (Breiding, 2015). That

316 • PART TWO Handl ing Specific Crises: Going Into the Trenches

percentage is most likely a lot worse on college cam- puses. Shorey, Cornelius, and Strauss (2015) found that in their study 38% of men and women in a cur- rent dating relationship had been stalked in the pre- vious 6 months. But those cases often go unreported because of fear of violence, gender norms , and shame (Cass & Mallicoat, 2015). So for those who are vic- tims, the official definition of stalking is "the will- ful or intentional commission of a series of acts that would cause a reasonable person to fear death or seri- ous bodily injury and that, in fact, does place the vic- tim in fear of death or serious bodily injury" (Office for Victims of Crime, 2002, p. 1).

Stalking is generally defined as repeated harass- ment, following, and/ or threats that are committed with the intent of causing the victim emotional dis- tress, fear of bodily harm, and/ or actual bodily harm. Fantasy stalkers who typically target movie stars may send out hundreds of e-mails, letters, or phone calls . Most of these stalkers are not targeting their victims for murder, as opposed to stalkers who are strangers to their victims who demonstrate a variety of pathol- ogies, are angry, and want power over their victims , and are extremely dangerous sexual predators and murderers (Dressing, Kuehner, & Gass, 2006; Mester, Birger, & Margolin, 2006; Schlesinger, 2006). How- ever, as evil as those stalking strangers may be, they are less likely to cause a woman injury as opposed to those who are familiar with the person. Tjaden and Thoennes (2000) reported that injury rates were four times higher among women stalked by acquaintances as opposed to strangers . To top it off they also have more severe mental health problems (Cole, Logan, & Shannon, 2005). It may interest you to know that the first state stalking law in California didn't come into existence until 1990 although all 50 states in the U.S. now have stalking laws (Lawson, 2013).

Stalking is not just a problem in the United States but apparently is worldwide (Maran et al., 2014; McKeon, McEwan, & Luebbers, 2015; Pengpid & Pelt- zer, 2014), and as McKeon and associates (2015) found out in Australia, males minimize the problem by believ- ing stalking isn't really serious, that it's romantic, and victims are to blame when it happens. Indeed, better you are stalked by a stranger from that standpoint be- cause Scott and associates (2014) found that the victim was perceived more responsible when the stalker was known to her as opposed to a lurking stranger.

Cyberstalking. There is probably no more terrifying experience than being stalked. A new phenomenon

is stalking over the Internet. Cyberstalking allows the stalker to collect information about the target and then, when communicating with the target. reveal these personal facts. Interestingly, in a study of cyberstalking among college students, Alexy and as - sociates (2005) found that males were more likely to be stalked than females by this method, and that was also found to be true in Strawhun and associates ' re - search (2013). Cavezza and McEwan (2014) found th at while cyberstalkers were more likely to be ex-intimate partners and less likely to approach their victims, t he majority still combined off-line stalking as well, a nd this behavior was also affirmed by Strawhun and as- sociates (2013). The field of cyberstalking has now grown to the point that a test, Fear 'of Online Interp er- sonal Victimization Measures (Henson, Reyns, & Fisher 2013), has been developed to measure three differe m forms of online victimization. The test measures on- line harassment, cyberstalking, and online threats of violence by a current/ former intimate partner, a friend/ acquaintance, or a stranger.

Stalking targets have many of the same PTSD- like symptoms that battered individuals do and re - sort to the same kinds of strategies when the stalking becomes intolerable, such as changing one's address moving away, quitting one's job, changing one's name and appearance, and going underground (Knox & Roberts , 2005) .

Stopping stalking can be highly frustrating be - cause the authorities will not likely intervene un- less the individual has some proof that she or he is being stalked (Brewster, 2002). Persons who are being stalked need to keep a recorded log of sightings phone calls, copies of e-mails and letters, and any wit- nesses to the stalking. The Stalking Behavior Check- list (Coleman, 1997), which is available through many advocacy groups, measures unwanted harassing and pursuit-oriented behavior and can be used to provide excellent documentation. If you are being stalked, yo u need to call the police now! You need to get in touch with victims' advocacy groups that know how to deal with this problem and have them go with you to the authorities. Federal antistalking legislation was im- plemented as part of the Violence Against Women Act in 1996, and all 50 states now have laws regarding stalking (Knox & Roberts, 2005). While many juris- dictions have paid little heed to stalking problems in the past, increased awareness has caused the instiga- tion of counterstalking programs like the Nashville Metropolitan Police Department's Counterstalking Plan, which uses a wide array of technology to trap

and prosecute stalkers (Roberts & Kurst-Swanger, 10 02). Michele Path (2002) has written an excellent survival manual for stalking victims.

Gay and Lesbian Violence It.SIM _.\l chough statistics indicate that same- -- ---

_,,e n dered sexual orientation is prevalent in about 0% of the people in the United States (Gebhard,

:9 97), even though the Supreme Court has ruled :avorably on same-sex unions, the attitude of the -eneral public is often highly negative, scornful, and openly hostile to gays and lesbians. This pre- "ailing attitude keeps many same-sex relationships :.mder wraps, so when violence occurs, no report is ;nade . There is also reluctance on the part of same- sex partners to report violence because of the added stigma attached to an already stigmatized percep- :ion that gay and lesbian relationships are unhealthy Bograd, 2005; Elliot, 1996; Kanuha, 2005) . Finally,

un less they themselves are gay or lesbian, few service :>roviders or researchers have the inclination, resources, ~r education about same-sex relationships to provide :neaningful help (Island & Letellier, 1991; Renzetti,

996) . The bottom line is that while same-sex rela- :ionships can become violent as easily as heterosexual ones, figuring out how to help both the victim and the ~atterer is a tough proposition since there is not much evidence-based practice or support systems specifi- .:ally designed for them. Indeed, the question arises in regard to whether the Duluth model for battering inte rvention, which has come to be seen as the gold standard intervention, works for same-sex battering Bu ttell & Hamel, 2014).

Prevalence of Violence The sparse statistics on gay and lesbian relations in- dicate that same-sex relationships are no more im- ;nu ne from partner violence than heterosexual ones.

hat has slowly come to light is that battering is an equal opportunity malady that affects gay men and :esbian women in the same staggering numbers as it do es those in heterosexual relationships (Mederos, 19 99; Peterman & Dixon, 2003; Ricks, Vaughan, & :Jziegielewski, 2002). From 25 % to 50% oflesbians re - ?O rt being in a battering relationship (Barnes, 1998; :E'riess, 1997; Lie & Gentlewarrier, 1991; Lockhart et al. , :9 94; Oatley, 1994). In one study, when all former re- lationships were considered, the figure moved up to 64% (Bologna, Waterman, & Dawson, 1987). In gay re- ·ationships, the data are even more sparse. Estimates

CHAPTER TEN Partner Violence • 317

are that about 10% to 20 % of males in gay relation- ships are assaulted each year (Island & Letellier, 1991). When all previous gay relationships are taken into consideration, the figure moves up to 44% (Bologna, Waterman, & Dawson, 1987). The bottom line is that it appears that a great deal of violence occurs in such relationships (Bartholomew, 1999; Gillis, 1999; Ristock, 1999; Stanley, 1999). Interestingly enough, in a study by Toro -Alfonso and Rodriguez-Madera (2004), while 48% of the gay men interviewed reported emotional abuse, they didn't consider it as interper- sonal violence. From your authors' experience of crisis intervention with women and men of same- sex orientations, their presenting problems usually revolve around "outing" (revealing to others, such as parents and employers, of the victim's same-sex ori- entation), jealousy and mistrust, unwanted breakups, and feelings ofloss, grief, and betrayal over dissolved relationships-all of which have the potential for violent confrontations.

Complicating Factors Although many of the same coercive controls used by heterosexual batterers are employed in the homosex- ual community, there are differences. Positive-HIV status can be used as a coercive control. Failing health or threat of infection may be used to make the part- ner feel afraid or guilty. If the victim is infected, the coercive partner may refus e to provide support or get medical care for the victim, or double "out" the part- ner (tell people she or he is both homosexual and HIV po sitive; West, 1998, p. 170). Indeed, the coercive part- ner often uses "homophobic" control by threatening to "out" the partner and by constantly reminding the partner that no one in a homophobic world (particu- larly the police) will b elieve her or him or will dismiss the violence as inconsequential or what the person may "deserve" (Hart, 1986).

A further complicating factor is that battering may be seen as "mutual." That is, in a same-sex re- lation there is no clear "identifiable" assailant and victim. Thus, the assaulter can discount the victim's accusations by claiming that both were equally re- sponsible for the violence. The foregoing is particu- larly true of gays who may be made to feel inadequate for "not taking it like a man" (Stanley et al., 2006; West, 1998, pp. 169-170).

To date, what research there is seems to indicate that many of the factors that influence violence in het- erosexual partners are contributors to violence among same-sex partners. Intergenerational transmission of

318 • PART TWO Handling Specific Crises: Going Into the Trenches

violence, alcohol abuse, dependency, autonomy issues, and power imbalances seem to contribute to same-sex partner abuse (Cruz, 2003; Peterman & Dixon, 2003; Ricks, Vaughan, & D ziegielewski, 2002).

Crisis Intervention Involving Gay and Lesbian Violence Gay and lesbian battering is no different from hetero- sexual battering in that power and control are the key motivating factors. Gays and lesbians are also much the same in their reluctance to admit that abuse and violence can occur. However, gay men rank domestic violence third, behind substance abuse and AIDS , as their most pressing health problems (Island & Letellier, 1991). An even more dismal outlook may be forecast for elderly homosexuals, who may be en- tirely at the economic mercy of their partners and be extremely isolated from other support systems (Peterman & Dixon, 2003).

Sensitivity. Your authors' own experience indicates a number of issues that make crisis intervention dif- ficult and sensitive with same-sex partners who have engaged in violent acts . First is the person's reluctance to talk about the problem because of trust issues with the crisis worker and the fear that the client will be held in low esteem for his or her sexual orientation. The worker must show a great deal of sensitivity and unconditional positive regard for the client to estab - lish safe ground for the client to talk about such trau- matic personal issues. This means that heterosexual workers must acquire knowledge and skills for work with this clientele and not allow their own homopho- bia to harm clients (Morrow, 2000) by obtaining training in counseling gays and lesbians (Matthews & Lease, 1999).

Precipitating Factors. Dependency versus autonomy, jealousy, and the perceived balance of power are ma- jor precipitating factors in battering in same-sex re- lationships (Renzetti, 1992). Balancing closeness and attachment with one's partner with independence and autonomy is difficult in any relationship, regard- less of sexual orientation. In same-sex relationships, an absence of support outside the relationship may cause couples to turn more intensely to one another. Such dependence on one another may cause major stressors when one partner perceives the other as hav- ing become too autonomous, and fears abandonment.

Jealousy is certainly not exclusive to same -sex re- lationships. However, it may be more pronounced in

same-sex relationships because another person of the same sex may pay attention to one partner and not to the other. As a result, such envy and jealousy may promote possessiveness and attempts to restrict and control the freedom of the other person, much as in a heterosexual relationship (Peterman & Dixon, 2003).

Distrust also tends to be much more pronounced in same-sex relationships than in heterosexual ones (Wiehe, 1998, p . 79). This is true because it is not un- common for former lovers to still be in the supp ort system of same-sex couples (all the same-sex people in a community may constitute each other's suppo rt system), whereas it is much easier to terminate those relationships in a heterosexual world (Kurdek, 1994). In summary, Craft and associates (2008) have found that some of the same issues of dependency and at- tachment theory that are abundant in heterosexual battering are also present in homosexual relations for both gay men and lesbian women. When stressors accumulate and escalate for those who have insecure attachment with their significant other, the threat of violence goes up.

Finally, the term balance of power refers to the ability of the person to influence and get others to do what he or she wants. Although heterosexual couples may have a division of labor in regard to household chores divided along stereotypical male- female lines, same -sex couples may have terrible conflicts over such domestic duties because they may perceive an inequity of power in doing these chores (Wiehe, 1998, p. 80).

Specific Issues. Any exploratory assessment shou ld deal with issues specific to same-sex couples. That is, threats of "outing" the other person's sexual orienta- tion or his or her HIV-positive status, exploration of internalized homophobia, degree of closeting (hiding same-sex orientation from others), and acceptance of sexual orientation are all components that advers ely affect gays and lesbians and may be used for coercio n .

It should never be assumed that one person is the victim and the other the perpetrator. It is also a myth that same-sex battering is mutual because both partners have equal strength and the ability to figh t back (Peterman & Dixon, 2003). Thus, for both t he police who respond to the assault and crisis workers who counsel the victims, sorting out the truth is eve n more complicated than it is in heterosexual battering.

Marrujo and Kreger (1996) found that a third of the lesbian battering relationships they investigated fell into what they call a "participant" category. Al- though they didn't initiate the aggression, participanrs

did fight back, and once engaged, gave as good as they go t. Hopefully, the worker can sort out who did what by the partners' responses. Aggressors may paradoxi- cally propose that they are the real victims, partici- ? ants may see themselves as righteously justified in ::-etaliating, and victims may express a desire to end the conflict and be safe. Indeed, some lesbian abusers have shown up at shelters claiming to be the abused part- ne r in hopes of finding the person who has left them Leventhal & Lundy, 1999).

Severity. By the time a gay man or lesbian woman se ek s therapeutic help with a relationship that in- rnlves battering, it is likely that a triage rating will put diem in the highly impaired range. Interestingly, the pe rs on who seeks out therapy in a violent same -sex ::-elationship may be the batterer. He or she may have rypical feelings of conjugal paranoia that involve jeal- o usy, betrayal, and fears of abandonment over some n ew or old partner (Peterman & Dixon, 2003; Ricks , Vaughan, & Dziegielewski, 2002). These feelings may ::-apidly escalate to guilt, contrition, self-doubt, and self-disparagement as the client attempts to repair the damage to the relationship . The person may be d ominated by an "all or none," "If I can't have him/ h er, nobody will," cognitive set, and be constantly at- tempting to keep the relationship intact and out of the arms of some other real or imagined threat (Bar- tholomew, 1999). At this point, lethality becomes a h igh probability.

Safety and Support. A major concern is establishing a safety net and a support system because the client will believe that support people or resources are not available to him or her (and in fact they may have few, if any). Locating a support system or a safe place may be very difficult for gay or lesbian clients because a majority report they would not us e support groups or go to a shelter and feel they are silenced and isolated when they do try to reach out for help (Lie & Gentle- warrier, 1991; Walters, 2011).

Treatment Issues. Complex issues revolve around tre atment delivery. Although heterosexual battered m en have few places to find shelter, there are even fe wer places for gay battered men to go-although a few shelters will offer hotel vouchers (Friess, 1997). Lesbians may not be welcomed with open arms by h eterosexual women at shelters (Ricks, Vaughan, & Dziegielewski, 2002). Group therapy may be helpful fo r victims because it reduces feelings of isolation and

CHAPTER TEN Partner Violence • 319

provides a safe place to work through their issues with empathic others. It may also be helpful for perpetra- tors, because of the same isolation issues, and it may also offer a place where the peer group can confront the batterer. The problem is that mixing homosexu- als with heterosexuals in groups is not recommended (Margolies & Leeder, 1995), and it may be very diffi- cult to generate an intact gay or lesbian group.

Couples therapy, mediation, conflict resolution, or any other approach that brings the two warring parties together is debatable from the standpoint of safety. Further, the abuser may heartily endorse this as a way of keeping the relationship going and shift- ing blame onto the abused partner (Ricks, Vaughan, & Dziegielewski, 2002). Setting aside the foregoing factors that differentiate homosexual from hetero- sexual battering relationships, the crisis worker still operates pretty much in the same manner of provid- ing for immediate safety needs, obtaining support, and empowering their clients to leave the relation ship (Peterman & Dixon, 2003; Ricks, Vaughan, & Dziegielewski, 2002).

Treating Batterers Couples Counseling. Hamel (2014) proposes that same-sex psychoeducational, one -size-fits-all group formats are limited in reducing recidivism, and rigor- ous studies using cognitive-behavioral therapy prove superior to the Duluth model (the gold standard you'll soon read about) and that couples counseling is safe and effective. This approach flies in the face of a the prevailing feminist view as blaming the victim as being partly culpable. However, McCollum and asso- ciates (2012) argue that it is becoming clear that all batterers are not the same and that same-sex-only group programs have very high dropout rates . To that end Stith, McCollum, and Rosen (2011) have devel- oped a solution-focused brief domestic violence ther- apy program for couples . How this will turn out remains to be seen, but it is a noteworthy shift in how perspectives are changing in trying to crack the tough nut of domestic violence.

During the early 1980s, the Coalition IC.H:I for Justice for Battered Women in San Francisco was instrumental in getting police to redefine how they handle domestic disputes and how the district at- torney prosecutes domestic assault cases (Sonkin, Martin, & Walker, 1985, p. 25). Police do not medi- ate but ar rest, and district attorneys do not dismiss but prosecute. In short, batterers need to realize that

320 • PART TWO Handling Specific Crises: Going Into the Trenches

domestic violence is a punishable crime (Sonkin, Martin, & Walker, 1985, p. 41), and in more and more cities and states it is becoming exactly that.

Although arrest may deter battering while the per- petrator is in jail (Gondolf, 1984; Sherman & Berk, 1984), that same perpetrator will come back to his family, or at least be in close proximity or inevitably form a relationship with another woman. While many believe that "throwing the bum in jail" is justified be- cause of the battering, jail will not have changed the barterer's attitudes and behavior in any way, and he will continue to be a threat (Bent-Goodley et al., 2011).

Many communities and most states have adopted some form of diversion program modeled along the lines of the program the Coalition for Justice for Bat- tered Women in San Francisco and the Domestic Abuse Intervention Program intervention model de- veloped in Duluth, Minnesota (the Duluth model). These are intervention models as opposed to treatment models. Note the distinction between intervention and treatment. As with many systemic crises, there are phil- osophical issues between grassroots activists who or- ganized and lobbied for aggressive intervention with batterers and mental health professionals, who came after them, who focus on the underlying pathology of the batterer and seek to provide treatment to change the personality structures that cause the battering (Rosenbaum & Kunkel, 2009).

Whereas treatment of any psychological issues is generally considered private and confidential, the Duluth model is not concerned with confidentiality and in many ways, according to its critics, goes out of its way to publicize batterers and their issues, in clear violation of the confidentiality rules that all psycho- logical treatment programs we know of abide by. Be- cause it sees battering as a public matter, this stance has invoked the ire of many professionals, who see real ethical dilemmas in approaching treatment of batterers in that manner. They further see the model as based not so much on evidence-based research as on emotion and political pressure (Corvo, Dutton, & Chen, 2009; Dutton, 2007; Dutton & Corvo, 2006, 2007; Rosenbaum & Kunkle, 2009). Supporters of the model, in turn, point to the critics' own research biases and maintain there is psychological theory and criminal justice research that support the Duluth model (Gondolf, 2007). The data are indeed conflict- ing as to what, if any, good any one of these models does in stopping recidivism of batterers.

There is also wide divergence in the length of programs, which range from one meeting a week for

12 weeks up to a full year. There is also wide diver- gence in the education and training that facilitators must have. In a number of states, no college deg ree or professional licensure is required, although m ost states do mandate that some sort of training in d o- mestic violence must be completed. Policies regardin6 absences and termination for conduct and absentee - ism are also extremely variable. The same is true of fees . Many batterers are of lower socioeconomic st a- tus and cannot afford the programs, so most states provide for a sliding fee schedule based on income. However, most states do demand that batterers pay some fees so that value is attached to the service (Rosenbaum & Kunkel, 2009).

Intervention Models

These models are feminist based, have highly inte- grated coordination between a variety of agencies, provide support to survivors of IPV across a range of issues, and provide psychoeducational treatment to batterers. That treatment focuses primarily on power and control issues (Rosenbaum & Kunkle, 2009).

The Duluth model requires a tremendous amou m of commitment and integration of community agen - cies, mental health facilities and institutions, police, and judiciary to provide services for battered women . In Duluth, more than 10 agencies, five distinct levels and types of government, and dozens of workers of those institutions will be involved. As you might well imagine, getting all these agencies and institutions working on the same page is equivalent to herding cats. Lindsay and Brady (2002) acknowledge and dis- cuss some of these issues when such massive integra- tion of services is undertaken. The treatment aspec t of the model does have a cognitive-behavioral com- ponent to it. However, it also examines the historic separation of roles and power for men and women and seeks to knock down those stereotypes. The program's aim is to give batterers insight into thei r mistaken beliefs and goals based on these age-old stereotypes about marital roles and functions and to change their belief systems in regard to marriage, re- lationships, women, masculinity, and the use of ag- gression to solve problems (Aymer, 2008; Miller, 2010; Pence & McDonnell, 2000).

Most other models have a cognitive-behavioral basis that focuses on cognitive restructuring of bat- terers' irrational thinking (Rosenbaum & Kunkle, 2009). Models that emphasize batterer strengths rather than deficits are being tried (Lehmann & Simmons, 2009) . Other models provide skill building

chrough self-empowerment strategies . This model works off the notion that targeting self-empowerment ca n revise and regulate feelings of powerlessness and wor thlessness, which are hypothesized as core values chat lead to the abuse. In this model, then, abuse is seen as a problem not of the woman, but rather of the ab user's own feelings of inadequacy and failure to de- velop compassion for loved ones (Stosny, 1995).

From a therapeutic treatment viewpoint, co gnitive -behavioral treatments are seen as the pre- erre d mode of operation. Indeed, treatment profes-

sionals take umbrage at the notion that this is "anger m anagement training" because they see the issues chat batterers are attempting to overcome as far more co mplex than that. Thus, it will probably come as a su rprise to you that most programs and many states prohibit "anger management" as a primary treat- ;nent because they see it as an excuse to rationalize a controlled behavior (Rosenbaum & Kunkel, 2009). The fact is that in many instances the Duluth model has been combined with cognitive-behavioral ther- apy for batterers, so there is a great deal of variance between programs that claim to follow the Duluth ;nodel (Bennett & Vincent, 2001 ; Healy, Smith, & O'Sullivan, 1998).

Hybrid Models A variety of models have been operationalized in same- sex domestic violence treatment programs that range :rom mind-body bridging (Tollefson & Phillips, 2015), :o Violent No More (Paymar, 2015), a book that uses sto- ries to illustrate how batterers were able to stop their us e of violent behavior and emotion-focused therapy :'"or incarcerated offenders (Pascual-Leone et al., 2011). These are a few examples of a lot of different types of ?rograms seeking to reduce battering.

In our own community of Memphis, an adjudi- cate d batterer is given a thorough assessment and di agnostic interview after adjudication. Although specific treatment recommendations such as par- ent training, drug abuse treatment, and individual ;nental health counseling are generated for each per- son, the vast majority will be recommended for anger :na nagement. Certainly, most batterers, particu- .:a rly those so adjudicated, do not willingly come to a tre atment program, nor are they willing to admit :hat they have problems. People who enter counsel- :Ug for abuse often manifest outright denial, mini- ;:n ization, or justification and projection of blame to es cape owning their abusive b ehavior (Shupe, Stacey, 3:: Hazlewood, 1987, pp. 26-28).

CHAPTER TEN Partner Violence • 321

Denying batterer: I never touched her. Sure, I'd been drinking a little, and we had an argument. She must have fallen , because she was pretty drunk too! (The complainant had three broken teeth, a frac- tured jaw, and two broken ribs, plus numerous contu- sions, cuts, and abrasions.)

Minimizing batterer: Well, I might have pushed her when we were arguing at the top of the stairs, but I'd never hit her. (The complainant had a broken nose, a bruised kidney, and two black eyes from the "push." )

Projecting batterer: Listen, she ain't no rose. She gives as good as she gets. Besides, I got some rights, like dinner when I get home from work, instead of a drunk sittin' in front of the TV suckin' on a drink. She deserved a lesson! She always gets the kids to stick up for her. (Both the woman and her two children were treated at an emergency room for contusions and lacerations from being whipped with a power cord.)

Although individual counseling, partner coun- seling, and partner counseling in groups have been attempted (Shupe, Stacey, & Hazlewood, 1987, pp. 26 - 27; Stith et al., 2004; Tolman & Bennett, 1990), the prevalent mode of counseling for batterers is court-ordered group counseling. Generally, couples counseling is not recommended until the batterer has made a great deal of progress on anger management and other personality issues, and only if both parties truly wish to reconcile (Hamberger, 1994; Lawson, 2003). Groups provide opportunities for social learn- ing and retraining that would be nearly impossible in individual or couple therapy (Adams & McCormick, 1982). The group also provides a support system for what are typically emotionally isolated individuals and enables these men and women to start to learn how to depend on others in times of stress.

Treatment Goals Group treatment formats, however they are config- ured, have four major purposes: (1) ensure the safety of the victimized partner, (2) alter the barterer's atti- tudes toward violence, (3) increase the barterer's sense of personal responsibility and teach him about equity issues, and (4) help the batterer learn nonviolent alter- natives to past behaviors (Edleson & Tolman, 1992; Mederos, 1999). Groups typically use either the Du- luth model (Pence & Paymar, 1993), which operates with a power and control focus , or an anger manage- ment model, which seeks to understand and control anger (Hamby, 1998, pp. 223 - 225). There appears to be merit in both approaches.

322 • PART TWO Handling Specific Crises: Going Into the Trenches

To accomplish these goals, most groups use a combination of anger management, stress reduc- tion, communication skills, and sex role resocial- ization components (Dutton, 1995; Gondolf, 1985; Hamby, 1998; Mederos, 1999). Therapeutically, most programs use some form of cognitive-behavioral ap- proach that deals with batterers' irrational thinking and also provides techniques to restructure maladap- tive cognitions, overreaction to violent urges, self- sabotage, setting oneself up for violence, and selective forgetting; offers assertiveness training and teaches problem solving; and handles premature "cures" (Dutton, 1995; Hamby, 1998; Hanson, 2002; Lawson, 2003; Mederos, 1999). Programs typically are psycho- educational, structured learning experiences with some time reserved for role play, discussion, and pro- cessing concepts and ideas (Edleson & Syers, 1990; Scales & Winter, 1991). Coleaders are generally used so that they can model together the types of behav- iors the batterers need to learn, and any interactions between one leader and a member can be facilitated by the other group leader (Sonkin, Martin, & Walker, 1985, p . 98). Groups typically meet once a week for 2 hours and range from 8 to 32 sessions (Tolman & Bennett, 1990). Before a batterer is inducted into a group, an assessment and intake interview should be conducted to obtain a profile of the battering behav- ior, incidence of other psychological problems, and motivation to participate in couns eling.

Assessment The Conflict Tactics Scale (Straus, 1979) has been the only instrument used on any wide scale to measure intrafamilial conflict. The scale looks mainly at physical means used to resolve conflicts, does not adequately account for verbal abuse, and entirely ignores the emotional, social, sexual, and economic forms of abuse. It al so does not look at power differ- ential-one of the key ingredients in domestic violence (Poynter, 1989). It certainly was not meant to - nor does it-predict who will be violent or who, after being arrested or completing counseling, will recidivate.

One test that should always be given is an alco- hol screening test such as the Substance Abuse Subtle Screening Inventory (Miller, 1983), with follow-up interview questions. Determining alcohol abuse is important for two reasons. First, numerous studies have shown chronic alcohol abuse to be a strong pre- dictor of more violent behavior (Blount et al., 1994; Heyman,Jouriles , & O'Leary, 1995; Stuart et al., 2006; Tolman & Bennett, 1990). Second, any individual

who is under the influence of a mind-altering sub- stance needs to get dried out first .

Probably the worst "bets" for success in anger management and those most likely to recidivate a re those individuals who fall into personality disor- der categories. Therefore, tests like the Millon Clini- cal Multiaxial Inventory (Millon, 1987) may be used to determine borderline, narcissistic, depressive, somatoform, antisocial, and other pathological types. If elevated scores on the Millon indicate psychop a- thology, these individuals may be served better in in- dividual therapy that targets their pathology rather than in a generic anger management group (Hanson. 2002; Lawson, 2003; Mederos, 1999). Dutton (Dutton, 1994, 1995; Dutton & Starzomski, 1993, 1994) h as extensively examined borderline personality disorder (BPD) as a unifying personality construct in domestic violence. Dutton's research seems to indicate that the individual who batters looks much more like a fu ll- blown BPD than a normal individual who does not batter. His research presents a strong argument that there are at least some batterers whose major problem is intimacy anxiety and fear of abandonment, hall- marks of the borderline personality, as opposed to the more universal and feminist notion of domestic violence as being an attempt to reinforce male domi- nance and preserve a patriarchal order (Dutton, 1995 p. 138). This "either/ or" view has much to say abo m how treatment for batterers should be conducted and has bred a great deal of controversy in regard to treat- ment approaches.

The Intake Interview The worker should conduct a comprehensive intake interview to assess the barterer's psychological sta- tus and motivation and provide information on what may be expected from a counseling group (Sonki n, Martin, & Walker, 1985; Tolman & Bennett, 1990). First, the worker should assess lethality, for both suicidal and homicidal ideation and/o r behavior. As paradoxical as it may seem, many batterers are so dependent on their partners that the thought of be- ing without them is worse than death, so suicide and murder may seem viable and realistic options.

There are apparent relationships between lethality and a number of factors common in battering relation- ships, such as frequency of violent incidents, severity of injuries, threats to kill, suicide threats by the woman, length and incidence of the barterer's drug use, fre- quency of intoxication, and forced or threatened sex- ual acts (Sonkin, Martin, & Walker, 1985, p . 73) . A fas t

assessment of the history of the violent relationship would seek details on the first, last, worst, and typical episode to provide a comprehensive profile of the kind,

egree, and length of abuse. Assaults and violence on o ther family members, previous criminal activity, vio- lence outside the home, increased social proximity of \'ictim, attitudes toward violence, life stresses, general m ental functioning, physical health, and physical and emotional isolation are important background infor- m ation on the potential for future violent behavior. The more these indicators appear, the more likely the client is to engage in lethal behavior (Sonkin, Martin, & Walker, 1985, pp. 75-83).

It should be remembered that these men and women are in crisis, and appropriate measures should be taken to ensure everyone's safety. Bodnarchuk and associates (1995) estimate that, based on the Na- cional Family Violence Surveys, their domestic violence clients fell into the most dangerous 1 % of the U.S. pop- ulation. During intake interviews, such people should

e given clear messages about expectations inside and outside the group and what the consequences of in- a ppropriate behavior will be. Finally, there is evidence chat clients who are apprised of the procedures, pur- ?Ose, and goals of the group are less likely to drop out and less likely to recidivate (Tolman & Bennett, 1990).

Motivation _ lo tivation depends on a number of variables. Men wh o are younger, are less educated, have lower incomes, were abused as children, and are minorities drop out a t a significantly higher rate (Tolman & Bennett, 1990) m an do those who are older, have no arrest record, are better educated, are employed, have more children, and witnessed abuse but were not abused themselves as children (Demaris, 1989; Grusznski & Carrillo, 1988). Tolman and Bennett (1990) report that struc- LU red groups tend to be more effective, and it appears :Tom the Memphis Famiiy Troubie Center's low at- :rition rate (10%) that the threat of having probation revoked and spending up to a year in jail is a strong ex ternal motivator for obtaining the points necessary :o complete the program (Winter, 1991).

A Typical 24-Session Domestic Violence eduction Group

-:- h e following profiles the highlights of IC.HW c;. ty pical 24-session group counseling format for jarrerers . The content of the course is taken from :ne Memphis Police Department's Family Trouble Center (FTC) anger management program. The

CHAPTER TEN Partner Violence • 3 2 3

counselor dialogue is abstracted from Betty Winter (1991), director of the program and facilitator of nu- merous anger management groups.

It would be an error to think that only men go through treatment for perpetrating domestic violence. Although better than 90% of those who go through the FTC program are men, the percentage of women adju- dicated for anger management is increasing. Therefore the generic terms clients, members, and participants will be used in describing the FTC anger management pro- gram because both genders are represented.

Starting the Group. A great deal of anger is ventilated over being arrested and adjudicated to the program. The batterers are mad and hostile about being there. The crisis worker starts the group by sitting in the middle of it and letting the group interview her. She responds to any professional and personal questions she deems appropriate.

CW: (after giving qualifications) One of my major cre- dentials is that I get angry a lot, but I've never been arrested for it. Now that I've given you my creden- tials, I'd like you to give me your credentials, the ones that got you here. I'd like you all to pair off, and I'd like for each pair to share with one another what caused you to get here. Then I'd like each pair to report back to the group.

By putting herself at risk with this group and let- ting them interview her, the crisis worker turns the tables on these angry clients. It is very difficult for these "macho" clients not to own up to what brought them here when a woman can face up to their angry and caustic interrogation of her and her credentials. The rules of attendance and conduct are reviewed, and positive and negative consequences of appropriate and inappropriate behavior are explained. For many of these individuals, it will be the first structure they hav·e experienced since high school, so they wiU need to know very clearly what is expected of them. The major purpose of this counseling is corrective and remedial. It is counseling within the criminal justice system. As a result, initially trust is not high, and in these early sessions the therapist meets the issue head on.

CW: I don't expect you to share everything in this group. Take some time to see how safe you feel in here. Although what you say will be held in confidence within the bounds of the legal and ethical standards I've talked about, you're undoubtedly feeling pretty victimized by the system right now. Nobody will force you to say anything you don't want to.

324 • PART TWO Handling Specific Crises: Going Into the Trenches

Paradoxically, the admonition to not trust probably does much to establish trust and breaks down some barriers and paranoia about the group.

Making Choices. The group is given an explana- tion of what taking an anger time-out is and is given a homework assignment of taking practice time-outs at home. Finally, the concept of choices is introduced.

CW: You'll think this is crazy, but you did have a choice in coming here. If you don't like what we're about, you can leave. (Gets up, walks to the door, and opens it.) Of course, you will have chosen to violate your probation terms and will probably go to jail.

Batterer: That's no damn choice.

CW: Granted, it's not a good choice, but it is a choice, just like what got you here. Battering was a bad choice, but it was one you made. During the course of the time we're here, we'll be looking at a lot of those choices you make.

Most of the clients do not realize that when they do something, they are making choices. Furthermore, they don't realize the variety of choices open to them. The concept of decision making and choosing wisely will be woven throughout the 24 sessions.

Support and Confrontation. Another key component of the group is instituted in these first sessions: dyadic interaction-"that pairing crap," as participants call it. Clients are immediately paired off and start working with one another in pairs. Pairing off starts to gener- ate closeness and bonding in the group. It also conveys early on that there is interest in hearing their story.

Open-ended questions and reflective responses alone are not conducive to facilitating the start-up phase of a group of hostile and anx ious batterers. Therefore, a combination of both open-ended and closed-ended questions and supportive and confron- tive statements is needed to break through defense systems, reflect threatening feelings , and reframe ir- rational thinking (Sonkin, Martin, & Walker, 1985, pp. 64-65).

CW: (indirectly confrontive) How did you come to be here?

Batterer: I sorta hit my wife.

CW: (directly confronting the minimization with a semio- pen question) I don't understand "sorta"! What do you mean?

Batterer: (projecting and blaming) I mean she made m e mad. She was running her mouth, so I had to hit her.

CW: (confronting all-or-none thinking) You say "had to" as if there were no options other than to smack her.

Batterer: Not really-she was really being a bitch!

CW: (proposing consequences and obtainingfacts) So your choice for stopping her bitching was breaking her jaw. That choice also got you arrested. What happened?

Batterer: She swore out a warrant, and I got sent to jail.

CW: (confrontive closed question) Had you ever been in jail before?

Batterer: Lord no!

CW: (empathically reflectingfeeling) I'm b etting that was a scary experience.

Batterer: You better believe it. There were some bad dudes in there. I didn't know ifI was gonna get out of there in one piece.

CW: (reflecting feeling and exploring affect) So you were feeling pretty alone and helpless . I'm wondering how you're feeling right now?

Batterer: Madder than hell that I got to be here.

CW: (closed question that seeks to elicit defensive respond- ing) Do you understand why you're here?

Batterer: (projecting) 'Cause she swore out a warrant on me.

CW: (confronting projection by making client own behav- ior) No! You are here because you put your wife in the hospital by beating her. That's criminal as- sault. The judge gave you a choice, and you are still free to exercise it. You may come here to 24 group sessions for people who have battered. You have the opportunity to learn some things here th at may help you with future relationships and th at may also keep you out of harm's way in the future. Or you may walk out of here right now.

Batterer: That's not much of a choice.

CW: (confronting batterer with consequences of his behav- ior) Maybe not, but it's more of a choice than you gave your partner.

The responses are typical of a barterer's way of d e- fending himself with denial, externalization ofblame, and black-and-white kinds of statements that give little consideration to behavioral options and long- term consequences of behavior. The crisis worker gen- tly but firmly wades into the client's defense system

while at the same time attempting to establish rap- riort. This is not an easy job.

Managing Stress. The time-out assignment is dis- cu ssed. Participants start looking for physical anger cues , and are asked to write down the signs as warning signals and learn to use those cues to time themselves out of an escalating dialogue that has the potential rn turn violent. Basic stress management skills and relaxation techniques are taught and practiced. The worker gives a homework assignment that combines recognizing physical cues of anger with the use of re - laxation techniques .

The prevailing pragmatic philosophy of the FTC program is that it is extremely difficult if not impos- sible to change ideology. Rather, the notion is that the barterer's sex role expectations may differ from his or her partner's and that he or she can be taught how rn negotiate those differences. That notion is much m ore palatable and makes much more sense within clients' social and work environment than attempt- in g to reindoctrinate them into a more feminist view of role expectations.

Understanding the Cycle of Violence. The idea is to m ake batterers aware of Walker's (1979) cycle and its commonality to all relationships, both at home and in the workplace, and to help them gain some dynamic insight into their own behavior and that of their part- n ers as they go around in this destructive cycle. Clients a re apprised of the difficulty of getting out of the cycle b ecause of how long it has been going on and its fa- m iliarity. Anger diaries are started. Anger diaries help rn identify instigators of anger and the physical and cognitive responses to it. They also help batterers start to identify feelings that support anger, such as guilt, shame, and depression. The diaries start to condition responsibility, because the person must constantly at- tend to diaries as he or she monitors anger.

Costs. Few batterers have stopped to think of the costs. Costs vary, but it is not uncommon for a group to average a minimum of $10,000 per person in fi- n ancing his or her anger.

CW: Add up all the money you've spent on lawyers, work time lost, furniture broken, hospital bills, bail, fines, motel rooms, not to mention divorce proceedings and alimony as a direct or indirect result of violence. What could it have bought you? Wouldn't it be great to never have to spend

CHAPTER TEN Partner Violence • 3 2 5

another dime on your anger? You see, learning to control your anger will make you money. How many of you would be against that?

Time is also spent on the emotional cost to vic- tims. These factors paradoxically start to describe some of the background ofbatterers because they have also become victims, albeit of their own behavior. In- deed, once they can start to see themselves as victims, they gain insight into how their victims feel. This is the start of empathic understanding for these clients.

CW: Add up all the emotional costs: the guilty, an- gry, hurt, depressed, dependent, hopeless, help- less feelings. Wouldn't it be great to never have another lousy feeling like that? How does that fit with your partner's notions of being your victim? Is there any difference between how your partner may feel about you after a beating and how you feel about the court system?

Shoulds, Oughts, and Musturbatory Thinking. Mem- bers are asked to write down three bad choices and three good choices they have made in their relation- ships. Anger diaries are used to help the batterers identify the emotional toll that their choice of anger and violence takes on them. The leader introduces the topics of irrational thinking and the maladaptive behavior resulting from it. Cognitive-behavioral tech- niques from Albert Ellis's (1990) Anger: How to Live With It and Without It are illustrated. Specific emphasis is placed on absolutist thinking and should, must, and ought statements. Discussion focuses on how these statements get constructed, what environmental cues set up "musturbatory" thinking ("I must have my self- gratification or it will be absolutely intolerable"), and how irrational, self.defeating thoughts and subse- quent maladaptive behavior are tied together.

Violence and Families of Origin. A violence and abuse assessment is made of the family of origin. Leaders ask members to respond to such questions as "Did your father hit your mother, or vice versa?" "How were disagreements handled?" "How did you feel about your parents?" "How were you disciplined as a child?" "How do all those events that you learned from early childhood carry over into your present family? " "How do you feel about that?" "How do those irrational be- liefs we talked about earlier in the session relate to the behavior that you saw and learned as a child?" Mem- bers are given didactic instruction on how transgen- erational violence occurs.

326 • PART TWO Handling Specific Crises: Going Into the Trenches

Processing the following discussion questions gen- erally results in a shocking and nasty insight, because the very thing the batterers hated most about their own parents they may now be perpetrating on their children. This will be the first time that many of the batterers have ever talked about their childhood expe- riences with domestic violence, and it is usually a very emotional experience.

CW: What was your feeling as a child in regard to the abuse you saw? How do you suppose your kids are affected by your violent behavior? Do they feel any different from the way you did? Guess at their feel- ings and what they might be thinking about you and why they might feel and think that way.

The homework assignment is to start changing members' ways of responding to stressful situations by (1) watching out for environmental cues that start musturbatory thinking and (2) using cooler cogni- tions, such as "It'd be nice, convenient, if XYZ hap- pened, but it doesn't have to happen."

Feelings. Participants are asked to list several posi- tive and negative feelings they have . Usually most of them will have a great deal of difficulty with this task, because they have never had to identify any feelings they have. Feelings generally get lumped into two cat- egories, angry and happy. A lecture is given on how males, in particular, are taught at a very early age to "stuff" their feelings and not acknowledge them as real. The anger diaries are used to expand their abil- ity to label and identify the many feelings that sup- port anger.

Outcomes from denying feelings are discussed. Examples are given from Stoop and Arterburn's (1991) The Angry Man: "Why Does He Act That Way?" This session is very difficult, because members will be asked to share feelings - a very threatening experience for most of them. Leader statements such as the fol- lowing are designed to minimi ze the threat.

CW: Although there are risks when you tell someone how you feel because you become vulnerable, you also become a lot more real. You become much more lovable and find it easier to love when you tell someone how you feel. You need to be pre- pared for them to do the same and understand that there is the possibility of feeling some pain and hurt from what is said. You don't tell someone your feelings just to get their sympathy. You share your feelings with significant others as a way of

taking care of yourself, so you don't have to stuff feelings anymore until they finally boil over and get you in trouble or hurt you.

Outcomes may be very dramatic as clients start to talk about their feelings, relive their experiences as children, and grapple with feelings of guilt, helples s- ness, dependency, and insecurity that they have had since childhood. It is not uncommon for some highly charged emotional catharsis to occur at this point and, as these feelings emerge, for some strong bonds to form as clients start, for the first time, to share deeply but closely held feelings with another person.

Power and Control. The attempt to convey verbally both positive and negative feelings is discussed and leads into issues of power and control. Power and con- trol are the focus of the session, discussed in relation to faulty belief systems. The stereotypical concept of power in batterers' issues develops out of a mistaken concept of independence: "I've got it, so you don't! " A new way of looking at power is interdependence: "The two of us together are more powerful than any one person!" Questions are posed about how they can form a team with their partner to reduce those powerless feelings. It is interesting that many of these clients who are physically strong may feel extremely powerless and frustrated when they are dealing ver- bally with others and when they are being "outtalked" in a relationship and may regress to their only way of regaining power and control-violence.

CW: When you allow someone else to push your but- ton, who is in control? How do you use anger as a control tool? Abuse is a last-ditch effort to gain control back in a relationship. Why is that so? Do you believe that you try to get power and control only when you feel you don't have any? If power and control are the bottom line, do abuse, anger, and battering get the job done for you? If they re- ally do get the job done, then why do you still have to rely on them?

Assertion. Closely allied with different ways of ob- taining power and control are the concepts of aggres- siveness and assertiveness. Because of their inability to use words in powerful ways , most of the partici- pants have difficulty making clear assertions about what their wants and needs are. Furthermore, they have an overriding fear that they will be rejected if they ask for something, and their insecurity does not handle rejection well at all. As a result, they use

aggression to meet their needs . The group is taught how to construct assertion statements and given an assignment of using them at home.

The most difficult part of an assertion statement fo r the group is the "I" or owning part. On the board, [h e leader puts up "I" or assertion statements and "you" or aggression statements so members know wh at they sound like, how they differ, and what can hap pen when each is used. Each member is asked to :o rmulate a problem in terms of "I" and "you " state- ments and practice with a partner. Using a describe, express, specify, and consequences script (Bower & Bower, 1976), members are asked to identify what be- h aviors in others bother them, to express how those !:>ehaviors make them feel, to specify what new behav- io rs they want, and to be able to positively reinforce orhers if those behaviors happen. Careful construc- rion of these clear, precise, and owned assertive state- ;nents is practiced through role plays .

Because jealousy is common to most of the stories (h at have brought members here, time is devoted to m embers' retelling their original story using the skills rhey have learned in their first 16 sessions . As these sto ries are reprocessed, other feelings undergirding rh e jealousy begin to surface. Hurt, betrayal, insecu- rity, lack of trust, and dependency are all threaten- ing feelings that are denied and replaced by jealousy, which allows batterers to place blame on their part- a ers for "transgressions," thus providing a face-saving way of not having to deal with their own problems.

Batterer: I hate to admit it, but all that stuff makes sense. Still and all, I don't believe I can trust her.

CW: Maybe you know she can't trust you, so you don't t rust her. Could you use some of those "I" state- ments and discuss it with her, and no matter what she said, not use "you" statements?

The homework is to name a time in their lives ':\hen jealousy turned to violence. The members are als o asked to mentally substitute a new feeling every illne they start to feel jealous and to report back on :heir experience.

Jcohol and Drug Effects. Because alcohol and drugs ?lay a predominant role in the vast majority of bat- : ering incidents, members are educated about how :bese issues apply to battering-specifically, that alco- ::iolism and drug abuse are not necessarily the cause o~ battering but release inhibitions enough that bat- :erers can give themselves permission to become vio- :ent. Results of the Substance Abuse Subtle Screening

CHAPTER TEN Partner Violence • 3 2 7

Inventory (Miller, 1983) are given to each participant. Participants are shown how alcohol or drugs can be a trigger for violent behavior and an excuse for making violent behavior acceptable.

Sex. Sex is an overriding concern because of all the myths that surround it. Much of the need of the bat- terer to feel superior, confident, and capable is tied to sex and, particularly for men, their concept of man- hood. Many times, particularly with young female leaders, members will say things and use language de- signed to shock and embarrass the leaders. Although X-rated language just for the sake ofX-rated language is not tolerated, some leeway is given for the street ver- nacular that is commonly used. The ability of group leaders, particularly young women, to weather the language goes a long way toward establishing their credentials with these men.

Batterer: So she wouldn't give me a blow job, so I smacked her. That's part of earning her keep, to blow my pipes, man!

CW: (youngfemale graduate student) So forcing oral sex on her keeps you in control. I wonder if the way you said that isn't designed to shock and embar- rass me and kinda control me through verbal sex like you control her physically through sex.

Batterer: Hey, I thought we was supposed to be talk- ing about the real stuff in here.

CW: (very calmly, with eyes leveled at the batterer, avoid- ing the taunt) I'm wondering how you'd like it if Harold (240-pound ironworker in the group) were to request oral sex of you, and if you didn't comply, start pounding on you, particularly in your groin. Do you start to get some of the feelings your part- ner would get? (The group members nod their heads in agreement.) I wonder if you can respond to that?

The many myths that hold men up to impossible Hollywood "stud" or women to "love goddess" stan- dards are discussed and debunked. For many of the clients, this will be the first valid information they have ever received about sexual behavior. They will typically experience relief after being told that no man or woman could live up to some of the perfor- mance expectations they have self-propagandized for themselves. Homework assignments focus on ir- rational and negative thoughts clients generate for themselves in their sexual relations. They are asked to watch for and write down some of their unrealistic expectations of themselves. They are also asked to try

328 • PART TWO Handling Specific Crises: Going Into the Trenches

using assertion statements when asking for sex. Com- ing to understand that making requests for sex ("I'd like to make love to you") rather than demanding sex ("You get in here and do it") may not only get them sex, but better sex, is a revelation. Finally, the leader asks each member to pick one of the subjects already covered in the group and be prepared to teach a review on it next session.

Summing Up. Amazingly, many of these groups bond. Members express that this is the first time in their lives they have been able to openly express feelings and feel they have been listened to by someone. Par- ticipants may actually form friendships as a result of the group.

CW: If you had to tell the judge anything about this program, what would it be? What did you like best and least? What would you like to see changed? What techniques seemed to work for you, and what didn't?

Members then discuss how they are putting their comprehensive anger management plans into action. They also indicate the strengths they now see in them- selves and positively reinforce one another for their efforts. Depending on how cohesive the group has become, it is not uncommon for the clients to bring food, exchange phone numbers, and have a gradua- tion party for one another at the last session.

Program Success Do battering programs work? The results are equivo- cal. Overall, batterers report that such programs help them gain control of their anger, enable them to com- municate better with their partners, and reduce their violence. Shupe, Stacey, and Hazlewood (1987) found that battered women in approximately 7 out of 10 cases reported that physical and sexual violence stopped after their partners went through an anger management program. When violence did recur af- ter the men graduated from these programs, it was almost always remarkably reduced. Relationships were also improved, and many women who had not attended indicated that they had picked up pointers that their partners brought home from the sessions (pp. 113-117). The following have all been found in a variety of studies involving battering groups with different cultural, racial, and socioeconomic back- grounds: increases in self-esteem (Kriner & Waldron, 1988) and assertiveness (Douglas & Perrin, 1987); decreases in depression and anger (Hamberger &

Hastings, 1986), in jealousy and negative attitudes to- ward women (Saunders & Hanusa, 1986), and in over- all psychological symptoms (Hawkins & Beauvais, 1985); reduction in both self-reported and corrob o - rated physical and psychological abuse on postcoun - seling follow-up (Edleson & Syers, 1990; Poynte r, 1989); and more cohesive, expressive, and less conflic t- ridden family life (Poynter, 1989).

Other researchers have found little evidence to indicate that rates of violence by perpetrators who obtain and complete treatment are very different from those who do not (Rosenfeld, 1992; Tolman & Bennett, 1990). More recent meta-analyses of batterer prevention programs have indicated less than satisfac- tory results (Babcock, Green, & Robie, 2004; Stover, Meadows, & Kaufman, 2009). Babcock and associates conducted a comprehensive meta-analysis ofbattering programs and found small effect size in overall suc- cess for programs. They also found little difference between programs that used the Duluth model and those that used CBT programs. What these results mean is that the programs appear to have little impact on recidivism. Stover and her associates found that the recidivism rate for both perpetrator- and partner- focused treatments was about 30% after 6 months.

However, there are some important footnotes to these sobering statistics. There are probably as many different programs and different styles of interven- tion as there are programs. Also, the expertise of indi- viduals providing the treatment may vary a great deal. A critical prerequisite for batterers' not recidivating is the imposition of severe consequences for not com- pleting the program or for battering again. Such con- sequences are not always enforced. Tracking batterers is difficult. Many of these people are very transient, moving from jurisdiction to jurisdiction, and there is no good way to determine if they have recidivated when they are halfway across the country. Frankly, be- cause of the severity of their pathology, some people do not or cannot profit from group programs.

It appears that close follow-up supervision of bat- terers makes a large difference in recidivism (Barber & Wright, 2010), so it may be that besides treatment, close follow-up may be a critical variable either from the standpoint of feeling supported or threat of pun- ishment. Where and to whom treatment is rendered also appears to make a difference . Smith (2003) re- ported that the Duluth model and the Military Family Advocacy Program LEAD model were both effective in reducing domestic violence, with only a 5% recidivism rate, in the U.S. Marine Corps. The fact

:hat noncompletion of such a program in the Marine Corps could ruin one's career may be a potent conse- ".uence in ensuring completion. Sartin (2005) found .iiffe rential effects by clustering batterer types. Not -urprisingly, family-only batterers were better pro- "' ram completers than antisocial and borderline clus - :er types. He also found that being employed was the on ly significant demographic variable predicting pro - gram completion. So, keeping a job by not going to }ail may be an important motivator.

Another issue is motivation to change. Walker and her associates (2010) developed the Perceived Consequences of Domestic Violence Questionnaire .:o assess the consequences of intimate partner vio- :en ce as perceived as the perpetrator. They found :hat the scale would significantly predict motivation :o change and treatment-seeking behavior. Thus, it tll ay be that screening instruments that separate out m ore pathological types may produce better results in terms of program completion and reduced recidi- ··ism . Research indicates that batterers must attend at least 75% of the sessions in anger management cr ro ups to have a chance of avoiding recidivism (Chen et al. , 1989). What is clear is that arrest alone will not change much of anything in a domestic violence situ- ation without concomitant treatment for the batterer Gelles, 1993; Hirschel, Hutchison, & Dean, 1992).

Although most clients come to battering pro- rams angry and hostile because they are pressured

Battering has deep roots in the psychological, socio- :ogical, and cultural makeup of the United States and aia ny other countries that go back to the beginnings of their patriarchal systems. Battering is pervasive :h rough all socioeconomic levels of society and knows ao ethnic, racial, or religious boundaries. Same-sex :-elationships are also not immune from domestic vio - :en ce. Dynamically, battering may be seen as having aiuch to do with the concept of power. A number of stressors that insinuate themselves into a relation- ship can escalate relational problems to violence.

A variety of theories have been proposed to explain why battering occurs. However, it is still unclear what ? ro pels people into battering rela tions , why people ba tter, and what will keep them from battering again.

CHAPTER TEN Partner Violence • 3 2 9

or required to be there, the majority report that they learn from and even come to enjoy the camaraderie of the group (Scales & Winter, 1991). Whether the pro- grams truly change their participants or whether they work in other ways, as graphically described in the following excerpt, clients who complete a battering program are not reported to the police nearly as often as those who have nothing happen to them .

Batterer: Man, I ain't never gonna b eat up on a woman again. Nothing will ever make me go through this crap twice! (Shupe, Stacey, & Hazlewood, 1987, p. 103)

Although research indicates that witnessing battering as a child is a primary modeling fac- tor for both the abused and the abuser, as innocu- ous an event as one's favorite professional football t ea m winning a game (White, Katz , & Scarborough, 1992) or watching World Wres tling Entertainment (Butryn, 2003) may have an impact on battering. Carden (1994) states that "Seventeen years after the founding of the first program designed to eliminate wife abuse by working with the wife abuser, we have only the most primitive notions about what works, why and how it works , or even whether in the long run, it does work" (p. 573). Sadly, after another 17 years and more , we are still only a little further along in our understanding and prevention of do - mestic violence.

Domestic violence is sequential, developmental, and dynamic. The situation of the battered client is unlike that of many others in crisis in that it is almost al- ways transcrisis in nature; that is, it is cyclic, reaching many peak levels over extended periods of time. For a variety of reasons, it is the rare person who leaves a violent relationship for good after the first batter- ing. Continued and increased violence over a period of years is the typical pattern of battering relationships.

In the last decade, crisis lines, shelters, and pro- grams for battered women and their children have grown exponentially across the United States. Courts and law enforcement agencies have become much more proactive in protecting the rights of these women. However, the number of battered women

330 • PART TWO Handling Specific Crises: Going Into the Trenches

still far exceeds the capacity of human services to deal with them comprehensively and effectively. One of the most frustrating components of intervention with clients who are victims of domestic violence is their seeming inability to extract themselves from the terrible situations they face.

Providing counseling in such trying circum- stances calls for a great deal of empathic understand- ing. The worker's job is to help keep the client as safe as possible, provide options, and, working patiently with the victim, help her or him explore alternatives and choose a plan of action. Recently, the focus on do- mestic violence has shifted to include comprehensive and integrated intervention and treatment programs that involve social services agencies, law enforcement, and the judicial system. IBPs operate throughout the country. Typically sent to such groups by court order, batterers learn to understand the factors that lead them to violence, learn to recognize and communicate

their feelings, and learn to avoid or stop confronta- tions that lead them to act out their feelings in violem ways. If you are being battered and don't know what to do, and there don't seem to be resources in you r community, call the National Domestic Violence Ho- tline at 1-800-799-SAFE or 1-800-787-3224 (TTY). If you are suffering from dating abuse, call the Helpline at 1-866-331-9474 or 1-866-331-8453 (TTY). If some- one is stalking you, call 1-800-394-2255 or 1-800-211- 7996 (TTY).

Visit CengageBrain.com for a variety of study aJ tools and useful resources such as video ex- ~ amples, case studies, interactive exercises, fla:~: W I cards, and quizzes. __J

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