Friday, October 10, 2008

Intimate Partner Violence Challenges Intervention And Solutions: Part 1 Barriers

This is the first in a series of posts about what I learned at the all-day workshop sponsored by the Mayo Clinic Intimate Partner Violence Education and Prevention Committee.

I applaud every member of that committee for creating a workshop which expertly mixed the technical with the personal so that attendees (primarily nurses and social workers) got information to help them do specific tasks such as screenings with enough context so that they would be less likely to miss subtle indicators or to do nothing about disclosures of domestic violence.

Throughout the sessions everyone acknowledged that men can be genuine victims of domestic violence committed by women and they acknowledge that the domestically violent can be in same-sex relationships, but most domestic abusers are men and most victims are women so the examples given fit the most common dynamic which most health care providers will see in their practices.

The first session given by Annelies Hagemeister, Associate Professor in the Dept. of Social Work at Minnesota State University Mankato was titled Barriers and Dynamics Involved in Leaving a Violent Relationship.

Note: I can only hit the highlights of this 2 hour session and my reactions to what I learned.

She focused on systematic abuse and gave the following definition for domestic violence:

"A pattern of tactics and behaviors, including physical, sexual, verbal, and psychological attacks, as well as forms of coercion and use of others, which adults and adolescents use against their intimate partners to gain power and control."

She referenced the Power and Control Wheel which has power and control at the center with using intimidation; using emotional abuse; using isolation; using minimizing, denying and blaming; using children; using male privilege, using economic abuse; and using coercion and threats as the spokes.

The Duluth Model also has an Equality Wheel (pdf) which was mentioned in several sessions. This wheel has equality at the center with non-threatening behavior; respect; trust and support; honesty and accountability; responsible parenting; shared responsibility; economic partnership; and negotiation and fairness as the spokes.

One of the tactics which often occurs before any overtly abusive behavior appears is for the abuser to seek changes which makes the abused person's leaving more difficult. Rather than using force at the beginning, the abuser will often use positive manipulation.

An example of this, from a later session, was an abuser who encouraged his girlfriend to quit her job, move in with him and go back to school so she could have the career she'd always wanted, but once she became economically reliant on him, her abuser systematically undermined her schooling while pretending to be supportive. Other traps were similarly packaged as positive changes.

Publicly, this move made to gain economic control often looks like an act of generosity and sacrifice by the abuser. That can result in the subtle efforts of the abused person to reach out to be dismissed because the abuser is clearly generous. This in turn can contribute to the abused person beginning to question her perceptions.

Hagemeister did a powerful scripted demonstration with 8 volunteers. She played the role of a widow who then married a man who seemed to her and to her family and friends to be a wonderful guy. Each of the volunteers played someone who responded to the isolating changes and/or to this woman's efforts to reach out in a way that failed this woman and severed the useful connection between them.

In the roles of people this widow interacted with first, they responded to the woman's concerns by telling her that she was married to a great man. This highlighted how the false assumptions made by non-abusers and non-abused can aid abusers in isolating victims of domestic abuse and how they can aid in undermining the victim's self-confidence even at the earliest stages of abuse.

At that early stage the domestic abuser hadn't yet physically abused her which explains why she couldn't name it.

This demonstration made it clear to me why it is important for every adult to understand the complete dynamics of systematic abuse from beginning to end. Systematic abusers need people to not understand how they operate for their traps to be effective.

If all of us saw all the traps and all the barriers victims of domestic violence deal with we couldn't blame the victims for being abused or for not leaving.

The highest risk of murder happens at 3 times: during pregnancy, when the victim has decided to leave, after the victim has left the abusive partner. During all 3 of these times, the violent person isn't in full control. That means the fear of being murdered by an abusive partner isn't an irrational fear.

In a health care setting, those who are screening for domestic violence need to understand these times of heightened danger and they need to understand why the danger goes up. If they don't understand the real barriers, they may decide that if the victim didn't leave or returned after leaving that she doesn't truly want the abuse to stop.

When domestic violence was detected in a health care setting, such as through a waiting room questionnaire, only 10% of those patient's charts included a referral and safety plan.

By making appropriate referrals and helping patients form a basic safety plan, health care professionals can help victims of domestic violence find ways over the barriers their abusers depend upon.

However, as later sessions demonstrated, there are a spectrum of areas that need improvement and which we can't afford to ignore. If the law responds to an attempted murder or the clear promise of murder with nothing more than an order of protection, that is a dangerous barrier to those who are told they will be killed if they leave.

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posted by Marcella Chester @ 12:41 PM   0 comments links to this post

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