As it is known, domestic violence is a heterogeneous problem that remains topical and urgent in today’s world. It a composed issue, because many individuals of different demographics (age, sex, level of education and income, disabilities, dependency, etc.) can become the victims of physical, verbal, and sexual assaults committed by their family members. In other words, both the means of domestic violence and risk groups are characterized by great diversity. For example, the most frequent cases of home assaults are various kinds of intimate partner violence or child abuse. Apart from those types of violence, a person may experience an abuse by care-givers (children, grandchildren, uncles, aunts, siblings, etc.). Considering the aforementioned heterogeneity, it is not surprising that the outcomes of domestic violence also vary greatly. The severity of symptoms ranges from the light negative emotions experienced while communicating with an assaulter to serious physical and emotional permanent trauma like suicidal propensities, drug and alcohol abuse, challenging behaviors, PTSDs, disabilities, and other adverse consequences. Therefore, there are a lot of intervention strategies that are utilized in accordance with trauma severity, demographics, and life circumstances of a victim. This paper is aimed at discussing the implications of domestic violence, its symptoms, risk groups, community strengths and, vice versa, challenges that inhibit resolving health issues and ensuring safety to the survivors of domestic assaults. Besides, this project provides the strategies of intervention plan and justifies the appropriateness of its implementation.
Discussing in detail a risk group of domestic violence, one should pay attention to intimate partners, especially to weaker ones or those who maintain submissive roles, children, elderly, disabled family members. In a word, given that abuse is typically applied to people who are more vulnerable both physically and mentally, they are at greater risk of becoming the victims of domestic abuse. Another reason of being attributed to the risk group is that these individuals are less likely to report home violence due to their physical/mental incapability or because of their dependence on abusive care-givers. In this regard, an extent of helplessness is a significant determinant that points to the level of threat to become a victim of domestic violence.
Given that children are heavily dependent on their care-givers, it is natural to deduce that they are at high risk of becoming the primary or secondary victims of home assaults. Consider the statistics, “every year an estimated 3.3 million to 10 million children are exposed to domestic violence in their home” (Moylan et al., 2010, p. 1). Besides, one should emphasize that the younger a child is, the more likely he/she becomes a victim of repetitive and/or multiple forms of domestic violence. In particular, it is identified that “88% of child abuse and neglect fatalities occurred among children 7 years of age and younger” (Buss, Warren & Horton, 2015, p. 225). Undoubtedly, this data reveals a strong connection between helplessness and likelihood to be assaulted.
Furthermore, domestic violence is closely related to the term ‘interpersonal violence’. This definition “has been used to describe a range of acts, including physical, sexual, and psychological abuse” (Cook, Dinnen & O’Donnell, 2011, p. 1076). A research has indicated that among 842 females around 60 “identified from primary care clinics, nearly half had experienced at least one type of abuse (i.e., physical, sexual, emotional, control, threat) since turning 55” (Cook et al., 2011, p. 1076). This finding correlates with another research, which reveals that “women are more likely than men to be exposed to recurring interpersonal violence perpetrated by intimates in childhood and adulthood, such as domestic violence and childhood sexual abuse” (Rhodes, Spinazzola, Kolk, 2016, p. 189). Moreover, Rhodes et al. (2016) indicate that females are twice more likely than males to acquire PTSD. The study conducted by Rhodes et al. suggests that women often develop PTSDs when becoming “the survivors of reoccurring interpersonal trauma” (p, 190). What makes the things even worse is that women at older age are more exposed to repetitive violence and combined types of abuse (Cook et al., 2011). In other words, researchers emphasize the tendency towards an increased risk of abuse for older, physically weaker, and/or unhealthier individuals.
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There is a strong connection between older age, healthy issues, and domestic violence. Specifically, exactly as in the case with small children, older individuals, especially females are more likely to become the victims of home-based assaults because of their helplessness. As a result, long-term consequences for the female victims of assaults range from PTSDs and depression to unhealthy coping strategies (especially alcohol abuse) (Cook et al., 2011). Undoubtedly, such lifestyle enhances the likelihood to acquire physical health problems.
What is more, it is appropriate to stress that the notion of defenselessness is closely related to such objective as disability. Many forms of mental and physical disabilities are interwoven with challenging behaviors. Specifically, CB may inflict domestic violence or be the outcome of cognitive disparity, which also heightens the risk of repetitive assaults.
Challenging behaviors (CBs) is a collective term used to describe “culturally abnormal behavior(s) of such intensity, frequency, or duration that the physical safety of the person or others is likely to be placed in serious jeopardy” (Brown et al., 2013, p. 281). Without a doubt, taking care of a family member with CBs is a great responsibility since these individuals possess a considerable threat for themselves, their caregivers, and community in general. For example, Brown et al. (2013) inform that in addition to cognitive limitations “individuals with intellectual and developmental disabilities (IDD)” are characterized by “comorbid psychiatric disorders, deficits in adaptive coping skills, and excessive maladaptive behaviors” (p. 281). These factors can trigger a violent response of their care-givers as well as of other surrounding individuals.
At the same time, to illustrate the reverse effect, one should refer to the study by Moylan et al. (2010). Specifically, Moylan et al. (2010) state that teenagers who are the survivors of domestic violence to which they were exposed at early age, are more likely to be engaged in a variety of challenging behavior. This supposition means that these victims of domestic assaults may adopt an aggressive style of communication and implement it while socializing at home and outdoors. Given the definition and plausible consequences of IDD and CBs, it becomes clear that this group is at great risk of becoming physically or verbally assaulted by their care-givers and other family members. The risk of this adverse scenario is inversely proportional to the level of informativeness and readiness of people who are expected to deal with challenging behaviors. That is why, it is important to underline the merits of providing a prior assistance aimed at preparing family members for living under the same roof with IDD.
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Besides, one should stress that this risk group is characterized with great heterogeneity (Brown et al., 2013). For instance, the level of cognitive evolvement of IDD varies considerably. Therefore, the ratio of challenges related to dealing with these individuals is also diverse. In addition, they come through different developmental stages, for example, a young and old woman with a developmental disparity requires diverse intervention strategies while addressing the consequences of domestic violence. For example, the level of complexity is manifested through the severity of challenging behaviors (Brown et al., 2013). In a case, if an organism is healthy, psychotropic medications can be used in addition to treatment approaches; however, an older or less not so fit organism suffers stronger from the side-effects of such medicines that is why curing psychological issues in older generation by prescribing medicines may be justified only in particular cases (Brown et al., 2013).
What is more, it is crucial to comprehend that the likelihood to be abused by family members increases when several of the above-mentioned objectives are joint together. For instance, elderly women who are physically or mentally dysfunctional are at greater risk of experiencing domestic abuse (Cook, Dinnen, O’Donnell, 2011). This example incorporates three above-discussed risk objectives: age, gender, and disability. One more example of an increased risk may be observed in providing care to disabled children under conditions of parents’ substance abuse and/or difficult financial situation. Besides, another example is an enhanced likelihood to be espoused to intimate partner violence during the pregnancy (Tsai, Tomlinson, Comulada, Rotheram-Borus, 2016). The fact is that, combination of several risk prone objectives enhances a person’s vulnerability.
Moreover, vulnerability is also expressed in socio-economic status. Specifically, the research conducted by Masters et al. (2015) reveals that, in term of sexual assaults, women who become the victims of incapacitated assault are more likely to belong to better economic and social environment (including the level of education) than the female victims of forceful sexual assaults. The limitation of applicability of this finding to the discussed issue of domestic violence is that Masters et al. (2015) cover all forms of violence, hence, the identified strong connection of abuse and socio-economic situation points out that this variable should be considered fully defining the risk group of domestic assaults.
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Undoubtedly, domestic violence is a complex problem; to understand the reasons of its complexity one should consider the following arguments. Typically, domestic assaults involve more than one person who needs help. Specifically, considering that there is an abuser and a victim, domestic violence possesses at least two (but often more) people who have mental problems that originate from their unhealthy relations. In most cases, psychological assistance is aimed at protecting and minimizing an obtained harm for the victim, which is a rationale given that the fact that an abused individual possesses the strongest need to receive acute and qualified help. Hence, it is important to remember that an abuser applies to different forms of violence because those are easy and affordable coping strategies. In other words, abuser fails to manage the problem with a responsibility of being a care-giver and/or a responsible one for successful relations (Brown, Brown & Dibiasio, 2013). This premise suggests that many cases of domestic violence can be prevented if people who become responsible for one or more family members receive a timely assistance. This help should be aimed at preventing the accumulation of negative emotions that are released by means of malevolent strategies such as an abusive behavior.
What is more, domestic violence is a complex issue because apart from direct interaction between a victim and an abuser, there are those individuals who witness the wrongdoing. In this way, they are exposed to secondary trauma. For instance, when children observe their patterns’ abusive attitude towards an old grandmother, they struggle to develop healthy emotional bonds firstly with their abusive parents and, later on, with other individuals. Buss et al. (2015) inform that “three million couples per year engage in severe in-home violence toward each other in the presence of young children” (p. 225). Observing the aforementioned examples, it becomes clear that that complexity is a main challenge that hinders the process of developing healthy coping skills, acquiring a healthy environment, and reducing the likelihood of reoccurring trauma. Therefore, treating the consequences of domestic violence requires constructing a multi-directional approach that targets both internal and external consequences of IPV, child abuse, and other issues.
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Scrutinizing the role of community in this process, researchers claim that coming to special shelters for the survivors of home assaults is a good way to increase safety and mitigate emotional burden in a short-run. In particular, Johnson et al. (2016) states that in-shelter treatment is proved to be more effective. Considering the rationale, it is statistically proven that the residents of shelters reveal lighter symptoms of PTSD and depression (Johnson et al., 2016). Besides, one can observe “more gain of personal and social resources” (Johnson et al., 2016, p. 9). Briefly, if possible, in-shelter treatment must be given a priority; especially, this recommendation is relevant for the severe PTSDs and depression obtained due to being a victim of domestic violence. The next section is aimed at describing the effective means of intervention that are aligned with the evidence-based approach of treatment.
The development of strategies intervention plan starts with the pre-treatment assessment of client’s condition. The first step is defining the ratio of trauma severity (OPTUM, n. d.). To accomplish this goal, a therapist uses Domestic Violence Survivor Assessment (DVSA) tool. This tool is developed to measure such important objectives as issues about safety, culture, health, and coping skills (DVSA, 2009). The appropriate frequency of this analysis tool usage is one time at prior treatment to construct effective intervention strategies and several times during the process of counseling. The latter is intended to monitor a client’s progress towards recovery and, thus, allows correcting the use of remedies and approaches with the purpose to make the strongest possible impact on the life situation of a client.
Besides, it is necessary to stress that in terms of time variable, a therapist defines short- and long-term interventions. Short-term interventions, however, are aimed at ensuring the safety to a victim and other involved parties (for example, children who witness domestic violence must be provided with the healthy atmosphere). Similarly, the purpose of long-term interventions is to ensure that healing of emotional wounds, preventing re-emergence of trauma in a case when certain conditions remind about painful events, etc. In short, the long-term interventions are aimed at increasing a person’s resilience by enhancing his/her coping mechanisms and providing with new benevolent options (socializing, hobbies and others) (Center for Substance Abuse Treatment, 1997). In their turn, interventions strategies must be developed “from a recovery and resiliency based approach with an understanding of complex factors such as trauma history, gender, culture, sexual orientation, and socioeconomic class” (OPTUM, n. d., p. 18). This requirement suggests that to treat the consequences of domestic violence a therapist should apply to trauma and evidence based techniques, such as Cognitive-Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (OPTUM, n. d., p. 19).
CBT possesses a range on short-term intervention strategies that are aimed at providing the help to a victim in short-terms (Warshaw, Sullivan & Rivera, 2013). While working at accomplishing short-term goals, one may define such strategies as learning a victim to assign the blame to an assaulter, dismissing the feeling of shame, and increasing the feeling of safety (Center for Substance Abuse Treatment, 1997). The latter is an especially changing task, because a victim of domestic violence is typically scared to stop being afraid of an offender (Karatzias, Jowett, Begley, Deas, 2016). Therefore, the critical goal of CBT is to help a client replace the destructive, negative cognitive schemata with the benevolent ones that emphasize safety and well-being.
Thereafter, once the immediate goals are achieved, it is appropriate to work at long-terms goals of coping skills. Iverson et al. (2011) informs that “CBT for PTSD helps reduce risk for future IPV among interpersonal trauma survivors” (p. 10). Specifically, at this stage a therapist should address to DBT, which is a kind of a CBT that is utilized to ensure a happy surviving for clients by means of changing their attitude to their situations. In this regard, “CBT interventions for PTSD and depression symptoms will improve interpersonal trauma survivors’ safety in intimate relationship” (p. 10). These strategies are the most popular in addressing the cases of domestic violence, which is not surprising given that these therapies provide an acute assistance to victims. The statistics shows that about “1 in 3 women (35.6%) and more than 1 in 4 men (28.5%) in the United States have experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime” (Black et al., 2011, p. 2). Many of them do not acknowledge the danger they are exposed to and, in many cases, these victims of home assaults tolerate an exposure to danger of other individuals who depend on them. This premise suggests that there are many clients who must receive an effective and instant assistance. This is another reason why CBT and DBT should be applied to the victims of domestic violence.
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Defining plausible barriers, it is appropriate to accentuate that CBT and DBT encourage victims to reveal their inner feelings and external life-situations. The crucial determinant of evidence-based approach is to act (provide assistance) in accordance with the person’s cognitive accentuations and external circumstances. This peculiarity requires a fast and considerable exposure to strange people, whereas, victims may feel uncomfortable to make a step for exposure. Besides, survivors of domestic violence often apply to denial or rationalizing of offender’s action. Thus, it may be difficult to assess the situation correctly and convince a client in the urgency for change. Moreover, in a case of CB and IDD, the task to alter cognitive schemata is even more complicated. Finally, severe forms of mental issues require a more prolonged treatment and/or prescribing medicines, inpatient care, etc. Therefore, despite being greatly effective, CBT and DBT should be utilized only in the cases that require an acute intervention as well as in those when a minimal or moderate level of therapist’s involvement is required.
In addition to the main intervention therapies, counselors are advised to use contemporary mind-body practices. For example, yoga is believed to be a safe and benevolent complementary approach that can be utilized to mitigate the negative effects of health issues. Rhodes et al. (2016) recommend implementing yoga as a remedy to cope with various kinds of interpersonal trauma including the consequences of domestic violence. Despite the fact that it is hard to verify the effect of practicing yoga without the action of other factors, Rhodes at al. advise utilizing yoga as an intervention strategy in cases of PTSDs, depressions, and other implications of domestic violence. In other words, yoga should be used as a complementary means of intervention along with other strategies.
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This finding resonates with a study conducted by Clark et al. (2014). The scholars claim that applying to yoga while treating the symptoms of intimate partner violence (IPV) is a completely safe intervention (meaning that it does not evoke re-occurrence of emotional trauma). Besides, apart from the merits of yoga for physical and emotional conditions of clients, it is a proper means to develop new social bonds and heal emotional wounds with a help of a new hobby. That is why it is natural to deduce that practicing yoga may be added to intervention plan while working on long-term goals. In particular, defining a proper recovering stage for this activity, one should accentuate that it is the second stage when a person resolve the issues of safety, culture, and health, and needs to enhance the resilience strategies to avoid the re-occurrence of victimization in the future.
Domestic violence is one of the main issues that predefine the emergence of physical and mental problems. This issue is characterized by a great variety of symptoms and consequences. In particular, one may become a victim of physical, verbal, or sexual abuse; it can be an intimate partner violence or child abuse, etc. Moreover, the risk group is quite heterogeneous with the tendency towards an increased likelihood of abuse when several risk factors coincide. To the representatives of risk group one may attribute children (especially small), women, or men (submissive intimate partner), elderly, and disabled individuals. Domestic violence may cause anxiety and depression, or cause the development of PTSDs, suicidal propensities, challenging behaviors and other permanent negative outcomes. Considering that the help should be urgent, a therapist may apply to CBT and CBT. Both therapies are aimed at shifting the negative cognitive connections of a victim to positive or, at least, tolerated ones. Thus, these strategies are appropriate and effective. Hence, in a case of developmental disparities or other mental conditions that complicates the work with rationale links of an individual, these therapies should be replaced with other interventions.