Domestic Violence: A Clinical Perspective

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Domestic ViolenceA Clinical Perspective

• Presented By Chuck Diviney, MC, LPC, NCC, CCMHC
• Statistics
• Theory and Research
• Diagnostics / Characteristics
• Treatment
• Relationship With Clients
• Domestic Violence / Elder Abuse

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DV Basics and Statistics

• What is Domestic Violence?
• Physical, emotional, mental, sexual abuse
• Statistics
• 1 in 3 Utah women are physically abused
• Utah 26 higher homicide rate
• Children 6X greater chance of DV relationships
• Statistics similar across cultural lines
• 25-33 of all relationships
• Leaving is the most dangerous time

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Theory and Research

• Domestic Violence Research
• Kernberg- A psychotic or borderline level of
  personality organization is a corollary of most
  homicidal attachments.

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Theory and Research

• Domestic Violence Research
• Gondolf- In a study of domestic violence
  batterers, no Axis I pathology emerged as typical
  for common to batterers. The characteristic
  that was found in most all batterers was
  narcissism.

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Theory and Research

• Narcissistic Traits
• Surface
• Grandiose
• Need to feel special/different
• Critical of others
• Controlling

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Theory and Research

• Narcissistic Traits
• Core Personality
• Emptiness
• Shame
• Fear of abandonment
• Extreme Vulnerability

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Theory and Research

• Narcissistic Traits
• Defense Mechanisms
• Rationalization
• Denial
• Grandiosity
• Splitting
• Projection
• Idealize and/or Devalue

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Theory and Research

• Domestic Violence Research
• Dutton- In his study, he found that 85 of men
  referred to his treatment program had a
  diagnosable personality disorder.
• He also found that approximately 40 had
  antisocial personality characteristics.

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Theory and Research

• DV Batterer Classification (one model)
• Family-Only Batterer
• Dysphoric/Borderline Batterer
• Generally Violent/Antisocial Batterer

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Diagnostics/Characteristics

• Cluster B Personality Disorders (DSMIV-TR)
• Developmental Continuum
• Histrionic Borderline Narcissistic Antisocial
• (less severe ? ? ? ? ? ? more severe)
• The farther to the right, the worse the pathology
  in terms of attachment, object-relations, and
  prognosis for change

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Diagnostics/Characteristics

• Histrionic Personality
• Pattern of excessive emotionality
• Attention seeking
• Constant need for approval
• Self-centeredness/self-preoccupation
• Sexual Seductiveness
• DV Very emotionally and psychologically abusive
  little physical abuse (very mild)

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Diagnostics/Characteristics

• Histrionic Personality (cont.)
• Risk Assessment Questions
• 10 Alcohol / Drug problems?
• 12 Mental Health Issues?
• 15 Abuse as a child? (mild to moderate)
• 16 Separations?
• 18 Suicide/Homicide?
• 19 Stalking?

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Diagnostics/Characteristics

• Borderline Personality
• Deflated false self and fragmented ego
• Labile/impaired emotional regulation
• Unstable, intense interpersonal relationships
• Extreme idealization and devaluation
• Use of thinking errors extreme (all/nothing)
• Low frustration tolerance
• DV Very emotionally and psychologically abusive
  mild to moderate physical abuse emotionally
  labile and unpredictable homicidal/suicidal
  threats

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Diagnostics/Characteristics

• Borderline Personality (cont.)
• Risk Assessment Questions
• 10 Alcohol / Drug problems?
• 12 Mental Health Issues?
• 15 Abuse as a child? (moderate)
• 16 Separations?
• 18 Suicide/Homicide?
• 19 Stalking?
• Higher level of intensity vs. HPD

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Diagnostics/Characteristics

• Narcissistic Personality
• Pervasive pattern of grandiosity / image
• Lack of empathy
• Hypersensitive to evaluation by others
• Inflated false self
• Emptiness and shame at core of personality
• Others seen as extension of self
• DV Dismantle victims emotionally complete
  control of activity manipulative moderate
  physical abuse, more likely emotional /
  psychological abuse

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Diagnostics/Characteristics

• Narcissistic Personality (cont.)
• Risk Assessment Questions
• 1 Control of money, activity, socialization?
• 8 Image outside of the home?
• 15 Abuse as child? (moderate to severe)
• 16 Separation?
• 18 Suicide/Homicide?
• 19 Stalking?
• Higher level of intensity vs. HPD and BPD

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Diagnostics/Characteristics

• Antisocial Personality
• Criminal activity/legal history extensive
• Behavior begins in adolescence (conduct)
• Extreme impulsivity
• Calm in crisis situations
• Lack emotional responsiveness / empathy
• No attachment (unless need driven)
• DV Terrorizing extreme physical abuse not
  likely to change with intervention most
  dangerous of personality disorders

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Diagnostics/Characteristics

• Antisocial Personality (cont.)
• Risk Assessment Questions
• 1 Control of money, activity, socialization?
• 2 Abuse of children?
• 3 Assault outside of family?
• 4 Weapons?
• 5 Cruel to animals/pets?
• 10 Alcohol/Drug issues?
• 13 Criminal record/history?

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Diagnostics/Characteristics

• Antisocial Personality (cont.)
• Risk Assessment Questions (cont.)
• 15 Abuse as a child? (severe)
• 16 Separated?
• 17 Forced into sexual act?
• 18 Suicide/Homicide?
• 19 Stalking?
• Most severe of personality disorders and least
  likely to change

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Diagnostics/Characteristics

• Other Risk Assessment Factors
• 1 Control of money, activity, and
  socialization- yes response more likely to
  represent DV (as opposed to poor
  communication/anger management issues)
• 6 Increase in severity/frequency- typical to
  all personality disorder types/DV relationships.

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Diagnostics/Characteristics

• Other Risk Assessment Factors
• SERIOUS RED FLAGS!
• 3 Abuse outside of the home?
• 4 Weapons?
• 5 Cruelty to animals/pets?
• 10 Drugs/Alcohol?
• 16 Recent/pending separation?
• 18 Suicide/Homicide threats?

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Diagnostics/Characteristics
DV Cycle
Power and Control
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Diagnostics/Characteristics
Sexual Assault Cycle
Power and Control
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Diagnostics/Characteristics
Substance Abuse Cycle
Power and Control
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Diagnostics/Characteristics

• Thinking Errors
• Used throughout the cycle
• Frequent use/daily living patterns
• Irrational thinking
• Perpetrators way to connect the dots
• EXAMPLES
• Justification, All or Nothing (B/W), Lying,
  Victim Stance, Blaming, Minimizing, Denying,
  Power Thrusting, Build Up

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Diagnostics/Characteristics

• Mental Health Disorders (Axis I)
• Depression
• Anxiety
• Bipolar
• Schizophrenia (paranoid)

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Diagnostics/Characteristics

• Victim Types
• Classical lacks phys/psych power
• Pseudo-Classical some psych power, e.g., sets
  up the violence/chooses when DV occurs
• Mutually Violent no pattern establishing either
  party as the victim

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Diagnostics/Characteristics

• Post Traumatic Stress Disorder
• Most common Axis I disorder for victims and
  children of DV
• Anxiety symptoms panic, dissociation,
  fragmentation of bodily experience
• Increased risk of alcohol/drug use
• Poor impulse control
• Depression likely to follow

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Diagnostics/Characteristics

• Dependent Personality Disorder
• Dependent and submissive behavior
• Intense preoccupation with abandonment
• Extreme discomfort with being alone
• Anxiety and depression very common
• Unable to make decisions alone

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Diagnostics/Characteristics

• Diagnoses with children
• PTSD vs. ADHD
• Depression
• Anxiety
• Personality Disorders 6X greater chance of being
  in DV relationships as an adult
• Oppositional Defiant/Conduct Disorder

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Diagnostics/Characteristics

• Brain Scan
• Victims of DV (children and adults)
• Frontal lobe development impaired (higher
  processing area of the brain)
• Hyperdevelopment of brainstem area (fight/flight)

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Treatment

• Batterer/Perpetrator Treatment
• Phases of Treatment
• Phase One- Elimination or change of dysfunctional
  or destructive behavior containment crisis
  intervention safety planning
• Phase Two- Education learning new skills
• Phase Three- Acquisition of personal insight

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Treatment

• Crisis Management/Initial Intervention
• Timeout Skills
• Safety Plan
• Stress Log
• Self-care

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Treatment

• Rational Emotive Behavioral Therapy (REBT)
• Albert Ellis, Ph.D., 1954
• Relationship between thoughts, behaviors, and
  emotions
• Teaching self-control
• Rational vs. Irrational thinking

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Treatment

• Rational Emotive Behavioral Therapy (REBT)

THOUGHTS
FEELINGS
BEHAVIORS
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Treatment

• Rational Emotive Behavioral Therapy (REBT)
• A B ? C
• Activating Belief ? Emotional/
• Event
  Behavioral
• 
  Consequence
• D ? E
• Dispute ? New Consequence

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Treatment

• Solution Focused Behavioral Therapy
• Scaling
• Plan For Progress
• Solution Generating/Focused Questions

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Treatment

• The Personality Balance Wheel

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Treatment

• Goals for treatment
• Increase perpetrator accountability
• Prevent further violence
• Decrease recidivism
• Increase mental health functioning

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Treatment

• PTSD
• Secure, consistent, predictable environment
• Ordering activity/daily routine
• Body awareness/use of sensory perception
• Relaxation techniques
• Goodbye letter (letting go)
• Journal
• Creating social support
• Open discussion and processing
• Children Play therapy

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Treatment

• DV Treatment Guidelines
• Perpetrator treatment 16 weeks
• No court ordered treatment for victims
• No couples therapy, unless
• 12 week minimum in treatment
• No continued risk of danger (comprehensive
  assessment completed)
• Safety plan in place
• Victim acknowledges desire for treatment
• Funds available
• Relapse to be expected (thinking vs. behaving)

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Relationship With Clients

• ENGAGEMENT
• Focus on help for the entire family
• SUPPORT, EMPATHY, TRUST
• Advocacy, Education, Support vs. Decision Maker
• Rapport with client is 75 predictor of success

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Relationship With Clients

• Nonverbal (specific to crisis intervention)
• Eye contact
• Matching
• Relaxation (Take a couple of deep breaths)
• Listening/allowing client to vent
• Empathy (That must be difficult)
• Being safe
• Avoiding attacks on partner

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Relationship With Clients

• Crisis Intervention Skills
• Take control of the situation
• Determine the real client
• Emphasize strengths
• Mobilize social resources

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Relationship With Clients

• Crisis Intervention Skills (continued)
• Lethality and Danger Assessment
• Look at the serious red flags
• Take people with you to help
• Identify a safe place and time to meet with the
  victim
• Safety plan

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Relationship With Clients

• Risk of Danger Form
• Form that belongs to the victim
• Assessment of danger and lethality, as well as an
  awareness tool
• Use the chart of dangerous behaviors to help
  increase awareness
• Dont blame the victim
• Listen

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Relationship With Clients

• Safety Planning
• Ask the victim about what has been done
• Identify support system
• Identify safe places (dont put the address)
• Plan for daily activities (work, groceries, etc.)
• If they stay vs. If they leave
• The role of the victim advocate, shelters,
  caseworkers ADVOCACY

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Relationship With Clients

• Approaching the counseling process
• Making contact
• Explain who you are/the counseling process
• Speak briefly
• Individualize your counseling
• When you dont know what to say,
• SAY NOTHING
• taken from Elements of Counseling (3rd ed),
  Meier and Davis, 1997

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Relationship With Clients

• Avoid these
• Positive thinking does not equal rational
  thinking
• Agreement does not equal empathy
• Change is not typically simple
• Make psychological assessments, not moral
  judgments
• Do not assume anything, clarify

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Relationship With Clients

• Dealing with a Personality Disorder
• Set firm boundaries with the client and FOLLOW
  THROUGH!
• Behavior logs
• Journal
• Strengths focused
• Dont expect TOTAL change-modification is key
• Work with a team/avoid triangulation
  (communicate)

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Relationship With Clients

• Know thyself!
• How did you decide to become a counselor?
• With what emotions are you uncomfortable?
• What amount of progress is acceptable?
• How will you deal with client feelings for you?
• How will you deal with your feelings for clients?
• Can you be flexible?
• What are your values? Any conflicts with clients?

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Domestic Violence / Elder Abuse

• Three Potential Scenarios in Elder Abuse/Domestic
  Violence
• Long-term relationship with early onset

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Domestic Violence / Elder Abuse

• Three Potential Scenarios in Elder Abuse/Domestic
  Violence
• Short-term relationship with early onset

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Domestic Violence / Elder Abuse

• Three Potential Scenarios in Elder Abuse/Domestic
  Violence
• Long-term relationship with late onset

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When I was a laddie, I lived with my granny, And
many a hiding my granny gied me. Now I am a
man, And I live with my granny. And I do to my
granny, What she did to me. -Anonymous
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VIDEOS QUESTIONS?????