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Domestic Violence: A Clinical Perspective

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1 in 3 Utah women are physically abused. Utah: 26% higher homicide rate ... I lived with my granny, And many a hiding my granny gi'ed me. Now I am a man, ... – PowerPoint PPT presentation

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Title: Domestic Violence: A Clinical Perspective


1
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

2
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

3
Theory and Research
  • Domestic Violence Research
  • Kernberg- A psychotic or borderline level of
    personality organization is a corollary of most
    homicidal attachments.

4
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.

5
Theory and Research
  • Narcissistic Traits
  • Surface
  • Grandiose
  • Need to feel special/different
  • Critical of others
  • Controlling

6
Theory and Research
  • Narcissistic Traits
  • Core Personality
  • Emptiness
  • Shame
  • Fear of abandonment
  • Extreme Vulnerability

7
Theory and Research
  • Narcissistic Traits
  • Defense Mechanisms
  • Rationalization
  • Denial
  • Grandiosity
  • Splitting
  • Projection
  • Idealize and/or Devalue

8
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.

9
Theory and Research
  • DV Batterer Classification (one model)
  • Family-Only Batterer
  • Dysphoric/Borderline Batterer
  • Generally Violent/Antisocial Batterer

10
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

11
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)

12
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?

13
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

14
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

15
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

16
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

17
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

18
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?

19
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

20
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.

21
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?

22
Diagnostics/Characteristics
DV Cycle
Power and Control
23
Diagnostics/Characteristics
Sexual Assault Cycle
Power and Control
24
Diagnostics/Characteristics
Substance Abuse Cycle
Power and Control
25
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

26
Diagnostics/Characteristics
  • Mental Health Disorders (Axis I)
  • Depression
  • Anxiety
  • Bipolar
  • Schizophrenia (paranoid)

27
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

28
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

29
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

30
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

31
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)

32
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

33
Treatment
  • Crisis Management/Initial Intervention
  • Timeout Skills
  • Safety Plan
  • Stress Log
  • Self-care

34
Treatment
  • Rational Emotive Behavioral Therapy (REBT)
  • Albert Ellis, Ph.D., 1954
  • Relationship between thoughts, behaviors, and
    emotions
  • Teaching self-control
  • Rational vs. Irrational thinking

35
Treatment
  • Rational Emotive Behavioral Therapy (REBT)

THOUGHTS
FEELINGS
BEHAVIORS
36
Treatment
  • Rational Emotive Behavioral Therapy (REBT)
  • A B ? C
  • Activating Belief ? Emotional/
  • Event
    Behavioral

  • Consequence
  • D ? E
  • Dispute ? New Consequence

37
Treatment
  • Solution Focused Behavioral Therapy
  • Scaling
  • Plan For Progress
  • Solution Generating/Focused Questions

38
Treatment
  • The Personality Balance Wheel

39
Treatment
  • Goals for treatment
  • Increase perpetrator accountability
  • Prevent further violence
  • Decrease recidivism
  • Increase mental health functioning

40
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

41
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)

42
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

43
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

44
Relationship With Clients
  • Crisis Intervention Skills
  • Take control of the situation
  • Determine the real client
  • Emphasize strengths
  • Mobilize social resources

45
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

46
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

47
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

48
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

49
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

50
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)

51
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?

52
Domestic Violence / Elder Abuse
  • Three Potential Scenarios in Elder Abuse/Domestic
    Violence
  • Long-term relationship with early onset

53
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54
Domestic Violence / Elder Abuse
  • Three Potential Scenarios in Elder Abuse/Domestic
    Violence
  • Short-term relationship with early onset

55
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56
Domestic Violence / Elder Abuse
  • Three Potential Scenarios in Elder Abuse/Domestic
    Violence
  • Long-term relationship with late onset

57
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
58
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