Counseling Today, Features

Working through the hurt

By Bethany Bray March 25, 2014

abusedMore than one-third of U.S. women (35.6 percent) and more than one-quarter of U.S. men (28.5 percent) have experienced rape, physical violence or stalking by an intimate partner during their lifetime, according to a recent survey by the National Center for Injury Prevention and Control.

Those statistics suggest that counselors of all specialties, from school counselors to addictions counselors, are likely to encounter clients who are familiar with the impact of domestic violence. Counselors with expertise in this area stress that the specter of domestic violence is a complicated issue that helping professionals must address with grace and competency.

Working past domestic violence in counseling sessions will almost assuredly involve other issues, says Christine Murray, a domestic violence researcher and associate professor in the University of North Carolina at Greensboro (UNCG) Department of Counseling and Educational Development. Those issues might range from self-esteem, anxiety and relationship challenges to financial problems and finding employment. As one example, Murray says, an abusive spouse may not have allowed your client to hold a job outside of the home or even leave the house unsupervised.

“Domestic violence is something that impacts someone’s mental health, but there are all these other pieces to it,” says Murray, an American Counseling Association member who teaches a class on family violence to her counseling students. “There’s no easy way to say, ‘This type of abuse has this specific answer.’ It’s different with each person. Any form of abuse can be really hurtful to somebody.”

A counselor’s approach might be different with each client involved in domestic violence and should be tailored to his or her experiences and symptoms. Clients may be victims of domestic violence, perpetrators of domestic violence or witnesses — for instance, a child or someone else in the home who saw the abuse occur.

Murray, who prefers the term intimate partner violence to domestic violence, adds a fourth category: survivors. Survivors may be out of their abusive relationship but still experiencing lingering effects of trauma, such as nightmares or flashbacks. According to Murray, counselors are more likely to encounter clients at the “survivor” stage than clients who are still in the thick of an abusive relationship.

Murray, a licensed professional counselor (LPC) and licensed marriage and family therapist, has good reason for applying the term survivor to clients who have withstood abusive relationships. “We don’t want to view people who have been abused as damaged. They may feel that way, but we need to help them and promote that view [that they are not damaged] in society,” she says. “They can have a happy life. They can have happy relationships. There is recovery [and] there is hope that people can experience even after having a horrific experience.”

“Just the fact that they’ve survived and lived to tell the story shows how strong they are, how resourceful,” Murray continues. “There is a lot of strength that comes through that process. They can be encouraged, and they don’t need to be ruined, [even though] that’s often how
they feel.”

Introducing the topic in session

Nancymarie Bride, an LPC, certified clinical mental health counselor and adjunct faculty member at Kean University in New Jersey, says individuals who have experienced domestic violence are often marginalized by the general public and even by mental health professionals. For that reason, these individuals often “do not expect to be believed,” says Bride, an ACA member and past president of the New Jersey Counseling Association who has worked with people affected by domestic violence — both victims and perpetrators — since the 1980s in private practice and group work. “Even sometimes when domestic violence is recognized, it’s not taken seriously enough,” she says.

Counselors shouldn’t expect that clients will bring up their abuse histories on their own, and there are several reasons for that, Murray says. For instance, some clients may not even recognize they are in an abusive, controlling relationship because that type of relationship may be “normal” for them, she says. Other clients assume that the term abuse should be applied only if a spouse or intimate partner has hurt them physically. These clients do not necessarily recognize psychological, verbal or other nonphysical forms of abuse as abuse.

But a lack of recognition is not the only thing that keeps clients from bringing up a history of abuse with counselors, Murray says. Many victims and survivors feel a sense of shame or embarrassment about these experiences. Some even feel they are somehow to blame for being the target of abuse. Others fear being judged or are otherwise unsure of how a counselor might react to their revelation. And some clients try to keep the truth hidden for safety reasons, Murray says, having been threatened with further harm by their perpetrators should they ever tell anyone.

Oftentimes, a client’s history of abuse emerges gradually — and only after the therapeutic alliance between the counselor and client has grown strong, says Allison Crowe, an assistant professor of counseling at East Carolina University who conducts research on domestic violence. “Chances are, [the client] is trying to determine whether or not I’m trustworthy, especially if they’ve been to professionals in the past,” says Crowe, an ACA member who is an LPC and approved clinical supervisor. “Many folks who have gone to seek help have not had a good experience and are very nervous about bringing this up with the next person.”

What if a counselor comes to suspect abuse or intimate partner violence, but the client doesn’t recognize the problem? The way that counselors word their questions is very important, says Brandon Ballantyne, an LPC in Reading, Pa., who facilitates domestic violence evaluations and makes treatment recommendations for families referred to counseling by the county’s department of children and youth services.

He suggests that counselors talk to clients about what it would look like if there were a problem. “You’re not trying to change their mind or indicate there is a problem but [rather] get them to talk about what would signal or indicate there is a problem,” says Ballantyne, a member of ACA. “It helps if it comes from their mouth. You know what direction you want to take the session, but you don’t want to plant any ideas.”

Murray and Bride recommend using the Duluth Model’s Power and Control Wheel (theduluthmodel.org), which categorizes specific abuse behaviors counselors can talk through with clients, including using coercion and threats, using intimidation, using isolation, using economic abuse, using emotional abuse and minimizing, denying and blaming.

Once the counselor establishes what the client views as abuse, the counselor can begin to challenge those beliefs, Ballantyne says. He adds that open-ended questions are most useful. For example, he says, ask the client how his or her personal definition of a healthy relationship is working out. What has it led to? Has it led the person to counseling?

“You never have to feel pressured to convince the client that they should think the way you’re thinking,” he says. “It’s OK to disagree. When you disagree, there’s more opportunity for growth. [Say], ‘It’s OK for us to think differently about this, but let’s talk a little bit more about it.’ Anytime you can [give] the control back to the client, I think that’s when changes tend to stick a little more.”

Self-perception and society’s perception

Clients who have a history with domestic violence can present with myriad related issues, Crowe says. For instance, they may have symptoms of posttraumatic stress disorder (PTSD), including feeling unsafe, experiencing flashbacks or being jumpy, she says. The counselors interviewed for this article also mentioned helping these clients with issues such as anxiety, depression, panic attacks, emotional withdrawal, feelings of helplessness and low self-esteem.

The self-blame and guilt associated with not leaving an abusive relationship sooner, especially if that relationship also involved children, is another major issue that counselors and clients must commonly work through together, Crowe says.

Providing psychoeducation and teaching clients what a healthy relationship looks like are basic but useful techniques that counselors can use, she says. Clients may need to learn that the manipulation and power struggles they have experienced in their intimate relationships — such as a spouse not allowing them to carry a checkbook or go grocery shopping — aren’t normal or healthy, Crowe says. The process involves clients “learning all that abuse entails and forgiving [themselves],” she adds.

Crowe and Murray recently surveyed and interviewed more than 230 domestic violence survivors (male and female) for a research project. The duo is preparing to publish its findings in an educational journal, as well as through a website (seethetriumph.org) and social media campaign.

Through their research, Murray and Crowe heard from domestic violence survivors who felt stigmatized not just in general society but also by the professionals they had turned to for help. In one case, a woman was fired because her employer didn’t want her abusive spouse showing up at the workplace to stalk her. In another case, a police officer asked a victim of domestic violence out on a date when she came to the station to file a report. Another interviewee said her doctor told her she was “stupid” for not leaving an abusive husband.

“The stories that we heard were overwhelming,” Crowe says. “I was taken aback by the poignancy of what these [people] experienced. When someone sees you as ‘she lets her husband beat her,’ people start forming ideas about you. … An incredible takeaway [from the research project] is how much survivors want to help each other” by sharing their stories of survival.

Helping clients recover

Safety first: A counselor working with someone who is experiencing domestic violence must make the client’s safety and well-being of the utmost importance.

Understand that simply giving your business card to an abuse victim can put that person in danger should an overcontrolling spouse or partner see the card and lash out in anger, Bride warns.

Safety should also be a counselor’s first and foremost consideration when choosing interventions to use with a client, says Murray. For example, counselors should use caution when working on assertiveness with a client who is still in a relationship with his or her abuser. If a client were to go home and try being more assertive with his or her partner, that action might spark more abuse, she points out.

Counselors should create and talk through a safety plan with their clients. This intervention can be done with children and adults, victims and perpetrators. For victims of intimate partner abuse, a safety plan might include keeping an extra house key and change of clothes in the car in case their spouse or partner throws them out during an argument. For perpetrators, safety planning might include learning to recognize the need to cool off or “take a time out” during an argument — and understanding that doesn’t mean going to a bar or driving down the highway at 90 mph, Bride says.

Murray recommends the Safety Strategies website (DVsafetyplanning.org), created by the Family Violence Research Group in the UNCG Department of Counseling and Educational Development, as a resource for counselors looking to create safety plans with clients.

Treading gently: A client who has been involved in abuse has been traumatized, and discussions about the abusive situation can trigger PTSD-like symptoms, Murray says. Counselors should talk through the client’s emotions, use trauma-informed care and allow the client to control the pace of therapy.

In addition, counselors must guard against judging these clients or even coming across as judgmental, Murray says. “Make sure as a counselor [that] you’re not restigmatizing your client. You never want them to get the impression that it’s their fault,” she says.

Victims or survivors of intimate partner abuse will talk about that abuse only when they are ready, Bride adds. Because they have navigated within a climate of abuse, they know when it is “safe” for them to talk about that abuse and when it is not, she says.

Assessment: Counselors shouldn’t just ask, ‘Have you ever been abused?’ because clients may have different perceptions of abuse, Murray says. Instead, she recommends asking more behavior-specific questions: Has your partner ever called you names? Who makes the decisions in the relationship? Does your partner check up on you? Have you ever been injured in a fight with your partner?

A holistic approach: Be aware that all aspects of the client’s life — from physical and mental health to parenting, finances and housing — can be affected by abuse. Look at all these areas of the person’s life that have been influenced and talk about what the client’s goals are, Murray says. Help them work toward recreating their life to “build back a sense of self-worth,” she says.

Counselors can also help clients learn coping mechanisms to deal with co-parenting children with an abusive ex-spouse or returning to the dating scene after an abusive relationship.

An interdisciplinary approach: Step out of the “counseling box” to work with other agencies in your community, Murray advises. The individuals interviewed for this article agreed that counselors should become knowledgeable about the domestic violence services in their areas, including abuse hotlines, shelters, school resource officers, women’s clinics, victim advocate organizations, support groups and so on. Also touch base and network with other professionals in your community, such as law enforcement personnel and social workers, who have frequent contact with victims of abuse.

Counselors should also learn the basics regarding how a client would file a police report or restraining order. Counselors — especially child and family counselors — should also know how and when to file a report of child endangerment with their state’s department of child services.

Storytelling and self-care: In talking with abuse survivors for their “See the Triumph” project (seethetriumph.org), Crowe and Murray found that many of these individuals craved the chance to tell their story. Likewise, talking through a client’s story in counseling can help the person to heal and feel validated, Murray says. “Understand that time alone may not determine how salient [a client’s] experience of being abused is,” whether that experience took place one year ago or 20 years ago, she says.

Journaling can be another useful therapy tool, she says, as can trauma-focused approaches such as developing coping resources, dealing with stress, goal-setting, relaxation, self-reflection and self-care. Each of these approaches is about “helping them recreate their own identity on their own terms,” explains Murray.

Social support is another key, especially as it relates to rebuilding relationships with friends or family members who may have been cut off from the client’s life during the period when the abuse was taking place.

Cognitive behavior therapy: Ballantyne recommends talking through these clients’ belief systems, particularly their beliefs about interpersonal issues and relationships. Ask them to describe what they think a healthy relationship looks like. He points out that some clients may have witnessed abuse between their parents and grown up regarding this as “normal,” with aggression or abuse representing the only way to work out problems or resolve issues.

“[Ask], ‘How can we work together to change the way you see relationships?’” Ballantyne says. “You’re encouraging them and planting the seed that they can look at relationships differently. They don’t have to continue the pattern of what they’ve seen [in the past].”

Counselors should also encourage these clients to veer away from thought patterns that are “all or nothing,” he says. Explore the middle ground with them and teach them that they don’t have to operate out of extremes. Ballantyne advises developing strategies to help these clients regulate their feelings, such as learning coping skills that will aid them in calming down and working through their sadness, anger or anxiety in a positive way.

Don’t make assumptions: A common assumption is that it is always the male who is abusing the female in a relationship. “That’s the majority, but … [abuse] happens in all types of situations,” Crowe says. There is added stigma in abusive situations that involve people with disabilities, same-sex couples and members of minority cultures, she adds. When it comes to abuse, it is important that counselors step outside of their typical frame of reference and drop all assumptions, she says.

Factor in trauma: It is unethical and inaccurate to diagnose clients without factoring in their abuse histories, Crowe asserts. Counselors should not label clients as having certain problems without first working through their experiences with abuse, she says.

Treating the family as a whole

In cases of abuse, Ballantyne advocates for treating the family as a whole when possible. He says this allows counselors and other helping professionals to focus on relationship patterns and behaviors and to begin addressing these problem areas more effectively.

Although he says the parents and children should also have individual counseling sessions, he believes that family therapy can be a major source of healing and insight. “[Clients can] learn that they can still be connected and care about mom and dad without following through with some of the negative decisions that the parents made,” he says. “They can be healthy individuals and be different from mom and dad, while still caring about mom and dad.”

Ballantyne begins by assessing the full history of each parent, from legal problems to addiction and mental health histories, to fully understand what they have struggled with and been treated for. “A lot of the time, mom or dad has a history of trauma themselves,” he says. “In a lot of cases, I’m discovering that when they’ve experienced that abuse and never been treated for it [and] never learned healthy ways to find intimacy with others, intimacy has always been something that’s scary and threatening.”

He works to return the couple and, ultimately, the family, to a place of stability. Ballantyne recommends that his clients take classes on parenting, conflict resolution, anger management, communication skills, setting boundaries and recognizing abusive behaviors. “The idea of being able to walk away from each other and cool off, and then come back and talk about what the problem is, is sometimes easier said than done. That can take a lot of practice,” he says.

After working with the entire family, a child that has been in a foster care situation can sometimes return home, Ballantyne says. “Not always,” he says, “but you need to go through the [therapy] process for everyone to figure out what’s in the best interest of the child.”

Working with perpetrators

Working with perpetrators of intimate partner violence can be controversial territory, and it brings its own set of challenges.

“I definitely don’t think this is a population that counselors should really work with unless they understand the dynamics of family violence,” Murray says. Crowe and Murray recommend that counselors who are not trained specifically to work with domestic violence perpetrators refer those clients to a specialized treatment program.

Bride ran a program for male batterers that was the first of its kind in her area of New Jersey. The group contained both self-referred members and court-referred participants. She used a process-oriented model that carried an expectation of change in the group’s participants.

Getting the men to take full responsibility for the abuse they had inflicted was paramount. “Getting him to admit his behavior, how bad it was and how hurtful it was, that’s where we had to move him,” Bride says.

Each week, the group leaders, who were specially trained counselors, would ask each participant why he was there. At first, Bride says, the answer was often, “The judge sent me.” Eventually, however, the group leaders weren’t the only ones saying that answer wasn’t sufficient; fellow group members wouldn’t stand for it either. “That was the cohesion, the power of the group,” Bride says.

Even so, she says it took six months — the full length of the program — before some participants could acknowledge the worst of their behavior. “Behavior was the first thing that would change. It takes a lot longer to change attitudes,” she says. “Our hope was that we could actually move the men to a place of empathy. And some of them made it.”

Another technique Bride used was to have group members write letters to the person they had abused, acknowledging their behavior and that it was hurtful. The letters were never sent but rather read aloud in group as an exercise, with members giving each other input.

Safety planning and self-care are also important to work on with perpetrators of abuse, Bride says. They need to learn the warning signs of anger and how to cool down, deal with their anger effectively and have a healthy conversation with their spouse, she says.

In her batterers group, Bride had members work to figure out what triggered their anger so they could learn to control it better. Group leaders had members talk about one of the more recent times their anger had gotten out of control. The group would then “hit the rewind button,” Bride says, and talk through the incident to figure out when and why the perpetrator had gotten so angry.

“How do you know you’re angry? Do you only know when you’re screaming? The minute you know that the discussion has escalated, you have to take a time-out and walk away,” Bride counseled her group members. Part of each group member’s safety plan involved a protocol for taking a time-out, such as ducking into the garage to tinker or going to the gym for a workout.

Being able to talk through what stresses them and then work through those stresses are essential skills for men who are prone to violence, Bride says. “It’s very easy to get men to talk the talk, but you have to get underneath to the pain … and move past being the blamer,” she says. “A lot of men talk about how they stuff [internalize] their anger until it’s an explosion.”

Do no harm

Exposure to domestic violence is more prevalent among their clients than many counselors realize, and Murray says many counselors are ill-equipped and undertrained to deal with the issue properly. “Personally, I would like to see a lot more training on this topic within the profession,” says Murray.

Crowe encourages counselors to look for workshops on domestic or family violence to continue their professional development, especially if they didn’t take a class on the topic in their master’s programs.

Counselors who are undertrained may not know how to talk about abuse with a client or may fail to recognize it altogether, which can be very dangerous, Murray says.

“You can do a lot of damage if you don’t understand [domestic violence],” she says, “and you can do a lot of good if you do.”

 

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Myths of abuse

Counselors need to advocate for victims and survivors of domestic violence and expose some of the myths that are prevalent in society at large, says Nancymarie Bride, a New Jersey-based licensed professional counselor and certified clinical mental health counselor who specializes in working in domestic violence.

 

Myth: Domestic abuse is caused by alcohol or drug abuse or addiction, and going through Alcoholics Anonymous or another rehabilitation program will fix the problem.

Reality: Domestic abuse is an issue separate from addiction. In some cases, domestic abuse may even increase when the perpetrator gets sober, Bride says.

 

Myth: Psychopathology, or mental illness, is to blame for domestic violence. The abuser is “not in his right mind,” under extreme stress or mentally ill.

Reality: This is not always the case, Bride says. “When you look at the pattern of domestic violence, [the perpetrator] believes he has the right to control his partner,” she says.

 

Myth: Battering and abuse do not occur in upper-middle-class families.

Reality: “That’s simply not true,” Bride says. Abuse occurs across all demographics.

 

Myth: The abuse was provoked or the victim “brought it upon herself.”

Reality: A victim does not enjoy the abuse and would not provoke it, Bride says.

 

Myth: Abuse is temporary, occurring only during an abuser’s lapse of control.

Reality: In fact, batterers are often very deliberate, Bride says, carefully inflicting physical or mental wounds on their victims in ways that won’t be seen or noticed by others. “The abuser often has an unbelievable ability to choose the time and place of his attack,” Bride says. “It’s sometimes planned.”

 

Myth: The victim is staying in an abusive relationship because she or he wants to. The person could leave at any time if she or he chose to.

Reality: Leaving an abusive relationship is the most dangerous time for the victim, Bride says. It is important for counselors to understand that victims of domestic violence will leave only when they feel it is safe to do so.

 

Myth: What happens behind closed doors is private. Society shouldn’t interfere with family dynamics and problems.

Reality: This myth only makes it harder for victims to realize they are not responsible for what is happening. Bride draws the following parallel: There is no difference between getting angry and shoving someone you just got in a fender bender with and doing the same thing to your spouse at home. Both are assault, Bride says.

 

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See the Triumph

Learn more about Christine Murray and Allison Crowe’s “See the Triumph” research project and social media campaign created to address intimate partner violence in a related article posted on CT Online: wp.me/p2BxKN-3qo

 

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Bethany Bray is a staff writer for Counseling Today. She can be reached at bbray@counseling.org

Letters to the editor: CT@counseling.org

1 Comment

  1. Ray

    Ya I stopped reading after this person wrote” they feel like damaged goods , but we help them fell and believe their hope.”Oh and soon after that this person wrote” they won’t bring it up on their own we the ones to bring it up for they feel they need to meet in secret”

    Reply

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