Tag Archives: domestic violence

The relationship as client

By Laurie Meyers September 22, 2016

Among the most common difficulties that bring couples to counseling are infidelity, financial problems, sex and intimacy issues, parenting challenges and ongoing tensions with the in-laws. Each of these problems has its own unique characteristics, but according to couples counselors, they tend to share a similar root cause — namely, lack of communication. The challenge for couples counselors (and their clients) is to identify how communication went awry — or if it ever truly existed in the first place — and then work to reestablish it.

Couples counseling is fundamentally different from individual counseling, says Paul Peluso, past president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

“Too often, counselors think that couples counseling is ‘individual counseling times two,’ and they conduct individual counseling with each person, while the other partner observes,” Peluso says. “That really isn’t couples counseling. Instead, with couples counseling, you have not just branding-images_inkhearttwo perspectives in the room that you have to balance, but you have the … relationship that you are working with. In fact, it is the couple’s relationship that technically is your client, not the individuals in the couple.”

Having a relationship as the client instead of an individual makes it much more challenging to build a therapeutic alliance, says Barbara Mahaffey, a licensed professional clinical counselor and ACA member who practices in Chillicothe, Ohio. The relationship is not just an entity, but rather two separate people who have different thresholds for opening up and trusting, she explains. Couples also come in with different goals and expectations. Mahaffey, who specializes in counseling couples and families, says her task as a counselor is not just to address these goals and expectations, but to help the couple discover how they can reconcile their personal expectations and establish new goals that will allow them to move forward as partners.

“Couples will come in and want to fight over who is right and who is wrong in the relationship,” Peluso says. “It is the couples therapist who has to sell the idea that no one is wholly ‘right’ or wholly ‘wrong.’ Paradoxically, neither is to blame and both are to blame — in the technical sense — for the state of the relationship at the same time. Both have played a role in setting up the conditions for the relationship. So the focus is on how each person’s behavior and reactions to [the] other affect the couple’s relationship. If each person wants to be in the relationship, then they have to take responsibility for how their behavior impacts the health of the relationship. And this is very different than individual counseling.”

Confronting infidelity

Unfortunately, the catalyst that most often pushes couples into a counselor’s office is also one of the most difficult issues to move past.

“The single most common issue that brings couples into therapy is infidelity,” says Peluso, a licensed marriage and family therapist (LMFT) who has written several books about both infidelity and couples counseling. “Over the last 20 years, researchers have demonstrated that this is the most common presenting concern, and if it is not revealed initially, it is often disclosed in the course of couples therapy. Infidelity can take many forms, from sexual to nonphysical intimacy, and it now includes relationships online.”

“In terms of who cheats, researchers have found that women are just as likely as men to participate in infidelity,” Peluso continues. “As a result, practitioners have to know how to deal with the complex and often devastating issues that accompany infidelity. Unfortunately, when couples counselors are asked about it, they overwhelmingly say that it is the topic they feel least prepared to treat.”

Amber Lange, a licensed professional counselor who owns and practices at Bedford Health, a group practice in Lambertville, Michigan, can attest to the high demand for infidelity counseling. Her practice has become known for specializing in issues surrounding infidelity and betrayal. Initially, the sheer need for counselors knowledgeable about and willing to tackle this particular relationship threat astounded her. “I’ll never be out of a job [as an infidelity specialist],” she says ruefully.

Among couples for whom the act of infidelity is fresh, the nonoffending partner is typically experiencing acute stress and may even have symptoms that resemble posttraumatic stress disorder, Lange says. The offending partner, on the other hand, is typically feeling beaten down because he or she has repeatedly been asked blunt questions that shine a direct light on his or her indiscretions: What did you do? Where? How much money did you spend?

In cases in which the infidelity is years in the past, the core counseling issue more often involves a lingering lack of trust, Lange says. “The nonoffending partner [may have] forgiven the offending partner, but they have never rebuilt trust,” she explains. “So the nonoffending partner is hypervigilant about trust and the [possibility of the] offending partner reoffending.”

If the act of infidelity is recent, Lange helps the couple work through their “why, who, where, how” stage. “I talk about the idea of how you can’t ‘unknow’ something once you know it,” says Lange, a professor of counseling at Capella University. “There’s a lot of knowledge that you can gain that may further traumatize you, such as the sexual positions that your partner was in with someone else.”

Clients may also wonder if their partner did things with another person that the nonoffending partner refused to do. If this information is disclosed, Lange explains, it can lead the nonoffending partner to do things he or she is uncomfortable with in an attempt to please the offending partner.

Instead of attempting to get answers to questions that can further damage the relationship, Lange encourages the nonoffending partner to ask structured questions such as: When did you start having sex? When did you stop? Did you have unprotected sex? These types of questions provide information that the nonoffending partner needs to know, Lange says.

The next phase of Lange’s therapeutic approach involves narrative therapy. As part of this stage, Lange might ask couples who delayed getting therapy after the infidelity to briefly touch on information about the affair as a way to see if there are lingering questions. This process also helps Lange to assess the strength of the couple’s bond.

The story of ‘us’

Regardless of whether the couple is confronting a recent infidelity or the infidelity happened years in the past, constructing the story of their relationship represents the core of the healing process, according to Lange. Couples build the narrative to gain a clearer understanding of how and when the cracks in their relationship developed, she explains. They talk about the beginning of their relationship and explore how they interacted. Were they friends and true partners? What happened that started pulling them apart?

“Life” — deaths, births, work, money and so on — is usually the answer to that second question, Lange says. In addition, people typically change over time, which further alters the nature of the relationship, she notes. All of these factors in combination can make a relationship vulnerable to disruption. Add in misperceptions and unmet expectations, and once tiny relationship fissures can turn into large cracks that cause couples to drift apart.

Among the most common life events that can start to pull some relationships apart is the birth of a child, Lange says. “Before the birth, couples were able to spend all their time and energy and money on each other. After the birth of a child, ideally, you love that child and invest all of that [time, energy and money] in parenting and child rearing — which is not bad, but [couples] come into my office, and they haven’t been on a date in three years.”

In addition to not making time for the romantic relationship, the couple may be trapped in patterns that are actively pulling them apart, Lange says. “You’ve been great parents, but the mother is staying home or working and raising kids at the same time, the father is working and overworking to pay for the mortgage and save for retirement — those kinds of things can hurt a relationship,” she says.

When a couple stops talking to each other, it creates a gap, and it is tempting to fill that gap with other people or activities, Lange notes. Partners may begin to betray each other in different ways, whether it is spending time on social media instead of with each other, watching pornography or working long hours, she says. “In the process, we’ve let the relationship go awry,” Lange observes.

But this risk of unraveling is not exclusive to couples with children. Those who get married or enter into domestic partnerships too quickly upon meeting or when they are very young are also particularly vulnerable, Lange says. For example, those who form romantic relationships in their teens or early 20s are in the midst of experiencing significant personal development. This may not happen at the same rate for both partners, eventually leaving them feeling as if they don’t know each other, Lange explains. Likewise, people who get married or form a domestic partnership in the matter of a few weeks have not typically had enough time to establish a strong base of friendship. Over time, it’s not uncommon for them to realize that they don’t even like each other, Lange says.

Lange asks clients not to make a decision about whether to stay together until after they have gone through the process of identifying what went wrong. Then, if they choose to stay together, Lange helps them start to discuss how to protect the relationship going forward. This typically includes setting aside time to talk with each other more frequently, being intentional about making time for dates and even going on vacations without the kids. But it also involves each partner identifying the behaviors in which he or she engages that play a role in pulling the relationship apart.

For example, Lange recounts something that a client recently shared. “One of the things that I have recognized about myself over the past six months is that I tend to withdraw,” the client told her. “When my partner and I got into an argument, I went away, slept in the kids’ room and wouldn’t talk. I would work 85 hours a week. Even when I wasn’t in the office, I was checking my email.”

In essence, Lange says, the client just wasn’t “there” in the relationship. Other people do the same thing by burying themselves in hobbies such as sports or scrapbooking. As a result, they end up spending more time with friends or with hobbies than they do with their partner and family, Lange says.

The process of building the couple’s story in counseling and finding the cracks and vulnerabilities is a long one. For the first four to six weeks, when a couple is still going through the initial trauma phase of the infidelity, Lange has them come to counseling every week. Once a couple moves on to the storytelling stage, she has them come to counseling only about once per month, in part because she feels that much of the processing and healing needs to take place between sessions as the couple slowly rebuilds the relationship.

“They have to have time to figure out things … how to be in relationship, how to recreate their friendship and how to build [new] good memories,” Lange says. During the process of rebuilding the relationship, trust is also being reestablished and forgiveness is being granted. Then the couple can move forward, she explains.

Ideally, the couple will also identify potential problem areas and reach compromises on how to address those issues. For example: “You say I can’t work 90 hours a week, but we need money, so how are we going to figure that out? … This is [our] story. Here’s the way we go forward. Here’s what we need to do.”

Symptom vs. problem

Brian Canfield, a past president of ACA, also says that infidelity is the event that most commonly brings couples into his office. But he believes infidelity is always indicative of other underlying problems in the marriage or relationship.

“I view an affair not as the problem but as a symptom,” he says. “An affair is like malarial fever. It’s uncomfortable, but it’s not the fever itself that’s going to kill you — it’s the disease.”

Canfield believes that if a counselor addresses the underlying issue first, it will help to stabilize the couple, which will then allow them to deal with the ramifications of the infidelity. “You [the counselor] have to assess if there is a commitment and desire to save the relationship,” says Canfield, an LMFT whose practice has offices in Louisiana, Arkansas and Florida. “Trust and betrayal, that’s not where you put the spotlight. The trust will return once you stabilize the relationship.”

Canfield starts by asking the couple what they want out of the counseling process and their relationship as a whole. “What would you like to see happen? If it is possible to salvage the marriage, would you be willing?” Canfield asks. “A lot of people want to know why [the affair happened], but here is where we are. Where do you want to be? If you were going to redesign marriage, how would it look?”

Canfield says financial difficulties are the most common underlying issue that couples bring into his office. In his experience, there is so much shame surrounding finances that most couples would rather talk about the details of their sex lives than money. He frequently encounters situations with couples in which one partner has been maintaining a hidden bank account or run up the balance on their credit cards without the other partner knowing. He tells couples that part of the counseling process involves full disclosure.

“A lot of couples are in tremendous denial,” Canfield says. “They don’t know how much debt they are in, what their bills are or have a good picture of how much income they are bringing in.”

Sometimes people feel entitled or convince themselves that it’s OK to buy what they want regardless of how it affects their spouse or partner. They tell themselves that they work hard and that they deserve it. Canfield sees part of his role as helping to bring clarity to these situations to encourage better choices.

“The other spouse may say that if this doesn’t change, I will exit the marriage for my own survival. Which circumstances are more important? Keeping the marriage or continuing to spend?” he asks.

Canfield doesn’t try to play the part of financial adviser to couples (although he does recommend that couples seek professional financial advice elsewhere if needed). Instead, he helps couples recognize their need to possess a clear picture of their financial situation and to develop a reasonable budget.

“It’s a matter of priorities and trade-offs,” he says. “The key as a couples counselor is to have the couple work together as a team. Most couples, when they work as a team, can find common ground.”

Canfield emphasizes that as a couples counselor, it’s not up to him to dictate how much a couple will spend on their priorities. Instead, his focus is simply on making sure that they have agreed on a plan going forward.

Once the underlying issues have been addressed, Canfield helps the couple deal with what he calls the “moral disparity” in a relationship in which infidelity has occurred. The nonoffending partner may feel like he or she has the higher moral ground, but to move forward, the couple must try to reach a “mutual amnesty,” Canfield says.

This involves a delicate balance. Canfield tries to make the couple aware that the infidelity occurred because of the underlying problems — to which they both contributed — that were straining the relationship. However, he always makes it clear that it is not the fault of the nonoffending partner that the other partner cheated. Yes, they both contributed to the relationship’s problems, but the offending partner chose to act out by having an affair.

Matters of miscommunication

Mahaffey, an associate professor of human services technology at Ohio University–Chillicothe, finds that relationship difficulties usually involve a significant degree of miscommunication, which is exacerbated by a number of factors. She helps couples understand how communication can get mixed up by explaining the pieces of a “miscommunication model” that she has devised.

Mahaffey starts by asking both partners to list all of the traits they possess that are different from their partner’s traits. She then takes these lists and draws two people facing each other. This represents two people talking, whereas the lists represent their different — and sometimes conflicting — points of view. Mahaffey often also draws a “family rule book” between the two figures. This represents how a person’s family of origin can affect the way he or she interprets interactions with a partner. Mahaffey often asks couples about their family backgrounds and experiences to illustrate the influence of the family of origin.

Mahaffey will then ask both partners to think about all the times they asked for something and didn’t receive what they wanted from their partner. As they voice these details, it’s not unusual for one partner to exclaim, “You never said that!” Typically, the case is not that either partner is lying, Mahaffey says. Rather, it’s that one of the partners has not been phrasing the requests in a way that effectively communicates what he or she needs, Mahaffey explains. She also informs the couple that humans think at about 500 words per minute but cannot speak more than 125 words per minute, meaning there is ample opportunity for the intended message to get lost.

Other complicating factors in communication include different coping styles (such as one member of the couple shutting down verbally or retreating physically or emotionally during times of stress), the fact that women often process information differently than men and the daily anxieties of life, Mahaffey says. For example, it’s hard for a couple to communicate effectively when one or both partners are stressed about finances, work or the car breaking down.

The last part of Mahaffey’s model entails explaining how words themselves — or how people define them — can get in the way. For example, Mahaffey might ask a couple, “What’s the definition of love? Is it that supper is on the table when I come home? Or liking to snuggle? Or texting 60 times a day?”

At this point, Mahaffey has the couple use “I” statements and talk about what needs they feel are being unmet. One partner might say, “I like to have help with housework.” The other partner might note that the request usually comes during a football game or while engaged in something else that he or she enjoys doing. At this point, Mahaffey might ask if the partner would be willing to provide help either before or after the game. This exercise highlights just one example of an area of possible compromise. The larger point is that the couple needs to sit down and talk about what they need from each other and how those needs can be met, Mahaffey says.

Intimate partner violence 

All counselors, but couples counselors in particular, should be looking for signs of intimate partner violence (IPV) among their clients, asserts Ryan Carlson, an ACA member and couples counselor who has done research on screening methods for IPV.

Because IPV is such a prevalent societal problem, all counselors — knowingly or unknowingly — will encounter clients who have experienced or are currently experiencing violence at the hands of their partners, Carlson says. According to data gathered in 2011 and published in 2014 by the Centers for Disease Control and Prevention, more than 1 in 4 women and more than 1 in 10 men in the United States have in their lifetime experienced sexual violence, physical violence or stalking by an intimate partner.

Providing counseling in the presence of such interpersonal violence can be dangerous, not just to the victim but also to the counselor, says Carlson, a licensed mental health counselor practicing in Columbia, South Carolina. That is a primary reason it is important for counselors to be alert to the signs of IPV and to have a protocol to follow should a client be a victim.

Perhaps the most beneficial thing counselors can do is to get connected to the people Carlson calls the “real experts” on this issue — those who work at local domestic violence shelters. “Most of what I have learned [about IPV] has come from domestic violence advocates,” he acknowledges.

Not only can these advocates help counselors assess whether it is safe to work with a couple in which IPV is a reality, but they also stand ready to assist clients who are looking for help, says Carlson, an assistant professor of counselor education at the University of South Carolina.

Carlson says he uses the term IPV because it is more inclusive than domestic violence. There is an IPV continuum, and domestic violence is on the extreme end of the spectrum, representing the most severe cases that involve, as Carlson puts it, “power and control,” as opposed to nonlethal violence or verbal abuse. From Carlson’s perspective, it is not safe to try to conduct counseling in those cases involving power and control.

Carlson advises counselors to use a formal screening tool for IPV at intake but says there are other red flags to look for, including a client’s unwillingness to take responsibility for actions. “Control over finances or transportation is [also a] red flag,” he continues. “Is one partner restricting access to cell phones, finances, the car, who the other partner can interact with? … Look for body language. Does one partner consistently look to the other when they answer questions? Is it permission seeking? Is there inconsistency in their answers? For example, as part of a meeting to determine whether or not a couple would want to participate in a research study I was doing, I asked about income. The husband gave me an answer, but when I met with the wife separately, she said the husband wasn’t really working and that she wasn’t allowed to talk about that.”

This one disparity turned out to be an indication of severe domestic violence. Carlson followed his protocol and was able to get help for the victim.

What does a protocol look like? Carlson says he has a formal memorandum of understanding with the local domestic violence shelter saying he can call at certain hours when he has a need for consultation. The memorandum also states that he will not provide identifying information about the client, only basic relevant information. This includes the presenting problem and any context he feels is important. The consultant can then advise him on whether the couple’s case might be a power-and-control situation. In those instances, Carlson must find a way to offer help to the victim without tipping off the partner who is engaging in the abuse.

With all of the couples Carlson counsels, his regular practice is to meet briefly with each individual separately at the beginning of each session. This is primarily so that he can get each partner’s point of view independently on the difficulties the couple is experiencing, but it also provides him with a chance to provide contact information for the domestic violence shelter if circumstances warrant. Carlson and the partner who is the target of the abuse may even call the shelter together.

In some cases, however, the victim of the abuse is not ready to leave the relationship. Carlson say many counselors may have a hard time relating to that. “We think we need to get the person out of the relationship immediately, but [we] need to do it safely,” he cautions

The victim has typically been living under abusive circumstances for years and may not yet have reached a crisis point, Carlson explains. Again, he uses consultation with his domestic violence resources to help him navigate this terrain. Regardless of whether the victim is ready to leave, Carlson says the average counselor should not try to continue providing services in these power-and-control cases. Telling the couple that he feels this particular modality will not work for them has proved to be a successful way of terminating treatment without escalating the problem of abuse, he says.

Lynn Linde, senior director of the ACA Center for Counseling Practice, Policy and Research, adds the caveat that counselors should make sure their states do not require them to report suspected cases of IPV under mandated reporting laws.

There are IPV cases for which Carlson thinks couples counselors are qualified to help. These involve lower lethality or “situational couple violence” (as opposed to one partner begin generally aggressive outside of the relationship as well). In such instances, a couple’s arguments may get out of hand and they may engage in behaviors such as pushing or throwing things at each other. “This can be dangerous, but it’s not as dangerous as choking or using a weapon,” Carlson says. However, he says, it is important for the couple to acknowledge that this behavior is unhealthy and to show a willingness to learn more appropriate ways to interact. It’s also essential that neither partner is afraid of the other, Carlson stresses.

In contrast, partners who engage in power-and-control tactics usually show little or no remorse and may exhibit antisocial-type behavior, Carlson explains. In fact, he says, studies have shown that when engaging in the abuse, these types of offenders typically experience a drop in heart rate rather than an escalating heart rate that is typically associated with anxiety over one’s situation or actions. Carlson also notes that whereas research indicates that men are almost always the perpetrators of power-and-control types of IPV, situational IPV is gender neutral.

None of this information constitutes a foolproof method for deciding whether it is safe for a counselor to work with a couple with a history of IPV. That’s why Carlson continues to do research on screening methods that are better at identifying the presence of violence among couples and where on the spectrum of severity that violence falls.

“Getting it wrong can be very dangerous,” Carlson concludes.

Counseling LGBTQ couples

Although the issues that bring lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) couples into counseling are generally the same as those that affect heterosexual couples, the legalization of same-sex marriage has raised some issues unique to LGBTQ relationships, say counselors who work with this population.

“There is a tremendous validation both from the legal system and from society upon their relationships,” says John T. Super, an LMFT who is also a clinical assistant professor of counselor education at the University of Florida. “This validation can provide an emotional confidence or boost surrounding a same-sex relationship that lessens the perceived stigmatization that has occurred. Additionally, since the Supreme Court decision [legalizing same-sex marriage], we have seen a large number of those in long-term relationships choosing to marry and report feeling equality to traditional marriages.”

Although the Supreme Court’s decision is a huge advancement for the LGBTQ community and has given many couples the opportunity for which they have long waited, actually getting married has not been absent of negative consequences for some couples, says Super, a member of ACA. “Clients have explained [that] when they announced their marriage … it was in many ways similar to the coming-out process in that those who are choosing to marry and are in same-sex relationships may face resistance from friends and family as they legalize the relationship,” he explains. “I have heard clients say that their friends and family accepted their relationship, but when they choose to marry, the thought of the same-sex couple entering into a legal marriage is a line the friends or family are not comfortable crossing.”

Counselors have an important role in helping same-sex couples navigate the resistance they may face when they decide to get married, agrees Joy Whitman, a past president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. Amidst the joy of getting married, there may be feelings of hurt and loss from being rejected all over again by certain individuals or segments of society, she says. Counselors can help couples grieve and process this loss.

According to Whitman, who previously worked as a couples counselor, marriage can also exacerbate a common problem in same-sex relationships: unequal comfort levels with being “out.” Marriage can make the partner who is less “out” feel especially vulnerable, she explains.

Counselors should also be aware that for the first time, LGBTQ couples are facing divorce, Whitman says. Not only is this a new experience, but the need in many cases to stand up in court and disclose intimate relationship details can be particularly disconcerting for clients in same-sex relationships, she says.

Super and Whitman also note that counselors need to be aware of the generation gap among different LGBTQ couples. “Couples who are in their 20s experienced a very different level of social acceptance than couples in their 50s or older,” Super points out. “This generational difference can be important to understand when determining the levels of internalized oppression the individual or couple has experienced.”

Despite these issues and other issues that are specific to the LGBTQ community, Super and Whitman emphasize that couples counseling is couples counseling. Peluso, an associate professor of counselor education at Florida Atlantic University, agrees.

“In many respects, the practice of couples counseling shouldn’t change that much,” he says. “Focusing on the relationship means taking the relationship as it is created by the partners involved. The only judgment that the couples counselor is making is, ‘Is this healthy for you right now?’ and then seeing how the couple can change that. That is fairly universal.”

 

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Additional resources

To learn more about the topics addressed in this article, see the following select resources offered by the American Counseling Association.

 

Books (counseling.org/bookstore)

Podcasts (counseling.org/continuing-education/podcasts)

  • “Love and Sex and Relationships” with Erica Goodstone

Webinars (counseling.org/continuing-education/webinars)

  • “Crazy Love: Dealing With Your Partner’s Problem Personality” with W. Brad Johnson
  • “The Secrets to Surviving Infidelity” with Scott Halzman

VISTAS Online articles (counseling.org/continuing-education/vistas)

  • “Five Counseling Techniques for Increasing Attachment, Intimacy and Sexual Functioning in Couples” by Elisabeth D. Bennett, Jaleh Davari, Jeanette Perales, Annette Perales, Brock Sumner, Gurpreet Gill & Tin Weng Mak
  • “Helping Couples Reconnect: Developing Relational Competencies and Expanding Worldviews Using the Enneagram Personality Typology” by Thelma Duffey & Shane Haberstroh
  • “Loving Kindness Meditation and Couples Therapy: Healing After an Infidelity” by Laura Cunningham & Yuleisy Cardoso
  • “Supporting Same-Sex Couples in the Decision to Start a Family” by Debbie C. Sturm, Erika Metzler Sawin & Anne L. Metz
  • “Working With Intercultural Couples and Families: Exploring Cultural Dissonance to Identify Transformative Opportunities” by Cheryl L. Crippen
  • “Working With Sexual Addictions in Couples Therapy” by Sara L. Wood

Practice Briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling Couples With a Trauma History” by Catherine J. Brack & Greg Brack

ACA Divisions

  • The International Association of Marriage and Family Counselors helps develop healthy family systems through prevention, education and therapy (see iamfconline.org).
  • The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling seeks to promote greater awareness and understanding of LGBT issues and improve standards and delivery of counseling services provided to LGBT clients and communities (see algbtic.org).

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

The toll of childhood trauma

By Laurie Meyers June 23, 2014

Little-girl_brandingMention the word trauma to Americans in the 21st century, and their thoughts are likely to turn to images of terrorism, war, natural disasters and a seemingly continual stream of school shootings. The horrific scenes at Newtown and Columbine still dominate public consciousness, particularly when our society discusses child trauma. While those events make headlines, however, counseling professionals say the most pervasive traumatic threat to children is found not in big events or stranger danger, but in chronic and systemic violence that happens in or close to the home.

This kind of ongoing trauma, much of which takes place out of public view, leaves deep scars that can cause a lifetime of emotional, mental, physical and social dysfunction if left untreated. Research shows that chronic, complex trauma can even rewire a child’s brain, leading to cognitive and developmental issues.

The good news is that counselors in all areas of practice — in schools, agencies, shelters, clinics, private practice and elsewhere — can and are working with children and, when possible, their parents to stop the cycle of violence, or at least to mitigate its effects.

Behind closed doors

The number of children exposed to violence in the United States is staggering. According to the National Survey of Children’s Exposure to Violence (NatSCEV), funded by the U.S. Department of Justice and the Centers for Disease Control and Prevention (CDC) and carried out by the University of New Hampshire’s Crimes against Children Research Center, more than 60 percent of children surveyed had been exposed to direct or indirect violence during the 12 months prior to the survey. Nearly half — 46.3 percent — had been assaulted at least once in the past year, meaning they had experienced one or more of the following: any physical assault, assault with a weapon, assault with injury, attempted assault, attempted or completed kidnapping, assault by a brother or sister, assault by another child or adolescent, nonsexual genital assault, dating violence, bias attacks or threats. One in 10 had experienced some form of maltreatment, which includes nonsexual physical abuse, psychological or emotional abuse, child neglect and custodial interference. Other CDC research indicates that 1 in 4 girls and 1 in 6 boys are victims of sexual abuse. However, many experts emphasize that due to the stigma involved, sexual abuse is underreported.

Significant exposure to violence and trauma can also lead to illness later in life. From 1995-1997, the CDC, in collaboration with Kaiser Permanente, collected detailed medical information from 17,000 patients at Kaiser’s Health Appraisal Clinic in San Diego. These patients also answered detailed questions about childhood experiences of abuse, neglect and family dysfunction. The initial study, Adverse Childhood Experiences, as well as more than 50 studies since using the same population, found that adult survivors of childhood abuse are more likely to develop chronic conditions and diseases such as heart disease, obesity, cancer, chronic obstructive pulmonary disease and liver disease. They are also more likely to engage in risky health behaviors such as smoking and drug and alcohol abuse. In addition, adult survivors of child abuse may have autobiographical memory problems; exhibit increased problems with depression, anxiety and other mental illnesses; and struggle with suicidal tendencies.

NatSCEV data, collected between January and May 2008, indicate that one in 10 children surveyed experienced five or more incidents of direct violence. It is this kind of ongoing abuse that can cause polyvictimization, or what many researchers call complex trauma — repeated exposure to traumatic events over time and often at the hands of caregivers or other loved ones.

“This cumulative trauma has much more serious effects than a single event,” says David Lawson, a licensed professional counselor (LPC) and licensed marriage and family therapist in Nacogdoches, Texas, who has worked with victims and perpetrators of sexual and domestic abuse since the 1980s. Because the abuse is ongoing, it disrupts a child’s sense of security, safety and self and alters the way he or she sees others, explains Lawson, an American Counseling Association member who is also a researcher and professor in the school psychology and counseling program at Stephen F. Austin State University in Nacogdoches.

“In childhood, attachments are still forming, and abuse can shatter this developing ability,” says Jennifer Baggerly, an ACA member, LPC and play therapist who studies child trauma intervention. “It can also distort their forming personality and the way they interact with people as a whole.” This distortion can cause the child to believe that the world is an unsafe place and that people aren’t trustworthy, adds Baggerly, an associate professor and chair of the Department of Counseling and Human Services at the University of North Texas at Dallas.

That pattern of uncertainty and instability can cause cognitive distortion, dissociation and problems with emotional self-regulation and relationship formation, and even alter a child’s brain structure, notes Lawson, the author of Family Violence: Explanations and Evidence-Based Clinical Practice, published by ACA in 2013.

“Children get stuck in flight or fight,” adds Baggerly. “Everything is a threat, so instead of strengthening the prefrontal cortex, the brain operates more from the limbic system, which causes them to be more hypervigilant.”

Because they are almost constantly on alert, these children and adolescents most of the time use what Lawson calls their “survival brain” instead of their “learning brain.” Childhood and adolescence are periods in which the brain is developing rapidly and crucial cognitive skills are being learned. If children and adolescents spend too much time in survival mode, they are not accessing areas in the brain that are responsible for learning developmentally appropriate cognitive skills and laying down the neural pathways that are critical to future learning.

“As the child gets older, this chronic hypervigilance — and the overload of cortisol that comes with it — completely remaps the brain and just stifles development,” says Gail Roaten, president-elect of the Association for Child and Adolescent Counseling, a division of ACA. “You see them lose ground cognitively, especially in their ability to learn.”

Support and stability

Traumatized children’s problems with cognition, learning, self-regulation and development can last a lifetime, making it more likely that they will continue the cycle of abuse in their relationships, abuse drugs and alcohol, have trouble finding and keeping jobs or end up in the criminal justice system. Adults who were traumatized as children also are much more likely to face a host of physical and mental health problems.

The situation is far from hopeless, however. Counseling interventions for trauma can make a dramatic difference, and the earlier a child starts receiving therapy, the better. A variety of techniques have proved to be effective, but interventions are most successful when a supportive environment is created, Lawson emphasizes. Whenever possible, a parent or parents should be participants in a child’s therapy (as long as they are not the perpetrators of the abuse), and if not the biological parents, then foster parents or grandparents.

“I try to bring in whoever can help build a support system for the child,” Lawson says, “because an hour a week [of counseling] is woefully inadequate, and I need to have them able to take what they learn in therapy into the home.”

In many cases, parents or caregivers need help learning how to support the abused child emotionally, he says. When parents come to sessions with their children, the counselor can help the parents learn not just the best way to support the child in therapy, but also how to strengthen their parenting skills.

“We really emphasize connection,” Lawson says. “Once they [abused children] have attachment, they may be ready to tell parents about their abuse and may just blurt it out at home. I try to prepare parents to listen to the child. If the parents are not comfortable addressing this [topic], I have them at least write down what the child says and then use that as a therapeutic prompt.”

In sessions, Lawson guides parents, teaching them how to interact and better bond with children who have been traumatized. Some parents and caregivers have never really learned how to play with their children, he says.

At the same time, he notes that learning positive interaction skills is not just about the fun stuff. Parents and caregivers also need to know how to effectively discipline the child. “Many times when parents find out that their child has been abused, they are hesitant to discipline or correct behavior because they feel sorry for them,” he says. “Or they come down too hard.”

Lawson encourages parents to use time-outs, to not respond when a child is acting out with attention-getting behavior and to not use corporal punishment.

In the absence of parents or other supportive adults, the counselor may become the stabilizing adult in a traumatized child’s life. Although the counselor is not with the child as often as a parent or caregiver would be, just having someone who is concerned and will listen to whatever the child wants to say can be enough for an abused child to start to heal, Lawson says, even if he or she never chooses to talk about the abuse. He notes that even in the absence of other supportive figures, the therapeutic bond between counselor and child can help in decreasing hyperarousal.

Counselors need to know that although it may seem best to address the child’s trauma right away, establishing and cementing the therapeutic relationship must come first, Lawson says. The child needs to feel safe and supported — even if it is only in the counselor’s office — before he or she can begin to process the trauma.

“You’re trying to get them in a safe place if possible, or at least a predictable place,” Lawson says. “Then we can start teaching them how to cope [with the trauma] without lashing out or
avoiding it.”

Abused children do not know how to cope with what they are experiencing, Lawson says. It is common for children who are traumatized to lash out in anger when stressed and to feel that the best way to establish some sort of stability in their lives is to try to control everything. They may be moody, irritable or withdrawn. Abused children may also bully and hit other children or turn their anger on themselves and engage in self-abusive behaviors such as cutting.

Once a child feels supported, the counselor can also begin to teach the child how to self-soothe. Lawson guides traumatized children in using calming techniques such as diaphragmatic breathing or grounding themselves by focusing on something external such as the ticking of the clock or the texture of their clothes. “The point is to experience emotions in a safe place and cut out bad coping behaviors,” he says.

Safety first

Jennifer Foster, an assistant professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University, studies child sexual abuse. Much of her research has involved listening to the narratives of abuse victims and how they perceive what has happened to them. Although these children display myriad reactions and emotions, Foster says two themes are always prominent: fear and safety.

“Child victims of sexual abuse often view the world as unsafe and are likely to enter counseling with unresolved fears,” Foster says. “They need help from their counselor to learn how to cope with their fears.”

“Although adults often see disclosure as a positive thing that will put an end to the abuse, for many children it is embarrassing and frightening, especially for those who feel at fault for their abuse and believe they will be blamed or, worse, not believed,” says Foster, who studied the experiences of sexually abused children for her dissertation.

Several counseling interventions are designed to help sexually abused children regain a sense of safety. One is called the “safe place technique,” in which a counselor guides the child in visualizing and vividly describing an imaginary safe place.

“The counselor may say, ‘Close your eyes and picture a special place where you feel completely safe,’” Foster explains. “This can be followed by specific questions to capture additional details such as: What do you see? What do you hear? What do you feel? What are you doing in your safe place? The details are recorded by the counselor and used to create a script.”

Once the safe place has been established, the child can return to it mentally anytime he or she feels stressed or scared, Foster says.

Another intervention called the “comfort kit,” developed by Liana Lowenstein, helps children who engage in nonsuicidal self-injury to learn self-soothing strategies, says Foster. “Counselors help children brainstorm and create a list of items that bring them comfort and make them feel better,” she explains. “Although the process is guided by the counselor, children are the ones who choose what will go inside their box or bag.”

Foster says children commonly include items such as a blanket, music, a favorite stuffed animal, written or recorded guided imagery, a stress ball, a list of relaxation activities, bubbles (for deep breathing exercises), a favorite book, a picture of a caring person or special place, a journal and pen, art supplies and a list of self-affirmations.

Foster is also a proponent of bibliotherapy. “Children’s books about sexual abuse can introduce child victims to others who have had similar experiences, which may lead to decreased feelings of isolation and normalize their trauma-related symptoms,” she says.

Books can also provide comfort, offer coping suggestions and teach kids important lessons such as that the abuse is not their fault, Foster adds.

Because fear is a predominant issue for child victims of sexual abuse, Foster also recommends stories that specifically address feeling afraid. Her suggestions include Once Upon a Time: Therapeutic Stories That Teach and Heal by Nancy Davis and A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma by Margaret Holmes. To help older adolescents explore their memories and feelings connected to sexual abuse, Foster recommends The Secret: Art & Healing from Sexual Abuse by Francie Lyshak-Stelzer. Foster notes that the author’s artwork is particularly effective at capturing fear and the myriad other feelings generated by abuse.

Finding relief through play

Play therapy is one of the most commonly used interventions with children, particularly those who have suffered complex trauma, meaning they have experienced long-term (and often multiple types of) abuse, says Roaten, an LPC who works with traumatized children in clinics and schools, and an associate professor at Hardin-Simmons University in Abilene, Texas.

Most therapeutic playrooms feature a fairly specific set of toys that might include an art center, play dough, a Bobo doll (an inflatable plastic doll modeled after the inflatable clown used in Alfred Bandura’s seminal study on children and aggression), a dollhouse with miniature people, animal figures, toy weapons, costumes and a sandbox. These toys and activities help children to act out their experiences in a safe and less negative manner, Roaten says. For instance, she recounts treating one child who “would just attack and slash the doll where the penis was. She was a victim of sexual abuse.”

In some cases, Roaten says, children just “play through,” processing their trauma entirely through play without needing to talk to the play therapist.

In many instances, Baggerly says, traumatized children act out things they aren’t able to verbalize. She once treated a 6-year-old who didn’t speak for about 10 sessions because the girl had a severe case of internalized anxiety and depression. But as the girl played, she would express her rage by taking a gun and shooting the Bobo doll in the head, stomach and groin area. Baggerly took this cue as a chance to ask the child about the anger and hurt she was feeling.

Catherine Tucker, a licensed mental health counselor who works with traumatized children in her role as a counselor supervisor and consultant, uses a child and family therapy called Theraplay, which was developed by the Theraplay Institute in the 1960s. “Theraplay works on a four-dimensional model: structure, nurture, engagement and challenge,” says Tucker, an associate professor in the college of education at Indiana State University.

Theraplay builds and enhances attachment, self-esteem, trust in others and engagement through participation in simple games. The idea is that the four dimensions — structure, nurture, engagement and challenge — are needed by children for healthy emotional and psychological development. The “play” in Theraplay is built around activities that teach participants what the elements of those dimensions are. Ideally, children engage in Theraplay with their parents or caregivers. Participating together teaches skills to parents or caregivers who don’t know how to provide the four dimensions, while enhancing the bond with the child. In the absence of parents or caregivers — whether because they are abusive or because they cannot or do not want to participate — the counselor plays directly with the child so the child can still learn how to interact in an emotionally healthy way.

The games and activities are simple — suitable for children as young as 1, yet still engaging for older children — and include things such as blowing bubbles, playing with stuffed animals, cotton ball hockey, cotton ball wars and newspaper basketball. The activities teach parenting skills and also help traumatized children with affect regulation, impulse control, feeling safe and not feeling like they have to be in control of the world, Tucker says. She notes that, oftentimes, kids who have suffered trauma feel like they have to be in charge either because a parent is abusive or simply doesn’t know how to provide a sense of security or stability, or because the child’s sense of control is being undermined by the abuse he or she experienced at the hands of another adult or peer.

Finding help at school

Counselors who are treating traumatized children should tap all available resources to help these clients, Lawson says, working not only with caregivers or other relatives but also with the child’s school. School counselors may be a source of additional one-on-one counseling for the child, or they could get the child involved in group activities with other children who are trauma victims or with children who share common interests such as music, sports or art, Lawson says. These peer networks provide abused children additional sources of support and can also teach them how to interact with people — something that many abused and isolated children have never learned to do.

Perpetrators of abuse seek to control and isolate their victims. An abusive parent has the power to cut off or severely limit a child’s healthy interactions with people outside of the circle of abuse. “[These] kids often didn’t learn social skills because they are kept away from other people,” Lawson says.

Abuse is often part of a viciously long-lived cycle, handed down from generation to generation, Lawson adds. Parents who were abused as children often grow up to abuse their own children. Even if parents with an abusive background are not abusive themselves, they may still carry on other dysfunctional behaviors, he says.

“You may have three or four generations of people [who] have a very skewed view of how to interact with people,” he says. “So they never learn how to interact with others. You have to help [these children] connect with other sources.”

School counselors also can play important roles as advocates and educators. Many people — including teachers and administrators — do not understand that many children who act out are doing so because they have been or are being abused, Tucker asserts.

“School counselors can really make a difference by making sure that kids get evaluated instead of just automatically disciplined,” Tucker says.

“So many boys end up in the criminal justice system because they were physically acting out in response to trauma,” she adds.

School counselors can also help abused and traumatized children learn how to help themselves, says Elsa Leggett, an ACA member, associate professor of counseling at the University of Houston-Victoria and president of the Association for Child and Adolescent Counseling.

“Talk to kids about safety plans,” Leggett urges. “Ask them, ‘When abusive things are going on at home, where do you go? How do you know when things are getting dangerous?’”

The most important thing that all practicing counselors can do to address childhood trauma is to ask questions, Lawson says. Children — and sometimes adults who were traumatized as children — don’t always recognize what they’ve experienced as abuse, so rather than asking “have you been abused?” Lawson instructs his students to pose questions such as “has anyone ever hit you?” and “has anyone ever touched you in a way that made you feel uncomfortable?”

ACA member Cynthia Miller is an assistant professor of counseling at South University in Richmond, Virginia, and an LPC who has worked with incarcerated women. She has seen the kind of positive change that can occur when people get the help they need, but she has also witnessed the pattern of incarceration, addiction and institutionalization that can become entrenched in generation after generation.

“If you want to decrease the amount of money we spend on treating people with substance abuse or incarceration,” Miller says, “address child abuse.”

Caring for children during a disaster

Although ongoing trauma causes the biggest and longest-lasting kind of damage, one-time events can also create problems that linger. It is particularly important for children to receive timely counseling intervention, experts say.

“Typically, most children will have short-term responses to a disaster that include five basic realms,” Baggerly says. These realms are:

  • Physical: Symptoms include headache or stomachache
  • Thought process: Children exhibit confusion and inattention
  • Emotional: Children are scared and sad
  • Behavioral: Children might become very withdrawn or clingy, or may start sucking their thumb or wetting the bed again
  • Spiritual/worldview: Children may question their beliefs about God and the world

(For more information about typical trauma responses and recommended interventions, see “Children’s trauma responses and intervention guidelines” below.)

“Typically these [responses] don’t last long,” Baggerly says, “but that depends on the kind of support kids get in the immediate aftermath.”

Ultimately, the purpose of any counseling intervention after a traumatic event is to reduce or eliminate a child’s anxiety and stress, Baggerly asserts. She attempts to do that by “resetting” the child and connecting him or her to coping strategies.

“They need caring family and community support,” Baggerly says, “but if it is a huge disaster, then parents and teachers are equally traumatized, so they are not able to give support to kids. That’s when you need to bring people from outside.”

Some children are at greater risk than others, Baggerly says. “Kids who don’t have supportive family [and] who already have anxiety or have some type of developmental disability often will have ongoing symptoms that go longer than 30 days,” she explains. “Counselors need to triage to find out who is at most risk.”

During her roughly dozen years of experience working with chronic trauma and disasters, Baggerly has developed an integrated approach that she calls disaster response play therapy. The approach uses a trauma-informed philosophy in which counselors train parents and teachers in typical and atypical reactions to disasters so they can screen children and determine which ones need more help, she explains. “We also normalize typical symptoms, provide psychoeducation that informs kids about the impact of disasters, teach them coping strategies and provide them with child-centered play therapy.”

Baggerly usually begins by gathering a group of children and talking with them about rebuilding the community. She also encourages children to use expressive arts or drama to communicate their feelings.

“The other part of what we do is facilitate connection and conversation between kids and parents,” Baggerly says. “We may start out with Theraplay and do structured activities, such as holding hands or singing ‘Row, Row, Row Your Boat.’ The point is to have them [parents and children] looking at each other so that the mirror neurons can be engaged.”

Baggerly also educates parents on activities they can do at home with their children. She refers them to an online workbook, “After the Storm,” which has scales of 1 to 10 or a thermometer that kids can fill in to indicate how much stress they are feeling.

Roaten often does volunteer trauma work and provided on-site support in the wake of the April 2013 fertilizer plant explosion in West, Texas, that killed 15 people, injured more than 150 and caused extensive damage to buildings and property.

“One girl, a seventh-grader, had been standing outside in a neighborhood with a view of the plant and observed the explosion itself,” Roaten says. “So she had that image in her head and it would not go away. I taught her some deep breathing and progressive relaxation and did some guided imagery about her favorite place to be.

“When that picture came up in her mind, she could breathe, relax and go to her good place. By the fourth day I was there, she was no longer seeing the image.”

Roaten uses expressive therapy for children who aren’t very verbal or who don’t have the vocabulary to talk about their feelings. She brings a sand tray with miniatures of fences, people and buildings. She then allows children (and even adults) to set up scenarios or vignettes that help them express and act out what they are feeling.

“I might say something like, ‘Create your world before [Hurricane] Katrina; then create your world after Katrina,” Roaten explains.

Roaten also uses trauma-focused cognitive behavior therapy to help children and adolescents learn coping skills.

“You teach them about trauma and its impact on them,” she explains. “Then you teach them relaxation and breathing skills. Once you get them to be able to self-soothe, relax and be calm, you can help them deal with pictures or scenarios that come up. You help them change the story — what they are telling themselves and what that means — which helps them work through the trauma a little bit at a time.”

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Children’s trauma responses and intervention guidelines

 

Preschool through 2nd grade

Typical trauma responses:

  • Believes death is reversible
  • Magical thinking
  • Intense but brief grief responses
  • Worries others will die
  • Separation anxiety
  • Avoidance
  • Regressive symptoms
  • Fear of the dark
  • Reenactment through traumatic play

Intervention guidelines:

  • Give simple, concrete explanations as needed
  • Provide physical closeness
  • Allow expression through play
  • Read storybooks such as A Terrible Thing Happened, Brave Bart, Don’t Pop Your Cork on Monday

 

3rd through 6th grade

Typical trauma responses:

  • Asks a lot of questions
  • Begins to understand that death is permanent
  • Worries about own death
  • Increased fighting and aggression
  • Hyperactivity and inattentiveness
  • Withdrawal from friends
  • Reenactment though traumatic play

Intervention guidelines:

  • Give clear, accurate explanations
  • Allow expression through art, play or journaling
  • Read storybooks

 

Middle school

Typical trauma responses:

  • Physical symptoms such as headaches and stomachaches
  • Wide range of emotions
  • More verbal but still needs physical outlet
  • Arguments and fighting
  • Moodiness

Intervention guidelines:

  • Be accepting of moodiness
  • Be supportive and discuss when they are ready
  • Groups with structured activities or games

 

High school

Typical trauma responses:

  • Understands death is irreversible but believe it won’t happen to them
  • Depression
  • Risk-taking behaviors
  • Lack of concentration
  • Decline in responsible behavior
  • Apathy
  • Rebellion at home or school

Intervention guidelines:

  • Listen
  • Encourage expression of feelings
  • Groups with guiding questions and projects

 

Source: “Systematic Trauma Interventions for Children: A 10-Step Protocol,” by Jennifer Baggerly in Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, third edition, American Counseling Association Foundation, 201

 

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ACA Traumatology Interest Network

Counselors and counselors-in-training who have an interest in providing counseling services to trauma- or disaster-affected individuals and communities should consider joining the ACA Traumatology Interest Network. Network participants share insights, experiences, new plans and advances in trauma counseling services. For more information on joining the interest network, go to counseling.org/aca-community/aca-groups/interest-networks.

 

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To contact individuals interviewed for this article, email:

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

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

Triumph tales: Counselors’ domestic violence research project blossoms into website, social media campaign highlighting survivors’ personal stories

By Bethany Bray March 20, 2014

seethetriumphWhile surveying survivors of domestic violence for a recent research project, Allison Crowe and Christine Murray were thoroughly compelled by the stories they heard. So much so that they knew the stories should be shared with a wider audience rather than limited to publication in an academic journal.

In one case, an interviewee said she 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 participant said her doctor told her she was “stupid” for not leaving an abusive husband.

Crowe and Murray, counselor educators and American Counseling Association members who focus on domestic violence and family counseling, launched the “See the Triumph” campaign in January 2013.

While they still plan to publish their research — their article is currently undergoing peer review at a journal – the duo is putting much of their effort into managing a website and social media campaign to share their research findings and spread awareness of the complicated issues and stigma that surround domestic violence.

The project title, “See the Triumph,” is part of a quote from one of their interviewees, who spoke of the triumph of surviving abuse and starting life over.

“The stories that we heard were overwhelming,” says Crowe, an assistant professor of counseling at East Carolina University, a licensed professional counselor and an approved clinical supervisor. “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.”

Crowe and Murray surveyed more than 230 men and women for their research.

They believe the website and social media campaign offer more timely and immediate ways of sharing their data, while also allowing them to reach a wider population than those who read professional or academic journals.

“We had the data and felt like we needed to do more with it,” Crowe says. “We decided to spread the results in an innovative, nontraditional way. … We wanted to reach more people.”

Seethetriumph.org hosts a blog written by Crowe, Murray and guest bloggers. It also contains a plethora of information and links to resources about domestic violence, such as a “checklist” of questions domestic violence survivors can ask their potential counselors to see if they are properly trained to deal with such a complicated and nuanced issue.

Through their research, the duo has found that domestic violence survivors want –- sometimes even crave the chance — to “share their stories,” says Murray, an associate professor in the University of North Carolina at Greensboro (UNCG) Department of Counseling and Educational Development.

Participants felt validated by talking about what they had been through, says Murray, a licensed professional counselor and licensed marriage and family therapist.

Additionally, some interviewees felt sharing what they had been through and overcome could help others who were still experiencing domestic violence, says Crowe.

“An incredible takeaway is how [survivors] want to help each other,” she says. “Their enthusiasm and passion for helping each other [and] doing what they can was really mind-blowing.”

Crowe and Murray continue to accept survivor narratives through a survey at seethetriumph.org. They are also launching another round of research focusing on immigrants’ perceptions of domestic violence, stigma and culture. A survey for first- and second-generation immigrants is posted on the See the Triumph home page.

Crowe and Murray’s research project began as an exploration of the term “stigma” and its connection to domestic violence.

“There’s a lot more than just blame in the term ‘stigma’,” Crowe explains. “[It involves] blame, discrimination, labeling, secrecy, shame, social exclusion, stereotyping and losing status or power.”

The duo conducted face-to-face interviews with domestic violence survivors about the stigma they experienced in general society as well as at the hands of professional helpers such as police officers, lawyers, medical personnel, mental health workers and others. Crowe and Murray spoke with 12 women, conducting hourlong interviews with each.

The interviews were poignant, says Crowe, and confirmed that many domestic violence survivors do experience stigma, such as the woman who was asked out on a date by the police officer she turned to for help.

Crowe and Murray then expanded their research, surveying more than 200 men and women in the United States and internationally who had experienced domestic violence. For this second round of research, they conducted an online survey with open-ended questions about stigma.

In case after case, interviewees talked of experiencing stigma, from the assumptions people made, such as the belief that abuse victims somehow invite or bring the abuse upon themselves, to a religious leader who told a victim it was her responsibility to keep her marriage to an abusive spouse together at all costs.

“Our results confirmed what we felt in the first round,” Crowe says. “Those results were unfortunate, but very important to us.”

The duo launched Seethetriumph.org and their social media campaign last year after receiving approval from their universities’ research boards.

“One really surprising and rewarding part of this has been the ability to be a part of someone’s healing,” says Crowe. “[The fact] that they can use this as a vehicle for healing is incredible. I think the role of advocate has really been brought out in me and Christine.”

 

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On the web: seethetriumph.org

 

Sample blog posts:

 

“Finding a counselor who is competent to serve survivors”

bit.ly/1gtBlsL

 

“Five things I wish I had known when I left”

bit.ly/1nU6oUp

 

“Being a victim, being a survivor and triumphing: The words that describe our experiences”

bit.ly/1fzP7y3

 

“Intimate partner violence affects everybody, even you”

bit.ly/1dViTfm

 

 

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See the April issue of Counseling Today for an in-depth feature article on counseling victims, survivors and perpetrators of domestic violence, to which Crowe and Murray contributed.

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline

 

Screening for possible domestic abuse

Susan H. Robinson October 24, 2011

A Columbus, Ohio, mother and her two children are stabbed to death. A mother and grandmother is beaten and shot to death in Newark, Ohio. A Logan, Ohio, mother with three children under the age of 6 is kidnapped and strangled; her body is dumped in a sewer. The commonalities? Each of the women was from central Ohio, and all were attacked at their home or work. Estranged boyfriends or husbands are facing charges in each case.

These cases happen to have taken place in my county or counties adjoining mine, but many people reading this article will likely be able to recount numerous cases with similar tragic endings that happened in their own localities. The details may vary, but almost all of the cases involve women and children with lives, hopes and dreams that are dashed because someone decided to go overboard in an obsession with power and control.

Many victims and potential victims of domestic abuse have sought help from various sources, including professional counselors. In numerous other cases, friends and family members have expressed concern. It is important for members of our profession to understand the dynamics of domestic abuse and to utilize that knowledge whenever possible to reduce the incidence of violent outcomes. We also need to be aware that this violence occurs in traditional and nontraditional family settings, among gay couples and among straight couples. The violence can be parent-to-child, child-to-parent and all other possible variations.

I grew up in an era in which most considered abuse a private matter. My nosy parents taught me otherwise. As an attorney, my father heard stories from his clients and made it clear to me that this behavior was not to be tolerated. Because this was the 1960s, knowledge of the signs of a potential abuser was essentially nonexistent.

Lenore Walker conducted groundbreaking research on the dynamics of abuse, and her first major publication was released in 1978. What followed was mountains of research and the shelter movement taking hold, so this issue became general public knowledge. Or so we thought.

As an adjunct psychology professor at a community college, I routinely include a section on the dynamics of domestic and intimate partner abuse in my courses. This is not a part of the standard curriculum, although some texts do incorporate information on the subject. The Ohio State University has its own policy on domestic and intimate partner violence; my school has drafted a policy that is scheduled to be reviewed for approval Nov. 1.

I started teaching a few months after my distant cousin was murdered. Realizing that it is not in my character to get a huge program started, I looked at that first class and decided, “I can reach these 35 people.” The response has been both heartwarming and scary. I have been told and learned through class papers that various students realized the danger of a situation for the first time after I taught on the subject. One of my students reached out to help a best friend who was in serious danger. I have heard horrific stories of people who lost their lives because of inaction. And people have shared with me how they found the courage to reclaim their own lives.

As a counselor, I am adamant about screening for possible abuse. Clients have come to me indicating they were victims. I have even had some clients who admitted abusing others, took responsibility and indicated a desire to stop. (In those cases, post-traumatic stress disorder was involved, and the problem was very quickly resolved.) It is equally common, however, for clients to recite details that indicate clear abuse patterns, while simultaneously denying the existence of abuse in their relationships. This is when I bring out the Power and Control Wheel, the Wheel of Equality and Respect, the cycle of violence and a list of signs of a potential abuser — the type of information I obtained during my initial attendance at a support group. It is not new information.

Two events were seminal in my becoming so active in this field. The first was my own misguided romance, the second my distant cousin’s death. I met my cousin only once. She had recently married and mentioned having “fallen and broken her nose” two days before the wedding ceremony. Three weeks after our meeting, she was dead.

In my case, I became involved with an extremely (more like insanely) jealous and verbally abusive partner. When I expressed concern to a counselor about the level of jealousy, I was told, “We’ll process that.”

Unfortunately, I didn’t recognize the jealousy as a sign of a potential abuser or his verbal attacks as actual abuse. Yes, I knew it was unacceptable behavior, but I had no idea it could be the precursor to or a sign of serious danger. When we (predictably) broke up, I was blindsided. Safety planning had never occurred to me, yet I wound up leaving my own home, first for several individual nights, then staying with various friends over a two-week period until he vacated. To do otherwise would have meant putting my life at risk.

After the dust ultimately settled, I contacted Ohio’s Counselor, Social Worker and Marriage and Family Therapist Board. The staff member who took my call indicated there definitely would be a meeting about establishing mandatory course work on domestic and intimate partner violence. That was in 1995.

I didn’t begin my own graduate studies until September 2001, eight days prior to the infamous terrorist attacks. Never was there any required course work pertaining to the subject of domestic and intimate partner violence. (I took the only elective I saw offered at the time on treating abusers.) At one point, I was even chastised for bringing the matter up. I garnered infinitely more domestic violence/intimate partner violence information from one hour at a support group sponsored by CHOICES for Victims of Domestic Violence than I did from my three years in graduate school. This is shameful.

Victims seek counseling every day in huge numbers, although they often start out unaware that abuse is an underlying issue for them. Many counselors are veterans of continuing education courses on the subject and read prolifically, providing the expertise these clients deserve. On the other hand, a shocking number of counselors take these victims on as clients when they truly have no idea what they are doing. Many even conduct couples counseling with these clients, further endangering the victims. Clearly, no counselor can be expected to become an expert in everything she or he might encounter. We do, however, have a responsibility to know when to make educated referrals.

There is no need to reinvent the wheel as counselors. In Ohio, nurses have a protocol they are required to follow whenever someone presents in the emergency room — a series of questions they have no choice but to ask. Counselors who do not work in a shelter setting have no such legal guidelines, however.

Nursing is surely not the only profession with such a protocol. Mental health professionals who work in shelter situations are no doubt well-informed and could be a good resource for the rest of us. Screening for domestic and/or intimate partner abuse needs to become a national counselor mandate.

It will save lives. Absolutely.

Susan H. Robinson is a professional counselor who practices in Ohio. Contact her  at sueslistening.com

Letters to the editor: ct@counseling.org