Everything You Always Wanted to Know about Domestic Violence but were Afraid to Ask

Margaux Helm, LMFT

Director of Programs at WEAVE

Have you ever wondered if it is appropriate to see a couple for therapy who are regularly arguing, you suspect there is abuse, but no one has disclosed it?  Have you had the experience of treating a couple who both yell and throw things so you are not sure how to assess who is the dominant aggressor?  Are you not sure if individual or couple treatment is the most clinically sound recommendation for your clients?  Is it sometimes hard to know if you should refer to a domestic violence specialist or treat yourself?

You are not alone in asking these questions.  Whether you work in an agency or private practice, it is often complicated to determine the best course of action to take when there is abuse present in an intimate partner relationship.  It is often not apparent on the surface what is happening behind closed doors.  This is due to the shame associated with abuse, denial of the abuse by the perpetrator and the tendency for victims to normalize what is happening.  Domestic violence is rarely black or white, leaving lots of room for speculation which can be dangerous (literally) when assessing a family, couple or individual.

WEAVE is the primary provider of domestic violence services in Sacramento County and is the sole Rape Crisis Center.  Last year, WEAVE answered 10,263 Support & Information Line calls, provided 1,334 victims counseling services and offered 11,267 bed-nights of safe shelter.  Having been the Director of Programs at WEAVE for over 10 years and learning to treat these cases through work in the trenches, I have some clinical recommendations to share.  The following are not a one size fits all prescription but can be used as guidelines when considering the best course of action when assessing and treating domestic violence cases.

Do not assume you know what is happening in the relationship

Make sure that you do a thorough psycho-social assessment with each client prior to starting treatment.  Do not think that if no one is talking about abuse, it is not happening.  Building trust to talk about abuse takes time.  Ask about abusive behavior in the initial phone screening and if there are any indicators that there are patterns of coercive control, physical incidents, financial manipulation, sexual abuse, violence in previous relationships, drug abuse or other red flags.  Be aware that couple therapy may not be the best approach.  Start with individual assessment sessions prior to treating clients as a couple.  If one or both of the clients are reluctant to do individual sessions, find out their reasons and let them know it helps you to create the best recommendation for treatment.  I request that clients come to their individual sessions separately and schedule them on different days.  If there is an abusive partner waiting outside, that can be intimidating for a victim.  Giving them each an hour of individual time puts them on more equal footing and gives you the time needed to make the best assessment.  It allows each partner to disclose information confidentially so that you can decide if it is safe and advisable to start couple therapy or to recommend individual counseling.

Disclose and elaborate on your mandated reporting obligations

Clients may not consider your responsibility to report child abuse if there are children in the home and they are disclosing domestic violence.  They may think that if the children are not being directly or physically abused, it will not be reported.  During the intake process is the perfect opportunity to educate clients about the effects of domestic violence on children.  Clarify that direct exposure to domestic violence is considered child abuse and when you would be mandated to report it.  You can also use this time discuss your mandated reporting responsibility regarding harm to self or others.  Individually assessing for suicidal and homicidal ideation is also important because they are often concurrent with domestic violence.

Do not use the term domestic violence

Very often clients do not relate to the term domestic violence.  They may not be married or living together and assume it does not relate to them.  The abuse may be emotional and financial but not physical so they will not think it “rates” as domestic violence.  Sometimes clients are not aware that calling someone names, humiliating them and/or controlling their actions is abuse.  You are in a powerful position to name these behaviors as abuse and acknowledge the severity of the impact on the victim.  If the client has normalized these types of behaviors because of childhood trauma, chronicity of occurrence or other reasons, you may need to educate them about healthy relationships.  Sometimes talking about what love is and isn’t can helpful.

Address safety concerns

If you suspect the client is minimizing the abuse, you can utilize an online danger assessment that can be helpful in validating if the relationship is potentially lethal www.dangerassessment.org/.  If there have been threats to the client’s life, take it seriously.  Creating a safety plan with your client will be empowering and may be lifesaving.  If a client discloses domestic violence, assess if it is safe to return to the abuser and, if not, find out if they have alternatives where they can stay such as with a trusted friend unbeknownst to the abuser or at a hotel out of the area.  If these are not options, you can offer resources for a confidential domestic violence safehouse.  You are welcome to call the WEAVE support line to help you guide your client through the safety planning process or give the number to the client if they are willing and able to call.  You can also refer to our website at www.weaveinc.org to access information on safety planning and the safehouse. 

Be aware there are many types of abuse

The vast majority of clients at WEAVE have more than one type of abuse occurring and many do not have any physical abuse.  We recognize that emotional/mental, financial, sexual and spiritual abuse are all types of domestic violence and may or may not occur with physical abuse.  Clients tend to minimize the other types of abuse, thinking that they somehow do not count.  When their experience and reactions are validated, it often creates the safety for them to disclose a broader range of behaviors that are abusive.  Sexual abuse is often the most hidden form of abuse and asking an open ended question such as if their partner does anything that makes them uncomfortable sexually, can be a way to open up communication.  Abuse is often hidden.  The perpetrator can use coercive control in many areas including drugs, alcohol, mental health and reproduction.  I will talk more about these during my presentation at the SVC-CAMFT meeting on April 17th.

Trauma will impact assessment and treatment

When abuse is occurring in a relationship, it is often challenging for the victim to disclose important information because it is not remembered and/or it is too dangerous to reveal family secrets.  Be patient and remember there may be valid reasons that a client is not forthcoming with information.  Complex trauma and a history of adverse childhood experiences can compound the issues present in the current abusive relationship.  Creating a safe container for disclosure by remaining nonjudgmental and pacing with the client will allow secrets to be shared when the client feels safe.  Keep in mind that perpetrators often have histories of trauma and are likely to normalize their behaviors.  Be firm with your clinical boundaries while remaining compassionate about their situation.

Recommend individual before couple therapy if there is active or recent abuse

Many of us were taught in graduate school to recommend individual services if there is domestic violence in the relationship.  That sounds so easy.  Not so.  Does this mean one or more incidents and in what time frame?  How much is too much abusive behavior?  When people are in conflict, they often say and do things that are hurtful.  Determining what is abuse and what is part of normal conflict is dependent on the experience of the individuals and the judgment of the clinician.  If one person is fearful in the relationship, if there is coercive control, if one or both partners are not able to manage their anger without being abusive, individual work before couple counseling is recommended.  If couple therapy is started without their individual issues being addressed, it will be less effective and potentially dangerous.

Remember it happens to men too

Sometimes clinicians will ask questions to a female to determine if there has been victimization in the relationship but the same questions are not asked to a male.  It is important to ask the same questions to both partners in both gay and straight relationships.  Men also minimize their victimization and have barriers to disclosing the truth about abuse.  If the whole family is seeking therapy, talk to the children about their perspective.  Ask if there are things happening at home that make them feel scared or worried.  There are instruments to assess abuse in couples including conflict tactics, lethality and anger styles in the book Gender Inclusive Treatment of Intimate Partner Abuse by John Hamel.  It is a useful resource for these assessment tools as well as how to approach the issue from a family systems, gender inclusive model.

Consult and refer if necessary

If you are out of your comfort zone because the presenting issues are too complex or the danger level makes you anxious, you can call WEAVE for extra support in knowing what to do next.  Our multi-lingual support and information line at 916-920-2952 is available 24 hours 7 days a week to talk to someone who is a Certified Domestic Violence Counselor.  The counselors on the phones have specialized training in domestic violence to help assess risk factors, provide guidance regarding safety and provide relevant referrals.  WEAVE also offers free drop in individual triage counseling and group orientation sessions that educate about domestic and sexual violence as well as other services WEAVE provides.  All in person services are available in English and Spanish.  Information about WEAVE services can be found on the website at www.weaveinc.org.

The presentation to SVC-CAMFT on April 17th will focus on a gender inclusive approach to domestic violence assessment and intervention.  We will discuss mutual vs unilateral abuse, traumatic bonding, and correlating factors to domestic violence, how to determine risk factors and recommendations for individual vs couple treatment.  There will be plenty of time for group discussion about practical application and to answer questions making the complex issue of domestic violence more manageable.  

The views expressed in the Special Feature Articles do not necessarily reflect the Sacramento Valley Chapter of CAMFT or CAMFT. They should be understood as the personal opinions of the author. No information in this articles will be understood as official.  Other views and commentary are welcome and will be published as long as they are respectful and stick to the topic.

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