Domestic Violence Intervention Research Paper

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Domestic violence is now considered to be a serious public health problem, because one woman is battered every 15 seconds in the United States. The number of emergency room visits by battered women exceeds those caused by accidents and rape, and many battered women are killed by their abusers. Woman abuse refers to the physical and psychological maltreatment of a woman by a partner, usually in the context of an ongoing or recently terminated intimate relationship. Physical abuse to the woman is usually accompanied by acts designed to control her behavior and to intimidate her. These can include humiliating, shaming, threatening, coercing, isolating, and otherwise dominating the woman in order to establish her subordination within the relationship. For most batterers, the acts of physical assault are infrequent. However, verbal abuse, for example, threats to kill or to injure the woman, can have similar devastating effects, particularly for women who have been traumatized by previous assaults.

We know from national surveys that at least 3.3 million children live in homes where the mother is being abused. While children exposed to the battering of their mothers were once considered to be the ‘‘unintended victims’’ of domestic violence, more recent formulations have described woman abuse as also abusive to any child who watches these traumatic events. In addition, many children of battered women are themselves at-risk for abuse and serious injury during a battering incident. Domestic violence is a crime, a social problem, a public health epidemic, and a political issue in this country. Thus, efforts to intervene and to prevent domestic violence take many forms.

Outline

I. Interventions for Men Who Batter

A. Who Are the Batterers?

B. Range of Programs and Underlying Theoretical Assumptions

C. Current Issues in Interventions for Men

1. Individual versus Group Therapy

2. Is Couples’ Treatment Safe?

D. Efficacy of Treatment

1. Study Design and Criterion for Success

2. Rates of Retention and Recidivism

3. Current Issues in Assessment

II. Interventions for Battered Women

A. Impact of Battering on the Woman

B. Shelter-Based Programs

1. Goals and Range of Services

2. Support Groups for Battered Women

3. Shelter Parenting Groups

4. Substance Abuse

5. Advocacy and Placement

C. Coordinated Community Response

1. Hospital/Emergency Room Interventions

2. Community Support Groups for Women

3. Individual Treatment

D. What Works and Why

III. Preventive Interventions for Children Exposed to Domestic Violence

A. Children’s Reactions to Witnessing Domestic Violence

B. Theoretical Assumptions of Programs for Children

C. Programs for Preschoolers

D. Programs for Children Ages 6 to 12

E. Parenting Support and Education Programs

F. Assessment of Intervention Efficacy

IV. Preventive Interventions for Adolescents Exposed to Domestic Violence

A. Developmental Strengths and Needs of Adolescents

B. Domestic Violence Intervention Programs for Teenagers

V. Preventive Interventions in Community Settings

VI. Conclusions

I. Interventions for Men Who Batter

A. Who Are the Batterers?

There is currently considerable debate in the research literature as to whether and how abuse is transmitted from one generation to the next. Retrospective studies have found high rates of transmission; upward of 60% of abusive parents or partner-abusers report having been abused themselves during their childhood. On the other hand, prospective studies have found rates between 18 and 40%. The distinction appears to be that a large majority of currently abusive parents or partners were abused as children, but a lower percentage of abused children grow up to be abusers. In addition, some initial research has indicated that boys who lived in families with violence (either spouse or child abuse) are more likely than are girls to be involved in violent dating relationships as adolescents. Other contextual variables may add to the risk, for example, living in a community with high rates of interpersonal violence, high levels of exposure to violence against women in movies and media, and low arrest and conviction rates of batterers. Although there are clearly other factors that influence whether or not an abused child will be involved in abusive relationships as an adult, the overall evidence shows that the childhood experience of abuse is an important risk factor for problems in relationships in adolescence and adulthood.

The results of studies of the typologies of batterers generally agree on at least three subtypes based on their violent behavior, the family history, as well as the personality characteristics and disorders of the batterer. First are the family-only batterers who show the least severe levels of emotional abuse and violence to their partner. This group of men is least likely to be violent outside the home, is less psychologically abusive, is more likely to report being satisfied in their marriages, and is less likely to have a history of being abused as children than other types of batterers. Substance abuse is associated with their violence only about half of the time. Within-family abusers do not appear to have clinical levels of depression or anger, but do appear to be jealous and to minimize their violent behavior. Approximately half of all batterers who enter treatment programs match the description of the family-only batterer.

The second categorical dimension is the pan-violent or antisocial batterer. Approximately one-fourth of batterers in treatment programs fit this description. Generally, pan-violent batterers have the highest rates of severe physical assault to their partners and are most likely to behave in violent ways in settings outside of the family. Not surprisingly, they have high rates of substance abuse, arrest, and involvement with the legal system. They are likely to have been severely abused as children and show only moderate levels of marital satisfaction, anger, and depression. Yet they are most likely to score high on antisocial personality disorder or psychopathy. That is, they are dominating and bullying, do not feel guilty about their abusive behavior, and lack empathy toward the victim.

The third type are dysphoric or have borderline personality disorders. This group is depressed, psychologically distressed, and emotionally volatile. They engage in moderate to severe levels of psychological and sexual abuse, as well as physical violence toward their partners. They are likely to be dependent on the woman and suspicious of her activities and motives. Intense jealousy characterizes these men. Approximately one-fourth of those who enter treatment are personality-disordered batterers.

Substance abuse may accompany battering, may precede battering, or may not be involved at all. We know that approximately half of all abuse incidents involve the use or abuse of drugs or alcohol but that the two are not inextricably linked.

B. Range of Programs and Underlying Theoretical Assumptions

The best intervention programs for batterers are those that take a comprehensive and coordinated approach to the problem. That is, communities that offer treatment programs that are tied to the police and judicial systems, as well as to programs that offer services to the victims of abuse, are better able to monitor the progress of the offender from initial arrest through several years of treatment than are services that focus on only one part of the problem. Some communities have antiviolence education campaigns, school-based antiviolence programs, mandatory arrest policies, and judges and probation officers who are sophisticated about the dynamics and patterns of abusers. Clearly, the strong and immediate response of professionals to domestic violence plays a part in reducing the chances that such violence in families will happen again. Psychoeducational intervention programs designed to stop the batterer’s violent behavior take a number of forms. Many programs use a combination of strategies, but the unique properties of different types of programs will be explained.

Programs that rely on a behavioral learning approach first identify factors that reinforce and maintain the abuser’s behavior toward the woman. These behaviors typically include controlling her access to money and resources, monitoring her behavior when outside the home, restricting access to family and friends, verbal abuse aimed at undermining her sense of competence, and, of course, physical assault to reinforce the other forms of intimidation. Hence, in addition to the physical assault, the batterers’ behaviors that serve to control and to limit the woman are the focus of treatment. Behavioral programs for batterers are typically group programs that use skills training to teach alternative behaviors. A prerequisite for most programs is to have the abuser take responsibility for his actions and to not blame the woman for his abusive behavior. By focusing on the behavior of the batterer, rather than on his explanations for events, behavioral programs seek to force recognition that the abuser is ultimately responsible for the violence.

Somewhat akin are programs that take a cognitive restructuring approach and recognize that cognitions or thinking processes play an important role in the development of abusive behavior. Many researchers have described cognitive-behavioral models designed to focus on skills training and attitude change. These programs are considered suitable for antisocial and generally violent batterers, in addition to the other batterer types. The assumptions of this model of treatment are that batterers who have been victimized during their childhoods, who hold rigid stereotypes about women, and who have poor social skills need direct teaching and education, rather than interventions that only require the ability to build trust and develop relationships with group leaders and other group members. Men who lacked adequate role models as children may not have learned appropriate interpersonal skills and may continue to rely on distorted cognitions and inappropriate problem-solving techniques in their relationships as adults. Without intervention, these men will continue destructive and hurtful patterns of interacting with the important people in their lives.

Cognitive-behavioral groups typically have 6 to 10 participants, and one or two leaders. They use a teaching and training format that may include homework and specific lessons each week. Cognitive-behavioral practices such as the rehearsal of new thoughts and behavior are standard fare. For example, participants learn to identify and to reinterpret their reactions to stressful events and to think differently about appropriate responses. There is a weekly emphasis on improving communication, building cognitive skills, and consciousness-raising about men’s attitudes toward women’s roles and violence against women.

Abusive and controlling behaviors toward a partner are reported each week in the group session. With the help of the group leaders, batterers can be confronted about their illogical thinking and reinforced when they take responsibility for their behavior and make a change toward more appropriate ways of relating to the women in their lives. Cognitive-behavioral groups typically discuss managing and expressing anger at women, they discuss alternative ways to express anger and other negative emotions, and they learn to respect the rights and wishes of others, including wives or partners and their children. Change is achieved through feedback, reinforcement from the group, as well as from social learning or modeling one’s behavior on other members and leaders.

Another type of program employs relationship-based interventions and is considered to be most appropriate for batterers who experienced trauma during childhood. Psychodynamic theory is used to explain the ways in which the abuser’s current behavior is the result of efforts to cope with past experiences of witnessing violence or being abused. It is thought that some men, in their efforts to overcome feeling inadequate and powerless in relationships as a child, have identified with the perpetrator, or currently try to gain control over traumatic memories by venting anger and behaving aggressively. The process-psychodynamic treatment model is focused on revisiting past relationships in order to work through and overcome the trauma in a supportive group setting.

These groups are not structured with a teaching agenda but rather they allow each participant the chance to explore the ways in which early abusive experiences have led to unhealthy patterns in relationships today. By uncovering past trauma and discussing it in a supportive group setting, the batterer can then realize the ways in which current violent behavior is an attempt to control past abuse and feelings of inadequacy related to the trauma. The goal is for men to be able to respect and to have empathy for others after having insights and empathy for themselves as children. The relationships of group members to the leaders and to one another are salient here and provide the support needed for this type of self-exploration. This is a relatively new approach to treating batterers and, thus far, it is not widely used.

C. Current Issues in Interventions for Men

1. Individual versus Group Therapy

A variety of treatment modalities exists for most types of psychological and behavioral problems, but group therapy is considered the treatment of choice for abusive men. Group sessions can range from 6 to 32 weeks in design. While individual therapy can focus on the behavioral, psychodynamic, or the cognitive methods described above, most experts in this field consider group therapy to be the most effective. There are several reasons. First, there are distinct benefits in discussing abusive behavior in front of other abusers. Many batterers are in denial about their own abusive behavior yet are able to identify violent behavior in other people. Thus, the group can be used to help break through an individual member’s denial of his negative attitudes, or abuse toward his partner. Here the culture of violence is challenged by the group. Second, men can find comfort and support when they discover that others like them have had similarly difficult experiences during childhood, and/or suffer from the same feelings of frustration in dealing with the stress and the women in their lives. Group leaders also serve as living models of nonviolent men who are sensitive to their own and other peoples’ needs.

2. Is Couples’ Treatment Safe?

There is considerable debate in the field as to whether it is ever acceptable to treat a batterer and abused woman together as a couple. The underlying assumptions of couples’ therapy are that both parties are able to participate fully in the treatment, that there are no power differentials supported by an external system, and that each person is free to discuss issues of importance to him- or herself and to the couple. However, when one partner is being abused and dominated by the other, these assumptions are often violated. That is, battered women may not be free to participate fully in the treatment, to disclose their opinions, or to report on the behavior of the abuser. Battered women know that there are serious and often severe consequences for revealing the abuse—they may be reprimanded, beaten, or even killed by their partner. We know from research studies that battered women who go to emergency rooms do not often report on the abuse when asked about it in the presence of the abuser. Similarly, battered women may not be free to discuss the most important and urgent issues in their lives (e.g., their victimization) in couples treatment.

Psychologists have argued that, by treating the couple, the focus of the problems may shift to the interactions between batterer and victim, thus deflecting the batterer’s responsibility for his abusive behavior onto features of the woman or of the couple. Obviously, many batterers would prefer to engage in couples’ treatment where their actions would be considered as part of a system that includes the personality of the battered woman, her reactions to the violence, and her behavior that could be used to justify the abuse. Batterers regularly use denial and they blame the victim for her plight. The bottom line, however, is that the abuser alone is responsible for his violent behavior and until he receives non-couples’ treatment to change his behavior, there is little that can be accomplished in the couples’ treatment setting. Given the physical and emotional consequences to the woman, couples’ treatment is considered by many to be completely safe only after the batterer has successfully completed an intervention program specifically designed to stop his violence.

Some therapists who endorse couples’ treatment for domestic violence argue that not all physical abuse is severe or frequent, that not all violence is the sole responsibility of the abuser, and that battered women want to remain in their relationships, despite the risks to themselves. Yet many therapists may not be familiar with the dynamics of abusive relationships, may minimize the danger to the woman, and may see battering as an exaggerated form of marital conflict. Just knowing that the woman may be threatened with harm or may be harmed as a result of her participation in couples’ treatment renders it particularly risky. Still, we know that when a woman is battered, the physical assault is but one of many forms of domination and control exerted by her partner. Nonetheless, once the batterer has completed a group intervention program, couples’ treatment may be appropriate if the therapist has a firm grasp of the dynamics of domestic violence and is vigilant in monitoring the abuser’s behavior.

D. Efficacy of Treatment

Studies of the effectiveness of treatment programs for men who batter show inconsistent results and have many problems. Even so, there is preliminary evidence that some forms of treatment work to reduce recidivism, or additional assaults, for some men when they stay in therapy. More recent studies have tried to sort out which qualities of particular programs are helpful, and for which men various types of programs are best suited.

1. Study Design and Criterion for Success

It is difficult to compare studies because they often measure different things. For example, some treatment programs are based on changing behavior, others on changing thinking, and still others rely on success in exploring childhood trauma. All programs for men work to stop the violence, to change attitudes about women, and in many, to increase the man’s feelings of adequacy and reduce his level of anger. Success has traditionally been predicated on whether the program is effective in stopping the violence. Studies currently underway also include outcomes such as reducing the amount of sexual abuse and/or emotional maltreatment, eliminating the woman’s fear, and reducing concomitant abuse of the children.

Given the above qualifiers, we can say that there are preliminary findings that some treatment is better than no treatment in reducing violence rates. In well-controlled studies, that is studies that use random assignment to treatment groups, outcomes varied not by the kind of treatment group but by the type of batterer in a particular group. In 1996, Saunders found that the cognitive-behavioral treatment was more effective for generally violent/antisocial batterers than for other types and that process-psychodynamic treatment was more successful for the dependent batterers than for other types. In each group less than half of the participants were violent 2 years following treatment. There is no evidence that programs that treat couples are effective in stopping the violence or are better than those that treat groups of men. Similarly, we have no evidence that individual treatment is more or less effective than group intervention programs.

2. Rates of Retention and Recidivism

A major problem with samples in research studies includes subject attrition, or dropping out of the research program before the end of the study. We do know that batterers who drop out of treatment are more likely to be young, to have substance abuse problems, and to have a longer history of abuse. Yet some offenders are so violent as to be considered untreatable and thus are not referred for intervention by courts, probation officers, or community agencies. They are seldom included in treatment outcome studies. In addition, women may not want to participate initially or to continue in research studies for a number of reasons, including deciding to return to the abuser, lack of interest, or out of fear for their safety.

3. Current Issues in Assessment

In doing program evaluation research it is essential to have more than one source of information about the abuser’s behavior. Thus, multimethod studies that include police reports and arrest records, reports from the abusers and the women they assault, as well documentation of injuries from hospitals and doctors, are preferred. In addition, studies that have an extended post-treatment evaluation are more convincing as they give more evidence that the intervention has had a lasting effect. For example, some of the early outcome studies relied on only a 6-month period to test whether the batterer had changed his pattern of behavior. Some studies relied on the batterer’s report of the amount of his violence. More recent studies have followed batterers for 2 to 4 years and beyond and have relied on reports from several sources. Finally, assessment of a range of batterer behaviors should be included in efforts to decide whether or not change has occurred. Studies can go beyond documenting rearrest (which essentially counts only about one-tenth of physical assaults), to include incidents of stalking, harassment, violating protection orders, as well as rates of psychological maltreatment of the woman.

II. Interventions for Battered Women

A. Impact of Battering on the Woman

Battered women are at high-risk for physical and psychological problems directly related to the violence and to the emotional abuse that they have endured. Battering by an intimate partner is considered to be the primary cause of injury to women ages 15 to 44. Some battered women may suffer contusions, bruises, or broken bones as a result of assault or they may be killed by their assailant. Although the vast majority of battered women do not seek treatment for their injuries, those who do use medical facilities do so for only the most severe injuries and often not after the first incident of abuse.

Many battered women are clinically depressed. They are more likely to have major depressive episodes than women with serious relationship problems that do not include violence. Depression and low self-esteem, in turn, influence the woman’s coping, as she may become less active and more avoidant as she feels a loss of personal control. Recall that batterers strive to take control away from the woman so as to more easily dominate her. Several studies of battered women in shelters report that approximately 40 to 60% experience posttraumatic stress disorder related to the threats to their life, repeated physical assaults, and the extent and severity of abuse. However, with more time out of the abusive relationship, the rates of PTSD decrease, depression abates, and women can be helped to feel a sense of control over their lives once more.

B. Shelter-Based Programs

1. Goals and Range of Services

The battered women’s movement started in the 1970s when the first shelters for women and children were created. Today there are more than 1300 shelters and thousands of service programs in the United States; most are overcrowded and have waiting lists. The immediate goal of most shelters is to provide safety to the woman. Referral for emergency medical care is often provided for those who arrive with injuries. Additional goals including providing legal advocacy for women, help in finding jobs, and social services. Many shelters offer support in the form of group programs and individual advocacy for women and some provide programs for their children. Ultimately, battered women need to find affordable shelter and ways to support themselves should they elect to leave the batterer for good.

2. Support Groups for Battered Women

The primary goals of most support groups are keeping the woman safe from harm and providing education about the dynamics of woman abuse. In addition, support groups are often the source of information about a range of topics from effective childcare methods to obtaining housing. The main topic of conversation in support groups is the abuse that the women have endured. For those who have left the abuser for the first time, or those who have never told anyone about their suffering, it is empowering and eye-opening to hear quite similar stories from other women with a range of educational, economic, and cultural backgrounds. Only women with shared experiences can resonate so strongly to one another’s stories. Thus, the chief contribution of support groups within shelters is to provide a format for women to share and to explore what they have endured, and to then get help in becoming safe and avoiding the abuse.

3. Shelter Parenting Groups

When battered women elect to come to a shelter, they are often escaping from a severe assault, leaving in the middle of the night, and taking their children and possessions with them to an unknown place. This stream of events often leaves the women and children confused, anxious, and eventually angry. Yet the women must assume complete control over their children, at a time when they may feel least up to the task. In addition, children who have been traumatized by violence are often agitated and aggressive, making the mother’s job even harder. The problem is further compounded by having so many children in the same small space. Thus, support for the development of parenting skills is routinely provided in battered women’s shelters. These groups focus on behavior management techniques, on identifying children’s feelings, and on children’s developmental needs.

4. Substance Abuse

There is currently a debate about whether some women are beaten because their own substance abuse renders them vulnerable to attack or whether they self-medicate in response to being abused over a period of years. These may be two distinct groups of women. Either way, many abused women suffer from addiction to drugs or alcohol. Recent studies have shown that a far greater percentage of substance-abusing battered women did not use or abuse substances before the start of the battering. Some women have reported that the batterer encouraged them to drink or to use drugs. Others have noted that the batterer forced them to use alcohol or drugs along with him. Nonetheless, many shelters address the issues of drug and alcohol dependency in their efforts to help battered women survive. These efforts can take the form of classes, support groups, or transportation to existing programs in the community.

5. Advocacy and Placement

Individual advocacy is an important part of most shelter programs as many battered women must decide whether to file charges, whether to stay out of the abusive relationship, whether to get a job, an apartment, or food stamps—all while recovering from the most traumatic events in their lives. Most battered women face a number of adjustments that require action immediately following assault. Recall, however, that, for some women, the healing process often brings with it renewed energy, less depression, and release from debilitating fears and nightmares associated with the abuse. Yet for others, the healing process takes more time. Many abused women are left with PTSD symptoms and a realistic fear of re-assault for years after separating from the batterer.

C. Coordinated Community Response

The battered women’s movement has involved thousands of grass-roots workers and professionals, often battered women themselves, in efforts to combat violence against women. Most cities nowhave emergency hotlines, information directories, advocacy programs, and victim services. Many shelters and community groups work with law enforcement agencies, judges, and social service agencies to coordinate services from the time of the first emergency call to sentencing, treatment, and follow-up. In many states, volunteers and shelter workers have fought for legislation such as mandatory arrest laws and anti-stalking laws. The National Coalition Against Domestic Violence was established in 1978 to coordinate the efforts of workers from around the country and to disseminate information on various aspects of domestic violence.

1. Hospital/Emergency Room Interventions

Efforts are underway nationwide to train emergency room staff and medical students in the identification and treatment of violence against women. Currently, few medical schools spend more than a few minutes on evaluating and treating women for abuse injury. Studies of hospital clinics and emergency rooms reveal that many physicians do not recognize the signs of abuse and few ever ask the woman whether she is in a violent relationship or whether her injuries are the result of interpersonal conflict. When the batterer does accompany the woman to the ER oftentimes he may not be separated from the woman when she is questioned about her injuries. Clearly, policies aimed at educating emergency room personnel are needed to protect abused women and to facilitate the prosecution of the abuser. Just as in the case of rape, when a woman’s claim of abuse is backed up by medical reports and photographs of her injuries, the case will be stronger in court. Many feminists argue that woman abuse will stop in this country only after men in positions of authority are willing to take a zero-tolerance stand against such violence. This will take primary prevention programs. Thus, coordinated efforts are underway in some communities to train police, physicians, prosecutors, and judges to reduce their tolerance for violence against women.

2. Community Support Groups for Women

Many communities offer free drop-in groups for battered women that have the same goals as those run within a shelter. These groups provide support on an as-needed basis and rely mostly on education, referral to services, and the chance to speak with other women about their experiences. The group leaders may be volunteers, formerly battered women and/or professionals, and the number of participants varies from week to week. Many women go to drop-in groups as a first step in getting help. Thus, they differ from shelter groups in that some women may still reside with their partner, while others may be in the process of leaving, may have already left, or may have returned. Once again, the important contribution of drop-in groups is the opportunity to listen to other women with shared experiences. Most often community dropin groups are supported and run as part of the shelter program. Very few groups are provided by established clinical settings, such as mental health clinics, social service agencies, or private practice settings.

Some communities do provide longer term, or ongoing, clinical intervention groups for battered women. These are distinguished from drop-in groups by the stability of the group, for example, the same women return each week, and often by the presence of professionally trained group leaders such as social workers or psychologists. Ongoing groups take many forms and can last anywhere from several weeks to several years. Some programs are free, while others charge a nominal fee.

One program which adopts a feminist-ecological model in efforts to help women to overcome the effects of battering on their lives was created in 1985 by Ginette Larouche in Quebec, Canada. Feminists believe that woman abuse originates in a male-dominated society and that the responsibility for ending the violence rests with the community. The aims of the feminist model are to denounce woman abuse, to return responsibility for violence to the man, as opposed to the victim, and to focus on counterbalancing the negative consequences to the woman.

These groups take a social and psycho-educational approach that includes listening to the woman and providing active support, as well as clarification and education designed to explode myths perpetrated by the abuser. For example, many women come to believe that they are the cause of the violence against them, as batterers often cite small infractions by the woman as the reason for their violent behavior. Over time, some battered women come to believe the abuser and work diligently to avoid setting off a confrontation. These efforts are seldom successful and lead to low self-esteem, to self-blame, and to guilt, as well as to the risk of injury. Support groups provide battered women with information about their rights, available resources, and they empower women to endorse a broader range of gender roles. Along the way, it is hoped that tension is reduced, support is provided for reducing victim behaviors, and the woman’s sense of autonomy is restored.

3. Individual Treatment

The exact number of battered women who receive individual therapy for their problems is unknown. Clearly, one difference in who obtains individual treatment is socioeconomic status. The ability to pay is associated with private therapy, although some community mental health centers accept low-fee clients that may include battered women. It is interesting to note that the socioeconomic status of women who are abused usually does not reflect the total household income. Many battered women are denied access to money and so must rely on public services. An additional constraint is that of using insurance to obtain treatment. Often insurance companies reimburse the account holder, who is not atypically the abuser. Efforts to keep treatment information confidential and away from the spouse might prove unsuccessful and thus are not worth the risk to some battered women.

Women enter individual therapy for a number of reasons, most often having to do with relationships and emotional disturbances such as depression. Battered women who are able to find a supportive therapist, one who understands the dynamics of woman abuse, can build the therapeutic, bridging relationship needed to explore their current lives.

D. What Works and Why

One of the most frequently heard complaints of care providers and shelter workers is that, despite their efforts, so many battered women elect to return to their abuser. Yet it is essential to note here that most battered women eventually DO leave their abusive partners for good. In one study, 67% eventually separated from or divorced an abusive partner and did not return.

Studies of the efficacy of treatment and intervention programs for battered women are few. The goals of treatment for women usually do not focus on stopping the violence but rather on the degree to which the woman is empowered, has increased her self-esteem, has reduced her depression, and has heightened her sense of autonomy. Overall results indicate that those women who receive treatment improve more than those who receive no treatment.

Studies of the correlates of violence and women’s success at leaving the abuser show that both objective and subjective aspects of the woman’s life are important to consider. Objectively, battered women cite fear, lack of money, unemployment, and other economic factors as reasons for returning to the abuser. Subjectively, the loss of friends, loss of intimacy with the batterer, loneliness, facing the anger of other relatives, or a misplaced sense of responsibility for the dysfunction in their relationships are the interpersonal reasons given by battered women for not leaving the abuser. However, we know that many battered women are at highest risk for injury or even death when the batterer becomes convinced that the relationship is over. Thus, treatment programs that address these concerns are most likely to lead to success.

How abuse is treated shows that, for many women, community resources are absent. Without help, many battered women cannot leave the abuser. For example, few men who abuse their wives are arrested and convicted of this crime. In most communities, if the batterer had assaulted someone outside the home, the chances that he would be arrested are much greater than if he elected to assault his partner. Many battered women do not have an extended family who will support them, they do not have police who will come to the home and arrest the perpetrator of violence, they do not have shelters with room for them, they do not have judges who will issue and then enforce restraining orders, and they do not have access to affordable housing, and to treatment for themselves or their children. Programs should evaluate and then address the woman’s help-seeking history as part of the treatment she receives.

Just as there are different typologies of battering men, battered women’s experiences vary as well. Researchers have shown that the varieties of abuse experienced by the woman are related to her ability to leave the abuser. One-third of the battered women most likely to leave and to stay out have partners who are unstable, explosive, and severely abusive. About one-fifth are rarely physically abused, but experience severe emotional abuse. These women are most likely to have a stable relationship with the abuser and are most likely to stay. Another one-fifth have extensive and chronic abuse but may leave and return several times before being able to successfully live apart from the abuser. Approximately 10% leave only when the abuser starts to abuse the children as well. Those who are least likely to leave, who repeatedly go back to the perpetrator despite severe physical violence, are most likely to have a family history of violence, to have been abused themselves as children, and to think that violence is inescapable and expected. Programs to help battered women could take these typologies into account and tailor their services to the needs of the individual woman. In the future, outcome studies may include the entire community as the sample, to see whether education efforts have had an impact on attitude change, whether there have been fewer repeat offenders, whether arrest rates have increased, and whether the number of women who are abused by a partner each year has decreased.

III. Preventive Interventions for Children Exposed to Domestic Violence

A. Children’s Reactions to Witnessing Domestic Violence

Children whose mothers have been physically and emotionally abused are considered victims of family violence. We know from research studies that individual children respond differently to the violence, from those who evidence major psychological disorders and posttraumatic stress symptoms, to those who appear resilient and unaffected by the trauma. Approximately 40 to 60% of children who witness the abuse of their mothers are above the clinical cutoff level on measures of mood and behaviors. That is, they are in need of clinical treatment for their anxiety, depression, and aggressive behavior. In one study, more than half of the children who witnessed domestic violence had symptoms of posttraumatic stress, and 13% qualified for a full Posttraumatic Stress Disorder (PTSD) diagnosis—the diagnosis first given to returning combat veterans who showed extreme stress reactions to the atrocities witnessed during war.

Most children who observe violence in the family are worried and concerned about the behavior of their father and the welfare of their mother relative to children who have not observed such violence. Many of these children feel anxious because they harbor a terrible family secret—one that they often are unable to share with friends. In this instance, they may avoid or withdraw from social contacts. Other children may behave aggressively with peers and find themselves rejected by others, socially neglected, or avoided. Without some intervention, these lessons and reactions can interfere with a child’s social and emotional development. Yet there is often little opportunity for children to discuss their perceptions, worries, and fears, or to get new information.

B. Theoretical Assumptions of Programs for Children

Social learning theory tells us that children learn about violence and aggressive tactics as a result of being exposed to the abuse of their mothers. In the process children develop attitudes about violence, and learn lessons about power in relationships. Children are highly likely to believe that at least some of the blame for the parents’ conflicts resides within themselves. In some families, the children are directly blamed for the fighting in the family. As children get older, they are much more capable of seeing alternative explanations as causes for the events happening around them. However, children raised in violent families may either attempt to reject the aggressive behavior of the adults in their family, or they may attempt to wholly incorporate this aggressive behavior. Both approaches are problematic. For most children, these conflictual role models hamper the child’s efforts to move forward with a clear sense of competence.

Children’s reaction to the violence is mediated by their level of cognitive development. Preschool-age children are considered to be egocentric. That is, they understand the world in terms of themselves. Thus, younger children are more likely to blame themselves for their parents’ problems and/or to believe many of the threats made by the batterer. They are often frightened yet unable to discuss what is happening. Most children aged 6 to 12 understand that one person may have different feelings than another in response to different situations or events. In terms of understanding domestic violence, the school-age child is able to imagine various causes for the violence. In particular, the child can see the causes of domestic violence as beyond those immediately connected with her- or himself. The child also is able to play out or imagine other possibilities or outcomes to domestic conflict.

C. Programs for Preschoolers

While many communities have programs designed to aid and support battered women and to treat the batterers, the development of children’s programs lags far behind. In many communities there are simply no services available for children of abused women. When services do exist, they often take the form of drop-in groups in shelters. Programs designed for younger children most often have the goals of providing support and building self-esteem. For reasons stated above, younger children are less cognitively mature, and hence, less able to consider and to process the distressing events in their family. Yet they are no less affected by these events. We know from the few research studies on preschool-age children of battered women that they are more likely to have difficulty modulating negative emotions and solving problems in social situations than children who have not been exposed to such abuse. Therefore, programs that emphasize the role-modeling of appropriate social interaction may be very helpful to these children.

It is generally believed that the best way to help young children is to help their mothers. Thus, programs that focus on honing and developing better parenting skills, in addition to keeping the mother safe, indirectly serve to help the young child. Programs that involve both the mother and the child may be the most successful of all, as they focus on interaction and provide an opportunity to enhance and to support parenting efforts. However, many battered women need to have their own support before they can attend to the needs of their youngest children. In this case, child care and groups for preschool children are necessary. Also, many of the youngest children of battered women are often cared for by their older siblings. Efforts to include relief and skill building for these older children may be additional and appropriate ways to provide for the preschool age child’s needs.

D. Programs for Children Ages 6 to 12

The strategy most widely recommended for working with children of abused mothers is the small group format. These groups can be either ongoing, with the same children meeting over a set period of time, or drop-in, where the participants vary from week to week. Drop-in groups are typically found in shelters whereas ongoing groups for children are best suited for children in the community. Children who come to shelters following the abuse of their mothers are in need of an accepting environment, and of the self-esteem-enhancing activities usually provided by drop-in groups. It is a time when children need to recover and receive support in mastering their anxiety, but not to uncover their deepest fears and worries about the violence in their lives.

Before children can be expected to discuss the trauma in their lives, it is necessary to build trusting relationships. When these relationships are strong, they facilitate disclosure and the child’s acceptance of the group leader’s support. Thus, ongoing groups that build relationships both with the group leader and with the other group members are considered the most appropriate intervention strategy either before or after the child’s stay in a shelter. Efforts by group leaders and therapists to disconfirm negative stereotypes and distorted expectations about family and gender roles focus on experiential exercises, such as those described below for the children in one intervention group program. Strategies such as role playing or puppet play are expected to show greater changes in the children’s understanding of the experience of domestic violence over strategies using direct teaching, dialogue, or discussion alone.

‘‘The Kids’ Club: A Preventive Intervention Group Program for Children of Battered Women’’ is a time limited, 10-week clinical program designed by Sandra Graham-Bermann in 1992. This intervention is directed at three levels. The goal at the cognitive level is to improve the child’s knowledge base about family violence and conflict resolution. By expressing and identifying feelings, fears and worries associated with fighting in the family, children learn that others their age have similar, negative reactions to the violence. Discussions of safety planning teach children different ways of responding to violence. The goal at the social level is to build skills and to change behavior in interaction with others. Here, discussions of gender roles and practicing alternative problem-solving strategies provide a platform for discussing social behavior and expectations. At the relationship level the focus is on building trust and gaining support from both the group and the group leaders. Relationships with peers in the group are equally important in that there is a special quality of relief and comfort in being with other children who share the ‘‘secret’’ of domestic violence in their own families. This atmosphere allows children to feel less stigmatized and less alone in their distress, to exchange information and impressions, and to validate their feelings of outrage and sadness.

Children between the ages of 6 and 12 are accepted into two groups based on their age. They may or may not be living with the batterer. Each group is led by two therapists who receive weekly supervision of their work. Here, group leaders are master’s-level or doctoral-level clinical psychologists and social workers. The curriculum helps children to discuss a specific aspect of domestic violence and how it affects their lives each week, although there is no pressure for children to participate or to disclose anything about themselves or their families. In fact, all activities are designed to use displacement. For example, group leaders seek the child’s thoughts, referring to children as ‘‘experts on what most kids really think,’’ thus making it both safe and compelling for the child to give his or her advice.

As a result of participating in the group, it is hoped that children learn that the violence between parents is not their fault, that they have a right to feel angry at the perpetrators of the violence, and even at their mothers, and that they can employ a broader range of conflict resolution skills, along with the understanding that physical aggression is not an acceptable way of coping with family stress and conflict.

E. Parenting Support and Education Programs

One program designed specifically to address the needs of battered women through empowering them as parents was designed in 1994 by Graham-Bermann and Levendosky. Many battered women do not identify their own needs and are reluctant to seek help for themselves, but are often quite worried about their children. On the other hand, many battered women cite the children’s needs as a primary reason for staying with the abuser. Specifically, the women want to have a family, think it is important for children to have a father, and worry about whether they could manage raising children alone. When society reinforces the importance of having a man as the head of the family, many battered women feel caught in the bind of whether an abusive father is better than no father at all. Further, it is often difficult for women as mothers to claim power and to take control of their families. Battered women often struggle with asserting themselves as mothers and in handling aggression by their children.

The parenting support program provides basic education about domestic violence, advocacy for women to obtain services in the community, and a support group where the woman can share and process issues related to both the violence and to parenting children under these most difficult family circumstances. Two trained clinicians (social workers or clinical psychologists) serve as leaders for each group of approximately five to eight women. It is essential that the group leaders receive weekly supervision for their work, in order to reduce the potential for secondary traumatization from the many vivid and horrific stories that are heard each week.

The groups begin with each woman telling her story, including her present circumstances and concerns. A list of worries about children and concerns about parenting is kept. Each session emphasizes both the emotional and physical abuse as well as child-rearing issues. Along the way, these parenting topics are addressed— discipline and controlling negative behavior in children, mothers’ worries and fears about their children, the impact of woman abuse on the child, understanding children’s developmental needs, having fun with children, helping children to identify emotions, and communication in the mother–child relationship. Group leaders make referrals as needed to shelters, lawyers, doctors, and other advocates and community agencies that provide support for battered women.

This program is designed to serve only as a starting point for battered women to think about issues associated with domestic violence and raising healthy children. The aim is not to cover all that can be learned about any subject in a few hours’ time, but to provide an opportunity for the women to discover their shared concerns and to learn new strategies for dealing with the very real problems presented by their children. In this way it is hoped that battered women may experience a sense of empowerment as they become more effective mothers to their children.

F. Assessment of Intervention Efficacy

While the best programs are firmly grounded in theory and take into account the results of previous research on children exposed to domestic violence, we know little about whether these programs are effective and for which children they are most effective. Some of the risk variables that should be considered are the duration of the abuse, the number of abusive partners, other stressful family and neighborhood events, the child’s role in family violence, and the presence of physical abuse to the child. Protective factors may include the amount of support available to the child and the mother, as well as the response of the community to the violence. The timing of the assessment, relative to the violence events, should also be considered, as many children exposed to domestic violence do not show evidence of dysfunction at the time of assessment. These children may be either resilient or unaffected by the events, or more likely, they may show symptoms later. Finally, children whose mothers join support groups for abused women, or who remove themselves from a violent situation through separation and divorce, may be expected to fare better in treatment programs than those in families with ongoing abuse.

Some fathers successfully complete programs designed to address domestic aggression. Studies have shown a concomitant decrease in child abuse by some graduates of domestic aggression treatment programs. Thus, some children have seen a resolution to the battering, and have witnessed a parent acting in the child’s interest. Other children from woman-abusing families have extensive contact with positive male adult figures, such as grandparents or teachers, who may serve as alternative role models. Efforts to test the efficacy of intervention programs for children are underway in several states, with projects funded by the National Injury Prevention Center, Centers for Disease Control in Atlanta, Georgia.

IV. Preventive Interventions for Adolescents Exposed to Domestic Violence

A. Developmental Strengths and Needs of Adolescents

Teenagers are in an important transitional period in terms of gaining their independence and establishing their identities apart from the family, and in solidifying social relationships with friends. In addition, patterns of relating to others are formed with intimate partners during adolescence. For teens whose mothers are abused, these tasks can be complicated by the deleterious models of male and female adult behavior that they have witnessed and, perhaps, incorporated and taken as their own. Further, teenagers who have witnessed domestic violence are more likely to be depressed, to behave in antisocial ways, and to be physically aggressive and anxious than are teens from nonviolent families. In addition to the psychological scars, teenagers may be recovering from physical abuse and injury, as they are more likely to intervene in parents’ fights than are younger children.

The cognitive skills of teenagers vastly exceed those of younger children. At this point, most adolescents can consider many causes for events, can think abstractly, and can entertain a range of possible outcomes to events. They are able to take a longer time perspective and to envision their futures more clearly than are younger children. At the same time, biological changes require the management and regulation of more intense emotions, such as anger and love, as well as sexual urges. Programs designed to address their needs must take into account their longer histories of coping with domestic violence, as well as the developmental tasks of establishing themselves as competent, well liked, and independent from their families.

Research studies tell us that the long-term effects of witnessing domestic violence differ for boys and for girls, with many boys at-risk for repeating violence in relationships with others outside the home. Males who have grown up around men who use power and control tactics need to learn other ways of communicating and they to develop skill in nonviolent conflict resolution. Females who have witnessed their mothers as victims of violence, or have been abused themselves, may need to develop a better understanding of themselves as competent, they may need to learn more about self-protection and about intolerance for various forms of abuse and harassment. While complicated by many developmental changes, adolescence is considered a good time to intervene, as children are forming their own intimate relationships and are beginning to put into practice the models that they have learned.

B. Domestic Violence Intervention Programs for Teenagers

The program ‘‘Promoting Healthy, Nonviolent Relationships: A Group Approach with Adolescents for the Prevention of Woman Abuse and Interpersonal Violence’’ was created by David Wolfe in 1994. It was based on his extensive clinical work and research with children living in abusive homes. The three main elements of the program are information dissemination, skills development, and social action learning. The program is unique as it capitalizes on adolescents’ interest in forming and maintaining healthy relationships with members of the opposite sex. It takes a positive view of adolescents’ development rather than the ‘‘youth as problem’’ approach that characterizes many other intervention programs designed for this age group. Finally, the program includes the adolescents themselves in finding solutions to the broader problem of woman abuse in their community.

One-third of the program is focused on understanding gender stereotypes, attitudes toward women, and violence in intimate relationships. These concepts are placed in the context of the broader society as each adolescent seeks to expose myths and to learn the ways in which aggression against women is promulgated in the media and in the culture. Group facilitators work with questionnaires, active exercises, video presentations, and group discussion to explode myths and to get at the facts. Discussion of dating violence is included.

The second section focuses on skills development and requires change at the level of the individual. Here each participant works to improve the ways in which he or she interacts with members of the opposite sex. Males learn about noncoercive communication and listening skills, while females learn personal safety skills. Assertiveness training is geared toward empowering youth to take responsibility for their interpersonal signals and actions.

The social action part of the program actively engages group members in working together to identify and to challenge some aspect of violence in their own community. First, there is a series of exercises aimed at teaching group members about resources available to teenagers, men, and women in their community. Next, group members develop a social action or a fundraising activity in which they all participate. Examples include setting up a display about stopping sexual assault in a shopping mall and selling t-shirts to raise funds for a local battered women’s shelter. In this way teenagers put their skills to use on the broader community level. Along the way they learn to respect one another and themselves, to think differently about sex roles and family roles, and to develop healthier relationships as they work together to stop violence against women.

V. Preventive Interventions in Community Settings

There is considerable debate in the field as to whether it is better to move intervention efforts into established institutional settings—places that have traditionally not been responsive to abused women—or to focus on community-based services. However, help is needed throughout each community. A similar debate occurs over whether volunteers or professionals are best equipped to bring the most help to battered women and their children. Yet, these labels can be misleading when they dichotomize roles. For example, they do not recognize the number of professionals who are battered women, the number of volunteers who are professionals, and the professional training of shelter workers. Further, many theorists and researchers have taken an ecological perspective and they have conceptualized the problem and hence the solutions to woman abuse on a number of levels. On the societal level primary prevention has focused on national policy to bring attention to the problem and to obtain needed funds. On the community level both professional and volunteer workers share secondary prevention initiatives to provide services and to work on prevention with children. Some of these efforts are described below.

Social skills building and violence prevention programs are now offered in many schools. They are designed to offer education to all children but are considered to be particularly useful to children exposed to violence in the home. Typically, these programs include identifying feelings associated with violence, teaching and modeling alternative problem-solving skills, and demonstrating intolerance for violence at home, at school, and in the community. By addressing the problems early on, rather than waiting until after violent patterns have been established, it is hoped that all children can be empowered to respond to violence, and that those who have witnessed violence at home can get help. Concomitantly, some schools have trained teachers and counselors how to respond to children exposed to domestic violence and how to make referrals to provide for their needs.

Police departments in some communities provide training for dealing with domestic violence, for when and how to make arrests of batterers, for identifying battered women, and for providing for the needs of both women and children in the family following a domestic assault. These training programs include educating officers about the impact of domestic violence on women and children, and teaching them how to handle the often confusing presentation of abused women when asked to file complaints about the assailant, how to inform women of their rights to protection, and how to obtain services for victims of such abuse. Some police departments have developed domestic violence units and have hired social workers and psychologists specifically trained to work with women and children before and during the court process.

In some communities police department and battered women’s shelters work hand in hand to track abusers, to identify women at risk for repeated abuse, and to monitor compliance with the conditions of an abuser’s probation. Such efforts are sorely needed, as studies of both the training of police officers and the attitudes they hold toward domestic violence cases show that many officers avoid these calls or handle them quickly because they feel uncomfortable dealing with these issues. However, the legal understanding of domestic violence has come a long way from early identification of this as a ‘‘family problem’’ to our current understanding of the social, emotional, and economic costs to individual women, to children, and to the larger community.

Similarly, the legal community has expanded its understanding of domestic violence and what is needed to provide protection to women and children. Hence, many states have enacted mandatory arrest laws and antistalking ordinances with strict penalties and sentencing guidelines. There is currently some debate as to whether mandatory arrest reduces the occurrence of domestic violence or whether it puts the woman at greater risk for abuse. In addition, the cost of arresting all batterers has been a significant burden for some communities. However, research has shown that younger abusers and those with an active criminal history were more likely to abuse after a restraining order was issued than were older and less violent men. In the future, researchers should be able to provide more sophisticated answers to these questions as they move away from gross generalizations of whether mandatory arrest works to deciding for whom it works best. Then, policies and laws can be tailored to the needs of individual perpetrators and victims to provide the most effective, safest, and economical response to domestic violence.

Innovative educational initiatives sponsored by some communities include postering in subways and on buses and using billboards and newspaper advertisements in efforts to stop violence against women. Other cities have started campaigns with easily identifiable slogans and logos, such as ‘‘zero tolerance for violence against women.’’ In some areas businesses and other volunteer groups have worked with local shelters to sponsor communitywide events in support of stopping the violence. These efforts reflect the growing knowledge that societal attitudes that condone violence against women need to change. Challenging the culture of violence in communities is another way to protect women and to inoculate children against committing or tolerating violence in their lives.

VI. Conclusions

Domestic violence is a serious public health problem in America with far-reaching consequences for women and children. Efforts to stop the violence have taken many forms and include diverse settings such as community shelters, schools, courts, hospitals and clinics, and research institutions.

While treatment outcome research is in its infancy, there is some preliminary evidence that certain kinds of interventions work better for particular batterer types than for others, that some offenders may not be helped by traditional interventions, and that even brief intervention programs are better than no treatment at all. Group treatment is generally preferred to individual or couples’ treatment. Those batterers who drop out of treatment, and are therefore hardest to treat, are likely to be young substance abusers with a long history of violence.

Interventions for women generally take the form of shelter programs and group treatment programs. However, few communities offer interventions designed specifically to meet the needs of children exposed to domestic violence. While most battered women eventually do leave their abusive partners, those who have access to social and financial support, and who feel protected in the community and by the police, are more likely to leave.

Current efforts can be seen in communities that take an ecological or multilayered approach to the problem. That is, they offer coordinated responses to domestic violence in terms of primary, secondary, and tertiary prevention. Educational programs aimed at reducing the culture of violence against women and school-based programs that teach nonviolent problem solving and social skills are primary preventions. Dating violence programs for teenagers and psychoeducational intervention programs for younger children exposed to domestic violence are examples of innovative secondary preventions. It is hoped that in the future communities that take the initiative in preempting and combating violence against women will need fewer treatment programs and police units to respond to domestic violence after it occurs.

Bibliography:

1. Buzawa, E. S., & Buzawa, C. G. (1996). Domestic violence: The criminal justice response (2nd Ed.). Thousand Oaks, CA: Sage Publications, Inc.
2. Edelson, J. L., & Eisikovits, Z. C. (Eds.) (1996). Future interventions with battered women and their families. Thousand Oaks, CA: Sage Publications, Inc.
3. Edelson, J. L., & Tolman, R. M. (1992). Intervention for men who batter: An ecological approach. Newbury Park, CA: Sage Publications, Inc.
4. Graham-Bermann, S. A. (1992). The kids’ club: A preventive intervention program for children of battered women. Ann Arbor: University of Michigan, Department of Psychology.
5. Graham-Bermann, S. A., & Levendosky, A. A. (1994). The moms’ group: A parenting support and intervention program for battered women who are mothers. Ann Arbor: University of Michigan.
6. Larouche, G. (1985). A guide to intervention with battered women. Montreal: Corporation professionnelle des travailleurs sociaux du Quebec.
7. Saunders, D. (1996). Cognitive-behavioral and process-psychodynamic treatments for men who batter: Interaction of abuser traits and treatment models. Violence and Victims, 11(4), 393– 414.

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