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Spouse / Partner Abuse > Chapter 2, Part A
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SpeedyCEUS
Spouse and Partner Abuse Chapter 2, Part A: Assessment
II. Assessment Destroying possessions or treasured objects, hitting walls, breaking doors, abusing and/or killing one's pets are acts of psychological domestic violence. (CAADV, 2005) Women who appear for physical abuse may additionally have been victims of psychological and sexual abuse. Optimally, social workers should assess for psychological and sexual abuse and, should they be present, attend to the consequences of these types of abuse in interventions with battered women. Focus on physical abuse alone may not be sufficient in helping women with violence and safety (Macy, Nurius, Kernic and Holt, 2005) This is part of the reason why assessment of spousal/partner abuse is complicated, involving multi-levels of assessment. The first task is to determine if and what types of abuse are taking place. Second, the professional healthcare provider needs to understand the emotional and psychological issues that are involved in abusive relationships. This includes the psyche/profile of the abuser, the victim and the relationship. Third, the cycle of violence needs to be understood, taking into account how these cycles spiral into more serious violence. Assessment also needs to be understood in regards to cultural factors and the characteristics of those who seek services.
A. Detection: Is there abuse? I’d get worked up waiting. I believe it was just a matter of luck. Maybe this time a nurse would look at me and know. A doctor would look past his nose. He'd ask the questions. He'd ask the right question, and I would answer it and it would be over. Charlo was always with me. He was always there. Behind the curtain was the only time I was alone. His shadow on the curtain. A few minutes. One question. One question. I'd answer; I'd tell them everything if they'd ask......Ask me." Roddy Doyle, 1996 (as found in Fisher et al., 2005) Victims, for reasons addressed below, are often hesitant to disclose when they are in an abusive relationship. They often do not say directly, "my partner is abusing me." For this reason the professional healthcare provider needs to know the red flags/signs of abuse in order to determine if abuse is a factor in why the individual is seeking help. These red flags are behavioral, and manifested in present and historical physical symptoms. The following is from
Behavioral symptoms that would trigger a cause for concern include: 1. Patient's behavior o Discrepancy between physical findings and verbal report of injury. o Vagueness about cause of injury, for example, "bruise easily." o Evasive when questioned about injury. o Delay between time of injury and seeking treatment o Non-compliance with medical advice, especially when non-compliance is life threatening. 2. Patient and partner relationship o Expressed or observed fear of partner o Reluctance to speak in presence of partner o Overly protective or controlling partner o Intense irrational jealously or possessiveness expressed by partner or reported by patient o Inappropriate behavior by partner (lack of concern, over concern, threatening demeanor, reluctance to leave partner) 3. Possible indirect indicators o Depression o Addictions to prescription medications, alcohol, and/or illegal drugs o Symptoms of post traumatic stress disorder, for example, exaggerated startle response, nightmares, sudden panic attacks, emotional numbness, and statements about expecting to die in the near future o Suicide attempts o Isolation from friends and family-only ties seem to be with partner o Work absenteeism/lateness o Indirectly brings up the subject of abuse. o Directly brings up the subject of abuse.
Physical symptoms that are red flags for abuse: o Chronic pain and /or areas of tenderness especially at the extremities o Bruises, welts, edema or scars, particularly in the genital and anal areas and the breasts o Swelling of eyes o o Unconjunctival hemorrhage o Signs of choking on throat o Intra-abdominal injury o Shoulder dislocation o Chronic pelvic pain, particularly without obvious somatic pathology o Chronic headaches o Chronic GI problem o Sexual assault Historical Physical Indicators of Domestic Violence include: o Pattern of emergency room treatment for injuries o Bruises in various stages of healing o Past fractures in various stages of healing, especially of facial bones, spiral fractures of radius or ulna, fracture of ribs with no reasonable story for the mechanism of the injury o Limited motion of an extremity o Past injuries while pregnant o Spontaneous abortions/series of miscarriages o Closed head injury Whereas the physical symptoms of abuse are easier to view, it takes the skillful provider to notice and assess the behavioral indicators. Through exploratory questions the providers can encourage the victim to discuss their abuse more openly. Suggested ways to frame questions regarding abuse include: "I'm concerned that your (symptoms, injury) may have been caused by someone hurting you. Has someone been hurting you?" or "Sometimes when I see an injury like yours, it's because somebody hit them - did that happen to you?" (UMICH, 2005) These questions are effective because the provider is showing care and concern for the victim while simultaneously inquiring about the possibility of the abuse. Suggested questions regarding suspicions in a relationship can be presented this way:
"Sometimes when people tell me they are stressed, it has something to do with a relationship they are in. I am wondering if there might be something bothering you in your relationship with your boyfriend?" "Tell me what happens when you don't agree with your partner." "Has your partner ever hit you or physically hurt you?" (UMICH, 2005) Again, the provider is showing empathy by inquiring about the causes of the patient's stress, and then inquiring as to the possibility of its cause being some type of violence. When red flags or symptoms do appear, it is important for the provider to follow up on these by asking questions in a similar manner. The tones of the questions are not attacking but show care and concern. The framing of these questions are important in order to find out if there is spousal/partner abuse present. Adults can often hide the effects of abuse. Healthcare providers have not been taught with as much attention to identifying adult victims of abuse whereas child abuse awareness and the red flags of it are more widely known. Providers have been trained to be vigilant in the detection and reporting of child abuse. With the prevalence and danger of spouse/partner abuse it is essential for providers to have a similar awareness regarding the abuse of intimate partners.
B. Profile of the Abuser, the Victim, and the Relationship. Domestic violence is a pattern of coercive behavior [perpetrators use] to control their partners, involving a physical assault or the threat of physical assault. (UMICH, 2005) What are the characteristics of the abuser? Abusers do not look different than others, do not speak different than others and in fact, do not appear different than anybody else. They may appear as very kind and friendly in public, even as someone who is enjoyable and fun to be around. In public they may also be loving to their spouse and family, and often only display their temper behind closed doors. There is no single description of an abuser, other than that they are usually male. Frequently the abuser has low-self esteem. It is important to remember that abuse is not an accident. Rather, it is an intentional act that cannot be blamed on alcohol or drug use. (Eicher, 2004) As mentioned, the abuser is responsible for the choices they make. The abuser often uses the abuse as a way to exert power and control over another. Abusers use the abuse to get what they want. They often minimize the abuse, or blame the victim, and have a history of having been abused themselves. The abuser may feel remorse for the abusive episode, and may believe that they will not do it again, however, the assault usually continues to escalate in severity and frequency. (CAGO, 2002). Socioeconomic indicators associated with the abuser include men who are African American, young, divorced or separated and living in rented housing. (Rennison and Welchans, 2000) Society's Response to the Abuser Society's response to the abuser has evolved over the years to a greater level of criminal accountability. That is not to say there is not some debate about the subject. In her book Insult to Injury: Rethinking Our Response to Intimate Abuse, Mills (2004) asserts that sending abusers to jail is not productive to changing the cycle of violence, but that they need guidance and counseling instead. This assertion resulted in the following response to the book by C. Douglas Kern, a former special prosecutor for violence against women in TRUE story, from Insult to Injury: A man beats and rapes his wife; later, he holds a loaded gun to her head in front of her small children. His guilt is indisputable. Total punishment: six months of incarceration, followed by a term of probation. Now, complete the following statement. "The six months of incarceration was a travesty because ..." (a) "the sentence was absurdly short; serious crimes require serious punishment" or (b) "the sentence was absurdly long; the victim wanted counseling for the offender, not punishment, so incarceration was unduly harsh." Did you choose (a)? Linda Mills, a professor of social work at Under the status quo, Mills complains, it is prosecutors, not victims, who make the decisions in the criminal-justice system. Policies that are tilted toward prosecution fail to acknowledge that women themselves perpetuate domestic violence by abusing children; and, of course, the system is biased against the poor, the black, and the disenfranchised. This is vintage left-wing criminology, with the flavor notes unique to the memorable 1967 harvest: Crime is never a choice, society is to blame, and punishment is merely avoiding the problem. In lieu of punishment, Mills advocates Intimate Abuse Circles. May I propose that no aspect of crime has ever been or will ever be solved by the use of anything involving the words "Intimate" and "Circles?" Forget jail; now you can be "punished" with the punishment no criminal dreads: hours of harmless blather. Mills wants experts to meet with abusers, abusees, and their family and friends to discuss abuse problems. And whereas mandatory prosecution is "playing God," "human transformation should be the heart and soul of the Will ill-socialized men feel anything but contempt toward covens of experts yammering about "communication"? Such efforts will indeed earn the contempt of the more inarticulate abusers, most of whom are no strangers to the lectures of well-meaning professionals with degrees in social work. And the crafty, manipulative abusers will learn from these Intimate Circles a new lexicon of buzzwords and catchphrases with which to dazzle judges and probation officers at future sentencing hearings. Mills is correct on one point: Current policies ignore the wishes of most domestic-violence victims. For this, I believe, we should be thankful. You can beat these victims senseless; you can scar them for life; you can torture them for days and reduce their children to whimpering nothings, and still the stories won't change: "I can't live without a man in my life"; "I need his paycheck because I just can't work a job"; "I know he'll change with some counseling"; "It's all my fault." To give these pathetic delusions any credence "empowers" no one. When Mills airily characterizes the lies and excuses of domestic violence as "narratives," she condescends to abusers and abusees more completely than criminal laws ever could. Criminal laws assign victims and abusers responsibility for their actions and for the truth and falsehood of their words. To Mills, words--and, for that matter, criminal laws--are just tools with which to promote or deny psychological adjustment. At no time does Mills reflect any awareness that spousal abusers should be punished because they are spousal abusers. And yet she advocates mandatory jail (yes, mandatory, thus contradicting the whole point of the book) for men who act violently after enduring her precious Intimate Abuse Circles. To Mills, ignoring the wisdom of the experts seems to be a far more serious crime than attacking others. Words often substitute for reality in Insult to Injury. For example, Mills argues that women are just as abusive in relationships as men are. How? Mills expands the definition of "intimate abuse" to encompass physical and emotional abuse. And since every wife-beater can grumble some complaint about emotional abuse, then--presto!--women are as abusive as men. To Mills, words are violence, and words can dispel violence. Harry Potter's magic incantations should be so effective. Insult to Injury is surprisingly old-fashioned. It sanitizes every hoary cliche about domestic violence that ever dripped from the lips of the sleaziest defense lawyer…and the right of women to degrade themselves in the manner of their choosing is a right that every wife-beater will cheerfully defend. Oh, and as for the monster who served six months? His sentence was so short because the victim found a prosecutor who agreed with Linda Mills. His probation was a failure. He never stopped blaming the victim for his crimes. Such is the world Linda Mills apparently wants for you and your daughters. Reject it. What do you think? Characteristics of an abusive relationship Abusive relationships are often somewhat of an enigma to people. It would seem obvious that if somebody is being abusive, that the victim would leave and/or press charges against the abuser. One question that is frequently asked is why the victim does not leave. The answer to this question is often complicated as the setting of abusive relationships are presented in a variety of circumstances. The characteristics of abusive relationships form barriers to assessment. The victim is reluctant to disclose to the provider out of fear of the consequences. So the provider must be aware of the red flags and symptoms of partner abuse. The provider also needs to create an open and honest therapeutic environment. When a victim feels they can be safe in disclosing information, that it can make a difference, or that there is somebody who cares, they will be more likely to disclose the abuse. These relationships maintain complicated physical and emotional issues that are tied into intimate and cohabitational relationships. These issues contribute to abuse being underreported. For example, a woman who has children, with little schooling or work experience realizes that if she leaves the abusive mate, it places her, and her children in poverty with no home, no money, and little hope. At least there is food and shelter residing with the abusive mate. The victim in this case may not leave because of the prohibitive feelings of guilt for taking the children away from their father, especially if the father is not "physically" abusive to the children. There are also cultural and religious factors that may impact the definition of the relationship and play a role in the victim's decision to stay in the relationship. As shown in the cycle of violence, the abuser will make promises to change, and the victim wants to believe it is true so much that they will stay, even if those promises have been broken repeatedly in the past. (CAGO, 2002). In studying the relationships involving domestic violence in the The following is an interesting and informative look at the anatomy of the abusive relationship and suggests the possibility of, not excusing, but understanding the abuser in the formulation of treatment.
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Spouse / Partner Abuse > Chapter 2, Part A
Page Last Modified On: July 8, 2008, 04:34 PM
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