Overview of the Problem

The FBI estimates that one woman is beaten by her husband or partner every 15 seconds in the United States (U.S. Department of Justice, Federal Bureau of Investigation, 1988). Every year, 2 to 4 million women in the United States are battered by a partner (Horton, 1992). According to the U.S. Department of Justice, Office of Justice Programs, 1 in 5 women who had been victimized by a partner or ex-partner had been the victim of three assaults within a six-month period (Harlow, 1991). A 1990 study by the Colorado Department of Health reports that incidents of domestic abuse among disabled women may be as high as 85 percent. Disabled women are also vulnerable to sexual assault (National Center on Women and Family Law).

More than 1 million women seek medical assistance for injuries caused by battering each year (U.S. Department of Health and Human Services, 1991). Twenty-eight percent of women who come to an emergency department with injuries due to domestic violence require admission to the hospital, and 13 percent require major surgical treatment; one-third of these attacks involve a weapon (Berrios and Grady, 1991). Eighty percent of abused women report their injuries to medical personnel on at least one occasion and 40 percent seek medical attention on at least 5 different occasions (Morrison, 1988). Abused women are more likely to seek help from their physicians than from lawyers or police officers (Mehta and Dandrea, 1988). Forty percent of assaults on women by their male partners begin during the first pregnancy; pregnant women are at twice the risk of battery (Martins, et al., 1992). Abused women are twice as likely NOT to begin prenatal care until the third trimester (McFarlane et al., 1992).

According to the Nebraska Domestic Violence and Sexual Assault Commission, an estimated 43 percent of battered WOMEN NEVER TELL ANYONE (Nebraska Commission on the Status of Women, 1991).

It is clear that while an enormous amount of resources are required to provide care and safety for those women who come to the attention of the authorities, neither the full force of the law nor the work of various committed advocacy groups have been able to provide a systemic fundamental long-term remedy for this critical public health hazard.

The availability of appropriate laws and statutes mandating the police to arrest batterers, the willingness of the District Attorneys to prosecute and the judges to issue orders of protection have resulted in exposing the complex, multi-determined reality along with the insufficiency of our conceptualization of the problem.

While it is clear that in respect to the cases that come to the attention of Victim Services the courts and other agencies, women's fear for their own and their children's safety play a central and motivating factor in their seeking help, fear is not the only emotion requiring attention. Intense rage, the tenacity with which the aggressor remains involved with the victim and vice versa, the ambivalence exhibited by the victim when the question of pressing charges and testifying against the abuser is raised, must all be taken into account when devising a more effective strategy against the physical and mental health devastation caused by abusive patterns of interaction among intimates.

Contrary to what may be expected, resorting to physical aggression in navigating the intense emotional arena of intimate relationship does not create a sense of power and effectiveness in the aggressor. Both the intimidating party and the frightened victim experience a sense of powerlessness and misery. The aggressor is often full of remorse and the victim apprehensive and baffled. It is clear to both parties that a frighteningly significant event has taken place, but both try to deny its importance, to promise that it will never happen again, to blame it on too much alcohol, too much pressure at work, a terrible misunderstanding, etc., etc. It is rarely, if ever, viewed as a symptom of a potentially malignant process in their relationship.

At times, the first slap or punch, etc. may indeed be the only occasion that loss of control occurs, but the more likely scenario is that of repetition and escalation of destructive behavior, sometimes ending in such catastrophic events as homicide and suicide.

Unlike other acts of violence, the goal of the aggressive act among intimates is not to create distance but to bind and enmesh. The flight of the victim is not experienced as a victory by the aggressor but a further affront. Total submission and virtual enslavement of the victim to the aggressor does not appease but seem to enrage even further. Indeed, most often, the aggressor does not hide when the enormity of abuse is obvious to all, but promises to continue to follow, stalk or harass his tormented victim even as he is convinced that he is the one being tormented and or abused. It is reported that seventy-nine percent of spousal abuse is committed by men who are divorced or separated from their wives (Harlow 1991).

The unique characteristics of psychological and physical battering between intimates indicate that the behavior pattern must be viewed as a disorder of an interpersonal relationship that is reinforced and validated by cultural and political norms. Bio-psycho-social factors as well as historical, cultural and economic issues play an important motivating role in all individual behaviors including aggression. Personal relationships are played out against and through a socio-political background that validates traditional gender differences and power differentials. The cultural roles of man/woman husband/wife partner/lovers have within them the seeds of potential conflict and abuse.

Societies over evaluation of males and their resulting sense of superiority and entitlement gives them a false sense of adequacy and self sufficiency which is sorely challenged when confronted with the difficult task of navigating interpersonal situations. Concurrently, socialization of female children imbues them with the expectation of being taken care of, led and cherished by men and unequipped to deal with partners who make irrational demands, isolate intimidate and torment them. The added sense of being responsible for the health and longevity of the relationship as well as believing that "everything will turn out right if I just do the right thing" -- disenables many women from developing an adequate sense of autonomy and agency.

As it has become clear that good intentions and mutual attraction do not guarantee the success of intimate relationships, it is necessary to identify the skills needed to negotiate this emotionally charged arena and to provide counseling when the earliest signs of problems appear. Various social agencies and institutions can educate and make appropriate referrals, physicians can ask and identify symptoms of destructive interactions and offer help long before the first slap or punch -- or before the only available avenue of intervention or help is through the criminal justice system.

Disorders of Intimacy Paradigm

Choices Mental Health Center Disorders of Intimacy Paradigm has been developed to address the treatment needs of couples involved in patterns of interactions that could and often do lead to violence. C.M.H.C. is committed to addressing the range of needed therapeutic interventions to prevent and reduce the incidence of what has heretofore been labeled "domestic violence". To that end, C.M.H.C. has developed a theoretical framework applicable to multi-ethnic, multi-cultural, heterosexual and same sex partners which allows us to provide treatment for the individual and/or the couple depending on the dynamics, needs and abilities of the parties involved.

C.M.H.C.'s short-term, focused, treatment model has been designed after extensive clinical experience and a thorough review of research in the area. There have been many and various theoretical constructs defining the etiology and treatment of domestic violence. Historically and currently these theories have been viewed as conceptually mutually exclusive or politically adversarial, resulting in a general failure to effectively address the escalation of the problem. C.M.H.C.'s eclectic approach allows intervention on various points of the cycle of abuse and maltreatment in order to prevent the onset of physical violence as well as prevent its escalation and reduce harm when it has occurred.

Our program is designed to address the political and psychological aspects of the problem without further re-victimizing the victim of violence--or demonizing the abuser. It is well known that there are indeed women who continue to stay in abusive relationships because there are positive emotional and psychological bonds. Others stay because they feel their lives would be further endangered if they leave. We will not further shame and victimize the woman who wants to maintain her relationship. On the other hand, we will not cast the abuser in the role of a pariah. We believe there are victimizers who want to and can be helped to change.

C.M.H.C. has reframed and renamed the issue of domestic violence as Disorders of Intimacy in order to address the continuum of abuse and the need for harm reduction strategies. As a misguided communication strategy between couples, violence must be addressed in the context of their relationship.

Choices Mental Health Center treats:

• the batterers who need to be removed from the home and be in treatment before any possibility of reconciliation takes place ( if this is desired);
• the batterers who can acknowledge their unacceptable behavior and can respond positively in couples counseling;
• the victims, some of whom have successfully left violence behind them and some of whom find themselves leaving one abusive relationship for another; and
• the couples, men and women and men and men and women and women who find themselves bound to one another in spite of the violence.

C.M.H.C. will also treat the families who have been impacted on by the violence.

No one strategy can hope to treat the dysfunction represented by disorders of intimacy. It is our responsibility to help maintain the emotional integrity and physical safety of the victim, continuously acknowledge the responsibility of the batterer and when present, support the couples desire to remain together. All of this is done in collaboration with the law enforcement and court system as well as broader community supports when available.

In order to end the violence in the home, treatment can be with: the victim, the batterer and/or the couple.

PART II

PART III

For more information and to request a copy of the complete paradigm, email 74013.352@compuserve.com, call or write to us at the address given below.

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CHOICES MENTAL HEALTH CENTER
29-28 41st Avenue / Long Island City, NY 11101-3303
Mental Health patient calls: 718-937-5000
Rape Crisis Hotline: 718-729-8888
Mental Health administration: 718-392-6200
Mental Health fax: 718-392-3060