Domestic Violence and Systemic Interventions

Assessment Strategy

My first assessment priority for this client is her safety. In our initial conversation, I would assess her interpretation of her husband's threat of violence in the event that she would file for divorce. I would ask questions like: "Has he said anything like this before?" "Is this the first time you have felt afraid of your husband?" "Has he ever hurt you or your daughter?" "Does he have access to weapons/do you have weapons in your home?" "What do your fights look like?" "Does he use alcohol or drugs?". It is critical to ask these questions in a non-judgmental way that references specific behaviors (like kicking or slapping), as many people do not consider certain behaviors as violence (Stith, 2000). This information would inform the development of a safety plan going forward. If this is the first time such a threat has been issued, or she feels there is low risk of harm in her marriage, other assessment priorities would include her feelings about her husband attending therapy with her, and her goals for their marriage (whether or not she is open to working through issues or definitively wants to leave).

Assuming that she wants to work on her marriage, I would assess the feasibility of working with both partners. If he is agreeable and comes to therapy with her, it would be important to assess family of origin violence, cultural factors, gender roles and expectations, and strengths and resources in the relationship, as well as within each partner (Stith, 2000). After working to develop trust with the couple, I would conduct separate interviews and use the Conflict Tactics Scale (CTS), an 18-item instrument that includes 8 items specific to physical aggression (Stith, 2000). If it is determined that violence has occurred within their marriage, a thorough assessment regarding the lethality of the violence would need to occur. Asking questions that pertain to the severity, frequency, timing of the violence, and her beliefs about the level of danger of the situation would be critical, as studies show that victim's predictions of the risk for severe assault is a good predictor of dangerousness (Stith, 2000).

Presence or Absence of Domestic Violence Incident Without any history or additional assessment information, I would unable to detect a domestic violence incident based on the brief description in the clinical vignette. However, if additional assessment information yielded insights that domestic violence had occurred, it would be critical to determine what type of violence is occurring in the relationship. For example, Johnson & Leone (2005) describe intimate partner violence as two different types: one type that aims to control the relationship (referred to as intimate terrorism), and the other stemming from stressors related to specific conflicts (referred to as situational couple violence). If the woman's husband is attempting to exert control over her through other ways (such as limiting her social connections, financial resources, etc.) intimate terrorism is a better categorization of the situation. Importantly, specific behaviors such as stalking or spying on a woman place her twice as likely to become a victim of fatal violence (McFarlane, Campbell & Watson, 2002).

Cultural considerations for effective treatment

To provide culturally-competent and effective treatment for my client, it is important to understand the cultural context and intersectionality of her identity as a Jewish woman. A thorough discussion to assess her role and specific cultural practices that are important to her may help bring out strengths, as well as shed light on other ways her husband's actions have been hindering her expressions of self. As Cares & Cusick (2012) note, many abusers attempt to warp Jewish laws and customs to create an abusive situation that is reinforced by cultural norms within the Jewish community. Additionally, the get process (the term for marriage dissolution or divorce between two Jewish people that goes through Jewish rabbinical court) is fundamentally difficult for women, as only the husband can grant a get and he cannot be forced to give a get. Without an official get, a woman may live with great social costs and although she may live separately from her husband, she cannot remarry or have "legitimate" children under Jewish law (Cares & Cusick, 2012).

Additionally, with a strong emphasis on family and reconciliation, especially during holidays, women may find great difficulty approaching a Rabbi of other members of the faith community for help, and may feel guilt, shame and failure for not upholding and presenting the family as a fully-functioning unit (Cares & Cusick, 2012).

Proposed Intervention Strategy

The first step in the intervention strategy is determining what type of intimate partner violence is occurring, whether it is intimate terrorism or situational couple violence, as each type produces different consequences for women (Johnson & Leone, 2005). Pinpointing the types of violence through the use of validated instruments help mental health professionals differentiate the context of the issue and use appropriate interventions with the couple (Johnson & Leone, 2005). In the case of intimate terrorism, couples counseling would be not only inappropriate, but also dangerous. If the issue is categorized as situational couple violence, counseling can facilitate skills related to problem solving, managing anger and resolving conflicts. (Johnson & Leone, 2005).

Assuming this client's experiences can be categorized as situational couple violence and her husband is willing to come to therapy, systemic treatments based in the Couples Abuse Prevention Program (CAPP) can help address risk factors through cognitive-behavioral couple treatment (Stith, McCollum, Amanor-Boadu & Smith, 2012). CAPP is appropriate in situations categorized as low-risk for couples with a history of minor to moderate physical and/or psychological aggression (Stith, 2000). By aiming to improve relationship satisfaction and decrease the risk of violence, CAPP addresses negative attributions, while facilitating adaptive communication patterns, and problem-solving issues (Stith, 2000). With the primary goal of CAPP for the couple is to have an abuse-free relationship (Stith, 2000), the approach begins with both partners acknowledging the issue of abuse and committing to work together. In the first session of CAPP, the couple is given an overview of the program and complete a contract agreeing to non-violence.

This contract also includes their goals for therapy. Reviewing and revising goals is assigned to the couple as homework. The next session focuses on the revision of treatment goals and learning about constructive and destructive communication processes. Homework following this session focuses on practicing anger management strategies. In the third and fourth session, the couple learns more about expressive and listening skills and they are tasked to practice these before the fifth through seventh sessions that focus on resolving problems without abuse through communication and probem-solving. In the final sessions, communication and problem-solving abilities are enriched with an emphasis on recovering the relationship (Stith, 2000). Within this intervention strategy, it is critical that if the no-abuse contract is violated, appropriate treatment changes occur.

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