Personality Factors Associated with Domestic Abuse: The Importance of Perspective

1. Personality Factors Associated with Domestic Abuse: The Importance of Perspective Angelique Jenney, M.S.W.(PhD Candidate) Director, Family Violence Services

2. OVERVIEW OF THE PRESENTATION • Why is this issue important? • Impact of abuse/trauma on Interpersonal Relationships - • Importance of Perspective • Challenges to Practice

3. Prevalence of Domestic Abuse in the Population Domestic Violence: • 29% of women ever married, or living in a common law relationship have been physically or sexually assaulted by their intimate partners at some point in their relationship (Statistics Canada 2000) • It is estimated that about half a million children are exposed to domestic violence EVERY YEAR in Canada (Dauvergne, & Johnson, 2001) Co-ocurrence of Other Forms of Trauma with Domestic Abuse: • Experiences of War, Immigration • Historical childhood abuse (physical, sexual, emotional/neglect)

4. Why Where You Come From is Important: History/Context • The quality of the environment directly influences the quality of caregiving - which is how we all learn to modulate stress • This care then ‘influences the development of the brain and in particular, alters the development of particular genes (largely responsible for stress/danger response). • “Under conditions of poverty, animals that are most likely to survive are those who have an exaggerated stress response” (Meaney, as cited in Begley, 2007 p.175)

5. Understanding Individuals who have Experienced/Perpetrated Domestic Abuse • Experiences • Thoughts/ • Feelings • Behaviours • Needs

6. Effects of Experiencing Domestic Abuse and the Impact on Behaviours • hyper-arousal, numbing of emotions, and avoiding traumatic stimulus • aggression or withdrawal • disruption in sleep patterns, eating, lowered self-esteem, and feelings of helplessness and hopelessness • Depressive and anxiety disorders • Physical health problems (chronic pain etc. and symptomology with no apparent biological/physical cause) • Cognitive distortions (making sense of the unthinkable) • patterns of dysfunctional relationships (disorganized attachment/traumatic bonding) ‘dread to repeat vs need to repeat’ “We inhabit our histories, and our histories inhabit us” -Angela Davis

7. Trauma, the Environment and Development A Lesson from the natural world…

8. No predator - remains unarmed Odor of predator - the same genetic clone grows armour - MOVE that one to the no-predator aquarium - armour recedes! Female water flea who has been exposed and then placed in predator-free zone - lays eggs - offspring are fully armoured Nature vs Nurture: The Case of the Water Flea

9. Handled vs Unhandled More exploratory Less fearful Less reactive to stress when adults The reason? Handling increased Maternal Licking Behaviours! High Lickers: Mellow, well-adjusted rodenthood Grew up to be HLs Low Lickers: Fearful, stressed-out Grew up to be LLs Switch them up? LLs HLs HLs  LLs Nature vs Nuture: The Case of the Lab Rat

10. Oh The Possibilities!

11. Ironically…. Survival of the fittest (or most stressed out in this case) • Stress hormones offer a certain amount of protection in threatening environments - not all behaviours are maladaptive (e.g. hyper-vigilance could be protective) • Problems begin when stress response is prolonged without a break (not just in our clients - ourselves) • Homeostasis (body resilience)

12. Caution: People Are More Complex Than Rats (thank goodness!) Opportunities for conditions to be mediated by social supports.

13. Trauma and the Brain: the science behind behaviours • Experience changes the brain • Trauma is encoded in the language in which it occurs • What fires together - wires together (understanding the power to repeat) • Different parts of the brain process emotion - in words and feelings - if that process is separated - problematic (this is what EMDR attempts to address) • Memory is an interpersonal process • Insight doesn’t necessarily lead to change

14. Trauma and the Brain: • Direct connection between trauma, prolonged stress response, and resulting disrupted neurodevelopment…. • Leading to social, emotional and cognitive problems…. • Which may then lead to ..health risk behaviours (smoking, substance abuse etc.)…difficulties with affect regulation and subsequently relationships.

15. Discourse around Trauma • Mind Over Matter sends the message that your mind doesn’t matter to me…. • A Hidden Injury - not hidden for those living with it • What may be seen as a problem, bad habit, or self-destructive behaviour may actually be a coping mechanism or adopted solution for an unknown traumatic life experience • Never assume that the trauma you are intervening with is the most influential event in the person’s life • Our expectations should not do harm to families

16. Challenges to Recovery • Inability to make connection between symptoms and previous experiences (actions/behaviours) - so change is problematic! • Unwillingness/inability to talk about or remember traumatic experiences • Getting worse before getting better is not that attractive! • Feeling defensive/protective of family - potential that victimization is ongoing (adapted from Perry, 2003)

17. Maintaining focus of intervention within context of abuse/trauma • Recognition of the issues, needs and expectations of the patient-doctor relationship • Reality checking and grounding in the present • Recognition of strengths and limitations of both doctor and patient • Recognizing and responding to evocative emotions • Helping patients access resources/material supports to meet tangible needs • Using skills in engagement as well as goal setting • REPEAT, REPEAT, REPEAT (this issue took years to become entrenched, we must think about longer term intervention)

18. VOLUNTEERS???

19. Importance of Perspective Appreciating/managing diversity: • cultural differences in the expression of emotion • Differences in thoughts/beliefs about relationships particularly about marriage, parenting and child development • recognizing, surviving and working through miscommunication

20. Recognizing Diversity • Individual differences contribute to the human experience - including the likelihood of getting the full benefit of community resources • Stresses inherent in poverty bring out personality differences and accentuate their implications for receptivity to helping relationships • Individual differences tend to be especially apparent under conditions of difficulty.

21. How do people manage trauma?

22. Engagement and the Importance of Relationships • Quality of personal relationship or working alliance between doctor and patient is central to engagement levels • Client’s relationship history may affect his or her ability to engage effectively • Personality is linked to the quality of individual’s interpersonal experiences and expectations • strong relational base will be protective factor in the event of difficult decision making (challenging risk behaviours and reporting to authorities)

23. Acts of Resistance or Survival? • Challenging the legitimacy of professional claims or expertise • Non-compliance with physician’s direction • Concealing practices such as contact with abuser (possibly to present herself as compliant) • Actively avoiding services • Ambiguity between wanting help and resisting scrutiny (McIntosh, 1987; Bloor & McIntosh, 1990)

24. Engagement:Finding the Connections The need for empathic connection - the only way to get through difficult areas - find a way to understand and care Build on: • Use the knowledge base of child development and infant research: (attunement, joining, yielding, tracking) • Harm Reduction Compromise (e.g. leaving may be more frightening than staying; so support staying with a solid safety plan)

25. What You Can Do: Have posters/pamphlets (educational/service related) about domestic violence in your waiting room (research shows it increases patient comfort with disclosure (Ahmad, 2009) Know the people in your neighbourhood (pass the baton) Never underestimate the power of listening and acceptance (change takes time; you want them to keep telling you) Intervene when you must (child welfare, police) Follow-Up (the last time I saw you…how are things now?) Keep it in perspective (windows of opportunity)

26. What to Avoid: Assuming patients will get the help they need from someone/somewhere else (health care providers are often the first point of contact and sometimes the only point) Prescribe a bitter pill (if you know they won’t take it) Not having a back up plan (These patients WILL catch you off guard - consider it like any other medical issue - suggest a follow up visit) If all else fails: “I’m glad you told me”

27. Key Provincial Resources: Assaulted Women’s Helpline (24 hr crisis line) Toronto: 416.863.0511 Toll-Free: 1.866.863.0511 http://www.awhl.org/ Shelternet (access to shelters and on-line safety plan) http://www.shelternet.ca/en/ Kids HelpPhone (24 hr crisis line) 1-800-668-6868 http://www.kidshelpphone.ca/

28. LANDSCAPES EXERCISE • WHICH OF THE FOLLOWING LANDSCAPES DO YOU PREFER?

29. How Important You AreA Final Note: • Research shows that the most high-risk individuals in regards to domestic abuse - particularly men and women who later become involved in domestic homicides have only one common intervention entry point: The Healthcare System.