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SPOUSAL ABUSE

SPOUSAL ABUSE. Goals of Lecture: Assessment & Treatment. Goals of the Class. THE STRUCTURE OF ASSESSMENT THERAPEUTIC ALLIANCE RISK ASSEMENT NEUROBIOLOGY OF VIOLENCE SYSTEMIC THEORY OF DOMESTIC VIOLENCE & ATTACHMENT THEORY UNRESOLVED TRAUMA. GOALS OF ASSESSMENT PROCESS.

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SPOUSAL ABUSE

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  1. SPOUSAL ABUSE Goals of Lecture: Assessment & Treatment

  2. Goals of the Class THE STRUCTURE OF ASSESSMENT • THERAPEUTIC ALLIANCE • RISK ASSEMENT • NEUROBIOLOGY OF VIOLENCE • SYSTEMIC THEORY OF DOMESTIC VIOLENCE & ATTACHMENT THEORY • UNRESOLVED TRAUMA

  3. GOALS OF ASSESSMENT PROCESS • WORKING TO DEVELOP THE THERAPEUTIC RELATIONSHIP • ASSESS CLIENT’S SUITABILLITY FOR TREATMENT • CLINCICAL DIAGNOSIS • ASSESS VIOLENCE & SOCIAL HISTORY • ASSESS RISK FOR FURTHER VIOLENCE • PROVIDE INTERVENTION FOR VIOLENCE CONTROL • DEVELOP ASSESSMENT-BASED TREATMENT PLAN

  4. THERAPEUTIC ALLIANCE • THE CHALLENGE… • TO BUILD A Therapeutic Alliance WITHOUT COLLUDING WITH DANGEROUS ACTING OUT BEHAVIORS • Because so many perpetrators and victims have experienced abuse by authority figures, the process is difficult.

  5. OBSTACLES 1. LOW MOTIVATION • INVOLUNTARY CONSUMER • SECONDARY MOTIVATION: IE. KEEP PARTNER FROM LEAVING OR TESTIFYING MOST Perpetrators. AND Victims HAVE INSECURE ATTACHMENTS>AFFECTING THE WAY THEY REGULATE ATTACHMENT. BECAUSE OF THESE DEFENSE MECHANISMS>RESULTS IN CREATING MORE EMOTIONAL DISTANCE BETWEEN SELF AND OTHER. • Perpetrators MAY PULL FOR NEGATIVE REACTIONS IN THEIR THERAPISTS.

  6. OBSTACLES FOR THE THERAPIST • Balancing client’s needs for privacy with criminal justices needs for information • Therapists anxiety about exposure to liability working with a high risk population may compromise comfort and availability

  7. THERAPEUTIC ALLIANCE • Client , on the one hand, elevates the therapist to a position of authority • On the other hand, client believes power and authority is shared between them • A deep sense of collaboration and participation occurs in the process • A positive attachment develops, yet this is rarely true for the perpetrator due to maladaptive defenses

  8. ATTACHMENT • Attachment is a tie or bond that binds two people and serves a psychological and biological function across a life span. • The biological function = both physical protection and the development of neurobiological capacities in the developing brain of the infant.

  9. Attachment • The psychological function = development of the self & an understanding of self in relationship to others. • For the adult, the biological function can be physical protection but also psychological protection. As emotional caretaking allows the adult the freedom to go out and explore their world.

  10. ATTACHMENT • For adult partners, each person can be the caregiver and the care receiver. • Balance of these roles varies from relationship to relationship.

  11. CHARACTERISTICS OF ATTACHMENT RELATIONSHIPS • PROXIMITY MAINTENANCE • ONE WANTS TO BE CLOSE IN PROXIMITY • ONE FEELS LOSS WHEN ONE IS AWAY • THERE MAY BE ANGER AND FRUSTRATION AT REUNION

  12. IRONIC SAFE HAVEN • ONE RETREATS TO ANGER AND FRUSTRATION WHEN FEELING ANXIOUS AND FEARFUL. • ANGER AND FRUSTRATION OFFER A SECURE BASE TO RETURN “HOME” TO.

  13. ATTACHMENT THEORY • BOWLBY AND AINSWORTH BELIEVED THAT • SECURE ATTACHMENTS DEVELOP DUE TO • MATERNAL AND PATERNAL SENSITIVITY AND COOPERATION.

  14. SENSITIVITY • CAREGIVERS ability to accurately interpret the infants ever changing need. To accurately read the infant and to respond accordingly within a timeliness.

  15. 4 components of sensitivity • Awareness of signals • Accurate interpretations • Appropriate response • Prompt response

  16. COOPERATION • Do interventions break into, cut across, or interrupt the infants ongoing activity or are they geared in both timing & quality to the child’s state, mood, & current interests?

  17. Facilitating secure attachments • Sensitivity & cooperation are the basis for healthy parent child/child interactions. • If this process breaks down the child experiences a break in the connection, or feels ignored, or intruded upon • When there is misattunement which occurs with frequency…the child becomes anxious (escalated) or cut-off (avoidant).

  18. ATTACHMENTS • Understanding your client’s attachment status is critical to breaking long held beliefs about close relationships or what Bowlby described as the internal working models of self and other”.

  19. DANIEL SIEGEL :PROCESS OF EMOTION • THE BODY KNOWS WHAT ITS FEELING BEFORE THE MIND KNOWS • THE MIND PICKS UP THE MESSAGE RELAYING: “PAY ATTENTION, THIS IS IMPORTANT!” • THE MIND MAKES A DECISION—THIS IS GOOD OR THIS IS BAD(MOOD) • THIS PROCESS OF AFFECT(MOOD) CAN BE ELABORATED INTO CATEGORIES OF AFFECT:

  20. CATEGORIES OF AFFECT • ANGER • FEAR • SURPRIZE • DISGUST • JOY • EXCITEMENT • SHAME • SEE NOTES ON SHAME(CLASS SET)

  21. MOST COMUNICATIONS BETWEEN INFANT and PARENTS OR ADULTS IS PRIMARY AFFECT AS OPPOSES TO CATEGORICAL AFFECT. • MUCH IS SAID WITHOUT SAYING IT.

  22. PRIMARY AFFECT STATES

  23. POSITIVE PARENTING • THOSE who grew up in healthy families where primary emotions/positive affect was shared and negative emotions/ primary affects soothed constructively are more sensitive to themselves and others.

  24. LESS POSITIVE PARENTING • THOSE WITH LESS POSITIVE PARENTING ARE QUITE OUT OF TOUCH WITH OR UNABLE TO ARTICULATE THEIR PRIMARY AFFECTS AND THEIR CATEGORICAL EMOTIONS. • MUCH OF WHAT THEY ARE FEELING IS COMMUNICATED BEHAVIORALLY RATHER THAN WITH WORDS. • NOR ARE THEY SENSITIVE TO THE EMOTIONS OF OTHERS

  25. IN THERAPY • Many clients have not learned the language of primary affect nor the language of categorical emotion • Many cannot discern primary affect communicated via facial expression, eye gaze, tone of voice, body motion, and timing of responses.

  26. IN THERAPY THIS CAN BE: • TAUGHT • REFLECTED • PRACTICED

  27. In therapy • Clients feel understood because their state of mind is being “felt” by another. • discussion & movie excerpt :IN THE BEDROOM

  28. WHAT CONSTITUTES MOTIVATION FOR CHANGE • PRECONTEMPATION • CONTEMPLATION • PREPARATION • ACTION • MAINTENANCE • RELAPSE PREVENTION AND RESPONSE

  29. WAYS OF CHANGING

  30. AN INCORRECT MYSTIQUE • The idea that all individuals are in complete control of their behavior stems from the socio-political perspective that emphasizes • Power • Control • Self-will • Accountability • discussion

  31. THE VAST MAJORITY OF BATTERERS NEED MORE THAN JUST THE MESSAGE: “ USE VIOLENCE…GO TO JAIL”.

  32. NEGATIVITY TO CHANGE

  33. Violence is a function of a complex interaction of biological, psychological, and social processes that require complex interventions. • Change takes time • New opportunities arise for deepening the work • Learning new coping skills • Refining and personalizing interventions • Securing safety

  34. COMMON PSYCHOLOGICAL DIAGNOSES • Depression, anxiety or both • Psychoactive substance abuse and dependency • Posttraumatic stress disorder • Neurobiological disorders • Personality disorders

  35. DUTTON’S TYPOLOGY

  36. DUTTON’S BATTERY TYPOLOGY • OVER-CONTROLLED: deny rage while experiencing chronic frustration an resentment • UNDERCONTROLLED: act out frequently • INSTRUMENTAL: use violence “coldly” to obtain specific objectives • IMPULSIVE: • act out in response to a buiding inner psychological tension

  37. REACTIONS TO DISSATISFACTION

  38. Conditional model of violence prediction • Individual biological/psychological factors: • History of violence • Substance abuse • Need for medication • Psychiatric disorders

  39. SOCIAL/ENVIRONMENTAL FACTORS • PEER support for violence(ie. Gangs) • Economic stressors • Occupational stressors

  40. RATIOANAL FOR USING ATTACHMENT THEORY • Violence occurs in the context of attachment relationships • Anger and loss associated with maintenance of proximity • Very high rates amongst batterers with insecure attachment • High rates of childhood trauma among perpetrators and victims of violence(30-50% among victims).

  41. PARENTS & CHILDREN

  42. PARENTS AND CHILDREN • Most parents, in their efforts to help their children, focus attention: • on decoding the child’s behavior yielding an expertise about the child • but also a blindness to their own contribution.

  43. POWER • Violence is an ugly form of power in the face of which we all feel threatened. • 2 forms of violence • Violence to achieve a goal = coercive • Pleading violence in which the victimizer perceives himself/herself to be the victim

  44. divorce • Children of divorce do scary things. • They have seen parents stop loving each other. • The possibility of abandonment terrifies them • Competition with new members ( step families) becomes very serious business, it’s survival of the fittest.

  45. Rollo May

  46. Rollo May’s levels of power These levels of power are seen as potentialities within everyone: The power to be-neither good nor evil, but NOT neutral. Power is energy. This energy must be lived out or it results impotently in death, neurosis, psychosis, or violence

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