ASSESSMENT: RESEARCH AND PRACTICE

Abstract

The authors present a comprehensive assessment protocol for court-mandated perpetrators of domestic violence. Because of the inherent risk of harm to others present in the context of domestic violence treatment, the authors present an assessment process with a clear set of goals and expressed expectations. These goals help to set the context of treatment from the onset and serve as a continual frame of reference that both therapist and patient will refer to throughout the treatment process. The authors discuss the following assessment issue: informed consent and disclosure; confidentiality; patient rapport; patient motivation for treatment; patients' suitability for treatment; differential diagnosis; the assessment of violence and social history; patients' risk for further violence and other acting-out; behavioral interventions for violence control; developing treatment plans.     

Occupational Therapy and Victim Advocacy

ABSTRACT

This article provides an orientation to increase the profession's awareness of occupational therapy's role in victim advocacy, an emerging area of community-based practice. Analysis and comparison of OT's core assumptions and values with general principles of victim advocacy and empowerment demonstrate striking similarities: Each acknowledges holism and a profound connection between the individual and society, as well as their ability to interact and influence each other. In addition, the cultures of OT and victim advocacy both value the dignity and worth of persons, self-determination, freedom and autonomy, latent capacity, human uniqueness and subjectivity, and active and mutual cooperation in restoration or recovery. The compatibility of OT and victim advocacy is further demonstrated in the context of one therapist's work with survivors of domestic and sexual violence.     

Innovative Approaches to Child Custody and Domestic Violence in New Zealand

Summary

In 1995, as part of a major review of domestic violence law, the New Zealand Parliament amended the legislation under which disputes about custody of and access to children are determined by the Court. Specifically, the amendment introduced a rebuttable presumption that a parent who had used violence against a child or against the other parent would not have custody of, or unsupervised access to the child unless the Court could be satisfied that the child would be safe during visitation arrangements. Three years after the implementation of this legislation, it is timely to reflect on the impact of this major domestic violence law reform initiative. Our findings indicate that there are indeed advances. Psychological violence is now clearly being considered when Courts are assessing the issue of children's safety. As well, the delineation of mandatory risk assessment factors has led many judges to see a continuum of power and control tactics as relevant in domestic violence related visitation proceedings; the previous emphasis on physical violence has given way to an analysis which more closely reflects accords with women's and children's realities of the abuse they are exposed to. Some of the old problems continue to exist despite the law changes. There are still recent cases where perpetrators of serious violence are awarded unsupervised access and where their violence continues to be construed as “out of character,” arising because of the perpetrator's “despair” about the breakdown of his relationship. These and other issues are discussed.     

Therapeutic Relationships Re-Defined

Abstract

The therapeutic relationship has traditionally been central to occupational therapy. This study surveyed 129 practicing occupational therapists in Connecticut, concerning how they define and use the therapeutic relationship with clients in today's cost-conscious health care environment. The following four hypotheses: (1) Therapeutic relationships are related to functional outcome, (2) Definitions of therapeutic relationships include words and phrases expressed in the literature and by experts, (3) There are differences in perceptions of therapeutic relationships among pediatric, adult, and geriatric specialty subgroups, (4) Most occupational therapists learned skills in developing therapeutic relationships “on the job,” rather than during professional education, were all supported. This study reaffirms the importance of the therapeutic relationship in occupational therapy practice and provides an updated definition: A trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect.     

Fieldwork Journal at F.E.G.S.

SUMMARY

The challenge of working with the mentally ill population on the first Level I fieldwork exposure is often experienced in a setting where the on-site supervisor is a therapist from another discipline. Many skilled mental health professionals can offer a rich learning experience and assist students in mastering generic clinical skills in relating to and understanding the psychiatric population. Occupational therapy students bring to this clinical relationship the opportunity to demonstrate the effectiveness of occupational therapy interventions through group work, and individual evaluation and treatment, which benefits both the clients and the larger program. This article recounts the journal of a Level I student's journey through a setting that provided a receptive environment for fostering growth in the process of becoming truly comfortable and effective in the skills and roles of an occupational therapist in a mental health environment.     

Inspirational Beginnings in an Occupational Therapy Mental Health Setting

SUMMARY

This article includes excerpts from a fieldwork log for a student's Level I experience. The student was assigned to the Brooklyn Veteran's Administration Medical Center Inpatient and Day Hospital Program with an occupational therapist supervisor. It recounts the student's concerns, in a beginning placement, as an individual who had no previous exposure to a mentally ill population. In the course of understanding the role of occupational therapy with the benefit of a strong clinician role model, the student not only learns procedural skills in occupational therapy assessment and group leadership, but also engages in a reflective process of professional growth and begins to develop a more conditional and holistic perspective of the patients with whom she is working towards fine-tuning critical aspects of the therapeutic use of self. Through the use of a learning contract developed in the format of a Goal Attainment Scale (GAS), she formulates a goal for the psychomotor domain of improving skills in interpersonal relationships with patients focusing on using verbal and nonverbal communication for interaction in a     

Trauma and Parenting in Battered Women

Summary

While research has documented the harmful effects of domestic violence on women and children, little attention has been paid to the effects on women's ability to parent in this dangerous environment. This paper examines theoretical perspectives on the effects of domestic violence on parenting and proposes an ecologically-based model which can be used to inform research on parenting and treatment of battered mothers. Trauma theory and traumatic bonding are integrated into the ecological model of parenting in battered women.     

Voices from the Group

Summary

This article presents experiential reactions of male and female domestic violence perpetrators one year after completing a 52-week court-mandated intervention program. Data were derived from in-depth interviews as part of a larger research study looking at recidivism and other outcomes in a probation department with a domestic violence courtand a coordinated legal, programmatic and community response. Overall, elements that were most helpful in domestic violence intervention were primarily relational ones, such as group support and therapist/facilitator alliances, and secondarily, specific strategies of handling anger and other emotions, and interpersonal communication. The discussion focuses on the implications of these findings for therapists and facilitators involved in providing services for this population.     

Female Offenders in Domestic Violence

SUMMARY

It is well accepted that large numbers of men batter women. Although some data also reveal that women report assaulting men in large numbers, interpretation of the latter data has been fraught with controversy. The present article reports on a sample of women arrested for domestic violence. When questions were asked about frequency of violence initiation, which partner began the overall pattern of violence in the relationship, and the women's reasons for using violence, it was found that about two-thirds of the women were battered and using violence to protect themselves or to retaliate for previous violence against them. Implications of these findings for conceptualizing women's violence as well as for training law enforcement personnel are discussed.     

Addressing Family Violence Within Juvenile Courts

Summary

Whether as overt or underlying issues, family violence is prevalent within juvenile court caseloads, yet often is not identified within intake and disposition. Focusing on juvenile victimization of parents, and to a lesser extent teen dating partners, this article discusses model programs emerging in juvenile courts specifically addressing these issues. A comparative analysis of the drug court trend is explored in the context of its applicability for specialized family violence applications in the Juvenile Court. An overview of the King County (Washington) Juvenile Court's Step-Up Program and the Santa Clara County (California) Juvenile Court's Family Violence program is offered, followed by the process by which the Travis County (Texas) Juvenile Court has implemented a program similar to these models. Effective interventions with violent families must be informed by the domestic violence community's treatment expertise, building on the paradigm of youth resilience.     

Custody and Visitation Trends in the United States in Domestic Violence Cases

Summary

This article addresses custody and visitation trends in domestic violence cases in the United States. It defines domestic violence behaviorally, looks briefly at its prevalence, and discusses national policy statements and studies. It also examines statutory trends concerning the role of domestic violence in custody and visitation cases, including the O. J. Simpson guardianship case. Practical suggestions for litigants and judges are included. The article concludes that the way domestic violence issues are treated in custody and visitation cases is often problematic, and calls for specific reforms.     

Batterer Program Directors' Views on Substance Abuse and Domestic Violence

This article reports on a national survey of batterer intervention program (BIP) directors (N?=?150). The beliefs of these directors on the relationship of substance abuse and domestic violence is reported and discussed. BIP director's opinions are important because they make programmatic and treatment decisions. Most BIP directors believe that for many of their clients, both men and women, perpetrator and victim, violence and substance abuse is related. Treatment and methodological considerations are discussed.     

Brief consultation with headache sufferers

Abstract

This paper describes the author's efforts at involving chronic headache sufferers in brief consultations with individual, family, and group therapy programs in an inpatient medical treatment facility. A variety of difficult issues facing chronic headache sufferers are presented, including the rationale for utilizing each therapeutic modality and the role and strategies that the therapist undertakes in each program. The author provides some case vignettes and discusses the importance of communication between the therapist, the primary physician, and the medical staff members.     

A Psychoanalytically Oriented Approach as Primary and Secondary Prevention: Discussion of Joy Osofsky's “Psychoanalytically Based Treatment for Traumatized Children and Families”

Violence prevention programs can help children cope with trauma if effective strategies are developed to address youth victimization and children's exposure to domestic violence and trauma. Psychoanalysts are in a unique position to develop such primary and secondary prevention programs for children for whom violence is part of everyday life. An intense long-term relationship is an essential treatment ingredient for these profoundly troubled youngsters. In such a relationship, the therapist/analyst cannot react automatically to the inevitable hostile, destructive aggression that emerges in the treatment of severely traumatized children. A particularly key contribution by Osofsky is her discussion of the ubiquity of “countertransference every day in people who work with traumatized children.” Here I provide a clinical example of a failure that resulted from my own countertransference.     

Chapter 7. Conclusion

ABSTRACT

Children who witness domestic violence experience a variety of negative effects. These include maladaptation in the areas of behavioral, emotional, social, cognitive, and physical functioning. The Occupational Therapy Psychosocial Assessment of Learning (OT PAL) is a tool that can be used to evaluate the psychosocial functioning of a student's performance in a classroom environment. Presented is the case study of a child witness of domestic violence and the use of the OT PAL in measuring the psychosocial aspects of his performance in a non-traditional classroom setting.     

Research & clinical exchange

Abstract

Question: Family therapists are often called upon to do consultations to schools about children having social and educational difficulties. In what ways is the family therapist's role different when he or she is called in to consult as an “outsider’ to the school system about a particular child whom he or she does not know, compared to being called upon by the school for advice about a child who is already being seen in treatment by that therapist?     

Multifaceted Approaches in Spouse Abuse Treatment

SUMMARY

The understanding of spouse abuse has changed considerably in the last 30 years, shifting from a perspective based on individual psychopathology to that of a pervasive social problem. Current treatment solutions for stopping violence are limited to those that address resocializing the batterer. Several states often restrict the use of state funds for batterers' groups and forbid couples treatment as a primary treatment option in spite of the fact that most couples choose to remain in their relationships in the presence of repeated violence. This article argues for broadening options to include a specific type of couples treatment as a part of a coordinated community response to remediate domestic violence. Solution-focused therapy is described as an example of treatment of relationships that makes safety a priority and is not victim-blaming. It is suitable treatment both for couples who wish to stay together and those seeking a safe way to separate.     

Introduction

Abstract

The authors describe the rationale for a publication that explores new and innovativeapproaches to treating domestic violence perpetrators. A brief history is also presented on perpetrator treatment, the feminist perspectives on treatment and how recent research findings suggest that perpetrators of domestic violence need more than education and attitude adjustment.     

The Neglected Variable of Physiology in Domestic Violence

Summary

In the early stages of research concerning domestic violence and its effects on children, scholars have focused almost exclusively on isolated psychological variables. Little attention has been paid to events that might inform the research community about the effects of physiological factors surrounding such exposure on children's subsequent development. In order to go beyond a narrow disciplinary perspective that would exclude such important variables, a broader research agenda that includes multiple partners must be forged. The understanding of multiple etiologies and sequelae of domestic violence requires the use of comprehensive conceptual models that can bring together multiple theoretical perspectives under a broad umbrella. This article presents a developmental ecological perspective that allows for a more thorough and accurate examination of the influences of domestic violence on child development by simultaneously addressing child and environmental characteristics.     

Seeing and Being Seen: Courage and the Therapist in Cross-Racial Treatment

ABSTRACT

Correction of the patient's distortion is often the focus of therapeutic treatment. However, the therapist's distortions, based upon pre-existing fears, which themselves are often rooted in greater societal issues and energized by the work with the patient (especially as they relate to issues of racial difference between the therapist and patient), can lead to clinical impasse. Just as an effective treatment relies upon the patient's opening up to correcting distortions, so too the therapist must be able to use transference response and become vulnerable to knowing and moving beyond his own fears and distortions.