Adapting Group Therapy to Address Real World Problems: Insights from Groups Offered in the Bahamas

This article presents a cultural adaptation of a group therapeutic approach that is being offered in the Bahamas. “The Family: People Helping People” project was designed as an intervention to improve socialization in New Providence, the Bahamian capital and its most heavily populated city. “The Family” group model offers support and training to improve communication in relationships and to encourage constructive emotional expression. This article will provide an overview of “The Family,” address key elements of this approach that are culturally tailored, and offer clinical examples and note implications for group therapy training. This cultural adaptation offers helpful insights for addressing community problems, such as violence and societal fragmentation, and may inform the development of community-based group interventions in other settings.     

Children's response to community violence: What do we know?

This article presents a framework for understanding the developmental significance of violence-related trauma in the lives of young children. It emphasizes the importance of the distinction between acute and chronic trauma. Acute trauma is more readily dealt with through “psychological first aid” and a “therapy of reassurance.” Chronic trauma requires a more systematic reconstruction of the child's “social map” of the world. The socioeconomic and demographic correlates of violent trauma predict an accumulation of risk factors in the child's life that compounds the problem of developmental disability. The problem community violence poses for the child must be understood in the larger context of greater risk for family disruption (including less than secure attachment) as well as domestic violence, poverty, and minority group status. The increasing incidence and prevalence of community violence poses a major challenge to the mental health of children.     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

Domestic Violence

Summary

In this paper, the authors outline their experience in incorporating a curriculum on domestic violence into an urban family practice residency program. Based on the concept that in order to successfully develop such a curriculum, it is necessary to address the “culture of the organization,” joint educational strategies that in-elude resident education as well as faculty development were considered. A research question was designed to inquire as to the difference in the level of knowledge about domestic violence in family practice faculty as compared to residents prior to the introduction of educational strategies. The authors describe curriculum goals and objectives and outline specific teaching methods as well as the evaluation instrument utilized in the study to measure actual difference in knowledge between faculty and residents about domestic violence with a focus specifically on spousal abuse. Their conclusions point to the need for an educational strategy that includes emphasis on the faculty-resident interface which utilizes both traditional and non-traditional integrated formats in order to successfully train residents in the identification and treatment of domestic violence.     

Men and Violence

The authors explore violence in men from cultural, historical, social, and individual perspectives. The many ways in which violence is expressed by men are examined. The remediation of violent behavior through counseling is studied, and a model for understanding that process is indicated. Resources, both organizational and bibliographical, are furnished. Violence … is as American as cherry pie. H. Rap Brown We've got to stop it, it's you and me, oh violence never did make a man. Geof Morgan     

EDMUND D. PELLEGRINO's PHILOSOPHY OF FAMILY PRACTICE

Family medicine has grown as a specialty from its early days of general practice. It was established as a Board Certified specialty in 1969. This growth and maturation can be traced in the philosophy of family medicine as articulated by Edmund D. Pellegrino, M.D. Long before it was popular to do so, Pellegrino supported the development of family medicine. In this essay I examine the development of Pellegrino's philosophical thought about family practice, and contrast it to other thinkers like Ian McWhinney, Kerr White, Walter Spitzer, Donald Ransom, and Hebert Vandervoort. The arguments focus on whether the goals of family medicine and family practice (possibly two distinct entities) can be articulated, especially considering the definitional problems of “family” and “community.” I conclude by echoing Pellegrino's hope that family medicine can contribute a fresh alternative to isolated, individualistic and technological thinking in medicine.     

rethinking domestic violence in theory and practice

Drawing on the author's previous work, this article suggests that conceptual advantages result from envisioning domestic violence on a larger continuum of “normalized” to “extreme” sadomasochistic interactions (including gendered interactions that can also range from “ordinary” to “deviant” in how they are perceived). Thereafter, it may be harder to ignore how redressing social inequities involving gender as well as racial and class imbalances can amount, at least in terms of prevention, to anti-domestic violence measures of one important kind. More concretely, proceeding from the assumption that domestic violence remains disturbingly common (even though its exact scope is difficult to ascertain), this article contrasts how this social problem would best be approached in theory and how it often continues to be dealt with in practice. In making this comparison, a cursory review of recent policy developments in this area, from mandatory arrest policies and laws (and the criticisms these have engendered) to more recent interest in restorative justice and collaborative empowerment, is presented and incorporated into the paper's larger argument.     

Women who perpetrate intimate partner violence: A review of the literature with recommendations for treatment

The purpose of this article is to review the literature on women as perpetrators of violence in their intimate relationships (i.e., domestically violent women) and summarize the scant literature on intervention programs for these women. Particular attention is paid to the cultural influences that shape our conceptualization of “domestic violence” and the fact that empirical research suggests that domestic violence has been falsely framed as exclusively male initiated violence. The article concludes with a discussion of the similarities and differences between male and female domestic violence offenders and identifies areas where treatment for female offenders might be improved.     

Introduction to Multi-Level Community Based Culturally Situated Interventions

This introduction to a special issue of the American Journal of Community Psychiatry is the result of a symposium at the Annual Meeting of the Society for Applied Anthropology, 2006, that brought together anthropologists and psychologists involved in community based collaborative intervention studies to examine critically the assumptions, processes and results of their multilevel interventions in local communities with local partners. The papers were an effort to examine context by offering a theoretical framework for the concept of “level” in intervention science, and advocating for “multi‐level” approaches to social/behavioral change. They presented examples of ways in which interventions targeted social “levels” either simultaneously or sequentially by working together with communities across levels, and drawing on and co‐constructing elements of local culture as components of the intervention. The papers raised a number of important issues, for example: (1) How are levels defined and how should collaborators be chosen; (2) does it matter at which level multilevel interventions begin; (3) do multilevel interventions have a greater effect on desired outcomes than level‐specific interventions; (4) are multilevel interventions more sustainable; (5) are multilevel interventions cost effective to run, and evaluate; (6) how can theories of intervention be generated and adapted to each level of a multilevel intervention; (7) how should intervention activities at each level coordinate to facilitate community resident or target population empowerment? Many of these questions were only partially addressed in the papers presented at that time, and are more fully addressed in the theoretical papers, case studies and approach to evaluation included in this collection.     

Metanoia

SUMMARY

The author draws on her experience working with individual men who are violent to their partners to think about the problem of international violence. A parallel is drawn between a man's feeling of “entitlement” to forcefully keep his partner “in line” and feelings of national entitlement to engage in violence to force one group's agenda on another. The differences between morals and taboos are discussed underscoring the community value of that which becomes socially and ethically “unthinkable.”     

Is this America? Unfinished business with the U.S. national imaginary,religion and violence

This article first proposes definitions and raises questions about what it means to be a nation. I then analyze the national imaginary of the United States, and suggest that at its deepest core we find “substitute ultimates” regarding America's sacrificial war‐culture. This cultural violence perpetuates destructive consequences, including the phenomena of “U.S. war‐culture,” and “moral injury” among military servicemembers and veterans. But widespread legitimation of the imaginary largely inhibits citizens from awareness about their own reality. Lastly, I inquire about the role of prophetic public theology to address nationalism, and engage in a thought experiment with an imagined community of diverse partners.     

The response to domestic violence in a model court: some initial findings and implications

This study utilized a non-experimental design to obtain information on a full range of domestic violence incidents brought before the Quincy, Massachusetts District Court, a model court. One limitation of previous research on spouse assaults using more sophisticated designs is that the target population has been restricted to specific subgroups of cases thereby limiting subsequent discussions of policy/practice implications of the findings vis-a-vis all spouse assault cases. To address this research “shortfall”, we obtained permission from the Quincy District Court to examine all the spouse assault cases brought before the court during a 7-month period (June, 1995, through February, 1996). The findings show that in a full enforcement environment, victims took out restraining orders only against the most violent, criminally abusive men. Most men who were arrested for domestic violence had prior criminal histories for a variety of offenses. Domestic violence offenders appeared to be of two types: those with extensive and diverse criminal histories and those with little or no such involvement. However, active criminal justice intervention against domestic violence offenders appears to be primarily directed toward offenders already active in the criminal justice system. © 1998 John Wiley & Sons, Ltd.     

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.     

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.     

Validation of the Chinese version of the Walsh Family Resilience Questionnaire

The Walsh Family Resilience Questionnaire (WFRQ) is one of the most widely used and strong theory-based measurement tools of family resilience. This study aimed to develop and psychometrically test the Chinese version of the WFRQ (WFRQ-C). The WFRQ was translated following Brislin's translation model. Psychometric testing, combining classical theory test and item response theory, was conducted with a sample of 800 community adult residents. The Connor-Davidson resilience scale-10 (CD-RISC-10), Self-reported Family Happiness Scale (SFHS-1), and Family APGAR (Adaption, Partnership, Growth, Affection, Resolve) Scale (Family APGAR-5) were applied for convergent validity. Six items were deleted at the item analysis level. The minimum average partial test and a parallel analysis supported a three-factor structure, which was validated by confirmatory factor analysis. The three factors were named “Family belief system,” “Organization, communication and problem solving,” and “Utilization of external resources.” The WFRQ-C was significantly correlated with CD-RISC-10, SFHS-1, and Family APGAR-5, with r values ranged from 0.51 to 0.56. The Cronbach's α was 0.97 for the scale and 0.93, 0.95, and 0.72 for the three factors, respectively. The ICCs of 0.96 for the whole scale, and 0.95, 0.75, and 0.95 for the three factors, respectively. The mean score for the WFRQ-C was 97.00 ± 17.94, of which per capita monthly income and education level were predictors. The 26-item WFRQ-C is a stable, concise, and validated tool to measure family resilience. It is applicable for Chinese community adults in nonspecific stressful settings and has potential utility in the health care domain.     

The splitting between separate and symbiotic stätes of the self in the psychodynamic of schizophrenia

Abstract

We explore the problematic dynamics in the relationship between societal systems of care and the chronically excluded, with particular reference to severe personality disorder and the “difficult-to-reach” patient. The individual who “refuses” is often met with a violent response: yet his violence must be understood as related to an experience of being violently excluded. We reformulate personality disorder as a disturbance of “groupishness” and suggest, as a paradigm for the problem of refusal, the story of Diogenes the Cynic, who “holed himself up” in a barrel; and of his legendary encounter with Alexander the Great, who tried unsuccessfully to persuade him to “come in from the cold.” We suggest it may be as important to focus on Alexander's violence as on that of Diogenes, and we examine modes of violence deployed by society against the excluded outsider, with particular reference to the hostile attribution of intentionality to the personality disordered individual's acts of violence and self-harm. We conclude by considering both the merits of the democratic therapeutic community model as a response to severe personality disorder and the dangers, inherent in this model among others, in an unconscious identification with Diogenes in his barrel.     

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.     

Empowerment and Advocacy for Domestic Violence Victims

Empowering women victims of domestic violence has been a goal of advocacy since its inception. The concept of empowerment is also widely shared in social science disciplines where the goal of applied research is to address the lived effects of social injustice. While in some fields, such as community psychology, there has been a long history of engaging theoretically with the concept of empowerment, elsewhere theory has received less attention. In the case of addressing domestic violence, victim advocacy has often been assumed to be empowering. Advocates worked to establish support services for individual women and participate in coordinating community responses to domestic violence that included the criminal justice system so as to improve women's safety. The question of whether this kind of social action is empowering domestic violence victims has been discussed in the literature for almost a decade. In this paper, we consider a proposed theory of empowerment and recommendations of advocacy practices by Kasturirangan (2008) to consider how her conceptualisation of empowerment processes has influenced the field and whether it provides a scaffold for bridging the theoretical gaps that have been identified.     

Developing Guidelines for Domestic Violence Offender Programs

Summary

This article reviews research on domestic violence that can help inform the development of guidelines for programs for men who batter. It also illustrates some successes and problems in other fields that might be instructive for the domestic violence field. Firm conclusions about “best practice” guidelines for intervention seem to be premature because of flaws in evaluation studies. In addition, there is growing evidence of variability among men who batter on dimensions such as severity of violence, childhood traumas, generality of violence and personality traits. Programs also need to be able to respond to motivational and cultural difference among abusers. Existence of variability implies the need for multiple forms of interventions.