Intimate partner violence (IPV) against women of all backgrounds is distressingly common and more often than not the consequences of such abuse is devastating and lasting. Studies have estimated that in the United States, nearly two-thirds of $6 billion dollars per year are associated with costs of direct physical and mental health care for the victims/survivors of IPV (Bridges, Karlsson, & Lindly, 2015). IPV includes a vast majority of female victims within the United States and throughout the world. Studies have shown that more attentiveness and collaboration is needed from researchers, practitioners and local communities to aid in the identification of effective means of reducing violence and treating the victims/survivors (Shorey, Tirone, & Stuart, 2014).
Future visions of advocates and practitioners include the ultimate goal of addressing the ways in which women that screen positive, show signs of being at risk for IPV, and are survivors, will receive intervention services at the time of the visit and continue to do so after. This is to be achieved by brief group intervention/counseling, psychoeducation, and/or appropriate referrals to both internal and external service providers (Ghandour, Campbell, & Lloyd, 2015).
This paper hopes to address the extent by which women suffer due to IPV exposure, utilize past and present research that will help to identify the scope of the problem and ways in which it has been addressed in the past and currently being battled. This paper will also propose possible group counseling techniques based on prior research that would be beneficial for females ranging from the reproductive ages of 18 – 46 that are or have fallen victim to IPV by implementing a group program methodology utilizing psychoeducation and counseling. This paper aims to broaden awareness and education of this socially persistent problem.
Intimate Partner Violence
Intimate Partner Violence is a serious public, and nationally persistent problem suffered by many women (Hamberger, Rhodes, & Brown, 2015). IPV includes physical, emotional or sexual aggression, as well as, stalking and economic aggression directed at a partner in the context of a romantic relationship. Research has suggested that the motivation behind IPV involves an individual’s desire to maintain power or exert control over a partner (Arroyo, Lundahl, Butters, Vanderloo, & Wood, 2017). As victims of such violence, these individuals experience an array of injuries both physically and psychologically that more often than not are permanent consequences of such violence.
Injuries as a result of IPV include and are not limited to a physical nature such as eye, face, neck, and other bodily injuries; traumatic brain injuries that may or may not cause lifelong disabilities. As well as, that of a psychological effect where reports have shown higher rates and levels of depressive symptom (persisting as long as 5 years after the violence has ended), elevated rates of anxiety, post-traumatic stress disorder (PTSD), substance and alcohol abuse, and increased suicidal ideations and attempts (Hamberger, Rhodes, & Brown, 2015).
Victims also reported higher levels of various cognitive disorders, disassociation, low self-esteem, and somatization. In more severe cases, victims suffer the most destructive consequence of maltreatment such as homicide (Santos, Matos, & Machado, 2017). Subsequently, victims are also subjected to other negative impacts due to IPV and lose economic security as result of leaving the household to escape the violence often becoming functionally homeless (Arroyo, et. al., 2017). The economic abuse suffered by IPV victims commonly involves the use of domineering behaviors that constrain a partner’s ability to acquire, maintain, and use financial assets (Shorey, Tirone, & Stuart, 2014).
Several studies conducted within the United States have revealed that women between the ages of 18 and 24 are most vulnerable to experience IPV within their lifetime. While prevalence rates have shown significant variation across the globe, women from all walks of life fall victim. The difference of prevalence rates has been said to be due to the fact that rates of violence generally vary between populations and there are also many differences surrounding laws that make IPV a crime. However, systematic reviews of lifetime IPV have shown high rates of physical, emotional, and sexual violence against women (Bridges, Karlsson, & Lindly, 2015). While reports conclude that between 2.7% and 13.9% of women are affected by IPV each year, men also fall victim to such violence at a reported rate of 2.0% and 18.1% each year (Hamberger, Rhodes, & Brown, 2015).
Research revealed that in the United States 1.9 million women are affected by IPV each year (Shorey, Tirone, & Stuart, 2014). The National Intimate Partner and Sexual Violence Survey have revealed that one in four women within the United States experience severe physical violence, one in two are psychologically abused, and one in 10 are raped, committed by the intimate partner within their lifetimes (Santos, Matos, & Machado, 2017). Reports have also shown that 1 in 5 women reporting to emergency departments present with injuries as a result of IPV. Additionally, studies have revealed that approximately 1 in 2 homicides relating to females in the United States is due to IPV (Hamberger, Rhodes, & Brown, 2015).
Prior Research and Practice
Empirical studies have emerged in the late 1980’s surrounding IPV interventions (Eckhardt, Murphy, Whitaker, Sprunger, Dykstra, & Woodard, 2013). Prior to its emergence little was known or researched regarding the topic of IPV. As cases became more evident healthcare facilities began to take small notice. Earlier studies conducted regarding screening and identification of IPV victims showed that fewer than 2% of women were asked about IPV by practitioners and clinicians. In emergency settings, it was reported that only a mere one-tenth of abuse victims were identified (Hamberger, Rhodes, & Brown, 2015). However, within the last century, IPV has become more widely documented and studied, as well as socially and judicially criticized.
As the increase of cases came about within the criminal justice systems, along with media exposure, worldwide altercations of criminal law were implicated and availability of information surrounding the issue has arisen (Santos, Matos, & Machado, 2017). However, despite the surge of information, empirical evidence also has provided limitations to interventions, screening processes and information surrounding IPV. Studies may not provide a comprehensive picture of IPV and the abilities and effectiveness of services offered due to the fact that certain marginalized groups avoid contact with IPV services, refuse to admit the extent to which they suffer, and are less likely to seek formal support due to cultural implications or immigrant status (Shorey, Tirone, & Stuart, 2014).
Prior research has shown, the most common type of cost-effective and time appropriate intervention for female victims of IPV is the use of brief group interventions. Female victims at all ages benefit immensely from such psychological interventions designed to facilitate the reduction of the elevated personal, interpersonal and societal costs commonly connected with IPV. Reports have shown that victim participation in group interventions often stems from an expressed need to share their experience, feel acceptance, and gain and/or offer support among other women with related life plights. Such innovative interventions offer members opportunities to gain validation of such victimization, gain encouragement and support, and are often provided with important education surrounding IPV.
Women who have participated in group counseling sessions have also reported a significant reduction in social isolation, due to the network of relationships built from this form of intervention. Victims have specifically shown improvements within clinical symptomology. As well as beliefs towards violence, personal and social skills, social support, and self-esteem. These changes are a result of participation by learning from fellow group members, identifying common difficulties and sharing strategies for problem-solving both within the group and outside of the group in everyday life (Santos, Matos, & Machado, 2017).
When individuals enter group interventions, there is much to consider about the individuals that will make up the groups. They not only have to deal with the victimization but are also faced with many other complexities. These may include economic challenges, significant life changes such as maintaining or leaving the abusive relationship, limited time due to shelter placements and/or finances and lack of resources to continue such treatment modalities. Additionally, victims report a lack of ability to live on their own due to economic dependence on the abuser, and this fact alone is a barrier for women and their ability to leave the relationship and continue intervention. Therefore, intervention and screening sites can greatly benefit by keeping community resources available and on hand (Shorey, Tirone, & Stuart, 2014).
Selection and Screening Techniques
With such sizeable lifetime and current prevalence rates of IPV among women, effective IPV screening and intervention within the healthcare and community settings is imperative to successfully battle such current and long-term physical and mental health problems. Evidence has shown that clinicians have long sought out efficacious intervention strategies that implement routine screenings, and access to counseling. As a result, The United States Department of Health and Human Services (DHHS) has shown tremendous support by implementing programmatic activities geared toward the increase of both IPV prevention and methods to improve services offered to those affected.
Paired with the efforts of the DHHS, the passage of the Affordable Care Act in 2010, further opened the necessary door to bolster various preventative services for women, including IPV screening and intervention. Furthermore, in 2013, The United States Preventive Services Task Force issued a B-recommendation that included all women of reproductive ages (14-46 years of age) to be screened by their healthcare clinicians. This ensured that regardless of point of entry to health care or behavioral healthcare settings (e.g., primary, urgent, and emergency), all adolescent girls and women were assessed (Ghandour, Campbell, & Lloyd, 2015). Additional research has found that screening for IPV in the emergency room (ER) settings has proved to be sufficient and increases detection rates. These studies have shown that 1% – 7% of ER admissions involving females is a result of seeking emergency services due to IPV (Eckhardt, et al., 2013).
In order for adequate and efficient screening to occur, healthcare clinicians and all others involved in the screening processes must be equipped with the proper tools and education regarding such assessment. It is suggested that all individuals screened for IPV are provided with information that contains community resources, safety planning, support and advocacy through such healthcare facilities and practitioners in the form of active or passive psychoeducation dependent on the severity of the individual’s case (Eckhardt, et al., 2013). When selecting individuals for intervention as well as for purposes of the proposed group program in this paper, women must meet several criteria, and should specifically be targeted due to the following:
- being a female between the ages of 18-46, a prime reproductive age where abuse is more likely to occur, and
- having documented/reported IPV victimization history that includes but is not limited to physical abuse or assault, psychological, emotional, sexual abuse and/or economic abuse from an intimate partner (Eckhardt, et al., 2013).
Studies have found that primary and emergency care facilities are important locations in which to identify and aid IPV victims/survivors. However, even if victims are identified it does not always constitute referrals to advocacy-support resources, or that such victims will seek further support after receiving the information (Hamberger, Rhodes, & Brown, 2015).
Structure of Group Sessions
Numerous IPV interventions consist of a hybrid nature that incorporates various counseling techniques similar to that of cognitive behavioral therapy (CBT) to facilitate a positive change in both behaviors and thinking (Eckhardt, et al., 2013). However, as research has indicated, the aims of group interventions should include a combination of psychoeducation and counseling addressing common goals within sessions methodologically such as validation of personal stories of victimization, stimulation of empowerment per member individually and as a whole, reduction of social isolation, provide skills and knowledge to restore control over daily life, develop healthy problem solving and decision making thought processes, and to promote personal and social skills (Santos, Matos, & Machado, 2017). Data has shown that members of groups benefit from fixed treatment exposure where the number of sessions ranged from 6 – 10 sessions, the duration of contact ranged from 10 to 15 hours in total and entailed a pre and post-test. Such interventions showed to be efficacious in bringing about adequate change a preventing revictimization in a large percentage of participants (Eckhardt, et al., 2013).
When developing a group intervention for IPV victims the group context goal should foster women’s awareness that “she is not alone and that her feelings of confusion, fear and despair are real and shared by other women”. In doing so, women show improvements associated with tolerance toward violence and abuse, as well as, increased personal, social, and coping skills, and self-esteem (Santos, Matos, & Machado, 2017). Given the cyclic nature of abuse suffered by victims and the lasting consequences of IPV, group interventions need to be mindful of diminished functioning of victims in multiple facets of life and need to focus on breaking the cycle and building stronger perceptions of the self, step by step and not addressed all at once (Arroyo, et. al., 2017).
While preventative counseling techniques and therapy efforts are critical, there is also a need for psychoeducation. It is an important part of an intervention that allows for individuals to obtain information, education materials or feedback/advice that can be offered in forms such as leaflets, posters, audio-visual aids, lectures, internet material and/or software. These forms offer encouragement and often entail explicit direction to carry-out certain recommendations through these passive and active measures. There is also evidence that when IPV victims are provided with such education they are better able to identify unhealthy relationships, behaviors, patterns of abuse, and the many forms of such (Bridges, Karlsson, & Lindly, 2015).
As expressed in group logistic, this group program aims to facilitate change at both the individual a group level. It is recommended that each group meeting should be outlined prior to the start of the session and members should be aware of the overall goal and context of each session. Research recommends that groups programs should involve strategies that simultaneously utilize didactic techniques such as bibliotherapy, training skills that incorporate role play and relaxation, and support for an opportunity to transfer learning to real life. It is also suggested that a less structured approach be implemented into sessions that allow venting anger sessions and group discussion involving various concerns of the members. Groups sessions should also include vocational counseling and job search training (Santos, Matos, & Machado, 2017).
As extensive research has shown, intimate partner violence places women in danger all over the world and leaves victims suffering from serious consequences physically, psychologically, and economically. By implementing various methods in which practitioners and healthcare facilities can correctly screen, identify, and address individuals that are IPV victims, IPV can be properly addressed and the attempts to gradually reduce victimization can increase.
Group interventions with female victims have proven to be most beneficial when psychoeducation and counseling techniques are involved, and females make tremendous improvements with overall wellbeing, and great reductions in their risk of reabuse (Shorey, Tirone, & Stuart, 2014). Ideally, attempts to protect current IPV victims, prevent revictimization and provide resources and education for victims of IPV are most efficacious when such goals are combined into group sessions and done so in a brief time and cost-effective manner (Santos, Matos, & Machado, 2017).