title: The psychological consequences of violence against women and possibilities of help through specialized social counseling type: Practice papers language: English published: 23 Jan 2014 updated: 09 Apr 2018 category: Psychológia author: PhDr. Ľudmila Húsková source: https://www.prohuman.sk/socialna-praca/psychicke-nasledky-nasilia-pachaneho-na-zenach-a-moznosti-pomoci-specializovanym-socialnym-poradenstvom

1 Forms of domestic violence

Victims of domestic violence are rarely exposed to only one form of abuse. In professional settings, five basic forms of domestic violence are usually distinguished: physical, psychological, sexual, social, and economic (financial) violence.

Physical violence manifests in a wide range of attack intensities. It “includes all kinds of brutality, increasing in intensity, from slapping, kicking and hitting, with rising aggression leading to beating with the intention to kill. Physical violence is often accompanied by destruction of property, mainly items to which the woman is attached, for example breaking furniture. As a result of such violence, women suffer injuries and health problems with varying degrees of risk to health and life. The attacks often require medical treatment or hospitalization. Women rarely see a doctor even when they have serious injuries” (Löw, 1998, p. 56).

Psychological violence “includes emotional and verbal abuse; the woman experiences it as the destruction of her sense of self-worth and psychological health. We learn of its presence from women’s subjective reports. It includes humiliating her at home and in public, insulting comments about appearance or character, denigration, and outbursts of anger. Statements that the woman is crazy, mentally ill, paranoid, or has suicidal tendencies” (Egger, 2000, p. 3). Men use these expressions to deflect attention from their own actions, locating the problem in the woman (Ponešický, 2005).

Sexualized violence lies between physical and psychological violence in terms of its effects on the victim’s bodily and psychological health (Egger, 2000). The woman suffers not only physically but, above all, psychologically. Sexualized violence includes all sexual acts that are forced upon her. It is an act of aggression and abuse of power, not the result of uncontrollable sexual drives (Matějková, 2007). “Rape, coerced vaginal, oral or anal penetration, forcing sadomasochistic practices, forcing prostitution, forcing sexual contact with the perpetrator’s friends, forcing a woman to watch pornography—this is the most common form of sexual violence” (Matejková, 2009, p. 120).

Social violence is “behavior aimed at isolating the woman. A strategy often used to manipulate and control the victim” (Egger, 2000, p. 4). From our practice we list forms such as preventing contact with family, friends, locking her in the home, canceling a phone subscription, monitoring calls and emails, and banning her from using a car.

Economic violence means an imbalance in access to financial resources and using a stronger economic position as a means of control. “Abusing power through control of money resources, by refusing or minimizing financial support, by preventing a woman from working, from employment. The man pressures the woman to leave a job and restricts her own income” (Sopková, 1998, p. 103). From our practice, we have observed that perpetrators give women too little money for household expenses or keep income sources, assets, or spending hidden from the victim.

The severity of violent acts committed against a woman can be demonstrated convincingly, especially by their consequences. The experienced violence affects the victim of partner violence in many areas of life. Abuse by an intimate partner affects not only physical health but primarily leaves profoundly damaging effects on her psyche. Domestic violence significantly disrupts the victim’s quality of life. Its impact is, for example, shown in job performance, which can further endanger the victim’s economic situation (sick leave, increased risk of job loss, reduced work performance); social status also decreases (a woman often becomes homeless while fleeing a violent partner), among other effects. In the following part, we focus on identifying more closely the psychological consequences of violence, as we consider these the most common consequences of partner violence.

2 Psychological consequences of violence against women

Domestic violence and its individual forms committed against women are part of both our history and present. Based on our experience, domestic violence is a frequent phenomenon in some Slovak households. We can speak of violence directed at women, children, elderly people, and men. Our practice shows that among the most frequent forms in violent relationships are psychological forms of violence against women. Domestic violence has a marked impact on women as victims, including their psyche. The victim’s shaken mental health appears in her specific experiences and behavior. These women more often seek psychiatric care, and there is also a higher risk of suicide attempts or attempts to escape through alcohol, drugs, or medication (Vágnerová, 2004, p. 643). At the same time, emotional disorders or behavior disorders may develop as a result of abuse, such as low self-esteem and self-worth, depression, anxiety, phobias, inability to trust anyone or develop close relationships, obsessive-compulsive disorder, symptoms of post-traumatic stress disorder, particularly the battered woman syndrome or Stockholm syndrome, alcoholism, suicidal behavior, and others. From my practice, these disorders are common long-term responses to violence.

Some authors describe psychological changes in victims of domestic violence through the concept of traumatic bonding, which occurs when one person in a relationship has too much power and “becomes completely dependent on the powerless person for their relative feeling of omnipotence” (Kones, 2003, p. 194). From our practice, a subordinated woman under the power of that person increasingly feels more powerless, fearful, and depressed. It is possible to place within this framework the so-called Stockholm syndrome. According to J. Buriánek and Z. Podaná (2006), for traumatic bonding to develop two clear conditions must be met: an imbalance of power that creates a strong dependence of the submissive individual on the dominant one, and alternation of periods of abuse and normal behavior, which is particularly effective in creating a strong emotional bond.

Stockholm syndrome is characterized precisely by the fact that “between victim and perpetrator a special relationship is formed—attachment. One sign of this specific relationship is, for example, loyalty to the perpetrator, efforts to protect them, and even sympathy and ‘cooperation’ with them. Another sign is the inability to seek help from outside, especially institutions, and also the inability to leave the relationship and the perpetrator” (Sopková, 1998, p. 455). In our view, Stockholm syndrome directly marks a specific attachment of the victim toward her tormentor, which we encounter in long-term partner violence. To speak of Stockholm syndrome, four conditions must be met: the victim’s life is in danger, the victim cannot escape, or is convinced they cannot; isolation from others; transient attachment; and transient friendliness of the perpetrator (Egger, 1999). In our view, the specific feature is the emotional bond between victim and perpetrator, based on fear and gratitude at the same time (the woman feels gratitude even for a reduction in the level or frequency of abuse), which leads to identification with her tormentor and his needs, and the victim’s inability to express negative emotions. Notably, the need to survive is stronger than impulses to hate the perpetrator; instead, he begins to be perceived as someone good.

2.2 Battered woman syndrome

The situation of a woman in a pathological relationship with a violent partner is defined by the concept of battered woman syndrome, which was introduced into professional literature in the 1980s as violence against women became explicitly foregrounded. It is a concept developed in 1978 by psychologist Lenore Walker to “name the broad range of psychological symptoms and behavioral patterns that are a consequence of chronic intimate partner violence and that help the victim survive in violent situations” (Marvanová, Vargová, 2008, p. 40). Battered woman syndrome is defined as “a set of specific characteristics and consequences of abuse that lead to reduced capacity of the woman to respond effectively to experienced violence. It is therefore a development of characteristic physical, psychological and social symptoms such as depression, low self-esteem, or isolation, re-experiencing trauma, learned helplessness, withdrawal from others, eating disorders, fatigue, headaches, and so on, which are consequences of direct personal experience with repeated violent attacks, especially inconsistent and variable behavior of the perpetrator and reduced ability of the victim to influence her own life” (Marvanová, Vargová, 2008, p. 40).

At least two full repetitions of the cycle of violence must occur for battered woman syndrome to develop. Four basic characteristics of this syndrome are also defined: the woman believes she is at fault for the violence, cannot imagine someone else being responsible, she fears for her own life or that of her children, and she has an irrational feeling that the perpetrator is omnipresent and knows everything. (Marvanová, Vargová, 2008) It can be stated that in women who are victims of violence, we encountered phenomena that are not seen among victims of other crimes. We consider, for example, the persistent bond to the aggressor, staying in the relationship, concealing the seriousness and causes of injuries, and denial of victimization as distinctive. Battered woman syndrome most often appears as post-traumatic stress disorder, learned helplessness, and self-destructive reactions.

2.2.1 Post-traumatic stress disorder

Post-traumatic stress disorder is a term used for an anxiety disorder that typically develops after an emotionally overwhelming and highly stressful event whose severity exceeds ordinary human experience and is traumatic for most people (Egger, 1999). A traumatic reaction arises as a response to feelings of helplessness and inability to act meaningfully when confronted with trauma. If escape or flight is not possible, personality integrity can be disrupted. Traumatic events bring lasting deep changes in physiological, emotional, and cognitive areas. For victims, it is difficult to integrate these experiences into prior life experiences and understand the meaning of the suffering they endure. “At traumatic events, learned coping and adaptation strategies cannot really be used” (Egger, 1999, p. 77). Partner violence is unquestionably one of the most serious stressors in the family because it strongly contributes to the development of post-traumatic stress disorder in victims, especially when intervals between violent incidents shorten and the victim has less and less time to process the trauma. In cases where trauma is part of domestic violence, symptoms are more complex, last longer, and are less accessible to intervention (Marvanová, Vargová, 2008, p. 42). Symptoms of post-traumatic disorder fall into three main categories (Egger 1999):

  • Hyperarousal – women exposed to such trauma remain in permanent expectation of new danger, keeping their bodies in constant alertness; they stay in a state of constant alarm and can show exaggerated reactions. They often report sleep disorders, concentration problems, irritability, and sometimes symptoms of generalized anxiety.
  • Intrusive symptoms (intrusions) – these are so-called “flashbacks,” i.e., sudden, intrusive and inescapable feelings of re-experiencing traumatic situations. Women often say that once the moment of trauma occurs, “time stands still” (and life is no longer life as they know it; they cannot return to a normal life rhythm).
  • Constriction – these symptoms appear as a “traumatic trance,” where a woman exposed to total helplessness and inability to resist or flee perceives reality as altered, as if the situation were happening outside her body or was merely part of a bad dream.

These symptoms can trigger situations that resemble the experienced trauma. For the victim this leads to emotional numbing, emotional paralysis, and avoidance of situations that may feel threatening; it can involve loss of interest in the surrounding world and aversion to thinking about the future.

2.2.2 Learned helplessness (Learned Helplessness)

The theory of learned helplessness starts from the fact that some women are literally imprisoned in a violent relationship (Marvánová, Vargová, 2008). It is based “on social learning theory and the findings of experimental psychologist M. Seligman—violent incidents in the relationship occur unexpectedly, resulting in women feeling a loss of control over their situation and gradually losing motivation to respond. As a consequence, helplessness emerges, as does vulnerability to depression and anxiety, and the ability to begin addressing the situation declines” (Buriánek, Podaná, 2006, p. 28).

Of course, the syndrome does not occur to all victims to the same extent; some try at least partially to control the place and timing of incidents, but for the most part all victims consider the violence inevitable. A notable feature is also passive and submissive behavior of victims. From experience, we found that in the early phases of relationship violence, the victim is first shocked by partner aggression and neutralizes this with various reality-manipulation mechanisms. In a subsequent phase, she gains the experience that she cannot control the violence, which leads to loss of activity and motivation to seek solutions, falling into helplessness, loss of a sense of competence, decline of self-confidence, emotional deficits (depression, apathy), and no longer hoping for change, for solutions, or for help, thereby adapting her life to permanent terror and threat. For this reason, we consider learned helplessness one of the reasons why battered women do not perceive their ability to escape a violent relationship (Buriánek, Podaná, 2006).

“To eliminate the syndrome, it is first necessary to separate the victim from the violent partner, for which outside assistance may be essential. Then it is necessary to change negative expectations, restore her confidence and self-esteem, and help her regain a sense of control over her own life” (Buriánek, Podaná, 2006, p. 28). Counseling and psychotherapy are effective forms of help that we can apply.

2.2.3 Self-destructive reactions

Self-destructive reactions paradoxically represent effects of victimization by a close person, which should not be viewed in abused women as psychopathology or character weakness. They are, in fact, a typical and natural coping strategy for repeated and unpredictable violence (Vágnerová, 2004). These reactions appear mainly in long-term abuse and include primarily the following phenomena:

  • denial of perpetrator blame – “a battered woman tends to relativize the perpetrator’s guilt and attribute it to someone or something else (e.g., negative childhood experiences, unemployment, alcohol), while emphasizing the perpetrator’s positive traits (e.g., caring for the family and similar)” (Vágnerová, 2004, p. 98).
  • minimization of consequences – the woman denies the seriousness of individual incidents and the overall situation; this is a form of illusory defense. The woman blames herself for violent incidents because she was unable to meet her partner’s expectations or demands or satisfy his standards. Self-blame by the victim becomes an important distinguishing marker between genuine and alleged victimization, since in staged allegations of domestic violence we do not encounter self-blame in the purported victim (Vágnerová, 2004).

In our view, the response to the first incidents from the aggressor is also important. Our experience shows that women who respond actively in the initial phase of abuse (setting boundaries regarding future cohabitation, threatening sanctions and disclosure of incidents) are later able to respond effectively to continued violence (seek counseling, leave for crisis centers, etc.). In contrast, for women with a passive response to the first incidents, the likelihood of prolonged abuse sharply increases.

3 Possibilities to help women victims of domestic violence

In work with a woman experiencing violence from her husband/partner, it is necessary, in our view, to provide the woman with a free and safe space to consider her decisions and orient herself toward her future. A battered woman does not decide only for herself; her decisions have major impact on her children. Therefore, we consider it important that the battered woman take ownership of the problem-solving process with attention to multiprofessional support, which we recommend as guidance through her recovery process. The European Union developed European service standards that define basic principles for work with battered women. From these principles, we select:

  • help toward self-help,
  • guidance toward independent existence and autonomy,
  • anonymity,
  • safety and protection (confidentiality of alternative housing, confidentiality in providing help),
  • women helping women (female staff). (Karlovarská, Krokavcová, 2009)

Women experiencing violence have been in psychological, social, and often economic strain for a prolonged time. They experience stress and are in serious life crisis; before they seek professional help, they often first turn to close ones and family. We consider such informal support important, but we align with the view of Čírtková and Vitoušová (2007) that it should include the following recommendations: support for emotional expression, belief in one’s own abilities, restoration of feelings of safety and trust, support in addressing the victim’s key problems—relatives can play a positive role, for example by accompanying her when filing a criminal report, attending investigative procedures, and so on.

In cases where the battered woman cannot manage domestic violence with help only from relatives and close persons, specialized help in crisis intervention is sought. Štepanovská, N. (2005) distinguishes crisis support into direct and distance forms. For direct crisis support, personal, face-to-face contact is essential, which can take place in a shelter, in an office, or in the field—directly in the client’s residence. Distance crisis support includes hotline services and internet-based services.

Crisis hotline – anonymous crisis lines provide battered women with necessary information, space to seek help, and the opportunity to establish cooperation. We consider the main advantage of a crisis line to be its easy accessibility, the possibility to call when the woman needs it, and protection of privacy. Online counseling – currently, we consider this counseling to be a fast, fairly accessible, and anonymous way of making contact. Through the websites of helping organizations or email communication, a client can quickly obtain needed information about forms of social intervention.

Clients often first choose a hotline or email as a first point of contact. Only after receiving basic information, their fears about anonymity and communication security decrease, and they choose direct contact with a social worker through outpatient or residential social services. In the context of outpatient services, the helping organization provides:

  • specialized counseling,
  • legal counseling in family, criminal, and property law,
  • social counseling,
  • psychological counseling,
  • help with writing requests and petitions,
  • creation of a safety exit plan from the perpetrator, accompaniment to courts,
  • filial therapy,
  • support groups,
  • help in finding housing,
  • preventive programs. (Brnová, 2011)

In a shelter housing facility, temporary accommodation is provided at a confidential address. From our experience, today shelter housing is hampered by difficult financial conditions in shelters, which at times have trouble securing basic conditions for operation. From the activities of these facilities, we selected: protection and safety, 24-hour availability, standard provision of food and hygiene for clients and their children, as well as services of a social worker, psychologist, lawyer, and others.

In connection with this issue, we briefly note the importance of prevention in this field, which is carried out through preventive activities. Preventive interventions should target clients, professionals, and the general public, directing them toward awareness and the elimination of serious socio-pathological phenomena such as violence against women.

3.1 Possibilities for helping through specialized social counseling

Counseling for women victims of domestic violence belongs to professional counseling and, depending on professional specialization, may be social, psychological, or legal counseling. Boundaries between these professions are not always clearly separated. “Social counseling is a process that takes place through development of the relationship between the social client and the social counselor, using various counseling forms and working methods, with the goal of improving the client’s quality of life through mobilization of natural internal and external resources in their environment” (Mydlíková, 2004, p. 19)

In helping a battered woman, we understand specialized social counseling as providing professional expert advice and methodical guidance to the client with acceptance of her decisions. The aim should be to resolve and overcome her problem using methods of social counseling and additional techniques and methods from social work (e.g., encouragement, feedback, active listening, empathy). Counseling should be oriented primarily toward providing information that helps her navigate options available in adverse social circumstances—helping her to recognize further possibilities, end feelings of isolation, take control of her life, and therapeutically eliminate trauma-related impacts caused by violence (Brnová, 2011)

In specialized social counseling with social clients who are battered women, it is essential that the social worker works in a multiprofessional team and has basic legal and psychological knowledge and skills. We recommend that social workers, when specific needs arise, refer the client and connect her to other specialists in psychology, psychotherapy, psychiatry, and law. A woman exposed to violence may experience helplessness, loss of control, and loss of agency in life decisions. In the help process, it is therefore important that the social worker and the battered woman think through options that help her regain control over her own life. If a social worker is to help a victim of domestic violence effectively, they should know all significant indicators of this phenomenon and respect the victim’s experience even if they do not fully understand or identify with it (Bednářová, 2006). A social worker cannot pressure the victim, and boundaries set by the victim must be respected unconditionally. A basic principle of contemporary counseling states: “To help means to help people so that they can help themselves” (Matoušek, 2003, p. 84). The center of attention should not be the problem (violence), but the client herself. We accept the view that counseling for women victims of domestic violence should be person-centered in the spirit of “Rogerian” client-centered therapy, where the counselor creates conditions for growth through congruence, full acceptance (unconditional positive regard), and empathetic understanding.

3.1 Conducting counseling interviews

For the elimination of violence and the healing of its consequences, naming the violence is one of the basic steps. In conducting counseling interviews with a victim, it is appropriate to observe the following principles: (Gabura, 2005, p. 24–31)

  • the counselor should introduce themselves at the outset with their name and specialization;
  • a sensitive, patient approach—do not rush, do not interrupt; the woman needs time to formulate the problem, feels shame, use an empathetic approach—try to enter the client’s experience, set aside one’s own reference frame; validate emotions—allow her to cry, reassure her she has a right to cry; show understanding; these are “normal reactions to an abnormal situation”;
  • express interest and solidarity—verbally and nonverbally (eye contact, facial expression, appropriate gesturing, body orientation); support her in telling her story, ask questions, paraphrase, summarize what is heard; the client needs to feel human concern;
  • show trust in what she says—sometimes a victim’s story is hard to believe, but often the situation is far worse than described; the client needs to feel accepted and safe, and to feel recognized that she sought help and wants to change the situation; highlight her strengths;
  • name domestic violence and its unacceptability—assure her that the perpetrator is responsible for the violence, and she did not in any way “cause” it, even if the perpetrator claims otherwise; reassure her the situation is solvable (she may think that nothing and no one can help);
  • the counselor should balance direction and acceptance, bring structure and clarity into communication, and guide the client;
  • do not give advice (nondirective approach), rather activate her to find her own path, offer support in problem-solving, but do not force rapid solutions;
  • respect the woman’s decision even if the counselor disagrees (e.g., if she refuses to leave the perpetrator);
  • be honest, i.e., provide truthful information about the complexity of the situation;
  • do not give false hope, do not promise what cannot be fulfilled, do not omit facts, and maintain and develop dialogue so the counselor learns what the client is experiencing;
  • assess the level of threat to the victim (danger posed by the aggressor); risk signals include the aggressor owning a firearm, drinking alcohol or using drugs, threatening to kill, attacking children, showing tendencies to stalk the woman, etc.; orient the client toward the future (she may keep returning to the past), propose small incremental goals that lead to change rather than an immediate total change.

In case management, precise and detailed documentation of findings and measures taken is also important. However, the client should know that her personal data are protected. In addition to counseling services within social service facilities (“shelters”) in Slovakia, there are specialized counseling centers for battered women (Pro Familia, Fenestra, Centrum Nádej, Aliancia žien). A social worker who chooses to work in this field must master all required methods and techniques (Rusnáková, 2007). It is important that counseling is offered also to women where violence does not reach the minimum intensity threshold of criminal offenses and who do not need crisis accommodation. In each Office of Labor, Social Affairs and Family there are Counseling and Psychological Services Departments, where counseling and therapy are also part of the work in cases of domestic violence.

Conclusion

Today there is a fairly extensive network of services that support people threatened by domestic violence. Services are offered at different levels. Some organizations provide only counseling through personal, telephone, or email consultations; others offer broader services such as shelter accommodation, psychological, legal, or economic assistance. Effective help for victims of domestic violence can be provided only by social workers who are well informed about domestic violence.

Author: PhDr. Ľudmila Húsková Katolícka univerzita v Ružomberku, Pedagogická fakulta, Katedra sociálnej práce

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