Interventions for Leaving a Violent Relationship

Let us consider this interactional relationship further. In the last chapter it was noted that psychiatric labeling has been used to explain why women stay and to excuse their assailants. Here the medicalization of violence and its victims is examined from two perspectives: (1) How did the victims interpret their status vis-à-vis illness and health while they were battered? (2) Can a medical paradigm explain the process by which these women finally ended their violent relationships?

Figure 4.1 Interactive relationship between stress and crisis and possible illness in a battering situation. The arrows suggest the interactional relationship between stress, crisis, and illness. Trouble and stressors in a marriage can lead to positive or negative outcomes through several diff routes, depending on personal, social, and economic circumstances.

The women's self-evaluations revealed physical and psychological abuse to varying degrees over a two to twelve-year period. What is not clear is the extent to which these women were in 'crisis' in the clinical sense: an acute emotional upset in which one's usual problem solving ability fails. Whether these women could be termed in crisis is important not only theoretically, but also clinically since it has implications for social and clinical responses to battered women. Clinical definitions of crisis confine it to acute upsets lasting between one and six weeks (Caplan 1964; Hoff 1989). If this definition is followed, then each battering episode could retrospectively be viewed as a crisis, but not the entire battering period of several years. Application of the term 'crisis' depends on objective observations as well as subjective interpretations supplied by the upset person. Accordingly, these women cannot be assessed retrospectively for whether they were or were not in emotional crisis during each battering episode. What we do know, however, is that they somehow coped with the trauma of battering by various means, some of which were constructive (e.g. seeking help) and some destructive (e.g. suicide attempts or overeating). What needs to be examined further is the adequacy of their coping.

In earlier analysis (p. 46-SO), the women's self-destructive behavior was linked to women's traditional socialization to channel their stress responses and deviant tendencies inward, since they have been socialized to perceive their troubles as originating from within themselves rather than from external sources. But these women also channeled their stress responses outward, in fantasies about killing their violent mates. The combination of the women's self-destructive and other-destructive responses to stress can be better understood if linked to the concepts of 'resistance resources' and the women's values about women, marriage, the family, and violence.

It has been noted that some of these women felt socially isolated. They coped essentially alone for many years with the trauma of battering. Whether they were in emotional crisis with each battering episode or not, the fact that they survived and no longer live in terror demonstrates that they managed highly traumatic situations to the best of their ability. Significantly, no matter how they felt emotionally, they nevertheless carried out their social roles as wives, mothers, and/or wage-earners over many years of repeated trauma. This picture of competence, strength, and ability to cope starkly contrasts with the one of helpless victim or one haplessly driven by 'forces' inside and outside the 'family system'. It also suggests that 'survivor' is a more appropriate term for them than 'victim'.
- Hoff, Lee Ann, Battered Women as Survivors, Routledge: London, 1990.

=================================
Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 250 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about developmental versus medical paradigms in violent relationships. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 15
In Hoff's interactive relationship diagram of stress and crisis, what four factors are considered? Record the letter of the correct answer the CEU Answer Booklet.