To assess the risk of further abuse, ask the woman to describe the first abusive incident that she can remember, the worst or one of the worst episodes, the last abuse before she came to see you, and typical incidents. Such questioning usually elicits sufficient information to determine the level of lethality and risk that she faces. The patterns of violence depicted in the Figure can also be used to help you assess the level of danger.
Negotiate a treatment plan with the woman. The Survivor Therapy Empowerment Program (STEP) has been used effectively with individual women as well as with groups (Table 3).8
Although gathering information about the woman’s childhood history is useful, it is probably not the first area to explore. While almost half of the women in our research sample of more than 400 battered women had experienced child abuse (usually sexual abuse by a father or stepfather), many of these women were not ready to discuss these traumatic experiences initially and often were more likely to reveal them as treatment progressed.8
In an earlier research project conducted by this author, women were asked about factors that made it more difficult for them to leave the abusive relationship.8 Mental illness and previous trauma were not specified by the women interviewed, although learned helplessness and drug abuse were factors that stood out as deterrents to finding safety from violence.
Women who have experienced multiple traumas may have relatively little resilience to deal with current trauma. This is an important clue to the psychotherapist to move slowly in the treatment plan, regardless of whether earlier trauma is discussed. Medication may be discussed with the woman when appropriate, but it is important for her to contribute to any decision so that she feels more in control of her life.
Most battered women respond to cognitive rather than affective techniques initially—although both areas eventually need to be part of the treatment plan. As cognitive clarity is developed, attention, concentration, and memory will be enhanced. A battered woman may be so anxious during the initial interview that she cannot remember much of what has been said. It can be helpful to provide her with a card that lists resources, such as the local shelter for battered women. Repetition of the areas discussed may be important, especially until the woman has regained attention and concentration.
It often helps to recommend that the woman engage in more and different types of activities with other people. Such activities can help her overcome some of the isolation and the power and control that the batterer holds over her. She needs to understand that she may still be in danger, even if her partner has completed a treatment program.15
OPTIONS FOR THERAPY
Treatment of PTSD and BWS includes a combination of feminist and trauma therapy.8,16 The feminist therapy contribution acknowledges that psychotherapy is a relationship in which the formal power resides with both the therapist and the client.16 Acknowledgment of the situational factors that can be beyond a woman’s control (eg, the lack of equality in society between men and women) helps her accept that she still can attempt to change those factors that she can control.
Legal action may contribute to a woman’s sense of empowerment—especially if she is able to use domestic violence statutes in criminal or civil court to obtain a restraining or protective order, to cause the batterer to be arrested, and to get him into a batterer’s intervention program. Filing for divorce is also a stressful legal action in family court. When the batterer has financial resources, suing him for a personal injury tort might also be an empowering action, although it is difficult to spend the time and attention often necessary to win such a case.