• World Health Organization issues new guidelines on Intimate-Partner Violence. Domestic Violence Expert Tina Royles

     

    While I welcome the importance of a careful approach on speaking to victims of domestic violence; (this report refers to female victims), an area that actually concerns me is the fact that the guidelines apparently: 

    discourage[s] universal screening, on the basis that it has not produced better outcomes for women. Instead, they ask doctors to inquire about intimate-partner violence when assessing conditions that could be caused or complicated by such violence’

    It also suggest to move away from the routine list of questions and instead ask the victim:

    ‘how she is doing. Ask her if she is safe at home – and then start that conversation’

    Wow pure genius; forgive my skepticism – we have just been transported back in the world of domestic violence about twenty years, when it was left to health care and other professionals to use discretion and use their own assumptions from a general conversation to detect whether domestic violence is present or not, as opposed to using pre defined and also thought out pivotal questions arisen through practitioners years of experience. 

    Yes it is important to have flexibility of a conversation; because that helps establish the rapport needed for a victim to feel safe enough to disclose such information, but equally a list of questions pre determined also means the practitioner asks those questions, and answers (whether true or false) are given by a victim. 

    When trying to establish if domestic violence is present in a relationship a victim can often be in a distressed or chaotic place therefore unless the practitioner is skilled in working with domestic violence or sexual abuse/violence victims, then there is a danger of the practitioner being diverted through conversation away from the difficult questions; because some victims might not want those questions to be asked. A list of questions means that these questions are at least asked!

    By all means have both the pre determined questions and the ability to have a flexible conversation but don’t advocate to just rely on the discretion and flexibility because this is where the system has fallen down in the past and has the potential to fall again.

    Its like every so often, not just with domestic violence, but with other things in life we seem to go full circle with things. Research is often useful as it makes us aware but there are always pitfalls if we rush off and act on new research, because depending on what organisation has conducted the research will always mean different outcomes or perspectives depending on the theoretical approach and also the modality of the research model/s used.

    Which brings me onto the therapeutic angle. Is the World Health Organisation seriously recommending through their guidelines that only one of two therapeutic approaches: Cognitive Behaviour Therapy (CBT) or Eye Movement Desensitization and Reprocessing (EMDR) are to be used. I can see why it would be recommended by the World Health Organization because only health care providers generally offer these therapies.

    Heres the thing though. We are all individuals and one size definitely does not fit all, and domestic violence is no different. There are so many complexities with it, yes there are similarities but there are also key fundamental differences. CBT doesn’t work with all victims or domestic violence just as EMDR doesn’t either. Just as there are many that go to Relate for Relationship Counselling because Relate are thought of as the Relationships People, that come away from seeking their help and  try other relationship counsellors because it hasn’t worked for them. It is important for individuals to have choices, and to work with an approach, an organisation, and person who can help them as an individual. It is important for individuals particularly victims of abuse to have a range of services and therapies on offer in order for them to explore, heal and recover. 

    Domestic Violence cannot be addressed solely from one or two particular academic findings or perspectives, nor should it be from one or two theoretical approach, a psycho-educational approach, or a practitioner approach solely – but it needs to be from an integrative perspective where all of these approaches are taken into account in order to bring a rationale and element of logic to it.

    When clients come to me specifically for domestic violence, through years of experience it became clear that it has been vitally important for me to work in an integrative way. I liken it to me having a toolbox, it is a toolbox of experience, knowledge, and skills, and when a client comes to me, it is about assessing their own unique experiences and situation, and then exploring with them thoughts and ideas, holding the range of academic and theoretical approaches/models lightly to guide me, and using practitioner skill set, knowledge and experience of techniques to not only empower, but to provide and enable a platform for them to perhaps move forward, recover and heal, and in order to assist effectively for each individual I open up my toolbox and search for the most appropriate tools and using my knowledge and skill set we work together on the issues presented.

    So it is important in effect to have an integrative approach, because no one size fits all. It is also important for the counsellor, psychotherapist, or psychologist to have in-depth background or skill set in working with domestic violence in particular because the work will often open up lot’s of issues for the victim and the practitioner needs to be in a position to address or work with these and not leave the victim struggling to deal with what has been unearthed, and leaving the victim in a more vulnerable place. 

    The World Health Organization recommends the need for health professionals to have training on domestic violence. Health professionals have had training available on domestic violence for at least the last 10 – 15 years if not longer, the same as other organsiations like the police and social services, but unless training on domestic violence is mandatory then difficulties will and often do arise. Even if training is mandatory failures happen and victims slip through the net – why because there is a lack of monitoring and accountability, and it is left to the discretion of individuals involved, and that will always present problems for the practitioner and ultimately the service user.

    To see the article around the early release of new World Health Organizations guidelines on intimate partner violence click on the link below:

    http://www.cmaj.ca/site/earlyreleases/26sept13_new-who-guidelines-on-intimate-partner-violence.xhtml

    About Tina Royles

    Connet with me: Google+ Tina Royles is the UKs leading expert in domestic violence offering Domestic Violence Counselling, Relationship Counselling and Anger as well as Stress Management Counselling. She is one of the UK’s most qualified and experienced domestic violence experts providing consultancy and advice to those who have suffered domestic violence, are currently in violent relationships or to friends and family of those affected. Tina provides the materials and tools to manage relationship difficulties and domestic violence through awareness and education and is regularly called upon by the national and local press to provide expert comments on high profile cases. Tina Royles

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