Simmons MA Chapter 260 Training on Sexual and Domestic Violence

Training Overview, Purpose, and Guiding Principles

A Note on Terminology

This training is packed with terminology, some of which might be different than you are used to. Below we define and provide our rationale for the key terms that we have chosen to use throughout the training. Our choices are based on careful consideration, provider wisdom, and a review of the literature.

Domestic Violence:

Throughout this training, we use domestic violence instead of other terms you may have heard (e.g., intimate partner violence, battering) because it is the wording used most commonly by the general public and the advocacy community. However, we use domestic violence and intimate partner violence interchangeably and have adopted the definition developed by the Centers for Disease Control and Prevention (CDC):

“Intimate partner violence includes physical violence, sexual violence, stalking, and psychological aggression (including coercive tactics) by a current or former intimate partner (i.e., spouse, boyfriend/girlfriend, dating partner, or ongoing sexual partner).”¹

Sexual Violence:

Throughout this training, we use the term sexual violence instead of sexual assault because it more accurately reflects the range and duration of tactics that people can experience. In addition, as will be discussed in Unit 1, although sexual violence is a form of domestic violence, in this training we conceptualize sexual violence as its own distinct form of violence that can be perpetrated by a range of individuals beyond an intimate partner. There are nine categories of “perpetrator” according to the CDC: “intimate partner; family member; non-intimate partner; person in position of power, authority, or trust; friend/acquaintance; person briefly known; another non-stranger; and stranger.”² In this training, we have adopted the CDC’s definition of sexual violence:

“A sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse. It includes: forced or alcohol/drug facilitated penetration of a victim; forced or alcohol/drug facilitated incidents in which the victim was made to penetrate a perpetrator or someone else; nonphysically pressured unwanted penetration; intentional sexual touching; or non-contact acts of a sexual nature. Sexual violence can also occur when a perpetrator forces or coerces a victim to engage in sexual acts with a third party.”²

Sex Trafficking:

According to the annual Trafficking in Persons Report released by the U.S. Department of State (2018), the following is the definition of sex trafficking:

“When an adult engages in a commercial sex act, such as prostitution, as the result of force, threats of force, fraud, coercion, or any combination of such means. Under such circumstances, perpetrators involved in recruiting, harboring, transporting, providing, obtaining, patronizing, or soliciting of a person for that purpose are guilty of sex trafficking of an adult.” ³

Survivor:

When referring to people who have experienced direct domestic or sexual violence victimization, we use “survivor” rather than “victim” because it focuses on people’s inherent resilience, rather than their experience of trauma. Also, we use gender-neutral language throughout to reflect female, male, non-binary, and transgender survivors. That said, it is important to note several established gender differences. Compared to men, women are at substantially greater risk of being raped and sexually assaulted,⁴ strangled,⁵ injured,⁴ threatened,⁴ or killed by an intimate partner.⁶

Healthcare Provider:

Throughout this training, the term healthcare provider refers to physicians, physician assistants, nurses, psychologists, educational psychologists, social workers, mental health counselors, marriage and family therapists, rehabilitation counselors, and nursing home administrators. In the interest of brevity, we use the term healthcare provider (or just provider) throughout the training and use it interchangeably with practitioner.

LGBTQ People:

We strive to use language that reflects the reality that people of every sexual orientation and gender expression can experience domestic and sexual violence. We use the acronym LGBTQ throughout, which refers to people who identify as lesbian, gay, bisexual, transgender, queer/questioning, and all others for whom cisgender and heterosexual are not applicable. We use the term LGBTQ and the expression “sexual and gender minorities” interchangeably.

Transgender and Cisgender People

We have adopted the definition of transgender used by GLAAD, “An umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth.” Cisgender is a term used to describe individuals whose gender identity aligns with the gender they were assigned at birth. We use “they/them” (vs. he/she) as singular gender-neutral pronouns. When gendered language is used, it reflects the population on which research findings were based. For more information on these and related terms, see here.⁷

Person Who Uses Violence and/or Abusive Behaviors:

We have chosen to use the “person first” language rather than terms such as “perpetrator,” “batterer,” or “abuser.” Doing so separates people’s identity from their violent actions, which is essential when helping them to adopt non-violent behaviors. In addition, we recognize that people who use violence and abusive behaviors are not a monolithic group. Instead, they vary in terms of frequency and severity of violent behavior, motivation, level of dangerousness and manipulation, and capacity for change – as well as social location, life experiences, available resources, and strengths.^8-10 Ignoring those factors or applying a one-size-fits-all approach is ineffective and potentially dangerous.

Safer:

Davies and Lyon assert that safety “requires more than the absence of physical violence;” instead, it means “there is no violence, their basic human needs are met, and they experience social and emotional well-being.”¹¹ Thus, absolute safety is an unrealistic goal when working with some survivors. A focus on “safer” or “increased safety” is generally the more realistic goal.

Guiding Framework

This training is informed by a conceptual framework that blends core elements from research, theory, and practice. These include intersectionality theory,¹² the Five Domains of Wellbeing Framework developed by the Full Frame Initiative (FFI), a social work strengths-based approach,¹³ and trauma-informed approaches and practices.^14,15 We describe each here briefly and provide examples of how they manifest in people’s lives. For a more in-depth discussion, please visit our original training here.

Guiding Principles with Examples

1) Intersecting forms of structural oppression (i.e. intersectionality) affect people's experiences of domestic and sexual violence and the informal and formal resources available to them

The term intersectionality, or structural intersectionality, refers to the idea that people possess multiple, converging identities that are influenced by larger social contexts (e.g., racism), and that people's unique combination of identities must be considered when developing interventions.¹² Structural intersectionality in the context of domestic and sexual violence essentially means that in addition to being abused by a partner, many survivors are dealing with other forms of oppression (e.g., discrimination, institutional poverty, classism, xenophobia) that converge to create barriers to safety and wellbeing.¹² Intersectionality also refers to the ways in which other forms of intentional violence (e.g., community violence, commercial sexual exploitation) overlap to affect survivors' wellbeing.

Example:

Jose and Marta are a young Latino couple living in a financially impoverished neighborhood marked by disproportionate levels of community violence. Jose is often violent toward Marta, and recently strangled her despite her being pregnant. Although Marta is scared of Jose, she is even more scared of the violence in her neighborhood, making it hard for her to think about leaving Jose. In addition, Marta cannot afford to leave because her income opportunities are limited as a result of structural inequality (i.e., her health is compromised from years of living in dilapidated public housing).

2) The Five Domains of Wellbeing are universal and individually experienced

All people are "hard-wired" to make progress (i.e., build assets) in the Five Domains of Wellbeing: social connectedness, stability, safety, mastery, and meaningful access to relevant resources. Making progress in one domain, however, requires trying to minimize tradeoffs in other domains. Although weighing tradeoffs (i.e., prioritizing one need over another or trading one opportunity for another) is a normal part of decision-making, the actual tradeoffs are often greater in the context of domestic and sexual violence. Furthermore, because each of us has unique life experiences, priorities, and different access to the conditions that support wellbeing, how we experience each domain and the corresponding tradeoffs will differ.

Example:

For some survivors of sexual violence, efforts to become safer will mean having to isolate themselves from unsupportive friends and family – thereby decreasing their level of social connectedness. Whether a survivor is willing and able to do that depends on individual preferences and circumstances. Because the experience and costs of safety are unique for every individual, the role of providers is to understand each person's unique experience and situation.

3) All people have assets and strengths

All people have parts of their lives that are going well and have people they can count on in various positive ways – including survivors of sexual and domestic violence. Moreover, survivors often use a variety of sophisticated strategies and help from others to keep themselves alive and even thrive. Identifying and capitalizing on people's existing assets is more than the "warm and fuzzy" way of saying everyone has strengths. It is a vital part of safety planning and supporting people's self-determination.

Example:

You are working with a survivor named Sherisse whose landlord is willing to be flexible about rent, especially if Sherisse is tight on money for food. Knowing about this resource requires asking questions about what is going well, not just what the problems are. Once you are aware of people's assets, you can help access or strengthen these assets to support lasting change. Recognizing assets also means being aware of the costs (tradeoffs) of what it means to make change. In this case, if Sherisse needs to move for safety reasons, losing her flexible landlord is a costly tradeoff.

4) Trauma-informed approaches and practices are essential in domestic and sexual violence work.

It is essential that people in helping professions be familiar with what constitutes a traumatic experience, understand the myriad impacts of trauma, and adopt a trauma-informed approach. According to SAMHSA, "individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being."¹⁴ Trauma can alter a person's physical and emotional body, and even affect brain development, depending on the age of onset, severity, and duration. Although people are not defined solely by their traumatic experiences, trauma can influence how people process information, make decisions, and weigh tradeoffs. Experiencing domestic violence and sexual violence can be profoundly traumatic, especially when they occur in the context of other sources of trauma (e.g., childhood abuse, poverty, discrimination).

Being a trauma-informed provider means that you explore and recognize the ways in which trauma is affecting someone’s actions, reactions, and options for healing. It also requires taking steps to ensure that your interactions with and treatment plans for patients/clients do not cause re-victimization.¹⁴ Being a trauma-informed provider is easier when your workplace has adopted a trauma-informed approach, which is defined as "a program, organization, or system that is trauma-informed: realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization."¹⁴. If your workplace has not yet adopted a trauma-informed approach, we encourage you to get involved to help make it happen. See Unit 3 for more detail on how your work can be trauma-informed.

Example:

You are working with Mike, a gay-identified survivor who had been badly injured in a hate crime a few years ago while waiting for public transportation. As a result, Mike may be unwilling or emotionally unable to take the bus anywhere. Without knowing his experiences of trauma, it may be easy to label him as uncooperative or even lazy. However, being mindful of his trauma history provides insight into his choices about tradeoffs and the need to support a different plan for him.

Practicing Self-Care

Working with people who have experienced domestic and sexual violence can be incredibly taxing on your emotional, mental, spiritual, and physical health. Ignoring the negative impact of trauma work, especially when your work environment does not support self-care, can lead to the development of burnout, compassion fatigue, or secondary traumatic stress, which can be harmful for you and for your clients/patients. It is essential to take of care yourself so that you can take care of others!

Please also be sure to practice self-care while you take this training. The content has the potential to be upsetting just by the very nature of the topic and detail provided. For those of you who have experienced DV/SV, whether directly or indirectly, it is possible that some of the content might actually be triggering (i.e., acutely relive your painful experiences). Please keep this in mind as you begin the training and throughout the course of the training. We encourage you to take breaks as needed and, reach out to informal (e.g., friends, family) and formal (e.g., therapist, crisis hotlines) supports. Unit 4 lists contact information for several relevant formal resources.

Finally, a very helpful resource on practicing self-care is the 2009 book Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others by Laura van Dernoot Lipsky. You can visit her website to learn more: http://traumastewardship.com/.

This concludes the Introduction Unit of this training. Please proceed to Unit 1, which can be found here.

Kristie Thomas, PhD, MSW is the instructor for this course. To view her Curriculum Vitae, please click here.

References

1. Breiding MJ, Basile KC, Smith SG, Black MC, Mahendra R. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements. Centers for Disease Control and Prevention National Center for Injury Prevention and Control; 2015.

2. Basile KC, Smith SG, Breiding MJ, Black MC, Mahendra R. Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements. Atlanta, GA: Centers for Disease Control and Prevention National Center for Injury Prevention and Control; 2014.

3. U.S. Department of State. 2018 Trafficking in Persons Report. Washington, DC: Author

4. Black MC, Basile KC, Breiding MJ, et al. National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011.

5. Sorenson SB, Joshi M, Sivitz E. A systematic review of the epidemiology of nonfatal strangulation, a human rights and health concern. American Journal of Public Health. 2014;104(11):e54-e61. doi:10.2105/AJPH.2014.302191.

6. Sabri, B, Campbell, JC, & Messing, JT Intimate partner homicides in the United States, 2003-2013: A comparison of immigrants and nonimmigrant victims. J Interpersonal Violence. 2018. http://doi.org/10.1177/0886260518792249

7. GLAAD. GLAAD media reference guide: Transgender. glaad.org/reference/transgender. Accessed February 21, 2019.

8. Eckhardt C, Holtzworth-Munroe A, Norlander B, Sibley A, Cahill M. Readiness to change, partner violence subtypes, and treatment outcomes among men in treatment for partner assault. Violence & Victims. 2008;23(4):446-475. doi:10.1891/0886-6708.23.4.446.

9. Mederos F. Accountability and Connection with Abusive Men: A New Child Protection Response to Increasing Family Safety. San Francisco, CA: Family Violence Prevention Fund; 2004.

10. Larance, LY, & Miller, SL. In her own words: Women describe their use of force resulting in court-ordered intervention. Violence Against Women. 2017;23:1536–1559.

11. Davies J, Lyon E. Domestic Violence Advocacy: Complex Lives/Difficult Choices. Thousand Oaks, CA: Sage; 2014.

12. Crenshaw K. Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford law review. 1991;43(6):1241-1299.

13. Saleebey D. The strengths perspective in social work practice: Extensions and cautions. Social Work. 1996;41(3):296-305.

14. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.

15. Wilson JM, Fauci JE, Goodman LA. Bringing trauma-informed practice to domestic violence programs: A qualitative analysis of current approaches. American Journal of Orthopsychiatry. 2015;85(6):586-599. doi:10.1037/ort0000098.