As a mental health practitioner, you need to routinely ask women about present or past incidents of domestic violence, especially if a client is diagnosed with depression or anxiety, or if they show any other signs of mental distress. You should be able to provide referrals to specialist services like the police, lawyers, and NGOs working in the space of domestic violence. You also need to be adequately trained to respond to those who disclose domestic violence. This means not focusing solely on medical treatment, but also on referrals and support.
Routine assessment is important for women at all stages - those who are in an abusive relationship, who are planning to leave or who have left a violent relationship. Leaving an abusive partner or finalizing a divorce may increase her risk for abuse. At that stage, when the legal proceedings have begun, the mental health professional should provide appropriate follow-up sessions and assess the woman’s need for emergency shelter or any other resources.
Once abuse is recognized, a number of interventions are possible, but even if a woman is not ready to leave the relationship or take other action, the professional’s recognition and validation of her situation is important.
World Health Organization (WHO) recommends the “LIVES” approach when it comes to engaging with the woman, when the abuse is recognized—
Listen, be empathetic and non-judgemental
Inquire about the individual’s needs and concerns
Validate—show that you understand and believe them. You can say, “Unfortunately this is common in our society”. Affirm that violence is unacceptable and they have a right to feel safe at home. Tell them that their disclosure is helpful and important.
Enhance safety—ask about safety and discuss a plan with the individual as needed.
Support—understand the domestic violence legislation and help them connect with services available to them. Tell her that she is not alone and it’s not her fault.
No critical remarks—never say things like,” Why don’t you just leave?” Remember, the individual is the best judge of their situation and your job is to help them in making a decision for themselves.
Respect the individual’s concerns and decisions—as most of the individuals in an abusive relationship experience a sense of loss of control, this will help them regain confidence.
What kind of resources should I have with me in order to better support my client?
It is useful to develop a network with other professionals who are involved in the care of survivors of domestic violence like police personnel, lawyers, NGOs, women’s organizations, and other mental health professionals. Have a list of addresses or contact numbers of possible referral agencies in the area for easy access.
It would be useful if you can make an introductory call to these agencies and give a brief summary of what they know so the woman is not questioned repeatedly about her experiences by different people. Keep a list of organizations you can share with your clients.
Where can I get more information about domestic violence?
The World Psychiatric Association’s (WPA) International Competency-Based Curriculum for Mental Health Care Providers is a good source, designed especially for mental health professionals to understand about IPV and interventions for it.
The Indian National Family Survey (NFHS)-4 (2015-16) and WHO Multicentre Study (2005) can be referred to to understand the prevalence rates of IPV in India and the world.
For clients in an abusive relationship, what information and resources can I share with them?
You can show them how to contact the police, NGOs, mental health organizations offering remote consultation, and crisis helplines. You can also provide details of trusted lawyers or legal organizations.
Explain to the clients, in non-technical terms, what constitutes abuse, how prevalent it is, and what its signs and symptoms are. Tell them what the cycle of abuse is, draw a diagram on paper if it helps, and ask the client to provide inputs about what can be done differently. Reassuring her that help is available is important but also remember to not raise her hopes by saying that the violence will stop. Don’t push her to leave the relationship, let her come to the decision on her own.
It is good practice to provide as much information as possible in the first visit since many clients might not be able to come for a follow-up. It is also important to ask the client if it is safe to carry the handouts/ resource material home before giving any. To maintain caution in sharing resources, you can share the phone numbers on a piece of paper or through a message on her phone.
Handling abuse-related trauma in therapy is a series by White Swan Foundation in collaboration with Shakti. This series is a guide for mental health practitioners to help survivors of abuse heal with therapy. This series refers to survivors as women, however, we acknowledge that survivors can belong to any identity. The usage of the word "women" has been used to reflect laws that are focused on women as survivors of domestic violence, and other guidelines that are framed keeping women in mind.
Written by Bhumika Sahani, journalist and social worker by training; consultant at Shakti; and Dr Parul Mathur, resident doctor, Department of Psychiatry, NIMHANS
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