Domestic abuse—whether physical, psychological,or both—can have repercussions for a client’s mental health. Healthcare providers are likely to be the first point of contact for survivors of intimate partner violence or sexual assault. It is imperative to follow a code of ethics and maintain strict client confidentiality while also ensuring the client’s safety.
How can I enable my client to open up about the violence she is facing?
Remember to never raise the issue of domestic violence unless the woman is alone. A private, safe, supportive, and confidential environment, without her partner and family members present, can help her talk about abuse. Do not ask her family members to play the role of a translator.
Since some women may not initially recognize that they are facing domestic violence, the mental health professional should routinely ask all women, direct and specific questions about abuse. Such questions may be included while collecting information about the client’s social history, past medical history, or history of present illness, as appropriate.
Although women may not bring up the subject of abuse on their own, many will discuss it when asked in a confidential setting.
The professional should make an opening statement that is supportive, such as: “Because abuse and violence are so common in women’s lives, I've begun to ask about it routinely.” Concern about abuse validates the client’s feelings, and reinforces her capacity to seek help when she feels ready and able to do so. Such statements can give the client an opening to talk about her current or past experience of violence.
If you do ask her about violence, do it in an empathetic, and non-judgemental manner. Use language that is appropriate and relevant to the culture and community you are working in. Some women may not like the words ‘violence’ and ‘abuse’.
Women facing violence may appear frightened, ashamed, evasive or embarrassed. They may believe they deserve the abuse because the abuser tells them so, and they may take responsibility for his violence to maintain some sense of control over the situation.
Be conscious of cultural factors in establishing a trusting relationship with the client—most survivors of violence may feel comfortable confiding in a woman mental health professional, and some may feel confident talking to a male professional. Giving the clients a choice about who they want to talk to can instill in them a greater sense of control.
What ethics of the counselling relationship do I need to keep in mind, if my client is facing domestic violence?
Confidentiality—ensure you protect your client’s privacy, both in routine clinical settings and during teleconsultations. Before discussing her case with other professionals involved in her care, make sure to ask for her consent and proceed only if she gives it.
Autonomy—treat the client with dignity and respect; but prioritize safety over autonomy.
Minimize risk of further violence—prepare her for any trouble, and help her develop a safety plan, to keep herself and her children safe.
Awareness about her rights—educate her about her rights and empower her to assert them.
When am I required to break client confidentiality?
Confidentiality can be broken when privileged communication applies, for instance if there are homicidal threats from the perpetrator to the client, their children or pets; if the client expresses suicidal ideas; or is suffering from a communicable illness like HIV, Hepatitis-B.
In such cases it might be essential to disclose certain details to the police or healthcare personnel, depending on the situation.
Handling abuse-related trauma in therapy is a series by White Swan Foundation in collaboration with . 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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