domestic violence: understanding the...

Domestic Violence: Domestic Violence: Understanding the Perpetrator Understanding the Perpetrator

Arlene Bradley, MD, FACPArlene Bradley, MD, FACPWomen's Health Clinical DirectorWomen's Health Clinical DirectorVA Roseburg Healthcare System (A209)VA Roseburg Healthcare System (A209)Roseburg, OR 97470Roseburg, OR 97470ee--mail: mail: [email protected]@wizzards.net

James M James M DugoDugo, Ph.D. , Ph.D. Licensed Clinical Psychologist, Professor,Licensed Clinical Psychologist, Professor,Illinois School of Professional PsychologyIllinois School of Professional Psychology--North WestNorth Westand private practice domestic violence interventionand private practice domestic violence interventionprogram for perpetratorsprogram for perpetratorsChicago, ILChicago, [email protected]@yahoo.com

Kerstin Kerstin EdinEdin, MPH, RNM , MPH, RNM Epidemiology, Dept. of Public Health and Clinical MedicineEpidemiology, Dept. of Public Health and Clinical MedicineUmeåUmeå UniversityUniversityUmeåUmeå, Sweden, [email protected]@epiph.umu.se

Sandra LemaSandra Lema--Stern, Ph.D. Licensed Clinical Psychologist, Stern, Ph.D. Licensed Clinical Psychologist, ProfessorProfessor

Illinois School of Professional PsychologyIllinois School of Professional Psychology--North WestNorth Westand and priviatepriviate practice domestic violence interventionpractice domestic violence interventionprogram for perpetrators.program for perpetrators.Chicago, ILChicago, [email protected]@yahoo.com

**Diane Morse, M.D.**Diane Morse, M.D.Assistant Professor of MedicineAssistant Professor of MedicineUniversity of Rochester School of Medicine and DentistryUniversity of Rochester School of Medicine and DentistryRochester, NYRochester, [email protected]@viahealth.org

Efficacy of Perpetrator Efficacy of Perpetrator ProgramsPrograms

Diane Morse, MDDiane Morse, MDMay 14, 2004May 14, 2004

SGIMSGIM

Broward County, FLBroward County, FL

1 yr probation +/1 yr probation +/-- 26 wk program26 wk program5 sites total, all certified Duluth 5 sites total, all certified Duluth modelmodelBatterers/victims interviewed at 0, 6 Batterers/victims interviewed at 0, 6 mo, 12 momo, 12 moBatterer attacks tracked using Batterer attacks tracked using computer police recordscomputer police records

Broward County ProgramBroward County Program

Age 19Age 19--71, typical 35yo71, typical 35yo57% Caucasian, 36% AA, 6% Hispanic57% Caucasian, 36% AA, 6% Hispanic25% not HS grad; 9% college grad25% not HS grad; 9% college grad72% employed; 85 % first arrest for DV, 72% employed; 85 % first arrest for DV, but many had prior arrests for felonies but many had prior arrests for felonies (20%) and misdemeanors (40%)(20%) and misdemeanors (40%)29% attended all initial sessions, though 29% attended all initial sessions, though 66% eventually attended after make up; 66% eventually attended after make up; 13% attended none 13% attended none vsvs 97% in controls97% in controls

Broward County ProgramBroward County ProgramInstruments: Inventory of Beliefs About Instruments: Inventory of Beliefs About Wife Beating and Attitudes Towards Wife Beating and Attitudes Towards Women and revised Conflicts Tactics ScaleWomen and revised Conflicts Tactics ScaleVictims asked re batterer behavior, who Victims asked re batterer behavior, who was responsible, likelihood of another was responsible, likelihood of another batteringbatteringResponse rate: didn’t volunteer, but could Response rate: didn’t volunteer, but could refuse interviewrefuse interviewPerpetrator: 80Perpetrator: 80-->50%; Victims: 49%>50%; Victims: 49%-->30>22%>30>22%

Broward ProgramBroward Program

Found no significant difference Found no significant difference between groups who had/didn’t have between groups who had/didn’t have intervention in reintervention in re--offense or attitude offense or attitude or victim prediction of reor victim prediction of re--offenseoffense

Brooklyn, NYBrooklyn, NY

Sentenced to tx only by Judicial (Sentenced to tx only by Judicial (vsvsProbation) Branch; all parties had to Probation) Branch; all parties had to agreeagree--ieie, more selective and , more selective and motivated; judges allowed to motivated; judges allowed to override randomizationoverride randomizationCompared tx to community serviceCompared tx to community serviceDuluth modelDuluth model

Brooklyn ProgramBrooklyn Program

Control group had better follow upControl group had better follow upInterview completion: victim: 50Interview completion: victim: 50-->46>46-->50%; perpetrator: 95>50%; perpetrator: 95-->40>>40>--24%. Used incentives for victim.24%. Used incentives for victim.67% completed short program; 67% completed short program; vsvs27% long27% long

Brooklyn ProgramBrooklyn Program

After 8 wk program, no difference in After 8 wk program, no difference in complaints against them, but 26 wk complaints against them, but 26 wk participants showed difference from participants showed difference from controls: 10% vs. 25% controls: 10% vs. 25% vsvs 26% @ 12 26% @ 12 mo.mo.AttitudesAttitudes--no differenceno difference

LimitationsLimitations

Response rates lowResponse rates lowDrop outsDrop outsNot all not interviewedNot all not interviewedRandomization/instruments Randomization/instruments questionablequestionableDuluth model assumes all seek Duluth model assumes all seek control, but motivation may differcontrol, but motivation may differDid not assess participant motivation Did not assess participant motivation to change and adjust programto change and adjust program

Policy questionsPolicy questions

Do batterer programs waste valuable Do batterer programs waste valuable resources?resources?Do they lead to a false sense of Do they lead to a false sense of security in the victim?security in the victim?Is it prudent to mandate tx in Is it prudent to mandate tx in absence of evidence of efficacy?absence of evidence of efficacy?

ResponsesResponsesMay be dose related, like substance abuse May be dose related, like substance abuse txtxNeed to design interventions according to Need to design interventions according to research about perpetratorsresearch about perpetratorsMay need to mandate longer tx, May need to mandate longer tx, ieie until no until no longer a danger to partnerlonger a danger to partnerRelatively new approach and too early to Relatively new approach and too early to abandon without further trialsabandon without further trialsDifferentiate mandated and voluntary Differentiate mandated and voluntary attendeesattendees

ReferencesReferences

Special Report: Where Do We Go Special Report: Where Do We Go From Here? Batterer Intervention From Here? Batterer Intervention Programs, U.S. Department of Programs, U.S. Department of Justice, Office of Justice Programs Justice, Office of Justice Programs National Institute of Justice, JUNE 03 National Institute of Justice, JUNE 03

http://www.ncjrs.org/pdffiles1/nij/195http://www.ncjrs.org/pdffiles1/nij/195079.pdf079.pdf

ReferencesReferences

The World Health Organization's Department of The World Health Organization's Department of Injuries and Violence Prevention (VIP): Injuries and Violence Prevention (VIP): "Intervening with Perpetrators of Intimate "Intervening with Perpetrators of Intimate Partner Violence: A Global Perspective".Partner Violence: A Global Perspective".In 2001, VIP surveyed 56 batterer intervention In 2001, VIP surveyed 56 batterer intervention programs in 37 countries in order to describe programs in 37 countries in order to describe their characteristics, operational philosophies, their characteristics, operational philosophies, funding mechanisms, intervention goals and funding mechanisms, intervention goals and content, availability of evaluation results, and content, availability of evaluation results, and other features of interest. Not efficacy. other features of interest. Not efficacy. http://www.who.int/violence_injury_prevention/uhttp://www.who.int/violence_injury_prevention/unintentional_injuries/injpub/en/index.html/nintentional_injuries/injpub/en/index.html/

Identifying Domestic Identifying Domestic Violence OffendersViolence Offenders

James M. James M. DugoDugo, , Ph.D. and Sandra Ph.D. and Sandra LemaLema--Stern, Ph.D.Stern, Ph.D.

May 14, 2004May 14, 2004SGIMSGIM

Definition of domestic violence:Definition of domestic violence:

an escalating process of verbal, an escalating process of verbal, physical, economic or sexual misuse physical, economic or sexual misuse of power. It can be initiated with a of power. It can be initiated with a single event, or it can escalate single event, or it can escalate gradually over a series of gradually over a series of interactions.interactions.

““Male batterers”Male batterers”

is a term that defines the criminality is a term that defines the criminality and danger but can be misleading in and danger but can be misleading in diagnosing domestic violence. diagnosing domestic violence. Seldom will the man or a victim Seldom will the man or a victim define the aggressor as a “batterer,” define the aggressor as a “batterer,” nor does the man have to nor does the man have to beat her beat her upup to achieve dominance. to achieve dominance.

Batterers are invisible.Batterers are invisible.

There are no common demographics There are no common demographics such as age, race, culture, or sociosuch as age, race, culture, or socio--economic class. 85 percent of them economic class. 85 percent of them do not seem aggressive to the do not seem aggressive to the outside world. There are, however, outside world. There are, however, common patterns that are common patterns that are indications.indications.

A man who misuses power A man who misuses power can have any of the following can have any of the following

characteristics or patternscharacteristics or patternsof behaviors and attitudes:of behaviors and attitudes:

He presents himself He presents himself as the victimas the victim in his in his relationship. He talks about his partner as the relationship. He talks about his partner as the problem, seldom suggesting he has any problem, seldom suggesting he has any responsibility.responsibility.He uses He uses demeaning language demeaning language to describe his to describe his partner, including such adjectives as stupid, lazy, partner, including such adjectives as stupid, lazy, crazy, psycho, drunk, irresponsible, etc. crazy, psycho, drunk, irresponsible, etc. He He blames othersblames others for his problems, feelings or for his problems, feelings or behaviors.behaviors.He uses He uses threats of violencethreats of violence meant to control or meant to control or punish his partner.punish his partner.He He makes physical contactmakes physical contact, which he describes , which he describes as provoked, reactive or in selfas provoked, reactive or in self--defense of his defense of his partner. He might push, shove, grab, restrain, etc.partner. He might push, shove, grab, restrain, etc.He may be He may be jealous or possessive jealous or possessive or try to or try to isolateisolate his partner.his partner.

He may have He may have perfectionist attitudes perfectionist attitudes towards his towards his partner’s behavior and be very critical of her.partner’s behavior and be very critical of her.

He may have He may have Doctor Jekyll and Mr. HydeDoctor Jekyll and Mr. Hydeswitches in personality.switches in personality.

He may He may throw or breakthrow or break objects or objects or punch walls punch walls or slam doors.or slam doors.

He has a family history of watching violence He has a family history of watching violence towards women.towards women.

He has anHe has an attitude of male entitlementattitude of male entitlement as as reflected in statements that it is his house or his reflected in statements that it is his house or his money. He makes decisions unilaterally, and he money. He makes decisions unilaterally, and he argues his viewpoint to win. argues his viewpoint to win.

He regularly or periodically He regularly or periodically abuses alcohol or abuses alcohol or drugs.drugs.

Sandra LemaSandra Lema--Stern, Ph.D.Stern, Ph.D.James M. James M. DugoDugo, Ph.D., Ph.D.

May 14, May 14, SGIMSGIM

Partner abuse intervention for Partner abuse intervention for male offendersmale offenders

Components in the change processComponents in the change process

I.I. Acknowledging responsibilityAcknowledging responsibilityThe first step towards change is for the man The first step towards change is for the man to recognize that his abusive behavior is the to recognize that his abusive behavior is the reason he was arrested and is now in the reason he was arrested and is now in the group. Abuse is a choice, not a reaction to group. Abuse is a choice, not a reaction to another person’s actions. another person’s actions. Interventions include:Interventions include:The man telling a detailed story of his actions The man telling a detailed story of his actions to the group on his first night of attendance.to the group on his first night of attendance.Respectful confrontation of denial by the Respectful confrontation of denial by the group and cogroup and co--leaders.leaders.Identifying demeaning language as it occurs in Identifying demeaning language as it occurs in the group.the group.Presenting the woman’s perspective through Presenting the woman’s perspective through reactions of the female coreactions of the female co--leader.leader.

II.II. Understanding that abuse is a means to Understanding that abuse is a means to control his spouse or girlfriendcontrol his spouse or girlfriend

Domestic violence is generally not an anger Domestic violence is generally not an anger problem. If it were, then the man would problem. If it were, then the man would “explode” in a variety of situations with a variety “explode” in a variety of situations with a variety of people. Instead the man is selective and uses of people. Instead the man is selective and uses his abusive behavior to intimidate, threaten, and his abusive behavior to intimidate, threaten, and get his way.get his way.Interventions include:Interventions include:Identifying and challenging controlling behaviors Identifying and challenging controlling behaviors such as isolating the victim, jealous questioning, such as isolating the victim, jealous questioning, and intimidating actions (e.g., slamming fist on and intimidating actions (e.g., slamming fist on the table).the table).Control inventory or log.Control inventory or log.Reframing violence/temper as instrumental rather Reframing violence/temper as instrumental rather than emotional.than emotional.Introducing the idea that the only thing one can Introducing the idea that the only thing one can control is oneself.control is oneself.

III.III. Understanding the impact of abusive Understanding the impact of abusive behavior on othersbehavior on others

The men often do not believe that their The men often do not believe that their behavior has scared the woman, and they do behavior has scared the woman, and they do not think about the impact of their behavior on not think about the impact of their behavior on their children. their children. Interventions include:Interventions include:Presenting analogies that males understand Presenting analogies that males understand and situations where they themselves have and situations where they themselves have had reactions similar to the woman’s.had reactions similar to the woman’s.Presenting research on the impact of domestic Presenting research on the impact of domestic violence on children.violence on children.Using popular films that depict the impact of Using popular films that depict the impact of violence on women and children.violence on women and children.Explaining the dynamics of the transmission of Explaining the dynamics of the transmission of fearfearHaving the men explain the event of their Having the men explain the event of their arrest from the woman’s perspective.arrest from the woman’s perspective.

IV. IV. Eliminating abusive and controlling Eliminating abusive and controlling behaviors and constructively managing behaviors and constructively managing conflictconflict

Although some new skills will need to be Although some new skills will need to be taught, this step requires a decision and a taught, this step requires a decision and a firm commitment to that decision more than firm commitment to that decision more than anything else.anything else.Interventions include:Interventions include:Teaching communication skills and appropriate Teaching communication skills and appropriate expression of feelings.expression of feelings.Rehearsing appropriate ways to take a timeRehearsing appropriate ways to take a time--out and to stop the man’s own escalation out and to stop the man’s own escalation cycle.cycle.Identifying and reforming abusive and sexist Identifying and reforming abusive and sexist language.language.Teaching appropriate (Teaching appropriate (nonabusivenonabusive) forms of ) forms of discipline for children.discipline for children.

V.V. Changing attitudes and beliefs that Changing attitudes and beliefs that support abuse, entitlement and male support abuse, entitlement and male dominancedominance

The men hold beliefs that frequently have to do with The men hold beliefs that frequently have to do with their conception of male identity and privilege. The their conception of male identity and privilege. The beliefs may be that the man is the head of the house; beliefs may be that the man is the head of the house; that, as primary breadwinner, he should make the that, as primary breadwinner, he should make the decisions; that his way is the only “right” way; or that decisions; that his way is the only “right” way; or that he has the right to react when he feels he is not being he has the right to react when he feels he is not being respected.respected.Interventions include:Interventions include:Demonstrating ways to change the man’s competitive Demonstrating ways to change the man’s competitive model of interaction to a collaborative model.model of interaction to a collaborative model.Presenting and modeling different notions of what it Presenting and modeling different notions of what it means to be a strong, nonmeans to be a strong, non--aggressive, but still assertive aggressive, but still assertive male (e.g., Martin Luther King , Jr.).male (e.g., Martin Luther King , Jr.).Reinforcing attitudes and behaviors that emphasize Reinforcing attitudes and behaviors that emphasize responsibility and respect towards others regardless of responsibility and respect towards others regardless of circumstances or perceived provocation.circumstances or perceived provocation.Modeling an egalitarian relationship by the coModeling an egalitarian relationship by the co--leaders.leaders.Examining social and familial influences on sexist Examining social and familial influences on sexist attitudes and beliefs. attitudes and beliefs.

VI.VI. Being accountableBeing accountable

When a man accepts responsibility for his actions, When a man accepts responsibility for his actions, understands the impact his actions had on others, and understands the impact his actions had on others, and has changed his attitudes and behaviors, he is in a has changed his attitudes and behaviors, he is in a position to have a positive influence on other men in the position to have a positive influence on other men in the group and in the community. Being accountable is group and in the community. Being accountable is acting in a way that respects and promotes the safety acting in a way that respects and promotes the safety of those around him.of those around him.Interventions by these men include:Interventions by these men include:Confronting other men in the group concerning their Confronting other men in the group concerning their abusive language and behavior.abusive language and behavior.Modeling the process of change for other men in the Modeling the process of change for other men in the group and sharing their own experiences in honest and group and sharing their own experiences in honest and direct ways.direct ways.Demonstrating a concern for domestic violence as a Demonstrating a concern for domestic violence as a problem in their communities (e.g., referring a friend problem in their communities (e.g., referring a friend into treatment, seeing domestic violence as a problem into treatment, seeing domestic violence as a problem that requires a community response).that requires a community response).

Perceptions and discourses Perceptions and discourses among professionals among professionals

working with men inclined to violenceworking with men inclined to violenceUNDERSTANDING THE PERPETRATORUNDERSTANDING THE PERPETRATOR

SGIM Chicago May 2004SGIM Chicago May 2004

Kerstin Edin, RNM, MPHKerstin Edin, RNM, MPHEpidemiologyEpidemiology, , Dep.ofDep.of Public Health and Clinical Medicine Public Health and Clinical Medicine

The National The National GraduateGraduate School of School of GenderGender studies studies Gynecology&ObstetricsGynecology&Obstetrics

Umeå University, SwedenUmeå University, Sweden

ProjectProjectINTIMATE PARTNER VIOLENCE INTIMATE PARTNER VIOLENCE

in the period of pregnancy and childbirthin the period of pregnancy and childbirth

•• MidwivesMidwives in in antenatalantenatal carecareInterviewsInterviews and and questionnairesquestionnaires, , studystudy completedcompletedEdin KE & Högberg U Edin KE & Högberg U MidwiferyMidwifery (2002)(2002)1818,268,268--278278

•• ProfessionalsProfessionals workingworking with men with men inclinedinclined to to violenceviolence InterviewsInterviews and and analysisanalysis completedcompleted

•• WomenWomen that have been living in violent that have been living in violent relationships relationships Interviews completedInterviews completed

•• MenMen that have been living in violent relationships that have been living in violent relationships Interviews in progressInterviews in progress

Professionals working with men Professionals working with men inclined to violenceinclined to violence

Interviews withInterviews with•• 3 psychologists3 psychologists

•• 3 social workers3 social workers

•• 2 prison officers/ group leaders2 prison officers/ group leaders

At a At a crisiscrisis centrecentre for men,for men,a a crisiscrisis centrecentre withinwithin the the probationprobation service service and at and at twotwo prisonsprisons

MethodsMethodsQualitativeQualitative research research interviewsinterviews

informedinformed by by GroundedGrounded TheoryTheory

•• CDCD--recordedrecorded interviewsinterviews•• InterviewsInterviews transcribedtranscribed verbatimverbatim•• Interview text coded into categories Interview text coded into categories

and theoretical conceptsand theoretical concepts

To exploreTo exploreperceptionsperceptions and and discoursesdiscourses

among among professionalsprofessionalswho who carecare for this population for this population

regarding intimate partner violence….regarding intimate partner violence….

with focus on the period of with focus on the period of pregnancy and childbirthpregnancy and childbirth

AIMAIM

SOME FINDINGSSOME FINDINGSFROM INTERVIEWS FROM INTERVIEWS

WITH WITH PROFESSIONALSPROFESSIONALS

”Professional perceptions and discourses”

The perpetrator less frequently exhibits The perpetrator less frequently exhibits “power and control” “power and control”

but commonly discloses feelings such as but commonly discloses feelings such as fear, threat, low selffear, threat, low self-- confidence, confidence,

inferiority, dependency and jealousy….inferiority, dependency and jealousy….

… he seems on one hand to be rigid and toughbut on the other hand

rather insecure and weak


Power and controlPower and controlHe wants and has a need of power and control

and is afraid of the opposite“power and control is what the paradigm says –

but not what we commonly meet”“power and control is a stereotyped thinking that

says nothing about the complexity in context and interplay”


Expresses fear and threatExpresses fear and threat“he’s afraid of being nobody”“he’s scared to be left by her“

He isafraid and feels insecurejealous very dependent on her

He has a low self- esteem, feels worthless, unloved, vulnerable, hurt, incapable, a failure, in a tight spot, afraid of not being good enough…



Men and women usually Men and women usually solve conflicts differently and solve conflicts differently and in the same gendered way in the same gendered way

as they were as they were raisedraised

Men Men “are traditionally encouraged to show

aggressiveness”“are brought up to be less human and taught in

military service to kill others”“find it easier to start a battle instead of

communicating”““areare not supposed to or not trained to show

weaknesses and feelings”“lack emotional expressions”

“learn to keep silent”“some grow up with a dominant father and violence as a way to solve conflicts, raised to fight back”


WomenWomen“are trapped by empathy”

“have a rich vocabulary and good verbal communicative skills”

“have a wide range of feelings ”“are raised to take care and to be responsible

for the well being of others ” “at an early age girls accept the role assigned

to them in relation to boys and adjust themselves to male aggressive behaviour”


The period of The period of pregnancy and childbirth pregnancy and childbirth

is often marked by is often marked by strugglesstruggles

in the relationship in the relationship and may be a triggerand may be a trigger

for conflicts and violencefor conflicts and violence


In In mostmost relationshipsrelationshipsthe period

of pregnancy and childbirthrepresents

aa ”big step”a ”strain”a ”crisis”

particularlyparticularly whenwhen expectingexpecting the first the first childchild

and and especiallyespecially whenwhen livingliving in in

aa volatilevolatile relationshiprelationship


Professional’sProfessional’s descriptionsdescriptionsof a ”of a ”volatilevolatile relationshiprelationship””

”both are havingproblems””negative everydaylanguage””jealousy””feeling unsafe in the relationship””fear of losing the partner”

”unfaithfulness”“uncontrolled impulses and aggressiveness””vulnerable, both take offense”“a troublesome relationship””immature relationship” ”different standpoints on having a baby”


THE CRISIS THE CRISIS of of pregnancypregnancy and and childbirthchildbirth

maymay havehave different different outcomesoutcomes

””DeepenDeepen” and ” and ””maturemature” the love ” the love and and relationshiprelationship TRIGGERTRIGGER

VIOLENCEVIOLENCE“put the screws on”“put the screws on”

”make it ”make it worseworse”””make it ”make it overlyoverly intenseintense””

”make the situation ”make the situation dangerousdangerous””

CauseCause a a changechangefor the for the worseworseSeparationSeparation


““the problem might already have been there, the problem might already have been there, but this was the but this was the start offstart off””

“the pregnancy becomes a “the pregnancy becomes a worsening factorworsening factorin an already strained relationship”in an already strained relationship”

““repressed feelingsrepressed feelings come up to the surface come up to the surface (own childhood and family)”(own childhood and family)”


Pregnancy as a triggerPregnancy as a trigger

““unattainable demands might unattainable demands might initiate initiate violence”violence”

“the pressure increases and for many “the pressure increases and for many it will come to a it will come to a breakdownbreakdown””

“men inclined to violence are “men inclined to violence are moremore vulnerablevulnerablearound pregnancy and parenthood”around pregnancy and parenthood”

“the situation gets“the situation gets moremore dangerousdangerous””


……. pregnancy as a trigger. pregnancy as a trigger

WhatWhat make the period of make the period of pregnancypregnancy and and childbirthchildbirth so so challengingchallenging? ?


Changes and disturbances

Demands

Changes and Changes and disturbancesdisturbances

THE MAN TAKES A DISLIKE TO HERTHE MAN TAKES A DISLIKE TO HER

”the ”the ideal imageideal image of the of the womanwoman crackscracks” ” ”from ”from beingbeing naturalnatural, , veryvery beautifulbeautiful and and placedplaced on a on a pedestalpedestal sheshe becomesbecomes repulsiverepulsive and and uglyugly, a , a monstermonster; ; hehe doesn’tdoesn’t recognizerecognize herher” ” ””hehe can’tcan’t standstand the the everydayeveryday picturepicture of the of the womanwoman””””herher hormonal hormonal fluctuationsfluctuations, , upsups and and downsdownsand and tirednesstiredness” ” ””sheshe is is withoutwithout selfself--controlcontrol, , demandingdemandingand and selfself--centredcentred””


........changeschanges and and disturbancesdisturbancesHE FEELS OUT OF ITHE FEELS OUT OF IT

”from ”from togethernesstogetherness betweenbetween twotwo in love to in love to becomingbecoming threethree”””the ”the pregnancypregnancy and the and the prepre and postnatal and postnatal carecare is is monopolizedmonopolized by by womenwomen with no real with no real placeplace for men”for men””the ”the childchild is a is a threatthreat to his position”to his position”””sheshe seeksseeks support in support in otherother womenwomen””””hehe losesloses controlcontrol, , feelsfeels worthlessworthless, as , as ifif hehe is no is no longerlonger therethere””””hehe feelsfeels insecureinsecure, , leavesleaves his his adultadult rolerole and and becomesbecomes like a like a childchild””


…………changeschanges and and disturbancesdisturbances

ANOTHER PHASE OF THE RELATIONSHIPANOTHER PHASE OF THE RELATIONSHIP

””sheshe refusesrefuses sex”sex””from ”from beingbeing a a sexualizedsexualized partner, partner, a a sexualsexual objectobject to to beingbeing a a mothermother” ”

””traumatictraumatic picturespictures from the from the deliverydelivery-- from from viewingviewing the genitals as the genitals as beautifulbeautiful and and mysteriousmysteriousto an overall to an overall bloodybloody battlefieldbattlefield and and the mere thought of it makes him feel sick”the mere thought of it makes him feel sick”

”the ”the experienceexperience of of deliverydelivery waswas tootoo muchmuch, , it it waswas terrifyingterrifying and shocking”and shocking”


DemandsDemandsINSECURE ABOUT PARENTHOODINSECURE ABOUT PARENTHOOD

””needneed to to taketake responsibilityresponsibility and and becomebecome a a growngrown--upup””””condemnscondemns himselfhimself in in advanceadvance as a as a fatherfather””

””feelsfeels lostlost, no man to , no man to useuse for a for a modelmodel””””ownown fatherfather waswas absent or a bad absent or a bad modelmodel of a of a fatherfather” ”

”the pregnant ”the pregnant stomachstomach becomesbecomes a symbol a symbol of the of the threatthreat of of failurefailure and and inadequacyinadequacy””””ownown and and otherother person’sperson’s expectationsexpectations

aboutabout parenthoodparenthood””””feelsfeels pressurepressure, must , must taketake on the on the maskmask

of of beingbeing capablecapable””


PregnancyPregnancy and and childbirthchildbirthis a is a challengechallenge butbut……..……..

During the interviews; During the interviews; the professionals realized the professionals realized that theythat they had left out had left out important topics important topics like like “pregnancy and childbirth” “pregnancy and childbirth” as themes in the as themes in the conversation groups conversation groups with men and they found with men and they found many explanations many explanations for that………for that………


THE SILENCE OF THE PERPETRATORSTHE SILENCE OF THE PERPETRATORSIn the groups, men don’t spontaneously talk about

pregnancy and parenthoodsexualitychildren


because…• it’s too intimate• it’s too shameful• it’s taboo• sexual violence and child

assault have the loweststatus

THE SILENCE OF THE PROFESSIONALSTHE SILENCE OF THE PROFESSIONALS

Because …

• unaware that these subjects were that important for men

• not in the manuals• not brought up by men• sensitive subjects• forced to report (police, CPS)• aware of the ranking order

(sexual violence and childassault have low status)

Professionals don’t commonly bring up issues like pregnancy and parenthood

sexualitychildren


CONCLUSIONS CONCLUSIONS exclusionsexclusions andand inclusionsinclusions

Conversations with men and group therapy for perpetrators often leave out sensitive issues…….whereas conversations with women and group therapy for victims seem to include such issues spontaneously


QUESTIONSQUESTIONS

•• Does the professional’s choice of topicsDoes the professional’s choice of topicsreinforce stereotypical male rolesreinforce stereotypical male rolesthat they in factthat they in facthave the intention to change?have the intention to change?

•• Does the dichotomy between Does the dichotomy between the choice of “male and female topics” the choice of “male and female topics” maintain taboosmaintain taboos and and promote furtherpromote furtherviolence?violence?


Together with the victim Together with the victim and the perpetratorand the perpetrator

Arlene Bradley, MDArlene Bradley, MDMay 14, 2004May 14, 2004SGIMSGIM

Guiding PrinciplesGuiding Principles

Be patientBe patientEvery situation unique; address likewiseEvery situation unique; address likewiseVictim safetyVictim safetyVictim autonomyVictim autonomyOffender/perpetrator accountabilityOffender/perpetrator accountability

Separating the twoSeparating the two

Examine patient aloneExamine patient aloneHave patient leave with a nurse for a Have patient leave with a nurse for a “test” and then interview separately“test” and then interview separatelyConsider a protocol the staff knows to Consider a protocol the staff knows to expedite processexpedite process

What if the potential What if the potential offender is the interpreter?offender is the interpreter?

Do not use children as interpretersDo not use children as interpretersInvolve local hospital staff who have Involve local hospital staff who have the needed linguistic expertisethe needed linguistic expertiseInvolve the AT & T telephone Involve the AT & T telephone interpreters (free)interpreters (free)

Do’s and Don’tsDo’s and Don’ts

AVOID:AVOID:Dictating cessation Dictating cessation of Violence of Violence Saying you can’t Saying you can’t

help help Blaming Blaming Letting the Letting the perpetrator know perpetrator know that the victim has that the victim has disclosed violencedisclosed violence

DO:DO:Remember the Remember the Guiding PrinciplesGuiding PrinciplesOffer hope, help to Offer hope, help to both victim and both victim and perpetratorperpetratorMaintain neutrality Maintain neutrality while not while not compromising compromising support of the support of the victim victim

domestic violence: understanding the...

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