________________________________ Intimate Partner Violence: Compassionate Care, Effective Assessment
Derived from the experiences of women living with men who batter, the Power and Control Wheel was developed to graphi- cally represent the idea that acts of physical or sexual violence are part of a more general pattern of controlling behaviors, rather than isolated incidents of abuse, or as cyclical expres- sions of pent-up anger, frustration, or painful feelings. Johnson’s Typology of Domestic Violence Although the perpetrators of IPV are most often men, research that defines “violence” more broadly than just physical vio- lence, finds that men and women use “violent” tactics equally often in relationships [15]. Michael Johnson’s research divided couples into those who use what he terms “intimate terrorism,” in which an abuser (usually male) uses violence and power and control tactics that usually escalate. Their targets are the women most often seen in hospital emergency departments with severe injury, those likely to be abused during pregnancy, those most often forced into sex, and those with severe psycho- logical trauma. In contrast, “situational couple violence,” is a more frequent type of IPV and this term describes relationships in which both partners (heterosexual as well as same-sex) use aggressive tactics characterized by less severe and less control- ling tactics. Generally, these arise as a result of an argument in which one or both parties physically lash out. Situational couple violence is also less likely to involve sexual violence [15]. THE CYCLE OF VIOLENCE Many times abuse occurs in a predictable pattern or cycle. When the perpetrator shows affection to the survivor between abusive episodes, it can make it difficult for the survivor to leave the relationship. The cycle can involve the following phases: • Abuse – the perpetrator abuses their partner, asserting their power and control. • Guilt – the perpetrator feels guilty and fears that the abuse may lead to getting caught and facing consequences. • Excuses – the perpetrator rationalizes their abusive actions by blaming the partner and avoiding responsibility. • “Normal” behavior or “Honeymoon Phase” – the perpetrator attempts to regain control and keep the partner in the relationship, either by showing affection or acting as if the abuse never happened. • Fantasy and planning – the perpetrator starts to fantasize about abusing their partner again and plan the next episode of abuse. • Set-up – the perpetrator creates a situation where they can justify or blame their partner for the next abusive episode.
THE IPV CYCLE
Tension Building Phase
Honeymoon Phase
Abusive Incident
Source: [16]
MYTHS VS. REALITIES OF IPV Frustration is common among professionals who work with IPV survivors, and this frustration can be rooted in funda- mental misunderstandings about the way survivors of IPV behave. For example, contrary to a common perception that many women don’t leave abusive relationships, the majority do indeed leave or manage to make the violence end [17]. But leaving an abusive relationship is a process that may involve leaving and returning several times. Behavior change takes time and cycles of “relapse” and “remission” commonly seen in people trying to stop addictive behaviors such as smoking or drinking alcohol are also seen in people trying to escape abusive relationships. Patients need to move from a familiar unhealthy environment to a healthy unfamiliar one. Several studies have shown that formerly abused women are no more likely to go on to an abusive relationship than are other women in unhappy relationships [17]. Other studies have shown that survivors of IPV are best able to stay out of future abusive relationships and improve their health if economic and/or employment and/or housing opportunities are avail- able to enable financial independence [18]. It is important to remember that there is no “classic” type of victimized individual. Any person can be abused. Survivors come from all backgrounds, sexual orientations, genders, capabilities, education levels, and economic backgrounds. Universally, survivors desire lives free from abuse and are most likely to take steps toward this goal if provided with validation, support, opportunity, and health and economic security. The following statements reflect faulty beliefs or dysfunctional atti- tudes toward IPV, which are explained in the associated text. “She doesn’t look battered.” Often there are no obvious physical signs of abuse and/or the abuse may be psychological or emotional, rather than physical. Many elements that increase risk for lethality in IPV (i.e., threats of violence, jealousy) leave no signs.
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MDFL0627
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