Handbook on Sexual Violence (49 page)

In working towards safety, we use the concepts of risk, responsibility and collaboration (Vetere and Cooper 2001, 2008). We divide risk into the management of risk and the assessment of risk. We look for signs of safety in what people do and try to do, and we hold people responsible for their behaviour. We are clear with our clients about our responsibilities as therapists in the therapeutic work. Finally we try to create an atmosphere of collaborative practice, even though some of our clients are told to meet with us by the family courts, and have little choice but to meet us! At all times, we put our concerns and issues on the table for discussion, alongside those of our clients. If we have anything to say that is difficult, we find a way to say it to them directly. We are able to honour this commitment within our working relationships. Jan and I work together in the therapy room, with one taking the lead therapist/assessment position and the other taking the role of the in- room consultant. We use our reflecting process to raise difficult questions in ways that are less directly challenging to the therapeutic relationship. We write extensively about our use of the reflecting process in Cooper and Vetere (2005).

We pay attention to our own safety in a number of ways: we have an alarm and our colleagues in the building are well briefed in what we do, and what assistance we may require; we do not sit in front of the door inadvertently blocking someone’s way out, should they need to leave if they feel unable to manage themselves in a difficult conversation; we do not have objects in the room that could be used as weapons; and so on. This is all as you might expect. It seems to us though, based on our lengthy experience, that it is our approach to safety, our wish to work collaboratively, and our use of our reflecting relationship in the room together, that most contributes to a calm, well managed and secure working environment, for ourselves and for the families who look to us for help.

Establishing safety

1.(a) Risk management

When we know that violence has occurred in a couple or family relationship at the time of referral, we manage the risk of future violence by bringing in a ‘stable third’ person, and establishing a safety plan with family members, using a no-violence contract. The ‘stable third’ advises on whether the safety plan can work, and is seen to be working. In our experience, the stable third is crucial, as we now explain.

When violence is known about and/or suspected, it creates anxiety within the family system and within the professional network. It is essential to understand and manage that anxiety within a safety methodology that enables you, the practitioner, to get on with your work with the couple and/or family. If the anxiety about future possible violence is not addressed it will slip around the ‘system of concern’ (extended family members, the professional network, and other interested parties) and will have a negative impact on your ability to settle down into your work. For example, family members may receive contradictory and ambivalent messages about the safety of working with you, and may miss meetings or be called to attend meetings with other professionals too often to be able to meet with you consistently. Similarly, other professionals, worried about the possibility of further violence, may believe that family members will lie about the cessation of violence and that practitioner therapists will simply believe what they are told. For these reasons it is necessary to manage risk and corroborate what family members tell us about how and when they ended the violence. We do this by including a stable third in both our thinking and our practice. This expands the system and offers more points of view about safety and protection. Who, then, can be the stable third?

The stable third may be the referrer, such as a social worker, but must be a person who is trusted by the family and the professional network. It may be a grandparent, a faith leader, a community worker, a family doctor, and so on – but if children are involved it has to be someone who knows the children and can visit the family home. Thus our minimum sufficient condition for safe practice in our therapeutic work is a triangle, based on the psychodynamic idea that the triangle is the basic human relationship and has the potential for stabilising relationships (Vetere and Dallos 2003). The triangle consists of ourselves, the couple/family, and the stable third. The stable third helps us think about safety and safety planning and helps corroborate what the family members tell us about the cessation of violence. We include the stable third in our first meeting with the family, where possible, or as soon as possible thereafter. Subsequently, we meet with the stable third at the third or fourth meeting, to review safety and the safety plan. Very often, families are involved with other professional practitioners, and they too may be part of safety planning. When we can all begin to have confidence that the safety plan is working, then the stable third can reduce their attendance at safety review meetings as we begin to address other therapeutic issues and concerns with the family members.

We require a minimum of six meetings to establish the safety plan and to

see if the no-violence contract can hold. Typically we meet people every week or every two weeks for this safety planning work. If we are working with a couple, we see them separately and together, and similarly with other family relationships, we meet people on their own and in combination. When all three perspectives (us, the couple/family, and the stable third) are satisfied that the safety plan can work, and is working, then we can proceed with other therapeutic tasks.

Safety planning is done within a no-violence contract. We ask perpetrators/ family members to agree to stop the violence by making a no-violence contract. The contract may be spoken or written. If social services are involved, they usually want a written contract. In our experience, our clients use the no- violence contract creatively. For example, we met a divorced father who hit his 16-year-old daughter during an argument on a contact visit. As a result, his daughter refused to see him again. The father contacted us and asked us to help him, so that he did not behave with violence again. He wanted a written no-violence contract so that he could lodge it with his family lawyer, as evidence of his commitment to ending violence, and in the hope his daughter would one day read it.

The no-violence contract is underpinned by the safety plan. The safety plan attempts to predict those interactions and circumstances where an escalation into violence is likely, in an attempt to pre-empt violence and de-escalate unhelpful and distressing interactions. In order to do this, we first identify the last episode of violence or the worst episode of violence. We use behavioural tracking techniques to deconstruct the episode and ascertain what happened, so that we may identify the triggers to violence. Behavioural tracking involves asking:

1. who was there;
   

2. what happened;
   

3. who said what; and
   

4. what happened next, and so on.
   

We do this tracking very slowly so that we can be sure we understand what happened as well as is possible. Precursors and immediate triggers to intimate violence in couple relationships are often attachment-related triggers, for example, fear of loss, rejection or abandonment, or actual loss, rejection and abandonment. Thus a partner may threaten to walk out or leave, or a parent may threaten to put a child ‘in care’ in an angry verbal exchange; or anger might be the response to fearing a partner loves us less. It is the attachment significance that is key to understanding the cycle of behaviour that escalates to violence, and how power and control are used in response to a perceived or actual attachment threat. Similarly other associated emotional responses, such as shame, anger, fear and humiliation, are often present in the moment, including the paradox of power – it is often when a person feels powerless in an interaction (powerless to stop a partner leaving, or powerless to get children to do as they are told) that they strike out, but of course, the victim feels them to be very powerful in that moment. From the attacker’s perspective they ‘lost it’, but from the victim’s perspective they ‘gained it’.

Attachment theory suggests that anger is the secondary emotion in response to the primary emotions of fear, sadness and shame when we perceive ourselves to be threatened by loss – real or imagined (Bowlby 1988). For example, a man who was humiliated by his own father, watched his father beat his mother, and whose mother was less emotionally available to him as a result, may be prone to shame, and primed to seeing the intent to humiliate him, or demean him, during an argument with an intimate partner, when none was intended. Many of the couples/family members we work with are prone to shame and oversensitised to interpreting their partner’s behaviour as an attempt to humiliate them. Such sensitivity is often the legacy of earlier childhood abuse that included parental shaming, and of witnessing domestic violence. We find that many perpetrators we work with are not so easily able to soothe themselves and calm themselves down when unhelpfully aroused, both emotionally and physiologically. Often people will turn to psychoactive substances to help them avoid painful emotions, to numb themselves and otherwise manage their emotional experience. If a perpetrator has a drugs and alcohol problem, we insist they seek help from the local drugs and alcohol service, with whom we seek permission to liaise, so that we can work alongside them. We do not insist the drugs/alcohol work is finished before we do our safety planning work as, often, the alcohol is used to help manage difficult and unbearable feelings in response to interpersonal distress. So, in understanding the violent episode and its triggers, we coach people in other forms of coping and looking after themselves, to increase their range of responses in difficult, threatening and painful interpersonal encounters, such as seeing others as potentially helpful and talking with others, turning to faith, developing and maintaining reflective abilities, distraction activities, and other methods known to calm and soothe. Sometimes, when a person has been treated badly as a child and they have learned not to trust others as a form of self-protection, the slow development of a trusting therapeutic relationship forms the first bridge back into trusting others, and thus can a therapist work to help rebuild trust more widely in family relationships. Learning to understand and manage our emotional responses is arguably a lifelong task, but for those who protected themselves from danger as children by learning to downplay their emotional reactions, or who never learned to regulate emotional responding or who never developed a sense of entitlement to comfort or to being looked after, trust is necessary. It is the platform from which people are encouraged to take emotional risks that make them feel vulnerable, to learn to see others as a source of comfort, and to seek comfort,

and to help process trauma responses, past and present.

At the same time as we slowly deconstruct the episode/s of violence, we want to know about other stressors the family members must cope with, such as debt, poverty, family conflict, work-related stress, community harassment, adverse life events, and so on. Similarly, we seek out resources and sources of strength and inspiration for family members that will support them in their efforts to end the violence. We want to know about family members’ aspirations, for themselves and others. Asking future questions often allows people to speak well of what they wish for the future – for their children, their partners, their families, themselves, and so on. Such a future orientation often

enables people to soften, to feel less blamed, and thus to engage in responsibility work without feeling the need to be too defensive. So, we might ask, ‘John, as a father, what do you want your son/daughter to learn from you about how to keep themselves safe in their future relationships?’ ‘Mary, as a mother, what do you want your son/daughter to learn from you about how men and women show respect to each other for their future relationships?’

When we think we have sufficient information to understand what fuels unhelpful arousal and distress, and what triggers an escalation into interpersonal violence, so that we can predict where the risk lies for the family members, we agree a safety strategy, such as time out, using mediation, developing self-talk and other calming strategies, predicting and avoiding certain topics for discussion and then bringing them to a meeting with us, and learning to listen. These safety strategies are initially short-term, and designed to de-escalate potentially conflictual, hostile and/or inflammatory interactions. If we are working with a perpetrator who is in an intimate relationship, we seek the partner’s involvement as a consultant to the safety plan. If the partner is not in agreement with the safety plan or is not convinced it can work, we need to know this and include their views. For example, at home, during a difficult argument, if the perpetrator uses time out, the partner might fear the perpetrator is using time out to avoid a difficult conversation, and may bar their exit from the room – under those circumstances the victim is not thinking of their own safety. Similarly, the victim may fear the perpetrator will abandon them during time out and not return. In using time out successfully, the perpetrator needs to recognise their own emotional and physiological arousal and make judgements about when to leave a conversation. For example, a person may not be practised in naming their own emotional responses, in reflecting on their emotional responses, or in recognising the build-up of muscle tension, or changes in breathing and heart rate as indicators of unhelpful physiological arousal. In addition, we ask about self-talk, for example, what does the perpetrator say to him or herself during the build-up to violence. Our clients tell us they cannot identify self-talk, but with patience and persistence, we can help people recognise how they ‘talk’ themselves up into a state of unhelpful physiological and emotional arousal, where they find it harder to exercise self-control. The development and use of constructive self- talk strategies has been pioneered by the cognitive behavioural therapists (Novaco 1993).