| When the family wants the patient sick, treatment | | | | relevant family member, it now becomes completely |
| and recovery are impossible. This is the way it usually | | | | confidential. The patient's involvement in getting help |
| appears for all practical purposes. Family members' | | | | becomes a sacred secret between her/him and |
| defenses protect interpersonal and intergenerational | | | | yourself as the clinician/advocate. |
| dysfunction...unless the patient is internally inspired and | | | | 2) Thorough evaluation and proper intimate partner |
| externally supported to break the cycle. | | | | violence assessment are essential and can be |
| As clinicians we know the patient's resistance is an | | | | conducted in the context of this professional |
| integral part of the psychotherapeutic change | | | | relationship if you are trained in domestic violence |
| process. And in the context of therapy we learn to | | | | assessment. If not, refer the patient to a domestic |
| work with it. We use it to create openings in the | | | | violence specialist. |
| patient for inquiry, growth and transformation. | | | | 3) Once intimate partner violence is substantiated |
| However, when that resistance is not before us to | | | | (and diagnosed) as best as can be done in the |
| work with but is clearly working against us, we must | | | | context of the resources and assessment tools |
| see it for what it is. You absolutely cannot fight | | | | currently available, the patient is informed of the |
| against it, as doing so will strengthen it. | | | | findings. |
| Family Resistance in Families of Domestic Violence | | | | 4) General abuse dynamics and the specific |
| This is especially true when working in families | | | | constellation of symptoms characterizing intimate |
| suffering from domestic violence. The question that | | | | partner violence are clearly conveyed to the patient. |
| remains then is: How do you help a patient who is a | | | | 5) The patient that wants to break the cycle of |
| victim of intimate partner violence when the family | | | | abuse agrees to keep all matters pertaining to their |
| network supports keeping her/his victimization status | | | | intervention, including the fact that they are involved |
| quo? | | | | in getting help, confidential particularly with respect to |
| Under these conditions, do not expect to get the | | | | the perpetrator and those who support the family |
| cooperation of the family members because you will | | | | abuse dynamics. |
| get lip service at best, and then ultimately the true | | | | 6) Once the confidential relationship is established and |
| agendas will present themselves. And you will see it's | | | | the commitment to privacy is demonstrated, then |
| all in an effort to keep an intervention at bay. | | | | the patient must be guided in all necessary and |
| So the next natural and responsible clinical position to | | | | relevant safety issues surrounding domestic violence |
| take is to create a (or nourish an existing) | | | | interventions. |
| therapeutic alliance with the identified patient. This | | | | 7) If you are not trained in the nuances of domestic |
| alliance must have the ingredients of both | | | | violence safety measures, it is essential that you |
| psychotherapy patient-doctor relationship and | | | | seek the collaboration of a domestic violence |
| domestic abuse victim-advocate relationship. | | | | specialist to assist in your treatment with this patient. |
| The Domestic Violence Model in the Context of | | | | 8) Safety considerations remain in the forefront all |
| Psychotherapy | | | | while providing appropriate psychotherapy to inspire |
| In the case of intimate partner victimization, one will | | | | change. When interpersonal psychotherapeutic |
| need to follow a domestic violence intervention | | | | process and safety are in conflict, safety takes |
| protocol to facilitate long-term therapeutic value for | | | | precedent. |
| the patient. How is this protocol different from | | | | The dynamics of domestic abuse and the essential |
| treatment plans when domestic violence is not the | | | | safety precautions in dealing with patients who are |
| presenting condition? | | | | victims of domestic violence must be part of the |
| 1) First and foremost you will want to establish new | | | | clinician's professional repertoire in order for the |
| treatment parameters for your patient. Instead of | | | | ongoing intervention to be effective. |
| their intervention being public knowledge to the | | | | |