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Empowerment Theory
20
Empowerment on Human Behavior within Post-Traumatic Stress Disorder Support Groups of Intimate Partner Violence Victims and Survivors
Ger Lor, Monica Reyes, Naly Thao, Rosilyne Wright
Post-Traumatic
Stress Disorder (PTSD)
Post-Traumatic Stress Disorder
- "... is characterized by fear, disruptions in social networks, weakened family bonds, mental health disturbances and emotional devastation.
- According to the U.S. Department of Veterans Affairs (2020), “PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault” (para. 1).
- No discriminatory factor associated with PTSD, nor does age or gender prevent its occurrence.
- Mental and environmental triggers can exacerbate the PTSD, which can potentially exist for years."
Symptoms
DSM-V Diagnosis Criterion for PTSD
Criterion A: Traumatic event
Trauma survivors must have been exposed to actual or threatened:
- death
- serious injury
- sexual violence
The exposure can be:
- direct
- witnessed
- indirect, by hearing of a relative or close friend who has experienced the event—indirectly experienced death must be accidental or violent
- repeated or extreme indirect exposure to qualifying events, usually by professionals—non-professional exposure by media does not count
Criterion B: Intrusion or Re-experiencing
These symptoms envelope ways that someone re-experiences the event. This could look like:
- Intrusive thoughts or memories
- Nightmares related to the traumatic event
- Flashbacks, feeling like the event is happening again
- Psychological and physical reactivity to reminders of the traumatic event, such as an anniversary
Criterion C: Avoidant symptoms
Avoidant symptoms describe ways that someone may try to avoid any memory of the event, and must include one of the following:
- Avoiding thoughts or feelings connected to the traumatic event
- Avoiding people or situations connected to the traumatic event
Criterion D: Negative alterations in mood or cognitions
This criterion is new, but captures many symptoms that have long been observed by PTSD sufferers and clinicians. Basically, there is a decline in someone’s mood or though patterns, which can include:
- Memory problems that are exclusive to the event
- Negative thoughts or beliefs about one’s self or the world
- Distorted sense of blame for one’s self or others, related to the event
- Being stuck in severe emotions related to the trauma (e.g. horror, shame, sadness)
- Severely reduced interest in pre-trauma activities
- Feeling detached, isolated or disconnected from other people
Criterion E: Increased arousal symptoms
Increased arousal symptoms are used to describe the ways that the brain remains “on edge,” wary and watchful of further threats. Symptoms include the following:
- Difficulty concentrating
- Irritability, increased temper or anger
- Difficulty falling or staying asleep
- Hypervigilance
- Being easily startled
Criteria F, G and H
These criteria all describe the severity of the symptoms listed above. Basically, they have to have lasted at least a month, seriously affect one’s ability to function and can’t be due to substance use, medical illness or anything except the event itself.
Intimate
Partner Violence (IPV)
Is "physical violence, sexual violence, stalking, or psychological
harm by a current or former partner or spouse [...and...] can occur among heterosexual or same-sex couples and does not require sexual intimacy." (Centers for Disease Control and Prevention, 2019)
Intimate Partner Violence (IPV)
IPV is a significant public health issue.
Consequences
Subtopic 1
- Physical injury
- Death
- Range of conditions affecting the heart, digestive, reproductive, muscle and bones, and nervous systems, many of which are chronic in nature
- Survivors can experience mental health problems such as depression and posttraumatic stress disorder (PTSD)
- At higher risk for engaging in health risk behaviors such as smoking, binge drinking, and sexual risk behaviors
- Economic cost associated with medical services for IPV-related injuries, lost productivity from paid work, criminal justice and other costs, was $3.6 trillion
- Cost of IPV over a victim’s lifetime was $103,767 for women and $23,414 for men
(Centers for Disease Control and Prevention, 2019)
PTSD & IPV
- PTSD is the most prevalent disorder associated with female survivors of IPV due to traumatic injuries caused by other people
- The unhealthy dysfunctionality of the intimate relationship creates a state of brokenness in which physical, mental and emotional healing is paramount as a means to rebuild and establish trust.
- The fear that accompanies intimate partner violence has the potential to stagnate, creating a state of disequilibrium.
- Anxiety can also immobilize the survivor, necessitating therapeutic intervention via group support.
Subtopic 2
Treatment
Individualized treatments:
- Exposure therapy
- Reprocessing therapy
- Eye movement desensitization
- Cognitive therapy
- HOPE (Helping to Overcome PTSD through Empowerment): a new promising short-term cognitive behavioral therapy that teaches IPV survivors PTSD coping skills in which to obtain self-sufficiency (Johnson & Zlotnick, 2009).
Treatment
Individual therapy only allows for one on one interaction/feedback, which omits the multiple beneficial factors (shared experiences, socialization skills) derived from group support. There is much security generated within the boundaries of solid relationships and social support, where the collective (members) are like minded in
their purpose. In fact, Charuvastra and Cloitre (2008)
states, “…a functional social network provides a sense
of safety to an individual through the presence
of stable, reliable interpersonal
connections (para. 26).
A group...
“a small, face-to-face collection of persons who interact to accomplish some purpose”
(Shriver, p. 348)
Purpose of Support Groups
IPV PTSD Support Groups
Sharing by way of group support links individuals through similarity of experiences, and instills a sense of belonging in an otherwise world of trauma induced anxiety and isolation. According to Shriver (2004), “…how we feel about our membership in a group influences the level of membership we will have in the group” (p. 352).
Support group benefits are:
1. Reduced feelings of isolation.
2. Trust re-building opportunity through social
connections.
3. Group support of holding one another
accountable through shared experiences.
Therapeutic Structure of Support Groups
- The therapeutic group structure is specific to the audience and/or the targeted PTSD behaviors.
- There is a range of diversity in the therapeutic group intervention approaches, where the cognitive behavioral therapy, psychotherapeutic and motivational interviewing models are all frequently used.
Examples of diverse therapeutic groups:
- Implementation of a cultural empowerment group intervention for suicidal African American women yields beneficial results (Zhang et al., 2013)
- A reduction in psychological distress has been founded when using a social support group therapy approach (Constantino, Kim and Crane, 2005).
Therapeutic Structure of Support Groups
Empowerment Theory
Empowerment
Theory
is “an interactive process through which people experience personal and social change, enabling them to take action to improve their situation and redefine their sense of self as empowered rather than powerless"
Three Levels
Empowerment Can Exist In:
Levels
of Empowerment
A) Personal Level: where empowerment is the experience of gaining increasing control and influence in daily life and community participation
B) Small Group Level: where empowerment involves the shared experience, analysis, and influence of groups on their own efforts
C) Community Level: where empowerment revolves around the utilization of resources and strategies to enhance community control
Leading Questions that Empowers VS. Dis-Empower
Facilitating Questions
Empowerment
- What worked for you before?
- What do you want to accomplish by coming here today?
- What concerns of yours do you want to address and change in our work together?
- What can we work on together to achieve your goals?
Dis-Empowerment
- How can I help you?
- Why did you relapse?
- What problems bring you in today?
- What brought you here today?
How does the
empowerment theory
influence behavior in groups?
Influence in Groups
Practicing the empowerment theory in groups "influences human behavior by supporting the members with accessing resources and is value based focusing on the strengths of the members and supporting them with using those strengths.”
Therapeutic Role
Survivors of IPV often feel alone & isolated
due to feelings of fear and/or shame
Empowerment begins when these individuals make
the decision to join a support group, before the group
itself even begins!
Support groups are often the first time survivors speak openly about the ways their lives have been
affected by trauma.
Therapeutic Role
Empowerment
continues through the
physical structure of support groups...
- Facilitator & group members sit in a circle, distributing power amongst all present
- Power is generated through interaction within the group, both individually and collectively.
- Members direct their level of participation & identification of individual goals
- There are no requirements to share
Empowerment operationalizes through group goals...
Structure and Group Goals
- Connection to people with similar experiences
- Learn to rebuild trust
- Trust spectrum
- Build resilience
- Identification & practice coping skills
- Individuals share their challenges & successes since the last group
- Harm reduction
- Feel hopeful & confident
- Mentorship of others
Activity: MSW
Hybrid Support Group
This group is open to graduate students of the MSW Hybrid
Program of CSU Stanislaus. This group provides a confidential space
to discuss graduate student concerns, stress and anxiety, conflict
resolution, and adjustment concerns. Additional topics may include family, cultural, social, and personal dynamics that may arise and have an impact on your graduate school experience. The primary function of the group is to be collaborative and supportive in nature in order to assist in improving your graduate experience.
Ground Rules:
Relevance
1. This is a safe space.
» Be honest about your feelings and thoughts
» Use “I” statements and express your feelings, not your opinions
» Respect confidentiality
2. Share the air.
» Keep your comments relevant so everyone can participate
3. Listen generously.
» Hear what people are saying. Don’t interrupt.
» Put your electronics on silent or vibrate, and step out if you must take a call
4. Demonstrate respect cultural differences and diversity of views.
» No one is better than another – we are all equal with different perspectives and lenses.
Relevance
Relevance of Groups
“We come to groups having had past experiences in groups—both positive and negative. We come to groups with perspectives on other people based on our past experiences with others. Depending on the quality of our past individual and group experiences, it is possible that two different people can join the same group at the same time and have diametrically opposed perceptions about what their shared experience in the new group will be like. Andrea can enter a group for the first time and see in the faces of the other group members rich and exciting possibilities for new friendships, new ideas, and new solutions to her problems. Mitchell can look at the same faces and see a terrifying collection of strangers and potential enemies waiting to create many more problems for him than they could ever solve. It is out of this diversity of perceptions, based on radically different pasts, that the challenge of groupness emerges. As social workers, we are often charged with guiding these very different people to share their differences in an attempt to confirm the hopes of Andrea and to allay the anxiety and the fears of Mitchell so both can benefit from each other’s experiences and come closer to fulfilling both their potentials as humans.”
Works Cited
Works Cited
Charuvastra, A., & Cloitre, M. (2008). Social bonds and posttraumatic stress disorder. Annual review of psychology, 59, 301–328.
https://doi.org/10.1146/annurev.psych.58.110405.085650
Constantino, R., Kim, Y., & Crane, P. A. (January 01, 2005). EFFECTS OF A SOCIAL SUPPORT INTERVENTION ON HEALTH OUTCOMES IN RESIDENTS OF
DOMESTIC VIOLENCE SHELTER: A PILOT STUDY. Issues in Mental Health Nursing, 26, 6, 575-590.
Greene, G. J., Lee, M. Y., & Hoffpauir, S. (2005). The Languages of Empowerment and Strengths in Clinical Social Work: A Constructivist Perspective. Families in
Society: The Journal of Contemporary Social Services, 86(2), 267–277. doi: 10.1606/1044-3894.2465
Johnson, D. M., & Zlotnick, C. (2009). HOPE for battered women with PTSD in domestic violence shelters. Professional psychology, research and practice, 40(3),
234–241. https://doi.org/10.1037/a0012519
Schriver, J. (2004). Human Behavior and the Social Environment: Shifting Paradigms in Essential Knowledge for Social Work Practice (4th ed.). Boston: Pearson Education
Sullivan, C. M. (2018). Understanding How Domestic Violence Support Services Promote Survivor Well-being: A Conceptual Model. Journal of family violence,
33(2), 123–131. https://doi.org/10.1007/s10896-017-9931-6
U.S. Department of Veterans Affairs. (2020). PTSD Basics. PTSD: National Center for PTSD.
Retrieved from https://www.ptsd.va.gov/understand/what/ptsd_basics.asp
Zhang, H., Neelarambam, K., Schwenke, T. J., Rhodes, M. N., Pittman, D. M., & Kaslow, N. J.
(2013). Mediators of a culturally-sensitive intervention for suicidal African American
women. Journal of clinical psychology in medical settings, 20(4), 401–414.
https://doi.org/10.1007/s10880-013-9373-0