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Group Therapy for Survivors of Domestic Violence

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on 4 November 2014

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Transcript of Group Therapy for Survivors of Domestic Violence

Group Therapy for Survivors of Intimate Partner Violence
Therapeutic Issues
The group will address the following:
The victim’s tendency towards manipulation and control.
Interpersonal issues.
Mood-related factors such as anger, anxiety, and depression.
Increasing feelings of safety, goal-setting behaviors, and coping skills.
According to the findings of the National Violence Against Women Survey funded by the National Institute of Justice and the CDC in 2000, IPV is the most common type of violence against women.
Each therapy group will have two master’s level facilitators who will run the weekly sessions. In each group there will be both a male and female facilitator.

1) Make the clients feel more comfortable easing into the therapeutic experience with a woman.
2) Help them to develop trust in the opposite sex.

The facilitators will receive weekly training and supervision from doctoral-level clinicians to ensure that all therapeutic protocols are being met.


If a male facilitator is selected, there may be issues regarding the female group members building rapport with and establishing trust in the group facilitator. There will likely be resistance towards opening up to a male specifically because they have been abused by males in the past.
Women in the group could become more dependent on male leaders. They may try to be what they perceive the therapist wants or expects them to be in order to avoid potential abuse.
Female clients may also feel as though they have to manipulate male facilitators to gain control, since this is what they have learned to do in the relationship with their abuser (Walker, 1991).

Women who have experienced IPV may also have a difficult time trusting women group leaders as well.
There will likely be clinical resistance to opening up and letting anyone into their lives given the heightened vulnerability and fear of this group. Each group member has been in a relationship where her control and safety were taken away. It will be difficult for a facilitator of either gender to gain the trust of the clients.
Ehlers and Clark (2000) found that targeting clients’ core beliefs is crucial to understanding how they are currently coping with the trauma they have experienced. How the individual negatively appraises the trauma also provides important information for their symptoms. Therapeutic interventions that address one’s core beliefs about oneself and their trauma are effective in decreasing the effect of the trauma on the client’s daily functioning. Specifically, modification of cognitive appraisals and addressing maladaptive coping strategies (such as manipulation) have been found to reduce PTSD symptoms (Ehlers and Clark, 2000).

Johnson and Zlontnick (2009) used a CBT approach to promote client safety, empowerment, coping skills, and interpersonal relationships. The intervention, “Helping to Overcome PTSD Through Empowerment (HOPE),” was provided to women living in domestic violence shelters. By targeting a client’s sense of control, power, safety, self-esteem, and intimacy, the intervention was able to decrease the severity of the client’s PTSD and depression symptoms as well as increase personal and social resources for the client (Johnson and Zlontnick, 2009).
Target Population
The group will include 10-15 women between the ages 25-45.
Additional inclusion criteria are as follows:
Women who have left their abuser for more than one month.
Women who are currently living in a women’s shelter or similar agency.
Women who meet DSM V criteria for Post Traumatic Stress Disorder (PTSD).
Women will also be screened for other mental health issues such as depression or other anxiety disorders; these women will be included in the group as long as they also meet the criteria for PTSD.
Exclusion Criteria are as follows:
Women who present with psychotic features, severe dissociation, or bipolar with active manic symptoms will not be included in the group.
The Centers for Disease Control and Prevention (CDC) defines intimate partner violence (IPV) as physical, sexual, or emotional/ psychological abuse as well as threats of violence between two people in a close relationship.
Research has shown that such violence can have long-term effects on the physical and emotional well-being of the individual.
In 2003, $8.3 billion was spent on the medical and mental health care of victims of physical and sexual assault.
Victims lose 8 million days of paid work and 5.6 million days of household productivity on average every year.
PTSD Symptom Scale—
Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum,1993). The PSS-I is a 17-item questionnaire measuring re-experiencing, arousal, and avoidance on a Likert-type scale.
Post Traumatic Diagnostic Scale (PDS; Foa, Cashman, Jaycox, & Perry, 1997).
The PDS is a 49-item self-report measure recommended for use in clinical or research settings to measure severity of PTSD symptoms related to a single identified traumatic event.
The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996).
The BDI-II will be used to measure severity of depression symptoms.
The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988).
This scale measures perceived adequacy of social support from three different sources: family, friends, and significant others. The MSPSS consists of 12 items that are rated on a Likert-type scale.
The group will move towards increased social support and trust in others, and will learn new communication skills to enhance their ability to effectively express and control anger.
Group members to gain a better understanding of IPV and its effects.
Group work will promote self-understanding.
Facilitator Issues
This group will meet every Tuesday at the Counseling Center of Intimate Partner Violence from 7:00-8:30pm for 15 sessions.
Session 1: Rapport building between group members and facilitators.
Session 2: Creating a detailed safety plan.
Session 3: Empowering group members by providing psycho-education about the development of PTSD.
Session 4: Empowering group members by providing psycho-education about the short-and-long term effects of IPV.
Session 5: CBT Techniques
Session 6: CBT Techniques
Session 7: CBT Techniques
Session 8: CBT Techniques
Session 9: Identifying triggers and maladaptive coping strategies.
Session 10: Implementing effective coping strategies and communication techniques.
Session 11: Capitalize feelings of trust and safety within the group.
Session 12: Focus on role-playing techniques to address healthy expression of anger, pain, resentment.
Session 13: Focus on role-playing techniques to address healthy expression of anger, pain, resentment.
Session 14: Termination
Session 15: Termination
IPV is a growing issue in the United States. Finding effective treatment modalities for women leaving their abusers has important implications for personal as well as societal well-being. The techniques given in this group therapy addresses the developed symptoms of Post-Traumatic Stress Disorder as a result of violence in the group member’s romantic relationships. This intervention will use Cognitive-Behavioral Therapy (CBT) techniques such as thought-stopping, automatic thought records, and role playing in order to help the women safely re-enter their community.
Batt, M. (2010) Domestic violence in elderly women: A systematic review. Texas Medical Center Dissertations (via ProQuest). Paper AAI484206.
Center for Disease Control and Prevention (CDC). (2012). Violence prevention: Intimate partner violence.
Devine, H. (2011) Disabled Women and Domestic Violence.
Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 319-345.
Iverson, K. M. (2011). Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors. Journal of Consulting and Clinical Psychology, 79(2), 193-202. doi:http://dx.doi.org/10.1037/a0022512
Johnson, D., & Zlotnick, C. (2009). HOPE for battered women with PTSD in domestic violence shelters. Professional Psychology: Research and Practice, 40, 234-241.
Lawrence A., & Greenfield, B. (1998) US Department of Justice, Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends.
Lothstein, L. M. (2013). Group therapy for intimate partner violence (IPV). International Journal of Group Psychotherapy, 63(3), 449-452. doi:http://dx.doi.org/10.1521/ijgp.2013.63.3.449
Morrel, T. M. (2003). Cognitive behavioral and supportive group treatments for partner-violent men. Behavior Therapy, 34(1), 77-95. doi:http://dx.doi.org/10.1016/S0005-7894(03)80023-0
Walker, L. (1991). Post-traumatic stress disorder in women: Diagnosis and treatment of battered woman syndrome. Psychotherapy, 28, 21-29.

New Image Emergency Shelter 323-751-9446
8720 S Figueroa St., Los Angeles, CA 90003
Downtown Women's Center 213-613-1024
325 S Los Angeles St., Los Angeles, CA 90013
Beyond Shelter Inc. 323-232-9000
5101 S Broadway, Los Angeles, CA 90037

Southern California Domestic Violence Hotline 1-800-978-3600

Centers for Disease Control and Prevention
One in four women are victimized by IPV in her lifetime.
According to the U.S. Department of Justice, women are 90-95% more likely to be victims of IPV than are men.
IPV occurs in every culture, country, and age group. It affects people from all socioeconomic, educational, and religious backgrounds and happens in both same-sex and heterosexual relationships.
Lawrence and Greenfield (1998)
Immigrant Communities
Reporting crimes and domestic violence to police or authorities generates fear of deportation, whether the immigrant is documented or not.
Language and cultural barriers also serve as roadblocks to safety. As a result, some immigrant victims often don’t know their rights, how to gain access to services, or how to work with police.
Target Population
Lesbian, Gay, Bisexual, Transgender Community
The same issues of power and control can be present in the whole continuum of relationships, no matter a person’s sexual orientation or gender identity (Lawrence and Greenfield, 1998).
Women with Disabilities
An abuser can utilize many tactics to keep a partner with disabilities under control. These range from manipulation of medication to refusal to help meet basic needs to destruction of adaptive equipment.
Mobility and accessibility barriers may keep a woman with disabilities from leaving an intimate partner or reporting violence.
Fear of losing independence and fear of losing vital support can keep a woman in an abusive relationship (Devine, 2011).
Target Population
Elderly Women
The challenge to assist elderly women facing abusive relationships may escalate as the “baby boomer” generation begins to enter old age.

More than one in ten women over 50 suffers from physical, sexual, or verbal abuse perpetrated by an intimate partner.

Two categories of IPV against the Elderly:

IPV grown old – this is a pattern of violence that continues into old age.
Late onset IPV – this begins in old age, and may be linked to challenges surrounding retirement, disabilities, new roles for family members, or sexual changes.
Batt (2010)
Center for Disease Control and Prevention (2012)
The risks, rights, and responsibilities will be disclosed in the informed consent and confidentiality notice that all group members will sign at the first session.

The participants may exhibit a degree of discomfort in discussing emotional and painful topics surrounding their experienced trauma. Confidentiality cannot be guaranteed in a group therapy setting.
Participation in this group is voluntary and members are free to terminate at any time. Participants have the right to know what the group therapy will entail. Participants have the right to confidentiality to the extent that members will not disclose information or events that occur in group unless the information is shared from one’s personal experience.
It is the facilitator’s responsibility to protect the safety of group members. Participants are responsible for attending the sessions in a timely manner. It is the member's responsibility to fully participate throughout the group sessions.
The theoretical conceptualization useful in this group setting is Cognitive-Behavioral Therapy (CBT).

CBT has become the standard treatment for survivors of intimate partner violence.
CBT suggests that one's thoughts influence how an individual feels. This approach addresses one's automatic thoughts, distorted and negative thought patterns.
CBT is most effective in enhancing one's self-concept.
CBT assists an individual's cognitive restructuring, reducing one's feelings of worthlessness.
Use techniques such as role playing.
In the study,
Group Therapy for Intimate Partner Violence,
by Mary Lothstein (2013), examined the efficacy of psychological treatment for women victims of intimate partner violence (IPV) throughout various women’s centers throughout Spain.

Compared two brief group cognitive behavior therapy (CBT) treatment approaches. 1. Exposure therapy 2. Communication skills training (without exposure)
Both interventions showed reduction in most of the symptoms.
Post-traumatic symptoms disappearing by the end of the first month of treatment and maintained over the first year.
The study,
Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors
, by Kyle Iverson (2011), examined the effect of CBT for PTSD and depressive symptoms on the risk of future IPV.

The sample included 150 women survivors of IPV who are currently diagnosed with PTSD.
A randomized clinical trial of different forms of cognitive processing therapy for the treatment of PTSD.
Participants were assessed at pretreatment, 6 times during treatment, post-treatment, and 6-month follow-up.
Reductions in PTSD and in depressive symptoms during treatment were associated with a decreased likelihood of IPV at a 6-month follow-up even after controlling for recent IPV (IPV from a current partner within the year prior to beginning the study).
The study,
Cognitive behavioral and supportive group treatments for survivors of intimate partner violence
by Tanya Morrel (2003), evaluated the relative efficacy of cognitive-behavioral group therapy (CBT) and supportive group therapy (ST) for survivors of intimate partner violence at a community agency.

86 women were assigned and exposed to CBT or ST.
Outcome analysis were collected and based on participant self reports
1. Pre-Treatment
2. Post-Treatment
3. 6-Month Follow-Up
Participants exposed to CBT reported significant increases in self-esteem and self-efficacy for abstaining from aggressive partners.
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