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As clinicians we know the patient's resistance is an integral part of the psychotherapeutic change process. And in the context of therapy we learn to work with it. We use it to create openings in the patient for inquiry, growth and transformation. However, when that resistance is not before us to work with but is clearly working against us, we must see it for what it is. You absolutely cannot fight against it, as doing so will strengthen it. Family Resistance in Families of Domestic Violence This is especially true when working in families suffering from domestic violence. The question that remains then is: How do you help a patient who is a victim of intimate partner violence when the family network supports keeping her/his victimization status quo? Under these conditions, do not expect to get the cooperation of the family members because you will get lip service at best, and then ultimately the true agendas will present themselves. And you will see it's all in an effort to keep an intervention at bay. So the next natural and responsible clinical position to take is to create a (or nourish an existing) therapeutic alliance with the identified patient. This alliance must have the ingredients of both psychotherapy patient-doctor relationship and domestic abuse victim-advocate relationship. The Domestic Violence Model in the Context of Psychotherapy In the case of intimate partner victimization, one will need to follow a domestic violence intervention protocol to facilitate long-term therapeutic value for the patient. How is this protocol different from treatment plans when domestic violence is not the presenting condition? 1) First and foremost you will want to establish new treatment parameters for your patient. Instead of their intervention being public knowledge to the relevant family member, it now becomes completely confidential. The patient's involvement in getting help becomes a sacred secret between her/him and yourself as the clinician/advocate. 2) Thorough evaluation and proper intimate partner violence assessment are essential and can be conducted in the context of this professional relationship if you are trained in domestic violence assessment. If not, refer the patient to a domestic violence specialist. 3) Once intimate partner violence is substantiated (and diagnosed) as best as can be done in the context of the resources and assessment tools currently available, the patient is informed of the findings. 4) General abuse dynamics and the specific constellation of symptoms characterizing intimate partner violence are clearly conveyed to the patient. 5) The patient that wants to break the cycle of abuse agrees to keep all matters pertaining to their intervention, including the fact that they are involved in getting help, confidential particularly with respect to the perpetrator and those who support the family abuse dynamics. 6) Once the confidential relationship is established and the commitment to privacy is demonstrated, then the patient must be guided in all necessary and relevant safety issues surrounding domestic violence interventions. 7) If you are not trained in the nuances of domestic violence safety measures, it is essential that you seek the collaboration of a domestic violence specialist to assist in your treatment with this patient. 8) Safety considerations remain in the forefront all while providing appropriate psychotherapy to inspire change. When interpersonal psychotherapeutic process and safety are in conflict, safety takes precedent. The dynamics of domestic abuse and the essential safety precautions in dealing with patients who are victims of domestic violence must be part of the clinician's professional repertoire in order for the ongoing intervention to be effective.
Article Source: http://www.bharatbhasha.net Article Url: http://www.bharatbhasha.net/health.php/195564 Article Added on Wednesday, December 9, 2009
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