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To prepare for this Discussion:Review Chapters 6 and 7 of the Frankfort-Nachmias & Leon-Guerrero text and in Chapter 7, p. 188, consider Hispanic migration and earnings and focus on how different levels of confidence and sample size work together.Review Magnusson’s web blog found in the Learning Resources to further your visualization and understanding of confidence intervals.Use the Course Guide and Assignment Help found in this week’s Learning Resources to search for a quantitative article related to confidence intervals.Using the SPSS software, General Social Survey dataset and choose a quantitative variable that interests you.By Day 3Using SPSS:Take a random sample of 100.Calculate the 95% confidence interval for the variable.Calculate a 90% confidence interval.Take another random sample of 400.Calculate the 95% confidence interval for the variable.Calculate a 90% confidence interval.Post your results and an explanation of how different levels of confidence and sample size affect the width of the confidence interval. Next, consider the statement, “Confidence intervals are underutilized” and explain what the implications might be of using or not using confidence intervals. Provide examples based on the results of your data. Also, use your research to support your findings.Be sure to support your Main Post and Response Post with reference to the week’s Learning Resources and other scholarly evidence in APA Style.
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Social Work in Mental Health
ISSN: 1533-2985 (Print) 1533-2993 (Online) Journal homepage: https://www.tandfonline.com/loi/wsmh20
The Language of Healing: Women’s Voices in
Healing and Recovering From Domestic Violence
Karen Neuman Allen LMSW ACSW PhD & Danielle F. Wozniak MSW ACSW
PhD
To cite this article: Karen Neuman Allen LMSW ACSW PhD & Danielle F. Wozniak MSW ACSW
PhD (2010) The Language of Healing: Women’s Voices in Healing and Recovering From Domestic
Violence, Social Work in Mental Health, 9:1, 37-55, DOI: 10.1080/15332985.2010.494540
To link to this article: https://doi.org/10.1080/15332985.2010.494540
Published online: 03 Jan 2011.
Submit your article to this journal
Article views: 3395
Citing articles: 23 View citing articles
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https://www.tandfonline.com/action/journalInformation?journalCode=wsmh20
Social Work in Mental Health, 9:37–55, 2011
Copyright © Taylor & Francis Group, LLC
ISSN: 1533-2985 print/1533-2993 online
DOI: 10.1080/15332985.2010.494540
The Language of Healing: Women’s
Voices in Healing and Recovering
From Domestic Violence
KAREN NEUMAN ALLEN, LMSW, ACSW, PhD
Social Work Program, Oakland University, Rochester, Michigan, USA
DANIELLE F. WOZNIAK, MSW, ACSW, PhD
School of Social Work, University of Montana, Missoula, Montana, USA
Little is known about the course of recovery or healing from
intimate partner violence. Shelter-based interventions are limited
and frequently end before traumatized women can adequately
reconstruct social and personal identity. Based on the belief
that healing from relationship violence is a social, spiritual, cultural, and psychological process, we designed a group treatment
approach that discouraged repetitive disclosure about the history of
abuse and that used holistic, integrative, and alternative healing
approaches such as prayer, meditation, yoga, creative visualization, and art therapy. Structured interviews and focus groups were
used to engage the women in articulating a conceptualization of
healing from domestic violence. The Post-traumatic Checklist was
used as a pre and posttest measure to assess the group’s effectiveness. Positive quantitative and qualitative results were obtained
and are presented. Implications for further research are also
discussed.
KEYWORDS recovery and domestic violence, healing and domestic violence, alternative treatment approaches and domestic violence, integrative treatment and domestic violence, group therapy
and domestic violence, post-traumatic stress and domestic violence
We gratefully acknowledge the support of the FAHS-BECK Fund for Research and
Experimentation which was essential to carrying out this project.
Address correspondence to Karen Neuman Allen, LMSW, ACSW, PhD, Associate
Professor, Director, Social Work Program, 512 Varner Hall, Oakland University, Rochester,
MI 48309, USA. E-mail: [email protected]
37
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K. N. Allen and D. F. Wozniak
INTRODUCTION
Intimate partner violence occurs in every socioeconomic class, culture, and
community in the United States. It constitutes the leading cause of injury
among women, resulting in nearly 2 million injuries and 1,300 deaths each
year for U.S. women aged 18 and older (Centers for Disease Control and
Prevention [CDC], 2003). During their lifetimes, over half of all women
will experience some form of physical abuse within a domestic relationship, and over 6.8 million incidents of intimate partner violence and sexual
assault by an intimate partner are reported each year. Estimates are that intimate partner violence costs over $8.3 billion annually in lost productivity
as well as health, mental health, and legal costs (Burke, Gielen, McDonnell,
O’Campo, & Maman, 2001; CDC 2003). Yet, the real cost of intimate partner
violence significantly exceed this estimate as the lifelong physical, emotional,
and financial impact of violence is felt by women. Despite this reality, little is known about the course of recovery or healing from intimate partner
violence.
Traditional interventions in this population are typically short term,
shelter/agency-based and crisis-oriented, lacking an adequately operationalized construct of “success” (Burke et al., 2001; Brown, 1997; HamRowbottom, Gordon, Jarvis, & Novaco, 2005; Wathen & MacMillan, 2003;
Zink & Putnam 2005). When linear, transtheoretical, staged-based change
models are applied to interpersonal violence (Prochaska & DiClemente,
1982; Prochaska, Norcross, & DiClemente, 1994; Prochaska & Prochaska,
2002) recovery ends with either “maintenance,” in which women demonstrate increased autonomy and leave their abusers (Burke, Denison, Gielen,
McDonnell, & O’Campo, 2004), or with “termination” in which women are
able to “improve their behavior and intra psychic functioning” (Burman,
2003, p. 96; Fortune, 2002) such that they are physically safe and emotionally and cognitively stable. While these women may no longer show overt
physical manifestations or psychological symptoms of trauma, they often
define themselves relative to their experience with violence, identifying as a
“victim” or at best “survivor” of abuse. Beyond a certain point in recovery,
women who continue to retell and relive their traumatic experiences may
ultimately run the risk of foreclosing their identity as primarily survivors or
victims rather than integrating the experience into a more holistic sense of
self. In this state, women, because of their continued fear and distrust of
others, may continue in their isolation and have difficulty with interpersonal relationships. Further, the pattern of domestic violence means that
for many women, batterers continue to intrude in their lives retraumatizing them and exercising control in ways that perpetuate crises and impede
further growth.
We hypothesize that current intimate partner violence interventions
can be enhanced to produce transformative healing effects by supporting
The Language of Healing
39
women in making the necessary changes in social and personal identity
(Burke & Stets, 2009) transitioning from thriving rather than surviving in
spite of the abuse.
Based on the belief that healing from relationship violence is a social,
spiritual, cultural, and psychological process, we designed a group treatment approach that helps facilitates the “shift” in women from “surviving” to a “thriving.” Using holistic, integrative, and alternative healing
approaches such as prayer, meditation, yoga, creative visualization, and
art therapy, the group draws on philosophical underpinnings from human
development/human improvement literature, narrative therapy, feminist
spirituality, anthropology, and social work group process theory to facilitate
sequential steps away from an identity embedded in trauma and violence
toward a sense of self embedded in wholeness, health, and strength. It
is premised on the idea that women, within the context of a supportive community, transition through stages of healing by creating a vision
of themselves and their future that is radically different from their past.
Because we also hypothesize that repetitive disclosure about the violence
and self-identification as a “survivor” can be reinforcing, preventing some
women from truly “moving on,” an important aspect of the group was to
create a space where women did not routinely discuss their particular history of abuse (women were provided with resources and other supports
should crises or emergencies arise). Finally, premised on an understanding of healing as a rite of passage from one stage, (victim or survivor) to
another (thriver) we involved women in creating their own healing rituals
to facilitate transitioning and strengthen group cohesiveness (Turner, 1969;
van Gennep, 1960) As our conceptualization of healing and recovery in
this population was still being conceptualized, we used a grounded theory
approach (Glaser & Strauss, 1967) to engage the women in constructing
a full and rich definition of healing that was generated from the participants themselves. Structured intake interviews and focus groups with the
participants were transcribed an analyzed for themes that were illustrative
of defined healing. To quantitatively assess the effectiveness of the group in
reducing psychological distress, the Post-Traumatic Stress Disorder (PTSD)
Checklist was administered as a pre- and posttest. This article presents an
overview of the group, identifies themes of healing, and the results from the
PTSD Checklist.
REVIEW OF THE LITERATURE
Most domestic violence interventions focus on women’s empowerment and
cognitive-behavioral change sufficient to assist them in extricating themselves from a violent relationship (Dutton, 1992; Freeman, Simon, Bentler &
Arkowiz, 1989). But studies of intervention effects leave us guessing about
40
K. N. Allen and D. F. Wozniak
the long-term cognitive and behavioral processes that allow women not
only to leave abusive relationships, but to heal from the physically and psychologically traumatic effects of violence, to become self-caring, functional,
healthy members of society (Cox & Stoltenberg, 1991; Harway & Hensen,
1993; Rounsaville, Lifton, & Bieber, 1979). For example, women’s shelters
generally provide crisis intervention and short term counseling services with
the aim of restoring cognitive equilibrium compromised or overwhelmed
through violence, and facilitate the return of pre-crisis equilibrium (Roberts &
Burman, 1998; Roberts, 2000; Brewster, 2002). Support group interventions
provided largely through community-based domestic violence shelters offer
strong legal, psychological, and educational advocacy that reduces women’s
sense of isolation, increases their feelings of empowerment, and provides
a sense of commonality that can reduce guilt (Yalom, 1995) and promote
psychological well-being (Bowker, 1984; Dobash, Dobash, & Cavanagh,
1985; Donato & Bowker, 1984; Hoff, 1990; Mitchell & Hodson, 1983; Tan,
Basta, Sullivan, & Davidson, 1995; Sullivan, Campbell, Angelique, Eby, &
Davidson II, 1995). Yet, none of these interventions has as a goal of women’s
healing or the restoration of health and thus cannot represent the culmination of intervention (Bogard, 1984; Ham-Rowbottom et al., 2005; Leenerts,
1999). To further confound our understanding of the impact of intervention,
a national survey to assess the kinds and types of interventions provided at
women’s shelters found that 87% of directors were unable to provide basic
information on practice models, types of treatments, or strategies provided
to women and failed to test for service efficacy (Roberts & Burman, 1998).
No shelter-based interventions reviewed in the literature had as a service
goal, healing or recovery or health and Ham-Rowbottom et al. (2005) report
that up to 75% of women who received extensive emergency or transitional
living shelter continue to exhibit signs of depression, trauma, and life dissatisfaction. In the words of one director of a transitional living facility, “Women
leave here better, but they don’t leave here healed—they aren’t happy, or
goal directed or feeling empowered” (Marzey, 2007).
Intermediate-term interventions premised on stages of change models
have been helpful in outlining a woman’s journey away from her abuser
and delineating the parallel cognitive-problem solving and cognitiverestructuring processes that accompanies change (Burman, 2003; Prochaska
& DiClemente, 1982; Prochaska, Norcross, & DiClemente, 1994; Roberts &
Burman, 1998; Walker, 1994). But these interventions are often short term
(six months or less) and have a poorly operationalized construct of “success.” For example, in most cases “success” simply refers to being “abuse
free” for six months (Burke et al., 2001; Brown 1997), refers to an increase
in self-esteem with no plans to return to their abuser (Burke et al., 2004) or
improvements in “behavior and intra-psychic functioning” (Burman, 2003,
p. 96; Fortune, 2002) such that they are physically safe and emotionally and
cognitively stable.
The Language of Healing
41
Similar challenges in articulating the goals and outcomes of intervention exist for women who receive intermediate and/or long-term treatment.
These women may be diagnosed and treated for PTSD, anxiety-disorder,
or depression, and treated for intimate partner violence as a heterogeneous
symptom of other personality or intra-psychic dynamics. Intervention “success” or “effectiveness” measures are often in the reduction of anxiety,
depression, or trauma. But few of these interventions have documented the
duration of symptom reduction, whether or when symptom reduction translates into an increased quality of life (Foa, Dancu, & Hembree, 1999; Chard,
2005; Cloitre, Koenen, & Cohen, 2002; Resnick, 2004) or whether or not
these are the primary changes that women need to make in order to “heal”
from their experiences, resume a normal routine, and assume an identity
as someone who is abuse-free. Even compelling and experimental findings
from women-centered empowerment interventions premised on cognitive
change models (Zust, 2003; Little & Kantor, 2004) or social-interactionism
and the need to repair a damaged sense of self (Leenerts, 1999) have not
followed women’s behavioral and cognitive changes past six months nor
have they operationalized a clear idea of what changes women can and
should make in order to be “healthy.” And, thus, there remain no criteria
for “recovery” or “health” from the experience of intimate partner violence
specifically. And few services integrate a holistic approach to intervention
that includes not only improvement in intra-psychic and social relationship
functioning, but also educational, employment, career resources, and fiscal
management skills necessary to sustain long-term personal changes.
The need for continued movement past already established stages of
change may be especially important in situations where current battering
relationships are extensions of lifetime trauma since these women show
significantly higher vulnerability to comorbid depression, PTSD, drug and
alcohol abuse, and suicidal ideation (Corstorphine, Waller, & Lawson, 2007;
Harned, Najavits, & Weiss, 2006; Lipsky, Field, & Caetano, 2005; Nixon, Resnick,
& Nishith, 2004; O’Campo, Kub, & Woods, 2006; Pico-Alfonso, Garcia-Linares,
& Celda-Navarro, 2006; Stein, Jensen, & Loge, 2006; Ullman, Townsend, &
Starzynski, 2006). Thus taking the “next step” may not just be leaving an
abusive relationship and establishing ego-equilibrium, but shifting psychoaffective and cognitive processes and self-constructs, such that women no
longer define themselves and their futures in terms of the trauma associated
with the past. In other words, once stabilized outside an abusive relationship,
women need to make a final stage transition that breaks with past patterns
and ways of thinking about themselves and their world. This intervention
tests the hypothesis that women can continue their journey away from abuse
toward healing in sequential stages that involve an interpersonally and socially
recognized transition, and tests the efficacy of intervention designed to facilitate
these steps.
42
K. N. Allen and D. F. Wozniak
DESCRIPTION OF THE GROUP
Rites of Passage is a ten week group intervention model was originally developed and piloted in two groups in Connecticut. The title of the group Rites
of Passage refers to the activity of creating rituals that support women the
women on the healing journey. The curriculum was refined and then replicated and studied in Montana and Michigan. This article presents the results
from those two groups. Initially, we conceptualized healing from trauma as
a transitional period that involves passing through three stages—separation,
liminality, and incorporation. This approach was based on the work of van
Gennep (1960) and later, Turner (1969), who suggested transitional stages
initially involve separation and letting go of one’s old life ways. They are
then marked by liminality, which is a time of ambiguity, uncertainty, and
rolelessness, in which those undergoing change are neither the people they
were, nor have they yet become personally or socially something different. Turner and van Gennep also described the importance of communitas,
or the intense camaraderie and emotional bond that develops between
individuals experiencing the same transitions and sustains those who are
undergoing change. Once those making change have shed their old identity
and life-ways and learned the components of their new identity, they gradually re-emerge in their new role or identity and are reintegrated into society,
a stage called integration (Goodenough, 1963).
The group uses a semi-structured curriculum that focuses on helping
women develop alternative ways of thinking about themselves and their
futures through cultural myths, projective stories, meditation, active day
dreaming, and personal metaphors. The group also provides women with a
space for reflection and an opportunity to explore the role of joy in healing
through creative and spiritual exercises.
Although the group generally followed a specific outline, each week
women were consulted about group activities as well as the overall pacing
for the group. Community partners were often enlisted to facilitate a session and were eager to volunteer their expertise. A typical session involved
a didactic presentation by the group leaders and community partners,
followed by experiential activities and exercises, with guided discussion
occurring throughout. For example, one exercise facilitated by an art therapist in the community, including drumming and meditation to create a
personal collage from various images and pictures cut from magazines and
discussion occurred throughout the activity. In the creation of a self-defining
ritual, the women created a blessing and prayer that was used to open
and close each session. This blessing was selected as the title page of the
scrapbook for the future that they later created.
Creating and running the group involved a paradigm shift for us as
social worker/researchers. First, creating a vision of the future that was
not contingent on exploring the pre-morbid conditions and the history of
The Language of Healing
43
violence experienced by these women ran counter to our experience and
training. Secondly, we had to monitor and change our lexicon. These women
saw themselves through the lens of “clients” or “patients” and certainly
through the social lens of “victim” and “survivor.” The process of healing as
experienced in the group was antithetical to the idea of a therapist “working with clients” and required the development of a partnership in which
the women were acknowledged as the experts in their own lives who were
moving beyond the violence and crisis. We drew from integrated narrative
and post-modernist perspectives of treatment in which the therapist acts as
a facilitator bringing in resources, information, activities and opportunities,
and collaborates with clients to co-create meanings and reality (Freedman &
Combs, 1996). This therapeutic position encouraged the women to join with
us in directing the group, which fostered their ownership and investment
in the experience. It was also critical in establishing the trust necessary for
the women to commit to avoiding discussion that centered on the history
of abuse. Once it was established that the women would be empowered to
help direct the group, the women’s initial anxiety about participating in the
group visibly decreased and their enthusiasm visibly increased. Thus, we
were all simply women on a journey.
METHODS AND RESULTS
A mixed methodology research design was selected to evaluate the project
that included a quantitative measure of symptoms (the PTSD Checklist)
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