© Springer International Publishing Switzerland 2015S. Megan BertholdHuman Rights-Based Approaches to Clinical Social WorkSpringerBriefs in Rights-Based Approaches to Social Work10.1007/978-3-319-08560-9_4
4. Intimate Partner Violence and a Rights-Based Approach to Healing
School of Social Work, University of Connecticut, West Hartford, Connecticut, USA
S. Megan Berthold
Claire1, a 32-year-old African American lesbian biologist, entered treatment with a clinical social worker as she was experiencing frequent troubling memories of her abuse as a child. These memories had intensified after she and her partner Helen adopted a daughter 1 year earlier. After several months of treatment, Claire revealed to her social worker that Helen had left her after a particularly bad argument during which Claire had punched Helen multiple times in the back. Claire was remorseful, recalling how it reminded her of seeing her father beat her mother on many occasions when she was young. She recounted that this was not the first time she had punched Helen. “I never wanted to grow up to be like my dad,” Claire pronounced to her social worker.
What rights issues may be particularly relevant in this case? What would your reaction be upon learning that Claire had punched Helen? How would you approach working with Claire? How would a rights-based approach inform your strategy? Where would you start? How might you balance and attend to issues of safety and rights in your work? What other information would you want to know to guide your work with Claire?
Intimate partner violence (IPV)2 is a worldwide problem with serious consequences for individuals, families, and societies. IPV can result in death and, for those who survive, serious injuries. The consequences can span physical, mental, social, cultural, and spiritual domains (Black et al., 2011; WHO, 2013a). This chapter applies principles from a rights-based approach to clinical practice to work with those who have experienced IPV. The problem of IPV is defined and framed within the context of human rights and selected prevalence data are summarized. Space constraints do not allow for comprehensive attention to the full range of types of IPV cases. The experiences of several special populations affected by IPV are highlighted (i.e., children and families; heterosexual male and lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) survivors; and undocumented survivors). Relevant human rights mechanisms and tools are described, and selected core principles and foundational considerations for clinical social workers working with IPV survivors are discussed. Rights-based recommendations and several key challenges for clinical practice with this population are presented. Often, social work practitioners and society at large think of trauma survivors (or “victims”) as being distinct from perpetrators. The reality is often more complex and nuanced, with some survivors of trauma having also perpetrated violence against others at some time in their life. A human rights-based approach facilitates effective and ethical practice with both perpetrators and survivors of IPV. Attention to work with perpetrators (a commonly underexamined topic) is explored in this chapter, highlighting the value of conducting a holistic assessment and working with the complexities presented from a rights-based framework including with those perpetrators who may have been mandated to receive services (Rooney, 2009; UN Special Rapporteur on Violence Against Women, 2013). Restorative justice approaches are described and discussed as an alternative model to addressing the problem of IPV. The chapter ends with suggested class activities and selected resources.
Definitional and Contextual Issues
Defining Intimate Partner Violence
The United Nations (UN) Committee on the Elimination of Discrimination Against Women3 (1992; hereafter referred to as the CEDAW Committee) did not originally explicitly address violence against women as discrimination or a human rights concern. Over time, violence against women came to be identified as a serious form of discrimination, a human rights concern for which states were to be held accountable. The Declaration on the Elimination of Violence Against Women (DEVAW; UN General Assembly, 1993), adopted by the UN General Assembly in 1993, was based on the CEDAW Committee’s General Recommendation 19 (UN CEDAW, 1992). DEVAW defined violence against women as follows:
… the term “violence against women” means any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. (UN General Assembly, 1993, Article 1)
Article 2 of DEVAW specifies physical, sexual, and/or psychological IPV as a possible form of violence against women.
Prevalence of Intimate Partner Violence
There is an ample literature regarding the high prevalence of IPV and the host of negative associated consequences (Black et al., 2011; WHO, 2013b). The World Health Organization (WHO) considers IPV to be an epidemic (WHO, 2013a). The prevalence of IPV worldwide is alarming: approximately one-third (30%) of all women in the world who have been in an intimate relationship have been subjected to sexual and/or physical violence by their partner; the rate is 38% in some parts of the world (i.e., Southeast Asia); and approximately 38% of murdered women worldwide were killed by their intimate partners (WHO, 2013a).
In the United States, IPV is also a significant yet preventable problem that violates the human rights of its immediate target and other family members. The 2010 National Intimate Partner and Sexual Violence Survey (NISVS) was conducted with a nationally representative sample of 16,507 noninstitutionalized English and/or Spanish-speaking adult women and men in the United States. Results from the NISVS indicated that 35.6% of women and 28.5% of men in the United States had been subjected to physical violence, rape, and/or stalking by an intimate partner during their lifetime (Black et al., 2011). Not everyone is equally at risk for experiencing IPV. Compared to the overall sample in the 2010 NISVS (Black et al., 2011), young women and racial and ethnic minority men and women are disproportionately at risk. Black et al. (2011) comment that the higher rates in these sub-groups may be influenced in part due to significant stressors and social determinants of health including low income and relatively limited access to community resources, services, and education. These indicators are also signs of discrimination and disproportionality. These statistics point to widespread structural failures on the part of states to protect its citizens and other residents (McDowell, Libal, & Brown, 2012). Nonprofits and US officials who work with survivors of IPV and human trafficking understand that often survivors experience both types of violence, and that being subjected to IPV and/or threats of IPV has made some individuals at risk for being trafficked domestically or internationally (Freedom Network, 2012; Kelley, 2013).
Special Populations of Concern
IPV is a widespread problem that affects individuals from diverse backgrounds. Attention will be given below to the phenomenon of IPV in several special populations of concern (i.e., children and families; heterosexual male and LGBTQ survivors; and undocumented survivors). This is not meant to be a comprehensive examination of IPV, given space constraints, but rather to be illustrative of some examples of the scope of the problem.
Impact on Children and Other Family Members
Rights-based clinical social workers need to proactively be alert for the impact of IPV not only on the immediate target but also on others in the household and family, including children who may witness the violence or in situations where there is co-occurring IPV and child abuse (Appel & Holde, 1998; Bragg, 2003). Children also have a right to have their voices heard, and have their best interests protected (see the Convention on the Rights of the Child (UN General Assembly, 1989)). Children and other family members are at risk of being psychologically affected by witnessing IPV in their homes. Their rights to safety and security of person and to the highest standard attainable of mental health are often violated in the process. For those who first experience IPV at an early age, the impact can continue across their lifespan. Guidelines on best practices for screening, assessing, and protecting children in situations of IPV have been developed by the Children’s Bureau at the Office on Child Abuse and Neglect (Bragg, 2003).
Heterosexual Male Victims and IPV Within LGBTQ Relationships
The perpetrators of IPV are typically portrayed as heterosexual men and guidelines for providers often focus on women-centered care (WHO, 2013b). While existing evidence suggests that the majority of those who inflict violence on their intimate partners are heterosexual males, insufficient attention has been paid to the very real phenomenon that some women and LGBTQ individuals also perpetrate violence against those close to them (see NCAVP, 2013). It may be particularly difficult for heterosexual male or LGBTQ survivors to come forward to report IPV or seek assistance, feeling marginalized, stereotyped, and in some cases revictimized (NCAVP, 2013; Public Health Agency of Canada, 2009). Rights-based practitioners should be vigilant that they do not make assumptions or stereotype the heterosexual male and LGBTQ people they work with in this (or any other) regard (or any other persons for that matter).
Undeniably, advocates for women’s rights in the United States won an important battle in passing the Violence Against Women Act (VAWA)4 (and its subsequent reauthorizations) as part of a larger campaign to promote and protect the rights and well-being of women, a historically oppressed population. Social workers should remember that, despite the name of the law protecting victims of IPV, (heterosexual) women are not the only victims of such crimes. A variety of genders/sexes are targeted by IPV and, although women still disproportionately suffer, VAWA also provides protection to men subjected to IPV (National Task Force to End Sexual and Domestic Violence Against Women, 2006). Despite its advances, VAWA was not fully in keeping with all human rights principles. For example, it was not implemented equitably, such that male IPV survivors reported a harder time accessing and qualifying for services (Stop Abusive and Violent Environments, 2010).
A major improvement from a rights perspective came with the 2013 reauthorization of VAWA that closed many of the justice and service gaps. An Inclusion Mandate was added banning discrimination of any person in the United States “on the basis of actual or perceived race, color, religion, national origin, sex, gender identity (as defined in paragraph 249(c)(4) of title 18, United States Code), sexual orientation, or disability” (VAWA, 2013, p. 8). Various provisions in the law were designed to stop discriminatory practices and make all programs and services funded in whole or in part by VAWA or the Office on Violence Against Women inclusive (e.g., Sect. 3, 13 A regarding civil rights and non-discrimination5 ). The 2013 VAWA legislation also used gender-neutral terms in most of its provisions (e.g., “victims” instead of “women”).
IPV in the context of intimate LGBTQ partnerships is often unrecognized and subject to considerable false assumptions, underreporting, denial by LGBTQ and non-LGBTQ individuals, and lack of appropriate shelters and other services (NCAVP, 2013). Researchers have uncovered a number of reasons that may lead LGBTQ survivors not to report IPV, including: homophobia; biphobia; transphobia; anti-HIV bias (both societal and internalized); concern that their safety will be further compromised if they report; fears that LGBTQ and HIV-affected communities may censure them; and insufficient knowledge by providers and responders about IPV in LGBTQ and HIV-affected communities (Davidson & Duke, 2009; Stotzer, 2009). Sizeable numbers of LGBTQ survivors reported misconduct by police officers in 2012 including: profiling, record rates of deportation, and being arrested when they reported IPV (NCAVP, 2013). Police are charged with protecting and serving the public, not with abusing them. The survivors had gone to the police for help after having their rights violated by their intimate partner.
The misconduct found by the National Coalition of Anti-Violence Programs (NCAVP, 2013) includes human rights violations against, among other things, the right to equal protection under the law. The NCVAP (2013) recommends that LGBTQ-specific service providers are needed in every state to address these barriers to care. A rights-based clinical social worker would go a step further, and frame it as a right, stressing that social workers and other practitioners and first responders, including law enforcement, must develop the knowledge base and attitudes to serve LGBTQ survivors without prejudice or discrimination. Such an approach is in conformance with social work professional ethics (NASW, 1999), laws against hate crimes, and human rights.
The Case of Undocumented Survivors of IPV
Undocumented individuals who are in the United States and have suffered IPV at the hands of their US-citizen- or permanent-resident spouses may be eligible for immigration relief through the VAWA (Violence Against Women Reauthorization Act of 2013, 2013). This would allow them to remain legally in the United States. In addition, some US immigration judges have granted asylum in cases where state actors were found to be accountable for failing to protect individuals from persecution in the form of IPV; however, the rulings are not consistent across judges, resulting in arbitrary and contradictory decisions and the lack of protection for many (Bookey, 2013; Musalo, 2010).
Clinical social workers potentially have much to contribute to VAWA cases and asylum cases that are based on IPV in much the same way as discussed in relation to torture cases in Chapter 2 of this book. Applying for relief under an act named to protect women may reinforce shame and stigma in a man abused by his female spouse who may already feel ashamed that a woman abused him, even more so if the meaning of such an experience detracts from his sense of masculinity valued in his culture (Migliaccio, 2001; Public Health Agency of Canada, 2009). Men and other individuals who are less commonly recognized as victims of IPV (e.g., LGBTQ persons or intimate partners of law enforcement or clergy or others in respected or prominent positions in society) may be particularly prone to feeling shame and guilt (Bragg, 2003). Social workers need to ensure that these marginalized survivors have equal rights and that their dignity and worth as human beings are respected.
Historical Challenges to Framing IPV as a Human Rights Issue
There have been a number of historical challenges to framing IPV as a human rights issue. One of these key challenges relates to holding states accountable for their actions and inactions that contribute to the existence of IPV (Bunch, 1990; UN Special Rapporteur on Violence Against Women, 2013). Many countries continue to maintain that IPV is a private matter, one that is outside the public realm such that the state cannot and should not intervene (Libal & Parekh, 2009). The perpetrator of the act(s) of IPV is typically not a state actor.
Violence inflicted within the context of intimate partnerships has also traditionally not been considered a human rights violation in some parts of the world due to cultural and social values and norms. Violence against women and wives is often viewed as normal and to be expected—often the woman is blamed (Krug, Mercy, Dahlberg, & Zwi, 2002; UN Special Rapporteur on Violence Against Women, 2002). Most of the work on IPV has focused on violence against heterosexual women perpetrated by heterosexual men, although individuals of all gender identities and sexual orientations are at risk for IPV as well as those of all races, cultures, ages, faith communities, and socioeconomic status. Transgender survivors or those who are abused within homosexual relationships often occupy marginalized and oppressed positions in society already, putting them at further risk for IPV (NCAVP, 2013). The perpetration of IPV by women on their male partners is a relatively taboo subject in many societies, and the men often experience significant shame as a result (Migliaccio, 2001, 2002; Public Health Agency of Canada, 2009). All of these factors have hampered efforts to safeguard the rights of those affected by IPV.
Human Rights Mechanisms and Tools
Framing IPV as a Human Rights Issue
In recent years, significant advances have been made in the framing of IPV as a human rights issue. IPV has been recognized as a clear violation of the human rights of women that has a significant but preventable public health impact6 (WHO, 2013a). The Secretary-General of the UN, Ban Ki-Moon, has come out strongly against violence against women in all its forms. “There is one universal truth, applicable to all countries, cultures and communities: violence against women is never acceptable, never excusable, never tolerable” (Ki-Moon, 2008, para. 20).
IPV violates the victim’s right to security of person, his or her right to bodily integrity, and sometimes, his or her right to life—all of which are violations of the person’s human rights (Libal & Parekh, 2009). Over the last several decades many national, regional, and international bodies have framed IPV as a human rights issue in the United States and internationally (Amnesty International, 2005; Beasley & Thomas, 1994; Hawkins & Humes, 2002; Morgaine, 2009; Roth, 1994). The International Women’s Rights Action Watch Asia Pacific, Center for Domestic Violence Prevention in Uganda, Coalition on Violence against Women—Kenya, and Women for Women’s Human Rights/New Ways in Turkey are examples of organizations using a human rights framework in their work against IPV (Morgaine, 2009). The UN has been quite clear on this point, declaring IPV a pervasive human rights problem (UN Special Rapporteur on Violence Against Women, 2011).
A number of international treaties are relevant to framing IPV as a human rights issue and advancing the rights of those targeted by IPV. These include the International Covenant on Civil and Political Rights (ICCPR; UN General Assembly, 1966) and the CEDAW (UN General Assembly, 1979). In the context of women survivors of IPV, these documents provide for the right for women to receive equal protection under the law, just compensation, and due diligence to investigate and hold accountable perpetrators and prevent violations (Morgaine, 2009). In addition, the UN’s Special Rapporteur on Violence Against Women and various human rights organizations, governmental, and intergovernmental bodies have created an important body of knowledge on this issue, finding some states to be complicit in failing to respond to prevent or protect individuals from IPV. The UN’s Special Rapporteur on Violence Against Women (2011) issued a report on its mission to the United States in 2011. The Special Rapporteur noted some advancement but also observed insufficient legislation and implementation of existing laws to substantively prevent violence against women or protect women from such violence. The report includes recommendations regarding: remedies for victims; addressing discrimination against women particularly vulnerable to being targeted for violence, such as minority, immigrant, and poor women in the United States; improving detention conditions for women; and further investigating violence and prosecuting those responsible for inflicting violence against military women.
Use of Human Rights Tools in Campaigns to Combat and Prevent IPV
Human rights tools have been creatively employed to advance state action against IPV (American Civil Liberties Union, 2013; Ford Foundation, 2004; New Tactics in Human Rights, n.d.). One such tool is DEVAW. While it does not hold the same force or legal authority as a convention or a treaty, DEVAW does provide strong guidance, sets a strong standard that is used in the CEDAW Committee’s work with individual complaints, and provides a foundation for the Special Rapporteur’s work. DEVAW holds states accountable for violence against women if the state condones such violence in the home or community, such as when the state formally prohibits violence against women but tolerates it by not acting or not effectively acting to end it. In addition, states are held accountable if state actors perpetrate the violence. DEVAW takes a strong stand against viewing IPV as solely a family matter that should not be scrutinized and whose perpetrators should not be held accountable publically.
Article 3 of DEVAW outlines the various human rights that women are entitled to equally enjoy and have protected, including:
The right to life;
The right to equality;
The right to liberty and security of person;
The right to equal protection under the law;
The right to be free from all forms of discrimination;
The right to the highest standard attainable of physical and mental health;
The right to just and favorable conditions of work; and
The right not to be subjected to torture, or other cruel, inhuman or degrading treatment or punishment (UN General Assembly, 1993).
The existence of human rights tools related to IPV has lent support to various campaigns around the world. On the International Day for the Elimination of Violence against Women in November 2011, then UN Women executive director Michelle Bachelet outlined policies and called for governments to take responsibility for ending violence against women. Bachelet stated:
Although equality between women and men is guaranteed in the Constitutions of 139 countries and territories, all too often women are denied justice and protection from violence. This failure does not stem from a lack of knowledge but rather a lack of investment and political will to meet women’s needs and protect their fundamental rights. It is time for governments to take responsibility. (Anderson, 2011, para. 7)
In response to the UN Women’s COMMIT initiative, the European Union and 61 countries had pledged to take concrete actions to end violence against girls and women by the end of 2013 (UN Women, n.d.). These actions included: ratifying international conventions, passing relevant laws, strengthening legal and policy prevention efforts, engaging in public education campaigns, and providing enhanced services such as free hotlines, safe houses, and legal aid at no cost to survivors. In addition, some countries made efforts to expand the number of women in frontline peacekeeping, law enforcement, and other services (UN Special Rapporteur on Violence Against Women, 2013).
Clinical Work with IPV: Key Roles for Social Workers, Application of Core Principles of a Rights-Based Approach, and Recommendations and Challenges
Key Roles for Rights-Based Social Workers
Clinical social workers frequently come into contact with individuals affected by IPV. Indeed, they may be the first persons to become aware of the violence and can play a critical role in engaging survivors and ensuring that they have access to intervention and that their rights are promoted in the process. The WHO (2013c) recommendations for clinicians who provide first-line support are in keeping with the human rights-based approach to clinical social work discussed in Chapter 1 of this book. These relate to addressing confidentiality and its limits in situations of mandatory reporting, safeguarding the privacy of survivors, working with the survivor to increase safety, and approaching IPV survivors with a supportive and nonjudgmental attitude, validating their experiences and reinforcing that IPV is never acceptable. In a meta-analysis of qualitative studies of women IPV survivors’ experiences with healthcare providers, women who did not feel pressured to pursue charges, leave the perpetrator, reveal information, or make therapeutic progress at a faster pace than they felt ready for reported more positive experiences (Feder, Hutson, Ramsay, & Taket, 2006).
Members of Multisystem Coordinated Teams
Interdisciplinary comprehensive and coordinated care for survivors of IPV is strongly recommended by the WHO (2013c) and is in keeping with a rights-based approach. This could be provided either in healthcare settings or comprehensive service centers that address the casework, psychological, health, and legal issues relevant to survivors. Clinical social workers can play important roles on these teams. Responses should be coordinated across system, community, and individual levels, have a lifespan approach, and involve prevention as well as assessment and treatment for those subjected to IPV and the perpetrators. A social work response that spans micro, mezzo, and macro practice is needed to address IPV (similar to what is needed with torture and human trafficking as seen in Chapters 2 and 3 in this book).
Advocacy and Support Roles for Social Workers
Clinicians working with this population should not feel constrained to only work individually or in groups with survivors of IPV. The WHO guidelines (2013c) note evidence for support and empowerment services as well as advocacy. When the IPV is occurring in a context where violence within intimate partnerships is normalized and condoned and perpetrators act in an atmosphere of impunity such as in Turkey, it is not enough to focus entirely at the micro level (Amnesty International, 2004; Freedom House, 2014). By ratifying the Optional Protocol to the Women’s Convention, Turkey has authorized the CEDAW Committee to consider individual and group complaints for individual and structural redress for violations of their rights under the Convention. Rights-based clinical social workers can become educated about the complaint mechanisms of UN Treaty Bodies available to those who are subjected to IPV and other human rights violations. They can connect those targeted by IPV with specialized advocates or attorneys to assist them in filing complaints (Prasad, 2014) and, as appropriate, provide psychosocial evidence of their abuse. Complaint mechanisms have been used successfully to hold states accountable for protecting survivors of severe IPV.
Training for Police and Others in the Criminal Justice System
Improved training for those within the criminal justice system is recommended (Black et al., 2011). This is vital to the effort to combat impunity for perpetrators. Enhanced and strengthened data, and monitoring and evaluation systems are also required. Clinical social workers can play several important roles in response to the problem of police misconduct and a “culture” of lack of responsiveness or understanding toward survivors who report IPV. Social workers can collaborate with survivors of IPV to conduct training for law enforcement and serve as evaluators and consultants to guide effective changes in the system.
Social workers are well equipped to participate in comprehensive training (or retraining) for law enforcement and other personnel to prevent discrimination and other rights violations against survivors. Training should emphasize that everyone has the right to have equal access to law enforcement intervention, protective orders, shelters, and other services. Social workers can advocate for the inclusion of a diverse array of IPV survivors in all prevention efforts such as homicide and lethality assessments and community response models such as the one utilized by the Family Justice Center in Boston (NCAVP, 2013). In addition, documentation of the psychosocial evidence of police abuse by clinical social workers working closely with survivors may be valuable for use in disciplinary hearings and civil and criminal lawsuits.
Core Principles of a Rights-Based Approach Applied
Rights-based clinical social workers must be trauma-informed and approach their work with cultural humility as discussed in depth in Chapter 1. These domains are foundational to working with survivors of IPV given the multifaceted contextual factors that may contribute to or complicate the healing of these survivors. These factors include, in part: prior traumas and violations of human rights, sociocultural factors, socioeconomic status, the presence or lack of a positive support system, the role of substances, and the history of marginalization and oppression.
Clinical social workers and others working with those who have (or may have) experienced IPV must have expertise about the experiences of IPV as well as expertise regarding and experience in providing trauma-informed and trauma-specific treatment of common mental health conditions associated with IPV, such as depression and posttraumatic stress disorder (PTSD). This is vital given the risk of unintended harm to the survivor from intervention (WHO, 2013a). As is true in working with any person, care must be taken to avoid medicalizing or adopting too narrow of a lens regarding what the consequences and appropriate steps may be for any survivor. For example, it should not be assumed that the survivor necessarily wants to leave the relationship with the person who perpetrated IPV or that this is a viable option in the person’s cultural context (Blagg, 2002). While there is a bias in some societies, including the United States, to remove the perpetrator of IPV from the home or to separate the perpetrator or victim, this is not the preferred course of action for some survivors and in other societies. Some persons who experience IPV prefer, for cultural and/or other reasons, to stay with their partner and seek ways to reduce harm and keep the family or relationship together. This is the case, for example, for some of those who participate in restorative justice programs that will be discussed later in this chapter.
A rights-based practitioner would approach their work with cultural humility and take the time to fully understand the experience from the person’s point of view. He or she would ensure that the person has full control over selecting if they want treatment, and if so, what treatment or interventions they want and from whom. As discussed in depth in Chapter 1 of this book, this must be done with true informed consent. Rights-based clinical social workers must practice from a standpoint of cultural humility, recognizing that culture affects the way that survivors define and experience IPV and its effects, the types of stressors they experience, the decisions they make, their styles of coping and sources of support, how they respond to offers of assistance, how they present in treatment, and what services they may or may not deem to be welcomed or healing (Akinsulure-Smith, Chu, Keatley, & Rasmussen, 2013; Office for Victims of Crime, 2004; Warshaw & Brashler, 2009). Not only is this good practice, it is a must in order to further the human rights of survivors and ensure that they do not have services imposed on them that they do not want or were normed on other very different populations. The approach must be individually tailored, keeping in mind that what is appropriate may be a communal approach (perhaps including working with the couple, extended family, and/or others in the community) rather than one that works solely with the individual survivor. Promising outreach, advocacy, and intervention efforts being implemented throughout Indian country developed by and for various Indian tribes affected by IPV show examples of culturally responsive IPV services (Office for Victims of Crime, 2004). Treatment protocols that are developed in collaboration with advocates and survivors of IPV are supportive of a rights-based approach to practice, and give priority to ensuring that their voices are heard and right to self-determination is safeguarded.