Problems and Questions that often arise
Here are answers to some questions that might come up for health-care providers working with victims subjected to domestic violence.
“Why not offer advice?”
It is important for victims to be listened to and to have an opportunity to tell their story to an empathetic person. Most victims do not want to be told what to do. In fact, listening well and responding with empathy is far more helpful than you may realize. It may be the most important thing you can do. Victims need to find their own path and come to their own decisions. Talking about it can help them do this.
However, information (e.g., via pamphlets) on available resources (e.g., financial support, contact data of shelter) should be offered.
“Why do they not just leave them?”
There are many reasons for victims to stay in violent relationships. It is important not to judge them and not to urge them to leave. They have to make that decision themselves, in their own time. Reasons for not leaving include:
- they depend on their partner’s income. In some societies it is difficult for a woman to earn her own living.
- they believe that children should be raised with a father/mother and think that their own welfare is less important than this ideal.
- they think that violence is normal in relationships and that all partners will be violent and controlling and that they deserve it.
- they fear an extreme and violent reaction to their leaving.
- their self-esteem is low, and they believe that they cannot manage on their own.
- they feel they have no place to go or no one to turn to for support.
- they still love them and think they will change.
- they think that they need them.
- they do not want to be alone.
- they are afraid of being abandoned by the community for having left their partner.
“How did they get themselves into this situation?”
It is important to avoid blaming the victim for what happened. Blaming the victim will get in the way of your giving them good care. Violence is never appropriate in any situation. There is no excuse or justification for violence or abuse. Just because a victim did something that made their partner or another family member angry does not mean that they deserved to be hurt.
“What can I do when I have few resources and little time?”
It does not necessarily take long, and it does not require additional resources: sometimes, one sentence is enough to let the victim know that they are not alone, that violence is never an option and that they can get help if they want to. Also, you can learn about resources in the health-care system and in the community that can help them.
“That wasn’t the way we were taught.”
Health-care providers are generally taught that their main role is to diagnose the problem and treat it. However, in this situation limiting the focus to medical concerns is not helpful. Instead, you need to add a human focus by listening, identifying victim’s needs and concerns, strengthening their social support, and enhancing their safety. Also, you can help them see and consider their options and help them feel they have the strength to make and carry out important decisions.
“What if they decide not to report to the police?”
Respect their decision. Let them know that they can change their mind. Let them know that there is someone they can talk to about their options and help them make the report if they choose to.
“How can I promise confidentiality if the law says I have to report to the police?”
If your law requires you to report violence to the police, you must tell them this. You can say, for example, “What you tell me is confidential, that means I won’t tell anyone else about what you share with me. The only exception to this is…”
As a health-care provider, learn about the specifics of the law and conditions in which you are required to report (for example, the law may require reporting rape or child abuse). Assure them that, outside of this required reporting, you will not tell anyone else without their permission.
“What if they start to cry?”
Give them time to do so. You can say, “I know this is difficult to talk about. You can take your time.”
“What if I suspect violence but they do not acknowledge it?”
Do not try to force them to disclose. (Your suspicions could be wrong.) You can still provide care and offer further help.
“What if they want me to talk to their partner?”
It is not a good idea for you to take on this responsibility. However, if the victim feels it is safe to do so and it will not make the violence worse, it may be helpful for someone they respect to talk to them – perhaps a family member, a friend, or a religious leader. Warn them that if this is not done carefully, it could lead to more violence.
“What if the partner is one of my clients, too?”
It is very hard to keep seeing both partners when there is violence and abuse in the relationship. Best practice is to try to get a colleague to see one of them, while ensuring that confidentiality of the victim’s disclosure is protected. Do not offer couple counselling.
“What if I think their partner is likely to kill them?”
Share your concerns with the victim honestly, explain why you think they might be at grave risk and explain that you want to discuss possible options for keeping them safe. In this situation identifying and offering secure alternatives where they can go is particularly important.
Be prepared for such a situation and have a leaflet with respective telephone numbers (e.g., from a shelter) at hand. Make sure this list is up to date.
Depending on the country’s legal situation you may be obliged to report the risk to the police.
Ask if there is a trusted person you can include in the discussion and whom you can alert to the risk.
“What if I cannot handle what I hear?”
Your needs are as important as those of the victim you are caring for. You may have strong reactions or emotions when listening to or talking about violence with victims. This is especially true if you have experienced abuse or violence yourself – or are experiencing it now.
Be aware of your emotions and take the opportunity to understand yourself better.
Make sure to get the help and support you need for yourself.
Inquire about needs and concerns
Be patient and calm.
Let them know you are listening; for example, nod your head or say, “hmm….”.
Acknowledge how they are feeling.
Let them tell their story at their own pace.
Give them the opportunity to say what they want. Ask, “How can we help you?”.
Encourage them to keep talking if they wish. Ask, “Would you like to tell me more?”.
Allow for silence. Give them time to think.
Stay focused on their experience and on offering them support.
Acknowledge what they want and respect their wishes.
Don’t pressure them to tell their story.
Don’t look at your watch or speak too rapidly. Don’t answer the telephone, look at a computer or write.
Don’t judge what they have or have not done, or how they are feeling. Don’t say, “You shouldn’t feel that way” or, “You should feel lucky you survived” or, “Poor you”.
Don’t rush them.
Don’t assume that you know what is best for them.
Don’t interrupt. Wait until they have finished before asking questions.
Don’t try to finish their thoughts for them.
Don’t tell them someone else’s story or talk about your own troubles.
Don’t think and act as if you must solve their problems for them.
Respect their wishes and respond to their needs. As you listen to the victim’s story, pay particular attention to what they say about their needs and concerns – and what they do not say but imply with words or body language. They may let you know about physical needs, emotional needs, or economic needs, their safety concerns, or the social support they need. You can use the techniques below to help them express what they need and to be sure that you understand.
Phrase your questions as invitations to speak.
“What would you like to talk about?”
Ask open-ended questions to encourage them to talk instead of saying yes or no.
“How do you feel about that?”
Repeat or restate what the person says to check your understanding.
“You mentioned that you feel very frustrated.”
Reflect their feelings.
“It sounds as if you are feeling angry about that…”
Help them to identify and express their needs and concerns.
“Is there anything that you need or are concerned about?”
Sum up what they have expressed.
“You seem to be saying that….”
Don’t ask leading questions, such as:
“I would imagine that made you feel upset, didn’t it?”
Don’t ask “why” questions, such as:
“Why did you do that…?”
They may sound accusing.
Let them know that their feelings are normal, that it is safe to express them and that they have a right to live without violence and fear.
Validating another’s experience means letting the person know that you are listening attentively, that you understand what they are saying, and that you believe what they say without judgment or conditions.
Important things that you can say:
- “It’s not your fault. You are not to blame.”
- “It’s okay to talk.”
- “Help is available.” [Say this only if it is true.]
- “There is no justification or excuse for what has happened.”
- “No one deserves to be hit by their partner or other family member in a relationship.”
- “You are not alone. Unfortunately, many other people have faced this problem too.”
- “Your life, your health, you are of value.”
- “Everybody deserves to feel safe at home.”
- “I am worried that this may be affecting your health.”
Thought-provoking tasks for healthcare professionals
Preparation to identify and respond to domestic violence is paramount.
(1) How well prepared do you feel in this regard and what education and/or training resources are available to you or are you aware of in your area of practice?
(2) Do you have a room in your clinical practice where you can speak to patients privately? (Behind curtains or screens is clearly not private or confidential).
(3) In your area of practice, how might patients alert you that they wish to speak with you in private?
(4) Do you currently have a clear referral pathway for patients to other services and support?
(5) Do you know what services and supports are available for those who disclose domestic violence in your area of practice —and are contact details available to you?
(6) Do you know how to make a referral to adult and children safeguarding services?
Domestic violence in the media
Domestic violence is present in the news, in newspaper articles and on the Internet. Books, films, and series (e.g., “Sleeping with the Enemy”, “Fifty Shades of Grey”, “365 Days”), documentaries and reports as well as song lyrics take up the topic. In most cases, however, they are not aimed at informing about domestic violence, but at entertaining and polarising consumers.
Domestic violence is often trivialised or romanticised. Stalking, physical violence and deprivation of freedom are presented as signs of true love and justifying jealousy. The perpetrators are almost exclusively men – the blame for the experienced violence lies with the female victim.
Romantic movies often follow the logic of “The beauty and the beast”, where ‘good’ women can rescue ‘bad’ guys through their love. Although there might be some evidence that men behave better in the presence of women, this is not true in abusive relationships. Instead, women are caught in the circle of violence. That means, an abusive incident happens, afterwards the perpetrator feels guilty, apologises, and promises to not let that happen again in the future. This is followed by the “honeymoon phase”: the perpetrator appears to be loving and caring. After some time, the perpetrator is getting more and more aggressive towards the victim until a new “big” incident of domestic abuse happens and the circle starts over again. These vicious circles trap women in abusive relationships – partly, because they falsely hope that the perpetrator will change for the better and violent incidents will not happen again.
The consequences are serious for the victims and the public perception of domestic violence.
“It is precisely because domestic violence is so counterintuitive that the media need to continue to tell these stories. However, we journalists need training so that we do not continue to make the usual mistakes. We cannot accept journalists examining a woman’s behaviour to explain why she was murdered or injured. We cannot accept that journalists make excuses for men who killed their families as if they had been pressured to do so.” (CIG (Comissão para a Cidadania e Igualdade de Género – Commission for Citizenship and Gender Equality) (2019): Guide to good media practice in preventing and combating VAW and DV)Jess Hill, journalist of The Guardian
How the media deals with crimes of domestic violence is decisive for how they are understood and interpreted by the public:
- the frequency with which incidents are reported,
- the emphasis placed on them, the information included or omitted,
- the words used to describe what happened.
All these factors make a difference in the social understanding of violence.
The role of the media in the field of domestic violence is decisive,
- not only because it makes crimes visible that are, today, still often wrongly regarded as belonging to the private and relationship sphere,
- but also, because it influences the possibilities of reaction and building a fairer, more secure, more attentive society.
Good journalistic practice should be that, after an article or film, readers are sensitised about domestic violence, and
– recognise signs of violence when confronted with them,
– have a better knowledge of what to do,
– and better understand the dynamics of the escalation of abuse and know how to prevent it.
Offering Information sheets
Written information on intimate partner violence and domestic violence should be on display in healthcare settings in the form of posters, and pamphlets, or leaflets in private areas such as washrooms (with appropriate warnings about not taking them home if an abusive partner could find them). A QR code leading to a website with further information should be included on the information materials. The posters, pamphlets, or leaflets should be directed to female and male victims of domestic violence and not use stereotypes. Naming specific contact persons on site and providing telephone numbers of counselling centres or websites offering (anonymous) counselling can support victims of domestic violence when seeking help.
Zero Tolerance works proactively with the media and has a variety of resources that can help journalists and editors to ensure their reporting on violence against women is both accurate and sensitive.
Find more advice for journalists here.
Find a bank of free to use, ethical, diverse, and impactful stock images, created in partnership with Scottish Women’s Aid, that illustrate domestic abuse and other forms of violence against women here.