Module 3: Communication in cases of domestic violence

1. Barriers to Disclosure
2. Communication Strategies
3. Screening Questions for Domestic Violence
4. Responding to a Disclosure
5. Questions that Often Arise in the Context of DV
6. Visual Communication

Sources

Introduction to the topic

Welcome to Module 3 on ā€œCommunication in cases of domestic violenceā€. In this module, we delve into the critical aspects of communication when addressing domestic violence. Understanding the complexities related to disclosure of DV, employing effective communication strategies, and crafting appropriate responses are paramount in providing comprehensive support to victims experiencing domestic violence.

Learning objectives

+ Understanding existing barriers that can prevent individuals from disclosing domestic violence.

+ Being able to implement communication strategies tailored to the specific challenges of domestic violence cases.

+ Being able to use screening questions to identify cases of domestic violence.

+ Being able to respond in an appropriate and empathetic way when faced with disclosures of domestic violence, ensuring that victims feel supported and understood.

+ Being able to understand and apply visual communication methods to enhance communication in cases of domestic violence.

+ Understanding what do to next when victims disclose violence.


1. Barriers to Disclosure

Individuals experiencing domestic violence may face various challenges that can make it difficult for them to openly discuss their situation.

Please click on the crosses below each term in the illustration to see further information on some common barriers:

Please remember: Victims of domestic violence come from all social, cultural, economic, and religious backgrounds with different age, gender and sexual orientation, including people with disabilities. It affects people from all socio-economic backgrounds and education levels. It is important to understand, that there is NO ā€œtypical victimā€.

Even though many example videos depict a female as the victim in heterogenous relationships, please do not be misled. Victims can be anyone, including men, children, individuals with disabilities, or non-binary persons. The same applies to perpetrators. For more information on perpetrators, check out Module 1. Also, domestic violence can occur between couples, same-sex couples, parent and child, siblings, uncles, aunts, cousins, grandparents or even roommates.


2. Communication Strategies

To foster a respect- and trustful communication about the experienced violence, ensure victims have a private space without accompanying individuals (partner, children, other family members or non-family caretakers) allowing them to speak freely and comfortably. In general, it is useful to use ā€œI-Messagesā€. It can be used specifically to solve ambivalences in a victim during the counselling or in case of less time for counselling.

Please click on the crosses below each term in the illustration to see further information.


3. Screening Questions for Domestic Violence

It is crucial to inquire about domestic violence through screening questions without exacerbating the risk of harm to victims and their children. The screening process should commence with a framing statement to introduce and normalise the questions.2

  • Every effort should be made to screen in the victimā€™s preferred language in case of language difficulties, and cultural barriers should be recognised during the screening process.
  • Pose behavioural questions that solicit descriptions of behaviour rather than solely focusing on the impact or meaning of behaviours.
  • Present questions in a calm, matter-of-fact manner. In cases where responses are unclear, briefly seek further clarification through additional questions.
  • Always express gratitude for the provided information.3

Remember: Explore different approaches to discover the one that suits you best, recognising that each victim may respond differently to various methods.


Start with asking general questions

Use statements like these to raise the subject of violence before you ask direct questions. Open questions should be asked to encourage the victim to talk instead of saying yes or no. Avoid questions that put the blame on the victim.


Framing the question

Create space for silence, allowing the individual time to gather their thoughts. Demonstrate patience and maintain a calm demeanour. Signal your attentive listening, whether through nodding or verbal cues like “hmmā€¦.”. Validate the emotions and encourage the victim to share the story at a pace that feels comfortable for them.

ā€œI donā€™t know if this is a problem for you, but many people are dealing with abusive relationships. Some are too afraid or uncomfortable to bring it up themselves, so Iā€™ve started asking about it routinely.ā€5

ā€œViolence affects many families. Violence in the home may result in physical and emotional problems for you and your child. We are offering services to anyone who may be concerned about violence in their home.ā€6


Ask direct questions

Here are some simple and direct questions that you can start with. They show you want to hear about their problems. Depending on their answers, continue to ask questions and listen to their story. If they answer ā€œyesā€ to any of these questions, offer support. Do not tell the victim it is not that bad or minimise the pain.

ā€œAre you ever afraid at home or in your relationship?ā€

ā€œHas your partner or someone else at home ever threatened to hurt or physically harm you in some way? If so, when has it happened?ā€

ā€œDoes your partner or someone else at home try to control you, for example not letting you have money or go out of the house?ā€

More examples

ā€œHave you been pressured or made to do anything sexually that you did not want to?ā€7


ā€œHave you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?ā€

ā€œDo you feel unsafe in your current relationship?ā€8


ā€œIs there a partner from a previous relationship who is making you feel unsafe now?ā€
9


ā€œHave you ever felt controlled or isolated by someone close to you?ā€
10


ā€œDo you have a safe place to go in an emergency?ā€
11

ā€œDoes your partner or someone else at home ever try to control you by threatening to hurt you or your family?ā€12

ā€œHave you ever been slapped, pushed or shoved by someone close to you?ā€

ā€œWhy are you still living with your partner/family member who treats you like that?ā€

ā€œCould you have avoided the situation?ā€

ā€œAre you a victim of domestic violence?ā€13

ā€œYou are lucky that nothing worse happened.ā€

ā€œWhy did you do thatā€¦?ā€

If an interpreter is needed:

  • Never use a victim’s relative or friend as an interpreter.
  • Preferably, engage a professional interpreter with DV training or an advocate affiliated with a local specialised DV agency.
  • Choose an interpreter of the same gender as the patient, and contemplate having them sign a confidentiality agreement to uphold privacy and trust.

Guidelines how to work with interpreters can be found under these links:


4. Responding to a Disclosure

Opting to reveal experiences of domestic violence is an individual choice, and DV victims may opt not to communicate about it for various reasons, such as concerns for safety, fear of potential consequences, or a lack of trust, among others. Professionals can act as advocates for domestic violence victims, drawing on their resilience and strengths.14

Description: The video illustrates how one should respond to a disclosure in cases of domestic violence.

When someone opens up, listen actively without judgment or offering solutions, giving them the space to express their needs. While you can seek clarification through questions, focus on allowing them to share their emotions. Use the following techniques to help them articulate their needs, ensuring a better understanding.


Empower the individual

The victim should be helped to identify and express their needs and concerns. Allow silences. If the individual cries, give enough time to recover.

No ā€œwhyā€ questions should be asked.

ā€œWhen you said earlier that your partner/family member lashes out at you [or whatever behaviour theyā€™ve described], Iā€™m wondering if you can tell me what that means?ā€15

ā€œIs there anything you need or are worried about?ā€

ā€œWhy did you do that?ā€

ā€œWhy did you upset your partner/family member?ā€

Donā€™t try to finish the thoughts for the individual.16


Building trust and showing empathy

Ensure clarity in communication by repeating what the victim has shared to confirm your understanding. Reflect the emotions conveyed by the victim and summarise their expressed concerns. Avoid using suggestive questions during the conversation.

ā€œYou mentioned that you feel very frustrated.ā€

ā€œIt sounds as if you are angry about this…ā€

ā€œYou seem to be saying that…ā€

ā€œI imagine that upsets you, doesn’t it?ā€

Donā€™t look at your watch or speak too rapidly. Donā€™t answer the telephone, look at a computer or write.17


Validate feelings

Assure the other person that their emotions are typical, create an environment where it’s secure to share those feelings, and emphasise their entitlement to a life free from violence and fear. Validation involves expressing attentive listening, comprehension, and belief in what they communicate without passing judgment or attaching conditions.

ā€œItā€™s not your fault. You are not to blame.ā€

ā€œItā€™s okay to talk.ā€

ā€œHelp is available.ā€ [Say this only if it is true.]

More examples

ā€œThere is no justification or excuse for what has happened.ā€

ā€œNo one deserves to be hit by their partner or other family member in a relationship.ā€

ā€œYou are not alone. Unfortunately, many other people have faced this problem too.ā€

ā€œYour life, your health, you are of value.ā€

ā€œEverybody deserves to feel safe at home.ā€

ā€œI am worried that this may be affecting your health.ā€

ā€œThis feeling will go away, do not worry.ā€


Offer support

Assure you are not judgemental. Donā€™t advise things. Signalise that there is no excuse for violent behaviour. Take the victim seriously. Be empathetic. Appreciate the victimā€™s experiences. Assist the individual in recognising and articulating their needs and concerns.

ā€œI know this is difficult to discuss, but you can talk to me.ā€

ā€œYou are not alone. Iā€™m here for you.ā€

ā€œYou are not responsible for whatā€™s going on.ā€

More examples

ā€œViolence is never ok and you do not deserve it.ā€

ā€œThank you for trusting me and sharing your feelings.ā€

ā€œIs there anything that you need or are concerned about?ā€

ā€œYou should definitely get divorced.ā€

ā€œI believe this conforms to typical ‘men’/’women’ behaviour, and there’s no need to overreact.ā€

Donā€™t tell the person someone elseā€™s story or talk about your own troubles.18


Avoid confrontation

If the victim is not ready to talk about the situation, do not force it. Recognise the right time and let the victim know about it. Lay off the pressure.

ā€œIā€™m here to help, and Iā€™m available, even if I understand that you donā€™t want to talk about it now.ā€

ā€œRemember that youā€™re not alone. Iā€™ll be here for you when youā€™re ready.ā€


Let the individual make their own decisions

Avoid judging the victimā€™s ability to make decisions, thus preventing that she/he loses confidence in you. Encouragement and asking is the key.

ā€œWhat can I do to support you?ā€

ā€œHow can I help to protect your safety?ā€


Provide ways to get help

Let the individual know about specialist family violence services that can offer professional support. Avoid convicting or condemning statements.

ā€œHere is the number to your local victim support office. They can help with shelter and counselling.ā€

ā€œDo you want me to help you develop a safety plan?ā€

ā€œYou should definitely call this number and leave the perpetrator immediately!ā€

ā€œWhy didn’t you leave your this person long ago?ā€

ā€œIf you would have come earlier, I could have helped you better.ā€


Next steps:

Talk with the victim about safety measures and risk assessment. Find further information in Module 5: Risk assessment and safety planning.

If there is a legal case in the future, you may be questioned about the victim, so you should document everything well. Find further information in Module 4: Police investigation and legal proceedings.

Find more information about the criminal processes involved after reporting to the police here.



5. Questions that often arise in the context of DV

Here are answers to some questions that might come up when working with victims subjected to domestic violence.19

ā€œWhat if they start to cry?ā€

Give them time to do so. You can say, ā€œI know this is difficult to talk about. You can take your time.ā€

ā€œWhat can I do when I have few resources and little time?ā€

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.

ā€œWhy not offer advice?ā€

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 realise. 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.

ā€œWhy do they not just leave them?ā€

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:

  • Financial/social etc. dependence can be experienced. Some individuals rely on their caregivers.
  • Some individuals may think that violence is normal in relationships and that all partners/family members will be violent and controlling, believing they deserve it.
  • Fear of an extreme and violent reaction to leaving.
  • Feeling there’s no place to go or no one to turn to for support.

Find more information on the dynamics of domestic violence in Module 1.

ā€œHow did they get themselves into this situation?ā€

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. No one ever deserves to be hurt.

ā€œThat wasnā€™t the way we were taught.ā€

You need to add a human focus by listening, identifying victimā€™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.

ā€œWhat if they decide not to report to the police?ā€

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.

ā€œWhat if I suspect violence but they do not acknowledge it?ā€

Do not try to force them to disclose. (Your suspicions could be wrong.) You can still provide care and offer further help.

ā€œWhat if they want me to talk to their partner/family member/caregiver?ā€

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 ā€“ 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.

ā€œWhat if the partner/family member/caregiver is one of my client, too?ā€

It is very hard to keep seeing both individuals when there is violence in the relationship. Best practice is to try to get a colleague to see one of them, while ensuring that confidentiality of the victimā€™s disclosure is protected.

ā€œWhat if I think their partner/family member/caregiver is likely to kill them?ā€

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.

Depending on the countryā€™s legal situation you may be obliged to report the risk to the police.

ā€œWhat if I cannot handle what I hear?ā€

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 ā€“ 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.

Find more information on Self-care in Module 9.


6. Visual Communication

Often, individuals experiencing domestic violence find it challenging to access information or support services. Visual communication plays a crucial role in raising awareness about domestic violence. Utilising tools like posters (e.g., with QR codes), leaflets, or pamphlets displays strategically placed in waiting rooms, bathrooms, and other visible areas is essential. Place information with support services in washrooms (with appropriate warnings about not taking them home if the perpetrator could find them).

These visual aids serve to communicate that the facility is a safe space for discussing domestic violence and make support services readily apparent. By creating a visual environment that openly addresses domestic violence, individuals are more likely to feel encouraged to speak up and seek help. This proactive approach contributes to breaking the silence around domestic violence and fostering a supportive atmosphere.

Remember:

  • Use inclusive visuals that accurately represent the diverse experiences of individuals affected by violence (all genders without stereotypes).
  • If possible, use information available in multiple languages.
  • Choose impactful images that promote a positive message. Avoid harmful visuals such as depictions of physical violence (because DV is not only physical), sexualised portrayals of victim-survivors, and images exclusive to specific demographics.

Here are some examples on different tools:

International signal for help:

This is an international single-handed gesture used to draw attention to domestic violence. It can be employed when the person in need of help cannot speak loudly, for instance, because the perpetrator is nearby (in the car, at home etc.).

ā€œThe signal is performed by holding one hand up with the thumb tucked into the palm, then folding the four other fingers down, symbolically trapping the thumb by the rest of the finger.ā€20


Distribute informational brochures about domestic violence awareness or local counselling services. Ideally, choose those that are in your vicinity and offer anonymous online counselling.

Some examples:


Sources

  1. RACGP, Factsheet: Improving Responses,Ā https://www.racgp.org.au/familyviolence/resources.htm, accessed 10.01.2024 ā†©ļøŽ
  2. www.endgv.org, Working together for gender equity and social justice in King County,
    Screening for Domestic Violence,Ā https://endgv.org/wp-content/uploads/2016/05/Screening-for-Domestic-Violence-00000002.pdf ā†©ļøŽ
  3. www.endgv.org, Working together for gender equity and social justice in King County,
    Screening for Domestic Violence,Ā https://endgv.org/wp-content/uploads/2016/05/Screening-for-Domestic-Violence-00000002.pdf ā†©ļøŽ
  4. Rhodes KV, Frankel RM, Levinthal N, Prenoveau E, Bailey J, Levinson W. ā€œYouā€™re not a victim of domestic violence, are you?ā€ Provider patient communication about domestic violence. Ann Intern Med. 2007 Nov 6;147(9):620-7. doi: 10.7326/0003-4819-147-9-200711060-00006. PMID: 17975184; PMCID: PMC2365713. ā†©ļøŽ
  5. Ashur M. L. (1993). Asking about domestic violence: SAFE questions. JAMA, 269(18), 2367. ā†©ļøŽ
  6. Ashur M. L. (1993). Asking about domestic violence: SAFE questions. JAMA, 269(18), 2367. ā†©ļøŽ
  7. www.endgv.org, Working together for gender equity and social justice in King County,
    Screening for Domestic Violence,Ā https://endgv.org/wp-content/uploads/2016/05/Screening-for-Domestic-Violence-00000002.pdf ā†©ļøŽ
  8. www.endgv.org, Working together for gender equity and social justice in King County,
    Screening for Domestic Violence,Ā https://endgv.org/wp-content/uploads/2016/05/Screening-for-Domestic-Violence-00000002.pdf ā†©ļøŽ
  9. www.endgv.org, Working together for gender equity and social justice in King County,
    Screening for Domestic Violence,Ā https://endgv.org/wp-content/uploads/2016/05/Screening-for-Domestic-Violence-00000002.pdf ā†©ļøŽ
  10. www.endgv.org, Working together for gender equity and social justice in King County,
    Screening for Domestic Violence,Ā https://endgv.org/wp-content/uploads/2016/05/Screening-for-Domestic-Violence-00000002.pdf ā†©ļøŽ
  11. Ashur M. L. (1993). Asking about domestic violence: SAFE questions. JAMA, 269(18), 2367. ā†©ļøŽ
  12. Ashur M. L. (1993). Asking about domestic violence: SAFE questions. JAMA, 269(18), 2367. ā†©ļøŽ
  13. Rhodes KV, Frankel RM, Levinthal N, Prenoveau E, Bailey J, Levinson W. ā€œYouā€™re not a victim of domestic violence, are you?ā€ Provider patient communication about domestic violence. Ann Intern Med. 2007 Nov 6;147(9):620-7. doi: 10.7326/0003-4819-147-9-200711060-00006. PMID: 17975184; PMCID: PMC2365713.Ā  ā†©ļøŽ
  14. Thackeray, J., Livingston, N., Ragavan, M. I., Schaechter, J., Sigel, E., COUNCIL ON CHILD ABUSE AND NEGLECT, & COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION (2023). Intimate Partner Violence: Role of the Pediatrician. Pediatrics, 152(1), e2023062509. https://doi.org/10.1542/peds.2023-062509 ā†©ļøŽ
  15. Safe+Equal ā€œIdentifying family violenceā€, accessed 12.01.2024.Ā https://safeandequal.org.au/working-in-family-violence/identifying-family-violence/ ā†©ļøŽ
  16. World Health Organization, Clinical Handbook ā€œHealth Care for Women Subjected to Intimate Partner Violence or Sexual Violenceā€, 2014, p. 19.Ā Ā 
    http://apps.who.int/iris/bitstream/handle/10665/136101/WHO_RHR_14.26_eng.pdf;jsessionid=2BA58E813B52A1105271DB988D1AAC88?sequence=1 ā†©ļøŽ
  17. World Health Organization, Clinical Handbook ā€œHealth Care for Women Subjected to Intimate Partner Violence or Sexual Violenceā€, 2014.Ā Ā 
    http://apps.who.int/iris/bitstream/handle/10665/136101/WHO_RHR_14.26_eng.pdf;jsessionid=2BA58E813B52A1105271DB988D1AAC88?sequence=1 ā†©ļøŽ
  18. World Health Organization, Clinical Handbook ā€œHealth Care for Women Subjected to Intimate Partner Violence or Sexual Violenceā€, 2014, p. 19.Ā Ā 
    http://apps.who.int/iris/bitstream/handle/10665/136101/WHO_RHR_14.26_eng.pdf;jsessionid=2BA58E813B52A1105271DB988D1AAC88?sequence=1 ā†©ļøŽ
  19. World Health Organization, Clinical Handbook ā€œHealth Care for Women Subjected to Intimate Partner Violence or Sexual Violenceā€, 2014.Ā Ā 
    http://apps.who.int/iris/bitstream/handle/10665/136101/WHO_RHR_14.26_eng.pdf;jsessionid=2BA58E813B52A1105271DB988D1AAC88?sequence=1 ā†©ļøŽ
  20. Nadia, Ebrahim (April 22, 2020). ā€œThis Secret Signal Could Help Women in Lockdown with Their Abusersā€. Refinery29. Accessed 12.02.2024.Ā https://www.refinery29.com/en-ca/2020/04/9699234/domestic-violence-quarantine-coronavirus-signal-help ā†©ļøŽ