Module 4: Support services of the social sector

Children and adolescents can also experience crises. Often, their reactions to these experiences involve regressive behaviours they had previously outgrown. For instance, children might revert to thumb-sucking, bedwetting, or seeking comfort by sleeping with their parents. Similarly, adolescents may react by changing their behaviour, such as becoming withdrawn or isolating themselves, or they may develop impulsive or aggressive behaviour, either directed towards themselves or others.

While behavioural changes can stem from various causes, it is important to take action if you suspect domestic violence. Learn more about frequent indicators in children and adolescents in Module 2.

• Crisis services offer support for individuals experiencing acute mental health issues. While typically providing short-term assistance, they may offer longer-term support in exceptional cases. Services can be provided either on an outpatient basis or through mobile crisis teams that visit those affected at home.
• Social psychiatric services of health authorities provide advice and support for individuals facing mental and social challenges. They offer easy-to-access support, including crisis intervention. They can assess the situation, provide on-the-spot help and initiate further steps.

• Helplines can provide accessible support for adults, as well as for children and adolescents.
• They link information, counselling, and support services for victims experiencing domestic violence.
• They work independently and can also be used in addition to other offers of help.

Online services provide a range of options for those in need, catering to both communication and information dissemination.

Online communication services:

• Many people find it easier to write about their situation rather than speak about it in person.
• There are numerous online communication services available for people in crisis, such as email or chat services. These platforms allow for immediate and accessible support.
• Additionally, many local advice and counselling centres offer confidential advice online, particularly for victims of domestic violence. This includes support via chatbots, emails, and live chat services.

Online information providers:

• Besides local services, there are many online information providers that offer comprehensive resources. These include websites from government ministries and other national organisations.
• Such websites provide valuable information and guidelines on various issues, including crisis management, domestic violence support, and more. These resources are often accessible to a broader audience, not limited by locality.

• Psychosocial services and counselling centres offer crisis intervention and support.
• Their websites or phone lines can provide information about their services and areas of expertise, including specialised support for victims of domestic violence.

• Specialists in psychiatry and psychotherapy offer support during office hours. They give advice, medication if necessary, and provide acute treatment.
• Family doctors, nurses and midwives serve as an important initial point of contact for many victims of domestic violence, treating injuries and providing guidance on further steps. They also play a crucial role in referring victims to violence protection centres and ensuring thorough medical documentation, which is essential for providing evidence in legal proceedings or at the youth welfare office.

Various outpatient clinics, including trauma, violence protection, child protection, and psychiatric outpatient clinics, offer immediate support in emergencies:

• Trauma outpatient clinics mainly offer psychotherapy support for traumatised people. There are trauma outpatient clinics for adults, as well as for children and adolescents.
• Violence protection outpatient clinics offer victims of violence the opportunity to have their injuries examined and documented by a forensic medicine specialist. This can be done without the crime having been reported to the police.
• Child protection outpatient clinics investigate acute and chronic cases of physical or psychological violence, neglect and sexual violence against children and initiate further help where necessary.
• Psychiatric outpatient clinics and outpatient clinics for child and adolescent psychiatry are part of the local psychiatric hospital and come into play when other psychiatric or psychotherapy treatment is not available.

• Shelters provide refuge for victims of domestic violence, especially if there is an acute risk of violence.
• There are shelters for women or men (children can be brought along). An increasing number of shelters are wheelchair accessible or have an infrastructure for the deaf. Some address specifically non-binary and transgender people.
• Admission and stay in a shelter happen on a voluntary basis. The shelter’s address is generally not publicly known. However, this may not apply to all countries.
• People can usually call the shelters at any time of the day or night and ask for refuge. Some regions have offices that coordinate places in shelters in that region.
• Shelters are a safe place for victims to find stability, where they can take their time to consider what to do next.

• “Trauma” is an ancient Greek word meaning wound or injury. In psychology, trauma refers to a severe psychological injury.
• Trauma often arises from experiences where a person is subjected to significant threat and helplessness. Observing such threats can also be traumatic.
• When children are exposed to such significant threats and experience trauma, it is colloquially referred to as childhood trauma. If this disrupts a child’s development, it may be termed developmental trauma. When the threat comes from a close person, attachment trauma can also occur.
• Especially in cases of severe, prolonged, or repetitive threats, the likelihood of individuals developing trauma-related disorders increases.
• Trauma can also affect the next generation, known as transgenerational transmission. It is believed that trauma is not simply inherited but that traumatised parents may interact differently with their children in some areas than non-traumatised parents.

• Individuals who have been exposed to significant threats often struggle to process their experiences. This can lead to immediate or even years later, psychological or physical suffering as a result of the experiences. The symptoms of trauma can be diverse, but certain characteristic symptoms often occur together. In such cases, doctors or psychotherapists can diagnose a trauma-related disorder.
• Victims of domestic violence can develop a condition known as post-traumatic stress disorder (PTSD) as a psychological trauma-related disorder. In severe cases of traumatic experiences, trauma-related disorders can also lead to a dissociative disorder.
• There are also other disorders that can result from experienced trauma, such as obsessive-compulsive disorder, eating disorders, anxiety disorders, depression, or alcohol dependence. Pain disorders or sexual problems can also be a result of trauma.
• Sometimes, the symptoms of experienced trauma are less visible, and the suffering of the victims manifests subtly – for example, in withdrawal or low self-confidence. These less noticeable effects do not diminish the trauma’s severity. The consequences of the experiences may also manifest in individuals finding it difficult to maintain healthy relationships, or they may not be able to achieve their full potential in education or work.

• Post-traumatic stress disorder (PTSD) is a trauma-related disorder that can develop when someone has been exposed to an extreme threat. Typical characteristics of PTSD include repeatedly reliving the threat through intrusive memories or dreams, and an increased nervousness.
• A complex PTSD can develop if someone has been exposed to repeated or prolonged threatening events. For example, suffering from domestic violence can lead to trauma and thus to PTSD.
• In addition to the typical characteristics of PTSD mentioned above, complex PTSD is also characterised by difficulties in regulating emotions, problems in interacting with other people, and feelings of worthlessness.

• A dissociative disorder is a possible consequence of trauma.
• The term “dissociation” comes from Latin, meaning “to separate” or “to split”. In psychology, it refers to a state where thoughts, feelings, memories, and actions are experienced as disconnected from each other.
• Many people experience mild forms of dissociation, such as daydreaming or feeling “outside” of themselves. A dissociative disorder means these symptoms are severe enough to disrupt daily life.
• Dissociation is thought to protect the psyche during severe threats. When this happens, individuals often cannot fully remember the threatening situation, a phenomenon known as dissociative amnesia. Therefore, dissociation can be a symptom of trauma.
• In daily life, dissociations can occur when something subconsciously reminds a person of the threatening situation. This is a strategy the brain uses to avoid further stress.
• In the most severe cases, a person may develop a dissociative identity disorder (DID), where multiple identities or personality states emerge as a result of extreme and prolonged trauma. This is often linked to the experience of very severe forms of violence.

• Retraumatisation occurs when a previously experienced trauma is triggered, causing the victim to re-experience feelings of threat and helplessness. This can happen in everyday life, for example, when someone hears or sees something that reminds them of the past threatening situation.
• Retraumatisation can also occur during investigations or in a court trial when the victim is reminded of the traumatic event.
• Retraumatisation can also happen in psychotherapy. Addressing the traumatic event can be very beneficial, but the timing and process must be carefully planned.

• There are specific treatment methods for therapy when a trauma-related disorder is present. Such treatment methods focus on processing the memory of the traumatic event. This is called “trauma processing“. When these treatment methods are used to cope with traumatic events, psychotherapy is colloquially referred to as “trauma therapy“.
• Trauma therapy usually assumes that there are no current threats, such as ongoing contact with perpetrators. If there are still current threats, psychotherapy without trauma-focused treatment methods can still be very helpful.
• In general, the treatment of a post-traumatic stress disorder (PTSD) or a dissociative disorder should be handled by psychotherapists or psychiatrists. These professionals create an individual treatment plan and support victims in processing their experiences, including recognising early warning signs and practicing strategies to return to the “here and now”.

• In the initial stages, counsellors should discuss the situation with the person seeking advice, allowing them to express their feelings and articulate their challenges.
• Together, they should explore available options and plan the next steps, empowering victims to make informed decisions. This may include determining the need for further support and identifying suitable resources.
• Additionally, counselling centres often have extensive networks within the region and can facilitate connections with medical, psychological, or legal professionals as needed.

• For those with suspicions, counsellors should provide guidance on the appropriate next steps.
• They should assist in contacting public authorities and can even accompany individuals to meetings. This is particularly helpful when individuals need to engage with entities such as the youth welfare office or the police.
• For immediate support, individuals can reach out to specialised helplines.

Many counselling centres are tailored to the needs of women or men, girls or boys who have experienced domestic violence. These services are typically inclusive of transgender and non-binary individuals. Additionally, there are counselling centres for everyone, regardless of age or gender. There are an increasing number of services for people from the LGTBIQ+ community.

Many specialised advice centres are prepared to support people with a migration and/or refugee background. They often have staff from different cultures, can offer counselling in different languages or work with interpreters.

Some services are tailored to meet the needs of victims with physical disabilities or cognitive or sensory impairments. These centres consider the unique life circumstances of people with disabilities, providing wheelchair-accessible facilities, an infrastructure for the deaf and offering support in easily understandable language or sign language.

Many centres operate within specific regional catchment areas, offering services to residents of particular towns or districts based on their funding arrangements. Visiting a centre’s website or contacting them directly can clarify whether they can provide support within one’s own locality. Many centres are willing to find solutions for victims who may not have a suitable alternative nearby.

Specialised counselling centres often serve as valuable resources for seeking information on domestic violence (also for professionals).

They, in particular, offer a wide range of information on this topic. They provide helpful tips on how to protect (including the children) and offer guidance on what steps to take if there are suspicions of domestic violence.

In addition, many specialised counselling centres organise training courses for professionals on the topic of “Domestic/sexual violence and intervention” or “Children and domestic violence”. These training courses aim to qualify professionals to recognise and address domestic violence, deal with ambivalence and know the needs of people affected by violence, possible safety measures and the help available.

Specialised counselling centres often employ professionals with psychotherapeutic or psychological qualifications who can provide psychological support. These services are free and may be more accessible than psychotherapy, especially during the waiting period for therapy sessions with an external therapist. Victims can find their way to psychotherapy through these centres, or sometimes counselling sessions may be sufficient.

Counselling centres work confidentially and usually also anonymously, if required. Furthermore, counselling centres are not obligated to report information to law enforcement agencies or youth welfare offices. This means victims can freely discuss any concerns or issues without fear of mandatory reporting. However, this may not apply to all counselling services in Europe.

Anna, a 34-year-old woman and mother of two young children, had been experiencing domestic violence from her husband, Sebastian, for the past four years. The abuse had gradually escalated from psychological to physical violence. Her financial dependency on Sebastian, combined with her fear for her children’s safety and the lack of support from her close family, made it extremely difficult for her to leave the abusive situation.

A turning point came when a concerned neighbour, alarmed by the frequent disturbances and visible signs of abuse, helped Anna to contact a local counselling centre. Catherine, a social worker at the local counselling centre, arranged a meeting with Anna. During their conversation, Anna disclosed the extent of the abuse she had suffered from, including physical injuries, threats, and psychological manipulation. Catherine noted Anna’s heightened fear, indicating that she and her children might be in danger.

She assessed Anna’s situation thoroughly and found out that she was unaware of her legal rights and the resources available to her. Catherine prioritised developing a safety plan together with her, which included providing Anna with emergency contact numbers, arranging temporary accommodation for Anna and her children at a local women’s shelter, and informing Anna about her legal options.

Over the following weeks, Catherine provided continuous support to Anna through regular check-ins and coordination with the local women’s shelter. Anna and her children received counselling to help them process their experiences.

Tasks for reflection
1) What are the key factors that contributed to Anna feeling trapped in her abusive relationship? How could Catherine address these in her intervention?
2) How important is mutual trust between a social worker and a victim of domestic violence? What strategies could Catherine use to build this trust with Anna?

Psychotherapists usually specialise in one specific method. These include:

• Behavioural therapy focuses on changing negative behaviours and thought patterns.
• Depth psychology-based psychotherapy explores underlying psychological processes.
• Analytical psychotherapy involves in-depth exploration of past experiences and unconscious processes.
• Systemic therapy for adults looks at individual issues within the context of relationships and systems.

These therapies can be conducted in individual or group settings.

Specific therapy methods for trauma patients include trauma-focused cognitive behavioural therapy or Eye Movement Desensitisation and Reprocessing (EMDR). EMDR supports the processing of traumatic experiences through guided eye movements. Other therapy types include conversational psychotherapy, Gestalt therapy, and body-oriented therapy.

Individuals who have experienced domestic violence, either recently or in the past, or those close to an affected person, may exhibit symptoms that psychotherapy can address. Therapy can help process the trauma immediately after an event or even years later. It can be beneficial for those experiencing sleep problems, flashbacks (vivid reliving of traumatic events), difficulty managing daily tasks, or challenges at work. Psychotherapy might be a suitable option when close relationships are in conflict and the sense of fear and anxiety is present.

Children and adolescents often respond to domestic violence in various and unique ways. Young children might regress in their behaviour, such as thumb-sucking, bed-wetting, or needing to sleep with their parents. They may show extreme attachment to their parents, or express psychological distress through physical symptoms like stomach aches and headaches. Mood swings, withdrawal from social interactions, irritability, and tantrums are common responses. Previously manageable situations might become sources of anxiety and overwhelm, leading to noticeable declines in school performance or, occasionally, unexpected improvements. Some adolescents might engage in self-harm to cope with intense internal stress.

These symptoms are not exclusively caused by experiences of domestic violence and can have other origins. However, psychotherapy can be highly beneficial when children or adolescents are struggling with distress, difficulty in daily interactions, school challenges, or other aspects of their lives.

Before starting therapy, individuals undergo initial consultation sessions. These sessions can take place in the same practice or different ones. Their purpose is to assess if therapy is suitable for the person seeking support. During these sessions, patients discuss their psychological symptoms and how they impact their daily lives. The psychotherapist provides information about various therapy methods and treatment options, addressing any questions or concerns.

Therapy may not always begin immediately after the initial consultation. However, patients can use this opportunity to explore if therapy is suitable for them and determine the appropriate approach.

At the session’s conclusion, patients receive written recommendations outlining the recommended type of assistance, such as psychotherapy, hospital treatment, counselling, or participation in a self-help group.

When a patient faces a severe crisis, their psychotherapist may offer immediate additional appointments or make a referral following the initial consultation. This intervention is known as acute treatment and aims to help individuals overcome acute psychological crises. During these sessions, the therapist discusses the next steps with the patient, considering options such as outpatient or (partial) inpatient psychotherapy.

Trauma outpatient clinics offer initial and immediate help after a traumatic event.

After the initial consultation, patients who decide to proceed with psychotherapy attend trial sessions.

The primary goal of these trial sessions is for both the patient and therapist to establish mutual trust as it is important for the success of therapy. Patients should pay close attention to their feelings during these sessions and ask any questions they may have. They should assess whether they feel well-supported and comfortable sharing their thoughts and concerns. If not, they have the option to explore other practices where they feel more at ease.

Simultaneously, these sessions allow the therapist to assess the patient’s needs and develop a tailored treatment plan.

Short-term therapy typically comprises two phases. If the initial phase proves insufficient, patients have the option to request an extension for additional sessions. Moreover, if required, short-term therapy can transition seamlessly into long-term therapy.

Long-term therapy, on the other hand, varies significantly in duration, depending on the therapeutic approach. In acute cases, additional therapy hours may be justified and requested.

Inpatient treatment involves admitting a patient to a clinic where they receive round-the-clock care. This level of care is typically necessary for patients with severe mental illnesses or when outpatient treatment proves ineffective. It provides immediate access to support in case of crises and allows for intensive therapeutic intervention.

Inpatient-equivalent treatment offers a similar level of care to traditional inpatient treatment but takes place in the patient’s home. This approach helps patients receive the necessary support while gradually reintegrating into everyday life, mitigating the risk of relapse upon returning home.

Semi-residential and day-care treatment involves spending the day in a clinic and returning home in the evening. This option provides comprehensive care during the day while allowing patients to maintain connections with their home environment. It can facilitate a smoother transition back to everyday life after treatment.

In criminal law, the state, represented by the police and the public prosecutor’s office, conducts a judicial inquiry against an accused person. If there is sufficient evidence that a crime was committed, the prosecution brings charges and the court sentences the accused person. The main aim of criminal law is to hold the guilty party accountable and to deliver justice on behalf of society. Additionally, criminal proceedings often result in protective measures and institutional acknowledgment of the violence, which many victims identify as their primary reasons for engaging with the criminal justice system. In these proceedings, the victim is primarily involved as a witness. In the case of serious offences, the accessory prosecution can be admitted.

Criminal proceedings can be complex and very time-consuming, often spanning several months or even years from the time an offence is reported. This duration can be even longer in cases involving offences committed long ago or those with numerous witnesses.

In civil law, the injured party can take action against the defendant themselves. The objective here is to enforce claims against someone, such as civil law protection orders, omission or elimination of harmful behaviour, damages or compensation for pain and suffering. The victim, instead of being a witness, is one of the parties in the trial. This means that they have the right to take action directly against the defendant, typically with the help of legal representation like a lawyer. For victims of domestic violence, legal proceedings or extensive applications are often an additional burden. Social workers should offer support or refer them to specialised advice centres or lawyers.

In many European countries, victims of domestic violence can receive state benefits if their health has been adversely affected. Benefits can include costs for therapies, immediate help in trauma outpatient clinics, travel for medical appointments, rehabilitation and necessary aids. The extent of the benefits victims are entitled to is regulated by law and largely depends on the severity and duration of their health issues.

Possible benefits can include:

• Remedial and medical treatments, including psychotherapy and services of the trauma outpatient clinics
• Pension benefits, depending on the severity of the impact on health and income
• Welfare benefits, for example, for participation in working life, care, upkeep of the household and benefits to help with living expenses
• Benefits in other life situations such as the costs of accommodation for a victim in a women’s refuge
• Rehabilitation programmes, such as stays at a health resort.

Victims of domestic violence may be entitled to a (partial) reduced earning capacity pension if they are no longer able to work or are only able to work to a limited extent due to health problems. This includes health impairments resulting from domestic violence. The entitlement to this pension depends on the extent to which their capacity to work is impaired.

In many European countries, victims of crime can receive financial support from foundations or victim assistance institutions.

Self-help means “helping yourself”, often through sharing practical tips for daily life. Self-help groups allow participants to connect with others who have had similar experiences or are currently facing similar challenges. Many victims of domestic violence find that, within the group, they are not alone in their experiences and that others truly understand them. Discussing their situations with peers helps them see how others manage similar stresses and challenges.

In self-help groups, the focus is often on the stresses resulting from traumatic experiences rather than the traumatic events themselves. Some groups may even have guidelines that discourage detailed discussions of violent experiences to avoid triggering other participants.

Self-help groups provide significant support, but they are not a substitute for professional counselling or therapy.

Participants in self-help groups meet regularly, with attendance always being voluntary and usually free of charge. However, there may be costs involved if the group needs to rent a room for their meetings.

An important rule applies to all groups: what is discussed in the group remains confidential and must not be shared outside the group.

Self-help groups can be attended independently or in addition to therapy, and they come in various formats. Some groups have a moderator, while others do not. This moderator can be either a victim or a professional who may not have been affected by domestic violence. The group dynamics can vary depending on the format, so it is important to understand how the group operates and whether its approach aligns with the victim’s needs.

Not everyone will find a suitable group immediately. Some victims choose to start their own self-help groups, creating a supportive environment for themselves and others.

General and specialised counselling centres can assist victims of domestic violence in finding a suitable self-help group by offering information and connecting them with local groups.

While not every area has groups specifically focused on domestic violence, some groups address related topics such as trauma. It is important to inquire about each group’s particular focus.

Online self-help groups

Many people find it easier to initially read or write about their experiences rather than talking face-to-face. Online self-help groups are available anytime and anywhere, providing constant support. They allow victims to read about others’ experiences before sharing their own. In internet forums, participants discuss their situations and concerns similarly to local self-help groups.

Some internet forums are fully public, while others have both public and private areas for members. Victims should review the website’s privacy and anonymity policies to ensure they meet their needs.

Every victim has unique needs and preferences, which means there is no predefined way to approach a self-help group, whether online or offline.

To protect each participant in a group or internet forum, it is important to establish a shared framework and transparent rules and to discuss these with all participants to ensure a mutual understanding.

Before joining a group or internet forum, victims should consider these questions to prepare themselves:

• Purpose and topic: What is the focus of the self-help group or forum?
• Meeting details: How often and where does the group meet? Does the victim feel comfortable with the location and frequency?
• Moderator: Is there a moderator? If so, who are they, and what is their role?
• Participants: Who can join the group? Are there specific criteria?
• Confidentiality: What are the confidentiality rules?
• Etiquette: What are the expectations for behaviour within the group?
• Discussion content: Do participants discuss traumatic experiences, or do they focus on related topics?
• Crisis management: What are the protocols if a participant is in crisis during a session?
• Well-being during sessions: What happens if a participant does not feel well during a meeting?
• Power dynamics: How are power imbalances addressed within and outside the group?

After attending the first meeting, victims should reflect on their feelings and experiences:

• Did they feel comfortable and supported?
• Did they feel like they interacted as equals with the other participants?
• Did the group atmosphere feel right for them?

If they felt positive about the meeting, that is a good sign. If not, they should remember that participation is voluntary, and that they are not obligated to stay. It is okay to question the group’s rules and seek a setting where they feel safe and supported and that suits their needs.

Not at first. Teachers are obliged to inform parents about indications of a risk to the child’s or young person’s well-being, as long as this does not jeopardise his/her protection. It may therefore be necessary to seek outside expertise, such as school counsellors, psychologists, social workers, or specialists for child protection to assess the risk situation before considering further steps. If there is a well-founded suspicion of neglect or maltreatment, a decision should be made in consultation with the school management whether to file a criminal complaint. In individual cases, however, it may make more sense to involve competent authorities such as the institutional service responsible for the care of children and youth victims of domestic violence and to take other appropriate measures to help the pupil.

It is important to react calmly in consultation with the school management and talk to the affected child/young person first in order to gain their trust and find out more. Rushing and panic are not good counsellors. Children and young people can be informed about their rights and options. Teachers should make their own procedure transparent.

Teachers should discuss the situation with the child or young person and their legal guardians and, if necessary, encourage the legal guardians to seek help, provided that this does not jeopardise the effective protection of the child or young person. If you are not sure what to do, seek advice yourself. The involvement of a qualified child protection specialist in assessing the risk of danger to a child or young person in individual cases may help you to act with greater certainty, as the indications that a child’s welfare is at risk are often not clear.

Yes. The duty to act in coordination with the school management arises from the employment relationship or contract of employment (duty of care), from school statutes or school laws, or national laws on child protection. Violations of duties to act and provide information can lead to disciplinary and labour law sanctions.

It must also be taken into account that teachers and school management may be liable to prosecution under criminal law if they do nothing at all despite clear signs of domestic violence, abuse and neglect of a pupil and breach their duty of care.

Teachers must observe the official channels and, in particular, coordinate every external action with the head of the school. However, the official channels do not have to be adhered to when, for example, discussions are held with parents or informal advice is sought from other institutions (e.g., the institutional service responsible for the care of children and youth victims of domestic violence).

In Germany, for example, there is no statutory obligation to report domestic violence, sexual abuse, child abuse or neglect to the police. However, this may be different in other European countries.

If a report is wrongly made to the police or the youth welfare office due to a suspicion of child abuse, this can have negative consequences for the teacher or school management (defamation, slander). It is important for self-protection to document and report an objective description based on facts, your own observations, or statements by the pupil.

Yes, you would be a witness in such preliminary proceedings. Further obligations may arise from the respective country civil service regulations.

In principle, parents have a right to information and must be made aware of any suspicious circumstances, as they are also responsible for protecting children from danger as part of their parenting responsibilities. If you decide to inform the institutional service responsible for the care of children and young people, you must inform the legal guardians in advance, as long as this does not jeopardise the protection of the children/young people.

Before involving the police, you must carefully consider whether their action is in the best interests of the child to be protected! Criminal proceedings are a burden for children and if they make statements against their own parents, they may experience a crisis of loyalty.