Psychotherapy Volume 34/Winter 1997/Number 4

THE BARRIERS MODEL: AN INTEGRATED STRATEGY FOR INTERVENTION WITH BATTERED WOMEN

NANCY GRIGSBY BRENDA R. HARTMAN Artemis Center for Alternatives to University of Michigan Ann Arbor, Michigan Dayton, Ohio This article examines the barriers facing gle with meeting the needs of these women. To- victims of domestic violence and offers day, many cities across the country have shelters or domestic violence resource centers available. therapists an integrated model of In addition, more and more therapists are citing intervention combining both case family violence as an area of clinical expertise. management and psychotherapy Women experiencing family violence, however, strategies. Visually represented, The continue to report difficulties in receiving these Barriers Model places the battered services. Battered women often report that there woman in the center of four concentric are numerous barriers impeding their efforts to free their lives of violence. This article examines circles. Each circle represents a layer of the barriers facing victims of domestic violence barriers in the battered woman's and offers care providers an integrated model, experience that potentially impedes her combining both case management and psycho- safety. These layers include: barriers in therapy strategies, for working to meet the needs the environment; barriers due to family, of this population of women within the context of these barriers. The model was developed as a socialization, and role expectations; result of the authors' combined experience of 23 barriers from the psychological years of work with thousands of battered women consequences of violence; and finally, in shelter and nonshelter settings. barriers from childhood abuse/neglect The Barriers Model was developed in response issues. Therapists are provided with an to the strong movement of the late explanation of each layer of barriers, 1980s that pathologized battered women without recognizing or addressing the external and inter- questions to help identify the extent to nal oppression accounting for their behaviors and which these barriers are preventing the symptoms. Clearly, battered women and their woman from becoming safe, and therapists recognized the behaviors of battered strategies to address these barriers with women in the proliferation of self-help books that the battered woman. appeared on the topic of codependency. Hagan (1993) summarized several attributes defined in the literature as codependency, such as external While resources available to battered women referencing, martyrdom, poor self-esteem, con- have grown in recent years, professionals work- trolling behavior, demoralization, and needing to ing with this population have continued to strug- be needed. Indeed, many battered women do dis- play these qualities. What these books failed to acknowledge is that these symptoms identified as codependency may not have been a disorder Correspondence regarding this article should be addressed resulting in unhealthy patterns of intimacy, but to Brenda Hartman, Psy.D., Counseling and Psychological instead, the very behaviors that allowed women Services, 3100 Michigan Union, University of Michigan, Ann to survive relationships with violent partners. As Arbor, MI 48109. Email: [email protected] Hagan (1993) explains, the term codependency

485 N. Grigsby & B. R. Hartman masks the political context of oppression in which ognize the barriers facing these women is asking women live. The neutrality of the term minimizes therapists to recognize a daunting and over- the power differential between men and women whelming world view. Yet, this is precisely what and pathologizes women who have been social- is required to work effectively with this, and any, ized into a system of dominance (Hagan, 1993). oppressed population. To continue to collude with The temptation for both therapists and clients an individual pathology framework is at best, in- to collude with the belief that the oppressed indi- effective and, at worst, detrimental to the welfare vidual is to blame is understandable. Victims are of clients from oppressed populations. likely to be drawn to the idea that they are at The Barriers Model is presented to facilitate a fault for the violence in their lives because it paradigm shift for therapists working with mar- is consistent with their socialization as women ginalized populations. This model is presented (Hagan, 1993). It is conceivable that battered with the recognition that the most important client women may prefer to believe that the problems of feminist therapy is the very culture in which the in their relationships are rooted within themselves therapy takes place (Brown, 1994). The model and thus changeable, rather than acknowledge the provides a theoretical road map for therapists lack of social and legal controls placed on their working with clients who are experiencing prob- partners and the resultant low probability that they lems living in a patriarchal society due to exter- will actually become nonviolent. Therapists may nalized and internalized oppression. It presup- be tempted to collude with victims' investment poses that symptoms displayed by clients are in the label of codependency because most tradi- often the result of colliding with socially im- tionally trained therapists have been taught to posed barriers to well-being rather than deep- view all clients' struggles from an individualistic, seated, individually rooted pathology. By defi- not social, perspective. Asking therapists to rec- nition, The Barriers Model places the primary

Layer 1: Barriers in the Environment. Layer 2: Family and Social Role Expectations Layer 3: Psychological Consequences of Abuse Layer 4: Childhood Abuse and Neglect Issues

Figure 1. Model of Barriers: Effects of External Environment and Life Experiences on Victims of Domestic Violence

486 Intervention with Battered Women locus of analysis on society and context rather "they will remove the children if you go to a than on the individual. shelter" often become her only reference informa- tion. Even when victims have contact with out- The Barriers Model siders, they are often not given the information Visually represented, The Barriers Model they need. One study (Sugg & Inui, 1992) found places the battered woman in the center of four that more than half of physicians in the United concentric circles (see Figure 1). Each circle rep- States report being uncomfortable asking pa- resents a cluster of barriers in the battered tients about the cause of injuries being treated. woman's experience that potentially impedes her This silence allows even victims who reach out safety. These clusters, or layers, are not linear. to remain uninformed about their options and Victims may experience barriers in all four layers rights. or in some combination of them. The centrality of information as a powerful tool In working with domestic violence victims, one for escape from abuse is best demonstrated by the should begin with a focus on the barriers in Layer frequency and intensity of the abuser's attempts to 1 (Barriers in the Environment). Until these barri- keep the victim uninformed, isolated, and con- ers have been addressed, focusing therapy around fused. Many battered women report some attempt issues presented in the other three layers will be at isolation by abusive partners, ranging from ma- ineffective and could contribute to the victim's nipulative attempts to keep the victim out of touch isolation and self-blame, and thus, the danger she with family and friends, to extreme measures is in. Contrary to traditional training and practice, such as removing the phone or wires from the which often focuses exclusively on the innermost car. If information were not such a powerful tool layers represented in this model (i.e., purely psy- for escape, abusers would not try to maintain such chological or childhood issues), care providers control over it. Rather than assume the client's are advised to avoid initial focus on the more level of insight, therapists need to explore what internal layers for two primary reasons. First, the client knows about abuse dynamics, what help helping the victim access resources and eliminate is available, and be willing to link the client to the barriers in her environment (Layer 1) may needed resources. save her life. Second, focusing on the more inter- nal barriers before addressing the external ones Batterer will reinforce her sense that there is something Trained therapists often become so focused on wrong with her, or that her history caused her what is going on in the victim's psyche that they to be abused. Each of the layers will now be often forget tangible, even physical barriers to considered individually. her leaving. In severe and advanced battering situ- ations, the abuser physically prevents the victim Layer 1: Barriers in the Environment from leaving. This includes locking her in the Depending on the resources in any given com- house or out of the house away from medication, munity, these barriers may or may not be influ- the children, money, and other resources. Victims encing a victim's perception and experience of living with extreme domestic violence are locked resources needed to escape a violent partner. It in rooms and accompanied in public by the bat- is unlikely that all of these barriers would be terer at all times. Some report being kept in the present in one client's life, but many battered house by their abuser's relatives or friends when women will be experiencing several of them. he needs to leave the house; in extreme cases older children are inducted into this role. An Ohio Information/Misinformation judge shared a classic lesson learned about how Because of the social isolation battered women real a barrier the abuser can be. Frustrated by the experience (NiCarthy, 1986), they often have lit- number of domestic violence complaintants not tle access to information about the dynamics of appearing for the arraignment of the defendant, abuse, where they can go to get safe, community other local judges had issued bench warrants so resources, and legal options for a more permanent that they could arrest the victim to get her to come separation from the abusive partner. For many, to court. This judge, not wanting to take such the batterer is a central source of information punitive measures, sent a deputy to the home of about the abuse. The abuser's messages such as one such battered woman who had failed to ap- "no one will believe you," "no one will help you," pear at court. The deputy peered through the win-

487 N. Grigsby &B. R. Hartman dows prior to seeking entrance only to find the atively address their needs to move around the defendant literally sitting on top of the victim community as they implement plans for safety or on the living room floor, preventing her from separation. This includes a plan for how the vic- appearing at court, in hopes the charges would tim will get to a shelter if necessary. be dropped. Therapists need to explore what tac- tics the abusive partner has employed to keep the Police Assistance victim from leaving. The police can provide key tools to escape or put up serious barriers to safety. Many in the Money psychological field assume that consistent police The better-compensated caregivers are, the response occurs, and are sometimes surprised to more difficult it may be to remember or imagine hear stories to the contrary from clients. First, not life without enough money to get by. Leaving an every state in the has a mandatory or abusive partner is an expensive venture in and of preferred arrest statute. This means that for many itself, irrespective of the general means on which battered women, a call to the police may still be one has to live. Consider fees for attorneys, hous- answered by officers practicing antiquated strate- ing and utility deposits, transportation, and child gies such as mediation, walking the abuser around care. Starting a home from scratch means replac- the block, advising the victim to buy a gun be- ing basic items such as sheets, towels, and house- cause "there is nothing we can do," and threaten- hold supplies. Some victims have additional med- ing to place both parties in jail if they are called ical bills from injuries or stress-related illnesses back. Before a therapist focuses on clinical resis- for themselves and their children. While the vic- tance as an explanation for a client's reticence to tim may have been living a middle-class existence call the police, more information about local po- or higher, leaving the abuser often means leaving lice practice is needed by the therapist. Care pro- everything behind. Often when a victim flees the viders are encouraged to explore answers to the home after an assault and attempts to remove following questions: What policies do the police funds from a bank account to live on, she finds have in your community regarding arrest? Will her partner has anticipated her next move and the victim be required to cooperate with criminal closed the account. Still many other battered prosecution to get the abuser arrested? Will any- women, whose partners control information in the one be there to explain what that means to the relationship, do not know how much money is in victim and assist her through the difficult prose- bank accounts or where they are. cution process? Do police enforce violation of Once the victim with children has committed protection orders with arrest? For any battered to terminating the relationship, more serious costs woman, involving outsiders, especially powerful may arise. If the abuser is the legal or biological entities like the police, is a risky venture. If the parent of the children, seeking custody of the police do not respond firmly with the offender, children is a frequently used strategy to get her both the victim and the abuser learn a powerful to come back. Some battered women, not able lesson: that no one will stop the violence and hold to afford psychological evaluations or sustained the abuser accountable. The abuser's message court battles, reconcile when it appears they may that "no one will help you if you try to leave" lose permanent custody of their children. Thera- is validated. pists need to understand the financial means their clients have, to actually make a transition to inde- Criminal Justice System pendence from the abuser, and be familiar with Similar concerns arise as victims attempt to use community resources to which they can link cli- the criminal justice system. An analogy about ents for financial assistance. medical care best illustrates the dilemma many victims experience. Suppose someone were suf- Transportation fering from medical symptoms that made them Many victims, particularly those in rural com- concerned for their life. Suppose they saw a doc- munities, lack transportation to get to safe shelter, tor who told them he or she would perform a and subsequently to appointments for themselves procedure, but could not explain exactly how it and their children (e.g., medical, legal, looking would be done. Imagine that this physician also for housing, welfare). Those working with vic- advises this person that it is impossible to predict tims who are physically isolated will need to cre- whether the procedure will make their health con-

488 Intervention with Battered Women cern any better. Would anyone accept medical able for any domestic violence victim, particu- care on these terms? Yet this is precisely the larly those with children, to enter into a legal premise upon which we ask domestic violence process with their abuser without an attorney. victims to enter the criminal justice system. While With some members of congress attempting to some courts permit victims to have advocates downsize or eliminate the Legal Services Corpo- with them, even these workers cannot with cer- ration which funds many Legal Aid offices across tainty predict the outcome of the prosecution pro- this country, many victims simply cannot get an cess. Everyday in many communities, victims co- attorney to file for emergency protection orders, operate with prosecution of their abusers only to child custody, and alimony. Many must rely on discover predial service workers who recommend abusive families of origin to get the money for noncash bonds in the most dangerous of cases. an attorney. When victims secure pro bono attor- They find prosecutors with mind-boggling dock- neys, they sometimes find they are represented ets who plead their cases down in the hallway by corporate attorneys with no domestic relations without any consultation with them. Some bat- experience, or individuals who do not deliver the tered women are asked to help enforce house ar- same caliber of legal services they provide paying rest as a condition of bond in cities where jail clients. Many victims receive legal advice that pri- overcrowding is an issue. Others find that their oritizes their property interests over their safety and abuser is released directly from jail, usually with- that of their children. Therapists need to know how out notice to them. They often find judges who clients can retain affordable legal counsel in their still issue the typical sentence of a suspended fine, community and help clients access these services. a suspended sentence, and unsupervised proba- tion. As in the case of the police, abusers and Religious Counseling/Guidance victims can learn powerful messages from the Many victims seek the help of a priest, rabbi, inaction of courts. Offenders can learn that the pastor, or other faith leader first. Depending on system is a joke, and that it is unprepared to hold the religious values about the family, many vic- them accountable. Victims often learn there is no tims hear that the abuse is their fault, God's will, help for them here, and may turn to other strate- and within their control if they are only more gies such as buying weapons. obedient partners. Rarely do battered women re- While best practice in this area has been de- port that it was the advice of a religious figure fined, most cities in the United States lag far that convinced them their safety was the most behind. Quincy, Massachusetts, has eliminated important issue. Therapists working with battered domestic violence homicide for over nine years; women who require a spiritual component to their San Diego, California, has reduced their domestic process are encouraged to locate religious guid- violence homicide by 60% in two years. These ance that will prioritize safety first. cities recognize the risk the victim incurs when she cooperates with prosecution, and they prose- Mental Health System cute based on evidence, often without her testi- Many battered women need therapy to heal mony. Bonds are set high, weapons are removed from the complex effects of trauma. In the age of from abusers, outstanding warrants are checked, managed care, they often discover brief treadnent lethality assessments are done, and sentencing modalities as their only option. For this popula- imposes real limits and a strong message to abus- tion, the inaccessibility of longer-term therapy ers. Therapists need to explore what the likely is a barrier to both safety and recovery. Brief response is from prosecutors, predial evaluators, modalities exclude the trauma victim's specific judges, and probation officers in their own cities. needs for time to build dust, time to take tiie risk of disclosing often humiliating abuse, time Attorneys to explore options, time to begin implementing a Inaccessibility of legal counsel is a major bar- plan of action to escape abuse, and time to begin rier for many domestic violence victims. This is and complete the exhaustive healing process. ironic, since the most powerful relief in many Some battered women end up in tiie mental states, such as long-term protection orders, child healtii system, after presenting in tiie hospital custody and child support, is available under civil emergency room (Stark & Flitcraft, 1982). What codes best accessed through legal counsel. While many of these women find is a system so focused some states allow pro sae filings, it is not advis- in a disease/pathology model, that mental health

489 N. Grigsby & B. R. Hartman becomes paramount over survival and safety. Many battered women continue to be labeled Many battered women develop anxiety and de- as addicted/codependent and put in a group for pression, as well as chemical-abuse problems in "women who love too much." As noted earlier, response to ongoing trauma. Some develop post- many battered women may display characteristics traumatic stress reactions. These are real symp- consistent with codependency theory. While toms that need attention, but within the context many women who do these things are simply of trauma. A common mistake is to move toward acting on overwhelming female socialization (Ha- medication immediately, in the name of stabiliza- gan, 1993), battered women also do them to sur- tion. What care providers may forget is that do- vive. It is important for therapists to recognize mestic violence victims need all their faculties, client behavior within the context of real trauma. and that certain drugs may impair their ability to Domestic violence victims have no less desire to perceive imminent danger and react to it. Further, live than nonabused women. Their behavior is many are unaware of the correlation of domestic almost always strategic, albeit puzzling to out- violence with suicide. One study found that one siders. The real tragedy is to label compliance out of four female suicide attempts was preceded with the abuser as codependency, when, at least by abuse (Heise, 1993). Unfortunately, many in that moment, it may be the only thing that kept therapists are so focused on these symptoms, they this person alive long enough to get to the therapy forget that they may be the only ones who can office. These behaviors are survival-based while help victims navigate the community systems with a dangerous mate, and will need to be they need to get safe. A therapist may be the adapted once the survivor is safe. A strength- only one to give the domestic violence victim the based therapy approach will help the domestic number to the local shelter. violence victim to see how skillful she was while Many mental health practitioners continue to em- in the unsafe situation, and will help her to adapt ploy contraindicated modalities, such as couples to behaviors more centered on her own needs counseling, that do not address the victim's needs later, when it is safe to do so. Walker (1994) and may endanger her. Some still see domestic refers to this approach as survivor therapy. violence as a relationship issue much like many Finally, the area of psychological evaluation used to see rape as a sexual issue. The reality is often poses formidable barriers to battered that marital/relationship therapy endangers victims, women. Standardized tests such as the MMPI does not address the behavioral problems of the are often administered on battered women in the abuser, and does not succeed in getting the violence context of custody evaluations by individuals who to stop (Bograd, 1984). Many battered women re- are not aware that victims of trauma will score port going into sessions with the abuser, making false positives on some scales (Rosewater, 1985). disclosures about the abuse in response to the thera- Unfortunately, the results of these tests often lead pist, and getting beaten on the way home from psychologists to conclude and eventually portray the session, sometimes while still in the counseling to the court a victim who is angry, paranoid, facilities. Victims are also routinely pulled into con- psychotic, and/or highly conflictual. These con- joint modalities in the context of chemical-depen- clusions are often the cornerstones of court deci- dency treatment for their abusive partners. While sions about whether her abuser gets custody of treatment of all family members is the norm in her children. As noted by Liss and Stahly (1993), chemical-dependency treatment, it is a strategy that the effect of abuse on an individual's ability to can undermine the safety of battered women. The parent is rarely considered by courts when deter- aforementioned risks that come with disclosure oc- mining custody. Therapists conducting psycho- cur here as well, and there is a danger she will be logical examinations need to become familiar pulled into seeing him as having a "disease," and with the pitfalls of using standardized tests on will consequently feel responsible to aid in his re- both victims and abusers, and establish other covery. The tendency of some battered women to means of assessment. remain with, and feel responsible for, their chemi- cally-dependent, abusive partners becomes less baf- Physical and Cultural Accessibility to fling to care providers in light of the common use Shelters/Services of treatment strategies that support such feelings for The system of protective shelter in the United abusers, no matter how much danger they may pose States evolved beginning in the late 1970s. The for the victim. groundswell of domestic violence victims who

490 Intervention with Battered Women now seek shelter continues to increase every year, tered women defend themselves with weapons to while beds do not. Many domestic violence shel- offset size and power differences between them- ters, to the horror of those victims who finally selves and their attackers, often resulting in seri- muster the courage to leave, have waiting lists. ous injury to the primary aggressor. Programs Therapists need to have information about many in states with newly adopted mandatory/proarrest different shelters in their state so that they can statutes report that primary aggressor assessments effectively link a client to a shelter in a crisis. are difficult, and sometimes officers arrest the Therapists may also want to consider the theoreti- victim. Domestic violence agencies report that cal orientation guiding services at shelters to battered women are being arrested, sometimes which they refer, as these will vary. even with visible injuries inflicted upon them, While this model may have a separate applica- such as concussions, broken bones, and head in- tion for understanding the barriers to well-being juries requiring stitches. Unfortunately, some faced by any person marginalized by physical shelters now have policies that refuse admission abilities, ethnicity, or sexual orientation, within to victims who have been arrested, regardless of this application these factors pose additional con- whether they were defending themselves. Thera- crete barriers to domestic violence victims. Ac- pists need to understand what the admission crite- cessibility, while potentially a barrier to all vic- ria are for shelters in their own community and tims, is a larger concern for marginalized groups. perhaps engage shelter policymakers in a dialogue. Discrimination. Often due to ignorance, cer- Language. Many police departments still re- tain victims encounter difficulty accessing shelter spond without language interpreters to 911 calls services. Some programs have policies that offi- from victims who are deaf or hard of hearing or cially or unofficially do not admit prostitutes, nonEnglish speaking. Many social service agen- HIV-positive victims, and women who have cies, including shelters, do not have TTY ma- physically defended themselves. Chemically de- chines. Deaf and hard-of-hearing victims, and pendent and mentally ill victims are also often those who do not speak English, often find their not admitted to shelters, either due to ignorance children must serve as interpreters for them to or inadequate staff resources for addressing these call crisis lines and have intakes at shelters. This additional needs. reliance on child interpreters poses problems be- This also occurs with many lesbian victims yond the obvious impact of exposure to all of who are often officially or unofficially unwelcome the details of the abuse of their mothers and the at some battered women's shelters by either staff, responsibility placed on them. If children who other clients, or both. Because the abuser is also translate for their mothers later disclose allega- female in these cases, many lesbian victims fear tions of physical or sexual abuse, they are often the abusive partner will get admitted to the shelter suspected of being coached because of their ad- posing as a victim. Lesbian victims also face the vanced language skills. Therapists working with the choice of coming out, or lying about who the children of such women need to explore how much abuser is. Because coming out may pose the threat responsibility has been placed on them due to the of loss of job, housing, family support, and child language barriers of their abused mothers, and con- custody, many choose to lie about the gender and sider their adult-like language in this context. identity of the abuser, and forgo any protection Battered women who do not speak English the legal system might afford as a result. often have limited access to support groups or Battered women who have been arrested also court because of the lack of interpreters. De- face discrimination and difficulty getting into pending on how rare the language requiring trans- some shelters. As states adopt proarrest policies, lation is in a particular community, the only trans- some which require that one of the two parties lators available may be people the victim and be taken to jail, many battered women are being abuser know, thus potentially impeding trust and arrested for self-defense. This often occurs in possibly further endangering the victim. Thera- choking/strangulation cases, where the victim has pists working with clients who face language bar- no visible injuries until later (and then only detect- riers need to become familiar with translator re- able by trained officers) and the real offender is sources and the dynamics of using them in often covered with scratches and marks inflicted these cases. by the victim while being choked. Police officers Physical barriers. Most domestic violence may also make arrest errors in cases where bat- shelters in the United States opened in the late

491 N. Grigs by &B. R. Hartman

1970s to early 1980s, often in old houses. Many neighborhood. She reconciled with a very danger- are not accessible to victims in wheelchairs or ous partner, explaining that the predictability and those who need assistance getting around. Many familiarity of his violence was preferable to un- use bunk beds to increase capacity. Even with the predictable attacks by strangers. Americans with Disabilities Act, these and other In summary, most battered women face sev- agencies the victim may need are often not acces- eral, but usually not all, of the barriers outlined sible to individuals with particular handicaps. here. The presence of these barriers requires that While some shelters have contracted with local the therapist working with battered women be hotels or motels to provide access, many have willing to step out of the therapy role to educate not. For the victim in a wheelchair, or with an herself or himself about public policy and law, illness that requires care, often the choice is be- provide information, case management and advo- tween an abusive caretaker and independence in cacy for her or his clients, and become a force substandard living conditions. Other resources, for systems change when it is required for the such as disability agencies, should be explored safety of clients. as potential referral sources as well. Culture. Women of color, foreign-born women, Layer 2: Barriers Due to Family/Socialization/ and women who are not from the majority culture Role Expectations may be admitted to shelter programs only to find In working through this layer of barriers, sev- a monoculturally-based menu of services. Most eral factors within the battered woman's life need domestic violence programs center around coun- to be considered including: female socialization in seling (usually with a person from the majority patriarchal culture, individual and societal values culture), support groups (where the battered and attitudes, personal identity, religious beliefs, woman of color may be the only person of her and rules learned within one's family of origin. ethnicity), and legal services. This last option First, consider the impact of female socialization ultimately relies on the police for enforcement of in the context of patriarchal culture. orders from the court. Many victims of color find their mistrust of the police not understood by shel- ter workers who see protection orders as the foun- Values/Beliefs about Relationships dation of safety. The psychology of women has provided im- Immigration. Battered immigrant women face portant examples of how women's relationships, additional cultural barriers and legal barriers. behaviors, attitudes, and beliefs are shaped by the Many of these women are undocumented. Be- demands and threats of the dominant patriarchy in cause some shelters require that victims have a which women live (Debold, Wilson, & Malave, job or apply for public assistance, undocumented 1993). Gilligan, Rogers, and Tolman (1992) have victims often face the choice of violence or tem- suggested that when adolescent girls encounter porary shelter followed by deportation. Thera- this wall of patriarchy, they learn to give up parts pists need to know the shelter policies before re- of themselves in a compromise for safety and ferring battered, immigrant women. Also, while acceptance within society. This compromise often federal immigration law has recently changed to results in girls and women looking to men to increase protections for battered women, thera- validate their own personal authority (Young- pists working with this population should become Eisendrath & Widemann, 1987). As a result, familiar with local immigration legal resources. many women have been socialized to believe that Affordable housing. The lack of affordable and they need a man to have value. Minimally, safe housing can be a barrier for domestic vio- women learn to develop their identity in the con- lence victims who often can only stay in shelters text of relationships; few role models exist for for 30-90 days, regardless of the availability of the autonomous development of female identity. transitional or permanent housing. Many find the To survive in this system of dominance (Hagan, only affordable housing is in high-crime areas 1993), many women learn to put themselves last. where they and their children face further trauma They learn to sacrifice their needs for those of from strangers. One battered woman, counseled their partners or their children. For battered by the first author, was raped by a neighbor only women who have made this compromise, asking weeks after leaving the shelter to move into a them to leave their abuser is asking them to leave minimally secured apartment in a high-crime that which they may believe they need to survive.

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Identity landscape. Contemporary culture also romanti- All women straggle to form healthy identities cizes jealousy and obsession, even naming in a patriarchal society. Forming a sense of per- women's colognes after these concepts. As a re- sonal identity is often an even more daunting chal- sult, many women believe that a certain level of lenge for battered women. Attempting to placate jealousy or obsession is merely confirmation of an abusive mate often requires one's full atten- their desirability and an indication of their part- tion. Little time is left to be introspective about ner's commitment. Therefore, it is likely that bat- one's own wants, needs, or dreams for the future. tered women have come to expect abuse, in some Indeed, doing so often only serves to remind bat- form, in their lives. The following questions need tered women of the sharp contrast between their to be considered: What does this woman believe dreams and the harsh reality of abuse. about violence?; Does she perceive it to be a In addition, the well-noted isolation battered normal part of a relationship?; Is it acceptable as women experience often forces them out of the long as her mate does less damage to her than workplace, out of old friendships, and away from her father did to her mother?; Is jealousy from a alternate sources of support. As a result, the vic- mate validation that she is loved and desired or tim's relationship with the abuser may be the only a sign of danger?; Is divorce wrong?; and Are significant relationship in her life. Many battered children better off with any father, even a violent women have been brainwashed for years by the father, rather than no father? abuser to believe they are incapable of surviving Religious Values/Beliefs on their own, mirroring potent cautionary mes- sages in the culture about the ability of any Deeply held religious beliefs also enter the pic- woman to survive on her own. Asking a battered ture when working with women through the barri- woman to give up that relationship may be asking ers found in this layer. For many, religion pro- her to do what feels impossible. These ingrained vides guidance, reassurance, and hope. Battered messages about needing to be in a relationship women may benefit from strong ties within a and needing male protection represent examples church, synagogue, or temple. Care providers of barriers experienced in the second layer. who are able to align themselves with these built- To be most effective in removing the barriers in support systems are likely to increase their battered woman face as a result of their socializa- effectiveness with this population. Unfortunately, tion, care proviers are encouraged to explore the patriarchal beliefs are often reinforced in religious following areas: What does this client believe institutions that tell women to obey their husbands about living without a partner?; What does she as their husbands obey God, and refuse to sanc- believe she can accomplish on her own?; What tion divorce despite knowledge of abuse within does she believe about putting herself first, before the family. Part of moving through this layer of what her abuser or her children want?; and finally, barriers means exploring the following religious Who does she believe she is, or can be, if she is beliefs: Is it ever acceptable within this woman's not in this relationship? The answers provided by faith to end a marriage?; Does she believe God clients to these questions allow care providers to expects her to love, honor, and obey her mate gain insight into how to work with this client to despite the violence?; and Does she believe God overcome these barriers stemming from social- would never give her more to deal with than she ization. could take? Values/Beliefs about Abuse Family of Origin Values/Beliefs Another crucial area of exploration in Layer 2 Finally, it is important to consider the impact is the client's own values and beliefs about vio- of rales learned in the battered woman's family lence. One result of socialization into American of origin. According to Debold et al. (1993), im- society is a desensitization to violence. Meidzian portant information on values, ethics, and the (1991) articulates the concern that American soci- world in which we live is passed on from one ety accepts, and in fact, encourages violent be- generation of the family to the next. Few would havior in men and boys. She contends that though argue the contention that the family provides the it is known that most acts of violence are commit- stage for socialization into society. Therefore, ted by men, this knowledge is often taken for care providers working with battered women must granted because it is so much a part of our mental understand the family rales from which women

493 N. Grigsby & B. R. Hartman are operating. What rules from her upbringing will several injuries in various stages of healing. Some she be breaking if she leaves this partner? What develop stress-related illnesses. Others suffer bar- will the consequences be from her family of origin riers related to serious head trauma such as mem- if she prioritizes her safety above her marriage? By ory impairment. Victims who experience ongoing exploring these rules, care providers can work with, injury lose touch with their physical being, often rather than against, these long-held beliefs. resulting in their not seeking needed medical In summary, even once the barriers in the envi- treatment. All of these experiences drain the vic- ronment (Layer 1) are removed, battered women tim's physical resources and become barriers to face countless obstacles due to family, socializa- her having the kind of energy needed to manage tion, and role expectations. While advocacy, case escape and safety. Therapists working with se- management, and social action are required to verely battered women can enhance the therapy address the barriers in the first layer, this second process by helping the victim focus on her physi- layer of barriers requires alliances, support sys- cal needs to heal and rest. tems, and consciousness raising. Care providers may best facilitate movement through these barri- Psychological Consequences ers by assisting battered women's efforts to link, Walker (1994) described a host of typical psy- both formally, in the form of support groups, chological consequences of ongoing battering. and informally, by reaching out to neighbors and Most common are anxiety, depression, self-doubt friends, with other survivors of abuse. In addi- and self-blame, eroded self-esteem, and memory tion, care providers may wish to align themselves impairment. Many victims report feeling as if with progressive religious leaders in the commu- they are "going crazy," often resulting from the nity to establish community-based support for batterer's use of emotional abuse tactics geared women trying to escape violence, for whom spir- to undermine her sense of herself. Victims also itual guidance is important. Most importantly, report feeling crazy as a result of mixed messages care providers need to be patient and nonjudg- from helping professionals. Those experiencing mental while working through this layer of barri- years of abuse may begin to live long periods ers. Beliefs that have taken a lifetime to develop of their lives in a crisis state. Others develop do not change in one session or after one assault. chemical-abuse or dependency problems in at- Many may also be culturally based, making them tempts to numb the terror or other overwhelming more ingrained and intrinsic to identity, and more feelings. Almost all survivors of ongoing abuse difficult to let go of in a time of crisis. have minimal emotional resources left by the time Layer 3: Barriers from Psychological they need them the most: when they are trying to Consequences of Violence escape for good. Defense Mechanisms Isolation Domestic violence victims exposed to high lev- Many battered women lose family ties and els of trauma experience terror. A number of com- friendships as their relationships progress. It is not plex defense mechanisms can develop in response uncommon for abusers to be hypercritical of poten- to terror, most commonly minimization of danger tial supporters, discouraging or even forbidding that and denial. While these defense mechanisms the victim see them. Sometimes, the people who allow the victim to psychologically survive terror, care about her do not understand why she is with they act as barriers by impairing her ability to the abuser or they are afraid of him. Sometimes, judge how much danger she is in. Dissociative the abuser is so charismatic that they do not believe responses such as numbing also play this role. her. Over time, especially if friends and family have supported earlier separations, contact stops or Physical!Somatic Results becomes minimal. Eventually, the victim becomes Victims often report sleep deprivation resulting emotionally isolated from others. Sometimes, no from the abuser keeping them up all night with one knows how dangerous the abuse has become. assaults and arguing, or from ongoing vigilance Therapists need to understand the key role isolation on the victim's part in preparation for anticipated plays, and work with the victim to get involved in assaults. Victims in advanced battering situations a support group with other battered women as an are often injured for long periods of time, with adjunct to individual therapy work.

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Brainwashing complex response to severe trauma are often emo- An overview of Amnesty International's docu- tionally depleted by nightmares, intrusive recol- mentation on and Biderman's Chart lections of violent assaults, and so on. Posttrau- of Coercion (NiCarthy, 1986) gives a quick un- matic Stress Disorder (PTSD) is both an effect of derstanding of the complexity of barriers created domestic violence and a barrier to escaping it; by the nonphysical abuse many victims experi- managing PTSD symptoms takes energy, skill, ence. A number of tactics are common such as and often the support of a skillful therapist with humiliation/degradation, trivial demands, demon- expertise in this area. stration of power and threats, exhaustion, occa- Layer 4: Barriers from Childhood Abuse and sional indulgences, emotional distance, and Neglect Issues "crazy-making." In addition to the cognitive and Childhood trauma or neglect sets the stage for, psychological effects of brainwashing, isolation and increases the power of, the barriers in each often ensures there is no other source of informa- of the other three layers. tion that will contradict these messages. Thera- pists need to assess the severity and forms of Early Messages about Abuse and Safety emotional abuse that occurred and help the victim As noted previously, it is within the family that answer the confusing messages she may believe children first learn what to expect from people, about the abuse and about herself. how to communicate, and how to handle emotions (Debold et al., 1993). As Burstow (1992) ex- Compliance Strategies/Stockholm Syndrome plains, family members are trusted figures. Victims exposed to severe and life-threatening When these trusted figures abuse children in abuse, combined with acts of kindness can de- their care, children assume that anyone is capa- velop complex reactions described as Stockholm ble, and perhaps entitled, to abuse them. Chil- syndrome (Graham & Rawlings, 1991). Victims dren experiencing abuse within their own experiencing such abuse dynamics, in addition to homes or in the homes of trusted individuals many of the barriers outlined above, can become learn that there is no escape. They learn that hypervigilant on behalf of the abuser, adapting danger is always present (Burstow, 1992). Our his world view as their own as a strategy to emo- clinical experience tells us that children most tionally and physically survive. Even victims not often have small worlds. They are surrounded showing full Stockholm symptoms can experi- by a limited number of people and have had few ence abuse so severe that they become locked experiences. When a child's tiny world betrays into compliance as a strategy to survive. The her, teaching her that she is unsafe and her emo- abuser often blames the abuse on her, by saying tions do not count, she has no other reality to she's too fat, too thin, not smart, dinner was late, counteract that lesson. For survivors of child- the kids are too loud, she spent too much money, hood trauma, adult partner violence merely con- and so on. This litany of complaints and blaming firms an already suspected world view. is reinforced with trivial demands and physical Care providers working with battered women assaults. The title of an early film about domestic who have histories of childhood trauma are likely violence in the 1980s called Too Much Salt in the to notice that these women often have an impaired Beans, underscores this dynamic. As a result of ability to judge the trustworthiness of others. this constant criticism, the victim engages in strat- Often the internal radar system of these women egies to change these factors that have been iden- has quit functioning; in cases of early abuse it tified as the cause of the abuse. These excuses may have never developed. Care providers are that blame the victim always change, keeping her encouraged to explore the following areas: Was busy trying to fix herself until she eventually sees her abuse or neglect as a child such that she never that the abuse does not originate with her. Thera- learned how to perceive danger from others?; pists working with domestic violence victims Does she need concrete help in recognizing when must address the general misplacement of respon- the abuse is escalating?; and Can she see when sibility that is so common with this population. people pose a threat to her children? Posttraumatic Stress Disorder (PTSD) Psychological Consequences Posttraumatic stress reactions occupy a great A wide array of long-term effects have been associ- deal of emotional energy. Victims suffering this ated with childhood abuse and trauma, including: de-

495 N. Grigsby & B. R. Hartman pression, anxiety, eating/body image issues, sexual viders appreciate the complexities of the barriers faced dysfunction, dissociative reactions, personality disor- by this population. Intervention aimed at the barriers ders, posttraumatic stress reactions, and substance in Layer 4 is best facilitated by working alliances abuse (Read, 1997). Clearly, women who enter into among the victim, her advocate, her therapist, and adult relationships carrying these effects of childhood other reliable people within the victim's support sys- trauma are vulnerable to further abuse. When old tem. Therapists should also consider the potential pos- trauma is unresolved and new trauma is occurring, the itive benefits of getting the client involved in an adults- victim's childhood feelings can magnify the current abused-as-children group with peers who share her emotions about abuse. Events in the present that are abuse experiences. When evaluating such resources similar to old trauma can trigger overwhelming emo- for clients, therapists should note that some such treat- tional responses to current abuse that can become ment groups construe the effects of childhood trauma immobilizing for the survivor. as codependency, that may undermine the victim's Additional effects of childhood trauma that ability to benefit. may be interfering with the woman's abilities to stay safe include dissociative reactions and long- Discussion standing mental health problems stemming from As with most contributions to feminist theory, early abuse or neglect. For victims who have had this model was developed in practice before the- a life of abuse, the moments of love, tenderness, ory. The authors are in the preliminary stages of and attention from this abusive mate may be the considering how this theory might apply to other first in her life. She may need these so deeply marginalized populations, specifically, people of that the need outweighs the possible risk, if she color, sexual minorities, and economically de- is able to perceive the risk at all. This becomes prived individuals. As pointed out by Brown particularly powerful if the level of abuse in the (1994), all forms of oppression within a patriar- current relationship is not greater than earlier chal structure are linked at the root. The authors abuse she has survived. believe that this model contributes to an integrated Thorough understanding of these issues in- analysis of oppression (Brown, 1994; Kanuha, volves considering the following questions: Is the 1990) that may be useful in working with a wide interaction between old and current abuse so over- variety of marginalized individuals. whelming that she is dissociating?; Was the abuse The Barriers Model presents an alternative con- so severe or perpetuated so many times by so ceptual framework for understanding and work- many abusers that she knows nothing but abuse?; ing with battered women and therapeutic strate- Is she so eroded by her old abuse experiences that gies to best address their needs. By moving the she will risk her life for the small episodes of love initial therapeutic focus away from psychological and tenderness she receives from mis mate?; and factors to an analysis of primary environmental Was her childhood abuse so severe that it resulted in barriers, this model helps therapists understand long-term mental health problems (e.g., depression, the behavior of battered women previously attrib- anxiety, or personality disorders) that have now uted to more pathological factors such as depres- created a second presenting problem and a serious sion, tendencies toward self-defeat, codepende- barrier to her ability to escape? ncy, and clinical resistance. The model takes into Care providers working with this population of account the whole of the battered woman's expe- battered women need to carefully assess several rience, including community barriers as well as areas in helping them secure lasting safety. For more internal factors such as female socialization, example: Are old experiences with abuse and ter- family of origin, psychological consequences of ror compounding and magnifying this woman's trauma and unresolved childhood abuse and ne- responses to similar events as an adult?; Are child- glect issues (see Figures 1 and 2). This model is hood messages about her worthiness and value im- based on a foundation that asserts that even these pairing her ability to expect anything different from more internal barriers have their roots in an exter- adult partners?; and Did childhood abuse or neglect nal cultural and social context. experiences interfere with her development of skills The training we receive to prepare us for helping she now needs to escape this abuser? individuals through emotional problems rarely in- Battered women with histories of childhood abuse cludes information specific to the phenomenon of and neglect are often extremely challenging for care domestic violence, sexual abuse, and trauma in gen- providers. Assessing all of these areas helps care pro- eral. Yet, a significant portion of any private prac-

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Layer 1: Barriers in the Environment policy and law in the area in which they practice, to Information/misinformation engage in interdisciplinary intervention, to provide Batterer information, linkage, case management and advo- Money cacy for battered clients, to help build a coordinated Transportation Police assistance community response through participation on local Criminal justice system task forces, and to become a force for change in Attorneys their own communities. Religious counseling/guidance Mental health system References Physical and cultural accessibility to shelters/services BOGRAD, M. (1984, October). Family-systems approach to Discrimination wife beating: A feminist critique. Paper presented at the Language barriers the annual meeting of the American Orthopsychiatric Asso- Physical barriers ciation. Toronto, Canada. Cultural barriers BROWN, L. (1994). Subversive dialogues: Theory in feminist Immigration issues therapy. New York: Basic. Affordable housing BURSTOW. B. (1992). Radical feminist therapy: Working in Layer 2: Family/Social/Role Expectations the context of violence. Newbury Park, CA: Sage. DEBOLD, E., WILSON, M., & MALAVE, I. (1993). Mother- Values/beliefs about relationships daughter revolution: From good girls to great women. New Identity York: Bantam. Values/beliefs about abuse GILLIOAN, C., ROGERS, A., & TOLMAN, D. (1992). Women, Religious values/beliefs girls, and psychotherapy. New York: Haworth. Family of origin GRAHAM, D., & RAWUNGS, E. I. (1991). Bonding with abu- Layer 3: Psychological Consequences of Violence sive dating partners: Dynamics of Stockholm syndrome. In B. Ledy (Ed.), Dating violence: Young women in danger. Defense mechanisms HAGAN, K. L. (1993). Codependency and the myth of recov- Physical/somatic results ery. In K. L. Hagan, Fugitive information: Essays from a Psychological consequences feminist hothead (pp. 27-39). New York: Pandora. Isolation HEISE, L. (1993). Gender violence as a health issue. In Brainwashing Women's Actions Coalition (Ed.), The facts about women. Compliance strategies/Stockholm syndrome New York: The New Press. PTSD KANUHA, V. (1990). The need for an integrated analysis of Layer 4: Childhood Abuse/Neglect Issues oppression in feminist therapy ethics. In H. Lerman & N. Porter (Eds.), Feminist ethics in psychotherapy (pp. Early messages about abuse and safety 24-36). New York: Springer. Psychological consequences of childhood abuse/neglect Liss, M., & STAHLY, G. (1993). Domestic violence and child custody. In M. Hansen & M. Harway (Eds.), Recovering Figure 2. Summary of Layers in The Barriers Model from battering: Family therapy and feminism (pp. 175— 187). Newbury Park, CA: Sage. METDZIAN, M. (1991). Boys will be boys. New York: Doubleday. NiCARTHY, G. (1986). Getting free: You can end abuse and tice, or general, public mental health agency ser- take back your life. Seattle, WA: Seal Press. vices will be provided to individuals living with READ, J. (1997). Child abuse and psychosis: A literature re- view and implications for professional practice. Profes- the current or residual effects of these problems. sional P sychology Research and Practice, 28(5), 448—456. Because we are trained within a model that empha- ROSEWATER, L. B. (1985). Schizophrenia, borderline or bat- sizes the inner psychological structure of the client, tered. In L. B. Rosewater & L. E. A. Walker (Eds.), we are trained to look away from that which must Handbook of feminist therapy: Psychotherapy for women (pp. 215-225). New York: Springer. be focused on in these cases. Until we can place STARK, E., & FUTCRAFT, A. (1982). Medical therapy as repres- the victim of interpersonal trauma within a social, sion: The case of the battered woman. Health and Medicine, economic, and political context, we are forever lim- Summer/Fall, 29-32. ited to a disease-model approach. SUGG, N. K., & INUI, T. (1992). Primary care physicians The Barriers Model poses a challenge to those respond to domestic violence: Opening Pandora's box. Journal of American Medical Association, 267(223), 3157- therapists working with this population in that it 3160. presents a call for a paradigm shift. Not only does WALKER, L. (1994). Abused women and survivor therapy: A the model present an alternate view of the battering practical guide for the psychotherapist. Washington, DC: and escape process, it presents an alternate model American Psychological Association. YouNG-EisENDRATH, P., & WIDEMANN, F. (1987). Female for therapy. Full use of The Barriers Model requires authority: Empowering women through psychotherapy. therapists to expand their role beyond traditional New York: Guilford. definition, to become educated about local public

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