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 Domestic Violence 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 codependency 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