I’ll never forget the evening I went out to get my mail and had somebody else’s flashback. While I had a trauma history, the vision that had just swooped in from the darkness and jarred me to fear for my immediate safety had never happened to me. I felt like I had been struck from inside, and froze with my mail in my hand. I looked all around and found only shrubs, locked up bicycles, and trash cans. What I had just seen didn’t fit with my story and I wondered if I was losing it. My abusive ex-boyfriend used to tell me I had a mental health condition whenever I was upset with him. Had he been right? Once I had hurried back into my apartment and reoriented, I realized I had conjured the sight of my client’s abuse. As a second year MSW student, I was providing individual therapy at a sliding fee community mental health clinic. Most of my clients were women who had significant trauma experiences. Some were currently in abusive partnerships. I identified with the woman whose trauma intruded into my consciousness but had never anticipated that I would begin to somehow live her past. At the same time, I believe the experience benefited the treatment. She seemed to think I really got it at times. I certainly grew as a therapist. It was a valuable example of countertransference that helped me grow as a therapist.
According to the CDC’s National Intimate Partner and Sexual Violence Survey (NISVS), approximately one in four women and one in ten men experience contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime (CDC, 2020). Domestic violence includes manipulation, threats, undermining, and coercive control that can involve forcing use of alcohol and other drugs and preventing individuals from getting mental health care and substance use disorder treatment (NCDVTMH, 2014). Surges in domestic violence have been documented during prior catastrophes, and the Covid-19 pandemic social isolation requirements seem to have led to increased risk of new or escalated violence (Kofman & Garfin, 2020). Counselors who work with domestic violence survivors may experience the same feelings of traumatization, anger, and helplessness that their clients feel. These parallel process dynamics, or induced countertransference have led many practitioners to seek more consultation, supervision, education, and support (Beckerman, 2018).
In addition to strained systems of care, many survivors will face further health inequities of racism, poverty, and discrimination due to sexuality, gender identity, and disability (Hegarty et al, 2020). The deck is stacked and that’s the truth. Let your clients know you know it. They have likely been failed before and may not trust you. Be mindful of your own use of power when working with your Intimate Partner Violence clients and develop a collaborative dialogue.
As my career progressed, I learned to leave stories and their visual impressions at work and generally maintain boundaries for my home and personal life. Maybe I should write a psychological thriller involving time warps and identity confusion. Whose story is this? Who am I this time? It’s been déjà vu for centuries. For now, I just continue to provide therapy and enjoy the company of my dogs.
One of the best things you can do for your clients is to take good care of yourself. A truly ethical practice demands it. They say your work cannot be better than your instrument. Take care of you. Keep your voice, stay in your truth. Have a reflective practice and seek feedback. Find your co-conspirators and hatch cunning plots. Be selective about media and entertainment consumption. How many images do you need rattling around in your brain? There’s better mind food. When did beating and raping people become art? Some violence can be turned off. Really, who needs it.
It’s a long haul, a journey, so invest in the relationship and pace with your client’s stage of change. They may have difficulty practicing good self-care due to having been made to feel like trash by their violent partner. Stay in there, hold out hope, and tolerate frustration. Some of your clients may view you as powerless and ineffectual as they feel. Act like you can handle it, be strong and accepting. Just be happy they’re still there talking with you. Survival is defiance so help your rebel yell. And if you are one, (what are the odds) you have something to say, don’t you?
References
- Beckerman, N. (2018). Domestic violence shelter counselors: Implications for clinical supervision. Journal of Anxiety & Depression, 1(2).
- CDC National Center for Injury Prevention and Control Division of Violence Prevention. (2020). Preventing intimate partner violence. CDC. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html
- Hegarty, K., McKibbin, G., Hameed, M., Koziol-McLain J., Feder, G., Tarzia L., et al. (2020). Health practitioners’ readiness to address domestic violence and abuse: A qualitative meta-synthesis. PLos ONE, 15 (6), e0234067.
- Kofman, Y. B., & Garfin, D. R. (2020). Home is not always a haven: The domestic violence crisis amid the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S199.
- Warshaw, C., Lyon, E., Bland, P. J., Phillips, H., & Hooper, M. (2014). Mental health and substance use coercion surveys. Report from the National Center on Domestic Violence, Trauma & Mental Health and the National Domestic Violence Hotline. National Center on Domestic Violence, Trauma & Mental Health and the National Domestic Violence Hotline.
