||Violence Hits Home: Comprehensive Treatment Approaches
to Domestic Violence
||Sandra M. Stith, Mary Beth Williams, and Karen Rosen
||Praeger Publishers, ©1997
Springer Publishing Company
New York, NY 10012
This 363-page book is an overview of treatment approaches in dealing with
various forms of domestic violence — spouse abuse, child physical and sexual abuse,
elder abuse, and treatment of adults molested as children. The contributors to
the book include family therapists, social workers, psychologists, and human
service workers, and the emphasis is on practical rather than theoretical
aspects of intervention. The authors do not present a unified perspective on
treatment approaches, illustrating the influences of their own educational and
experiential backgrounds, although they tend to reinforce some basic treatment
The first chapter addresses some theoretical aspects of intervention. It offers
a definition of domestic violence, identifies factors which might influence its
occurrence, and explores which families may be more susceptible to violence. It
describes an interactive model in which individual and family vulnerabilities,
resources, and stressors interreact within the greater socio-cultural context to
contribute to or inhibit domestic violence.
The remainder of the book is in six parts, each focusing on a specific treatment
Part I contains four chapters on the treatment of spouse abuse. There are
chapters on crisis intervention, treatment of abused women, treatment of
spouse-abusing men, and family therapy.
Part II covers the treatment of physical child abuse. Chapters discuss the use
of multidisciplinary teams, working with unmotivated clients, abuse of
adolescents, and models of community coordination in treating abused and
Treatment of child sexual abuse is addressed in Part III. There is a chapter
describing a cognitive-behavioral approach in treating incest families. Other
chapters address the multidimensional role of therapists working in this field
and nonverbal treatment methods.
Part IV discusses the treatment of adults molested as children. In one chapter
an incest survivor tells her own story, and this is followed by her therapist's
account of specific issues relating to her treatment process. Another chapter
claims that adults seldom spontaneously disclose a history of sexual abuse, and
advocates exploring the possibility with all psychotherapy clients.
Part V discusses assessment and treatment of elder abuse and neglect.
The final section offers a model for assessing and treating victims of domestic
trauma of various forms. Abuse victims are identified as suffering from variants
of the posttraumatic stress syndrome. It argues that treatment must involve
eliminating a client's denial of the trauma suffered, and that healing can only
occur after a client has integrated memory fragments into whole memories and re-enacted the event in a safe environment. Empowerment of clients and enhancing
self-esteem are two other identified goals of treatment.
Although covering a broad range of treatments for various forms of domestic
abuse, this book is not a comprehensive overview of current therapeutic
approaches. In the chapters on child sexual abuse, there is generally an
assumption that all cases referred for treatment will be genuine. There is no
discussion regarding the possibility of false allegations.
In the chapter on treating child victims of sexual abuse, Shelley Kramer-Dover
emphasizes that disclosure of sexual abuse is usually piecemeal, and may only be
revealed after some time in therapy. She advocates the use of play and art
materials, including anatomical dolls, for evaluation and treatment, and
supports mandatory reporting of suspected abuse. It appears that she sees no
conflict in the same person performing interrogations for court evidence and
providing ongoing therapy for abuse. Parental disbelief and denial may call for
removal of the child into foster care.
Jana Stanton's chapter on non-verbal treatment advocates using creative art and
acting out scenes with
puppets and dolls so that the child can relive the experience "in small safe
steps, much as in remembering a dream." She suggests encouraging children to
vent their anger towards the perpetrator or nonprotecting parent, for instance
by thumping or stamping on clay.
The chapter on adult survivors of incest advocates professionals actively
pursuing disclosure of belief, which clients will tend to deny.
Throughout this book, most of the references cited are books and papers written
within the mainstream abuse network. There is little or no evidence that any of
the literature which challenges conventional abuse ideology has been considered
by the authors.
There are two chapters which offer a different perspective. Linda Little's
contribution on Gestalt therapy with battered women advocates a treatment aimed
at women taking full responsibility for themselves. The goal of the therapist is
to facilitate the client to behave maturely, perceiving her options and making
decisions, and being able to ask for what she wants. I found this a
refreshing change from the more common course of supporting women and
children in the role of powerless victim, and encouraging them to distrust
and blame men.
Barry McCarthy also describes an interesting approach to treating incestuous
families, using a cognitive-behavioral model. He advocates a therapeutic (not
legal or adversarial) approach, working with the entire family. It is the
husband and wife's decision as to whether they wish to keep the marriage and the
family together. The therapy aims to restore the bond of respect, trust and
intimacy between the parents. Each person in the family must assume
responsibility for his or her behavior, including sexual behavior, and the
family is restructured to prevent any further inappropriate sexual activities
occurring. The treatment is formally terminated with an apology session by the
offender and nonprotecting parent. The children are told that once they have
accepted the apology, they may no longer use incest as a way of asserting power,
blame or control in the family.
This appears to be an excellent model for establishing a healthy functioning
family. Generally, however, this book expounds some of the basic assumptions of
the contemporary sexual abuse field: that all child/adult sexual contact is an
act of violence; that children seldom disclose spontaneously or fully and
require encouragement from a therapist to admit abuse; and that therapy should
aim at recovering and reliving traumatic memories until they "can eventually be
laid to rest."
This book is targeted at workers in the family violence field. With a few
exceptions, it offers very little that has not previously been said by other
Reviewed by Felicity Goodyear-Smith, General Practitioner, Wrights Road RD 2,
Albany, New Zealand.