Is family therapy recommended where there has been domestic violence?

July 3, 2015 8:51 PM

When a child is in therapy, is it recommended to have parent meetings with the therapist if one of the parents has a history of violence toward the other?

My friend has a child who has some complex needs. The child sees a psychologist to help with these issues. The psychologist is apparently amazing and my friend has learned a ton and her child has made lots of progress. The psychologist insists that both parents come to meetings with the psych 1-4x a month, where they can go over the challenges the parents are having with the child, collaborate on strategies for turning things around and so on.

My girlfriend says that she initially told the psych she was very reluctant to do joint sessions. The child has been in other therapies in the past and my friend always had no problem getting therapists to set up separate meetings for mom and dad. In fact, early on, when her ex insisted on doing only joint sessions, the then therapist became very concerned about that.

My friend has repeatedly told the psych that these joint sessions are highly triggering and feel like torture. Some of the situation have brought up discussion of neglect situations and skills deficits - words the psych has used to describe her ex. Moreover, during this timespan, her ex has started becoming abusive (again) outside sessions and it got pretty bad recently. But we were talking and we are concerned about this upward tick in the abuse situation. Moreover, the psych sounds really poorly trained in talking about the abuse or being well informed about how to talk and will say stuff like saying they need couples counselling to parent together better. Our perspective is that, if he wasn't abusing her, she wouldn't have trouble parenting with him.

I pointed out to her that she never went to couples counselling when they were married or when they separated, because she had read extensively that couples therapy is inappropriate when abuse is going on. Even the past therapists involved with their child noted this. And there have been several incidents of abuse, even since she left several years ago, so it's not like this stuff is all still 8 or 10 years ago. We are both starting to wonder if these sorts of family sessions are recommended when one parent has been abusive (and is being abusive) toward the other.

So, if couples counselling is not recommend when abuse is going on, is there a case to be made from literature/research about the situation my friend faces? She's basically at the point where she's going to tell the psych enough is enough. But she says the psych is really science/research-focused and more likely to listen to what's in the literature. Both of us are research ninjas, but we don't have access to scholarly material and couldn't really find examples for this sort of situation. The psych apparently doesn't necessarily listen to what my friend says - she listens more to "authorities" and research, which my friend and her therapist think is stupid. (Apparently the pysch didn't even believe my friend about the abuse history until she talked to my friend's own therapist, because she didn't think it was possible for my friend to be so polite and collaborative if the guy was really that bad. OMG, the rest of us used to go to BBQs/school/parties/etc and had no idea and so my friend has been containing this stuff for years, so why wouldn't she be able to do that now?!) The psych, who seems otherwise awesome and, honestly, seems to be a fantastic support for my friend, has freely admitted to having zero experience with DV, not having the right words to deal with it and it sure sounds likes the psych sucks in this particular area.

Both of us, having had a talk over drinks tonight, are starting to think it has just *got* to be ridiculous to have joint sessions when this guy is becoming increasingly abusive.

Please don't detail by telling her to get a new psych. This one, in 10 years of therapy interventions, has, by far, been the most helpful and really has an amazing bond with the kid. And I guess it's possible for someone to be a fantastic child psychologist but a thoroughly crappy DV interventionist!

So, Hivemind, have you any research to offer up about therapy meetings when there has been a history of domestic violence?

posted by Chaussette and the Pussy Cats to Human Relations (18 answers total)

This sounds like something your friend"s own therapist should take point on. She presumably has access to the literature and has the additional benefit of being a trusted colleague, meaning the other doctor might find it easier to hear coming from her.
posted by MsMolly at 9:01 PM on July 3, 2015 [7 favorites]

Response by poster: She says her own therapist thinks it's ridiculous that the psych takes the opinion of a therapist over those of my friend, who's articulate, assertive and well informed and making a reasonable request. (Apparently the therapist wasn't too impressed that the psych had discounted the abuse history my friend reported and was gobsmacked that anyone would think my friend incapable of advocating for herself.)
posted by Chaussette and the Pussy Cats at 9:26 PM on July 3, 2015 [1 favorite]

Can you clarify whether the therapy is court-mandated or in any way overseen by Child Protective Services or anyone involved in custody/visitation decisions? Your friend is completely right, but the best way to proceed might change depending on how much power the child's therapist has.
posted by jaguar at 9:29 PM on July 3, 2015 [3 favorites]

Response by poster: See pm.
posted by Chaussette and the Pussy Cats at 9:35 PM on July 3, 2015

My go-to resource for understanding the dynamics of domestic violence is Lundy Bancroft. He's a therapist who focuses on treating abusive men, and has used his practice to study and research domestic violence. He's written several fantastic, readable books on the subject. (My favorite is Why Does He Do That?) He's an acknowledged expert in his field, and I would expect him to be enough of an "authority" on abuse dynamics to impress your friend's psych.

Bancroft absolutely does NOT recommend joint therapy with an active abuser. Only one person contributes to and is responsible for abuse: the abuser. Joint therapy is appropriate for resolving issues that two people contribute to. Joint therapy implies that both parties bear a responsibility to mend the relationship and ameliorate the consequences of the abusive behavior when that is only possible if the abuser first stops abusing.

I hope your friend sticks to her guns; it's 100% inappropriate to be in couples' counseling with your abuser. And speaking as a someone who was once a kid in this dynamic, it's also important for her kid to see that the abuse is not some kind of shared dynamic between both parents that can be fixed with enough joint effort and counseling. Your friend is not contributing to an abusive dynamic, her ex is choosing to be abusive. (I don't mean to say that your friend isn't already making this clear to her kid, but just emphasizing it because I wish it had been made clearer to me as a kid.)
posted by emilyanemone at 9:35 PM on July 3, 2015 [7 favorites]

That sounds like your friend's therapist should be very willing to do a quick search of the professional literature for your friend. I am a librarian, but I'm not a medical librarian, so these are just a few random things I found through PubMed that may or may not be in the right ballpark.

Efficacy of family mediation and the role of family violence: study protocol

Barriers and facilitators of disclosures of domestic violence by mental health service users: qualitative study.
posted by MsMolly at 9:37 PM on July 3, 2015 [5 favorites]

What's stopping your friend from simply declining to attend joint therapy sessions? I'm assuming there's a reason, but can you clarify what that is? What power does this psych have to compel her to attend these sessions?
posted by sam_harms at 9:43 PM on July 3, 2015

Response by poster: I hope this isn't thread sitting. She had to wait a long time for her kid to get into this therapist, who has been the most effective of all the various interventions they've had over the years and who really clicks with her kid and has amazing parenting advice. Anyway, the psychologist has given them a sliding scale spot. She figures the psych doesn't want to give them any more spots and the psych really thinks both parents need to be on the same page. She does *not* want to lose the important information she gets from these sessions. When she asks to stop going, the psych doesn't offer her a time on her own. So she feels like it is either do the joint sessions and get help with how to support her kid or only have sessions for her kid. She says she feels like there is a power dynamic, because the psych could just bail on it all. (It is possible the psych does not know they're coming across that way and just really thinks that joint sessions are the most effective.) We are guessing the psych doesn't want to take up therapy spots to talk to two parents when she could have them in the same room and when she has cut her rate for them. So she probably would rather use that additional hour to make another $100 an hour and help another kid/family.
posted by Chaussette and the Pussy Cats at 9:48 PM on July 3, 2015

Here's another possibility.

The role of parenting stress in young children's mental health functioning after exposure to family violence.

Here's a pro searching tip: if you find an article with something useful, check its list of references at the end for the articles that the researchers cited when writing it. Then also check PubMed to see who has cited the author's article in their article. This is how one article can lead you to another that might be more useful.
posted by MsMolly at 10:05 PM on July 3, 2015 [6 favorites]

Could the information be conveyed in an alternate format such as Skype/facetime? If the concern is that the therapist won't have time to duplicate parenting advice it would allow limited interaction between the parents in a controlled environment.

My other thought was why the parent did not already have a restraining order against the abusive parent if the abuse is on-going. The therapist can't argue against a court order.
posted by saucysault at 6:14 AM on July 4, 2015 [1 favorite]

Look, I get that her child is doing great in his current therapy but, with the continued abuse, there is a good chance that all of this will end up in court, and does your friend really want this psych to be on the stand, giving her opinion of where the child should live and how long visits should be?

Go down the long road. See the psych telling the court that the mom refused joint sessions, which are in the best interest of the child. And then see the child having to live with an abusive dad, because mom kept a psych that did not understand domestic violence.

I'm calling bullshit on this one. She needs to find someone else to take care of her son, or she could risk losing him in court.

And no, family therapy is NOT recommended where there has been domestic violence and there is current abuse. All that does is give the abuser more access to the victim. It does not heal any wounds and will not help the child.
posted by myselfasme at 6:27 AM on July 4, 2015 [10 favorites]

this guy is becoming increasingly abusive.

You or your friend can call the National Domestic Violence Hotline at 1-800-799-SAFE (7233) to ask for citations to research literature, and for support with safety planning in this situation. The national hotline can make referrals to local anti-violence organizations that may be able to help your friend Get a lawyer [MeFi Wiki], at least for a free or low-cost consultation about her options.

A lawyer in your state can assess the situation in the context of applicable laws, current court orders and any caselaw that may address situations that are similar to what your friend is experiencing. Your friend may benefit from a better understanding of her legal options and how the courts in her state tend to view these issues. Any information that you feel can only be shared through private messages should likely be shared only with an attorney in your state who has experience in high-conflict family law.

I also don't think it is a derail to question the competence of the psychologist and whether the psychologist is potentially doing more harm than good without an appropriate understanding of issues related to domestic violence. What safety planning protocols does the psychologist have in place to deal with the possibility that an abusive situation might occur during the sessions?

There seems to be a disconnect between the value assigned to the psychologist's services and the seemingly obvious risks of harm to the child from joint sessions, as well as other potential risks of harm due to the psychologist having "zero experience" with issues related to domestic violence.

"They're so great, except for the risk of harm to myself and my child" seems like an urgent reason to find a new psychologist. A local anti-violence organization may be able to assist with referrals to affordable psychologists who have appropriate training and experience.

From the Best Practices Manual for Domestic Violence Programs published by the Arizona Coalition Against Domestic Violence (2000):

[at 93] There are numerous programs available for children, but they may not always be in the best interest of children (from a domestic violence program's perspective) and may not have expertise on domestic violence issues.

[at 109] When working in the field of domestic violence, it is also important to have an agency safety plan, and if funding allows, some type of security system in place. Regardless of how high-tech or low-tech a security system may be, each agency should always have a safety plan for a variety of potential dangerous scenarios in place. [...] In addition to safety planning, the agency should also consider obtaining insurance and potential liability issues.

[at 112] Domestic violence is a very serious issue in our society that requires the support of individuals who are willing to acknowledge the seriousness of the issue and committed to address it in all of its forms. For that reason, it is important to obtain staff members who demonstrate a combination of attitude and skill toward empowerment and zero tolerance of domestic violence.

via The National Online Resource Center on Violence Against Women

Your friend found a psychologist that otherwise works well for her child, but the psychologist seems unable to take even the most basic precautions to protect the child from the risks of harm presented by the abusive parent. It is completely understandable to want to find a way to prevent yet another loss due to the abusive conduct by the other parent, but there may not be a better way to protect the child from the escalating abuse than to find a psychologist who already has appropriate training and experience.

_{IAAL, IANYL, TINLA. To obtain legal advice, your friend can Get a lawyer.}
posted by Little Dawn at 11:02 AM on July 4, 2015 [2 favorites]

Response by poster: She has seen her lawyer. She's talked to the local DV group extensively. She has a safety plan. If you need to know why she has decided against an RO, pm me. There are some other steps she has taken which I'm not going to post here.

There are very, very few psychologists in her city trained to deal with this. It's not like she can drop this one and find another one. This is in Canada and there are not the same resources as in the US.
posted by Chaussette and the Pussy Cats at 11:32 AM on July 4, 2015

Leander, K., et al. (2012). Violence: Health in Sweden: The National Public Health Report. Scand J Public Health, vol. 40 no. 9 suppl, 229-254. http://sjp.sagepub.com/content/40/9_suppl/229.full

Research based on clinical studies and questionnaire surveys clearly shows that violence in partner relationships has a severe impact on victims’ physical and mental health, both in the short term and long term [2, 32 ⇓–34]. Even long after the violence has ceased, a strong connection persists between women’s ill health and their exposure to violence [24].

Groves, BMA. (Winter, 1999). Mental Health Services for Children Who Witness Domestic Violence. Vol. 9, No. 3, Domestic Violence and Children, pp. 122-132. http://www.jstor.org/stable/1602786

Exposure to domestic violence has significant negative repercussions for children's social, emotional, and academic functioning. In the past decade, mental health professionals have developed treatment programs and approaches aimed at mitigating these deleterious effects. Their efforts, however, are often hampered by difficulty identifying and gaining access to the target population because the occurrence of domestic violence remains a family secret in many households. Clinicians and researchers have published descriptions of group and individual therapy approaches for children who witness domestic violence. These approaches share several goals: promoting open discussion about children's experiences with domestic violence, helping children to deal with the emotions and consequences that follow such exposure, reducing the problematic symptoms children experience, strengthening children's relationships with their nonabusive caregivers, and helping children and their families to create and maintain relationships and living situations that are free from violence and abuse.

Holt, S., Buckley, H. & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review of the literature. Child Abuse & Neglect, Vol. 32, No. 8, August 2008, pp. 797–810. http://www.sciencedirect.com/science/article/pii/S0145213408001348

This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioral problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother.

Horner, G. (2005). Domestic Violence and Children. J Pediatr Health Care. Vol. 19, No. 4, pp. 206–212. DOI: http://dx.doi.org/10.1016/j.pedhc.2005.02.002

Domestic violence affects the lives of many Americans, including children. It is imperative that primary care providers working with children, including pediatric nurse practitioners, understand the dynamics of domestic violence, recognize domestic violence, and intervene appropriately. Domestic violence places children at risk physically, emotionally, and developmentally. The effect on children who witness domestic violence will be discussed. Primary care providers have a professional responsibility to screen for domestic violence. The primary care provider can play a pivotal role in breaking the cycle of family violence by timely identification of and appropriate intervention for domestic violence.

posted by Little Dawn at 2:35 PM on July 4, 2015 [3 favorites]

McKinney, C., et al. (2006) Children's Exposure to Domestic Violence. Journal of Emotional Abuse, Vol. 6, No. 3, pp. 1 -23. http://www.tandfonline.com/doi/abs/10.1300/J135v06n01_01

The frequency with which children are exposed to domestic violence is unsettling. Children's exposure to domestic violence can have adverse effects on their functioning, including the promotion of emotional and behavioral difficulties as well as other difficulties. A number of factors, such as the age of the children when they are exposed and the psychological well being of their mothers, may have mediating and moderating effects on the outcomes for children.

Gopalan, G., et al (2010). Engaging Families into Child Mental Health Treatment: Updates and Special Considerations. J Can Acad Child Adolesc Psychiatry, 19(3): 182–196. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938751/

As many parents may experience their own difficulties following a traumatic event (deVries et al., 1999), parents should also be educated on the importance of treatment for themselves and provided referrals. Moreover, framing parent well-being within a family systems context helps parents to understand how their own mental health status affects their child.

Alaggia, R. et al. (2007). In Whose Best Interest? A Canadian Case Study of the Impact of Child Welfare Policies in Cases of Domestic Violence, Brief Treat Crisis Interven, 7 (4): 275. doi:10.1093/brief-treatment/mhm018, http://btci.edina.clockss.org/cgi/reprint/7/4/275

[at 276] Legislative amendments to the Ontario Child and Family Services Act were implemented in 2000. These amendments resulted in more emphasis being placed on investigating children exposed to domestic violence (DV). The recognition of exposure to DV as a form of child maltreatment represented a shift in child protection services. As a result of most provinces across Canada recognizing exposure to DV as a form of child abuse, it has become clear that exposure of children to DV occurs with alarming frequency and these children are increasingly coming to the attention of child welfare authorities. Child welfare agencies across Canada have experienced a dramatic rise in reports of emotional abuse, a large proportion of which are children exposed to DV (Trocme ́et al., 2005).

[at 283] most service providers feel they do not have the training to deal with the abusive partner.

posted by Little Dawn at 3:31 PM on July 4, 2015 [3 favorites]

Response by poster: Thanks for all this. She's taken a look at the articles and they back up what she has read before. She did mention to me that these articles and those she's read before do not talk about situations where it's the child's therapy. The psych also has these policies, such as zero secrets. She feels this can compromise her privacy - why should her ex get to know if she's feeling triggered? This situation seems complicated and, after more discussion, she is planning to tell the psych that she is done with joint sessions. Her ex becoming abusive to her is not okay, happens in front of kid and compromises the support she needs from him in emergencies.
posted by Chaussette and the Pussy Cats at 10:44 PM on July 5, 2015 [1 favorite]

She did mention to me that these articles and those she's read before do not talk about situations where it's the child's therapy.

I also noticed that when I was searching Google Scholar, and I was wondering if joint sessions with an increasingly abusive parent is simply such an obvious risk of harm, it isn't being studied. Past abuse is a risk factor for further abuse, and escalating abuse is a serious risk factor for further abuse, which might happen during the sessions.

Her ex becoming abusive to her is not okay, happens in front of kid and compromises the support she needs from him in emergencies.

It sounds like your friend should consult with her lawyer before speaking with the psychologist. Maybe the lawyer can speak with the psychologist, and find a way to protect your friend's privacy while notifying the psychologist that joint sessions are not happening under the current circumstances. I don't want to speculate about the legal implications, but there may be legal implications that your friend should discuss with her lawyer.
posted by Little Dawn at 12:13 AM on July 6, 2015 [2 favorites]

Response by poster: Thanks. Both of us had some people say things along similar lines, so she's going to try to get the psych to come to this conclusion instead, until her lawyer is available.
posted by Chaussette and the Pussy Cats at 11:26 PM on July 6, 2015