Statement on the Serious Detrimental Impacts of Domestic Violence on Mental Health and Well-Being

California Association of Marriage and Family Therapists
June 6, 2021

The California Association of Marriage and Family Therapists (CAMFT) recognizes the pervasive mental health and public health impacts of domestic and interpersonal violence.

According to the National Coalition Against Domestic Violence (NCADV), more than one in three women in the U.S. are victimized by domestic violence in their lifetimes. Although men are also victimized by domestic violence, four out of five victims of domestic violence in the United States are women, with a higher incidence of domestic violence recorded for women of color and multiracial women than for white women (Philpart et al., 2019). Within the LGBTQ community, gay, lesbian and bisexual persons report domestic violence victimization at rates of 25 percent or higher, and the transgender community reports a domestic violence rate of 50 percent (Brown & Herman, 2015). Rates of domestic violence in California are slightly lower than the national average, yet still denote a significant health concern.

NCADV estimates that 20 persons per minute suffer from domestic violence. Under-reporting is quite common, primarily because victims fear, and often experience, retaliation from their abusers. Victims also under-report because of a lack of confidence that police involvement would make their situations better or safer (Philpart et al., 2019). In a study conducted by the National Domestic Violence Hotline, 70 to 80 percent of participants, including those who had previously asked for police assistance, reported that they were afraid the police would not believe them and would do nothing to help them. While many survivors do not file police reports, some manage to escape the abusive relationship either with the help of a family member or friend or with the help of a domestic violence advocate.

The psychological impacts of domestic violence cause victims to suffer from serious mental health conditions for years, if not for the rest of their lives. Such conditions include depression (Arroyo et al., 2017), generalized anxiety disorder (Beck et al., 2014), and notably high rates of post-traumatic stress disorder (PTSD) (Kastello et al., 2015). The pervasive effects of PTSD negatively impact victims’ emotional well-being, relationships, livelihoods, and physical health.

Victims of domestic violence who are able to escape their abusers often deal with negative impacts long after reporting the abuse and leaving the relationship (Maddoux et al., 2017). Those who have children with their abuser often find themselves entangled in a family court system that re-traumatizes them by allowing their abusers to file repeated court orders (Douglas, 2018) and forcing victims into mediation with their abusers. The inability of the family court system to protect domestic violence victims can cause even deeper levels of traumatization (Coker, 2002). Victims of domestic violence are often economically impacted. Some victims find it difficult to maintain employment, while others are not able to attain higher—paying jobs because of their anxiety levels (Beck et al., 2014).

As marriage and family therapists, it is imperative that we understand the effects domestic violence has on the family system and especially on children. One in 15 children in the United States witnesses domestic violence each year (Howell et al., 2016). Witnessing domestic violence may have significant long-term consequences for children and their overall development. One study found that children who witnessed domestic violence were 42 percent to 69 percent more likely to be developmentally compromised in their physical health, their social competence, their emotional maturity, their cognitive skills, and their communication skills (Orr et al., 2020). In addition, Adverse Childhood Experience studies (ACES) show that difficult childhood experiences such as witnessing violence in the home are associated with an increased likelihood of intimate partner violence in adulthood (Mair, Cunradi & Todd, 2012). Another study asserts that children who witness domestic violence should not be treated as passive witnesses but rather as direct victims of domestic violence; understanding the witnessing of domestic violence as child abuse could improve how professionals respond to the children in these circumstances (Callaghan et al., 2018).

Both adults and children who have experienced domestic violence benefit greatly from trauma-informed practices that focus on understanding the specific impacts of trauma associated with domestic violence. Trauma-informed practices prioritize the need for victims to feel not only physically safe but also psychologically safe throughout the therapeutic process, empowering victims to feel that they have control over their lives and improving their self—efficacy (Goodman et al., 2018). When treating victims of domestic violence, the integration of trauma—informed practice with psychoeducation processes may prove to be quite successful.  These techniques work holistically to help people fully understand the effects their experiences have had on their mental health while, offering coping mechanisms to overcome their challenges and helping them recognize their inherent strengths and abilities. Mindfulness-based therapies that incorporate trauma-informed practice and psychoeducation processes can support emotional, psychological, and physical healing.

Therapists working with victims of domestic violence have the following ethical responsibilities:

1. Be properly trained to understand and navigate the complex psychological, emotional, social, cultural, and economic factors that influence, contribute to, and stem from domestic violence and interpersonal violence.
2. Work as allies and advocates for the victims by, moving beyond the therapy room to collaborate with service providers and trained domestic violence professionals both inside and outside of the therapists’ own organizations and group practices and by, looking to the health care system for support, training, and resources (Hegerty et al., 2020).
3. Practice within a trauma-informed framework that prioritizes the physical and emotional safety of the victims of domestic and interpersonal violence. This includes understanding the complexities and safety implications of reporting incidents of domestic violence to the authorities. It is important to note the factors that influence whether or not MFTs are mandated to report domestic or interpersonal violence in a given situation. Clinicians can read CAMFT’s 2017 report, Domestic Violence and the Duty to Make Mandated Reports.

The prevalence of domestic and interpersonal violence is a systemic social issue that cannot be solved by therapists alone. In addition to social justice reforms at a legislative level, it is critical that all service providers including clinicians, social service providers, health providers, and law enforcement officials, have sufficient training to offer care and support that does not re-traumatize or endanger those seeking help. More information and support resources can be found at the following websites:

• California Partnership to End Domestic Violence https://www.cpedv.org/domestic-violence-organizations-california
• National Coalition Against Domestic Violence. https://ncadv.org
• National Network to End Domestic Violence https://nnedv.org/
• National Resource Center on Domestic Violence https://www.nrcdv.org/

A Special Note Concerning the Impacts of the COVID-19 Pandemic on Domestic Violence: Since March, 2020, it is likely that rates of domestic and interpersonal violence will reflect considerable increases. The COVID-19 pandemic has caused tremendous hardships for millions of people, highlighting the social and economic inequities that exist in the United States and exacerbating dangers for victims of domestic violence. The stay-at-home orders placed across California, the country, and the world were made with the intention of curbing the spread of the virus and protecting the public; however, these orders left many domestic violence victims trapped in homes with their abusers. Although many domestic violence agencies have seen a significant drop in the number of calls placed to hotlines, they believe the drop is not because of decreased victimization but because of the inability of victims to safely make calls to service providers (Evans et al., 2021). Their convictions are supported by studies that have found instances of domestic violence have increased more than 20 percent since the stay-at-home orders were first mandated in March 2020 (Boserup et al., 2020).

This statement was created in collaboration with Deana Payne, Domestic Violence Transitional Shelter Program Director and member of the L.A. County Domestic Violence Council’s subcommittee on policy, for publication at www.camft.org. Individual contributors to the development of this statement include:

• Nabil El-Ghoroury and Holly Daniels, CAMFT Executive Staff
• Robin Andersen, Juan Gavidia, Maureen Houtz, and Lisa Romain; CAMFT’s Social Policy Task Force

Any correspondence or inquiries regarding CAMFT Social Policy Statements should be addressed to communications@camft.org.

The CAMFT Board of Directors has prioritized the publishing of Social Policy Statements to raise understanding and awareness about the impact of social and systemic issues on mental health and well-being, and to emphasize the importance of culturally responsive training for mental health clinicians.

CAMFT develops these positions and responds to social issues relevant to the practice of psychotherapy, mental health policy, and social concerns impacting the mental health of individuals, families, and communities in California in order to guide the profession, amplify the voices of marriage and family therapists, educate the public, and influence decision makers.

CAMFT is aware that social justice issues are dynamic developmental processes responsive to evolving social, political, economic, and other world circumstances, as well as clinical, ethical, and legal considerations. This statement is both a commitment on the part of CAMFT to address these issues and intended to provoke discourse and evolution in recognition of the realities of members of all communities.

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References

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