Medical Care

Questions about the possibility of domestic violence should be part of all regular medical histories for all women in all settings where women come for medical care. Domestic violence affects women of all economic groups, educational levels, ethnic groups, religions, and ages. Routinely asking about violence and childhood sexual abuse may help abused women recognize that they are not alone and that help is available. Questions should be posed so that they do not impute blame to women. Women who are abused may well deny their abuse out of fear, shame, or distrust. This is far more likely when their partners accompany them to doctors' offices or emergency rooms: Women need to be asked about abuse when they are alone, or at least when their partners are not able to hear their responses. Information about resources for battered women should be prominently displayed and easily available for women to take without their asking.

Battered women who have left their abusers are also likely to return more than once before they are ready to leave permanently. This can be frustrating to medical professionals who treat a particular woman's injuries repeatedly and can lead them to blame the woman, who needs to take her own time to decide how she can live in safety. Accurate medical records, including clinical reasons for suspecting abuse, are essential evidence for women who may eventually press criminal or civil charges against their abusers. Suspicious bruises should be noted on medical charts for an accurate history and evidence for possible future use. No laws require reporting suspected abuse against women

(whereas there are such laws for suspected child abuse), because women are not "dependent." Nonetheless, if medical professionals incorporate questions and information about domestic violence into their routine treatment of women, they will address some of the social barriers that keep battered women from finding safety.

Ignorance about domestic violence and childhood sexual abuse also plagues psychotherapists, psychiatrists, and clergy who do not understand the emotional or material barriers that make leaving difficult. Often, they either blame women for remaining in dangerous relationships or they consistently ignore signs of abuse and refuse to pay serious attention to women who talk about abuse. Couples therapy often tries to assign responsibility for problems equally to each partner in the relationship, which ignores the reality of violence and the fear of the abuser that makes abusive relationships inherently unequal. Attributing responsibility for the violence to the offender, and specific treatment for the batterer in individual therapy or groups, is essential if abuse is to end. Fear of retaliation by the abuser can also prevent counseling professionals from intervening in situations of domestic abuse.

Treatment resources for male abusers are still scarce. Most abusers deny they have a problem. Most batterers participate in treatment groups for batterers only when they are ordered to do so by a judicial authority. Inconsistent prosecution, enforcement, and sentencing often reinforce abusers' beliefs that their abuse is not a serious problem. Mandated treatment programs are often predominantly attended by low-income men, men on welfare, or men with prior criminal records. They are likely to conclude that learning to avoid arrest is more important than changing their abusive behaviors. Treatment programs take several different approaches: Some are primarily didactic (designed to teach), some use cognitive and behavioral approaches, and some include attention to a batterer's psychological history and psychodynamic issues and the circumstances of the abuse. There is no definitive study that has proved the effectiveness of any treatment approach (see Sherman et al.).

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