The Impact of Domestic Violence on Children

Patricia Fearing
CNS 762 BG FA 16
2 October 2016

Introduction to topic with rationale:

In 2015, New York State reported that over half of the clients who stayed in a domestic
violence shelter were children in their 2015 Domestic Violence Report. Yet, most domestic
violence programs in the state are geared toward the provision, education and healing of the adult
clients. This statistic begs the question, if over half the victims of domestic violence utilizing
services are children, what kind of impact is this form of trauma having on them?
The literature available on the topic has a tendency to focus on the children of domestic
violence as secondary victims, and, as a result, secondary research topics. In the past 5 years, this
void of information has begun to fill and more professionals are focusing the children as a
primary sample. The poverty line, the mental health of parents and the ecological realities of
these children play a major role in the impact domestic abuse has on their mental health, leaving
them with stretched coping skills, diagnoses of PTSD, anxiety disorders and aggression
disorders, such as ODD.
Review of existing literature to provide background on topic:
According to the the National Domestic Violence Hotline website, domestic violence is
defined in the following way:
Abuse is a repetitive pattern of behaviors to maintain power and control over an intimate
partner. These are behaviors that physically harm, arouse fear, prevent a partner from
doing what they wish or force them to behave in ways they do not want. Abuse includes
the use of physical and sexual violence, threats and intimidation, emotional abuse and
economic deprivation. Many of these different forms of abuse can be going on at any one
time. (http://www.thehotline.org/is-this-abuse/abuse-defined/)
As stated earlier, over half of the victims receiving state services for domestic violence
abuse are children, and thats just in the state of New York. Based on the definition, and the
statistics, it can be concluded that a great number of children are experiencing this form of
trauma either firsthand or secondhand. Nationally, as of 2013, it was estimated that over 4.5
million children each year are exposed to intimate partner violence (IPV) (Holmes, 2013).

Domestic violence is an issue that has surpassed many of our cultural labels. It is present
in the homes of every race, economic class, religion and culture. In an attempt to fight against its
prevalence in our culture, we continue to search for reasons why. One study suggests that there is
a higher occurrence rate of domestic violence in homes where there is poor maternal mental
health, which led to a higher likelihood of the children responding with aggressive behavior or
developing aggressive disorders such as ODD. (Holmes, 2013)
Yet another study, which followed in the footsteps of similar research, found that poverty
and race were contributing factors, finding prevalence of PTSD and anxiety disorders along with
aggression in the children of those homes. This was found regardless of their housing status. In
this same study, it was found that children who felt they had good coping skills, based on the
ERC, were less likely to have mental health maladjustment or a diagnosis that correlated with the
abuse present. (Mohammad, Shapiro, Wainwright and Carter, 2014)
No matter the cause of the domestic violence, the presence of mental health issues in the
children exposed to it is undeniable. Other than the suggestion that the presence high coping
skills in children act as barrier against mental health maladjustment, there are treatments and
interventions that help with this reality. As the case study for this paper is of a child residing in a
domestic violence shelter, the interventions and treatments looked out were specifically used in
that environment.
Early Childhood Mental Health Consultations (ECMHC) area first line of defense that
can be used within a shelter environment, evaluating the needs of the children residing there. So
often mothers within this setting are suffering from their own experiences of shock and PTSD,
taking their focus away from their children and debilitating their parenting skills. The parent's
availability and ability for relationships may be understandably compromised, yet are crucial for

mitigating the effects of extreme forms of stress (e.g., homelessness and domestic violence) on
the child's personality development (Brinamen, Taranta and Johnston, 2012).
Individual interventions for children, such as state funded developmental services,
individual counseling with the use of play therapy and EMDR and child group counseling
sessions have proven to be helpful in those elements of building up self-esteem, resiliency,
coping skills and processing. One intervention that has had some mixed reviews is safety
planning with children. While this intervention may provide empowerment and safety for the
child, it can also cause fear and anxiety, mixed feelings about how the child should react to the
abusive parent and create a disconnect between mother and child. (Chanmugam and Hall, 2012)
While the needs of the children, and the building up of their coping and resiliency skill is
important, it is also crucial to bridge the divide between victimized parent and child. As
mentioned before, the ability of a victim to parent effectively in the shelter environment, along
with their many other stressors, is at best difficult. However, this divide that has occurred
between parent and child will only grow wider with the separation of services. Interventions that
connect the child and the parent, such as family counseling sessions, help bridge that gap.
(Brinamen, Taranta and Johnston, 2012)

Case study, conceptualization, treatment formulation:

The client is a 4 year old boy from Bangladesh. His educational background includes
some pre-school. He is small for his age and is at a stage where side-by-side play is his best
communication tool. The client is here because his mother brought him with her to a domestic
violence shelter. She had experienced extreme physical abuse by her husband, which was
witnessed by the client. The client is in counseling due to the immediate discontinuation of
verbal communication after witnessing the most recent attack on his mother, stand-off behavior

towards others adults and children, as well as triggered moments of shielding his mother from
strangers.
His mother also experienced extreme physical abuse at the hands of her husband while
the client was in utero, which led her to go to multiple shelters before his birth. Other than the
ongoing experience of his mothers abusive relationship with his father, the client has not
experienced any other familial trauma. He has never been in counseling before now, nor has he
received other developmental services in his lifetime.
The following is the case conceptualization for client R, according to the framework of
Len and Jonathan Sperry in their book Case Conceptualization: Mastering this Competency with
Ease and Confidence. (Sperry&Sperry, 3-29)
Client R was brought into counseling with the presenting problems of lack of verbal
communication, eye contact, and interaction with other adults and children. He also presented the
triggered behavior of shielding his mother any time they were in the room alone with another
adult he didnt know, particularly males. Considering the symptoms presented, the diagnosis of
PTSD of the Preschool Subtype, as described by the DSM-V, is likely. The symptoms in the
client started presenting themselves after the client witnessed his mother being attacked with a
knife by his father. This experience of trauma, as well as the history of observing the physical
abuse against his mother, and the abuse that occurred to her while the client was in utero,
explains the diagnostic suggestion. The goals of treatment include, but are not limited to creating
safe space for interaction, using play to help with interaction and verbal communication and
helping the client and his mother establish a more trusting and safe relationship.
The clients mother was born in Bangladesh, but was raised in the United States. The
client was born in United States. Cultural impacts on treatment that may occur include mothers

understanding of gender roles and the role of mental health in their culture, or lack thereof.
Treatment formulation has been fulfilled in the form of DO A CLIENT MAP.
DO A CLIENT MAP:
Diagnosis: The client meets the criteria of PTSD in the preschool subtype .
Objectives: Short-term Goal 1: Increase play interaction between mother and client on a daily
basis in a safe environment. Objective: To increase safe connection between mother and child.
Short-term Goal 2: Create safe space in the counseling room through unstructured play and
interaction. Objective: Allow for child to feel safe enough to play without inhibition.
Long-term Goal 1: Help client regain reactivity when interacting with others. Objective: Practice
interaction through play therapy and interaction based toys. Long-term goal 2: Help client return
to developmentally appropriate verbal communication. Objective: Practice verbal interaction
during play therapy sessions with use of interactive toys and strategies.
Assessment: In assessing the client, the use of the DSM-V Criteria for PTSD Preschool Subtype,
as well as the Trauma Symptom Checklist for Young Children (TSCYC). (ptsd.va.gov)
Clinician Characteristics: Clinician should be a woman, based on the trigger reactions the
client currently has to men. The clinician should also have a background in trauma and training
in play therapy with children the clients age.
Location of Treatment: The services will be provided in the counseling office of the domestic
violence shelter they are currently residing in. The office will be set up for play therapy.
Interventions: Considering the age and interaction level of the client, the intervention will be
play therapy. This will be both directive and nondirective.
Emphasis: Client Motivation is not applicable, as he is coming to counseling involuntarily by
his mother. In the Directiveness Continuum, the sessions will be structured with the first 5-8 as

non-directive play, and the following 8-10 session combining both directive and nondirective
play based on the reaction of the client in the first 5-8 sessions. Considering the age of the client,
the session will be present focused.
Numbers: Client will be attending individual sessions, as well as family sessions with his
mother. Timing: The client will receive two, 30 minute individual sessions a week, followed by
one, 30 minute family session with his mother a week. All together that will be 3 sessions a week
for a total of 90 minutes.
Medication: Not applicable or appropriate at this time.
Adjunct Services: The client will be receiving state provided services, including OT, PT and
Speech Therapy.
Prognosis: The clients prognosis is Good due to the support and involvement of his mother, the
services being offered to him through the state and his educational opportunities. The prognosis
does not fit into the Very Good or Excellent categories due to the lack of a support system the
client has, the lack of housing options outside of a homeless shelter available to him and his
mother after their time in the domestic violence shelter and the potential presence of his abusive
father in the future.
Advocacy, multicultural, and legal/ethical considerations:
In regards to this client, I would follow agency policy in advocating for him legally.
According to our agency, this may come in the form of a letter recommending that visitation with
the clients father be suspended due to the triggers and presenting symptoms displayed by the
client. A letter could also consist of information about the number of sessions the client and I
have had, the dates of those sessions, a generalized description of what occurs during those
sessions, like play therapy, and the date of our next scheduled session.

As mentioned before, the clients family is from Bangladesh, although the client was born
in the United States. Multicultural understandings of mental health provision are important when
considering not only the support system of the client, but the way that the client will be treated
by those in his community. According to the article Pathways to psychiatric care in Bangladesh,
there are not many pathways to mental health services, and Family members had a significant
role on the decision to seek help from health service (136). Mental health is an underutilized
service in this culture, which may or may not impact further work with the client.
Working with children, it can feel quite natural to share with the parent exactly what
occurs during the session. However, just like with adults, privacy and confidentiality are rights of
the client. The 2014 ACA Code of Ethics states that in regards to a counselors responsibility to
parents is to get consent to counsel the child, and Counselors work to establish, as appropriate,
collaborative relationships with parents/guardians to best serve clients (7, 12).
References

2015 Domestic Violence Prevention Act Report. (n.d.). Retrieved October 02, 2016, from
http://ocfs.ny.gov/main/reports/dvpa.asp
Abuse Defined. (n.d.). Retrieved October 02, 2016, from
http://www.thehotline.org/is-this-abuse/abuse-defined/
American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author.
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders,
(5th ed.). Washington, DC: Author.
Chanmugam, A., & Hall, K. (2012). Safety Planning With Children and Adolescents in Domestic
Violence Shelters. Violence and Victims, 27(6), 831-848. doi:10.1891/08866708.27.6.831
Giasuddin, N. A., Chowdhury, N. F., Hashimoto, N., Fujisawa, D., & Waheed, S. (2010).

Pathways to psychiatric care in Bangladesh. Social Psychiatry and Psychiatric

Epidemiology, 47(1), 129-136. doi:10.1007/s00127-010-0315-y
Mohammad, E. T., Shapiro, E. R., Wainwright, L. D., & Carter, A. S. (2014, August 02). Impacts
of Family and Community Violence Exposure on Child Coping and Mental Health.
Journal of Abnormal Child Psychology, 43(2), 203-215. doi:10.1007/s10802-014-9889-2
PTSD: National Center for PTSD. (n.d.). Retrieved October 02, 2016, from
http://www.ptsd.va.gov/professional/assessment/child/tscyc.asp