[Music] [Music] a [Music] e [Music] [Music] oh [Music] [Music] and good afternoon everyone from St Louis Missouri in the home of the Missouri Institute of Mental Health my name is Tom Panella with MH thanks for taking time out of your schedule to join us this afternoon for our program our first part of intimate partner violence next week we'll do the second part and we hope you'll join us for that as well I'm I am very pleased to introduce our speaker to you and I'm going to do that to you in just a second for the but I'd first like to explain a little bit of the screen geography to you if you've joined us for the first time we welcome you some of you are familiar with this part of the talk already just below the video window you're going to see our open captioning we welcome our captioner we we're pleased to provide this service to you to anyone who needs it or would like to take advantage of it underneath that you'll see several links if you're interested in continuing education credit for today's program there's a link to purchase cus underneath the video window down below that you'll see a couple more links one of them is a link to the slides as a PDF you can pop those up in a separate window if you'd like to to follow them that way they'll also appear on the video window itself but that's up to you if you'd like to do that and as well you'll see a link to the project DEH High website and she's going to explain all about deive as we get going here today and so you'll be able to follow that if at any time you have questions or comments or other feedback for us to the right there is a chat window use that chat window to submit questions we'll hold those questions to the end of the presentation block but I encourage you to submit them at any time because we'd like to keep them here and we'll be ready to ask them for you on your behalf so you can do that at any time the first time you have you type in a question or comment you might have to enter a nickname for yourself uh but you should never have to hit the login just enter it and click say and you'll enter your nickname the first time so now I'd like to introduce Belinda James to you and it's always a great pleasure to introduce people who have a terrific passion for the work that they're doing you're about to experiencing that she is a passionate advocate for children youth and families she's a native of St Louis Missouri and she received her Bachelor of Arts from the Southern Illinois University Edwardsville she had her master's degree from the brown school at social work at the Washington University here in St Louis and the Missouri develop family development credential from the University of Missouri Kansas City as well as certification in trauma focused cognitive behavioral therapy from the Medical University of Southern California that's the second time I've said Southern California South Carolina for the past 17 years she's been facilitating youth leadership programs sexuality education sessions and parent education workshops as well as staff development training in the areas of mental health 101 Communications customer service group dynamics motivational interviewing the art of deescalation and Trauma recovery she has also taught in the field of social work as an adjunct instructor at the brown school she is currently the Chief Executive Officer of project DEH High Incorporated whose mission is to provide opportunities for discussion education and awareness of mental health issues in addition she counsels women who are homeless pregnant and may have dual diagnosis of mental health and chemical dependency Andor extensive trauma backgrounds Belinda thank you for joining us today and the floor is yours great thank you Tom I would like to start off by thanking the Missouri Institute for mental health for the opportunity to share some information on intimate partner violence I'm very humbled by that opportunity it is my hope that this information will be a platform for further discussion about the topic and certainly an encouragement to reach out for resources and maybe even look at some collaborative efforts of Community Partners that are addressing this issue so I am here today representing project DEH High Incorporated which is a nonprofit that provides a great deal of mental health education in the community we also address intimate partner violence issues we have support groups for adolescents and we do a great deal of life skills programming for middle high school and college students in addition we do a great deal of professional development training in the community and this is a an exciting opportunity for us to talk about intimate partner violence so as Tom mentioned this is a two-part Series today we'll talk a great deal about what intimate partner violence actually is and how it affects those that are involved and next week's training will really be a practical experience for participants where you will receive tools that you can actually use with your clients on strength-based practice addressing the issue of intimate partner violence so let's go over some Workshop obje just so that we are pretty clear about what it is that we're going to cover so for today we are going to Define intimate partner violence we are going to identify the effects that intimate partner violence actually has on all that are involved and then we'll take a look at some mental health issues associated with the intimate partner violence and begin to address some of those barriers that our clients actually have including some provider barriers and that's the part that I really hope that we as providers can really do is some self- assessment to figure out what parts are we playing that are helpful and inviting and what parts could be a barrier for our clients to access resources so let's talk a little bit about what intimate partner violence is and I'm a mover and Shaker and presentation so I'll just let you know that I'll kind of be flowing and so I'd like for you as you are sitting at your uh desk or at your computer think about what intimate partner violence is what are some specific things that you can actually identify as intimate partner violence so we can SE SE def definitely say physical abuse emotional abuse other examples verbal abuse psychological abuse okay so those are definitely some to name a few intimate partner violence is really a pattern of Co of behavior that attempts to take power and control over an individual in a relationship and so it could be a number of abuses from physical to emotional abuse to psychological to spiritual abuse to intimidation and coercion to actual sexual abuse economic abuse it could also be deprivation and stalking and more of that verbal so all of those are included in the intimate partner violence all of them are about power and control and hurt so as you think about what intimate partner violence is who do you think is affected by that everybody it's everybody that that's affected by it so as we talk about what everybody actually looks like it could be any age group it could be any social economical level it could be any ethnic or racial group any educational background any sexual orientation there are no barriers intimate partner violence affects all and one of the things that we do want to focus on is that we don't want to label and we don't want to tie into any of the assumptions or biases that are already out out there about intimate partner of violence it affects everyone however it is important to point out that women represent the largest number of intimate partner violence survivors so as you look at pictures I just really want these pictures to resonate on your heart of who intimate partner violence actually affects it could be the couple with the child and the child is present and can be traumatized by that violence it could be a same-sex couple it could be a couple where the female is the abuser and the aggressive one it could be in an adolescent relationship as we talk about intimate partner violence it's also important to talk about the effects that the violence has on a pregnant woman and her fetus so let's talk about some statistics one in Four Women report intimate partner violence in their relationship at some point in their lifetime and that's from the Centers for Disease Control 155 million children witness intimate partner violence in their household 62% of 11 to 14 year olds say they know friends who have been verbally abused by a boyfriend or girlfriend and one in five 13 to 14 year olds say they know friends and peers who have been struck in Anger by their partner so again sending that message and just letting that resonate on your heart that it is any group there are no special groups that are not affected by intimate partner violence it's any group let's talk about the elderly the elderly is not necessarily a group that we have lots of conversation about when it comes to intimate partner violence but they are just as affected as any other group so men are just as likely in the elderly population to be abused as women however elderly women sustain more serious uh damages more serious effects from the intimate partner of violence in the LGBT population in 2003 there was a study done that identified 6,523 LGBT individuals that reported intimate partner violence in their relationship of those 6523 44% of them were men 36% were women and 2% were transgendered so again everybody is affected male survivors as we talk about male survivors of intimate partner violence male survivors are less likely to report their incidences of abuse for fear of being belittled for fear of being judged so we have a lot of males that are not reaching out for resources when they could so we just want to encourage any male Survivor it is okay it is okay to share your story The supports are out there violence and pregnancy is also a very sensitive issue as we know that fetus is exposed to stress and so when a woman is pregnant and she is involved in an intimate partner violent relationship that's huge so we're looking at 4 to 8% of women that report violence during their pregnancy and that affects about 324,000 women every year so that's the woman and her child so issues asso assciated with intimate partner violence and pregnant women include delayed prenatal care smoking alcohol and drug abuse issues and sometimes before the pregnancy it's actually unintended pregnancy because of the sexual abuse that could happen in the relationship so Direct effects to the fetus include spontaneous abortion there could be fetal injury or death from that maternal trauma and indirect effects are maternal stress maternal smoking and then the alcohol or substance abuse uses so we know that intimate partner violence has a very strong effect on our children and some of those effects include low birth weight an exaggerated straddled response so you may have a young child that jumps very quickly at a a sound a noise somewhere in their house because they have been exposed to that violence in the home it could be sematic complaints so you could have a child that complains a lot of stomach aches or a lot of headaches and so if you know that your child has been exposed to any type of violence in the home that is certainly something to look for as that could be a sign that the child is really suffering from that trauma it could be regression in toileting or in language so here you have a child that developmentally is moving forward like they're supposed to and then all of a sudden they revert they are wetting their pants their language goes from using full words to maybe more of the baby language and you as a parent or caretaker are stressed out about that so I really encourage you to think about any particular trauma that that child may have been exposed to because those can be direct indicators of that violence that they have experienced it could be sleep disturbances so if your child has a hard time falling asleep or if they fall asleep and they pop up a lot again those are just signs to to be aware of because if you don't necessarily know the effect that intimate partner violence has on a child in particular you may just think developmentally that's just part of what they're going through maybe it's nightmares and they're just not able to settle but if you think about the fact that you know two years ago she was a witness to a lot of violence in the relationship that's certainly something to think about there could be difficulty attaching to a caregiver so if a child has a hard time emotionally connecting to an adult a hard time being comforted by an adult that can also be a direct sign of that intimate partner violence there could be some hypervigilance as well so this is where a child is overly sensitive to the Dynamics that are going on in their environment so overly sensitive to noises overly sensitive to voices and touch and and has that strole response again that again is a direct indicator of the exposure that intimate partner violence actually has on children and that impact there could be separation anxiety where it is really hard for a child to separate we know that some of that happens anyway naturally with children but if it is this very deep layer where it is so difficult for the child to separate that it just becomes emotional and they are distraught by that and you know that there has been some intimate partner violence exposure that is certainly something to think about and then we also can look at some eating disorders that can come about in children as well so we want to just be aware of that and we certainly don't want to dismiss that a lot of times I'll hear some client say well she was so young she doesn't remember that or he was so young he doesn't remember that because he was only one well now he's three and he's very aggressive in his behavior that could be from his exposure to that intimate partner violence so certainly something to think about not only for the parent or the caretaker but for us as the providers as well just being able to recognize those signs so we can do some psycho education with our clients on increasing awareness of what those signs actually look like so here are some more consequences for children boys are more likely to become abusive adults girls are 300 times more likely to become involved in an abusive relationship if they have been exposed to intimate partner violence and then people abused as children 18 times more likely to commit suicide again long-term effects of exposure to that intimate partner violence can turn into some mental health issues and certainly some behavioral issues with our children experiencing abuse as a child has been associated with things such as depression substance use issues poor school performance and highrisk sexual behavior so as we move through this discussion and we prepare for next week's discussion on creating an opportunity to have conversation about intimate partner violence I really encourage people to know the backgrounds of your clients and assess in a way that is comfortable for them so I challenge those of you that are watching today that don't necessarily assess for intimate partner violence and I'll challenge you to think of ways that you can Infuse some conversation into your assessment process to be able to actually capture the essence of maybe some reporting that your clients can do around that particular issue it's very scary excuse me it is a worrisome issue that sometimes our clients fear will cause more damage if they say something about it than not but by us asking the question and actually gives them permission to talk about it so I really continue to encourage you to do that another factor with uh children exposed to an intimate partner of violence is that boys who witness violence against their mothers are 10 times more likely to abuse in their adulthood compared to boys that grew up in nonviolent homes so it does affect Behavior it does affect a child's view of the world so let's talk a little bit about behavioral effects on children and teenagers as you think about young people sometimes young people will overcontrol their emotions and what I mean by that is they will try to internalize that they will not share all of the feelings that they have they will not necessarily be as truthful or cover up some of the struggle because it's hurtful and they don't know how to process that and if they've not had that opportunity where they he they hear people ask about it then they're less likely to talk about it some young people under contr control their emotions so they externalize it so they become more explosive so externalizing it means they will explode they will throw temper tantrums they will have lots of fighting in school so if you have a child that has become one identified as a troubled child in school because of maybe problems with their peers or they are fighting a lot or they're getting suspended I really encourage you to ask whether or not they've been exposed to intimate partner violence because it could actually be the case and we don't know unless we ask and unfortunately sometimes our young people are labeled incorrectly because the social worker the counselor the teacher they are not aware that intimate partner violence actually takes place in the home and so that's why it's just so important for us to really ask that question and part two and I really do encourage all of you that are are participating in this webinar now to participate in next week's webinar as well because we will be taking this information and really turning that into some practical steps of how do you do that so you hear me say now ask the question so I'm encouraging you but next week's session we'll give you the house we'll give you that actual language strength based language to use in order to do that so as we're talking about effects of intimate partner violence on everyone children in particular let's look at some factors that really influence our survivors so our survivors are the individuals that have been through the abuse and they're no longer in the relationship or they're still in that violent relationship and trying to deal with that so some of those factors or before we get to the factors let me share with you this this quick story this is a picture of a child that Drew their feelings about intimate partner of violence so if you really want to know what children think about any exposure they may have had ask them to draw this is a drawing from an 8-year-old and this drawing actually specifies this child's feelings of his father and he wrote in Spanish my father be because he often gets angry and drunk and his eyes turn red that's his depiction of his exposure to intimate partner violence so again we always want to ask we always want to assess because we don't know what people go through and there is a lot of masking that goes on for plenty of reasons and let's talk about some of those factors that influence our survivors there could be a loss of status that can be a factor that influences survivors it could be a money issue one of the reasons that an individual may stay in that relationship is because maybe they focus on the good times there were good times in that relationship it wasn't always bad and so that could be one of the factors that that keeps people in it could be because of family I don't want to break up my family even though I'm concerned by this this violence I'm hurt by this violence what would that do if I break up my family so that's a huge issue for people to to think about religion and other cultural beliefs can be a factor for survivors it could certainly be about the children even though they are exposed to it sometimes people will think but they'll lose a parent or they they'll lose that stability I don't want to change that and a lot of it is fear it's fear of the unknown I don't know what life will look like if I leave despite the fact that I really want to because this is hurtful but the hurt is predictable I'm speaking from some of the clients that I do therapy with where I hear them say the hurt is predictable I understand the cycle of violence now so it's predictable and I know what to expect but change I may not know what to expect so just really encouraging our survivors to to know that it is okay to make that change you have resources out there that can help you do that but let's take a look at the breakdown of power and control because as we we started off we identified what intimate partner of violence was it's a pattern of course of behavior with an attempt of power and control on one person in the relationship so there are some very intricate components to this cycle the use of coercion and threats could be that the partner is making or carrying out threats to do something to hurt the other person or to hurt their family using economic abuse it could be that the abuser controls the M the money in the relationship and so that Survivor is in that relationship because there is no other monetary support it could be using male privilege treating the Survivor like a servant making all of the decisions acting on their behalf speaking for them so the Survivor does not have a voice if it could be using the children it's a guilt trip if you leave me what will happen to our children I can't believe that you would even think of doing that remember it's the power and control minimizing and denying blame making light of the abuse it's not that bad I I only hit you twice and I told you I didn't mean it so don't make such a big deal of it power and control using isolation so the Survivor is isolated from supports he or she is isolated from their family isolated from their friends isolated from any social networks any supports in the community so they're feeling very lonely and they're feeling as if the abuser is the one that they have to rely on emotional abuse so it could be put Downs name calling making that individual feel like they are less of a person and no one else will want them so why would you leave that's part of the intimate partner of violence and power and control and using intimidation of course making that person fearful as part of the power and control this is the cycle that we're dealing with I encourage people to think about this cycle before you make a judgment because quite honestly there have been lots of judgments made about the person that remains in that hurtful relationship and some of them might be I don't believe that that that person is still there why doesn't he or she just leave I would never deal with violence in my relationship those are very judgmental statements and if that Survivor feels like they're being judged they're not going to talk to you they're not we're losing that opportunity to support them to motivate them so please just think of that and challenge others when they make a not when they make a judgmental statement challenge them to think about the cycle and all the factors that play into intimate partner violence so let's talk about more of the phases of the violence because there are four phases one is a calm phase everything's okay everything's peaceful the abuser is acting like there's not a problem but then we get to a point where there is tension that builds there's anger that builds there is aggression that builds and instead of talking it out it actually comes out through hurts physical hurts emotional hurts verbal hurts the abuse occurs and then we move into the reconciliation phase I'm sorry I did not mean for that to happen it's my issue over here it's my issue over here it's not me so it's the excuse making to allow or to make that Survivor remain and accept it so it is a cycle of violence so as we think about the cycle I would like to encourage each and every one of us to think about a cycle of change we know there's a cycle of violence four phases we just talked about but let's look at it as a cycle of change as well so in considering this a cycle of change it is important for us to look at intimate partner violence as a public health issue this is a public health issue because there are medical costs there are direct costs there are indirect costs for a Survivor so for a female Survivor intimate partner violence is actually greater than breast cancer cervical cancer and diabetes I just want you to think about that let that sit on your heart for a moment intimate partner violence for a female Survivor ever is more prevalent than breast cancer cervical cancer and diabetes that's major that's major nearly one in three women will report an intimate partner violence experience in their lifetime that's one and three so if you are sitting in a room right now with six female colleagues two of them in their lifetime according to the statistics will report intimate partner violence at some point in their life based on some data from the Centers for Disease Control in 2003 intimate partner violence direct costs for the United States was over 8.3 billion doll for medical care alone for the needs that the Survivor had from that violence the indirect costs such as lack of productivity being at work but you can't focus or calling off of work because of the violence is over $1.8 million mental health care costs are 800% higher for those that are abused versus those that are not abused and we have a lot of mental health issues in our community already that are not even tied into intimate partner violence so I just really encourage people to think about that in addition injuries that are sustained from violent episodes can be linked to arthritis migraines stomach problems pregnancy complications chronic neck and back pains sexually transmitted effect and drug use this is why it makes it a public health issue but I want to encourage us that this can be a cycle of change we can be a part of a cycle of change but in order to move towards that stage of change we do have to understand what those barriers to resources are what are the barriers that clients actually go through let's talk about that so provider barriers and client barriers according to theis vision of injury and violence prevention the office of family health services and this is from the Virginia Department of Health in 2009 there was a survey that was done to address intimate partner violence in the health care setting and from that survey 95% of providers have never attended a training on intimate pardon of violence I'm sorry I did say 95% just in case someone misheard that 95% that's huge that means those providers are not assessing for intimate partner violence in their health care setting which we would hope would be a safe place for a Survivor to share that information out of 1,53 of those surveys completed from social workers 42.1% stated that they don't have time to ask about intimate partner violence in their practice I'm sorry yes I said they don't have time to ask again just in case you didn't hear that part we need to take the time to ask this is my Challenge from one practitioner to another please take the time to ask the question because that could be the first invitation that a Survivor has ever had to address the issue and if a Survivor never hears anyone ask them about it then they may not know that it's okay to talk about it because they're already fearful for a number of reasons so as providers how are we a part of the problem this is self assessment and self assessment is not always the most comfortable but it is necessary violating confidentiality do we talk about it in our front office with our co-workers normalizing victimization well you know here we have another one that just came in and said that she you know has dealt with some violence in her relationship or here we go again he just came in and said his partner throws things at him all the time and curses them out they just need to get with it so you're normalizing it ignoring the need for safety so someone says to you that they're dealing with intimate partner violence are we asking the question of whether or not where going tonight or where they're going when they leave our office is a safe place those are some basic questions to think about not there's no respect or no autonomy so there's more of the power and control from you from us I'm including myself in this because self assessment is something that we all need to do on a regular basis our words are they words of partnership with your client or are they words of power and control here's what you you need to do that's a power and control phrase compared to Let's kind of talk about what you think might be helpful what do you think you need right now because there's power in our words if we trivialize or minimize the abuse then we're almost blaming the Survivor so these are our own barriers as a practitioner so think about the barriers that we we've already discussed about the Survivor the loss of status if they share their their violence experiences the money issues the concerns about their children concerns about their family those are their own personal barriers but we also have some in our organizations as well so one of the things that I certainly would like to encourage you to think about in your practice in your offices on your intake forms are just words and we can do a dayong workshop on words alone avoiding labels so avoiding labels such as spouse abuse avoiding labels such as battered woman avoiding labels such as emotional abuse or victim versus Survivor they're survivors they've been through some things or they're going through some things and they have a story to tell victim is more of that negative labeling that may hinder someone from sharing what they need to share so those are certainly important key pieces to think about and I challenge you on the language because in our part two series we really are going to go over some very practical ways some actual specific verbiage that you can use when talking to a client that is strength based that invites them into the conversation around intimate partner violence in a way that lets them know this is a safe Zone this is a nonjudgmental environment this is your platform to be able to release so there's a there's a process that we're going through we're just laying the foundation now of what intimate partner violence actually looks like next week we're really going to jump into the how do you address it the house so as we think about creating opportunities to have the conversation which is part two of next week let's think about the first step research actually says that intimate partner violence survivors are often judged and they're not believed and they're blamed by professionals now for those of us that are very focus on strength-based practice that touches our hearts because we just can't imagine that a professional would blame or judge someone we can't imagine that that's really not supposed to happen in our Fields but it does so it's no wonder that our survivors are hesitant to bring up any of the violence because if they hear judgmental comments already they're surely not going to think of a time when you wanted to share something and then someone made a comment to you was judgmental I bet you held back you might have held back often people who experience intimate partner violence lack a support network they may only have health care providers that they feel are their supports but guess what the healthc care providers might not be asking and that's the only support that they have or guess what the that their child is in might be the only support they feel they have but are you asking it think outside of the box if you run a program that is an after school program for Children and Youth do you have a form that asks what the family's needs are do you ask if there's intimate partner violence in the home or do you just focus on the child's needs and activities they would like to be placed in I'm going outside of the box right now so go with me on this think creatively about your your process of connecting with clients in building relationship from the beginning from the moment your staff answers the phone to the moment that they hang up because we want to challenge ourselves to put a client in a position to walk away saying I am so grateful that I talked to them that was so well worth my time and it hit my heart so in part two of our series you as participants will use a strength-based model to really focus on help healthy relationship building to focus on a way to bring a client into a conversation without feeling judged we're going to discuss the process of assessing for intimate partner violence what does that look like what specific questions would you ask they don't have to be long-winded it doesn't have to throw off your whole intake process and cost your organization a lot of money to redo your your paperwork but it certainly is something to think about we'll practice a therapeutic model called motivational interviewing which is a technique that invites a client in to be a partner in this process think about a client who's coming to ask for assistance it's very courageous for them to get to that point to even say to themselves I'm going to go to the ABC program and let them know that this is what my family needs that's huge huge I hope that we're all humbled by that opportunity to connect with a person when they get to that point of asking for help it's such a sign of strength when they do we want to be able to use this motivational interviewing technique to make them feel like their partner it's not a power over this is a power with this is a partnership that we're building and so we're going to practice that we have a tool that will actually uh be able to use during the training you'll have access to it on the website and we will practice what that feels like using that with your clients then we're also going to talk about using an abuse assessment tool that you can actually Infuse into your paperwork process so again not a cumbersome process not a process where you'll have to change all of the Dynamics of your your intake and your your paperwork but just a way for us to include this in our process so as we think about change and as we think about cycle of change we think about assessment to ask about intimate partner violence I really would like to encourage us to think of what it feels like to be our client and we do this but but do it regularly what does it feel like to be our client one of the things that I that I always share with clients is I'm not on the other side of the table from you I sit on the same side of the table as you I'm human you're human let's cry together let's breathe together let's figure it out together this is a partnership and I really challenge myself to do that because of this statement here this came from a family member in a focused group back in the late 90s and it says rich people can decide what they want to do poor people are usually told what they have to do now I want you to switch that because we're not here to talk about poor people but what we are here to talk about is a Survivor a person in need and so sometimes the person in need can be told what to do or can be judged because of their need I put that statement up there specifically to throw you off and make you think about that we want our clients to feel a part of this partnership process I invite you to think about what that looks like for your organization for your network that you're a part of for your parent or social group that you are a part of for your community for your neighborhood for your faith-based organization what does that look like I challenge you to think about that write it down come back to next week's session so that we can really talk about what that looks like and is there potential to tweak it just a little bit as we think about partnering with our clients questions and yes we do have questions I would encourage people to take advantage of the chat window to the right of the video screen to submit your questions or comments first question that's come in uh do you think that the social work field views ipv is such a special specific topic and therefore does not encourage trainings for those in Social Work positions what's your opinion on the disconnect I appreciate the question it is a thought-provoking question I do get the sense that intimate partner violence is a specialized component of our social work field that places us in a position to only offer trainings in a very specific way versus broadly so as I think about social work education there should be a mandatory class on intimate partner violence because I guarantee to you as a social worker you're going to run across that at some point in the medical field there should be a mandatory course on intimate partner violence because at some point one of your patients will come into your office with an intimate partner violence issue an injury an emotional scar so I do feel like it's a specialized field but I do want to give the field of Social Work credit I do do think there is more infusion of this discussion into our work but I almost feel like it should be mandatory it's still optional and if we are preparing social workers for the field it shouldn't be optional because we're going to come across it at some point and when we have the option of saying I'm not dealing with that we probably will not so I thank that person for that question a question from someone joining us in the room here hi Belinda hello uh I wanted to know how important do you think it is for as we're working with the women the the women when they come into our services for uh ipv uh Services also to have a component uh in their service that works with the children as well because often the time we find that as we're working with the women uh that they can focus mainly on them because their children because they of the effects of the IV with their children that they can focus on uh a lot of things for themselves surek no thank you for the question I think it's imperative for any Survivor that has children to have some services offered for them whether they have been directly involved in that intimate partner of violence exposure or they see their parent they see the mother they see their caretaker dealing with that I do think that services for the child is imperative because we know it affects a child from the womb it affects the child from the womb so yes if we're looking at things as a holistic approach and we are really addressing Mind Body Spirit we do need to look at not only the adult but the child as well thank you for that question what are your feelings about doing couple counseling as a means for addressing ipv should couple work be put off until there is individual treatment and if so why if not how do you do couples work I would not encourage couples counseling when addressing issues of intimate partner violence because of the fact that it's about power and control and it would be very hard for a healthy atmosphere to be built if you have the abuser and the Survivor in the room at the same time and that practitioner is trying to address those issues it needs to be individual counseling so that the abuse user can address those issues of aggression and anger and maybe hurts from the past and the Survivor and his or her own counseling session can address their hurts from the violence that would be my recommendation to keep it very separate and then after some time of individual therapy then yes coming together to do some couples counseling is important because that will help build the relationship and set that healthier Foundation of communicationa do you think that in the individual counseling if the abuser is knowing that the wife is getting individual c do you think that will cause more conflict in the home and then what should she do with that if it's bringing more confusion in the home and maybe more violence in the home you know it's an interesting question on whether or not the individual counseling can become a problem it it certainly can because if there's a power and control issue that abuser is concerned that the Survivor is going to maybe gain some more Independence uh get some help and then maybe disconnect themselves from the abuser so yes it can definitely be a challenge however it is empowering it is empowering for that Survivor to do that for themselves that's part of the self-care piece that's part of the healing process but it is also about timing so for that Survivor they have to know the timing and the Dynamics in their relationship to be able to do that but yes I encourage it this may be a teaser for next week you tell me how do you as a therapist deal with a client for whom you're convinced is experiencing abuse but insists on minimizing the problem it's a Therapeutic Alliance that you build with the client so over time once you build that Alliance you also building a safe place for you as the clinician to gently challenge the client's thinking so if the client is minimizing the issues over time as the clinician you do say think about this you do challenge the person to use what's called bifocal vision and see the full picture of the hurts and the positives because part of Behavioral change is to challenge a client's thinking and so that's done in a very very caring very safe therapeutic environment but yes it is done all right I think we've done it great if there are other questions you know I certainly encourage those questions to continue to the chat send questions to the chat and they can email them to us as well and tune in again next week to make sure as we begin the process of the conversation that you're able to have your questions addressed as well so thank you very much for joining us this afternoon we'll leave the links open for the cus and the slides we'll send them to you in in a follow-up email as well so you can purchase cus after the fact if you're interested be sure and join us next week for part two of this discussion encourage your friends and your colleagues to join us as well we had a good crowd online today thanks to the folks who joined us in the room and especially Belinda thank you for your time and your expertise thank you time I appreciate the [Music] opportunity [Music] oh [Music] [Music]