Violence Threatens Families – From Without and Within
By Becky Palmer, MS
Nearly every day American media informs us of violence in our communities, schools, and places of worship. Yet the proliferation of violence within our homes is scarcely talked about. According to NCADV (National Coalition Against Domestic Violence), one in three women and one in four men have experienced some form of physical violence by an intimate partner. Furthermore, NCADV reports that on an average day there are more than 20,000 phone calls placed to domestic violence hotlines.1
These statistics do not even account for sexual violence against children and adolescents and the impact of sexual violence on families. Nor do they account for the opioid epidemic devastating vast regions of our country.
Family therapists today face the challenges of treating families traumatized by violence in the community and disrupted by violence, sexual abuse, and drug addiction within their own homes. A key question for the mental health profession today is this: Are there enough professionals who have been adequately trained to provide the necessary services to disrupted and traumatized families?
A Brief History of Family Therapy
Family therapy differs from individual therapy in that it sees the whole as greater than the sum of its parts. Whereas individual therapists address individual clients’ problems in order to effect change in their family relationships, family therapists view the family as a system of interconnected individuals, none of whom can be completely understood in isolation from the system.
Family therapy as a profession began in the 1940s as marriage counseling. Its purpose was to help married couples stay married. It often involved determining who was right and who was wrong in different aspects of the relationship. It was more like individual therapy with an observer than a combined effort with both partners.
In the 1950s it became marriage and family therapy, as therapists recognized that issues were developed and maintained because of the social constructs within a family or marital relationship. This switched the focus of treatment from the individual to the family or couple.
By the 1960s, the idea that family problems were caused by internal dysfunction was replaced by the idea that healthy people can have unhealthy relationships and that sometimes even healthy relationships struggle when under extreme stress.
Violence, Drug Addiction, and Sexual Abuse in the Home
Violence
A 2009 comprehensive national survey funded by the US Department of Submissions Justice found that 60 percent of the American children surveyed had Contact Us been exposed to violence, crime, or abuse in their homes, schools, and communities in the previous year. Of those children:
• 46 percent had been assaulted at least once.
• 25 percent had been victims of robbery, vandalism, or theft.
• 10 percent had seen one family member assault another family member.2
Addiction
Substance abuse in various forms harms the family directly and indirectly on a daily basis. While numerous forms of intervention identify the disease of drug and alcohol addiction to be the individual’s problem, its impact on family life and dynamics cannot be understated. Family members can knowingly and unknowingly enable the continued abuse of drugs or alcohol. Long-term abuse of drugs or alcohol can have devastating consequences, from shattered relationships and financial ruin to loss of status within one’s community.3
Sexual Abuse
Helping professionals also consider sexual abuse a target for individual treatment, providing therapy for victims and rehabilitation for perpetrators. However, according to a 2016 US Department of Health and Human Services Child Maltreatment Survey, about one third (34 percent) of all sexual abuse perpetrators are members of the victim’s family.4
The Challenge: Finding Affordable Training in Family Therapy
In my experience both as a consultant and trainer I have discovered that what is being identified as family therapy is often in fact not family therapy. For example, what many professionals who treat sexual offenders think of as family therapy is essentially sitting with the family of a sexual offender before his release back into the community to review safety and visitation plans, none of which addresses the dysfunction of the family of which the offender had been a member.
The lack of training budgets in most agencies has left well-intended therapists and clinicians to figure out how to do family therapy on their own. Inadequately trained clinicians “think” they are doing family therapy because they care and have a graduate counseling degree. We know that the roots of family violence or abuse don’t develop overnight. Identifying the contributing factors requires a skilled family therapist who understands abusive family systems and dysfunctional patterns of interacting.
Granted, underfunded agencies are doing the best they can— especially considering that state and federal funders are compounding the problem. How? By decreasing funding for staff training while demanding that agencies provide more evidence-based services to families of domestic and sexual violence, which, of course, requires more specialized—and more expensive—training. Unbeknownst to most professionals, in January 2018, the Trump administration quietly and indefinitely suspended The National Registry of Evidence-Based Programs and Practices (NREPP). NREPP was the Federal agency that “listed effective, science-based interventions for behavioral health issues, including the prevention and treatment of mental illness and substance use disorders (SUD).” As a result, the federal agency that provided information for consumers about evidence-based practices is no longer functioning and programs that sought this endorsement, and had agreed to be independently audited by NREPP, are no longer able to attain this endorsement.5
In sum, mental health agencies are grappling with massive funding cuts while being called upon to provide the same or expanded services. Families seeking services from an agency or private therapist are discovering that most often their health insurance no longer provides mental health coverage or will not cover family therapy unless one family member is given a treatable diagnosis.6
Perhaps agencies and clinicians need to rethink how to adequately train staff to provide family therapy and graduate degree counseling and therapy programs should consider how to equip their graduating students to work with abusive family systems. In the family therapy article of The New Circle’s next issue, we will explore how some agencies and therapists are becoming innovative in training staff and in future issues, we will consider innovative approaches to working with families of at-risk children.
1. The National Coalition Against Domestic Violence. www.NCADV.org2. Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
3. Substance Abuse and Mental Health Services Administration. (2004). Substance abuse treatment and family therapy. (Treatment Improvement Protocol Series, No. 39, Chapter 2). U.S. Department of Health & Human Services.
4. Administration on Children, Youth & Families, Children’s Bureau. (2018). Child Maltreatment Survey, 2016. U.S. Department of Health & Human Services, Administration for Children and Families.
5. Sun, Lena H., & Eilperin, J. (2018, January 10). Trump administration freezes database of addiction and mental health treatments. The Washington Post. https://www.washingtonpost.com/national/healthscience/trump-administration-freezes-database-of-addiction-and-mentalhealth-programs/2018/01/10/ed421654-f577-11e7-beb6-c8d48830c54d_ story.html
6. Peter G. Dodge Foundation. (2018). SAMHSA’s Registry of evidence-based programs (NREPP) suspended. https://pgdf.org/samhsas-registry-ofevidence-based-programs-nrepp-suspended/
Becky Palmer, MS
Becky Palmer currently provides consultations and trainings to agencies, individual therapists, and parents, both nationally and internationally. She holds a master’s degree in counseling psychology and completed post graduate training in marriage and family therapy at the Institute for Juvenile Research in Chicago. Becky specializes in working with abusive family systems and previously worked in residential care and outpatient therapy. She has published articles and book chapters about survivors and perpetrators of sexual abuse, and has taught and lectured at several graduate institutions on abusive family systems and psychotherapy of sex offenders.
