What are some short-term and long-term therapeutic considerations?

Counseling an Intimate Partner Violence Victim: Melinda’s Journey

Melinda, a 25-year-old, middle-class, African American female, first came to counseling for depression. During the initial intake interview, Melinda reported experiencing difficulty sleeping, frequent crying spells, low self-esteem, and feelings of hopelessness. Melinda’s counselor, Candace, screened for suicidal ideation, homicidal ideation, and IPV as a routine part of the initial interview. Melinda denied suicidal and homicidal ideation and said that she had never been abused by her current boyfriend. At the end of the initial session, Candace provided Melinda with a packet of materials that she distributes to all new clients, which included a pamphlet on IPV.

Over the next two sessions, Melinda and Candace developed a strong rapport. During her third session, Melinda tearfully disclosed that her live-in boyfriend sometimes pushes or hits her when he has been drinking. Candace listened empathically to Melinda and let her know that the abuse was not her fault and that she believed her. After Melinda’s disclosure, Candace asked for more information about the abuse, including how arguments usually begin, details of the most recent incident of violence, and Melinda’s history of experience with IPV. Melinda reported that the last time her boyfriend hit her was a week ago, when he came home drunk from a party. Melinda sustained a split lip but did not require stitches.

Candace also completed a lethality assessment and determined that Melinda’s boyfriend had never threatened to kill her, did not have a criminal record, and did not have a gun in the house. Melinda stated that she had never feared for her life when her boyfriend became abusive. She indicated that she did not want to break up with her boyfriend and that she did not think the abuse was serious enough to report to the police. Candace respected Melinda’s autonomy and provided her with additional educational materials about IPV and information on 24-hour IPV crisis resources that Melinda could use in case of an emergency. Since Melinda reported that her boyfriend typically drank every weekend, Candace scheduled another appointment with Melinda before the upcoming weekend in order to develop a safety plan. Melinda and Candace collaboratively developed the following safety plan in order to minimize the risk and impact of IPV:

1. Plan to be away from the house when boyfriend comes home drunk.

2. If boyfriend comes home drunk unexpectedly, stay away from the bathroom and kitchen.

3. Pack and hide an emergency bag with clothes, cash, and an extra set of keys in case of the need to flee the house quickly.

4. Program IPV crisis hotline number into cell phone.

Melinda and Candace also discussed ideas for building coping resources, including engaging in self-care activities like reading empowerment books and joining a women’s support group at church.

Over the next several months, Candace and Melinda met once a week for counseling. They continued to discuss and evaluate Melinda’s safety. Despite her efforts to avoid physical violence from her boyfriend, the incidents of abuse became more frequent over time. Melinda had now sustained several injuries, including a broken arm and a broken rib. A turning point occurred when Melinda learned that she was 8 weeks pregnant with her first child. Melinda decided that she did not want to raise a child in an abusive home. She was ready to leave. Candace and Melinda discussed the risks associated with leaving an abusive partner and tips for ensuring a safe escape. Together, they decided that an IPV shelter was the best option, since Melinda had no trusted family or friends in the area. Candace arranged for transportation to the shelter straight from her office and waited with Melinda until help arrived.

Discussion Questions

1. Are there other considerations that will need to be implemented into Melinda’s treatment?

2. What are some short-term and long-term therapeutic considerations?

3. What are some case management issues that must be addressed?

4. What referrals need to be made for Melinda?

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