Groves, B.M. (1999). Mental Health Services For Children Who Witness Domestic Violence. The Future of Children, 9(3), 122-132.
This article provides a good introduction for practitioners working with child witnesses of family violence. It is not a presentation of new research, rather it is an overview of important issues. The article begins by summarizing the effects on children of exposure to family violence. These effects include aggressive behavior, depression, anxiety, sleep disturbance and learning problems.
Groves next stresses the importance of proper identification and assessment of children exposed to domestic violence. She notes that often, children who have witnessed domestic violence are "hidden". That is, their mothers do not seek assistance from a shelter. Also, the families keep their violent histories cloaked in secrecy. Assessment should rely on a clinical interview supplemented by sources like parents and teachers.
The article goes on to describe four goals of intervention with children. These are: reducing the child’s sense of isolation, helping children understand their emotional responses to violence, reducing the symptoms that children experience (e.g. nightmares) and working with the family to develop a safe and nurturing environment for the child.
Next, therapeutic approaches such as group therapy, are discussed. The article states that an advantage of group work is that it breaks the child’s sense of isolation and allows children to identify with each other. Individual therapy is also mentioned, but the article states that little has been written about that specific approach.
The article concludes with a summary of the challenges facing practitioners in this area. The first is addressing the possibility of concurrent child abuse or neglect. The second is meeting the complex emotional needs of the child client and his/her family. The article recommends that agencies and schools increase efforts to identify children who are exposed to domestic violence.
Ducharme, J.M., Atkinson, L. & Poulton, L. (2000). Success-Based, Noncoercive Treatment of Oppositional Behavior in Children From Violent Homes. Journal of the American Academy of Child & Adolescent Psychiatry, 39(8), 995-1004.
This article provides research results on a specific type of intervention with children from violent homes. It begins with a brief literature review that documents the high rate of oppositional behavior in children from violent homes. Next, the importance of compliance training is discussed. The article explains that this training can offer parents a way to get children to comply with requests without resorting to physical punishment.
The method of the study involved observing parent-child interactions and determining the probability of compliance to a range of parental requests. These requests were then rated on a scale from one (highly probable compliance), to four (compliance is unlikely). It is important to note that each of the fifteen children involved in the study had "severe disciplinary problems including noncompliance and aggression". The research design involved multiple baseline measures of noncompliant behavior. Parents involved in the study were trained to begin by praising their children for following their requests. If the child did not comply, he/she was not punished. The parent ignored the noncompliance. Regular activities continued until the next request was made of the child. As the child’s rate of compliance increased, the parent began to make higher level requests of his/her child, based on the established scale. Requests continued until a high rate of compliance was reached for requests classified as level four.
The researchers conclude that their technique is very effective, as determined by statistical analysis. They also state that the mothers’ subjective reports indicate significant improvement in their children’s behavior.
Tutty, L.M. & Wagar, J. (1994). The Evolution of a Group for Young Children Who Have Witnessed Family Violence. Social Work With Groups, 17(1-2), 89-104.
This article describes a therapy group for children between the ages of five to seven years old. The authors claim that this therapy group is innovative because of the young age of the participants. Most group programs are for children between the ages of eight and twelve.
The authors begin by summarizing a brief history of group intervention with children. Over the years, groups have evolved from loosely structured gatherings to ones containing more adult-directed, structured activities.
The authors present their group model, which is called "storybook club". This group uses stories as metaphors for children to express their feelings and build problem solving skills. The group also uses a variety of activities to help children process their feelings. These activities include the use of a "mood chart" for the children to classify how they are feeling at a particular time. Furthermore, group leaders read short stories with a specific theme (such as divorce or sadness). The children often identify themselves as the focus of these stories, which generates discussion. Finally, the children act out plays or "dramas" to further help them express their feelings. These techniques are used because traditional verbal discussion is usually difficult for children this young.
The authors conclude the article by stating that one of the main problems they encountered was the lack of engagement from the parents. This lead to poor attendance at times. Also, the authors add that positive changes in children are often not met with corresponding positive changes in the parents. At the time of the article’s publication, data concerning the impact of the group therapy was unavailable. However, the participating children and their parents and teachers reported positive changes.
Wilson, S.K., Cameron, S., Jaffe, P. & Wolfe, D. (1989). Children Exposed to Wife Abuse: An Intervention Model. Social Casework: The Journal of Contemporary Social Work, p.180-184.
This article describes a ten-session group therapy intervention designed specifically for children who have witnessed family violence. The authors begin by defining six "lessons" that children learn from their violent families: "(1) Violence is an appropriate form of conflict resolution; (2) violence has a place within the family interaction; (3) if violence is reported to others in the community…there are few consequences; (4) sexism, as defined by…roles within the family…is to be encouraged; (5) violence is an appropriate means of stress management; and (6) victims of violence are…to tolerate this behavior" (p.180).
Next, the article defines the goals of the group. These goals are to learn new problem solving techniques, examine the use of violence to resolve conflict, adjust attitudes toward relationships and responsibility and build self-esteem. The group is designed for children from nine to thirteen years old.
The authors describe specific activities and objectives for each of the ten sessions. A condensed list of topics follows: Session 1; introduction, Session 2; labeling feelings, Session 3; dealing with anger, Session 4; safety skills, Session 5; building social support, Session 6; improving self-concept, Session 7; understanding responsibility for parents’ violence, Session 8; understanding family violence, Session 9; wishes about the family, Session 10; review and termination.
The authors conclude the article with recommendations for practitioners to address a child’s hesitation to disclose information about the "family secret" of domestic violence.
Anderson, S.A. & Cramer-Benjamin, D.B. (1999). The Impact of Couple Violence on Parenting and Children: An Overview and Clinical Implications. American Journal of Family Therapy, 27(1), 1-19.
This article provides an excellent literature review on the subject of children who witness family violence. The article begins with a summary of theoretical explanations for the negative effects of witnessing family violence. Social Learning Theory, Systems Theory and the Psychiatric Model, based on Post-Traumatic Stress Disorder, are all discussed.
Next, the article presents a summary of research results in four major areas of inquiry. First, the magnitude of the problem is explored. A variety of statistics concerning children’s exposure to couple violence are presented. Second, the context of children’s exposure to violence is discussed. The authors make an important point in this section. They specify that "children who witness couple violence are as disturbed as children who are directly abused themselves" (p.5). Third, the direct and indirect effects of witnessing violence are presented. This section includes information on gender differences in witnesses as well as the effects on parenting. Finally, factors related to children’s treatment outcomes are described. The article provides information on five different areas influencing outcomes. These are: severity and frequency of violent events, the content of parental disagreements, the depth of the child’s relationship to the victim and the perpetrator, a parent’s ability to use conflict resolution skills and child involvement in the interparental conflict.
The next section of the article suggests clinical implications of the summarized information. These implications are focused around assessment, as well as special considerations for treating children exposed to violence.
A final section presents several examples of treatment programs for adults and children exposed to violence. Each of these programs incorporates teachers, mental health professionals and often, law enforcement officers.
Silvern, L. & Kaersvang, L. (1989). The Traumatized Children of Violent Marriages. Child Welfare, 68(4), 421-435.
The article presents a very specific view of treatment for children who witness family violence. In the introduction, the authors state "This article hypothesizes that traumatization underlies the difficulties these children experience…interventions should be designed to counteract post-traumatic disorders" (p.422).
The authors begin by defining the emotions experienced during the traumatic event of witnessing parental violence. These feelings include fear, helplessness and overstimulation. Next, they explain the "traumatic process" (p.424). An important element of this process is mental repetition of the event. Signs of repetition include nightmares and flashbacks. The authors then discuss trauma resolution. They make the important point that children’s trauma must be discussed by direct disclosure in order for them to resolve their issues. Simple play therapy, these authors believe, is not adequate to do this.
The authors then present a detailed case report of an eight-year old boy, named Jon, who exhibited violent behavior at school. Jon’s fantasy play was described in detail. Most of it involved viewing himself as a superhero, with four snakes that helped him fight "bad guys". Jon drew a picture of these snakes that resembled human fingers. When this was pointed out by the therapist, Jon was eventually able to talk about (and therefore process and resolve) the time he witnessed his father choke his mother. This therapeutic process for Jon lasted over 14 months and eventually his violent behavior vanished.
The authors conclude with the recommendation that practitioners balance symbolic expression play therapy with direct talking. In this way, children can master the experience of witnessing family violence.
Kilpatrick, K.L., Litt, M. & Williams, L.M. (1997). Post-Traumatic Stress Disorder in Child Witnesses to Domestic Violence. American Journal of Orthopsychiatry, 67(4), 639-644.
This article is an excellent study which provides empirical evidence that "witnessing domestic violence is an experience sufficiently intense to precipitate PTSD in children" (p.639).
The authors present only a brief introduction before describing the method of their study. The participants in the research were recruited with the help of community social service agencies. A total of 58 children were divided into two groups, either a "witnesses" or "non-witnesses" group. It is important to mention that the mothers of the child witnesses were all violence victims, not perpetrators. The two groups were matched as closely as possible regarding variables of age, socioeconomic status and residential situations.
The next section of the article defined the measures used to assess exposure to domestic violence and other stressors contributing to the possibility of PTSD. The Child Post-Traumatic Stress Reaction Index (PTSRI) was used. Another assessment tool was simply identified as the "CTS", which the authors state was designed to elicit information concerning exposure to domestic violence. The authors then describe in detail the three- step procedure to assign children to the experimental groups.
The results section states very clearly what the researchers found: "All the children in the non-witnesses group scored below the minimum necessary…for a diagnosis of PTSD…Only one child in the witnesses group did not qualify for such a diagnosis" (p.641).
The article concludes with a discussion about clinical implications of the results. Many of the implications included ideas that this author has read in other articles. However, one quote did resonate with me and that is, "Given the similarity in trauma outcome, therapy successful in treating child victims of sexual and physical assault would appear appropriate for child witnesses of domestic violence" (p.643).
Burman, S. & Allen-Meares, P. (1994). Neglected Victims of Murder: Children’s Witness to Parental Homicide. Social Work, 39(1), 28-34.
This article presents information concerning children who have witnessed the murder of one parent by another. It begins with some statistics concerning the scope of the problem. Next, the multiple levels of trauma that children in this situation experience are discussed. These include coping with a violent trauma, the instantaneous loss of both parents, dislocation from their homes, insecurity about where and with whom they will live and feelings of anger, depression and guilt.
The authors then present a case study of "Joseph and Sam", who witnessed the shooting death of their mother by their father. These children were brought in for treatment two years after the event, mainly because of problems they were having in school. Other symptoms the children demonstrated included bedwetting, nightmares, trouble in sleeping and an obsessive fascination with guns and violence (in Sam only).
The authors describe the two theoretical frameworks upon which their intervention was based. These include the Theory of Psychosocial Development, based on Erikson’s stages of development. Also, Social Learning Theory is offered as a way to explain modeling behaviors.
The treatment section details significant events that occurred during the eight months that the children worked with a therapist. A variety of techniques were described, including play therapy, cognitive-behavioral techniques to address anger management and family sessions with the children’s aunt (with whom they lived).
The article concludes with a discussion that addresses the more "macro" issues of family violence, which are the lack of equal opportunities for minorities and women.
Lehmann, P., Rabenstein, S., Duff, J. & Van Meyel, R. (1994). A Multi-Dimensional Model for Treating Families that have Survived Mother Assault. Contemporary Family Therapy, 16(1), 7-23.
This article presents a Family Systems model for treatment of child witnesses to mother assault. The authors begin with a background section that presents some statistics about family violence. It also outlines a treatment plan developed by another researcher, involving individual and family systems.
Next, the authors present three areas of research that may help family therapists. The first is the documentation of the negative effects of violence on child witnesses, including anger, withdrawal and peer relation problems. The second area of research mentioned is the increasing body of knowledge that child witnesses to mother assault may develop PTSD. Finally, the authors present feminist family therapy, which addresses the social and political elements of family violence.
The authors then describe their guidelines for practitioners to consider. These guidelines are: To focus on the assault, deal with accountability, engage in open family discussion and adopt a personal and political position on violence.
Three intervention approaches that develop from these guidelines are then explored. The first is working with the larger system, including the economic system. Second, the traumatic after-effects of witnessing violence must be addressed. Third, relational imbalances among family members must be rebuilt.
The authors conclude their article with a discussion of nine issues that could be important for clinical consideration for both mother and child. These issues are: Basic safety skills, responsibility for behavior, building social support systems, understanding departure from the abusive relationships, learning flexible, non-gender stereotyped behaviors, learning differences between conflict and abuse, disclosure of family secrets, conflicting feelings of loyalty to both parents and accepting the permanent loss of the previous family unit.
Fontes, L.A. (2000). Children Exposed to Marital Violence: How School Counselors Can Help. Professional School Counseling, 3(4), 231-236.
This article was chosen because it offered a different perspective than that of previous ones. Obviously, its focus is on interventions potentially useful to school counselors. However, this author felt it was an important article to include. This is because private practitioners frequently consult with school counselors about their client’s school behavior and academic achievement. Familiarity with the ways a school counselor can help could prove very valuable.
The article begins with an extensive literature review. This review provides statistics, definitions of terms, a description of the connection between wife abuse and child abuse and theoretical frameworks to understand the effects of violence. These theoretical frameworks include Social Learning Theory, the PTSD theory and Attachment Theory.
Next, the authors offer techniques to identify children from violent homes. These techniques include looking for a child who acts out scenes of marital violence in play. It is recommended that the child be asked direct questions about family violence.
The issue of mandated reporting of domestic violence is covered in the next section. Legal obligations are reviewed. Also, the types of risks to which children can be exposed are listed.
Ways to help the child in school are then presented. These include the goals of individual counseling and suggestions on how to aid the child in improving classroom performance. The article concludes with a list of important cultural considerations of which school counselors should be aware.