Melbourne ~ Australia
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A new treatment population has recently emerged. This population is the children who find themselves in shelters for victims of domestic violence. In recent years there has been a dramatic increase in these shelters. A recent publication (Programs Providing Services to Battered Children, 1981) cited the number of such shelters in the United States as 394. There are 325 shelters reported to accept children. Of those, 172 stated that they had some form of program for those children. The type of program was generally described as "child care." Counseling for these children was reportedly offered as a service in only three of the shelters, despite the fact that children who come to shelters are experiencing crisis.The purpose of this article is to identify this new population and its special needs and characteristics; to establish, based on the literature and on our clinical experience, the need to treat these children; to identify problems inherent in treating these young people; and to offer a treatment style that we have developed to treat this group of children.
The children who find themselves in shelters are in crisis. Their normal coping patterns (which were probably not initially that healthy) and their support systems are disrupted. They have experienced the loss of school, friends, neighborhood, home, and usually the significant adult male in their lives. These children are experiencing acute feelings of separation, loss (anger, fear, and emotional pain), and they have difficulty coping with these feelings in a healthy fashion (Davidson, 1978; Fleming, 1979). As Myers and Wright report (1980) these children "are in as much crisis as their mothers" (p. 4).It is our contention that appropriate services for children in shelters are lacking. A publication of the New York State Department of Social Services (1980) states:
Although the primary focus of a Special Care Home program (shelter) is the adult victim, children often outnumber adult residents by a factor of two to three. Some shelter programs have planned inadequately for child care and supervision. This results in more stress and frustration for both residents and staff, thereby undermining the real work that should be going on in the shelter. (p. 4)
It appears, from the statement, that the work of the shelter is defined merely as treating the adult victim with little appreciation for the child as victim.Kinard's (1980) review of the literature, primarily focusing on abused children, makes note of the same dilemma: "Although concern with the problems of abused children has increased dramatically in the last decade, the primary target of intervention, particularly in the mental health field, has been the abusing parents. The impact of abuse on the child's future emotional development has seldom been considered." He goes on to state:
Recent studies of emotional development in abused children indicate that these children have serious emotional problems despite the services provided to their families. Knowledge about these problems is necessary in order to develop intervention and treatment strategies for ameliorating them. (p. 4)
Walker (1979), Martin (1976), Pizzey (1977), the Justices (1976), and Myers and Wright (1980) have all commented on and documented the nature of the problems and characteristics of children who find themselves in shelters. In her book The Battered Woman, Walker writes:
...that children who live in a battering relationship experience the most insidious form of child abuse. Whether or not they are physically abused by either parent is less important than the psychological scars they bear from watching their fathers beat their mothers. They learn to become part of a dishonest conspiracy of silence. They learn to lie to prevent inappropriate behavior, and they learn to suspend fulfillment of their needs rather than risk another confrontation... They do expend a lot of energy avoiding problems. They live in a world of make-believe. (p. 46)
Martin explains how children suffer "simply because they exist" in a battering household and how they run the risk of being battered themselves, or, at least, being scapegoated by the mother who has been scapegoated by her mate. Martin goes on to note how the child suffers emotional trauma-shock, fear, and guilt. Not only is the young person terrified because he/she is at a loss as to what to do, but also the child feels responsible and guilty. Pizzey (1977) offers countless examples of how the "children of battered women cannot win." Subject to and witnesses of rejection, inconsistency, and violence, boys and girls come to shelters passive and withdrawn, as well as aggressive and destructive. The Justices' (1976) characterization of abused children's behavior coincides with those of Kinard, Walker, Martin, and Pizzey. Myers and Wright (1980) echo these characterizations. They have noticed the withdrawal and passivity, the use of aggression to solve problems, impaired peer relations, and immature and regressive behavior, as well as a "pseudo-maturity" resulting from their being made to play an adult role, encouraged by parents who are themselves emotionally immature. Myers and Wright also explain that not only do children feel responsible and guilty about violence, but they tend to see themselves as responsible for their mother leaving.The characteristics of the children we have treated and observed mirror those described in the literature. The shelter where we are working has served more than 700 women and more than 900 children (ranging from infants to teenagers) since it opened in May 1979. Haven House is a shelter in Buffalo, New York for victims of domestic violence. It was founded by the Erie County Coalition for Victims of Domestic Violence. Treatment for children is provided by the Adult, Child and Family Clinic (formerly the Child Guidance Clinic), Department of Psychiatry, Erie County Medical Center, Buffalo, New York. The women sheltered here have been battered by husbands, boyfriends, adult sons, fathers, brothers, mothers, and sisters-in-law. There have also been children who have been abused by fathers and/or mothers. Several of these children have been incest victims. Most of the children who come to the shelter have witnessed violence and other abusive behavior (for example, verbal and sexual abuse, sleep and nutritional deprivation) in their homes. By the time a woman and her children come to the shelter, they have usually left the abusive household several times.As stated earlier, coming to a shelter precipitates a crisis in the children's lives. Based on our observations and clinical experience, we have classified, according to age, the characteristic ways in which children react to this crisis. Infants tend to be irritable, to have difficulty sleeping, to suffer from diarrhea, and to become ill frequently. Preschool aged children tend to be irritable, reluctant to leave their mothers, fearful of being alone, and yet open about violence in their families. Elementary school aged children vacillate between being eager to please adults and eager to make new friends and being hostile and aggressive. They are also verbal about their home life. Children 11 years and older are very protective of mother and very guarded and secretive about their family situations. They often deny that violence ever occurred in their homes.There are several characteristics which these shelter children, ages 2 through 17, share. Their initial method of solving problems is by hitting. They do not seem aware of other alternatives. They tend to be aggressive with each other as well as with adults, animals, and inanimate objects. They often use abusive language. Children as young as 2 years old have been heard voicing abusive words in adult contexts. The children of this particular population attribute their own faults and mistakes to other people and to inanimate objects. They tend to regress in areas where they had previously made developmental gains. The children exhibit a high degree of anxiety - biting their fingernails, pulling their hair, and somaticizing feelings as manifested by complaints of headaches and "tight" stomachs. They often verbalize feelings of responsibility for their parents' fighting and separation. They are confused about their feelings for their father. They hate him and love him at the same time.
After working with children in the shelter and becoming familiar with the literature, the need for treatment was obvious. Supportive activities were being done with all children in the shelter. These included encouraging children to talk about their family situations and to express feelings through art, puppetry, dramatic play, creative writing, music, and creative movement. Children's "house meetings" were scheduled in which all children had an opportunity to discuss complaints, problems and suggestions. However, there was no specifically structured treatment program for these children.
Once the decision was made to provide treatment, it became clear there were a number of obstacles inherent in working with children in a shelter. The shelter population is unique for the following reasons:
Treatment of Choice. We overcame these obstacles by first deciding that group treatment would be the treatment of choice. A group not only enabled us to work with a greater amount of children in a limited amount of time but also offered support and was less threatening than was individual counseling for these children. It helps them to feel more secure and enhances their sense of being supported and accepted. To deal with the transient nature of this population we developed a highly structured, time limited, intensive group model. This model will be described in detail later in the article.Age. We chose to limit the children treated to ages 8 through 16. Our rationale was to provide the older children with a group experience structured to their cognitive and maturational needs since the supportive activities in the shelter provided an avenue for younger children to express themselves (in nonverbal and symbolic ways) and because there were staff and time limitations.Staffing. The problem of availability of staff for leading the group was resolved by using the expertise available in working with children in groups. This was found at a local clinic providing services to families and children. Thus a mutual process of identifying the need, realizing fiscal constraints, combining resources and responding to a critical problem in the community was realized. In this case, the child care coordinator of the shelter teamed with a clinical social worker from the clinic. This team approach was done in recognition of the social worker's expertise in treating children in groups and the child care coordinator's expertise in child development and in working with the children in the shelter. It was very valuable that one of the group leaders was from the shelter. This provided the children with a sense of continuity and grounding from which a successful group experience might spring.Location. We dealt with the problem of finding an appropriate place to provide treatment by experimenting with available rooms in the shelter and at the clinic. We also learned to cope with such problems as the children's school schedules and limited transportation. This meant working together in a creative and cooperative fashion to find a location which is private, has adequate space, and is easily accessible to the children and to the leaders of the group.
The goals of the treatment group were to give children living in the shelter the opportunity to:
A Crisis Model Component. This component allows for the ventilation of feelings, the reestablishment of equilibrium, and a focus on problem-solving skills. What equilibrium existed in these children's lives has been disrupted (Lindemann, 1961). First and foremost, the function of the group is to help children find some stability; they have a need to express feelings in an atmosphere of support. It is important for them to correct distortions in thinking that may have arisen following their abrupt departure from home. Crisis theory (Parad et al., 1976; Rapoport, 1970) provides the structure for these tasks.An Accelerated Model Component. This means there is a time-limited contract, an ahistorical here and now focus, an avoidance of the mental illness model, an emphasis on the individual for taking responsibility for solving his or her problems, a focus on the future, and emphasis on an individual's potential rather than on the difficulties (Garvin, Reid, & Epstein, 1976; Stoller, 1972). These children are only with us for a short period of time. We want to offer them an intensive experience that is immediately of value to them. We are not interested in, nor do we expect, personality change. We are pragmatic. We hope these children can take away tools with which to cope more effectively in the future whether they return to their home and father (which happens frequently) or start a new life living with mother and siblings separate from their father.An Educational Component. This is essential to this model. Children are either misinformed or uninformed as to how to cope with their present problems in healthy ways. Children need information, not only about distortions and misconceptions that have arisen from their present trauma, but about how to cope with unpleasant feelings and problems in the future (Slavson & Schiffen, 1975). Children need to know that there are healthy as well as unhealthy ways to respond to their feelings of anger, fear, and pain. They are taught how to problem solve and are encouraged to choose healthy solutions (Somers, 1976).This group model includes the ten curative factors of groups that have been identified by Yalom (1970):
Treatment is comprised of a sequence of six sessions, each with its own focus: (1) the identification and expression of feelings; (2) violence; (3) unhealthy ways to solve problems; (4) healthy ways to solve problems; (5) sex, love, and sexuality; and (6) termination and saying goodbye. We chose these focal areas because we found they best met the needs of the children given the limited amount of time they are at the shelter.The Identification and Expression of Feelings. The purpose of this session is to introduce the children to the therapist from the clinic, explain the reasons for the group, identify and express feelings, and teach the children why identifying and expressing feelings is important.Since the children already know the child care coordinator who works full-time at the shelter (and who has already prepared the children with general information about the group), time is spent, initially, getting the children acquainted with the clinical social worker. This is also a time to observe the children and get a sense of each child (how to approach and interact with him or her). We explain to the the children that they need a special time to discuss things that they have on their mind. We introduce feelings and name them: Mad, Glad, Sad, and Scared. It is explained that there are lots of other words for feelings, like lonely for sad, frustrated for mad, and frightened for scared. We explain that if we use these simple words we will all understand what the other is saying. We tell the children that the reason we name and express feelings is to feel better and to use feelings to solve problems.A variety of exercises are used to facilitate learning: faces are drawn on paper or chalkboard to express the four basic feelings; we make faces at each other - sad ones, angry ones, and so forth; children are asked to print the feeling words expressively (for example, one child drew the word "sad" three dimensionally, colored it blue with tears dripping, and another drew the word "mad" with each letter having teeth and colored it red); the children are given sentences to complete ("I feel sad when... " or "When I feel mad I... "). We, as leaders of the group, always
participate in all of the exercises. When we risk and share it is easier for the children to trust us and share themselves. The exercises are designed to provide structure which decreases anxiety, and to involve the children in active learning. This facilitates retention. We always assign homework, the purpose of which is to keep the session alive for the children during the week. After this session we ask each child to return the following week with a poem or short essay about a particular feeling they had and what they did to take care of that feeling. In addition, these exercises are usually a positive experience for the children and set the tone for the rest of group sessions.Violence. The purpose of the session on violence is to give children an opportunity to explore and express feelings about the violence in their families and how it has affected them. This helps children break down their denial and minimization of the problem. It also gives children a chance to learn that other families have similar problems and that many families do not. The following questions are presented to each of the children for reflection and discussion:
The homework for this session is to create a minidrama about family violence and present the play the following week.Unhealthy Ways to Solve Problems. The goal of this session is to help the children realize that when they have a problem, and its accompanying unpleasant feelings, one choice they have is to solve the problem using unhealthy solutions. Using brainstorming techniques (and a chalkboard), children are encouraged to think of unhealthy ways to solve problems. Some of the ways identified by the children are: using drugs (including alcohol), sex, getting married very young, problems with the court system and police (stealing, vandalizing), running away from home, skipping school, getting poor grades, eating too much or too little, sleeping too much or too little, losing friends, fighting, day dreaming, and so on.We have found that the children have no problem thinking of many unhealthy solutions to problems. Their homework is to bring back a list of the unhealthy ways that they each try to solve problems. We think that this process helps children become aware of their individual coping patterns and aids them in thinking in terms of having choices in responding to problems.Healthy Ways to Solve Problems. The goal of this session is to teach problem solving and to help group members think of healthy ways to cope with problems. We are honest with the children. We tell them that we know that sometimes young people have to live in bad situations and that there are times that parents do not change. We encourage them not to try to solve their parents' arguments and not to get caught between their parents, literally and figuratively. We have found that children spend a great deal of time and energy in efforts to solve their parents' problems. We encourage the children to devote this time and energy, instead, to solving their own problems. We teach that problem solving means connecting one's feelings with one's thinking, exploring available options and choosing the best option - the healthy one.We encourage the children to think on their own and explain that there are healthy ways to make themselves feel better. Some of the healthy solutions that children have identified are: In an emergency (when someone in the family is going to get hurt), leave the house (don't try to stop an angry, violent adult) and get help or call for help; talk with friends, counselors, clergy, relatives; when sad listen to music, exercise, draw, write in a diary, talk with friends, write stories or poems; and when angry exercise, play sports, hit a pillow or punching bag in controlled situations.It is important to communicate to children that they have some control over their lives and they can do things to feel better. Their homework is to bring a list to the next session of healthy ways that each of them can use to cope with their feelings and their problems.Sex, Love and Sexuality. This topic is included because we have found it to be an important concern of preadolescents and adolescents. They need information and want clarification not only about sex but also about relationships. The children in the shelter tend to come from families who poorly model all aspects of a loving, caring relationship, including sex. Several of the children have experienced incest and sodomy. The group provides a confidential and trusting setting for children to discuss their thoughts and feelings and to ask questions on this subject. Age related films such as Sol Gordon's "How Can I Tell When I'm Really in Love?," together with other films on sexuality, provoke questions and vivid discussions. After such films, we have the children write anonymous questions for us to answer.Termination and Saying Goodbye. This session is a summary and review of the five previous sessions. Group members might bring cookies and we will have a party. We end on a positive note, showing by example that goodbyes can be a positive experience. We also give the children a short written evaluation of nine questions for them to complete.
In this way we get feedback about what they learned and our actions
and words say "you're important and what you say is important."
Based on our observations, clinical experience, and the literature, it is clear that children in shelters for victims of domestic violence are in need of treatment. We propose a short-term treatment model that helps these children cope with the crisis they are experiencing as well as providing them with information and problem-solving skills that will be useful once they leave the shelter. This treatment approach includes a crisis model component, an accelerated model component, an educational component, as well as the ten curative factors of groups as identified by Yalom. The treatment group involves a sequence of six sessions.