ABA Therapy and Autism Resources

What is ABA? Applied Behavior Analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior

Getting Services in Texas

I will tell you how we got services for my own child, and that only 30% of autistic children will ever have access to ABA therapy. First and foremost I think the BEST resource for families and providers in the Autism community is Autism Live. Jump on YouTube and start watching their biweekly show. Speaking of Autism live, they partner with CARD who have a home based program called Skillz. CARD offers full scholarships for the SKILlz program which is an online ABA program parents do themselves.

There are a few grants out there for services but they a few and far between. The first place to go is to the employer, ask the insurance person in HR to have a single policy inclusion for ABA if it's not already covered. Ask for a single policy copay waiver, this is almost unheard of as not collecting copays can be considered insurance fraud, but some insurance companies will drop copays if appealed.

If they make less than 50k they can get SSI. That money should be used to pay copays. Medicaid that comes with SSI can be used to pay speech and OT copays, but not ABA, as it is not a service covered by Medicaid.

Depending on the age of the child either ECI or special ED can provide therapy , although the services are too infrequent and not adequate to make meaningful change, however some therapy is better than no therapy.

Go to Families for Effective Autism Treatment support meetings in North Richland Hills. Parents are a wonderful resource to each other and can tell each other tips and tricks they used to get services.

Assure them that unless rich, every single autism parent has been there. Sadly it's been my experience that 90% of parents just throw their hands in the air and give up. No matter how severe the autism the child can improve their level of functioning! So encourage them not to give up, and keep watching Autism Live. That program has been invaluable to me.

Good luck.
 
Also as a side note i would encourage them if they are willing and able to move to another state. Colorado is the closest state that offers much better access to care than Texas. In fact Texas is one of the worst states to live in if you have a disability.

Introductory Guide to Hospice and Palliative Care Social Work

 

By Kaitlin Louie

Hospice and palliative care settings provide medical care, pain management services and treatments, as well as psychological, emotional, social, and spiritual support to patients across the age spectrum who are suffering from severely debilitating conditions or terminal diagnoses. Patients who require hospice care and their families can experience a number of severe hardships, such as depression, anger, and anxiety, intense physical pain or discomfort, financial strain, social isolation, and family conflict.

Hospice social workers help both patients and their families navigate the difficult process of end-of-life planning; manage the mental, emotional, familial, and monetary stressors of debilitating physical illness; understand their treatment plan and be vocal about their needs; overcome crisis situations; and connect to other support services in the area. Hospice workers are advocates for patients and their families, and possess a deep knowledge of what their clients need and what resources are available within and outside of hospice settings to help them.

Hospice and palliative services are delivered, not only at hospice centers, but also through in-home care services and palliative care departments of hospitals. Hospice and palliative care social workers can work in one or more of these settings; for instance, they might conduct home visits to help patients and their families with establishing effective palliative care in patients’ homes, while also providing services to visitors of hospice centers and following up with terminally ill patients who must visit the hospital for intensive medical care.

Hospice and palliative care social work can be a challenging field, as it involves helping individuals through some of the most difficult and stressful times of their lives. However, the rewards of the field can include making deep connections with individuals, learning and celebrating their life stories, and having a dramatically positive impact on patients and their families.

The Difference Between Hospice and Palliative Care

While very much related, hospice and palliative care are distinct from each other in several key ways. Hospice care involves caring for patients who are suffering from an acute terminal illness that has progressed to the point that they have fewer than six months to live. Palliative care is defined as medical treatment that does not seek to cure disease, but rather aims to help patients manage the symptoms of their condition. Hospice care includes palliative care, but palliative care also applies to patients who are not suffering from terminal illnesses and who require non-curative remedies for painful or debilitating symptoms.

Sheila Clifford, LCSW, who worked for over six years at Hospice by the Bay, explained the difference between hospice and palliative care in an interview with OnlineMSWPrograms.com. “Hospice social work and palliative care are closely related and often work together. The palliative care movement is growing and is able to reach patients and families prior to hospice. Palliative care does not require a patient to have a prognosis of six months or less, while hospice does,” she said, “Palliative care provides support to patients and their families during treatment with the hope of alleviating symptom burden. A palliative care social worker might meet with a family during the course of treatment and offer support.”

The simultaneous distinction and overlap between hospice and palliative care means that social workers who work in hospice care by necessity work in palliative care, while palliative care social workers may not work in hospice settings.

Where Hospice and Palliative Care Social Workers Work

Hospice and palliative care social workers typically work in hospice centers, but also conduct home visits and sometimes work with patients in hospital settings. Depending on their work setting, hospice and palliative care social workers may specialize in serving a particular age group, such as pediatric patients or the elderly, or they may serve patients across the age spectrum.

Hospice Centers

Hospices are the primary settings in which hospice social workers work. Hospices provide medical care with an emphasis on pain management, emotional and spiritual support for patients and their families (including individual and group therapy and bereavement counseling), and resource navigation services.

Social workers at hospices help to coordinate the care of hospice patients by communicating with all parties involved in a patient’s care, including physicians, nurses, hospice chaplains, and the patient’s family.

Palliative Care Departments of Hospitals

Palliative care departments in hospitals are another setting in which social workers provide care coordination services, emotional support, and resource navigation guidance to patients and their families. According to the Center to Advance Palliative Care, palliative care departments are becoming increasingly available at hospitals and have been proven to improve patient outcomes. Social workers in these settings typically work with a team of care providers, such as physicians, nurses, medical assistants, hospital chaplains.

In-Home Care Services

Some hospice and palliative care social workers work for companies that exclusively provide home care to patients with terminal or incurable and debilitating diseases. Social workers in these settings help patients and their families set up the proper structures for effective home care and also ensure that clients get the medical, psychological, and social care they need outside of a medical setting in their own homes. For example, they may help clients and their families complete the necessary insurance paperwork to receive in-home care support or equipment, and may communicate clients’ concerns to their medical care providers, and vice versa.

What Hospice Social Workers Do

Whether they work at hospice centers, hospitals, or in-home care services, hospice and palliative care social workers provide personalized support to clients and their families to help them manage the mental, emotional, and social challenges of terminal illness. Sheila Clifford, LCSW explained in an interview with OnlineMSWPrograms.com how hospice social workers tailor their services and support to each patient and family member in their care. “Hospice social workers wear many hats and their role depends on the needs of each family and patient,” she explained, “Some patients and families need assistance with caregiving, logistics of where the patient will live during their final days or assistance with documentation. Other families/patients are in need of processing their terminal diagnosis and the process that leads to their hospice admission.”

Hospice social workers’ core responsibilities include conducting psychosocial assessments, coordinating care, providing counseling and psychotherapy, intervening in client crisis situations, and educating patients and families about their treatment plan and the resources and support systems that are available to them.

Psychosocial Assessments

Hospice and palliative care social workers conduct psychosocial assessments of patients and their families in order to determine their psychological, emotional, spiritual, and social needs; this information is very important for the larger hospice and/or palliative care team to develop an effective and compassionate care plan. Through their completion of psychosocial assessments, hospice and palliative care social workers gather the following information about their clients:

• Past and present medical condition(s)
• Previous and current treatment plans and health care team, including current primary care physician, specialized doctors (ex. oncologists, pulmonary physicians, etc.) nurses, and/or home care assistants
• Their mental and emotional health, including past and present psychological, emotional, and behavioral conditions that affect their physical health (ex. depression, anxiety, substance abuse, etc.)
• Any and all social, cultural, financial, and familial considerations, including socioeconomic hardships, family conflicts, engagement and/or disengagement with friends and the community in general, etc.

Upon completing their evaluation of patients’ psychological, emotional, and behavioral health, as well as their familial, social, and financial situation, hospice and palliative care social workers write up recommendations for the types of psychological and social support a patient and his or her family may require. They may also use the information they gather to conduct risk assessments, which are specialized assessments aimed at determining the likelihood that a patient will experience a severely negative outcome in their current situation and state of health.

Care Coordination

One of the most important responsibilities that hospice social workers have is coordinating the care of patients in collaboration with a larger team of medical and human service professionals. Care coordination is defined as the delivery of effective medical, psychological, and/or social care through the organization of primary and secondary care providers. With their knowledge of systems of care and support both within medical settings and the larger community, hospice and palliative care social workers are often the point of contact between different care providers, as well as the liaison between clients and their treatment team.

Hospice and palliative care social workers also play an important role in patient intakes and discharges. During the intake process, they gather crucial data from patients upon their enrollment in a care program (through the psychosocial assessment), orient patients and their families to the hospice or palliative care environment, and communicate with the treatment team regarding patients’ ongoing needs.

Counseling and Psychotherapy

Hospice and palliative care social workers also provide emotional support, counseling, and psychotherapy to patients and their families who are experiencing psychological and emotional difficulties in the face of terminal and/or debilitating illness. Social workers may employ a combination of clinical social work modalities to help their clients evaluate and manage their thoughts and emotions, as well as overcome various behavioral challenges. Examples of modalities that social workers may use in their work with clients are mindfulness based stress reduction, cognitive behavioral therapy, dialectical behavioral therapy, supportive psychotherapy, expressive arts therapy, and storytelling therapy. (For more information on the therapeutic modalities that hospice and palliative care social workers may use in their work with patients and their families, please refer to our Guide to Clinical Social Work.)

In her interview with OnlineMSWPrograms.com, Charis Stiles explained the therapeutic methods she used with geriatric patients and individuals in hospice settings at Odyssey Healthcare and the Institute on Aging. “Counseling and case management are the primary forms of intervention as well as life review, grief support, and bibliotherapy can also be helpful,” she said, “Life review is essentially actively listening to individuals tell the stories of their lives; many older clients do not get to share the wisdom and lessons they’ve learned over the decades. Many clients, like clients of any age, need to tell the stories of their experiences in order to integrate and explore themes, come to new insights, and better understand the path they have taken.”

Crisis Intervention

Social workers in hospice and palliative care settings must also be prepared to intervene and provide emergency psychological support when clients and/or their loved ones are experiencing mental, emotional, social, or familial crises. Crises are generally defined as events that cause a degree of distress that exceeds an individual’s capacity to cope in the short term; qualifying events vary from client to client, but can include the unexpected advancement of a particular condition; traumatic family conflicts; instances of physical violence, neglect, or verbal abuse that result in trauma; or the development of suicidal desires in a client.

During these situations, hospice and palliative care social workers provide immediate psychological support and counseling, while also completing care coordination services by informing the rest of a client’s treatment team so that they can collaborate to effectively address the patient’s distress.

Patient Education and Resource Navigation Services

Hospice and palliative care social workers help patients and their families understand their treatment plan and the processes involved in hospice and palliative care. “Hospice social workers also educate,” Ms. Clifford noted, “Many families have never experienced a death and need constant education around end of life issues and what to expect as their loved one is declining. Hospice social workers will walk the family through decision making along with the assistance of their nurse and/or MD.”

Hospice and palliative care social workers also help patients and their families navigate relevant resources and assistance that are available to them. For example, for patients who qualify for Medicare or Medicaid, social workers help them navigate the process of applying for benefits. In addition, social workers help their clients connect with local resources, such as cancer or terminal illness support groups, pro bono counseling services, and religious communities. Social workers’ resource navigation services are also an important part of patients’ discharge plans, as these services help ensure that patients and their families receive the support they need even after leaving palliative care.

The Challenges and Rewards of Hospice and Palliative Care Social Work

Hospice and palliative care social work is a very challenging field, as the daily work involves helping patients and their families cope with severe illness and death. The close and regular interactions that hospice and palliative care social workers have with patients and their families can prove to be both rewarding and incredibly challenging, especially during the moments when patients must face and prepare for their own mortality. Ms. Clifford explained to OnlineMSWPrograms.com how working with pediatric hospice patients was particularly challenging for her. “Working with children around death can be a difficult task. Some families choose to not tell the kids about their diagnosis or prognosis but so many children are perceptive and recognize a sudden shift in their treatment course,” she said, “There is one family who will always sit with me, as the patient was the same age as my son. Same toys in his room and the similarities were startling.”

Despite its challenges, hospice and palliative care social work can also be a deeply rewarding field for the opportunity it provides to form meaningful connections with people in need, and to have a concrete and dramatic impact on their well-being as they face some of the most difficult moments of their lives. In addition, hearing and participating in the life stories of patients and their families can be a very meaningful experience. “One of the most incredible parts of this job is listening to patients tell their life story which is often referred to as ‘life review,’” Ms. Clifford said, “Patients recall all of the occurrences in their life…the pain, joy, love and triumph.”

Being a voice and a staunch advocate for vulnerable patients and families can also be deeply rewarding. “I have had so many rewarding experiences with clients–so many frail, dying individuals I’ve had the honor of working with and being present for, so many people I’ve been privileged to advocate for when they were not able to speak for themselves, so many grieving families I’ve been able to comfort and counsel,” Ms. Stiles said, “It’s been really incredible how many clients have really touched me.”

Advice on How to Become a Hospice or Palliative Care Social Worker

Hospice and palliative care social work requires considerable academic, professional, and emotional preparation. Due to the complex nature of hospice and palliative care patients’ medical conditions, and the need to provide intensive care coordination and therapeutic services, social workers in hospice and palliative care settings typically require an MSW from a CSWE-accredited institution (though social workers who hold a BSW may be able to work in entry-level hospice and palliative care roles under supervision).

Ms. Stiles advises social work students interested in working with hospice and geriatric patients to take as many relevant classes as possible during their MSW program. “I highly recommend taking whatever gerontology-focused classes your program offers. A basic course in death and dying is a wonderful asset, even just for you personally,” she said.

Social work students who are interested in becoming hospice social workers should also proactively seek field internships in medical, hospice, and/or palliative care settings during their undergraduate and graduate work. If they are unable to obtain internships in such settings, they should try and find professional opportunities that can give them experience working in health care settings. For example, Ms. Clifford explained to OnlineMSWPrograms.com how a job that she took outside of her MSW field practicums sparked her interest in hospice social work. “I worked as a unit secretary in the Intensive Care Nursery while completing my schooling,” she said, “This experience transformed my professional goals entirely. The exposure to the hospital, clinical terms and education around diagnosis strongly assisted in my ability to gain a position as a medical social worker.”

Ms. Clifford recommends that social work students seek volunteer opportunities in hospice and palliative care settings. “Also look for opportunities to volunteer at a local hospice. This experience will allow you to be part of the team and may lead to an internship or even job,” she advised, “Hospice volunteer programs typically have intense training programs that all will allow you to test out the opportunity.”

Students who wish to become hospice and/or palliative care social workers should build and maintain a self-care plan so that they have a way to recharge from the demands of this field. In addition, they should work to establish social support systems during and after their MSW program to ensure that they have friends, colleagues, and family members who can help them manage the emotional burdens that come with working with terminally ill patients and their families. “I tend to run to relieve stress,” Ms. Clifford said when describing her own self-care plan, “Also having incredible colleagues is so helpful and supportive. Not many people lose patients on an almost daily basis and so it is important to be able to process these losses with people who can relate to that experience.”

Hospice and palliative care social workers’ mission is to help patients and their families manage incredibly difficult situations with dignity and peace of mind. Through adequate academic and professional training, a solid network of friends and family, and a sound self-care plan, social workers in hospice and palliative care settings can achieve this mission while building a sustainable and fulfilling career.

How Social Workers Help Struggling Teens

By Frederic Reamer, PhDand Deborah Siegel, PhD, LISCSW

	Introduction		Special Schools and Programs
	Warning Signs		Substance Abuse and Truancy Courts
	How to Find Help		How Social Workers Help
	Cost of Programs and Services		Resources
	Crisis Intervention

Introduction

The adolescent years can be very challenging for some teenagers and their families. While adolescence can be an emotionally intense, stormy phase for virtually all teenagers, sometimes a teen’s struggles require special intervention. Many teens struggle with issues related to mental health, family relationships, friends, school performance, substance abuse, sexuality, and other high-risk behaviors.

Warning Signs

Struggling teens usually show signs of distress. Common warning signs include:

• Low self-esteem
• School failure and truancy
• Defiance towards authority (such as parents, teachers, police)
• Running away from home
• Choosing the “wrong” friends
• Impulsive behavior (such as speeding, taking other unsafe risks)
• Getting in trouble with the law
• Depression
• Abusing alcohol or drugs
• Social isolation
• Eating disorders (overeating, not eating, self-induced vomiting)
• Self injury (such as cutting)

There is help for these youngsters and their families through many avenues.

How to Find Help

There are many ways to locate and access programs and services for struggling teens. Initially parents can seek help by contacting school personnel (guidance counselors, social workers, administrators), family service agencies, community mental health centers, other community-based social service programs designed specifically for at-risk youngsters and their families, public child welfare agencies, family and juvenile courts, and specialty courts (such as truancy and drug courts).
Social workers can help parents and struggling teens identify and explore difficult and challenging family issues. Individual, family, and group counseling provided by clinical social workers may help parents and teens improve their communication skills and relationships, resolve conflicts, and address important mental health issues.
Professionals called “educational advocates” and “educational consultants” may be able to help parents and teens obtain needed services. Educational advocates, who are often attorneys, help people obtain specialized educational services. Educational advocates charge parents a fee and work with local, state, and federal education officials to ensure that students receive the services and “special accommodations” to which they are entitled by law. Advocates may file claims in court to force school districts to provide or pay for special-needs services and programs outside the school district.
Educational consultants help parents locate programs and services designed to meet their child’s needs. Educational consultants charge parents a fee, assess each teen’s unique strengths and needs, and help the family find the most appropriate schools or programs for their teen. Many educational consultants monitor students’ progress in the new program or school and, when necessary, advocate for the teen with that program or school when challenging issues arise.

Cost of Programs and Services

Programs and services for struggling teens can be very expensive. Some families are able to pay for these programs and services “out of pocket.” Some families have health insurance that pays for all or part of the program, or the public school system may pay the cost.
Many families cannot afford needed programs and services, do not have adequate insurance, and are unable to obtain funding from their public school department. In some instances families that cannot afford needed services agree to give legal custody of their teen to the local public child welfare agency, which then funds the services or programs (in several states the public child welfare agency will fund services without requiring that parents hand over legal custody). In still other circumstances, desperate parents may turn to the juvenile or family court and formally request that the teen be declared “wayward,” thus enabling the court to require the child to accept intervention. In these cases the state typically pays for needed services and programs. Some parents may be reluctant to use this route to services because the court, not they, determine where the child goes for help.
There is a wide range of services and programs run by private and public agencies for struggling teens and their families. Some programs may be available locally; however, some programs may be in other communities or states, which means that the teen must live away from home in order to receive needed services.

Crisis Intervention

A broad range of professionals and agencies offer crisis intervention and follow-up counseling services to teens and families. These services may be available through family service agencies, community mental health centers, hospital outpatient clinics, public child welfare departments, and psychotherapists in private practice (such as clinical social workers, clinical and counseling psychologists, mental health counselors, pastoral counselors, psychiatric nurses, and psychiatrists).
Many communities offer comprehensive counseling and family-intervention programs specifically for teens and families in crisis. These programs – known by names such as “comprehensive emergency services” or “comprehensive intensive services” – provide home-based assessment, emergency counseling, information, and referrals for longer term help.

Special Schools and Programs

A variety of alternative schools, therapeutic schools, and treatment programs serve teens who struggle with significant behavioral, emotional, mental health, and substance abuse issues. Some programs, such as alternative high schools, focus primarily on education while being sensitive to students’ mental health and behavioral challenges. Other programs, such as residential treatment programs, therapeutic boarding schools, and wilderness therapy programs, focus primarily on mental health, emotional and behavioral issues, while including an educational component. “Emotional growth” boarding schools address mental health, emotional, behavioral, and educational issues simultaneously. Other boarding schools focus on specific learning disabilities while also paying attention to the whole student. In short, different programs give different degrees of emphasis to personal and academic issues.
Parents of struggling teens – particularly teens who are oppositional and defiant – may be tempted to place their child in a school or program that promises to impose needed discipline and structure. Often these schools and programs – such as some military boarding schools and those that advertise their mission as “character education” – do not provide the mental health services many struggling teens need. These schools and programs can cause more harm than good for struggling teens who have personal and mental health issues that contribute to their challenges.
Prominent program options include:

• Alternative high schools provide education, including special education services to teens who have floundered academically or socially in traditional high schools. These schools may be freestanding or sponsored by a community mental health center, family service agency, school district, or a “collaborative” composed of several social service and educational programs.

• Youth diversion programs typically attempt to help struggling teens who have had contact with the police avoid more formal involvement in the juvenile justice system (juvenile courts and correctional facilities). Typical youth diversion programs offer first offenders individual and family counseling, links to other needed services (such as psychiatric medication), and education.

• Independent living programs are designed to help adolescents develop the skills they need to live independently. These programs primarily serve teens who do not have stable families and are in the state’s custody. Some independent living programs also serve teens whose families are able to pay for these services privately. Typical services include practice in daily living skills, money management, career and educational planning, mental health services, housing assistance, recreational, and social activities and case management.

• Wilderness therapy programs offer highly structured intensive short-term (three to six weeks) therapy in remote locations that remove adolescents from the distractions available in their home communities (such as television, music, computers, cars, drugs and alcohol, movies, delinquent peer groups). The challenges of living full-time outdoors and developing wilderness survival skills help teens develop self-confidence and pro-social behaviors. Often, families are advised to send their struggling teen first to a wilderness therapy program and then to a therapeutic or emotional growth boarding school, rather than return the teen to their home community environment.

• Boarding schools for teens with significant learning disabilities offer structured academic programs that focus on education and learning while addressing relevant emotional and behavioral issues.

• Emotional growth boarding schools offer structured academic programs and focus on emotional development and personal growth but do not provide the intensive treatment services offered by therapeutic boarding schools.

• Therapeutic boarding schools focus intensively on students’ mental health, substance abuse, and behavioral needs while also providing an academic educational program.

• Residential treatment centers offer highly structured treatment addressing substance abuse, family, and other mental health issues. In contrast with therapeutic boarding schools, residential treatment centers are more like a psychiatric hospital than a school, although they may have an academic/educational component in their program.

Substance Abuse and Truancy Courts

Many communities run substance abuse courts (sometimes known as drug courts) and truancy courts. These specialty courts use a supportive and nurturing approach rather than a punitive one to help struggling teens. Using case management, counseling, tutoring, mentoring, and parent education, the courts’ goal is to prevent future problems and more formal involvement with the juvenile justice system.

How Social Workers Help

Social workers can provide struggling teens and their families with:

• Assessment of the teenager’s and family’s needs and strengths
• Information about and referral to needed programs and services
• Information about financial and legal issues and resources
• Names of reputable educational advocates and educational consultants
• Crisis intervention counseling services
• On-going psychotherapy for the teen, the parents, and the family as a whole
• Case management (helping staff from multiple agencies coordinate and communicate on behalf of the teen, and advocating for the family with these providers)
• Information about important “warning signs” of teens who are on a downward spiral and the steps needed to get help
• The National Association of Social Workers provides a listing of social workers in your area who can help you with these issues. Please click here to find a social worker.

Resources

Information about services and programs for struggling teens and families is available from social workers, schools, public child welfare agencies, juvenile and family courts, family service agencies, community mental health centers, educational advocates, educational consultants, and lawyers. Useful Web sites include:

• Adventure and Wilderness Therapy Treatment Programs (http://www.wilderness-therapy.org/)
• Alcoholics Anonymous (http://www.alcoholics-anonymous.org/)
• The Association of Boarding Schools (http://www.schools.com/)
• Cocaine anonymous (http://www.ca.org/)
• The Drug Court Clearinghouse (http://spa.american.edu/justice/drugcourts.php)
• The Independent Educational Consultants Association (http://www.educationalconsulting.org/)
• Narcotics Anonymous (http://www.na.org/)
• National Association of Therapeutic Schools and Programs (NATSAP): (http://www.natsap.org/)
• The National Independent Living Association (http://www.nilausa.org/)
• The National Youth Court Center (http://www.youthcourt.net/)
• The Substance Abuse Treatment Facility Locator, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (http://findtreatment.samhsa.gov/)
• Woodbury Reports – a guide to programs for struggling teens (http://www.strugglingteens.com/)

Frederic G. Reamer, PhD, is the author of The Pocket Guide to Essential Human Services which contains diverse resources compiled into a user-friendly guidebook appropriate for use by professionals, volunteers, and consumers.
### The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

Tags: adolescence, help, intervention, programs, resources, teens, warning signs

Common Myths and Why They are Wrong

Domestic violence only happens to poor women and women of color.

• Domestic violence happens in all kinds of families and relationships. Persons of any class, culture, religion, sexual orientation, marital status, age, and sex can be victims or perpetrators of domestic violence.

Some people deserve to be hit.

• No one deserves to be abused. Period. The only person responsible for the abuse is the abuser.
• Physical violence, even among family members, is wrong and against the law.

Alcohol, drug abuse, stress, and mental illness cause domestic violence.

• Alcohol use, drug use, and stress do not cause domestic violence; they may go along with domestic violence, but they do not cause the violence. Abusers often say they use these excuses for their violence. (Michigan Judicial Institute, Domestic Violence Benchbook, 1998, p. 1.6 - 1.7)
• Generally, domestic violence happens when an abuser has learned and chooses to abuse. (Michigan Judicial Institute, Domestic Violence Benchbook, 1998, p. 1 - 5)
• Domestic violence is rarely caused by mental illness, but it is often used as an excuse for domestic violence. (Michigan Judicial Institute, Domestic Violence Benchbook, 1998, p. 1 - 8)

Domestic violence is a personal problem between a husband and a wife.

• Domestic violence affects everyone.
• About 1 in 3 American women have been physically or sexually abused by a husband or boyfriend at some point in their lives. (Commonwealth Fund, Health Concerns Across a Woman's Lifespan: the Commonwealth Fund 1998 Survey of Women's Health, 1999)
• In 1996, 30% of all female murder victims were killed by their husbands or boyfriends. (Federal Bureau of Investigation, 1997)
• 40% to 60% of men who abuse women also abuse children. (American Psychological Association, Violence and the Family, 1996)

If it were that bad, she would just leave.

• There are many reasons why women may not leave. Not leaving does not mean that the situation is okay or that the victim want to be abused.
• Leaving can be dangerous. The most dangerous time for a woman who is being abused is when she tries to leave. (United States Department of Justice, National Crime Victim Survey, 1995)
  
  MANY VICTIMS DO LEAVE AND LEAD SUCCESSFUL, VIOLENCE FREE LIVES.

So Why Do They Stay?

By Linda A. Osmundson

Slapping, hair-pulling, kicking, biting…battered women relate a litany of abuse experienced at the hand of our intimate partners. The results are bruises, broken bones, black eyes, internal injuries, sometimes and death. Always there are broken hearts.

Yet, most battered women really do not want to leave their abusive partners. Many of the women who call shelter crisis lines tell the staff and volunteers that they just want the abuse to end. We hope for fantasy TV endings like the lives of Claire and Heathcliff Huxtable or Ward and June Cleaver.

So why do we stay? When the person who had promised to love and cherish us beats us, what makes us stay for the second and third beating? When I speak to community groups about domestic violence, I am nearly always asked this question. Often women in the audience would exclaim, "if my partner laid a hand on me, I would be out the door!"

Imagine, for a moment, your own family. Would you really be able to walk out the door? Could you leave your home, neighborhood and friends? Where would you go? Could you, your two lively children, plus the dog, stay at your brother’s apartment on his couch for an indefinite period of time? What would his two roommates have to say about that? Could you stay with your parents who live in one of those adults-only condos?

I would not be surprised if the first time it happened you would help your partner rationalize why it happened. Your partner was (tired, stressed, angry, drinking, jealous, upset about losing a job or worried about expenses). Any excuse will fill the blank! YOU (made a mistake, came home late, disagreed with your partner, bought lunch at the mall….) fill this blank with the reason your partner says you caused the abuse.

But abuse is not about reason. It is about power. It is about control of one’s partner. And it works. The physical abuse is only the most obvious. It is reinforced by a whole spectrum of other kinds of abuse. We’ve already mentioned the excuses, the minimizing and blaming, saying it was her fault or it really wasn’t that serious. Abusers isolate their victims and keep them from having friends or family around. They control what we do, who we see, what we read and where we go.

Abusers abuse our psyche and emotions by calling us unprintable names, humiliating us, constantly criticizing us.

Abusers are intimidating. I knew an abuser who left a single bullet on the kitchen counter! It takes only a look, a threat, to instill fear. Abusers are coercive, threatening to leave, forcing us to participate in illegal activities. Abusers make sure we have no money, keep us from getting a job, making us put our check in to their account. Abusers treat their partners like servants, acting like "master of the castle," making all the important decisions.

Finally, abusers use the children by making us feel guilty about them, threatening to take the children, using the children to relay messages to their mother.

Abuse works because many of us continue to pretend it does not happen to "good" women. So anyone who is abused must be "bad"! We blame the victim for her own abuse by calling her codependent. We expect her to prevent the abuse instead of why the abuser chose to abuse. In short, we collude with the abuser.

Abusers succeed because they are not abusive all the time. In fact, sometimes they are fun and charming. They are almost always charming around other people.

Battered women stay because we are afraid. We are afraid no one will believe the truth. We fear we will lose our children. We are afraid we will have nowhere to go. We are fearful we will not be able to support the children. We are afraid our church or family will condemn us. We are terrified the abuser will hurt our friends or family. Ultimately, we fear we will be killed trying to leave.

All these fears are legitimate. Most battered women, killed by their abusers, have tried to leave. Some die in the process of leaving and many are killed trying to start over. The blood of millions of battered women is on the hands of friends and families, social workers, clergy, doctors, police, attorneys, judges and anyone else who failed to believe them, failed to heed their pleas for help.

Maybe we should reverse that question, "why does she stay?" and ask, "So why does the abuser abuse?" With all the obstacles in our path the real question is, "How can we possibly leave?"

Signs to Look for in a Battering Personality

Many women are interested in ways they can predict whether they are about to become involved with someone who will be physically abusive. Usually battering occurs between a man and a woman, but battering also takes place in same-sex relationships. Below is a list of behaviors seen in people who beat their partners; the last four signs listed are battering, but many women do not realize that this is the beginning of physical abuse. If a person exhibits several of the other behaviors, say, three or more, there is strong potential for physical violence. The more signs a

person has, the more likely the person is a batterer. In some cases, a batterer may have only a few behaviors that the woman can recognize, but they are very exaggerated (for example, will try to explain the behavior as a sign of love and concern); a woman may be flattered at first. As time goes on, the behaviors become more severe and serve to dominate and control the woman.

1. JEALOUSY. At the beginning of a relationship, an abuser may say that jealousy is a sign of love. Jealousy has nothing to do with love. It is a sign of possessiveness and lack of trust. The abuser may question his partner about who she talks to, accuse her of flirting, or be jealous of time she spends with family, friends, or children. As the jealousy progresses, he may call her
   frequently during the day or drop by unexpectedly. He may refuse to let her work for fear she'll meet someone else, or even engage in behaviors such as checking her car mileage or asking friends to watch her.
2. CONTROLLING BEHAVIOR. At first the batterer will say this behavior is due to his concern for her safety, her need to use her time well, or her need to make good decisions. He will be angry if the woman is "late" coming back from the store or an appointment; he will question her closely about where she went and who she talked with. As this behavior progresses, he may not let the
   woman make personal decisions about the house, her clothing, or even going to church. He may keep all the money or even make her ask permission to leave the house or room.
3. QUICK INVOLVEMENT. Many battered women dated or knew their abuser for less than six months before they were married, engaged, or living together. He comes on like a whirlwind, claiming, "you're the only person I could ever talk to", or "I've never been loved like this by anyone." He will pressure the woman to commit to the relationship in such a way that later the woman may feel very guilty or that she's "letting him down" if she wants to slow down involvement
   or break off the relationship.
4. UNREALISTIC EXPECTATIONS. Abusive people will expect their partner to meet all their needs. He expects a perfect wife, mother, lover, friend. He will says things such as "if you love me, I'm all you need, and you're all I need." His partner is expected to take care of everything for him emotionally and in the home.
5. ISOLATION. The abusive person tries to cut his partner off from all resources. If she has male friends, she's a "whore." If she has women friends, she's a lesbian. If she's close to family, she's "tied to the apron strings." He accuses people who are the woman's supports of "causing trouble." He may want to live in the country, without a telephone, or refuse to let her drive the car, or he
   may try to keep her from working or going to school.
6. BLAMES OTHERS FOR PROBLEMS. If he is chronically unemployed, someone is always doing him wrong or out to get him. He may make mistakes and then blame the women for upsetting him and keeping him from concentrating on the task at hand. He may tell the woman she is at fault for virtually anything that goes wrong in his life.
7. BLAMES OTHERS FOR FEELINGS. The abuser may tell his partner "you make me mad," "you 're hurting me by not doing what I want you to do," or "I can't help being angry ." He is the one who makes the decision about what he thinks or feels, but he will use these feelings to manipulate his partner. Harder to catch are claims, "you make me happy," or "you control how I feel.”
8. HYPERSENSITIVITY. An abuser is easily insulted, claiming his feelings are "hurt," when in actuality he is angry or taking the slightest setback as a personal attack. He will "rant and rave" about the injustice of things that have happened, things that are just a part of living (for example, being asked to work late, getting a traffic ticket, being asked to help with chores, or being told some behavior is annoying).
9. CRUELTY TO ANIMALS OR CHILDREN. Abusers may punish animals brutally or be insensitive to their pain or suffering. An abuser may expect children to be capable of things beyond their abilities (punishes a 2-year old for wetting a diaper). He may tease children or young brothers and sisters until they cry. He may not want children to eat at the table or may expect them to be kept in their rooms when he is home. Studies indicate that about 60% of men who
   physically abuse their partners also abuse their children.
10. "PLAYFUL" USE OF FORCE IN SEX. An abuser may enjoy throwing the woman down or holding her down during sex. He may want to act out fantasies during sex where the woman is helpless. He is letting his partner know that the idea of rape is exciting. He may show little concern about whether the woman wants to have sex and uses sulking or anger to manipulate her into compliance. He may begin having sex with the woman while she is sleeping or demand
    sex when she is ill or tired.
11. VERBAL ABUSE. In addition to saying things that are intentionally meant to be cruel and hurtful, verbal abuse is also apparent in the abuser's degrading of his partner, cursing her, and belittling her accomplishments. The abuser tells her she is stupid and unable to function without him. This may involve waking her up to verbally abuse her or not letting her go to sleep.
12. RIGID SEX ROLES. The abuser expects his partner to serve him. He may even say the woman must stay at home and obey in all things-even acts that are criminal in nature. The abuser sees women as inferior to men, responsible for menial tasks, and unable to be a whole person without a relationship.
13. DR. JEKYL/MR. HYDE PERSONALITY. Many women are confused by the abuser's sudden changes in mood. She may think he has some sort of mental problem because one minute he's agreeable, the next he's exploding. Explosiveness and moodiness are typical of men who beat their partners. These behaviors are related to other characteristics, such as hypersensitivity.
14. PAST BATTERING. The abuser may say he has hit women in the past, but blame them for the abuse ('~hey made me do it"). The women may hear from relatives or ex-partners that he is
    abusive. A batterer will abuse any woman he is with if the relationship lasts long enough for the violence to begin~ situational circumstances do not make one's personality abusive.
15. THREATS OF VIOLENCE. This includes any threat of physical force meant to control the partner: "I'll slap your mouth off," "1'11 kill you," "I'll break your neck." Most people do not threaten their partners~ abusers will try to excuse their threats by saying "everybody talks like that."
16. BREAKING OR STRIKING OBJECTS. Breaking loved possessions is used as a punishment, but mostly to terrorize the woman into submission. The abuser may beat on the table with his fist, or throw objects around or near his partner. Again, this is remarkable behavior. Not only is this a sign of extreme immaturity, but there is great danger when someone thinks he has the right to
    punish or frighten his partner.
17. ANY FORCE DURING AN ARGUMENT. This may involve the abuser's holding the woman down, physically restraining her from leaving the room, or any pushing or shoving. He may hold his partner against the wall, telling her "You're going to listen to me!"

Protecting Your Children in the Court System

A mother who spent a decade trying to protect her daughter from her abusive ex shares her advice

Maralee Mclean is a survivor in every sense of the word. After living through a marriage to an abusive man, she lived through a custody battle with her ex-husband after he was accused of sexually abusing their 2-year-old daughter. He won.

Even though multiple police and hospital reports confirmed the abuse occurred, Mclean says her ex was able to manipulate the court system to his advantage. Says Mclean, “The family courts are failing, and failing miserably.”

For a decade, Mclean fought for custody and to protect her daughter. She wrote a book about her journey, Prosecuted But Not Silenced: Courtroom Reform for Sexually Abused Children. Says Mclean about her ordeal, “You may be emotionally and financially depleted, and the heartbreak may be overwhelming, but never ever give up. This was a nightmare no mother would want to endure but we are doing well today. I am an activist and she is a survivor.”

In her book, Mclean shares tips for parents on protecting their children while in the court system, specifically when dealing with domestic abuse or child sexual abuse. Below, some of the things she hopes all parents facing the justice system with their children could know.

• Hire a good attorney. This might go without saying, but you need one who has experience in the proceedings of child sexual abuse cases and who knows that civil court will make it into a custody issue versus a sexual abuse issue, explains Mclean. “Most family law attorneys do not have the information required to litigate these cases. This will take a lot of work on your part by looking on the Internet for an attorney who works on domestic violence and child abuse cases. Make the phone calls and get in the door for an appointment,” she writes.

•  If you can’t afford an attorney, you may be able to find someone for free. Domestic violence shelters near you should be able to refer you to local legal aid attorneys who could take on your case pro bono. “You must have your facts in order and more or less plead for help,” writes Mclean.

•  Educate yourself. Read up, advises Mclean. Study what is happening in similar types of cases and see if it can be applied to your own.

•  Do not run. “This is not the answer for your child and will be doing more damage,” writes Mclean. 

•  Stay as calm as you can. “Follow all court orders and rules no matter how outlandish they become, and keep it together,” advises Mclean. 


•  Document everything. “I suggest getting a legal binder organized with hearings, dates and times when motions were filed—all correspondence. Make sure this binder explains your case. If you have therapy reports, police reports, doctor reports, hospital reports with abuse information or physical evidence, place all of it in sequential order. You need to be your child’s number-one advocate so you can present professionally what is happening in your case,” writes Mclean. 


•  Don’t speak for your child during an examination. If a medical examination is required for your child, it’s important you refer to your child, if old enough, to answer for him or herself. “[The courts] will say you coached your child if you answer for them,” explains Mclean.

•  Maintain a routine. Whenever possible, keep your child in his or her same surroundings and schools, near family and friends they’re familiar with. They need some normalcy.

•  Affiliate yourself with people of influence. “You are the one on trial, so affiliate yourself with as many organizations as you can. Go to your senators, congressman, the governor, and do not be afraid to state what is happening to your child and how it is being handled in the courts,” writes Mclean.

•  Stay neutral. Mclean says, unfair or not, showing too much emotion in court can make you seem unstable, and not showing enough emotion will make you seem uncaring.  

• Supervised visits are hard, but always go. Mclean knows firsthand the emotional toll supervised visits will take on a parent, and if you’re the one ordered to undergo them, stay in them no matter what. Otherwise, she warns, the courts could end your parental rights. “Make it a great hour and think quality time is precious time.”

•  Take care of yourself. “Try to emotionally and physically surround yourself with a support system of family and friends. This is a nightmare … let your child see your strength.” She also advises parents to look to their spiritual side for comfort. And, if suicidal, get help. “Be aware the healthier you are, the more you can do to free your child from this nightmare. This will be difficult, and maybe unbearable, but in the end, you will be proud that you stood up for your child and made a difference in the world.”

Finally, writes Mclean, “Love, love, love with all your heart and soul.”

Person Centered Therapy

Person Centered Therapy

Theoretical Foundations

■ Focus is on the person and not the presenting problem

Humanism

o Philosophical movement that emphasizes worth of the individual and the centrality of human values
o Attends to matters of ethics and personal worth
o Gives credit to the human spirit
o Emphasis on creative, spontaneous, and active nature of humans
o Optimistic
o Human capacity to overcome hardship and despair

Non-Deterministic

o Beliefs that it is oversimplification to view people as controlled by fixed physical laws.
o Encouragement of therapy that considers individual initiative, creativity, and self fulfillment

Self Actualization

 o Innate process by which a person tends to grow spiritually and realize potential

The Experiencing Person

o Important issues must be defined by the client
o Special concerns are discrepancies between what a person thinks of himself and the total range of things he experiences

Techniques

■ Listening
■ Accepting
■ Respecting
■ Understanding
■ Empathic Responding

Potential Ethical Violations

■ YAVIS- Counselors tend to prefer clients who are young, attractive, verbal, intelligent, and successful, but the most influencing factor is similar cultural backgrounds and experiences.

■ Viewing clients from the counselors perspective
o The following can be misinterpreted as “problems” in counseling, causing the therapist to see the client as resistant or non-responsive

• ■ Silence
• ■ Lack of eye contact
• ■ Deference to authority

o Client defensiveness or non-disclosure may be termed “healthy cultural paranoia”

• ■ For many clients the majority cultural environment is hostile and therefore a defensive stance is a rational response.
• ■ The counselor must acknowledge that the problem may not lie in the client but rather the environment in which the client lives as a minority member

■ Stereotyping clients by group
o May be unintentional in that the counselor researches the “group” and what the group beliefs are according to research but in so doing generalizes and may miss something about the individual sitting in front of them.

■ Inappropriate Selection of techniques
o Counselors often depend on high level of verbal exchange to achieve therapeutic progress.

■ Inappropriate Selection of Tests and Measurements
o Many test reviews have only been done on the majority population type and may not be applicable to all cultures, skewing “normal” results.
o There should be an investigation of possible differences in validity for ethnicity, sex, or other sub-samples that can be identified when test is given.
o What is considered an objective assessment instrument within a majority culture may not be so within a minority culture or a different cultural orientation.
o It is an ethical duty to be aware of this research prior to administering assessments.