INTIMATE VIOLENCE: INNOVATIVE MULTILEVEL APPROACHES

By Jane Ariel

INTRODUCTION

I welcome you all this morning, our AFTA members and our guests from the United States and abroad. The two words that make up the title of this plenary create together a paradox that defines our challenge. The first word, "Intimate," opens the heart and, then, in the next instant, "violence" freezes it. Each of us lives within that tension almost daily in this twenty-first century in the Western world, if we choose to be awake to it. We search for what is meaningful, sacred or beautiful to us and our significant others. Sometimes we fail. We hear about or witness lives shaped by murder, rape, homelessness, prejudice, and ethnic cleansing. As a woman, a mother, a lesbian, a White Jew, an Israeli, and a family therapist, I know well about both aspects of this paradox. Sometimes in my office I want to scream when hearing one more detail about the consequences of a father's violence to the body and psyche of his child, even as the now-grown woman client herself is cold in the telling.

I have long understood that this kind of personal wounding mirrors and echoes destructive forces alive in the broader social context. The theoretical vocabulary of mental health has most often fostered an analysis of these occurrences at the individual, personal level, and trained its therapists and created its programs within that perspective. But, like third-world countries stripped of their resources, bodies of women and poor men of color have been and still are colonized or controlled for money and power, Hate groups and governments predicated upon White, ethnic, or religious supremacy have enslaved and killed entire populations who were seen as "other" and have often left in their wake citizens who were indifferent, acquiescent, and silent about the ravages of cruelty or the privileges resulting from racism or sexism or classism. This painful history is part of our present moment and part of the heritage with which our mental health system must cope.

Contextualization of these damaging forces is necessary to a broader healing process. Each of our lives is embedded in a complex continuum: psychological, social, spiritual, political, and economic. Sometimes these complex realities are in harmony, sometimes in tension, and sometimes in unbearable contradiction. This leads to a fundamental questioning and requestioning of the assumptions of our work. If children see their mother being beaten, what is love or family? What does a son understand about masculinity or a daughter about security? If one's country is run by the military, how will social justice find its way through brutal repression to poor, indigenous families? If one's God is thought to condone killing in the name of turf wars, what kind of faith will young people have? Why wouldn't one high school student shoot another? Will the increasingly dominant narrative that global corporations dictate, based on power and profit, ever include in it accountability for the effects of oppression on the human spirit and the environment?

In the last two decades, our theoretical consciousness has expanded to include the understanding that the lived reality of our clients grows out of their social location. Our interventions cannot be divorced from the knowledge that identities, desires and motivations are both organically and socially constructed. Our work must thus be multi-layered and continually sensitive to complexity and contradiction. Many of us, as therapists, have chosen to enter the arena of healing at some place along the continuum. As we sit with individuals and different combinations of family, difficult as many painful situations can be, we are also often blessed with moments of illumination, with sacred moments of connection. The work of the two presenters this morning has been compelled by a fierce humanity as they witness and touch the lives of their clients. Each has expanded our vision of how therapy can be utilized, or even defined, focusing on the particular while embedding it in an inclusive analysis. Both, when necessary, have chosen to move beyond the clinical frame and become activists outside the oasis of the treatment room. It is a gift to be sitting with Dr. Marcia Sheinberg and Dr. Ignacio Maldonado, two people I greatly respect and with whom I share a world-view, both psychological and political.

The Plenary

This plenary presented two widely differing but significant approaches to dealing with the issues of domestic violence and abuse. The first presentation, by Marcia Sheinberg, focused on the clinical, while the second, by Nacho Maldonado, began from the political. Each helped the other to create a whole picture from which members of the audience could choose to enrich their understanding.

Marcia began by talking about the relational approach developed by the Incest Project at the Ackerman Institute in New York City. This approach takes into account the severe relational trauma experienced when incest occurs, disrupting a sense of safety and trust and often blocking communication among family members. Her clinical work thus becomes a vehicle for opening difficult conversations, mobilizing family resources to heal emotional wounds, and strengthening the innate resiliency of the family. Marcia also goes outside of the clinical office to deal with any external forces which influence her clients, such as talking to people in the justice or social service systems when it can be beneficial to her clients.

Before presenting the video of a particular family, Marcia spoke about the general goals of treatment. Briefly, these goals relate to 1) the abused child (to develop personal agency, to not blame herself, to reconnect with trustworthy family members, to find emotional balance), 2) the non-offending parent (to be a trustworthy parent, to tolerate the expression of a range of feelings, to deal with feelings about the offending parent), 3) the person who offended (to take responsibility, show empathy, participate in the generation of a safety plan, and 4) the family as a whole (to regain stories of pride without diminishing the incest "story"). Underlying these goals is the persistent clinical dilemma in cases of incest of both empowering individuals and families as they struggle with decisions concerning psychological and factual realities while continually ensuring safety from further abuse. One particularly powerful aspect of this dilemma is seen in the expression of conflicted feelings, such as the hate and love or loyalty that can be felt by the child and the partner toward the abuser, or the anger felt towards a loved one that didn't protect sufficiently.

Another important aspect of the clinical work presented was the collaboration between clinicians and family members relating to the multiple modalities of treatment used. These can include individual and conjoint sessions as well as groups for children and non-offending parents. The transfer of information among these modalities is accomplished by what The Incest Project has called the "Decision Dialogue," where a family member and the therapist discuss what information should be communicated. Much important clinical information is revealed in the negotiation of this process besides giving the clients an important sense of agency in their healing.

The video screened by Marcia gave the audience an intimate and instructive look at the interior of the therapeutic process that has grown out of the compelling work of the Incest Project. Further elaboration of this effort can be found in her book, co-authored by Peter Fraenkel, The Relational Trauma of Incest.

The second presenter, Ignacio (Nacho) Maldonado, gave an overview of the development of programs in Mexico City which are dedicated to preventing and healing family violence. These particular programs (CAVIDA and ILEF) are based on the ideas of equity, justice, tolerance and respect. The political context in which they were developed derived from three occurrences in Mexico. The first was the change of government after 70 years, from the PRI to the PAN. The second was the earthquake of 1985, and the third was the Zapatista movement, culminating in its march and entrance into Mexico's capital to insist on the rights of all oppressed peoples.

The new political context has fostered a number of social initiatives, dealing with the creation of shelters, assistance modules, and care centers for women who have been abused. ILEF and CAVIDA provide direct service and training of clinical personnel in community settings. Their programs are based on firm theoretical and ethical principles, while insisting on flexibility in all relevant practical applications.

The theoretical framework underlying this work is two-fold: general systems theory and social constructionism, including the structural and narrative models. General systems theory is used within the parameters of a dialectical understanding which includes the ideas that systems are alive when open and in tension and that there is multi-causality. Social constructionism is understood to differ from the notion of "constructivism" in that it takes into account the fact that the playing field is often not equal and not everybody has the same capacity to create "reality."

Many different structures have been put in place to deal with the effects of domestic violence and are related to the work of ILEF and CAVIDA. These include different groups for women, for men, for older people and for women with young children, including massage techniques for babies. The shelters which were created help to rebuild women's lives and give them the tools to provide security and safety for themselves and their children. This includes, among other things, raising consciousness about gender socialization and teaching skills of effective communication. Another important aspect of the work is with men, although many feminist approaches, which have influenced the philosophy of the Mexican projects, have advocated their exclusion. It is believed that men should be part of the healing process when possible. Working with both partners, when physical safety is guaranteed, is found to be more conducive to ending the cycles of violence that have dominated couples' lives. It is also hoped that the tender, more vulnerable aspects of all the concerned individuals will be touched in the process of striving for family harmony.

Turning the focus to the needs of the caretakers, the programs with which Nacho has been involved advocate various forms of nurturing for the workers in direct services. It is clear that, if this does not happen, depression or burnout results in multiple personnel turnovers or in the subtle acting out of otherwise unexpressed needs. This can be seen, for example, in unsupportive interactions with clients or other staff, outright rejection (or its converse, adoption) of sheltered women, or other such unproductive manifestations of internal discomfort. To meet this need, laboratories have been set up where caretakers can deal with their issues using reflective teams and other facilitative techniques. Informal structures have also been created to encourage and assist communication within the working teams and with those in charge.

In the last, quite moving, part of Nacho's presentation, he spoke about what he calls peace as an antidote to violence. It could be likened to a spiritual state. To arrive at peace requires, first of all, complete attention and, then, an opening to compassion, humor and patience. In addition, there is a quality of selectivity, a willingness to simplify one's life by choosing what "will or won't be taken in one's suitcase" as life's path is determined. Further, peace is understanding that the fundamental law of the universe is change and impermanence; the search for it is paradoxical and includes observation, acceptance, and letting go. To infuse one's clinical practice with this spiritual understanding portends the possibility of transformation at different levels. It seems a very special opportunity to be part of this many-layered clinical effort towards different aspects of social justice.

Jane Ariel, Ph.D. is a psychotherapist in private practice in Oakland, CA, where she sees individuals, couples and families. She is particularly interested in alternative families and the effect of social conditioning on individual lives. She teaches family therapy and works with issues of diversity at the Wright Institute in Berkeley, California and is a consultant with Visions, a national organization dedicated to providing training for multiculturalism in numerous settings.