User:Jamie Kerby/sandbox

= Psychotherapeutic treatments for domestic violence = Domestic violence, also called intimate partner violence or family violence occurs within partners, families, or cohabitating persons. Women are at the highest risk of experiencing domestic violence, but men, young children, and adolescents also can be survivors of domestic violence. Women are two times more likely to develop posttraumatic stress disorder (PSTD) than men. Children and adolescents who have lived through abuse also have a significant risk of developing PTSD. Women are frequently perpetrators of domestic violence, although society tends to view men as the perpetrators. Both people involved in the abusive relationship often take turns between being in the victim role and being in the perpetrator role, although this does not always happen. Research has recently started to differentiate which evidence-based psychological treatments are helpful or harmful to domestic violence survivors. Currently, psychotherapeutic treatments for domestic violence survivors include cognitive-behavioral therapies (CBTs) as well as integrated therapies involving psychodynamic therapies, attachment-based therapies, feminist-based therapies, and others. Survivors of domestic violence do not seek services or treatment for various reasons, which makes it crucial that counselors create an open, comfortable, and confidential space for the those who do seek help.

Cognitive Behavioral Therapies
CBTs are the most used interventions for most mental disorders or life problems, including domestic violence. Many of the current interventions or programs, for both survivors and perpetrators of domestic violence, have a sole or partial basis in the CBT framework. Many clinicians treat survivors of domestic violence using CBT because it effectively decreases or eliminates a person’s symptoms of PTSD, depression, or other symptoms of being in an abusive relationship. The World Health Organization (WHO) recommended that women who have been the victims of domestic violence and have left the abusive relationship should be treated with CBT. This type of therapy has been shown to reduce levels of physical and psychological abuse at a higher rate than standard care, especially when survivors sought therapy services on their own. CBT can be somewhat effective in treating male domestic violence perpetrators, although it is not clear how effective these treatments are for female perpetrators. Doing CBT with a perpetrator of domestic violence can involve emotional dysregulation, anger management, communication, and substance use, especially for managing alcohol use. CBT's overall effectiveness for this group is still unclear because CBT is beneficial to perpetrators of domestic violence, although there is no evidence that it reduces violence among perpetrators.

Integrated Therapies
Integrated therapies are psychotherapeutic treatments that combine specific elements from different psychology orientations and treat those who have experienced trauma(s). Many integrated therapies combine CBT aspects like addressing a person’s thoughts and behaviors with aspects from different psychotherapeutic orientations, such as psychodynamic techniques, feminist psychoeducation, attachment-based techniques, or motivational interviewing techniques.

Some clinicians treat PTSD and domestic violence with integrative CBT and psychodynamic therapies. Psychodynamic therapy addresses themes relating to trust, social relationships, and their relationships with a person’s trauma. Perpetrators of domestic violence or those who were abused in childhood can be treated with integrated psychodynamic treatment. Psychodynamic integrated therapies can also treat survivors who have PTSD or Complex PTSD. Integrating CBT and feminist therapies or motivational interviewing therapies may improve survivor outcomes post-treatment about half of the time. Feminist psychoeducation aims to educate perpetrators about the dynamics of power, control, and violence between men and women to reduce violence and promote women's equalitarian views. Feminist psychoeducation also can help survivors who are women build their confidence, self-esteem, and a sense of independence.

Insight-oriented therapy, a type of therapy that uses positive reactions to insight to help create change, can treat people who were abused when they were children or adolescents. Clinicians or programs sometimes integrate substance use management into treatment. It is common for both survivors and perpetrators of domestic violence to use substances like alcohol or cocaine, and up to 92% reports of domestic violence document that the perpetrator used alcohol before the incident occurred. Integrating substance use management into domestic violence treatment can reduce the frequency of violence committed by both men and women if a relapse does not occur. New advances in technology combined with the Covid-19 pandemic have resulted in some survivors having access to individual and group therapy through their computers or cellphones, although these methods are still being researched.

Systemic Barriers
In the last few decades, there has been a shift from blaming domestic violence victims to blaming the perpetrators, although victim-blaming still frequently occurs. It is not uncommon for the survivors and perpetrators of domestic violence to have mental health disorders such as PTSD, substance use disorders, or depression but many do not seek treatment for various reasons. Survivors may not have access to information about or referrals to programs that can provide them with treatment because many the programs use word-of-mouth systems to help protect the survivor. Many of the current programs and interventions for domestic violence are designed for women and neglect the consideration that boys and men can also be survivors of domestic violence, which interferes with this group from seeking help. This design might not be a helpful approach for the boys and men who do seek help because the programs often frame the survivors as women and men as perpetrators. It is unclear if programs make considerations or adaptions for folks who identify with the LGBTQIA+ community. Regions with mandatory arrest laws, or laws that require officials to arrest someone based off suspicion of assault, may prevent both survivors and perpetrators from seeking help.

Individual Barriers
Survivors may not seek treatment because they do not have the resources to leave their abuser. Financial considerations have shown to be one of the strongest predictors of help seeking among survivors of domestic violence. It can be challenging for survivors to find housing, childcare, or jobs, adding more barriers for the person to find both the funds and the time to seek treatment. Survivors of abuse often have negative perceptions of themselves, have low self-esteem, or have a sense of incompetence that can influence their beliefs about how capable they are to seek help or treatment. It is less common for men to seek help than women, and they are less likely to report personal problems or struggles than women. Survivors may attempt to leave their abusers several times and eventually return to their abusive relationship because their living arrangements were temporary (like staying on a family member’s couch), they did not want to live in a shelter, or they became homeless because they had nowhere else to go.