Discussion Paper: Cultural Competence

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Working With Survivors of Domestic Violence: The Case of Charo

Charo is a 34-year-old, heterosexual, Hispanic female. She is unemployed and currently lives in an apartment with her five chil- dren, ages 2, 3, 6, 7, and 8. She came to this country 8 years ago from Mexico with her husband, Paulo. During intake, Charo reported that she suffered severe abuse and neglect in the home as a child and rape as a young adult. Charo does not speak English and currently does not have a visa to work. Discussion Paper: Cultural Competence

Charo initially came for services at our domestic violence agency because Child Protective Services (CPS) and the court ordered her to attend a domestic violence support group after allegations of domestic violence were made by one of her chil- dren to a teacher at their school. Her husband was ordered to attend a batterer’s intervention program (BIP). Charo attended the domestic violence support group but seldom said a word. Although she rarely shared during group, she also rarely missed a session. While she attended the group, she also met with me weekly for individual sessions. During these sessions I informed her of the dynamics of domestic violence and helped her create a safety plan. She often said that she was only attending the group because it was mandated and that she just wanted CPS to close her case. One week, Charo suddenly stopped attending group. When I called her, she said that she had been busy and unable to attend. That same day her husband called me to verify that I was who his wife said I was, as he often accused Charo of having affairs.

Charo showed up to group again one day after a 3-month absence. Her appearance was disheveled, and she had lost a significant amount of weight. The next day she called me and requested an emergency individual session. During the session, she reported that her husband had an imaginary friend who was telling him to kill her and that the previous weekend he had placed a knife on her pillow and threatened to take her life. Charo stated that her husband would force her to wear short skirts and bleach

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her hair. He would also throw plates of food on the floor and walls of the house whenever meals were not to his satisfaction. She said he would spend his days drinking alcohol with friends and would beat her relentlessly in front of the children. She told me she had thought he would change after CPS became involved but that, instead, his abuse became more calculating and discreet.

I worked on an updated safety plan with the client, and she agreed to hide herself and the children in the agency’s safe house. The safety plan included information on obtaining a restraining order, going into a safe house, identifying safe people she could talk to, and teaching the children safety planning strategies as well as tips on important documentation and the importance of journ- aling all significant details of the abuse. Charo’s husband showed up outside of the agency that day while she was there and called her phone repeatedly. Charo put the call on speaker so I could hear his voice. He ordered her to go outside and go home with him and made threats toward her. I called the police, and Charo’s husband was arrested outside of the agency. I went to the court- house with Charo, helping her file a temporary restraining order and providing her with emotional support throughout the experi- ence. After obtaining the restraining order, Charo and her five children were admitted to the agency’s safe house.

While at the safe house, Charo met with me weekly for indi- vidual counseling and continued to attend the domestic violence support groups. She reported feeling damaged, ugly, and unlov- able. She also reported feeling anxious, depressed, and hopeless, crying often, and losing weight. Charo’s husband was eventually deported back to Mexico.

I discussed with Charo the dynamics of domestic violence and provided her with numerous resources that could serve as informal and formal supports to her and the children. Charo was referred to a psychiatrist, who prescribed 50 mg of Zoloft to help manage the anxiety and depressive symptoms she was experiencing. Charo began attending a church nearby where she quickly felt connected and also began attending English as a second language (ESL) classes twice a week. We met once a week for 9 months. During the first 3 months, we focused on stabilization. During the second 3 months, we focused on decreasing symptoms of anxiety

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and depression. During the final 3 months of our time together we focused on financial empowerment, reintegrating back into the community, and renewing connections with family.

While Charo met with me for counseling and case manage- ment, her children participated in a 6-month trauma reduction art therapy program for children within the agency. At the 9-month mark, we agreed to terminate services. She continued to attend the group sessions for support and found new friends who had become a support network for her. She also completed a financial empowerment program, which further taught her how to manage her finances.

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7. How would you advocate for social change to positively affect this case?

Mary and her family could benefit from help exploring their assumptions about race, but this was out of the scope of Mary’s initial therapy.

8. Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?

It is difficult but important to respect Mary’s therapeutic process while remaining nonjudgmental about the assump- tions about race Mary and her sisters hold as truth.

9. How can evidence-based practice be integrated into this situation?

Mary and I identified her PTSD symptoms in her treatment plan. We were able to measure the successes she had with specific behavioral interventions in changing the frequency and severity of her symptoms.

10. Describe any additional personal reflections about this case. Mary clearly felt that she needed to trust that I would not bring

my own judgments or opinions about racism into therapy. As with all trauma treatment, building a therapeutic alliance and trust was essential. We built such an alliance so she could feel safe enough to tell her traumatic story and work to assimi- late that story into her own sense of strength and resilience. Discussion Paper: Cultural Competence

Working With Survivors of Domestic Violence: The Case of Charo 1. What specific intervention strategies (skills, knowledge,

etc.) did you use to address this client situation? I utilized psychoeducational support groups, case manage-

ment, and solution-focused interventions. 2. Which theory or theories did you use to guide your practice? I used learning theory and feminist empowerment and strengths-

based perspectives to guide my practice. 3. What were the identified strengths of the client(s)? Charo’s many strengths included her level of resilience and

being a strong advocate for her children and a support to

Reflection Questions

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other survivors at the shelter. She also shared her resources with other survivors no matter how little she had. She was very kind.

4. What were the identified challenges faced by the client(s)? The barriers for this client are enormous; aside from the

domestic violence, some of the barriers include not speaking English, the involvement of Child Protective Services, a lack of affordable housing, obtaining employment without a visa, discrimination, and needing child care for five children.

5. What were the agreed-upon goals to be met to address the concern?

The three treatment goals we set were reducing depressive and anxiety symptoms, connecting to resources in the community that would help her become more stable, and obtaining therapy for the children.

6. What local, state, or federal policies could (or did) affect this situation?

The Violence Against Women Act (VAWA) affected the situation.

7. How would you advocate for social change to positively affect this case?

Victims should not be mandated to attend a domestic violence support group. Participation should be voluntary. These women have been coerced in their relationships and then they are coerced by the system and made to feel like they have done something wrong. Much more education is needed in the courts and with Child Protective Services.

8. How can evidence-based practice be integrated into this situation?

Clients are asked to complete client satisfaction surveys at termination. We also call the clients for follow-ups for up to a year. Lastly, clients complete a survey on a monthly basis, which is used statewide and called the Family Violence Preven- tion and Services Act (FVPSA) survey. The surveys mainly measure whether the client learned additional resources and additional ways of planning for safety.

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9. Describe any additional personal reflections about this case. When Charo’s husband was arrested outside of the agency, it

broke my heart to see all five children playing in the waiting area and doing homework with no clue about what was happening with their father right outside the door. I became very attached to this family and had to take some very intentional steps to create boundaries. When the family was in crisis, I was always available to them, even when I was “off the clock.” I had to separate myself and involve other staff in the case as Charo was very attached to me and would only want to see me. I was able to set appropriate boundaries and stick to our weekly indi- vidual sessions and weekly group sessions and to redirect her to other staff when issues came up at the safe house. Discussion Paper: Cultural Competence

Working With Survivors of Domestic Violence: The Case of Debra 1. What specific intervention strategies (skills, knowledge,

etc), did you use to address this client situation? I used the knowledge that not all victims of domestic abuse

identify what they are experiencing as abuse. Because Debra was not willing to identify her husband’s behavior as abuse, I needed to be careful not push her to do so.

2. What were the identified strengths of the client(s)? Debra was a loving and caring mother. She went to great

lengths to help protect and serve her children. 3. What were the identified challenges faced by the client(s)? The biggest challenge was Debra’s cultural beliefs, which would

not allow her to leave her husband. It was also difficult for her to figure out what to do because she did not have the support of her family and did not have anyone to talk to.

4. Did you have to address any issues around cultural compe- tence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?

I was not familiar with the Chinese cultural beliefs regarding marriage, divorce, and domestic violence. I learned primarily