UNDERSTANDING AND

DEALING WITH VIOLENCE

IRENE GRACE FERNANDEZ
 OVERVIEW

PSYCHOLOGICAL FAMILY GROUP

01 CONSIDERATIONS THERAPY 02
Psychological Considerations Despair, Resilience and the
in Assessment, Diagnosis and Meaning of Family Group
Treatment of Survivors Therapy

03 THE CONFLICT
RESOLUTION MODEL
The Conflict Resolution Model for
Violence
 01
Psychological
Considerations in
Assessment, Diagnosis
and Treatment of
Survivors
ASSESSMENT
SAFETY ASSESSMENT

To assess the safety of a

survivor and develop a plan to
ensure immediate safety of
the survivor. Health care
providers may connect
survivors to a nurse, social
worker, advocate, community
resource, psychologists, or
health care workers who are
trained in violence prevention.
 SUICIDE ASSESSMENT

Studies have found a link

between the number of
previous traumatic events
and the risk of attempting
suicide. Mental health
providers should conduct a
suicide risk assessment in
all interactions with
survivors.
 Mental health care providers should:
➔ Conduct the assessment in a private, confidential space.
➔ Provide interpreters as needed.
➔ Discuss the reasons for assessment with your patients. It will reduce their
fear, anxiety and the risk of aggression.
➔ Describe with as much detail as possible what is happening or going to
happen which will increase a sense of control and decrease fear and
anxiety.
➔ Debrief with staff involved in the process.
➔ Work with the patient on a safety plan. This will increase a sense of control
and collaboration.
➔ Focus on coping strategies for risky situations. It will help survivors’ identity
and reinforce strengths, social supports and motivations to seek help.
DANGER ASSESSMENT
A widely validated tool that
determines the level of danger an
abused woman has of being killed by
an intimate partner. Using the Danger
Assessment requires the weighted
scoring and interpretation that is
provided after completing the training.

The Danger Assessment is available in

a variety of languages.
 TREATMENT
(MENTAL HEALTH INTERVENTIONS)
 Mental Health Interventions
Crimes can have a devastating effect on victims and their families, and
they may need help coping with the impact of victimization. Emotional
and behavioural reactions to crime victimization are normal and to be
expected. For most, stabilization will occur within 90 days of the
victimization. However, some individuals may lack the coping skills and
post-trauma resilience for an unassisted return to pre-trauma
functioning. These individuals may be at risk for developing mental
health disorders; therefore, a comprehensive evaluation by a qualified
mental health professional may be warranted.
 SIGNS AND SYMPTOMS
Physical Emotional Cognitive
● Eating disturbances ● Depression, despair ● Memory lapses
● Sleep disturbances ● Anxiety ● Difficulty making
(more/less than the ● Panic Attacks decisions
usual) ● Fearfulness ● Decreased
● Sleep disturbances ● Feeling out of control concentration
● Sexual dysfunction ● Irritability, Anger ● Feeling distracted
● Low energy ● Emotional Numbness ● Guilt/blaming
● Chronic, unexplained ● Hypersensitivity
pain ● Withdrawal from
● Gastrointestinal routine and
distress relationships
MENTAL HEALTh
SERVICES AND
TREATMENT
 MENTAL HEALTh SERVICES
Psychological First Aid.
Reduces presenting symptoms such as anxiety through listening and
reassurance. Can consist of a one-time intervention by a
para-professional or licensed mental health practitioner.
Crisis Intervention.
Focuses on one to four goals for symptom reduction that are chosen
by the victim. Assists the victim in building a short-term framework
for understanding the experience and assessing related risks versus
gains. Conducted by a para-professional or licensed mental health
practitioner and can include non-traditional interventions such as
tribal healers and peer support groups.
Exposure Therapy.
Uses confrontation of thoughts or actual situations to reduce
anxiety and fears associated with victimization. Conducted by a
licensed mental health practitioner.
 MENTAL HEALTh SERVICES
Stress Inoculation Training.
Combines psycho-education with anxiety management techniques
such as relaxation training, breathing training, and “thought
stopping” to treat trauma symptoms. Conducted by a licensed
mental health practitioner.
Cognitive Therapy.
Challenges dysfunctional thoughts related to victimization based on
irrational or illogical assumptions. Conducted by a licensed mental
health practitioner.
Cognitive Behavioral Therapy.
CBT helps people attain safety while helping to reduce
trauma/PTSD symptoms and substance misuse. It can be delivered
in the group and individual formats, in both adults and adolescents.
DIAGNOSIS
PTSD. Post-traumatic stress
disorder (PTSD) is a mental
health condition that is triggered
by a terrifying event. Some
common symptoms associated
with PTSD are flashbacks,
nightmares, severe anxiety and
uncontrollable thoughts about
the event. Many people who go
through traumatic events have
difficulty adjusting and coping
for a while. But with time and
support, such traumatic
reactions usually get better.
Depression. Depression is more than
common feelings of temporary sadness.
Symptoms can include prolonged
sadness, feelings of hopelessness,
unexplained crying, changes in appetite
with significant weight loss or gain, loss
of energy or loss of interest and
pleasure in activities previously enjoyed.
Depression can affect a person’s
outlook, which can lead to feelings of
hopelessness. This, in turn, can impact
his or her thought process and ability to
make decisions. In extreme cases of
depression, people may even experience
suicidal thoughts and/or attempts.
Dissociation. Dissociation usually
refers to feeling like one has
“checked out” or is not present. In
some instances of dissociation,
people may find themselves
daydreaming. But in situations
where dissociation is chronic and
more complex it may impair an
individual’s ability to function in the
“real” world, such as not being able
to focus on work related duties or
being able to concentrate on
schoolwork.
Survivor’s Guilt. Survivor’s guilt is
when a person has feelings of guilt
because they survived a
life-threatening situation when
others did not. It is a common
reaction to traumatic events and a
symptom of post-traumatic stress
disorder (PTSD).
Substance Use Disorder.
A complex condition in which there
is uncontrolled use of a substance
despite harmful consequences.
People with SUD have an intense
focus on using a certain
substance(s) such as alcohol,
tobacco, or illicit drugs, to the point
where the person's ability to
function in day-to-day life becomes
impaired. Crime victims evidenced
significantly elevated rates of
alcohol, cocaine, and opioid use
disorders.
Considerations
for Survivors
with Mental
Health
Concerns or
Psychiatric
Symptoms
➔ Focus on the survivor as a complete person

➔ Be patient and allow enough time for the survivor to communicate.

➔ Allow time for the survivor to calm down, if needed. Ask basic questions
first.

➔ Do not laugh at/make fun of, appear shocked by, minimize or dismiss bizarre
content in survivor’s speech/conversation. This could be related to
psychiatric symptoms.

➔ If the survivor appears to be responding to internal stimuli/hallucinations, do

not try to talk them out of it or say, “this is not real”. The feelings are very
real. You will not be able to talk them out of the hallucination. These
symptoms may be particularly pronounced after a recent sexual assault, as a
new trauma can make mental health symptoms get worse.
➔ When at all possible, explain why you need certain information or are
asking detailed questions about the survivor’s history. This will help
decrease defensiveness which can be triggered if a survivor does not
feel safe with you.

➔ If the survivor has a support person accompanying them, resist

directing questions to the support person rather than the individual. Do
not speak about the survivor as if they are not there.

➔ Remember that the fact that some thoughts or experiences may not be
based in reality does not mean that an assault did not occur. People
with mental health concerns are targeted by abusers/offenders
because they are often not believed when the survivor tries to report
sexual assault to law enforcement.
 02
Despair,
Resilience and the
Meaning of Family
Group Therapy
DESPAIR
- Despair is one of the most negative and
destructive of human affects, and as
The emotion or feeling such it is a primary area for
of hopelessness psychotherapeutic intervention.

- The feeling can be described as a mix

of misery, discouragement, anguish,
agony, and distress.

- For those with depression, this feeling

is often associated with suicidal
thoughts. Since we may feel that there
is no hope for a happier future, life
itself can seem meaningless.
RESILIENCE The process and outcome of successfully
adapting to difficult or challenging life
experiences, especially through mental,
emotional, and behavioral flexibility and
adjustment to external and internal demands.

Resilience does not eliminate stress or erase

life's difficulties.They understand that setbacks
happen and that sometimes life is hard and
painful. They still experience the negative
emotions that come after a tragedy, but their
mental outlook allows them to work through
these feelings and recover.
 TYPES OF RESILIENCE

PHYSICAL MENTAL
RESILIENCE RESILIENCE

SOCIAL EMOTIONAL
RESILIENCE RESILIENCE
PHYSICAL RESILIENCE

Our body’s capacity to meet

physical challenges when they
arise.

Ability of an individual to recover or

bounce back effectively (i.e., regain
their functional ability) upon facing
a stressor
MENTAL RESILIENCE
Our ability to meet challenging
circumstances through
problem solving, coming up
with viable alternatives, being
agile, creative and flexible with
our ideas and thinking. The
ability to work with change to
develop solutions to issues as
they arise.
SOCIAL RESILIENCE

Is all about our

connections to others and
how we can support each
other through difficult
times. Community, family,
and friendship supports are
all essential when we are
navigating personal or
collective challenges.
EMOTIONAL RESILIENCE
How we manage our emotional
response to challenges and deal with
our feelings and ‘negative’ emotions
like anger, vulnerability or sadness.
It’s important to accept the reality of
our situation but have the emotional
strength to sustain ourselves through
it. Emotional awareness or
intelligence is key here,
understanding how we react to
challenges so that we can minimise
the impact on both ourselves and
others.
 SIGNS OF RESILIENCE
⟶ A survivor mentality:

When people are resilient, they view themselves as

survivors. They know that even when things are
difficult, they can keep going until they make it
through.

⟶ Effective emotional regulation:

Resilience is marked by an ability to manage

emotions in the face of stress.2 This doesn't mean
that resilient people don't experience strong
emotions such as anger, sadness, or fear. It means
that they recognize those feelings are temporary
and can be managed until they pass.
SIGNS OF RESILIENCE
⟶ Feeling in control:

Resilient people tend to have a strong internal

locus of control and feel that their actions can play
a part in determining the outcome of events.

⟶ Problem-solving skills:

When problems arise, resilient people look at the

situation rationally and try to come up with
solutions that will make a difference.
 SIGNS OF RESILIENCE
⟶ Self-compassion:

Another sign of resilience is showing self-acceptance

and self-compassion. Resilient people treat themselves
with kindness, especially when things are hard.

⟶ Social Support:

Having a solid network of supportive people is another

sign of resilience. Resilient people recognize the
importance of support and knowing when they need to
ask for help.
FAMILY GROUP THERAPY
FAMILY GROUP Family therapy helps family members
understand each other and work through
THERAPY difficult feelings in a safe space.

This type of therapy focuses on improving

the interactions and communication
between family members.

It is usually used when the family is

contributing to a person's difficulties or
when one person's problems are impacting
other family members.
 FAMILY THERAPIST
1. MAY:
talk about each person's hopes
2. encourage everyone to talk about their experiences and
listen to each other
3. clarify each person's beliefs, values, needs, hopes and
assumptions so that everyone understands each other
4. help families stop blaming each other and begin exploring
how everyone can work together to make positive changes
5. help people understand the impact of their words and
behaviours on other members of the family
6. help families talk about the challenges they're facing
7. support families as they work through their own goals.
Family-based counseling plays a significant role in reducing the various types of
violence against women through increasing the awareness of couples and by improving
the relationship between couples during pregnancy. (Babaheidarian et. al, 2021)

When the family and others dose to the victim have a negative reaction, blame the
victim, do not want to ever talk about what happened, do not believe that it happened,
or protect the perpetrator, the results are psychologically devastating and set up a poor
prognosis for the victim's ability to heal from the trauma.

The family will most likely become secondary trauma victims, exhibiting
similar responses as described in PTSD, including depression, anxiety, rage, denial, and
reliving the event based on what they have learned.
 03
The Conflict
Resolution Model
for Violence
The Conflict Resolution Model
 The Conflict Resolution Model
Conflict occurs whenever people
disagree. The disagreement could be
over their perceptions, ideas, values,
motivations, or desires.

This model is based on two dimensions of

conflict management: assertiveness and
empathy.

Based on these two dimensions, there are

five conflict resolution strategies:
Competing, Avoiding, Accommodating,
Collaborating and Compromising.
ASSERTIVENESS AND EMPATHY
Assertiveness refers to the ability to speak up and stand by your
opinions. It can be used either positively or negatively, depending on its
application. While assertive behaviour may seem aggressive, it is actually a
way of expressing yourself effectively.

Empathy is the second dimension of conflict management. Empathy

means understanding another person's point of view and feelings. When
you empathize with someone else, you're able to put yourself into that
other person's situation. As a result, you'll find ways to resolve the conflict
more easily.
The Five 1. Competing
Conflict 2. Avoiding
3. Accommodating
Resolution 4. Collaborating
Strategies 5. Compromising
 COMPETING
The first strategy for dealing with conflict is
competing.

Competing is not always bad. Competing

helps us to achieve our goals.

DRAWBACKS:

- competing usually leads to negative

emotions such as anger, frustration,
aggression and hostility.

We use competing as a conflict resolution strategy

- it doesn't help you build good
whenever we resort to being aggressive. We also get relationships because you don't listen
uncooperative with the opponent. to what others say.

HIGH ASSERTIVENESS + LOW EMPATHY

 AVOIDING
The second strategy for dealing with
conflict is avoiding it.

People use this conflict management

strategy when they know that they don't
have any authority over the other person.

They avoid confrontation by ignoring or

avoiding the conflict entirely. They also
choose to ignore the issue altogether.

DRAWBACKS:

- Avoiding is often seen as passive and That means you neither assert your position nor do you
consider or emphasize the other party's point of view.
weak.

LOW ASSERTIVENESS + LOW EMPATHY

 ACCOMMODATING
The third strategy for dealing with
conflict is accommodating.

The idea behind this approach is to

make concessions. For example, if
one person makes a request, you
agree to do what the first person
requested instead of arguing about
the matter.

It's an effective way to manage conflict when you lack

power.

LOW ASSERTIVENESS + HIGH EMPATHY

 COLLABORATING
The fourth strategy for dealing with conflict
is collaborating.

When you collaborate, you take a moderate

approach to solving problems. You attempt
to balance power between yourself and
another person. You also try to find common
ground and work together towards achieving
a shared goal.

Collaboration isn't always easy. It requires

sharing personal opinions and feelings. It
also needs two people who trust each other
and value working together. The goal here is to reach an agreement with each other.

HIGH ASSERTIVENESS + HIGH EMPATHY

 COMPROMISING
The middle of the model and the fifth
strategy for dealing with conflict is
compromising

If you compromise, you take the middle

road between opposing views. And since
you're trying to resolve a disagreement, it's
important that you show flexibility.
This strategy usually gives the feeling of a
win-win scenario, where both parties feel
that they gained something out of the
conflict.
This means agreeing to specific terms and giving up on
certain other items.

MIDDLE ASSERTIVENESS + MIDDLE EMPATHY

04
Patterns of Behavior,
Impact Factors, Warning
Signs, Reactionary Gap
and Reasonable Response
Options to Violence
 WARNING SIGNS
While it's almost ● Repeated loss of temper
● Frequent physical fighting
impossible to identify a
● Vandalism or property damage
person who wants to ● Increased use of drugs and alcohol
commit an act of ● Increased demonstration of risk-taking behavior
violence, according to ● Announcing plans or threats to commit acts of violence or hurt
the American others
Psychological ● Enjoyment in hurting animals
● Carrying, access to or fascination with weapons, especially guns
Association, violence is
● Withdrawal from friends and usual activities
a serious possibility if a ● Feelings of rejections and marginalization
number of these ● Being a victim of bullying
warning signs are ● Poor school performance
witnessed: ● History of discipline problems or frequent run-ins with authority
● Failing to acknowledge the feelings or rights of others
REACTIONARY GAP

It is simply the distance needed

between you and an attacker so
you will have the time to
defensively react to an
aggressive attack. Most
defensive tactics systems teach
that you should be between six
and eight feet from the subject
 REASONABLE
RESPONSE OPTIONS
TO VIOLENCE
Disruptive behavior disturbs, interferes with or prevents normal work
functions or activities. Examples: Yelling, using profanity, waving arms
or fists, verbally abusing others and refusing reasonable requests for
identification.

Threatening behavior includes physical actions short of actual

contact/injury such as moving closer aggressively, general, oral or
written threats to people or property, (“You better watch your back” or
“I’ll get you”) as well as implicit threats (“You’ll be sorry” or “This isn’t
over”).

Violent behavior includes any physical assault, with or without

weapons; behavior that a reasonable person would interpret as being
potentially violent (e.g. throwing things, pounding on a desk or door, or
destroying property) or specific threats to inflict physical harm (e.g. a
threat to shoot a named individual).
Responding to Disruptive,
Threatening or Violent
Behavior
General response to disruptive behavior (no threats or weapons)

● Respond quietly and calmly. Try to defuse the situation.

● Do not take the behavior personally. Usually, the behavior has little to do with
you, but you are used as a target in the situation
● Ask questions. Respectful concern and interest may demonstrate that
aggression is not necessary
● Consider offering an apology. Even if you’ve done nothing wrong, an apology may
calm the individual and encourage cooperation. “I’m sorry that happened. What
can we do now that will solve the problem?”
● Summarize what you hear the individual saying. Make sure you are
communicating clearly. In a crisis, a person feels humiliated and wants respect
and attention. Your summary of the individual’s concerns reflects your attention.
Focus on areas of agreement to help resolve the concern.
● If this approach does not stop the disruption, assess whether the individual
seems dangerous. If, in your best judgment, he/she is upset but not a threat, set
limits and seek assistance as necessary
Individual DOES NOT seem dangerous

● Calmly and firmly set limits. “Please lower your voice. There will be no
disruptions in this office.” “Please be patient so that I can understand
what you need and try to help you.”
● Ask the individual to stop the behavior and warn that official action may
be taken. “Disruption is subject to District action. Stop or you may be
reported.”
● If the disruption continues despite a warning, tell the individual that
he/she may be disciplined or prosecuted, state that the discussion is
over, and direct them to leave the office. “Please leave now. If you do
not leave, I will call the Police.”
● If the individual refuses to leave after being directed to do so, state that
this refusal is also a violation subject to discipline, exclusion from work
or arrest.
Response ineffective and the individual SEEMS DANGEROUS

● If possible, find a quiet, safe place to talk but do not isolate yourself with an
individual you believe may be dangerous. Maintain a safe distance, do not turn
your back and stay seated if possible. Leave the door open or open a closed
door and sit near the door. Keep furniture between the two of you. Be sure a
co-worker is near to help if needed.
● Use a calm, non-confrontational approach to defuse the situation. Indicate
your desire to listen and understand the problem. Allow the person to describe
the problem. “I can see you are really upset.”
● NEVER touch the individual yourself to try to remove him/her from the area.
Even a gentle push or holding the person’s arm may be interpreted as an
assault by an agitated individual who may respond with violence toward you or
file a lawsuit later.
THANKS!
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