Graduating Social Work Students Perspectives on Domestic Violence

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1 Graduating Social Work Students Perspectives on Domestic Violence Affilia: Journal of Women and Social Work 25(2) ª The Author(s) 2010 Reprints and permission: sagepub.com/journalspermissions.nav DOI: / Beverly M. Black 1, Arlene N. Weisz 2, and Larry W. Bennett 3 Abstract This article reports the findings of a qualitative study that examined 124 social work students views on the causes and dynamics of domestic violence and their recommended interventions in a case scenario. Most students graduated from the master of social work (MSW) program with a mental health perspective on domestic violence. Only a small percentage were aware of specific interventions for domestic violence and many continued to attribute domestic violence to mental health and substance abuse problems in the victim and perpetrator. Graduates with domestic violence experience varied little from their peers in suggested domestic violence interventions or comments about the causes of domestic violence. The findings suggest that a deliberate, focused attempt to inform students about domestic violence is needed, rather than a reliance on general MSW courses. Keywords social work students, perspectives on domestic violence, interventions in domestic violence scenario Abstract This article presents research on social work graduates views on the causes of domestic violence and interventions in domestic violence cases. Domestic violence continues to be a multifaceted problem that an estimated 22% of women experience over their lifetimes (Thoennes & Tjaden, 2000). Many people believe that a woman s behavior can contribute to intimate partner violence, some believe that women want to be abused, and a large majority believe that women can easily leave abusive relationships (Worden & Carlson, 2005). Overall, most people believe that the causes 1 School of Social Work, University of Texas at Arlington, USA 2 School of Social Work, Wayne State University, MI, USA 3 Jane Addams College of Social Work, University of Illinois at Chicago, IL, USA Corresponding Author: Beverly M. Black, School of Social Work, University of Texas at Arlington, Box 19129, 211 South Coooper, Suite 301F, Arlington, TX 76019, USA. beverlyblack@uta.edu 173

2 174 Affilia: Journal of Women and Social Work 25(2) of domestic violence are rooted in the individual and family; few people view domestic violence as a problem with roots in society or culture (Worden & Carlson, 2005). Review of the Literature High rates of domestic violence occur in most of the varied settings in which social workers work, including family service settings, mental health treatment settings, and child welfare agencies (Danis & Lockhart, 2003; Forgey & Colarossi, 2003). Domestic violence is related to many other social problems, including homelessness (Bassuk et al., 1997), poverty (Tolman & Raphael, 2000), and elder abuse (Harris, 1996). Although most social workers will work with clients who have been victims of intimate partner violence, social workers often lack adequate education and training on the issue of domestic violence (Bennett & Fineran, 2003; Danis, 2004). In addition, social workers have sometimes been accused of blaming victims of domestic violence, failing to recognize that domestic violence is a problem, and failing to make appropriate interventions and referrals (Danis & Lockhart, 2003; Hansen, Harway, & Cervantes, 1991; Ross & Glisson, 1991). However, some researchers have suggested that social work has begun to progress in its handling of domestic violence. Pyles and Postmus (2004) noted that social workers are doing a better job of treating women from diverse backgrounds and coming to a general consensus on naming the issue as domestic violence. Danis (2003) noted that social workers are improving their ability to assess and intervene appropriately with battered women but do not practice universal screening for domestic violence. Furthermore, there is growing evidence that professionals have adopted a mental health focus, rather than a feminist perspective, on intimate partner violence (Goodman & Epstein, 2008). Few schools of social work offer courses specifically on domestic violence or family violence (Cohn, Salmon, & Stobo, 2002). No professional standards related to domestic violence have been set forth by the National Association of Social Workers or competencies established by the Council on Social Work Education. Danis (2003, pp. 5-6) stated that at the fundamental level our responsibilities as educators require us to ensure that we prepare competent and effective professionals with beginning knowledge, skills, and attitudes to address domestic abuse in a safe, culturally competent manner. Are social work students coming out of school with the knowledge and skills they need to work effectively with domestic violence cases? This article reports on a study that examined students thinking about the causes of domestic violence and their recommended interventions in a case scenario about domestic violence following the completion of graduate social work education. Social Work Students and Domestic Violence The review by Cohn et al. (2002) of the Web sites of social work programs reported that only 5 out of 74 master of social work (MSW) programs offered courses on intimate partner violence and only 17 had courses that addressed family violence. Kadushin and Egan (1997) found that less than 25% of graduate-level social work courses included content on domestic violence. Danis (2004) indicated that 55% of social workers reported that they had little to no academic preparation for addressing domestic violence issues. Many deans and directors of schools of social work have attributed the lack of specific social work courses on domestic violence to the fact that the necessary knowledge, attitudes, and skills to address domestic violence issues are being taught in foundation courses and that content is integrated throughout the social work curriculum (Cohn et al., 2002). However, Friend and Petrucci (2001) found that 31% of the direct-practice textbooks that were used in social work programs in California contained no information on domestic violence. Many of the remaining textbooks either supported or failed to address common myths about domestic violence. Advocates for victims of domestic violence and educators have argued for more in-depth content on domestic violence in social work curricula. Forgey and Colarossi (2003) called for a specialized 174

3 Black et al. 175 course that emphasizes the prevalence, characteristics, and treatment of domestic violence and specifically noted the importance of assisting clients who are involved in the legal system because many survivors and perpetrators are involved in the system. Bent-Goodley (2005) called for more focus on cultural competence in working with clients who have been subject to domestic violence, and Wilke and Vinton (2003) argued for more attention to domestic violence among the elderly. Students need to go beyond being able to identify the stereotypical explanations for domestic violence, such as the use of alcohol, financial strain, and anger management issues, to a better understanding of the more complex risk factors such as youth, relationship status or stability, victims or offenders histories of previous victimization or emotional abuse, sexist beliefs and gender-role stereotyping, ethnic and cultural background, and urban residence (Worden & Carlson, 2005, p. 1237). Although many researchers on domestic violence have called for including more content on domestic violence in the social work curriculum, Tower (2003) found that there was no relationship between exposure to content on domestic violence in MSW education and social workers perceptions of barriers to screening. However, Danis (2004) found that academic preparation, in addition to professional experience, was the strongest predictor of self-efficacious practice with battered women in a random sample of licensed social workers. Training and education about domestic violence are also associated with less burnout when working with battered women (Iliffe & Steed, 2000). Danis (2003) contended that social workers are becoming more aware than their predecessors of the need for specialized services for battered women, yet she found that only 47% of social workers reported that they helped clients develop personalized safety plans, and only 27% said they were able to help clients obtain protective orders. The majority of social workers did not ask whether the abuser had ever been arrested and prosecuted; less than a third asked whether the abuser had ever attended a batterers intervention program, and only 40% asked about the abuser s access to weapons (Danis, 2003). Feminist Perspective on Domestic Violence Feminist theory focuses on patriarchy, the domination of the major political, economic, cultural, and legal systems by men, and stresses the need to identify the attitudes, expectations, language behaviors, and social arrangements that have contributed to the oppression and marginalization of people (Robbins, Chatterjee, & Canda, 2006, p. 97). The feminist model challenges male entitlement and privilege as well as the traditional notion that domestic violence is a private matter (McPhail, Busch, Kulkarni, & Rice, 2007). Feminist theory views violence against women as a social and political problem that affects all women and locates relationship violence within the pervading traditional power structures of male dominance and female subservience. All forms of abuse are about the power and control that is embedded in a patriarchal value system (Jackson, 1999). Thus, the model rejects treatment models that focus on individual and interpersonal solutions. It seeks public solutions, including the establishment of programs and services for women who are battered, treatment for male batterers, and the involvement of the criminal justice system to hold men accountable for their violence (McPhail et al., 2007, p. 818). Higher Education and Changes in Critical Thinking Paul and Elder (2003, p. 1) stated that critical thinking is a process by which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. They noted that thinking with an open mind is one key aspect of critical thinking. Critical thinking can also be thought of in stages. A beginning theory is characterized as simplistic, undifferentiated, and absolute; a developing theory is expanded, 175

4 176 Affilia: Journal of Women and Social Work 25(2) porous, and complex; and an advanced theory is multiplistic, tentative, and contingent (Kasschau, 1986, p. 13). Applying a developmental model of critical thinking to education, Kasschau (1986) conceptualized students beginning models as based on the knowledge that students gleaned from their own life experiences and stated that students use this knowledge to construct a personal theory (p. 7) that explains the events they encounter. It is hoped that education will challenge students with ideas that create discrepancies in their personal theories and that they will be motivated to seek new information and evaluate that information critically. Students should encounter multiple discrepancies in their education about complex human behaviors, so their advanced personal theories will take multiple factors into account. Writing about social work education, O Connor and Dalgleish (1986) noted that as students progress through their programs, their thinking should evidence a wide range of more abstract, complex occupationally relevant constructs (p. 11). Their research on 142 social work students in Australia showed that graduates demonstrated more complex and more abstract thinking than did social work students. In social work, critical thinking can be implemented in both assessment and practice. Taleff (2006) noted that practitioners often assess clients on the basis of limited information and fill in these gaps in assessment with their prior ideas and emotions (p. 11). Similarly, one may fail to apply critical thinking in recommending interventions, falling back on commonsense assumptions about what will be effective. Because there is no single approach, or industry standard (Dersch, Harris, & Rappleyea, 2006, p. 319), research on social work students learning about domestic violence cannot measure whether the students mastered certain standard professional views on how to respond. Therefore, we used a grounded theory approach (Strauss & Corbin, 1990) and then later looked at the trends through the lens of feminist theory about domestic violence. Method After receiving approval from the university s human investigation committee, we administered a survey to MSW students. Only the students recommended interventions on a domestic violence scenario and their thoughts about the causes of domestic violence on exiting an MSW program are reported here. All the surveys were administered in May 2003 to graduating students who were concentrating on interpersonal practice. The case scenario read: Mary Jones, a 28-year-old White woman, and her husband, Mike Jones, a 29-year-old White man, were taken for questioning after police officers responded to a domestic violence call. When the officers arrived on the scene, they found Mary Jones with a swollen black eye and bleeding from facial injuries and Mike Jones bleeding from a cut across the head. Mike Jones was intoxicated and, according to Mary, had been drinking the better part of the day. Mary believes Mike has a drinking problem. Mary reported that they had been in the living room arguing over the cleanliness of the house when things got out of control. Suddenly, Mike began swinging at her and punched her several times. Then he hit her over the head with a glass ashtray that was lying there. Mary said, I was surprised and scared and was just trying to protect myself, so I grabbed him and pushed him down, and that s when he hit his head on the table. I didn t mean to hurt him. We asked the students to describe the intervention or series of interventions that they believed would be most helpful for Mike and Mary. At the end of the survey, we also asked them to provide further details on their opinions about the causes of domestic violence, about why some battered women remain with their batterers, and about what should be done to prevent and treat domestic violence or about their experiences. 176

5 Black et al. 177 Sample One hundred twenty-four students from an urban, public university described their recommended interventions in the domestic violence scenario, and 69 students wrote comments about their thoughts on the causes of domestic violence. Forty-one percent of the students who completed the survey were enrolled in the Advanced Standing program; the remaining students were in the 2-year MSW program. The mean age of the students who completed the survey was (SD ¼ 9.78); 25% were aged 25 or younger and 21% were aged 40 or older. Although some students failed to identify their gender, the large majority of the sample was female (97%). Of the participants who reported their ethnicity at the pretest, 66% identified as European American and 28% identified as African American; the remaining students reported their ethnicity as Other or failed to report this information. Twenty-two percent of the students reported that they have had a fair amount or a lot of experience working with battered women and 11% reported they had a fair amount or a lot of experience working with batterers. The MSW program offered one elective class in family violence and 24 respondents said they had taken the class. Analysis The responses were open coded to permit an unrestricted view of the students understandings. Using NVivo, two researchers used a grounded theory approach (Strauss & Corbin, 1990) to develop codes and coded the recommended interventions independently. They reached a consensus when they disagreed. Many answers received more than one code. The third researcher developed codes for students comments at the end of the survey about the causes of domestic violence and why some battered women remain with their batterers. The first two authors used these codes and reached a consensus in coding the comments section. We separated students who reported that they had some or a substantial amount of experience working with domestic violence victims or perpetrators or who took our elective MSW course in family violence from other graduating MSW students. Half the 14-week course covered domestic violence and the other half covered child abuse. Content on domestic violence was approached from a feminist perceptive, but the students were encouraged to apply critical theory to various explanations of violence against women. Tables 1 and 2 describe the findings of our analysis of answers to the open-ended questions. Results Recommended Interventions in the Domestic Violence Scenario Counseling. As Table 1 shows, most students recommended some general form of counseling not specific to domestic violence. About 30% of the codes recommended counseling. Often, the students recommended more than one form of counseling. The students highly endorsed individual counseling, but marital and family counseling was the preferred form of counseling. Those who had taken the domestic violence course or stated they had a fair amount or a lot of experience with domestic violence similarly recommended individual counseling as did the other students. Of the statements that recommended individual counseling, 71% targeted both Mary s and Mike s need for individual counseling. Some exemplary comments were as follows: Mike and Mary should seek counseling, both couples and individual. Also, if appropriate, Mike should enter AA [Alcoholics Anonymous]. In counseling, they should discuss the arguing, the violence, Mike s drinking, and the interaction of those three things. 177

6 178 Affilia: Journal of Women and Social Work 25(2) Table 1. Recommended Interventions in the Domestic Violence Case Scenario Type of Intervention Codes Total Codes ¼ 251 Class Total on or Experience With Codes ¼ 257 Domestic Violence % % 1. Counseling a. Marital/family b. Individual c. Group d. Religious e. Cognitive behavior Substance abuse intervention Education a. Communication skills b. Empowerment c. Conflict management/resolution/anger management d. Assertiveness e. Education Domestic violence/batterers intervention a. Batterers /domestic violence interventions for Mike b. Domestic violence counseling for Mary c. Domestic violence intervention for both Legal a. Arrest b. Restraining order c. Legal advice or advocacy Separate Mike and Mary a. Leave or separate b. Shelter Further assessment/explore underlying issues Self-help groups/support groups Medical attention Safety planning for Mary Table 2. Responses to the Comments Section Codes Total Codes ¼ 46 % Total Codes ¼ 76 Domestic Violence Class or Experience, % Explanation of causes: Domestic violence is complex Interventions Explanations: Domestic violence is simple or can be understood Explanation of causes: Blaming victims or victims play a role Women are violent, too If this was the first occurrence of domestic violence, I would suggest immediate counseling for the couple both individually and together. In addition, support groups for both of them. Some students recognized the need for marital or family counseling to occur after other forms of intervention had occurred. Of the codes that recommended marital or family counseling, 11% suggested that such intervention should occur only after other forms of intervention. One student 178

7 Black et al. 179 commented: Substance abuse intervention for Mike and individual counseling, counseling, or support for Mary, couple therapy (only when the violence has stopped). Substance abuse and anger management. In addition to counseling, the students strongly endorsed treatment for substance abuse and conflict management or anger management interventions. Of the students with experience with domestic violence, similar percentages of codes recommended substance abuse (more than 18%) and conflict management and anger management (more than 10%) interventions compared to other students. Almost 34% of the codes that recommended anger management specified that both Mike and Mary needed this intervention. Two recommendations stated: Have the husband go to AA. Have the husband go to anger management class. Have the husband and wife take marriage counseling together. The intervention should address both of them individually and then as a couple. He should be assessed and receive substance abuse treatment and anger management therapy. She should receive individual counseling on empowerment and maybe group therapy to help find support.they should also receive couples therapy to address their relationship problems. Mike needs substance abuse counseling, anger management. Marriage counseling for both. Medical attention for injuries. Mary could be confined to a shelter for counseling. Specific domestic violence interventions. Relatively few recommendations showed a familiarity with specific domestic violence interventions and terminology. Only about 17% of the codes identified specific domestic violence interventions (arrest, restraining order, legal advice or advocacy, domestic violence counseling or batterers interventions, shelter, or safety planning). For the students who had taken the domestic violence class stated that they had a fair amount or a lot of domestic violence experience; about 20% of the codes identified specific domestic violence interventions. The following statements indicate that some students had an understanding of specialized services for domestic violence Provide safety options for Mary, arrest and consequences for Mike immediate; counseling/shelter if Mary wants it; present other options if another incident occurs (as opposed to pushing him, although that may have been her only option) short term; education and awareness for society, training for police officers when there appear to be two victims, although that is rarely the case long term. Mary should leave her husband and seek counseling. Mike should receive help for his drinking problem. Mike should also receive counseling in a program for batterers. There is some indication that the students recognized that Mike was the primary perpetrator even though Mary pushed him. All comments that mentioned arrest focused specifically on Mike. About twice as many comments suggested anger management classes for Mike as comments suggesting anger management classes for both Mike and Mary. This was true among both groups of students. Analysis of the Comments Question at the End of the Survey Nearly 23% of the codes were further ideas about how to intervene in the case scenario. We chose not to do another analysis of the recommended interventions in the comments section for two reasons. First, we analyzed the comments about intervention thoroughly in our discussion of responses to the vignette. Second, the comments were not in response to a specific scenario, so it would be difficult to compare them. 179

8 180 Affilia: Journal of Women and Social Work 25(2) Domestic violence is a complex issue. The most common comment, other than interventions, was that domestic violence is complex (see Table 2). We defined complex by applying that code to statements in which the students mentioned two or more causes of domestic violence. About 26% of the codes reflected this view. These are some typical comments: This questionnaire is interesting. I believe women stay because they are dependant on their partners financially and emotionally. They may also be worried that leaving will create a greater risk of harm for themselves and their children and feel they have nowhere else to go. I think women remain with their batterer because of fear, not wanting to be alone, and in denial that, that is how love is shown from their partner. My opinion of domestic violence is possibly caused by a history of violence, drugs and alcohol, work or money pressures, or maybe unable to control anger. Recent research has indicated that men who batter change their behavior when in relationships with women who are not battered. Before this program, I thought partner abuse was the man s fault entirely. Now, I believe partner abuse is a complex family dynamic involving both partners. Domestic violence is understandable. About 13% of the codes were statements that we coded as saying that domestic violence can be understood; about 18% for those who had experience working in domestic violence or took the family violence course reflected on this theme. Some of the answers that attributed domestic violence to simple causes found that these causes were lodged within the woman, but others saw social learning, societal, and power issues playing a role. Here are some typical comments: Women remain with their batterers due to low self-esteem and fear of further danger. Harsher punishments for batterers would be helpful. There need to be some major improvements in the available resources for a woman after she leaves her abuser. In most cases, she returns or doesn t leave because of the fear that she will not be able to take care of herself or her children, if any. Blaming victims. More than 32% of the comments reflected an explanation that we coded as blaming victims or implying that victims play a role in causing domestic violence. We applied this code to statements that attributed domestic violence to some characteristic of the victim, such as low self-esteem: Some battered women lack courage to face fear and live alone. Some battered women s low self-esteem interferes with growth. Some battered women are made cowards at an early age. The woman who is battered doesn t realize that she deserves better and has a great fear of the man. A woman often believes she deserves the abuse and that she has done something wrong. About 20% of the students who had experience working in domestic violence or took the family violence course wrote comments that received the code of blaming victims (in addition to other codes). Self-esteem issues were again frequently mentioned: There is never an excuse for domestic violence. I work part time in a shelter for abused women. It s complex why a man abuses; there is no short answer. Much has to do with upbringing. Education is important for both the victims and the abusers. Many women stay out of fear for greater violence; they suffer from low self-esteem and may be financially dependent. Women violent, too. A small percentage of the codes (2%) mentioned in the discussion of the causes and dynamic of domestic violence that women are also violent. Slightly more than 5% of the coded comments from students who had domestic violence experience discussed the violence that women perpetrate. 180

9 Black et al. 181 Discussion Most students recommended a package of interventions, rather than a single intervention, for the complex scenario of domestic violence presented to them, and many students recognized that the causes of domestic violence are complex. However, the students seemed to be graduating with a mental health or commonsense (Worden & Carlson, 2005) orientation to domestic violence. They appeared to be focused on the individual and interpersonal dynamics of abusive relationships, rather than on issues related to power and control. Few students seemed to have adopted a feminist perspective on domestic violence or placed the cause of violence within traditional power structures of male dominance and female subservience. The students appeared to have limited knowledge of how to intervene effectively in a domestic violence case. Although the vignette was deliberately complex in that Mike was pushed and injured, many of the students did view Mike as the primary perpetrator, and almost all recognized the importance of intervention for him. The students endorsement of counseling and family counseling is evident. Perhaps, the strong endorsement of counseling is the result of the selection process of who attends social work graduate programs. Collins and Dressler (2008) noted that there is controversy about whether people who choose social work may already be distinct and bring certain beliefs and attitudes with them. Students may have beliefs about the psychological causes of suffering that lead them to apply to an MSW program in the first place. Furthermore, most people who enter social work as a profession want to be helpful and have a commonsense idea that counseling will help. They may be quick to view counseling and improved communication or anger management as panaceas for this complex and troubling scenario. Without specific course content on domestic violence, few students may graduate from MSW programs with a different perspective. The fact that more than three times the number of students recommendations for intervention focused on counseling than those that suggested some form of specific domestic violence intervention suggests that students may not understand the difference between these two types of interventions. In addition, the relative lack of recommendations that indicated a familiarity with the terminology used specifically with domestic violence (domestic violence counseling or batterers intervention, legal avenues, shelter, or safety planning) suggests that the students had little specific knowledge about domestic violence on graduating from an MSW program. For the most part, the students seemed to be unfamiliar with some of the literature on domestic violence that suggests that couples intervention or family intervention should take place only after the batterer has been involved in a batterers intervention program or takes full responsibility for the violence (Bograd & Mederos, 2007). The students may not have thought about whether women in abusive relationships are free to engage in the open exchange of feelings that is promoted in a marital counseling session. The need for safety planning was identified in less than 2% of the codes for all the MSW students and from those who had experience in domestic violence. Ensuring the safety of clients must be the first priority of social workers (Stout & McPhail, 1998). Although Danis (2003) contended that social workers are becoming more aware than their predecessors of the need for specialized services for battered women, such increased familiarity may not take place in many graduate programs. Some of the students in our study stated that they had experience working with victims of domestic violence or batterers when they entered the program or on leaving the program. However, their recommended interventions revealed no more knowledge of specific domestic violence interventions than did those of students who had little or no experience working with domestic violence. This finding may reflect the professionalization or mental health perspective of the programs where they worked (Goodman & Epstein, 2008). Researchers and long-time domestic violence practitioners do not agree on the causes and dynamics of domestic violence and most recognize its complexity (Barnett, Miller-Perrin, & Perrin, 181

10 182 Affilia: Journal of Women and Social Work 25(2) 2004). Thus, MSW students may receive unclear or ambivalent explanations for domestic violence. Although almost one quarter of the codes suggested that the students recognized that domestic violence is a complex phenomenon, an even higher percentage of codes showed evidence that the students believed that victims play a role in causing their abuse. The substantial percentage of codes indicating that the causes of domestic violence are simple or can be understood suggests that social work education did not assist the students to use a higher level of critical thinking about domestic violence (Paul & Elder, 2003). Some students seem to graduate believing there are simple explanations for domestic violence. Students with experience in domestic violence or who had a class on domestic violence appear somewhat less prone to using victim-blaming comments in their explanations of domestic violence. This finding suggests that students with special training in domestic violence are less likely to attribute this violence to victims psychological problems. Understanding that problems with self-esteem do not cause domestic violence requires complex, abstract thinking that must be carefully taught to most students. Critical thinking must also be used before systems theory is applied to domestic violence because it can imply that all parts of a family system contribute to causing family problems (Avis, 1992; Bograd, 1984). Directly addressing domestic violence and gender issues in social work classes will assist students to understand and critically assess the complex sociological issues that contribute to domestic violence. Limitations. There are several limitations of the study. First, the sample came from one MSW program. The study would have been strengthened by including other social work programs in the sample that may differ in their attention to domestic violence or their emphasis on a mental health perspective. Second, we used only one scenario to elicit students ideas about intervention, and this scenario did not contain much information about the context or history of the couple. Thus, the scenario may not have provided sufficient details to ascertain students total thinking about domestic violence. Third, our analysis did not separate students with bachelor of social work (BSW) or psychology majors from the other students. Furthermore, by including the students with domestic violence experience or the domestic violence class in the whole posttest group, we minimized the potential difference between those students and students with neither of these experiences. Students seem to exit their MSW program with a strong mental health view of intervention and causality regarding domestic violence. Without a clear mandate to infuse the curriculum with a feminist or sociological view of causality, they may not graduate with an understanding of the complexity of domestic violence. Bryant and Spencer (2003) contended that universities need to play a more active role in changing attitudes about the acceptance of interpersonal violence by providing training and programs for students. Surely, social work programs have a responsibility to do so and more. Declaration of Conflicting Interests The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Funding The authors received no financial support for the research and/or authorship of this article. References Avis, J. M. (1992). Where are all the family therapists? Abuse and violence within families and family therapy s response. Journal of Marital and Family Therapy, 18,

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