1 American Journal of Community Psychology, Vol. 36, Nos. 1/2, September 2005 ( C 2005) DOI: /s A Theoretical Framework for Understanding Help-Seeking Processes Among Survivors of Intimate Partner Violence Belle Liang, 1,3 Lisa Goodman, 1 Pratyusha Tummala-Narra, 2 and Sarah Weintraub 1 This paper suggests a conceptual framework for understanding the processes of help-seeking among survivors of intimate partner violence (IPV). A cognitive theory from general literature on help-seeking in stigmatizing situations suggests three relevant processes or stages of seeking help in the IPV context: defining the problem, deciding to seek help, and selecting a source of support. Individual, interpersonal, and sociocultural factors that influence decisionmaking at each of these stages are discussed and illustrated with case examples. KEY WORDS: intimate partner violence; social support; help-seeking; culture; domestic violence; battered women. INTRODUCTION Since the early 1970s when feminist advocates first brought intimate partner violence (IPV) to public notice, it has seized the attention of policy-makers, advocates, and researchers. Legal and legislative reforms have broadened the options for battered women, while researchers have shed light on IPV s prevalence, causes, consequences, and potential solutions. As the knowledge base has expanded, conceptualizations of the problem have also shifted. Until recently, the most common research approach to IPV was to investigate the personal characteristics of the perpetrator or the victim (see Koss et al., 1994, for an overview). Although this kind of individual level approach had validity, it rendered invisible the larger sociocultural context in which IPV occurs, and implicitly conceptualized violence as stemming from individual pathology or deviance, ignoring the 1 Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education, Boston College, Chestnut Hill, Massachusetts. 2 Georgetown University School of Medicine, Washington, D.C. 3 To whom correspondence should be addressed at Department of Counseling and Developmental Psychology, Lynch School of Education, Boston College, Campion 314, Chestnut Hill, MA 02461; important ways that violence is embedded within social contexts and cultures. More contemporary research reflects an ecological or contextual approach, with a growing body of work examining the quantity, quality, and impact of social support on IPV victims, and the ways in which victims access that support (Astin, Lawrence, & Foy, 1993; Kemp, Rawlings, & Green, 1991; Sullivan, Tan, Basta, Rumptz, & Davidson, 1992; Tan, Basta, Sullivan, & Davidson, 1995). Although research findings clearly indicate the importance of social support in the lives and outcomes of IPV victims, victims do not always ask for the support they need. This paper explores individual, familial, economic, and cultural influences on women s decisions to seek help and support in the face of violence. 4 In the first section we focus on research demonstrating the critical role of social support both informal and formal in improving the mental health and physical 4 Although women and men can be both perpetrators and victims of violence, for the sake of simplicity we use the male pronoun to refer to perpetrators and the feminine pronoun to refer to victims. It should also be noted that we use several terms to refer to women who have experienced violence in intimate relationships. We intend our use of the terms battered women, IPV victim, and IPV survivor to portray these women as both victims and survivors who actively resist the violence in their lives in order to be safe /05/ /0 C 2005 Springer Science+Business Media, Inc.
2 72 Liang, Goodman, Tummala-Narra, and Weintraub safety of battered women, as well as studies examining IPV victims help-seeking patterns. In the second section we explore research on help-seeking and stigmatizing problems in order to illuminate the individual, interpersonal, and sociocultural factors that are involved in the process of help-seeking among IPV victims. Finally, in the third section we discuss implications of these ideas for research and practice. THE ROLE OF SOCIAL SUPPORT IN IPV Informal and formal social support have been shown to improve battered women s mental health, willingness and ability to seek help from formal sources, and subsequent capacity to stay safe. Friends and relatives often provide women with informal supports (Gondolf & Fisher, 1988; Horton & Johnson, 1993) in the forms of emotional sustenance (e.g., advice, encouragement, or affirmation) and material assistance (such as financial help, babysitting, or a place to stay; Goodkind, Gillum, Bybee, & Sullivan, 2003). Formal support may be provided by the police, actors within the criminal justice system, social service agency staff, medical services personnel, crisis hotline workers, mental health professionals, clergy members, domestic violence advocates, and staff at battered women s shelters (Bowker, 1988; Goodman, Dutton, Weinfurt, & Cook, 2003; Donato & Bowker, 1984). Social Support and Mental Health General social support research has identified an association between support mainly from informal sources and mental health functioning. For instance, many studies have demonstrated that the size of one s informal social network, as well as the level of perceived supportiveness of its members, predicts psychological health (Cohen & Wills, 1985; Flannery, 1990; White, Richter, & Fry, 1992). This literature suggests that those with close relationships that provide both psychological and material resources are in better psychological health than those with fewer informal supports (Cohen & Wills, 1985). With regard to IPV in particular, a number of studies have documented the relative dearth of social support among battered women, as well as the reluctance of IPV victims to access existing support networks both informal and formal (e.g., Barnett, Martinez, & Keyson, 1996; Dunham & Senn, 2000). This is significant, considering that informal social support has been identified as a key protective factor that is associated with fewer mental health problems among battered women (Astin et al., 1993; Carlson, McNutt, Choi, & Rose, 2002; Kemp et al., 1991; Mitchell & Hodson, 1983; Tan et al., 1995). Taken together, these studies suggest that battered women who receive emotional and tangible support may be less susceptible to the deleterious psychological impact of their partner s abuse, including anxiety, depression, suicide attempts, and posttraumatic stress disorder. Victims perceptions of social support may directly affect their mental health by moderating their sense of well-being (Arias, Lyons, & Street, 1997) or by mediating the relationship between abuse and mental health (Thompson et al., 2000). Social Support and Physical Safety Researchers have also shown that both informal and formal social support serve to protect battered women against ongoing violence, perhaps in part by triggering battered women s own coping efforts. Goodman, Dutton, Weinfurt, and Vankos (in press) found, for example, that even taking into account the severity of prior violence and other key predictors of ongoing abuse, the stronger battered women s informal support networks were, the less likely they were to experience violence over the course of a year. Interestingly, however, for the quarter of research participants who had experienced the most severe violence, even informal social support did not diminish the likelihood of ongoing violence. For these women, reabuse was equally likely no matter their level of social support. Thus, when violence reaches a certain level of severity, even the support of family and friends may be insufficient to prevent it or stop it from continuing. The use of formal support has also been shown to influence the physical safety of abuse survivors. In an evaluation of the impact of intensive advocacy services provided as battered women left a shelter, Sullivan and Bybee (1999) found that women who received these services were twice as likely to be free of IPV in the subsequent 2 years compared to those who did not receive the services. Similarly, a recent study evaluating the impact of legal advocacy provided to battered women seeking civil protection orders found that relative to control group participants, those who received advocacy services were significantly less likely to be reabused over the course of
3 Help-Seeking and IPV 73 6 weeks (Bell & Goodman, 2001). These studies provide strong support for the contributions of both informal and formal social support to women s physical safety. Despite the benefits of social support, however, rather than relying on other people or outside agencies, women appear to be most likely to use private strategies, such as placating or resistance, to combat IPV. This is significant, considering that IPV survivors also rate informal support strategies and many formal support strategies as more helpful than private strategies (Goodman et al., 2003). In the following section, we apply general theories of help-seeking in examining the nature and context of battered women s decision-making around seeking help for IPV. PROCESSES OF HELP-SEEKING Although research findings have examined the nature and extent of help-seeking behavior among IPV victims, a theory of help-seeking that provides a framework for such findings has yet to be developed. Thus, we draw from current, general models of helpseeking in order to elucidate the process of helpseeking among IPV survivors (Fox, Blank, Rovnyak, & Barnett, 2001; Greenlay & Mullen, 1990; Pavuluri, Luk, & McGee, 1996; Pescosolido, 1992; Srebnik, Cauce, & Bayder, 1996). These models tend to focus on the individual help-seeker s internal, cognitive processes, and include three stages: problem recognition and definition, the decision to seek help, and the selection of a help provider. See model of helpseeking in Fig. 1. Although the process of defining a problem, deciding whether to seek help, and choosing a support provider is presented as distinct stages, this process is by no means linear. Although it is true that a battered woman s appraisal or definition of her situation undoubtedly shapes her decisions around whether and from whom to seek help, it is also true that the helper she chooses will influence how she defines the problem and whether she chooses to seek help again. Fig. 1. A model of help-seeking and change.
4 74 Liang, Goodman, Tummala-Narra, and Weintraub Thus, these stages together form a dialectical process, with each informing the other in an ongoing feedback loop. To capture the complexity of this interactive process, double-headed arrows are placed between each of the stages presented in Fig. 1. It must also be noted that although our theoretical model describes help-seeking among IPV survivors in primarily cognitive terms, emotions are linked to, and mediate between, cognitions and intentional actions (Brandstadter, 1998). For example, feelings of guilt and shame that may result from a decision to seek help may deter a battered woman from actually acting on her decision. Moreover, these internal processes are themselves influenced by interpersonal and sociocultural factors such as the IPV survivor s individual and relational history and the economic, political, and cultural context in which her life experiences are embedded. Indeed, as Brandstadter (1998) argued, explanations for intentional actions that center on the inner influences of action (individual expectations, goals, beliefs, etc.) without taking into account broader contextual influences provide an ahistorical and adynamic picture of action. Thus, interpersonal and sociocultural factors are also depicted in Fig. 1. Problem Definition and Appraisal Individuals respond to problems in a variety of ways depending upon how they define or label those problems (Fox et al., 2001; Tsogia, Copello, & Orford, 2001) and evaluate their severity (Greenlay & Mullen, 1990). A therapist who defines her client s problem as depression, for example, will make recommendations that most likely make little sense to a client who has defined that same problem as a spiritual crisis. However, scant research focuses on how individuals evaluate and define their difficulties, and how these definitions, in turn, influence their helpseeking behavior. Instead, much of the help-seeking literature frames particular problems a priori, assuming that these definitions of problems are universal. A recent review on help-seeking emphasized the importance of moving beyond research that is limited to professional assumptions of problem definition, and exploring the processes of problem definition among individuals in need (Broadhurst, 2003). In particular, the definition of domestic violence has varied considerably within the mental health and legal fields, reflecting distinct viewpoints, and implying very different treatment and public health responses (Walker, 1999), ranging from shelter and counseling services to law enforcement and legal aid. Given the range of definitions offered by professionals, the same discrepancies could be expected in and across individuals who experience IPV. With few exceptions (e.g., Kearney, 2001; Lempert, 1997), however, researchers have most often focused on what women in violent relationships do rather than how they interpret their violent encounters, or how these interpretations affect their process of help-seeking. Moreover, as Lempert (1997) notes in her qualitative study, much of the research on battered women s help-seeking has focused on formal support, primarily help from police, medical agencies, and community shelters (Berk, Berk, Loseke, & Rauma, 1983; Berk, Berk, Newton, & Loseke, 1984; Berk & Loseke, ; Bowker & Maurer, 1987; Edwards, 1987; Ferraro, 1987, 1989; Loseke, 1992; Schecter, 1982; Stark & Flitcraft, 1983, 1988). These narrow foci limit our understanding of the processes of problem definition and how these processes may lead to or inhibit a broad range of types of help-seeking behavior. Examining the ways in which abused women come to interpret their abusive situations requires that we recognize the overlapping influences of multiple factors. Below we discuss individual, relational, and sociocultural influences on problem definition for abused women. Individual Influences on Defining IPV Just as women s characterizations of IPV influence their strategies for combating the violence, so too does their readiness to employ certain strategies influence their characterizations. In other words, victims definitions shift over time, depending on how ready they are to make changes in their lives and vice versa. Specifically, according to Prochanska, DiClemente, and Norcross (1992) Transtheoretical Model, a woman in the pre-contemplation stage accepts the abuser s definition of the situation, minimizes the abuse by labeling it as an aberrant event, or denies the severity of the event by comparing herself to others with more serious problems. Given these characterizations, it is likely that this woman would not seek help (Haggerty & Goodman, 2003). In the contemplation stage, women experiencing the very same level of violence begin to recognize the abuse as a problem and consider pros and cons for taking action. Abused women in
5 Help-Seeking and IPV 75 the preparation stage stop thinking about the abuse as their own fault or as trivial and begin to seek out others for help in reconceptualizing and acting on the problem. Where women lie along this continuum is not only the result of internal cognitive processes, however. Interpersonal and sociocultural factors also significantly affect women s definitions of IPV. Interpersonal Influences on Defining IPV Unlike other social relationships with more limited or prescribed roles, relationships between intimate partners include a wide range of contacts, including eating, sleeping, co-parenting, playing, working, making large and small decisions, and sexual activity. The fluid, liberal, and intimate nature of these interactions may make subtle violations and abuses difficult to detect and harder still to understand or define. Moreover, because the actual nature, severity, and presence of violence in an intimate relationship may be constantly shifting, with abusers alternating between violence and loving contrition, clarifying the relationship as abusive may be difficult and confusing. Further complicating problem definition for IPV victims, cognitive distortions and dissonances can be caused both by the abuser and by members of victims support networks. For example, in response to verbal and physical abuse by intimate partners, victims have been shown to doubt themselves and cognitively reconstruct past violent episodes, reframing and redefining their meanings (Lempert, 1997). Moreover, when these victims disclosed their abuse in attempts to make sense of and validate their interpretations of their situations, they were often met with shock and disbelief from friends and family. This discounting of their stories and lack of validation challenged the victims perceptions and definitions and further strengthened the abusive partner s definitions. Sociocultural Influences on Defining IPV An individuals definition of interpersonal violence is also situated in a social context that is shaped by the interacting dimensions of gender, class, and culture. With regard to the interaction between gender and culture, women victimized by IPV perceive the abuse within the context of particular social, religious, and cultural institutions that reinforce power inequities between men and women (Connell, 1987). As an extreme example, in certain cultures, a husband is legally permitted to beat or kill his wife in response to infidelity or other infractions to family honor (Beyer, 1999; Vandello & Cohen, 2003). Indeed, in some communities terms such as domestic violence or battering do not even exist (Ellsberg, Caldera, Herrera, Winkvist, & Kullgren, 1999; Horne, 1999; McWhirter, 1999). Less extreme, but still pernicious, religious and social norms in many communities uphold the view that IPV is a private matter between intimate partners rather than a crime for which the perpetrator should be held legally responsible. It is therefore not difficult to understand why many women might have trouble recognizing intimate violence as a problem for which help should be sought. Class or socioeconomic status also shapes IPV victims understanding of the violence that they face. Women with more resources often have more options for action available to them, and are therefore freer to define certain situations as unacceptable or intolerable. By contrast, women living in poverty with fewer resources available may be less free to conceptualize the problem as intolerable because of the unlikelihood that the problem with be solved. If the violence is indeed perceived to be intolerable, a woman with no means to escape the violent situation may find herself in an untenable psychological situation that requires creative solutions. For example, homeless women who need protection against dangerous men out on the streets may pay their protectors with their own bodies. When asked if these sexual interactions were unwanted or coerced (that is, abusive), these women were hard pressed to answer the question (L. Goodman, personal communication, August 3, 2004). With very limited resources and few alternatives available, it became difficult for these women to appraise the situation as abusive, as that characterization would lead them to act in ways that felt impossible (i.e., going without protection on the streets). In sum, women s interpretations of male domination and violence are shaped by gender, culture, and social location in the hierarchies of class and race (e.g., Lamphere, Zavella, & Gozales, 1993). The following case vignette illustrates ways in which gender, class, culture, and other sociocultural aspects of women s experiences contribute to their process of defining and appraising intimate partner violence. Yin is a 38-year-old woman who relocated with her husband and two children from Thailand to the
6 76 Liang, Goodman, Tummala-Narra, and Weintraub United States. Both she and her husband experienced a difficult adjustment to living in the United States. Despite his attempts to secure a job in his uncle s business, Yin s husband was unable to find a job that fit with his interests and skills. He therefore worked as a custodian in a school, became increasingly depressed, and began drinking alcohol excessively. Yin worked as a waitress in a restaurant, whereas the children attended school. Yin and her husband at times discussed possibly moving back to Thailand, particularly when they notice people at work or at their children s school make derogatory comments about their Asian accent and their immigration status. After about 1 year into their arrival to the United States, Yin s husband began to hit her and verbally abuse her. The frequency of the abuse increased with her husband s alcohol abuse. The children, over time, witnessed these incidents almost routinely, and felt helpless to protect themselves and their mother. Yin made several attempts to talk to her husband about his behavior. However, he kept none of his promises to stop hitting her. Yin thought about leaving her husband, but worried about the future of her status as an immigrant, and the ability of her children to obtain a green card if she left him. The idea that she could return to Thailand without her husband also felt overwhelming, as she worried about how she would fit in to her community in Thailand as a single or divorced mother. After a few months, Yin revealed the abuse to her parents in Thailand. Although they expressed their sadness and concern for her, they were not able to think of ways to help her. She then spoke with members of her husband s family about the violence. They responded to her by stating, It is your duty to take care of him. He is sick, and he needs your help. Think about the children. They need their father to get better. Eventually, constrained by practical difficulties, and influenced by family, cultural, and gender-role expectations, Yin came to see the abuse as the inevitable consequence of her husband s stress and culture shock in other words, not her husband s fault. Rather than defining her situation as unacceptable, she normalized her particular experience, and defined it as her cross to bear for the family s sake. Yin s case illustrates how gender roles and cultural beliefs influence women s understandings of domestic violence. Although Yin was exposed to mainstream culture through her children s school, her job, and television, her primary affective connections remained with other Thai immigrants who tended to uphold a set of traditional values related to gender. For example, Yin s belief that she was responsible for maintaining family unity was tied to the broader cultural value of collectivism, according to which individual needs are outweighed by the long-term benefits of securing the integrity of the family unit in the context of a new cultural context (Roland, 1996). Yin s central role in the family unit lent itself to the notion of being a good woman or a strong woman who is self-sacrificing (Ho, 1990; Root, 1996). At the same time, her experiences of hostility from mainstream society reified her identifications with traditional gender role expectations. Given her gender role identification within the context of her cultural identification, it is not surprising that Yin understood IPV as her cross to bear and not as a problem warranting intervention and further threat to family integrity. It is worth noting that a woman who has a different, more welcoming reception from, and more consistent exposure to, a diverse group of people in mainstream culture, may be more inclined to alter her definition of her role in intimate relationships, and relatedly, her appraisal of an abusive situation. Indeed, several studies have noted that level of acculturation affects women s definitions of intimate partner violence and related help-seeking behavior (Lee & Au, 1998; West, Kantor, & Jasinski, 1998). Other aspects of Yin s sociocultural context, such as her class and immigration status, guided her conceptualization of the abuse by her husband. She and her family had limited financial resources and a pending status on her green card, both of which contributed to her perception of the abuse and what was possible to do about it. A lack of legal and economic resources obviously exacerbates IPV victims sense of helplessness (Bui, 2003); and the predicament of immigration status can foster a legal dependency on the perpetrator that prevents women from envisioning alternative courses of action a necessary precursor to defining the situation as intolerable. Decision to Seek Help As noted previously, the decision of whether to seek help stems from problem definition and continually shifts as women s cognitive appraisal of their situation and external circumstances shift.
7 Help-Seeking and IPV 77 Individual Influences on Deciding to Seek Help for IPV The help-seeking literature (e.g., Cauce et al., 2002) suggests two internal conditions that are fundamental for seeking support: (1) recognizing a problem as undesirable and (2) seeing the problem as unlikely to go away without help from others. Consistent with the first of these conditions, research demonstrates a correlation between severity of abuse and help-seeking among IPV survivors (Coker, Derrick, Lumpkin, Aldrich, & Oldendick, 2000; Goodman et al., 2003). Further, a number of qualitative and quantitative studies have given rise to a stage model, whereby IPV survivors progress from more private attempts to deal with abuse (e.g., placating and resisting) to informal support-seeking (e.g., from family and friends), and as violence worsens (e.g., Brown, 1997; Goodman et al., 2003; Haggerty & Goodman, 2003), to more public help-seeking (e.g., from legal system or community agencies). This may be particularly true within many ethnic minority communities. Indeed, in several studies regarding Asian women, participants tended to report abuse incidents and seek help only when the violence reached a severe or crisis level (Abraham, 2000; Huisman, 1996). Consistent with the second condition for seeking support, a recognition that the problem is unlikely to go away without help, battered women who interpret their violent experiences as a consequence of their own shortcomings might be more likely to deal with the problem themselves and believe that they have the power to effect change through their own behavior. Likewise, in Lempert s (1997) qualitative study, battered women sought help only when they regarded their own resources and alternatives as depleted and when they had lost hope in their own ability to stop the violence. However, evaluating whether abuse is likely to remit without seeking help can be especially difficult in IPV situations due to the shifting nature of the violence and the relationship, including convincing promises to change by the abusive partner following abuse episodes. In addition to these two conditions, an individual s style of relating to others is a key characteristic that influences whether a battered woman decides to seek help. In their qualitative study of 31 abused women, Rose, Campbell, and Kub (2000) identified two common themes that prevented women from seeking support: a pattern of cautious relating to others, and seeing the self as isolated. More specifically, those women who chose not to seek support from others often described feelings of insecurity, ambivalence about reaching out for help in new or current relationships, and patterns of closing up around people. Although some described experiences of forced isolation, women more often defined themselves as loners, hard to get to know, or uncomfortable with others. Indeed, these individual characteristics may result from being in abusive relationships as well as pose an obstacle to leaving such relationships. Interpersonal and Sociocultural Influences in Deciding to Seek Help for IPV Interpersonal and sociocultural influences such as gender, class, and cultural factors also play a powerful role in battered women s decisions about whether or not to seek help from friends, family, or outside agencies. For example, Asian cultural traditions that emphasize family privacy, fear of divorce, and gender roles that place men in superior social standing may prevent many women from seeking help outside the family, even when they define the IPV as a problem. Battered women s desires to seek help may also be influenced by their prior experiences both direct and indirect with friends, family, and formal services. Many women question the cultural sensitivity of mainstream service providers. For example, Latta and Goodman (in press) found that Haitian women regarded the lack of culturally sensitive shelters and the scarcity of shelters serving the Haitian community, in particular, as barriers to their seeking help for IPV. These women feared being misunderstood and marginalized by formal agencies that seemed to exclude both helpproviders and help-seekers from the Haitian community. Fraser, McNutt, Clark, Williams-Muhammed, and Lee (2002) similarly noted that although shelters in the United States have become more diverse, many African American women seeking help continue to ask themselves If I go outside my community, will I be the only Black person there? (p. 364). Significantly influencing women s likelihood of seeking formal support, many abused women have heard about or experienced negative police responses, including failure to arrest the batterer; mistaken identification of victim as batterer; the victim not listened to or the situation trivialized; and race, socioeconomic status, and homophobic stereotyping
8 78 Liang, Goodman, Tummala-Narra, and Weintraub (Bennett, Goodman, & Dutton, 1999; Wolf, Ly, Hobart, & Kernic, 2003). Criminal justice responses to IPV have, at times, been regarded as similarly ineffective and even harmful. For example, while domestic violence prosecution policies (e.g., no drop policy) take into account offender accountability in the short-term, the victim is not protected from abuse in the long-term (Epstein, Bell, & Goodman, 2003). Poor access to existing services, due to class or cultural barriers, also contributes to some women s reluctance to seek help. For immigrant women, for example, low social class and economic and cultural isolation often inhibit their efforts to seek help. Having lost social status and power, access to financial resources, and the support of extended family and friends who have been left behind in countries of origin, immigrant women may be financially and emotionally dependent on their partners, and thus unable to escape from abusive situations even to ask for help. Moreover, because of language barriers and lack of education, immigrant women may not be aware of and have trouble communicating with available support services (Huisman, 1996; Rasche, 1988). Similarly, problems in accessing help for domestic violence are evident in rural communities where individuals of various backgrounds cope with poverty, high unemployment, and substandard housing, and are often isolated from shelters, public health, medical, and mental health services (Krishnan, Hilbert, & VanLeeuwen, 2001). Even when services are effective, abused women must also consider potential costs of seeking help that arise from their making the situation public, including the loss of privacy, stigmatization, and threats on their lives made by abusive partners (Fleury, Sullivan, Bybee, & Davidson, 1998; Goodkind et al., 2003; Lempert, 1997). Indeed, almost 90% of abused women in one study reported reasons for not calling the police, such as shame, embarrassment, and not wanting people to know ; 26% feared for their physical safety or the physical safety of their children (Fleury et al., 1998). Bui s (2003) study of abused Vietnamese American women highlights the complex interactions among interpersonal and sociocultural factors, as they influence women s decisions to seek help for IPV. Bui interviewed women from four different Vietnamese communities located in different regions of the United States and found that women were less likely to seek help in areas lacking services in the Vietnamese language. Also less likely to seek help from mainstream agencies were women who perceived the local police as treating their abusive partners unfairly due to racial prejudice. Within the Vietnamese community, Amerasians and women whose partners were from other racial or ethnic groups tended not to seek help from other Vietnamese individuals. Thus, understanding why women do or do not choose to seek help from mainstream agencies necessitates that we consider the availability, quality, and cultural competence of these services, as well as women s previous experiences with them. An example of how sociocultural factors shape women s decisions around help-seeking is provided in the following vignette. Rezia is a 32-year-old married woman who was born and raised in Bangladesh in an upper/middleclass home and moved to the United Sates after she was married. She spoke English fluently and felt a strong sense of pride about coming from an educated family. After 4 years in the marriage, her husband began to abuse her physically. Her 4-year-old daughter witnessed arguments between Rezia and her husband, and Rezia made several attempts to protect her daughter from witnessing the physical violence. Rezia confided in her parents and her in-laws that she was being hit, sometimes severely, by her husband. Her parents encouraged her to leave the marriage, but were unable to help her directly as they lived in Bangladesh. Her in-laws, who lived in the United States, told her that she should stay married, and that this type of behavior was typical of most marriages in their extended family. As Rezia s concerns about her daughter s emotional well-being increased over time. She grappled with her sense of failure in the marriage, and at the same time, wanted to secure her safety. In desperation, she decided to seek help from a shelter that served Asian American women. After several months of meeting with a counselor at the shelter, she decided to move to the shelter with her daughter. On the third day of her stay at the shelter, however, she decided to return to living with her husband. She later sought psychotherapy to help cope with her depressed mood and anxiety related to the ongoing abuse. When asked about her decision to leave the shelter, she stated, I was hoping that going to an Asian shelter would be a good thing, but it was really meant for Cantonese and Vietnamese women. They served pork for meals, and I just couldn t handle it. I didn t want my daughter to eat pork. Rezia s decision to leave was at least partly
9 Help-Seeking and IPV 79 due to her desire to preserve her religious tradition as a Muslim woman, and the absence of services attuned to these specific needs. Moreover, she admitted feeling shame at the prospect of living in a shelter, having previously come from a position of means as an upper/middle class woman in Bangladesh. The case of Rezia illustrates some important aspects of help-seeking among women who face competing needs in establishing safety. That is, many immigrant women have similar concerns with protecting their personal relationships, and their cultural belief systems both of which are critical in the process of establishing safety in their lives. Moreover, Rezia s case also highlights the scarcity of resources that are culturally appropriate and sensitive to immigrant and ethnic minority women. Finally, the relevance of class is noted as shifts in socioeconomic status following immigration can have lasting impact on the individual s sense of competence and well-being. Selection of a Help Provider Selecting a help provider involves identifying a source of support, either informal or formal, after having recognized a problem and deciding to seek help. Although finding help would seem to follow these first two steps, the decision-making process is seldom straightforward or linear. The process of choosing a source of support may evoke multiple, interacting cognitive and affective processes, and be influenced by individual, interpersonal, and sociocultural factors. Indeed, research suggests that social support will function as a stress buffer only if the type of support that is provided matches the abuse survivor s particular coping needs and situation (Cohen & McKay, 1984; Cohen, Underwood, & Gottleib, 2000). Further, battered women may even avoid or subvert help that fails to acknowledge the realities specific to their lives (Baker, 1997). It is therefore not surprising that there is a great deal of variability in battered women s choice of helper. Individual Influences on Choosing Source of Support for IPV A woman s appraisal of her abuse situation may lead her to define her situation as a personal psychological problem for which she needs emotional comfort from a trusted friend; one that necessitates counsel from a therapist; a spiritual battle for which she needs counsel from a religious leader; or a crime for which she needs legal intervention. The type of support a woman chooses will also be influenced by her coping and relational styles, as well as by her cost benefit analysis of the situation. The general literature on coping suggests that individuals with problem-focused coping styles seek solutions that actively manage specific problems; whereas, those with emotion-focused styles seek solutions that help regulate their internal distress (Lazarus & Folkman, 1984). Thus, women with problem-focused coping styles may be more likely to manage their situation by choosing a legal intervention or escaping to the homes of family or friends. Likewise, women with emotion-focused coping styles may seek out social support (e.g., friend, therapist, or religious leader) in order to obtain help regulating their distress (Goodman et al., 2003). An individual s relational style may also influence whom she approaches for help. In Rose et al. s study (2000), whether a battered woman viewed friends as sources of support was related to whether she perceived herself as comfortable with others and worthy of help. A woman s weighing of the costs and benefits of seeking help may also influence the source of help she chooses. The literature on help-seeking offers a cognitive framework called the Health Belief Model that stresses this cost benefit analysis (Broadhurst, 2003; Tucker, 1995). Battered women s decisions regarding which informal or formal support source to approach may be determined by this cognitive weighing of the relative benefits and costs of each potential source of support, as well as the ways in which they define and cope with the problem. Thus, when deciding whether to seek formal support, a battered woman may consider the relative costs of loss of privacy and stigmatization in seeking informal sources versus the costs of a loss of control and the unsolicited removal of the abusive partner from the home. For some, the potential consequences of handing over control to the police or other formal services may seem particularly costly given their immigrant status, compromised psychological and economic resources, or other sources of disempowerment. On the other hand in the case of severe violence, if friends and family fail to protect her from the abuser, a woman may decide that the life and death costs of remaining silent or relying solely on informal supports may exceed the risks of seeking formal support.
10 80 Liang, Goodman, Tummala-Narra, and Weintraub Interpersonal Influences on Choosing Source of Support This cognitive process of cost benefit analysis is inevitably influenced by the survivor s interpersonal interactions and relationships. For example, Rose et al. s (2000) qualitative interviews with IPV victims revealed that few women spoke with their parents about their abusive situations. Indeed, over a third of the women had either witnessed or were aware of their mothers being abused and thus viewed their mothers problems or dependency needs to be greater than their own. Further, none of the women identified their fathers as someone with whom they could speak about the abuse, and instead described them as cold, distant, stormy, and in extreme cases, as perpetrators of abuse in the family. Instead, girlfriends were most often identified as a source of emotional support and as most helpful. In turn, the level of supportiveness and availability of friends and family may influence a woman s ability or willingness to seek and use formal support. Women seeking help from the justice system, for example, face a court process that is inevitably draining, at the very least, as it forces women to tell their stories numerous times, participate in numerous proceedings, face their batterers repeatedly, and expose themselves to the public eye (Bennett et al., 1999; Epstein et al., 2003). During the course of their participation in the justice system, battered women may have to make decisions that will trigger enormous life changes, such as whether to leave their batterer, whether to request jail time for the batterer, or how to handle visitation arrangements. They may have to find babysitting for their children each time they come to court, pay for complicated transportation arrangements, and miss numerous days of work. Given the challenges involved in seeking this and other kinds of formal support, it seems likely that only women with sufficient support from family and friends would be emotionally and materially prepared to go forward. Indeed, one recent study found that for low-income victims seeking help from a major urban criminal justice system, the extent of tangible support from family and friends was a major predictor of their likelihood of following through with the prosecution of their abusive partners (Goodman, Bennett, & Dutton, 1999). Other research findings have similarly shown that the greater their access to informal social support, the greater number of helpseeking efforts battered women are likely to engage in (Mitchell & Hodson, 1983). It seems, then, that the presence of informal support increases women s likelihood of acting to end the violence by accessing formal sources of support. Sociocultural Influences on Choosing Source of Support In addition to interpersonal factors, the process of choosing a help provider is also influenced by sociocultural context, as is evidenced by the varying patterns of help-seeking within and across different ethnic groups. For example, in a comparative study of help-seeking among South Asian, African American, and Hispanic battered women; Yoshioka, Gilbert, El-Bassel, and Baig-Amin (2003) found that although most of the women in each group sought help from their family network, nearly half of the African American and Hispanic women in the study sought help from a counselor, the police, or a lawyer; but only a quarter of the South Asian women sought help from these professionals. Moreover, fewer south Asian women were encouraged by family members to leave their partners. The differences in help-seeking behaviors among these groups might be related to cultural differences in gender roles and notions of patriarchy. Indeed, relatively extreme manifestations of patriarchy such as honor killings and dowry death are prevalent in south Asia (Johnson & Johnson, 2001), and research has shown that women with strong patriarchal beliefs are less likely to approve of seeking help from formal sources and more likely to consider wife abuse a matter to be dealt with inside the family (Ahmad, Riaz, Barata, & Stewart, 2004). Feedback Loops Between Help-Seeking Stages While considering the interplay among the various individual, interpersonal, and sociocultural factors that affect help-seeking behavior among battered women, it is worth noting that the ways in which women define IPV and seek help for IPV mutually influence each other. Women whose definitions more closely match mainstream conceptualizations of IPV may more readily seek help from informal and formal supports. Conversely, even when individual construals of IPV closely match mainstream definitions, either negative or positive experiences with formal and informal support seeking may determine how a woman modifies her definition
11 Help-Seeking and IPV 81 of IPV and what she decides to do about it (e.g., whether to seek additional help or not). For instance, a woman may choose to disclose her abuse to a trusted clergy member who may, in turn, advise her to remain in the abusive relationship. In this case, help-seeking confirms and reifies the woman s beliefs that abuse should be tolerated and that she is obligated to stay married to her abusive partner. IMPLICATIONS FOR RESEARCH AND PRACTICE By applying a theoretical framework for helpseeking to IPV survivors, we have attempted to describe the influences on women s decision-making at each stage of help-seeking (problem definition, deciding to seek help, and choosing help). In the next section, we utilize this framework to make a series of recommendations for research and practice. Recommendations Related to Problem Definition and Appraisal Research With regard to problem definition, we must attempt to understand battered women s experiences from their own perspectives, using samples that include help-seekers and non-help-seekers in research samples. Studies that rely only on help-seekers or service users experiences will not adequately represent many other women s experiences, in that problem definition is influenced by contact and interaction with support sources (Pilgrim & Rogers, 1997). Also, we must continue to conduct qualitative studies to explore the process through which IPV survivors appraise and arrive at definitions for their abusive situations. Such studies may explore process of definition in varying states of readiness for change (i.e., pre-contemplation, contemplation, and preparation states). core problem in their family, helpers might attend to parenting challenges that are related to the abuse. We also encourage helpers to view the experience of domestic violence not as a unitary construct, but as a complex phenomenon that is subjectively experienced by each woman and thus affected by distinct histories and values. For example, for some women, IPV may be an out and out violation of the self, with the only possible outcome being separation and punishment of the abuser. For other women, IPV may be perceived as the result of stress caused by poverty, and thus the idea of leaving their partners may be unthinkable and further cause for stress (and continued abuse). Decision to Seek Help Research Future studies should evaluate the concept of negative support among battered women. For example, friends and family may inhibit a woman from leaving or accessing formal support resources. A woman may choose not to seek help due to the financial support offered by the abuser himself. Or a woman may choose not to seek help from the justice system following an assault, because she is unsure whether the batterer will be jailed, and therefore fears retaliation. In any case, the provision of support and the process of help-seeking should not be assumed a universally positive experience, as it can be a source of danger, conflict, rejection, and criticism. Practice For all these reasons, it is important that helpers refrain from judging battered women for refusing to seek formal help. Indeed, in some cases such refusals are informed, rational decisions. Thus, helpers should be encouraged to understand women s decisions and help-seeking behavior within the context of their ongoing struggle to free themselves from harm. Practice It is also important that potential helpers both informal and formal work with abused women to address the problem as these women define it, rather than as the helpers define it. For instance, with Haitian women who do not regard the abuse as the Selection of Type of Support Research Research related to the selection of type of support among IPV survivors should address both the pattern of help-seeking from formal and informal
12 82 Liang, Goodman, Tummala-Narra, and Weintraub supports, as well as the impact on women s lives of seeking these supports. It is critical that we understand the complex decision-making process around choosing a particular form of help and its success in helping women cope with IPV in order to make conclusions about the relevance of different types of support in women s lives. Practice There is a need for more woman-defined rather than service-defined support services that are more flexible and adaptive in both meeting women s real needs and expanding the range of choices for women seeking support (Davies, Lyons, & Monti-Catania, 1998). For example, because most battered women who seek help do so through informal sources, it would be helpful if information related to IPV, its emotional and physical consequences, and access to formal supports were disseminated to community groups, religious institutions, adult education programs, and self-help groups. Alternatively, a trusted, credible help provider may bridge the gap between informal and formal forms of support by serving as a personal advocate or mentor for a battered woman as she navigates formal services, such as the criminal justice system or battered women s shelters. It is also important that women-defined support services focus on battered women s long-term social support needs, rather than merely crisisoriented needs. Moreover, because women s needs may evolve over time, the type of support provided should be timed appropriately. For example, some battered women may first need tangible support and crisis intervention such as a place to stay, help with federal benefits, and information about options with the court system, such as no drop policy and possibility of deferring prosecution. This concrete support may be necessary before women are in the position to seek counseling, legal intervention, or other types of formal help that will enable them to change the abusive relationship. In any case, it is critical that all types of help-providers, including those in mental health care, the legal system, and victim advocacy, receive cultural competence training in order to enhance the fit and efficacy of their interventions. CONCLUSION In sum, we have presented a conceptual framework for examining the processes of help-seeking among diverse survivors of intimate partner violence. This framework involves three processes or stages of seeking help in the IPV context (defining the problem, deciding to seek help, and selecting a source of support). Analysis of this framework is useful in highlighting various implications for IPV research and practice. 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5 198 I The Johns Hopkins and the International Federation of Red Cross and Red Crescent Societies Emergency mental health and Visit to flood affected north Bangladesh Jigamarighat chor (chor is a small
THE CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES Training Guide No. 19 Professional Training Series The Convention on the Rights of Persons with Disabilities Training Guide Professional Training
At risk, yet dismissed The criminal victimisation of people with mental health problems Bridget Pettitt Sian Greenhead Hind Khalifeh Vari Drennan Tina Hart Jo Hogg Rohan Borschmann Emma Mamo Paul Moran
Improving mental health support for refugee communities an advocacy approach Mind s mission The activities detailed in this report were part of Mind s Refugee and asylum-seeker advocacy project which was
WORKING WITH ETHICAL SYMMETRY IN SOCIAL RESEARCH WITH CHILDREN PIA CHRISTENSEN National Institute of Public Health ALAN PROUT University of Stirling Key words: childhood, children, ethics, methodology,
ARC resource pack Study material Foundation module 7 Psychosocial support http://www.arc online.org Page 1 of 47 Contents Introduction 7 Definitions of terms 7 Section 1 What is psychosocial support and