Responding to Family Violence by Murray Christine E.;Graves Kelly N.;Graves Kelly N.; & Kelly N. Graves

Author:Murray, Christine E.;Graves, Kelly N.;Graves, Kelly N.; & Kelly N. Graves [Christine E. Murray]
Language: eng
Format: epub
ISBN: 1181045
Publisher: Taylor & Francis Group

Assessment Considerations

As Horton and Cruise (1997) wrote, “Knowing that an individual has been abused is only the beginning of clinical evaluation” (p. 96). This statement illustrates the importance and complexity of conducting a comprehensive clinical assessment with adult survivors. Treatment should be tailored to unique client needs (Morrison & Ferris, 2002), and a comprehensive assessment can help identify these needs. Three recommendations for assessment with survivors include viewing the assessment as an ongoing process, being sensitive to clients’ discussion of maltreatment experiences, and assessing a broad range of potentially related factors.

The Assessment Process. Assessment should begin early and continue throughout therapy (McGregor, Thomas, & Read, 2006). Therapists should maintain a stance of professionalism, respect, and support throughout the process (Bernstein, 2000). In particular, ongoing attention should be paid to safety (Connor & Higgins, 2008b) to ensure that any new risks are addressed. Also, symptoms should be monitored throughout treatment, especially as new phases of treatment begin, to ensure that clients do not become overwhelmed by them (Horton & Cruise, 1997). Clients’ needs are likely to change as therapy progresses, so ongoing assessment will help the therapist stay alert to changes that may impact the therapy process.

Assessment of the Maltreatment. Maltreatment-specific areas to assess include how clients describe the abuse, the impact of the abuse on clients’ current and past functioning, and coping resources (Bernstein, 2000; Higgins Kessler, Nelson, Jurich, & White, 2004). Disclosing abuse histories can be very diffi cult (Farmer, Khurgin-Bott, & Feldman, 2009; Follette et al., 2010), and clients may take time before they are able to fully disclose their experiences (Lock, Lewis, & Rourke, 2005; McGregor et al., 2006). A variety of factors can contribute to clients’ discomfort in disclosing their abuse histories. These include shame, guilt, avoidance, fear of being disbelieved, and feeling unsafe with their therapists (Follette et al., 2010; Lock et al., 2005). It is not necessary for clients to reveal every single detail of their abuse experiences in order for them to make progress in therapy, so therapists should help their clients discover the best balance of disclosure and privacy (Farmer et al., 2009). Bernstein (2000) suggests that therapists avoid using direct language as “abuse” and “victim,” which may decrease a client’s willingness to disclose. Rather, therapists can inquire about abuse experiences with questions such as “When you were growing up, did anyone ever tough you in a sexual way or make you touch them?” or “When you were a child or teenager, did anyone ever hit you or beat you?” (Bernstein, 2000, pp. 27-28).

Many therapists rely solely on their clients’ self-reported information to assess for childhood maltreatment histories (Lock et al., 2005). In addition, self-report instruments may be used to supplement the assessment. For example, see Hulme (2004) for a review of instruments related to childhood sexual abuse, although the primary focus of Hulme’s review is instruments used for research, not clinical purposes. However, there are some common measurement problems in these instruments, so they should be combined with other assessment strategies (Hulme, 2004).

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