Treading Dangerous Waters:
Intervening In Elder Domestic
Violence Cases
2012 IL Elder Rights Conference
Holly Ramsey-Klawsnik, Ph.D.
© Ramsey-Klawsnik 2012
All Rights Reserved
Agenda
 Common dynamics in Elder DV
 Community and facility illustrative cases
 Strategies for assisting victims
 Pitfalls to avoid
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The Many Potential Pitfalls
 68 y.o. Mrs. S., psychiatric disability,
mentioned marital problems to MD
 MD inquired re: details
 Long-term DV disclosed
 MD reported & provided expert opinion
to APS, hospitalized Mrs. S.
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Mrs. S. con’t
 As the case unfolded…
 There are many junctures at which a
case can be mishandled to the
detriment of the victim
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Common Dynamics in LL IPV
 Often long-term abuse
 May be mutual attachment, dependency
 Complex victim feelings
 Abuser feels entitled to bully, control, use
 Danger often high
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Socio-Cultural Factors
 Social, cultural, gender, legal realities
during formative years of today’s elders
 Very much affect older victims of today
 Must be considered when attempting
investigation or intervention
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Child & Grandchild Perpetrators
 Assault by offspring often causes
powerful ambivalence
 Fear of perp arrest & other harm,
shame, responsibility for kin’s wrong,
attachment
 Feelings complicate trauma response
and help-seeking
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Video Clip
 Mother abused by adult son
 From “A Mother Never Gives Up Hope”
by Terra Nova & NCALL
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Elder DV in Facilities
 May occur in facilities during visits
 May occur during outings
 Staff may hear disclosure, witness
assault or evidence
 Facility response & responsibilities
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Case: DV Signs Noticed
 Woman with aphasia & paralysis
evidences fear of leaving w/ spouse
 Facility response
 APS response
 Family response
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Case: DV Signs Observed
 Upon return from outings aides
repeatedly observe abuse evidence
 Facility response
 APS response
 Family response
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Helpful Response
 Build rapport
 Listen carefully
 Offer safety options
 Help victim consider options
 Encourage use of effective strategies
 Support victim’s choices
 Follow legal mandates
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Strategies for Victim Assistance
 Active listening
 Crisis-intervention counseling
 Problem-solving counseling
 Referrals to other agencies, including
criminal justice
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Active Listening
 Client feels heard & understood
 Critical in all helping relationships
 Foundation of all counseling skills
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Active Listening
Listen respectfully, completely to understand message
Watch non-verbal behavior to better understand
Demonstrate sincere interest client
Avoid placing attention elsewhere
Provide minimal encouragements to continue
Repeat key words
Ask questions after client’s presentation
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Case: Failure to Listen
 Betty, 76 y.o., stroke, son lives with her
 Son highly problematic, evidence of FE
 APS worker offers money manager
 Betty refuses
 Worker documents: Betty wants son to
continue handling finances
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Crisis Intervention
Crisis - crucial situation, causes disequilibrium
Short-term intervention to help settle crisis
Goal - help client return to pre-crisis state
NOT solve long-term problems
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Crisis Symptoms
 Strong, fluctuating emotions
 Inability to function normally: think, eat, sleep
 Overwhelming fear, worry, anxiety
 Reduced problem-solving ability
 Acting on impulse, poor decision-making
 Inability to see a solution
 Belief that things will never be normal
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Steps in Crisis Reduction
 Encourage venting
 Avoid joining crisis mind set
 Actively listen
 Focus on client’s reactions, thoughts, feelings
 Provide emotional support
 Validate
 Normalize feelings and reactions
 Gently correct cognitive distortions
 Reframe to help see positives
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Steps con’t
 Provide info re: options, resources
 Help mobilize resources
 Use problem-solving counseling
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Problem-Solving
 Analyze problems with client
 Help explore options for resolution
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Determine
 Nature & scope of problem
 Steps already taken & outcome
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Explore Options
Encourage client to suggest & consider options
Provide info re: options, resources
Anticipate likely & possible consequences
Empower client to make informed choices
Provide support while client implements
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Dynamics
 Victimization » helplessness,hopelessness
 Avoid joining client in these feelings
 Model optimistic but realistic attitude
 With support people explore options,
become hopeful
 Improved outlook » energy & confidence
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Respect Self-Determination
• Avoid telling clients what to do
• People more likely to implement own choices
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Assisting Mr. R.
 APS report - 82 yo Jose Rodriquez
 Clinic filed: rectal bleeding, anal tears,
DV disclosure
 Investigation revealed…
 Mr. R’s ambivalent feelings
 Intervention provided
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Tearing Down Strengths
 Critical to avoid tearing down victim’s
strengths and defenses
 Must be able to recognize the +
 Build on these
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Case: Sibling Violence
 Elderly, ill sisters reported to APS
 Mutual physical violence
 Both treated at hospital repeatedly
 Police involved & reported
 Mutual strong attachment
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Intervention Missed the Mark
 Broke down resolve to improve
 Worker failed to grasp clinical dynamics
 Did not use problem-solving strategies
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Pitfalls to Avoid
 Victim-blaming
 Colluding with perpetrator
 Expecting too much change too quickly
 Telling victim how to solve problems
 Tearing down strengths and defenses
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Our Language Matters
 “We work with people who have family
problems”
 Better…
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Do No Harm
 Home visit to inv PA & EA by husband
of wife with Parkinson’s Disease
 Investigator observes…
 Investigator remarks…
 Harm to victim and to case
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Summary
 Worker behavior, statements,
attempted interventions carry much
potential to significantly help or harm
older DV victims
 Importance of professional training, selfreflection and quality supervision
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