7.1 GENDER—BASED VIOLENCE

GENDER—BASED VIOLENCE

GENDER—BASED VIOLENCE → FOUR TYPES

• Psychological

• Physical

• Sexual

• Economic

Psychological

• Control, humiliation, isolation, intimidation, & undermining.

• Often the earliest & least recognised form

Economic

• controlling money, work or access to resources

Gender-based violence is 

• Violence directed against women because they are women, or that affects women disproportionately.

• It is rooted in gender inequality & unequal power relations & may involve physical, psychological, sexual, or other forms of harm.

Psychological violence is often

• present from the beginning & is the form least likely to be named as violence.

GENDER—BASED VIOLENCE → what is does?

• Fatal consequences

• Non-fatal consequences

• Psychological impact

Fatal consequences

• homicide & suicide

Non-fatal consequences

• physical injury

• genitourinary & pregnancy-related problems

• risk behaviours

• mental health difficulties & effects on children.

Psychological impact

• Aggravation of existing difficulties

• Cognitive & relational disturbance

• Depression: hopelessness, low self-esteem, guilt, loss of future perspective, & suicide risk

• Post-traumatic stress disorder

A woman experiencing violence is one of the 

• highest risk groups you will assess

• psychological consequences & the risk of crisis are closely connected.

The cycle of gender based violence

• Tension building → incident → reconciliation → calm → tension building

The cycle helps explain two things that a list of symptoms cannot

• Why the relationship can also contain good periods, making it possible to stay & difficult to leave.

• Why asking “Why does she stay?”misses the complexity of the situation & the dynamics of abuse.

Several factors can make leaving difficult

• Traditional gender-role beliefs

• Normalisation of violence within the family

• Economic dependence & lack of social support

• The dynamics and cycle of abuse

• Attributions about the cause of the abuse

• Commitment and self-responsibility for ending the violence

• The myth of romantic love

• Chronic traumatisation & reduced coping skills

• Fear of harassment and retaliation

Fear of retaliation is not a belief to be challenged

• It is a safety issue

• The period around separation can be one of the most dangerous.

What you would notice, when nobody says the word

• Most people do not arrive saying they are being abused.

• They may present with anxiety, insomnia, depression, somatic complaints, or difficulties involving their children.

Pay attention to what they say

• Describes the relationship through what she does wrong or what triggers him

• Follows unexplained rules about where she goes, who she sees, or when she returns

• Minimises: “He’s not normaly like that”, “I provoked him”, “It was only once”

• Increasing isolation from friends or family

• Financial restrictions or having given up work

• Checking her phone or needing to justify the appointment

How a woman says it

• Vagueness around one particular topic

• Fear responses that do not fit the content

• Watching the door or the clock

what happens within the therapist

• the urge to tell her what to do

The goal in gender based violence

• The goal is not to diagnose

• It is to notice enough to ask one careful question → & to be someone she could tell

Intervening when she is not ready to leave

• she may be ambivalent, not “in denial → principles of motivational interviewing becomes important

What does not help in an interview

• Telling her to leave: the righting reflex can increase resistance & make you another person telling her what to do.

• Decisional balance: do not force a four-box exercise when safety & ambivalence are central.

• Making continued therapy conditional on leaving.

what helps in an interview (gender violence)

• Evoke her own reasons: “What would you like to be different?”

• Affirm her efforts: coming to therapy already required something from her.

• Use the ruler: “How important is it that something changes, 0–10?”→ “Why that number &

• not lower?”

• Give information without instructions: provide resources and information about rights &

• options.

• Keep the door open: continuing to attend means she has a place where the situation is known

• & can be revisited.

• The measure of a session is not whether she left. It is whether she feels able to come back.

Intervening when she is not ready to leave

• opportunity

• goals

• evaluation

• a safety plan is not a plan to leave

• make it with her &v in her own words

Opportunity

• Provide immediate, accessible, & safe support when risk is high.

Goals

• Help her get through the immediate crisis & begin identifying ways forward.

Evaluation

• Assess risks, coping resources, strengths, vulnerabilities, & available support.

• The BASIC profile can help organise this assessment.

A safety plan is not a plan to leave → It is a plan for what to do if the situation escalates

• Where she could go & how she would get there

• Who she would contact & an agreed code word/message

• Documents, money, & keys kept somewhere accessible

• What to do if violence occurs when the children are present

• What has worked in previous situations

Make it with her & in her own words.

• A safety plan only works if it is realistic & usable for her.

BREAKING BAD NEWS → Before the protocol: six questions

• What is bad news, for you?

• If you had to deliver bad news to a patient, what do you think would be the most difficult part for you?

• Have you ever received bad news, you or someone close to you? How was it given to you? How did you live it? Did the way it was communicated influence your reaction?

• Do you think a patient has the right to be informed, even when the news is bad?

• Do you think all patients want to have all the information?

• Imagine you are the psychologist in an emergency service & you are asked to inform a family that a patient has just died. How would you do it?

• Keep your answer to the last one. We will come back to it after the protocol.

A six-step protocol for delivering bad news: SPIKES

• Setting

• Perception

• Invitation

• Knowledge

• Emotions

• Strategy & summary

S —Setting 

• Arrange privacy

• Involve the people they want present

• Sit down

• Make contact before you speak

• Manage time & interruptions

P —Perception

• Find out what they already know or suspect, before you say anything.

• Listen for their level of understanding

• Accept denial; do not confront it here

I —Invitation 

• Ask how much they want to know, & in what detail

• Accept their right not to know.

K —Knowledge 

• Give a warning shot

• Then plain language, small pieces, no jargon, pauses to check

• Do not say "there is nothing more we can do."

E —Emotions 

• Observe the emotion

• Name it to yourself

• Identify what it is a response to

• Then say something that connects the two

S —Strategy & summary

• A plan for what happens next, made with them

• Summarise

• Check what they took away.

The part everyone fears the most when breaking news

• emotions

Observe the emotion

• tears

• silence

• a change in facial expression

• looking down

• shock or withdrawal

Do not assume → check what is happening

• If the person looks upset but says nothing, gently invite them to share:

  • “I noticed you became quiet just now. What is going through your mind?”

  • “I can see this is difficult. What are you feeling right now?”

 Identify what the emotion is responding to

• if you are unsure, ask:

  • “What is the most difficult part of what I’ve just told you?”

  • “What does this news mean for you?”

Give them time

• Do not rush to fill the silence. Once they have had space, acknowledge what you see

  • “I can see this isn’t what you were hoping to hear.”

  • “I can see how painful this is for you.”

  • “It sounds like this has come as a real shock.”

And what not to do → when breaking bad news

• Do not talk just to fill the silence.

• Do not reassure before they have had a chance to react:

  • “Don’t worry, everything will be fine.”

• Do not minimise or immediately look for a positive:

  • “At least we caught it early.”

• Do not move straight to solutions while the emotion is still arriving:

  • “OK, so let’s talk about what we’re going to do next.”