Sue Penna Associates

Recovering from the psychological impacts of domestic abuse/violence

Good mental health

• Positive attachments as a child• Healthy traumas as a child• Parenting that gives us boundaries and helps

us develop positive self identity and positive core beliefs about ourselves and the world around us

• Stable interpersonal adult relations• Safety and security

Positive mental health

• Feeling in control• Being able to make rational decisions• Being in touch with our feelings• Being able to form positive relationships• Feeling good about ourselves• Knowing how to look after ourselves

• Good mental health and no abuse as adult

• Positive coping strategies

• Good mental health and abuse as adult

• Adaptive coping strategies

• PRE ABUSE• Feeling in control• Being able to form positive

relationships• Feeling good about herself

• Being in touch with her feelings• Knowing how to look after herself• Being able to make rational

decisions

• POST ABUSE• Isolated not in control • Only perspective of abuser not

forming positive relationship• Her inner core beliefs about

herself have almost been ‘abused' out of her not feeling good about herself

• But these core beliefs tell her what is happening is wrong not in touch with her feelings

• BUT she can’t stop it not able to make rationale decisions or knowing to look after herself

Mental health issues including problem substance use are defences against the horror. We are all vulnerable given the right circumstances to develop mental health issues or problem substance useDomestic violence and abuse is the most prevalent cause of depression and other mental health difficulties in women

HousingHealth careEducationUtilitiesImmigrationReligionSocial InteractionsFood

PoliceArmyLawsHousingJobsReproductionClothingRelationship/Marriage

InfiltrateInform

Depression

LieSteal

BullyingSecretive

Sub-groupsEscape

Keep

quiet

It’s normal

Hide

Drugs/AlcoholAnxietySelf-harm

Fight back

Rebel

Collude

Accept

Coping strategies• About safety and risk• About protecting self and others• About maintaining status quo so it doesn't

escalate• About seeing everything from the abusers

perspective (safety)• About taking responsibility for abuse and

therefore any change

Cognitive Dissonance• The feeling of uncomfortable tension when

we hold two conflicting thoughts in our mind at the same time

• Dissonance is strong when we believe something about ourselves and then do something against the belief,

• I am an assertive person, so why can’t I assert myself with my partner?

To release the tension we

• Change our behaviour (have tea ready at a set time)

• Justify our behaviour by changing the conflicting cognition ( having tea ready at a set time isn't a problem for me)

• Justify out behaviour by adding new cognitions (my partner has every right to expect tea at a certain time, they are the breadwinner)

• Cognitive dissonance is central to many forms of persuasion to change beliefs, values attitudes and behaviours

• Used in cults, extreme societies and families where there is domestic abuse

So what happens

• Change in beliefs affects the way we see the world

• Changes positive beliefs about ourselves into negative beliefs

• POSTIVE BELIEFS• RESPONSIBILTY I am a

good/loving person• RESPONSIBILTY I do the best I

can, I can learn

• SAFETY/VULNERABLITY I can choose who to trust

• CONTROL/CHOICE I know have choices

• NEGATIVE BELIEFS• RESPONSIBILTY ‘I AM SOMETHING

WRONG; E.G I am a bad person• RESPONSIBILITY I DID SOMETHING

WRONG E.G I should have known better

• SAFETY/VULNERABLITY E.G I cannot trust anyone

• CONTROL/CHOICE E.G I am powerless

What happens if not addressed

• Develop mental health issues (Inevitable given the horror of the situation)

• Remain vulnerable to further abuse• Use of coping strategies that were vital in

abusive situation but post abuse destructive/unhelpful

• Continue to hold beliefs imposed by perpetrator and so continue to feel bad about self

Post Traumatic Stress Disorder

• Type 1 stressors occur unexpectedly, one time and extend beyond normal everyday stressors that most people experience on a regular basis.

• Type 2 stressors occur on an ongoing basis, the longer the stressor continues the longer the PDST likely to endure

RECOMMENDED

• National Centre for Clinical Excellence (N.I.C.E) recommends

• Trauma focused cognitive behaviour therapy

The Recovery Toolkit• Psycho - educational model - refers to the

education offered to people who live with a psychological disturbance

• A goal is for the patient to understand and be better able to deal with the presented illness. Also, the patient’s own strengths, resources and coping skills are reinforced, in order to avoid relapse and contribute to their own health and wellness on a long-term basis.

Trauma focused CBT

• Provide survivor with skills for dealing with stress in the future

• Alleviate painful emotions through gentle exposure

• Challenge negative self image• Reframe the problematic cognitions that keep

survivor on edge of trauma

Sessions covered over 12 weeks

• What is abuse • Self esteem• Impact on children• Anger and assertiveness• Boundaries and trust• Making mistakes/ setting goals• Healthy relationships

Tools provided• How to recognise and challenge negative

automatic thoughts• Relaxation techniques• Positive affirmations• How to manage anger• Learning assertiveness skills• Education on protective behaviours• Goal setting for the future

• NOCN accredited ‘Developing personnel confidence and self esteem’

• Pre course assessment• Not living with perpetrator• Pre and post group assessments• Homework every week• Need to commit to each session

• Since the course I am now confident, happy and free from abuse. I have taken in all the knowledge of what the women have taught me, this definitely was the course that covered all I need to know. For anyone who has gone through abuse I would recommend this is the course to go on because I am no longer a victim just a happy and grateful survivor.

• "the course has actually changed my life, I know that sounds dramatic but the difference I feel is dramatic. I had a down period a few months ago and instead of going deeper into depression I was able to use the tools that I learnt on the course and I could work out for myself the early warning signs and the triggers which helped me to feel better and I got through the depression a lot quicker, I also now feel that because I did this once next time I feel like this I know I will be able to help myself rather than relying on professionals. So the course really has changed my life I feel that I am actually in a new chapter and am starting to get brave and build my confidence more."

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