Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Introduction and Assessing
Pre-Somatoform Risk Behaviors

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Introduction
Welcome to the Home Study Course sponsored by the Healthcare Training Institute. This course is entitled,
"Interventions for Leaving the Violent Relationship."

Our primary intent for this home study course is to provide quality education to foster your professional growth. The Institute has provided quality education since 1979.

Hi. My name is Catherine Appleton. I will be the narrator of this CD set. We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding how to treat patients, clients, etc. dealing with battered women. As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting. However, these notes are for your purposes only and are not to be sent to the Institute. Also each track is very content dense. So feel free to replay the track to review the content.

At the end of each CD track, a question will be asked. The question at the end of each track corresponds with the questions in your Answer Booklet. Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions. They are merely intended to verify the playing of this CD set.

Each of the questions that are included on this CD set is also reprinted in your Answer Booklet. These questions are sequential and deal with the section of content that preceded it. For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track. By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer. So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a "heads up" to listen for the content that contains the answer to the next question.

For the purpose of brevity, most generally, I will use the term "therapist" or "mental health professional." However, don't let these terms deter you from applying the concepts to your situation. When you hear the word "therapist," if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don't let my use of the term "therapist" cognitively set you off track from hearing the content because your job title is school counselor, for example. I will also use the term "client" for the purposes of brevity. However, if you deal with patients, residents, students, consumers, etc., transpose "client" for the term that is the most meaningful to you in your work setting.

Regarding pronouns and gender brevity, I am in full agreement that women can be just as powerful, controlling, and manipulative as men in relationships. And it goes without saying that this dynamic can happen in same sex relationships as well. However, for the purposes of brevity in this CD set we will mainly deal with women who are battered by men.

This CD set will be discussing the following therapeutic issues regarding interventions for leaving the violent relationship: assessing pre-somatoform risk behaviors, role of the irresponsible child, psychological control vs. leaving; mental diagnosis, physical handicap, and leaving; the double bind; Tonia's anger letter; feeling sorry for their batterer; survival until she leaves; hurdling road blocks to leaving; leaving addictive love; life preservers; emotional getaways; and hidden fears. It is hoped you have found several tracks that you will replay often pior to seeing a client with similar issues, and perhaps playing a track in an individual or group session for client educational purposes should you deem appropriate and beneficial.

Now let's get started.

In the remainder of this track we will be discussing unexplained physical symptoms that battered women often report experiencing.

Somatoform Disorder
Have you found, like I, that many battered women will report various physical ailments ranging from high blood pressure, to asthmatic attacks, to skin irritations, all of which are non-related to the abuse she is experiencing? This may occur in conjunction with thoughts of leaving or be a causative factor in making the decision to leave. Do these symptoms sound like possible forms of a Somatoform Disorder to you? As you know, Somatoform Disorders are characterized by isolated and unexplained physical symptoms that seem to have no physiological cause.

Here is how I worked through a possible Somatoform Disorder with Jessica. Jessica, a 22-year-old student in her final year of college, first came to me with a stutter she had been experiencing for two days. In her Tuesday Women's Issues class, each student had to speak on the topic of sexual molestation. Jessica stated, "When it was my turn to talk, I had such a pr-pr-pro-pro-difficult time talking I had to give up." It appeared Jessica had substituted the word difficult for the word problem to stop the stuttering. In addition to the onset of her stuttering, Jessica had also been suffering from severe stomach aches for several months. After several trips to the hospital, MRIs and extensive tests Jessica was told there was nothing physically wrong with her.

I felt Jessica's stuttering may have had an antecedent of abuse. As you know, for many battered women, these physical problems occur automatically on a physiological level without any trace of consciousness. In fact, it is almost impossible for these women to connect their physical symptoms with their emotions about their abuse. As with Jessica, the origin of the physical symptoms was thoroughly masked in her subconscious.

With clients like Jessica, I like to use a Three-step Contextualization Method to help reveal the causes of her unexplained symptoms.
Step #1. For me, as is the case probably for you, the first step is to look at the battered woman's symptoms contextually. Jessica stated, "About two months ago my boyfriend Eric and I started to a-a-argue a lot, and he got r-r-r-really mean."

Step #2. Once I became aware of the context of the problem, is your second step, like mine, to connect the problem with the events that took place at the time the symptoms began? Jessica stated, "The first stomach ache was awful…I think it happened right after a really bad night with Eric. He wanted to ha-ha-have s-sex, but we were going to bed and I was really tired and said no. I woke up later that night with him on to-to-top of me in the bed forcing me to have sex with him."

Step #3. As you know, once the battered woman has connected her symptoms with the events, she can begin developing coping strategies to overcome the symptoms.

Why is it some battered clients develop a Somatoform Disorder and others do not? What are the Risk Factors that may predispose a client of yours to this disorder? Let's look at six of these Risk Factors.

Pre-Somatoform Risk Behavior #1 is Compartmentalization. Many aspects of the battered woman's life might be kept apart from other aspects. This may have caused Jessica to appear as two separate people at school and with Eric. As you know, battered women are often well-adjusted at work, but meek and passive at home with their abuser to avoid attack. Does your battered client wear two faces, so to speak?
Pre-Somatoform Risk Behavior #2 is Repression. A Battered woman may remove her own thoughts and feelings from her consciousness. In our sessions, Jessica stated that she rarely felt angry or scared, even though she had plenty to be angry about. Does your client repress her negative feelings?
Pre-Somatoform Risk Behavior #3 is Deadening. Battered women often force themselves to become less active. With Jessica, she stopped attending the weekly Intramural basketball games in which she usually played. To what extent is your battered client deadening herself by eliminating joyful or fulfilling experiences?
Pre-Somatoform Risk Behavior #4 is Resigning. In addition to compartmentalization, repression, and deadening, to what extent does your client withdraw from daily life? Jessica found that she had begun to lay in bed as soon as her classes were over for the day instead of studying or being with friends.
Pre-Somatoform Risk Behavior #5 is Projection. Jessica believed she wasn't good enough, so she attached herself to Eric, who treated her as though she wasn't good enough. How does a current client you are treating project her feelings onto others?
Pre-Somatoform Risk Behavior #6 is Externalization. Jessica externalized in that she felt her life and value as a person were in the hands of other people. If the people around Jessica accepted her for that moment, she felt good about herself. However, if they rejected her, she felt destroyed.

Have you overlooked Somatoform regarding your battered client who is contemplating leaving. If so, you might replay this track to rethink the risk factors of compartmentalization -- repression, deadening, resigning, projection, and externalization -- to set therapy goals for your next session that may assist them in weighing and measuring leaving.

These risk behavior can be exacerbated by the battered woman assuming the role of the Irresponsible Child where she seeks comfort by being treated as the underdog. This Underdog syndrome will be discussed on the next track.

QUESTION 1
What are six Pre-Somatoform Risk Behaviors battered women may display? To select and enter your answer go to Answer Booklet.