IPT Book Reviews

Title: Violence Hits Home: Comprehensive Treatment Approaches to Domestic Violence  Neutral Review
Authors: Sandra M. Stith, Mary Beth Williams, and Karen Rosen
Publisher: Praeger Publishers, 1997

Springer Publishing Company
536 Broadway
New York, NY 10012
(212) 431-4370


This 363-page book is an overview of treatment approaches in dealing with various forms of domestic violence spouse abuse, child physical and sexual abuse, elder abuse, and treatment of adults molested as children.  The contributors to the book include family therapists, social workers, psychologists, and human service workers, and the emphasis is on practical rather than theoretical aspects of intervention.  The authors do not present a unified perspective on treatment approaches, illustrating the influences of their own educational and experiential backgrounds, although they tend to reinforce some basic treatment principles.

The first chapter addresses some theoretical aspects of intervention.  It offers a definition of domestic violence, identifies factors which might influence its occurrence, and explores which families may be more susceptible to violence.  It describes an interactive model in which individual and family vulnerabilities, resources, and stressors interreact within the greater socio-cultural context to contribute to or inhibit domestic violence.

The remainder of the book is in six parts, each focusing on a specific treatment area.

Part I contains four chapters on the treatment of spouse abuse.  There are chapters on crisis intervention, treatment of abused women, treatment of spouse-abusing men, and family therapy.

Part II covers the treatment of physical child abuse.  Chapters discuss the use of multidisciplinary teams, working with unmotivated clients, abuse of adolescents, and models of community coordination in treating abused and neglected children.

Treatment of child sexual abuse is addressed in Part III.  There is a chapter describing a cognitive-behavioral approach in treating incest families.  Other chapters address the multidimensional role of therapists working in this field and nonverbal treatment methods.

Part IV discusses the treatment of adults molested as children.  In one chapter an incest survivor tells her own story, and this is followed by her therapist's account of specific issues relating to her treatment process.  Another chapter claims that adults seldom spontaneously disclose a history of sexual abuse, and advocates exploring the possibility with all psychotherapy clients.

Part V discusses assessment and treatment of elder abuse and neglect.

The final section offers a model for assessing and treating victims of domestic trauma of various forms.  Abuse victims are identified as suffering from variants of the posttraumatic stress syndrome.  It argues that treatment must involve eliminating a client's denial of the trauma suffered, and that healing can only occur after a client has integrated memory fragments into whole memories and re-enacted the event in a safe environment. Empowerment of clients and enhancing self-esteem are two other identified goals of treatment.


Although covering a broad range of treatments for various forms of domestic abuse, this book is not a comprehensive overview of current therapeutic approaches.  In the chapters on child sexual abuse, there is generally an assumption that all cases referred for treatment will be genuine.  There is no discussion regarding the possibility of false allegations.

In the chapter on treating child victims of sexual abuse, Shelley Kramer-Dover emphasizes that disclosure of sexual abuse is usually piecemeal, and may only be revealed after some time in therapy.  She advocates the use of play and art materials, including anatomical dolls, for evaluation and treatment, and supports mandatory reporting of suspected abuse.  It appears that she sees no conflict in the same person performing interrogations for court evidence and providing ongoing therapy for abuse.  Parental disbelief and denial may call for removal of the child into foster care.

Jana Stanton's chapter on non-verbal treatment advocates using creative art and acting out scenes with puppets and dolls so that the child can relive the experience "in small safe steps, much as in remembering a dream."  She suggests encouraging children to vent their anger towards the perpetrator or nonprotecting parent, for instance by thumping or stamping on clay.

The chapter on adult survivors of incest advocates professionals actively pursuing disclosure of belief, which clients will tend to deny.

Throughout this book, most of the references cited are books and papers written within the mainstream abuse network.  There is little or no evidence that any of the literature which challenges conventional abuse ideology has been considered by the authors.

There are two chapters which offer a different perspective.  Linda Little's contribution on Gestalt therapy with battered women advocates a treatment aimed at women taking full responsibility for themselves.  The goal of the therapist is to facilitate the client to behave maturely, perceiving her options and making decisions, and being able to ask for what she wants.  I found this a refreshing change from the more common course of supporting women and children in the role of powerless victim, and encouraging them to distrust and blame men.

Barry McCarthy also describes an interesting approach to treating incestuous families, using a cognitive-behavioral model.  He advocates a therapeutic (not legal or adversarial) approach, working with the entire family.  It is the husband and wife's decision as to whether they wish to keep the marriage and the family together.  The therapy aims to restore the bond of respect, trust and intimacy between the parents.  Each person in the family must assume responsibility for his or her behavior, including sexual behavior, and the family is restructured to prevent any further inappropriate sexual activities occurring.  The treatment is formally terminated with an apology session by the offender and nonprotecting parent.  The children are told that once they have accepted the apology, they may no longer use incest as a way of asserting power, blame or control in the family.

This appears to be an excellent model for establishing a healthy functioning family.  Generally, however, this book expounds some of the basic assumptions of the contemporary sexual abuse field: that all child/adult sexual contact is an act of violence; that children seldom disclose spontaneously or fully and require encouragement from a therapist to admit abuse; and that therapy should aim at recovering and reliving traumatic memories until they "can eventually be laid to rest."

This book is targeted at workers in the family violence field.  With a few exceptions, it offers very little that has not previously been said by other writers.

Reviewed by Felicity Goodyear-Smith, General Practitioner, Wrights Road RD 2, Albany, New Zealand.

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