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Veterans and Domestic Violence

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copyright CADRE program. Batterer Intervention Program for Veterans with PTSD

copyright CADRE program. Batterer Intervention Program for Veterans with PTSD

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  • Co-facilitator, research assistant, and outreach assistant. Eddie is Staff Sergeant. In the Oregon Army National Guard and trains soldiers who are being sent into combat as infantry. He is a Marine Corps Desert Storm veteran and a National Guard OIF veteran and has completed a BS in Psychology and also Philosophy. He plans to continue with his education and obtain a Master’s Degree in one of the therapy related fields (i.e. Psychology, Social Work, Counseling).
  • A short commercial about Marine Corps Bootcamp. Though the services all have a different approach to conducting recruit training, the similarity is that they take people from different walks of life and remold them into essentially what is a different ethnic group called “military” complete with its own language, traditions and histories, and cultural norms. This isn’t merely beginning a ‘job’ somewhere, it is the adoption of a persona, of characteristics into one’s personality, a reshaping of the Self.
  • We train in a rough, loud, rude, environment. We make our training tough, constantly pushing people with tougher challenges, contingency planning, and adapting to worse and worse situations. We learn that the individual is not as important as the group. We train for the worse. Our communication is direct and at times abusive. We train for automatic response to orders.
  • Scripts are acts recognized by a particular group, the rules or guidelines for a expected behavior and the expected punishment for violating the norms. How is one ‘supposed’ to act within a given context. Scripts are powerful modifiers of our behavior. Many scripts operate underneath our awareness.
  • Women are taught in our society, through books and movies and cultural norms, to be attractive, to be alluring, to be the caretaker of the relationship, the one with the feelings, and to be the object of attention. Men are supposed to pursue her and give her flowers.
  • Men are supposed to be the ones making the first move, paying for the date, be the bread winner, the hero. He is the quarterback who wins the game and goes after the cheerleaders. He is supposed to not show weakness, be strong, and never back down.
  • Another double bind: A man may be ‘weak’ if he expresses emotion, talks about his feelings. Talking about his feelings may trigger his anxiety or force a couple to face the issues head on instead of ignoring or managing the stress. Things aren’t they way they used to be before deployment. If he doesn’t express feelings he is a cold-hearted person. If he does, he is soft and not a man.
  • Military culture emphasizes control, accountability, command, decisiveness, aggression. Men go and do. Men do not show weakness, do not do frilly things, do not go for the softer things. One interview with a marine he referred to literature as ‘feminine stuff’. A man that orders a strawberry daiquiri in a bar is assumed to be gay. Common masculinity in the military has competing values of misogyny and chivalry. Both, however, are forms of sexism. Anger can be a ‘secondary’ emotion intended to increase emotional distance between people and to mask the primary emotion. Erbes et al. Couple therapy with combat veterans and their partners. Journal of clinical psychology (2008) vol. 64 (8) pp. 972-983 If you are angry, you are not ‘fearful’ or ‘vulnerable’, in some men’s minds. Anger is a mask.
  • Video of a small IED (improvised explosive device) in Iraq.
  • Picture from a firefight that A Company, 2-162 had in Baghdad in October 2004. That is Eddie’s humvee with the body on top. The body is a teenage Iraqi who panicked and drove his vehicle into the middle of firefight. Faced with an onrushing vehicle that was gaining speed, soldiers did what they were trained to do in order to protect themselves. It was later discovered it was a teenager who simply panicked and his body was collected in the middle of the firefight and taken to an Iraqi Police station.
  • Our job isn’t necessarily a ‘nice’ job. What is the one emotion that fits with our job? Anger. Not arguing that anger is either good or bad, but that it depends on the context. But due to training, experience, beliefs, roles, scripts and schemas we soldiers have a huge hurdle to overcome. We’ve lost our mission but kept the reactions. Those reactions do not work well with handling the new sets of problems in a non-combat environment. There are new processes that we’ve learned, adding to our confusion.
  • Portland defense attorney Kathleen Bergland frequently represents veterans, primarily in domestic violence cases. She describes a scenario she sees all too often: A vet comes home and his or her spouse attempts to reestablish intimacy, either physically or by asking questions about their wartime experiences. The vet, not yet prepared for that level of intimacy, responds by acting out inappropriately. The spouse files a restraining order and, if children are involved, the Department of Human Services intervenes. “ Besides getting stuck in a system that is ill-prepared and not designed to handle this number of vets, there are a growing number of vets who are losing their families and their children because of the way the system mishandles it,” she says. Bergland began working with vets about four years ago, when she took on a death penalty case involving a veteran who had come home and killed his wife. Bergland’s team was the second set of attorneys to defend the accused because the first refused to introduce PTSD as a mitigating factor. At the time, Bergland knew little about PTSD, and finding witnesses who could accurately describe its causes and symptoms was a challenge. She met Robert Stanulis, a Portland forensic psychologist who specializes in PTSD, and often relies on him for expert testimony. Both Bergland and Stanulis say they have seen an increase in clients with PTSD. Stanulis, who testified for the defense during the Bratcher trial, says Fort Hood in Texas already has seen a 27 percent increase in domestic violence involving veterans. The U.S. legal system handles most domestic violence cases according to the Duluth Model of intervention, which doesn’t take into account PTSD or any other mental and emotional issues combat veterans face, he says. “ In the majority of military cases, the veteran isn’t seen as a wounded warrior but as a batterer who needs to be separated from the family,” Stanulis says, noting that while men are most commonly perceived as the aggressors, studies show female vets are just as likely to become violent. “ And the worst thing about all of this is that we haven’t even seen the really bad cases with people who are on their fourth or fifth tour,” Stanulis says.
  • Many of the attitudes, beliefs, and behaviors that were learned in a combat zone were necessary in order to keep one alive. These same attitudes, beliefs, and behaviors are not appropriate for many situations back home. However, a lot of the same things still trigger the veteran, such as traffic, noise, smells, people speaking in a certain language, sounds, etc... and it is very easy for someone struggling with reintegration to slip into combat-appropriate behaviors.
  • Working with returning veterans there seems to be some commonalities. Screaming kids are extremely irritating, traffic is unbearable and triggers out of proportion reactions. Perhaps there is no job to return to and the person may feel worthless, unable to provide for a family or self. There seems to be a connection with rank with the lower ranks more likely to have problems. Perhaps this is life experience, perhaps it is social support, perhaps it is a variety of things. Looking around there seems to be nobody who understands what it is like to come home and one feels very isolated. Communication with a loved-one is difficult. Add this to a loss of intimacy and relationships are strained, particularly when other emotions are triggered by traffic, people, explosions and intrusive memories. A veteran may become more combative and look for fights in bars, or perhaps sees injustice everywhere in the world and is quick to attack that injustice, no matter how small or trivial. Finding it difficult to deal with intrusive thoughts, or constant hyper arousal, and other stress, the veteran may begin self medication with alcohol and/or drugs.
  • Post Deployment Health Reassessment 38 % Army soldiers 31 % of Marines 49 % National Guard repeated deployments were at extremely high risk of problems and the toll on their family members was great. New England Journal of Medicine (2003) Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351:13- 22. European & Pacific Theater Battle Fatigue was 25% - 33% of casualties Grossman, D (1995) On Killing . Back Bay Books Publishing.
  • No substance abuse in sample. This is a convenience sample of 179 couples-therapy-seeking veterans at a VA clinic. If it was determined that either abused a substance they were not admitted into the program. Average drinks per week for veteran was 2. Average per week for partner was 1. Couples were seeking help for one of four relationship issues: anger or violence, relationship improvement, help coping with a mental illness, or a specific relationship issue Violence in the past year. Sherman et al. Domestic Violence in Veterans with Post-Traumatic Stress Disorder Who Seek Couples Therapy. Journal of Marital and Family Therapy (2006) vol. 32 (4) pp. 479-490 When comparing relationships satisfaction, the PTSD group was not lower than the Comparison group. Possibly due to empathy of partner to traumatized warrior. Conflict Tactics Scale- Form R. Measures physical aggression, severity, and frequency.
  • Military members were four times as likely to choke their victims into unconsciousness or leave them with bruised windpipes and neck muscles. Compared to couples seeking therapy in university clinics, veterans with PTSD/Depression were 6 times more likely to perpetuate violence, 14 times more likely to perpetuate severe violence. Hansen. A Considerable Service: An Advocate’s Introduction to Domestic Violence and the Military. Domestic Violence Report (2001) vol. 6 (4) pp. 1-6 Sherman et al. Domestic Violence in Veterans with Post-Traumatic Stress Disorder Who Seek Couples Therapy. Journal of Marital and Family Therapy (2006) vol. 32 (4) pp. 479-490
  • Rates among U.S. that report IPV 12% In Military 36% Rates among military veterans and active duty are up to three times higher without screening for psychopathology. Marshall et al. Intimate partner violence among military veterans and active duty servicemen. Clinical Psychological Review (2005) vol. 25 pp. 862-876 the number of 972 is based off of the general rates of IPV without regard for psychopathology and estimated for 2700 national guard soldiers. Part of the scripts and schemas that we have is that we handle matters. Add how we are expected to act/react with our very real hyperarousal and violence is quite likely.
  • Reported number of Physical Aggressive acts over the past year among help seeking vietnam veterans. 75% and 17% The numbers in white are the average number of aggressive acts in the year. Beckam, Feldman, Kirby, Hertzberg, and Moor (1997) as cited in Taft et al. Intimate partner and general aggression perpetration among combat veterans presenting to a posttraumatic stress disorder clinic. American Journal of Orthopsychiatry (2009) vol. 79 (4) pp. 461-468
  • Posttraumatic stress disorder symptoms were assessed using the PTSD Checklist Military Version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993) The sample for this retrospective review study was com- prised of consecutive Iraq and Afghanistan War combat vet- erans (N = 117), who presented with a variety of concerns to the Deployment Health Clinic of the VA Puget Sound Health Care System between May 2004 and June 2005 Combat exposure was significantly positively associated with trait anger, r =.20, p < .05, but was not significantly related to aggression, r = .14, ns. Prob- lem drinking was significantly positively associated with trait anger, r = .27, p < .01, hostility, r = .25, p < .01, and aggression, Jakupcak et al. Anger, hostility, and aggression among Iraq and Afghanistan War veterans reporting PTSD and subthreshold PTSD. Journal of traumatic stress (2007) vol. 20 (6) pp. 945-954
  • Julie Kingsland, Director of the CADRE Program, received her Master of Social Work degree from Portland State University in 2003. She has over 5 years working as a domestic violence intervention treatment provider for The Men’s Resource Center, Inc. Prior to working in the domestic violence field, Julie worked as a Correctional Officer for the State of Oregon, completed a two year internship at the Salem Vet Center, and volunteered as a re-adjustment counselor at the Salem Vet Center for an additional two years. She has developed working relationships with service agencies in the area of domestic violence, veteran’s services, and law enforcement. Julie is also the director of The Medical Empowerment Program and Counseling Services, Inc. which provides services to persons who are disabled and/or chronically ill. As veteran’s often have physical challenges, her expertise in this area is a valuable asset to CADRE.
  • The typical batterer in a relationship is male. There was a time when it was considered the male’s role/right to beat his wife and kids. The picture on the left is from an English drawing. The “rule of thumb” was English law stating that a man could use a rod no bigger than his thumb to beat his wife with. The typical batterer has a pattern of control and abuse against his partner as well as attitudes and beliefs about his right to do so. While such attitudes, beliefs, and behaviors do exist among some men in the military, a great number of cases involving male veterans with intimate partner violence stems not from their belief about women, but instead on the physiological changes undergone through combat PTSD. These sudden rises in adrenaline, anger, hostility, and loss of empathy and emotion, combined with a quick reaction to react in dangerous ways, have many male veterans reacting to situations in an abusive manner. Add to this the typical male response/pattern of repressing any emotions or signs of weakness and this creates an even larger powder keg of emotion. Add to this the tendency for some combat ptsd veterans to self medicate with alcohol, which inhibits the prefrontal cortex ability to regulate emotional outbursts, and the likelihood of dangerous angry outbursts by the combat ptsd veteran increases.
  • Some therapists have said they wish they could respond like this at times. Failure to NOT do this with a veteran at times is to show, even more, the gulf between you and the therapist. The world is a hard place (recall Rousseau’s theory, among others such as Hobbes) where nothing is owed to you and nothing is given. Kleenex did not get men past Normandy. But emotional feeling, healing, connection, grieving, anguish, and such are needed in the healing process. The question is how do you get veterans to feel they can express such? It is unlikely to be in a place where the veteran must maintain an identity as soldier, unless the context of that is different and incorporates showing of emotion. An example is not a military funeral, we strive to be stoic at these, but perhaps at a veteran group session where veterans discuss their ordeals.
  • The Soldier Box. These statements represent norms of behavior and values. It is very hard for us to imagine anyone being successful in the military and not holding on to these beliefs and behaviors.
  • “ Wheels” Adapted from the Power and Control Wheel Model The original Power and Control Wheel and Equality Wheel were dev eloped by the Domestic Abuse Intervention Programs in Duluth, MN. http://www.ncdsv.org/ publications_wheel.html
  • http://www.ncdsv.org/images/PowerControlwheelNOSHADING.pdf
  • http://www.ncdsv.org/images/MilitarycontrolwheelNOSHADING.pdf

Veterans and Domestic Violence Veterans and Domestic Violence Presentation Transcript

  • Veterans and Domestic Violence The C.A.D.R.E. Program http:// www.CADREProgram.org
  • What C.A.D.R.E. IsHelping veteran batterers reclaimtheir lives through education and group work. We advocate responsibility, safety and understanding.
  • What C.A.D.R.E. Is NotWe do not give excuses or a ‘free pass’. We recognize there is adifference between an excuse and a reason.
  • How It Came About• Julie’s story
  • Eddie Black B.S. Psy/Phil US Marines - Oregon National Guard
  • TrainingThe aim of military training is not just to prepare men for battle, but to make them long for it.  ~Louis Simpson
  • Push Beyond Initiative Breaking TeamworkMilitary Bearing ObedienceAttention to Detail Support Your Team Abusive Uniformity Communication Style Quick Action Individual Mistakes cost EVERYBODY PUNISHMENT
  • Scripts and Schemas“We see the world, not as it is, but as we are -- or, as we are conditioned to see it.” ~Stephen Covey
  • ScriptsScripts are acts recognized by a particular group,the rules or guidelines for a expected behaviorand the expected punishment for violating thenorms
  • On the First Date Women… • Assume the subordinate role • Be alluring • Facilitate conversation • Limit sexual activity
  • On the First Date Men…• Initiate the date• Plan the date• Pay for the date• Be the sexual aggressor
  • A Double Bind Token Resistance, says no but intends to have sex Males learn that no doesn’t really mean no If a woman acts other than expected role she is condemned Lilith
  • What are men supposedto act like?
  • Combat"Wars may be fought with weapons, but they are won by men." ~General George S. Patton Jr.
  • QuickTime™ and a decompressorare needed to see this picture.
  • What skills, behaviors, thoughts,responses, habits have you learned?
  • HomeI dream of giving birth to a child who will ask, "Mother, what was war?"  ~Eve Merriam
  • The “Script”• Soldier’s deployment was more important• Home is romanticized• No problems are real• Soldier is appreciated• The hard part is over with• Things will be just like they were before deployment• Going to have/want sex all the time• Only ‘weak’ or ‘crazy’ soldiers have mental issues and need treatment 20
  • Problems“What does not kill me, makes me stronger.” ~Friedrich Nietzsche
  • B Buddies VS WithdrawalA Accountability VS Controlling InappropriateT Targeted VS AggressionT Tactical Awareness VS Hyper-vigilanceL Lethally Armed VS Locked and LoadedE Emotional Control VS Detachment Mission OperationalM Security VS SecretivenessI Individual Responsibility VS Guilt Non-defensive DrivingN (combat) VS Aggressive DrivingD Discipline and Ordering VS Conflict
  • 23
  • Statistics Say you were standing with one foot in the oven andone foot in an ice bucket.  According to the percentage people, you should be perfectly comfortable.  ~Bobby Bragan, 1963
  • Couples-Therapy-Seeking Veterans 26
  • At least One Act Reported Among Couples- Seeking-Therapy in Past Year 27
  • Interpersonal Violence and the Military no screening for psychopathology 972 28
  • Help-Seeking Vietnam Veterans 22 0.2 29
  • 30
  • Julie Kingsland M.S.W. Air Force
  • The Program
  • Mission StatementThe mission of the CADRE Program is toprovide combat veterans a treatment programthat addresses combat post traumatic stressdisorder that manifests in domestic violence.Once we receive funding, CADRE will coverthe entire cost of services for any veteran whoqualifies. Those veterans who do not qualify for100% relief, will be provided services at halfcost.
  • • 48 Weeks + 3 Monthly Follow-Ups• The Program First 20-25 Weeks – Buy into the system• Set down ‘weapons’• P/U tools• Man Box vs Soldier Box• Question Beliefs (stereotypes, scripts, schemas)• Learn warning signs • Physical • Behavioral• Tools to manage PTSD• Tools to manage anger
  • Two PopulationsBeliefs about men and Trained in automatic women. Patterns of aggressive response to control and abuse. any perceived threat.
  • Power and Control Wheel
  • Rate Your Anger • Ears are hot • Skin is red • Gritting your teeth • Staring down the other person • Balled-up fists • Cursing1 2 3 4 5 6 7 8 9 10 41
  • Things Not to Do
  • • Aggression is met with aggression
  • Contact Us Julie Kingsland MSW Eddie Black B.S. Director Co-Facilitatorjkingsland@mepscounseling.com eblack@cadreprogram.org 503-235-3433 503-737-5968 www.CADREProgram.org info@cadreprogram.org