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There have been on-going public and professional concerns about the issue of domestic violence in the world. This interest has resulted in a growing body of research evidence which examine the prevalence and correlates of this type of violence (Archer, 2002; Fagan & Browne, 1994; Johnson & Ferraro, 2000).
The most common form of violence against women is domestic violence, or the violence against women in families. Research consistently demonstrates that a woman is more likely to be injured, raped or killed by a current or former partner than by any other persons. Men may kick, bite, slap, punch or try to strangle their wives or partners; they may burn them or throw acid on their faces; they may beat or rape them, with either their body parts or sharp objects and they may use deadly weapons to stab or shoot them. At times, women are seriously injured, and in some cases they are killed or die, as a result of their injuries (United Nations Economic and Social Council, 1996).
The assaults are intended to injure women’s psychological health and bodies, which usually include humiliation and physical violence. Just like torture, the assaults are unpredictable and bear little relation to women’s own behaviour. Moreover, the assaults may continue for weeks, and even years. Some women may believe that they deserve the beatings because of some wrong actions on their parts, while others refrain from speaking about the abuse because they fear that their partner will further harm them in reprisal for revealing the “family secrets” or they may simply be ashamed of their situation (United Nations Economic and Social Council, Report of the Special Reporters on violence against women, E/CN.4/1996/53, February 1996).
Physical and sexual violence against women is an enormous problem throughout the world. The perpetrators are typically males close to women, such as their intimate partners and family members. Violence puts women at risk for both short- and long-term sequel which involves their physical, psychological, and social well-being. The prevalence of violence involving women is alarming and it constitutes a serious health problem. No woman is safe from domestic violence, no matter what country or culture she lives in. According to the latest UN report, one in three women is raped, beaten, or abused during her lifetime. The occasion of today’s world “Eliminate Violence against Women’s Day” focuses on Iran, where abuse largely goes unreported and – officially at least – unrecognized.
Some researchers have argued that violence is equally a problem for both sexes (Gelles, 1974; Straus, Gelles and Steinmetz, 1980; both cited in Dwyer, 1996). However, as Bograd (1988) points out, this argument ignores the disproportionate rate of male violence against women and that most documented female violence is committed in self-defence. Moreover, it also ignores the structural supports for male violence against women. There is abundant evidence which suggests that violence, against women by their husbands or partners, is a historical and current norm (i.e. Dobash and Dobash, 1988; Geller, 1992; Gordon, 1998).
Some of the criticisms of cognitive behavioural therapies are that they tend to ignore social and political factors which affect clients (Enns, 1997). People who are homeless, battered, or poor may not have the financial resources or social support to use some cognitive and behavioural methods. Cognitive-behaviour therapy views that behaviour is primarily determined by what that person thinks. Cognitive-behaviour therapy works on the premise that thoughts of low self-worth are incorrect and due to faulty learning. In addition, the aim of therapy is to get rid of the faulty concepts which influence negative thinking. Furthermore, cognitive behavioural therapies may not attend to client’s cultural assumptions about rationality which are rather implicit in such therapies.
To make cognitive and behavioural therapies more compatible with the feminist therapy, Worell and Remer (2003) suggested changing labels that stress the pathology of people, focusing on feeling, and integrating ideas about gender-role socialization, rather than using negative or pathological labels such as distortion, irrationality, or faulty thinking. Worell and Remer (2003) suggest that clients explore ideas, based on the gender-role generalizations which appear to be distorted or irrational. For example, rather than labelling the thought that “women’s place is in the home” as irrational, the therapist should explore the actual rewards and punishments for living out this stereotyped belief. By focusing on anger, particularly angry ones which arise as a result of gender-role limitations or discrimination, women can be helped to feel independent and gain control over their lives. Therefore, helping women with their social-role issues, gender-role and power analysis can be helpful in exploring ways of dealing with societal pressures which interfere with women’s development. This is supported by Wyche (2001) who believes that cognitive and behaviour therapies are particularly relevant for women of colour because they focus on the present, providing clients with methods to use in handling the current problems.
1.2 Statement of the Problem
Violence by intimate partners has been recognized throughout the world as a significant health problem. For instance, the World Health Organization (WHO) focuses on violence against women as a priority health issue. Violence by intimate partners refers to any behaviour within an intimate partnership which causes physical, psychological, or sexual harm to those in the relationship.
Violence against women is a manifestation of historically unequal power relations between men and women (Declaration on the Elimination of Violence Against Women, 1993). According to this Declaration fear is the biggest outcome of violence against women. Fear from violence is a big obstacle of women’s independence and results in women to continue seeking the men’s support, and in many instances this support results in the vulnerability and dependency of women, and is the main obstacle in the empowerment of women’s potentials, which can bring about the development of their capacities and to use their energy in the improvement of society.
Violence and abuse across the world are a common phenomenon and are not specific to a particular society, culture or mentality. Women in any given country and society are in one way or another subjected to violence in the private (home) environment or public (social) environment. In view of the irreversible consequences of violence for both the human, social and family structure of society, and for women themselves. This issue must become extra sensitive in the world. In fact, gender-based violence against women is the violation of their human rights and fundamental freedoms, the denial of their spiritual and physical integrity and an insult to their dignity. Violence against women is an obstacle of access to equal objectives, development and peace. The term “violence against women” is associated to any violent act that is gender-based that results in physical, mental and sexual hurt and suffering.
The main reason for the separation of men and women is mental abuse. Mental abuse is an abusive behaviour which hurts and damages the woman’s honour, dignity and self-confidence. This type of abuse results the loss of perception, loss of self-confidence, various types of depression, woman’s failure in managing the family, greed at the work environment, the reconstruction of violent behaviour in children, woman’s dysfunction in the family, turning to sedatives, alcohol, drugs, fortune-telling (Mehrangiz Kar 2000).
Violence against women in Iran takes place in a number of ways: 1 – Honour killing; 2 – Self-immolation; 3 – Domestic violence; 4 – Prostitution; 5 – Human trafficking, women and children in particular.
Violence reduces the self-confidence of women in the family. Women, who are abused, usually become depressed, secluded, and withdrawn people. Depression is also one of the most fundamental psychological problems in women who are in domestic violence. (Enayat, Halimeh,2006).
Standards for counselling practice was developed in response to reports from women who were dissatisfied with the counselling they received after experiencing domestic violence, and concerns raised by workers in women’s domestic violence services (Inner South Domestic Violence Service in Melbourne). According to the Welfare Organization of Iran (2006), the rate of mental illness among women victimized by domestic violence is significantly higher than among other women having hospital contact. It was noted that while an established network existed for domestic violence crisis and support services were designed specifically to meet the needs of women, counselling services tended to be generalized, with only a few practitioners specializing in the area. Furthermore, there has been no study to show counsellors which treatment for the mental health treatment of women who experienced domestic violence is better than the others (WBO, 2006).
Family laws in Iran, create inequality between men and women, and these laws do not have the capacity to protect women who live with violent men, and violence has turned into a power tool for men.
As the country progresses into an industrial nation, more academically qualified professionals are in great demand in Iran. Women who have experienced domestic violence are subjected to considerable amount of problems concerning mental health related to domestic violence. In a study by A. A. Noorbala, conducted at the Tehran University of Medical Sciences, the prevalence of mental disorders was shown to be 21.3% in the rural areas, and this was 20.9% in the urban areas.
According to an old Iranian saying, “Women should sacrifice themselves and tolerate.” This shows that many women, if not most women, are involved in domestic violence. It happens in private life and a legal complaint can destroy the life of a woman. In other words, parts of the population have the perception that abuse is done in order to keep with the traditions of the society and out of love. Women, who are victims of domestic violence, perceived that their husbands’ jealous reactions which turn into violence are a sign of their love and attention to them.
In a very traditional and religious setting in which many [in Iran] live, their understanding of religion and the interpretation given to them throughout the centuries is that a man can beat his wife. They believe that it is a religious command and the commentators, who have portrayed Islam in this light as a violent religion, have also contributed to the growth of this kind of culture. The police and judicial system are of little help. If a battered woman calls the police, it is unlikely that they will intervene. Ironically, the traditional attitude towards marital conflict in Iran inclines people to mediate between the couple. In many cases, the woman is usually sent back to her violent home. In the Iranian judicial system, there has been no law established to prevent domestic violence. On the contrary, there are many indicators which encourage violence against women in families in the Iranian Islamic penal code. Some authors estimate that the number of intimate relationships with violent husbands is about 20 to 30 percent (Stark & Flitcraft, 1988; Straus & Gelles, 1986). Broken bones, miscarriages, broken families, death, and some mental health disorders are some of the consequences of battering in intimate relationships. Each year, over one million women seek medical care due to battering (Nadelson & Sauzier, 1989). Victims also experience nightmares and somatic consequences, while children who witness abuse may be symptomatic, displaying a high number of somatic, psychological and behavioural problems (Nadelson & Sauzier, 1989). In addition to psychological scarring for victims, children, and batterers, there are broader societal repercussions of domestic violence. Williams-White (1989) state that “the structural, cultural, and social characteristics of our society continue to perpetuate the victimization of women at all levels.” In a way, violence within familial relationships reflects and helps maintain violence and oppression it widely in culture. Jennings (1987:195) explains this by stating that violent husbands not only contribute to maintaining the level of violence in society, they also reflect “a direct manifestation of socially learned sex-role behaviours.” Moreover, the prevalence of battering has crossed race, ethnicity, and socioeconomic status (Hotaling & Sugarman, 1986). Maltreatment of violence can lead to more violence (Walker, 1984). In systems which do not change, future generations may continue to resort to violence to solve problems. In addition, in many of those systems, violence may become more severe with time. For this reason, it is therefore necessary to work on treating the consequences of violence. However, to date, funding for mental health interventions is still limited, and it often only supports short-term treatment which will not adequately address the long-term symptoms.
In view of the special treatment for the mental health of women, counseling centres and support houses for women can reduce the mental health problem of abused women and also reduce the domestic violence statistics.
At the Welfare Organization’s Counselling Centres in Iran, women who are victimized by domestic violence are treated by social workers and counsellors utilizing the cognitive behaviour therapy. Based on the above discussion, this study also analyzed the comparison of the treatments given to women who have experienced domestic violence, using four different therapies, namely combination therapy (cognitive behaviour therapy and feminist therapy) with cognitive behaviour therapy, feminist therapy and social work skills.
1.3 Objectives of the Study
1.3.1 General Objective
In general, this study was carried out to:
Examine the influence of four different mental health treatments given to women who have experienced domestic violence;
Empirically investigate the outcomes of the mental health treatments given to victimized women under combination therapy comprising of (CBT and Feminism), CBT, Feminism therapy and social work skills.
1.3.2 Specific Objectives
This study was undertaken specifically to:
Examine the effects of the combination of therapies comprising of cognitive-behavioural-feminist on the mental health of the women who have experienced domestic violence;
Examine the effects of the cognitive behaviour therapy on the mental health of the women who have experienced domestic violence;
Examine the effects of the feminism therapy on the mental health of the women who have experienced domestic violence;
Examine the effects of the social work on the mental health of the women who have experienced domestic violence.
The following hypotheses are postulated in the current study:
There is a significant difference in the improvement of the mental health of the women who underwent the treatment using a combination of different therapies (cognitive, behaviour, feminism therapy) and those who were treated using only social work skills.
There is a significant difference in the improvement of the mental health of the women who underwent the treatment using the cognitive behaviour therapy and those who were treated using only social work skills
There is a significant difference in the improvements of the mental health of the women who underwent the treatment using the feminism therapy and those who were treated using only social work skills.
There is a significant difference between the combination of therapies (cognitive, behaviour therapy), feminism therapy and social work skills.
1.5 Significance of the Study
Violence can shatter a woman’s life in many ways. Being a victim of violence is widely recognized as a cause for mental health problems, including post-traumatic stress disorder, depression, anxiety, and panic attacks. Being abused also plays a major role in developing or worsening substance abuse problems. For many women who are affected by violence, their first abuse usually occurred in their childhood or adolescence. Victimized women as children’s mothers frequently end up losing custody of their own children due to allegations of abuse or neglect, and over 50% of child abuse and neglect cases involve parental alcohol and drug abuse.
In addition to institutionalized violence against women in Iran, the majority of the women and young girls are facing domestic violence at home at the time when they are still living with their parents. In most cases, it is the father and the other elder male members in the family are among those who first commit the aggression against the women and young girls. According to the latest statistics, two out of every three Iranian women have experienced discrimination and domestic violence from the father or the other male members of their family. For the vast majority of the Iranian women, married life marks the beginning of horror, pain, and humiliation, i.e. being the victim of their husbands and sometimes the other family members. Moreover, eighty one out of 100 married women have experienced domestic violence in the first year of their marriage (Mehrangiz Kar 2000). Even women with outstanding jobs and prestigious social standings are subject to this violation. In most of the cases, this abuse leaves permanent physical and psychological damages for the rest of their lives. Ironically, without saying even a word and with much pain and yet no support, crimes against women have gone unnoticed. Ninety out of 100 women suffer from a severe case of depression, from which they ultimately commit suicide and 71% of those women experience nervous breakdowns. (Mehrangiz Kar 2000). Their methods of suicide include setting themselves ablaze. For them, this is the only way of escaping from segregation and humiliation. For instance in Ilam (a city in Iran), 15 girls set themselves ablaze each month, fighting against oppression or depression (Welfare Organization of Iran, 2005). Looking at how serious this problem has become, it is therefore the responsibility of everyone to fight the oppression against women. Female victims need to believe that they should not be blamed on whatever happens to them. An active participation in the Welfare Organization of Iran to defend the women’s rights and opposition to the Iranian Islamic fundamentalism is the least one can do to help end the pain and suffering of the victims of violence in both private and public spheres. Violence against women, in human and brutal punishments, such as stoning and complete elimination of the women from the political and social arenas represent some aspects of the modus operandi of fundamentalists leading to institutionalized violence. This also means that the struggle for equality, safety and security cannot be separated from the fight against fundamentalism in Iran.
This study made use of the theoretical framework, combining the cognitive-behaviour theory and feminist theory for the mental health of the women who have been victimized by domestic violence. The present study could provide knowledge on the different types of mental health treatments adopted by counsellors at various counselling centres throughout the country. This research also examined the quality of the treatment by combining two therapies (cognitive-behaviour therapy and feminist therapy).
Armed with this knowledge, the leaders of the Welfare Organizations, the society, families and counsellors can benefit from the consequences of change in the women’s mental health. The suggested theoretical framework would provide a better understanding of the women’s mental health and their performance in the society.
In summery, battered and abused women need a wide range of responses, flexible services, and supportive policies to enhance their safety and self-sufficiency and to restore their self-esteem and welfare. These might include mental and physical health evaluation and referral; relocation services; confidential advocacy, shelter, and other domestic violence support services; educational and vocational training; legal representation concerning divorce, custody and protective orders; evaluation of immigration status and ethnic or cultural issues; and the effective enforcement of criminal laws and court orders to help free them from their partners’ control and to keep them and their children safe.
We know that women who have suffered abuse are more likely to suffer posttraumatic stress disorder (PTSD), depression, and somatization than those who have never experienced abuse; the more extensive the abuse, the greater the risk of mental health disorder.
Women’s mental health treatment is an important area to consider for research because (1) girls and women as a group are exposed to more traumatic stressors than boys and men; (2) the mental health of women may be severely affected, resulting not only in immediate psychological symptoms, but also lifetime risk for self-destructive or suicidal behaviour, anxiety and panic attacks, eating disorders, substance abuse, somatization disorder, and sexual adjustment disorders; and (3) psychologists are not regularly trained to work specifically with trauma survivors, which can reduce the effectiveness of the treatment survivors receive.
Currently there are 22 crisis intervention centres (women’s crisis intervention centre) across the country (Iran), and women can stay in these centres between 6 to 8 months.
As violence causes psychological pressures and uncontrolled stresses on and ultimately depression in women generally, this study was intended to find a better and useful treatment in the attempt to improve the treatment for the mental health of the women who have become the victims of domestic violence. The present study would also provide further knowledge and understanding on the three different types of the treatments used, namely the Cognitive-behaviour therapy (CBT), Feminist therapy and the combination of the two treatments. The results of this study would therefore contribute the theoretical development and practice in counselling.
1.6 Operational Definition of Terms
1.6.1 Domestic violence
“Domestic violence is a pattern of coercive behaviour, which includes physical, sexual, economic, emotional and/or psychological abuse, exerted by an intimate partner over another with the goal of establishing and maintaining power and control.”
1.6.2 Mental health
a state of mind characterized by emotional well-being, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life. Mental Health is the balance between all aspects of life – social, physical, spiritual and emotional. It impacts on how we manage our surroundings and make choices in our lives – clearly it is an integral part of our overall health. In this study, mental health refers to the score which the client gets from the SCL-90-R test.
1.6.3 Cognitive behaviour Therapy (CBT)
A set of principles and procedures that assume that cognitive processes affect behaviour and conversely that behaviour affects cognitive processes. It emphasizes a here-and-now process without emphasizing causation. (D.Meichenbaum) .A treatment approach that helps clients examines and changes the relationship consequences, thoughts, feelings, behaviours and resultant consequences. It incorporates a number of diverse intervention (for example, cognitive restructuring procedures, problem solving, coping skills interventions, stress inoculation training, and self instructional training.
1.6.4 Feminist Therapy
A philosophical and practical approach with certain assumptions; for example, strategies are needed, and therapists must be aware of personal, gender-biased value system in relation to appropriate behaviour. Feminist therapists promote se4lf-awareness, self-affirmation, and personal integration, outcomes that may conflict with the societal norms that were the original source of dysfunctional behaviour patterns of women.
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