Using the stages of change model to counsel victims of intimate partner violence

Abstract

Medical expenses from intimate partner violence (IPV) total between $3 and $5 billion annually. Many abuse victims are exposed to serious injuries, and are likely to see their physicians more frequently than other patients. Practitioners must have a reliable and realistic approach to counseling patients who are victims of IPV. This paper presents the stages of change model as a practical guide for counseling victims. Through patients’ responses to a series of questions, the practitioner can identify which of five stages of change (precontemplation, preparation, contemplation, action, maintenance) the patient is in. The practitioner can then employ stage-specific strategies for counseling the patient. Using this model shifts the definition of successful outcome from the traditional focus of trying to ‘fix the problem’ to a patient-centered focus, working with the patient to explore the most effective strategies given his/her stage of change.

Introduction

Intimate partner violence (IPV) and its health consequences for the entire family are important issues in primary care. “A recent national survey of 6000 families revealed that 50% of the men who frequently assaulted their partners also abused their children, and women who suffer a pattern of abuse are reported twice as likely as other mothers to abuse a child” [1]. Although heterosexual women are the targets of IPV in 95% of reported cases, research also documents abuse of men by women partners, as well as battering among lesbian and gay partners [2], [3], [4]. IPV victims may require medical care, although they often conceal the cause of their injuries. Studies report that battered women, for example, comprise 20–30% of ambulatory care patients, yet only 1 in 20 is correctly identified as such by medical providers [5], [6]. Screening for these patients is, therefore, a critical issue.

Research has shown that the following questions, posed by any health care provider in a supportive and non-judgmental environment, can identify about 65% of patients who are abuse victims [7]: “Have you been hit, kicked, punched or otherwise physically hurt by someone in the past year? If so, by whom?” Not withstanding the importance of screening, a major question for providers is what to do after a patient has been identified as a victim of IPV.