How to detect and deal with domestic violence as a caregiver?

Domestic violence is the result of a dysfunctional bond in the couple. Violence between intimate partners is to be placed in conjugal and family life cycles but also in the individual history of the members of the couple.

It is very important to always keep in mind that violence in general and domestic violence exists and occurs regardless of the socio-cultural and professional level of individuals, couples and families.

In 2020, following the Grenelle on conjugal violence of 2019, the Ministry of Justice put in place a number of measures to strengthen the fight against violence against women by their spouses (reinforced criminal sanctions / removal measures and protection of the victim).

The 3919 telephone line is now accessible 24 hours a day, 7 days a week. It is often the first collection of the words of women victims. The dedicated website is very comprehensive.

The government site ” Let’s stop the violence Is also very well informed and provides simple and clear information that can easily be given to patients.

The law also provides for new measures to protect children who are “co-victims”, witnessing violence against their mother and often against themselves, at home.

Finally, for foreign women who do not have a good command of the French language and / or risk losing their residence permit by breaking up with their companion and / or by reporting to the police, know that there are depending on the region lawyers and associations that deal specifically with these particular situations.

In summary, there are three main elements to remember in preventing domestic violence:

• The need for support in three parts: justice service / health care system / associations
• The need to know the spiral of domestic violence
• The need for knowledge of risky situations, in particular pregnancy and separations

The cycle of violence

Violence evolves in cycles:

• Phase of rising tension in the couple (external event or internal state of stress or anger of the author).
• Episodes of violence during the aggression phase (physical and / or verbal violence)
• The perpetrator made the victim feel guilty during the phase of justifying this violence (projection mechanisms with headlights as follows: “If you hadn’t pissed me off, we wouldn’t be there”, “You did on purpose to make me angry ”,“ You looked for it ”etc.)
• Reconciliation during the lull phase (inappropriately called “honeymoon”, during which the author promises, for example, that he will make an effort and that it will not happen again).

In the absence of intervention, the cycle repeats with an increase in the intensity of the violence and a decrease in the duration and intensity of the lull phases.

Be aware that the care of perpetrators of domestic violence as part of individual or group therapy (sometimes required by the courts as part of an obligation of care) are efficient.

Knowledge of the cyclical nature of violence within the couple is essential to understand one of the characteristics of the behavior of victims, namely their tendency to be reversible in the request for help and in their procedures. It also makes it possible to adapt the support proposals.

Indeed, women victims of violence within their couple, always think and hope for an improvement in their marital relationship and a change in their partner’s behavior (which can happen if real care and a sincere long process of change is initiated. ), who, as we have understood, is not, in many cases, only a violent man, since he can be gentle and understanding at other times. This is the complexity of this phenomenon and of the human relationship.

Main factors associated with acts of violence (non-exhaustive list)

Questions adapted to the context

The Haute Autorité de Santé offers health professionals and the medico-social sector examples of questions to ask women to get them to talk about their violent experiences at home.

You can choose the formulation that suits you best, or in any case the one with which you feel most comfortable.

Note, as in matters of sexual disorder, that the patient will not approach these difficulties easily on her own, but will be relieved and inclined to confide if it is the professional who proactively questions her.

• “How do you feel at home? “
• “How does your spouse behave with you? “
• “In the event of an argument, how does it work? “
• “How are your intimate relationships going?” And in case of disagreement? “
• “Are you afraid for your children? “
• “Have you ever been a victim of violence (physical, verbal, mental, sexual) in your life? “
• “Have you experienced events that have hurt you or that continue to hurt you? “” Have you ever been verbally, physically or sexually assaulted by your partner? “” Have you ever been afraid of your partner? “
• “Have you ever felt humiliated or insulted by your partner?” “

You can also tell your patient that these issues are discussed with all patients given the frequency of the risk of domestic violence and the current policy focus increasingly on prevention.

Some reference tools

• “The wheel of violence”: a tool that names concrete examples of all forms of violence between intimate partners.
• “Responding to domestic violence”: a reference sheet which details the means available to victims.

These tools are a support for mediation and communication on the subject with your patient.

List of numbers at national level

Useful links

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References