Domestic Violence Complexity Challenges Support Efforts

A man who shakes his wife during fits of rage, or a frustrated mother who, after a few beers, hits her children. It happens, but in many more cases of domestic violence there is no such clear-cut distinction between a 'perpetrator' and a 'victim', says Marie-Louise Kullberg, a researcher in the Department of Clinical Psychology and a trauma therapist at the Leiden University Treatment and Expertise Centre (LUBEC). 'Far more often, there is a dynamic in which people trigger one another and violence occurs on both sides,' she explains. 'That also makes treatment difficult: it is not always immediately clear what is needed to stop the violence within a family.'

A systemic perspective

A systemic perspective, in which domestic violence is seen as the result of a family dynamic that has become stuck, also calls for a systemic approach. But what does that look like in practice? And what obstacles do professionals and families encounter? These were the questions Kullberg and her colleagues explored in SaFe Home, a research project in which several youth care and mental health organisations in Leiden jointly draw up and implement a treatment plan. They were inspired by Switch, a similar initiative in Amsterdam that had proved effective. 'In Amsterdam, Youth Protection Services played a central role. In Leiden, we worked with a greater number of different organisations. That made things more challenging in practical terms.'

'In most families, there is a dynamic in which people trigger one another and violence occurs on both sides'

SaFe Home

When domestic violence is identified within a family, individual support is currently often arranged for the children. 'That is usually neither a systemic approach nor psychological treatment. It tends to focus more on practical support, such as help with parenting, with the aim of getting the basics back on track,' says Kullberg. 'A large number of professionals are often involved: outreach youth care, a mental health service for the child and support from the local community team.' What sets SaFe Home apart is its integrated approach to the whole family, with greater attention paid to the causes and consequences of the violence and psychological treatment provided where necessary.

Family plan

Since 2023, twelve families have started a programme with SaFe Home, referred by organisations including Leiden women's refuge Rosa Manus, Youth Protection Services and Veilig Thuis, the Dutch domestic violence and child abuse advice and reporting centre. For as short a time as possible, but for as long as necessary, they received support from various organisations on the basis of a jointly developed family plan. This support could range from individual therapy for parents and children, for example focusing on emotional regulation, to couples therapy.

A broad range of expertise

During the programme, Kullberg and her colleagues used questionnaires and interviews to investigate how both the families and the professionals experienced the process and what obstacles they encountered. 'Beforehand, we expected people to present with a lot of trauma-related symptoms, but the range of issues was much broader: depression, anxiety, autism, behavioural problems and substance use. The professionals really needed expertise across a wide range of areas.' The key question at the beginning of each programme was therefore: where do you start? 'It was often important for parents to receive help first, so that they had the mental capacity to support their child.'

'When parents received help themselves first, they had more mental capacity to support their child'

Inspiring

Different organisations worked together in teams and met regularly, sometimes with the families present and sometimes without them. The youth team often took the lead in coordinating the process. 'The professionals found it inspiring to learn from different disciplines. Personally, I learnt from colleagues working in forensic care to talk about "people who use violence" rather than defining them as "perpetrators".'

Different terminology

Even so, finding a shared language sometimes remained a challenge, occasionally leading to misunderstandings. 'For example, there were differences in what we meant by "family-focused treatment". Does it mean taking the children into account during a treatment programme, or does it mean actively working with every member of the family and providing, for example, systemic family therapy?' The term 'coordination' also meant different things to different professionals. 'It can mean determining the clinical direction of a programme, or it can mean coordinating the different services from a more overarching position.' In her research, Kullberg identifies speaking the same language as one of the conditions necessary for SaFe Home to continue successfully. 'What helped was that, during the project, the team was trained according to the same therapeutic framework: attachment-based family therapy. That gave us a shared perspective and a shared language.'

Obstacles when getting started

Other challenges were mainly organisational. 'Within mental health services, there is often a considerable amount of time between referral, assessment and the start of treatment. But with domestic violence, problems are often acute; you want to strike while the iron is hot.' In one family, for example, tensions escalated around the Christmas holidays, but LUBEC was closed between Christmas and New Year. 'It would have been better if support could have started more quickly and if this family could have received a referral sooner.' There were also many steps involved in getting a programme up and running: referral, completing forms and other administrative procedures. 'Sometimes we would then discover that what we were offering was not actually suitable and, for example, that addiction treatment was needed first, even though the family had already spent quite some time waiting.'

'I would like us to organise care in such a way that parents no longer have to go from one organisation to another for help.'

Positive experiences

Families are still receiving support through SaFe Home, although data collection for Kullberg's research has now been completed. De Waag is working with Leiden City Council to continue the initiative, as both families and professionals have been largely positive about their experiences. 'The violence has not stopped in every family, but every family has made progress.'

Tackling violence at family level

Kullberg therefore argues that an integrated approach, including psychological treatment, should become standard practice in cases of domestic violence. 'At local level, I hope SaFe Home can be developed further and that more families in the region can be supported,' she says. 'More broadly, I would like us to organise domestic violence services in such a way that we are better able to work within and around families, and so that they no longer have to approach a series of different organisations for help. We need to be able to focus properly on the substance of the problems and address the impact of violence at family level.'