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Coursework - Counseling Abused Women: Factors Contributing to Successful Outcome

 

Introduction

Violence against women happens in every country all over the world. There is no country in which women are not exposed to some kind of violence. Women and children around the world, across lines of income, class and traditional views, are exposed to physical, sexual and psychological abuse, domestic abuse, inequality, and, in addition, lack of human rights. Worldwide, at least one in every three women is beaten, forced into sex, or abused in some way, most frequently by someone she knows, including her spouse or another male in the family. Violence relates to the lack of human rights, and to legal, economical, and public health problems as well. It influences all areas of the world and is a crucial problem that needs research initiatives directed at the improvement of universal understanding.

This paper collects and analyses the latest data and samples corresponding to the study of counseling abused women and identifies the most pertinent intervention and treatment of abused women that occurs all over the world. It also highlights the current problems such as lack of funding and political party’s involvement, especially in the developing countries. Finally, the document provides pointers to the most pressing issues that need to be considered by national policy and programme authorities in order to improve the position of the abused women.

To clarify the present problem, descriptions of life situations, case studies and direct quotes from women themselves have been used to vivify the contexts in which depression, post-traumatic stress disorder, suicide, alcohol and drug use, and other psychological disorders occur. It is hoped that the given samples of the experiences of inequality, violence intervention and different progammes will assist in developing a more accurate understanding of the structural barriers women face in attempting to find a solution to their urgent problems. It is needed to better inform the promotion of women’s mental health. Moreover, subjective perceptions of health are significantly related to psychological well being and utilization of the health care system (Ustin and Sartorius, 1995, p.35).

The paper is divided into five parts as follows:

The first part contains a brief discussion of violence against women, reactions, consequences to violence and causes of the mental problem. This is useful in providing a broad context from which to consider intervention ways of treatment for abused women and the critical analysis of the present situation that are discussed in subsequent sections.

Parts two and three consider the importance of clinical and community treatment along with the family participation and treatment in groups. In part four, relevant demographic variables and equal access to treatment are examined based on abuse of women with disabilities with an emphasis on financial and political barrier. Part five explains the positions of the various political parties concerning the problem of abused women treatment and gives a synthesis and critical analysis of various positions concerning the issue.

Part One: Violence against Women.

The problem

Violence influences all members of society. However, violence against women is an urgent problem that is closely connected to inequalities and power disproportion in society. It seriously influences the ability of women to achieve equal status. As a matter of fact, it is not only the great number of violence cases against women that threatens women's lives, but the fear of violence that influences their everyday life, how they dress, where they go, with whom they communicate, etc. Violence against women continues to be an urgent social and economic problem in the world with serious influences on our health and social services systems.

Violence against women is any act of gender-based violence that leads to, or is likely to lead to, physical, sexual or psychological damage or suffering to women, including threats of such acts, assault or arbitrary deprivation of liberty, whether happening in public or private life.

Scientific interest in the issue of violence against women and its connections to poor mental health used to be insignificant. Nevertheless, the rise of second wave feminism and activism around women’s rights generated the development of interest in the worldwide social problem of violence against women (Walker 1989, p. 702). The importance of this problem has now been affirmed. Violence against women is legally realized as a priority health and human rights problem (WHO, 1997). In March 1999 at the 43 rd session of the UN Commission on the Status of Women, a Resolution was adopted that admitted that violence against women is becoming acute in all countries, societies and socio-economic groups and as a aftermath the predominance of mental disorders in women, during all their life, is also on the rise.

In 1992, the America Medical Association Council on Scientific Affairs noted that: “Women in the United States are more likely to be abused and injured, assaulted, or killed by the present or ex-male partner than by an accidental assailant” (America Medical Association on Scientific Affairs 1992, p. 3185).

The National Commorbility Study (Kessler, Foster, Webster 1992, p. 119) acknowledged that women in comparison with men had a greatly increased risk of being abused by partners. That violence is more likely to be made by someone known intimately to the woman, is probably its most defining feature. It is surely one that deserves special care when seeking to explain the gender particular psychological influence of violence.

Violence against women is made in “peace” time in their countries and their own homes, usually by intimate partner and to a much lesser degree by strangers. Women are more likely than men to be abused by a member of the family or those whom they know well (Datta, Sharma, Razack, Ghosh, and Arora 1980, p. 285).

In war time, violence often becomes acute when women become a particular attention of organized violence by opposing armed forces (Littlewood 1997, p. 15).

Despite millions of women all over the world being caught up in wars, pursuit and torture, most of the studies on violence against women conducted nowadays has occurred on “peace” time.

Consequences of violence

Many women think that the psychological consequences of abuse are even more dangerous than its physical effects. The experience of abuse often shakes women's self-esteem and puts them at greate risk of a number of mental health problems, such as:

Depression that is becoming broadly recognized as a main health problem in the world (Bruyniks 1994, p. 56). Women who are abused by their partners suffer more depression, anxiety, and phobias than women who have not been abused, according to studies in Australia, Nicaragua, Pakistan, and the US (Kwast 1992, p. 11).

Post-traumatic stress disorder (PTSD) is a strong anxiety disorder that can happen when people go through or witness a traumatic event in which they feel despondent, helplessness or fear of death or injury (Adewole 1992, p. 115). The symptoms of PTSD contain mentally reliving the traumatic event by means of flashbacks; avoiding anything that would remind one of the event; experiencing discomfort in sleeping and concentrating; and being easily alarmed or frightened.

When a person's everyday life functioning or life alternatives continue to be influences, a post-traumatic stress disorder may be the problem, requiring professional treatment.

Suicide. Some women kill themselves or try to do so. Researches from some countries, including Sweden, and the US, have displayed that domestic violence is closely connected with suicide (Verme, Happer, Misra, and Neamatalla 1993, p. 67). Battered women who have PTSD symptoms prove to be most likely to try suicide.

Alcohol and drug use. Abused women are more likely than other women to misuse alcohol and drugs (United States: Agency for International development 1996. p. 7).

Origins of violence

The basic cause of violence against women lies in discrimination, which refutes women equality with men in all spheres of life. Violence is both underlies in discrimination and serves to strengthen discrimination.

Violence against women is a display of historically unequal status of women compared to men, which have resulted into domination and discrimination against women by men and to the prevention of the full development of women. Violence against women is one of the important social mechanisms by which women are constrained into a subordinate position in comparison with men. As violence against women is spread worldwide, many women are targets because of their ethnicity, class, sexual orientation or disability status.

Part Two: Treatment/Intervention models.

Service and treatment options

Abused women have service and treatment options accessible in their local community. The main treatment approaches made at the micro level are such types of interventions as counseling, legal advocacy and shelters.

Counseling is provided with experienced advocates and licensed counselors for adults, teenagers, and children. These services are accessible free of charge to anyone who has been abused. All client talks, even their name, are greatly confidential.

Legal advocacy. For more than two decades women's advocacy groups all over the world have been working to catch more attention to the physical and psychological abuse of women and to stress the urgency for action. Nowadays, these efforts are having positive outcomes. International institutions are speaking out against violence to women. Organizations, service providers, and policy-makers recognize that violence has serious unfavourable consequences for women's health and for society.

Shelters provide a safe refuge for abused women. Women who have been physically and / or psychologically abused may seek support at a shelter. Women may themselves decide if they want to stay for a night or two, or over a longer period of time. They may also choose whether just come and speak to a shelter worker for several hours, or seek counseling over the telephone. Shelters also attempt to influence public opinion and to change a societal attitude that is very important and effective.

Medications

Medications for abused women have traditionally been available only in abused women's shelters or from agencies providing services to abused women. However, in recent years, more programmes serving these women have been established in other places, reflecting the growing acknowledgement that women affected by violence live outside of shelters as well, and need service availability in a wide range of settings (National Council of Juvenile and Family Court Judges 1998, p. 69).

Although generically, most abuse related disorders are cured through a number of medications to allay immediate symptoms, and psychotherapy to help with long-term aims and solutions, the particular types of medications and psychotherapies used will differ from the type of disorders that have appeared to develop as a result of having been abused. For example, one person who has been abused might be suffering with posttraumatic stress disorder, while another might suffer from depression. Various disorders require various medications and psychotherapy approaches. The medications that better to fit the requirements of a patient will be most effective and will give good results.

Community Treatment/Intervention

Community gives health, legal, and social services. Therefore, an abused woman does not need to apply to another agency. It happens in most cities in the United States. Although, professionals in the fields of domestic violence and assault try to make this happen more frequently. Support in the community can come in different forms (Denver 2001, p. 217):

1) Crisis interference, such as emergency housing, medical treatment, and laws that protect women;

2) Advocacy and legal intervention, such as keeping the abuser from seeing the woman, granting custody of children, and helping financially;

3) Emotional help, such as self-help support groups and self-confidence training;

3) Other necessary services, such as safe housing and child care.

All kinds of community environments (residential, vocational, educational and social) are helpful though the effectiveness of each type of community environment is to be considered in every concrete case.

Women who have been abused have service and treatment choice available in their local community (for example, counseling, legal advocacy, shelters).

Part Three: Client/Family participation.

Client participation

Women who witness domestic or any other type of violence may be seen in group or individual therapy. The most widespread intervention for women who have witnessed domestic violence is group counseling (Peled and Edleson 1995, p. 4). Most of such groups are time-limited, and apply a particular psychoeducational programme that provides plan for discussions about violence against women, personal security, and identification of feelings. Some of the groups are based in abused women's shelters, others are held in mental health clinics.

In some cases groups are not quite appropriate for women who may be more seriously traumatized, because such abused women have more complex needs and are maybe better treated by individual approach. For instance, women who have witnessed fatal domestic violence and are suffering not only from the trauma of the events, but also with problems of bereavement, fall into this category (Pynoos and Eth 1984, p. 108). In these cases individual treatment with client participation is of great importance as it makes easier the problem of treatment. Clients should be involved in identifying and managing her problem behaviors though it is not wise to give them much power in treatment panning. Studies directed at investigation of the results of these interventions point out that treatment with active client participation becomes more effective. The interviews with participants, however, show that the therapeutic interventions have positive effects (Jaffe and Wolfe 1986, p. 356).

Family involvement

In spite of setting or kind of treatment, most descriptions of treatment of abused women stress the significance of involving family. Stabilizing the woman in a safe home situation is an important part of successful treatment, as it creates a positive bond between the woman and the nonviolent caregiver.

Individual interventions with strong family counseling features are usually recommended for abused women. Therapists can help a family recognize the influence of violence on an abused woman, can increase the stability and routine in their family’s lives, and can work out strategies to help the woman cope (Groves and Zuckerman 1997, p. 183). In addition therapists can assist family in learning how to communicate with an abused woman about the violent events. Finally, therapists may help as advocates, assisting family in securing a number of services: legal help, housing and health care. Although advocacy of this kind is a less traditional therapeutic function, it is often vital to helping families affected by violence considerably stabilize their lives so that family can benefit from direct treatment.

This therapy program is directed to help the abused woman and family deal with the impacts of the violence, while fortifying their abilities to function as a healthy family. Early outcomes of an evaluation component show the improvement in family relationships, the improvement in individual woman functioning (especially with learning readiness), and a decrease in woman's symptoms.

Providers must solve a variety of tasks as they seek to serve abused women. These include working with the women’s family members, responding to the women’s intense emotional experiences, and addressing suspicions and evidence of concurrent abuse of the woman by family members.

Part Four: Special needs.

The needs of victims are various. A woman in crisis requires physical security, emotional support, and help in resolving such issues as child support, ward, and employment. If she decides to press legal accusation against her abuser, she also requires help negotiating police and court procedures. Often, what she needs most is secure, supportive surroundings in which she can explore her problems and decide what to do next.

In many countries advocates have decided to found crisis centers or some other services to address the many requirements of battered women and girls. Such centers usually offer medical, legal, and counseling help, often all in one place. Some services are financially supported and directed by government, and others, by women's organizations or other support groups.

Services given by women's groups have contributed to the use of support groups and nondirective feminist counseling created to support women. Support groups can play a determinant role in reducing women's sense of loneliness, allowing them to educe a common understanding of violence from the event and to share managing strategies.

Developed countries often have rested upon shelters to protect women in difficult situation. Shelters are expensive to maintain, though, and require women to leave the place when familiar environment and the need in friendship could be a great help. Communities are now experimenting with other low-cost methods to increase women's security, such as providing secure home networks and refuge churches where women can seek security and support. In industrial countries such as Sweden and the US, governments and private organizations have tried to provide abused women with cellular phones, alarm appliances, and even guard dogs to help protect them from abusers.

Elsewhere, states decided to conduct an experiment with police stations where work only women - an innovation that was applied in Brazil and has now spread all over Latin America and in parts of Asia (Valentente et al., 1966, p. 78). Although good in theory, such attempts have faced many problems (Singh, Cabigon and Perez 1997, p. 105).

While the number of a women's police station grows, the number of battered women increases, often the women need services—such as legal advice and emotional help - that are not accessible at the stations. Moreover, the supposition that female officers will be more sympathetic to abused woman has not always proved true. Female officers work in all-women stations often have been mocked by their peers and have become demoralized. To be feasible, this strategy must be led along with sensitivity training for officers, mechanisms to recompense and legitimate the work, and provision of a wider number of services.

Women's needs are frequently neglected because of bureaucratic gaps or inappropriate coordination of ties between the health and criminal justice systems. In some states doctors are forbiden from treating women who have been abused or battered without licences from the courts or police. In other countries only court-appointed forensic experts may analyse crime victims. In Zimbabwe, for instance, a woman who has been abused may have to wait three days or more for an arrangement with a state medical officer. These officers are the only doctors authorized to document abuse or assault cases. By that time most of the physical proof may be missed. Similar demands exist elsewhere, including the states of Central America, India, and Peru (Oakley 1994, p. 158).

The absence of referral services and deficient coordination between health employees and referral services frequently prevent women from getting necessary medical care, involving emergency contraception and STI screening. In Zimbabwe a woman who had been abused said that, “The police reported they could not open my case without medico-legal findings. I went to the nurse at the health center. I was then suggested to come to the women's center. They referred me to Social Welfare. At Social Welfare I kept on being sent from one person to another the whole day. I went back the next day and was informed to go back to the police post”.

Abuse of women with disabilities

"Women have been hit, had their wheelchairs picked out and their phones broken, and have been locked in their rooms without admission to the bathroom. Women in organizations have medications withheld as a means of control; they have been over-medicated, flapped, neglected and physically and sexually abused with no way of complaints or help" (British Columbia Task Force 1992, p. 208).

Abused women with disabilities should be given the adequate quality of services in mainstream institutions as non-disabled women. Organizations can no longer justify the absence of understanding of the problems and a lack of admittance based on financial basis. Service agencies can reach their purposes by working in co-operation with one another.

There is no question that abuse of women with disabilities is an issue of epidemic proportions that is only beginning to captivate the attention of researchers, service suppliers, and funding agencies. The gaps in the literature are great. For each disability type, various dynamics of abuse come into play. For women with physical disabilities, restrictions in physically escaping brutal situations are in acute contrast to women with problems of hearing, who may be able to flee but face communication barriers in most settings provided to help abused women. Certain commonalities exist across disabled groups, such as financial dependence, social isolation, and the diminishing of self-esteem on the ground of disability as a cause of abuse. Research that employs methodological severity must be led with women who have disabilities such as deafness, blindness, mental illness, and mental retardation. Special attention must be given to distinguishing vulnerability factors that are disability-related as contrasted to those aspects experienced by all women.

Equity/ Access to treatment

Various organizations, such as shelters and communities, need financial support from government. They are mainly rested upon individual donations that they get from their supporters all over the world. The membership due of members and supporters is another source of their finances. Such organizations also get money from additional sources however it is difficult to match ever increasing needs of abused women. The aim would be almost fully achieved if organizations were not in financial dire straits.

Abused women suggest that cost is a serious reason for drop-out. Most of them add financial barrier to treatment in addition to other ones. The other barriers often take priority over the brutality. The women require help with child care, appropriate housing, transportation, and living-wage jobs to provide themselves and their children with all the necessary things. Security questions require family violence services to be achievable. As lasting change can only be influenced through medium-to long-term interventions, additional costs can restrain client participation in family violence programmes.

Another significant problem is political barrier. In most countries women should overcome many institutional problems to get the help they require. There is little arrangement among many institutions with which abuse women interact, such as health care, child welfare, and law enforcement organizations. When abused women seek help, some of these institutions tend to be unresponsive or even invidious.

Organizations at all ranks of the health care delivery system and in the association can best respond to the requirements of abused women if they are trained and told to do so. The proper types of response depend on the level and staffing of the organization. Many countries have composed national and internal plans to make coordination better between public representatives and community defenders and to monitor the quality of services for abused women. First of all, the project should contain creating coordinating councils at the community level, reorganizing the necessity of formal institutions such as the police and health system, and forming support groups for abused women and treatment programmes for abusers (Nichols, Ladipo and Otolorin 1986, p. 102).

Part Five: Parties’ promotion of various positions and their critical analysis.

Promotion the realization of Women’s Human Rights (Elimination of Violence against Women)

Acts of violence are still taken place against women and children and new solutions that will always be required have the purpose of stopping abuse against women and observation of these solutions will be needed in all societies that consider women and children are not to be abused in any way. In 1979, The Convention on the elimination of all forms of discrimination against women was accepted by the General Assembly of the United Nations. Nowadays, a number of 165 states have adopted this convention as of January 2000 (United Nations Population Fund 2000, p. 37). The affirmation declares that states should ensure that women have equal rights in education and equal access to data: diminishes discrimination against women in health care, and stops discrimination against women in all affairs concerning to marriage and family relations.

It is not only the United Nations who works on solving the problem of violence against women and children but all the existing political parties within the state itself.

In some countries women's human rights go on to be impeded thanks to the persistence of a culture of abuse against women, lack of knowledge about women's human rights and inappropriate resource distribution to combat abuses, including VAW at national and regional levels. This continues in nearly all countries of the region, in spite of governments' international obligations to uphold women's human rights and liquidate violence against women.

Nevertheless, what kind of programme and what aims the political parties have, they pay attention to the issue of counseling abused women. They have on their agenda the promotion of this problem. Action is demanded at the regional, national and local levels to make governments to account to take constructive actions to implement the obligations they have made under international conventions, such as CEDAW, and in international conference such as the Fourth World forum on Women.

Due to this regional programme UNIFEM looks for building on its strategic role at the regional sector in the thematic sphere of women's human rights and in accordance with the strategic purpose of increasing variants and opportunities for women, particularly those who live in poverty.

The programme has the purpose of promoting women's human rights in order to liquidate all types of violence against women and alter development into a more peaceful, appropriate and sustainable process; strengthening the ability of civil society organizations and communities to cooperate, advocate and teach citizens about abuse against women; placing the problem of violence against women on the policy agenda of states at all levels; increasing the effectiveness and vitality of existing methods and activities to liquidate violence against women; applying global social campaigns such as the 16 Days of Activism as catalyst factors to ensure that abuse against women problem are gradually brought to public attention and given grown priority by states at all ranks; promoting self-help and integrated techniques to the liquidation of violence against women in local authorities.

The present programme consists of:

  1. Forming national and regional EVAW action networks of state organizations, NGOs and international developing institutions.

The particular objective is to apply networking to put EVAW on the policy agenda at the local, regional and national ranks in the participating states and connect these activities at the regional level to grow the pressure on governments to take appropriate policy action. The activities will be stated in Cambodia, Philippines and Thailand, and later will be transferred to other states in the region.

  1. Supporting EVAW projects in the region.

Use global public projects such as the 16 Days of Activism as catalyst factor to ensure that EVAW problems are gradually put to public observation and given grown priority by governments at all stages. The main strategy is to broaden national activities and advance a regional dimension with the help of networking and advocacy.

  1. Activities

In 2001, the programme sponsored activities for the 16 Days of Activism project to diminish abuse against women in some countries.

  1. Consciousness rising among the young people.

Under this component one activity will apply theatre-in-education to form consciousness among the young people of the origins and consequences of abuse against women, including the connection between VAW and HIV/AIDS.

  1. Developing of self-help to the diminishing of VAW in local authorities.

This element will use a community-based advance to combat abuse against women. One activity under the element has the purpose to involve people of communities - families, students, women's groups, youth groups and local state officials - to assist women, survivors of violence, prevent such cases of abuse and better understand the problem.

  1. Setting EVAW on the political agenda.

Setting EVAW on the national political agenda will implicate lobbying members of parliament, senators, political parties and women's trends of political parties. At local levels, activities will involve lobbying with regional and local authorities.

Critical analysis of various positions

Although the governments and various political parties are working out the strategies for the issue solving, their positions require critical analysis. The lack of documentation on counseling abused women, its overgeneralization without concrete cases’ description as well as omission of some scandal facts is a significant problem that is to be solved.

Health systems and political parties all over the world have only recently started to deal with the challenge of reacting to physical and sexual violence. Most abuse interventions in health care institutions - except of the US - have not been formally appreciated, and pilot interventions in resource- poor settings are just taking place (Frejka, Atkin and Toro 1989, p. 124). There is an urgent necessity for demonstration projects, with appropriate evaluation, to define what works or does not work in different settings. However, some lessons have appeared:

  1. Having more training. As social workers’ training is important, it is seldom sufficient to change their behavior toward abused women. Although training can ameliorate the knowledge and practice during the short time, the impact of training usually erodes unless a number of other measures also are used that support new approaches.
  2. Applying a systems approach. Acquiring lasting change requires changing the health system itself as well as modifying the behavior of social workers. As administrators, managers and the health care system itself cheer new behavior towards abused women, social workers will better recognize and face violence (Djohan, Adenan and Tan 1993, p. 32).
  3. Making procedural alterations in client treatment. Applying such procedural alterations as adding prompts for social workers on medical charts or implying adequate questions and interview plans can arouse attention to domestic violence.
  4. Facing underlying attitudes and beliefs. Many training programmes for social workers have concentrated on the clinical treatment of abused women. However, his approach has limited results as social workers themselves have the same biases, beliefs, and fears concerning the abuse in the society in general. As programmes have obtained experience, it was found out that social workers should consider their own attitudes and prejudices about gender, abuse, and sexuality before they can acquire new professional experience while dealing with abused women.
  5. Reconsidering success. Social workers often want to face cases of domestic abuse because as it is a problem that is not easily solved or even addressed. Consequently, some training programmes have attempted to help the social worker to change their job from “fixing” the problem and giving advice to providing help.

Changing the social worker's role also helps to advance women's self- determination. Counseling concerning abuse, like contraceptive counseling, should be nondirective and respect women's choices.

  1. Giving opportunities to form new behavior. Two main barriers to asking women about abuse are health care workers’ belief that violence is unusual among their clients and health care workers’ fear of how the clients will act. Opportunities to experience new behavior can help to get over both barriers.

This practice breaks down the client’s resistance, replaces suppositions with experience, and encourages their interest in learning more about family abuse. Mainly, client’s come back from the experience wondering how many women experienced abuse and how willing women are to talk about such cases.

  1. Being strategic about where you begin. Modifying health systems is not easy. Consequently, the best practice should be started where success is most expected. As a rule, this method means choosing to undertake experimental interventions first in surroundings where there is essential inner and external support for change.

Firstly, it should be emphasized that it is significant to win the commitment and help of top managers previously. Attempts to join concern for sexuality into family planning projects have shown that organizational support is absolutely necessary to programme success (Barker 1992, p. 25).

Secondly, it is best to practice experimental interventions where help and referral services for abused women already take place. Perhaps, it is not possible in all cases, but, there are so few experimental initiatives, that it makes sense to start where there are institutional resources to draw upon.

  1. Planning for staff turnover. In many health systems, especially in developing countries, staff workers routinely rotate in and out of health institutions and other centers. Therefore, policies on abuse must be institutionalized, and experience will be needed for new staff workers on a lasting basis.
  2. Following up. Programmes should ensure constant support to persons and institutions trying to reform their actions to domestic abuse. Programmes that have tried to spark change by using a “train the trainer model” - encouraging health care workers to attend training in the centers and then supposing them to repeat the training in their home surroundings - have mainly found that such methods do not work well without essential continuity and helping (Djohan, Indrawasih, Adenan and Tan 1993, p. 32).

Conclusion

Stopping violence against women needs strategies coordinated among many parts of society and at regional and national levels. In some states effective health programs have taken the first place in addressing abuse against women. Though attempts should broaden beyond the health sector only. An agenda for change must contain: empowering abused women; coordinating organizational and individual demands; involving young people; and changing social norms.

Social workers often feel that the problem of violence against women is too complex and too overpowering to cope with. But essential change can - and often must - begin increasingly. A graduated response to abuse could begin with the following recommendations:

Developing pilot projects. More must be studied about how to unite concern for gender-based abuse into other effective health programs. Immediate support is required for pilot projects with strong evaluation features to discover what works best in various settings, especially where devices are few.

Integration into lasting training. The most effective method for a social worker to improve training of abused women is to integrate it into present training, particularly when training concerns quality of care, counseling, and male’s taking part. At a minimum all training for providers can add exercises about gender, sexuality, and offense.

Make new norms a programme equitable. Measurable indicators of effective health programme success can include, for instance, changes in the number of women and men who admit that a married woman has a right to refuse sex. The DHS now involve such problems. With new norms as a programme factual, managers will draw attention to how best to promote changes in public attitudes about women's independance and men's behavior.

A social worker should discuss with abused woman how much they can control sexual encounters. This is a decisive consideration in choosing of a family planning method. Providers can draw attention to methods that a woman can apply without her partner's knowledge or if she cannot expect sex. Also, providers can stress that sex - including sex within marriage - should be wished by both parties, not only by the man.

It should be noted that programmes on counseling abused women must involve people into discussion but not estrange them by arising to “demonize” men. To cheer people to study new norms, programmes have applied such methods as Community Theater and work in a small-group.

Not only programmes are to be created but also laws can be altered and programmes enacted that better protect abused women, raise the self-esteem of the abuser, and effect cultural values. Maybe most significant, however, social attitudes should be changed so that women get greater control over their own bodies, over financial and family support, and over their lives in general.

Social work professionals are to be acquainted with all the modern data and projects on counseling abused women. Social workers should obtain not only the theoretical ground, but the practical experience before starting work. Social workers can help solve the problem of abuse against women if they know how to question abused women about violence, become better familiar with the signs that can denote victims of domestic violence or sexual abuse, and assist women protect themselves by organizing a personal security plan. Everyone can take some measures to help promote nonviolent relationships.

For instance, the best way to discover a history of violence against female clients is to ask about it. Nevertheless, several kinds of physical damages, health conditions, and client conduct should raise social workers’ suspicion of domestic violence or sexual abuse. When these features, or “red flags,” take place, social workers should be sure to question abused women about possible abuse, remembering to feel empathy and respect with the client’s privacy.

Particular attention should be given to counseling abused women with disabilities and such recommendations for social workers can be given:

Make all services offered by abused women's programmes (for example, hot lines, personal counseling, and support groups) fully available and integrated for disabled women.

Provide with legal help for getting restraining orders and ruling court systems which is available to women with disabilities.

Maintain statistics on the number of disabled women who call crisis hot lines or apply other programme services.

Summarizing all the above discussed training staff on how to communicate with abused women is of primary importance. Social worker is a profession which requires understanding environmental barriers faced by abused women especially those with physical and sensory disabilities when offering advice or referrals for obtaining shelter. Abused women face serious barriers to accessing existing programmes to help women remove violence from their lives.

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