Factors Affecting Counseling Services in Social Service Structures Providing Support to Women Who Are Victims of Violence: A Qualitative Research in Greece

Introduction

The purpose of this study is to identify and designate the factors that influence the counseling process and the attitude of counselors in social service structures aimed to provide support to women who are victims of violence.

In Greece, the phenomenon of domestic violence has been intensified especially due to the capitalist/financial crisis. For the years 2008 and 2009 (years of entry into the financial crisis), there have been 33 murderous attempts against women by their spouses/companions, most of which resulted in the death or the severe disability of these women. According to the General Secretariat for Gender Equality (GSGE), 40% of women’s murders internationally are carried out by their spouses/companions. In Greece, in response to the intensity of the phenomenon in the recent years (especially from 2013 onward), an expanded network of services for the prevention and treatment of all forms of violence against women has been developed (domestic, intimate partner, rape, trafficking, and sexual harassment), designed, and created by GSGE and funded by the National Strategic Reference Framework (NSRF) under the National Program for Substantive Gender Equality 2010-2013.

This network includes (a) the telephone hotline that operates 24 hr a day/365 days a year and provides information services and telephone counseling to women who are victims of all forms of violence; (b) the 25 counseling centers set up in large municipalities of the country; (c) the 19 shelters for women who are victims of violence and their children, also set up in large municipalities; and (d) the two shelters of the National Centre for Social Solidarity (NCSS) in Athens and Thessaloniki, which were already operating earlier, but now have upgraded and expanded their operation.

The counseling centers provide psychological and social support as well as law counseling. The shelters provide psychological and social support, hospitality (room and board), and safety (the shelters are guarded). The services are provided to women of all ethnic and class backgrounds.

The GSGE coordinates and monitors the network with the aim of ensuring its successful and efficient operation, while implementing a model for the operation of the network’s social service structures that is based on the methodological approach of counseling with a gender perspective. It also designs and develops actions of public information and awareness (conferences, radio and television campaigns, brochures, etc.).

Given the fact that these social service organizations are newly created, and although they undoubtedly serve important social needs, the question that arises is how the counselors (especially social workers and psychologists) employed in these centers will actually meet the needs of those in need of counseling in the optimally best way possible. More specifically, what are the factors that influence the counseling process and the attitude of counselors in structures which are aimed to provide support to women who are victims of violence?

In the existing literature, we found significant evidence connected with our work, namely, with the factors affecting counseling services for abused women.

Goldblatt, Buchbinder, and Eisikovits (2009) note the importance of providing training to professionals who work with issues of abuse. They state that such training should place emphasis to the preparation of professionals for their emotional potential problems arising from this type of work, which can affect their personal lives. Goldblatt et al. (2009) argue that the techniques for managing and critically approaching personal relations and the monitoring balance between work and private life should actually be stressed than avoided or assumed. In addition, training in issues regarding gender, relationships, equality, and inequality, and strategies of responding to them are also considered indispensable. In this context, the professional counselors employed in social service structures aimed to support women will need to become familiar with elements of the female culture, the modes of women’s behavior and feelings, their unique needs, and the ways for their fulfillment. Finally, equally important is the placement of emphasis on socialization issues, implicit and explicit to the framework, with respect to broader matters such as individuality, freedom, choice, identity, and culture that are often neglected in the name of adopting technical skills as a sign of professionalism.

In an interesting and extensive study that focuses on sexual abuse (Ullman & Townsend, 2007), counselors refer to obstacles in working with women who report abuse, that are divided into three categories: social, organizational, and those related to the nature of the provision of service as such. All three categories, however, are characterized by the phenomenon of vocational burnout, which is a permanent risk in this type of work. The social obstacles include the clients’ denial of violence, counselors’ prejudices about race and social class, prejudices about gender and sexual orientation, as well as prejudices about the vulnerable groups of the population (e.g., disabilities biases). The organizational obstacles include the lack of funding, environmental factors (e.g., lack of privacy and limited space for doing advocacy in their workplace, safety concerns), professionalism, the presence of different philosophies, and racism. Finally, the obstacles related to the nature of the provision of service as such include access and availability barriers, the lack of resources to meet the needs of the victims, and vicarious trauma experienced by counselors. The difficulty and the risks related to vicarious trauma and to the vocational burnout are also confirmed by a multiplicity of studies (i.e., Kadambi &Truscott, 2003; Pack, 2004; Salston & Figley, 2003; Trippany, White Kress, & Wilcoxon, 2004). There is, however, conflicting evidence that does not confirm the occurrence of vocational burnout in persons working in shelters for victims of abuse, though they also associate factors such as time pressure and low self-efficacy with emotional exhaustion (Baker, O’Brien, & Salahuddin, 2007).

A recent quantitative study (Roush & Kurth, 2016) presents encouraging findings regarding knowledge, attitudes, beliefs, and behaviors of rural health care providers in intimate partner violence (IPV) agencies. In general, the respondents demonstrated good overall knowledge, judicious attitudes, and beliefs congruent with the available evidence related to IPV. Of concern were their knowledge and practice gaps regarding the prevalence of IPV, the higher risk of injury faced by women who leave their abusers, the ability of women to make appropriate choices about their situations, and what actions to take when someone discloses abuse. The results of this study were encouraging with regard to the IPV-related knowledge, attitudes, beliefs, and behaviors of rural health care providers. But the findings also indicated important knowledge and practice gaps. Preparing providers to deliver compassionate, effective care to women who experience IPV is essential for the health and well-being of women and their families (Roush & Kurth, 2016).

A qualitative study on stress and vicarious trauma highlights the preservation of relations with colleagues as a protective factor against vicarious trauma (Pack, 2004). The creation of colleague networks and the discussion of various issues and contradictions among theory, practice, and personal worldview seem to prevent the emergence of negative psychological consequences. Also, especially emphasized as essential for this type of work is the use of a collaborative framework. This is also confirmed in another study that highlights the role of social support, noting, however, that different forms of social support deal with different aspects of the so-called vocational burnout (Lambert, Altheimer, & Hogan, 2010). Another protective factor is a kind of inner spirituality arising out of the counselor’s work and sometimes replacing religious spirituality (Pack, 2004). In addition, significant is the maintenance of balance between both professional and personal life, as well as among the different work roles that the counselors are required to carry out. Moreover, experience appears to be more important than training on overcoming difficulties (Pack, 2004).

To address the negative consequences of the counseling vocation, and more specifically to mitigate the development of vicarious trauma, are the pursuit of psychotherapeutic help, the seeking of advice from professional peers, supervision, professional training, the reduction of workload of trauma cases, and the continuous care of the self. However, Bober and Rogehr (2006) emphasize that the adoption of the above strategies in the workplace is not effective alone: Each individual counselor’s needs must be taken care individually both on the level of prevention and on that of the subsequent treatment.

Additional factors mentioned as important in counselors of abused women are possible obstacles resulting from religious beliefs that reinforce the legitimacy of convictions regarding marriage and gender specific roles (Whipple, 1987), as well as cultural factors, including gender socialization and feminism (Kasturirangan & Williams, 2003).

Method

The present study uses qualitative research methodology and, in particular, the interpretative phenomenological (IP) method. IP method is a qualitative research methodology used to understand participants’ subjective realities through personal interpretations of their lived experiences and the meanings they attach to these experiences (Smith, 2011). Taking into account both its purpose to explore the idiosyncratic subjective experience and the social awareness of the participants, as well as its context—as it addresses the sensitive issue of abuse—this study uses the interpretative phenomenology to better approach the participants’ experiences and opinions (Smith, 2007). The use of IP approach—according to which the researchers’ involvement with the text gives them margin for more interpretative comments—was made on the basis that this method allows access to the inner world of the individual (Smith, 2007); IP does not aim for the generalization of the research results but, rather, focuses on in-depth study of phenomena in pursuit of the participants’ own frame of reference (Smith, Flowers, & Larkin, 2009).

Results

The response was positive, which can be partly attributed to the fact that the two researchers are clinical psychologists with considerable prior clinical and research experience.

Our research participants were 10 professional counselors (nine women and one man) working in social service structures that provide support to women who are victims of violence. Six of them are psychologists and the remaining four are social workers. Five of the participants work at the women’s counseling center, whereas the other five work at a shelter for women who are victims of violence. Three of the 10 participants had basic higher education degrees, six of them had graduate degrees, and one had a PhD. All the counselors had been employed for 24 months and the average of their work experience was 124 months. Regarding their family status, five participants were married, one was in a relationship, and four were single. Half of the participants had at least one child, and all 10 of them were of Greek nationality.

Discussion

Our study findings illustrate and confirm the importance of training (Goldblatt et al., 2009) and, more specifically, in this context of abused women, the importance of the oriented and more specialized counseling basic training on abuse and on the particular needs of this population. According to the recommendations of the counselors, this training must certainly be provided before the commencement of work, and continue in an ongoing process. The importance of prior learning is expressed in two ways. The training on the side of the responsible authority shows that the latter recognizes the importance of training for the work of the counselors. However, it is being described as short shows a disposition toward a further and more enhanced training. It is important to emphasize that for the training to have meaning, usefulness, and results for the employees in the specific context of work, its planning and implementation should take into account the professional and educational background of each individual employee. The personalized provision of training and supervision is also supported in earlier studies (e.g., Bober & Rogehr, 2006).

Besides training, emphasis has also been given to the role of supervision as something necessary at each step of this work. Insufficient supervision seems to create great difficulties at work, both due to the complex nature of the work as well as due to feelings of insecurity and the need for feedback and debriefing on the part of the employed counselors. Here, the need for contextualization becomes strongly evident, something that can also be confirmed by most therapists who work with specific groups of people.

The experience of the contact with women who are victims of abuse is reported as particularly rich and with a positive side by most counselors. It broadens their perspective, gives them a chance to work on a major psychosocial issue, and fills them with experiences and emotions. However, a contact with experiences of trauma can at the same time be burdensome; this may constitute a difficulty of this work in the long run. As a general observation, the responses of the counselors indicate familiarity with the abusive environment through the narratives of women—as victims and perpetrators. One notable issue is what the counselors often examine with respect to the women if, eventually, there is an interchange between the roles of the victim and of the perpetrator. They introduce this point in some form into their answers about the factors and complex issues that affect their work.

The difficulty of the work is even mitigated by the finding that the relationship with colleagues is positive and supportive. As documented earlier (Pack, 2004), practical and emotional support from colleagues with whom one shares the same difficulties and anxieties of the work is also important. In the context of working with abused women, the importance of the multidisciplinary team becomes obvious, both in terms of the complexity of the issues that arise (psychological, social, and legal) and in terms of the need for the complementarity of the different specialties.

In contrast to this positive assessment of the relations among colleagues, the connection with the municipal and state authorities is presented as burdensome. The latter is characterized mostly by structural difficulties, relating either to bureaucracy or to issues of funding, whereas there is reference to positive elements on the level of human conciliation.

A solution to the above issues could be broader disclosure of both the difficulties and the positive results of the structure’s operation. This could be done at the institutional level as well as at the level of information by means of organizing information days, publishing relevant articles, and cross institutional exchanges of information.

In addition, the provision of more systematic supervision appears as one of the most important needs, as it will provide the necessary support and framework to the hard work of counselors. Given the inherent difficulties of this work and the many findings on the risk of burnout (e.g., Kadambi & Truscott, 2003; Pack, 2004; Salston & Figley, 2003; Trippany et al., 2004), this seems to be a compelling need.

An ultimate consequence of highlighting the important factors, in providing counseling support to women who have suffered abuse, is the fuller understanding of the anthropocentric professions, of their importance, and of the difficulties they encounter. It is important to even stress, at the level of policies and strategies, the contrast between the growing increase in psychosocial problems and the degradation and the subsequent underfunding of anthropocentric professions at a moment when these are so necessary. In spite of the macropolitical chaos, it is important to provide continuity and resources at the micro level of the unknown and chaotic elements of abuse.

This specific research experience and the writing of an article on a major and sensitive psychosocial issue coincided with the news of the murder of two women by their partners in two Greek cities. Events such as this designate the critical seriousness of the phenomenon; this is something that also kept emerging during the research, because an almost permanent feeling of the researchers was that this phenomenon is much more widespread than most of us think. From findings such as this and up to the development of empathy not only for the counselors, but also, indirectly, for women/victims of abuse, this experience has been very rich in information and emotions. An important part of the process has been our respect toward and our non-directional approach of the participants, because the common professional identity of the researchers and the participants could easily create a more close-knit, intra-professional climate. However, it is certain that this shared identity has been one of the factors that contributed to the trust given to us by the participants from the very beginning.

Limitations of the Study

This study captures an image of the counseling provided in the social service organizations for the support of women who are victims of violence in Greece. Having collected our sample of participants from the relevant structures of three cities, which adds the perspective to identify local specific issues to an important area of knowledge. Despite this, we know that a future study would be more complete if there were participants from the totality of the country’s social service structures. Also, a comparative study with other European countries could possibly contribute to the identification of the similarities and differences, as well as to the depiction of cultural divergences related to the issue of abuse. Finally, despite the fact that our sample is a representative one—as in Greece the vast majority of counselors on issues of abuse are women— a study with a larger number of male participants would probably give us interesting information. That said, the IP method is aimed at a rich, detailed, local understanding of a phenomenon not generalizability.