Abstract
Violence against people is a widespread phenomenon and violence against people with disabilities even more common. Studies have examined different types of violence toward people with disabilities, but there has been almost no research to date on verbal violence involving people with intellectual or development disabilities (IDD). The present research focused on this subject. A qualitative study was conducted using an intervention program. The research questions were (a) what can help people with IDD expand their understanding of verbal violence and differentiate different situations of verbal violence and (b) what can help people with IDD expand their means for handling verbal violence of their own and that directed toward them? The sample included 64 people (45 males, 19 females; ages 22–75) with mild IDD, who were divided into four groups of 16 participants each in the intervention program. The findings indicate that the participants’ conceptualization of verbal violence improved after the intervention program. Three main themes were identified: (a) differentiation between good and bad; (b) choosing how to handle verbal violence; and (c) helping others cope with verbal violence. Consistent with the humanistic perspective, the findings show that people with IDD can learn to handle verbal violence toward them in a way that promotes their understanding, enables them to choose their reactions, and affects those around them, as well as strengthening their self-efficacy. The research contributes to the sparse knowledge regarding verbal violence, especially against people with IDD, and offers ways of intervening to help them handle verbal violence.
Keywords
Introduction
According to the research literature, one of the factors that impacts the lives and integration of people with disabilities, including those with intellectual or development disabilities (IDD), is the incidence of violence, including verbal violence (Dammeyer & Chapman, 2018; Dembo et al., 2018). Extensive research has investigated the use of violence, especially domestic, physical, and sexual violence, toward people with different disabilities, by relatives, spouses, neighbors, and caregivers (McGowan & Elliott, 2019; Stern et al., 2020). Studies have found that people with disabilities experience violence more frequently compared with the general population, and women with disabilities are exposed to violence more often than their male counterparts (Curtiss & Kammes, 2020; Valentine et al., 2019; van der Heijden et al., 2019).
It is important to note that for the most part, the research literature refers to people with disabilities in general; less has dealt specifically with people with IDD. This might be explained by the findings in Dinora et al.’s (2020) literature survey that people with IDD are often excluded from evaluation research because the measures employed are not cognitively accessible and many people with IDD have communications difficulties. It is important to note that although few studies have been published on verbal violence against people with disabilities, reports suggest that it is a frequent occurrence (Derdar, 2017; Karni-Vizer, 2018).
Verbal violence is part of the language that shapes social culture; it constitutes an integral part of language. Some words might be considered violent in one culture but not in another (Derdar, 2017). Verbal violence includes humiliation, insulting, name-calling, ridiculing, threatening, uses of rude words, cursing, and yelling. It can have destructive implications that are liable to cause long-term mental harm (Uzun, 2003). In addition, verbal violence might cause more severe harm than physical violence does (Teicher et al., 2006).
For example, in their study in the United States on verbal violence toward people with mental diseases, Karni-Vizer and Salzer (2016) found that 82% of the 50 research participants had experienced at least one of the eight types of verbal violence. The types most frequently reported (60%) by the participants were name-calling, humiliation, and insults. Thirty percent reported that they were ridiculed and yelled at; 10% reported being cursed. Threats and rude words were reported less. The most frequent sources of verbal violence toward them were their friends and relatives (especially parents).
Karni (2014) studied the frequency of verbal violence among 90 people with IDD who resided in different housing programs. The focus was on describing and identifying verbal violence toward people with IDD, a significant aspect of social interactions that shapes and influences the life of the adults with IDD. The findings showed that the level of exposure to verbal violence was significantly higher and more frequently reported among residents of community and dormitory housing compared with those residing with their families.
Based on the findings of previous studies, the main purpose of the present research was to find ways to address the high incidence of verbal violence toward people with IDD. In addition to the need to change the social attitudes toward people with IDD and eliminate verbal violence toward them, the research focused on strengthening the ability of people with IDD to handle such violence toward them. According to the humanistic perspective, individuals with IDD can gain insights about their life and its management, sometimes with appropriate mediation. They have the ability to choose between alternatives and conduct social relationships that benefit them (Reiter, 2016). Moreover, according to this perspective, people with IDD can learn to develop life skills, study skills, acquire knowledge, and establish their identity and values through practice and development (Brown et al., 2009; Friedman, 2020).
Accordingly, the purpose of the present research was to examine whether it is possible to improve the ability of people with IDD to handle verbal violence toward them. The underly premise was that verbal violence is an existing part of the social relationships between people with IDD with those around them and influences their sense of social belonging, and in turn, their quality of life. Conducting good social relationships that include social support improves quality of life, sense of personal well-being, mental health, and sense of social belonging. Sense of social belonging and maintaining friendships foster greater involvement in society and better conflict management (Friedman & Rizzolo, 2018; Petrina et al., 2017).
In addition to the basic need for interpersonal relationships, previous research has found difficulties in social relationships among people with IDD. Compared with people who do not have disabilities, people with IDD report more loneliness, demonstrate difficulty in building and maintaining relationships, and conduct less deep interpersonal relationships with their peer group (Friedman & Rizzolo, 2018; Fulford & Cobigo, 2018; Petrina et al., 2017). For example, Shpigelman (2019) reported that people with IDD sometimes found themselves ostracized from the community because of environmental barriers, especially stigmatization, and they are less successful in managing social relationships.
The intervention program operated for the present research was based on the cycle of internalized learning (CIL) model (Reiter, 2016). This model outlines stages in the process of change that individuals undergo in the interrelationships they develop with their peer group. The assumption is that every person has the ability to understand those around them and themselves, control oneself and one’s behavior, set goals, plan their implementation, and act to achieve them. Consequently, our objective in the present research was to teach people with IDD to handle verbal violence toward them by acquiring tools and improving their social skills. Another objective of the program was to teach people with IDD to identify situations in which verbal violence was directed at them and choose to react in constructive ways to eliminate the verbal violence toward them.
The CIL model has been used in studies on diverse aspects of children and adolescents with IDD. For example, Almousni’s (2013) research with students with IDD in the context of adapted physical activity in schools included an intervention program based on this model. The sample included 90 students with IDD aged 18 to 21 with similar motoric abilities and no physical restrictions. The objectives of the program focused on improving personal autonomy of the research participants, to promote their development of a positive self-image and their willingness and ability to make personal decisions in their daily lives as equal members of the community. The researcher concluded that the role of the physical education teacher is to create a democratic learning environment that respects every student. To this end, instructors must provide suitable conditions for empowering learning. She suggested that teachers should provide opportunities that enable learners to realize their decision-making ability as an important parameter in the experience of quality of life.
Shavit (2015) employed the CIL model to examine the impact of an effective learning environment on increased self-determination and quality of life among students with IDD. Her study included 74 adolescents with IDD, divided into two groups, one based on the traditional instruction model and the second on the CIL model. The findings indicated that the participants in the CIL reported higher autonomy, empowerment, and self-regulation compared with the other group. In addition, they reported increased sense of satisfaction, productivity, and social belonging. Thus, the program employed in the research was found to be effective.
In summary, the findings of the existing research indicate that the CIL program is effective mainly among children and adolescents with IDD. In the present research, the program was adapted and implemented for adults with IDD. The aim was to understand how people with IDD experience verbal violence that is directed at them and how an intervention program can help them improve their life skills to enable them more effective handling of this type of violence directed. Qualitative methodology was used in the present study. This choice was based on the lack of research on the nature and responses to verbal violence among people with intellectual disabilities; to date, only the existence of such violence has been tested. Therefore, as a first research step, we sought to hear the voices of people with disabilities, to learn how they identified, experienced, and interpreted their experience of encountering verbal violence.
Based on this, the research questions were (a) what can help people with IDD expand their understanding of verbal violence of different types and differentiate different situations of verbal violence and (b) what can help people with IDD expand their means for handling verbal violence of their own and that directed toward them?
Method
This present research was a qualitative study in which participants were asked to describe their experiences authentically. The aim was to give maximum expression to the participants’ view and to understand their life experiences in the context of the researched experience (Groenewald, 2004; Moustakas, 1994).
Participants
The study was conducted in Israel and included 64 (45 males and 19 females) people with mild to moderate IDD. Their ages ranged between 22 and 75 years (M = 40.95, SD = 14.85). Of the 64 participants, 30 lived in the community and 34 in residential houses. In all, 21 of the participants were employed in the free market and 43 in workplace rehabilitation. The sample was selected from a population living in the north of the country (a convenience sample).
Instrument
The CIL program
The CIL model developed by Reiter (2016) comprises five stages. The first stage is presentation of a specific subject related to experiences from daily life. The second stage is composed on academic instruction, including analysis of the research subject and clarification of definitions, concepts, and generalizations. In the third stage, the participants are asked to express their views on the subject and their personal associations with it in the past and present. Based on the concepts they are taught in the program, the participants suggest alternative or new behaviors and means to resolve dilemmas and problems that were raised in the first stage. In the fourth stage, the group members use role play, simulation, and practical experiences from their daily lives to develop suggestions for alternative behaviors. Finally, in the fifth stage, a discussion is held that focuses on the values that underly the personal and group behavior, and what the participants have learned about themselves and the others.
The intervention program was implemented in 20 weekly sessions over approximately 5 months. Each session lasted about 1 hour. The participants were divided randomly into four groups, each with 16 participants and a leader who a social worker by profession. The social workers were trained and received guidance in the principles of the intervention program and professional facilitation throughout the research period. Each session addressed a different subject related to verbal violence incidents that arose in the lives of the participants. The intervention program focused on (a) the definition, identification, and participants’ ways of coping with verbal violence; (b) the existence of verbal violence in the lives of the participants as expressed in their social satisfaction; (c) exposure to verbal violence as expressed in the self-efficacy and productivity of the participations; (d) exposure to verbal violence as expressed in the feelings of empowerment and independence of the participants; and (e) exposure to verbal violence as expressed in their social belonging and community inclusion.
Procedure
The study was conducted with the approval and collaboration of the Ministry of Social Affairs and Social Services in Israel and approved by its Ethics Committee. Based on this, the directors of the residential framework also approved the research. The legal guardians of the participants signed a letter of informed consent. Finally, people with IDD ware approached and asked if they were willing to volunteer to take part in the study. Four social workers (three women and one man) who work with adults with IDD were recruited to individually lead the four intervention group sessions. All of them were employed as case managers with people disabilities, with work experience ranging from 3 to 10 years.
The researchers trained the social workers (in five 1-hour sessions) to lead the sessions of the intervention program based on the CIL model. After this, each social worker provided the participants with additional explanations about the study and described how confidentiality and anonymity would be maintained. They also informed the participants that they had the right not to participant and to stop their participation at any time during the research. In addition, they asked the participants for consent to record the sessions in situ and later transcribe them. The 64 participants who agreed to participate in the study signed on an informed consent form. Each social worker met with 16 participants every week for 5 months, 1 hour per week. All 80 recordings of the group sessions were transcribed and analyzed by the researchers. They were destroyed after the data processing was complete.
Analysis
Following the approach developed by Lincoln and Guba (1986), two researchers independently coded and analyzed all the intervention program sessions, using thematic content analysis (Anderson, 2007). To address potential bias, one coder was male and the other female.
The researchers both had extensive experience in working with adults with disabilities. One had focused their research on verbal violence toward adults with disabilities and had previously used the CIL model in studies with children with IDD (Karni, 2014). The second researcher had engaged primarily in qualitative research of strategies to support adults with disabilities (Neuman, 2020a, 2020b).
We conducted independent analyses of the participants’ narratives, focusing on how they reflected their experiences of verbal violence, feelings about those situations, and strategies for coping with them, in keeping with the research questions. The content analysis was conducted in six steps (Braun & Clarke, 2006). The first was familiarization with the data. We each listened to the recordings of the intervention program sessions and read the transcripts. The second step was coding, in which each of us found data and selected excerpts that were relevant to the research questions that guided the analysis. We then analyzed five transcripts from the intervention program each, with the aim of finding the key issues that emerged from the intervention program sessions. In the third step, we identified themes that emerged from the analyzed data. After doing so, we met to compare our respective analyses, formulate categories that would serve as a framework for analysis of the transcripts, and connect these to the themes. This meeting continued until we reached consensus. We then separately analyzed the additional transcripts to find patterns. The fourth step was to review the themes and coding for their correspondence to the research questions. In the fifth step, we met to assign names to the themes and conduct a detailed analysis of each of these topics. In the sixth step, we constructed a comprehensive document that mapped out the themes, accompanied by relevant excerpts from the session transcripts.
In a second layer of analysis, the researchers sought links among the different themes to create overarching themes. Trustworthiness and credibility were achieved with peer debriefing, in which an expert colleague reviewed the analysis and provided critical feedback (Brantlinger et al., 2005). The external reviewer confirmed the themes and overarching themes initially extracted from the intervention program meetings without alteration.
In the next stage, member checking was conducted to enhance trustworthiness. However, some of the participants (adults with IDD) had difficulty responding to the concepts presented to them. This might have been due to their cognitive disability or to their tendency to seek social desirability.
Findings
The participants were asked to describe the eight types of verbal violence (humiliation, insulting, name-calling, ridiculing, threatening, cursing, rudeness, and yelling) at two points in time, before the intervention program was implemented (Point 1) and at its end (Point 2). Table 1 presents a summary of their explanations of each type of verbal violence at the two points of time.
Participants’ Explanation of the Types of Verbal Violence at the Beginning and End of the Intervention.
Humiliation
At Point 1, the participants expressed lack of clarity in differentiating humiliation from other behaviors, such as insulting or rudeness, that represent verbal violence. For example, one participant (57) remarked that humiliation for him was when “someone says a naughty word to you and says you’re not good enough, tells you you’re a nobody.” At Point 2, they described humiliation in reference to people who did not respect them as a person. For example, Participant 57 explained: When someone says about a certain person that he cannot do things and humiliates him, saying he cannot do certain things and limiting him in things. The injured person lowers his eyes because he feels uncomfortable and humiliated. He [the offending person] hurts his dignity.
Insulting
At Point 1, the participants could not identify insults or differentiate them from other types (like cursing or name-calling) of verbal violence. Examples were as follows: “They tell you—you are fat, full, they say all sorts of nonsense, like cursing” (Participant 21). “Someone comes and hurts you in the sensitive spot” (Participant 5). At Point 2, the participants described insults mainly as talking unpleasantly to someone else. For example, one explained: “I want to sit in a chair next to someone and she doesn’t want me to and tells me to go away and not sit there. That’s insulting” (Participant 43).
Name-Calling
The program participants knew how to identify name-calling at both points in time of the research. At Point 1, they described it as “when someone calls someone else names that are not their names, and not any names, but rude names” (Participant 28). At Point 2, they offered similar descriptions, such as “instead of calling him by his name, they call him a rude name” (Participant 9).
Ridiculing
The participants knew how to describe ridicule both before and after the intervention. At Point 1, their descriptions referred to “laughing at a person because he’s different from society, at his speech or something that he feels uncomfortable about” (Participant 33). At Point 2, there was a notably deeper understanding of the emotional experience of the person who was hurt by such behavior. One explained, for example: “He was emotionally hurt by them laughing at him. It was intentional, meant to hurt him by talking unpleasantly” (Participant 1).
Threatening
At both points in time during the research, the participants demonstrated understanding of what it was to threaten someone. At Point 1, for instance, one explained: “They say someone will hurt him. Some do this in our lobby at the residence; they say they will do bad things” (Participant 11). At Point 2, an example was: “When you threaten someone that if he doesn’t do this or that, you’ll take these measures. It’s a sort of warning” (Participant 49).
Cursing
At Point 1, the participants knew mainly to give examples of curses, such as “To say rude words—‘disgusting, son of a bitch, fucked up’” (Participant 16). At Point 2, they conceptualized this type of verbal violence and the underlying intention (of insulting). For example, one explained, “A curse is something that dirties the mouth and saying things to insult and hurt, when people speak rudely” (Participant 62).
Rudeness
At Point 1, the participants described rudeness as use of curses, such as “You’re a woman so it’s better not to say . . . but for example, slut” (Participant 44). At Point 2, the descriptions were more precise, distinct from cursing and associated with the underlying intention, such as “To say rude things. To talk about immodest body parts in public and to draw them in public and to tease intentionally—unpleasant things that hurt a person” (Participant 25).
Yelling
The description of yelling is clear and one-dimensional (“raising one’s voice in order to hurt someone”). Therefore, the participants were asked how they felt when people yelled at them. At Point 1, they said that they were hurt or frightened. For example, one explained, “It’s unpleasant, I feel sad and lonely, I don’t feel like being there. It’s an unpleasant feeling and I close myself up at home; I’m afraid” (Participant 17). At Point 2, they more often described being yelled at as an unpleasant feeling that aroused their anger, which they chose to ignore or later relate their feelings to the assailant. Examples were as follows: “I don’t react. Ignore it. I don’t feel good in my heart; it makes me angry” (Participant 13); and “I tell him, ‘excuse me, that’s not nice for me.’ This happened a lot with my roommate” (Participant 23).
In summary, the participants’ descriptions at the beginning of the intervention program were very vague. It was very hard for them to talk about how they handled situations in which they were exposed to verbal violence. It is difficult to say whether the low number of reports was an expression of difficulty coping, conceptualizing, or talking about coping in group sessions. The few descriptions that they nevertheless provided were brief and focused mainly on withdrawal and reporting the incident to an authority figure.
At the beginning of the intervention program, most of the participants chose to talk about unpleasant feelings that they experienced when they were exposed to verbal violence, distress that they experienced as an outcome, and a tendency, at least in some instances, to ignore it and move away: “It’s unpleasant when they do this to me, and it’s disrespectful of me” (14 times), “I was insulted” (16 times), “I was hurt” (29 times), “I was afraid” (7 times), “I ignored it” (17 times), and “I moved away/left” (22 times). The participants also noted that their response to the distress they experienced because of verbal violence was to turn to an authority figure, usually a welfare worker: “I told my welfare worker” (these words were used 58 times by the program participants) and bosses: “While gardening, someone yelled at me and called me a ‘retard’. I was really insulted by him. I was afraid and cried a bit. And that’s okay, because I told my boss” (these words—“I told my boss”—were used 34 times by program participants).
In comparison, at the end of the intervention program, when the participants were asked to describe what verbal violence meant to them, they were able to differentiate between the various aspects of verbal violence. For instance, they distinguished insults (rude speech) from humiliation (injury to respect) and conceptualized the aspects of verbal violence and the respective underlying intention of this injury. Their descriptions were more precise and they knew how to describe the feelings that arose because of the exposure to verbal violence.
During the program, the participants described incidents associated with three main themes, each of them representing a different point of view in the discourse about verbal violence.
The first of these themes focused on the ability of a person with IDD to refrain from using verbal violence, that is to differentiate between good and bad and choose not to use verbal violence. The second focused on the person with IDD being a victim, that is to manage feelings and choose how to cope with verbal violence directed at you. The third theme focused on the ability of a person with IDD to help people in their immediate environment handle verbal violence directed at them, that is to help others cope with verbal violence that they experienced.
Theme 1: Differentiating between good and bad
During the program, the program participants gained increased understanding and recognition that they could choose a nonviolent path. In other words, they realized they could decide how they would behave and held sole responsibility for this choice. They began referring to additional dimensions of incidents of violence, including the role of the assailant, the victim, and of the outside observer (as part of social responsibility). They discussed their potential to change a situation that included use and exposure to violence by learning from experience in the intervention program. In this context, they referred to their ability to choose to avoid unnecessary complex situations that could lead to violent incidents.
The texts indicated that they had learned to change their behavior patterns, distinguishing between permissible and forbidden actions, or what was socially acceptable and what was not. They also addressed their own responsibility for their behavior, including their role in situations of violence. “I learned that one shouldn’t use verbal violence and shouldn’t raise one’s voice at someone else. We shouldn’t hit one another or curse—that’s not allowed. One should take initiative, take responsibility and be independent” (Participant 18). During the intervention program, their self-confidence increased, as did the recognition that they could control their behavior. For example, Participant 29 said, “I learned to be more self-confident. . . . This group helped me not to hit. I didn’t hit anyone.”
The contribution of the sessions was expressed in the power of the group to help find solutions such as avoiding situations of violence, choosing not to use violence, and getting help from the peer group to reduce one’s involvement in violence: I say that the sessions here are increasingly helping me, to the point that there won’t be disagreements at all. Everything will be perfect. I learned from the incident that happened to me—not to fight back, but to talk with someone and find a solution thanks to the group. (Participant 54)
Other participants shared that because of the program they learned not to intervene in matters that were not related to them directly and to avoid situations that could arouse uneasiness. For example, Participant 3 shared, “I learned not to intervene in things not related to me. Once I would sometimes do this.” They also expressed the understanding that such intervention could be harmful to everyone. For example, “I also learned not to get involved. It wasn’t good that I got involved. What we go through here is like the school of life” (Participant 15).
Theme 2: Choosing how to handle verbal violence
The second theme referred to the encounter of the program participants with a variety of feelings during incidents of verbal violence against them, including a sense of fear and a deliberate choice to react by using their inner strengths to control this and achieve calm. In other words, the participants were able to identify and work on their deep feelings when exposed to verbal violence. For example, one of them described talking to himself as a coping strategy: “Go away, go away, fear, get out of here, fear” (Participant 54), and another spoke about the sense of being able to control these feelings: “I take the strength within me and I calm myself! I tell myself ‘go away, fear’” (Participant 48).
In the course of the program, the participants began describing their ability to manage events that included verbal violence and their responses to this violence. In these descriptions, it was evident how passiveness and a sense of helplessness, which were expressed in accepting their role as victims, were replaced by a sense of self-efficacy and activeness. They chose to cope with violence by actively ignoring the assailant and choosing not to be drawn into responding with violence. At the same time, there was a discourse of separation between feelings and reactions and heightened recognition that even if feelings didn’t always change, their reaction could. For example: On Monday he did this to me, he called me stupid, retarded. It’s insulting. I can’t keep this inside anymore . . . I mean I hear the positive thing in my head—he can say what he wants and I will ignore him despite what I feel. (Participant 13)
The feelings that arose from the transcripts reflected the participants’ understanding that they could choose and direct the process they were undergoing and develop their sense of identity by recognizing their abilities. For example, Participant 22 said, “Sometimes you have to think about what you want to do, whether it will help you breathe, calm down, think.” They also expressed an understanding that they could calm things down: “You threw fire and relit the match instead of calming things down and telling him ‘that’s enough’—you caused even more argument.’ You got him angry” (Participant 17). The identity they were developing during the process was reflected, among other things, in a sense of self-efficacy to handle situations. For example, Participant 5 said, “The power I have is not to pay attention, to choose to ignore the words he says to me. It goes in one ear and out the other and I leave. That way I won’t say rude words back to him.”
Another expression of self-efficacy can be found in the participants’ descriptions of their ability to reflect their hurt feelings to their assailant: “I choose to respond, to tell them I don’t like it” (Participant 17). Another example was “First of all I would say that the way you talk to me is unpleasant, and if you can’t respect how I sing, don’t listen to me. It insults me and I want you to respect me” (Participant 8).
Some of the participants described a sense that they could face their assailant and demand that he stop his behavior toward them. For example, Participant 20 said, “I chose to answer him on the spot instead of being insulted. I told him to please stop.” While building their identity, the participants demonstrated an ability to differentiate between choosing a reaction that was good for them (not to use violence) and a bad choice for them (using violence) in social situations. For example, “The end will be worse when you use violence in front of everyone. The more politely and civilly she asks [me], the better it will end” (Participant 60). The differentiation between good and bad seemed to be connected to the potential undesirable outcome of their actions—the choice of using violence and its social implications. In other words, remaining socially isolated because when you choose to use violence is an anti-social choice that leads to a reaction from society that categorizes people who use violence. For example, “People react in one way, you react in a different way, and they react to you. If you react rudely, they react rudely. You end up alone” (Participant 12).
Theme 3: Helping others cope with verbal violence
During the program, the participants began to understand that they could help in cases of verbal violence in their immediate environment. Program participants began supporting one another by offering solutions for coping with verbal violence toward other members of the group. They also shared their personal insights that the use of verbal violence was not a solution for handling with social situations. A positive shift in the group became evident when participants asked the members, rather than the group facilitator, what should be done when one of them experienced verbal violence. For example, Participant 33 said, “There are people at work who curse at me. I told my boss. There are friends who curse me.” She then asked the group, “What can I do?” The group members helped her with suggestions: “ignore it” (Participant 27) and “once, I would curse them; now I don’t anymore. Don’t curse back” (Participant 24).
In the sessions, the program participants offered several suggestions for getting people who used verbal violence to change their ways. It seemed that the participants succeeded in advising others to change their view and behavior in cases of verbal violence toward them: We learned that if something happens with one of the members of the workshop, you should talk outside, so not everyone hears. That’s what I did with a friend; I suggested we go outside to talk. And then we each heard what the other side had to say. (Participant 11)
They demonstrated an ability to explain to the group members and others that one should convey the unpleasant feelings of the victim to the assailant—especially the distress that the victim experienced during an incident of verbal violence—to the assailant. This involved deep feelings that arose in the intervention program about expressing difficulties and the deep desire for intimate friendships. In other words, the ability to convey to someone else the desire to be a friend but without knowledge or understanding of how to conduct friendship properly testified to high-order thinking. For example, Participant 64 said, “Instead of being hurtful he should say, ‘Maybe you can be my friends’? Maybe it’s hard for me because I don’t know how?’”
Discussion
Violence is a widespread and diverse phenomenon. It has many expressions, including verbal ones. Most research on violence in general and against people with disabilities, in particular, has focused on its scope. The findings indicated that people with disabilities are exposed to violence, humiliation, and abuse four times as much as people without disabilities, and women are exposed more than men (Araten-Bergman & Bigby, 2020; Lund, 2020; Wiseman & Watson, 2022). Moreover, such violence is often perpetrated by familiar people, caregivers, relatives, friends, and professionals (McGowan & Elliott, 2019; Scolese et al., 2020). Research has shown that people with IDD are exposed to violence 10 times more than people without disabilities (Dembo et al., 2018; Karni, 2014).
However, there is little information in the research literature about verbal violence. For example, in their research, Marín-Navarrete et al. (2022) noted that exposure to verbal violence and discrimination, which causes interpersonal problems and health problems, might be related to mental problems among people with disabilities. An examination of verbal violence among 90 people with intellectual disabilities living in different housing settings indicated a high frequency of reports. When asked if they had ever been exposed to verbal violence, more than half of the participants reported being yelled at (72%), insulted (65%), humiliated (60%), laughed at (58%), and cursed (51%) (Karni-Vizer, 2015). A later study of verbal violence, which was conducted among 99 people with intellectual disabilities living in community housing and institutional housing, indicated similar rates of reports of yelling (60%) and humiliation (52%) (Karni-Vizer, 2018).
In light of the high frequency of incidents of verbal violence and based on the humanistic premise that individuals with disabilities can learn to cope with many challenges in life (Reiter, 2015), the present research examined the effectiveness of an intervention program to help people with IDD handle the use of verbal violence by and toward them. Employing an intervention program, we examined (a) what can help people with IDD broaden their understanding of the different types of verbal violence and differentiate among situations of verbal violence and (b) how they handled verbal violence by and toward them before and after their participation in the program.
The findings indicate a significant change in both these measures. In general, they show, consistent with the humanistic perspective, that people with IDD are capable of learning about and handling verbal violence used by them and toward them in a way that promotes their understanding and enables them to choose their reactions and influence their environment. Moreover, this strengthens their sense of self-efficacy. These findings are consistent with those of other studies in which the CIL model was used (Ivzori et al., 2020; Reiter, 2016; Shavit, 2015) and found to be effective in increased self-determination that including self-efficacy students with IDD.
The decision to focus on the coping of individuals with disabilities was not meant to deny the responsibility of society for verbal violence toward people with disabilities. It is a social imperative to remove social barriers and eliminate of violence of all types. However, the present research focused on the life skills of individuals with disabilities, based on the assumption that the effort toward their full integration in life must include learning to handle their own conduct and life challenges (Presnell & Keesler, 2022; Schalock & Luckasson, 2021).
The present research was conducted with 64 people with IDD who lived in dormitory and community residences. The participants were divided into four groups that participated in an intervention program for 20 weekly sessions of about 1 hour each. The intervention program dealt with verbal violence that occurs in the lives of people with IDD in different places (in the community, at work, during leisure time) and their ways of handling it. At the beginning of the program, the participants were asked to describe what verbal violence meant to them. Their descriptions of the types of verbal violence were vague. They had difficulty describing how they handled violence toward them and focused mainly on describing their withdrawal and reporting to authority figures (mainly social workers), when encountering such incidents. This may reflect poor personal and interpersonal social skills.
At the end of the intervention program, their descriptions of verbal violence indicated that they knew how to differentiate the different types of verbal violence and to conceptualize the violence and the underlying intention when such violence was directed at them. This testifies to a change in their understanding and thinking. The participants also demonstrated notable ability to articulate the emotions they experienced due to verbal violence.
In addition to this, during the program, the participants described three additional main themes: (a) differentiation between good and bad; (b) choosing how to handle verbal violence; and (c) helping others cope with verbal violence. These themes were expressed in the three aspects of learning and development—knowledge, skills, and building an identity and personal value system—in an intervention program based on the CIL, which addresses all three of these types (Reiter, 2015).
On the level of knowledge, the program participants learned what verbal violence is and how to identify it when directed toward them. This knowledge is the foundation for coping with such incidents. On the level of skills, they demonstrated rich and precise ability to identify diverse emotions that they experienced when exposed to verbal violence and possible ways available to them for dealing with it. One of the characteristics of people with IDD is reliance on their caregivers to solve daily problems (Arnold & Heller, 2018; Holingue et al., 2020). After participation in the intervention program, the participants learned what other figures in their environment, in addition to their caregivers (mainly social workers), could help them in times of distress. These included their friends, coworkers, employers, staff members, and families. They also learned that they could choose several alternative solutions in situations of social conflict. In addition to knowledge and skills, the ability of the program participants to examine and choose alternative ways based on a value system they created through participation in the intervention program.
All these express a sense of autonomy that they acquired and newfound ability to choose their reactions according to the values they set themselves. The program participants demonstrated the ability to choose their responses and try to influence the reaction of those around them. These important processes are consistent with the overall aim of the CIL program, namely, autonomous conduct, which enables problem-solving according to one’s personal order of priorities (Reiter, 2016).
The findings of the present research have relevance beyond the issue of verbal violence and coping with it. The program contributed to the acknowledgment that people with IDD are capable of learning and changing patterns of thought and behavior. Moreover, they can influence their immediate environment by means of personal development. The intervention program based on the cycles of internalized learning model was effective in dealing with the issue of verbal violence involving people with IDD. The findings suggest that participation in the program led to a change in the self-awareness and the sense of personal and interpersonal responsibility of the participants. The findings broaden the knowledge regarding verbal violence, in general, and toward people with IDD, in particular. They suggest ways of intervening to help them handle verbal violence.
Limitations of the Research
The intervention program included 64 people with IDD, divided into four groups. A larger number of participants and of groups in a similar program could shed light on other aspects that did not arise in the present research. The intervention program, which dealt with personal development as part of life skills, included 20 sessions. The process of personal development is often a lengthy one, which requires long-term intervention. It should also be noted that the intervention program dealt with behavioral change of people with disabilities. As discussed, social change is also necessary, among other things in the immediate environment of the person with disabilities—family and professional staff members. Another limitation of the research could lie in its location in a single setting in northern Israel. It is important to examine this subject in additional frameworks.
Recommendations for Further Research
Qualitative studies with people with intellectual disabilities represent a complex challenge that contains many obstacles. As a result, it is not surprising that such an important and complex field such as verbal violence, which is present in the lives of people with intellectual disabilities, has hardly been studied to date. Among other goals, it is important to create a discourse regarding the possibility of helping people with disabilities deal with violence directed toward them.
Further to the present research, it is important to examine how professional staff members, including counselors in residential frameworks, workplaces, and leisure time programs handle verbal violence directed at people with IDD. In addition, it is necessary to examine how families of people with IDD who live with them handle verbal violence directed at their children and the ways in which they can help. Given the effectiveness of the intervention in empowering people with disabilities to deal with life challenges, it is also recommended to implement programs based on the CIL model in other areas of life of adults with IDD. In addition, it is important to compare the effect of verbal violence and responses to it with the effects of and responses to other types of violence, such as physical violence directed at them. Adopting these recommendations could inform the people who work and spend time with people with disabilities.
Footnotes
Acknowledgements
We would like to thank to Keren Shalem Foundation for funding this research.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: Grant number: 73401 (Keren Shalem Foundation); The study was approved by the Tel-Hai College Ethics Committee (Approval no. 09/2017-4).
