General Practice and Primary Care - Theses
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Item“They have their own agenda”: Women domestic violence survivors’ accounts of seeing psychologists( 2023-08)Domestic violence (DV) is common in Australia with around a quarter of women experiencing physical, emotional or financial abuse by a partner during their lifetime. Survivors of DV often experience long lasting effects on their mental and emotional wellbeing and DV is strongly associated with a diagnosis of mental disorder. In Australia, the main pathway to receiving support for mental and emotional wellbeing is through government subsidised sessions with a psychologist in private practice. However, despite the prevalence of DV and the predominance of psychologists as the avenue of support, little is known about women survivors’ experiences in consulting psychologists. To address this gap, this thesis aimed to explore women’s experiences and expectations when consulting with psychologists after DV. This was done by asking two research questions: what were the experiences of seeing psychologists for women survivors of DV and what did women survivors of DV expect from psychologists? Semi-structured interviews with 20 women survivors were conducted. These interviews explored their accounts of consulting with psychologists and whether their experiences met what they expected from these consultations. The data from these interviews was analysed using Reflexive Thematic Analysis and the findings are presented in three groups of themes. Chapter Four presents two themes: ‘mirroring abuse or being supportive’ and ‘it did me quite a bit of damage’. This chapter discusses how psychologists often mirrored the abusive tactics of DV. These findings show how this was harmful and retraumatising and hindered further helpseeking by the women survivors. Chapter Five presents three themes: ‘see all of me’, ‘see me for my expertise’ and ‘don’t impose an agenda on me’. This chapter discusses how psychologists also often replicated the power and control dynamics of DV. These findings discuss the nature of power in the relationship between the survivors and the psychologists. Chapter Six, the final findings chapter, presents three themes: ‘narcissist description was helpful, ‘not all bad all the time’ and ‘structural explanations’. This chapter discusses how most psychologists showed a willingness to work with the women survivors to explore why their individual partners used DV. The women survivors found this helpful to their healing and to restoring their sense of self, replacing the negative view of self that their partners had engendered. These findings showed that, overall, many of the practices of psychologists did not meet what these women survivors wanted and expected. The findings suggest that whether or not the women survivors’ experiences with psychologists met their expectations was most likely to be connected to the psychologists’ general approach to practice or their worldview. To address this, the findings were synthesised to develop a DV Practice Framework to represent significant aspects of practice related to worldview. This is described in Chapter Seven. This framework was then applied to the trauma informed-care paradigm that is currently influential in the mental health system, as outlined in Chapter Eight. The resulting Trauma and Domestic Violence-informed Practice Model offers guidance to psychologists to help them develop a ‘whole of practice’ approach to working with survivors of DV.
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ItemSafety and resiliency at home: voices of children from a primary care population( 2015)Almost one quarter of Australian children experience family violence perpetrated by their father or step father which has significant health outcomes across the lifespan. However, some children who experience family violence are thought to be resilient. Children lack opportunities to have their voices heard, therefore children’s own understandings of their safety and resilience are often missing. As a site of early intervention, primary care is well placed to respond to these children. The aim of the research was to hear children’s voices about their safety and resilience in the context of family violence, and to determine an appropriate primary care response. Qualitative methodologies underpinned the research which involved semi-structured interviews and focus groups with 23 children and 18 mothers from primary care settings, all of whom had experienced family violence. I developed a child-centred approach utilising ethical and safe methods. A theoretical framework of ethics of care and dialogical ethics informed the research. Hermeneutic phenomenological analysis revealed that children and mothers understood children’s safety in the context of: awareness of family violence; whether the violence was named and by whom; who provided care and protection; and children’s sense of trust in relationships. Resilience was understood differently by children and mothers. Children understood their resilience according to social recognition of their achievements and talents. The children’s meaning was independent of adversity and aligned with the concept of relational self-worth. Mothers however, only understood children’s resilience with reference to the adversity their child had experienced. This was underpinned by the mother’s sense of responsibility for the adversity and the child’s apparent resilience despite this adversity. Understandings of safety and resiliency were further analysed to reveal the key finding that children required agency to negotiate their safety in the context of family violence and post-separation. A ‘model of children’s agency’ was developed to reflect the four factors that facilitated children’s agency: physical and emotional distance from the perpetrator; awareness of disruption or danger in the parental relationship; modelling of safety in relationships by non-violent adults; and the child’s sense of co-constructing family resiliency. To inform an appropriate primary care response, I also sought children’s and mothers’ understandings of primary care. Their insights focused on: questioning the role of primary care to respond to children experiencing family violence; the importance of knowing and modelling within the child-mother-health practitioner relationship; and the expectation that the health practitioner would facilitate communication about family violence. Using these insights, I proposed an approach based on collaboration, relationship and shared language, an ‘informed trialogue’ within the child-mother-health practitioner triad to foster children’s agency in the primary care consultation. The ‘informed trialogue’ guides the health practitioner to encourage and impart the ‘model of children’s agency’ by advocating physical and emotional distance from the perpetrator; building child awareness of family violence; supporting the modelling of safety in trusted relationships and demystifying family resiliency. The ‘model of children’s agency’ and the ‘informed trialogue’ bring children’s voices to the fore to inform primary care and those that work with children experiencing family violence.