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In health care, we teach our clinicians to introduce the kinds of questions we want to ask to patients about, whether it's abuse or whatever, with the question, "Is home a safe place?" And when I would ask patients that, some of them would get it and their eyes would get big and some would say, "Wait a minute, what do you mean is home a safe place?" But we're going to talk about that today about whether home is a safe place.

And in this episode, we'll be talking about intimate partner violence and abuse. And if you feel the contents of this topic is too difficult to listen to, we'll be back next time with something that's a little easier for you. But if you're listening, and this is hard, make sure you're in a safe place and you have people around you.

Dr. Jones: In our studio, we're talking with Ellie Goldberg, who's a licensed clinical social worker. And she's the Assistant Director for Advocacy and at the University of Utah. And Ellie is going to help us make this real but not too scary. Thanks, Ellie.

Ellie: Thank you for having me.

Dr. Jones: So we're going to be talking about the seven domains and domestic violence. We're going to talk about violence in the home, whether it's emotional, spiritual, physical, financial. We're going to cover all the seven domains so we know that awful things can happen to people outside the home. But where often a lot of the violence happens is in the home.

Ellie: Right.

Dr. Jones: So do people come to you and talk about their home situation?

Ellie: Absolutely.

Dr. Jones: So how would you define domestic violence or domestic abuse? How do you define that?

Ellie: First of all, we like to say that our clients can define what is happening to them however they want.

Dr. Jones: Oh, that's good. That's brilliant.

Ellie: So if folks come in and they say, "This is happening, and this, this and this, what is going on with me? How do you define this?" We try to explore how they conceptualize what, for example, domestic violence is to them, what that means to them. Their definitions can be impacted by their culture, by their upbringing, by their faith, by lots of different factors. So each individual defines things differently.

However, we do have state policies that define domestic violence, and we also have university policies that define domestic violence. So going with those, it is violence of any type between intimate partners who live together or have lived together. And actually, more recently, a component has been added to the definition that is if folks have had an intimate relationship. So if they've had a sexual relationship or do have a sexual relationship, it can be considered domestic violence.

Dr. Jones: So intimate partner violence suggests that there's violence between intimate partners. But in the home, of course, we know that not just intimate partners can be violent against each other, but we can be violent against our children or our parents.

The Social Domain of Domestic Abuse

And I was thinking a little bit about cultural norms, and that there's some cultures and, of course, I think of cultures which are very hierarchical, where the man runs the show, and partner violence is considered a norm. It's considered somewhat acceptable. I don't think it's ever acceptable, but what the man and the woman might think and the culture itself might consider it acceptable.

Dr. Jones: So here, in the U.S., we're in Utah, and you have students from all over the world. And how do you deal with that when they come in if they've defined it as violence, then you accept that definition?

Ellie: Absolutely. We believe that if someone has been harmed or is being harmed, that they're feeling unsafe, they have been impacted, they're experiencing trauma that they can define it however they want, and they're eligible for our services. And we will start where they are, explore how the violence and the harm and the trauma is impacting them, and then figure out what their options are and help them decide how they want to move forward.

Dr. Jones: I like the phrase that you use "trauma-informed." Help me understand that because it's so powerful. A phrase or a set of words, it's the way you think about taking care of someone.

Ellie: Yeah. And I think it's something that not just in clinical or in helping professions, being trauma-informed just is understanding what trauma is, how it impacts people in lots of different ways, like in the seven domains of health, and the prevalence of trauma.

I think understanding that all of us have experienced some type of trauma at different levels in childhood as adults, but really, I would say understanding what trauma is, understanding the prevalence, and then being open to supporting folks, at least knowing what the resources are in getting folks connected with those resources, whether that's friends, family, intimate partners, or colleagues, anything. Just understanding what trauma does to people, how you can support and be compassionate and empathetic.

Dr. Jones: We have a refugee, we have refugees here in Salt Lake City. And certainly, I've had refugees from around the world come to settle in the U.S. And for many, many of those women, not only did they experience trauma within the refugee camps in their country, but even before that, they experienced trauma in their homes. And actually, I think of I'm a mother-in-law and I know in some cultures mother-in-laws are so powerful that they abuse young brides of their sons. And so this is such a big cultural issue for us. And I think we sometimes we normalize it on TV or we normalize physical abuse among intimate partners. And have you watched "Big Little Lies"?

Ellie: Yeah.

Dr. Jones: At the center of this very, very popular award-winning TV show, at the very core of this was a very abusive relationship. And both members were involved in this abuse, but it was horrifying to watch. And by having it out there, I don't know whether it helped people come forward, or did it just normalize like, "Oh, this is what happens." It was a difficult thing to see.

Ellie: Yeah. It was. Spoiler alert. But in the second season, the mother-in-law comes into play and is really blaming Nicole Kidman's character. I can't remember her name for the family being broken apart, for her husband dying and is trying to take her kids away. She's played by Meryl Streep, the mother-in-law. It's such an awesome show and I think it does . . . It's a glamorous show. It's very aesthetically beautiful. It's got such an amazing cast, but I would say that it's very disturbing.

Dr. Jones: It's very disturbing. And the young character, they're all these women are beautiful and incredibly smart and very wealthy, except for a younger character who comes to this little town. And partly, she's been the victim of rape.

Ellie: Yeah.

Dr. Jones: And she has so much memory trauma from that rape.

Ellie: Yeah. And it's interesting to draw it back with their socio-economic status on that show and then talking about folks with refugee backgrounds. Actually, what drew me to this job in this point in my career is that I worked with . . . I've been a social worker for a long time, and I worked with all sorts of different folks.

I actually worked with folks in refugee and immigrant communities, with kids in crisis, with older adults with dementia and their families. And I noticed that it didn't matter what people's identities were, their backgrounds, there was a common thread of interpersonal violence. And so I decided, after having worked in the community, that I wanted to focus in on helping folks who have or are experiencing interpersonal violence.

Dr. Jones: This doesn't excuse anything, anyone, but we are not. We are very social. And as a species, we're capable of great empathy. But we are capable of great violence and our nearest neighbors, we have two nearest neighbors in the great apes. One are the bonobos, and the others are the chimpanzees. And the chimpanzees are violent and they rape and they are very violent among their peers and to others. Bonobos fix everything with love. Not that they can't be violent. If a male starts in on a female, all the females gang up and start beating up the guy. But they use sex in different ways. And so we are our own species and we're not always very nice. I'm hoping we're getting toward nicer.

The Emotional Domain of Domestic Abuse

So the social aspects of domestic violence are complicated because there are cultures that do normalize it. But getting to the emotional aspects, I think that the background of every abusive relationship is this sense that if it happens more than once, a woman must be so traumatized that she doesn't stand up or she can't stand up, and she feels like she deserves it. And she must be depressed and anxious. Her emotional life must be traumatized completely.

Dr. Jones: I always wonder why women don't leave, but I've always had the resources. If anything had happened to me, thank God it didn't, I had the resources to walk out. Many women don't.

Ellie: I think because intimate partner violence, domestic violence in families and with child-free couples, it is so complex and there are so many intertwining factors. One of the most common things that I hear, when folks come in who have experienced domestic violence, is that they don't want to ruin their abuser's life.

They don't want to call the police. There's lots of different factors around that if they are undocumented, or if their husband is black and they don't want to put another black man in the system. They love and care for the person. They're obviously intimate partners, so they have a spiritual connection and a romantic connection. And if they're the parent of their children, of course, that adds in a whole other layer. But there's financial pieces, folks are dependent. A lot of times, partners who are women are dependent financially or their partner controls the finances.

The Financial Domain of Domestic Abuse

Dr. Jones: But let's talk about that just a little bit. Because I think in terms of the risks for abuse, I think certainly being a female is the number one risk for domestic violence. Just being female, being minority female is another. But relationships when there's power disparity and financial disparity, keeps someone from going because a relationship can be financially abusive just if one person who has the money hides the money and doesn't give that person any kind of financial independence or even let them know what resources they can call on.

Ellie: Right. They don't have passwords to bank accounts. They don't have their own checking account or access to a checking account. We even see with financial abuse partners that won't allow their spouse to work, to make their own money or that they will have their paycheck if they do work direct deposited into an account that they don't have access to. So employment plays a role in that. I definitely see financial abuse in lots of different ways, but you can't survive without money.

Dr. Jones: No. And you can't leave without money.

Ellie: Right.

Dr. Jones: Are there are resources, though? I think that the Y here in town is trying to help people leave in abusive situations. And often people would leave on their own, they could make it on their own, but they can't leave their kids, and that's something that's powerful with their children.

Ellie: I just learned about a resource at South Valley Services, which is a shelter and they also have community case management and things like that out on the southwest side of the valley. They have a financial empowerment component to their services, where they help with match savings and debt repayment and an emergency fund and things like that that will help folks be able to get out of their situations and recover from financial abuse that's had long-term impacts on them.

I have heard of men in relationships that will take out credit cards in their spouse's name, max them out. And so after someone leaves even they have a terrible credit score and their money is all gone. And even thinking about those long-term pieces of debt repayment, that's a service that is needed.

Dr. Jones: I didn't know that. That's new for me. I think of United Way and I think of umbrella services where you could call and say, "This is happening to me, where can I access help?" Do you call 911? Well, financial isn't . . . 911 is no financial resource for women who are being emotionally abused or are financially abused.

Ellie: Yeah. The YWCA and Family Justice Center in downtown Salt Lake are a fabulous resource. And then South Valley Services is another really great resource for folks.

The Environmental Domain of Domestic Abuse

As we think about financial resources and you think about women not being able to leave because they can't take their children, I think a lot about what happens to children who witness emotional or physical abuse in the family that is considered one of the adverse childhood events that leads to long-term hypertension, depression, anxiety, and maybe behaviors that perpetuate that abuse.

Ellie: I worked at Salt Lake County Youth Services in the juvenile receiving center doing crisis and family therapy and we saw really resilient, amazing, strong kids who also had a lot of behavior issues and had a lot of impulse control issues, substance abuse. You could tell that that was because of behavior that was modeled and just really ingrained trauma. And you could see patterns even in early adolescence in relationships that were really unhealthy.

Dr. Jones: The model now suggests that kids who are exposed to early childhood emotional trauma or witness trauma, that stress remodels their brain for handling stress. They don't handle stress, they become reactive children. However they might react, they can't calm themselves as well. They become a little hyperactive, they're always stressed. And that's partly a learned response, but the brain has been remodeled.

Ellie: Right.

Dr. Jones: And that's a pretty difficult thing to try to deal with, both as a mom who wants to keep the family together, but their children continue to witness this.

Ellie: It is actually illegal in the state of Utah. There's an enhancement to domestic violence charges. If it is domestic violence in the presence of a child, it is an enhancement to a criminal charge.

Dr. Jones: And what that means is a person might get a longer sentence or a higher fine or something like that.

Ellie: Yeah. And it's DCFS involvement. And there's a pretty strong consequence, of course. Not all domestic violence rises to criminal involvement, but I think that that shows that even on a criminal level or a statewide level that that is something that is recognized as a huge problem with lasting impacts.

Dr. Jones: Right. So the question I have as a provider, if a woman confides in me that she's being physically abused, she's an adult. I do not have, by law, the requirement to report that. If she's doing it in the presence of a child, and she's being abused, do I have to report that? The child isn't being directly abused, but the child is at the corner of an abusive relationship.

Ellie: Yeah. I think it would . . . I'm always a big fan of just calling DCFS if you suspect any sort of abuse of a child, but I think yeah. I would say that emotional and psychological abuses could be as damaging or even more damaging than physical abuse. And I think it happens a lot more frequently in domestic violence relationships. Yeah. I think that there's definitely a reason to call and get an intervention and help for that family.

Dr. Jones: Well, we've been thinking and reading more about how drugs, particularly stimulants or drugs which are disinhibitors, like alcohol or meth, can be part of a pattern of domestic violence, particularly alcohol. But I read an interesting article that in states where they legalized marijuana, serious physical domestic abuse events had gone down.

Ellie: Interesting.

Dr. Jones: When you think of men drinking too much or women drinking too much and getting violent, but it's really hard for me to think of someone getting a little high and getting violent. It's not part of the marijuana picture. Have you heard anything about these news? So people who might use marijuana instead of alcohol to relax tend to be less physically violent.

Ellie: That's interesting. I haven't.

Dr. Jones: Not that I'm suggesting that we add another thing that people can be addicted to, but in states where they're following this and people are using more THC for relaxation than alcohol, the rates of physical violence have gone down and domestic abuse.

Ellie: Fascinating.

Dr. Jones: Oh, I know. I know. Just hey. Just chill, dude.

Ellie: Just chill out.

Dr. Jones: Well, back to environmental issues. Do you think there's any season?

Ellie: Summer.

Dr. Jones: Summer?

Ellie: Yeah. I don't know if there's research behind this, but . . .

Dr. Jones: I think there's some data that when it gets hot, people's tempers get short.

Ellie: I think people get . . . Exactly. Their tempers get short. A lot of times kids are off school, so they're home and that adds a layer of stress. But a couple of summers ago, we had in the span of two and a half months, I think we had eight pretty serious domestic violence cases come in. And usually, summers are a little more chill for us.

Dr. Jones: Because students are off or they're maybe not in the classroom. And so I think that people have suggested summer, I mean, holidays are stressful and people are often drinking more. But when it gets hot summer in the city, it isn't very pretty. And when people are hot, they just get short.

Ellie: Yeah, I do. I don't harm other people, but I do.

The Intellectual Domain of Domestic Abuse

Dr. Jones: I get lemonade. So it's what I need when I get hot. Well, what about education? There's a myth that only poor women are abused, and there's a myth that smart women are not abused. And I think that that's a myth.

Ellie: Those are myths. Yes.

Dr. Jones: Those are myths because we know and you work here at the university. And so you're working with students and faculty and staff, all pretty well educated. How do we begin to use education to help women and men rise above this pattern of violence in their home?

Ellie: I think creating awareness that this is an issue that it goes across all spectrums of identities and socio-economic status and education level and race and ethnicity. Getting the awareness out there that this is an issue, and also the awareness of what domestic violence is, teaching about healthy relationships, teaching about unhealthy relationships, what are pink flags and what are red flags that show up?

Dr. Jones: Tell me about a pink flag. What's a pink flag?

Ellie: I think a pink flag is a lower level on the spectrum of abuse. Just patterns maybe that are emerging with power or with control, with jealousy, different things like that that haven't risen to the level where the person would consider them abuse or a red flag, but are just these emerging patterns or just this stuff where you get a gut feeling that it's not right or it's unhealthy.

Dr. Jones: Yeah. But there may be some pink flags earlier in a relationship about money. People don't want to talk about money, people are controlling about money and abuse is all about control and whoever is doing it.

Ellie: Yeah. And we see a lot of, especially with students, social media, and technology and internet, different kinds of internet venues and types of media. We definitely see a lot of pink flags starting to emerge when there's surveillance or who are you friends with? Whose posts are you liking? You're posting pictures with this group of friends, why are there all these guys in there? So we see a lot of emerging cyber pink and red flags and different things like that.

Dr. Jones: Well, so what's a red flag?

Ellie: Well, I think that's where the power and control starts to become really apparent. Obviously, physical abuse, preventing someone from leaving a room or taking away car keys or different things like that. I think what you would consider normal abuse are these red flags or the anger management isn't there. Someone is blowing up and in fits of rage. Someone is using substances and getting to the point where they're abusing their partner. Those are some red flags out there.

Dr. Jones: I like that comment of pink flags because I think I understand exactly what you mean. But giving it a name, a pink flag is powerful. And people know it. They say, this just doesn't feel good anymore. This relationship has this edge to it over these issues and I feel threatened. Has he ever hit you? No. He's never hit me, but I just feel threatened. My chest gets tight when we talk about things like this or when he yells at me or when he yells about somebody else. And I don't like that.

Ellie: We always tell the women we work with to trust their gut. If they are feeling like something is off, they are right. They know their bodies. They know what a healthy relationship means to them. And so a lot of women I think throughout their lives are told to not trust their gut, but we definitely say if you feel like something is off, something is off. Trust your gut. Go with your instincts They're right.

Dr. Jones: So do you have any myth-busting? Do you have any myths when you talk to people or train people about domestic abuse or abusive relationships?

Ellie: We do a lot of busting the myth that it is the victim's fault. That is something that comes up for whatever reason, and this could be a really overt statement or really covert underlying attitude towards domestic violence that somehow the woman brought it on. She did something to deserve it, she did something to piss her husband off or her partner.

Dr. Jones: And that may be the message that she gets from him too, or whoever is doing the abusing isn't always . . . It could be same-sex couples can be abusive too, but the abuser will say, "You made me do this." And that's internalized.

Ellie: Well, and it happens when women go back to their partners. You chose to go back, so you are asking for it because you should have left. And I think the statistic is, is that a partner will go back seven times before they permanently leave a situation. And that could be physically or it could just be the relationship is over, it's back on, it's over, it's back on. But I want to say if I'm recalling correctly, it's seven times. So there's potential for victim-blaming in that. And that's the biggest myth.

The Physical Domain of Domestic Abuse

Ellie: An important thing to consider is just that it does impact people in different ways. So there's no perfect victim or no perfect survivor. I think this just speaks to trauma in general, but we experience trauma, we experience abuse, and the harm from abuse in so many different ways. And it can look very, very different person to person.

One of the huge impacts that we see in the immediate aftermath of interpersonal violence, is the ability to not really be able to focus or remember things or remember things in order. It's actually a physiological response to trauma. And so if people can't really like, they're not telling the same story to an investigator, for example, things happened this way. No, they actually happen that way. This was the timeline. No, no, it was actually . . . This came first and then that happened. I think that makes people look not credible, that makes survivors look not credible.

Dr. Jones: Well, anxiety is toxic to the hippocampus. There's a center in our brain where it helps triage memory and anxiety is toxic to the hippocampus and people lay down memories abnormally, or they don't remember things at all. And it becomes very difficult too. So people say I must be losing my mind, and it's like, well, no, you're experiencing things which are changing the way your brain is remembering things.

Ellie: You don't have access to that part of your brain, and it's not your fault, it's just the way that your body is responding.

Dr. Jones: Well, in our world, we see it as chronic pain. So a very high percent of women with chronic headaches or chronic pelvic pain or chronic back pain, that chronic pain for which we're having a hard time pinning down exactly why this person is not resilient compared to the other person who's doing fine is a history of abuse.

And I think also people might come with pain. They want to talk about their real pain, which is the violence that they're experiencing, but that's not what they can do get into the doctor for. They feel like the doctor's office is a safe place, but if the doctor doesn't ask as part of the workup for their headaches, is home a safe place? You may not get the answer for what's really happening. And I think that's why we need as clinicians to just remember that little phrase, "Is home a safe place?" And just let people open up in the way they can talk about why it isn't safe.

Ellie: Yeah.

The Spiritual Domain of Domestic Abuse

Dr. Jones: Well, I've been also thinking some about spiritual abuse. And I think because many women feel that they're spiritual persons, but the way they practice their spirituality may be inhibited by their partner, by the person that they live with. But you would think of religious communities just being a place of safe haven, but sometimes religious communities allow intimate partner violence and to be perpetuated. What are your thoughts on that?

Ellie: Yeah. I've seen it go both ways. I've seen faith communities be very, very supportive. And actually, I had a situation or a case that I worked with where really that their church saved them. They were able to get them into a new place to live. They took care of their children. They gave them financial resources until they could get on their feet. I think they really recognized that it was a serious and dangerous situation. And I worked closely with the faith leader in that, and we coordinated to really get this woman out and her children out and into a safe place. But I've also . . . I think more rarely have seen a community maybe turn against or victim blame someone that's experiencing IPV.

Dr. Jones: Yeah. I think, in particularly religions where the cultural norm is for men to be in the positions of power, and therefore, the husband is often in a position of power, and therefore, perhaps it's his right to behave in a certain way or it's tolerated more.

But I think that for many women, religion is their spirituality, is their source of safe haven. And finding that in a community, not just in themselves, their own prayer life is important to them. But having someone in the religious community would be really important.

Where to for Domestic Abuse

Dr. Jones: Of course, if the situation is serious, if you are in serious physical trouble right now, 911 will get you the most immediate resources. However, if you're struggling and you feel like you'd like to get more help, what can we do for people who are listening? Where can they go?

Ellie: A really great resource that is a 24/7 phone number that you can call locally in Utah is the . And that's 1-800-897-LINK, which is 1-800-897-5465. And they are staffed by experts in domestic violence that can get you connected to resources very quickly.

I also think a couple of really good resources in the community are the and . The Family Justice Center in downtown Salt Lake has dozens of different partners that are there that can help address those seven domains. So they have forensic nurses that are there, DWS that can help with case management and food stamps in different impacts on financial and the case management of life. They have every resource that you can imagine for survivors of domestic violence at the Family Justice Center.

Dr. Jones: I guess if you call the 1-800 number here in Salt Lake and you say, "But I'm in Tennessee," they probably have the resources that will help you in Tennessee.

Ellie: Yeah. And in fact, if you call the domestic violence LINKline in Utah and the wait time is too long, they just connect you with the national one.

Dr. Jones: Great. So you could use that number wherever you might be. Well, at least in the U.S. in terms of helping people get access to help in their community.

Ellie: And then, of course, I have to plug the University of Utah Center for Student Wellness, our . We can be reached at 801-581-7776. And our email that you can email for an appointment to meet with an advocate is advocate@sa.utah.edu. And we serve any student, faculty or staff member at the University of Utah who's experienced any type of interpersonal violence.

Dr. Jones: Right. And that's a big number. As I think about all the people come to our town, our 50,000-person town at the north end of the valley. So I think the business about reaching out can also be very threatening. You have to find a time when you're alone when it's safe for you to reach out. If someone is taking your phone, if someone is always watching what you do, if you don't have access to keys, you can't go out and go grocery shopping, there's no opportunity for you to actually reach out in an incredibly controlling situation. But mostly, women can, I think or men, depending because it isn't always women, if they can find a place where they can have some privacy to make a call.

Ellie: Yeah. A doctor is a great . . . yeah, I think that's really important.

Dr. Jones: This is very reasonable. I think this is why people come in with chronic pain and what they really want is some help with what's happening at home. Is home a safe place?

Ellie: Yeah.

So I like to end as I think about the seven domains with a little Haiku. And I've got a little one here for us.

This just isn't right
My home is not a safe place
I'm strong, not alone

Thanks for joining us on "The 7 Domains."