How health care providers help battered women: The survivor's perspective

This qualitative study aimed to describe, from the perspective of domestic violence survivors, what helped victims in health care encounters improve t heir situation and thus their health, and how disclosure to and identificat ion by health care providers were related to these helpful experiences. Sem i-structured, open-ended interviews were conducted with a purposeful sample of survivors in the San Francisco Bay Area. Data were analyzed using const ant comparative techniques and interpretative processes. Twenty-five women were interviewed, the majority being white and middle-class, with some coll ege education. Two overlapping phenomena related to helpful experiences eme rged: (1) the complicated dance of disclosure by victims and identification by health care providers, and (2) the power of receiving validation (ackno wledgment of abuse and confirmation of patient worth) from a health care pr ovider. The women described a range of disclosure and identification behavi ors from direct to indirect or tacit. They also described how-with or witho ut direct identification or disclosure-validation provided "relief," "comfo rt," "planted a seed," and "started the wheels turning" toward changing the way they perceived their situations, and moving them toward safety. Our da ta suggest that if health care providers suspect domestic violence, they sh ould not depend on direct disclosure, but rather assume that the patient is being battered, acknowledge that battering is wrong, and confirm the patie nt's worth. Participants described how successful validation may take on ta cit forms that do not jeopardize patient safety. After validating the patie nt's situation and worth, we suggest health care providers document the abu se and plan with the patient for safety, while offering ongoing validation, support, and referrals.