From our understanding of the IPV faced by women in sex work in India, it is clear that multiple strategies and types of resources are needed to respond to this complex issue. Broadly, the strategies include: unobtrusivefirst contact, assurance of safe
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communication, risk analysis, safety plans, action against violence, support systems to handle repercussions and long-term support to heal.
7.9.1 Step 1: Unobtrusive First Contact
Objective: Opening a Support Channel
Thefirst step is the discreet identification of the violence situation (see Box7.3).
Since women facing violence do not report it, it needs to be picked up and primary disclosure enabled by someone with access to them. Often neighbours, close friends, siblings or parents play this role. For women in sex work, these supports may not always be available. However, today, in India, there are structures created by the HIV prevention programmes which can offer peer support in the community setting.
There are community counsellors and crisis teams in almost every HIV prevention programme and there are 508 such programmes in the country to draw on.
Violence depletes personal coping resources and confidence in oneself. The vulnerable situation that womenfind themselves in, fosters a sense of helplessness, hopelessness and a sense of fatalism. The key intervention here is to reach out and make a helping connection. Confidentiality is paramount. While in crisis inter- ventions, thefirst priority is moving the client to a place of safety, here it could sometimes be counterproductive, unless the client is prepared for it.
Box 7.3: Key Challenges for the Counsellor: Identifying the Person in an IPV Situation; Facilitating Help Seeking
InterventionListening, assessing immediate danger, infusing hope, assuring support
Key Counselling PrinciplesRespect, confidentiality, self-determination Key Ethical PrinciplesAutonomy, non-maleficence
7.9.2 Step 2: Creating Safe Spaces for Communication and Interaction
Objective: Assuring Safety and providing Psychological and Emotional Support Referrals may come from hospitals or the police when the violence is extreme and has become public; or the sex worker herself may have sought the counsellor out. If there is an open report of violence and identification of the perpetrator, it can move on to the next stage of detailed history taking and risk assessment. If not, the process will need to start from creating a safe environment for disclosure (see Box7.4).
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A safe space to vent and share the trauma and receive emotional and psycho- logical support is critical. This may vary from situation to situation. If the person is unable to leave home, community counsellors will need to provide it at home.
When the person is willing and able to access a counselling centre, then this intervention can take place there. Taking safety concerns seriously, reiterating confidentiality and building trust are the critical interventions at this stage.
Box 7.4: Key Challenge for the Counsellor: Building Trust and Communication Channels
InterventionListening, validation of the individual, communication, provid- ing assurance of confidentiality and ensuring safety.
Key Counselling PrinciplesConfidentiality, self-determination, non-judgemental stance
Key Ethical PrinciplesAutonomy, non-maleficence, beneficence
7.9.3 Step 3: History Taking
Objective: Recording the History of Violence and Analysing Risk
History taking may not be easy or straightforward as the client may travel back and forth in the narration of the traumatic incidents. There may be a lot of sup- pressed grief emerging, and it may require a few sessions to record the history.
However, the counsellor would need to analyse the risks involved, related even to this primary disclosure. Emotional support may be needed throughout this period.
Peer support outside the counselling sessions would be a great help.
Despite the possibility of continuing violence, if the client is not willing to take any action, respecting her pace is critical. Often the client’s reluctance may be based on intuitive knowledge of repercussions, and till she can plan safety measures, the pace should not be forced. If the client is not prepared for action, she might either retract, or there may be other repercussions. The counsellor will need to deal with the client’s anxiety and fear for personal safety and safety of the children. It is probable that the client has lived with the violence for a while before reaching the counsellor and has some temporary strategies to deal with it.
The counsellor has to be mindful of the possible trauma of recall, the humiliation and the low self-worth that the violence may have caused. Asking for unnecessary details of the abuse, particularly sexual abuse would be voyeuristic and could cause further damage to the client’s self-esteem.
The analysis of the risks involved in larger decisions such as reporting the violence,filing a case, asking for police protection or leaving the partner has to be discussed jointly with the client (see Box7.5).
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Box 7.5: Key Challenge for the Counsellor: Assessing and Anticipating Internal Trauma and External Dangers in the Context of Reluctance to Report
InterventionListening, taking history, providing assurance of confidentiality and ensuring safety.
Key Counselling PrinciplesConfidentiality, privacy, non-judgemental stance Key Ethical PrinciplesNon-maleficence, beneficence
7.9.4 Step 4: Overcoming Ambivalence and Taking Decisions
Objective: Exploring and Strengthening Motivation for Action
The client may have stayed in the violent relationship, for any of the reasons mentioned earlier. It is good to remember that coming out of violence is a process and takes time. Personal preparation is critical and it is important not to rush the person into action (see Box7.6). Motivation to change status quo, may take time.
At this stage, testimonial sharing has proven to be helpful. This can be on a one-to-one basis, or a group sharing with others in a similar situation. Groups are useful, as participants may be at various points in their journey out of the violence and multiple strategies may surface. The ambivalence regarding the violent rela- tionship may also get clarified. Testimonial sharing in the group needs to be fol- lowed by support for any possible backlash.
Box 7.6: Key Challenge for the Counsellor: Walking at the Client’s Pace;
Accepting any Resistance to step out of a Harmful Situation
Intervention Individual and group support through testimonial sharing, offering multiple strategies for action
Key Counselling PrinciplesRespect, non-judgemental stance Key Ethical PrinciplesAutonomy, beneficence.
7.9.5 Step 5: Drawing up Safety Plans
Objective: Ensuring Safety
Once the client begins contemplating action, safety plans can be drawn up, based on the risk analysis (see Box7.7). These could span a number of situations: how to get
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children to a safe place; how to remove personal and precious possessions;finding a safe place to stay on leaving the house; identifying whom to call in an emergency;
listing who could be on hand for a physical rescue; how to counter slander and public shaming; and how to deal with social ostracism on disclosure of the sex worker’s identity. Often it is also psychological preparation for the loss of the relationship. Mapping social supports jointly with the client, and listing various support resources and shelter options is a good strategy. Crisis teams of sex worker collectives can mobilize a rescue and support group within a couple of hours and drawing on that resource can be considered.
Box 7.7: Key Challenge for the Counsellor: Helping Clients Overcome Resistance to Analyse Risk and Create Concrete Safety Plans
InterventionPractical and psychological preparation for action
Key Counselling PrinciplesRespect, non-judgemental stance, self-determination Key Ethical PrinciplesAutonomy, non-maleficence, beneficence.
7.9.6 Step 6: Action Against Violence: Accompaniment and Support
Objective: Providing Confidence and Ensuring Safety
A coordinated effort is needed for this stage. A counsellor or social worker needs to help mobilize the appropriate supports. If the client wants to challenge the violence directly, support from peers can be made available. But there may continue to be ambivalence around the decision and the client may retract. Box7.8illustrates the ground realities and the need for coordinated effort in taking action against violence.
Box 7.8: Case Scenario 3
Shalini sought the support of the counsellor and some peers tofile a com- plaint with the police and seek police protection against partner violence. The next day she went and withdrew the complaint, saying her partner had assured her that it would not happen again, and she did not want to lose him.
This happened two times before shefinally took action to move away from him permanently.
If the decision is to ask the partner to leave, the woman in sex work may need back up support, in case there is violence against the client or children. On the other hand, if the sex worker wants to file a complaint at the police station, then peer accompaniment and crisis support are needed. In all cases, physical and practical support may be needed at this point (see Box7.9).
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Box 7.9 Key Challenge for the Counsellor
1. Retraction of the client from the planned action, even at the risk of harm.
2. Lack of resources to protect the client around the clock, from harm resulting through action against the violence
Intervention Physical and psychological accompaniment, coordination with other supports
Key Counselling PrinciplesRespect, non-judgemental stance, self-determination Key Ethical PrinciplesAutonomy, non-maleficence, beneficence, justice
7.9.7 Step 7: Long-Term Psychological Support
In a review of 75 studies on IPV and its impact, Dillon et al. (2013) found that women who had experienced IPV (physical, sexual, or psychological) consistently had lower mental health and social functioning scores than women who had not.
There is enough evidence that systematic and long-term violence destroys confi- dence, self-esteem and a total sense of self. It leaves deep scars that take a long time to go away. This is an area which has not received enough attention in IPV work.
Rescue from the violence is not enough. The healing process is long, and multi- sectoral long-term support is needed (see Box7.10). The counsellor’s role is vital here. Both individual and group therapy may help.
Box 7.10: Key Challenge for the Counsellor: Retention in therapy InterventionPsychotherapy, emotional support
Key Counselling PrinciplesRespect, non-judgemental stance, self-determination Through the entire process, professional supervision and support for the coun- sellor is critical. The autonomy for the client also has to balance her safety and this is a tremendous responsibility and burden for the counsellor. It will be absolutely vital for the counsellor to have regular personal supervision to deal with his or her own emotional and psychological processes.