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Mothers who have left an abusive relationship : the effect of their participation in a parenting support… Petersen, Karin Anne 1997

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M O T H E R S W H O HAVE LEFT A N ABUSIVE RELATIONSHIP: THE E F F E C T OF THEIR PARTICIPATION IN A PARENTING S U P P O R T G R O U P By KARIN A N N E P E T E R S E N B.S.N., The University of British Columbia, 1993 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIRMENTS FOR THE D E G R E E OF M A S T E R OF S C I E N C E IN NURSING in THE F A C U L T Y OF G R A D U A T E STUDIES The School of Nursing We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA © Karin Anne Petersen, 1997 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada Date DE-6 (2/88) Abstract Abuse of women in intimate relationships has gained international recognition as an important social phenomenon which has significant physical and psychological implications for those exposed to it (Heise, Pitanguy, & Germain, 1994). History has repeatedly shown that abuse does not end with separation or divorce but, rather, often increases at these times. This reality, in combination with the deleterious effects of the physical and emotional abuse within the relationship, affects the abused woman's ability to cope with the challenges faced when she leaves the abusive relationship. One of these challenges is to parent the children she may have. The role of mothering is of primary importance to these women. However, the competing issues associated with the abusive relationship and establishing a new life away from the abuser often leaves the women unprepared for the role of a single parent. One intervention that is available to assist women during this period in their lives is a parenting support group. A research study was initiated to evaluate the effect of one particular parenting support group on mothers who had left an abusive relationship. The methodology of this study was guided by a feminist perspective. Data collection involved the use of focus groups. Participants were drawn from a pool of 16 women subjects who had participated in the parenting support group program. Participants were divided into two focus group sessions. Giorgi's (1975) four stage method of phenomenological analysis was used to analyze the data. T h e f indings of this study showed that women va lued the parenting support group intervention and utilized the insight and ski l ls they gained to move forward in their l ives. T h e descript ion of their exper iences resulted in the deve lopment of four themes: 1) C O N N E C T I O N ; 2) C O N F I D E N C E ; 3) R E F R A M I N G ; and , 4) S E L F - E F F I C A C Y . The a reas within these themes warranting further d iscuss ion were highlighted, and the implicat ions for nursing in terms of pract ice, educat ion and research were identif ied. iv Table of Contents A B S T R A C T ii T A B L E OF C O N T E N T S iv LIST OF F IGURES vii A C K N O W L E D G M E N T S viii C H A P T E R ONE: INTRODUCTION Background to the Problem 1 Problem Statement 9 Purpose 10 Objectives 11 Conceptual Perspective 11 Research Question 12 Definition of Terms 12 Assumptions 14 Limitations 14 Significance of the Study 15 Summary 16 C H A P T E R TWO: L ITERATURE REVIEW Introduction 17 Abuse - Women's Experience 17 Issues for Women After Leaving an Abusive Relationship 21 Custody and Access 22 Behavioral Reactions of the Children 24 Support Interventions and Their Evaluation 25 Summary 28 V C H A P T E R T H R E E : METHOD Introduction 30 Descriptive Research - Use of Focus Groups 31 Sample Selection and Recruitment 31 Sample 31 Recruitment 32 Data Collection 33 Data Analysis 36 Reliability and Validity 38 Ethical Considerations 39 Summary 41 C H A P T E R FOUR: FINDINGS Introduction 43 The Women's Experience - Description of the Participants 43 Connection: Shared Meaning and Shared Experience 48 Confidence 52 Intimate Relationships With Children 53 Parenting Skill 57 Reframing 61 Self-Acceptance 62 Boundaries With The Abuser 66 Assertiveness With External Forces 71 Self-Efficacy 74 Planning for the Future 77 Defining Ongoing Support Needs 78 Summary 83 C H A P T E R FIVE: DISCUSSION OF THE FINDINGS Introduction 87 The Importance of Support 87 The Effect of Time 92 The Work of Integrating the Experience 95 Summary 99 C H A P T E R SIX: S U M M A R Y , CONCLUSIONS, AND IMPLICATIONS FOR NURSING Summary 102 Conclusions 107 Implications for Nursing 108 Practice 108 Education 110 Research 113 R E F E R E N C E S 116 APPENDIX A: Parenting Support Group Information 123 APPENDIX B: Participant's Information Letter 125 APPENDIX C: Consent Form 127 APPENDIX D: Interview Questions 128 vii L is t of F igures Figure 1: Conceptualization of the Women's Experiences Following Participation in a Parenting Support Group Page 47 Acknowledgments I would like to acknowledge severa l people for making complet ion of this study possib le. First, to the women who shared with me, their exper iences of living in and away from an abus ive relationship. Y o u r courage and commitment to making a new life free of v io lence for yourse lves and your chi ldren has been inspiring. Y o u are all truly powerful w o m e n ! Second ly , I would like to thank the members of my thesis commit tee, Janet Er icksen (Chair), Ange la Henderson , and Conn ie C a n a m for their gu idance, support and contributions to this study. To Janet and Ange la , your dedicat ion to cultivating my interest and knowledge of family v io lence has been limitless. I will a lways be grateful for your academic mentoring and en thus iasm during this p rocess . T o Conn ie , whose insightful feedback has been invaluable to my learning. Thank you a lso to T ina Sha lansky , for your fr iendship and shar ing of your knowledge about family v io lence. I would a lso like to acknowledge the incredible support of fr iends and co l leagues throughout this p rocess . In particular, to Karen for the love and support that you have given my chi ldren. I couldn't have done this without you ! To Rosemary , J o a n , Cathy, and Patti, thank you for your l imitless supply of fr iendship, support and encouragement throughout the years and during my studies. It is to the love, support, sacri f ice, and encouragement of my family that I owe spec ia l acknowledgment . To my parents, you have been the foundation for my s u c c e s s . Y o u have continually encouraged my academic efforts and I will a lways be grateful for your never-ending sources of support. M y sister S u s a n , beyond being my best friend and confidante, you have been an invaluable editor and source of encouragement . To my husband K e n , you have demonstrated limitless pat ience and support throughout this p rocess , a lways encourag ing me to reach for my goals . T o my chi ldren, N ico le and Lauren, thank you for showing such interest and pat ience in my academic pursuits. 1 CHAPTER ONE: INTRODUCTION Background to the Problem In the last decade , v io lence against women has increasingly ga ined recognition as an international socia l phenomenon that has signif icant physical and psychological implications for those exposed to it (Heise, Pitanguy, & Germa in , 1994). T h e s e authors note that while many forms of v io lence against women exist, probably the most common form is abuse of women by an intimate partner - often referred to as wife battering. Accura te f igures on wife battering are difficult to generate; however, the current research indicates that it is a phenomenon which c rosses all soc ia l , religious, cultural, and economic boundar ies (Moss & Taylor, 1991). M a c L e o d (1987) est imates that almost one million women in C a n a d a are battered each year. Statist ics C a n a d a (1993) supports this finding in its survey of male v io lence against women . In a randomly selected sample of 12,300 women 18 years and older, 2 9 % reported being physical ly assaul ted by a current or former partner s ince the age of 16; 6 5 % more than once. Separat ion or divorce does not end the harassment or v io lence for women who have been abused (Henderson, 1990; Page low, 1984; Sha lansky , 1995; Statist ics C a n a d a , 1993). Resea rch indicates that the threat of v io lence actually increases when the woman leaves the relationship. The Statist ics C a n a d a (1993) survey found that "repeated or ongoing abuse was more commonly reported in marr iages that had ended" . Three-quarters of women who exper ienced v io lence by past partners endured repeated 2 assaul ts , 4 1 % on more than ten occas ions" (p. 5). This s a m e survey found that 19% of the women who reported being exposed to v io lence from a partner exper ienced this v io lence during or following separat ion from the abuser. O n e third of these reported c a s e s involved an escalat ion in the severity of the v io lence during the separat ion from the abuser . Zo rza (1995) notes that in the United States it has been reported that 7 5 % of all women hospital ized due to domest ic v io lence are separated or d ivorced. The ev idence is strong to suggest that women who have been abused and have left their abusers are at risk for cont inued exposure to v io lence and the mental and physical consequences of this exposure (Pe led, Jaf fe, & Ed leson , 1995). This is clearly a major stressor for women who leave an abus ive relationship. It is often difficult for women to openly acknowledge the occur rence of, or seek ass is tance in escap ing , the v io lence assoc ia ted with the abus ive relationship (Dobash & Dobash , 1987; M a c L e o d , 1980). Many women do not feel that they would have the support or ass is tance of family members or fr iends if they admit to the abuse (Campbel l , 1992). The dec is ion to leave the abusive relationship, therefore, requires immense courage and determination for a better ex is tence. Many factors such as poverty, safety, and legal i ssues affect whether or not women leave an abusive relationship (Moss & Taylor, 1991). Often, however, w o m e n must cons ider not only their own survival, but a lso that of their chi ldren. In many c a s e s the decid ing factor to leave the relationship ar ises from concern for the children and the inf luence that the continuing 3 v io lence has on them (Bohn, 1990). W h e n women do find the courage to leave an abus ive relationship, s o m e seek the ass is tance of crisis centers and transition houses to provide them with the initial support resources of safety, shelter, counsel ing, and f inancial aid (Humphreys, 1993). Shel ter workers and other women who have been abused provide the support and practical adv ice required for abused women to survive apart from the abus ive relationship. Over 7 0 % of abused women who enter transition houses have children who accompany them (MacLeod , 1987). A b u s e d women who are mothers face the addit ional chal lenge of being single parents, often with limited personal support networks, once they leave the abus ive relationship. The role of mothering is of primary importance to these women ; however, the compet ing issues assoc ia ted with the abusive relationship and establ ishing a new life away from the abuser often leave them unprepared for the role of a single parent. In addit ion, many of the women have been soc ia l ized in a patriarchal culture to the extent that they are unable to envis ion parenting their children a lone (Bilinkoff, 1995). Chi ldren are often wi tnesses to the v io lence assoc ia ted with the abusive relationship (Er icksen, & Henderson , 1992; Jaf fe, Wol fe , & Wi l son , 1990). T h e s e children are a lso at risk for developing physical and mental health concerns because of their exposure to violent parental role models and the constant fear of physical abuse directed towards their mother and/or themselves (Rosenbaum & O'Leary, 1981). Resea rch studies report that the 4 children exper ience emotional and behavioral difficulties that have t remendous potential for influencing their adjustment as adults (Hughes, 1986). Resea rch a lso suggests that chi ldren who wi tness abuse of their mothers are at greater risk for becoming victims or perpetrators of v io lence later in life, thus perpetuating "the cycle of v io lence" (Cappel l & Heiner, 1990; Ka lmuss , 1984). In a study which examined the chi ldren's exper ience with witnessing abuse of their mothers, it was found that children who had wi tnessed spouse abuse exper ienced increased anxiety, altered and ineffective coping behaviors which put them at risk for future mental and physical health problems (Er icksen & Henderson , 1992). The children in this study descr ibed feel ings of fear, uncertainty, s a d n e s s , and power lessness in directing their l ives. In addit ion, they d isplayed an alarming acceptance of v io lence as a method of coping with conflict resolution. Two addit ional studies a lso examined the abused women 's percept ions of their chi ldren's needs after leaving an abus ive relationship (Henderson, 1990 & 1993). It was noted that the mothers, while aware of the difficulties that their chi ldren were exper iencing, were too immersed in their own issues to focus on their chi ldren's needs . The mothers appeared to lack conf idence in deal ing with their own issues and were not receiving organized support to do so . T h e s e women 's unavoidable preoccupat ion with their own issues, therefore, detracted from their ability to parent their chi ldren effectively, during a time when the chi ldren most needed their mothers. 5 Chi ldren who witness abuse often display altered behavior patterns and unique needs as a result of their exposure to an abusive environment, making them difficult chi ldren to parent (Henderson, 1993). In fact, the difficulty with parenting cont inues, even after the women leave the abus ive relationship. In one qualitative study involving abused women in a transition house, the women reported that their most difficult initial problem was deal ing with the children who had been separated from the abusers (Henderson, 1990). W o m e n who leave abusive relat ionships, therefore, need support in deal ing with the chi ldren's reactions to witnessing v io lence and to leaving the abus ive parent. Mothers a lso require addit ional support in deal ing with their own feel ings related to the chal lenges assoc ia ted with parenting these chi ldren. R e s e a r c h related to parenting after leaving an abus ive relationship is scarce . It appears , however, that even women who have been out of an abusive relationship for over a year continue to perceive parenting as an ongoing chal lenge (Henderson, 1993). W o m e n report being unable to meet their chi ldren's needs effectively as they struggle to resolve their own issues related to the abuse . Nurses are in a unique position to intervene in the cyc le of v io lence assoc ia ted with abuse of women , both in the acute and community care settings. Contact with women through the emergency department and hospital settings, prenatal c l asses , postnatal fol low-up visits, and wel l -baby cl inics provide nurses with the opportunity for identification of, and ongoing intervention for, the survivors of abuse (Henderson, & Er icksen, 1994). There 6 is a lso the potential for ongoing nursing involvement with women who have been abused through women 's transition shelters, support groups, and private counsel ing. Nursing's focus on holistic care and the capaci ty of nurses to initiate and foster a c lose nurse/cl ient relationship facilitate the building of a trusting and effective relationship between nurses and w o m e n who have been abused (Campbel l , Smith M c K e n n a , Torres, Sher idan, & Landenburger , 1993; Henderson & Er icksen, 1994). Henderson and Er icksen (1994) suggest that "focusing on wel lness and who leness differentiates nursing from other health care professionals and p laces nurses in an optimal posit ion to empower and assist famil ies for which v io lence is a major concern" (p. 12). C h e z (1994) states that empowerment of women who have been abused should be the primary goal of intervention for health care providers. To ensure fulfillment of this role, however, nurses must recognize the impact of the abus ive relationship on the survivors of the abuse both after the initial separat ion from the abuser as well as in the long term. Issues such as ongoing threats or acts of v io lence from the abuser , custody and a c c e s s difficulties, f inancial insecurity, and dec reased self-conf idence and worth all affect the physical and mental health of women who have been abused . W o m e n recognize that the unique needs of their chi ldren should a lso be addressed , but report feel ing too s t ressed and overwhelmed by the other compet ing issues to meet this role effectively (Henderson, 1993). T h e s e mothers, therefore, might benefit from support and ass is tance to address the numerous issues assoc ia ted with leaving the abus ive relationship. 7 Effective intervention regarding parenting support for mothers who have been abused may provide them with more resources to meet their chi ldren's needs, thereby reducing the mother's feel ings of stress and inadequacy in their parenting roles. A s part of an ongoing study, a parenting support group intervention (Appendix A) has been deve loped and implemented in response to previous study f indings regarding percept ions of abused women and their chi ldren who had left abus ive relat ionships (Er icksen & Henderson 1992; Henderson , 1990 & 1993). This parenting support group intervention was des igned to 1) dec rease the mother's stress in the parenting role and increase their percept ions of support; and 2) dec rease the chi ldren's anxiety and increase their coping skil ls. The purpose of this study was to assist women in gaining coping skil ls to deal with the general issues facing them, which would give them more energy to deal with their chi ldren's needs. Th is in turn would enhance their interaction with their chi ldren and improve the chi ldren's coping skil ls and dec rease their anxiety. It was hypothesized by the researchers that mothers would be better able to meet the needs of their chi ldren if intervention was directed at deal ing with the general issues assoc ia ted with surviving away from the abus ive relationship. The enhanced parent/child interaction would reduce the risk of intragenerational t ransmission of v io lence. In this program, both formative and summat ive program evaluat ion methods were implemented by the researchers to provide data regarding the participants' percept ions of socia l support and stress following participation in 8 the parenting support program as well as the chi ldren's percept ions of coping and anxiety. The formative evaluation method consis ted of an individual interview with each of the women during the course of the program. The group facilitators a lso kept individual field notes regarding perceived strengths and w e a k n e s s e s of each sess ion . Summat ive evaluation methods included: 1) the col lection of demograph ic statistics on both the mothers and the chi ldren; 2) the administration of quest ionnaires measur ing the mothers' level of s t ress related to parenting and perceived level of soc ia l support and ; 3) the administration of quest ionnaires measur ing the chi ldren's levels of anxiety, s t ress and coping strategies. T h e s e quest ionnaires were administered to the mothers and their chi ldren upon their recruitment into the research study and again at one and three months after complet ion of the parenting support program. I became involved with the above descr ibed research study through my role as the research assistant who was responsib le for the administrat ion of the summat ive quest ionnaires to the mothers and chi ldren. During the data collection p rocess I was often able to observe the interactional p rocesses between the mothers and their chi ldren. In addit ion, there were opportunit ies for informal d iscuss ions with the mothers regarding their percept ion of their current life situation and their percept ions of the changes s ince participating in the parenting support program. I noticed that the women 's percept ions of their lives s ince participating in the study s e e m e d to vary, as did their exper iences with their chi ldren. A s a result of these sess ions , I bel ieved that a qualitative 9 study that focused on the exper iences of these women who participated in the parenting support program study would provide valuable information regarding the effect that such a parenting support group has in meeting their needs . In addit ion, valuable information regarding their percept ions of their parenting approaches s ince participating in the parenting support group could be obtained. S u c h f indings would be helpful for health professionals planning future support programs related to parenting support for w o m e n who have been abused . Problem Statement R e s e a r c h indicates that women who have left an abus ive relationship continue to exper ience ongoing stress from various sources including ongoing abuse from the ex-partners, lack of socia l support (Er icksen & Henderson , 1992; Henderson , 1990 & 1993; Statist ics C a n a d a , 1993), and ongoing custody and a c c e s s issues (Shalansky, 1995). T h e s e women must contend with these issues in addition to meeting the various behavioral and emot ional needs of their chi ldren. O n e consistent area of concern that has been identified by these women is the effect that wi tnessing the abuse has on their children (Henderson, 1990; Humphreys, 1993). How to parent these children effectively is a lso a concern. R e s e a r c h related to the evaluation of the ef fect iveness of support serv ices for women , beyond the initial transition period of leaving the abusive relationship, is limited. There is a need to focus on support interventions, a imed at meeting the long-term needs of abused women as they struggle to 10 distance themselves from the abusers and recover from the v io lence (Henderson, 1990). The previously d i scussed parenting support group intervention had been deve loped to address the long-term needs identified by women in previous studies. Resea rch focused on the evaluat ion of this support intervention is a lso essent ia l to ascertain its ef fect iveness in meeting the needs of abused women, as often a determining factor as to whether a program cont inues is the evaluation results. With smal l numbers of participants, it is important to utilize both quantitative and qualitative methods to develop a full s cope of evaluat ion data. R e s e a r c h directed at understanding the effect that a parenting support group intervention has on the lives of abused women provides a valuable addition to the limited body of knowledge on the long-term support needs of these women . It is a lso necessary for the planning and provision of ongoing interventions to support these women . S u c h evaluat ion should occur in col laboration with the women , as they are in the best posit ion to determine whether their needs are being met. A qualitative study which elicits the exper iences and percept ions of the women 's lives following participation in a parenting support group was required in order to develop a more thorough understanding of support interventions for abused women . Purpose The purpose of this study is to understand what effect participation in a parenting support group has on mothers who have left an abus ive relationship. The women 's percept ions of their l ives following exposure to the 11 group have not been previously examined. The findings from this study can assist in the evaluation of the parenting support group and, in turn, the planning of future support interventions for abused women . Objectives 1. To explore women 's percept ions of their exper iences following exposure to the parenting support group. 2. To identify factors which had an impact on how women exper ienced the group. 3. To identify implications for program planning for future parenting support interventions for battered women . Conceptual Perspect ive A feminist perspect ive provides the direction for this research study. A feminist perspect ive advocates "starting with women 's exper iences, putting women first, making connect ions between our exper iences as w o m e n and analyzing how women live in society. It means recognizing that women are oppressed social ly and economical ly and that all of us are as w o m e n affected by women 's oppress ion" (Barnsley, 1985, p. 8). This viewpoint acknowledges women 's exper iences and locates them in the historical context of a patriarchal hierarchy. A feminist approach, therefore, directed me to consider a qualitative methodology that encouraged the "voice" of w o m e n in descr ib ing issues related to the abusive relationship exper ience, thereby validating both the women and their exper iences (MacPherson , 1988). I bel ieve that the women involved in the parenting support group intervention provide valuable 12 insight regarding how participation in the group has affected their l ives. Furthermore, I bel ieve that choos ing a perspect ive that encourages the women to share their exper iences and percept ions provides the opportunity for significant contribution in the planning of future support programs. Th is sharing p rocess may also validate the women 's percept ions and exper iences and empower the women involved in this study in their search for meaning in their exper iences. Research Quest ion What percept ions do mothers who have left an abus ive relationship have of the effect of a parenting support group program on their l ives? Definition of Terms 1) A b u s e is def ined as : the loss of dignity, control, and safety as well as the feel ing of power lessness and entrapment exper ienced by w o m e n who are direct vict ims of ongoing or repeated physical , psychologica l , economic , sexua l and/or verbal v io lence or who are subject to persistent threats or wi tnessing of such v io lence against their chi ldren, other relatives, fr iends by their boyfr iends, husbands, live-in lovers, ex -husbands or ex-partners, whether male or female. (MacLeod , 1987, p. 16). 2) For the purpose of this study an abusive relationship is def ined as one where there is an unequal power ba lance in the relationship between a man and woman , and where the man exerc ises dominance over the woman through act ions of intimidation, violent force, or the threat of v io lence. The 13 intent in the abusive relationship is to exerc ise control over the w o m a n either physical ly or psychological ly through the inducement of fear (MacLeod , 1987). 3) Effect is def ined as "the overall reaction or impression produced by something s e e n , heard, or done" (Landau, 1980, p.202). 4) For the purpose of this study parenting is def ined as the nurturing relationship between children and their mothers. Th is relationship includes the ability of the mother to attend not only to the chi ldren's physical needs, but a lso to their psychological , emot ional , and spiritual needs . The nurturing relationship a lso includes the interaction that occurs between the mother and her chi ldren as this occurs. 5) Parent ing support is def ined as the provision of ass is tance to the parent by individuals outside of the parent-child relationship to facilitate the nurturing process of parenting. The ass is tance can be tangible (i.e. f inancial , daycare provision) or less concrete (i.e. empathet ic l istening, practical suggest ions). 6) For the purpose of this study the parenting support program refers to a ten week intervention program currently being implemented by nurse researchers as part of an ongoing research study (Appendix A) . 7) Part icipation refers to the women 's at tendance and complet ion of the previously def ined ten week parenting support program. 14 Assumpt ions The assumpt ions that underlie this study are as fol lows: 1) Al l of the women who participated in the proposed study exper ienced s o m e effect as a result of their participation in the parenting support program. 2) The women who participated in the proposed study were able to descr ibe their exper iences as they related to participation in the parenting support group. 3) The women who participated in the proposed study were representative of all women who have participated in the parenting support group program. Limitat ions The limitations of this study are as fol lows: 1) The parenting support group study was limited to women who can speak Engl ish. The results of this study are, therefore, limited in terms of cultural considerat ions related to women who have been abused . 2) Due to their exposure to abuse and the isolating nature of this soc ia l issue, the women in this study may have limited ability to form a trusting relationship and thus have been less than candid when relating their exper iences. 3) The women in this study may have been select ive in what they d isc losed due to ongoing custody disputes and may have a feared that their ex-partners would gain a c c e s s to information generated from this study and use it for adverse legal purposes. 15 4) The interactional nature of the focus group may have resulted in b iased results due to se lected group p rocesses such as dominat ion by a particular participant. 5) The interactional nature of focus groups produced responses from the participants that were not independent of each other. The general isabi l i ty of the results are therefore restricted. Signi f icance of the Study Literature related to long-term formal support for women who have been abused is limited. It is c lear that mothers who have left an abus ive relationship cont inue to have complex support needs that extend beyond the initial separat ion from the abuser . R e s e a r c h demonstrates that concerns related to parenting and percept ions of socia l support have been reported by abused women as significant ongoing issues (Henderson, 1990; Sha lansky , 1995). Funding constraints for transition houses , however, are frequently cited as restricting the opportunity for follow-up programs (Henderson, 1990; Humphreys, 1993). Nurses ' holistic v iew of the individual and advanced therapeut ic communicat ion skil ls enab les them to effectively a s s e s s and address s o m e of the complex needs of abused women and their chi ldren. The development of a parenting support group program to address the voiced concerns of the women in relation to their parenting skil ls falls within the s c o p e of nursing's caring mandate (Er icksen & Henderson , 1992). F indings from a qualitative evaluat ion of this parenting support program, reported from the perspect ive of 1 6 the women who participated in the program, will have implications for future program development and implementat ion. Evaluat ion which is conducted from the perspect ive of the women may also serve to val idate the women 's exper iences and empower them in their journey from vio lence to independence. Summary This study was deve loped in order to understand the effect participation in a parenting support group has on mothers who have left an abus ive relationship. Th is thesis is organized into six chapters. Chap te r O n e outl ines the background and signi f icance to the study and provides the purpose, objectives and conceptual perspect ive directing the research process . The research quest ion to be addressed is articulated, and the definition of terms, assumpt ions and limitations of the study are identified. A detai led literature review as it relates to issues and exper iences of women surrounding abuse is presented in Chapter Two. Chapter Three outl ines the qualitative research des ign, methods, sample and ethical considerat ions pertaining to this study. Chapter Four descr ibes the women 's percept ions of their l ives s ince participating in the parenting support group, and presents the researcher 's interpretation of these stories. Chapter Five provides a d iscuss ion of the research f indings. Chapter S ix summar izes the research study, outlining the study's implications for research, educat ion and practice. 17 C H A P T E R TWO: L ITERATURE REVIEW Introduction In this chapter, a literature review is presented to briefly descr ibe the var ious conceptual izat ions of women 's exper ience with abuse , examine the issues for women after leaving the abusive relationship, explore the var ious support interventions des igned for abused women , and outline the methods utilized to evaluate the support interventions. Al though cons iderab le research has been conducted in the area of abuse , there is limited publ ished research related to the long-term effects of abusive relat ionships on both mothers and their chi ldren. Th is literature review provides the background and context which directs this research study. The three themes presented are: 1) A b u s e -women 's exper ience; 2) Issues for women after leaving an abus ive relationship, and ; 3) Support interventions and their evaluat ion. Abuse - Women 's Exper ience Cons iderab le research has been directed at analyz ing the abus ive relationship in an attempt to descr ibe women 's exper ience as they leave or stay in the relationship. O n e of the pioneer studies was conducted by Parker and S c h u m a c h e r (1977) who attempted to def ine the term "battered wife syndrome". The researchers descr ibed the symptom complex, identifying speci f ic behaviors that had to occur in the relationship before the syndrome had occurred. It is of interest to note that the syndrome in this early definition appl ied only to married women , and the wife had to have been physical ly 18 beaten deliberately and severely more than three t imes. In this controlled pilot study, Parker and Schumache r (1977) a lso identified a separate group of women whom they labeled "violence syndrome averters", women who were able to reduce the v io lence by seek ing help or leaving the abus ive relationship. They noted that women in this group were less likely to have wi tnessed spousa l abuse as chi ldren. M a c L e o d (1987), in a rare Canad ian -based study, w a s able to provide insight regarding the abusive relationship exper ience from the women 's perspect ive. The women in this study descr ibed the exper ience as occurring within an environment of "a shifting, ambiguous type of power" (p.41). Many of the women reported an unusual ly intense and loving connect ion with their abuser when they first began their relationship which, upon reflection, a lso involved the abuser demonstrat ing behaviors assoc ia ted with possess i veness and isolation. M a c L e o d also noted that in many c a s e s where physical abuse occurred, the women were unable to identify exactly when it began, citing instead a gradual increase in verbal, f inancial and emot ional abuse which became a normal part of the relationship. M a c L e o d noted that after prolonged battering women begin to display similar behavioral and psychological traits. They report dec reased sel f -esteem and an increased s e n s e of power lessness over their situation. They display emotional dependence on the abuser , blaming themselves for the v io lence. Often the women report staying in the relationship "for the sake of the family" (p. 44). M a c L e o d (1987) noted that the majority of the women who reported the v io lence or left did so out of the hope 19 that the abuse would stop and the relationship would return to the pre-violent state. It was noted that most women left out of concern for their chi ldren, in order to create a violence-free environment. The speci f ic s tages of the abusive relationship and the ongoing issues, if the women left the relationship, were not identified in this study. Va luab le insight was provided, however, into the emotional and psychological decis ion-making p rocesses of w o m e n who had been abused . Henderson (1989) examined the use of socia l support for women who had left abuse to enter a transition shelter. Four s tages of support were identified by Henderson following interviews with eight women . The first s tage of support was reassurance. During this stage, the women are attempting to gather information to make s e n s e of the past. The second stage of support was analys is , where the women worked to put the past into perspect ive. The third stage involved reciprocity, during which the women who had worked through the first two s tages of support gave support to w o m e n new to the shelter. Th is s tage was seen as significant for both groups of women . The final s tage was that of independence, where the women adjusted to their new exis tence and began to exper ience feel ings of self-growth. Th is study examined women beyond the exper ience of residing in the abus ive relationship and examined the factor of socia l support as intrinsic to influencing the adjustment of abused women after leaving the relationship. Landenburger 's (1989) study a lso examined the exper ience of abuse , including leaving the relationship, from the women 's perspect ive. 20 Landenburger descr ibes the exper ience of abused women as having four s tages: binding, endur ing, d isengaging, and recovering. In the first three stages, the abuse is initiated and usually esca la tes in f requency and intensity until, in the end of the d isengaging stage, women remove themselves from the relationship. Landenburger contends that the recovery stage begins when women leave the relationship and begin to formulate a new identity apart from their abusive partner. The women work to meet bas ic survival needs for food, shelter, and safety, while struggling to overcome and find meaning in their ongoing emot ional turmoil related to the ending of the relationship. During the recovery stage many women who have been abused a lso feel the need to justify to others the reason for leaving the relationship while concurrently grieving the loss of the relationship. The grieving can be intensified if chi ldren are involved, as the women may feel responsib le for breaking up the family or may be b lamed by the children for this occurrence. W o m e n in this stage, therefore, are attempting to find meaning for themselves and a ba lance in their l ives, often while contending with their chi ldren's reactions to the past abuse , new living arrangements, and ongoing contact with the abuser through custody and a c c e s s visits to the chi ldren. Developing research indicates that the abuse of these women by the ex-partner often cont inues even after leaving the relationship and may actually esca la te in f requency and intensity (Henderson, 1992; Page low, 1984; Sha lansky , 1995; Statist ics C a n a d a , 1993; Zo rza , 1995). It is within the fourth stage of the 21 abusive relationship exper ience as descr ibed by Landenburger (1989) that this study will be addressed . Issues for Women After Leaving an Abus ive Relat ionship A s identified by Landenburger (1989), the work involved in the recovery stage of an abusive relationship requires intense emot ional and physical energy. The women need to work through the grief assoc ia ted with ending the relationship and dea l with the physical and emotional losses assoc ia ted with this p rocess (Turner & Shapi ro, 1986). Unfortunately, the genera l public and the famil ies of women who have been abused may not understand the rationale for the women 's grief in this context and may not be support ive of the women 's feel ings. The isolating nature of the abusive relationship, therefore, may leave these women with limited support persons to listen to their concerns . In addit ion to working through the complex issues assoc ia ted with coming to terms with the end of the relationship, most abused women have an addit ional s t ressor to deal with - that of the children that they take with them when leaving the relationship. W h e n the women find the courage to leave an abusive relationship, they do so with the hope of escap ing the v io lence and raising their chi ldren in a non-violent environment. A s previously al luded to, however, women often find themselves and their chi ldren at increased risk for v io lence and harassment from the abuser (Pagelow, 1984; Sha lansky , 1995; Zo rza , 1995). In addit ion, the women are faced with new concerns including custody and a c c e s s issues (Shalansky, 1995), f inancial insecurity, and 22 behavioral adjustments of the children (Henderson, 1990; Pe led , Jaf fe, & Ed leson , 1995) Custody and A c c e s s Issues It is a s s u m e d by society that the violence ends when a woman leaves the abusive ex-partner (Sampsel le , 1991). A s previously stated, however, the risk of v io lence actually increases for women after leaving the abus ive relationship (Statistics C a n a d a , 1993; Zorza , 1995). Th is often occurs as a result of the abus ive ex-partner having a c c e s s to the w o m e n and their chi ldren through court- imposed visitation a c c e s s . It is during the encounter with the exchange of the children that both the women and the chi ldren are at increased risk for acts of v io lence or harassment from the abuser (Shalansky, 1995; Zo rza , 1995). W o m e n who have left an abus ive relationship are therefore faced with the ongoing st ressor of fear for their safety and that of their chi ldren as a result of a court- imposed custody and a c c e s s order. To deny the abuser custody would incite the consequence of legal sanct ion because "few judges treat her protecting herself from even threatened physical abuse as a legitimate reason for her to refuse him custody" (Zorza, 1995 p.156). The literature related to court- imposed custody and a c c e s s issues for women who have left an abusive relationship is limited (Shalansky, 1995; Zo rza , 1995). Zo rza notes that these women are often d isadvantaged and intimidated by the custody action process. The women are often v iewed by the court sys tem as less stable than the abuser because of dec reased 23 f inancial resources, potential home lessness , and inability to maintain employment (Zorza, 1995). Usual ly these problems are intensified by the abuser. Zo rza notes that "many batterers refuse to let their partners work, thus undermining the mother's sel f -conf idence and leaving them d isadvantaged in the workplace" (p. 151). It is a lso noted that 20 % of abused w o m e n who are working are harassed by the abusers either at work or on the phone to the extent that they lose their jobs (Zorza, 1995). Finally, the ongoing legal harassment of the abusers exacts a t remendous f inancial cost to the women in such items as legal expenses , unlisted phone numbers, moving expenses , and counsel ing serv ices. The women are therefore deal ing with numerous obstac les initiated by the abuser which often do not receive considerat ion by the courts. Sha lansky (1995) conducted a phenomenolog ica l study in which five women were interviewed to ascertain their exper iences surrounding continuing exposure to an abusive ex-partner as a result of a court - imposed custody order. The findings of this study indicate that the abused woman 's ongoing contact with, and potential abuse from, the ex-partner is a signif icant st ressor in woman 's ability to function on a day-to-day bas is . The women reported continued abuse from their partners made possib le by this court - imposed a c c e s s to the chi ldren. This abuse is present in the forms of "harassment , threats, intimidation, and using the children against the mother" (p.132). Wh i le the women reported feel ings of anger, power lessness , and despai r in relation to the legal restrictions allowing the abuser a c c e s s to the chi ldren, they 24 expressed the most anger related to the ongoing abuse and their inability to make it stop. The women felt that the law and the legal sys tem did not support them in their struggle to end the abuse, and this lack of support created feel ings of power lessness . The "power lessness against both their abuser and the legal sys tem led to feel ings of despair" (p. 132). Sha lansky ' s (1995) study supports the need for both formal and informal support interventions which will increase the women 's feel ings of empowerment , thereby decreas ing their feel ings of anger and despair . The introduction of interventions a imed at empower ing the mothers will a lso have benefits for the chi ldren. Kl ine, Tschann , Johnston and Wal lerste in (1989) note that "a support ive empathet ic relationship with the custodial parent has been found to protect the child against both parental psychopathology and marital conflict" (p.436). Behavioral React ions of the Chi ldren Cons iderab le research has been devoted to the effects that exposure to maternal abuse has on child w i tnesses to the abuse (Er icksen & Henderson , 1992; G a g e , 1990; Hi lberman & Munson , 1978; Hughes , 1986 & 1988; R o s e n b a u m , & O'Leary, 1981; Wol fe , & Korsch , 1994). In genera l , the f indings of these reports indicate that chi ldren who have wi tnessed abuse of their mothers exhibit behaviors such as depress ion, withdrawal, low self-es teem, rebell ion, and hyperactivity. In addit ion, the literature indicates that chi ldhood witnessing of maternal abuse is a strong indicator of being a perpetrator of abuse (Cappel l , & Heiner, 1990; Ka lmuss , 1984; R o s e n b a u m , & 25 O'Leary, 1981). It is noted that males who have grown up in an abus ive home commit ten t imes the rate of wife abuse as do those who grew up in non-violent homes (Sudermann, Jaffe, & Hast ings, 1995). Accord ing to Sudermann et a l . , females who have been exposed to v io lence in chi ldhood are not more inclined to choose an abusive spouse ; however, once in the violent relationship, they are less likely to leave. The mothers of these chi ldren, therefore, are chal lenged by the various behavioral responses of their chi ldren during a period when they are possibly resolving their own issues related to the abusive relationship. The mothers, while attempting to deal with the behavioral and emot ional needs of the chi ldren, often must a lso contend with continual manipulat ion of the children by the abuser during a c c e s s visitation (Shalansky, 1995). The abuser may blame the disintegration of the family on the mother and encourage the child to "act out" towards the mother. The abuser may also attempt to force a reconcil iation of the marr iage by threatening to obtain custody of, or kidnap, the children (Elbow, 1982). The ongoing connect ion with the abuser , therefore, can have an impact on the woman 's ability to deal effectively with the needs of the chi ldren. Subsequent ly , how to parent these children effectively is a lso an ongoing issue for the woman . Support Interventions and Their Evaluation It is obvious from the previously descr ibed literature that abused women often require support in address ing the complex issues surrounding the abusive relationship exper ience. Mackey (1992) notes that "there is 26 empir ical ev idence that suggests a posit ive relationship between mental and physical health and socia l networks and socia l support on the one hand, and between coping strategies and adjustment to subsequent t raumas on the other" (p. 50). Led ingham and Crombie (1988) noted that the "socia l support sys tems of parents, and perhaps especia l ly mothers, appear to have spec ia l s igni f icance for child development" (p. 13). The "buffering effect" of soc ia l support sys tems for the mothers would, therefore, help them to address the ongoing issues assoc ia ted with their battering and empower them to meet their chi ldren's needs . O n e study examined the impact of a support program on mothers' percept ions of socia l support and parenting stress (Tel leen, Herzog, & Ki lbane, 1989). The researchers noted that numerous interventions have been deve loped to provide socia l support for parents and to enhance parenting competence. O n e of the goals of this study was to d iscover whether a self-help d iscuss ion group would provide mothers with a s e n s e of soc ia l support. The second goal was to ascertain the effect that the group had on the mother's perception of parenting stress, measured by examining their perception of the chi ld's manageabi l i ty. The findings from this study noted that parenting support groups do make a not iceable dif ference in mother 's percept ions of socia l support and have a positive effect on the maternal/chi ld interaction. The use of group therapy as a method of providing support is used extensively by transition house staff (Humphreys, 1993; R h o d e s , & Ze lman , 1986). Through the shar ing of exper iences and s u c c e s s e s , abused women are often able to gain insight into and work through aspec ts of their own exper ience with abuse. In doing so , they gain conf idence in their ability to create a non-violent environment for themselves and their chi ldren. Whi le literature regarding evaluat ion of group therapy as a method of soc ia l support for women who have been abused is limited, avai lable literature suggests favorable results (Rhodes, & Ze lman , 1986). U s e of group therapy appears to be posit ive "in meeting the following goals: strengthening mutually support ive aspec ts of parent-child functioning in a period of crisis, enhanc ing cohes iveness and mental support among famil ies at the shelter,... and assess ing the ongoing mental health needs of the children and their mothers" (Rhodes & Ze lman , 1986, p. 130). There is, however; an absence of literature related to the development of support serv ices which address the long-term needs of women who have been abused . O n e reason cited for this is the lack of funding for transition houses to provide serv ices to abused women after they leave the shelters (Humphreys, 1993). Nursing is becoming more involved in address ing the problem of abuse of women by conduct ing research in this a rea of study and providing information and direction to its members (Canad ian Nurses Assoc ia t ion , 1992). In particular, nurse researchers are getting involved in looking at the support needs of women who have left abus ive relat ionships (Er icksen & Henderson , 1992; Henderson , 1993). Two of the nurses who have identified this need as significant are Er icksen and Henderson , who have 28 des igned the parenting support group intervention, previously descr ibed in this study. Qualitat ive evaluation of this intervention would provide valuable insight into women 's percept ion of the group as a socia l support intervention and would facilitate future program planning of subsequent parenting groups for women who have been abused . The phi losophical commitment of nursing to providing cl ient-centered care and the reality of f iscal restraint for future programs directs nurses to provide solid ev idence of program eff icacy through qualitative and quantitative methods. Summary This literature review has examined the exper ience of the abuse from the perspect ive of the women , the ongoing issues for w o m e n once they have left the violent relationship, and support interventions and their evaluat ion . Literature related to the ongoing issues of women following separat ion from the abusive relationship is scarce . The literature that focuses on issues for women who have left an abusive relationship revolves around the initial transition period immediately following the separat ion (Er icksen & Henderson , 1992; Humphreys, 1993). S o m e areas require further development to fully expl icate the complex issues of abused women and their chi ldren. It is obvious, however, that interventions which address the long-term support needs of these women need to be deve loped and evaluated. In summary, the provision of socia l support has been demonstrated in the literature to enhance the ability of individuals to cope with life exper iences. A parenting support group intervention which add resses the previously 29 identified issues of women who have been abused , therefore, could provide these women with valuable skills to cope with not only the effects of the ongoing issues related to the battering, but a lso the cha l lenges of parenting their chi ldren. In particular, research directed at understanding the long-term issues for women who have left an abusive relationship needs to be expanded . This research would facilitate the development of more interventions des igned to meet not only the needs of the mothers, but a lso those of the chi ldren. Qualitative research which evaluates the effect of interventions, in particular a parenting support program for mothers who have left an abus ive relationship, would contribute significantly to the nurse's understanding of the support provision serv ices that these women require to progress through the recovery stage (Landenburger, 1989) of the abusive relationship. 30 C H A P T E R T H R E E : METHOD Introduction The purpose of this study is to understand what effect participation in a parenting support group has on mothers who have left an abus ive relationship. A qualitative descript ive program evaluat ion approach , utilizing a focus group method, has been chosen to address the research quest ion. Polit and Hungler (1991) del ineate descript ive research as aiming to descr ibe phenomena rather than explain them. Descript ive research is often used when a field of research is new or when there are inconclusive f indings. Evaluat ive research is def ined as appl ied research utilized to "appraise the operation and impact of socia l action programmes" (Luker, 1981, p. 87). A review of a number of nursing textbooks reveals that very little has been reported about the value or implications of qualitative program evaluat ion methods (Bulkeldee, & M c M a h o n , 1994; LoB iondo -Wood , & Haber, 1990; Morse , 1988 &1992; Munhal l , & Oiler, 1986). I bel ieve that it is important with cl ient-centered care to involve the client as a partner in all aspec ts of program delivery, including the evaluation component . In this chapter I will provide an overview of the utility of descript ive research as it appl ies to program evaluat ion. The methodology of focus groups is outl ined, and the sampl ing, data col lect ion, and analys is procedures d i scussed . 31 Descript ive Research - Use of Focus Groups The descript ive methodology of this study was guided by a feminist perspect ive to research inquiry. A s mentioned earlier, a feminist perspect ive encourages the "voice" of women and multiple perspect ives of a given exper ience. Focus groups were chosen as an appropriate research method as they a lso encourage the interaction of participants in shar ing percept ions and exper iences surrounding a common theme, and capital ize on the col lective exper ience of group members . Krueger (1994) notes that "the intent of focus groups is not to infer but to understand, not to general ize but to determine the range, not to make statements about the population but to provide insights about how people perceive a situation" (p. 87). Focus groups encourage substant ive d iscuss ion , in which the exchange of percept ions and exper iences serve as the "fundamental data" (Morgan, 1988, p. 26). A s such , the results of focus group research can be reported independently or as part of a larger research project. Sample Select ion and Recruitment Sample Krueger (1988) notes that with a focus group method "the driving force in participant select ion is the purpose of the study" (p. 87). The purpose of this study is to d iscover what effect participation in a parenting support group has on mothers who have left an abusive relationship. Theoret ical sampl ing procedures were utilized as I was interested in a speci f ic populat ion, with unique percept ions and exper iences. Theoret ical sampl ing involves non-32 random, consc ious select ion of subjects for a study by the researcher (Krueger, 1988). The literature indicates that choice of focus group s ize is reasonably flexible; the s ize is determined by practical and substant ive considerat ions including cost, logistics, and group dynamics (Krueger, 1994; Morgan , 1988). Morgan (1988) recommends focus groups contain between four to twelve participants in order to obtain opt imum participant interaction. Krueger (1994) notes that smal ler focus groups of four to six participants is advantageous with spec ia l ized aud iences who "may have a great dealt to share about the topic or have had intense or lengthy exper iences with the topic of d iscuss ion" (p. 79.). Considerat ion was given to this criterion as well as recognit ion of the scope of this study. Due to the intensity of the subject matter, I determined that a sample s ize of four to six participants per group was opt imum to address the research quest ion. Recruitment The participants were drawn from a pool of 16 women subjects who had participated in the parenting support group program and could, therefore, address the proposed research quest ion. Criteria for inclusion into the sample included: 1) mothers who had left an abusive relationship, and 2) participated in the previously descr ibed parenting support program. The participants of this study were known to me from my previous contact as a research assistant in the study involving the women 's initial participation in the parenting support group program. 3 3 A letter of information (Appendix B) was mai led to each of the women by myself. W o m e n who were interested in being participants in this study were invited to leave their name and te lephone number with the referral agency which provides serv ices for women who have been abused and which provided the facility for the parenting support program sess ions . If interest was expressed , I then contacted the potential participants and provided further explanat ion regarding the nature of the study. The date and t ime of the focus group was arranged during this contact sess ion . The participants were again provided with a letter of information regarding the study when they attended the focus group sess ion . In addit ion, I provided clarification of the information to the participants at this t ime as necessary . The participants were then requested to sign a letter of consent (Appendix C) , following explanat ion of the study, Indicating that they understood the purpose and approach of the study and agreed to participate. It was emphas i zed strongly to each participant, both in the information letter and during te lephone contact, that they were in no way obl igated to participate in the study as a result of previous contact with this researcher in the parenting support group study. The final sample s ize consis ted of seven women spread over two focus groups who met the above descr ibed criteria. Data Col lect ion Determining the number of focus groups to be conducted is crucial to the saturation of coding categories in the analys is stage of the study (Morgan, 1988). Wh i le one group is never sufficient, as the data produced may be 34 altered as a result of the dynamics of the group, using too many groups is unreasonable both in terms of economics and time constraints. Morgan (1988) notes that "the more homogeneous your groups are in terms of both background and ro le-based perspect ives, the fewer [groups] you need" (p.42). Wh i le the participants had varied socia l and economic backgrounds, the common themes of being victims of abuse , having child w i tnesses to the abuse , and having participated in the parenting support program lended a homogenei ty to the group which al lowed for fewer groups. B a s e d on this considerat ion I conducted the study using two separate focus groups. The first group consis ted of four participants, and the second contained three. The second group contained less than the ideal sample s ize previously d i scussed , despite follow-up letters of recruitment. I dec ided, however, to proceed with the focus group and remained cognizant that the range of percept ions and exper iences within this group could be limited by its s ize. The first focus group sess ion took p lace at an agency which provides serv ices for women who have been abused . This facility previously sponsored the s p a c e for the parenting support program and was , therefore, a famil iar environment to all of the participants. Due to the unavailabil ity of the agency facilit ies, the second focus group sess ion was conducted in a hotel room setting. Al l of the participants agreed in advance to the hotel location. The focus group sess ions took place in the evening and lasted approximately one to one and a half hours. A period of 15-30 minutes was al located to the enjoyment of light refreshments prior to commencemen t of the 35 focus group interview. Th is served as an opportunity for the w o m e n to become familiar or reacquainted with each other, thereby creating the opportunity for more open dialogue. The focus group sess ions were audio-taped using two separate tape recorders. The transcriptionist responsib le for transcribing the recorded data was present to facilitate the operation of the tape recorders. The transcriptionist consented to signing a confidentiality form prior to assist ing with the data col lect ion. Th is was necessary due to the sensitivity of the subject matter. The participants were also informed, in the letter of information, that there would be a transcriptionist present during the focus group sess ion . Consen t for her p resence was included on the consent form which participants had s igned prior to engaging in the focus group sess ion . Wh i le focus groups require the presence of a moderator, the level of moderator involvement can be determined prior to implementat ion of the sess ion (Morgan, 1988). W h e n examining knowledge from the participants perspect ives, it is recommended that a low level of moderator involvement be establ ished, in order to encourage a forum in which the participant's v iews, and not those of the researcher 's , are able to be heard. The use of non-directive quest ions and low level moderat ion involves a limited amount of input by the group facilitator into the ongoing group d iscuss ion . Low level moderat ion a lso encourages the participants to speak for themse lves in a spontaneous manner and organize their d iscuss ion around subjects that are v iewed as important by them. A low level moderator approach was chosen for 36 this study. This is consistent with a feminist approach to data col lect ion, encouraging the 'voice' of women, and enhances the opportunity for data saturation. The format of the focus group sess ions fol lowed the suggest ions by Krueger (1994) which are outlined as fol lows; "1) the we lcome; 2) an overview of the topic; 3) the ground rules; 4) the first quest ion" (p. 112). Tr igger quest ions were introduced to stimulate the d iscuss ion and give s o m e direction to the participants (Appendix D). I bel ieved that by carefully sequenc ing the quest ions during the focus group sess ions , the quality of the data would be enhanced ; this systemat ic process encouraged flow of participant percept ions and exper iences in a more organized fashion. In addit ion, however, spontaneous quest ions were introduced in both focus group sess ions . T h e s e quest ions, while kept to a min imum, encouraged spontaneity and group control of the data saturation process. At the end of the focus group sess ions , I presented a brief summary of the main percept ions and viewpoints, allowing the participants to judge and correct the accuracy of my percept ions. Fol lowing the focus group sess ions , I constructed field notes relating to any factors cons idered significant in the sess ion , including personal insights which could be incorporated into the analys is . Data Analys is A s with other types of qualitative research des igns, data analys is for a program evaluat ion des ign occurs concurrently with data col lect ion (Krueger, 1994). Data analys is for this study was conducted using a content analys is 37 strategy. I initially read the transcripts from the focus group sess ions to develop a s e n s e of the data. A second reading of the data occurred with attention to the seven factors suggested by Krueger (1994) when conduct ing focus group analys is: "1) cons ider the words; 2) cons ider the context; 3) consider the internal consistency; 4) consider the f requency or ex tens iveness of comments ; 5) cons ider the intensity of the comments ; 6) cons ider the specif icity of responses ; 7) find the big ideas" (p. 149-151). T h e s e big ideas were coded as "meaning units" as outlined by Giorgi (1975). During the entire analys is p rocess , careful attention was directed to the words used by the participants as well as the context in which those words occurred. A s suggested by Giorgi , the next step in the analys is p rocess involved clarification or elaborat ion of the meaning units "by relating them to each other" (p. 74). Further s teps that were utilized are outlined by Giorgi as fol lows: 1) The researcher reflects on the given units, still identified in the concrete language of the participants, and transforms them into more abstract language., 2) The researcher then integrates and synthes izes the insights into a descript ive structure of the meaning of the exper ience. Th is final product is then communicated to other researchers for critique and confirmation of the f indings (p.75). The synthes ized version of the f indings were reviewed by the thesis committee for confirmation. 38 Reliabil ity and Validity In qualitative research, reliability is measured by the auditability of a study (Sandelowsk i , 1986). This is establ ished by the p resence of a c lear decis ion trail that can lead another researcher to replicate the study with comparab le results, given similar data, perspect ive and situations. Auditabil i ty of this study was maintained by the provision of a c lear descript ion of the research p rocess including data col lection methodology, data analys is procedures and measures used for interpretation of results. Ongoing consultat ion with members of the thesis committee also ensured the p resence of a decis ion trail to protect against reliability issues. "Validity is the degree to which the procedure really measu res what it p roposes to measure" (Krueger, 1994, p. 31). Internal validity in qualitative research is measured in terms of the credibility of the study. Sande lowsk i (1986) descr ibes credibility being present in a qualitative study when "... it presents such faithful descript ions or interpretations of a human exper ience that the people having that exper ience would immediately recognize it from those descr ipt ions or interpretations as their own " (p. 30). A threat to the credibility of qualitative research exists in the s igni f icance of the investigator-subject relationship. Theoretical ly, it is possib le that knowing the investigator from a previous or current relationship may inhibit participant d isc losure, especia l ly if there is an ongoing relationship. I a s s u m e d that previous contact with the participants would affect the interactive nature of the researcher-participant relationship. I bel ieve, however, that the quality of this relationship 39 contributed, rather than detracted from the data col lection process , as the participants and myself exper ienced a bond with each other which facilitated an openness in express ion of feel ings. Sande lowsk i (1986) states that "the credibility of qualitative research is enhanced when investigators descr ibe and interpret their own behavior and exper iences as researchers in relation to the behavior and exper iences of subjects" (p.30). To ensure credibility of this study, my percept ions were summar ized to the participants at the end of each focus group sess ion , in order to al low for val idation. Furthermore, I constructed detai led field notes outlining my percept ions following each sess ion , and these were incorporated into the analys is as indicated. During the analys is phase , I a lso kept a journal of my percept ions and beliefs and d iscussed these with members of the thesis committee. A further threat to the validity of qualitative research is 'holistic fal lacy' (Sandelowsk i , 1986). Th is is when the researcher attempts to present the data as more patterned or regular than it really is. The f indings of the study should be wel l -grounded in the participants' exper iences and reflect both the typical and atypical e lements of their life exper iences. "Check ins" with members of the thesis committee ass is ted in ensur ing that the credibility and fitt ingness of the research study f indings were maintained (Sandelowsk i , 1986). Ethical Considerat ions The women who were eligible for participation in this study had previously been subjects in an ongoing research study related to the parenting 40 support group program. A s I was involved in the previous study as a research assistant, a relationship with these women had been establ ished prior to this study. The potential participants were provided with both written and verbal reassurance that this prior relationship in no way obligated them to participate in this study. The possibil ity of subject burden was a lso cons idered and addressed , as the participants had recently been involved in the previous study. The participants were informed that their participation was voluntary, and that they could withdraw at any point in the research process . The participants were aware that this study was closely connected with the ongoing research study that they previously participated in which was , in turn, l inked to the agency that provides serv ices for women who have been abused . The participants were, therefore, overtly reassured that their refusal or withdrawal from participation in this study would not in any way jeopardize future a c c e s s to serv ices provided by the agency. A s ment ioned earlier, women who have been abused cont inue to be at risk for continuation of the v io lence from the abuser , even after leaving the abusive relationship. In addit ion, these women are often embroi led in custody and other litigation with the ex-partners, putting them in a further vulnerable posit ion due to the scrutiny of their lives by the courts and their ex-partners. The women who participated in this study were, therefore, assured strict adherence to measures ensur ing their confidentiality and anonymity. T h e s e measures included the following: 1) use of a first name only when obtaining 41 consent from the participants; 2) a master list which identified the participants with a corresponding focus group; 3) al location of code numbers for each taped focus sess ion interview to identify the audiotapes and the interview transcriptions with the participants; 4) use of fictitious names in the documentat ion of the f indings; 5) d isseminat ion of the f indings of this study provided to the participants through the agency which provides serv ices for battered women . The master list was access ib le only to myself, for the purpose of tracking of participants during analys is of the tapes and transcripts. This list was destroyed upon complet ion of the study, and the audiotapes erased following typed transcription. A c c e s s to the coded typed transcripts was restricted to mysel f and members of the thesis committee. Al l material which was relevant to this study and/or identifies the participants including the consent form, master list of participants, focus group audiotapes and coded transcripts was secured in a locked filing cabinet. Ethical approval of this study was obtained from the University of British Co lumb ia Ethics Rev iew Commit tee. Summary In this chapter, the research design and methodology were d i scussed . This descript ive program evaluat ion was operat ional ised through the use of focus group interviews. A n explanat ion of this p rocess , including sampl ing, recruitment, and data collection procedures germane to focus group methodology was presented. Data analys is procedures were descr ibed in detail, and reliability and validity issues addressed in the study outl ined Finally, the ethical considerat ions relevant to this study were d i scussed C H A P T E R FOUR: FINDINGS Introduction In this chapter, the women 's percept ions of the effect that the parenting support group ( P S G ) has had on their l ives is descr ibed through participant statements and my interpretation of the data. A brief descript ion of each participant and relevant demograph ics are provided a s a context to the exper iences descr ibed by the women . A s ment ioned in the previous chapter, the steps of Giorgi 's (1975 ) method of data analys is were used to identify central themes arising from the data. The components that make up these themes are d i scussed to give a descript ive structure to the meaning of the women 's exper ience. I have a lso incorporated field note observat ions into the analys is, where appl icable, to provide the context for speci f ic narratives. The Women 's Exper ience - Descript ion of the Part ic ipants A s previously ment ioned, the sample involved two separate focus groups, consist ing of four w o m e n in the first group (Group A) and three in the second (Group B). The participants in Group A were She i la , S u s a n , Caro l ine and E m m a . 1 The first three women had attended the P S G during the s a m e ten week period. E m m a had participated in a later P S G with other women . Al l of these women had been out of the P S G for over one year. 1 In all cases, the women's names are fictitious and specific details leading to their identification altered to protect their anonymity. The essence of their experience, however, has been maintained. 44 She i la had been separated from her abuser for two years prior to her participation in the P S G . S h e had two children ages eight and twelve. S u s a n had been separated from her abuser for less than one year prior to her participation in the P S G . S h e was beginning legal proceedings related to custody and a c c e s s just prior to the start of the P S G . S h e had four chi ldren, ranging in age from seven to twenty years of age. Caro l ine had been separated less than one year from her abuser prior to the P S G . S h e had been involved extensively in legal proceedings related to custody and a c c e s s issues, restraint orders, and criminal charges against her abuser. Prior to and following the P S G , Caro l ine lived in constant threat of physical v io lence from her abuser, despite the p resence of an order of restraint against him. The level of danger to her was so significant that the pol ice expressed concern for her safety and provided her with spec ia l ized a larms and informal survei l lance of her home. S h e had two chi ldren ages four and ten years. E m m a had been separated from her abuser for over two years . S h e had a legal custody and a c c e s s arrangement with her abuser prior to joining the P S G . S h e had three children ranging from three to nine years of age. Group B consis ted of three women , Katr ina, Heather, and Vicky. T h e s e women had participated in the s a m e P S G and had been out of the group for less than six months. Katr ina had been separated from her abuser for two years. S h e had completed legal proceedings related to custody and a c c e s s prior to 45 participating in the P S G ; however, she was awaiting a court date to resolve issues re: f inancial support from the abuser. S h e had one three-year-old child. Heather had been separated approximately one year from her abuser prior to joining the P S G . Like Katr ina, she had completed legal proceedings related to custody and a c c e s s , but had not received a legal dec is ion regarding f inancial support from her abuser. S h e had two children ages one and five years of age. V icky had been separated from her abuser less than one year prior to joining the P S G . Throughout the time of the P S G group, and up to the focus group sess ion for this study, V icky was involved in legal proceedings against her abuser related to custody, a c c e s s and f inancial support. S h e had two children ages five and eight years of age. Prior to joining the P S G , the women in both focus groups perceived themselves as not being in control of their lives in relation to their role as a parent, their ability to remove themselves from the abuser, and their ability to control their future. The women reported that when they joined the P S G they were feeling var ious levels of guilt, low sel f -esteem and power lessness . The women in both of the focus groups descr ibed exper iences that were significant to them as a result of their participation in the P S G . The women general ly perceived that many of the changes that had occurred in their l ives fol lowing participation in the P S G had evo lved a s a result of changes within themselves - not as a result of a change in their external world. 46 Heather descr ibed the change in herself with the following example , "I'm more sure of what I'm doing. . . I mean that's a huge change in me." In descr ib ing their exper iences with the parenting support group, four themes were apparent: 1) connect ion, 2) conf idence, 3) reframing, and 4) self-eff icacy. T h e s e themes are non-l inear in nature, with both backward and forward movement. Specif ical ly, women who had participated in the P S G found that the feel ings of connect ion exper ienced during the P S G exper ience led to subsequent feel ings of conf idence, the ability to reframe the exper ience and to feel in control of self. E a c h of these themes will now be descr ibed with support ing narratives from the women . The narratives presented within the descr ipt ion of e a c h of these themes are meant to illustrate the women 's percept ions and represent their vo ice. Th is is in keeping with a feminist perspect ive to research which encourages the researcher to recognize the women 's percept ions as the "truth" and the most accurate interpretation of their exper ience (Campbel l , & Bunting, 1991). Through the forum of the P S G , the women formed a connect ion with each other. The shar ing of exper iences and the meanings that these exper iences held for them facilitated the emergence of the subsequent thematic p rocesses descr ibed in this chapter (see Figure 1). 47 Figure 1: Conceptualization of the Women's Experiences Following Participation in a Parenting Support Group Parenting Support Group • provides a forum for shared meaning and shared experience 48 Connect ion : Shared Meaning and Shared Exper ience Connect ion is descr ibed in the literature as a relational p rocess and a state of being within a relationship. Connect ion occurs as a result of relational and behavioral factors and involves the knowing of self and others in relation to self. The "recognizing of similarit ies" (Perry, 1996, p. 9) or "finding the common bond" (Davies & Ober le , 1990, p. 89) are a part of the knowing that serve as an impetus for the occurrence of connect ion. The act ions of knowing that support connect ion include valuing of the other, spending time, p resence, being there, engagement and communicat ion (Davies & Ober le , 1990). T h e s e act ions support the formation of connect ion both at the individual and at the group level. The w o m e n descr ibed these act ions when talking about their P S G exper ience. They felt that the P S G provided a forum for shared meaning and exper iences leading to feel ings of connect ion. Caro l ine indicated that the P S G was different from any other group she had participated in as , "I perceived that we were in the s a m e boat, and that was really helpful . . .and that you know that every person in the group goes through the s a m e thing...". V icky a lso commented on how she felt the P S G provided the means for al lowing the women to share their exper iences, and as a result, "I felt connected to you all". Al l of the women emphatical ly stated that, as a result of being able to share meaning and exper iences in a manner that created feel ings of connect ion to each other, the P S G was unique. 49 The women stated that, prior to participating in the P S G , they did not have people to talk to who could understand their past history with abuse and the effect that it still had on their l ives. They bel ieved that the abuse had somehow separated them from others and they were unable to explain their l ives. They bel ieved that the exper ience of their abusive relat ionships had not only isolated them from friends and family, but a lso affected how they had v iewed themselves. V icky related the feel ings of many of the w o m e n in her focus group in the following example : I find that abuse really changes your life and it really separa tes you from other people in a lot of ways . Y o u need to feel normal. Y o u need to feel that you're okay. I think that's what the group did for me. Whi le the perception of being isolated did not change as a result of participating in the P S G , the women perceived the group as having provided them with the opportunity to share exper iences, not previously vo iced or understood, in an environment that facilitated shared mean ing. Al l of the women related vignettes about participation in the P S G in which the feeling of "being heard and understood" f ramed their percept ion of their subsequent life exper iences. The women felt a connect ion to each other as a result of having exper ienced the common denominators of being mothers and having left abus ive relat ionships. Al l of the participants perceived a greater and more immediate level of understanding and accep tance from the other members of the group than they could ach ieve with either family members or fr iends. 50 The women felt that they could tell their story to w o m e n in the P S G without providing the s a m e amount of background as they would to others who had not exper ienced abuse . Many of the women perceived that being able to start their story at a point that they considered important w a s a liberating exper ience unique to this P S G . She i la descr ibed her percept ion of this exper ience in the following example : Being abused was like a full t ime job. Like how do you explain ten years of your life in a soc ia l situation when people ask you if you're divorced...I still feel somewhat set apart like almost as if I've had this exper ience but it's a common exper ience with these ladies. S u s a n related an example of her sense of shared meaning when she descr ibed her exper ience in the P S G after a custody hearing with her abuser . S h e had been preparing for the court custody hearing prior to participating in the P S G , and , on one occas ion , had shared her fears related to the outcome of this hearing with the group: W h e n I talked to other people around me, they didn't have that exper ience. They didn't understand the legal terminology and what the process is or it's very different from what is normal l o g i c . . . W h e n you talk to a friend about it and the friend says well I don't understand. W h y don't you just do this. It doesn' t work like that, you know. [In the PSG] . . . I could tell my story in a short form and they'd understood what was going on because you've all been there. That made a big dif ference. A n d then when I won that was . . .Th is was the first p lace I 5 1 wanted to tell because there was an understanding. Other people around me weren't going to understand what I had won and how great that in fact was, so that made a huge difference. The sense of shared meaning, regardless of age, socioeconomic background, or degree of previous abuse appeared to help normalize the women's struggle to make sense of their lives. Vicky identified herself as significantly older than the other two women in her PSG. Initially upon joining the PSG, she had believed that her age and difference in background would be factors deterring from her identifying with others in her group. She was surprised to find that the commonality of the abusive experience transcended other differences. She explained : I mean like probably I'm older than you guys, but that doesn't mean anything. But it's just like you know, we didn't grow up together. We don't live in the same neighborhood. We would never really ...like I've walked by you on the street I don't know how many times and not known you. Now I know you. Vicky, Heather, and Katrina continue to live very different lives; however, following the PSG, they have maintained regular contact with each other. They indicate that the past abuse, their lives asmothers, and the bond formed while in the PSG serve as the "glue" for their continued friendship. Heather described her feelings related to these relationships very passionately: We have one thing in common above anything else, and we're moms who have been through abusive relationships. But all this still keeps 52 happening. S o we're connected that way and it's no matter what, we have that. Doesn' t matter anything about us, it's spec ia l . A l l of the women appeared to value the connect ion that they were able to establ ish with each other in the P S G . The s e n s e of shared meaning w a s perceived by the women as essent ia l to the development of a group atmosphere in which they could d iscuss common issues and explore new strategies to use in various aspec ts of their l ives. S u s a n descr ibed her perception of the P S G atmosphere and how it facilitated her ability to "open up" to the other women : Th is was the first t ime I've done support group. I think I w a s hesitant. I like to keep things very, very private, so this was really difficult for me to do... l got more out of this than I have through counse lors that I've dealt with one on one. Conf idence A common issue for all of the women prior to joining the P S G was their ability to effectively parent their chi ldren. The women were able to d i scuss their concerns in an accept ing a tmosphere and share their exper iences. From these d iscuss ions numerous strategies and ideas related to parenting were presented by the women and the P S G facilitator. The women perceived that this shar ing exper ience generated many positive changes in their ability to develop intimate relat ionships with and effectively parent their chi ldren. Th is sect ion outl ines these components within the theme of conf idence. 53 A n increased s e n s e of conf idence was one outcome descr ibed by the women that resulted from their shared exper ience and subsequent connect ion in the P S G . Conf idence can be descr ibed as a feeling of se l f -assurance or certainty in one 's ability (Bullock, & Pr idham, 1988; G r o s s , & Tucker , 1994). Furthermore, conf idence often involves a s e n s e of accompl ishment as a result of successfu l ly achieving a predetermined goal or outcome (Bullock, & Pr idham, 1988). A l l but one of the women in the study reported var ious examples of increased conf idence s ince participating in the P S G . T h e one woman who perceived that her conf idence had dec reased bel ieved that the ongoing harassment from her abuser had interfered with her ability to move forward in her life. The kinds of situations where conf idence was ev idenced are descr ibed within the components of: 1) intimate relat ionships with chi ldren; and , 2) parenting skil l. T h e s e components are presented and d i scussed with examples provided from the women . Intimate Relat ionships with Chi ldren Severa l of the women d i scussed the relat ionships that they had with their chi ldren prior to joining the P S G . They verbal ized feel ings related to their children and how they addressed those feel ings following support and/or suggest ions from the P S G . The women descr ibed the difficulty they had exper ienced in establ ishing or maintaining intimate relat ionships with their children prior to participating in the P S G . Fol lowing participation in the P S G , many of the women achieved some understanding of their relationship difficulties with their chi ldren. Th is understanding often led to improved 54 intimate relationships. For example, She i la stated that prior to the P S G , she often felt i l l-equipped to effectively deal with her daughter 's temper tantrums and to provide support to her daughter during those per iods. S h e went on to descr ibe how the P S G provided her with s o m e insight to relate to her daughter with more posit ive results: I started thinking a little bit about what we had done in group which was a bit of a se l f -acceptance thing...I just suddenly said to my daughter, "You know, we all have our p lace in this life and you're okay by me". After that, things just started to change. . . It was a pivotal point! Two of the women , E m m a and She i la , descr ibed situations in which one child in e a c h family was perceived as interfering with the possibil i ty of family ba lance, and how participating in the P S G gave them insight into this situation. E m m a descr ibed how she felt al ienated from one child and ill-equipped to connect with him in a constructive manner prior to the P S G , and how coming to the P S G and d iscuss ing these issues ass is ted her in address ing her feel ings: My boy,...I was going through a really, really hard time with him...not because I had left his father or but probably that affected him too . . .Coming to the group.. . l ike I'd come feeling like I hated h im . . .So I got a lot of support coming here to do with him...st ick it out and wait it out and...It 's taken two years but...that was sort of affecting the whole family, my relationship with the girls....I couldn't talk to my girls because he was so d isrupt ive. . .So we were really down on him and if he weren't 55 here we would be able to have fun and do things that we would like to do because we were the three females and we were all older. S o I guess coming helped me vent a little bit about him and have people say that's normal . . . She i la descr ibed her relationship with her daughters before participating in the P S G . A s ment ioned previously, she perceived that one daughter had completely disrupted the family dynamics with her temper tantrums. She i la raised this issue during the P S G and pract iced strategies that she was subsequent ly able to use with her daughter at home. S h e perceived that following participation in the P S G she was able to recognize her role in address ing these dynamics , strengthening the intimacy bond with her daughter: I started to think that P.[other daughter] and I were getting down on her all the t ime because she had, she wielded this incredible power over the household with these temper tantrums and she w a s a lways the person out of the circle. A n d when I went forward and sa id "hey you're the s a m e as the rest of us", things really started to change. I never thought I'd s e e the day...It 's like see ing this b lossom happening like she 's so vibrant now. In both situations, the women perceived that participating in the d iscuss ion with the P S G and sharing their exper iences and strategies facilitated their understanding of their children and dif fused the ep isodes of confrontation in these relationships. 56 Many of the women bel ieved that they were more confident in their communicat ion patterns with their chi ldren following the P S G , and they felt that this had subsequent ly strengthened the intimacy bonds with their chi ldren. Caro l ine d i scussed the communicat ion patterns she had with her son , descr ib ing it before joining the P S G and the improvement in their relationship that occurred over t ime: W e lived in a household where you just didn't say how you were doing or anything. Y o u just kind of kept everything to yourself and kept quiet. B. is still very private. I think that I give him lots to think about anyway even if he doesn' t vocal ize it. He still is a bit more open than he was before and I don't think he's as angry at me as he w a s before because for a long time he was really, really angry and he thought that it was all my fault. Our relationship is a lot better now. It's still not wonderful ly open or anything like that, but it's a lot better. Many of the women perceived that the ongoing contact their chi ldren had with the abuser threatened the intimacy relationship the children had with them as mothers. They often descr ibed feel ings of resentment towards the abuser related to practical i ssues such as missed support check payments, custody and a c c e s s issues; more specif ical ly, they descr ibed the eroding effect the abuser had on their authority as a parent. Caro l ine related how she felt threatened by the inf luence that her abuser had over the children and descr ibed her act ions prior to participating in the P S G as being driven by feel ings of inadequacy as a mother and single 57 parent. T h e s e feel ings were as a result of the frequent ep i sodes of harassment from her abuser in the form of written letters to her fr iends accus ing her of psychological ly harming the chi ldren. Caro l ine perceived the P S G as instrumental in helping her to separate the acts of her abuser from her role as a parent. Subsequent ly , her level of anxiety related to maintaining an intimacy bond was reduced: I feel a lot stronger than I did before. I feel like I'm a better parent... The family is going to stay together. We ' re not going to all break apart...I feel more comfortable handling situations, that would have really put me in a crisis before. . . temper tantrums and things like that. I'm more capab le of deal ing with it now that I was before. S o no matter how hard it gets, it's better. Parenting Ski l l Many of the women related stories of situations in which they had felt i l l-equipped to parent their chi ldren prior to the P S G . Severa l of the examp les related to ep isodes where their chi ldren had displayed outbursts of aggress ion or anger. The women reflected on how the P S G had provided them with the tools and conf idence to deal with these situations. Katr ina related her exper ience with her son prior to joining the P S G . S h e noted that there were numerous situations in which she felt inadequate in her ability to set boundar ies or dea l with his behavior. S h e bel ieved that the secure a tmosphere of the P S G al lowed her to verbal ize her frustration and anxiety 58 without fear of censure. The support of the group members and facilitator provided her with the conf idence to try new parenting strategies: I learned a lot about discipl ine.. . things to do and you know like spank. I spank my child three t imes in a row and its like, like I was angry. We l l , at least you stopped at three. . . those things are the kinds of things that they [the group] would say, or at least you apolog ized for yel l ing. . .Or at least you stopped yelling and talked to him and just things like that, that you feel guilty for. Like, you know, locking him in his room. . .and if you keep banging your toys against the door and throwing them and kicking the door, I'm going to come in and spank you because I have other control over you. A n d then K. (the facilitator) said to me, she says , "Wel l , he 's got to get his anger out and anger is healthy." A n d we learned that, that anger was very healthy , but its just what you do with it that can be not healthy. S u s a n descr ibed a situation in which she incorporated s o m e of the strategies that she had learned in the P S G to deal with her own feel ings of guilt and lack of conf idence in parenting. S h e related her story in a chronological manner, descr ib ing her feel ings and relat ionships with her chi ldren before entering the P S G , and the improvement that she saw following the group: I was feeling so guilty about the kids and feeling so sorry for them that discipl ine just sort of went out the window and it was just total chaos all 59 the t ime... For months it was just, everything was just kind of all over the p lace and no discipl ine whatsoever. S h e cont inued by providing an example of how she utilized a speci f ic strategy she had learned from the P S G to assist her daughter in deal ing with her anger towards her older brother: Her big brother. . .was always harassing her . . .so I showed her how to do the bal loons one day when they were bugging her and she really liked tha t . . .She pulled out a bal loon and blew it up really big and she put a face on either s ide and one was [her brother] and one was (his buddy) and she popped it...It w a s a wonderful s ide effect...It wasn' t something that had to be repeated. S u s a n a lso perceived that the P S G had had a direct impact on her relationship with her chi ldren in terms of her conf idence in her parenting ski l ls: S ince the last year and a half, I feel strong in my relationship with my kids. I feel a little more confident and maybe I'm ca lmer around them and s o m e of the behavior that they were going through, s o m e of stuff they were doing....I feel stronger as a parent on my own. . .maybe a little bit c loser to my kids and more able to handle that, and . . .maybe not a s guilty feel ing that I've inflicted someth ing on them or taken something away from them. Al l of the women acknowledged that their chi ldren had wi tnessed s o m e form of abuse , and they expressed concern as to how the chi ldren's deve lopment would be affected. The women d i scussed being overly vigilant of their 60 chi ldren's behavior prior to joining the P S G . S u s a n perceived that, as result of being in the P S G , she was learning to dist inguish between the healthy angry behavior of her chi ldren and the anger projected as a result of wi tnessing the abuse : I feel more confident about it. I'm more likely to kind of shrug my shoulders and walk away from something my son has done . . .and I'm not panicked and I have to solve it right now...I feel much better that it's not a reflection on me that s o m e of the things he does he can deal with. I give him more credit. It's certainly more compat ib le with it . . . . I haven't done something that's caus ing permanent damage . Many of the women had been manipulated by their abusers to feel inadequate in their ability to parent their chi ldren. E m m a descr ibed the subtle erosion of her conf idence in her ability to parent her chi ldren that occurred during her abus ive relationship and following her separat ion from her abuser . S h e a lso descr ibed the positive inf luence the P S G had on her level of conf idence in parenting: He a lways found ways to let me know that I was a bad mother, a negligent mother, and that every time a child fell down and hurt their head or sc raped their knee it was because I had not prevented it. Or I had done something to cause it or to not prevent it...But it's so subtle that it does get in there . . .So coming to a group like this...I needed to be reaffirmed that I was a good mother, because I wasn' t really sure . . .Th is is the e s s e n c e of abuse.. . I t 's so subtle and s o manipulat ive 61 that you end up thinking the thing about yourself because he never c o m e s right out and says it. Fol lowing participation in the P S G , She i la descr ibed her increased conf idence in her parenting skil ls as a growing p rocess which required t ime and support: I think because I trust myself as a parent now. It isn't the issue anymore. It's like putting on your clothes in the morning to go to work...I feel confident and comfortable with it. I know that I'm there for my kids A perception of conf idence in parenting, both in intimacy formation and skil l, was cons idered by all of the women as an essent ia l component of recovering from the abusive relationship. Despi te the belief that the P S G provided them with tools to enhance their relat ionships and parenting abilities with their chi ldren, the women expressed ongoing concern related to their abilities to foster intimate relat ionships with their chi ldren and provide them with a secure environment. Reframing Reframing is descr ibed as a healing process in which individuals review an event or period in their l ives and construct a new mean ing for it. T h e new meaning al lows for redefining their lives in a way that promotes posit ive outcomes and growth (Draucker, 1992; Taylor, 1983). The women descr ibed examples that addressed the characterist ics of reframing within the context of their own exper iences with abuse . The work of reframing descr ibed by the 62 women will be d i scussed within the components of: 1) se l f -acceptance; 2) boundar ies with the abuser ; and , 3) asser t iveness with external forces. Self -Acceptance The women in this study reflected on their exper iences both before participating in the P S G and s ince its ending. A s ment ioned previously, most of the women reported feel ings of dec reased se l f -esteem, guilt and power lessness prior to joining the P S G . They were posit ive about the changes that had occurred following participation in the P S G and recognized areas of growth in themselves. Th is growth, descr ibed in terms of se l f -acceptance, e n c o m p a s s e d their parenting abilit ies, their lifestyle, and their abilit ies to effect change in their l ives. Most of the women related examples of what the process of se l f -acceptance meant for them. S o m e of the women perceived that the P S G gave them the support and affirmation to a s s u m e control of var ious aspec ts of their l ives. Heather descr ibed her life before entering the P S G and how she felt in a state of turmoil, i l l-equipped to help her chi ldren: W h e n you're in crisis yourself, you're going through things and your kids are going through things, but you've got to dea l with both at the s a m e time and you're not completely there yet. She i la , who had been separated from her husband for two years prior to participating in the P S G , descr ibed how she cont inued to exper ience emot ional abuse from her husband which made her feel inadequate as a 63 mother and guilty for leaving him. S h e also descr ibed the posit ive impact of the P S G on her journey towards se l f -acceptance: I know now... really thinking honestly about my mothering ski l ls. I did quest ion mysel f many t imes and apologize and make amends. . .sk i r t around him all the time to try and convince him all the t ime that yes , I am a good mother . . .And I never was . . .So you see , I c a m e with all that baggage to the group and I needed to be reaff i rmed.. . ! needed to be told that it was O.K....I started thinking about what we had talked about and done in group. . .accept ing that you make mis takes. . .knowing that I was not a lone made a big difference. The validation that She i la descr ibed was ment ioned by other women in both focus groups and it appeared to al low them the f reedom to explore their l ives without fear of censure from other members . The women perceived themselves as being in a p lace where they could focus on themse lves and develop a s e n s e of who they were. They v iewed this p rocess of f inding a "sense of themselves" as beneficial in gaining control over their l ives and strengthening the int imacy bonds with their chi ldren. S u s a n had deve loped a s e n s e of se l f -acceptance to the point where she recognized strength not only in herself, but a lso as a potential in her chi ldren: I feel stronger and it sort of feels like battle wounds or someth ing. I a lso feel like I can take on a lot more, but as well I think that for awhile initially...you feel like, look at what you've done to your kids. You ' ve 64 hurt them. . .You 've taken something away from them. They 've lost something, or I've made them less than I could have I think I recognize that my children have been different because of this. They ' re not necessar i ly going to be any worse or any better than whatever they might have been. . .Bu t they're going to be stronger people and very different people because of the exper ience. I know that... I've gotten stronger. I feel better about the strength that they've gotten out of it... The w o m e n perceived that absolut ion of guilt and accep tance of self were necessary in their recovery from the abusive relationship. Katr ina had exper ienced a dec reased s e n s e of self-worth and a perce ived inability to effectively parent her son prior to the P S G . S h e related that, following her participation in the P S G she was able to accept and find pride in her accompl ishments : Y e a h , I'm proud to be who I am and I'm proud that I look after my son everyday. A n d I'm proud that I look after the children I do, because they need it. Many of the women perceived their lives as being less chaot ic and crisis driven following participation in the P S G . They attributed this s e n s e of stability to an accep tance of their limitations and recognit ion of their strengths in deal ing with their situations. Prior to the P S G , She i la felt out of control and unable to dea l with day to day issues. S h e descr ibed her t ime in the P S G as one where she learned to "not feel as responsib le and guilty for everything". 65 She i la descr ibed her se l f -acceptance as a process of making s e n s e of the chaos assoc ia ted with her previous parenting patterns: I'm not in crisis every other day, you know. Even though there's a lot happening especia l ly with the kids, it's not so critical anymore. They ' re not going to die every six minutes if I don't get it f igured out....[I'm] more forgiving of myself, I think. I felt guilty that I couldn't fix things all the t ime for them. A n d then I started to realize that there are s o m e things beyond your control and.. . just try and fix things you can to make a change. Start with yourself first, you know. But it's been really good, posit ive for them. It's positive for them to s e e that I can stumble and fall and still stand up, get up aga in . . . The w o m e n d i scussed how they felt more capab le of interacting positively with their children once they had first sorted through and made s e n s e of their own issues. Many of them identified with the example provided by S u s a n , who expla ined how her conf idence and accep tance of herself had created an exis tence in which she felt more posit ive in her relat ionships with her chi ldren and others: I think that makes them [the children] feel more secure. . . I 'm more likely to end a d iscuss ion with them, not having to justify myself. Y o u know, they can deal with that and that's fine. Se l f -acceptance appeared to be enhanced by posit ive re-enforcement from others outside of the P S G . Al though all of the women felt a s e n s e of uncondit ional accep tance from members of the P S G , many of the women 66 perceived that they were misunderstood by other members of society. It appeared , however, that positive comments made by significant people in their l ives were t reasured and served to enhance their own feel ings of self-worth and accep tance . She i la appeared to reflect the feel ings of others in her focus group when she related her example : Y o u know, somebody did that to me the other day. It's a teacher who doesn' t teach my kids. I had never ever spoken to her before, but I s e e her all the t ime. . .she sa id , "I wanted to say that I've been observ ing you and I've been in this bus iness a long time. I'm an educator and I'm a nurse. I know what I'm talking about, and I think you're a fabulous parent. A fabulous mother, the way you are here for your kids". I sa id to her, "Tell me more, tell me more!" Boundar ies With The Abuser Many of the women perceived that their se l f -acceptance ass is ted them in being less suscept ib le to the abuser 's continuing attempts at manipulat ion. Fol lowing the P S G , they were more often able to p lace b lame for past events and current situations with the abuser rather than with themselves. The women reported, however, that although the physical abuse was no longer present, the abuser constantly used other avenues to try to upset the new found ba lance in their l ives. The most frequently reported ep isodes surrounded custody and a c c e s s issues: 67 That 's what is the hardest thing, is the chi ldren. B e c a u s e if it wasn' t for the chi ld, you wouldn't have to answer the phone again. Y o u would never have to, you know, s e e them again or whatever. This perception was shared by many of the women . A c c e s s visitation per iods were identified by all the women as the most stressful t ime when the abuser would initiate harassment or manipulat ion. The w o m e n reported that the P S G gave them opportunit ies to try new strategies to thwart the abuser 's attempts at manipulat ing them during a c c e s s visitation periods. Katr ina arranged to meet her abuser in the park for drop-off and pick-up a c c e s s per iods, as she wanted to create a situation that was impersonal and public. Wh i le this type of situation dec reased the opportunity for ongoing harassment and abuse , Katr ina still bel ieved that the abuse would continue: The only reason why my ex comes to s e e S . is b e c a u s e he can s e e me and he 's not supposed to see me. But I can meet him at the park and he 's a lways got something to say . . .And it will go on forever. The women noted how they had learned in the P S G group to handle these a c c e s s per iods in a manner that they perceived was less disruptive to their chi ldren's l ives. Th is use of new strategies armed them in developing boundar ies with the abuser. V icky descr ibed how prior to the P S G , her abuser would p lace her chi ldren in a situation of conflict by manipulat ing both her and her chi ldren into a state of high anxiety during a c c e s s per iods. S h e related how, through the shar ing of her exper ience and hearing those of others in the 68 group, she was able to reflect on past a c c e s s exper iences and recognize patterns in her abuser 's attempts at manipulat ion. S h e subsequent ly tried new strategies d i scussed in the P S G to sabotage the abuser 's manipulat ive attempts. V icky acknowledged that this practice requires t remendous energy, as she struggles to overcome past patterns of responding : Y o u bite your lip because they pre-warn the ch i ldren. . .Your mum's nuts and we're an hour and twenty-five minutes late, but that's no big dea l . S h e ' s going to be really mad at me. A n d preparing for all of it. A n d then, when your kid says , "Are you mad at daddy because he's late?"... i t took every ounce of strength to say, "Oh no, anybody can get stuck in traffic" (laughter). A n d that took a lot for me to do that. Katr ina, the woman who arranged child a c c e s s drop-off and pick-up at the park, found that ignoring her abuser and directing her comments to her child gave her more conf idence and control over a c c e s s per iods, "Now I just go. I don't even direct the quest ions to [the abuser]. I say, " S . I'll s e e you back at the park at five o'clock, okay? Have a nice day. Bye" . W o m e n who had been out of the P S G for a longer period talked about the action of "setting boundar ies" as a consc ious method of maintaining control on the effect of the abuser 's ongoing harassment . She i la felt that, prior to the group, she had limited control over her life in terms of boundar ies with her abuser . S h e expla ined that, as her conf idence in her relat ionship with her children improved and her conf idence in her ability as a mother stabi l ized, she felt more secure in setting boundar ies: 69 I started setting boundar ies for myself and what I was going to tolerate, and what I was going to accept and not accept . I started getting results which was amaz ing , with my ex-husband (laughter)...It's not about setting boundar ies for other people. It's about setting boundar ies with what you're comfortable with and it worked. E m m a related the ongoing subtle attempts of her abuser to manipulate her activities. S h e descr ibed her reaction to these events and the limits she now puts on their relationship in order to maintain a s e n s e of control. S h e related her ability to set limits resulting in her feeling less guilty and more confident in herself: I haven't lived with him for two years. He still asks me where I go and I say it's none of your bus iness and he says okay. But he still needs to ask me where I'm going I need to keep coming out and reaffirming and saying yes , I can come out. I'm doing this on my own and nobody is telling me no. A n d the icing on the cake is that I'm learning! The setting of boundar ies was perceived by the w o m e n as an important step in taking back control of their l ives and distancing themse lves from their abusers . The distancing appeared at t imes more emot ional than physica l , due to court imposed a c c e s s visits to the chi ldren: We l l I've gone through crap with him today on the phone and he's been here at the door and he's done this and he's done that about the kids and the a c c e s s . . . I'm see ing him once a week, but at least at the end of the day I c lose the door and he goes away. . .That in itself is a major 70 accompl ishment , even though I've got all the crap to dea l with during the day, during the week. She i la shared an extraordinary vignette related to her percept ion of the ef fect iveness of 'setting boundar ies ' with her abuser. S h e felt that the setting of boundar ies provided her with a s e n s e of control previously unimaginable: I mean my ex, we haven't talked. I had set all those boundar ies. I think I remember telling you about the court order and we're not supposed to ta lk. . .he w a s actually the pall bearer at my father's funeral in March (laughing). I thought I'd come a long way that I could tolerate his very p resence in the room; and actually, we had a few civil words to say to each other...but that I wasn' t shaking in my boots was amaz ing ! B e c a u s e just the mere thought, just getting on the phone with the man was enough to get my heart palpitating and swea t . . .And my mind going blank. S o that's coming a long way! Al l of the women bel ieved that being able to emotional ly detach from their abuser was an integral part of moving on in their l ives and regaining control. They d i scussed this within the P S G environment and shared personal strategies for detaching themselves both emotional ly and physical ly from the abuser. V icky descr ibed the mental exerc ise that she now util izes to reduce her react ions to her abuser 's attempts at manipulat ing her: If I just talk in monotone and if I look at him like he's just a sperm bank, as weak as it may be, it works. But it works.. . i f I just keep an even keel. . .but if I don't do that, then I just go way off. 71 Although none of the women saw themselves as being free from their abuser, only Heather perceived her situation as having deteriorated to the point where she had limited control. This was due to a court order forbidding her from leaving town: I'm the prisoner in the Lower Mainland. I can't even move back to my parent's home [due to the] court order. I have to stay here. I live in a free country and I'm a prisoner. The women report that the energy exerted in maintaining control of and setting boundaries is exhausting. It appears, however, that the women value the sense of control that they feel and view this process as a necessary component of successfully surviving away from the abusive relationship. The ability to maintain boundaries, however, appears contingent on their feelings of confidence related to parenting and a perception of ongoing support. Asser t iveness With External Forces The women perceived that another dimension in reframing their experiences was related to their ability to assert themselves effectively with others. Many of the women, prior to the P S G , saw themselves as having come from a position of powerlessness when interacting with others. They felt that the P S G provided them with skills and confidence in their ability to effectively assert themselves in a variety of situations. The legal system was perceived by most of the women to augment these feelings of powerlessness. The feeling of 'being abused all over again' was echoed in many of the women's stories as they related their perceptions 72 of their l ives following the parenting support group. V icky, who as ment ioned earlier was exper iencing cont inuous harassment via legal manipulat ion from her abuser , expla ined the frustration she felt in deal ing with the legal sys tem prior to joining the P S G : They make you crazy with all this stuff, and you're through enough as it is. Then you have to go find things to help you and your chi ldren out and then you have to fight little sys tems here and there because you don't know how this works, because you're not famil iar with any of it. A n d there's no one out there guiding you a long. S h e provided an example related to her feel ings of frustration in deal ing with the legal sys tem, and how, after learning to assert herself in the P S G , she practiced these new-found assert ive skills on a socia l worker who had been ass igned to her child custody case . After becoming very angry at her s e n s e of power lessness when interacting with the socia l worker and perceiving that she was being verbally abused , V icky lodged a complaint with the soc ia l worker 's superior: It took me a week. It took me sitting there with not losing s leep, but fretting that this woman could say something bad about me and I could lose my kids or whatever. A n d I had to get that off my chest and I d id, and I think the group helped m e do it in a really posit ive way instead of me phoning up and yell ing. I phoned up and went right to the top of the c o m m a n d b e c a u s e I didn't even trust her to let him know. I needed to do it myself, and that's the strength I got from that. 73 Carol ine related her exper ience of engaging legal advice. A s previously ment ioned, Caro l ine was living in constant threat of such extreme physical v io lence that the pol ice had expressed concern for her safety. In addit ion, Caro l ine was continually harassed by her abuser by te lephone and during a c c e s s periods. Caro l ine was existing in a constant state of v ig i lance as well as being overwhelmed by her chi ldren's reactions to her separat ion from the abuser. S h e had not been satisf ied with her lawyer's adv ice but did not know how, nor had the emot ional energy, to change the situation. S u s a n had maintained contact with Caro l ine following c losure of the P S G . S u s a n contacted Caro l ine and supported her in her transition to another lawyer who better met Caro l ine 's needs . In the following dia logue, Caro l ine relates how significant this change was in terms of her ability to assert herself: That was .a huge thing. It took s o m e nerve to change lawyers after going along with that one lawyer for such a long t ime and it was almost like an abus ive relationship, where I used to burden mysel f enough to make it like that anyway. To get up enough nerve because other people were going through it, you know. The women in this study identified other areas of their l ives where they had become more assert ive with positive results. She i la descr ibed how she had previously felt like she was cont inuously defending herself to others. S h e perceived the support that she gained from the P S G , and her own reframing of her situation, as integral in her ability to assert herself effectively: 74 I found I became more firm...I started setting boundar ies for mysel f and what I was going to tolerate and what I was going to accept and not accept with my kids, with people I was deal ing with...with the schoo l . . .and I started getting results which was amaz ing ! Al l of the women perceived that they had retrieved s o m e measure of control over external forces in their l ives. This perception of boundary control appeared to have a posit ive effect on their " sense of s e l f and their conf idence in parenting their chi ldren. Many of the women perceived themse lves as having more control over their interactions with their chi ldren or, rather, their responses to their chi ldren's behavior. She i la descr ibed how she had adjusted her way of coping with the ambiguity of her chi ldren's behavior, resulting in her feeling less defensive and more positive about the outcome: It's like being able to, with your kids say take it just to the point and not carry it on forever. A n d s o m e things I'm able to tell my kids that just aren't so lvable either. It's just the way it is. A s the w o m e n related their retrospective accounts of their l ives, and their percept ions of how they had changed following the P S G , reframing became apparent as an important precursor to the women 's ' ability to ach ieve self-eff icacy. Self-Eff icacy Self-eff icacy is def ined as "a person 's judgments of own capabi l i t ies to execute a given level of performance" (Murdock, & Neafsey , 1995, p. 159). Self-ef f icacy "demonstrates how confident an individual is in the ability to 75 perform a speci f ic task to success fu l complet ion" (p. 159). It is affected by percept ions of past performance, support from others, and level of comfort with self when performing or anticipating performing a task. In addit ion, a person 's level of self-eff icacy will inf luence the planning of and perseverance in future activities and the individual's level of anxiety in approaching new tasks. In this study, self-eff icacy appeared to be a goal that the women were striving to ach ieve. Al l of the women perceived themse lves as having changed as a result of participating in the P S G . T h e s e changes were individually def ined; however, similarit ies in the meanings emerged as the w o m e n shared their percept ions. Most of the women were in the p rocess of reframing their past exper ience in an abusive relationship and were exploring their future. The women who had been out of the P S G for the longest period of t ime appeared further a long in this p rocess and were able to def ine the types of ongoing support necessary for growth towards, and cont inuance of, self-eff icacy. She i la reflected on her exper ience s ince participating in the P S G . Prior to joining the P S G , She i la had perceived herself as "not in control" as a mother and struggling to overcome her abuser 's attempts at harassment . S h e descr ibed the p rocess of participating in the P S G as a t ime when she "let go of the guilt" and al lowed herself to recognize her capabil i t ies as a mother and as a survivor of abuse . She i la descr ibed her conf idence and reframing as being so much a part of her "way of being" that it was almost unexpla inable to people who had not had the exper ience. S h e perceived this exper ience as 76 something she had grown and emerged from as a stronger person - different from others as a result of her journey: I feel like I'm starting now to rejoin the human race in a w a y . . . O n my own terms. But I find myself in socia l situations where it's a lways in the back of my mind, and it's almost as if it's a part of how I communica te with people . . .Wi th s o m e of my fr iends it's a lmost like you can go back to that and say, "hey I c a m e from there and I'm still okay but, there's this one thing about my life that's still changed" . It's still changed everything for me. It's almost like having ten million dol lars in your bank account but wanting to be able to tell people that you c a m e from the bottom you know, to get there . . .So the group did that for me, and being here now reminds me that I feel proud of having gone through this process and having made it. Many of the women in She i la 's focus group (Group A) identified with her narrative. They descr ibed their l ives as having changed and appeared to be a m a z e d at how much they had progressed. F o c u s Group B did not report as many components of self-eff icacy as defined in this study; however, they perceived many positive changes in terms of conf idence with their chi ldren and ability to reframe their exper ience. I bel ieve that self-eff icacy e n c o m p a s s e s s o m e of the components of conf idence and reframing, and that the cont inued feedback with these components is necessary before self-eff icacy can be ach ieved. The following components that I present in this paper are characterist ic of what I perceive the women in this study display 77 when demonstrating self-efficacy. The two components outlined include a desire to plan for the future and an ability to self-define ongoing support needs. Planning for the Future As mentioned previously, many of the women in the groups perceived the most significant changes in their lives had come from within themselves and were not as a result of external factors. Generally, their socioeconomic status had not improved, nor had custody and access conflicts dissipated. All of the women were on welfare but saw this as temporary. They perceived that they would only require this type of support until either financial support from the abuser had been determined and enforced by the courts, or their children reached school age and the women could seek employment. Katrina explained the reframing of her perception of this experience, "I learned that no matter [what], like I'm proud to be who I am and I'm not going to be on welfare forever, but I need it until he [pays]. Emma reflected on her present situation and reported that the greatest change in her life had been intrinsic rather than external. Her increased sense of self-worth and confidence in her abilities had helped her reframe her perception of her experience and provided her with the tools to consider her future: Two years has gone by and that's a long time. Back then I was new to this. So the difference between then and now is...I'm feeling comfortable and secure in my lifestyle now, whereas back then it was 78 all in the future...And it turned out to be all right. The next scary part is now. The change is coming...I'm hoping that the skills and the tools I've found, been using so far will get me over the next hump which is going to be the next big change...So I feel that this group and the other groups have given me, have backed me up in this process that I've been going through. The other women from focus Group A agreed with Emma in terms that planning for the future was an intimidating process; however, they felt more equipped to take on this task as a result of having gone through the P S G . Some of the women also identified that custody and access issues were not as prominent, having been settled legally. The women in this group appeared very excited to reflect on how their lives had been before the P S G , and described how they were at times not even aware that they now had confidence to plan for their future; the confidence seemed so much a part of who they were now. They did feel, however, that both formal and informal support was imperative to the success of their continued growth. Defining Ongoing Support Needs Prior to participating in the P S G , the women in both groups agreed that they had concerns related to parenting their children, dealing with custody and access issues, and trying to make a new life away from their abuser. Most had come to the P S G believing that it would assist them in meeting their children's needs. The women generally felt, however, that they had been unclear as to their own unique needs. Following the P S G , the women were more clear 79 about their own ongoing needs and those of their children. The general consensus amongst the women was that the P S G needed to continue for longer than ten weeks in order to help them to address ongoing issues associated with recovering from an abusive relationship: I think that it really needs to be ongoing to take you through the process or the changes with your kids, and it recognizes that situation. There's possibly a two or three year battle, and it can't be just crisis intervention. Most of the women perceived that they required not only a longer period of parenting support, but also more time during the sessions to address issues that had surfaced during the previous week: So the group is [done] but our problems don't finish...And it was really supportive and it was really, really nice to have that it was only two hours so it wasn't long enough. Like it would have been better if it was three hours. The women recognized that the recovery and subsequent growth away from an abusive relationship is an ongoing process. Despite recognizing their increased confidence and effectiveness in addressing issues surrounding the abusive relationship, they continued to see themselves as vulnerable to new threats: You need some support and you're sort of scrambling around trying to find the right support and support that's going to recognize that abuse has been a part of your life, and that it has its ongoing influence in 80 s o m e way. That you're still going to have that conflict to dea l with, that inf luence. The w o m e n also expressed concern regarding the scarcity of support groups for their chi ldren. They v iewed their chi ldren as continuing to exist in a vulnerable posit ion with the abuser despi te the improved maternal-chi ld relationship. The women bel ieved that ongoing and consistent support for themselves and also their chi ldren was necessary for them to address future problems confidently. S u s a n descr ibed her perception of her chi ldren's d i lemma surrounding a c c e s s visits and the subsequent lack of support for her chi ldren in address ing this situation: I think the kids get str ipped of power even more so than we do. Certainly I don't a lways have the power that I should have to protect them or do something for them. Then they get shuff led back and forth in a c c e s s or I'm pushing them out the door and they don't want to go with him and they don't have anybody to bitch to about that. They have to be careful what they say or how s o m e of those things get handled. Al l of the women recognized that the abuse will be ongoing and , therefore, will cont inue to affect the chi ldren. Many have attempted to find resources for their chi ldren that could support the chi ldren, especia l ly when deal ing with custody and a c c e s s issues. Often the abusers were perceived as sabotaging the women 's attempts to seek support for their chi ldren. Caro l ine, whose husband frequently interfered with her attempts to seek counsel ing for 81 her chi ldren, descr ibed how by seek ing support for herself, she could circumvent her abuser 's attempts at manipulat ion: I tried to help them deal with s o m e of the stuff. I tried to do that by putting them in counsel ing but in so many situations, you've got an ex-husband who sabotages all the time. S o I felt like there's only certain things I can take home to them that they can maybe use. Al l of the women in focus Group A agreed that support serv ices for their chi ldren, provided without fear of harassment from the abuser , were necessary for the wel l-being of their chi ldren. The women appeared to link the wel l-being of their chi ldren to their own recovery from the abus ive relationship. They felt that the P S G had provided them with s o m e tools to foster their chi ldren's unique needs in recovering from the abus ive relationship. E m m a descr ibed her ongoing s u c c e s s with her chi ldren as a result of using strategies from the P S G : W e were taught. . .an approach. . I can apply it even though e a c h c a s e is so different, but at least you've got something that you can refer back to and approach this problem.. . every single problem and all its diversity and come out at least with a little bit of s u c c e s s . Al l of the women agreed that their s u c c e s s in meeting their chi ldren's needs boosted their own s e n s e of accompl ishment ; however, the women bel ieved that they needed ongoing support to ensure cont inuance of this s u c c e s s when new issues arose. 82 W o m e n who had been out of the P S G longer felt that their needs had shifted to include issues that had not been addressed in the group. They expressed a desire for "another generat ion of parenting support group" to address new and ongoing issues which they felt affected their day to day maternal-chi ld interactions. O n e example of a new issue was how to address the abuser dating other women . Subsequent ly , if they a lso started to date, how to support their chi ldren and explore their own feel ings in relation to this issue. S u s a n expressed concern related to support ing her chi ldren following their exposure to their father's multiple partners. S h e also appeared unsure about how to move forward in her own life and extend her boundar ies to include new relat ionships with other men: Deal ing with him dating other women . Having other w o m e n around the kids, or many other women around the kids and s o m e of the kids feel ings about that. How I should handle it when I'm feel ing really sensit ive about it. Then me dating and how do I bring that into my family or how are my kids are going to feel about that. That 's all new ground, you know and again, I'm sensit ive. Creat ing a b lended family was another issue that s o m e of these women a lso v iewed in their future. They bel ieved that support for this reframing exper ience was required, but scarce . She i la d i scussed her concerns related to her new blended family ex is tence: 83 B lended famil ies is actually part of a very natural step and you are left there dangl ing. Trying to figure why even though you 've gone in with both eyes open. . .and I walk into this and I'm left with this whole basket of, l ike. . .how do I deal with this. I found one book and it was about ten years old and I left me kind of at that spot. Most of the women noted that they expected to form new relat ionships and family structures in the future. They also felt, however, that due to their history of abuse , they would require support in creating these new relat ionships. Summary In this chapter the f indings from the data analys is were presented and supported by narratives provided by the women . A conceptual d iagram of these f indings was a lso presented to provide a visual structure for the reader. Forming the bas is of the women 's exper iences was their percept ion that, as a result of all being mothers who have left abusive relat ionships, they had exper ienced a relationship with each other that was unique. Th is "shared exper ience" cont inued to inf luence their percept ions of their l ives after the group and was intertwined in the themes as they emerged . The three themes that were descr ibed in the exper iences of the women were: 1) connect ion; 2) conf idence; 3) reframing; and 4) self-eff icacy. E a c h of these themes were def ined and the components of the women ' s exper iences that supported these themes d i scussed . A s demonstrated in Figure 1, the themes over lapped. A s the women gained conf idence, they were able to 84 reframe their situation. Feel ings of self-eff icacy emerged as a result of posit ive outcomes and increased conf idence. Even though external events may have inf luenced their ability to sustain their progress, resulting in a slip back to a previous state, there was a general perception of forward movement . The theme of connect ion was descr ibed by the women in terms of their shared exper ience and shared meaning while participating in the P S G . The components descr ibed appeared to provide the women with an a tmosphere of trust and safety in which to d isc lose their feel ings and try new strategies outside of the group. The theme of conf idence was v iewed as having two components which were cons idered important to the women . T h e s e components inc luded: 1) intimate relat ionships with chi ldren; and , 2) parenting skil l. T h e w o m e n provided examp les descr ib ing how, prior to joining the P S G , they felt uncomfortable with their abilities to communicate effectively and share themse lves with their chi ldren. They perceived that they often were unable to separate their feel ings related to the abus ive relationship from those involved in maintaining a relationship with their chi ldren. Their percept ion of their ability to parent their chi ldren effectively was also identified as a component in the theme of conf idence. The women perceived that their previous patterns of parenting were ineffective in address ing their chi ldren's behavioral outbursts and attending to their needs. Strategies were provided in the P S G that the women integrated into their own situations. Equ ipped with new tools, the 85 women perceived that they were more effective and confident in their parenting skil ls. The themes of conf idence and reframing were cons idered interconnected and fluid, with characterist ics from one theme affecting the other. The character ist ics identified in the theme of reframing were: 1) self accep tance ; 2) boundar ies with the abuser; and 3) asser t iveness with external forces. Many of the women had not explored how previous feel ings of guilt and power lessness had affected their s e n s e of control over their l ives. T h e women bel ieved that the group gave them a safe and secure p lace in which to focus on themselves. They related examples descr ib ing how they felt affirmed in their strength to remove themselves and their chi ldren from an abus ive relationship. Another important area of control identified by the women , related to deal ing with the abuser, especia l ly around the issue of custody and a c c e s s . T h e w o m e n cont inued to perceive this a rea of their l ives as stressful , but identified strategies that they had implemented to minimize the control that the abuser had over them in this area of their l ives. The w o m e n a lso deve loped new ways of taking back the control that had been se ized from them. T h e work of setting boundar ies and taking back control w a s v iewed by all of the women as cont inuous and exhaust ing. They all be l ieved, however, that reframing the exper ience was essent ia l before they could move forward in their l ives. Self-ef f icacy involved: 1) planning for the future; and 2) descr ib ing ongoing support needs. A n integral part of reframing the women 's exper ience 86 of the abus ive relationship was self acceptance. This p rocess w a s identified as an important step in making s e n s e of their l ives and separat ing themse lves from the abus ive relationship. Being able to make s e n s e of their past, and present situation, appeared to facilitate planning for the future. P lann ing for the future involved exploring new situations which might involve risk. The women bel ieved, however, that they required ongoing support to address their future. Support was cons idered integral to their ability to find ba lance in new relat ionships and to support their chi ldren in their developmenta l and situational needs . 87 C H A P T E R FIVE: DISCUSSION OF THE FINDINGS Introduction In this chapter the f indings from this study will be d i scussed . Al though e a c h of the previously identified themes is crucial to the understanding of the women 's story, I will limit this d iscuss ion to what I bel ieve are the most significant a reas requiring addit ional exploration. The a reas that warrant more in-depth d iscuss ion are: 1) the importance of support; 2) the effect of t ime; and 3) the work of integrating the exper ience. E a c h of these areas will be explored in relation to both the conceptual f ramework of the study and the relevant literature. The Importance of Support A s previously ment ioned, most of the women descr ibed their l ives as being in a state of chaos and uncertainty prior to joining the parenting support group ( P S G ) . The women reported joining the P S G feel ing varying levels of guilt, low se l f -esteem, and power lessness in many aspec ts of their l ives. They all bel ieved that their continuing exper ience with abuse had left them with dec reased conf idence in their ability to parent their chi ldren in an effective way, establ ish boundar ies with their abuser and assert themselves. T h e women in both focus groups identified the s e n s e of connect ion that they deve loped with e a c h other during participation in the P S G as fundamenta l to their ability to move forward in their l ives. T h e affinity that they had with e a c h other evolved from the belief that they shared a c o m m o n bond as a result of being mothers surviving away from abus ive relat ionships. T h e 88 women noted that they all had other forms of formal and informal support. The support found in the P S G , however, was different from any other form of support that they had previously exper ienced due to the shar ing of meaning and exper iences. It was very important for them to be able to c o m e to the P S G and exper ience this s e n s e of connect ion. The women noted that, as a result, they felt safe to talk openly and explore var ious issues. The support ive a tmosphere facilitated the d iscuss ion of new skil ls and strategies to address their i ssues. R e s e a r c h focusing on the inf luence of support group interaction with women who have been abused indicates that intense bonding can occur from the s e n s e of shar ing common problems, thus reducing the women ' s s e n s e of isolation (Varvaro, 1990). The women in this study identified a need to feel "normal" and more in control of their l ives. They felt that, in shar ing their common problems in the forum provided by the P S G , they felt more normal. The women v iewed the relat ionships that they deve loped as a result of being in the P S G as unique - different from any other group or one on one counsel ing that they had previously participated in, different f rom the connect ion that they had with fr iends or family members . Subsequent ly , they were able to relate to and support e a c h other in a signif icant way that m a d e s e n s e of the a b u s e and normal ized the exper ience. Accord ing to them, this support gave them courage to try new strategies with their chi ldren and others. 89 The f indings in the literature indicate that the support ive p rocesses of a group can facilitate the development of insight and control in w o m e n who have left an abusive relationship (Campbel l , 1986; Draucker, 1992; Henderson , 1989; Lewis, 1986; Varvaro , 1990; Weingourt , 1985). F rom what I observed in the women during my visits as a research assistant, the overal l movement forward could not have been possib le without the support found in the P S G . During the visits I noticed that the women appeared more comfortable interacting with their chi ldren. The women a lso reported "feeling better" about themse lves and they appeared more ca lm when descr ib ing their abuser 's attempts at ongoing manipulat ion. The women stated in the focus group sess ions that they had employed many of the strategies learned in the P S G to build improved relat ionships with their chi ldren and to detach themselves emotional ly from the abuser. The support found in the P S G , therefore, w a s fundamenta l to the women 's p rocess of growth after leaving the abus ive relationship. Campbe l l ' s (1986) research supports this asser t ion by indicating that the components of recognizing one 's strengths, regenerat ion and growth are possib le outcomes of an effective support group process . O n e of the goals of support group work for women who have been in an abusive relationship is to promote the search for meaning and to facilitate growth and self-determination (Campbel l , 1986; Lewis, 1986; Varvaro , 1990). The women in this study, prior to joining the P S G , s a w themselves as having survived the initial transition period of separat ing from the abuser and finding new accommodat ion . They reported to me in my visits as a research 90 assistant, however, that they were in a state of chaos and uncertainty as to how to deal with their chi ldren, the legal sys tem, and the ongoing manipulat ion from the abuser . They all identified that they needed help to address these areas in their l ives. The women felt that the support ive relationship found in the P S G was fundamental in order to develop insight and skil ls necessary for helping themselves and their chi ldren to move forward in their l ives. I was a lso intrigued by the intensity and duration of the bond that had formed in the P S G . In fact, when the women were reunited again for the focus groups, they demonstrated an intense affection for each other. I observed the w o m e n greeting e a c h other excitedly and hugging one another. During the focus group sess ions , the women reflected on previous shared moments in the P S G with obvious enjoyment, often crediting each other for making a dif ference in the lives of others in the group. At the end of both focus group sess ions , the women cont inued to "catch up" with each other, stating that they wished that they didn't have to end the d iscuss ion and leave. It was clearly apparent that the P S G provided someth ing unique and spec ia l to these women . The women in this study felt that they had never exper ienced the type of bonding found in the P S G where they were intuitively understood. T h e women felt that having s o m e o n e who understood where they were coming from and what the exper ience of abuse had been like normal ized the exper ience, making it just that much eas ier to talk about and strategize how to move forward. 91 O n e might hypothesize that if the women benefit f rom this s e n s e of support and perceived growth in themselves, their chi ldren will a lso benefit from the "spil l-over" effects of the P S G intervention. The literature f indings suggest that working with the mothers produces a posit ive impact on the children (Blinikoff, 1995; Er icksen, & Henderson, 1993; Henderson , 1992; Humphreys, 1993; Led ingham, & Crombie , 1988). The w o m e n in both focus groups shared stories of how they had taken strategies from the P S G and incorporated them into their parenting with posit ive results. During my visits to the women 's homes as a research assistant, I a lso noted that s o m e of the children appeared more "sett led" and receptive to their mother 's directions in the months following the P S G intervention. During these visits, many of the women reported that their chi ldren's behavioral outbursts had dec reased in f requency and , in s o m e c a s e s , in intensity. A s previously ment ioned, the women noted that the P S G provided them with a mechan i sm to d i scuss and develop strategies to resolve many of their i ssues . T h e f indings of this study indicate that once the mothers felt comfortable with new strategies to deal with anger and coping, they would often talk about, and teach them, to their chi ldren. The women val idated that this p rocess ass is ted in creating a healthy a tmosphere for heal ing in the home. The support that the women gained from the P S G had a different meaning for them than that from other kinds of groups b e c a u s e of the express ion of mutuality within the group. They perceived a more equa l 92 distribution of giving and receiving of time and support within this group than in the group experiences in transition house situations. Henderson's (1989, & 1995) research surrounding social support in a transition house group experience also supports that, due to the chaotic and often life-threatening events happening in women's lives upon initial separation from the abuse, reciprocity of support is not always possible. It may be that the women who participated in the P S G saw themselves as being at a point in their lives when they were able to engage with each other with a level of mutuality that met their needs. The Effect of Time There were differences noted in the women's perceptions of their experiences dependent on the time since leaving the abusive relationship and time since finishing the P S G . The women in focus Group A had been out of their abusive relationships at least one year longer than those in Group B. The women in Group A had also been out of the P S G longer than those in Group B. The women from focus Group A appeared to demonstrate more confidence in their intimate relationships with their children and in their parenting skill. They perceived themselves as stronger as a result of their experience with abuse. They had journeyed further in their reframing of the abuse to the point where they could view positive outcomes as a result of their experiences. The women in Group A could, as a group, more clearly identify areas of their lives where they felt in control and those that they could not control. The boundaries that they had with their abusers were also more easy to delineate, and they appeared to feel more comfortable with them. Final ly, the w o m e n in Group A were better able to def ine what the future could hold, both for themselves and their chi ldren. They could a lso envis ion more clearly, the types of support that they would require to continue their growth p rocess . B a s e d on the exper ience of the two focus groups, I bel ieve that the process of t ime is an important factor to cons ider in the women 's growth towards self-eff icacy and beyond. Findings from the literature support the idea that recovery from a traumatic life event requires energy and t ime (Campbel l , 1986; Campbe l l , M c K e n n a , Torres, Sher idan, & Landenburger , 1993; Henderson , 1993; Herman, 1992; Landenburger, 1989; Taylor, 1983; Varvaro, 1990). The women participants in Draucker 's (1992) study of recovery from incest descr ibed their healing p rocess as "an active, ongoing, complex and t ime-consuming exper ience involving 'hard work'" (p. 5). Inherent in Draucker 's (1992) study was the belief that the participants' work of "constructing" a new p lace for themse lves required t ime for them to make s e n s e of new information and tools and to integrate it into their new ex is tence. The women in this study provided descriptors very similar to the w o m e n participants from Draucker 's (1992) study. The women in Draucker 's study descr ibed act ions of "constructing a new relationship with the self, regulating boundar ies, and influencing one 's community" (p. 6). T h e s e p rocesses required t remendous energy, t ime, and ongoing support from external sources. 94 Whi le the nature of the v io lence in Draucker 's (1992) study and this study were dissimilar, the e s s e n c e of abuse in both studies provides direction for understanding time as a factor in the recovery process of abuse in general . Landenburger 's (1989) study provides further support for the concept of t ime as an important mediating factor in the recovery from abuse . Landenburger proposes that "the process [of recovery from abuse] is not l inear and stable; p ieces constant ly weave together with the degree and types of behaviors, feel ings and thought changing in reaction to a cumulat ive exper ience" (p. 215). A s previously ment ioned, there were significant di f ferences between the focus groups in relation to where the women were in their growth towards self-eff icacy. There were also individual di f ferences amongst the w o m e n in each group; recovery for each woman was unique. For example , Heather perceived that the P S G had provided her with s o m e support to address her own i ssues ; however, s h e cont inued to feel unsure of herself and her abilit ies. Heather perce ived that she had " re lapsed" s ince participating in the P S G . S h e attributed this to the relentless manipulat ion of her abuser and the subsequent erosion of her se l f -esteem both as a person and a mother: I have re lapsed more. . .a l l that time and energy and everything is gone.. . I 've gone back to the way it was before. Despi te articulating feel ings of low sel f -esteem and a percept ion of dec reased coping, Heather recognized her situation as having moved forward, "I would 95 never go back to being a family with him even if it made it that his son 's life was the best. I wouldn't do it". It appears that there are external events that exist in time that can affect the growth of the women towards self-eff icacy. T h e s e external events were identified by the women as ongoing legal manipulat ion by the abuser surrounding custody and f inancial compensat ion, manipulat ion of the abuser of the women and their chi ldren, and subtle and overt harassment by the abuser . Landenburger (1989) notes that "what happens to a woman is not l inear and is full of contradict ions" (p. 223). Landenburger 's assumpt ion of backward and forward movement in recovery from the abus ive relationship is demonstrated in Heather 's exper ience and supports the f indings of this study; per iods of circularity in the recovery p rocess of abuse are natural and should be ant icipated. Wh i le it is apparent that time is an important factor in women 's recovery from abuse , it is difficult to identify what aspect of t ime inf luences the women 's exper iences. Poss ib le explanat ions could be that the inf luence of t ime al lows for the women 's acquisit ion and solidif ication of new skil ls and/or mental adaptat ion to new exper iences. Clear ly, this is an area requiring further research. The Work of Integrating the Exper ience The women 's work of integrating the exper ience of abuse with the new reality of their l ives following participation in the P S G w a s descr ibed in the f indings of this study. T h e integrative exper ience of f inding mean ing, mak ing s e n s e of the abuse , establ ishing boundar ies and planning for the future is 96 similar to the work descr ibed in grief and heal ing literature (Draucker, 1992; Larson, 1992; S i lverman, 1986; Taylor, 1983; Wend ler , 1996; Varvaro , 1990). The f indings from this study, women 's exper iences fol lowing participation in the P S G , appear very similar to the p rocess of heal ing descr ibed in the literature. Th is p rocess involves a "sense of who leness , integration, ba lance and transformation" (Wendler, 1996, p. 839). The women in this study appeared to have similar expectat ions as individuals going through the work of grief and heal ing. T h e s e expectat ions include making s e n s e of and constructing new meaning from the exper ience, becoming stronger as a result of surviving the exper ience, and constructing a future which integrates the exper ience in a posit ive way (Draucker, 1992; Larson, 1992; S i lverman, 1986; Taylor, 1983; Varvaro, 1990; Wend ler , 1996). T h e s e authors a lso note that is the presence of formal sys tems of support to facilitate recovery from and integration of traumatic exper iences is fundamental to the s u c c e s s of individuals exper iencing growth through the p rocesses of grief and heal ing. A n understanding of the concept of heal ing, therefore, may ass is t nurses in support ing women at this s tage in their recovery from an abusive relationship. Campbe l l , Smith M c K e n n a , Torres, Sher idan, and Landenburger (1993) provide support for this finding in their descript ion of the recovery p rocess that w o m e n go through after leaving an abusive relationship. They note that the provision of support may be the mediat ing factor in the s u c c e s s 97 of a woman finding meaning and posit ive outcomes after leaving an abus ive relationship - in integrating the exper ience. Many of the women attributed the growth in their l ives to the insight and new skil ls generated from the P S G . Landenburger (1993) notes that "the ability to learn that her efforts are effective is essent ia l for the [woman's] cultivation of a posit ive image of s e l f (p. 383). Al l of the women a lso perceived that they had become more comfortable and confident in their parenting skil ls and intimate relat ionships with their chi ldren. During the focus groups the women descr ibed this p rocess as one of the most important ou tcomes from the P S G in terms of their feel ing success fu l and confident about themselves . It b e c a m e quite apparent that being success fu l in their mothering role, by being able to address and meet their chi ldren's needs effectively, was crucial to the women 's recovery from their abuse . Th is finding is supported by previous research (Henderson, 1989, 1990 &, 1993). Henderson reports that women who have left abus ive relat ionships are aware that their chi ldren are affected by the abuse and that they require ass is tance in recovering from its effects. The women also felt that they could not meet their chi ldren's needs due to the overwhelming issues in their own recovery from the abuse . Wha t is important in this study, however, is that fol lowing participation in the P S G the women identified themselves as being able to meet many of their chi ldren's needs , provided they are suppor ted in this process . Th is new-found conf idence in relation to their mothering role appeared to serve as an impetus for further growth. 98 T h e themes identified in this study were over lapping, as the work of recovering from the abuse was constantly affected by external events and the women 's percept ions of support and feedback from others. Wha t was apparent, however, was the women 's perception that the abuse was ongoing and that they were continually vulnerable to the negative effect of external events. They a lso perceived that the support offered from the P S G facilitated the development of strategies that often promoted success fu l ou tcomes to previously negative or threatening events. The women descr ibed to me, both in the focus group sess ions and during my visits as a research assistant, how they had tried out new strategies related to interacting with their abuser . In most c a s e s , the women felt that they had ach ieved an increased measure of control over these situations as a result of the new strategies. After the P S G ended , the women perceived that they had also acquired new skil ls for deal ing with new events and threats to their recovery p rocess from the abuse . This exper ience of being able to feel success fu l in deal ing with the abuser and other external events is descr ibed by Landenburger (1993) as essent ia l to a woman 's attainment of "internal endorsement for who she is and her express ion of s e l f (p.383). Literature related to self-eff icacy provides addit ional support to the integrative p rocess descr ibed in this study (Murdock, & Neafsey , 1995; Strecher, DeVel l i s , Becker , & Rosens tock , 1986). O 'Leary (1985) and Strecher et a l . (1995) note that a cont inued percept ion of control and s u c c e s s in an important a rea of one 's ex is tence facil i tates the person 's expectat ion of 99 s u c c e s s in future situations. Furthermore, individuals who exper ience high levels of self-eff icacy are more likely to address new cha l lenges with conf idence, using accumula ted strategies from previous success fu l ou tcomes. Self-ef f icacy theory a lso recognizes the t ime element required for solidif ication of skil ls and the subsequent fluidity of growth. Th is recognit ion of fluidity paral lels Landenburger 's (1993) observat ion of w o m e n in the recovery phase of an abus ive relationship. Th is author notes that there is both forward, lateral, and backward movement in the recovery process . Wi th appropriate sou rces of support, w o m e n will feel more prepared to dea l with new situations and more confident in their abilit ies to have posit ive ou tcomes in the future. Summary This chapter has focused on significant components arising from the f indings of this study that I bel ieve warranted further d iscuss ion . T h e three components expanded upon and supported by addit ional literature were: 1) the importance of support; 2) the effect of t ime; and 3) the work of integrating the exper ience. T h e w o m e n in this study noted the unique role that the P S G played in their recovery p rocess . They descr ibed the intensity of the bond that they deve loped with other w o m e n who had a lso exper ienced abuse . Th is w a s a normal iz ing exper ience; it w a s a lso an exper ience which provided them with the conf idence to d i scuss their situations, as well as to develop new strategies and skil ls to address their i ssues. Most importantly, the women noted that the P S G w a s different and more useful than any other supports they had 100 a c c e s s e d , including one to one counsel ing, fr iends and family, b e c a u s e of the shared exper ience and understanding found in this group. T ime was clearly related to the process of recovery for the women in the P S G study. T h o s e that had been separated from the abuse longer were more able to reframe their exper ience and identify and address their i ssues as they had moved beyond a survival mode. Further, those who had been out of the P S G longer were more able to articulate their ongoing support needs . This study a lso highlighted the concept that the p rocess of recovery is not linear. Rather, women often go through a process of moving forward and backwards during the integration of new skil ls that they learn to ass is t them in their recovery p rocess . T h e f indings related to the relationship of t ime and the nature of the recovery p rocess are vital in the understanding of the long term support needs of women who have left an abusive relat ionship. T h e complexity of the interactive nature of these inf luences requires more study. In every case , the women were eager to progress to a new place in their l ives, separate from their abusive relationship. The goals of recovery from abuse were found to be similar to those outlined in the grief and heal ing literature which include: making s e n s e of and constructing new meaning from the exper ience, becoming stronger as a result of surviving the exper ience, and constructing a future which integrates the exper ience in a posit ive way. The support found in the P S G was fundamental to the reconstructing p rocess that women went through after leaving the abus ive relationship. The w o m e n found that one of the most important var iables in this p rocess was the increased 101 comfort and confidence in parenting their children which they derived from their peers in the P S G . 102 C H A P T E R SIX: S U M M A R Y , C O N C L U S I O N S , AND IMPLICATIONS FOR NURSING Summary Over the last decade , there is increased recognition that v io lence against women , as a socia l phenomena , has significant physical and psychological implications for those exposed to it (Heise, Pi tanguy, & Germa in , 1994). Separat ion or divorce does not end the harassment or v io lence for women who have been abused (Henderson, 1990; Page low, 1984; Sha lansky , 1995; Statist ics C a n a d a , 1993). In fact, research indicates that the threat of v io lence actually increases when the w o m a n leaves the relationship. Many factors such as poverty, safety, and legal i ssues affect whether or not w o m e n leave an abus ive relationship (Moss & Taylor, 1991) Confound ing this is the fact that women who are mothers must consider , not only their own survival, but a lso that of their chi ldren. In many c a s e s , the trigger for w o m e n to leave abus ive relat ionships is concern about the inf luence of the v io lence on their chi ldren (Bohn, 1990) Clear ly, the role of mothering is of primary importance to these women ; however, the compet ing issues assoc ia ted with the abus ive relationship and establ ishing a new life away from the abuser often leave them unprepared for the role of a single parent. Nurses are in a unique posit ion to intervene in the cyc le of v io lence through their involvement in the acute and community sett ings. A s wel l , they are in a posit ion to assist in providing support to women during the difficult 103 transition time following the separat ion from the abus ive relationship. A s identified by Landenburger (1989), the work involved in the recovery stage of an abus ive relationship requires intense emotional and physical energy. T h e s e women need to work through the grief assoc ia ted with ending the relationship and to dea l with the physical and emot ional losses assoc ia ted with this p rocess (Turner & Shapi ro , 1986). In addit ion, the women are faced with new concerns including custody and a c c e s s issues (Shalansky, 1995), f inancial insecurity, and behavioral adjustments of the chi ldren (Henderson, 1990; Pe led , Jaffe, & Ed leson , 1995). W o m e n at this s tage of their recovery have been found to benefit from s o m e form of support. Effective intervention in the form of a parenting support group has been deve loped and implemented in response to previous study f indings regarding percept ions of abused women and their chi ldren who had left abus ive relationship (Er icksen & Henderson 1992; Henderson, 1990 & 1993). Th is parenting support group ( P S G ) intervention was des igned to 1) dec rease the mothers' s t ress in the parenting role and increase their percept ions of support; and 2) dec rease the chi ldren's anxiety and increase their coping ski l ls. I became interested in the effect of this parenting support group on the women 's l ives through my role as the research assistant who was responsib le for the administration of the summat ive quest ionnaires to the mothers and chi ldren. During the data collection process I was often able to observe the interactional p rocesses between the mothers and their chi ldren. The women 's percept ions of their l ives s ince participating in the parenting support group 104 seemed to vary, as did their experiences with their children. As a result, I believed that it would be beneficial to do a qualitative study that focused on understanding the effect that a parenting support group had in meeting the needs of these women and how the group affected their subsequent life experiences. This has not previously been examined. In addition, valuable information regarding their perceptions of their parenting since participating in the parenting support group could also be obtained. Such findings would be beneficial for the planning and implementation of future parenting support groups for women who have been abused. Participants in this study were drawn from the 16 battered women who had participated in a parenting support group program. Each of the women who participated were mothers who had left an abusive relationship and had participated in the parenting support group program. The descriptive methodology of this study was guided by a feminist perspective to research inquiry and employed the use of focus groups. Consistent with this methodological approach to data collection, a low level moderator approach to the focus group was undertaken to ensure the 'voice' of the women, not the researcher was heard. Two focus groups were conducted; the first with four participants, the second contained three. The focus groups were audiotaped and subsequently transcribed verbatim by a transcriptionist. As with other types of qualitative research designs, data analysis occurred concurrently with data collection (Krueger, 1994). Data analysis was based on Giorgi's (1975) approach involving identification of meaning units, 105 reflection on theses units, and synthesis of these units into a descript ive structure. The themes arising during the analys is were descr ibed as 1) connect ion, 2) conf idence, 3) reframing, and 4) self-eff icacy. The w o m e n descr ibed these themes as being non-l inear in nature, as they found themselves moving backward and forward through these exper iences . The w o m e n descr ibed a strong s e n s e of connect ion that occurred within the parenting support group. Prior to the P S G , they noted that they often did not have people to talk to who understood their situation, and the effect that it still had on their l ives. They descr ibed feel ing isolated and different. In participating in the P S G , they found that they had the opportunity to share exper iences not previously vo iced or understood, in an environment that facil itated shared meaning. This shared meaning that took p lace regardless of the di f ferences in age, soc ioeconomic background or level of previous abuse , appeared to help normal ize the women 's struggle to make s e n s e of their l ives. Al l of the women perceived that this s e n s e of connect ion w a s essent ia l to the development of a group atmosphere in which they could d i scuss c o m m o n issues and explore new strategies to use in var ious aspec ts of their recovery process . Another common theme d iscussed was the increased conf idence the women felt, which they perceived resulted from their shared exper ience and subsequent connect ion in the P S G . In particular, the women descr ibed the change they exper ienced in their level of conf idence in 1) intimate relat ionships with their chi ldren, and 2) parenting skil l. Fol lowing participation 106 in the P S G , many felt they had a greater understanding of their relationship difficulties with their chi ldren and had some strategies to try to overcome these difficulties. The third theme descr ibed by the women has been entitled reframing. The work of reframing descr ibed by the women w a s d i scussed within the components of 1) se l f -acceptance 2) boundar ies with the abuser , and 3) asser t iveness with external forces. The women felt that the P S G al lowed them to chal lenge previously held beliefs in a support ive forum with w o m e n who had similar exper iences. They noted that the support they ga ined from the P S G was integral to their ability to reframe themselves and assert themselves effectively. Through their exper iences, the women descr ibed the components of self-eff icacy as : 1) planning for the future, and 2) defining ongoing support interventions. The women felt that the P S G had provided them with strategies and conf idence to plan for the future. Most of the women noted that they expected to form new relationships and family structures in the future; however, they a lso felt that they would require support in creating and maintaining these new relationships. The f indings of this study highlighted three important a reas warranting further d iscuss ion : 1) the importance of support; 2) the effect of t ime; and 3) the work of integrating the exper ience. The women clearly articulated the vital role provided by the support from other women who had a lso exper ienced abuse . The support found in the P S G provided a normalizing exper ience that 107 al lowed the women to freely express and strategize about their own issues; to address these issues. T ime was identified as integral to the recovery process , as those who had been away from the abuser longer were able to more clearly identify and address their i ssues and needs. In every c a s e , the w o m e n were working towards moving to a new place in their l ives, def ined apart from their abuser . Conc lus ions The following conc lus ions have been formulated based on the f indings and d iscuss ion of the f indings of this study: 1. The women derived a s e n s e of connect ion with each other in the parenting support group ( P S G ) that supported their development of knowledge and skil ls necessary for moving beyond the abus ive exper ience. 2. A s a result of their participation in the P S G the women were more confident in parenting their chi ldren and in deal ing with the ongoing manipulat ion from their abusers . 3. A P S G provides women with support to: a) develop insight into their exper ience with abuse ; b) develop skil ls to facilitate their growth in the recovery process ; and c) recognize the inf luence of external events on their internal state. 4. The women s a w the work that they had gone through s ince participating in the P S G as posit ive to their growth, but, they a lso identified the necessi ty of ongoing support to continue this p rocess . 108 5. The women who have participated in the P S G can articulate the kinds of ongoing support that is required to assist them in adjusting to new situations that occur for them and their chi ldren. 6. The recovery phase of an abusive relationship is not linear. W o m e n often go through a p rocess of moving backwards and forwards during the integration of new skil ls. 7. The process of recovery from an abusive relationship involves t ime. A n awareness of the p rocess of t ime in integrating new skil ls is necessary when planning, implementing and evaluating interventions with w o m e n who have exper ienced an abusive relationship. In looking at the conc lus ions of this study it appears that nurses are uniquely situated to address the needs of these w o m e n and their chi ldren and to assist them in their growth away from the abusive exper ience. In this chapter implications for nursing practice, educat ion, and research will be explored based on the conc lus ions of this study. Implications for Nurs ing Pract ice The exper ience of living in an abusive relationship can affect the long-term mental and physical wel l-being of women and their chi ldren. R e s e a r c h (Shalansky, 1995; Zo rza , 1995) suggests that, even after w o m e n and their chi ldren leave the abusive relationship, the abuse cont inues; therefore, its harmful effects cont inue as well . 109 The f indings of this study indicate that support needs to be avai lable for mothers who have left an abusive relationship. Furthermore, one of the most effective ways that this support can be provided is within the context of a group. The nature of the nurse-cl ient relationship provides the opportunity for nurses to deve lop and facilitate support group interventions in a variety of sett ings that are appropriate to women 's needs during their recovery from a b u s e (Campbel l , 1986; Campbe l l , Smith M c K e n n a , Torres, Sher idan , & Landenburger , 1993; Er icksen, & Henderson , 1992; Henderson , 1995 & 1989; Henderson , & Er icksen, 1994 & 1992). Further, Humphreys & Fu lmer (1993) note that, because of the nature of nursing and its predominately female membersh ip , nurses are uniquely situated to advocate for and relate to women who have exper ienced abuse . A variety of theoretical perspect ives need to be cons idered by nurses when developing a support group intervention for women at this phase of their growth away from the abusive relationship. Specif ical ly, nurses would benefit from an understanding of the relationship of self-eff icacy and heal ing in the integrative p rocess of recovering from an abusive relationship. Important considerat ions for nurses planning future support interventions include: 1) recognit ion of the non-l inear p rocess of the women 's recovery; and 2) a l lowance of t ime for solidif ication of new skil ls and strategies learned in the P S G . Furthermore, strategies a imed at empower ing should be deve loped to facilitate w o m e n moving through this p rocess . Wi th this knowledge, nurses can further support women in their empowerment and recognize opportunit ies 110 for women to direct and control the amount, type, and nature of the support for their recovery. Nurses must be aware of factors influencing the success of support groups and direct their efforts towards providing specific interventions which facilitate these outcomes. For example, parenting support groups that facilitate opportunities for the development of a sense of connection among members and the acquisition of new skills to help the women grow beyond the abusive relationship should be a priority. By working with other health care professionals and community and volunteer staff, nurses can assist in meeting some of the long term needs of both the women and their children through provision of parenting support group interventions. Educat ion The findings of this study indicate that women who have been in an abusive relationship found the P S G effective in providing them with the necessary insight and tools for facilitating their recovery from the abuse. The provision of a P S G intervention is clearly within the scope of nursing practice. It is not reasonable, however, for nurses to be expected to provide this type of support intervention without increased educational preparation related to understanding the women's lived experience of abuse. Educational and employment institutions need to recognize and challenge myths surrounding the incidence of abuse and advocate for the necessity of giving more educational time and value to this area of nursing practice. 111 Nurses need to become aware of the effects on w o m e n and their chi ldren of living in and recovery from an abusive relationship. Educat ion related to understanding the multi faceted exper ience of abuse is needed for nurses to meet the unique needs of women who have exper ienced abuse . Resea rch f indings indicate that nurses ' participation in address ing and intervening is directly related to their level of educat ion about abuse (Campbel l , & Sher idan, 1989; Drake, 1982). Clear ly, increased attention must be directed at providing educat ional opportunit ies at both the undergraduate and graduate level of nursing curr iculum. The literature indicates that educat ional preparation opportunit ies related to family v io lence is distinctly lacking for both undergraduate and graduate nurses (Henderson & Er icksen, 1994; Humphreys & Fulmer, 1993; Woodt l i , & Bresl in, 1996). Many reasons exist for this paucity of educat ional opportunit ies including a cont inued emphas is on other health problems and the ex is tence of nursing practice within a patriarchal medica l sys tem. O n e study investigating nursing curriculum content related to wife abuse found that in over half of the nursing programs surveyed, less than two hours of content t ime was devoted to this topic (Woodtl i , & Bresl in, 1996). More educat ional content and time is needed in order for nurses to become comfortable with working with abused women and to deve lop the critical thinking skil ls necessary to plan and advocate for abused women . Denham (1995) indicates that effective critical thinking skil ls would encourage nurses to develop a "wil l ingness to forsake personal judgment, stereotypic 112 attitudes, and dogmat ic narrow world v iews in order to ass is t cl ients to ana lyze situations, identify options and risks, and enable them to choose reflectively" (P-18). The f indings of this study indicate that nurses require educat ional preparation related to developing support interventions for abused w o m e n and their chi ldren at all phases of their exper ience with abuse . In addit ion, opportunit ies for nurse's self-exploration of va lues, beliefs and attitudes related to abuse are warranted during the provision of content regarding the dynamics of abuse . Cl in ical educat ional opportunit ies in transition shelters, community groups, and other support group interventions would a lso enl ighten nurses to the complexity of the support needed to ass is t w o m e n and their chi ldren in the recovery process and raise awareness as to the avai lable communi ty resources. T h e integration of both theoretical and experiential opportunit ies in a curr iculum would a lso provide insight for nurses as to the courage and determination of women who exper ience abuse; perhaps facilitating nurses to quest ion previously held beliefs and va lues and dispel c o m m o n myths about abuse . Ongo ing inservice educat ion related to assessmen t and intervention is a lso needed to reinforce the practicing nurse's knowledge and level of comfort in address ing the immediate and long term needs of abused women and their chi ldren. Initial educat ion should al low for exploration of beliefs, va lues and assumpt ions related to abuse in order to meet the learning needs of the 113 nurses. Further education must address not only strategies related to nurses' "case finding" of women and children but also nurses' awareness of appropriate resources and support once they have identified women and children in need. Research The findings of this study support the need for increased attention to the long-term needs of women who have experienced abuse beyond the transition period of leaving the abusive relationship. Despite the PSG intervention, these women continue to experience ongoing needs that are unique to their experience with abuse. Further exploration of the long-term needs of both abused women and their children using qualitative research methods would provide substantive support to the provision of ongoing interventions. In addition, the use of qualitative research has the potential to empower abused women and provide a reality to their experience of abuse that cannot be achieved by quantitative analysis. As indicated by Draucker (1992), "theoretical formulation based on survivors descriptions of their own healing, rather than on assumptions drawn from only partially relevant theories of victimization or from the clinician's perception, are essential to understanding the process of recovery" (pg. 5). The findings of this study support additional research focusing on the children of women who have participated in the PSG to ascertain the children's perceptions of their lives since their mother's participation in the PSG. Of particular interest would be the determination of whether a "spill-over" 114 recovery effect occurred for the children as a result of their mother 's participation in the P S G . A study focusing on the chi ldren's percept ions would provide further ev idence as to the eff icacy of the P S G as a support intervention in the recovery process from abuse . A longitudinal study of the women who have participated in the P S G group is a lso warranted in order to ascertain their percept ion of their l ives and the inf luence of the P S G over t ime. A s indicated in the f indings, the p rocess of recovery is related to the factor of t ime. I bel ieve that the w o m e n who have participated in this study could provide valuable insight for nurses regarding the long-term recovery and healing process from the exper ience of abuse . R e s e a r c h in this a rea could a lso provide nurses with a perspect ive related to the impact of external events on the recovery p rocess over the long-term. Findings from this research could assist in the lobbying for and the actual development of interventions to address ongoing external events impeding the recovery process . The f indings of this study a lso support the need for nurses to become aware of the long term needs of abused women and their chi ldren. T h e women in this study identified that they and their chi ldren had ongoing support needs that were not met by the P S G . Addit ional studies are needed to address this knowledge gap and to aid in the provision of appropriate support interventions to assist in the recovery process . The role of nursing in address ing the exper ience of abuse of mothers who have left an abus ive relationship was d i scussed through explorat ion of 1 1 5 the implications of this study for nursing practice, educat ion, and research. It is evident that nursing can make a difference in the lives of this group of women in their recovery process. By providing support ive interventions such as a parenting support group, nurses may a lso indirectly have a posit ive impact on the chi ldren of these women . Creat ive and realistic interventions, that address the needs identified by women who have exper ienced abuse , such as the P S G , need to be deve loped. Furthermore, attention to the ongoing needs of these women and their chi ldren need to be add ressed . Th is can be ach ieved by nursing research using qualitative methods that encourage the voice of both women and their chi ldren. Finally, through support ive educat ional preparation and awareness of their role as client advocates , nurses can prevent the inc idence of abuse and foster the recovery of the survivors of this exper ience, thus arresting the cycle of v io lence. 116 References Barnsley, J . , (1985). Feminist action, institutional reaction: Responses to wife assault. Vancouver, Canada: Women's Research Center. Bilinkoff, J . (1995). Empowering battered women as mothers. In E. Peled, P. G. Jaffe, & J . L. Edleson (Eds.), Ending the cycle of violence: Community responses to children of battered women (pp. 97-105). 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Response, 77(13), 17-20. 122 Weingourt, R. (1985). Never to be alone: Existential therapy with battered women. Journal of Psychiatric Nursing and Mental Health Services, 17, 24-29. Wendler, M. C. (1996). Understanding healing A conceptual analysis. Journal of Advanced Nursing, 24, 836-842. Wolfe, D. A., & Korsch, B. (1994). Witnessing domestic violence in childhood and adolescence: Implications for pediatric practice. Pediatrics, 94(4), 594-599. Woodtli, M. A., & Breslin, E. (1996). Violence-related content in the nursing curriculum: A national study. Journal of Nursing Education, 35(8), 367-374. Zorza, J . (1995). How abused women can use the law to help protect their children. In E. Peled, P. G. Jaffe, & J . L. Edleson, Ending the cycle of violence: Community responses to children of battered women (pp. 147-169). Thousand Oaks, CA: Sage. 123 Appendix A Parenting Support Group Information Er icksen, J . R. & Henderson , A . D. Chi ldren in transit ion: Parent ing support groups as a strategy for meeting the needs of child w i tnesses to wife abuse . B C Health Resea rch Foundat ion Grant # 5-53248. The goal of the parenting support program is to enhance the mothers' percept ions of their coping skil ls by increasing their feel ings of soc ia l support and decreas ing their s t ress. Th is is accompl ished by identifying issues that are pertinent to the women as affecting their ability to work through the battering relationship. The intended outcomes of this program are to first assist the w o m e n to develop coping skills to deal with their identified women 's issues, leaving them with more energy to effectively dea l with their chi ldren's needs. Second ly , the enhanced mother/child interaction will facilitate a posit ive impact on the anxiety levels and coping skil ls of the chi ldren. T h e program, which is offered in conjunction with an agency which provides serv ices to battered women , has been conducted utilizing a group d iscuss ion format with two facilitators in each sess ion . The program, which encourages women to share exper iences and be resources for each other, initially f ocuses on examining the mother 's issues and exper iences with their chi ldren, with the intent of developing an awareness of the effect that the v io lence has had on the women and their chi ldren. D iscuss ion related to the developmenta l s tages and expected behaviors of the children is a lso covered. Material and d iscuss ion related to utilization of healthy coping mechan isms , access ing 124 appropriate health and community resources, and posit ive parenting approaches is a lso covered. Top ic content area for the ten week sess ions includes: 1) introduction, 2) effects of living with v io lence, 3) realities of day-to-day survival, 4) ongoing contact with your chi ldren's father, 5) living non-violently, 6) assert ive communicat ion, 7) parenting approaches , 8) coping strategies for mothers, 9) the sys tem; what 's in it for you and your chi ldren, 10) wrap-up and summary. Content is covered using a variety of strategies including group-building exerc ises, smal l group work, role-playing, short f i lms or v ideos, and participants maintaining a diary. In addit ion written material is provided to the women relating to speci f ic content a reas . 125 A P P E N D I X B Part ic ipant 's Information Letter U B C Department Letterhead Dear My name is Karin Petersen. I a m a Registered Nurse and a Master 's student in the Schoo l of Nursing at the University of British Co lumb ia . My thesis is concerned with examining the effect that participation in a parenting support group has had on mothers who have left an abus ive relationship. Th is letter is to invite you to participate in my research study. T h e title of my study is: "Mothers W h o Have Left an Abus i ve Relat ionship: T h e Effect of Thei r Part icipation in a Parent ing Support Group" . I initially became interested in exploring the effect that a parenting support group had made in the lives of women who have left an abus ive relationship, through my role as a research assistant in the research study concerned with the development of the parenting support group. M y role was to col lect data from the participants during three schedu led visits, using quest ionnaires. T h e s e visits a lso al lowed me the opportunity to participate in informal d iscuss ions with the women who had participated in the group. I b e c a m e aware that the effect of participating in the parent ing support group varied for the women , depending on numerous factors. To perform my research study, I would like to meet with the women who participated in the parenting support program, to have them share their percept ions of the effect that participating in the group had on their l ives. Y o u r involvement will include participation in a one-t ime focus group d iscuss ion with other women who have a lso participated in the parenting support program. The group sess ion will be held at the North Sho re Cr is is Serv ices Society facility. The total t ime commitment will be approximately one to one and a half hours in length. T h e focus group sess ions will be audio-taped and transcr ibed. The secretary responsib le for transcribing the audio-tapes will a lso be present during the focus group sess ions , to ensure the efficient functioning of the tape recorder. S h e is sensi t ive to the confidential nature of the focus group sess ion , and will be required to s ign a letter of confidentiality prior to her participation in the study. P a g e 1 of 2 126 You r name or those of your chi ldren or ex-partner and any other identifying information will not be included in the transcript ion. On ly mysel f and the members of my thesis committee will have a c c e s s to the information that you provide. Al l the data which relates to you will be kept in a locked filing cabinet in my home, and destroyed at the end of the study. I recognize that a previous relationship exists as a result of my contact with you as a research assistant in the parenting support group study. A s a result of our relationship, you may feel addit ional pressure to participate in this study. I wish to make it abundantly c lear to you, however, that you are in no way obligated to participate in this study. If you choose to not participate or to withdraw from the study at any t ime, you will in no way jeopard ize your right to use the serv ices of the North Shore Cr is is Serv ices Society. Shou ld you wish to a c c e s s the counsel ing and support serv ices of the North Shore Cr is is Serv ices Society during or following the interview these will be made avai lable to you. If you are interested in participating in this study, or would like more information, p lease feel free to contact me by leaving your name and phone number with the North Shore Cr is is Serv ices Society at 987-1773. You rs sincerely, Karin Pe te rsen P a g e 2 of 2 A P P E N D I X D Interview Quest ions Trigger Questions: 1) What were your reasons for joining the parenting support group? 2) What did you hope to get out of it? 3) Describe what it was like being in the parenting support group. 4) How has being in the group affected you? 5) In what ways have you changed since participating in the program? terms of: - your behavior? - the way you think? - your feelings? - your approach to your child? 6) What suggestions would you have for similar upcoming groups? Prompts: - To what do you attribute this to? - Why was this important? - What would you have liked to have happened? Why? - How did that affect you? 

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