Relationships

Definitions

• A relationship is a connection, association, or involvement with another person.
• Domestic violence refers to abusive behavior against someone the person is in a relationship with, lives with, is related to, or has a familial connection with of some type. See the Alaska Statute on domestic violence for more information: http://www.law.alaska.gov/department/criminal/victims_assistDV.html

People can be in many types of relationship at once and throughout their lives, filling roles such as:

• Spouse.
• Boyfriend, girlfriend, or significant other.
• Friend.
• Sibling.
• Parent or child.
• Foster parent or foster child.
• Extended family member.
• Neighbor or community member.
• Coworker.
• Peer.
• Caregiver.
• Teacher, school staff, or student.

This chapter will focus primarily on romantic and committed relationships, but many of the principles can be utilized in other types of relationships.

Having healthy relationships is important for the wellbeing of individuals, families, children, and communities. Children often learn how to have relationships and interact with others through observing their parents’ and other adults’ relationships. It is important to encourage your clients to seek healthy relationships and to work on improving relationships that may not be healthy.

During a comprehensive assessment, it often comes up that a source of the client’s unhappiness is their relationships. It is often difficult for people to identify or evaluate if their relationships are “healthy” or “unhealthy,” but they do often recognize that they’re just “not happy.”

Characteristics of healthy relationships:

• The relationship is balanced, not one-sided.
• Each person respects the other.
• Each person is honest with the other and communicates openly.
• Disagreements are handled without violence or disrespect.
• Each person is respectful of the other’s boundaries.
• Neither person is trying to control the other.
• Any sexual intimacy is mutual and consensual.

Characteristics of unhealthy relationships:

• Disrespect.
• Jealousy to the point of attempting to control the other person’s actions.
• Poor communication.
• Isolation from other loved ones due to the relationship.
• Excessive fighting.
• Name calling, threats, violence, or abuse.
• Demands and orders.
• Forced sex, sexual contact, or sexual advances.
• Infidelity.

Common causes of relationship conflict:

• Stress.
• Disagreements about sexual intimacy.
• Financial problems.
• Depression.
• Jealousy.
• Anger.
• Infidelity.
• Different priorities, values, or morals.
• Different parenting approaches or beliefs.
• Differing views on substance use, or the presence of substance abuse.

The greatest predictor of domestic violence is witnessing domestic violence by person's own parents as a child, because this teaches the person in childhood that domestic violence is normal. Individuals living with domestic violence in their households learn that violence and mistreatment are ways to vent anger or to humiliate, intimidate, or hurt others.

Domestic violence does not only or always mean physical abuse. There are many types of abuse, including:

• Physical abuse.
• Verbal or nonverbal abuse (psychological, mental, or emotional abuse).
• Sexual aggression and abuse.
• Financial abuse.
• Stalking or cyberstalking (online).
• Cyberbullying.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history for adult clients, including:

• Collateral information from probation officers (police reports, probation violations, etc.).
• Collateral information from Office of Children’s Services (case notes, report history, etc.). Be sure you have an ROI on file before requesting access to these records.
• Online court records from CourtView.

Client history for minor clients, including:

• School records.
• School social worker records.
• Parental consent.

Treatment Plan, if one exists.

Common mental health issues you might see in someone who is experiencing relationship conflict:

• Depression.
• Anxiety.
• Suicidal thoughts or attempts.
• Sleep problems.
• High stress levels or feeling overwhelmed.

Signs that a client may be experiencing relationship problems or has recently experienced a difficult breakup:

• Feeling misunderstood, disconnected, or distant from the partner or family.
• Feeling numb or overly emotional.
• Withdrawing from others, the community, and activities.
• Losing patience with others, including children.
• Seeking an appointment “in crisis” or on an emergency basis because of a breakup.
• Experiencing grief over the loss of a relationship.
• Attempting to reconnect with the ex-partner.
• Self-harm or suicidal behavior.
• Using alcohol or drugs to cope with feelings.
• Social media posts about their relationship or breakup.
• Marital separation or divorce.
• Involvement in multiple intimate relationships at the same time.
• Infrequent or no sexual contact.
• Patterns of repeated, conflictual relationships.
• Trust issues.
• Tearfulness.
• Irritability.
• Various conflicting emotions such as guilt, remorse, relief, sadness, and loneliness.
• Mood swings.
• Low self-esteem.

Child-specific signs

• Not wanting to go to school.
• Not wanting to participate in sports or other activities they used to enjoy.
• Isolating themselves; not hanging out with friends they used to hang out with.
• Spending more time on the phone, texting, or on social media than in the past.
• Acting out; noticeable behavior changes.

Note: Many of these signs can be caused by relationship problems, bullying, or by a combination of the two. See Chapter D-14: Victims of Bullying for more information.

Emotions/Mood

• How do you feel about your relationship?
• Do you feel down, sad, or depressed now, or have you recently?
• Do you feel close and connected with others?
• Do you have difficulty maintaining relationships?
• Do you feel angry towards your loved ones, or have you recently?
• Do you frequently argue with your partner?
• Have you lost anyone close to you because of a breakup or death?
• Do you feel respected?
• Do you feel loved?

Physical

• Do you feel safe at home?
• How does your body feel when you are experiencing relationship problems?
• Have you been getting sick or injured more often than usual?
• Have you ever been threatened, intimidated, controlled, or abused by anyone?
• Do you feel like your physical boundaries are respected?
• Has anyone forced you to have sex or be intimate with them when you didn’t want to?
• Have you felt pressured to do things in your relationship that you didn’t want to do?

Social

• What are the common reasons you and your partner fight?
• Are there certain situations in which you and your partner have more trouble getting along than you do in others?
• Who do you talk to or what do you do when you are having relationship problems?
• Are there friendships or other relationships you have where you do not feel safe with or respected by the other person?
• How do social media and texting impact your relationship?
• Have you been divorced or separated?
• Have you had relationships similar to this one in the past?
• How is your communication with others?

Environmental

• Do you have more relationship issues when you or your loved ones are drinking alcohol or using substances?
• Did you witness domestic violence in your home as a child?
• Have you experienced a traumatic event, abuse, or neglect as a child or adult?
• How are your relationships with your family members?
• How are your relationships with your children ?
• Are there any people, places, or things that cause relationship conflict for you?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, you may consider:

• Individual therapy focused on:
  • Developing healthy communication.
  • Improving the ability to trust others.
  • Increasing awareness of the client’s own role in the relationship conflict.
  • Learning healthy emotional expression.
  • Learning to identify escalating behaviors that lead to conflict.
  • Improving self-esteem.
  • Learning conflict resolution skills.
• Cultural activities, including:
  • Talking with an elder about healthy relationships.
  • Subsistence activities as a couple to improve teamwork.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.