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Contemp Fam Ther (2008) 30:141151

DOI 10.1007/s10591-008-9067-1
ORIGINAL PAPER

A Solution-Focused Intervention with a Youth in a


Domestic Violence Situation: Longitudinal Evidence
Savvas Daniel Georgiades

Published online: 29 May 2008


Springer Science+Business Media, LLC 2008

Abstract This article reports on a 4-year therapeutic intervention combining in-person


and email communication with a 13-year-old Greek-Cypriot teenager who witnessed and
later was the victim of severe domestic violence. The intervention is based on an
empowerment philosophy and solution-focused strategies, and its usefulness is evaluated
by three standardized measures at five time points between the years 1999 and 2003.
Pertinent cultural and ethical dynamics of the interventional context are highlighted. The
intervention may have helped to produce better perpetratoryouth relations, remission of
the clients depression and post-traumatic stress symptoms, and improvement in his academic performance. Implications and limitations are discussed.
Keywords Youth exposure to domestic violence  Psychopathology 
Solution-focused email therapy  Longitudinal, evidence-based-intervention 
Cyprus

Introduction
Children may suffer devastating aftereffects at the sight of domestic cruelties, including
negative behavioral, cognitive, social, and emotional outcomes (Osofsky 2003, p. 162).
Abused parents may neglect their children as they recover from their traumas (Osofsky
2003), and these children are more likely to be victimized themselves (English 1998;
Folsom et al. 2003). Such deleterious effects may be multiplied when the abuse is lifeending or life-threatening for a parent (Lewandowski et al. 2004). In most cases of
domestic femicides, women are abused for years before they are murdered, subjecting
children to on-going observations of violence and trauma (Moracco et al. 1998; Smith
et al. 1998).

S. D. Georgiades (&)
School of Social Work, Saint Ambrose University, McMullen Hall, 518 West Locust, Davenport,
IA 52803, USA
e-mail: GeorgiadesSavvasD@sau.edu

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It is difficult to estimate precisely how many children experience domestic violence


because most incidents go unreported (Lewandowski et al. 2004). Moreover, Osofsky
(2003) cautions that use of different definitions of child exposure to domestic violence,
coupled with variations in methodology, contribute largely to the inconsistency in estimates of prevalence across different studies.
Most youth victims of domestic violence are underserved by professional intervention
(Burman and Allen-Meares 1994), as few localities routinely offer services to children in
these situations (Lewandowski et al. 2004, p. 217). Also, families often feel that the abuse
will be forgotten if kept silent. In addition, there is a lack of standardized measures that
capture holistically the various risk and resiliency factors and youth experiences in
domestic violence situations (Edleson et al. 2007). Finally, research demonstrates that
youth victims of domestic violence do not respond very well to traditional psychotherapy
(McAuley et al. 2006; Weiss et al. 2000; Weisz et al. 1992). Yet, recent evidence indicates
that more innovative interventions, such as expressive writing, strength-focused practice,
and e-mail therapy (Constantino et al. 2007; Mosher and Dannoff-Burg 2006; Parker et al.
2006), improve substantially these youths coping ability, and overall psychosomatic
wellness.
Linked Cultural Considerations
The present case study was pursued with a Greek Cypriot teenager living in Cyprus. In
Greek culture there is social stigma associated with reporting domestic abuse (Chatzifotiou
2003; Georgiades 2003; Stathopoulou 2004). Moreover, Greeks are hesitant to seek an
outside therapist for mental health challenges (e.g., Papadatou et al. 1995). Instead, they
turn to their in-group for comfort (e.g., family members, friends, neighbors, priests,
doctors).
Physical punishment is still used to discipline children and youth in Greek homes, albeit
to a lesser degree than in the past (Georgiades in press; Paritsis et al. 1984). Both parents
assume disciplinarian roles in the home. The father is, in most cases, the authoritarian
figure, and displays macho behavioral characteristics (Dedoussi et al. 2004). On the other
hand, mothers tend to be nurturing and in charge of socializing and comforting the child
(Kokkevi and Agathonos 1987; Vassiliou and Vassiliou 1974) (Fig. 1).
Theoretical Underpinnings of the Intervention
The intervention used is based on empowerment theory (Gutierrez 1994; Gutierrez et al.
1998; Solomon 1976) and solution-focused clinical strategies found effective in a multiplicity of therapeutic contexts (Berg and DeJong 2005; Berg and Shafer 2004; de Schazer
et al. 2007). Empowerment theorists and solution-focused interventionists believe that
individuals have the capacity to generate solutions to their own problems, and that the
therapists primary role is to help the client discover this intrinsic potential, and guide him/
her towards a positive future direction that the client defines in collaboration with the
therapist. At the heart of a solution-focused intervention is client strength identification.
This process serves to build and reinforce the clienttherapist partnership, secures the
clients trust and respect for the therapist, and allows both to focus on competencies that
the client already possesses in order to achieve targeted clinical objectives. Evidence
suggests that solution focused interventions are effective with youth facing challenges in a
variety of contexts (Burns and Hulusi 2005; Corcoran 1997; Franklin et al. 2001) (Fig. 2).

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143

Case Study Significance


Very little is known about how youth cope with violence that is either life-ending or
severely life-threatening for a parent. As Lewandowski et al. (2004) observe, Children
experiencing these situations have not, to date, been well studied (pp. 211212). What is
more, most available knowledge addresses young children, whereas adolescents experience with domestic violence has been largely ignored (Goldblatt 2003), with only a few
exceptions. The latter studies suggest that exposure to domestic violence affects adversely
youths relationship with the perpetrator, their school behavior, and their physical and
mental health (e.g., Al-Krenawi et al. 2007; Parker et al. 2006; Sullivan et al. 2007).
Finally, to this authors best knowledge, no previous case study concerning youths
affected by domestic violence reported on the efficacy of a solution focused intervention
with this population, or employed a longitudinal design to carry out such an assessment.
With these evidentiary gaps in mind, this longitudinal case study assessed the consequences of domestic violence on a youth at five distinct time points within a 4-year period,
and evaluated the effectiveness of a solution-focused intervention in enhancing his academic performance, mental health status, psychosocial adjustment, and the overall wellbeing of his intra-familial system.

Method
Brief Case Overview
This case study concerns a 13-year-old, Greek-Cypriot boy who battled with debilitating
fears about his father harming him and/or his family following exposure to a sequence of
traumatic events. Trauma in this boys life began at the age of eight when he first saw his
father physically and verbally abusing his mother. Thereafter, the abuse escalated, culminating in an incident when the fathers anger was directed at both his wife and son.
Following a volatile dispute with his spouse, and under the guise of the boy supposedly
irritating him with his unruly behavior, the father pulled his 9-year-old son by the hair,
threw him on the floor, and kicked him in the stomach a couple of times, calling him slurs.
The mother ran to her sons rescue but no report was filed with the police or child
protective services.
Following this abusive incident, the mother sought legal assistance and eventually
managed to have her spouse move out of the house while simultaneously beginning
divorce proceedings. At some point, the mother became concerned as the boys mood
changed very suddenly from one of great energy and excitement to continuous depression and gradual deterioration of his once excellent school performance. Oblivious to the
causes of her sons sudden mood swings, the mother sought out intervention from the
therapist.
The Onset of Therapy: In-person and E-mail Exchanges
Voluntary, not for fee, in-person therapy sessions with the boy began in December of 1999
and continued until January, 2000, but were reduced to e-mail communications in the
winter, spring, and summer of 2000, and the fall, winter, and spring of 2001, 2002, 2003,
due to the therapists stay in the U.S. All in all, 81 emails were exchanged between the boy

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and the therapist. Several in person conferences also occurred in the summers of 2002 and
2003 when the therapist returned to Cyprus.
The first therapy session was held at the boys home. During this meeting, the therapist
relayed to the boy his mothers concerns and noted that he wanted to help the boy overcome his personal challenges. It was also clarified that, if the boy consented to therapy, all
information shared would be kept strictly confidential unless associated with potential selfharm or harm to others. The boy agreed to therapy and the initial emphasis was briefly
placed on things the boy liked about himself, his school, and his family. The boy indicated
that he liked sports, he thought he was a good person, he loved his family, and dearly
enjoyed history and physical education classes. He was then asked about things he wanted
to change in his life and he indicated that he wanted to improve his relationship with his
dad and become a better student.
During the next session, exploration of the clients relationship with his dad led to
revelations about the abuse he and his mom had endured by his father 4 years previously.
The client also disclosed that he truly feared what his father could do to him and his family.
He made reference to a case he had heard of in which a Greek-Cypriot father murdered his
daughter during an overnight visitation he had with her after he divorced his wife. The boy
indicated that this case frightened him to a point that he often thought of his father
intruding into their house and murdering him, his mother, and his sister. He further
revealed that his fears were intensified because his father was calling him occasionally and
inviting him to spend weekends with him at his home.
Following an attempt to explore, identify, and validate the clients feelings, the therapist
questioned whether the father had ever made any life threats to himself and/or his family,
and the boy indicated that he had not. The therapists request to contact the father and
assess his intentions was categorically denied by the boy.
Solution-Focused Intervention
In e-mails, the therapist applied a solution-focused intervention that helped the boy construct his own safety plans in the event that his father turned violent again. At this juncture,
questions such as, What are some things that you think you could start doing now that
would help protect you from future violence from your father? were used. As a result of
this solution exploration process, the boy learned the phone numbers to the police and
medical first aid, began self-defense classes, and developed the assertiveness to tell his
father that he did not yet want to visit him at his house. The boys choice was to maintain
only occasional phone contact with his father because he felt that this was not life
threatening, would make the father less angry than having no contact at all, and eventually
could help improve his relationship with his father.
A Major Re-traumatizing Life Event
In 2001, the boys parents officially divorced against the will of his father, whose preference was for reconciliation with his wife. The following morning the father showed up at
the house, (while the boy and his sister were at school), and severely abused his ex-wife.
The punches and kicks left the woman unconscious on the floor, with a hematoma on her
head and heavy bruises on her face and all over her body. A neighbor heard the womans
screams and ran to her rescue. An ambulance was called and the boys mother was

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hospitalized for 2 weeks until her wounds subsided. The father was arrested then released
pending trial.
When the boy wrote to the therapist to inform him about the situation, the father had
already been released from jail and his mother was home receiving outpatient care for her
wounds. The boy also shared that his father called him and asked him to have his mom
drop the charges because if she didnt, he would kill her once he got out of jail. Out of fear,
the boy promised his father that he would try to convince his mom to comply with his
request. The therapist indicated that per their confidentiality agreement, he was legally
mandated to call his mother and inform her about the fathers threats; the boy indicated that
he had already done so.
When the therapist called the mother, she confirmed the boys claim. She also had gone
with him to the police to testify about the fathers recent maneuver. The response of the
police was that they could not make an arrest because a trial was pending, and no independent witness was available, so instead they issued a restraining order against the father.
The police department also offered to place the house under surveillance, but indicated that
this would simply be on a very temporary basis. The police briefed the mother that she and
her children had to be very vigilant and immediately contact them if the father appeared
anywhere in the vicinity of their house.
Solution Focused Therapy Post Re-trauma
Successive e-mail communications focused on the boys feelings about the abuse, his
articulation of a more meticulous safety plan in the event that his father attempted to reoffend, his personal choice to attempt to convince his mom to drop the charges out of fear
for her life, and his eventual success in doing so. Even though he felt greatly relieved when
his mother eventually was persuaded to remove the charges, he also experienced guilt
about pressuring his mom to do so because he felt she would not receive the justice she
deserved. He was confident, however, that his mother was now safer than if she attempted
to prosecute his father.
The boy then shared that he spent time trying to understand why his father turned out to
be so abusive to his mother immediately after their divorce. He thought that his father was
still in love with his mother, and was very upset about their divorce, as well as the fact that
he had no contact with his children. He suspected that the father thought his mom had
turned her children against him, which supposedly accentuated the fathers resentment,
which culminated in the abusive episode. Essentially, the boy felt that, in part, his father
was so abusive to his mom because he and his sister very persistently had avoided contact
with him in the past.
Solution-focused questions, such as, What do you think needs to be done to convince
your father that your mom is not to blame for you not keeping close contact with him? or
What do you think could help your father decrease his resentment towards your mom?
helped the boy visualize a strategy for rectifying his fathers faulty attributions. He indicated that even though he wanted to have an open conversation with his father, to explain
to him that his mom never turned him or his sister against him, he did not feel comfortable
doing so. When the therapist asked the boy about other ways of conveying this message to
the father, the boy replied, I could write him a letter. Ensuing discussion revealed that
this was the intervention option that the boy favored the most. The boy asked the therapist
if he would mind reading the letter before he sent it to his dad, and the therapist agreed to
do so.

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The Letter Intervention


In December 2001, the boy e-mailed the letter to the therapist, which read as follows
(direct translation from Greek):
Dear Dad, Im writing to you to let you know how I feel about the abuse you inflicted
upon my mom. I want you to know that you have hurt me very deeply when you did
this because it showed that not only you dont care about the well-being of my mom,
but also you dont care about us. Because if you loved us, why would you want to kill
our mom? Shes the only mom we have. Have you ever thought how miserable we
would be if you killed her? She never said a bad thing about you. She always told us
to love you and that what happened between the two of you should not affect our
relationship with you. I want to forgive you. I want to forget about what happened
and want to have a good relationship with you. But you have to promise me that you
will never hurt my mom again. I think my sister loves you too but shes very hurt
about what you did to our mom. I think with time she will be able to forgive you but
you have to prove to her that you truly regret what you did to our mom. . . .
The therapist expressed his enthusiasm and admiration about the very sincere letter the boy
had written, and agreed with the boy that he should mail the letter to his father. The father
replied to the boys letter with a phone call. He broke down in tears on the phone, and
asked his son to forgive him. He admitted that he had made a terrible mistake, and that he
wanted a chance to start fresh and show his children how much he truly loved them, and
that he never should have raised a hand against their mother. The boy cried also, and told
him that he forgave him, and that from that time on, they should spend more time together.
Initial meetings with the father were initially in the form of lunches at restaurants, and then
progressively advanced to entertainment trips.
Ethical Conflict
Throughout the intervention the therapist struggled with the ethical dilemma of whether or
not to continue email therapy with the boy. On the one hand, the therapist felt that if he
withdrew his availability to the boy, he might have been more inclined to seek psychological help from a source closer to him. On the other hand, ceasing therapy could have
caused the boy to deteriorate further, and have no psychological support when he needed it
most. Weighing the pros and cons of the situation, and in view of the boys repeated
rejection of an outside referral, and his ongoing request that email contact be continued, the
therapist was convinced to continue his email availability to the boy.
Longitudinal Standardized Assessment
During the second in-person session, the client was administered Greek versions of: (a) the
Childs Attitude toward Father (CAF) scale (Hudson 1997); and (b) the Depression SelfRating Scale (DSRS) (Birleson 1981). In the succeeding session, the youth completed a
Greek version of the Child Report of Posttraumatic Symptoms (CROPS) scale (Greenwald
and Rubin 1999). About 6 months after the first therapy meeting with the boy, the therapist
mailed the CAF, DSRS, and CROPS scales and asked the boy to complete them for a
second round of assessments, and return them to him. The same process was used
immediately after the re-traumatizing life event, 6-months later, and 9-months following

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the letter intervention. A total of 15 standardized assessments were completed by the client
between the years 1999 and 2003.
The CAF scale (Hudson 1997) is a 25 item instrument designed to measure the extent,
degree, or severity of problems a child has with his father. The CAF scale has two cut-off
scores. The first is a score of 30 (5); scores below this point indicate absence of a
clinically significant problem in this area. Scores above 30 suggest presence of a clinically
significant problem. The second cut-off score is 70. Scores above this point nearly always
indicate that clients are experiencing severe stress, with a clear possibility that some
violence could be considered or used to deal with problems. The CAF has a mean alpha of
.95, and excellent stability with 1-week testretest correlations of .96. It also has excellent
known-groups validity, significantly distinguishing between children who rate themselves
as having relationship problems with their parents, and those who do not, and good
predictive validity, significantly predicting childrens responses to questions regarding
problems with their parents (Corcoran and Fischer 2000).
The DSRS scale (Birleson 1981) is an 18 item instrument designed specifically to assess
depression in children. DSRS items are scored on a 3-point scale, with positively worded
items ranging from 0 to 2, and negatively worded items ranging from 2 to 0. These
responses are totaled, so the range of possible scores is 036. It has fair internal consistency ranging in alpha values from .86 and .73. Its testretest coefficient is .80, showing
good stability. The DSRS has good concurrent validity, correlating .81 with the Childrens
Depression Inventory. It also has good known-groups validity, significantly discriminating
between depressed and non-depressed children with very few false positive errors
(Corcoran and Fischer 2000).
Finally, the CROPS scale (Greenwald and Rubin 1999) is a 25 item instrument for
assessing a childs self-report of post-traumatic stress symptoms. It is easily scored by
summing item responses. The total possible range of scores on the CROPS is 052. Higher
scores indicate more intense posttraumatic stress. The CROPS has excellent internal
consistency with an alpha value of .91. Its 46 week testretest correlation is .80 (Corcoran
and Fischer 2000).

Results
Linegram 1 indicates the boys CAF, DSRS, and CROPS scores over time. As can be seen,
the boys feelings towards his father improved slightly at 6 months, deteriorated significantly immediately after the life-threatening wife abuse (LTWA) episode towards his
mom, remained as such at the 6 month follow up, but improved sharply 9 months after the
letter intervention was implemented. His depression level dropped slightly at 6 months,
significantly sharpened immediately after the LTWA episode, somewhat subsided at
6 months (while still remaining at a clinical level), and practically vanished at the 9-month,
post letter intervention, follow up.
Finally, the clients posttraumatic stress disorder symptoms augmented slightly at
6 months, sky-rocketed immediately after the LTWA episode, dropped off substantially at
the 6 month follow up, and completely evaporated 9 months after implementation of the
letter intervention.
Linegram 2 displays the boys grade average over time. As can be seen, his school
performance enhanced slightly at 6 months, declined significantly after the LTWA episode, and elevated substantially at 6 months, and 9 months after implementation of the
letter intervention.

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Total Scale Score


(0-100)

100

CAF

80

DSRS

60

CORPS

40
20
0
Baseline

6-month

Post-WAE 6-month

9-month
Post Ll

Assessment Time Point

Average Semester School Grade*


(0-100)

Fig. 1 Clients clinical progress over time. Note: WAE = Wife Abuse Episode; LI = Letter Intervention

94
92
90
88
86
84
82
80
Baseline

6-Months

Post-WAE

6-Months

9-Month Post-LI

Time
Fig. 2 Clients academic performance over time. Note: * Alphabetical grades were converted into
numerical grades as follows: A = 95, B = 85, C = 75; WAE = Wife Abuse Episode; LI = Letter
Intervention

Discussion
This longitudinal case study speaks volumes about the importance for clinicians to treat
youth clients as experts regarding their specific circumstances, and to respect, to the
highest degree possible, their personal assets, goals, and choices of intervention. The case
study also corroborates a bulk of scientific evidence suggesting that the solution-focused
clinical method is particularly effective with teenage populations in a multiplicity of
contexts (Burns and Hulusi 2005; Corcoran 1997; Franklin et al. 2001). Future research
should therefore continue to shed light on the immense potential of this treatment modality
in clinical work with youths in domestic violence situations and other oppressive contexts.
At the same time, it is important to note that the solution-focused intervention employed
would likely have failed if utilized in a vacuum. In the present case, it probably succeeded
because it was facilitated by a trustworthy therapeutic relationship, including unlimited
access to the therapist. Some of the therapeutic benefits observed also may have been the
direct result of the youths and/or the fathers maturation.
Nevertheless, this case study also illustrates the vitality of email therapy with youth
clients who are technologically literate and lack physical proximity to their therapist. An
obvious disadvantage of email therapy is that the therapist cannot have access to clients
nonverbal cues and reactions. On the other hand, such therapy allows for more reflective

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discussion, as both the therapist and the client have more time at their disposal to process
incoming information and decide on a course of action and reasonable solutions.
Ethics should be the guiding force in the selection of interventions with youth harmed
by any social malice, including domestic violence. The barometer of any decision should
be protection of the clients best interests. Despite an immense ethical challenge presented
throughout the intervention, the eventual outcomes of the latter seem quite positive, perhaps partly because this therapists utmost concern was to help the client in the most
personally meaningful way. The therapist also maintained genuine empathy, respect, and
optimism for this client throughout the intervention.
This case study is not free from limitations. The client of interest was a very witty
teenager, with an amazing intellect and insight into the affective landscape of his intrafamilial system, ample maternal and clinical support, and a paternal perpetrator very
amenable to the intervention of choice. Not all perpetrators will experience a life altering
impact owing to an expressive writing intervention designed by their offspring. In fact, for
some, such intervention might trigger disastrous consequences, if, for instance, words are
not prudently chosen to avoid ticking off the violent parent. Moreover, the intervention
under investigation may not be as salient in other cultural contexts, in which, for example,
there is not analogous weight placed on the significance of blood ties, respect towards
parents, and communal endorsement of ones actions, as in Greek culture (Bozionelos
2006; Georgas 1989, 1991; Ierodiakonou 1976, 1985; Skinner 1966; Vassiliou and
Vassiliou 1974). An additional limitation of the case study is that the Greek versions of the
three standardized instruments utilized had unknown validity and reliability.
In conclusion, this case study suggests that there may be utility in incorporating solution
focused interventions and email therapy in clinical work with youth clients suffering from
domestic violence. Future research should therefore assess further the efficacy of these
interventions. The present findings should only be treated as preliminary in view of the
case studys methodological shortcomings.
Acknowledgments This report would not have been possible without the gracefulness of this youth and
his family who consented to publication. The author also thanks Dr. David Cohen and Dr. Miriam Potocky
of Florida International University, and this journals editors and anonymous reviewers for comments made
to a previous draft.

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