1. Running head: CLINICAL PAPER 1
The Utilization of Attachment Theory in Counseling Victims of Domestic Violence
Sarah Zimmerman
SWK6521: Social Work Practice IV
Brenda Barnwell, LCSW, CADC
April 9, 2015

2. CLINICAL PAPER 2
Abstract
Violence against women continues to be a growing human rights concern. It has become a
“global health catastrophe, a social and economic impediment, and a threat to national security”
(Congresswoman Jan Schakowsky, 2012). Research has shown that some correlation exists
between attachment patterns and increased risk for victimization. Attachment research is based
on the premise that the attachments formed in infancy and childhood influence or “help shape the
attachment relationships people have as adults” by acting as the model for future relationships
(Lee, 2003). Through examination of current research and the utilization of a case study,
research determined that attachment theory can be beneficial in understanding the correlation
between violence and intimacy in relationships (McVey, 2012). Furthermore, using attachment
theory as a lens when working with victims of domestic violence can assist in the recognition of
patterns of attachment and in ending the cycle of abuse by allowing the victim to learn how to
establish safe attachments through the therapeutic relationship. Through the therapeutic process
the client is able to adapt and change their internal model of self and attachment. Integration of
attachment theory in counseling victims of domestic violence may further increase the likelihood
of successful treatment.
Keywords: attachment theory, domestic violence, counseling

3. CLINICAL PAPER 3
The Utilization of Attachment Theory in Counseling Victims of Domestic Violence
The purpose of this paper is to analyze and evaluate the impact of utilizing attachment
therapy when working with victims of domestic violence. In utilizing attachment theory as a lens
through which to work with victims of domestic violence the patterns of attachment are exposed
allowing the victims to learn how to end the cycle of abuse and establish safe attachments
through the therapeutic relationship. The paper will be broken into four sections: theory analysis,
social justice analysis, case study, and integration. The theory analysis portion of the paper will
examine attachment theory and its utilization in the therapeutic process. The social justice
section of the paper will look at the topic of violence against women, specifically in relation to
domestic violence, and its long range effects on the individual and society. The paper will then
provide introduction to a client through a case study. In the integration section of the paper the
case study will provide the backdrop in which to apply attachment theory to counseling victims
of domestic violence. The paper will conclude by summarizing the content of the above sections
and then propose strategies for future research and policy reform.
Analysis of Attachment Theory
The theory analysis portion of the paper will begin by conducting a thorough examination
of attachment theory including its definition and history. The analysis will also look at the gender
and cultural considerations, ethical implications, utilization of the theory in therapy, and
additional compatible therapies. The analysis will conclude by evaluating the theory’s
advantages and disadvantages as well as addressing the controversy and limitations surrounding
it.
Definition
John Bowlby, the “father” of attachment theory, defined attachment as a “lasting
psychological connection between human beings” (McLeod, 2009). While many types of

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attachment relationships develop over the span of a life, attachment theory focuses specifically
on attachments formed in infancy and childhood. As such, attachment theory has been defined as
“a set of concepts that explain the emergence of an emotional bond between an infant and
primary caregiver and the way in which this bond affects the child’s behavioral and emotional
development into adulthood” (Dictionary.com, 2014). The theory postulates that quality
relationship or attachment to a primary caregiver is essential in order for “normal” social and
emotional development to occur. According to the theory, these attachments formed in infancy
and childhood influence or “help shape the attachment relationships people have as adults” by
acting as the model for future relationships (Lee, 2003).
Four types of attachment patterns have been identified: secure, avoidant, ambivalent, and
disorganized. Infants or children who display a secure attachment relationship with the caregiver
use the caregiver as a “base’ or point of security from which to explore the environment or when
faced with a new situation or person. When the caregiver leaves or is no longer present, the child
displays anxiety and is only truly comforted when the caregiver return. The caregiver, in turn,
responds to the child’s needs in an appropriate and consistent manner. The remaining three
patterns of attachment are often referred to as “insecure” patterns of attachment. In contrast to
secure attachment, infants or children who display an avoidant attachment relationship with the
caregiver show no partiality between the caregiver and a stranger. Furthermore, they do not
display any concern or anxiety when the caregiver leaves or is no longer present. In the avoidant
attachment pattern, the caregiver shows little concern or response when the child expresses
anxiety and may instead discourage the child from such expressions (Saylor.org, 2010). The third
pattern of attachment is the ambivalent attachment pattern. While infants or children who display
an ambivalent attachment relationship with the caregiver express anxiety when the caregiver

5. CLINICAL PAPER 5
leaves or is no longer present and then appear to welcome the caregivers return, they are not
easily comforted and may even resist the caregivers attempts to comfort them. These children
also alternate between clinging to the caregiver and displaying anger with the caregiver. In the
ambivalent attachment pattern the caregiver is inconsistent in responding to the child’s needs and
anxiety. The responses given may also not be effective (Berzoff, et al., 2011). The final
attachment pattern is the disorganized attachment pattern. Infants or children who display a
disorganized pattern of attachment to the caregiver respond to return of the caregiver in an
illogical or irrational manner. The children’s behaviors are often contradictory or confusing. The
caregivers, in turn, often respond to the behaviors and expressions of anxiety by the child with
withdrawal or frightening or even abusive behaviors. “Insecure attachment patterns are non-
optimal as they can compromise exploration, self-confidence and mastery of the environment.
However, insecure patterns are also adaptive, as they are suitable responses to caregiver
unresponsiveness” (Saylor.org, 2010).
Two theories of attachment exist that attempt to explain how or why attachments are
formed. The first is the learning or behaviorist theory of attachment. This theory regarding
attachment believes that, as the name suggests, all behaviors are learned. This theory suggests
that attachments are formed through conditioning behaviors. For example, a child develops a
secure attachment to his mother or caregiver only as his need for food is consistently met.
Because the mother or caregiver becomes associated with food and the infant’s contentedness, a
secure attachment is formed. The second, theory of attachment and the basis for the attachment
theory is the evolutionary theory of attachment. This theory “suggests that children come into the
world biologically pre-programmed to form attachments with others, because this will help them
to survive” (McLeod, 2009). The theory further suggests that the care and responsiveness that the

6. CLINICAL PAPER 6
child receives from the caregiver is the main factor in determining the type or attachment that is
developed.
History
Attachment theory developed in the mid twentieth century out of the work of John
Bowlby, a British psychoanalyst. While working in a school for children who were maladjusted
Bowlby began to question the influence that parenting had on the development of the child.
Bowlby noted that infants often expressed extreme anxiety or distress when separated from the
parent or caregiver. The dominant psychoanalytical theory of that time held that “these
expressions were manifestations of immature defense mechanisms that were operating to repress
emotional pain” and related the infants expressions to the internal fantasy environment instead of
than reality (Fraley, 2010). Bowlby rejected this thought process however, in favor of a more
evolutionary approach to development. This approach was influenced by a number of case
studies including the work conducted by Konrad Lorenz, in which he studied the effects of
imprinting on young goslings. In the case study Lorenz removed half the eggs from a mother
goose and introduced them to an alternate mother figure at the time of hatching. The goslings
then attached to the alternate figure from that point on even after reintroduction to the mother
goose. Lorenz’s study showed that “imprinting has consequences both for short term survival
and in the longer term forming internal templates for later relationships” (McLeod, 2009). This
study helped to confirm Bowlby’s initial premise that all species have an attachment system.
Bowlby advanced the theory of attachment systems through his observation and later publication
of a study conducted on a group of antisocial children. His collaboration on a film that followed
the separation experiences of children from their parents while in a hospital setting not only
further validated his theory of attachment but also influenced hospital practice (Bretherton,
1992). Through his work on these and other studies Bowlby proposed “that children attach to

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carers instinctively, for the purpose of survival and, ultimately, genetic replication. The
biological aim is survival and the psychological aim is security” (Saylor.org, 2010).
Mary Ainsworth, an American psychologist living in London, began collaborations with
Bowlby in 1950 following the end of World War II. Ainsworth came to the partnership with a
theoretical background in William Blatz’s security theory, which, like Bowlby, “emphasized the
importance of early dependence on parents” (Berzoff, et al., 2011). Through their work together,
Bowlby and Ainsworth proposed the foundational concept of attachment theory that the
attachment relationships experienced in infancy create an unconscious mold or template for
future relationships and behaviors by defining the expectations for those relationships. Bowlby
and Ainsworth only remained partners briefly as Ainsworth’s husband was relocated for work
and she followed him. However, the partnership had a lasting impact on Ainsworth’s thought
process and the conceptualization of attachment theory. Ainsworth’s contribution to attachment
theory came through her work with families in Uganda and Baltimore in which she was able to
empirically and cross-culturally test Bowlby’s theory. Ainsworth expanded on the theory by
introducing “the concept of the attachment figure as a secure base from which an infant can
explore the world. In addition, she formulated the concept of maternal sensitivity to infant
signals and its role in the development of infant-mother attachment patterns” (Bretherton, 1992).
Ainsworth further classified the infant-mother attachment patterns identified, as three of the
attachment patterns described in the above section: secure, avoidant, and ambivalent. This
classification of patterns has had a lasting impact on the psychodynamic thought process
regarding development. Today much of Ainsworth’s findings are still considered relevant and
applicable to clinical work.

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Attachment theory continued to evolve through the work of several individuals including
Mary Main and collaborating theorists Rudolph Schaffer and Peggy Emerson. Mary Main, one
of Ainsworth’s students, is credited with conceiving the fourth pattern of attachment,
disorganized attachment. The fourth attachment pattern was proposed by Main after
reassessment of Ainsworth’s attachment categories revealed a small percentage of infants who
did not fit into Ainsworth’s other categories (Berzoff, et al., 2011). Schaffer and Emerson
formulated the stages of attachment after conducting a study which observed infants at monthly
intervals. The study revealed four sequences or sages in which attachment is first developed. The
first stage occurs anywhere from birth up to three months of age and during which the infant
displays indiscriminate attachment. The second stage occurs after four month of age and is
characterized by the infant displaying preference for certain individuals but still accept care from
anyone. The third stage occurs after seven months of age in which the infant displays extreme
preference for a single individual. The fourth stage occurs after nine months of age when the
infant is able to formulate multiple attachments and begin to express some independence
(McLeod, 2009).
The comprehensive documentation and explanation of attachment theory was first
completed through the publication of three papers. The first of the trilogy, Attachment, was
written by Bowlby and published in 1969. The second, Separation: Anxiety and Anger, was also
written by Bowlby and published in 1972. Bowlby also wrote the third and final paper in the
trilogy, Loss: Sadness and Depression, which was published in 1980. Bowlby’s theory of
attachment was not readily accepted in the psychoanalytical community. However, since that
time it has become "the dominant approach to understanding early social development, and has
given rise to a great surge of empirical research into the formation of children's close

9. CLINICAL PAPER 9
relationships” (Saylor.org, 2010). Furthermore, it has not only impacted existing theories and
the development of new theories, but it has influences policies related social welfare and
childcare.
Gender/Cultural Considerations
Since attachment theory initially grew out of a Caucasian, middle to upper class economy
with childcare patterns characteristic of the early twentieth century nuclear family Western
culture and in a male dominated field of study, one might expect to find differences or variances
in the theories application based on gender or culture. However, according to the authors of
Inside Out and Outside In (Berzoff, et al., 2011), few studies have determined that gender plays
any significant role in the formation of attachments in infancy. The authors suggest that one
possible reason for is because “the needs of the young infant are the same for both sexes – that is,
all infants need a ‘good enough caregiver’ for optimal development” (Berzoff, et al., 2011).
Therefore, when utilizing attachment theory, clinicians must be aware that the various patterns of
attachment have equal ability to present in either a male or female client.
That being said, does the cultural context or background influence the nature of the
attachment relationship that is developed? Mary Ainsworth found, when conducting her
research, that approximately two-thirds of a population displayed secure attachment patterns.
The remaining one-third of the population was therefore distributed among the remaining
insecure attachment patterns. Though there have been a limited number of studies conducted
with the specific purpose of testing the cross-cultural variability of attachment theory, those that
have been performed have yielded similar results (Berzoff, et al., 2011). Variations in the
distribution between the remaining insecure attachment patterns have yielded some cross-cultural
differences. For example, studies conducted in Germany noted that the avoidant attachment
pattern was more prevalent among the remaining one-third of the population than were the other

10. CLINICAL PAPER 10
insecure attachment patterns. In contrast studies conducted in Israel and Japan found that the
ambivalent attachment pattern was more prevalent than were the other insecure attachment
patterns (Berzoff, et al., 2011; Bretherton, 1992; vanIJezndoorn, 1990). It has been suggested
that the variances among the insecure patterns of attachment may be based on culturally
appropriate parenting goals. Following her extensive literature review and research regarding the
assertion that attachment theory adequately reflects and represents attachment behaviors in all
cultures, Yvonne McKenna concluded “that attachment theory is essentially universal with
culturally specific expressions of infant and maternal behaviors related to specific societal values
and beliefs” (McKenna, 2009). Therefore cultural competency remains highly important and
influential during the therapeutic process specifically regarding childrearing practices and
parental value systems.
Ethical Implications
In the past ethical concerns have been raised about Mary Ainsworth’s research
procedures when developing her assessment technique, the Strange Situation Classification, due
to the effect on the infant participants. During her assessment the participants were placed under
stress, producing anxiety. This anxiety was believed to have been in violation of the ethical
responsibility to protect the clients or participants (McLeod, 2008). In current practice, ethical
concerns are somewhat similar regarding protection of clients or participants. However, much of
the ethical implications centers on cultural competency and the relationship between the therapist
and the client.
The Code of Ethics of the National Association of Social Workers (NASW, 2013) states
that “social workers should understand culture and its function in human behavior and society,
recognizing the strengths that exist in all cultures. Social workers should have a knowledge base
of their clients’ cultures and be able to demonstrate competence in the provision of services that

11. CLINICAL PAPER 11
are sensitive to clients’ cultures and to differences among people and cultural groups.” As stated
in the above section, counselors or therapist must be culturally sensitive and competent about the
childrearing practices and parental value system of the client. “Promoting practices based on one
culture (usually the Euro-Western culture) may lead to under- or over-referrals based on
diagnoses of insecure attachment” (McKenna, 2009). It may also inhibit the therapeutic change
process.
Due to the nature of the relationship between the therapist and the client professional
boundaries must be established and maintained. Within attachment therapy the therapist takes on
or models a similar role as that of the client’s parent. While this role enables the therapist to gain
knowledge of past caregiving and attachment difficulties to assist in changing them, it may also
create a conflictual or dependent relationship on the part of the client through the processes of
transference.
Several additional ethical concerns have been brought to the forefront regarding specific
therapeutic interventions utilized with attachment therapy, such as holding. However,
“attachment theory does not suggest specific therapeutic interventions or a specific theory of
therapeutic change” (Berzoff, et al., 2011). Therefore, ethical implications or concerns regarding
specific therapeutic interventions will not be discussed in this section.
Utilization of Theory
Attachment theory provides an important lens through which to view behaviors and
relationships while working through the therapeutic process. “Under attachment theory, a major
goal in psychotherapy is the reappraisal of inadequate, outdated working models of self in
relation to attachment figures” (Bretherton, 1992). Utilizing attachment theory, the therapist and
client work together to uncover and understand the origin of the client’s internal model and
reasons for the client’s difficulties. Through the therapeutic process, the therapist is able to help

12. CLINICAL PAPER 12
the client refute the previously held expectations and assumptions while breaking through the
defense strategies and barriers to change that the client has instituted. The client is then able to
change the internal model of self and attachment.
The nature of the therapist-client relationship creates an opportunity for transference to
occur in which the client begins to recreate attachment patterns with the therapist similar to the
ones formed in infancy or childhood. The role of the therapist in this process is to provide a
secure base from which the client is able to begin exploring and changing these internal models
of attachment. The therapist utilizes attachment theory to determine the client’s attachment style
or pattern and then models appropriate attachment. The therapist may begin by “matching the
client’s attachment style at the beginning of therapy and then challenging it as the therapy
progresses” (Berzoff, et al., 2011). For the therapist, flexibility and awareness of personal
attachment patterns is important when utilizing attachment theory.
Attachment theory is universal and therefore does not have a specific population or group
of people with which its utilization most benefits. However, attachment theory has been
influential in the development of social welfare and child care policies as well as more recent
therapeutic approaches. Recently attachment theory has been utilized and researched regarding
foster care and adoption policies and practices. Attachment theory and its emphasis on quality of
attachment have been used in influencing court policy and decisions regarding removal and
placement of children in foster care. “Children entering the foster care system often experience
attachment difficulties due to exposure to traumatic experiences while in the care of their parents
or other caregivers prior to their removal” (Botes, 2008). These traumatic experiences and
attachment difficulties may continue to manifest in the difficult behaviors displayed by the
children after removal, often causing multiple placement disruptions for the child. “Considering

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the child's attachment needs can help determine the level of risk posed by placement options”
(Saylor.org, 2010).
Regarding adoption, policy has changed in the last several years regarding adoption
records. Adoption records that were once sealed or closed are now being unsealed in favor of
open adoption policies which allow for adopted individuals to search for their biological family
member. These changes are partly due to attachment theories influence and the research
surrounding the importance of early childhood attachment relationships. Furthermore,
attachment theory has been instrumental in the development of current psychoanalytical thought
and recent approaches to therapy, some of which will be discussed in the following section.
Additional Types of Therapy
As previously stated, attachment theory does not recommend specific therapeutic
interventions or theories of change. “As such, attachment theory is compatible with several
current psychodynamic theories” such as control-mastery theory, object relations theory, and
trauma theory (Berzoff, et al., 2011). In addition, attachment theory and its concepts have been
integrated into many therapeutic treatment models, such as mindfulness and mentalization. As
mentioned above, one theory that coincides naturally with attachment theory is object relations
theory. Like attachment theory, object relations theory places an emphasis on the client-therapist
relationship and utilizes the relationship that develops as a means of uncovering and processing
the effects of object relations that the client has experienced. Additionally, object relations theory
and attachment theory are based in the belief that the experiences an individual has had and the
internal nature of the individual both play an important role in the individual’s interactions and
relationships with other objects and individuals. The need for attachment and the extent to which
that need is met is an underlying factor. The psyche takes in what it experiences and creates

14. CLINICAL PAPER 14
mental representations that ultimately become the building blocks from which relationships with
the self and others are formed.
Another theory that is compatible with attachment theory is trauma theory. “Complex
trauma exposure has been linked to disruptions across multiple domains of development
spanning attachment, biological processes, self-regulating capacity, cognition and self-concept”
(Hodgdon, et al., 2013). Trauma theory focuses on a client’s symptoms with the goal of assisting
the client in regaining control over their emotions and behaviors. Attachment theory can easily
be combined with trauma therapy when working to establish a safe and secure base from which
to explore the trauma experience.
The therapeutic approach or model that has most significantly been influenced by
attachment theory is mentalization. Mentalization originated from attachment theory and as such
is easily compatible. “Mentalization refers to the ability to reflect upon, and to understand one's
state of mind; to have insight into what one is feeling, and why” (Hoermann, et al., 2015). The
ability to understand personal feelings and consider those of others is important to regulate
intense emotions and deal with difficult or frustrating situations. The mentalization model asserts
that a caregiver’s ability to model or reflect on a child’s feelings or emotions impacts the child’s
ability to develop the capacity to mentalize. Similar to the utilization of attachment theory in the
therapeutic process, the therapeutic alliance is of significance. Through this alliance the therapist
is able to encourage the client to verbalize and explore their thoughts, behaviors, and the
consequences for both. Through the therapeutic process the client is then able to garner new
skills.
Advantages and Disadvantages
As has been discussed in several of the above sections, utilizing attachment theory in the
therapeutic process has numerous advantages. First, because of its universal nature attachment

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theory is applicable to individuals of varying sexual and cultural backgrounds. Attachment
theory is flexible and allows for joint collaboration between the therapist and the client. While
the main goal of the theory is to understand the internal model of attachment and its impact on
the client’s current difficulties, it does not restrict its goals to a specific theory of change.
Furthermore, this flexibility causes attachment theory to be compatible with several other
theoretical approaches to therapy. Attachment theory does not outline or suggest specific
therapeutic interventions to be utilized in practice but allows the therapist and client to determine
which interventions are most effective.
While multiple advantages exist in utilizing attachment theory, several disadvantages are
also present. One of the primary disadvantages to attachment theory lies in its original premise
that the mother possesses the greatest influence over the development of an individual’s
character and personality. The theory does not take into account the importance or types of
attachments that may be developed between the infant and other family members or caregivers.
Furthermore, the theory focuses on the attachments that are formed during infancy or early
childhood and does not account for the influence of attachments formed later in life. Another
disadvantage is that the theory does not give credence to the environment, either physical or
societal, in which an individual develops. Physical and societal environments that are oppressive,
dangerous, or lack resources also influence an individual’s opportunity for development.
Controversies and Limitations
Controversy has surrounded attachment theory since its introduction to the field of
psychology. As previously stated, Bowlby’s theory of attachment was not readily accepted due
to its departure from the present day tenets of psychoanalytical thought. Bowlby’s theory has
further been criticized because its development came out of a Caucasian, middle to upper class
society with childcare patterns characteristic of the early twentieth century nuclear family

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Western culture. This has given rise to concerns regarding its continued relevance today’s
modern and culturally diverse cultural societies. Furthermore, “some feminist theorists have
interpreted attachment theory as supporting the traditional view of women as primary caregivers”
(Bretherton, 1992). More recently, this controversy has been related to arguments regarding the
role of nature vs. nurture in the development of individuals. Psychology researcher, J.R. Harris,
argues that peers have more influence on a child’s character than do the parents or caregiver
(Lee, 2003). Harris states that up until approximately the last century society was made up of
people groups in which the child was influenced by a number of extended family members
outside the traditional nuclear family.
Additional criticisms of attachment theory “relate to temperament, the complexity of
social relationships, and the limitations of discrete patterns for classifications” (Saylor.org,
2010). As previously discussed, attachment theory is based the study of attachment behaviors
displayed by infants during somewhat stressful, brief separations from their mothers. The
question has been brought up whether such brief episodes can truly represent or give a full
picture of the parent child relationship and attachment pattern. Additionally, the patterns of
classification are limited to the behaviors observed with the primary caregiver and are not
extended to behaviors or attachment to other family members or caregivers (Lee, 2003).
The application of attachment theory has created controversy because it has “become an
umbrella term to diagnose and treat behavior that could also be understood from different
frameworks” (Botes, 2008). Because attachment therapy is a young and understudied field, it has
been argued that it lacks the theoretical and empirical support for the interventions, some of
which utilize potentially harmful techniques (Chaffin, et. al., 2006). Therefore future research
focusing on treatment and intervention is necessary.

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Examination of Domestic Violence
Violence against women continues to be a growing human rights concern. Violence is a
broad subject matter and is not limited to a set age group, country, ethnicity, or culture and
therefore is also a global concern. It can take the form of gender inequality, gender mutilation,
child marriage, enslavement, domestic violence, and sex trafficking. “Violence against women is
a global health catastrophe, a social and economic impediment, and a threat to national security.
Women’s rights are human rights, and all women deserve to live a life free from violence,
intimidation, and fear” (Congresswoman Jan Schakowsky, 2012). The following section will
narrow the discussion of violence against women to specifically analyze the subtopic of domestic
violence. The nature of domestic violence will be defined and its negative impacts on the social,
emotional, vocational, mental and physical development of women will be discussed. The power
dynamics in place that allow domestic violence to continue in society will then be addressed. A
social action strategy will be proposed to address the human rights topic of domestic violence.
The section will then conclude by examining the challenges and
Definition
Domestic violence by definition is “any abusive, violent, coercive, forceful, or
threatening act or word inflicted by one member of a family or household on another” (The Free
Dictionary, 2014). Domestic violence includes physical, sexual, emotional, psychological, and
financial abuse. Physical Abuse can be defined as “inflicting or attempting to inflict physical
injury, withholding access to resources necessary to maintain health” (DVRT, 2014). Emotional
abuse occurs when an individual’s sense of worth or self-esteem is undermined. Sexual abuse is
defined as “coercing or attempting to coerce any sexual contact without consent, attempting to
undermine the victims' sexuality” (DVRT, 2014). Economic abuse occurs when an individual is
made financially dependent on another person. Psychological abuse is defined as “instilling or

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attempting to instill fear, isolating or attempting to isolate a victim from friends, family, school,
and/or work” (DVRT, 2014).
Prevalence
Domestic violence is not a respecter of persons, but affects individuals from all
backgrounds, nationalities, socioeconomic status, gender, and sexual orientation. Historically,
however, women have been at greater risk for becoming victims of domestic violence than have
men. Therefore, for this paper victims will be referred to in the female gender role as “she” or
“her.” According to the National Coalition Against Domestic Violence (2014), approximately
one in every four women will experience domestic violence during her lifetime. A study
conducted by Tjaden and Thoennes (2000) supports the above statistic and found that
“married/cohabiting women reported significantly more intimate perpetrated rape, physical
assault, and stalking than did married/cohabiting men” regardless of whether the time period
being reported was within the previous year or over a lifetime.
Micro/Mezzo/Macro Effects
The effects of domestic violence are far reaching and impact the victims, their families,
and the communities in which they live. The study conducted by Tjaden and Thoennes (2000)
also concluded that women “reported more frequent and longer lasting victimization; fear of
bodily injury, time lost from work, injuries, and use of medical, mental health, and justice system
services.” Victims of domestic violence often suffer from depression, anxiety, post-traumatic
stress disorder (PTSD), chronic illness, digestive disorders, eating disorders, substance
dependence, multiple physical and mental health problems, and low self-esteem
(GoodTherapy.org, 2013; Wathen & MacMillan, 2003; Kass-Bartelmes, 2004). Physical damages
caused by domestic violence range from cuts and bruises to broken bones, chronic pain, and in
some cases death. Violence during pregnancy may lead to miscarriage, low birth weight, and

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death of the infant. Domestic violence accounts for approximately 16,800 homicides and $2.2
million (medically treated) injuries each year within the United States. This cost increases to $4.1
billion when combining both direct medical and mental health services. Violence and the fear of
violence also place women at greater risk for contracting HIV and other sexually transmitted
diseases” (NCADV, 2014).
The social consequences to female victims of domestic violence include stigmatization,
ostracizing, and social degradation (Roy, 2010). Immigrants and refugee women that are victims
of domestic violence have further complications as they may not have legal residency or may be
dependent on their spouse for immigration status. The compounding fear of social and physical
consequences along with cultural dynamics and language barriers may “prevent her from leaving
her husband, seeking support from local agencies,” accessing the necessary treatment, or
requesting legal assistance due to lack of familiarity with the government structure (NCADV,
2014) thus making domestic violence one of the most underreported crimes. According to the
Center for Disease Control and Prevention (2003) within the Unites States “the direct health care
costs of domestic violence are approximately $4.1 billion with an additional $1.8 billion in
productivity losses associated with injuries and premature death.” The outcome and cost of these
compounding health and community issues has made domestic violence a “major public health
problem” (AHRQ, 2002).
Causes
Although no specific causes or reasons have been directly linked to why some individuals
become violent perpetrators and some become victims, several risk factors have been identified
that indicate an increased likelihood for both the batterers and the victims. According to the
NCADV (2014), children who witness violent interactions within their homes between their
parent and another parent or intimate partner are at greater risk for continuing that violent

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behavior. Furthermore, “boys who witness domestic violence are twice as likely to abuse their
own partners and children when they become adults” (NCADV, 2014). Regarding the correlation
between alcohol or substance abuse and domestic violence, study results are inconsistent. One
study cited by Wilt and Olson (1996) found that frequent use of alcohol increased the likelihood
of violence in the home. Whereas, another study found that in over half the incidents studied
alcohol did not play a factor in the domestic violent incident. However,
“in spite of the methodological weaknesses of many studies on alcohol and family
violence, the data strongly suggest that alcoholism and acute alcohol consumption . . . are
related to marital violence. The research indicates that a high percentage of those who
engage in marital violence are alcoholics or at least very heavy drinkers, and that the
marital violence is often associated with alcohol consumption” (Wilt & Olson, 1996).
Barriers to change
Often multiple barriers exist for victims of domestic violence that prevent them from
participating in all aspects of life, obtaining services, and experience basic human rights such as
freedom from violence. The social power dynamic can clearly be seen in the restraining forces to
change such as a patriarchal system of gender relations; economic inequality between women
and men; lack of legal awareness; limited education and healthcare for females particularly in
third world nations; lack of temporary housing; female attitude of dependence; and a lack of
access to resources. Structural violence is embedded in the patriarchal system of gender relations
held by many cultures. “The historical nature of gender-based violence confirms that it is not an
unfortunate aberration but systematically entrenched in culture and society, reinforced and
powered by patriarchy” (APIIDV, 2001). This patriarchal view of gender relations holds that all
important positions and decision-making power lie in the hands of men within a society or
culture. This view further perpetuates social, economic, and educational inequality, fostering an

21. CLINICAL PAPER 21
attitude of dependence and encouraging the internalization of feelings of powerlessness by
females.
The category of domestic violence and the amount power and control a perpetrator
maintains over a victim may create emotional barriers including fear, shame, guilt; economic
barriers such as a lack of resources, money, or refusing to allow her to obtain employment;
physical barriers such as isolation and threats; and the societal barriers such as stigma and lack of
public education. According to the National Coalition Against Domestic Violence (2014)
domestic violence is highly underreported with “only approximately one-quarter of all physical
assaults, one-fifth of all rapes, and one-half of all stalking perpetuated against females by
intimate partners are reported to the police” within the United States. In the article “Prevalence
of Domestic Violence in the United States” (Wilt & Olson, 1996), the authors conclude that
“physicians and nurses do not routinely identify and record domestic violence” which then leads
to an increase in underreporting. An additional study found that “very few women voluntarily
disclosed domestic violence to a health professional and even fewer were asked directly about
domestic violence by one” (Bacchus et al., 2003). Furthermore, a study conducted by Straus et
al. (1990) found that only approximately 2% of victims seek shelter assistance. Because a
majority of domestic violence cases are not reported, the victims often rely on help from friends,
family, and other social or mental health services (Kaukinen, et al., 2012).
Forces for change
In comparison, the driving forces of change include the empowerment of women;
increased educational opportunities for females; increased social awareness; the development of
an attitude of self-reliance among females; domestic violence training for healthcare
professionals, public officers , and public officials; the development of an international domestic
violence counseling curriculum; and the strengthening of laws protecting victims of domestic

22. CLINICAL PAPER 22
violence. A paper published by the National Resource Center on Domestic Violence (Lyon &
Sullivan, 2007) cited several studies in which shelter services were found to be “one of the most
supportive, effective resources” for victims of domestic violence. “Women who had more social
support and who reported fewer difficulties obtaining community resources reported higher
quality of life and less abuse over time” (Lyon & Sullivan, 2007). For victims of domestic
violence, counseling and advocacy further “reduce depression and future violence” (Iyengar,
2009). Two additional studies cited in the National Resource Center on Domestic Violence
publication supported these conclusions and found that victims who worked with advocates were
more likely to remain free from violence and abuse than were those who did not work with an
advocate (Lyon & Sullivan, 2007). Counseling helps facilitate healing by allowing victims to
address the fear and trauma that they have experienced in a safe place while also allowing them
to gain a healthy perspective of themselves and the impact that the trauma has had on their life
(GoodTherapy.org, 2013).
“Empowerment is a process that allows one to gain the knowledge, skill-sets and attitudes
needed to fight back violence” (Roy, 2010). Empowerment breaks down the emotional and
economic barriers listed above by providing females opportunities for paid employment and
increasing their ability to make decisions. Empowerment also assists in breaking down the
physical barriers ensuring the safety and security of the victims of domestic violence. In addition,
societal barriers are diminished through empowerment as resources are more readily accessible,
public safety is improved, and public awareness increases. Through empowerment the negative
interpretation of power and control within domestic violence can be redeemed and transformed
into a necessary strategy for social change.
Case Study
The case of Elizabeth Thomas will be introduced by first identifying the client and the

23. CLINICAL PAPER 23
presenting problem at the time of the initial assessment. Next this section will provide an in-
depth examination of the client’s history of domestic violence and the effects that these event
have had on her development and everyday life. The paper will then identify the client’s key
challenges and strengths and discuss any issues regarding diversity that may be present. To keep
consistency throughout this paper the subject of this assessment will be referred to as Elizabeth
or “the client.”
Introduction
Elizabeth Thomas (name has been changed to protect client’s confidentiality) presents as
a twenty-eight year old Caucasian female. She is not married and is currently unemployed. Her
work history includes bar tending, tattoo artist, delivering papers, and running a small
convenience store out of her apartment. Her education consists of obtaining her GED and some
college courses. Elizabeth is also the mother of four children, three of whom are not currently in
her custody and one that is deceased.
Elizabeth was referred to counseling after becoming involved with the Department of
Children and Family Services (DCFS). The counseling was made part of her DCFS service plan
due to her lengthy history as a victim of physical, verbal, emotional, and sexual abuse. The abuse
began during early childhood, has continued throughout adulthood, involving multiple abusers
including her mother, father, and at least one of her ex-partners and father of two of her children.
History
In discussing her extensive history of abuse Elizabeth’s behavior, demeanor, and dialogue
suggest that she does not view this history as a continuing problem or issue. She believes that she
has sufficiently dealt with the issues and effects of her childhood abuse and domestic violence
through her many years of counseling and multiple therapists. However, due to her recent
involvement with DCFS Elizabeth has decided to comply with counseling. Elizabeth’s DCFS

24. CLINICAL PAPER 24
caseworker and previous therapists have stated that due to her continued cycle of abusive
relationships and behaviors, Elizabeth has not yet fully acknowledged the profound effects that
this history of abuse has had and continues to have on her life.
Personal testimony from Elizabeth along with previous therapeutic notes reveals that
Elizabeth’s history of abuse and trauma began in early childhood primarily at the hand of her
mother and then extended to include her father. Elizabeth’s reports of childhood abuse include
verbal, emotional, and physical violence. Illustrations these incidents of abuse are bruises,
broken bones, deprivation of food, being locked in a closet, and verbal assaults. The cycle of
abuse continued through adolescents and into adulthood where Elizabeth became involved in a
series of physically, verbally, and sexually abusive relationships, two of which resulted in the
births of her children. Furthermore, at some point in time during young adulthood Elizabeth
reports being sexually assaulted by a group of young men. Additional traumatic experiences
include the separation from her first born child who currently resides with her mother, the death
of her second born child, and the current separation from her youngest two children due to
involvement with DCFS. Regarding the death of her second born child Elizabeth reports being
present at the hospital and holding her child both at the time of death for hours afterward.
Following the death of her child Elizabeth voluntarily entered in to an inpatient psychiatric
hospital and underwent treatment.
In the past Elizabeth utilized a number of coping mechanisms such as substance abuse,
self-harm, aggressive behaviors, and focusing her thoughts and attention on her children to
manage the effects of her history of abuse. Currently Elizabeth needs to develop positive coping
skills that she will be able to utilize to redirect her thought and behavior patterns. She also needs
to develop an awareness of the cycle of abusive relationships. Elizabeth does not appear

25. CLINICAL PAPER 25
emotional when discussing traumatic events from her past, but discusses them with matter-of-
factness in her attitude and demeanor. She does, however, become more emotional when talking
about her children and the stress of her current life events.
Developmental Impact
The history of abuse and domestic violence appears to have affected nearly every aspect
of Elizabeth’s life. Her inability to maintain stability or effectively cope with her history of abuse
has prevented her from retaining long term employment and completing her degree which would
allow her to become a physicist. These in turn have influenced Elizabeth’s financial status and
her ability to provide for herself and her children. The effects further extend to her current
situation and include separation from her children, estrangement from her family, and an
inability to maintain an appropriate and positive support system. Elizabeth’s presenting problem
is further exacerbated by her unmet need for affection and acceptance from her family members
and past significant romantic relationships. This unmet need coupled with the cycle of abusive
relationships often places Elizabeth in a state of transition or instability. Due to the long and
continued history of abuse during her psychosocial development Elizabeth has not been able to
successfully complete many of the developmental stages as evidenced by her inability to fully
trust others and form lasting or significant relationships (McLeod, 2013).
The effects of abuse are also evident in the thought patterns and behavioral reactions that
Elizabeth experiences. Her history of abuse will often manifest itself spontaneously when an
abusive memory is triggered either by a scene in a movie or television show, a lyric in a song, or
through contact with one of her abusers. As a result of the trigger, Elizabeth may become
enraged and either lash out physically or do something self-destructive. While Elizabeth does not
have any immediate physical health or safety concerns, she does have a disability due to an auto
accident and receives Social Security Income (SSI). She has also been diagnosed with Bi-polar

26. CLINICAL PAPER 26
Disorder and Attention Deficit Hyperactivity Disorder (ADHD). Elizabeth has admitted that both
of these disorders affect her behaviors and ability to make decisions. The pending legal case
against her for assault on a police officer could be viewed as a combination of both a triggering
event and complications of her mental health disorder.
Challenges
While Elizabeth possesses numerous strengths and abilities, some obstacles also exist that
have the potential to impede her progress in counseling. One such obstacle is her long history of
previous counseling. Elizabeth has been assessed by many counselors and is now able to speak
like a counselor. She is also a self-described analytical personality and will often try to address
her own issues. This presents an obstacle for both Elizabeth and the counselor. Elizabeth may be
resistant to any direction, additional coping skills, or counseling offered if that assistance is
something that she had previously heard or tried. On the other hand it may be difficult for a
counselor to bring any new or additional information to the sessions to promote progress.
Strengths
During the initial assessment several of Elizabeth’s strengths were identified; openness,
intelligence, articulate, and her ability to survive multiple traumas. Elizabeth’s intelligence and
ability to articulate her thoughts gives her confidence and increases her self-esteem. Elizabeth’s
intelligence and articulation have provided her with the opportunity to find past employment
within a variety of professions. They have also given her the desire to seek higher education and
an analytically demanding profession. That coupled with her openness allow for ongoing
dialogue between herself and the counselor. Elizabeth’s openness and ability to articulate also
work to create an honest environment. Elizabeth’s openness grants the counselor permission to
ask probing questions and address the effects of her traumas. The matter-of-factness in which she
discusses her history of childhood abuse and domestic violence and her ability to separate her

27. CLINICAL PAPER 27
emotions from the events has also been her strength. The survival of multiple traumas that have
been both extreme and painful speak to Elizabeth’s resilience and provide a glimpse into her
ability to process the effects and make positive changes.
Diversity Issues
Often an assumption is made that victims of abuse and assault are of a particular race,
ethnicity, gender, and socioeconomic status. While Elizabeth fits a majority of the criteria for this
stereotype her case is not without diversity related issues. Elizabeth is currently living within a
lower socioeconomic class for a variety of reasons, not the least of which includes her
unemployment. Living within a lower socioeconomic state than possibly the counselor or
therapist may bring a conflict of value systems, support systems, and may also cause Elizabeth to
feel resentful or jealous. If not addressed properly, all of these factors may impede progress or
reduce Elizabeth’s interest in talking openly.
Integration of Attachment Theory and Domestic Violence
Attachment theory is based on the premise that early experiences and patterns of
attachment during childhood and infancy create a model for future relationships and attachment
formation. “The impact of early attachment extends beyond adaptation to include one’s value
system and core sense of self” (Kerr, 2013). Therefore in applying attachment theory to victims
of domestic violence, how do those early attachments correlate or increase the likelihood of an
individual becoming a victim? Research has shown that domestic violence does not discriminate
based on gender, socio-economic status, sexual orientation, religion, or culture. However, a study
conducted by Brenda Joly and Karen Liller (2002), regarding possible associations between
abuse experiences and childhood patterns of attachment, concluded that a majority of female
victims of domestic violence display patterns of insecure attachment. In a review of six studies
linking attachment style to intimate partner violence, McVery (2012) collaborated and

28. CLINICAL PAPER 28
expounded on Joly and Liller’s findings. Four of the studies cited in the review (McVey, 2012),
showed a strong correlation between female patterns of anxious or preoccupied attachment with
the perpetration of male violence in relationship. McVey (2012) cited another study conducted
by Henderson, Bartholomew, and Dutton in which a preoccupied or anxiety attachment style was
correlated to an increased likelihood of remaining in an abusive relationship. Additionally, in the
study conducted by Bookwala and Zdaniuk (McVey, 2012), a correlation was also found
between avoidant or fearful attachment style and domestic violence. The above literature review
and research has established that “attachment theory provides a useful model for understanding
the co-occurrence of violence and intimacy in a relationship while analyzing the bonds of human
interaction” (McVey, 2012).
The remaining portion of this section will demonstrate implementation of attachment
theory in counseling victims of domestic violence by utilizing the above case study. It will then
examine the role of the social worker in the therapeutic relationship working with victims of
domestic violence. Finally the section will address any ethical implications and challenges.
Implementation
In implementing attachment theory or any other theory in counseling victims of domestic
violence an initial assessment is essential. The purpose of an assessment is to obtain
authorizations, establish confidentiality policies and disclosures, acquire a comprehensive client
history (diagnostic/medical and developmental), determine the level of continued risk for
violence, and begin to develop a plan for treatment. While an assessment can be performed in a
variety of ways, one of the more common methods utilized in the implementation of attachment
theory is the Adult Attachment Interview (AAI). This particular method was created by Mary
Main and several of her colleagues and consists of a twenty question interview. Utilizing AAI,
the therapist is able to garner information regarding the client’s past experiences with parents or

29. CLINICAL PAPER 29
caregivers, assess for acute loss or trauma, and gain an understanding of the client’s current
relationships. The information acquired in the interview allows the therapist to determine the
client’s pattern of attachment.
As eluded to in a previous section, domestic violence does not discriminate among
individuals. Victims of domestic violence may present with any one of the four patterns of
attachment including the secure attachment pattern. However, research has shown that a majority
of female victims of domestic violence display patterns of insecure attachment. Furthermore,
“adults assessed as having an insecure state-of-mind with regards to attachment have greater
difficulties in managing the vicissitudes of life generally, and interpersonal relationships
specifically, than those assessed as securely attached” (Sonkin, 2005). It should be noted that
implementation of attachment theory with victims of domestic violence should honor the client’s
ability to survive and develop adaptive defense mechanisms under such difficult circumstances
while also “developing more secure patterns of attachment/relationships” (Kerr, 2013).
In Elizabeth’s case, an AAI assessment would likely reveal a disorganized attachment
style. This would be evidenced in her dissociation from the multiple abusive and traumatic
incidents that she has experienced throughout her lifetime. This attachment style would further
be evidenced in Elizabeth’s descriptions of her relationship and interactions with her mother.
While this relationship continues to be volatile, consisting of verbal and emotional abuse,
Elizabeth also appears somewhat conflicted in her responses. She expresses an understandably
intense hatred for her mother on one hand, yet also conveys an underlying desire for support and
affection. Since her oldest child currently resides with her mother, Elizabeth continues to have
some telephone contact with her. Per her reports, these conversations vacillate between her
personal attempts to be nice and her deliberate attempts to instigate abuse.

30. CLINICAL PAPER 30
Following the assessment, the next step in implementation would be to begin establishing
a therapeutic relationship. The role of the social worker will be discussed in the following
section.
Social Worker Role
The client-therapist relationship continues to remain at the center of the therapeutic
process when utilizing attachment theory in counseling victims of domestic violence. The role of
the therapist or social worker in this process is to provide a secure base from which the client is
able to begin exploring and changing the internal models of attachment. Once the attachment
style or pattern has been determined, through the assessment, the therapist then models
appropriate attachment. To determine and model appropriate attachment the therapist must be
cognizant of the client’s non-verbal cues and then “work to interpret them and respond to them
appropriately” (Sonkin, 2005).
In working with Elizabeth, a therapist or social worker role would be to establish or act as
a secure base for her to begin exploring her early relationship and experiences with her mother.
This process would involve “concentrating on those aspects of the therapeutic relationship that
occur in secure attachments, safety and boundaries, attachment, responsiveness, reflective
functioning, verbal and nonverbal emotional communication, and repair of empathic breaks”
(Zilberstein, 2014). The responsibility of the therapist or social worker then is to assist Elizabeth
in resolving or reframing her relational cues and attachment behaviors. Part of this process will
involve relating how internal memories and childhood attachment patterns can be evoked from
external cues and relationships and in turn elicit internal triggers or feelings.
Ethical Implications
Counseling individuals who have experienced extreme trauma such as abuse or assault
may present both professional and personal ethical dilemmas. In the case of Elizabeth, one such

31. CLINICAL PAPER 31
professional ethical dilemma is in her right to self-determination. The Code of Ethics of the
National Association of Social Workers (NASW, 2013) states that “social workers respect and
promote the right of the client to self-determination and assist clients in their efforts to identify
and clarify their goals.” At one point while attending counseling Elizabeth determined that it
would be beneficial to get in contact with a former boyfriend whom she described as having
some controlling behaviors and character traits. The purpose of the contact was to generate some
income by teaming up to deliver papers. Though in hindsight Elizabeth admits the decision to
reconnect was not a positive or beneficial one as it placed her in a triggering situation that ended
in an additional arrest on her record, during the decision making process Elizabeth felt supported
in her self-determination to try to relieve some of her financial stress through part time
employment.
Confidentiality can also be an ethical issue that arises when counseling victims of
domestic violence. The Code of Ethics of the National Association of Social Workers (NASW,
2013) states that social workers have a commitment to their clients. While a social workers
primary responsibility is to protect and promote the well-being of the client, instances occur in
which that responsibility may shift such as in instances of child abuse or threats of harm to self
or others. In Elizabeth’s case child abuse is not a current threat as her children are not in her care.
However, due to the stress from her present involvement with DCFS coupled with her history of
self-harm, consistent check ins regarding her mental state would be necessary.
The commitment to protect and promote the well-being of the client would extend to the
therapeutic process. Discussing past abuses can trigger a defensive response and be trauma
inducing. In working with Elizabeth, however, after establishing a secure therapeutic relationship
a therapist or social worker may need to begin challenging or gently probing for additional

32. CLINICAL PAPER 32
information when specifically discussing her childhood abusive experiences and relationships
with her mother to break through the defense strategies and barriers to change that she has
instituted, such as her ability to separate her emotions from the events.
Challenges
Several potential challenges will be encountered during the advocacy and implementation
of the above strategy. Clients receiving therapy have the right to end therapy at any time of their
choosing. Attachment theory provides a lens through which to view or understand behavior but
does not necessarily provide a victim with concrete coping mechanisms or assistance for trauma
experienced or co-occurring disorders. Attachment theory in general centers on childhood
attachments. However, attachment can show up in a variety of ways depending on the
relationship between the individual and the subject of attachment.
In Elizabeth’s case, her history of housing and employment instability along with her
relationship seeking behaviors would suggest a possible risk for the termination of therapy prior
to completion of treatment. And as attachment theory does not provide or suggest any concrete
coping mechanisms, a dual approach to therapy may be necessary to provide her with a new
process for managing both external and internal triggers.
Conclusion
Violence against women continues to be a growing human rights concern. Approximately
one in every four women will experience domestic violence during her lifetime. Domestic
violence alone accounts for approximately 16,800 homicides and $2.2 million (medically
treated) injuries each year within the United States. Due to that fact effective treatment,
interventions, and public policies are needed to assess and treat victims.
While many successful strategies are already in place within communities around the
world to combat the effects and impacts of domestic violence, a majority of these interventions

33. CLINICAL PAPER 33
or resources are only made available in response to domestic violence and are not necessarily
effective in preventing domestic violence or changing the cultural or patriarchal mind set. For
victims of domestic violence, counseling and advocacy further “reduce depression and future
violence” (Iyengar, 2009). Counseling helps facilitate healing by allowing victims to address the
fear and trauma that they have experienced in a safe place while also allowing them to gain a
healthy perspective of themselves and the impact that the trauma has had on their life
(GoodTherapy.org, 2013).
Research has shown that some correlation exists between attachment patterns and
increased risk for victimization. Using attachment theory in as a lens in counseling victims of
domestic violence can assist in the recognition of patterns of attachment and in ending the cycle
of abuse by allowing the victim to learn how to establish safe attachments through the
therapeutic relationship. “Attachment theory provides a basis of understanding for how parent-
infant relationships go on to affect individuals into adulthood” (McVey, 2012). Research has
established that utilizing attachment theory can be beneficial in understanding the correlation
between violence and intimacy in relationships (McVey, 2012). Through the therapeutic process
the client is able to change their internal model of self and attachment. Integration of attachment
theory in counseling victims of domestic violence may further increase the likelihood of
successful treatment.
However, attachment therapy is a young and understudied field. It has been argued that it
lacks the theoretical and empirical support for the interventions, some of which utilize potentially
harmful techniques (Chaffin, et. al., 2006). Despite the recent “growth of many important
attachment-based therapies and techniques, the overall use of attachment in therapy remains
limited by a paucity of knowledge about how it combines with other aspects of a child’s life and

34. CLINICAL PAPER 34
clinical presentation” (Zilberstein, 2014). Therefore future research focusing on treatment and
public policy reform is necessary. One of the primary areas of focus would be studies regarding
the effectiveness of attachment theory in working with victims of domestic violence. Another
area primary area of focus would be the prevention of domestic violence. “Immediate action
involving treatment of victims and perpetrators alike, along with reformation of each state’s
crimes code, will allow for healthier relationships and a more productive society” (McVey,
2014).

35. CLINICAL PAPER 35
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Grading Sheet for Final Paper
Level ofCritical Thinking/Novelty (2 Points) Self-evaluation _1.5_ Faculty evaluation ____
a. Is the paperoriginal?
b. Doesthe studentaddressthe noveltyof the paper?
c. Doesthe work productbringin a new pointof view thathas not beendiscussedbefore
or doesit take a topicto a level of greaterdepth?
d. Doesthe paper clearlyuse existingknowledgeandpointouthow thispaperfillsagap in
the existingliterature?
e. Is the informationuseful andrelevanttosocial workpractice?
f. Doesthe studentintegrate previousworkfromsocial workers?
g. Didthe writeridentifythe theoretical application?
h. Are micro,mezzoand macro systemsidentifiedandexplored?
i. Doesthe final workproductreflectthe initial workof the proposal?
j. Doesthe final workproductreflectthe initial workof the outline?
Narrative:___________________________________________________________________
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Purpose (1 Point) Self-evaluation _1__ Faculty evaluation ____
a. Is there a clearstatementof purpose,orthesisstatementinthe abstract?
b. Is there a clearstatementof purpose,orthesisstatementinthe firstfew paragraphsof
the paper?
c. Doesthe author addressall issuesof the statedandimpliedpurposesof the paper?
d. Is thisa topicof significance thatothersocial workersshouldknow about?
e. Doesthe author explainhow thisarticle canimpactothersbothinpractice,policyand
future research?
Narrative:___________________________________________________________________
___________________________________________________________________________
Organization (1 Point) Self-evaluation _1__ Faculty evaluation ____
a. Doesthe paper have a clearabstract withkeyterms
b. Doesthe paper include andintroductionof the overall paper?
c. Doesthe bodyof the paperflow coherentlyandlogically?
d. Are subheadingsusedtohelpthe readertrackthe flow of the article?
e. Is there a clearconclusionof the overall paper?
Narrative:___________________________________________________________________

41. CLINICAL PAPER 41
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Content (11 Points) Self-evaluation _10__ Faculty evaluation ____
a. Doesthe paper drawfrom credible sourcesthatare effectivelyweavedinwiththe
author’sopinions?
b. Are all opinionspresentedbythe studentidentifiedclearly?
c. Doesthe paper incorporate workfromsocial workersandisthe work relatedtoexisting
social workknowledge onthe subject?
d. Doesthe work productofferinformationabouthistorical factors briefly?
e. Is historical informationintegratedwithcurrentinformationrelatedtothe topic?
f. Are biopsychosocial anddevelopmentalfactorsexplainedinthe paper?
g. Are cultural and spiritual factorsexplainedinthe paper?
h. Are ethical considerationsexplored?
i. Are solutionstostatedproblemsandstatedethical issuesprovided?
j. If applicable,iscase material usedtoillustratemajortheoretical conceptsratherthanto
serve asthe substance of the manuscript?
Narrative:___________________________________________________________________
___________________________________________________________________________
Style (1 Point) Self-evaluation _1__ Faculty evaluation ____
a. Doesthe paper remainculturallyaware andavoidanysortof biasor stereotyping?
b. Doesthe paper avoidanygeneralizingand/ormarginalizinglabels(i.e.one shoulduse
“personsdiagnosedwithamental illness”insteadof “the mentallyill?”)
c. Are all redundanciesandsuperfluouslanguage eliminated?
d. Is the writingfreshandlively withcolorfullanguage?
e. Doesthat studentmake use of hisownvoice?
Narrative:___________________________________________________________________
___________________________________________________________________________
Writing (2 Points) Self-evaluation _2__ Faculty evaluation ____
a. Are termsand conceptsclearlydefinedinthe paper? (i.e.don’tassume the readeris
familiarwithall aspectsthe topic)
b. Is the paperwritteninthe active voice throughout?
c. Has the paper beenproofread?
d. Is the paperdevoidof grammarerrors?

42. CLINICAL PAPER 42
e. Is the paperdevoidof spellingerrors?
Narrative:___________________________________________________________________
___________________________________________________________________________
APA style (2 Points) Self-evaluation __2__ Faculty evaluation ____
a. Is the title page properlyformatted?
b. Is a properlyformattedabstractincluded?
c. Are all citationsproperlyformatted?
d. Is the reference page properlydeveloped?
e. Are all referencesrelevanttothe topic?
f. Are all referencescitedwithinthe paper?
Narrative:___________________________________________________________________
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