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How I See DV: Dr. Barbara Van Dahlen

Today’s How I See DV perspective comes from Barbara Van Dahlen, named by TIME magazine as one of the 100 most influential people in the world. Dr. Van Dahlen is the founder and president of Give an Hour. A licensed clinical psychologist who has been practicing in the Washington, D.C., area for over 20 years, she received her Ph.D. in clinical psychology from the University of Maryland in 1991. We’re excited to have her share her voice during our DVAM campaign.

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Please help us understand what post traumatic stress is and how it differs from post traumatic stress disorder?

When a human being is traumatized, whether it’s due to combat, physical violence, natural disaster or something else, there are certain reactions that we expect people to have. Many of those are the symptoms that are now captured in the diagnosis of posttraumatic stress.

So if I’m in a car accident, we would expect that for quite some time I might be more jumpy, hyper-vigilant when pulling out of my driveway, I might have flashbacks of what happened, I might have bad dreams, I might get depressed…  so all of these reactions are what we expect for the situation that I’m in following my accident. It only becomes a disorder if it doesn’t get resolved, if I don’t heal, if I don’t receive the support I need to address all of my understandable reactions and symptoms  associated with this trauma.

What are some misconceptions around post-traumatic stress in the military and domestic violence?

Most people assume that PTS looks the same for everyone – many think of the Rambo version of PTS. That’s not the typical reaction at all. People who have experienced trauma, whether its due to combat or another event, can experience trauma differently from other folks who may have experienced the exact same event.

You might have two people who were in the same firefight — one person might become withdrawn and depressed, the other might become very anxious, agitated. A third person in the same fight might show no indication of stress – no interference  with their functioning. People assume that PTS looks similar and in fact, the manifestation of PTS really varies. In addition it exists on a continuum. What it looks like today is not what it necessarily looked like six months ago and not what it will look like in six months.

Another misconception is that most soldiers/service members come home with PTS. That is not true either. Depending on the studies you look at — 18%, 20%, high is 35% depending on what we are assessing or measuring. Not everyone comes back with PTS.

Even if someone has PTS that doesn’t mean that they’re an ineffective partner, parent, employee, student. Many people function with the aftermath of trauma. There are some people with severe and possibly disabling PTS – but that’s not the case all of the time.

Also, domestic violence is not a symptom of PTS. That’s really important. PTS, especially when it’s very severe, might, in some people, make them more likely to be violent towards a partner if they’re already agitated and aggressive, if they’re not sleeping or if there’s substance abuse. PTS can be one unfortunate risk factor that may make violence more likely.

It depends on who the person is with PTS. We all carry around our predispositions, our tendencies, our personalities, our view of the world. And that will be compounded or affected by PTS. If someone was already a fairly controlling person, or tended to be hot-tempered but wasn’t ever violent before… if they become distressed and aggressive as a result of trauma, they may be more likely to engage in domestic violence.

Returning servicemen and women may experience PTS and exhibit violent behaviors when they didn’t before they left for duty. What do couples in this situation need to know?

PTS for both the person experiencing it and their partner can be very unnerving and scary because the person who has PTS may not know when a trigger may elicit a reaction, anxiety or aggression. So both partners need to come to understand what PTS is going to look like in themselves or their loved one. It doesn’t mean that the person cant be a good partner. It’s like being diagnosed with diabetes — if you don’t recognize what that means, if you don’t take it seriously, you can get yourself in serious trouble.

If the spouse/ partner reacts angrily to the PTS, because they’re hurt and miss the person they love and they’re angry that the person is having trouble sleeping, doesn’t seem to be the same, etc., it’s like throwing gasoline on the fire. The partner’s reaction can exacerbate a difficult and potentially volatile situation. It’s the same for the person experiencing PTS. I’ve heard soliders say that they learned to be aware of what triggered them and their  reactions. They can also learn how to be more careful with their spouses – learn to be understanding of the feeling their spouses may have that are in reaction to the PTS.  Couples can learn together – to decrease the risk of violence. But they have to work on it.

It’s important to take PTS seriously because under the wrong combination of circumstances, that can really lead to a very dangerous and very upsetting situation … especially if you add alcohol to one or both of the partners. A fight or anger that would normally dissipate with them going off to their own corners, may turn into something far more violent than it ever would have before.

And just because we can understand how/why the violence occurred, that doesn’t mean that we can – or ever should – tolerate it.

What are some behaviors that a person who experienced trauma might exhibit?

There are many ways a person might show that they are processing trauma, especially if they are a victim of domestic violence. Their self-esteem may deteriorate. You can see that both in what they say – they say negative comments about themselves, negative perceptions of themselves – and also how they take care of themselves or don’t. Their self-care will start to be affected, falter, fail. They’re not dressing the way they used to, with care. They’re not working out, they’re not eating healthy. Or maybe there’s substance abuse. So anything that is a self-care clue that somebody is suffering, we can often see those in people we care about and notice them.

We all go through ups and downs in our lives, but if you see people who don’t seem like themselves for extended periods of time, several days or weeks, it may be a reaction to trauma.

What are some myths around mental health and domestic violence?

One myth about mental health is that someone with mental illness is having mental illness makes you more likely to be violent. In fact, having a mental illness makes you more likely to be the victim of violence.

People with severe mental health issues, maybe schizophrenia or bipolar disorder, are more likely to be the victim of domestic violence because they are often less able to take care of themselves, they are more vulnerable, their thinking is not always as clear.

In addition, mental health issues place a person at risk in other ways. Someone who is severely depressed may be less likely to step out of or seek help to get out of a domestic abuse situation. They may get more entrenched, and feel like “I’m worthless” because low self-esteem is part of the depression, so they see abuse as confirmation of how they feel. Or if someone has severe depression and is prone to being abusive, they might be more likely to become violent because of their mental health issue.

Those conditions — depression, anxiety, eating disorders, substance abuse — they don’t create domestic violence, or victims. They’re just risk factors on both sides .

About Our Contributor

Concerned about the mental health implications of the wars in Iraq and Afghanistan, Dr. Van Dahlen founded Give an Hour in 2005 to enlist mental health professionals to provide free services to U.S. troops, veterans, their loved ones, and their communities. Currently, the network has nearly 7,000 providers, who have collectively given over $9.4 million worth of services. 

Dr. Van Dahlen, a featured speaker at the October 2012 TEDxMidAtlantic “Be Fearless” event, has joined numerous panels, conferences, and hearings on issues facing veterans and has participated in discussions at the Pentagon, Veterans Administration, White House, and Congress. She has become a notable expert on the psychological impact of war on troops and families and a thought leader in mobilizing civilian constituencies in support of active duty service members, veterans, and their families. Working with other nonprofit leaders, Dr. Van Dahlen developed the Community Blueprint Network, a national initiative and online tool to assist communities in more effectively and strategically supporting veterans and military families. 

Dr. Van Dahlen and Give an Hour have received numerous awards, including selection as one of the five winners of the White House’s Joining Forces Community Challenge, sponsored by First Lady Michelle Obama and Dr. Jill Biden.

coping through counseling

Coping Through Counseling

Sometimes we all want a miracle solution for our problems. Especially after getting out of a bad relationship, the natural desire is to just feel better, now. It may be a frustrating saying, but time does heal wounds. While counseling isn’t an instant fix, the process is truly what’s important. Taking all the time you need to explore the past and think about the future can be invaluable in strengthening and rebuilding your life.

Today we’re continuing our conversation with clinical psychologist Martha Ramos Duffer to learn more about the ins and outs of deciding to start counseling, and how you can tell if it’s working for you.


Some people want to know that therapy is working. What is a good indicator of this?

At the beginning of the therapeutic process, every therapist and client should work together to identify goals and specific ways that they will know they’re moving toward those goals. This can be helpful in determining if therapy is working for you. Overall every therapy that is working will, over time, result in a person feeling increased self-awareness, capacity to choose, clarity and peace.

If you want to have the luxury of your own space to explore yourself then individual therapy is great for that. In individual therapy you can explore your own feelings and goals much more deeply.

Is therapy for everyone? When’s the right time to start therapy?

If you feel that therapy might be helpful, sooner is always better. Therapy can be beneficial for everyone because it’s a place where you can learn increased self-awareness, clarify your goals and look at the choices in front of you.

That being said, there are many things in life that can be therapeutic. If you don’t feel comfortable with therapy there are other healing practices you can explore like journaling, spending time in nature, cultivating friendships and networks, being part of community groups or volunteering. There are many activities that can be as healing as therapy.

What are the differences between group counseling and individual counseling?

In general, both can be very beneficial, and I would recommend that people consider the type that they feel most comfortable in. If you want to focus more on interpersonal skills, want to know how you come across to other people, and want to hear from experiences from other people in their growth processes, then group counseling is wonderful for that.

What advice would you give someone who is apprehensive about counseling?

Entering counseling does not necessarily mean that you are mentally ill or can’t cope on your own. Therapy is about how much you’re putting in place to support yourself in healing and succeeding.


Have you thought that therapy might be a good choice for you? Whether you’re struggling in an abusive relationship or trying to heal after leaving one, getting in touch with a counselor to strengthen your support system can have a powerful effect. Give us a call at 1-800-799-SAFE and our advocates can help you locate counselors in your area.

Further Reading

In our post on Counseling for Domestic Violence Survivors we talk more about breaking the isolation of domestic violence by seeking counseling and support.

This PDF brochure from the National Association of Social Workers has a helpful checklist of positive indicators when determining if your counselor is the right fit for you.

finding the right counselor for you

Finding the Right Counselor for You

The idea of sharing personal stories and emotions can be scary, especially if you’re still feeling hurt or vulnerable from a breakup. Delving into these difficult feelings can ultimately be one of the most helpful ways to cope and move on. That’s where counseling comes in. Talking with someone one-on-one in a safe space is a great option for anyone who may need support.

To learn more about the process of starting counseling, we met up with licensed clinical psychologist and motivational speaker Martha Ramos Duffer whose work is centered on trauma treatment, empowerment and personal growth. She provided us with incredibly helpful information on how to choose a counselor.


What are the differences between a counselor, therapist, psychologist and psychiatrist? Who would you suggest for someone who has left an abusive relationship?

That’s an important place to start. The words psychotherapist, therapist and counselor are all used interchangeably. These are people who have received master’s degrees in counseling, social work or psychology. Psychologists have more training because they are doctorate level therapists. Any of these professionals can do a great job providing therapy.

On the other hand, psychiatrists have a doctorate in medicine. In most states they are the only ones who can prescribe medicine and most don’t provide therapy. What most often happens is that somebody who needs medication will see a psychologist or other licensed counselor for therapy and see a psychiatrist for medication.

It’s important to make sure the professional you decide to speak with is a licensed mental health professional. Terms like “licensed professional counselor” are legally regulated, so not just anybody can call themselves that. Words like “counselor” or “coach” are not regulated, so anybody can call themselves that.

What are the steps to take in order to find the right counselor?

The first thing to think about is financial access. Will you try to use insurance to pay? If not, will you pay out of pocket and do you need sliding scale fees? Some therapists offer varying prices based on the client’s income level.

Some communities also have local mental health centers with low fees. If you’re just leaving an abusive relationship and you don’t have access to funds or insurance, see if one of these exists in your area.

If you have insurance, call and request a list of mental health care providers. After you have a list, you can begin to ask around to see which of these professionals are recommended by others. If you’re coming out of a shelter, ask the people who work there for recommendations. Ask friends and family if anybody has seen a mental health professional who has worked well for them.

If your friends and family members haven’t used mental health professionals, there are other options. Ask for recommendations from other health professionals in the community, like your physician or even other psychologists. Psychology Today is also a useful site where many mental health professionals advertise, allowing you to read doctors’ bios and research more options in your area.

Call several different therapists and talk with them before setting up an appointment. This lets you determine how comfortable you feel and how responsive they are. Ask if they have expertise working with clients who have experienced trauma and domestic violence.

What are some red flags that indicate that a therapist may not understand domestic violence or aren’t a good fit for you?

If a therapist gets defensive when you ask them if they have experience with trauma and domestic violence, then it is likely that they are not well trained in that area.

Another huge red flag is if a therapist wants to begin by looking at your role in the relationship and treats the abuse as a mutual-fault issue. That doesn’t mean that in complex ways we don’t all play a role in every dynamic but that’s not how to treat a survivor of domestic violence. If they start to discuss the situation as if it was a traditional marriage or relationship issue and try to explore your own role in triggering or participating in the abuse, this is a clear sign they don’t understand domestic violence.

If a counselor recommends couples therapy or marriage therapy, this is also a red flag. This is not recommended when there’s battering and violence in a relationship.

How do you know a counselor is a good fit for you?

A good match between therapist and client is one of the most powerful healing factors in a therapeutic relationship. Look for someone who makes you feel heard, understood, safe and comfortable.

If you don’t feel this way, it makes sense to look for someone else. However, it’s important to first ask yourself what is making you uncomfortable. Is your discomfort coming from how difficult it is to talk about this? Of course you’re going to feel badly as you start to talk about what happened. There are all kinds of things that can make a first session not feel good, and you need to discern if your discomfort is because starting the process is difficult, or because you don’t feel heard and understood by the counselor.


Check the blog on Wednesday for the second part of our interview with Martha.