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Starting the conversation

In this article, we’ll explore how to start a conversation about DVA.
A group of people hold up speech bubbles, representing the back and forth of a dialogue. Illustration.
© The University of Sheffield

Even if you suspect abuse might be occurring, it can still be difficult to bring up it up. Many professionals have reported feeling reluctant to ask patients about DVA. However, the evidence suggests that patients are not offended when asked. And for those who have experienced DVA, this could be an important first opportunity to disclose their experiences. In this article, we’ll explore how to start a conversation about DVA.

Start with an open mind

Some women who have experienced IPV have reported that healthcare professionals did not demonstrate compassion or concern for their situation (Yam, 2000). A lack of empathy and attentiveness are real barriers for identifying DVA and affect the victim’s ability and willingness to disclose their experiences.

The victim may already be experiencing feelings of shame, embarrassment, helplessness and hopelessness. Therefore, it is vital that they are not subjected to prejudiced, patronising or pressurising behaviour.

The first step in starting a conversation about DVA is to make sure you have an open mind and a non-judgemental attitude.

Conversation starters

If you think someone in your care may be experiencing DVA, you should not be afraid to ask them about it. The way you approach the subject will depend on how well you know them and what signs and symptoms you have observed.

Some example conversation starters include:

  • How are things at home?
  • Is there anything else happening that may be affecting your health?
  • You seem anxious. Is everything all right at home?
  • When I see injuries like this, I wonder if someone could have hurt you?
  • Is there anything else that we haven’t talked about that might be contributing to this condition?

Even if you suspect DVA is happening, the victim may still deny it. It is important to remember that opening up is not easy and it can take some time for the victim to gather the courage to disclose their experiences. You may have to try several times before they will confide in you.

Active listening

Active listening is the process of listening attentively while someone else speaks, paraphrasing and reflecting back what they say, whilst withholding your own judgment and advice.
When you practice active listening, you make the other person feel heard and valued. It also helps you to understand their situation better as well as earn their trust.
Here are some tips for practising active listening:

Give your full attention

Give the person your undivided attention. Put aside any distractions (like your phone or computer) and make eye contact with them.
You can use your own body language and gestures to show they have your attention, for example by nodding occasionally and using small verbal comments like ‘hmmm’ and ‘uh-huh’.
In addition to listening to what is said, watch their non-verbal behaviour to pick up on hidden meaning. Facial expressions, body language and tone of voice can sometimes tell you more than words alone.

Respond by reflecting and paraphrasing their words

From time to time, repeat what the person has said in your own words. This allows the speaker to ‘hear’ their own thoughts and to focus on what they say and feel.
It shows the person that you are really listening to what they are saying and encourages them to keep talking. It also helps to make sure you have fully understood the situation.
Phrases such as “it sounds like”, “it seems like” and “so what you are telling me is…” can be useful.

Don’t interrupt with your own judgement or advice

Resist the temptation to jump in with answers or advice. Interrupting may close down the conversation. If you’re already thinking about solutions or preparing your reply while they speak, you won’t be fully listening to what they are saying.

Summarise the conversation

Repeat a summary of what has been said back to the patient, pulling together the main points that they have made and organise them so that they can be reviewed, confirmed or corrected. “You have mentioned a lot of different instances where it sounds like you felt disempowered and unable to do what you wanted to do. When you mentioned… and … I was struck by how…

What do you think?

Can you think of other ways of starting a conversation about DVA?
© The University of Sheffield
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