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Health Care Providers > Addressing Suicide > Model Dialogue II

Model Dialogue II

The situation - Reena is a 35-year old woman, who has been brought by a neighbour as she was found lying on the ground. The history has been reported as accidental consumption of kerosene.

Technique 1 - Begin with / opening conversation with an open-ended question
Counsellor: (Self introduction) Salaam Reena. How are you feeling today?
Reena: I am ok, though my throat hurts a lot.
Counsellor: I see, have you informed this to the ward nurse? They may give you some painkiller for it.
Reena: No, no if I say anything they will keep me here for a longer time. I have to go home. Please ask them to discharge me today. My children are alone at home. I am here for two days. I don't know, how they are. My mother is so old, how will she manage taking care of them? I have to go.

Technique 2 -  Stressing need for complete medical treatment
Counsellor: I understand Reena. But you are kept in the hospital, so that you recover as soon as possible. See, once you go, you have to attend to your daily chores. Taking complete medical treatment may help you recover soon. They are discharging you today evening.
Reena: You are right in a way.

Technique 3 - Enabling the woman to overcome denial
Counsellor: Reena, in the indoor papers it has been reported that you have accidentally consumed kerosene. This may be true but in our experience we have also seen women who consume poison because of a very stressful situation.
Reena: No, no I was asleep. You see, and I drank kerosene instead of water.

Technique 4 - Be direct and share concern
Counsellor: I would like to tell you that if there was any such situation, or if you are facing domestic violence, you could share it with me. Whatever you share will remain confidential. I am concerned about you.
Reena: (Breaks down). No one has spoken so warmly to me. Madam I took kerosene on purpose. I know that I am wrong. I should not have done such a thing.

Technique 5 -  Communicate, don't be judgmental
Counsellor: I can understand how you must be feeling. Can you trust me and share your story in detail? We do not judge women on the basis of attempt to suicide. Instead we try to find out what was the situation that led them to taking such a step.
Reena: Madam, I have been taking my husband's beatings for the past 15 years but last evening I could not take any more. I asked him for some money, not for myself but for our younger son, so that I could buy some medicine.  But he refused outright.

Technique 6 - Reducing hierarchy in counselling situation
Counsellor: Just a minute Reena, why don't you call me by my name? I am not a boss, am  I?
Reena: How can I? (Smiles).
Counsellor: Ok, can you call me Behen or Didi?
Reena: Ok.
Counsellor: Oh! But how did this incident happen yesterday?
Reena: Abdul refused to give money. I am tired of making all ends meet. You know he has a good job in the BMC. But he doesn't give us a single rupee. I work as a maid and that's how I am able to put both my sons and my daughters in school. I keep taking advance from my employers and neighbours. But how long can I do that? He spends all his money on the other woman.
Counsellor: Did he marry again?
Reena: No, no but I fear that he will. Why should he remarry? When he has three children. We have suffered so much. I told him that if he remarries and brings that woman in this house, I will end my life. He said that I can go ahead and do it or he will kill me. (Breaks down). That's why I drank kerosene. He just ran away after that.

Technique  7 - Validate her feelings
Counsellor: I can understand how painful it must be. What do you think we can do?
Reena: I want him punished. He should suffer. I don't want him to remarry. What if he removes me and the children from his house?
Counsellor: Reena, you have faced so much violence in the past 15 years. I can see that you are feeling hurt and angry. It is completely justified to feel that he should be punished. But how do you think he should be punished? What help do you want from us?
Reena: I want to file a legal case. I want to teach him a lesson.
Counsellor: Ok, but can you tell me how you want to teach him a lesson? Do you have anything in mind?
Reena: No. I don't know how, but you must help me Didi. I want him to go to jail.
Counsellor: Reena, we are here to help you.

Technique 8 - Validate her feelings,  however share the effects of teaching lesson without preaching
Counsellor: It is valid that you want your husband to be punished. However, dragging him to the court may just increase your burden. In our experience, a legal battle is very long and doesn't always succeed. I don't mean to dishearten you, but at the same time, I don't want to give you false hopes. On the brighter side, there are other things that can be done.
Reena: (Seems disappointed). Is there nothing that can be done to him Didi? It is so unfair.
Counsellor:  I know Reena, but can I offer a suggestion?
Reena: Yes. Yes.

Technique  9 - Share tangible gains so that the woman  is not disheartened
Counsellor: Since he works in the BMC, we can talk to the higher officials. That way, we can get a part of his income for your children, what do you say?
Reena: Is that possible? What if he refuses?
Counsellor: We have to try our best. And we have dealt with such cases in the past.
Reena: If it happens, it will be very good. But I still feel that he should be punished. How can he get another woman in my house? I have suffered for 15 years. What if he throws me out?

Technique 10 - Assessing possible consequences in immediate future
Counsellor: Reena, you feel he may ask you to leave the house?
Reena: Didi, not only me, also my children.
Counsellor: Can you tell me in whose name is the house?
Reena: My husband's. But I had also given him so much money, what about all that? I won't leave the house.  Where will I go Didi?
Counsellor: Yes Reena. He cannot throw you out of the house even if it is in his name. We can take the help of the police. After all you are still married to him.
Reena: Yes, yes.  Tell me more about this.

Technique  11 - Giving information about formal redressal procedure
Counsellor: Ok, tell me Reena. Did the police record your statement in the hospital?
Reena: Yes, they had come and I told them the truth. I said that I consumed kerosene because of my husband's torture. They were asking me why are you giving such a statement?We will give him two slaps; after all it is a family matter. But I said that I want to say only this.
Counsellor: You are really courageous, Reena,  because most women out of fear don't give such a statement. Reena, this statement can act as a proof, in the future.

Technique  12 - Shift focus to woman's emotional world
Counsellor: Reena, we have spoken about different issues, but can you share your feelings regarding this marriage, your husband?
Reena: What is there to say Didi? (starts crying)
It's all over . Why did I tolerate so much violence? Because I thought that some day he would improve. But today, he has gone to another woman. He has ruined my life.
Counsellor: You don't deserve to face violence. No one deserves violence. But most of us tolerate it because of different reasons. So much is at stake in a marriage, isn't it?
Reena: That's so true Didi. Abdul was not such a bad person when we married.  But after the birth of my second son, he really became violent. I wonder since when he has been seeing this other woman. It is all because of her.
Counsellor: I know that you must be really angry with this other woman; what's her name?
Reena: Shehenaz, she is a bad woman, that's what everyone says. Someone was saying she is married . Maybe she is after Abdul's money. She is young, you know.

Technique 13 - Help the woman place the onus
Counsellor: Reena, I feel that Shehenaz is in an even worse situation. See everyone in the community is calling her a bad woman. To add to it, she doesn' even have the status of a married woman. Tomorrow Abdul may just leave her too.
Reena: Yes, you may be right, but I don't like her. She destroyed my home.
Counsellor: You don't have to like her. Currently your marriage is going through a rough phase, isn't it?
Reena: Yes Didi, I am scared that he may divorce me. I will end my life if any such thing happens. God save us !
 
Technique 14 - Communicate concern and ask her to seek help in distress.
Counsellor: Reena, I feel very concerned about you. I know that you are living in a very violent marriage. Do you think such a situation may occur again?
Reena: Definitely, he has run away now. He did not even come to the hospital. But once I go home, Abdul will hit me.
Counsellor: Reena, do you fear that he may try to harm you or even kill you or your children?
Reena: Yes, it is quite possible, but he may not harm the children.

Technique 15 - Draw a safety plan along with the woman.
Counsellor: What have you thought in terms of your own safety then? Have
such situations occurred in the past?
Reena: Not such a situation. I usually go to my neighbour. But when he is very violent.  I  just freeze. I take it.

Technique 16 - Communicate intensity of violence and encourage help seeking behaviours
Counsellor: Yes, but now the situation may be more violent, you know that at times we just freeze. But now you need to protect yourself from it. Can you still try to run out or if not then can you shout loudly for help?
Reena: Yes, I think so.
Counsellor: You can ask your elder son to get the neighbour. Is that a possibility?
Reena: Yes, he has done it in the past.
Counsellor: Reena, such difficult and violent situations may occur once we try to negotiate for getting some amount from your husband's salary. But we have to keep this hope, no matter how difficult it is. Always remember that your life is precious. We are concerned about you.
Reena: Yes Didi. I felt better when I read the Urdu pamphlet given to me by the ward nurse. I felt as though there is someone who is concerned about  me.
Counsellor: Yes Reena, now you know that you can visit us at Bhabha Hospital
anytime between 9.00 a.m and 4 p.m.
This incident has left an impact on your mind but remember that by threatening to commit suicide, you may harm yourself more. So even if such thoughts come to your mind, we can try to overcome those thoughts.
Reena:  Yes, yes I have realised it today that Abdul doesn't love me (breaks down). He did not even come to see whether I am dead or alive.
Counsellor: It is painful, but you have already survived a very difficult situation. This phase will also pass.
Reena: Yes Didi, I have to go now. I will call you on the number you have given. I will also get the necessary details about Abdul's job.  Bye.
 

 

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