Listening to the Voices of Important Others: How Adolescents Make Sense of Troubled Dating Relationships

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Listening to the Voices of Important Others: How Adolescents Make Sense of Troubled Dating Relationships Donna S. Martsolf, Claire B. Draucker, Lucy C. Bednarz, and Joshua A. Lea Nearly one third of adolescents experience dating relationship maltreatment. Grounded theory methods were used to explicate a typology of ways by which adolescents incorporate views of others in making sense of their troubled dating relationships. Interviews with 90 young adults (ages 18-21 years) who had troubled adolescent dating relationships were analyzed using constant comparative techniques. A typology of ways in which adolescents listen to the voices of important others emerged. The six ways were preventing challenging voices of important others, deflecting irksome voices of important others, succumbing to demanding voices of important others, soliciting confirming voices of important others, considering cautionary voices of important others, and heeding knowing voices of important others. Professionals can use this model when deciding how to offer input about troubled adolescent dating relationships. © 2011 Elsevier Inc. All rights reserved.

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ESPITE EFFORTS BY the public health community to prevent it, adolescent dating violence (ADV) is a serious health problem. ADV is defined as “physical, sexual, or psychological/ emotional violence within a dating relationship” (Centers for Disease Control & Prevention [CDC], 2008), and the incidence and prevalence are on the rise (Eaton et al., 2006, 2008). According to CDC data, annual rates of ADV in the United States range from 10% of students experiencing physical dating violence to 25% when verbal, emotional, and sexual dating violence are included (CDC). Findings from one study of seven ethnically diverse American high schools suggested that nearly one third of all students experienced some form of physical aggression perpetrated by a current or former romantic partner (O'Leary, Slep, Avery-Leaf, & Cascardi, 2008). When considering the impact of dating violence on the adolescent community, more than 40% of early adolescents (those 11–14) know at least one peer who has experienced verbal abuse

by someone they were dating (Liz Claiborne, Inc., 2008). Dating violence occurs within the context of adolescent psychosocial development. Adolescence has long been associated with the psychosocial tasks of developing autonomy and independence from parents (Novak & Pelaez, 2004), increasing intimacy through romantic relationships (Simon,

The initial version of the Listening to the Voices model was presented in the Senior Honors Thesis submitted to the Kent State University Honors College by Lucy C. Bednarz. Donna S. Martsolf, principal investigator, and Claire B. Draucker, co-investigator. From the College of Nursing, Kent State University, Kent, OH. Corresponding Author: Donna S. Martsolf, PhD, CNS, RN, 347 Henderson Hall, College of Nursing, Kent State University, Kent, OH 44242. E–mail address: [email protected] © 2011 Elsevier Inc. All rights reserved. 0883-9417/1801-0005$34.00/0 doi:10.1016/j.apnu.2011.01.001

Archives of Psychiatric Nursing, Vol. 25, No. 6 (December), 2011: pp 430–444

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Aikins, & Prinstein, 2008), and engaging in risktaking behaviors (Gardner & Steinberg, 2005). As adolescents differentiate from parents and begin to explore dating relationships, these relationships take on tremendous significance for adolescents (Simon et al., 2008). Risk-taking behaviors (e.g., unprotected sex, interpersonal violence) are often experienced within these highly important relationships (Gover, 2004). BACKGROUND AND SIGNIFICANCE

Numerous risk factors and negative outcomes have been shown to be associated with ADV. Among the risk factors are previous dating abuse (Chase, Treboux, & O'Leary, 2002), association with violent or victimized peers (Arragia & Foshee, 2004), personal involvement in violence, (Foshee, Benefield, Ennett, Bauman, & Suchindran, 2004), family problems (CDC, 2008), and risky lifestyle behaviors including risky sexual behavior and tobacco, drug, or alcohol use (Foshee, Benefield, Ennett, Bauman, & Suchindran, 2004; Gover, 2004). ADV has also been shown to have numerous negative outcomes, including poor school achievement, eating disorders, drug and alcohol use, depression, and suicide (CDC, 2008; Chiodo, Wolfe, Crooks, Hughes, & Jaffe, 2009). Of particular concern is the increased risk of adult intimate partner violence for those who experienced dating violence as adolescents (CDC, 2008). Studies have suggested that adolescents tend to elicit or receive input about their troubled dating relationships from at least three groups: peers, family (primarily parents), and community members (often school-based individuals). Research has shown that adolescent peers are the most frequently consulted for advice about a dating relationship that is troublesome because peers are perceived to be best able to understand (Weisz, Tolman, Callahan, Saunders, & Black, 2007) and to maintain confidentiality (Jackson, Cram, & Seymour, 2000). Although peers are the group most often consulted about troubled dating relationships, they often lack the maturity to assist their friends to successfully deal with these relationships. Weisz et al. determined that males are particularly prone to receive feedback that minimizes the ADV. Other researchers have found that adolescents believe that ADV can be justified as horseplay, love, self-defense, retaliation, or appropriate response to frustrating situations (Foshee, Bauman, Linder, Rice, &

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Wilcher, 2007; Gallopin & Leigh, 2009; Lavoie, Robitaille, & Herbert, 2000; Ocampo, Shelley, & Jaycox, 2007). Some researchers have determined that peers are often reluctant to encourage an adolescent to end a particularly troubled dating relationship because of disruption to the friendships in the peer group (Leadbeater, Banister, Ellis, & Yeung, 2008; Lavoie et al., 2000). Several studies have shown that adolescents who experience ADV tend to have friends who also experience ADV. For females, friends' ADV experience is predictive of their own; males may simply select friends who have had the same experience (Arragia & Foshee, 2004; Kinsfogel & Grych, 2004). Regardless, adolescent peers who are consulted about a teen's troubled dating relationship are likely to minimize the violence, believe that violence is justifiable, try to maintain the peer group integrity, or be experiencing a similar relationship. There is also evidence that teens rarely consult their parents or other family members for assistance with problematic dating relationships. Adolescents fear that their parents will overreact or not believe them (Black, Tolman, Callahan, Saunders, & Weisz, 2008; Ocampo et al., 2007). Talking with parents about troublesome dating relationships has been shown to differ by race and gender. African American adolescents have been shown to consult their parents more readily than teens of other racial backgrounds (Black & Weisz, 2003), and Latino males tend to talk to parents more about ADV than do females (Ocampo et al., 2007). Ocampo et al. (2007) attributed this willingness of Latino males to disclose ADV to parents to the fear that they would be ridiculed by friends if they shared that they had been maltreated by a female. Community members, especially school-based professionals, often provide input about ADV in prevention programs. These programs are typically universal interventions aimed at all students in a school and have been shown to have at least one positive outcome in knowledge, attitudes, and/or behavior related to ADV (Whitaker et al., 2006). Two of the most widely used and empirically tested prevention programs are Safe Dates (Foshee et al., 1996) and the Youth Relationships Project (Wolfe et al., 2003). Both of these programs assist adolescents to recognize behaviors that are considered to be unhealthy in dating relationships. In a recent study, Wolfe et al. (2009) demonstrated that over 2 years after receiving a 21-lesson curriculum

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about dating violence presented by teachers, intervention group members reported significantly less experiences of physical dating violence. Although adolescents have not elicited this input, these universal prevention programs provide needed knowledge that can be used by the adolescent to evaluate present or future dating relationships. The literature on input that adolescents elicit or receive about their troubled dating relationships suggests that most input comes from peers, with little from family or professionals in the community. Although school-based ADV prevention programs have shown some promise in changing adolescents' knowledge and attitudes about ADV, input that adolescents receive from peers tends to be mixed with some peers providing nurturing and confidential responses, whereas most responses tend to minimize, justify, perpetuate, or validate the ADV. Thus, there seems to be dissonance between what is presented in school-based programs and how adolescent peers actually respond in situations of ADV. This dissonance may be challenging for adolescents who are experiencing ADV. Little is known about the ways by which adolescents use varying opinions of others about their difficult dating relationships. The purpose of this study, therefore, was to develop a typology of ways by which adolescents incorporate the views of important others in making sense of their troubled dating relationships. METHOD

Qualitative research methods were used to determine the ways by which adolescents incorporate the views of important others in making sense of their troubled dating relationships. Specifically, grounded theory methods as developed by Glaser and Strauss (1967) were used. Grounded theory is a research method that has its origins in the philosophical position of symbolic interactionism (Blumer,1969). This method was selected because it allows the researcher to develop a theoretical explanation of ways used by participants to solve a psychosocial problem (Benoliel, 1996). In this study, the psychosocial problem was conceived as adolescents' need to determine how they will use others' opinions about their troubled dating relationships to make sense of them. This study was part of a larger funded study of ADV. The purpose of the larger study was to

develop a theoretical framework to describe, explain, and predict how ADV unfolds. Kent State University Institutional Review Board approval was obtained as was a Certificate of Confidentiality from the CDC. Ninety young adults with ages 18–21 years who had experienced dating violence when they were 13–18 years old were recruited in their communities through a process of community sampling. Twelve communities in northeastern Ohio were selected to provide diversity in household income, race, and levels of urbanicity (urban, suburban, rural). Research associates conducted assessments of each community to determine locations frequented by young adults (bars, gyms, beauty shops, college campuses, and malls) and to network with community leaders to gain community acceptance of the research project. Participants were recruited through fliers posted throughout each community, word of mouth, and public service announcements. Fliers and announcements indicated that the research team was interviewing young adults who had experienced troubled dating relationships as teens. Specific types of maltreatment were listed, including behaviors such as put-downs, criticism, shoving, punching, or sexual assault. The use of the term dating violence was purposely avoided because adolescents tend to limit the use of the word violence to describe only acts of physical aggression. The research team wanted to ensure that participants would be recruited who could provide narratives about other forms of violence such as verbal or emotional abuse. A toll-free number was provided on the fliers and announcements. Young adults who called the toll-free number heard a taped message describing the project. They were asked to leave their name and contact information. Three mental health clinicians holding master's degrees in mental health nursing or psychology served as research associates for the project. The research associates attended a 2-day training session focusing on ADV, adult intimate partner violence, grounded theory methods, and open-ended interviewing techniques. The research associates called potential participants and screened them according to study inclusion and exclusion criteria. Participants were included if they (a) were between the ages 18 and 21 years, (b) had experienced a troubled dating relationship as a teen between the ages of 13 and

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18 years, and (c) were able to understand and speak English. The research associates used a protocol developed by the research team (Draucker, Martsolf, & Poole, 2009) to screen out individuals for whom participation in the study would likely cause undue emotional harm or serious safety issues. No participants were excluded based on the screening protocol. The research associates scheduled individual, confidential interviews in secure settings located in the participant's local community. Participants signed informed consent before interviews were conducted. Interviews lasted approximately 1.5 to 2 hours and consisted of two parts. The first part was an open-ended interview in which the participant described the dating relationship and the violence and related significant life experiences. An interview guideline was used, and interviews were begun by the research associates stating, “You have indicated that you have experienced violence or mistreatment by someone you were going out with when you were a teen. I am interested in finding out what that experience or experiences was like for you and how they have affected your life. Tell me about the violence or mistreatment you have experienced.” For most participants, no further prompts were needed from the interviewer. For those who needed additional prompts, additional questions were asked, such as “Describe your relationship with the other person.” What was it like to live through the violence or mistreatment?” “How did you manage following the violence or mistreatment?” “How do you feel the violence or mistreatment affected your life?” The second part of the interview consisted of developing a timeline of specific violent events and then describing each event in very specific detail. If a participant experienced any distress during the interview, the research associates followed a protocol developed for the project by the researchers (Draucker et al., 2009). The protocol included providing the participant with appropriate community resources among which were the possibility of referrals to battered women's shelters or counseling services. The research team for the larger project included two community partners, the executive director of the Battered Women's Shelter and a psychologist on staff at the Center for Trauma at a local hospital. Participants who did not experience distress during the interview but who

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were currently in an abusive relationship were also provided with the referral information. Participants were compensated $35.00 for travel expenses and their time. Interviews were audiotaped and transcribed. Transcribed interviews were checked against the tapes for accuracy by the research associates. Monthly meetings were held with the research associates and the investigators to provide feedback on interviewing strategies to ensure that grounded theory methods were being followed. Data Analysis Transcripts were entered into NVivo 8 (QSR International, Pty, Ltd., 2008), a qualitative software program. A nine-member research team composed of faculty researchers, community partners, and doctoral and undergraduate students analyzed the data from the larger study using constant comparison methods (Charmaz, 2006). Data coding for the larger study began as soon as the first interview was conducted. After coding of the first 20 transcripts, the research team determined that the views of important others about the adolescents' troubled dating relationships was a salient category in the data. Three members of the research team (one faculty member and two undergraduate students; the first, third, and fourth authors) were assigned to explore this category in more depth. To analyze the data for the study on how adolescents incorporate the views of important others, data were compared by the three-member research team within each of the transcripts and across all 90 transcripts using three levels of coding. In Level 1 coding, the first 20 transcripts were read closely for any references to views of important others about the adolescents' troubled dating relationships. Every reference to the view of an important other about the participant's dating relationship was coded as a text unit. Text units were defined as portions of the transcribed interviews that presented a meaningful fact, idea, or story conveyed by the participant. Text units ranged in length from a sentence to several paragraphs in which a particular story was narrated. Because the aim of this study was to develop a theoretical understanding of the ways by which adolescents incorporate the views of important others about their troubled dating relationships, all references made by participants about views of important

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others were coded even if the participant did not actually receive direct feedback but merely predicted what the important other would say. Second-level coding was then conducted on the first 50 transcripts to determine relevant categories related to views of important others about adolescents' troubled dating relationships. At this level of coding, categories related to how adolescents “avoid,” “reject,” “acknowledge,” or “accept” the views of others such as peers, family members, or community professionals about the violence emerged. Memos (Charmaz, 2006) were created by the first or third authors after each coding session to record theoretical ideas and decision making and to create an audit trail. Third-level coding was conducted to explore the relationship among the various categories; categories were defined and renamed, and the category characteristics were explicated. All 90 transcripts were reread, and all text units were recoded to the categories to determine if the emerging typology was supported in the data. Using constant comparison techniques, text units within and across transcripts were compared to determine an overarching category, which adequately explained all text units and categories. Memos about the theoretical decisions were written by the first author. Rigor of this study was maintained through use of Guba's (1981) criteria of credibility, dependability, confirmability, and transferability. Credibility (the likelihood that findings are legitimate and realistic) was addressed through the use of numerous direct quotes of participants in reporting the findings. Dependability (consistency of the findings) was maintained through audiotaping of the interviews and checking of the accuracy of the transcript against the tape recording. Confirmability (objectivity of the findings) was established by the use of a research team, each member of which analyzed the transcripts individually and contributed to the developing typology. The emerging theory and relevant memos were presented to the second author who had not been involved in the coding related to how adolescents incorporate the views of important others to make sense of their troubled dating relationships. The second author determined that the theory was grounded in the data. Transferability (the extent to which findings may be applied to other samples) was handled by a description of the sample which follows.

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RESULTS

Sample The sample consisted of 90 young adults ages 18–21 years who had experienced dating violence as adolescents between ages 13 and 18 years. Of the 90 participants, 51 were female and 39 were male. Racial composition of the sample was 52 Caucasian, 29 African American, 5 multiracial, and 4 other. Family of origin household income ranged from less than $10,000 (n = 10), $10,000–39,999 (n = 29), $40,000–59,999 (n = 12), $60,000– 99,999 (n = 12), more than $100,000 (n = 14), and no report (n = 13). As expected, occupation of participants was primarily student (n = 64). Of the students, 48 were in college, 14 were in alternative high schools, and 2 were in technical schools. Others were homemakers (n = 4), retail workers (n = 3), or unemployed (n = 4) or did not report. Most participants indicated that they had no children (n = 65). Some had one child (n = 17), two children (n = 4), or three children (n = 3), and one participant had six children. Listening to the Voices of Important Others Analysis of the data about how adolescents incorporate the views of important others in making sense of their troubled dating relationships revealed a central way by which these opinions were handled. The research team named this way listening to the voices of important others. This name was selected to reflect data which indicated that almost all participants had a number of people in their lives who were influential and who either provided opinions about the troubled dating relationship or who would have done so if they had been permitted to do so by the adolescent. A handful of participants had no evidence of others having an opinion about their troubled dating relationship. In these few cases, the participant had been socially isolated as a teen both from family and from those outside the family. The word voices was selected to connote the idea that influential people in the participants' lives had something to say about the troublesome dating relationship; in many instances, the message conveyed by the “voice of important others” was never spoken but was assumed by the participant. “Listening” was selected to indicate that the adolescents recognized that important others were

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speaking or would have spoken if the adolescent had allowed them to do so. Data provided by the 90 participants revealed that these individuals used six ways to incorporate the views of influential others to make sense of their troubled dating relationships (see Table 1). The research team named the six ways: preventing the challenging voices of important others, deflecting the irksome voices of important others, considering the cautionary voices of important others, soliciting confirming voices of important others, succumbing to the demanding voices of important others, and heeding the knowing voices of important others. Each of these ways will be described in more depth. Preventing the Challenging Voices of Important Others Most of the participants indicated that they had prevented challenging voices of important others at least once during the period when the dating relationship first became troublesome. A challenging voice was an important other who opposed what the adolescent thought about the dating relationship by suggesting that the relationship was problematic or “not good for” the adolescent. Some participants prevented challenging voices of important others throughout the entire relationship, and a few continued to prevent these voices and acknowledged that the interviewer was the first person with whom they had discussed the troublesome nature of the dating relationship. The research team defined preventing the challenging voices of important

others as any effort made by adolescents to prohibit influential others from knowing that their dating relationships were troublesome and from offering negative opinions about them. The participants provided data about the context in which they prevented the challenging voices of important others. For these adolescents, being involved in a romantic relationship was critical to their status in their social group. The quality of the relationship was not as significant as the fact that they were in a relationship. Amy (pseudonyms are used for all participants and verbatim quotes are preserved), a 20-year-old woman, explained the importance of being involved romantically with someone of high status when she was in high school: I was a freshman in high school there was a senior…not a senior, a sophomore, a guy older than I was. And um, he was, like, the jock. You know, the athlete, 3 years, three letterman athlete. Nicest guy ever, like, nicest guy. Like, everyone would dream of him, like, “Oh I love this guy!” You know, “I wanna go to prom with him.” And all this kinda stuff. And I liked him, although so did the rest of my class.

The participants provided several reasons why they prevented challenging voices of important others. In some cases, the adolescent was concerned about the ability of the influential other to hear information about the dating relationship without worrying or becoming unduly upset. This concern was most frequently related to parental reactions. Raquel, a 19-year-old woman, said that when she was 18 years old and was dating a man in his 20s:

Table 1. Listening to the Voices of Important Others Theoretical Framework Way of listening

Core category Ways of listening

Label

Listening to the voices of important others Preventing the challenging voices of important others Deflecting the irksome voices of important others Considering the cautionary voices of important others Soliciting the confirming voices of important others Succumbing to the demanding voices of important others Heeding the knowing voices of important others

Definition

The response by adolescents to the opinions about their troubled dating relationships held by influential people in their lives Efforts made by adolescents to prohibit influential others from knowing that their dating relationship was troublesome and from offering negative opinions about it Efforts made by adolescents to discount, ignore, or resist opinions of others about their dating relationship when those opinions were interpreted as bothersome or annoying Efforts made by adolescents to compare and consider the worth of differing opinions about the extent to which the dating relationship is troublesome Efforts made by adolescents to inform others about the troubled dating relationship and to seek validation about the nature of the relationship Efforts made by adolescents to end a troubled dating relationship because they were forced to do so by others Efforts made by adolescents to (a) acknowledge that the others have valid knowledge about the troubled nature of their dating relationships and (b) make significant change in their lives—usually results in ending the troubled dating relationship

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I just couldn't tell my mom…Because she probably would've taken matters into her own hand and then she would have told my dad and my dad…he's not so nice. And I'm the baby. So, I really didn't want to go there with everybody. I mean, I just rather keep it to myself when it comes to my family..

Sometimes, challenging voices of important others were prevented so that the adolescent would not have to hear an influential other say “I told you so.” Twenty-one-year-old Miley had begun dating someone after high school and stated: I just don't share with them (my family) things like that (the troublesome nature of the relationship). I always felt like I had to keep it to myself cuz it would be like “Oh, haha, I told you so.” And I would never have that support or respect or anything.

However, the primary reason for preventing the challenging voices of important others was because the adolescents were concerned that their parents, friends, siblings, or coaches would challenge them to leave a harmful relationship when they were unwilling to do so. A 19-year-old woman named Dee Dee put it this way when talking about a relationship she had at age 16: I kept it (the troublesome nature of the relationship) to myself because I already knew about how my mom felt about it, but I didn't really want to hear what she was saying because I didn't want to be by myself.…And I never talked to my friends about it…..

Summary Most of the participants prevented challenging voices of important others. They made a number of assumptions about what influential people in their lives would say or do, and based on these assumptions, chose not to disclose what was going on in their dating relationships. Although some adolescents were fearful that others would overreact or disrespect them, the primary reason for withholding information about the troublesome nature of their dating relationships was to prevent influential individuals from insisting on them ending the relationship when they were unwilling to do so. Deflecting the Irksome Voices of Important Others Most of the participants indicated that they had resisted the opinions of influential others who were attempting to tell them that the dating relationship

was not good for them. The research team named this way of listening deflecting the irksome voices of important others. The irksome voices of important others were those that were interpreted to be bothersome or annoying because they persisted in suggesting that the dating relationship was problematic. This way of listening was defined as efforts made by adolescents to discount, ignore, or resist the opinions of others about their dating relationships when those opinions were interpreted as bothersome or annoying. Participants indicated that the context for this way of listening to the voices of important others was primarily related to their need as adolescents to differentiate from their parents and develop and assert their own ideas about managing their lives. Alec, a 20-year-old man, talked about a relationship he had in his freshman year of high school: There was nothin' my mom could do. My mom didn't like her that much, to be honest. But, you know, I told her, I'm like, you know, “It's my business. I'd really like it if you just stayed out of it.” You know, and, “I appreciate your opinions, but you can't do anything about it.”

Similarly, Raquel said: It's just like young people. I mean we tend to be stubborn, and not want to listen and don't take things seriously but after it actually happens it makes you wish that you would've taken that advice.

For some participants, this way of listening involved ignoring what was being said. Dee Dee stated: She (her mom) would tell me what she didn't like about him. She would tell me basically what I already knew. Would break it down for me and tell me how he was treating me and stuff like that. She just told me, “It's not going nowhere. He really don't want you.” She really just broke it down to me, but at the time I just [didn't] care and I didn't want to listen to it.

For other participants, deflecting the irksome voices of important others involved taking action to resist or defend against the opinions of others. A 20year-old woman named Kaleigh illustrated this way of deflecting the irksome voices of others when she dealt with feedback from her friends on the track team and from her sister when she was in early high school. Um, like pretty much they (her friends) told me that I should stop talking to him and I could do better pretty much. Like my sister was always against him. She always thought that I could do better than him. So pretty much telling me not to really talk to him.

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Interviewer: So how did you feel about them saying things like that? Kaleigh: Like I would get mad and offended. Like in my mind I would say, “He's not too bad even though that happened. Maybe he was just mad or whatever.” I was just kind of defending it and making it okay in my head and trying to convince them that it was okay. Like pretty much I would be ignoring the facts right in front of me.

Summary Deflecting the irksome voices of important others was a common practice, and most participants shared stories about times when they had done so. In these instances, they became irritated or annoyed when their friends or family members told them that the relationship was not good for them or that they needed to end it. Participants described expending energy to convince themselves and others that the relationship was not problematic and that the dating partner was misunderstood. Considering the Cautionary Voices of Important Others Many of the participants engaged in a way of listening to the voices of important others in which they weighed the opinions of influential others about their dating relationship against their own opinions of it. The team named this interactional process considering the cautionary voices of important others. The cautionary voice was one in which an important other warned that the likelihood was high that the relationship was or would be “not good” for the participant. We defined this process as the comparison and consideration of the worth of differing opinions about the extent to which the dating relationship is troublesome. Participants considered the cautionary voices of important others in the context of adolescent inexperience with dating relationships. Most of those who considered cautionary voices of important others indicated that they really had no experience against which to gauge the maltreatment. They frequently indicated that they were unsure about whether this behavior was common or “normal” in dating relationships. Candice, a 21year-old woman expressed it this way. I just kept talking to my mom a lot about it because I had never been in a relationship. He was my first boyfriend.

Usually, the adolescent and the influential others held the differing opinions. However, in some

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cases, the adolescent examined their own opinions, which vacillated between wanting to believe that the relationship was good for him or her and knowing that it was not because of feedback received from others. Jenna, a woman who was 21 years old, talked about a relationship that spanned her high school years: I didn't really think it was mistreatment until I talked with my friends about it and they were like, “Well why are you putting up with that?” “Why don't you just leave?” I was like “Well I just thought he REALLY cared about me.” And we (she and the boyfriend) talked about like our future and stuff and like I was it for him….So I thought maybe he was just really dedicated and he loved me that much that he wanted to be with me all the time. So I didn't really think it was anything bad until later…now that I think about it like it was probably pretty bad.

This quote illustrates the examination of differing opinions in an attempt to determine if the relationship was troublesome. Jenna indicates that even during the interview process, she is continuing to consider what the cautionary voices of important others have to say. For a number of participants, considering the cautionary voices of important others involved acknowledging that the influential others' opinions were different from their own. When asked by the interviewer to rate the severity of an incident in which her boyfriend had grabbed her arm and pulled her in response to her skating with another boy when she was 14, a 20-year-old woman named Ashlee said: Well, I looked at it as it wasn't that big of a deal, but my mom always told me “Be careful, because what would have happened if that incident would have occurred and you guys were still together? Later on down the line it could've been more serious.” Because I feel like my mom and dad thought it was something serious or extreme. My mom would probably say that it was serious. I look at it as moderate because I know people besides my parents who have literally gone crazy to some effect because of how their husbands treated them. And I mean, I'm still alive today and I feel like it hasn't affected me …like drastically affected me.

Bobby, a 21-year-old man, very clearly articulated the way in which he considered the cautionary voices of important others when he discussed his reaction to feedback given to him during his senior year by a friend who had previously dated Bobby's girlfriend. After describing to the friend some of the girlfriend's behavior, the friend said, “Dude. She's

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crazier than when I was with her.” This led the participant to consider that, “Maybe she is just a mean person, that's how she is. Maybe she's just a mentally, verbal abusive person.” The notion of considering rather than accepting or acknowledging the veracity of this opinion is evident in the participant's use of the word “maybe” to indicate that he is still considering whether his friend's caution about the girlfriend's behavior is correct. Summary Most of the participants described situations in which they considered the cautionary voices of important others. This way of listening was typified by a weighing of opinions of others against one's own view about the nature of the dating relationship and frequent vacillation between negative and positive assessments of it. Soliciting the Confirming Voices of Important Others Most participants eventually told an influential other about the troublesome nature of their dating relationship. In these situations, the participant was looking for affirmation that the relationship was not good for them. The team named this way of listening soliciting the confirming voices of important others. A confirming voice was one in which an important other validated that the dating relationship was problematic or “not good” for the participant. This way of listening was defined as actions taken by the adolescent to inform others about the troubled dating relationship and to seek validation about the nature of the relationship. Participants indicated that soliciting the confirming voices of important others often occurred in the context of an increasing suspicion that the relationship was not “worth it.” Although the desire to enjoy the status associated with being in a romantic relationship remained, participants had a growing awareness that this relationship was not getting them what they desired. A 19-year-old woman named Erika put it this way, “Two months ago I broke up with him 'cause I couldn't take it anymore and I was happy I was going to college to get away.” Frequently, the participant who solicited the confirming voices of important others did so after a particularly violent incident. A desire for validation of the fact that the relationship was troubled was implied in most of

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what the participants shared. However, a number of participants described situations in which they explicitly asked for verbal confirmation by the influential other that the relationship really was as bad as they had believed it to be. Lance, a man who was 19 years old, talked about his relationship, which began at age 16 and was recently ended: Like I'm the type of person that goes to people when I have issues 'cause I can't really handle them on my own. And pretty much like all of my friends have helped me through this at one point. Like every person I know has talked to me and one point and given me some sort of input.

Bobby talked about asking his parents to help him with his troublesome dating situation during his senior year of high school: I did talk to 'em (his parents) 'bout it a little bit. I'd tell 'em that she's getting mean and I don't know what to do. Like she's really bitchy with me. She yells at me in public, she yells at me…If I took her out to dinner, she'd yell at me about somethin' about food or something.

Similarly, 19-year-old Chris, a young man in a same-sex relationship, asked his friends to determine if his reaction in a particularly difficult encounter with his boyfriend at the end of his senior year was well founded: And I was like to my friends, I was like “Do you guys like think that (that the boyfriend initiated the violent event) or is it just me?” And they're like “No! You absolutely…It's not like you came up and hit him and said ‘Why are you doing that?’ You asked him not to do it and he kept doing it and he broke something for no reason.”

Several participants solicited a confirming voice from the interviewer. When the interviewer thanked Charmaine, an18-year-old woman, for coming to the interview and asked her if she had anything else she wanted to say about her dating relationship at age 16, Charmaine asked, “Do you think he was abusive or would have been abusive?” Data in this study revealed that although most participants eventually told an influential other about the troublesome nature of their dating relationships, the responses of many of the individuals from whom they solicited confirmation were not supportive. In fact, numerous influential others disconfirmed the participants' growing beliefs that their dating relationships were troubled. Participants were told, “if you really want it to work, you have to work at it”; “he/she is just going through a phase”; or “that's what love is like.” In a number of situations,

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the participant's family members or friends laughed about the situation when they were asked for advice, and in several cases, the influential other recommended that the participant stay in the relationship for economic reasons. Summary The opinions of significant people in their lives were solicited by most participants in an effort to determine whether their dating relationships were truly troubled. Although many of these participants received confirmation from friends and relatives that the relationship was unhealthy and should be ended, a number of the participants' ideas were disconfirmed by individuals who indicated that the relationship could be much worse. Succumbing to the Demanding Voices of Important Others A few participants ended their troublesome dating relationships at the insistence of influential others in their lives. The research team called this way succumbing to the demanding voices of important others. A demanding voice was one that not just warned the participant that the relationship was problematic but that insisted the participant take action. This way of listening to the voices of important others was defined as the adolescent ending the dating relationship because they were forced to do so by others. The action was one of succumbing—giving in reluctantly after attempting to resist. The context for this way of listening was typically within an involved family in which parents provided the demanding voice. Derrick, a 20-year-old man, described an incident before his senior prom in which his girlfriend scratched his neck until he bled. He went to the school office, and his mother was called. Derrick related ...my Mom said, “I don't want you taking her to the prom.”…and my Mom bought me a tux but she hid it from me. She said, “I'm not letting you take her to the prom.”

However, demanding voices also were provided by friends. For example, a 20-year-old woman named Olivia talked about how she ended the relationship she had begun with her abusive boyfriend when she was 15. Her friends told her that the break needed to be “Clean cut. Cold turkey.

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That's what my friends tell me. I'm not allowed to talk about him.” Summary Very few participants succumbed to demanding voices of important others. However, those who did acknowledged that they ended troubled relationships primarily or solely because significant people in their lives made it imperative that they do so. Heeding the Knowing Voices of Important Others Some participants listened to the opinions voiced by influential others about the troublesome relationship and took action to end the relationship. The research team named this way of listening heeding the knowing voices of important others. A knowing voice was one that, because of personal experience or maturity, was able to provide credible and accurate information that the dating relationship was problematic or unhealthy for the participant. This way of listening was defined as the interactions between the adolescent and an influential other in which the other clearly stated that the relationship was not good for the adolescent and gave reasons why. Not every knowing voice of an important other was heeded. Participants indicated that the context for heeding the knowing voices of important others was that the individual needed to be someone who was influential in their lives and who had credibility based on their personal experience or maturity. Raquel talked about the qualities of the knowing voice of an important other that should be heeded. My best friend…I would talk to her about it. And she like… she kind of helped me see that it was abuse….She broke it down to me because she was in a relationship like that where it wasn't really like that physical, but it still was [abuse]

An influential individual (her best friend) was able to help her see the relationship as abusive because of her own experience with this type of relationship. Similarly, Amy talked about her turning point during her senior year in which she heeded the knowing voices of important others. The event occurred when her boyfriend was disrespectful to her coach who was an older man who she viewed as a cherished grandfather figure. I could tell right then that he [the coach] disapproved and he was angry. But he wasn't going to take it a step further with

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a 20-year-old kid, you know. He is older and knows better than that. That actually was a big moment for us. I realized that my coach is very, I value his opinion.

Furthermore, participants who heeded the knowing voices of important others typically had been struggling with the relationship for a while and were, therefore, ready to hear the knowing voice. The adolescents who heeded these voices of important others acknowledged to themselves that the opinion of the others was valid because the individuals “know” the truth about the relationship and that they needed to make a significant change in their lives—primarily the change was demonstrated in ending the relationship. Starr, a 19-year-old woman, talked about a relationship she had at age 14 and 15: My mom told me that if you leave a person never go back because the problems that were there when you left, they're still gonna be there when you get back. And she would know….she got abused by her first husband.…I'm not saying that Steve (pseudonym for her boyfriend) would have taken it to that extent (trying to kill her). But once you hit a girl, you're bound to hit her again and again and again and again. I'm mean I couldn't deal with that.

Summary Participants who heeded the knowing voice of important others often referred to this way of listening as one in which they “faced the facts” sometimes after long periods of stubbornly resisting what others were saying. In most instances, those who had listened to and acted on the advice of someone whom they considered to be personally influential and knowledgeable about their situation, reflected on the dating relationship by sharing how much better things are since they ended it. DISCUSSION

A qualitative study using grounded theory methods was conducted to develop a typology to explain the ways by which adolescents incorporate the views of important others in making sense of their troubled dating relationships. Ninety young adults with ages 18–21 years who are living in 12 diverse communities were interviewed about their dating relationships between the ages of 13 and 18. Data about how the participants incorporated others' views were coded and analyzed using constant comparison techniques. A central category emerged and was labeled: listening to the voices of

important others. Six ways of listening to the voices of important others were related to the central category: preventing the challenging voices of important others, deflecting the irksome voices of important others, considering the cautionary voices of important others, soliciting confirming voices of important others, succumbing to the demanding voices of important others, and heeding the knowing voices of important others. These findings both support and extend existing knowledge about adolescent social relationships. For example, the notion of decision making by adolescents has been widely explored in the literature (Bednar & Fisher, 2003; Gordon, 1996; Halpern-Felsher, 2009; Kambam & Thompson, 2009; Rolison & Scherman, 2002). Researchers and adolescent development experts have suggested a number of theoretical models to explain how adolescents make decisions. Common ideas in the various models include the notions that adolescents tend to make decisions that are (a) both analytic/ reasoned and reactive/emotional, (b) similar to those of their peers or to their beliefs about what their peers are doing, (c) based on advice from peers, (d) based on beliefs about personal vulnerability, and (e) based on beliefs about the benefits of the decision (Bednar & Fisher, 2003; HalpernFelsher, 2009; Kambam & Thompson, 2009). Our findings both support and extend these theories. In this study, the primary decision faced by the participants was how to manage their troublesome dating relationships, including whether to ignore the problems, to try to fix them, or to end the relationship. The experience of listening to the voices of important others played an important role in those decisions. Our findings support existing decision-making theories in so far as the participants' decisions were both emotional and reasoned, and the most influential voices were their peers. However, our findings extend these theories by suggesting that the influence of the advice of others on decision making needs to be understood as an interaction between the perceived nature of the advice (e.g., irksome vs. knowing) and the openness of the teen (e.g., challenging vs. heeding) to considering the advice. The findings of this study support findings of prior studies that indicate that adolescents frequently do not tell others about the dating violence that they are experiencing. Researchers have suggested a number of explanations for these findings,

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including having no witness to the violence (Black et al., 2008), same-sex friends' disapproval of the dating partner and the relationship (Chung, 2007), embarrassment (Gallopin & Leigh, 2009), fear of retaliation (Johnson et al., 2005), or protecting the dating partner (Black et al., 2008). The finding in this study that some participants were reluctant to discuss their troubled dating relationship experiences with parents for fear that their parents might overreact supports similar findings by Black et al.

(2008) and Ocampo et al. (2007). In this study, some participants who solicited the confirming voices of important others received responses that suggested that the violence was really an expression of love. These findings support similar ones in Ocampo et al.'s (2007) study. Limitations of this study include the retrospective design that may have inherent limitations due to issues of recall. However, both the literature review and the findings in this study suggest that

Table 2. Guide to Using Listening to the Voices of Important Others Theoretical Framework in Practice Way of listening

Preventing the challenging voices of important others

Deflecting the irksome voices of important others

Considering the cautionary voices of important others

Soliciting the confirming voices of important others

Succumbing to the demanding voices of important others

Heeding the knowing voices of important others

Nurse interaction prompt

I'm interested in hearing about whether or not you've started dating. A fair number of teens who are beginning to date or who have dated for a while wonder whether the way that they are being treated by the person they are going out with is “normal.” Have you ever wondered about that? There are a lot of different ways in which teens take in the opinions of other people about their dating relationships. Here are six of the ways some teens have described how they handled such opinions. Do any of these fit with your experiences? Many teens are concerned that their friends or parents might try to tell them that the person that they are going out with is not good for them. Has anyone ever tried to tell you that? Many teens don't tell anyone about things like being “put down” or criticized or hurt in some way by the person they are dating. Have you ever kept details about your dating relationship a secret? What do you think your friends or parents would say if you told them about some of your dating experience? Sometimes when friends or family try to say that a dating partner is not treating a teen well, this “help” irritates or “bugs” the teen. Have you ever had an experience like this? When the advice or opinion given to you by a friend or family member irritates you, do you make excuses for your dating partner like saying “he or she is just showing me how much (s)he loves me? Many teens respond like that. Have any of your friends or family members ever tried to tell you that they don't think that your dating relationship is good for you? Some teens begin to wonder if their friends or family might be right. Have you ever had this experience? How have you handled it? Would you want to tell me a little bit about your dating relationship? Sometimes teens begin to wonder if how they are being treated by a dating partner is “normal.” Have you ever wondered about this? Have you had any classes at school or have you been given or searched for information about “normal” dating? What are your ideas about what healthy or “normal” dating looks like? Have you ever asked a friend or family member if they thought that your dating relationship was good for you or not? What did your friend or family member tell you? Was their opinion helpful for you to make sense of your dating relationship? Some teens stop seeing their dating partners when their friends or family members force them to end the relationship. Have your parents or your friends told you that you are definitely not allowed to see your dating partner anymore? How did you feel about them forcing you to end the relationship? Some teens decide to end a dating relationship because they think that it is not good for them or that it is not worth it anymore. Many of these teens end the relationships because a friend or a family member who had been in a bad relationship themselves helped them see that they needed to end their relationship. Have you ever had this experience?

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interviewing adolescents at the time they are experiencing troubled dating relationships might be problematic because they often do not share what is truly going on in the relationship. Thus, interviewing young adults who are reflecting back on the process of their troubled dating relationship as it unfolded and changed may allow for a more nuanced understanding of the spectrum of views of important others and how adolescents incorporate these views to make sense of dating violence. A second possible limitation is related to the fact that data were collected in one geographic region. However, care was taken to include participants from diverse communities within that geographic area. The sample included comparable numbers of men and women and Caucasian and African American participants from urban, suburban, and rural communities. Findings of this study suggest a number of implications for psychiatric/mental health nursing practice. Increasingly, mental health nurses are providing services across the lifespan. Prevalence rates for ADV indicate that approximately one third of adolescents in the community have experienced dating relationships in which there is verbal, emotional, sexual, or physical mistreatment. Therefore, the likelihood that teens in clinical populations are experiencing psychosocial stress in intimate relationships is high. Although the findings of this study indicate that many teens will prevent challenging voices of important others by withholding information about their dating relationships, additional study findings suggest that teens may also consider cautionary voices or heed knowing voices of important others. Mental health nurses can use the findings of this study as a guide to engage a teen client in a conversation about the possibility that the teen may be in a troubled dating relationship. The conversation could serve as a way to normalize the six ways of listening to voices and offer a springboard for discussion. Table 2 presents specific ways in which the nurse can engage in an interaction in which the six ways of listening can be explored with an adolescent. Further research is warranted to continue to develop this theoretical understanding of the ways used by adolescents to incorporate the views of significant others in making sense of troubled dating relationships. Although the research team was able to determine six ways of listening, we did not reveal a clear understanding of if or how

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adolescents move from preventing challenging voices of important others to considering cautionary voices of important others or heeding knowing voices of important others, for example. Further studies might contribute to our understanding of how adolescents make this transition and whether professional health care practitioners might be able to facilitate movement from preventing challenging voices of important others to heeding knowing voices of important others. ADV is a significant health concern that is prevalent despite concerted efforts toward its prevention. Understanding the ways by which adolescents incorporate the views of important others to make sense of the experience will provide needed knowledge to inform prevention and intervention efforts. ACKNOWLEDGMENT This study was funded by the CDC, Injury Prevention Division (5R01CE001183). Donna S. Martsolf, Principal Investigator and Claire B. Draucker, Co-Investigator.

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