Reducing situational violence in low-income couples by fostering healthy relationships

This work evaluated a psycho-educational intervention designed to reduce intimate partner violence (IPV) in low-income situationally violent couples. The primary objective was to evaluate the mechanism through which violence was reduced. It was hypothesized that IPV would be reduced via use of therapeutic skills taught during the intervention (i.e., friendship, sex/romance/passion, shared meaning, and conflict management skills). One-hundred-fifteen couples were randomly assigned to a treatment or no-treatment control group. Couples self-reported attitudes reflecting healthy relationship skills and IPV at multiple time points (baseline, post-intervention, and long-term post-intervention). Results support the notion that violence was reduced via an increase in intervention-based skills. Findings suggest that IPV can be safely reduced in low-income situationally violent couples via conjoint treatment focused on building healthy relationship skills.     

BATTERING AND COUPLES THERAPY: UNIVERSAL SCREENING AND SELECTION OF TREATMENT MODALITY

As family therapists begin to experiment with couples treatment models for batterers and their partners, a basic question is: Which couples can be safely treated with conjoint therapy? Following a definition of battering and a review of rationales for considering couples therapy in cases of domestic violence, a framework for assessment of domestic violence is outlined, including sample questions, criteria for excluding couples from conjoint therapy, how to conduct a lethality assessment, and how to conceptualize postassessment treatment recommendations. This article also introduces family and couples therapists to domestic violence literature that is often not well integrated in family therapy theory and practice.     

“They're not my favourite people”: What mothers who have experienced intimate partner violence say about involvement in the child protection system

Although the primary aim of child protection services (CPS) is to ensure the well-being and safety of children, policy decision-makers and service providers are increasingly concerned about the potential harm children encounter when they witness the abuse of their caregivers. Researchers who have conducted reviews of child protection files in both Canada and the United States report that few cases in which intimate partner violence (IPV) is substantiated are referred for additional services. In this article, we question whether this response is appropriate. Through examining the results of a qualitative study with sixty-four women who experienced IPV and were thus involved in the child protection system, we have been able to analyze the impact of CPS practices on those women who received services and those who did not. Our findings suggest that CPS can be an important resource for women who experience IPV, but changes to current practices are necessary to ensure that services offered are beneficial.     

Universal screening for intimate partner violence: a systematic review

Intimate partner violence (IPV) is known to be prevalent among therapy-seeking populations. Yet, despite a growing understanding of the dynamics of IPV and of the acceptability of screening, universal screening practices have not been systematically adopted in family therapy settings. A rapidly growing body of research data-almost entirely conducted in medical settings-has investigated attitudes and practices regarding universal screening for IPV. This article is a systematic review of the IPV universal screening research literature. The review summarizes literature related to IPV screening rates and practices, factors associated with provider screening practice, the role of training and institutional support on screening practice, impact of screening on disclosure rates, client beliefs and preferences for screening, and key safety considerations and screening competencies. Implications for family therapy and recommendations for further inquiry and screening model development are provided.     

Intervening with Couples Experiencing Domestic Violence: Development of a Systemic Framework

Current gendered interventions for couples experiencing intimate partner violence often do not address the complex systemic issues, nor allow for couple therapy. Experience of working in men's behaviour change group programs (or batterer programs) and with heterosexual couples, indicates this is not enough. Change options for men perpetrating domestic violence and support for partners are generally provided by individual services or gendered groups, located in separate agencies. This article initially poses some of the inadequacies of this gendered, ‘one size fits all’ ideology, which may compromise safety when couples stay together or there is shared parenting. It then explores further questions and possibilities raised by utilising a systemic lens in working with partners and families. It is possible to work systemically with a couple without compromising safety and accountability, where there is flexibility at intake, a both/and approach, ongoing assessment of risk, collaboration between professionals, and good transitions between individual and conjoint work. This article describes a systemic practice framework for working with partners, utilising individual, group, and conjoint sessions in a recursive four phase approach.     

From Scared to Repaired: Using an Attachment‐Based Perspective to Understand Situational Couple Violence

Situational couple violence (SCV) is a common problem in couples presenting for therapy. SCV, as seen through the lens of attachment, can be viewed as a result of an insecure attachment system within the couple. Although several authors have discussed individual attachment styles as predictors of both the receipt and perpetration of violence, in this article we seek to portray the attachment system as a relational and changing construct. As such, we argue for conjoint treatment for SCV as a way to restructure a more secure attachment system within the couple. Cautions for the appropriateness of couples counseling with ongoing violence are included. Finally, we discuss the use of an attachment‐based safety plan and time‐out strategy to use with couples experiencing SCV.     

Client narratives about experiences with a multicouple treatment program for intimate partner violence

A handful of clinical trials have concluded that conjoint couples treatment for intimate partner violence is safe and at least as effective as conventional batterer intervention programs, yet very few researchers have explored couples' perspectives on conjoint treatment. Using qualitative narrative analysis methodology, the researchers conducted 48 client participant interviews and five staff interviews to better understand couples' experiences of a conjoint treatment program for intimate partner violence. Themes that recurred throughout participants' narratives included (a) perceptions of safety, (b) benefits received, (c) attitudinal change, (d) behavioral change, and (e) important learning. Research directions and training implications are discussed.     

Systemic perspectives on intimate partner violence treatment

This article reviews changes in the research literature on intimate partner violence (IPV) since our earlier review (Stith, Rosen, & McCollum, 2003). A rationale for systemic treatment of IPV has emerged from research that has continued to document the limited effectiveness of single-gender treatment approaches for offenders and that has identified subtypes of abusive relationships, including situational couple violence, which often includes the reciprocal use of violence. Consistent findings from the available outcome research have demonstrated that for carefully screened couples who choose to stay together, systemic interventions decrease incidences of IPV and decrease the risk factors for IPV with no increase in risk. Implications for research and treatment are offered.     

Changes in Economic Hardship and Intimate Partner Violence: A Family Stress Framework

While recent studies underscore how financial stress and lack of tangible assets significantly increase the odds of intimate partner violence (IPV) among couples, little is known about these effects over time. Theoretically informed by family stress theory, this study examines the influence of changing subjective reports of economic hardship over time on the risk for IPV. Specifically, we test two hypotheses: (1) change in economic hardship significantly predicts IPV; and, specifically, (2) increased economic hardship or unstable economic conditions increases the risk of IPV. Using longitudinal data from the Fragile Families and Child Well-being Study, we assess the incidence of IPV for 941 women in committed relationships. Results from our logistic regression analyses suggest that after controlling for numerous demographic factors, women who never experienced economic hardship had lower odds of experiencing IPV than those who did. Further, women who experienced high levels of economic hardship over time had the highest odds of experiencing IPV. However, the effects of changing economic hardship on IPV were attenuated once maternal depression and parenting stress were controlled. Results are discussed in terms of practice and policy implications.     

Unidirectional and bidirectional intimate partner violence among White, Black, and Hispanic couples in the United States

This article describes the rates and risk factors of unidirectional and bidirectional intimate partner violence (IPV) among White, Black and Hispanic couples in the US. Subjects constitute a multistage area probability sample representative of married and cohabiting couples from the 48 contiguous United States. Results indicate that most couples reporting violence engage in bidirectional IPV. Blacks are more likely than Whites to report bidirectional IPV. In addition, severe unidirectional and bidirectional IPV are more common among Blacks and Hispanics. The results also indicate that predictors of IPV vary depending on whether it is unidirectional or bidirectional. Unidirectional female-to-male IPV and bidirectional IPV are more associated with the characteristics of the female. In contrast, the occurrence of unidirectional male-to-female IPV is associated with a single risk factor, male childhood physical abuse. These findings highlight the importance of distinguishing different types of IPV and have important epidemiological and prevention implications.     

Intimate justice. III: Healing the anguish of abuse and embracing the anguish of accountability

This article presents an exploratory approach to couples therapy for abuse based on intimate justice theory. The article explains "the accountability axiom," which brings the relationship between the anguish of abuse and the anguish of accountability into focus. Understanding the accountability axiom can help therapists simultaneously engage both the victim of abuse and the abuser by creating two therapeutic environments in conjoint therapy--one environment that affirms the victim and one that challenges the abuser. The ideas are based on a qualitative study conducted by the authors, and the approach is illustrated with a clinical case involving psychological abuse.     

International Adaptation of a Treatment Program for Situational Couple Violence

Intimate Partner Violence (IPV) is a serious international problem. Stith, S. M., McCollum, E. E., and Rosen, K. H. received funding from the US National Institute of Mental Health to develop and test a program for couples experiencing IPV: Domestic Violence Focused Couples Treatment (DVFCT). This article provides an overview of DVFCT, and presents three case studies illustrating how DVFCT has been adapted for use in Colombia, Iran, and Finland. This article emphasizes the need for adapting treatment models to be culturally informed, provides practice-based evidence for DVFCT as a treatment model, and highlights the importance of careful screening and assessment when working with couples who have experienced violence, no matter the country or location where treatment is being conducted.     

Affective disorders

Depression is a heterogeneous disorder with lifetime prevalence of "major depressive disorder" estimated to be 16.2%. Although the disorder is common and impairs functioning, it often goes untreated, with less than adequate response even when treated. We review research indicating the likely value of utilizing currently available, well-validated, couple- and family-based treatments with depressed individuals, and we provide empirically based treatment decision rules to guide effective application of marital and family interventions for depression in clinical practice. We suggest that traditional forms of couple-based intervention may be most appropriate for discordant, depressed couples, whereas nondiscordant, or mildly distressed, depressed couples may respond well to forms of intervention that have become available more recently and which focus on strengthening the dyad as a source of support. We also discuss parent training as an intervention for depression and describe briefly the directions for future research to enhance couple-based treatment for depression.     

Domestic Violence Assessment Procedures Among Couple Therapists

Guidelines for addressing domestic violence (DV) in couple therapy have been published, but reports of whether therapists routinely follow these suggestions are few. A national survey of 620 couple therapists randomly selected from American Association for Marriage and Family Therapy members was conducted in 2000 to assess therapists' strategies for assessing DV and selecting a treatment modality when violence is discovered. Less than 4% of respondents indicated consistently following key published guidelines for DV screening (universal screening using separate interviews and questionnaires). A minority indicated that they consider the victim's safety as a factor in treatment modality selection. DV may be under-identified by couple therapists and therapists may be using conjoint therapy with couples for whom such therapy is contraindicated because of relationship violence.     

The Mindful Couple

Couples who request conjoint treatment often demonstrate relationship problems that are exacerbated by emotional reactivity. Neurobiology research has clarified the process of emotional dysregulation, and the benefit of mindful interventions in managing and preventing hyperarousal. This paper examines the mechanics of emotional dysregulation and presents a case example that demonstrates how breathing and staying in the moment were used to help de-escalate an agitated couple. Mindful interventions can be used to help couples tolerate, understand, and manage emotional states that can otherwise become destructive. These techniques are particularly useful with volatile couples, and can be used in conjunction with other therapeutic interventions.     

Substance abuse

Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment for drug abuse concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using family-based approaches, particularly with adolescents. Family-based treatments are currently recognized as among the most effective approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has also advanced in important ways with the recent systematic application and testing of engagement techniques and behavioral couples therapy approaches. The current review characterizes and discusses the developmental status of this subspecialty and outlines areas in which continued research attention is needed.     

Narratives of aging in intimate partner violence: The double lens of violence and old age

PurposeWith the increase in life expectancy, couples living in intimate partner violence are aging together. The aim of this article is to explore the constructions of aging in intimate partner violence as narratives of couplehood or narratives of old age.Design and methodsThirty individual in-depth interviews with 15 older Israeli couples were tape-recorded, transcribed verbatim and analyzed using a narrative approach.ResultsThree main domains emerged from the data: health issue narratives, loneliness narratives and relationships with adult offspring narratives. Each of the narratives that emerged from the data analysis consists of a narrative of old age constructing IPV and a narrative of IPV constructing old age.ImplicationsConflictual couplehood dynamics, such as intimate partner violence in old age, is not one-dimensional, but is diverse and complex and this should be taken into consideration.     

Integration of Daniel Stern's developmental theory into a model of couples therapy

Therapists commonly use a combination of techniques derived from psychodynamic, cognitive and systemic approaches in their attempts to treat the resistant patterns brought into therapy by couples. In this paper we utilize Dan Stern's concept of RIGS (Representations of Interactions that have been Generalized) to generate an integrative model of conjoint therapy. The model presented here presents a framework within which these modalities can be effectively integrated.     

Exploring Partner Intimacy Among Couples Raising Children on the Autism Spectrum: A Grounded Theory Investigation

In this study, we explored how couples raising children with autism spectrum disorder negotiate intimacy, including what contextual and temporal factors influence these processes. We conducted conjoint interviews with 12 couples, employing grounded theory methodology to collect and analyze the data. Our results indicated that fostering intimacy in these couples' relationships involves partners working together to make key cognitive and relational shifts. Couples are aided or hindered in making these shifts by the degree to which they experience various contextual and environmental factors as resources or roadblocks. We also found that intimacy is not a fixed point at which couples one day arrive, but is an iterative process taking place over time and requiring work to develop and maintain.     

Child protection fathers' experiences of childhood,intimate partner violence and parenting

Research on mothers in child protection families has revealed that they often have a history of childhood abuse. Research has also shown that a considerable proportion of child maltreatment co-occurs with intimate partner violence (IPV) towards the mother. However, there is a dearth of research on the childhood histories and IPV victimization experiences of fathers in child protection families. To address these gaps in the literature this exploratory mixed method study of 35 men associated with a parenting program in Australia investigated fathers' childhood experiences, exposure to IPV and concern for their children's safety. Although this study was conducted with a specific group of fathers screened for serious personal problems, the findings suggest that, similar to mothers in child protection families, there are some fathers within typical child protection populations who have histories of childhood abuse and IPV victimization. In addition, many of the fathers in this study tried to protect their children from maltreatment related to the other parent. The main implication of the findings is that child protection fathers who have histories of abuse and IPV victimization should be afforded the same support and assistance as mothers in similar situations.