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.     

Couples Therapy for Intimate Partner Violence: A Systematic Review and Meta‐Analysis

Intimate partner violence is a serious public health problem accompanied by substantial morbidity and mortality. Despite its documented impact on health, there is no widely recognized treatment of choice. Some studies indicate that couples suffering from situational violence may benefit from couples therapy, but professionals are cautious to risk the possibility of violent retaliation between partners. After a comprehensive literature search of 1,733 citations, this systematic review and meta‐analysis compiles the results of six studies to investigate the effectiveness of couples therapy as a treatment for violence. Preliminary data suggest that couples therapy is a viable treatment in select situations.     

Couples treatment for interpersonal violence: a review of outcome research literature and current clinical practices

Conjoint couples treatment for interpersonal partner violence (IPV) remains controversial despite a growing body of research and practice experience indicating that it can be effective and safe. In addition, developing typologies of couples who are violent suggest that a "one-size-fits-all" treatment approach to IPV is not appropriate and conjoint treatment may have a place in the treatment of at least some couples. In this article, we review the experimental studies and clinical practices of conjoint treatment. Based on this review, we suggest current best practices for this approach to treatment. Best practices include couples treatment as part of a larger community response to IPV, careful screening of couples for inclusion in couples treatment, modification of typical conjoint approaches to promote safety and ongoing assessment of safety with contingency plans for increased risk.     

Domestic violence in veterans with posttraumatic stress disorder who seek couples therapy

Domestic violence rates among veterans with posttraumatic stress disorder (PTSD) are higher than those of the general population. Individuals who have been diagnosed with PTSD who seek couples therapy with their partners constitute an understudied population. Self-report measures of domestic violence, relationship satisfaction, and intimacy were administered at intake to 179 couples seeking relationship therapy at a Veterans Affairs clinic. Couples in which the veteran was diagnosed with combat-related PTSD were compared with two other groups based on the veteran's primary diagnosis (depression, adjustment disorder/V-code). Both the PTSD- and depression-diagnosed veterans perpetrated more violence than did those with adjustment/V-code diagnoses. Domestic violence rates among depressed and PTSD-diagnosed veterans were much higher than those found in previous research. Implications for assessment and treatment are discussed.     

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.     

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.     

THE "SPONTANEOUS" CESSATION OF MARITAL VIOLENCE: THREE CASE EXAMPLES

Despite general trends for violence in marriage to escalate in frequency and intensity, there are some couples who, through their own efforts, stop being violent. Three such couples are described below, with particular attention given to spouses' reports on the cessation of their violence. Discussion focuses on the implications of these couples' experiences for the treatment of wife battering.     

A Grounded Theory Study of How Couples Desist from Intimate Partner Violence

Intimate partner violence is a common and damaging experience for many couples, and therapists struggle to address it adequately (Johnson, 2008). Despite its negative effects, many violent couples stay together, with some stopping their violent behaviors. Unfortunately, we know little about the systemic factors affecting violence desistance. This study used grounded theory methods to analyze the process of desistance in formerly violent couples. A model of desistance consisting of three categories was developed, which for most couples included a (a) Turning Point, (b) Decision to Change, and (c) Doing Things Differently. Therapists are encouraged to use the model to better understand the varied and systemic nature of violence and desistance, and to make more sophisticated decisions about referral and treatment.     

Longitudinal model predicting mutual partner violence among White, Black, and Hispanic couples in the United States general population

This analysis determines the longitudinal predictors of male-to-female (MFPV) or female-to-male (FMPV) alone and mutual partner violence (MPV) among White, Black, and Hispanic couples. A national sample of couples 18 years of age or older was interviewed in 1995 and again in 2000. Participants 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 MPV. After controlling for other factors, Blacks are 3 times more likely to report MPV at follow-up and Hispanics are 9 times more likely to report MFPV. The results indicate that ethnic minorities are at greater risk of MPV. In addition, the predictors of partner violence vary depending on the type of partner violence. These findings highlight the importance of distinguishing different types of partner violence and have important epidemiological and prevention implications.     

Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants

Using data from a nationally representative telephone survey that was conducted from November 1995 to May 1996, this study compares lifetime experiences with violent victimization among men and women with a history of same-sex cohabitation and their counterparts with a history of marriage and/or opposite-sex cohabitation only. The study found that respondents who had lived with a same-sex intimate partner were significantly more likely than respondents who had married or lived with an opposite-sex partner only to have been: (a) raped as minors and adults; (b) physically assaulted as children by adult caretakers; and (c) physically assaulted as adults by all types of perpetrators, including intimate partners. The study also confirms previous reports that intimate partner violence is more prevalent among gay male couples than heterosexual couples. However, it contradicts reports that intimate partner violence is more prevalent among lesbian couples than heterosexual couples. Overall study findings suggest that intimate partner violence is perpetrated primarily by men, whether against same-sex or opposite-sex partners.     

The Influence of Intimate Violence on Transitions out of Cohabitation

Does the experience of violence in a cohabiting union lead participants away from marriage and toward separation, or does violence have only minimal impact once other characteristics of unions and their participants are controlled? This issue is examined using a sample of 411 cohabiting couples followed in both waves of the National Survey of Families and Households. Marriage and separation are treated as competing risks. Results show that violence does have an effect, although dissimilar effects emerge for transitions to separation, as opposed to marriage. Net of other factors, intense male violence—male violence that is more severe than the female partner's—raises the hazard of separation. In contrast, female violence, but not male violence, lowers the rate of marriage. The findings appear robust to a variety of operationalizations of partner violence.     

Relationship Violence Among Couples Seeking Therapy: Common Couple Violence or Battering?

Relationship violence is highly prevalent among couples seeking therapy (Ehrensaft and Vivian, 1996; Jouriles and O'Leary, 1985), yet few couple therapists regularly assess for violence (Dimidjian, Berns, and Jacobson, 1999), and there is limited research on the type of violence most characteristic of couples in this population. The current study uses latent class analysis to examine types of violence in a sample of 273 therapy-seeking couples. The results support a three-class typology, with the groups labeled no violence, low-level violence, and moderate-to-severe violence. Comparisons between the classes support hypothesized differences between groups in degree of marital satisfaction and difficulties in communication, providing further validation of the typology among couples seeking treatment. Clinical and research implications are discussed.     

Distal and Proximal Factors in Domestic Violence: A Test of an Integrated Model

We employed 4,095 couples from both waves of the National Survey of Families and Households (NSFH) to test a model of couple violence drawn from several theoretical perspectives. The outcome distinguishes among nonviolent couples and those experiencing either physical aggression or intense male violence. According to the model, background characteristics of couples are related to relationship stressors, which affect the risk of violence via their tendency to promote verbal conflict. Considerable support for the model was found. Couples were at higher risk for one or both forms of violence if they were younger at union inception, had been together for less time, were both in their first union, had only one partner who was employed, had a nontraditional woman paired with a traditional man, had at least one partner who abused substances, had more children, had more frequent disagreements, exhibited a more hostile disagreement style, or lived in an economically disadvantaged neighborhood. Moreover, the effects of stressors such as the number of children and couples' employment status disparities appear to be mediated by disagreement frequency and disagreement style.     

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.     

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.     

Developing a manualized couples treatment for domestic violence: overcoming challenges

This paper describes challenges faced in a four-year project to develop a manualized couples treatment program for domestic violence. The couples treatment program is an add-on to a male batterer program where the male partner has perpetrated mild-to-moderate violence, yet both partners want to remain together. The project involved the cooperation of a variety of community agencies and referrals from key domestic violence programs. While some anticipated challenges did not materialize over the course of the project, unanticipated challenges did. Qualitative data collected from therapists and clients throughout the project was used to refine the treatment approach.     

Treating intimate partner violence within intact couple relationships: outcomes of multi-couple versus individual couple therapy

An experimental design was used to determine outcomes of a domestic violence-focused treatment program for couples that choose to stay together after mild-to-moderate violence has occurred. Forty-two couples were randomly assigned to either individual couple or multi-couple group treatment. Nine couples served as the comparison group. Male violence recidivism rates 6 months after treatment were significantly lower for the multi-couple group (25%) than for the comparison group (66%). In contrast, men in the individual couple condition were not significantly less likely to recidivate (43%) than those in the comparison group. In addition, marital satisfaction increased significantly, and both marital aggression and acceptance of wife battering decreased significantly among individuals who participated in multi-couple group therapy, but not among those who participated in individual couple therapy or the comparison group.     

The relationship of alcohol problems to the risk for unidirectional and bidirectional intimate partner violence among a sample of blue-collar couples

Understanding how each partner's alcohol problems may contribute to the risk of male-to-female only, female-to-male only, or bidirectional partner violence is important for the prevention and treatment of these problems. Multinomial regression analysis was conducted using data from 848 blue-collar couples. Findings suggest that male alcohol problems are linked to male-to-female and bidirectional partner violence but not with female-to-male partner violence. Female alcohol problems do not appear to be related to any type of partner aggression. Each partner's level of impulsivity was associated with bidirectional partner violence. Male impulsivity was associated with male-to-female violence, and female impulsivity was associated with female-to-male violence. Prevention of male alcohol problems and promotion of nonconfrontational conflict-solving techniques may help reduce partner aggression among couples in the general household population.     

ASSERTION AND FAMILY VIOLENCE: CORRELATES OF SPOUSE ABUSE

Abusive couples, discordant couples, and satisfactorily married couples were compared on self-report measures of general assertion, spouse-specific assertion, spouse-specific aggression, and spousal physical aggression in their families of origin. Men and women in abusive relationships as well as those in discordant, but non-abusive, relationships have lower levels of spouse-specific assertion than satisfactorily married couples. However, men and women in abusive relationships did not differ from discordant, non-abusive men and women, on these measures. In brief, low levels of spouse-specific assertion are characteristic of discordant couples whether they are abusive or not. However, as in our past research, spousal violence in the family of origin was a critical distinguishing factor of physically abusive men versus discordant, but non-abusive, men. Also, as in ourpast research, violence in the family of origin was not a critical distinguishing characteristic of women in abusive relationships.     

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.