Couples Counseling to End Intimate Partner Violence
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Intimate partner violence (IPV) is a serious issue plaguing couples around the world. Numerous batterer intervention programs have been developed and empirically tested. Fewer treatment models have been empirically tested to work with couples who choose to stay together after violence. The concept of conjoint treatment of couples after they have experienced any type of IPV remains controversial. This chapter addresses the history of couples counseling to end IPV, including prevalence and risk markers for IPV and the controversy surrounding this type of treatment. The chapter also provides an overview of current models of treatment and highlights the importance of clear assessment, intervention, and treatment methods that are currently being used to safely treat couples who have experienced IPV but remain committed to their relationship.
KeywordsCouples counseling Intimate partner violence Systemic treatment
Couples Counseling to End Intimate Partner Violence
Intimate partner violence (IPV) is an international issue (Garcia-Moreno et al. 2006). In this chapter, when referring to IPV, the authors are referring to physical IPV, which can include slapping, pushing, punching, kicking, using a weapon against one’s partner, or other acts of physical aggression aimed at one’s partner. Although women are more likely to be identified as victims of IPV and men as offenders, it is also clear that there are different types of IPV and that both men and women can be offenders and/or victims. Numerous IPV typologies have been proposed. In 2008, a typology of IPV perpetrators was developed by Michael Johnson that has been widely accepted. Understanding and screening for type of violence occurring in a relationship is critical when discussing conjoint treatment for couples experiencing IPV in their relationship. Conjoint or systemic treatment is targeted treatment with both partners in the couple focusing on eliminating violence in the relationship. The two common types of IPV that can occur within relationships are intimate terrorism and situational couple violence (SCV). One partner using severe violence as a means to control, instill fear into, and wield power over their partner (Johnson 2008) characterizes intimate terrorism. In this case, couples treatment is generally not recommended and individual or offender group treatment may be more suitable (Stith et al. 2011). When intimate terrorism is occurring in a relationship, the victim generally does not feel safe in a conjoint treatment program. On the other hand, SCV is characterized by less frequent and severe acts of violence, violence as a result of a conflict, stress, or emotional dysregulation, the violence can be bi-directional (both partners using violence in the relationship), and violence is not used as a means to control one’s partner (Johnson 2008). In cases of SCV, couples therapy may be an appropriate treatment option (Stith et al. 2011). This chapter focuses on couples counseling, a type of systemic treatment, for couples experiencing SCV. The authors of this chapter agree that individuals who perpetrate intimate terrorism are not appropriate candidates for couples treatment and advocate for careful and thorough screening before beginning any systemic approach for couple violence, including couples treatment. However, there is clear evidence that for couples experiencing SCV, helping them improve conflict resolution skills and helping each partner become accountable for their own physical and/or psychological violence can reduce subsequent violence.
Prevalence and Risk Markers for Situational Couple Violence
Nearly one in four couples has experienced physical IPV in their relationship, and up to 58% of couples seeking couples counseling may have experienced IPV in their relationship (Jose and O’Leary 2009). Research suggests that SCV and bi-directional violence is more prevalent than intimate terrorism or unidirectional violence (Langhinrichsen-Rohling et al. 2012). When examining risk markers related to SCV, it is important to examine contextual factors related to the relationship, as SCV has been described as deriving from relationship conflict that is not motivated by control or obtaining power over one’s partner (Johnson 2008). This suggests that instead, SCV may be the result of unmanaged conflict, anger management issues, poor conflict resolution skills, poor communication skills, or a lack of healthy alternatives to managing and handling relationship conflict.
The majority of research examining risk markers for SCV has focused primarily on differentiating risk markers for SCV from risk markers for intimate terrorism. Authors of a recent meta-analysis examining SCV and intimate terrorism risk markers predicted that communication and conflict resolution, demand-withdraw relationship patterns, and relationship dissatisfaction would be stronger risk markers for SCV (Love et al. 2018). The authors also predicted that controlling behaviors, jealousy, patriarchal beliefs, the perpetrator’s power in the relationship, and stalking would be stronger risk markers for intimate terrorism. They examined the strength of these risk markers for IPV in general population samples and clinical samples (i.e., individuals who were in batterer’s treatment or women’s shelters). They found that risk factors for intimate terrorism, such as controlling behaviors, jealousy, patriarchal beliefs, and power, were all significantly stronger in clinical samples than in general population samples, supporting the notion that there are differences in risk markers for intimate terrorism compared to SCV. There were no significant differences in the strength of risk markers associated with SCV (i.e., communication and conflict resolution, demand-withdraw patterns, and relationship satisfaction) between the clinical and nonclinical samples, suggesting that these risk markers are present in couples experiencing either IT or SCV.
Another study compared women who have experienced intimate terrorism and women who have experienced SCV in regard to their help-seeking initiatives (Leone et al. 2014). This study found that women who have experienced SCV were more often likely to state that they did not need formal help for the violence they were experiencing compared to women experiencing intimate terrorism. When looking at the impact of violence, Johnson and Leone (2005) found that women experiencing intimate terrorism were significantly more likely to report having sustained injury, experienced symptoms of posttraumatic stress disorder, and used substances (specifically painkillers) compared to women who experienced SCV in their relationship. Overall, coercive control being used in the relationship, the perpetrator having more power in the relationship than the victim, injuries sustained by the victim, severe and frequent violence, and the victim displaying posttraumatic stress symptoms and/or fear of the offender may be clear signs that the type of violence in the relationship is not SCV and is consequently not appropriate for conjoint treatment.
History of Couples Counseling for IPV and the Controversy Surrounding It
Considerable controversy exists as to the appropriateness and safety of offering couples approaches for IPV. In the United States, over 90% of states have mandatory treatment standards for batterers (Boal and Mankowski 2014). Although there is no empirical research that supports a “one-size-fits-all” approach, most standards require a traditional batterer intervention program (BIP) and do not permit conjoint treatment. Traditional BIP programs consist of single sex groups that focus on psychological interventions designed to raise awareness about power and control tactics (Johnson and Kanzler 1993).However, the policy assumption that all offenders perpetrate intimate terrorism is not justified. In fact, most couples in the general population who experience IPV experience SCV, which is much more prevalent than is intimate terrorism (Johnson 2008). Findings of a recent meta-analysis indicate that couples therapy for IPV has a significant impact on violence reduction (Karakurt et al. 2016). The authors pooled data from 6 studies for a combined sample size of 470 participants. Results indicated that there was a significant reduction in IPV among intervention participants. While more research is needed, state standards often do not permit systemic or dyadic interventions (Maiuro and Eberley 2009). Several primary objections to offering couples who have experienced any type of IPV have been identified in the literature: (1) conjoint treatment might lead to escalation of violence (Adams 1988); (2) use of a systemic framework might lead to victim blaming; (3) lack of careful screening might lead to inappropriate clients participating in conjoint treatment; (4) conjoint treatment might provide a format that would support perpetrator control and abuse (as it may encourage couples to stay together), resulting in greater harm; and (5) conjoint treatment may not be trauma informed and may fail to consider the historical and cultural contexts that underlie violence against women. In the next section of this chapter, we examine each of these objections in depth and offer suggestions for addressing them.
Objection 1: Conjoint Treatment Might Lead to Escalation of Violence
Although family therapists have been treating couples for many years, many IPV practitioners and scholars have expressed concerns about conjoint treatment of IPV. One primary objection has been based on the possibility that conjoint treatment might lead to an escalation of violence in the couple relationship. Adams (1988) indicated that “Many battered women report that past family therapy sessions were followed by violent episodes” (p. 187). Bolton and Bolton (1987) remind us that early couples therapists encouraged “ventilationist (tension-reduction) activities” (p. 269) or catharsis, where clients were urged to “let it all out” (p. 269). Bagarozzi and Giddings (1983) suggested an approach that included a recommendation to “permit spouse temporary and controlled sublimation of pent up aggression only in the presence of the therapist” (as cited in Magill 1989, p. 53). Couples were encouraged to express their anger toward each other so that the anger would dissipate. In 1974, Straus conducted research, which highlighted the danger of this type of approach. He reported that “in fact, the weight of the evidence suggests that such an approach may be dangerous because rather than reducing subsequent aggression (as argued by the ventilationist), expressing aggression against others probably tends to increase subsequent aggressive acts” (Straus 1974, p. 27). He found that as the level of verbal aggression increases, the level of physical aggression does not merely keep up – it increases even more rapidly. Most current models for working with couples who have experienced SCV emphasize the importance of helping clients develop skills to communicate calmly and do not encourage couples to ventilate or escalate in the session. This suggests that a possible escalation in violence during couples treatment can be attributed to past techniques that are no longer considered suitable for couples treatment. However, continued research on aspects of current treatment modalities and techniques that may cause harm is necessary. Furthermore, research discussed throughout this chapter (e.g., Karakurt et al. 2016) suggests that couples treatment with carefully screened clients focusing on IPV leads to a reduction, rather than an escalation in IPV.
Objection 2: Use of a Systemic Framework Might Lead to Victim Blaming
A second concern regarding the appropriateness of couples treatment for IPV has to do with victim blaming or the implication that because a systemic treatment approach is being used, the therapist believes that both partners are co-responsible for the violence (Bograd 1992). Deschner (1984) developed one of the first systemic treatment programs. In her book, The Hitting Habit: Anger Control for Battering Couples, she describes a treatment program for couples who have experienced IPV, which includes same-sex and multi-couple groups focusing on relationship skills (Deschner and McNeil 1986). She included both partners who were abusive to children and those who were abusive to partners in her program. She writes that she includes both partners whenever possible because “it truly does take two to quarrel. Losers of battering episodes (usually but not always the woman or child) must also change their inputs into the antecedent coercion spirals if the outbreaks of rage and violence are to be eliminated for good” (Deschner & McNeil, p. 111). The notion that violence is the equal responsibility of the perpetrator and the victim is not appropriate for systematic treatment. Although both partners who choose to remain together after experiencing SCV need to be aware of and responsible for their own behavior, it is necessary that couples therapists make it clear that a victim of IPV is never responsible for the abusive partner’s behavior.
Neidig and Friedman (1984) developed a conflict containment program, Spouse Abuse: A Treatment Program for Couples, through their work with the US Marine Corps seeking to understand the cause and correlates of IPV. The program was used throughout many branches of the military. The Physical Aggression Couples Treatment Program (PACT; O’Leary et al. 1999; Neidig 1992) discussed later in this chapter was based on this program. The authors highlight that “the primary goal of the program is an immediate and complete cessation of violence in cases of spouse abuse” (Neidig and Friedman 1984, p. 1). To accomplish this goal, a 10-week, gender-neutral, multi-couple, skill-building training format was adopted that drew heavily on social-learning and cognitive-restructuring principles. The program, although including many useful aspects, was based on the theory of circular causality. This theory “implies that both parties are accountable, even when one person is clearly the dominant aggressor…Although causality is supposed to be circular, some clinicians put too much emphasis on transactional sequences prior to the violence, which subtly blames victims for provoking violence”(Hamel, 2005, p.79). Many aspects of Deschner’s and Neidig’s programs continue to be used; however, current approaches seek to ensure that violent partners take responsibility for their own behavior and that nothing the non-violent partner does should be assumed to be the “cause” of violence (e.g., Stith et al. 2011). Furthermore, in research highlighted by Murphy and Eckhardt (2005), “the fear that conjoint treatment will enhance women’s perception of personal responsibility for their partner’s aggressive behavior has not been supported” (p. 62). It is important to highlight that current standards of conjoint treatment for IPV should ensure that the violent partner takes full responsibility for their own behaviors and acts of violence.
Objection 3: Lack of a Careful Screening Process Might Lead to Inappropriate Clients Participating in Conjoint Treatment
A third concern expressed by many IPV scholars and researchers is the apparent lack of careful screening and decision-making regarding the appropriateness of a couple for a conjoint program. Several early programs did not highlight inclusion and exclusion criteria. For example, Neidig and Friedman (1984) indicated that they admitted most couples into the program but watched their progress. They report, “In cases where clients do not respond to treatment, the therapist has a responsibility to recommend further treatment, separation, and security measures for the abused partner. The emphasis then changes from training clients to eliminate violence to protecting the abused partner” (p. 7). Since no clear exclusion criteria were offered, the importance of careful training and ensuring that therapists can identify when clients are not responding to treatment is critical to decrease risk for further abuse.
An internationally known strategic family therapist, Cloe’ Madanes, and colleagues (Madanes et al. 1995) describe a therapy of social action in which, in many cases, the therapist requires that the couple live separately while they begin therapy. In a therapy of social action, each person is responsible for their own actions. “A violent father not only has to believe he has sole responsibility for his violence and that his violence is wrong; he also has to express this belief to those he has hurt and convey his sorrow for his violent actions” (Madanes et al. 1995, p. 10). The therapist also calls family members and/or friends of each partner in the first session to ensure that they have support during the separation. Guidance is provided to confront the offender with the effects of his violent behavior. Throughout the book and training offered by this team, many examples are provided for safely and effectively carrying out this work, but screening criteria are not emphasized and no empirical research has been conducted on the model. Careful screening prior to conducting conjoint treatment is necessary in order to ensure the safety of the victim. Research examining clinician’s abilities to screen into groups highlights the importance of training. Lohr et al. (2005) found that “clinicians may be able to reliably and accurately identify cluster membership for batterers” (p. 257). However, in this research the sorting was done by PhD-level clinical psychologists with experience in the field of domestic violence. It is clear that more research needs to be conducted on screening procedures.
Objection 4: Conjoint Treatment Might Provide a Format that Would Support Perpetrator Control and Abuse (As It May Encourage Couples to Stay Together), Resulting in Greater Harm
One serious concern many have regarding conjoint treatment is that therapists might, by the treatment model they use, or by their own value system, encourage violent couples to stay together. However, a great deal of research has found that between 20% and 80% of women remain with their abusive partners or return to their relationships after leaving a woman’s shelter (Sullivan et al. 1992; Sullivan and Rumptz 1994). There is also a clear connection between marital discord and IPV (Pan et al. 1994). Treatment of carefully screened couples, by trained therapists who target all forms of IPV in their work, has been shown to reduce relationship discord and reduce IPV, whether or not the couple stays together or chooses to separate non-violently (Stith et al. 2011).
Objection 5: Conjoint Treatment May Not Be Trauma Informed and May Fail to Consider the Historical and Cultural Contexts that Underlie Violence against Women
Because some conjoint treatment programs are not trauma informed, Taft et al. (2016b) developed a trauma-informed treatment program for couples at risk for IPV. Their work is described later in this chapter. Also, it cannot be overemphasized that careful screening and selection of voluntary couples who choose to take responsibility for their own actions are a critical component of safely delivering this program. Some couples seeking conjoint treatment are same-sex couples; some relationships include bilateral violence, which does not include power and control; and in some couples seeking treatment, the female is the primary or only partner who uses physical violence.
Treatment Approaches Including Both Partners Designed to Treat Court or Protective Service-Mandated Clients
Although most conjoint treatment programs exclude couples who are mandated to treatment, several programs have been developed and tested which allow both partners to participate. However, there are concerns about requiring conjoint treatment for IPV cases. “First, some partners are unwilling to participate in conjoint treatment, and it may be unethical, imprudent, and even illegal to consider mandating victims of crimes such as partner violence to participate in conjoint sessions” (Murphy and Eckhardt 2005, p. 172). The programs described in this section of the chapter carefully address these issues.
Safer Families: An approach developed in Great Britain by Cooper and Vetere (2005), “Safer Families,” is based on an attachment perspective and addresses needs of all family members. The first six sessions focus on screening for safety and suitability to engage in treatment, as well as enhancing safety, and two therapists are used to deliver the program. Children may also be included in the intervention and a “stable third” is always included. The stable third might be a protective service worker, family member, or other individual who is concerned about the couple and ending violence. About half of the clients in the project had children on the child protection register or involved in the family court process. Although Cooper and Vetere did not have a comparison group, they reported that they were able to help three quarters of all couples and families referred to both stop violence and maintain their safety plans over periods of follow-up (3 years maximum) whether they stayed together or parted.
Circles of Peace: Another approach, “Circles of Peace” (Mills et al. 2013), is a restorative justice-based program. “Restorative justice is an approach to addressing conflict that focuses on repairing harm and creating meaningful change in the lives of those involved in or impacted by an incident” (Barocas et al. 2016, p. 945). Although this type of program may involve partners, it is not actually a couples counseling program, but is included in this review because it accommodates the participation of victims who choose to join. The court-ordered IPV offender is expected to attend all Circle sessions (usually 26 weeks), as is the Circle Keeper, a restorative justice trained facilitator. Other participants often included one or more of the following: trained volunteer community member, offender’s support person, and family members who voluntarily agreed to participate. By design, the victim participates in a few sessions or more or does not attend at all (and could also have a support person present in the Circle with him or her), in order to avoid any suggestion of coercion. “In practice, some circles included all these participants each week while others may have included only the Circle Keeper and the offender” (Mills et al. 2013, p. 71). Circles of Peace can be used to address a variety of types of abuse cases including adult parent and child, female offenders, and same-sex offenders who can be classified as either IT or SCV (Mills et al. 2013).
Circles of Peace has been empirically tested for use as a type of batterer intervention program and has been implemented in criminal justice systems in Arizona and Utah (Barocas et al. 2016). Research conducted with this model involved a randomized controlled trial with 152 domestic violence cases randomly assigned to either Circles of Peace or a BIP based on a Duluth-style curriculum focusing on power and control, anger management, etc. (Mills et al. 2013). The BIP program was “first developed based on a theory that victims of domestic violence are invariably women and perpetrators are men” (Mills et al. 2013, p. 77); however, both male and female offenders attended the BIP. Circles of Peace participants experienced less domestic violence recidivism during each follow-up comparisons (6, 12, 18, and 24 months). However, because of high dropout levels in both treatment conditions, statistically significant differences between BIP participants and Circles of Peace participants were detected only for 6-month and 12-month non-domestic violence rearrests and not for domestic violence rearrests. These findings suggest, “treatment assignment does not have a statistically significant effect on domestic violence reoffending. At the same time, the results do not exhibit a significant backfiring effect either” (Mills, et al., p. 80). Circles of Peace differs from other programs described in this chapter because it is based on restorative justice and partners may or may not participate. The National Science Foundation has funded research supporting this approach as an alternative to BIP for some couples; however, state standards in most states do not permit couples therapy or alternative approaches.
Mutual Intimate Partner Violence Intervention: A Mutual Intimate Partner Violence Intervention (Wray et al. 2013) was tested among treatment-mandated couples with bilateral violence. This program includes 12 gender-specific group sessions addressing cognitive-behavioral and psychoeducational topics about IPV. Although the program included partners in separate sessions, the focus of each session was similar. Findings from research on this program indicated that couples in which both partners completed their groups (or make-up sessions) reported less IPV perpetration and victimization than did couples in which only one partner completed treatment. Although this treatment was not offered to couples conjointly, the research highlights the value of ensuring that both partners in bilaterally violent relationships receive and complete IPV-focused treatment.
Conjoint Treatment Approaches Designed for Carefully Screened Voluntary Clients
Behavioral Couples Therapy. Behavioral couples therapy (BCT) is designed for individuals seeking treatment for substance abuse (O’Farrell and Fals-Stewart 2006). Treatment is designed to improve support for abstinence by improving communication and enhancing relationships among couples where one partner abuses substances. Studies examining BCT for both male and female substance abusing clients demonstrate greater reductions in IPV after BCT compared to those completing individual substance abuse treatment (O’Farrell and Clements 2012). It appears that as relationships improved in the conjoint treatment condition, greater reductions in IPV occurred, in comparison with individual substance abuse treatment.
PACT . The Physical Aggression Couples Treatment Program (PACT; O’Leary et al. 1999; Neidig 1992) included many aspects of Neidig’s original program but was not gender neutral. The O’Leary group interviews spouses separately for their preference for individual or couples therapy which might also be something to include routinely. These researchers emphasized that men’s violence has more potential ability to cause physical damage, and as an inclusion criterion, participants had to exhibit at least two acts of male-to-female violence. Screening was used to ensure that the violence was not severe enough to cause injury and that “the wife, during a private interview, reported being comfortable being assigned to conjoint treatment and was not afraid of living with her husband” (O’Leary et al. 1999, p. 480). Seventy-five couples were randomly assigned to a gender-specific or conjoint 14-week group treatment for aggression. The PACT program included psychoeducation about the cycle of violence, time-out procedures, anger control techniques, stress management, communication principles and skills, and conflict resolution skills. “The major theoretical difference between the two treatments is that in Gender Specific Treatment the male is held fully responsible for the physical aggression in the marriage, whereas in PACT, each partner is held responsible for the control of his or her own physical aggression” (O’Leary et al. 1999, p. 488). Participants in both types of treatments reduced their psychological and physical aggression at post-treatment and 1-year follow-up. “No differential effects of treatment type were found, except that, as predicted, husbands in conjoint treatment improved more on marital adjustment. Neither form of treatment was superior to the other in terms of safety and effectiveness for volunteer, intact, and physically aggressive couples” (O’Leary et al. 1999, p. 475). Thus, results of this study support other studies in this chapter suggesting that conjoint treatment with volunteer, intact couples does not increase risk for future violence.
Creating Healthy Relationships Program (CHRP) . Another program that was specifically designed for carefully screened couples who volunteer for treatment is a psychoeducational group treatment program, the “Creating Healthy Relationships Program” (Bradley and Gottman 2012). This group program is based on many years of work by John Gottman and the Sound Relationship House theory (Gottman and Silver 2000). The program was researched and developed for low-income couples. The program is delivered as a 22-week group and utilizes a skills-based approach. Participation in the program involves careful screening including motivation for violence and beliefs regarding violence via the Intimate Justice Scale (Jory 2004). The authors conducted a randomized study comparing this program with a no-treatment comparison group and found no significant differences in IPV levels at the posttest. The authors conclude, “These findings show that, with the use of proper screening tools and experienced, well-trained clinicians who continually monitor the type and level of violence experienced by couples engaging in intervention groups, couples who exhibit low levels of IPV that is perpetrated mutually by both partners may safely engage in conjoint treatment and actually benefit from it” (Bradley et al. 2014, p. 557). Thus, this study suggests that conjoint treatment may be safe, and not increase violence as previously indicated, but this treatment did not result in lower levels of violence compared to a no-treatment comparison group.
Strength at Home-Couples (SAH-C). Taft et al. (2016b) also developed a treatment program for couples at risk for IPV. They tested it with a military population. The program is called “Strength at Home-Couples (SAH-C).” This program includes ten 2-h sessions, is trauma informed, and includes a cognitive-behavioral couples-based intervention designed to prevent IPV in returning male service members and their partners. A social information-processing model for IPV perpetration informs the intervention. In their pilot research, they randomly assigned couples to either SAH-C or supportive prevention couples groups and reassessed at post-intervention and at 6- and 12-month follow-ups. They reported extensive exclusion criteria including (1) reading difficulties preventing completion of assessment instruments; (2) active psychosis; (3) prominent suicidal or homicidal ideation by one or both participants; (4) alcohol dependency; (5) the female partner reported that her own violence included the use of weapons in the previous 6 months; (6) violence by female partner produced injuries; (7) the male partner indicated being afraid of the female partner; or (8) the male partner reported being violent in any way in the past 6 months in their current relationship (Taft et al. 2016a). Both partners engaged in fewer acts of reported physical and psychological IPV in the SAH-C condition at follow-up relative to the supportive prevention group. No differences were found between groups on relationship satisfaction (Taft et al. 2016). In the pilot study of this program, male participants in the intervention group reported low levels of IPV perpetration (on average 3.17 acts of mild physical IPV perpetration, 0 acts of severe IPV perpetration), and the results found that at follow-up, these males reported 0 acts of either mild or severe IPV perpetration at the 6-month follow-up, suggesting a reduction in violence (Taft et al. 2014).
Couples Abuse Prevention Program. LaTaillade et al. (2006) developed a cognitive-behavioral group program for couples, “Couples Abuse Prevention Program” (CAPP). The treatment is delivered over 10, 90-min sessions or 20, 45-min sessions. The program also focuses on skill development and enhanced relationship quality. Couples seeking help from their university-based family therapy clinic were randomly assigned to either a manualized CBT-based program or couples treatment as usual if they met criteria. Couples experiencing severe violence were excluded and referred to other agencies. Included couples reported mild-to-moderate physical abuse in the past 4 months that did not result in injury; they also expressed a desire to live together. Exclusion criteria included either partner using a weapon in previous violent incidents or physical abuse that lead to in an injury that should have resulted in medical treatment in the past 4 months, either partner having an untreated drug or alcohol problem, or either partner fearing living with and/or participating in therapy with their partners. The CAPP program included 10 weekly, 90-min sessions with a detailed intervention protocol for each session. Couples were removed from the program if either partner reported violence that led to an injury during treatment. Each partner was offered individual treatment and was allowed to return to the couple program when it was determined conjoint treatment was safe and appropriate. LaTaillade et al. (2006) reported that relationship satisfaction increased for men in both conditions and for women in the treatment-as-usual condition. Both programs reported similar decreases in psychological aggression. Negative communication behavior (coded from videotapes) decreased in CAPP program but not in the treatment-as-usual condition. There was minimal impact on physical aggression in either program because the frequency of physically violent acts was low in the sample. In their 2012 evaluation of the program, they found that men and women in both treatment conditions “exhibited decreased negative attributions, which moderated increase in satisfaction and decreases in negative communication, as well as increases in positive communication for men” (Hrapczynski et al. 2012, p. 117).
Domestic Violence-Focused Couples Treatment (DVFCT)
Domestic Violence-Focused Couples Treatment (DVFCT) has been described and reviewed in numerous publications (e.g., McCollum and Stith 2007; Stith and McCollum 2011; Stith et al. 2004, 2011). DVFCT is an 18-week-long program for couples experiencing SCV, based on a solution-focused approach (de Shazer et al. 2007). DVFCT has been tested using both a single-couple format and with multi-couple groups. In this section of the chapter, we provide an overview of the screening procedure used, additional safety measures used, and the format of the program.
All screening is conducted privately in a structured interview before assignment into conjoint treatment. Each partner also completes a survey including information about their violence and their partner’s violence (using the Revised Conflict Tactics Scale; Straus et al. 1996), their relationship satisfaction, and their problems with drugs or alcohol using the AUDIT (Babor et al. 2001) and the DAST-10 (Skinner 1982). If it appears that the victim is afraid to speak openly and honestly in conjoint treatment, especially if they fear retaliation by the partner, clients are referred to individual treatment or a batterer intervention program. Therapists who conduct the screening communicate with victims that couples therapy is not safe and offer a variety of safer options (including shelter services). They communicate with offenders that they are concerned that they each have serious individual issues that need to be addressed before they begin conjoint treatment. If the offender has reported using violence, they may be referred to a BIP, but if they have not reported using violence, even though the partner has reported being a victim of violence, the offender is referred to individual therapy so that the offender does not retaliate against the partner. Couples are not included in treatment if either partner does not wish to participate in treatment or if one partner wishes to end the relationship. Careful screening for co-occurring disorders is also emphasized. One issue, which may exclude a couple from treatment, is if one or both partners are currently abusing substances. If either partner scores above 7 on the AUDIT or above 2 on the DAST-10, and they are not willing to seek concurrent substance abuse treatment or remain sober, the couple will be encouraged to return to treatment after completing addiction treatment. After careful individual screening regarding perpetration and victimization of IPV using the Revised Conflict Tactics Scale (CTS2; Straus et al. 1996), it is imperative to examine the congruence between each partner’s report of violence perpetrated and experienced. If each partner’s reports of violence in the relationship are very different, these couples will be excluded from couples treatment. For example, if a female partner reports that her partner had strangled her, but the male partner reported that he “only” pushed her once, this would not be an appropriate couple for treatment, as it suggests that discussing the violence that has occurred in the relationship would not be safe. Lack of congruence on the level of violence is likely to suggest that conjoint treatment is unsafe (Langhinrichsen-Rohling et al. 2012)
Additional Safety Measures
Careful screening of couples allowed into the program is of great importance for safely delivering systemic treatment, and there are other safety measures that have been implemented in the DVFCT program. Before couples begin the DVFCT program, each partner (independently with the therapist or in a same gender group, if they are participating in the multi-couple group) develops a safety plan to implement in case tension or violence escalates in the relationship. Safety plans are discussed, and if the plan does not appear to be effective or clear in direct actions to take in the escalation of violence or tension, the plan is revised. For example, if a woman who is a primary victim reports that she will just leave if she becomes fearful of her partner’s anger, the therapist is encouraged to talk with her about getting access to the keys, knowing the phone number for the domestic violence shelter, etc. Individuals who are primarily perpetrators will document ways in which they will avoid the use of violence or escalation of conflict. DVFCT uses two co-therapists to administer treatment, as it allows couples to be treated individually if needed. In addition, couples are separated at the beginning and end of each session in order to assess whether or not there had been any physical, emotional, or sexual violence between sessions. Each partner is also asked about successes and challenges that they have experienced since the previous session. If either partner reports any escalation of conflict or violence, the therapist spends time talking with them about safety and about how they feel discussing the issue in a conjoint session. If they do not feel safe, the therapists make the decision to meet separately with each partner. At the end of each session, couples separately complete a survey regarding how safe they currently feel in their relationship. It is necessary to have ongoing and consistent assessment regarding the safety of each partner throughout the duration of treatment. If a partner feels unsafe in their relationship, and do not feel safe going home with their partner, clients are encouraged to use the safety plans they developed at the beginning of treatment.
The First 6 Weeks
The first 6 weeks of DVFCT focuses primarily on providing psychoeducation about IPV to the couples, which includes what constitutes IPV, how to recognize patterns of escalating violence, and the cycle of violence. The first 6 weeks also focuses on teaching clients how to develop and implement a technique referred to as a negotiated time-out. A negotiated time-out is developed with the couple before tension arises so that each person has agreed on what they will each do when conflict arises and a specific time to come back and discuss the topic of conflict together once each partner has focused on self-soothing and de-escalation of tension. Couples are also taught to use a mindfulness-based practice and are encouraged to use these mindfulness techniques between sessions. Every session of DVFCT begins with a mindfulness exercise in order to increase the likelihood that couples will be able to utilize these techniques between sessions if needed. Beginning with a mindfulness activity also helps clients begin the session focused and calm.
Final 12 Weeks of the Program
In the final 12 weeks of DVFCT, the format remains consistent, where partners are separated at the beginning and end of each session in order to assess for safety, and discuss successes and challenges that occurred during the previous week. The final 12 sessions of DVCFT is targeted to address the specific needs of the couples. This includes topics that the couples specifically want to address, and communication skills are also taught. For example, if one partner wishes to discuss household responsibilities and the distribution of these tasks, the other partner is encouraged to listen to the other and paraphrase what they heard their partner saying. If the couple is enrolled in the multi-group format of the DVCFT program, the group members are also encouraged to contribute their thoughts and suggestions to help the couple navigate the particular issue. In the final group session, each individual discusses successes and challenges they have been experiencing related to their own behavior, as well as acknowledging the successes they have seen in other group members. After the couples have completed the 18-week program, they have the ability to join an alumni multi-group program, which allows for continued support for these couples.
Programs Using Innovative Formats or Newer Approaches
Brief Motivational Intervention: Woodin and O’Leary (2010) conducted a study which used a brief targeted motivational interviewing intervention (MI: Miller and Rollnick 2002) aimed at preventing IPV in high-risk college dating couples. All couples completed a 2-hr assessment. Half of the participants received MI feedback and the other half received general feedback. In the 45-min MI feedback session, participants met individually with a therapist who used MI techniques to offer them feedback regarding their self-reported levels of aggression and risk factors such as alcohol use and relationship distress. After the individual session, the therapist met with the couple together for 15 min, not sharing individual feedback but focusing on the couples hopes and concerns for their relationship using MI techniques. In the general feedback condition, participants received a 10-min individual feedback session on their assessment, but no MI skills were used. Assessments were administered online at 3-, 6-, and 9-month follow-up, and both men and women in the MI group reported reduced physical aggression at a significantly greater rate than those in the minimal feedback condition (d = 0.56). Results of this study suggest that a one-session MI intervention with each partner in a high-risk college sample can reduce subsequent IPV.
OurRelationship Program (Doss et al. 2016). An interesting newer approach to reducing relationship distress, which is highly related to IPV, includes online programming. Doss et al. (2016) adapted their relationship education program and delivered it to 300 couples. To be included in the intervention, at least one partner had to score in the distress level on a measure of relationship distress, or both partners had to score below the mean on relationship distress. If either partner reported injury or fear resulting from IPV in the past 3 months, they were excluded from the program. The intervention program, OurRelationship, includes an 8-h online program and four 15-min calls with project staff. Participants were randomly assigned to receive the intervention immediately or wait 2 months for the intervention. The online program was based on Integrated Behavioral Couples Therapy (IBCT; Christensen et al. 2004) and focused on acceptance and resulting behavior change. Coach calls were scripted and addressed progress through the program. Compared to couples on the wait list, couples in the immediate intervention reported significant improvements in relationship satisfaction, relationship confidence, and negative relationship quality. The authors highlight that “the OurRelationship program was effective in significantly improving both relationship and individual functioning, suggesting it can substantially increase the reach of current interventions through its low-cost, Web-based format” (Doss et al. 2016, p. 285).
There have been several main controversies related to systemic treatment of couple violence, but recent treatment modalities and therapy techniques can overcome potential dangers or downfalls of a systemic approach.
Systemic interventions can be appropriate treatment options for couples who have experienced situational couple violence in their relationships and who choose this type of treatment.
Therapists must be well-trained both in treating high-conflict couples and in empirically supported systemic treatment approaches for IPV.
It is necessary to thoroughly assess for safety prior to beginning systemic treatment for couples experiencing violence in their relationship, and couples experiencing intimate terrorism in their relationships are not suitable candidates for couples counseling.
Summary and Conclusion
There have been a number of treatment programs designed to help couples who have experienced SCV in their relationship. This chapter highlights the importance of careful screening related to whether a couple seeking conjoint treatment is experiencing intimate terrorism or SCV in their relationship. This chapter provides an overview of the controversies surrounding conjoint treatment for IPV, as well as providing ways in which professionals can lower potential risk or harm related to these controversies. This chapter also provides an overview of many different systemic treatments for IPV, including an in-depth exploration of one couples treatment for IPV, Domestic Violence-Focused Couples Treatment. The authors of this chapter urge the continuation of careful and ongoing assessment when working with couples who have experienced IPV to ensure safety.
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