File Name: motivational interviewing and stages of change in intimate partner violence .zip
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Given the high stakes of IPV, it is imperative that treatment provided to perpetrators be efficacious to prevent further victimization and not lull survivors into a false sense of security. Unfortunately, the historically dominant modalities of perpetrator treatment, group-based Duluth and cognitive-behavioral therapy, show small effects at best in deterring re-assault. Because of this, new directions are needed. In this article, we report on a literature review that centered on IPV perpetrator treatment. Results suggest a prominent theme in the literature is a shift from these blanket approaches to treatment based on individual need and co-occurring issues.
Given the high stakes of IPV, it is imperative that treatment provided to perpetrators be efficacious to prevent further victimization and not lull survivors into a false sense of security. Unfortunately, the historically dominant modalities of perpetrator treatment, group-based Duluth and cognitive-behavioral therapy, show small effects at best in deterring re-assault.
Because of this, new directions are needed. In this article, we report on a literature review that centered on IPV perpetrator treatment. Results suggest a prominent theme in the literature is a shift from these blanket approaches to treatment based on individual need and co-occurring issues. Specifically, practitioners should be aware of 1 demographic factors affecting treatment completion and re-assault, 2 perpetrator typologies, 3 perpetrator readiness to change and use of motivation-based approaches, and 4 common individual co-occurring concerns, including substance use and mental health issues.
For each of these, we discuss treatment implications and make recommendations for future research. We envision a future where the landscape of perpetrator treatment is tailored to individual treatment needs and argue that social work practitioners bring a critical person-centered perspective to IPV perpetrator treatment.
Within a given year, women suffer over , violent victimization incidents perpetrated by their intimate partners Catalano Social work practitioners will inevitably encounter issues related to IPV in one way or another across a range of settings. Because IPV causes immense damage to individuals and families, including death, it is critical that social workers—even those not specializing in IPV treatment—be prepared to respond appropriately.
For these reasons, social workers have an ethical mandate to be apprised of the latest literature as it pertains to evidence-based treatment of perpetrators. Historical responses to IPV favored sheltering victimized women and children. Due to the large number of women returning to their partners, and because some perpetrators victimized multiple women, shelter workers recognized the need to develop interventions to address perpetrator behavior Davis and Taylor ; Feder and Wilson Over time, treatment programs for IPV perpetrators became more structured and incorporated psychoeducational models e.
This led to a surge of research on the effectiveness of these programs Eiskikovits and Edelson ; Saunders While this trend toward evidence-based practice is positive, it may be difficult for time-strapped social workers to stay apprised of this body of literature.
In this manuscript, we first provide a brief overview of historically dominant approaches to IPV perpetrator treatment and summarize the research on their efficacy, then report on a literature review that reveals a theme of shifting from blanket to more individualized approaches to treatment. In many instances of IPV, perpetrator treatment is court mandated, and most U.
State standards dictate a variety of aspects of treatment, including length of treatment, treatment format, and modality used by providers Bennett and Vincent ; Miller et al.
Regarding the latter, the majority of states promote the use of feminist-derived psychoeducation groups i. These two modalities are the most widely used and have been the focus of the majority of research on IPV perpetrator treatment Arias et al. It holds that IPV is the product of patriarchy or male socialization and results because the perpetrator wants power and control over his partner Pender While treatment length widely varies in practice, the Duluth intervention is designed as a week group treatment Pence and Paymar ; Pender Duluth, however, is not therapy per se; facilitators are not required to have a graduate or professional degree nor to follow a particular theoretical orientation Pender Rather, the Duluth model is comprised of psychoeducational groups, and facilitators are instructed to exclude men with severe substance use or mental health issues Pender Eckhardt et al.
Reeducation is accomplished through video reenactments, role plays, individualized action plans, worksheets and logs, and figures that contrast equality as the root of healthy relationships versus power and control as the root of abusive ones Pence and Paymar ; Pender CBT is a therapeutic modality that seeks to change unhelpful thoughts and behaviors and improve skills to enhance functioning Babcock and Taillade ; Dutton and Corvo ; Murphy and Eckhardt Whereas the Duluth model relies primarily on a coordinated criminal justice system response, CBT targets thoughts and behaviors that contribute to violence and offers an alternative to incarceration, prosecution, and associated costs Murphy and Eckhardt CBT can be performed in individual or group settings.
Facilitators may utilize a variety of techniques, including functional analysis of abusive behaviors, cognitive restructuring, identification of relapse patterns and cues, anger management, and relationship skills training Murphy and Eckhardt CBT interventions address intrapersonal processes that are theorized to perpetuate abuse; this approach has been criticized by Duluth adherents for 1 its dismissal of structural factors e.
Despite these critiques, many components of CBT have been integrated into more recent iterations of Duluth treatment. Though these integrated models vary, several components across iterations are common: increasing personal responsibility; raising consciousness of abusive behaviors and reinforcing adaptive relationship behaviors; recognizing relationship thinking errors and other distorted thought patterns; and teaching anger management, problem-solving, and communication skills Babcock and Taillade ; Saunders ; Tollefson and Gross Calculation of effect size is a common means of assessing the magnitude of treatment effects on some outcome Field , and understanding the magnitude of treatment effects is critical for practitioners in determining whether an intervention has clinical utility.
Babcock et al. Likewise, Arias et al. They further noted no significant differences between Duluth- and CBT-like treatments. Other reviews have produced similar results, with treatment effects ranging from nil to small—and effects decreasing in magnitude when based on survivor rather than police reports and with increased methodological rigor of the study design Barnett and Fitzalan Howard ; Cheng et al.
Given these discouraging results, we sought to identify alternative trends in the IPV perpetrator treatment literature. We conducted a literature search that concluded in the spring of First, we sought reviews on IPV perpetrator treatment to get a sense of the literature. The search terms, detailed in Appendix , returned 13 results, of which six were identified as meta-analyses or systematic reviews addressing the effectiveness of perpetrator interventions.
To capture recent trends in the literature, we next used a broader search strategy. We first reviewed the citation lists of these six reviews, looking for all titles not just reviews pertinent to IPV perpetrator treatment. When new titles were identified, they were incorporated into the larger article database. Upon identifying new reviews , we likewise audited their citation lists, in a snowball sampling strategy. This continued until no new titles were found. In all, we reviewed 12 citation lists available upon request , and references were gleaned from these preliminary searches.
Finally, we conducted a wider database search, adding several other databases i. This returned results, which when added to the aforementioned references, totaled articles. Duplicate references were identified and deleted, resulting in references.
Article titles were then reviewed, and clearly irrelevant titles were deleted, resulting in results. All abstracts were subsequently reviewed and clearly irrelevant articles were deleted, resulting in remaining articles. During this winnowing, we organized articles by intervention type e.
We chose to focus on the latter for the current article. All data were imported into and managed via EndNote X8. As noted, a prominent theme across our review of articles was advocacy for a shift from blanket group intervention approaches that have historically characterized BIPs to treatments tailored to individual characteristics, backgrounds, and co-occurring needs.
Further, Eckhardt argues the universal ideologies that have historically undergirded IPV advocacy and treatment i. For example, Arias et al. Likewise, Bennett and Williams concluded that BIPs are more effective for some perpetrators than others:. A summary of these subthemes and implications for social work practice can be found in Table 1.
There is evidence that individual perpetrator characteristics impact program completion and recidivism. Similarly, Tollefson found that mental health issues and low socioeconomic status were important determinants of recidivism and treatment dropout.
Bennett et al. Likewise, Catlett et al. These results should be interpreted with some caution, however, as other studies have found no significant relationship between demographic, background, and intrapersonal variables and program completion Carney et al. Taken as a whole, these results suggest that younger perpetrators with fewer resources and more emotional difficulties may benefit from a more intensive track of treatment, including an assessment of co-occurring needs outside of direct IPV treatment.
By helping perpetrators from disadvantaged backgrounds access basic necessities like housing, employment, education, and health care, social workers may indirectly be addressing IPV by helping perpetrators stay in treatment longer and reducing stressors that magnify risk for IPV.
More research is needed in this regard. Several researchers have proposed and attempted to validate a typology of IPV perpetrators Gottman et al. For example, Gottman et al. Perpetrators whose heart rates decrease during altercations referred to as characterologically violent perpetrators may make better candidates for individual treatment, whereas perpetrators whose heart rates increase during altercations referred to as situationally violent perpetrators may make better candidates for conjoint or group couples treatment Stare and Fernando The most cited typology of IPV perpetrators, however, was proposed by Holtzworth-Munroe and Stuart and appears to have some empirical support Hamberger et al.
According to Huss and Ralston , family-only perpetrators exhibit relatively low IPV and exhibit lower rates of alcohol abuse, depression, and personality disorders than the other groups.
They exhibit higher levels of IPV but low generalized violence. Holtzworth-Munroe et al. Utilizing this typology, researchers have explored whether there are differences across perpetrator subtypes. These results again point to the importance of assessing perpetrators and assigning treatment format and intensity based on individual characteristics, histories, and need.
For this latter group, several types of therapy may be contraindicated that are acceptable and effective for lower-risk perpetrators, including couples counseling and insight-oriented or psychodynamic approaches Huss et al. DBT is oftentimes utilized with difficult-to-treat clients, where traditional interventions have shown limited success Banks et al.
Further, DBT has proved helpful for concomitant problems of emotion dysregulation , such as substance use, that perpetrators often face Fruzzetti and Levensky Fruzzetti and Levensky describe a treatment model for IPV perpetrators that includes many of the core components of traditional DBT, including first addressing exigent behavior e.
The transtheoretical model of change TTM postulates that people progress through five stages of change: 1 precontemplation , wherein a person is unaware of problematic behaviors and has no intention to change; 2 contemplation , wherein a person is aware a problem exists and is considering changing it but has yet to commit to taking action; 3 preparation , wherein a person plans on taking action immediately and may have already made preliminary, minor behavioral changes; 4 action , wherein a person is actively engaged in modifying behaviors and working to overcome problems; and 5 maintenance , wherein a person works to maintain changes and prevent falling back into former behaviors Prochaska et al.
Motivational interviewing MI is a non-confrontational, person-centered interviewing approach that emphasizes client autonomy and decision-making and change Miller and Rollnick It was initially developed for individuals struggling with alcoholism but has since been found effective in a variety of other contexts, such as in medical settings Lundahl et al.
Rather than taking an authoritarian role, the therapist reflectively listens, provides support, and develops a collaborative relationship. MI shows promise, both as a standalone treatment and an adjunct intervention paired with other treatments, for certain IPV perpetrators.
The MI condition was found to be more effective in reducing re-assault for first-time perpetrators, men court-ordered to treatment, and men in early stages of change. The MI condition was no more effective than the CBT condition, however, for perpetrators with multiple admissions.
Men who were at later stages of change benefitted more from the CBT treatment see also Alexander et al. Most studies incorporating motivation-based approaches did not look at MI as a primary treatment but as a brief adjunct to improve attendance, adherence, and outcomes in other interventions. The latter significantly increased treatment compliance compared to those in the standard BIP alone.
Congruent with this study, other research suggests adding an adjunct MI component prior to treatment significantly increases attendance and completion Scott et al. Across these studies, with few exceptions e. Because perpetrators are frequently court mandated to participate in treatment or otherwise feel compelled to participate , many may arrive in earlier stages of change.
Murphy and Baxter argue that interventions that are confrontational may paradoxically increase defensiveness and resistance to treatment in IPV perpetrators. For these reasons, non-confrontational approaches, like MI, should be utilized for clients in earlier stages of change.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Considering the high rate of report on intimate partner violence in Africa and other parts of the world, Motivational Interviewing MI , serve as a good approach and platform to help clients who are victims of intimate partner violence IPV. MI is an evidence-based, directive client-centered and guiding communication style of working with resistant clients to elicit and enhance readiness to change. Save to Library. Create Alert.
Bowen, E. Domestic violence treatment for abusive women: A treatment manual. New York: Routledge.
Given the high stakes of IPV, it is imperative that treatment provided to perpetrators be efficacious to prevent further victimization and not lull survivors into a false sense of security. Unfortunately, the historically dominant modalities of perpetrator treatment, group-based Duluth and cognitive-behavioral therapy, show small effects at best in deterring re-assault. Because of this, new directions are needed.
Practitioners of intensive family support programs may frequently encounter parents who present as ambivalent and "resistant" to engaging with the service.
Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. Volume 41, No. One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting. Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management. When patients receive compelling advice to adopt a healthier lifestyle by cutting back or ceasing harmful behaviours eg.
Log in. Request new password. Found results. Understanding and facilitating the change process in perpetrators and victims of intimate partner violence: An introduction and commentary. Motivational interviewing and stages of change in intimate partner violence. New York, NY: Springer;
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