A Systematic Review of the Quality of Perpetrator Programs' Outcome Studies: Toward A New Model of Outcome Measurement

This systematic review assessed whether studies on the outcomes of perpetrator programs comply with the model recommendations for outcome evaluation. Three databases (PsycINFO, Medline, and Scopus) were used to identify perpetrator program outcome studies from 1988 to 2021. The inclusion criteria were as follows: empirical studies with no time restriction; published in English or Spanish; evaluated interventions aimed at male perpetrators of any type of abuse toward women; evaluated the effectiveness of the intervention in a follow-up post-intervention; and provided an indicator of recidivism. The search and selection process resulted in 46 original studies. The results showed that studies did not include a thorough description of the study sample. Many approaches to psychological intervention are used, with cognitive behavioral therapy being the most widely used. Most studies did not describe the program content. Dropout rates varied greatly from one study to another (from 0% to 64%) and only eight studies provided dropout rates specified by each type of perpetrator. The follow-up period ranged from 3 months to 9 years. The recidivism rates (ranging from 5% to 72.5%), and their assessments were also very different. Only 12 of the 46 studies (26.1%) used more than one source to obtain recidivism rates. In terms of outcomes, few studies considered (ex-) partner accounts. Some studies had other measures of outcome, whereas a few included a pretest-posttest. In summary, these studies do not follow the recommendations of the model.

Predicting attrition of men with a history of violence from randomised clinical trials

Preventing dropout (attrition) from clinical trials is vital for improving study validity. Dropout is particularly important in justice-involved populations as they can be very challenging to engage and recruit in the first instance. This study identifies factors associated with dropout in a double-blind, placebo-controlled randomised control trial of a selective serotonin reuptake inhibitor (SSRI) aimed at reducing reoffending in highly impulsive men with histories of violent offending. Age, education, social support, psychiatric history, and length of previous incarceration were identified as factors that predict attrition. These findings are consistent with previous research examining variables associated with attrition in clinical trials for community and offender populations. We also explored referral source and treatment allocation as attrition predictors. Although neither significantly predicted attrition, we identified that there are discernible differences in the median time to attrition among the referral source subgroups. Understanding factors that predict treatment completion and attrition will allow researchers to identify participants for whom additional provisions may optimise retention and inform development of targeted interventions.

A randomized controlled trial examining the effects of intranasal oxytocin on alcohol craving and intimate partner aggression among couples

BACKGROUND

While alcohol use disorder (AUD) is a well-established risk factor for intimate partner aggression (IPA), effective treatments for co-occurring AUD and IPA (AUD/IPA) are lacking. Oxytocin is one promising pharmacological candidate for AUD/IPA given its potential to modulate social behavior and attenuate alcohol use. However, emerging data suggests that oxytocin's prosocial effects are inconsistent, and a small number of studies have also found that oxytocin might have the potential to be aggressogenic. No studies have directly examined the impact of oxytocin on alcohol- or IPA-related outcomes in a dyadic context.

METHODS

The goal of this double-blind, randomized, and placebo-controlled trial was to examine the effects of a single dose of intranasal oxytocin (40 international units) on cue-induced alcohol craving, subjective aggression, laboratory task-based IPA, and cortisol reactivity in a sample of 100 couples (N = 200 individuals) with AUD and physical IPA in their current relationship.

RESULTS

There were no statistically significant differences between the oxytocin and placebo conditions for any of the primary outcomes.

CONCLUSIONS

Findings suggest that a single dose of intranasal oxytocin was not efficacious in mitigating alcohol craving or aggression in this sample. Although hypotheses were not supported, the findings provide important evidence that oxytocin was not aggressogenic in this high-risk sample. Future research investigating dispositional and contextual moderators of oxytocin response in addition to the therapeutic effects of more intensive oxytocin dosing or administration strategies on alcohol craving and aggression is warranted.

Pathways to Seeking Help From a Partner Abuse Intervention Program: A Qualitative Study of Voluntary and Non-Court-Mandated Latino Men's Experiences

Involvement in treatment for intimate partner violence and abuse (IPV/A) perpetration is often limited to those who are arrested and convicted of domestic violence offenses. Consequently, the majority of research into partner abuse intervention programs (PAIPs; also known as batterer intervention programs [BIPs]) has utilized data from court-mandated participants despite the existence of voluntary programs. Therefore, little is known about the experiences of voluntary and non-court-mandated BIP/PAIP participants. Using an interpretive phenomenological analysis, this study sought to understand how participants perceived their lived experience in seeking help from a voluntary BIP/PAIP serving Latino men. Men volunteering for this study participated in semi-structured in-depth interviews (N = 16). The findings reveal that the decision to engage in a BIP/PAIP voluntarily is process laden. Participants described the process as involving a breakdown in the health of their intimate relationship, reaching tipping points at which avoiding help was no longer an option, and locating specific information on where to seek treatment. The findings also reveal that once involved, most participants anticipated and desired to engage in the program long term. This study illuminates the many factors that may contribute to decision-making when men who have acted abusively seek help. Strategies for increasing voluntary BIP/PAIP participation may involve enhancing marketing of services or information for accessing services, and personal relationship building between facilitators and potential participants.

Examining strength at home for preventing intimate partner violence in civilians

The Strength at Home (SAH) intervention, a trauma-informed, cognitive-behavioral intervention for intimate partner violence (IPV), was examined in a sample of court-mandated men. Evidence from prior research indicates that SAH is effective in military veterans but the program has not been examined in civilians. It was expected that SAH participants would evidence reductions in physical and psychological IPV, as well as secondary outcomes of post-traumatic stress disorder (PTSD) symptoms and alcohol use problems. Participants included 23 men court mandated to IPV intervention. The sample was low income and 72.7% had a reported prior history of severe physical IPV perpetration. Data from these participants and collateral partners were examined across assessments reflecting baseline, post-treatment, and two 3-month follow-ups. The outcome variables were assessed at each time point to examine change over time and a post-treatment satisfaction measure was also administered immediately following the intervention. Participants showed a significant linear decrease between baseline and post-treatment in all of the primary and secondary IPV outcomes, which maintained at 3- and 6-month follow-up time points. Effect sizes across models were moderate to large. Participants reported high satisfaction with SAH. Study findings provide preliminary support that the SAH intervention is associated with reductions in IPV among civilians and addresses other trauma- and alcohol-related problems. Further research including larger randomized controlled trials are needed to determine the efficacy of this intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Finding a Common Ground: Therapist Responsiveness to Male Clients Who Have Acted Violently Against Their Female Partner

Men in treatment for intimate partner violence (IPV) do often present with problem formulations that do not fit the therapeutic endeavor of personal change and may, therefore, challenge therapists in their effort to build an alliance. However, the therapist's initial contributions are also likely to influence whether the client finds it worthwhile to become involved in a working alliance. In a qualitative study of the in-session interactions between experienced therapists and men in IPV individual therapy, we looked for variations in therapist responsiveness to the client's initial invitations to identify whether and, eventually, how the two parties were able to reach common ground for working together. We studied therapist-client interactions in 20 therapy cases, including 10 completed cases with good outcomes and 10 dropout cases. Two sessions during the early phase of the therapy and the final session were audiotaped and transcribed verbatim. The transcriptions were analyzed following the guidelines of constructivist grounded theory. The analysis revealed three interactional patterns: co-creative exploration, pull-avoid repetitions, and tiptoeing softly around, each of which was associated with a distinctive set of therapist strategies. Clients participating in the co-creative pattern appeared to experience the most successful treatment. Our findings suggest that a model of therapist responses to client invitations is valuable for the conceptualization of the therapeutic alliance during the early sessions of psychotherapy. The findings also highlight the importance of clarifying and expanding upon the client's personal experience with his abuse to form a viable working alliance.

Risk and Protective Factors for Batterer Intervention Treatment Program Attrition: How Completers Are Distinct From Dropouts and No-Shows

The current study assessed attrition in batterer intervention treatment programs (BIPs). The influence of 25 risk and protective factors on treatment "no shows," "dropouts," and "completers" were examined for a large sample of male and female intimate partner violence offenders (n = 1,553). Multinomial regression analysis demonstrated that the relationship between risk/protective factors and treatment engagement was different across most factors: No shows were less likely to have a high school diploma/general educational development (GED), be employed, or to be on probation, and more likely to report a mental health problem, or have a history of drug crimes than completers (but not dropouts), while dropouts were more likely to have a history of general violence or property crimes than completers (but not no-shows). These distinctions can inform efforts to improve intake procedures and engagement strategies, and enhance recognition of "red flags" for early treatment disengagement.

Compared to What? A Meta-Analysis of Batterer Intervention Studies Using Nontreated Controls or Comparisons

This meta-analysis updates the literature on the effectiveness of batterer intervention programs (BIPs) in decreasing recidivism of domestic violence (DV) by focusing on studies with nontreated comparison groups (N = 17). Included studies were published between 1986 and 2016, and 14 of the 17 provided sufficient information for the meta-analysis. Analysis focused on three reported outcomes: DV recidivism reported by the criminal justice system, intimate partner violence (IPV) perpetration assessed by the survivor, and general offense recidivism reported by the criminal justice system. Results of meta-analysis indicated that BIPs were effective in decreasing DV recidivism and general offense recidivism when reported by the criminal justice system, but not when assessed by the survivor. BIP participants were about 3 times less likely to have DV recidivism and about 2.5 times less likely to have general offense recidivism, compared to nontreated control/comparison groups. The pooled effect size varied, however, by research design. Specifically, results indicated a nonsignificant pooled effect size for randomized controlled trials but a significant pooled effect size for quasi-experimental design studies. Implications for future practice and research are discussed.

Pathways to Engagement: An Exploratory Qualitative Analysis of Factors That Facilitate Men's Engagement in IPV Intervention Programs

Research on intimate partner violence (IPV) interventions has long indicated mixed support for their effectiveness at reducing abusive behaviors. Limited prior research has focused on factors associated with participant engagement in the treatment process. Using a qualitative thematic analysis and a sample of 180 participants who completed an IPV intervention program, the purpose of this study was to identify key factors that facilitate men's responsiveness to IPV intervention programs. The findings highlight several commonalities in participants' perceptions of pathways that facilitated and/or hindered their engagement in the treatment process, and provide insights into how program/process elements can be structured to enhance engagement.

Mandated Treatment and Its Impact on Therapeutic Process and Outcome Factors

Court-mandated treatments imply a dual role for therapy providers not only of caring for, but also of having control over, involuntary clients. The impact of legal coercion on the therapeutic relationship and feelings of stigma is widely regarded as negative and detrimental for treatment outcomes. This point of view stands in contrast to advocates of the perspective that involuntary treatment can ameliorate social functioning and thus promote a better quality of life. Regarding other outcome measures, there is evidence that offender treatment is effective and leads to reduced recidivism in criminal behavior. This narrative review provides an overview of research assessing the effects of mandatory treatment on therapeutic process and outcome factors. We conclude that legal mandatory treatment does not have to necessarily result in perceived coercion and reduced satisfaction with treatment and that a caring and authoritative treatment style aids a favorable therapeutic alliance, motivation, and therapy outcomes.

Factors Associated With Batterer Intervention Program Attrition

Batterer intervention programs' (BIPs) curriculum have been criticized for their one-size-fits-all approach to rehabilitation with recent research suggesting specialized and client-centric approaches to batterer intervention may be more effective than traditional programming. Adverse childhood experiences (ACEs) have been examined as a risk factor for intimate partner violence (IPV) perpetration and numerous studies suggest a relationship between ACEs and low mental health treatment engagement. However, absent from the conversation is how ACEs may influence BIP treatment engagement and more specifically how ACEs influence BIP program attendance and attrition. The current study used administrative data from a sample of 268 men enrolled in a county-operated BIP to explore this question. BIP participants who experienced any ACEs, only household dysfunction ACEs, and/or both household dysfunction ACEs and child abuse/neglect ACEs had decreased odds of BIP attrition compared to participants with no ACEs. These findings have practical implications regarding screening, service delivery, and BIP curricula and highlight additional research needed on this topic.

Perpetrators' and Victims' Attributions for IPV: A Critical Review of the Literature

Research shows that there are a variety of reasons why people self-report engaging in intimate partner violence (IPV) perpetration, but few studies report victims' attributions for their partners' IPV perpetration. Because there are two acting partners in relationships, as well as the IPV incidents that occur in the relationships, to fully understand the dynamics of IPV, both partners' perceptions of why the incidents occur must be understood. The authors of this article systematically reviewed the available empirical evidence regarding male and female perpetrators' endorsed attributions for their IPV perpetration, as well victims' attributions for their partners' IPV perpetration. Several literature databases were explored, resulting in 50 articles that met the criteria for inclusion in this review. IPV perpetrators' commonly endorsed attributions for physical and psychological IPV consisted of control, anger, retaliation, self-defense, to get attention, and an inability to express oneself verbally. Research has not examined endorsed attributions for coercive control. The few studies examining attributions for sexual IPV found that it was attributed to dominance or hedonism. Themes regarding victims' attributions were largely similar to those of the perpetrators, however, there were some differences. Victims' attributions for physical IPV perpetration consisted of anger, control, jealousy, and the influence of drugs/alcohol, which are similar to perpetrators' self-reported attributions for engaging in IPV perpetration. Victims' attributions for their partners' psychological IPV perpetration consisted of the perpetrator's personality, relationship dissolution, alcohol, and their partners' jealousy. Victims' attributions for their partners' sexual IPV perpetration, however, differed from perpetrators' attributions, consisting of the victim believing that the perpetrator thought they wanted it, being under the influence of alcohol/drugs, and doing it out of love. Methodological inconsistencies, directions for future research, and treatment implications are also discussed.

Integrated treatment options for male perpetrators of intimate partner violence

ISSUES

Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach.

APPROACH

We reviewed the partner violence literature for detailed reports of traditional as well as innovative, integrated treatment approaches. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered.

KEY FINDINGS

Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options.

IMPLICATIONS

We have advanced several recommendations, including the development of and exclusive reliance upon empirically supported treatments, conducting a thorough risk and needs assessment of the offender and the immediate family to facilitate appropriate treatment referrals, integrating content to foster the offender's internal motivation to change maladaptive behaviours, and attempting to minimise offender treatment burdens through the strategic use of integrated treatment models.

CONCLUSIONS

Intimate partner violence is a complicated and nuanced problem that is perpetrated by a heterogeneous population and requires greater variability in integrated treatment options. [Crane CA, Easton CJ. Integrated treatment options for male perpetrators of intimate partner violence. Drug Alcohol Rev 2017;36:24-33].

All Absences Are Not the Same: What Happens to the Group Climate When Someone is Absent From Group?

Clinical wisdom dictates that group member absences are harmful to the group; however, this has not been empirically examined. How do group member absences affect the group's climate, and do absences earlier or later in a group's life differentially impact group climate? The current study examined the relationship between group member absence and the climate perceptions for attending members, during earlier and later sessions in a group's development. As hypothesized, a significant interaction was found for group climate and time such that absences during early sessions were significantly related to higher levels of engagement and lower levels of avoidance (a more productive group atmosphere), while absences during later sessions were related to lower levels of engagement and higher levels of avoidance. Implications are discussed.

Exposure to violence, typology, and recidivism in a probation sample of domestic violence perpetrators

The present study investigated the predictive utility of self-reported domestic violence perpetrators' exposure to violence in their family of origin and patterns related to this exposure through the use of longitudinal analyses on a sample of 228 men on probation in Lake County, Illinois. Differences in typology, recidivism, recidivism frequency, and violent behavior survival patterns in men with a history of domestic violence perpetration and with varying levels of family of origin violence exposure were examined. Findings suggest that those who witnessed interparental violence (either alone, or in combination with experiencing violence) were most likely to be classified as Generally Violent offenders (e.g., perpetrators who direct violence toward their family and others), compared to those who did not report experiencing or witnessing violence. In addition, results also indicate that men who experienced both witnessing interparental violence and receiving physical abuse in childhood were more likely to recidivate more frequently compared to those who did not report experiencing or witnessing violence. No significant findings for typology and recidivism were noted. Clinical and policy/practice implications are discussed.

Dyadic violence and readiness to change among male intimate partner violence offenders

BACKGROUND

Although readiness to change is associated with mandated partner violence treatment compliance and subsequent violent behaviour among male offenders (e.g. Scott and Wolfe, 2003; Eckhardt et al., 2004), our understanding of the factors associated with pretreatment change remains limited. Offender research indicates that individual and dyadic violent behaviour are highly variable and that such variability may provide insight into levels of pretreatment change (Holtzworth-Munroe and Stuart, 1994; Archer, 2002).

AIMS/HYPOTHESES

We sought to examine the associations between indicators of change and individual as well as dyadic violence frequency in a sample of male partner violence offenders.

METHOD

To determine whether severity and perceived concordance in the use of violence among male offenders and their female partners influenced readiness to change at pretreatment, 82 recently adjudicated male perpetrators of intimate partner violence were recruited into the current study and administered measures of readiness to change violent behaviour (Revised Safe at Home Scale; Begun et al., 2008) as well as partner violence experiences (Revised Conflict Tactics Scale; Straus et al., 1996).

RESULTS

Analyses revealed an interaction between offender-reported male and female violence in the prediction of pretreatment readiness to change such that greater male violence was associated with greater readiness to change among males who reported that their female partners perpetrated low, but not high, levels of violence. Consistently, greater female violence was associated with lower readiness to change only among the most violent male offenders.

CONCLUSIONS AND IMPLICATIONS FOR CLINICAL PRACTICE

Results provide support for the assertion that the most violent offenders may be the most resistant to partner violence intervention efforts, particularly when they perceive themselves to be victims as well. Enhanced motivational and couples programming may facilitate treatment engagement among the high-risk group of male offenders who report concordant relationship violence.

Efficacy Assessment of an Intervention Program With Batterers

This study examines the efficacy of an intervention program with male batterers. Twenty-six batterers who attended the intervention and 19 batterers who did not attend the intervention were compared using self-report measures. Batterers who attended the intervention showed significant reductions in abusive behaviors, in attitudes toward domestic violence, in risk of future violence, and in psychopathology, and an increase in self-esteem and problem solving. These changes were confirmed at the 6-month follow-up. The control group also revealed reductions in abusive behaviors, psychopathology, and risk of violence; however, the intervention group showed higher effect sizes. Comparing the groups at post-test, differences were found on abusive behaviors, attitudes, and risk of violence; at the follow-up, differences were found on abusive behaviors, attitudes, self-esteem, and problem solving, with intervention group showing more positive changes. These findings suggest that the intervention program has a therapeutic effect and reduces the risk of future violence.

A Review of Quality Assurance Methods to Assist Professional Record Keeping: Implications for Providers of Interpersonal Violence Treatment

Errors have been found to frequently occur in the management of case records within mental health service systems. In cases involving interpersonal violence, such errors have been found to negatively impact service implementation and lead to significant trauma and fatalities. In an effort to ensure adherence to specified standards of care, quality assurance programs (QA) have been developed to monitor and enhance service implementation. These programs have generally been successful in facilitating record management. However, these systems are rarely disseminated, and not well integrated. Therefore, within the context of interpersonal violence, we provide an extensive review of evidence supported record keeping practices, and methods to assist in assuring these practices are implemented with adherence.

The alliance in relationship education programs

Couple relationship education (CRE) programs are associated with positive romantic relationship outcomes; however, the mechanisms by which these gains occur are less understood. The current study (122 couples) utilized actor-partner modeling to examine the association between the therapeutic alliance and dedication and negative and positive communication for racial/ethnic minority couples. Additionally, we examined whether gender and delivery format moderated these relationships. Results demonstrated that both men's and women's alliance scores were significantly related to their own outcomes. Higher ratings of alliance were related to partner outcomes for men only. The association between partners' alliance and dedication outcomes was stronger within the group format as compared to the couple format. Implications for leaders of CRE programs are offered.

The association of readiness to change and motivational interviewing with treatment outcomes in males involved in domestic violence group therapy

The present study investigated the impact of motivational interviewing (MI) and stage of change on a self-report measure of global functioning (Outcome Questionnaire [OQ 45.2]). Participants were men mandated to attend the Responsible Choices for Men (RCM) group therapy program following an incident of domestic violence. The study design utilized a quasi-experimental between-groups comparison utilizing data collected at three time points (pregroup, first group session, and final group session). One group of mandated program attendees received two sessions of MI (n = 106), whereas the comparison group did not (n = 106). Stage of change was assessed using the URICA-G and the URICA-DV (University of Rhode Island Change Assessment--Domestic Violence). Multilevel growth modeling indicated that stage of change has a significant relationship to global functioning. Discussion focuses on the potential benefits of MI as a pregroup treatment and the importance of accounting for individual readiness to change.

Male Abuser: Type of Violence and Perception of the Relationship with the Victim

This article explores violent behavior within a relationship from the male abuser's perspective. A systemic approach was used, combining qualitative and quantitative information in two parallel studies. The first (Study 1) is a descriptive analysis of a group of men ( N = 220) who participated in a program to address violence within the couple. In the second (Study 2), a subgroup of 8 participants was interviewed in-depth for describing and analyzing their perceptions of violence. The data analysis suggest that relationship violence (a) begins in the early stages of the relationship, (b) is long-term, (c) rarely includes serious physical aggression, (d) is dominated by a growing hostility and isolation, (e) is characterized by a lack of awareness and responsibility for the violent behavior, and (f) includes intentional and strategic use of violent behavior.

The physician's unique role in preventing violence: a neglected opportunity?

BACKGROUND

Episodes of explosive rage and violence comprise a symptom complex which can have a devastating effect on a person's life. In the community this behavior is seen as workplace violence, domestic abuse and road rage, while in the clinical setting, this behavior is rarely mentioned by patients, despite evidence that it can signify an important biological disorder that may afflict more than three percent of the population.

DISCUSSION

Patients are often reluctant to seek help for episodic attacks of rage, especially attacks which are accompanied by physical violence. Although, in the past, clinicians have had few treatment options to offer, recent neuroscience advances have created new possibilities to understand and help patients with this neglected problem. No formal medical guidelines for treating violence exist; however, many patients can be helped by diagnosis, referral and treatment. Treatment can include pharmaceuticals and nutrients, as well as referral for anger management or behavioral therapy.

SUMMARY

The astute clinician has an opportunity to positively impact an important problem through the diagnosis and treatment of patients with symptoms of intermittent explosive disorder.

Male perpetrators, the gender symmetry debate, and the rejection-abuse cycle: implications for treatment

This review article examined the gender symmetry debate in light of recent research relating to the feminist and family research perspectives on intimate partner violence, providing a context for rethinking perpetrator programs. The concept of coercive control is considered as an explanatory factor in an attempt to integrate the feminist and family research perspectives. The limited effectiveness of perpetrator programs is examined. Research highlighting potential factors that could improve the effectiveness of perpetrator programs is introduced, followed by a discussion of the rejection-abuse cycle, one attempt to incorporate current research into a more inclusive program. The rejection-abuse cycle identifies a pattern of perpetrator behavior, which links rejection, threat to self, defense against threat, and abuse. Finally, suggestions for changing perpetrator programs are elaborated, incorporating past research, which would make them appropriate for both male and female perpetrators. These implications are contextualized within a meta-theory to provide greater clarity for the development of future perpetrator programs.

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.

Psychological dimensions of antisocial personality disorder as predictors of psychotherapy noncompletion among sexual offenders

The goal of this study was to examine whether psychological dimensions of antisocial personality disorder (ASPD), as conceptualized by Kernberg (1992), could predict psychotherapy noncompletion (PNC) among 50 men found guilty of sexual abuse of children. All participants began a 65-week, court-mandated course of cognitive-behavioral psychotherapy, which 20 (40%) of them did not complete. Pretherapy personality was assessed with the Structured Clinical Interview for DSM Axis II Disorders (First, Spitzer, Gibbon, Williams, & Benjamin, 1997), the Personality Organization Diagnostic Form (Diguer, Normandin, & Hébert, 2001), and Blatt and colleagues' (Blatt, Bers, & Schaffer, 1993; Blatt, Chevron, Quinlan, Schaffer, & Wein, 1988) scales of mental representations, as well as the State-Trait Anger Expression Inventory (Spielberger, 1988). A discriminant function analysis, which explained 46% of the total variance, showed that descriptive (antisocial and narcissistic personality disorders), psychological (primitive defense mechanisms, identity diffusion and self-representations), and demographic (work status and income) variables predicted PNC. The classification analysis correctly classified 78% of the participants. These findings support the hypothesis that psychological dimensions of ASPD help explain PNC among sexual offenders. The authors discuss the theoretical and clinical implications of these results.

An examination of mandated versus voluntary referral as a determinant of clinical outcome

A literature review was undertaken to examine evidence for the effectiveness of psychotherapy with mandated clients. The primary question addressed was whether or not clients mandated to therapy, whether by court order or by order of their employers, show poorer outcomes than clients who enter therapy voluntarily. To this end, research on client resistance and motivational readiness to change was reviewed. This was followed by an examination of research on the effectiveness of mandated treatment. The question of the potential influence of relationship factors such as the therapeutic alliance was also addressed. The literature review was followed by suggestions for future research on the effectiveness of treatment for clients with mandated or voluntary referral status.

Resistance Among Domestic Violence Offenders

Batterers' resistance to traditional intervention programs has been well documented. Within a Transtheoretical Model of Change (stage of change) framework, a measure of processes of resistance was developed and administered to 346 adult male domestic violence offenders in treatment. The study yielded a 38-item measure that assesses eight dimensions of resistance: (a) System Blaming, (b) Problems with Partner, (c) Problems with Alliance, (d) Social Justification, (e) Hopelessness, (f) Isolation, (g) Psychological Reactance, and (h) Passive Reactance. The relationship between resistance and stage of change, time in treatment, and partner aggression are reported. Results suggest that we look beyond the most common forms of resistance (e.g., denial and victim-blaming) to identify and address other forms of resistance that may be more internally based and difficult to detect. The processes of resistance measure provides a tool for measuring those types of resistance.

Resistance, reluctance, and readiness in perpetrators of abuse against women and children

Perpetrators of abuse and violence against women and children are often reluctant participants in intervention programs. They frequently fail to attend scheduled appointments, are sometimes openly hostile to intervention staff, and often judge program materials as irrelevant to their situation. Recognizing this problem, researchers and practitioners have begun to develop models and tools to more appropriately assess and intervene with reluctant clients. Unfortunately, the resulting proliferation and inconsistent application of terms and theories have led to considerable confusion in characterizing reluctant clients and have significantly hampered research on strategies that may be helpful to better meet the needs of this client group. The purpose of this review is to help standardize the definition and measurement of treatment reluctance as it applies to violence perpetration and to review evidence for the importance of these aspects of client reluctance to intervention. Recommendations for assessing reluctance in research and clinical practice are also provided.

CBT intensity and outcome for panic disorder in a primary care setting

A hybrid efficacy-effectiveness design in which participants (n = 91/93) were retained in the study regardless of whether or not they received treatment enabled evaluation of CBT intensity in relation to panic disorder in the primary care setting. CBT intensity was operationalized as number of cognitive-behavioral therapy sessions, number of follow-up booster phone calls, and secondarily, as number of cognitive behavioral coping and exposure strategies. Baseline psychosocial and demographic predictors of CBT intensity were analyzed first. Severity of anxiety sensitivity predicted number of cognitive behavioral sessions, but no baseline variables predicted number of follow-up booster phone calls or number of coping and exposure strategies. Multivariate logistic and linear regressions were used to evaluate the degree to which treatment intensity predicted 3-month and 12-month outcomes (anxiety sensitivity, phobic avoidance, depressive symptoms, disability, and medical and mental health functioning) after controlling for potential confounding baseline variables. Number of cognitive behavioral therapy sessions predicted lower anxiety sensitivity at 3 and 12 months, and number of follow-up booster phone calls predicted lower anxiety sensitivity, less phobic avoidance, and less depression at 12 months. These findings indicate that "dose" of psychotherapy was an important predictor of outcome. The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment.

Does batterers' treatment work? A meta-analytic review of domestic violence treatment

This meta-analytic review examines the findings of 22 studies evaluating treatment efficacy for domestically violent males. The outcome literature of controlled quasi-experimental and experimental studies was reviewed to test the relative impact of Duluth model, cognitive-behavioral therapy (CBT), and other types of treatment on subsequent recidivism of violence. Study design and type of treatment were tested as moderators. Treatment design tended to have a small influence on effect size. There were no differences in effect sizes in comparing Duluth model vs. CBT-type interventions. Overall, effects due to treatment were in the small range, meaning that the current interventions have a minimal impact on reducing recidivism beyond the effect of being arrested. Analogies to treatment for other populations are presented for comparison. Implications for policy decisions and future research are discussed.

Personality, interpersonal, and motivational predictors of the working alliance in group cognitive-behavioral therapy for partner violent men

Recent studies have demonstrated that the working alliance predicts treatment outcome for partner violent men. This study examined the influence of personality and interpersonal characteristics, motivational readiness to change, and demographic factors on working alliance formation among a sample of men (N = 107) participating in a cognitive-behavioral group treatment program for partner violence. Motivational readiness to change was the strongest predictor of the working alliance. Psychopathic personality characteristics also emerged as a strong (negative) predictor of the working alliance. Lower levels of borderline personality characteristics and interpersonal problems, self-referred status, married status, and higher age and income predicted higher working alliance ratings. The results support recent clinical efforts to address motivational readiness in programs for partner violent men.

Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men

This study used multilevel modeling to examine process and treatment adherence factors as predictors of collateral partner reports of abuse following participation in a cognitive-behavioral grouptreatment program for partner violent men (N = 107). Therapist working alliance ratings predicted lower levels of physical and psychological abuse at the 6-month follow-up and were the strongest predictors of outcome. Homework compliance partially mediated associations between early alliance ratings and psychological abuse at follow-up. Greater group cohesion during treatment, assessed byclient report, also predicted lower physical and psychological abuse at follow-up. The findings support the promotion of a collaborative therapeutic environment to induce change among partner violent men.

Evaluation of an informal peer group experience on baccalaureate nursing students' emotional well-being and professional socialization

Although studies have documented the importance of the academic environment in promoting positive outcomes among students, few quantitative studies in nursing have been performed to identify strategies through which a nurturing learning environment can be created. A randomized two-group pretest-posttest design was used to investigate effects of an informal peer group experience on baccalaureate nursing students' emotional well-being and professional socialization as caring practitioners. Groups did not differ significantly on the outcomes measured in this study. As a whole, students showed statistically significant increases in anxiety, depression, and negative affect, along with decreased self-esteem and positive affect during the junior year of nursing school. Psychological problems and stress-related symptoms have been well documented among college students in general and professional students in particular. Although the findings from this study are not unique, they suggest the need to reconsider strategies by which the affective and professional socialization goals of undergraduate nursing education can be achieved.