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

Which battering interventions work? An updated Meta-analytic review of intimate partner violence treatment outcome research

This meta-analytic review is an update to the first meta-analysis of battering interventions (Babcock et al., 2004) and includes 59 studies that evaluated treatment efficacy for domestically violent men and women. The outcome literature of controlled quasi-experimental and experimental studies was reviewed to test the relative impact of Duluth, cognitive-behavioral therapy (CBT), and novel types of treatment on subsequent recidivism of violence. The first model examines studies comparing interventions to no treatment control conditions. The second model compares novel interventions to treatment as usual (i.e., the Duluth curriculum). Study design and type of treatment were tested as moderators in both models. Consistent with previous meta-analyses, effect sizes were in the small range, smaller in true experiments as compared to quasi-experimental designs when recidivism was based on partner or police reports. However, new experiments comparing novel treatments to the Duluth curriculum reveal effect sizes comparable to when comparing novel interventions to an untreated comparison group. Novel interventions, including Acceptance and Commitment Therapy and Circles of Peace had the largest effect sizes when put head-to-head with Duluth control groups. Future research directions include testing moderators and mechanisms of change of the battering interventions that work. Implications for evidence-based practice in criminal justice include broader implementation and continued testing of these novel interventions with demonstrated efficacy in stopping intimate partner violence.

Magnus J, Assefa N, Wordofa MA. The protocol for a cluster randomized controlled trial to evaluate couple-based violence prevention education and its ability to reduce intimate partner violence during pregnancy in Southwest Ethiopia

BACKGROUND

A significant proportion of women in Ethiopia suffer from violence by their intimate partner during pregnancy, which has adverse maternal and newborn outcomes. Couple-focused interventions are effective in reducing and/or controlling violence between women and their intimate partners. However, interventions addressing intimate partners of the victims are not well studied, particularly in the Ethiopian setting. This study aims to assess the effect of couple-based violence prevention education on intimate partner violence during pregnancy.

METHODS

We will use a cluster randomized controlled trial to evaluate the effectiveness of couple-based violence prevention education compared to routine care in reducing intimate partner violence during pregnancy. Sixteen kebeles will be randomly assigned to 8 interventions and 8 control groups. In the trial, 432 couples whose wife is pregnant will participate. Health extension workers (HEWs) will provide health education. Data will be collected at baseline and endline. All the collected data will be analyzed using Stata version 16.0 or SPSS version 25.0. We will use the McNemar test to assess the differences in outcomes of interest in both intervention and control groups before and after the intervention for categorical data. A paired t-test will be used to compare continuous outcome of interest in the intervention and the control groups after and before the intervention. The GEE (Generalized Estimating Equation), will be used to test the independent effect of the intervention on the outcome of the interest. Data analysis will be performed with an intention-to-treat analysis approach. During the analysis, the effect size, confidence interval, and p-value will be calculated. All tests will be two-sided, and statistical significance will be declared at p < 0.05.

DISCUSSION

We expect that the study will generate findings that can illuminate violence prevention strategies and practices in Ethiopia.

TRIAL REGISTRATION

It has been registered on ClinicalTrials.gov as NCT05856214 on May 4, 2023.

Beyond the Surface: Intimate Partner Violence Typology and Recent Depression

Depression and intimate partner violence (IPV) are highly related. However, it is unclear what drives this relationship: the form of violence (psychological, physical, or sexual) or its severity. In this study, we first identify patterns of combined forms and severity of violence and then estimate the effects of IPV on depression. We use the DHS and focus on Peru, a country with high IPV rates. Five classes of IPV were identified. The more intense the IPV class, the higher the effect on recent depression. However, the effect on depression tends to be smaller when levels of depression are higher.

Efficacy of Psychosocial Interventions for Survivors of Intimate Partner Violence: A Systematic Review and Meta-Analysis

Survivors of intimate partner violence (IPV) face serious health-related, social and economic consequences. Prior meta-analyses indicate efficacy of psychosocial interventions for support of IPV survivors, but their results are affected by methodological limitations. Extensive subgroup analyses on the moderating effects of intervention and study characteristics are lacking. To address these limitations in an up-to-date and comprehensive meta-analytic review, four literature databases (PsycInfo, Medline, Embase, and CENTRAL, March 23, 2022) were searched for randomized-controlled trials examining the efficacy of psychosocial interventions compared to control groups in improving safety-related, mental health, and psychosocial outcomes in IPV survivors. Weighted effects on IPV, depression, posttraumatic stress disorder (PTSD), and psychosocial outcomes were calculated under random-effects assumption. Subgroup analyses were performed to investigate moderating effects of predefined intervention and study characteristics. Study quality was rated. In all, 80 studies were included in qualitative synthesis, and 40 studies in meta-analyses. Psychosocial interventions significantly reduced symptoms of depression (SMD: -0.15 [95% confidence interval, CI [-0.25, -0.04]; p = .006], I2 = 54%) and PTSD (SMD: -0.15 [95% CI [-0.29, -0.01]; p = .04], I2 = 52%), but not IPV reexperience (SMD: -0.02 [95% CI [ -0.09, 0.06]; p = .70], I2 = 21%) compared to control conditions at post. High-intensive and integrative interventions, combining advocacy-based and psychological components, were favorable subgroups. Yielded effects were modest and not maintained long term. The quality of evidence was low and potential harms remain unclear. Future research should adopt higher standards of research conduct and reporting and must account for the complexity and diversity of IPV experiences.

The relationship between emotional intimate partner violence and other forms of violence: A metaanalytic review

The present study aimed to explore the relationship between emotional intimate partner violence (IPV) and different forms of violence (e.g., stalking perpetration and victimization, physical IPV perpetration and victimization, sexual IPV perpetration and victimization, and controlling behaviors) using a meta-analysis. Data from 188 studies, yielding 382 effect sizes, were used to compare the strength of correlates for IPV victimization versus perpetration, as well as gendered results. This meta-analysis found, in order of strength, controlling behaviors victimization, physical IPV victimization, physical IPV perpetration, sexual IPV victimization, stalking victimization, and sexual IPV perpetration were significantly associated with emotional IPV victimization. The meta-analysis also found, in order of strength, emotional IPV perpetration was positively associated with stalking perpetration, physical IPV perpetration, causing injury to a partner, controlling behaviors victimization, sexual IPV perpetration, physical IPV victimization, controlling behaviors perpetration, and sexual IPV victimization. This study found limited significant differences around gender, with physical IPV victimization approaching significance for emotional IPV perpetration for women. The current study highlights the implications associated with early assessment and intervention in cases of IPV.

Is It Safe Enough? An IPA Study of How Couple Therapists Make Sense of Their Decision to Either Stop or Continue with Couple Therapy When Violence Becomes the Issue

BACKGROUND

Couple therapists will encounter couple violence in their practice at some point. In this context, one of the main questions they must address is whether to continue with conjoint sessions. This study explores how couple therapists make sense of their decision whether or not to continue with conjoint sessions when violence has become an issue.

METHODS

This qualitative study used four semi-structured focus groups and Interpretative Phenomenological Analysis (IPA) to analyse the data from the twelve experienced couple therapist participants.

RESULTS

Our IPA analysis led to three main group experiential themes across the focus groups: (1) Is it safe enough? (2) Do we have a joint and regenerative project? (3) Three key sources for sense making.

CONCLUSION

Partner violence challenges the realm of couple therapy. This article explored how the couple therapists orient themselves and grapple with decision making when violence becomes an issue. The article offers unique insights regarding what the therapists orient themselves towards and how they try to form an impression of whether to continue conjoint sessions. We outline immediate clinical implications and propose measures for building individual and organisational capacity regarding "clinical sense making". Suggestions for further research are also addressed.

Systematic review and data synthesis on the treatment of sexual violence victimization by an intimate partner

This study aims to conduct a systematic review and synthesis on the treatment of sexual violence victimization by an intimate partner evaluating specifically the impact of treatment on mental health outcomes of female sexual intimate partner violence (IPV) survivors. We followed the Cochrane Handbook for Systemic Reviews of Interventions guidelines for the process of conducting systematic reviews. We were unable to conduct meta-analyses due to the substantial heterogeneity of the interventions for IPV. A qualitative summary of 6 controlled studies identified no benefit to the treatment of sexual coercion, posttraumatic stress disorder, depression, or anxiety for female sexual IPV survivors. However, we are limited by a paucity of data for each outcome on this subject. In conclusion, sexual coercion is a complex issue that has adverse effects on mental health and the well-being of the survivors. More research is needed that investigates what kind of interventions are effective for this specific population.

Mental and Physical Health Correlates for Emotional Intimate Partner Violence Perpetration and Victimization: A Meta-Analysis

Approximately 50% of both men and women will experience emotional intimate partner violence (IPV) in their lifetime-a form of violence highly associated with other forms of IPV-making it important to develop further understanding of for assessment and treatment purposes. The bio-psycho-social model was used to guide the study. Utilizing data from 181 studies, yielding 348 effect sizes, we conducted a meta-analysis examining mental and physical health correlates with emotional IPV perpetration and victimization. We also examined if mental and physical health correlates were significantly stronger for emotional IPV perpetration or victimization, as well as if correlates were stronger for men or women. Suicidal ideation, post-traumatic stress, anxiety, depressive symptoms, borderline personality disorder (PD), psychological distress, physical pain, trauma, anger, shame, poor physical health, antisocial PD, and somatic symptoms were significantly associated with emotional IPV victimization. Borderline PD, narcissism, emotional dysregulation, anger, post-traumatic stress, antisocial PD, psychopathy, depressive symptoms, anxiety symptoms, and trauma were significantly associated with emotional IPV perpetration. Anger, emotional dysregulation, and psychopathology were stronger correlates for emotional IPV perpetration compared to victimization, and post-traumatic stress disorder (PTSD) and psychological distress were stronger correlates for victimization. PTSD and suicidal ideation were stronger correlates of IPV victimization for women than men, and anger was a significantly stronger correlate of IPV perpetration for women than men. This study highlights the importance of a holistic approach when working with victims and perpetrators of IPV, focusing on the importance of taking all aspects of the bio-psycho-social model into account.

Risk Markers for Victimization and Perpetration of Male-to-Female Physical Intimate Partner Violence in Sub-Saharan Africa: A Meta-Analysis

Exposure to intimate partner violence (IPV) incurs significant public health consequences. Understanding risk markers can accelerate prevention and response efforts, important in settings like Sub-Saharan Africa (SSA) where resources are scarce. In this study, four databases were searched to identify studies that examined risk markers for male-to-female physical IPV. With application of the socioecological model, we analyzed 11 risk markers for male physical IPV perpetration (with 71 effect sizes) and 16 risk markers for female physical IPV victimization (with 131 effect sizes) in SSA from 51 studies. For male IPV perpetration, we found medium-to-large effect sizes for six risk markers: perpetrating emotional abuse and sexual IPV, witnessing parental IPV, being abused as a child, cohabitating (not married), and exhibiting controlling behaviors. We found small effect sizes for substance use. Employment, age, marital status, and education were not significant risk markers. For female IPV victimization, a medium effect size was found for post-traumatic stress symptoms. Small effect sizes were found for reporting depressive symptoms, being abused as a child, witnessing parental IPV, and reporting drug and alcohol use. Rural residence, approval of violence, length of relationship, income, education, employment, age, marital status, and religiosity were not significant risk markers. Findings highlight opportunities for screening and intervention at the couple level, show the need to test and incorporate interventions for IPV in mental health treatment, and emphasize the importance of further research on sociodemographic risk markers and the interventions that target them.

Relationship risk factors for intimate partner violence among sexual and gender minorities: A multilevel analysis

Intimate partner violence (IPV) is alarmingly prevalent among sexual and gender minority youth assigned female at birth (SGM-AFAB), making it important to identify risk factors that can be targeted in prevention efforts for this population. Although several relationship-level risk factors for IPV have been identified in different-sex couples, research on SGM-AFAB is sparse and predominantly cross-sectional. The present study used seven waves of data from a longitudinal cohort study of SGM-AFAB youth (n = 463) to explore relationship factors (relationship quality, destructive conflict, and self- and partner-jealousy) as risk factors for perpetration and victimization of three types of IPV (physical, psychological, and coercive control). At each wave, participants reported on relationship factors and IPV for up to three romantic partners in the past 6 months. Multilevel models tested for associations between the relationship factors and IPV at three levels: between-persons, within-persons across time (wave), and within-persons across relationships. Relationship quality was associated with IPV mostly at the between-persons and within-persons (wave) levels. Couple conflict was associated with all IPV outcomes at all levels. Partner jealousy was more consistently associated with IPV victimization; participant jealousy was more consistently linked with IPV perpetration. These novel findings suggest that, within SGM individuals, IPV may be influenced by relationship quality, destructive conflict, and jealousy as they fluctuate within individuals from relationship to relationship and within individuals over time. As such, these relationship factors represent promising potential targets for interventions to reduce IPV among SGM-AFAB youth.

'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women

Transgender women are among the populations at highest risk for HIV in the USA and have elevated risk for intimate partner violence (IPV). There is an urgent need for integrated HIV-IPV prevention interventions for transgender women. Using qualitative methods, we explored transgender women's lived experiences of IPV and the relationship between IPV and HIV risk. Using thematic analysis, we identified four key concepts that warrant inclusion in the development of models for IPV and HIV interventions: (1) considering the boundaries of IPV; (2) normalising expectations of chronic violence; (3) relationship safety; (4) calls for trans-affirming and empowering services.

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

Women Veterans' experiences discussing household firearms with their intimate partners: collaborative, devalued, and deferential relational types

BACKGROUND

Rates of firearm suicide have increased among women Veterans. Discussing firearm access and reducing access to lethal means of suicide when suicide risk is heightened are central tenets of suicide prevention, as is tailoring suicide prevention strategies to specific populations. While research has begun to explore how to optimize firearm lethal means safety counseling with women Veterans, there is limited knowledge of women Veterans' perspectives on including their intimate partners in such efforts. This gap is notable since many women Veterans have access to firearms owned by other household members. Understanding women Veterans' experiences and perspectives regarding including their partners in firearm lethal means safety conversations can provide important information for tailoring firearm lethal means safety counseling for women Veterans.

METHODS

Qualitative interviews were conducted with 40 women Veterans with current or prior household firearm access. Interview questions focused on the roles of women Veterans' partners in household firearm access and storage, as well as women Veterans' perspectives regarding including intimate partners in firearm lethal means safety counseling. Inductive thematic analysis was performed.

RESULTS

Three relational types characterized how household firearms were discussed between women Veterans and their partners: collaborative, devalued, and deferential. These types were distinguished via women Veterans' agency in decision-making related to household firearms, partners' receptivity to women Veterans' mental health or trauma histories, and willingness (or lack thereof) of partners to change household firearm access and storage considering such histories. Intimate partner violence was common in the devalued relational subtype.

CONCLUSIONS

Findings extend knowledge regarding the context of women Veterans' household firearm access, including relational dynamics between women Veterans and their partners. The acceptability, feasibility, challenges, and facilitators of including women Veterans' partners in firearm lethal means safety efforts likely vary for each relational type. For example, in dyads with a collaborative dynamic, incorporating partners may create opportunities for increased firearm safety, whereas including partners in devalued dynamics may present unique challenges. Research is warranted to determine optimal methods of navigating firearm lethal means safety counseling in the presence of each relational dynamic.

Cumulative Childhood Trauma, Communication Patterns, and Intimate Partner Violence Perpetrated by Men Seeking Help

Intimate partner violence (IPV) is a complex and multifactorial public health problem associated with important physical and psychological repercussions. Recent studies suggest that cumulative childhood trauma (CCT) may be related to higher IPV perpetration through dysfunctional communication patterns, but to our knowledge, no study has tested this proposition in a clinical population. This study aimed to explore the direct and indirect links between CCT and perpetrated IPV through dysfunctional communication patterns among 577 men seeking help from community centers specializing in IPV. Prior to receiving services, participants completed a battery of questionnaires including validated brief measures of CCT (sexual, physical, and psychological abuse; physical and psychological neglect; witnessing of physical and psychological parental violence; bullying), communication patterns (demand/demand, partner demands/man withdraws, man demands/partner withdraws), and IPV (psychological, physical, coercive control). Results from a path analysis reveal that having sustained a higher number of different forms of childhood trauma is directly related to men's higher risk of perpetrating psychological IPV. CCT is also indirectly related to higher perpetrated psychological and physical IPV and coercive control through a higher report of the demand/demand communication pattern and a higher report of the man demands/partner withdraws communication pattern. The tested model explains 23% of the variance in psychological IPV, 6% of the variance in physical IPV, and 12% of the variance in coercive control. Results highlight the importance of assessing, in therapy, both distal and proximal variables associated with IPV, including the accumulation of many forms of childhood interpersonal trauma, and to tailor trauma-informed interventions that promote constructive communication strategies.

Relationship dynamics associated with emotional IPV perpetration and victimization: A meta-analysis

Emotional intimate partner violence (IPV) is the most common form of IPV and frequently co-occurs with other forms of IPV. Risk factors of IPV can give insight to potential pathways and consequences associated with IPV, enhancing treatment efforts. This meta-analysis examined relationship dynamics associated with IPV perpetration and victimization. Our study found victimization of controlling behavior, demand/withdrawal relationship pattern, perpetration of controlling behavior, jealousy, relationship distress, perpetrator's power in the relationship, anxious attachment, and traditional gender roles were all significantly associated with IPV perpetration. For IPV victimization, victimization of controlling behaviors, fear of the perpetrator, relationship distress, anxious and avoidant attachment, and traditional gender roles were all found to be significantly associated. Relationship satisfaction was found to be negatively associated with emotional IPV perpetration and victimization. Implications for clinicians are discussed.

Systemic Obstacles to Addressing Research Misconduct in Higher Education: A Case Study

Several widely publicized incidents of academic research misconduct, combined with the politicization of the role of science in public health and policy discourse (e.g., COVID, immunizations) threaten to undermine faith in the integrity of empirical research. Researchers often maintain that peer-review and study replication allow the field to self-police and self-correct; however, stark disparities between official reports of academic research misconduct and self-reports of academic researchers, specifically with regard to data fabrication, belie this argument. Further, systemic imperatives in academic settings often incentivize institutional responses that focus on minimizing reputational harm rather than the impact of fabricated data on the integrity of extant and future research.

Child Maltreatment and Intimate Partner Violence in Mental Health Settings

Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.

Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels

This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.

Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity

Purposeof Review

Intimate partner violence (IPV) is a complex traumatic experience that often co-occurs, or is causally linked, with other forms of structural violence and oppression. However, few IPV interventions integrate this social-ecological perspective. We examine trauma- and violence-informed care (TVIC) in the context of existing IPV interventions as an explicitly equity-oriented approach to IPV prevention and response.

Recent Findings

Systematic reviews of IPV interventions along the public health prevention spectrum show mixed findings, with those with a theoretically grounded, structural approach that integrates a trauma lens more likely to show benefit.

Summary

TVIC, embedded in survivor-centered protocols with an explicit theory of change, is emerging as an equity-promoting approach underpinning IPV intervention. Explicit attention to structural violence and the complexity of IPV, systems and sites of intervention, and survivors’ diverse and intersectional lived experiences has significant potential to transform policy and practice.

Intimate Partner Violence Perpetration Among Military Spouses

Military spouses are an understudied population with respect to intimate partner violence (IPV) perpetration. Due to the unique demands of service members' jobs, military couples are documented to experience particular individual, couple, and family-level risk factors that may lead to IPV perpetration. Using the frustration-aggression hypothesis and considering the possibility of mutual violence, we examined (a) the direct effects of stressful events, marital discord, and work-family conflict on IPV perpetration among military spouses and (b) the indirect effect of anger arousal between stressful events, marital discord, and work-family conflict on IPV perpetration. This study is a secondary analysis of data drawn from a survey of army spouses conducted by the Walter Reed Army Institute of Research in 2012. The sample consists of 314 female spouses of active-duty members (white 75%, enlisted 80%). After controlling for covariates (including spouse race, rank, household size, age, living distance from military installation), the direct effects of marital discord and anger on IPV perpetration were statistically significant. Also, the direct effects of marital discord and work-family conflict on anger were significant. The path model demonstrated that the indirect effects of marital discord and work-family conflict on IPV perpetration via anger were significant. Finally, most physical and verbal violence was reported to occur in the form of mutual violence with their partners. Study findings suggest that the pathway of risk factors impacting IPV might differ depending on the sources of stress. The Family Advocacy Program, military social work practitioners, and other behavioral health providers should consider domains of risk and provide support to military spouses that is specifically tailored to these risk factors. Furthermore, considering the mediating role of anger arousal in the relationship between marital discord, work-family conflict and IPV, programs to address anger might be helpful to reduce IPV among military spouse perpetrators.

Improving the mental health of women intimate partner violence survivors: Findings from a realist review of psychosocial interventions

BACKGROUND

Intimate partner violence (IPV) is highly prevalent and is associated with a range of mental health problems. A broad range of psychosocial interventions have been developed to support the recovery of women survivors of IPV, but their mechanisms of action remain unclear.

METHODS

Realist review following a prospectively published protocol in PROSPERO (CRD42018114207) and reported using the Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMSES) guidelines.

RESULTS

Evidence was extracted from 60 reviews and triangulated in expert consultations. Mechanisms of action were categorised as either associated with intervention design and delivery or with specific intervention components (access to resources and services; safety, control and support; increased knowledge; alterations to affective states and cognitions; improved self-management; improved family and social relations).

CONCLUSIONS

Findings suggest that psychosocial interventions to improve the mental health of women survivors of IPV have the greatest impact when they take a holistic view of the problem and provide individualised and trauma-informed support.

Thinking under fire: Mentalization-based couple therapy for high conflict and domestically abusive couples'

BACKGROUND

The question of working psychotherapeutically with high conflict and domestically abusive couples is one that continues to raise anxieties within the field.

AIMS

Embracing a relational approach offers an alternative perspective to the more familiar individual-based treatment interventions.

MATERIALS AND METHODS

Drawing on my therapy with a married couple who presented in a crisis following an abusive incident, I will outline how I approached the assessment, my understanding of their presenting problem and the basis on which the therapy was conducted.

RESULTS

During the eight months of treatment, the couple had frequent breakdowns in communication, and I found myself drawing on a range of mentalization-based techniques that supported and maintained the working alliance.

DISCUSSION

Helping the couple break the damaging effects of the abuse, which was seriously affecting them and impacting their children, provides a particular focus for this submission.

CONCLUSION

The rationale for undertaking couple therapy in situations of domestic violence and abuse was examined. The dynamic elements of theory underpinning practice, together with mentalization-based techniques designed to tackle disregulated states of mind that may lead to violent and abusive exchanges, were considered through the presentation of a case example.

Using systemic interventions to reduce intimate partner violence or child maltreatment: A systematic review of publications between 2010 and 2019

This systematic review seeks to understand the effectiveness of systemic interventions to reduce Intimate Partner Violence (IPV) or child maltreatment published between January 2010 and December 2019. We found nine studies reviewing systemic interventions for IPV and 12 studies reviewing systemic interventions for child maltreatment. In our discussion, we added relevant articles published before 2010 to determine the overall state of the evidence for these interventions. We determined that parent training programs with in vivo coaching components for child maltreatment meet the criteria for well-established interventions. Relationship education approaches are probably efficacious. Parent education and family therapy programs to reduce child maltreatment, and cognitive behavioral couples treatment to reduce IPV are possibly efficacious interventions. Programs based on "naturalistic" couples therapy for IPV are experimental interventions. This review also highlights limitations in this research in addressing the needs of marginalized couples and families.

Exposición a la violencia de pareja: comprensiones desde su naturalización en hombres y mujeres colombianos

Objetivo Evaluar si las representaciones sociales sobre violencia de pareja se relacionan con su naturalización. Material y Métodos Estudio exploratorio, mediante cuestionario, con participación de 731 hombres y mujeres en unión marital vigente. Resultados El 82% reporta haber sufrido violencia de su pareja. De este grupo el 51% se reconoce como víctima. El grupo que no reporta haber sufrido episodios violentos muestra una puntuación media inferior en la aceptación de los mitos en comparación con los grupos que reportan haber padecido violencia, se reconozcan o no como víctimas. Al relacionar el grado de acuerdo de los mitos con variables sociodemo-gráficas, se obtiene una correlación significativa con el nivel de educación (r=-0,283; p<0.000). Este puntaje tiene una correlación significativa con violencia psicológica (r=0.194; p<0.001) y física. Conclusiones Los resultados no son concluyentes puesto que no todos los mitos incluidos en esta investigación se relacionan directamente con procesos de naturalización de la violencia. No obstante, se constituye en un avance de conocimiento por las trazas de naturalización de la violencia encontradas respecto a los factores culturales, sociales y familiares que facilitan la reproducción de las relaciones asimétricas entre hombres y mujeres. Asimismo, el nivel de desacuerdo con los mitos se reconoce como factor protector.

Treatment for perpetrators of intimate partner violence: What is the evidence?

Intimate partner violence (IPV) is recognized as a worldwide health issue that calls for urgent interventions to prevent the significant physical and mental harm it poses to the individuals involved and to reduce its wider deleterious impacts on society. Despite 40 years of research in the field, incidence rates of IPV have not significantly declined and treatment services for perpetrators of IPV are scarce. Empirical research has been hindered by ideological disputes, and the most commonly used treatment approaches-the feminist-oriented Duluth approach and cognitive-behavioral treatments-lack evidence for their efficacy. This introduction to this issue of In Session reviews these ideological controversies and the current state of empirical evidence for the treatment of perpetrators of IPV; and summarizes the five papers, commissioned from different countries in Europe, North America, and Africa, comprising this issue, each of which presents a novel therapeutic intervention for this heterogeneous population.

Clinical Care of Victims of Interpersonal Violence and Rape in Tanzania: A Qualitative Investigation

Introduction

Africa has high rates of interpersonal violence and rape, although little is known about how these cases are handled in the clinical setting.

Methods

We enrolled 121 health care professionals and students in Tanzania from the fields of midwifery, nursing and medicine, and conducted 18 focus group discussions stratified by both professional and clinical experience. Two clinical scenarios were presented across all groups and participants were asked to give their opinions on how the hospital they worked in would manage the cases. Case 1 focused on how to address a case of an injured woman beaten by her husband (and whether the perpetrator would be reported to the police). Case 2 focused on how to handle a rape victim who is brought to the hospital by the police.

Results

Participants considered both cases as emergencies. There was a similarity in the clinical care procedures across both scenarios. This included building rapport with the patient, prioritization of the medical care, history taking, and referring to other specialties for follow-up. Participants differed in how they would handle the legal aspects of both cases, including whether and how to best follow mandated reporting policies. Providers wondered if they should report the husband in case study 1, the criteria for reporting, and where to report. Providers displayed a lack of knowledge about resources needed for sexual violence victim and the availability of resources.

Conclusion

These findings indicate that cases of intimate partner violence and rape are likely to be under-reported within hospitals and clinics in Tanzania. Health care providers lack training in their required obligations and procedures that need to be followed to ensure victim’s safety. The findings confirm that there is a need for health care students in Tanzania (and possibly Africa) to receive comprehensive training in how to handle such cases.

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.

Development and Psychometric Properties of the Test of Passive Aggression

Background: To date, most research on aggression in mental disorders focused on active-aggressive behavior and found self-directed and other-directed active aggression to be a symptom and risk-factor of psychopathology. On the other hand, passive-aggressive behavior has been investigated less frequently and only in research on psychodynamic defense mechanisms, personality disorders, and dysfunctional self-control processes. This small number of studies primarily reflects a lack of a reliable and valid clinical assessment of passive-aggressive behavior. To address this gap, we developed the Test of Passive Aggression (TPA), a 24-item self-rating scale for the assessment of self-directed and other-directed passive-aggressive behavior. Method: Study 1 examined the internal consistency and factorial validity of the TPA in an inpatient sample (N = 307). Study 2 investigated the retest-reliability, internal consistency, and construct validity (active aggression, personality traits, impulsivity) of the TPA in a student sample (N = 180). Results: In line with our hypothesis, Exploratory Structural Equation Modeling revealed an acceptable to good fit of a bi-factorial structure of the TPA (Chi-square-df-ratio = 1.98; RMSR = 0.05, fit.off = 0.96). Both TPA scales showed good to excellent internal consistency (α = 0.83-0.90) and 4-week retest-reliability (r tt = 0.86). Correlations with well-established aggression scales, measures of personality, and impulsivity support discriminant and convergent validity of the TPA. Conclusions: The TPA is a reliable and valid instrument for the assessment of self-directed and other-directed passive-aggressive behavior.

The Association between Attachment Styles and Physical Intimate Partner Violence Perpetration and Victimization: A Meta-Analysis

In this meta-analysis, we examine attachment styles-something commonly incorporated into couples therapy-and their association with physical intimate partner violence (IPV) perpetration and victimization among men and women. This meta-analysis incorporated 33 studies that looked at the association between four different attachment styles and IPV. This study examined the strength of the correlation among different attachment styles and IPV perpetration and victimization, examined gender differences in the strength of the association among attachment styles and IPV, and compared the strength of the association with IPV among different attachment styles. We found that anxious attachment, avoidant attachment, and disorganized attachment styles were all significantly associated with physical IPV perpetration and victimization. Secure attachment was significantly negatively related to IPV perpetration and victimization. There was a significantly stronger association between avoidant attachment and IPV victimization for women compared to men. Clinical implications related to the importance of fostering secure attachments when working with couples or individuals who have experienced IPV are addressed.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.

International Adaptation of a Treatment Program for Situational Couple Violence

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

Interventions for Couples

Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.

A Whole Life Of Threats: A Qualitative Exploration Of Lived Experiences Of Palestinian Women Suffering From Intimate Partner Violence

Background

Violence against women is a widespread public health problem in the Palestinian community considered to be a traditional community. It is usually underreported due to cultural and religious issues. The present study was carried out in order to deepen the understanding of the feelings, thoughts, and perceptions of Palestinian women living in the Gaza Strip and suffering from intimate partner violence.

Methods

Hermeneutic phenomenological study was conducted. The recruited 11 Palestinian women suffering from intimate partner violence were selected via purposive means. Semi-structured in-depth interviews conducted from May to Sept 2018 were used to understand their lived experience. Data was analyzed through the Van Manen method.

Results

In the process of data analysis, living in a threatening world was the main theme that was extracted from the data. The theme refers to the condition that participants were committed to their marriage and are compelled to remain in a threatening situation. That was interpreted as a whole life of threats, which was labeled as the main theme emerging from three sub-themes. This main theme included 3 subthemes namely “live in a physically threatening environment”, “live in psychologically threatening environment”, and “live in sexual threatening environment”.

Conclusion

As revealed in our study, the participant suffered extremely from intimate partner violence and its consequences, which negatively affected their lives. However, their concerns about their children and lack of support were barriers for them to get a divorce; therefore, abused women need help to deal with their current lives like access to social and psychological counseling.

Prevalence and correlates of partner violence among adolescent girls and young women: Evidence from baseline data of a cluster randomised trial in Tanzania

Background

Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania.

Methods

A cross-sectional analysis of data from AGYW aged 15–23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association.

Results

2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence.

Conclusions

Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW.

Trial registration

ClinicalTrials.gov—IDNCT03597243.

Designing a Pilot Study Protocol to Test a Male Alcohol Use and Intimate Partner Violence Reduction Intervention in India: Beautiful Home

Introduction: Evidence suggests alcohol consumption is correlated with intimate partner violence (IPV) making alcohol reduction interventions a promising method for reducing IPV. While both financial incentive and cognitive behavioral therapy (CBT) interventions in high-income countries, respectively, have effectively reduced alcohol consumption and IPV perpetration among men, little evidence exists demonstrating that these approaches can work in a low-resource setting. Methods: The objective of this study is to design and pilot test a low-cost, scalable intervention for reducing alcohol consumption and IPV in Bengaluru, India, where alcohol has been shown to be a key driver of high rates of IPV. A pilot randomized controlled trial (RCT) design will be used to examine the feasibility of testing a combined incentive and CBT based intervention among couples to stimulate immediate behavior change and to sustain positive behaviors pertaining to alcohol use and IPV. Sixty couples will be screened and enrolled into one of three study arms: an incentive-only, incentive plus counseling, or a control arm. Extensive procedures have been included to ensure participant safety, including staff training on global safety procedures for violence intervention research, careful messaging of study aims, screening procedures to exclude those at high risk of alcohol withdrawal or severe violence due to the study, and a referral and case management system. Male and female participants will complete surveys at baseline and immediately and 3-months post-intervention. Breathalyzers will be used to capture male participants' blood alcohol content daily for intervention arm participants and three times a week for control participants. A sub-sample of male and female members of couples will participate in qualitative in-depth interviews to further explore pathways to change. The results from this preliminary study will inform the development of a larger RCT study of male alcohol and IPV reduction.

HIV Positive Diagnosis During Pregnancy Increases Risk of IPV Postpartum Among Women with No History of IPV in Their Relationship

There has been limited study of whether and for whom physical intimate partner violence (IPV) is a consequence of an HIV-positive diagnosis. Per the diathesis stress model, the consequences of HIV infection may be worse for women with a history of IPV. We hypothesize that the positive association between HIV diagnosis in pregnancy and postpartum IPV will be exacerbated for women with a history of IPV. Data come from a prospective cohort study with 1015 participants who completed a baseline antenatal and 9-month postpartum visit. Using logistic regression analyses, we found a statistically significant interaction between HIV diagnosis, history of IPV and postpartum IPV (AOR: 0.40, 95% CI 0.17-0.96). The findings were in the opposite direction as expected: HIV-diagnosis was not associated with IPV for women with a history of IPV (AOR: 2.17, 95% CI 1.06, 4.42). However, HIV-positive women without a history of IPV faced more than two times the risk of incident postpartum IPV than HIV-negative women (AOR: 2.17, 95% CI 1.06, 4.42). Interventions to reduce incident and ongoing IPV during the perinatal period are needed.

Annual Research Review: Interparental conflict and youth psychopathology: an evidence review and practice focused update

The quality of the interparental relationship is recognized as an important influence on child and adolescent psychopathology. Historically, clinically oriented research on this topic has focused on the impacts of parental divorce and domestic violence as primary interparental relationship influences on child outcomes, to the relative neglect of dimensional or qualitative features of the couple/interparental relationship for youth (child and adolescent) psychopathology. Recent research has highlighted that children are affected by attributes of interparental conflict, specifically how parents express and manage conflicts in their relationship, across a continuum of expressed severity and negativity - ranging from silence to violence. Furthermore, new evidence highlights that children's emotional, behavioral, social, academic outcomes, and future interpersonal relationships are adversely affected by conflict between parents/carers whether adults are living together or not (i.e. married or separated), or where children are or are not genetically related to their rearing parents (e.g. adoption). We review evidence and present an integrated theoretical model, highlighting how children are affected by interparental conflict and what this evidence base means for effective intervention and prevention program development, as well as the development of possible cost-benefit models. Additionally, we review policy implications of this research and highlight some very recent examples of UK-based policy focusing on addressing the interparental relationship and its impact on youth psychopathology.