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.

Changes in Violence and Clinical Distress Among Men in Individual Psychotherapy for Violence Against Their Female Partner: An Explorative Study

Most interventions for men who have acted violently toward their partner have been conducted as group interventions within a criminal justice context. Therefore, few studies have examined individual psychotherapy and how such interventions may reduce partner violence. In this study, we aimed to describe changes in violence, and changes in clinical distress in men undergoing individual psychotherapy targeting their use of partner violence, at a clinic organized within a psychosocial health care context. This is a naturalistic prospective study of men voluntarily receiving individual psychotherapy for their use of violence against their female partner. Participants were 84 male clients, and data on their use of physical violence, physical controlling violence, property violence and psychological violence were collected pretreatment, posttreatment and at follow-up 1.5 years after treatment from both the men, and their partners (n = 58). The percentage of use of all types of violence during a typical month the last year decreased from pretreatment to follow-up, according to both the men, and their partners. Over the course of treatment, use of all types of self-reported violence during the last month was reduced, however, this was only partially confirmed by their partners. Number of sessions was associated with a lower risk of having used physical and physically controlling violence 1.5 years after treatment. Alcohol abuse or dependency, or qualifying for one or more psychiatric diagnoses, were not associated with levels or change in use of violence. On average, the men's clinical distress declined over the course of psychotherapy. The findings suggest that individual psychotherapy may be a promising and worthwhile intervention for intimate partner violence. Studies with more elaborate designs are needed to identify the core mechanisms of psychotherapy for violence, and to corroborate these results with higher levels of evidence.

Braving the Elements: Ambivalence as Opportunities for Change in Individual Psychotherapy With Men Using Intimate Partner Violence

This study examines client utterances that can be understood as ambivalent in violence-focused therapy. The purpose is to enrich our scientific understanding of client contributions to therapy when they appear ambivalent to the therapeutic project and develop clinically relevant perspectives that enable us to help this and other client groups. Using constructivist grounded theory analysis of five completed therapies, we describe three categories of client ambivalence present throughout all five therapies: I am bad, but I am not that bad; I have tried and tried in vain; and I know it is wrong, but I have to, I have no choice. The categories are described and understood from a clinical perspective. They are developed on the basis of an interpretation of what seems to be at stake for the client in the here-and-now of therapy. Clinical implications are discussed.

From Resistance to Invitations: How Men Voluntarily in Therapy for Intimate Partner Violence May Contribute to the Development of a Working Alliance

The high drop-out rate and modest outcome for men in treatment for intimate partner violence (IPV) have highlighted the question of how therapists can establish an effective working alliance with these clients. The aim of this study was to conceptualize the variety of ways in which male clients using violence against a female partner might present themselves to form a working alliance that might appeal to them. We studied how 20 men voluntarily in individual IPV treatment contributed at the beginning of therapy to forming an alliance with therapists skilled in such treatment. The first therapy session in 10 drop-out and 10 completed cases was transcribed verbatim and analyzed qualitatively, following guidelines drawn from the constructionist grounded theory. The analysis resulted in a conceptual model of gateways and invitations to an alliance. Gateways are themes that have the potential to open a path toward collaboration on personal change. Each of the three gateways identified, comprised solide and weak invitations to an alliance: (a) presenting reasons for seeking treatment-as their own choice, as avoidance, or as a mistake; (b) presenting notions of change-as their own need to change their violent behavior, as ambivalence toward the project, or as a need to change the partner; and (c) disclosing and describing violence-as a personal narrative, as a scene, as a fragment of their life, or as something else. Implications for therapists' understanding of clients' motivational goals, negotiation of alliance, and disclosure of violence early in therapy are discussed.

Reporting possible sexual abuse: a qualitative study on children's perspectives and the context for disclosure

OBJECTIVE

The present study investigated the context in which children were able to report their child sexual abuse experiences and the children's views as to what made it difficult to talk about abuse and what helped them in the disclosing process. The aim was to study disclosures as they were occurring in their natural settings.

METHOD

Data were obtained from therapeutic sessions and follow-up interviews from 20 families with 22 children. These children had said something that made their caregivers concerned about ongoing child sexual abuse. Qualitative analysis was conducted to capture the children's and caregiver's perspectives of the disclosure process.

RESULTS

The children felt it was difficult to find situations containing enough privacy and prompts that they could share their experiences. They also were sensitive to others reactions, and whether their disclosures would be misinterpreted. When the children did disclose they did it in situations where the theme of child sexual abuse was in some form addressed or activated. The results indicate that disclosure is a fundamentally dialogical process that becomes less difficult if the children perceive that there is an opportunity to talk, and a purpose for speaking, and a connection has been established to what they are talking about.

CONCLUSIONS

It is difficult for children to initiate a conversation about something secret, confusing and distressful, and where there are few conversational routines in a family for talking about such themes. Children also are sensitive to the needs of their caregivers and fear consequences for their family and offender. Children need a supportive structure or scaffold in order to reveal their experiences of child sexual abuse.