Read the following articles on couples treatment: Intimate Partner Violence: Making the Case for Joint Couple Treatment and Intimate Partner Violence and the Victim-Offender Overlap. In your short paper, address the following elements: Evaluate the effica

Article

Intimate Partner Violence: Making the Case for Joint Couple Treatment

Sara Antunes-Alves1 and Jack De Stefano1

Abstract Intimate partner violence (IPV) has received increasing public awareness in recent decades because of its prevalence and widespread deleterious and sometimes fatal effects. While clinicians and researchers alike are turning their attention more than ever to the treatment of the problem, there is continuing debate in the field on how to best address and manage the problem legally, socially, and therapeutically. This article adds to the debate by reviewing some of the major issues in IPV and its treatment. In spite of advances in our understanding, the use of gender exclusive batterer groups continues to be a preferred approach to dealing with the problem. We describe how and why, in many cases, conjoint couple therapy has replaced group treatment as an alternate approach and provide empirical evidence in support of this practice. We conclude with some practical guidelines for clinicians who are to engage in conjoint treatment for IPV.

Keywords intimate partner violence, batterer groups, couple therapy, couple counseling

Intimate partner violence (IPV) is a painful reality in the rela-

tionships of men and women of all ages, cultural backgrounds,

and socioeconomic classes and as such it is seen as a major

social problem. The harmful effects of IPV extend to all areas

of the individual’s life, and there is well-established evidence

that victims of IPV experience negative medical, psychologi-

cal, and material outcomes (Bledsoe & Sar, 2011; Garcia-

Moreno, Jansen, Ellsberg, Heise, & Watts, 2006). In the psy-

chological domain IPV has been linked to increased risks of

depression, posttraumatic stress disorder, substance abuse, and

suicidality (Golding, 1999). Added to these is the growing rea-

lization that children exposed to domestic violence develop

vulnerabilities to a host of psychosocial difficulties (Horner,

2005) and that parents who are the recipient of physical abuse

are compromised with respect to their parental capacities

(Buchbinder, 2004).

While there is widespread agreement among the public at

large that ending IPV is desirable, how to best achieve this goal

has become a daunting task. Certainly, since the movement to

expose and end IPV began in the late 1970s (Cooper-White,

2011), considerable strides have been made, especially by the

legal justice system and other governmental organizations, to

address the problem. Jurisdictions in both the United States and

Canada have standards that are used for the credentialing of

practitioners and agencies working with victims and perpetra-

tors of violence (Dankwort & Austin, 1999). In Canada, for

example, common threads run across the provinces and terri-

tories, and we are seeing a convergence of certain accepted

practices and beliefs. Yet, in spite of concerted efforts to pro-

vide services for individuals and families beset by violence,

there is still widespread debate and disagreement about how

IPV should be regarded and treated 1 . The debate in the field

is due in part to our growing understanding of IPV as a com-

plex, multidimensional phenomenon that will not respond to

a one-size-fits-all intervention process.

In this article, we argue that a conjoint couple therapy

approach to IPV is advantageous under specific circumstances.

We first highlight some of the dominant ideas and practices

surrounding IPV as a background against which we can begin

to consider conjoint treatment as a modality with certain cli-

ents. Advocating for conjoint treatment is not a new concept

and we build on the previous excellent work of others (e.g.,

Allen & St. George, 2001; McCollum & Stith, 2008). Our focus

is two-fold: First, we present the literature about when and

under which circumstances conjoint treatment is indicated.

Second, we try to distill from this literature implications for

general practice. IPV is often not the purview of the specialist

and given the scope of the problem many practitioners, includ-

ing generalists and other health care specialists, will be con-

fronted with a client or patient for whom violence is part of a

larger presentation.

1 Department of Educational and Counseling Psychology, McGill University,

Montreal, QC, Canada

Corresponding Author:

Jack De Stefano, Department of Counseling Psychology, McGill University,

3700 McTavish St, Montreal, QC, Canada H3A 1Y2.

Email: [email protected]

The Family Journal: Counseling and Therapy for Couples and Families 2014, Vol 22(1) 62-68 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066480713505056 tfj.sagepub.com

IPV and the Dominant Conceptual Framework

Our understanding of IPV has evolved since its early begin-

nings when groups for batterers were considered the only

acceptable way to intervene in partner violence. Over the past

few decades, there have been a handful of interventions, but

there is little evidence that any of them are very effective in

stopping the recurrence of family violence (Babcock, Green,

& Robbie, 2004). In tracking the history of IPV, Greene and

Bogo (2002) describe how women were historically often held

equally responsible for male perpetrated abuse. They explain

that with the growing acceptance of feminism and the feminist

critique of gender and male power privilege, society was forced

to attend to patriarchy, and domestic violence was explicitly

squeezed into a framework that saw violence as the result of

male privilege and abuse. This understanding of IPV followed

the rationale that violence is not merely the result of a batterer’s

lack of impulse control or poor interpersonal skills but of a

wider, societal problem (Cooper-White, 2011).

However, addressing IPV was initially dominated by an

individual level approach in both the research and the clinical

practice (Gelles & Maynard, 1987). For victims, this included

shelters and crisis centers for women and children, whereas

offenders received rehabilitation services in the form of coun-

seling for battering spouses and self-help groups for violent

men. Shelter workers and feminist advocates sought to make

batterers solely accountable for their criminal behavior rather

than punctuating these violent acts as a consequence of inter-

personal deficits (Babcock, Canady, Graham, & Schart,

2007). These trends gave credence to the view that IPV was the

batterer’s (usually the man) problem, and the goal of interven-

tion was to educate and to resocialize the perpetrators of abuse

(Feder & Wilson, 2005). Thus, the perception of the public at

large was that men were responsible for domestic violence and

they should therefore be the target of intervention. This led to a

gender-specific, individually oriented (i.e., male) focus that

isolated and protected the woman while her partner was being

rehabilitated.

The dominance of the partner violence discourse as being

situated squarely within a gender exclusive, perpetrator frame

probably accounts for the widespread use and popularity of bat-

terer groups. However, while the use of groups was considered

de rigueur for IPV treatment, the outcomes of these programs

have had mixed results (Babcock et al., 2007). In fact, Bab-

cock, Green, and Robbie (2004) conducted a meta-analysis of

five randomized clinical trials investigating violent men who

were part of a batterer’s program and found effect sizes of

.09 and .12 for recidivism. In other words, IPV treatment pro-

grams account for about a 10% decrease in the reoccurrence of violence. The authors further stated that violent partners have a

35% chance of maintaining nonviolent behaviors without treat- ment, while this number only increases to 40% with treatment. Systematic reviews of empirical studies report similar findings

leading to doubts about the efficacy of batterer programs and

thereby opening the door to alternate or parallel treatments

(Feder & Wilson, 2005; Levesque, 1998).

Added to the relatively modest effect sizes for these pro-

grams is the fact that these (like other studies) are limited

by conceptual and methodological problems (Allen & St.

George, 2001). Conceptually, most of these forms of treat-

ment have been based on a single understanding of the nature

of relational violence, that there is a clear perpetrator and a

victim. This view is now seen as unidimensional, since IPV

is a complex phenomenon where multiple factors coalesce

to form the phenomenon. For male perpetrators, our view has

expanded to consider the individual characteristics and traits

of these men (Dutton, 2007; Murphy & Eckhardt, 2005). Dut-

ton (2007) in particular has been critical of the feminist

paradigm for not considering such aspects as borderline per-

sonality organization, substance use issues, and behavioral

skills deficits that are often manifest among perpetrators, as

these become important considerations in studying treatment

effectiveness and outcome studies. 2

Differentiating the Types of Violence

The recognition that all batterers are not identical (and thus

respond quite differently to intervention) led to the creation

of theories of specific subtypes of violent men. In spite of nuan-

ces among classes of subtypes, most typologies recognize that

there is a subclass of men for whom violence is part of a life-

style and thus a preferred strategy for solving their problems.

This notion is contained in Holtzworth-Munroe and Stuart’s

(1994) typology of male batterers as falling into one of the

three types of perpetrators: the family-only type, dysphoric/

borderline type, and violent/antisocial type. These classifica-

tions were based on personality and contextual evidence

including frequency of violence, psychopathology, and past

or current risk factors for using violence. Both the dysphoric/

borderline and the violent/antisocial men generally do not

respond to group treatments and many would probably meet

criteria for a personality disorder (Dutton, 2007). Also, the lit-

erature on typologies recognizes the contributions of contex-

tual factors like social and structural stressors, economic

adversity, and intergenerational modeling of violence to an

understanding of the violence of men (Rowe, Doss, Hsueh,

Libet, & Mitchell, 2011).

As all batterers are not identical, neither is the nature of part-

ner violence. Johnson (1995, p. 285) suggests a useful proposal

where violence can be categorized as either ‘‘patriarchal terror-

ism or common couple violence.’’ Patriarchal terrorism refers to

coercive actions used to achieve control over one’s partner and

tends to escalate over time. Common couple violence, by con-

trast, is not characterized by control, tends to be situational, and

is more likely to be mutual in the couple. The distinction

between the two lies in the motivation: Common couple vio-

lence is less purposive and erupts from interpersonal conflicts

and stresses, whereas patriarchal terrorism is motivated by the

desire to control one’s partner. Common couple violence tends

to (a) be more situational, (b) be less one-sided and less frequent,

(c) not elicit a pervasive fear in the partner, and (d) be the result

of an escalating pattern of conflict (Stith & McCollum, 2011).

Antunes-Alves and De Stefano 63

Greene and Bogo (2002) propose that both types of vio-

lence may be treated with therapy, but that most therapists

will encounter individuals where common couple violence

is at play. This has been said to be the most common form

of relationship violence (Stith & McCollum, 2011). Research

on IPV has illustrated that many couples who seek therapy

tend to experience lower level, mutual aggression (Simpson,

2005), but often do not consider the physical abuse as their

primary or presenting problem (Aldorondo & Straus, 1994;

Ehrensaft & Vivian, 1996).

While the majority of therapists working with voluntary

couples will encounter mostly common couple violence,

Greene and Bogo (2002) warn that therapists must be able to

identify the differences between the types of violence and

adjust their interventions accordingly, or to refer clients else-

where. This implies that practitioners entertain different, some-

times competing, perspectives as they decide on what approach

or program is best for the client. Thus, even as there is disagree-

ment in the field about how to best treat the problem of IPV, our

increasing accumulation of knowledge about intervention

options means that clients will be offered what they need and

not what is available or politically correct.

It is hard to imagine that at one time treating IPV with con-

joint couple therapy was seen as questionable (Stith, Rosen,

McCollum, & Thomsen, 2004), because it did not fit with the

Zeitgeist of the time. IPV has historically been considered as

falling outside the scope of traditional couple therapy, largely

due to the concern that therapy could increase the risk of vio-

lence or encourage victim-blaming (Rowe et al., 2011). Yet,

traditional interventions that focused exclusively on the reduc-

tion or elimination of violence without addressing other impor-

tant needs have had poor success rates (Brown, O’Leary, &

Feldbau, 1997). Also, conjoint treatment implies that narrow,

dichotomized descriptions of partner violence are ipso facto

exclusionary and may not be what the couple needs or wants.

Conjoint Work With IPV: When Is It a Good Idea?

The use of conjoint couple therapy to treat cases of IPV has been

debated in the professional and scientific communities. Much of

the criticisms in the literature describe how conjoint treatment

might put the victims at greater risk by directing blame at them

(Stith et al., 2004) or by making future aggression and retaliation

more likely (Simpson, 2005). Whether the danger is perceived or

real, the victim of violence is obviously not free to speak in the

presence of a controlling abuser. Stith and McCollum (2011)

talk about how help-seeking by the perpetrator may actually

have the unintended consequence of reducing or eliminating

their legal or moral accountability for the violence. These con-

cerns are not unique to conjoint treatment, but they must none-

theless be more carefully considered when deciding whether

conjoint work is feasible for a particular couple.

Under specific circumstances, conjoint couple therapy may

be the appropriate intervention for IPV if certain conditions are

present. As a general guideline, conjoint couple therapy may be

helpful with couples where there is common couple violence

and where the violence is mild to moderate in nature (Bagar-

ozzi & Giddings, 1983). There seems to be general consensus

that where violence is severe and life-threatening, systems-

based interventions are contraindicated and a more traditional

approach of parallel treatment or intervention would be called

for (Gelles & Maynard, 1987; Straus & Gelles, 1986). There is

also agreement that couples who take responsibility for their

aggressive behavior, are motivated to change, and do not attri-

bute their behavior to external factors are also good candidates

for conjoint work (Bograd & Mederos, 1999; Dutton, 1986;

Holtzworth-Munroe, Bates, Smutzler, & Sandin, 1997).

Thus, in the actual clinical work with these couples, counse-

lors are advised to conduct a thorough assessment of the type and

severity of the violence as well as the couple’s stage of change

(Bograd & Mederos, 1999; Lipchik & Kubicki, 1996). This can

be accomplished more efficiently with well-validated assess-

ment instruments (Stith & McCollum, 2011), such as the Abuse

Assessment Screen (McFarlane, Parker, Soeken, & Bullock,

1992), the Assessment of Immediate Safety Screening Ques-

tions (Family Violence Prevention Fund, 2002), and the Domes-

tic Violence Initiative Screening Questions (Webster, Stratigos,

& Grimes, 2001), which must include a thorough screen for sub-

stance use or mental health problems as these may compromise

the safety or evolution of the case (Dutton, 2007). Such instru-

ments help provide clinicians with additional background on the

nature of violence and aid in identifying the need for additional

services and outside referrals for both victims and perpetrators

separately (see the Intimate Partner Violence and Sexual Vio-

lence Victimization Assessment Instruments for Use in Health-

care Settings: Version 1, 2007 for a comprehensive list of the

valid assessment tools related to IPV). In short, these guidelines

imply that therapists working in this area have received training

in IPV and high-conflict couples and that they network with

other professionals in the field as a way to maintain competent

practice and avoid burnout.

One important criterion in the success of conjoint counsel-

ing is the context in which violence occurs during the couple’s

interpersonal conflict. For example, Pan, Neidig, and O’Leary

(1994) conducted a large-scale study on randomly selected mil-

itary personnel and found that marital discord was the most

accurate predictor of partner violence. Thus, clinicians are

advised to focus on improving the relationship and interactions

in conjoint couple therapy by facilitating problem solving

around such issues of finances, career decisions, and sexual

satisfaction. Similarly, Burman, Margolin, and John (1993)

observed that physically aggressive couples were significantly

more mutually hostile and had inflexible and rigid behavior

patterns compared to nonviolent troubled couples. Violent cou-

ples have deficits in communication and problem-solving

skills, particularly during conflict or when either partner

becomes angry (Babcock, Green, Webb, & Yerington, 2005).

This implies that the violence that we see in these couples is

often a result of ineffective interpersonal problem solving and

thus skills training could be a goal of conjoint treatment.

In fact, there is evidence that conjoint interventions are as

effective at reducing violence as gender-specific treatments,

64 The Family Journal: Counseling and Therapy for Couples and Families 22(1)

such as men and women’s groups. O’Leary, Heyman, and Nei-

dig (1999) conducted a study with 75 intact couples assigned to

either a gender-specific or a conjoint treatment for psychologi-

cal and (mild to moderate) physical aggression. They found

that both treatments significantly reduced physical aggression

(by 55%) in the short term and long term. While there was no significant difference found between treatment types, hus-

bands in conjoint treatment improved significantly on marital

adjustment.

The notion that conjoint therapy increases the chance of fur-

ther violence for cases of mild and infrequent common couple

violence seems to be challenged by Simpson’s (2005) study of

134 couples that reported mutual, mild levels of violence. In

that study, rates of psychological and physical aggression

remained at close to zero during and after conjoint treatment.

It would appear that conjoint couple therapy addresses

important issues such as relationship satisfaction and individual

functioning in a way that other interventions such as batterer

programs and men’s groups do not. Thus, while conjoint treat-

ment is as effective at reducing violence as traditional men’s

treatment programs (Brown & O’Leary, 1997; Morrel, Elliott,

Murphy, & Taft, 2003), it may be better suited for tackling the

interpersonal conflict and poor problem solving that are part

and parcel of the problem (McCollum & Stith, 2008). This fact

may actually diminish the fear that women might feel in con-

joint treatment. Studies of mild to moderate IPV found that

very few women were afraid in their husbands’ presence during

conjoint meetings (Greene & Bogo, 2002) and that these

women were actually at no further risk of abuse compared to

those who obtained individual therapy (Brannen & Rubin,

1996; O’Leary, Heyman, & Neidig, 1999; Stith et al., 2004).

LaTaillade, Epstein, and Werlinich (2006) argue that

because relationship distress and conflict are strong predictors

of IPV, not addressing these issues in the couple therapy con-

text can actually increase the risk of violence. Conjoint modal-

ities may bolster a sense of safety in the relationship, as they are

tailored interventions that take into account the couple’s unique

background and behaviors in a way that a batterer group often

cannot (Allen & St. George, 2001). The highly structured group

approaches follow a standard protocol to all perpetrators and

victims, with the aim of policing or surveillance (Aguirre, Leh-

mann, & Patton, 2011). Tailored treatment, unlike protocol dri-

ven interventions, has the advantage of keeping couples more

engaged in their own therapy (Allen & St. George, 2001).

Group treatment of batterers typically uses a confrontational

style in its attempts at fostering responsibility in batterers (Pence

& Paymar, 1993). Unfortunately, this confrontational approach

elicits a host of untoward reactions from clients: fervent counter-

arguments, silence, phony agreement, or termination of treat-

ment; supportive strategies seem better able to motivate clients

(Murphy & Baxter, 1997). For example, the brief motivational

interviewing technique (Miller & Rollnick, 2002) was applied

to enhance interpersonal skills using an emotion-focused

approach that emphasized expressive skills, empathy, and com-

munication (Morrel et al., 2003). With this technique, the thera-

pist provides feedback in an empathic and nonconfrontational

way, reinforcing any statements made by clients that indicate a

willingness to change any risk factors for aggression. Morrel,

Elliott, Murphy, and Taft (2003) found a significant overall reduc-

tion in physical aggression over time (effect size d ¼.58). Taken together, the literature converges on the fact that con-

joint treatment is better able to address underlying relationship

dynamics and, especially, each partner’s decision to remain in

the relationship. This is an important factor that is often over-

looked in other forms of therapy (Stith & McCollum, 2011).

Where traditional programs typically focus primarily on reduc-

ing violence (and this is obviously an important primary goal),

conjoint treatment focuses on other relational dynamics like

distress and dissatisfaction, which are highly correlated with

the perpetration of violence (Stith, Green, Smith, & Ward,

2008). Certainly, if the couple chooses to stay together, one-

on-one treatments for the abuser may disadvantage the victims

as they are excluded from the process of improving the rela-

tionship (Heyman & Neidig, 1997). Thus, a one-sided approach

that isolates the partner and deprives the therapist of the oppor-

tunity to observe how this plays out in the give and take of the

relationship is something that batterer intervention programs

cannot provide (Rosen, Matheson, Stith, McCollum, & Locke,

2003). This is particularly salient when we consider that much

of IPV is bilateral (Madsen, Stith, Thomsen, & McCollum,

2010), and thus the communicational and interpersonal display

of both partners is needed for a thorough assessment.

Some Considerations and Guidelines for Practitioners

While batterer programs and groups for violent men continue to

be both popular and necessary, expanding the paradigm to

include other modalities and approaches is always desirable.

The initial thrust of these programs was the reduction of violence

and this continues to be an important goal of all treatment (Hey-

man & Neidig, 1997). However, we must acknowledge that our

thinking about intimate relationships violence has expanded,

and we can now see that all IPV is not identical (Greene & Bogo,

2002). Violence reduction, the goal of many batterer programs,

can also be achieved through different avenues: By resolving the

couple’s interpersonal problems and helping them establish bet-

ter ways to manage relational stressors, two possible outcomes

that can be addressed in conjoint format. Thus, conjoint therapy

can be directed both at having the perpetrator take responsibility

for the aggression (i.e., the goal of most group interventions) and

at assisting the partners to develop mutual problem-solving

capacities (Holtzworth-Munroe et al., 1997).

In many couples, violence is not a means to control but,

rather, as research shows, an ineffective strategy for trying to

deal with personal and interpersonal issues (Johnson, 1995).

In fact, as is often the case, individuals seek help when their

available psychological resources and strategies no longer

allow them to cope with the difficulties that they are encounter-

ing. Additionally, even when violence is a factor in their lives,

clients rarely seek out specialized programs for IPV first. Many

individuals still rely on available sources of social support (Pol-

lack et al., 2010) and when professional help is sought, primary

Antunes-Alves and De Stefano 65

care physicians and public health specialists may be the first

consulted. Thus, many practitioners (without training in IPV)

may find themselves hearing a client’s report of violence even

when the request for help is unrelated to the violence (Goldner,

1998). Being untrained or inexperienced in IPV does not pro-

tect a practitioner from a client’s disclosures. In fact, when a

treatment is already established and a strong alliance is in

place, a client may take the risk of talking about incidences

of violence when they may not have originally intended to do

so. The clinician will thus find himself or herself in the position

of having to make a referral or continuing with the case with

appropriate supervision. Regardless of the choice that the clin-

ician and client make, some basic, research-informed ideas

about IPV and its treatment will serve clinicians with limited

experience with IPV well. After all, a clinician may already

have prior information (e.g., the couple’s or individual’s sub-

stance use or comorbid conditions) and knowing about factors

that compromise treatment is essential for appropriate clinical

decision making (Stith & McCollum, 2011).

Among these factors, the couple’s commitment to the rela-

tionship and the desire to stay together are important motivators

that are likely to predict the eventual outcome (Morrel et al.,

2003). Where a therapist does feel confident to provide services,

case management is essential especially as it concerns gauging,

on an ongoing basis, the level of distress in a couple and the

severity and imminence of aggressive acts. Additionally, service

providers (even those with considerable experience) should not

be working in isolation and liaison with agencies and other ser-

vice providers provide an added layer of support when needed

(Simpson, Gattis, Atkins, & Christensen, 2008). This implies

that regardless of the clientele with which we work, up-to-date

familiarity with community and other resources is essential.

Obtaining supervision and working closely with other profes-

sionals who have related experience are advised, not only for

professional guidance but also as a means of self-care in dealing

with the oftentimes high-conflict nature of the couple in session

(Stith & McCollum, 2011).

In sum, conjoint couple therapy for IPV is becoming estab-

lished as a legitimate treatment for partner violence and has

been shown to be effective in stopping the violence, and

increasing appropriate interpersonal communication in the cou-

ple (Heyman & Neidig, 1997). The collective insights from the

literature on conjoint treatment are worth summarizing as they

can provide practitioners from various camps with a start point

for decision making (e.g., refer or continue with supervision).

Therefore, conjoint treatment should be considered when (a)

there is no substance abuse or mental health issues that may

compromise safety; (b) the couple experiences common couple

violence of mild to moderate severity; (c) the violence is a

result of poor problem solving (i.e., is situational) and is not

motivated by need for control; and (d) the violent individual

takes responsibility and does not blame the partner for the vio-

lence. Once these important parameters have been weighed,

ongoing adjustments and case management (with realistic con-

tingency plans) guard against eruption or escalation of violence

and ensuring that therapy is a safe place for both partners.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to

the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, author-

ship, and/or publication of this article.

Notes

1. While violence in same-sex relationships is also a serious problem

(see Lockhart, White, Causby, & Issac, 1994; Tjaden, Thoennes, &

Allison, 1999 for a more detailed review), the current article will

focus exclusively on violence in heterosexual couples where the

man is the perpetrator of the violence.

2. In an effort to reconcile the two ends of the continuum, Murphy and

Eckhardt (2005) propose that feminist approaches are focusing on

distal factors, that is, cultural and social norms conducive to vio-

lence against women, whereas a more person-focused approach

in assessment and treatment is concerned with proximal factors

specific to the individual.

References

Aguirre, R. T., Lehmann, P., & Patton, J. D. (2011). A qualitative look

at the perceived strengths of male batterers: Implications for inter-

vention programs. Journal of Family Social Work, 14, 125–143.

Aldorondo, E., & Straus, M. (1994). Screening for physical violence in

marital therapy: Methodological, practical, and ethical considera-

tions. Family Process, 33, 425–439.

Allen, J. R., & St., George, S. A. (2001, September). What couples say

works in domestic violence therapy. The Qualitative Report, 6.

Retrieved from http://www.nova.edu/ssss/QR/QR6-3/allen.html

Babcock, J. C., Canady, B. E., Graham, K., & Schart, L. (2007). The

evolution of battering interventions: From the dark ages into the

scientific age. In J. Hamel & T. L. Nicholls (Eds.), Family inter-

ventions in domestic violence: A handbook of gender-inclusive the-

ory and treatment (pp. 215–244). New York, NY: Springer.

Babcock, J. C., Green, C. E., & Robbie, C. (2004). Does batterers’

treatment work? A meta-analytic review of domestic violence

treatment outcome research. Clinical Psychology Review, 23,

1023–1053.

Babcock, J. C., Green, C. E., Webb, S. A., & Yerington, T. P. (2005).

Psychophysiological profiles of batterers: Autonomic emotional

reactivity as it predicts the antisocial spectrum of behavior among

intimate partner abusers. Journal of Abnormal Psychology, 114,

445–455.

Bagarozzi, D. A., & Giddings, C. W. (1983). Conjugal violence: A

critical review of research and clinical practices. American Journal

of Family Therapy, 11, 3–15.

Bledsoe, L. K., & Sar, B. K. (2011). Intimate partner violence control

scale: Development and initial testing. Journal of Family Violence,

26, 171–184.

Bograd, M., & Mederos, F. (1999). Battering and couples therapy:

Universal screening and selection of treatment modality. Journal

of Marital and Family Therapy, 25, 291–312.

Brannen, S. J., & Rubin, A. (1996). Comparing the effectiveness of

gender-specific and couples groups in a court-mandated spouse

66 The Family Journal: Counseling and Therapy for Couples and Families 22(1)

abuse treatment program. Research on Social Work Practice, 6,

405–424.

Brown, P. D., & O’Leary, K. D. (1997). Wife abuse in intact couples:

A review of couples treatment programs. In G. K. Kantor & J. L.

Jasinski (Eds.), Out of the darkness: Contemporary perspectives

on family violence (pp. 195–207). Thousand Oaks, CA: Sage.

Brown, P. D., O’Leary, K. D., & Feldbau, S. R. (1997). Dropout in a

treatment program for self-referring wife abusing men. Journal of

Family Violence, 12, 365–387.

Buchbinder, E. (2004). Motherhood of battered women: The struggle

for repairing the past. Clinical Social Work Journal, 23, 307–326.

Burman, B., Margolin, G., & John, R. S. (1993). America’s angriest

home videos: Behavioral contingencies observed in home reenact-

ments of marital conflict. Journal of Consulting and Clinical Psy-

chology, 61, 28–39.

Cooper-White, P. (2011). Intimate violence against women: Trajec-

tories for pastoral care in a new millennium. Pastoral Psychology,

60, 809–855.

Dankwort, J., & Austin, J. B. (1999). Standards for batterer programs: A

review and analysis. Journal of Interpersonal Violence, 14, 152–168.

Dutton, D. G. (1986). Wife assaulter’s explanations for assault: The

neutralization of self-punishment. Canadian Journal of Behavioral

Science, 18, 381–390.

Dutton, D. G. (2007). The abusive personality (2nd ed.). New York,

NY: Guilford.

Ehrensaft, M. K., & Vivian, D. (1996). Spouses’ reasons for not

reporting existing marital aggression as a marital problem. Journal

of Family Psychology, 10, 443–453.

Family Violence Prevention Fund. (2002). National consensus guide-

lines on identifying and responding to domestic violence victimiza-

tion in health care settings. San Francisco, CA: Author. Retrieved

from www.endabuse.org/programs/healthcare/files/Consensus.pdf

Feder, L., & Wilson, D. B. (2005). A meta-analytic review of court-

mandated batterer interventions programs: Can courts affect abu-

sers’ behavior? Journal of Experimental Criminology, 1, 239–262.

Garcia-Moreno, C., Jansen, M. E., Ellsberg, M., Heise, L., & Watts, C.

H. (2006). Prevalence of intimate partner violence: Findings from

the WHO multi-country study on women’s health and domestic

violence. The Lancet, 368, 1260–1269.

Gelles, R. J., & Maynard, P. E. (1987). A structural family systems

approach to intervention in cases of family violence. Family Rela-

tions, 36, 270–275.

Golding, J. (1999). Intimate partner violence as a risk factor for mental

disorders: A meta-analysis. Journal of Family Violence, 14, 99–132.

Goldner, V. (1998). The treatment of violence and victimization in

intimate relationships. Family Process, 37, 263–286.

Greene, K., & Bogo, M. (2002). The different faces of intimate vio-

lence: Implications for assessment and treatment. Journal of Mar-

ital and Family Therapy, 28, 455–466.

Heyman, R. E., & Neidig, P. H. (1997). Physical aggression couples

treatment. In W. K. Halford & H. J. Markman (Eds.), Clinical

handbook of marriage and couples intervention (pp. 589–617).

New York, NY: John Wiley.

Holtzworth-Munroe, A., Bates, L., Smutzler, N., & Sandin, E. (1997).

A brief review of the research on husband violence. Aggression

and Violent Behavior, 2, 65–99.

Holtzworth-Munroe, A., & Stuart, G. (1994). Typologies of male bat-

terers: Three subtypes and the differences among them. Psycholo-

gical Bulletin, 116, 476–497.

Horner, G. (2005). Domestic violence and children: Effects of domestic

violence on children. Journal of Pediatric Health Care, 19, 206–212.

Intimate Partner Violence and Sexual Violence Victimization Assess-

ment Instruments for Use in Healthcare Settings: Version 1.

(2007). Centers for Disease Control and Prevention, National

Center for Injury Prevention and Control. Retrieved June 28, from,

http://www.cdc.gov/ncipc/pub-res/images/ipvandsvscreening.pdf

Johnson, M. P. (1995). Patriarchal terrorism and common couple vio-

lence: Two forms of violence against women. Journal of Marriage

and the Family, 57, 283–294.

LaTaillade, J. J., Epstein, N. B., & Werlinich, C. A. (2006). Conjoint

treatment of intimate partner violence: A cognitive behavioural

approach. Journal of Cognitive Psychotherapy: An International

Quarterly, 20, 393–410.

Levesque, D. (1998). Violence desistance among battering men:

Existing interventions and the applications of the transtheoretical

model of change. Dissertation Abstracts International: Section

B: Sciences and Engineering, 59, 4449.

Lipchik, E., & Kubicki, A. D. (1996). Solution-focused domestic vio-

lence views: Bridges towards a new reality in couples therapy. In

Miller S., Hubble M. & Duncan B. (Eds.), Handbook of solution

focused brief therapy (pp. 65–99). San Francisco, CA: Jossey-Bass.

Lockhart, L. L., White, B. W., Causby, V., & Issac, A. (1994). Letting

out the secret: Violence in lesbian relationships. Journal of Inter-

personal Violence, 9, 469–492.

Madsen, C., Stith, S. M., Thomsen, C., & McCollum, E. E. (2010).

Therapy-seeking violent couples. Unpublished paper.

McCollum, E. E., & Stith, S. M. (2008). Couples treatment for inter-

personal violence: A review of outcome research literature and cur-

rent clinical practices. Violence and Victims, 23, 187–201.

McFarlane, J., Parker, B., Soeken, K., & Bullock, L. (1992). Assessing

for abuse during pregnancy: Severity and frequency of injuries and

associated entry into prenatal care. Journal of the American Med-

ical Association, 267, 3176–3178.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Pre-

paring people for change. New York, NY: Guilford.

Morrel, T. M., Elliott, J. D., Murphy, C. M., & Taft, C. T. (2003). Cog-

nitive behavioural and supportive group treatments for partner vio-

lent men. Behaviour Therapy, 34, 77–95.

Murphy, C. M., & Baxter, V. A. (1997). Motivating batterers to

change in the treatment context. Journal of Interpersonal Violence,

12, 607–619.

Murphy, C. M., & Eckhardt, C. I. (2005). Treating the abusive part-

ner: An individualized cognitive-behavioral approach. New York,

NY: Guilford.

O’Leary, K. D., Heyman, R. E., & Neidig, P. H. (1999). Treatment of

wife abuse: A comparison of gender-specific and couples

approaches. Behavior Therapy, 30, 475–505.

Pan, H. S., Neidig, P. H., & O’Leary, K. D. (1994). Predicting mild

and severe husband-to-wife physical aggression. Journal of Con-

sulting and Clinical Psychology, 62, 975–981.

Pence, E., & Paymar, M. (1993). Education groups for men who bat-

ter: The Duluth model. New York, NY: Springer.

Antunes-Alves and De Stefano 67

Pollack, K. M., Cummiskey, C., Krotki, K., Salomon, M., Dickin, A.,

Gray, W. A., & Grisso, J. A. (2010). Reasons women experiencing

intimate partner violence seek assistance from employee assistance

programs. Journal of Workplace Behavioral Health, 25, 181–194.

Rosen, K. H., Matheson, J., Stith, S. M., McCollum, E. E., & Locke,

L. D. (2003). Negotiated time-out: A de-escalation tool for cou-

ples. Journal of Marital and Family Therapy, 29, 291–298.

Rowe, L. S., Doss, B. D., Hsueh, A. C., Libet, J., & Mitchell, A. E.

(2011). Coexisting difficulties and couple therapy outcomes: Psy-

chopathology and intimate partner violence. Journal of Family

Psychology, 25, 455–458.

Simpson, L. E. (2005). Low-level violence and couple therapy out-

comes. Dissertation Abstracts International, 66, 6294.

Simpson, L. E., Gattis, K. S., Atkins, D. C., & Christensen, A. (2008).

Low-level relationship aggression and couple therapy outcomes.

Journal of Family Psychology, 22, 102–111.

Stith, S. M., Green, N., Smith, D. B., & Ward, D. (2008). Marital

satisfaction and discord as risk markers for intimate partner

violence: A meta-analytical review. Journal of Family Violence,

23, 149–160.

Stith, S. M., & McCollum, E. E. (2011). Conjoint treatment of couples

who have experienced intimate partner violence. Aggression and

Violent Behavior, 16, 312–328.

Stith, S. M., Rosen, K. H., McCollum, E. E., & Thomsen, C. J. (2004).

Treating intimate partner violence within intact couple relation-

ships: Outcomes of multi-couple versus individual couple therapy.

Journal of Marital and Family Therapy, 30, 305–318.

Straus, M. A., & Gelles, R. J. (1986). Societal change and change in

family violence from 1975 to 1985 as revealed by two national sur-

veys. Journal of Marriage and the Family, 48, 465–479.

Tjaden, P., Thoennes, N., & Allison, C. J. (1999). Comparing violence

over the life span in samples of same-sex and opposite-sex cohabi-

tants. Violence and Victims, 14, 413–425.

Webster, J., Stratigos, S. M., & Grimes, K. M. (2001). Women’s

responses to screening for domestic violence in a health-care setting.

Midwifery, 17, 289–294.

68 The Family Journal: Counseling and Therapy for Couples and Families 22(1)