Spouse Abuse Research Update: 1999


(Section 17 of the FAP Prevention Resource Manual)

INTRODUCTION

Over the past couple decades, the prevalence and consequences of wife abuse/intimate violence have been defined and acknowledged, and research has been conducted to document the size, effects, and characteristics of what some describe as an epidemic. After years of working to create awareness of the problem and garner support for program interventions to combat its deleterious effects, domestic violence shelters, violence prevention programs, batterer treatment programs, and program theory abound. Research and program evaluation on different program interventions are also plentiful by this time. Given limited funds and the need to justify program expenditures, and in the on-going effort to improve programs by disseminating knowledge related to innovative and/or effective approaches to ending violence, the field now turns to the question: What really works?

In August 1994, the National Research Council (NRC) and the Institute of Medicine (IOM) established a Committee on the Assessment of Family Violence Interventions (hereafter referred to as "the Committee") to review the research base on family violence. In its text, Violence in Families: Assessing Prevention and Treatment Programs, the Committee synthesizes the research in the areas of child maltreatment, domestic violence, and elder abuse. For the purposes of this update to the Army Prevention Resource Manual, the sections on domestic violence are highlighted from that text. In addition, a review of the literature since the last Prevention Resource Manual update (1995) was conducted, and pertinent studies are included.

The main finding of the Committee was that the research on, and evaluations of, family violence prevention and intervention programs is not scientifically sound enough to warrant strong recommendations to service providers and policy makers. Most studies are descriptive, anecdotal, and based on small clinical samples of convenience. Several are methodologically problematic, non-experimental, and therefore their conclusions are ambiguous and non-causal. Despite the probable shortcomings of available research, advocates and service providers are clearly unable to sit around and wait for the definitive study to identify "what really works." As the Committee suggests, then, information from the available research can and should guide practitioners while attempts are made to improve evaluation capacity in the field of family violence. Again, with this in mind, several studies from the past 20 years have been identified and are reviewed below.

In part due to this inability to define what works, the chosen articles reflect the contentions and disagreement in the field of family violence research. Readers are reminded that just a couple of the studies presented meet the standards of being "sound" evaluations as defined by the Committee. The Committee reviewed sources ranging from scientific journals to national research databases and

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foundation studies and identified over 2,000 studies to determine the soundness of their evaluation and research methods. Only 114 were ultimately selected for detailed analysis, based on meeting the following criteria:

• The evaluation involved a program that was designed to treat or prevent some aspect of child maltreatment, domestic violence, or elder abuse;

• The evaluation was conducted between 1980 and 1996 (this time period was selected to provide a contemporary history of the evaluation research literature while maintaining manageable limits on the scope of the evidence considered by the committee);

• The evaluation used an experimental or quasi-experimental design and included measurement tools and outcomes related to family violence; and

• The evaluation included a comparison group as part of the study design (Chalk & King, 1998, p. 21).

Researchers have suggested that communication skills are important tools for building and maintaining healthy relationships, and that marital distress and abusiveness may be related to a dearth in these skills among couples. Indeed, some couples receiving counseling point to poor communication as the main problem in their relationship. However, a recent study by Burleson & Denton (1997) suggests the importance of distinguishing between communication skills and communication behaviors and argues that the relationship between communication and marital functioning is not as clear-cut as past research has implied.

Still some couples have cited that among their reasons for leaving a counseling program to curb marital violence was the lack of emphasis on communication (Brown, O'Leary, & Feldbau, 1997). Given that still more research suggests that therapy/counseling is most effective when clients and therapists agree on treatment goals (Murphy & Baxter, 1997), what type(s) of counseling should intact couples in violent relationships receive? Should communication skills be taught? Should couples be counseled individually or in groups? While no easy answers emerge from the literature, such relationship support issues as communication and counseling are discussed in the following annotations.

Since the problem of wife abuse undoubtedly exists at this time, it is important to understand how to intervene in and treat it. Is wife abuse a result of witnessing family violence as a youth? Do children who experience family violence firsthand become more likely to commit violence in their families of procreation? The specifics of intergenerational violence transmission are still largely unknown, but of great interest is knowing how to prevent intimate abuse in the first place, so that intervention and treatment become less necessary. With this in mind, prevention programs aimed at children, adolescents, teenagers, and college students have

Relationship Support

Prevention

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been implemented in various settings (Krajewski, Rybarik, Dosch, & Gilmore, 1996) with the goal of changing the knowledge, attitudes, and behaviors of youth relative to violence against women. To review, the FAP Manual on Program Evaluation defines these outcome indicators in the following way:

Knowledge: these indicate improvements in the level of knowledge that clients will acquire in order to be able to operate effectively in the area of concern for the agency;

Attitudes: these include changes in client perceptions or beliefs that are considered important to achieving desired outcomes, or that reflect outcomes that the agency or organization considers necessary for optimum performance;

Behavior: these are specific client behaviors that would change, or activities that should occur if the program has been effective or that the community deems necessary on the part of some portion of its people (FAP, Evaluation chapter, p.8).

While many violence prevention programs seem to positively enhance knowledge and attitude in participants (Krajewski et al., 1996), at least in the short term, longitudinal research is necessary before any determinations can be made regarding whether behavior is affected by prevention programs of this type. Still, because it has been established that aggressive behavior by children manifests in adult aggression in the absence of intervention (National Research Council, 1993) and that reconstituting values related to violence and practicing non-aggressive behavior may reduce violence (Tolan & Guerra, 1994), it is important that intervention programs such as the teen dating violence prevention program described below are implemented and evaluated.

What works, when, and for whom? These prominent questions in the current literature surrounding batterer treatment programs focus on the issue of program dropout, program content and format, and how batterer characteristics relate to program treatment and post treatment recidivism. Much remains to be learned about the saliency of batterer treatment programs. While, overall, program completers seem to be less likely to exhibit physical violence (Gondolf, 1997), some studies suggest that the personality type of a batterer will impact his individual response to treatment (Dutton, Bodnarchuk, Kropp, Hart, & Ogloff, 1997). For instance, new research by Dutton and his colleagues links avoidant, antisocial, and borderline personality characteristics with an increased incidence of post treatment violence.

In some instances, couples experiencing intimate violence wish to remain in tact. In these situations, it is of interest and debate as to whether couples should

What Works in

Programs for Batterers?

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receive group counseling, couples counseling, or individual counseling (Berliner, O'Leary, McMahon, & Pence, 1996; Brown, O'Leary, & Feldbau, 1997). Still other research concerns itself with the approach to batterer therapy, suggesting that confrontational, in-your-face programs have little therapeutic benefit and, in fact, may operate to escalate violent attitudes and promote program drop-out and noncompliance (Murphy & Baxter, 1997). In his review of batterer intervention literature, Gondolf (1997) describes these and other program variations. His conclusions are similar to those of the Committee, suggesting the need for greater rigor in the methodology used to evaluate such programs.

In terms of "what works" for female victims of intimate abuse, the Committee articulates the difficulties in identifying appropriate outcome measures of success in regard to programs for female victims. For example, it is counterintuitive to expect a short term shelter intervention to result in decreased violence in the home. However, the reduction or cessation of violence and/or whether a woman successfully leaves a violent relationship are often the outcomes of interest in program evaluations. Outcomes such as empowerment and increased self-esteem, which are important to the well-being of women, are challenging to measure, especially considering the process of change (which is not linear) that many victims go through before they are ready to leave a violent relationship.

The fact that it often takes women several stays at a shelter before she ultimately leaves a violent relationship (if she leaves at all) can be frustrating to service providers, friends, and family. This frustration and sense of helplessness can lead to a reduction in tolerance and support for battered women, which has been documented in both legal and medical settings (Hattendorf & Tollerud, 1997). The current literature cautions against the secondary victimization of battered women and emphasizes the importance of social support in victims' lives (Hattendorf & Tollerud, 1997; Tan, Basta, Sullivan, & Davidson, 1995). Tan et al. studied the social support of female victims and concluded that social support insulates battered women from stress, increases perceived quality of life, and has the potential for improving physical and psychological health.

What Works For Female Victims?

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Title Client Personality Disorders Affecting Wife Assault Post-Treatment Recidivism

Author Dutton, D.G., Bodnarchuk, M., Kropp, R., Hart, S.D., & Ogloff, J.P.

Journal Violence and Victims, 12(1), 37-50.

Year 1997

According to the author, research in the field concentrating on recidivism among batterers who had received treatment suggests that treatment seems to diminish recidivism by about 66% (p.38). Additional research in regard to batterers demonstrates that there are certain "typologies" of batterers and suggests that many batters meet the criteria for having personality disorder. With this in mind, the current study examined the question of whether recidivism was different among male batterers who were personality disordered than among their non-disordered counterparts.

Sixty-five men who had previously participated in batterer programs and their partners (44 were able to be reached) participated in this follow-up study. Analyses indicated that the follow-up participants were representative of the original sample of program participants with two exceptions: those who participated in the follow-up study were likely to be older and employed.

Participants were interviewed by people trained in the field. The measurement instruments included the Conflict Tactics Scale (CTS), the Severity of violence Against Women Scales (SVAWS), a Modified CTS Scale (CTS-Mod), the Psychological Maltreatment of Women Inventory (PMWI), the Multidimensional Anger Inventor (MAI), the Marlowe-Crown Social Desirability Scale, the Self-report Instrument for Borderline Personality Organization (BPO), and the Millon Clinical Multiaxial Inventory II (MCMI II).

Results of the study indicated that at mean follow-up of 26.8 months, men reported less anger and physical violence. This was corroborated by female partners who reported less physical and psychological abuse. These finding were highly significant. Researchers assessed the possibility that these results were influenced by social desirability factors by correlating men's and partner's scores on several instruments with the Marlowe-Crown Social Desirability Scale. None were significant, but the authors warn that something other that social desirability could be operating. In addition, they caution that the outcome could be more positive for this group than for one with younger, unemployed men.

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Additional analysis indicated that several categories of personality disorder influenced the incidence of post treatment violence. As replicated in other studies, avoidant, antisocial, and borderline categories appeared as predictors of post treatment abuse. This triad of personality types had been identified in previous research but never linked to treatment outcome. The implication is that for men who present with high personality disorder profiles, group treatment might not be effective and individualized treatment should be considered.

Title Batterer Programs: What We Know and Need to Know

Author Gondolf, E.W.

Journal Journal of Interpersonal Violence, 12(1), 83-98

Year 1997

This paper echoes the concern of the Committee pertaining to the quality of batterer intervention research as it reviews the current research literature on the subject. The author calls for more technologically rigorous evaluation studies and methods as well as increased collaboration among researchers and practitioners.

After a brief historical overview of batterer program development, Gondolf describes the typical batterer program as "a gender-based, cognitive-behavior modality: Men are confronted with the consequences of their behavior, held responsible for their abuse, have their rationalizations and excuses confronted, and are taught alternative behaviors and reactions (p.85). He also recognizes such competing modalities as "healing men's trauma, redirecting emotions (particularly anger), and addressing couple communications and interactions (p. 85). Without doubt, competing variations in the nature and format of batterer programs exist (e.g., educational versus therapeutic, brief therapy versus long term therapy, individual versus couples therapy), despite the implementation of standards in at least 11 states.

The author identifies five important questions facing the field:

Do Batterer Counseling Programs Work? Research in the field suggests that cessation of violence occurs in 60-80% of program completers over a six-month follow-up, while reduction in psychological abuse is less well documented. The reasons why and the means by which this reduction occurs are still unclear. Moreover, the studies documenting what is known about recidivism are difficult to interpret due to such methodological shortcomings as low response rates, short term follow-up, self-report measures, omission of control groups and the like.

What Program Approach is the Most Effective and Appropriate? Definitive studies have not been conducted to distinguish one particular program mode over another,

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nor is it clear what type of program duration of format is most successful. Some studies indicate that couples groups are less effective in stopping violence than men's groups, and current standards recommend a program duration of one year in the wake of evaluations showing lower levels of recidivism than for short-term programs.

How Do We Reduce Program Dropout and Noncompliance? Dropout is a problem in 40-60% of batterer programs within the first three months, and as few as 10% of men referred to programs might actually complete them. Certain dropout characteristics, such as previous criminal offenses, substance abuse problems, and personality disorders have been observed in at least three different studies, but the "dangerousness" of dropouts is not well understood. The author suggests looking to alcohol and drug treatment research for guidance in understanding who drops out and why in batterer programs.

How Do We Increase the Safety and Protection of Battered Women? Although the problem of assessing dangerousness and lethality are difficult to answer, the research on batterer typology may be promising. Still, further investigation on the diagnostic, explanatory, or predictive potential of these categories is needed. We might also study the effectiveness of matching different batterer "types" with distinct interventions to see if batterers who are more dangerous can be contained in different programs. In the meantime, more specific criteria for discharging men from batterer programs is necessary. Currently, program completion and compliance are often all that is required for discharge, but the author suggests examining the clinical judgments of staff who work with this population as well as the decision making of battered women to see what information is most useful in assessing safety.

How Do We Extend Batterer Programs to Rural and Minority Communities? The available research suggests that the batterer program field is in danger of becoming segmented due to the uneven program development between populated areas, rural and smaller towns, and within minority neighborhoods. Batterer programs must also be more concerned with issues surrounding race and ethnicity, as minority participants are known to "perceive, interpret, and justify their abuse differently" (p. 92).

Because batterer counseling programs are at the core of batterer intervention, their effectiveness and appropriateness with different populations must be determined. As stated, this will require an advance in current family violence methodology and research. It will also require collaboration among researchers, practitioners, and victims so that research is appropriately grounded and practically relevant.

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Title Motivating Batterers to Change in the Treatment Context

Author Murphy, C.M., & Baxter, V.A.

Journal Journal of Interpersonal Violence, 12(4), 607-619

Year 1997

Current batterer treatment interventions often adopt a highly confrontational approach in relation to batterers' denial and minimization of their own actions in an effort to reeducate batterers about power and control over females. While getting the batterer to accept personal responsibility for his abuse is an acceptable goal, current research suggests that hostile, confrontational therapy may limit treatment effectiveness as well as harm clients. "Most important, high levels of confrontation at the outset may jeopardize the development of a trusting, collaborative alliance [between therapist and batterer], a critical element in motivating behavior change" (p. 609). In addition, such confrontational approaches "may reinforce the client's view that relationships are inevitably grounded in coercion and control, rather than in understanding, trust, and support" (p. 609).

The authors argue that the goal of safety and justice for battered women will not be realized if these types of batterer intervention programs are utilized. They use studies of confrontational therapies, ideas about collaborative working alliances, and motivational interventions to suggest the need for alternative strategies to batterer programs. For example, motivational research demonstrates that empathetic therapists are more successful than their confrontational counterparts in helping clients enter and complete treatment. Moreover, limited research available on client deterioration in marital and family therapy indicates confrontational therapists lose more clients. Problems with this type of approach might be exaggerated when there are differences between therapist and client in terms of race, ethnicity, or social class, although more research is needed in this area. This is important information, given what we know about lowered recidivism among program completers.

In light of the fact that many batterers are unwilling participants in the process of change and rehabilitation, the importance of a collaborative working alliance between therapist and client is stressed. Confrontational styles are not conductive to collaboration. In addition, if batterers are entering treatment reluctantly, it is assumed that they have not contemplated the need to change. In the treatment context, they will need motivation to do so. An alternative approach to confrontation will include an understanding of the change process and supportive therapeutic strategies.

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Title Dropout in a Treatment Program for Self-referring Wife Abusing Men

Author Brown, P.D., O'Leary, K.D., & Feldbau, S.R.

Journal Journal of Family Violence, 12(4), 365-387

Year 1997

Data suggest that the largest proportion of violent couples coming into contact with service providers are self-referring, intact couples reporting mild to moderate levels of physical abuse, and that treatment of these couples can be effective in reducing violence in their relationships. This study focused on dropout rates among self-referring intact couples to examine more meaningful dropout predictors than the typical demographic variables, such as age, race, and education used to explain dropout rates. Two of the predictor variables of interest were pre-treatment disposition and agreement upon treatment goals. Research suggests a positive relation between therapeutic alliance (e.g., agreeing on treatment outcomes) and therapeutic change. The implication is that couples who believe an intervention does not address their primary problems will be likely to drop out of the program.

The program intervention was designed to assess the efficacy of couples treatment programs for male partner violence. Seventy couples participated. It is important to note that couples were screened out for severe physical aggression to prevent further harm to female victims. Cases where either the husband or the wife was alcoholic were also excluded. Study participation required that the female reported at least two acts of male to female violence in the year prior to study participation and that the male reported at least one such act.

Couples were randomly assigned to a conjoint or gender specific treatment group, both of which named elimination of intimate violence as a goal and targeted the husband's aggression as the focus of therapy. While the women's group focused on personal growth, the men's group focused on acceptance of personal responsibility for violent behavior. The conjoint therapy was based upon family systems and social learning models.

Measurement instruments used included the Dyadic Adjustment Scale (DAS); the Modified Conflict Tactics Scale (MCTS): Measure of Mild Psychological Aggression; and the Psychological Maltreatment of Women Scale (PMTW): Measure of Severe Psychological Aggression.

Thirty-seven couples completed the program, while 33 couples dropped out. Couples who attended fewer than 10 of the weekly 2-hour sessions (70%) were

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considered dropouts, and a structured interview was administered to all dropouts who could be reached at the end of the program. Because no difference existed in the rates of dropout for the two treatment groups (i.e., gender-specific versus conjoint), they were collapsed into one group.

The results of the study showed that demographic variables (age and years of education, family income) were not associated with dropout rate, but pre-treatment variables were related to dropout rate. Specifically, based on wives' reports, husbands' severe psychological aggression (as measured by the PMTW, which "reflect[s] an individual's attempts to control his partner's contact with the external world, demand subservience, degrade, humiliate, and threaten) distinguished between completers and dropouts. This has clear implications for treatment, which are discussed in the summary recommendations. Based on husbands' reports, the best predictor for distinguishing between completers and dropouts was wives' mild psychological aggression (as measured by the MCTS, based on answers to such questions as "spouse refused to give sex or affection; spouse insulted or swore at you; spouse sulked," etc.).

Seventy-one percent of the 33 couples who dropped out were contacted for follow-up. Thirty-six percent of the males reported that they dropped out because they did not like the treatment. This meant they did not like the content or structure of the intervention. Forty-four percent of females also endorsed treatment-related reasons for discontinuing program treatment. In relation to predictions about termination, the study supported the importance of the perceived match of client's goals and the goals of therapy, because mismatch was the most frequently cited reason for treatment discontinuation. Interestingly, dropouts for both gender-specific and conjoint groups had a tendency to report that the program did not focus adequately on communication.

Summary Recommendations: 1) Individual sessions with men exhibiting severe psychological aggression (as defined by scores on the PMTW scale) may be warranted before couples therapy can be effective; 2) Attention should be paid to both partners' psychological aggression in order to engage both spouses in treatment; 3) Group treatment should allow for the discussion of individual couples issues; and 4) Therapists should frame therapy on aggression as critical to improving the marital relationship. Interventions which are more palatable to clients and in line with their perceived goals might decrease dropout rates.

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Title Domestic Violence: Counseling Strategies That Minimize the Impact of Secondary Victimization

Author Hattendorf, J., & Tollerud, T.R.

Journal Perspectives in Psychiatric Care, 33(1), 14-23

Year 1997

This paper reviews developmental factors associated with domestic violence, describes the processes of secondary victimization and traumatic response, and discusses the implications for intervening appropriately with battered women.

The authors cite previous exposure to violence in the family of origin as "the most consistent factor in developmental background" of victims and perpetrators of intimate violence but note that how this exposure impacts individual behavior is influenced by many other contextual and environmental variables and not yet fully understood by researchers. The authors go on to cite characteristics of male batterers (egocentric, narcissistic, abusive of drugs and alcohol) and female victims (women exhibiting learned helplessness, including passivity, depression and decreased expectations regarding future outcomes as a result of that learned helplessness) as expressed in the research literature and explain the importance of understanding the cycle of violence in the context of intimate relationships. In terms of characteristics of couples, the authors cite a 1991 study of couples that indicated the degree of disengagement a couple experienced and role rigidity within relationships were positively related to violence.

The difficulties of predicting the response an individual woman will have to the decision to remain with a batterer or leave him are substantial. Exiting a violent relationship does not guarantee safety for the victim, but when relationship violence is perceived as more dangerous than leaving, female victims may seek help from individuals or social services. However, secondary victimization of battered women often occurs at this point. The literature focuses heavily on two potential sources: the criminal justice system and the health care system. This article highlights the potential for secondary victimization by health care providers.

Revictimization can be explained both socially and biologically. Socially, secondary victimization in the health care setting occurs when, for example, a battered woman presents in an emergency room and her trauma is minimized or her behaviors are labeled as pathological. Biologically, a woman can be revictimized through experiences with post traumatic stress disorder (PTSD) in which she relives the trauma over and over and develops a range of symptoms such as diminished interest in normal activity, intense psychological distress, and hypervigilance.

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Although immediate intervention is necessary in order to stop the cycle of PTSD, most women are not seen in therapy immediately following a crisis. When women do seek help, supportive individual therapy is necessary, but again, this type of therapy is often nonexistent or too brief to resolve the woman's trauma. Instead, early marital therapy is offered. When therapists do get to see battered women individually, they must determine priorities early on, assess the lethality of the situation and, if the woman remains with her batterer, design an escape plan to affirm the grave nature of the situation and to encourage assertive action. For unremitting PTSD symptoms, pharmacological intervention may be necessary in the short term.

For couples who remain together and seek or are referred to marital counseling, the selection of a theoretical basis for couples counseling is crucial. The authors point out the disadvantages of family systems theory (this theory addresses violent couples rather than violent males and can be seen as victim-blaming), although it is perhaps the most common approach to marriage therapy. Additionally, the male is not required to assume sole responsibility for his violence under the family systems theory approach, and it is often based on traditional role assumptions within marriage. Nonsexist family counseling is an alternative to family systems theory but is not without its drawbacks. Neither approach is recommended for female victims suffering from PTSD. The authors promote feminist family counseling which is based on restructuring existing (patriarchal) value systems to achieve alternative attitudes and nonviolent behaviors.

Implications for practitioners include:

• avoiding gender stereotypes and overuse of medication;

• taking care not to minimize the traumatic event; and

• postponing referral to marriage counseling until adequate, individualized therapy has succeeded.

Title The Role of Social Support in the Lives of Women Exiting Domestic Violence Shelters

Author Tan, C., Basta, J., Sullivan, C.M., & Davidson II, W.S.

Journal Journal of Interpersonal Violence, 10(4), 437-451

Year 1995

Because abusive men are known to isolate their female intimates from social contacts such as friends and family, social support networks become an important resource in allowing battered women to escape and recover from violent relationships. Although a strong link has been demonstrated between mental health and

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supportive social networks, such resources are often reported to be inadequate in the case of women exiting abusive situations. An intervention to increase battered women's social support and make existing supports more responsive to their needs was developed and evaluated using an experimental design.

The program provided post-shelter advocacy services to women, which included assisting women in accessing needed resources, as well as expanding the clients' social networks, if so desired. In all, 141 women participated, of which 71 were randomly assigned a post-shelter advocate. Demographic data indicate that the sample was representative of women who utilize shelters. This paper describes the social support of these women, relates such support variables to mental well-being and subsequent experience with abuse, and investigates the impact of the intervention immediately and at 6-month follow-up.

Study measures included a measure of client relationship with assailant, a social support measure tapping functional and structural support, a modified version of the violence subscale of the Conflict Tactics Scale (CTS), a modification of Andrews and Withey's Quality of Life measure, and the Center for Epidemiological Studies Depression Scale (CES-D). Postintervention interviews also assessed effectiveness in obtaining resources such as housing, material goods, education, child care, etc.

The results of the study identified relatives and friends as the most common social support source for all women. Children and staff of formal organizations were listed by a majority of women, and approximately 1/3 of women mentioned local shelter staff and/or their assailants as sources of support. After the 10-week program, the experimental group expressed significantly greater satisfaction with their perceived social support, but at 6-month follow-up, these scores decreased slightly. Satisfaction with social support was significantly correlated with both the number of close friends a woman had and with age (younger women appeared more satisfied).

At the 6-month follow-up, 34% of women were still involved with their assailants. This involvement was not correlated with satisfaction with social support. Additionally, there were no significant differences between the experimental and control groups in terms of experiencing further violence, although women who continued involvement with their assailants were more likely to continue experiencing both physical and psychological abuse.

High social support satisfaction scores were highly correlated with women's psychological well-being and negatively related with depression scores. Moreover, social support satisfaction scores were positively related to women's perceived

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effectiveness in obtaining needed resources.

The provision of advocacy services appeared effective only in the short term, which is likely due to the additional stressors these women face in addition to abuse (e.g., poverty, inadequate housing). These problems cannot be easily remedied. However, the authors suggest that social support insulates battered women from stress, increases perceived quality of life, and has the potential for reducing physical and mental health symptoms; therefore, providing advocacy services to battered women is an effective intervention.

Title Commentary: Intervening in Domestic Violence: Should Victims and Offenders or Couples Be the Focus?

Author Berliner, L., O'Learly, K.D., McMahon, M., & Pence, E.

Journal Journal of Interpersonal Violence, 11(3), 449-455.

Year 1996

As suggested, many different approaches to interpersonal violence and treatment and prevention services are advanced in the literature and in practice. The question of preferred strategies has indeed been controversial, and no study provides the definitive answer as to whether couples counseling or individual treatment is more advantageous and effective. The debate is often related to the problem of conceptualizing intimate violence.

O'Learly et al. relate the problem to the extremely common nature of physical aggression in relationships and the fact that most married couples seeking treatment do not see such acts of aggression as a major problem in their relationships. Interestingly, O'Leary contends that 80% of men and women cite lack of communication as the major problem in their relationships. He contends that there is no single answer to the problem of treating physical abuse and believes the appropriate solution depends on the severity of the problem, although current practice tries to promote a one-size-fits-all solution.

O'Leary advocates a couples treatment for physically aggressive relationships that focus on the elimination of physical and mental abuse, accepting responsibility, self-control over anger, improved communication, increasing care and pleasure, and advancing respect for partner. He contends that this treatment approach is effective (noting that the most physically aggressive couples are excluded from this type of treatment) and ethically justifiable in cases where the wife wishes to remain with her abusive husband.

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McMahon and Pence disagree with O'Leary, because their conceptualization of the problem is different. They believe the appropriate primary purpose of intervention should be to end the male violence against women. These researchers find that couples counseling is appropriate "only after the full extent of the violence or abuse has been assessed and only after the violence has stopped" (p. 453). Currently, violent behavior is identified only as a symptom of a larger or underlying problem (e.g., lack of communication skills) in couples counseling, and thus the woman remains at risk for abuse. McMahon and Pence contend that women who have been abused in a relationship "cannot engage in an assessment of their experiences either quickly or in conjunction with their abuser" (p. 455). For these and other reasons, these researchers advocate individual counseling over couples treatment.

Title The Relationship Between Communication Skill and Marital Satisfaction: Some Moderating Effects

Author Burleson, B.R., & Denton, W.H.

Journal Journal of Marriage and the Family, 59, 884-902.

Year 1997

Communication problems are frequently cited by couples in community surveys as reasons for entering marital therapy. It has been suggested in the literature that the cause of many marital problems (including aggressiveness and abuse) is the result of a lack of effective communication skills, and this assumption has been largely accepted without sufficient testing. In fact, the literature on interspousal violence demonstrates that treatment is often "explicitly conducted from a skill-deficit framework" (p. 885).

This paper proposes a more complicated relationship between communication skills and marital satisfaction than has been put forth by past research, differentiating between communication skill and communication behavior. The former refers to the ability to realize communicative goals during a conversation or interaction, while the latter refers to both nonverbal and verbal actions that are actually observable by others. While research indicates differences in the communication behaviors of distressed and non-distressed couples, it is difficult to gauge whether these behavior actions are the differences in motivations, skills, or a combination of the two.

Making the distinction between different communication motivations, skills, and contexts is important but is rarely assessed in research. For example, if both

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spouses possess adequate communication skills yet are ill-motivated toward one another, marital satisfaction is likely to be low. Attending counseling focused on building communication skills is not likely to help in this situation.

The majority of marital communication literature expects communication skill and marital satisfaction to be highly and positively associated. The present research asserts that the association between skill and satisfaction varies as a complex function of the skill type examined, the context in which the skill is used, and on whose satisfaction is assessed as affected by the exercise of skill. Four different communication skills were assessed: communication effectiveness, perceptual accuracy, predictive accuracy, and interpersonal cognitive complexity.

"Communication effectiveness involves producing messages that have their intended effect". Perceptual accuracy refers to comprehending correctly the intentions underlying another's message. Predictive accuracy involves correctly anticipating how one's message will affect another interpersonal cognitive complexity is a structural assessment of the capacity to process social information and taps a fundamental aspect of social perception skill" (p. 889). Research has indicated the importance of these four skills in marital interaction.

Sixty couples participated in the study. Each participant individually completed several questionnaires and then couples jointly participated in a communication exercise based on Markman's communication box. Measures of marital satisfaction included the Dyadic Adjustment Scale (DAS) and the Positive Feeling Questionnaire (PFQ). Couples in which one spouse scored less than 100 on the DAS were considered distressed. Communication skill assessment was conducted with a two-role version of Crockett's Role Category Questionnaire (RCQ), used to assess interpersonal cognitive complexity, and the communication box (assessing communication effectiveness, perceptual accuracy, and predictive accuracy).

Results. In terms of gender differences, females exhibited slightly elevated levels of cognitive complexity than males. No other gender differences were significant. Significant, positive associations were noted between the couples' aggregate levels of cognitive complexity and their aggregate levels of marital satisfaction. Interpretation of this finding suggests that couples who are collectively better at predicting the impact of their messages on one another had more positive feelings toward each other. Analyses showed that non-distressed couples exhibited associations between communication skill and satisfaction, while distressed couples did not. In fact, in distressed couples, no relation between wives' skills and husbands' satisfaction existed, and vice versa.

These results suggest that there is a complicated relationship between communi

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cation and marital satisfaction, and the authors emphasize that these results "do not support sweeping generalizations about good communication skills contributing to satisfying marriages" (p. 897). In fact, distressed husbands and wives were found to be no less skilled than non-distressed couples with respect to the number of skills studied in this particular instance. This may indicate that negative communication behaviors so often observed in distressed couples may be less a result of poor skill and more a function of ill will. In sum, if after careful diagnosis, a couple's problems are shown to result from poor communication skills, then skills training may be called for. However, the universal prescription for communication skills training in couples therapy is unwarranted and may be used "to sharpen the tools used to inflict pain" (p. 900) in couples whose emotional or motivation troubles are the real problem.

Title Results of a Curriculum Intervention with Seventh Graders Regarding Violence in Relationships

Author Krajewski, S.S., Rybarik, M.F., Dosch, M.F., & Gilmore, G.D.

Journal Journal of Family Violence, 11(2), 93-112

Year 1996

While many programs currently exist to serve and protect family violence victims and treat family violence perpetrators, the ultimate social goal is to prevent its occurrence in the first place. With data demonstrating that most violence occurs between intimate partners, family members, or acquaintances, researchers in the field have begun concentrating on primary prevention programs, hypothesizing that we can learn how to protect ourselves, and teach our children how to protect themselves, from this type of intimate abuse.

This paper reports on an evaluation of the program, "Skills for Violence-Free Relationships (SVFR)," a curriculum for young people ages 13-18 developed by the Southern California Coalition on Battered Women. This program "challenged sex role stereotypes, offers alternative conflict resolution strategies, and assumes that violence is related to power and control" (p.99). The stated goals of the curriculum are:

Participants will be able to define the terms abuse, domestic violence, and battered woman. Participants will know facts that dispel the most common myths about battered women. Participants will know why battering in intimate relationships happens. Participants will have skills and knowledge that will reduce the likelihood that they will be abused or abuse their partners (p. 95).

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The purpose of the study was to measure the outcomes of this prevention program on the attitudes and knowledge of seventh graders in a health education class. The authors report that this is the first such program to be evaluated with a valid and reliable instrument.

The most appropriate age for intervention of this type is not agreed upon in the field. Some researchers advocate intervening with adolescents, while others believe that stereotypes and gender role expectations are already too well formed at this point for interventions to be effective. These experts think early and pre-adolescents are ideal for this type of intervention, and this population was used for the current program assessment.

Experimental and control groups were formed, and pretests, post-tests, and post post-tests regarding students' knowledge of and attitudes toward woman abuse were administered to each group. Again, the instrumentation was specifically designed for the SVFR curriculum and was shown to be valid and reliable.

Results: Significant differences in both knowledge and attitude were demonstrated between experimental and control groups from pre- to post-test. Analysis of gender differences also revealed that, for the experimental group, females scored significantly higher than males on the attitude section from post-test to post post-test. While the intervention had significant on both knowledge and attitude, these differences were unstable over time. The generalizability of results is limited in this study due to the fact that the subjects were predominantly European-American.

Because longitudinal studies have shown that the impact of violence prevention impact generally weakens in the long-run, the authors support the position often proffered by those in the battered women's movement: intervention cannot be a one-time event but must be a continuous process. Thus, it is recommended that violence prevention skills be integrated into an entire school curriculum rather than solely as special units of health education classes.

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