Coming down the homestretch here! Crazy semester, but I just read these three articles and found them so interesting in how they all say the same thing regarding abusive relationships.
Three recent articles discuss substance abuse (SA) and intimate partner violence (IPV) and several treatment modalities that were found to be effective. The interesting points to note from each article are listed below, but collectively the articles shared two themes that can be translated into a given theoretical framework.
First, the articles stress that in some cases conjoint therapy was equally effective to individual therapy; however in most cases it was found to be more effective and substantially so in some cases. In some cases of SA and IPV treatment, conjoint therapy is controversial in that the non-offending partner does not feel responsible for the condition or behavior. In other cases, the non-offending partner attributes conjoint therapy to a continuation of the controlling behavior they are subjected to daily. Other cases of disinterest in long-term treatment modalities and other conditions all existed. Each article addresses these concerns respectively; however they all speak of reciprocal behavioral patterns that perpetuate the abusive behavior and that ignoring treatment of this condition results in dramatically less effective treatments. Karen Rosen, et al summarize the point well writing, “If reciprocal violence is occurring, treating men without treating women is not likely to stop the violence.” (Rosen, Matheson, Stith, McCollum & Locke, 2003, pp.291-292)
Second, the articles all speak to the extensive victimization that currently afflicts couples in the U.S. Nationwide, approximately 30% of married couples experience at least one incident of violence leading to 1,300 IPV related deaths and up to 2 million severely assaulted women each year. (La Taillade, Epstein & Werlinich, 2006) SA exacerbates the condition dramatically as nearly 60% of men seeking SA treatment admit to at least one incident of male-to-female aggression in the previous year. (Fals-Stewart, O’Farrell, Birchler, Córdova, & Kelley, 2005) To speak to the aforementioned theme and clearly demonstrate the complexity involved in treatment of these couples, Gottman points out that 71% of all violent fights between partners begin with the woman engaging in violence first. (Gottman, 1999) He further clarifies this interesting statistic by stating that “…it is only men who use violence to systematically terrorize, control and subdue their wives.” (Gottman, 1999, p.62) It is not the act of violence but the intent of control and domination behind it that classifies it as ‘battering’. (Gottman, 1999)
Given these collective themes, each article seeks to address SA and/or IPV using a certain treatment modality or technique to assist in treatment. Fals-Stewart and fellow authors discuss excessively the Behavioral Couples Therapy (BCT) model and how it is found to be especially effective in treatment of SA and in some cases SA and IPV. (Fals-Stewart, et al, 2005) The model incorporates aspects of the popular Alcoholics Anonymous self help group and behavioral therapy into a daily contractual agreement between the partner and the offender. This daily contract, referred to as the Recovery or Sobriety Contract, spells out certain agreements that allow each person to be individually responsible and accountable to each other for certain behaviors. The authors provide a sound example stating, “…the substance-abusing partner states his or her intent not to drink or use drugs that day [and] in turn, the non-substance-abusing partner verbally expresses positive support for the patient’s efforts to remain sober.” (Fals-Stewart, et al, 2005, p.231) This daily contract is addresses several issues in that the offending partner does not have to relive or seek amends for past transgressions on a daily basis and provides a neutral discussion between the couple that perpetuates support and motivation. Weekly, or more if there is a ‘relapse’, the couple will attend a session with the BCT therapist and have open discussions regarding the progress or relapse. As the abusive behavior becomes less prevalent, the therapist can focus on other aspects of the couple’s marriage such as constructive communication, positive feelings and shared activities. These other aspects of therapy help provide a new context to the couple’s marriage that is not centered on the abusive patterns of the past, but their newly established traditions and behavior.
The next article used in this discussion dealt directly with the conjoint treatment of IPV using a cognitive behavioral approach entitled CAPP (Couples Abusive Prevention Program.) CAPP focuses directly on the risk factors of IPV such as anger management, couple’s communication, and problem solving skills and “… helping the couple recover from any past trauma and broken trust, and increasing partners’ mutual support and shared positive activities.” (La Taillade, Epstein & Werlinich, 2006, p.401) Using the given protocol format, the therapist can provide cognitive behavioral therapy that like the aforementioned article provide a new context for the couple’s relationship that de-emphasizes the abusive patterns of the past through forgiveness and accountability.
The final article mentioned here presents an alternative approach to a common Time Out behavioral technique used in treatment of abusive partners. There are numerous limitations associated with this technique mostly stemming from its abuse by the offending partner or it’s misunderstood intentions by the non-offending partner. This abuse and lack of understanding of the time out is directly addressed in conjoint therapy by developing a ‘Negotiated Time Out’ in which both partners agree on the premise and implementation of the time out. This not only creates an opportunity for the couple to learn to communication constructively, but also develops a skill or tool that they can use in future crisis moments. (Rosen, et al, 2003) By having the couples negotiate the terms of a time out prior to the crisis; the therapist has facilitated successful communication between the couple and helped them establish an intervention that can be used and modified as needed.
As a significant final note regarding the themes of all of the aforementioned articles, each author began with the premise that a full assessment should be performed to determine the extent of the presumed abuse that is taking place. At no point should any therapy model take the place of a person’s safety. Each author specifically noted that the proposed intervention or model should be preceded by such an assessment to determine the viability of treatment. All the aforementioned interventions were designed for low to moderate risk offenders and more serious cases should be referred to shelters, law enforcement or appropriate medical facilities. This theme was absolutely constant in all three articles as well as the Gottman text.
Adam T
References
Fals-Stewart, W., O’Farrell, T., Birchler, G., Córdova, J., & Kelley, M. (2005). Behavioral Couples Therapy for Alcoholism and Drug Abuse: Where We’ve Been, Where We Are, and Where We’re Going. Journal of Cognitive Psychotherapy, 19(3), 229-246. Retrieved September 2, 2009, from Academic Search Premier database.
Gottman, J. M. (1999). The marriage clinic: A scientifically based marital therapy. New York: Norton
La Taillade, J., Epstein, N., & Werlinich, C. (2006). Conjoint Treatment of Intimate Partner Violence: A Cognitive Behavioral Approach. Journal of Cognitive Psychotherapy, 20(4), 393-410. Retrieved September 2, 2009, from Academic Search Premier database.
Rosen, K., Matheson, J., Stith, S., McCollum, E., Locke, L. (2003). Negotiated time-out: A de-escalation tool for couples. Journal of Marital and Family Therapy, 29(3), 291. Retrieved September 2, 2009, from ProQuest Medical Library. (Document ID: 374230631).
