Conjoint therapy and domestic violence: Treating the individuals and the relationship

Domestic violence is a common complaint encountered by counselling psychologists and other mental health professionals. Common psychological treatment practices separate perpetrators and victims into individual intervention modalities. However, there is some research that has been emerging that suggests in some cases a couples treatment approach may be a useful adjunct to existing treatments. The present paper examines research and considerations in making the decision to employ a conjoint approach to treating domestic violence issues.     

Conjoint Couple's Treatment for Intimate Partner Violence

Abstract

Despite lingering concerns in the field about the wisdom of seeing couples conjointly when there has been Intimate Partner Violence (IPV), the research literature and clinical practice experience both indicate that this approach can be safe and effective for at least some couples. In this paper, we briefly review the existing outcome research on Couple's treatment for IPV and then suggest best clinical practices for this work. Best practices, in our view, include seeing Couple's treatment of IPV as a clinical specialty necessitating specific training, working as part of a coordinated community response to IPV, modification of the structure of therapy to increase safety, as well as careful screening of couples and on-going assessment of the propriety of conjoint treatment.     

Moving Toward Comprehensiveness and Sustainability in a Social Ecological Approach to Youth Violence Prevention: Lessons from the Asian/Pacific Islander Youth Violence Prevention Center

Youth violence is a serious public health problem affecting communities across the United States. The use of a social ecological approach has helped reduce its prevalence. However, those who have put the approach into practice often face challenges to effective implementation. Addressing social ecology in all its complexity presents one obstacle; the ability of private non-profit and public agencies to sustain such comprehensive efforts presents another. Here, we provide an example of our efforts to prevent youth violence. We worked with the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) and two communities on O`ahu. We provide a case example from the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) of our work, in collaboration with two communities on O`ahu, to develop and implement a youth violence prevention initiative that is becoming both comprehensive and sustainable. We illustrate the incremental nature of what it means to be comprehensive and we underscore the importance of reaching sustainability as the project unfolds.     

Limitations in the Prediction of Mass Violence: Cautionary Tales

The incidents of mass violence that have occurred in the United States have been deeply disturbing to the public as well as to mental health professionals. The public, the media, as well as our patients, family members, and friends have reached out to mental health professionals in the hope that we can provide an understanding of these events that might serve to reduce their frequency in the future. This article explores how we can best respond to these requests, including the current limitations of psychologists in the prediction of mass violence. Two incidents of mass violence are used to illustrate these issues. The first is a review of the investigation of the explosion on the U.S.S. Iowa in April 1989 that resulted in the deaths of 47 seamen. The second incident used for illustration purposes will be the University of Texas Clock Tower shootings that occurred in August 1968. This article discusses the reliability and validity problems inherent in retrospective reviews of the personality characteristics of perpetrators, and the limitations imposed by base-rate issues in the prediction of mass violence.     

The development and validation of the guidelines for stalking assessment and management

International research has established that stalking is a prevalent problem with serious and often life-threatening consequences for victims. Stalking is also a unique form of violence due to its nature and diversity, making it difficult for criminal justice and health professionals to establish which perpetrators and victims have the greatest need for services and protection. Risk assessment is one way to address these problems but few tools exist. This article describes the development of the Guidelines for Stalking Assessment and Management (SAM), the first risk assessment instrument designed specifically for the stalking situation. Preliminary data are presented, indicating that the SAM has promise for use by professionals working with stalkers and their victims. Results indicated that interrater reliabilities for the SAM risk factors and total scores range from fair to good, and the structural reliability of the SAM is sound. Moreover, the SAM showed good concurrent validity when compared with two other measures of violence propensity: the Psychopathy Checklist Screening Version (PCL:SV) and the Violence Risk Appraisal Guide (VRAG). Limitations of the study are discussed, especially those related to the difficulties inherent in file-based research, and suggestions for future research are offered.     

Gender Affirmation: A Framework for Conceptualizing Risk Behavior Among Transgender Women of Color

Experiences of stigma, discrimination, and violence as well as extreme health disparities and high rates of sexual risk behavior and substance use have been well-documented among transgender women of color. Using an intersectional approach and integrating prominent theories from stigma, eating disorders, and HIV-related research, this article offers a new framework for conceptualizing risk behavior among transgender women of color, specifically sexual risk behavior and risky body modification practices. This framework is centered on the concept of ‘gender affirmation,’ the process by which individuals are affirmed in their gender identity through social interactions. Qualitative data from 22 interviews with transgender women of color from the San Francisco Bay Area in the United States are analyzed and discussed in the context of the gender affirmation framework.     

Consequences of Violence Exposures by Emergency Nurses

Emergency nurses are among the most likely groups of health care professionals to be exposed to violence. Violence exposure is the witnessing or receiving of a violent act with or without the intention to cause physical or psychological harm. The purpose of this paper is to evaluate the literature in relation to emergency nurses' exposure to violence and discuss the implications for emergency nursing practice. A review of the literature was conducted using the keywords violence, emergency nursing, health care workers, and productivity. Emergency nurses exhibited anxiety, vulnerability, guilt, anger, sadness, and peer blaming following violence exposures. Violence exposures affect emergency nurses both physically and psychologically. Interventions should be developed to reduce the negative consequences of violence exposures.     

Infusing Multicultural and Social Justice Competencies Within Counseling Practice: A Guide for Trainers

In light of rapidly changing demographics within the United States, counselors are challenged to provide culturally responsive services to facilitate optimal client functioning. This article highlights recommended training strategies within a developmental framework to promote multicultural and social justice competencies for trainers of mental health professionals.     

Intimate Partner Violence in African Immigrant Communities in the United States: Reflections from the IDVAAC African Women’s Round Table on Domestic Violence

African women face many challenges when they come to the United States due to the immigration experience, acculturation, and leaving family members in countries of origin. Intimate partner violence (IPV) complicates African women’s experience within their home countries as well as in the United States. There is little literature on IPV in African ethnic groups. This information is even sparser regarding IPV among African immigrant and refugee communities in the United States. To better address the needs of these communities, the Institute on Domestic Violence in the African American Community brought together service providers and survivors representing 16 different African countries to attend a roundtable and explore issues of IPV. This article highlights the unique challenges they identified.     

Short- and long-term effectiveness of two communication training modalities with distressed couples

Abstract

Communication training is a widely practiced therapeutic approach for the treatment of marital discord. Although there is some empirical support for the theoretical assumptions underlying constructive communication patterns, it has not yet been ascertained whether changing these behaviors is sufficient in bringing about stable changes in distressed marriages. The present study was designed to investigate the efficacy of this treatment approach in a conjoint and conjoint group modality. Following therapy, conjoint couples (n = 16) when compared with a waiting list control group (n = 17) showed improvement on five of the seven outcome variables. Couples in the conjoint group modality (n = 13) improved on only two of the seven variables. Follow-up assessments one year after treatment showed that initial gains had been substantially reduced. On the basis of these results it is now open to question whether conjoint group treatments are an appropriate treatment modality for even moderately distressed couples.     

The Formal Systems Response to Violence Against Women in India: A Cultural Lens

Violence against women (VAW) has become an increasingly salient issue in India, with women at risk for different forms of gendered violence. While there may be universal elements in the international phenomenon of violence against women, it is a complex, multifaceted phenomenon that takes shape in a particular sociocultural context. The current study employs a narrative framework to systematically examine how culture is expressed in the formal systems response and women's help‐seeking in two metropolitan cities in India. Specifically, we sought to understand, among formal system responders (a) what characterizes the dominant cultural narratives on violence against women in India; and (b) how these are reflected in community narratives of formal responders. Interviews were conducted with formal responders working in different types of local agencies (e.g., police, health centers, and non‐governmental agencies). The paper illustrates the major themes that emerged from participants’ narratives describing the multilevel influences that shape the formal system response to violence against women and women's help‐seeking efforts. The implications of these findings for effective response and directions for future research are summarized.     

The Western Cape Government's new Integrated Provincial Violence Prevention Policy Framework: Successes and challenges

In August 2013, the Western Cape Government adopted an Integrated Provincial Violence Prevention Policy Framework initiated by the provincial Department of Health in response to the unusually high incidence of, and health burden arising from, interpersonal violence. The policy framework encompasses a more comprehensive intersectoral approach to the prevention of violence than the traditional criminal justice and security-centred approach typically promoted in South Africa as the conventional wisdom. It aims to bring coherence and clarity to the government's objectives in the field of violence prevention by way of a whole-of-government approach encompassing all sectors. The Policy Framework attempts to balance short-term evidence-based interventions, such as reducing the availability and harmful use of alcohol, with longer term interventions that require the state and all citizens to take active responsibility in addressing more holistically the complex social norms that support violence. It is consonant with a “whole-of-society” approach current in the South African polity to policy formulation and implementation, and is underpinned by the public health-centred guidelines set out by the international Global Campaign for the Prevention of Violence. The policy framework supports evidence-based approaches for violence prevention and a review and consultation process aimed at aligning existing performance priorities and deliverables across departments. One year after its adoption we review the uptake of this policy and reflect on some of its early successes as well as barriers to its implementation. We identify early resistance arising from its conflict with intra-departmental priorities, the impact of competing policies and directives, and we propose a research agenda to support its uptake.     

Collaborative Home-Based Therapy (CHBT): A Culturally Responsive Model for Treating Children and Adolescents Involved in Child Protective Service Systems

Mental Health professionals are challenged with utilizing innovative treatment models to meet the needs of diverse communities. Enhancements in interventions have led to a reconceptualization of the role of mental health professionals, specifically, family therapists. This paper presents a collaborative, home-based model for working with children and adolescents involved in foster care. We begin by examining literature on home-based therapy. This review provides a framework to understand the need for a culturally responsive approach. A collaborative, home-based approach is presented along with unique issues and guidelines for practice. A clinical case is presented to illustrate implications for treatment.     

Domestic violence and sexual assault services: Inside the black box

Research examining the efficacy of community-based domestic violence and sexual assault services is yielding promising findings; however, little is known about the structure, components, and content of these services. Although service guidelines exist, a critical gap persists because review, comparison, and synthesis of these recommendations have not been undertaken. This research addresses this knowledge gap through a review of the domestic violence and sexual assault services literature. We gathered relevant literature by conducting systematic searches of databases, and by soliciting the service guidelines and training manuals from all the Domestic Violence and Sexual Assault Coalitions in the United States. These efforts yielded 43 articles, books, or manuals for review. The findings show strong consensus on core services for survivors, including crisis services, legal and medical advocacy, support groups, individual counseling, and shelter. This article presents the review results in tables comparing the service goals, intervention strategies, and recommendations for service delivery. We also found areas of contention (e.g., whether to continuously staff domestic violence shelters, and whether combined agencies can effectively offer both domestic violence and sexual assault services). Building upon the review findings, we discuss the implications for domestic violence and sexual assault services and intervention research.     

Comparison of impulsive and premeditated perpetrators of intimate partner violence

Violence occurs in four to five million intimate relationships each year in the United States. Past research has investigated the concept of batterer subtypes based on the nature of the violent behavior. To extend this research, the present study used the Impulsive/Premeditated Aggression Scale (IPAS) along with a battery of relevant self-report measures in a sample of men (N = 113) convicted of domestic violence and court ordered into an intervention program. Batterers whose violence was classified as premeditated scored higher on psychopathic traits and a measure of treatment rejection. Batterers whose violence was classified as impulsive in nature reported a wider range of serious psychopathology. It is suggested that the use of a bimodal classification (Impulsive/Premeditated) in batterers may have significant clinical and legal policy implications. Copyright © 2008 John Wiley & Sons, Ltd.     

“Peace with the Earth” in the Context of the Decade to Overcome Violence

Abstract In this article, Guillermo Kerber situates theWorld Council of Churches' Decade to Overcome Violence against the background of debates about war and peace that have taken place within the ecumenical movement since the Second World War. He shows how this initiative has contributed to an understanding of the concept of “just peace” that goes beyond being the opposite of “just war, but rather demands the absence of all forms of structural violence, including gender‐based, cultural and media violence”. Against this background, this article underlines the need for an ecological understanding of “peace with the earth” to be an integral part of such a “just peace”.     

Fabry Disease Practice Guidelines: Recommendations of the National Society of Genetic Counselors

Identification and comprehensive care of individuals who have Fabry disease (FD) requires a multidisciplinary approach inclusive of genetic testing, test interpretation, genetic counseling, long term disease symptom monitoring, treatment recommendations, and coordination of therapy. The purpose of this document is to provide health care professionals with guidelines for testing, care coordination, identification of psychosocial issues, and to facilitate a better understanding of disease treatment expert recommendations for patients with Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as representatives/founders of the two United States based Fabry disease patient advocacy groups who are themselves affected by Fabry disease. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing, interpretation of results, psychosocial considerations, and references to professional and patient resources.     

Treating survivors of war trauma and torture.

Psychologists are in a unique position to assist individuals and groups in the world who have survived torture and war trauma. Symptoms of posttraumatic stress disorder and other psychological diagnoses can be treated effectively by mental health professionals and trained lay counselors in the smallest of communities in the world. This article proposes a model for the treatment of survivors of torture and war trauma. This model has been designed to be useful to mental health professionals and to lay individuals in communities who constitute the front line in treatment: health providers, midwives, ministers, and teachers. The model is presented through examples of its use in the training of mental health counselors in the United States and in the training of promotores (health promoters) and comodrones (midwives) in Guatemala.     

Collaborating on Family Safety

Summary

The problems of child maltreatment and violence against women have traditionally been viewed and treated as two distinct issues. In response to these two forms of family violence, two separate service systems with different approaches to prevention, treatment and intervention have developed. This article outlines sources of conflicts between child protection workers and battered women's advocates, and elaborates on these conflicts using child protection workers' and battered women's advocates' own words elicited in a series of focus groups. Models of cross-system collaboration in the United States are then described, and recommendations are made for practice and policy which support collaboration across systems.     

Assessing Violence Risk: A Review and Clinical Recommendations

Guidance to identify and manage clients with a perceived high risk for future violence is of great importance for mental health professionals. In the past decade, several structured instruments have been developed to assess risk of future violence. Awareness of the limits and abilities of such instruments is required. This article reviews the most well‐known risk assessment tools and provides recommendations for how to approach the area of violence risk assessment.