Batterer Program Directors' Views on Substance Abuse and Domestic Violence

This article reports on a national survey of batterer intervention program (BIP) directors (N?=?150). The beliefs of these directors on the relationship of substance abuse and domestic violence is reported and discussed. BIP director's opinions are important because they make programmatic and treatment decisions. Most BIP directors believe that for many of their clients, both men and women, perpetrator and victim, violence and substance abuse is related. Treatment and methodological considerations are discussed.     

Emotional availability and psychosocial correlates among mothers in substance‐abuse treatment and their young infants

Emotional availability (EA) was investigated among low‐income mothers enrolled in substance‐abuse treatment and their young infants (n = 21) compared with a demographically matched group of mother–infant pairs who, by self‐report, were not at risk for substance abuse (n = 27). The mother–infant dyads in the treatment group generally demonstrated poorer EA functioning than those in the comparison group, but few differences between the groups on individual dimensions of EA were significant. This finding was notable considering that mothers in treatment reported significantly higher levels of depressive symptoms and psychological stress. Treatment effects may have buffered the negative impact of depression and psychological stress on mothers' EA scores. The clinical implications of the findings are discussed as they relate to substance‐abuse‐treatment services for pregnant and parenting women.     

Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment

Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.     

The Bystander Dilemma and Child Abuse: Extending the Latane and Darley Model to Domestic Violence1

In this paper, the theoretical framework of the bystander paradigm, as originally developed by Latane and Darley (1968, 1970), is extended to include an example of domestic violence on the basis of empirical research. The purpose of this study is to examine which personal and situational characteristics are associated with noticing and interpretation of child abuse. Records of telephone calls (n= 696) from nonprofessional bystanders who alleged child abuse were analyzed. Results show that these bystanders of child abuse are a diverse group, and include a considerable number of children (peers). Bystanders' characteristics, such as gender and age group, and bystanders' visual and auditory perceptions, affect their interpretation of the abusive situation, i. e., their level of certainty of the abuse. These and other findings are discussed, and implications for future research and the definition of bystanders are formulated.     

Relationships Between Treatment Components, Client-Level Factors, and Positive Treatment Outcomes

How different amounts and components of treatment affect substance abuse treatment outcomes is fundamentally important to evaluating current treatment practices and recommending improvements. Through a secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES), the present study examined the relationships between treatment components, client-level factors, and positive treatment outcomes. Several components were shown tohave significant effects on the odds of a positive outcome, over and above the effects of client background characteristics. Depending on treatment modality, these included length of stay; whether or not clients reported seeing their treatment plan hours per month in group and individual counseling; utilization ofeducational, vocational, and other ancillary services; use of antianxiety and drug and alcohol medications; and client matching. Several interactions between client-level factors and treatment components were also observed. Studylimitations are discussed, followed by implications for policy and practiceand suggestions for further research.     

The Importance of a Comprehensive Clinical Diagnosis for Group Psychotherapy of Borderline and Narcissistic Patients

This article presents a psychoanalytically oriented model of group treatment for female adult survivors of childhood sexual abuse. Two key treatment, issues—the survivor's struggle to trust her own mind and her tenacious allegiance to an omnipotent, all-bad self-representation—are used to illustrate ways in which the transference/countertransference matrix of the group permits members to enact, identify, and work through central internalized relational configurations. The group therapist's role is to maintain transitionality, a focus on process, and the capacity for play.     

Self‐Efficacy Among Adults in Substance Abuse Treatment: The Role of Religious Coping

In substance abuse treatment, general self‐efficacy and religiousness are factors that may support positive outcomes. The authors surveyed clients receiving substance abuse treatment (N = 121) and found that religious coping predicted general self‐efficacy scores. Clinical implications are discussed.     

Sex and Aggression: The Relationship Between Gender and Abuse Experience in Youngsters Referred to Residential Treatment

We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and both sexual and physical abuse. Results indicate that girls exhibited higher levels of internalizing and externalizing symptoms even though abuse experience was accounted for in the analyses. Moreover, youngsters who had experienced sexual abuse (but not physical abuse) exhibited higher levels of internalizing and externalizing symptoms than youngsters who had not been abused. Implications for developing individualized interventions based on gender and abuse experience in residential treatment programs is discussed.     

Into the Haunted House of Mirrors

Abstract

The treatment of youth with histories of multiple victimization is discussed. A developmental treatment approach is presented based on Eriksonian theory that highlights particular difficulties abuse presents for a child's successful movement through different developmental stages. Interventions addressing these difficulties are also discussed with many case examples. Finally, the issue is raised concerning which multiple abuse victims can be helped by the therapeutic process.     

Group Therapy with Sexually Abused Boys: Leadership,Projective Identification,and Countertransference Issues

Group therapy is an essential component of the treatment of sexually abused children. Since the painful affects associated with the abuse are often dissociated or acted out, the group leaders learn of the affective experience of the abuse through the process of projective identification. The leaders must be aware of this process, set limits on the abusive acting out in the group, and help moderate, label, and empathize with the affect. It is through this difficult process that the children have a chance to reintegrate and work through their abuse experiences so they no longer feel compelled to act them out through repetitive abusive relationships. Specific leadership, countertransference, and projective identification issues in group therapy with sexually abused boys are discussed.     

Interpersonal Dependency in Child Abuse Perpetrators and Victims: A Meta-Analytic Review

Meta-analysis of studies assessing interpersonal dependency in child abuse perpetrators (N of studies = 7) and victims (N of studies = 9) indicated that perpetrators have higher dependency levels than nonabusing controls (d = 0.43), and child abuse victims have higher dependency levels in early adulthood than people who were not abused as children (d = 0.47). An array of other personality traits and disorders showed comparable associations with abuse suggesting that in both populations increased dependency reflects a generalized increase in pathology and distress. Theoretical implications of these results are discussed, and suggestions for future research on dependency and abuse are offered.     

Maternal attitudes towards pre-natal substance abuse,medical care,and treatment in a historically disadvantaged South African community

This study explored maternal substance abuse and the access to pre-natal medical care and treatment for substance abuse during pregnancy. Respondent mothers (n?=?102; mean age?=?27.8 years, SD?=?10.9 years) were from Mitchell’s Plain, a historically disadvantaged South African community. The mothers completed a mixed methods interview on the context and influences of their substance abuse during their pregnancy. Findings suggest that these mothers adopt the drug taking behaviour in their social environment. Women with prior histories of substance abuse were active consumers and dependent on drugs while childbearing. These findings may be important for possible intervention strategies among this particular group of vulnerable women.     

The challenge of defining child sexual abuse

Although child sexual abuse has been a concern for many researchers, therapists, and advocates for the past 3 decades, several fundamental issues regarding child sexual abuse remain unresolved. In particular, the term child sexual abuse has never been unequivocally defined. The lack of a commonly accepted definition of child sexual abuse continues to inhibit research, treatment, and advocacy efforts. Early researchers used broad and inclusive definitions of child sexual abuse--definitions that often continue to be used today. The consequences of these definitions are discussed, and strategies for developing other definitions of child sexual abuse are suggested.     

Fathers for Change for Substance Use and Intimate Partner Violence: Initial Community Pilot

The lack of focus on the role of men as fathers within intervention programs for men with histories of Intimate Partner Violence (IPV) or substance abuse is of significant concern given the large numbers of these men who are actively parenting and coparenting children. Fathers for Change is a new intervention designed to fill this gap. Eighteen fathers with co‐occurring IPV and substance abuse were randomly assigned to Fathers for Change or Individual Drug Counseling (IDC). They were assessed at baseline, post‐intervention and 3 months following the 16‐week intervention period. Men in the Fathers for Change group: (1) were more likely to complete treatment; (2) reported significantly greater satisfaction with the program; (3) reported a trend toward less IPV; and (4) exhibited significantly less intrusiveness in coded play interactions with their children following treatment than fathers in the IDC group. Results indicate further evaluation of this intervention in a larger sample is warranted. Limitations and directions for future research are discussed.     

Juegos en Dinamica de Grupo (Games in Group Dynamics)

Abstract

It is widely recognized that military service during wartime can take a toll on a soldier’s psychological health. Recent work has revealed effects on the families left behind as well, as reflected, for example, in an increase in child abuse and neglect in these families. My interest in studying the transgenerational transmission of trauma led me to offer the National Guard a pro bono group therapy for women whose husbands had been deployed overseas. A slightly unorthodox approach paved the way not only to group treatment but, ultimately, individual treatment for these women and their children. My hope is that this work can serve as a model for other therapists who share my interest in treating the intergenerational transmission of trauma by implementing group and mother-child psychotherapy.     

Treatment of co-occurring child maltreatment and substance abuse

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.     

Current Treatment Strategies for Sexually Abused Children

SUMMARY

Given the disturbingly high prevalence of child sexual abuse, the expertise of medical and mental health professionals in treating child sexual abuse victims is essential. Relevant issues in treating these children include the mindfulness of developmental considerations, incorporation of a multi-modal therapeutic evaluation approach, clarification of treatment goals, appropriate use of and integration of various treatment modalities, and effective treatment termination. This article provides an introduction aid overview of treatment of sexually abused children of all ages, from preschoolers to adolescents, with special emphasis on the importance of developmentally linked evaluation and treatment strategies. Treatment is discussed in terms of goals, stages from evaluation to termination, and formats and modalities including individual psychotherapy, family psychotherapy, group psychotherapy and hypnotherapy, to provide a comprehensive overview of current treatment strategies for sexually abused children.     

Are Disease and Other Conceptions of Alcohol Abuse Related to Beliefs About Outcome and Recovery?1

Visitors to a science center (N= 189) responded to a questionnaire measuring their agreement with different conceptions of alcohol abuse (disease, sin, habit, and addiction conceptions) and their beliefs regarding treatment for alcohol abusers. Respondents who agreed with a disease concept thought alcohol abuse was a more serious problem, were more skeptical of statements about recovery, and were more likely to feel that treatment was necessary to achieve change, compared to those who disagreed with or were neutral toward the disease concept. Agreement with the sin, habit, and addiction conceptions was not related to beliefs about treatment and outcome. The utility of promoting various conceptualizations of alcohol abuse is discussed.     

The Influence of Posttreatment Mutual Help Group Participation on the Friendship Networks of Substance Abuse Patients

The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.     

Children Exposed to Intra-Familial Violence

Abstract

This investigation examined factors associated with attrition and retention within a sample of children with a history of intra-familial violence referred for outpatient services. The sample included 118 children, aged 4-17 years; of these 64% completed treatment, 20% did not engage in treatment and 16% terminated prematurely. Caregivers reporting high child-related parental distress (F(2, 32) = 3.9, p = 0.03) and high psychological distress (F(2, 70) = 3.3, p = 0.04) were less likely to engage in treatment. Making a child abuse report during assessment or treatment was not found to be associated with treatment engagement or attrition, χ² ₍₂₎= 0.4, p = 0.82. The implications of these findings for clinical practice and treatment outcome research are discussed.