Using Reoffenders’ Experiences and Perspectives to Improve Intimate Partner Violence Treatment

Abstract

A substantial proportion of partner-violent men reoffend subsequent to completing intimate partner violence (IPV) treatment. A critical step in enhancing treatment for IPV perpetration is to understand reoffense among those who recidivate following treatment completion. Investigating reoffenders’ own perceptions regarding potential directions for treatment modification may improve overall treatment outcomes. Qualitative research examining the experiences of participants who utilize IPV treatment is limited. In the present study, we examined implications for treatment from an exploration of reoffenders’ interpretation of their recidivist events and their beliefs regarding treatment effectiveness. A constructivist grounded theory approach was used to generate theory regarding behavior change, treatment perceptions, and recidivist processes among men who experience difficulty staying nonviolent. Emergent qualitative themes revealed reoffenders’ perceptions of treatment and suggestions for treatment modification. Reoffenders identified program factors that they believed would have enhanced program effectiveness for themselves, and thus may have prevented their recidivist incidents. Treatment implications that emerged from reoffenders’ narratives are organized along three key dimensions: modality-specific variables, which were relevant to treatment approach and effectiveness of group therapy; content-specific variables, which were relevant to skill acquisition and skill application; and participant-specific variables, which were relevant to intrapersonal characteristics of the participants themselves. Recommendations for treatment enhancement are discussed.

Keywords

domestic violence batterers intervention/treatment violent offenders

Introduction

Intimate partner violence (IPV) is a far-reaching problem that can have significant short- and long-term deleterious effects on victims and families (Black et al., 2011). Risk factors for IPV operate at multiple levels, including individual characteristics, relationship dynamics, and societal norms. However, most existing intervention models for partner-violent men have emerged from singular theories that focus on a limited range of factors that influence IPV. Some prominent intervention models focus on distal contributors of violence perpetration that emphasize the social context in which male-perpetrated partner violence occurs. These models utilize a didactic, consciousness raising approach, encouraging partner-violent men to acknowledge their male privilege within patriarchal systems and to accept responsibility for their behavior (Pence & Paymar, 1993).

Other prominent treatment models focus on factors that are more proximal to IPV perpetration. For example, social learning and cognitive behavioral approaches underscore the importance of learning new, healthy, relationship skills to replace attitudes, cognitions, and beliefs that promote and maintain abusive behavior (Murphy & Eckhardt, 2005). Some approaches focus on psychopathological correlates of IPV, emphasizing how intrapersonal problems such as personality disorders, trauma symptoms, and/or substance abuse can increase individuals’ vulnerability to becoming violent; thus, being abusive is considered a symptom of, or strongly influenced by, underlying psychopathological problems (Healey, Smith, & O’Sullivan, 1998). Despite divergence in program philosophy, survey research has uncovered some widespread similarities in abuser intervention practice. Notably, the vast majority of programs are psychoeducational in nature, serve predominantly court-mandated populations, use group counseling as the primary or exclusive mode of intervention, and deploy gender-specific approaches (Price & Rosenbaum, 2009).

Treatment Effectiveness

Abuser intervention program (AIP) treatment effectiveness is most commonly measured by victim-partner report of abusive behavior, offender self-report of abusive behavior, and official legal system reports of recidivism (Babcock, Green, & Robie, 2004). Overall, the findings of treatment effectiveness have been inconsistent or inconclusive due to a number of factors, including serious methodological shortcomings, limited follow-up data, a lack of documentation of intervention models and adherence, and the diversity of models included in analysis (Gondolf, 2004; Gondolf, 2012; Healey et al., 1998). Conclusions range from assertions that AIPs are ineffective (Feder & Wilson, 2005), have a small positive influence in reducing violence (Babcock et al., 2004), or have a substantial positive influence in reducing violence for those who are retained and complete these programs (Jones & Gondolf, 2001). (Babcock, Canady, Graham, & Schart, 2007; Dutton, 2010). In Gondolf’s (2012) review of abuser intervention research, he posits the drawbacks of research that dichotomize treatment effectiveness into whether AIP treatment works or does not work. In his review, Gondolf suggests that a better model for the field may be assessing why AIPs do not work and addressing strategies for making treatment more effective.

Consistent with Gondolf (2012) and others’ recommendations (see Chang et al., 2010; Murphy & O’Leary, 1994), qualitative research has made a valuable contribution to enhancing the understanding of specific components and characteristics essential to AIP treatment effectiveness. For example, Scott and Wolfe (2000) identified key variables related to behavior change among samples of partner-violent men, including increased responsibility for past abusive behavior, development of empathy for partners’ victimization, reduced dependency on partners, and enhanced communication skills. Mutual respect between the clinician and group members, facilitating an emotionally safe space or “asylum” was another key component identified in support of AIP treatment effectiveness through qualitative analysis (Silvergleid & Mankowski, 2006; Wangsgaard, 2001). In Silvergleid and Mankowski’s research with participants and facilitators of an AIP, the authors found that both participants and facilitators emphasize the key role that group experiences play in offenders’ processes of change. Particularly, a balance of support and confrontation from facilitators and other group members, sharing and hearing others’ stories, modeling that takes place during group sessions, skill acquisition, engagement in program activities, self-awareness, and the decision and/or motivation to change were identified as treatment-specific factors by participants and facilitators (Silvergleid & Mankowski, 2006).

These qualitative studies contribute important insights to understand and enhance AIP treatment effectiveness. In previous qualitative explorations of treatment experiences and behavioral change processes, researchers made inferences and drew conclusions based on their interpretation of participants’ reports. A useful next step is to investigate offenders’ own perceptions regarding potential directions for enhancing treatment effectiveness. In the current study, we examined implications for AIP treatment from an exploration of reoffenders’ interpretation of their recidivist events and their beliefs regarding AIP treatment effectiveness, gathered through in-depth qualitative interviews. Reoffenders identified program factors that they believed would have enhanced program effectiveness for themselves, and thus may have prevented their recidivist incidents. The current study provides a summary of their recommendations for treatment variations or innovations to prevent IPV recidivism.

Method

Sample

To be eligible for this study, participants must have (a) completed a “credible dose” of AIP treatment (i.e., attended at least 15 treatment sessions equaling 75% of the program); (b) obtained new criminal or civil charges related to domestic violence following treatment completion, as indicated through a search of publicly available electronic data in the State of Maryland legal system actions database; and (c) agreed to participate in an interview regarding their recidivist incident and experiences in the AIP. The sample consisted of 11 men of whom five received new protective orders following AIP completion. Charges following treatment completion included four participants facing second degree criminal charges for assault, one facing harassment charges specifically related to telephone misuse, and one facing first degree criminal charges for assault. The age of the participants ranged from 23 to 53 years at the time of the interview, with an average age of 37.45 years. At the time of the interview, six participants were employed full-time, one was employed part-time, and four were unemployed. Four participants identified as Black or African American, five as White or Caucasian, one as Indian, and one as Hispanic or Latino and White. Four participants reported completing high school, five stated they completed some college, one reported completing graduate school, and one completed the 11th grade and was studying for his general educational development (GED) at the time of research interview. Of the nine participants who completed group treatment prior to the recidivist incident, two completed individual treatment following their new charges and four completed group a second time following new charges. Two participants completed individual treatment only as their initial intervention. At the time of treatment initiation, eight participants reported being court ordered to an AIP and three reported attending voluntarily. Please see Table 1 for an overview description of participants.

Table 1.

Description of Participants.

Name^a	Age	Race/Ethnicity	Charge(s) Following Treatment Completion	Education	Employment	Treatment Modality
Andre	41	Black or African American	Two protective orders filed by (ex-)partner	Some college	Unemployed	Group
Darrell	45	Black or African American	Protective order filed by (ex-)partner	Graduate school	Full-time	Individual^b
Carl	42	White or Caucasian	First degree assault of partner	11th grade	Full-time	Group and individual
Glen	38	White or Caucasian	Second degree assault of partner; protective order filed by partner two years later	High school	Unemployed	Group
Gavin	27	White or Caucasian	Protective order filed by (ex-)partner, violation of protective order, willful motor vehicle tampering	Some college	Full-time	Group 2x
Javier	44	Hispanic or Latino/White or Caucasian	Two protective orders filed by (ex-)partner, violation of protective order	Some college	Unemployed	Group 2x
Dominic	29	Black or African American	Second degree assault of partner; destruction of property	High school	Full-time	Group 2x
Dev	37	Indian	Second degree assault of partner	High school	Unemployed	Group 2x
Hank	33	White or Caucasian	Protective order filed by (ex-)partner; violation of protective order	Some college	Full-time	Group and individual^b
Dan	53	White or Caucasian	Second degree assault of partner; violation of protective order	Some college	Full-time	Group^b
Marcus	23	Black or African American	Telephone misuse (repeated calls/harassment)	High school	Part-time	Individual

Participants’ names were replaced with pseudonyms to maintain participant anonymity. These pseudonyms were generated with the intention of reflecting racial/ethnic characteristics of the participants’ real names.

Participant reported enrolling in abuser intervention program (AIP) treatment voluntarily at time of intake assessment.

The AIP that participants completed employed a treatment philosophy that incorporates cognitive behavioral therapy (CBT), motivational enhancement, and family/relationship systems approaches to enhance clients’ self-regulation and relationship skills. These skills are designed to provide alternatives to conflict escalation and abusive behavior; they are taught through the use of psychoeducation, in-session practice, troubleshooting past experiences, and homework assignments. Although group intervention was the standard program approach, some participants were enrolled in individual treatment based on several considerations, including work schedule, problems that may preclude group engagement or cannot be readily addressed in group, and availability of individual therapy staff. The philosophy, treatment approach, and duration of treatment were similar regardless of treatment modality. However, due to the ability to offer more individualized focus, and in line with standard therapy practice, individual sessions were 1 hr in duration, whereas group sessions lasted 2 hr.

Procedures

Qualitative data were collected through individual interviews with participants. A start list of semistructured questions helped to guide the initial interviews; these questions were further developed and narrowed through the iterative interviewing process (Charmaz, 2002). Participants were asked about their recidivist events, experiences participating in the AIP, beliefs regarding the effectiveness of the AIP treatment, and factors that they believed would have enhanced the effectiveness of treatment in their unique circumstances. The interview guide consisted of introductory, follow-up, probing, topic-related, and ending questions (Charmaz, 2006; Kvale & Brinkmann, 2009); examples of specific questions used appear in Table 2. Participants were interviewed in a private room at the community AIP agency. Each participant received US$50 in cash for participating in the research study interview. Interviews were digitally audio-recorded and subsequently transcribed verbatim. Study procedures were approved by the university institutional review board.

Table 2.

Interview Guide Sample Questions.

Introductory questions

How have you been doing since completing the [AIP]?

I would like to learn about any changes that have occurred in your life since you completed the [AIP]. What has changed in your life since completing treatment?

Topic-related questions: Recidivist event(s)

Could you describe the events that led up to the incident? What was going on right before the conflict began?

How, if at all, did the incident affect your relationship?

Who or what was the most helpful to you during this time? How?

Topic-related questions: Participation in the AIP

What was participating in the [AIP] like for you?

What did you hope to get out of participating in the program?

What, if anything, was missing for you from the [AIP] group?

Ending questions

Was there anything that you might not have thought about before that occurred to you during this interview?

Is there anything else you think I should know to better understand domestic violence in relationships?

Note. AIP = abuser intervention program.

Data Analysis

In this study, we employed a qualitative research design based in constructivist grounded theory (Charmaz, 2002; Glaser & Strauss, 1967). Data analysis occurred during several phases, including during data collection, immediately following each interview, and after the transcription of data while engaging in the coding process. During the study’s interview phase (i.e., data collection), analysis occurred through clarifying participants’ responses to questions, thus reducing the risk of misinterpreting meaning, and by refining interview questions during and between interview participants. Following interviews, field notes were maintained to identify initial reactions, reflections, and observations. A systematic but flexible structured approach to data analysis was used (Charmaz, 2006). Coding occurred in three phases: initial, focused, and axial. During the initial coding phase, lines and segments of data were identified to separate the data into discrete ideas that represent meaningful pieces of text. During the focused coding phase, the most salient and/or frequently noted themes were identified to synthesize, compare, sort, and organize the data. Finally, during the axial coding phase, categories and themes were connected to subcategories, a strategy that enhances data coherence and enables theory emergence. In addition, disconfirming and “if-then” data were purposely pursued. Examples of disconfirmation were investigated by intentionally seeking out negative evidence to reveal data that opposes conclusions being drawn; “if-then” codes were identified and analyzed as conditional statements of relation between variables (Miles & Huberman, 1994). To enhance the trustworthiness of study findings, six of Creswell’s (2007) eight verification strategies were used, including researchers’ prolonged engagement in the field of study, peer review, triangulation, external audit, ongoing reflexivity to explore and clarify researcher bias, and rich description of data and context. Results are presented alongside participant quotations to enhance data verification and provide rich description.

Results

Treatment implications in the form of AIP recommendations emerged from an investigation of reoffenders’ perceptions and beliefs regarding their experiences in an abuser intervention treatment program. Themes that emerged include potential elements of treatment that may enhance program effectiveness from the unique perspectives of those who reoffend following treatment completion. Our findings suggest that AIP participants’ perceptions of their reoffense can be organized along several specific dimensions. These treatment considerations include modality-specific variables relevant to treatment approach and effectiveness of group therapy, content-specific variables relevant to skill acquisition and skill application, and participant-specific variables relevant to intrapersonal characteristics of the participants.

Modality-Specific Variables

Flexible treatment approach

The narrative accounts of AIP participants in this study reflect the importance of flexibility in AIP treatment. Nearly all study participants indicated how helpful various treatment modalities could be. For example, participants described that having the option of group therapy, individual therapy, and/or couples therapy may enhance therapeutic gains related to relationship skills. Individual therapy was identified as especially helpful due to participants’ willingness to be more open and forthcoming in individual therapy as compared with group, having sufficient time during individual sessions rather than having to share time with others in group, and the unique interpersonal dynamics of individual therapy (such as the relationship between client and therapist). Couples therapy was also identified as a potentially useful treatment modality, especially for those participants who noted that their partners also displayed deficits in relationship skills. For example, one participant expressed frustration that couples therapy was not available for him and his partner during his treatment episode, indicating benefit from both partners gaining relationships skills:

At that time I wish I could have gotten couples counseling for me and her. Somebody that’s striving for that goal of trying to work on whatever we are going through . . . Because this is a one man band when you are coming here and getting help and they are not.

In addition, each of the participants who completed individual treatment, along with several participants who only completed group treatment, discussed the benefits of individual therapy. All of the study participants who engaged in an episode of care through both treatment modalities, group and individual therapy, expressed their certainty regarding the benefits of individual therapy versus group. For example, one participant noted that opportunity for deeper exploration was meaningful to him:

I think everybody should do a one on one session . . . ’Cuz then they get more involved into their feelings, relationship, everything else, you know what I mean? Instead of just sitting there in the corner in there and just [saying], “okay. It’s okay.” It’s not okay! Um, I don’t know, I really never liked the group, but the one on one, I think that’s the best thing ever.

Elements of group effectiveness

During their discussion of group treatment, participants described their perceptions of the effective and ineffective elements of group. Characteristics of group that made treatment particularly useful or beneficial to participants, and thus likely facilitated the greatest chance of behavior change, included perceiving the group as an emotionally safe space (a variable termed “asylum” in past qualitative studies describing group effectiveness (Wangsgaard, 2001), experiencing the group as normalizing, being able to relate to other group members by sharing and hearing their diverse experiences, learning from other group members and being open to feedback from other group members, and experiencing positive relationships with the other group members and with the facilitators. For example, one participant indicated that he benefited from the different opinions of participants in group. These differences in opinions resulted from the diversity of the group itself. He perceived that the diversity of viewpoints was valuable for him in his change process:

I wasn’t any greater than them, I wasn’t any less than them. We was all in the same situation and even though we came from different walks of life, we all had problems and it didn’t mean that you had two problems and I had five. The thing that really caught my attention was everybody’s different viewpoints and their opinions . . . And I think that was interesting, the diversity of that was interesting because I might be at a point where I think I’m right and everybody else wrong. And then hearing it from somebody else, is like, it gives you the ability to check yourself and say, “Hey, I might need to look in the mirror and really think about this”

Elements of group ineffectiveness

Participants also described their perceptions of the ineffective elements of group treatment. The characteristics of group that participants indicated as particularly ineffective, and thus likely interfered with behavior change, included monopolization of conversation by certain group members leading to insufficient time for everyone, sessions that went off topic, group members who did not take treatment seriously, sessions in which participants seemed to collude with one another in the denial of responsibility, and facilitators’ styles. Particularly, several participants described that a therapeutic approach that balanced support and confrontation likely facilitates behavior change best. Perhaps unsurprisingly, participants who noted that some group members did not take treatment seriously also indicated that group facilitators were not holding these group members accountable for their behavior. During their AIP group treatment, these participants shared that facilitators often “let people off the hook too easily” and were not challenging/confrontational enough:

Some nights the group seemed like they would take over. Uh, a lotta times I’d just be disappointed because it seemed like these guys in here would just go off the wall to subjects that didn’t even mean anything . . . And I just think your counselors in your group ought to break it down into as, you’re here, you’re here for a reason, I want to hear what it is. Really. And be hard on ’em. Make ’em really tell you why are you here . . . You really need to be hard on ’em. Make them speak up. Make them say something.

Content-Specific Variables

Skill acquisition

Throughout the exploration of reoffenders’ interpretation of their recidivist events and experiences of treatment, themes related specifically to the content covered in treatment emerged. We were able to organize these themes into two categories: challenges related to skill acquisition and challenges related to skill application. Addressing both of these content-specific factors in treatment efforts could serve to enhance program effectiveness among those who reoffend following treatment completion. Challenges with skill acquisition emerged in the data following the identification of specific skills deficits that existed within the sample of reoffenders. Skill deficits were particularly salient regarding interpersonal effectiveness, communication skills, emotion regulation, distress tolerance, anger management, cognitive restructuring, and substance use. Several participants offered explanations regarding lack of skill acquisition, often attributing it to their lack of participation in therapy sessions. For example, one participant described his awareness of the lack of gains made alongside his regret regarding not taking treatment seriously his first time around:

If I had been more involved then probably wouldn’t be here [for the second time] . . . If I had really paid attention, you know what I mean, I could’ve got some behavior skills out of it . . . I didn’t learn nothing about controlling my anger like I should’ve. ’Cause I’m just, I’m just angry. I’m angry all the time. It’s just the way I have been, just angry . . . I wish I would of learned something last time, you know what I mean. I wouldn’t been this way with my wife, you know what I mean, and I wouldn’t of put my hands on her, if I had really paid attention.

Some participants demonstrated insight regarding their lack of skill acquisition, whereas others exhibited less awareness of their skill deficits. In the latter group of participants who struggled to demonstrate insight regarding their lack of skills, participants described skills incorrectly during the interview, often asserting their beliefs that behavioral examples they provided were effective use of skills. For example, when asked about the specific skills learned in group that helped men during relationship conflict, one participant demonstrated a lack of accurate skill acquisition by describing a likely ineffective approach to communication. This participant stated that through treatment, he learned to communicate with his partner during times of intense emotional distress; however, the skills taught in AIP treatment emphasized the importance of using cooling down strategies and emotion regulation prior to engaging in communication with a partner:

You gotta communicate, and when you communicate, communicate when your emotions are running high.

Skill application

Barriers to skill application also emerged in the data. Learning skills but not applying them when needed, as well as ineffective use of skills, were commonly discussed during interviews. Participants suggested that skills practice during treatment would serve to enhance program effectiveness. They speculated that skills practice in and between sessions could have enhanced the likelihood of successful skill application during times of conflict. Specific opportunities for skills practice addressed by participants included self-monitoring, role-plays, and homework.

Study participants varied in their insight regarding their degree of successful skill application during times of conflict or emotional distress. Whereas some participants explicitly noted that ineffective skill use, or lack of skill use altogether, was a major factor contributing to partner violence, others had less awareness regarding ways that the use of skills could have benefited them in moments of conflict or distress. These examples were most prevalent and notable during interview discussions of emotional regulation. For example, one participant recognized that difficulty with applying emotion regulation skills (in this case, use of a “time out” skill) contributed to negative consequences with his partner:

I should’ve just took that time out. I wasn’t thinking about it. No. Didn’t even cross my mind. I don’t know, I was just probably so heated already. I was already at boiling point. I was already at number ten before, you know, before I catch number one.

Participant-Specific Variables

Intrapersonal characteristics

Characteristics of the participants themselves surfaced in the narratives, presenting as an important element of treatment. Specific factors related to participants’ intrapersonal characteristics included ways that participants engaged in treatment, participants’ decision and/or motivation for behavior change, participants’ intentions to use skills, participants’ expectations of treatment, and participants cognitive flexibility, particularly as related to gender-based beliefs and beliefs regarding masculinity. In addition, the emotions that participants identified as particularly difficult to tolerate fit into the category of intrapersonal characteristics and included feeling regret, guilt, shame, and disrespect. The intrapersonal characteristics that emerged from reoffenders’ narratives of their experiences in treatment enable us to modify intervention efforts to include these factors.

Motivation for treatment played a key role in participants’ program engagement, as did their perceptions of how relevant they experienced treatment to be for them personally. The relevance of treatment also shaped their perceptions of program effectiveness. The majority of participants experienced topics covered in treatment to be relevant and useful for them, but one negative example in the data demonstrates the importance of relevance as related to skill acquisition and application. While most participants noted the relevance of treatment, particularly related to the skills covered in group, one participant discussed how unlikely he and others were to apply the relaxation techniques reviewed during treatment. This participant noted how “ridiculous” he found the relaxation training to be:

Come on. These guys aren’t gonna sit there and do some kinda CD with this [deep breath to mimic the breathing exercise]. [Interviewer: how about you? Did you ever do the relaxation?] Hell, no! [laughs] I mean, I sat there goin’, like, [breathing in and out], all right, breathe, just sit there [laughs] and breathe. [laughs] Don’t lose it. You know? It just seemed ridiculous.

The final intrapersonal characteristic that related to implications for treatment was participants’ expectations of treatment itself. One participant described motivation for treatment linked to his expectations for participating. He noted a very specific gain made following group engagement regarding his understanding of partner violence itself. His comment illustrates the importance of tapping into participants’ motivation for change to facilitate program engagement. When this participant was asked what he hoped to get out of the AIP group before starting treatment, he responded,

Um, realizing the monster that I was. And fixing it. And so the only way to stay away from it is to change your behavior. I was surprised doing a lot of the stuff that was abuse that I didn’t look at as being abusive.

Discussion

The current study is unique in using in-depth qualitative analysis of reoffenders’ experiences and perspectives to identify potential areas for improvement in AIP practice. Qualitative interviews were used to explore reoffenders’ interpretation of their recidivist events, experiences in AIP services, and recommendations for treatment improvements. The study identified important elements of treatment that warrant further analysis and modification to enhance program efficacy and reduce recidivism. These program elements were grouped into superordinate categories involving modality-specific variables, content-specific variables, and participant-specific variables.

Modality-specific variables that emerged from the qualitative analysis include (a) offering AIP participants a more flexible treatment approach (e.g., through group therapy, individual counseling, couples therapy, substance use treatment), (b) decreasing elements of group ineffectiveness (e.g., group monopolizing, group members not taking treatment seriously, groups going off topic, clients colluding in denial of responsibility, and ineffective facilitation), and (c) increasing elements of group that bolstered effectiveness (e.g., fostering an emotionally safe space or “asylum” and enabling the sharing and hearing of others’ stories). Relatedly, content-specific variables include (a) elements related to skill acquisition (e.g., skills not learned during treatment and specific skills missing from treatment that are needed to address skill deficits in participants) and (b) barriers to skill application (e.g., having learned skills but not being able to apply them when needed, and lack of opportunities for skill practice).

For clients with co-occurring needs, offering a flexible treatment approach may be particularly useful. Emerging evidence in a small controlled trial indicates that, although uptake and attendance was greater in individual treatment, on average, group treatment for partner-violent men may be more efficacious than individual treatment (Murphy, Eckhardt, Clifford, Lamotte, & Meis, 2017). Nevertheless, providing enhanced treatment flexibility and offering complementary interventions may maximize offenders’ motivation for treatment and enhance engagement in a process of change. Flexibility may be especially important for those who reoffend after completing a standard group intervention and need additional or alternative services. In the present study, it is possible that participants were more motivated for behavior change and treatment engagement following their recidivist event and reenrollment in the AIP, leading them to experience treatment differently the second time. A more flexible approach to AIP treatment may also be important for those who show poor initial response to group intervention or have problems engaging meaningfully in group interactions. However, it is important to acknowledge that there exists a wide range of policies regulating AIPs wherein some states mandate specific requirements of treatment programs (e.g., length, content, court-system collaboration, etc.); these policy differences may pose barriers to flexible implementation of AIP services.

Based on current findings, offering couples’ therapy following AIP treatment completion may also warrant consideration, especially for cases in which the relationship partner acknowledges ongoing mutual problems with relationship communication and problem solving. Some researchers caution that couples therapy may inadvertently diffuse responsibility to both members of the couple, increasing risk for further manipulation or coercion of the victimized partner (Bograd & Mederos, 1999). Careful screening, prior treatment of the abusive partner, and exploration of the abusive partner’s motivations for requesting couples therapy are important safety considerations for therapists who emphasize the relational context or family system approaches. A number of study participants stated that IPV occurred within the context of bidirectional violence, and many provided explanations involving relationship dysfunction that included their partners. One important recommendation is to train providers in effective methods for validating clients’ difficulties with bidirectional violence and their partners’ contribution to relationship problems without colluding in the denial of their personal responsibility. Another potential treatment recommendation involves providing greater outreach efforts and services for partners who may themselves struggle with anger and aggression. Programs may also consider innovative treatment strategies to engage partners in IPV services that may not involve a full course of couples’ therapy but involve partner participation, such as occasional conjoint sessions. Obviously, all such recommendations rely on clinical assessment of the partner’s comfort and freedom of choice for engaging in this work.

Focusing on substance use treatment concurrently with, or sequentially to, participation in the AIP was another key issue highlighted by this study. All of the participants who reported alcohol use preceding their recidivist event noted that drinking influenced their decision making and made it more difficult to apply skills. Scholars have long identified the role of alcohol in partner violence. Strong empirical evidence exists supporting the relationship between alcohol use and IPV generally (e.g., O’Farrell & Murphy, 1995; Quigley & Leonard, 2000), and alcohol use is an identified factor contributing to IPV recidivism specifically (e.g., Jones & Gondolf, 2001; Mbilinyi et al., 2011). Accordingly, treatment models that integrate the two have shown promise. For example, concurrent IPV and substance abuse treatment was shown to reduce alcohol use and IPV in two separate randomized pilot treatment studies (Easton et al., 2007; Stover, 2015). The empirical literature and participants in the present study suggest that substance abuse treatment, particularly alcohol use intervention, may be a valuable addition to treatment, especially for participants for whom alcohol use has been problematic in the past.

Participants’ discussion of factors related to group effectiveness and ineffectiveness enables us to consider the significance of facilitators’ style and the development of an “asylum” in group. Participants indicated the importance of facilitators balancing support and confrontation, holding group members accountable for their actions, and not allowing group members to get away with denial strategies. Silvergleid and Mankowski (2006) notably found similar evidence that a balanced supportive and confrontational facilitator style may be necessary for behavior change. In addition, the maintenance of an “asylum” (or emotionally safe space) has been widely noted to facilitate participants’ ability to share and hear others’ experiences and practice skills in group. In this study, participants also discussed specific factors leading to ineffective group sessions, including group members who monopolized sessions, groups containing participants who did not take treatment seriously, groups containing participants who regularly went off topic, and groups in which participants would collude with one another in their denial of accountability for their behavior. None of these “ineffective group factors” appeared in previous qualitative research but are nonetheless notable due to their clinical implications for treatment.

These findings reveal the importance of therapists attending to group dynamics and intervening when noticing any of these ineffective group variables. Schopler and Galinsky (2005) suggested the use of open-ended groups to reduce the phenomenon of colluding described by the present study participants. In open-ended groups, participants enter and exit group as they complete treatment rather than with a cohort of participants, enabling men further along in the change process to support others as they entered the program. The use of open-ended groups may significantly decrease participants’ tendency to collude in the denial expressed regularly by those first entering treatment. Finally, addressing both skill acquisition and skill application is crucial; interventions should include a skills training component that enables clients to understand the skills taught as well as offer opportunities to practice applying skills both in-session and for homework.

Participant-specific variables primarily illustrated the intrapersonal characteristics of the participants themselves, including engagement in program activities and method of program engagement; expectations and assumptions prior to starting treatment, participants’ ability to tolerating difficult emotions; and participants’ cognitive rigidity/flexibility. Consistent with previous findings demonstrating the importance of motivation-related variables, participants in the present study noted their level of engagement in treatment and motivation to change (Murphy & Ting, 2010). For example, all six participants who returned to the AIP following treatment completion and subsequent reoffense, described that they did not take treatment seriously the first time through, and thus did not acquire skills during treatment. As they reflected on their level of engagement and motivation after having returned to treatment, most described the importance of having made the decision to take treatment seriously and engage in behavior change upon reenrollment. These participants appeared to discuss the type of self-awareness that Silvergleid and Mankowski (2006) emphasized was necessary when making the decision to change abusive patterns of behavior and thus become motivated to change.

Although arguably one of the most important factors for positive treatment outcomes, treatment engagement and motivation for change are difficult to identify clearly for AIP participation. Some AIPs (including the AIP in which participants in the present study participated) measure motivation through Prochaska and DiClemente’s (1984) stages of change model. Another commonly used measure of treatment engagement is attendance. However, attendance may be a less accurate measure of engagement and motivation in the case of partner-violent men who are court ordered to treatment due to their possible motivation being driven by external factors (e.g., avoiding legal consequences) rather than internal factors (e.g., desire and commitment to change). In addition, it may be beneficial to consider individual differences of those completing treatment (e.g., socioeconomic status, types of violence used, criminal record, age, etc.) when identifying strategies for enhancing motivation and treatment engagement; motivational enhancements strategies based on perpetrators’ unique characteristics may be a valuable line of inquiry for future research.

Measuring and enhancing engagement and motivation among partner-violent men in treatment is crucial for lasting change and requires further investigation. Chovanec (2009) offered several recommendations for IPV treatment engagement and motivation including validation, addressing shame, supporting group leadership, and providing information to challenge previously held beliefs. Enhancing the use of these strategies would likely benefit partner-violent men and increase the effectiveness of AIP treatment. Another specific method for enhancing motivation for treatment is by offering treatment options that clients perceive as relevant. For example, for some clients, as discussed above, offering a flexible treatment approach may be particularly useful. The specifics of a tailored treatment would need to be identified through thorough assessment of presenting concerns, skills deficits, treatment needs, treatment barriers, and motivation for treatment. In addition, enhancing skills training in specific content areas that participants indicate difficulty may be particularly beneficial. In the present study, these areas included distress tolerance, emotion regulation, interpersonal effectiveness, communication, anger management, and cognitive restructuring.

No research study is without limitations. Although qualitative research has many advantages, including the in-depth analysis and interpretive presentation of data, it also yields findings that are contextually situated representations of experiences, rather than a representation of the phenomena themselves (Dyson & Genishi, 2005). Therefore, the study findings cannot be interpreted as generalizable representations of broader phenomena beyond the 11 men interviewed for the present study. The transferability of these findings may not be applicable in other contexts due to several factors. First, the sample size in the present study is small relative to most studies in the field of psychology. However, standards and guidelines for quantitative research are different from those of qualitative studies, wherein appropriate sample size is determined by the identified purpose of the research (Kvale & Brinkmann, 2009). The purpose of the present grounded theory research was to reach a point of theme saturation. Therefore, sample size was determined by an iterative analysis of data, assessing for saturation of themes during data collection.

A second sample consideration is related to the strategic sampling of participants with unfavorable outcomes. As only those participants who reoffended were included in the study, results cannot be assumed to extend to partner-violent men who do not recidivate. An interesting comparison in the future may be to conduct similar interviews with participants who complete IPV treatment and remain nonviolent as well as with those who drop out of treatment. Interestingly, a number of themes identified in the current study converge with thematic content from interviews with a strategic sample of men who were favorably affected by abuser intervention services (Silvergleid & Mankowski, 2006). Nevertheless, it remains important to explore whether aspects of AIP practice deemed unhelpful by those who reoffend are appraised differently by those with more favorable outcomes. In addition, caution is needed in extending the resulting treatment recommendations to first-time AIP participants whose experiences of treatment and perceptions of violence may be different from those who have reoffended.

In addition, being a woman researcher may have had an effect on the data gathered as well. As a woman interviewer of men who have been abusive toward women, my gender may have biased the participants’ responses by, for example, limiting the depth of the information obtained or decreasing the accuracy due to impression management. In addition, it is possible that interviewing participants at the agency where they received AIP treatment may have affected their responses. However, study participants appeared to feel comfortable and seemed to share their stories honestly, evidenced emotional expression across participants ranging from laughing to crying during the interview, participants’ choice to extend their interview times, and seemingly strong rapport felt by the researcher during most of the interviews.

Qualitative research examining the experiences of participants that utilize AIP treatment is limited. In this study, we identified elements of treatment that may facilitate better outcomes for partner-violent men seeking IPV treatment. To our knowledge, the present study is the first to examine IPV treatment recommendations based on narratives of clients who reoffended after completing AIP treatment. Implications for treatment modality, intervention content, and participant variables of importance emerged among those who have reoffended following AIP treatment completion. The study findings can potentially inform the modification of AIPs and development of new interventions that could serve to reduce IPV perpetration. Finally, an important implication of this line of inquiry is the value of regularly seeking feedback from AIP participants to identify areas for program improvement and unmet client needs. Ideally, these efforts to bridge the gap between providers and consumers may be critical in reducing recidivism and enhancing safety and well-being for survivors of IPV.

Footnotes

Acknowledgements

The authors wish to acknowledge the contributions of the many research assistants and graduate clinical trainees who helped with this project, and the staff of HopeWorks in Columbia, Maryland.

Authors’ Note

This research is based on work submitted in partial fulfillment of dissertation requirements for the first author at the University of Maryland, Baltimore County. Portions of this article were presented at the International Family Violence and Child Victimization Research Conference in Portsmouth, NH in July 2016.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Galina A. Portnoy, PhD, is a postdoctoral fellow through the Yale School of Medicine and VA Connecticut Healthcare System’s Advanced Fellowship in Women’s Health. Her primary research interests include intimate partner violence (IPV) perpetration, detection, treatment, and prevention and the intersecting areas of trauma, reducing risk for revictimization, and women’s health. She is also interested in conducting program evaluation, implementation, and treatment outcome research, particularly as it relates to IPV.

Christopher M. Murphy, PhD, is a professor of psychology at the University of Maryland, Baltimore County. His research focuses on cognitive behavioral, motivational, and trauma-informed interventions for perpetrators of intimate partner abuse; the role of alcohol and drug use in intimate partner violence and its treatment; and the prevention of intimate partner abuse in emerging adulthood.

References

Babcock

J. C.

Canady

Graham

K. H.

Schart

(2007). The evolution of battering interventions: From the dark ages into the scientific age. In Hamel

Nicholls

(Eds.), Family therapy for domestic violence: A practitioner’s guide to gender-inclusive research and treatment (pp. 215-244). New York, NY: Springer.

Babcock

J. C.

Green

C. E.

Robie

(2004). Does batterer’s treatment work? A meta-analytic review of domestic violence treatment. Clinical Psychology Review, 23, 1023-1053. doi:10.1016/j.cpr.2002.07.001

Black

M. C.

Basile

K. C.

Breiding

M. J.

Smith

S. G.

Walters

M. L.

Merrick

M. T.

. . .Stevens

M. R.

(2011). The national intimate partner and sexual violence survey (NISVS): 2010 summary report. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

Bograd

Mederos

(1999). Battering and couples therapy: Universal screening and selection of treatment modality. Journal of Marital and Family Therapy, 25, 291-312. doi:10.1111/j.1752-0606.1999.tb00249.x

Chang

J. C.

Dado

Hawker

Cluss

P. A.

Buranosky

Slagel

. . .Scholle

S. H.

(2010). Understanding turning points in intimate partner violence: Factors and circumstances leading women victims toward change. Journal of Women’s Health, 19, 251-259. doi:10.1089/jwh.2009.1568

Charmaz

(2002). Qualitative interviewing and grounded theory analysis. In Gubrium

J. F.

Holstein

J. A.

(Eds.), Handbook of interview research: Context and Method (pp. 675-693). Thousand Oaks, CA: Sage.

Charmaz

(2006). Constructing grounded theory. London, England: Sage.

Chovanec

M. G.

(2009). Facilitating change in group work with abusive men: Examining stages of change. Social Work With Groups, 32, 125-142. doi:10.1080/01609510802413055

Creswell

J. W.

(2007). Qualitative inquiry and research design: Choosing among five traditions (2nd ed.). Thousand Oaks, CA: Sage.

10.

Dutton

D. G.

(2010). The gender paradigm and the architecture of antiscience. Partner Abuse, 1(1), 5-25. doi:10.1891/1946-6560.1.1.5

11.

Dyson

A. H.

Genishi

(2005). On the case: Approaches to language and literacy research. New York, NY: Teachers College Press.

12.

Easton

C. J.

Mandel

D. L.

Hunkele

K. A.

Nich

Rounsaville

B. J.

Carroll

K. M.

(2007). A cognitive behavioral therapy for alcohol-dependent domestic violence offenders: An integrated substance abuse–domestic violence treatment approach (SADV). American Journal on Addictions, 16(1), 24-31. doi:10.1080/10550490601077809

13.

Feder

Wilson

(2005). A meta-analytic review of court-mandated batterer intervention programs: Can courts affect abusers’ behavior? Journal of Experimental Criminology, 1(2), 239-262. doi:10.1007/s11292-005-1179-0

14.

Glaser

B. G.

Strauss

A. L.

(1967). The discovery of grounded theory: Strategies for qualitative research. New York, NY: Aldine de Gruyter.

15.

Gondolf

E. W.

(2004). Evaluating batterer counseling programs: A difficult task showing some effects and implications. Aggression and Violent Behavior, 9, 605-631. doi:10.1016/j.avb.2003.06.001

16.

Gondolf

E. W.

(2012). The future of batterer programs: Reassessing evidence-based practice. Lebanon, NH: University Press of New England.

17.

Healey

Smith

O’Sullivan

(1998). Batterer intervention: Program approaches and criminal justice strategies. Washington, DC: National Institute of Justice, U.S. Department of Justice. Retrieved from https://www.ncjrs.gov/pdffiles/168638.pdf

18.

Jones

A. S.

Gondolf

E. W.

(2001). Time-varying risk factors for reassault among batterer program participants. Journal of Family Violence, 16, 345-359. doi:10.1023/A:1012268725273

19.

Kvale

Brinkmann

(2009). Interviews: Learning the craft of qualitative research interviewing. Thousand Oaks, CA: Sage.

20.

Mbilinyi

L. F.

Neighbors

Walker

D. D.

Roffman

R. A.

Zegree

Edleson

. . .O’Rourke

(2011). A telephone intervention for substance-using adult male perpetrators of intimate partner violence. Research on Social Work Practice, 21(1), 43-56. doi:10.1177/1049731509359008

21.

Miles

M. B.

Huberman

A. M.

(1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks, CA: Sage.

22.

Murphy

C. M.

Eckhardt

C. I.

(2005). Treating the abusive partner: An individualized cognitive-behavioral approach. New York, NY: Guilford Press.

23.

Murphy

C. M.

Eckhardt

C. I.

Clifford

J. M.

Lamotte

A. D.

Meis

L. A.

(2017). Individual versus group cognitive-behavioral therapy for partner-violent men: A preliminary randomized trial. Journal of Interpersonal Violence, doi:0886260517705666

24.

Murphy

C. M.

O’Leary

K. D.

(1994). Research paradigms, values, and spouse abuse. Journal of Interpersonal Violence, 9, 207-223. doi:10.1177/088626094009002005

25.

Murphy

C. M.

Ting

L. A.

(2010). Interventions for perpetrators of intimate partner violence: A review of efficacy research and recent trends. Partner Abuse, 1, 26-44. doi:10.1891/1946-6560

26.

O’Farrell

T. J.

Murphy

C. M.

(1995). Marital violence before and after alcoholism treatment. Journal of Consulting and Clinical Psychology, 63, 256-262. doi:10.1037/0022-006X.63.2.256

27.

Pence

Paymar

(1993). Education groups for men who batter: The Duluth model. New York, NY: Springer Publishing Company.

28.

Price

B. J.

Rosenbaum

(2009). Batterer intervention programs: A report from the field. Violence and Victims, 24, 757-770. doi:10.1891/0886-6708.24.6.757

29.

Prochaska

J. O.

DiClemente

C. C.

(1984). Self change processes, self efficacy and decisional balance across five stages of smoking cessation. Progress in Clinical and Biological Research, 156, 131-140.

30.

Quigley

B. M.

Leonard

K. E.

(2000). Alcohol and the continuation of early marital aggression. Alcoholism: Clinical & Experimental Research, 24, 1003-1010. doi:10.1111/j.1530-0277.2000.tb04643

31.

Schopler

J. H.

Galinsky

M. J.

(2005). Meeting practice needs: Conceptualizing the open-ended group. Social Work with Groups, 28(2/3), 49-68. doi:10.1300/J009v28n03_05

32.

Scott

K. L.

Wolfe

D. A.

(2000). Change among batterers examining men’s success stories. Journal of Interpersonal Violence, 158, 827-842. doi:10.1177/088626000015008003

33.

Silvergleid

C. S.

Mankowski

E. S.

(2006). How batterer intervention programs work: Participant and facilitator accounts of processes of change. Journal of Interpersonal Violence, 211, 139-159. doi:10.1177/0886260505282103

34.

Stover

C. S.

(2015). Fathers for change for substance use and intimate partner violence: Initial community pilot. Family Process, 54, 600-609. doi:10.1111/famp.12136

35.

Wangsgaard

S. M.

(2001). The participants’ perspectives: Factors of batterer group treatment that facilitate change. Dissertation Abstracts International: Section B: Sciences & Engineering, 61(11-B), 6153. (UMI No. 2001-95010-071)