Abstract
Research on intimate partner violence (IPV) interventions has long indicated mixed support for their effectiveness at reducing abusive behaviors. Limited prior research has focused on factors associated with participant engagement in the treatment process. Using a qualitative thematic analysis and a sample of 180 participants who completed an IPV intervention program, the purpose of this study was to identify key factors that facilitate men’s responsiveness to IPV intervention programs. The findings highlight several commonalities in participants’ perceptions of pathways that facilitated and/or hindered their engagement in the treatment process, and provide insights into how program/process elements can be structured to enhance engagement.
Keywords
Introduction
Intimate partner violence (IPV) intervention programs (also referred to as Batterer Intervention Programs) are the primary treatment strategy used for men who perpetrate violence against their intimate partners (Babcock et al., 2016; Cannon et al., 2016). In Canada and the United States, group-based programs implemented by community organizations/agencies are the predominant intervention approach used in rehabilitation efforts for perpetrators of IPV (approximately, 97% are served in group treatment; Babcock et al., 2016; Cannon et al., 2016; Roy et al., 2014). In general, research suggests that group-based interventions offer several advantages over other intervention types such as individual treatment and couples-based programs, including decreasing feelings of isolation, promoting sharing and openness, and encouraging help-seeking behaviors (Sternbach, 2001; Yalom & Leszcz, 2005). However, there are also a number of limitations to group-based programs, such as challenges with addressing individual needs (i.e., a “one-size-fits-all” model) and concerns of a negative peer influence/peer contagion effect (see Murphy & Meis, 2008, for a more in-depth discussion). Furthermore, existing summative research on the effectiveness of group-based IPV programs widely suggests that regardless of the particular therapeutic approach used (e.g., Duluth, cognitive-behavioral therapy), intervention programs for male perpetrators of IPV have a negligible impact on reducing abusive behavior (Arias et al., 2013; Babcock et al., 2004; Eckhardt et al., 2013; Karakurt et al., 2019).
Examining the (In)effectiveness of Group-Based IPV Intervention Programs
As the pool of primary and secondary research on IPV interventions has long indicated mixed support for the effectiveness of IPV programs at reducing abusive behavior, substantial effort has been put forth to examine factors that inhibit the consistent production of strong and positive intervention effects. First, high rates of attrition/dropout have been identified as particularly common in such programs, especially in the early stages of intervention (Babcock et al., 2016; Eckhardt et al., 2013; Jewell & Wormith, 2010). For example, studies have shown that attrition in IPV interventions commonly ranges between 22–99% (Catlett et al., 2010; Daly et al., 2001; Daly & Pelowski, 2000; Olver et al., 2011; Rondeau et al., 2001). Second, lack of attendance and program non-completion are also not uncommon in IPV intervention programs (Babcock et al., 2016; Cannon et al., 2016; Daly & Pelowski, 2000). Rates of attendance, attrition, dropout, and program completion are all important contributing factors to intervention effectiveness, as research has demonstrated that non-completion is associated with greater risk of repeat IPV (Bennett et al., 2007; Eckhardt et al., 2008; Rondeau et al., 2001).
In addition to attendance-related factors, there is some consensus that lack of responsiveness to the intervention, and/or lack of engagement with the treatment process, is a strong contributing factor to overall IPV intervention ineffectiveness (Arias et al., 2013; Eckhardt et al., 2013; Maldonado & Murphy, 2021; McMurran & Ward, 2010; Scott & King, 2007). For instance, indicators of group engagement such as motivation and/or readiness to change, homework completion, active participation, and self-disclosure have all been identified as significant predictors of both program completion and decreased relationship violence (Taft et al., 2001, 2003).
Association Between Participant Engagement and Program Effectiveness
The vast majority of research on IPV interventions has focused on program effectiveness and treatment outcomes, with limited focus on the nuanced role of participant engagement (Babcock et al., 2004; Gondolf, 2004). Some existing research suggests a clear association between measures of engagement and program outcomes, as successful program outcomes are often dependent on participant engagement (Orford et al., 2009; Roy et al., 2011; Soleymani et al., 2018). Specifically, research suggests that participants who measure lower on indicators of engagement (e.g., attendance, contributing to discussion, homework compliance, motivation/readiness to change) are significantly more likely to continue their perpetration of IPV (Bennett et al., 2007; Eckhardt et al., 2008; Rondeau et al., 2001; Scott & King, 2007). Conversely, the literature suggests a link between strong engagement and desirable treatment outcomes such as retention of program content and reductions in abusive behavior (Dowling & Cosic, 2011; Holdsworth et al., 2014; Schley et al., 2012; Taft et al., 2003; Wormith & Olver, 2002). Taken together, existing research suggests that to improve program outcomes in IPV interventions, it is essential to address, create, foster, build, and promote participant engagement—particularly in the first few sessions of the program when engagement is most fragile (Chovanec, 2012; Day et al., 2009; Soleymani et al., 2018). As such, understanding the process of engagement and identifying factors that enhance responsiveness to the intervention is paramount to facilitate changed behavior and to improve overall IPV intervention effectiveness.
Engagement as a Mechanism of Change
Several practitioners and researchers posit that participant engagement is a key mechanism of change in IPV intervention programs (McMurran & Ward, 2010; Scott & King, 2007). Consistently, there is a growing body of literature that focuses on examining factors that help and/or hinder men’s engagement (Roy et al., 2014; Soleymani et al., 2018).
Determinants of engagement
Engaging participants in treatment is commonly cited as a major challenge in IPV intervention programs for men (Daly & Pelowski, 2000; Scott & King, 2007; Wormith & Olver, 2002). Challenges can include, for example, individual-level factors such as a general reluctance to accept help, hostile attributions, and resistance toward self-disclosure (Scott & King, 2007; Yatchmenoff, 2005); treatment-based factors such as the program content/curriculum; and treatment-process factors such as group cohesion and the relationship between client and practitioner (Holdsworth et al., 2014).
Individual-level factors
A number of participant characteristics have been associated with challenges concerning program engagement; these factors can be internal to the individual (i.e., intrinsic) or external (i.e., contextual/situational). Internal factors linked with impairment in a participant’s ability to engage in treatment include cognitive factors (e.g., self-centered beliefs, blaming others, minimizing and mislabeling behaviors, hostility; Chambers et al., 2008; Taft et al., 2004), psychological factors (e.g., personality disorders; Chambers et al., 2008; Taft et al., 2004), and participant volition (e.g., lack of motivation/readiness to change; Ward et al., 2004). External factors that influence engagement include, for example, referral status of the participant (e.g., mandated or voluntary; Ward et al., 2004), substance use (Daly & Pelowski, 2000; Ting et al., 2009), and interpersonal supports (e.g., support of family/friends; Ward et al., 2004).
Treatment-based factors
Characteristics of the program (i.e., tangible components of the intervention such as the curriculum and characteristics of the facilitators) have also been shown to influence participant engagement. Barriers to engagement in the context of treatment-based factors are under-researched; what little research exists suggests that participant engagement is related to quality of the program, training and qualification of therapists, and cultural appropriateness of the curriculum (Silvergleid & Mankowski, 2006; Ward et al., 2004), therapist characteristics (e.g., warmth, optimism, and humor; Holdsworth et al., 2014), and program elements such as motivational enhancements (Holdsworth et al., 2014).
Treatment-process factors
Intangible factors that result from participants’ interaction with the group process (i.e., interaction with other participants, facilitators, and/or program content) have also been shown to impact the way in which participants engage with the treatment process (Schafers, 2019; Simpson, 2004; Taft et al., 2003). Specifically, treatment-process factors refer to “individual differences in perceptions and experiences within the larger context of the treatment program” as a result of the intervention’s underlying operations, procedures, and conditions (Broome et al., 1996, p. 488). Much of the research on treatment-process variables has focused on the therapeutic alliance (Chovanec, 2012; Parra-Cardona et al., 2013). In particular, a strong relationship between facilitator and participant is predictive of decreased relationship violence (Brown & O’Leary, 2000; Rondeau et al., 2001; Roy et al., 2013; Simpson, 2004; Taft et al., 2003; Wangsgaard, 2001). Group cohesion has also been identified as an important factor that influences engagement and overall effectiveness of the intervention (e.g., group-level dynamics that foster an emotionally safe therapeutic environment such as bonding, establishing rapport, sharing stories, mentoring, and mutual support; Brown & O’Leary, 2000; Chovanec, 2012; Marshall & Burton, 2010; Parra-Cardona et al., 2013; Roy et al., 2013; Silvergleid & Mankowski, 2006; Taft et al., 2003). Participant satisfaction with the program, as well as the applicability of the program content to their personal situation, have also been hypothesized to play an important role in engagement (Garner et al., 2007; Joe et al., 2002; Schafers, 2019).
Altogether, despite the inconsistent effects of IPV intervention programs for men, and the demonstrated association between participant engagement and program effectiveness, research in the field presents a limited understanding of the factors that influence men’s engagement in IPV intervention programs. To address this gap in the literature, the aim of this study is to improve what is currently known about promoting participant engagement by exploring the key factors that facilitate men’s responsiveness to the IPV intervention programs. This exploratory study examines qualitative data that were derived from a large simultaneous evaluation of 12 unique IPV intervention programs operating across the province of British Columbia (BC), Canada, in 2017-2018.
Method
Research Design and Data Collection
The overall study involved a comprehensive evaluation of 12 group-based IPV intervention programs, most serving a mix of voluntary and mandated male participants with varying degrees of partner violence history. The majority of participants were referred but not court-mandated to attend the intervention; programs differed substantially in terms of length (number of weeks), theoretical orientation (e.g., feminist-based, cognitive-behavioral therapy), and weekly curriculum content. A pretest/posttest/follow-up single-group design was used to evaluate each program, and data were collected from participants enrolled in program “cycles” that began and ended between March 2017 and August 2018 (i.e., some sites involved multiple cycles of the program). Prior to the start of the first program cycle, the evaluation team reviewed the questionnaires with staff from each program and trained staff in survey administration procedures. Hard copy questionnaires were administered to each participant by the program’s service providers. Prior to survey administration, participants reviewed an information package that included an infographic and consent form outlining the evaluation purposes, voluntary participation, risks and benefits of participation, assurances of confidentiality of responses, and contact information for additional support. All surveys and consent forms adhered to the Canadian Tri-Council Policy Statement (TCPS-2) standards for ethical conduct for research involving humans. Pretests were administered either during the program intake sessions or on the first day of the program (but prior to delivery of any program content). Similarly, questionnaires were administered by program staff on the last day of the program. All completed surveys were mailed by program staff to the evaluation team; no copies were retained by staff or the organization, and the procedure for data handling was specified to respondents in the study consent form. To encourage participation in the surveys, respondents were informed that completion of the follow-up questionnaire would be rewarded with a Can$50 payment in the form of an Amazon e-gift card, a check, or cash.
Measures and Instrumentation
In addition to measures used to examine the perpetration of abusive behaviors and questions assessing respondent knowledge of content from the program curriculum (these outcomes are not examined in this study and as such are not described here), posttest surveys contained several open-ended questions assessing participant feedback regarding program satisfaction. In particular, participants were asked to provide feedback on specific aspects of the program that they liked most and aspects of the program that they liked least. We contend that the responses to these questions represent factors linked to participant engagement—or lack of engagement—and general responsiveness to the IPV interventions.
Conceptually, measures of treatment satisfaction (e.g., what participants like most or least) have been used as indicators of offender engagement in therapeutic group treatment. In particular, the Client Evaluation of Self and Treatment (CEST)—an instrument for treatment programs to assess patient motivation, psychosocial functioning, and treatment engagement (Joe et al., 2002)—uses (a) participation, (b) treatment satisfaction, and (c) counselor rapport as variables that represent engagement in group interventions (Joe et al., 2002). Holdsworth and colleagues (2014) explain that although what participants in a therapeutic intervention like the most about a program “may not always translate to engagement” (p. 107), they contend that treatment satisfaction as a measure of engagement “captures offenders’ perceptions of the relevance of the program that is likely to be of importance to engagement” (p. 107). Although there exist numerous measures to assess treatment satisfaction (e.g., overall program satisfaction, perceptions of treatment helpfulness, program organization, satisfaction with staff), the broad assessment of participants’ perceptions of the programs used in this study (e.g., discussing what they liked most and least about the program) is pertinent to informing what might be preventing responsiveness to the group process, obstacles that may prevent engagement in treatment, as well as for informing strategies concerning how IPV intervention programs can be modified to increase levels of engagement (Holdsworth et al., 2014; Roy et al., 2013; Ward et al., 2004).
Analytic Approach
Sample Characteristics
Frequency counts and percentages were calculated for background questionnaire items for the full sample of participants who completed the open-ended questions on the posttest survey (n = 180).
Thematic Analysis
Thematic analysis is a qualitative analytic technique used to examine data, identify common patterns, analyze themes, and derive meaning from an entire data set (Braun & Clarke, 2006). Compared with other techniques used to analyze qualitative data, thematic analysis relies heavily on interpretation of the data, and is “the most useful in capturing the complexities of meaning within a textual data set” (Guest et al., 2012, p. 11). A multiphase, exploratory (content-driven) process was used to systematically analyze the open-ended text-based participant survey responses. Open coding was used in the first phase of the analysis to identify multiple thematic categories (or “codes”; that is, categories of “like items”) across participant responses. In the second phase of the analysis, initial themes were generated by collating the thematic categories from Phase 1. Next, broad patterns and overarching themes were identified. Then, initial themes were reviewed and refined through inductive, iterative, and continuous thematic coding of the data. Finally, the most pertinent themes identified in the data were selected for reporting, data within each theme were analyzed, and subthemes were developed and interpreted (see Braun & Clarke, 2006, for a detailed overview of the six key phases of thematic analysis used to analyze the data in this study).
Two coders reviewed all participant responses, identified categories and themes, and coded the data separately; disagreements were discussed and consensus for each response was reached. All participant responses were included in the analysis (i.e., no responses were deemed to be “irrelevant” to the purpose of the question). Disparate written responses that were not classifiable within any of the major themes identified in the analytic process were categorized as “Other” (due to the small number of cases with disparate responses, the “Other” category is not discussed here). Pertinent quotes were selected by the coders to exemplify each theme and/or thematic category. All text-based responses were organized, coded, and analyzed manually using Excel.
Findings
Description of Sample
The 180 men who completed the open-ended questions in the posttest survey are described here and shown in Table 1. The average age of the full sample was 41.2 years, with a range of 21–73 years. With respect to racial/ethnic background, 60% of respondents identified as Caucasian, 16% as Aboriginal, and 11% as South Asian. More than three quarters (78%) indicated that they were born in Canada. More than half of the respondents (57%) had at least some post-secondary education, with 26% reporting that they did not graduate from high school. More than two thirds of the participants indicated that they were currently employed (78%), with 62% employed full-time. With respect to marital status, nearly half (46%) of the men were married or living common-law, and 82% had children. Overall, 40% of the participants indicated that they were mandated to attend, whereas 60% were attending voluntarily. One quarter of the participants had previously participated in an IPV intervention program.
Sample Characteristics.
Note. DV = domestic violence.
The percent represents the % responding of the total respondents for that survey item.
With respect to criminal history, 47% of men self-reported a prior arrest for spousal assault, and 18% had been convicted. In addition, one third of the respondents had received other charges or convictions (for offenses unrelated to IPV). One third of the respondents indicated that child protection services was currently (or had previously been) involved with their family, and 32% noted that a protection order was in place for him concerning his partner/or their children. When asked about their history of exposure to domestic violence, just more than half of the respondents reported that, as a child, they had been exposed to domestic violence at home, whereas 47% had been a direct victim of domestic violence as a child. Participants were also asked about their history of substance use in the 3 months prior to beginning the program; of the responders, 55% reported drinking alcohol and 36% had used marijuana. With respect to mental health, 45% of the respondents reported experiencing anxiety, whereas 40% had experienced depression.
Factors Facilitating Men’s Responsiveness to IPV Intervention
The section below provides an overview of the four themes that were identified across the 180 participants of the 12 IPV intervention programs, as well as associated thematic subcategories (where applicable). The overarching themes are as follows: (a) group cohesion, (b) therapeutic alliance, (c) treatment-based factors, and (d) observing personal transformation.
Theme 1: Group cohesion
Within their responses to the open-ended questions, participants discuss the formulation of group cohesion through three thematic categories: (a) bonding/interacting with other participants, (b) safe space to open up and share feelings/experiences, and (c) listening to others’ stories/feeling of universality. Each of them is discussed below.
Bonding/interacting with other participants
When discussing their experience in the program, the importance of bonding and interacting with the other men in the group was frequently discussed. In particular, participants discussed that through their interactions with other participants, they were able to build rapport, trust, and mutual respect–creating opportunities for bonding, mentoring, and providing support to one another throughout the program. Some participants discussed the importance of group cohesion in terms of the overall group experience (e.g., “great group of guys,” “meeting the other guys in the program,” “the people attending and what they brought to it,” and “the other guys doing the work and all around the energy”). In addition, some of the participants noted enjoyment of the mutual support that was received through their shared experiences (e.g., what I liked most about the program was “the support, and it made me want to change” and “the people I met, got to know some people who to go my church, supporting each other”).
Safe space to open up and share feelings/experiences
Relatedly, several participants discussed the importance of having a comfortable space to open up and share their personal feelings and experiences. More specifically, participants highlighted their appreciation for a “safe space” to engage in meaningful dialogue and disclose their personal experiences and struggles, wherein they could share their experiences without fear of judgment or stigma (e.g., “The ability to share and not feel like I was being judged in any way,” “The feeling of safety and being able to open up about how I am dealing,” “I liked the fact that I felt comfortable to speak my mind and share my personal stories without judgment,” and “Safe space to talk”). In addition, a number of participants stated that what they liked most was the opportunity to express themselves openly and have their feelings validated (e.g., “The ability to speak freely and feel like I was being heard,” “Being able to share my experiences and let them out, let them go,” “Having a place where I can be open, vulnerable to share my stories and struggles,” “Being welcomed and comfortable to be open and express myself,” and “The change to be able to open up and express my feelings. Even though it was difficult for me to do I felt comfortable in this environment”).
Listening to others’ stories/feeling of universality
Reciprocally, by hearing and listening to others’ stories, participants were able to relate to one another in their struggles and realize that they are not alone in their feelings, personal experiences, and/or relationship problems. Specifically, hearing others’ stories and experiences allowed participants to relate to other men through their circumstances, gain new insights toward their own problems and how to deal with them (e.g., “Listening to everybody’s situations and input” and “Listening to participants speak and gave me more ideas—broaden my mind”). In addition, several participants discussed the benefit of hearing about other participants’ successes and how that motivated and encouraged them to succeed in making changes (e.g., “Learning from an older man who has been through the mess and is recovering good example,” “Listening to all the different men and their stories and seeing success in some and seeing the joy it brings them,” and “Also hearing stories of success gives me hope to my future. It is encouraging and motivating”). Moreover, as a result of hearing others’ stories, many participants discussed the importance of relating to other men, and coming to the realization that their thoughts/feelings are not aberrant (e.g., “Knowing I’m not alone in my thoughts,” “Relating to other men,” “I was able to relate to many of the men in the group which allowed me a lot of freedom from self because I realized I wasn’t alone,” “To know I’m not the only one going through these struggles in life,” and “Knowing and hearing I’m not alone suffering from this situation”).
Theme 2: Therapeutic alliance
Here, participants discussed appreciating that the facilitators treated them as equals (e.g., “The instructors used many examples of their troubles and experiences. Showing us that they are not above us”). They also discussed being appreciative of the straightforward guidance that was provided by facilitators (e.g., “[the facilitators] don’t sugar coat, they say it as it is,” “Non-judgmental and opinionated facilitators,” and “The truthfulness of the counselors and not being looked down on”). In turn, as a result of the combination of trust and honesty received from the facilitators, participants felt they had permission to express themselves freely, without fear of being judged (e.g., “[the facilitators] spoke to everyone at an adult level without any obvious judgment of the individual,” “Facilitators were excellent. They educated without being accusatory,” and “The facilitators’ understanding and their support . . . never negative”).
Theme 3: Treatment-based factors
With respect to these factors, participants raised the importance of (a) group discussions associated with course content, and (b) the importance of learning a variety of tools and strategies to help reduce violence in their relationships.
Group discussion of course content
Several elements of the program curriculum were noted by participants. However, program elements that allowed for group discussions (e.g., the check-ins and takeaways, stories, videos, interactive exercises) were discussed most frequently. In particular, participant responses indicated that the open discussions of course content allowed them to think about the applicability and utility of course material in a real-world scenario. For example, when asked about what he liked most about the program, one participant responded, “The open discussion about topics being covered. Hits home more effectively when you can see or hear how it is working in others.” Another participant discussed how the “Mock scenarios [allowed me to work] through different ways of controlling thoughts and outcomes of conflict. Taught me different outcomes are possible with understanding and the right tools.” Another participant discussed how one of the exercises allowed him to see his behaviors from a different perspective: “Rustling the Bushes really let me see how my behaviour is received. The story actually took me on a visual trip to really see how I’m being received.”
Learning tools and strategies
In addition, participants appreciated learning a variety of tools and strategies to help reduce violence in their relationships. In particular, participants highlighted tools to stay calm (e.g., “How to take a time out”), how to deal with certain situations, and controlling thoughts/emotions (e.g., “Understanding my anger issues and the tools to manage it in good way,” “Gaining a tool box to use going forward in life,” “Being taught new ways to manage warning signs and trigger,” and “Learning how to communicate better with loved ones”). Notably, one participant discussed how learning tools and strategies throughout the program had given him confidence to implement change (e.g., what I liked most about the program was “Learning how to deal with my emotions. I really needed this program. I feel a lot more confident now and am ready to start practicing what I’ve learned”), whereas another participant stated, “I have learned anger management and maintenance of relationship. It has a positive impact on my life.”
Theme 4: Observing personal transformation
Finally, participants in this study discussed observing positive behavioral change in themselves and gaining insight toward their emotional/behavioral patterns as an element of the program that they liked the most. In particular, participant responses suggest that confronting challenging behavior, identifying patterns, and observing growth within themselves (as well as their relationships with others) encouraged them to engage with the program. For example, one participant discussed, “The constant ‘light bulb’ moments that I had almost every session into my behaviour patterns.” Another participant discussed how the program gave “insight to emotion and how it relates to anger. Being able to understand anger and how other emotions left undealt with builds up and causes anger.” In addition, observing growth within themselves as well as their relationships with others seems to have played a role in encouraging participants to continue to attend the program; for example, I am grateful to have seen how much I hated coming, hated myself for letting things get so bad, that I had to come here to being glad I was coming and looking forward to doing this a 2nd time to joining the Alumni group. Is that is not just for abusive men but I could apply in my relationship with son, which helped me tremendously to communicate with him in a way that he understands.
Factors Hindering Men’s Responsiveness to IPV Intervention
Two key overarching themes were observed with respect to factors that played a role in hindering participant responsiveness. These themes are as follows: (a) program logistics, and (b) relevance and applicability of the program’s content/topics.
Theme 1: Program logistics
Program logistics, such as the time schedule and location of the program, have been hypothesized to play an important role in hindering men’s responsiveness to and/or engagement in treatment (Garner et al., 2007). Here, participants discussed several logistical challenges that made attending the program difficult. In particular, several participants discussed the time of day of the program (e.g., “The time at which it starts because I have to leave work early,” “It was right after work so it made for a long day,” and “Time frame during the day interfered with work”), time of the week (e.g., “The least liked thing about the program was just that the program was not at the end of the week”), and location of the program (e.g., “The location is a bit far for me,” “it was hard for me to get a ride,” and “had to commute over an hour to get there”) as a barrier/challenge to regular attendance. In addition, the length of each program session was discussed as a hindrance to participation and engagement (e.g., “the 2.5 hrs—sometimes you are drained from the day or other appointments and have a hard time concentrating,” “Length of time for 1 night of the week,” and “Have to come out for 3 hrs each week after working a 9 hr shift”). Relatedly, several participants made note of the quantity/quality of food available (“Wasn’t enough food,” “Lack of snacks,” and “No gluten free cookies”).
Theme 2: Relevance and applicability of program content/topics
Participant satisfaction with the applicability of the program content to their personal situation has also been discussed in the literature as important to foster engagement in treatment (Garner et al., 2007). Specifically, relevance and applicability of program content have been hypothesized to play an important role in the process of engagement, as these factors enhance the participant’s ability to benefit from the program and relate to the content being discussed. Many participants noted irrelevant topics of conversation and/or program content that was not applicable to their personal situation as hindering their engagement with the program (e.g., “Talking about being abused as a child. I had a good loving family growing up and it was hard to relate” and “Some of the material really did not feel relevant to me”). Notably, although participants indicated that listening to others’ stories was a factor that enhanced engagement, some participants discussed that lengthy and/or over-drawn personal stories from other participants detracted from their time in the program (e.g., “some people would talk so much that we wouldn’t have enough time to go into detail over the material,” “with chatty group sometimes not enough time [to get through material],” and “Sometimes some people would talk too much, go on and on about unrelated stuff”).
Discussion
As the pool of research on IPV intervention programs has long indicated limited or mixed support for the effectiveness of IPV interventions at reducing abusive behaviors, substantial effort has been put forth to examine factors that inhibit the production of strong and positive intervention effects. Although participant engagement has been hypothesized to be influential in producing positive program effects (McMurran & Ward, 2010; Orford et al., 2009; Roy et al., 2014; Scott & King, 2007), limited research has focused on the factors associated with increased and decreased responsiveness to the treatment process (Babcock et al., 2004; Gondolf, 2004). The purpose of this exploratory study was to identify the key factors that facilitate men’s responsiveness to IPV intervention in a sample of 180 participants who completed an IPV intervention program. Qualitative data were derived from a large simultaneous evaluation of 12 unique IPV intervention programs operating across the province of British Columbia in 2017-2018. Findings from the qualitative analysis highlighted several commonalities in participants’ perceptions of pathways that facilitated and/or hindered their engagement in the treatment process. Altogether, our findings suggest that there exist multiple pathways to facilitating men’s responsiveness to IPV intervention and increasing overall engagement in the treatment process. As such, the degree to which an intervention is successful at engaging participants depends upon a variety of factors that interact over the course of the intervention. Given that the specific factors that facilitate and/or hinder men’s responsiveness to IPV intervention groups is not currently well understood, this study fills an important gap in the literature by identifying subsets of factors (or themes) that participants perceive as promoting engagement.
First, in line with existing literature, our findings suggest that treatment-process factors are important determinants of engagement for men in IPV intervention programs. The first theme identified as an important pathway to engagement was group cohesion. Here, participants discussed (a) bonding/interacting with other participants, (b) having a safe space to open up and share feelings/experiences, and (c) listening to others’ stories/feeling of universality. The importance of establishing healthy group dynamics that foster an emotionally safe and therapeutic environment has been discussed extensively in the literature on enhancing engagement (Brown & O’Leary, 2000; Chovanec, 2012; Marshall & Burton, 2010; Parra-Cardona et al., 2013; Roy et al., 2013; Silvergleid & Mankowski, 2006; Taft et al., 2003). In particular, the literature suggests that when a healthy group dynamic is established, participants engage in a reciprocal relationship of support and guidance where “the engagement of one participant is fostered by that of the other members of the group and, by helping the others, the participant becomes more engaged himself” (Gragg, 2006; Roy et al., 2011, p. 34). Consistent with existing literature, participants from this study clearly indicate that group cohesion played a formative role in influencing and facilitating their engagement. However, although the concept of group cohesion has been frequently addressed in existing research, there is a dearth of literature with respect to specific sub-factors that contribute to establish group cohesion. Our study extends existing knowledge on group cohesion by identifying three specific facets of group cohesion that contribute to increased responsiveness to intervention. Overall, having the opportunity to interact and bond with other men in the group and establish rapport appears to have been an important contributing factor in creating an enjoyable experience for the participants, and encouraged them to engage with one another and provide mutual support.
Second, several aspects of the therapeutic alliance were frequently noted by participants as important factors contributing to their responsiveness to the treatment process. Here, participants discussed appreciating that the facilitators treated them as equals, were grateful for the straightforward guidance that was provided, and welcomed the facilitators creating an environment that allowed freedom of expression and validation of their experiences, without fear of being judged. The latter point is a key factor in promoting engagement, as fear of criticism and/or being judged are known to have adverse effects on group engagement (Gragg, 2006; Wangsgaard, 2001). However, although participants indicate that receiving treatment in a supportive and judgment-free environment is an important element that fosters engagement, holding men accountable for their abusive behaviors is commonly viewed as essential by program facilitators to help men engage in the change process (Chovanec, 2012). As such, it is noteworthy that, at times, the participants’ desire for supportive program facilitators may contradict facilitators’ needs to challenge problematic attitudes, behaviors, and norms of some group participants. As modeling support and showing validation without criticism or judgment encourage participants to ultimately increase responsiveness to the treatment process, future research should examine facilitation techniques that balance this tension between participants and facilitators throughout the intervention and over the course of the change process.
Third, participants discussed certain treatment-based factors as important elements that facilitated their responsiveness to treatment, suggesting that program characteristics can have an influence on how men engage with the program (Roy et al., 2013). Existing literature has provided some support for the role of program characteristics (e.g., tangible components of the intervention such as the curriculum) in participant engagement (Holdsworth et al., 2014). However, as engagement in the context of treatment-based factors is under-researched, little is known about the role of such factors in fostering responsiveness to treatment and overall engagement. Our findings advance knowledge on this topic by suggesting that it is not necessarily the specific content of the program, but rather the applicability and usefulness of the content that is important in determining whether a participant will engage with the material. For example, several participants in this study simply stated that learning tools and strategies that could be used in their daily lives to help reduce violence in their relationships was what they liked most about the program overall. Relatedly, Fiorentine and colleagues (1999) suggest it is not necessarily the specific content of the program that matters in fostering engagement, but rather whether the participants perceive the group as useful, and whether the content is relevant to their own lives. Various program logistics (i.e., time schedule, location of the program, and length of each session) were also identified in this study as challenges to overcome, which hindered opportunities to fully engage with the group and the program material. Future research should continue to investigate which specific program characteristics and curriculum content are linked to increased responsiveness and overall enhanced engagement.
Finally, although not discussed extensively in the literature as a factor that influences participant engagement, our findings suggest that observing positive personal transformation, such as gaining insight into one’s emotional/behavioral patterns, confronting challenging behavior, identifying patterns, and observing personal growth within themselves (as well as their relationships with others), facilitated men’s responsiveness to the treatment process, and encouraged participants to engage with and feel satisfied with the program. This is an important finding as some research suggests that an effective strategy to promote change is urging participants to confront their maladaptive behaviors and challenge their patterns of thought (e.g., gendered thinking, victim-blaming; Morrison et al., 2017). However, as discussed above, this is often held in direct conflict with creating an environment where participants feel safe to discuss their thoughts openly without the fear of being criticized or judged by others. Future research should continue to closely examine the role of accountability in instigating personal transformation, and how facilitators can help participants confront maladaptive behaviors and thoughts in such a way that bolsters responsiveness to the treatment process rather than hinders it.
As effectively engaging participants in IPV interventions can be a major challenge (Daly & Pelowski, 2000; Scott & King, 2007; Wormith & Olver, 2002), and lack of engagement is associated with poor treatment outcomes, developing strategies to enhance engagement is undoubtedly an important consideration for improving overall IPV intervention effectiveness. However, very little research has examined specific strategies to enhance engagement in IPV interventions. The majority of current strategies to enhance engagement primarily focus on motivational strategies (Day et al., 2009; Jewell & Wormith, 2010; Kistenmacher & Weiss, 2008; Musser et al., 2008; Roy et al., 2011; Soleymani et al., 2018; Taft et al., 2001). For example, Motivational Interviewing (MI) has been used prior to intervention and in the early stages of a program to assess a participant’s readiness to change and/or increase their motivation to change their behavior (Lundahl et al., 2010). The overall efficacy of motivational interventions in IPV intervention programs has been mixed; however, findings from previous research indicate that MI may be an effective supplementary intervention strategy for IPV offenders (Crane & Eckhardt, 2013; Murphy et al., 2012; Scott et al., 2011). For instance, research has demonstrated positive impacts of MI on various forms of participant engagement in treatment (e.g., attendance, attrition, completion, and homework compliance; Crane & Eckhardt, 2013; Eckhardt et al., 2008; Kistenmacher & Weiss, 2008; Lundahl et al., 2010; Musser et al., 2008; Soleymani et al., 2018; Taft et al., 2001), as well as positive behavioral changes such as reduced recidivism (Lincourt et al., 2002; Schumacher et al., 2011).
However, although motivational strategies are perhaps useful in addressing participants’ motivation and readiness to change, the link between a participant’s motivation to engage in an intervention and their actual engagement with treatment remains unclear (Scott & King, 2007). In this study, using measures of treatment satisfaction to develop a better understanding of key factors that facilitate responsiveness to IPV intervention points to several recommendations concerning how interventions can maximize elements that enhance participant engagement. To begin, as the literature suggests that effective engagement-enhancing strategies should strengthen factors that promote responsiveness (Roy et al., 2011), based on the findings from this study, we contend that developing strategies to strengthen group cohesion and the therapeutic alliance, considering specific client mix and the applicability of course content, and building in opportunities for participants to witness personal growth are all important factors to consider. Specifically, it seems particularly important to ensure that participants have the opportunity to establish rapport and build trusting relationships with those involved in the treatment process (i.e., other participants, program facilitators). In addition, our findings suggest that to facilitate self-disclosure, it is important that the program is delivered in an emotionally safe environment in which participants feel accepted, respected, and supported. Program staff may consider incorporating activities that facilitate opening up/sharing at an early point in the program. As group discussions, sharing stories, and learning from other men in the group were highlighted by many participants as most liked aspects of their program, facilitating conversation and creating an environment wherein participants feel comfortable and safe to share is likely to benefit individual learning as well as the overall group dynamic. Further research is needed to understand what factors facilitate engagement, and how these can be incorporated by program designers and facilitators into engagement-enhancing strategies.
Given that effective engagement-enhancing strategies should also seek to minimize factors that hinder responsiveness (Roy et al., 2011), our findings suggest that consideration of logistical aspects of the program may minimize challenges to attendance and participation. For instance, holding the program session at a time of day that is most convenient for participants may increase both attendance and engagement: directly consulting current and former participants may elicit more detailed feedback regarding ideal program logistics. Furthermore, participant engagement and acquisition of knowledge may be increased if men are able to sustain focus; this could mean shorter weekly sessions, or sessions with additional energy breaks/activities scheduled in, or by providing plenty of snacks to help fuel participant focus at the end of a long day. In addition, adapting program content to increase relevance/applicability of the material and discussion topics may help improve overall engagement. Considering that the process of promoting engagement in IPV intervention programs is not well understood, future research should also continue to examine the role of and predictors of group cohesion, therapeutic alliance, and treatment-based factors in the larger context of change and program effectiveness for IPV interventions. Furthermore, to increase our understanding of participant engagement as a mechanism of change, future study should focus on interaction effects between individual-level characteristics and treatment-based factors (e.g., treatment approach, characteristics of the facilitators) and how these influence treatment-process factors.
Limitations
Although this study fills an important gap in the literature by extending our current understanding of participant engagement by identifying several subsets of factors that participants perceive as promoting responsiveness and engagement, there are some limitations to consider. First, though the unique nature of the sample is not a limitation to the study (i.e., the majority of respondents were voluntary participants while typical IPV interventions serve mandated clients), it is important to note how this affects the interpretation and generalizability of the findings. In particular, as the programs included in this study intentionally targeted highly motivated offenders (i.e., because they volunteered to participate in a violence intervention program), the perceptions and viewpoints of these participants with respect to factors that enhance engagement may be different than those who were mandated to attend. Importantly, as this study only includes data from participants who completed an IPV intervention program, the findings presented here may not generalize to individuals who dropped out of the program or otherwise failed to complete the posttest. Dropouts may have a different perspective concerning factors that facilitate/inhibit their engagement with a program, and it is certainly possible that these differences are related to attrition from the program. Finally, we used open-ended questions focused on program components that participants like best and liked least as proxies for factors associated with program engagement. While we believe that these questions, and, more importantly, the types of responses given, do relate directly to factors associated with participants’ responsiveness to an IPV program, they were nonetheless broad, open-ended questions. Some respondents may have given different answers had the questions been more targeted on factors expected to relate to program engagement.
Conclusion
The process of men’s engagement in IPV intervention groups is not currently well understood; however, participant engagement has been hypothesized to play an influential role in the effectiveness of IPV intervention programs. Consistent with existing literature, the findings from this study suggest that there are a number of pathways linked with participant engagement, including group cohesion, therapeutic alliance, treatment-based factors, and observations of personal transformation. This study fills an important gap in the literature by identifying several subsets of factors that participants perceive to promote responsiveness to treatment, and by providing insight into how facilitators can structure program/process elements to enhance engagement. Future research on men’s engagement in IPV intervention programs should continue to examine treatment-process factors that influence engagement, as well as barriers to engagement in the context of treatment-based factors. Further development of engagement-enhancing strategies is needed to improve IPV intervention efficiency.
Footnotes
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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by a grant from the British Columbia Ministry of Public Safety and Solicitor General, Community Safety and Crime Prevention Branch.
