Abstract
Intervention programs for male intimate partner violence (IPV) perpetrators mostly use the group intervention modality. Notwithstanding, the literature has neglected the study of group-related variables and their possible association with these interventions’ functioning and outcomes. This systematic review aimed to analyze group-related variables, their predictors, and their relation to the functioning and outcomes of intervention programs for IPV perpetrators. The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched from inception to November 2022: Web of Science, Scopus, PUBMED, and PsycINFO. Of the 5,941 identified studies, 13 were included in the review. The main predictors of group-related variables were: intervention stage, motivational strategies, and leadership (counseling approach). The group-related variables as predictors of intervention outcomes were: group management behaviors and support (facilitator behavior within the group); positive confrontation, protherapeutic behavior, active involvement, positive interaction with peers, and positive interaction with the facilitator (participant behavior within the group); and group cohesion and group climate (group dynamics). Group cohesion and participants’ protherapeutic behavior stood out for their association with positive treatment outcomes (i.e., greater participation and working alliance, lower rates of violent behavior during follow-up). The findings from this review suggest that group processes are key factors in intervention programs for IPV perpetrators, and a better understanding of how these group processes are shaped, and how they can contribute to positive program outcomes, provides a new approach and insights to improve their effectiveness.
Keywords
Intervention programs for male intimate partner violence (IPV) perpetrators represent a preventive strategy of this type of violence that emerged in the mid-1970s and has been widely implemented in most western countries (Lila & Gilchrist, 2023; Lilley-Walker et al., 2018; Yakeley, 2022). A recurring question about intervention programs for IPV perpetrators is their effectiveness. The effectiveness of these programs has been analyzed by meta-analytic studies, which have found small or moderate effect sizes (e.g., Arce et al., 2020; Babcock et al., 2004; Expósito-Álvarez et al., 2023; Santirso, Gilchrist et al., 2020; Wilson et al., 2021). In these studies, recidivism of IPV has been generally considered the main outcome of intervention (Turner et al., 2023). However, the use of recidivism rates as the only indicator of intervention success has been questioned (Gondolf, 2004; Westmarland & Kelly, 2013). Several authors have emphasized the need to include other variables involved in the intervention process to gain a better understanding of the impact of interventions on IPV perpetrators (Bowen & Gilchrist, 2004; Velonis et al., 2020; Westmarland & Kelly, 2013). For example, Bowen and Gilchrist (2004) have suggested that variables, such as the competence of the facilitators or the climate in which the intervention takes place, should be considered to evaluate intervention programs for IPV perpetrators with a more comprehensive approach.
In intervention programs for IPV perpetrators, and regardless of the applied theoretical approach or model used, group treatment is the most common intervention modality (Babcock et al., 2016; Gondolf, 2015; Nicholas et al., 2020; Semiatin et al., 2013; Travers et al., 2021). For example, in a survey of 238 directors of intervention programs for IPV perpetrators in the United States and Canada, Cannon et al. (2016) found that more than 95% of the participants had taken part in a group modality. In Europe, group treatment is also the most frequent modality of intervention programs for IPV perpetrators. For example, in Akoensi et al.’s (2013) systematic review, only one of the 12 evaluated programs delivered an individual treatment rather than a group intervention modality.
Intervention programs for IPV perpetrators that use the group-based modality offer several advantages. Group-based interventions have been found to be cost-effective and provide facilitators with the opportunity to observe participants’ behavior in a social context. Group intervention provides additional advantages, such as: interpersonal learning; sharing common problems with peers by encouraging emotional openness; sharing, practicing, and acquiring skills and information; reducing isolation and stigma associated with IPV; receiving and providing social support; positive peer influence; modeling prosocial and protherapeutic behaviors; or confronting violent or negative behaviors (Hamel et al., 2021; McGinn et al., 2017; Portnoy & Murphy, 2020; Yalom & Leszcz, 2005).
Several qualitative studies have also identified group factors that can promote change and accountability. For example, IPV perpetrators who participated in group-based interventions report that the group enhanced their change process and accountability through learning from others, confronting one another to become more accountable, feeling less alone, gaining motivation to change from observing the process of change of others, and feeling safe and supported (Enosh & Buchbinder, 2019; Gray et al., 2014; Holtrop et al., 2017; Morrison et al., 2017, 2019). In addition, the participants reported that the facilitators who were able to encourage their participation, challenge them, support them in their change process, and ask appropriate and respectful questions facilitated the process of change and accountability (Holtrop et al., 2017). Finally, in these qualitative studies, the facilitators of intervention programs for IPV perpetrators identified three key group processes that can influence the participants’ change process: confronting or challenging them about their behavior; fostering an environment of safety and openness; and striving to adapt to their needs (Morrison et al., 2017).
Group-based interventions also offer advantages compared to individual treatment approaches. For example, Murphy et al. (2020) compared the results of a group-based intervention program for IPV perpetrators to those of an individual intervention with motivational components and showed that although participation and attendance were greater in the individual modality, the group-based intervention produced better final intervention outcomes. However, as Murphy and Meis (2008) pointed out, group-based interventions may also have some potential disadvantages, such as the possible diffusion of attitudes and behaviors favorable to violence against women, and the difficulty to adapt interventions to specific treatment needs, risk factors, and the stage of change of participants. Qualitative research has suggested that the group may also pose risks to the IPV perpetrators who participate in group-based intervention programs, such as: the influence of domineering, disruptive and resistant participants, the possible lack of participation, discussion, or engagement, and the negative comments made outside the group, which could reduce group cohesion and motivation to change (Gray et al., 2014; Morrison et al., 2019).
Regardless of the potential advantages and disadvantages of group-based interventions, group-related variables in the analysis of intervention programs for male IPV perpetrators have not received sufficient attention in the literature (Gray et al., 2014; Morrison et al., 2019; Murphy et al., 2020). Knowledge about what factors determine group-related variables in IPV intervention programs, or how group-related variables influence the functioning and outcomes of these programs, is limited and not systematized. Therefore, the aim of this systematic review is to synthesize and systematize the available scientific literature on group-related variables in group-based interventions for male IPV perpetrators. Group-related variables encompass the interaction and dynamics of the parties implicated in intervention groups and include group composition (e.g., homogeneity or heterogeneity of members, group size, duration), as well as the interactions and processes within the group (e.g., group climate, confrontation between peers), and also between facilitators and participants (e.g., confrontation, counseling). In this systematic review, we first identify the group-related variables that are commonly analyzed in the existing literature on group-based interventions for IPV perpetrators to address two research questions: (a) What are the predictors of these group-related variables? (b) Do these group-related variables influence the functioning and outcomes of intervention programs for IPV perpetrators? By examining both the predictors of group-related variables and group-related variables as predictors of program functioning and outcomes, we aimed to gain a deeper understanding of the role of group-related variables in intervention programs for IPV perpetrators, and the extent to which this knowledge can help to improve their effectiveness. To the best of our knowledge, this is the first systematic review to focus on the relevance of group-related variables in intervention programs for male IPV perpetrators.
Method
A systematic literature review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (Page et al., 2021). The study protocol was registered in PROSPERO, an international prospective register for review protocols (registration number: CRD42022313243).
Search Strategy
A systematic computerized literature search was conducted in the following databases: Web of Science, Scopus, PUBMED, and PsycINFO. There were no restrictions on publication dates. The search was conducted in September 2020 and repeated in November 2022. The search strategy was carried out through an iterative back-and-forth process using multiple combinations of the keywords in five clusters. The following terms were included: (group* OR peer* OR leader* OR climate OR interaction OR social influence OR support OR facilitator* OR therapist*) AND (intervention OR treatment OR program*) AND (perpetrator* OR batterer* OR offender* OR aggressor*) AND (couple OR partner* OR marital OR spouse* OR husband OR wife OR intimate OR gender OR domestic) AND (violence OR aggress* OR maltreat* OR abuse*). In addition, the forward and backward citation tracking of the reference lists of the included studies was conducted to identify other potentially eligible articles.
Eligibility
The inclusion criteria were: (a) studies that included an intervention for male IPV perpetrators; (b) the intervention was administered at the group level; (c) studies included any quantitatively evaluated group-related variable (e.g., group climate, facilitator leadership); (d) the predictors of group-related variables or the influence of these variables on the functioning or outcomes of intervention programs for IPV perpetrators were analyzed; (e) studies published in English and in peer-reviewed journals; and (f) quantitative studies. The initial screening was performed by two authors (MR and FS) who independently reviewed the articles according to their abstract and title to identify those studies that met the eligibility criteria. The full texts of all the potentially eligible articles were independently assessed (MR and FS). Discrepancies were overcome through discussion and by reaching a consensus with two other authors (EG and ML).
Data Extraction
Two reviewers (MR and FS) independently extracted the information below from the included studies into a standardized coding form, including the following information: author(s), publication date, country, sample, type of intervention, study design, predictors of group-related variables in intervention programs for IPV perpetrators, outcome measures, and results. Discrepant codes were discussed with additional authors (EG and ML) until issues were resolved.
Quality Assessment
The quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT; Hong et al., 2018) developed by the Department of Family Medicine at McGill University. The MMAT is a critical appraisal tool designed to support researchers in assessing the quality of manuscripts. Specifically, the five core criteria for a nonrandomized quantitative study methodological design were used. The first criterion was related to the representativeness of the target population through the study sample. Indicators of representativeness included a clear description of the target population and the sample, the reasons why certain eligible participants did not participate, and any attempts to form a sample of participants that was representative of the target population. The second criterion referred to the appropriateness of the measures for the examined outcomes and the implemented interventions. Indicators of appropriate measures included that variables were clearly defined and accurately measured, measures were justified and appropriate to the research questions, validated and reliability-tested measures were used, and measures reflected what they were intended to measure. The third criterion was the availability of complete outcome data. There was no absolute and standard cutoff acceptable complete data. In the literature, acceptable complete data ranged from 80% to 95% (Higgins et al., 2016; Thomas et al., 2004). The fourth criterion referred to the consideration of confounders in the design and analysis. Confounders are factors that predict both the outcome of interest and the intervention received at the baseline. Confounding bias was low when confounding was not expected or appropriate methods were used to control for it (e.g., stratification, regression). Finally, the last criterion was whether the intervention or exposure occurred as intended. Consideration was given to whether participants were treated in a consistent manner with the planned intervention and/or whether changes in exposure status occurred in the participants. Each criterion was rated as “yes,” “no,” or “cannot tell.” Quality appraisal was carried out by two reviewers (MR and FS). Any disagreements were settled by discussion to reach a consensus with additional reviewers (MS and EG).
Results
Study Selection
The database searches yielded 5,941 records, and two additional records were identified through other sources (Figure 1). After removing duplicates, 4,176 articles were retained for title and abstract screening. In all, 4,129 abstracts were excluded because they did not meet the inclusion criteria and 47 manuscripts were selected for the full-text review. Thirty-four studies were excluded because: they did not analyze group-related variables (n = 7); they did not relate group-related variables to intervention outcomes or other variables of interest (n = 3); they did not use a quantitative methodology (n = 21); the sample was not composed of adult men and the facilitators of intervention programs for IPV perpetrators (n = 1); and they were not published in English (n = 2). The remaining 13 studies were included in the qualitative analysis. Two of the included studies (Boira et al., 2013; Chovanec, 2012) used both quantitative and qualitative methods. In the context of the proposed review, only the quantitative results of both studies are presented. Therefore, it is safe to conclude that there is a paucity of studies that consider group-related variables of intervention programs for IPV perpetrators.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Quality and Publication Bias Assessment
The risk of a bias assessment for each study included in the systematic review is shown in Figure 2. Five of the studies (38.5%; Musser et al., 2008; Santirso et al., 2018; Santirso, Lila et al., 2020; Semiatin et al., 2013; Taft et al., 2003) met at least three assessment criteria. Only two studies met all the assessment criteria (15.4%; Santirso, Lila et al., 2020; Taft et al., 2003).

Risk of Bias in Included Studies.
Regarding the representativeness of the sample, three of the 13 studies (23.2%; Santirso et al., 2018; Santirso, Lila et al., 2020; Taft et al., 2003) used a representative sample, and the remaining 10 studies (76.8%; Boira et al., 2013; Bowen, 2010; Chovanec & Roseborough, 2016; Chovanec, 2012; Hamel et al., 2021; Musser et al., 2008; Rondeau et al., 2001; Scott et al., 2011; Semiatin et al., 2013; Waldo et al., 2007) did not provide information on sample representativeness. Nine studies (69.2%; Boira et al., 2013; Bowen, 2010; Chovanec & Roseborough, 2016; Musser et al., 2008; Santirso et al., 2018; Santirso, Lila et al., 2020; Scott et al., 2011; Semiatin et al., 2013; Taft et al., 2003) applied appropriate assessment measures, and four studies (30.8%; Chovanec, 2012; Hamel et al., 2021; Rondeau et al., 2001; Waldo et al., 2007) did not provide information on appropriate assessment. In seven studies (53.8%; Chovanec & Roseborough, 2016; Musser et al., 2008; Rondeau et al., 2001; Santirso, Lila et al., 2020; Semiatin et al., 2013; Taft et al., 2003; Waldo et al., 2007), all the numbers were provided, and missing data were accounted for or explained, and the remaining six studies (46.2%; Boira et al., 2013; Bowen, 2010; Chovanec, 2012; Hamel et al., 2021; Santirso et al., 2018; Scott et al., 2011) did not report information on completed outcome data. Nine studies (69.2%; Chovanec, 2012; Musser et al., 2008; Rondeau et al., 2001; Santirso et al., 2018; Santirso, Lila et al., 2020; Scott et al., 2011; Semiatin et al., 2013; Taft et al., 2003; Waldo et al., 2007) adequately accounted for confounders in their design and analysis, three studies (23.2%; Boira et al., 2013; Bowen, 2010; Chovanec & Roseborough, 2016) did not inform about confounders methods, and Hamel et al. (2021) did not include a control procedure for potential confounders in their design and analysis. Finally, seven studies (53.8%; Boira et al., 2013; Bowen, 2010; Chovanec, 2012; Santirso et al., 2018; Santirso, Lila et al., 2020; Semiatin et al., 2013; Taft et al., 2003) reported that the participants were treated in a manner that was consistent with the planned intervention. Finally, six studies (46.2%; Chovanec & Roseborough, 2016; Hamel et al., 2021; Musser et al., 2008; Rondeau et al., 2001; Scott et al., 2011; Waldo et al., 2007) did not report any information on consistency with the planned intervention.
Qualitative Analysis
Most studies were conducted in the United States (n = 7; Chovanec, 2012; Chovanec & Roseborough, 2016; Hamel et al., 2021; Musser et al., 2008; Semiatin et al., 2013; Taft et al., 2003; Waldo et al., 2007), three studies in Spain (Boira et al., 2013; Santirso et al., 2018; Santirso, Lila et al., 2020), two studies in Canada (Scott et al., 2011; Rondeau et al., 2001), and one study in the United Kingdom (Bowen, 2010).
The target sample in most of the included studies was male IPV perpetrators (n = 12; Boira et al., 2013; Bowen, 2010; Chovanec, 2012; Hamel et al., 2021; Musser et al., 2008; Rondeau et al., 2001; Santirso et al., 2018; Santirso, Lila et al., 2020; Scott et al., 2011; Semiatin et al., 2013; Taft et al., 2003; Waldo et al., 2007). Additionally, in most studies the participants were court-referred (n = 11; Boira et al., 2013; Bowen, 2010; Chovanec, 2012; Musser et al., 2008; Rondeau et al., 2001; Santirso et al., 2018; Santirso, Lila et al., 2020; Scott et al., 2011; Semiatin et al., 2013; Taft et al., 2003; Waldo et al., 2007). However, Hamel et al. (2021) did not determine whether their sample was composed of court-referred participants, volunteers, or both. Three studies included a sample made up of male IPV perpetrators and the facilitators of the group-based intervention (Bowen, 2010; Chovanec & Roseborough, 2016; Hamel et al., 2021). As for the studies that employed a sample of facilitators, in Hamel et al. (2021) the facilitators were primarily white males aged between 55 and 64 years with an average of 11 years of experience in the field of intervention with IPV perpetrators. In the study by Chovanec and Roseborough (2016), the facilitators were white female social work graduates with an average of 12 years of experience in intervention with IPV perpetrators. Bowen (2010) did not provide any data about this matter.
The most delivered intervention model was cognitive-behavioral therapy (n = 7, 53.8%; Boira et al., 2013; Hamel et al., 2021; Musser et al., 2008; Santirso et al., 2018; Santirso, Lila et al., 2020; Semiatin et al., 2013; Taft et al., 2003). Of these studies, cognitive-behavioral therapy was combined with psychoeducation in one study (Boira et al., 2013), with the client-centered approach based on genuineness, listening and focusing on the client’s strengths, in another (Hamel et al., 2021), and with motivational interviewing in two studies (Santirso et al., 2018; Santirso, Lila et al., 2020). The Duluth Model was the intervention model delivered in three studies (23.1%; Bowen, 2010; Chovanec & Roseborough, 2016; Scott et al., 2011). Another less common intervention was the psychoeducational model (n = 1, 7.7%; Chovanec, 2012). Finally, two studies did not specify the intervention model (15.4%; Rondeau et al., 2001; Waldo et al., 2007).
Study Authors’ Findings and Conclusions
Group-Related Variables in Intervention Programs for Male IPV Perpetrators
Three main categories of group-related variables were identified in the reviewed studies (Table 1): (a) facilitator behavior within the group; (b) participant behavior within the group; and (c) group dynamics. Table 1 shows the total number of studies that assessed at least one of the group-related variables included in each category (n-value), as well as the number of studies that examined each group-related variable within categories (k-value). The categories with the highest frequency were group dynamics (n = 7) and participant behavior within the group (n = 7). Finally, the category with the lowest frequency was facilitator behavior within the group (n = 3).
Group-Related Variables Analyzed.
Note. k = number of studies that investigated the group-related variable; n = number of studies that assessed at least one of the group-related variables included in the category.
Facilitator Behavior Within the Group
This category (n = 3, k = 6) included five group-related variables. Negative confrontation was analyzed in one study (Scott et al., 2011), defined as the facilitator contributions that exacerbated or did not resolve group conflicts. Negative confrontation was measured by the Helping Skills System (HSS; Hill & O’Brien, 1999). Second, nonprotherapeutic style, characterized by an inflexible and/or directive style (k = 1; Scott et al., 2011), was assessed by the HSS (Hill & O’Brien, 1999). Third, group management behaviors were analyzed in two studies (Hamel et al., 2021; Scott et al., 2011) and included behaviors like being caring, committed and nonjudgmental, or being willing to respectfully challenge participants’ behavior. Group management behaviors were measured by the HSS (Hill & O’Brien, 1999) in the study by Scott et al. (2011), and by an ad hoc scale (Hamel et al., 2021). Fourth, support, which refers to participants’ perceptions of the support they received from the facilitator, was analyzed in one study (Bowen, 2010) and was assessed by the Group Environment Scale (GES; Moos, 1994). Finally, interpretations, which meant giving a new meaning or explanation to a behavior or recognition, thought, or emotion, were analyzed in one study (Scott et al., 2011) and measured by the HSS (Hill & O’Brien, 1999).
Participant Behavior Within the Group
This was the predominant category (n = 7, k = 16), which included six different group-related variables. Positive confrontation, which includes efforts to change another participant’s denial of abuse, externalization of responsibility, and minimization of the effects of abuse or avoidance of the need for change, was analyzed in five studies (Chovanec & Roseborough, 2016; Hamel et al., 2021; Musser et al., 2008; Santirso, Lila et al., 2020; Waldo et al., 2007). Positive confrontation was assessed by the Group Engagement Measure (GEM; Macgowan, 2003) in two studies (Chovanec & Roseborough, 2016; Hamel et al., 2021), the Observational Coding of Protherapeutic Group Behaviors (OCPGB; Semiatin et al., 2013) in the study of Santirso, Lila et al. (2020), the Critical Incident Questionnaire (CIQ; Bloch et al., 1979) in Waldo et al. (2007), and by an ad hoc scale (Musser et al., 2008). Second, three studies (Santirso et al., 2018; Santirso, Lila et al., 2020; Semiatin et al., 2013) analyzed protherapeutic behaviors, which included demonstrations in the group with taking responsibility for violent behavior, orientation to change and participants’ positive attitude toward peers and facilitators. Protherapeutic behavior was evaluated using the OCPGB (Semiatin et al., 2013) in all three studies. Third, positive attitude toward the group, which meant necessity, relevance, and the perceived personal value of group treatment, was analyzed in two studies (Musser et al., 2008; Santirso, Lila et al., 2020). Positive attitude toward the group was assessed by the OCPGB (Semiatin et al., 2013) in the study of Santirso, Lila et al. (2020) and by an ad hoc scale (Musser et al., 2008). Fourth, active involvement was defined as active participation and contribution during group sessions (k = 2; Chovanec & Roseborough, 2016; Hamel et al., 2021). Fifth, two studies (Chovanec & Roseborough, 2016; Hamel et al., 2021) analyzed positive interaction with peers, meaning peer interaction based on enthusiasm, concern and closeness among group members. Finally, positive interaction with the facilitator, which involves facilitator–participant interaction based on enthusiasm, guidance, and closeness, was analyzed by two studies (Chovanec & Roseborough, 2016; Hamel et al., 2021). Active involvement, positive interaction with peers, and a positive interaction with the facilitator were all assessed by GEM (Macgowan, 2003) in both studies (Chovanec & Roseborough, 2016; Hamel et al., 2021).
Group Dynamics
This was the second most widely studied category (n = 7, k = 10), which included five group-related variables. Engagement, which comprised attendance, contributing, contracting and working on one’s own and others’ problems, was analyzed in two studies (Chovanec, 2012; Scott et al., 2011). Engagement was measured by GEM (Macgowan, 2003) in the study by Chovanec (2012), and was self-reported by the facilitator in the study by Scott et al. (2011). Second, group cohesion was analyzed in three studies (Bowen, 2010; Taft et al., 2003; Waldo et al., 2007) and was defined as group members’ commitment to and concern about one another. The GES (Moos, 1994) and the CIQ (Bloch et al., 1979) were used to assess group cohesion in all three studies. Third, support referred to participants’ perceptions of being cared for, valued and understood by other participants (k = 1; Waldo et al., 2007), and was assessed by the CIQ (Bloch et al., 1979). Fourth, group climate was analyzed in three studies (Boira et al., 2013; Rondeau et al., 2001; Waldo et al., 2007), and was defined as the atmosphere created in the group. Group climate was measured by the Group Climate Questionnaire (Mackenzie, 1983) in the study of Rondeau et al. (2001), the CIQ (Bloch et al., 1979) in that by Waldo et al. (2007), and by an ad hoc scale (Boira et al., 2013). Finally, interpersonal learning, which included learning from peers’ feedback and experiences (k = 1; Waldo et al., 2007), was assessed by the CIQ (Bloch et al., 1979).
Predictors of Group-Related Variables
The results and conclusions of the studies that analyzed the predictors of group-related variables in intervention programs for IPV perpetrators are presented in Table 2. The predictors analyzed by these studies were: motivational strategies, intervention stage, and leadership (counseling approach).
Predictors of Group-Related Variables in Intervention Programs for IPV Male Perpetrators.
Note. ns = nonsignificant association/differences; vs. = versus; > = significantly higher than; < = significantly less than.
Three studies examined motivational strategies as predictors of group-related variables (Musser et al., 2008; Santirso, Lila et al., 2020; Scott et al., 2011). Musser et al. (2008) compared a standard intervention to a standard intervention with two individual motivational interviews prior to the group intervention. The use of motivational strategies predicted a higher positive attitude toward the group taken by the participants during the initial sessions, but not during the intermediate and final sessions. In contrast, motivational strategies were not associated with positive confrontation among participants. Santirso, Lila et al. (2020) compared a standard intervention to a standard intervention with the addition of an individualized motivational plan. The use of motivational strategies predicted higher protherapeutic behavior levels, positive confrontation and the participants taking a positive attitude toward the group. Scott et al. (2011) compared a standard intervention to a standard intervention with the addition of motivational strategies. The use of motivational strategies predicted a greater use of group management behaviors, and a lesser use of nonprotherapeutic style, negative confrontation, and the facilitator’s interpretations.
Two studies examined the intervention stage as a predictor of group-related variables (Chovanec, 2012; Santirso, Lila et al., 2020). Chovanec (2012) assessed engagement in three stages: early, middle, and late. Intervention stage was a predictor of engagement because it was significantly higher in the middle and late intervention stages than during the early intervention. Santirso, Lila et al. (2020) assessed participants’ protherapeutic behavior, positive confrontation, and positive attitude toward the group in two intervention stages (early and late). Intervention stage was a predictor of all three group-related variables. They all had higher levels in the late intervention stage. In addition, Santirso, Lila et al. (2020) reported an interaction effect between intervention stage and motivational strategies in relation to protherapeutic behavior. The frequency for protherapeutic behavior was higher during the early and late interventions for the motivational condition than during the early and late interventions for the standard condition.
Finally, one study (Waldo et al., 2007) examined leadership as a predictor of group-related variables. A guidance leadership approach, which refers to the process of helping and guiding perpetrators to discover and develop their potential, was compared to a counseling leadership approach, which focused on facilitating and instructing personal and interpersonal functioning. The guidance leadership approach predicted higher levels of the participants’ interpersonal learning and positive confrontation compared to the counseling leadership approach.
Group-Related Variables as Predictors of Program Outcomes
The results and conclusions of the studies that analyzed group-related variables as predictors of program outcomes are presented in Table 3. The group-related variables analyzed as predictors were: group management behaviors and support (facilitator behavior within the group); positive confrontation, protherapeutic behavior, active involvement, positive interaction with peers, and positive interaction with the facilitator (participant behavior within the group); and group cohesion and group climate (group dynamics).
Group-Related Variables as Predictors of Outcomes in Intervention Programs for IPV Male Perpetrators.
Note. + = significantly higher/significantly and positively associated; − = significantly lower/significantly and negatively associated; ns = nonsignificant association/differences.
Facilitator Behavior Within the Group
Two studies examined the effect of facilitator behavior within the group on program outcomes (Bowen, 2010; Hamel et al., 2021). Bowen (2010) examined perceptions of the therapeutic environment in a sample of perpetrators and probation officers, and the relation between these perceptions and psychological change and recidivism. Facilitator support increased self-exploration, task orientation, and expression of feelings and situations within the group, but was not related to recidivism. Hamel et al. (2021) analyzed the perceptions of both participants and facilitators of an intervention program for IPV perpetrators, and their association with satisfaction and the final intervention outcomes. The participants perceived more benefits from the intervention when the facilitator engaged in more group management behaviors (see Table 4 for a summary of critical findings).
Critical Findings From this Study.
Participant Behavior Within the Group
Four studies examined the effect of participant behavior within the group on program outcomes (Chovanec & Roseborough, 2016; Hamel et al., 2021; Santirso et al., 2018; Semiatin et al., 2013). Chovanec and Roseborough (2016) analyzed several group-related variables (positive confrontation, active involvement, positive interaction with peers, and positive interaction with facilitators) across four different types of participants in an intervention program for IPV perpetrators: completers, repeat-completers, dropouts, and repeat-dropouts. The completer participants showed higher positive confrontation levels, active involvement, positive interaction with peers, and positive interaction with facilitators than the dropout participants. Similarly, the repeat-completers showed higher positive confrontation levels, active involvement, positive interaction with peers, and positive interaction with facilitators than the completers, and repeat-dropout participants. Therefore, positive confrontation, active involvement, positive interaction with peers, and positive interaction with facilitators predicted treatment adherence. Santirso et al. (2018) examined levels of working alliance and protherapeutic behavior by assessing recorded group sessions by four trained research assistants. Protherapeutic behaviors predicted higher working alliance levels for both agreement (task/goal) and bond subscales. Semiatin et al. (2013) followed an observational methodology of videotaped group sessions to examine the responsibility assumption, change discourse, and treatment perceptions of the IPV perpetrators attending an intervention program. They found that the presence of protherapeutic behaviors was associated with higher levels of facilitator-reported working alliance, homework compliance, and participant-reported motivation to change, and with lower rates of psychological and physical re-assault (6-month follow-up). However, no significant associations were reported among protherapeutic behavior and treatment dose and the participant-reported working alliance. Hamel et al. (2021) reported no significant associations among client-perceived benefits of group and positive confrontation, active involvement, positive interaction with peers and positive interaction with the facilitator (see Table 4 for a summary of the critical findings).
Group Dynamics
Four studies related group dynamics to intervention outcomes (Boira et al., 2013; Bowen, 2010; Rondeau et al., 2001; Taft et al., 2003). Bowen (2010) reported that group cohesion increased self-exploration, task orientation, and the expression of feelings and situations within the group, but was not related to recidivism. Taft et al. (2003) examined predictors of recidivism while following up the participants in an intervention program for IPV perpetrators. Group cohesion was related to higher working alliance and lower physical abuse rates upon follow-up, but not to treatment adherence. Rondeau et al. (2001) attempted to identify predictors of dropout and program completion in a sample of participants in an intervention program for IPV perpetrators from eight different community programs. No relation was found between group climate and dropout. Finally, Boira et al. (2013) examined the working alliance and the intervention context, and their relation to the therapeutic process in a sample of perpetrators. No relation was found between group climate and working alliance (see Table 4 for a summary of the critical findings).
Discussion
The present systematic review focused on the relevance of group-related variables in group-based intervention programs for male IPV perpetrators. This review included 13 studies. These studies analyzed group-related variables in group intervention programs for male IPV perpetrators, the predictors of these variables, and group-related variables as predictors of intervention outcomes.
The group-related variables were classified into three categories: facilitator behavior within the group; participant behavior within the group; and group dynamics. The most analyzed group-related variables were: positive confrontation (participant behavior within the group; Chovanec & Roseborough, 2016; Hamel et al., 2021; Musser et al., 2008; Santirso, Lila et al., 2020; Waldo et al., 2007); protherapeutic behavior (participant behavior within the group; Santirso et al., 2018; Santirso, Lila et al., 2020; Semiatin et al., 2013); group cohesion (group dynamics; Bowen, 2010; Taft et al., 2003; Waldo et al., 2007); and group climate (group dynamics; Boira et al., 2013; Rondeau et al., 2001; Waldo et al., 2007). The remaining variables were analyzed in only one or two studies (e.g., interpretations, interpersonal learning). This suggests that quantitative research into group-related variables in intervention programs for male IPV perpetrators is not only scarce, but has also neglected several variables that could be crucial for the analysis of intervention outcomes. For example, the impact of positive confrontation has been studied (Chovanec & Roseborough, 2016; Hamel et al., 2021; Musser et al., 2008; Santirso, Lila et al., 2020; Waldo et al., 2007), but research has not analyzed the impact of negative confrontation between participants. Moreover, the influence of negative confrontation and the facilitator’s protherapeutic style has been analyzed (Scott et al., 2011), but the study of positive confrontation and protherapeutic style has not been considered.
The results identified three main predictors of group-related variables in intervention programs for male IPV perpetrators: motivational strategies, leadership, and intervention stage. First, motivational strategies increased the facilitator’s group management behavior level, and decreased the occurrence of negative confrontation, nonprotherapeutic style, and interpretations (Scott et al., 2011). Likewise, motivational strategies were associated with higher participants’ protherapeutic behavior levels and a positive attitude toward the group (Musser et al., 2008; Santirso, Lila et al., 2020). Findings on the relation between motivational strategies and positive confrontation were inconclusive. Santirso, Lila et al. (2020) found that the participants who underwent an intervention that included motivational strategies showed greater positive confrontation, whereas Musser et al. (2008) reported that both variables failed to correlate. Differences in the experimental conditions of these two studies may account for the discrepant results. The participants in the study by Santirso, Lila et al. (2020) participated in five individual motivational interviews, while only two were conducted in the study by Musser et al. (2008). In addition, Musser et al. (2008) reported that the intervention format of the second motivational interview differed between study conditions. A group-based intervention was used for the standard-intervention condition, whereas an individual-based intervention was applied for the motivational-intervention condition. Therefore, inconsistency in intervention delivery between conditions might explain lack of results in terms of motivational strategies and positive confrontation. Furthermore, the use of motivational strategies was not associated with engagement (Scott et al., 2011). However, a recent systematic review demonstrated that motivational strategies increased engagement levels (Santirso, Gilchrist et al., 2020). Second, leadership was considered a predictor of group dynamics and participant behavior within the group. Counseling leadership was associated with greater interpersonal learning and group cohesion, but not with group support or group climate (Waldo et al., 2007). This leadership style also increased positive confrontation among participants (Waldo et al., 2007). Finally, intervention stage (i.e., early, middle, and late intervention) was identified as a predictor of group-related variables. Late intervention was associated with higher engagement scores (Chovanec, 2012), and with higher participants’ protherapeutic behavior levels, a positive attitude toward the group and positive confrontation scores (Santirso, Lila et al., 2020).
Three sets of group-related variables have been identified as predictors of the functioning and outcomes of intervention programs for male IPV perpetrators: facilitator behavior within the group; participant behavior within the group; and group dynamics.
First, regarding facilitator behavior, the support provided to the group predicted greater participant task orientation, self-exploration, and participation, but was not related to recidivism rates of violent behavior (Bowen, 2010). Lack of significant results between recidivism and support may be due to the fact that only official reports were included. The quality of these data is questionable because case identification depends on the perceptions of the individuals who report a crime to the police (Bowen, 2010). Facilitator’s management behaviors increased positive treatment outcomes and participants’ perceived benefits of the group intervention format (Hamel et al., 2021).
Second, regarding participants’ behavior, protherapeutic behavior predicted lower psychological and physical recidivism rates at the 6-month follow-up (Semiatin et al., 2013), as well as greater working alliance (Santirso et al., 2018; Semiatin et al., 2013), homework compliance and participants’ self-reported motivation to change (Semiatin et al., 2013). However, protherapeutic behavior was not related to participants’ self-reported working alliance, perhaps because facilitators had access to additional information and direct experience in assessing working alliance, and participants’ reports were more limited (Semiatin et al., 2013). In addition, protherapeutic behavior was not associated with treatment dose, which suggests that factors other than mere attendance determine participants’ attitudes toward the intervention (Semiatin et al., 2013). A positive interaction with the facilitator and peers, active involvement, and positive confrontation all predicted greater treatment adherence (Chovanec & Roseborough, 2016). However, none of these variables were associated with participants’ perceived benefits of the group intervention (Hamel et al., 2021). This may be explained by the fact that records of group-related variables were provided by external observers, and participants’ benefits from the group intervention were self-reported. Thus, inconsistency between facilitators and participants’ perceptions could influence the obtained results.
Finally, in group dynamics terms, group cohesion was positively associated with participants’ task orientation, self-exploration and participation (Bowen, 2010), and working alliance (Taft et al., 2003). In addition, group cohesion predicted a lower physical abuse rate upon follow-up (Taft et al., 2003). In contrast, group cohesion was not related to treatment adherence (Taft et al., 2003), possibly because of the limited variability in session attendance. Nor was group cohesion related to recidivism (Bowen, 2010). It should be underlined that only police call-out data were used, which could have influenced the results. Group climate did not predict working alliance (Boira et al., 2013) or lower dropout rates (Rondeau et al., 2001). The authors of both studies noted the need to increase their sample size and consider a more precise assessment to obtain generalizable results.
In summary, motivational strategies and counseling leadership were identified as the main predictors of group-related variables. Moreover, group cohesion, participants’ positive confrontation, and protherapeutic behaviors stood out for their association with positive intervention outcomes, such as greater working alliance and participation, and lower violent behavior rates after follow-up. These results are consistent with qualitative research. Several authors have found that positive peer confrontation, positive peer influence and modeling, learning from others, and a climate based on a sense of safety, openness, and support enhance participants’ process of change and accountability (Enosh & Buchbinder, 2019; Gray et al., 2014; Holtrop et al., 2017; Morrison et al., 2017, 2019). Morrison et al. (2017) identified three key group processes during intervention: participants’ confrontation; cohesion; and tailoring participants’ needs. Our findings supported the relevance of these processes. Positive confrontation between participants and group cohesion have been identified as predictors of functioning and outcomes of intervention programs for male IPV perpetrators. Motivational strategies, which involve assessing participants’ needs and tailoring the intervention to meet them (e.g., motivational interviewing, Murphy & Maiuro, 2009), also emerge in our study as one of the main predictors of group-related variables. Therefore, this review of quantitative studies is in line with previous qualitative research and suggests that group-related variables are key intervention processes related to the functioning and outcomes of intervention programs for male IPV perpetrators (Table 5) and may contribute to participants’ change. However, further research is needed to identify additional predictors of group-related variables and to gain a deeper understanding of how group-related variables predict the functioning and outcomes of intervention programs for male IPV perpetrators.
Implications for Practice, Policy, and Research.
Taken together, our findings have practical implications and highlight the importance of training facilitators to use motivational strategies and a protherapeutic leadership style to improve intervention outcomes. Facilitator training is a key process that influences the effectiveness of intervention programs for male IPV perpetrators (Eckhardt et al., 2006). Training that focuses on using motivational strategies and counseling leadership has been shown to be effective in improving treatment adherence and reducing dropout rates and physical and psychological reoffence (Cunha et al., 2023; Santirso, Gilchrist et al., 2020). Training would also help to create a climate of cooperation, learning, and support during interventions between participants and the facilitator. This climate could be useful for setting self-determined goals through positive confrontation and interpersonal learning, and by exploring the potential benefits of change (Lee et al., 2014; Miller & Rollnick, 2002). Another practical implication arising from this review is the necessity to create, validate, and employ measurement instruments for group-related variables. These instruments ought to be reliable and precise to comprehend the operation of group dynamics and processes within the group, and to measure the impact of these variables on the outcomes and functioning of group-based intervention programs for male IPV perpetrators.
This systematic review is not without limitations. First, only the quantitative studies that analyzed group-related variables in intervention programs for male IPV perpetrators were included. Whereas a quantitative methodology facilitates the generalization of the results and allows for the prediction of relations among variables, a qualitative methodology helps to contextualize and interpret the results in more depth (Castellan, 2010). Future research should independently examine qualitative studies to better understand the impact of group-related variables on the functioning, outcomes, and effectiveness of intervention programs for IPV perpetrators. Second, the methodology used in the included studies was quite heterogeneous in terms of intervention length, sample characteristics, measurement instruments, statistical analysis, or intervention theoretical models. This made it difficult to compare the results across studies. Third, group-related variables were mostly analyzed only in one or two studies, which made it difficult to generalize the results. Therefore, our review revealed the limited number of studies that have considered the impact of group-related variables on the functioning and outcomes of intervention programs for IPV perpetrators, a limitation that other scholars have also noted (Gray et al., 2014; Morrison et al., 2019; Murphy et al., 2020; Taft et al., 2003). Finally, further research is needed to also study the impact of group-related variables in intervention programs for IPV among women and other gender minorities (i.e., LGBTIQ+).
Despite the aforementioned limitations, this review systematizes available knowledge about group-related variables in intervention programs for male IPV perpetrators, and about the predictors of these variables and their impact on intervention outcomes. To our knowledge, this is the first systematic review to address this issue. Several authors have highlighted the need for a more comprehensive approach to address the effectiveness of intervention programs for male IPV perpetrators (Bowen & Gilchrist, 2004; Velonis et al., 2020; Westmarland & Kelly, 2013). Examining group-related variables and their impact on program functioning and outcomes may provide a better understanding of the factors that increase the effectiveness of intervention programs for IPV perpetrators.
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: Manuel Roldán-Pardo was supported by ACIF Program of the Generalitat Valenciana, Regional Department of Innovation, Universities, Science and Digital Society (ACIF/2021/362).
Marisol Lila and Enrique Gracia were supported by PROMETEO 2022: Projects for Research Excellence Groups of the Generalitat Valenciana, Regional Department of Innovation, Universities, Science and Digital Society (CIPROM/2021/046)
Author Biographies
). She is an associate editor of Psychosocial Intervention.
). His research focuses on IPV against women, with a particular emphasis on public perceptions and attitudes, and on analyzing the influence of social environmental variables. He has developed new intervention strategies for intervention programs for IPV perpetrators.
