Predictors of Attrition in a Treatment Program for Battering Men

This study examines factors associated with the high attrition rate in treatment programs for men who batter. In accord with past research, we expected demographic variables of age, race, employment status, relationship status, and socioeconomic status to predict attrition. We also hypothesized that attitudinal and personality variables, as well as contextual/program variables, might account for attrition more parsimoniously. Specifically, we hypothesized that attrition would be predicted by frequency and severity of violence, denial of a problem with violence, rigidity of thinking, low levels of self-disclosure, and higher anxiety and constriction in social situations. In addition, we predicted attrition would relate to dependency, maladaptive personality styles, and expectations regarding group counseling (e.g., whether treatment is perceived as aversive). Finally, we proposed that attrition would relate to whether batterer participation in treatment was self-motivated or the result of external pressures. Participants were 61 men enrolled in a batterer treatment program in a mid-sized city. Analyses of variance and discriminant analyses indicated that program attrition was unrelated to demographic, attitudinal, or personality variables. Only the contextual/program variables of mileage traveled to attend and external monitoring of attendance significantly differentiated treatment rejecters, drop-outs, and treatment continuers. Findings are discussed with regard to intrinsic and extrinsic motivational factors. Future directions for exploration are discussed.     

Stage of Change as a Predictor of Attrition Among Men in a Batterer Treatment Program

This study assessed the contribution of the men's stage of change to the prediction of attrition among men attending a batterer treatment program. As outlined by the transtheoretical model of change, men were classified into the precontemplation, contemplation, or action stage based on their level of change motivation and behavior. It was hypothesized that men in the precontemplation stage would dropout of treatment at higher rates than men in later stages of change. Participants were 308 men who enrolled in a batterer treatment program over the course of 1 year, 61.4% of whom dropped out of treatment. Counselor rated, but not self-rated stage of change significantly predicted treatment completion once traditionally used demographic, contextual, and personality variables were taken into account. Specifically, men identified by counselors as being in the precontemplation stage were 2.3 times as likely as men rated in the contemplation stage and 8.8 times as likely as men rated in the action stage to dropout of treatment. Referral source, age, and history of arrest also made significant contributions to the prediction of attrition. The best combination of predictors led to the successful classification of 72% of the cases, 98% of the dropouts but only 19% of the completers. Discussion focuses on the limitations of current findings and their implications for the use of the transtheoretical model to predict attrition from batterer treatment.     

The Treatment Needs of Substance Abusing Batterers: A Comparison of Men Who Batter Their Female Partners

Though the co-occurrence rate of intimate partner violence (IPV) and problems with alcohol and other drugs (AOD) is 50 % or higher among men in clinical samples, little attention has been given to examining the characteristics of batterers with AOD problems (AOD batterers). We compared 274 AOD batterers and 524 non-AOD Batterers (batterers who do not have AOD problems). Results indicated AOD batterers were more violent, and were more likely to perpetrate violence that is severe in nature. They also reported higher levels of anger and trauma, had a greater proclivity toward a borderline personality orientation, and were much more likely to use AOD during an incident of violence at least half of the time (41 % versus 9 %). Results underscore the need for screening of batterers for AOD problems and substance abusers for IPV, and suggest that AOD problems might serve as an important indicator to help identify particularly complex cases.     

Adolescents with Psychopathic Characteristics in a Substance Abusing Cohort: Treatment Process and Outcomes

Psychopathy is a condition with important consequences both for individuals who experience it and for the communities in which they live. Although the assessment of psychopathy among adolescents remains controversial, some evidence suggests that the affective and behavioral traits of adult psychopathy begin to emerge in childhood (B. B. Lahey & A. Kazdin, 1990) and continue across the lifespan (A. E. Forth, S. D. Hart, & R. D. Hare, 1990). The present study used the Psychopathy Checklist: Youth Version (PCL:YV; A. E. Forth, S. D. Kosson, & R. D. Hare, in press) to retrospectively assess psychopathic characteristics, treatment process, and outcomes of 64 individuals referred for treatment to a substance abuse program for adjudicated adolescents. This study focused on the relationship between psychopathic characteristics and treatment process and outcome variables, including attrition rates, quality of participation, substance use throughout treatment, clinical improvement, and 12-month recidivism rates. Psychopathic characteristics were negatively related to treatment process and outcome variables, including attrition, participation, substance use, and clinical improvement. Psychopathic characteristics were positively related to the number of arrests in the 12 months following treatment completion. Implications for treatment and future research with adolescents displaying psychopathic characteristics are discussed.     

Treatment programmes for adolescents who commit sexual offences: Dropout and recidivism

This paper reviews the state of research into treatment programmes for adolescent sexual offenders, focusing first on treatment dropout, then on recidivism studies. Pre-treatment variables, which may predict dropout from programmes for these adolescents, have hardly been considered, despite obvious financial and ethical implications. In relation to recidivism studies, these have been carried out quite consistently since the mid 1980s, yet, as is discussed, they still suffer from many methodological problems. The authors also note that research into treatment programmes comes almost exclusively from North America. Thus, such research needs replicating with UK samples in order to assure the applicability of any research findings to this population.     

Attitudes of Men and Women Towards Wife Beating: Findings From Palestinian Refugee Camps in Jordan

The aim of this study is to investigate the factors associated with the acceptance of wife beating among currently married men and women living in disadvantaged Palestinian refugee camps in Jordan. The study uses data from a cross-sectional survey of 3,100 households from 12 refugee camps, conducted in 1999, with a sub-sample of 395 married women and men selected for this analysis. Associations between acceptance of wife beating and experience of abuse as well as other risk factors are assessed for men and women separately, using χ ² tests and odds ratios from binary logistic regression models. The majority of men (60.1%) and women (61.8%) believe that wife beating is justified in at least one of the eight hypothetical marital situations presented to them. Among women, those that had been victims of intimate partner violence are significantly more likely to report acceptance of wife beating. Among men, acceptance of wife beating is also significantly associated with their current age, labor force participation, their view on women’s autonomy, and their own history as perpetrators of IPV. The majority of respondents justify wife beating in this context, with essentially no difference between men and women. Acceptance of wife beating by both men and women was strongly associated with previous experiences of wife beating adjusting for other risk factors.     

Predicting Attrition From Treatment Programs for Abusive Men

Attrition in male battering treatment programs is a serious problem. To keep clients in treatment, it is crucial to understand why they drop out. The current study examined the contribution of both client and program characteristics in predicting dropout from treatment programs for abusive men. Data were collected at intake from 306 abusive men who sought treatment at four different sites. The rate of preprogram attrition (from intake to the first treatment session) was higher in the program that had a lengthy waiting list (46%) than in the other programs amp lpar3%-13%). In-program attrition was more highly related to client characteristics than program characteristics (all programs had rates between 36% and 42%). Those men who dropped out after starting treatment tended to have unstable lifestyles (e.g., substance abuse problems, criminal history, unemployment) and to have inflicted more severe abuse than those who completed treatment. Results also supported a significant interaction between verbal aptitude and structure of program; men with low verbal aptitude were the most likely to drop out of an unstructured program. Possible strategies for preventing attrition are discussed.     

Evaluation of a Treatment Program for Sexually Abused Adult Males

This study evaluated the effectiveness of an individual treatment program for five adult males who experienced childhood sexual abuse. A treatment manual focusing on abuse-related self-blame, anger, and anxiety was developed. Daily self-blame, anger, and anxiety self-ratings were completed before and throughout treatment. A multiple-baseline approach was used to evaluate treatment effects. Overall findings indicated that most participants experienced significant reductions in self-blame, anger, and anxiety as a result of their involvement in the sexual abuse treatment program. Treatment was particularly helpful in decreasing feelings of self-blame and anger. The study made an important initial contribution to the development of systematic treatment outcome research for a population of individuals that has received relatively little attention. The results have implications for future clinical and research efforts with sexually abused adult males.     

Beliefs About Wife Beating Among Arab Men from Israel: The Influence of Their Patriarchal Ideology

Despite the recent increase in public and professional interest in the problem of wife beating in Arab society, in Israel, and in the rest of the Arab world, there is a serious lack of empirical research on different dimensions of the problem in those societies. This paper presents the results of a survey conducted among a systematic random sample of 362 Arab husbands from Israel, in an attempt to examine the contribution of patriarchal ideology toward explaining their beliefs about wife beating. Although about 58% of the participants indicated that there is no excuse for a man to beat his wife, 15–62% still justified wife beating on certain occasions (e.g., adultery, failure to obey husbands, disrespect for parents and relatives). In addition, although the participants tended to perceive abusive and violent husbands as responsible for their behavior, 52% still expressed understanding of that behavior and, on some occasions, 23–43% even blamed the wife for violence against her. Regression and multiple regression analyses revealed that over and above the participants' age and level of education, their masculine sex-role stereotypes, negative and traditional attitudes toward women, nonegalitarian marital role expectations, and familial patriarchal beliefs were the most significant predictors of beliefs about wife beating. Implications of the results and limitations of the study are also discussed.     

Race and Demographic Factors in Treatment Attendance for Domestically Abusive Men

This study examined the influence of race and other demographic characteristics on session attendance and dropout from a cognitive-behavioral treatment program for male domestic abusers (N = 101). Multiple regression analyses revealed that lower session attendance was significantly predicted by unemployed status and African American (versus Caucasian) race. Other demographic factors could not account for the race differences in session attendance. Race was the strongest predictor of dropout and session attendance in all analyses. Racial composition of treatment groups was not significantly related to number of sessions attended for Caucasian or African American clients. Although the combined (interactive) effect of race and referral source on number of sessions was not statistically significant, the pattern of means suggested that self-referred African Americans were at the greatest risk for dropout. Results suggest that race differences in dropout, and the mechanisms that account for these differences, deserve more clinical and research attention in treatment for domestic abusers.     

Change in Self-Esteem and Physical Aggression During Treatment for Partner Violent Men

The role of low self-esteem in aggressive behavior has been questioned by theorists who claim that inflated, rather than deflated, self-esteem is associated with violence, and that societal efforts to increase self-esteem may actually increase, rather than decrease, violent behavior. This conjecture was tested in two treatment samples of partner violent men, one (n = 61) that received a behavioral intervention, and one (n = 107) that received a workshop program designed to enhance compassion for self and others. Both samples reported significant reductions in relationship violence perpetration and significant increases in self-esteem from pre- to post-treatment. In both samples, change in self-esteem was inversely correlated with change in physical aggression. Follow-up data from victims were available for one of the samples, and revealed that self-esteem and its enhancement during treatment did not significantly predict relationship violence during the year after treatment. These results indicate that self-esteem enhancement during treatment for partner violent men is correlated with violence reduction, and does not increase the risk for subsequent relationship aggression.     

Female Perpetrated Dyadic Psychological Aggression Predicts Relapse in a Treatment Sample of Men with Substance Use Disorders

This study examined whether female-to-male (FTM) psychological aggression predicted men’s relapse of substance use disorder (SUD) 6 months following substance use treatment. Men diagnosed with either a substance abuse or dependence disorder who had recently begun an SUD treatment program participated in the study with their female relationship partners (N = 173). Logistic regression was used to examine the relationship between baseline FTM psychological aggression and SUD relapse when controlling for baseline demographic, dyadic, substance abuse- and treatment-related variables, as well as frequencies of other male- and female-perpetrated aggressive dyadic behaviors. Higher frequencies of severe, but not minor, forms of FTM psychological aggression uniquely predicted an increased risk of relapse at 6 months follow-up. These data add to the developing research program highlighting the negative sequelae of female-perpetrated psychological aggression and also provide an empirical basis for targeting specific dyadic behaviors in the context of SUD treatment and relapse prevention.     

Distress Tolerance and Intimate Partner Violence among Men in Substance Use Treatment

Intimate partner violence (IPV) is overrepresented among men in substance use treatment. Individuals who relapse following substance use treatment report greater IPV perpetration relative to individuals who remain remitted. In addition, distress tolerance has been shown to be an important treatment target in substance use treatment, with distress tolerance predicting relapse following treatment. However, we are unaware of any research that has examined the relationship between distress tolerance and IPV among men in substance use treatment, which may hold important treatment implications. The current study therefore examined this relationship in a sample of men in substance use treatment (N = 138). Results demonstrated that distress tolerance was negatively associated with physical and psychological IPV perpetration. After controlling for age and substance use and problems, distress tolerance remained associated with psychological, but not physical, IPV perpetration. These findings suggest that distress tolerance may be an important component of treatments for IPV, particularly for psychological aggression. Substance use treatment programs that target distress tolerance may concurrently reduce the risk for relapse to substance use and IPV perpetration.     

Decision Making in a Hybrid Organization: A Case Study of a Southwestern Drug Court Treatment Program

This article presents a case study of decision making in a drug court located the southwestern United States. This study seeks to fill a gap in research on decision making by attending to the ways that drug court officials navigate the demands of a court that is dedicated to both therapy and criminal justice. This analysis differs from previous research by viewing the drug court as a “hybrid organization” and asking how the staff members interact in the decision‐making process. Additionally, this research provides an opportunity to investigate the concerns over collaborative decision making raised by critics. The data from this case study reveal that as a hybrid organization, the drug court staff often divides along institutional lines by allowing the counseling staff to manage treatment and the judge to manage punishment. When tensions arise, they are resolved by the structure of the court, which is hierarchical rather than collaborative.     

A Coordinated Approach to Improving Outcomes for Substance‐Abusing Families in Juvenile Dependency Court

This paper describes a coordinated approach to providing enhanced services for substance‐abusing families in the juvenile dependency court. The enhanced services consisted of an interagency collaborative model including the Department of Social Services, Court Appointed Special Advocates, Public Health Nurses, and Family Support Specialists. The purpose of the intervention was to increase the likelihood of family reunification. Families were randomly assigned to either the enhanced services (N=48) or to a regular services group (N=41). Variables included social background factors, data related to court hearings and court orders, and final court outcomes regarding placement and custody. Significant factors predicting final placement of the child were completion of court ordered programs, a stable home, and mothers' cooperation and motivation. Families who received the enhanced services had significantly higher rates of reunification of children with parents.