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.     

Predictors of Attrition in Two Types of Group Programs for Men Who Batter

This study examines the predictors of precounseling attrition, incounseling attrition, and duration of attendance in 2 group programs for men who batter. Predictors of precounseling attrition were a history of child abuse, being non-White, and having more self-reported anger. Younger age and antisocial personality were significant predictors of attrition during counseling in both logit and Zero Inflated Poisson regression analyses. We further identified predictors of attrition by type of group treatment. In cognitive–behavioral groups, younger age, no reports of violence in childhood, and antisocial personality were significantly related to attrition. In process-psychodynamic groups, low income was related to attrition. Program and research implications of these findings are discussed.     

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.     

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.     

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.     

Predictors of Underreporting of Male Violence by Batterer Program Participants and Their Partners

Self-reports on domestic violence inventories remain the basis of court and clinical decision-making and program outcome evaluations, but previous research questions their reliability and validity. Accurate prediction of underreporting would help practitioners and researchers adjust batterer and victim self-reports. We develop prediction equations of underreporting on the Conflict Tactics Scale, using a multi-site database of men admitted to batterer programs and their female partners (n = 840). First we use variables measured at program intake to predict female and male underreporting of male violence at program intake. Second, we use variables measured at program intake, as well as measures of program participation, to predict male-female disagreement (male underreporting) at 12-month follow-up. Several variables were predictive of underreporting, both at intake and follow-up, but overall prediction was marginally better than chance. The findings suggest that men and women underreport based on situational factors (such as relationship characteristics) and rational reasons, rather than based on personality traits or social desirability. However, the ability to predict underreporting is too weak for adjustment of self-reports by clinicians and program evaluators.     

Injuries and Health Care Use in Women with Partners in Batterer Intervention Programs

Objective:To characterize injury frequency, injury patterns, and health care seeking behavior in women with intimate partners enrolled in batterer intervention programs. Methods: A standardized telephone interview was conducted on a sample of women with male partners enrolled in batterer intervention programs in four U.S. cities. Information on prior injuries and the utilization of health care services was sought. Results: Four hundred and eighty eight of the 648 women (75.3%) reported a history of prior injury as a result of abuse. Contusions were the most common injury. Of the women reporting contusions, 233 (51.4%) reported contusions as their only injuries. Another 220 women (48.6%) reported other injuries in addition to contusions. In the majority of cases (63.2%) the contusions were to multiple body parts. When the contusion involved only one anatomical region, it was mostly to the face. A total of 192 of the 488 injured women (39.3%) reported ever seeking medical care for injuries caused by their intimate partner. Twenty-three women (4.7% of the injured cohort or 3.5% of the total cohort) reported having ever been hospitalized for injuries sustained from abuse.     

Dimensions of Self-Concept as Predictors of Men Who Assault Their Female Partners

While professionals working in the field of domestic violence have gleaned much information about the prevalence and scope of spouse abuse, there is still a need for information on contributing variables in men who assault their female partners. Constructs emerging from the self-concept literature provide some promise for understanding personality attributes that can help explain why some men assault their partners and others do not. There are two constructs in particular that seem to help explain volatile reactions in relationships. The first construct is negative self-concept associated with rela-tionship role performance. The second construct is the unstable self-concep-tion. This study examines the role of self-concept in discriminating men who assault their female partners from their nonbattering peers. Using a sample of 272 men matched on educational achievement, this study uses negative self concept and unstable self concept to predict known wife assaulters from their non-assaultive peers. Findings of a logistic regression analysis indicate that each construct is able to accurately predict violent and nonviolent groups with about 77% accuracy.     

Child Abuse Potential: A Comparison of Subtypes of Maritally Violent Men and Nonviolent Men

Researchers have demonstrated an overlap between husband-to-wife violence and child abuse, but we know little about which maritally violent men are at greatest risk for engaging in child abuse. This study examined child abuse potential across 4 subtypes of maritally violent men (i.e., family only, low level antisocial, borderline/dysphoric, and generally violent/antisocial; Holtzworth-Munroe et al., and 2 comparison groups of nonviolent men (i.e., maritally distressed or not), using the Child Abuse Potential Inventory (CAP; J. S. Milner [1986])). The results revealed that the borderline/dysphoric batterer subtype had significantly higher child abuse potential scores than all of the other violent subtypes and the nonviolent comparison groups. Theoretical and clinical implications are briefly discussed.     

Dropout in a Treatment Program for Self-referring Wife Abusing Men

Demographic factors and levels of psychological and physical aggression were assessed as predictors of dropout for those who participated in a group treatment program for maritally discordant couples reporting husband to wife physical aggression. In addition, follow-up assessments with dropouts were conducted to obtain clients' reasons for termination. Demographic variables and levels of physical aggression did not predict dropout; however, higher levels of psychological aggression did. The most frequently cited reasons for dropout by participants were treatment-related issues. Specifically, clients reported that the group format did not enable them to address their individual couple issues. Regarding future treatment planning, our findings indicate that in cases where men are severely psychologically abusive, individual sessions may be warranted that precede or are in conjunction with couple sessions. Also, it is as important to target women's psychological aggression as it is to target men's psychological aggression. Finally, our findings indicate that treatment programs should utilize some mechanism that allows for more personalized attention to each couple, such as an individual couples format and/or an individual supplement to the group format.     

Time-Varying Risk Factors for Reassault Among Batterer Program Participants

This study uses longitudinal data to identify risk markers for reassault among batterer program participants. Data are from 308 men and their partners collected at five, 3-month intervals. Time-varying situational and behavioral risk factors, as well as time-invariant individual characteristics, are examined. The most influential risk markers, in terms of relative risk and level of statistical significance, were time-varying: 2 measures of the man's drunkenness during the follow-up interval in which the reassault occurred (OR: 3.5-16.3; p > .0005). Other included time-varying batterer characteristics had no significant effect on reassault. Two significant time-invariant batterer risk factors were (1) severe psychopathology and (2) a history of non-domestic-violence arrest, both measured at intake. Results suggest that batterers' drinking behavior after program intake may provide an important and easily observed marker for risk of reassault and that prediction of reassault with individual risk factors at program intake remains problematical.     

The Clinical Utility of Batterer Typologies

Domestic violence research has increasingly focused on the identification of batterer subgroups. Although typologies have been proposed using the utility of both empirical and theoretical methodologies, studies comparing empirically derived and theoretically based typology solutions have not been conducted. To what degree mental health practitioners can successfully classify batterers into subgroups is also not known. To address these questions, data were gathered from 49 male batterers who were treated for domestic violence in an outpatient mental health facility. A preliminary comparison of an empirically derived and a theoretically based typology solution revealed that many batterers were classified differently by the two strategies, although the overall grouping strategies were similar in content. Further, mental health professionals had substantial difficulty choosing which of the cluster analytically created subgroups into which to sort individual batterer's MMPI profile. Finally, different treatment efficacy indicators differentiated among the men in the two subtyping systems, suggesting that each system offers unique clinical information.The second author was supported as a predoctoral fellow by a NIMH Training grant     

Characteristics of Callers to the Domestic Abuse Helpline for Men

Intimate partner violence (IPV) by women against men has been the subject of much debate. Feminists typically argue that IPV is committed only by men against women. Others argue that violence is a human problem and women also commit much IPV. To resolve these debates, IPV has been classified into two categories: common couple violence captured by population-based studies, and patriarchal terrorism, captured by studies of battered women. This typology ignores male victims of extreme IPV. The current study addresses this omission by describing 190 male callers to the Domestic Abuse Helpline for Men. All callers experienced physical abuse from their female partners, and a substantial minority feared their wives’ violence and were stalked. Over 90% experienced controlling behaviors, and several men reported frustrating experiences with the domestic violence system. Callers’ reports indicated that their female abusers had a history of trauma, alcohol/drug problems, mental illness, and homicidal and suicidal ideations.

Classification Typology and Assessment of Five Levels of Woman Battering

Family violence is a prevalent, dangerous, and often life-threatening social and public health problem. It is an indiscriminating crime that knows few boundaries, as recent annual estimates indicate that over 8.7 million women are battered by husbands, boyfriends, and other intimate partners [Roberts, 2002; Roberts & Roberts, 2005]. This article examines a new five-level classificatory schema or typology detailing the duration and severity of woman battering. Five hundred and one battered women completed in-depth interviews which formed the basis for a new classification typology ranging from short-term to chronic to homicidal levels. The current research on different types of battering relationships provides clinicians and forensic specialists with psychosocial indicators that can be utilized as a basis for early intervention and prevention of lethal consequences. The concept of the unknown prevalence of women abuse, or the “dark figure,” is also addressed in this article. Additionally, practical suggestions are made for implementing crisis intervention protocols.     

Outcomes of Case Management for African-American Men in Batterer Counseling

Case management for additional referrals has been recommended especially for African-American men in batterer counseling programs. Additional services addressing “at risk” needs may help to improve batterer program outcomes. To test this expectation, a quasi-experimental evaluation of a case management project was conducted for both “intention-to-treat” and “received-treatment.” The case management included brief assessment at batterer program intake, referral to relevant services, and follow-up calls from batterer program staff. Re-assault and re-arrests during a 12-month follow-up, along with program dropout from the 16 required sessions of the batterer program, were compared for 202 African-American program participants under case management and a sample of 482 African-American participants previously in the batterer program. In both bivariate and confirmatory multivariate analyses, neither the case management nor actual service contact significantly improved outcomes. However, the small portion of men contacting drug and alcohol treatment did tend toward better program outcomes. Poor implementation of the case management procedures may have contributed to the overall weak effects.     

Predictors of Physical Spousal/Intimate Violence in Chinese American Families

A total of 262 Chinese Americans (133 males and 129 females) were randomly selected from the Los Angeles County telephone directory using Chinese surnames as the identifying marker. A structured telephone interview was administered measuring respondents' gender role beliefs, acculturation, sociodemographic factors, and their victimization experiences with physical aggression by a spouse or intimate partner. Contrary to the feminist literature on domestic violence, gender role beliefs was not related to physical intimate violence. Acculturation, however, significantly predicted severe physical violence experienced during respondents' lifetime. Whether respondents were employed also predicted lifetime minor forms physical violence by a spouse/intimate partner. Findings are discussed in a cultural context, and social work practice and research implications are also highlighted.     

Group Treatment for Spouse Abuse: Are Women with PTSD Appropriate Participants?

Eighty four abused women seeking therapy with their husbands were accepted into a group treatment program for spouse abuse. In the current study, we evaluated the treatment outcome of those women (n = 27) diagnosed with Posttraumatic Stress Disorder (PTSD). PTSD diagnosis, itself, did not differentiate those women who dropped out of treatment. Results indicated, however, that across all women, avoidance symptomatology significantly differentiated treatment completers from dropouts. Although women with PTSD began treatment in worse condition (lower marital satisfaction, higher depressive symptomatology, greater fear of spouse), post-assessment revealed they achieved positive treatment gains parallel to those of women without PTSD. Women with PTSD improved on each outcome variable measured, including a reduction in fear of spouse. Women with PTSD also did not differentially drop out of either treatment condition (men's/women's versus conjoint groups) which lends support to the appropriateness of conjoint treatment for spouse abuse.     

Assessing the Effect of Batterer Program Completion on Reassault: An Instrumental Variables Analysis

The main objective of this paper is to investigate the utility of using the instrumental variables (IV) method to estimate batterer program efficacy, i.e., the program effect among batterers who complete batterer programs. This method takes account of possible confounding due to unmeasured traits of compliers and non-compliers. A structural model is used to estimate the impact of program completion on reassault using instrumental variables (IV) regression. Data on 640 batterers enrolled at three batterer programs are used. Results obtained from IV regression are compared with those obtained from a more traditional regression analysis. The results indicate that usual regression methods yield estimates of program effect that may be biased due to confounding by unmeasured batterer characteristics. Unfortunately, IV estimates may be unreliable due to failure of some of the assumptions on which they are based. If equations are adequately identified by the non-linear functional form used to estimate them, then IV results indicate that among a very select group of batterers, program completion significantly reduces the probability of reassault. The implications of confounding due to program non-compliance, program non-enrollment and attrition for future evaluations of batterer programs are discussed.     

Family violence reported in a psychiatric emergency room

The prevalence of family violence reported in psychiatric emergency rooms is relatively undocumented, despite the clinical and legal concern for dangerousness. This study assesses the prevalence of aggression incidents reported to clinicians and physicians during evaluation interviews (n =389).Two-thirds of the total number of subjects reported being involved in an aggression incident sometime in their past. Only 8% reported being the victim of such incidents. About one-half of the cases involved physical assaults; nearly one-half of these assaults had family members as victims. One third of the total cases had been assaultive within 3 months; one sixth had been assaultive within 2 weeks of visiting the hospital. Clinicians and researchers are urged to consider more systematically family violence in psychiatric settings.