Comparing cognitive behavioral therapy and integrated cognitive behavioral therapy/psychodynamic therapy in group treatment for partner violent men.

This was a pilot study comparing the effectiveness of cognitive–behavioral therapy (CBT; n = 18) with integrated CBT and psychodynamic therapy (CBT/PT; n = 27) in reducing partner violence. The study examined differences between the two treatment groups at posttreatment with regard to attachment dimensions, interpersonal problems, psychological/behavioral functioning, and general symptom and relationship distress. Results indicated that the CBT/PT groups showed significantly more improvement than the CBT groups on measures of partner violence, attachment, and interpersonal problems at posttreatment. Conversely, the CBT groups showed significantly more improvement than the CBT/PT groups on measures of psychological/behavioral functioning and general symptom and relationship distress. Finally, there was a significant difference between the treatment groups on recidivism rate, with the CBT/PT groups having the lowest rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult attachment styles and group psychotherapy attitudes.

The current study examined the relationship between 63 intake clients’ and 28 college student’s attachment styles and their attitudes of group psychotherapy. The authors examined the relationship between attachment anxiety and avoidance and the subscales of the Group Therapy Survey-R (Carter, Mitchell, & Krautheim, 2001). Results revealed a significant relationship between attachment avoidance in adult romantic relationships and increased fears of being vulnerable in group psychotherapy. As hypothesized, avoidance in romantic relationships was related to fears of shame and humiliation in group therapy. Contrary to predictions, clients’ anxiety ratings were negatively related to negative myths of group psychotherapy. The greater the clients rated fears of being rejected and abandoned, the less they rated negative myths about group treatment. Neither attachment anxiety nor avoidance was related to ratings of group therapy efficacy. Implications of the findings for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men.

This study used multilevel modeling to examine process and treatment adherence factors as predictors of collateral partner reports of abuse following participation in a cognitive-behavioral group treatment program for partner violent men (N = 107). Therapist working alliance ratings predicted lower levels of physical and psychological abuse at the 6-month follow-up and were the strongest predictors of outcome. Homework compliance partially mediated associations between early alliance ratings and psychological abuse at follow-up. Greater group cohesion during treatment, assessed by client report, also predicted lower physical and psychological abuse at follow-up. The findings support the promotion of a collaborative therapeutic environment to induce change among partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Application of adult attachment theory to group member transference and the group therapy process.

Although clinical researchers have applied attachment theory to client conceptualization and treatment in individual therapy, few researchers have applied this theory to group therapy. The purpose of this article is to begin to apply theory and research on adult dyadic and group attachment styles to our understanding of group dynamics and processes in adult therapy groups. In particular, we set forth theoretical propositions on how group members’ attachment styles affect relationships within the group. Specifically, this article offers some predictions on how identifying group member dyadic and group attachment styles could help leaders predict member transference within the therapy group. Implications of group member attachment for the selection and composition of a group and the different group stages are discussed. Recommendations for group clinicians and researchers are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychodynamic and cognitive therapy regarding acute treatment.

Cognitive–behavioral therapy (CBT) and psychodynamic psychotherapy either in their pure forms or possibly synthesized as a form of eclectic therapy appear to be the 2 most commonly utilized forms of psychotherapy, both having levels of empirical support. As the majority of outpatient therapy in America appears to be very brief, 1 reasonable assumption is that treatment is often sought for resolution of acute episodes. A relevant question for practice and clinical training is what are the potential implications with brief psychodynamic and cognitive therapy for this type of treatment? This brief commentary will address the following: (a) the current general differential empirical status of each approach; (b) distinctions between acute treatment and traditional brief therapy and current common treatment patterns; and (c) the general clinical mechanisms for change for each approach and their potential implications regarding acute treatment and clinical supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive behavioral treatment of PTSD in residents of battered women's shelters: Results of a randomized clinical trial.

Objective: This study was designed to explore the acceptability, feasibility, and initial efficacy of a new shelter-based treatment for victims of intimate partner violence (IPV; i.e., Helping to Overcome PTSD through Empowerment [HOPE]). Method: A Phase I randomized clinical trial comparing HOPE (n = 35) with standard shelter services (SSS) (n = 35) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (CAPS; D. D. Blake et al., 1995) and the Conflict Tactic Scales-Revised (M. A. Straus, S. L. Hamby, S. Boney-McCoy, & D. B. Sugarman, 1996). Participants were followed at 1-week, 3- and 6-months postshelter. Results: Participants reported HOPE to be credible and indicated a high degree of satisfaction with treatment. Only 2 women withdrew from treatment. Both intent to treat (ITT) and minimal attendance (MA) analyses found that HOPE treatment relative to SSS was significantly associated with a lower likelihood of reabuse over the 6-month follow-up period (OR = 5.1, RR = 1.75; OR = 12.6, RR = 3.12, respectively). Results of hierarchical linear model analyses found a significant treatment effect for emotional numbing symptom severity in the ITT sample, t(67) = ?2.046, p     

Coexisting difficulties and couple therapy outcomes: Psychopathology and intimate partner violence.

Couples presenting for treatment of relationship distress often experience additional problems, including individual psychopathology and intimate partner violence (IPV). Both issues are associated with current and future poor relationship functioning in nontreatment samples, but relatively little is understood about their association with initial presentation and outcomes in couple therapy. The current study examined these associations in a sample of 177 heterosexual couples who received therapy at two Veteran's Affairs clinics. Unlike most studies of couple therapy outcomes, couples were not excluded from treatment specifically because of high levels of psychopathology or IPV. Results of Actor Partner Interdependence Model (APIM) analyses revealed actor and partner effects of depression, actor effects of anxiety, and partner effects of IPV on initial relationship satisfaction, such that greater coexisting difficulties were associated with poorer initial satisfaction. However, improvement in relationship satisfaction over the course of therapy was not associated with psychopathology, and, contrary to hypothesis, was positively associated with men's IPV prior to treatment, even when initial level of satisfaction was controlled. The results suggest that coexisting symptoms of psychopathology or IPV may not necessarily interfere with therapy outcomes and, indeed, therapy may have positive effects for couples with these problems. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Personality, Interpersonal, and Motivational Predictors of the Working Alliance in Group Cognitive-Behavioral Therapy for Partner Violent Men.

Recent studies have demonstrated that the working alliance predicts treatment outcome for partner violent men. This study examined the influence of personality and interpersonal characteristics, motivational readiness to change, and demographic factors on working alliance formation among a sample of men (N = 107) participating in a cognitive-behavioral group treatment program for partner violence. Motivational readiness to change was the strongest predictor of the working alliance. Psychopathic personality characteristics also emerged as a strong (negative) predictor of the working alliance. Lower levels of borderline personality characteristics and interpersonal problems, self-referred status, married status, and higher age and income predicted higher working alliance ratings. The results support recent clinical efforts to address motivational readiness in programs for partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal risk factors for intimate partner violence among men in treatment for alcohol use disorders.

Objective: This study examined static and time-varying risk factors for perpetration of intimate partner violence (IPV) among men in treatment for alcohol use disorders. Method: Participants were 178 men diagnosed with alcohol abuse or dependence and their partners. Most (85%) of the men were European American; their average age was 41.0 years. Participants completed measures assessing initial alcohol problem severity, baseline beliefs related to alcohol use, antisocial personality characteristics, alcohol and drug use, relationship adjustment, and IPV. Results: According to couples' reconciled reports, 42% of participants perpetrated IPV at baseline. Among this group, the IPV recurrence rate was 43% at 6-month follow-up and 36% at 12-month follow-up. For participants without IPV perpetration at baseline, new incidence of IPV was 15% and 7% at the 6-month and 12-month follow-up points, respectively. Fixed marker predictors of IPV rates included baseline alcohol problem severity variables, baseline beliefs related to alcohol use, and antisocial personality characteristics. Variable risk factor predictors included alcohol and drug use variables, relationship adjustment factors, and anger. Alcohol use variables and anger were associated with new incidents of IPV among those without reported IPV at baseline only. Conclusions: Findings suggest that assessing and monitoring IPV occurrence by both partners is important for men in treatment for alcohol use disorders. Results indicate vulnerability factors that may identify individuals at risk for IPV and provide targets for IPV prevention among those with alcohol use disorders. These findings can aid in the development of more comprehensive models that more precisely predict IPV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of intimate partner violence among male alcoholic patients.

Male-to-female partner violence was investigated in heterosexual couples with an alcoholic male partner. Partner violent (PV) alcoholic patients (n?=?183), when compared with nonviolent (NV) alcoholic patients (n?=?120), had more antisocial personality characteristics, greater alcohol problem severity, greater use of other drugs, higher relationship distress, and stronger beliefs in the link between alcohol consumption and relationship problems. Demographic factors did not account for these PV–NV differences. Relationship distress and alcohol problem severity had independent associations with partner violence. Relationship adjustment and drug use remained significantly associated with partner violence, whereas alcohol problem severity did not, after controlling for patient antisocial traits. Beliefs in the link between drinking and relationship problems were associated with partner violence independent of other clinical factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interventions for intimate partner violence: Review and implications for evidence-based practice.

The objective of this article was to survey available intimate partner violence (IPV) treatment studies with (a) randomized case assignment, and (b) at least 20 participants per group. Studies were classified into 4 categories according to primary treatment focus: perpetrator, victim, couples, or child-witness interventions. The results suggest that extant interventions have limited effect on repeat violence, with most treatments reporting minimal benefit above arrest alone. There is a lack of research evidence for the effectiveness of the most common treatments provided for victims and perpetrators of IPV, including the Duluth model for perpetrators and shelter–advocacy approaches for victims. Rates of recidivism in most perpetrator- and partner-focused treatments are approximately 30% within 6 months, regardless of intervention strategy used. Couples treatment approaches that simultaneously address problems with substance abuse and aggression yield the lowest recidivism rates, and manualized child trauma treatments are effective in reducing child symptoms secondary to IPV. This review shows the benefit of integrating empirically validated substance abuse and trauma treatments into IPV interventions and highlights the need for more work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner violence before and after individually based alcoholism treatment for male alcoholic patients.

This study examined partner violence in the year before and the year after individually based, outpatient alcoholism treatment for 301 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before treatment, 56% of the alcoholic patients had been violent toward their female partner, 4 times the rate of 14% in the comparison sample. In the year after treatment, violence decreased significantly to 25% of the alcoholic sample but remained higher than in the comparison group. Among remitted alcoholics after treatment, violence prevalence of 15% was nearly identical to the comparison sample and half the rate among relapsed patients (32%). Thus, partner violence decreased after alcoholism treatment, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overt male homosexuals in combined group and individual treatment.

Of 10 homosexual men who voluntarily entered treatment and remained in combined therapy for 2 or more yr., all report improved general adjustment. 3 report satisfactory heterosexual adjustment, 3 hope to achieve it eventually. Advantages of combined therapy include: dissolution of rationalizations about homosexuality, development of a stronger sense of personal identity through contact with women and heterosexual men, emergence of hitherto unconscious anxieties related to their heterosexual drives, and corrective emotional experiences, often resulting in enhanced self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of partner violence perpetrators among male and female psychiatric patients.

The goal of this naturalistic study was to examine heterogeneity among female and male civil psychiatric patients with a history of intimate partner violence (IPV) perpetration. Participants were 567 patients drawn from the MacArthur Violence Risk Assessment Study (J. Monahan et al., 2001). The authors examined subtype composition among 138 women and 93 men with positive histories of IPV and compared these groups with 111 women and 225 men with no histories of IPV. Findings for men and women were consistent with reports from studies of male perpetrators in forensic and community settings in that generally violent/antisocial, borderline/dysphoric, and family only/low-psychopathology subtypes of perpetrators were identified in both men and women. This study provides preliminary evidence for the generalizability of typologies derived from nonpsychiatric partner violence perpetrators to psychiatric populations and suggests that typologies derived from studies of male IPV perpetrators may provide useful guidance for the investigation of female IPV perpetration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger problem profiles among partner violent men: Differences in clinical presentation and treatment outcome.

Cluster analysis of 139 partner violent men's self-reports on the State-Trait Anger Expression Inventory identified profiles reflecting pathological anger (PA), low anger control (LAC), and normal anger (NA). The PA group self-reported higher pretreatment partner abuse, interpersonal dysfunction, distress, and substance abuse and had lower treatment attendance than the NA and LAC groups. Collateral (victim) partners reported higher pretreatment abuse by the PA and LAC groups than the NA group. At posttreatment and 6-month follow-up, the PA group had the highest levels of physical assault and injury. The LAC group exceeded the NA group in physical assault at posttreatment and psychological aggression at posttreatment and follow-up. The recognition of distinct anger problem profiles may lead to new strategies for research and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychodynamics of partner, stranger, and generally violent male college students.

Understanding the dynamics of partner violence has been complicated by the fact that "partner violence" may include both partner and generally violent men. The authors hypothesized that partner violence may involve intimacy-related threats to masculinity, violence toward strangers may relate to alcohol abuse, and both partner and stranger violence may relate to object relations pathology. College men were nonviolent or violent toward partners, strangers, or partners and strangers (n?=?10 men in each group). Partner violence was related to higher Schwartz Castration Anxiety Scale scores (B. Schwartz, 1991), from Thematic Apperception Test responses. Stranger violence was related to higher Minnesota Multiphasic Personality Inventory (MMPI-2) and MacAndrew Alcoholism Scale-Revised scores. Neither partner nor stranger violence was related to MMPI-2 anxiety or Westen's Social Cognition and Object Relations Scale (D. Westen, A. Barends, J. Leigh, M. Mendel, & D. Silbert, 1990). The authors discussed implications for understanding the dynamics of partner violence and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in attachment anxiety is associated with improved depression among women with binge eating disorder.

The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychoanalytic group theory and therapy: Essays in honor of Saul Scheidlinger.

Reviews the book, Psychoanalytic group theory and therapy: Essays in honor of Saul Scheidlinger (American Group Psychotherapy Association Monograph 7) edited by Saul Tuttman (1991). This book, which consists of original articles and is dedicated to Saul Scheidlinger and edited by Saul Tuttman, will be of great interest to the practicing analytic group therapist. It can also provide the individual analyst with an excellent overview of the current thinking of some of the leading figures in psychodynamic group therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in clients' attachment styles over the course of time-limited dynamic psychotherapy.

This study utilized a theory-specific measure to examine client relational change over the course of time-limited dynamic psychotherapy in 84 Ss (aged 26–64 yrs). Specifically, this study examined change and stability in clients' attachment style. Categorical and dimensional ratings attachment styles were obtained. Pretreatment and posttreatment measures of attachment styles were then examined in association with Global Assessment Scale (GAS) scores and symptoms. Results show that at posttreatment, a significant number of clients were evaluated as having changed from an insecure to a secure attachment style. Additionally, the sample as a whole demonstrated significant changes toward increased secure attachment. Significant relationships were also found among changes in attachment style, GAS scores, and symptom levels. Implications for psychodynamic/interpersonal psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)