GROUP TREATMENT OF SITUATIONAL DOMESTIC VIOLENCE FOR LOWER-INCOME COUPLES

1. GROUP TREATMENT OF SITUATIONAL DOMESTIC VIOLENCE FOR LOWER-INCOME COUPLES John & Julie Gottman The Gottman Institute The Relationship Research Institute

2. WHAT PERCENT OF WOMEN HAVE EXPERIENCED DOMESTIC VIOLENCE? (UNESCO REPORT) • USA 28% • CANADA 29% • EGYPT 35% • JAPAN 59% • KOREA 38% • NEW ZEALAND 20% • SWITZERLAND 20% • UK 25% • CHILE 26% • KENYA 42% • MEXICO 30% • NICARAGUA 52% • POLAND 60% • UGANDA 41% • ZIMBABWE 32%

3. Domestic Violence a Major Problem Throughout the World • According to a UNICEF survey, the percentage of women aged 15–49 who think that a husband is justified in hitting or beating his wife is: • 90% in Jordan, • 85.6% in Guinea, • 85.4% in Zambia, • 85% in Sierra Leone, • 81.2% in Laos, • 81% in Ethiopia.

4. DOMESTIC VIOLENCE AND BABIES • According to the Centers for Disease Control, every year in the United States more than 300,000 pregnant women experience some kind of violence involving an intimate partner. • Almost a third of domestic violence cases start during pregnancy. • Women who are already in abusive relationships often report that abuse gets worse when they are pregnant. • Pregnant women who are abused are more likely to experience serious pregnancy complications, such as miscarriage, high blood pressure and premature birth.

5. DOMESTIC VIOLENCE AND BABIES (CONT.) • Pregnant women who experience domestic violence are also more likely to have a baby who is stillborn. Blows to the tummy, pregnancy complications • Between 2006 and 2008, domestic abuse was reported in 12 per cent of maternal deaths. • In UK one in four babies at high risk of infant abuse due to being born into homes where domestic violence is present.

6. RESEARCH FROM OUR LAB:
HOW A BABY AFFECTS A RELATIONSHIP • WORK WITH MIDDLE-CLASS COUPLES • Increase in domestic violence • Dramatic increase in hostility between parents (OBSERVED ON VIDEO) • 67% drop in relationship satisfaction of parents • Dramatic increase in symptoms of post-partum depression: 50-70% moms had post-partum depression symptoms • Compromised parenting due to conflict between parents • This conflict transfers to the baby (Alyson Shapiro’s work) • Problems in infant emotional development: babies at risk for developing physical health, mental health and behavioral problems. • Problems in infant cognitive development: babies of depressed moms show same changes in brain wave patterns as their moms. Later, baby has problems focusing attention in school.

7. RESEARCH WITH LOWER-INCOME COUPLES • THE FRAGILE FAMILIES STUDY 16 CITIES: For 82% “unwed mothers,” father of baby is romantically involved with the mother at time of baby’s birth. • But 85% of these couples have split up by time when baby is 1-year old, and dads have left. • These couples want to stay together but lack skills to do so. • Desire to work on relationship is strongest when couples are becoming parents. • Over 200 studies show that what keeps fathers in families with babies is minimal conflict and warm and intimate relationship with their babies’ mother. • High co-morbidities: Infidelity, alcohol & drug abuse, violence, prior incarceration.

8. IMPACT OF FATHERS’ ABSENCE • Children likely to be raised in poverty • Children have higher drop-out rates • Children more likely to become teen parents • Children more likely to engage in criminal and risk-taking behavior • Children have difficulty maintaining employment as young adults

9. TWO ENTIRELY BIASED LITERATURES EXIST ON DOMESTIC VIOLENCE (DV) • Michael Johnson: There are two very biased “literatures” on family violence • 1. Family survey research elicits primarily situational domestic violence: Arguments that have gone out of control. Problem here: 40% of families hang up when telephoned in these surveys. We are getting a biased sample. • 2. Women’s shelters: Elicit primarily characterological batterers. Problem here: No research base for this work. We are getting a biased sample.

10. THERE ARE 2 TYPES OF DOMESTIC VIOLENCE: “SITUATIONAL” AND “CHARACTEROLOGICAL”

11. CHARACTEROLOGICAL VIOLENCE • Asymmetrical with a clear perpetrator and victim. • Controlling and dominating behavior, or belligerence. • Perpetrators show little remorse. • Perpetrators attribute blame to victim. They tend to think verbal hostility justifies physical retaliation. • Victim fears perpetrator. • TWO TYPES: Pit Bulls or Cobras (Gottman & Jacobson) • Cobras exhibit similar behaviors outside the family. • Victim has no control over perpetrator. • Shelter victims mostly fit into this category. • Show films of Pit Bull and Cobra.

12. SITUATIONAL VIOLENCE IS DIFFERENT THAN CHARACRTEROLOGICAL • Violence is reciprocal - No clear perpetrator or victim. • Does not involve control or dominance. • Those involved show remorse, understand its impact, and internalize not externalize blame. • Often arises from conflict that has escalated out of control. • Does not escalate to characterological domestic violence (Jacobson & Gottman study) • No fear.

13. JACOBSON & GOTTMAN STUDY SHOWED THAT SITUATIONAL DOMESTIC VIOLENCE IS REAL • 9-year longitudinal study • Had 4 groups: (1) Happy non-violent, (2) Unhappy non-violent, (3) Situational DV, (3) Characterological DV (male perpetrators only). • IN 9 YEARS no situational DV COUPLE escalated to characterological or more serious DV. The 2 groups remained distinct. • Discovered two types of characterological DV perpetrators: “Pit Bulls” and “Cobras” • CONCLUSION: Situational violence may occur with couples who lack conflict resolution skills, or extreme physiological reactivity.

14. COUPLES WHO ARE IN COUPLE’S THERAPY • O’Leary study found that 67% of all couples in couples’ therapy have been violent with one another. • Yet most couples therapists do not assess for domestic violence. This is a huge mistake. • Most of these violent couples are probably situationally violent, not characterologically violent.

15. HISTORY OF TREATMENT FOR DOMESTIC VIOLENCE • Social service programs mostly do not distinguish between the two types of DV. • Julia Babcock’s meta-analysis. Effect sizes .01 and .12, that is essentially nonexistent. All male group interventions have no effect beyond what is achieved by arrest alone. • Yet these treatments are mandated by law in many states in USA. Couples’ treatment is mostly illegal! • The fear is that couples’ treatment blames the woman. • Yet in situational DV women do throw first punch or object 71% of time (Dutton, 1995). Women can indeed be violent. DV not uncommon among lesbians. Bullying in middle and high school – female aggression now very well documented.

16. OUR THEORY ABOUT SITUATIONAL DOMESTIC VIOLENCE • TWO PARTS • 1. The lack of social skills in dealing with conflict is a central part of situational domestic violence. • 2. Diffuse physiological arousal (DPA) plays a major role in the escalation of conflict toward physical violence. DPA creates dysregulation in negative emotions.

17. EVIDENCE OF SKILLS DEFICITS IN DV • Substantial evidence now exists that dysfunctional relationship conflict plays a role in DV. • Sample of 11,870 randomly selected military personnel, marital discord best predictor of DV. For every 20% increase in discord odds of milder DV increased 102% and severe DV by 183%. (Pan, Nelding, & O’Leary, 1994) • Compared to unhappy nonviolent couples, DV couples reciprocate and escalate negative affect more, are more hostile, don’t exit negative sequences as easily, or as fast, have no exit withdrawal ritual, reject influence from women, reverse demand-withdraw patterns, show more belligerence, less empathy, less positive affect, more domineering, defensiveness, disgust, anger, contempt, and tension.

18. WHAT PROPORTION OF DV IS SITUATIONAL VERSUS CHARACTEROLOGICAL? • The answer in the Jacobson-Gottman study was that 80% of DV is situational, 20% is characterological. Estimates range between 50 and 80% situational DV. • Police reports bear these 80/20 % estimates out. • Characterological incidents get all the media attention, so we think it is the most common form of DV. It’s not. Victims show up in shelters. • Note: in most states in the Union, a couples’ treatment is against the law after a domestic violence incident.

19. IN TREATMENT, CAN WE SCREEN OUT CHARACTEROLOGICAL DV? • Yes, we can: Our lab developed an effective screening tool for screening out characterological perpetrators. Three criteria: • Amount and type of violence – use CTS2 • Fear of Partner • Social Control of Partner • The Intimate Justice Scale does almost as well as our scale, except for an under-reporting of situational DV by women on that scale.

20. GOTTMAN ET AL DOMESTIC VIOLENCE SCREENING PROCEDURE September 21, 2005 SEVERITY SCREEN (CTS2, 19 items) No DV Incidents (Score of zero on all items) “Minor” Violence in past 6 months (Score of 1-6 on any Minor Items (#1,2, 4-6) Severe Violence, Not in past 6 months (Score of “7” on any Severe items #3, 7-19) Severe Violence in past 6 months (Scores of 1-6 on Severe items #3, 7-19) SCREEN FOR CHARACTER VIOLENCE SCREEN FOR CHARACTER VIOLENCE EXCLUDE SCREEN FOR CHARACTEROLOGICAL VIOLENCE (7 items) 2 or Fewer Yes Responses 3 or More Yes Responses SCREEN FOR FEAR OF PARTNER EXCLUDE SCREEN FOR FEAR OF PARTNER (3 Items)

21. COUPLES TREATMENT FOR DOMESTIC VIOLENCE? • Couples interventions are criticized for placing women at increased risk, and implying that the victim is partially to blame. • Most states mandate NO COUPLES’ TREATMENT FOR DV (Babcock, Green, & Robie 2004) • Many agencies refuse to recognize that SITUATIONAL DV exists at all. Will not cooperate with research. This is a very highly politicized field, controlled by “advocates,” the former victims of characterological perpetrators, i.e., shelter staff. • Yet a small study by Stith et al. (2004) showed promising results: a group intervention for couples experiencing only situational DV was effective at nearly eliminating recidivism of violence and improving relationship satisfaction, with no increase in risk at 1 year.

22. STITH, ROSEN, & MCCOLLUM: GROUP COUPLES TREATMENT FOR DV STUDY • Screened out characterological batterers, but di not do so systematically. So hard to replicate screening methods. • Stith and McClollum used a solution-focused treatment, both couples’ group, and couple therapy. Only couples’ group treatment effective. • Findings: Male recidivism rates were lower for experimental (25%) than comparison (67%), significant in reducing partner violence. • Either a couples’ group or just usual couples’ therapy equally effective.

23. PROBLEMS WITH THE STITH-MCCOLLUM STUDY • It is a landmark study, and we are grateful for its existence. • Yet, only 1/3 of their couples were lower-income. • Small samples were used. • No clear screening tool. • No randomization. • Intervention was not skill-based. • No recognition of the role of physiological arousal in violence. • Their “solution-focused” intervention consisted of: (1) purposelynot focusing on couples’ emotions (we don’t understand why), (2) telling couples that no violence would be permitted, that it was wrong, and (3) telling people that they already knew how to end their violence. • Procedures seemed confusing, even to some clients they quote, methods seem imprecise, and hard to duplicate or disseminate to others. • Hence, the intervention may behard to replicate.

24. BACK TO BABIES: RANDOMIZED CLINICAL TRIALS:
WEEKEND PSYCHO-EDUCATIONAL INTERVENTION WITH MIDDLE-CLASS COUPLES
 • John & Julie Gottman’s book “And Baby Makes Three” • Bringing Baby Home program (see www.gottman.com) • Reversed the drop in relationship satisfaction. • Reduced hostility between parents. • Reduced incidence of post-partum depression in mothers from 62.5% to 23.5%. • Dramatically increased father involvement. Dramatically increased father’s positive feelings towards baby. • Increased father’s cooperation with mother. • Improved baby’s emotional and cognitive development at 1-year follow-up.

25. OUR CHALLENGES • Lower-income people probably didn’t have a great experience with school. • Presentation method needed to be exciting and involving. • Didn’t want our program to feel like a classroom, where participants might feel lectured to and judged.

26. WITH LOWER-INCOME PEOPLE WE NEEDED TO SOLVE A PROBLEM • Needed to make program structured and didacticso it was replicable by others • Teach information and skills needed to succeed as a couple and family. • Allow for spontaneity. • Foster respect, counteract shame and disrespect expected from authority figuresby lower-income people. • Give couples sense of pride in making it as family. • Create community for couples to connect with each other. • To prevent attrition, couples needed to come to meetings for each other, not just to hear facilitators.

27. WE DEVELOPED A COUPLES’ “CURRICULUM,” WITH A CHILD FOCUS AS WELL • We designed 42 modules on specific issues. Talk-show videos begin each module. • Structured skill training and information. • But couples group is the center of intervention. • Mathematica and MDRC conducted randomized clinical trial in 7 states. • “CURRICULUM” program most effective with African-American couples • “CURRICULUM” program more effective with married couples. • “CURRICULUM” program later extended to include foster parents.

28. ADAPTED “CURRICULUM” TO “COUPLES TOGETHER AGAINST VIOLENCE” CURRICULUM • “CURRICULUM” topics adopted to focus more heavily on conflict management. • Included methods for managing emotional flooding through physiological soothing. • Rituals developed for withdrawing from escalating conflict. • Included mechanisms for ensuring safety • Useful for broader population of couples with children.

29. FOCUS OF RESEARCH • Formally test a screening instrument for distinguishing between types of violence. • Target couples who are experiencing low levels of situational violence. • Include special emphasis on skills for reducing violence. • Analyze whether reduced situational violence leads to healthier marriage and responsible fatherhood. • Intervention named “Couples Together Against Violence,” or CTAV

30. RESEARCH APPROACH • Longitudinal randomized clinical trial comparing CTAV intervention to no-treatment control group. • Couples screened carefully to rule out characterological violence using our screening instrument. • Eligibility based on female partner’s report of violence, and Personality Assessment Inventory. Screened out antisocial personality disorder and alcohol-drug addiction. • Low level situational violence couples in both groups. • In addition, telephone interview plus in-home assessment. • Randomly assigned to treatment or control groups, 96 couples in each.

31. EVALUATION METHOD • Baseline assessment. • Three follow-up assessments at 6, 12, and 24 months post-randomization. HOME VISITS. • Assessment include 15 minute video-taped conflict discussion while physiological data measured. • Videotapes coded with Gottman SPAFF system. • Physiological measures and observational leave more room for sensitive measures of change. • Police records used as well as self-report on DV. • Control group given information on safety and DV.

32. OUR “MODULE” CONCEPT • Couples meet together in small groups with up to 6 couples and 2 facilitators per group. • Each group meeting covers 1 module. Same group meets together throughout curriculum to create community. • Every module starts with 15-minute video of talk show on that week’s topic. • Then information given in understandable language. • Then skill-building exercise is conducted to teach couples skills of successful relationship. Exercises may be fun or may facilitate deeper connection with partner and/or group.

33. CTAV VIDEOS • Talk show videos stars are couples from lower-income populations from Atlanta, Baltimore and Seattle. • Julie Gottman was the “Oprah” for this study • Couples discuss topics like preventing harmful fights, avoiding domestic violence, healing from infidelity, building friendship and intimacy, and creating positive legacies for their children.

34. MODULES CREATE COMMUNITY AND LEARNING • Talk show videos help couples feel less alone with their struggles and triumphs, and lead to self-disclosure. • Group discussions weave couples together into supportive communities. • Information is provided in straightforward, clear language. • Exercises teach skills while deepening connections between partners. • Before every exercise couples use Emwave, biofeedback device that helps teach physiological self-soothing. • Show collage video.

35. CTAV HAS FIVE CONTENT AREAS:22 MODULES • Preserving Intimacy • Managing Conflict • Creating Shared Meaning • Managing Stress • Fathers, Marriage, and Parenting

36. CTAV INTIMACY: CORE MODULES • Stay Close • Have Close Conversations • Express Needs • Turn Toward, Not Away • Magnify and Savor Positive Emotions • Building a Culture of Respect and Appreciation • Build Passion and Good Sex • Heal Old Wounds, including 1) Feeling Proud of Ourselves, and 2) I am my Family’s Protector • Prevent and Recover from Infidelity

37. EXAMPLE: HEAL OLD WOUNDS • One woman described to her partner her story from when she was 6-years old. • Drug-addicted and violent father cut hole in her bedroom window, caught and kidnapped her. • The woman’s partner understood for first time why his partner was so controlling of him now she’d felt so out of control of her life back then.

38. EXAMPLE: PREVENT AND RECOVER FROM INFIDELITY • After this module, one gentleman reported he’d gone out with guy friends to a club. • In past, he might have messed around, which was their pattern. • This time in club, he broke out in cold sweat. He realized he needed to go home. • This wasn’t the life he wanted anymore. • To group he said, I’m with her for life. If they’re against that, they’re against me, and I’ll build a wall between them and my girl and me.

39. CTAV MANAGING CONFLICT: CORE MODULES • Prevent Harmful Fights • Compromise • Self-Soothe, including Em-Wave Biofeedback Training • Manage Anger (Your Own and Others’) • Have Recovery Conversations After A Fight • Know When Endless Fights Turn Harmful • Avoid And Heal Violence 1- Recognize when you are Heating Up • Avoid and Heal Violence 2 - Avoiding Domestic Violence is Everyone’s Responsibility

40. CTAV MANAGE CONFLICT (CONTINUED) • Know When Endless Fights Turn Harmful • Edit Out Negativity and Accept Influence

41. PREVENT & RECOVER FROM VIOLENCE • Couples first watch video, then discuss it. Self-disclosure & Group building follows. • Couples next hear information • Then couples learn one skill for how to bring up a problem with Softened Startup • First they get into “the Green Zone” with emwave biofeedback instruments. • Then they do the Softened Startup exercise

42. SESSION EXAMPLE • In one group, couples focused on “Reaching your boiling point.” A ritual for withdrawing from one another. • Jacobson & Gottman had reported that violent couples had no methods of withdrawing from one another as conflict escalated. • The next week, one couple reported that they’d had frequent PAST episodes of domestic violence. • This week they’d had another bad fight. • This time, however, husband locked himself in bathroom while his wife called a support worker. • Very proud that they’d avoided violence for 1st time.

43. CTAV SHARED MEANING: CORE MODULES • Honor Your Partner’s Dreams･ • Connect Emotionally – Create Rituals of Connection

44. CTAV MANAGE STRESS: CORE MODULE • Practice Self-Care - The Consequences of Triumphs and Setbacks • Have Stress-Reducing Conversations • Example: One woman confessed that she’d had thoughts of wanting to throw her baby against wall. She felt hopeless, ashamed and despairing. Because of trust in group, she told the group - PPD. Group empathized with her, immediately recognized she needed support. Now she is getting help and reports that these thoughts and impulses have subsided.

45. FATHERS, MARRIAGE, AND PARENTING: CORE MODULES • Heal Old Wounds - I am my family’s protector Example: Dads are reporting that they are loving being with their babies and with their babies’ moms. They are proud of how different they are from their own dads. • Most have never had fathers in their lives. One father who had been incarcerated for 7 years before becoming a dad said, Being a husband and father gives me a reason to live. I never had one before now. • Stay Close - Taking time to know our partners and our children • Practice Emotion Coaching as parents

46. TWO-STAGE SCREENING • Telephone screening instrument – shown to be effective. Female partner screened alone. • In home assessment before assignment people fill out the Personality Assessment Inventory measuring 11 DSM diagnoses. • The initial IPV scores for our sample were very low. • Screened out antisocial personality disorder. • Alcohol and drug problems were also screened out. • Safety continuously monitored throughout study, with referrals if needed. • Home visits at 4 time points as well. Checks self report about DV against interview.

47. RESULTS – THE COUPLES’ RELATIONSHIP (SELF REPORTS) • Treatment couples showed significantly higherrelationship satisfaction and lower conflict than control couples. • EFFECTS LASTED ON 18-month FOLLOW UP. • There were significant improvements in self-reports of Friendship and Shared Meaning for experimental couples, and through these a greater parenting alliance was created in the experimental group.

48. RESULTS – PHYSIOLOGICAL AROUSAL DURING CONFLICT DISCUSSIONS Males became more successful in their ability to physiologically self soothe during conflict discussions. WHILE, control group males showed significantly greater heart rate reactivity over time.

49. RESULTS – DOMESTIC VIOLENCE • IPV was reduced over time in the treatment group, but only mediated through the increased use of relational skills, whereas no such changes occurred in control couples. • Couples who did not improve on the relationship skills did not change on IPV as a result of treatment. • Who were the couples who changed?

50. SELF-REPORT ON IPV • Self report of IPV: No differences, but it was A FLOOR EFFECT BECAUSE • THERE WERE SIGNIFICANT DIFFERENCES ON DOMESTIC VIOLENCE BASED ON POLICE RECORDS.