What is the purpose of this study?
This study addresses the question: What is the safest and most effective treatment of wife abuse? Currently, Gender-Specific Treatment (GST) is the dominant approach to treating domestic violence. GST works separately with abusers and victims in same sex groups. Conjoint treatment, or couples therapy, is another treatment approach. Controversy exists about the safety of treating abusive partners together as a couple because of the fear that topics discussed in therapy could precipitate violence after a session. Most outcomes research on the efficacy of domestic violence treatment is based on court-mandated male-perpetrator samples consisting largely of men who are not in intact intimate relationships. In contrast, this study investigates domestic violence treatments among intact, self-referring couples. It compares the effectiveness of GST with that of a conjoint approach, Physically Aggressive Couples Treatment (PACT), on reducing marital violence among married couples experiencing male-on-female violence.

How was the study conducted?

Subjects

Subjects were drawn from a primarily white, middle-class suburban Long Island, NY, community. Newspaper ads announcing free treatment for couples, whose "arguments led to throwing, pushing, shoving, etc.," solicited study participation. Of the many couples who responded to the ad, 75 couples met criteria to participate in the study and were randomly assigned to receive either GST or PACT. All participants had experienced at least two acts of husband-to-wife aggression that did not cause injuries requiring medical attention in the year prior to participating in the study.

Safety considerations

Because of safety concerns, wives participating in the study were interviewed briefly in private by researchers and asked if they would be comfortable with couples' treatment; all were. Also, none reported being afraid of living with her husband. Throughout the study, researchers administered a brief questionnaire before each treatment session to assess physical or psychological aggression that might have resulted from topics discussed in a previous therapy session.

Treatment protocols

Both GST and PACT consisted of 14 two-hour sessions and were conducted as group therapy. Women's GST groups had six to eight participants plus a female therapist. Men's GST groups were similarly composed. PACT groups consisted of six to eight couples plus a male-female therapy team per group. To ensure that treatment conditions adhered to the different theoretical models for GST and PACT, therapists followed detailed, session-by-session treatment outlines.

Assessment and follow-up

Before treatment, immediately after treatment and at one year posttreatment, subjects completed a packet of self-report surveys that explored characteristics of their marital violence and subjects' responses to the violence. Standardized measures assessed psychological and physical abuse, husbands' behaviors that involved dominance or attempts to isolate his wife from others, victims' fearfulness, spouses' appraisal of blame and causality of the marital violence, depression, degree of marital satisfaction, deficits in verbal skill at resolving conflict, and overall psychological well-being. Researchers also developed two questionnaires for the study: one asked about incidents of violence precipitated by treatment and participants' fearfulness resulting from treatment; the other assessed consumer satisfaction with treatment. Subjects' responses to these surveys were analyzed and the effectiveness of GST versus PACT for reducing marital violence and improving marital satisfaction was statistically evaluated.

How did GST and PACT differ in the way they addressed domestic violence with couples in this treatment study?
The primary, theoretical difference between GST and PACT is in the attribution of responsibility for domestic violence. Both treatment approaches share techniques, but reasons behind these techniques differ. According to GST, aggression is the responsibility of the aggressor. Therefore GST treatment goals focus on getting the men to change controlling/aggressive behaviors. PACT, on the other hand, addresses the interactional aspects of conflict in relationships; PACT treatment goals focus on improving mutual communication.

What are the study's findings?
There was no significant difference between treatments when comparing effectiveness in reducing marital violence.

Reducing marital violence

Both GST and PACT couples who completed treatment reported a significant decrease in marital aggression and violence during treatment, at posttreatment and at the one-year follow-up.

1. 39% of husbands completely ceased physical aggression during treatment.
2. 26% of husbands did not use any mild or severely violent aggression against their wives in the year following treatment.
3. Whereas only 23% of husbands were not severely abusive in the year prior to receiving treatment, during the year posttreatment 66% of husbands refrained from being severely abusive towards their wives.

Improving marital relationships

Significant improvements in marital satisfaction were reported as a result of treatment, regardless of treatment method.

1. Over 53% of husbands reported reduced marital distress posttreatment; over 58% of wives reported similar improvement.
2. Among GST couples, husbands' reduced use of dominance/isolation behaviors towards wives was associated with wives' reports of less marital conflict.
3. PACT couples' reports of improved mutual communication were associated with wives' reports of reduced marital conflict.

   Treatment shortfalls

1. Neither treatment achieved the program's primary goal of eliminating marital violence from the home. Approximately 75% of husbands in the study used physical aggression against their wives in the year following treatment; one-third of husbands committed acts of severe aggression.
2. Forty-seven percent of subjects dropped out before completing treatment. This dropout rate is similar to that of most other batterer treatment programs in the U.S. and represents a serious problem in domestic violence intervention programs.

Reviewed by Priscilla Schulz, February 2000