Finding a Common Ground: Therapist Responsiveness to Male Clients Who Have Acted Violently Against Their Female Partner

Abstract

Men in treatment for intimate partner violence (IPV) do often present with problem formulations that do not fit the therapeutic endeavor of personal change and may, therefore, challenge therapists in their effort to build an alliance. However, the therapist’s initial contributions are also likely to influence whether the client finds it worthwhile to become involved in a working alliance. In a qualitative study of the in-session interactions between experienced therapists and men in IPV individual therapy, we looked for variations in therapist responsiveness to the client’s initial invitations to identify whether and, eventually, how the two parties were able to reach common ground for working together. We studied therapist–client interactions in 20 therapy cases, including 10 completed cases with good outcomes and 10 dropout cases. Two sessions during the early phase of the therapy and the final session were audiotaped and transcribed verbatim. The transcriptions were analyzed following the guidelines of constructivist grounded theory. The analysis revealed three interactional patterns: co-creative exploration, pull-avoid repetitions, and tiptoeing softly around, each of which was associated with a distinctive set of therapist strategies. Clients participating in the co-creative pattern appeared to experience the most successful treatment. Our findings suggest that a model of therapist responses to client invitations is valuable for the conceptualization of the therapeutic alliance during the early sessions of psychotherapy. The findings also highlight the importance of clarifying and expanding upon the client’s personal experience with his abuse to form a viable working alliance.

Braving the Elements: Ambivalence as Opportunities for Change in Individual Psychotherapy With Men Using Intimate Partner Violence

“…At the same time, he seeks the therapist’s help to resolve the conflict between the need to see himself as a good person and the desire to recognize and deal with the violence. We understand this as a step toward alliance building by securing a shared understanding of the problem (as described in Lømo et al, 2019), and by contributing to the bond that allows the client to feel secure enough to explore these shameful topics. This could explain why this category of ambivalence was more prevalent in the beginning of therapy, and when clients disclosed new episodes of violence.…”

“…In a clinical context, these utterances can be understood as the client saying: this is where I end and we begin in my work to end this violence. Addressing one’s previous solution strategies can be understood as client engagement and an invitation to co-create agreement on the task of therapy (Lømo et al, 2019). From the therapist’s perspective, Oddli and Rønnestad (2012) describe exploration of the client’s theory of change and his past and current solution strategies as one of the techniques experienced therapists use to strengthen the client’s agency.…”

“…That is, the client might agree that the violence is bad, but may fail to explore the dynamic that causes it to happen in spite of this. This seems to characterize less fruitful client-therapist dynamics (Lømo et al, 2019). When expressing ambivalence to the therapist, the client has the courage to show him or her the conflicts and contradictions he is struggling with in his change work, that are stopping him from changing his violent behavior.…”

“…Examining ambivalence in the context of IPV therapy is advantageous because of both its prominence (it occurs frequently throughout the therapeutic process in our data) and its salience (it is, we argue, an important element of opening for change). Furthermore, it is a context about which there is a grave paucity of process knowledge (Eckhardt et al, 2006; Pandya, 2009), in particular on individual interventions (Murphy and Meis, 2008; Sheehan et al, 2012, though see Lømo et al, 2016, 2019). We argue that our mode of inquiry can provide meaningful insights to the field by providing a “distinctive form of practical knowledge that uniquely captures the complexity of naturally-occurring phenomena” (McLeod, 2013, p. 382; Tebes, 2000; Barlow and Nock, 2009; Dattilio et al, 2010).…”

The Conditions Around Engagement in Interventions Among Perpetrators of Domestic Violence: Literature Review

“…Given key theoretical frameworks around the stages of engagement for offenders, such techniques and approaches are essential in increasing domestic violence abusers' motivation in involving in interventions and taking responsibility process for their violence. For instance, several scholars stated that the facilitators' application of working alliance or building a therapeutic alliance is often useful for the participants' active engagement (Taft et al, 2004;Walling et al, 2012;Boira and Castillo, 2013;Lømo et al, 2019). Similarly, motivational interviewing is identified as critical approach for the men's involvement in as well as completion of the intervention programme (Kistenmacher and Weiss, 2008;Musser et al, 2008;Zalmanowitz et al, 2013).…”