Treatment for men using violence against a partner has for several years been considered an important approach in stopping and preventing violence in intimate relationships. In Norway, Alternative to Violence (ATV) was the very first treatment center, opening in 1987. In the last decade there has been a growing focus on intimate partner violence (IPV). However, there is a general lack of research on men in treatment for IPV in Norway.
There are several theories on the etiology behind IPV and, hence, on how to treat IPV. In this thesis, I have focused on men in psychological treatment for violent behavior at an ATV clinic. Treatment at ATV is primarily targeted towards the men and their individual therapeutic needs. Therefore, the main focus of the thesis has been on the intrapersonal models that describe individual characteristics of men who engage in IPV.
The supreme goal of this thesis has been to expand the knowledge of what characterizes men voluntarily in treatment for IPV at an ATV clinic in terms of traumatic experiences, violent behavior, mental health conditions and what makes them susceptible to dropping out of treatment early. The results of these investigations are presented in three studies.
The first study examined different types of violence reported by the men on entering treatment at ATV. An important goal was to explore whether these men had experienced violence in their families of origin and to explore associations between different types of own violent behavior and the types of violence experienced.
The second study aimed to estimate the prevalence of psychiatric disorders in men attending therapy at ATV, measured by a structured clinical diagnostic interview.
The third study focused on early dropout rates. Furthermore, we sought to explore several potential predictors of early dropout and whether therapist’s experience possibly affects the rate of dropout.
Study one showed that men attending treatment at an ATV clinic appear to use a wide range of violent behaviors. More specifically: most men reported having used different types of physical, psychological and property violence while a few men reported the use of sexual violence. Eight out of ten men reported using more than three different types of violence. The majority reported having experienced some type of violence in their families of origin and those who had childhood experiences of violence reported more use of violence.
Results from study two showed that most of the men struggle with extensive psychiatric symptomatology. As many as seven out of ten men fulfilled the diagnostic criteria for at least one current psychiatric disorder. Approximately four out of ten fulfilled the criteria for an anxiety disorder. The same prevalence was found for depressive disorder and alcohol/substance abuse disorder. Comorbidity was high, with nearly half of the men assigned two or more diagnoses.
Study three indicated that some men are particularly vulnerable to dropping out of treatment at an early stage. Nearly one in four men dropped out of treatment before the fourth session. Men with a non-Norwegian ethnic background, young men, men without prior experiences of mental health care and men counseled by a student therapist were particularly vulnerable to dropping out of treatment.
Together these studies show that men in treatment at ATV present a broad spectrum of difficulties. First of all, the majority reported substantial use of psychologically controlling violence, which along with physical violence may indicate more severe relational problems.
Furthermore, in addition to their violent behavior, the majority seem to struggle with substantial psychopathology. This suggests a need for further development of therapeutic interventions such as routinely screening for trauma history, possible long-term effects of childhood exposure and psychiatric disorders, addressing dropout issues in treatment and implementation of culturally sensitive or culturally focused counseling for ethnic minorities.
Our findings also have implications for the providers of IPV treatment. Many men attending treatment at ATV seem to display characteristics which may call for substantial psychotherapeutic treatment. This may require treatment providers with extensive training according to the therapeutic needs of the individual man in treatment.