JOINING FORCES

Joining Families

Volume 18, Issue 6 • Fall 2021

R E A L W O R L D R E S E A R C H F O R F A M I LY A D V O C A C Y P R O G R A M S
F E AT U R E D I N T E R V I E W

Learning About the Treatment of Intimate Partner
Violence Perpetration
Christopher M. Murphy, PhD
Dr. Murphy is Professor of Psychology at the
University of Maryland, Baltimore County. He
earned a BA in Psychology from the University of New Hampshire, and a PhD in ClinicalPsychology from Stony Brook University. His
research focuses on the efficacy of cognitivebehavioral, motivational, trauma-informed, andIn This Issue

The focus of this issue of JFJF is on the clinical treatment of perpetratorsof intimate partner violence (IPV). In our highlighted interview, Chris Murphy,
Professor of Psychology at the University of Maryland, Baltimore County, anda subject matter expert on this topic, shares his experiences on the origins anddevelopment of IPV perpetrator treatment. A key part of Dr. Murphy’s approach
to treatment is the recognition of the importance of trauma-informed care (TIC).
Both perpetrators and victims of IPV can have a history of significant traumatic
events that affect many aspects of their lives. As background to Dr. Murphy’sinterview, we describe TIC as it has developed in assisting children and adults
with a history of traumatic experiences. Our statistics article, Building Bridges to
Research, describes the concept of validity as it applies to the development of
two instruments that Dr. Murphy noted are used in clinical practice: the Spousal
Assault Risk Assessment Guide (SARA) and the Danger Assessment (DA).
The SARA estimates the risk of spousal aggression; the DA estimates the riskof femicide. Why is it important to discuss the validity of these instruments?
They are used to estimate risk. The user of these instruments should haveknowledge of how they were developed and how much confidence to have inthe results of their use. Finally, our Websites of Interest page presents resources
for information about trauma, trauma and violence, trauma-informed care, andunderstanding trauma in children.

Contents
Learning About the Treatment of Intimate Partner Violence Perpetration.....1
Trauma-Informed Care and Its Role in the Treatment of Intimate Partner
Violence Perpetrators...................................................................................8
Validity in Measures of the Risk of Intimate Partner Violence — “Do the
Measures Measure What They Say They Measure? For Whom?”..............10
Websites of Interest...................................................................................12comprehensive interventions for individuals who
engage in intimate partner violence; the identification of personal, contextual, and intervention factors that facilitate and inhibit treatment
response in this population, and the preventionof intimate partner abuse and sexual assault in
emerging adulthood. Dr. Murphy has publishedover 100 peer reviewed articles and his researchhas been supported by the National Institutesof Health, the U.S. Office of Violence Against
Women, and various state and local agencies andprivate foundations. Dr. Murphy was the recipient of the 2015 Linda Saltzman Memorial Intimate Partner Violence Researcher Award fromthe Institute on Violence, Abuse, and Trauma.

Dr. McCarroll: Intimate partner violence(IPV) is a worldwide public health problem.
Interventions to reduce abuse and violence
require the effective treatment of perpetratorsand victims. As a clinical psychologist,
you have invested many years in treating
perpetrators of IPV. How have you seen
treatment for IPV perpetrators change over theyears?
Dr. Murphy: Domestic violence intervention programs date back to the late 1970s. The
original programs were mostly run by men’scollectives that were connected in some way tothe battered women’s movement of the 1960s
and 70s and had an explicitly pro-feminist perspective. This approach was based on the theory
Continued on page 2

Interview with Christopher
M. Murphy Ph.D., frompage 1

We work with acognitive-behavioral
approach, whichmeans that weassumed that abuseand violence arelearned behaviors andthat clients can learn
more constructive
ways to deal with
their feelings andchange the way
they interact withrelationship partners.

that IPV is primarily a gender-based problem
where men use various controlling tactics andphysical abuse and that these acts are supported by a society that made it acceptable andunlikely that men would be held responsible
and punished for engaging in abuse. That philosophy is still at the core of a lot of the work in
the field. Some of those programs for IPV perpetrators were actually started at the request of
women’s organizations who had set up shelters and safe houses for battered women andwanted some place that the abusive partners
could go and talk about what was happening,
to have them resocialized to not be controlling
and abusive. There have been other changes
over time as well. Now, women, gay men andlesbian women, and gender-diverse individuals
are also referred to our programs.
Another aspect of the early work was theview that the people who engaged in abusive
behavior need to be held accountable. Providers were encouraged to confront abusive
clients and to point out all the ways they were
controlling and all the ways they engaged in
victim blaming. In my opinion these recommendations make it difficult for providers toestablish a connection and rapport with theabusive client. Without that kind of trust andrelationship, it is very hard to promote change.
Part of what has happened over the years isthat providers have realized that they need tohave a softer way of confronting. They need

JOINING FORCES
Joining Families
Joining Forces Joining
Families is a publication of
the Center for the Study ofTraumatic Stress (CSTS)
and the Family Advocacy
Program, Office of the Army
Deputy Chief of Staff, G-9.
The CSTS is part of the
Department of Psychiatry,
Uniformed Services
University (USU), Bethesda,
MD 20814. USU is themilitary medical school.

EditorRonald J. Whalen, PhD, LMSW
Research Assistant Professor
Department of Psychiatry, USU
e-mail to ronald.whalen.ctr@usuhs.edu(301) 319-8003
Editorial Consultants
Joshua C. Morganstein, MD
Captain, US Public Health Service
Assistant Director, CSTS
Associate Professor and Assistant Chair
Department of Psychiatry, USU
James E. McCarroll, PhD, MPH
Research Professor
Department of Psychiatry, USU
Assistants to the Editors
Alexandra Burris, BA
Britany Mullins-Husain, BA

2 • Joining Forces/Joining Families

to use empathy and understand that a lot of
the clients that they work with have trauma
histories themselves and were abused as
children. An empathic stance is used to build
the connection, which then helps motivate aperson to want to change their behavior. This is
an important part of the work. We cannot justpoint our fingers and tell our clients that they
are controlling and behave in bad ways. Thatkind of shaming is rarely valuable or productive even though we still believe that societyneeds to hold abusive individuals accountable.
Finding that balance between confronting the
problem and building rapport and an allianceis one of the core challenges of this work.
Dr. McCarroll: What is the approach of
the programs that you conducted and yourresearch?
Dr. Murphy: For about 25 years, I directed
a community-based IPV intervention program in Howard County, Maryland, which
is a diverse suburban county between Baltimore and Washington, DC. These programs
are commonly called batterer programs, but I
generally do not use that term because I feel
it is ambiguous and stigmatizing. We use theterm abuse intervention programs. About 85%of our cases were court-referred. We would get
80 to 100 referrals per year. About 10-15% wereself-referred and the rest came from various
court-referrals, some from probation, somefrom deferred prosecution, and some from civil
court proceedings. We had a smaller program
for women; a larger program for men.
There is a lot of variation in the frequency
and severity of the abuse and violence. We
would see people across this spectrum. Someof them had been physically violent very
infrequently or only once, while some had
been frequently and severely violent withmultiple relationship partners. We also hadclients referred for being emotionally abusive.
Some had never been physically assaultive with
their relationship partners, but had done otherthings such as destroying property, harassment,
stalking or unwanted pursuits after breaking
up. These are problem behaviors that are also
very disturbing to the victim.
We worked in gender-specific groups witha cognitive-behavioral approach, which meansthat we assumed that abuse and violence arelearned behaviors and that clients can learn
Continued on p. 3
Fall 2021

Interview with Christopher
M. Murphy Ph.D., frompage 2

At one point, we ran
both closed-ended
and open-endedgroups. There arepluses and minuseswith both of theseapproaches. With
closed-endedgroups, people
tended to build moreconnection andrapport. With the
open-ended groups,
the more experienced
members can help
the less experienced
members. A lot of theclients that we workwith listen to one
another more than tothe counselors.

more constructive ways to deal with their
feelings and change the way they interact withrelationship partners. The vast majority of ourclients would go into group treatment, but we
did have options. We could provide individual
counseling if we thought they would benefit
more from that or if they had a mental healthproblem or other characteristics that would
not make them a good group candidate. Somepeople might have issues that they would not
feel comfortable talking about in group, suchas a sexual abuse history, or they might havesignificant emotional conditions like mood disorders, bipolar disorder, or psychotic thoughtprocesses.
We had weekly two-hour sessions. At one
point, we ran our programs with closed-endedgroups and then shifted to open-ended groups
with ongoing enrollment. There are pluses andminuses with both of those approaches. With
closed-ended groups, people tended to build
more connection and rapport because they are
working with the same group of peers for thewhole time. With the open-ended groups, themore experienced members can help the lessexperienced members. These groups are, in myopinion, the best way to do the work because
a lot of the clients that we work with listen to
one another more than to the counselors. They
have many different reasons as to why theymight not trust the counselors or facilitators.
If the facilitators are skillful, they can create an
atmosphere where there is open dialogue andencouragement of one another.
We did a small study comparing one-onone therapy to group therapy. Both were basedon a cognitive-behavioral model. We originally had the idea that the one-on-one therapy
might be more effective because you can tailor
what you are doing to the individual and their
specific problems and needs. We found noevidence that the individual work was more effective and, in some scenarios, the groups had
better outcomes.
Dr. McCarroll: Can you describe a typicalsession?
Dr. Murphy: Our program had a balance ofstructured and unstructured time. Each week
we would review some of the things that theindividuals were asked to work on. We would
have some focus topic for the group. It could beanger cues, anger triggers, stress management,
communication skills, listening, problemsolving, respect, and other similar issues. We

http://www.CSTSonline.org

would typically have discussion, role plays, orvignettes with scenarios that we asked them toconsider. Next, we would typically have 45 minutes to an hour for more of a process-oriented
group experience in which people would help
one another. Sometimes that would focus on
one or two people and things they were struggling with. At other times, we would focus oncommon themes or common challenges thatmany people were having. The unstructured
open-ended format gave people the opportunity to talk and bond and help one another, which
may be more important than the structured
cognitive-behavioral training. If they cannot
make it relevant to their own situation, then theother things that we had for them to work on
and learn are not going to be effective. Whenpeople give advice, they are more likely to takeit. Sometimes it is easier to analyze and think
about someone else’s situation than your own.
When they see someone else’s situation or theysee some things that they know are wrong, it
makes it easier for them to start applying thesame ideas and principals to their own situationand in this way begin handling things differently.
Dr. McCarroll: You have described twointeresting techniques you have used: first,
the perception of whether the effects of their
violence were positive or negative or helpful
or not helpful, and then, secondly, theirlong-term expectancies of the effects of their
violence.
Dr. Murphy: We have developed a measureof these positive and negative expectancies,
sometimes called the pros and cons of engaging
in abusive behavior: what are you getting out of
this; what is this costing you (Miles-McLean,
LaMotte, & Murphy, 2021). We would administer a questionnaire during the intake process
and then use their responses to help stimulatea discussion about change. For example, if
someone says, “The only way to get your point
across is to yell or shout,” or “Sometimes, youhave to intimidate people.” We would use their
responses to these sorts of items to say, “Yousaid you believe this. Can we talk more about
that?” Or you said, “If you are abusive toward
your partner, she is going to leave you.” You also
said that “If you are abusive toward your partner, you are going to end up in jail.” They mightendorse many of these kinds of statements,
which helps to stimulate a discussion about
Continued on p.4
Joining Forces/Joining Families • 3

Interview with Christopher
M. Murphy Ph.D., frompage 3

Ongoing abuse ofalcohol is a reallybig problem in thispopulation. Abouthalf of our clients
have some unhealthy
and problematic
patterns of alcohol orother drug use. Someof them use alcohol
to cope with negative
experiences including
anger problems,
histories of trauma,and posttraumaticstress symptoms.

their motivations, why they might continue to
use these controlling and abusive behaviors,
and why they need to change.
Most of the positive consequences areshort-term. They might say, “Sometimes I get
my way by yelling and screaming.” Some of thenegative consequences can have longer lasting
effects. “Your behavior can have a negative
impact on children.” “You might end up in jail.”“Your partner’s not going to trust you.” What
we would tend to find is what you would calla self-control trap where you have short-term
reinforcement and long-term punishment. It
is often hard to change those behaviors, but wewould start by making people aware of themand then saying “Do you see why it would be
helpful to have other ways to try to addressthese short-term goals and outcomes that you
are looking for without the long-term negative
consequences?” “If you can find another way
to express how angry you are without being
abusive, then wouldn’t that be better?”Dr. McCarroll: You have spent a lot of
your career studying the role of alcohol indomestic violence.
Dr. Murphy: Ongoing abuse of alcohol isa very big problem in this population. Abouthalf of our clients have some unhealthy andproblematic patterns of alcohol or other druguse. Some of them use alcohol to cope withnegative experiences including anger problems,
histories of trauma, and posttraumatic stresssymptoms. Alcohol is one of the biggest risk
factors for continuing to be abusive and violent
during and after engaging in these programs.
When you interview women abuse survivors,
one very common theme is that the abusive
partner is much more abusive when drinking. You need a variety of strategies to address
alcohol problems depending on how severe itis and how intense the difficulties are.
The first order of business is to try to getthem on board, recognizing how it is negatively affecting their relationships and to help
them understand why they are using. We
then provide a brief motivational intervention to try to address their drinking, give them
feedback about the way their drinking wascausing problems, and try to get them to planfor changes. However, sometimes people needmore extended alcohol treatment.

4 • Joining Forces/Joining Families

Dr. McCarroll: You have some people in yourgroups whose partners have left them andsome who are thinking about it. Do you talkwith them in any different ways?
Dr. Murphy: The idea of learning to havebetter relationships is pretty consistent acrosspeople whether they are still with a partneror they have moved on. Sometimes they havegoals of understanding what happened in theirrelationship, so as not to repeat the problem inthe future. It is challenging to engage people
who have ended their relationship and have theattitude that they do not ever want to be in a
relationship again. So, if somebody says, “Thatdoesn’t apply to me. I am not planning on having relationships,” then we have to help themdevelop other goals. But we can still deal with
the issues of emotion regulation, of wanting to
be in control, and the effects of their childhood
experiences. A lot of those issues are common
regardless of where someone is in relationships
in the present.
Dr. McCarroll: How do you work with people
who have a history of abuse as a child?
Dr. Murphy: I had the good fortune to collaborate on the development of the Strengthat Home program, which is used in many VAhospitals (Taft, Macdonald, Creech, Monson, &Murphy, 2016). Casey Taft has done great workin expanding our model of cognitive-behavioral
therapy to be much more trauma-informed.
Part of that focus is to help people understandthat some of the traumatic experiences they
have had either in childhood, in combat, or inother contexts have had negative impacts on
their relationships. This is particularly important in terms of their ability to trust otherpeople or the desire to be in control of everything, including their relationship partners or
their children. Often, these experiences also
have had a negative impact on their self-esteem.
In that case, we focus more on the aftereffectsof trauma, the ways in which these experiences have negatively impacted their ability tohave healthy relationships. We generally do not
get into the details of the trauma in the way
you would in trauma-focused therapies. But
if someone wanted or needed that we would
provide or arrange it as an additional treatment
for them.
Continued on p. 5

Fall 2021

Interview with Christopher
M. Murphy Ph.D., frompage 4

A trauma-informed
focus helps
people understandthat some of
their traumatic
experiences have
had negative
impacts on theirrelationships,
particularly in theirability to trust otherpeople or the desire
to be in control ofeverything.

Dr. McCarroll: In one of your articles on
trauma you found significant differences intrauma histories of women and men (LaMotte,
Gower, Miles-McLean, Farzan-Kashani, &Murphy, 2018).
Dr. Murphy: Women are more likely to report having experienced gender-based trauma,
intimate partner violence or sexual assault,
but the rates of other types of trauma experiences, such as childhood abuse and witnessing
violence, are high in both men and women.
We did not find many differences, but where
we did find differences in trauma exposure,
women were more likely than men to reportgender-based trauma exposures.
When we compared women and men in
our group program, women were more likely tohave a level of trauma symptoms that met thecutoff for PTSD. The men reported fewer PTSD
symptoms overall. Importantly, we find thattrauma has negative effects on their relationships, even if they do not have PTSD. One of
the biggest is the ability to trust, which comesout in being suspicious in their relationships,
being controlling, wanting to monitor what theother person is doing, wanting to know where
they are all the time. I think it is helpful for
people to understand that this is coming fromsomewhere for them and is not just somethingthat they cooked up one day. There are reasons
why they feel that need to be in control, sometimes because they felt so out of control during
trauma exposures or because they were hurt bypeople who they were supposed to be able totrust. We can help them understand that and,hopefully, let go of some of the problems that
result from always wanting to control things.
There are ways to build trust and to recognizethat a lot of the mistrust is not what the otherperson is doing, it is their own personal history
that is causing them to be so mistrustful.
Dr. McCarroll: Do you see differences in thegroups for women compared to those formen?
Dr. Murphy: The facilitators running
women’s groups usually report that the clientsbonded more quickly and were more open
about what was happening in their relationships. With men’s groups, we typically would
get to the same place, but it takes a little moretime. Men often need to see other men sharing before they are comfortable doing it. The
women’s groups also tended to focus more on

http://www.CSTSonline.org

their own experiences of trauma and their own
histories of being abused in relationships, more
often by men. It comes up in the men’s groups,
but it is not as consistent a focus. The content
that we would focus on was fairly similar interms of the basic ways in which their relating was not as healthy and productive as it
could be, such as in their ability to understand,accept, and handle their emotions. Military
veterans also tend to have rapid bonding andopenness. Because of shared experiences, someveterans are more likely to trust other veteransthan civilians or people who have never beenin the military. There is a culture-specific element for some groups, that enables them toget to a deeper level quickly. Alternatively, inother groups, background and experiences canmake it harder for people to trust or to open
up and hold one another accountable, and that
may take a bit more time. It is also importantto acknowledge that men, in particular, may be
uncomfortable at first and that talking about
feelings and personal issues in a group setting
can be scary.
Dr. McCarroll: What are the challenges andissues with having mixed male and female
groups?
Dr. Murphy: Over the years I have heard
very positive experiences reported from people
who have run mixed groups. Part of what they
say is that often the men or the women in thesegroups have very generalized views of the opposite sex. The men will say, “All women think
this way; all women want this; all women act
this way.” Facilitators have also reported thatin mixed groups, members have the ability fordirect feedback and to challenge some of theseovergeneralized beliefs and thoughts. People
can tell you directly, “No, that is not true.” or “I
do not think that way.”
But there are dangers and risks, particularly for the women who have been the victimsof sexual assault or domestic violence. The
concern is whether they feel safe in a mixed
gender group and if it can be triggering forthem in some way. Also, there might be somegender-specific content. With the men, we talkabout men’s socialization in terms of what is
acceptable social behavior, how you have to be
tough, not show your feelings, and so on. Whilethese conversations tend to flow a certain way
in all-men’s groups, it is possible to hold theseContinued on p. 6
Joining Forces/Joining Families • 5

Interview with Christopher
M. Murphy Ph.D., frompage 5

There are some goodrisk assessment
instruments forthis population.

conversations in a mixed-gender group. My
feeling is that people are very sensitive to safety
and comfort and if the facilitators are highly
skillful and thoughtful, a lot of different things
may be possible and may work.
Dr. McCarroll: I imagine you have hadsome concern about severe aggression andfatalities occurring with the people you workwith, either at the time or when they leave.
How do you think about this risk?

on more specific clinical

Dr. Murphy: We operate under the standard principles of mental health practice. If wethought there was imminent danger, we would
inform the person in danger, involve the authorities, and seek hospitalization if necessary.
There is ongoing danger for everybody whocomes into these programs. I believe it is partof ethical practice to do vigorous outreach tothe partners for everybody who comes throughthese programs. In other words, you may notknow that this person is in imminent danger
to be abused today or tomorrow, but you knowthat this person is at risk to be the victim ofviolence from your client at some point overtime and so I think we should contact partners
to inquire about their feelings of safety, dosome basic assessment, provide safety planning if needed, give them resources, and makesure they know they can reach out to us. That
outreach requires the abusive client’s consent.
We would generally not accept someone into
our program if they weren’t willing to providethat consent for partner outreach.

or psychosocial factors

Dr. McCarroll: How did you assess risk?

These include theSpousal Assault Risk
Assessment and theDanger Assessment.
They count up thenumber of risk factors toassign someone to a risk
level. A lot of risk factors
co-occur. Individuals
who have alcohol
problems are more
likely to have mental
health symptoms and ahistory of violence andso forth. I tend to focus

that could possibly be
addressed and try to
identify a smaller setof these factors thatcan be incorporated
into people’s treatment
plans.

Dr. Murphy: There are some good risk
assessment instruments specifically for thispopulation. There is The Spousal Assault Risk
Assessment Guide (https://storefront.mhs.com/
collections/sara) and the Danger Assessment(https://vawnet.org/material/danger-assessment). They count up the number of different
factors to assign someone to a risk level. A lotof risk factors aggregate and co-occur. Individuals who have alcohol problems are more
likely to have mental health symptoms and ahistory of violence, and so forth. My perspective has been a bit different. I tend to focus on
more specific clinical or psychosocial factorsthat could potentially be addressed and try to
identify a smaller set of these factors that canbe incorporated into people’s treatment plans.
Some of the data from my program found6 • Joining Forces/Joining Families

that certain specific risk factors are often equally predictive of recidivism as an overall risk
score. In other words, certain key factors seemto be very associated with risk for continued
violence. One of them is unemployment, which
does not get a lot of attention in this field. Thereis little research on trying to address it throughemployment support or other types of interventions. We found that people who are employedfull-time have substantially lower rates ofviolence than people who are not employedfull-time when they come to our program.
Other significant risk factors are generalized
anger problems, alcohol problems, and PTSD.
So, my view is that managing some of these
specific risk factors may be more useful thansimply getting an overall risk score or categorizing individuals as high or low risk.
Dr. McCarroll: What about follow-up? I knowthat recidivism in terms of re-arrest and otherelements are one measure that some people
use. How do you assess the effects of yourprogram?
Dr. Murphy: For many years, our primary
outcomes were based on contacting the victim
partner and then re-contacting them every
three months or every six months over a period
of about a year. Partner reports of abuse are
the gold standard for evaluating outcome. We
would ask about a range of emotionally andphysically abusive behaviors to see whether
these behaviors had stopped or were continuing. However, with so many cell phones, it isharder and harder to contact people. In recent
years it has been a challenge to contact evenhalf of the partners. The other aspect of follow up is that typically we have just assessed
the abusive behaviors, but we have not done as
good a job of assessing the ways in which thesethings have been harmful to the survivors. I
think that it is very important to better understand the negative experiences they are having
and how our program could help them to feelbetter, safer, and more comfortable.
When we were able to reach partners, we
often found that they appreciated it and wanted
to talk about what was going on. Some partners
would say they have difficulties themselves withanger and aggression and want help in thoseareas. We try to see if they are interested inengaging with the victim counseling services orother resources. However, some partners haveleft the relationship, were getting beyond it, andwere not particularly interested in going backFall 2021

Interview with Christopher
M. Murphy Ph.D., frompage 6and talking about the past.
The other piece of follow-up is short-termchanges in behavior that we hope have evolved
into long-term changes in reducing abusive
violence. Are they learning how to regulate
their emotions better? Are they learning how
to communicate their needs more effectively?
How to be a better listener, how to be supportive? Are they developing these sorts of capacities and skills and is that what is leading to achange in the outcome for them? Or, are they
just avoiding being physically violent to avoid
going back to jail?
Dr. McCarroll: What did I not ask you that you
wish I had?
Dr. Murphy: I think the biggest thing we
did not talk much about is “Are these programs
effective? Are they a good use of resources andwhat are the alternatives, if any, if they are notas effective as we would like?” My perspective,
after having been in this for a long time anddoing research, is that the programs do have apositive benefit, particularly in reducing criminal recidivism and engagement with the criminal justice system. However, the programs are
not nearly as effective as we would like them tobe, so it is sort of a glass half-full / half-empty
situation. We do not have many great alternatives. We cannot just lock everybody up and weknow that locking people up does not necessarily fix these problems, although for somepeople, that may be what is needed. Some people are so dangerous that incarceration may benecessary, but that is not a wonderful solution.
Neither can we do nothing, not prosecute or
not address the problem. Given that the abuseintervention programs have some benefit, myperspective is that we should invest in them andfigure out how to make them more effective.
We should also learn how to use them as a way
to better meet the needs of survivors who areoften not connected to services or supports. I
do wish that the programs were more effective,
but they do have positive benefits. That is where
we are starting, but we really need to look at
new models. We need to look at ways to extend
and expand their impact, so that we can have abetter effect overall on the safety and well-beingof everyone who is affected by partner violence.
Dr. McCarroll: Thank you so very much foryour willingness to talk and for explaining
your approach to treating domestic violence
perpetrators.
Dr. Murphy: You are very welcome.

References

LaMotte, A. D., Gower, T., Miles-McLean, H.,
Farzan-Kashani, J., & Murphy, C. M. (2018).
Trauma’s influence on relationships: Clients’perspectives at an intimate partner violenceintervention program. Journal of Family Violence, 34(7), 655-662.
Miles-McLean, H. A., LaMotte, A. D., & Murphy,
C. M. (2021). Positive and negative outcome
expectancies of partner abuse among men
in partner violence treatment. Psychology ofViolence. doi:10.1037/vio0000372
Taft, C. T., Macdonald, A., Creech, S. K., Monson,
C. M., & Murphy, C. M. (2016). A randomized controlled clinical trial of the Strength at
Home Men’s Program for Partner Violence inmilitary veterans. Journal of Clinical Psychiatry, 77(9), 1168-1175.

Are these programs effective? Are they a good use of resources
and what are the alternatives, if any? My perspective is that they
have a positive benefit in reducing criminal recidivism. However, weshould also learn how to use these programs to meet the needs ofsurvivors. We need to look at ways to expand their impact so that
we can have a better overall effect on the safety and well-being of
everyone who is affected by partner violence.

http://www.CSTSonline.org

Joining Forces/Joining Families • 7

Trauma-Informed Care and Its Role in the Treatment
of Intimate Partner Violence Perpetrators
James E. McCarroll, PhD, Ronald J. Whalen, PhD, Joshua C. Morganstein, MD, Robert J. Ursano, MD

Trauma andposttraumatic stresssymptoms (PTSS)
are importantrisk factors in theperpetration of IPV.

The search for an effective treatment
program for intimate partner violence (IPV)
perpetrators has long been the Holy Grail forpractitioners, advocates, courts, and victims.
Early studies of IPV perpetrator cessation programs have almost universally failed to show
effectiveness of any one approach or differencesin outcomes between approaches. However, it
should be noted that intervention research isinherently difficult due to variations in counseling approach, program duration, extent ofservices, linkages to the court, victim services,and connections to other community agencies (Gondolf, 1999). In a review of significant
questions about intervention programs, themost frequent question was “do the programs
work?” (Gondolf, 1997). Gondolf concluded
that their effectiveness had not been satisfactorily determined. A subsequent comparisonof program outcome from four sites found no
significant differences in the re-assault rate,
proportion of men making threats, or victim
quality of life. However, batterer programs did
appear to contribute to the cessation of violence in some men over a 6-month follow-up
period. The author concluded that intervention
systems that conform to fundamental standards (e.g., holding perpetrators accountable)
can achieve similar results (Gondolf, 1999).
An evaluation of an intervention for Navy
service members and their partners who had
physically assaulted their partner compared
four different groups. These groups were: men
only, a couple’s group, a rigorously monitoredgroup in which perpetrators were seen monthly for individual counseling and a court record
check every six weeks, and a control group inwhich men received no family advocacy treatment, but partners received assistance in stabilization and safety planning (Dunford, 2000).
A cognitive-behavioral intervention was usedin the men’s and conjoint groups. Outcomes
after an 18-month interval found nonsignificant differences. A meta-analytic review of 22
studies that evaluated treatment efficacy foundthat treatment effects of programs (primarily
power and control versus cognitive-behavior
therapy) were in the small range. The conclusion was that the interventions had a minimal

effect on recidivism beyond the effect of beingarrested (Babcock, Green, & Robie, 2004).
A new twist was added to intervention programs for IPV cessation when trauma-informedcare (TIC) was added to traditional treatment(Voith, Logan-Greene, Strodthoff, & Bender,2020). This approach is theoretically grounded insocial learning theory which posits that violence is a learned behavior in which aggression
modeled by adults is subsequently adopted bychildren (Bandura & Badar, 1971). Interventionsattempt to produce new learning based on negative consequence of aggressive behavior and byobservation of appropriate models of behavior.
TIC is a broad educational approach that promotes awareness of the effects of trauma throughclasses, seminars, webinars, and in treatmentthat raises the awareness of trauma and its effects
on behavior and psychopathology (Berliner &Kolko, 2016). TIC is distinguished from traumaspecific care, which refers to the application of atreatment method for a particular distress suchas posttraumatic stress disorder (PTSD) (Ennis,
Sijercic, & Monson, 2021).
Dr. Murphy described TIC as part of his
approach to the treatment of perpetrators of
IPV. Trauma and posttraumatic stress symptoms(PTSS) are important risk factors in the perpetration of IPV. A history of trauma is common
in IPV perpetrators and often figures heavily
in their lives. For example, male perpetratorsof IPV presenting for treatment (n=293) in acommunity-based program were assessed fortraumatic event exposure, PTSS, depression,and alcohol problems. Over three quarters
reported past trauma exposures, 62% reported
multiple exposures, and 11% screened positive for probable PTSD. PTSD symptom levels
significantly predicted relationship dysfunction
and relationship abuse over and above alcohol
problems, drug use, and depression (Semiatin,
Torres, LaMotte, Portnoy, & Murphy, 2017).
Those with probable PTSD at pre-treatment
had four times higher odds of general violence
recidivism even when controlling for substanceabuse and depression during the two years after
the scheduled completion of a 20-session treatment. Higher levels of PTSS were also associatedwith lower task orientation and group cohesion
Continued on p. 9

8 • Joining Forces/Joining Families

Fall 2021

Trauma-informedcare (TIC) posits that
violence is a learned
behavior in which
aggression modeledby adults is adopted
by children, but it canalso be unlearned
through education,observation, andappropriate behavior
modeled by others.

http://www.CSTSonline.org

later in treatment. The authors concluded thattrauma symptoms affect violence cessation in
IPV treatment thereby highlighting the need toassess for unique clinical issues and the mechanisms associated with PTSS in this population(Miles-McLean et al., 2019). PTSD symptoms
have also been associated with treatment
engagement and criminal recidivism (MilesMcLean et al., 2019).
In addition to PTSS, the centrality of a
traumatic event if often crucial for the person’s
identity. When a traumatic event is central toidentity, it marks a key point in life that influences the meaning of subsequent posttraumatic
events. Treatment for IPV perpetration may beenhanced by decentering the trauma within the
person’s narrative such as by challenging beliefs
related to the centrality of such beliefs (Webermann et al., 2020).
While the above research involved male
IPV perpetrators, a similar study with female
perpetrators also found significant effects oftrauma exposure for women who perpetrate
IPV. In an exploratory study of 32 women
who were demographically similar to 64 men
who participated in a community-based abuseintervention program, 93.5% of the womenreported trauma exposure and 43.8% screened
positive for probable PTSD, higher than that of
the male participants. Women’s PTSD symptoms correlated significantly with emotional
abuse perpetration and, after controlling for
substance use, with physical assault. Importantly, gender did not significantly moderate
the associations between PTSD symptoms andIPV perpetration (Miles-McLean, LaMotte,
Williams, & Murphy, 2021).
A program on reducing violence in military
couples, Strength at Home (SAH), tested its
efficacy on reducing violence. SAH is a cognitive-behavioral trauma-informed IPV preventive intervention for married or partnered
military couples (Taft, Creech, et al., 2016).
Couples (135 male veterans and service members and 111 female partners) were recruited
between February 2010 and August 2013 at
two Veterans Affairs hospitals for participation in a randomized trial of a 12-week grouptreatment. Those randomized to SAH werecompared to a supportive prevention treatmentgroup in which there was minimal therapist
intervention beyond encouraging members to
support each other and focus on relationshipissues. Those participating in SAH had greater
reductions in physical and psychological IPV
and reduced controlling behaviors involving

isolation and monitoring of the partner at followup at 3 and 6 months (Taft, Macdonald, Creech,
Monson, & Murphy, 2016).
SAH has since been introduced as part ofa national program of the U.S. Department of
Veterans Affairs to help veterans who use or
experience IPV (Taft, Macdonald, et al., 2016).
Further research is ongoing to replicate thesefindings examining psychopathology in addition
to PTSD, types of traumas experienced, and relationship satisfaction. Further work is also needed
to determine if the SAH program is effective forwomen veterans (Taft, Creech, et al., 2016).
IPV cessation treatment is difficult to evaluate, but an increasing body of evidence highlights
the need for trauma-informed care of IPV perpetrators. The mitigating and moderating effectsof trauma are just beginning to be understoodand applied in the practice of TIC. As a resultof the importance of trauma in IPV, screening
for trauma exposure and PTSD should be partof routine practice in IPV perpetrator treatment(Semiatin et al., 2017).

References

Babcock, J. C., Green, C. E., & Robie, C. (2004).
Does batterers’ treatment work? A meta-analytic
review of domestic violence treatment. ClinicalPsychology Review, 23(8), 1023-1053.
Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child
Maltreatment, 21(2), 168-172.
Ennis, N., Sijercic, I., & Monson, C. M. (2021).
Trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder underongoing threat: A systematic review. ClinicalPsychology Review, 88, 102049. doi:10.1016/j.
cpr.2021.102049
Gondolf, E. W. (1997). Batterer programs: what weknow and need to know. Journal of Interpersonal
Violence, 12(1), 1-9.
Gondolf, E. W. (1999). A comparison of four batterer intervention systems. Journal of Interpersonal Violence, 14(1), 41-61.
Miles-McLean, H. A., LaMotte, A. D., Semiatin, J.
N., Farzan-Kashani, J., Torres, S., Poole, G. M.,& Murphy, C. M. (2019). PTSD as a predictor of treatment engagement and recidivism inpartner abusive men. Psychology of Violence,
9(1), 39-47.
Miles-McLean, H. A., LaMotte, A. D., Williams, M.
R., & Murphy, C. M. (2021). Trauma exposureand PTSD among women receiving treatment
for intimate partner violence perpetration. Journal of Interpersonal Violence, 36(13-14).

Continued on p. 11
Joining Forces/Joining Families • 9

BUILDING BRIDGES TO RESEARCH

Validity in Measures of the Risk of Intimate Partner
Violence — “Do the Measures Measure What They Say
They Measure? For Whom?”
Validation of
instruments is acomplex task thatinvolves determiningthat the instrument
measures that which
it is purported tomeasure.

By James E. McCarroll, PhD, Ronald J. Whalen, PhD, Joshua C. Morganstein, MD,
and Robert J. Ursano, MD
In his interview, Dr. Murphy noted instruments that can be used in research andclinical care of perpetrators of intimate partner
violence (IPV) like the Spouse Assault Risk Assessment Guide (SARA) (Kropp & Hart, 2000)
and the Danger Assessment (DA) (Campbell,
Webster, & Glass, 2009; Campbell et al., 2003).
These instruments estimate the risk of IPV
recidivism and femicide, respectively. Bothinstruments are validated for their purpose,but what does validated mean and how should
it be interpreted?
Much research in the social sciences
involves estimates of some characteristic of
behavior or the prediction of a future event.
Such characteristics are commonly called constructs. A construct is an unobserved, abstract
characteristic of interest, such as intelligence,
based on observation or theory (see “Websitesof Interest” for more on the statistical concepts
involved in validity).
In reports of the outcomes of studies thathave used instruments (paper and pencil,
verbal, or internet) to measure a given construct, authors often report that the instrument
has been validated. To some readers, this isenough information for them to accept that themeasure is ready to use in practice. However,the validation of instruments is a complex task
involving the determination that an instrument
measures what it is purported to measure, so
it is important that the reader ask at least someof the following questions: How was validity
established? What kind of validity? Valid forwhom? Validated when?
The SARA is a tool for making judgments
about the risk for spousal violence, a more general prediction than the DA, which measures
the risk of spousal homicide. The SARA isbased on 20 risk factors, 10 related to violencein general and 10 that are specifically related tospousal violence. Examples of general violencerisk factors are: “Past assault of strangers or acquaintances,” ‘Recent substance abuse/dependence,” and “Personality disorder with anger,

10 • Joining Forces/Joining Families

impulsivity, or behavioral instability.” Examplesof spousal violence risk factors are: “Past physicalassault,” “Past violation of ‘No Contact’ orders,”and “Past sexual assault/sexual jealousy.” Items
are coded by an evaluator.
The SARA was validated in samples of male
IPV offenders (N=2,681) with a documented
history of spousal assault in British Columbia, Canada, in 1996-1997 in participants withand without such history. Some offenders werefederal prison inmates and others were probationers. Assessments for the SARA ratings werebased on interviews or evaluations of files foreach of the 20 risk factors. Validation was basedon the differentiation of risk factors by groups.
It was found that despite the variability in risk
factors, there was a consistent pattern of differences between inmates and probationers inwhich inmates had higher scores on risk factors than probationers. The authors concluded
that the SARA had good validity and that theiranalyses supported the use of the SARA in clinical and forensic decision making and in researchon the perpetration of spousal assault. Further
clarification regarding the uses of the SARA
noted that it is an instrument to guide structured
professional judgment (authors’ italics), and that
final decisions about risk should include judgments of external factors, such as the nature of
the environment into which an individual would
be released. Further research using the SARA in
Sweden found that it had significant predictive
validity for IPV recidivism when used by police
officers over an 18-month period (Belfrage et al.,2011).
The DA, designed to predict the likelihoodof lethal or near lethal IPV of women by theirpartner or ex-intimate partners, was found to bea valid instrument capable of assessing intimate
partner violence in clinical and research settings.
The research supporting the predictive validity of
the DA was conducted by comparing data from
310 women that had been killed with 324 abusedcontrol women in urban American cities. Data ofdeceased women were collected from records andFall 2021

The Spousal Assault
Risk Assessment is
a guide for making a
structural professional
judgment about
the risk for spousal
violence. The Danger
Assessment was
designed to predictthe likelihood of
lethal or near lethal
IPV of women by
their partners or expartners.

Trauma-Informed Care,from page 9interviews of proxies who knew the deceased
women’s relationships with intimate or former intimate partners. Information collected
included demographics, relationship characteristics, type, frequency, and severity of abuse,harassment, weapon availability, and substanceuse. Control women were identified throughrandom digit dialing. They were consideredabused if physically assaulted or threatenedwith a weapon by a current or former intimate
partner within the past two years. Results ofthis study produced the final version of the DA,
20 items scored Yes or No. Examples are: “Hasthe physical violence increased in severity or
frequency over the past year?” “Does he own
a gun?” and “Do you believe he is capable ofkilling you?” Odds ratios from analyses of the
femicides and abused controls were used to develop an algorithm for four levels of risk basedon the DA score: variable danger, increased
danger, severe danger, and extreme danger.
This version of the DA was also used in a
subsequent study with an independent sample
of 194 women victims of attempted femicide
who were compared to controls. The DA scoresof attempted femicide victims were similar
to the femicides, more than twice as high as
the scores of the abused controls, and weremore likely to fall into the three higher danger categories (increased, severe, and extreme
danger) than controls. The authors concluded
that the DA provided acceptable levels of
sensitivity and specificity and could accurately
identify the majority of abused women at riskof femicide or attempted femicide, distinguish
the women at the lowest risk, and provide risk
factors for prevention.
Similar to the SARA, the DA is expected to
be used collaboratively with others involved in

the assessment of risk such as advocates, healthcare professionals, criminal justice practitioners and the abused woman. Knowledge of risk
can be useful in developing safety plans andinterventions for the woman as well as for theabuser.
This brief description of the backgroundof two instruments widely used in services for
IPV victims and abusers and for researchers
gives only the highlights of the research that
established their validity. In this summary weattempt to make readers more aware of validation procedures in general as well as somespecific information about the two measuresdescribed here.

Semiatin, J. N., Torres, S., LaMotte, A. D., Portnoy, G. A., & Murphy, C. M. (2017). Trauma
exposure, PTSD symptoms, and presenting
clinical problems among male perpetratorsof intimate partner violence. Psychology ofViolence, 7(1), 91-100.

randomized controlled clinical trial of theStrength at Home Men’s Program for Partner
Violence in military veterans. Jpournal of
Clinical Psychiatry, 77(9), 1168-1175.

Taft, C. T., Creech, S. K., Gallagher, M. W., Macdonald, A., Murphy, C. M., & Monson, C. M.
(2016). Strength at Home couples program toprevent military partner violence: A randomized controlled trial. Journal of Consulting andClinical Psychology, 84(11), 935-945.
Taft, C. T., Macdonald, A., Creech, S. K., Monson, C. M., & Murphy, C. M. (2016). A
http://www.CSTSonline.org

References

Belfrage, H., Strand, S., Storey, J. E., Gibas, A. L.,
Kropp, P. R., & Hart, S. D. (2011). Assessmentand management of risk for intimate partner
violence by police officers using the Spousal
Assault Risk Assessment Guide. Law and Human Behavior. doi:10.1037/h0093948
Campbell, J. C., Webster, D., & Glass, N.
(2009). The Danger Assessment: Validation of a lethality risk assessment instrument for intimate partner femicide. Journalof Interpersonal Violence, 24(4), 653-674.
doi:10.1177/0886260508317180
Campbell, J. C., Webster, D., Koziol-McLain,J., Block, C., Campbell, D., Curry, M. A., .…
Laughton, K. (2003). Risk factors for femicide
in abusive relationships: Results from a multisite case control study. American Journal of
Public Health, 93(7), 1089-1097.
Kropp, P. R., & Hart, S. D. (2000). The Spousal
Assault Risk Assessment Guide (SARA): Reliability and validiy in adult male offenders. Law
and Human Behavior, 24, 101-118.

Voith, L. A., Logan-Greene, P., Strodthoff, T.,& Bender, A. E. (2020). A paradigm shift inbatterer intervention programming: A need toaddress unresolved trauma. Trauma Violence& Abuse, 21(4), 691-705. dWebermann, A. R., Maldonado, A., Singh,
R., Torres, S., Bushee, S., & Murphy, C. M.
(2020). Centrality of traumatic events andmen’s intimate partner violence perpetration.
Psychological Trauma, 12(2), 200-206.
Joining Forces/Joining Families • 11

Websites of Interest
The Substance Abuse and Mental Health Services
Administration (SAMHSA) has taken the federal leadin informing the public about the effects of trauma
on children and adults. Several websites listed below
provide information and links to their resources.

TRAUMA

https://www.samhsa.gov/homelessness-programsresources/hpr-resources/trauma

TRAUMA-INFORMED CARE

https://www.samhsa.gov/resource/ebp/tip-57-traumainformed-care-behavioral-health-services

TRAUMA AND VIOLENCE

https://www.samhsa.gov/trauma-violence

RESOURCES FOR CHILD TRAUMA-INFORMED CARE
https://www.samhsa.gov/childrens-awareness-day/past-events/2018/child-traumatic-stress-resources

UNDERSTANDING CHILD TRAUMA

https://www.samhsa.gov/child-trauma/understandingchild-trauma

Finally, the following link is a presentationthat reviews the terminology associated withdetermining validity. It is a product of the
National Assessment Governing Board, afederal agency that sets policy for the National
Assessment of Educational Progress, thenation’s report card. The presentation discusses
the statistical concept of validity in its many
forms: sources, evidence, and issues in validity
theory.
https://www.nagb.gov/content/dam/nagb/en/
documents/naep/cizek-introduction-validity.pdf

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