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The current status of marriage and family therapists' graduate training in the identification, assessment, and treatment of relationship violence

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The current status of marriage and family therapists' graduate training in the identification, assessment, and treatment of relationship violence
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Bracciale, Marie T
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Domestic violence ( jstor )
Factor analysis ( jstor )
Family therapy ( jstor )
Graduate studies ( jstor )
Marriage ( jstor )
Professional training ( jstor )
Statistics ( jstor )
Students ( jstor )
Violence ( jstor )
Women ( jstor )
Counselor Education thesis, Ph. D
Dissertations, Academic -- Counselor Education -- UF
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Thesis (Ph. D.)--University of Florida, 2004.
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Includes bibliographical references.
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Printout.
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Vita.
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by Marie T. Bracciale.

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THE CURRENT STATUS OF MARRIAGE AND FAMILY THERAPISTS'
GRADUATE TRAINING IN THE IDENTIFICATION, ASSESSMENT,
AND TREATMENT OF RELATIONSHIP VIOLENCE














By

MARIE T. BRACCIALE


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


2004
































Copyright 2004

by

Marie T. Bracciale














ACKNOWLEDGMENTS

The author acknowledges the entire faculty in the Counselor Education Department

for preparing me to do this research. I am most appreciative of Dr. Silvia Echevarria-

Doan, chair, and my online editor, Dr. Jerry Byrd, for their many suggestions during

discussions and editing sessions. My thanks go to Dr. Bimrnbaum of California State

University, Fullerton, who developed the SurveyWiz program for the behavioral

sciences, made it accessible to me, and gave me permission to use it to build my

electronic survey; this made it possible for me to reach a nationwide sample. I am deeply

grateful to my committee members: Dr. Barbara Rienzo for her inspiration, Dr. David

Miller for statistical consultation and teaching, Dr. Sondra Smith for her academic

excellence and her role as a mentor for my teaching experience, and Dr. Peter Sherrard

for his continued supervision and coaching and his wonderful ideas that got this research

started in the right direction. I thank each of them for valuable comments, revisions, and

references during the course of my research.

I am indebted to the department chair, Dr. Harry Daniels, for supporting my

education through a Graduate Teaching Assistantship in the department to allow me to

work and to gain university teaching experience that will be valuable for future

endeavors.

I would also like to acknowledge Dr. Max Parker, Ph.D., for being a mentor to me

throughout my program and for being available for consultation whenever I needed him.

The training that I received from Dr. Mary Howard Hamilton in her consultation class








proved helpful in my professional development as a consultant. She also provided

mentorship throughout my program and was always available for consultation.

Personally, I acknowledge my parents, Rose and Roy, for their continued support;

my brothers, Dominick and Daniel, for unconditional love; and especially my partner,

E. J. Updyke, LMFT, for compassion, understanding, and patience through this process.

Others who contributed and whom I wish to thank include Jason Burkhardt for computer

consultation; Rosaria Upchurch, LMFT, for support and wisdom; Rebecca Waumett,

graduate student, who helped me to prepare email lists and databases; Mike Padilla from

educational psychology, who helped with methods selection and data analysis; Amy

Bradshaw, fellow doctoral student, for statistics coding, data entry, and dear friendship;

and Gary Sipe and the entire Stetson University CIT department for their help with the

SurveyWiz program, development of the online survey development, and resolving

glitches along the way.

Another mentor who is acknowledged for her contributions is Dr. Mickie Miller,

who took me under her wing as a graduate assistant at the University of Florida and at the

Brain Institute and helped me to develop courses. I acknowledge the Gainesville Family

Institute and its two faculty members, Dr. Herb Steier and Dr. Gina Early; I am grateful

for their constant consultation and coaching throughout my graduate program. Their

support and mentorship have changed me personally and professionally to be a better

person. Last, I thank all of my supervisees and interns from whom I have learned so

much over the years at the university; it has been a pleasure to work closely with them.














TABLE OF CONTENTS
Page

ACKNOW LEDGM ENTS ................................................................................................. iii

LIST OF TABLES............................................................................................................. ix

ABSTRACT........................................................................................................................ x

CHAPTER

1 INTRODUCTION ........................................................................................................ I

Increase in Incidence of Relationship Violence........................................................... 3
Professional Responsibility: Legal, Ethical, and Therapeutic Issues.......................... 4
Ethical Standards of the Commission on the Accreditation of Marriage
and Fam ily Therapy Education (COAM FTE) ......................................................... 6
Scope of the Problem .................................................................................................... 8
The Extent of the Problem ........................................................................................... 9
Multiforms of Treatment (Metatheoretical, Postmodernism, Feminism,
Sociocultural. and Social Learning) ...................................................................... 11
M etatheoretical Approach................................................................................... 11
Postm odernism .................................................................................................... 12
Sociocultural Theory........................................................................................... 13
Social Learning Theory ...................................................................................... 14
Treatm ent for Battered W om en.................................................................................. 15
Treatm ent for the Batterer.......................................................................................... 18
Duluth M odel...................................................................................................... 19
Society and Culture............................................................................................. 20
The Fam ily.......................................................................................................... 20
The Individual .................................................................................................... 21
Sum m ary ............................................................................................................ 21
Graduate Training in Relationship Violence: Identification of Training Needs ......22
Assessm ent of Violence in Treatm ent........................................................................ 24
Statem ent of the Problem ........................................................................................... 26
Need for the Study...................................................................................................... 27
Purpose of the Study................................................................................................... 29
Rationale for the Study............................................................................................... 31
Definitions of Term s................................................................................................... 32
Organization of the D issertation................................................................................. 34








2 REV IEW OF THE LITERATU RE ............................................................................ 35

Increase in Incidence of Relationship V iolence......................................................... 35
Professional Responsibility: Legal, Ethical, and Therapeutic Issues ........................ 38
Licensing Boards ................................................................................................ 38
Lack of Training in Fam ily Violence ................................................................. 38
M inim um State Requirem ents for Training........................................................ 39
Theoretical Constructs Underlying the Study ............................................................ 40
Fem inist V iew ..................................................................................................... 40
The Study of Power ............................................................................................ 41
Social Learning Theory ...................................................................................... 43
Social Structural Theory..................................................................................... 45
Treatm ent of Relationship Violence........................................................................... 47
Choice to Leave or to Stay in Abusive Relationships ........................................ 47
Gottm an's Batterer O ffender Typologies ........................................................... 49
Hum an Heart Reactivity ..................................................................................... 50
Holtzworth-Munroe and Stuart's Three Major Types of Batterers .................... 51
Identification of Training Needs ................................................................................ 52
Current Status of Training and Need for Additional Curriculum....................... 52
Continuing Education Units................................................................................ 53
Skills in Assessing Relationship Violence and Imminent Danger ..................... 54
Assessing for Risk Factors Associated With Relationship Violence ................. 55
Identifying Risk Factors Associated With Relationship Violence ..................... 55
Prior Relationship A ggression............................................................................ 56
Dem graphic Characteristics.............................................................................. 56
Psychological Characteristics ............................................................................. 57
Specific Psychological Syndrom es..................................................................... 58
Other Risk Factors .............................................................................................. 59
Ability to A ssess V violence Risk ......................................................................... 60
V violence Risk A ssessm ent Study ....................................................................... 60
A ssessing and M managing Risk............................................................................ 61
H CR-20 Item Risk Assessm ent Instrum ent........................................................ 62
Static and D ynam ic Risk..................................................................................... 62
Conclusion.................................................................................................................. 63

3 M ETHODOLOG Y ..................................................................................................... 66

Research M ethod........................................................................................................ 67
Survey Design ............................................................................................................ 69
Rating Scales in the Social Sciences .......................................................................... 70
Research Procedures................................................................................................... 73
Sam ple ................................................................................................................ 73
Sources of Error in Sam ple W eb Surveys .......................................................... 74
Survey Research in Fam ily Therapy .......................................................................... 78
Data Analyses............................................................................................................. 81
The Nature of Factors ......................................................................................... 81
Stages in a Factor Analysis................................................................................. 83


vi





vii


Rotation of Factors ......................................................................................... 85
Validity in Factor Analysis ............................................................................. 86
Reliability in Factor Analysis.......................................................................... 87
Internal Consistency ....................................................................................... 87
M FT Training Program s ................................................................................. 88
Conclusions............................................................................................................ 89

4 RESULTS.............................................................................................................. 91

Participants and Dem graphic Description............................................................. 91
Factor Analysis Results.......................................................................................... 93
Principal Axis Factoring and Oblique Rotation....................................................... 94
Extraction M ethod: Principal Axis Factoring......................................................... 95
Factor Analysis Results ......................................................................................... 96
Identification and Nam ing of Factors...................................................................... 97
Reliability and Validity .......................................................................................... 98
Factor 1 .................................................................................................................. 98
Factor 2..................................................................................................................99
Factor 3................................................................................................................ 104
Sum m ary of Reliability Statistics for Factors 1 to 3.............................................. 106
Summ ary .............................................................................................................. 106

5 DISCUSSION ...................................................................................................... 108

Evaluation and Discussion of the Results.......................................................... 108
Ratings of Importance .................................................................................. 109
Training M ethods ......................................................................................... 112
Clinical Assessm ents ................................................................................... 115
Lim stations of the Study....................................................................................... 117
Respondents ................................................................................................. 117
Potential Confounders .................................................................................. 117
Random Error .............................................................................................. 118
Response Rate ............................................................................................. 120
Possible Nonrespondent Bias ....................................................................... 120
Nonrandomized Samples ............................................................................. 120
Alternative Explanations .............................................................................. 121
Implications and Recommendations for Further Research.................................... 122
Theoretical, Training, and Ethnical Implications.................................................. 123
Conclusion........................................................................................................... 125

APPENDIX

A RELATIONSHIP VIOLENCE TRAINING SURVEY (WEB VERSION)........... 129

B COAMFTE ACCREDITATION STANDARDS.................................................. 136

C AAM FT CODE OF ETHICS .............................................................................. 147








D INVITATION LETTER TO PARTICIPATE IN SURVEY.................................. 155

E FOLLOW-UP LETTER TO NONRESPONDENTS ............................................ 156

F SAMPLE CODED RESPONSE FORM............................................................... 157

G DESCRIPTIVE STATISTICS MEAN RATINGS AND STANDARD
D EV IA TION S ..................................................................................................... 158

H FACTOR CORRELATION MATRIX................................................................. 159

LIST OF REFERENCES............................................................................................. 160

BIOGRAPHICAL SKETCH....................................................................................... 187














LIST OF TABLES

T'Fable pae

1. Variables Used for the Relationship Violence Training Survey (RVTS) ................ 82

2. Characteristics of Respondents................................................................................. 92

3. Eigenvalues and Total Variance Explained ............................................................. 94

4. Factor Loading Matrix: Rotated Factor Loadings of .40 or Greater in the
Principal Axis Factoring, Based Upon N = 171 ................................................... 96

5. Factor 1 (Item s 11-20): Sam ple Size Sum m ary....................................................... 99

6. Factors 1, 2, and 3: Reliability Statistics.................................................................. 99

7. Factor 1: Item Statistics ......................................................................................... 100

8. Factor 1: Summ ary Item Statistics......................................................................... 100

9. Factor 1: Item -Total Statistics............................................................................... 101

10. Factor 1: Scale Statistics........................................................................................ 101

11. Factor 2 (Item s 6-9): Sample Size Summ ary......................................................... 102

12. Factor 2: Item Statistics ......................................................................................... 102

13. Factor 2: Summ ary Item Statistics......................................................................... 103

14. Factor 2: Item -Total Statistics............................................................................... 103

15. Factor 2: Scale Statistics ........................................................................................ 103

16. Factor 3 (Item s 1-5): Sam ple Size Summ ary......................................................... 104

17. Factor 3: Item Statistics ......................................................................................... 104

18. Factor 3: Summ ary Item Statistics......................................................................... 105

19. Factor 3: Item -Total Statistics............................................................................... 105

20. Factor 3: Scale Statistics ........................................................................................ 106














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

THE CURRENT STATUS OF MARRIAGE AND FAMILY THERAPISTS'
GRADUATE TRAINING IN THE IDENTIFICATION, ASSESSMENT,
AND TREATMENT OF RELATIONSHIP VIOLENCE

By

Marie T. Bracciale

August 2004

Chair: Silvia Echevarria-Doan
Major Department: Counselor Education

The incidence of relationship violence (RV) has increased dramatically in the past

decade. Clinical counselors trained in marriage and family therapy (MFT) who interact

with perpetrators and victims of RV must be informed about associated personality

factors, transactional dynamics of perpetrators and victims, structural and environmental

influences leading to RV, and comparative effectiveness of intervention strategies. This

national study focused on graduate MFT training received by clinical members of the

American Association of Marriage and Family Therapists (AAMFT).

The Relationship Violence Training Survey (RVTS), designed by the researcher

and measured for content validity by experts in the field, contained two subscales: (a)

assessment of RV, and (b) training/treatment issues in RV. Demographic data included

age, ethnicity, gender, years of therapy experience, and years of supervisory experience.

The RVTS was designed to measure whether graduate MFT programs adequately prepare

therapists in assessment and treatment of RV. Program success was measured by survey








responses regarding required coursework in RV, program endorsement by accreditation

standards, and practitioners' self-reported self-efficacy in assessing and treating RV.

Respondents were 197 clinical members of AAMFT, AAMFT approved supervisors, and

faculty members in MFT training programs, obtained via nationwide random sampling

(response rate of 19.7%).

Statistical analysis of responses to the RTVS indicated three factors: (a)

respondents' rating of the importance of clinical competencies associated with the

identification, assessment, and treatment of RV; (b) respondents' rating of their graduate

training in RV; and (c) respondents' self-rating of their knowledge and skills in

identification, assessment, and treatment of RV. Cronbach alphas for the three factors

were .814, .967 and .812, respectively.

The study results indicated problems in the ability of responding practitioners to

(a) use systematic risk assessments to recognize imminent danger and formulate

appropriate interventions, (b) intervene within violent gay and lesbian relationships, and

(c) obtain Restraining Order Injunctions. The need for improved quality and longer

duration of graduate training in RV and more stringent training requirements by licensing

boards and accreditation standards were supported. The results may be helpful to

researchers, treatment providers, graduate programs, accreditation boards, third-party

payers, and benefits officers.














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

THE CURRENT STATUS OF MARRIAGE AND FAMILY THERAPISTS'
GRADUATE TRAINING IN THE IDENTIFICATION, ASSESSMENT,
AND TREATMENT OF RELATIONSHIP VIOLENCE

By

Marie T. Bracciale

March, 2004

Chair: Silvia Echevarria-Doan
Major Department: Counselor Education

The incidence of relationship violence has increased dramatically in the past

decade. This national study focused on training that clinical members of the American

Association of Marriage and Family Therapists (AAMFT) received during their graduate

marriage and family therapy (MFT) programs.

The Relationship Violence Training Survey was designed to measure whether these

programs prepare therapists in assessment and treatment of relationship violence.

Respondents were 197 clinical members of AAMFT, AAMFT approved supervisors, and

faculty members in MFT training programs, obtained via nationwide random sampling.

Results may be helpful to researchers, treatment providers, graduate programs, licensure

boards, accreditation standards, third-party payers, and benefits officers.













CHAPTER 1
INTRODUCTION

Whether or not human beings are inherently aggressive, as some have asserted

(Lorenz, 1966), it appears that they are most likely to behave aggressively in their most

intimate social relationships. Almost one fourth of all murders occur between relatives,

most often involving spouses killing one another (Straus, 1986). Child abuse, spouse

abuse, and elder abuse have become substantial problems in their own right. Date rape

and courtship violence occur with distressing frequency. Violence between homosexual

couples also has been documented in the literature. No type of interpersonal relationship

seems to be immune (Rosenbaum, Cohen, & Forsstrom-Cohen, 1991). In 2000, the

number of females shot and killed by a husband or intimate acquaintance was nearly 4

times higher than the number murdered by male strangers (Centers for Disease Control

and Prevention, 2001).

Why should one conduct a national survey of practices in assessment and

treatment of relationship violence? Due to the large increase of violence in society (as

the statistics will show), this survey is needed to respond to this incidence. Ethically, we

need to respond as an organization to have an impact on our clients, our research, our

treatment protocols, and our community/courts systems.

Very few national studies have been done on marriage and family therapist

practices. None has directly surveyed practices directly relating to relationship violence.

The results will be information of importance to researchers in the field, treatment








providers, graduate programs, and accreditation boards. It may also be helpful to third-

party payers and benefits officers.

In 1995 Doherty and Simmons conducted the first national survey of marriage and

family therapists on clinical patterns of marriage and family therapists. Their sample of

526 therapists from 15 states gave descriptive information on their training, level of

experience, and professional practices, along with detailed information on recently

completed cases. The findings indicated that marriage and family therapists treat a wide

range of serious mental health and relational problems, that they do so in relatively short-

term fashion, and that they use individual, couple, and family treatment modalities

(Doherty & Simmons, 1996).

The goal of this project is to obtain detailed information about the clinical practices

of clinical members of the American Association of Marriage and Family Therapists

(AAMFT) throughout the United States. Specifically, the Relationship Violence Training

Survey (RVTS) is designed to answer questions about the adequacy and competencies of

marriage and family therapists, supervisors, and faculty members in identification,

assessment, and treatment of relationship violence and to look at the current status of

graduate training in relationship violence (appendix A).

The theoretical basis for this study is drawn from (a) the increase in incidence of

relationship violence as indicated by statistics; (b) professional responsibility: legal,

ethical, and therapeutic issues; (c) multiforms of treatment (metatheoretical,

postmodernism, feminism, sociocultural, social learning); and (d) identification of

training needs.








Increase in Incidence of Relationship Violence

In the United States today, violent crimes occur more frequently within families

than among strangers (Gelles & Straus, 1988; Langan & Innes, 1986; Straus & Gelles,

1990). Government surveys conducted between 1973 and 1981 identified 4.1 million

reports of intrafamilial victimizations (U.S. Department of Justice, 1984). In 1990 alone,

of the 6,008,790 crimes of violence against persons ages 12 and older reported in a

national crime victimization survey (U.S. Department of Justice, 1992), 39% were

perpetrated by a member of the victim's family or by a person in a relationship with the

victim. Less than half of these crimes were reported to the police. Fifty-eight percent of

crimes reported involved the spouse or ex-spouse of the victim.

Although intimate partner violence (IPV) is known to occur among all social

classes, research over the past 30 years has demonstrated a consistent link between low

socioeconomic status (SES) and occurrence of partner violence (Gelles, 1997). In terms

of clinical studies, O'Brien (1971) found that, in a sample of divorcing couples, the

husband's achievement status (measured by job dissatisfaction, education, income, and

occupational status) was much lower among the violent couples than among the

nonviolent couples. Gayford (1975) and Roy (1977) found that husbands of battered

women tended to hold unskilled occupations and have high levels of unemployment.

Hotaling and Sugarman (1986), in their review of 52 case comparison studies, found that

three indicators of the husband's SES (occupational status, income, and educational

level) demonstrated a consistent inverse association with the occurrence of husband-to-

wife violence (Cunradi, Caetano, & Schaefer, 2002).

Data from the 1992-93 National Crime Victimization Survey indicate that young

women (ages 19-29) in low-income families (under $10,000) were more likely than other








women to be victims of partner violence (Bachman & Saltzman, 1995). Longitudinal

research suggests that men characterized by low SES indicators (unemployment, low

educational attainment) are more likely to initiate IPV than men without such

characteristics (Magdol et al., 1977), and these indicators are associated with the

persistence of wife assault over time (Alderondo & Sugarman, 1996). On the other hand,

Quigley and Leonard (1996) found no significant differences in education between

couples whose husbands desisted their marital violence after 2 years of follow-up and

those who did not (Cunradi, Caetano, & Schaefer, 2002).

Professional Responsibility: Legal, Ethical, and Therapeutic Issues

The duty to warn third parties of dangers posed by a client's behavior, as Monahan

(1993) noted, "is now a fact of professional life for nearly all American clinicians" (p.

242). Family therapists, when deciding whether to warn a third party of a threat resulting

from a client's behavior, must consider legal, ethical, and therapeutic issues. On the one

hand, courts in most states have ruled that therapists have a legal duty to warn (or avert

danger to) third parties to whom clients pose a risk. On the other hand, certain sorts of

client confidences are protected by law. Thus, therapists must determine whether they

have a legal duty to warn third parties of the danger posed by their client's behavior and,

if not, whether the client's information is legally protected (thus prohibiting the therapist

from disclosing the information). Ethical and therapeutic issues arise about client

information that state law does not expressly require or forbid therapists to disclose. In

such cases, therapists and clients are generally free to negotiate a mutually agreeable

disclosure policy.

All three factors (legal, ethical, and therapeutic) play a role in formulating the

written disclosure policy statement that each therapist should negotiate with prospective








clients. Some states regulate disclosure statements. In any case, therapists' disclosure

policies must conform to all applicable laws.

The landmark case establishing that therapists, in certain cases, have a legal duty to

warn potential victims of their clients' behavior is Tarasoffv. Regents of University of

California (1976). The details of the case are well known. In the course of therapy,

Prosenjit Poddar threatened to kill Tatiana Tarasoff, a fellow student in his square

dancing class. (Although Tarasoff was not mentioned by name, the therapist was well

aware of the identity of the potential victim.) Poddar was held for observation and then

released. No one notified Tarasoff of the threat that Poddar had made against her. Two

months later, Poddar murdered Tarasoff, and the Tarasoff family filed suit. The court

held that "when a therapist determines or pursuant to the standards of his profession

should determine, that his patient presents a serious danger of violence to another, he

incurs an obligation to use reasonable care to protect the intended victim against such

danger" (p. 346).

A disclosure statement is a written document detailing the policy, negotiated

between therapist and client, concerning therapist disclosure of client information.

(Frequently, the document expresses the standard policy of the therapist and is signed by

the client.) It should inform the client of the therapist's legal responsibilities and indicate

how the therapist will use discretion within the limits of the law (Schlossberger &

Hecker, 1996).

The legal evolution of the "battered women's defense," as it came to be known,

was built on the "rape defense" successfully argued by lawyer Susan Jordan in the second

trial of Inez Garcia and the successful appeal filed by Jordan, Nancy Stearns, and Liz








Schneider for Yvonne Wanrow, the Spokane woman hobbling on crutches who killed a

man for molesting her son. Armed with new, and newsworthy, feminist concepts-

"battered women's syndrome," "unequal combat," and "imminent danger"-their defense

strategies helped to focus a spotlight on domestic violence. After nearly a decade of

feminist agitation in concert with legislative initiatives pioneered by Representative

Lindy Boggs and Senator Barbara Mikulski, Congress passed the Family Violence

Prevention and Services Act in 1984. Today, approximately 1,800 battered women's

shelters, hot lines, and advocacy programs around the country are funded by the federal

program (Brownmiller, 1999).

Ethical Standards of the Commission on the Accreditation
of Marriage and Family Therapy Education (COAMFTE)

The Commission on Accreditation for Marriage and Family Therapy Education

was established by the AAMFT Board of Directors in 1974. In 1978, the Commission

gained official recognition by the U.S. Department of Education as the accrediting

agency for the graduate degree and post-degree training programs in marriage and family

therapy. These training programs are located throughout the United States and Canada.

In 1978, in recognition of its increased level of activities and responsibilities, the

Commission was restructured and renamed the COAMFTE.

The Commission on Recognition of Post-secondary Accreditation (CORPA)

officially granted recognition to the COAMFTE in 1994. CORPA is a nongovernmental

organization that works to foster and facilitate the role of accrediting bodies in promoting

and ensuring the quality and diversity of American postsecondary education.








COAMFTE serves under a broad mandate from the AAMFT Board of Directors to

set standards for and accredit master's, doctoral, and post-degree clinical training

programs in marriage and family therapy (COAMFTE, 1994).

Specific standards developed by the COAMFTE (appendix B) outlining the

importance of this study include the following:

320: Area II: Clinical Knowledge

320.02 Area II content will address contemporary issues, which include but are
not limited to gender, violence, addictions, and abuse, in the treatment of
individuals, couples, and families from a relational/systemic perspective.

340.04 Area IV will address the AAMFT Code of Ethics [appendix C],
confidentiality issues, the legal responsibilities and liabilities of clinical practice
and research, family law, record keeping, reimbursement, and the business aspects
of practice. Area IV content will inform students about the interface between
therapist responsibility and the professional, social, and political context of
treatment.

Accreditation Bodies

COAMFTE Preamble to the Standards on Accreditation, Version 10.2

Accreditation is a voluntary process on the part of the program whose major
purpose is to ensure quality in a marriage and family therapy program. All
accredited programs are expected to meet or exceed all standards of accreditation
throughout their period of accreditation. The integrity of an institution and the
program is fundamental and critical to the process of accreditation. Accreditation
standards are usually regarded as minimal requirements for quality training. All
accredited programs are free to include other requirements, which they deem
necessary and contribute to the overall quality of the program. Programs must
continually evaluate their programs in relation to their institution's mission and
their own program mission, goals and educational objectives. Accreditation
standards, like other aspects of accreditation, are part of a slowly evolving,
continuous process. In the long view, there are continuing conversations among
accreditors, training programs, trainees, trained professionals, employers, and
consumers from which the standards and other aspects of accreditation evolve.

The objective of these standards is to assure, as much as possible that individuals
trained in accredited programs are competently trained to become marriage and
family therapists at the entry and doctoral levels. The standards are designed to be
unique to the practice and supervision of marriage and family therapy. Some
standards apply to training programs in general, including elements such as








organizational stability, faculty accessibility, appropriate student selection
processes, and fairness to students and employees. Some standards apply to all
psychotherapy training, including elements such as adequate numbers of client
contact hours and supervision hours.

Graduates from COAMFTE accredited marriage and family therapy programs are
trained to be clinical mental health practitioners. COAMFTE adopts the Standard
Occupational Classification of the Bureau of Labor and Statistics which states that
Mats are qualified to "[d]diagnose and treat mental and emotional disorders,
whether cognitive, affective, or behavioral, within the context of marriage and
family systems. [They] Apply psychotherapeutic and family systems theories and
techniques in the delivery of professional services to individuals, couples, and
families for the purpose of treating such diagnosed nervous and mental disorders."
All persons properly trained in marriage and family therapy are to be competent in
working with individuals. (American Association for Marriage and Family
Therapy, 2003)

Marriage and family therapists are bound ethically by the standards of accreditation

and clinical ethical guidelines to understand the importance of assessing for abuse and

violence with each case. In some cases, the reasons that abuse and violence are present

may be difficult to detect.

Scope of the Problem

Current researchers who report on the treatment of relationship violence have only

recently written that this type of treatment is evolving into a specialized field. Although

for many years there have been specialized treatment programs available in a few states,

it is only recently that the need has been recognized to develop and fund specialized

treatment programs in every state. This recognition has been spurred on by two factors:

(a) increasing and widespread acknowledgement of the extent of the problem, and (b)

increasing acceptance that traditional forms of therapy are not effective with the

relationship violence population (Crawford, 1981).

Two decades of empirical research on child abuse, wife beating, and domestic

violence are conclusive on one point: The causes of violence are multidimensional (Gil,








1971; Straus, Gelles, & Steinmetz, 1980). There is no one cause of this violence-not

poverty, not stress, not mental illness or psychopathology, not being raised in a violent

home, and not alcohol and/or drugs (Gelles & Maynard, 1987).

It is apparent that the treatment for a multidimensional problem would include

varied approaches, depending on the context. Straus's (1973) general systems model of

violence between family members was one of the first theoretical applications of a

systems perspective to family violence. Another presentation of a research systems

model is Giles-Sims's (1985) examination of wife battering. Giles-Sims's systems

models looked at the factors influencing a battered woman's decision to stay, flee, and/or

return to violent relationships.

The Extent of the Problem

Domestic violence is one of the most common crimes. Many of us know someone

in our close family or among our friends to whom it has happened, or we have

experienced it ourselves, but we tend to think that we are different or alone, not realizing

perhaps just how widespread and enduring domestic abuse is. Domestic violence occurs

in almost all cultures and countries, across all known divisions of wealth, race, caste, and

social class. There may never have been a time when it did not exist; it certainly

stretches back deep into history. Centuries, indeed millennia, are filled with millions of

assaults, attacks, rapes, violations, psychological abuses, maimings, killings of women in

their homes by men (Hague & Malos, 1998).

Although it is true that approximately 6 million women in the United States are

beaten in their homes each year, there is more to the domestic violence picture. For

example, 70% of male partners (batterers) also abuse children in the home. More tragic,

boys often attempt to protect their mothers from battering and are themselves injured or








killed. Incredibly, over 60% of males ages 15 to 20 who were incarcerated for homicide

had killed their mother's batterer (Summers & Hoffman, 2002).

Domestic violence is not a new phenomenon. It has been a common occurrence

throughout recorded history. In many societies, women were traditionally considered the

property of the man; his duty was to discipline her and the children (and slaves) with

thorough beatings. The only concerns about this related to the thickness of the stick that

the law allowed for the beatings. Although there were some earlier unenforced laws

against spousal abuse, it was only as recently as the 1970s in the United States that the

justice system began to view the problem seriously and consider domestic violence as a

crime. Up until that time, social services for victims of domestic violence were almost

nonexistent.

There are many contributing factors to domestic violence, usually associated with

differing views of what the problem is based on. Some of these views are learned

behavior, gender socialization, patriarchy or power and privilege, and risk factors,

including criminal or psychological profiles. Even countries view the nature of the

problem differently. For example, some of the risk factors for domestic violence in

England and Wales are gender inequality, poverty, social exclusion, having a criminal

background, and having experienced abuse as a child. The families are classified as

patriarchal (male dominated), and women have a subordinate status. This also seems to

be the case in Italy, where the view is held that religion keeps domestic violence as an

isolated and personal problem rather than a serious social ill. Both the Catholic church

and the state view domestic violence as a personal and private matter. Battered women

are encouraged to return home to their abusing partners. In their zeal to preserve the








family, domestic violence has often been overlooked and even considered "normal." In

Australia, most citizens see domestic violence as rooted in the aggressive nature of men.

Yet the indigenous population sees it as learned behavior. In Jamaica, the problem is

regarded as stemming from a lack of education, abject poverty, drug abuse, and the

mythology surrounding the traditional role of the male. In Russia, Germany, and

Slovenia, major political change is identified as another contributing factor (Summers &

Hoffman, 2002).

Overall, domestic violence presents a profoundly disturbing and distressing picture.

Some people choose to turn away from that picture. Partner abuse is an epidemic with

potentially dire consequences for individuals, families, and society. Family therapists

must be competent to assess for and intervene in abuse situations (Haddock, 2002).

Multiforms of Treatment (Metatheoretical, Postmodernism,
Feminism, Sociocultural, and Social Learning)

Various theoretical and treatment approaches are being used within the relationship

violence field. Four of these approaches are reviewed in this section.

Metatheoretical Approach

Metatheoretical, as a general term, refers to the philosophical (e.g., epistemic,

ontological, metaphysical) assumptions that influence or form the basic structure of

various disciplines in science and the social sciences (Hoshmand, 1996). When working

with batterers, the most therapeutic interventions in cases of relationship violence are still

based on behavioral approaches (Bagarozzi, 1983; Taylor & Gunn, 1984). Cook and

Franz-Cook (1984) presented a systematic treatment approach to wife battering.

Margolin (1979) and Taylor and Gunn proposed conjoint therapy for spouse abuse cases.

The radical feminist perspective and the systemic view of family violence are not








mutually exclusive, and Cook and Franz-Cook stated that treatment based on both views

is necessary and important.

Archer (2000), in a meta-analysis, compared samples selected for male violence

(from battered women's shelters) with community samples to assess whether the couple

violence looked different across these populations. Very high levels of male aggression

were reported in shelter samples, whereas in community samples women were slightly

more physically aggressive. Archer also examined studies of couples undergoing

treatment for marital problems and found that men were slightly more likely than women

to be physically aggressive. However, in contrast to shelter samples, the level of male

aggression was much lower. This suggests that couples receiving counseling, even for

problems specifically related to male violence, do not have nearly the same kind of

imbalance in physical aggression as might be found in couples in which the woman has

sought shelter from abuse (Greene & Bogo, 2002). This study will describe current

empirical research to support a conceptual framework for helping marriage and family

therapists to assess and treat relationship violence. Depending on the context, flexibility

in searching for approaches when working with the needs of couples may be indicated. A

broader lens that takes into account the various faces of intimate violence may expand

alternatives for assessing and treating these couples (Greene & Bogo, 2002).

Postmodernism

Postmodern perspectives have had considerable impact on the field of couple

therapy in the 1990s. Focused on self-organizing and proactive features of human

knowing, they emphasize that reality is constructed, reflecting language, culture, and

social context (Anderson, 1997; Neimeyer, 1993). Meaning and knowledge are seen as

being created through social communication with others. The most radical forms of








constructionism see every case as unique and suggest that no single version of reality or

problem formulation is better than another. Problems are viewed as "interpretations" that

can be "dis-solved" in language (Anderson).

Specific techniques have been developed in solution-focused and narrative

therapies to help clients to "deconstruct" the problematic aspects of their relationship and

allow new possibilities to emerge. However, there are many ways to help clients to

create new meanings and many ways to access and work with aspects of experience that

have gone "unstoried." More generally, this perspective may be viewed as an "attitude"

or philosophical stance for therapy rather than as a model for intervention or a set of

techniques.

From a respectful, collaborative stance, therapists regard clients as experts on their

own reality and discover with clients how they construct that reality. Therapists show

sensitivity to each individual and enlarge the frame to include larger contextual issues,

such as gender, class, and culture. Therapists also focus more on a couple's strengths and

competencies, striving to honor and validate clients' wisdom and strengths in dealing

with difficult realities. Social-constructionist ideas can also be integrated with more

traditional research if certain guidelines are followed (Myers Avis, 1996); for example, if

researchers recognize and reveal their own values and beliefs with the research context.

Sociocultural Theory

The search for the causes of domestic aggression has focused largely on

sociocultural and psychological factors. It has been a short search, the primary strategy

of which has been to identify characteristics of participants that distinguish them from

their nonaggressive counterparts. It has been an theoretical search in which theory is

occasionally invoked, post hoc, to explain one or another research finding. Social








learning theory, for example, is used as an explanation for the intergenerational

transmission of aggression, and female masochism is sometimes employed to account for

the battered woman's reluctance to leave an abusive mate (Rosenbaum & O'Leary,

1981).

Sex-role socialization, in general, tends to support the notion that the success or

failure of intimate relationships is the woman's responsibility, and this may lead some

women to make great efforts to stay in intimate relationships, even after episodes of

abuse, to show their commitment to their partner and to weathering the "difficult times"

together (Dutton & Painter, 1981; Strube, 1988). In addition, when an abusive event

occurs, the woman may presume that it will not recur, and so will "try to make the

relationship work under the belief that, if she tries hard enough, her efforts will succeed"

(Strube, p. 240).

Sociological and sociocultural theory assumes that social structures affect people

and their behavior. The major social structural influences on family violence are age,

gender, position in the socioeconomic structure, and race and ethnicity (Gelles, 1983).

Social Learning Theory

According to Bandura's (1973, 1977) social learning analysis of aggression,

witnessing interparental violence may predispose some young males to abusive behaviors

in their adult intimate relationships with women. Social learning theory maintains that

violence (in the form of a learned response) is transmitted from the family of origin to the

adult intimate dyad through the vicarious reinforcement of interpersonal violence as a

method of conflict resolution and a means to the maintenance of power and control in

intimate relationships.








In addition to external reward/punishment contingencies, Bandura (1973)

proposed that the following self-regulatory mechanisms modulate self-recrimination

processes by "neutralizing" aggressive behaviors: (a) justification of the behavior on the

basis of some higher authority (e.g., scripture); (b) comparison of the behavior with more

serious violence; (c) projection of responsibility for the behavior onto drugs, alcohol,

work stressors, or the provocation of the victim; (d) normalization of the behaviors as a

common and socially acceptable occurrence; (e) depersonalization of the victim through

the use of disparaging labels; and (f) minimization of the consequences of the behavior.

One or more of these neutralizing tactics have been observed among batterers in

treatment (Carden, 1994).

Treatment for Battered Women

Varieties of counseling approaches have been proposed for battered women in

recent years, including grieving, existential, and shame therapy (Turner & Shapiro,

1986). Some of these approaches are reviewed in this section.

Empowerment and safety-based interventions have been found useful. In her text

Counseling Female Offenders: A Strength-Restorative Approach, Katherine Van

Wormer (2001) established a link between the crimes of female offenders and

environmental factors such as substance abuse and sexual abuse. Combining strategies

from the fields of criminal justice and social work, she showed how to empower female

offenders and how to rehabilitate them to society by building on their personal strengths.

From her unique "strengths-restorative" approach, the author presented strategies for

anger management, substance abuse treatment, and domestic violence counseling.

In 2000, the University of Northern Iowa applied for and received a federal grant

to combat gender-based violence in a comprehensive manner. The planning and








implementation of the grant used an interdisciplinary approach, linking pre-existing law

enforcement, prevention programs, and victim services while adding a variety of new

tools and efforts. Below are some of the new and expanded programs offered as part of

the Violence Against Women grant. Some of the programs that they have developed are

RAD-Rape Aggression Defense Class and a Blue Light program, with five blue light

safety phones spread throughout the campus. These are some examples of safety

prevention programs that are effective and work well to decrease violence on campuses

(University of Northern Iowa, 2003).

Fundamental to the counseling efforts should be a design to move the battered

woman from status as a "victim" to that of a "survivor" (Rieker & Carmen, 1986). It is

this shift in self-perception that is most associated with safety and recovery (Gondolf &

Fisher, 1988).

The Duluth Model (Minnesota Program Development, 2003) contacts partners of

offending men and offers advocacy, community resources, and a women's group. The

model uses a curriculum called In Our Best Interest: A Process for Personal and Social

Change for their battered women's group. Women who have been arrested for using

violence are also ordered to attend nonviolence classes.

According to several victimization studies, battered women tend to move through

several phases in response to abuse (Ferraro & Johnson, 1983; Mills, 1985). These

phases are distinguished by an attributional shift on the woman's part. In essence, she

begins to perceive that the battering was not "all her fault" but was largely due to her

husband's behavior. It is not up to her to change the batterer; in fact, it is not likely that








he will change. Instead, she is capable of taking care of herself, with the support and

assistance from others that she deserves (Gondolf & Fisher, 1991).

Therefore, the objective in counseling might be to reinforce and encourage this

realization. Many shelters subscribe to an "empowerment" mode of counseling to

achieve this end. The feminist approach is directed toward helping the woman to realize

her options and choices and to begin to make decisions that assure her worth, integrity,

and determination (Bograd, 1988). One study of formerly battered women rated this sort

of counseling to be the most effective in stopping violence (Bowker, L., 1983).

Some clinicians (e.g., Almeida & Durkin, 1999) who are sensitive to issues of

power, abuse, and trauma have recommended the use of gender-specific support groups

for the victim as the most appropriate treatment strategy. It can be noted that a

combination of individual and group treatment is often desirable.

Some theorists have argued against the use of couples therapy in situations of abuse

(Avis, 1992; Bograd, 1992; Dutton; 1992). However, feminist-identified family

therapists have begun to experiment cautiously with the use of couples treatment in

situations of abuse (Goldner, Penn, Sheinberg, & Walker, 1990; Jenkins, 1990; Jory &

Anderson, 2000). Some therapists are using proposed criteria to determine situations in

which couples therapy may be appropriate. These indicators, listed by Bograd and

Mederos (1999), rule out the appropriate use of couples therapy. Since the issues of

partner abuse situations are complex, therapists should resist formulaic approaches to

treatment planning. Relevant variables should be carefully considered in making

treatment decisions, such as the power differential between the partners, the nature and

extent of the abuse, lethality indicators, the effects of the abuse on the victim, the ability








of the victim to stay safe, the resources of the victim, the responsibility taken by the

perpetrator, and the commitment to change demonstrated by the perpetrator (Haddock,

2002).

Treatment for the Batterer

The treatment of batterers has similarly seen a proliferation of approaches and, with

it, increased debate. The leading programs are characterized by group process that

prompts men to take responsibility for their abuse, to exercise alternatives to the violence,

and to restructure their sex-role perceptions (Gondolf, 1987b). However, there is a

questionable trend toward short-term anger control treatment that unwittingly reinforces

the batterer's penchant for control (Gondolf & Russell, 1986).

The research on cessation suggests that batterers who reform their behavior pass

through a series of developmental stages (Fagan, 1987; Gondolf, 1987a). The change

process begins with "realization." The egocentric batterer acknowledges the

consequences of his abuse and that it may be in his own self-interest to contain the anger

that led to the abuse. Gradually, the batterer becomes more "other oriented" and begins

to make "behavioral changes" to improve relationships, or at least to avoid totally

destroying them. Some men eventually begin to think more in terms of values and

principles and integrate these into a change of self-concept. Consequently, a number of

leading batterer programs employ a phased approach that moves batterers from didactic

sessions of accountability and consequence to social support groups with a focus on

service (Gondolf, 1985).

When treating batterers, marriage and family therapists should be aware of the

heterogeneity among batterers across several dimensions, including the severity of the

violence and the psychopathology and physiological responses of the batterer








(Holtzworth-Munroe, Smutzler, Bates, & Sandin, 1996; Jacobson & Gottman, 1998).

Understanding the differences between two types of batterers-Type 1 ("cobras") and

Type 2 ("pit bulls")-can also be useful (Gottman et al., 1995; Jacobson & Gottman).

These typologies are described in the literature review section of this dissertation.

According to Haddock (2000), novice therapists should be advised against treating

most perpetrators of abuse; indeed, for court-ordered batterers, most states mandate

certain kinds of treatment by certified professionals. Therapists should be familiar with

local agencies that serve batterers and the methods for making referrals to local batterer-

specific treatment programs.

Duluth Model

In 1981 nine city, county, and private agencies in Duluth, Minnesota, adopted

policies and procedures that coordinated their intervention in domestic assault cases.

These measures focused on protecting victims from continued acts of violence by

combining legal sanctions, nonviolence classes, and, when necessary, incarceration to

end the violence. Consistently applied, their message to offenders is clear: "Your use of

violence is unacceptable."

The Domestic Abuse Intervention Project (DAIP) was the coordinating agency for

this effort. An additional component of the DAIP was the nonviolence program, which

consisted of classes for offenders who were court-ordered to the programs. The programs

used the curriculum "Power and Control: Tactics of Men Who Batter," a 24-week

educational curriculum (Pence & Paymar, 1993).

Batterer intervention programs, which seek to educate or rehabilitate known

perpetrators of IPV to be nonviolent, have proliferated since the 1980s under the auspices

of both the criminal justice system and the mental health system. Three theoretical








approaches to the conduct of these programs have been consistently documented (Healey,

Smith, & O'Sullivan, 1997): society and culture, the family, and the individual. These

theories influence the content and delivery of interventions.

Society and Culture

Feminist theorists attribute battering to social and cultural norms and values that

endorse or tolerate the use of violence by men against their women partners. The

feminist model of intervention educates men concerning the impact of these social norms

and values and attempts to resocialize men through education, emphasizing nonviolence

and equality in relationships.

It has been well documented by feminist researchers that gender is a central

organizing principle for both individuals and couple relationships and therefore must be

an integral feature in family therapy (Goldner, 1985; Hare-Mustin, 1986). More research,

analysis, and understanding are needed regarding how intersecting factors such as gender,

class, race, and ethnicity operate in cases of couple violence.

We must acknowledge the limits of generalizations that can be made on the basis of

populations included in research to date. Most couple therapy clients are White and

middle class. The considerable influence of cultural diversity and changing gender roles

is, as yet, largely unexamined (Johnson & Lebow, 2000). The adaptation of couple and

family therapy to consider the impact of culture will be a vital concern of future research

in the field.

The Family

Family-based theories of IPV focus on the structure and social isolation of families.

The family systems model of intervention focuses on communication skills, with the goal

of family preservation, and may use couples counseling/conjoint therapy. Wife battering,








like other forms of family violence, raises a variety of family issues. But, unlike child

and elder abuse, it threatens the very foundation of the family structure-the marriage (or

partnership). Therefore, the most crucial family issue is whether the family is to

continue. Given the tendency of wife battering to escalate and denial of the problem to

persist, most practitioners in the field have, in the past, strongly recommend separating

the batterer from the battered women and children (Gondolf & Fisher, 1991).

The Individual

Psychological theories attribute perpetration of IPV to personality disorders, the

batterer's social environment during childhood, or biological predispositions.

Psychotherapeutic interventions target individual problems and/or build cognitive skills

to help the batterer to control violent behaviors.

Summary

Currently, there is little evidence to suggest the effectiveness of one approach over

another or of the differential effectiveness of different programs with different "types" of

batterers, although one study has suggested that process-psychodynamic groups may

function better for men with dependent personalities and cognitive-behavioral groups

may be more effective for those with antisocial traits (Saunders, 1996).

The most widely evaluated intervention model for men who batter is that of group

interventions using cognitive-behavioral techniques, often in combination with feminist

content. One review of these studies reported that rates of successful outcomes (i.e.,

reduced or no reassault) from these programs varied from 53% to 85% (Tollman &

Bennett, 1990). However, other reviews have pointed out those methodological problems

in the studies limit conclusions about the effectiveness of such programs.








Graduate Training in Relationship Violence:
Identification of Training Needs

The importance of intervening in cases of so-called "minor" spousal violence is

underscored by the assumption by many researchers that minor violence, if left untreated,

can escalate into severe or life-threatening violence (Rosenberg, 1985). In most graduate

programs, this area of assessment is poorly presented, unless graduate students

specifically discuss relationship violence during intake. Research suggests that, unlike

graduate students, emergency personnel are well trained in this area of assessment, since

these personnel are primarily working the "front lines" with respect to relationship

violence victims. These personnel have incorporated violence assessments into their

intake procedures.

According to Wolf-Smith & LaRossa (1992), professional counselors, therapists,

and social workers have an obligation to help victims to gain insight into their abuse.

They also have an obligation to be nonjudgmental of whatever decision a woman makes

about her abusive relationship. Professionals provide varied services to victims and their

families to help heal the effects of violent relationships. Treatment providers may

recommend many different approaches, including individual, group, and/or family

therapy. However, the specific treatment approaches that are currently being taught in

graduate school training for counselors are unknown. Furthermore, it is unknown

whether the treatment recommended varies depending on the context of the case. Are

professionals being trained to treat the victim? the batterer? the couple? the individual?

the family? Is there coursework from a relationship-violence context or through a

relational violence lens? This information would allow the professional counselor to gain

knowledge in treating clients who present with issues of relationship violence.








"Victims of male battering face difficult choices-choices about what to say to

their abusers, choices about whether to stay. Respecting the choices that women make is

an integral part of the counseling/therapeutic process" (Wolf-Smith & LaRossa, 1992,

p. 324).

Understanding the tendency to reduce the inherent complexity of partner abuse

cases in response to concerns about potential lethality, therapists would benefit by

learning to conceptualize each case within its own unique and multifaceted context

(Dutton, 1992; Goldner, 1999), while attending to the intersections of gender, race, class,

religion, and sexual orientation (Bograd, 1999).

Goldner's (1992, 1999) "both/and" stance can be introduced as a way to manage

these complexities.

There is an enormous pressure to "get it right" immediately and, as a result, the
impulse is to lapses into extremes: to side with one partner against the other, to
refuse to ever take sides at all, to exaggerate or minimize danger, to insist on a
particular paradigm and argue against all others-in other words, to polarize
everything. (Goldner, 1992, p. 56)

Part of the difficulty for faculty and marriage and family supervisors in training

students effectively has been that the domestic violence literature includes disparate and

controversial findings. On the one hand, studies of community samples find generally

low levels of violence perpetrated by both males and females. On the other hand, studies

of clinical samples drawn from courts, hospitals, and shelters find severe violence,

mainly perpetrated by men (Archer, 2000; Johnson, 1995). For instance, feminist

researchers have studied primarily clinical samples and have concluded that intimate

violence is the result of patriarchy and, thus, is primarily perpetrated by men as a means

to maintain power and control (Dobash & Dobash, 1979; Pagelow, 1984). Family

conflict researchers have studied mainly representative community samples and have








concluded that intimate violence between partners results from individual, relational, and

societal variables that tend to be more gender neutral (Berkowitz, 1993; Straus & Smith,

1990). These two different perspectives have led to a longstanding debate about the

veracity of each position, which impacts training in terms of approaches taken to address

the identified problem.

The majority of studies on couple violence have limitations, notably largely using

samples involving only severely violent men. Conclusions and conceptualizations about

violence and appropriate clinical interventions have been generalized from these samples

to all couples in which there is aggression (Johnson & Ferraro, 2000). Comparably little

research has involved couples voluntarily seeking conjoint treatment for intimate

violence (Brown & O'Leary, 1997). Despite growing evidence of difference between

these populations, distinctions have yet to be included in assessment (Greene & Bogo,

2002).

Assessment of Violence in Treatment

For those professionals using traditional assessment methods, rather than

assessments geared toward gleaning information about relationship violence, clients may

be allowed to "maintain the silence," since appropriate questions are not asked initially.

Without vital skills in assessing relationship violence specifically, counselors are more

likely colluding with the system to maintain the violence and thus may be putting their

clients at risk. It is unclear why the majority of counselors are not trained in this

important area of assessment.

Previous research establishes a precedent for needed improvements in the education

and training of psychotherapists. For example, Hansen, Harway, and Cervantes (1991)

surveyed the national membership of the AAMFT. Therapists participating in the survey








were asked to read two vignettes with proven therapeutic interventions for domestic

violence cases portraying female victims and domestic violence. The results indicated

that most of the counselors did not attend to the seriousness of the violence and many did

not attend to it at all. Indeed, one of the vignettes was based on an actual case study in

which a family member had been killed. In this survey of 362 members of the AAMFT,

respondents were asked to conceptualize the case and to describe how they would

intervene. Forty-one percent of those surveyed indicated no recognition of domestic

violence.

The use of various written assessments for detecting abuse and violence may prove

beneficial. One such instrument is the HCR-20: Assessing Risk for Violence (Version 2)

by Webster, Douglas, Eaves, and Hart (1997). Another assessment tool is the Clinical

Guidelines on Routine Screening published by the Family Violence Prevention Fund and

available at no cost from their Web site. This includes screening questions, history intake

form, abuse assessment screen, domestic violence screening/documentation form,

assessment of patient safety, referrals, reporting procedures, and photographs that might

be taken (Family Violence Prevention Fund, 2003)

To underscore the importance of assuming abuse with each case until ruled out,

Bograd and Mederos (1999) developed a comprehensive protocol for screening for abuse.

Therapists should also be informed of other written instruments, including multimodal

assessments of partner abuse (Alderondo, 1998; Alderondo & Strauss, 1994; Gottman,

1999).

In her 2002 text Seeking Safety: A Treatment Manual for PTSD and Substance

Abuse Najavits discussed safety plans as well as many other resources, including








individual and group therapy guidelines. Seeking Safety also provides clinicians with a

session format, including a check-in and check-out procedure that helps the client to

commit to safe coping strategies.

Dunford (2000), along with other researchers (Holtzworth-Munroe, Meehan,

Herron, Rehman, & Stuart, 2000; Saunders, 1996; Waltz, Babcock, Jacobson, &

Gottman, 2000), has suggested that treating physically aggressive men as one

homogenous group, rather than tailoring interventions according to the different

motivations and needs of physically aggressive men, could be responsible for the

ineffectiveness of treatment. Dunford urged therapists to give "full and preferential

attention" to the possibility that one-size-fits-all approaches to treatment may not meet

the needs of these couples (p. 475). Examining the effectiveness of distinguishing

between couples in various types of violent relationships and tailoring treatment

interventions accordingly constitutes a promising area for future clinical exploration and

empirical research (Greene & Bogo, 2002)

In the cases of common couple violence, intervention should maintain a dual and

simultaneous focus on both anger management and relationship building. Gottman's

(1999) research has also highlighted the importance of addressing issues beyond conflict,

such as strengthening the marital bond.

Statement of the Problem

Partner abuse is an epidemic with potentially dire consequences for individuals,

families, and society. As part of responding to this epidemic, researchers and clinicians

suggest that therapists should develop competence in the areas of assessing and treating

violence.








Intrafamilial violence has been documented in relationships of every race, religion,

social class, and educational level (Straus & Gelles, 1986; Straus et al., 1980; U.S.

Department of Justice, 1984, 1992). In response, theorists and practitioners have created

specialized treatment methods and programs for recovery from relationship violence

(Bagarozzi, 1983; Cook & Franz-Cook, 1984; Dobash & Dobash, 1979; Giles-Sims,

1981; Margolin, 1979; Straus, 1973; Taylor, & Gunn, 1984; Walker, 1979). However,

battered victims often enter counseling with a marriage and family therapist without

having knowledge about what type of treatment may be recommended.

Need for the Study

Data on the prevalence and seriousness of intimate partner violence vary, but they

unequivocally establish partner abuse as a widespread and serious problem among

heterosexual, gay, and lesbian couples (Bograd & Mederos, 1999; Carillo & Tello, 1998;

Renzetti, 1997). Haddock (2002) suggested that it is imperative that family therapists

possess the knowledge and skills to manage partner abuse cases effectively.

The most significant theories on treatment approaches are discussed and

highlighted in this dissertation. The results of this study will have broad implications for

curriculum development on the graduate level of counseling programs and graduate

institutes, mental health policy and codes of ethics, social policy, and, most important,

counselor efficacy in treatment of relationship violence.

If specific treatments are recommended more often because they are believed to

produce positive outcomes, clinicians may be able to utilize these available interventions.

Since family violence is multifaceted and multidimensional, this research may help

clinicians to determine alternative treatment modalities that will prove to be successful

when working with a relationship violence population.








Clearly, this information will help graduate programs to provide better and more

informed, theoretically based training on the topic of relationship violence, which in turn

will produce clinicians who can effectively assess risk factors for relationship violence,

effectively treatment plan, create safety plans with clients, and provide valuable services

to clients with problems in the area of relationship violence.

Data will be collected to answer the following questions:

1. How do MFTs rate themselves on their knowledge in the identification,
assessment, and treatment of relationship violence?

2. How do MFTs rate their graduate training in the identification, assessment, and
treatment of relationship violence?

3. How do MFTs rate the importance of specified competencies and skills in the
identification, assessment, and treatment of relationship violence?

Future credentialing boards may have to expand requirements regarding training

hours required in domestic violence training. By surveying professionals in marriage and

family therapy, this study will provide information that may assist credentialing boards,

graduate and institute training programs, and third party payers for this specific client

group.

Implications of this study are not limited to graduate training programs and

counseling professionals. Since this treatment issue is embedded in the context of legal,

educational, medical, emergency, social, and family services, all are affected by advances

in prevention and treatment programs for relationship violence.

The results of this study and its external validity will help to inform theoretical

constructs in the area, as well as the current status of graduate training in relationship

violence. Future research may focus on specific methodology and identification of which

techniques are most often recommended in these cases.








As a result of this research, graduate schools, program developers, and managed

care companies may want to create assessments that include questions addressing

relationship violence to better serve their client base. These providers may find it more

cost effective to screen thoroughly clients who may be in current danger for violence.

Mental health professionals across disciplines may be able to use the results of this study

to facilitate the prevention and treatment of relationship violence.

Purpose of the Study

The specific type of method of inquiry for this study is a Web-based survey

developed by the researcher to gain information on factors related to the current status of

graduate-level preparation on relationship violence within four main subtopics regarding

relationship violence: identification, assessment, treatment, and training.

The primary purpose of this study is to determine the factors most frequently

reported by MFTs to be related to the identification, assessment and treatment of violence

via (a) a self-rating scale of their knowledge in the identification, assessment, and

treatment of relationship violence, (b) a self-rating scale of their graduate training in the

identification, assessment, and treatment of relationship violence and (c) their rating of

the importance of competencies and skills in the identification, assessment, and treatment

of relationship violence. The populations to be sampled are licensed marriage and family

therapists, approved marriage and family therapist supervisors, and marriage and family

therapy faculty.

The results of this survey would be helpful to the field of marriage and family

therapy, as it will help to inform researchers regarding the current status of theoretical

constructs currently being used in the field. The results of this survey would also be

helpful in looking at clinical patterns that may be generalizable to the larger population of








marriage and family therapists, accreditation boards, and marriage and family therapist

faculty and training programs.

The variables in this study are (a) the quality of graduate training in the

identification, assessment, and treatment of relationship violence as reported by MFTs,

and (b) competencies in the identification, assessment, and treatment of relationship

violence as reported by MFTs. Additional variables are (a) the MFTs' self-rating of their

knowledge in the identification, assessment, and treatment of relationship violence;

(b) their ratings of the adequacy of their graduate training in relationship violence; and

(c) their ratings of the importance of specified competencies and skills in the

identification, assessment, and treating of relationships violence. Specific competencies

and skills to be rated by the respondents include assessing for relationship violence,

assessing imminent danger, performing assessments quickly, understanding batterers'

typologies, identifying clients' strengths, and recognizing the signs and symptoms of

relationship violence, their ability to adhere to ethical standards, their use of multicultural

mode, their ability to include identification of risk factors in their assessments of clients,

and their ability to recommend risk assessment manuals. Intervening or extraneous

variables are demographics items such as gender, age, marital status, sexual orientation,

race, discipline, years of experience, and accreditation.

The study will examine the following question: What factors are most frequently

reported by MFTs to be related to the identification, assessment, and treatment of

relationship violence?

Rationale for the Study

Given the magnitude of the problem of intrafamilial violence, it is reasonable to

assume that clinical counselors in hospitals, colleges, corporations, agencies, and private








settings already interact on a regular basis with perpetrators and victims. This especially

includes those working in the field of alcohol and other drug addictions. To treat

relationship violence effectively, it is essential that these practitioners be informed about

personality factors associated with spouse abusers; transactional dynamics of perpetrators

and victims; and the structure and comparative effectiveness of existing intervention

strategies. Counselors and researchers, as experts in psychosocial development,

personality dynamics, and change processes, have much to contribute in the way of

theoretically and empirically derived answers to the questions, "Why does he do it?"

"What will stop him?" and "Why does she stay?" (Carden, 1994).

Although some models derived from certain perspectives (systemic or feminist)

seem to "fit" better with certain types of violence, there is a growing recognition in the

family therapy field of the need to integrate various theoretical perspectives and practice

models for effective practice. Johnson and Lebow (2000) saw the trend toward

integration as a "sign of a maturing field that general principles and interventions become

delineated and applied in varying formats and context" (p. 32).

Lebow (1997) believed that integrative approaches have the potential to offer

greater flexibility, an increased repertoire of interventions, higher treatment efficacy, and

greater acceptability among clients. The last of these is particularly important in

domestic violence cases, given that many clinicians have noted that women and men

often want to be seen together (Goldner, 1999; Lipchick & Kubicki, 1996; Shamai,

1996). Shamai noted how the categorical dismissal of systemic principles in the treatment

of domestic violence, may be akin to "throwing the baby out with the bath water" (p.








202) and serves to detract from efforts to develop a more effective, broader range of

interventions.

Goldner and her colleagues at the Ackerman Institute (Goldner, 1998, 1999;

Goldner et al., 1990) spent 10 years developing an integrative treatment model for

intimate violence in which systemic and feminist perspectives inform and enrich one

another. They have articulated how each of these perspectives in isolation from the other

serves as an insufficient explanatory framework, and they highlight the need to move

from an either/or orientation to a both/and position. Over the years, a complex and

sophisticated "multisystemic" approach to treatment, consisting of several different

approaches-feminist, systemic, psychodynamic, narrative, neurobiological, and

behavioral-has been integrated under the guiding principle that one level of description

or explanation does not have to exclude another (Greenspun, 2000).

This research and its results will advance the existing knowledge in thie relationship

violence field as it is part of a programmatic research effort. That is, when the results of

the study are considered in relation to other concurrent and/or sequential studies, there

may be theoretical and/or practical applications to the marriage and family field of

research.

Definitions of Terms

For purposes of this study, relationship violence is defined as any unwanted

physical, sexual, emotional, or financial control or power between two partners who are

in an intimate relationship. Verbal aggression would be included in the definition of

relationship violence.

Several terms are used in the literature to identify and describe family members

affected by relationship violence. In particular, offender or perpetrator refers to the








person who has committed the crime of domestic violence. The terms survivor or victim

are utilized in this study to identify a male or female adult who has experienced violence

in an intimate relationship.

According to the Florida Statute 741.28-741.31,

Domestic violence refers to any assault, aggravated assault, battery, aggravated
battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping,
false imprisonment, or any criminal offense resulting in physical injury or death of
one family or household member by another who is or was residing in the same
single dwelling unit.

Family or household member means spouses, former spouses, persons related by
blood or marriage, persons who are presently residing together as if a family or
who have resided together in the past as if a family, and persons who have a child
in common, regardless of whether they have been married or have resided together
at any time.

In feminist writing on the patriarchal structure and content of language, writers

stress that women's experience is silenced and made invisible by the lack of words with

which to name it (Daly, 1978; Spender, 1980). A major contribution of feminist social

action around sexual violence has been to provide or create new terms with which to

describe and name the experience. For example, the terms battered woman and sexual

harassment did not exist 20 years ago. Even if a name exists and is known, the way it is

understood can vary greatly. For example, feminists have challenged the limited

traditional definitions of forms of sexual violence by expanding the definition of rape to

include unwanted and/or forced intercourse between husband and wife and by including

psychological abuse and coercive sex in the definition of domestic violence. Limited

definitions tend to draw on stereotypes of forms of sexual violence, stressing particular

features and ignoring others (Kelly, 1988).

In this study, individual therapy is used to describe sessions with an individual

client alone, using individual techniques and theories of counseling. Conjoint therapy (or








couples therapy) is used to describe sessions with a couple or dyad together. Group

therapy is used to describe therapy involving three or more clients and a counselor.

Family therapy is used to describe a variety of counseling approaches that work with

family members together in a session with a counselor.

The term survey is used to include cross-sectional and longitudinal studies using

questionnaires or structured interviews for data collection with the intent of generalizing

from a sample to a population (Babbie, 1990). A variable is a discrete phenomenon that

can be measured or observed in two or more categories (Kerlinger, 1979). Psychologists

use the term construct interchangeably with the term variable, according to Kerlinger.

Variables could be gender, age, SES, or attitudes or behaviors such as racism, social

control, political power, and socialization. Because the phenomena vary (in two or more

categories), they are called variables (Creswell, 1994).

Organization of the Dissertation

Presented in chapter 2 is a review of the related literature, including an overview of

relationship violence and the training of family therapists. Individual, group, conjoint,

and family therapy treatment modalities are discussed as they apply to the population of

this study. Presented in chapter 3 is a description of the methodology for the study,

including the research design, sample, Internet survey, instruments, and data analysis.

Chapter 4 presents a demographic description of the participants and results of factor

analysis of the data. Chapter 5 presents an evaluation and discussion of the results,

identifies the limitations of the study, discusses implications of the findings, and presents

a conclusion to the study.













CHAPTER 2
REVIEW OF THE LITERATURE

To review what was stated in Chapter 1, this study will be organized around four

points of research and literature review. They are (a) increase in incidence of relationship

violence as indicated by statistics; (b) professional responsibility: legal, ethical, and

therapeutic issues; (c) multiforms of treatment (metatheoretical, postmodernism,

feminism, sociocultural, and social learning); and (d) identification cf training needs.

Increase in Incidence of Relationship Violence

Violence in America has reached epidemic proportions and is exceeding the

capacity and the responsibility of law enforcement alone to curtail it. Although still

unacceptably high, overall criminal violence statistics have declined in recent years.

However, the frequency and severity of violence against children, women, and the elderly

are increasing at alarming rates. Between 1986 and 1993, reported cases of child abuse

and neglect increased by 98%, while reported cases of elder abuse increased by 106%. It

has been estimated that one woman in the United States is physically abused by her

husband every 9 seconds (Heise, Ellsberg, & Gottenmoeller, 1999). Every day in the

United States, four women murdered by male partners. This horrific fact is made worse

by the realization that there are more women killed in acts of domestic violence in any 5-

year period than all of the Americans killed in the Vietnam War (Berry, 1998).

Preventing violence and providing appropriate treatment for the victims of family

violence are important concerns for the health care system and society. Training

professional counselors in the current approaches to treating family violence is an area








that has recently drawn much attention. Incorporating family violence coursework into

graduate training programs is an ethical decision with which each department is faced.

The incidence of graduating students who are ill prepared to handle complex cases

involving family violence does not serve future clients, the clinician, or the community in

which the violence is occurring.

Interpersonal relationship violence has a long history as a deep-seated social

phenomenon. Several social historians have documented the informal and formal

sanctions that have encouraged wife battering (Davidson, 1978; Martin, 1976; Pleck,

1987). In early 19th-century America, a husband was permitted to discipline his wife

physically without prosecution for assault and battery. The legendary "rule of thumb"

law derived from English common law eventually restricted the instrument of wife

beatings to a stick no thicker than the man's thumb. Only in the past 15 years have courts

finally considered wife battering to be a criminal offense. These historical circumstances

led several social scientists to explain that men batter women basically because they are

permitted and encouraged to do so (Gelles, 1983).

Such "selective inattention," as it has been called (Pleck, Pleck, Grossman, & Bart,

1978), has important social implications. It was not until the women's movement in the

1970s identified and responded to wife battering that it emerged as a "social problem"

(Tiemey, 1982). Prior to this time, social scientists, physicians, social workers,

psychologists, and clergy had virtually overlooked and even denied that wife battering

existed. This markedly contrasted the extensive professional involvement in the issue of

child battering (Finkelhor, 1983).








Feminists concluded that such negligence was a symptom of the sexist attitudes

that pervade our society and contribute to relationship violence (Martin, 1976).

According to the feminist analysis, wife battering is the rape, sexual harassment, incest,

and pornography to which women are disproportionately subjected. To address this

problem and compensate for what other social services and the criminal justice system

have largely shunned, nearly 1,000 women's shelters were established across the country,

largely through the grass roots efforts of the women's movement of the 1970s (Schechter,

1982).

While differences remain over the definition of battering and its dynamics, there is

consensus that social services have inadequately responded to the problem. Clergy have

been accused of promoting compliance and submission to the abusive man (Horton,

1988); physicians have tended to identify battered women as "troublesome" (Kurz,

1987); police have, for the most part, taken a "hands off" approach (Dolon, Hendricks, &

Meagher, 1986); psychiatric staff are inclined to overmedicate battered women and return

them to their spouses (Gondolf, 1990).

These deficiencies are reflected in the observations of battered women. A survey

of formerly battered women rated women's shelters to be the most effective avenue in

helping to end the violence. Lawyers were the next most helpful. Other forms of social

service were, on the whole, rated as less than satisfactory (Bowker, L., 1983, 1986).

Partner violence has many causes. This is one of the reasons that there is no single

solution. The major points discussed in this chapter are viewed through a multitude of

lenses, including looking at power, sociocultural factors, worldwide prevalence of

relationship violence, feminist views, social learning theory, and the social structure of








our society. Treatment philosophies and batterer's typologies are also discussed. Current

literature is reviewed to identify risk factors for relationship violence.

Professional Responsibility: Legal, Ethical, and Therapeutic Issues

Licensing Boards

A skill deficit of the magnitude described above poses legal problems for licensing

boards, accreditation boards, and academic and training institutions overseeing therapists.

The various boards and institutions would theoretically be ethically and morally

responsible to victims of family violence if therapists were not properly trained to assess

and intervene in these specialized cases. Therefore, more training and specialized

programs should be developed to meet the growing demand of family violence cases that

professionals treat. Counselors are well trained to initiate screening for suicide but not as

likely to screen for safety issues related to domestic violence (Jansinski & Williams,

1998).

Lack of Training in Family Violence

One reason for the lack of appropriate training in prevention and treatment of

family violence is thought to be that professionals are uncomfortable in asking clients

about possible violence. This discomfort is common and should be explored with

counseling students during their training and supervision (Jansinski & Williams, 1998).

A supervision practicum in family violence issues would make the training component

more comprehensive; individual issues that face students regarding this issue could be

discussed.

Counselor education programs should include in their curriculum a course in family

violence or should address this theoretical approach in one or more core classes.

Students should be informed regarding methods of family violence assessment and








should be given vignettes to test their level of mastery in this skill area. Such training

should take place before students are made eligible for practicums or internships.

Requirements such as these would better prepare students to treat family violence cases

effectively.

Minimum State Requirements for Training

Currently, most states require a minimum of 2 hours in domestic violence training

for licensure or professional credentialing. In 2003 California has led the way by

increasing the minimum state requirement to 6 hours in domestic violence training.

However, some state and profession licensing and credentialing bodies have no required

training in the area of relationship violence.

In her article on training family therapists to assess for and intervene in partner

abuse, Haddock (2002) summarized core assumptions regarding curriculum development

in this area. First, feminist theoretical perspectives and treatment approaches are

essential to the effective treatment of partner abuse; however, privileging feminist

explanatory theories and treatment protocols do not disallow the inclusion of

complementary theoretical explanations and approaches (Goldner, 1992, 1999). The

second core assumption presented by Haddock was that therapists should be exposed to

current developments, controversies, and inconsistencies in the theoretical literature;

however, they also should be provided with specific principles, protocols, and skills to

guide their clinical work. The third core assumption presented by Haddock was that,

given therapists' tendency to reduce the inherent complexity of partner abuse cases in

response to concerns about potential lethality, therapists should learn to conceptualize

each case within its in own unique and multifaceted context (Dutton, 1992; Goldner,

1999), while attending to the intersections of gender, race, class, religion, and sexual








orientation (Bograd, 1999). The fourth core assumption presented by Haddock was that

therapists should be cautioned to utilize the most conservative assessment and treatment

approaches and to obtain direct and close supervision on cases involving partner abuse.

Theoretical Constructs Underlying the Study

Feminist View

Many different approaches are used when counseling battered women and

perpetrators of relationship violence. One approach is the feminist approach, in which

the batterer is viewed as being completely responsible for the battering. Feminists view

the battering as a criminal act that is used to control, intimidate, and inflict harm

(Goldner, 1999).

Walker (1995) particularly broadened the playing field by bringing in anecdotes

about how to match certain types of batterers with specific psychotherapies. Given the

sociopolitical context in which battering occurs, if psychotherapy is to be successful in

the treatment of battering, it must be integrated within a community-wide response. This

would involve coordination among therapists, police officers, probation officers,

prosecutors, judges, and advocates. Walker (1995) claimed that the Duluth model (Pence

& Paymar, 1993) is particularly promising, since treatment includes attention to the entire

social context of battering through community organizing.

Feminist theory has also been used as a conceptual framework for explaining the

presence of violence between males and females. In feminist theory, violence is viewed

as a manifestation of the patriarchal structure in our culture, which is reflected in the

patterns of behaviors and attitudes of individuals (Gentemann, 1984; Kalmuss, 1984). As

part of Lenore Walker's (1999) theorizing, violence against women in general has been

conceptualized as gender-based; interventions are stressed by using advocacy, victim








services, and educational efforts. The feminist perspective on domestic violence is

accepted worldwide. Where women and girls are primary targets of male abuse, violence

cannot be eradicated without looking carefully at gender socialization issues that

maintain and possibly facilitate such violence in the home.

The incorporation of social justice perspectives into family therapy training,

practice, and research has been a recent focus of family therapy scholarship (Bograd,

1999; Haddock, Zimmerman, & MacPhee, 2000; McGoldrick et al., 1999). These

authors have focused on intersections of race, class, sexual orientation, and gender as

they relate to the training and practice of family therapy. Goldner (1988) recognized that

both age and gender organize families, and she implored family therapists to reduce

power differentials based on gender within family therapy.

Feminist therapists claim that a therapist who does not directly challenge power

and control based on traditional gender hierarchies contributes to the maintenance of

unjust power differentials between men and women (Avis, 1996; Goldner, 1988; Hare-

Mustin, 1987; Walters, Carter, Papp, & Silverstein, 1988). These feminist scholars urge

therapists to challenge powerful acts by men over women and to expose gender

hierarchies by calling attention to them in therapy. As Hardy (2000) pointed out, family

therapists are often guilty of allowing the most powerful members of society to continue

speaking while inadvertently silencing those with less power. To heal strained

relationships, we must let the oppressed have an opportunity to speak during therapy that

takes the needs of all family members into account.

The Study of Power

In his 1993 book Understanding Family Process, Broderick organized family

process literature, which he called "relational space," into three major areas: (a)








regulation of interpersonal distance, (b) regulation of interpersonal transactions, and (c)

regulation of "vertical space," by which he meant power. The idea of "regulation"

implied a homeostatic set point theory. In a therapy context, these three areas were

respectively discussed as positivity/caring, responsiveness, and status/influence

(Gottman, Notarius, Gonso, & Markman, 1976).

Historically, the regulation of interpersonal distance was first explored by

examining the clarity of communication. Hypotheses were advanced to explore the role

of unclear communication in dysfunctional families and family distress. More specific

hypotheses were advanced that unclear communication was responsible for

psychopathology (Bateson, Jackson, Haley, & Weakland, 1956; Watzlawick, Beavin, &

Jackson, 1967), and the cybernetic model or the systems approach to family process was

born.

In their decade review of observing marital interactions, Gottman and Notarius

(2000) stated that historical research was complex but included the result that balance in

husband-wife power was related to marital quality; however, self-report and

observational measures did not show a high level of agreement in classifying couples.

These researchers stated that the issues of blending the study of affect and power are

central to the integration of psychological and sociological approaches to marriage.

Power is now being studied more precisely, using coding of the couple's influence

patterns during a discussion of the Inventory of Marital Conflicts (Olson & Ryder, 1970)

used by Gray-Little, Baucom, and Hamby (1996). They found that egalitarian couples

had the highest "Time 1" marital satisfaction and fewer negative marital inventory

conflicts scale behaviors. Power is also being explored in the context of gender and








relational hierarchy. Feminist writers have pointed to the central role that power must

play in understanding marriages. Quantitative observational research has now begun to

explore these ideas (Gottman & Notatius, 2001).

Equipped with a sound theoretical basis for addressing intimate violence in a

couple format, feminist family therapists have continued to develop couple approaches

that are sensitive to issues of power and gender (Almeida & Durkin, 1999; Bograd &

Mederos, 1999; Greenspun, 2000; Jory & Anderson, 2000; Lipchik & Kubicki, 1996;

Shamai, 1996). Hardy (2000) cautioned that the most powerful members of society

continue to speak while inadvertently silencing those with less power.

Social Learning Theory

Research by Alexander, Moore, and Alexander (1991) applied social learning

theory to investigate the intergenerational transmission of violence among dating

partners. This perspective explains that a man's involvement in dating violence is best

predicted by a personal history of severe abuse by his father. Although his behavior is

not directly predicted by having witnessed violence between his parents, his attitude

toward women apparently is thus predicted. His own attitudes are relevant to the

perpetration of violence only as they interact with those of his partners.

Scientists have traditionally believed that experiencing physical abuse as a child

increases the risk of later aggressive behaviors, based on social learning theory (Bandura,

1973). Social learning theory proposes that people acquire novel behaviors and expand

personal behavior repertoires by observing others' behaviors as well as through classical

and operant conditioning (Bandura, 1965, 1973). They observe other individuals and use

imitation to perform novel behaviors.








To imitate a behavior, the person must have some motivation or incentive for doing

so. Incentives are what the person expects to obtain once the behavior is performed.

Incentives act as reinforcers. When incentives are available, observation is more quickly

translated into action. Incentives also influence the attention and retention processes.

Children pay attention when given incentives to do so and, with more attention, more

information is retained. In the Bobo doll experiment, some children witnessed the adult

being rewarded for aggression. Therefore, these children performed the same act to

achieve the same rewards (Bandura, 1977).

Bandura asserted that people can also learn new behaviors without practice and

without reinforcement. Simply stated, an observer may copy a model's behavior long

after he or she saw the action performed, even without any immediate reinforcement

being earned by the model or the observer. Researchers have begun to consider the role

of previous abuse and violence on propensity for victimization, although only very

limited data have supported this theory; indeed, myriad unanswered questions remain.

Social learning theory not only deals with learning but also seeks to describe how a

group of social and personal competencies (i.e., personality) could evolve out of social

conditions within which learning occurs. It also addresses techniques of personality

assessment and behavior modification in clinical and educational settings (Bandura,

1977).

Social learning theory not only deals with learning but also seeks to describe how a

group of social and personal competencies (i.e., personality) could evolve out of social

conditions within which learning occurs. It also addresses techniques of personality








assessment and behavior modification in clinical and educational settings (Bandura,

1977).

Further, the principles of social learning theory have been applied to a wide range

of social behaviors, including competitiveness, aggressiveness, sex roles, deviance, and

pathological behavior (Bandura & Walters, 1963). Currently, it is impossible to ascertain

the exact social cognitive processes at work or how the observation of violence translates

into victim versus perpetrator status. The specific effect of social learning theory remains

an unresolved issue (Lewis & Fremouw, 2001).

Lenore Walker studied some intriguing animal behavior theories based on

laboratory research. She began to see startling connections between the coping

mechanisms of battered women and the behavior of caged dogs subjected to random and

variable electric shocks. "Learned helplessness" became one the linchpins of The

Battered Woman, published by Harper and Row in 1979. Coining the phrase "battered

women's syndrome," Walker delineated a common cycle of violence: a honeymoon

period followed by a buildup of tension, followed by an explosion and battery, followed

by regrets and apologies, followed by another honeymoon period, and so forth. By

featuring stories of several professional women who had endured physical abuse in

marriage, Walker put to rest the myth that battery was strictly a lower-class problem

(Brownmiller, 1999).

Social Structural Theory

The social structural approach examines patterns first applied by Goode (1971),

which applied Blood and Wolfe's (1960) resource theory of power to explain a husband's

use of physical force against his wife. Goode maintained that violence is a resource,

similar to money or personal attributes, that can be used to deter unwanted actions or to








induce desired behaviors. The use of violence thus can be seen as the most overt and

effective means of husbands' social control over wives (Yllo & Bograd, 1988) in that it is

used when other and more subtle methods of control do not lead to submission.

In a study by Allen and Straus (1980), key propositions of Goode's (1971) resource

theory of violence were tested using occupational prestige, educational level, income, and

satisfaction with income as measures of extrinsic resources. This study also used

variables for assessing interpersonal, intrinsic resources. The researchers found a strong,

positive correlation between the low resources/working class variable and the husband's

use of physical force. This is consistent with other studies that have shown that husbands

who experienced resource deprivation were more likely to physically abuse their wives

(Bowker, L., 1983; Pagelow, 1981).

Around the world, state-sanctioned violence, such as civil and interstate wars, often

increases the amount of violence against women; rape and brutal physical beatings of the

enemy's women have been considered just the spoils of war. Better understanding of the

relationships among civil war, domestic violence, and women's mental health is

important to help countries to provide both prevention and rehabilitation strategies

(Walker, 1999).

Strong cultural traditions tying women to small communities with few resources

(and power), state-sponsored conflicts, and greater acceptance of gender inequities all

contribute to the greater risk for a woman to be battered in her home (Heise, 1994; Koss

et al., 1994; Root, 1992; Walker, 1994).

An association in the marital literature between spouse abuse and self-esteem is

well documented (Goldstein, 1985; Hotaling, 1988), with the level of self-esteem








negatively correlated with frequency and severity of violence (Cascardi & O'Leary,

1992). However, it is often unclear whether low self-esteem precipitates violence or is

the result of chronic battering. Empirical support exists that low self-esteem contributes

to the difficulty that victims experience in disengaging from an abusive marriage (Aguilar

& Nightingale, 1994). As a result, low self-esteem may be associated with increased

tolerance for interpersonal violence.

Treatment of Relationship Violence

Choice to Leave or to Stay in Abusive Relationships

The cognitive process that a victim undergoes when choosing to disengage from an

abusive relationship provides important information with regard to victimology. Rosen

and Stith (1995), employing a multiple-case qualitative research design, identified a

progression of hierarchical cognitive steps utilized by individuals who eventually

disengaged from abusers.

The process included a five-step progression of disengagement: (a) seeds of doubt,

such as fleeting thoughts, often not identified until the dissolution of the relationship;

(b) turning points, or events that significantly impacted the intimate relationship;

(c) reappraisals, occurring when the victim re-evaluated the relationship; (d) paradigmatic

shifts, which included a shift in perspective about the relationship; and (e) last straw

events, or events providing the impetus to terminate the abusive relationship.

The explanations of why individuals remain in abusive relationships has

traditionally focused on dispositional characteristics such as low self-esteem, learned

helplessness, or masochistic personalities (Rusbult & Martz, 1995). A new model shifts

the focus away from blaming the victim and examines the interdependent nature of

ongoing relationships. This model proposes that victims apply a two-step model,








considering their resources and level of satisfaction when deciding to stay or leave an

abusive relationship (Choice & Lamrnke, 1997). According to this model, an abused

woman may stay in the relationship for several reasons. For example, she may

experience feelings of satisfaction, believing her best available alternative to staying is

not attractive enough to terminate the relationship. Second, she may believe that she has

a strong emotional investment and, thus, does not feel ready to leave the relationship.

This model is not proposing that victims want to be abused, but rather that some women

choose to remain in a relationship despite the abuse (Lewis & Fremouw, 2001).

Rusbult and Martz (1995) provided additional support for the supposition that

victims' decisions to stay in abusive relationships are influenced by environmental as

well as intrapersonal variables. Researchers found that a victim's choice to remain in an

abusive relationship was strongly related to level of satisfaction in the relationship,

quality of alternatives, and size of the investment. These models (Choice & Lamnke,

1997; Rusbult & Martz) represent a shift in conceptual understanding of the subtle

nuances and dynamics of victimization. Additional research is needed to examine the

conditions that trigger victims to leave abusive relationships. As described above, a

variety of factors may predispose a couple to relationship violence.

Most likely, it is a combination of these factors that motivates a perpetrator to

offend. A contemporary study of American couples conservatively documented that 1 in

8 husbands had committed a violent act against his wife during the preceding year. A

comprehensive review of studies using probability samples revealed that the reported rate

of wife abuse in the United States was between 11% and 22% (Straus & Gelles, 1990).








Gottman's Batterer Offender Typologies

Two distinct typologies are described by Gottman et al. (1995). In the 200

seriously violent couples studied, these researchers found at least two kinds of batterers:

Type 1 ("cobras") and Type 2 ("pit bulls"). This research dealt primarily with the

physiological response of male batterers to a high-conflict marital discussion. In this

study, Type 1 men's heart rates lowered from baseline in response to the high-conflict

marital discussion, while Type 2 men's heart rates increased from baseline. Type 2 refers

to men whose emotions quickly boil over, whereas Type 1 refers to men who remain cool

and methodical as they inflict pain and humiliation on their partners. This was evident in

physiological data taken from heart monitors while participants had angry responses to

their partners.

Type 2 men were referred to as "pit bulls." These men are characterized as having

a quick temper and are physiologically aroused when behaving aggressively. Using the

metaphor of the "pit bull," this type of dog is used in dog fights and is known as a vicious

fighter that will often fight until death. These dogs become aroused and aggressive when

other dogs are being aggressive. The "pit bulls" or Type 2 men scrutinize their wives and

display excessive need for approval and self-fulfillment.

According to Gottman et al. (1995), the Type 1 batterer is referred to as the

"cobra." Most striking is the swift escalation of anger and violence displayed by these

men during a disagreement, again relating to the analogy of the cobra snake, which is

swift and dangerous.

The "cobra" men enjoy shocking and scaring people. They are opposite to the "pit

bulls" in that they are not worried or jealous, nor are they emotionally dependent. The

significant finding of the Gottman et al. (1995) research was that "the cobra" offender's








heart rate actually got lower during an argument. Internally, these men remain calm, yet

they are externally more violent and severe in their violence than the "pit bulls."

Jacobson and Gottman (1998) discussed the pit bulls and cobras further. They

concluded that these two batterer types resemble dysphoric/borderline batterers and

generally violent/antisocial batterers, respectively (Holtzworth-Munroe et al., 2000).

Although Jacobson and Gottman focused their study on severely violent men, they also

discovered what they called a "low-level violent" group of couples, which they followed

with the expectation of tracking the development of violence from minor to more severe

forms. Unexpectedly, however, this group almost never escalated their use of violence,

and they were described by Jacobson and Gottman as a "stable group of couples who

periodically have arguments that escalate into pushing and shoving, but never reach the

point where we could call the men batterers" (p. 25). This description coincides with

Johnson's (1995) description of common couple violence.

Overall, findings across research by Gottman et al. (1995), Meehan, Holtzworth-

Munroe, and Herron (2001), and Babcock, Yerrington, Green, and Miller (2001) do not

lend strong support to the Type 1-Type 2 batterer typology. Although severely violent

men can be split into two groups on the basis of heart rate reactivity, so can both less

violent and nonviolent men, raising questions about the theoretical meaning of this

distinction. In addition, consistent differences between Type 1 and Type 2 severely

violent men have not been found across studies.

Human Heart Reactivity

A review of previous research suggests that the use of human heart reactivity

(HRR) may prove useful for differentiating male batterers on the dimension of








anger/hostility. There is less evidence that this approach will be effective for studying

antisocial personality in these men.

Meehan et al. (2001) failed to replicate the batterer typology proposed by the

Gottman et al. (1995) article. Therefore, caution is advised when discussing possible

implications of these studies for public policy and clinical application. To be

appropriately cautious, it should be noted that the Gottman et al. (1995) typology was

supported in one study (i.e., their initial study) but was not supported in another study

(i.e., the Meehan et al. study). Such an even scoreboard suggests that further attempts at

replication are necessary before definitive conclusions may be drawn about the validity of

the Gottman et al. typology.

It is possible that the Gottman et al. (1995) typology will remain a valid one after

further scrutiny; therefore, clinicians and public policy makers should not abandon the

idea of batterer typologies altogether. Indeed, across multiple research laboratories, there

is increasing convergence regarding the descriptive and theoretical dimensions that can

be used to meaningfully categorize variability among samples of batterers.

Holtzworth-Munroe and Stuart's Three Major Types of Batterers

Other research on men who batter women has suggested that there are three major

types of batterers: (a) those who use violence as a strategy to gain power and control

within their family, (b) those who use violence as a strategy and are also mentally ill, and

(c) those who have serious personality flaws that permit them to use violence to commit

other criminal acts as well as to abuse their partners (Dutton, 1995; Holtzworth-Munroe

& Stuart, 1994; Jacobson & Gottman, 1998; Meloy, 1998; Saunders, 1992; Walker &

Meloy, 1998).








Although other typologies for differentiating male batterers have been proposed,

research on female perpetrators is much less extensive. Holtzworth-Munroe and Stuart

(1994) proposed three types of male batterers: family-only, dysphoric/borderline, and

generally violent/antisocial. Batterers can be identified along three descriptive

dimensions: severity/frequency of violence, generality of violence, and psychopathology

or personality disorders, as well as by risk factors correlated with the development of

violent behavior (such as witnessing violence in the family of origin).

Dysphoric/borderline and generally violent/antisocial batterers engage in moderate to

severe levels of violence, and the latter are most likely to be involved in criminal

behavior and use violence both within and outside the home. The dysphoric/borderline

batterers tend to confine their violence to the intimate relationship. Family-only batterers

engage in the least amount of violence, show little or no psychopathology, and have very

low levels of risk factors. Empirical testing of the model has supported this batterer

typology (Hamberger, Lohr, Bonge, & Tolin, 1996; Holtzworth-Munroe et al., 2000;

Tweed & Dutton, 1998; Waltz et al., 2000).

Identification of Training Needs

Current Status of Training and Need for Additional Curriculum

There was a time when learning one particular school of therapy was deemed

sufficient empowerment to treat all manner of clients---or at least sufficient to make one

feel prepared to treat all types of clients. With time, specific treatments began to be

developed for particular problems. Alcoholism became widely recognized as a problem

that necessitated a particular type of therapy. Phobias were found to respond best to

behavioral treatment. Treatment began to be problem specific rather than school

oriented. Added to this is a new pressure: the necessity of keeping up in a field where,








seemingly, every new day reveals a new type of therapy for a new type of problem

(Salter, 1988). The treatment of family violence as well as child sexual abuse offenders

and victims has only recently evolved into a specialized field. Although for many years

there have been specialized treatment programs available in a few states, the need to set

up more specialized treatment programs in every state has only recently been recognized.

This recognition has been spurred by two factors: (a) the increasingly widespread

acknowledgement of the extent of the problem, and (b) the increasing acceptance that

traditional forms of therapy are not effective with this population (Crawford, 1981).

However, specialized treatment does appear to have an impact (Knopp, 1984).

Continuing Education Units

Academic institutions, institutes, workshops, and continuing education credits are

responsible for the successful dissemination of academic knowledge pertinent to the

profession. These educational areas must provide an integrated course of study as well as

appropriate professional training. An ethical education program with quality is one that

uses traditional and managed care approaches of training emphasizing the current

theories of practice and those presented in the Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV) of the American Psychiatric Association (1994). It should

be a program that develops competency in people working with diverse aspects of

society, resulting in effective, cost-efficient treatment plans and service delivery. Only

recently (in 1995), California began specialized spousal abuse training for marriage and

family therapists. Psychologists are required to have coursework in human sexuality,

chemical and substance abuse, and child abuse.

However, spousal abuse training is not currently a requirement for licensing in

California or in many other states. Both trainees and interns are permitted to perform








counseling in a governmental entity, school, college, university, nonprofit agency,

charitable corporation, or licensed health facility under the direct supervision of a

licensed supervisor, regardless of whether that supervisor has received specialized

training in the area of spousal abuse (Board of Behavioral Science Examiners [BBSE],

2000).

Skills in Assessing Relationship Violence and Imminent Danger

In previous research there is a precedent for needed improvement in the education

and training of psychotherapists. Hansen et al. (1991) surveyed members of a marriage

and family therapy organization. The therapists in this survey were asked to read two

vignettes with proven therapeutic interventions for domestic violence cases. These cases

portrayed female victims and domestic violence. The results indicated that the

counselors did not attend to the seriousness of the violence portrayed in the vignettes, and

many did not attend to the violence at all. As a group, the therapists did not attend to the

crisis nature of the cases portrayed and failed to intervene for needed protection of female

victims from their batterers. Forty-one percent of the therapists surveyed indicated no

recognition of domestic violence. Interventions provided by therapists in this study were

also negligent with regard to violence potential. For example, 55% of respondents

reported that they would not intervene even when the violence portrayed required

immediate action. Only 2% reported a potential for lethality in these cases. A scant 11%

of the respondents indicated that they would obtain protection for the wife by helping her

to develop a safety plan, obtain shelter, or obtain a restraining order.

Psychologists were significantly less likely than other respondents to conceptualize

the case in terms of conflict or to describe the problem as violence. Because few

counseling or clinical psychology graduate programs provide academic or clinical








exposure to the problem of domestic violence presently (and even fewer have done so in

the past), there is reason to expect that knowledge and skill deficits similar to those

observed among physicians and family therapists in the Hansen et al. study might be

found among practicing psychologists as well (Carden, 1994).

Assessing for Risk Factors Associated With Relationship Violence

Riggs, Caulfield, and Street (2000) discussed the need for identifying risk factors

for domestic violence. They stated that the extent and potential dangerousness of the

problem of domestic violence warrant systematic screening and assessment in all mental

health settings. Few empirical studies have approached the question of domestic violence

with the aim of identifying risk markers, making it impossible to identify persons at risk

for perpetrating or becoming victims of domestic violence.

Identifying Risk Factors Associated With Relationship Violence

A number of factors have been identified as correlates of domestic violence that

may eventually prove useful for identifying persons at risk. However, existent literature

does not provide empirical support for these factors. Identifying factors that might assist

clinicians in the recognition of clients who are at risk for domestic violence would help

clinicians to attend appropriately to this potentially dangerous problem.

Ongoing assessment in the context of knowledge regarding correlates of domestic

violence can provide important information for evaluating risk of a particular violent

incident. In addition, strategies for assessing violence and violence risk in both

perpetrators and victims can assist clinicians in approaching this difficult topic in a

clinical setting. A careful assessment of the potential for violence within clients' ongoing

relationships is necessary for clinicians to provide appropriate care (Riggs et al., 2000).








Prior Relationship Aggression

One of the primary risk factors for perpetrating violence against a spouse or

significant other is having committed such violence against that same person previously.

Rarely, if ever, does an incident of spouse abuse occur in isolation; typically, violence

occurs throughout the relationship. In a longitudinal study of violence within marriages,

O'Leary et al. (1989) examined couples engaged to be married and followed them for 3

years. These researchers found that violence was relatively stable over the first few years

of marriage. For example, of men who perpetrated aggression prior to marriage, 51%

also had engaged in aggression during the first 18 months after marriage. In comparison,

the probability of a man who was not aggressive prior to marriage being aggressive 18

months into the marriage was 15%.

In another study of engaged and newly married couples, men who perpetrated

violence against their partners prior to the wedding were significantly more likely than

were men with no history of relationship violence to perpetrate violence within the

following year (Leonard & Senchak, 1996). Examining more established relationships,

Feld and Straus (1989) found that frequency of self-reported aggression was predictive of

aggression in the ensuing year: Almost 50% of men who had been violent prior to the

initial assessment in the study engaged in violence in the following year. In comparison,

only 10% of those who had not been violent prior to the initial assessment engaged in

violence in the following year.

Demographic Characteristics

Rates of domestic violence tend to decrease slightly as the age of couples increases

(Straus et al., 1980). Other demographic risk factors for marital violence appear to be

related to increased stress in the family. For example, men of lower SES are at an








increased risk for perpetrating domestic violence and tend to perpetrate more severe

violence than higher-SES counterparts. Similarly, men who are unemployed appear to be

at an increased risk for perpetration of spouse abuse.

National surveys suggest that men of color are at an increased risk, compared to

Caucasian men, for perpetrating violence against their wives and partners. However, this

difference appears to be at least partially the result of different SES levels in White and

minority samples (Holtzworth-Munroe et al., 1996).

Psychological Characteristics

Men who have perpetrated violence against a spouse tend to differ from those who

have not done so on a number of psychological constructs. Many of these factors,

according to Riggs et al. (2000), are of theoretical interest for understanding why spouse

abuse occurs and may be helpful in identifying men at risk for such violence. For

example, spouse abusers tended to be more angry and hostile in general than their

nonabusive counterparts (Eckhardt, Barbour, & Stuart, 1997). Further, when confronted

with marital conflict situations, abusive men tended to be less assertive and respond more

with anger and hostility than nonviolent men. Particular topics of conflict such as

jealousy and threats of abandonment may have exacerbated this pattern of response

(Holtzworth-Munroe & Anglin, 1991). This latter finding fits with research that

identifies fear of abandonment as an important aspect of abusive men's behavior (Dutton,

Saunders, Starzomski, & Bartholomew, 1994) and may serve to identify specific points in

time when the risk of spouse abuse is particularly high. Unfortunately, few of these

variables have been investigated in ways that translate the findings into specific

indicators of risk.








Specific Psychological Syndromes

Post Traumatic Stress Disorder (PTSD). Researchers have linked men's

symptoms of depression, PTSD, borderline personality disorder, and substance abuse to

the perpetration of violence against their wives and partners. Important with regard to the

present discussion, some of these syndromes have been examined as risk factors rather

than simply as correlates of marital violence. Thus, they may serve as useful markers or

risk factors of future perpetration.

Researchers have examined the link between symptoms of PTSD and the

perpetration of marital violence. Studies in this area indicate that men with PTSD are at

considerable risk for perpetrating marital violence. Jordan et al. (1992) found that wives

of Vietnam veterans with PTSD were about twice as likely (30%) as wives of veterans

without PTSD (15%) to report that their husbands had engaged in marital violence.

Depression. Depressive symptoms have been related to the perpetration of marital

violence in a number of studies (Maiuro, Cahn, Vitaliano, Wagner, & Zegree, 1988; Pan,

Neidig, & O'Leary, 1994). Generally speaking, men who are aggressive toward their

wives exhibit more depressive symptoms than do nonaggressive men. For example, in

one study, significantly more abusive men, as compared to a nonabusive group, scored

within the depressed range of the Beck Depression Inventory (Maiuro et al.). Higher

scores on this inventory have also been related to violence in couples seeking marital

therapy (Vivian & Malone, 1997) and in general population samples (Pan et al.).

Substance abuse. The rates of spouse abuse among men diagnosed with substance

abuse problems indicate that men with diagnosable alcohol problems are at substantially

increased risk for spouse abuse (Gondolf & Foster, 1991; Leonard, Bromet, Parkinson,

Day, & Ryan, 1985; Murphy & O'Farrell, 1994; Stith, Crossman, & Bischof, 1991). For








example, Leonard et al. found rates of marital aggression in men diagnosed with a current

alcohol problem (44%) to be about 3 times greater than in men without an alcohol use

disorder (15%) or a past alcohol problem (14%). Murphy and O'Farrell reported that

about two thirds of a sample of married male treatment-seeking alcoholics had engaged

in marital violence.

Borderline personality disorder. Another disorder that has been linked to the

perpetration of spouse abuse is borderline personality disorder. This disorder is

characterized by identity issues that become salient in intimate relationships and that vary

on three defining features: identity diffusion, primitive defenses, and reality testing.

Studies have found that abusive men score higher on measures of borderline personality

disorder than do nonabusive men and that, among men who assault their wives, more

severe violence is associated with higher levels of borderline personality disorder

(Dutton, Starzomski, & Ryan, 1996).

Other Risk Factors

Marital dissatisfaction. As a group, men who perpetrate violence against their

partners are less satisfied with their relationships than are nonviolent men (Alderondo &

Sugarman, 1996; Hotaling & Sugarman, 1986; Sugarman & Hotaling, 1989).

Witness to spouse abuse or victim of child abuse. Many studies have found that

men who perpetrated violence against their wives were more likely than men in

nonviolent comparison groups to report that they had experienced violence in the family

of origin, either as a witness to spouse abuse or as the victim of child abuse (Alderondo &

Sugarman, 1996; Dutton & Hart, 1992; Hotaling & Sugarman, 1986; Kalmuss, 1984;

Sugarman & Hotaling, 1989).








Previous head injury. Rosenbaum et al. (1994) documented a link between a

history of head injuries and the perpetration of spouse abuse. In one study, these

researchers found that men in treatment for abusing their wives reported a significantly

higher rate of head injuries than did a group of nonabusive men.

Ability to Assess Violence Risk

Otto (2000) spoke to the importance of the mental health practitioner having the

ability to assess violence risk in clients. The perception that persons with mental illness

are at increased risk for violence, as compared to their non-mentally ill counterparts, can

be dated at least to the time of Plato (Monahan, 1992). Indeed, among the rationales

offered for establishing some of the first public psychiatric hospitals in this country was

the need to protect the public by confining persons with mental illness who posed a risk

of violence to the community. Flowing logically from the belief that there was a

connection between violence and mental disorders was the assumption that mental health

professionals, as a function of their expertise, were uniquely able to identify and treat

persons whose emotional functioning increased their risk for violence, and could thereby

reduce such risk (Otto).

Violence Risk Assessment Study

In response to the above, Monahan (1984, 1988) identified limitations of research

examining the relationship between mental disorders and violence, as well as mental

health professionals' abilities to assess violence risk. Due to these limitations, Monahan

called for a "second generation" of investigations to better address these issues. This call

resulted in a series of studies (Monahan & Steadman, 1994, for summary) and review

articles (Mossman, 1994; Otto, 1992, 1994) and formed the basis for the Violence Risk

Assessment Study organized by John Monahan under the auspices of the MacArthur








Research Network on Mental Health and the Law. Findings from this "second

generation" of research, which incorporated many of Monahan's (1984, 1988)

recommendations, suggest the following: (a) violent behavior is not necessarily a low

base rate behavior and occurs with some degree of frequency among persons with mental

disorder (Otto, 1992; Steadman et al., 1998; Wessely & Taylor, 1991); (b) persons with

certain mental disorders and symptom clusters are more likely to engage in violent

behavior than are persons without such disorders or symptom clusters (Swanson, 1994;

Swanson, Holzer, Ganzu, & Jono, 1990); and (c) mental health professionals have some

ability to assess violence risk among persons with mental disorders (Mossman; Mulvey &

Lidz, 1998; Otto, 1992, 1994).

Assessing and Managing Risk

It is this body of developing research, along with research examining violence risk

factors among criminal and nonclinical populations, that provides direction for clinicians

faced with the task of assessing and managing risk with their clients. Although one might

question whether findings from one population are applicable to other populations, a

meta-analysis by Bonta, Law, and Hanson (1998) provides some support for the claim

that risk factors for violent behavior may be similar across populations.

It should be no surprise to even beginning clinicians that more remains unknown

than known about risk factors for violence among persons with mental disorders. Good

practice requires that clinicians familiarize themselves with relevant literature and use

informed clinical judgment in cases for which research literature provides no direction

(Otto, 2000).








HCR-20 Item Risk Assessment Instrument

Use of a structured, guided clinical assessment developed in light of the extant

research, such as HCR-20 (Webster, Douglas, Eaves, & Hart, 1997) can help to form the

basis of a comprehensive evaluation that assesses factors relevant to violence risk. The

HCR-20 directs clinicians to cover a total of 20 areas considered to be relevant to

violence risk: 10 historical items, 5 clinical items, and 5 risk management items.

Preliminary data indicate that the HCR-20 can be reliably scored (Belfrage, 1998;

Douglas, & Webster, 1999; Ross, Hart, & Webster, 1998) and has some predictive power

when compared to other risk assessment instruments.

Static and Dynamic Risk

Otto (2000) stated that, broadly speaking, risk factors for violence among persons

with mental disorders fall into one of two categories. Static risk factors are those that

either cannot be changed (e.g., age, gender) or are not particularly amenable to change

(e.g., psychopathic personality structure). Identification of these factors is important in

terms of identifying the client's absolute or relative level of risk; however, these factors

typically have few implications for treatment or management of risk, since the factors, by

definition, cannot be changed. In contrast, dynamic risk factors are those that are

amenable to change (e.g., substance abuse, psychotic symptomatology). Identification of

these factors is important, both in terms of estimating the client's absolute or relative

level of risk and for purposes of treatment planning.

Hanson (1998) made a similar distinction: between stable dynamic factors and

acute dynamic factors. Stable dynamic factors can change but have some enduring

quality over time and across situations (e.g., deviant sexual preferences or alcoholism),

whereas acute dynamic factors (e.g., sexual arousal or alcohol intoxication) are "states"








which can change much more rapidly. Assessing the former category may be more

important for treatment planning and intervention planning when dealing with persons for

whom there are concerns for violence in the future, while the latter category may be more

important in terms of assessing imminent risk and making decisions about immediate

interventions.

Conclusion

Feminist writings have focused attention on domestic violence and challenged the

assumptions of approaches that blame women for their victimization. They support both

the growing emphasis on interdependence and mutuality, rather than on autonomy and

differentiation, in couple relationships and they focus on a more collaborative respectful

relationship with clients (Luepnitz, 1988).

Graduate counselor education programs would ethically be fulfilling their ethical

code and accreditation standards by including in their curriculum a course in family

violence. Students would benefit by being informed regarding methods of family

violence assessment and could be given vignettes to test their level of mastery in this skill

area. Such training preparation could take place before students are made eligible for

practicums or internships. Requirements such as these would better prepare students to

treat family violence cases effectively.

Various intervention models are used in treating relationship violence. According

to Harrell (1991), the short-term, court-ordered, batterer-only psychoeducational model

had a high rate of recidivism, along with increased amounts of psychological abuse.

Edleson and Grusznski (1988) and Pence and Paymar (1993) found better results from

the short-term psychoeducational model used in the Domestic Abuse Project in Duluth,

Minnesota. On the other hand, Dutton (1995) and Hamberger and Ambuel (1997) found








that interventions having the best results in stopping men from using violence were those

that required attendance for a minimum of 2 years. Dutton's research suggests that many

batterers have serious mental illnesses in addition to problems with power and control

that underlie their use of violence (Walker, 1999). O'Leary (1993) and Geffner (1995)

found that special techniques in family psychotherapy can be effective in helping to stop

violence in the family.

Corsi (1999) developed a model that appears to incorporate the best features from

available programs and is easy to apply across cultures due to its ecological approach

(Walker, 1999). The recommended treatment approach begins with individual

counseling for all parties and then marital and dyad sessions, in addition to family and

group sessions (Giarretto, 1976).

Violence in close relationships is now acknowledged as a highly significant issue

across diverse cultural groups (Walker, 1999). The underreporting of couple violence,

even in couple therapy, is a major finding that has emerged over the past decade. One

line of research has differentiated different patters of violent behavior, distinguishing

those patterns that are more or less likely to be amenable to treatment (Jacobson &

Gottman, 1998). Such research may assist the couple therapist in determining when and

how to intervene.

In general, assessment procedures, risk factors, and treatment feasibility issues in

violent relationships are now beginning to be addressed (Bograd & Mederos, 1999;

Holtzworth-Munroe, Beatty, & Anglin, 1995). Well-defined assessment procedures

(Bograd & Mederos) and differentiated treatment strategies are essential for client safety.

All couple therapists must know how to identify and address patterns of violence, ranging





65


from verbal intimidation and threats to coercion and battering, and they must be able to

make informed decisions about the best interventions to use in particular cases (Johnson

& Lebow, 2000).

This literature review would be appropriate for an audience including mental health

practitioners, faculty, health care workers, trauma and crisis center employees, domestic

violence workers, parents, educators, and law enforcement personnel.













CHAPTER 3
METHODOLOGY

Relationship violence is a problem of extensive proportions in America. There are

several theoretical models for assessing and treating violence survivors in order to

prevent continuing abuse. However, it is unknown which treatment methods, assessment

questions, and prevention models are actually put into practice with this population.

Therefore, the primary purpose of this study was (a) to determine the factors that are most

frequently reported by MFTs to be related to the identification, assessment, and treatment

of relationship violence; (b) to measure how therapists, supervisors, and faculty members

in marriage and family therapy rate themselves on their competence in the identification,

assessment and treatment of relationship violence; and (c) to measure their rating of the

importance of certain competencies and skills in the identification, assessment, and

treatment of relationship violence.

These purposes were accomplished by examining two variables via the survey.

The first variable, Quality of Graduate Training, was assigned two subscales, each with

five items in the survey. The first subscale, Knowledge, was measured by five items

eliciting respondents' self-rating of their knowledge in relationship violence. The second

subscale, Graduate Training Received, was measured by five items asking respondents to

rate the graduate training that they received in relationship violence. The second

variable, Competencies in the Identification, Assessment, and Treatment of Relationship

Violence, was measured by 10 items asking respondents to rate the importance of certain

competencies identified by the researcher as directly related to this variable.








In an attempt to clarify some of the unresolved problems in the existing literature,

this study was designed to answer the following questions:

1. How do MFTs rate themselves on their knowledge in the identification,
assessment, and treatment of relationship violence?

2. How do MFTs rate their graduate training in the identification, assessment, and
treatment of relationship violence?

3. How do MFTs rate the importance of specified competencies and skills in the
identification, assessment, and treatment of relationship violence?

The significance of this study was discussed in chapters 1 and 2, based on (a) the

increase in incidence of relationship violence as indicated by statistics; (b) professional

responsibility: legal, ethical, and therapeutic issues; (c) multiple forms of treatment

(metatheoretical, postmodernism, feminism, sociocultural, and social learning); and

(d) identification of training needs.

The research methodology is described in this chapter. Included are descriptions of

the research method, survey design, rating scales in the social sciences, research

procedures, sample, sources of error in Web-based designs, survey research, research

barriers, and limitations in relationship violence.

Research Method

Approximately 1,000 active members of AAMFT from various geographic regions

of the United States were asked to participate in the research (appendix D). The RVTS

was used to collect demographic data, including the professional counselor's age, gender,

ethnicity, marital status, and highest academic degree.

This study was conducted using a Web-based survey sent to therapists, approved

supervisors, and faculty members in marriage and family therapy. An exploratory factor








analysis was used to identify the related factors of training in the identification,

assessment, and treatment of relationship violence as reported by MFTs.

A preliminary self-designed survey instrument (RVTS) was developed based on

clinical expertise and research reviews. The model's elements were refined, based on

field testing suggestions offered by 10 colleagues with practice expertise and research

backgrounds. These colleagues were recruited based on their expertise in the areas of

measurement, relationship violence, and family therapy, which included experience in

teaching assessment and prevention of relationship violence. Certain variables were

selected over others for the instrument, based on research and clinical knowledge. A

panel of experts in the field reviewed the variables, and a revised selection was made

based on their feedback on the items. This testing was important in establishing validity

of the instrument and served to make improvements in the formatting and structure of the

instrument.

This model was further refined based on a field study given to experts in the above

areas. Results from the field studies were used to improve the model. Approximately

20% of the original items were deleted and another 20% were refined after feedback

about the interpretation of items was given.

The exploratory factor analysis program was conducted on the basis of the

researcher's specifications of the following items: (a) the variables to be factor analyzed;

(b) whether the data were in raw form or in the form of a correlation or covariance

matrix; (c) the number of factors to be extracted or the criteria by which to determine

such a number; (d) whether the diagonal elements of the correlation matrix were to be

replaced by communality estimates and, if so, what types of estimates were to be used;








(e) whether to employ orthogonal or oblique rotation; (f) the particular type of rotation to

be used (Kim & Mueller, 1978); and (g) giving the extracted factors names that would be

inclusive of all the items within that factor loading

Survey Design

In this section the prevalence of using surveys and rating scales in the social

sciences is discussed. Rating scales and their relevance to the RVTS survey development

are highlighted.

A survey design provides a quantitative or numeric description of some fraction of

the population-the sample-through the data collection process of asking questions of

people (Fowler, 1988). One goal of this data collection will be to generalize the findings

on the current status of graduate training in relationship violence from a sample of

responses to a population.

The data in this study were collected and compared via a Web-based survey system

that scored responses electronically. Data from the individual marriage and family

therapists, approved supervisors, and faculty members were examined to identify factors

in the assessment/training provided to marriage and family therapists at respective

schools regarding relationship violence. Factors related to treatment of relationship

violence were correlated. Since this is an exploratory factor analysis, identifying factors

that are important in the training of marriage and family therapists in working with

relationship violence was highlighted.

The purpose of survey research is to generalize from a sample to a population so

that inferences can be made about some characteristic, attitude, or behavior of this

population (Babbie, 1990). Broadly, a sample is a part selected to represent a larger

whole (Warwick & Lininger, 1975). The variables are the concepts or information in








which the researcher is interested. A questionnaire is a series of questions presented to

the sample in person by an interviewer, over the telephone, via Internet, or via computer,

through a self-administered Internet or Web-based instrument or in some other way. The

data analyses and reports are then used to describe the group or to draw inferences about

the variables, their relationships to each other, and their relationships to the population of

interest (Nelson, 1996).

Surveys usually focus on people-facts about them or their opinions, attitudes,

motivations, behaviors, and so on-and the relationship between variables under study

related to these people. For example, survey research might be used to compare

demographic characteristics of a sample of people in a particular location, their access to

mental health services, and their perceptions about the efficacy of those services. This

family therapy research could be used to make recommendations about improving the

curriculum/training provided to marriage and family therapist in relationship violence.

These generalizations have been made in previous research. For example, in their

1989 survey research on family therapy Wetchler, Piercy, and Sprinkle surveyed both

supervisors and supervisees about their impressions of their supervision experiences and

made some suggestions about marriage and family therapy training based on responses to

their survey.

Rating Scales in the Social Sciences

Various types of questionnaires are by far the most-used method of data collection

in psychology and other social sciences, and almost all of them use rating scales as their

primary response mode. Countless articles have followed the seminal work of authors

such as Freyd (1923), Thurstone, (1928), and Likert (1932). A response scale should








fulfill psychometric standards of measurement quality as well as practicality criteria, such

as comprehensibility for respondents and ease of use.

It has been recognized for many years that answers to self-administered

questionnaires are influenced by the way in which the questions and answers are

displayed on questionnaire pages (e.g., Rothwell, 1985; Smith, 1993; Wright & Barnard,

1975, 1978). However, scientific understanding of the natures of those effects is not well

developed. Although it has been argued on theoretical grounds that visual layout and

design make a difference in how people answer questionnaires (Jenkins & Dillman, 1997;

Sless, 1994), little experimental evidence exists that changing the visual presentation of

individual survey questions influences people's answers.

On occasion, rating scales are used in which verbal labels are compressed to

saturate one end of the response continuum. In these scales, differences arise between the

normal meaning of the label and its scalar position. In some instances, however, equally

spaced options across the entire response continuum may not provide the desired

properties in the measurements. For instance, Symonds (1931) recommended the use of

evaluative rating scales of a set of labels that were packed with positive descriptions to

overcome individuals' tendencies to be lenient in their description of others. For a 5-

point rating scale, he recommended using the labels Poor, Fair, Good, Very Good, and

Excellent. Guilford, in his classic Psychometric Methods (1936), reiterated Symonds's

solution for the problem of errors of leniency, hi addition, Guilford recommended that

"in a similar manner in the numerical type of scale, the strength of the descriptive

adjectives may be adjusted so as to counteract the error of central tendency" (p. 272).








French-Lazovik and Gibson (1984) also demonstrated that the labels used

influenced the distribution parameters of rating scale data. By using more positive labels,

they were able to systematically change the ratings in the predicted directions.

The meaning of the verbal label of a scale may depend upon the contexts of the

label. One important context to be considered is the position of the label. Chase (1969)

suggested that the meaning of the scale adjectives be determined by the relative position

of the adjective in a group of response categories rather than by the "standard" definition

of the scale labels. This suggestion was consistent with findings by Wildt and Mazis

(1978) that both label and location had an impact on subjects' responses.

Klockars and Yamagishi (1988) found that the meaning of the labeled position was

defined as a compromise between the label itself and the relative position. They showed

results that suggested the use of rating scales containing verbal anchors predominantly

from one end of a continuum to provide increased discrimination in the portion of the

scale. This provides the respondent with response options that are more discriminating in

one portion of the underlying continuum. Consequently, as stated by Worcester and

Bums (1975), "The problem is not just that different words mean different things but that

the same word can be made to mean different things as the context changes (p. 182)."

Usually, rating scales (category scales in psychometric terms) offer between 4 and

11 response alternatives (ordinal scale points which are supposed to be equidistant).

Numbers or words or graphic symbols ( or a combination thereof) can be used to denote

the categories, but verbal labeling has become the dominant approach to facilitate

communication (Rohrman, 2002). Instead of labeling every point on the scale, end points

may be verbalized. In the Relationship Violence Training Survey (RVTS) instrument








constructed for this study a 6-point rating scale was used, with only the labels Very Poor

and Excellent to define the two end positions for items 1-10 and Not Important and Very

Important for items 11-20; intermediate positions were unlabeled. The respondent was

allowed to discriminate between the two end points to define the meaning of the response

without the judgment of labels used in other positions.

Research Procedures

The researcher requested permission and obtained approval from the University of

Florida Institutional Review Board to proceed with the study as proposed. Following this

approval, the researcher sent research packets to professional counselors across the

United States who were active therapist members of AAMFT, approved supervisors, and

COAMFTE graduate training program faculty members.

Informed consent was obtained from participants. The participants were given the

option to refuse participation in the study. All participation was voluntary and

confidential. The results from the study are summarized as group findings and will be

available to participants who express an interest in the results. The individual responses

of counselors were not reported to their institutions/agencies or anyone else. See

appendix D for the letter of invitation to participate in the survey and the accompanying

consent form.

Sample

The first in a series of three Internet Web-based RVTS was sent electronically to a

random sample of licensed marriage and family therapists. The list of Internet mail

addresses was obtained from the AAMFT. The second questionnaire in the RVTS series

was sent to a random sample of marriage and family therapy faculty members who teach

in training programs in major university settings. This list was generated from approved








marriage and family therapy training programs from the AAMFT organization branch

COAMFTE, which monitors and credentials marriage and family therapy training

programs. The third questionnaire in the RVTS series was sent to a random sample of

AAMFT approved supervisors from a list obtained from the AAMFT organization,

retrieved from their national list of approved supervisors.

The questionnaire requested information about demographic variables (age, gender,

etc.) and information about education and training. Therapists, supervisors, and faculty

members were asked to rate themselves, using a 6-point scale, on their knowledge of

factors related to the identification, assessment, and treatment of cases relating to

relationship violence. They were also asked to rate their marriage and family therapy

graduate training in the identification, assessment, and treatment of violence. They were

also asked to rate the importance of certain competencies identified by the researcher to

be related to the identification, assessment, and treatment of relationship violence.

Due to the initial response rate on the electronic response (error rate or nonresponse

rate), an electronic follow-up mailing (appendix E) was sent out 2 weeks after the first

electronic mailing to those who had not responded, with a reminder announcement listing

the Web site link for participants to contact to be involved in the survey.

Sources of Error in Sample Web Surveys

The remarkable power of a sample survey is its ability to estimate, with precision,

the distribution of a characteristic in a defined population. In addition, that estimate can

usually be made by surveying only a small portion of the population under study. Sample

surveys are subject to four major sources of error, and each must be attended to in order

to have confidence in the precision of the sample survey estimates (Groves, 1989). These

errors are (a) coverage error, the result of all units in a defined population not having a








known nonzero probability of being included in the sample drawn to represent the

population; (b) sampling error, the result of surveying a sample of the population rather

than an entire population; (c) measurement error, the result of inaccurate responses that

stem from poor question wording, poor interviewing, survey mode effects, and/or some

aspect of the respondent's behavior; and (d) nonresponse error, the result of nonresponse

from people in the sample, who, had they responded, might have provided different

answers to the survey questions from those given by persons who responded to the survey

(Dillman & Bowker, 2001).

All four of these sources of error are as applicable to the design, and implementation

of Web surveys as they are to mail interview surveys. However, the early

implementation of Web surveys suggests that some aspects of error, and in particular

coverage and nonresponse, have been mostly ignored. Sampling error, although not

being neglected, is instead often inferred when it is not appropriate to do so. For

example, many Web surveys are conducted using samples of convenience or availability,

and thus depend heavily on the solicitation of volunteer respondents, as described by

Bandilla (2001).

One of the basic assumptions in surveying is the recognition that, for simple

random samples of a defined population, the precision of results is closely related to

completed sample size, or the number of respondents. For example, simple random

samples of 100 have a precision of 10 percentage points, and those of 1,100-1,200 (the

size commonly used for election survey prediction) have a precision of 3 percentage

points. Sampling error is decreased by about half when sample size is quadrupled. Thus,

samples of several thousand are expected to have precision measure in tenths of a








percentage point, assuming no other sources of error. Large number of volunteers

respondents, by themselves, have no meaning. Ignoring the need to define survey

populations, select probability samples, and obtain high response rates together provide a

major threat to the validity of web surveys (Dillman & Bowker, 2001).

Regarding coverage error, using the Web to survey the general public remains quite

limited. Moreover, Black and Hispanic households are about two fifths as likely to have

Internet access as are White households, and rural Americans about half as likely to have

access as urban Americans with comparable incomes. Nua Internet Surveys (1997)

estimated that 179 million people, or about 3% of the world's populations, has been

online at least once, and over 40% of U.S. households now own computers but only one

quarter of all households have Internet access (National Telecommunication and

Information Administration [NTIA], 1999).

However, this does not mean that researchers are unable to conduct scientifically

valid Web surveys. Some populations-employees of certain organizations, members of

professional organizations, certain types of businesses, students at many universities and

colleges, and groups with high levels of education-do not exhibit large coverage

problems. When nearly all members of a population have computers and Internet access,

as is the case for many such groups, coverage is less of a problem.

Another serious source of potential error in Web surveys is the nonresponse

problem associated with positing a Web questionnaire and inviting people to respond.

Number of contacts (or call-backs) has always been a major influence on response rates

to other survey methods, and the tool most depended upon to reduce nonresponse error.

There is little doubt that procedures can be developed for achieving response rates to








Web surveys that are reasonably comparable with those obtained by other methods

(Dillman, 2000).

The advent of Web surveying presents measurement challenges not previously

faced by survey methodologists and for which research has not yet provided solutions.

The enduring problem is that what the designer of a Web questionnaire sees on the screen

may differ significantly from what some, and in other cases most, respondents see on

their screens. Evaluation of the Web surveys located by D. Bowker (1999) revealed

much variability in methods of construction. When tested on various levels and types of

Web browsers, operating systems, screen configurations, and hardware, the visual

stimulus of the survey items (i.e., physical placement and presentation) was often

different from what had originally been intended by the designer.

Although measurement error effects represent one of the most serious threats to the

conduct of quality Web surveys, they are also among the most easily addressed through

various design controls by programmers. In the construction of this survey HyperText

Markup Language (HTML) was used in conjunction with SurveyWiz0, a program that

was originated by Michael Bimbaum in 1998 (Birnbaum, 2000). This program was

recommended by Dr. Roger L. Worthington, Ph.D., from the Department of Educational

and Counseling Psychology at the University of Missouri-Columbia while attending a

Web-based research methods forum at the 2001 Southern Association for Counselor

Education and Supervision (SACES) convention of the American Counseling

Association in Athens, Georgia. Dr. Worthington shared some of his experiences and

explained how he had enhanced the programming to alleviate some of the measurement

errors mentioned in this section. Dr. Worthington encouraged development of the survey








for the present study using the SurveyWiz formatting, as he believed that it would help

greatly in coding and reducing error while working with the data set prior to running

factor analysis.

During the survey development, the researcher worked closely with Mr. Gary Sipe

from Stetson University CIT Media Services to learn how to run SurveyWiz (Bimbaum,

2000) programming and how to set up the HTML documents. These files were edited

each time a revision was made to the items on the survey and saved on a working

clipboard and then resaved into the actual document. The final versions of all three

surveys were then saved onto the Stetson University Secured Server under an HTML file

reserved for the researcher as an adjunct professor. All responses to the survey were

forwarded from the Stetson server automatically to the researcher's email address, where

they were automatically coded by question number. One way of reducing nonrespondent

errors in this study was that each respondent was automatically coded by response time

and email address (appendix F). This assured that no respondent could submit responses

more than once. This process also helped in sending nonresponse notices to the correct

nonrespondents. Finally, the data were placed into a standard computer application

spreadsheet and prepared for run through a leading computer software statistical analysis

(Statistical Package for the Social Sciences; SPSS, 1975) for the factor analysis and

demographics.

Survey Research in Family Therapy

In family therapy research, many surveys have been designed to determine what

clinicians think or do. Survey research has been used to ask clinicians about their use of

assessment instruments (Boughner, Hayes, Bubenzer, & West, 1994), about how they act

when faced with ethical dilemmas (Green & Hansen, 1989), about their preferred models








of therapy (Quinn & Davidson, 1984), about how they use or view their clinical training

(Carter, 1989; Coleman, Myers Avis, & Turin, 1990; Keller, Huber, & Hardy, 1988) and

admission and program requirements (O'Sullivan & Gilbert, 1989), as well as about

issues related to ethnicity and gender in curricula (Coleman et al., 1990; Wilson & Stith,

1993). Students have been surveyed about their ethnic minority status as therapists in

training (Wetchler, 1989; Wetchler et al., 1989). Supervisors have been asked about their

training practices (Lewis & Rohrbaugh, 1989; Nichols, Nichols, & Hardy, 1990), about

what they view as essential basic family therapy skills (Figley & Nelson, 1989; Nelson &

Figley, 1990; Nelson, Heilbrun, & Figley, 1993), and about the essential elements of

marriage and family therapy and its supervision (White & Russell, 95).

On occasion, the general population or a class of clients has been surveyed to

determine their experience with a particular issue. Examples include wives' experiences

of their husbands' post-traumatic stress symptoms or combat stress reactions (Solomon,

Ott, & Roach, 1986), couples' experiences of marriage encounter weekends (Doherty,

Lester, & Leigh, 1986), and the effects of differing wake-sleep patterns on marital

relationships (Larson, Crane, & Smith, 1991). Halik, Rosenthal, and Pattison (1990)

measured personal authority (Bray, Williamson, & Malon, 1984) of daughters of Jewish

Holocaust survivors or immigrants. These examples of survey research pertain to family

therapy by virtue of the factors measured, which are often easily extrapolated into family

therapy interventions.

The research enterprise in family therapy has undergone two major transformations

since its early investigations. In the first transformation the field moved from its

impressionistic beginnings to an emphasis on quantitative and experimental research. It








also challenged family therapy researchers to develop reliable and valid measures, which

in conjunction with respectable research designs, helped to gain credibility for a fledgling

discipline in a skeptical clinical world (Sprenkle & Bischoff, 1995).

The second transformation involved a shift from a strict adherence to quantitative

methods to incorporation and gradual acceptance of alternate methodologies, especially

qualitative methods (Hoshmand, 1989; Moon, Dillon, & Sprenkle, 1990; Sprenkle &

Bischoff, 1995). Critics also argued that family therapy had made its quantitative leap

too soon, before clearly delineating what was meant by systemic constructs (Bednar,

Burlingame, & Masters, 1988). Therefore, concepts were operationalized before they

were truly understood and consequently seemed removed from clinical reality. This

called for more attention to contextual variables (Atkinson, Heath, & Chenail, 1991).

In terms of practice, marriage and family therapists and other mental health

professionals routinely assess violence potential for children and adolescents and make

related management decisions in psychiatric emergency services, civil psychiatric

hospitals, juvenile justice, and outpatient clinics. Each of these settings may have

different policy requirements for the evaluations, the amount and quality of available

information may vary, and the nature and decisional thresholds may differ. Each of these

factors can influence the way in which the risk assessment is conducted. Aware of this

diversity, this paper outlines some broad principles for violence risk assessment that may

be useful for marriage and family therapists in assessing risk of general violent

recidivism in various contexts.

In his article on risk assessment Borum discussed historical, clinical, and contextual

categories as the factors that show the most robust empirical support. He stated that the








history of violence would include being a victim of abuse or marital conflict. In his

clinical factors category he included substance abuse problems, mental or behavioral

problems, lack of empathy/remorse and attitudes that support violence. Included in

contextual factors were negative relationships, lack of social support, stress and losses,

community disorganization, and availability of drugs (Borum, 2000).

Data Analyses

The statistical technique used in this study was an exploratory factor analysis

(EFA). The variables operationalized in this study are summarized in Table 1. Validity

and reliability of the RVTS instrument are discussed in this section.

The Nature of Factors

The purpose of factor analysis is to discern and to quantify the dimensions

supposed to underlie mathematical entities, which can be thought of as a classificatory

axis with respect to which the test in a battery can be "plotted." The greater the value of

a test's co-ordinate, or loading, on a factor, the more important is that factor in

accounting for the correlations between the test and other factors in the battery.

An exploratory factor analysis is mainly used as a means of exploring the

underlying factor structure without prior specification of number of factors and their

loadings. In this study the responses were extracted into factors of what was most

commonly identified by the participants in the prevention, assessment, and treatment of

relationship violence.

The common factor model incorporates several parameters worthy of review in this

study. This term is not to be confused with the "common factor" theory across models

within the marriage and family literature, which implies a common theory of ideas

between different theoretical approaches. In this study, common factors were defined as








Table 1

Variables Used for the Relationship Violence Training Survey (RVTS)


Exploratory factor analysis variables


Quality of graduate training
in the identification, assessment,
and treatment of relationship
violence as reported by
Marriage and Family Therapists


Importance of competencies
and skills in the identification,
assessment, and treatment of
relationship violence as reported
by Marriage and Family Therapists


Variables


Rating my knowledge and skills in RV
Assessment and treatment in RV
Working with gay and lesbian clients
Obtaining restraining orders
RV skills today versus 5 years ago
RV screening in premarital counseling

Rating my graduate training received in RV
MFT graduate training programs overall
MFT graduate training that I attended
Intake/assessment of RV
Treatment approaches
Continuing education units in RV

Importance of competencies and skills
Self-knowledge in assessment skills
Identifying/assessing imminent danger
Performing protection assessments rating
Recognizing batterer typologies
Identifying client resources
Recognizing signs and symptoms/
cycle of violence
Assessing ethical standards
Assessing through a multicultural model
Identifying risk factors in relationship
violence
Recommending risk assessment/
instruments


Note. RV = relationship violence.

an unmeasured (or hypothetical) underlying variable that is the source of variation in at

least two observed variables under consideration( Kim & Mueller, 1978).

Thurstone (1947) originally advocated the simple structure principle as reflecting

truth about the psychology of cognition; this is where the concept originated. Thurstone,








at the time of the introduction of simple structure, explicitly regarded factoring as a

scientific revival of an old, discredited, unscientific notion of the principle of parsimony

to supplement the first, by which all of the correlations are explained by as few factors as

possible and each correlation is explained with as few of those factors as possible.

Thurstone stated that factor analysis is a technique to show the correlation of all

tests of mental ability. Thurstone found that all of the mental ability tests were positively

correlated, indicating a common factor among them. The analysis indicated the

following seven primary mental abilities: verbal, number, spatial, perceptual, memory,

reasoning, and word fluency (Thurstone, 1947).

Spearman (1904) viewed factor analysis as a data reduction procedure whereby a

matrix of obtained measurements of N individuals on n experimental variables is replaced

by a smaller matrix of factor coefficients or loadings, relating every variable to each of r

factors, each an underlying variable assumed to represent an ability or other kind of trait,

which is conceived as a vector in r-dimensional space (N > n > r).

According to McDonald (1985), the factor is "most like" the variables that increase

most rapidly as the factor score increases. It is unlike the variables with zero loadings, as

these do not vary as the large factor varies, and least like those variables that have large

negative regression weights on it (i.e., the variables that decrease most rapidly as the

factor score increases).

Stages in a Factor Analysis

The factor analysis in the present study was conducted in three stages.

1. A matrix of correlation coefficients was generated for all of the variable
combinations.








2. Factors were extracted from the correlation matrix. The most common method
is called principal factors (often wrongly referred to as principal components extraction,
hence, the abbreviation PC).

3. The factors (axes) were rotated to maximize the relationship between the
variables and some of the factors. In this study a Promax rotation method was used.
Promax is an oblique rotation method through which a simple structure is sought; factors
are rotated without imposing the orthogonality condition (i.e., that they be kept at right
angles), and resulting terminal factors are in general correlated with each other.

A fourth stage can be added in which the scores of each subject on each of the

factors emerging from the analysis are calculated. It should be stressed that these factor

scores are not the results of any actual test taken by the subjects; they are the estimates of

the subjects' standings on the supposed latent variables that have emerged as

mathematical axes from the factor analysis of the data set. Factor scores can be very

useful, because they can subsequently be used as input for further statistical analysis.

In this research study it was deemed advisable to carry out only the first stage

initially, in order to be able to inspect the correlation coefficients in the correlation matrix

R. Since the purpose of this analysis is to link variables into factors, those variables must

be related to one another and therefore have correlation coefficients larger than a

Cronbach's alpha of .70 and factor loadings greater than .30. These numbers are

consistent with the minimums needed in the social sciences for statistically significant

correlations. Any variables that showed no substantial correlation with any of the others

were removed from R in subsequent analysis. It is also advisable to check that the

correlation matrix does not possess the highly undesirable properties of multicollinearity

and singularity. The former is the condition in which the variables are very highly

(although imperfectly) correlated; the latter arises when some of the variables are exact

linear functions of others in the battery, as when the variable C is constructed by adding

the subjects' scores on variables A and B. Should either multicollinearity or singularity








be present, it would be necessary to drop some of the variables from the analysis (Gray &

Kinnear, 1998).

Rotation of Factors

Factor analysis is a variable reduction technique that simplification of data by

combining numerous variables into a much smaller set of synthetic variables called

"factors." Factor analysis is "designed to identify factors, or dimensions, that underlie

the relations among a set of observed variables" (Pedhazur & Schmelkin, 1991, p. 66).

As Tinsley and Tinsley (1987) noted:

Factor analysis is an analytic technique that permits the reduction of a large number
of interrelated variables to a smaller number of latent or hidden dimensions. The
goal of factor analysis is to achieve parsimony by using the smallest number of
explanatory concepts to explain the maximum amount of common variance in a
correlation matrix. (p. 414)

The ability of factor analysis to detect underlying factors makes it an extremely useful

tool for researchers who want to demonstrate that their results have construct validity.

Similarly, Gorsuch (1983) stated that "a prime use of factor analysis has been in the

development of both the operational constructs for an area and the operational

representatives for the theoretical constructs" (p. 350).

Thurstone's goal in developing his set of guidelines for rotating factors was that

"the factor pattern of any given variable would be constant when the variable was

included in another factor analysis containing the same common factors" (Gorsuch, 1983,

p. 177). This leads to findings that are more replicable across studies. As Gorsuch noted,

"Thurstone showed that such rotation leads to a position being identified for each factor

that would be independent of the number of variables defining it. Therefore, a simple

structure factor should be relatively invariant across studies" (p. 177).








In the present study an oblique rotation was used with a Promax procedure, since it

was the assumption of the researcher that the primary factors might be related. The

generalizability and replication of this research were better served with an oblique

rotation.

Validity in Factor Analysis

Validity is the strength of conclusions, inferences, or propositions. More formally,

Cook and Campbell (1979) defined it as the "best available approximation to the truth or

falsity of a given inference, proposition or conclusion" (p. 93). In short, "Were we

right?"

Validity can be established in a number of ways. The determination of the most

appropriate way depends on the kind of measure. Face validity is usually not enough. If

the variable is meant to assess mastery of subject matter, a test of content validity is

valuable. Usually, a panel of experts agree that all important content areas have been

covered. Construct validity can be determined by an appraisal of the correlation of the

test with other measures of the same trait or ability. Factorial validity confirms the test

with other measures of the same trait or ability. Factorial validity confirms the construct

by showing the strong presence of expected factors in the tests. Criterion-related validity

demonstrates that the test measure correlates highly with the concurrent validity or

predicts future performance (predictive validity). Study validity refers to the validity of

the measure, experiment, and people for the specific designated purpose. No test has

omnibus validity; that is, no one test does it all (Metzloff, 1998).

Professionals have consistently distinguished between actual validity and face

validity. Anastasi (1988) began a section on face validity as follows:








Content validity should not be confused with face validity. The latter is not validity
in the technical sense; it refers, not to what the test actually measures, but to what it
appears superficially to measure. Face validity pertains to whether the test "looks
valid" to the examinees who take it, the administrative personnel who decide on its
use, and other technically untrained observers. (p. 144)

In the present study, content validity, construct validity, and factorial validity were

considered to be important and tests of these forms of validity were applied. The survey

was given to a panel of experts to review the content and constructs, the wording of the

questions, and the extent to which the constructs accurately reflect the variables to be

measured in the study. Feedback from both groups was incorporated into the final survey

format. Tests of the factorial validity were done, once the data were collected and

correlated for various factors.

Reliability in Factor Analysis

Reliability is the consistency of the measurement, or the degree to which the

instrument measures the same way each time it is used under the same conditions with

the same subjects. In short, it is the consistent repeatability of the measure. A measure is

considered reliable if a person's scores on the same test, given twice, are similar. It is

important to remember that reliability is not measured; it is estimated. Reliability is

usually estimated in one of two ways: test/retest or internal consistency. For this study,

the RVTS will be administered only one time, and internal consistency will be used to

estimate reliability.

Internal Consistency

Internal consistency estimates reliability by grouping questions in a questionnaire

that measure the same concept. In the present study two groups of 10 questions each

measured the same concept (e.g., training in relationship violence). This permitted a








measurement of correlation between responses to those two groups of 10 questions to

determine whether the instrument was reliably measuring that concept.

This study applied the common way of computing correlation values among the

questions on the instrument: calculation of Cronbach's Alpha (Cronbach, 1951).

Cronbach's alpha splits all questions on the instrument in every possible way and

computes correlation values for all such combinations. The computerized statistical

analysis software generates one number for Cronbach's alpha; as with a correlation

coefficient, the closer this alpha to 1, the higher the reliability estimate of the instrument.

Cronbach's alpha is a less conservative estimate of reliability than test/retest. The

primary difference between test/retest and internal consistency estimates of reliability is

that test/retest involves two administrations of the measurement instrument, whereas the

internal consistency method involves only one administration of that instrument.

MFT Training Programs

Due to the nature of this research topic, it may be important to look at the status of

graduate-level training being offered by counselor training programs in prevention and

treatment of family violence. This was done to answer the following questions: Is the

curriculum using the current factors that are highlighted in the literature and

incorporating assessment for risk factors? What are the current assessments tools in

family violence prevention and treatment? Is imminent danger being assessed and are

safety plans being employed for victims at risk? Is administration of these instruments

being taught in counselor preparation programs; if so, are the assessment instruments for

violence used with each case that the marriage and family therapy graduate sees?

Rating of the graduate training program themselves will help in a correlation of

marriage and family therapy graduates, licensed practitioners, faculty, and the training




Full Text
THE CURRENT STATUS OF MARRIAGE AND FAMILY THERAPISTS’
GRADUATE TRAINING IN THE IDENTIFICATION, ASSESSMENT,
AND TREATMENT OF RELATIONSHIP VIOLENCE
By
MARIE T. BR ACC I ALE
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
2004

Copyright 2004
by
Marie T. Bracciale
11

ACKNOWLEDGMENTS
The author acknowledges the entire faculty in the Counselor Education Department
for preparing me to do this research. I am most appreciative of Dr. Silvia Echevarria-
Doan, chair, and my online editor, Dr. Jerry Byrd, for their many suggestions during
discussions and editing sessions. My thanks go to Dr. Bimbaum of California State
University, Fullerton, who developed the SurveyWiz program for the behavioral
sciences, made it accessible to me, and gave me permission to use it to build my
electronic survey; this made it possible for me to reach a nationwide sample. I am deeply
grateful to my committee members: Dr. Barbara Rienzo for her inspiration, Dr. David
Miller for statistical consultation and teaching, Dr. Sondra Smith for her academic
excellence and her role as a mentor for my teaching experience, and Dr. Peter Sherrard
for his continued supervision and coaching and his wonderful ideas that got this research
started in the right direction. I thank each of them for valuable comments, revisions, and
references during the course of my research.
I am indebted to the department chair, Dr. Harry Daniels, for supporting my
education through a Graduate Teaching Assistantship in the department to allow me to
work and to gain university teaching experience that will be valuable for future
endeavors.
I would also like to acknowledge Dr. Max Parker, Ph.D., for being a mentor to me
throughout my program and for being available for consultation whenever I needed him.
The training that I received from Dr. Mary Howard Hamilton in her consultation class

proved helpful in my professional development as a consultant. She also provided
mentorship throughout my program and was always available for consultation.
Personally, I acknowledge my parents, Rose and Roy, for their continued support;
my brothers, Dominick and Daniel, for unconditional love; and especially my partner,
E. J. Updyke, LMFT, for compassion, understanding, and patience through this process.
Others who contributed and whom I wish to thank include Jason Burkhardt for computer
consultation; Rosaría Upchurch, LMFT, for support and wisdom; Rebecca Waumett.
graduate student, who helped me to prepare email lists and databases; Mike Padilla from
educational psychology, who helped with methods selection and data analysis; Amy
Bradshaw, fellow doctoral student, for statistics coding, data entry, and dear friendship;
and Gary Sipe and the entire Stetson University CIT department for their help with the
SurveyWiz program, development of the online survey development, and resolving
glitches along the way.
Another mentor who is acknowledged for her contributions is Dr. Mickie Miller,
who took me under her wing as a graduate assistant at the University of Florida and at the
Brain Institute and helped me to develop courses. I acknowledge the Gainesville Family
Institute and its two faculty members, Dr. Herb Steier and Dr. Gina Early; I am grateful
for their constant consultation and coaching throughout my graduate program. Their
support and mentorship have changed me personally and professionally to be a better
person. Last, I thank all of my supervisees and interns from whom I have learned so
much over the years at the university; it has been a pleasure to work closely with them.
IV

TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iii
LIST OF TABLES ix
ABSTRACT x
CHAPTER
1 INTRODUCTION 1
Increase in Incidence of Relationship Violence
Professional Responsibility: Legal, Ethical, and Therapeutic Issues
Ethical Standards of the Commission on the Accreditation of Marriage
and Family Therapy Education (COAMFTE)
Scope of the Problem
The Extent of the Problem
Multiforms of Treatment (Metatheoretical, Postmodernism, Feminism,
Sociocultural, and Social Learning)
Metatheoretical Approach
Postmodernism
Sociocultural Theory
Social Learning Theory
Treatment for Battered Women
Treatment for the Batterer
Duluth Model
Society and Culture
The Family
The Individual
Summary
Graduate Training in Relationship Violence: Identification of Training Needs
Assessment of Violence in Treatment
Statement of the Problem
Need for the Study
Purpose of the Study
Rationale for the Study
Definitions of Terms
Organization of the Dissertation
...4
...6
...8
...9
.11
.11
.12
.13
.14
.15
.18
.19
.20
.20
.21
.21
,22
,24
,26
.27
29
31
32
34
v

VI
2 REVIEW OF THE LITERATURE 35
Increase in Incidence of Relationship Violence 35
Professional Responsibility: Legal, Ethical, and Therapeutic Issues 38
Licensing Boards 38
Lack of Training in Family Violence 38
Minimum State Requirements for Training 39
Theoretical Constructs Underlying the Study 40
Feminist View 40
The Study of Power 41
Social Learning Theory 43
Social Structural Theory 45
Treatment of Relationship Violence 47
Choice to Leave or to Stay in Abusive Relationships 47
Gottman’s Batterer Offender Typologies 49
Human Heart Reactivity 50
Holtzworth-Munroe and Stuart’s Three Major Types of Batterers 51
Identification of Training Needs 52
Current Status of Training and Need for Additional Curriculum 52
Continuing Education Units 53
Skills in Assessing Relationship Violence and Imminent Danger 54
Assessing for Risk Factors Associated With Relationship Violence 55
Identifying Risk Factors Associated With Relationship Violence 55
Prior Relationship Aggression 56
Demographic Characteristics 56
Psychological Characteristics 57
Specific Psychological Syndromes 58
Other Risk Factors 59
Ability to Assess Violence Risk 60
Violence Risk Assessment Study 60
Assessing and Managing Risk 61
HCR-20 Item Risk Assessment Instrument 62
Static and Dynamic Risk 62
Conclusion 63
3 METHODOLOGY 66
Research Method 67
Survey Design 69
Rating Scales in the Social Sciences 70
Research Procedures 73
Sample 73
Sources of Error in Sample Web Surveys 74
Survey Research in Family Therapy 78
Data Analyses 81
The Nature of Factors 81
Stages in a Factor Analysis 83
vi

vii
Rotation of Factors 85
Validity in Factor Analysis 86
Reliability in Factor Analysis 87
Internal Consistency 87
MFT Training Programs 88
Conclusions 89
4 RESULTS 91
Participants and Demographic Description 91
Factor Analysis Results 93
Principal Axis Factoring and Oblique Rotation 94
Extraction Method: Principal Axis Factoring 95
Factor Analysis Results 96
Identification and Naming of Factors 97
Reliability and Validity 98
Factor 1 98
Factor 2 99
Factor 3 104
Summary of Reliability Statistics for Factors 1 to 3 106
Summary 106
5 DISCUSSION 108
Evaluation and Discussion of the Results 108
Ratings of Importance 109
Training Methods 112
Clinical Assessments 115
Limitations of the Study 117
Respondents 117
Potential Confounders 117
Random Error 118
Response Rate 120
Possible Nonrespondent Bias 120
Nonrandomized Samples 120
Alternative Explanations 121
Implications and Recommendations for Further Research 122
Theoretical, Training, and Ethnical Implications 123
Conclusion 125
APPENDIX
A RELATIONSHIP VIOLENCE TRAINING SURVEY (WEB VERSION) 129
B COAMFTE ACCREDITATION STANDARDS 136
C AAMFT CODE OF ETHICS 147
vii

viii
D INVITATION LETTER TO PARTICIPATE IN SURVEY 155
E FOLLOW-UP LETTER TO NONRESPONDENTS 156
F SAMPLE CODED RESPONSE FORM 157
G DESCRIPTIVE STATISTICS MEAN RATINGS AND STANDARD
DEVIATIONS 158
H FACTOR CORRELATION MATRIX 159
LIST OF REFERENCES 160
BIOGRAPHICAL SKETCH 187
Vlll

LIST OF TABLES
Table Page
1. Variables Used for the Relationship Violence Training Survey (RVTS) 82
2. Characteristics of Respondents 92
3. Eigenvalues and Total Variance Explained 94
4. Factor Loading Matrix: Rotated Factor Loadings of .40 or Greater in the
Principal Axis Factoring, Based Upon N = 171 96
5. Factor 1 (Items 11-20): Sample Size Summary 99
6. Factors 1, 2, and 3: Reliability Statistics 99
7. Factor 1: Item Statistics 100
8. Factor 1: Summary Item Statistics 100
9. Factor 1: Item-Total Statistics 101
10. Factor 1: Scale Statistics 101
11. Factor 2 (Items 6-9): Sample Size Summary 102
12. Factor 2: Item Statistics 102
13. Factor 2: Summary Item Statistics 103
14. Factor 2: Item-Total Statistics 103
15. Factor 2: Scale Statistics 103
16. Factor 3 (Items 1-5): Sample Size Summary 104
17. Factor 3: Item Statistics 104
18. Factor 3: Summary Item Statistics 105
19. Factor 3: Item-Total Statistics 105
20. Factor 3: Scale Statistics 106
IX

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
THE CURRENT STATUS OF MARRIAGE AND FAMILY THERAPISTS’
GRADUATE TRAINING IN THE IDENTIFICATION, ASSESSMENT,
AND TREATMENT OF RELATIONSHIP VIOLENCE
By
Marie T. Bracciale
August 2004
Chair: Silvia Echevarria-Doan
Major Department: Counselor Education
The incidence of relationship violence (RV) has increased dramatically in the past
decade. Clinical counselors trained in marriage and family therapy (MFT) who interact
with perpetrators and victims of RV must be informed about associated personality
factors, transactional dynamics of perpetrators and victims, structural and environmental
influences leading to RV, and comparative effectiveness of intervention strategies. This
national study focused on graduate MFT training received by clinical members of the
American Association of Marriage and Family Therapists (AAMFT).
The Relationship Violence Training Survey (RVTS), designed by the researcher
and measured for content validity by experts in the field, contained two subscales: (a)
assessment of RV, and (b) training/treatment issues in RV. Demographic data included
age, ethnicity, gender, years of therapy experience, and years of supervisory experience.
The RVTS was designed to measure whether graduate MFT programs adequately prepare
therapists in assessment and treatment of RV. Program success was measured by survey
x

XI
responses regarding required coursework in RV, program endorsement by accreditation
standards, and practitioners’ self-reported self-efficacy in assessing and treating RV.
Respondents were 197 clinical members of AAMFT, AAMFT approved supervisors, and
faculty members in MFT training programs, obtained via nationwide random sampling
(response rate of 19.7%).
Statistical analysis of responses to the RTVS indicated three factors: (a)
respondents’ rating of the importance of clinical competencies associated with the
identification, assessment, and treatment of RV; (b) respondents’ rating of their graduate
training in RV; and (c) respondents’ self-rating of their knowledge and skills in
identification, assessment, and treatment of RV. Cronbach alphas for the three factors
were .814, .967 and .812, respectively.
The study results indicated problems in the ability of responding practitioners to
(a) use systematic risk assessments to recognize imminent danger and formulate
appropriate interventions, (b) intervene within violent gay and lesbian relationships, and
(c) obtain Restraining Order Injunctions. The need for improved quality and longer
duration of graduate training in RV and more stringent training requirements by licensing
boards and accreditation standards were supported. The results may be helpful to
researchers, treatment providers, graduate programs, accreditation boards, third-party
payers, and benefits officers.
xi

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
THE CURRENT STATUS OF MARRIAGE AND FAMILY THERAPISTS’
GRADUATE TRAINING IN THE IDENTIFICATION, ASSESSMENT,
AND TREATMENT OF RELATIONSHIP VIOLENCE
By
Marie T. Bracciale
March, 2004
Chair: Silvia Echevarria-Doan
Major Department: Counselor Education
The incidence of relationship violence has increased dramatically in the past
decade. This national study focused on training that clinical members of the American
Association of Marriage and Family Therapists (AAMFT) received during their graduate
marriage and family therapy (MFT) programs.
The Relationship Violence Training Survey was designed to measure whether these
programs prepare therapists in assessment and treatment of relationship violence.
Respondents were 197 clinical members of AAMFT, AAMFT approved supervisors, and
faculty members in MFT training programs, obtained via nationwide random sampling.
Results may be helpful to researchers, treatment providers, graduate programs, licensure
boards, accreditation standards, third-party payers, and benefits officers.
12

CHAPTER 1
INTRODUCTION
Whether or not human beings are inherently aggressive, as some have asserted
(Lorenz, 1966), it appears that they are most likely to behave aggressively in their most
intimate social relationships. Almost one fourth of all murders occur between relatives,
most often involving spouses killing one another (Straus, 1986). Child abuse, spouse
abuse, and elder abuse have become substantial problems in their own right. Date rape
and courtship violence occur with distressing frequency. Violence between homosexual
couples also has been documented in the literature. No type of interpersonal relationship
seems to be immune (Rosenbaum, Cohen, & Forsstrom-Cohen, 1991). In 2000, the
number of females shot and killed by a husband or intimate acquaintance was near ly 4
times higher than the number murdered by male strangers (Centers for Disease Control
and Prevention, 2001).
Why should one conduct a national survey of practices in assessment and
treatment of relationship violence? Due to the large increase of violence in society (as
the statistics will show), this survey is needed to respond to this incidence. Ethically, we
need to respond as an organization to have an impact on our clients, our research, our
treatment protocols, and our community/courts systems.
Very few national studies have been done on marriage and family therapist
practices. None has directly surveyed practices directly relating to relationship violence.
The results will be information of importance to researchers in the field, treatment
1

2
providers, graduate programs, and accreditation boards. It may also be helpful to third-
party payers and benefits officers.
In 1995 Doherty and Simmons conducted the first national survey of marriage and
family therapists on clinical patterns of marriage and family therapists. Their sample of
526 therapists from 15 states gave descriptive information on their training, level of
experience, and professional practices, along with detailed information on recently
completed cases. The findings indicated that marriage and family therapists treat a wide
range of serious mental health and relational problems, that they do so in relatively short¬
term fashion, and that they use individual, couple, and family treatment modalities
(Doherty & Simmons, 1996).
The goal of this project is to obtain detailed information about the clinical practices
of clinical members of the American Association of Marriage and Family Therapists
(AAMFT) throughout the United States. Specifically, the Relationship Violence Training
Survey (RVTS) is designed to answer questions about the adequacy and competencies of
marriage and family therapists, supervisors, and faculty members in identification,
assessment, and treatment of relationship violence and to look at the current status of
graduate training in relationship violence (appendix A).
The theoretical basis for this study is drawn from (a) the increase in incidence of
relationship violence as indicated by statistics; (b) professional responsibility: legal,
ethical, and therapeutic issues; (c) multiforms of treatment (metatheoretical,
postmodernism, feminism, sociocultural, social learning); and (d) identification of
training needs.

3
Increase in Incidence of Relationship Violence
In the United States today, violent crimes occur more frequently within families
than among strangers (Gelles & Straus, 1988; Langan & Innes, 1986; Straus & Gelles,
1990). Government surveys conducted between 1973 and 1981 identified 4.1 million
reports of intrafamilial victimizations (U.S. Department of Justice, 1984). In 1990 alone,
of the 6,008,790 crimes of violence against persons ages 12 and older reported in a
national crime victimization survey (U.S. Department of Justice, 1992), 39% were
perpetrated by a member of the victim’s family or by a person in a relationship with the
victim. Less than half of these crimes were reported to the police. Fifty-eight percent of
crimes reported involved the spouse or ex-spouse of the victim.
Although intimate partner violence (IPV) is known to occur among all social
classes, research over the past 30 years has demonstrated a consistent link between low
socioeconomic status (SES) and occurrence of partner violence (Gelles, 1997). In terms
of clinical studies, O’Brien (1971) found that, in a sample of divorcing couples, the
husband’s achievement status (measured by job dissatisfaction, education, income, and
occupational status) was much lower among the violent couples than among the
nonviolent couples. Gayford (1975) and Roy (1977) found that husbands of battered
women tended to hold unskilled occupations and have high levels of unemployment.
Hotaling and Sugarman (1986), in their review of 52 case comparison studies, found that
three indicators of the husband’s SES (occupational status, income, and educational
level) demonstrated a consistent inverse association with the occurrence of husband-to-
wife violence (Cunradi, Caetano, & Schaefer, 2002).
Data from the 1992-93 National Crime Victimization Survey indicate that young
women (ages 19-29) in low-income families (under $10,000) were more likely than other

4
women to be victims of partner violence (Bachman & Saltzman, 1995). Longitudinal
research suggests that men characterized by low SES indicators (unemployment, low
educational attainment) are more likely to initiate IPV than men without such
characteristics (Magdol et al., 1977), and these indicators are associated with the
persistence of wife assault over time (Alderondo & Sugarman, 1996). On the other hand,
Quigley and Leonard (1996) found no significant differences in education between
couples whose husbands desisted their marital violence after 2 years of follow-up and
those who did not (Cunradi, Caetano, & Schaefer, 2002).
Professional Responsibility: Legal, Ethical, and Therapeutic Issues
The duty to warn third parties of dangers posed by a client’s behavior, as Monahan
(1993) noted, “is now a fact of professional life for nearly all American clinicians” (p.
242). Family therapists, when deciding whether to warn a third party of a threat resulting
from a client’s behavior, must consider legal, ethical, and therapeutic issues. On the one
hand, courts in most states have ruled that therapists have a legal duty to warn (or avert
danger to) third parties to whom clients pose a risk. On the other hand, certain sorts of
client confidences are protected by law. Thus, therapists must determine whether they
have a legal duty to warn third parties of the danger posed by their client’s behavior and,
if not, whether the client’s information is legally protected (thus prohibiting the therapist
from disclosing the information). Ethical and therapeutic issues arise about client
information that state law does not expressly require or forbid therapists to disclose. In
such cases, therapists and clients are generally free to negotiate a mutually agreeable
disclosure policy.
All three factors (legal, ethical, and therapeutic) play a role in formulating the
written disclosure policy statement that each therapist should negotiate with prospective

5
clients. Some states regulate disclosure statements. In any case, therapists’ disclosure
policies must conform to all applicable laws.
The landmark case establishing that therapists, in certain cases, have a legal duty to
warn potential victims of their clients’ behavior is Tarasoff v. Regents of University of
California (1976). The details of the case are well known, in the course of therapy,
Prosenjit Poddar threatened to kill Tatiana Tarasoff, a fellow student in his square
dancing class. (Although Tarasoff was not mentioned by name, the therapist was well
aware of the identity of the potential victim.) Poddar was held for observation and then
released. No one notified Tarasoff of the threat that Poddar had made against her. Two
months later, Poddar murdered Tarasoff, and the Tarasoff family filed suit. The court
held that “when a therapist determines or pursuant to the standards of his profession
should determine, that his patient presents a serious danger of violence to another, he
incurs an obligation to use reasonable care to protect the intended victim against such
danger” (p. 346).
A disclosure statement is a written document detailing the policy, negotiated
between therapist and client, concerning therapist disclosure of client information.
(Frequently, the document expresses the standard policy of the therapist and is signed by
the client.) It should inform the client of the therapist’s legal responsibilities and indicate
how the therapist will use discretion within the limits of the law (Schlossberger &
Hecker, 1996).
The legal evolution of the “battered women’s defense,” as it came to be known,
was built on the “rape defense” successfully argued by lawyer Susan Jordan in the second
trial of Inez Garcia and the successful appeal filed by Jordan, Nancy Steams, and Liz

Schneider for Yvonne Wanrow, the Spokane woman hobbling on crutches who killed a
man for molesting her son. Armed with new, and newsworthy, feminist concepts—
6
“battered women’s syndrome,” “unequal combat,” and “imminent danger”—their defense
strategies helped to focus a spotlight on domestic violence. After nearly a decade of
feminist agitation in concert with legislative initiatives pioneered by Representative
Lindy Boggs and Senator Barbara Mikulski, Congress passed the Family Violence
Prevention and Services Act in 1984. Today, approximately 1,800 battered women’s
shelters, hot lines, and advocacy programs around the country are funded by the federal
program (Brownmiller, 1999).
Ethical Standards of the Commission on the Accreditation
of Marriage and Family Therapy Education (COAMFTE)
The Commission on Accreditation for Marriage and Family Therapy Education
was established by the AAMFT Board of Directors in 1974. In 1978, the Commission
gained official recognition by the U.S. Department of Education as the accrediting
agency for the graduate degree and post-degree training programs in marriage and family
therapy. These training programs are located throughout the United States and Canada.
In 1978, in recognition of its increased level of activities and responsibilities, the
Commission was restructured and renamed the COAMFTE.
The Commission on Recognition of Post-secondary Accreditation (CORPA)
officially granted recognition to the COAMFTE in 1994. CORPA is a nongovernmental
organization that works to foster and facilitate the role of accrediting bodies in promoting
and ensuring the quality and diversity of American postsecondary education.

7
COAMFTE serves under a broad mandate from the AAMFT Board of Directors to
set standards for and accredit master’s, doctoral, and post-degree clinical training
programs in marriage and family therapy (COAMFTE, 1994).
Specific standards developed by the COAMFTE (appendix B) outlining the
importance of this study include the following:
320: Area II: Clinical Knowledge
320.02 Area II content will address contemporary issues, which include but are
not limited to gender, violence, addictions, and abuse, in the treatment of
individuals, couples, and families from a relational/systemic perspective.
340.04 Area IV will address the AAMFT Code of Ethics [appendix Cl,
confidentiality issues, the legal responsibilities and liabilities of clinical practice
and research, family law, record keeping, reimbursement, and the business aspects
of practice. Area IV content will inform students about the interface between
therapist responsibility and the professional, social, and political context of
treatment.
Accreditation Bodies
COAMFTE Preamble to the Standards on Accreditation, Version 10.2
Accreditation is a voluntary process on the part of the program whose major
purpose is to ensure quality in a marriage and family therapy program. All
accredited programs are expected to meet or exceed all standards of accreditation
throughout their period of accreditation. The integrity of an institution and the
program is fundamental and critical to the process of accreditation. Accreditation
standards are usually regarded as minimal requirements for quality training. All
accredited programs are free to include other requirements, which they deem
necessary and contribute to the overall quality of the program. Programs must
continually evaluate their programs in relation to their institution’s mission and
their own program mission, goals and educational objectives. Accreditation
standards, like other aspects of accreditation, are part of a slowly evolving,
continuous process. In the long view, there are continuing conversations among
accreditors, training programs, trainees, trained professionals, employers, and
consumers from which the standards and other aspects of accreditation evolve.
The objective of these standards is to assure, as much as possible that individuals
trained in accredited programs are competently trained to become marriage and
family therapists at the entry and doctoral levels. The standards are designed to be
unique to the practice and supervision of marriage and family therapy. Some
standards apply to training programs in general, including elements such as

8
organizational stability, faculty accessibility, appropriate student selection
processes, and fairness to students and employees. Some standards apply to all
psychotherapy training, including elements such as adequate numbers of client
contact hours and supervision hours.
Graduates from COAMFTE accredited marriage and family therapy programs are
trained to be clinical mental health practitioners. COAMFTE adopts the Standard
Occupational Classification of the Bureau of Labor and Statistics which states that
Mats are qualified to “[d]diagnose and treat mental and emotional disorders,
whether cognitive, affective, or behavioral, within the context of marriage and
family systems. [They] Apply psychotherapeutic and family systems theories and
techniques in the delivery of professional services to individuals, couples, and
families for the purpose of treating such diagnosed nervous and mental disorders.”
All persons properly trained in marriage and family therapy are to be competent in
working with individuals. (American Association for Marriage and Family
Therapy, 2003)
Marriage and family therapists are bound ethically by the standards of accreditation
and clinical ethical guidelines to understand the importance of assessing for abuse and
violence with each case. In some cases, the reasons that abuse and violence are present
may be difficult to detect.
Scope of the Problem
Current researchers who report on the treatment of relationship violence have only
recently written that this type of treatment is evolving into a specialized field. Although
for many years there have been specialized treatment programs available in a few states,
it is only recently that the need has been recognized to develop and fund specialized
treatment programs in every state. This recognition has been spurred on by two factors:
(a) increasing and widespread acknowledgement of the extent of the problem, and (b)
increasing acceptance that traditional forms of therapy are not effective with the
relationship violence population (Crawford, 1981).
Two decades of empirical research on child abuse, wife beating, and domestic
violence are conclusive on one point: The causes of violence are multidimensional (Gil,

9
1971; Straus, Gelles, & Steinmetz, 1980). There is no one cause of this violence—not
poverty, not stress, not mental illness or psychopathology, not being raised in a violent
home, and not alcohol and/or drugs (Gelles & Maynard, 1987).
It is apparent that the treatment for a multidimensional problem would include
varied approaches, depending on the context. Straus’s (1973) general systems model of
violence between family members was one of the first theoretical applications of a
systems perspective to family violence. Another presentation of a research systems
model is Giles-Sims’s (1985) examination of wife battering. Giles-Sims’s systems
models looked at the factors influencing a battered woman’s decision to stay, flee, and/or
return to violent relationships.
The Extent of the Problem
Domestic violence is one of the most common crimes. Many of us know someone
in our close family or among our friends to whom it has happened, or we have
experienced it ourselves, but we tend to think that we are different or alone, not realizing
perhaps just how widespread and enduring domestic abuse is. Domestic violence occurs
in almost all cultures and countries, across all known divisions of wealth, race, caste, and
social class. There may never have been a time when it did not exist; it certainly
stretches back deep into history. Centuries, indeed millennia, are filled with millions of
assaults, attacks, rapes, violations, psychological abuses, maimings, killings of women in
their homes by men (Hague & Malos, 1998).
Although it is true that approximately 6 million women in the United States are
beaten in their homes each year, there is more to the domestic violence picture. For
example, 70% of male partners (batterers) also abuse children in the home. More tragic,
boys often attempt to protect their mothers from battering and are themselves injured or

10
killed. Incredibly, over 60% of males ages 15 to 20 who were incarcerated for homicide
had killed their mother’s batterer (Summers & Hoffman, 2002).
Domestic violence is not a new phenomenon. It has been a common occurrence
throughout recorded history. In many societies, women were traditionally considered the
property of the man; his duty was to discipline her and the children (and slaves) with
thorough beatings. The only concerns about this related to the thickness of the stick that
the law allowed for the beatings. Although there were some earlier unenforced laws
against spousal abuse, it was only as recently as the 1970s in the United States that the
justice system began to view the problem seriously and consider domestic violence as a
crime. Up until that time, social services for victims of domestic violence were almost
nonexistent.
There are many contributing factors to domestic violence, usually associated with
differing views of what the problem is based on. Some of these views are learned
behavior, gender socialization, patriarchy or power and privilege, and risk factors,
including criminal or psychological profiles. Even countries view the nature of the
problem differently. For example, some of the risk factors for domestic violence in
England and Wales are gender inequality, poverty, social exclusion, having a criminal
background, and having experienced abuse as a child. The families are classified as
patriarchal (male dominated), and women have a subordinate status. This also seems to
be the case in Italy, where the view is held that religion keeps domestic violence as an
isolated and personal problem rather than a serious social ill. Both the Catholic church
and the state view domestic violence as a personal and private matter. Battered women
are encouraged to return home to their abusing partners. In their zeal to preserve the

11
family, domestic violence has often been overlooked and even considered “normal.” In
Australia, most citizens see domestic violence as rooted in the aggressive nature of men.
Yet the indigenous population sees it as learned behavior. In Jamaica, the problem is
regarded as stemming from a lack of education, abject poverty, drug abuse, and the
mythology surrounding the traditional role of the male. In Russia, Germany, and
Slovenia, major political change is identified as another contributing factor (Summers &
Hoffman, 2002).
Overall, domestic violence presents a profoundly disturbing and distressing picture.
Some people choose to turn away from that picture. Partner abuse is an epidemic with
potentially dire consequences for individuals, families, and society. Family therapists
must be competent to assess for and intervene in abuse situations (Haddock, 2002).
Multiforms of Treatment (Metatheoretical, Postmodernism,
Feminism, Sociocultural, and Social Learning)
Various theoretical and treatment approaches are being used within the relationship
violence field. Four of these approaches are reviewed in this section.
Metatheoretical Approach
Metatheoretical, as a general term, refers to the philosophical (e.g., epistemic,
ontological, metaphysical) assumptions that influence or form the basic structure of
various disciplines in science and the social sciences (Hoshmand, 1996). When working
with batterers, the most therapeutic interventions in cases of relationship violence are still
based on behavioral approaches (Bagarozzi, 1983; Taylor & Gunn, 1984). Cook and
Franz-Cook (1984) presented a systematic treatment approach to wife battering.
Margolin (1979) and Taylor and Gunn proposed conjoint therapy for spouse abuse cases.
The radical feminist perspective and the systemic view of family violence are not

12
mutually exclusive, and Cook and Franz-Cook stated that treatment based on both views
is necessary and important.
Archer (2000), in a meta-analysis, compared samples selected for male violence
(from battered women’s shelters) with community samples to assess whether the couple
violence looked different across these populations. Very high levels of male aggression
were reported in shelter samples, whereas in community samples women were slightly
more physically aggressive. Archer also examined studies of couples undergoing
treatment for marital problems and found that men were slightly more likely than women
to be physically aggressive. However, in contrast to shelter samples, the level of male
aggression was much lower. This suggests that couples receiving counseling, even for
problems specifically related to male violence, do not have nearly the same kind of
imbalance in physical aggression as might be found in couples in which the woman has
sought shelter from abuse (Greene & Bogo, 2002). This study will describe current
empirical research to support a conceptual framework for helping marriage and family
therapists to assess and treat relationship violence. Depending on the context, flexibility
in searching for approaches when working with the needs of couples may be indicated. A
broader lens that takes into account the various faces of intimate violence may expand
alternatives for assessing and treating these couples (Greene & Bogo, 2002).
Postmodernism
Postmodern perspectives have had considerable impact on the field of couple
therapy in the 1990s. Focused on self-organizing and proactive features of human
knowing, they emphasize that reality is constructed, reflecting language, culture, and
social context (Anderson, 1997; Neimeyer, 1993). Meaning and knowledge are seen as
being created through social communication with others. The most radical forms of

13
constructionism see every case as unique and suggest that no single version of reality or
problem formulation is better than another. Problems are viewed as “interpretations” that
can be “dis-solved” in language (Anderson).
Specific techniques have been developed in solution-focused and narrative
therapies to help clients to “deconstruct” the problematic aspects of their relationship and
allow new possibilities to emerge. However, there are many ways to help clients to
create new meanings and many ways to access and work with aspects of experience that
have gone “unstoried.” More generally, this perspective may be viewed as an “attitude”
or philosophical stance for therapy rather than as a model for intervention or a set of
techniques.
From a respectful, collaborative stance, therapists regard clients as experts on their
own reality and discover with clients how they construct that reality. Therapists show
sensitivity to each individual and enlarge the frame to include larger contextual issues,
such as gender, class, and culture. Therapists also focus more on a couple’s strengths and
competencies, striving to honor and validate clients’ wisdom and strengths in dealing
with difficult realities. Social-constructionist ideas can also be integrated with more
traditional research if certain guidelines are followed (Myers Avis, 1996); for example, if
researchers recognize and reveal their own values and beliefs with the research context.
Sociocultural Theory
The search for the causes of domestic aggression has focused largely on
sociocultural and psychological factors. It has been a short search, the primary strategy
of which has been to identify characteristics of participants that distinguish them from
their nonaggressive counterparts. It has been an atheoretical search in which theory is
occasionally invoked, post hoc, to explain one or another research finding. Social

14
learning theory, for example, is used as an explanation for the intergenerational
transmission of aggression, and female masochism is sometimes employed to account for
the battered woman’s reluctance to leave an abusive mate (Rosenbaum & O’Leary,
1981).
Sex-role socialization, in general, tends to support the notion that the success or
failure of intimate relationships is the woman’s responsibility, and this may lead some
women to make great efforts to stay in intimate relationships, even after episodes of
abuse, to show their commitment to their partner and to weathering the “difficult times”
together (Dutton & Painter, 1981; Strube, 1988). In addition, when an abusive event
occurs, the woman may presume that it will not recur, and so will “try to make the
relationship work under the belief that, if she tries hard enough, her efforts will succeed”
(Strube, p. 240).
Sociological and sociocultural theory assumes that social structures affect people
and their behavior. The major social structural influences on family violence are age,
gender, position in the socioeconomic structure, and race and ethnicity (Gelles, 1983).
Social Learning Theory
According to Bandura’s (1973, 1977) social learning analysis of aggression,
witnessing interparental violence may predispose some young males to abusive behaviors
in their adult intimate relationships with women. Social learning theory maintains that
violence (in the form of a learned response) is transmitted from the family of origin to the
adult intimate dyad through the vicarious reinforcement of interpersonal violence as a
method of conflict resolution and a means to the maintenance of power and control in
intimate relationships.

15
In addition to external reward/punishment contingencies, Bandura (1973)
proposed that the following self-regulatory mechanisms modulate self-recrimination
processes by “neutralizing” aggressive behaviors: (a) justification of the behavior on the
basis of some higher authority (e.g., scripture); (b) comparison of the behavior with more
serious violence; (c) projection of responsibility for the behavior onto drugs, alcohol,
work stressors, or the provocation of the victim; (d) normalization of the behaviors as a
common and socially acceptable occurrence; (e) depersonalization of the victim through
the use of disparaging labels; and (f) minimization of the consequences of the behavior.
One or more of these neutralizing tactics have been observed among batterers in
treatment (Carden, 1994).
Treatment for Battered Women
Varieties of counseling approaches have been proposed for battered women in
recent years, including grieving, existential, and shame therapy (Turner & Shapiro,
1986). Some of these approaches are reviewed in this section.
Empowerment and safety-based interventions have been found useful. In her text
Counseling Female Offenders: A Strength-Restorative Approach, Katherine Van
Wormer (2001) established a link between the crimes of female offenders and
environmental factors such as substance abuse and sexual abuse. Combining strategies
from the fields of criminal justice and social work, she showed how to empower female
offenders and how to rehabilitate them to society by building on their personal strengths.
From her unique “strengths-restorative” approach, the author presented strategies for
anger management, substance abuse treatment, and domestic violence counseling.
In 2000, the University of Northern Iowa applied for and received a federal grant
to combat gender-based violence in a comprehensive manner. The planning and

16
implementation of the grant used an interdisciplinary approach, linking pre-existing law
enforcement, prevention programs, and victim services while adding a variety of new
tools and efforts. Below are some of the new and expanded programs offered as part of
the Violence Against Women grant. Some of the programs that they have developed are
RAD—Rape Aggression Defense Class and a Blue Light program, with five blue light
safety phones spread throughout the campus. These are some examples of safety
prevention programs that are effective and work well to decrease violence on campuses
(University of Northern Iowa, 2003).
Fundamental to the counseling efforts should be a design to move the battered
woman from status as a “victim” to that of a “survivor” (Rieker & Carmen, 1986). It is
this shift in self-perception that is most associated with safety and recovery (Gondolf &
Fisher, 1988).
The Duluth Model (Minnesota Program Development, 2003) contacts partners of
offending men and offers advocacy, community resources, and a women’s group. The
model uses a curriculum called In Our Best Interest: A Process for Personal and Social
Change for their battered women’s group. Women who have been arrested for using
violence are also ordered to attend nonviolence classes.
According to several victimization studies, battered women tend to move through
several phases in response to abuse (Ferraro & Johnson, 1983; Mills, 1985). These
phases are distinguished by an attributional shift on the woman’s part. In essence, she
begins to perceive that the battering was not “all her fault” but was largely due to her
husband’s behavior. It is not up to her to change the batterer; in fact, it is not likely that

17
he will change. Instead, she is capable of taking care of herself, with the support and
assistance from others that she deserves (Gondolf & Fisher, 1991).
Therefore, the objective in counseling might be to reinforce and encourage this
realization. Many shelters subscribe to an “empowerment” mode of counseling to
achieve this end. The feminist approach is directed toward helping the woman to realize
her options and choices and to begin to make decisions that assure her worth, integrity,
and determination (Bograd, 1988). One study of formerly battered women rated this sort
of counseling to be the most effective in stopping violence (Bowker, L., 1983).
Some clinicians (e.g., Almeida & Durkin, 1999) who are sensitive to issues of
power, abuse, and trauma have recommended the use of gender-specific support groups
for the victim as the most appropriate treatment strategy, it can be noted that a
combination of individual and group treatment is often desirable.
Some theorists have argued against the use of couples therapy in situations of abuse
(Avis, 1992; Bograd, 1992; Dutton; 1992). However, feminist-identified family
therapists have begun to experiment cautiously with the use of couples treatment in
situations of abuse (Goldner, Penn, Sheinberg, & Walker, 1990; Jenkins, 1990; Jory &
Anderson, 2000). Some therapists are using proposed criteria to determine situations in
which couples therapy may be appropriate. These indicators, listed by Bograd and
Mederos (1999), rule out the appropriate use of couples therapy. Since the issues of
partner abuse situations are complex, therapists should resist formulaic approaches to
treatment planning. Relevant variables should be carefully considered in making
treatment decisions, such as the power differential between the partners, the nature and
extent of the abuse, lethality indicators, the effects of the abuse on the victim, the ability

18
of the victim to stay safe, the resources of the victim, the responsibility taken by the
perpetrator, and the commitment to change demonstrated by the perpetrator (Haddock,
2002).
Treatment for the Batterer
The treatment of batterers has similarly seen a proliferation of approaches and, with
it, increased debate. The leading programs are characterized by group process that
prompts men to take responsibility for their abuse, to exercise alternatives to the violence,
and to restructure their sex-role perceptions (Gondolf, 1987b). However, there is a
questionable trend toward short-term anger control treatment that unwittingly reinforces
the batterer’s penchant for control (Gondolf & Russell, 1986).
The research on cessation suggests that batterers who reform their behavior pass
through a series of developmental stages (Fagan, 1987; Gondolf, 1987a). The change
process begins with “realization.” The egocentric batterer acknowledges the
consequences of his abuse and that it may be in his own self-interest to contain the anger
that led to the abuse. Gradually, the batterer becomes more “other oriented” and begins
to make “behavioral changes” to improve relationships, or at least to avoid totally
destroying them. Some men eventually begin to think more in terms of values and
principles and integrate these into a change of self-concept. Consequently, a number of
leading batterer programs employ a phased approach that moves batterers from didactic
sessions of accountability and consequence to social support groups with a focus on
service (Gondolf, 1985).
When treating batterers, marriage and family therapists should be aware of the
heterogeneity among batterers across several dimensions, including the severity of the
violence and the psychopathology and physiological responses of the batterer

19
(Holtzworth-Munroe, Smutzler, Bates, & Sandin, 1996; Jacobson & Gottman, 1998).
Understanding the differences between two types of batterers—Type 1 (“cobras”) and
Type 2 (“pit bulls”)—can also be useful (Gottman et al., 1995; Jacobson & Gottman).
These typologies are described in the literature review section of this dissertation.
According to Haddock (2000), novice therapists should be advised against treating
most perpetrators of abuse; indeed, for court-ordered batterers, most states mandate
certain kinds of treatment by certified professionals. Therapists should be familiar with
local agencies that serve batterers and the methods for making referrals to local batterer-
specific treatment programs.
Duluth Model
In 1981 nine city, county, and private agencies in Duluth, Minnesota, adopted
policies and procedures that coordinated their intervention in domestic assault cases.
These measures focused on protecting victims from continued acts of violence by
combining legal sanctions, nonviolence classes, and, when necessary, incarceration to
end the violence. Consistently applied, their message to offenders is clear: “Your use of
violence is unacceptable.”
The Domestic Abuse Intervention Project (DAIP) was the coordinating agency for
this effort. An additional component of the DAIP was the nonviolence program, which
consisted of classes for offenders who were court-ordered to the programs. The programs
used the curriculum “Power and Control: Tactics of Men Who Batter,” a 24-week
educational curriculum (Pence & Paymar, 1993).
Batterer intervention programs, which seek to educate or rehabilitate known
perpetrators of IPV to be nonviolent, have proliferated since the 1980s under the auspices
of both the criminal justice system and the mental health system. Three theoretical

20
approaches to the conduct of these programs have been consistently documented (Healey,
Smith, & O’Sullivan, 1997): society and culture, the family, and the individual. These
theories influence the content and delivery of interventions.
Society and Culture
Feminist theorists attribute battering to social and cultural norms and values that
endorse or tolerate the use of violence by men against their women partners. The
feminist model of intervention educates men concerning the impact of these social norms
and values and attempts to resocialize men through education, emphasizing nonviolence
and equality in relationships.
It has been well documented by feminist researchers that gender is a central
organizing principle for both individuals and couple relationships and therefore must be
an integral feature in family therapy (Goldner, 1985; Hare-Mustin, 1986). More research,
analysis, and understanding are needed regarding how intersecting factors such as gender,
class, race, and ethnicity operate in cases of couple violence.
We must acknowledge the limits of generalizations that can be made on the basis of
populations included in research to date. Most couple therapy clients are White and
middle class. The considerable influence of cultural diversity and changing gender roles
is, as yet, largely unexamined (Johnson & Lebow, 2000). The adaptation of couple and
family therapy to consider the impact of culture will be a vital concern of future research
in the field.
The Family
Family-based theories of IPV focus on the structure and social isolation of families.
The family systems model of intervention focuses on communication skills, with the goal
of family preservation, and may use couples counseling/conjoint therapy. Wife battering,

21
like other forms of family violence, raises a variety of family issues. But, unlike child
and elder abuse, it threatens the very foundation of the family structure—the marriage (or
partnership). Therefore, the most crucial family issue is whether the family is to
continue. Given the tendency of wife battering to escalate and denial of the problem to
persist, most practitioners in the field have, in the past., strongly recommend separating
the batterer from the battered women and children (Gondolf & Fisher, 1991).
The Individual
Psychological theories attribute perpetration of IPV to personality disorders, the
batterer’s social environment during childhood, or biological predispositions.
Psychotherapeutic interventions target individual problems and/or build cognitive skills
to help the batterer to control violent behaviors.
Summary
Currently, there is little evidence to suggest the effectiveness of one approach over
another or of the differential effectiveness of different programs with different “types” of
batterers, although one study has suggested that process-psychodynamic groups may
function better for men with dependent personalities and cognitive-behavioral groups
may be more effective for those with antisocial traits (Saunders, 1996).
The most widely evaluated intervention model for men who batter is that of group
interventions using cognitive-behavioral techniques, often in combination with feminist
content. One review of these studies reported that rates of successful outcomes (i.e.,
reduced or no reassault) from these programs varied from 53% to 85% (Tollman &
Bennett, 1990). However, other reviews have pointed out those methodological problems
in the studies limit conclusions about the effectiveness of such programs.

22
Graduate Training in Relationship Violence:
Identification of Training Needs
The importance of intervening in cases of so-called “minor” spousal violence is
underscored by the assumption by many researchers that minor violence, if left untreated,
can escalate into severe or life-threatening violence (Rosenberg, 1985). In most graduate
programs, this area of assessment is poorly presented, unless graduate students
specifically discuss relationship violence during intake. Research suggests that, unlike
graduate students, emergency personnel are well trained in this area of assessment, since
these personnel are primarily working the “front lines” with respect to relationship
violence victims. These personnel have incorporated violence assessments into their
intake procedures.
According to Wolf-Smith & LaRossa (1992), professional counselors, therapists,
and social workers have an obligation to help victims to gain insight into their abuse.
They also have an obligation to be nonjudgmental of whatever decision a woman makes
about her abusive relationship. Professionals provide varied services to victims and their
families to help heal the effects of violent relationships. Treatment providers may
recommend many different approaches, including individual, group, and/or family
therapy. However, the specific treatment approaches that are currently being taught in
graduate school training for counselors are unknown. Furthermore, it is unknown
whether the treatment recommended varies depending on the context of the case. Are
professionals being trained to treat the victim? the batterer? the couple? the individual?
the family? Is there coursework from a relationship-violence context or through a
relational violence lens? This information would allow the professional counselor to gain
knowledge in treating clients who present with issues of relationship violence.

23
“Victims of male battering face difficult choices—choices about what to say to
their abusers, choices about whether to stay. Respecting the choices that women make is
an integral part of the counseling/therapeutic process” (Wolf-Smith & LaRossa, 1992,
p. 324).
Understanding the tendency to reduce the inherent complexity of partner abuse
cases in response to concerns about potential lethality, therapists would benefit by
learning to conceptualize each case within its own unique and multifaceted context
(Dutton, 1992; Goldner, 1999), while attending to the intersections of gender, race, class,
religion, and sexual orientation (Bograd, 1999).
Goldner’s (1992, 1999) “both/and” stance can be introduced as a way to manage
these complexities.
There is an enormous pressure to “get it right” immediately and, as a result, the
impulse is to lapses into extremes: to side with one partner against the other, to
refuse to ever take sides at all, to exaggerate or minimize danger, to insist on a
particular paradigm and argue against all others—in other words, to polarize
everything. (Goldner, 1992, p. 56)
Part of the difficulty for faculty and marriage and family supervisors in training
students effectively has been that the domestic violence literature includes disparate and
controversial findings. On the one hand, studies of community samples find generally
low levels of violence perpetrated by both males and females. On the other hand, studies
of clinical samples drawn from courts, hospitals, and shelters find severe violence,
mainly perpetrated by men (Archer, 2000; Johnson, 1995). For instance, feminist
researchers have studied primarily clinical samples and have concluded that intimate
violence is the result of patriarchy and, thus, is primarily perpetrated by men as a means
to maintain power and control (Dobash & Dobash, 1979; Pagelow, 1984). Family
conflict researchers have studied mainly representative community samples and have

24
concluded that intimate violence between partners results from individual, relational, and
societal variables that tend to be more gender neutral (Berkowitz, 1993; Straus & Smith,
1990). These two different perspectives have led to a longstanding debate about the
veracity of each position, which impacts training in terms of approaches taken to address
the identified problem.
The majority of studies on couple violence have limitations, notably largely using
samples involving only severely violent men. Conclusions and conceptualizations about
violence and appropriate clinical interventions have been generalized from these samples
to all couples in which there is aggression (Johnson & Ferraro, 2000). Comparably little
research has involved couples voluntarily seeking conjoint treatment for intimate
violence (Brown & O’Leary, 1997). Despite growing evidence of difference between
these populations, distinctions have yet to be included in assessment (Greene & Bogo,
2002).
Assessment of Violence in Treatment
For those professionals using traditional assessment methods, rather than
assessments geared toward gleaning information about relationship violence, clients may
be allowed to “maintain the silence,” since appropriate questions are not asked initially.
Without vital skills in assessing relationship violence specifically, counselors are more
likely colluding with the system to maintain the violence and thus may be putting their
clients at risk. It is unclear why the majority of counselors are not trained in this
important area of assessment.
Previous research establishes a precedent for needed improvements in the education
and training of psychotherapists. For example, Hansen, Harway, and Cervantes (1991)
surveyed the national membership of the AAMFT. Therapists participating in the survey

25
were asked to read two vignettes with proven therapeutic interventions for domestic
violence cases portraying female victims and domestic violence. The results indicated
that most of the counselors did not attend to the seriousness of the violence and many did
not attend to it at all. Indeed, one of the vignettes was based on an actual case study in
which a family member had been killed. In this survey of 362 members of the AAMFT,
respondents were asked to conceptualize the case and to describe how they would
intervene. Forty-one percent of those surveyed indicated no recognition of domestic
violence.
The use of various written assessments for detecting abuse and violence may prove
beneficial. One such instrument is the HCR-20: Assessing Risk for Violence (Version 2)
by Webster, Douglas, Eaves, and Hart (1997). Another assessment tool is the Clinical
Guidelines on Routine Screening published by the Family Violence Prevention Fund and
available at no cost from their Web site. This includes screening questions, history intake
form, abuse assessment screen, domestic violence screening/documentation form,
assessment of patient safety, referrals, reporting procedures, and photographs that might
be taken (Family Violence Prevention Fund, 2003)
To underscore the importance of assuming abuse with each case until ruled out,
Bograd and Mederos (1999) developed a comprehensive protocol for screening for abuse.
Therapists should also be informed of other written instruments, including multimodal
assessments of partner abuse (Alderondo, 1998; Alderondo & Strauss, 1994; Gottman,
1999).
In her 2002 text Seeking Safety: A Treatment Manual for PTSD and Substance
Abuse Najavits discussed safety plans as well as many other resources, including

26
individual and group therapy guidelines. Seeking Safety also provides clinicians with a
session format, including a check-in and check-out procedure that helps the client to
commit to safe coping strategies.
Dunford (2000), along with other researchers (Holtzworth-Munroe, Meehan,
Herron, Rehman, & Stuart, 2000; Saunders, 1996; Waltz, Babcock, Jacobson, &
Gottman, 2000), has suggested that treating physically aggressive men as one
homogenous group, rather than tailoring interventions according to the different
motivations and needs of physically aggressive men, could be responsible for the
ineffectiveness of treatment. Dunford urged therapists to give “full and preferential
attention” to the possibility that one-size-fits-all approaches to treatment may not meet
the needs of these couples (p. 475). Examining the effectiveness of distinguishing
between couples in various types of violent relationships and tailoring treatment
interventions accordingly constitutes a promising area for future clinical exploration and
empirical research (Greene & Bogo, 2002)
In the cases of common couple violence, intervention should maintain a dual and
simultaneous focus on both anger management and relationship building. Gottman’s
(1999) research has also highlighted the importance of addressing issues beyond conflict,
such as strengthening the marital bond.
Statement of the Problem
Partner abuse is an epidemic with potentially dire consequences for individuals,
families, and society. As part of responding to this epidemic, researchers and clinicians
suggest that therapists should develop competence in the areas of assessing and treating
violence.

27
Intrafamilial violence has been documented in relationships of every race, religion,
social class, and educational level (Straus & Gelles, 1986; Straus et al., 1980; U.S.
Department of Justice, 1984, 1992). In response, theorists and practitioners have created
specialized treatment methods and programs for recovery from relationship violence
(Bagarozzi, 1983; Cook & Franz-Cook, 1984; Dobash & Dobash, 1979; Giles-Sims,
1981; Margolin, 1979; Straus, 1973; Taylor, & Gunn, 1984; Walker, 1979). However,
battered victims often enter counseling with a marriage and family therapist without
having knowledge about what type of treatment may be recommended.
Need for the Study
Data on the prevalence and seriousness of intimate partner violence vary, but they
unequivocally establish partner abuse as a widespread and serious problem among
heterosexual, gay, and lesbian couples (Bograd & Mederos, 1999; Carillo & Tello, 1998;
Renzetti, 1997). Haddock (2002) suggested that it is imperative that family therapists
possess the knowledge and skills to manage partner abuse cases effectively.
The most significant theories on treatment approaches are discussed and
highlighted in this dissertation. The results of this study will have broad implications for
curriculum development on the graduate level of counseling programs and graduate
institutes, mental health policy and codes of ethics, social policy, and, most important,
counselor efficacy in treatment of relationship violence.
If specific treatments are recommended more often because they are believed to
produce positive outcomes, clinicians may be able to utilize these available interventions.
Since family violence is multifaceted and multidimensional, this research may help
clinicians to determine alternative treatment modalities that will prove to be successful
when working with a relationship violence population.

28
Clearly, this information will help graduate programs to provide better and more
informed, theoretically based training on the topic of relationship violence, which in turn
will produce clinicians who can effectively assess risk factors for relationship violence,
effectively treatment plan, create safety plans with clients, and provide valuable services
to clients with problems in the area of relationship violence.
Data will be collected to answer the following questions:
1. How do MFTs rate themselves on their knowledge in the identification,
assessment, and treatment of relationship violence?
2. How do MFTs rate their graduate training in the identification, assessment, and
treatment of relationship violence?
3. How do MFTs rate the importance of specified competencies and skills in the
identification, assessment, and treatment of relationship violence?
Future credentialing boards may have to expand requirements regarding training
hours required in domestic violence training. By surveying professionals in marriage and
family therapy, this study will provide information that may assist credentialing boards,
graduate and institute training programs, and third party payers for this specific client
group.
Implications of this study are not limited to graduate training programs and
counseling professionals. Since this treatment issue is embedded in the context of legal,
educational, medical, emergency, social, and family services, all are affected by advances
in prevention and treatment programs for relationship violence.
The results of this study and its external validity will help to inform theoretical
constructs in the area, as well as the current status of graduate training in relationship
violence. Future research may focus on specific methodology and identification of which
techniques are most often recommended in these cases.

29
As a result of this research, graduate schools, program developers, and managed
care companies may want to create assessments that include questions addressing
relationship violence to better serve their client base. These providers may find it more
cost effective to screen thoroughly clients who may be in current danger for violence.
Mental health professionals across disciplines may be able to use the results of this study
to facilitate the prevention and treatment of relationship violence.
Purpose of the Study
The specific type of method of inquiry for this study is a Web-based survey
developed by the researcher to gain information on factors related to the current status of
graduate-level preparation on relationship violence within four main subtopics regarding
relationship violence: identification, assessment, treatment, and training.
The primary purpose of this study is to determine the factors most frequently
reported by MFTs to be related to the identification, assessment and treatment of violence
via (a) a self-rating scale of their knowledge in the identification, assessment, and
treatment of relationship violence, (b) a self-rating scale of their graduate training in the
identification, assessment, and treatment of relationship violence and (c) their rating of
the importance of competencies and skills in the identification, assessment, and treatment
of relationship violence. The populations to be sampled are licensed marriage and family
therapists, approved marriage and family therapist supervisors, and marriage and family
therapy faculty.
The results of this survey would be helpful to the field of marriage and family
therapy, as it will help to inform researchers regarding the current status of theoretical
constructs currently being used in the field. The results of this survey would also be
helpful in looking at clinical patterns that may be generalizable to the larger population of

30
marriage and family therapists, accreditation boards, and marriage and family therapist
faculty and training programs.
The variables in this study are (a) the quality of graduate training in the
identification, assessment, and treatment of relationship violence as reported by MFTs,
and (b) competencies in the identification, assessment, and treatment of relationship
violence as reported by MFTs. Additional variables are (a) the MFTs’ self-rating of their
knowledge in the identification, assessment, and treatment of relationship violence;
(b) their ratings of the adequacy of their graduate training in relationship violence; and
(c) their ratings of the importance of specified competencies and skills in the
identification, assessment, and treating of relationships violence. Specific competencies
and skills to be rated by the respondents include assessing for relationship violence,
assessing imminent danger, performing assessments quickly, understanding batterers’
typologies, identifying clients’ strengths, and recognizing the signs and symptoms of
relationship violence, their ability to adhere to ethical standards, their use of multicultural
mode, their ability to include identification of risk factors in their assessments of clients,
and their ability to recommend risk assessment manuals. Intervening or extraneous
variables are demographics items such as gender, age, marital status, sexual orientation,
race, discipline, years of experience, and accreditation.
The study will examine the following question: What factors are most frequently
reported by MFTs to be related to the identification, assessment, and treatment of
relationship violence?
Rationale for the Study
Given the magnitude of the problem of intrafamilial violence, it is reasonable to
assume that clinical counselors in hospitals, colleges, corporations, agencies, and private

31
settings already interact on a regular basis with perpetrators and victims. This especially
includes those working in the field of alcohol and other drug addictions. To treat
relationship violence effectively, it is essential that these practitioners be informed about
personality factors associated with spouse abusers; transactional dynamics of perpetrators
and victims; and the structure and comparative effectiveness of existing intervention
strategies. Counselors and researchers, as experts in psychosocial development,
personality dynamics, and change processes, have much to contribute in the way of
theoretically and empirically derived answers to the questions, “Why does he do it?”
“What will stop him?” and “Why does she stay?” (Carden, 1994).
Although some models derived from certain perspectives (systemic or feminist)
seem to “fit” better with certain types of violence, there is a growing recognition in the
family therapy field of the need to integrate various theoretical perspectives and practice
models for effective practice. Johnson and Lebow (2000) saw the trend toward
integration as a “sign of a maturing field that general principles and interventions become
delineated and applied in varying formats and context” (p. 32).
Lebow (1997) believed that integrative approaches have the potential to offer
greater flexibility, an increased repertoire of interventions, higher treatment efficacy, and
greater acceptability among clients. The last of these is particularly important in
domestic violence cases, given that many clinicians have noted that women and men
often want to be seen together (Goldner, 1999; Lipchick & Kubicki, 1996; Shamai,
1996). Shamai noted how the categorical dismissal of systemic principles in the treatment
of domestic violence, may be akin to “throwing the baby out with the bath water” (p.

32
202) and serves to detract from efforts to develop a more effective, broader range of
interventions.
Goldner and her colleagues at the Ackerman Institute (Goldner, 1998, 1999;
Goldner et al., 1990) spent 10 years developing an integrative treatment model for
intimate violence in which systemic and feminist perspectives inform and enrich one
another. They have articulated how each of these perspectives in isolation from the other
serves as an insufficient explanatory framework, and they highlight the need to move
from an either/or orientation to a both/and position. Over the years, a complex and
sophisticated “multisystemic” approach to treatment, consisting of several different
approaches—feminist, systemic, psychodynamic, narrative, neurobiological, and
behavioral—has been integrated under the guiding principle that one level of description
or explanation does not have to exclude another (Greenspun, 2000).
This research and its results will advance the existing knowledge in the relationship
violence field as it is part of a programmatic research effort. That is, when the results of
the study are considered in relation to other concurrent and/or sequential studies, there
may be theoretical and/or practical applications to the marriage and family field of
research.
Definitions of Terms
For purposes of this study, relationship violence is defined as any unwanted
physical, sexual, emotional, or financial control or power between two partners who are
in an intimate relationship. Verbal aggression would be included in the definition of
relationship violence.
Several terms are used in the literature to identify and describe family members
affected by relationship violence. In particular, offender or perpetrator refers to the

33
person who has committed the crime of domestic violence. The terms swvivor or victim
are utilized in this study to identify a male or female adult who has experienced violence
in an intimate relationship.
According to the Florida Statute 741.28-741.31,
Domestic violence refers to any assault, aggravated assault, battery, aggravated
battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping,
false imprisonment, or any criminal offense resulting in physical injury or death of
one family or household member by another who is or was residing in the same
single dwelling unit.
Family or household member means spouses, former spouses, persons related by
blood or marriage, persons who are presently residing together as if a family or
who have resided together in the past as if a family, and persons who have a child
in common, regardless of whether they have been married or have resided together
at any time.
In feminist writing on the patriarchal structure and content of language, writers
stress that women’s experience is silenced and made invisible by the lack of words with
which to name it (Daly, 1978; Spender, 1980). A major contribution of feminist social
action around sexual violence has been to provide or create new terms with which to
describe and name the experience. For example, the terms battered woman and sexual
harassment did not exist 20 years ago. Even if a name exists and is known, the way it is
understood can vary greatly. For example, feminists have challenged the limited
traditional definitions of forms of sexual violence by expanding the definition of rape to
include unwanted and/or forced intercourse between husband and wife and by including
psychological abuse and coercive sex in the definition of domestic violence. Limited
definitions tend to draw on stereotypes of forms of sexual violence, stressing particular
features and ignoring others (Kelly, 1988).
In this study, individual therapy is used to describe sessions with an individual
client alone, using individual techniques and theories of counseling. Conjoint therapy (or

34
couples therapy) is used to describe sessions with a couple or dyad together. Group
therapy is used to describe therapy involving three or more clients and a counselor.
Family therapy is used to describe a variety of counseling approaches that work with
family members together in a session with a counselor.
The term survey is used to include cross-sectional and longitudinal studies using
questionnaires or structured interviews for data collection with the intent of generalizing
from a sample to a population (Babbie, 1990). A variable is a discrete phenomenon that
can be measured or observed in two or more categories (Kerlinger, 1979). Psychologists
use the term construct interchangeably with the term variable, according to Kerlinger.
Variables could be gender, age, SES, or attitudes or behaviors such as racism, social
control, political power, and socialization. Because the phenomena vary (in two or more
categories), they are called variables (Creswell, 1994).
Organization of the Dissertation
Presented in chapter 2 is a review of the related literature, including an overview of
relationship violence and the training of family therapists. Individual, group, conjoint,
and family therapy treatment modalities are discussed as they apply to the population of
this study. Presented in chapter 3 is a description of the methodology for the study,
including the research design, sample, Internet survey, instruments, and data analysis.
Chapter 4 presents a demographic description of the participants and results of factor
analysis of the data. Chapter 5 presents an evaluation and discussion of the results,
identifies the limitations of the study, discusses implications of the findings, and presents
a conclusion to the study.

CHAPTER 2
REVIEW OF THE LITERATURE
To review what was stated in Chapter 1, this study will be organized around four
points of research and literature review. They are (a) increase in incidence of relationship
violence as indicated by statistics; (b) professional responsibility: legal, ethical, and
therapeutic issues; (c) multifonns of treatment (metatheoretical, postmodernism,
feminism, sociocultural, and social learning); and (d) identification of training needs.
Increase in Incidence of Relationship Violence
Violence in America has reached epidemic proportions and is exceeding the
capacity and the responsibility of law enforcement alone to curtail it. Although still
unacceptably high, overall criminal violence statistics have declined in recent years.
However, the frequency and severity of violence against children, women, and the elderly
are increasing at alarming rates. Between 1986 and 1993, reported cases of child abuse
and neglect increased by 98%, while reported cases of elder abuse increased by 106%. It
has been estimated that one woman in the United States is physically abused by her
husband every 9 seconds (Heise, Ellsberg, & Gottenmoeller, 1999). Every day in the
United States, four women murdered by male partners. This horrific fact is made worse
by the realization that there are more women killed in acts of domestic violence in any 5-
year period than all of the Americans killed in the Vietnam War (Berry, 1998).
Preventing violence and providing appropriate treatment for the victims of family
violence are important concerns for the health care system and society. Training
professional counselors in the current approaches to treating family violence is an area
35

36
that has recently drawn much attention. Incorporating family violence coursework into
graduate training programs is an ethical decision with which each department is faced.
The incidence of graduating students who are ill prepared to handle complex cases
involving family violence does not serve future clients, the clinician, or the community in
which the violence is occurring.
Interpersonal relationship violence has a long history as a deep-seated social
phenomenon. Several social historians have documented the informal and formal
sanctions that have encouraged wife battering (Davidson, 1978; Martin, 1976; Pleck,
1987). In early 19th-century America, a husband was permitted to discipline his wife
physically without prosecution for assault and battery. The legendary “rule of thumb”
law derived from English common law eventually restricted the instrument of wife
beatings to a stick no thicker than the man’s thumb. Only in the past 15 years have courts
finally considered wife battering to be a criminal offense. These historical circumstances
led several social scientists to explain that men batter women basically because they are
permitted and encouraged to do so (Gelles, 1983).
Such “selective inattention,” as it has been called (Pleck, Pleck, Grossman, & Bart,
1978), has important social implications. It was not until the women’s movement in the
1970s identified and responded to wife battering that it emerged as a “social problem”
(Tierney, 1982). Prior to this time, social scientists, physicians, social workers,
psychologists, and clergy had virtually overlooked and even denied that wife battering
existed. This markedly contrasted the extensive professional involvement in the issue of
child battering (Finkelhor, 1983).

37
Feminists concluded that such negligence was a symptom of the sexist attitudes
that pervade our society and contribute to relationship violence (Martin, 1976).
According to the feminist analysis, wife battering is the rape, sexual harassment, incest,
and pornography to which women are disproportionately subjected. To address this
problem and compensate for what other social services and the criminal justice system
have largely shunned, nearly 1,000 women’s shelters were established across the country,
largely through the grass roots efforts of the women’s movement of the 1970s (Schechter,
1982).
While differences remain over the definition of battering and its dynamics, there is
consensus that social services have inadequately responded to the problem. Clergy have
been accused of promoting compliance and submission to the abusive man (Horton,
1988); physicians have tended to identify battered women as “troublesome” (Kurz,
1987); police have, for the most part, taken a “hands off “ approach (Dolon, Hendricks, &
Meagher, 1986); psychiatric staff are inclined to overmedicate battered women and return
them to their spouses (Gondolf, 1990).
These deficiencies are reflected in the observations of battered women. A survey
of formerly battered women rated women’s shelters to be the most effective avenue in
helping to end the violence. Lawyers were the next most helpful. Other forms of social
service were, on the whole, rated as less than satisfactory (Bowker, L., 1983, 1986).
Partner violence has many causes. This is one of the reasons that there is no single
solution. The major points discussed in this chapter are viewed through a multitude of
lenses, including looking at power, sociocultural factors, worldwide prevalence of
relationship violence, feminist views, social learning theory, and the social structure of

38
our society. Treatment philosophies and batterer’s typologies are also discussed. Current
literature is reviewed to identify risk factors for relationship violence.
Professional Responsibility: Legal, Ethical, and Therapeutic Issues
Licensing Boards
A skill deficit of the magnitude described above poses legal problems for licensing
boards, accreditation boards, and academic and training institutions overseeing therapists.
The various boards and institutions would theoretically be ethically and morally
responsible to victims of family violence if therapists were not properly trained to assess
and intervene in these specialized cases. Therefore, more training and specialized
programs should be developed to meet the growing demand of family violence cases that
professionals treat. Counselors are well trained to initiate screening for suicide but not as
likely to screen for safety issues related to domestic violence (Jansinski & Williams,
1998).
Lack of Training in Family Violence
One reason for the lack of appropriate training in prevention and treatment of
family violence is thought to be that professionals are uncomfortable in asking clients
about possible violence. This discomfort is common and should be explored with
counseling students during their training and supervision (Jansinski & Williams, 1998).
A supervision practicum in family violence issues would make the training component
more comprehensive; individual issues that face students regarding this issue could be
discussed.
Counselor education programs should include in their curriculum a course in family
violence or should address this theoretical approach in one or more core classes.
Students should be informed regarding methods of family violence assessment and

39
should be given vignettes to test their level of mastery in this skill area. Such training
should take place before students are made eligible for practicums or internships.
Requirements such as these would better prepare students to treat family violence cases
effectively.
Minimum State Requirements for Training
Currently, most states require a minimum of 2 hours in domestic violence training
for licensure or professional credentialing. In 2003 California has led the way by
increasing the minimum state requirement to 6 hours in domestic violence training.
However, some state and profession licensing and credentialing bodies have no required
training in the area of relationship violence.
In her article on training family therapists to assess for and intervene in partner
abuse, Haddock (2002) summarized core assumptions regarding curriculum development
in this area. First, feminist theoretical perspectives and treatment approaches are
essential to the effective treatment of partner abuse; however, privileging feminist
explanatory theories and treatment protocols do not disallow the inclusion of
complementary theoretical explanations and approaches (Goldner, 1992, 1999). The
second core assumption presented by Haddock was that therapists should be exposed to
current developments, controversies, and inconsistencies in the theoretical literature;
however, they also should be provided with specific principles, protocols, and skills to
guide their clinical work. The third core assumption presented by Haddock was that,
given therapists’ tendency to reduce the inherent complexity of partner abuse cases in
response to concerns about potential lethality, therapists should learn to conceptualize
each case within its in own unique and multifaceted context (Dutton, 1992; Goldner,
1999), while attending to the intersections of gender, race, class, religion, and sexual

40
orientation (Bograd, 1999). The fourth core assumption presented by Haddock was that
therapists should be cautioned to utilize the most conservative assessment and treatment
approaches and to obtain direct and close supervision on cases involving partner abuse.
Theoretical Constructs Underlying the Study
Feminist View
Many different approaches are used when counseling battered women and
perpetrators of relationship violence. One approach is the feminist approach, in which
the batterer is viewed as being completely responsible for the battering. Feminists view
the battering as a criminal act that is used to control, intimidate, and inflict harm
(Goldner, 1999).
Walker (1995) particularly broadened the playing field by bringing in anecdotes
about how to match certain types of batterers with specific psychotherapies. Given the
sociopolitical context in which battering occurs, if psychotherapy is to be successful in
the treatment of battering, it must be integrated within a community-wide response. This
would involve coordination among therapists, police officers, probation officers,
prosecutors, judges, and advocates. Walker (1995) claimed that the Duluth model (Pence
& Paymar, 1993) is particularly promising, since treatment includes attention to the entire
social context of battering through community organizing.
Feminist theory has also been used as a conceptual framework for explaining the
presence of violence between males and females. In feminist theory, violence is viewed
as a manifestation of the patriarchal structure in our culture, which is reflected in the
patterns of behaviors and attitudes of individuals (Gentemann, 1984; Kalmuss, 1984). As
part of Lenore Walker’s (1999) theorizing, violence against women in general has been
conceptualized as gender-based; interventions are stressed by using advocacy, victim

41
services, and educational efforts. The feminist perspective on domestic violence is
accepted worldwide. Where women and girls are primary targets of male abuse, violence
cannot be eradicated without looking carefully at gender socialization issues that
maintain and possibly facilitate such violence in the home.
The incorporation of social justice perspectives into family therapy training,
practice, and research has been a recent focus of family therapy scholarship (Bograd,
1999; Haddock, Zimmerman, & MacPhee, 2000; McGoldrick et al., 1999). These
authors have focused on intersections of race, class, sexual orientation, and gender as
they relate to the training and practice of family therapy. Goldner (1988) recognized that
both age and gender organize families, and she implored family therapists to reduce
power differentials based on gender within family therapy.
Feminist therapists claim that a therapist who does not directly challenge power
and control based on traditional gender hierarchies contributes to the maintenance of
unjust power differentials between men and women (Avis, 1996; Goldner, 1988; Hare-
Mustin, 1987; Walters, Carter, Papp, & Silverstein, 1988). These feminist scholars urge
therapists to challenge powerful acts by men over women and to expose gender
hierarchies by calling attention to them in therapy. As Hardy (2000) pointed out, family
therapists are often guilty of allowing the most powerful members of society to continue
speaking while inadvertently silencing those with less power. To heal strained
relationships, we must let the oppressed have an opportunity to speak during therapy that
takes the needs of all family members into account.
The Study of Power
In his 1993 book Understanding Family Process, Broderick organized family
process literature, which he called “relational space,” into three major areas: (a)

42
regulation of interpersonal distance, (b) regulation of interpersonal transactions, and (c)
regulation of “vertical space,” by which he meant power. The idea of “regulation”
implied a homeostatic set point theory. In a therapy context, these three areas were
respectively discussed as positivity/caring, responsiveness, and status/influence
(Gottman, Notarius, Gonso, & Markman, 1976).
Historically, the regulation of interpersonal distance was first explored by
examining the clarity of communication. Hypotheses were advanced to explore the role
of unclear communication in dysfunctional families and family distress. More specific
hypotheses were advanced that unclear communication was responsible for
psychopathology (Bateson, Jackson, Haley, & Weakland, 1956; Watzlawick, Beavin, &
Jackson, 1967), and the cybernetic model or the systems approach to family process was
bom.
In their decade review of observing marital interactions, Gottman and Notarius
(2000) stated that historical research was complex but included the result that balance in
husband-wife power was related to marital quality; however, self-report and
observational measures did not show a high level of agreement in classifying couples.
These researchers stated that the issues of blending the study of affect and power are
central to the integration of psychological and sociological approaches to marriage.
Power is now being studied more precisely, using coding of the couple’s influence
patterns during a discussion of the Inventory of Marital Conflicts (Olson & Ryder, 1970)
used by Gray-Little, Baucom, and Hamby (1996). They found that egalitarian couples
had the highest “Time 1” marital satisfaction and fewer negative marital inventory
conflicts scale behaviors. Power is also being explored in the context of gender and

43
relational hierarchy. Feminist writers have pointed to the central role that power must
play in understanding marriages. Quantitative observational research has now begun to
explore these ideas (Gottman & Notatius, 2001).
Equipped with a sound theoretical basis for addressing intimate violence in a
couple format, feminist family therapists have continued to develop couple approaches
that are sensitive to issues of power and gender (Almeida & Durkin, 1999; Bograd &
Mederos, 1999; Greenspun, 2000; Jory & Anderson, 2000; Lipchik & Kubicki, 1996;
Shamai, 1996). Hardy (2000) cautioned that the most powerful members of society
continue to speak while inadvertently silencing those with less power.
Social Learning Theory
Research by Alexander, Moore, and Alexander (1991) applied social learning
theory to investigate the intergenerational transmission of violence among dating
partners. This perspective explains that a man’s involvement in dating violence is best
predicted by a personal history of severe abuse by his father. Although his behavior is
not directly predicted by having witnessed violence between his parents, his attitude
toward women apparently is thus predicted. His own attitudes are relevant to the
peipetration of violence only as they interact with those of his partners.
Scientists have traditionally believed that experiencing physical abuse as a child
increases the risk of later aggressive behaviors, based on social learning theory (Bandura,
1973). Social learning theory proposes that people acquire novel behaviors and expand
personal behavior repertoires by observing others’ behaviors as well as through classical
and operant conditioning (Bandura, 1965, 1973). They observe other individuals and use
imitation to perform novel behaviors.

44
To imitate a behavior, the person must have some motivation or incentive for doing
so. Incentives are what the person expects to obtain once the behavior is performed.
Incentives act as reinforcers. When incentives are available, observation is more quickly
translated into action. Incentives also influence the attention and retention processes.
Children pay attention when given incentives to do so and, with more attention, more
information is retained. In the Bobo doll experiment, some children witnessed the adult
being rewarded for aggression. Therefore, these children performed the same act to
achieve the same rewards (Bandura, 1977).
Bandura asserted that people can also learn new behaviors without practice and
without reinforcement. Simply stated, an observer may copy a model’s behavior long
after he or she saw the action performed, even without any immediate reinforcement
being earned by the model or the observer. Researchers have begun to consider the role
of previous abuse and violence on propensity for victimization, although only very
limited data have supported this theory; indeed, myriad unanswered questions remain.
Social learning theory not only deals with learning but also seeks to describe how a
group of social and personal competencies (i.e., personality) could evolve out of social
conditions within which learning occurs. It also addresses techniques of personality
assessment and behavior modification in clinical and educational settings (Bandura,
1977).
Social learning theory not only deals with learning but also seeks to describe how a
group of social and personal competencies (i.e., personality) could evolve out of social
conditions within which learning occurs. It also addresses techniques of personality

45
assessment and behavior modification in clinical and educational settings (Bandura,
1977).
Further, the principles of social learning theory have been applied to a wide range
of social behaviors, including competitiveness, aggressiveness, sex roles, deviance, and
pathological behavior (Bandura & Walters, 1963). Currently, it is impossible to ascertain
the exact social cognitive processes at work or how the observation of violence translates
into victim versus perpetrator status. The specific effect of social learning theory remains
an unresolved issue (Lewis & Fremouw, 2001).
Lenore Walker studied some intriguing animal behavior theories based on
laboratory research. She began to see startling connections between the coping
mechanisms of battered women and the behavior of caged dogs subjected to random and
variable electric shocks. “Learned helplessness” became one the linchpins of The
Battered Woman, published by Harper and Row in 1979. Coining the phrase “battered
women’s syndrome,” Walker delineated a common cycle of violence: a honeymoon
period followed by a buildup of tension, followed by an explosion and battery, followed
by regrets and apologies, followed by another honeymoon period, and so forth. By
featuring stories of several professional women who had endured physical abuse in
marriage, Walker put to rest the myth that battery was strictly a lower-class problem
(Brownmiller, 1999).
Social Structural Theory
The social structural approach examines patterns first applied by Goode (1971),
which applied Blood and Wolfe’s (1960) resource theory of power to explain a husband’s
use of physical force against his wife. Goode maintained that violence is a resource,
similar to money or personal attributes, that can be used to deter unwanted actions or to

46
induce desired behaviors. The use of violence thus can be seen as the most overt and
effective means of husbands’ social control over wives (Yllo & Bograd, 1988) in that it is
used when other and more subtle methods of control do not lead to submission.
In a study by Allen and Straus (1980), key propositions of Goode’s (1971) resource
theory of violence were tested using occupational prestige, educational level, income, and
satisfaction with income as measures of extrinsic resources. This study also used
variables for assessing interpersonal, intrinsic resources. The researchers found a strong,
positive correlation between the low resources/working class variable and the husband’s
use of physical force. This is consistent with other studies that have shown that husbands
who experienced resource deprivation were more likely to physically abuse their wives
(Bowker, L., 1983; Pagelow, 1981).
Around the world, state-sanctioned violence, such as civil and interstate wars, often
increases the amount of violence against women; rape and brutal physical beatings of the
enemy’s women have been considered just the spoils of war. Better understanding of the
relationships among civil war, domestic violence, and women’s mental health is
important to help countries to provide both prevention and rehabilitation strategies
(Walker, 1999).
Strong cultural traditions tying women to small communities with few resources
(and power), state-sponsored conflicts, and greater acceptance of gender inequities all
contribute to the greater risk for a woman to be battered in her home (Heise, 1994; Koss
et al., 1994; Root, 1992; Walker, 1994).
An association in the marital literature between spouse abuse and self-esteem is
well documented (Goldstein, 1985; Hotaling, 1988), with the level of self-esteem

47
negatively correlated with frequency and severity of violence (Cascardi & O’Leary,
1992). However, it is often unclear whether low self-esteem precipitates violence or is
the result of chronic battering. Empirical support exists that low self-esteem contributes
to the difficulty that victims experience in disengaging from an abusive marriage (Aguilar
& Nightingale, 1994). As a result, low self-esteem may be associated with increased
tolerance for interpersonal violence.
Treatment of Relationship Violence
Choice to Leave or to Stay in Abusive Relationships
The cognitive process that a victim undergoes when choosing to disengage from an
abusive relationship provides important information with regard to victimology. Rosen
and Stith (1995), employing a multiple-case qualitative research design, identified a
progression of hierarchical cognitive steps utilized by individuals who eventually
disengaged from abusers.
The process included a five-step progression of disengagement: (a) seeds of doubt,
such as fleeting thoughts, often not identified until the dissolution of the relationship;
(b) turning points, or events that significantly impacted the intimate relationship;
(c) reappraisals, occurring when the victim re-evaluated the relationship; (d) paradigmatic
shifts, which included a shift in perspective about the relationship; and (e) last straw
events, or events providing the impetus to terminate the abusive relationship.
The explanations of why individuals remain in abusive relationships has
traditionally focused on dispositional characteristics such as low self-esteem, learned
helplessness, or masochistic personalities (Rusbult & Martz, 1995). A new model shifts
the focus away from blaming the victim and examines the interdependent nature of
ongoing relationships. This model proposes that victims apply a two-step model,

48
considering their resources and level of satisfaction when deciding to stay or leave an
abusive relationship (Choice & Larnke, 1997). According to this model, an abused
woman may stay in the relationship for several reasons. For example, she may
experience feelings of satisfaction, believing her best available alternative to staying is
not attractive enough to terminate the relationship. Second, she may believe that she has
a strong emotional investment and, thus, does not feel ready to leave the relationship.
This model is not proposing that victims want to be abused, but rather that some women
choose to remain in a relationship despite the abuse (Lewis & Fremouw, 2001).
Rusbult and Martz (1995) provided additional support for the supposition that
victims’ decisions to stay in abusive relationships are influenced by environmental as
well as intrapersonal variables. Researchers found that a victim’s choice to remain in an
abusive relationship was strongly related to level of satisfaction in the relationship,
quality of alternatives, and size of the investment. These models (Choice & Larnke,
1997; Rusbult & Martz) represent a shift in conceptual understanding of the subtle
nuances and dynamics of victimization. Additional research is needed to examine the
conditions that trigger victims to leave abusive relationships. As described above, a
variety of factors may predispose a couple to relationship violence.
Most likely, it is a combination of these factors that motivates a perpetrator to
offend. A contemporary study of American couples conservatively documented that 1 in
8 husbands had committed a violent act against his wife during the preceding year. A
comprehensive review of studies using probability samples revealed that the reported rate
of wife abuse in the United States was between 11% and 22% (Straus & Gelles, 1990).

49
Gottman’s Batterer Offender Typologies
Two distinct typologies are described by Gottman et al. (1995). In the 200
seriously violent couples studied, these researchers found at least two kinds of batterers:
Type 1 (“cobras”) and Type 2 (“pit bulls”). This research dealt primarily with the
physiological response of male batterers to a high-conflict marital discussion. In this
study, Type 1 men’s heart rates lowered from baseline in response to the high-conflict
marital discussion, while Type 2 men’s heart rates increased from baseline. Type 2 refers
to men whose emotions quickly boil over, whereas Type 1 refers to men who remain cool
and methodical as they inflict pain and humiliation on their partners. This was evident in
physiological data taken from heart monitors while participants had angry responses to
their partners.
Type 2 men were referred to as “pit bulls.” These men are characterized as having
a quick temper and are physiologically aroused when behaving aggressively. Using the
metaphor of the “pit bull,” this type of dog is used in dog fights and is known as a vicious
fighter that will often fight until death. These dogs become aroused and aggressive when
other dogs are being aggressive. The “pit bulls” or Type 2 men scrutinize their wives and
display excessive need for approval and self-fulfillment.
According to Gottman et al. (1995), the Type 1 batterer is referred to as the
“cobra.” Most striking is the swift escalation of anger and violence displayed by these
men during a disagreement, again relating to the analogy of the cobra snake, which is
swift and dangerous.
The “cobra” men enjoy shocking and scaring people. They are opposite to the “pit
bulls” in that they are not worried or jealous, nor are they emotionally dependent. The
significant finding of the Gottman et al. (1995) research was that “the cobra” offender’s

50
heart rate actually got lower during an argument. Internally, these men remain calm, yet
they are externally more violent and severe in their violence than the “pit bulls.”
Jacobson and Gottman (1998) discussed the pit bulls and cobras further. They
concluded that these two batterer types resemble dysphoric/borderline batterers and
generally violent/antisocial batterers, respectively (Holtzworth-Munroe et al., 2000).
Although Jacobson and Gottman focused their study on severely violent men, they also
discovered what they called a “low-level violent” group of couples, which they followed
with the expectation of tracking the development of violence from minor to more severe
forms. Unexpectedly, however, this group almost never escalated their use of violence,
and they were described by Jacobson and Gottman as a “stable group of couples who
periodically have arguments that escalate into pushing and shoving, but never reach the
point where we could call the men batterers” (p. 25). This description coincides with
Johnson’s (1995) description of common couple violence.
Overall, findings across research by Gottman et al. (1995), Meehan, Holtzworth-
Munroe, and Herron (2001), and Babcock, Yerrington, Green, and Miller (2001) do not
lend strong support to the Type 1-Type 2 batterer typology. Although severely violent
men can be split into two groups on the basis of heart rate reactivity, so can both less
violent and nonviolent men, raising questions about the theoretical meaning of this
distinction. In addition, consistent differences between Type 1 and Type 2 severely
violent men have not been found across studies.
Human Heart Reactivity
A review of previous research suggests that the use of human heart reactivity
(HRR) may prove useful for differentiating male batterers on the dimension of

51
anger/hostility. There is less evidence that this approach will be effective for studying
antisocial personality in these men.
Meehan et al. (2001) failed to replicate the batterer typology proposed by the
Gottman et al. (1995) article. Therefore, caution is advised when discussing possible
implications of these studies for public policy and clinical application. To be
appropriately cautious, it should be noted that the Gottman et al. (1995) typology was
supported in one study (i.e., their initial study) but was not supported in another study
(i.e., the Meehan et al. study). Such an even scoreboard suggests that further attempts at
replication are necessary before definitive conclusions may be drawn about the validity of
the Gottman et al. typology.
It is possible that the Gottman et al. (1995) typology will remain a valid one after
further scrutiny; therefore, clinicians and public policy makers should not abandon the
idea of batterer typologies altogether. Indeed, across multiple research laboratories, there
is increasing convergence regarding the descriptive and theoretical dimensions that can
be used to meaningfully categorize variability among samples of batterers.
Holtzworth-Munroe and Stuart’s Three Major Types of Batterers
Other research on men who batter women has suggested that there are three major
types of batterers: (a) those who use violence as a strategy to gain power and control
within their family, (b) those who use violence as a strategy and are also mentally ill, and
(c) those who have serious personality flaws that permit them to use violence to commit
other criminal acts as well as to abuse their partners (Dutton, 1995; Holtzworth-Munroe
& Stuart, 1994; Jacobson & Gottman, 1998; Meloy, 1998; Saunders, 1992; Walker &
Meloy, 1998).

52
Although other typologies for differentiating male batterers have been proposed,
research on female perpetrators is much less extensive. Holtzworth-Munroe and Stuart
(1994) proposed three types of male batterers: family-only, dysphoric/borderline, and
generally violent/antisocial. Batterers can be identified along three descriptive
dimensions: severity/frequency of violence, generality of violence, and psychopathology
or personality disorders, as well as by risk factors correlated with the development of
violent behavior (such as witnessing violence in the family of origin).
Dysphoric/borderline and generally violent/antisocial batterers engage in moderate to
severe levels of violence, and the latter are most likely to be involved in criminal
behavior and use violence both within and outside the home. The dysphoric/borderline
batterers tend to confine their violence to the intimate relationship. Family-only batterers
engage in the least amount of violence, show little or no psychopathology, and have very
low levels of risk factors. Empirical testing of the model has supported this batterer
typology (Hamberger, Lohr, Bonge, & Tolin, 1996; Holtzworth-Munroe et al., 2000;
Tweed & Dutton, 1998; Waltz et ah, 2000).
Identification of Training Needs
Current Status of Training and Need for Additional Curriculum
There was a time when learning one particular school of therapy was deemed
sufficient empowerment to treat all manner of clients—or at least sufficient to make one
feel prepared to treat all types of clients. With time, specific treatments began to be
developed for particular problems. Alcoholism became widely recognized as a problem
that necessitated a particular type of therapy. Phobias were found to respond best to
behavioral treatment. Treatment began to be problem specific rather than school
oriented. Added to this is a new pressure: the necessity of keeping up in a field where,

53
seemingly, every new day reveals a new type of therapy for a new type of problem
(Salter, 1988). The treatment of family violence as well as child sexual abuse offenders
and victims has only recently evolved into a specialized field. Although for many years
there have been specialized treatment programs available in a few states, the need to set
up more specialized treatment programs in every state has only recently been recognized.
This recognition has been spurred by two factors: (a) the increasingly widespread
acknowledgement of the extent of the problem, and (b) the increasing acceptance that
traditional forms of therapy are not effective with this population (Crawford, 1981).
However, specialized treatment does appear to have an impact (Knopp, 1984).
Continuing Education Units
Academic institutions, institutes, workshops, and continuing education credits are
responsible for the successful dissemination of academic knowledge pertinent to the
profession. These educational areas must provide an integrated course of study as well as
appropriate professional training. An ethical education program with quality is one that
uses traditional and managed care approaches of training emphasizing the current
theories of practice and those presented in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV) of the American Psychiatric Association (1994). It should
be a program that develops competency in people working with diverse aspects of
society, resulting in effective, cost-efficient treatment plans and service delivery. Only
recently (in 1995), California began specialized spousal abuse training for marriage and
family therapists. Psychologists are required to have coursework in human sexuality,
chemical and substance abuse, and child abuse.
However, spousal abuse training is not currently a requirement for licensing in
California or in many other states. Both trainees and interns are permitted to perform

54
counseling in a governmental entity, school, college, university, nonprofit agency,
charitable corporation, or licensed health facility under the direct supervision of a
licensed supervisor, regardless of whether that supervisor has received specialized
training in the area of spousal abuse (Board of Behavioral Science Examiners [BBSE],
2000).
Skills in Assessing Relationship Violence and Imminent Danger
In previous research there is a precedent for needed improvement in the education
and training of psychotherapists. Hansen et al. (1991) surveyed members of a marriage
and family therapy organization. The therapists in this survey were asked to read two
vignettes with proven therapeutic interventions for domestic violence cases. These cases
portrayed female victims and domestic violence. The results indicated that the
counselors did not attend to the seriousness of the violence portrayed in the vignettes, and
many did not attend to the violence at all. As a group, the therapists did not attend to the
crisis nature of the cases portrayed and failed to intervene for needed protection of female
victims from their batterers. Forty-one percent of the therapists surveyed indicated no
recognition of domestic violence. Interventions provided by therapists in this study were
also negligent with regard to violence potential. For example, 55% of respondents
reported that they would not intervene even when the violence portrayed required
immediate action. Only 2% reported a potential for lethality in these cases. A scant 11%
of the respondents indicated that they would obtain protection for the wife by helping her
to develop a safety plan, obtain shelter, or obtain a restraining order.
Psychologists were significantly less likely than other respondents to conceptualize
the case in terms of conflict or to describe the problem as violence. Because few
counseling or clinical psychology graduate programs provide academic or clinical

55
exposure to the problem of domestic violence presently (and even fewer have done so in
the past), there is reason to expect that knowledge and skill deficits similar to those
observed among physicians and family therapists in the Hansen et al. study might be
found among practicing psychologists as well (Carden, 1994).
Assessing for Risk Factors Associated With Relationship Violence
Riggs, Caulfield, and Street (2000) discussed the need for identifying risk factors
for domestic violence. They stated that the extent and potential dangerousness of the
problem of domestic violence warrant systematic screening and assessment in all mental
health settings. Few empirical studies have approached the question of domestic violence
with the aim of identifying risk markers, making it impossible to identify persons at risk
for perpetrating or becoming victims of domestic violence.
Identifying Risk Factors Associated With Relationship Violence
A number of factors have been identified as correlates of domestic violence that
may eventually prove useful for identifying persons at risk. However, existent literature
does not provide empirical support for these factors. Identifying factors that might assist
clinicians in the recognition of clients who are at risk for domestic violence would help
clinicians to attend appropriately to this potentially dangerous problem.
Ongoing assessment in the context of knowledge regarding correlates of domestic
violence can provide important information for evaluating risk of a particular violent
incident. In addition, strategies for assessing violence and violence risk in both
perpetrators and victims can assist clinicians in approaching this difficult topic in a
clinical setting. A careful assessment of the potential for violence within clients’ ongoing
relationships is necessary for clinicians to provide appropriate care (Riggs et al., 2000).

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Prior Relationship Aggression
One of the primary risk factors for perpetrating violence against a spouse or
significant other is having committed such violence against that same person previously.
Rarely, if ever, does an incident of spouse abuse occur in isolation; typically, violence
occurs throughout the relationship. In a longitudinal study of violence within marriages,
O’Leary et al. (1989) examined couples engaged to be married and followed them for 3
years. These researchers found that violence was relatively stable over the first few years
of marriage. For example, of men who perpetrated aggression prior to marriage, 51%
also had engaged in aggression during the first 18 months after marriage. In comparison,
the probability of a man who was not aggressive prior to marriage being aggressive 18
months into the marriage was 15%.
In another study of engaged and newly married couples, men who perpetrated
violence against their partners prior to the wedding were significantly more likely than
were men with no history of relationship violence to perpetrate violence within the
following year (Leonard & Senchak, 1996). Examining more established relationships,
Feld and Straus (1989) found that frequency of self-reported aggression was predictive of
aggression in the ensuing year: Almost 50% of men who had been violent prior to the
initial assessment in the study engaged in violence in the following year. In comparison,
only 10% of those who had not been violent prior to the initial assessment engaged in
violence in the following year.
Demographic Characteristics
Rates of domestic violence tend to decrease slightly as the age of couples increases
(Straus et al., 1980). Other demographic risk factors for marital violence appear to be
related to increased stress in the family. For example, men of lower SES are at an

57
increased risk for perpetrating domestic violence and tend to perpetrate more severe
violence than higher-SES counterparts. Similarly, men who are unemployed appear to be
at an increased risk for perpetration of spouse abuse.
National surveys suggest that men of color are at an increased risk, compared to
Caucasian men, for perpetrating violence against their wives and partners. However, this
difference appears to be at least partially the result of different SES levels in White and
minority samples (Holtzworth-Munroe et al., 1996).
Psychological Characteristics
Men who have perpetrated violence against a spouse tend to differ from those who
have not done so on a number of psychological constructs. Many of these factors,
according to Riggs et al. (2000), are of theoretical interest for understanding why spouse
abuse occurs and may be helpful in identifying men at risk for such violence. For
example, spouse abusers tended to be more angry and hostile in general than their
nonabusive counterparts (Eckhardt, Barbour, & Stuart, 1997). Further, when confronted
with marital conflict situations, abusive men tended to be less assertive and respond more
with anger and hostility than nonviolent men. Particular topics of conflict such as
jealousy and threats of abandonment may have exacerbated this pattern of response
(Holtzworth-Munroe & Anglin, 1991). This latter finding fits with research that
identifies fear of abandonment as an important aspect of abusive men’s behavior (Dutton,
Saunders, Starzomski, & Bartholomew, 1994) and may serve to identify specific points in
time when the risk of spouse abuse is particularly high. Unfortunately, few of these
variables have been investigated in ways that translate the findings into specific
indicators of risk.

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Specific Psychological Syndromes
Post Traumatic Stress Disorder (PTSD). Researchers have linked men’s
symptoms of depression, PTSD, borderline personality disorder, and substance abuse to
the perpetration of violence against their wives and partners. Important with regard to the
present discussion, some of these syndromes have been examined as risk factors rather
than simply as correlates of marital violence. Thus, they may serve as useful markers or
risk factors of future perpetration.
Researchers have examined the link between symptoms of PTSD and the
perpetration of marital violence. Studies in this area indicate that men with PTSD are at
considerable risk for perpetrating marital violence. Jordan et al. (1992) found that wives
of Vietnam veterans with PTSD were about twice as likely (30%) as wives of veterans
without PTSD (15%) to report that their husbands had engaged in marital violence.
Depression. Depressive symptoms have been related to the perpetration of marital
violence in a number of studies (Maiuro, Cahn, Vitaliano, Wagner, & Zegree, 1988; Pan,
Neidig, & O’Leary, 1994). Generally speaking, men who are aggressive toward their
wives exhibit more depressive symptoms than do nonaggressive men. For example, in
one study, significantly more abusive men, as compared to a nonabusive group, scored
within the depressed range of the Beck Depression Inventory (Maiuro et al.). Higher
scores on this inventory have also been related to violence in couples seeking marital
therapy (Vivian & Malone, 1997) and in general population samples (Pan et al.).
Substance abuse. The rates of spouse abuse among men diagnosed with substance
abuse problems indicate that men with diagnosable alcohol problems are at substantially
increased risk for spouse abuse (Gondolf & Foster, 1991; Leonard, Broinet, Parkinson,
Day, & Ryan, 1985; Murphy & O’Farrell, 1994; Stith, Crossman, & Bischof, 1991). For

59
example, Leonard et al. found rates of marital aggression in men diagnosed with a current
alcohol problem (44%) to be about 3 times greater than in men without an alcohol use
disorder (15%) or a past alcohol problem (14%). Murphy and O’Farrell reported that
about two thirds of a sample of married male treatment-seeking alcoholics had engaged
in marital violence.
Borderline personality disorder. Another disorder that has been linked to the
perpetration of spouse abuse is borderline personality disorder. This disorder is
characterized by identity issues that become salient in intimate relationships and that vary
on three defining features: identity diffusion, primitive defenses, and reality testing.
Studies have found that abusive men score higher on measures of borderline personality
disorder than do nonabusive men and that, among men who assault their wives, more
severe violence is associated with higher levels of borderline personality disorder
(Dutton, Starzomski, & Ryan, 1996).
Other Risk Factors
Marital dissatisfaction. As a group, men who perpetrate violence against their
partners are less satisfied with their relationships than are nonviolent men (Alderondo &
Sugarman, 1996; Hotaling & Sugarman, 1986; Sugarman & Hotaling, 1989).
Witness to spouse abuse or victim of child abuse. Many studies have found that
men who perpetrated violence against their wives were more likely than men in
nonviolent comparison groups to report that they had experienced violence in the family
of origin, either as a witness to spouse abuse or as the victim of child abuse (Alderondo &
Sugarman, 1996; Dutton & Hart, 1992; Hotaling & Sugarman, 1986; Kalmuss, 1984;
Sugarman & Hotaling, 1989).

60
Previous head injury. Rosenbaum et al. (1994) documented a link between a
history of head injuries and the perpetration of spouse abuse. In one study, these
researchers found that men in treatment for abusing their wives reported a significantly
higher rate of head injuries than did a group of nonabusive men.
Ability to Assess Violence Risk
Otto (2000) spoke to the importance of the mental health practitioner having the
ability to assess violence risk in clients. The perception that persons with mental illness
are at increased risk for violence, as compared to their non-mentally ill counterparts, can
be dated at least to the time of Plato (Monahan, 1992). Indeed, among the rationales
offered for establishing some of the first public psychiatric hospitals in this country was
the need to protect the public by confining persons with mental illness who posed a risk
of violence to the community. Flowing logically from the belief that there was a
connection between violence and mental disorders was the assumption that mental health
professionals, as a function of their expertise, were uniquely able to identify and treat
persons whose emotional functioning increased their risk for violence, and could thereby
reduce such risk (Otto).
Violence Risk Assessment Study
In response to the above, Monahan (1984, 1988) identified limitations of research
examining the relationship between mental disorders and violence, as well as mental
health professionals’ abilities to assess violence risk. Due to these limitations, Monahan
called for a “second generation” of investigations to better address these issues. This call
resulted in a series of studies (Monahan & Steadman, 1994, for summary) and review
articles (Mossman, 1994; Otto, 1992, 1994) and formed the basis for the Violence Risk
Assessment Study organized by John Monahan under the auspices of the MacArthur

61
Research Network on Mental Health and the Law. Findings from this “second
generation” of research, which incorporated many of Monahan’s (1984, 1988)
recommendations, suggest the following: (a) violent behavior is not necessarily a low
base rate behavior and occurs with some degree of frequency among persons with mental
disorder (Otto, 1992; Steadman et al., 1998; Wessely & Taylor, 1991); (b) persons with
certain mental disorders and symptom clusters are more likely to engage in violent
behavior than are persons without such disorders or symptom clusters (Swanson, 1994;
Swanson, Holzer, Ganzu, & Jono, 1990); and (c) mental health professionals have some
ability to assess violence risk among persons with mental disorders (Mossman; Mulvey &
Lidz, 1998; Otto, 1992, 1994).
Assessing and Managing Risk
It is this body of developing research, along with research examining violence risk
factors among criminal and nonclinical populations, that provides direction for clinicians
faced with the task of assessing and managing risk with their clients. Although one might
question whether findings from one population are applicable to other populations, a
meta-analysis by Bonta, Law, and Hanson (1998) provides some support for the claim
that risk factors for violent behavior may be similar across populations.
It should be no surprise to even beginning clinicians that more remains unknown
than known about risk factors for violence among persons with mental disorders. Good
practice requires that clinicians familiarize themselves with relevant literature and use
informed clinical judgment in cases for which research literature provides no direction
(Otto, 2000).

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HCR-20 Item Risk Assessment Instrument
Use of a structured, guided clinical assessment developed in light of the extant
research, such as HCR-20 (Webster, Douglas, Eaves, & Hart, 1997) can help to form the
basis of a comprehensive evaluation that assesses factors relevant to violence risk. The
HCR-20 directs clinicians to cover a total of 20 areas considered to be relevant to
violence risk: 10 historical items, 5 clinical items, and 5 risk management items.
Preliminary data indicate that the HCR-20 can be reliably scored (Belfrage, 1998;
Douglas, & Webster, 1999; Ross, Hart, & Webster, 1998) and has some predictive power
when compared to other risk assessment instruments.
Static and Dynamic Risk
Otto (2000) stated that, broadly speaking, risk factors for violence among persons
with mental disorders fall into one of two categories. Static risk factors are those that
either cannot be changed (e.g., age, gender) or are not particularly amenable to change
(e.g., psychopathic personality structure). Identification of these factors is important in
terms of identifying the client’s absolute or relative level of risk; however, these factors
typically have few implications for treatment or management of risk, since the factors, by
definition, cannot be changed. In contrast, dynamic risk factors are those that are
amenable to change (e.g., substance abuse, psychotic symptomatology). Identification of
these factors is important, both in terms of estimating the client’s absolute or relative
level of risk and for purposes of treatment planning.
Hanson (1998) made a similar distinction: between stable dynamic factors and
acute dynamic factors. Stable dynamic factors can change but have some enduring
quality over time and across situations (e.g., deviant sexual preferences or alcoholism),
whereas acute dynamic factors (e.g., sexual arousal or alcohol intoxication) are “states”

63
which can change much more rapidly. Assessing the former category may be more
important for treatment planning and intervention planning when dealing with persons for
whom there are concerns for violence in the future, while the latter category may be more
important in terms of assessing imminent risk and making decisions about immediate
interventions.
Conclusion
Feminist writings have focused attention on domestic violence and challenged the
assumptions of approaches that blame women for their victimization. They support both
the growing emphasis on interdependence and mutuality, rather than on autonomy and
differentiation, in couple relationships and they focus on a more collaborative respectful
relationship with clients (Luepnitz, 1988).
Graduate counselor education programs would ethically be fulfilling their ethical
code and accreditation standards by including in their curriculum a course in family
violence. Students would benefit by being informed regarding methods of family
violence assessment and could be given vignettes to test their level of mastery in this skill
area. Such training preparation could take place before students are made eligible for
practicums or internships. Requirements such as these would better prepare students to
treat family violence cases effectively.
Various intervention models are used in treating relationship violence. According
to Harrell (1991), the short-term, court-ordered, batterer-only psychoeducational model
had a high rate of recidivism, along with increased amounts of psychological abuse.
Edleson and Grusznski (1988) and Pence and Paymar (1993) found better results from
the short-term psychoeducational model used in the Domestic Abuse Project in Duluth,
Minnesota. On the other hand, Dutton (1995) and Hamberger and Ambuel (1997) found

64
that interventions having the best results in stopping men from using violence were those
that required attendance for a minimum of 2 years. Dutton’s research suggests that many
batterers have serious mental illnesses in addition to problems with power and control
that underlie their use of violence (Walker, 1999). O’Leary (1993) and Geffner (1995)
found that special techniques in family psychotherapy can be effective in helping to stop
violence in the family.
Corsi (1999) developed a model that appears to incorporate the best features from
available programs and is easy to apply across cultures due to its ecological approach
(Walker, 1999). The recommended treatment approach begins with individual
counseling for all parties and then marital and dyad sessions, in addition to family and
group sessions (Giarretto, 1976).
Violence in close relationships is now acknowledged as a highly significant issue
across diverse cultural groups (Walker, 1999). The underreporting of couple violence,
even in couple therapy, is a major finding that has emerged over the past decade. One
line of research has differentiated different patters of violent behavior, distinguishing
those patterns that are more or less likely to be amenable to treatment (Jacobson &
Gottman, 1998). Such research may assist the couple therapist in determining when and
how to intervene.
In general, assessment procedures, risk factors, and treatment feasibility issues in
violent relationships are now beginning to be addressed (Bograd & Mederos, 1999;
Holtzworth-Munroe, Beatty, & Anglin, 1995). Well-defined assessment procedures
(Bograd & Mederos) and differentiated treatment strategies are essential for client safety.
All couple therapists must know how to identify and address patterns of violence, ranging

65
from verbal intimidation and threats to coercion and battering, and they must be able to
make informed decisions about the best interventions to use in particular cases (Johnson
& Lebow, 2000).
This literature review would be appropriate for an audience including mental health
practitioners, faculty, health care workers, trauma and crisis center employees, domestic
violence workers, parents, educators, and law enforcement personnel.

CHAPTER 3
METHODOLOGY
Relationship violence is a problem of extensive proportions in America. There are
several theoretical models for assessing and treating violence survivors in order to
prevent continuing abuse. However, it is unknown which treatment methods, assessment
questions, and prevention models are actually put into practice with this population.
Therefore, the primary purpose of this study was (a) to determine the factors that are most
frequently reported by MFTs to be related to the identification, assessment, and treatment
of relationship violence; (b) to measure how therapists, supervisors, and faculty members
in marriage and family therapy rate themselves on their competence in the identification,
assessment and treatment of relationship violence; and (c) to measure their rating of the
importance of certain competencies and skills in the identification, assessment, and
treatment of relationship violence.
These purposes were accomplished by examining two variables via the survey.
The first variable, Quality of Graduate Training, was assigned two subscales, each with
five items in the survey. The first subscale, Knowledge, was measured by five items
eliciting respondents’ self-rating of their knowledge in relationship violence. The second
subscale, Graduate Training Received, was measured by five items asking respondents to
rate the graduate training that they received in relationship violence. The second
variable, Competencies in the Identification, Assessment, and Treatment of Relationship
Violence, was measured by 10 items asking respondents to rate the importance of certain
competencies identified by the researcher as directly related to this variable.
66

67
In an attempt to clarify some of the unresolved problems in the existing literature,
this study was designed to answer the following questions:
1. How do MFTs rate themselves on their knowledge in the identification,
assessment, and treatment of relationship violence?
2. How do MFTs rate their graduate training in the identification, assessment, and
treatment of relationship violence?
3. How do MFTs rate the importance of specified competencies and skills in the
identification, assessment, and treatment of relationship violence?
The significance of this study was discussed in chapters 1 and 2, based on (a) the
increase in incidence of relationship violence as indicated by statistics; (b) professional
responsibility: legal, ethical, and therapeutic issues; (c) multiple forms of treatment
(metatheoretical, postmodernism, feminism, sociocultural, and social learning); and
(d) identification of training needs.
The research methodology is described in this chapter. Included are descriptions of
the research method, survey design, rating scales in the social sciences, research
procedures, sample, sources of error in Web-based designs, survey research, research
barriers, and limitations in relationship violence.
Research Method
Approximately 1,000 active members of AAMFT from various geographic regions
of the United States were asked to participate in the research (appendix D). The RVTS
was used to collect demographic data, including the professional counselor’s age, gender,
ethnicity, marital status, and highest academic degree.
This study was conducted using a Web-based survey sent to therapists, approved
supervisors, and faculty members in marriage and family therapy. An exploratory factor

68
analysis was used to identify the related factors of training in the identification,
assessment, and treatment of relationship violence as reported by MFTs.
A preliminary self-designed survey instrument (RVTS) was developed based on
clinical expertise and research reviews. The model’s elements were refined, based on
field testing suggestions offered by 10 colleagues with practice expertise and research
backgrounds. These colleagues were recruited based on their expertise in the areas of
measurement, relationship violence, and family therapy, which included experience in
teaching assessment and prevention of relationship violence. Certain variables were
selected over others for the instrument, based on research and clinical knowledge. A
panel of experts in the field reviewed the variables, and a revised selection was made
based on their feedback on the items. This testing was important in establishing validity
of the instrument and served to make improvements in the formatting and structure of the
instrument.
This model was further refined based on a field study given to experts in the above
areas. Results from the field studies were used to improve the model. Approximately
20% of the original items were deleted and another 20% were refined after feedback
about the interpretation of items was given.
The exploratory factor analysis program was conducted on the basis of the
researcher’s specifications of the following items: (a) the variables to be factor analyzed;
(b) whether the data were in raw form or in the form of a correlation or covariance
matrix; (c) the number of factors to be extracted or the criteria by which to determine
such a number; (d) whether the diagonal elements of the correlation matrix were to be
replaced by communality estimates and, if so, what types of estimates were to be used;

69
(e) whether to employ orthogonal or oblique rotation; (f) the particular type of rotation to
be used (Kim & Mueller, 1978); and (g) giving the extracted factors names that would be
inclusive of all the items within that factor loading
Survey Design
In this section the prevalence of using surveys and rating scales in the social
sciences is discussed. Rating scales and their relevance to the RVTS survey development
are highlighted.
A survey design provides a quantitative or numeric description of some fraction of
the population—the sample—through the data collection process of asking questions of
people (Fowler, 1988). One goal of this data collection will be to generalize the findings
on the current status of graduate training in relationship violence from a sample of
responses to a population.
The data in this study were collected and compared via a Web-based survey system
that scored responses electronically. Data from the individual marriage and family
therapists, approved supervisors, and faculty members were examined to identify factors
in the assessment/training provided to marriage and family therapists at respective
schools regarding relationship violence. Factors related to treatment of relationship
violence were correlated. Since this is an exploratory factor analysis, identifying factors
that are important in the training of marriage and family therapists in working with
relationship violence was highlighted.
The purpose of survey research is to generalize from a sample to a population so
that inferences can be made about some characteristic, attitude, or behavior of this
population (Babbie, 1990). Broadly, a sample is a part selected to represent a larger
whole (Warwick & Lininger, 1975). The variables are the concepts or information in

70
which the researcher is interested. A questionnaire is a series of questions presented to
the sample in person by an interviewer, over the telephone, via Internet, or via computer,
through a self-administered Internet or Web-based instrument or in some other way. The
data analyses and reports are then used to describe the group or to draw inferences about
the variables, their relationships to each other, and their relationships to the population of
interest (Nelson, 1996).
Surveys usually focus on people—facts about them or their opinions, attitudes,
motivations, behaviors, and so on—and the relationship between variables under study
related to these people. For example, survey research might be used to compare
demographic characteristics of a sample of people in a particular location, their access to
mental health services, and their perceptions about the efficacy of those services. This
family therapy research could be used to make recommendations about improving the
curriculum/training provided to marriage and family therapist in relationship violence.
These generalizations have been made in previous research. For example, in their
1989 survey research on family therapy Wetchler, Piercy, and Sprinkle surveyed both
supervisors and supervisees about their impressions of their supervision experiences and
made some suggestions about marriage and family therapy training based on responses to
their survey.
Rating Scales in the Social Sciences
Various types of questionnaires are by far the most-used method of data collection
in psychology and other social sciences, and almost all of them use rating scales as their
primary response mode. Countless articles have followed the seminal work of authors
such as Freyd (1923), Thurstone, (1928), and Likert (1932). A response scale should

71
fulfill psychometric standards of measurement quality as well as practicality criteria, such
as comprehensibility for respondents and ease of use.
It has been recognized for many years that answers to self-administered
questionnaires are influenced by the way in which the questions and answers are
displayed on questionnaire pages (e.g., Rothwell, 1985; Smith, 1993; Wright & Barnard,
1975, 1978). However, scientific understanding of the natures of those effects is not well
developed. Although it has been argued on theoretical grounds that visual layout and
design make a difference in how people answer questionnaires (Jenkins & Dillman, 1997;
Sless, 1994), little experimental evidence exists that changing the visual presentation of
individual survey questions influences people’s answers.
On occasion, rating scales are used in which verbal labels are compressed to
saturate one end of the response continuum. In these scales, differences arise between the
normal meaning of the label and its scalar position. In some instances, however, equally
spaced options across the entire response continuum may not provide the desired
properties in the measurements. For instance, Symonds (1931) recommended the use of
evaluative rating scales of a set of labels that were packed with positive descriptions to
overcome individuals’ tendencies to be lenient in their description of others. For a 5-
point rating scale, he recommended using the labels Poor, Fair, Good, Very Good, and
Excellent. Guilford, in his classic Psychometric Methods (1936), reiterated Symonds’s
solution for the problem of errors of leniency. In addition, Guilford recommended that
“in a similar manner in the numerical type of scale, the strength of the descriptive
adjectives may be adjusted so as to counteract the error of central tendency” (p. 272).

72
French-Lazovik and Gibson (1984) also demonstrated that the labels used
influenced the distribution parameters of rating scale data. By using more positive labels,
they were able to systematically change the ratings in the predicted directions.
The meaning of the verbal label of a scale may depend upon the contexts of the
label. One important context to be considered is the position of the label. Chase (1969)
suggested that the meaning of the scale adjectives be determined by the relative position
of the adjective in a group of response categories rather than by the “standard” definition
of the scale labels. This suggestion was consistent with findings by Wildt and Mazis
(1978) that both label and location had an impact on subjects’ responses.
Klockars and Yamagishi (1988) found that the meaning of the labeled position was
defined as a compromise between the label itself and the relative position. They showed
results that suggested the use of rating scales containing verbal anchors predominantly
from one end of a continuum to provide increased discrimination in the portion of the
scale. This provides the respondent with response options that are more discriminating in
one portion of the underlying continuum. Consequently, as stated by Worcester and
Bums (1975), “The problem is not just that different words mean different things but that
the same word can be made to mean different things as the context changes (p. 182).”
Usually, rating scales (category scales in psychometric terms) offer between 4 and
11 response alternatives (ordinal scale points which are supposed to be equidistant).
Numbers or words or graphic symbols ( or a combination thereof) can be used to denote
the categories, but verbal labeling has become the dominant approach to facilitate
communication (Rohrman, 2002). Instead of labeling every point on the scale, end points
may be verbalized. In the Relationship Violence Training Survey (RVTS) instrument

73
constructed for this study a 6-point rating scale was used, with only the labels Very Poor
and Excellent to define the two end positions for items 1-10 and Not Important and Very
Important for items 11-20; intermediate positions were unlabeled. The respondent was
allowed to discriminate between the two end points to define the meaning of the response
without the judgment of labels used in other positions.
Research Procedures
The researcher requested permission and obtained approval from the University of
Florida Institutional Review Board to proceed with the study as proposed. Following this
approval, the researcher sent research packets to professional counselors across the
United States who were active therapist members of AAMFT, approved supervisors, and
COAMFTE graduate training program faculty members.
Informed consent was obtained from participants. The participants were given the
option to refuse participation in the study. All participation was voluntary and
confidential. The results from the study are summarized as group findings and will be
available to participants who express an interest in the results. The individual responses
of counselors were not reported to their institutions/agencies or anyone else. See
appendix D for the letter of invitation to participate in the survey and the accompanying
consent form.
Sample
The first in a series of three Internet Web-based RVTS was sent electronically to a
random sample of licensed marriage and family therapists. The list of Internet mail
addresses was obtained from the AAMFT. The second questionnaire in the RVTS series
was sent to a random sample of marriage and family therapy faculty members who teach
in training programs in major university settings. This list was generated from approved

74
marriage and family therapy training programs from the AAMFT organization branch
COAMFTE, which monitors and credentials marriage and family therapy training
programs. The third questionnaire in the RVTS series was sent to a random sample of
AAMFT approved supervisors from a list obtained from the AAMFT organization,
retrieved from their national list of approved supervisors.
The questionnaire requested information about demographic variables (age, gender,
etc.) and information about education and training. Therapists, supervisors, and faculty
members were asked to rate themselves, using a 6-point scale, on their knowledge of
factors related to the identification, assessment, and treatment of cases relating to
relationship violence. They were also asked to rate their marriage and family therapy
graduate training in the identification, assessment, and treatment of violence. They were
also asked to rate the importance of certain competencies identified by the researcher to
be related to the identification, assessment, and treatment of relationship violence.
Due to the initial response rate on the electronic response (error rate or nonresponse
rate), an electronic follow-up mailing (appendix E) was sent out 2 weeks after the first
electronic mailing to those who had not responded, with a reminder announcement listing
the Web site link for participants to contact to be involved in the survey.
Sources of Error in Sample Web Surveys
The remarkable power of a sample survey is its ability to estimate, with precision,
the distribution of a characteristic in a defined population. In addition, that estimate can
usually be made by surveying only a small portion of the population under study. Sample
surveys are subject to four major sources of error, and each must be attended to in order
to have confidence in the precision of the sample survey estimates (Groves, 1989). These
errors are (a) coverage error, the result of all units in a defined population not having a

75
known nonzero probability of being included in the sample drawn to represent the
population; (b) sampling error, the result of surveying a sample of the population rather
than an entire population; (c) measurement error, the result of inaccurate responses that
stem from poor question wording, poor interviewing, survey mode effects, and/or some
aspect of the respondent’s behavior; and (d) nonresponse error, the result of nonresponse
from people in the sample, who, had they responded, might have provided different
answers to the survey questions from those given by persons who responded to the survey
(Dillman & Bowker, 2001).
All four of these sources of error are as applicable to the design and implementation
of Web surveys as they are to mail interview surveys. However, the early
implementation of Web surveys suggests that some aspects of error, and in particular
coverage and nonresponse, have been mostly ignored. Sampling error, although not
being neglected, is instead often inferred when it is not appropriate to do so. For
example, many Web surveys are conducted using samples of convenience or availability,
and thus depend heavily on the solicitation of volunteer respondents, as described by
Bandida (2001).
One of the basic assumptions in surveying is the recognition that, for simple
random samples of a defined population, the precision of results is closely related to
completed sample size, or the number of respondents. For example, simple random
samples of 100 have a precision of ±10 percentage points, and those of 1,100-1,200 (the
size commonly used for election survey prediction) have a precision of ±3 percentage
points. Sampling error is decreased by about half when sample size is quadrupled. Thus,
samples of several thousand are expected to have precision measure in tenths of a

76
percentage point, assuming no other sources of error. Large number of volunteers
respondents, by themselves, have no meaning. Ignoring the need to define survey
populations, select probability samples, and obtain high response rates together provide a
major thereat to the validity of web surveys (Dillman & Bowker, 2001).
Regarding coverage error, using the Web to survey the general public remains quite
limited. Moreover, Black and Hispanic households are about two fifths as likely to have
Internet access as are White households, and rural Americans about half as likely to have
access as urban Americans with comparable incomes. Nua Internet Surveys (1997)
estimated that 179 million people, or about 3% of the world’s populations, has been
online at least once, and over 40% of U.S. households now own computers but only one
quarter of all households have Internet access (National Telecommunication and
Information Administration [NTIA], 1999).
However, this does not mean that researchers are unable to conduct scientifically
valid Web surveys. Some populations—employees of certain organizations, members of
professional organizations, certain types of businesses, students at many universities and
colleges, and groups with high levels of education—do not exhibit large coverage
problems. When nearly all members of a population have computers and Internet access,
as is the case for many such groups, coverage is less of a problem.
Another serious source of potential error in Web surveys is the nonresponse
problem associated with positing a Web questionnaire and inviting people to respond.
Number of contacts (or call-backs) has always been a major influence on response rates
to other survey methods, and the tool most depended upon to reduce nonresponse error.
There is little doubt that procedures can be developed for achieving response rates to

77
Web surveys that are reasonably comparable with those obtained by other methods
(Dillman, 2000).
The advent of Web surveying presents measurement challenges not previously
faced by survey methodologists and for which research has not yet provided solutions.
The enduring problem is that what the designer of a Web questionnaire sees on the screen
may differ significantly from what some, and in other cases most, respondents see on
their screens. Evaluation of the Web surveys located by D. Bowker (1999) revealed
much variability in methods of construction. When tested on various levels and types of
Web browsers, operating systems, screen configurations, and hardware, the visual
stimulus of the survey items (i.e., physical placement and presentation) was often
different from what had originally been intended by the designer.
Although measurement error effects represent one of the most serious threats to the
conduct of quality Web surveys, they are also among the most easily addressed through
various design controls by programmers. In the construction of this survey HyperText
tp\
Markup Language (HTML) was used in conjunction with SurveyWiz , a program that
was originated by Michael Bimbaum in 1998 (Bimbaum, 2000). This program was
recommended by Dr. Roger L. Worthington, Ph.D., from the Department of Educational
and Counseling Psychology at the University of Missouri-Columbia while attending a
Web-based research methods forum at the 2001 Southern Association for Counselor
Education and Supervision (SACES) convention of the American Counseling
Association in Athens, Georgia. Dr. Worthington shared some of his experiences and
explained how he had enhanced the programming to alleviate some of the measurement
errors mentioned in this section. Dr. Worthington encouraged development of the survey

78
for the present study using the SurveyWiz0 formatting, as he believed that it would help
greatly in coding and reducing error while working with the data set prior to running
factor analysis.
During the survey development, the researcher worked closely with Mr. Gary Sipe
from Stetson University CIT Media Services to learn how to run SurveyWiz0 (Bimbaum,
2000) programming and how to set up the HTML documents. These files were edited
each time a revision was made to the items on the survey and saved on a working
clipboard and then resaved into the actual document. The final versions of all three
surveys were then saved onto the Stetson University Secured Server under an HTML file
reserved for the researcher as an adjunct professor. All responses to the survey were
forwarded from the Stetson server automatically to the researcher’s email address, where
they were automatically coded by question number. One way of reducing nonrespondent
errors in this study was that each respondent was automatically coded by response time
and email address (appendix F). This assured that no respondent could submit responses
more than once. This process also helped in sending nonresponse notices to the correct
nonrespondents. Finally, the data were placed into a standard computer application
spreadsheet and prepared for run through a leading computer software statistical analysis
(Statistical Package for the Social Sciences®; SPSS, 1975) for the factor analysis and
demographics.
Survey Research in Family Therapy
In family therapy research, many surveys have been designed to determine what
clinicians think or do. Survey research has been used to ask clinicians about their use of
assessment instruments (Boughner, Hayes, Bubenzer, & West, 1994), about how they act
when faced with ethical dilemmas (Green & Hansen, 1989), about their preferred models

79
of therapy (Quinn & Davidson, 1984), about how they use or view their clinical training
(Carter, 1989; Coleman, Myers Avis, & Turin, 1990; Keller, Huber, & Hardy, 1988) and
admission and program requirements (O’Sullivan & Gilbert, 1989), as well as about
issues related to ethnicity and gender in curricula (Coleman et al., 1990; Wilson & Stith,
1993). Students have been surveyed about their ethnic minority status as therapists in
training (Wetchler, 1989; Wetchler et ah, 1989). Supervisors have been asked about their
training practices (Lewis & Rohrbaugh, 1989; Nichols, Nichols, & Hardy, 1990), about
what they view as essential basic family therapy skills (Figley & Nelson, 1989; Nelson &
Figley, 1990; Nelson, Heilbrun, & Figley, 1993), and about the essential elements of
marriage and family therapy and its supervision (White & Russell, 95).
On occasion, the general population or a class of clients has been surveyed to
determine their experience with a particular issue. Examples include wives’ experiences
of their husbands’ post-traumatic stress symptoms or combat stress reactions (Solomon,
Ott, & Roach, 1986), couples’ experiences of marriage encounter weekends (Doherty,
Lester, & Leigh, 1986), and the effects of differing wake-sleep patterns on marital
relationships (Larson, Crane, & Smith, 1991). Halik, Rosenthal, and Pattison (1990)
measured personal authority (Bray, Williamson, & Malón, 1984) of daughters of Jewish
Holocaust survivors or immigrants. These examples of survey research pertain to family
therapy by virtue of the factors measured, which are often easily extrapolated into family
therapy interventions.
The research enterprise in family therapy has undergone two major transformations
since its early investigations. In the first transformation the field moved from its
impressionistic beginnings to an emphasis on quantitative and experimental research. It

80
also challenged family therapy researchers to develop reliable and valid measures, which
in conjunction with respectable research designs, helped to gain credibility for a fledgling
discipline in a skeptical clinical world (Sprenkle & Bischoff, 1995).
The second transformation involved a shift from a strict adherence to quantitative
methods to incorporation and gradual acceptance of alternate methodologies, especially
qualitative methods (Hoshmand, 1989; Moon, Dillon, & Sprenkle, 1990; Sprenkle &
Bischoff, 1995). Critics also argued that family therapy had made its quantitative leap
too soon, before clearly delineating what was meant by systemic constructs (Bednar,
Burlingame, & Masters, 1988). Therefore, concepts were operationalized before they
were truly understood and consequently seemed removed from clinical reality. This
called for more attention to contextual variables (Atkinson, Heath, & Chenail, 1991).
In terms of practice, marriage and family therapists and other mental health
professionals routinely assess violence potential for children and adolescents and make
related management decisions in psychiatric emergency services, civil psychiatric
hospitals, juvenile justice, and outpatient clinics. Each of these settings may have
different policy requirements for the evaluations, the amount and quality of available
information may vary, and the nature and decisional thresholds may differ. Each of these
factors can influence the way in which the risk assessment is conducted. Aware of this
diversity, this paper outlines some broad principles for violence risk assessment that may
be useful for marriage and family therapists in assessing risk of general violent
recidivism in various contexts.
In his article on risk assessment Borum discussed historical, clinical, and contextual
categories as the factors that show the most robust empirical support. He stated that the

81
history of violence would include being a victim of abuse or marital conflict, hi his
clinical factors category he included substance abuse problems, mental or behavioral
problems, lack of empathy/remorse and attitudes that support violence. Included in
contextual factors were negative relationships, lack of social support, stress and losses,
community disorganization, and availability of drugs (Borum, 2000).
Data Analyses
The statistical technique used in this study was an exploratory factor analysis
(EFA). The variables operationalized in this study are summarized in Table 1. Validity
and reliability of the RVTS instrument are discussed in this section.
The Nature of Factors
The purpose of factor analysis is to discern and to quantify the dimensions
supposed to underlie mathematical entities, which can be thought of as a classificatory
axis with respect to which the test in a battery can be “plotted.” The greater the value of
a test’s co-ordinate, or loading, on a factor, the more important is that factor in
accounting for the correlations between the test and other factors in the battery.
An exploratory factor analysis is mainly used as a means of exploring the
underlying factor structure without prior specification of number of factors and their
loadings. In this study the responses were extracted into factors of what was most
commonly identified by the participants in the prevention, assessment, and treatment of
relationship violence.
The common factor model incorporates several parameters worthy of review in this
study. This term is not to be confused with the “common factor” theory across models
within the marriage and family literature, which implies a common theory of ideas
between different theoretical approaches. In this study, common factors were defined as

82
Table 1
Variables Used for the Relationship Violence Training Survey (RVTS)
Exploratory factor analysis variables Variables
Quality of graduate training
in the identification, assessment,
and treatment of relationship
violence as reported by
Marriage and Family Therapists
Importance of competencies
and skills in the identification,
assessment, and treatment of
relationship violence as reported
by Marriage and Family Therapists
Rating my knowledge and skills in RV
Assessment and treatment in RV
Working with gay and lesbian clients
Obtaining restraining orders
RV skills today versus 5 years ago
RV screening in premarital counseling
Rating my graduate training received in RV
MFT graduate training programs overall
MFT graduate training that I attended
Intake/assessment of RV
Treatment approaches
Continuing education units in RV
Importance of competencies and skills
Self-knowledge in assessment skills
Identifying/assessing imminent danger
Performing protection assessments rating
Recognizing batterer typologies
Identifying client resources
Recognizing signs and symptoms/
cycle of violence
Assessing ethical standards
Assessing through a multicultural model
Identifying risk factors in relationship
violence
Recommending risk assessment/
instruments
Note. RV = relationship violence.
an unmeasured (or hypothetical) underlying variable that is the source of variation in at
least two observed variables under consideration/ Kim & Mueller, 1978).
Thurstone (1947) originally advocated the simple structure principle as reflecting
truth about the psychology of cognition; this is where the concept originated. Thurstone.

83
at the time of the introduction of simple structure, explicitly regarded factoring as a
scientific revival of an old, discredited, unscientific notion of the principle of parsimony
to supplement the first, by which all of the correlations are explained by as few factors as
possible and each correlation is explained with as few of those factors as possible.
Thurstone stated that factor analysis is a technique to show the correlation of all
tests of mental ability. Thurstone found that all of the mental ability tests were positively
correlated, indicating a common factor among them. The analysis indicated the
following seven primary mental abilities: verbal, number, spatial, perceptual, memory,
reasoning, and word fluency (Thurstone, 1947).
Spearman (1904) viewed factor analysis as a data reduction procedure whereby a
matrix of obtained measurements of N individuals on n experimental variables is replaced
by a smaller matrix of factor coefficients or loadings, relating every variable to each of r
factors, each an underlying variable assumed to represent an ability or other kind of trait,
which is conceived as a vector in r-dimensional space (N> n> r).
According to McDonald (1985), the factor is “most like” the variables that increase
most rapidly as the factor score increases. It is unlike the variables with zero loadings, as
these do not vary as the large factor varies, and least like those variables that have large
negative regression weights on it (i.e., the variables that decrease most rapidly as the
factor score increases).
Stages in a Factor Analysis
The factor analysis in the present study was conducted in three stages.
1. A matrix of correlation coefficients was generated for all of the variable
combinations.

84
2. Factors were extracted from the correlation matrix. The most common method
is called principal factors (often wrongly referred to as principal components extraction,
hence, the abbreviation PC).
3. The factors (axes) were rotated to maximize the relationship between the
variables and some of the factors. In this study a Promax rotation method was used.
Promax is an oblique rotation method through which a simple structure is sought; factors
are rotated without imposing the orthogonality condition (i.e., that they be kept at right
angles), and resulting terminal factors are in general correlated with each other.
A fourth stage can be added in which the scores of each subject on each of the
factors emerging from the analysis are calculated. It should be stressed that these factor
scores are not the results of any actual test taken by the subjects; they are the estimates of
the subjects’ standings on the supposed latent variables that have emerged as
mathematical axes from the factor analysis of the data set. Factor scores can be very
useful, because they can subsequently be used as input for further statistical analysis.
In this research study it was deemed advisable to carry out only the first stage
initially, in order to be able to inspect the correlation coefficients in the correlation matrix
R. Since the purpose of this analysis is to link variables into factors, those variables must
be related to one another and therefore have correlation coefficients larger than a
Cronbach’s alpha of .70 and factor loadings greater than .30. These numbers are
consistent with the mínimums needed in the social sciences for statistically significant
correlations. Any variables that showed no substantial correlation with any of the others
were removed from R in subsequent analysis. It is also advisable to check that the
correlation matrix does not possess the highly undesirable properties of multicollinearity
and singularity. The former is the condition in which the variables are very highly
(although imperfectly) correlated; the latter arises when some of the variables are exact
linear functions of others in the battery, as when the variable C is constructed by adding
the subjects’ scores on variables A and B. Should either multicollinearity or singularity

85
be present, it would be necessary to drop some of the variables from the analysis (Gray &
Kinnear, 1998).
Rotation of Factors
Factor analysis is a variable reduction technique that simplification of data by
combining numerous variables into a much smaller set of synthetic variables called
“factors.” Factor analysis is “designed to identify factors, or dimensions, that underlie
the relations among a set of observed variables” (Pedhazur & Schmelkin, 1991, p. 66).
As Tinsley and Tinsley (1987) noted:
Factor analysis is an analytic technique that permits the reduction of a large number
of interrelated variables to a smaller number of latent or hidden dimensions. The
goal of factor analysis is to achieve parsimony by using the smallest number of
explanatory concepts to explain the maximum amount of common variance in a
correlation matrix, (p. 414)
The ability of factor analysis to detect underlying factors makes it an extremely useful
tool for researchers who want to demonstrate that their results have construct validity.
Similarly, Gorsuch (1983) stated that “a prime use of factor analysis has been in the
development of both the operational constructs for an area and the operational
representatives for the theoretical constructs” (p. 350).
Thurstone’s goal in developing his set of guidelines for rotating factors was that
“the factor pattern of any given variable would be constant when the variable was
included in another factor analysis containing the same common factors” (Gorsuch, 1983,
p. 177). This leads to findings that are more replicable across studies. As Gorsuch noted,
“Thurstone showed that such rotation leads to a position being identified for each factor
that would be independent of the number of variables defining it. Therefore, a simple
structure factor should be relatively invariant across studies” (p. 177).

86
In the present study an oblique rotation was used with a Promax procedure, since it
was the assumption of the researcher that the primary factors might be related. The
generalizability and replication of this research were better served with an oblique
rotation.
Validity in Factor Analysis
Validity is the strength of conclusions, inferences, or propositions. More formally,
Cook and Campbell (1979) defined it as the “best available approximation to the truth or
falsity of a given inference, proposition or conclusion” (p. 93). In short, “Were we
right?”
Validity can be established in a number of ways. The determination of the most
appropriate way depends on the kind of measure. Face validity is usually not enough. If
the variable is meant to assess mastery of subject matter, a test of content validity is
valuable. Usually, a panel of experts agree that all important content areas have been
covered. Construct validity can be determined by an appraisal of the correlation of the
test with other measures of the same trait or ability. Factorial validity confirms the test
with other measures of the same trait or ability. Factorial validity confirms the construct
by showing the strong presence of expected factors in the tests. Criterion-related validity
demonstrates that the test measure correlates highly with the concurrent validity or
predicts future performance (predictive validity). Study validity refers to the validity of
the measure, experiment, and people for the specific designated purpose. No test has
omnibus validity; that is, no one test does it all (Metzloff, 1998).
Professionals have consistently distinguished between actual validity and face
validity. Anastasi (1988) began a section on face validity as follows:

87
Content validity should not be confused with face validity. The latter is not validity
in the technical sense; it refers, not to what the test actually measures, but to what it
appears superficially to measure. Face validity pertains to whether the test “looks
valid” to the examinees who take it, the administrative personnel who decide on its
use, and other technically untrained observers, (p. 144)
In the present study, content validity, construct validity, and factorial validity were
considered to be important and tests of these forms of validity were applied. The survey
was given to a panel of experts to review the content and constructs, the wording of the
questions, and the extent to which the constructs accurately reflect the variables to be
measured in the study. Feedback from both groups was incorporated into the final survey
format. Tests of the factorial validity were done, once the data were collected and
correlated for various factors.
Reliability in Factor Analysis
Reliability is the consistency of the measurement, or the degree to which the
instrument measures the same way each time it is used under the same conditions with
the same subjects. In short, it is the consistent repeatability of the measure. A measure is
considered reliable if a person’s scores on the same test, given twice, are similar. It is
important to remember that reliability is not measured; it is estimated. Reliability is
usually estimated in one of two ways: test/retest or internal consistency. For this study,
the RVTS will be administered only one time, and internal consistency will be used to
estimate reliability.
Internal Consistency
Internal consistency estimates reliability by grouping questions in a questionnaire
that measure the same concept. In the present study two groups of 10 questions each
measured the same concept (e.g., training in relationship violence). This permitted a

88
measurement of correlation between responses to those two groups of 10 questions to
determine whether the instrument was reliably measuring that concept.
This study applied the common way of computing correlation values among the
questions on the instrument: calculation of Cronbach’s Alpha (Cronbach, 1951).
Cronbach’s alpha splits all questions on the instrument in every possible way and
computes correlation values for all such combinations. The computerized statistical
analysis software generates one number for Cronbach’s alpha; as with a correlation
coefficient, the closer this alpha to 1, the higher the reliability estimate of the instrument.
Cronbach’s alpha is a less conservative estimate of reliability than test/retest. The
primary difference between test/retest and internal consistency estimates of reliability is
that test/retest involves two administrations of the measurement instrument, whereas the
internal consistency method involves only one administration of that instrument.
MFT Training Programs
Due to the nature of this research topic, it may be important to look at the status of
graduate-level training being offered by counselor training programs in prevention and
treatment of family violence. This was done to answer the following questions: Is the
curriculum using the current factors that are highlighted in the literature and
incorporating assessment for risk factors? What are the current assessments tools in
family violence prevention and treatment? Is imminent danger being assessed and are
safety plans being employed for victims at risk? Is administration of these instruments
being taught in counselor preparation programs; if so, are the assessment instruments for
violence used with each case that the marriage and family therapy graduate sees?
Rating of the graduate training program themselves will help in a correlation of
marriage and family therapy graduates, licensed practitioners, faculty, and the training

89
program. Using this lens, this study may be viewed as a system within a system, when
thinking of relationship violence treatment and prevention. The training and assessment
of marriage and family therapy graduates in relationship violence takes place on multiple
levels and in multiple contexts. It is intended in this study that the use of the RVTS
survey will bring clinical awareness of the current training and assessment issues that are
cited by experts in relationship violence in marriage and family therapy today.
Conclusions
It is important to remember that factor analysis is a relative procedure. There are
no hard and fast guidelines for its application. Factor analysis assumes a linear
relationship between variables (Guertin & Bailey, 1970); any other relationship would be
inaccurately represented by a factor analytic structure.
This study should have a number of noteworthy strengths. First, the data were
obtained from a national sample of marriage and family therapists, supervisors, and
faculty members. The factors are generalizable to marriage and family therapy training
programs and their content related to relationship violence assessment and treatment.
Despite its limitations, this study underscores the importance of measuring and including
training indicators within relationship violence coursework, treatment, and supervision.
At the state and local levels, prevention researchers and preventive intervention
staff can promote the need for, and the empirically supported success of, early preventive
interventions. Research findings indicating the effectiveness of preventive interventions
might become part of the state and local policy agendas, leading to more proactive,
constructive efforts to carefully and systematically implement proven prevention
programs. Prevention interventions could be provided in early childhood and at key
developmental transitions, using developmentally appropriate interventions.

90
It would be worthwhile to examine factors in the training process and in the host
systems (e.g., schools, community agencies) that affect dissemination. This is a central
focus for the next generation of prevention research. There is a critical need to
understand and identify the key factors within communities and agencies that can lead to
more or less acceptance of a new intervention. Often, the level of support for the
program may affect agency acceptance by key administrative staff and by the staff s
ability to critically review the program before its acceptance. Elements of the training
process also may have profound effects on the effectiveness of the implementation of the
program. Research is needed to examine these processes and factors with the same
degree of scientific rigor as is apparent in clinical trial research (Lochman, 2000).
The origins of family therapy, its clinical techniques, and its training and
supervision are mostly theory based. However, as the health care context changes,
practitioners are confronted with increasing demands to provide evidence for the
effectiveness of their practice (AAMFT, 2000). This includes how students are prepared
for the field and how inservice training keeps supervisors and faculty members updated.
This may also include a different way of measuring outcomes of graduate training
programs.

CHAPTER 4
RESULTS
A survey design provides a quantitative or numeric description of some fraction of
the population through the data collection process of asking questions of people (Fowler,
1988). This research implemented a cross-sectional online Web-based data collection
method. Data were collected by means of a questionnaire containing 30 items, the
majority of which were scored on a Likert-type scale from very poor to excellent on items
1-10 and least important to very important on items 11-20. Other questions asked for
factual information and demographics, such as age, gender, and years of training. The
variables were identified and are listed in Table 1 (chapter 3). All information used in
this analysis was derived from the questionnaire data. This questionnaire was developed
by the researcher and pilot tested for construct validity by a panel of experts in the field.
The advantages of this survey design included the economy of the design, the rapid
turnaround in data collection, the competency to get a national sample, and the ability to
identify attributes of a population from a small group of individuals.
Participants and Demographic Description
A random sampling of 1,000 potential participants was randomly taken from lists
obtained from the AAMFT clinical membership, AAMFT Approved Supervisor
membership, and COAMFT Approved Graduate School and Faculty membership
(AAMFT, 2003b). These 1,000 persons were sent an initial invitation to participate in
the research by completing the RVTS survey. A total of 197 clinical members of the
AAMFT responded by rating the 20 items on the RVTS survey questionnaire (appendix
91

92
A) regarding the degree of importance of the MFT training that they had received in the
identification, assessment, and treatment of relationship violence. A representative
sample of 1,000 potential participants realized 197 respondents (response rate 19.7%).
As shown in Table 2, 102 respondents (51.8%) were female and 92 (46.7%) were male,
with 3 (1.5%) missing data. The mean age of the respondents was 51.28 years, with a
standard deviation of 10.81 years and a range from 22 years to 81 years, with 55 years
and 53 years being the most frequently reported (13 respondents each). These data
correspond closely to the 2004 survey cited by Lee, Nichols, Nichols, and Odom in their
article “Trends in Family Therapy Supervision: The Past 25 Years and Into the Future.”
Using a similar population, they reported a mean age of 54 years (RVTS mean 51 years)
and 55% females (RVTS mean 52%).
Table 2
Characteristics of Respondents (N = 197)
Characteristic and category
n
%
Mean
SD
Range
Gender
Female
103
51.8
Male
92
47.4
Age (years)
51.28
10.81
22-81
Years as supervisors
Therapists (n = 122)
5.59
7.77
Supervisors (n = 15)
7.53
4.93
Faculty (n = 51)
12.55
7.62
Years licensed
Therapists (n = 121)
13.68
9.74
Supervisors (n = 15)
12.80
7.25
Faculty (n = 48)
15.04
9.59

93
The sample consisted of 51 MFT Faculty respondents, 15 supervisors, and 122
clinical members. Faculty had a mean of 15.04 years as a licensed therapist and 12.55
years as a supervisor, Supervisors had a mean of 12.80 years as a licensed therapist and
7.53 years as a supervisor, and Clinical Members had a mean of 13.68 years as a licensed
therapist and 5.59 years as a supervisor. Faculty had the most years as supervisors.
Regarding their nationality, 181 (91.9%) responses came from the United States, 1
from Taiwan, 1 from Germany, 1 from Japan, 2 from Canada, 1 from Italy, 1 from
Dominica, 1 from Holland, 1 from France, 1 from Peru, and 1 from Africa; 5 respondents
did not identify their ethnic nationality.
The RVTS rating scale ranged from 1 = very poor to 6 = excellent for items 1-10
and from 1= least important to 6 = most important for items 11-20. In addition, the
respondents answered 10 demographic items. The mean ratings (excluding item 10,
which was omitted from analysis) ranged from 2.96 to 5.83. The mean ratings for the 20
self-rated items, based upon the 171 respondents who rated all of them, are reported in
appendix G. The standard deviations of the responses for descriptive statistics ranged
from 0.461 to 1.477 and are reported in appendix G.
Principal Axis Factoring and Oblique Rotation
This study used a standard computer software program for the factor analysis. To
remove error variance, the study utilized a Principal Axis Factoring method of initial
factoring. The correlation matrix was then decomposed and a principal axis factor
analysis with iterated commonalties led to a least-squares solution of initial factoring.
Considering that the factors were probably related, the oblique rotation was also used.
Through this operation, a simple structure is sought; factors are rotated without imposing

the orthogonality condition and resulting factors are, in general, correlated with each
other.
94
For the principal axes solution based upon N = 171, the latent roots (eigenvalues),
differences in eigenvalues, and cumulative variance for which successive axes accounted
are presented in Table 3. These were the values that were examined to determine the
number of factors to carry into the initial rotations. In factor analyses, the eigenvalues
generally fall off rapidly at first because systematic common variance is being extracted.
The roots start decreasing almost linearly as mostly error variance is being extracted.
Table 3
Eigenvalues and Total Variance Explained
Extraction Sum of Square Loadings
Initial
%
Cumulative
Factor
total
variance
variance
Total
1
5.413
28.491
28.491
5.008
2
3.577
18.829
47.320
3.252
3
2.231
11.743
59.063
1.855
4
1.255
6.608
65.671
5
.994
5.232
70.903
6
.832
4.380
75.283
7
.659
3.471
78.754
8
.648
3.410
82.163
9
.542
2.854
85.017
10
.491
2.582
87.599
11
.457
2.407
90.006
12
.436
2.295
92.300
13
.396
2.085
94.386
14
.276
1.454
95.840
15
.259
1.363
97.202
16
.229
1.204
98.406
17
.160
.843
99.249
18
.080
.422
99.671
19
.063
.329
100.000

95
Extraction Method: Principal Axis Factoring
The rule of thumb for the scree test criterion for determining the number of
significant factors to retain is based on the graph of the roots (eigenvalues), claimed to be
appropriate in handling disturbances due to minor (unarticulated) factors (Kim &
Mueller, 1978). In this study the factors were extracted by using the formula “1 minus the
elbow.” In this study, the elbow was at 4 factors, so 4 - 1 = 3 factors. The Cattell scree
test (Figure 1) plots the components as the x axis and the corresponding eigenvalues as
the y axis. Moving to the right, toward later components, the eigenvalues drop. When
the drop ceases and the curve makes an elbow toward less steep decline, Cattell’s scree
test indicates to drop all further components after the one starting the elbow. The elbow
is somewhat subjective, but in this study the researcher decided that only the first three
factors were worth retaining in the analysis (Cattell, 1994).
Figure 1. Scree plot

Factor Analysis Results
The principal axes factor extraction method was applied to the correlation matrix
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and the factor loadings with a Promax solution with Kaiser Normalization (Table 4).
Only the factor loadings with a response greater than .40 were included in the factor
analysis.
Table 4
Factor Loading Matrix: Rotated Factor Loadings of .40 or Greater in the Principal Axis
Factoring, Based Upon N = 171
Item
1
2
3
Recognizing signs and symptoms/cycle of violence
.749
Identifying risk factors in relationship violence
.738
Performing protection assessments rating
.737
Identifying/assessing imminent danger
.650
Recognizing batterer typologies
.629
Self-knowledge in assessment skills
.603
Assessing ethical standards
.542
Recommending risk assessment/instruments
.480
Identifying client resources
.436
Assessing through a multicultural model
.431
Intake/assessment of RV
.957
MFT graduate training that I attended
.949
Treatment approaches
.932
MFT graduate training programs overall
.918
Assessment and treatment in relationship violence
.962
Relationship violence skills today versus 5 years ago
.749
Screening for relationship violence in premarital counseling
.717
Working with gay/lesbian clients in relationship violence
.599
Obtaining restraining orders
.578
Note. Extraction method: principal axis factoring; rotation method: Promax w/Kaiser
Normalization.

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The most evident feature of the data represented in Table 4 was that there was a
relatively stable three-factor structure. Factor 1 loadings ranged from .749 to .431, Factor
2 loadings ranged from .957 to .918, and Factor 3 loadings ranged from .962 to .578.
Factors loading greater than .40 are presented in Table 4. Factor loadings of less than .40
were considered insignificant for this study due to low alpha score and hence were not
included in the table.
Since the initial and extracted commonalties of item 10 were the lowest in the study
(.240 and .215, respectively), they were eliminated from consideration in this study.
According to Guertin and Bailey (1970), “The factors are best located when the produced
extraction is as simple as possible” (p. 98). The three general criteria for simple structure
are: (a) Factors should have the largest possible number of loadings approaching zero,
(b) the variables should have the largest possible number of loadings on the factors
approaching zero, and (c) every pair of factors should have the largest possible number of
loadings approaching zero on one factor but not on the other (p. 99).
Identification and Naming of Factors
The items for the final version were selected with several criteria in mind. First,
items were selected based on high factor loading with the three factors identified in the
RVTS survey results. Second, items were selected to reduce redundancy and not
overweight any single content area. Third, items were limited to keep the RVTS as brief
as possible. Once this was decided, labels were given to the factors.
Factor 1 (including items 11-20) was named the importance of competencies and
skills in the identification, assessment, and treatment of relationship violence. Factor 2
(including items 6-9 and excluding item 10) was named a self-rating scale of respond¬
ents’ graduate training in the identification, assessment, and treatment of relationship

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violence. Factor 3 (including items 1-5) was named a self-rating scale of respondents’
knowledge in the identification, assessment, and treatment of relationship violence.
Reliability and Validity
The RVTS was administered once, and internal consistency was used to estimate
reliability. Content validity, construct validity, and factorial validity were considered to
be important for this study, and tests of these forms of validity were applied. The survey
was given to a panel of experts to review content and constructs, wording of the ques¬
tions, and extent to which the constructs accurately reflect the variables to be measured in
the study. Feedback from both groups was incorporated into the final survey format.
Once the data were collected and correlated for various factors, tests of the factorial
validity were done. The study applied the common way of computing correlation values
among the questions on the instrument: calculation of Cronbach’s alpha (Cronbach,
1951). The computerized statistical analysis software generates one number for
Cronbach’s alpha; as with a correlation coefficient, the closer this alpha to 1, the higher
the reliability estimate of the instrument.
Factor 1
The sample size summary for Factor 1 is presented in Table 5. Calculation of
Cronbach’s alpha for Factors 1, 2, and 3 are shown in Table 6. Cronbach’s alpha for
Factor 1 was .814 for the 10 items. The item statistics for Factor 1 (mean score and
standard deviation) are presented in Table 7 for the 184 persons who responded to all 10
items. Listed under summary item statistics (Table 8) are the item means, the item
variances, and the inter-item correlation for the 10 items. The item-total statistics are
reported in Table 9 and the scale statistics (mean, variance, and standard deviation) are
presented in Table 10.

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Table 5
Factor 1 (Items 11-20): Sample Size Processing
Summary
Cases
N
%
Valid
184
93.4
Excluded3
13
6.6
Total
197
100.0
aLikewise deletion based on all variables in the
procedure.
Table 6
Factors 1, 2,
and 3: Reliability Statistics
Factor
Cronbach’s alpha
N of items
1
.814
10
2
.967
4
3
.812
5
Factor 2
For Factor 2 (items 6-9, with item 10 omitted from analysis), Cronbach’s alpha was
.967 for the four items. Item statistics for Factor 2, giving the mean score and standard
deviation, are presented for the 185 persons who responded to all four items. Also listed
under summary item statistics are the item means, the item variances, and the inter-item
correlation for the four items. The item-total statistics and the scale statistics are reported
and the mean, variance, and standard deviated are presented (Tables 11 through 15).

100
Table 7
Factor 1: Item Statistics (N - 184)
Item3
Mean
SD
Assessing ethical standards
5.83
0.454
Identifying/assessing imminent danger
5.81
0.481
Performing protection assessments rating
5.74
0.530
Self-knowledge in assessment skills
5.72
0.557
Identifying client resources
5.66
0.623
Recognizing signs and symptoms/
cycle of violence
5.64
0.620
Identifying risk factors
5.58
0.639
Assessing through a multicultural model
5.46
0.874
Recognizing batterer typologies
5.05
1.088
Recommending risk assessment instruments
4.11
1.343
aRating the importance of competencies and skills.
Table 8
Factor 1: Summary Item Statistics (N = 10)
Statistic Mean Min
Max
Range
Min
Variance
Item means 5.461 4.109
5.832
1.723
1.419
.277
Item variances .596 .206
1.802
1.596
8.731
.268
Inter-item correlations .372 .159
.638
.479
4.009
.016

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Table 9
Factor 1: Item-Total Statistics
Item
SMID
SVID
CITC
SMC
CAID
Identify signs/symptoms
49.97
18.524
.628
.511
.786
Identify risk factors
49.03
17.972
.716
.579
.777
Protection orders
48.87
19.196
.599
.495
.792
Imminent dangers
48.80
19.681
.550
.573
.796
Identify batterer’s typology
49.56
15.800
.610
.456
.785
Knowledge/skills
48.89
19.205
.562
.500
.794
Ethical standards (duty to warn)
48.78
20.076
.486
.314
.803
Use of risk assessments
50.50
15.902
.426
.268
.831
Identify client’s strengths
48.95
19.538
.424
.260
.804
Use multicultural model
49.15
18.159
.448
.340
.803
Note. SMID = scale mean if item deleted, SVID = scale variance if item deleted, CITC =
corrected item—total correlation, SMC = squared multiple correlation, CAID =
Cronbach’s alpha if item deleted
Table 10
Factor 1: Scale Statistics (N = 10)
Mean
Variance
SD
54.61
22.261
4.718

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Table 11
Factor 2 (Items 6-9): Sample Size Summary
Cases
N
%
Valid
185
93.9
Excluded3
12
6.1
Total
197
100.0
aLikewise deletion based on all variables in the
procedure.
Table 12
Factor 2: Item Statistics (N = 185)
Item2
Mean
SD
MFT graduate training programs overall
3.15
1.476
Treatment approaches
3.01
1.387
Intake/assessment of relationship violence
2.99
1.405
MFT graduate training that I attended
2.93
1.430
Note. MFT = Marriage and Family Therapist.
aRating of Graduate Training.

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Table 13
Factor 2: Summary Item Statistics (N = 4)
Statistic
Mean
Min
Max
Range
Min
Variance
Item means
3.020
2.930
3.146
.216
1.074
.008
Item variances
2.030
1.924
2.180
.256
1.133
.012
Inter-item correlations
.880
.842
.916
.075
1.089
.001
Table 14
Factor 2: Item-Total Statistics
Item
SMID
SVID
CITC SMC
CAID
Intake/assessment of RV
9.09
16.895
.925
.875
.954
MFT graduate training that I attended
8.94
16.268
.933
.885
.952
Treatment approaches
9.07
17.196
.907
.849
.959
MFT graduate training programs overall
9.15
16.868
.906
.850
.960
Note. SMID = scale mean if item deleted, SVID = scale variance if item deleted, CITC =
corrected item—total correlation, SMC = squared multiple correlation, CAID =
Cronbach’s alpha if item deleted
Table 15
Factor 2: Scale Statistics (N = 4)
Mean
Variance
SD
12.08
29.553
5.436

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Factor 3
For Factor 3 (items 1-5), Cronbach’s alpha was .812 for the five items. The item
statistics for Factor 3 (mean score and standard deviation) are presented for the 192
persons who responded to all five items. Also listed are summary item statistics, item
means, item variances, and inter-item correlation for the five items. The item-total
statistics and the scale statistics are reported, as well as mean, variance, and standard
deviated (Tables 16-20).
Table 16
Factor 3 (Items 1-5): Sample Size Summary
Cases
N
%
Valid
192
97.5
Excluded3
5
2.5
Total
197
100.0
aLikewise deletion based on all variables in the procedure.
Table 17
Factor 3: Item Statistics (N = 192)
Item3
Mean
SD
Assessment and treatment in relationship violence
4.92
0.909
Relationship violence skills today versus 5 years ago
4.92
0.932
Screening for relationship violence in premarital counseling
4.60
1.117
Working with gay/lesbian clients in relationship violence
4.25
1.206
Obtaining restraining orders
3.91
1.317
aRating Knowledge and Skills in Relationship Violence

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Table 18
Factor 3: Summary Item Statistics (N - 5)
Statistic Mean
Min
Max
Range
Min
Variance
Item means 4.521
3.911
4.922
1.010
1.258
.193
Item variances 1.226
0.826
1.736
0.909
2.100
.150
Inter-item correlations .492
.347
.648
.301
1.869
.011
Table 19
Factor 3: Item-Total Statistics
Item
SMID
SVID
CITC
SMC
CAID
Assessment and treatment in
relationship violence
17.68
11.768
.788
.633
.732
Relationship violence skills today
versus 5 years ago
17.68
12.459
.636
.447
.770
Screening for relationship violence
in premarital counseling
18.01
11.639
.607
.425
.774
Working with gay/lesbian clients
in relationship violence
18.35
11.455
.563
.356
.789
Obtaining restraining orders
18.69
11.334
.500
.284
.816
Note. SMID = scale mean if item deleted, SVID = scale variance if item deleted, CITC =
corrected item—total correlation, SMC = squared multiple correlation, CAID =
Cronbach’s alpha if item deleted
The factor correlation matrix of coefficients for the intercorrelations of the three
orthogonal extraction factors are presented in appendix H. The factors were rotated by an

106
Table 20
Factor 3: Scale Statistics (N = 5)
Mean
Variance
SD
22.60
17.507
4.184
Oblique Promax rotation method. These three sets of correlation coefficients were used
in the factor analysis.
Summary of Reliability Statistics for Factors 1 to 3
Based upon the above reports of high internal consistency reliability for the three
identified factors (a = .814, .967, and .812, respectively), the RVTS survey was a reliable
indicator of how well the different items measured the same issue. This is important
because a group of items that purports to measure one variable should indeed be clearly
focused on that variable, as seen in the factor loading matrix in Table 3, and supported
again through the calculation of the Cronbach’s alpha.
Summary
An exploratory factor analysis is used mainly as a means of exploring the
underlying factor structure without prior specification of number of factors and their
loading. The RVTS identified three factors from the results listed and controlled for
some of the error by the measurement design of the exploratory factor analysis.
The RVTS was developed by defining the construct to be measured, designing the
scale, generating an item pool, administering the scale, checking the data, measuring the
coefficient alpha, and applying factor analysis. The response rate for the RVTS was 197

107
respondents (19.7%). Three factors were extracted from the factor analysis, resulting in
Cronbach alphas of .814, .967, and .812.
The results of this exploratory study have provided support for three factors that are
statistically related when evaluating relationship violence identification, assessment, and
treatment. It has been shown that the information derived from these statistics was
consistent within the competency for skills, assessment, and treatment domains. The
factor structure of the RVTS indicates these three factors: Factor 1: Respondents’ rating
of the importance of clinical competencies associated with the identification, assessment,
and treatment of relationship violence; Factor 2: Respondents’ rating of their graduate
training received in relationship violence; Factor 3: Respondents’ self-rating of their
knowledge and skills in the identification, assessment, and treatment of relationship
violence.
Therefore, when evaluating MFT training in relationship violence, it is important to
note that these factors would be related when considering curriculum development,
continuing education training, licensure renewal coursework, initial licensure course
work, MFT supervision training, accreditation standards, and policy improvements
regarding relationship violence training on the graduate level. Ethical considerations,
ethical standards, and codes must be adhered to when it comes to client safety and duty to
warn. The ability to develop safety planning and to help clients to establish a restraining
order injunction (ROI) would benefit clients who are in need of these services. MFTs
must take the lead in this domain because they have the background training to make a
significant difference in effective identification, assessment, and treatment of relationship
violence.

CHAPTER 5
DISCUSSION
Evaluation and Discussion of the Results
This study investigated the current status of marriage and family therapists’
graduate training in the identification, assessment, and treatment of relationship violence.
Therefore, this study sought to address this issue through by attending to three research
questions:
1. How do MFTs rate themselves on their knowledge in the identification,
assessment, and treatment of relationship violence?
2. How do MFTs rate their graduate training in the identification, assessment,
and treatment of relationship violence ?
3. How do MFTs rate the importance of specified competencies and skills in the
identification, assessment, and treatment of relationship violence?
The primary purpose of this study was to determine the factors most frequently
reported by MFTs to be related to the identification, assessment, and treatment of
violence. The statistical results show that the factor structure of the RVTS indicates three
factors: Factor 1: Respondents’ rating of the importance of clinical competencies
associated with the identification, assessment, and treatment of relationship violence;
Factor 2: Respondents’ rating of their graduate training received in relationship violence;
Factor 3: Respondents’ self-rating of their knowledge and skills in the identification,
assessment, and treatment of relationship violence. The populations sampled were
licensed MFTs, approved MFT supervisors, and MFf faculty. This chapter includes
108

109
findings from the exploratory factor analyses, evaluations and discussion of results,
ratings of importance, training methods, clinical assessments, limitations of the study,
implications and recommendations for further research, and conclusions.
The RVTS, designed by the researcher, contained two subscales of 10 items each:
(a) assessment of relationship violence, and (b) training/treatment issues in relationship
violence; demographic data included age, ethnicity, gender, years of therapy experience,
and years of supervisory experience. Experts in counselor education and relationship
violence measured the content validity of this instrument. The RVTS was designed to
measure whether graduate MFT programs prepare therapists in assessment and treatment
of relationship violence. Program success was measured by survey responses regarding
required coursework in relationship violence, endorsement of the program by counseling
accreditation boards, and practitioners’ self-reported self-efficacy in assessing and
treating relationship violence. A representative sample of 1,000 potential participants
realized 197 respondents (response rate 19.7%): clinical members of AAMFT, AAMFT
Approved Supervisors, and faculty members in MFT training programs, recruited via
nationwide random sampling. The framework to support these implications of the results
and limitations of the study are discussed in this chapter.
Ratings of Importance
The findings for the first research question (items 1-5) correlated with Factor 3,
respondents’ self-rating of their knowledge and skills in the identification, assessment,
and treatment of relationship violence. Factor 3 indicated a higher rating (4.92 on a 6-
point Likert-type scale) for item 1, rating their skills to intervene adequately and
competently in the identification, assessment, and treatment of relationship violence.

110
Item 4 received a rating of 4.92, rating their interventions skills in cases of relationship
violence today as opposed to their skills 5 years earlier.
This is consistent with previous research that indicated that intervention and
assessment skills in relationship violence were rated higher for those having
graduated/become licensed within the past 5 years. The BBSE, an MFT regulating body
in California, passed a bill in January 2004 mandating that a one-time continuing
education units (CEU) course in assessment and treatment of intimate violence be taken
within 6 months of licensure (BBSE, 2004). Item 5 received a lower rating, 4.60, rating
their practice of screening for relationship violence in premarital counseling cases.
Item 2 received a lower rating, 4.25, rating their skills to intervene adequately and
competently in cases of relationship violence within gay and lesbian client relationships.
Item 3 received a lower rating, 3.91 (a little over midpoint on the scale), rating their
knowledge regarding the acquisition of ROl. This would indicate a specific need for
training and education in these items due to the low response regarding knowledge and
skills in three areas: (a) the use of systematic risk assessments in order to recognize
imminent danger and to formulate appropriate interventions related to safety, (b)
intervening for violence within gay and lesbian client relationships, and (c) obtaining
ROIs.
The mean years of experience among participating therapists was 13.6, among
supervisors 12.8, and among faculty 15.0. The mean years of experience as supervisors
among therapists was 5.59, among supervisors 7.53, and among faculty 12.55.
Additional training, updates, and continuing education workshops would be needed for
all three groups, since their experience was more than 5 years since graduating and, as a

Ill
group, they rated themselves lowest in this area. Inservice, updates, and additional
education and assessment materials on screening in premarital counseling sessions would
prove useful to improve the MFTs’ knowledge and skills in the identification,
assessment, and treatment of relationship violence, based upon these results. This would
have an effect on the quality of the supervision of interns in this area and in the graduate
training given by faculty members to MFT students.
The findings for the second research question (items 6-9) correlated with Factor 2,
respondents’ rating of their graduate training received in relationship violence. Factor 2
indicated a higher rating (3.15 on a 6-point Likert-type scale) for item 7, rating their MFT'
graduate training in relationship violence issues. Items on this subscale, questions 7, 9, 8,
and 6, reported scores of 3.15, 3.01, 2.99, and 2.93, respectively. All of the responses
were approximately 3 on this subscale. This indicates that additional graduate training is
needed in relationship violence identification, assessment, and treatment.
The findings for the third research question (items 11-20) con-elated with Factor 1,
respondents’ rating of the importance of clinical competencies associated with the
identification, assessment, and treatment of relationship violence. Factor 1 indicated a
higher rating (5.81 on a 6-point Likert-type scale ranging from not important to very
important) for item 12, the importance of assessing imminent danger in interpersonal
relationships. This was a higher score on this subscale, indicating that it was very
important to the MFTs responding to the study.
This was followed closely by item 13, with a score of 5.74, regarding the
importance of performing assessments quickly and efficiently to provide immediate
protection to the victim and/or children in the identification, assessment, and treatment of

112
relationship violence. Item 11 produced a score of 5.72, regarding the importance of
having knowledge and skills in identification, assessment, and treatment of relationship
violence. Item 19 produced a score of 5.58, regarding the importance of identification of
risk factors for relationship violence in assessment of clients.
The rest of the scale also rated highly, from 5.66 to 5.01, the lower rated being
item 20, which included the use of risk assessments rated at 4.11. The most interesting
result from this research was the lower rating of 4.11 for item 20. This low rating of
importance indicates an interesting juxtaposition in the results for this subscale. On the
one hand, the MFTs indicated that it was very important to have the specific
competencies and skills to identify, assess, and treat relationship violence; they also
indicated that it was very important to assess quickly for imminent danger to get
protection for the victims.
Training Methods
Previous research sets a precedent for this specific type of training. Riggs et al.
(2000) discussed the need for identifying risk factors for domestic violence. They stated
that the extent and potential danger of the problem of domestic violence warrant
systematic screening and assessment in all mental health settings. However, the MFTs in
this study also rated this as least important. They rated it very important in adhering to
ethical standards, duty to warn, confidentiality, or helping the client obtaining an ROI or
file an abuse report.
This would indicate a mixed feeling about the importance and understanding of
relationship violence identification, assessment, and treatment. These results suggest that
additional training in specific knowledge and skills in relationship violence should be
provided, along with additional training and testing on ethical standards with regard to

113
the duty to warn, confidentiality, helping clients to obtain ROIs, identifying batterers’
typologies and risk factors, and the use of risk assessments instruments.
A recent Johns Hopkins School of Nursing research report that also looked at the
importance of mental health professionals to assess for potential risk factors for imminent
danger included the Risk Factors for Femicide in Abusive Relationships: Results from a
Multisite Case Control Study. This study, published in the July 2003 issue of the
American Journal of Public Health, found that a combination of factors increased the
likelihood that a woman would be murdered by her partner. Among the most important
predictors were unemployment, access to guns, and threats to kill (Huson, 2003).
Such information can be useful in preventing these killings. In the United States,
women are killed by intimate partners more often than by any other type of
perpetrator, with the majority of these murders involving prior physical abuse.
Determining key risk factors, over and above a history of domestic violence, that
contribute to the abuse that escalates to murder will help us identify and intervene
with battered women who are most at risk. (p. 1)
According to Campbell, results of the study suggest that steps such as increasing shelter
services for battered women, increasing employment opportunities, and restricting
abusers’ access to guns can potentially reduce rates of femicide. She said that health care
professionals also play a critical role in identifying women at high risk.
J. Campbell (2003) recommended that, when treating women who have been
abused, health care professionals ask questions such as, “Is your partner unemployed? Is
he very controlling of your behavior all the time? Has he threatened you before? Is there
a stepchild in the home? Is there a gun in the home?”
These are all relatively simple questions that can help assess the level of risk. In
cases of extreme danger, such as a situation where the abuser is highly controlling
and the woman is preparing to leave him, it is important for practitioners to warn
the woman not to confront the partner with her decision and to alert her of the risk
of homicide and the need for shelter, (p. 1097)

114
A review of the AAMFT ethical standards should also reflect these specific
findings to educate and train their members with regard to identification, assessment, and
treatment of relationship violence. These results are also consistent with research by
Hansen et al. (1991), in which mental health practitioners did not value the importance of
the ability to identify, assess, and intervene for imminent danger in cases of relationship
violence. Forty-one percent of the therapists surveyed indicated no recognition of
domestic violence. Interventions provided by therapists in this study were also negligent
with regard to violence potential. For example, 55% of the respondents reported that they
would not intervene even when the demonstrated violence required immediate action.
Only 2% reported a potential for lethality in these cases. A scant 11% indicated that they
would obtain protection for the wife by helping her to develop a safety plan, obtain
shelter, or obtain an ROI. No risk assessment instruments were included in this research.
In a recent article in the Journal of Marital and Family Therapy by Lee, Nichols,
Nichols, and Odom (2004) entitled “Trends in Family Therapy Supervision: The Past 25
Years and Into the Future” the authors discussed the title and role of MFT and its scope
of practice that are regulated by law (see Sturkie & Bergen, 2001). They also stated that
there are approximately 46,000 practicing MFTs in the United States, only 40% of whom
are clinical members of the AAMFT (Northey, 2002) and therefore guided by that
organization’s standards.
Current COAMFTE standards also may be limiting the need for the AAMFT
Approved Supervisor credential. Currently in the United States there are 55 master’s
degree programs, 20 doctoral programs, and 13 postgraduate institutes that are either
accredited or candidates for accreditation (AAMFT, 2003a). COAMFTE still requires

115
accredited programs to have a minimum of three faculty members, only two of whom
must be AAMFT-approved supervisors; the other can be an “equivalent.” In the past the
AAMFT requirement for supervision was rigorous, with an on-site supervision
requirement. This has also changed for the supervision of students’ clinical experience;
an off-site supervisor is now acceptable and an “equivalent” supervisor may also be
acceptable for doctoral internships.
Approved supervisors constitute 13% of the approximately 2,046 clinical members,
with an increase in female supervisors from 22% to 55% since 1976 (Lee et al., 2004).
Clinical supervisors are an important part of the training for those 35% currently seeking
credentials as MFTs whose formal educations are in disciplines other than MFT (Lee,
2002). This study reviewed the current demographics of MFTs who responded to the
RVTS survey. In the RVTS survey 13% of the 1,000 clinical members also self-
identified as supervisors. They reported an average 12.8 years of licensure as supervisors
and 7.53 years of experience as supervisors. Similar results were noted that various
disciplines are now establishing themselves as MFTs with little or no specific training in
MFT or little or no supervision by an AAMFT-approved supervisor. There were also
changes noted on a programmatic level from MFT graduate programs primarily being
COAMFTE accredited to various other accreditation boards approving MFT curricula
and programs at the graduate level.
Clinical Assessments
Validity for violence assessments is greatly improved when they include both a
written questionnaire and a clinical interview conducted in private with individual clients
(Aldarondo, 1998). There have been many contradictory studies on the validity of
assessments from both perpetrators and female victims. Pence (1996) and Bograd and

116
Mederos (1999) have argued that clinical assessments should give more weight to reports
by women victims than to those by their male partners. Conversely, knowledge that
female victims sometimes block self-awareness about severe violence led J. C. Campbell
(1995) to argue that female victims are not always the best predictors of whether they are
at risk. Wiesz, Tolman, and Saunders (2000) investigated this apparent contraindication,
using data collected from women during exit interviews in a domestic violence shelter.
These researchers found that only 4% of the women failed to predict accurately whether
they would become victims of an attack in the 4 months following the exit interview.
The researchers suggested that women’s predictions should be given considerable weight
in abuse assessments, particularly when a women believes that she is in imminent danger
of an attack (Jory,2004).
MFTs have ethical and legal obligations to effectively evaluate and intervene to
protect victims of psychological or physical abuse (Jory, 2001). Bograd and Mederos
(1999) called on MFTs to incorporate universal screening procedures for domestic
violence and psychological abuse. Universal screening should include reasonable
assessments about the frequency and severity of past abuse and predictions about the
potential for future abuse. Screenings would help victims to take steps for self¬
protection, help perpetrators to establish relationships based on respect and
accountability, and guide decisions on treatment modalities (Jory & Anderson, 2000).
This study asked respondents to rate the importance of screening measures and assessing
risk factors and to self-rate the training that they received in the assessment and
treatment of relationship violence.

117
Limitations of the Study
This study was delimited to MFT practitioners, supervisors, and faculty members
from a national sample. Different results might have been obtained if other mental health
professionals had been sampled or if other training programs had been included in the
sample. Although effort was made to assure that the findings of this study were reliable,
limitations existed that should be considered when interpreting the results. In particular,
limitations of the study are associated with the respondents, potential confounders,
random error, the response rate, possible nonresponder bias, nonrandomized samples, and
alternative explanations.
Respondents
A few study limitations should be noted. First, these results are based on cross-
sectional data and do not provide a causal model. Second, relationship violence training
indicators were assessed at one point in time, which could bias the estimated relationship
violence training/assessment associations. The results may not take into account further
training or mandated update training in relationship violence that may occur before or
after formal graduate training. Longitudinal study designs that use more comprehensive
measures of relationship violence training and curricula are needed to minimize bias that
may result from measuring relationship violence in a “snapshot” manner.
Potential Confounders
A number of potential confounders (e.g., advanced training that occurs at institutes
outside of formal graduate school curricula, advanced consultation on relationship
violence, attendance at mandatory update training sessions on relationship violence) were
not assessed accurately. Item 10 was apparently not clear to respondents and was
dropped because it had too many confounding responses: Some respondents answered in

118
number of hours, others in number of courses, others in number of CEU credits.
Inclusion of the correlates that were intended to be measured by Item 10 might have
modified the findings related to the associations observed in this study.
Random Error
Random error is the unpredictable error that occurs in all research. It may be
caused by many different factors but it is affected primarily by sampling techniques.
Some of the random error in this study occurred (a) due to error messages of addresses
that were no longer valid, and (b) because some intended respondents were not able to
send their responses due to browser incompatibility.
A few respondents apparently had difficulty with the way in which a given question
was worded or the tone that they inferred from the question, and they declined to answer
that question. Missing data were automatically coded with listwise deletion, and all
responses from that respondent were eliminated from that statistical computation. The
researcher attempted to control for this possibility by extensive effort and consultation in
question design and subsequent revisions of items and scales. These efforts served to
reduce the extent of error in the final analysis and yielded high reliability and validity for
this instrument.
Selecting the Web-based design for this study required extensive time and effort
and presented many problems. Numerous consultations from those who had conducted
electronic studies provided sound advice but also included accounts of various problems
and glitches with operating systems. The eventual choice was the program SurveyWiz®,
which was specifically designed to receive data in the behavioral sciences. SurveyWiz
was developed by Dr. Bimbaum of California State University, Fullerton, who gave

119
permission to use the application in this study. The program was developed to work with
many operating and Internet browser systems, and was described as quick and easy to
use, confidential, and easily convertible to SPSS files. While the program is well
designed, the researcher met with numerous problems in applying it for this study.
Some glitches were identified in a pilot study, in which the survey was
administered to a pilot group in order to provide construct validity for the instrument.
The server Stetson University did not forward results to the data collection site. It was
necessary to enter to the server to change the program software ACTION and redo this
information. After this was successful, the next glitch appeared as incompatibility in the
various browsers that would receive the invitations to participate in the study. For
example, the instrument could be used in Mozilla (the browser for which SurveyWiz was
developed) but crashed in Explorer® and Netscape® browsers. This was a major
problem. The Stetson CIT department solved that problem so that the survey easy to read
and the respondent could complete it easily. Then, some respondents received the survey
in the html version because their browser did not support the other version. Once this
problem was fixed, the survey was easily accessible and the data were routed to the
collection site properly. Responses were saved in an SPSSâ„¢ format and converted for
factor analysis. This part of the research required extensive computer programming
consultation. However, building the Web page and using the survey instrument on the
Internet proved to be a valuable learning experience for the researcher and provided tools
that can be used to teach the process in the future.

120
Response Rate
The low response rate associated with the sampling procedures in this study also
places limitations on the interpretations of the findings. Even though a good distribution
based on personal and professional characteristics existed among the respondents that
closely equated to the same demographics of the AAMFT professional organization, the
initial response rate of 19.7% was low.
Possible Nonrespondent Bias
Findings from most studies cannot be generalized outside of the sample population
due to the difficulty of nonrespondent bias from culturally diverse, lower-socioeconomic
groups and the gay/lesbian population. These groups can have low respondent rates and
are generally undersampled.
Thus, when therapists work multiculturally, they must be aware of the importance
of both ethnic knowledge and cultural information elicited in conversations with clients.
Although specific practices for multicultural counseling vary among therapists,
practitioners in the field share common assumptions. These include exploring clients’
world views, considering the role of acculturation, and taking on additional roles. This
study included an automatic coding response form that recorded the respondents’
demographic data, including culture/nationality, gender, age, and level of training.
Included in the coded response were the dates of response and the respondents’ email
locations. This information was used in follow-up notices and to prevent a participant
from responding more than once.
Nonrandomized Samples
Many sample populations are convenience samples, usually taken at a clinic, school
or university. They are not usually randomly generated. In these cases there is not

121
enough use of regression analysis to control for confounding variables. Very few studies
on family violence have large sample sizes; they do not report effect size, confidence
intervals, or significance tests (Cohen, 1994). In this study a systematic random sample
was used to survey 1,000 family therapists, family therapy supervisors, and family
therapy faculty members.
Alternative Explanations
Other alternative findings and speculations from these data could suggest that the
results were not very surprising and that the three factors closely matched the initial
research questions. It is very difficult to eliminate errors in questionnaire construction.
The results fell neatly in place, which may be a result of respondent bias (wanting to rate
themselves well in certain areas). The respondents’ belief systems may have affected the
way in which they answered the questions. Readers should include these alternative
findings in the way in which they view the data. They should also consider the findings
as a way to change their thinking about how they conduct assessment questions for
relationship violence. Interventions for relationship violence based on previous training
assumptions may be challenged. This research can also bring additional benefit such as
improved knowledge in the awareness of critical issues in domestic violence for
clinicians, faculty, and supervisors. Potential implications for applied work and clinical
applications could involve the delivery method of training on domestic violence.
Inservice training, graduate seminars, continuing education units, graduate coursework,
and domestic violence supervision models are all viable methods of providing specific
training competencies to improve MFT deficits in this area.

122
Respondent bias related to the importance that is placed on learning more as part of
professional development may have contributed to some of the results. Research in the
area of relationship violence training advances with improvements in design and
measurement. In this study a Web-based exploratory factor analysis was used to gain the
results quickly and reliably. This design could be stronger if a follow-up confirmatory
factor analysis were completed with a different sample from the same population to yield
more conclusive results.
Implications and Recommendations for Further Research
This section presents the implications of the findings of this study for the current
status of MFT graduate training in the identification, assessment, and treatment of
relationship violence. Based on the lack of studies investigating MFT graduate training
factors in relationship violence, the results of this study can serve as baseline data for
further research. The results indicate that some factors are more important to MFTs than
others. The findings also have important implications for MFT therapist educators. For
example, MFT therapist educators could review the findings of the study with regard to
the curriculum components that they include in family violence coursework and other
clinical assessment coursework that they teach and/or offer in their programs.
Findings from this research suggest alternative training technologies that may be
more useful and relevant applications for training in relationship violence. Alternative
training could make use of technology such as online CEU training in specific areas of
need. It could also include training manuals with appropriate assessment and resource
information for working with imminent danger, including safety plans, assessing risks,
working with gay and lesbian violence, and obtaining ROIs. The advantage of using
relevant information would be to improve the knowledge base and competence skills of

123
MFTs in working with relationship violence cases. It would also benefit faculty and
supervisors in providing their trainees with relevant materials that would provide direct
impact on their domestic violence competency and skill level.
The RVTS provides a single measure by which results of studies in this area can be
compared. The development of the RVTS is a valuable contribution to research on
assessment, treatment, and training issues in relationship violence at the graduate level.
Further research is needed to replicate the results of the current study, to do a
confirmatory factor analysis with a different group from the same sample population, to
extend the findings of this study to other groups, and to establish more extensive
nonnative data for the RVTS.
Theoretical, Training, and Ethical Implications
Violence is escalating so quickly that professional counselor training is inadequate
to meet the increased need. Bandura (1982) suggested three ways to enhance
professional self-efficacy, in order of importance: (a) performance mastery, (b) vicarious
experiences, and (c) verbal persuasion. If professional counselor preparation courses are
not implementing adequate training for counselors to gain mastery or internship
experience in the field of family violence, what are the profession’s ethical obligations to
change this for the better? Ethically, by the COAMFTE standards for practice, this
competency is required to assess for imminent danger, to protect client safety, and to
comply with duty to warn.
According to Lochman (2000), inadequate training and supervision of intervention
providers is a barrier to effective dissemination. Training without ongoing supervision or
consultation may not be sufficient for training staff in how to deal with expected and

124
unexpected problems in the delivery of a parent training program and counselor training
programs. Better models of training can include up-front workshop training followed by
regular consultation meetings at a prearranged rate (e.g., monthly, weekly) and specific
in-service treatment based on empirical research findings. Other alternative training
opportunities could provide for immediate “crisis” consultation if significant difficulties
develop in the delivery of services.
The need for both quantitative and qualitative research in this area is great; the need
for approaches in counseling that address the needs of the sizeable population of children
and adults affected by maltreatment is critical. Qualitative methodology offers a means
for exploring the contextual nature and dynamics in a population of women with a shared
experience. Follow-up research involving interviews from some of the quantitative
findings could be used to measure intergenerational perspectives (Armsworth & Stronck,
1999).
As the system of health care delivery evolves, it is certain that practitioners will be
asked to demonstrate that the services that they provide are indeed effective for the
clients whom they serve. Perhaps a more important concern is that practitioners have an
ethical obligation to offer clients the best services possible, given the present state of
knowledge regarding program and treatment effectiveness.
From the data gathered via the RVTS instrument, a quantitative report was
produced from the exploratory factor analysis. A qualitative method could easily be
added to a confirmatory factor analysis in future research. This qualitative approach
could provide additional contextual data and give broader insight for interventions and
applications of treatments for relationship violence issues.

125
Conclusion
Recent attention to the problem of relationship violence requires MFTs and other
multidisciplinary professionals to identify appropriate policy and practice responses. The
statistical results show that the factor structure of the RVTS indicates three factors:
Factor 1: Respondents’ rating of the importance of clinical competencies associated with
the identification, assessment, and treatment of relationship violence; Factor 2:
Respondents’ rating of their graduate training received in relationship violence; Factor 3:
Respondents’ self-rating of their knowledge and skills in the identification, assessment,
and treatment of relationship violence.
Broader policy implications from the results from the first factor, clinical
competencies in the identification, assessment, and treatment of relationship violence,
indicate a correlational relationship between the importance of current practitioners to
recognize imminent danger and the importance to formulate appropriate interventions
related to safety and assessment skills. Findings from the second factor, graduate training
received, indicate a correlational relationship between graduate training and improved
quality and longer duration of graduate training in relationship violence. Findings from
the third factor, self-rating of knowledge and skill in relationship violence, indicate a
correlational relationship between ethical training requirements and licensing and
accreditation standards.
As a result of this study, alternative educational methods, such as inservice training
with specific curriculum, may be recommended. It may be necessary to adjust teaching
styles/delivery methods to include this study’s implications for ethical boards such as
COAMFT/AAMFT. This is expected to improve the knowledge of MFTs in the
treatment of relationship violence and to provide useful and relevant applications. This

126
type of training can also bring additional benefits such as updating MFTs who received
their initial training over 5 years prior and helping to provide better services to the
diverse client populations that they serve.
To summarize, this exploratory factor analysis indicated specific problems in the
ability of current practitioners on a national level to (a) use systematic risk assessments in
order to recognize imminent danger and to formulate appropriate interventions related to
safety, (b) intervene for violence within gay and lesbian client relationships, and (c)
obtain ROIs. The need for improved quality and longer duration of graduate training in
relationship violence and the need for more stringent training requirements by licensing
and accreditation boards are supported.
These results suggest that additional training in specific knowledge and skills in
relationship violence be offered, along with additional training and testing on ethical
standards with regard to the duty to warn, confidentiality, and helping clients to obtain
ROIs or file an abuse report. A review of the AAMFT ethical standards should also
reflect these specific findings to educate and train members with regard to identification,
assessment, and treatment of relationship violence.
As relationship violence continues to increase in the current political and social
spheres, therapists, supervisors, and faculty members must assign priority to which types
of intervention and assessments are currently working in the field. Practitioners,
supervisors, and faculty members must be well trained in these emerging areas. They
must show that existing programs are effective and efficient in meeting their clients’ and
students’ goals in the assessment and treatment of relationship violence.

127
While providing some quantitative and empirical results regarding relationship
violence training and treatment, it is intended that this paper contribute to policy
implications on a national level, such as (a) proactive policy formulation, that is, policies
more oriented to promoting specific assessment, treatment, and training activities among
MFT graduate training institutions and their students; (b) finding alternative ways to train
and update MFTs through creative training methods, such as a graduate seminar on issues
that do not fit into the general curriculum or specific continuing education coursework in
relationship violence so students can gain the competencies needed to treat relationship
violence effectively; and (c) increased collaboration between training institutions and
licensing boards to this end. Together, these improved conditions would enhance and
intensify the local treatment service capabilities and innovative competence of MFTs in
relationship violence treatment as a whole. Further research is needed to confirm the
results of the current study and to extend the findings of this study to other groups.
Findings from research lead to better understanding of relationship violence and
call for progress in the design and assessment of policy to improve an area of ethical
obligation in assessing imminent danger in cases of relationship violence. The advantage
of this would be the improved health, safety, and welfare of clients and the profession.

APPENDIX A
RELATIONSHIP VIOLENCE TRAINING SURVEY
(WEB VERSION)

Relationship Violence Training Survey
3/30/04 5 42 PM
Instructions for Relationship Violence Training Survey
Relationship ViolenceTrainingSurvey(RVTS)
Contact: Principal Investigator
Marie T. Bracciale, LMFT, LMFCC, CAP
AAMFT Approved Supervisor
Doctoral Candidate
Counselor Education Program
Department of Counselor Education
1215 Norman Hall
University of Florida
Gainesville, Florida
(386) 574-8155
mariebufl@aol.com
Faculty Advisor:
Dr. Silvia Echevarria-Doan, Ph.D.
silvia@coe.uf1.edu
(352) 392-0731
Fax: (352) 846-2697
UFIRB Office:
P.0. Box 12250
University of Florida
Gainesville, Florida
32611-2250
Title: The Current Status ofMarriage and Family Therapists' in theldentification, Assessment and Treatment of
Relationship Violence.
InformedConsentlnformation
Puipose of Research: The primary purpose of this study is to determine the factors most frequently reported by
MFT s to be related to the identification, assessment and treatment of violence via (a) a self-rating scale of their
knowledge in the identification, assessment, and treatment of relationship violence, (b) a self-rating scale oftheir
graduate training in the identification, assessment, and treatment of relationship violence and (c) how they rate the
importance of competencies and skills in the identification, assessment, and treatment of relationship violence. Other
types of questions will also be asked regarding demographics items such as: personal information, sexual preference,
years of education and years of experience you have as a licensed counselor.
ittp://www. steuon.edu/'-mbraccia/RVTS'Simpletcxi.htinl
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Relationship Violence Training Survey 3/30/04 5:42 PM
Assurance ofConfidentiality: In orderto assureyour frank and forthrightparticipation, the informationthatyouwill
be providing in this survey will be kept confidential. Individual data will not be shared with your co-workers,
supervisors, managers, or other administrators. The data will be summarized, and a summary will be provided to
those who are interested, but this summary will not include any information that could be linked back to you directly.
Your identity will be kept confidential to the extent provided by law.
Procedures to be Used / Voluntary Nature ofParticipation: After reading the passive consent form, you will be
taken to the questionnaire page. This is a Web-based survey design, with all data being entered into a secured
server. This will take you approximately 15 minutes to complete. If you wish to drop out of the study, you may do
so by leaving the Web-site before submitting the results, without any consequences. When you have completed the
questionnaire, you may submityourresponsesby clicking on the "Finished" button at the end of the survey.
Risks to the Individual: The risks involved in yourparticipation are minimal. There is apossibility that yourresponses
could be viewed by an outside party if you do not EXIT (CLOSE) your Internet browser (e.g., Netscape
Navigator, Internet Explorer) as soon as you finish responding to the questionnaire because your responses might be
visible ifyou(or someone else) clicks the BACK arrow on the browser. In order to ELIMINATE this possibility,
youshouldEXIT/CLOSE the browser as soon as you finish responding to the survey and have submitted your
responses.
Benefit to the Individual: Y our participation may help you think about some important aspect ofrelationship violence
that would be important to include in teaching and supervising students. Yourparticipation may also help you
develop a more conscious understanding of intimate partner violence (IPV) and the current assessment and
treatment factors.
Human Subject Statement: If you have any questions about this research project, contact theprincipal investigator,
Marie T. Bracciale, LMFT, Doctoral Candidate at mariebufl@aol.com or Dr. SilviaEchevarria-Doan, Ph.D.
Chairperson, at silvia@coe.ufl.edu. If there are concerns about the treatment of research contact UFIRB-
Institutional Research Board at the University ofFlorida, P.O.Box 112250, Gainesville, Florida, 32611-2250 or
http://irb.ufl.edu
Informed Consent: Below is a statement of informed consent, above you will find details regardingconfidentiality,
and how the study will be conducted. Please read it carefully. Ifyou have questions regarding the study call the
principal investigator, or send us an e-mail (phone number and e-mail listed). You do not have to answer any
question you do not wish to answer. Once you have read the above and agree to the following consent form please
click on the voluntary consent to participate link below.
I have had the opportunity to read the procedures described above, and ask questions about the right not to
participate in this study. I agree to participate in the procedure and I have received a copy of this description. By
clicking on the arrow below, completing the voluntary consent responses, I willing give my consent to participate in
thisstudy.
® I VOLUNTARILY GIVE MY CONSENT TO PARTICIPATE IN THIS STUDY
Yes O
For the purpose of this research, Relationship Violence will be defined using the terms as defined by Florida Statute
ittp://www. stetson.edu/~mbraccia/RVTS-simpletcxt.html
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Relationship Violence Training Survey 3/30/04 5:42 PM
741.28-741.31
"Relationship violence" means any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual
battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting inphy sical
injury or death of one family or household member by another who is or was residing in the same single dwelling
unit
" Family or household member" means spouses, former spouses, persons related by blood or marriage, persons
who are presently residing together as if a family or who have resided together in the past as if a family, and persons
who have a child in common regardless of whether they have been married or have resided together at any time.
"Assessing Risk Factors" means warning signs and profiles to identify persons who may be "at risk" for a serious
violent episode. F undamental principles for conducting an assessment ofviolence potential in clinical contexts. The
more contemporary conceptualization, dangerousness or "risk" as a construct is now predominantly viewed as
contextual (highlydependent on situations and circumstances), dynamic (subject to change), and continuous (varying
along a continuum ofprobability XNational Research Council, 1989).
"MFT Graduate Training" means any trainingyoureceived while registered inaMarriage andFamily Therapist
Graduate Training Program in which you received your degree. Any consultation or supervision you received while
inthistrainingprogram would be included inyour personal rating scale.
"MFT Graduates" forthe purposes ofthis study would include: current and former Marriage andFamily Therapy
students enrolled inaMarriage and Family Therapy program.
Rating System: Based on your own experience, consultation, MFT graduate coursework or supervision.
In the RTVS survey constructed for this study a six-point rating scale is used. In the first section relating to Graduate
Training in theldentification, Assessment and Treatment ofRelationship Violence only labels VERY POOR and
EXCELLENT will dictate the end points. In the second section on the Importance of Competencies in the
IdentificatiomAssessment and Treatment ofRelationship Violence only labels NOT IMPORTANT and VERY
IMPORTANT define the two end positions. All intermediate positions are unlabeled. You are asked to discriminate
between the two end points to define the meaning of your response. Please rate the survey using any of die points
between very poor and excellent
Relationship ViolenceTrainingSurvey(RVTS)
Rating System: Please rate y ourselfbased on your own individual experience, consultation, MFT graduate
coursework or supervision.
Title: The Current Status ofMarriage and Family Therapists' in the Identification, Assessment and Treatment of
RelationshipViolence.
Please use your mouse to rate your answer
Ratingmyknowledgeandskills:
® 1. How do I rate my skills to intervene adequately and competently in the identification, assessment and
treatment of relationshipviolence?
very poor O O O O O O excellent
http:/7www. stetson. edur~mbraccia/R VTS-simpletext.html
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132
Relationship Violence Training Survey 3/30/04 5:42 PM
® 2. How do 1 rate my skills to intervene adequately and competently in cases of relationshipviolencewithingay
and lesbianclientrelationships?
very poor O O O O O O excellent
® 3. How do I rate my knowledge regarding the acquisition ofRestraining Orders (ROI)?
very poor O O O O O O excellent
® 4. How do I rate my intervention skills in cases of relationship violence today, as opposed to my skills 5 years
ago?
very poor O O O O O O excellent
® 5. How would I rate my practice of screening for relationship violence in Premarital counselingcases?
very poor O O O O O O excellent
Ratingmy graduate training:
® 6. How do I rate the MFT graduate training program that I attended in training students inrelationship violence
identification, as sessmentand treatment?
very poor O O O O O O excellent
® 7. How do I rate my MFT Graduate Training regarding relationship violence issues?
very poor O O O O O O excellent
® 8. How dolratemy MFT Graduate Training in training in relationship violence intake assessments in the
identification, assessmentandtreatmentofrelationship violence?
very poor O O O O O O excellent
® 9. How do I rate my MFT Graduate Training in relationship violence treatment approaches in the identification,
assessment and treatment of relationship violence?
very poor O O O O O O excellent
® 10. How do I rate the adequacy of Continuing Education (CEU) requirements in relationship violence for MFT
Graduates? (Most states require a 2 hour CEU course for licensurerenewal)
very poor O O O O O O excellent
Competencies in the Identification, Assessment and Treatment ofRelationship Violence As Reported by MFTs
Please use your mouse to rate your answer
Importance of competencies and skills in identification, assessment, and treatment ofrelationshipviolence:
® 11. How important is it to have knowledge and skills in identification, assessment and treatment forrelationship
violence?
notimportant O O O O O O very important
® 12. How important is it to assess imminent danger in interpersonal relationships in identification, assessment and
treatment forrelationship violence?
notimportant O O O O O O very important
inp://www.stetson.edu/-mbraccia/RVTS-simpietcxt.htjnl
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Relationship Violence Training Survey 3/30/04 5:42 PM
® 13. How important is it to perform assessments quickly and efficiently to provide immediate protection to the
victimand/or his/her children inidentification, assessmentandtreatmentofrelationshipviolence?
notimportant O O O O O O veryimportant
® 14. How important is it to recognize Batterer’s Typologies in identification, assessment and treatment of
relationshipviolence?
notimportant O O O O O O veryimportant
® 15. How important is it to identify a client's resources and strengths during the assessment session in
identificatiomassessment and treatment of relationship violence?
notimportant O O O O O O veryimportant
® 16. How important is it to recognize the signs and symptoms of relationship violence and understand the cycle of
violence/power in the identification, assessment and treatment of relationshipviolence?
notimportant O O O O O O veryimportant
® 17. How important is it to assess and adhere to ethical standards?(confidentiality, duty to warn, help client obtain
a restraining order (ROI) or file an abuse report) in identification, assessment and treatment ofrelationshipviolence
notimportant O O O O O O veryimportant
® 18. How important is itto assess clients using a Multicultural Model? (Including looking at race, gender,
oppression, poverty, violence, substance abuse, contextual and community issues) in identification, assessment and
treatment of relationshipviolence?
notimportant O O O O O O veryimportant
® 19. How important is it to include identification of risk factors for relationship violence in the assessments of
clients in identification, assessment andtreatmentofrelationship violence?
notimportant O O O O O O veryimportant
® 20. How important is it to use risk assessment manuals/instruments (e.g. Seeking Safety by Lisa M. Najavits) in
identification, assessmentandtreatmentofrelationship violence?
notimportant O O O O O O veryimportant
Demographics
® 21. Are you Male or Female?
O Female
OMale
22. What is your age? 1 years.
23. How many years ofEducation have you completed?
Put 18 for Master's degree (M.A., M.S., MSW, etc.).
Put 20 for Doctorate degree (Ph.D., M.D., PsyD.,etc).
Education:!
24. Nationality (country ofbirth): |
up://www sietson.edu/-mbraccia/RVTS-sinipletext.htiiil
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Relationship Violence Training Survey
3/30/04 5:42 PM
25.Degree specialization:
Put 1 for marriage and family therapy
Put2 formental health counseling
Put 3 for counselor education
Put 4 for school counseling
Put 5 forclinical counseling
Put 6 for registered nurse
Put 7 for medical doctor
Put 8 for clergy
Put 9 for social worker
Put 10 for other
I
26. Number ofyears experience as a licensed marriage and family therapist: [
27. Number of years of experience as a supervisor: |
28. What is the number of supervision courses you have completed? 1""
29. What is your marital status?
Put 1 forsingle/unmarried
Put 2 for married
Put 3 for domestic partners
Put 4 for divorced/not remarried
Put 5 for separated
Put 6 for widow
Put 7 for divorced/remarried
30.What is your primary sexual orientation?
Put 1 for bisexual
Put 2 for homosexual
Put 3 for heterosexual
31.Is this University, Training Program, Business or Agency that you work for approved by COAMFTE
(Commissionon Accreditation for Marriage and Family Therapy Education) Credentialing?
Put 1 for Yes
Put 2 for No
Put 3 for Unsure
mp://www.sietson.edu/~mbraccia/RVTS-siinpletext.hUnl
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Relationship Violence Training Survey 3/30/04 5:42 PM
32.Are there other credential ing bodies that have accreditedyourUniversity, Training Program, Business or agency
suchas (e.g.. CACREP, CSWE, COAMFTE, NLAC, APA)?
Put 1 for CACREP (Council for Accredidation of Counseling and Related Edcuati onal Programs)
Put 2 for CSWE (Council on Social Work Education)
Put 3 for COAMFTE (Commission on Accredidation for Marriage and Family Therapy Education)
Put 4 forNLNAC (National League forNursing Accrediting Commission)
Put 5 for APA (American Psychological Association, Committee on Accredidation)
Put 6 for other
Put 7 for Unsure
List numbers seperated by comma if more than one accrediation
33. Please listyouremail address: f
34. Which profession do you spend most of your time doing?
Put 1 for Therapist
Put 2 for Supervisor
Put 3 forFaculty
Thank- you for your help and commitment to the field! Please review your survey, be sure you have answered every
question then click on the finished button below
Please check your answers. When you are done, push the button below.
finished |
Thank You!
inp://www.stetson.edu/~mbniccia/R VTS-simplctext.html
Page 7 of 7

APPENDIX B
COAMFTE ACCREDITATION STANDARDS
PREAMBLE TO STANDARDS ON ACCREDITATION
VERSION 10.2
Accreditation is a voluntary process on the part of the program whose major purpose is to ensure quality in
a marriage and family therapy program. All accredited programs are expected to meet or exceed all
standards of accreditation throughout their period of accreditation.
The integrity of an institution and the program is fundamental and critical to the process of accreditation.
Accreditation standards are usually regarded as minimal requirements for quality training.
All accredited programs are free to include other requirements, which they deem necessary and contribute
to the overall quality of the program.
Programs must continually evaluate their programs in relation to their institution’s mission and their own
program mission, goals and educational objectives.
Accreditation standards, like other aspects of accreditation, are part of a slowly evolving, continuous
process.
In the long view, there are continuing conversations among accreditors, training programs, trainees, trained
professionals, employers, and consumers from which the standards and other aspects of accreditation
evolve.
The Commission has the ability to change standards as needed to meet the changing needs of the
profession.
This version includes some substantive changes from Version 9.0 and editing to eliminate redundancies and
to clarify extant standards.
The Commission is earnestly interested in, and actively seeks, all comments and suggestions for
modification and improvement to these standards and the process.
We all seek the same goal: the best training, the most competent professionals, and the best service to the
public that is realistic and available.
The objective of these standards is to assure, as much as possible, that individuals trained in accredited
programs are competently trained to become marriage and family therapists at the entry and doctoral levels.
The standards are designed to be unique to the practice and supervision of marriage and family therapy.
Some standards apply to training programs in general, including elements such as organizational stability,
faculty accessibility, appropriate student selection processes, and fairness to students and employees.
Some standards apply to all psychotherapy training, including elements such as adequate numbers of client
contact hours and supervision hours
The standards apply to the training of marriage and family therapists and are based on a relational view of
life in which an understanding and respect for diversity and non-discrimination are fundamentally
addressed, practiced, and valued.
Based on this view, marriage and family therapy is a professional orientation toward life and is applicable
to a wide variety of circumstances, including individual, couple, family, group, and community problems.
136

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It is not a modality of treatment or of diagnosis.
It applies to all living systems; not only to persons who are married or who have a conventional family.
The Commission believes that a great area of concern for our profession and accredited programs is the
inclusion of racial diversity in our training contexts and in the student body of our programs. However, we
have removed all diversity standards pertaining to numbers of individuals.
Programs will be able to decide for themselves whether they want to enhance diversity in their training
contexts or maintain the status quo.
The Commission also seeks to enhance the diversity of our programs in terms of age, culture, ethnicity,
gender, physical ability, religion, sexual orientation, and socio-economic status, without disregarding the
rights of religiously affiliated institutions and institutions outside of the United States.
Religiously affiliated institutions that have core beliefs directed toward conduct within their communities
are entitled to protect those beliefs.
All institutions are exempt from those standards that would require them to violate the laws of their states
or provinces.
Graduates from COAMFTE accredited marriage and family therapy programs are trained to be clinical
mental health practitioners.
COAMFTE adopts the Standard Occupational Classification of the Bureau of Labor and Statistics which
states that MFTs are qualified to [d]iagnose and treat mental and emotional disorders, whether cognitive,
affective, or behavioral, within the context of marriage and family systems. [They] Apply
psychotherapeutic and family systems theories and techniques in the delivery of professional services to
individuals, couples, and families for the purpose of treating such diagnosed nervous and mental disorders.
As a marriage and family therapist, all training is relational, related to context, and culturally sensitive,
whether contact hours are relational or individual, whether diagnostic procedure is traditional or relational,
and whether a presenting problem is explicitly related to a marriage, a family, or to neither.
The standards, for instance, require a minimum number of relational contact hours (direct client contact
with more than one partner or family member in the therapy room), although all accredited programs also
include a large number of contact hours that are not relational in this sense.
All persons properly trained in marriage and family therapy are to be competent in working with
individuals.
The standards emphasize the relational hour requirement because this is the more exceptional aspect of the
profession of marriage and family therapy.
Standards of Accreditation, Version 10.2
100-199: All Accredited Programs
100: Professional Identity
100.01 The program will have clearly specified educational objectives, consistent with the institution
and the program’s mission and appropriate to the profession of marriage and family therapy.
100.02 The program will be clearly identifiable as training students in the profession of marriage and
family therapy.
100.03 Education in the profession of marriage and family therapy will be based on a systems/relational
understanding of people’s lives.
100.04 The program will demonstrate that it provides a learning context in which understanding and
respect for diversity and non-discrimination are fundamentally addressed, practiced, and valued
in the curriculum, program structure, and clinical training

138
100.05 Programs will establish their own definition of diversity, which will include race, religion,
culture, etc. Programs will provide a rationale for establishing their definition and a plan to
achieve diversity. The plan will establish benchmarks by which the Commission can evaluate
the progress of the program in achieving its own stated definition of diversity.
110: Leadership
110.01 Programs will be operated by at least three marriage and family therapy faculty, consisting of a
minimum of two AAMFT Approved Supervisors and a third individual who will be an
Approved Supervisor, Supervisor-in-Training, or the equivalent.
110.02 The Program Director, or whoever has or shares ultimate program responsibilities, will be an
AAMFT Approved Supervisor. Equivalency or Supervisor-in-Training status does not fulfill
this standard.
110.03 Program Director responsibilities will include the clinical training program, facilities, and
services, and the responsibility for maintenance and enhancement of program quality.
110.04 When director responsibilities are shared by more than one person, responsibilities will be
clearly defined.
110.05 The program will be directed on a 12-month basis.
120: Organization
120.01 The program will be in a stable organizational structure.
120.02 The program will have been in operation for at least two years.
120.03 The program will have strong administrative support.
120.04 The program will demonstrate responsible conduct in administrative, organizational, financial,
and personnel matters, using generally accepted policies and procedures.
120 05 The program or the institution will publish and adhere to policies prohibiting discrimination on
the basis of age, culture, ethnicity, gender, physical ability, nationality, race, religion, and sexual
orientation.
120.06 The program will have graduated at least one class of students.
120.07 The program will maintain on file syllabi for all didactic courses taught that comprise the
program curriculum, including documentation of appropriate and substantial course content, and
methods for evaluating student performance.
120.08 Programs will maintain academic records (transcripts) on file; they must publish catalogs and
academic calendars; published promotional materials and advertising cannot be false or
misleading; and admissions and grading policies (evaluations) must be written and provided to
students.
120.09 The institution will be accredited by the appropriate regional accrediting body, if an academic
degree is granted
120.10 The institution will be chartered or licensed by the appropriate state authority, if applicable.
120.11 The program will maintain clear relationships and regular liaison with all sites of clinical work,
which will be specified, in a written agreement.
120.12 All clinical records and interviews will be kept confidential, in compliance with ethical
standards of the profession, except when in conflict with applicable law and judicial
interpretation.
120.13 The program will provide information to prospective students regarding the racial and cultural
diversity of the MFT faculty, supervisors and student body.

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130: Program Personnel
130.01 Program faculty will be actively engaged in scholarship through contributions at the local,
regional, national, or international level.
130.02 All program faculty and supervisors will be engaged in direct client contact (as defined in
Standard 151.01).
130.03 Program faculty will have the freedom and responsibility to conduct the program.
130.04 Program faculty will be available to students and will be active participants in their didactic and
clinical training.
130.05 No student will be admitted to the program without the assent of the program faculty.
130.06 Responsibility for teaching couple and family therapy in degree-granting programs will be
vested principally in a full-time marriage and family therapy faculty.
130.07 Program faculty will have training, experience, and a demonstrated ability in teaching the
material that is their responsibility.
130.09 Program faculty and supervisors are to demonstrate personal and professional integrity,
including but not limited to compliance with the AAMFT Code of Ethics.
140: Students
140.01 The program will have and adhere to clearly defined and published policies and procedures for
assessing recruitment of prospective students, applicants’ qualifications and readiness for
admission into the program.
140.02 The program will have established policies for informing applicants and students regarding
disclosure of their personal information.
140.03 The program will inform students about how credentials earned in the program relate to
eligibility for AAMFT Clinical Membership, state licensure and certification, eligibility for
employment, salary expectations, and post degree requirements for credentialing.
140.04 For each student, the program will maintain on file, and keep up to date, a transcript,
documentation of the basis for admission, and documentation of the student’s progress
(including the number of client contact and supervision hours accrued).
140.05 Programs will have and inform students of available student support services. These services
may include, but not be limited to, clear institution policies and requirements needed for
completing professional educational requirements, the availability of social and psychological
counseling services for students, and employment opportunities in the field.
140.06 The program will have published policies and procedures in keeping with generally accepted
practices, for refunding fees to students who withdraw, and for dealing with student grievances
Programs will maintain records of student grievances received.
140.07 The program will document that all students are covered by liability insurance.
140.08 Students are to demonstrate personal and professional integrity, including but not limited to
compliance with the AAMFT Code of Ethics.
140.09 The program will have and adhere to published policies and procedures for evaluating students,
which will include verification of completing program requirements.
140 10 Evaluation of the progress and performance of each student will give the student a clear
representation of strengths and weaknesses.
140.11 The program will provide students with evaluations of their conceptual knowledge and
understanding of the couple, marriage, and family therapy literature.

140
140.12 The program will provide students with evaluations of their knowledge of and adherence to the
AAMFT Code of Ethics and pertinent laws.
140.13 The program will provide students with evaluations of their clinical skills.
140.14 Students will be given the opportunity to evaluate the program, including course work; clinical
practice; supervision (competency and availability); and faculty (competency and availability).
140.15 The program will solicit and review information for program improvement from graduates two
years after graduation that will include, but not be limited to, the following information:
professional employment status, credentialing status, preparedness to function in the workplace,
and student satisfaction with education.
140.16 The program will develop mechanisms to document success in student achievement for program
improvement in relation to the program’s mission including, but not limited to: state licensure
rates or clinical membership rates in AAMFT; rates for graduation and employment in the field;
and student satisfaction ratings.
140.17 For entering a non-degree granting program, an applicant must already hold a degree
comparable to a master’s. The institution granting the prior degree must be appropriately
accredited, in keeping with generally accepted customs and traditions for the degree discipline,
in the country or region of the institution.
150: Clinical Experience
151: Contact Hours
151.01 Direct client contact is defined as face-to-face (therapist and client) therapy with individuals,
couples, families, and/or groups from a relational perspective. Activities such as telephone
contact, case planning, observation of therapy, record keeping, travel, administrative activities,
consultation with community members or professionals, or supervision, are not considered
direct client contact. Assessments may be counted as direct client contact if they are face-to-
face processes that are more than clerical in nature and focus. Psychoeducation may be counted
as direct client contact.
152: Supervision
152.01 Supervision of students, when conducted in fulfillment of clinical requirements of these
standards, will be face-to-face or live supervision conducted by AAMFT Approved Supervisors,
Supervisors-in-Training, or the equivalent. If a student is simultaneously being supervised and
having direct client contact, the time may be counted as both supervision time and direct client
contact time.
152.02 A program may designate a person who is not an AAMFT Approved Supervisor as equivalent to
that status, for purposes of supervision if the person is an AAMFT Supervisor-in-Training. A
program may designate a person who is not an AAMFT Approved Supervisor or Supervisor-in-
Training as equivalent to an AAMFT Approved Supervisor for purposes of supervision, if (1)
the program documents that the equivalent supervisor has demonstrated training, education and
experience in marriage and family therapy. This may be demonstrated by state MFT credential,
AAMFT clinical membership or other documentation of training, education and experience in
marriage and family therapy, and (2) demonstrated training, education and experience in
marriage and family therapy supervision. This may be demonstrated by state credential to
provide MFT supervision, completing coursework or continuing education in MFT supervision,
significant MFT supervised supervision experience, or more than 10 years experience
supervising MFT students (Equivalency criteria must include training in MFT supervision.).
152.03 The program will have access to videotape, audiotape, or direct observation of students’ clinical
work, at all sites of climcal work.
152.04 Programs will have and adhere to written policies and procedures governing the transportation,
storage, and transmission of confidential media.
152.05 Individual supervision is defined as supervision of one or two individuals.

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152.06 When a supervisor is conducting live supervision, only the therapist(s) in the room with the
client (up to two therapists) may count the time as individual supervision.
152.07 Group supervision will not exceed six students per group.
152.08 Students observing someone else’s clinical work may receive credit for group supervision
provided that (1) at least one supervisor is present with the students, (2) there are no more than
six students altogether, and (3) the supervisory experiences involve an interactional process
between the therapist(s), the observing students, and the supervisor. If there are no more than
two students, the observing student may receive credit for individual supervision under the same
conditions.
152.09 Supervision will be distinguishable from psychotherapy or teaching.
152.10 Published program materials will inform applicants that they will receive individual supervision,
group supervision, and supervision based on direct observation, videotape, or audiotape.
152.11 Supervision of students by fellow students in the same department is permitted given all of the
following conditions: (1) the supervised student is explicitly informed that it is permissible to
decline, (2) the supervision is closely supervised by a non-student Approved Supervisor or the
equivalent, (3) the supervising student has completed or is presently in a graduate course in
family therapy supervision, (4) the supervision time does not count toward COAMFTE
supervision hour requirements of the supervised student, and (5) special attention is given to
power and privilege in the supervisory relationships involved.
160: Facilities
160.01 The program will have access to library facilities with sufficient quantities and kinds of relevant
books, journals, and other educational and research media.
160.02 There will be one or more clinical sites for which the program has broad, but not necessarily
sole, responsibility for supervision and clinical practice of individual, couple and family therapy
as carried out by program students. The facilities will offer these services to the public.
160.03 Clinical facilities used for training purposes will operate on a 12-month calendar year basis.
160.04 Clinical facilities will be adequate and conducive to clinical practice.
160.05 Clinical facilities will have policies and procedures concerning professional practice and
informed consent of clients; including but not limited to such areas as client rights, limits of
confidentiality, and the establishment and collection of fees.
160.06 Clinical facilities will have reasonable policies and procedures concerning safety, privacy, and
confidentiality.
160.07 The type of services rendered at clinical facilities and the training status of the therapist will be
accurately and well represented to the public.
170: Coursework Measurement
170.01 A Standard Didactic Unit (SDU) is a group of instructional interactions that is equivalent, in a
degree granting institution, to a customary three-credit course operated on a semester system
and to a customary four-credit course in a quarter system. In non-degree granting institutions,
an SDU is equivalent to a minimum of 30 instructional hours. One three-credit course cannot be
counted as more than one SDU by any program. Programs are able to divide courses among
SDUs and areas. A portion of one course could be used for one area while the other portion
could be used for another area. As long as the sum of student experiences adds up to the
required SDU minimum, programs can document SDUs in a variety of ways. Clinical
experience requirements such as practicum or internship (as documented in Section 400) cannot
be counted as SDUs.

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200-299: Standard Curriculum
200.01 The program will document that all students have completed, or will complete while in the
program, all coursework and clinical requirements of the standard curriculum, or equivalents
thereof. A transcript of completed requirements will be kept on file.
200.02 A master’s degree program will offer to its students the entire standard curriculum as presented
in this manual.
200.03 A non-degree-granting program will offer to its students at least four SDUs from Areas I and II.
It will offer to its students at least one SDU from Area I and at least one SDU from Area II. The
program decides which of the areas it increases beyond the minimum to arrive at the four SDUs.
300-399: Standard Curriculum Didactic Area Requirement
300.01 Programs are expected to infuse their curriculum with content that addresses issues related to
diversity and power and privilege as they relate to age, culture, environment, ethnicity, gender,
health/ability, nationality, race, religion, sexual orientation, spirituality, and socioeconomic
status.
300.02 The Standard Curriculum will address appropriate collaboration with other disciplines.
300.03 Either during the program or before it, students will complete 12 SDUs in the standard
curriculum, Areas I-VI.
300.04 Either during the program or before it, students will complete 9 SDUs in Areas I, II, and III (see
descriptions below). Students will take a minimum of seven SDUs in Areas II and III. Students
will complete a minimum of four SDUs in Area II and one SDU in Area III. The program
decides which of the areas it increases beyond the minimum to arrive at the seven SDUs.
310: Area 1: Theoretical Knowledge
310.01 Either during the program or before it, students will complete a minimum of two SDUs in
Area I.
310.02 Area I content will address the historical development, theoretical and empirical foundations,
and contemporary conceptual directions of the field of marriage and family therapy.
310.03 Area I content will enable students to conceptualize and distinguish the critical epistemological
issues in the profession of marriage and family therapy.
310.04 Area I material will provide a comprehensive survey and substantive understanding of the major
models of marriage, couple, and family therapy.
310.05 Area I content will be related conceptually to clinical concerns.
320: Area II: Clinical Knowledge
320.01 During the program or before it, students will complete a minimum of four SDUs in Area II.
320.02 Area II content will address, from a relational/systemic perspective, psychopharmacology,
physical health and illness, Iraditional psychodiagnostic categories, and the assessment and
treatment of major mental health issues.
320.03 Area II material will address couple and family therapy practice and be related conceptually to
theory.
320.04 Area II content will address contemporary issues, which include but are not limited to gender,
violence, addictions, and abuse, in the treatment of individuals, couples, and families from a
relational/systemic perspective.
320.05 Area II matenal will address a wide vanety of presenting clinical problems.

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320.06 Area II will include content on issues of gender and sexual functioning, sexual orientation, and
sex therapy as they relate to couple, marriage and family therapy theory and practice.
320.07 Area II content will include significant material on diversity and discrimination as it relates to
couple and family therapy theory and practice.
330: Area III: Individual Development and Family Relations
330.01 Students will take a minimum of one SDU in Area III.
330.02 Area III will include content on individual development across the life span.
330.03 Area III will include content on family development across the life span.
340: Area IV: Professional Identity and Ethics
340.01 Students will take a minimum of one SDU in Area IV.
340.02 Area IV content will include professional identity, including professional socialization, scope of
practice, professional organizations, licensure, and certification.
340.03 Area IV content will focus on ethical issues related to the profession of marriage and family
therapy and the practice of individual, couple, and family therapy. A generic course in ethics
does not meet this standard.
340.04 Area IV will address the AAMFT Code of Ethics, confidentiality issues, the legal
responsibilities and liabilities of clinical practice and research, family law, record keeping,
reimbursement, and the business aspects of practice.
340.05 Area IV content will inform students about the interface between therapist responsibility and the
professional, social, and political
350: Area V: Research
350.01 Students will take a minimum of one SDU in Area V.
350.02 Area V content will include significant material on research in couple and family therapy.
350.03 Area V content will focus on research methodology, data analysis and the evaluation of
research.
350.04 Area V content will include quantitative and qualitative research.
360: Area VI: Additional Learning
360.01 Students will take a minimum of one SDU in Area VI.
360.02 Additional learning will augment students’ specialized interest and background in individual,
couple, and family therapy. Additional courses may be chosen from coursework offered in a
variety of disciplines.
Standard Curriculum Didactic Area Requirements
Areas of Study Minimum Requirements
I.
Theoretical Foundations
2 SDUs
II.
Clinical Practice
4 SDUs
III.
Individual Development and Family Relations
1 SDU
Total Required for Areas I, II, and III (the program will decide
which of the areas it increases beyond the minimum)
9 SDUs

IV. Professional Identity and Ethics
V. Research
1 SDU
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VI.
400-499:
401:
401.01
401.02
401.03
401.04
401.05
401.06
401.07
401.08
410:
410.01
410.02
410.03
410.04
410.05
410.06
410.07
500-599:
1 SDU
Additional Learning 1 SDU
Total for Areas I through VI 12 SDUs
Standard Curriculum Clinical Experience Requirements
Contact Hours
Students will complete a minimum of 500 supervised, direct client contact hours. At least 400 of
these hours must be direct client contact fitting the criteria specified in Standard 151.01. Up to
100 hours may consist of alternative therapeutic contact that is systemic and interactional.
At least 250 hours (of the required 500 hours of client contact) will occur in clinical facilities
fitting the criteria stated in Standard 160.02.
At least 250 (of the required 500 hours of client contact) will be with couples or families present
in the therapy room.
Students will work with a wide variety of people, relationships, and problems.
The program will publish and adhere to criteria for determining when students are prepared for
clinical practice.
Published promotional materials will inform applicants that they must complete 500 direct client
contact hours.
Clinical work will not be interrupted for arbitrary student, administrative, or didactic scheduling
reasons, when interruption would be harmful to clients.
Programs will demonstrate that students have the opportunity to work with clients who are
diverse in terms of age, culture, physical ability, ethnicity, family composition, gender, race,
religion, sexual orientation and socioeconomic status.
Supervision
Students will receive at least 100 hours of face-to-face supervision.
Students will receive at least one hour of supervision for every five hours of direct client
contact.
Supervision will occur at least once every week in which students have direct client contact
hours.
Individual supervision will occur at least once every other week in which students have direct
client contact hours.
Students will receive at least 50 hours of supervision based on direct observation, videotape, or
audiotape. At least 25 hours of this supervision will be based on direct observation or videotape.
Smdents should be given opportunities to observe their supervisors’ clinical work. In this
context, “clinical work’’ includes therapy in progress, clinical evaluation in progress, and role
playing.
Group supervision is required.
Doctoral Programs

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501: Didactic Requirements
501.01 Doctoral programs will include a minimum of 14 SDUs of post-master’s coursework in Areas
VII-XII.
501.02 Doctoral programs will have available and will offer the standard curriculum to all students who
have not graduated from a master’s program accredited by the Commission on Accreditation for
Marriage and Family Therapy Education.
509:
509.01
509.02
510:
510.01
510.02
511:
511.01
511.02
511.03
512:
512.01
VII.
VIII
IX
X.
XI.
XII
Areas Vil, VIII, IX: Theory, Clinical Practice and Individual Development and Family
Relations
Areas VII, VIII, IX are continuations of Areas I, II, and III, respectively, at a doctoral level of
sophistication.
Students will take a minimum of four SDUs in Areas VII, VIII, and IX. Students will take
courses in at least two of the three areas.
Area X: Clinical Supervision
Students will take a minimum of one SDU in Area X.
Area X course content will be didactic and experiential, and will include current literature,
research and major issues related to supervision in the profession of marriage and family
therapy.
Area XI: Research
Students will take a minimum of four SDUs in Area XI.
Courses in Area XI will provide comprehensive coverage of the critique and execution of
couple, marriage, and family therapy research, statistics, research methodologies, and computer
analysis and interpretation, in qualitative and quantitative research.
Students will take a minimum of one SDU with a specific focus on couple, marriage, and family
therapy research.
Area XII: Additional Courses
Additional courses will augment students’ specialized interests and backgrounds in couple,
marriage, and family therapy. Additional courses may be chosen from coursework offered in a
variety of disciplines.
Doctoral Curriculum Didactic Requirements
(Students must complete the standard curriculum prior to the doctoral curriculum.)
Areas of Study Minimum Requirements
Theory Students will take courses in at least two of the areas to arrive at the total required.
Clinical Practice
Individual Development and Family Relations
Total Required for Areas VII, VIII, and IX 4 SDUs
Clinical Supervision 1 SDU
Research 4 SDUs
Additional Courses as program chooses
Total for Areas VIT-XII (the program will decide which
of the areas it increases to arrive at the total required)
14 SDUs

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513: The Doctoral Dissertation
513.01 The doctoral dissertation may not be counted toward the 14 SDU total didactic requirement.
513.02 The doctoral dissertation topic will be in the field of marriage and family therapy.
520: Clinical Experience
520.01 Doctoral students will be involved in clinical practice.
520.02 Before graduating from the doctoral program, doctoral students will have completed 1000 hours
of direct client contact equivalent to that which they would be receiving from an accredited
program.
520.03 Doctoral students who can document that their previous supervised clinical practice is
comparable to that which would be received in an accredited program, may petition the program
to waive some or all of the required 1000 direct client contact hours.
520.04 The program will have established criteria for waiving direct client contact hours.
530: The Internship
530.01 There will be an internship, not to be counted toward the 14 SDU total didactic requirement.
530.02 The internship is to provide doctoral students with a supervised full-time experience of at least
nine months duration, emphasizing relationally focused practice and/or research.
530.03 The majority of requirements in Areas VII, VIII, IX, and XI will be completed before the
beginning of the internship.
540: Site Requirements
540.01 The program will maintain clear relationships with all internship site(s), which will be specified
in a written document.
540.02 Activities of each intern will be documented at the internship site(s). These records will made
available to the marriage and family therapy program.
540.03 The institution sponsoring the internship site(s) will have been in operation for at least two
years.
540.04 Internship site(s) will provide adequate facilities and equipment for the intern to carry out
designated responsibilities.
540.05 Mechanisms for student evaluation of internship site(s) and supervision, and site evaluation of
the intern’s performance, will be demonstrated.
540.06 Documentation of liability insurance for interns will be confirmed. Liability insurance may be
provided by the internship site(s), the marriage and family therapy program, or the intern.
540.07 Internship site(s) will publish and adhere to policies prohibiting discrimination on the basis of
age, culture, ethnicity, gender, physical ability, race, religion, sexual orientation, and
socioeconomic status.
540.08 An AAMFT Approved Supervisor or the equivalent will supervise the intern’s clinical work
540.09 The internship supervisor will be available to the intern and will be an active participant in
her/his training.
540.10 The internship supervisor will be clearly senior in experience to the intern.
©2002 American Association for Marriage and Family Therapy, 112 South Alfred Street, Alexandria, VA
22314-3061 Phone: (703) 838-9808 Fax:(703) 838-9805 Reprinted with permission.

APPENDIX C
AAMFT CODE OF ETHICS
AAMFT Code of Ethics
Effective July 1, 2001
Preamble
The Board of Directors of the American Association for Marriage and Family Therapy (AAMFT)
hereby promulgates, pursuant to Article 2, Section 2.013 of the Association’s Bylaws, the
Revised AAMFT Code of Ethics, effective July 1,2001.
The AAMFT strives to honor the public trust in marriage and family therapists by setting
standards for ethical practice as described in this Code. The ethical standards define professional
expectations and are enforced by the AAMFT Ethics Committee. The absence of an explicit
reference to a specific behavior or situation in the Code does not mean that the behavior is ethical
or unethical. The standards are not exhaustive. Marriage and family therapists who are uncertain
about the ethics of a particular course of action are encouraged to seek counsel from consultants,
attorneys, supervisors, colleagues, or other appropriate authorities.
Both law and ethics govern the practice of marriage and family therapy. When making
decisions regarding professional behavior, marriage and family therapists must consider the
AAMFT Code of Ethics and applicable laws and regulations. If the AAMFT Code of Ethics
prescribes a standard higher than that required by law, marriage and family therapists must meet
the higher standard of the AAMFT Code of Ethics. Marriage and family therapists comply with
the mandates of law, but make known their commitment to the AAMFT Code of Ethics and take
steps to resolve the conflict in a responsible manner. The AAMFT supports legal mandates for
reporting of alleged unethical conduct.
The AAMFT Code of Ethics is binding on Members of AAMFT in all membership
categories, AAMFT-Approved Supervisors, and applicants for membership and the Approved
Supervisor designation (hereafter, AAMFT Member). AAMFT members have an obligation to be
familiar with, the AAMFT Code of Ethics and its application to their professional services. Fack
of awareness or misunderstanding of an ethical standard is not a defense to a charge of unethical
conduct
T he process for filing, investigating, and resolving complaints of unethical conduct is
described in the current Procedures for Handling Ethical Matters of the AAMFT Ethics
Committee. Persons accused are considered innocent by the Ethics Committee until proven
guilty, except as otherwise provided, and are entitled to due process. If an AAMFT Member
resigns in anticipation of, or during the course of, an ethics investigation, the Ethics Committee
will complete its investigation. Any publication of action taken by the Association will include
the fact that the Member attempted to resign during the investigation.
147

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Contents
1. Responsibility to clients
2. Confidentiality
3. Professional competence and integrity
4. Responsibility to students and supervisees
5. Responsibility to research participants
6. Responsibility to the profession
7. Financial arrangements
8. Advertising
Principle I
Responsibility to Clients
Marriage and family therapists advance the welfare offamilies and individuals They respect the rights of
those persons seeking their assistance, and make reasonable efforts to ensure that their services are used
appropriately.
1.1 Marriage and family therapists provide professional assistance to persons without discrimination
on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national
origin, or sexual orientation.
1 2 Marriage and family therapists obtain appropriate informed consent to therapy or related
procedures as early as feasible m the therapeutic relationship, and use language that is reasonably
understandable to clients. The content of informed consent may vary depending upon the client and
treatment plan; however, informed consent generally necessitates that the client; (a) has the capacity to
consent; (b) has been adequately informed of significant information concerning treatment processes and
procedures; (c) has been adequately informed of potential risks and benefits of treatments for which
generally recognized standards do not yet exist; (d) has freely and without undue influence expressed
consent; and (e) has provided consent that is appropriately documented. When persons, due to age or
mental status, are legally incapable of giving informed consent, marriage and family therapists obtain
informed permission from a legally authorized person, if such substitute consent is legally permissible.
1.3 Marriage and family therapists are aware of their influential positions with respect to clients, and
they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to
avoid conditions and multiple relationships with clients that could impair professional judgment or increase
the risk of exploitation. Such relationships include, but are not limited to, business or close personal
relationships with a client or the client’s immediate family When the risk of impairment or exploitation
exists due to conditions or multiple roles, therapists take appropriate precautions.
1.4 Sexual intimacy with clients is prohibited
1.5 Sexual intimacy with former clients is likely to be harmful and is therefore prohibited for two years
following the termination of therapy or last professional contact. In an effort to avoid exploiting the trust
and dependency of clients, marriage and family therapists should not engage in sexual intimacy with
former clients after the two years following termination or last professional contact. Should therapists
engage in sexual intimacy with former clients following two years after termination or last professional
contact, the burden shifts to the therapist to demonstrate that there has been no exploitation oi injury to the
former client or to the client’s immediate family.
1.6 Marriage and family therapists comply with applicable laws regarding the reporting of alleged
unethical conduct
1.7 Marriage and family therapists do not use their professional relationships with clients to further
their own interests

149
1.8 Marriage and family therapists respect the rights of clients to make decisions and help them to
understand the consequences of these decisions. Therapists clearly advise the clients that they have the
responsibility to make decisions regarding relationships such as cohabitation, marriage, divorce, separation,
reconciliation, custody, and visitation.
1.9 Marriage and family therapists continue therapeutic relationships only so long as it is reasonably
clear that clients are benefiting from the relationship.
1.10 Marriage and family therapists assist persons in obtaining other therapeutic services if the
therapist is unable or unwilling, for appropriate reasons, to provide professional help.
1.11 Marriage and family therapists do not abandon or neglect clients in treatment without making
reasonable arrangements for the continuation of such treatment.
1.12 Marriage and family therapists obtain written informed consent from clients before videotaping,
audio recording, or permitting third-party observation.
1.13 Marriage and family therapists, upon agreeing to provide services to a person or entity at the
request of a third party, clarify, to the extent feasible and at the outset of the service, the nature of the
relationship with each party and the limits of confidentiality.
Principle II
Confidentiality
Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic
relationship may be more than one person. Therapists respect and guard the confidences of each individual
client.
2.1 Marriage and family therapists disclose to clients and other interested parties, as early as feasible in
their professional contacts, the nature of confidentiality and possible limitations of the clients’ right to
confidentiality. Therapists review with clients the circumstances where confidential information may be
requested and where disclosure of confidential information may be legally required. Circumstances may
necessitate repeated disclosures.
2.2 Marriage and family therapists do not disclose client confidences except by written authorization or
waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in
emergency situations, unless prohibited by law. When providing couple, family or group treatment, the
therapist does not disclose information outside the treatment context without a written authorization from
each individual competent to execute a waiver. In the context of couple, family or group treatment, the
therapist may not reveal any individual’s confidences to others in the client unit without the prior written
permission of that individual.
2.3 Marriage and family therapists use client and/or clinical materials in teaching, writing, consulting,
research, and public presentations only if a written waiver has been obtained in accordance with
Subprinciple 2.2, or when appropriate steps have been taken to protect client identity and confidentiality.
2 4 Marriage and family therapists store, safeguard, and dispose of client records in ways that maintain
confidentiality and in accord with applicable laws and professional standards.
2.5 Subsequent to the therapist moving from the area, closing the practice, or upon the death of the
therapist, a marriage and family therapist arranges for the storage, transfer, or disposal of client records in
ways that maintain confidentiality and safeguard the welfare of clients.
2.6 Marriage and family therapists, when consulting with colleagues or referral sources, do not share
confidential information that could reasonably lead to the identification of a client, research participant,
supervisee, or other person with whom they have a confidential relationship unless they have obtained the
prior written consent of the client, research participant, supervisee, or other person with whom they have a
confidential relationship. Information may be shared only to the extent necessary to achieve the purposes of
the consultation.

150
Principle III
Professional Competence and Integrity
Marriage and family therapists maintain high standards of professional competence and integrity.
3.1 Marriage and family therapists pursue knowledge of new developments and maintain competence
in marriage and family therapy through education, training, or supervised experience.
3.2 Marriage and family therapists maintain adequate knowledge of and adhere to applicable laws,
ethics, and professional standards.
3.3 Marriage and family therapists seek appropriate professional assistance for their personal problems
or conflicts that may impair work performance or clinical judgment.
3.4 Marriage and family therapists do not provide services that create a conflict of interest that may
impair work performance or clinical judgment.
3.5 Marriage and family therapists, as presenters, teachers, supervisors, consultants and researchers,
are dedicated to high standards of scholarship, present accurate information, and disclose potential conflicts
of interest.
3.6 Marriage and family therapists maintain accurate and adequate clinical and financial records.
3.7 While developing new skills in specialty areas, marriage and family therapists take steps to ensure
the competence of their work and to protect clients from possible harm. Marriage and family therapists
practice in specialty areas new to them only after appropriate education, training, or supervised expenence.
3.8 Marriage and family therapists do not engage in sexual or other forms of harassment of clients,
students, trainees, supervisees, employees, colleagues, or research subjects.
3.9 Marriage and family therapists do not engage in the exploitation of clients, students, trainees,
supervisees, employees, colleagues, or research subjects.
3.10 Marriage and family therapists do not give to or receive from clients (a) gifts of substantial value
or (b) gifts that impair the integrity or efficacy of the therapeutic relationship.
3.11 Marriage and family therapists do not diagnose, treat, or advise on problems outside the
recogmzed boundaries of their competencies
3.12 Marriage and family therapists make efforts to prevent the distortion or misuse of their clinical
and research findings.
3.13 Marriage and family therapists, because of their ability to influence and alter the lives of others,
exercise special care when making public their professional recommendations and opinions through
testimony or other public statements
3.14 To avoid a conflict of interests, marriage and family therapists who treat minors or adults
involved in custody or visitation actions may not also perform forensic evaluations for custody, residence,
or visitation of the minor. The marriage and family therapist who treats the minor may provide the court or
mental health professional performing the evaluation with information about the minor from the marriage
and family therapist’s perspective as a treating marriage and family therapist, so long as the marriage and
family therapist does not violate confidentiality.
3.15 Marriage and family therapists are in violation of this Code and subject to termination of
membership or other appropriate action if they: (a) are convicted of any felony; (b ) are convicted of a
misdemeanor related to their qualifications or functions; (c) engage in conduct which could lead to
conviction of a felony, or a misdemeanor related to their qualifications or functions; (d) are expelled from
or disciplined by other professional organizations; (e) have their licenses or certificates suspended or
revoked or are otherwise disciplined by regulatory bodies; (f) continue to practice marriage and family
therapy while no longer competent to do so because they are impaired by physical or mental causes or the
abuse of alcohol or other substances; or (g) fail to cooperate with the Association at any point from the
inception of an ethical complaint through the completion of all proceedings regarding that complaint.

151
Principle IV
Responsibility to Students and Supervisees
Marriage and family therapists do not exploit the trust and dependency of students and supervisees.
4.1 Marriage and family therapists are aware of their influential positions with respect to students and
supervisees, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore,
make every effort to avoid conditions and multiple relationships that could impair professional objectivity
or increase the risk of exploitation. When the risk of impairment or exploitation exists due to conditions or
multiple roles, therapists take appropriate precautions.
4.2 Marriage and family therapists do not provide therapy to current students or supervisees.
4.3 Marriage and family therapists do not engage in sexual intimacy with students or supervisees
during the evaluative or training relationship between the therapist and student or supervisee. Should a
supervisor engage in sexual activity with a former supervisee, the burden of proof shifts to the supervisor to
demonstrate that there has been no exploitation or injury to the supervisee.
4.4 Marriage and family therapists do not permit students or supervisees to perform or to hold
themselves out as competent to perform professional services beyond their training, level of experience,
and competence.
4.5 Marriage and family therapists take reasonable measures to ensure that services provided by
supervisees are professional.
4.6 Marriage and family therapists avoid accepting as supervisees or students those individuals with
whom a prior or existing relationship could compromise the therapist’s objectivity. When such situations
camiot be avoided, therapists take appropriate precautions to maintain objectivity. Examples of such
relationships include, but are not limited to, those individuals with whom the therapist has a current or prior
sexual, close personal, immediate familial, or therapeutic relationship.
4.7 Marriage and family therapists do not disclose supervisee confidences except by written
authorization or waiver, or when mandated or permitted by law In educational or training settings where
there are multiple supervisors, disclosures are permitted only to other professional colleagues,
administrators, or employers who share responsibility for training of the supervisee Verbal authorization
will not be sufficient except in emergency situations, unless prohibited by law.
Principle V
Responsibility to Research Participants
Investigators respect the dignity and protect the welfare of research participants, and are aware of
applicable laws and regulations and professional standards governing the conduct of research.
5.1 Investigators are responsible for making careful examinations of ethical acceptability in planning
smdies. To the extent that services to research participants may be compromised by participation in
research, investigators seek the ethical advice of qualified professionals not dnectly involved in the
investigation and observe safeguards to protect the rights of research participants.
5.2 Investigators requesting participant involvement in research inform participants of the aspects of
the research that might reasonably be expected to influence willingness to participate. Investigators are
especially sensitive to the possibility' of diminished consent when participants are also receiving clinical
sendees, or have impairments which limit understanding and/or communication, or when participants are
children.
5.3 Investigators respect each participant’s freedom to decline participation in or to withdraw from a
research study at any time. This obligation requires special thought and consideration when investigators or
other members of the research team are in positions of authority or influence over participants. Marriage
and family therapists, therefore, make every effort to avoid multiple relationships with research participants
that could impair professional judgment or increase the risk of exploitation.
5.4 Information obtained about a research participant during the course of an investigation is
confidential unless there is a waiver previously obtained in writing. When the possibility exists that others,

152
including family members, may obtain access to such information, this possibility, together with the plan
for protecting confidentiality, is explained as part of the procedure for obtaining informed consent.
Principle VI
Responsibility to the Profession
Marriage and family therapists respect the rights and responsibilities of professional colleagues and
participate in activities that advance the goals of the profession.
6.1 Marriage and family therapists remain accountable to the standards of the profession when acting
as members or employees of organizations. If the mandates of an organization with which a marriage and
family therapist is affiliated, through employment, contract or otherwise, conflict with the AAMFT Code of
Ethics, marriage and family therapists make known to the organization their commitment to the AAMFT
Code of Ethics and attempt to resolve the conflict in a way that allows the fullest adherence to the Code of
Ethics.
6.2 Marriage and family therapists assign publication credit to those who have contributed to a
publication in proportion to their contributions and in accordance with customary professional publication
practices.
6.3 Marriage and family therapists do not accept or require authorship credit for a publication based on
research from a student's program, unless the therapist made a substantial contribution beyond being a
faculty advisor or research committee member. Coauthorship on a student thesis, dissertation, or project
should be determined in accordance with principles of fairness and justice.
6.4 Marriage and family therapists who are the authors of books or other materials that are published or
distributed do not plagiarize or fail to cite persons to whom credit for original ideas or work is due.
6.5 Marriage and family therapists who are the authors of books or other materials published or
distributed by an organization take reasonable precautions to ensure that the organization promotes and
advertises the materials accurately and factually.
6.6 Marriage and family therapists participate in activities that contribute to a better community and
society, including devoting a portion of their professional activity to services for which there is little or no
financial return.
6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to
marriage and family therapy that serve the public interest, and with altering such laws and regulations that
are not in the public interest.
6.8 Marriage and family therapists encourage public participation in the design and delivery of
professional services and in the regulation of practitioners.
Principle VII
Financial Arrangements
Marriage and family therapists make financial arrangements with clients, third-party payors, and
supervisees that are reasonably understandable and conform to accepted professional practices.
7 1 Marriage and family therapists do not offer or accept kickbacks, rebates, bonuses, or other
remuneration for referrals; fee-for-service arrangements are not prohibited.
7.2 Prior to entering into the therapeutic or supervisory relationship, marriage and family therapists
clearly disclose and explain to clients and supervisees: (a) all financial arrangements and fees related to
professional services, including charges for canceled or missed appointments; (b) the use of collection
agencies or legal measures for nonpayment; and (c) the procedure for obtaining payment from the client, to
the extent allowed by law, if payment is denied by the third-party payor. Once services have begun,
therapists provide reasonable notice of any changes in fees or other charges.
7.3 Marriage and family therapists give reasonable notice to clients with unpaid balances of their intent
to seek collection by agency or legal recourse. When such action is taken, therapists will not disclose
clinical information.

153
7.4 Marriage and family therapists represent facts truthfully to clients, third-party payors, and
supervisees regarding services rendered.
7.5 Marriage and family therapists ordinarily refrain from accepting goods and services from clients in
return for services rendered. Bartering for professional services may be conducted only if: (a) the
supervisee or client requests it, (b) the relationship is not exploitative, (c) the professional relationship is
not distorted, and (d) a clear written contract is established.
7.6 Marriage and family therapists may not withhold records under their immediate control that are
requested and needed for a client’s treatment solely because payment has not been received for past
services, except as otherwise provided by law.
Principle VIII
Advertising
Marriage and family therapists engage in appropriate informational activities, including those that enable
the public, refetral sources, or others to choose professional services on an informed basis.
8.1 Marriage and family therapists accurately represent their competencies, education, training, and
experience relevant to their practice of marriage and family therapy.
8.2 Marriage and family therapists ensure that advertisements and publications in any media (such as
directories, announcements, business cards, newspapers, radio, television, Internet, and facsimiles) convey
information that is necessary for the public to make an appropriate selection of professional services.
Information could include: (a) office information, such as name, address, telephone number, credit card
acceptability, fees, languages spoken, and office hours; (b) qualifying clinical degree (see subprinciple 8.5);
(c) other earned degrees (see subprinciple 8.5) and state or provincial licensures and/or certifications; (d)
AAMFT clinical member status; and (e) description of practice.
8.3 Marriage and family therapists do not use names that could mislead the public concerning the
identity, responsibility, source, and status of those practicing under that name, and do not hold themselves
out as being partners or associates of a firm if they are not.
8.4 Marriage and family therapists do not use any professional identification (such as a business card,
office sign, letterhead, Internet, or telephone or association directory listing) if it includes a statement or
claim that is false, fraudulent, misleading, or deceptive.
8.5 In representing their educational qualifications, marriage and family therapists list and claim as
evidence only those earned degrees: (a) from institutions accredited by regional accreditation sources
recognized by the United States Department of Education, (b) from institutions recognized by states or
provinces that license or certify marriage and family therapists, or (c)from equivalent foreign institutions.
8.6 Marriage and family therapists correct, wherever possible, false, misleading, or inaccurate
information and representations made by others concerning the therapist’s qualifications, services, or
products.
8.7 Marriage and family therapists make certain that the qualifications of their employees or
supervisees are represented in a manner that is not false, misleading, or deceptive.
8.8 Marriage and family therapists do not represent themselves as providing specialized services unless
they have the appropriate education, training, or supervised experience.
This Code is published by:
American Association for Marriage and Family Therapy
112 South Alfred Street, Alexandria, VA 22314
Phone: (703) 838-9808 Fax: (703) 838-9805
www.aamft.org

154
© Copyright 2001 by the AAMFT. All rights reserved. Printed in the United States of America. No part of
this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission
of the publisher.
Violations of this Code should be brought in writing to the attention of:
AAMFT Ethics Committee
112 South Alfred Street, Alexandria, VA 22314
Phone: (703) 838-9808 Fax: (703) 838-9805
email: ethics@aamft.org

APPENDIX D
INVITATION LETTER TO PARTICIPATE IN SURVEY
Dear Marriage and Family Therapist:
I invite you to participate in an important study on the current status of
relationship violence in MFT graduate training programs. I know your time is valuable,
so I have made it quick and easy to participate. If you go to the Web address below, you
will find more details about the study, a way to contact me if you have questions, and the
survey itself. Your participation is voluntary and totally anonymous. The survey can be
completed and submitted online in about 15 minutes.
From the results, I hope to better understand the most commonly identified factors
that MFT practitioners, approved supervisors, and MFT faculty consider impoitant in the
training, assessment, and treatment of relationship violence. Please consider your
participation one way in which you can personally contribute to the growth of the field.
Your viewpoint is important in this matter and your participation is greatly appreciated.
For more information and to participate, go to-
http://www.stetson.edu/~mbraccia/RVTS-simpletext.html
If this link does not click open immediately, copy and paste this link into your Internet
browser
Respectfully,
Principal Investigator:
Marie T. Bracciale, LMFT, CAP
AAMFT Approved Supervisor
Doctoral Candidate Counselor Education
University of Florida, MFT Program
manebufl@aol.com
Faculty advisor:
Silvia Echevarria-Doan, Ph.D. LMFT. LCSW,
Associate Professor
Doctoral Committee Chair
Department of Counselor Education
University of Florida
155

APPENDIX E
FOLLOW-UP LETTER TO NONRESPONDENTS
Dear Marriage and Family Therapist:
Recently I invited you to participate in an important study on the current status of
relationship violence in MFT graduate training programs. Your participation is very
important.
If you e-mailed the survey, thank you very much for your participation.
If you haven’t had the opportunity to do so yet, I would appreciate it greatly if
you could take the time to help me with my research. The survey can be completed and
submitted online in about 15 minutes.
I know that your time is valuable, so I have made it quick and easy to participate.
If you go to the Web address below, you will find more details about the study, a way to
contact me if you have questions, and the survey itself. Your participation is voluntary
and totally anonymous.
From the results, I hope to better understand the most commonly identified factors
that MFT practitioners, approved supervisors, and MFT faculty consider important in the
training, assessment, and treatment of relationship violence. Please consider your
participation one way in which you can personally contribute to the growth of the field.
Your viewpoint is important in this matter and your participation is greatly appreciated.
For more information and to participate, go to:
http://www.stetson.edu/~mbraccia/RVTS-simpletext.html
If this link does not click open immediately, copy and paste this link into your
Internet browser.
Respectfully,
Principal Investigator:
Marie T. Bracciale, LMFT, CAP
AAMFT Approved Supervisor
Doctoral Candidate Counselor Education
University of Florida, MFT Program
mariebuil@aol.com
Faculty advisor:
Silvia Echevarria-Doan, Ph.D. LMFT, LCSW,
Associate Professor
Doctoral Committee Chair
Department of Counselor Education
University of Florida
156

APPENDIX F
SAMPLE CODED RESPONSE FORM
Subj:
Fonn Response
Date:
2/14/2003 8:16:57 PM Eastern Standard Time
From:
Joumeyzen
To:
mariebufl
To:
mariebufl@aol.com
Subject;
Form posted from America Online
X-Mailer:
Mozilla/4.0 (compatible; MSIE 4.01; AOL 5.0; Mac PPC)
MIME-Version:
1.0
Content-type:
text/plain
Content-Length:
446
19vl6=4
20vl7=5
OOexp-(RVTS)
21vl8=4
01Date=-pfDate
22v19=2
02Time=pfrime
23v20=l
03 Adr=pfR emote Address 24sex=F
04vl=--2
25Age=44
05v2=2
26Ed=16
06v3=l
27Cn=USA
07v4---5
28v25=l
08v5=3
29v26=4
09v6-2
30v27=0
10v7=3
33v28=0
11 v8-2
34v29=l
12v9=3
35v30=2
13vl0-2
36v31=3
14vl1-4
37v32=3
15vl2=1
16vl3=2
17vl4=1
18vl5=3
38v33=joumeyzen@aol.com
21 of72
Include original text in reply.
157

APPENDIX G
DESCRIPTIVE STATISTICS MEAN RATINGS
AND STANDARD DEVIATIONS (N= 171)
Item
Mean
SD
vl
4.95
0.919
v2
4.27
1.245
v3
3.96
1.320
v4
4.92
0.942
v5
4.63
1.137
v6
2.96
1.439
v7
3.18
1.477
v8
3.03
1.416
v9
3.05
1.394
vll
5.74
0.538
vl2
5.81
0.473
vl3
5.75
0.510
vl4
5.06
1.083
vl5
5.66
0.625
vl6
5.64
0.630
vl7
5.83
0.461
vl8
5.46
0.876
vl9
5.59
0.610
v20
4.11
1.355
Note. V10 was omitted from the analysis.
158

APPENDIX H
FACTOR CORRELATION MATRIX
Factor
1
2
3
1
1.000
.107
.328
2
.107
1.000
.314
3
.328
.314
1.000
Extraction Method: Principal Axis Factoring
Rotation Method: Promax with Kaiser Normalization
159

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BIOGRAPHICAL SKETCH
Marie Theresa Bracciale was bom in Brooklyn, New York, July 2, 1957. She
attended Catholic school for her elementary and middle school years, then moved to
Florida. She has two brothers, a younger one named Dominick and an older one named
Dan; she is close with both of them. Her mother, Rose, is over 82 years old and is still an
avid reader; Marie feels that she learned the value of patience from her mother. Marie
received her Bachelor of Science degree in health science education from the University
of Florida in 1980. In 1987 she was awarded a Master of Arts in clinical holistic health
education counseling from John F. Kennedy University in Orinda, California. While in
California, she had a private practice in marriage and family therapy, specializing in
substance abuse recovery, codependency recovery, and sexual abuse recovery She has
worked in outpatient, residential, and inpatient facilities with both adolescents and adults.
She enjoys teaching, coaching, and consulting. She was awarded a Doctor of Philosophy
degree in counselor education, with a minor in statistics, from the University of Florida.
She lives with her partner of 9 years in Deltona, Florida. She enjoys music, especially
drumming, kayaking, and all beach activities. She is currently an Adjunct Professor at
the University of Central Florida and is continuing her research work in relationship
violence, supervising interns, and providing consultation services.
187

I certify that I have read this study and that in my opinion it conforms to accept¬
able standards of scholarly presentation and is fully^dequate, in scope and quality, as a
dissertation for the degree of Doctor of Philosop
Echevarria-Doan, Chair
Associate Professor of Counselor Education
I certify that I have read this study and that in my opinion it conforms to accept¬
able standards of scholarly presentation and is fully adequate, in scope and quality, as a
dissertation for the degree of Doctor of Education.
:ation./?
'AAA
Bárbara Rienzo
Professor of Health Scieri
I certify that I have read this study and that in my opinion it conforms to accept¬
able standards of scholarly presentation and is fully adequate, in scope and quality, as a
dissertation for the degree of Doctor of Philosophy.
David Miller
Professor of Educational Psychology
I certify that I have read this study and
able standards of scholarly presentation and i
dissertation for the degree of Doctor of Educdtio
1 in my opinion it conforms to accept-
quality, as a
Peter Sherrard
Associate Professor of Counselor Education
I certify that I have read this study and that in my opinion it conforms to accept¬
able standards of scholarly presentation and is fully adequate, in scope and quality, as a
dissertation for the degree of Doctor of Philosophy.
Sondra Smith
Assistant Professor of Counselor Education
This dissertation was submitted to the Graduate Faculty of the College of
Education and to the Graduate School and was accepted as partial fulfillment of the
requirements for the degree of Doctor of Philosophy.
August 2004
Dean, Graduate School




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