4 - (IOP 25) A Qualitative Study of Opinions on Factors to Consider in Determining Couple Suitability for Dyadic Treatment When Mutual Physical Aggression Is Present

Introduction: Physical aggression is a serious ethical concern for couple therapists and there remains debate as to when and to what extent dyadic approaches remain appropriate when both partners in a couple have recently engaged in mutual physical intimate partner violence (IPV). In cases not characterized by clear rule-outs (e.g., control or domination), clinicians are left with an important problem for which there is little guidance: how much physical aggression is too much? We explored this question via in-depth qualitative inquiry given the value of coding and summarizing this information for clinicians and researchers.

Methods: We conducted semi-structured qualitative interviews with 12 expert clinician-researchers who had clinical and research expertise in couple therapy and physical aggression (1+ article in a peer-reviewed journal on IPV treatment/prevention or on both couple treatment broadly and empirical work on IPV). We analyzed the data with a hybrid inductive and deductive approach to thematic analysis. Findings were organized in a-priori domains and themes within domains were generated from the data during coding.

Results: Participants reported 34 years of couple therapy experience (SD = 11.45, range = 20-49), on average. All reported having treated couples with physical IPV. Within Domain 1 (impressions of whether to treat couples with low-level IPV), most participants said yes (n = 10, 83.3%), a few said maybe (n = 2, 16.7%), and none said no. Participants emphasized ethical considerations and the need for judicious decision-making. Within Domain 2 (determining risk for treating couples together), participants emphasized that IPV severity is better determined by patterns rather than frequency and that they utilize clinical judgment rather than concrete frequency cutoffs. Within Domain 3 (assessment recommendations), participants emphasized the process and format of IPV assessment, how to assess the context of IPV, ongoing safety monitoring, individual motivation to change aggressive behavior, and “no-go” factors. Within Domain 4 (intervention recommendations), participants highlighted how couple therapy techniques can be applied to IPV (e.g., conflict de-escalation) in addition to ongoing safety planning and motivational enhancement. Within Domain 5 (barriers and supports), participants emphasized resources, lack of field-level guidelines, liability concerns, training, and concerns when providing telehealth therapy.

Limitations: The research team’s personal, educational, and professional experiences in clinical psychology and IPV research could have biased participant responses and the team’s approach to coding. Further, the sample’s generalizability is limited (i.e., clinician-researchers with PhDs).

Conclusions: Results provide more nuanced detail as to how clinicians and researchers may consider factors influencing clinical judgment in determining whether to proceed with couple therapy when mutual physical aggression is present. Findings can inform training (e.g., IPV assessment), practice (e.g., helping therapists weigh specific factors in determining whether to proceed), and future research (e.g., expert consensus on treatment suitability when IPV is present).