Review: current therapies for men committing acts of domestic violence are of limited benefit

摘要

Despite recognition since the 1970s that exposure to intimate partner violence (IPV) is associated with major morbidity and mortality,particularly among women, there have been few rigorous studies or reviews that examine interventions to reduce IPV.This review is a notable exception: it provides a comprehensive critical overview of a central question in the IPV field: "does treating batterers work?"The results, while sobering, are extremely important: clinicians, researchers, policy makers, and most importantly, victims of IPV, need to know that treatment of male batterers has little effect on preventing re-assault. The authors highlight a clinically relevant message when referring to the results of the five randomised controlled trials (RCTs) they review: "Based on a partner report, treated batterers have a 40% chance of being successfully nonviolent, and without treatment, men have a 35% chance of maintaining nonviolence." If is essential for women and their caregivers, particularly those advising them about safety planning, not to overemphasise the role of batterer treatment in reducing recidivism. Unfortunately, the evidence for approaches aimed at women to prevent recurrent IPV exposure is extremely limited. Based on results of a recent systematic review,2 only one methodologically adequate intervention-post-shelter advocacy counseling-reduced re-abuse.Where do we go from here? Babcock and colleagues conclude that their results do not warrant abandoning existing batterer intervention programmes. We agree. However, it is imperative that existing and new programmes include high quality evaluation, the results of which should directly influence any future dissemination efforts. Too often, a programme is implemented widely, without evidence of its effectiveness (indeed, this happened with universal screening for IPV-dissemination of screening without evidence of effective interventions to help women identified as experiencing IPV).Key gaps in the area of batterer interventions include evaluating the treatment of men who attend voluntarily, rather than being court mandated, as well as individual forms of therapy. While some argue that the ethical and legal challenges of IPV research preclude experimental studies, we assert that the trial by Dunford,4 included in the Babcock review, shows that it is not only feasible but necessary to conduct methodologically rigorous studies to determine the effectiveness of IPV interventions.