Group Cognitive–Behavioral Therapy in a Sample of Dutch Intimate Partner Violence Perpetrators: Development of a Coding Manual for Therapist Interventions

Figures & data

Table 1. Patient Gender, Age, and Marital Status (N = 155)

	Category	N	Percentage of total
Gender	Men	155	100%
Age	≤ 20	7	4.5%
	21–30	42	27.1%
	31–40	42	27.1%
	41–50 51–60 ≥ 60	49 12 3	31,6% 7.7% 1.9%
Marital status	Single	41	26.5%
	Married	50	32.3%
	Cohabiting In relationship, living apart Divorced Unknown	25 28 9 2	16.1% 18.1% 5.8% 1.3%

Table 2. Therapist Gender, Years of Experience, and Discipline (N = 18)

	Category	N	Percentage of total
Gender	Women	10	55.6%
	Men	8	44.4%
Years of experience	0–5 years	2	11.1%
	6–10 years	5	27.8%
	11–15 years	0	0%
	> 15 years	11	61.1%
Discipline	Psychologist	7	38.9%
	Social worker	9	50%
	Nurse	2	11.1%

Table 3. Therapist Interventions in Group CBT for IPV Perpetrators: Not “Losing It” Anymore

	Intervention type	Description and purpose of intervention	Verbatim examples
CBT-based interventions	Psychoeducation and advice	Explaining the problems in the broadest general principles and making recommendations regarding behavior. Self-disclosure may form part of this process. Purpose: Increase awareness of choice points and better understanding of the problem.	“What we would definitely like to see … before you’re in the escalation phase, is that you start looking for alternatives. That you start thinking: how can I prevent myself from snapping? Even if you feel like, it’s going very quick, that escalation, you’re about to snap, you still have choices.” “You often see that when you’re really angry, you can’t think clearly anymore. That’s something people often say afterwards: you make decisions and later you think: yeah, right, that wasn’t so smart.”
	Enhancing motivation	Discussing participant’s motivation and the consequences of certain behaviors. Purpose: Enhance motivation and readiness to change.	“Going back to the bigger picture: what do you think, what is your problem that we need to work on?” “So you’d really like to learn some more ways to handle it better.”
	Self-reflection	Encouraging the participants to reflect by means of concretizing questions. Purpose: Improve self-reflection and self-awareness.	“I get the impression that you’re trying to take back control, right, about that sense of powerlessness you have, by launching a counter-attack.”
	Behavioral techniques	Conducting manualized behavioral exercises. Purpose: Enhance response prevention, alternative behavior and stress reduction.	“I would like to introduce the time-out procedure.” “What kind of actions can you apply when stress is rising?’
	Role-playing	Role-playing based on challenging day-to-day situations experienced by participants. Purpose: Improve social skills.	“But the situation you just discussed, I think it would be good to practice with that, because I notice that you’re quick to revert to your old pattern. Let’s replay the situation, who would you like to join in as your boss in this situation?”
	Cognitive therapy	Identifying and evaluating maladaptive beliefs, using an ABC model or applying the Socratic dialogue. Purpose: Reduce dysfunctional cognitions and attune negative emotions.	“Can you actually know what someone is thinking?” “Can we investigate what cognitions are preceding your anger?”
	Homework assignments	Give and explain homework assignments.	“For next week, we would like you to read chapter 5 and fill out exercises 5.1 to 5.3”
Process-based interventions	Structuring	Structuring by keeping an eye on the time and task, providing information about the structure of the session, taking breaks, discussing group rules, letting people take turns and holding participants accountable for their behavior in the session, indicating boundaries. Purpose: Keep the structure of the sessions to ensure that participants work on the task, are involved as much as possible and prevent or stop undesirable behavior.	“Shall we continue where we left off?” “Let’s agree to this: whatever we discuss here stays right in this room … ” “And F … also said: if I’m no longer doing well I’m just going to walk out. And we would prefer you to do the same here. So if you think: If I stay in the group I’m going to lash out and attack someone that instead you say: I’m leaving and I’m not coming back but I’ll ring you later. Because I’d like to stay in touch with you afterwards.”
	Answering questions	Responding to questions from the group and providing information about matters not related to the treatment protocol. Purpose: Inform participants, put them at ease and model an open approach.	“Because of our holiday leave, the group will be interrupted the first two weeks of August.” “It’s not necessary to email us when you’ve filled the online questionnaires, we will receive a notification you did.” “I’m not divorced, no.”
	Involving the group	Promoting interaction by asking participants for recognition, noticing agreements, involving the group in the discussion and the decision-making process. Purpose: Enhance interpersonal cohesion, interpersonal learning through interaction with and observation of others, and adjust individual perceptions.	“Is that familiar to others?” “How else do you think John can benefit from being in this group?”
	Identifying emotions	Noticing what someone feels—consciously or subconsciously—in the here-and-now, including nonverbal signals. Acknowledging someone’s perceptions. Purpose: Increase awareness and contain personal feelings and displays of emotion.	“Yes, that’s pretty annoying. Absolutely!” “You feel it in your body and I can see it happening, too, when you talk about it, you can see the tension is rising. You’re getting a bit red in the face. And you, like, you kind of puff yourself up.”
	Rewarding	Showing interest, enthusiasm and empathy when participants report positive behavior in the context of the treatment objectives, giving recognition, giving compliments, thanking someone for his input, wishing someone positive things, talking about the group atmosphere, putting someone at ease, social small talk. Purpose: Reinforce positive behavior and motivate individuals and the group-as-a-whole to increase positive behavior, provide support, increase self-confidence and regulate tension.	“I think you did a really good job, because somewhere along the line you decided: I’m not going to be aggressive anymore.” “It seems quite logical to me that that bothers you. If you get that kind of message and you don’t know what to expect. Not surprising, really. I’d find it pretty strange if you could just shake that off, that would definitely be strange.” “I’m glad you were willing to share that here. Best of luck, okay? It’s a good thing you told us this. I’m happy you’re still here.”
	Humor	Using humor, self-deprecation or laughing about a joke the patient has made. Purpose: tension regulation, being able to present difficult interventions and promoting cohesion in a lighthearted manner.	“But you can’t control your son, right? It’s not like you have a ‘kid remote control.’ That would be easier!”
	Co-therapist interaction	A group therapist addresses the co-therapist or explains his/her behavior, reaction or absence. Purpose: Consult about the structure, contact the co-therapist or model collaboration.	“It takes a bit of getting used to if [my co-therapist] is not there.” “Are you working that Monday?” “Shall we … take a break?”
	Listening	Giving the patient room to talk, listening carefully and making it clear that you are paying attention to what he is saying.	“ … … ” “Hm. Aha.” “Yes … Yes … ”