Repeated explorations of violent scripts: psychotherapy for men acting violently against their female partner

ABSTRACT

The effects of psychotherapy for men perpetrating violence toward their female partners have been found to be modest or equivocal; therefore, further research is necessary to determine how therapists can intervene to help clients stop acting violently. To obtain a better understanding of successful therapist strategies in a particular case, we conducted an interpretive phenomenological analysis of interactional patterns and change processes during therapy sessions in four carefully selected cases - two cases in which the use of violence ended after the completion of therapy (violence ended) were compared with two cases in which the client completed therapy but continued to act violently (violence continued). The client’s use of violence was addressed repeatedly in all four cases, but the scripting of such events varied between the two case types. I) Violence ended: Joint explorations of the script of “the annoying other” led to therapist strategies that fostered new experiences of the states of mind of the client and partner. This seemed to help clients develop more caring and safer ways of relating to their partner. II) Violence continued: Engagement in the script of “hopeless me” was associated with therapist strategies that relied more on explanations of the client’s vulnerability to acting violently. This seemed to hinder deeper comprehension of the clients’ use of violence and the needs and intentions of their partners. Contrary to expectations, engagement in the script of “the annoying other” facilitated exploration of emotional states in both the client and his significant other. We present some empirically derived principles for moment-to-moment therapist strategies that facilitated in-session change with men acting violently toward their partner.

KEYWORDS:

• In-session change processes
• therapist strategies
• IPV individual therapy
• qualitative analysis
• scripts of violence

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Therapists who offer treatment to men acting violently toward their female partners face specific challenges. Several studies on intimate partner violence (IPV) therapy have reported high dropout rates, which highlights the difficulty of engaging these men in treatment (Jewell & Wormith, 2010). Clients often blame the partner for their use of violence and resist taking responsibility for their own actions (Flinck & Paavilainen, 2008). This situation might explain the high dropout rate and has inspired researchers to investigate how therapists can succeed in engaging clients in IPV therapy (Taft, Murphy, Elliott, & Morrel, 2001). In two previous studies, we analyzed the ways in which male clients and their therapists collaborated to create an early working alliance in IPV therapy (Lømo, Haavind, & Tjersland, 2018, 2021). By reference to a sample of 84 individual therapy processes, we studied 20 cases in which the client either dropped out of (10 cases) or completed therapy (10 cases). Our first step was to analyze the client’s contributions during the first session. Instead of searching for the more obvious phenomena of blaming the victim, denial, and externalization, we focused on a research question pertaining to the client’s hopes for therapy. This analysis resulted in a conceptual model of client-offered gateways and invitations to an alliance. Each of the gateways identified included strong, vague, and weak client invitations to a project of personal change. The strength of the client’s invitations seemed to determine whether he completed or dropped out of therapy (Lømo, Haavind, & Tjersland, 2018). This finding has been supported by studies indicating that clients’ readiness to change predicts their engagement in IPV therapy (Crane, Eckhardt, & Schlauch, 2015). In the following step, we investigated how the therapist responded to the client’s invitations to a working alliance. We found that the therapists were able to establish three different interactional patterns with their clients – co-creative exploration, pull-avoid repetitions, and tiptoeing softly around. Each pattern was associated with a distinctive set of therapist strategies. The pattern co-creative exploration seemed to be the most promising (Lømo, Haavind, & Tjersland, 2021). Other studies have found similar patterns and emphasized the importance of therapist responsiveness (Crane, Eckhardt, & Schlauch, 2015; Kistenmacher & Weiss, 2008; Musser & Murphy, 2009; Räsänen, Holma, & Seikkula, 2014; Scott, King, McGinn, & Hosseini, 2011; Taft, Murphy, Elliott, & Morrel, 2001).

Even when clients complete their IPV therapy programs, the proportion of clients who continue to use violence is considerable (Babcock et al., 2016; Babcock, Green, & Robie, 2004; Eckhardt et al., 2013; Jewell & Wormith, 2010; Karakurt, Koç, Çetinsaya, Ayluçtarhan, & Bolen, 2019; Nesset, Bjørngaard, Whittington, & Palmstierna, 2021; Smedslund, Clench-Aas, Dalsbo, Steiro, & Winsvold, 2011; Travers, McDonagh, Cunningham, Armour, & Hansen, 2021). These results are in accordance with our findings. Among 84 men in individual IPV therapy, we found a substantial early dropout rate (27.4%). Furthermore, according to reports from clients as well as their female partners, all types of violence decreased significantly from pretreatment to follow-up (Askeland, Birkeland, Lømo, & Tjersland, 2021). Although the majority of clients undergoing individual therapy reported benefits, some clients who completed their therapy program reported that they continued to use violence against the female partner after completing therapy.

These findings inspired us in the present study to examine the characteristics of completed therapy processes in which male clients ended their use of violence and to contrast these processes to those in which the client did not stop his use of violence after the termination of therapy. The current study explores the contributions of both the client and the therapist, including an examination of how interactional patterns are established, repeated, or changed during sessions from the beginning to completion of therapy. In addition, as the quality of the therapist seems to be crucial to the outcome of therapy (Wampold & Imel, 2015), we specifically aspire to investigate the therapist’s actions. For example, we attend to the ways in which the therapists approached the client’s disclosure of his use of violence.

The client’s way of explaining and comprehending the abuse toward his partner has previously been conceptualized as his script of violence (Gilbert & Daffern, 2017). Thus, the research aim of the current study is to identify patterns of addressing scripts of violence that can facilitate or hinder a successful outcome. We search for therapist strategies that seemed to matter in the particular case at hand with respect to bringing the use of violence to a definite end and helping the client relate to his partner and children in safer and more caring ways. Such knowledge can guide therapists in their moment-to-moment work with clients (Levitt, Neimeyer, & Williams, 2005; McLeod, 2013).

Individual IPV therapy

The therapy processes investigated in the current study took place within the health care system at a clinic called Alternative to Violence (ATV). At this clinic, male clients are offered individual therapy, and their participation in treatment is voluntary, i.e. they are not mandated to attend. Each treatment process is tailored to the client’s specific needs, and the end point is not set at the onset of therapy but is rather a matter of negotiation and agreement between the therapist and the client in each case. The ATV approach differs from the IPV programs that have been used most frequently in similar outcome studies in several respects. Usually, these IPV programs are based within the juridical system, are mandatory for clients, are group-based, and are structured by psychoeducational components (Eckhardt et al., 2013; Murphy, Eckhardt, Clifford, Lamotte, & Meis, 2017; Wilson, Feder, & Olaghere, 2021). The therapists at ATV are all specialists in clinical psychology with training and experience in IPV therapy.

The ATV model is violence-focused and integrates techniques and ideas drawn from other approaches to psychotherapy, including cognitive behavioral therapy, emotion-focused therapy, and trauma work (Askeland, Lømo, Råkil, & Isdal, 2020; Råkil, 2002). This assimilative integration (Stricker & Gold, 2003) allows the therapist to select specific strategies that appear to be useful for the needs of specific clients within the framework of addressing the client’s use of violence in the form of meaningful acts with antecedents and consequences. As the use of violence has severe consequences for those who are exposed to it, the client’s partner and children are also invited to participate in a session at the beginning of the male client’s treatment. They are informed about the ATV approach and offered support and therapy as well.

Methods

The present analysis draws upon data from a naturalistic process and outcome study of psychotherapy with male clients at ATV. This study was conducted by the Norwegian Centre for Violence and Traumatic Stress Studies. The collection of data from ongoing therapy processes was performed in collaboration with ATV. Eighty-four men participating in individual IPV therapy were included in this naturalistic process and outcome study (Askeland, Birkeland, Lømo, & Tjersland, 2021). The exclusion criteria were severe psychological disorders or substance addiction. An outcome questionnaire was used to assess the clients’ use of physical, psychological, property, or sexual violence at the onset and end of therapy and at follow-up 18 months after the completion of therapy. Both the client and the partner reported on the client’s use of violence. These self-reports were not available to the therapists. The therapy process was captured by audio recordings of all therapy sessions and client and therapist ratings of the quality of all sessions (Llewelyn, Elliott, Shapiro, Hardy, & Firth‐cozens, 1988).

For the current analysis, we followed and analyzed the processes of change that occurred during therapy sessions in a smaller selection of cases. Drawing on what we knew about outcomes pertaining to the perpetration of violence, we were able to compare cases in which the client’s use of violence ended with cases in which the client continued to use violence.

Design

A combination of two principles was used to select data for this qualitative study of therapy processes. One principle was to use the outcome questionnaires administered after therapy to identify and compare two cases in which violence ended with two cases in which violence continued. Another principle was to use the audio recordings of therapy sessions to analyze the ongoing interactions in these therapy processes from beginning to completion.

This design allowed for analysis of the interactional patterns between clients and therapists when addressing the client’s script of violence. This analysis focused on the ways in which such patterns were established, repeated, or changed throughout the course of therapy. The design also enabled us to identify therapist strategies that facilitated the ultimate goal of therapy – finding viable alternatives to the use of violence. Comparisons of therapist behavior between cases in which violence ended and those in which violence continued thereby enabled us to identify therapist strategies that seemed to be successful or unsuccessful in the sessions.

Data material

Therapy outcomes were determined by clients’ and their partners’ responses to the Violence, Alcohol and Substance Abuse self-report questionnaire, which includes 32 predefined descriptions of different violent acts covering physical, psychological, property, and sexual violence (Askeland, Birkeland, Lømo, & Tjersland, 2021; Strandmoen, Askeland, Tjersland, Wentzel-Larsen, & Heir, 2016), at the completion of therapy and at follow-up.

Among the 84 individual therapy cases, 31 cases were defined by the therapist as completed, indicating that the therapist and the client jointly decided that it was safe to end therapy. The qualitative analysis on therapists’ contributions to an early alliance mentioned above (Lømo, Haavind, & Tjersland, 2021) drew on 10 of these 31 completed cases. From these 10 cases, we were able to select two cases in which violence ended and two cases in which violence continued. In all four cases, the participants had established an early alliance pattern of co-creative exploration – indicating that they found common ground for working together to change the client’s use of violence – but the cases nevertheless differed in terms of the outcome of therapy. In the two cases in which violence continued, this outcome was identified from a combination of reports from the client himself and from his intimate partner at the termination of therapy and at follow-up. Conversely, in the other two cases, the same measurements were used to conclude that the use of violence had ended (i.e. based on the absence of reports of violence). We have used pseudonyms starting with E to identify clients in cases in which the perpetration of violence ended after therapy (i.e. Edward and Elliot) and pseudonyms starting with C to identify clients in cases in which the violence continued after the completion of therapy (i.e. Charles and Colin).

All four therapy processes consisted of regular meetings and included more than 20 sessions. A selection of 55 audio-recorded sessions was obtained from the four cases (see Table 1). The sessions were transcribed verbatim.

Table 1. Sessions selected and included as data.

Client name (by pseudonym indicating outcome)	Early sessions	Middle sessions	Late sessions	Sessions selected/total
Edward	1, 2	6, 8, 9, 10, 15, 21	23, 25	10/25
Elliot	1, 2	4, 10, 11, 16, 17	20, 21	9/21
Charles	1, 2, 3	5, 7, 9, 12, 14, 15, 19, 21, 24, 25	30, 32, 35	16/35
Colin	1, 2, 3	6, 10, 12, 15, 16, 17, 19, 21, 23, 25, 28, 31, 34, 36	38, 39, 40	20/40

In each case, the sessions selected for in-depth analysis of therapeutic interactional patterns and therapist strategies were drawn from each phase of therapy: the beginning, when the client and therapist were establishing an alliance to facilitate their working together; the middle, when the client and therapist directed their attention to previous and contemporary incidents of violence; and the final phase, when the client and therapist looked back on the therapy and discussed their accomplishments. To inform our selection of sessions from the middle phase, we drew on ratings of the quality of sessions according to independent responses from clients and therapists on a modified version of the Helpful Aspects of Therapy (HAT) form (Llewelyn, Elliott, Shapiro, Hardy, & Firth‐cozens, 1988). These ratings from the ATV therapy study were collected immediately after every session. Individuals could also provide free answers regarding important themes. Therefore, we were able to select sessions for which the participants reported working on recent episodes of violence. All therapists at ATV focus on the client’s use of violence and devote further exploration to such events in the client’s current relationships and personal history. Changing the premises of violent behavior and replacing this behavior with alternative responses was the main goal of all therapy cases; our aim in this study was to learn more about how this task was accomplished and what its consequences were.

Clients and their intimate relationships

The male clients were 35 years of age or older. All clients had completed higher education and worked full-time. They attended therapy voluntarily but were also urged to attend by their female partners. At the start of therapy, clients reported using physical, psychological, and/or property violence.

Edward lived with his female partner. His children had left home; thus, his wife was the only victim of his violent acts. Elliot had a partner who had left him just before he entered therapy. He lived with his teenage children, who were his closest kin and who became the victims of his violent outbursts. Charles and Colin both lived with their female partners and cared for their preschool children. Both their female partners and their children were the targets and victims of their violent acts.

All four clients met with therapists who were trained as clinical psychologists and had experience in applying the ATV treatment approach. These four therapists’ number of years of practice as psychotherapists varied from 6.5 to 16 years, and they each had 1 to 15 years of experience with IPV therapy. Both Elliot and Edward attended sessions with female therapists. Both Charles and Colin met with male therapists.

Researchers

All three authors have extensive experience as clinical psychologists and take an integrative and social constructionist approach to psychotherapy. The first author has a PhD in clinical psychology and is particularly interested in process-outcome research that can inform practice. She is experienced in psychotherapy with male clients perpetrating IPV as well as female clients exposed to IPV. The second author is a professor in clinical psychology with a particular interest in the relationship between men and women as coparents and love partners. The third author is a professor in clinical psychology who specializes in family and couple therapy. He has conducted studies investigating child sexual abuse and the mediation process involved in the separation of parents.

Procedures for analyzing data

The data analysis was guided by the principles of interpretative phenomenological analysis (IPA) (Smith, Flowers, & Larkin, 2009). IPA focuses on what is going on in social situations (in this context, in therapy sessions) and how participants make sense of their experiences with repeated exposure or changes in experience (in this context, changes over time from the beginning to the completion of therapy). The theoretical roots of IPA are phenomenology, hermeneutics, and ideography (Smith, 2011). We tried to remain close to the phenomenon of “in-session interaction and change” by analyzing each case from an inductive perspective with the aim of comprehending the interactions that took place between the client and therapist and how they addressed what was at stake in the life of the specific client. With the exception of an interest in how the male clients shared their experiences of perpetuating violence, we did not encounter the data with a specific therapeutic approach or theory in mind. The analysis was idiographic in the sense that each session in every case was analyzed individually and in detail. As we learned more about each case, we were able to interpret the interactions in each session within the context of the course of therapy (from beginning to end).

Data analysis followed a series of steps. Initially, all authors familiarized themselves with the cases by reading the transcript of sessions from each case. After reading the transcripts of all sessions from a case separately, the authors met and shared notes regarding how the therapist and client formed an understanding of the client’s use of violence and his intimate relationship, how the therapist approached the client’s contributions, and whether and how new meanings and perspectives were developed both within one session and across sessions. These discussions enabled us to identify preliminary themes concerning apparent processes that facilitated and hindered in-session changes associated with the specific therapy case. In subsequent meetings, we identified and coded patterns of client disclosures of experiences of acting violently – when, how, and why the client perpetrated violence. Furthermore, we aimed to identify patterns of therapist-client interactions and the ways in which such patterns were repeated and changed during and across sessions. These coded meaning units were then systematically compiled to generate condensed descriptions of the content and process of each therapy session (Malterud, 2001). The authors analyzed one case at a time and in detail.

In the following phase, the authors met to compare similarities and differences in interactional patterns across the four cases. This step involved comparing the coded segments from each case, which improved our understanding of the change processes that occurred during the sessions and in the life of the client. Through this analytical work, we arrived at a consensus regarding how to interpret the therapeutic dialog in sessions and the ways in which such dialogs contributed (or did not contribute) to the progression of the case in question. Thus, we were able to label superordinate themes of interactional patterns with associated subordinate themes of therapist strategies.

In the final step of the analysis, we investigated whether the super- and subordinate themes that we identified were valid by reading the transcripts of all sessions of the cases once again. We determined whether the themes captured the process of each case, whether the themes captured the similarities and differences among the cases, and whether we had overlooked aspects of the therapy process that could challenge the themes. This process resulted in some adjustments to the subordinate themes.

Ethics

The male clients who participated in the study received information regarding the study both verbally and in written form, and they provided written consent. Client participation in the research did not influence their possibility of receiving therapy. The study was approved by the Regional Committee for Medical and Health Research Ethics (Southeast Region) and the Norwegian Social Science Data Services. The details contained in the excerpts used to illustrate the findings have been changed to ensure anonymity.

Findings

In all four therapy processes, the clients’ use of violence was addressed repeatedly. There were, however, distinct differences in how the therapist and client engaged in the topic of acting violently in sessions with Elliot and Edward compared to sessions with Charles and Colin. From the clients’ position, two different core scripts pertaining to the ways in which they explained their use of violence were identified. One script presented violence as a response to “the annoying other”, while the other script interpreted violence as from the result of “hopeless me”. The script of “the annoying other” was introduced by Elliot & Edward, and Charles & Colin used the script of “hopeless me”. Although the clients could explain their use of violence against partners and children by reference to both scripts, they mainly and consistently engaged in one of them. The therapists approached these core scripts by exhibiting two different interactional patterns: repeated exploration of the script “the annoying other” and repeated explanation of the script “hopeless me”. These interactional patterns were identified as superordinate themes. Each interactional pattern was associated with a distinctive set of therapist strategies for creating changes. These strategies were identified as subordinate themes. Table 2 provides an overview of the two interactional patterns as superordinate themes and the therapeutic strategies that each interactional pattern seemed to facilitate as two sets of subordinate themes.

Table 2. Interactional patterns for addressing core scripts and therapist strategies.

Superordinate theme: Interactional patterns for addressing core scripts of violence
Repeated explorations of the core script of “the annoying other”	Repeated explanations of the core script of “hopeless me”
Subordinate themes: Therapist strategies
Specifying personal problems in ways that facilitate agency Including personal history to access feelings and needs in the present Encountering new incidents of violence as opportunities to expand relational involvement Practicing caring responses to facilitate awareness Exploring partner/children as subjects with needs and feelings	Explaining and describing “hopeless me” in general terms Using personal history to explain present personal problems Validating the client as human Encountering new incidents of violence as exceptions from otherwise positive progress Teaching caring responses to learn new skills Constructing partner/child as someone to be handled

In the following, the interactional patterns of engaging in the core scripts of violence and the constituent therapeutic strategies for change are presented and discussed in further detail. The findings are then illustrated by reference to excerpts from conversations between clients and therapists.

Repeated explorations of the core script of “the annoying other”

When the therapists and clients tried to make sense of clients’ violent acts in the cases in which violence ended, Edward and Elliot described violent events as being triggered by the partner’s or children’s disrespectful, annoying, or unfair behaviors. These behaviors created difficult feelings in the clients that could lead to the use of violence. Edward’s frequent repetitions of the ways in which his wife’s unjust accusations and criticism affected him can illustrate this script.

Client (C): “I find it difficult to deal with all those accusations that I know are wrong. (Therapist (T): yeah) And I think that the violence that’s just happened is a sort of wounded pride where I actually feel that I’ve done reasonably well (T: yeah) and wanted things to be good (T: yeah), and then it’s been misunderstood and portrayed as if it’s “oh no, you probably wanted to hurt me”.

Both Edward and Elliot tried to prevent violent actions by not letting the partner or the children’s annoying behavior upset them. However, they viewed this solution as vulnerable, as they were able to suppress the annoying effect of their partner only for a limited period and were thus vulnerable to acting violently once again.

The mode of interaction between the two parties was characterized by the therapist exploring what was at stake for the client in situations in which he viewed the partner or children as annoying. The two participants in the therapy explored the client’s actions, thoughts, feelings, and intentions to help him reflect on his agency and experience his state of mind in the here and now as well as the states of mind of his partner and children. Client responses to therapist explorations were characterized by investigations of their own feelings and intentions.

An excerpt from one of Edward’s therapy sessions can illustrate the mode of exploration as a means to experience. Edward noted that although he felt that his partner should recognize that he had changed, he could understand that she found it difficult to forget past violent events.

T: You get it. So, when you say that you get it, do you feel something when you say that you get it?

C: Yeah, no, feeling a sort of sadness that it [violence] happened at all. (T: yeah) And a real sorrow that it affected her, who I love so much. (T: yeah) So, yeah.

T: If I were to ask you, in the here and now, do you feel anything right now?

C: Yeah, it is a bit like, almost like really miserable.

C: Yeah (C: mm) makes sense. (C: mm) I felt it a bit too. Do you feel something, feel it in your stomach or something like that?

T: Mm. Yeah, I feel, well, yeah (T: yeah) mm. Because the intention was totally different, you know? (T: yeah) Mm.

T: I can see that.

The therapist’s exploration of Edward’s feelings seemed to help him transform his impatience with his wife’s reactions into feelings of sadness and regret. This change in emotions emphasized past violent acts as severe experiences that affected his relationship with his partner. He considered how important she was to him and his intention of becoming a more affectionate partner. As such, the script of “the annoying other”, which might be understood as externalizing one’s responsibility for acting violently, was transformed into an opportunity for self-reflection and change. The following therapist strategies constituted repeated work addressing the script of “the annoying other”.

Specifying personal problems in ways that facilitate agency

The therapists approached the script of “the annoying other” by directing the client’s attention away from his partner’s and children’s actions and toward his own feelings. For example, the therapist explored the client’s inner states when he perceived the partner as annoying.

T: What happens to you then, Edward, when you … say you’ve done certain things, and really exerted yourself, and then you get criticized. What do you feel inside then, do you think?

C: Well, I feel sort of very disappointed then. So, I certainly feel that I actually have just as much reason as her to be displeased (T: yeah) or hurt (T: yeah). But she is the one who has a monopoly on that.

T: So, you’re not allowed to have … you should not feel hurt or disappointed or upset or … ?

C: Well, it’s a bit me, but there is something there … I generally put myself and my feelings slightly in the background.

T: Yes. I think so too.

Through such exploration, the therapist and client were able to clarify and specify the client’s personal problematic pattern, which provided direction for their subsequent collaboration. Edward’s stories about the annoying wife were thus transformed into explorations of his struggle to express his vulnerable feelings, his fear of not being good enough, his expectations regarding the way in which he and his wife should express affection toward each other, and how he could contribute in ways that his wife would perceive as expressing affection.

Including personal history to access feelings and needs in the present

Another therapist strategy was to explore the history of the client’s personal problem in ways that helped the clients obtain access to their feelings and needs in the present and become more coherent. In Elliot’s therapy, his use of violence against the children was first connected to how he was raised by his father. If he did not obey his father, he was beaten. The therapist explored his experiences as a little boy and indicated how she observed him.

T: But, I, to me it sounds like you did it [obeyed your father] because you were afraid?

C: Yes, probably that too. Yes, that’s quite clear. I couldn’t talk back, are you crazy? Haha, ugh! Would’ve been tossed out. You weren’t allowed to talk back. Are you crazy!

Working through his traumatic experiences from childhood both illuminated and differentiated the fear he felt as a child and the fear and need for control (domination) he felt as a father. This process helped him explore more caring ways of relating to his children.

C: When I think about it [how I want to be as a dad], then I try to understand … eh … try to understand what the children are thinking. I am! I’m trying to… I don’t know. Maybe I should have done that. Try to imagine, when I say something, try to imagine how they’re feeling. I don’t do that.

Encountering new incidents of violence as opportunities to expand relational involvement

Although the clients disclosed that they handled most experiences with “the annoying other” without using violence, they also revealed that they had re-exposed the partner or the children to physical or psychological violence during the therapy process. The therapists addressed these disclosures as an opportunity to explore the client’s perceived meaning of his violent acts for himself, for his partner and for their relationship. This therapist strategy highlighted the severity of violent actions toward the partner and children and the client’s responsibility for continuing to engage in further therapeutic work.

For example, through thorough exploration of the fact that Edward had hit and, for the first time, threatened to kill his wife, Edward realized that although he knew that he could never have killed her, she must have been extremely frightened. His understanding of her thus changed from a view of her as an annoyance to recognition of the fact that she became fearful due to his actions. He became aware that he had to work on who he wanted to be as an intimate partner and the question of whether it was possible for him to repair their relationship. Thus, the repeated use of violence was interpreted by both the client and the therapist as a sign of the client continuing to have important issues to address in therapy.

Practicing caring responses to facilitate awareness

While working on the script of “the annoying other”, the therapists also attended to ways in which the clients could prevent themselves from acting violently. The therapists thus intervened in the session by offering ways in which the client could practice and rehearse sensitive responses in situations that would typically lead to the use of violence. They arranged role-playing exercises in which the client could experiment on ways of responding to his partner and children in a caring manner. In the following example, Elliot wanted to support his son and to avoid dominating or criticizing him for spending too much time gaming.

C: I have to say to him “I am desperate; I don’t know what else, what else I can do. I only want what’s best for you; I want you to get back on your feet, start doing stuff, having fun”.

T: Yeah. “Because I love you”, hm, “’cause I care about you”.

C: Yeah, “’cause I think about you”, and like, “when I think about you sitting here the way you do, I get really sad”.

T: Mm. Yeah, you can say that. You can tell him that …

C: “And you”, say like, “You used to be happy, going out with your mates, and now you’re sort of just sit there, and … ”

T: Maybe you shouldn’t tell him all that.

C: No, right, that’s when I go back to criticizing.

Such practicing helped the client become more self-aware in the moment of acting. Almost immediately after receiving the therapist’s feedback, Elliot discovered that he was accusatory. He was self-aware when he formed the intention to become involved with his son in a caring manner; however, when he acted, he appeared to lose such awareness until his initial intention was disturbed; thereafter, he became aware that his intention had changed from being supportive to being defensive and accusatory.

Exploring the partner/children as subjects with needs and feelings

From the very beginning of therapy, the therapists remained attentive to the clients’ comprehension of the partners’ or children’s state of mind and validated them when they described the feelings or reactions of the other. At the beginning of therapy, the therapists asked whether the partner or children were frightened or how they reacted when the client acted violently. However, as the therapy proceeded and the therapeutic relationships grew stronger, the therapists investigated not only the partners’ reactions to violence but also their feelings and intentions in the situations in which the client felt attacked.

T: Yes, because if we had to guess, what is it she really… if we had to guess, I sort of had the thought, what she really, if we were to attach an emotion to what she’s really saying, what would you guess that it was, if you were her?

C: No, well, I was going to say, “Love me so that I’ll understand you”, in a way.

This excerpt demonstrates that toward the end of therapy, Edward was able to understand his partner’s behavior even when it was disappointing and thus annoying to him. He recognized that her critique came from a different state of mind in her – her need to feel loved by him. The clients’ capacity to attribute agency and positive characteristics to the state of mind of the partner and children gradually replaced their description of them as annoying. In the final session, Elliot described how he had shifted his focus as a father and that this shift may explain why he had become less angry.

C: “I’m not so… it might sound weird, but I’m not so concerned now with, um… (that) the children do what I want them to do (…) As for the oldest one, I think that I’ve finally realized that it’s up to him to run his own life now. But, I’m there if he needs, needs anything”.

The foundation of these therapist strategies consistently focused on exploration of the client’s state of mind to expand his experience of self and the other and enabling him to practice caring ways of relating to the other. The therapists paid attention to the client’s state of mind to specify and refine therapeutic goals and tasks and searched for the client’s agency. The client’s initial understanding that he could stop acting violently by tolerating provocations better was expanded to an understanding that change could be achieved by exploring and becoming more familiar with his problematic patterns and the ways in which he experienced himself in relation to his partner and children. Such enduring engagement with the script of “the annoying other” seemed to help the clients develop more supportive and caring recognition of their partners and children.

Repeated explanations of the core script of “hopeless me”

Charles and Colin explained their use of violence by emphasizing their own problematic characteristics. They reported that they were usually grumpy in the morning, easily stressed, control freaks, or suffered from periods of depression. These qualities made them vulnerable to becoming angry and perpetrating violence. These traits were especially unfortunate, as both clients were fathers of preschool children who do not know anything about stress. Thus, Charles and Colin did not emphasize the behavior of partners and children as reasons for acting violently. Charles’s explanation of his use of violence illustrates the core script of “hopeless me”.

C: Yeah, right, so … .99% of the times when you’re at, when you’re angry or having problems. I feel that it’s that you don’t do anything. I am not dealing with it. (T: hm.) There’s a lot of things you could do. (T: yeah) But, then, chose not to (exhales) you know. (T: mhm). That’s at the heart of it, I would have loved for someone to give me a bit of a kick, so that I could have gotten (short silence). Or a poke (snaps fingers), reset my head. (T: mhm). Be calm, not sort of like … let anger, take control. (T: hmh) Take over. (T: yes) That … ’cause you lose control then.

Charles’ and Colin’s initial solution to end their use of violence was to control their hopeless feelings and reactions. They expressed that it was puzzling and frustrating to them that they continued to act in a way that they knew was wrong. Upon entering therapy, they hoped that the therapist could help them eliminate their hopeless reactions.

The interactional patterns of these two therapist-client pairs were characterized by the therapist’s attempts to explore how the client’s bothersome characteristics triggered his violent acts. Both Charles and Colin struggled to describe how the events of violence unfolded explicitly and to express how they had felt in relation to the partner or children when they perpetrated violence. This situation seemed to encourage the therapists to respond by explaining and making premature conclusions regarding what was at stake for the client. The clients noted that the therapist’s interpretations seemed reasonable. However, such explanations did not seem to increase the clients’ sense of agency or provide direction for further therapeutic tasks.

The therapist’s effort to help Charles describe a quarrel with his partner that ended in violence from beginning to end, such that they could understand what made him act violently, can illustrate this interactional mode that tended to end prematurely in explanations.

C: Yeah, she’s brought it, brought it up with me [that I work too much], and I’ve taken it badly. ’Cause I feel …

T: Has she brought, brought it up in an OK way, you think, or has she … ?

C: (pause) No, I think, I mean. I … she, I can’t quite remember (T: no) But in my head I’ve probably taken it badly then.

T: So, you’ve at least experienced it as an attack or … ?

C: Yeah.

Instead of exploring Charles’ initial reflection on how he felt in relation to the partner’s request, the therapist claimed that Charles experienced it as an attack. As such, a script on violence that “highlighted” the client’s personal struggle as the reason for using violence was transformed into a pattern of avoidance and stagnation. This repeated engagement with the script of “hopeless me” comprised the following therapist strategies.

Formulating personal problem in general terms

In their effort to formulate how stress and grumpiness were transformed into anger and violence toward partners and children, the therapists made suggestions regarding how clients might have felt or perceived the other during the specific violent incident they explored. Such therapeutic work often developed into conversations that could appear personal but nevertheless took the form of a conversation on a generic phenomenon:

C: It’s just like, I don’t know. You’re just so damned angry, I get so damned scared of emotions or of my emotions.

T: Anger is an easier emotion.

C: It’s as simple as. Either I suppress them, keep them at a distance. Or, yeah. (T: or you what?) Express, express them.

T: Through anger?

C: Through anger.

T: Yeah, right. Anger is largely a defense against other emotions.

The therapist’s general responses about anger and its functions obviated the possibility of elaborating on the client’s fear of his emotions. Although this strategy could help the client describe what seemed to be at stake for him in situations in which he acted violently more precisely, these descriptions were formulated as explanations for the use of violence and continued to position the client as “hopeless”. In Charles’ therapy, his low tolerance for stress developed into the knowledge that he could easily feel attacked and rejected by both his children and his partner, even when there was no objective reason for those feelings. The discovery of these feelings of rejection was formulated as a reasonable explanation for his use of violence; it caused him to defend himself by acting violently. Instead of exploring and identifying what kind of feelings and meanings Charles connected to the experience of rejection or critique and how violence became a solution to him in such situations, the therapist suggested that Charles could control his reactions by being more accepting toward himself and the other when he felt rejected. As such, the therapist and client were not able to clarify and process the more vulnerable feelings that might be embedded in the experience of rejection or critique.

Using personal history to explain present personal problems

To make sense of the client’s vulnerability, the therapist searched for connections in the client’s personal history. The therapist asked whether the client had childhood experiences that resembled or could illuminate in other ways his use of violence in the present. In Colin’s sessions, the therapist explored episodes in which he was punished physically.

T: What do you remember? Do you remember these episodes?

C: Eeh, yeah, I remember a couple of them, but not any … Yeah, I remember a couple of them. I remember my ear getting hot when she pulled it.

T: Do you remember how you felt, being handled that way?

C: Eh … Yeah … Partly, at least for the episodes I can remember.

T: Has your parents’ way of handling you helped you in any way?

C: I don’t know … eh … maybe it has.

T: Could it have hurt you?

C: No, I don’t think so. I don’t think it has hurt me in any way. I don’t feel it has. It didn’t happen very often. Maybe it helped me see the importance of being a decent person.

By prompting Colin to consider the negative effect of his mother’s physical punishment, it appears that the therapist wanted to help him understand that physical punishment was harmful to his children. However, Colin had already indicated several times that he was worried about the way in which he treated the children. Thus, addressing childhood incidents in this manner seemed to be a derailment from the task of clarifying what was at stake for Colin in difficult situations with the children and how he gave meaning to the children’s behaviors. Additionally, in Charles’ therapy, his vulnerability to feeling rejected was explained by reference to his childhood experiences. Since he had felt a lack of love from his parents, he could easily feel rejected. However, the questions of how he experienced his parents’ neglect in the here and now and how he could process such feelings did not become the center of attention. As such, the client’s personal history became an explanation of his hopelessness and not a perspective that could differentiate and give nuance to the feelings that he felt in relation to his partner and children.

Validating the client as human

Another strategy the therapists used was to foster the client’s self-acceptance. Instead of exploring the client’s resentment and resignation of his own reactions, the therapist normalized his reactions. The therapists appeared to interpret the clients’ frustration with their own shortcomings as unhealthy self-criticism. The therapist’s response when Charles discovered that he was constantly preoccupied with his own needs and did not pay attention to the needs of his partner and children may illustrate this strategy of reassurance.

C: Everything I say sound so damned egoistic.

T: Oh, do you think so?

C: Because it is only my needs all the time. I have expectations that should be fulfilled. Instead of paying attention to those at home and creating safety, being safe “hands”. [Circle of Security].

T: Right, everyone needs to be held, in a way. Right?

C: Yeah, that goes for adults too.

T: Yeah, that goes for adults too. Right. And how can adults have their needs met? That might be important to reflect on.

C: Yeah, I think so. Perhaps I don’t get, have my needs met by my wife. Perhaps not satisfactorily enough.

By claiming that everyone has needs, a general statement, the therapist lost the opportunity to scrutinize Charles’ discovery that he missed out on his partner’s and children’s needs. This therapist strategy seemed to hinder further investigation of what seemed to be significant client contributions that could have been explored to enhance an empathic view of the partner and children.

Encountering new incidents of violence as exceptions from otherwise positive progress

When Charles and Colin revealed having acted violently during therapy, they expressed frustration for taking the partner’s critique personally or not tolerating the children better as well as their disappointment for being unable to continue their good progression in the task of not using violence. The therapists assessed what types of violence that had been used and if whether the client had perpetrated more severe acts of violence than he initially disclosed. Based on such “assessments”, the therapist could conclude that the violence was not so severe by comparing the client’s acts to more brutal forms of violence. Furthermore, the therapist could interpret Colin’s grumpiness, stress, and tendency to use force against his children as normal but inappropriate reactions to a demanding life situation with small children. The client’s repeated use of violence was constructed as an exception from the otherwise good progress the client had made during therapy and remained a sign of the client’s insufficient skill at regulating and controlling his aggression.

Teaching caring responses to learn new skills

To help the client avoid acting violently, the therapists taught the client different strategies that they could apply in situations that they struggled to handle calmly. For example, Charles’s therapist claimed that by being aware of his tendency to feel rejected and accepting that this tendency was merely a matter of his feelings and not of real rejection by the partner and children, he could develop a tolerance for such vulnerable feelings and thus avoid responding to them automatically.

C: Yeah. I think you’re right in what you’re saying, that it’s very important that I think that now it is. That it’s my defenses working right now, and then the stress comes, and then the anger. And then feel it and breathe deeply. I feel breathing helps a lot. You know, breathing technique.

T: So, if you could manage to say something like. I mean, thinking along the lines of. What kind of attitude do you want toward yourself in this situation, you know? If you could manage in a way to be sort of, sort of empathic and understanding toward yourself. (C: OK.) If you could manage that. A bit like. Oh, yeah, here you are again, you know. You’re having a hard time right now. (C: Mhm.) Something like that, do you know where I’m heading with this?

C: Yeah. Maybe try and add some humor into it too?

Furthermore, when the clients disclosed perpetrating violence against their children, the therapist could respond by referring to research documenting the ineffectiveness of punishment and start teaching the client about children’s needs and how to respond in a caring manner.

Constructing the partner/child as someone to be handled

In the “hopeless me” cases, we observed little work on how the client comprehended and considered the female partner’s feelings, needs and intentions. In their dialog, the partner remained an object without agency. She was constructed as a person whom he either had to handle or a person who unfortunately had to endure him. However, the therapist frequently addressed the client’s violent behavior toward children. The therapists explained explicitly that violence against children damaged the development and attachment of those children and noted that it was important for the client to acquire better parental skills. In the case of Charles, the therapist involved child protective services. Both clients were enrolled in parental skill programs. Charles was instructed that if the child could be interpreted as being at the bottom of the circle, he should try to move closer to the child to comfort her. Although such parenting was much safer than shouting at the child, it appeared to be instrumental. The child was viewed as a child in general, and the clients did not expand and deepen their understanding and empathy for their specific daughters and sons. For example, in the final session, Charles disclosed that he felt more affection for the children and partner. Nevertheless, he continued to struggle, but it was unclear whether that struggle referred to his use of violence.

C: I don’t feel so easily attacked by her and the children now. I can feel more love and affection for both them and myself, and I’m more aware and take the right choice more often. However, now and then, I forget myself. It is like a crazy voice is screaming inside me, and it’s very easy to listen to it.

These therapist strategies consistently focused on explanations and interpretations that were intended to help the client become more aware and conscious of the feelings and personal problems that made him vulnerable to act violently. The rationale appeared to be that becoming more aware and accepting of their own feelings enabled clients to stop themselves from acting violently. As such, the therapists followed the client’s initial understanding of change, which maintained that they could stop using violence by reducing their stress. The repeated work on the script of “hopeless me” seemed to reduce the client’s possibility of experiencing and expanding his perception of his own state of mind as well as of the partner’s and children’s state of mind.

Discussion

This in-depth analysis of interactional patterns in IPV therapy illuminated important nuances regarding how to identify effective therapist strategies to obtain favorable outcomes. In this study, the interactional patterns of exploring and explaining were connected exclusively to either the core script of “annoying other” or “hopeless me”. All four cases seemed to feature a tight connection between repetitious engagement with the core scripts and therapist strategies. This fact does not necessarily indicate that the scripts of violence were the unavoidable cause of the strategies. Rather, the two scripts seemed to make different modes of strategies of recognition and change available to the therapists. We argue that findings such as these offer new theoretical perspectives on IPV therapy. Namely, the difference between aspiring to control one’s own aggression and aiming to end the use of violence in combination with developing safe and caring ways of relating truly matters to clients and to their partners and children. The findings have the capacity to challenge some theoretical assumptions regarding how IPV therapy works.

Contrary to expectations, the core script of “the annoying other” seemed to work better as a joint focus than the script of “hopeless me”, a finding for which there are some possible explanations. One might assume that because the script of “the annoying other” consisted of detailed descriptions of how the partner’s behavior became annoying and how he reacted, it was easier for the therapist to explore the client’s problematic pattern as it is embedded in his perception of the partner. In contrast, although the script of “hopeless me” acknowledged that the use of violence was connected to personal struggles, this script also conveyed a form of self-criticism, resignation, and a plea for understanding. Perhaps the repetitious return to this script misled therapists into believing that the client felt more responsible for his violent acts than he actually did. Such self-criticism and despair might have elicited comfort from the therapist with the aim of bolstering the client’s hope for change as well as explanations from the therapist to foster client insight and indicate a direction for change.

The design of this study does not allow for any determination of a causal relationship between the in-session processes and outcomes. However, several aspects indicate that therapist strategies based on explorations were more successful than those based on explanations. Clients’ use of violence may serve to enable them to avoid the painful feelings and self-schemas activated by situations featuring the partner or children. Thus, we might assume that the painful feelings, thoughts, and intentions clients sought to avoid were embedded in both scripts of violence. Exposure to feared and avoided stimuli is a change mechanism that has been well documented to reduce anxiety and increase client exploration and agency (Hirai, Vernon, & Cochran, 2007). The therapist strategies that gave the client the opportunity to experience his feelings, thoughts, and intentions could be interpreted as forms of exposure therapy, in that these strategies assisted clients in achieving closer contact with painful or disturbing inner states (Wachtel, 2011). Instead of avoiding painful information, the client was helped to approach these topics – both by reflecting on and practicing ways of relating to them – which seemed to increase his sense of agency (Rennie, 1994, 2004). Thus, we might assume that the client’s reflections on his feelings and actions regarding his intimate partner and children facilitated his awareness of them and allowed him to undergo new and corrective experiences (Castonguay & Beutler, 2006).

In contrast, therapist strategies that relied on explanation helped the client understand the connection between his feelings and actions intellectually but prevented deeper exploration of the emotional experience of “hopeless me” and thus created a kind of distance between the client and the needs of the significant other. Additionally, the general explanations provided may have hindered client exposure to specific issues and thus enabled the client to continue to avoid painful feelings. The therapists’ explanations also seemed to position the client as a recipient of the therapists’ clarification instead of facilitating his self-exploration (i.e. reducing his sense of agency).

Indeed, both core scripts of violence gave the impression that clients experienced a lack of agency regarding their feelings and actions toward their partners and children. Therefore, it might be especially important for IPV therapists to foster client agency. The methods that clients themselves identified as helpful during therapy support the importance of fostering agency (Castonguay et al., 2010). For example, clients have reported becoming more curious about themselves when the therapist encouraged sustained exploration of how they interacted with their significant others (Fitzpatrick, Janzen, Chamodraka, & Park, 2006; Fitzpatrick, Janzen, Chamodraka, Gamberg, & Blake, 2009; Levitt, Pomerville, & Surace, 2016), and a thorough understanding of the challenges they faced was more helpful for arriving at a solution than therapists’ persuasion (Levitt, Pomerville, & Surace, 2016). These client reflections fit the processes we observed in the repeated and enduring exploration of the core script of “the annoying other” in which both the client and the therapist were engaged.

Both scripts of violence also identified avoidance as an initial solution to end the use of violence either by not allowing the annoying behavior of the other to upset them or by eliminating their hopeless feelings and reactions. The therapist strategy of exploring offered a different theoretical assumption for change by conveying to the client the importance of scrutinizing one’s own feelings and reactions toward others as well as investigating the partner’s state of mind. This finding might illuminate the fact that in the later phases of therapy, Edward and Elliot could describe how their ways of relating to partner and children affected the significant other in a more nuanced manner. Both men were able to express more empathic views of their partners and children. Conversely, the therapist strategy of explaining suggested that the perpetration of violence could be prevented by trying to control and accept intense feelings of hopelessness (i.e. feelings of being rejected) simultaneously. Thus, the clients continued to pursue their initial solution to terminate (get rid of) their own hopeless reactions – a solution that was demonstrably not helpful in the first place (Watzlawick, Weakland, & Fisch, 1974). The disclosures made by Charles and Colin in the final session, which indicated that they had mostly succeeded in becoming aware of their own vulnerability and stopping themselves from reacting aggressively, are in line with the solution of aggression control.

We also highlight the salient finding that the client and therapist repeatedly and enduringly involved themselves in the client’s core script on violence. From a developmental perspective, the clients’ return to the same starting point despite the awareness and reflection shared during the previous session can be understood by reference to the concept of the zone of proximal development (Stetsenko, 1999). The client’s repeated engagement in the core script describes the actual level of development that the client could ensure on his own, while the perspectives developed in the course of a session demonstrate the client’s potential level alongside the therapist at that specific time (Vygotsky, 1978). The concept of procedural learning might also illuminate the value of repeated work. Complex activities (such as trusting the other, interpreting the other’s state of mind and processing one’s own feelings) must be repeated until all the relevant neural systems cooperate automatically to reproduce such activity (Grigsby & Stevens, 2000).

However, such repeated work was helpful only when the therapist applied the strategy of exploring that facilitated new client experiences. In such cases, repetitions are not a sign that the therapy is ineffective; instead, they signify that the client needs repeated exposure to develop and maintain new relational skills on his own. Similar interactive patterns of persistence have been observed to be helpful in psychotherapy with clients who experience difficulty trusting people (Halvorsen, Benum, Haavind, & McLeod, 2016). In line with this finding, we argue that therapy programs that feature a fixed number of sessions or are organized around preset topics might prevent such useful and necessary repetitive work.

Limitations

The comparisons of long-term therapies in which the client ended or continued the use of violence performed in this study were based on male clients’ self-reports regarding their use of violence immediately after completion of therapy and at follow-up. The assumption that Edward and Elliot no longer perpetrated violence and that Charles and Colin continued to use violence was also confirmed through inspection of what was said in the sessions during the final phase of therapy. Nevertheless, determining how IPV therapy may lead to reliable and enduring changes is a complex task. We also had access to partner reports of violence, with the exception of one case in which the female partner had ended the relationship and was unavailable. As male clients tend to report less violence than their partners (Strandmoen, Askeland, Tjersland, Wentzel-Larsen, & Heir, 2016), the report from this female partner would have strengthened the conclusion that this client’s violence had ended.

We should also note that certain qualities of therapists or clients could play a role in the outcome of IPV therapy; these qualities cannot be tested using a design based on analyses of interactions and processes of change over many sessions selected from a small number of cases. For example, the fact that Elliot and Edward met with a female therapist and Colin and Charles met with a male therapist might give the impression that the therapist’s gender is important to the therapy process and outcome. On the other hand, this finding could also be a coincidence. In addition, it is unclear how deliberate therapists’ strategies were. However, therapist qualities such as gender, experiences, and deliberation could be explored further through follow-up interviews with the therapists or by scrutinizing the performance of the therapists with a larger number of clients over time to identify recurring patterns. Thus, we consider our results to be based on a combination of client and therapist characteristics.

Implications

All four clients who participated in this study established an early alliance pattern with the therapist that could be conceptualized as co-creative exploration – the type of alliance pattern that seemed to be most successful (Lømo, Haavind, & Tjersland, 2021). The fact that the clients exhibited different levels of success in ending their use of violence indicates that the alliance pattern of co-creative exploration may be sufficient for engaging the client in attending therapy and reaching an agreement regarding therapy completion but is nevertheless not sufficient to help the client end his violent behavior and develop safe and caring ways of relating to his partner and children.

One implication of these results is that IPV therapists should be aware of how the client’s core script on violence impacts their interventions. The concepts of interactional patterns of exploring and explaining alongside the associated therapist strategies might help therapists be more aware and adjust their interventions in their moment-to-moment work with clients. A second implication is that therapists could evaluate clients’ progress in therapy by paying attention to whether the client gradually responds with self-reflection and interest in the needs of the significant other, as seen in the repeated work on the script “annoying other”, or whether the client instead merely repeats his frustration regarding his inability to act differently, as in the “hopeless me” script. Perhaps an exploration of the client’s feelings of hopelessness and the ways in which these feelings affect him might enable the client to establish closer contact with his own state of mind. A third implication is connected to the finding that IPV therapy seems to foster change gradually and slowly. IPV therapists should therefore be aware of the fact that the acute need for safety by partners and children must be obtained through means other than psychotherapy, i.e. through child protective services.

Conclusion

A good outcome in IPV therapy goes beyond merely avoiding the use of violence. A good outcome also includes a qualitative change in the clients’ view of the partner and children, which seems to help them relate to the significant other in a more caring and safe manner. Our findings suggest that both the solution of controlling anger and the therapist strategy of explanation tend not to promote clients’ safety in their own view or from the perspective of the significant other. The aim of therapy should be to explore the clients’ initial script of violence extensively with the aim of overcoming their basic assumptions and expanding their understanding of the partner and children’s state of mind sufficiently for them to feel safe and to act safely.

Acknowledgement

We would like to acknowledge John McLeod, Emeritus Professor of counselling at the University of Abertay Dundee, for his valuable comments to earlier versions of this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction http://dx.doi.org/10.1080/09515070.2023.2252719

Additional information

Notes on contributors

Bente Lømo

Bente Lømo, PhD., educated at the Department of Psychology, University of Oslo in 1993. She is a specialist in clinical psychology and a researcher at the Norwegian Centre for Violence and Traumatic Stress Studies. Central in her research is working alliance in intimate partner violence treatment, qualitative analysis of therapy processes and outcome. She has worked as a clinical psychologist for several years, with both perpetrators and survivors of domestic violence, and adults with substance abuse.

Hanne Haavind

Hanne Haavind, dr.philos, professor in clinical psychology, educated at the Department of Psychology, University of Oslo, and has since 1992 been a professor at the same department. She is a specialist in clinical psychology. For approximately 15 years full-time, she has worked as a clinical psychologist with children, youths, adults, and families. Central in her practice and research are personal development and sociocultural change, child care and social changes in parenting and family life, analyzing gendered meanings, and interpretative methods in clinical and social psychology.

Odd Arne Tjersland

Odd Arne Tjersland, dr.philos, professor in clinical psychology, educated at the Department of Psychology, University of Oslo in 1974. He is a specialist in clinical child psychology (1986) and in clinical family psychology (1995). For approximately 15 years full-time, he has worked as clinical psychologist with children, youths, couples, and families. Central in his practice and research are family conflicts connected to separation, concerns about sexual abuse, violence, and substance abuse.