ii

USE OF FEMINIST FAMILY THERAPY TO TREAT INTIMATE PARTNER

VIOLENCE IN SAME-SEX COUPLES

Rachel Bell

Dissertation

Approved:

Advisor Dr. Heather Katafiasz Committee Member Dr. Rikki Patton Committee Member Dr. David Tefteller Committee Member Dr. Bernard Jesiolowski Committee Member Dr. Wondimu Ahmed

Accepted: Department Chair Dr. Varunee Faii Sangganjanavanich Acting Dean of the College Dr. Timothy M. McCarragher Interim Director of the Graduate School Dr. Marnie M. Saunders Date

iii

ABSTRACT

In the last 30 years, researchers have seen a steady increase in violence among

same-sex couples (Rolle et al., 2018). Current statistics show that same-sex couples

experience intimate partner violence (IPV) at a rate 25% higher than heterosexual couples

(National Coalition Against Domestic Violence [NCADV], 2019). In an effort to curb

the growing incidents of violence, mental health treatment providers have begun using

Feminist Family Therapy (FFT) to treat same-sex couples. The feminist approach is the

most widely recommended modality to treat IPV in all couples because it is believed to

address a core cause of violence (Bohall, et al., 2016): an imbalance of power; however,

it has faced criticism since it was originally designed to address unequal gender roles in

heterosexual couples. Questions have also been raised regarding the model’s

effectiveness because rates of violence continue to rise. Proponents of the model argue

that same-sex couples are less likely to seek out services when experiencing violence in

their relationship so the model’s effectiveness cannot be measured by these statistics. In

this study, a descriptive analysis and one-way ANOVA assess whether clinicians report

using FFT and whether criticisms of the approach influence its use. Analyses revealed

that the participants reported high levels of usage of the approach, although only 1.8%

identified it as their primary theoretical orientation. Results also showed that

participants’ level of agreement with the criticisms of FFT significantly influenced their

use of the approach.

iv

ACKNOWLEDGEMENTS

I have been a graduate student at the University of Akron for almost 10 years and

it goes without saying that this time has not been without its challenges. Throughout

those times, I have had the support of many around me and I do not believe I will ever

find the words to express the extent of my gratitude, but I will try. To Drs. Rebecca

Boyle and Karin Jordan, thank you for your challenges and your encouragement. To Dr.

Patton, thank you for your kindness and your authenticity. To Dr. Tefteller, I cannot

express enough gratitude for the ways in which you have supported me without hesitation

since we have met. It will never be forgotten. To Dr. J., I thank you for the validation

you provide every time we interact. I have cherished every conversation. To Dr. Ahmed,

thank you for your endless patience as I stumbled through my chapter four. To Dr. K.,

whom I have known almost my entire Akron career, thank you for all you have taught me

along the way. Thank you for not letting me give up on myself or this degree.

Additionally, I thank those that have been my support outside of school. To my mom,

thank you for listening to every part of my graduate education, even when you had no

idea what I was talking about. To James, thank you for never letting me give up. To my

college mentor, Dr. Frank Hamilton, who remains invested in my success to this day,

thank you for reminding me of my potential and for believing I can do anything. Finally,

I would like to dedicate this manuscript to my dad, who would have been too excited for

words to witness this accomplishment. I hope I have made him proud.

v

TABLE OF CONTENTS

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

LIST OF FIGURES……………………………………………………………………….x

CHAPTER

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

Conceptual Framework……………………………………………………………2

Intimate Partner Violence………………………………...……………….2

Types of IPV………………………………………………………………3

Intimate Partner Violence Among Same-Sex Couples……………………5

Feminist Family Therapy and Intimate Partner Violence Among Same-Sex

Couples……………………………………………………………………7

Overview of Proposed Research…………………………………………...…….. 7

Research Goals.………………………………………………..…………. 7

Research Questions and Hypotheses……………………………………...9

Operational Definitions.……………………………………….………..... 9

Summary……………………………………………………………………..…..10

II. LITERATURE REVIEW……………………………………………………………. 12

Feminist Family Therapy………………………………………………………...12

Therapeutic Relationship………………………………………………...14

Gender……………………………………………………..……………..15

Egalitarian Relationships………………………………………………...15

vi

Empowerment……………………………………………………………16

Affirmation of the Less Powerful………………………………………..16

Power…………………………………………………………………….17

Interventions……………………………………………………………..17

Evolution of Feminist Family Therapy…………………………………..18

Clinical Use of Feminist Family Therapy………………………….…………….20

Criticisms of the FFT Approach ………...………………………………………21

Feminist Models for Treatment of IPV…………………………………………..24

The Duluth Model…………………………………….……………….....25

Criticisms of the Duluth Model………………………………………….27

The Integrative Feminist Model………………………………………....28

Criticisms of the Integrative Feminist Model……………………………29

Feminist Family Therapy to Treat IPV in Same-Sex Couples…………….…….30

Restatement of Research Questions and Hypotheses……………………………35

Summary…………………………………………………………………………35

III. RESEARCH METHODS……………………………………………………………36

Restatement of Research Goals………………………………………………….36

Restatement of Research Questions and Hypotheses…………………...……….37

Research Design…………………………………………………………………37

Participants………………………………………………………………………38

Criteria for Participation…………………………………………………38

Solicitation of Participants…………………………………………….…38

Incentives for Participation………………………………………………39

vii

Description of Sample……………………………………………………39

Sample Size………………………………………………………………40

Procedure…………………………………………………………...……...…….40

Data Analysis Method………………………………………………..…………..41

Measures…………………………………………………………………………41

Demographics Questionnaire………………………………………….…42

Feminist Family Therapist Behavior Checklist………………………….42

Adapting the Feminist Family Therapist Behavior Checklist……………43

Feminist Criticisms Questionnaire……………………………………….43

Summary…………………………………………………………………………43

IV. RESULTS………………………………………………………………………...…44

Restatement of Research Questions and Hypotheses…….……………………...44

Data Collection…………………………………………………………………..45

Demographic and Descriptive Statistics…………………………………………45

Recoding and Transforming of Variables………………………………………..49

Research Question One…………………………………………………………..50

Research Question Two………………………………………………………….51

Summary of Results……………………………………………………………...53

V. DISCUSSION………………………………………………………………………..55

Discussion of Overall Findings…………………………………………………..55

Demographics……………………………………………………………56

Research Question One…………………………………………………..56

Research Question Two………………………………………………….57

viii

Limitations of the Study…………………………………………………...……..58

Structure of the Study……………………………………………………58

Data Collection…………………………………………………………..59

Validity and Reliability of the Assessment Instruments…………………60

Clinical Implications……………………………………………………………..61

Future Research Implications……………………………………………………62

Summary…………………………………………………………………………64

REFERENCES…………………………………………………………………………..66

APPENDICES…………………………………………………………………………...75

APPENDIX A: INTEGRATIVE FEMINIST MODEL FOR INTIMATE

PARTNER VIOLENCE…………………………..…………………………….76

APPENDIX B: INFORMED CONSENT FORM……………………………….77

APPENDIX C: DEMOGRAPHICS QUESTIONNAIRE……………………….78

APPENDIX D: FEMINIST FAMILY THERAPY BEHAVIOR CHECKLIST...80

APPENDIX E: FEMINIST CRITCISMS QUESTIONNAIRE…………………82

APPENDIX F: GIFT CARD GIVEAWAY OPT-IN……………………………83

APPENDIX G: FFTBC SUBSCALES AND ITEMS…………………………...84

APPENDIX H: IRB APPROVAL……………………………...………………..87

ix

LIST OF TABLES

Table

4.1 Participants’ Demographic Information…………………………………………48

4.2 Criticism Groups Cutoff Scores………………………………………………….51

4.3 Participants’ Reported Usage of FFT and Subscales Based on Sum Score……...52

4.4 One-Way Analysis of Variance………………………………………………….53

4.5 Variables Significantly Influenced by Participants’ Level of Agreement with FFT

Criticisms………………………………………………………………………………...54

x

LIST OF FIGURES

Figure

2.1 Integrative Feminist Model for Intimate Partner Violence………………………76

1

CHAPTER ONE

INTRODUCTION TO THE USE OF FEMINIST FAMILY THERAPY TO TREAT

INTIMATE PARTNER VIOLENCE IN SAME-SEX COUPLES

In the last 30 years, researchers have seen a steady increase in violence among

same-sex couples (Rolle et al., 2018). Current statistics show that same-sex couples

experience intimate partner violence (IPV) at a rate 25% higher than heterosexual couples

(National Coalition Against Domestic Violence [NCADV], 2019). In an effort to curb

the growing incidents of violence, mental health treatment providers have begun using

Feminist Family Therapy (FFT) to treat same-sex couples. The feminist approach is the

most widely recommended modality to treat IPV in all couples because it is believed to

address a core cause of violence (Bohall, et al., 2016): an imbalance of power; however,

it has faced criticism due to the fact that it was originally designed to address unequal

gender roles in heterosexual couples. Questions have also been raised regarding the

model’s effectiveness because rates of violence continue to rise. Proponents of the model

argue that same-sex couples are less likely to seek out services when experiencing

violence in their relationship so the model’s effectiveness cannot be measured by these

statistics. The proposed study intends to gain clarity on some of these issues by

surveying clinicians who have or are currently treating IPV in same-sex couples to

determine three things: 1) whether they are using a feminist perspective, 2)

2

whether they agree with the criticisms of the model, and 3) whether these criticisms

appear to influence their use of the model.

This chapter provides an overview of the concepts involved in the proposed study,

a review of the proposed study’s research goals and research questions, and a total

chapter summary.

Conceptual Framework

The following section provides an overview of the main concepts of this study,

including IPV, prevalence of violence in same-sex couples, and the Feminist Family

Therapy model for treatment of IPV.

Intimate Partner Violence

For the purposes of this study, IPV is being defined as “Physical, sexual, or

psychological harm by a current or former partner or spouse. This type of violence can

occur among heterosexual or same-sex couples and does not require sexual intimacy”

(Center for Disease Control and Prevention [CDC], 2018, para. 1). The CDC has

identified IPV as a health epidemic having a broad range of significant consequences.

The most recent data from the CDC’s annual National Intimate Partner and Sexual

Violence Survey shows that nearly one in four women and one in seven men report have

experienced IPV in their lifetime (CDC, 2019).

In the United States, it is estimated that nearly 20 people per minute are

physically abused by a current or former intimate partner (NCADV, 2019). On a typical

day, domestic violence support hotlines receive over 20,000 calls from victims seeking

assistance (NCADV, 2019). In Ohio, support hotlines average more than 27 calls every

hour (NCADV, 2019). Research also indicates that one in six women and one in 14 men

3

report have experienced sexual violence in intimate relationships. Of those that have

experienced IPV, the CDC reports that 41% of women and 14% of men have sustained a

physical injury as a result of abuse in their relationships. Most shockingly, data from

U.S. crime reports show that 16% of murder victims are killed by a current or former

intimate partner, and that 40% of females killed die at the hand of a partner (CDC, 2019).

The CDC has declared the rising rates of IPV to be an epidemic with significant

physical and mental health risks (CDC, 2019). Additionally, the NCADV identified

economic consequences of IPV, reporting that victims of violence lose a total of eight

million days of paid work per year, and as many as 60% of victims lose their job due to

reasons tied to abuse (2019). As a result of these growing statistics, the CDC has

identified several health risks related to having endured IPV, including cardiovascular,

gastrointestinal, reproductive, musculoskeletal, and nervous system conditions (CDC,

2018). Additionally, there are obvious mental health implications, including increased

risk for depression, anxiety, and PTSD symptoms. These mental health symptoms have

already been found to be increasingly linked to physical health, such as impaired immune

responses, increased risk of substance abuse, and increased risk of stroke (CDC, 2018).

The evidence for the adverse effects of IPV is overwhelming and does not only influence

a victim’s mental health, but can have long-lasting consequences on physical health and

economic struggle.

Types of IPV

IPV, also sometimes referred to as domestic violence, is a broad term that

addresses several types of abusive behaviors towards a current or former romantic partner

(National Institute of Justice [NIJ], 2019). In the United States, these various types of

4

abusive behaviors have increased significantly and have been linked to several physical,

psychological, and economic concerns (NIJ, 2019). Contrary to popular belief, IPV does

not just involve physical and sexual violence towards a partner, but also includes

psychological aggression and stalking, both of which involve intimidation and coercion

of another person (CDC, 2019). There have been several different types of IPV identified

in research literature.

The following outlines the type of violence and provides their definitions.

Physical Violence. Most simply defined, physical violence “is when a person

hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force”

(CDC, 2019, para. 1).

Sexual Violence. “Forcing or attempting to force a partner to take part in a sex

act, sexual touching, or a non-physical sexual event (e.g., sexting) when the partner does

not or cannot consent” (CDC, 2019, para. 2).

Stalking. “is a pattern of repeated, unwanted attention and contact by a partner

that causes fear or concern for one’s own safety or the safety of someone close to the

victim” (CDC, 2019, para. 3).

Psychological Aggression. Psychological aggression is defined as “the use of

verbal and non-verbal communication with the intent to harm another person mentally or

emotionally and/or exert control over another person” (CDC, 2019, para. 4).

Uni-Directional and Bi-Directional Violence. In addition to specific forms of

violence, there are also ways to describe which partner is abusive to the other. Uni-

directional and bi-directional violence, also referred to as uni-lateral and bi-lateral

5

violence, describes whether there is one abuser and one victim or whether both partners

engage in abusive behaviors (Madsen et al., 2012).

Intimate Partner Violence Among Same-Sex Couples

Despite this focus on heterosexual couples, IPV rates among same-sex couples

have been found to be significantly higher than that of heterosexual relationships

(National Coalition Against Domestic Violence [NCADV], 2019). According to the

NCADV, 43.8% of lesbian women and 26% of gay men have experienced rape, physical

violence, and/or stalking by an intimate partner in their lifetime (2019). These statistics

indicate a frequency of violence that is 10% higher than heterosexual couples, on

average. In addition to higher rates of violence, the NCADV found that gay and lesbian

victims of near-lethal domestic violence only called for the assistance of law enforcement

26% of the time and fewer than 5% of victims sought out orders of protection (2013).

It has also been documented that same-sex couples experiencing IPV face more

difficult outcomes compared to the heterosexual population (Rolle et al., 2018). While

reliable research organizations such as the CDC and the World Health Organization

(WHO) have found many substantiated health and economic consequences to

experiencing IPV, research suggests that same-sex partners experience these

consequences to an even greater degree (Rolle et al., 2018). This is attributed to the fact

that same-sex couples experience amplified adverse effects of IPV due to societal

oppression and the additional risk of judgment and discrimination associated with being a

sexual minority (Rolle et al., 2018).

Additionally, rates of bi-directional violence have also been found to be higher in

same-sex relationships, versus more common uni-directional violence in heterosexual

6

relationships (NCADV, 2019). Due to the significant prevalence of violence in same-sex

relationships, it stands to reason that perhaps same-sex relationships are suffering as a

result of a societal power differential and the inability to maintain equality within the

relationship.

Despite the growing rates of IPV among same-sex couples, there is still relatively

little research in comparison with heterosexual couples. A 2015 literature review found

that studies focusing on same-sex couples made up only three percent of results, when

searching for literature focused on IPV (Rolle et al., 2018).

Several limitations have been identified to explain the lack of inclusive Lesbian,

Gay, Bisexual, Transgender, and Queer (LGBTQ) research on IPV. Most often, LGBTQ

participants are hesitant to self-identify due to fear of how the research may be used

(Baker et al., 2013, Clark et al., 2019). As will be discussed in chapter two, many

LGBTQ members avoid involvement with law enforcement, research initiatives, and

even mental health support, due to wanting to avoid unwanted attention and perpetuating

the stigma of LGBTQ violence in relationships (Baker et al., 2013; Clark et al., 2019).

Because researchers are aware of this fear, many large research surveys do not include

items that request participants to identify their sexual orientation, for fear of limiting or

biasing their results (Baker et al., 2013).

It has also been identified that it is sometimes difficult for participants to specify

their sexual orientation, as this concept is now considered to be more fluid than static

(Baker et al., 2013; Clark et al., 2019). Because orientation is not easily defined, it is

difficult for participants to identify themselves, and for researchers to provide appropriate

options on surveys, in order to allow participants to accurately self-identify. Again,

7

because orientation is not easily surmised, many large research initiatives have opted to

overlook this information altogether (Baker et al., 2013; Clark et al., 2019).

Feminist Family Therapy and Intimate Partner Violence Among Same-Sex Couples

Although there is relatively little treatment research in comparison with

heterosexual couples, the FFT model remains the most common recommendation for

treatment of IPV in same-sex couples (McPhail et al., 2007). The model has been largely

unadapted for use with same-sex couples, with the exception of some theoretical

literature and a handful of feminist models. Proponents of the feminist perspective point

to efforts to broaden its reach by including the concept of intersectionality, which

addresses not only gender oppression but also sexual, racial, and ethnic oppression when

treating IPV.

Overview of Proposed Research

This section introduces the specific research goals for this study and the research

questions that are being proposed. Operational definitions of key concepts are also

outlined.

Research Goals

The proposed study intends to determine whether clinicians who are actively

treating IPV in same-sex couples are utilizing FFT as a primary modality, as

recommended in the literature. Due to varying levels of training on couples therapy,

multicultural competence, and intersectionality, combined with the rising rates of IPV in

same-sex relationships, it is possible that clinicians are not utilizing the literature to guide

their approach to treat this important issue. This study aspires to determine the extent to

which clinicians are utilizing FFT as the most commonly suggested strategy to treat IPV

8

so that the frequency of violence in same-sex relationships can be decreased and treated

effectively.

As evident above, there is a significant dissonance between what is being

recommended for treatment of violence in same-sex relationships and criticisms of the

approach. The population for this study was narrowed to same-sex couples due to the

fluidity of sexual orientation, in general, making it difficult to research IPVs effects on

relationships for all members of the LGBTQ population. By focusing on a specific

portion of the LGBTQ community, this study can examine the effects of violence in

relationships among those who identify specifically as homosexual, as it is not yet clear

how to expand research to be inclusive of the entire spectrum of sexual orientation (Baker

et al., 2013; Clark et al., 2019). The proposed study attempts to explore the dissonance

by focusing on clinicians’ own perceptions of the approach and its criticisms, and

whether or not this impacts clinicians’ use of the approach. Since the rate of violence in

same-sex couples continues to rise, it is crucial that we investigate the effectiveness of

the recommended treatments and determine whether they are being used consistently or

not, in order to determine next steps in evaluating effective treatment options. Since the

feminist approach has been so heavily criticized within the mental health community, it is

a distinct possibility that these criticisms have influenced clinicians’ use of the theory.

The study intends to assess whether clinicians who have worked to treat violence in

same-sex relationships have used the feminist theory and whether they agree with its

criticisms.

In sum, due to the rising rates of IPV in same-sex relationships, this study aims to

assess whether clinicians are utilizing FFT; whether clinicians are confident in the

9

effectiveness of FFT; and whether their level of confidence is correlated with their

utilization of the approach to treat IPV in same-sex couples. This exploration is crucial

because the majority of literature written on treating IPV in same-sex couples suggests

that a feminist approach is the most effective methodology for this presenting issue.

However, the feminist perspective has also been under scrutiny for decades and often

elicits very strong and polarizing reactions.

Research Questions and Hypotheses

This study’s research questions are:

1) Are clinicians using Feminist Family Therapy principles to treat Intimate Partner

Violence in same-sex individual and couple clients?

Hypothesis 0: Clinicians are using Feminist Family Therapy thoroughly, as measured by

a response on the FFT checklist of either “Often,” or “Always”.

Hypothesis 1: Clinicians are not using Feminist Family Therapy thoroughly, as measured

by a response on the FFT checklist of either “Sometimes,” “Rarely,” or “Never”.

2) Is the use of Feminist Family Therapy being influenced by whether or not clinicians

agree with criticisms of the approach?

Hypothesis 0: The use of Feminist Family Therapy is not being influenced by clinicians’

agreement or disagreement with its criticisms.

Hypothesis 1: The use of Feminist Family Therapy is being influenced by clinicians’


Operational Definitions

Clinician: For the purposes of this study, “clinician” will refer to any mental-health

professional who is licensed to provide clinical therapy to clients diagnosed with any

10

disorder found in the Diagnostic and Statistical Manual V (American Psychiatric

Association, 2013). This may include licensed counselors, marriage and family

therapists, social workers, psychologists, and psychiatrists.

Feminist Family Therapy (FFT): A treatment model focused on challenging assumptions

regarding sex roles within all systems: family, society, and culture (Ault-Riche, 1986).

Gender: A human cultural status of feminine or masculine, differing from biological

status (Piercy et al., 1996).

Intimate Partner Violence (IPV): Physical, sexual, or psychological harm by a current or

former partner or spouse. This type of violence can occur among heterosexual or same-

sex couples and does not require sexual intimacy (Center for Disease Control and

Prevention, 2018).

Same-Sex Couple/Relationship: For the purposes of this study, a same-sex couple or

relationship is defined as two individuals of the same sex involved in an emotionally and

possibly physically intimate relationship.

Same-Sex Intimate Partner Violence (SSIPV): Intimate partner violence which occurs in

same-sex relationships (Rolle et al., 2018).

Power: Defined as "the capacity to gain whatever resources are necessary to remove

oneself from a condition of oppression, to guarantee one's ability to perform, and to affect

not only one's own circumstances, but also more general circumstances outside one's

intimate surroundings" (Goodrich, 1991, p. 10).

Summary

This chapter provides an overview of the focus of the proposed study. It presents

statistics demonstrating the prevalence of IPV in same-sex relationships, indicating our

11

need to ensure these couples are receiving evidence-based treatment. It also offers

foundational information on relevant concepts, such as FFT principles and treatment

guidelines suggested for same-sex couples.

12

CHAPTER II

LITERATURE REVIEW

This chapter provides an overview of the foundational concepts of this study and

the existing literature on them. Feminist Family Therapy (FFT) is outlined, including a

discussion of key concepts, the evolution of the theory, and a discussion of the clinical

applications of FFT. Finally, a thorough exploration of the recommended treatment

modalities for Intimate Partner Violence (IPV) in same-sex couples is provided. The

chapter concludes by highlighting the minimal literature in some of these areas, justifying

the need for studying clinicians’ frequency of use of the recommended treatments.

Feminist Family Therapy

Feminist Theory, created during the civil rights movement of the late 1960s and

early 1970s, originally focused on systemic issues born from gender inequality. From the

social movement, it was then integrated into approaches with therapy and involves

psychoeducation regarding systemic gender oppression and equalizing the power

differential between partners in couples' therapy (Thomas, 1977). As stated in an early

article on Feminist Therapy from 1977:

Coupled with the feminist humanism of such therapists is their feminist

consciousness and feminist framework, which are revealed in a particular

sensitivity to and understanding of the problems women bring to therapy,

the experience of being a woman, and the limitations that stereotypical sex

13

roles have historically placed on women and continue to place on their

achievement of self-actualization. (Thomas, 1977, p. 449)

Feminist Theory has broadened in the decades since its inception to include issues that

affect all oppressed groups, such as racial, cultural, ethnic, and sexual minorities. The

same principles for these various people groups apply, in that a feminist therapist would

seek to acknowledge the power differentials between the minority client and the

oppressor, whether that be the client’s partner or society as a whole.

Beginning in the 1980s, Feminist Theory began integrating feminist principles

into family therapy approaches. This integration manifested into six major tenets that

outline an FFT approach: 1) the therapist-client relationship is non-hierarchical and

invites open dialogue between clients and therapist; 2) gender is a primary focus in

therapy and is directly connected to a couple or family’s presenting concern(s); 3) the

therapist will encourage an egalitarian relationship, as unbalanced roles are considered

pathological from a feminist perspective; 4) empowerment is established as a formal

treatment goal, in order to ensure that both partners enjoy equal influence within the

relationship; 5) the therapist will avoid reinforcing traditional gender roles, which

feminist clinicians criticize in other family therapy models; and 6) the construct of power

is assessed, openly discussed in session, and made the focus of therapeutic interventions

(Vatcher & Bogo, 2001).

It should be emphasized that this framework is not considered a fully developed

systemic treatment model, but instead is a collection of principles that guide systemic

therapy approaches and prioritizes the empowerment of powerless clients (Goodrichet al.,

1988; Seligman & Reichenberg, 2010; Stith, 2006). FFT seeks to establish equality

14

throughout the many systems and subsystems involved in treatment. For example, the

therapist would take on an egalitarian role in treatment but also seek to reinforce equality

between partners, as well as address the greater societal oppression at play (Goodrich et

al.,1988; Seligman & Reichenberg, 2010; Stith, 2006).

In its infancy, FFT’s primary focus was to address traditional gender roles in

heterosexual couples and assess how these role assignments created an imbalance of

power in the relationship. Several analysis questions were developed in order to assess

for imbalances of power and the specific ways in which a couple’s gender roles were

linked to the couple’s presenting issues in therapy. These analysis questions assessed the

couple’s level of belief in gender stereotypes, how this affected the distribution of labor

in the household, how beliefs in stereotypes limited the solutions the couple would

entertain, how their belief in stereotypes influenced their expectations of their male or

female therapist, and how societal, social, and environmental pressures created or

exacerbated issues in their relationship (Goodrich et al., 1988; Seligman & Reichenberg,

2010, Stith, 2006).

Although FFT comes under criticism for not having thoroughly developed its

treatment model like many other established family therapy theories, it does abide by six

main tenets that guide feminist therapists: supportive therapeutic relationships; a focus on

addressing gender issues; egalitarian relationships; empowerment; affirming the less

powerful; and a focus on power dynamics (Goodrich, et al., 1988).

Therapeutic Relationship

The first tenet of FFT outlines the role of the therapist throughout treatment. A

feminist lens mandates that there be a non-hierarchical relationship between therapist and

15

client, allowing for open dialogue in sessions. This dynamic reinforces the overall goal

of feminist therapy, which is to empower clients and equalize power (Thomas, 1977). A

feminist therapist would accomplish this by establishing a relationship in which the

therapist is viewed as a supporter and collaborator. A feminist therapist may even refer

to their client as “the expert”, downplaying the assumption that the therapist knows best.

It has even been suggested that a feminist therapist use self-disclosure, in order to

normalize a client’s presenting issues (Goodrich et al., 1988)

Gender

The second tenet of FFT originally addressed differences in gender roles and how

this influences the client’s presenting problem(s). It asks that the feminist therapist view

the relationship between partners as egalitarian and focus on equalizing any imbalances

of power due to differing gender roles. A modern revision of this tenet also addresses the

concept of intersectionality, in order to broaden this focus to be more inclusive

(Crenshaw, 1989). The modern take also accounts for pressures minorities experience

within and outside of their relationship, as well as the unique pressures same-sex couples

face in trying to understand their roles in their relationship while navigating invalidating

societal pressure (McPhail et al., 2007). More will be discussed about this concept when

discussing the evolution of FFT.

Egalitarian Relationships

The third tenet of FFT emphasizes the importance of equality within relationships

as opposed to traditional roles in which one partner may wield more power than the other.

In traditional heterosexual gender roles, we often see that the “breadwinner” (usually the

male in heterosexual couples) has greater power, frequently having the final say in

16

decision-making, greater authority regarding finances, and less obligation in child rearing

and household duties. FFT seeks to equalize the power differential assigned to partners

in a relationship. Although each partner may play different roles within the relationship,

the overall goal is to ensure that each partner has equal influence, obligation, and regard

within and outside of the relationship (Thomas, 1977).

Empowerment

The fourth tenet of FFT involves the therapist aligning with and empowering

clients who experience a lesser degree of power and influence within their relationship,

similar to the concept of unbalancing in Structural Family Therapy (Seligman &

Reichenberg, 2010). A modernized revision of this tenet also addresses the

disempowerment same-sex couples may feel in their greater environment as the result of

identifying as a sexual minority (McPhail et al., 2007).

Affirmation of the Less Powerful

The fifth tenet of FFT originally focused on the empowerment of women, specifically,

and intended to address the power differential evident in many heterosexual relationships and in

greater society. FFT observes that the difference in power among genders stems from traditional

societal norms that saw men as the decision-makers, providers, and ultimate authority figures

within their family structures. While other family theories suggested that therapists take a

neutral role with their clients, FFT demands that clinicians assess client relationships for power

differentials and seek to create balance within them. While this approach began by addressing

gender inequality, it has broadened to acknowledge the power imbalances that exist for a

multitude of oppressed groups, including racial minority groups, the Lesbian, Gay, Bisexual,

17

Transgender and Queer (LGBTQ) community, those of lower socio-economic status, and those

who lack access to resources and education, such as urban and rural populations.

Power

Finally, the sixth tenet addresses the issue of power. Power is defined as "the

capacity to gain whatever resources are necessary to remove oneself from a condition of

oppression, to guarantee one's ability to perform, and to affect not only one's own

circumstances, but also more general circumstances outside one's intimate surroundings"

(Goodrich, 1991 p. 10). The primary goal of FFT is to first acknowledge differentials of

power in relationships, and then seek to create balance in relationships, in order to

equalize the distribution of power within those relationships (Thomas, 1977).

Interventions

The above tenets are accomplished in FFT through the use of three main

interventions: immediacy, self-disclosure, and psychoeducation (Ali & Naylor, 2013;

Allen, 2015). Immediacy is defined as a therapist “disclosing immediate feelings about

her- or himself in relation to the client or about the therapeutic situation” (APA, 2019,

para. 2) and is also how an FFT therapist would utilize self-disclosure. The intention of

this intervention is to promote insight for a client by reflecting either a therapist’s own

emotional response to a situation or behavior described by the client. Aptly named, this

skill is typically done as an immediate response in session (APA, 2019, para. 3).

Psychoeducation “refers to the process of providing education and information to

those seeking or receiving mental health services” (APA, 2019, para. 2). Therapists

utilize psychoeducation in a variety of ways, from providing clients information about

18

their diagnoses, how their brains and bodies process their emotions, and, specifically to

FFT, how a client’s presenting issues can be tied to societal norms and pressures.

It is encouraged for a feminist family therapist to consistently use immediacy and

psychoeducation to initiate conversations regarding apparent power imbalances in

relationships and the outside societal influences that may be adding pressure to a couple’s

dynamics. In fact, a feminist family therapist might align with the partner that appears to

have less power, in an effort to shift power dynamics and eventually equalize them. As

one study put it, to assume a neutral role as a therapist was to actually reinforce the

dysfunction occurring in the couple system (Siegenthaler & Boss, 1998).

As mentioned earlier, FFT therapists will often use self-disclosure in order to

ensure balance in the therapeutic relationship, normalize a client’s concerns, and to avoid

appearing as the expert. The FFT perspective believes that self-disclosure creates a

collaborative and safe environment, and one that does not reinforce a differential in

power dynamics between the therapist and the client (Black, 1991).

Evolution of Feminist Family Therapy

Although this approach centers on treating heterosexual couples in which partners

assume traditional gender roles, many of these concepts are still applicable to couples and

families today. In order to improve FFT’s relevance to modern family therapy treatment,

significant changes in its approach have been made. For instance, the introduction of

intersectionality into the feminist conceptual lens allowed the approach to broaden its

ability to apply to clients of varying backgrounds and experiences.

Intersectionality was originally introduced by Kimberlé Crenshaw in 1989, in her

published critique of feminist theory. Speaking specifically to her own experiences as a

19

black woman, Crenshaw (1989) argued that reducing a black woman’s identity to her

gender did not account for the layered experiences of a black woman and wrote that by

doing so, black women were being even more marginalized. She rightly argued that by

not acknowledging the complicated existence of those who are considered minorities on

multiple levels, the theory did not empower black women but instead continued to

oppress them by assuming that all women experience the same type of discrimination and

powerlessness (Crenshaw, 1989).

By introducing this concept of intersectionality, the feminist lens was able to

apply its principles of equality to a broad spectrum of couples with varying backgrounds

and identities (Crenshaw, 1989). No longer was the emphasis on gender, but it now

included the experience of being a minority in a variety of ways, by acknowledging race,

sexual orientation, and ethnicity. However, because this approach had its beginnings in

empowering women specifically, it is often misperceived as an approach for heterosexual

couples. Even the use of the root word “fem” can mislead clinicians and clients alike to

believe that the modern feminist approach is much narrower (Crenshaw, 1989).

For that reason, much of the literature regarding the clinical use of FFT focuses

specifically on gender and women’s issues. The majority of works published on FFT are

conceptual pieces that outline how to incorporate intersectionality into treatment with

heterosexual couples, how to integrate FFT with other systemic theories, and feminist

critiques of popular treatment models (Black, 1991; Blumer et al., 2013). The empirical

studies that have been conducted to show FFT’s effectiveness most often focus on female

survivors of physical and/or sexual abuse and the treatment of IPV in heterosexual

couples (Blumer et al., 2013).

20

Clinical Use of Feminist Family Therapy

FFT has been used in a variety of settings, often in conjunction with similarly

minded theoretical approaches, such as person-centered therapy, emotion-focused

therapy, and structural family therapy (Vatcher & Bogo, 2001). According to a 2015

literature review, the most common use of FFT is to address power imbalances in client

dynamics perpetuated by social inequality (Baugher & Gazmararian, 2015). This can

take several forms, including addressing multicultural issues, hierarchical imbalances

within a family system, and violence in relationships (Blumer, 2013; Chronister et al.,

2014).

As mentioned earlier, because FFT is not considered a standalone model for

family therapy, it is often utilized in conjunction with other models, particularly those

that emphasize a validating, egalitarian, and empowering therapeutic alliance with clients

(Enns, 1993; Hamel, 2010). Despite not being considered a comprehensive model, FFT

does emphasize issues overlooked by other models, such as the social context of the

client and their presenting issues, and the influence of society’s political climate on the

client.

A common tagline used in FFT is “the personal is political” (Brown, 2006;

McPhail et al. 2007). This has led to a significant feminist presence in areas of advocacy

for minorities, policy-making that addresses social justice issues, and involvement in the

court system (Greene & Bogo, 2002; McPhail et al., 2007; Staggs & Schewe, 2011).

This type of involvement is unlike the role encouraged by any other family therapy model

and assumes that a therapist’s role does not exist solely in the therapy room, but in every

21

aspect of society that influences our clients. In essence, a feminist family therapist’s role

is systemic in the purest sense by transcending the traditional expectation of a therapist.

Despite FFT’s long standing presence as a systemic approach, there is very little

evidence to demonstrate its effectiveness in empirical studies (Brown, 2006). There are a

handful of theories as to why FFT has not been studied rigorously, including suggestions

that it would be difficult to study since it is not a comprehensive model, that the

implementation of the theory varies too broadly to be operationalized, and that the

criticisms of FFT have biased researchers and clinicians against studying the model

(Brown, 2006). What is evidence-based about the approach, however, is the relationship

feminist therapists develop with their clients. Research endorses the value of a therapist

who is multiculturally competent and seeks to empower and support clients from an

egalitarian role (Brown, 2006). Many studies have validated that this type of therapeutic

alliance leads to better therapeutic outcomes for clients, including more frequent second-

order change, quicker resolution of presenting issues, and more frequent permanent

change (Macneil et al., 2009; Martin et al., 2000; Marziali et al., 1999).

Criticisms of the FFT Approach

Despite FFT being the most recommended approach for treatment of violence in

same-sex couples, the approach has been the focus of criticism. One such criticism is

that the underpinnings of feminism’s explanation of violence in relationships is rooted in

concepts only relevant to heterosexual relationships. Critics state that FFT assumes that a

power differential exists based on gender and does not take into account race,

socioeconomic status, income, or education. Critics dismiss the idea that patriarchal

22

dynamics can lead to violence in relationships, citing the increased rates of violence in

same-sex relationships where these dynamics arguably are not present.

The feminist community has been seen as resistant to acknowledging same-sex

violence, particularly among lesbian couples (Barnes, 2010; Rolle, 2018). While the

underlying theory regarding gender oppression seems to explain violence amongst male

same-sex couples, in that males are socialized to dominate their partners, same-sex

violence among women is more difficult to explain using these principles. In response,

feminist theory has argued that it has expanded its perspective to include concepts such as

intersectionality and oppression of sexual minorities (Brown, 2008).

Another common criticism of the feminist perspective is that it seems to focus

only on uni-directional violence, which is less common in same-sex relationships. By

definition, a uni-directional concept assumes that there is one abuser who holds the

majority of power in the relationship and that any violent behaviors from the abused

partner are in self-defense and not perpetuating violence in the relationship (Ali &

Naylor, 2013). In contrast, many studies have found that in heterosexual relationships,

women are just as likely be as violent as their male partners (Ali & Naylor, 2013).

Feminism is also criticized for its reliance on the criminal justice system in order

to respond to violence in relationships. Since one of the main tenets of feminism is to

become involved in the justice system and advocate for victims, feminists often support

criminal punishment as a consequence for violent behavior. Critics argue that this creates

a systemic issue in which the power of the abuser over their partner is simply replaced by

the power of the criminal justice system (Herzog, 2007). This creates a dependence on

external sources of control rather than empowering the victims to make decisions for

23

themselves. Additionally, involvement in the justice system sometimes results in

negative consequences for the victims of abuse, such as increased monitoring by law

enforcement and increased involvement in court proceedings.

Feminist approaches are also criticized due to the fragmented nature of the theory.

Feminism is divided into various approaches, including first, second, and third wave

feminism, neo-feminism, post-colonial feminism, and third world feminism. These

various denominations can, at times, contradict and even criticize one another, making it

difficult to present an easily defined understanding of what is meant by a “feminist

approach.” This division within the theory creates challenges for clinicians in

understanding how to implement the approach in treatment (Herzog, 2007).

Finally, criticism of the feminist approach comes due to the lack of empirical

evidence demonstrating its effectiveness. Much of what is written arguing for the use of

feminism is theoretical and very few empirical studies have been conducted. In a 2015

study on self-disclosure of IPV, researchers Sylaska and Edwards found that many

participants hesitated to identify as LGBTQ when sharing their experiences. The study

identified reasons for this hesitation, including participants not wanting to perpetuate

stereotypes of violence in same-sex relationships and concerns over how the data would

be used to generalize to the greater LGBTQ community (Sylaska & Edwards, 2015). The

study also noted that some of the largest studies on IPV in relationships did not ask

participants to identify their sexual orientation due to the possibility of decreasing

participation (Sylaska & Edwards, 2015).

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Feminist Models for Treatment of IPV

Although there are no specific limitations on what populations FFT can be used

with, it is most frequently used with clients who can benefit from empowerment

(McPhail et al., 2007). For this reason, it is frequently used with survivors of abuse and

is often utilized in addressing IPV in relationships.

The minimal empirical data published on the use of FFT most frequently focuses

on addressing IPV; however, these treatments often require separating partners into

gender-specific groups (Karakurt et al., 2016; McPhail et al., 2007; Murray, 2009). More

specifically, heterosexual females in abusive relationships are often offered services and

support that are contingent on her leaving the relationship, thus limiting the data on how

effective feminist treatment for violence in relationships can be (Karakurt et al., 2016).

Additionally, the literature that does suggest using FFT to treat IPV is mostly conceptual

and does not offer tangible data to ascertain the effectiveness of the approach (Enns,

1993; McPhail et al., 2007). Although much of the literature is conceptual in nature,

there are a handful of studies that have offered structured feminist models for clinicians

to adopt in the treatment of IPV.

The Duluth Model, created in the 1980s, aims to take a communal approach to

addressing IPV. Informed by the principles of feminist theory, it works with victims and

perpetrators in a variety of environments, including the courts, detention centers, and

throughout their mental health treatment. In an attempt to address criticisms of FFT for

treatment of IPV, the Integrative Feminist Model was also developed in 2007 (McPhail et

al.). This model seeks to offer a feminist treatment modality for IPV that not only

incorporates the foundational tenets of feminism, but also has an increased emphasis on

25

multicultural competence and intersectionality, in order to broaden the relevance of

feminist treatment beyond just heterosexual dynamics. These models are outlined in the

following sections.

The Duluth Model

The most commonly used model to date for the treatment of IPV is the Duluth

Model. Developed by an organization called Domestic Abuse Intervention Programs

(DAIP), this model focuses on integrating feminist theory and sociocultural concepts, and

was created to treat court-ordered men convicted of domestic violence charges (Bohall et

al., 2016). IPV curriculums often include psychoeducation regarding gender oppression

and its link to relational violence. This approach is most often used in heterosexual

relationships, in which the power differential between a male batterer and a female victim

is most apparent.

The model seeks to intervene with both the victim and the perpetrator in the

various settings they may be involved in, including court proceedings, sentencing, and

treatment. Because it is rooted in the principles of feminist theory, the model seeks to

advocate for victims of abuse, while holding abusers accountable. Proponents of the

model say it has been successful in uniting agencies, such as 911 and the courts, by

offering psychoeducation and training that assist employees of these agencies in

recognizing various forms of abuse and familiarizing them with resources for victims and

perpetrators (DAIP, 2019).

Similar to the Feminist Therapy tenets, the Duluth Model outlines its values as

follows:

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1. We listen to battered women: Our work involves active

engagement with women who have experienced violence so that

our efforts are guided by their realities and concerns.

2. We educate to promote liberation: An educational process of

dialogue and critical thinking is key to our efforts to assist women

in understanding and confronting the violence directed against

them, and to our efforts to challenge and support men who commit

to ending battering.

3. We advocate for institutional and social change: We examine the

practices and policies of social and governmental agencies that

intervene in the lives of battered women and address systemic

problems by engaging with institutional practitioners and leaders in

the development of creative and effective solutions.

4. We struggle against all forms of oppression. Women are not

defined by a single identity, but live in the intersection of their

race, gender, class, ethnicity, nationality, disability, age, religion

and sexual orientation. Our work must also challenge all systems

of oppression that create a climate of supremacy and intolerance

that facilitates violence and exploitation in women’s lives.

5. We promote non-violence and peace: Every step we take, every

interaction we have with others, is an opportunity to advance non-

violence, continually working toward and building a culture and a

future of peace. (DAIP, 2019, para. 1)

27

One of the most common tools of the Duluth Model is use of the Power and

Control Wheel. This tool visually illustrates ways in which men coerce and intimidate

their partners through emotional, physical, sexual, or economic abuse, and is used to

promote awareness of how the belief in gender inequality influences men’s likelihood of

responding violently to their partners. The wheel, along with an alternate “equality”

wheel and five other specialized versions, is available for free download on DAIPs

website. The Power and Control Wheel is available in fifteen languages, in addition to

English (DAIP, 2019), making it one of the most widely accessible free resources

addressing IPV to ever be available to the public.

In a 2014 study looking at the use of the Duluth Model, it was found that 63% of

men designated to participate in the Duluth treatment model agreed with the statement

that “women provoke IPV by using bad judgment or by provoking the man’s anger”

(Herman et al., 2014, p. 9). This same study also found that 45% of men believed that

“men have the natural right to be in charge of the relationship” (Herman et al., 2014, p.

9). Because these beliefs seem to be widely held by men convicted of IPV, it supports

the need to use a feminist perspective in their treatment. In post-test measures following

the use of the Duluth model, these beliefs were significantly reduced in participants

(Herman et al., 2014).

Criticisms of the Duluth Model

Despite its popularity, the Duluth model has come under scrutiny. The creators of

the model refer to themselves in the seminal publication as a “small group of activists in

the battered women’s movement” (Pence & Paymar, 1993, p. xiii). Critics take exception

to the fact that the model was not developed by trained clinicians and are concerned that

28

non-professionals, who cannot diagnose or clinically conceptualize participants, are

administering treatment to violent offenders. Critics call this use of treatment unethical

as it is being delivered by non-licensed individuals without specific clinical training.

The model was also criticized for being exclusive to a specific gender and a

limited number of races. The model was designed to be used with men who batter

women and has no protocol for addressing treatment with women who batter men, or

same-sex couples who experience partner violence (Pender, 2012). The model has also

only been used with Caucasian, African American, Native American, and Latino

populations.

Despite the issues with the model, it remains the most common form of treatment

for addressing IPV and had been shown to be effective (DAIP, 2019). Suggestions have

been made to overhaul the treatment approach, in order to include a broader spectrum of

violent offenders, a means of addressing bi-directional violence, and norming it to many

more sexual, racial, and ethnic groups. It has also been suggested that this and all other

treatments for IPV only be administered by licensed and qualified professionals in the

mental health field.

The Integrative Feminist Model

The Integrative Feminist Model (IFM) was developed as a means of modernizing

the feminist perspective by addressing common criticisms of a feminist approach

(McPhail et al., 2007). These criticisms challenge the use of a feminist perspective to

treat IPV by asserting that feminism is only designed to address uni-directional partner

violence in heterosexual couples and is limited in addressing a broader range of issues

that cause violence in relationships (McPhail et al., 2007).

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In response, the IFM is made up of seven key concepts, or puzzle pieces, as

depicted in the model’s visual aid (Appendix A) indicating that the following foci overlap

with the original tenets of FFT and are systemic in nature: 1) the personal is political; 2)

acknowledging male victims and female perpetrators; 3) changing policies and

institutional responses; 4) exploring alternative interventions such as justice restoring

solutions; 5) increasing victim choice and voice by crafting personalized solutions; 6)

integrating additional explanatory models of violence causation; and 7) feminist analysis

of power differentials based on gender, class, race, national origin, disability, sexual

orientation, and age (McPhail et al., 2007).

These additions to the feminist perspective attempt to take into consideration the

concerns that some critics have had with the model, however, it is difficult to say whether

these new considerations have been effective in treatment due to such limited literature

being published as a follow up to this model’s introduction. It would be beneficial for

researchers and clinicians to continue exploring how effective these additions are in order

to continue the dialogue regarding best practices for treatment of this specific population.

Criticisms of the Integrative Feminist Model

While the IFM does not have any published responses or critiques, the creators of

the model offer their own suggestions for potential skepticism of the model from

clinicians (McPhail et al., 2007). The most obvious of these initial concerns is the fact

that the model is not evidence-based because it is a relatively new approach (McPhail et

al., 2007). The authors caution that, like any alternative treatment, client care and safety

must be considered. Should a clinician choose to implement the strategy outlined in their

article, close attention must be paid to effectiveness and ethics (McPhail et al., 2007).

30

The authors also point to Feminist purists who may be concerned that the

integration of intersectionality into the feminist perspective is deviating from the original

theory. In response, the authors welcome formal critiques of the IFM to be published, in

order to spur on professional dialogue. They also state that a singular feminist

perspective is not thorough enough to address the many layers of intersectionality that

exist in clients. Finally, they suggest that to have a feminist perspective on theoretical

development is to be progressive and adaptive to our culture (McPhail, 2007). By doing

this, feminist family therapists attend to the greatest call of feminism, which is meeting

the needs of clients otherwise marginalized by a social hierarchy (McPhail, 2007).

Feminist Family Therapy to Treat IPV in Same-Sex Couples

Although same-sex treatment of IPV using FFT is not as prevalent in the

literature, success with this approach has been documented with this population and

continues to be a common suggestion for treatment recommendations (George & Stith,

2014; Herzog, 2007; Hill et al., 2012). Proponents of the model say that the advantage of

using FFT with same-sex couples is that the principles of FFT address the core issues that

lead to violence in their relationships. For instance, studies show that same-sex couples

are less likely to seek assistance from mental health providers or law enforcement with

experiencing violence in their relationships (Martin-Storey, 2015). FFT addresses this in

several forms. First, FFT expects therapists to be informed about the context of their

clients and assumes that therapists would already be educated on this dynamic of silence

in same-sex couples (Barnes, 2010). Second, FFT is designed to empower clients to

assert and protect themselves, hopefully breaking the cycle of silence on violence

(Barnes, 2010).

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Because a feminist approach was originally created specifically to empower

women, it continues to be used to focus on the treatment of heterosexual couples, even

today. A literature review revealed that IPV literature continues to center around

heterosexual couples and the gender differential in conceptualization and treatment of

IPV (Cannon & Buttell, 2015). It has been argued that clinicians and researchers alike

hold a heteronormative bias when exploring treatment options for IPV, as a significant

majority of the literature ignores same-sex couples.

One study identified several myths that heterosexuals hold about same-sex

relationships. The first is that violence in same-sex relationships is a conflict between

equals and assumes that each partner is physically similar and is received similarly in

society. In short, each partner in a same-sex relationship has the same number of

resources and that one does not hold any advantage or privilege over another (Brown,

2008). Another myth identified is that physical violence in a same-sex relationship could

be some form of sadomasochism. Again, this view of same-sex relationships reduces the

connection between partners to something sexual and does not acknowledge the

emotional connection between them, thereby invalidating the relationship and sending the

message that these partners do not experience the depth of emotion or validity of their

relationship to the extent that heterosexual couples do (Brown, 2008).

While these myths were found to be held by the general public, it is this

researcher’s opinion that it is certainly possible that clinicians may hold these biases to be

true, as well. For that reason, using FFT with same-sex couples may be counterintuitive

for some clinicians who assume that the power differential between genders or violent

behaviors between partners are non-issues. However, the societal pressure for same-sex

32

relationships can still manifest power differentials on many levels. There may be a

differential between the two partners for other reasons besides gender, such as income,

intelligence, career, and their individual roles at home and in their communities.

Surrounding the couple dynamics, both partners may feel less powerful in their greater

environment, in which heterosexual couples are still the vast majority of partnerships

considered “acceptable” by society and hold the sheer majority. Therefore, same-sex

relationships experience the dynamics that FFT was designed to address.

There is a clear relevancy to using FFT because of its ability to address unique

issues in same-sex relationships. A study looking at the treatment of violence in male

same-sex relationships revealed that clients report a very clear power differential when

describing their relationships (Kay & Jeffries, 2010). They reference language such as

“top” and “bottom” when describing themselves or their partners, and the role each of

them play. Clients also identified issues of inequality regarding income and reported that

the partner who earned more money had more power in the relationship. They spoke of

sometimes feeling as though the partner earning less money was forced into a more

traditional female role by the partner earning more money and were expected to

contribute to household chores to a greater degree.

A more recent study found that, despite societal progression in normalizing same-

sex relationships, sexual minorities continue to experience stigma, discrimination, and

resulting dissonance in their own identities (Martin-Storey, 2015). These stressors were

found to lead to increased abuse of substances, increased violence in same-sex

relationships, and more frequent aggressive behavior (Martin-Storey, 2015). In fact, the

group to experience the most violence in relationships was the group who identified as

33

“unsure” of their sexual preferences, indicating that perhaps the greater a person’s

deviation from the societal norm, the greater the stressors, resulting in more frequent

occurrences of violence.

This dissonance, coupled with conflict within a same-sex relationship, can result

in explosive reactions that can turn violent. It was also found that these dynamics are

surfacing very early on in the development of sexual minorities. Martin-Storey’s (2015)

study found that in a sample of 12,984 high school students, 16% of heterosexual females

and 6% of heterosexual males reported experiencing violence in their romantic

relationships. In contrast, 42% of lesbian females and 32% of gay males reported

violence in their relationships.

In a 2017 study that attempted to inventory societal stressors placed on same-sex

relationships, findings showed that the level of stigma consciousness for sexual

minorities contributed to increased violence in their relationships (Longobardi &

Badenes-Ribera). This validates the suggestion that because same-sex relationships are

more scrutinized in society, sexual minorities feel greater pressure and experience more

conflict within their relationships.

The research also demonstrates unique societal barriers to treatment faced by

those in same-sex relationships. An executive summary released from the Williams

Institute in November of 2015 found the following issues hindering access to treatment:

1) Legal definitions of domestic violence that exclude same-sex

couples

2) Dangers of “outing” oneself when seeking help and the risk of

rejection and isolation from family, friends, and society

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3) The lack of, or survivors not knowing about, LGBT-specific or

LGBT-friendly assistance resources

4) Potential homophobia from staff of service providers or from non-

LGBT survivors of IPV and IPSA with whom they may interact

5) Low levels of confidence in the sensitivity and effectiveness of law

enforcement officials and courts for LGBT people. (Brown & Herman,

2015, p. 3)

This report also found that literature addressing treatment for same-sex couples

varied widely in the way its participants identified (Brown & Herman, 2015). Some

studies were conducted on self-identified lesbian or gay participants, while others were

included in such studies based on their behaviors, such as men who have sex with men

(MSM) (Baugher & Gazmararian, 2015; Ford et al., 2013). However, this degree of

variation in the participants studied makes it nearly impossible to develop accurate and

precise means of treatment that thoroughly address the above-mentioned barriers.

Research has already demonstrated that the level of identification as a gay or

lesbian, coupled with an individual’s level of stigma consciousness, is directly correlated

with violence in same-sex relationships (Lewis, et al., 2003; Lewis et al., 2014).

Therefore, to summarize all same-sex relationship research without regard to the level of

identity and stigma consciousness of each participant, creates a potentially inaccurate

guide in treating same-sex violence.

35

Restatement of Research Questions and Hypotheses








2) Is the use of the Feminist Family Therapy being influenced by whether or not

clinicians agree with criticisms of the approach?





Summary

This chapter provided an overview of current literature relevant to this study by

outlining the major tenets of FFT, as well as FFT models that have been developed to

treat IPV. The chapter went on to explore how LGB individuals experience violence in

their relationships, as well as barriers to pursuing mental health treatment. The chapter

also provided an outline of criticisms of the FFT approach and reviewed the research

questions for this study.

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.CHAPTER III

RESEARCH METHODS

This chapter focuses on the purpose of the research study as well as the statistical

methods utilized to conduct the study. This chapter will also outline the data collection

and data analysis methods utilized for this study.

Restatement of Research Goals

The proposed study intended to determine whether clinicians who are actively

treating Intimate Partner Violence (IPV) in same-sex couples are utilizing Feminist

Family Therapy (FFT) as a primary modality, as recommended in the literature. Due to

varying levels of training on couples therapy, multicultural competence, and

intersectionality, along with the rising rates of IPV in same-sex relationships, it is

possible that clinicians are not utilizing the literature to guide their approach to treat this

important issue. This study aspires to determine the extent to which clinicians are

utilizing FFT as the most commonly suggested strategy to treat IPV so that the frequency

of violence in same-sex relationships can be decreased and treated effectively.

As evident above, there is a significant dissonance between what is being

recommended for treatment of violence in same-sex relationships and criticisms of the

approach. The proposed study attempts to explore the dissonance by focusing on

clinicians’ own perceptions of the approach and its criticisms, and whether or not this

impacts clinicians’ use of the approach. Since the rate of violence in same-sex couples

continues to rise, it is crucial that we investigate the effectiveness of the recommended

37

treatments and determine whether they are being used consistently or not, in order to

determine next steps in evaluating effective treatment options. Since the feminist

approach has been so heavily criticized within the mental health community, it is a

distinct possibility that these criticisms have influenced clinicians’ use of the theory. The

study intended to assess whether or not clinicians who have worked to treat IPV in same-

sex relationships have used FFT and whether or not they agree with its criticisms.















Research Design

This was a quantitative exploratory study. The design format was chosen due to

the novel nature of these particular research questions, which do not have any precedent,

38

based on the literature review conducted. While this researcher has made a hypothesis

regarding the outcomes of the data collection, it is important to allow the flexibility

offered by an exploratory study in order to properly interpret the data and allow for

numerous possibilities. John Tukey, the lauded and influential mathematician and

statistician, wrote of the necessity of exploratory research, saying in part, “Neither

exploratory or confirmatory [research] is sufficient alone” (Tukey, 1980, p. 23).

Typically, a confirmatory study is based on exploratory research that has already

been completed (Tukey, 1980). These studies are founded on the discoveries of

exploratory research, however, when there has been no exploratory research done on a

topic, such as in the case of this study, an exploratory study is warranted.

Participants

Criteria for Participation. In order to participate in this study, the participants

had to be licensed as a mental health clinician, social worker, psychologist, or

psychiatrist, and have provided or were currently providing counseling services to at least

one individual or same-sex couple client that experienced intimate partner violence in

their relationship. Due to the advanced nature of the survey questions, participants with

trainee licenses were not permitted to complete the survey.

Solicitation of Participants. In order to attract participants, emails requesting

participation were sent to the counseling departments of the following schools:

Youngstown State University, The Ohio State University, Cleveland State University,

Kent State University, and the University of Akron. The survey was also be distributed

via the researcher’s personal social media accounts requesting participation from

qualified individuals, as well the following Facebook groups: Ohio MFT Network,

39

UAkron MFT Masters Alumni, Sex Positive Therapists Group, Counselor/Therapist

Networking/Consultation Group, and Ohio Social Workers.

Additionally, two mass emails to members of the Counselor, Social Worker, and

Marriage and Family Therapist Board of Ohio were sent requesting participation.

Colleagues at the Coleman Professional Service’s Akron location and OhioGuidestone’s

Lorain County location distributed the survey to qualified participants. Finally, a paid

advertisement was run nationally on Facebook and Instagram.

Incentives for Participation. In order to encourage participation, participants

were offered the opportunity to win one $100 Amazon gift card, which was determined

by a random drawing. Each participant was assigned a number and the winner was

chosen using Google’s random number generator. The participant was notified using the

email address they provided. Only participants who met the criteria of the study were

eligible to win. There were no other incentives offered, monetary or otherwise. The

form to opt into the giveaway can be found in Appendix F.

Description of Sample. The sample collected represented 29 out of 50 states,

although 81.3% of participants were located in the state of Ohio. Eighty-six point six

percent identified as female, 11.3% as male, 1.8% as non-binary, and 0.4% as gender

queer. Social workers made up the largest group of participants (37.7%), followed by

counselors (31%). MFTs made up 13.7%, and psychologists made up 1.8% of the

responses. Additionally, 15.8% of participants identified themselves as holding two or

more clinical licenses. When asked about their primary theoretical orientation,

participants reported a significant variety of approaches. The most common responses

were Cognitive Behavioral Therapy (23.9%) and Eclectic (26.3%). Only five participants

40

(1.8%) indicated that they utilized FFT as their primary approach. Being that there was

such a wide variety of responses, the rest were categorized as “All Others” which made

up almost half of the responses (49.8%).

Sample Size. A power analysis using a hypothesized medium effect size and an alpha

level of p < .05 revealed that a total of 252 participants were necessary to accurately

assess the above hypotheses (Cohen, 1992). Upon completion of data collection, a

sample size of 284 was collected.

Procedure

Participants were asked to complete an online survey based in Qualtrics, which

presented them with an informed consent form (Appendix B), a demographic

questionnaire to ensure they met eligibility criteria (Appendix C), the Feminist Family

Therapist Behavior Checklist (Appendix D), and a Feminist Criticism Questionnaire

(Appendix E). Once data collection was complete, a descriptive analysis was used to

determine demographics of the participants such as gender identification, type of

licensure, years practicing, and what theoretical orientation is used as the participant’s

primary approach.

Responses to the FFTBC were summed to calculate a total raw score. FFTBC

subscale scores were also summed to calculate a raw score for each scale. Responses to

the FCQ were recoded to reflect any responses of Always or Often to be calculated as a 1,

and all other responses to be calculated as 0. A one-way between-subjects ANOVA was

conducted to compare participants’ responses to the FCQ to those on their FFTBC. This

allowed the researcher to determine whether clinicians use of FFT is being influenced by

41

the criticisms of the approach. Cut-off scores were determined (as detailed in the next

chapter) in order to sort participants into one of three conditions of their FCQ score.

Data Analysis Method

This study involved conducting a descriptive analysis to determine the

demographics of the participants, and a one-way between-subjects ANOVA, which

compared participants on their use of FFT, based on their level of agreement with the

FFT criticisms. To address research question one, reported frequency of FFT behaviors

was assessed to determine how frequently FFT and its specific interventions were used to

treat same-sex couples experiencing IPV.

To address research question two, a one-way between-subjects ANOVA assessed

how clinicians differed from one another on the FFTBC when taken with their level of

agreement of the criticisms. The use of the ANOVA is based on the need to divide

participants’ responses on the FCQ into one of three conditions: low agreement, medium

agreement/undecided, and high agreement. Chapter four discusses cut-off scores that

were developed to determine how to sort participants into one of the three mentioned

groups.

Measures

In order to collect data from participants, three instruments were used: a

demographic questionnaire; with permission from the author, an adapted version of the

38-item Feminist Family Therapist Behavior Checklist (Chaney & Piercy, 1988); and a

Feminist Criticisms Questionnaire, created by this researcher, using criticisms of

Feminist Family Therapy, as noted in relevant literature, that were summarized into one-

sentence statements to assess participants’ agreement with those statements.

42

Demographics Questionnaire

Modeled after the demographic questionnaire included in the FFTBC, this survey

included questions that participants responded to in order to determine their eligibility for

the study and provide data for the descriptive analysis. A copy of this questionnaire can

be found in Appendix B.

Feminist Family Therapist Behavior Checklist

The Feminist Family Therapist Behavior Checklist (FFTBC) was developed by

Drs. Chaney and Piercy in 1988. The checklist is the only one of its kind and was

developed in order to measure the FFT behaviors of clinicians in their work with clients.

It is designed as a self-report instrument and contains 38 items which measure the

following subscales: Sex-Role Analysis, Shifts Balance of Power Between Male and

Female Clients, Therapist Empowers Female Clients, Skills Training, and Therapist

Minimizes Hierarchy Between Therapist and Clients.

The original checklist items were developed from a Delphi questionnaire

administered to 40 experienced feminist family therapists and subsequently normed on 60

family therapists, 33 of whom identified as female and 27 of whom identified as male.

The mean age of the participants was 35 and mean years of experience conducting

therapy was 4.4 years. 54 of the participants identified as White, three identified as

Black, two identified as Hispanic, and one identified as Asian. Test-Retest Reliability

was calculated using Kappa to account for chance and equaling a 92.5% rate of

agreement between time one administration and time two administration. A copy of this

questionnaire with revised items can be found in Appendix C.

43

Adapting the Feminist Family Therapist Behavior Checklist

Due to the heteronormative nature of the original scale, permission from Dr.

Piercy to alter the checklist items was obtained via email. Dr. Piercy noted that the first

author of the original instrument, Dr. Chaney, had passed away and only his permission

was necessary. The items were altered minimally in order to include wording that was

relevant to same-sex couples. Additionally, the names of the original subscales have

been minimally revised to reflect more inclusive language. The revised subscale names

are: Sex-Role Analysis, Shifts Balance of Power Between Dominant and Non-Dominant

Clients, Therapist Empowers Both Clients, Skill Training, and Therapist Minimizes

Hierarchy Between Therapist and Clients.

Feminist Criticism Questionnaire

This instrument consisted of six statements, each of which summarized a specific

and documented criticism of the feminist perspective. Responses to this questionnaire

were on a five-point Likert scale: Strongly Agree, Agree, Undecided, Disagree, and

Strongly Disagree. A copy of this questionnaire can be found in Appendix D.

Summary

This chapter provided an overview of the methods of this study, including the desired

sample demographics, utilization of incentives for participation, the statistical analysis

used to address the research questions, and an overview of the instruments used in the

study. It also discussed the revising of the FFTBC instrument to eliminate hetero-

normative language.. Finally, it discussed the formatting of the individual questionnaires

and provided a description of the Likert scale questions. The actual survey

questionnaires are included in the Appendices.

44

CHAPTER IV

RESULTS

The purpose of this study was to examine the use of Feminist Family Therapy

(FFT) by clinicians who work with same sex couples and whether the use of it is

influenced by their level of agreement with the common criticisms of the FFT approach.

This chapter outlines the details of data collection, data cleaning, and then is followed by

a detailed summary of the descriptive statistics of the study variables. Finally, the results

of the one-way between-subjects ANOVA are shared.






a response on the FFTBC of either “Often,” or “Always”.


by a response on the FFTBC of either “Sometimes,” “Rarely,” or “Never”.





45



Data Collection

Data was collected via Qualtrics over the course of six months, from December

2019 to May 2020. To minimize the potential for incomplete data, incomplete surveys

were not saved to the data set. Additionally, participants who did not meet the eligibility

criteria were routed out of the survey and were not given a chance to continue. Due to

this structure, very little data cleaning was necessary. With the focus of this study being

on same-sex couples, the survey attracted significant negative attention when advertised

on Facebook. Some individuals were able to submit erroneous and/or homophobic

responses. For this reason, data was checked for erroneous responses and removed from

the set. These responses were clearly identifiable due to these participants being unable

to appropriately answer very field-specific questions, such as “What is your primary

theoretical orientation?” Once the data set reached the appropriate sample size,

advertisements were stopped, and the survey closed. The data were then exported to

SPSS for analysis.

Demographics and Descriptive Statistics

There were a total of 284 participants in this study. In order to qualify for the

study, each participant had to be a licensed mental health clinician with full licensure in

their state of practice. Participants represented 29 out of 50 states, with Ohio making up

81.3% of total responses. The majority (86.6%) identified as female, 11.3% as male,

1.8% identified as non-binary, and 0.4% identified as gender queer. Social workers made

up the largest group of participants (37.7%), followed by counselors (31%). MFTs made

46

up 13.7%, and psychologists made up 1.8% of responses. Additionally, 15.8% of

participants identified themselves as holding two or more clinical licenses.

When asked about their primary theoretical orientation, participants reported a

significant variety of approaches. The most common responses were Cognitive

Behavioral Therapy (23.9%) and Eclectic (26.3%). Only five participants (1.8%)

indicated that they utilized FFT as their primary approach. Being that there was such a

wide variety of responses, the rest were categorized as “All Others,” which made up

almost half of the responses (49.8%).

Regarding the ages of their clientele, clinicians were given the option to select any

age groups that applied. Thirty-nine point four percent of the participants reported seeing

children ages 0 to 12, while 56.7% reported seeing adolescents ages 13 to 17. 81.3%

reported seeing adult individuals ages 18 and over, and 46.5% reported seeing adult

couples. Forty-one point five percent reported seeing families, and 4.9% identified the

age demographic of their clients as “Other”.

Since this study focused on same-sex couples who are experiencing intimate

partner violence, the questionnaire went on to ask participants to identify the percentage

of clients that they believe are experiencing violence in their romantic relationships.

Over half the participants (55.3%) reported that 0-25% of their clientele experience

violence. Twenty-seven point eight percent of responses reported up to half of their

clients experienced violence, 12.7% reported that up to 75% of their clients experience

violence, and 4.2% reported that up to 100% of their clients experience violence.

The majority of participants (78.5%) reported that up to 25% of their caseload

identifies as gay or lesbian, 15.5% reported up to 50% of their caseload identifies as gay

47

or lesbian, 4.9% reported that up to 75% of their clients identify as gay or lesbian, and

1.1% of participants report that up to 100% of their clients identify as gay or lesbian.

Finally, when asked to identify their primary employment setting, a third of

participants (31.3%) reported working at a non-profit outpatient setting. Another third

(30.6%) reported working at a private practice outpatient setting. Eleven percent reported

either an inpatient setting and/or a partial hospitalization setting. Four point nine percent

reported working in an Intensive Outpatient Program and 9.9% reported their

employment setting as “other”. The demographics are reported by category in the table

below.

Table 4.1

Participants’ Demographic Information

Category Frequency (n) Percent (%)

Gender Identity

Male 32 11.3 Female 246 86.6 Non-Binary 5 1.8 Gender Queer 1 .4

License

MFT 39 13.7 Counseling 88 31 Social Work 107 37.7 Psychologist 5 1.8 2 or more licenses 45 15.8

Years Licensed

0-2 80 28.2 3-5 101 35.6 6-8 33 11.6 9+ 70 24.6

48

Primary Theory

CBT 68 23.9 Eclectic 75 26.3 Feminist 5 1.8 All Others 141 49.8

Client Populations

Children 0-12 112 39.4 Adolescents 13-17 161 56.7 Adult Individuals 231 81.3 Adult Couples 132 46.5 Families 118 41.5 Other Groups 14 4.9

Employment Setting

Outpatient - Nonprofit

31.3

Outpatient - Private Practice

30.6

Inpatient/Hospital

8.5

IOP

4.9 PHP

2.5

Other

9.9

Estimated % on caseload that are experiencing violence in relationships

0-25%

55.30%

26-50%

27.80% 51-75%

12.70%

76-100%

4.20%

49

Recoding and Transforming of Variables

Several steps were taken in order to recode and transform variables measured in

the survey. First, as indicated in the seminal FFTBC article, each participant’s responses

to the FFTBC were summed to determine their overall score, creating a new variable

referred to as FFT Practice. Although this variable provided us with the total score on the

FFTBC, the original authors of the instrument never provided cutoff scores to interpret

whether the score indicated a low or high level of usage of the approach. Each item on

the FFTBC was a Likert scale question from one to five, with one being “Often” and five

being “Never.” As proposed, the analysis separated participants’ responses into two

groups: Responses that were marked as “Always” or “Often” were recoded as 1, and

responses marked as “Sometimes,” “Rarely,” or “Never” were recoded as 0. This

effectively separated participants into two groups: those that were thoroughly utilizing

the FFT approach and those who were not.

Second, items corresponding to each of the five subscales of the FFTBC were

recoded so that individual subscale scores could be assessed. This was done by

identifying the items of each subscale on the questionnaire and sorting the responses into

the following newly created variables: Role Analysis, Shifts Balance, Therapist

Empowers, Skills Training, and Therapist Minimizes Hierarchy. Table one (Appendix

Estimated % on caseload that identify as gay/lesbian

0-25%

78.50%

26-50%

15.50% 51-75%

4.90%

76-100% 1.10%

50

H) displays the five subscales of the FFTBC and the specific questionnaire items that

correspond with each of them.

Third, participants’ responses to the FCQ were averaged to calculate each

participant’s total mean score. This was done in an attempt to identify and utilize cutoff

scores to sort participants’ FCQ scores into a new variable referred to as Criticism Group

with the following three conditions: High Agreement, Medium Agreement/Undecided,

and Low Agreement. The cutoff scores for the Criticism Group conditions can be seen in

the table below.

Table 4.2

Criticism Groups Cutoff Scores

Mean Criticism Score Criticism Groups N Percentage (%) 1-2.99 High Agreement 126 44.40% 3-3.99 Med Agreement 60 21.10%

4-5 Low Agreement 98 34.50% Note. Responses were on a Likert scale from 1 to 5, with 1 being Strongly Agree and 5 being Strongly Disagree

Research Question One

Participants were compared on their scores on the FFTBC to determine their level

of usage of the FFT approach, as well as their level of usage of each subscale technique.

Descriptive results indicated that 63% of participants were utilizing FFT thoroughly,

according to their overall FFTBC score (M = 24.07, SD = 9.97). Role Analysis was

shown to be thoroughly utilized by 63% of participants (M = 5.66, SD = 2.38); Shifts

Balance was thoroughly utilized by 60% of participants (M = 7.24, SD = 3.82); Therapist

Empowers was utilized thoroughly by 66% of participants (M = 3.30, SD = 0.93); Skills

training was utilized thoroughly by 66% of participants (M = 4.64, SD = 2.04); and

51

Therapist Minimizes Hierarchy was utilized thoroughly by 45% of participants, (M =

2.26, SD = 1.66). These results can also be seen in the table below.

Table 4.3

Participants’ Reported Usage of FFT and Subscales Based on Sum Score

Std. Variable Mean Deviation Usage (%) Max Score

FFT Practice 24.07 9.97 63% 38 Role Analysis 5.66 2.38 63% 9 Shifts Balance 7.24 3.82 60% 12 TherapistEmpowers

3.30 0.93 66% 5

Skills Training 4.64 2.04 66% 7 TherapistMinimizes

2.26 1.66 45% 5

These results indicate that at least some clinicians are utilizing FFT and its

subscale techniques thoroughly. All variables were shown to be utilized thoroughly by

over half the participants, with the exception of Therapist Minimizes Hierarchy (45%). It

is important to also note that all participants indicated some usage of FFT or one of its

subscale techniques, meaning that no participant scored a 0 on the FFTBC.

Research Question Two

A One-Way between-subjects ANOVA was conducted to test if there were

statistically significant differences in the use of FFT based on participants’ level of

agreement with the criticisms of the FFT approach. The dependent variables varied in

significance, with the following subscales showing a statistically significant difference in

use: Role Analysis [F(2, 281) = 3.98, p = .02], Skills Training [F(2, 281) = 3.42, p = .03],

Therapist Minimizes Hierarchy [F(2, 281) = 5.78, p = .00], and overall FFTBC score

[F(2, 281) = 3.87, p = .02]. Therapist Empowers was slightly outside of significance

52

[F(2, 281) = 2.89, p = .06], and Therapist Shifts Balance was not statistically significant

[F(2, 281) = 1.85, p = .16].

Table 4.4

One-Way Analysis of Variance

Levene’s Test for Equality of Variances indicated that the assumption of

normality for the dependent variables were met. An inspection of the boxplot determined

there to be no outliers in the data set. The skewness was found to be within acceptable

range however the kurtosis was outside acceptable range at -1.498.

Due to the exploratory nature of this study, the Bonferoni correction post hoc was

chosen in order to minimize Type I Error (Ludbrook, 1998). Post hoc comparisons

indicated significant differences in the use of the majority of the dependent variables,

when taken with participants’ level of agreement with FFT criticisms. However,

Therapist Empowers and Therapist Shifts Balance did not significantly differ based on

participants’ level of agreement.

When looking at overall FFTBC scores, we see a statistically significant

difference in use of FFT between those with low agreement (M = 22.25), SD = 10.17)

and those with high agreement (M = 25.67, SD = 9.74). There were significant

differences in the use of Role Analysis between those with low agreement (M = 2.35, SD

Dependent Variable

Sum of Squares df

Mean Square F Sig.

FFT Practice 753.434 2 376.72 3.87 .02 Role Analysis 5.015 2 2.51 3.98 .02 Shifts Balance 2.748 2 1.37 1.85 .16 TherapistEmpowers 2.688 2 1.34 2.89 .06 Skills_Training 4.830 2 2.42 3.42 .03 TherapistMinimizes 9.038 2 4.52 5.78 .00

53

= 0.86) with FFT criticisms and those with high agreement (M = 2.07, SD = .69)

Significant differences in use of Skills Training between those with low agreement (M =

2.42, SD = .89) and those with high agreement (M = 2.14, SD = .79); Significant

differences in use of Therapist Minimizes Hierarchy between those with low agreement

(M = 2.90, SD = .94) and those with medium agreement (M.= 2.51, SD = .87), and also

between those with low agreement and those with high agreement (M = 2.56, SD = .81).

Table 4.5 Variables Significantly Influenced by Participants’ Level of Agreement with FFT Criticisms Variable Crit

Group Crit

Group Mean

Difference Std.

Error Sig.

FFT Practice

Low Agreement

High Agreement

-3.420 1.329 .03

Role Analysis

Low Agreement

High Agreement

.281 0.107 .03

Skills Training

Low Agreement

High Agreement

.277 0.113 .05

Therapist Minimizes

Low Agreement

Med Agreement

.390 0.139 .02

High Agreement

.337 0.119 .02

Summary of Results

Results indicated that FFT is being used thoroughly by at least some clinicians.

Specifically, over half of participants utilized FFT and its specific techniques thoroughly,

with the exception of the use of Therapist Minimizes Hierarchy (45%). A one-way

between-subjects ANOVA indicated that use of four of the six dependent variables were

significantly based on participants’ level of agreement with the criticisms of FFT. The

results indicate that the higher participants’ level of agreement with the criticisms of FFT,

54

the less likely they were to thoroughly utilize FFT in their clinical work with lesbian and

gay clients experiencing intimate partner violence. These findings are consistent with the

alternative hypothesis for research question two.

55

CHAPTER V

Discussion

The goal of this research was to explore whether Feminist Family Therapy (FFT)

is being utilized as commonly as it is recommended in literature for treatment of violence

in relationships. A secondary goal for this study was to determine whether there was a

clear indication that a clinicians’ agreement or disagreement with the common criticisms

of FFT seemed to influence whether a clinician utilized feminist techniques. This study

attempted to explore some novel questions not addressed in the existing literature. The

data revealed several interesting trends and created implications for future clinical

application and research. These findings are summarized and discussed in this chapter. A

critique of the methodology and limitations of the study are also explored.

Discussion of Overall Findings

Demographics

The demographics revealed interesting data regarding the sample of this study.

Although the majority of participants reported being licensed in Ohio, the demographic

statistics regarding reported intimate partner violence and mental healthcare utilization

reflect national trends that are reported in well-known and credible studies (SAMSHA,

2019). This means that, although the majority of the participants provided experiences

based on their clinical work in Ohio, it accurately parallels what is reported in national

studies.

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Further, the percentage of estimated gay and lesbian clients on participants’

caseloads was extremely low, as is the estimated percentage of clients reporting violence

in their relationships. This also accurately parallels the rates of mental health utilization

by gay and lesbian individuals, as well as those that experience violence in their

relationships (SAMHSA, 2019). Despite these low numbers, almost half the participants

(45%) indicated that at least a quarter of their LGB clients experience intimate partner

violence, which can potentially translate to countless affected victims.

The demographic data also revealed that only 5% of participants identified FFT as

their primary theoretical orientation. This result was surprising, considering the majority

of participants indicated using FFT techniques in some capacity on the FFTBC.

However, the data also indicates that almost half of the participants (49.8%) identified

themselves as utilizing a wide variety of approaches, while the other half of participants

(50.2%) reported utilizing CBT or “Eclectic” as their primary theory. The next section

will discuss this disparity in greater detail.

Research Question One

This study’s first research question regarding whether FFT is being utilized by

clinicians to treat intimate partner violence in same-sex couples revealed that despite

whether clinicians self-reported that they utilize the approach, results indicated that over

half of the participants (63%) use the FFT approach and its specific techniques

thoroughly, with the exception of minimizing power imbalances (45%). There was a

noticeable contrast between the use of the FFT approach when compared to clinicians’

self-reported primary theoretical orientation. Although 63% were found to be utilizing

57

FFT thoroughly, only 1.8% of participants reported FFT as their primary theoretical

orientation.

These results do not provide a clear explanation of why this contrast occurred;

however, it could be explained by the apparent overlap of FFT techniques with the

mental health field’s prioritizing of intersectionality and cultural competency as best

practices (Gutierrez, 2018). In recent years, mental health clinicians have increased their

focus on cultural competency, which more recently includes competency in working with

sexual minorities (Springer et al., 2021). This trend reflects the goal of the FFT approach

but according to the data, clinicians may not be associating FFT with these priorities.

Recent studies have suggested integrating FFT with many modern theoretical

approaches. Popular clinical models such as Emotion-Focused Therapy (Coppola, 2019),

Narrative Family Therapy (Crumb, 2018), and Structural Family Therapy (Levittt, et al.,

2019) have all been the focus of publications looking to integrate FFT principles in order

to ensure these models are inclusive and can treat a diverse number of clients and

presenting issues. These recent publications indicate that the use of FFT is still seen as

relevant and important. In fact, the integration of FFT into popular clinical models may

make the common criticism that it is not a well-developed treatment model on its own a

moot point.

Research Question Two

This study’s second research question explored whether a participant’s agreement

with the criticisms of FFT would influence their use of the approach. The data analysis

revealed that there were some statistically significant differences in the use of FFT and

some of its techniques, based on a participant’s level of agreement. When looking at

58

overall use of the FFT approach, there was a statistically significant difference between

those who held high agreement with FFT’s criticisms and those who held low agreement.

Those with high agreement utilized the approach less frequently than those with low

agreement. This was also the case for participants’ use of role analysis assessment,

feminist skills training, and minimizing role imbalance within a couple. This means that

the higher the level of agreement of the FFT criticisms, the less frequently the above-

mentioned techniques were used, as well as the overall approach. Interestingly,

minimizing role imbalance showed a statistically significant difference in usage between

low and high agreement groups, and low and medium agreement groups.

Limitations of the Study

Due to the novel nature of this study, several limitations became apparent. These

limitations are regarding the structure of the study, data collection, and the instruments

used. They are discussed in detail below.

Structure of the Study

While reviewing the data and analyses, several limitations regarding the structure

of the study were apparent. The first limitation was in the sampling method chosen for

the study. Convenience and snowball sampling did not provide a wide variety of

participants, with the majority of participants (81.3%) responding from Ohio. In order to

be able to better generalize the results to the greater population, all states should be

represented and in correspondence with each state’s population.

Second, the focus of this study may have been too narrow. Assessing FFT and

gay and lesbian clients specifically may be too specific considering there is much

conversation about overall intersectionality and fluidity of sexuality and gender, when

59

looking at current literature (Ramos et al., 2021). Although FFT does include the concept

of intersectionality, it may not be a well-known fact among clinicians. This could be

especially true considering only 1.8% of participants identified FFT as their primary

theoretical orientation, yet 63% of participants were utilizing FFT thoroughly, according

to their FFTBC scores. Additionally, some participants indicated that they were not

familiar with FFT, even though all participants indicated using FFT in some capacity.

Data Collection

The quantitative nature of the survey likely limited responses from participants

and did not allow them to discuss nuances and factors that may not have been taken into

consideration during this study. The survey also did not provide an operational definition

of feminism and FFT to the participants. There were a handful of participants that

indicated they did not know the meaning of those terms.

There were also multiple purposeful attempts to distort data with falsified

responses. In order to advertise the survey, a Facebook ad was taken out during the initial

months of data collection. The ad attracted homophobic and politically extreme

responses. Some of these individuals also attempted to complete the survey with

incomplete, false, and/or nonsensical responses. Although these individuals intended on

interfering with data collection, it was clear from their responses which data sets needed

to be removed. This is likely due to the highly specialized nature of the questions on the

survey, which individuals who are not clinical professionals would have difficulty

answering. For example, when participants were asked to write in their response for their

primary theoretical orientation, irrelevant or vulgar responses were provided.

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Although not widely researched, this phenomenon has received attention from

scholars. Research has identified issues with data collection when large entities and

organization attempt to skew results, referred to as “political interference” (Prewitt,

2010). However, in recent years, there has been a closer exploration of small-scale

interference by small groups of individuals. In 2017, Fish and Russell published on their

experiences with what they referred to as “mischievous responders”. Fronek and Briggs

(2018) proposed an actual term and operational definition to identify and describe this

phenomenon. They refer to it as “political interference by fake participants” defined as

“political motivation (agency and power struggles) whether personal or organizational, is

not driven by financial or other rewards, and involves active, covert deception with the

purpose of negatively impacting on the viability of research or to manipulate the

findings” (p. 3). Although the focus on political motives is relevant, it may be necessary

to expand these terms to include phobic motivations for interference.

Validity and Reliability of the Assessment Instruments

The FFTBC is not a well-developed instrument. Revisions of the wording of each

item were necessary in order to make the checklist relevant to same-sex couples and to

remove heterosexual-specific language. Also, no cutoff scores for the subscales of the

checklist were provided, so it was necessary to use best judgement and consultation to

determine cutoff scores that were reasonable.

The FCQ, which was designed by this researcher, may also deliver questionable

results. The FCQ was created because no other instrument that measured the level of

agreement of common criticisms of FFT existed. A factor analysis on the items of this

61

questionnaire was also not done, which would have provided more insight into whether

the items were accurately measuring participants’ level of agreement.

Finally, some demographic questions, such as the percentage of clients who

identify as gay or lesbian on a participants’ caseload, and the percentage of clients

experiencing violence in their relationships, relied on an estimate from participants. The

implication, of course, is that the data received from participants may not reflect accurate

trends that are generalizable to the greater population of clinicians.

Clinical Implications

Based on the data, FFT and its techniques, in some form, do appear to be widely

used by clinicians. However, it seems as though clinicians are not associating the

techniques they use with the FFT approach. Perhaps it may be more productive to ensure

all theoretical models include concepts like intersectionality, social justice, cultural and

social competency, and a trauma-informed perspective (Coppola, 2019; Gutierrez, 2018;

Crumb, 2018; Levitt et al., 2019). Due to the continual increase in violence in same-sex

relationships, clinicians may need to pay special attention to the effectiveness of their

treatment approaches (SAMSHA, 2019).

The results of the ANOVA demonstrated a clear connection between the thorough

use of the FFT approach and a clinician’s level of agreement with the criticisms.

However, because all participants indicated they use the techniques on some level, it may

be important to explore what the next steps for FFT should be. Since the inclusion of

intersectionality and cultural competence is now generally expected, regardless of the

model a clinician uses, it is worth considering how FFT can be integrated into models

that lack attention to diversity. It is also important to consider that if the criticisms of the

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approach are influential enough to affect a clinician’s use of it, this may render the

approach irrelevant in its current form. Some critics of the approach have even suggested

a “rebranding” of FFT, which would include a name change, moving away from using

the word “feminism,” in order to be more inclusive of all oppressed and minority groups

(Evans & Bussey-Chamberlin, 2021).

Regardless of what direction FFT must move in, it is clear that there needs to be

more education among clinicians regarding the source of the techniques the majority of

participants report utilizing at such a high level. As discussed in the next section, there

appears to be a need for research to demonstrate that clinicians are scoring high on the

FFTBC yet are not attributing these techniques to FFT. This could mean moving forward

with the idea to integrate FFT into popular clinical models, which has been a topic of

research in recent years.

Future Research Implications

For future research, it would be much needed to assess the validity and reliability

of the reworded items on the FFTBC. Running a factor analysis would give a much

clearer idea of whether these items are appropriately measuring their intended subscales.

It would also be important to develop an appropriately assessed FCQ to ensure validity.

Although there is not necessarily a debate about what common criticisms of FFT exist in

the literature, ensuring that items are clearly written and easy to understand would be

meaningful for gathering accurate data. This would also allow us to see whether one item

per criticism, as it is written in the current FCQ, is sufficient for measuring agreement or

disagreement. Additionally, developing statistically sound cutoff scores for each

instrument would be imperative.

63

The focus of a study such as this may also be too specific. The study did not

expand beyond assessing clinicians’ work with same-sex couples. Although, same-sex

couples have been a significant focus in literature, discussions are trending more towards

the fluidity of sexuality, possibly creating the need for an operationalized definition of

sexuality that is both broad enough to be inclusive of all types of clients, while also being

specific enough to study and quantify.

Having more demographic data would add important details of participants’

context to our understanding. It may be possible to focus on pulling more specific and

accurate data about demographic information from organizations such as clinics,

hospitals, and practices, instead of relying on clinicians’ estimated description of their

clientele.

This study would also likely garner more information if it was conducted as a

qualitative project. There are an incredible number of nuances that influence the way a

clinician may address minority clients who experience violence in their relationships.

Hearing from a small number of qualitative participants regarding these nuances and

influences would add significant context to the data received in this study. Qualitative

interviews may also shed light on influential concepts not considered in this study. One

such topic may be clinicians’ perspectives on whether FFT remains a relevant treatment

approach in mental health. Interviewing a small group of clinicians would also make it

possible to better confirm that each participant was actively seeing LGBTQ clients

experiencing violence in their relationships, versus relying on their self-report and

estimates.

64

Finally, it may be very necessary to assess clinicians’ fear of addressing violence

in relationships as a possible treatment barrier. Although clinicians typically have good

intentions for treating their clients to the best of their ability, it is also well known that

there are certain topics that arise which clinicians may struggle with acknowledging

(Olszowy, 2020). Violence in relationships, especially among minority clients, may not

be as frequently addressed as is needed. This possible barrier could be investigated during

a qualitative interview, as mentioned above.

Summary

This chapter included a discussion of the results following the collection of

demographic data and a one-way between-subjects ANOVA. It also explored

implications for both clinicians and future research, while providing an in-depth analysis

of possible limitations. The overall goal of this study was to determine the level of usage

of FFT as a treatment for violence in same-sex relationships. Further, it examined how

the level of agreement with common criticisms of FFT may or may not influence a

clinician’s use of the approach.

The study revealed that FFT and its techniques seem to be utilized within

participants’ clinical practice, however, it was rarely identified as a primary theoretical

orientation. In contrast, other approaches such as CBT and identifying as eclectic were

more common. The data also revealed that a clinician’s level of agreement of FFT

criticisms was influential on whether participants used the approach thoroughly. These

results provide a foundation for further exploration of treatment barriers for minorities

experiencing violence, as well as the consideration that FFT may be seen as irrelevant

within the mental health field.

65

The most urgent aspect of this study is to draw more attention to statistical trends

indicating that violence among sexual minorities continues to rise and likely coincides

with the low rate of mental health services utilization. To conclude, this researcher holds

two hopes. First, that we can continue to explore what we can do for our clients and our

communities to ensure each individual’s emotional and physical safety. Secondly, that we

can all look forward to there being effective treatment solutions to this significant cultural

issue in the future.

66

REFERENCES

(n.d.). American Psychological Association. Retrieved from https://www.apa.org/

(n.d.). National Institute of Justice. Retrieved from https://www.nij.gov/Pages/welcome.aspx

Ali, P. A., & Naylor, P. B. (2013). Intimate partner violence: A narrative review of the

feminist, social and ecological explanations for its causation. Aggression and Violent

Behavior, 18(6), 611–619.doi:10.1016/j.avb.2013.07.009

Ault-Riche, M. (1986). A feminist critique of five schools of family therapy. PsycEXTRA

Dataset. doi:10.1037/e437082004-001

Barnes, R. (2010). Suffering in a silent vacuum: Woman-to-woman partner abuse as a

challenge to the lesbian feminist vision. Feminism & Psychology, 21(2), 233–

239.doi:10.1177/0959353510370183

Baugher, A. R., & Gazmararian, J. A. (2015). Masculine gender role stress and violence: A

literature review and future directions. Aggression and Violent Behavior, 24, 107–

112.doi:10.1016/j.avb.2015.04.002

Black, L., & Piercy, F. P. (1991). A feminist family therapy scale. Journal of Marital and

Family Therapy, 17(2), 111–120. doi:10.1111/j.1752-0606.1991.tb00874.x

Blumer, M. L. C., Papaj, A. K., & Erolin, K. S. (2013). Feminist family therapy for treating

female survivors of childhood sexual abuse. Journal of Feminist Family Therapy,

25(2), 65–79.doi:10.1080/08952833.2013.777871

67

Bohall, G., Bautista, M.-J., & Musson, S. (2016). Intimate partner iolence and the Duluth

Model: An examination of the model and recommendations for future research and

practice. Journal of Family Violence, 31(8), 1029–1033. doi:10.1007/s10896-016-

9888-x

Brown, C. (2008). Gender-Role implications on same-sex intimate partner abuse. Journal of

Family Violence, 23(6), 457–462.doi:10.1007/s10896-008-9172-9

Brown, M. J., Serovich, J. M., & Kimberly, J. A. (2016). Depressive symptoms, substance use

and partner violence victimization associated with HIV disclosure among men who

have sex with men. AIDS and Behavior, 20(1), 184–192.doi:10.1007/s10461-015-

1122-y

Brown, T., & Herman, J. (2015) Intimate partner violence and sexual abuse among LGBT

people: A review of existing research. The Williams Institute. Los Angeles, CA.

Cannon, C. (2015). Illusion of inclusion: The failure of the gender paradigm to account for

intimate partner violence in LGBT relationships. Partner Abuse, 6(1), 65-77.

doi:10.1891/1946-6560.6.1.65

Centers for Disease Control and Prevention. (n.d.). Retrieved August 2, 2019, from

https://www.cdc.gov/

Chaney, S. E., & Piercy, F. P. (1988). A feminist family therapist behavior checklist. The

American Journal of Family Therapy, 16(4), 305-

318.doi:10.1080/01926188808250736

Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159.

68

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist

critique of antidiscrimination doctrine, feminist theory, and antiracist politics. Feminist

Legal Theory, 57-80. doi:10.4324/9780429500480-5

Coppola, J., (2019). An integrated EFT-Contextual approach for couples therapy: Suggested

model and ideas for practice. Journal of Family Therapy 42(4), 588-612.

https://doi.org/10.1111/1467-6427.12282

Diagnostic and statistical manual of mental disorders: DSM-5. (2017). Arlington, VA:

American Psychiatric Association.

Enns, C. Z. (1993). Twenty years of feminist counseling and therapy. The Counseling

Psychologist, 21(1), 3–87.doi:10.1177/0011000093211001

Evans, E. & Bussey-Chamberlain, P. (2021). The problems with feminist nostalgia:

Intersectionality and white popular feminism. European Journal of Women’s Studies,

ISSN 1350-5068 [Article] (Forthcoming)

Fish, J. & Russell, S. (2018). Have mischievous responders misidentified sexual minority

youth disparities in the National Longitudinal Study of Adolescent to Adult Health?

Archives of Sexual Behavior, 47, 1053-1067. https://doi.org/10.1007/s10508-017-0993-

6

Ford, C. L., Slavin, T., Hilton, K. L., & Holt, S. L. (2012). Intimate partner violence

prevention services and resources in Los Angeles. Health Promotion Practice, 14(6),

841–849.doi:10.1177/1524839912467645

Fronek, P., & Briggs, L. (2018). Faking participant identity: Vested interests and purposeful

interference. Research Ethics, 14(2), 1–5. https://doi.org/10.1177/1747016117740177

69

George, J., & Stith, S. M. (2014). An updated feminist view of intimate partner violence.

Family Process, 53(2), 179–193.doi:10.1111/famp.12073

Goodrich, T. J. (1988). Feminist family therapy: A casebook. New York: W.W. Norton &

Company.

Goodrich, T. J. (1991). Women, power, and family therapy. Journal of Feminist Family

Therapy, 3(1-2), 5-37. doi:10.1300/j086v03n01_02

Greene, K., & Bogo, M. (2002). The different faces of intimate violence: Implications for

assessment and treatment. Journal of Marital and Family Therapy, 28(4), 455–

466. doi:10.1111/j.1752-0606.2002.tb00370.x

Hamel, J. (2010). Do we want to be politically correct, or do we want to reduce partner

violence in our communities? Partner Abuse, 1(1), 82-91. doi:10.1891/1946-

6560.1.1.82

Herman, K., Rotunda, R., Williamson, G., & Vodanovich, S. (2014). Outcomes from a Duluth

Model batterer intervention program at completion and long term follow-up. Journal of

Offender Rehabilitation, 53(1), 1–18.doi:10.1080/10509674.2013.861316

Herzog, S. (2007). An empirical test of feminist theory and research. Feminist Criminology,

2(3), 223–244.doi:10.1177/1557085107301836

Hill, N. A., Woodson, K. M., Ferguson, A. D., & Parks, C. W. (2012). Intimate partner abuse

among African American lesbians: Prevalence, risk factors, theory, and resilience.

Journal of Family Violence, 27(5), 401–413. doi:10.1007/s10896-012-9439-z

(n.d.). Domestic Abuse Intervention Programs. Retrieved August 2, 2019, from

https://www.theduluthmodel.org/

70

Home. (n.d.). World Health Organization. Retrieved August 2, 2019, from

https://www.who.int/

http://dx.doi.org/10.1037/0033-2909.112.1.155

Karakurt, G., Whiting, K., van Esch, C., Bolen, S. D., & Calabrese, J. R. (2016). Couples

therapy for intimate partner violence: A systematic review and meta-analysis. Journal

of Marital and Family Therapy, 42(4), 567–583.doi:10.1111/jmft.12178

Kay, M., & Jeffries, S. (2010). Homophobia, heteronormativism and hegemonic masculinity:

Male same-sex intimate violence from the perspective of Brisbane service providers.

Psychiatry, Psychology and Law, 17(3), 412–423.doi:10.1080/13218710903566953

Leong, F. T. (2014). APA handbook of multicultural psychology. Washington, DC: American

Psychological Association.

Lewis, R. J., Derlega, V. J., Griffin, J. L., & Krowinski, A. C. (2003). Stressors for gay men

and lesbians: Life stress, gay-related stress, stigma consciousness, and depressive

symptoms. Journal of Social and Clinical Psychology, 22(6), 716–

729.doi:10.1521/jscp.22.6.716.22932

Lewis, R. J., Milletich, R. J., Derlega, V. J., & Padilla, M. A. (2014). Sexual minority stressors

and psychological aggression in lesbian women’s intimate relationships. Psychology of

Women Quarterly, 38(4), 535–550.doi:10.1177/0361684313517866

Levitt, H., Whelton, W., & Iwakabe, S. (2019). Integrating feminist-multicultural perspectives

into emotion-focused therapy. Clinical handbook of emotion-focused therapy, 425–444.

American Psychological Association. https://doi.org/10.1037/0000112-019 Longobardi, C., & Badenes-Ribera, L. (2017). Intimate partner violence in same-sex

relationships and the role of sexual minority stressors: A systematic review of the past

71

10 Years. Journal of Child and Family Studies, 26(8), 2039–2049.doi:10.1007/s10826-

017-0734-4

Ludbrook, J. (1998). Multiple comparison procedures updated. Clinical and Experiemental

Pharmacology and Physiology, 25, 1032-1037.

Macneil, C. A., Hasty, M. K., Evans, M., Redlich, C., & Berk, M. (2009). The therapeutic

alliance: Is it necessary or sufficient to engender positive outcomes? Neuropsychiatry,

21(02), 95–98. doi:10.1111/j.1601-5215.2009.00372.x

Madsen, C. A., Stith, S. M., Thomsen, C. J., & Mccollum, E. E. (2012). Violent Couples

Seeking Therapy: Bilateral and Unilateral Violence. Partner Abuse, 3(1), 43-58.

doi:10.1891/1946-6560.3.1.43

Martin-Storey, A. (2014). Prevalence of dating violence among sexual minority youth:

Variation across gender, sexual minority identity and gender of sexual partners.

Journal of Youth and Adolescence, 44(1), 211–224. doi:10.1007/s10964-013-0089-0

Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with

outcome and other variables: A meta-analytic review. Journal of Consulting and

Clinical Psychology, 68(3), 438–450.doi:10.1037/0022-006x.68.3.438

Marziali, E., Munroe-Blum, H., & McCleary, L. (1999). The effects of the therapeutic alliance

on the outcomes of individual and group psychotherapy with Borderline Personality

Disorder. Psychotherapy Research, 9(4), 424–

436.doi:10.1080/10503309912331332841

Mcphail, B. A., Busch, N. B., Kulkarni, S., & Rice, G. (2007). An integrative feminist model.

Violence Against Women, 13(8), 817-841. doi:10.1177/1077801207302039

72

Murray, S. (2009). Somewhere safe to call home: Violence against women during

homelessness. Melbourne: RMIT University.

NCADV: National Coalition Against Domestic Violence. (n.d.). Retrieved August 2, 2019,

from https://ncadv.org/

Olszowy, L., Jaffe, P., Dawson, M., Straatman, A., Saxton, M. (2020). Voices from the

frontline: Child protection workers’ perspectives on barriers to assessing risk in

domestic violence cases. Children and Youth Services Review,16, 105208.

https://doi.org/10.1016/j.childyouth.2020.105208.

Pence, E., & Paymar, M. (1993). Education groups for men who batter: The Duluth model.

New York: Springer.

Pender, R. L. (2012). ASGW best practice guidelines: An evaluation of the Duluth Model. The

Journal for Specialists in Group Work, 37(3), 218

231.doi:10.1080/01933922.2011.632813

Piercy, F. P., Sprenkle, D. H., & Wetchler, J. L. (1996). Family therapy sourcebook. New

York: Guilford Press.

Prewitt, K. (2010). What is political interference in federal statistics? The ANNALS of the

American Academy of Political and Social Science, 631(1), 225–238.

https://doi.org/10.1177/0002716210373737

Ramos, S., Lardier, D., Jr, Opara, I., Turpin, R., Boyd, D., Gutierrez, J., Jr, Williams, C.,

Nelson, L., & Kershaw, T. (2021). Intersectional effects of sexual orientation

concealment, internalized homophobia, and gender expression on sexual identity and

HIV risk among sexual minority men of color: A path analysis. The Journal of the

73

Association of Nurses in AIDS Care : JANAC, 32(4), 495–511.

https://doi.org/10.1097/JNC.0000000000000274

Rollè, L., Giardina, G., Caldarera, A. M., Gerino, E., & Brustia, P. (2018). When intimate

partner violence meets same sex couples: A review of same sex intimate partner

violence. Frontiers in Psychology, 10. doi:10.3389/fpsyg.2019.01706

Seligman, L., & Reichenberg, L. W. (2010). Theories of counseling and psychotherapy:

Systems, strategies, and skills. Upper Saddle River: Pearson.

Siegenthaler, A. L., & Boss, P. (1998). Contemporary Family Therapy, 20(3), 333–

340.doi:10.1023/a:1022468913378

Staggs, S. L., & Schewe, P. A. (n.d.). Primary prevention of domestic violence. Violence

against women and children, Vol 2: Navigating Solutions., 237-257.

doi:10.1037/12308-012

Stith, S., Pruitt, I., Dees, J., Fronce, M., Green, N., Som, A., & Linkh, D. (2006).

Implementing community-based prevention programming: A review of the literature.

The Journal of Primary Prevention, 27(6), 599-617. doi:10.1007/s10935-006-0062-8

Substance Abuse and Mental Health Services Administration. (2019). 2019 National

survey on drug use and health: Lesbian, gay, and bisexual (LGB) adults. Retrieved

August 2, 2019 from https://www.samhsa.gov/data/report/2019-nsduh-lesbian-gay-

bisexual-lgb-adults.

Springer, P., Bischoff, R., Taylor, N., Neuhaus, V., & Leow, C. (2021). Competency-based

training in the supervision of relational telemental supervision. Journal of Marital and

Family Therapy, 47(2), 375-391. https://doi.org/10.1111/jmft.12513

74

Thomas, S. (1977). Theory and practice in feminist therapy. Social Work, 447-454.

doi:10.1093/sw/22.6.447

Tukey, J. W. (1980). We Need Both Exploratory and Confirmatory. The American Statistician,

34(1), 23–25.doi:10.1080/00031305.1980.10482706

Vatcher, C., & Bogo, M. (2007). The Feminist/Emotionally-Focused Therapy practice model:

An integrated approach For couple therapy. Journal of Marital and Family Therapy,

27(1), 69-83. doi:10.1111/j.1752-0606.2001.tb01140.x

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APPENDICES

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APPENDIX A

INTEGRATIVE FEMINIST MODEL FOR INTIMATE PARTNER VIOLENCE

Figure 1. Integrative Feminist model for intimate partner violence

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APPENDIX B

INFORMED CONSENT FORM

You are invited to participate in a research project being conducted by Rachel Bell, a doctoral student in the School of Counseling at The University of Akron. The purpose of this research is to determine how licensed clinicians feel about feminist family therapy techniques and how often they are being utilized with a specific population. While there are no tangible benefits for the participants of this study, your participation will assist in the collection and analysis of data to address an important issue in the mental health field. If you decide to participate, you will be asked to complete an anonymous web-based survey. The survey should take no more than 30 minutes and I hope to recruit 252 participants. The survey will not collect any identifiable information, and no one will be able to connect your responses to you. Your anonymity is further protected by not asking you to sign and return a consent form. Your completion of the survey will serve as your consent. Please print this introduction for future reference. At the end of the survey, you will be given an opportunity to opt-in to an Amazon gift card giveaway, as an incentive for participating in the survey and you will be asked to provide your email address as a means of contacting you. One winner will be chosen at random and will be sent a $100 Amazon gift card electronically via the email address you provide. Please note that your email address will be kept separate from your survey responses and will not be used for anything other than contacting you, should you win a gift card. If you have any questions about this study, you may email me at [email protected], or my advisor, Dr. Heather Katafiasz, at [email protected]. This project has been reviewed and approved by The University of Akron Institutional Review Board. If you have any questions about your rights as a research participant, you may call the IRB at (330) 972-7666. Please click on the link below to access the survey. Thank you. By pressing the “continue” button, I hereby consent to participate in this research project.

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APPENDIX C

DEMOGRAPHIC QUESTIONNAIRE

1. Are you a licensed clinician (this does not include trainee licenses)? a. Yes b. No

2. Type of Clinician/License (please write out full title of license): a. Text box

3. What state do you practice in? a. Drop down menu of states

4. Years You’ve held Your Current License: a. Text box

5. Your gender identity: a. Male b. Female c. Non-Binary d. Other. Please Specify: (Text box)

6. What client populations do you typically see (select all that apply)? a. Children (Ages 0 to 12) b. Adolescents (Ages 13 to 17) c. Adult individuals (Ages 18 and up) d. Adult couples (Ages 18 and up) e. Families f. Other. Please specify: (Text box)

7. What are your areas of specialty? a. (Text box)

8. What percentage of your adult clients do you estimate experience violence in their relationships?

a. 0%-25% b. 26%-50% c. 51%-75% d. 76%-100%

9. Have you or are you currently treating either an adult gay/lesbian individual client or a same-sex adult couple who has experienced violence in their relationship?

a. Yes b. No

10. What is/was your employment setting when seeing the client(s) referenced in question 9 (Check all that apply)?

a. Outpatient at Non-Profit Agency

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b. Outpatient at Private Practice c. Inpatient/Hospital d. Partial Hospitalization Program e. Intensive Outpatient f. Other. Please specify: (Text box) g. I answered “no” to question 8

11. What percentage of your clients identify as either gay or lesbian (Please estimate)?

a. 0% to 25% b. 26% to 50% c. 51% to 75% d. 76% to 100%

12. What is your primary theoretical orientation? a. Text box

13. Do you regularly integrate feminist family therapy techniques into your practice of counseling/therapy?

a. Always b. Often c. Sometimes d. Rarely e. Never

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APPENDIX D

FEMINIST FAMILY THERAPY BEHAVIOR CHECKLIST

Please answer how frequently you use each skill in your clinical work using the following

scale:

1-Always 2-Often 3-Sometimes 4-Rarely 5-Never

1. Encourage couples to develop more egalitarian relationships. 2. Negotiate a more equal distribution of parenting and/or household tasks. 3. Encourage clients to become more aware of their own needs and make those

needs a priority. 4. Encourage clients to better identify and express their feelings in their relationship. 5. Educate couples about aspects of social inequality that have been oppressive and

hurtful. 6. Reframe and challenge the clients’ definitions of the problem to include the

impact of social inequality. 7. If there is a partner with less power, support that partner in asserting their

decision-making power. 8. Raise issues of social inequality whether or not the couple brings them up. 9. Teach couples about the concept of social privilege. 10. If there is a dominant partner, hold that partner equally responsible for change in

their relationship. 11. If there is a partner with less power, support that partner in continuing to assert

themselves in their couple relationship. 12. If there is a dominant partner, encourage that partner to be more nurturing and

better meet the emotional needs of their partner. 13. Address derogatory comments towards each other and self-deprecating comments

related to their own social inequality when they are expressed by clients. 14. Reframe and challenge the clients’ definition of the problem(s) to include the

impact of social inequality. 15. Ask if control and manipulation is occurring or has occurred in their couple

relationship. 16. Ask if emotional violence is occurring or has occurred in their couple

relationship. 17. Ask if sexual violence is occurring or has occurred in their couple relationship. 18. Ask if physical violence is occurring or has occurred in their couple relationship. 19. Raise and explore issues of social inequality that disadvantages either partner

regardless of presenting issue.

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20. Clearly communicate through my words and actions my opposition to controlling, violent, and abusive behaviors.

21. Assess for and attend to issues of safety when violence and control are present in relationships.

22. Clearly communicate through my words and actions my opposition to any behaviors by either partner that are intended to control or subtly control their partner’s actions, times, choices, and relationships with others.

23. Promote relationships characterized by mutuality, reciprocity, interdependence, and a balance between intimacy and autonomy.

24. Encourage a shared knowledge of financial information and shared financial decision-making power.

25. Encourage a mutual, consensual sexual relationship based on intimacy. 26. Encourage partners to grant equal value to each other’s activities, work, life goals,

opinions, hopes, and dreams. 27. Explore the ways that social inequality has influenced both partners’ identities. 28. If there is a dominant partner, explore with that partner potential ways they may

be misusing power in their relationship with their partner. 29. If there is a dominant partner, encourage that partner to grant greater value to their

partner’s activities, work, career, life goals, hopes, and dreams than their own in an effort to offset social inequalities.

30. If there is a dominant partner, encourage that partner to explore potential ways they may be misusing power in their sexual relationship.

31. Challenge couples to develop equal levels of power in their relationship. 32. If there is a dominant partner, hold that partner more responsible for change when

there is a power imbalance in their relationship. 33. If there is a dominant partner, challenge that partner to accept their partner’s

decision-making power. 34. Raise and explore issues of social privilege with clients regardless of the

presenting issue. 35. Explore ways that social inequality has influenced both partners’ identities. 36. If there is a dominant partner, challenge that partner to give up power in order to

establish more equal levels of power in their relationship. 37. If there is a dominant partner, hold that partner more responsible for the change

than their partner. 38. If there is a dominant partner, encourage that partner to grant equal value to their

partner’s activities, work, career, life goals, hopes, and dream

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APPENDIX E

FEMINIST CRITICISMS QUESTIONNAIRE

Please rate your level of agreement with the following statements regarding Feminism and Feminist Family Therapy using: 1-Strongly Agree 2-Somewhat Agree 3-Undecided 4-Somewhat Disagree 5-Strongly

Disagree

1. Feminism assumes that a power differential exists based only on gender and

does not take into account other aspects of social inequality such as race, sexual orientation, socioeconomic status, income, or education.

2. The feminist community has been resistant to acknowledge the issue of same-sex violence.

3. The feminist perspective focuses only on uni-directional violence. 4. Feminism is too reliant on the criminal justice system in order to respond to

violence in relationships, giving the power to the courts and not empowering the victims.

5. Feminist Family Therapy is not a comprehensive treatment model and is too fragmented to be considered a standalone approach.

6. Feminist Family Therapy lacks empirical evidence demonstrating its effectiveness in treating intimate partner violence in same-sex couple

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APPENDIX F

GIFT CARD GIVEAWAY OPT-IN

Please enter your email address if you wish to be entered into the gift card giveaway.

Please note that your email address will be kept separate from your questionnaire

responses and will not be used for anything other than contacting you, should you win a

gift card.

1. Text Box for Email

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APPENDIX G

FFTBC SUBSCALES AND ITEMS

FFTBC Subscales and Items

FFTBC Subscale FFTBC Item

Subscale 1: Role Analysis

6. Reframes and challenge the client's definition of the problem to include the impact of social inequality

14. Reframe and challenge the clients’ definition of the problem(s) to include the impact of social inequality.

15. Ask if control and manipulation is occurring or has occurred in their couple relationship.

16. Ask if emotional violence is occurring or has occurred in their couple relationship.

17. Ask if sexual violence is occurring or has occurred in their couple relationship.

18. Ask if physical violence is occurring or has occurred in their couple relationship.

19. Raise and explore issues of social inequality that disadvantages either partner regardless of presenting issue.

20. Clearly communicate through my words and actions my opposition to controlling, violent, and abusive behaviors.

21. Assess for and attend to issues of safety when violence and control are present in relationships.

Subscale 2: Shifts Balance

2. Negotiate a more equal distribution of parenting and/or household tasks.

10. If there is a dominant partner, hold that partner equally responsible for change in their relationship.

12. If there is a dominant partner, encourage that partner to be more nurturing and better meet the emotional needs of their partner.

22. Clearly communicate through my words and actions my opposition to any behaviors by either partner that are intended to

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control or subtly control their partner’s actions, times, choices, and relationships with others.

28. If there is a dominant partner, explore with that partner potential ways they may be misusing power in their relationship with their partner.

29. If there is a dominant partner, encourage that partner to grant greater value to their partner’s activities, work, career, life goals, hopes, and dreams than their own in an effort to offset social inequalities.

30. If there is a dominant partner, encourage that partner to explore potential ways they may be misusing power in their sexual relationship.

32. If there is a dominant partner, hold that partner more responsible for change when there is a power imbalance in their relationship.

33. If there is a dominant partner, challenge that partner to accept their partner’s decision making power.

36. If there is a dominant partner, challenge that partner to give up power in order to establish more equal levels of power in their relationship.

37. If there is a dominant partner, hold that partner more responsible for the change than their partner.

38. If there is a dominant partner, encourage that partner to grant equal value to their partner’s activities, work, career, life goals, hopes, and dreams.

Subscale 3: Therapist Empowers 1. Encourage couples to develop more egalitarian relationships.

3. Encourage clients to become more aware of their own needs and make those needs a priority.

4. Encourage clients to better identify and express their feelings in their relationship.

7. If there is a partner with less power, support that partner in asserting their decision-making power.

11. If there is a partner with less power, support that partner in continuing to assert themselves in their couple relationship.

Subscale 4: Skills Training

5. Educate couples about aspects of social inequality that have been oppressive and hurtful.

9. Educate couples about the concept of social privilege.

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13. Address derogatory comments towards each other and self-deprecating comments related to their own social inequality when they are expressed by clients.

24. Encourage a shared knowledge of financial information and shared financial decision-making power.

25. Encourage a mutual, consensual sexual relationship based on intimacy.

26. Encourage partners to grant equal value to each other’s activities, work, life goals, opinions, hopes, and dreams.

31. Challenge couples to develop equal levels of power in their relationship.

Subscale 5: Minimizes Hierarchy

8. Raise issues of social inequality whether or not the couple brings them up.

23. Promote relationships characterized by mutuality, reciprocity, interdependence, and a balance between intimacy and autonomy.

27. Explore the ways that social inequality has influenced both partners’ identities.

34. Raise and explore issues of social privilege with clients regardless of the presenting issue.

35. Explore ways that social inequality has influenced both partners' identities.

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APPENDIX H

IRB APPROVAL

use of feminist family therapy to treat intimate partner

Documents

Transcript of use of feminist family therapy to treat intimate partner