Domestic violence survivors' empowerment and mental health: Exploring the role of the alliance with advocates.

Over the last 4 decades, domestic violence (DV) programs-both residential and nonresidential-have sprung up in communities across the country with the aim of helping survivors become safe. These programs place strong emphasis on the relationship between the advocate and survivor as critical to becoming safer and healing from the trauma of abuse. Yet little research has demonstrated the extent to which specific aspects of the advocate-survivor alliance are related to specific indicators of survivor well-being, nor shown what factors might mediate that relationship. This study explored in a sample of help-seeking survivors (N = 370) whether the strength of the alliance between survivors and their advocates is related to lower symptoms of depression and posttraumatic stress disorder (PTSD) and whether this association is mediated by survivors' sense of empowerment in the domain of safety. The structural equation model we tested also controlled for variables that might influence these relationships, including race/ethnicity, financial strain, and length of stay in the program. As expected, stronger alliance was associated with reduced symptoms of both depression and PTSD, through the mechanism of empowerment in the domain safety. These findings provide direction to programs seeking to establish a theory of change and point the way toward longitudinal research on the nature and function of the alliance as a potential contributor to healing. (PsycINFO Database Record

[1]  Julie M. Woulfe,et al.  Survivor-Defined Practice in Domestic Violence Work , 2016, Journal of interpersonal violence.

[2]  L. Goodman,et al.  Bringing trauma-informed practice to domestic violence programs: A qualitative analysis of current approaches. , 2015, The American journal of orthopsychiatry.

[3]  Judith Lewis Herman,et al.  Trauma and Recovery , 2015 .

[4]  L. Goodman,et al.  Low-income women’s experiences in outpatient psychotherapy: A qualitative descriptive analysis , 2015 .

[5]  Julie M. Woulfe,et al.  Advancing domestic violence program evaluation: Development and validation of the Measure of Victim Empowerment Related to Safety (MOVERS). , 2015 .

[6]  Cris M. Sullivan,et al.  Oppression Within Safe Spaces , 2014 .

[7]  A. Taket,et al.  Selecting outcomes for intimate partner violence intervention trials: overview and recommendations , 2014 .

[8]  Rashmita S. Mistry,et al.  Best Practices in Conceptualizing and Measuring Social Class in Psychological Research , 2013 .

[9]  E. Lyon,et al.  Domestic Violence Advocacy: Complex Lives/Difficult Choices , 2013 .

[10]  Alisha Ali,et al.  The therapist as advocate: anti-oppression advocacy in psychological practice. , 2013, Journal of clinical psychology.

[11]  Gina Dillon,et al.  Mental and Physical Health and Intimate Partner Violence against Women: A Review of the Literature , 2013, International journal of family medicine.

[12]  H. Bell,et al.  Back to Basics , 2012, Violence against women.

[13]  Sara Perez,et al.  The Attenuating Effect of Empowerment on IPV-Related PTSD Symptoms in Battered Women Living in Domestic Violence Shelters , 2012, Violence against women.

[14]  C. Zlotnick,et al.  Cognitive behavioral treatment of PTSD in residents of battered women's shelters: results of a randomized clinical trial. , 2011, Journal of consulting and clinical psychology.

[15]  A. Horvath Alliance in Common Factor Land: A view through the research lens * , 2011 .

[16]  David P MacKinnon,et al.  RMediation: An R package for mediation analysis confidence intervals , 2011, Behavior research methods.

[17]  L. Goodman,et al.  Through the Lens of Therapeutic Jurisprudence , 2010, Journal of interpersonal violence.

[18]  Rachel R. Singer,et al.  When Crises Collide , 2009, Trauma, violence & abuse.

[19]  Rebecca J. Macy,et al.  Domestic violence and sexual assault services: Inside the black box , 2009 .

[20]  L. Goodman,et al.  Feminist Relational Advocacy , 2009 .

[21]  M. Stein,et al.  Mental Health Correlates of Intimate Partner Violence in Marital Relationships in a Nationally Representative Sample of Males and Females , 2009, Journal of interpersonal violence.

[22]  Laura Smith Enhancing training and practice in the context of poverty. , 2009 .

[23]  Janel M. Leone Listening to Battered Women: A Survivor‐Centered Approach to Advocacy, Mental Health, and Justice ‐ by Lisa A. Goodman and Deborah Epstein , 2008 .

[24]  Aarati Kasturirangan Empowerment and Programs Designed to Address Domestic Violence , 2008, Violence against women.

[25]  F. Chen Sensitivity of Goodness of Fit Indexes to Lack of Measurement Invariance , 2007 .

[26]  L. Goodman,et al.  The full-frame approach: a new response to marginalized women left behind by specialized services. , 2006, American Journal of Orthopsychiatry.

[27]  R. DeRubeis,et al.  A Conceptual and Methodological Analysis of the Nonspecifics Argument , 2006 .

[28]  J. Gillaspy,et al.  Development and validation of a revised short version of the working alliance inventory , 2006 .

[29]  N. Sokoloff,et al.  Domestic Violence at the Intersections of Race, Class, and Gender , 2005, Violence against women.

[30]  C. Chemtob,et al.  Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder. , 2004, Journal of consulting and clinical psychology.

[31]  J. Markowitz,et al.  Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics. , 2003, Journal of consulting and clinical psychology.

[32]  H. Barnes,et al.  Fragmented services, unmet needs: building collaboration between the mental health and domestic violence communities. , 2003, Health affairs.

[33]  C. West,et al.  Violence in the Lives of Black Women: Battered, Black, and Blue , 2003 .

[34]  Gordon W. Cheung,et al.  Evaluating Goodness-of-Fit Indexes for Testing Measurement Invariance , 2002 .

[35]  J. Garske,et al.  Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. , 2000, Journal of consulting and clinical psychology.

[36]  W. Hwang,et al.  Role of the Working Alliance in the Treatment of Delinquent Boys in Community-Based Programs , 2000, Journal of clinical child psychology.

[37]  A. Weisz Legal Advocacy for Domestic Violence Survivors: The Power of an Informative Relationship , 1999 .

[38]  E. Lyon,et al.  Safety Planning with Battered Women: Complex Lives/Difficult Choices , 1998 .

[39]  A. Horvath,et al.  The role of the therapeutic alliance in psychotherapy. , 1993, Journal of consulting and clinical psychology.

[40]  L. Gutiérrez Working with Women of Color: An Empowerment Perspective , 1990 .

[41]  D. Belle The Impact of Poverty on Social Networks and Supports , 1983 .

[42]  L. Radloff The CES-D Scale , 1977 .

[43]  Lauren B. Cattaneo,et al.  What Is Empowerment Anyway? A Model for Domestic Violence Practice, Research, and Evaluation , 2015 .

[44]  Cris M. Sullivan,et al.  EXPLORING THE CORE SERVICE DELIVERY PROCESSES OF AN EVIDENCE‐BASED COMMUNITY ADVOCACY PROGRAM FOR WOMEN WITH ABUSIVE PARTNERS , 2013 .

[45]  M. Harris,et al.  Comprar New Directions for Mental Health Services, Using Trauma Theory to Design Service Systems, No. 89 Spring 2001 | Roger D. Fallot | 9780787914387 | Wiley , 2007 .

[46]  L. Brown Feminist paradigms of trauma treatment. , 2004 .

[47]  J. Sheikh,et al.  The primary care PTSD screen (PC-PTSD): development and operating characteristics , 2004 .

[48]  M. Harris,et al.  Using trauma theory to design service systems. , 2001 .

[49]  P. Bentler,et al.  Cutoff criteria for fit indexes in covariance structure analysis : Conventional criteria versus new alternatives , 1999 .

[50]  J. Miller The Healing Connection: How Women Form Relationships in Therapy and in Life , 1997 .

[51]  E. Bordin,et al.  Theory and research on the therapeutic working alliance: New directions. , 1994 .

[52]  A. Horvath,et al.  Development and validation of the Working Alliance Inventory. , 1989 .

[53]  S. Schechter Women and Male Violence: The Visions and Struggles of the Battered Women's Movement , 1982 .