The authors attempted to replicate and extend D. M. Kivlighan and P. Shaughnessy's (2000) findings of (a) 3 distinctive patterns of alliance development across sessions and (b) a differential association of one of these, a U-shaped quadratic growth pattern, with positive treatment outcome. In data drawn from a clinical trial of brief psychotherapies for depression (N ϭ 79 clients), the authors distinguished 4 patterns of alliance development. These matched 2 of Kivlighan and Shaughnessy's patterns, but not the U-shaped pattern, and none was differentially associated with outcome. However, further examination of the data identified a subset of clients (n ϭ 17) who experienced rupture-repair sequences-brief V-shaped deflections rather than U-shaped profiles. These clients tended to make greater gains in treatment than did the other clients.

There is a high prevalence of domestic violence in psychiatric populations but the extent of the increased risk in psychiatric patients compared with other populations is not clear because of the limitations of the methodology used in the studies identified. There is also very limited evidence on how to address domestic violence with respect to the identification and provision of evidence-based interventions in mental health services.

There are clear gender differences in the experience of domestic violence and associated mental health outcomes. There is also increasing evidence of chronic, severe and often long-term adverse mental health effects for victims. This paper explores these gender differences and the evidence on how mental health care services should respond to domestic violence. The authors argue that any strategy to reduce the burden of women's mental health problems should include efforts to identify, prevent or reduce violence against women.

BackgroundDomestic violence and abuse (DVA) are associated with increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services.ObjectiveOur goal was to characterise the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators.DesignBaseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors were analysed. We report the prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. The following mental health measures were used: Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalised Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale to measure posttraumatic stress disorder (PTSD). The Composite Abuse Scale (CAS) measured abuse.ResultsExposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70–81%). Depression and anxiety levels were high, with means close to clinical thresholds, and more than three-quarters of respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA.ConclusionsWomen DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services.

Clients (n = 79) and therapists (n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pretreatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.

INTRODUCTIONIdentification and Referral to Improve Safety (IRIS) is a training and support programme for general practice that aims to improve the response to women experiencing domestic violence and abuse (DVA). The programme trains clinicians in identification, initial response or validation, referral to specialist DVA advocacy, and continuing support.In a cluster randomised trial the IRIS intervention had a substantial effect on identification of women experiencing DVA and on referral to DVA advocacy.1 A meta-analysis of qualitative studies found women survivors of DVA see healthcare professionals as potential sources of support.2 However, there is still uncertainty about effective responses from clinicians, 3 including those working in general practice, 4 and about how women experience programmes such as IRIS that are designed to improve clinician engagement with DVA.The aims of this study were to understand women's experiences of disclosure of DVA in general practice settings in the context of the IRIS programme, focusing on women's subsequent referral by their GP or practice nurse to a DVA advocate. The study set out to explore women's experience of the initial contact with an advocate after the GP referral and their views on how important this initial meeting and contact was to any changes that they subsequently reported in attitude and behaviour that improved their sense of safety. It also aimed to investigate whether it mattered to the women that they had been referred to a DVA advocate by a healthcare professional and what impact, if any, their subsequent contact with their GP or nurse had on any changes they made after seeing the DVA advocate. METHOD Study designA service-user collaborative study using a qualitative study design was conducted. A multidisciplinary team of two DVA advocates, one social scientist, and one DVA specialist clinical psychologist supported a survivor of DVA (KS) to design and deliver a piece of service-user research (service user in this case refers to previous use of domestic violence agencies and services). SamplingWomen were recruited who had been referred to a domestic violence agency by general practice professionals taking part in a randomised controlled trial testing the IRIS programme. Recruitment took place across the trial sites in Bristol and Hackney. A purposive sampling strategy was adopted to maximise heterogeneity in terms of age, ethnicity, length of DVA, and whether or not women were still with the perpetrator. Twenty women were approached initially in each site by a specialist advocate and told about the study. Thirty-five women

This article reports the development and psychometric properties of two short forms of the 28-item Agnew Relationship Measure, the ARM-12 and ARM-5. For the ARM-12, results of previous research were used together with conceptual considerations to select three items to represent each of four ARM subscales: Bond, Partnership, Confidence, and Openness. For the ARM-5, item-analytic principles were used to select five items to represent overall alliance. In all three ARMs, client and therapist versions were constructed to contain parallel items. We drew data to assess reliability and validity from three UK trials of brief therapy for depression. Results indicated that the two short ARMs have acceptable psychometric properties and that they converged with each other and with the full ARM.

Aims. High numbers of psychiatric service users experience domestic violence, yet limited interventions exist for these victims. We piloted a domestic violence intervention for community mental health services to explore the feasibility of a future cluster randomized controlled trial. Methods. Quasi-experimental controlled design within five Community Mental Health Teams (three intervention and two control teams). The intervention comprised domestic violence training for clinicians' and referral to domestic violence advocacy for service users. Clinicians' (n = 29) domestic violence knowledge, attitudes and behaviours were assessed before and 6 months post-training. Service users' (n = 34) safety behaviours, unmet needs, quality of life and frequency/severity of abuse were examined at baseline and 3 months follow-up. Process evaluation data were also collected. Results. Clinicians receiving the intervention reported significant improvements in domestic violence knowledge, attitudes and behaviours at follow-up (p < 0.05). Service users receiving the intervention reported significant reductions in violence (p < 0.001) and unmet needs at follow-up (p < 0.05). Conclusions. Interventions comprising domestic violence training for clinicians and referral to domestic violence advocacy may improve responses of psychiatric services. Low rates of identification among teams not receiving training suggest that future trials using service user outcomes are unlikely to be feasible. Therefore, other methods of evaluation are needed.