Therapeutic approaches to empower recovery from domestic violence

PATH
Psychological Advocacy Towards Healing

This study is the first randomised controlled trial of an intervention to improve mental health symptoms of women experiencing DVA delivered by advocates with additional training in psychological methods. The PATH intervention, unlike the majority of psychological treatments for survivors of DVA, which are delivered by psychologists or counsellors, is based on a relatively brief training of advocates already in the DVA sector with ongoing supervision by a clinical psychologist.


We found that the primary outcomes of psychological distress and symptoms of depression were reduced in both arms compared to baseline, with a significant difference between the groups at 12 months follow up. This was also the case for post-traumatic stress symptoms and a general measure of mental health state.


Implications of findings

The PATH intervention delivered by specialist psychological advocates can improve psychological distress and depressive symptoms in women survivors of DVA, the majority of whom had experienced IPV. These findings from our pragmatic trial can be implemented in DVA agency settings that already employ advocates, if they undergo further training. The findings of the trial and of the nested qualitative study show heterogeneity in response to the intervention, with further abuse possibly attenuating its effect. Further evaluation based on exploratory subgroup analyses may identify women most likely to benefit and further tailoring of the intervention.

PATH Training

25 day Training Programme

Week 1       


Day 1                  Full day              Introductions and Overview

                                                       Therapeutic Principles and the Working Relationship

                                                       Introduction to Counselling Skills

                                

Day 2                   Full day             The first session and organising later sessions

                                                       Session Structure

                                                       Understanding domestic violence

                                                       Using handouts 

Day 3                   Full day             Research logistics

                                                       Introduction to Post-traumatic Stress

                                                       Reading hour

                                                       Using DVD packs


Day 4                   Half day              Assessing experiences of abuse

                                                         Assessing trauma

                             Half day              Reading and homework

Week 2       

Day 5                   Half day              Reading

                             Half day              PTSD: Flashbacks and Intrusive memories

Day 6                   Half day              PTSD: Avoidance & Numbing

                             Half day              PTSD: Arousal – physical strategies (bring a cushion)

Day 7                   Half day             Sleeping difficulties

                             Half day             Complex PTSD

                                                        Special issues for women from BME communities

Day 8                    Half day             Anxiety – cognitive strategies

                             Half day              Reading and homework

Week 3       

Day 9                    Half day             Reading

                              Half day             Goal setting

Day 10                  Half day              Unresolved Anger

                              Half day              Empty Chair work

Day   11                 Half day             Depression – planning

                               Half day             Depression – cognitive strategies

Day 12                  Full day              Injured self-esteem

                                

Day 13                 Half day              Reclaiming physical self-esteem

                             Half day              Reading and exercises

Week 4   

Day 14                   Half day              Reading

                               Half day              Inner child work

Day 15                   Half day              Split work

                               Half day              Problematic Substance Use

Day 16                    Half day              Re-parenting children in a family experiencing domestic violence                                                                        Half day               Reading and reviewing DVDs

Day 17                     Half day             Social skills / Developing Assertion

                                 Half day             Rebuilding relationships

Day 18                      Half day             Unusual signs: Psychotic symptoms & self harm                                                                                                       Half day             Reviewing handouts

  

Week 5       

Day 19                       Half day             Reading

                                  Half day              Eating Problems


Day 20                       Half day              Revision papers

                                  Half day              Managing end of contracts

Day 21                       Half day              Making sense of it all

                                  Half day              Time management


Day 22                       Full day              Abuse in childhood

                                                              Addressing issues in the working relationship

Day 23                       Half day              Clinical Practice          

                                                               Revision

Week 6       


Day 24                       Half day              Reading

                                  Half day              Clinical practice

Day 25                       Half day              Caring for the carer

                                   Half day              Closing ceremonies

 

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