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
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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.
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PATH Training has been delivered to Cardiff Women's Aid and Devon County Council. A version modified for victims of stalking has been delivered to the Suzy Lamplugh Trust.
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PATH Training
25 day Training Programme
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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
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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
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Week 2
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Day 5 Half day Reading
Half day PTSD: Flashbacks and Intrusive memories
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Day 6 Half day PTSD: Avoidance & Numbing
Half day PTSD: Arousal – physical strategies (bring a cushion)
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Day 7 Half day Sleeping difficulties
Half day Complex PTSD
Special issues for women from BME communities
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Day 8 Half day Anxiety – cognitive strategies
Half day Reading and homework
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Week 3
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Day 9 Half day Reading
Half day Goal setting
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Day 10 Half day Unresolved Anger
Half day Empty Chair work
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Day 11 Half day Depression – planning
Half day Depression – cognitive strategies
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Day 12 Full day Injured self-esteem
Day 13 Half day Reclaiming physical self-esteem
Half day Reading and exercises
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Week 4
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Day 14 Half day Reading
Half day Inner child work
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Day 15 Half day Split work
Half day Problematic Substance Use
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Day 16 Half day Re-parenting children in a family experiencing domestic violence Half day Reading and reviewing DVDs
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Day 17 Half day Social skills / Developing Assertion
Half day Rebuilding relationships
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Day 18 Half day Unusual signs: Psychotic symptoms & self harm Half day Reviewing handouts
Week 5
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Day 19 Half day Reading
Half day Eating Problems
Day 20 Half day Revision papers
Half day Managing end of contracts
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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
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Day 23 Half day Clinical Practice
Revision
Week 6
Day 24 Half day Reading
Half day Clinical practice
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Day 25 Half day Caring for the carer
Half day Closing ceremonies
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