Predictors of Attrition in a Treatment Program for ... - Springer Link

Journal of Family Violence, Vol. 14, No. 1, 1999

Predictors of Attrition in a Treatment Program for Battering Men Dana D. DeHart,1,3 Robert J. Kennedy,1 Leslie K. Burke,1 and Diane R. Follingstad1

This study examines factors associated with the high attrition rate in treatment programs for men who batter. In accord with past research, we expected demographic variables of age, race, employment status, relationship status, and socioeconomic status to predict attrition. We also hypothesized that attitudinal and personality variables, as well as contextual/program variables, might account for attrition more parsimoniously. Specifically, we hypothesized that attrition would be predicted by frequency and severity of violence, denial of a problem with violence, rigidity of thinking, low levels of self-disclosure, and higher anxiety and constriction in social situations. In addition, we predicted attrition would relate to dependency, maladaptive personality styles, and expectations regarding group counseling (e.g., whether treatment is perceived as aversive). Finally, we proposed that attrition would relate to whether batterer participation in treatment was self-motivated or the result of external pressures. Participants were 61 men enrolled in a batterer treatment program in a mid-sized city. Analyses of variance and discriminant analyses indicated that program attrition was unrelated to demographic, attitudinal, or personality variables. Only the contextual/program variables of mileage traveled to attend and external monitoring of attendance significantly differentiated treatment rejecters, drop-outs, and treatment continuers. Findings are discussed with regard to intrinsic and extrinsic motivational factors. Future directions for exploration are discussed. KEY WORDS: batterer; attrition; treatment; drop-out; violence.

1The

Center for Child & Family Studies, College of Social Work, University of South Carolina, Columbia, South Carolina 29208. 2Department of Psychology, University of South Carolina, Columbia, South Carolina. 3To whom correspondence should be addressed.

19 0885-7482/99/0300-0019$16.00/0 © 1999 Plenum Publishing Corporation

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In an effort to increase batterer accountability in the cessation of domestic abuse, batterer treatment programs have been implemented throughout the United States. These programs typically consist of weekly group counseling sessions attended by batterers who are self-referred, court-referred, or referred by partners, friends, or family members. Programs often focus on issues of anger management and coping skills, nonviolent conflict resolution, reducing need for control, and personal accountability for violent behavior. The groups are usually intended to provide a supportive environment for psychosocial-skill building while exposing the batterer to positive role models for change (e.g., peer counselors, reformed batterers). Although recidivism rates indicate that some 70 to 88% of program completers do not return to physical battering, batterer programs have met with limited success. Over 90% of men who inquire about program entry fail to ever complete the suggested number of treatment sessions. For example, Gondolf and Foster (1991) estimated 93% of individuals inquiring about a batterer program never actually attended counseling sessions. In past research, numerous men have dropped out directly after intake, and over half of men enrolled have failed to complete treatment (Gondolf and Foster, 1991; Pirog-Good and Stets-Kealey, 1985, 1986). Researchers who examined program success in terms of batterer recidivism have indicated that reduction of domestic violence offenses occurs only for those batterers who attend over 75% of sessions (eight-session program; Chen et al., 1989). Further, researchers have indicated that any reduction in physical violence may not be accompanied by a reduction in the amount of verbal or emotional abuse which the ‘reformed’ batterer directs toward his partner (Edleson and Grusznski, cited in Saunders and Hanusa, 1986). Selection biases in referral and differential drop-out further obfuscate program evaluation. Because completers may differ from non-attendees and drop-outs on numerous dimensions, including motivation to change, attitudinal factors, and demographic variables, low recidivism among program completers provides little information regarding effectiveness of interventions for batterers in general (Gondolf and Foster, 1991). Thus, establishing ways in which program completers differ from program dropouts not only has implications for tailoring programs to promote completion, but also has implications for evaluating the effectiveness of existing programs. Although some researchers have explored attrition in relation to demographic and program characteristics, few have examined psychological predictors of attrition. The current project examines psychological dimensions as well as demographic and program characteristics.

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LITERATURE ON ATTRITION FROM THERAPY

In a review of the literature on attrition within general psychotherapy programs, Garfield (1994) noted that socioeconomic status (SES) is one of the few variables found to consistently predict drop-out among program participants. While program affordability is likely a major contributor to greater attrition among the economically disadvantaged, factors associated with lower SES—education, ethnicity, housing stability, life strain, and amenability to the therapeutic setting (e.g., rapport)—may also play a role (Garfield, 1994; Pirog-Good and Stets, 1986). When considered independently, however, such correlates of SES have failed to yield consistent findings. Further, variables, such as age, sex, and psychiatric diagnoses, have not reliably predicted attrition. Batterer programs differ from traditional psychotherapy in a number of ways which might affect evaluation of attrition. First, many programs routinely screen out participants who have drug/alcohol problems, who have psychological disorders, and who are illiterate, lack motivation, or have a history of violence beyond the family (Pirog-Good and Stets-Kealey, 1985; Saunders and Hanusa, 1986). Many batterers are likely to be referred to treatment via intimate partners or legal personnel. Thus, these programs may address treatment only for those batterers who seem most manageable (Chen et al., 1989; Pirog-Good and Stets-Kealey, 1985). Considering recent research on different typologies of batterers (Holtzworth-Munroe and Stuart, 1994), it is reasonable to presume that batterers who enroll in such programs comprise a less-than-representative sample of batterers in general. Past research has indicated that most persons attending batterer programs are White, married, and have incomes of less than $15,000 (Pirog-Good and Stets, 1986; Pirog-Good and Stets-Kealey, 1985). When researchers have directed a focus toward identification of factors related to drop-out from batterer programs, variables considered were usually limited to demographics of the men or to program characteristics. Attrition, for instance, has been more prevalent among men who are younger (e.g., Hamberger and Hastings, 1989), White, unemployed or blue-collar workers (e.g., Hamberger and Hastings, 1989), single or separated, poorly educated (e.g., Grusznski and Carillo, 1988), and men in shorter-term relationships (Pirog-Good and Stets, 1986; Saunders and Hanusa, 1986). A few unreplicated studies have indicated that drop-out may be associated with greater criminal history, severe substance abuse, and lower incomes (DeMaris, 1989; Grusznski and Carrillo, 1988; Hamberger and Hastings, 1989, 1990). Few researchers have attempted to identify the relative importance of demographic factors in determining drop-out, and few studies have explored whether the characteristics identified may actually be asso-

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ciated with other psychological factors which may explain attrition more parsimoniously (e.g., inability to communicate effectively or rigidity of thinking). Gondolf and Foster (1991) note instances of attrition being related to denial and narcissism—qualities which would feasibly contribute to resistance to therapeutic interventions. It is also possible that the attitudes of the participants toward attending treatment sessions could influence attrition. In a study investigating attrition from a treatment program for depression, Jacob (1984) followed up on individuals who had completed versus dropped out of the program. Jacob determined that participants in the two groups had similar attitudes about the treatment program but significantly different personality variables. Thus, investigation of personality variables in relation to dropping out of these programs appears to be an important next step, although attitudes toward counseling have yet to be investigated in predicting drop out rates for battering men. With regard to the programs themselves, longer programs and programs with higher fees are less likely to retain participants. Men referred from informal sources versus court-mandated attendance are more likely to experience higher attrition (Gondolf and Foster, 1991; Pirog-Good and Stets, 1986; Pirog-Good and Stets-Kealey, 1985). Informal explanations from program coordinators have suggested that attrition may be associated with cessation of outside pressure to remain in the program (e.g., wife leaving, wife returning; Pirog-Good and Stets, 1986). Thus, the relationship between program characteristics and attrition seems to be determined, at least in part, by perceived costs of attendance (length, fees) and expectation of negative consequences for nonattendance. Such findings are consistent with criminal justice research demonstrating the effectiveness of external monitoring for promoting program compliance (e.g., use of electronic monitoring devices, monitoring payment of restitution) (Armstrong et al., 1987; Smith et al., 1989). The current study was designed to assess replicability of existing demographic findings, as well as to explore a number of attitudinal and psychological test variables which may account for batterer attrition in a more parsimonious manner. Social desirability response bias was explored in relation to attrition, in that denial of difficulty and presenting oneself in an unrealistically good light would seem to make one less accepting of treatment for physical abuse. Alternatively, one might expect that high levels of social desirability might prompt men to complete measures and attend treatment in order to appear to be making an effort toward change. Literature from another treatment outcome study with a difficult population indicated that program completers in an alcohol treatment program represented themselves in a more socially desirable way and had a greater need for approval than dropouts. Thus, it was expected that men entering

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the treatment program for battering would be more likely to attend longer if social-desirability scores were higher (Krasnoff, 1976). Because therapy may require individuals to challenge prior views of themselves and try new approaches, we expected persons with highly rigid personal styles to be resistant to therapy and drop out of treatment earlier. A number of studies by Hamberger and Hastings (1986, 1988a, b, 1989, 1990, 1991) and by Hastings and Hamberger (1988, 1994) have identified patterns of personality disorders in male spouse abusers. Because personality disorders are defined as rigid, fixed, maladaptive patterns of living, it was expected that rigidity as a trait would help explain which individuals drop out of battering men’s treatment programs. An analysis of the severity and frequency of violence in the man’s relationship was considered important because higher levels of severity and frequency may influence the man’s perception as to whether he has a problem, thereby influencing motivation to remain in the program. Saunders and Parker (1989) provided some support for this idea in finding greater treatment retention of battering men who reported higher levels of conflict and anger in their marriages. In considering a potential client’s response to therapy, self-disclosure was hypothesized to be a factor influencing attrition because the person’s willingness to discuss personal information would be directly tapped in a counseling setting. Personality characteristics, in the form of personality disorders and major symptoms, were considered potential factors influencing attrition. More severely disturbed clients were expected to be less amenable to therapy and would thereby be more likely to drop out of the program. Beliefs and expectations regarding the counseling experience were expected to be predictive of attrition. Particular beliefs and expectations included: considerations of treatment as indicative of weakness; the belief that one should leave problems alone; willingness to admit problems; expectation of blame, ridicule, or embarrassment in treatment; expectation that good things would happen in counseling; expectation that treatment would be emotionally painful; and client’s perception of whether he could communicate clearly. Contextual/program characteristics such as mileage traveled to attend and whether attendance was court-mandated were also assessed in relation to attrition.

METHOD Participants Of the 61 participants, 17 men were referred to the program by legal personnel, 23 were referred by partners, family, or friends, 15 were self-re-

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ferred, and source of referral was unavailable for 6 men (i.e., item was left blank or participant provided name—e.g., John Doe—without other identifying information). Men ranged in age from 19 to 60, with the median age being 33.5. Sixty seven percent of men were White, 26% were African American, 2% were Hispanic, and 4% were unidentified in terms of ethnicity. Most men (64%) had a high-school education, and most (77%) had full-time jobs. Fifteen percent were employed in unskilled labor positions, 38% had technical jobs, 15% clerical, 8% white-collar, and the remaining 24% were unidentified in terms of employment setting. Forty three percent of men earned less than 10,000 dollars per year, 25% earned between 10,000 and 20,000, 25% earned between 20,000 and 40,000, and 7% earned over 40,000. Most men (41%) were married, although an additional 18% were separated, 7% were divorced, 8% were cohabiting, and 26% were single. Classification of Participants In past research on attrition from general psychotherapy, participants have been classified as “drop-outs” in a somewhat arbitrary manner, with the number of sessions attended by drop-outs ranging from 4 to 20 (Garfield, 1994). A national survey of batterer programs found that the largest percentage of programs defined completion as participation in between four and twelve program weeks and that almost half of participants who attended any sessions dropped out before program completion (Pirog-Good and Stets-Kealey, 1985). With consideration of this, we chose an empirical criterion for dividing our sample into treatment rejecters, drop-outs, and continuers. Over 90% of our sample failed to complete the recommended 12 sessions, thus a separate completer group would be of limited statistical value and would not contribute to our stated research goals of examining factors associated with attrition (versus recidivism, for which program completion would be of greater theoretical importance). Approximately 50% of our participants attended at least four treatment sessions; four sessions would also fall at the lower bound of previous criteria used to differentiate drop-outs from completers. These 30 men were thereby labeled continuers for the purpose of this study. Those men remaining were almost evenly split between treatment drop-outs (n = 15), who attended one to three sessions, and treatment rejecters (n = 16), who attended no sessions. Research Site At the time that the current study was being conducted, the Men’s Resource Center in Columbia, South Carolina functioned primarily as a

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facilitated support group for men who had engaged in emotional and physical abuse toward their adult partners. Co-facilitators were either one male and one female Master’s-level counselor or one female counselor and one male peer (reformed-batterer). Weekly discussions centered around current issues for participants, with particular emphasis upon providing a supportive environment in which men could explore their feelings while simultaneously developing new nonviolent ways of coping and skills in listening and communicating. Sessions followed no sequential progression, but facilitators were provided with topically organized manuals which could be used as instructional supports when appropriate. For example, if a man brought up the topic of self-esteem, facilitators could refer to manuals for a summary of relevant issues which might be introduced into the discussion. The proposed goal of treatment was attendance of twelve program sessions, as program designers estimated that this number of sessions would likely expose participants to all major principles in the manual. Enrollment was open-ended, with men being added to an existing group following an intake session. Although attendance of 12 sessions was recommended, there was no formal legal mechanism for ensuring that clients actually did attend at least 12 sessions (e.g., punitive actions for failure to comply with mandates were inconsistently applied by the courts). Sessions typically lasted one and one-half hours, with participants paying sliding-scale fees of $5 to $20 per session. Procedure Upon standard individual intakes, men were invited to complete survey measures. These measures were not part of the Center’s routine intake program; thus, our sample consists of volunteers who chose to complete the self-report survey. Although some men who attended the intake chose not to complete the measures, no formal records were kept regarding those persons. Therefore, it is possible that our particular survey sample is biased in some respects, in that men who consented to participation may have had greater motivation to change or may have wished to appear more motivated. Unfortunately, intake workers were unable to provide any estimate of the refusal rate. Measures Measures, which took approximately one and one-half hours to complete, are described below.

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Psychopathology Participants completed a brief demographic questionnaire and the MilIon Clinical Multiaxial Inventory (MCMI; Millon, 1983), which was used to assess personality disorders, psychotic symptoms, somatoform symptoms, hypomania, dysthymia, defensiveness, anxiety, depression, and alcohol/drug abuse.

Social Desirability Social-desirability response bias (unrealistically positive response sets) was measured using the MMPI Lie Scale ( = .48; Hathaway and McKinley, 1942), and a short-form of the Marlowe-Crowne Social Desirability Scale ( = .47; Zook and Sipps, 1985). Answering even half of the items on these measures in a socially desirable manner is considered to be indicative of high social-desirability. Consequently, the atypically low reliability of these measures may be the result of such responding among men in our sample (e.g., means in our study indicated almost 60% of responses were socially desirable, relative to a “normal” Population rates of approximately 45%).

Rigidity Social rigidity was measured using the Anxiety and Constriction in Social Situations subscale of the Rigidity Scale (Rehfisch, 1958). The Rigidity of Attitudes Regarding Personal Habits Scale (Meresko et al., 1954) was used to measure opposition to change and intolerance of ambiguity. Self-Disclosure Self-disclosure was measured via the Self-Disclosure Questionnaire (Jourard, 1971). Attitudes Toward Counseling We also used an unpublished Attitudes Towards Counseling Scale (Follingstad, 1993), which consisted of 43 four-point Likert-type items designed to assess the participant’s general attitude towards professional counselors and counseling experiences. These items also included two additional subscales measuring current relationship satisfaction and whether the man believed that his use of force in the relationship was a problem.

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Relationship Violence and Satisfaction A modified Conflict Tactics Scale (Straus, 1979) was used to measure use of reasoning, verbal aggression, and violence within the family. Eleven Likert-type items were used to assess extent of mild/moderate/severe injuries suffered by partner and psychological effects suffered by partner (e.g., anxiety, suicidal thoughts, eating problems). RESULTS

Preliminary examination of our data indicated that our research goals, sample size, and data structure were appropriately-suited to discriminant analysis. In accord with Tabachnick and Fidell’s (1989) suggested methodology, we preceded discriminant analyses with analyses of individual predictor variables. Analyses of Demographic Variables

Analyses of variance were performed for each demographic variable in order to establish whether rejecters, drop-outs, and continuers differed with regard to personal history. Analyses indicated that the three groups of men did not differ in terms of age, education, income, number of previous marriages, or length of current relationship. Chi Square analyses indicated no between-group differences for the variables ethnicity (White versus Ethnic Minority), marital status (married versus nonmarried), relationship status (involved versus single), or occupational position (office worker versus other). Analyses of Abuse

Multivariate analyses of variance (MANOVA) indicated that groups did not differ with regard to use of psychological maltreatment or physical force for the Conflict Tactics subscales assessing psychological abuse, threats to kill, physical abuse, severe abuse, or rape. That is, there was no main effect for attendance and no interaction between attendance and selfreported use of force. Similar analyses were conducted with dependent variables being effects of force on the partner, including mild injuries, moderate injuries, severe injuries, and psychological effects for the woman. In these analyses, there was no main effect for attendance, and no interaction between attendance and effects of force.

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Analyses of Attitudinal and Bias Measures Analyses of variance indicated that there were no attendance-group differences on measures of self-disclosure, opposition to change, social rigidity, or attitudes toward counseling. Further, no group differences were observed in ratings of program convenience. A multivariate analysis of variance for the dependent variables relationship satisfaction and addressing issues of force indicated no main effect for attendance group, and no interaction between group and these attitudes. Groups also did not differ on measures of socially-desirable responding. That is a MANOVA including the dependent variables Marlowe-Crowne, MMPI Lie, and MCMI Defensiveness (V) scales demonstrated no main effect for attendance, and no interaction between attendance and response bias. Analyses of Mental Disorders Analyses of variance were used to examine whether rejecters, dropouts, and continuers differed with regard to clinical disorders. No betweengroups differences were found for MCMI scales assessing anxiety (A scale), somatoform symptoms (H scale), or hypomania (N scale). Multivariate analyses of variance using MCMI scales 1 through 8 indicated that groups did not differ with regard to personality disorders. Groups also demonstrated no differences on severe personality disorders, dysthymia and major depression, psychoticism, or substance use. Analyses of Situational/Program Characteristics There were differences between groups on two of the three program variables tested. Chi-Square tests indicated that groups did not differ in reason for attending (wanting to personally attend versus encouraged by family/friends/courts), but did differ regarding whether someone would be checking on their attendance (anyone checking—including partners or legal/social-services personnel versus nobody checking), x2 (2) = 6.47, p < .05. As can be seen in Table I, examination of adjusted residuals (those greater than 1.96 indicate a significant difference between observed and expected values at p < .05) suggests that men whose attendance was not checked were overrepresented among drop-outs (2 = 3.9) and underrepresented among continuers (z = -4.3). Exploratory analyses indicated that this result held up no matter whether the person checking was a wife/partner (n = 18) or legal personnel (n = 14). Analyses of variance demonstrated differences between groups in distance traveled to attend sessions,

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29 Table I. Completion of Program for Men Whose Attendance Was Checked Versus Unchecked Rejectors Dropouts

Continuers

Nobody checking Observed Expected Adjusted residual

8.0 7.6 0.4

11.0 7.1 3.9a

10.0 14.3 -4.3a

Someone checking Observed Expected Adjusted residual

8.0 8.4 -0.4

4.0 7.9 -3.9a

20.0 15.7 4.3a

ap

< .05.

F(2, 55) = 7.12, p < .01. Although rejecters (M = 13.94) and drop-outs (M = 11.43) did not differ, t(27.36) = 0.77, ns, continuers (M = 29.52) traveled significantly further than did either rejecters, t(38.44) = 3.25, or drop-outs, t(38.72) = 3.71, ps < .01. Exploratory analyses demonstrated no significant curvilinear effect for mileage traveled (means were 13.94, 11.43, and 29.52 for rejecters, drop-outs, and continuers, with standard deviations approximating 8.9 for all groups). Discriminant Analyses In order to examine the magnitude of contribution of program characteristics to prediction of group membership, a direct discriminant function analysis was performed using mileage traveled and attendance monitored as predictors of membership in the three groups (rejecters, drop-outs, continuers). Exploratory analyses indicated that findings were not altered when data transformations were conducted to address statistical assumptions (e.g., nonnormality, heterogeneity of variance). Therefore, we chose to maintain optimal interpretability by using original data for analyses. Two discriminant functions were calculated, with a combined x2 (4) = 18.99, p < .001. After removal of the first function, however, there was little association between groups and predictors, x2(1) = 0.60, ns. Canonical correlations indicate that the first function accounted for 29% of variability attributable to differences between groups, and the second accounted only for about 1%. The first discriminant function maximally separated continuers from the other two groups. The second discriminant function discriminated rejecters from drop-outs.

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The loading matrix of correlations between predictors and discriminant functions suggests that the best predictors for distinguishing between continuers and the other two groups (first function) was greater mileage traveled (r = .80), although having attendance monitored was also influential (r = .51). For the second function, which distinguished between rejecters and drop-outs, the best predictor was attendance monitored (r = .86), with mileage traveled loading r = -.60. Fewer men represented among the dropouts indicated that their attendance was being monitored than men represented in the rejecter or continuer groups (29% versus 50% and 68%, respectively). These discriminant function analyses using only the variables mileage traveled and attendance monitored resulted in correct classification for 50% of cases, exceeding the 33% classification rate which would be expected by chance. The most accurate classification was for drop-outs, 64% of whom were correctly classified, with the greatest number of misclassified cases (29%) falling under the classification of continuers. Fifty seven percent of continuers were correctly classified, with the most misclassifications (29%) falling in the rejecter category. Finally, rejecters appear to have the highest rates of misclassification, with only 25% of cases being correctly classified and the rest of cases erroneously falling in the drop-out (44%) and continuer (31%) categories.

DISCUSSION Previous studies assessing attrition in these programs have typically used demographics as predictors, and it was anticipated that the addition of attitudinal factors and personality factors would provide a richer explanation for which men are likely to drop out of or not even enter treatment after an intake session. The analyses indicated that only the situational/program characteristics of mileage traveled and monitored attendance predicted attrition. It appears that those men who had to travel greater distances to sessions were more likely to attend and remain in the program. Of those men who did attend at least some sessions, those whose attendance was in some way monitored were most likely to continue in the program. Taken together, our two predictor variables did result in a significant increment in the ability to classify cases into the three groups, but discriminant analyses indicated that treatment rejecters were the most difficult cases to classify. One of the first issues to be considered in discussing the results is why so few variables were predictive of attendance by the men in the treatment program. Even though our attitudinal/personality variables appeared conceptually relevant, there may be several explanations for nonsignificance. First, it is possible that less than straightforward information may result

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from collecting data on attitudes about counseling, self-disclosure, anxiety, and social comfort as well as aspects of personality upon immediate presentation for intake. It is possible that the men feel great demand at intake to present themselves in an uncharacteristic and socially-desirable manner. There is some support for this idea, in that the social desirability scores of the men in this study were elevated over what would be expected in a normal population. Thus, if researchers had been able to collect information at a different point in time—possibly after more rapport-building or after the men were convinced to respond straightforwardly—there might be evidence of other hypothesized variables being predictive of attendance. Exploratory analyses in which social desirability was controlled, however, indicated no significant changes in our findings. Because we do not have access to data on men who chose not to complete our survey at intake, the possibility remains that our sample is unrepresentative of batterers who enroll in treatment. That is, our sample may consist of a sub-group of batterers whose attitudes are fairly homogenous, and hence no differences between groups would be manifest. Examination of attitudinal measures, however, suggests that survey participants held a broad range of attitudes which were normally distributed and for which measurement was highly reliable. Another possibility for few variables predicting attendance is that personality and attitudinal variables may be unimportant for influencing attendance, whereas motivational factors such as having attendance monitored may be much more salient. While we conceptualized motivation to attend these groups as including attitudes which would influence comfort with and belief in participating in group treatment, it may be that these attitudes are not strong enough predictors. Rather, the degree of external pressure on an individual may be more important to overcome internal barriers for attendance (i.e., whether or not the person expects to be comfortable with the group process). This is consistent with containment theory, which posits that cultural institutions cultivate a buffer against aggression by providing a social framework from within which the individual may internalize rules, perceive role offers as meaningful, and experience group reinforcement (Long, 1978). Our finding that men who had to travel further to attend sessions may attest to motivation, in that greater effort via mileage traveled may be indicative of greater commitment at the onset of the program. This finding may also have a parallel with general psychotherapy literature (e.g., Axsom and Cooper, 1985) which has suggested that individuals who feel there is some effort required to engage in the process may be more likely to value that process. Cognitive dissonance may play a part here, in that expending effort to attend may result in a higher valuation of the experience and

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thereby support continuation in treatment. Accordingly, in a recent qualitative study of reformed batterers’ experiences of successful treatment, men repeatedly emphasized the importance of wanting to change (Gondolf and Hanneken, 1987). Another possibility, of course, is that the relationship between attendance and mileage traveled was idiosyncratic within the current sample. Thus, researchers may wish to assess the replicability of this finding. Taken at face value, our findings would indicate that reducing attrition in batterer programs might be most effectively accomplished by enhancing internal and external motivations to attend, especially to the extent that external containment may facilitate internalization of rules, meaningful roles, and group reinforcement. These may in turn contribute to internal factors such as norm retention and acceptance of appropriate goals. Possibly, more focus could be placed on educating the judiciary’of the need for external sanctions on abusive men to find and complete treatment. Researchers may also wish to examine whether experimental manipulation of dissonance might have a discernable effect on treatment attendance for batterers. That is, in accord with dissonance paradigms used to explore liking for ‘social clubs’ (Aronson and Carlsmith, 1963), researcher might encourage men to undergo some sort of initiation procedure which would enhance the participant-group bond via arousal of dissonance. Of course, such experimental manipulation should be carefully evaluated prior to implementation, in that effortfulness of attendance may actually deter men from continuation in treatment under certain conditions. Another direction for future research might involve collecting information about participants from legal records and partner/family/friend-reports rather than simply using self-report. Data regarding severity and frequency of violence, monitored attendance, prior criminal history, and relationship-specific attitudes/behaviors might yield significant group differences if the verity of these data are not distorted by response biases in self-presentation. Saunders and Hanusa (1986) have already made successful use of partner reports in assessing recidivism to physical violence, although those follow-ups conducted were relatively short-term. Also, in accord with Gondolf and Hanneken’s (1987) qualitative research on reformed batterers, researchers could conduct interviews with drop-outs and rejecters to determine reasons for premature termination of treatment. Because some men never even attend the actual intake session after phoning for an appointment, some initial data on potential predictor variables might also be collected over the phone. In this way, some useful predictors for who will not show for the intake might also be established.

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