中華心理衛生協會

Purpose: This study explores the characteristics of men with a major mental illness who engage in marital violence and examines the outcomes of the Relational Development Program (RDP) and the effectiveness of marital therapy, the main intervention used in RDP. Methods: Seventy couples participated in RDP. All of them received an ordinary psychiatric practice and were prepared into an additional course of marital therapy, yet only 29 (41.4%) of them completed it. All RDP participants were allocated to the three groups in the study according to the diagnosis of the husband's mental disorder: no psychiatric diagnosis, minor mental illness, and major mental illness (eg, schizophrenia and bipolar disorder). Statistical comparisons of associated variables between diagnostic groups were performed to identify the unique characteristics of married violent men with a major mental illness. All participants' mean pre-and post-test violence scores (severity, person involved, and frequency of verbal aggression, mild, moderate, severe, and extreme violence) were compared to examine the effectiveness of the RDP. We also compared the data of participants who completed the marital therapy with those who did not complete it to examine the effectiveness of marital therapy. Results: Five characteristics of married violent men with a major mental illness were identified: 1) younger in age, 2) lower socioeconomic status, 3) more serious violent behaviors, 4) low in the marital power hierarchy, and 5) batterers' roles and relationships inflicted by major mental illness as well. RDP reduced the violence scores of all participants significantly, and the violence scores of those who completed the marital therapy were reduced significantly more than those who did not complete it, but there were no difference among the three groups with different psychiatric diagnoses. Conclusions: 1) Male perpetrators with a major mental illness are a distinct subtype of batterers. Based on the characteristics identified, we propose ways to refine the treatment model and suggest specific interventions. 2) The outcome of the RDP is as good as other treatment models for male perpetrators. 3) Adding marital therapy to current ordinary psychiatric practices could further reduce marital violence.