Research & Action Fall/Winter 2006

Research & Action Report Fall/Winter 2006

The Wellesley Centers for Women (WCW) recently welcomed Pamela Alexander, a senior research scientist whose work focuses on gender violence. Alexander, a recent senior research investigator at the Center for Research on Youth and Social Policy at the University of Pennsylvania, received her Ph.D. in clinical psychology from Emory University, was on the psychology faculty at Memphis State University (now the University of Memphis), and held a tenured associate professorship in psychology at the University of Maryland. She has conducted research in the area of gender-based violence for more than 25 years.

What led you to study gender violence?

After my internship in clinical psychology I was working at a small, rural mental health center outside of Memphis and I found I was interviewing many women who had histories of incest. At that time, there was virtually nothing written on this but when you begin to study incest, you find out you’re also studying physical abuse, marital violence, and neglect. There’s a huge overlap between different types of violence that occur within a family context.

Several years later when I was at Memphis State University, I compared different kinds of group treatment for adult female incest survivors. I became interested in attachment theory as a way of looking at the importance of early family relationships in affecting a child’s ability to regulate her affect and her view of intimate relationships. I conducted another interview study of incest survivors in Washington, D.C., looking at the variety of symptoms associated with different kinds of family dynamics. Gradually, I became more focused on intimate partner violence or domestic violence.

I’m really interested in the relational context of current violence and child abuse. Specifically, I’m interested in what keeps people connected even though there’s violence going on, and what contributes to people’s vulnerability or risk for either perpetrating or being the victim of violence? And as a clinical psychologist, I am very interested in prevention and treatment—what kinds of interventions not only stop abusive behaviors by the batterer, but also help both batterers and victims learn new patterns for interacting that are satisfying and successful?

From a feminist perspective, it’s absolutely essential that men receive some sort of effective intervention to stop being violent. A lot of victims don’t want to leave their partners; they want the violence to stop but they have a sense of connection, they have relationships, they may be parents together. And even if a couple does separate successfully and safely, a failure to intervene with the man does very little to protect the next woman with whom he is in a relationship.

It’s not clear whether current kinds of treatment are any more effective than some sort of legal intervention so I am now looking at a different kind of treatment model, through a [National Institute of Justice] grant, that uses a stages-of-change motivational interviewing perspective. The stages-of-change model is based on the notion that for any of us, any kind of change that we want or that we experience occurs through a series of stages. Initially, we don’t feel that we have a problem, then we start to think about it, then we may make preparations to change behavior, then we begin making changes, and hopefully we continue.

This model suggests that different kinds of interventions are important for people in different stages. The wrong kind of intervention at the wrong time is just not going to work. Since most batterers who are court-ordered to treatment are in an early stage of change, standard batterer treatment that is focused on behavioral change for men in a later stage of change is not particularly effective. Instead, this new intervention is focused on increasing court-ordered batterers’ motivation for change. These men need to identify a personal reason for changing their behavior—such as being a better role model to their kids or being a better husband or not interacting in ways that ultimately make them ashamed. If violence is clearly contradictory to one’s values as a man, a father or a partner, it’s much more likely to end. That is the rationale for this intervention and preliminary results suggest that it is more successful than standard treatment.

The data collection is through the Abused Persons Program in Montgomery County, Maryland. They see 400-500 men each year who are court ordered for 26-week treatment sessions, and it’s a very diverse group: culturally, racially, economically. The men are randomly assigned to a standard condition or a stages-ofchange condition. The purpose of this particular project is to see how batterer treatment can become more effective than just legal intervention in reducing the rate of future violence, as well as stopping verbal abuse and intimidation.

In addition to gathering partner follow-up on the stages-of-change project, I’m currently analyzing data on a study funded by the [Centers for Disease Control] that looks at what predicts batterers’ response to treatment. This is a large sample (1800 batterers from six counties in Maryland) and while there’s been a lot written on types of batterers—family-only batterers versus more borderline/dependent individuals who are more volatile versus psychopathic men who are not just violent to their partners but in other relationships and situations as well—I’m looking at the readiness to change of different types of batterers. We’ll have enough data eventually to look at how these batterers respond to treat- With Pamela Alexander and Tracy Gladstone ment. Further, as a clinician, I’m interested in looking at the impact of group dynamics in treatment. For example, what’s the impact of diversity in groups—demographic diversity or diversity of psychopathology—in predicting every group member’s response to treatment? What’s the impact of certain group members’ psychopathy on everyone’s response to treatment? Does it motivate others when some in the group are ready to change?

I’m also working on several projects with battered women. For example, I’m looking at how battered women’s view of the violence they have experienced impacts their willingness and ability to leave an abusive relationship. I’m finding that some women’s history of sexual abuse in childhood affects their dependency upon their partner and their tendency to excuse their partner’s violence. So, how do early relationships and internal working models of relationship affect how battered women view their current relationships? Eventually, I would like to develop an intervention for battered women with a history of child sexual abuse to help prevent their abuse by another partner, a phenomenon that actually affects a sizeable portion of battered women who seek services.

I will be finalizing work on the stages-of-change research—writing reports and articles for publication. I also want to look at what kinds of services that battered women receive are empirically associated with their future safety. I’m paying particular attention to the use of services by women of different ethnic groups and by women who are immigrants.

I am interested in looking at the effects of exposure to political violence, community violence, military combat, and child abuse on the perpetration of intimate partner violence and will be collecting new data on this with colleagues in Montgomery County. I am hoping to also examine attachment in batterers in terms of how it relates to their cognitive associations to violence.

Ultimately, I expect that I will be able to collaborate on some exciting projects with other researchers and program staff at WCW. Before coming here I was really interested in the research that was being conducted at the Centers. I am delighted to find that people here are willing to look at the complexity of issues and not from one particular stance. I think this will make our work together much more meaningful and beneficial.

The Wellesley Centers for Women (WCW) has named Tracy Gladstone the inaugural director of the Robert S. and Grace W. Stone Primary Prevention Initiative. Gladstone, an assistant in psychology at Children’s Hospital, Boston, MA and an instructor at Harvard Medical School, earned her undergraduate degree at Brown University and her doctorate in clinical psychology at Emory University. Following a postdoctoral fellowship at Judge Baker Children’s Center and Children’s Hospital, Gladstone continued her research on building resilience in children and adolescents at risk for depression. Gladstone is actively at work developing strategies to promote positive sibling relationships in children of depressed parents and has a strong record of scholarly publications and presentations.

My father is a clinical psychologist, so I was exposed to the field of child and adolescent psychology as a child, and I immediately began taking psychology courses when I got to college. I quickly realized that my foundation in cognitive psychology from Brown’s psychology department would serve me well in addressing the problem of depression, because cognitive processes are central to the development and maintenance of depressive disorders. And, depression was a natural area to study given my longstanding interest in understanding more about sex differences in psychopathology, since rates of depression are so much higher for females than for males, starting in adolescence. My earliest work on depression focused on a study of sex differences in rates of depression across the high school to college transition, and also possible explanations for these sex differences, including differences in social support, pubertal timing, negative life events, and cognitive styles. Overall, I was interested in understanding cognitive processes in depression, and what made certain teens and young adults vulnerable to depressive illness.

Although I found this work on risk factors for depression in youth to be stimulating, I was eager to explore applications of this research in the community, particularly in the area of prevention. I was struck by research showing that once a person has an initial episode of depression, he or she is more likely to have a repeat episode, and that earlier onset of depression is associated with a worse prognosis. I remember thinking that a prevention focus was needed for mental health research on depression, so that people at risk for depression could have help preventing the initial onset of disorder. I thus sought a postdoctoral fellowship at the Judge Baker Children’s Center and Harvard Medical School to work with William Beardslee, M.D. on a family-based program to prevent depression in early adolescents. I spent 11 years working as part of Dr. Beardslee’s research team, which highlighted for me the importance of finding resources for children who are coping with parental depression.

The work that I’ve been doing focuses on a population of children at risk primarily because their parents have been depressed. We know there’s a biological link in depressive illness, but actually about 75% of the variance in the transmission of depression from parent to child is due to social-environmental factors, like parenting practices, marital conflict, and stressful life events. Of course we can’t control genetics, but we can control factors involved in the expression of genetic liability. Take skin cancer, for example. If you know your family or heritage is vulnerable to developing skin cancer, you can be sure to wear hats and long sleeves, or sunscreen, and you may be able to prevent the expression of this genetic vulnerability so that you can reduce the risk of a skin cancer diagnosis for yourself and for your children. Likewise, knowing that your kids are at risk for depression, there are things you can do for them, cognitive skills you can teach them and changes you can make in how you parent them, that may help prevent them from experiencing depression themselves.

I’ve been working with colleagues to develop and evaluate different prevention programs that teach teens, parents, and families about depression, risks for depression, and ways of preventing. We’ve been looking at characteristics of families with parental depression that may make family members more or less responsive to different prevention approaches. So, for example, families with a depressed father may benefit only from a very personal, clinician-based prevention program, whereas families with a depressed mother may be better able to benefit from less intensive, lecture-based prevention programming. Also, I’ve been working with colleagues in Nashville, Pittsburgh, and Portland, Oregon to evaluate a group cognitive-behavioral intervention program for adolescents at risk for depression.

I believe there are several key components to successful prevention programs for child and adolescent depression. First, parental involvement is crucial in preventing any kind of illness in children and adolescents. I think group programs for kids are not useful if they do not include parents, garner support and commitment from parents, and provide psycho-education for parents. Most parents, even in an acute condition, are concerned about their kids. When parents know the features of resilience in children of depressed parents, then they can work to promote resilience in their children. Second, I believe psycho-education for kids is equally important. Many children of depressed parents do not realize that their parents are depressed. They see their parents as tired and irritable and inconsistent, and they often blame themselves for their parents’ malcontent. It’s very important that kids understand that depression is an illness and that they are not responsible for their parent’s difficulties. Third, I think that quality prevention programs for teens at risk for depression include a cognitivebehavioral focus, given the important role of cognitive distortions in the development of depression across the lifespan.

To date, most work on the prevention of depression in youth focuses on the child independently, or on the child in relation to his or her parents. No one has considered the possible resource that siblings can provide to one another in coping with parental depression, despite evidence suggesting that the sibling relationship may serve as a buffer during times of family stress. I want to know how siblings can support one another in the face of family depression. I am presently developing a study that examines the connection between parental depression, parenting styles as they pertain to sibling relationship quality, sibling relationship quality, and depressive symptoms in children. Ultimately, I aim to develop a preventive intervention program for children of depressed parents that focuses on enhancing the sibling relationship through cognitive and behavioral change both in parents and in children.

I’ve been working with colleagues at the University of Chicago to develop a parent component to an Internet-based prevention program for adolescents at risk for depression, called CATCH-IT. This program aims to teach coping skills to adolescents who are at risk for depression. It also teaches parents about depression, ways of recognizing depression in their teens, and also ways they can help to prevent depression in their kids by promoting resilience. By working their way through the computer modules at their own pace, teens obtain skills to improve mood, increase energy, cope with negative thoughts, deal well with stressful situations, improve communication and conflict resolution skills, and more. My involvement here has focused on the development of the parent modules for this internet-based program.

I’m very committed to continuing the research I’ve been doing over the past several years, including my work comparing two different family-based prevention protocols for families with parental depression, and my work on a large national, multi-site study evaluating a group cognitive behavioral preventive intervention for at-risk adolescents. I am excited about new work I’m developing with a colleague at the University of Chicago that uses a more community- based approach to preventing depression in teens. And, I’m focusing much of my efforts on launching my new sibling-based prevention work.

I am also extremely excited about the possibilities I see for collaboration with projects and programs here at WCW. I look at Open Circle and the National Institute on Out-of-School Time, and I envision conducting psycho-educational programs for parents where we could talk about depression, resources for kids, and promoting resilience in kids. We could perhaps teach kids about ways of thinking and interpreting events in their lives to keep themselves healthy through programs like these. What’s key is that these programs are well-established and they have connections with schools. Such collaborations— through these programs or other school- or community-based organizations— could offer a public health approach to the prevention of depression. The mission of the new Stone Primary Prevention Initiatives encourages opportunities to identify and develop effective mental health prevention programs. There are just so many possibilities to explore.