重型精神疾患丈夫為施暴者之婚姻處遇：施暴者之特徵及治療成效研究

Couples Treatment for Male Perpetrators with a Major Mental Illness: A Study of the Characteristics of Batterers and Therapeutic Outcomes

研究目的：探討重型精神疾患丈夫施暴者之特徵，驗證「關係成長方案」及其主要介入形式之婚姻治療對降低婚姻暴力行為的成效。研究方法：70對臨床夫妻依丈夫的精神病診斷分為無精神病、輕型和重型精神病三組，比較相關變項以描述重型精神疾患丈夫施暴者的特徵。所有參與者都接受一般精神醫療處遇，其中41.4%完成婚姻治療的為實驗組，其餘為對照組。比較所有個案前、後測之差異以驗證「關係成長方案」之整體成效；比較實驗組與對照組以驗證婚姻治療對降低婚姻暴力行為之成效，若有差異則比較實驗組個案中診斷別的差異。研究結果：重型精神疾患丈夫施暴者的特徵如下：更年輕就開始婚暴、更低的社經地位、更嚴重的暴力、更低的權力位階和重型精神病造成施暴者的角色及關係轉變。「關係成長方案」及婚姻治療對降低婚姻暴力行為的效果顯著，但診斷別間則無差異。研究結論：1.建議視重型精神疾患施暴者為一亞型，並據以發展相關的治療模式和技術；2.「關係成長方案」之處遇效果不亞於針對施暴者個人的處遇模式；3.在一般精神醫療處遇的基礎上，婚姻治療可進一步減輕婚姻暴力。

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.