A Qualitative Study of Couple Therapy Exclusion Practices Related to Mutual Physical Intimate Partner Violence

Physical aggression poses a serious ethical concern for couple therapists, particularly when dealing with recent mutual physical intimate partner violence (IPV). We interviewed 12 expert clinician researchers to explore their views on treating couples with recent (~6 months) mutual IPV and analyzed the data using a hybrid inductive-deductive approach to thematic analysis. Most (83.3%) participants were willing to treat such couples. Participants emphasized assessing the context and function of IPV, using clinical judgment to determine treatment suitability. They provided assessment recommendations and suggested standardized questionnaires and separate in-depth discussions with partners to understand context and ensure safety. Intervention recommendations included applying traditional couple therapy to address IPV, helping couples manage conflict, and enhancing motivation and safety. Participants highlighted barriers and supports surrounding needed resources, lack of guidelines, liability concerns, training, and telehealth concerns. Results inform the development of IPV assessment guidelines for couple therapists.