Treatment for Male Batterers - A National Study Of Batterer Intervention

violence programs program abuse

In Batterer Intervention: Program Approaches and Criminal Justice Strategies (Washington, DC: National Institute of Justice, 1998), Kerry Healey and Christine Smith reported on their study of batterer intervention programs. The study was designed to help criminal justice personnel better understand the issues surrounding batterer intervention to enable them to make appropriate referrals to programs and to communicate effectively with program providers. Healey and Smith looked at both "mainstream" programs and innovative approaches across the country. Although many programs are structurally similar, there is considerable diversity in terms of the theoretical approaches used to treat perpetrators of intimate partner violence.

The Feminist Model

The feminist model attributes domestic violence to social values that legitimize male control. In this view, violence is a way to maintain male dominance of the family. Feminist programs attempt to raise consciousness about sex-role conditioning and how it influences men's emotions and behavior. These programs use education and skill building to resocialize batterers and help them learn to build relationships based on trust instead of fear. Most feminist approaches also support confronting men about their misuse of power and control tactics.

Detractors of this approach claim that the feminist perspective overemphasizes sociocultural factors to the exclusion of individual factors, such as growing up abused or witnessing family violence. Some observers argue that the feminist approach is too confrontational and alienates the batterer, thereby increasing his hostility.

The Family Systems Model

The family systems model is based on the theory that violent behavior stems from dysfunctional family interactions. It focuses on cultivating communication and conflict resolution skills within the family. According to this model, both partners may contribute to the escalation of conflict, with each attempting to dominate the other. Either partner may resort to violence, although the male's violence will likely have greater consequences. From this perspective, interactions produce violence; therefore, no one is considered to be a perpetrator or victim.

Critics of the family systems model contest the idea that the majority of partner abuse involves shared responsibility. They believe batterers bear full responsibility for the violence. Many also fear that counseling of the couple may place the victim at risk if the woman expresses complaints during a counseling session. This model is not widely used; in fact, couples counseling is expressly prohibited in twenty state standards.

Psychological Approaches

The psychological perspective views abuse as a symptom of underlying emotional problems. This approach emphasizes therapy and counseling to uncover and resolve a batterer's unconscious problems. Proponents of this approach believe that other interventions are superficial and only suppress violence temporarily. Critics argue that attaching psychiatric labels to batterers provides them with an excuse for their behavior.

Cognitive-behavioral group therapy is the most common psychological approach used in batterer intervention programs. This therapy is intended to help individuals function better by changing how they think and act, focusing on skills training and anger management. According to the theory underlying this approach, behaviors are learned as a result of positive and negative reinforcements, and interventions should focus on building skills and changing thought patterns. Feminists criticize this approach, however, saying it fails to explain why intimate partner batterers are not violent in other relationships and why some men continue to abuse women even when their behavior is not rewarded.

Some investigators use the psychological model to study battering behavior. In "Neuropsychological Correlates of Domestic Violence" (Violence and Victims, vol. 14, no. 4, Winter 1999), researchers Ronald A. Cohen et al. studied the neurological functioning of thirty-nine male abusers and sixty-three nonviolent subjects to determine whether there was any relationship between neurological functioning and domestic abuse. They divided the groups into men who suffered from head injuries and men who had not, and measured both groups for general intelligence and neurological functioning. The subjects were tested to assess their marital satisfaction and their current level of emotional distress. The subjects were also tested to diagnose antisocial personality disorders.

Cohen et al. found that the batterers had less formal education than the nonbatterers, but that neither group differed in the amount of alcohol they consumed, nor in the number of times they used illegal drugs. The batterers did, however, have past problems with aggression while under the influence of alcohol. The study also revealed a higher incidence of head injury among batterers, with 46.2% of that group reporting head injuries, compared to 20.6% of nonbatterers. In addition, batterers had a higher incidence of prior academic problems.

Batterers with head injuries also showed a higher level of frontal lobe dysfunction, which is among the clinical variables most strongly associated with violence and aggressive behavior. Researchers reported a strong relationship between neurological functioning and domestic violence.

Cohen et al. concluded that brain dysfunction may contribute to the propensity for violence and other aggressive behaviors; however, they cautioned that while dys-function contributes to the propensity for domestic violence among some batterers, it is not involved in all cases of domestic violence, nor does it explain all types of aggression. Nonetheless, they believe that the relationship between brain dysfunction and domestic violence has significance for planning preventive and therapeutic interventions for some batterers. Patients identified with cognitive defects and with a propensity for aggression may be taught behavioral and cognitive strategies to inhibit aggressive behaviors. The results of this research also indicate the need to investigate the efficacy of biological and pharmacological (prescription drug) treatment of domestic violence.

Content of Batterer Intervention Programs

Among the batterer programs Healy and Smith studied, most combine elements of different theoretical models. They reviewed three mainstream programs. The Duluth Curriculum uses a classroom format and focuses on issues of power and control. The development of critical

TABLE 6.1

Prevalence of criminal justice incidents involving same victim and perpetrator, 1996
6 months after assignment1 12 months after assignment2
1Chi-square (2)=12.35, p=.003
2Chi-square (2)=13.13, p=.001
SOURCE: Shelly Jackson, Lynette Feder, David R. Forde, Robert C. Davis, Christopher D. Maxwell, and Bruce G. Taylor, "Exhibit 3. Prevalence of Criminal Justice Incidents Involving Same Victim and Perpetrator," in Batterer Intervention Programs: Where Do We Go From Here? National Institute of Justice, NCJ 195079, June 2003, http://www.ncjrs.org/pdffiles1/nij/195079.pdf (accessed November 12, 2004)
26-week batterer treatment (n=129) 7% 10%
8-week batterer treatment (n=61) 15% 25%
Control (community service) (n=186) 22% 26%

thinking skills is emphasized to help batterers understand and change their behavior. In contrast, the other two mainstream models, Emerge and AMEND, involve more in-depth counseling and are of longer duration.

THE DULUTH CURRICULUM. The Duluth model, based on the feminist idea that patriarchal ideology causes domestic violence, was developed in the early 1980s by the Domestic Abuse Intervention Project of Duluth, Minnesota. The classroom curriculum focuses on the development of critical thinking skills relating to the themes of nonviolence, nonthreatening behavior, respect, support, trust, honesty, partnership, negotiation, and fairness. Two or three sessions are devoted to exploring each theme. For example, the first session begins with a video demonstration of specific controlling behaviors. The video is followed by discussion of the actions used by the batterer in the video. Each participant contributes by describing his particular use of the controlling behavior. The group then identifies and discusses alternative behaviors that can build healthier, more equal relationships. Programs based on the Duluth model are the most commonly used batterer invention program in the country, with many states mandating its use.

The National Institute of Justice reported on evaluations of batterer intervention programs based on the Duluth model in "Do Batterer Intervention Programs Work? Two Studies" (NCJ 200331, September 2003). Two studies based in New York and Florida found that the programs had little or no effect on subsequent domestic violence, and that the programs did not change batterers' attitudes toward women and battering. The New York study, conducted in 1996, did find that men assigned to a longer, twenty-six-week program were less likely to be arrested again within twelve months than men assigned to an eight-week, accelerated program. (See Table 6.1.) However, men were much more likely to graduate from the shorter program than the longer program, illustrating the problem of high drop-out rates in implementing effective batterer intervention programs. (See Table 6.2.)

TABLE 6.2

Attendance in 8- versus 26-week batterers' group, 1996
No attendance Some attendance Graduated
SOURCE: Shelly Jackson, Lynette Feder, David R. Forde, Robert C. Davis, Christopher D. Maxwell, and Bruce G. Taylor, "Exhibit 2. Attendance in 8- versus 26-Week Batterers' Group," in Batterer Intervention Programs: Where Do We Go From Here? National Institute of Justice, NCJ 195079, June 2003, http://www.ncjrs.org/pdffiles1/nij/195079.pdf (accessed November 12, 2004)
26-week format (n=129) 29% 44% 27%
8-week format (n=61) 23% 10% 67%

EMERGE. Emerge, a forty-eight-week batterer intervention program in Cambridge, Massachusetts, combines several different models. It begins with eight weeks of educational and skill-building sessions. Program members who complete this phase and admit to domestic violence then progress to an ongoing group that blends cognitive behavioral techniques with group therapy centered on personal accountability.

In the group, new members describe the events and actions that brought them to the program, answer questions about their behavior, and accept responsibility for their violence. Regular group members also talk about their actions during the previous week. There may also be discussion of particular incidents disclosed by members of the group.

David Adams, the president and cofounder of Emerge, considers battering any act that forces the victim to do something she does not want to do, prevents her from doing something she wants to do, or causes her to be afraid. He views violence as not simply a series of isolated blowups, but a process of deliberate intimidation intended to coerce the victim to comply with the victimizer's wishes. According to Adams, the abuser's high level of control can be seen in how agreeable he can be with police, bosses, neighbors, and others with whom it is in his best interest to appear reasonable.

Even though abusive men in the program are supposed to be working on their relationships, Emerge counselors have observed that the men devalue and denigrate their partners. Ellen Pence, who helped to develop the Duluth Curriculum, noticed that men rarely call the women they abuse by name, because they refuse to see them as people in their own right. In one group session, she counted ninety-seven references to women, many of them obscene, before someone used his partner's name. When Pence insisted program participants use the names of their partners, she reported that many could hardly speak.

Emerge focuses not only on the abusive behavior, but also on the broader relationship between the batterer and the victim. Each member formulates goals related to his control tactics, and the group helps him develop ways to address these concerns. It combines a psycho-educational curriculum, cognitive-behavioral therapy, and an assessment of the needs of the individual.

AMEND. The professionals who created AMEND (Abusive Men Exploring New Directions), a program in Denver, Colorado, share the same commitment to long-term treatment based on several treatment models as the founders of Emerge. The purpose of AMEND is to establish client accountability, increase awareness of the social context of battering, and build new social skills. AMEND group leaders serve as "moral guides" who take a firm position against violence and vigorously describe their clients' behavior as unacceptable and illegal.

The program's long-term approach has four stages. The first two stages consist of several months of education and confrontation to break through the batterer's denial and resistance. Several months of advanced group therapy follow during which the batterer identifies his own rationalizations for abusive behavior and admits the truth about his actions. This stage includes ongoing contact of program leaders with the abused partner, who can reveal relapses or more subtle forms of abuse. During this stage, the client develops a plan that includes participation in a support network to prevent future violence. The fourth stage, which is optional, consists of involvement in community service and political action to stop domestic violence.

SAN DIEGO NAVY EXPERIMENT: THE COGNITIVE-BEHAVIORAL APPROACH. In the study "The San Diego Navy Experiment: An Assessment of Interventions for Men Who Assault Their Wives" (Journal of Consulting and Clinical Psychology, vol. 68, no. 3, June 2000), Franklyn W. Dunford compared three different year-long interventions for men who had physically assaulted their wives. The study involved randomly assigning 861 couples to one of four groups: a men's group, a conjoint group (men and women), a rigorously monitored group, and a control group. The men's and conjoint groups received cognitive-behavioral therapy and outcomes were measured every six months.

The men's group met weekly for six months, and then monthly for the second six months. Group leaders covered a wide range of perpetrator attitudes and values and taught skills believed to be important to ending the abuse of women, such as empathy and communication skills, as well as anger and jealousy management. Along with instruction, participants practiced their newly acquired skills and developed plans to assume complete responsibility for their behavior.

Employing the same curriculum used by the men's group, the conjoint group, composed of victims and perpetrators, was a controversial treatment approach since most conventional programs do not believe it is useful or effective to treat victims and their abusers together. But the leaders were interested in finding out if couple therapy would be effective. They also anticipated some benefits from the presence of the wives, such as less "women bashing" within the context of the group and more realistic opportunities to engage participants in role-playing to help them practice more constructive behaviors.

The rigorous monitoring intervention aimed to inhibit abuse by making service members' commanding officers aware of every instance of abuse. By closely monitoring and reporting their behavior, this approach attempted to increase scrutiny of the perpetrators' lives, creating a situation Dunford called a "fishbowl" effect.

Men assigned to the control group received no treatment; however, to ensure their wives' safety, the wives were given preliminary stabilization and safety planning counseling to help prevent additional instances of abuse.

The results of the interventions were measured, controlling for demographic variables—age, rank, family size, ethnicity, education, and income—and outcome assessments. Outcomes were evaluated using self-reports and spouse reports, and the Modified Conflict Tactics Scale, which examined forty-two aspects relating to the type and frequency of abuse. Official police and court records, as well as reports of new injuries, were also considered as outcome measures.

The study found no significant differences in the prevalence or frequency of abuse, as reported by the wives or their spouses, between the treatment groups. No significant differences were found among the four groups in Modified Conflict Tactics Scale scores. The study also found no differences in terms of new arrests among the perpetrators in all four groups. These findings suggest that none of the three treatment approaches was any more effective at reducing abuse than participation in the control group.

Dunford concluded that the cognitive-behavioral model is ineffective as an intervention for spouse abuse, at least in this military setting. He called for further research to confirm his study's findings and hypothesized that the one-size-fits-all approach to treatment may be responsible for the ineffectiveness of treatment.

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