Treatment for Male Batterers - Treatment Of Types Of Batterers
violence abuse program intervention
Most observers conclude that a single intervention program cannot accommodate the staggering diversity of batterers. Unlike mainstream programs, innovative approaches focus on the individual profile and characteristics of a batterer, and some programs tailor their interventions to the various categories of batterers.
The criminal justice system, for example, categorizes offenders based on their potential danger, history of sub-stance abuse, psychological problems, and risk of dropout and re-arrest. Interventions focus on the specific type of batterer and the approach that will most effectively produce results, such as linking a substance abuse treatment program with a batterer intervention program. Other program approaches focus on specific sociocultural characteristics, such as poverty, race, ethnicity, and age. Researcher Shelly Jackson argues that the effectiveness of batterer intervention programs might improve if the programs were seen as "part of a broader criminal justice and community response to domestic violence that includes arrest, restraining orders, intensive monitoring of batterers, and changes to social norms that may inadvertently tolerate partner violence." She was co-author, with Lynette Feder, David R. Forde, Robert C. Davis, Christopher D. Maxwell, and Bruce G. Taylor, of "Analyzing the Studies" (Batterer Intervention Programs: Where Do We Go From Here? [Washington, DC: National Institute of Justice, NCJ 195079, June 2003]).
One program that focuses on individualizing batterer treatment, currently in use in Somerset, New Jersey, is based on the Cultural Context Model, an intervention method that acknowledges a cultural basis for battering among some ethnic groups. While this treatment model requires accountability from batterers and supports the empowerment of abused spouses and their children, it also recognizes the impact that social forces have in cultures where battering is considered acceptable.
Rhea V. Ameida and Ken Dolan-Delvecchio contend that the impact of culture is often overlooked or minimized by people who work with batterers in traditional treatment programs. In "Addressing Culture in Batterers Intervention: The Asian Indian Community as an Illustrative Example" (Violence against Women, vol. 5, no. 6, June 1999), Ameida and Dolan-Delvecchio suggested that if program workers were trained in cultural differences, they would be better able to serve the needs of both the abuser and his family. The Cultural Context Model works by providing treatment not only to the batterer, but also to the victims of abuse, generally in a family therapy atmosphere.
As part of their therapy, participants are shown videos that illustrate abusive situations and are encouraged to talk about the video incidents and their own instances of abuse. The participants then study power and control wheel illustrations, which give them graphic, visual perspectives about how a variety of factors interact to create abusive situations. The treatment model attempts to reeducate the abused and abuser by raising their consciousness about gender, race, culture, and sexual orientation. One desired outcome of this therapy, Ameida and Dolan-Delvecchio explained, is to make participants more aware of the social impact of their actions.
Regardless of an intervention program's philosophy or methods, program directors and criminal justice professionals generally monitor the offenders' behavior closely. Most batterers enter intervention programs after having been charged by the police with a specific incident of abuse. As a requirement of probation, most courts will order a batterer into an intervention program.
At the court, the batterer is first interviewed to determine the type of program that may be most effective. Known as an "intake assessment," this process may take as long as eight weeks. During this time, the batterer agrees to the terms of the program, his behavior is assessed, and he is screened for other problems, such as substance abuse or mental illness. If other problems are detected, he may be referred to a program or treatment that specifically addresses those issues. Not all batterers are accepted at intake. Some programs consider batterers inappropriate for treatment if they deny having committed violence.
Several states require that the victim be notified at various points of the intervention, and programs with a strong advocacy policy contact victims every two or three months. Victims may be asked for additional information about the relationship, given information about the program's goals and methods, and helped with safety planning. In addition, the batterer's counselor will inform the victim if further abuse appears imminent.
Batterers leave the program either because of successful completion or because they are asked to leave. Reasons for termination include failure to cooperate, nonpayment of fees, revocation of parole or probation, failure to attend group sessions regularly, or violation of program rules. Successful completion of a program means that the offender has attended the required sessions and accomplished the program's objectives. With court-mandated clients, a final report also is made to probation officials.
The Criminal Justice Response
To be successful, batterer intervention programs must have the support of the criminal justice system, which includes coordinated efforts between police, prosecutors, judges, victim advocates, and probation officers. Healey and Smith suggested that authorities can reinforce the message that battering is a crime and further support the efforts of batterer programs by taking the following steps:
expediting domestic violence cases though the court system
using special domestic violence prosecution and probation units and centralizing dockets where all aspects of domestic violence may be managed in one location in order to improve services to victims and better coordinate prosecution, sentencing, and supervision
gathering offender information quickly, including previous arrests and convictions, substance abuse history, child welfare contacts, and victim information
taking advantage of culturally competent or specialized interventions and finding appropriate interventions for batterers who are indigent, high-risk, or mentally ill
coordinating batterer intervention with substance abuse treatment and mandate treatment where appropriate, making sure it is monitored intensively
being alert to the risks to children in abusive households by coordinating with child protective services to ensure that the batterer's children are safe and receiving appropriate services
creating a continuum of support and protection for victims by using victim advocates to assist victims with the criminal justice system and to monitor their safety while their batterers are sentenced to treatment programs
encouraging interagency cooperation by organizing formal committees of probation officers, prosecutors, battered women advocates, child protection workers, and batterer intervention providers to discuss referral and monitoring policies
Post-traumatic Stress Disorder and Shame
Donald Dutton, a psychology professor and author of The Batterer: A Psychological Profile (New York: Basic Books, 1995), found that many of his clients suffered the same symptoms manifested in post-traumatic stress disorder (PTSD), a psychological response to extreme trauma. These symptoms include depression, anxiety, sleep disturbances, disassociation, flashbacks, and out-of-body experiences. Dutton's batterers had psychological profiles surprisingly similar to Vietnam War veterans who had been diagnosed with PTSD. Dutton argued that although abusers are rarely seen as victims, their psychological profiles reveal they have been victimized and suffered trauma. He wrote that the batterers' chronic anger and abusiveness pointed to a common source of early childhood trauma.
Researching his clients' childhood experiences, Dutton determined that the crucial factor in abusive behavior is the shame the men suffered as children. Dutton defined shame as an emotional response to an attack on the global sense of self. The men Dutton studied had experienced childhoods in which they had been continually humiliated, embarrassed, and shamed. He found that physical abuse alone did not predict later abusive behavior, but that the combination of shame and abuse was a dangerous mix.
According to Dutton, shame attacks a child's entire identity and teaches the child that he is worthless. Punishing a child at random also poses a serious attack on his identity. Because the punishment does not relate to a particular behavior, it teaches the child that his very being is wrong and unlovable. The child has no outlet for his rage and shame until he enters an intimate relationship. When his bravado—the "tough guy" mask—is threatened, he responds with rage. The shame of his rage is too great to bear, so he blames the woman and the destructive pattern is established.
Dutton listed the early childhood experiences he believes make the strongest contributions to predicting wife assault in order of importance: feeling rejected by one's father, a lack of warmth from one's father, physical abuse from one's father, verbal abuse by one's father, and feeling rejected by one's mother.
Research has increasingly focused on differing types of male batterers. Daniel G. Saunders, in "A Typology of Men Who Batter: Three Types Derived from Cluster Analysis" (American Journal of Orthopsychiatry, vol. 62, no. 2, 1992), surveyed 165 abusive men, using such psychological measures as childhood victimization, severity of violence, psychological abuse, domestic decision making, level of conflict, anger, jealousy, depression, the ability to make a good impression on others, and alcohol use. His pioneering work defined three types of batterers:
Type I men are characterized as "family-only" aggressors. These men report low levels of anger, depression, and jealousy, and are the least likely to have been severely abused as children. They claim the most satisfaction in their relationships, the least marital conflict, and the least psychological abuse. Their violence is associated with alcohol about half the time. Members of this group suppress their anger until alcohol or stress triggers its release.
Type II men are "generally violent" and are the most likely to be violent inside and outside the home. The majority have been severely abused as children, yet they report low levels of depression and anger. Their lower anger may reflect an attitude of "I don't get mad, I get even." Their violence is usually associated with alcohol, and they report the most frequent severe violence. Their attitudes about sex roles are more rigid than those of Type I men.
Type III men report the highest levels of anger, depression, and jealousy. They are characterized as "emotionally volatile" aggressors. They are most likely to fear losing their partners and feel suicidal and angry. These men are not as physically aggressive as Type II men, but they are the most psychologically abusive and the least satisfied with their relationships. They also have the most rigid sex-role attitudes. About half of these men have previously received counseling and are thought to be the most likely to complete treatment.
Based on these three categories of batterers, Saunders proposed different types of counseling that would be most effective for each type. The family-only aggressor, Type I, might gain the most from an emphasis on the communication aspects of assertiveness training. He needs to learn how to express anger and understand his rights. He may be helped by couples counseling if his past violence level is low enough and if he remains nonviolent and committed to the relationship.
The Type II man may need help dealing with the psychic wounds of his childhood, stopping his abuse of alcohol, and learning how to express his feelings rather than by exploding. He also needs to recognize that his rigid sex-role notions are harmful. Saunders proposed that this type of abuser will probably require more than the standard three- to six-month treatment program.
The emotionally volatile man, Type III, must learn to express his feelings in nonaggressive ways and to accept his "weaker" feelings of jealousy and depression rather than express them through anger. He also needs to understand the damage caused by his psychological abuse and rigid sex-role beliefs.
In a follow-up study titled "Feminist-Cognitive-Behavioral and Process-Psychodynamic Treatments for Men Who Batter," Saunders went a step further than other researchers have done (Violence and Victims, vol. 4, 1996). While other researchers have hypothesized that identifying subtypes of batterers may help identify which treatments would be most effective for each type, Saunders actually evaluated different treatments for different types of batterers. He found that antisocial batterers did better in cognitive-behavioral group therapy, and "dependent" batterers did better in a new, psychodynamic treatment setting.
Survey of Typologies of Male Batterers
Amy Holtzworth-Munroe and Gregory L. Stuart reviewed fifteen studies of typologies of male batterers, including the Saunders study, and found that three dimensions of battering were generally used to distinguish among subtypes of batterers: severity of marital violence, whether the violence was directed at people other than the intimate partner, and the presence of personality disorders. They reported their findings in "Typologies of Male Batterers: Three Subtypes and the Differences Among Them" (Psychological Bulletin, vol. 116, no. 3, 1994). They synthesized the studies to propose a typology of three types of batterers: family only, dysphoric/borderline personality, and generally violent/antisocial.
In the researchers' conceptualization, family-only batterers are the least violent both in and outside the home. They do not suffer from personality disorders or other psychological disorders, they have low levels of abuse in their childhoods, and they have low levels of hostile attitudes toward women. Dysphoric/borderline batterers engage in moderate to severe abuse of their partners. They likely were abused themselves in childhood and are psychologically distressed. They do not engage in violence outside the home. Violent/antisocial abusers engage in moderate to severe wife battering and exhibit violence outside the home, have hostile attitudes toward women, and are most likely to abuse substances and engage in other criminal behaviors.
Holtzworth-Munroe and other researchers later conducted a study titled "Testing the Holtzworth-Munroe and Stuart (1994) Batterer Typology" (Journal of Consulting and Clinical Psychology, vol. 68, 2000). It generally validated the initial hypotheses. The researchers conducted a follow-up study to determine whether batterer characteristics were stable over time; in other words, did batterers continue to differ on the individual characteristics related to intimate partner violence across time? Holtzworth-Munroe et al. went on in "Do Sub-Types of Maritally Violent Men Continue to Differ over Time?" to find that in fact, relationship violence is related to stable individual characteristics (the typologies) of the men (Journal of Consulting and Clinical Psychology, vol. 71, 2003).
Personality Differences and Treatment
Robert J. White and Edward W. Gondolf, in "Implications of Personality Profiles for Batterer Treatment," classified battering men by personality types with the intent to recommend treatment approaches for each type (Journal of Interpersonal Violence, vol. 15, May 2000). They found three levels of personality pathology that they characterized as low, moderate, and severe personality dysfunction. They also found that most batterers fell into one of two groups that cut across the personality types: narcissistic (overly focused on themselves) and avoidant/depressive.
The researchers argued that most batterers, whether avoidant or narcissistic, did not suffer from severe personality dysfunction and were therefore good candidates for cognitive-behavioral group therapy. This treatment could help the batterers with self-image problems as well as provide feedback to correct distorted thinking about relationships. The researchers stated that men with more severe personality problems (as many as 15% of batterers) would need additional attention within the group and possibly individualized psychological treatment. The researchers believed that the approach of different treatments for different batterers is overemphasized: "It appears that although one size does not fit all, one size appears to fit most," they wrote.
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