Batterer intervention providers, anger management counselors, mental health professionals, and research scholars dedicated to evidence-based practice worldwide.
My colleague, Shelly Wagers, has reminded me about the recently-completed report from the National Partnership to End Interpersonal Violence Across the Lifespan. I have read it and I plan on endorsing it. Here is the link to the web location to see the National plan and endorse it: https://www.npeiv.org/a-national-plan
Here is the link to NPEIV’s home page to learn more about our organization. https://www.npeiv.org/
In response to research finding batterer intervention programs to be limited overall in their ability to reduce rates of recidivism, stakeholders in the field of domestic violence have been calling for more evidence-based treatment models. Meanwhile, because of the limitations of state standards, lack of information and other factors, providers are often polarized and confused. The recent literature review by Julia Babcock and colleagues on what works in batterer intervention indicates that while there are some serious conceptual flaws to gendered models of treatment, such as Duluth (including the unsupported focus on the power and control motive and patriarchy as a major risk factor for violence), outcome studies have not found CBT to always be more effective, and that certain approaches (e.g., developing a strong facilitator-client relationship) may in fact account for successful interventions regardless of the program’s stated philosophy.
Based on this common factor research, discussions with facilitators and clients from various programs, and a comparison of my own program with observations of a gender-based model in action, I have put together a training for treatment providers, with suggestions on how to reduce polarization among providers and increase treatment effectiveness. Let me know if you want to know more. Meanwhile, I highly recommend the second edition of the book, The Great Psychotherapy Debate, by B. Wampold and Z. Imel (Routledge, 2015). The book showcases a new psychotherapy meta-model, the Contextual Model, that nicely accounts for findings from recent RAC batterer intervention outcome studies on the importance of the facilitator-client relationship and the value of Motivational Interviewing.
Individuals convicted of domestic violence in the United States are typically mandated to attend a course of treatment in lieu of, or in addition to, incarceration. The type of treatment, also known as batterer intervention, is determined and regulated by each state. In most states, it takes the form of a weekly psycho-educational same-sex group, from 1.5 to 2 hours per session, and for a duration of 16-52 weeks, with the average around 26 weeks. While standards usually allow individual counseling in special cases, couples therapy is expressly forbidden in all but a few states. A majority of programs take a gendered perspective of domestic violence.
The most methodologically-sound research suggests that these programs are minimally effective in reducing domestic violence. A primary reason is that unlike interventions for other social problems (e.g., substance abuse), domestic violence treatment policies have not been sufficiently informed by the body of empirical research. A consensus has emerged, that for treatment to be effective it needs to be tailored to client needs, based on a sound assessment, in contrast to the standard “one-size-fits-all” models currently in existence. Below are some useful resources for anyone wanting to promote evidence-based policies in the field of domestic violence:
Visit the website of the Association of Domestic Violence Intervention Programs (ADVIP) at www.battererintervention.org. Click on the link at the bottom left section of the home page (“click here for full articles and summaries”), or go directly to: http://www.domesticviolenceintervention.net/advip-2016-world-conference-findings/
Look for: Domestic violence perpetrator programs: A proposal for evidence-based standards in the United States. Researched by 17 renowned domestic violence scholars, this is the most comprehensive review of the domestic violence intervention literature. If time is an issue, read the summaries.
Also look for: A survey of domestic violence perpetrator programs in the U.S. and Canada: Findings and implications for policy intervention. This article, by John Hamel and Fred Buttell of Tulane University, reports on a recent survey of batterer intervention programs in the United States and Canada, and provides valuable insights by experienced clinicians.
Read the excellent article by Canadian researchers Lynn Stewart and Claire Slavin-Stewart, Applying effective corrections principles (RNR) to partner abuse interventions. The RNR model is the gold standard for evidence-based interventions with incarcerated populations and general criminal recidivism. The article was originally published in the peer-reviewed scholarly journal, Partner Abuse, Volume 4, Number 4, in 2013, but is now available on the ADVIP website. Click on the “Research” link, and then “Articles,” or go directly to: http://www.domesticviolenceintervention.net/wp-content/uploads/2014/02/Stewart2013.pdf
A thorough and up-to-date review of the literature on risk assessment instruments can be found in the article, Assessment in intimate partner violence: A review of contemporary approaches, by Tonia Nicholls and her colleagues. This is also available in the research section of the ADVIP website, and can be accessed directly at: http://www.domesticviolenceintervention.net/wp-content/uploads/2014/02/Nicholls.etal2013.Manuscript.pdf
Two states have already demonstrated the effectiveness of domestic violence intervention policies based on risk assessment – Colorado and Florida.
For information about research on the Colorado model, read: Gover, A. (2011). New directions for domestic violence offender treatment standards: Colorado’s innovative approach to differentiated treatment. Partner Abuse, 2 (1), 95-120.
To read about research on the Florida model, read: Coulter, M., & VandeWeerd, C. (2009). Reducing domestic violence and other criminal recidivism: Effectiveness of a multilevel batterers intervention program. Violence and Victims, 24 (2), 139-152.
(You can get an electronic copy of either or both articles by contacting John Hamel, LCSW, at
johnmhamel@comcast.net)
One of the most reliable and widely-used risk assessment instrument, the Ontario Domestic Assault Risk Assessment (ODARA), is available from the Waypoint Centre for Mental Health Care. For information and to watch the free training video, go to: http://odara.waypointcentre.ca/
For an excellent discussion on how couples therapy can be a safe and effective treatment option, read: The trials and tribulations of testing couples-based interventions for intimate partner violence, by the notable researcher-practitioner Julia Babcock of the University of Houston. It is available at: domesticviolenceintervention.net/wp-content/uploads/2017/03/Babcock2017.pdf
I and several other batterer intervention providers in the Greater San Francisco Bay Area (U.S.A.) have been working with our local Probation departments to discuss ways to improve our perpetrator programs. A major issue has been a tendency by “rogue” judges to ignore current laws, and sentencing some defendants to an 8-hour or 16-hour anger management program instead of the 52-week psycho-educational group mandated for everyone convicted of a domestic violence offense. Judges do this for many reasons, but one of them is that prosecutors often bring weak cases to court, involving first time offenders who have committed a low-level misdemeanor offense, and/or those where the victim refuses to cooperate. We are concerned that some of these defendants may pose a greater risk to victims than what the judges have determined, but at the same time we recognize that other defendants pose a very minor risk and do not require the full 52 mandated number of sessions. We believe that current one-size-fits-all policies are a major part of the problem; but while judges may demand some discretion in their sentencing decisions, we argue that it makes more sense, in terms of victim safety and offender accountability, for sentencing decisions to be made on a more systematic and rational basis.
Recently, we have been advancing the Risk-Need-Responsivity (RNR) model of offender rehabilitation as a possible solution to this ongoing problem. A very well-written article on the RNR model and its applicability to domestic violence cases can be found in the Research section of our website (or go directly to: http://www.domesticviolenceintervention.net/wp-content/uploads/2014/02/Stewart2013.pdf).
The responsivity piece of the model calls for a treatment approach that acknowledges the large degree of heterogeneity among perpetrators, and the importance of establishing treatment goals based on a sound assessment and the unique characteristics of each client. I have been using such an assessment protocol for my perpetrator programs for several years, and it is available for free to anyone who is interested. E-mail me at johnmhamel@comcast.net, or call me at (415) 472-3275.
Canada, and the state of Colorado in the United States, use the RNR model for perpetrator treatment. How is intervention determined in your area, and are you satisfied with the status quo?
The evidence-based Alternative Behavior Choices group curriculum is appropriate for both voluntary and court-mandated individuals, and meets the requirements of California PC 1203.097 for batterer intervention programs. The curriculum can easily be adapted to a 16-week or 32-week format. Topics include: The nature of violence, emotional management, gender roles, socialization, power and control, the impact of domestic violence on children, and communication and conflict resolution skills.
The Association of Domestic Violence Intervention Programs (ADVIP) 2016 International Conference was held July 10 at the Portsmouth Sheraton Hotel, Portsmouth, New Hampshire, in conjunction with the International Family Violence and Child Victimization Conference and the Family Research Laboratory. ADVIP is the only international organization of mental health professionals, batterer intervention providers, and research scholars dedicated to evidence-based practice worldwide (www.domesticviolenceintervention.net)
This was a historic event, featuring presentations on domestic violence perpetrator treatment programs in the United States, Canada, Latin America, the U.K., and Africa, and representing a number of perspectives and solutions.
OVERALL FINDINGS:
Domestic violence is a worldwide problem, and consists of physical, emotional and sexual forms of interpersonal abuse.
The causes, characteristics and consequences of domestic violence in some ways differ across countries and regions, but in other ways quite similar.
Outside of the United States, and particularly in underdeveloped countries, where laws against domestic violence either do not exist or remain unenforced, domestic violence intervention programs are scant, and underfunded.
There is a consensus that the causes of domestic violence can best be understood according to an Ecological Model, which acknowledges the importance of societal, neighborhood, family, and individual factors.
Interventions should be delivered within a cultural context. There should be a comparatively greater emphasis on social factors, such as the general oppression of women, in more patriarchal countries, but psychological, developmental and relationship factors have been found to be relevant everywhere.
These findings will be of enormous help in establishing more promising evidence-based policies for perpetrator programs throughout the world.
RECOMMENDATIONS FOR NATIONAL STANDARDS IN THE UNITED STATES:
Holding offenders accountable requires a multi-system response, including effective policing, prosecution, incarceration, judicial monitoring, and/or treatment.
Perpetrator treatment is one part of a coordinated community response that includes law enforcement, victim advocates, mental health professionals and other social service agencies.
Regardless of a perpetrator’s legal status, treatment should be based on the needs of that individual and the extent to which he or she presents a threat to current and future victims.
Treatment should be delivered by providers with substantial and accurate knowledge of partner abuse, including prevalence rates, abuser characteristics, causes and contributing factors, dynamics, and the negative impact on victims and families.
Perpetrator treatment plans should be determined through a thorough psychosocial assessment that includes, but is not limited to, known PA risk factors.
Treatment should be based on current best practices informed by empirical research on treatment outcome, treatment engagement, and risk factors for PA recidivism.
Although group is the most popular from of treatment, there is no empirical support for the wholesale prohibition of any particular modality.
Complete conference findings will be published in three special issues of the peer-reviewed journal, Partner Abuse: volume 7 (2016), issues number 3-4; and volume 8 (2017), issue number 1, and will include papers not presented at the conference – for example, on perpetrator programs in South Asia (www.springerpub.com/pa).
Most of you, at least in the United States, are aware of the highly publicized domestic violence incidents involving NFL football players Ray Rice of the Baltimore Ravens and Ray McDonald of the San Francisco Forty-Niners. Both cases have drawn attention to the very serious problem of domestic violence. What can we learn from these cases, as concerned citizens and as providers of perpetrator treatment programs? We can start by recognizing that while domestic violence is not always taken as seriously as it should, and victims not always sufficiently protected, it is nonetheless a complex problem and should not be reduced to easy stereotypes.
The respective football teams, and the NFL league office, were widely faulted for not responding appropriately. In the Ray Rice case, people wanted to know why a man who knocked out his girlfriend, Janay, was only suspended for two games. In the Ray McDonald case, there were calls for his suspension by San Francisco sports writers and victim advocates, despite the fact that Mr. McDonald was never charged with a crime, because initial reports indicated that his girlfriend has suffered “visible injuries.”
We know that Ray Rice, as shown in that elevator video, punched his girlfriend so hard that she was rendered unconscious. We also know that he did so after she tried to hit him, as is also evident from that video. There is no question that his response was grossly out of proportion to the threat posed, and he clearly the dominant aggressor in that incident, for which he rightfully deserved to be arrested. So, let’s imagine that Ray Rice was referred to you for counseling, and let’s imagine you could use whatever intervention approach you thought would work best, to make sure that he never again assaulted his girlfriend. What would you do? The consensus among victim advocates interviewed by the media was that these men (Ray Rice in particular) are typical batterers who use violence as a means to dominate and control their partners. I have not read or heard any specific suggestions on what intervention, aside from incarceration, would be appropriate in each case, but I am fairly certain that victim advocates would want for these men to complete a batter intervention perpetrator program. They would most certainly strongly oppose any suggestions that the female partners should also join a batterer intervention or anger management program, or participate in couples counseling, because this would, in their view, be “victim blaming.” Here is all that we know about the Ray Rice incident, from media reports:
In their hotel room, Ray and Janay had both been drinking, and at some point Janay tried to forcibly take his cell phone from him.
He responded by spitting at her.
She then responded by slapping him.
Later, in the elevator, Janay attempted to physically strike him.
He responded by punching her and knocking her out.
Janay says that this was the first time that either of them ever used physical force on the other.
It is possible that Janay was minimizing Ray’s violence and that he had in fact assaulted her in the past. It is equally possible that she, too, had assaulted him previously. But if we take her at her word, then the facts indicate that this was a classic case of a mutually-escalated conflict, in which both partners contributed to the escalation. This does not mean in any way that Janay “deserved” to be knocked out. Ray Rice should have been mandated to attend a batterer intervention program. However, we don’t know whether Ray Rice’s violence was intended to “send a message” to Janay that he is in charge of the relationship and that she had better not ever challenge his authority, or whether he came from an abusive background and when threatened with physical violence by Janay, and being under the influence of alcohol, reflexively struck out. If Ray’s violence was more instrumental than expressive, then I would insist that he attend a lengthier course of batterer intervention, and perhaps also participate in intensive individual therapy. Either way, however, I would treat both partners, because both need to learn ways to better manage their anger and resolve their conflicts peacefully. I would also recommend that they each undergo a thorough substance abuse assessment.
Do you agree?
Now, with respect to the Ray McDonald case, here is what the Deputy District Attorney concluded, after looking at all of the evidence, as reported in ESPN NFL (Online): “Conflicting versions of the event, a lack of verifiable eyewitnesses and a significant lack of cooperation from Jane Doe; we cannot prove a crime occurred,” said Lindsay Walsh, Santa Clara Deputy District Attorney in charge of the case. (my italics).
“Both Jane Doe and McDonald agree that Jane Doe struck first,” according to the memo. “Jane Doe said it was a single push. McDonald said Jane Doe hit him multiple times with a closed fist. … [McDonald had no visible injuries or complaints of pain.] McDonald grabbed Jane Doe’s arms to restrain her, resulting in visible injury.”
According to the San Francisco Chronicle (November 10, 2014: In late May, officials said, officers went to the residence to deal with an altercation in which McDonald and his fiancée had an argument involving a gun. McDonald called police, and, at the time, denied that she ever pointed the firearm at him or fired it. During the investigation into the domestic violence incident, however, McDonald changed his story, saying his fiancée fired the gun into the ground as he drove away, prosecutors said.
So, there was insufficient evidence to charge Ray McDonald with a crime. In retrospect, although he was subsequently accused of sexual assault (in another case), the Forty-Niners made the right call in not suspending him from the team and waiting instead to hear from the District Attorney’s office. But is it in fact true that a crime did not occur? The same girlfriend who admitted to initiating a physical assault on Ray McDonald, for which he had to defend himself by grabbing her by the wrists, had previously fired a gun in his presence. It troubles me that the District Attorney chose to ignore this evidence. Do you think she should have been charged? And would you have a different view if he were to be charged and found guilty of sexual assault?
I just finished reading Emotions Revealed, by Paul Ekman (Henry Holt & Company, 2003). Initially, I was looking for more information about his famous research on the trans-cultural nature of emotions, and how the basic emotions of fear, sadness, anger, disgust, contempt, surprise, and happiness appear to be hard-wired into the human brain. I was pleasantly surprised to find a great deal of very practical information and advice on how to identify and mange emotions, including anger, from a combined evolutionary/cognitive-behavioral approach. It is the best book on emotions I have ever read, and directly relevant to the work we do with domestic violence perpetrators. Our clients not only have difficulties managing strong emotions, but also correctly reading other people’s emotions and other social cues. I would love to hear feedback from other ADVIP members who are familiar with Ekman’s work.
I had been looking for a way to supplement my basic batterer intervention curriculum (anger and stress management, communication and conflict-resolution training, CBT exercises) with information that would help my clients to improve their overall functioning long after they have finished the program, and in particular their ability to properly regulate emotions and maintain healthy relationships. In this respect, I have found the book by Richard Davidson, The Emotional Life of Your Brain (Penguin Books, 2013), to be immensely useful. How we go about getting our needs met is described from a neuroscientist’s perspective, based in studies of how behavior is related to specific brain functioning. Compared to other theories on personality, his concept of Emotional Styles is easier to understand and more suited to the work we do with partner-abusive clients. The table below is central to the materials I have put together, based on Davidson’s research, for my programs here in the San Francisco Bay Area, United States. We go over this table in group, after each clients has completed the Emotional Styles questionnaire. Afterwards, we discuss how our program’s standard material, as well as suggestions by Davidson, can help improve their functioning in the various categories.
The Six Dimensions of Emotional Style
Dimension
Description, Brain Basis, and Impact on Emotion Regulation/Relationships
Resilience
How slowly or quickly you recover from adversity. Marked by greater left activation in the Prefrontal Cortex (a center of intention and self-control), and by inhibitory signals to the Amygdala (a center of flight-or-fight responses). Low resilience is associated with depression, intense emotions (such as anger), and impulsive behaviors. Individuals low in resilience get discouraged easily, or obsess over minor failures, and give up on long-term goals.
Outlook
How long you are able to sustain positive emotion. Individuals with a positive outlook have high neuronal activity in the Ventral Striatum, where neurons release dopamine, a neurotransmitter that plays a role in motivation, desire and positive emotion, as well as endogenous opiates (“runner’s high”). Activity in this part of the brain is increased by signals from the Prefrontal Cortex. Individuals with a negative outlook are more likely to be depressed, avoid social relationships, and to be unmotivated to pursue goals.
Social Intuition
How adept you are at reading faces and body language and picking up social signals from people around you. High social intuition is associated with high activity in the Fusiform Gyrus, and low levels of activity in the Amygdala. Low social intuition can lead to isolation, poor interpersonal communication, anger, increased conflict and aggression, and depression.
Self-Awareness
How well you perceive bodily feelings that reflect emotions (in addition to beliefs, values, motives, etc.). High self-awareness is characterized in the brain by high levels of activity in the Insula, which is connected to the “visceral” organs – e.g., heart, lungs, stomach, sexual organs. Low self-awareness is associated with difficulties in accurately gauging levels of stress, such as increased heart rate, as well as identifying emotions. People who have poor self-awareness are less likely than others to take care of themselves. They are more at risk for depression, feeling overwhelmed by their emotions and engaging in impulsive or aggressive behavior.
Sensitivity to Context
How good you are at regulating your emotional responses to take into account the context you find yourself in. Excellence at determining context is associated with high levels of neuronal activity in the Hippocampus, a part of the brain that is also associated with the transfer of short-term memories into long-term storage. Individuals who have poor sensitivity to context have experienced some sort of trauma in the past (e.g., have grown up in an abusive or highly dysfunctional home, experienced serious assaults or accidents). They tend to react to mild or moderate stress or provocation as though they were being re-traumatized. In intimate relationships, this would include reacting to being yelled at by punching the other person, or interpreting a partner’s request for space as an indication of betrayal or abandonment.
Attention
How sharp and clear your focus is, as determined by patterns of neuronal activity in the prefrontal cortex. Individuals who are high on the attention dimension are able to detect a high degree of detail in the environment without being overwhelmed, but can also focus their attention on something specific if they need to without shutting out everything else entirely. Individuals who are at the low end, who tend to be unfocused, can miss important social cues, or hyper-focus too much, causing miscommunication and relationship conflict.
For those of you interested in research on domestic violence in countries outside of the United States, you might want to read the literature review by Esquivel-Santovena, Lambert and Hamel (2012). The full reference is: Esquivel-Santovena, E., Lambert, T., & Hamel, J. (2013). Partner abuse worldwide. Partner Abuse, 4(1), 6-75. This article is part of the Partner Abuse State of Knowledge Project (PASK), and is available for free to anyone who is interested. Just go to www.domesticviolenceresearch.org. On the left side, under PASK, click on “17 Full PASK Manuscripts and Tables of Summarized Studies.” This will take you to all of the PASK literature reviews, including the one by Esquivel-Santovena et al. A list of international researchers and thier contact information can be found on the left side of the home page by clicking on “INTERNATIONAL RESEARCH.”
Two articles on the effectiveness of intervention programs in Europe can be found on the ADVIP website, in the “articles” page under “research.”
