Program Descriptions

The Needs ABC Model – Supportive Challenging & Responsibility-Taking

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There are strong reasons why men who batter would be resistant to treatment through group therapy.  Domestic violence involving physical injury is legally defined as a punishable behavior.  Because many batterers are implicitly required to participate in treatment groups through their involvement with the legal system, group work may be seen by them as a form of punishment.  Jenkins (1990) posits that men who batter externalize responsibility and therefore minimize the importance of treatment.  Indeed, batterers frequently hold their partners accountable for “provoking” the violence and are often puzzled as to why their partners are not also in treatment.  Thorne Finch (1992), in discussing the social construction of masculinity, suggests that society has so legitimized violence against women that batterers might perceive treatment groups as ludicrous.  Gondolf (1993) and Star (1983) describe a consistent profile of batterers as men with low self-esteem and insufficient knowledge of social skills; feelings of inadequacy might cause these men to fear exposure in a group setting. Many batterers request individual treatment, reflecting this anxiety.

Further, writers generalize that many men perceive group work in a negative way.  Sternbach (1990) writes that long standing patriarchal constructs of masculine autonomy and competition have traditionally made disclosure, emotional expression and vulnerability among men in a group difficult.  Strauss and Gelles (1992) in their research also point to autonomy and control as important aspects of men’s modus vivendi; group work challenges these precepts.  Goldberg Wood and Middleman (1992) describe the resistance to changing one’s world view as a constant struggle for men in treatment groups.  World view refers to one’s perception of self in relation to others and one’s meaning in society; it is one’s personal philosophy, and it mandates one’s behavior.

A logical progression from the above notions is that many men who batter perceive entry into a treatment group as: 1) punishment to be either avoided or stoically endured; 2) a threat to their masculine identity and world view, which may include having a dominant role in a relationship or family; and 3) an attack on their already diminished capacity for self-worth.  It could be imagined that batterers contemplating entry into a treatment group stand at a cross roads. On one side lies the desire for a “second chance” through learning new ways to behave, but on the other side lies a vision of being mortified in the presence of a group of men through coerced humiliating admissions of failure and inadequacy.

Because the consequences of domestic violence are so serious, very often brutal, and sometimes irreparable, treatment for batterers requires an environment where clients feel reassured enough to talk casually but candidly about themselves.  Effective treatment engages these men in non-defensive conversations about their behaviors and life experience.  The Needs ABC Model creates and maintains an environment in which men and women can consider more productive problem-solving options.

(https://www.amazon.ca/Needs-ABC-Acquisition-Behaviour-Psychotherapies/dp/1861770537/ref=sr_1_2?ie=UTF8&qid=1466977323&sr=8-2&keywords=tom+caplan).

S.A.F.E. Counseling Program, Inc.

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John Anthony Bochnowicz, SAFE Director, entered the field of DV counseling for victims and perpetrators in 1982 in Kings Beach, California. SAFE was founded in 1994, first named Supportive Alliances for Family Empowerment (SAFE). SAFE’s office is located in Langhorne, Pennsylvania. Serving court referred and self-referred men, women and families in the Greater Philadelphia Area – primarily Bucks County – 40 min north of Philadelphia and 2 hours south of New York. Since 1994 SAFE has been affiliated with the Peace Center, a non-profit peace education and violence prevention organization in Langhorne.

 

SAFE is a BIP provider for male and female offenders and victims in gender specific groups. SAFE’s services are a part of a coordinated community response to IPV. Recently implemented local standards strictly and explicitly prohibit providers of DV offender programs from reaching out to participants’ victims. SAFE holds the controversial position that is confirmed by recent social sciences and neuroscience research, that there are characteristics that parties in conflict share in common. SAFE has narrowed these down to 10 core areas in common for DV partners. Establishing a secure relationship with the facilitator is central in the intervention, along with using motivational interviewing as an approach to enroll the clients into their treatment. SAFE employs CBT Techniques to challenge and reframe client’s beliefs, biases and cognitive distortions and teaches self-awareness and self-regulation as the basis of safe practices to build the client’s ability to experience and express empathy, genuine interest, and insight into the emotional world of others. SAFE teaches an emotional healing process, and uses Gestalt Therapy Principles of being in the present to facilitate attunement and synchronicity with each group participant during each session.

 

SAFE has the experience and unique intervention model designed for work with the entire family, and with victims and perpetrators since 1982. SAFE’s intervention model is trauma-informed, resilience-focused, strength-based and client-centered. The emphasis in SAFE’s intervention is on the experiential involvement of each client over didactic instruction, by teaching a set of tools and a specific process to work through whenever an incident or trauma is experienced. The client is walked through this process repeatedly every week to facilitate the development of new neural pathways. The clients are conditioned to have new emotional and behavioral responses to their shames and fears by bringing Love into their lives to alleviate their emotional pain in the form of giving themselves R.U.A.C.A.T. (Respect, Understanding, Acceptance, Caring, Appreciation, and Trust). The repetition as a way of learning new behavior is supported by Dr. Daniel Sonkin’s work with Secure Base Priming. The importance of learning how to give love to oneself as a way of stopping violence is supported by Erin Pizzey’s talk in the Toronto Symposium of 2014. The clients also receive a written text of the course along with weekly reading and homework assignments with exercises that can be personalized. SAFE’s Intervention rationale and approach are consistent with CDC’s Connecting the Dots Study; Attachment Theory; Trauma-Informed Practices and Care; Resilience and Strength Based approaches to healing and behavior transformation; underpinnings of Motivational Interviewing; ACEs study findings and recommendations; neuroscience and social sciences intersections on best approaches to teach empathy, motivate change and transform harmful behavior to others and self; recent social sciences research outlining the risk factors for perpetrating IPV, the psychological and developmental characteristics of the perpetrators, and the categories and dynamics of IPV incidents.

Suicidality and Intimate Partner Abuse

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I just finished an online CEU course  that was probably one of the best I’ve ever taken – “Suicide – What Every Therapist Need to Know”  through Professional Psych Seminars – Lisa Firestone, PhD., instructor. (I have no affiliation with her or PPS). I took this course because suicide risk is something I always assess for and something that I find a significant portion of my clients have struggled with.

I am an LCSW in Santa Rosa, CA and co-founder of NOVA Non-Violent Alternatives. In addition to my private practice, I facilitate two groups for female offenders and one group for male offenders. My special interest is working with women around their violence. (I wrote a book on my treatment approach because there has been so little available about working specifically with abusive women. My book is “Domestic Violence Treatment for Abusive Women – A Treatment Manual”).

I started out working only with men. Our program was certified based on our willingness to be trained at Duluth and follow their model. What an eye-opener it was when I actually got to know the men in our group AND their female partners! I found that women are truly equally capable of intimate partner violence – sometimes as primary aggressors, sometimes as victims and later aggressors, sometimes in mutually aggressive relationships, sometimes as reflections of their own mental illness. etc. (Of course, all of this has since been borne out by formal research). Clearly, domestic violence is not a one-size-fits-all problem.

Now, we do things very differently than when we first started. While we teach cognitive-behavioral skills for emotional regulation, our program is now based on Attachment Theory, Trauma Theory and Social Learning Theory. I aim to find a balance between compassion and holding clients responsible/accountable for their behavior. I’ve found that clients typically have significant histories of childhood trauma, abuse and neglect – so much so that it is not surprising that they would believe that partner abuse is normal and appropriate – and that they have often struggled with suicidal thoughts/attempts.

We now always do a thorough individual assessment before accepting someone into a group.  During these assessment interviews is when I’ve found how often clients have significant histories of suicide attempts, ideation, self-harm, psychiatric hospitalizations, etc.

I am curious to know from other treatment providers whether they have had clients who have attempted or committed suicide while in treatment.

 

Brain change and domestic violence

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The goal of any domestic violence prevention program that treats offenders is to help the participants adopt and maintain a set of new behaviors and thought processes. It is relatively easy to educate clients about behavioral alternatives to violence. It is more difficult to have them practice these new behaviors within the group and hopefully in their real life home situations. What is most troublesome., though, is helping clients practice, practice, practice these new actions to the point they become totally familiar, habitual and automatic. Fortunately, our knowledge of how the brain works can help counselors promote real change. That is because real change inevitably involves brain transformation. New neuronal networks must be developed, improved and maintained while older, less desired networks are diminished in size and potency. A fuller description of neuronal networks, along with more information about my treatment program can be found in my upcoming article, “The Utilization of Neuroplastic Change Principles in Domestic Violence Treatment: An Experimental Program,” to be published in the October, 2014 issue of the peer-reviewed journal, Partner Abuse.

Here is an example of how such brain change patterns can be described to clients. Let’s  propose a client decides that one aspect of his tendency toward domestic violence is related to his habit of frequently making critical remarks. Although it would be useless to attempt to describe exactly how and where criticism is located in the brain (in reality, an abstract concept such as criticism will be linked with many overlapping circuits in the brain) it is meaningful to most clients to have them envision their criticism as a single network. Thus, the “criticism network” becomes the target for neural diminishment. The only way to do taht, of course, is by lessening the number of times one makes critical remarks as well as the number of times one even thinks about making such remarks. Here the phrase “use it or lose it” becomes paramount. The first goal for this client becomes not making criticisms so that the strength and interconnectivity of the criticism network will be weakened. Next comes building a more desired network, here entitled the “praise network.” Since “neurons that fire together wire together” it is imperative that the client identify and implement giving praise several times a day to his domestic partner, children, etc. By doing so over a fairly lengthy period (I generally estimate about six months) the client’s praise network will gradually evolve from a difficult, awkward task that requires conscious effort toward one in which the client can quickly and gracefully give praise to others in a natural, almost habitual manner. Thus the principles of long-term potentiation predict that the criticism network will be diminished through non-usage while the praise network will grow stronger and more efficient over time.

Arborization will predictably also affect the client’s behavior. For example, as the praise network grows it literally takes up more space in the brain and connects with other networks. So, for instance, the client might discover that giving praise makes it easier to be connected family members since they are now more likely to stay present and even seek his company. Connection in turn leads to engagement which leads to improved empathy toward the people he no longer criticizes and instead praises.

This last possibility demonstrates one way that brain change plans differ from standard behavioral management rpograms. Brain change in intrinsically evolutionary and therefore somewhat unpredictable. As the targeted network expands it links up with other neural networks in patterns unique to the history, wants and needs of the participant. For example, building a praise network might lead from praise to connection to empathy as above but it could also extend from praise toward self-praise and self-nurturing.

 

 

Emotional Styles

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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.

Couples Counselling Team in Malmö, Sweden and Solution Focused Counselling

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Solution Focused Counselling in Domestic Violence Cases:

The last couple of years Domestic Violence have been in focus in Sweden. Severe cases and murders challenged the authorities and much effort have been made to provide individuals and families with professional help.

In Sweden the individual view on domestic violence still dominates – abuser and abused are treated individualy by most professionals working with domestic violence. In our Couple Counselling Team in Malmö we see a lot of couples every year and many of them are in conflicts they can´t handle. 25% of the couples are in hard conflicts where one or both cross the other persons bounderies by humiliations and physical abuse. Most of the couples we meet can be categorizad as situational violence, we don´t see the most severe cases (intimate terror cases).

We are interested in and will focus more on how to use Solution Focused Brief Therapy in our couples sessions. We want to challenge the dominating idea in our field and develop a relational model for working with domestic violence couples. Solution Focused Brief Therapy focuses couples goals and exceptions and there are interesting research being done pointing in direction of the importance of mutual agreement (couples and therapists) on goals and the goals described in specific details.

In Malmö there is also a team working individually with severe domestic cases and our plan is to collaborate with them to develop different options for individuals, couples and families struggling with hard conflicts, violence and abuse.

In our team we are also working with Single Session, a very brief model for counselling, with all couples who choose that when they schedule a session. In Single Session work we evaluate the sessions by using two scales before and efter the sessions – a stress scale and a handle the problem scale and we also use SRS.

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