Finding Common Ground Across Batterer Intervention Models
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.
May 19, 2017 @ 15:12:28
Thank you for offering this work. I think you framed the predicament well. My sense has been for some time that while models do have importance it is also possible that they account for less of the variance for change than the kind of common factors outlined in the work of Miller, Hubble, Duncan and others. So what to do? Well at least from common factors we know that we should, whenever possible (but admittedly difficult in group settings) try to work from the client’s model of the world and focus on coming to a conjoint view of the problem and solution to build relationship, instill hope or positive expectancy for change and when we use a model like CBT, Duluth, Solution-Oriented, whatever, to do so flexibly not rigidly and never forget that models are not reality. So many of the professional conflicts I see seem to be predicated on over identification with particular models. I help myself by viewing all models as just packs of lies……useful ones for some people for some issues/behaviors at some times. Don’t get me wrong…I’m not suggesting they be abandoned, just used to form hunches and hypothesis, not rigidly applied or promulgated as “the truth”. Motivational Interviewing is also a very useful set of skills, for example to help one of the most powerful common factors in successful therapy outcomes, namely the quality of the client’s participation/engagement in the change process. I wonder what and how other DV intervention programs address these issues to capitalize on what we are learning about working more effectively?
Jun 06, 2017 @ 21:40:54
RE: Comment Author: Sam Bachman
Murphy, C. M., & Maiuro, R. D. (2009). Motivational interviewing and stages of change in intimate partner violence
. New York: Springer.
http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826119773/9780826119773_chapter.pdf
May 20, 2017 @ 03:52:42
I agree, Sam, that the Motivational Interviewing approach is very effective, and when properly used is the type of intervention that works regardless of the model one uses. One might argue that the Duluth model, when carried out in its pure form, has little in common with M.I. , but my survey of batterer intervention programs in the U.S. and Canada tells me that most providers who say they use Duluth also incorporate a lot of CBT techniques, and some of the responses they gave indicate that they understand the importance of treating clients respectfully. Even Ellen Pence, the co-founded of the Duluth Model, eventually came to realize that her model was unnecessarily restrictive. Here is what she said in a book chapter published in the 1990’s:
“By determining that the need or desire for power was the motivating force behind battering, we created a conceptual framework that, in fact, did not fit the lived experience of many of the men and women we were working with. The DAIP staff […] remained undaunted by the difference in our theory and the actual experiences of those we were working with […] It was the cases themselves that created the chink in each of our theoretical suits of armor. Speaking for myself, I found that many of the men I interviewed did not seem to articulate a desire for power over their partner. Although I relentlessly took every opportunity to point out to men in the groups that they were so motivated and merely in denial, the fact that few men ever articulated such a desire went unnoticed by me and many of my coworkers. Eventually, we realized that we were finding what we had already predetermined to find.“ (Pence, 1999).
Reference: Pence, E. (1999). Some thoughts on philosophy. In M.Shepherd & E. (Eds.), Coordinating
community responses to domestic violence: Lessons from Duluth and beyond. Thousand Oaks, CA.: Sage. pp. 29–30.
Jun 04, 2017 @ 11:26:09
Motivational interviewing – a more cautionary tale.
It’s good to hear of new ideas emerging and also that they gain endorsements to be tested out properly.
I am troubled by a couple of things about “motivational interviewing.”
Firstly, the title. The client is deemed to be “lacking in motivation”? My voluntary sector experience of 1100 men and women demonstrates resentments may be high; motivation is rarely lacking!
My next concern is that I see work with domestic abusers as being “co-operative”. We “go with the client” on a journey of discovery about themselves and their relationships. Obviously programmes working in different settings will have different concerns, worries and challenges.
Outcomes from a program which was probably focused on motivational interviewing.
http://www.bristol.ac.uk/media-library/sites/sps/migrated/documents/finalreport1.pdf
On page 8 of the above linked document, you’ll read “motivational engagement.” In the rest of the document you’ll read how the research, conducted by probably the most “feminist” university in the UK, established virtually no outcomes.
I’m going to suggest that the above programme represents very probably a piece of research into at least the early roots of the implementation of one version of “motivational interviewing”. I attended a lecture in which the trainer of the above programme expressed his ideas of his version of “motivational interviewing”. Historically he had been deeply involved with the “accreditation” process and Duluth. As with the “Duluth”programs the problem for his programme was that at the end there was virtually nobody available on whom to base any research. Perhaps this was a genuine effort to move away from what he had finally recognised as a failed method, or perhaps not!
Was he really still infected with the Duluth virus? Were the elements which cause Duluth to fail also built into his programme?
Was his motivation to undertake some “genuine” work with men on domestic abuse or was it cynically the introduction of another system which would produce a) work and money for his business, b) occupy oceans of time and money and effort and c) still take the agenda very little further forward, if at all?
My take on this version of “motivational interviewing” has obviously been seriously tainted by the research outcomes and this UK progenitor. My colleague points out that Motivational Interviewing is about motivating people towards change, rather than bringing about change. It reminds me of the Mirabal research – “steps towards change”.
All I would acknowledge is that the vast majority of the people with whom we work are not at all lacking in motivation, and although it might be desirable to be working with those that are lacking in motivation, if we’re ever going to learn anything about what brings about change in such men (and women) then we need to be working successfully with a motivated group so that we can learn from them about just what motivates them, and potentially what might motivate the much less motivated, whom others would like to involve!
Motivation: where does it really come from, within – without?
One enormously motivating factor for many is the very strong desire for re-attachment with children and a strong desire to be free from the sheer, gut-gnawing grief of being separated from those children.
Jun 05, 2017 @ 14:22:25
David, I have a pretty positive experience with MI not as a treatment approach, but more of a tool to be used in intake assessments when inquiring about the reason for referral/precipitating events-history. Yes, I don’t see clients as lacking in motivation either and I don’t think MI is organized to create motivation where it doesn’t exist. My experience is that if a counselor focuses on the “basics” empathically, defenses will be reduced and clients will more openly share their own sense of guilt/shame and acknowledge that “abusive behavior” particularly when reactive doesn’t reflect on their deeper and more positive core sense of themselves. Using the Transtheoretical Stages of Change Model, MI based interviewing can help clients move from precontemplative to comtemplative stages and from comptemplative to preparation or action stages. To me it seems very gentle, and inviting of change vs. the more “bull dozing” or confrontational approaches often used in substance abuse intervention and in our own field some time ago. Motivational interviewing (Miller & Rollnick, 2013) is a collaborative goal-oriented method of communication with particular attention to the language of change. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change.”
So for us the tool helps us in that the first meeting or two PRIOR to group start…so that our male and female clients are more “ready” to get to work learning how to regulate themselves so they don’t purposely or inadvertently hurt those in their families. But I think MI could be helpful in whatever approach is used, Duluth, CBT, Core Value, ACT, eclectic, whatever….
Jun 04, 2017 @ 16:59:49
Regardless of the model used, as Sam suggested when referring to “common factors,” relationship building with the client is of paramount importance. Not wishing to self promote, the first few chapters in “Needs ABC: Acquisition and Behaviour Change a Model for Group Work and Other Psychotherapies” might be worth a read.