Evidence-Based Domestic Violence Perpetrator Treatment
John Hamel, LCSW
Domestic violence, also known as partner violence (PV), is a major social and public health problem in the United States. For the past three decades, individuals arrested for PV have been mandated to complete a course of treatment in accordance with the various standards in the states in which they were arrested. The specified course of treatment typically consists of between 16 and 52 weeks of participation in a psychoeducational group, also known as batterer intervention programs, or BIPs (Kernsmith & Kernsmith, 2009; Maiuro & Eberle, 2008). In California, these groups are facilitated by various mental health professionals, including marriage and family therapists, but also, and primarily, by non-licensed counselors with minimal training. Results of rigorous experimental studies indicate that, on average, participation in a BIP contributes only a 5% reduction in recidivistic violence above and beyond arrest and court monitoring (Babcock, Green, & Robie, 2004; Eckhardt, Murphy, Black, & Suhr, 2006; Eckhardt, Murphy, Shitaker, Sprunger, Dykstra, & Woodard (2013). Clearly, there is a need for further research on best practices for treating the PV offender population.
Guides to evidence-based practice have been developed in the medical and some mental health fields (e.g., SAMHSA, 2013), but not yet in the field of partner violence. From a social work perspective, Shlonsky and Gibbs (2004) define evidence-based practice as “a systematic process that blends current best evidence, client preferences (wherever possible), and clinical expertise, resulting in services that are both individualized and empirically sound” (p. 137). According to the American Psychological Association (2006): “Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (p. 273). The best available research can be ranked on a scale of most to least reliable (e.g., Centre for Evidence-based Medicine, 2001). Level I evidence derives from meta-analyses and RAC (random assignment to conditions) studies. Level II evidence includes quasi-experimental designs (controlled studies without randomization, using non-equivalent control groups or a pretest-posttest design). Level III consists of well-designed non-experimental studies (i.e., case and correlational studies, also known as explanatory research). The vast majority of research on partner violence falls in this category. (Unless otherwise indicated, the studies in this review are the level III type.) Level IV data are qualitative and descriptive, based on observations, theory and/or clinical experience (e.g., program descriptions and case studies). Reliable evidence in the field of partner violence can also be obtained from Level I-III studies conducted with related populations (e.g., substance abusers, criminals, people with mental health issues). Level IV information is the least reliable and policies and interventions based on this alone cannot be considered evidence-based.
Based on these criteria, current policies on batterer intervention are not evidence-based for a number of reasons. PV policy and intervention, including state batterer intervention standards, are based on recommendations from battered women’s advocates and limited to Level IV information and theory, or based on Level I-III selected data sets—e.g., relying exclusively on crime studies rather than general population studies, cherry-picking from outdated studies (Corvo et al., 2008, 2009; Hines, in press). While these organizations should be applauded for the work they have done on behalf of victims, they are an unreliable source of data on partner violence.
In addition, most states emphasize gender role factors and offender use of “power and control” behaviors and ignore, discourage, or outright ban evidence-based approaches such as anger management (Maiuro & Eberle, 2008). Although all offenders are referred to as “batterers,” mandatory and pro-arrest laws have led to an increase in arrests of lower-level offenders who do not fit a “batterer” profile. These offenders engage in infrequent, low-level PV that arises mostly in the context of escalated conflict, are not particularly coercive, and are highly remorseful. Even before mandatory arrest laws were fully implemented, a meta-analysis found that these “family only” perpetrators accounted for 50% of all offenders in batterer intervention (Holtzworth- Munroe & Stewart, 1994). Approximately half of the partners of men arrested for PV in one major American city said they were minimally or only slightly afraid or thought that the partner would be violent in the future (Apsler et al., 2002). It is also the case that PV usually desists over time rather than increase in frequency (Morse, 1995; O’Leary et al., 1989), while a small percentage of offenders account for the large majority of repeat offenses (Maxwell et al., 2001).
Criminal justice studies find that victims who call the police have sometimes been mistaken as perpetrators when, for example, police deem them to be too “hysterical” (typically a woman; Buzawa, Buzawa, & Stark, 2012). California law discourages mutual arrest, and the “predominant aggressor” guidelines that are supposed to protect victims from being arrested are poorly written, confusing, and without scientific merit; and the examples and scenarios contained in the Police Officers Standards and Training (POST) manual section on domestic violence define the “predominant aggressor” as male in every case (Hamel, 2011). It cannot be assumed, therefore, that a batterer intervention client (whether male or female) is necessarily the predominant aggressor in the relationship. Nonetheless, state laws mandate a “one-size-fits all” treatment for all offenders, regardless of history and risk posed to victims (Maiuro & Eberle, 2008). It has been suggested that these standards not only do not reflect best practice standards, but that mental health professionals, such as marriage and family therapists, who are forced to honor these standards, may be violating their professional code of ethics (Corvo, Dutton, & Chen, 2009).
Overview of the Explanatory Literature (Level III)
Currently, the most up-to-date, accurate source of social science research on partner violence comes from the comprehensive literature reviews of the Partner Abuse State of Knowledge Project, also known as PASK (Hamel, Langhinrichsen-Rohling, & Hines, 2012), and yields the following data:
- Overall, 25.3% of individuals have perpetrated PV in their lifetime (28.3% of women, 19.3% of men) (Desmarais et al., 2012).
- According to a literature review by Carney & Barner (2012), 40% of women and 32% of men have perpetrated expressive abuse (out of anger, in response to provocations), while 41% of women and 43% of men have perpetrated coercive abuse (intended to monitor, threaten, control). Men are more likely to physically stalk and to engage in sexual coercion, women are more likely to physically and emotionally abuse.
These findings that “power and control” behaviors are not a gendered phenomenon have also been found in the International Dating Violence Survey, conducted at 32 universities worldwide (Straus, 2008). Individuals of either sex use power and control behaviors not to maintain “gender privilege” but because they have aggressive personalities and are driven to dominate others.
- 57.5% of PV has been found to be bi-directional, 28.3% is female-on-male and 13.8% male-on-female (Langhinrichsen- Rohling et al., 2012a).
- Men and women initiate PV at approximately equal rates (see: Hamel, 2007, 2009).
- Men and women are motivated to perpetrate PV for the same reasons— primarily in retribution, because of stress or jealousy, to express anger or other feelings, and to get a partner’s attention. Power and control and self-defense are not as frequently endorsed, but somewhat more so by female perpetrators (Langhinrichsen- Rohling et al., 2012b).
- Male and female perpetrated PV are correlated with the same risk factors (Capaldi et al., 2012):
- Demographic: younger age, stress from low income, unemployment, minority group membership
- Childhood dysfunction: witnessing PV between parents, being directly abused, experiencing general family dysfunction
- Negative peer involvement, conduct disorder in childhood
- Aggressive and antisocial personality traits: impulsive, domineering
- Insecure adult attachment style
- Substance abuse
- Low relationship satisfaction, high relationship conflict
- As with the meta-analysis by Sugarman and Frankel (1996), Capaldi et al. (2012) found a correlation between pro-violent attitudes and PV, but none for rigid male sex-role ideology
- Rates of minor injuries are incurred at similar rates across gender, and some research suggests that males and females may be equally affected by emotional abuse and control (Lawrence et al., 2012); however, female victims of physical PV incur significantly more serious injuries as well as psychological symptoms (e.g., depression, PTSD).
- Exposure to PV is associated with internalizing (e.g., anxiety, depression, poor self-esteem) and externalizing (e.g., aggression, academic failure) symptoms in children, regardless of the parent’s gender. Father-perpetrated PV is significantly correlated with both internalizing and externalizing symptoms, while mother-perpetrated PV is significantly correlated primarily with externalizing symptoms (MacDonnel, 2012).
- Partner-abusive adults, male and female, are just as likely to have witnessed mother-to-father PV as father-to-mother PV in childhood (see Hamel, 2007, 2009, for review).
- Child abuse and PV are significantly correlated (Sturge-Apple et al., 2012). Although the most common pattern of family violence involves violence by the parents against each other and the children (Slep & O’Leary, 2005), abuse can take a variety of possible pathways (Appel & Holden, 1998; Davies & Sturge-Apple, 2007). Family violence is often reciprocal (Ullman & Straus, 2003) and sometimes initiated by the children, upon their parents and each other (Caffaro & Con-Caffaro, 1998; Lynch & Cicchetti, 1998; Moretti, Penney, Obsuth, & Odgers, 2007; Straus & Gelles, 1990). The one common element appears to be the role of stress in maintaining the various dysfunctional and abusive interactions (Margolin & Gordis, 2003; Salzinger et al., 2003). PV in families can thus be best understood according to a systemic perspective.
Batterer Intervention Research Findings
Most batterer intervention programs are of the psychoeducational variety, based on the Duluth or the Cognitive-Behavioral Therapy (CBT) models, the rest on assorted process/ psychotherapeutic approaches (Price & Rosenbaum, 2009). Minimal reductions in rates of recidivism have been found among Level I outcome studies, but moderate rates among Level II studies (Murphy & Ting, 2010; Jones & Gondolf, 2002). A rigorous meta-analysis of 11 Level I and II studies recently published by Miller et al. (2013) found CBT, as well as couples therapy, to be superior to Duluth in reducing rates of recidivism.
Program Characteristics: Modality, Length, Composition and Standards
There does not appear to be clear-cut evidence that treatment should be limited to one particular modality. Due to serious mental health or personality issues, some offenders are too disruptive in a group setting and may be required to enroll in individual counseling, but research is inconclusive as to whether individual therapy is superior to group for partner-violent offenders (Murphy & Eckhardt, 2005). With respect to couples work, one RAC study found offenders in couples treatment less likely to re-offend during a follow-up period compared to offenders in a Duluth-type group (Brannen & Rubin, 1996). Both single-couple and multi-couple formats have been shown to significantly reduce recidivism when compared to no-treatment control groups, with the multi-couple format somewhat more effective (Stith et al., 2004). The few remaining studies using RAC or quasi-experimental designs found no significant difference between modalities of group versus couples (see Eckhardt et al., 2012). One important caveat is that all of the interventions targeted only low-moderate risk male offenders. Nevertheless, Level I and II experimental studies (Eckhardt et al., 2012) and Level III program reviews (e.g., Geffner et al., 1989; Shupe et al., 1989) have shown the couples format to be as safe for victims as traditional group programs. The objection to couples treatment are based on qualitative reports or clinical experience and therefore not evidence-based.
The couples format is supported by other findings as well. The explanatory literature finds couple conflict to be a significant risk factor for male and female perpetrated PV (Capaldi et al., 2012); and correlational research based on controlled laboratory observations of couples have found PV to be related to escalating couples dynamics (see Hamel, 2014; Dutton, 2006, for reviews and analysis). Although there is no Level I or II outcome research on family therapy for PV, correlational/explanatory findings suggest that partner violence is best understood as a systemic, family problem; and the meta-analysis by Stanton and Shadish (1997) found family therapy to be the most effective modality of treatment for substance abusers, an “acting out” population that shares many personality and behavior characteristics with partner-violent individuals (Potter-Efron, 2007).
The few studies that have looked at length of treatment, at least for the psychoeducational group format, indicates that clients benefit most from more, rather than less, sessions. The RAC experimental study by Taylor et al. (2001) found reduced rates of recidivism for men who completed a 26-week group compared to 8 weeks, and the quasi-experimental (Level II) multi-site study (Gondolf, 1999) found significantly lower rates of moderate-severe violence recidivism among men who completed a 9-month group compared to 3 months. No experimental studies have been conducted on group size, but clinical experience suggests that group cohesion and a strong client-facilitator alliance, so important for group retention and lower levels of post-treatment violence, may not be possible with larger groups (e.g., more than 10).
A very small number of studies have examined the value of differential treatment for offenders as an alternative to the prevailing “one size fits all” standard. There is some RAC and quasi-experimental evidence for the superiority of psychoeducational groups for generally violent/antisocial male offenders and the superiority of process-type groups for male offenders who exhibit signs of depression and dependent personality traits (Saunders, 1996). In Florida, where male offenders were assigned to a low, medium, or high risk offender group, recidivism rates were significantly lower than those reported by traditional programs (Coulter & VandeWeerd, 2009). Additionally, research with non-PV criminal offenders finds that letting offenders from different risk categories participate in the same treatment program may have adverse consequences, primarily due to the negative influence that high risk offenders can have on the low risk ones (Bonta, 1996; Stewart et al., 2013).
Only a handful of studies have looked at sexual orientation or ethnicity as treatment variables. Except for African Americans, information on batterer intervention programs for ethnic minority populations has consisted of Level IV clinical reports. A quasi-experimental study by Gondolf (2007) found no difference in recidivism between African American offenders who completed a heterogeneous group versus those who completed a culturally focused homogeneous group limited to African Americans. Another study found Caucasian and African American male perpetrators to benefit equally from a CBT group, including lower post-treatment scores on the PAS risk assessment (Buttell & Carney, 2006). Coleman (2002, 2007) has provided qualitative accounts of group work with lesbian offenders and couples work with gay men, but no empirical studies have been conducted on treatment outcomes among LGBTQ offender populations.
Based on clinical experience, there are advantages to same-gender groups (e.g., men less inhibited about sharing certain topics, such as sex, with other men, identify more with men), as well as advantages to mixed-gender groups (e.g., men and women can learn to view things from another perspective). The case review by Hexam (2010) found mixed-gender groups for batterers to be safe and effective; however, no experimental studies have been conducted on the question of whether clients benefit more from mixed gender vs. male or female only groups. There is also the question of whether female groups should be conducted differently than male groups. Some observers (e.g., Kernsmith & Kernsmith, 2009; Leisring et al., 2003) recommend that female batterer programs should be guided by their own set of state regulations and standards, on the assumption that women in BIPs are predominantly victims. Some BIP studies do find female offenders to have more mental health and personality disorders than male offenders (Hamel, 2014), but recent studies find that they engage in physical and most types of emotional abuse at similar rates (Carney & Barner, 2012), that their abuse is correlated with the same risk factors (Capaldi et al., 2012), and that it is similarly motivated (Langhinrichsen-Rohling et al., 2012b). Large-scale studies of offenders court-mandated to BIPs in California have found comparable motives across gender, including a desire to dominate and control (Elmquist et al., in press) as well as rates of emotional abuse and control (Hamel et al., under review); and results from the PAS risk assessment instrument indicate that men and women in BIPs are equally at risk for perpetrating violence in the future (Carney & Buttell, 2004; Dutton, 2006). It is noteworthy that results of a South Carolina Level II study found female perpetrators (African American as well as Caucasian) who completed a traditional psychoeducational group to evidence significantly lower post-treatment scores on measures of psychological abuse, power and control behaviors and passive-aggressiveness, and lower scores on the PAS (Carney & Buttell, 2006).
Group Facilitation Factors
The general psychotherapy and corrections outcome literature has yielded strong correlations between treatment success and a client-centered approach (characterized by a warm bond between therapist/group facilitator and client, agreement on the goals of treatment and the tasks and strategies required to attain these goals) (Eckhardt et al., 2006; Wampold, 2001).
In the field of partner violence, RAC and quasi-experimental research finds significantly higher responsibility-taking and reduced rates of recidivism among men who are exposed to some form of Motivational Interviewing (MI), a client-centered, empathetic, non-confrontational means of increasing client motivation and cooperation and strengthening the facilitator client-alliance (Mbilinyi et. al., 2011; Musser et al., 2008; Woodin & O’Leary, 2010). One RAC study compared men enrolled in a group based on the Stages of Change model, upon which MI approaches are based, to a standard psychoeducational format. Victimized partners reported a significant reduction in recidivism for the former (Alexander et al., 2010). The RAC study by Taft et al. (2003) found group cohesion to predict less recidivism; and male batterers who were interviewed in depth in two other studies cited the support they received from their fellow group members as the primary reason for their willingness to take responsibility and cease their abuse (Rosenberg, 2003; Silvergleid & Mandowski, 2006).
Other tasks related to creating a strong therapist-client alliance and increasing group cohesion have also been investigated. The Taft et al. (2003) study found a positive correlation between homework compliance and lowered rates of psychological and physical abuse perpetration. In one quasi-experimental study, the groups in which facilitators reached out to clients (e.g., supportive phone calls after a missed session) had lower dropout rates compared to a no-treatment comparison group (Taft et al., 2001). Case management may also be important. Along with previous history of violence, comprehensive literature reviews have determined that substance abuse is the primary predictor of violence following BIP participation (Gondolf, 2012; Stewart et al., 2012). In one multi-site study (Gondolf, 1999), men who were helped with referrals to mental health and substance abuse counseling and other services engaged in lesser levels of severe violence recidivism, although a follow-up study was inconclusive (Gondolf, 2008).
Program Components and Client Treatment Goals
The research literature suggests 5 important goals that counselors ought to help clients in achieving:
Overcome Stress and Manage Emotions
A major risk factor for PV perpetration is the stress that comes from unemployment or having a low income (Capaldi et al., 2012), and national surveys have found a correlation between having witnessed PV as a child and the perpetration of PV and perceived stress in adulthood (Straus et al., 1990). The CBT programs that have been found in BIP outcome studies to be the most effective in reducing recidivism include stress reduction components in their curriculum (Babcock et al., 2004; Eckhardt et al., 2012).
Numerous studies have determined that men who physically assault their partners experience significantly higher levels of anger than nonviolent men (e.g., Boyle & Vivian, 1996; Holtzworth-Munroe & Smutzler, 1996). The meta-analysis conducted by Schumacher et al. (2001) found elevated levels of anger and hostility among men with histories of PV perpetration; and according to the meta-analysis by Norlander and Eckhardt (2005) levels of anger as well as hostility are moderately higher among partner-violent men when compared to nonviolent men. In one BIP outcome study using a pretest-posttest (Level II) design (Hamberger & Hastings, 1988) men whose levels of anger were reduced as a result of anger management treatment engaged in reduced levels of violence at a one-year follow-up; and another pre-post study of men who completed a 20-week CBT/ process group with an anger management component found similar results (Saunders & Hanusa, 1986). When presented with anger-provoking scenarios in one study and asked how they should respond, partner-violent men were less able to articulate anger control strategies than nonviolent men (Eckhardt & Kassinove, 1998). Finally, jealousy is highly correlated in most societies with anger, aggression and stalking, and is included as a risk factor for femicide in the Danger Assessment (see Stewart, 2013 for a review).
Change Pro-Violent and Irrational Beliefs
Although the meta-analysis by Sugarman & Frankel (1996) did not find a correlation between male offenders’ sexist, traditional sex-role beliefs and PV perpetration, it did find attitudes supportive of violence to predict PV; and such attitudes have been linked to PV in the reviews by Capaldi et al. (2012) and the National Family Violence Survey (Chan & Straus, 2008). Identifying, disputing, and changing irrational beliefs is a central component of effective CBT programs (Babcock et al., 2004; Eckhardt et al., 2012). In one study of abusive men, those who articulated distorted thinking styles and irrational beliefs (e.g., rigid black-and-white thinking, drawing arbitrary inferences) when angry were more likely to perpetrate PV than men who did not articulate these beliefs (Murphy & Eckhardt, 2005).
Identify Unhealthy/Abusive Interaction Patterns
A number of observational laboratory experiments with abusive men and their partners found that the aggression increased when the couple mutually escalated their conflicts in such patterns as negative reciprocity, demand-withdraw, and attack-defend (Babcock, Waltz, Jacobson, & Gottman, 1993; Burman, John, & Margolin, 1992; Cordova, Jacobson, Gottman, Rushe, & Cox, 1993; Jacobsen et al., 1994; Margolin et al., 1993). One study of partner-violent women found similar patterns of escalating relationship conflict (Ridley & Feldman, 2003). Unilateral battering may involve three phases, as postulated by Lenore Walker, or only one or two (e.g., anti-social offenders may not experience a build-up period and do not feel contrition after the acute battering incident (see Dutton, 2006, for a review).
Acquire Communication and Conflict Resolution Skills
As previously mentioned, high conflict was one of the more significant predictors of relationship aggression in Capaldi et al’s comprehensive literature review (2012). In the Cornelius et al. (2010) study of university students, emotional and physical PV were both correlated with poor communication and conflict resolution skills. In the Ronan et al. (2004) study, poor communication and conflict resolution skills were more likely to be present when couples discussed high-conflict problems as opposed to low-conflict ones. In addition, positive communication has been related to lower levels of male perpetrated PV (Follette & Alexander, 1992; Robertson & Murachver, 2007); and improved communication has been correlated with less PV among couples in one clinical study (Gordis et al., 2005). One of the most successful interventions discussed in the literature review by Babcock et al. (2004) was Guerney’s (1977) relationship skills-building program. Furthermore, CBT programs found to be effective in reducing recidivism heavily focus on teaching communication and conflict resolution skills (Babcock et al., 2004; Eckhardt et al., 2012).
Overcome Mental Disorders and Past Trauma
According to large national surveys, having witnessed PV as a child predicts both the perpetration of PV and symptoms of depression in adulthood (Straus et al., 1990). There is a weak correlation between depression and PV overall (Capaldi et al., 2012), but a stronger one for depression and severe PV (Hotzworth-Munroe & Stuart, 1994; Danielson et al., 1998; Pan et al., 1994). Among severely abusive perpetrators, shame has been found in several studies to be the foundation for anger (Harper et al., 2005; Retzinger, 1991; Tangney et al., 1996); the highest levels of rage and abuse among men in one well-researched Canadian program were among those who had experienced rejection and shame in their family of origin (Dutton, 1998), Likewise, insecure attachment has also been associated with PV, especially preoccupied attachment (dependent, fears abandonment); and the pairing of individuals with various attachment styles has been found to increase the likelihood of both unilateral and mutual violence (see Hamel, 2014 for a review).
- Current BIP policy and guidelines across the United States, including California, are NOT evidence-based. Until such a time when the laws are changed, program directors are encouraged to incorporate the findings from this review, so that they can become as evidence-based as possible within the law’s limitations.
- Some programs that use a Feminist/Duluth type of model have been found as effective as the primary alternatives (cognitive-behavioral-therapy or psychodynamic/ process groups); therefore, these programs cannot be summarily dismissed, and certainly should not be disallowed by state law. Conversely, they have very little support in the explanatory literature, and there are good reasons to suspect that to the extent that they are effective it is despite, and not because of their ideological underpinnings—e.g., because the group facilitator has successfully built a working alliance with his/her clients.
- All programs are advised to conduct a thorough psychosocial assessment, to initiate a working client-facilitator alliance and collect the information necessary in determining a client’s level of motivation, type of abuse dynamics and risk posed to victims, as well as the mental health issues that may impede treatment. The use of standardized questionnaires is recommended, to gage a client’s relationship strengths and weaknesses and tailor treatment to client needs. Examples of empirically based assessment tools can be found at www.springerpub.com/hamel-ancillary. A Motivational Interviewing or similar approach is recommended, during the assessment and throughout the course of treatment, that eschews an overly confrontative or authoritarian approach, and help clients take responsibility by showing concern, respecting their choices, and focusing on their strengths rather than their failures.
- Because of state regulations regarding group length and format, it is not possible for BIPs to base treatment fully on client needs and risk assessment. In California, for example, all clients must complete a 52-week program. The law does allow individuals who are too pathological or disruptive for group participation to complete their obligation in individual therapy; however, all others are required to enter into a same-sex, two-hour group. Still, programs that offer several groups can, and should, make every effort to match the group with a client’s particular needs. There is no empirical data on group size, but given the importance of the facilitator-client alliance and group cohesion, smaller groups should be encourage. Of course, groups using a primarily process/ psychodynamic approach should be facilitated only by a licensed therapist.
- There is no Level I or II research on whether groups should include both male and female offenders. The only published program description of a coed perpetrator group (Level IV) indicates that this format can be safe and effective. Given correlational studies finding that male and female offenders have much more in common than not, there is no reason for policies that disallow same-gender groups. Level III research strongly suggests that female offender groups should not be regulated by different standards then men; and the only outcome study that addresses this issue finds the standard CBT approach effective for women as well as men.
- The only Level I or II studies on the needs of ethnic minority and LGBT offenders have reported on African Americans and find no difference in treatment outcomes for homogeneous versus heterogeneous group composition. Clinical reports (Level IV) strongly suggest that facilitators conducting heterogeneous groups should use culturally sensitive materials and approaches.
- Ideally, the modalities of couples and family counseling should be included as part of a batterer intervention program, along with individual and group. In states such as California, current BIP guidelines ought to be rewritten accordingly. For now, while some Probation departments in California have interpreted PC 1203.097 as prohibiting all couples or family counseling, the law in fact only prohibits programs from including these modalities as part of the 52-week requirement. In light of compelling Level I and II research evidence for the that the effectiveness of couples therapy, there is no reason for Probation to prevent or discourage couples to seek such counseling on their own, so long as it is in addition to and not a part of the 52-week group program. Certainly, appropriate guidelines are needed on how referrals should be made, to whom, and under what circumstances. At a minimum, couples or family therapy should be conducted by a licensed mental health professional who is also a certified BIP, and only take place when the victim approves and when the offender has demonstrated a sufficient ability to control his or her violence.
- A preponderance of Level III, and some compelling Level I and II research finds that partner-violent individuals benefit from acquiring pro-social interpersonal skills, including anger and stress management and conflict resolution. These should be part a central component of any BIP curriculum. Examples of client workbook handouts can be found at www. springerpub.com/hamel-ancillary
- California PC 1203.097 and most state laws require providers to include in their curriculum information on gender roles, even though the empirical literature does not support feminist-advocate claims that partner violence is primarily a gender issue of men abusing women in order to maintain “gender privilege.” That is not to say that some male (and female) offenders in batterer intervention do not harbor rigid gender role beliefs; however, these beliefs are just as likely to be found among non-violent individuals. What distinguishes one from the other is that partner-violent individuals have abusive personalities and harbor attitudes supportive of violence generally. On the other hand, offenders sometimes cite male (or female) privilege as a pretext for their violence, so these attitudes ought to be confronted, but as part of an overall CBT approach that addresses distorted thinking and irrational beliefs. It is also the case that men and women differ in how they process emotions and communicate interpersonally. For the majority of offenders who fit into the less-severe “family-only” type, discussions of gender are more useful when focused on these differences rather than sexism, per se.
- 1203.097 requires that BIPs include material on “the nature of violence,” which is typically interpreted as referring to battering behavior, as depicted in the Duluth “Power and Control Wheel” and the three-phase model first proposed by Lenore Walker. However, Lenore Walker’s model was based on clinical interviews, has many conceptual flaws, and applies primarily to a subset of offenders—i.e., men and women with characteristics of Borderline Personality Disorder. Program curricula should also include information on the dynamics of anti-social PV. Much more common is “situational violence,” in which the violence occurs within the context of a mutually escalating conflict. Clients should always be held responsible for their actions, but acknowledging that a client may be involved in a bilaterally abusive relationship is not “colluding”; it is an example of the kind of client-centered approach that the most rigorous experimental evidence finds effective in reducing rates of recidivism. Clearly, programs should discuss all types of abuse types and cycles.
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