in Articles, Opinion

It’s Time for Domestic Violence Treatment to Grow Up

alternative domestic violence treatmentThe crime of domestic violence is given special status in the U.S. criminal justice system. Rather than simply facing financial penalty or incarceration, batterers are often remanded to special treatment programs with the purpose of diverting them from the prison system. The most common forms of treatment for men who abuse women stem from the Duluth model (National Institute of Justice, September 2003). The underlying theory of this model is that batterers act out of a need to control their partners, and that changing the need to control others is the most efficient way to eliminate battering behavior.

Some states, such as Florida and Iowa, mandate the use of Duluth model batterer intervention programs (BIP’s; Babcock, Green, & Robie, 2004). Colorado, this author’s home state, mandates what some have called a one-size-fits-all treatment approach based largely on the Duluth model (Kilzer, 2005). Most Duluth-based BIPs are conducted in groups and operate under the assumption that societal power inequities and victim-blaming are root causes of battering behavior. They teach that men can overcome their abusive ideologies by learning to challenge each other’s attitudes and beliefs about their victims (Babcock et al., 2004). (1)

What is the Duluth Model?

This summary of the Duluth model is based on the book, Education Groups for Men Who Batter: The Duluth Model (Pence & Paymar, 1993).

The Duluth model of male domestic violence treatment was created in Duluth, Minnesota after Duluth Domestic Abuse Intervention Project (DAIP) successfully lobbied for an overhaul of the police, court, and human services responses to domestic violence and homicide. Their efforts resulted in a dramatic increase in arrests, creating the need to manage hundreds of new domestic violence cases.

DAIP responded to this increased caseload by developing a batter intervention curriculum with “the help of a small group of activists in the battered women’s movement” (p. xiii). That group based their curriculum on the theory that “violence is used to control people’s behavior” (p. 1). They further assumed that male batterers operate from a position of socially sanctioned power. With the source of domestic violence thus succinctly defined, the authors and their focus group concluded that male battering behavior is only preventable when men learn to participate in egalitarian relationships with their female partners. They explained that “if a batterer does not have a personal commitment to give up his position of power, he will eventually return to the use of threats or violence to gain control” (p. 7).

Pence and Paymar illustrated the types of power abuses that they believe lead to domestic violence in the now famous Power and Control Wheel (figure 1). The Power and Control Wheel lists coercive and abusive behaviors ranging from economic abuse to intimidation. Duluth-model curricula seek to replace the behaviors of power and control with the egalitarian behaviors of the Equality Wheel, which lists relationship ideals such as economic partnership and respect.

Duluth Model domestic violence treatment

Figure 1. “Power and Control Wheel” and “Equality Wheel” (Pence & Paymar, 1993).

The Duluth model is not merely a curriculum, but was at the time a groundbreaking approach that involved the cooperation of police, jails, prosecutors, women’s shelters, county courts, probation departments, and mental health agencies. DAIP oversaw the process as a monitoring agency. It was an ambitious and highly successful project – such sea changes in policy and procedure do not come easily.

The project eventually gained the overwhelming support of the Minnesota legal system, and by the time Education Groups for Men Who Batter was published, “ninety-seven percent of all civil protection orders granted in cases in which minor children [were] involved also [carried] a mandate to attend batterers’ groups conducted by the DAIP” (p. 18). DAIP had gone far beyond the role of merely offering a new BIP. They took an on a powerful advocacy role in the civil and criminal court referral and oversight process.

In current practice, men are generally not accepted into Duluth model treatment until they have passed screenings for drugs, psychological problems, and disruptive behavior. Once screened, participants begin the therapeutic curriculum. Men are typically required to attend group sessions focusing on eight themes:

  • nonviolence
  • non-threatening behavior
  • respect
  • support and trust
  • accountability and honesty
  • sexual respect
  • partnership
  • negotiation and fairness

During these sessions, men are asked to examine their thoughts, attitudes and beliefs about women, power, and control. They are encouraged to examine their own role in choosing to use violence, and are asked to consider the effects of their behavior from a feminine point of view. The program focuses on thought patterns and attitudes about relationships rather than a discussion of personal problems, and men are offered cognitive-based interventions to change their thought patterns, as well as in-class opportunities to practice new behaviors. They are also educated on the Pence and Paymar’s theories regarding gender inequities in the U.S., and how “patriarchal socialization” has created the context in which violence against women is “acceptable.” Facilitators are held to a fairly strict treatment schedule and are expected to pursue these goals:

  1. to participate in an interagency effort to hold participants in a group accountable for further acts of violence and for failure to complete the rehabilitation program,
  2. to keep the group focused on the issues of violence, abuse, control, and change,
  3. to facilitate reflective and critical thinking in the group,
  4. to maintain an atmosphere that challenges rather than colludes,
  5. to provide new information and teach non-controlling relationship skills, and
  6. to facilitate an open and respectful group process to all members.

In a latter chapter of the book, the authors offer some thoughts regarding evaluation of BIPs. They suggest a three-fold strategy of evaluating 1) practitioner compliance, 2) the protection of women who seek help from the legal system, and 3) deterrence of continued battering behavior. Researchers have been happy to test the effectiveness of the Duluth model but they have not always followed the authors’ guidelines.

Does the Duluth Model Lead to Effective Treatment?

The authors of the Duluth model point out that evaluation must be tempered against evidence that not all batterers are amenable to treatment. Though the number of “treatment resistant clients” is sure to vary according to treatment modality, it is wise to bear in mind that some unknown number of individuals are willing to resort to violence despite available consequences. Any examination of the Duluth model must also bear in mind that, despite the existence of other treatment approaches, most male batterers have had few other practical alternatives to date.

Those caveats aside, research is beginning to suggest that BIPs based on the Duluth model offer little in terms of rehabilitation or prevention of recidivism. In a meta-analytic review, Babcock et al. (2004) examined the impact of current BIPs based on the Duluth model, cognitive-behavioral interventions, and other methods. They found that “effects due to treatment were in the small range, meaning that the current interventions have a minimal impact on reducing recidivism beyond the effect of being arrested.” They also pointed out that there was no significant difference between Duluth type interventions and Cognitive Behavioral interventions, noting the similarity in content and approach. In comparing this type of treatment against incarceration alone, the authors noted that, “to a clinician, [the low success rate of the Duluth model] means that a woman is 5% less likely to be re-assaulted by a man who was arrested, sanctioned, and went to a batterers’ program than by a man who was simply arrested and sanctioned.”

According to a study by the National Institute of Justice (NIJ; September, 2003), BIPs based on the Duluth model “do not change batterers’ attitudes and may have only minor effects on behavior.” NIJ (June, 2003) noted studies indicating that offenders who completed a 26-week program had fewer follow-up complaints lodged against them than those who only completed eight weeks of treatment, but was quick to point out that such studies were likely to be confounded by the pre-existing motivation of men who were able to complete a 26-week course. Even then, according to the study, the differences were not statistically significant.

Nor does Pence and Paymar’s underlying theory appear to function smoothly in the real world. The Duluth model is predicated on the notion that changing attitudes about gender relations will change behavior. The NIJ (June, 2003) study noted that “six months after adjudication, those in the experimental [Duluth model] group saw the woman as slightly less responsible [for his violent behavior]. Even so, the men in the experimental group still viewed their partners as ‘somewhat’ or ‘equally’ responsible for the incident.” NIJ suggested that current BIPs appear to suppress violent behavior for the duration of treatment, but do not appear to lead to lasting changes in behavior.

In fact, one study based in Broward County, Florida suggested that mandatory treatment based on the Duluth model may have a paradoxically negative effect: “Other things being equal, those assigned to the experimental [Duluth model] group were 2.8 times more likely to be cited for VOPs [parole violations] than those in the control group” (NIJ, June, 2003). (2)

By way of explaining such lackluster results, NIJ (June, 2003) suggested two possibilities: “One is that the evaluations were methodologically flawed; the other is that the design of the programs themselves may be flawed. These two explanations are not necessarily mutually exclusive.”

Offering a More Useful Question

In light of such evidence, the limited scope and empirically untested theoretical framework of the Duluth model are troubling. Some authors have suggested that the treatment of family violence perpetrators has taken place in the absence of empirical data or scientific inquiry (see for example Chalk, 2000; Babcock et al, 2004; NIJ, 2003), and this appears to be the case with Duluth model treatment.

The authors of the Duluth model explained that the curriculum was defined by the question, “what do the women who have lived through the nightmare of being battered want us to do in these groups?” (Pence & Paymar, 1993, p. 64). If the goal of BIPs is to reduce recidivism rates, a more useful question would be, “what are the dynamics that lead to violence in a given intimate relationship?” The former question may be more satisfying to those with an eye toward punishing men in general, but the latter has the advantage of questioning the context, history, and function of violent behavior. And the latter question, by definition, requires empirical research to find the answer. The Duluth model is based not on empiricism but on the feelings and opinion of a politically-charged committee comprised largely of lay people.

As such, BIPs based on the Duluth model tend to ignore important factors related to violence, including substance abuse, stake-in-conformity motivations, personality features of the batterer, relational dynamics within the couple, history of trauma, and the role of shame.

  • Substance abuse: Dalton (2001) found that substance abuse was a reliable predictor of treatment program failure – even more reliable than legal threats. Fals-Stewart (2003) found that the chances of violence were eleven times higher during days when the batterer consumed alcohol. While substance abuse is clearly a contributor to many acts of domestic violence, Duluth model programs specifically screen out clients with substance abuse problems.
  • Stake-in-conformity: Dalton (2001) noted that unemployment is a significant predictor of treatment failure. NIJ (June, 2003) noted that stake-in-conformity variables such as marital status, residential stability and unemployment are crucial factors in treatment success. Men who are more socially invested tend to have higher success rates in treatment. The Duluth model does not address social investment.
  • Personality of the batterer: Those who commit crimes of domestic violence (both males and females) score higher on antisocial, aggressive-sadistic, and narcissistic scales on one factor loading, and schizoid, avoidant, and self-defeating scales on a second factor loading (Ley, 2001). Blanchard (2001) noted that: “Narcissism was found to be related to a higher incidence of both minor and total psychological aggression. For the outward expression of anger, there was a main effect for narcissism and an interaction effect for narcissism and self-esteem.” The Duluth model does not account, or even allow for, individual differences in personality or motivation.
  • Relational dynamics: Resmaa Menakem, a researcher with the Tubman Family Alliance in Minneapolis, is one of many researchers who believes that it is unwise to ignore the couple dynamics in violent relationships (Kilzer, 2005). He explained, “most domestic violence organizations don’t know how and don’t want to deal with couple dynamics… Their line of thinking is that when you begin to do that, you have to blame the victim.”
    Problem solving strategies, which can be ideally developed in a couple treatment modality, might be one key to reducing violence among men who do not pose an immediate threat to their spouses. (3) Schmidt (2003) noted that “…men who endorsed higher levels of perceived masculine gender role stress, a tendency to attribute more hostile intentions to the partner, and who favored emotion-focused coping over problem-focused coping skills were those most likely to batter.” Despite such evidence, the Duluth model specifically prescribes against examining couple dynamics in the service of ending violent behavior.
  • History of trauma: Both male and female perpetrators report significantly higher experiences of personal trauma than the general population (Rumsey, 2003). However, the Duluth model views the discussion of personal history as “collusion” with the batterer’s violent behavior. Ignoring the connection between personal history and individual violence is, in this author’s opinion, shamefully short-sighted and dangerous.
  • Role of shame: Many researchers have drawn a strong connection between shame and violence (see for example Brown, 2004; Goldner, 1998, Gilligan, 1997). Jennings & Murphy (2000) believe shame and humiliation to be pivotal in male battering behavior. They hypothesized that because of different communication styles and cultural influences, women frequently don’t understand when they are humiliating men, and that men who lack communication skills have difficulty knowing how to respond to unintentional humiliation. This is perhaps another argument for couple interventions when deemed safe and appropriate. Goldner advocates working with individuals “at the level of shame with its connection to violence.” Numerous forensic clients have informed this author (and common sense suggests) that the Duluth model is a shame-inducing modality that may actually increase the odds of recidivism.

Researchers are beginning to confirm what common sense dicatates: that violence between individuals, while influenced by social and cultural variables, is more parsimoniously explained by an examination of individual characteristics, contexts, and functions of behavior (see for example Smith, 2003). Not surprisingly, empirical research is beginning to identify shame, individual stressors such as substance abuse and trauma history, and personality characteristics as main contributors to violent behavior in intimate relationships. These findings, combined with the lack of demonstrable success of currently accepted BIPs, call into question the theoretical framework and treatment approach of programs based on the Duluth method.

Noting that no current broadly-accepted treatment modality has a clear edge over others, Babcock et al. (2004) suggest that “Battering intervention agencies are more likely to improve their services by adding components or tailoring their treatments to specific clientele, than by rigidly adhering to any one curriculum in the absence of empirical evidence of its superior efficacy.” They go on to suggest that specific subsamples of the battering population will need to be catered to in order to avoid incarceration. Salient factors include: different cultural groups, batterers who are chemically dependent, batterers at different motivational stages, women arrested for domestic violence, and different profiles of batterers (e.g., family-only, borderline personality styles, and antisocial personality styles).

Domestic violence treatment has reached a muddled state in which there is no clear delineation between treatment, social activism, and punishment. As psychologists, we must give serious consideration as to whether it is our job to mete out justice, or whether we should leave that to others and focus on providing the most efficacious and empirically supported treatment when called upon to do so.

-IS

Footnotes:
1. Several recent studies have suggested that women initiate violence in intimate relationships as often or more often than men (see for example Loy, 2005). However, since there are no widely accepted interventions for female batterers, this paper focuses on approaches designed specifically for male batterers.

2. This study originally sought to isolate stake-in-conformity variables. Stake-in-conformity theory suggests that men who are invested in homes, families, and careers are more socially bonded and are therefore more amenable to treatment. Research seems to bear this out. See for example Babcock et al. (2004).

3. Making this determination is one of the goals of those who hope to successfully profile batterers (see for example the work of Amy Holtzworth-Munroe).

References:
Babcock, J. C., Green, C. E., & Robie, C. (2004). Does batterers’ treatment work? A meta-analytic review of domestic violence treatment. Clinical Psychology Review, 23(8), 1023-1053.

Blanchard, B. D. (2001). Extremes of narcissism and self esteem and the differential experience and expression of anger and use of conflict tactics in male batterers. Dissertation Abstracts International: Section B: The Sciences & Engineering, 62(5-B), 2476.

Brown, J. (2004). Shame and domestic violence: treatment perspectives for perpetrators from self psychology and affect theory. Sexual and Relationship Therapy, 19(1), 39-56.

Chalk, R. (2000). Assessing family violence interventions: Linking programs to research-based strategies. Journal of Aggression, Maltreatment & Trauma, 4(1), 29-53.

Dalton, B. (2001). Batterer characteristics and treatment completion. Journal of Interpersonal Violence, 16(12), 1223-1238.

Fals-Stewart, W. (2003). The occurrence of partner physical aggression on days of consumption: a longitudinal study. Journal of Consulting and Clinical Psychology, 71(1), 41-25.

Gilligan, J. (1997). Violence: Reflections on a National Epidemic. New York: Vintage Books.

Jennings, J. L., & Murphy, C. M. (2000). Male-male dimensions of male-female battering: a new look at domestic violence. Psychology of Men and Masculinity, 1(1), 21-29.

Kilzer, L. (February 9, 2005). Colorado called resistant to change. Rocky Mountain News, pp. 2S-4S.

Ley, D. J. J. (2001). Effectiveness of a court-ordered domestic violence treatment program: A clinical utility study. Dissertation Abstracts International: Section B: The Sciences & Engineering, 62(4-B), 2065.

Loy, E., Machen, L., Beaulieu, M., & Greif, G. L. (2005). Common themes in clinical work with women who are domestically violent. American Journal of Family Therapy, 33(1), 33-44.

National Institute of Justice. (June 2003). Batterer Intervention Programs: Where Do We Go From Here? Washington D.C.: U.S. Department of Justice, Office of Justice Programs.

National Institute of Justice. (September 2003). Do Batterer Intervention Programs Work? Two Studies. Washington DC: U.S. Department of Justice, Office of Justice Programs.

Pence, E., & Paymar, M. (1993). Education Groups for Men who Batter. New York: Springer.

Schmidt, J. J. (2003). Masculine gender role stress within the context of an integrative model of male battering. Dissertation Abstracts International: Section B: The Sciences & Engineering, 64(3-B), 1506.

Smith, S. T. (2003). Surviving Aggressive People: Practical Violence Prevention Skills for the Workplace and the Street. Boulder, CO: Sentient Publications.