Title: Batterer Intervention: Program Approaches and Criminal Justice Strategies. Series: Issues and Practices Author: Kerry Healey, Christine Smith, with Chris O'Sullivan Published: February 1998 Subject: domestic violence 211 pages 407,000 bytes -------------------------------- Figures, charts, forms and tables are not included in this ASCII plain-text file. To view this document in its entirety, order a print copy from NCJRS at 800-851-3420. -------------------------------- U.S. Department of Justice Office of Justice Programs National Institute of Justice Batterer Intervention: Program Approaches and Criminal Justice Strategies by Kerry Healey, Ph. D. Christine Smith with Chris O'Sullivan, Ph.D. February 1998 -------------------------------- Issues and Practices in Criminal Justice is a publication series of the National Institute of Justice. Each report presents the program options and management issues in a topic area, based on a review of research and evaluation findings, operational experience, and expert opinion on the subject. The intent is to provide information to make informed choices in planning, implementing, and improving programs and practice in criminal justice. -------------------------------- Carolyn Peake Program Monitor National Institute of Justice Jeremy Travis Director Advisory Panel Robert A. Foster, M.S.W., C.E.O. Domestic Abuse Counseling Center 411 Boggs Avenue Pittsburgh, PA 15211 Adele Harrell, Ph.D. The Urban Institute 2100 M Street, N.W. Washington, DC 20037 Daniel Saunders, Ph.D. University of Michigan School of Social Work 1065 Frieze Boulevard Ann Arbor, MI 48109-1284 Richard M. Tolman, Ph.D. Associate Professor University of Michigan School of Social Work 1065 Frieze Boulevard Ann Arbor, MI 48109-1284 Oliver Williams, Ph.D. Associate Professor University of Minnesota Graduate School of Social Work Ford Hall, Room 400 2224 Church Street Minneapolis, MN 55455 -------------------------------- Prepared for the National Institute of Justice, U.S. Department of Justice by Abt Associates Inc., under contract #OJP-94-C-007. Points of view or opinions stated in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice. -------------------------------- The National Institute of Justice is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. NCJ 168638 -------------------------------- Table of Contents Foreword Acknowledgements Executive Summary Chapter 1: Introduction -- Key Points -- The Nature of the Problem -- What Is Domestic Violence? -- Who Batters? -- Who Are the Victims? -- The Impact of Battering on Victims and Society -- What Works: Do Interventions Stop Battering? -- Conclusion -- Endnotes Chapter 2: The Causes of Domestic Violence: From Theory to Intervention -- Key Points -- Overview of Theories and Related Interventions -- Feminist Approaches: The Social Problem Approach -- The Family Systems Model -- Psychological Approaches: A Focus on Individual Problems -- Compatibility of the Models With Criminal Justice Goals -- Conclusion: Multidimensional Models Dominate the Field -- Endnotes Chapter 3: Pioneers in Batterer Intervention: Program Models -- Key Points -- Program Procedures -- Intake and Assessment -- Victim Contacts -- Raising Victim Awareness -- Ongoing Advocacy and Safety Planning -- Orientation -- Leaving the Program -- Program Content: Established Interventions Using Weekly Groups -- Accountability as the Foremost Goal -- Cognitive-Behavioral Techniques -- The Duluth Curriculum: Issues of Power and Control as Primary Targets -- EMERGE and AMEND: More In-depth Group Counseling -- Conclusion -- Endnotes Chapter 4: Current Trends in Batterer Intervention: Innovations From the Field and the Research Community -- Key Points -- Interventions Based on Batterer Typologies -- Mounting Evidence of the Need for Typologies -- Typology in Action: Colorado's 18th Judicial District -- Cultural Specificity: The Influence of Class, Race, and Subculture -- Adapting Interventions to Accommodate Differences in Socioeconomic Status -- Culturally Competent Interventions: Addressing Race, Ethnicity, and Subculture -- Countering the Specialized Programming Trend: The Compassion Workshop -- Advantages and Criticisms of the Compassion Workshop Approach -- Conclusion -- Endnotes Chapter 5: Criminal Justice Response -- Key Points -- Criminal Justice System Issues Affecting Batterer Intervention -- Enrollment in a Batterer Intervention Should Occur Quickly -- Centralization Improves Service Delivery -- Prosecutors and Judges Need Accurate and Complete Defendant Information -- Intervention Is Needed for All Batterers -- State Service Provider Standards Help Control Abuses but May Block Program -- Diversity -- The Key Role of Probation: Batterer Supervision -- Collaboration Among Community Partners -- Informal Cooperation Between Probation and Program Staff -- Local Domestic Violence Coordinating Committees -- State-Level Domestic Violence Committees and Task Forces -- Conclusion -- Endnotes Chapter 6: Sources of Help and Information -- Key Points -- Batterer Intervention Training and Materials -- Criminal Justice Materials and Information -- National Organizations Concerned With Domestic Violence -- State Coalitions on Domestic Violence -- Information Concerning State and Local Standards and Guidelines on Batterer Intervention -- Individuals -- Selected Bibliography -- General Information -- Resources for Practitioners -- Criminal Justice Issues -- Specialized Populations and Intervention Strategies -- Government Publications Related to Domestic Violence -- Program Evaluation Appendixes Appendix A -- State Standards Matrix Appendix B -- Program Personnel and Criminal Justice Professionals Interviewed for This Report Appendix C -- Results of Program Survey Appendix D -- Sample Program Forms -------------------------------- Foreword In the late 1970's, activists working with battered women realized that, although they might help individual victims, no real progress could be made against the problem of domestic violence unless actions were taken to reform perpetrators and challenge the cultural and legal supports for battering. Batterer intervention was initiated as a first step toward changing batterers and raising cultural awareness of the problem. Criminal justice agencies have responded by referring an increasing number of batterers to interventions via pretrial or diversion programs or as part of sentencing. Among the programs contacted for this report, court-mandated batterers accounted for approximately 80 percent of all batterers attending programs. To be effective, an integrated criminal justice response to battering must include all branches of the criminal justice system, from police to pretrial screeners, prosecutors, judges, victim advocates, and probation officers. This report provides information that these professionals need to work effectively and knowledgeably with batterer intervention staff and to make informed choices about program referral. Program staff will find information on the responsibilities and concerns of criminal justice personnel who prosecute, sentence, and supervise batterers. The primary goal of the report is to improve the working relationship and mutual understanding between criminal justice personnel and batterer program staff. A secondary goal of the report is to expand the debate about innovative batterer intervention approaches to include criminal justice personnel who work with batterers daily and criminal justice policymakers who are concerned with domestic violence. Jeremy Travis Director National Institute of Justice -------------------------------- Acknowledgements We wish to thank the many individuals in the study sites who laid aside their pressing and important work to share with us their considerable knowledge about batterer intervention. In particular, we wish to thank the batterer intervention program directors who welcomed us: Meg Crager of Family Services of Seattle; Joan Zegree of Zegree, Ellner and Berrysmith, Seattle; Dr. Ann Ganley, Seattle V.A. Medical Center; Dr. Roland Maiuro, Harborview Medical Center of Seattle; Roxanne Roos Finney, Ina Maka, Seattle; Anna Meyer, Seattle Counseling Service for Sexual Minorities; Buruch Giday, Refugee Women's Alliance of Seattle; Dr. David Adams of EMERGE, Cambridge; Dale Chell, Domestic Abuse Intervention Service (DAIS), Des Moines; Robert Gallup of AMEND, Denver; Robert McBride, The Third Path, Denver; Dr. Steven Stosny, Compassion Workshop, Montgomery County, Maryland; Wil Avery, House of Ruth, Baltimore; and Jonathan Cohen, Batterers Intervention Project, New York City. A number of other program directors shared their experiences with us by phone; in particular we would like to thank Terrence P. Crowley of Men Stopping Violence, Atlanta, and Sunya Faloyan of the Empowerment Project, Charlotte. We also thank the numerous criminal justice professionals, victim advocates, and policymakers who helped us with our site visits, including: Judith Shoshana, Hon. Helen Halpert, Sheila Hargesheimer, Sid Hoover, and Lynne Gordon in Seattle; Dr. Andrew Klein and Beth Ledoux in Cambridge; Hon. Carol S. Egly, Hon. Cynthia Moisan, and Joe Quinn in Des Moines; Suzanne Sigona, Linda Foote Smith, Dexter Shipman, Dr. Frank Robinson, Amy Houghton, Debbie Buckmaster, Mark Barnes, and Linda Ferry in Denver; and Roni Young, W. Roland Knapp, L. Tracy Brown, Rachel Wohl, and Peggy Araya in Baltimore. Advisory board members, Robert Foster, Dr. Adele Harrell, Dr. Daniel Saunders, Dr. Richard Tolman, and Dr. Oliver Williams, were especially responsive and involved in guiding this report to completion. We are very grateful for their advice and insights. Dr. Edward Gondolf also provided important suggestions and information throughout the research process. Carolyn Peake, program manager for the project at the National Institute of Justice (NIJ), took an active interest in the development of the report, including attending site visits to Seattle and Montgomery County, Maryland, and provided valuable support throughout the project. Cheryl Crawford, the contracting officer's technical representative at NIJ, and Virginia Baldau, former Director of NIJ's Office of Development and Dissemination, both provided helpful suggestions that improved the report. Peter Finn of Abt Associates substantially improved drafts with his careful editing. Jocelyn Page of Abt Associates ably assisted with the compilation and analysis of State standards and guidelines for batterer intervention. Karen Minich, Angela Allegro, Sherri Brooks, Patricia Harmon, and Mary-Ellen Perry patiently coordinated the production of the report and the final desktop publication. Kerry Murphy Healey, Ph.D. Consultant to Abt Associates Inc. Cambridge, Massachusetts Christine Smith Abt Associates Inc. Cambridge, Massachusetts Chris O'Sullivan, Ph.D. Victim Services Research New York, New York -------------------------------- Executive Summary Requiring batterers to attend intervention programming as a condition of probation or component of pretrial diversion is fast becoming an integral part of many jurisdictions' response to domestic violence, yet many judges and probation officers lack basic information about the goals of and methods used by local batterer programs. The diversity of available programming and the emotionally charged ideological subtext to program choice make understanding and working with program providers potentially difficult for criminal justice professionals. This report is intended to meet the need for increased information exchange between criminal justice professionals and batterer treatment providers. Specifically, this report will help criminal justice personnel -- including prosecutors, judges, probation officers, and victim advocates - - better understand the issues surrounding batterer intervention and enable them to make appropriate referrals to programs and to communicate effectively with program providers. Program staff will find the report helpful in their efforts to understand the constraints faced by the criminal justice agencies that refer and monitor batterers as well as the underlying goals of the criminal justice system -- to protect victims and to deter reoffense -- and thus be able to align program practices with criminal justice expectations. The Nature of the Problem The legal definition of battering varies from State to State. As defined by many intervention providers, battering is a constellation of physical, sexual, and psychological abuses that may include physical violence, intimidation, threats, emotional abuse, isolation, sexual abuse, manipulation, the using of children, economic coercion, and the assertion of male privilege (such as making all major family decisions, or expecting the woman to perform all household duties). Only some of these behaviors -- most commonly assault and sexual assault -- are illegal. The majority of batterers arrested are heterosexual men; however, between 5 and 15 percent of those arrested for battering are women. Among females arrested for battering, many are thought to be "self-defending victims" who have been mistakenly arrested as primary or mutual aggressors. A small percentage of those arrested for battering are gay or lesbian. According to the 1992 National Crime Victimization Survey (NCVS), over 1,000,000 women were victimized by intimates (boyfriend, girlfriend, spouse or ex-spouse) compared to 143,000 men. In murders where the relationship between the victim and the offender was known, 26 percent of female murder victims were killed by intimates while 3 percent of male murder victims were killed by wives or girlfriends. (For the purposes of this report, the term "batterer" is given a masculine pronoun unless female batterers are being discussed.) The cost of domestic violence to society and to the victims of battering is immense. Battering results in physical and psychological damage to victims, deaths, increased health care costs, prenatal injury to infants, increased homelessness of women and children, physical and psychological damage to children exposed to violence in their homes, and corresponding increases in demand for social, medical, and criminal justice services. The Causes of Domestic Violence Three theoretical approaches dominate the field of batterer intervention; however, in practice, most interventions draw on several explanations for domestic violence in their work. Each theory of domestic violence locates the cause of the violence differently. o Social and cultural theories attribute domestic violence to social structures -- such as patriarchy -- and cultural values that legitimate male control and dominance over their domestic partners. Feminist (or "profeminist") batterer interventions are based on women's experience of these social and cultural factors, and use education and skills-building to resocialize batterers, emphasizing equality in intimate relationships. o Family-based theories blame violent behaviors on the structure of the family and family interactions rather than on an individual within a family. Family systems interventions emphasize building communications skills and may involve the use of couples counseling with the aim of family preservation. Family systems interventions are less common than other types of interventions because many practitioners object to treatments that do not assign blame to the batterer and identify a victim, and because this intervention approach may transfer some responsibility for the battering to the victim or endanger the victim if not performed conscientiously. As of 1996, 20 States had standards or guidelines that prohibit the use of couples counseling in batterer treatment. o Individual-based theories attribute domestic violence to psychological problems such as personality disorders, the batterer's childhood experiences, or biological disposition. Psychotherapeutic, cognitive-behavioral, and attachment abuse interventions are based on this theory. Pioneers in Batterer Intervention: Program Models Most pioneers in batterer intervention established programs based on a feminist educational model. The Duluth model is an example of a feminist educational curriculum. The EMERGE model blends feminist educational approaches with more intensive group work concerning relationships. At AMEND, feminist educational topics are used as a basis for an in-depth intervention addressing batterer psychology and moral development. All program models for batterer intervention discussed in chapter 3 are structurally similar; each proceeds from intake to assessment, victim contact, orientation, group treatment, completion or termination, and follow-up. Current Trends in Batterer Intervention A "one-size-fits-all" approach to batterer intervention cannot accommodate the diverse population of batterers entering the criminal justice system. Two new trends reflect the belief that more specialized approaches are needed: o interventions tailored to a specific type of batterer (based on psychological factors, risk assessment, or substance abuse history); and o interventions designed to enhance program retention and efficacy with specific populations (based on sociocultural differences such as poverty, literacy, race, ethnicity, nationality, gender, or sexual orientation). Criminal Justice Response Batterer intervention programs cannot be expected to deter domestic violence in isolation: a strong, coordinated criminal justice response is also needed. The combined impact of arrest, incarceration, adjudication, and intensive probation supervision may send as strong -- or even stronger -- message to batterers about their responsibility for their abusive behavior as batterer programs can. As key actions the criminal justice system can: o Expedite Domestic Violence Cases. Adopt policies to expedite batterers' trial dates, sentencing, probation contact, and batterer program intake. o Use Specialized Units and Centralized Dockets. Specialized domestic violence prosecution and probation units, and centralized court dockets for battering cases and restraining orders improve services to victims and better coordinate batterer prosecution, sentencing, and supervision. o Gather Broad-based Offender Information Quickly. Create a system to gather complete defendant information for prosecutors and judges, including previous arrests and convictions (for both domestic violence and other crimes), substance abuse, child welfare contacts, and victim information. o Take Advantage of Culturally Competent or Specialized Interventions. Maximize effective use of batterer programming by seeking appropriate interventions for batterers who are indigent, high risk, female, mentally ill, or incarcerated. o Coordinate Batterer Intervention with Substance Abuse Treatment. In cases where the batterer has an alcohol or drug abuse problem, courts should mandate treatment as well as batterer intervention. Probation officers should intensively monitor batterers' compliance with substance abuse treatment through weekly urine testing. o Be Alert to the Risks to Children in Domestically Abusive Households. Judges and probation officers should be alert to the danger posed by domestic violence to children (even to children who are not themselves physically abused) and coordinate with child protective services and programs that specialize in domestically abusive families to insure that batterers' children are safe and are receiving appropriate services. o Create a Continuum of Supports and Protection for Victims. Victim advocates should be provided to monitor victim safety and to assist victims with the criminal justice system from the time of the assault through trial and/or probation. Victim advocates attached to probation units are particularly important in monitoring the safety of women whose batterers are sentenced to a batterer program. o Encourage Interagency Cooperation. Organize formal coordinating committees of probation officers, prosecutors, battered women's advocates, child protection workers, and batterer intervention providers to discuss batterer referral and monitoring policies regularly. Conscientious supervision by criminal justice agencies (including monitoring by pretrial services, the judiciary, and probation officers) is central to criminal justice policy concerning battering and successful cooperation with batterer interventions. Sources of Help and Information There are numerous sources of additional information on batterer intervention, including State and national organizations, reference services, research literature and program manuals, and individuals who are willing to share their expertise with others in the field. -------------------------------- Chapter 1: Introduction The field of batterer intervention and the criminal justice system are becoming increasingly intertwined. On average, batterer intervention programs surveyed for this report estimated that 80 percent of their referrals were court-mandated. As a result, criminal justice personnel and victim advocates need reliable information about the nature and effectiveness of local interventions, while intervention providers need to understand the procedures used and constraints faced by criminal justice agencies that refer and monitor batterers. Obtaining current and accurate information on batterer interventions is challenging for criminal justice practitioners because programs are extremely diverse in approach and reflect a broad -- and often contradictory -- range of beliefs about explanations for battering as well as appropriate modes of intervention. In addition, the field is growing and diversifying in terms of the number of programs being offered, staff qualifications, and techniques used. Service providers, criminal justice professionals, mental health workers, and researchers in the field of batterer intervention often have deeply held beliefs concerning "what works" with batterers and what best serves the needs of the victim and the criminal justice system. As a result, debates about batterer intervention may be contentious and personal, grounded in a mix of social philosophy, research findings, personal experience, and self- interest. To assist courts and probation officers in selecting suitable batterer interventions -- that is, programs that emphasize victim safety and have goals consistent with those of the criminal justice system -- 27 States and the District of Columbia had mandated or supported the development of State-level standards or guidelines for batterer programs, and another 13 States were in the process of developing standards by 1997 (see chapter 5, "Criminal Justice Response," and appendix A, "State Standards Matrix"). However, even in States where guidelines or standards are in place, community domestic violence coalitions, the judiciary, probation officers, and other criminal justice professionals often retain considerable discretion over program accreditation and referral. Because of the complexity of the field -- and the seriousness of the ongoing threat posed to battered women when offenders are mishandled -- criminal justice professionals who handle domestic violence cases have increased responsibility to be knowledgeable about the content and structure of batterer programs in their jurisdictions in order to make informed choices among the interventions being offered. The Nature of the Problem Domestic violence intersects with the criminal justice system in the form of a number of criminal behaviors: assault and battery, harassment, breaking and entering, telephone misuse, violation of an ex parte or protection order, malicious destruction of property, sexual assault, and stalking as well as a number of other offenses that may not be immediately recognizable as domestic in origin (such as arson, fraud, or embezzlement). The classification of a crime as domestic violence may result in a less serious charge for the batterer despite evidence that "injuries that battered women receive are at least as serious as injuries suffered in 90 percent of violent felony crimes."[2] For this reason, judges, prosecutors, and probation officers need a clear sense of what behaviors constitute battering, who batters, who the victims of domestic violence are, and how they may appear in the criminal justice system. What Is Domestic Violence? While the origins of domestic violence remain controversial (see chapter 2, "The Causes of Domestic Violence"), the majority of intervention directors interviewed for this report defined domestic violence as a constellation of physical, sexual, and psychological abuses. Anne Ganley, one of the first mental health providers to establish a batterer treatment program in the late 1970's, defines domestic violence in terms of 1) the relationship of parties to the violence, 2) the perpetrator's behaviors, and 3) the function these behaviors serve. Domestic violence is a pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks, as well as economic coercion, that adults or adolescents use against their intimate partners.[3] Programs reflecting a feminist perspective define domestic violence as coercive behavior aimed at gaining power and control within a relationship (see the discussion of the feminist model in chapter 2). This definition, pioneered by Ellen Pence of Duluth, Minnesota, is summarized in exhibit 1-1, "The Power and Control Wheel" of the Duluth model. [4] Several Behaviors Batterers Use Ganley's and Pence's work points to the following common abusive behaviors: o Physical violence. Physical abuse may include any unwanted physical behavior against a partner, such as pushing or shoving, throwing objects, hitting or beating, choking, burning, using a weapon, or restraining the partner from leaving. Physical abuse may also include refusing to get help for a partner if he or she is sick or injured. Physical abuse acts as a deterrent to independent action by the victim, including attempts to end a relationship or cooperate with the criminal justice system. Women are in the most severe danger of physical violence when they try to leave an abusive relationship: 75 percent of emergency room visits and calls to the police by battered women occur after separation.[5] Half the homicides resulting from domestic violence occur after separation.[6] o Intimidation. Intimidation includes looks, gestures, and actions that remind the victim of the abuser's potential for physical violence, such as smashing things, destroying her property, abusing pets, or displaying weapons. Intimidation may also include abandoning a partner in a dangerous place. o Threats. Abusers may threaten to hurt the victim, her family, her children, or her pets. They may also threaten to commit suicide or to cause trouble for the victim with government authorities, employers, family, or friends. Whether credible or not, threats can be as effective as taking action in deterring the victim from seeking help. o Isolation. Isolation includes controlling what the victim does or whom she sees or contacts. The abuser may hold the victim against her will, deny access to a car or telephone, deter her from working or attending school, or alienate her from her family and friends. Isolating the victim destroys the support networks a victim usually needs to end an abusive relationship and makes her more vulnerable to the batterer's coercion. o Emotional abuse. Verbal insults serve to undermine the victim's self-confidence, thereby discouraging her from ending the relationship. The abuser may strive to convince the victim that she is unattractive, a bad parent or wife, stupid, unemployable, crazy, incompetent, promiscuous, and the cause of the batterer's abuse. o Sexual abuse. Between 33 and 46 percent of battered women are subjected to sexual abuse,[7] such as rape (especially following other physical violence), unwanted sexual practices, sexual mutilation, or forced or coerced prostitution. Other practices that some programs consider sexual abuse include not disclosing a sexually transmitted disease, making degrading sexual statements, accusing the woman of having affairs or attempting to attract other men, forcing her to imitate pornography or pose for pornographic photographs,and comparing her body and sexual behavior to that of other women.[8] o Using the children. A recent study of batterers in Dade County, Florida, found that between 30 and 50 percent of the batterers and victims shared children.[9] The abuser can control the victim by threats or violence against the children, criticism of her parenting skills, and threats related to child custody. By providing for ongoing contact, joint custody enables the batterer to continue to intimidate or attack the victim, the children, or both. Some State statutes now prohibit joint custody in the event of domestic violence convictions, and recent research suggests that witnessing domestic violence has a serious long-term psychological impact on children, including increasing the child's own propensity for violence and delinquency.[10] o Using economic control. The batterer might keep control over all of the family's resources, including the victim's own income if she works, giving her an allowance or forcing her to ask for money for basic necessities. He might keep some sources of family income secret. As a result, many victims of domestic abuse have to live in a shelter or become homeless if they leave the relationship. o Using male privilege. Batterers use "male privilege" -- acting like the "master of the castle," making all important family decisions, expecting the woman to perform all the household duties and to wait on him -- to legitimize their control over the victim by placing their own behavior in the context of common sexist norms. Not all of these abusive behaviors are illegal. However, from the standpoint of many batterer interventions, all abusive behaviors must be changed to correct the pattern of abuse (see chapter 2, "The Causes of Domestic Violence"). David Adams, program director of EMERGE in Cambridge, Massachusetts, speaks of the need to "hold convicted batterers to a higher standard" than the legal standard because, in the context of a formerly abusive relationship, a perfectly legal shout or insult recalls for the victim her partner's earlier abuse, the mere recollection of which can revive her terror. Officers point out, however, that legal coercion cannot be used to enforce a standard not specified in the batterer's sentence. For example, a probationer sentenced to attend a batterer program once a week is not in violation of his probation if program counselors recommend that he attend additional sessions and the batterer does not comply. Who Batters? The majority of arrested batterers are heterosexual men. While the 1985 National Family Violence Resurvey found that a similar number of men and women (11.6 percent and 12.4 percent, respectively) admitted engaging in "any violence" against their partner during the previous year, authors of the survey point out that the superior physical strength and greater aggressiveness of men is more likely to result in serious injury to the woman, and that women's violence is often in retaliation or self-defense.[11] A recent study of defendants in domestic violence cases in one jurisdiction found that men were respondents in 90 percent of misdemeanor cases, 85 percent of felony cases, and 75 percent of civil actions.[12] Among the smaller percentage of batterers who are female, four distinct types of offenders are identified by program directors, probation officers, and victim advocates. They are lesbian batterers, so-called "female defendants" (battered women arrested for violent acts of self-defense), angry victims who have resorted to violence to preempt further abuse, and a small proportion of women batterers who have been the primary aggressors in an abusive relationship. Researchers have found that the genuinely violent woman is usually a former victim of some type of violence - - child abuse, domestic violence, or sexual crimes -- and often engages in violent behavior in order to deter future victimization.[13] (See chapter 4, "Current Trends in Batterer Intervention," for a discussion of issues surrounding batterer intervention with female offenders. Programs contacted for this report estimate that approximately 5 percent of batterers referred to them by the courts were female. Because the majority of interventions discussed in this report are designed for male batterers, the term "batterer" will be given a male pronoun unless female offenders are being specifically discussed.) Although there are no reliable estimates of prevalence, some gay men also batter their intimate partners and are arrested.[14] According to the 1992 National Crime Victimization Survey (the Victimization Survey), 51 percent of domestic violence victims were attacked by a boyfriend or girlfriend, 34 percent by a spouse, and 15 percent by a former spouse.[15] The backgrounds of incarcerated batterers -- the most serious offenders -- are similar to those of offenders convicted of assaults against strangers and acquaintances: half grew up living with both parents; 12 percent had lived in a foster home; 22 percent had been physically or sexually abused; 31 percent were the children of substance abusers; and 35 percent had a family member who had been incarcerated.[16] Less is known about the demographic characteristics of low-risk or "typical" batterers, but program staff and probation officers emphasized the cultural and economic diversity of these offenders. Efforts to identify key demographic, psychological, and criminal characteristics of men who batter have led some researchers to propose batterer profiles or "typologies" to aid criminal justice professionals and batterer interventions in predicting batterers' dangerousness and potential for reoffending, as well as to match batterers with specialized forms of intervention[17] (see chapter 4, "Current Trends in Batterer Intervention"). Preliminary results from a four-site study directed by Edward Gondolf have yielded a few clues to batterer psychological characteristics; for example, 25 percent were found to have major or severe psychological syndromes, including paranoia, borderline tendencies, thought disorders, and major depression. In terms of personality traits, o 25 percent had elevated narcissism scores; o 15 percent were antisocial; and o 10 percent were clinically compulsive. The other 50 percent fell into a broad array of personality types. Gondolf emphasized that no "uniform or simplistic typologies" were emerging from his data.[18] More promising from a criminal justice perspective are typologies based on simple demographic data, criminal records, and substance abuse data. One study by Goldkamp suggests that offenders with prior arrests involving the same victim, prior domestic violence or assault and battery arrests, and drug involvement may be at highest risk for reoffending.[19] Gondolf found that batterers who were drunk once a month reoffended at three times the rate of others in the study.[20] The significant role of alcohol and drug abuse in domestic violence -- especially in those cases coming to the attention of the criminal justice system -- is often downplayed by program staff because they wish to keep their intervention focused on the voluntary nature of domestic abuse and not excuse the batterer's behavior on the basis of a medical model of addiction. Nonetheless, analyses of domestic abuse cases and restraining orders suggest that between 71 and 85 percent of domestic violence cases involve batterers who are substance abusers.[21] According to Peter Kosciusko, a substance abuse counselor at the Dudley, Massachusetts, District Court, "While I can't say drinking is the cause of domestic abuse, it definitely pours gasoline on the fire. If we can get them sober, we have a good chance of not seeing them again."[22] While research findings and most programs contacted for this study agree that there is no "typical" batterer, the National Domestic Violence Hotline cautions victims to be aware of the potential for danger when a partner manifests several key behaviors together: o demonstrating extreme jealousy or possessiveness; o switching from charm to anger without warning; o blaming others for his own negative actions; o withdrawing love, money, or approval as punishment; o undermining his partner's feelings and accomplishments; o isolating his partner from friends and family; and o exhibiting problems with drugs or alcohol.[23] Who Are the Victims? According to the Victimization Survey in 1992, more than 1,000,000 women and 143,000 men were violently victimized by intimates.[24] Twenty-six percent of female murder victims and 3 percent of male murder victims were killed by intimates (where the relationship between the victim and the offender is known). Victimization by intimates does not vary significantly by race, ethnicity, or geography. However, some victims of domestic violence are more vulnerable to abuse because of age or economic, educational, or marital status. The Victimization Survey found that the women who are most likely to be victims of domestic violence were between 20 and 34 years of age, had not graduated from college, had annual family incomes under $10,000, and were divorced or separated.[25] A recent analysis of homicide data in New York City revealed that women in the poorest boroughs (the Bronx and Brooklyn) comprised two-thirds of the victims killed by their partners and that 75 percent of women killed by husbands or boyfriends were African-American or Hispanic.[26] According to Jeff Fagan, Director of the Center for Violence Research and Prevention, "The myth of the classlessness of domestic violence is one that has persisted since the 1960's. The truth is, it is a problem of poverty, associated with other characteristics like low marriage rates, high unemployment and social problems."[27] Experts on battering emphasize that teenagers and young women in dating relationships are also at risk for violence and that battering outside cohabiting relationships should not be minimized or ignored.[28] Intervention providers interviewed for this report had the impression that another group of women may be at unusually high risk: women in cross-cultural relationships. Men and women from different cultural backgrounds may have very different expectations about sex roles, acceptable behaviors, and the use of violence within a relationship, and men may use these different perceptions to justify battering. Immigrant women are also especially vulnerable to abuse. Language barriers may prevent these women from seeking assistance from police or victim advocates; their culture may discourage them from asserting their legal rights; and, in the case of undocumented female immigrants, maintaining the relationship with their abuser may be the only way they can gain citizenship or avoid deportation.[29] While women from all professions and socioeconomic classes -- including businesswomen, lawyers, doctors, and judges -- are victims of domestic violence, women with higher incomes and status in the community often have the resources to deal with domestic violence privately without involving the criminal justice system (e.g., by using hotels or private psychological counseling). Women with limited employment options or little economic independence must often rely exclusively on the criminal justice system for protection.[30] According to Linda Ferry, who supervises domestic violence prosecutions in the Denver City Attorney's Office: "Wealthy people have other resources. That victim is not necessarily going to call the police unless she believes her life is in danger. She may, after the battering episode, go to her family, or a hotel, or a private physician who may or may not comply with the law and report it . . . . Somebody from a poorer neighborhood will probably end up in Denver General, where physicians will report it."[31] Another study found that of 11,218 women presenting at a metropolitan emergency department with injuries suffered in domestic violence, 28 percent required admission to the hospital from injuries and 13 percent required major medical treatment. Forty percent had previously required medical care for abuse.[32] The Impact of Battering on Victims and Society The prevalence, impact, and expense of domestic abuse in terms of injuries and fatalities, medical care, and harm to children is extensive. o In a 1993 national survey, 7 percent of women in the United States (3.9 million) reported physical abuse by their spouse or partner in the previous year.[33] o Another 1993 study found that 14 percent of women reported having been violently abused by a spouse or boyfriend at some time in their lives.[34] o From 1988 to 1991, 42 percent of murdered women had been killed by their partners.[35] A study of New York City homicides from 1990 to 1994 found that 49 percent of murdered women had been killed by husbands or boyfriends.[36] o In 1994, 250,000 people were treated in emergency rooms for injuries inflicted by an intimate partner -- 18 percent of all victims of violence admitted to hospital emergency rooms that year.[37] In 1989, a study of one emergency ward found that 30 percent of women needing attention were victims of battering.[38] o Between 8 and 26 percent of pregnant women in public and private clinics are victims of domestic violence.[39] Between 25 and 45 percent of battered women experience abuse during pregnancy.[40] o In 1992, the cost of medical services to battered women, children, and elderly in Chicago was $1,633 per person.[41] These statistics reflect only domestic violence cases identified by researchers, reported to the police, or brought to the attention of medical workers; some researchers estimate that as many as six out of seven domestic assaults go unreported.[42] A 1986 Bureau of Justice Statistics study found that 48 percent of domestic violence incidents reported in the National Crime Victimization Survey had not been reported to the police.[43] Furthermore, females victimized by intimates were six times more likely not to report the crime for fear of reprisal than female victims of violent crimes committed by strangers.[44] Researchers point out that the National Crime Victimization Survey is likely to record only the most egregious acts of domestic violence because violence not resulting in serious injury or police intervention may not be regarded by the survey respondents as a "crime." Finally, children exposed to domestic violence are at greater risk for behavioral and developmental problems, substance abuse, juvenile delinquency, and suicide. Witnessing domestic violence as a child probably contributes to the cycle of violence: many adult batterers witnessed domestic violence in their homes as children.[45] The severe personal and social costs of domestic violence make helping the victim and her children a moral imperative. However, there can be no lasting progress against domestic violence without deterring and rehabilitating the batterer himself. What Works: Do Interventions Stop Battering? While numerous evaluations of batterer interventions have been conducted, domestic violence researchers concur that findings from the majority of these studies are inconclusive because of methodological problems, such as small samples, lack of random assignment or control groups, high attrition rates, short or unrepresentative program curriculums, short follow-up periods, or unreliable or inadequate sources of follow-up data (e.g., only arrest data, only self-reported data, or only data from the original victim).[46] Among evaluations considered methodologically sound, the majority have found modest but statistically significant reductions in recidivism among men participating in batterer interventions. (See exhibit 1-2, "Selected Treatment Outcomes.") A notable exception is Adele Harrell's 1991 methodologically rigorous quasi-experimental evaluation of batterer interventions in Baltimore, conducted for the Urban Institute. Harrell's study raised particular concern in the field by its unexpected findings that participants in all three batterer interventions recidivated at a higher rate than those in the control group.[47] Preliminary results from Gondolf's four-site study sponsored by the Centers for Disease Control are inconclusive: at 12 months, reoffense rates for program graduates are similar to those for batterers who dropped out at intake, and no significant variations exist in outcomes for batterers in programs of varied length and curriculum (although a three-month, pretrial, educational program has shown slightly better outcomes when socioeconomic factors are taken into account).[48] Frustration with the lack of empirical evidence favoring one curriculum or length of treatment has led some researchers increasingly to look at batterers as a diverse group for whom specially tailored interventions may be the only effective approach. As a result, current research is shifting toward studying which subgroups of batterers respond to which specialized interventions (see chapter 4, "Current Trends in Batterer Intervention"). At the same time, the question of how to evaluate batterer interventions may need to be reframed to include the broader context of criminal justice support. For example, research suggests that arrest alone is not as effective in reducing recidivism as is arrest as part of a coordinated multiagency response to domestic violence.[49] These findings point to the need for a broader, systemic examination of the efficacy of batterer intervention. It seems likely that even if research identifies the perfect matches between interventions and offenders, criminal justice and community support for the interventions will have a crucial impact on the effort's success. Andrew Klein, chief probation officer of the Quincy, Massachusetts, District Court Model Domestic Abuse Program, observed, "You can't separate batterer treatment from its [criminal justice system] context. You can't study the effectiveness of treatment without studying the quality of force which supports it." Research supports this view: "[P]olice visits to the home, combined with an eventual arrest of the perpetrator, which was also followed by court-mandated treatment, were significantly more likely than other combinations of criminal justice actions to end repeat incidents of violence."[50] Gondolf's research also points to the importance of systemwide assessments of batterer intervention. In particular, Gondolf is concerned about the often long delay between arrest and program enrollment: "The lag may be so long that the program may be addressing men about a former life."[51] Systemwide evaluation could answer the important question of whether the speed of criminal justice response and program enrollment is more important than either program content or length. In conclusion, Andrew Klein emphasizes that, at a minimum, every intervention must be effective in monitoring abusive behavior during the program because victims are more likely to stay with batterers who are in an intervention. In Klein's opinion, "[B]atterer intervention is a public safety program, not treatment; you must keep the focus on victim safety. Otherwise, the criminal justice system is only offering the batterer a safe haven to escape the consequences of his offense." Conclusion While the criminal justice system is devoting increased attention to domestic violence, many mechanisms and protocols for dealing with batterers are new and still being refined. A number of States are still in the process of writing standards or guidelines for batterer programs. In the absence of conclusive research findings, practitioners and academics continue to debate the appropriate content of batterer interventions. In this dynamic environment, judges who adjudicate and prosecutors who try domestic violence cases, probation officers who supervise batterers, and advocates who serve victims of domestic violence all need to keep informed about new developments in the field of batterer intervention in order to perform their jobs effectively. The remainder of the report provides information on the theoretical debate surrounding domestic violence and batterer intervention (chapter 2); batterer program operation (chapter 3); current trends and refinements of practice in batterer intervention (chapter 4); criminal justice responses to batterer interventions, including community and interagency cooperation (chapter 5); and national and local sources of help and information (chapter 6). Endnotes 1. For a comprehensive treatment of law enforcement issues, see Buzawa, E. and C. Buzawa, Do Arrests and Restraining Orders Work? Thousand Oaks, CA: Sage Publications, 1996. 2. See Zorza, Joan, "The Gender Bias Committee's Domestic Violence Study: Important Recommendations and First Steps," 33 Boston Bar J.4, 13 (July/August 1989); and Langan, P.A. and C.A. Innes, Preventing Domestic Violence Against Women, Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics, August 1986: 3. 3. Ganley, A., "Understanding Domestic Violence," in Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers, Harrisburg, PA: Family Violence Prevention Fund and the Pennsylvania Coalition Against Domestic Violence, n.d. 4. For an overview of Pence's philosophy and the Duluth program model (which is also discussed in chapter 3, "Pioneers in Batterer Intervention"), see Pence, E., "Batterers' Programs: Shifting from Community Collusion to Community Confrontation," February 1988, available from the Domestic Abuse Intervention Project (see chapter 6, "Sources of Help and Information"). 5. Stark, E. and A. Flitcraft, "Spouse Abuse, Surgeon General's Workshop on Violence and Public Health Sourcebook," presented at the Surgeon General's Workshop on Violence and Public Health, Leesburg, Virginia, October 1985, cited in National Clearing House for the Defense of Battered Women, Statistics Packet, 3d ed., Philadelphia: February 1994. 6. Langhan and Innes, Preventing Domestic Violence Against Women. 7. Frieze, I. H. and A. Browne, "Violence in Marriage," in Family Violence: Crime and Justice, n.d., cited in State of Iowa, Final Report of the Supreme Court Task Force on Courts' and Communities' Response to Domestic Abuse, submitted to the Supreme Court of Iowa, August 1994:10. 8. Material provided by House of Ruth, Baltimore. 9. Goldkamp, J. S., The Role of Drug and Alcohol Abuse in Domestic Violence and Its Treatment: Dade County's Domestic Violence Court Experiment, Final Report, Philadelphia: Crime and Justice Research Institute, June 1996: Executive Summary, viii. 10. A number of child welfare departments, notably the Department of Social Services in Massachusetts, have developed protocols and interventions for children who have witnessed domestic violence. Research citing the harmful impact of domestic violence on children include: Widom, C.S., "The Cycle of Violence," Research in Brief, Washington, DC: U.S. Department of Justice, National Institute of Justice, October 1992: 3; Thornberry, T.P., "Violent Families and Youth Violence," Office of Juvenile Justice and Delinquency Prevention (OJJDP) Fact Sheet #21, Washington, DC: OJJDP, December 1994; Straus, M.A., F.J. Gelles, and S. Steinmetz, Behind Closed Doors, Garden City, NY: Anchor/Doubleday, 1980; Peled, I., P.G. Jaffe, and J.L. Edelson, eds., Breaking the Cycle of Violence: Community Responses to Children of Battered Women, Thousand Oaks, CA: Sage Publications, 1995; Miller, G., "Violence By and Against America's Children," Journal of Juvenile Justice Digest, 17(12) (1989): 6; Carlson, B.E., "Children's Observations of Interparental Violence" in Battered Women and Their Families, ed. A.R. Edwards, New York: Springer, 1984: 147-167. 11. Straus, M.A. and R.J. Gelles, eds., Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families, New Brunswick, NJ: Transaction Publishers, 1990: 96- 98. See also Straus, M.A., "Physical Assaults by Wives: A Major Social Problem," in Current Controversies on Family Violence, ed. R.J. Gelles and D.R. Loseke, Newbury Park, CA: Sage Publications, 1993: 67-87. This article raises questions about the nature and prevalence of violence by women against their partners. 12. Ibid. 13. Recent research on the sequelae of child abuse and neglect, including child sexual abuse and witnessing domestic violence as a child, suggest a link between child victimization and later involvement in domestic violence for men as well. See Straus, Gelles, and Steinmetz, Behind Closed Doors. 14. Island, D. and P. Letellier, Men Who Beat the Men Who Love Them: Battered Gay Men and Domestic Violence, New York: Harrington Park Press, n.d.: 12-14. 15. Bureau of Justice Statistics, Domestic Violence: Violence Between Intimates, Selected Findings, Washington, DC: U.S. Department of Justice, November 1994: 1. (NCJ-149259) 16. Ibid. 17. Edward Gondolf, Associate Director of Research, Mid-Atlantic Training Institute, is conducting a quasi-experimental evaluation of four model batterer intervention programs. This study, when concluded, is expected to advance knowledge of batterer typologies. Daniel Saunders has analyzed interview data that compares treatment outcomes of graduates from a cognitive behavioral group to batterers who received process- psychodynamic group therapy. See Saunders, D., "Interventions for Men Who Batter: Do We Know What Works?" In Session: Psychotherapy in Practice, 2(3) (1996): 81-93. See also Saunders, D., "Husbands Who Assault: Multiple Profiles Requiring Multiple Responses," in Legal Responses to Wife Assault, ed. N.Z. Hilton, Newbury Park, CA: Sage Publications, 1993; Saunders, D., "A Typology of Men Who Batter: Three Types Derived from a Cluster Analysis," American Journal of Orthopsychiatry, 62(2) (1992); and Goldkamp, The Role of Drug and Alcohol Abuse, 191ff. 18. Interview with Edward Gondolf, October 22, 1996. 19. Goldkamp, The Role of Drug and Alcohol Abuse, 197. 20. Interview with Edward Gondolf, October 22, 1996. 21. Doherty, W.F., "Cases Spur Debate on Alcohol's Link to Domestic Violence," Boston Globe, July 21, 1997, B2. 22. Ibid. 23. National Domestic Violence Hotline, quoted in program materials provided by the House of Ruth, Baltimore. 24. Bureau of Justice Statistics, Violence Between Intimates. 25. Ibid. 26. Belleck, Pam, "A Woman's Killer Is Likely to Be Her Partner, A New Study in New York Finds," New York Times, March 31, 1997, A16NE. 27. Ibid. 28. See Sousa, C., L. Bancroft, and T. German, "Preventing Teen Dating Violence: A Three Session Curriculum for Teaching Adolescents," produced by the Dating Violence Intervention Project, Cambridge, MA (see chapter 6, "Sources of Help and Information"). 29. See Lin, M.W.L. and C.I. Tan, "Holding Up More Than Half the Heavens: Domestic Violence in Our Communities, A Call for Justice," in K. Aguilar- San Juan, ed., The State of Asian America: Activism and Resistance in the 1990s, Boston: South End Press, n.d.: 321. 30. See Butler, C., "Myths About Woman Abuse," in For Shelter and Beyond, 2d ed., Boston: Massachusetts Coalition of Battered Women's Groups, n.d., 21. 31. Not all States require physicians to report cases involving domestic violence. 32. Berrios, D.C. and D. Grady, "Domestic Violence: Risk Factors and Outcomes," The Western Journal of Medicine, 155(2) (August 1991) cited in Family Violence Prevention Fund, "The Healthcare Response to Domestic Violence Fact Sheet," San Francisco, n.d. 33. The Commonwealth Fund, "First Comprehensive National Survey of American Women Finds Them at Significant Risk " (news release), New York: July 14, 1993. 34. Family Violence Prevention Fund, Men Beating Women: Ending Domestic Violence, A Qualitative and Quantitative Study of Public Attitudes on Violence Against Women, New York: conducted by EDK Associates, 1993, cited in "The Health Care Response to Domestic Violence Fact Sheet." 35. Analysis by the Center for the Study and Prevention of Violence, Institute for Behavioral Science, University of Colorado at Boulder, cited in "The Health Care Response to Domestic Violence Fact Sheet." 36. Belleck, "A Woman's Killer Is Likely to Be Her Partner." 37. "Abuse High, Survey Finds," Boston Globe, August 25, 1997. 38. McLeer, S. and R. Anwar, "A Study of Battered Women Presenting in an Emergency Department," American Journal of Public Health, 79(1) (January 1989), cited in "The Health Care Response to Domestic Violence Fact Sheet." 39. Berrios, D.C. and D. Grady, "Domestic Violence: Risk Factors and Outcomes." 40. State of Iowa, Final Report of the Supreme Court Task Force, 17. 41. Meyer, H., "The Billion Dollar Epidemic," American Medical News, January 6, 1992, cited in "The Health Care Response to Domestic Violence Fact Sheet." 42. National Clearinghouse for the Defense of Battered Women, Statistics Packet, 3d ed., Philadelphia, February 1994. 43. Langhan and Innes, Preventing Domestic Violence Against Women. 44. Bureau of Justice Statistics, Domestic Violence: Violence Between Intimates, 5. 45. Roberts, L. and R. Burger, "Child Abuse," in For Shelter and Beyond: Ending Violence Against Women and Their Children, 2d ed., Boston: Massachusetts Coalition of Battered Women Service Groups, n.d.: 107; see also note 10. 46. For a critique of major batterer intervention evaluations, see Davis, R.C. and B.G. Taylor, "Does Batterer Treatment Reduce Violence? A Synthesis of the Literature," Victim Services Research, New York, NY, July 1997; Tolman, R. and J. Edelson, "Interventions for Men Who Batter: A Review of Research" in Understanding Partner Violence: Prevalence, Causes, Consequences, and Solutions, Minneapolis: National Council on Family Relations, 1995: 262-273; Saunders, D., "Interventions for Men Who Batter: Do We Know What Works?" In Session: Psychotherapy in Practice, 2(3) (1996): 81-93; and Gondolf, E., "Batterer Intervention: What We Know and What We Need to Know," Paper presented at the Violence Against Women Strategic Planning Meeting, sponsored by the National Institute of Justice, Washington, DC, March 31, 1995. 47. Harrell, A., Evaluation of Court Ordered Treatment for Domestic Violence Offenders, Final Report, Washington, DC: The Urban Institute, October 1991. 48. Interview with Edward Gondolf, October 22, 1996. Similarly, Davis and Taylor's study reported positive outcomes for short-term, intensive programs. 49. See Rebovich, D.J., "Prosecution Responses to Domestic Violence: Results of a Survey of Large Jurisdictions," in Do Arrests and Restraining Orders Work?, ed. Buzawa and Buzawa, 176-191; and Schmidt, J. and L. Sherman, "Does Arrest Deter Domestic Violence," in Do Arrests and Restraining Orders Work?, ed. Buzawa and Buzawa, 43-53. 50. Tolman and Edelson, p. 264, citing Syers, M. and J. Edelson, "The Combined Effects of Coordinated Criminal Justice Intervention in Women Abuse," Journal of Interpersonal Violence, 7: 490- 502. 51. Interview with Edward Gondolf, October 22, 1996. -------------------------------- Key Points o The connection between the criminal justice system and batterer interventions is increasing: on average, 80 percent of clients in batterer programs are referred by probation officers or by court mandate. o Judges, probation officers, criminal justice policymakers, and victim advocates need to understand the issues surrounding batterer intervention so they can make responsible referrals and communicate effectively with program providers. o Batterer program providers need to understand the constraints faced by criminal justice agencies that refer and monitor batterers, as well as the goals of the criminal justice system. o Battering -- or domestic violence -- may be defined as a constellation of physical, sexual, and psychological abuses that may include: physical violence, intimidation, threats, isolation, emotional abuse, sexual abuse, manipulation using children, total economic control, and assertion of male privilege (such as making all major family decisions and expecting the woman to perform all household duties). o The majority of batterers are heterosexual men. Heterosexual women offenders constitute between 5 and 15 percent of those arrested for battering, and a small percentage of arrestees are gay or lesbian. o Victims of battering come from all races, ethnicities, and socioeconomic groups; however, women with lower socioeconomic status may be at greater risk for abuse. o Domestic violence inflicts immense damage to society in terms of physical and psychological injury to victims, deaths, health care costs, prenatal damage to infants, and physical and psychological damage to children exposed to violence in their homes. o Evaluations of batterer interventions often raise methodological concerns and have yielded few generalizable conclusions. o A broader, systemic examination of batterer intervention that focuses on the criminal justice response as well as program characteristics is needed. -------------------------------- About This Publication The primary audiences for this report are judges handling and prosecutors trying domestic violence cases, probation officers supervising batterers, victim advocates, and batterer intervention providers. The report will also be useful to State and local domestic violence policy planners, domestic violence coordinating committees, and departments of public health and child welfare. Goals of the Report The primary goals of the report are to: o provide current and objective information concerning the range of batterer interventions currently in operation throughout the country; o review the most critical issues being debated by criminal justice professionals, academics, and service providers in the field; o review promising criminal justice practices related to batterer intervention; and o provide examples of coordinated criminal justice responses to battering that include referral to batterer intervention programs. Program enrollment, completion, and success rates were provided by the programs described in this report. No independent evaluations of the programs were undertaken for the report. However, selected evaluation literature is listed in chapter 6, "Sources of Help and Information," and evaluation outcomes are discussed briefly in this chapter. The report's focus is batterer interventions and their links to the criminal justice system. Because law enforcement commonly has little or no direct contact with batterer interventions, the report does not discuss police responses to domestic violence (e.g., the impact of mandatory arrest or the effectiveness of restraining orders).[1] -------------------------------- Sources of Information for This Report The information in this report comes from the following sources: o structured telephone interviews with program directors at 22 programs across the country; o on-site interviews at 13 programs with more than 60 criminal justice professionals, batterer program directors and service providers, battered women's advocates and domestic violence policymakers in Cambridge and Quincy, Massachusetts; Des Moines, Iowa; Baltimore, Maryland; Denver, Colorado; and Seattle, Washington; o interviews with academics in the field of batterer treatment and intervention, including Donald Dutton, University of British Columbia; Edward Gondolf, Research Director of the Mid- Atlantic Addiction Training Institute; Kevin Hamberger, Medical College of Wisconsin; Daniel Saunders, University of Michigan; Richard Tolman, University of Michigan; and Oliver Williams, University of Minnesota; and o a review of books, reports, and journal articles, program evaluations, program materials, and State and local criminal justice protocols. Site work also included observations: a four-day batterer treatment training program sponsored by EMERGE of Cambridge, Massachusetts; a two-day seminar on intervention with high-risk batterers given by Michael Lindsey, founder of The Third Path and AMEND, for Iowa criminal justice professionals; a domestic violence court docket in Seattle; and State and local coalition meetings concerning batterer intervention and batterer classes and groups. Appendix B lists the names and affiliations of the individuals contacted at each site. Selection criteria for programs are discussed in chapter 3, "Pioneers in Batterer Intervention: Program Models." Chapter 6, "Sources of Help and Information," provides a selected bibliography. -------------------------------- Chapter 2: The Causes of Domestic Violence: From Theory to Intervention The origins of domestic violence are the subject of active debate among victim advocates, social workers, researchers, and psychologists concerned with batterer intervention. More than in most fields, the theoretical debate affects practice. Over the last two decades, a number of practitioners representing divergent theoretical camps have begun to move toward a more integrated "multidimensional" model of batterer intervention in order to better address the complexity of a problem that has psychological, interpersonal, social, cultural, and legal aspects. Two practitioners who advocate an eclectic approach to batterer intervention describe the dilemma of practitioners looking for a single explanation for battering as follows: During a recent conversation, a respected colleague of ours suggested that marital aggression was rooted in a need for control. "Men," he said, "use aggression to control their female partners." We agreed. Control is certainly an important factor in the dynamics of marital violence. His treatment approach, well known and effective, focused on helping abusers relinquish control and share power with their spouses. Several weeks later, we discussed the same topic with the director of a treatment program for wife abusers, who stated that "poor impulse control" and "defective self-concept" were the critical factors. We agreed. Abusers are certainly impulsive and often have poor self-esteem. Her treatment program, which focused on these factors was, she claimed, very successful. Sometime later, one of our graduate students, well aware of these previous conversations, reported on a workshop she had attended. The model presented at the workshop conceptualized marital violence as a couples' problem and suggested that communication between spouses was the critical factor. Conjoint couples' counseling was suggested as an effective intervention for violent couples. Again, we could agree. The safest conclusion would appear to be that there are numerous routes by which husbands come to be wife abusers and a multitude of variables that increase the likelihood of violence.[1] In practice, few batterer programs represent a "pure" expression of one theory of domestic violence; the majority of programs contacted for this report combine elements of different theoretical models. As a result, when discussing program theory with batterer intervention providers, criminal justice professionals need to understand not only the primary theory the program espouses but also the program's content, because programs may identify with one theory but draw on or two more theories in their work. Experts caution criminal justice agencies against accepting an eclectic curriculum uncritically: program components borrowed from different theoretical perspectives should be thoughtfully chosen to create a coherent approach, not a scattershot attempt hoping to hit some technique that works. Criminal justice professionals are likely to encounter programs based on one or more of the following theories of domestic violence. Each theory locates the cause of the violence differently: o Society and culture -- Social theories of domestic violence attribute the problem to social structures and cultural norms and values that endorse or tolerate the use of violence by men against women partners. For example, the feminist model of intervention educates men concerning the impact of these social and cultural norms and attempts to resocialize them emphasizing nonviolence and equality in relationships. o The family -- Some sociologists locate the cause of domestic violence in the structure of the family, the interpersonal interactions of families, and the social isolation of families. For example, family systems theory attributes the cause to communication problems and conflict within intimate relationships and teaches communication skills to help partners avoid violence. As noted below, couples counseling, an intervention based on family systems theory, is controversial because of its failure to assign blame for the abuse to one person and to identify a victim. Couples counseling is also considered dangerous to the victim because it encourages the victim to discuss openly issues that may spark later retaliation by the batterer. o The individual -- Psychological theories attribute domestic violence to the individual batterer's predispositions and experiences. Battering may be attributed to personality disorders and biological dispositions to violence or, as social learning theory suggests, to the role of the batterer's social environment during childhood. Attachment theory, a form of social learning theory, focuses on the interaction of caregivers with their children and the impact of that first attachment on an individual's ability to establish safe and healthy relationships later in life. Batterer interventions based on this theory attempt to facilitate secure attachments between batterers and loved ones (intimate partners, children, and parents). Psychodynamic approaches target the underlying psychological cause of the violence, while cognitive behavioral approaches teach batterers new patterns of nonviolent thinking and behavior. It is important for criminal justice professionals to understand the assumptions and goals of service providers whose interventions have divergent theoretical bases, because not all intervention approaches employ techniques that are equally compatible with the goals of the criminal justice system -- protecting the victim as well as rehabilitating the offender. Overview of Theories and Related Interventions Feminist (or profeminist; see box, "The Language of Batterer Intervention"), family systems, and psychotherapeutic theories of domestic violence offer divergent explanations of the root causes of battering and lead to distinct intervention models. The following section outlines the basic tenets of each theory, illustrates how these assumptions influence the choice of intervention strategies, and notes the advantages and disadvantages of each theoretical and treatment approach. As noted previously, however, examples of programming based exclusively on one theory are becoming increasingly rare. Feminist Approaches: The Social Problem Approach Batterer intervention programs originated in the early 1970's, as feminists and others brought to public attention the victimization of women and spawned grass roots services such as rape hot lines and battered women's shelters.[3] According to Anne Ganley of Seattle's Veteran Administration Medical Center and David Adams of EMERGE in Boston, providers of services to battered women felt that victims who had received services either returned home to face the same destructive environment or left the relationship -- and the batterer found a new victim. To help victims, advocates realized, it was also necessary to address the root cause of their problems -- the perpetrators of violence. Profeminist men concerned with sexism in themselves and society felt a particular responsibility for working with male abusers. As a result, some of the first systematic interventions for batterers developed from a profeminist perspective. What Is a Feminist Model of Battering? Central to the feminist perspective on battering is a gender analysis of power.[4] According to this view, domestic violence in intimate relationships mirrors the patriarchal organization of society in which men play a dominant role in most social institutions. Along with verbal, emotional, and economic abuse, violence is a means of maintaining male power in the family when men feel their dominance is being threatened. Economic roles have left women dependent on men and unable to escape abusive situations.[5] Men's superior physical strength may enable them to dominate women through violence. Feminists argue that a consequence of the social arrangement in which men hold the positions of respect and power is that men and women alike devalue the feminine and over-value the masculine. To the batterer, women are childlike and incompetent. It is not uncommon for batterers to convince their wives that they are not capable of adult activities, such as driving a car or holding a job.[6] For example, a former victim reported that her husband had convinced her that she could not turn on the washing machine without breaking it, so she had to wait until he returned from work before she could do the laundry for their seven children. Similarly, in disputed custody cases when a batterer and partner separate, the husband often contends that his wife is incapable of taking care of the children.[7] In the feminist view, batterers feel that they should be in charge of the family: making decisions, laying down rules, disciplining disobedient wives and children, and correcting unsatisfactory performance of duties.[8] Batterers may typically exercise control over the family in nonviolent, coercive ways and only sometimes resort to violence. As men, batterers feel entitled to gender-based respect and obedience; therefore, what they perceive to be disrespect and disobedience infuriates them. Batterers often rationalize their violence on the grounds that it was necessitated by their partner's actions: she provoked or caused it, and they simply reacted as any man would. Feminist programs attempt to raise consciousness about sex role conditioning and how it constrains men's emotions and behavior (through education around sexism, male privilege, male socialization). Programs with a feminist philosophy present a model of egalitarian relationships along with the benefits of nonviolence and of building relationships based on trust instead of fear (see exhibit 2-1, "Equality Wheel"). Most feminist approaches support confronting men over their power and control tactics in all domains of the relationship, including verbal and psychological abuse, social isolation, the undermining of the victim's self- confidence, and sexual coercion (see exhibit 1-1, "The Power and Control Wheel"). A particular concern of profeminist male group facilitators is the constant risk and temptation of colluding with batterers. For example, a male facilitator at Family Services of Seattle reported that when his female cofacilitator was absent at one session, the men in the group expected him to drop his profeminist "guise" and participate in or agree with their negative characterizations of women. Advantages and Criticisms of the Feminist Model Perhaps because work with batterers was originated by battered women's advocates and feminists, the feminist perspective has influenced most programs. A national survey conducted in 1986 found that 80 percent of programs attempt to change sex role attitudes, stop violence, and increase self- esteem.[9] Even programs adopting a family systems model (see below) may advocate an egalitarian and democratic relationship to couples in treatment. Support for the feminist analysis of the role of power in domestic violence comes from the observation that most batterers are able to control their anger and avoid resorting to violence when "provoked" by someone more powerful than they, such as their work supervisors, police officers, or judges. Further support for the feminist analysis comes from research showing that batterers are less secure in their masculinity than nonbatterers[10] -- the theory being that men who do not feel masculine will need to assert their masculinity more forcefully to compensate for their sense of inadequacy. Other studies have documented the sense of entitlement batterers feel in controlling their partners' behavior and in justifying violence if these women deviate from the female sex role.[11] Critics have claimed that the feminist perspective overemphasizes sociocultural factors, such as patriarchal values, to the exclusion of individual factors like growing up abused.[12] Men's behavior in intimate relationships varies across individuals, and broad cultural factors cannot explain this variability. Feminist theory predicts that all men in our society will be abusive, claim its critics, adding that besides being untrue, this theory makes it impossible to predict which men will be violent. To make individual predictions, a model must assign a role to other factors including, but not limited to, psychological deviance. Other criticisms center not on the validity of feminist explanations of battering but on the translation of that theory into programming. For example, some observers argue that feminist educational interventions are too confrontational in tone and, as a result, are ultimately self- defeating, alienating batterers, increasing their hostility, and making them less likely to become engaged in treatment. It is possible that the goal of the feminist model -- to rebuild the batterer's belief system in order to achieve nonviolence -- may be unnecessarily ambitious and adversarial. Batterers' existing value systems may be more easily fine-tuned to emphasize nonviolence (e.g., building on religious convictions or humanism) without a feminist overlay. Another concern is that educational programs may effectively transmit information without deterring violent behavior. A 1991 evaluation of three short-term psychoeducational batterer programs in Baltimore found that while batterers considered the curriculum helpful, they recidivated at a higher rate than batterers who did not receive treatment.[13] A study of graduates of Duluth's Domestic Abuse Intervention Project found that completion of the feminist educational intervention had no impact on recidivism after five years.[14] Outcomes such as these point to the need for broader evaluations that examine the impact of systemic factors -- arrest and prosecution policies, court procedures, and probation supervision -- on intervention effectiveness, as well as a clarification of the goals of feminist-based interventions. If deterrence is not a likely outcome of an intervention, other goals, such as punishment, education, behavioral monitoring, or social change, must be explicitly advanced. (A few practitioners are in fact shifting their primary focus away from individual change in batterers in favor of social change through a coordinated community response. See chapter 5, "Criminal Justice Response"). The Family Systems Model The family systems model regards individual problem behaviors as a manifestation of a dysfunctional family unit, with each family member contributing to the problem. Rather than identifying one individual as the cause of the violence and removing that person from the home or singling that person out for treatment, the model advocates working with the family or couple together, providing support with the goal of keeping the family intact. According to the family systems (or "interactional") model,[15] both partners may contribute to the escalation of conflict, with each striving to dominate the other. Family systems theorists believe that most abuse is verbal and emotional, but as the conflict escalates, either partner may resort to violence. Because, from this perspective, interactions produce violence, no one is considered to be the perpetrator or victim, even if only one person is physically violent. Family systems theory also suggests that interactions may permit or facilitate abusive behaviors in one person, such as a nonabusive parent's failure to intervene in child abuse or a family member's failure to establish appropriate personal boundaries, thus setting the stage for their own victimization. Family systems therapists criticize psychological approaches that focus on individual deficits (low self-esteem, dependence, anger) while neglecting to teach interpersonal skills that could promote safety. Family systems theory leads to treatment that involves improving communication and conflict resolution skills. Both members of the couple can develop these skills through "solution-focused brief therapy" that: o locates the problem in the interaction rather than in the pathology of one individual; o focuses on solving the problem, rather than looking for causes; and o accentuates the positive -- for example, examining occasions when the couple avoided violence. Advantages and Criticisms of the Family Systems Model Advocates of the family systems approach note that many violent couples would like to remain together and that there may be positive aspects to the relationship that counseling can build on. However, while some observers report that over half of domestic violence couples remain together,[16] a study of abused wives whose husbands did become nonviolent found that most of the women subsequently terminated the marriage because of other marital problems that became apparent after the violence ended.[17] Both feminist and cognitive-behavioral approaches agree that partner abuse does not involve shared responsibility. Both approaches firmly hold that batterers bear full responsibility for the violence, victims play no causal role, and no one incites violence. Of particular concern to both feminist and cognitive-behavioral proponents is the format of couples counseling: encouraging each partner to discuss problems openly with the other partner can put the victim at risk after the session if the woman expresses complaints. Furthermore, no frank exchange between counselor and victim concerning the abuse is likely to be possible in the presence of the batterer. Moreover, the format is conducive to victim- blaming. Finally, if the court prohibits the batterer from contacting the victim, the family systems approach will violate the court order. For these reasons, couples counseling is expressly prohibited in 20 State standards and guidelines (see box, "Controversial Approaches to Batterer Intervention" and appendix A.3). Judges involved with partner abuse cases that also involve child abuse need to pay particular attention to safety issues raised by family systems interventions, which may be the treatment approach recommended by child welfare workers who are working toward a goal of family reunification. In such cases, issues of victim and child safety must be weighed carefully, and if a family systems approach is chosen, close monitoring is needed. Psychological Approaches: A Focus on Individual Problems Psychological perspectives hold that personality disorders or early experiences of trauma predispose some individuals to violence.[18] Being physically abusive is seen as a symptom of an underlying emotional problem.[19] Parental abuse, rejection, and failure to meet a child's dependence needs can be the psychological source of battering. People with these underlying problems may choose partners with whom they can reenact the dysfunctional relationship they had with their parents. Two forms of batterer intervention have evolved from this perspective: individual and group psychodynamic therapy and cognitive-behavioral group therapy. Individual and Group Psychodynamic Counseling Psychoanalysis can be undertaken not only in individual counseling but also in unstructured batterer groups that allow members to explore their life experiences. Psychodynamic therapies involve uncovering the batterer's unconscious problem and resolving it consciously. Proponents of psychodynamic therapy for batterers believe that other interventions are superficial: since other therapies are unable to eliminate the abuser's deep-rooted and unconscious motive for aggression, they cannot end violence but only suppress it temporarily. Long-term change requires exposing and resolving the root cause of the violent behavior. Advantages and Criticisms of Psychodynamic Approaches Browne and Saunders recently conducted a study comparing a "process psychodynamic treatment model" with a feminist/cognitive-behavioral intervention and found no difference in recidivism rates based on partners' reports. Nevertheless, they argue: [T]here were two advantages to the process- psychodynamic model. It retained a significantly higher percentage of men in treatment and it was more successful with men who had dependent personality disorders. Regardless of the treatment approach used, more self-disclosure and less lecturing were related to greater group cohesion, which in turn was related to lower recidivism rates.[20] Critics argue that psychodynamic therapy merely assigns a psychiatric label to people who batter (e.g., insecure, narcissistic, dependent, compulsive, or suffering from intermittent explosive disorder) without explaining how they got that way or what can be done about it.[21] The psychodynamic approach has also been criticized for allowing batterers to continue the behavior until the underlying psychological problem is resolved.[22] David Adams, director of EMERGE, gives the example of a batterer mandated to treatment who had already learned in individual psychotherapy that he battered because he was insecure. At the intake interview for the batterer program, the counselor asked the man whether he was going to continue to choose to be violent until he resolved his insecurity. The man said that he had never thought of battering as a choice, but now he would reconsider the notion.[23] Feminists argue that labeling batterers as having psychological problems not only exonerates them in their own eyes but also ignores the cultural acceptability of male dominance in the family and how it serves to keep the batterer in control of his partner. The approach pays attention to internal psychological functions of abuse for the batterer but ignores the interpersonal function of controlling the other person's behavior. In practice, many psychologically oriented programs have moved away from the original stance that battering is caused primarily by psychological disorder and always indicates an emotional problem. Instead, they have integrated social explanations with psychological explanations. For example, some psychologically oriented theorists propose that it is the combination of a man's low self-esteem and a cultural expectation that men should be dominant and successful that produces a batterer. Cognitive-Behavioral Model of Change Cognitive-behavioral therapy is used in the treatment of violent offenders. Whereas the psychoanalytic tradition focuses on psychological disorders based in the unconscious and early childhood experiences, the cognitive-behavioral model focuses on conscious material in the present: therapy is intended to help individuals function better by modifying how they think and behave in current situations. The theory behind cognitive-behavioral batterer interventions maintains that behaviors are learned as a result of positive and negative reinforcements (rewards and punishments) for engaging in particular behaviors under particular circumstances (e.g., parental pride or praise for aggressive behavior). Behavior is also influenced by how people mentally construct and interpret their environment and experiences -- that is, the way they think about themselves,other people, and their relationships. The cognitive-behavioral theory postulates that men batter because: o they are imitating examples of abuse they have witnessed during childhood or in the media; o abuse is rewarded; o it enables the batterer to get what he wants; and o abuse is reinforced through victim compliance and submission. Cognitive-behavioral interventions focus on "cognitive restructuring" and skill building. Counselors focus on identifying the chain of events that lead each batterer to violence, starting with beliefs and "self-talk" -- the way we talk to ourselves in our minds (see exhibit 2- 2, "A Cognitive Model of Woman Abuse"). For example, a batterer whose partner is ten minutes late may tell himself, "She's out with her boyfriend" or "She can't be trusted." The programs attempt to restructure the beliefs and "self-talk" that lead to violence; for example, "I don't know why she's late, but I'm sure she's trying to get here." The programs help batterers to analyze the thought patterns underlying violent reactions (e.g., "Dinner isn't ready because my wife doesn't respect me") and learn new ways of understanding situations that trigger violence (e.g., "Dinner isn't ready because my wife had a busy day"). The program teaches nonviolent alternative behaviors, such as conflict-resolution tactics, relaxation techniques, and communication skills.[24] Advantages and Criticism of the Cognitive- Behavioral Models One advantage of the cognitive-behavioral model is that its analysis of battering and its intervention strategy are compatible with a criminal justice response to domestic violence. The approach holds the batterer fully responsible for his violence and fully responsible for learning and adopting nonviolent alternatives. Without trying to solve larger issues of social inequality on the one hand, or delving into deep- seated psychological issues on the other, the cognitive-behavioral approach simply focuses on the violent acts themselves and attempts to change them. The model also offers a straightforward intervention that can be implemented in a limited period of time. The feminist perspective criticizes the cognitive- behavioral approach for failing to explain why many men with thought patterns or skills deficits that allegedly explain their domestic violence are not violent in other relationships, how culture or subcultures influence patterns of violence, and why some men continue to abuse women even when the behavior is not rewarded.[33] These criticisms are usually moot because most cognitive-behavioral programs integrate the feminist analysis of domestic violence, both in the cognitive component (for example, by examining thoughts that encourage wife-beating, such as "She should obey me. I'm the man of the household.") and the social learning aspects (for example, by discussing how sexism in the media and in society provides models of social support for abusing and degrading women). (See exhibit 2-3, "Example of an Integrated Feminist/Cognitive-Behavioral Strategy.") Compatibility of the Models With Criminal Justice Goals The feminist educational approach to batterer intervention is theoretically more compatible with a criminal justice perspective than either the family systems or psychotherapeutic approaches in several respects.[34] o The feminist educational view of domestic violence is that the behavior is criminal, not just the result of faulty couple interactions or mental illness. o The feminist educational view is that consequences are appropriate. By contrast, the psychotherapeutic explanation results in a treatment approach that is designed to modify the inner emotional life of the batterer through insight and possibly medication. Changing the inner person and prescribing medication to alter behavior may be considered by some to be beyond the scope of a criminal justice intervention. o The primary goal of feminist educational programs is to hold batterers responsible for their violence. While most psychological programs also make this claim, feminists believe that the psychotherapeutic view of batterers as victims of childhood trauma or other mistreatment undercuts a program's ability to hold batterers responsible. The family systems approach -- unlike the criminal justice system -- holds the victim as well as the batterer accountable. o The explicit goal of feminist educational approaches is to end the abusive behavior rather than to heal the batterer (the psychotherapeutic goal) or to improve relationships (the family systems goal). A case can be made, however, that psychological interventions can also meet the needs of the criminal justice system. The aim of the criminal justice system in sending men to batterer programs is to reduce recidivism; for this to happen, the intervention has to be effective. While advocates of the feminist educational model criticize the psychotherapeutic model for failing to hold batterers responsible for their behavior, advocates of the psychotherapeutic approach respond that educational interventions are not successful in deterring or rehabilitating batterers because they are too short and superficial and do not address the needs of batterers with severe mental illness, who may comprise up to 25 percent of all batterers.[35] Indeed, the "confrontational" and didactic process of the feminist model -- as well as the feminist rhetoric in which it is framed -- may alienate the batterer and increase his hostility and resistance. For example, an assistant group facilitator for the Compassion Workshop in Silver Spring, Maryland, reported that, when he was in treatment, feminist interventions had only increased his anger and denial, while subsequent, nonconfrontational, compassion-based treatment had helped him become nonviolent. His wife, a cofacilitator of the group whose role was to give the perspective of the victim, agreed that the feminist education model had exacerbated her husband's abuse but that after psychologically oriented counseling, he was now violence free. While the narrow treatment goals of the strictly educational feminist programs are compatible with the criminal justice view -- simply stopping the abusive behavior as expeditiously as possible and holding the batterer responsible -- the feminist theory of domestic violence also has broad social goals that may be seen as going beyond the purview of the criminal justice system. Because feminist theory locates the cause of domestic violence in social structures and the organization of society, social change may be seen as the ultimate goal of the curriculums. In a sense, though, even this broad goal is consistent with a criminal justice agenda in that it suggests that broad-based community education and a coordinated community response are necessary for preventing domestic violence. In contrast, it is difficult to identify a broad prevention strategy that follows from either the individualistic psychotherapeutic theory of domestic violence or the family systems model. Finally, some practitioners and criminal justice professionals are beginning to regard any form of batterer intervention as a proxy for intensive probation. While the curriculum may not deter reoffenses over time, at least during program participation batterers are being monitored closely, and their victims are receiving at least minimal attention and referrals. This heightened vigilance with regard to the batterer's behavior and the victim's welfare is compatible with criminal justice goals. As will be seen in the following chapters, however, theoretical compatibility with the criminal justice system is not the only important factor in selecting a batterer intervention. On a practical level, interventions must be able to retain batterers in treatment and address any obstacles to program participation. Conclusion: Multidimensional Models Dominate the Field Many practitioners accept that there are compelling features in more than one theoretical model. In practice, regardless of their primary perspective, most programs have adopted some tenets of the feminist model. For example, they view sexual inequality and masculine role expectations of dominance as core issues to address -- along with cognitive-behavioral techniques for modifying behavior -- and they teach batterers to use "time-outs" (a behavioral technique for controlling emotional outbursts). Longer-term programs may progress through the feminist and cognitive models in stages, and some even progress to a psychotherapeutic group process model for aftercare. These programs have a brief initial phase using a feminist educational model to tackle denial of responsibility, a longer second phase teaching cognitive-behavioral techniques for skill-building, and a third phase delving into individual psychological issues in an unstructured format for those men identified as having psychological problems contributing to battering. (See chapter 3, "Pioneers in Batterer Intervention: Program Models," for a detailed description of various program models.) Other programs blend treatment modalities and approaches by combining individual, group, and couples treatment sequentially over an extended period of two to three years. Programs may also use different models or materials to accommodate the special needs of specific types of batterers, most commonly substance abusers, African Americans, Asians, Latinos, recent immigrants, female offenders, gay and lesbian batterers, or batterers with poor literacy skills. (See chapter 4, "Current Trends in Batterer Intervention," for a discussion of culturally specific interventions.) Some practitioners may resist incorporating consideration of individual psychology and cultural differences in interventions because they are concerned that the individual approach will eclipse consideration of the sociological factors emphasized by the prevailing feminist model. However, the critical issue from a criminal justice perspective is simply "what works"; if mixed-model interventions that incorporate psychotherapeutic elements or cultural competence are shown to be more effective in retaining and engaging batterers in treatment, questions of theory are likely to become secondary. Discussions such as these are rapidly being translated into experiments in practice. Chapter 4, "Current Trends in Batterer Intervention," discusses a range of innovations in batterer treatment that attempt to link individual characteristics of batterers to specific interventions or combinations of interventions in order to increase program retention and effectiveness. Endnotes 1. Rosenbaum, A. and R.D. Maiuro, "Eclectic Approaches in Working With Men Who Batter," in Treating Men Who Batter: Theory, Practice, and Programs, ed. P.L. Caesar and K.L. Hamberger, New York: Springer, 1989: 65-195. 2. Mary Russell, for example, justifies her use of the expression "wife assault" on the grounds that "domestic violence" and "family violence" ignore the "male to female direction" of most violence between partners. See Russell, M., "Wife Assault Theory, Research, and Treatment: A Literature Review," Journal of Family Violence, 3 (3) (1988): 193-208. 3. Schechter, S., Women and Male Violence: The Visions and Struggles of the Battered Women's Movement, Boston: South End Press, 1982. 4. Pence, E. and M. Paymar, Education Groups for Men Who Batter: The Duluth Model, New York: Springer, 1993. 5. In support of the point that women may remain with men who abuse them because of economic dependence, Ida Johnson found in a study of 426 battered women leaving a Central Florida battered women's shelter that a woman was more likely to return home if the batterer had a high income and the woman was unemployed; if she had an independent income and his income was insufficient to support a family, the woman was unlikely to return home. Johnson, I. M., "Economic, Situational, and Psychological Correlates of the Decision-making Process of Battered Women," Families in Society: The Journal of Contemporary Human Services, (March 1992): 168-176. 6. There is disagreement over whether batterers actually believe that women are incompetent or whether promoting that notion merely serves their needs to control their wives in order to restrict their activities. Rusbult and Martz, in a study of women leaving a domestic violence shelter in Lexington, Kentucky, found that the strongest predictor of whether women would return to the batterer was whether they had a driver's license and access to a car. Rusbult, C.E. and J. M. Martz, "Remaining in an Abusive Relationship: An Investment Model Analysis of Nonvoluntary Dependence," Personality and Social Psychology Bulletin, 21 (1995): 558-571. 7. O'Sullivan, C. and B. Birns, Contested Custody Cases When Violent Marriages End, Paper presented at the First National Conference on Children Exposed to Family Violence, Austin, Texas, June 1996. 8. Browne, K., D.G. Saunders, and K.M. Staecker, "Process-Psychodynamic Groups for Men Who Batter: Description of a Brief Treatment Model," University of Michigan, January 26, 1996. 9. Gondolf, E. W. and J. Hanneken, "The Gender Warrior: Reformed Batterers on Abuse, Treatment, and Change," Journal of Family Violence, 2 (2) (1987): 177-191. 10. Gondolf and Hanneken, "The Gender Warrior." The measure is Bem's Sex Role Inventory. 11. Browne, Saunders, and Staecker, "Process- Psychodynamic Groups for Men Who Batter." 12. Dutton, D., "Patriarchy and Wife Assault: The Ecological Fallacy," Violence and Victims, 9 (2) (1994): 167-182. 13. Harrell, A., "Evaluation of Court Ordered Treatment for Domestic Violence Offenders," Final Report, Washington, DC: The Urban Institute, 1991. 14. A 1990 evaluation of the Duluth Domestic Abuse Intervention Project (DAIP) found that program participation had no impact on recidivism. She, M., "Predicting Batterer Recidivism Five Years After Community Intervention," Report, Duluth, Minnesota, 1990. 15. Giles-Sims, J., Wife-battering: A Systems Theory Approach, New York: Guilford, 1983. 16. While it is true that many victims who seek services want to maintain the relationship while eliminating the abuse, and that most programs report that 30 to 40 percent of the men in treatment are separated, no long-term data show what percent of relationships in which there has been battery last. See Sirles, E.A., S. Lipchik, and K. Kowalski, "A Consumer's Perspective on Domestic Violence Interventions," Journal of Family Violence, 8 (3) (1993): 267. 17. Bowker, L., Ending the Violence: A Guidebook Based on the Experience of 1,000 Battered Wives, Holmes Beach, FL: Learning Publications, 1986. 18. Russell, "Wife Assault Theory." 19. Specific disorders that have been found in batterers are post-traumatic stress disorder (probably due to childhood trauma), depression, low self-esteem, and personality disorders. Personality disorders usually mentioned by therapists who work with batterers are antisocial personality disorder, narcissism, and borderline personality disorder. In addition, passive- aggression, paranoia, obsessive-compulsive disorder, and intermittent explosive disorder have been said to foster aggression. A psychotherapeutic reference describes the personality disorders as follows: People with antisocial personality disorder are irresponsible, irritable, and aggressive; they are not sadistic but are reckless and have no remorse; they are unable to maintain friendships or romantic relationships. Narcissists are hypersensitive but lack empathy; they have difficulty with relationships because they expect others to meet their special needs. Borderline personalities are characterized by instability of identity, self- image, and relationships; they want to be alone but fear abandonment; they are often moody and depressed and, in severe cases, self-destructive and suicidal. Reid, W.H. and M.G. Weise, The DSM- III-R Training Guide, New York: Brunner/Mazel, 1989. See also Dutton, D., "Trauma Symptoms and PTSD-like Profiles in Perpetrators of Intimate Abuse," Journal of Traumatic Stress, 8 (2)(1995): 299-316; and Maiuro, R., T.S. Cahn, P.P. Vitaliano, B.C. Wagner, and J.B. Zegree, "Anger, Hostility, and Depression in Domestically Violent Versus Generally Assaultive and Nonviolent Control Subjects," Journal of Consulting and Clinical Psychology, 56 (1) (1988): 17-23. 20. Browne, Saunders, and Straecker, "Process- Psychodynamic Groups for Men Who Batter." 21. See Dutton, "Patriarchy and Wife Assault." 22. Adams, D., "Treatment Models for Men Who Batter: A Profeminist Analysis," in Feminist Perspectives on Wife Abuse, ed. K. Yllo and M. Bograd, Newbury Park, CA: Sage Publications, 1988: 176-199. 23. Adams, "Treatment Models for Men Who Batter," 176-177. 24. Hamberger, K.L. and J. E. Hastings, "Recidivism Following Spouse Abuse Abatement Counseling: Treatment Program Implications," Violence and Victims, 5 (3) (1990): 160. 25. Information provided by Roland Mauiro. 26. Hamberger, K.L. and J. E. Hastings, "Court- Mandated Treatment of Men Who Assault Their Partner: Issues, Controversies, and Outcomes," in Legal Responses to Wife Assault, ed. Z. Hilton, Newbury Park, CA: Sage Publications, 1993: 188- 229. 27. Tolman, R. M. and D. G. Saunders, "The Case for the Cautious Use of Anger Control With Men Who Batter," Response, 11 (2) (1988): 15-20. 28. Tolman and Saunders articulate this concern, while accepting anger management as part of a cognitive-behavioral intervention: "The use of anger control techniques with batterers is problematic when battering is framed exclusively as an anger problem, when the issues of dominance and control of women by men are ignored in treatment, and when practitioners fail to address societal reinforcements for battering." Tolman and Saunders, "The Case for the Cautious Use of Anger Control With Men Who Batter," 19. See also Ptacek, J., "The Clinical Literature on Men Who Batter, A Review and Critiques," in Family Abuse and Its Consequences: New Directions in Research, ed. B.T. Hotaling, D. Finkelhor, J.T. Kirkpatrick, and M.A. Straus, Newbury Park, CA: Sage Publications, 1986: 149-162. 29. Dutton, D., The Domestic Assault of Women: Psychological and Criminal Justice Perspectives (revised), Vancouver: University of British Columbia, 1995. 30. Two studies showing a recurrence of violence among program participants who said they used anger management to reduce their violence are: Gondolf, E., "Men Who Batter: How They Stop Their Abuse," Paper presented at the Second National Conference for Family Violence Researchers, Durham, NC, 1984; and Kelso, D. and L. Personette, Domestic Violence and Treatment Services for Victims and Abusers, Anchorage: Altam, 1985. 31. Daniel O'Leary's studies comparing single-sex group and couples-group interventions were unable to retain couples when the batterer had a history of severe violence. Rosenbaum, A. and K. D. O'Leary, "The Treatment of Marital Violence," in Clinical Handbook of Marital Therapy, ed. N.S. Jacobsen and A.S. Gurman, New York: Guilford, 1986. Gondolf studied 12 men who had been through a men's group program and were deemed to be fully reformed (versus 38 who were not). Several of these highly motivated men had sought professional help before coming to the batterer program but they had found no improvement after individual or couples therapy. According to their self-reports, the batterer group they subsequently attended gave them what they needed to stop battering. Gondolf and Hanneken, "The Gender Warrior." 32. Edelson, J. L. and M. Syers, "Relative Effectiveness of Group Treatments for Men Who Batter," Social Work Research and Abstracts, (June 1990): 10-17. 33. According to social learning theory, a retaliatory attack should decrease future abuse. However, two national surveys found that when women resist violently, the batterer's violence usually increases in severity. This result is consistent with the feminist view that the intent of physical abuse is to punish resistance and disobedience. Bowker, L., Ending the Violence: A Guidebook Based on the Experience of 1,000 Battered Wives, Holmes Beach, FL: Learning Publications, 1986; Feld, S. L. and M.A. Straus, "Escalation and Desistance From Wife Assault in Marriage," in Physical Violence in American Families, ed. M.A. Straus, and R.J. Gelles, New Brunswick, NJ: Transaction, 1990: 489-505. 34. Edelson and Syers, "Relative Effectiveness of Group Treatments for Men Who Batter." This article reports an experiment in which all comers to a program were assigned to a brief or intense intervention and to one of three models: the Duluth "educational" model, a self-help group, and a combined group process-educational model. The results showed no difference between the brief and intense programs, except for the few men of color who were less likely to recidivate if they completed the long program; the structured feminist educational model was found to be most effective. 35. Gondolf, E., "Multi-Site Evaluation of Batterer Intervention Systems: A Summary of Preliminary Findings," Working Paper, Mid-Atlantic Addiction Training Institute, October 24, 1996. -------------------------------- Key Points o Most interventions employ a mixture of theories in their curriculums, the most common of which is a psychoeducational model that encourages profeminist attitude change while building interpersonal skills using cognitive-behavioral techniques. o Three categories of theories of domestic violence dominate the field. Each locates the cause of domestic violence differently, and each theory leads practitioners to employ different approaches to batterer intervention: -- Society and Culture. Social and cultural theories attribute the problem to social structure and cultural norms and values that endorse or tolerate the use of violence by men against women partners. The feminist model of intervention educates men concerning the impact of these social and cultural norms and attempts to resocialize them emphasizing nonviolence and equality in relationships. -- The Family. Family-based theories of domestic violence focus on the structure of the family, interpersonal interactions within the family, and the social isolation of families. The family systems model of intervention focuses on developing healthy communication skills with a goal of family preservation and may use couples therapy, a treatment approach prohibited by 20 State standards and -- guidelines regulating batterer intervention (to protect the safety of the victim). -- The Individual. Psychological theories attribute domestic violence to personality disorders, the batterer's social environment during childhood, biological disposition, or attachment disorders. Psychotherapeutic interventions target individual problems and/or build cognitive skills to help the batterer control violent behaviors. o Both feminist educational and cognitive- behavioral interventions can be compatible with the goals of the criminal justice system -- protecting the victim as well as rehabilitating the offender. However, feminist educational programs offer some advantages. By contrast, family systems interventions conflict with criminal justice goals by failing to identify a victim and a perpetrator, an identification the law requires. -------------------------------- The Language of Batterer Intervention The shift in providers of help to batterers and their partners from psychotherapists to feminist social activists to professional mental health providers has created tensions in the field that are exhibited in the language of batterer interventions. Criminal justice professionals need to be aware of the connotations of various terms so that they can communicate effectively with service providers. For example, the term "domestic violence" itself has a gender-neutral connotation. A number of feminists, seeing a link with other violence against women and noting the severity of injuries inflicted on women by male partners, prefer such terms as "wife abuse" and "woman abuse."2 Programs based on feminist theories of battering are often described as "profeminist," indicating male support for feminist goals. Mental health professionals may talk about "counselors" or "therapists" providing "treatment" to "clients," while profeminist "facilitators" or "teachers" provide an "intervention" to "batterers" using a didactic format described as "classes." Feminist- based programs object especially to the word "treatment" and may not consider rehabilitation the program's primary goal, as Red Crowley of Atlanta's Men Stopping Violence program explains: Let's start with the word treatment. We do not see our work as therapy. Battering is the natural outgrowth of patriarchal values. We want to change those values. Batterers' intervention classes serve a number of purposes: they, like shelters, make visible what has been systematically concealed, that is, the horrendous problem of violence against women; create an opportunity to engage the community and the criminal justice system in the effort to stop the violence; and contribute to research. Giving men who want to change the opportunity to do so is just one purpose of the intervention. The three most widely used intervention approaches -- "educational" or "psychoeducational classes," "couples therapy," and "group process" -- are each associated with a theory of the cause of domestic violence. Thus, "educational programs" are most often based on feminist theory; "couples therapy" may suggest a link with family systems theory; and "group process" programs base their work on either psychodynamic or cognitive behavioral theories. Some practitioners -- especially those with eclectic programming -- may use terms interchangeably; others harbor strong objections to mislabeling their approach and consider some terms to have great symbolic meaning. Criminal justice professionals need to be sensitive to the language used by intervention providers and to ask practitioners to explain the importance of unfamiliar terminology. -------------------------------- Attachment Abuse A small number of practitioners base batterer interventions on psychological theories of attachment, affect, and individuation. These interventions consider battering to be "attachment abuse" -- that is, abusive behaviors toward intimates arising from the individual's insecure attachment to his or her caregivers as a child. Attachment theory describes two broad categories of attachment relationships: secure attachments that result from the caregiver's responsiveness to the child's emotional and physical needs, and a range of insecure attachment patterns that may develop if a child's emotional and physical needs are not met by caregivers. Insecure attachments in childhood may lead, in adult relationships, to emotional distress, anxiety, anger, depression, and emotional detachment when the specter of loss or separation arises in an intimate relationship. These feelings may lead to attachment abuse. Batterer interventions based on theories of attachment, such as the Compassion Workshop (see chapter 4), seek to enhance the batterers' ability to regulate their own emotions and to stimulate a sense of "compassion" for both themselves and their intimates (partners, children, and elders) using cognitive behavior techniques that are designed to interrupt the batterers' violent emotional response to guilt, shame, and fear of abandonment. -------------------------------- Controversial Approaches to Batterer Intervention The following approaches, although commonly used, are controversial. Criminal justice professionals referring batterers to programs that feature these techniques must be careful to learn how these approaches are being integrated into the programs and be wary of programs using these methods as their primary intervention. Anger Management While some researchers have suggested that a small percentage of battering may be attributable to a psychological disorder involving uncontrollable rage,[25] the "anger management" model attributes battering to out-of-control (rather than uncontrollable) anger. Anger management programs offer a short-term intervention that teaches batterers to recognize the physiological signs of anger and to then implement relaxation techniques to defuse the anger.[26] The intervention may also teach stress management and communication skills.[27] Many batterer treatment providers disavow the single-focus "anger management" treatment, instead incorporating anger management as one component of their intervention, sometimes under another name. Critics have raised several concerns about the anger management approach -- even as a component of more comprehensive treatment: o Anger management programs address a single cause of battering, ignoring other, perhaps -- more profound, causes.[28] o According to the feminist model, although they may claim to feel out of control, batterers -- are not out of control: battering is a decision, a choice. The social learning model adds that -- batterers choose to use or threaten violence because of its effectiveness in controlling their -- partners. The violence persists because it is rewarded. o Anger management programs teach batterers nonviolent ways to control their partners. If -- the underlying issue of batterer control of the victim is not addressed, critics maintain, men-- will misuse the techniques used to "control" anger -- stress management and communication skills -- to continue to control the victim. For example, a batterer could refuse his -- childcare responsibilities on the grounds that it is stressful. o According to "misattribution of arousal" theory, men learn to label all strong emotional states -- as anger when they are, in fact, experiencing feelings of betrayal or hurt. o Interventions therefore need to focus on identifying the underlying emotion men are feeling -- in situations in which they batter rather than on means of controlling the mislabeled anger.[29] o Two studies of anger management interventions that were parts of comprehensive batterer treatment programs found that men who completed the programs but whose violence continued reported that they had used anger management techniques to attempt to control their violence, whereas men who were successful in avoiding violence after the program said they ended their abuse through empathy, a redefinition of manhood, and cooperative decisionmaking.[30] Finally, some practitioners are concerned that any short-term, single-focus approach can be dangerous because it gives victims, judges, and batterers the illusion that the problem has been solved. Some practitioners feel that the availability of brief, inexpensive anger management programs even undermines the credibility of the more difficult, lengthy, and expensive treatments other programs provide. One-time "Saturday Afternoon Special"- style anger management programs arouse particular concern among practitioners who feel that such short-term programs trivialize the severity of the problem in the eyes of the batterer and are unlikely to have any deterrent effect. Individual and Couples Counseling Many practitioners disapprove of -- and at least 20 State standards and guidelines expressly prohibit -- couples counseling for batterers. In addition, a number of program directors disapprove of individual counseling as the sole intervention for battering. Group work is considered important in helping abusers to overcome their denial by hearing other men acknowledge and deal with their behavior, and to break the isolation that is considered part of the syndrome of abuse. Although systematic research comparing couples and group interventions has not been conducted,[31] anecdotal evidence and the beliefs of providers (many of whom serve on committees to draft or approve State standards or guidelines) have limited the utilization of couples therapy for domestic violence. The practitioners' disapproval is based on a belief that victims of abuse are intimidated and cannot fully participate in therapy in the presence of their abusers. If victims do reveal the batterer's violence or disclose other problems, they face the threat of reprisal. Restrictions on couples therapy and individual psychotherapy for battering are a point of contention between feminist-oriented batterer intervention providers and mental health providers in many communities. Self-Help Groups: Batterers Anonymous Self-help batterer groups are modeled on Alcoholics Anonymous and Parents Anonymous. Member-run support groups are facilitated by former batterers who have been nonviolent for at least a year.[32] Although there are some ground rules and facilitators may introduce specific topics, the approach is unstructured, with members setting the agenda, usually addressing their personal concerns. Self-help or support groups are an accepted model of follow-up for batterers who have completed a program and want continued support to prevent relapse, to continue the change process, or to have a place to address ongoing problems. Self- help groups are controversial as an initial intervention, however, because it is questionable whether former batterers -- especially those who have been nonviolent for only a year -- are qualified to conduct groups, unless they have been extensively involved with a program, have been trained, and are supervised. In addition, facilitators tend to use an aggressive, even belligerent, style of confrontation that more traditional programs view as inappropriate modeling of antagonistic behavior that borders on abuse. By contrast, other professionals are concerned that support groups run by former batterers may be insufficiently confrontational about members' excuses for violence and too supportive of batterers' hostility toward women. -------------------------------- Chapter 3: Pioneers in Batterer Intervention: Program Models This chapter provides an overview of program services and procedures in five communities visited for this report. The chapter's primary focus is on larger mainstream batterer interventions. The following chapter, "Current Trends in Batterer Intervention," discusses smaller specialized interventions in detail (see box, "Selection of Programs Studied," and appendix B, a listing of individuals interviewed at each site). No mainstream program approach or curriculum has yet been proven to be more effective in reducing recidivism than any other.[1] As a result, many program directors and criminal justice professionals stress structure over content; they believe that regardless of a program's philosophy or methods, any responsible intervention that requires weekly contact can help contain batterers' abuse through close monitoring of their behavior (see chapter 5, "Criminal Justice Response").[2] According to Andrew Klein, chief probation officer for the Quincy, Massachusetts, District Court, "If only appropriate clients are referred -- people who know they did wrong, have some motivation to change, are under external pressure to change, and are sober -- if the program monitors behavior, not attitude, and if the program lasts long enough, then the content doesn't matter. . . . To be considered effective, the program must stop the battering and keep offenders from battering again for at least one year." Program Procedures The following discussion draws on program practices at the five sites with special emphasis on issues of common concern. Intake and Assessment The batterer's first contact with the program occurs when he arranges for an intake interview. At this time, the client signs release forms that give the program permission to contact his probation officer and his partner. The program then notifies the probation office that the client has chosen it for treatment. (See appendix D for sample intake and assessment forms.) The first step of the intervention is the intake assessment, a process that can span one to eight weekly sessions.[3] The initial session may be done as an individual interview or as part of a group orientation. Intake sessions serve several purposes: o to get the client to agree with the terms and conditions of treatment and to sign the program contract; o to begin to assess the nature and extent of the -- batterer's abusive behavior; and o to screen for other problems such as substance - - abuse, mental illness, and illiteracy. In addition to specific questions about domestic violence, the assessment typically includes questions about the batterer's family history, propensity for violence outside the family, and substance abuse. Ideally, the session begins to foster rapport between the clinician and the batterer, in addition to initiating the actual intervention. For example, details about the nature of the abuse are often gleaned through questions regarding the first, the most recent, and the most severe battering incidents. Describing this behavior in detail can increase the batterer's awareness of the extent of his violence, and this can form a foundation for later, more in-depth discussions of the abuse and its consequences. Similarly, programs usually ask about a range of behaviors that are psychologically or sexually abusive. This questioning helps the batterer broaden his definition of abuse. Programs vary in how clinical their assessments are and to what extent they measure the batterer's psychological makeup in an effort to identify other problems that could interfere with the intervention. Some programs screen for possible problems by using simple checklists and then referring the client for formal psychological evaluation if a substance abuse or mental health problem is suspected. Other programs, such as AMEND and The Third Path, use standardized instruments like the Millon Clinical Multiaxial Inventory (MCMI) to do clinical assessments themselves. The director of one of the AMEND programs4 explains, "We use the MCMI both as a diagnostic tool and a treatment planning tool, and to start thinking about the majority of our clients who have personality disturbances as falling along a continuum from mild personality dysfunction to more pronounced conditions." Programs may refer batterers who are found to have other psychological problems, like clinical depression, elsewhere for psychiatric treatment or individual counseling. However, referrals are not considered a substitute for the batterer intervention program. Rather, psychotherapy is delivered concurrently with the batterer intervention, as is also typically the case when substance abuse is the problem. Programs try not to screen out batterers with multiple problems as long as they comply with the concurrent treatment. For example, batterers who are clinically depressed may continue in the program as long as they take their psychiat