Batterers: education verses therapy

I’ve just come to terms with some trouble that’s been on my mind for years, thanks to this blog post I found at random. To make a long story short, I do para-professional counseling when I’m in good mental health and for a time I was working on intervention with batterers.

I dropped out, and I just learned why.

When it comes to method I am a big believer in Carl Rogers, and try to practice his theory in social life generally (hands-off, let it unfold, don’t push the river) and I want others to do this to me, in my perfect world we’d all be in awe of the Other and any interventions would be non-directive with the facilitator as witness who shows the person healing hirself. There is a lot to be said for being a mirror.

But it didn’t work when helping treat men who batter, because *treatment* was not elucidated at the agency I worked at so I quit that job because I had qualms about what I was doing and no one on the treatment team identified my confusion, including me. That was 12 years ago, and finally, I got some insight, from A Clinician’s Journal who is asked why he is advocating any therapy-based techniques at all and if treatment shouldn’t be strictly education. Bingo.

To wit:

There are two points I think we need to keep in mind:

One is to make sure that we understand why we are making the distinction between therapy and education in working with men who batter. If we clearly identify why we focus on education rather than therapy it will help guide us in understanding when and why we bring in elements from the therapeutic realm. I believe that a main reason for this distinction is that philosophically, to say we are doing therapy with domestic batterers runs counter to the principles which founded this work. If you look at the history, batterer’s intervention was born out of a hope to further provide safety to victims. Any healing (a word that may be associated with therapy) on the part of the perpetrator is secondary, if considered a goal at all. Perhaps a goal that many people are more comfortable with is change (cognitive and behavioral) rather than healing.

Some other reasons to lean away from calling this work therapy:

* It might suggest mutual responsibility for the violence between perpetrator and victim.

* Some therapy models might recommend rage-expression or anger management, approaches which may increase risk of violence or fundamentally misunderstand the beliefs that support domestic violence.

* Other therapy models might see the violence as poor impulse control, rather than as an exertion of control over one’s partner.

* If a man becomes violent again, a therapy-based approach might see this as “relapse” behavior, which suggests his “affliction” got the best of him rather than seeing the behavior as a calculated choice on his part.

Understanding these basic principles, I think it is possible, if not necessary to bring in techniques from the realm of therapy without softening on these principles…. Perhaps where we borrow most from the therapy world is in cognitive-behavioral techniques, which focus on confronting thoughts and expecting behavior change. But again, I think we are borrowing techniques more than embracing theories.

My second point may be an extension of the first, and it relates directly to the phrase “meeting the client where he is at”.

I think (my beliefs, here!) that there is a key difference in what we traditionally mean by this in therapy and what the Motivational Interviewing model suggests. The Rogerian concept of self-actualization, or self-efficacy, which guides many therapists, really takes this idea of “meeting the client where they are at” seriously. It’s a belief that the client will take you where they need to go. It’s also a belief that the client has what they need to achieve self-actualization and the key role of the helping professional is to affirm and accurately empathize.

Motivational Interviewing is not exactly the same. If any thing, it’s like Carl Rogers with a hidden motive. Here’s a quote from the original MI book by Rollnick and Miller:

“…Motivational interviewing differs from the method described by Rogers as it is consciously directive. The terms “client-centered” and “non-directive” are sometimes used interchangeably, but they refer to different aspects of counseling style. Motivational interviewing is intentionally addressed to the resolution of ambivalence, often in a particular direction of change. The interviewer elicits and selectively reinforces change talk and then responds to resistance in a way that is intended to diminish it.”

I think that if motivational interviewing can help a facilitator effect behavioral change in a batterer’s group participant, then it’s worth looking at. I am constantly using MI skills in batterer’s groups to elicit change-talk from the men with the goal of helping them move in a direction that I am very intentionally hoping they move toward.

So, they’re using this MI stuff on abusers along with my arch-enemy CBT, and this is better for batterers than the Rogerian style. I get that, I do, and had to do a post on it. Every crack in my dogma is a cause for celebration.

But shit. The question he was asked, “why do any therapy at all” he answered by describing the therapy they’re using with batterers as CBT.

This is why I don’t consider CBT “therapy” by a long shot, and resent that it is the only “therapy” available for the poor, who like batterers, are considered in need of psychological “correction”, but this is the subject of another post or fifty.