Beyond shame and blame: New approach needed for treating domestically violent men: CrossCurrents Winter 2003/04
CrossCurrents
Abigail Pugh
Most of us are aware of the pervasiveness of domestic violence through media reports, television documentaries or direct experience.
A 1999 study by Statistics Canada found that seven per cent of adults in Canada have experienced violence at the hands of
a live-in partner within the previous five years. And 88 per cent of reported victims were women.
But while mental health experts acknowledge the scale of physical, emotional and economic damage wreaked by domestic assault,
they disagree on its root causes and how to treat men who are domestically violent. But addressing these issues is crucial,
given the poor outcomes of existing treatment approaches.
Most U.S. and Canadian jurisdictions provide a mandated training program, lasting several weeks or months, as part of rehabilitation
for convicted male spouse-batterers. The most widespread treatment protocol for offenders is the Duluth model. Developed by
the Minnesota-based Duluth Domestic Abuse Intervention Project in 1981, the model takes a psychoeducational approach and seeks
to make violent men aware of gender inequity and power issues. Underpinning the program is the principle that domestic abuse
has social or political (as opposed to psychological or biological) roots, and that abusers can be trained to substitute non-controlling,
non-abusive behaviour for violence.
The 16-week program in Ontario seeks to "provide participants with an opportunity to examine the beliefs and attitudes that
they have used to justify their abusive behaviour and to learn non-abusive ways of resolving conflict," according to the Web
site of the Ministry of the Attorney General.
But such established treatments, focused on social contexts, have not met with much success. Re-offence rates among men who
batter their partners are high. Between 1989 and 1998, several major studies examining treatment outcomes of programs for
domestically violent men found no significant difference in recidivism rates between batterers who underwent treatment and
those who did not. A 2002 study by Dr. Edward Gondolf, published in the Journal of Family Violence, found that non-physical abuse decreases even less than physical abuse following treatment: almost half of those treated
are likely to continue to engage in verbal violence.
The reason for the failure of existing treatments to stop abuse, according to some critics, is because they focus on the wrong
issues.
Dr. Donald Dutton, a psychologist at the University of British Columbia, who was an expert witness for the prosecution at
the 1995 trial of O.J. Simpson, has written extensively on domestic violence and its causes. He rejects the tenets of the
Duluth model. "The problem is that the model is based on shaming," says Dutton. "How do you establish a connection with a
client when you're making him feel bad about being male?"
Dr. Lorne Korman, head of the Anger and Addiction Clinic at the Centre for Addiction and Mental Health in Toronto, agrees.
He feels that dysregulated emotions, including shame and fear, lead to the secondary emotions, such as anger and rage, which
are associated with domestic violence. He is particularly interested in the role played by substance abuse in domestic violence
situations and cites studies showing that alcohol plays a part in many battering cases. In the clinic, clients with anger
problems are admitted for treatment whether or not they abuse alcohol or other substances, in the belief that underlying problems
with emotional regulation and personality issues predispose many men to both violence and addiction problems. Most other programs
screen out men with addiction issues, which reduces the chance that help reaches those who most need it.
Dr. Daniel Sonkin, a California-based psychologist who specializes in treating domestically violent clients, says that in
his local jurisdiction, Duluth is the treatment of choice for domestically violent men, yet it doesn't seem to be working.
"I get men coming to me in private practice (after the program is over) because it hasn't helped," says Sonkin. "It's anti-intellectual,
it's not sophisticated and it doesn't lend itself to a complex analysis of the problem," he adds. "It's a very Euro-Christian
view of the world - about self-control, making choices and how it's all up to you."
Dutton's and Sonkin's objections to the Duluth model are based on their belief that underlying personality issues are a more
powerful cause of domestic violence than socially-based problems such as power imbalances between men and women. Dutton believes
that while psychoeducational work simply tries to substitute one set of beliefs for another, cognitive-behavioural and other
therapies work on a deeper level and have more impressive long-term results. Dutton attempts to address fearful attachment
styles, which he believes are predominant in domestically violent men. He hypothesizes that fearful attachment is closely
linked to borderline personality disorder, and that sufferers often experience large amounts of self-generated shame. The
so-called "shaming and blaming" style of Duluth practitioners may actually serve to reinforce their difficulties.
Sonkin takes a biopsychosocial approach, looking at biological issues as well as the social component advocated by practitioners
of the Duluth model and the emotional aspects suggested by Dutton. He cites research by psychologist Dr. Alan Rosenbaum at
the University of Massachusetts Medical Center, which found that 50 per cent of domestically violent men show signs of previous
head trauma, as opposed to 15 per cent of non-violent men. He also believes that high rates of post-traumatic stress disorder
(PTSD) exist among male batterers. Sonkin advocates the use of antidepressant and anti-anxiety drugs to address increase low
serotonin levels, an issue related to head injury and to violent behaviour. Newer antipsychotics may also help with extreme
paranoia or delusional thinking.
Many psychologists working in the field of domestic violence believe, along with Dutton, Sonkin and Korman, that the role
played by childhood experience, prior physical abuse, PTSD and resulting emotional dysregulation are key to understanding
why men batter women. They argue that with its emphasis on re-education, the Duluth method omits crucial elements of batterer
psychology. "We have to find better ways to protect victims, by effectively treating perpetrators rather than simply re-educating
them about power and control," says Korman.
In a 2000 article published in the Journal of Interpersonal Violence, psychologists Dr. Katreena L. Scott and Dr. David A. Wolfe hypothesized that improving communication and relationship skills
and addressing anger problems are more instrumental than re-educational approaches in the success of those few men who do
benefit from programs.
Dr. Ellen Pence, the psychologist who developed the Duluth model and who now works with Minnesota-based Praxis International,
an anti-violence research and training organization, feels that fear of punishment is also a major factor in success. Men
who are court-ordered to complete treatment are more likely to do so and thus receive some benefit than men who enter programs
on a less coerced basis. Sonkin, however, believes that men who are put into treatment by the courts may be at an earlier,
less motivated stage and thus may not be ready to adopt new behaviours.
But while some researchers and therapists may be questioning the efficacy of socially-based approaches such as the Duluth
model, and are calling for new treatment modalities, some experts believe that evaluating the Duluth model against other treatment
approaches can lead to misleading conclusions because programs for domestically violent men tend to fail regardless of whether
they take a psychoeducational or psychodynamic approach. "It may not just be the Duluth model but batterer intervention per
se that fails," says Scott, now at the Ontario Institute for Studies in Education in Toronto.
In a forthcoming article in the journal Trauma, Violence, and Abuse, Scott argues that conditions of entry to a program are key determinants of its success. Motivated men are less likely to
drop out of treatment and less likely to re-offend. She cites work by Gondolf that compared the Duluth model with longer-term
treatments and found little difference in success rates between them.
Despite the shortcomings of therapies that focus on social context, Dr. Donna Akman, a researcher and therapist at the Women's
Therapy Centre at CAMH, says that it is a mistake to suggest that therapy should focus solely on personality issues or emotion
regulation. "After all, many women also have problems with emotion regulation, but they are less likely than men to abuse
their partners. It is important to examine why there are these differences between men and women in how they deal with emotion
regulation difficulties," says Akman. "And men who abuse their female spouses do not necessarily abuse other people. If the
issue was simply one of personality or emotion regulation, we would likely see men who abuse their spouses involved in assaults
against other people as well," adds Akman. "So there are clearly some choices being made with regard to who does and does
not become a target of violence." Akman thinks that any comprehensive treatment program needs to address both personal issues
and broader contextual issues.
Tim Kelly, director of Changing Ways, the main treatment provider for domestically violent men in London, Ontario, thinks
that examining gender-based power dynamics, as does the Duluth model, is useful, particularly at the beginning of treatment.
"Aspects of Duluth give the men common ground for talking," explains Kelly. "The societal context is a good entry point. We
need to meet clients in some way to begin working with them." Kelly says that deeply personal, mental health issues can then
be identified and addressed by various other specialized treatments, once the client has committed to change.
For Scott, the entry point lies earlier. She thinks that the value of treatment programs may lie more in identifying than
treating men who are especially likely to re-offend: "We can put more resources into more dangerous men who are unlikely to
benefit. We could try working with the victim instead, or turn to legal solutions."
Centre for Addiction
