chapter 6
TREATMENT FOR MALE BATTERERS

The first batterer intervention programs were established in the late 1970s. Activists working with battered women created the programs because they felt that real progress in reducing domestic violence required changing the behavior of batterers. Criminal justice agencies responded by referring an increasing number of batterers to intervention programs in an effort to deter further violence. Several hundred intervention and treatment programs for batterers now exist throughout the United States.

Studies of the effectiveness of male batterer treatment programs are inconclusive and many are discouraging about the programs' effectiveness. Some follow-up studies performed four to twenty-four months after batterers complete programs indicate nonviolence rates of between 53% 85%. Other reports find no difference in outcomes between those attending batterer programs and control groups that did not. In assessing whether these programs work, many factors must be considered, including the type of batterer and the kind of treatment that works best. Although researchers are beginning to identify different types of abusers, they have not yet definitively shown which treatment approach is most effective with each group.

STANDARDS FOR BATTERER INTERVENTION PROGRAMS

Most states have developed battering intervention programs to deal with violent batterers. But states differ over the type of batterers who must attend and the penalties they incur if they fail to attend. Critics contend that state-mandated standards for participation and program type produce inflexible programs that fail to take into account research demonstrating the need for different approaches to deal with different batterers.

Some critics charge that these standards were written by those who felt regulation was necessary to ensure that male batterers were held accountable. They believe such standards focus on domestic violence as a crime that requires criminal sanctions. Mental health professionals, however, view domestic abuse as a dysfunctional disorder that is best treated with mental health treatment and therapy. Other critics feel that the standards may result in a limited treatment approach, even though research has not yet determined the effectiveness of any one program in deterring future abuse.

In "Standards for Batterer Intervention Programs: In Whose Interest?" (Violence against Women, vol. 5, no. 1, 1999), Larry Bennett and Marianne Piet found that much of the conflict over program standards results from a misunderstanding about the purpose of these standards. They argued that rather than focus on program content and potentially prevent creation and implementation of innovative practices, standards should be designed to hold men accountable for their actions, hold providers accountable for their programs, and increase the safety of the victims of domestic violence.

A NATIONAL STUDY OF BATTERER INTERVENTION

In Batterer Intervention: Program Approaches and Criminal Justice Strategies (Washington, DC: National Institute of Justice, 1998), Kerry Healey and Christine Smith reported on their study of batterer intervention programs. The study was designed to help criminal justice personnel better understand the issues surrounding batterer intervention to enable them to make appropriate referrals to programs and to communicate effectively with program providers. Healey and Smith looked at both "mainstream" programs and innovative approaches across the country. Although many programs are structurally similar, there is considerable diversity in terms of the theoretical approaches used to treat perpetrators of intimate partner violence.

The Feminist Model

The feminist model attributes domestic violence to social values that legitimize male control. In this view, violence is a way to maintain male dominance of the family. Feminist programs attempt to raise consciousness about sex-role conditioning and how it influences men's emotions and behavior. These programs use education and skill building to resocialize batterers and help them learn to build relationships based on trust instead of fear. Most feminist approaches also support confronting men about their misuse of power and control tactics.

Detractors of this approach claim that the feminist perspective overemphasizes sociocultural factors to the exclusion of individual factors, such as growing up abused or witnessing family violence. Some observers argue that the feminist approach is too confrontational and alienates the batterer, thereby increasing his hostility.

The Family Systems Model

The family systems model is based on the theory that violent behavior stems from dysfunctional family interactions. It focuses on cultivating communication and conflict resolution skills within the family. According to this model, both partners may contribute to the escalation of conflict, with each attempting to dominate the other. Either partner may resort to violence, although the male's violence will likely have greater consequences. From this perspective, interactions produce violence; therefore, no one is considered to be a perpetrator or victim.

Critics of the family systems model contest the idea that the majority of partner abuse involves shared responsibility. They believe batterers bear full responsibility for the violence. Many also fear that counseling of the couple may place the victim at risk if the woman expresses complaints during a counseling session. This model is not widely used; in fact, couples counseling is expressly prohibited in twenty state standards.

Psychological Approaches

The psychological perspective views abuse as a symptom of underlying emotional problems. This approach emphasizes therapy and counseling to uncover and resolve a batterer's unconscious problems. Proponents of this approach believe that other interventions are superficial and only suppress violence temporarily. Critics argue that attaching psychiatric labels to batterers provides them with an excuse for their behavior.

Cognitive-behavioral group therapy is the most common psychological approach used in batterer intervention programs. This therapy is intended to help individuals function better by changing how they think and act, focusing on skills training and anger management. According to the theory underlying this approach, behaviors are learned as a result of positive and negative reinforcements, and interventions should focus on building skills and changing thought patterns. Feminists criticize this approach, however, saying it fails to explain why intimate partner batterers are not violent in other relationships and why some men continue to abuse women even when their behavior is not rewarded.

Some investigators use the psychological model to study battering behavior. In "Neuropsychological Correlates of Domestic Violence" (Violence and Victims, vol. 14, no. 4, Winter 1999), researchers Ronald A. Cohen et al. studied the neurological functioning of thirty-nine male abusers and sixty-three nonviolent subjects to determine whether there was any relationship between neurological functioning and domestic abuse. They divided the groups into men who suffered from head injuries and men who had not, and measured both groups for general intelligence and neurological functioning. The subjects were tested to assess their marital satisfaction and their current level of emotional distress. The subjects were also tested to diagnose antisocial personality disorders.

Cohen et al. found that the batterers had less formal education than the nonbatterers, but that neither group differed in the amount of alcohol they consumed, nor in the number of times they used illegal drugs. The batterers did, however, have past problems with aggression while under the influence of alcohol. The study also revealed a higher incidence of head injury among batterers, with 46.2% of that group reporting head injuries, compared to 20.6% of nonbatterers. In addition, batterers had a higher incidence of prior academic problems.

Batterers with head injuries also showed a higher level of frontal lobe dysfunction, which is among the clinical variables most strongly associated with violence and aggressive behavior. Researchers reported a strong relationship between neurological functioning and domestic violence.

Cohen et al. concluded that brain dysfunction may contribute to the propensity for violence and other aggressive behaviors; however, they cautioned that while dys-function contributes to the propensity for domestic violence among some batterers, it is not involved in all cases of domestic violence, nor does it explain all types of aggression. Nonetheless, they believe that the relationship between brain dysfunction and domestic violence has significance for planning preventive and therapeutic interventions for some batterers. Patients identified with cognitive defects and with a propensity for aggression may be taught behavioral and cognitive strategies to inhibit aggressive behaviors. The results of this research also indicate the need to investigate the efficacy of biological and pharmacological (prescription drug) treatment of domestic violence.

Content of Batterer Intervention Programs

Among the batterer programs Healy and Smith studied, most combine elements of different theoretical models. They reviewed three mainstream programs. The Duluth Curriculum uses a classroom format and focuses on issues of power and control. The development of critical

TABLE 6.1

thinking skills is emphasized to help batterers understand and change their behavior. In contrast, the other two mainstream models, Emerge and AMEND, involve more in-depth counseling and are of longer duration.

the duluth curriculum. The Duluth model, based on the feminist idea that patriarchal ideology causes domestic violence, was developed in the early 1980s by the Domestic Abuse Intervention Project of Duluth, Minnesota. The classroom curriculum focuses on the development of critical thinking skills relating to the themes of nonviolence, nonthreatening behavior, respect, support, trust, honesty, partnership, negotiation, and fairness. Two or three sessions are devoted to exploring each theme. For example, the first session begins with a video demonstration of specific controlling behaviors. The video is followed by discussion of the actions used by the batterer in the video. Each participant contributes by describing his particular use of the controlling behavior. The group then identifies and discusses alternative behaviors that can build healthier, more equal relationships. Programs based on the Duluth model are the most commonly used batterer invention program in the country, with many states mandating its use.

The National Institute of Justice reported on evaluations of batterer intervention programs based on the Duluth model in "Do Batterer Intervention Programs Work? Two Studies" (NCJ 200331, September 2003). Two studies based in New York and Florida found that the programs had little or no effect on subsequent domestic violence, and that the programs did not change batterers' attitudes toward women and battering. The New York study, conducted in 1996, did find that men assigned to a longer, twenty-six-week program were less likely to be arrested again within twelve months than men assigned to an eight-week, accelerated program. (See Table 6.1.) However, men were much more likely to graduate from the shorter program than the longer program, illustrating the problem of high drop-out rates in implementing effective batterer intervention programs. (See Table 6.2.)

TABLE 6.2

emerge. Emerge, a forty-eight-week batterer intervention program in Cambridge, Massachusetts, combines several different models. It begins with eight weeks of educational and skill-building sessions. Program members who complete this phase and admit to domestic violence then progress to an ongoing group that blends cognitive behavioral techniques with group therapy centered on personal accountability.

In the group, new members describe the events and actions that brought them to the program, answer questions about their behavior, and accept responsibility for their violence. Regular group members also talk about their actions during the previous week. There may also be discussion of particular incidents disclosed by members of the group.

David Adams, the president and cofounder of Emerge, considers battering any act that forces the victim to do something she does not want to do, prevents her from doing something she wants to do, or causes her to be afraid. He views violence as not simply a series of isolated blowups, but a process of deliberate intimidation intended to coerce the victim to comply with the victimizer's wishes. According to Adams, the abuser's high level of control can be seen in how agreeable he can be with police, bosses, neighbors, and others with whom it is in his best interest to appear reasonable.

Even though abusive men in the program are supposed to be working on their relationships, Emerge counselors have observed that the men devalue and denigrate their partners. Ellen Pence, who helped to develop the Duluth Curriculum, noticed that men rarely call the women they abuse by name, because they refuse to see them as people in their own right. In one group session, she counted ninety-seven references to women, many of them obscene, before someone used his partner's name. When Pence insisted program participants use the names of their partners, she reported that many could hardly speak.

Emerge focuses not only on the abusive behavior, but also on the broader relationship between the batterer and the victim. Each member formulates goals related to his control tactics, and the group helps him develop ways to address these concerns. It combines a psycho-educational curriculum, cognitive-behavioral therapy, and an assessment of the needs of the individual.

amend. The professionals who created AMEND (Abusive Men Exploring New Directions), a program in Denver, Colorado, share the same commitment to long-term treatment based on several treatment models as the founders of Emerge. The purpose of AMEND is to establish client accountability, increase awareness of the social context of battering, and build new social skills. AMEND group leaders serve as "moral guides" who take a firm position against violence and vigorously describe their clients' behavior as unacceptable and illegal.

The program's long-term approach has four stages. The first two stages consist of several months of education and confrontation to break through the batterer's denial and resistance. Several months of advanced group therapy follow during which the batterer identifies his own rationalizations for abusive behavior and admits the truth about his actions. This stage includes ongoing contact of program leaders with the abused partner, who can reveal relapses or more subtle forms of abuse. During this stage, the client develops a plan that includes participation in a support network to prevent future violence. The fourth stage, which is optional, consists of involvement in community service and political action to stop domestic violence.

san diego navy experiment: the cognitive-behavioral approach. In the study "The San Diego Navy Experiment: An Assessment of Interventions for Men Who Assault Their Wives" (Journal of Consulting and Clinical Psychology, vol. 68, no. 3, June 2000), Franklyn W. Dunford compared three different year-long interventions for men who had physically assaulted their wives. The study involved randomly assigning 861 couples to one of four groups: a men's group, a conjoint group (men and women), a rigorously monitored group, and a control group. The men's and conjoint groups received cognitive-behavioral therapy and outcomes were measured every six months.

The men's group met weekly for six months, and then monthly for the second six months. Group leaders covered a wide range of perpetrator attitudes and values and taught skills believed to be important to ending the abuse of women, such as empathy and communication skills, as well as anger and jealousy management. Along with instruction, participants practiced their newly acquired skills and developed plans to assume complete responsibility for their behavior.

Employing the same curriculum used by the men's group, the conjoint group, composed of victims and perpetrators, was a controversial treatment approach since most conventional programs do not believe it is useful or effective to treat victims and their abusers together. But the leaders were interested in finding out if couple therapy would be effective. They also anticipated some benefits from the presence of the wives, such as less "women bashing" within the context of the group and more realistic opportunities to engage participants in role-playing to help them practice more constructive behaviors.

The rigorous monitoring intervention aimed to inhibit abuse by making service members' commanding officers aware of every instance of abuse. By closely monitoring and reporting their behavior, this approach attempted to increase scrutiny of the perpetrators' lives, creating a situation Dunford called a "fishbowl" effect.

Men assigned to the control group received no treatment; however, to ensure their wives' safety, the wives were given preliminary stabilization and safety planning counseling to help prevent additional instances of abuse.

The results of the interventions were measured, controlling for demographic variables—age, rank, family size, ethnicity, education, and income—and outcome assessments. Outcomes were evaluated using self-reports and spouse reports, and the Modified Conflict Tactics Scale, which examined forty-two aspects relating to the type and frequency of abuse. Official police and court records, as well as reports of new injuries, were also considered as outcome measures.

The study found no significant differences in the prevalence or frequency of abuse, as reported by the wives or their spouses, between the treatment groups. No significant differences were found among the four groups in Modified Conflict Tactics Scale scores. The study also found no differences in terms of new arrests among the perpetrators in all four groups. These findings suggest that none of the three treatment approaches was any more effective at reducing abuse than participation in the control group.

Dunford concluded that the cognitive-behavioral model is ineffective as an intervention for spouse abuse, at least in this military setting. He called for further research to confirm his study's findings and hypothesized that the one-size-fits-all approach to treatment may be responsible for the ineffectiveness of treatment.

TREATMENT OF TYPES OF BATTERERS

Most observers conclude that a single intervention program cannot accommodate the staggering diversity of batterers. Unlike mainstream programs, innovative approaches focus on the individual profile and characteristics of a batterer, and some programs tailor their interventions to the various categories of batterers.

The criminal justice system, for example, categorizes offenders based on their potential danger, history of sub-stance abuse, psychological problems, and risk of dropout and re-arrest. Interventions focus on the specific type of batterer and the approach that will most effectively produce results, such as linking a substance abuse treatment program with a batterer intervention program. Other program approaches focus on specific sociocultural characteristics, such as poverty, race, ethnicity, and age. Researcher Shelly Jackson argues that the effectiveness of batterer intervention programs might improve if the programs were seen as "part of a broader criminal justice and community response to domestic violence that includes arrest, restraining orders, intensive monitoring of batterers, and changes to social norms that may inadvertently tolerate partner violence." She was co-author, with Lynette Feder, David R. Forde, Robert C. Davis, Christopher D. Maxwell, and Bruce G. Taylor, of "Analyzing the Studies" (Batterer Intervention Programs: Where Do We Go From Here? [Washington, DC: National Institute of Justice, NCJ 195079, June 2003]).

One program that focuses on individualizing batterer treatment, currently in use in Somerset, New Jersey, is based on the Cultural Context Model, an intervention method that acknowledges a cultural basis for battering among some ethnic groups. While this treatment model requires accountability from batterers and supports the empowerment of abused spouses and their children, it also recognizes the impact that social forces have in cultures where battering is considered acceptable.

Rhea V. Ameida and Ken Dolan-Delvecchio contend that the impact of culture is often overlooked or minimized by people who work with batterers in traditional treatment programs. In "Addressing Culture in Batterers Intervention: The Asian Indian Community as an Illustrative Example" (Violence against Women, vol. 5, no. 6, June 1999), Ameida and Dolan-Delvecchio suggested that if program workers were trained in cultural differences, they would be better able to serve the needs of both the abuser and his family. The Cultural Context Model works by providing treatment not only to the batterer, but also to the victims of abuse, generally in a family therapy atmosphere.

As part of their therapy, participants are shown videos that illustrate abusive situations and are encouraged to talk about the video incidents and their own instances of abuse. The participants then study power and control wheel illustrations, which give them graphic, visual perspectives about how a variety of factors interact to create abusive situations. The treatment model attempts to reeducate the abused and abuser by raising their consciousness about gender, race, culture, and sexual orientation. One desired outcome of this therapy, Ameida and Dolan-Delvecchio explained, is to make participants more aware of the social impact of their actions.

Program Procedures

Regardless of an intervention program's philosophy or methods, program directors and criminal justice professionals generally monitor the offenders' behavior closely. Most batterers enter intervention programs after having been charged by the police with a specific incident of abuse. As a requirement of probation, most courts will order a batterer into an intervention program.

At the court, the batterer is first interviewed to determine the type of program that may be most effective. Known as an "intake assessment," this process may take as long as eight weeks. During this time, the batterer agrees to the terms of the program, his behavior is assessed, and he is screened for other problems, such as substance abuse or mental illness. If other problems are detected, he may be referred to a program or treatment that specifically addresses those issues. Not all batterers are accepted at intake. Some programs consider batterers inappropriate for treatment if they deny having committed violence.

Several states require that the victim be notified at various points of the intervention, and programs with a strong advocacy policy contact victims every two or three months. Victims may be asked for additional information about the relationship, given information about the program's goals and methods, and helped with safety planning. In addition, the batterer's counselor will inform the victim if further abuse appears imminent.

Batterers leave the program either because of successful completion or because they are asked to leave. Reasons for termination include failure to cooperate, nonpayment of fees, revocation of parole or probation, failure to attend group sessions regularly, or violation of program rules. Successful completion of a program means that the offender has attended the required sessions and accomplished the program's objectives. With court-mandated clients, a final report also is made to probation officials.

The Criminal Justice Response

To be successful, batterer intervention programs must have the support of the criminal justice system, which includes coordinated efforts between police, prosecutors, judges, victim advocates, and probation officers. Healey and Smith suggested that authorities can reinforce the message that battering is a crime and further support the efforts of batterer programs by taking the following steps:

• expediting domestic violence cases though the court system
• using special domestic violence prosecution and probation units and centralizing dockets where all aspects of domestic violence may be managed in one location in order to improve services to victims and better coordinate prosecution, sentencing, and supervision
• gathering offender information quickly, including previous arrests and convictions, substance abuse history, child welfare contacts, and victim information
• taking advantage of culturally competent or specialized interventions and finding appropriate interventions for batterers who are indigent, high-risk, or mentally ill
• coordinating batterer intervention with substance abuse treatment and mandate treatment where appropriate, making sure it is monitored intensively
• being alert to the risks to children in abusive households by coordinating with child protective services to ensure that the batterer's children are safe and receiving appropriate services
• creating a continuum of support and protection for victims by using victim advocates to assist victims with the criminal justice system and to monitor their safety while their batterers are sentenced to treatment programs
• encouraging interagency cooperation by organizing formal committees of probation officers, prosecutors, battered women advocates, child protection workers, and batterer intervention providers to discuss referral and monitoring policies

Post-traumatic Stress Disorder and Shame

Donald Dutton, a psychology professor and author of The Batterer: A Psychological Profile (New York: Basic Books, 1995), found that many of his clients suffered the same symptoms manifested in post-traumatic stress disorder (PTSD), a psychological response to extreme trauma. These symptoms include depression, anxiety, sleep disturbances, disassociation, flashbacks, and out-of-body experiences. Dutton's batterers had psychological profiles surprisingly similar to Vietnam War veterans who had been diagnosed with PTSD. Dutton argued that although abusers are rarely seen as victims, their psychological profiles reveal they have been victimized and suffered trauma. He wrote that the batterers' chronic anger and abusiveness pointed to a common source of early childhood trauma.

Researching his clients' childhood experiences, Dutton determined that the crucial factor in abusive behavior is the shame the men suffered as children. Dutton defined shame as an emotional response to an attack on the global sense of self. The men Dutton studied had experienced childhoods in which they had been continually humiliated, embarrassed, and shamed. He found that physical abuse alone did not predict later abusive behavior, but that the combination of shame and abuse was a dangerous mix.

According to Dutton, shame attacks a child's entire identity and teaches the child that he is worthless. Punishing a child at random also poses a serious attack on his identity. Because the punishment does not relate to a particular behavior, it teaches the child that his very being is wrong and unlovable. The child has no outlet for his rage and shame until he enters an intimate relationship. When his bravado—the "tough guy" mask—is threatened, he responds with rage. The shame of his rage is too great to bear, so he blames the woman and the destructive pattern is established.

Dutton listed the early childhood experiences he believes make the strongest contributions to predicting wife assault in order of importance: feeling rejected by one's father, a lack of warmth from one's father, physical abuse from one's father, verbal abuse by one's father, and feeling rejected by one's mother.

Abuser Types

Research has increasingly focused on differing types of male batterers. Daniel G. Saunders, in "A Typology of Men Who Batter: Three Types Derived from Cluster Analysis" (American Journal of Orthopsychiatry, vol. 62, no. 2, 1992), surveyed 165 abusive men, using such psychological measures as childhood victimization, severity of violence, psychological abuse, domestic decision making, level of conflict, anger, jealousy, depression, the ability to make a good impression on others, and alcohol use. His pioneering work defined three types of batterers:

• Type I men are characterized as "family-only" aggressors. These men report low levels of anger, depression, and jealousy, and are the least likely to have been severely abused as children. They claim the most satisfaction in their relationships, the least marital conflict, and the least psychological abuse. Their violence is associated with alcohol about half the time. Members of this group suppress their anger until alcohol or stress triggers its release.
• Type II men are "generally violent" and are the most likely to be violent inside and outside the home. The majority have been severely abused as children, yet they report low levels of depression and anger. Their lower anger may reflect an attitude of "I don't get mad, I get even." Their violence is usually associated with alcohol, and they report the most frequent severe violence. Their attitudes about sex roles are more rigid than those of Type I men.
• Type III men report the highest levels of anger, depression, and jealousy. They are characterized as "emotionally volatile" aggressors. They are most likely to fear losing their partners and feel suicidal and angry. These men are not as physically aggressive as Type II men, but they are the most psychologically abusive and the least satisfied with their relationships. They also have the most rigid sex-role attitudes. About half of these men have previously received counseling and are thought to be the most likely to complete treatment.

Based on these three categories of batterers, Saunders proposed different types of counseling that would be most effective for each type. The family-only aggressor, Type I, might gain the most from an emphasis on the communication aspects of assertiveness training. He needs to learn how to express anger and understand his rights. He may be helped by couples counseling if his past violence level is low enough and if he remains nonviolent and committed to the relationship.

The Type II man may need help dealing with the psychic wounds of his childhood, stopping his abuse of alcohol, and learning how to express his feelings rather than by exploding. He also needs to recognize that his rigid sex-role notions are harmful. Saunders proposed that this type of abuser will probably require more than the standard three- to six-month treatment program.

The emotionally volatile man, Type III, must learn to express his feelings in nonaggressive ways and to accept his "weaker" feelings of jealousy and depression rather than express them through anger. He also needs to understand the damage caused by his psychological abuse and rigid sex-role beliefs.

In a follow-up study titled "Feminist-Cognitive-Behavioral and Process-Psychodynamic Treatments for Men Who Batter," Saunders went a step further than other researchers have done (Violence and Victims, vol. 4, 1996). While other researchers have hypothesized that identifying subtypes of batterers may help identify which treatments would be most effective for each type, Saunders actually evaluated different treatments for different types of batterers. He found that antisocial batterers did better in cognitive-behavioral group therapy, and "dependent" batterers did better in a new, psychodynamic treatment setting.

Survey of Typologies of Male Batterers

Amy Holtzworth-Munroe and Gregory L. Stuart reviewed fifteen studies of typologies of male batterers, including the Saunders study, and found that three dimensions of battering were generally used to distinguish among subtypes of batterers: severity of marital violence, whether the violence was directed at people other than the intimate partner, and the presence of personality disorders. They reported their findings in "Typologies of Male Batterers: Three Subtypes and the Differences Among Them" (Psychological Bulletin, vol. 116, no. 3, 1994). They synthesized the studies to propose a typology of three types of batterers: family only, dysphoric/borderline personality, and generally violent/antisocial.

In the researchers' conceptualization, family-only batterers are the least violent both in and outside the home. They do not suffer from personality disorders or other psychological disorders, they have low levels of abuse in their childhoods, and they have low levels of hostile attitudes toward women. Dysphoric/borderline batterers engage in moderate to severe abuse of their partners. They likely were abused themselves in childhood and are psychologically distressed. They do not engage in violence outside the home. Violent/antisocial abusers engage in moderate to severe wife battering and exhibit violence outside the home, have hostile attitudes toward women, and are most likely to abuse substances and engage in other criminal behaviors.

Holtzworth-Munroe and other researchers later conducted a study titled "Testing the Holtzworth-Munroe and Stuart (1994) Batterer Typology" (Journal of Consulting and Clinical Psychology, vol. 68, 2000). It generally validated the initial hypotheses. The researchers conducted a follow-up study to determine whether batterer characteristics were stable over time; in other words, did batterers continue to differ on the individual characteristics related to intimate partner violence across time? Holtzworth-Munroe et al. went on in "Do Sub-Types of Maritally Violent Men Continue to Differ over Time?" to find that in fact, relationship violence is related to stable individual characteristics (the typologies) of the men (Journal of Consulting and Clinical Psychology, vol. 71, 2003).

Personality Differences and Treatment

Robert J. White and Edward W. Gondolf, in "Implications of Personality Profiles for Batterer Treatment," classified battering men by personality types with the intent to recommend treatment approaches for each type (Journal of Interpersonal Violence, vol. 15, May 2000). They found three levels of personality pathology that they characterized as low, moderate, and severe personality dysfunction. They also found that most batterers fell into one of two groups that cut across the personality types: narcissistic (overly focused on themselves) and avoidant/depressive.

The researchers argued that most batterers, whether avoidant or narcissistic, did not suffer from severe personality dysfunction and were therefore good candidates for cognitive-behavioral group therapy. This treatment could help the batterers with self-image problems as well as provide feedback to correct distorted thinking about relationships. The researchers stated that men with more severe personality problems (as many as 15% of batterers) would need additional attention within the group and possibly individualized psychological treatment. The researchers believed that the approach of different treatments for different batterers is overemphasized: "It appears that although one size does not fit all, one size appears to fit most," they wrote.

PROGRAM DROPOUT RATES

Dropout rates in battering programs are high, even though courts have ordered most clients to attend. Several studies indicate that 20% to 30% of the men who begin short-term treatment programs do not complete them. A 1990 survey of thirty programs of differing lengths found a wide range in completion rates. Half of the programs reported completion rates of 50% or less. If dropout rates are based on attendance at the intake session, rather than the first treatment session, noncompletion rates are even higher. A 1999 study that documented the dropout rate after the initial assessment found that 59% of those who completed the initial assessment never attended a single session and that 75% dropped out before the ten-week program was over.

High dropout rates in batterer intervention programs make it difficult to evaluate their success. Evaluations based on men who complete these programs focus on a very select group of highly motivated men who likely do not reflect the composition of the group when it began. Since a follow-up is not conducted with program dropouts, the men most likely to continue their violence, research generally fails to accurately indicate the success or failure of a given treatment program.

Certain characteristics are generally related to dropout rates. Bruce Dalton, in "Batterer Characteristics and Treatment Completion," found that the level of threat that the batterer perceived from the referral source (for example, the court) was, surprisingly, not related to program completion (Journal of Interpersonal Violence, vol. 16, December 2001). Unemployment is the one characteristic most consistently related to dropping out of treatment. Dalton theorized that these men both have trouble paying for the treatment and have a lower investment in the "official social order."

Other researchers have found that factors influencing completion rates of batterer intervention programs include youth, not being legally married, low income and little education, unstable work histories, criminal backgrounds, and excessive drinking or drug abuse. Voluntary clients, especially those with college educations, remain in treatment longer. Some researchers have found better attendance among college-educated men, regardless of whether their enrollment in a program is court ordered or voluntary. Such findings were reported by A. DeMaris in "Attrition in Batterers' Counseling: The Role of Social and Demographic Factors" (Social Service Review, Vol. 63, 1989); E. W. Gondolf in "A Comparison of Four Batterer Intervention Systems: Do Court Referral, Program Length, and Services Matter?" (Journal of Interpersonal Violence, Vol. 14, Issue 1, 1999); and J. Jacobs in The Links between Substance Misuse and Domestic Violence: Current Knowledge and Debates (London: Institute for the Study of Drug Dependence, 1999).

Nearly all professionals involved in domestic violence prevention and treatment programs concur that batterer intervention programs must address the issue of dropouts. Reducing or eliminating intake sessions and immediately engaging batterers in useful interventions may help to promote attendance and participation by immediately engaging participants in the treatment program. Counselors should provide more information about the purpose of the program in the preprogram orientation sessions. Other suggested retention measures include courtroom assistance, mentors, and stiffer and quicker punishment for dropouts. One study found that home visits after a batterer misses a meeting also help decrease dropout rates. Researchers on this subject include Bruce Dalton in "Batterer Characteristics and Treatment Completion" (Journal of Interpersonal Violence, Vol. 16, No. 12, December 2001) and A. DeMaris in "Attrition in Batterers' Counseling: The Role of Social and Demographic Factors" (Social Service Review, Vol. 63, 1989).

RECIDIVISM RATES

Recidivism, the tendency to relapse to old ingrained patterns of behavior, is a well-documented problem among persons in intimate partner violence treatment programs. In "Pattern of Reassault in Batterer Programs" (Violence and Victims, vol. 12, no. 4, 1997), Edward Gondolf reported his evaluation of four well-established batterer programs to assess the pattern of reassault or a return to battering. All the research sites had operated for five years or more and received at least forty to fifty referrals per month. Located in Pittsburgh, Pennsylvania; Denver, Colorado; and Dallas and Houston, Texas, the programs ranged from three to nine months in duration.

Of the 840 batterers recruited, 210 at each site, 82% were referred to the program by court order, and 18% entered the program voluntarily. Both batterers and their partners were interviewed by phone every three months for fifteen months after intake. The female partners of 79% of the batterers were interviewed at least once during the fifteen-month follow-up.

In follow-up reports on 662 batterers, 32% of the female partners reported at least one reassault during the fifteen months after treatment. Of the 210 reassault cases, 61% resulted in bruises or injuries, and 12% of victims required medical attention. The reassault rate was significantly higher for program dropouts than for participants who completed the program. Voluntary participants were also more likely to reassault their partners than court-ordered participants.

While the proportion of women who were reassaulted was relatively low, 70% of the women were subjected to verbal abuse, 45% were subjected to controlling behaviors, and 43% experienced threats. Nonetheless, 66% of the women said their "quality of life" had improved, and 73% reported feeling "very safe" during the follow-up periods.

Fourteen percent of first-time reassaults occurred in the first three months of the program, and 8% occurred within four to six months. Early reassault appeared to be a high-risk marker for continued abuse. Men who reassaulted their partners within the first three months were much more likely to repeat their attacks than were men who reassaulted for the first time after the first three months. The repeat offenders were also highly likely to use severe tactics and inflict injuries. Gondolf speculated that intervention may have been less effective for this group of men because of previous contact with the criminal justice system and/or severe psychological disorders.

Gondolf concluded that well-established programs seem to contribute to the cessation of assault, at least in the short term. For "resistant batterers," he recommended more extensive monitoring and intervention.

Other Studies

Saunders, in "Husbands Who Assault: Multiple Profiles Requiring Multiple Responses," reviewed the available information on male batterers and found that the recurrence of violence six months or more after treatment averages 35% across a number of studies (Legal Response to Wife Assault, [Newbury Park, CA: Sage, 1993]). For men who do not complete treatment, the average reassault rate is 52%. The men most likely to return to violence are on average younger, report alcohol problems, score higher for narcissism (excessive self-involvement) on psychological tests, and have longer histories of pretreatment violence.

Julia C. Babcock and Ramalina Steiner reported some cautiously optimistic findings in "The Relationship between Treatment, Incarceration, and Recidivism of Battering: A Program Evaluation of Seattle's Coordinated Community Response to Domestic Violence" (Journal of Family Psychology, vol. 13, no. 1, March 1999). Their research measured recidivism of domestic violence after arrest and completion or noncompletion of a mandatory, coordinated program of treatment involving the courts, probation officers, and treatment providers.

Babcock and Steiner followed 387 people arrested for misdemeanor domestic violence offences, thirty-one of whom were women. More than three-quarters of participants had no prior domestic violence convictions and 69% had no prior criminal history. The average age of participants was 32.7 years, 45% had graduated from high school, and 36% had attended college or were college graduates. About 41% of participants were white, 36% were African American, 6.6% were Hispanic, 8.6% were Asian American, and 7.8% identified themselves as "other." Half of the participants were employed and 31% were married.

Participants were referred to one of eleven certified domestic violence treatment programs. The majority attended programs that use the Duluth model, while the remainder participated in feminist, psychoeducational, and cognitive-behavioral men's groups. About 31% completed at least twenty-four sessions of treatment, and those batterers considered to have completed treatment attended an average of thirty-two sessions. In contrast, batterers who did not complete treatment attended an average of just 5.8 sessions. Treatment completers were generally first-time offenders, better educated, employed, and had less prior criminal involvement. Of the noncompleters, 58% did not attend any sessions, but the majority were not legally punished, despite their failure to attend court-ordered treatment.

Program completion was related to lower rates of recidivism—treatment completers had significantly fewer domestic violence arrests at follow-up than noncompleters, and this difference remained even when the researchers controlled for differences in prior criminal record and history. Batterers who had been court ordered to attend treatment and failed to complete it were more likely to commit further offenses than treatment completers. Babcock and Steiner concluded that their findings support the premise that completing treatment is directly related to reduced rates of domestic violence. They cautioned, however, that participants who completed treatment were probably not representative of the entire population of batterers—they likely had more to lose as a result of failure to complete treatment than the treatment dropouts.

Jill A. Gordon and Laura J. Moriarty in their study of the effect of batterer treatment on recidivism reported more pessimistic results ("The Effects of Domestic Violence Batterer Treatment on Domestic Violence Recidivism," Criminal Justice and Behavior, vol. 30, February 2003). They found that attending treatment had no impact on recidivism when comparing the treatment group as a whole with the experimental group. However, they also found that among the treatment group, the more sessions a batterer completed, the less likely he was to batter again. Batterers who completed all sessions were less likely to be rearrested for domestic violence than were batterers who had not completed all sessions.