Treating perpetrators is a challenge

The National Coalition Against Domestic Violence reports that an estimated 1.3 million women are victims of physical assault by an intimate partner every year; boys who witness the violence are twice as likely to abuse their partners when they become adults. Although significant research has been done, no clear answer to resolving the problem of domestic violence has emerged.

During 30 years of studying male behavior, William S. Pollack, Ph.D., ABPP, associate clinical professor of psychology in the department of psychiatry at Harvard Medical School and senior clinical consultant on the mental health of men, adolescent males and boys at Cambridge Health Alliance, has found that early socialization models have some bearing on future conduct. “Boys are given the message around three to five years old that they need to buck up and do things on their own. This is a harmful message,” he says. “We replace nurturance, empathy, caring and expressing feelings openly with stoicism, achievement and assertion.”

Pollack suggests that suppressing feelings can lead to frustration and anger. “If males can’t talk about pain and vulnerability, the final pathway is anger. If no words are allowed, that anger is expressed through action. Physical harm is the result.”

Pollack supports the theory that a boy’s upbringing in a violent household can also impact future behavior. “Kids learn from observing. It’s a rare male who engages in domestic violence who hasn’t seen this in his childhood. He gets the sense it’s his right to control,” he says.

Moreover, men who perpetrate domestic violence crimes typically blame others for the behaviors. “Physical abuse may occur when the male is failing. He blames someone else. He uses anger and rage as a way to feel better,” Pollack adds.

However, not every boy brought up in this “code” will become abusive as an adult, although the conditions make it more likely if the baseline of masculinity depends on continually proving yourself. “If men feel put down, especially by women they don’t see as equals, they blot out the feeling by taking their anger out on her. Some of the most fragile men are only held up by putting down others who threaten their masculine integrity.”

Joseph A. Camilleri, Ph.D., a research psychologist and assistant professor, psychology department at Westfield State University, cites a number of variables associated with perpetrators of domestic violence, including characteristics such as anti-social attitudes and perceptions, proclivity toward committing other offenses and, sometimes, substance abuse.

“There is work being done to identify batterer typologies,” Camilleri says. For instance, researchers A. Holtzman and G.L. Stuart see some batterers as “family only,” i.e., they target their aggression within the family, mostly against their partners. “Others are classified as dysphoric borderline. They have a mental diagnosis, such as depression or anxiety that may be associated with violence. In general, they have a history of criminal behavior in addition to domestic violence,” he says.

In spite of research, determining why men batter is challenging. “Some men view domestic violence and don’t grow up to be batterers,” Camilleri says, but points out that socioeconomic status has been identified as a strong indicator during risk assessment. “If a male perpetrator is unemployed, it’s a predictor of future violence,” he says.

Sexual jealousy may also prompt domestic violence, Camilleri says. “We all have inherent sexual jealousy, but there’s a difference between responses. If a male suspects infidelity or is persistently jealous, it could lead to some type of violence.”

Based upon correctional literature, programs that focus on targeting criminogenic needs hold some promise. “These are characteristics of the individual not only associated with crime but also changeable,” Camilleri explains. “A dynamic risk assessment identifies high risk to reoffend. By changing behavior, you can reduce the risk.”

Two common treatment options include the Duluth model and cognitive behavioral therapy (CBT), according to Camilleri. The first model places an emphasis on men’s use of power and control and how to transition toward equality in relationships. “CBT targets violent behavior and thinking and provides skills training and anger management. It identifies facets related to the behavior,” he says.

Despite efforts to reduce violent tendencies in men, a meta-analysis on domestic violence programs and treatment finds a “pretty small effect on fixing the problem,” Camilleri points out. He suggests that a risk assessment of criminogenic needs together with dynamic risk assessment could inform an appropriate treatment program. “By using the risk assessment, you can know what to address,” he notes.

In 1986, Susan Cayouette, Ed.D., became co-director of Emerge: Counseling and Education to Stop Domestic Violence in Boston, one of 15 certified domestic violence programs in Massachusetts. The organization focuses on teaching the benefits of change and personal engagement to perpetrators of domestic violence.

Sixty-five percent of Emerge participants are there by court order, between five and 10 percent are referred by the Department of Children and Families and 15 to 25 percent come voluntarily, e.g., at the behest of a partner or therapist or as a result of an employee assistance program.

“The treatment of choice is group therapy. They work with others with the same problem,” she says. The Department of Public Health supervises the 40-week program, which takes place in two stages, the first of which is didactic in nature and runs for eight weeks. “We don’t want a lot of feedback during the first stage. At that point, the men would only reinforce the abusive behavior, give it credibility,” says Cayouette.

In stage two, the men examine past relationship history, look at patterns of abusive behavior and develop individual goals. “We train them to give good feedback so they can interact with each other, while focusing on their own relationships history,” says Cayouette. “We are giving the tools to motivate and provide an impetus to change. We want to engage the person, always keeping concern for the safety of victims in mind.”

Cayouette emphasizes, “Sometimes the change you see is not before you. It comes later. We want the person to have a shot at having a good relationship.”