Domestic Violence Family Therapy Interventions

The traditional therapeutic approach to working with those who commit domestic violence has been the Duluth educational model. However, this model faces a significant amount of criticism in its gender-divided model that does not allow for relevant psychological factors to be considered. In this paper, I will review the points of the Duluth model that have been criticized and provide two alternative approaches that have shown to consider important therapeutic factors and benefits to both families and couples seeking treatment around domestic violence issues.

Failings of Traditional Duluth Educational Model

The Duluth Model was developed in the 1980's as a pro-feminist, political thought reform movement in response to concerns over victim safety and men's responsibility and has served as the standard approach for domestic violence intervention programs. It is an educational program where the client is taught about many different topics that contribute to the perpetration of domestic violence, including male socialization to privilege, power and exploitation, gender inequality, addressing denials of responsibility and the societal expectation of masculine dominance. Skill building includes alternative thinking and behaviors for positive conflict resolution and stress management (Augusta-Scott & Dankwort, 2002). Main criticisms of the Duluth Model centers around its 40% recidivism rate, its tenant that domestic violence only happens due to male's desire for power and control over their female partner, and its ignoring of systemic and societal factors that contribute to the perpetration of domestic violence (Dutton & Corvo, 2007).

The Duluth model has been criticized for its use of gender shaming and emphasis on male privilege as a primary motivation for violence. One of the objectives in the Duluth model is getting the male perpetrator to admit their privilege, and it does not accept the client speaking of other contributing underlying factors, including anger, depression, hostility and substance use for fear of absolving them of responsibility and placing the male perpetrator in the role of victim. However, research has shown that men who perpetrate domestic violence had significantly higher levels of anger, depression and hostility that were linked to past paternal rejection, exposure to abuse themselves and failures in protective attachment (Dutton & Corvo, 2007). Also, recent research shows that relationship violence often co-occurs with substance abuse. The United States Department of Justice suggests that two-thirds of incidents of relationship violence involve alcohol, and domestic violence perpetrators who report substance use ranges from 40-92% (Stith et al. 2012). Critics of the Duluth model state that ignoring these underlying systemic factors in the therapeutic process contributes to failures at preventing recidivism.

With the Duluth model, power and control are what drives domestic violence perpetration, but only in males, and holds that females do not have this innate drive and they have no need for it. However, research has shown that in fact, males and females equally describe having power and control motivations, and using techniques to gain dominance in the relationship (Dutton & Corvo, 2007). Additionally, Whitaker, Haileyesus, Swahm and Saltzman (2007) found in the 2001 National Longitudinal Study of Adolescent Health that almost 24% of all relationships from 11,370 US adults aged 18 to 28 had some violence. In this study, nearly half of these relationships were reciprocally violent, where both partners used violence towards each other, and where the violence was one-sided, 70% of the time the female partner was the perpetrator. This statistic raises concerns of how a model can appropriately treat female perpetrators of violence when the model only characterizes them as the victim?

Even though research shows more women than men reported perpetrating violence, it still stands that a majority (62%) of those injured by a partner were women. Reciprocal partner violence was associated with greater injury than was nonreciprocal, regardless of the gender of the perpetrator (Stith et al. 2012). As family therapists it becomes critical to recognize this and work towards ending all forms of relationship violence, not only male-perpetrated violence.

Narrative Therapy

The debate over preferred intervention is often framed in terms of feminist education versus therapeutic counseling, but this misses the emergence of (pro-)feminist, narrative therapists who have also developed conversations underscoring women's safety and men's responsibility for abusive behavior (Augusta-Scott & Dankwort, 2002, p. 787).

Narrative therapy is similar to the Duluth educational model in identifying destructive ways of thinking and behavior and providing interventions to reauthor their stories, and as a result, their beliefs and behavior. Narrative therapy differs from the Duluth educational model in its acceptance of underlying factors as a part of the client's story and perception of reality, as well as in its confrontation of irresponsibility. Augusta-Scott & Dankwort (2002) point out four main differences between the two models: interpretation of the relationship desires of men, interpretation and use of affect, interpretation of men telling their experiences of injustice, and what intervention directives are used to address the aforementioned themes.

As mentioned, the Duluth model centers around contributing men's abusive behavior to their desire for power and control over their female partners, which will provide them dominance and privilege in the relationship. Narrative therapy model does recognize this desire for power and control, but also believes men desire an equal, loving, caring relationship. Narrative therapy strategy assumes men prefer being in non-abusive relationships with partners who are with them out of love rather than fear (Augusta-Scott & Dankwort, 2002).

The Duluth model does not allow for exploration of affect, such as feeling helpless, confused, and shameful, to keep men from justifying their own abusive behavior by externalizing their responsibility for their actions and as well as denies placing men in the role of victim. The narrative therapy model accepts that men can feel both shame and entitlement to power and exposes this through use of deconstruction. For example, clients may lack shame regarding their specific actions taken, but still feel shame about the negative affects their actions had on others. Narrative therapists view the expression of shame as evidence of the man's desire to have a respectful relationship, as long as this is not accompanied my minimization or denial of their actions (Augusta-Scott & Dankwort, 2002).

In the Duluth educational model, outside stories of injustice faced by clients are viewed as attempts to excuse abusive behavior. Granted, if these stories are told in a way to excuse abusive behavior a narrative therapist would interrupt the story as inappropriate. However, if the story of injustice is told in a responsible way, the narrative therapist is open to using these stories as a reframe tool to encourage men to counter injustice and place themselves in the role of someone who stands up against violence. Reframing past stories of injustice in this way can place the client on a path towards self-directed change instead of wholly dismissed as resistance (Augusta-Scott & Dankwort, 2002).

Narrative interventions start with working with the client to construct relationship goals around equality, respect, and love, and discuss how to achieve these goals in a way that is violence-free and builds self-respect. A safe space is created where men can safely identify their irresponsible stories or use of distractions such as blame, minimization or denial, and facilitators interrupt irresponsible stories with questions instead of confrontation in order to shift the focus from self-righteousness back to a previously stated responsible position. Men are invited to speak about their actions, such as by asking Can you handle me asking you about the abuse? , in order to discuss how these irresponsible ideas and behaviors have affected the respect and love they want in relationships. For example, a narrative therapist could ask How has yelling and name-calling affected what you want in your relationship? The use of violence or abuse is identified for its failure to achieve the desired relationship goals, and in turn helps them become personally motivated in their change process (Augusta-Scott & Dankwort, 2002).

The narrative approach uses empathy as well in its held view that the abusive behavior is undesired and unrewarding for the man. Narrative therapy sees empathy for a client who expresses shame over their abusive actions as necessary to avoid supporting the adversarial gender relationship, or victim/victimizer relationship, from where the abusive action first took place. Narrative therapy uses a stance of empathy and curiosity to encourage positive, self-motivated change without appearing to tolerate abusive behavior (Augusta-Scott & Dankwort, 2002).

Systemic Therapy

In their research, Stith, McCollum, Amanor-Boadu & Smith (2012) propose a systemic approach to addressing relationship violence, citing the limited effectiveness of gender-divided treatment and highlighting a significant amount of relationship violence is reciprocal and situational between couples. They propose that for carefully screened couples who have chosen to stay together, systemic interventions with both partners could result in a decrease in domestic violence incidents. Two of their proposed interventions are discussed below.

As stated prior, many domestic violence incidents are reported to have also involved substance use. Behavioral Couples Treatment (BCT) is an approach that can be used to treat substance abuse disorders by bringing both partners into the treatment session and enlisting the non-using partner as support and accountability for the other partner's commitment to sobriety. A Sobriety Contract is negotiated and includes a daily Sobriety Trust discussion where the abusing partner states their commitment to not using that day, and the non-using partner provides encouragement and support. A calendar is used to keep track of outside self-help program attendance, medication use, and relapse, and is brought into session for further discussion, to support successes and investigate relapses. Sessions also include positive conflict resolution skill building. In the cases of alcohol abuse, BCT resulted in reduced violence with total abstinence from alcohol resulting in the largest reduction in reported relationship violence (Stith et al. 2012).

Domestic Violence Focused Couples Treatment is an 18-week program based on Solution Focused Brief Therapy, delivered by co-therapists either in multi-couple groups or single couple sessions. For the first 6 weeks of the program the couples are divided by gender where the therapists help the partners develop a healthy relationship picture that will guide them through the rest of the program, as well as skill building in domestic violence education, asking for timeouts and safety planning prior to starting couples work. Once the couples work does begin, risk and safety are continually monitored through conducting brief individual sessions with each partner separately before and after each session. Couples' session work focuses on eliminating all forms of violence, promoting self-responsibility and enhancing relationship satisfaction. Results show that for both men and women in the single and multi-couple sessions, completing the Domestic Violence Focused Couples Treatment program led to significant reduction of physical aggression. Both men and women involved in the multi-couple groups showed reduction in physical aggression, marital conflict and destructive communication, and an increase in constructive communication and marital satisfaction. Interestingly, men involved in the multi-couple group in particular appeared to receive benefit in all areas of the studies report, suggesting the multi-couple approach as the best option for a systemic couples approach (Stith et al. 2012).

Important Considerations for All Family Therapists

Stith et al. (2012) argue that domestic violence is a critical issue all marriage and family therapists should be familiar with as studies have demonstrated that between 36 to 58% of couples seeking treatment have experienced male-to-female physical assault in the past year, and 37% to 57% have experienced female-to-male physical assault. This means therapists should be skilled in appropriate techniques for screening and monitoring for domestic violence in order to determine if sessions with both partners present can proceed safely. Appropriate guidelines for screening include conducting separate individual interviews with both partners, as well as using both written and verbal screening questions.

The narrative approach highlights the already well-known therapeutic idea that all clients come into the therapy process with a problematic story to tell. The challenge for family therapists using the narrative approach could be how to appropriately make room for the untold stories that lie beneath the story being told in session. These stories may not have been talked about due to fear of consequences, shame or confusion, or because other members of the family are not willing to listen. Rober, Van Eesbeek & Elliot (2006) argue for taking a dialogical view when approaching highly sensitive or charged topics such as domestic violence. With this view, storytelling is viewed as collaborative social performance which includes all members of the family in session as well as the therapist themselves. In their research, they identified two adjacency pairs from conversation analysis (CA) “ invitation & acceptance and hesitation & reassurance - which appeared in their microanalysis of a family session where domestic violence was being revealed and can help a family therapist understand how the sensitive topic of domestic violence can emerge in session.

The concept of adjacency pairs basically states that when someone says something, it then naturally creates a slot for another person to fill in an expected way. This can be seen in question-answer or greeting-return greeting interactions. Key in both these interactions is reassurance provided by other persons in the conversation. For the first adjacency pair, invitation & acceptance, the adult couple in the case study family were speaking of arguments they have had when the mother changes the topic to an instance where her partner pushed one of the children. This can be considered the invitation by the mother to speak of a possibly abusive scenario. The male partner agrees with her story, providing the acceptance of the invitation and reassurance that this story is acceptable to continue and be spoken about in session, and allows for other members of the session to become part of the story. At this point the therapist asks, So there is fear of aggression in the family? and is able to begin to address the topic of domestic violence in the household (Rober et al., 2006).

The second adjacency pair, hesitation“reassurance, is seen when the mother is addressing why the family is coming to therapy, stating her worries that her two boys fight aggressively and often with one another. The therapist hesitates to accept the invitation of this topic of discussion because he has only observed the boys playing respectfully and quietly in the room, and senses danger that the children might be blamed. The therapist expresses surprise and does not accept her invitation to talk about the violence between the boys, but rather points to their current cooperative behavior. Only when the mother verbally stated her reassurance by recognition of their current positive state, and the boys provided reassurance to the therapist in agreeing with their mother that they do in fact fight violently with each other, does the conversation then proceed to talking about violence. This illustrates the use of interpersonal negotiation in the raising and taking up of conversationally delicate topics such as domestic violence with respect to assuring the safety of everyone in the room (Rober et al., 2006).

The research suggested that in instances of sensitive topics, an implicit negotiation is occurring in the dialogue of everyone in the room, where reassurance by other members is provided or not provided in the event of an invitation of or hesitation to a sensitive subject. This reassurance can either encourage and support the development of the new narrative, or when the reassurance wasn't provided, the invited story was withdrawn or suppressed. In the back-and-forth process of the dialogue being created by the family, it appears the level of safety in the session is concurrently being weighed by all members of the room. Only when the invitation or hesitation can be provided with reassurance does it becomes possible for the sensitive experiences, such as violence in the family, to be talked about. It is important for the therapist realize they too can invite new stories to be told, be hesitant or even silence stories of violence and suffering, just like the other participants in the conversation (Rober et al., 2006).

Conclusion

As we can see, the research shows that domestic violence still occurs in a significant amount of couples' relationships, which may reach as high as 50% (Stith et al. 2012). It is therefore clearly implied that all marriage and family therapists will eventually work with couples and families that have been affected by this violence. It is essential for therapists to understand the necessity of and how to first screen couples individually for relationship violence. Just as important is reevaluating the acceptance of the standard Duluth educational model regarding relationship violence, which characterizes domestic violence as a controlling male perpetrator and female victim. Research clearly shows both men and women perpetrate relationship violence, and both men and women can be victims. Systematic approaches such as Behavioral Couples Treatment or Domestic Violence Focused Couples Treatment show promise in working with couples who has chosen to stay together after violent incidents and have underlying issues such as substance abuse. Particular benefits appear to be had for men when working in multi-couple group formats. Narrative approaches show promise above the Duluth model in its use of empathy and allowing clients to tell outside stories as tools for reframing and deconstructing. This allows for less aggressive confrontation of irresponsible stories and avoids supporting the adversarial relationship dynamic which may be conducive to domestic violence occurring in the first place. Family therapists approaching domestic violence work with their clients would benefit from a closer review of these alternate theories and interventions.

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