Group therapy intervention for male batterers: A microethnographic study.
Treatment of male batterers has been a controversial issue for study and practice in the field of behavioral health care. Empirical evidence on success of treatment of male abusers is mixed. Little is known about what makes a treatment successful for an individual abusive man. Knowledge of how batterers learn and change in therapy and how they apply this learning in their day-to-day lives can be useful in designing successful treatments. The microethnographic study of a group therapy for male batterers discussed in this article describes change processes in abusers and examines the dynamics of unsuccessful processes. In doing so, this study provides a useful evaluation of group therapy as it is offered to batterers. The authors conclude by discussing the implications of micro ethnographic methods for social work students learning to evaluate their practice.
Domestic violence--the physical, sexual, and emotional abuse of an intimate partner--is a growing social problem in our society (Caplan & Thomas, 1995; Davis, 1995). Domestic violence occurs in all types of intimate relationships, including dating, married, common-law, separated, and divorced couples. Compared with men, women experience more than 10 times as many incidents of violence by an intimate partner (Bachman, 1994).
Although a partner of any gender can engage in violent acts, women are more often the victims and report more injuries (Davis, 1995). Approximately 1.5 million women are assaulted sexually or physically every year in the United States (Tjaden & Thoenner, 1998). Recently, it has come to light that "serial battering" may be a serious problem ("Editorial," 2000). Out of all serial batterers tracked in Massachusetts between 1992 and 1998,87 percent were men, who had two to eight different victims ("Editorial," 2000). This is an alarming trend that supports a close look at change processes for male abusers. Domestic violence disrupts couple relationships and family life, causing deep emotional scars leading to mental health concerns for the abusers, victims, and children (Davis, 1995; Gelles, 1974; Parisi, 1992).
Although the controversy between use of punitive and rehabilitative approaches to dealing with abusive men is unresolved, we believe that treatment of male abusers, along with the empowerment of victims, is vital in rebuilding healthy families and preventing future episodes of domestic violence; hence, our interest in exploring change processes in therapeutic group treatment of male batterers.
Group treatment is the most common mode of intervention with male abusers. The feminist movement of the 1970s brought the problem of domestic violence to the forefront and compelled the criminal justice system to respond, resulting in development of group treatment interventions for male abusers. These models commonly integrated cognitive--behavioral, social learning, communication, and feminist theories to alter the behavior of male abusers, (for example, Domestic Abuse Project, 1993).
Some studies of group treatment for male abusers reported a decrease or cessation of physical violence immediately after treatment and at 6 months follow-up among program completers (Deschner & McNeil, 1986; Edleson & Grusznski, 1988; Hamberger & Hastings, 1988; Saunders & Hanusa, 1986). The decrease or cessation of violence appeared to be greater among severely abusive participants. Verbal abuse, however, seemed to continue even after treatment. Some studies reported a high attrition rate of participants, ranging between 23 and 51 percent (DeMaris & Jackson, 1987; Edleson & Tolman, 1992; Pandya, 1996). High attrition rates of study participants can result from not completing treatment and the difficulty in locating treatment completers at follow-up. High attrition rates make it difficult to interpret the overall effectiveness of treatment programs.
Some studies (DeMaris, 1989; Edleson & Grusznski, 1988; Grusznski & Carrillo, 1988) identified factors associated with completion or non-completion of treatment. History of mental health treatment, prior arrest, addictions, nonspouse abuse, unemployment, and low income were factors associated with noncompletion. Men with a higher level of education, steady employment, and exposure to violence but not abused were more likely to complete treatment. Contrary to this finding, Hamberger and Hastings (1986) reported men abused as children were the ones who voluntarily accepted and followed through with the treatment.
Edleson and Syers (1990) reported that the education model (using cognitive-behavior therapy, social skills training, and problem-solving skills training, by themselves or in combination) was more effective than a self-help approach. An education model combined with a self-help approach was most successful in bringing about long-lasting change in violent behavior (Edleson & Syers, 1991). The same authors also reported that 12-week groups were more effective in immediate reduction and elimination of violence, whereas long-term, open-ended, self-help groups were needed to sustain nonviolent behavior over a period of time.
Although we know more now than we knew two decades ago about what factors are associated with completion of treatment, relatively little is known about the dynamic interaction between abuser characteristics, components of therapy, and the change process itself that leads to successful therapy outcomes. Such knowledge could be vital in developing new models for reducing treatment dropouts, improving outcomes, and reducing the rate of "serial batterers." We find success stories in men of diverse backgrounds, even among groups of men who have a history of mental disorders, substance abuse problems, and involvement with the law enforcement system. However, we do not know the reasons why men decide to change and how they learn to become nonviolent and maintain a nonviolent lifestyle in the future. This gap in knowledge led us to conduct a microethnographic field study of abusive men in group therapy.
The research questions that guided our study included the following:
1. Who is the abuser?
2. How does the abuser describe himself and his relationships
3. How and to what did the abuser connect during the therapeutic social situation?
4. How does the abuser describe his process of change?
5. How does the abuser attempt to transfer the learned behavior to his intimate relationship?
6. Are there patterns of change across abusers?
The University Institutional Review Board approved the study procedure described in the following sections. We used microethnography in a short-term study of a single group situation to understand the culture of abuse as experienced by abusers themselves and when and how they decide to transform themselves. Culture, in this context, is the complex meaning system that abusers use to organize their behavior, to understand themselves and others, and to make sense out of the world in which they live.
A social services agency in a midwestern city offering group therapy to male domestic abusers was selected as the site of this study. The agency was geographically accessible, and the agency and therapist showed interest in this study and a readiness to participate in it. The agency is located in a blue-collar community where street violence is common. Most of the clients of this agency are court referred.
The agency offers the Compassion Workshop program developed by Stosny (1993), which is based on attachment theory. Compassion is presented as an incompatible emotional response with abuse--a compassionate person cannot be abusive. The therapist shares the treatment manual (Stosny, 1993) with all the group members. Group therapists are advised to be structured and didactic in the beginning, until clients learn basic skills to regulate anger, hostility, and anxiety.
The therapy consists of six modules, which are covered in 12 weekly two-hour sessions. The first module is "healing" and runs through three sessions. During the first session, the group members watch a video, Shadows of the Heart, depicting a scenario where a man under the influence of alcohol physically hurts a woman and the woman clings to her child in an effort to save herself and her child from the beating. There are a series of questions to guide the discussion of the video. The session ends with each member working out a temporary safety plan.
The second session provides information on physiological and psychological aspects of anger arousal. The third session introduces the group members to the process of HEALS (healing, explaining to self, apply self-compassion, love yourself, and solve) to control anger. This session guides the members to heal the core hurts they may be suppressing from their earlier experiences. The members are urged to practice by recalling earlier incidents of anger.
The second module, "compassion," covers what compassion is, why have compassion, and how compassion can lead to positive interactions. The third module, "self-esteem," is presented in the fifth and sixth sessions, and helps members to understand and analyze their self-esteem and differentiate between ordinary feelings and defenses. The fourth module, "empowerment," spans the seventh and eighth sessions and discusses relationships, communication, and empathy as empowering tools.
The fifth module, "negotiating an attachment relationship," discusses resentment and the effect of fear of abandonment or engulfment on the attachment bond. The last and sixth module, "relapse prevention," consists of two sessions and ends with writing and processing a final apology letter to each member's victim. (For further details, readers should see Stosny, 1993, in the reference list for contact information.)
Because this was a short-term study, data collection was limited to observing one complete group treatment program (12 sessions, two hours each) using passive participant observation. In passive participation an ethnographer is present at the scene of action but does not participate in or interact with the research participants to any great extent (Spradley, 1980). One of us (Pandya) observed the group sessions and attempted to take verbatim notes of what participants said. Observations of their nonverbal behaviors were jotted down during the sessions. Data from the agency files of the group members and homework assignments were reviewed. Discussions with the therapist were used to help understand the implementation of therapy.
Framework for Data Analysis
We used ethnographic domain and theme analysis as suggested by Spradley (1979, 1980). Domain analysis involves discovering cover terms or names of things, including objects, places, people, processes, and the like. We classified domains in the data under the relevant research question. For example, when a participant shared with us historical moments in his life, we related it to the question, "Who is the abuser?"
Themes are principles "recurrent in a number of domains, tacit or explicit, and serving as a relationship among subsystems of cultural meaning" (Spradley, 1980, p. 141). Because our research questions focused on discovery of the change process, we looked for relationships between domains, using the strategy of thematic writing of the change process as it emerged from each biography. We looked specifically for chronological or sequential patterns in these thematic writings. We also tried to stay close to the data and avoid making inferential leaps in discovering themes and chronological patterns.
We adopted a two-tier analytic process. In the first tier, each participant's process of change is presented in biographical form. In the second tier, shared contexts and experiences of change across subjects are examined.
BIOGRAPHIES OF TREATMENT COMPLETERS
Six of the eight group members (Bill, Mike, Sam, Stan, Dane, and Phil) agreed to participate in the study. (Names have been changed to safeguard confidentiality.) We present biographies written to match the sequence of research questions. We report Mike's biography in detail to illustrate how we constructed the biographies. The remaining five biographies are condensed to conserve space.
"Who was he and how did he describe his relationships?" Mike was a 31-year-old black man on a domestic diversion program that ordered him into treatment for 26 weeks. This was his first arrest and jail sentence. The experience had shaken him such that he was highly motivated to complete the treatment. On a domestic violence inventory, he accepted the problem and expressed regret at what had happened. He identified himself as a person who admitted mistakes, accepted constructive suggestions, and was adaptable, with a sense of humor. He frequently stated that he had full-time employment at a supermarket as an assistant manager in the video department and that he was liked at work.
He indicated that he was nurtured by his mother, that his mother was the one adult in his life who was lovable and loving, and that his mother had appropriately disciplined him. At school, he turned in his homework fairly regularly and credited that behavior to his mother. He recalled with gratitude that his mother had a rule that he could not hang out with his friends unless he completed his homework. He graduated from high school when most of his friends did not. "No matter what you did, she is always there." He never shared with us anything about a father or father figure. When specifically asked, he once responded that his brother was the most violent person he had known.
The physical abuse of his live-in girlfriend occurred over an argument that she was always on the Internet, keeping the only phone line busy. He was worried that his elderly mother would call with an emergency and would not be able to reach him. During the course of the therapy, Mike got another phone line to resolve the problem. "Gate also feels lonely, when I am at work. Being on Internet passes her time."
"How and to what therapeutic themes did he connect?" During the first session, Mike was very disinterested and yawned during most of the session. He missed the second session, but from then on he participated actively in the sessions. He identified with the child in the video and showed understanding for the woman's behavior. "The woman felt that having the kid in her arms would change his mind. But the child was scared." Mike related most to the HEALS practice and the theme of empowerment. He found that practicing HEALS prevented anger and resulted in his partner feeling more free to express herself, which led to problem solving. He also commented that, "At work I always solve problems--if I can do that at work, I can do it everywhere. My coworkers come to me with problems." He was most intrigued by learning the skill of formulating "I" statements. He had not used feeling words in his communications previously and anticipated that the listener, specifically his girlfriend, would make fun of him. The therapi st then reminded him that it would take time for the other person to adapt to the changed "you. He recalled then that when he began these classes, his coworkers made fun of him, but now they respect the changes in him. By session 8, he had become very friendly with group members and often pleasantly gossiped with them about amusing events in his day-to-day life. Mike's sharing in session 11 expresses the essence of his learning.
"How did he change and integrate empowerment in his life?" "Coming to these classes taught me that deep down I did have an anger problem. Earlier I did not believe it. It taught me not to react immediately, sit back. Earlier I would fly off the handle. Now I realize that there is nothing to argue about. I can solve problems. It makes me feel a lot better, more relaxed. First I always thought I am right. Now I think maybe I am wrong. I also don't leave the other person mad. I sit and talk it out and leave only when the other person is not mad no more. I have taught some of the skills to her. She reads my homework. She is understanding a whole lot about me. It is neat. When someone is not holding a grudge against you, you feel comfortable at home."
During the last session Mike wrote an apology letter in which he requested that his partner tell him if he ever slipped back to the earlier pattern of behavior. It appeared that he had found inner rewards to continue his changed behavior.
Bill, a 21-year-old white man, described himself as a person with low self-esteem who could not control his anger. He had experienced serious emotional and mental problems during the preceding year.
Bill described himself as a child who was hurt by the violence he witnessed between his parents. His emotional expressions centered on negative attitudes toward women (learned from his father) and rejection of dominating male figures like his father (who hurt his mother). He coped with these conflicting feelings by immersing himself in work and using anger to avoid depression. "I know people who 'catastrophise,' use anger to avoid depression."
In therapy, Bill was engaged by the concept of HEALS. He could describe the process of HEALS without referring to the handouts. In summarizing his learning, he emphatically stated that HEALS practice would help him, "don't get mad, control own behavior." He was aware of his impulsive nature and believed that control of his impulses was a necessary part of the solution. On his homework, he reported week after week that "he was not trying to resolve conflicts within himself, with fairness, compassion, and a desire to understand?' This went unshared and unnoticed by anyone in the group. Because he was in therapy only for six weeks, it appeared as if he left therapy without appropriate closure.
Sam was a middle-aged white man who had a history of arrests related to his behavior under the influence of alcohol. This was his first arrest for family violence. On the domestic violence inventory, he admitted to a substance abuse problem, but he denied having an anger problem. In the group, he was quiet, introverted, and contemplative. He stated, "I keep everything bottled up?' He was in the group for 12 weeks.
During therapy, he described two incidents that bothered him the most. One was when he learned from the bank that his wife had overdrawn on his credit card. He was more hurt than angry that she ignored him and treated him like a "paycheck." The second incident he shared was what precipitated his recent arrest and his being referred to this treatment. He was frustrated when his disobedient son walked out despite being grounded. Sam was under the influence of alcohol at the time, and he hit his son. He repeatedly stated that he had never dared to defy his own parents. "This is howl was raised. You are grounded--you don't walk out or nothin'."
Sam engaged himself in therapy during a session where communication using "I" statements was taught. He began practicing with his four-year-old granddaughter at home and reported proudly to the group that they were working! "She no more yells, and temper tantrums are down." The therapist encouraged him to continue to practice with a "safer" person, like his granddaughter, so that he would be prepared to use this approach with significant others when the time came. He was unable to take this leap by the end of the therapy, however. In the last session Sam was very reluctant to write an apology letter to his son. Other group members encouraged him to do so to set an example for his son to follow. He commented, "Wife is a wife, a son is a son, and a man is a man--some of these feelings are changing. I ain't a stranger to him. But he won't talk to me or none. We are not close now. It's a shameful bullshit. You cannot handle a family situation under influence. It is all over with. Just suffer the pain." In his be lief system the parent--child relationship is hierarchical and he was not yet ready to give it up. His introverted nature and grounding in traditional structures prevented him from progressing toward change at a pace set by the therapy. He was just beginning to get ready for change when the therapy ended. There was no real closure for him at the end of therapy.
CASE STUDIES OF TREATMENT NONCOMPLETERS
Stan was a 29-year-old white, divorced man. He was court ordered for 12 weeks into this program for battering his girlfriend. He continued in the program only until the third session. He identified with the abuser in the video. He emphatically stated that he liked anger as much as he liked compassion as an emotion. "I like it when I get up in the morning pissed. That's the way it is?'
During the third session when Sam shared the incident about his wife overdrawing on his credit card, Stan got angry. Although Sam's voice was devoid of anger, Stan commented that some things were really worth getting angry about. "Anger is sometimes justifiable. You don't ask her to come and take the beating... but ... like credit card issue ... she is ruining your credit." His nostrils flared, his face turned red, he was very angry. The therapist ignored Stan and continued her conversation with other group members. She did so because in the treatment manual (Stosny, 1993) the "'Foreword for Group Leaders" instructs one to ignore any and all attempts of "blaming the victim" and expressions of hostility and anger in the group. Stan reacted strongly to this behavior of the therapist, "I am going to ask questions! I am working and I will pay back to the bank. Anger is a normal reaction to wife's behavior." The therapist continued to ignore him. Stan did not return for any of the subsequent sessions.
Dane was a middle-aged white, divorced man, who talked about his "wife" and three "step-sons" throughout the course of the therapy. Dane attended six sessions. Dane denied having any problem with violence. He described himself as a workaholic. "Workaholism is a positive trait. It substitutes violence. Don't harm nobody." In his homework on goals, he wrote, "no change will occur. When out, [I am] ... done with it." He did not agree with the HEALS process, but made helpful remarks to other group members. When a member shared an incident about being cut off by another car in traffic, he volunteered, "Can we go back to core hurts? Did you feel disregarded and unimportant because the driver of that car did not care for you? Could it be that she was in a hurry to go somewhere and had nothing 10 do with you as a person?" Then he made a crass remark that her car should be crushed. He laughingly added, "just joking! I want some business because I own a garage." Sharing about his relationships with significant others, Dane narrated an incident with his ex-wife. He volunteered to repair the car for his ex-wife because "poor woman! She will face a lot of hassles when she will take the car to the garage. Then he did not do the work on time for her to have the car when she would need it. "He would do it when he has time! But the ungrateful bitch called him and cussed him for not doing the job in time!" Once Dane missed four sessions, he was dropped from the group as required by agency policy. Dane remained at the periphery, ambivalent about the treatment.
Phil was a 22-year-old white man who had five arrests, two for nondomestic violence assaults, two for domestic abuse, and one misedemeanor. He indicated multiple problems on the domestic violence inventory. Phil explained that anger was like a heat rush for him. He liked it. As the therapist went over the material on anger, Phil identified himself as an "anger junkie." He shared with the group, "I'm hurting a lot. I can't be compassioned. I have a bunch of damn pools. How can I deal with it myself? I am perceptive. I can analyze others but if I do that to myself, it gets me pissed." The therapist suggested Phil practice HEALS, to which he replied sarcastically, "Go and practice at home--'oh baby, you had a bad day and shit? I broke the lamp and the mirror that her grandma gave. I don't regret, what is done is done. I stay because of my kid and me. She stays because she wants to. Oh I'm compassionate, I cry on 'Free Willy'." Phil did not come for the next two sessions. When he came late for the fifth session, the therapist informed him that he was out of the group, and he would need to attend a group with another therapist. "Works for me," he said and banged the door as he left.
We laid the biographies side by side and read them repeatedly to identify themes we could use to describe common patterns of the change process in the narrative of each biography. The following themes occurred sequentially in the biographies.
"My violent behavior is something beyond my control." At the onset of the treatment, even though all group members were vaguely aware of the need for treatment and change, all of them externalized the responsibility for their own violence. For Bill, it was anger caused by someone else's behavior that made him lose his touch with reality. Mike thought the other person entering an argument was always wrong and therefore anger was justified. Sam justified his anger because others 'were disobedient. For Stan, anger was justified because of someone else's erratic behavior. Dane felt the others' expectations of him were unfair. Phil argued that if others could hurt him, he could hurt them too.
"The costs of violent behavior outweigh the benefits?' The treatment completers felt that the consequences of their violent behavior were bad enough that it was in their interest to change that behavior. For Mike, it was the lockup experience; for Bill, he was turning into the likeness of his father that he despised; and for Sam, his violent outbursts were breaking up his family. The treatment noncompleters, however, felt their violent behavior was meeting one or more emotional needs that were important for their survival. Stan and Phil said that they liked to be angry and that anger was often experienced as a positive emotion. Dane felt that immersing himself in work was good enough to cover up anger and that change was not necessary. Thus, notably, the treatment noncompleters skipped this step.
"I know what my problem is." The therapy helped group members identify their contribution to violent episodes: Bill--"my problem is uncontrolled anger"; Mike--" my problem is not listening to my partner and believing that I am always right"; Sam--"my problem is trying to solve problems [while] under the influence ... I must act like a man"; Phil-"I am hurting too much. ... I compensate my hurt by hurting others?' It is important to note that one noncompleter, Phil, was able to acknowledge his problem. Dane and Stan continued to justify their behavior and resist change.
"This part of therapy tells me how to resolve my problem." Each abuser engaged in therapy when he identified one or more components of therapy that seemed to address his identified problem. Bill, who was aware of his uncontrolled anger, devoted his energy to learning the HEALS technique for anger control. Mike, who was aware of his self-righteous attitude, identified that he needed to practice HEALS for problem solving and use "I" statements to communicate in a nonrighteous manner with his partner. Sam completed substance abuse treatment successfully and devoted his energy toward learning "I" statements to communicate openly with his family members. Toward the end of therapy, he began to realize a need for reformulating a masculine image for himself. Phil, who acknowledged his problem with violence, failed to engage in therapy because of the painful experience of change, He would have needed a strong support system to sustain him in the change process. The two members who lacked awareness of their problem, S tan and Dane, did not progress to this point in change process.
"Learning in therapy is changing me and my environment for the better." Bill recounted that learning HEALS helped him to "not get mad, to] control [my] own behavior?' Mike stated that he had learned to replace anger with the ability to solve problems calmly. This has helped his partner to forgive him and feel comfortable in their relationship. His coworkers, who initially made fun of him, began to respect him more as a result. Sam's gender role socialization prevented him from transferring his learning in therapy to his real life situation. However, he showed promise in building new relationships in a nonhierarchical manner, as demonstrated by his changing relationship with his granddaughter.
"I will continue to practice what I learned." Both Bill and Mike stated that the therapy was helpful and they would continue to practice in their real life what they learned in therapy. Sam was less clear about this phase of the change process; he neither adequately learned in therapy to transfer his learning to real life situations nor completed all he needed to learn, change, and maintain a changed self.
"I need to revisit past wrongs to my victim and apologize?' Although the therapy manual is clear about this as a final step in the change process for abusers, only Mike reached this stage because he learned to give up his self- righteous attitude.
Our findings are based on only six research participants in one group treatment program and clearly cannot be generalized to batterers in group therapy programs in general. However, the data provide some preliminary answers to our research questions by capturing the understandings of batterers about themselves, their environment, their learning in therapy, and most important the change process as it unfolded for them in this group treatment program.
The biographies describe who the abuser is, how he describes his relationships, and the factors that may have influenced him to connect to the therapeutic situation. For example, Mike projected himself as a person with comparatively high self-esteem, an able problem solver, and a nurturing person. He had positive relationships in his life, including that with his intimate partner. He lost his self-control when certain behaviors of his intimate partner caused extreme anxiety and worry about his mother's well being. He failed to communicate his feelings verbally to his partner at the time and on reflection, he learned that this was a general pattern with him. Mike connected with the empowerment module of the treatment program, the module that taught communication skills, presumably because he felt it was relevant to his particular situation.
Similar self-understanding is evident in other biographies, including those of treatment noncompleters. For example, Stan was honest in sharing his viewpoint that it is okay to experience a range of emotions from compassion to anger. He believed that anger was justified sometimes. Consequently, he was unable to link with the therapeutic situation because his beliefs were ignored. Perhaps, had the treatment program acknowledged Mike's viewpoint and helped him to examine critically how he expressed his anger, he might have engaged in therapeutic process.
The theme analysis points to common factors in how batterers described their process of change, and how they attempted to transfer their learning from therapy to real situations. The treatment completers not only acknowledged that they had a problem but also identified what that problem was. When the treatment program presented new information or skills that the participants thought would work for them in resolving their identified problem, they focused on learning that information and transferring it to their life situation.
Mike's story is the best fit with this process of change. It showed consistent results with the findings of studies reviewed earlier (for example, DeMaris, 1989; Edleson & Grusznski, 1988; Grusznski & Carrillo, 1988). He did not have mental health or addiction problems, was a high school graduate, had a steady job, and had high self-esteem-all the factors associated with successful completion of treatment.
When the change process discovered in theme analysis was matched with the stories of Sam and Bill, the other two treatment completers, we learned that their movement through the stages of the change process was slow and difficult. Sam had a history of addiction, a factor associated in the literature with treatment noncompletion. What then worked for Sam? His successful substance use treatment and his commitment to his family seemed to be important factors that kept him in therapy. However, his progress was blocked at the last stage of the change process because he was not able to overcome his traditional masculine identity and role.
Bill, who had a history of mental health treatment, a factor also associated with unsuccessful outcome of therapy, completed this treatment program successfully. Why? Bill did not want to continue in the image of his abusive father, and therefore he was committed to learn to control his anger. He focused on practicing HEALS to control his anger and began transferring his learning to his life situation. However, Bill acknowledged unresolved issues such as inner conflicts and lack of self-compassion, which put him at high risk of relapse.
The stories of three treatment completers suggest that individual abusers may move through the change process at different paces depending on what barriers they have to overcome to connect with the therapy. It also suggests that a history of addictions and mental health issues by themselves may not be determining factors in predicting successful treatment outcomes.
The biographies of treatment noncompleters in our study suggest the need for flexibility and perhaps more individualized services to engage batterers in therapy. Dane showed a need to control, a problem much discussed in the literature on domestic violence (for example, Domestic Abuse Project, 1993; Edleson & Tolman, 1992), but not addressed by this therapy model. Phil needed a strong support system to help him through the intense emotional pain associated with change. Stan showed cognitive errors that led to a denial of problematic behavior and possibly could have benefited from a cognitive-behavior component in therapy. These findings suggest that it may be useful to provide supplementary services as needed and to allow for more flexibility in incorporating modules from different therapy models.
The findings of this short-term qualitative study of change processes among male domestic abusers are tentative, with limited ability to generalize. We need more studies that closely examine change processes in this population to substantiate the validity of the findings of this study. Formative evaluation research of treatment that integrates some of the practice suggestions we made would enhance practice development with this population. Using confirmatory designs to establish the stages of change process among this population has potential to make worthwhile additions to the development of change process theories.
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|Author:||Pandya, Varsha; Gingerich, Wallace J.|
|Publication:||Health and Social Work|
|Date:||Feb 1, 2002|
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