Case Stiudy

Subject Social Work Topic Case Study 7-4: Group Work with Men Who Batter

Paper details
Group Work With Men Who Batter
RICHARD M. TOLMAN AND LARRY BENNETT

Social workers often work with nonvoluntary clients. This case study describes a group model of working with such clients because of battering behavior.

Questions

1. How can social workers respond to denial when working with nonvoluntary clients?
2. How did the social worker use confrontation in working with the resistant client?
3. What interventions contributed to the changes described in the client?
4. How does group treatment address the special circumstances of men who batter?
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Sam, a White 26-year-old laborer who lives in a working-class suburb, was referred by the court to a group program for men who batter. He is employed full-time, earning about $20,000 annually. Sam has been arrested three times. His most recent arrest was for the battery of his wife. He received 6 months’ probation and was mandated to attend domestic violence counseling. He had two previous arrests, one for auto theft when he was a teenager and one 2 years ago for disorderly conduct.

At the initial intake interview, Sam was secretive, and it seemed that he did not want the worker to know much about him. His flat affect and deceptive manner made it appear that he thought the agency was out to get him rather than help him. This type of presentation was not unusual for a court-ordered client. For the most part, men who batter do not come to treatment voluntarily. They are generally either court-mandated or “wife-mandated”; that is, their partners left or threatened to leave the relationship unless they receive counseling. Our experience is that despite the men’S nonvoluntary status, they may be helped, and a court order can actually facilitate progress when they might otherwise drop out. In fact, some evidence suggests that batterers’ contact with the criminal justice system in itself is effective in reducing violence (Sherman & Berk, 1984). In a national study of 840 male batterers and their female partners, court-ordered participants were more likely to complete the batterer intervention program and were less likely to reoffend than were participants who were in the program voluntarily (Gondolf, 2002).

To enter the program, men must minimally be willing to admit that they have battered and to verbalize a willingness to take responsibility for change. Ongoing denial of battering and responsibility for it is common and expected and must be confronted throughout the treatment process.

An important step in the intake process is taking a history of past and current abuse. The history taking may be facilitated by using structured interview protocols and checklists. In this case, the use of such checklists revealed that Sam had a significant history of both psychological and physical maltreatment of his partner, including interrupting her eating and sleeping; refusing to let her see people; frequently insulting, swearing, and screaming at her; threatening to hit her; pushing, grabbing, and restraining her; slapping her; driving recklessly to frighten her; throwing objects at her; hitting her with his fists; and hitting her with an object.

Generally, men who batter will minimize or deny their violent behavior. In addition, they may attempt to use the treatment program manipulatively, perhaps to convince their partners not to leave them or to drop charges in the court system. Treatment for the men can be stressful and can inadvertently increase the risk of abuse. Therefore, contact with the men’S partners is crucial in delivering safe services. When Debbie was interviewed, she corroborated Sam’S account of the violence. The fact that Sam accurately described his violent behavior was a good sign that he could come to take responsibility for his behavior.

At intake, Sam was asked about his own alcohol and drug use, and his perception of the role of drugs in his violence. This information is important, because untreated substance problems make progress in treatment for violence unlikely. Many clients attribute their violent behavior to the effects of the substance. It is important to uncover and challenge such a defense in treatment. In this case, Sam attributed none of his violence to alcohol or drugs. He has been abstinent for 5 years. His family history (adult child of an alcoholic, brother with drinking problem) and his own history suggest that he is an alcoholic (he reports blackouts, drinking-related amnesia, friends and family expressing concern about his drinking, and trying to cut down unsuccessfully). He has, however, maintained his abstinence without involvement in any treatment program or attendance of Alcoholics Anonymous.

Sam grew up in an alcoholic, violent family. His father and stepmother are active alcoholics. Sam’S brother is currently facing a prison sentence for a felony. Sam witnessed physical abuse of his mother, and he was physically abused. As Straus, Gelles, and Steinmetz (1980) report, both witnessing and being a victim of abuse in one’S family of origin are predictors of subsequent abusive behavior.

Sam met his wife, Debbie, when he was 21, 5 years earlier. At that time she was 15 and working as a waitress. He was attracted to her because she was “cute.” He had been dating her for 1 week when he was kicked out of his home. Debbie’S mother invited him to move in with their family. He never moved out. The first year of their relationship was stormy because of “forced closeness.” Sam felt he was underemployed. He blamed money for the arguments between him and Debbie. He described his in-laws’ household as very stressful.

Following intake, Sam was placed in an ongoing group. The group approach is preferred over couples or individual treatment for several reasons. Despite obvious problems in Sam and Debbie’S relationship that might warrant couples counseling, conjoint sessions are potentially dangerous if undertaken before a man successfully stops his violent behavior. The safety necessary to foster cooperation and adequate self-disclosure cannot be assured while men are actively violent toward their partners. Conjoint therapy may compromise the goal of changing violence because of its emphasis on strengthening or healing the existing relationship. Some men won’t change until they are threatened with loss of their partners and, in the couples treatment context, a woman may not be able to safely explore her ambivalent wishes to leave the relationship.

Furthermore, counseling in a couples context may be implicitly victim-blaming. Men have frequently told their partners that the battering would stop if she only changed her behavior. Bograd (1984) points out that there is a subtle but crucial difference between suggesting that a man’S partner modify her behavior to protect herself and suggesting that she initiate events so that she can control him. As a result, even couples counseling that explicitly focuses on a woman’S safety may reinforce a man’S projections of blame on his partner. Although conjoint work to deal with marital discord can be very useful, it should not occur until the primary problem of violence has been addressed successfully and the woman feels safe when participating in the sessions.

A group format offers the men a variety of models and sources of feedback for learning to self-observe, change cognitions, and interact differently. Although many men who batter express regret about their behavior, they are given mixed messages by those around them. The importance of having other men in the same situation saying “I don’t like what I am doing and I want to stop” supports a commitment to nonviolent behavior. In a follow-up study of a program for men who batter, Gondolf (1984, 2002) found that men ranked the group support as the most important element in helping them to stop their violence.

Sam’S group treatment had several goals. First, Sam had to take responsibility for his violent behavior. This required confronting his denial. Second, he needed to learn skills to help maintain nonviolence. The necessary skills include self-observation, time-out, cognitive restructuring, and interpersonal skills training. They will be described in more detail in the following sections. Third, Sam needed to examine and adjust his attitudes and expectations that encouraged his violence. Fourth, it was hoped that Sam would begin to explore his family of origin and other personal issues that may be related to his violence.

The main ingredients of the group experience are the support and confrontation of the men by other group members and the leaders, education practice in group, and homework assignments. Each group session is relatively structured and begins with a check-in. At check-in the men report if they have been violent or controlling in the past week and if they have used any of the techniques they have learned in group. Problematic situations are then discussed in group in detail, and various techniques are practiced further. This work with the problematic situations the men describe is followed by discussions of specific themes, such as men’S control of women or sexually abusive behavior.

In the first sessions with Sam, the primary focus was on helping him take responsibility for his violent behavior, to begin to observe the behavioral chain that leads to violent behavior, and to practice time-outs. Initial training in self-observation begins at intake. The use of a contract for nonviolence encourages men to identify physical, cognitive, affective, and situational cues for violence. Once these cues are identified, a plan for using alternative coping behaviors can be formulated. The metaphor of an early-awareness system is used: Intervention is easier when the cues are identified at subtler, earlier points in the chain of events.

Time-out is a crisis intervention technique that a man can use to take a break from conflict when he feels himself becoming extremely tense in a conflict. Men can use time-out to short-circuit what might become an abusive act. Time-out may include leaving the house or closing oneself in a room alone. Time-outs give men the time to use relaxation techniques, to problem-solve solutions to the conflict, or to reach out for support from others. The skill is often taught quite early in treatment, at intake, and may be incorporated into a no-violence contract, in which a man identifies high-risk situations and agrees to use a time-out or other skill rather than become abusive. When men first join the group, the leaders assign practice time-outs to help the men learn the technique and to troubleshoot problems in the men’S application of time-out. Noncompliance with the assignment often becomes a point of confrontation.

For Sam, one problem in using time-out was that Debbie at times tried to block his leaving the house. This problem actually occurs frequently. Partners may perceive time-outs as an attempt to avoid discussing an issue or an attempt to punish her by withdrawing. Many men do abuse time-out in these ways. For Sam, the group helped him problem-solve ways of getting out of the house or taking a time-out when he needed to without using physical aggression toward Debbie.

At first, Sam disclosed relatively little in group. He seemed to have very little ability to be introspective. As he began to discuss details of his life, it was clear that he saw the conflicts he faced with Debbie as totally her fault. Although the leaders and group members could empathize with Sam’S pain in the relationship, these descriptions were not accepted at face value, and limits were set on Sam’S use of the group to complain about Debbie. The importance of keeping men focused on themselves rather than on their partners cannot be emphasized enough. If unchecked, the group sessions could easily become exclusively focused on how badly treated the men are by their partners. It is critical for the group leader to listen empathically to the men’S complaints and the pain that underlies them but to appropriately refocus the group discussion on the men’S responsibility for change. When modeled appropriately in the group, the other members begin to take over the function of confrontation from the leader. Such peer confrontation is more powerful, because it is perceived as coming from someone else who knows what it is like to be in the group member’S place.

At first Sam was not confronted very directly in the group. His denial was addressed, however, in several ways. First, as mentioned, limits were placed on his complaining about his wife. Second, other members modeled taking responsibility for their own behavior. Gradually, the confrontation became more direct.

In the 10th session, Sam discussed an argument he had with Debbie:

Sam: I work two jobs and she just lays around. She’S lazy, she doesn’t work, and she doesn’t even keep the house clean—her mother does all that. She’S like a teenager. And then she goes out and bangs up my car.

Co-leader: You’re blaming your wife for everything that’S wrong in your relationship. What can you do to improve the situation?

Member 1: Yeah, you need to take more responsibility for problems at home. You’re just trying to make it seem like your abuse is her fault.

Member 2: You don’t even face the real problems. You just give us your “magic fairy” report every week. You have a big blowup, and then the next day everything is fine. You don’t talk over the issues with her; you don’t tell her the feelings that were underneath your anger—a magic fairy just comes and takes the problem away.

Member 3: That’S stuffing—just like it talks about in the manual.

Member 2: Yeah, you’re “saving stamps,” man. If you don’t work on the real issues and tell her how you feel, you are just going to store up those resentments and blow up again. We don’t want to see that happen to you. You’ve got to get your head out of your ass and start to take care of yourself.

A group discussion of how to deal with resentments followed. The group leader followed up and asked Sam to focus concretely on what he could do between sessions to improve the situation. The plan was for Sam to praise Debbie for doing the bills. By framing the general discussion of the group into a specific homework assignment for Sam, the worker extended the work of the group into the week. Behavioral change was promoted by giving a concrete task and holding Sam accountable for accomplishing it. This particular directive had several purposes. First, in asking Sam to praise Debbie for her help, Sam had to take responsibility for using positive reinforcement rather than coercion in dealing with the issues he has with his wife. Second, focusing on praising Debbie for her help got at the issue of entitlement that Sam felt in regard to her labor. Frequently, men assume that they deserve their partner’S labor and that she simply must comply with his requests for what she must do in the home. In this case, Sam was getting the message that labor in a relationship is negotiated and that he is responsible for showing Debbie that he appreciates those things she does for him in the relationship. Thus, the group challenges a sexist attitude that contributes to violence against women, because that attitude diminishes the status and value of women.

This directive also illustrates an initial application of interpersonal skills training. Men who batter are often limited in their ability to resolve conflicts with others assertively rather than passively or aggressively (Rosenbaum & O’Leary, 1981). An important component of group treatment for men who batter therefore involves teaching the man new interpersonal skills for conflict resolution. Applying skills training procedures with men who batter requires that a specific set of skills be identified and then taught to men, using situations that are personally relevant to them. Training in nonviolent conflict resolution often focuses on the man’S ability to identify and express his own feelings about what is happening, identify and state his partner’S point of view, offer solutions from which both he and his partner will benefit, and negotiate a final compromise.

It should be noted that although completion of the assignment might have led to improvements in Sam’S relationship, that was not the purpose per se. The function was to teach Sam noncoercive means for dealing with conflict and with his feelings. It is possible that Debbie will not fulfill Sam’S expectations for her behavior, despite Sam’S attempts to change himself in a positive manner. In such a case, Sam would be reminded that his responsibility is to act noncoercively, despite her actions. Abusive behavior is never justified, however uncooperative she may be.

At the next session, Sam reported that the arguments with Debbie had continued and that he did not complete his assignment. Interpersonal skills training continued. Training often begins, as it did with Sam, by identifying interpersonal situations in which the man has experienced difficulties. Various ways of achieving a more positive outcome are explored in the group. After sifting through the alternatives, the man chooses one that is most likely to increase the chances of a positive resolution. This alternative can be demonstrated by the leader or a group member. After observing the modeling, the man rehearses the new skill, with someone else playing the role of his partner. Group members then offer feedback on the man’S performance, and he may optionally rehearse the new skills a second time to incorporate the feedback. The skills training usually culminates with an agreement to use the new skills in an upcoming situation and report back on the effect.

In this session, the leader spent 10 minutes of rehearsal with Sam on how to praise his wife. During this discussion, several men praised Sam’S empathic presentation of his wife’S chronic unemployment problem. The evidence for Sam’S progress in this session is mixed. His empathy indicated a willingness to view Debbie as a person rather than as an object. This empathy reduces the probability of violence and suggests that Sam was internalizing the group content. However, his issues of control appeared to be surfacing around homework completion. In regard to the noncompletion of his previous assignment, the leader reinforced the importance of assignment completion by confronting his noncompliance and dealing with it in a concrete manner. He was reassigned the same homework.

The following session demonstrated Sam’S progress vividly. His adoption of new prosocial behavior is mirrored in his group behavior as well as reports of behavior outside of the group. Sam collected the group members’ fees, a shared group responsibility, for the first time. He reported that he completed his assignment, to tell his wife that he appreciated her doing the bills. She blushed and felt good. Sam also reported a surprising improvement in the home situation: Debbie got a job.

During the next group session, Sam was discussing his relationship with Debbie and frequently remarked, “I’m just stupid.” The group leader pointed out how easily Sam slipped into such negative self-talk; this was an opportunity to apply some cognitive restructuring techniques with Sam. Cognitive-restructuring techniques teach individuals to analyze and modify maladaptive thinking patterns. A man’S rigid beliefs about how he and his partner should behave in a relationship increase the probability that he will be violent. Several interlocking steps are involved in the application of cognitive restructuring in groups. In discussing situations the men have encountered during the week, the following steps may be used: (1) elicit internal dialogue; (2) identify underlying irrational beliefs and faulty assumptions; (3) challenge irrational or faulty beliefs; (4) replace irrational or faulty beliefs with more realistic appraisals; and (5) generate self-instructions for using nonviolent coping behavior.

Much of Sam’S negative self-talk in this case was self-referent; that is, he was making unrealistically negative appraisals of himself and his abilities. He had difficulty generating positive self-appraisals, so the leader asked if Sam would listen while the group made positive statements about him. Sam said he would listen, because nobody ever made positive statements about him. The depth of his problems with self-esteem and the role of his family of origin in the genesis of those problems was then revealed in his apparent off-task comments about his brother’S impending prison sentence and how his father’S long drinking binge put his family deep in debt.

The leader refocused the group on giving Sam positive feedback and then asked the group to proceed. About half of the group was able to give him positive comments. Sam was pleased with the feedback from the group members. Following the feedback, Sam commented that he wanted his brother-in-law to come to the group: “I didn’t realize the different types of abuse there are; my brother-in-law is emotionally abusive.”

Sam’S comment illustrated that progress had been made on several important treatment goals. His recognition of his brother-in-law’S emotional abusiveness demonstrated that Sam had come to redefine abusive behavior more broadly. He no longer limited his definition of abuse to physical aggression. Of course, it is critical that Sam recognize his own use of such behaviors and not focus only on others’ behavior.

This session also illustrates how the group becomes an instrument of social change. Frequently, group members begin to reach out to their own social networks—and the abusive men that they know—to bring them to group (Douglas, Bathrick, & Perry, 2008). Such action can be seen as a demonstration that an individual man has internalized the need for change—confronting another man about his abuse takes a degree of courage and self-disclosure. In doing so, the man has begun to exercise an influence on his environment. One of the most important maintaining causes of violence against women is the lack of negative social sanctions and the sometimes overt social support for abusive behavior that men receive from other men around them. When men begin to confront other men, they are removing some of that social support. Involvement of men in efforts as allies in working to prevent violence against women is growing worldwide, and these efforts within programs for men who batter are part of the continuum of change efforts (Tolman & Edleson, 2011).

The need for Sam to focus on his own controlling behavior was apparent at the next session. Sam did not come to the group. He had called the crisis line earlier, saying he had gone to Debbie’S workplace and been told by her boss that it didn’t matter if she came in or not because she was always late and a poor worker. This checking-up behavior was illustrative of his need to control and infantilize his partner.

At the next session, Sam demonstrated that he continued to redefine abuse for himself and was beginning to address his responsibility for behavior change. During the group, Sam described as abusive his breaking of a mirror while talking on the phone. He recognized this behavior as indicating that he was at risk of using direct aggression toward his partner and that breaking a mirror could imply a physical threat to Debbie. The group confronted him on his checking up on Debbie at work, and Sam was able to see how such behavior illustrated his need to control Debbie.

Some of the core cognitions that support Sam’S abusive behavior were also identified and challenged in this session. Sam began to discuss his belief that he was worthless without his partner. Such beliefs may lead men to extreme behaviors to control their partners. A plan was developed for how Sam can directly enact behavior that further challenges this irrational belief. He was to attend groups for adult children of alcoholics, to spend some time by himself away from Debbie, and to monitor his feelings of worthwhile with these people.

This session also began a direct focus for Sam on his family of origin. He began to be in touch with his own victimization as a child. Focusing on family-of-origin issues can be a tricky process. On the one hand, it is helpful because it can help Sam begin to empathize with Debbie and what his victimization of her feels like. He can begin to understand the role of his early learning in a way that can lead to healthier coping behaviors—that is, caring for himself rather than coercing Debbie into fulfilling his needs. However, a focus on family-of-origin issues can be counterproductive if it deflects responsibility and defocuses Sam and the group off of the primary issue of his current abusive behavior.

In the next session, men’S control of women was the theme. Sam was quiet during most of the group. In commenting on another member’S attempt to control his wife, Sam compared the man to his own father: “I was scared of him all the time. . . . If I would have stood up to him we would be talking today, but we aren’t.” Sam revealed that he recently told his father that he was coming to the group and that he wanted to live his life differently. His father was scornful. Despite the unsupportive response of his father, his self-disclosure to his father illustrated that Sam was actively integrating the work of the group into his life.

As it turned out, this session was Sam’S last mandated session. His court supervision ended the following week. Through the period of his mandated treatment, Sam progressed steadily. He moved from blaming his partner for his abusive behavior to a sense of responsibility for his own behavior. He expanded his definition of abuse beyond direct physical aggression and began to modify his other abusive behavior, actively applying the skills that were taught in the group. He made linkages between his current problems and the problems in his own family of origin. He applied this connection positively; that is, he began to challenge family members to accept his new definition of himself as someone who was attempting to live nonviolently. He had initiated linkages with other services. The challenge for Sam in participating in the group following his completion of the court mandate is to maintain these changes and to progress.

CONCLUSION
Although this case focused primarily on intervention with one man in a group setting, it is important to recognize that the intervention did not occur in isolation. Intervention for men who batter needs to be part of a comprehensive, multisystem approach to ending violence. At a minimum, intervention in any community should include (a) immediate protection, support, and advocacy for battered women and their children; (b) intervention for the abusive men; (c) ongoing support and education for battered women and their children; and (d) coordinated intervention in social institutional responses to battering (Brygger & Edleson, 1987). When services are provided for men, they must be coordinated with intervention with other family members. If these services do not occur within the same agency, practitioners working with men must work to establish and maintain good working relationships with shelters and other agencies working with battered women.

A final point to be made here is that Sam’S treatment was facilitated by a court mandate. It is important for programs working with men who batter to coordinate closely with institutions that provide social sanctions for violent behavior. When working with criminal justice systems, social workers need to provide pressure for the courts to impose meaningful sanctions if the man is not successfully complying with program requirements (Pence & Shepard, 1999). A court-mandated client for whom no sanctions are delivered upon failure in treatment will soon learn that police, court, and social service actions are not credible. The resulting message will be that he can continue his behavior without serious consequences. The message to his partner will be that his abusive behavior is not to be taken seriously. Social workers must be proactive in working for change in larger systems so that they may provide effective direct service to men who batter.

REFERENCES
Bograd, M. (1984). Family systems approaches to wife battering: A feminist critique. American Journal of Orthopsychiatry, 54, 558–568.

Brygger, M. P., & Edleson, J. L. (1987). The Domestic Abuse Project: A multisystems intervention in woman battering. Journal of Interpersonal Violence, 2, 324–337.

Douglas, U., Bathrick, D., & Perry, P. A. (2008). Deconstructing male violence against women: The Men Stopping Violence community accountability model. Violence Against Women, 14, 247–261.

Gondolf, E. (1984, August). Men who batter: How they stop their abuse. Paper presented at the Second National Conference for Family Violence Researchers, Durham, NH.

Gondolf, E. (2002). Batterer intervention systems: Issues, outcomes, and recommendations. Thousand Oaks, CA: Sage.

Pence, E. L., & Shepard, M. F. (1999). An introduction: Developing a coordinated community response. In M. F. Shepard & E. L. Pence (Eds.), Coordinating community responses to domestic violence: Lessons from Duluth and beyond (pp. 3–23). Thousand Oaks, CA: Sage.

Rosenbaum, A., & O’Leary, K. D. (1981). Marital violence: Characteristics of abusive couples. Journal of Clinical and Consulting Psychology, 49, 63–71.

Sherman, L. W., & Berk, R. A. (1984). The specific deterrent effects of arrest for domestic assault. American Sociological Review, 49, 261–272.

Straus, M. A., Gelles, R. J., & Steinmetz, S. (1980). Behind closed doors: Violence in the American family. New York, NY: Doubleday & Co.

Tolman, R., & Edleson, J. (2011). Intervening with men for violence prevention. In Sourcebook on violence against women (2nd ed., pp. 351–371). Thousand Oaks, CA: Sage.

Wagner, C. & Ingersoll, K. (2013) Motivational Interviewing in Groups. Guilford Press.

Chapter 9: Phase I: Engaging the Group
Chapter 10: Phase II: Exploring Perspectives
Chapter 11: Phase III: Broadening Perspectives
Chapter 12: Phase IV: Moving Toward Action
LeCroy, C. (2014). Case Studies in Social Work Practice (3rd ed.). Wiley & Sons.