The General Role of 'Perpetrator' Treatment

Mandated group treatment  for primary aggression is more a sociological intervention than a psychotherapeutic one. The first goal of 'perpetrator' treatment is safety of the survivors. Enrolling primary aggressors in a treatment group can advance survivor safety in four ways.

First, treatment acts like a very sensitive probation. With at least a weekly check in, some spirals of obsessive, irresponsible, addictive, or despairing behaviors can be detected early and confronted or addressed. For some survivors, a treatment group will represent the only time during a week that she is free of the primary aggressor's direct control.

Second, the treatment period provides a 'breathing space' during which the survivor can re-group, strengthen herself, start healing, and possibly prepare to leave the relationship. Abuse often continues during the treatment period, but it usually is noticeably less in frequency and severity. After the treatment period, abusive behavior, in most cases, (but not all) tends to return to pre-treatment levels. It is important for survivors to understand that they may be punished by the primary aggressor after the treatment period for their assertive actions during the treatment.

Third, even without a change in attitude, primary aggressors will tend to moderate tactics. This is motivated by the desire 'to stay out of trouble.' This treatment effect is controversial since it is believed to create more skillful abusers, who use more subtle tactics to achieve the same effect. Certainly survivors must understand controlling tactics in all variations so that they are not fooled by superficial change. Real intimacy is not possible, of course, without real safety. However, being allowed to leave the house, spend money, own a cell phone, etc, where that was impossible before does increase the survivor's ability to act in her own interest to improve her life. That may include getting stronger, or better positioned before leaving a relationship.

Fourth, primary aggressors sometimes change attitudes. Of the four treatment effects discussed, this is the most hoped for, and when it occurs, the most effective and most durable. However, it must be honestly noted that it is the least commonly achieved. Psychological change is difficult even when sought out, and overwhelmingly, perpetrator treatment is involuntary.

The involuntary treatment model for domestic abuse grew out of the documented success with involuntary treatment for chemical dependency. With addiction treatment, it was found that length of treatment was actually more a determinant of success than whether clients entered voluntarily or involuntarily. Since with few exceptions, clients will only enter primary aggression treatment involuntarily, this was an is a very comforting analogy. However, the success of domestic abuse treatment ( if measured by recidivism) has in fact been less than chemical dependency treatment. Perhaps the difference is this: With addiction, abstinence is an enforced condition of treatment, and therefore, a long treatment is necessarily along abstinence. The consequences of non-intoxication must be dealt with in some way by all clients. Controlling another person, however, is an attitude that can be hidden once a week but not really given up. Therefore, the client, unless willing, never really faces the consequence of non-intoxication.

Professionals directly involved in primary aggressor treatment often witness a superficial transition that, while it can be a start of something, should not by itself be considered evidence of change or effectiveness. Court-ordered clients often start treatment with hostility and non-cooperation. As they experience the staff's willingness to listen and treat them with respect, this often changes into casual friendliness and cooperation with the routines of treatment, such as attendance and payment. This is generaly called compliance. Staff often welcome the onset of compliance as some kind of 'turn for the better.' But compliance correlates poorly with eventual change in relationship behavior. Basic cooperation should be a given in any treatment setting from the outset. Compliance is a condition of treatment, not a goal of treatment. It is also the epitome of a demand characteristic.

This 'conditional' cooperation that often develops is actually just a variation of basic coercion. Early uncivil behavior, why it usually is not premeditated, creates an opportunity for pseudo-change. Moreover, it is often the treatment staff who have subtly adjusted themselves to avoid triggers and have 'peace.' It is of course a truism that any therapist wants to work with a client and not a client's defenses. In voluntary therapy situations, client self-confrontation is of course best-- if clients had no intention of being honest, they would not keep coming. But in court-ordered settings clients have a strong external reason to keep coming and accumulate seat hours, so avoiding confrontation makes treatment into a waiting-it-out game.

Another treatment effect has been proposed, stratification. This describes the idea that the primary aggressors least amenable to change will show themselves over time as treatment goes on and they respond with bad faith, insincerety and non-compliance. The thinking goes, these individuals can be designated high risk and stronger external controls can be implemented. This has the benefit of salvaging some benefit from treatment failure. While this type of self-identification happens anyway in treatment, it does not as of 2012 seem like the 'system', or individual survivors have anyway to access or respond to this type of information.

Michael Paymar and Ellen Pence in Duluth, Minnesota developed the universal concept for certified domestic abuse perpetrator treatment programs called the coordinated-community response. The coordinated-community response focuses on a community response from all agencies that have contact with survivors or perpetrators. Battered woman shelters, victim advocates, employers, police, prosecutors, probation officers, judges, city and county administrators, and treatment providers are all work together to coordinate resources and defeat compartmetalization