Shifting practice – thoughts on stopping violence work

Mike Cagney has a long history of working in the area of child protection, family violence and sex offender intervention. Last year Mike addressed the National Network of Stopping Violence services/Te Kupenga whatoti (the net etc) at their AGM and pondered where the field was currently situated within New Zealand and what direction would best serve the families and men that access programmes to stop violence and promote wellbeing. He raises a number of key questions to debate. Mike has given us permission to reprint his keynote address.

This address is directed to Tauiwi Agencies and services foremost and to all agencies generally. It reflects the discussions and directions that the Tauiwi Executive of NNSVS has been considering and attempting to find direction with. The particular focus here is the work with men who abuse, while making links with and seeing the implications for work with adult and child survivors of violence.

A key theme of this address is to raise, not only what our services focus upon with regards to men’s violence, but how we as Tauiwi carry out this work? More specifically, how do we look towards the next 5 years …10 years … of this essential work and embrace the challenges, developments and potential new directions? How will we give our mahi the ‘critical edge’ to remain relevant so as to be leading agencies in the ‘field of practice’ of stopping violence work? The intention here is to raise questions, encourage debate and while not guaranteeing answers, invite an open dialogue of how we both sustain and develop effective intervention with men who have abused.

There are fundamentals in this work that we can and should assume:

• Men’s violence to women and children is a core issue for Te Kupenga.
• Survivors should be provided ethical, legal and safe support that validates their experience.
• Abusers need to be encouraged to ‘face’ their violence and lift the veil of denial that perpetuates it.
• Attribution of responsibility, blame, distorted beliefs, fear and secrecy within families and communities are core in maintaining contexts of violence and these processes need to be challenged.

… yet, are we being effective – or at least are we being effective enough? How we carry out these tasks – at whatever level we are engaged in – is worthy of critical reflection.

A place to begin is to consider one – among many – key issue: Fragmentation and working in ‘silos’ – focusing only upon one area of intervention. This has to varying degrees, exemplified how many services have developed and worked over the last 26 years of my involvement, yet increasingly there is a shift to engaging systemic and holistic approaches – working at the many levels of individual and family – and having an integrated approach.

The genesis of this ‘issue’ of fragmentation had (and has) a sensible rationale – not putting women and children in danger, promoting safe practices and not exposing those affected to the perpetrator. Yet, fragmentation and ‘siloed’ approaches are increasingly seen as limited at best and at worst [outside of emergency scenarios] potentially contributing to risk longer term. Examples of this are most apparent in high profile child-death situations. This does not mean that we blindly put survivors ‘with’ perpetrators, yet it raises the question of ‘what does collaboration mean at the individual and family level of the work?’ How do we manage not only safety, but also work towards restitution and appropriate resolution, such as decisions about continuing a relationship or contact with children? Restitution and resolution are concepts that do not simply presume re-integration or restoration (but might allow for this), yet point in the direction of ‘next steps’ and ‘outcomes’ after a treatment programme is concluded.

Following on, we regularly promote the concept of accountability in this work – yet what does accountability of an offender in practice, look like? Particularly after the direct interventions of arrest, Protection Order and entering a treatment Programme? Alan Jenkins (1991, 2009), with whom many practitioners have attended training with this year, presents a tangible and compelling approach that proffers the question of how do we engage accountability – what are practices of accountability? I invite us to consider the questions of ‘what comes after a Stopping Violence Programme and are Programmes a sufficient intervention alone, to promote safety and accountability?’ (I do not believe that this was ever intended to be the case). Jenkins’ (2009) concept of an ‘ethical journey’ warrants consideration as a way forward, whereby he promotes working with a man to: (i) face the abuse and effects; (ii) revisioning of the offending; (iii) making restitution; (iv) demonstrating respect; (v) reclamation …within a context of accountability. This ‘direction’ is useful in recognising the issues for Aoteoroa of:

• At the completion of a men’s programme, a large percentage of women and children have not accessed or had access to, support and education processes.
• Often the timing for support does not match the focus and timing of the offender’s intervention and Programme.
• Some offenders with real potential to engage in resolution work and enact a process of restitution are blocked from the opportunity.
• Some high risk offenders with little integrity in treatment ‘slide’ back into families with almost no accountability.

The endeavour to reconcile these dilemmas and engage practices of accountability and processes of resolution present in my view, the core challenges for practice in the next decade. What can we look to therefore, to enable the development of such practices and directions?

One potentiality is the drawing together of education and therapy. Prior to and at the time of the establishment of the Domestic Violence Act, educational models were promoted. This was with good reason, as traditional western models of counselling and therapy risked [at that time] victim blaming, did not situate men’s violence within the dynamics of power and control and potentially ignored the perpetrator’s responsibility to choose violence. Further, cultural understandings and the context of colonial racism were not integrated. The catch-phrase for many years was ‘this is education, not therapy.’

We have though over the last 20 years within Aoteoroa, witnessed the emergence and developments of innovative ways forward – effective Maori Ora based models (Kruger et al 2004) and emerging Whanau Ora concepts, ‘Just’ Therapy (Family Centre – Waldegrave et al 2008), systemic / family therapy, narrative therapy (Jenkins 1991, 2009; White 1988; White and Epston 1990; Augusta-Scott 2003) and solution-focused therapy (Lehman and Simmons 2009) – models of therapy that are well situated within analyses of gender and race power dynamics, while addressing specifically the ‘how’ of therapy with individuals, couples and families. Further, cognitive behavioural therapy (CBT) has established itself as a common intervention in Programmes. Therapy has in effect, caught up with the challenge of education – the challenge I suggest now, is to resist the polemic of education versus therapy and move to education and therapy.

The invitation to we practitioners therefore, is to keep asking ‘what is working in the work’ and to engage a critical process of action and reflection; this does not mean throwing out ‘power and control analysis’ and ‘education’, so to speak, with the therapeutic bathwater. It does question though, how do we integrate models and concepts like Relapse Prevention, Motivational Interviewing ((Miller and Rollnick 1991), Solution Focused, Narrative and Strength-based Approaches and appropriate family and systemic interventions into all levels of the work – adult, child, individual, couple, family, wider family and community? This raises positive challenges such as:

• Recognizing ‘continuums’ of change and intervention and that not all clients are in the ‘same place.’
• Can we engage systemic interventions and approaches that draw upon couple and family work, particularly post-programme for men?
• What will be effective future partnerships between service providers of different client groups (men/women/children) that can be developed?

Clearly, such a direction change would have implications for many current Programmes and a potent question may be ‘is it worth it – will it place our clients in jeopardy?’ It is fair to recognize that ‘intervention’ and ‘collaboration’ have been common terms in this field of practice that have been more obvious at the community and organizational levels but not so obvious in the direct practice with clients (acknowledging there are exceptions and that emerging services possibly offer family based work).

Recent research, into what factors are apparent in generating and supporting positive change at the level of ‘the client’, points to potential new foci and highlights:

• 40% relates to extra-therapeutic factors (social support/skills/motivation).
• 30% relates to client/therapist relationship
• 15% relates to therapist attitude and conveying a sense of hope.
• 15% relates to the model of intervention.
(Miller Duncan and Hubble 2004; in Lehman and Simmons 2009)

To accept these figures, potentially ‘turns upon its head’ the enormous focus we have placed upon the 15% of models of intervention for many years, while not giving in my view, significant value to the ‘non-specifics’ of client needs in the community and the importance of the therapeutic relationship offered to the man who abuses – again the theme of how we carry out the work. In my experience, 20 years ago the ‘talk’ within our field did not place emphasis upon these aspects of the work. The over-riding concern then [and now] was not to enter into collusive practices with men who abuse – this remains a valid concern, yet the challenge I suggest is not to create this ethos into a restraint that inhibits the development of innovations and new directions.

To summarise thus far, placing emphasis upon conditions of change, the unifying of education and therapy and developing practices of accountability, has significant implications for approaches, models, practice and training in violence intervention work.

Two further areas to explore are: (i) ‘typologies’ of violent offenders and the (ii) considerations for assessment – particularly risk assessment – of offenders. Three key questions for Stopping Violence Services that follow-on are:

• How ably are we assessing and understanding the men whom we assist and have we slipped into a ‘one shoe fits all’ perspective i.e. are all perpetrators the same?
• How ably are we assessing risk and can we differentiate risk assessment from processes of induction and orientation?
• What does ‘safety’ mean and how is it assessed when graduating a man out of a stopping violence programme?

Recognising ‘types’ of offenders may for some members of Te Kupenga, be contentious – we have a strong investment in the Power and Control Model over the last 20 years. Yet, the consequence of not doing so is to treat all offenders as the same. ‘And why not’, some may ask?’ A position that we can assert with clarity is that which can be termed ‘terrorist violence’ (Johnson 2008) – ‘rape, murder and pillage’ – is by far the realm of male offenders. We only have to understand the rape and child sexual assault statistics to see this reality. Yet, a challenge [despite how we might struggle with this concept], is the need to make sense of, that many men attending Programmes are not ‘terrorists’ and while their behaviour is unacceptable and controlling, it is not at the risk level ‘terrorism.’ Johnson (2008) differentiates this ‘terrorism-type’ from ‘situational’, ‘resistance’ and ‘mutual’ violence.

To further the discussion, many services are now providing ‘anger-management’ services for women, very much a development from the traditional ‘men’s programmes services’ of 10 – 20 years ago (and notably many of the new services joining Te Kupenga at this AGM provide such services). These women as a rule are not ‘terrorists’ and very likely the violence they use will be ‘situational’ and in the context of ‘resistance’ to power abuse they experience. The challenge regarding male abusers is that some men will also be ‘situational’ and ‘resistance’ perpetrators. I offer this contrast between male and female perpetrators deliberately and provocatively, recognising the risks of perceiving men’s and women’s violence as ‘the same’ – yet the ethical challenge is how do we recognize the times when this is the case and not assume all male offenders are ‘terrorists’? Simply, I pose you the dilemma and ask that you not dismiss outright, the debate that this generates. This does not mean to throw the ‘power and control’ model out, but it does challenge how do we recognize ‘difference’ amongst the men we work with and following, how we might treat offenders differently? And, if we accept the premise of ‘types’ of offender, what are the implications for assessment and programme approach? Some case scenarios at this point will aide the discussion:

• A young man profoundly sexually abused by his mother over many years. He perpetrates violence and clearly this needs to stop. But, arguably his pathway into violence is not the common power and control pathway and to ignore his victimization risks replicating aspects of the dynamic of abuse he experienced. How should we work with him? Can we ethically place him in a group that addresses only men’s power and control?

• A client with diagnosed psychosis who self-manages in the community. He requires anti-psychotic injections every 2 months and with a balanced medication, maintains a healthy relationship. Mis-management of medication can bring periods of crisis and generally behaviour that is self-harming – and very distressing for his partner. How important is well informed medical and mental health management with such a client and simply, is an ‘educational’ approach with someone who experiences delusions, sufficient?

• A teenage client who has a glue-sniffing and marijuana addiction and has frightening moments of hallucinating, when he sees ‘monsters’. Violence is regularly linked to times that he is ‘hanging out’ for glue or dope. Can we ethically work with him without also working with the addiction? How receptive when regularly under the influence, is he going to be to a stopping violence programme? Is addiction a ‘pathway’ to offending that runs parallel to power and control?

• A young teenage father – [seemingly more and more common I find] – who is struggling with parenthood and ‘being the breadwinner’. He has been violent in limited ways and profoundly struggling with the changes in life … but is motivated to be a good partner and parent. Is he the same as engrained and ‘terrorist’ offenders? How should we work with him and what place does mentoring from positive role models have? Are there risks of placing him in a group of much older men who might have high levels of resistance to change?

• A man who regularly and seemingly habitually, uses assault and life threatening behaviour to his partner and children and utilizes every behaviour outlined in the power and control wheel. His chances of killing are real and his motivation for change varies, but is essentially limited. What is the right approach with this client? Are there risks placing him in a group? What other interventions are necessary?

… at this juncture I wonder if you are experiencing a sense of dilemma? A stream of questions that have no simple answer? Possibly, feeling challenged regarding assumptions and ‘truths’ that you hold about the work? I invite you to engage these dilemmas, questions and assumptions, as these examples indicate a range of offending and potentially different ‘pathways’ that our practice needs to find direction with … age / experience …mental health … addictions … parenting … imminent dangerousness …

Where then do we look, assuming that you are enticed by the invitation to develop this work? Other fields of practice and models I propose as useful for establishing new directions are …

(i) Drawing from the sex offender treatment field, the concept and model of pathways into offending (Hudson and Ward 1998), challenges that ‘one route’ analyses are too limiting for understanding how clients offend. Highlighting the case scenarios outlined, I propose that Stopping Violence Work would benefit from adopting a ‘pathways approach’ that would challenge us to address both the differences for how violent offending occurs and how we should work with these differences. Johnson (2008) as mentioned, gives us typologies of offenders that could provide us a new ‘language’ for assessing offenders that has potential to be compatible with the pathways model. We can in this regard, come along side the positive and influential developments of Kruger et al (P.3 Whanau Violence, A Maori Conceptual Framework 2002) in stating, “There is no singular cause of whanau violence and no singular response to it. A singular cause and effect model has limited relevance to healing the impacts of whanau violence.”

(ii) Cognitive Behavioural Therapy and variations of, is a common approach in this field. I consider it very useful, particularly as it is offence focused and invites clients to recognise patterned behaviour and the choices they make to use violence. CBT is nevertheless limited if used only to paint a picture of ‘how’ violence occurs without addressing ‘how’ it will stop. A key question I believe Te Kupenga will face increasingly is, what are the outcomes that men’s programmes produce? At the individual and group level, can we all confidently say that clients have well developed, written and accountable safety plans? While the overall efficacy of Programmes may be debated ad finitum, I suggest the adoption of Relapse Prevention Models and safety planning will both enhance the use of CBT and potentially promote more accountability and outcomes of offenders. For example, programmes utilizing personalized/individualised ‘immediate danger’ and ‘high risk’ safety plans that men would need to complete to conclude a programme ‘satisfactorily’ (as per the ‘Notice of Conclusion of Programme’ outcome form). ‘Relapse Prevention’ would require us to look critically at our assessment processes; also to look critically at the criteria for how we ‘graduate’ an offender out of a programme. An essential question, is should an offender be assessed ‘satisfactory’ if they have not completed a well developed safety plan that they commit to and that can be provided to those affected? And, do the current educational models promote this?

I have already discussed collaboration and the issue of fragmentation. Historically I view that Te Kupenga has had an uneasy ideological relationship with counselling and family services [not necessarily a bad thing!]; I propose there are many useful and ‘safe’ therapy partners that we can form alliances with. Further, that Te Kupenga agencies can explore providing a wider range of services and look to how the work when judged safe to do so, can bring couples and families together for the critical task of addressing ‘how’ safety will be taken on within the family and relationship? The alternative is that people randomly re-integrate with little assistance and/or challenge – is this acceptable?

(iii) Lastly, I invite you to consider that how we work with offenders is a significant determinant of outcome and I reiterate, the practices we engage with violent offenders has had a too cursory a focus and historically in my view, the value has been diminished. I am though encouraged by new developments, that are centering on Solution Focused Batterer Interventions (refer Lehman and Simmons 2009), that promote how we positively engage and establish solutions with men who have abused. The principles of solution focused work are compatible with the work and training of Alan Jenkins and Ken McMaster, whom many practitioners have most currently, attended training with over the last 12 months. Both these practitioners for example, promote the ‘skills’ of being ‘invitational’ and ‘curious’ with clients and such skills should be ‘foundational’ in this work. But, to engage this Solution Focused Model does invite a major shift in focus and practice – essentially a movement away from ‘problems’ to engaging ‘solutions.’ For example, Solution Focused in contrast to traditional interventions emphasizes:

• Being open to the multidirectional ‘pathways’ to the offending.
• No one theory describes all offenders – there are differences
• Programmes are therapeutic AND educational… Open to restorative outcomes.
• Strengths – focused vs. problem-focus – clients capacity to change is built upon.
• Victim – survivor has a place in the work, in manner she desires.
• Confrontation as a ‘goal’, not a style: therapeutic relationship is important.
• Facilitation that is collaborative – client is the expert of their offending and safety, not the facilitator / therapist.
• Resistance and denial are not viewed as static positions and blocks, but as ‘normal’ and part of change.

These are not ‘soft options’- done well it is demanding work. And, an underlying premise is that clients are more likely to change when they ‘own’ the solutions and the solutions have real meaning to their lives. Combined with a Relapse Prevention model and given direction for restitution and resolution work through [timely] other modes of counselling and family work, I see potential to develop practices of accountability and outcomes that are both safe foremost and meaningful to the participants.

As a footnote, other Agencies are adopting these models, for instance Child Youth and Family are utilizing the solution focused work of Andrew Turnell (Signs of Safety, 1999) and Solution Focused work is establishing as a ‘common approach / language’ across many sectors. Models such as Maori Ora and Whanau Ora for Maori, also present possibilites to adapt more holistic as well as whanau / family oriented and ‘systemic’ interventions for Tauiwi as well generally – and for those Tauiwi services specifically, also working with Maori. The opportunity exists to develop complimentary practices and collaborate in very real terms, with our partners in the community. Certainly, this is a healthy challenge.

So … where to? Here we sit as practitioners at an AGM, many of whom who have discussed ‘quietly’ these ideas but not found form or direction to progress them. I am aware of many Tauiwi practitioners who have voiced support for developing the work. I leave you then with a suggestion; at the Tauiwi Practice Conference, I ask that a ‘focus group’ be convened and that agencies actively explore ‘what are we doing that works – what are we doing that is different – what are we doing that we don’t tell anyone about’? That the group takes on a ‘committee role’ for Tauiwi groups and look to planning and promoting useful changes and solutions in the work. That this also then, forms a strategic direction for the Tauiwi Executive to develop on behalf of member agencies … to enter into our own Solution Focused Strategy.

I invite you to dialogue further with me and I welcome your views. You are also welcome to visit me in Paekakariki and I am happy to freely give you time over a coffee. I wish you and the Network well.

Kia kaha

Mike Cagney
mikecagney@clear.net.nz

References and Recommended Reading:

Augusta-Scott, T. (2003). Chapter 12: Dichotomies in the Power and Control Story. In: Responding to Violence: A collection of papers relating to child sexual abuse and violence in intimate relationships. Dulwich Centre, Adelaide

Hudson, S., and Ward, T. (1998). Journal of Interpersonal Violence, Vol. 13, No. 6, 700-725

Jenkins, A., (1990) Invitations to Responsibility: the therapeutic engagement of men who are violent and abusive. Dulwich Centre Publications. Adelaide.

Jenkins, A., (2009) Becoming Ethical: a Parallel, Political Journey With Men Who Have Abused. Russell House Pub. Lyme Regis.

Johnson, M.P., (2008) A Typology of Domestic Violence, intimate, terrorism, violent resistance and situational couple violence. Northeastern University Press, New England.

Kruger et al, (2002). Whanau Violence – A Maori Conceptual Framework. Report to the Hon Tariana Turia.

Kruger et al, (2004). Transforming Whanau Violence – A Conceptual Framework. Report to the Hon Tariana Turia.

Lehmann, P. & Simmons, C.A., (Eds) (2009) Strengths-Based Batterer Interventions: A New Paradigm in Ending Family Violence. Springer Publishing Company, LLC. New York.

Miller R., and Rollnick S., (1991). Motivational Interviewing – preparing people to change addictive behaviour. Guildford Press: London

Turnell, A., and Edwards, S., (1999). Signs of Safety: A Solution and Safety Oriented Approach to Child Protection Casework. W.W. Norton and Company, New York.

Waldegrave, C., Tamasese, K., Tuhaka, F., and Campbell, W., (2003) Just Therapy – a journey. Dulwich Centre: Adelaide.

White, M., (1988/9) The externalizing of the problem and the re-authoring of lives and relationships. Dulwich Centre Newsletter 3-20.

White M., and Epston D., (1990) Narrative Means to Therapeutic Ends. Norton: New York

Published on Thursday, February 25th, 2010, under Family violence, Learning & development, Practice tips and techniques

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