JUVIE OFFENDERSResource: Brochure BuilderChoose a special population within the correctional system from the following:Create a 6-panel brochure for this special population to help them understand
Answer questions in RED only with 150 words per question Chapters provided. Identify which counseling models would be effective in an incarceration setting. Identify which counseling models would be effective in community corrections. Describe techniques for changing behavior, according to a specified counseling model. Discuss behavioral approaches to counseling. Identify basic techniques used in cognitive therapy. Discuss reality therapy. Discuss Gestalt therapy. Identify common techniques used in Gestalt therapy. Know the basic principles of family systems therapy, including circular causality, cybernetics, homeostasis, and feedback loops. . What are the basic components and processes to anger management and domestic abuse group interventions. . Identify Groetsch’s three categories of domestic batterers. 5 Common Theoretical Counseling Perspectives CHAPTER OBJECTIVES After reading this chapter, you will be able to: Discuss behavioral approaches to counseling. Identify common techniques used in behavioral therapy. Discuss cognitive approaches to counseling. Identify basic techniques used in cognitive therapy. Discuss reality therapy. Identify common techniques used in reality therapy. Discuss Gestalt therapy. Identify common techniques used in Gestalt therapy. Explain the theoretical aspects and techniques associated with Bowenian family systems therapy. What are the various techniques of family systems therapy that correctional counselors can utilize. INTRODUCTION A variety of counseling perspectives have been created since the birth of psychology and the helping professions. Counseling perspective is a particular approach to counseling based on specific assumptions regarding determinants of cognition and behavior. Most counseling perspectives also include specific techniques of intervention directly related to the perspective’s assumptions concerning human behavior. An important prelude to what follows is that each perspective contains unique contributions to help people identify and overcome psychological and emotional issues causing distress. The various causes of distress are broad and diverse. As a result we encourage students to maintain an open mind while critically reviewing each perspective. The extreme diversity within the offender population cannot be overemphasized. In addition, our society is becoming more diverse as different cultures are increasingly forced to interact due to spatial limitations as well as the process of globalism. Based on these facts we suggest the following intellectual framework as a foundation for readers of this chapter: 1. There is no right or wrong counseling perspective. 2. Each perspective contains parameters that may be useful under certain conditions with certain offenders. 3. Counselors should be flexible in their approach to help and should be able to draw techniques and reasoning from various perspectives. 4. In order to effectively help others counselors, themselves must have a good understanding of their own strengths and weaknesses. 5. As you examine each counseling perspective reflect on the following question: “How can this information help me to better understand my own intellectual perceptions and behavior?” In this chapter we present four counseling perspectives: (1) Behavioral Therapy, (2) Cognitive Therapy (including Cognitive Behavior Therapy), (3) Reality Therapy, and (4) Gestalt Therapy. Obviously, there are additional therapeutic approaches found throughout the literature. Some of these approaches are very specific aimed at particular types of dysfunction and prescribe specific types of treatment. The reason for our selections is that each perspective is used extensively within the offender population. We make no claim that one perspective is superior to the other. In fact, we urge the opposite and once again invite students to explore this information from a point of neutrality accompanied by personal introspection. Finally, we would like to point out that we rely heavily on the work of Corey (2005) in creating the foundation for much of the information contained in this chapter. PART ONE: BEHAVIORAL APPROACHES One of the most significant proponents of behavioral theory was B. F. Skinner (1904–1990). Skinner spent much of his career researching various behavioral techniques all of which are aimed at increasing one’s personal choices through the creations of new conditions of learning. Behavior therapy is heavily grounded in objectivity with the basic assumption that behavior can be learned. For example, behavior theorists posit that addiction is a learned behavior and because it is learned new behaviors can also be learned in order to replace the dysfunctional qualities of addiction. Corey (2005) provides 10 key factors related to behavior therapy that provides a robust foundation from which one is able to intellectually frame the basic underpinnings of behavior therapy. In addition to Corey (2005), several other authors including Kazdin (2001), Miltenberger (2004), as well as Speigler and Gueveremont (2003) have made significant contributions to the following factors. 1. As mentioned above, behavior therapy is primarily rooted in objectivity. As such, the scientific method of conducting research and experiments is central to behavior therapy. Corey (2005) notes, “the distinguishing characteristic of behavioral practitioners is their systematic adherence to precision and to empirical evaluation” (p. 232). The problem is clearly stated, the intervention is clearly identified, outcomes are empirically tested, and the entire process undergoes continual revision. 2. The primary interest of behavior therapy is the specific nature of the offender’s current problem. Past events may be useful at times but are not considered primary. For example, an offender suffering from substance abuse would be examined and treated based on the positive and negative reinforcers associated with the substance abuse. Ultimately, the goal is to find alternative behaviors that maximize positive consequences based on freedom to choose responses other than the use of substances. Behavior therapists are most interested in current behaviors associated with distress and the environmental stimulants that contribute to and maintain the behavior. Once the distressing behavior is identified the behavior therapist will then begin exploring various measurable techniques aimed at altering the environmental stimuli correlated with the problem behavior. 3. Behavior therapy requires specific actions from the offender aimed at altering and enhancing his or her possible responses to certain stimuli. Behavior therapy is not talk therapy. Action and learning is paramount. 4. Behavioral therapy relies heavily on educating a client in regards to new behaviors. Therapists take an active role in pointing out alternative behaviors that may produce more desired results. For example, an offender who routinely turns to marijuana when faced with anxiety-provoking decisions may be taught to exercise instead. 5. The focus of behavior therapy is on assessing behavior through which problems can be identified. Once identified, specific and measurable interventions are introduced and results are evaluated. 6. Self-control is central to behavior therapy. In order for behavior therapy to be effective clients must be able to identify problem behavior and then consciously choose to carry out learned behavior more capable of reducing distress and negative consequences. 7. There is no universal behavioral treatment protocol appropriate for all individuals. Instead, interventions and teaching are specific to the individual and the problem behavior. This is an important characteristic of behavior therapy. We must remain cognizant of the fact that human beings are extremely diverse and complex. 8. As mentioned above, behavior therapy relies heavily on the participation of the client. In essence, a partnership must be forged between the counselor and client where both are active participants in the path to change. The counseling process is open and clients are generally informed about the decisions and process of treatment. 9. The focus is on developing interventions aimed at reducing problem behavior that can be practically applied in all areas of one’s life. “Practicality” is the key word in this characteristic. Theoretical postulations that are unable to be measured in daily life are not generally part of the main focus. 10. Counselors must be culturally competent in order to provide treatment protocols best suited for a particular client and the client’s problem behavior. Classical Conditioning Classical conditioning refers to a process of learning based on the idea of pairing. Ivan Pavlov, a Russian physiologist, is a central figure in classical conditioning based on his work with dogs. Through various experiments, Pavlov found that when food was presented to dogs they salivated. Pavlov considered both the presentation of food and the process of salivating to be unconditioned responses. Through additional experiments he found that a conditioned response could be generated through the pairing of an unconditioned stimulus with a conditioned stimulus. Specifically, Pavlov learned that after several repetitions of pairing food with a buzzer the dogs began to salivate in response to the buzzer even in the absence of food. And, maybe even more significant in the context of criminal offending is the fact that Pavlov also found that if the conditioned stimulus (buzzer) is repeatedly presented without the pairing of food the salivation response is reduced and over time is extinguished. Classical conditioning provides the foundation of one form of learned behavior. As noted by Gladding (1996) a variety of human emotions are often experienced as a result of classical conditioning via paired associations. Phobias are also often linked to paired associations. For example, a person may learn that he or she cannot trust others due to repeated exposure of disappointment by not being adequately attended to by caregivers. In fact, it could be argued that antisocial behavior, commonly used to describe criminal offending, is in part a result of classical conditioning. In essence, a person learns through paired associations that it is dangerous to overly rely on or openly present oneself to others. Operant Conditioning Whereas classical conditioning refers to what takes place prior to learning, operant conditioning describes learning in which behavior is influenced by the consequences that follow them (Corey, 2005). Generally, operant conditioning describes a process of learning that is heavily influenced by rewards and punishments. If a person is rewarded for a particular action it is more likely that the action will be repeated. When an action is followed by a punishment it is less likely to be repeated. Therefore people often learn to discriminate between actions that result in reward and those that result in punishment (Gladding, 1996). To once again contrast classical and operant conditioning, it could be said that classical conditioning is the conditioning of involuntary responses whereas operant conditioning is the conditioning of voluntary responses. People will often repeat behaviors that produce some type of desired attention, feeling, or emotional gain. Within the offender population one’s toughness is often viewed in high esteem. Therefore one may learn that the ability to intimidate or physically overtake others results in the elevation of status among peers. This is a very powerful motivator for someone who has nothing else to rely on for feelings of worth and acceptance, especially when this is due to inadequate early child care. The same is true in relation to money and the ability to obtain material possessions. The bedrock of operant conditioning as noted by Skinner (1953) is that individual behavior is primarily driven by one’s environment. Operationalizing Behavior Therapy with Criminal Offenders According to behavior theorists behavior that is learned can be unlearned. Therefore the goal is to help offenders identify problem/criminal behavior and replace it with socially acceptable law-abiding behavior. In order for behavior therapy to be effective there must be significant collaboration between the counselor and offender. Offenders take an active role in deciding which behaviors to address and also the formulation of specific goals. “Goals must be clear, concrete, understood, and agreed on … This process of determining therapeutic goals entails a negotiation between client and counselor that results in a contract that guides the course of therapy” (Corey, 2005, p. 234). The importance of collaboration in the therapeutic process cannot be overstated. In fact, Corey (2005) notes the work of Cormier and Nurius (2003) who provide five guiding principles illuminating the importance of collaboration: 1. The counselor provides a rationale for goals, explaining the role of goals in therapy, the purpose of goals, and the client’s participation in the goal-setting process. 2. The client identifies desired outcomes by specifying the positive changes he or she wants from counseling. Focus is on what the client wants to do rather than on what the client does not want to do. 3. The client is the person seeking help, and only he or she can make a change. The counselor helps the client accept the responsibility for change rather than trying to get someone else to change. 4. The cost–benefit effect of all identified goals is explored, and counselor and client discuss the possible advantages and disadvantages of these goals. 5. The client and counselor then decide to continue pursuing the selected goals, to reconsider the client’s initial goals, or to seek the services of another practitioner (p. 234). One of the most important tasks of a behavior therapist is to conduct a functional analysis of the problem behavior. Here, it is important to remember that all behavior serves some purpose. The goal is to identify environmental factors, parameters of the actions, and the results that accompany the problem behavior. For example, some offenders may use aggression to mask fear and anxiety. The aggression may consist of physically assaulting others to stave off appearances of being afraid. In certain cultures, this behavior is both acceptable and admired. Socially, however, it is disruptive and a criminal offense accompanied by sanctions. In this case, obviously the role of the counselor is to help the offender identify and define the problem of aggression; identify its destructive and dangerous nature; identify alternative responses to fear and anxiety that replace aggression; and evaluate the success of the alternative responses. The basic premise being dysfunctional behavior is learned and then integrated based on inappropriate reinforcement (Figure 5.1). Common Techniques of Behavior Therapy Systematic desensitization refers to the process of reducing anxiety primarily based on physical and mental relaxation. Systematic desensitization was developed by Joseph Wolpe (1958) and is a technique based on the principles of classical conditioning (Corey, 2005). Generally, a client will describe a particular situation that results in anxiety and then rank certain elements of the situation hierarchically ranging from little or no concern to extreme concern. The real task of the therapist is to help clients substitute feelings of anxiety with the competing response of relaxation. This is done by teaching the client to relax as successive elements of the anxiety-provoking circumstances are introduced beginning with those that are of little to no concern. Over time clients become desensitized and are then freer to make choices from an enhanced range of options. Masters (2004) notes systematic desensitization is often used with phobias, neurotic anxieties, interpersonal difficulties, as well as some forms of sexual problems. For specific steps in relaxation training see Wolpe (1990). FIGURE 5.1 Functional Analysis Source: SAMHSA TIP 34. Implosive therapy first introduced in the 1960s by Thomas Stampfl (Gladding, 1996) is a concept that describes the process of guiding clients through imaginary details of a situation that may have catastrophic consequences. The offender is asked to imagine in detail circumstances that create extreme anxiety and then verbalize them. The anxiety is extinguished over time due to the repeated exposure in the counseling setting absent of the feared results. Gladding (1996) notes this technique should not be used by beginning counselors. Implosive therapy can produce extreme anxiety and even trauma if not properly delivered. One of the delineating factors between implosive therapy and systematic desensitization is that implosive therapy techniques of relaxation are not introduced prior to the presentation of the anxiety-provoking circumstance. Assertive training is a process of teaching clients that they have the right to choose their own method of expression and do not have to continue with those responses that do not produce desired results. The major underpinning of assertive training is that a person should have the freedom to make choices without having to endure anxiety or emotional pain. Once a particular objective has been identified (speaking in front of groups, expressing true feelings, saying no to deviant peers), counselors will generally explore a client’s current behavior in regards to the objective. Feedback from the counselor is an important part of assertive training. Especially once the desired behavior has been identified it is important that counselors are able to help clients engineer clever ways of implementing and maintaining healthier and more productive responses. Coaching is a process of showing clients how to carry out or perform certain actions more conducive to healthy living. Sometimes referred to as modeling, coaching assumes that clients do not have to necessarily experience each aspect of a distressing circumstance in order to learn more effective behaviors. They can instead be taught by simply observing or watching others (Masters, 2004). Counselors are often in a powerful position to provide coaching. Corey (2005) notes, “Because clients often view the therapist as worthy of emulation, clients pattern attitudes, values, beliefs, and behavior after the therapist. It is essential that therapists be aware of the crucial role they play in the therapeutic process” (p. 235). Behavioral homework is the process of practicing a desired behavior usually after it has been appropriately modeled for the offender by the counselor (Gladding, 1996). Typically, the offender will receive feedback as the desired behavior is shaped. Homework is designed to help the offender practice the behavior in a more natural setting outside the counselor’s office. It is important that clients actively participate in this technique so that accurate reporting can be made on the outcomes of new behavior or responses. Accurate reporting is necessary so that further progress can be made in subsequent sessions usually in the form of modifications aimed at enhancing success and ultimately generalization of the more effective behavior. Finally, specific measurement is an important component of behavior therapy. One of the hallmarks of behavior therapy is the ability to quantitatively measure the progress of clients. Success is largely gauged by the frequency in which an offender is able to substitute problem behavior with that which is more likely to produce desirable results. This is precisely why behavior therapists are interested in identifying the specific problem behavior, how the behavior is carried out, the circumstances in which the behavior occurs, and the general results that accompanies the behavior. These factors are critical in order to determine how best to treat a client. In the end the success of behavior therapy is contingent on the numerical observations of employed corrective behaviors taking the place of former behaviors unable to elicit desirable outcomes. Through the process of quantifying results counselors are able to hone in on circumstances in which the corrective behaviors were not employed. In these occasions the specific circumstances are further explored in order to modify or develop new corrective behaviors that may prove useful. In behavior therapy the scientific model is closely followed in an attempt to broaden one’s repertoire of responses to aversive circumstances that are more likely to lead to healthier lifestyles and greater freedom to make choices. SECTION SUMMARY Behavior therapy is predicated on the assumption that behavior is learned and can therefore be unlearned. Classical and operant conditioning are the staples of behavior therapy and both describe types of learning. Classical conditioning refers to what takes place prior to learning and focuses largely on pairing. Operant conditioning focuses on learning that takes place based on the consequences that follow behavior. The types of reinforcements a person receives will determine whether the behavior is continued or extinguished. Behavioral interventions are individually tailored to the specific needs of a client. The relationship between client and counselor is one of collaboration and participation. Both must be active in the process of changing behavior. LEARNING CHECK 1. Objectivity is not a major concern of behavior therapy. a. True b. False 2. Classical conditioning describes learning in which behaviors are influenced by the reinforcements that follow them. a. True b. False 3. A very important aspect of behavior therapy is the functional assessment of behavior. a. True b. False 4. Behavior therapy places strong emphasis on self-control. a. True b. False 5. The primary goal of behavior therapy is to increase personal choice and create new conditions for learning. a. True b. False CASE VIGNETTE: Example of Behavioral Therapy Used with an Offender Convicted of Domestic Violence Gus has recently been convicted of domestic violence. He has been sentenced to probation for one year and also ordered to receive counseling for his aggressive and violent outbursts. The incident that led to Gus’s arrest happened one afternoon as he and his wife were watching television. Gus reports his wife began verbally assaulting him due to his lack of participation in carrying out household chores. Gus stated he had been drinking and when his wife failed to stop criticizing him he became violent and began to push and strike her. Gus stated that only after he initiates violence does his wife stop nagging him. Gus goes on to state that after the violent episodes he and his wife spend hours and even days not communicating. Gus claims to feel remorse for his violent actions and also extreme loneliness due to the lack of intimacy and connection following the violence. Gus also claims that he is concerned about his children growing up in an atmosphere of violence as he did. Gus states that while growing up he witnessed his father routinely batter his mother until finally his mother filed for divorce. Shortly after the divorce Gus’s father committed suicide. Gus states he must learn how to change his behavior before he, too, loses his family and permanently damages his children. The functional analysis of Gus’s behavior is carefully reviewed: COUNSELOR: When do you become violent? GUS: Usually, after I have been drinking and just want to relax. COUNSELOR: What typically triggers your violent outbursts? GUS: Usually, when my wife begins nagging me about something that needs to be done around the house. I try to tell her that I do not feel like doing it at the time but she continues to nag saying that I never feel like doing anything. COUNSELOR: How do you usually carry out the violence? GUS: I just finally have enough and get up and grab her by the shirt or hair. By this point I can’t take anymore. Once I have grabbed her I shake her and yell that I am tired of her constant nagging. Sometimes I punch her in the stomach or back. I never hit her in the face. COUNSELOR: What does your violence accomplish? GUS: Well, it gets her to shut up. I can finally sit and relax and watch TV without hearing her criticize me. COUNSELOR: What else happens after your violent outbursts? GUS: Well, to be honest, I hate it. I hate being violent with my wife. I really love her and she is wonderful to my kids. And, after the violence is over she is so scared and hurt by what I have done. She does not talk to me or even look at me. I know how much it hurts her and disappoints her. I am a people person and have to live in the same house with my wife and kids and not communicating with them is terrible. And, after the last time she took my kids and went to her mom’s place for three days. She would not let me see or even talk to them. I can’t take this anymore. COUNSELOR: Ok, it seems as though the specific behaviors we need to work on consist of violent outbursts directed at your wife. Is this correct? GUS: Yes. COUNSELOR: How often do you use violence to keep your wife from nagging you? GUS: Well, it depends on the nagging. Sometimes she says a few things and then stops. Other times, she just keeps going and says that she is not going to stop until I get up and do something. So when she says this I always get violent because my anger becomes too much. COUNSELOR: So, when your wife continues to nag you use violence about 100% of the time? GUS: Yes. COUNSELOR: To what percentage would you like to reduce your violent outbursts? GUS: 0% COUNSELOR: What is your main motivation for wanting to eliminate your violent behaviors? GUS: I want to save my marriage; I want to be closer to my wife and family; and I can’t bear to think of my wife leaving me. I want my family to stay together. COUNSELOR: I want to begin by suggesting alternative responses to violence. First, how would you feel about getting up and walking out of the room? This would create distance between you and your wife and allow you to implement a very important skill-breathing techniques aimed at helping you relax. When you feel yourself beginning to get angry, I want you to leave the room and begin concentrating on your breathing. I want you to concentrate, specifically, on slowing your breathing and focusing on the consequences of using violence. GUS: I can try that. It will be difficult, but I think I can do it. See, where I grew up when the man said he had enough the woman knew to be quiet. The woman didn’t keep talking because she knew what was going to happen. COUNSELOR: I understand, however, if you continue to rely on this learned behavior what will happen? GUS: I will end up in prison and I will lose my family. I get it. I am ready and willing to change my behavior. It is not worth it. COUNSELOR: Ok, I want you to describe a typical circumstance that is likely to lead to violence? Do this slowly and I am going to help you work through it without resorting to violence. I am going to help desensitize you so that you have a fuller range of options to respond that does not include violence. In fact, I would like to get a working contract with you. The contract states that under no circumstances are you to engage in violence with your wife. How do you feel about this? Are you able to engage in this contract? GUS: Yes, I can do it. I must do it. Usually, after I get home from work I like to sit around for a while and drink a few beers. I try to relax and unwind and let go of the stress. My wife stays home with the kids and if she wants me to do something she tells me to do it. This is where I usually begin to get upset. She could at least ask me instead of telling me. COUNSELOR: Do you ever resort to violence when you are not drinking? GUS: No, the only times I have been violent with my wife are after I have been drinking. I am able to relax after a few beers but I also get very angry and very quickly. COUNSELOR: If you were not drinking, do you think you would get as angry with your wife based on her telling you to do something as opposed to asking? GUS: Probably not. COUNSELOR: How hard would it be for you to not drink alcohol? GUS: Not that hard. As I get older, it is becoming harder to go to sleep after I have been drinking and it also makes me feel terrible in the mornings. I really need to stop drinking altogether. I am glad you brought this up because this is what I needed, to finally make the decision to stop. It is not helping me at all. COUNSELOR: I want you to imagine coming home from work and sitting down to watch TV. Let’s even assume that you are having a couple of beers. Your wife starts nagging at you to cut the grass. You tell her you do not feel like it and she continues. You feel yourself becoming angry. These are the steps I want you to follow: 1. Get up and create distance between you and your wife. 2. Begin to focus on your breathing. If you allow yourself to become enraged violence will be much more likely. 3. Think of the negative consequences of becoming violent. You will go to jail, and eventually lose your family. 4. In a calm voice, tell your wife that you need a little space to collect your thoughts. It is important to assert your rights in this instance because a violent outburst is at stake. Tell your wife that you would be happy to discuss household activities with her but you would like for her to please talk to you in a respectful manner. 5. If you feel as though violence is inevitable you will leave your house until you are able to return without engaging in violence. GUS: I can do this. I feel better with the thought of having more options. I really felt stuck. I felt as though I had no options. In this example, Gus must be lead from the point of no options other than violence to the point of having various options including leaving the house. Gus must understand that at no time is violence acceptable. In essence, Gus must begin to consider other options that are capable of producing the desired result. Gus would be given homework consisting of monitoring the interactions between him and his wife and the circumstances which produced the anger. Gus would be responsible for carrying out the objectives identified and evaluating their success. Based on the outcomes future sessions would be geared toward better enabling Gus to respond without violence. PART TWO: COGNITIVE APPROACHES Where behavior therapy is primarily concerned with behavior, cognitive therapy is primarily concerned with cognitions. Cognition is a concept that describes the process through which knowledge is acquired. The basic assumption of cognitive theory is that behavior is largely predicated on one’s thoughts, beliefs, and perceptions and that it is through faulty perceptions that much of dysfunctional behavior is predicated. Cognitive theory attempts to identify and correct faulty thinking patterns responsible for behaviors that are distressing, destructive, and criminal. Ultimately, faulty cognitions must be replaced with those that contain balance and flexibility that foster healthier behavior patterns and responses to certain stimuli. Cognitive therapy was developed by Aron T. Beck and resulted from his extensive work on depression (Corey, 2005). Psychoeducation plays a strong role in cognitive therapy as clients are taught how to identify internal cues and messages that are probably contributing to their distress. This process is often referred to as cognitive restructuring. Cognitive restructuring refers to a set of techniques that help people examine and reframe certain thoughts or beliefs that contribute to negative feelings or dysfunctional behavior (Beck, 1995). In essence, people’s reactions to situations are determined by their thoughts and beliefs in those situations in particular, and about the world and themselves in general (Beck, 1995). Cognitive restructuring is a strategy aimed at enhancing one’s awareness of one’s own thoughts and especially perceptions and then challenging those that generate strong negative feeling or emotion. Cognitive therapy builds on behavior therapy and attempts to account for the mental processes associated with behavior. In fact, although we keep the two separated in order to clearly depict the basics of each style, the combination of cognitive and behavior therapy techniques has led to one of the most robust therapeutic modalities known as cognitive behavioral therapy. Cognitive behavioral therapy has been researched extensively and is among the evidence-based modalities shown to be effective with a wide range of people including offenders. As noted by Corey (2005), Beck was primarily interested in automatic thoughts. Automatic thoughts are described as the often immediate intellectual reaction to some event or stimulus that culminates in an emotion-based response. Beck hypothesized that people suffering from emotional difficulties, especially depression, were highly prone to shift reality toward self-deprecation even in the absence of objectivity (Beck, 1967). “Cognitive distortion” is a term used to describe erroneous conclusions based on errors in reasoning. Cognitive restructuring, mentioned above, is the therapeutic response to cognitive distortion under many circumstances due to the assumption that healthy behavior is unlikely if one is experiencing perceptions and thoughts not properly aligned with reality. Table 5.1 contains a list of many of the most common cognitive errors. TABLE 5.1 Common Cognitive Errors 1. Filtering—taking negative details and magnifying them, while filtering out all positive aspects of a situation 2. Polarized thinking—thinking of things as black or white, good or bad, perfect or failures, with no middle ground 3. Overgeneralization—jumping to a general conclusion based on a single incident or piece of evidence; expecting something bad to happen over and over again if one bad thing occurs 4. Mind reading—thinking that you know, without any external proof, what people are feeling and why they act the way they do; believing yourself able to discern how people are feeling about you 5. Catastrophizing—expecting disaster; hearing about a problem and then automatically considering the possible negative consequences (e.g., “What if tragedy strikes?” “What if it happens to me?”) 6. Personalization—thinking that everything people do or say is some kind of reaction to you; comparing yourself to others, trying to determine who’s smarter or better looking 7. Control fallacies—feeling externally controlled as helpless or a victim of fate or feeling internally controlled, responsible for the pain and happiness of everyone around 8. Fallacy of fairness—feeling resentful because you think you know what is fair, even though other people do not agree 9. Blaming—holding other people responsible for your pain or blaming yourself for every problem 10. Shoulds—having a list of ironclad rules about how you and other people “should” act; becoming angry at people who break the rules and feeling guilty if you violate the rules 11. Emotional reasoning—believing that what you feel must be true, automatically (e.g., if you feel stupid and boring, then you must be stupid and boring) 12. Fallacy of change—expecting that other people will change to suit you if you pressure them enough; having to change people because your hopes for happiness seem to depend on them 13. Global labeling—generalizing one or two qualities into a negative global judgment 14. Being right—proving that your opinions and actions are correct on a continual basis; thinking that being wrong is unthinkable; going to any lengths to prove that you are correct 15. Heaven’s reward fallacy—expecting all sacrifice and self-denial to pay off, as if there were someone keeping score, and feeling disappointed and even bitter when the reward does not come Source: Beck, 1976. Adapted from TIP 34. The Effects of Depression and the Cognitive Triad As mentioned, much of Beck’s work focuses on depression and the debilitating consequences of this disorder. According to Beck (1987) what triggers depression is the coexistence of three main components he calls the cognitive triad. The triad consists of (1) a negative view of oneself, (2) negative interpretations of experiences, and (3) a negative view of future outcomes. When one generally views oneself from a negative standpoint, it is very difficult to experience the actions and words of others from a balanced or accurate perspective. In essence, the starting point for any interaction is always negative. Negative views of oneself, especially when objective evidence does not support such a view, is usually the result of not being properly attended to in earlier formative years. And, this is the case for many offenders. The unfortunate reality is that many offenders, especially those engaged in persistent criminality, have experienced significant neglect and trauma. Common cognitions include, “I am not good enough; I must be wrong; No one will take me serious; if people really knew who I am they would not want to be around me.” Especially, when something goes “wrong,” or not as planned, the immediate reaction is that it is based on their failures. The list of examples is legion. The important element is that the negative view is central to one’s mental landscape even in the absence of evidence. The result of having a negative view of oneself manifests into negative interpretations of experiences. Regardless of the encounter, the default perception is lined with negativism. Beck (1987) referred to this tendency as selective abstraction. Generally, one will focus on negative aspects of an encounter and ignore anything positive. For example, “You have done a good job, overall. Your work ethic is good and you are always on time. Also, the quality of your work is exceptional and beyond that routinely performed by your colleagues. The only negative comment, worthy of mention, is that you are not always clear in your communication. If you could improve this aspect of your performance it would greatly enhance your overall contribution.” A generally balanced and psychologically healthy individual is likely to interpret the above example as a positive review. Individuals with negative views of themselves, however, will focus solely on the suggestion to communicate clearer and construe this element as being an example of their failure. They will selectively abstract the one piece of information that is not positive and view their performance as a complete failure. The third component of the triad relates to one’s negative views of future experiences. A depressed person simply does not see the “light at the end of the tunnel.” Most if not all of their conscious thoughts are centered around past, perceived failures, and the likelihood that nothing will change. Everything is grist for the mill. Even past attempts to change their faulty perceptions or behavior will be used to foster their negative perceptions. Thoughts such as, “I am going to begin working on aspects of my life that I can improve” are often met with judgmental retorts such as, “Yeah right, I said that a million times before and still haven’t done anything.” Corey (2005) provides several examples of generally depressed people that do a good job of illuminating the core framework from which they operate. Depressed people often set goals that are impossible to attain, not only for them but for anyone. They are often very rigid and lack flexibility. If some event or circumstance does not go as planned they see it as a complete failure. Their worth is judged almost solely on external sources. In other words, what is most important is the view of others and anything short of perfection is not tolerable. Depressed people often hold rigid expectations of others as well. And, in the event that one is not able to meet certain expectations there is a profound feeling of disappointment. Failure is almost always anticipated. One way to guard against failure, for the depressed person, is to make exhaustive efforts to control all variables related to one’s life or experience. This, too, however, is a futile attempt. The reality is that one is never able to control all circumstances. Trust is a very scary thought for someone suffering from depression. In essence, they have been “let down” so many times in the past that the only response they know is to not believe in anyone in a misguided attempt to stave off sadness, disappointment, and pain. Finally, depressed people often exaggerate the extent of their responsibilities and external demands. They feel overwhelmed which is accompanied by the expectation that they will not be able to get it done on time. Beck Depression Inventory Clearly, depression is among the most robust antecedents of psychological and emotional distress. As a result Beck (1967) created an instrument to objectively measure depression in an attempt to pinpoint the severity of a client’s depression as well as possible origins. The Beck Depression Inventory (BDI) consists of 21 variables that depict common symptoms and basic beliefs of depressed people. The depth of one’s depression is generally considered to be reflective of the scores provided for each of the variables. The variables measured in the BDI consist of the following: 1. Sadness 2. Pessimism 3. Sense of failure 4. Dissatisfaction 5. Guilt 6. Sense of punishment 7. Self-dislike 8. Self-accusations 9. Suicidal ideation 10. Crying spells 11. Irritability 12. Social withdrawal 13. Indecision 14. Distorted body image 15. Work inhibition 16. Sleep disturbance 17. Fatigue 18. Loss of appetite 19. Weight loss 20. Somatic issues 21. Loss of libido Based on information gleaned through the BDI, cognitive therapists are able to focus specifically on problem areas and attempt to understand the origins of the symptoms. In essence, the BDI serves as a tool to provide clarity and direction for treating clients suffering from depression. As noted by Corey (2005) the goal is to persuade clients to buy into the idea that enacting some type of change is more likely to alleviate powerful pangs of distress rather than continuing with past behaviors. Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is a therapeutic modality that combines various aspects of several different therapeutic approaches including behavioral, cognitive, rational, emotive, and others. The hallmark of CBT is the assumption that distress is a result of improper or faulty cognitive framing that provides the foundation for self-defeating thoughts that lead to maladaptive behaviors. Over the last couple of decades CBT has been the focus of extensive research aimed at validating its theoretical foundation and therapeutic techniques. Much of the research reports favorable outcomes within a variety of settings as CBT is often considered among the most diverse therapeutic modalities available to practitioners. CBT is the logical extension to behavioral and cognitive therapy. It combines the basic components of behavior and cognitive therapy in an attempt to better attend to a fuller range of psychological and emotional stressors that significantly influence behavior. Mahoney and Lyddon (1988) argue that many of the most exciting and advanced therapeutic techniques developed since the 1970s have been within the theoretical construct of CBT. Ultimately, a person’s behavior is driven and guided by a combination of external and internal events. External events driving behavior are well accounted for with the theoretical foundation of behavior therapy. Classical and operant conditioning, when combined, account for behavior that occurs prior and subsequent to learning usually in the form of a reward or punishment. Internal events are more complex and “sneaky” in the manner in which they drive behavior. Internal event refers to internal dialogues that take place within a person’s cognitive structure as a result of some stimuli. For example, “You should put in for that award.” “Oh no, Gosh, if they really knew how screwed up I am. Well, you are doing a great job with the offenders. Yes, but these offenders are really doing all of the work. I am just lucky I have them on my caseload. Really, there is nothing that I have done that makes a difference.” The internal message within this hypothetical is one of not being good enough and low self-esteem among others. The result of this basic cognitive structure is likely to limit one’s ability to reach his or her fullest potential which results in stress that accumulates and demands some type of release. The type of release is what is critical and we would argue that the type of release is related to the level of one’s dysfunction and distress. For example, one would be hard pressed to find a human being who is so well adjusted that he or she does not experience anxiety or depression. We are all flawed; however, the extent is what is critical. Criminal offenders, especially those whose criminality has persisted over time, are likely to have the most negative and destructive internal dialogues. The result of these negative dialogues is often criminality, a behavioral act considered wrong by society as well as our legal system. The essence on which the following information is constructed is that most people who engage in persistent criminal behavior over prolonged periods of time and have experienced various correctional responses from incarceration to probation are likely to possess the most negative and destructive internal dialogues that must be restructured if criminal behavior can realistically be expected to be reduced or eliminated. Bartol and Bartol (2008) provide direct support for our basic thesis by stating, “CBT has become the preferred treatment approach for dealing with certain groups of offenders, including sex offender, violent offenders, and a variety of persistent property offenders” (p. 621). Cognitive Restructuring “Cognitive restructuring is a process through which offenders are taught to identify, evaluate, and change self-defeating, or irrational thoughts that negatively influence their behavior” (Gladding, 1996, p. 274). Irrational thoughts often occur in the form of “shoulds,” “oughts,” or “musts.” Many offenders have developed a powerful cognitive structure that demands they appear tough, strong, smart, and powerful. These demands have been learned via social processes throughout one’s life usually from caretakers and those in his or her immediate environment that seem to garner the most respect. What makes these cognitive schemas so powerful is they are backed by emotional punishments if disobeyed. For example, an offender who has learned that it is important to be tough may feel extreme shame in the face of showing weakness or “backing down.” The experienced shame is very powerful because it is directly related to a prototype the offender views as more powerful than him. The offender who has internalized and accepted the cognitive structure of having to be tough at all times may have heard this from his father. He may have heard his father refer to others perceived as weak in a derogatory fashion. Furthermore, the offender may have even received instruction from his father that he better not find out his son is weak and that no son of his will ever be “seen” as weak. This type of dialogue and learning is extremely powerful due to the authority of the source. This experience manifests itself into the creation of powerful prototypes (authoritative sources) that continuously provide cognitive messages even when they are not physically present. If the offender does not obey the “must” to be tough he has in essence let down his father. For some offenders the emotional pain resulting from such a circumstance may be sufficient to warrant extreme violence. Within the offender population the concept of respect is so powerful that it is likely a factor within the context of most murders. How does CBT attempt to restructure these dysfunctional cognitions? Meichenbaum (1977) provides a well accepted three-phase process. Phase one is self-observation where the offender begins the process of learning how to identify faulty cognitions and dysfunctional behavior. This can be a very challenging phase for correctional counselors because the task is to disassemble the structure of the dysfunctional, internal message that was crafted and sealed by an important source of authority within the offender’s life. The real task of phase one is to get the offender to realize that many of the cognitive structures and internal dialogues governing his life are faulty and will never lead to an existence described as psychologically and emotionally healthy. Phase two is the process of re-creating internal dialogues that are more adaptive and less likely to lead offenders into conflict. They may begin to recreate the dialogue pertaining to respect. It may be that the new dialogue says that if someone disrespects me it does not mean that I have to engage in violence to “save face.” This is not the only option I have. In phase three new skills are taught and learned. This is where offenders are taught specific behavioral responses to aversive stimuli that in the past have led to problems. For example, instead of violence the offender may be taught to immediately remove himself from the situation. SECTION SUMMARY CBT is a robust therapeutic modality that has received favorable results among many empirical tests. Cognitive and cognitive behavior therapy both focus on the importance of cognition and internal dialogues. Within the offender population a large percentage operate from a skewed cognitive structure heavily influenced by various associations with authoritative sources. The hallmark of CBT is that offenders learn to identify self-defeating messages and behaviors, begin the process of altering faulty messages, and then adapt new behaviors that are more likely to lead to positive results. LEARNING CHECK 1. Overgeneralization is when someone holds extreme beliefs based on many past incidents. a. True b. False 2. Cognitive therapy attempts to alleviate distress by teaching offenders new behavior. a. True b. False 3. According to Beck, people with emotional distress often tilt objective reality toward self-deprecation. a. True b. False 4. The cognitive triad describes a pattern that triggers depression. a. True b. False 5. The first phase of Michenbaum’s approach is to immediately begin a new internal dialogue. a. True b. False CASE VIGNETTE: An Example of CBT with an Offender John a 23-year-old male residing in an urban area on the west coast has been arrested numerous times for a variety of charges. His most recent charge involves domestic violence as a result of him assaulting his girlfriend after she failed to return home within 30 minutes of completing her shift at work. Sally, John’s girlfriend, works for a fast-food restaurant approximately 15 minutes from her apartment (depending on traffic). On the afternoon of John’s arrest, Sally was 45 minutes late which infuriated John. When Sally did return home John demanded to know exactly why Sally was late. Sally seemed confused and unsure as to how to answer John because she was late due to her stopping off to pick up John a surprise gift. Sally did not want to ruin the surprise so she hesitated when pressed about her whereabouts. To John, the fact that Sally did not have a definitive and immediate answer proved that she had something to hide. John became convinced that Sally was hiding something from him and was likely cheating on him. In fact, John had been suspicious of one of Sally’s co-workers for some time. This was the final bit of evidence he needed. At this point, in John’s mind, Sally was being unfaithful and this was not acceptable. John was raised in an environment where men were dominant and made all important decisions. In addition, the men in John’s life were free to come and go as they pleased but the females were not allowed the same freedom. In fact, the females were expected to be home and tend to domestic duties. In John’s upbringing he was taught that a female who was not obedient needed to be put in her place. John was arrested for twice striking Sally in the back of her head. COUNSELOR: Can you tell about the day of the incident for which you were arrested? JOHN: Yes, my girlfriend was late. She did not have any explanation for why she was late. I know that she was probably with another guy. I am a man, and she is not going to disrespect me that way. I will not tolerate it. She is going to understand that I am incharge. COUNSELOR: Do you have any evidence that your girlfriend was with another man? JOHN: No, but what would you think if your wife was 45 minutes late? COUNSELOR: Well, I would probably begin by asking her if she is ok? JOHN: Asking her if she is ok, man, where I come from a woman is not late and if she is she better have a good reason and she better not start hesitating when questioned. At this point the counselor has identified several important cognitive structures from which John is operating that are faulty. In this case the counselor will probably have to spend a significant amount of time, maybe several sessions, establishing a strong therapeutic alliance with John. For some counselors John’s cognitive framework may be very troubling. This must be worked through in order to avoid any hint of judgmentalism. In order to form a strong therapeutic alliance, John will have to grow to trust the counselor and feel that the counselor has valuable information. This will be the foundation on which the counselor is able to slowly begin to teach John how to begin the process of cognitive restructuring. First, the counselor will need to train John to be attentive to his basic internal dialogues. Second, John will need to develop new internal dialogues that are more functional and reflective of objective reality. Finally, John will need to identify behaviors that are first, not illegal and second more conducive to establish meaningful connections with significant others. COUNSELOR: John, as you were standing in the yard, furious, and waiting for Sally, what was going through your mind? JOHN: Well, I kept thinking about how my dad used to say that no woman should be allowed to disrespect her man. He used to say that it was not tolerable for a woman to be late and if she was she was probably up to no good. I also started thinking, what is wrong with me? What is it that some other guy has that I don’t? COUNSELOR: Where is your dad? JOHN: He is in jail. He has been married three times and his last wife just left him. He began drinking one night and when he came in the house she was hanging up the phone. She was said she was talking to her mother but he did not believe her. He roughed her up and the neighbors heard what was going on and called the police. He is probably going to spend some time in prison for this charge because this is like the fifth time he has been arrested for domestic violence. COUNSELOR: How long have you been in jail? JOHN: I have been locked up for three weeks because I do not have the money to make bail. And, I hate it in here. I hate to admit it but I am scared. I see people getting beaten up all the time. COUNSELOR: Ok, John, are you ready to begin working on bettering your life and ultimately identifying healthier responses to certain aversive stimuli? JOHN: Yes, but how do I do it? COUNSELOR: First, you have to begin closely monitoring your internal messages regarding such issues as respect and self-worth. Can you envision a scenario where Sally may be late from work but yet have a very valid reason? Can you envision a time where Sally may not immediately come home from work simply because she wanted to go shopping for a while? Can you begin to envision a time where you do not relate such incidents to your self-worth or to the concept of respect? JOHN: Yes, I think so, but it will be hard. COUNSELOR: I understand it will be difficult. It is hard to let go of deep, entrenched thought processes that are laced with “shoulds,” “oughts,” and “musts.” However, it will be necessary to change the basic messages you send and receive to yourself regarding the appropriate behavior of Sally or any other woman with whom you may engage in a relationship. JOHN: So, what types of thoughts should I have? How do I not immediately get angry because I feel disrespected? COUNSELOR: You can begin by first recognizing that it is never acceptable to strike another person. Regardless of the circumstance, it is never legal to assault another person because you feel disrespected. Your father has engaged in this type of behavior and look where he is at. You have tried it and look where you are at. JOHN: Yes, you are right. I do not want to spend my life in jail. I also do not want to go through several divorces. I want to marry someone I love and I want to remain with them. COUNSELOR: What if you tried something different when you begin to feel angry? For example, what if you said to yourself, ok, I am feeling angry because Sally has not yet returned home. But, I am not going to overreact. I am going to wait to hear from Sally. It is possible that there is a valid reason for her not being home yet. JOHN: Yes, I think I can do this because, really, Sally has never done anything to hurt me. I hate that I scared her so bad and got so angry with her. All I can think about is telling her how sorry I am. And, you know, I really want to be different. I remember my dad telling my mom he was sorry but then he would hit her again the next time he got mad. I want to change so that we can be happy. COUNSELOR: Ok, so far we have accomplished two important tasks: (1) You have learned that you must be aware of and monitor your internal dialogues. Such messages like a woman’s place is in the home and a woman should never be late are not healthy messages from which to make decisions or base your actions; (2) you have learned that it is ok for Sally to be late. It does not mean that she does not respect you. It may be because she is not ready to come home and that is ok. Or, it may be that she has somewhere to go prior to coming home. Regardless of the circumstance, it does not mean that you are being disrespected. At this point, the counselor may check with John to ensure that the therapeutic alliance is still strong. It may also be beneficial to probe John as to whether he is truly able to internalize these suggestions and new cognitive structures. If so, the counselor is ready to proceed to the final phase which is helping John identify new behaviors. If not, the counselor may need to spend more time with John talking about his concerns as there may be additional information that will need to be explored prior to John being ready to proceed. JOHN: So what type of suggestions do you have that can help me change my behavior? COUNSELOR: First, remember that it is never acceptable to assault another person. So that is the first step, to commit to the fact that violence is not an option. And, when you feel yourself beginning to feel threatened that you remember that you will at least talk to Sally before concluding that she is doing something hurtful. JOHN: Ok, I get it. I know that I can not hit Sally. And, I have committed to never doing this again. Like I said before, I do not want to spend my life in jail. I am better than that. And, I don’t have to believe everything I learned from my dad. Look where he is at. And, even when he is not in jail he is not happy because he is constantly worried about making sure he is the “man” of the house. COUNSELOR: Yes, and you may try this also: When you feel yourself getting worked up and anxious tell Sally how you are feeling. Begin the conversation by first acknowledging that you are feeling angry or fearful. Let Sally begin to help you work through this. Instead of immediately attacking Sally for something she probably did not do, tell her that you are angry and that you are going to do all that you can to remain calm but that you may need some help. Tell Sally that you are working very hard to not buy into the old cognitive structures that demand you not be disrespected. If necessary, you may also take a little time to gather your thoughts before talking with Sally. In fact, you may create distance between you and Sally until you feel ready to talk in a nonthreatening manner. JOHN: It will not be easy but at least now I have a new way of thinking about things. In the past I was not open or familiar with any alternatives other than feeling disrespected and feeling as though I must do something about it or I was not a real man. I realize that this is crazy and will only lead to trouble. PART THREE: REALITY THERAPY Reality therapy was created by William Glasser, born in 1925 in Cleveland, Ohio. Glasser’s initial training was in chemical engineering where he received a degree from Case Institute of Technology. He then decided to attend graduate school and in so doing began studying clinical psychology. After completing his master’s degree, Glasser then chose to attend medical school graduating in 1953 from Western Reserve University. Glasser specialized in psychiatry and was board certified in 1961. By 1962 Glasser had created the structure for what he called reality therapy (Corey, 2056; Gladding, 1996). The foundation of Glasser’s reality therapy is predicated on a few central postulates. First, Glasser and Zunin (1979) delineated old and new brain needs. Formerly, humans were mostly guided by physical needs to survive. Paramount concerns included those related to food and drink. In modern times, however, most humans do not experience these same concerns. Therefore, with basic (old brain) needs mostly met humans began grappling with the powerful pangs and often elusive new brain needs. According to Gladding (1996) new brain needs consist of the following four psychological needs: 1. Belonging—the need for friends, family, and love 2. Power—the need for self-esteem, recognition, and competition 3. Freedom—the need to make choices and decisions 4. Fun—the need for play, laughter, learning, and recreation (p. 279). How do we best satisfy each of these new brain needs? According to reality therapy new brain needs are best satisfied through healthy relationships with others. Therefore, the second major postulate is the realization that modern humans need to establish nurturing, loving, and lasting relationships with others. Without satisfying relationships through which people are able to connect in meaningful and fulfilling ways modern human needs can not be met. When humans are not able to establish meaningful connections with others most will begin to engage in maladaptive behaviors that are misguided attempts to fulfill basic needs. For reality therapists this is the crux of most dysfunctions. People are either not meaningfully connected to others or the connection is unsatisfying. And, it is from this basic framework that Glasser largely rejects the medical model related to mental illness (Glasser, 2003) and adamantly denounces the use of medication to treat emotional and psychological symptoms related to a lack of satisfying human connections (Corey, 2005). The third major postulate of reality therapy is that people make choices in relation to how they respond to various stimuli. This is an important component of reality therapy. In essence, behavior is purposeful and based on conscious thoughts that direct us in ways we feel are most likely to get our needs met. Total behavior is a concept used by reality therapists that describe four interrelated components of all behaviors: 1. Doing—the outward, overt, physical act of taking some form of action 2. Thinking—the thought process of driving the specific physical actions we choose to carry out 3. Feeling—the feelings associated with our thoughts and actions that can be either positive or negative 4. Physiology—the physiological reactions related to what we do, think, and feel. Similar to feelings, physiological reactions can be positive or negative. An example could include the energized feeling one gets as a result of exercise (Corey, 2006; Gladding, 1996). Fundamental to reality therapy is its emphasis on personal responsibility. Especially, with offender populations this concept is critical. Many offenders avoid taking responsibility for their actions and instead adopt the role of victim. Choice therapy, however, operates from the assumption that people do have choices and it is based on these choices that one will achieve our most basic desire—closeness with another. In order to accentuate this concept, Glasser published Positive addiction (1976) and also the Identity society (1972). The essence of both of these works is fundamentally related to the idea of choice as well as the need for identity. We all have a basic psychological need to establish an identity that is unique and meaningful. Glasser (1972) made these points clear in what he called the success identity. Central to developing a success identity is being accepted for who you are, including faults and imperfections, by others. When one feels accepted by others there is usually a transfusion of feelings of love and worth, both of which are central components to a success identity. The antithesis is a failure identity usually developed in the absence of love and acceptance. Common characteristics of a failure identity include a basic sense of insecurity where one’s conclusions based on some stimuli are often erroneous. In addition, people suffering from a failure identity usually lack confidence to try new things and tend to give up easily. In essence they see life as a string of failures and come to accept this as normal. Common verbiage coinciding with a failure identity may include, “Why try, I never succeed. I guess my family was right, I am useless.” The Function and Role of the Therapist Reality therapists work to create success identities and help offenders gain psychological strength. The first and most important goal is to establish a strong therapeutic alliance. This is important to understand when one considers that most offenders are offenders because they never felt truly accepted by their caregivers. Most offenders have developed a failure identity as a result of being abused and/or neglected. The reality therapists’ first task is to therefore accept the offender via nonjudgmental caring and empathy. This is the foundation that will eventually allow the therapist to gently confront the offender when necessary or to focus on reality and also what is rational. Without building a strong therapeutic alliance, subsequent techniques will be rejected primarily due to the lack of feeling perceived by the offender in relation to the therapist and therapeutic process. According to Gladding (1996) therapists may even choose to disclose personal information as a gesture to help establish understanding and acceptance as well as an attempt to express to the offender the therapist’s belief and faith in his or her ability to change. In essence, counselors get involved with the offender and work to establish a meaningful relationship. Once a strong relationship between offender and therapist has been forged various action-oriented techniques may be deployed. Gladding (1996) notes that reality therapists routinely use techniques such as teaching, humor, confrontation, role-playing, feedback, plans, and contracts within the therapeutic process. The most important task beyond the therapeutic alliance is identifying behavior that is dysfunctional. Reality therapists work to help offenders face the reality of their behaviors and that their behavior is their responsibility. This recognition often requires confrontation in order to help an offender identify and accept responsibility for his or her actions. It is critical to note, however, that this process is delicate and as is always the case the counselor must be well grounded because the counselor must reject the offender’s dysfunctional behavior without rejecting the offender as a person. Well-placed and cleverly guided humor may serve as an excellent tool in this process. Positive, nonjudgmental humor can be significantly lighten the emotional burden offenders carry into the counseling process as a result of the very natural fear of exposing oneself. Once the problem behavior(s) have been identified reality therapists begin to work with offenders by helping them identify new behaviors more capable of producing desired results. This is often done through teaching and role-playing. Wubbolding (1991, 1998), a significant contributor to reality therapy, established the WDEP system which can be used as an excellent guide for reality therapists. Each of the letters within the acronym signifies one of the major components of reality therapy: W = wants, D = doing, E = evaluate, and P = plan. It is critical to find out what clients want. For example, what kind of person do you want to be? And, what are you doing to be the person you want to be? Counselors also help offenders evaluate their actions. For example, when you steal as opposed to buying what you want, what has happened? And, each time you are arrested, how does this affect your chances of obtaining meaningful employment? The remaining step is planning for future behaviors that are more likely to produce positive results. This is among the most difficult aspects of the reality therapy process. While in the presence of a sanitized environment, the counselor’s office, most plans seem good and are readily agreed upon by the offender. In the real world of the offender, however, and in the presence of peers who are also likely to be involved in criminal activity, the fragility of most plans quickly resonates. Plans must be concrete, executable, and realistic in relation to many of the variables most offenders must contend with. For example, it would not be realistic and even counterproductive to construct a plan with an offender that calls for him or her to no longer associate with anyone involved in criminal activity. It may be that his or her parents or brothers and sisters also engage in criminal acts. Obviously, this point would not be valid in the case of serious or violent crimes. What is critical is that the plan be one that is attainable and specific to the offender so that he or she is able to take ownership of the plan and make a sincere commitment to carry it out. In some cases the plan may be written out with each component clearly articulated simulating a formal contract. Once the contract has been agreed upon, reality therapists make clear that no excuses will be accepted for a lack of execution. Although this is a critical step that we strongly support, a word of caution is necessary. Counselors should only execute a contract followed up with strong expectations highlighted by no excuses when they are confident in their alliance with the offenders. Many offenders endure harsh verbal and physical abuse at the hands of authoritative figures. Without a strong alliance some offenders may aversely react to messages or language implying authority. Finally, the reality therapist must be fully committed to the offender. As noted by Glasser (1965, 1980), counselors should not give up on clients even when they fail to follow through on agreements. In fact, we would argue that it would be the rare case where an offender would follow through with all agreements without any deviation. Most offenders will fail or relapse at various points in counseling. Counselors must understand this natural process and not take it personally. It may be that the mot significant gains are made after a breach of contract when the offender realized that the counselor is still there, still committed to his success, and is not going to abandon him. Most individuals whose criminal offending persists into adulthood have experienced chronic abandonment by those who were supposed to love them. A counselor’s genuine care that clearly articulates that he or she will not abandon the offender may be sufficient to begin the process of restructuring the cycle of failure prevalent in the offender population. SECTION SUMMARY Reality therapy is a popular therapeutic modality with the offender population. Its primary focus is on the present and what the offender is doing now. The therapeutic alliance is critical and offenders must feel accepted, respected, and understood. It will be the alliance that will allow the reality therapist to confront dysfunctional behavior as well as the natural hesitancy to take ownership of behavior. Once the alliance has been established the focus turns to dysfunctional behavior that is inhibiting the formation of a meaningful success identity. Nonjudgmental guidance is paramount as the counselor begins to formulate a plan, in conjunction with the offender, aimed at identifying alternative responses and behavior to negative stimuli. Plans must be specific and concrete but also flexible. Plans should be drafted in the form of a contract in order to stimulate ownership as well as to ensure comprehension especially as it relates to realism and attainability. Finally, reality therapists need to be engaged with offenders. Counselors must be empathic and tenacious in their attempt to help offenders and always cognizant of the importance of reassuring offenders that they believe in their ability to change and that they will not be abandoned. LEARNING CHECK 1. The successful creation of a therapeutic alliance is not that important as reality therapy techniques are designed to focus on analyzing subconscious processes. a. True b. False 2. Autonomy and accepting responsibility for behavior are primary components of reality therapy. a. True b. False 3. In reality therapy counselors should never confront offenders as this may damage the therapeutic alliance. a. True b. False 4. Reality therapists are more interested in present behaviors than they are in the past. a. True b. False 5. In reality therapy the counselor should always refrain from using humor. a. True b. False CASE VIGNETTE: Using Reality Therapy with an Offender Arrested for Theft John is a 24-year-old white male who has been arrested several times for theft. He began stealing things early in his life and the process continued up until his most recent arrest for attempting to steal a flat screen television set from the local Home Depot. John’s parents divorced when he was 10 years old. His father was an alcoholic who frequently abused his mother both verbally and physically. His mother worked several different jobs and was rarely available to tend to anything more than John’s most basic needs. John has been sentenced to probation and one of the requirements is that John attends weekly counseling sessions. The following dialogue generally captures the main components of John’s exposure to reality therapy. A very important caveat, however, must be clearly expressed. The following dialogue is based on the assumption that John trusts and believes the counselor. In other words, a therapeutic alliance has been established. JOHN: A lot of times it’s just easier to take something. I don’t have a regular job and things are expensive. COUNSELOR: I understand; however, is stealing something getting you what you want? JOHN: Well, not really because I am always worried about getting arrested and the judge told me that if I go back to court I am going to be sent to prison. COUNSELOR: So, what do you want to do? JOHN: I don’t know, I am scared. I never went to college so I can’t get a good job. COUNSELOR: It is ok to be scared, however, to get what you are really needing you must change your behavior. JOHN: That’s easy for you to say. COUNSELOR: It’s also easy for you to continue to steal and not change your behavior. JOHN: Well, if it is so easy, tell me what to do. COUNSELOR: Tell me something, how would you describe the life you would like to be living? JOHN: Well, I really would like to be a certified auto mechanic. I like working on engines and they make good money. COUNSELOR: Then go do it. JOHN: I can’t, I don’t know how to work on ALL engines. COUNSELOR: How can you not do it? What is the alternative? Once John was able to articulate a style of life that would be more fulfilling the process then progressed to formulating a plan capable of getting John what he wanted. This dialogue is primarily aimed at depicting the process of confronting an offender. Offenders involved with the criminal justice system will not usually give up behavioral adaptations easily. If they were open to alternatives they probably would not be in the criminal justice system. Once the offenders accept the fact that they will not get what they want unless they change their behavior they are usually ready to work with the counselor in constructing a plan. Some offenders, however, will not make this transition from openly acknowledging their current behavior is not able to get their needs met to actually constructing and taking ownership of a plan to change. If this occurs it is critical that counselors remain nonjudgmental and supportive. Some offenders may need more time. A counselor who takes this personal will likely do grave harm to the alliance. Finally, once the plan has been established and agreed upon the counselor will remain committed to the client, constantly providing reassurance. PART FOUR: GESTALT THERAPY Gestalt therapy is among the most popular therapeutic modalities in current practice. Gestalt is a concept that describes the process of becoming whole. The thrust of Gestalt therapy is aimed at helping individuals experience enhanced perceptions of wholeness. The focus is primarily on awareness and what a person is feeling and experiencing now as opposed to the past. Frederick Solomon Perls is regarded as being most responsible for popularizing Gestalt therapy (Gladding, 1996). Perls, born in 1893 to a middle class family in Germany, immigrated to the United States in 1946 where he established the Gestalt institutes providing training in Gestalt therapy through lectures and workshops. Throughout Perl’s professional life he was fortunate to meet and work with some of the most significant contributors to the field of psychology including Sigmund Freud, Wilhelm Reich, and Karen Horney (Corey, 2006). It may be, however, that Perls’s most significant association was with Kurt Goldstein. According to Gladding (1996) it was from Goldstien that Perls came to view people as whole or complete beings as opposed to being composed of separate parts. As noted by Perls (1969) individuals are more than simply the sum of their parts. Basics of Gestalt Therapy Gestalt therapy is a modality most focused on the concept of “now.” Perhaps Perls (1970) articulates this best in a formula he developed stating, “Now = experience = awareness = reality” (p. 14). Perls believed that many people suffering distress were engaged in excessive intellectualization of life events that inhibited the flow of natural emotion. For example, intellectually, a person may reason that they “should” or “should not” react in a certain way to some stimuli. The result of this “intellectualizing” is the stymied flow of true emotion resulting in their suppression and over time will lead to distress. In essence, overintellectualization inhibits the natural self’s expression and fractures the gestalt. This is precisely the reason that in Gestalt therapy, “why” questions are avoided. “Why” questions have a tendency to initiate intellectualization as opposed to what and how questions that focus more on the present (Gladding, 1996). Another significant aspect of Gestalt therapy is working with unfinished business. In this context, unfinished business is past figures or experiences that manifest such feelings as anger, rage, guilt, fear, and abandonment. Unfinished business is significant and must be dealt with in order to restore the gestalt. Unfinished business from the past that results in powerful negative emotions in the present is generally the result of someone experiencing negative stimuli at a time or place where one did not feel he or she was in possession of significant power to respond authentically. As a result of these experiences emotions were again suppressed and in the present often provide the foundation from which one feels fractured. For example, someone who has experienced significant abandonment by primary caregivers while growing up may experience severe anxiety in certain circumstances that may be expressed in rage as one attempts to regain control. An adult suffering from the effects from such unfinished business is likely to engage in behavior that significantly reduces the individual’s ability to reach his or her fullest potential. Working with unfinished business can be difficult and extremely demanding. For most people, the thought of revisiting past events that were extremely painful and traumatic fosters fear and anxiety. These precise moments can be very beneficial to the counselor as the offenders are likely to respond in similar fashions as they would in real-world interactions. The offender who becomes defensive or hostile while attempting to work through unfinished business is likely to do the same in other settings. And, it will usually be these behaviors presented as troublesome and causing distress. For example, offenders may initially report that they often feel defensive or anxious when engaged with others and would like to work on this because it is limiting their ability to feel whole. What they may not realize initially is that these behaviors are a result of unfinished business regarding prototypes. Herein lies the essence of working with unfinished business and why it is paramount. The offender must be guided through the process of experiencing the real, unfettered emotion of harmful past experiences. Only by experiencing these suppressed emotions in the present will one be freer to choose his or her responses in the now. It may be that offenders will be most open to working with unfinished business when they perceive themselves to be stuck or at an impasse. In other words, they do not know what else to do and their traditional responses of control, anger, violence, fear, and intimidation have failed them. At this point counselors may provide the most assistance by simply being there with the offender and providing an opportunity, free of judgmentalism, for the offender to experience and feel his or her frustrations fully. The goal is to become aware of their feelings and “accept whatever is, rather than wishing they were different” (Corey, 2006, p. 197). The Value of Contact and Resistance to Contact Contact in Gestalt therapy describes the process of interacting with the environment, especially with other people, in order to learn and grow as individuals (Corey, 2006). Human beings need contact in order to be whole. Positive contact allows us to experience sensations in the present that foster energy through the process of expression (Zinker, 1978). It is through contact with others that we get a sense of being “good enough” and that our authentic self is worthy. Through such positive interactions we are better able to experience gestalt and are free from having to pretend or appearing to be something we are not. Unfortunately, contact with others is not always positive. In fact, some contacts can be extremely damaging and can greatly affect one’s sense of self-worth. The most damaging contact is likely to result from being rejected by primary caregivers. This is usually the source of unfinished business most likely to be encountered within the counseling process. When one experiences negative contact whether from caregivers or others the result is usually in the form of painful emotion. In essence, we feel rejected and as a result of these painful experiences begin to construct defenses to reduce the likelihood of experiencing similar circumstances in future contacts. Often these defenses, or resistances to contact, are constructed early in life and become firmly ingrained as one proceeds through life. The power of these defenses is firmly rooted in our attempt to avoid painful feelings that detract from our self-concept and leave us feeling inadequate. The paradox lies in the fact that the defenses we use to protect our self are precisely what keep us from being whole. E. Polster and Polster (1973), who have written prolifically in regards to Gestalt therapy, provide five primary defenses that must be challenged. Introjection describes the process of freely accepting information from others without any critique of one’s own thoughts or ideas. In spite of any evidence, we internalize whatever we receive from our environment. If someone says “we are not good enough, or will never achieve what others have,” we accept this without restructuring it into a realistic framework. Projection is commonly used as a defense and is the opposite of introjection. We project onto others the traits or characteristics that are not congruous with the person we would like to be. This defense allows us to blame others for the characteristics we refuse to face in ourselves. Subconsciously we decide that it is easier to blame others than face the painful reality that we are not perfect. Retroflection is the process of doing to ourselves what we would like to do to someone else. We may injure our self in an attempt to reduce strong feelings of pain or anger instead of directing our actions toward others whom we likely view as being too powerful. In some cases, prolonged drug abuse can be seen as an example of retroflection. Instead of confronting those who have harmed us we direct our pain inward through the use of foreign substances that eventually destroy our bodies. Deflection describes the process of diverting meaningful contact that is perceived to be threatening. People who do not have a basic sense of well-being often experience extreme difficulty with accepting praise or compliments; beneath the surface there is the rebuttal of, “Yeah, but …,” “If they only knew …” This defense greatly reduces one’s ability to experience meaningful emotion. Confluence is a defense that describes the process of staying safe by not expressing one’s feelings or opinions. People may engage in criminality with others because they are afraid to say no. They want to be liked and accepted and so they feel that the only way to accomplish this is through compliance. These types of resistance to contact share a fundamental foundation. The attempt, albeit misguided, is to control one’s environment in order to reduce his or her chances of being hurt. As noted above, however, when one or more of these defenses are employed the ability to experience wholeness is impossible. The Function and Role of the Therapist The first and most important role of the therapist is to create the foundation from which a strong therapeutic alliance can be built. This is a critical aspect of any therapeutic modality but is especially so with therapies that employ confrontation, such as Gestalt therapy. The atmosphere must be one that encourages offenders to freely and fully explore areas of their life that are creating or contributing to distress. Especially when working with offenders, counselors must be honest and involved. Counselors need to be energetic and exciting (Polster & Polster, 1973) and work to keep offenders focused in the now (Perls, 1969). The Importance of Verbal and Nonverbal Communication For Gestalt counselors one of the most important tasks is to guide offenders into the “now.” The focus is on rationality and assisting offenders in taking ownership of thoughts and behaviors. To do this, counselors pay careful attention to verbal and nonverbal communication. Corey (2006) discusses several important clues that provide rich insight into an offender’s internal dialogue that often needs to be modified. The central theme to the following clues is they are aimed at reducing the offender’s sense of responsibility for actions. Often offenders will use “it” talk as opposed to “I” talk. “It” talk functions to depersonalize circumstances relegating them to the “general” instead of the “present.” An offender may say, “it is very difficult to stay out of fights.” The alert counselor may suggest the offender restate this in the form of “I have difficulty staying out of fights.” “You” talk is similar to “it” talk. This type of verbal communication functions to keep the offender sheltered by globalizing circumstances. The implied question associated with “you” talk is “Wouldn’t you?” “Would you not do the same thing?” The counselor’s task is to get the offender to substitute “you” with “I.” Questions also keep the offender sheltered and mysterious. Often offenders will respond with numerous questions instead of direct statements. Questions function to keep the offender from directly facing reality. Language that denies power is very important to identify. As long as an offender is allowed to use language that detracts from his or her personal power he or she will not realize the essence of Gestalt therapy—wholeness. Qualifiers such as “maybe, perhaps, sort of, I guess, possibly and I suppose” (Corey, 2006, p. 201) need to be transformed into direct statements. Similarly, offenders will often use “I can’t” instead of the accurate and direct statement of “I won’t.” Finally, listening for language that uncovers a story can provide a wealth of information regarding an offender’s true mental and emotional landscape. This can be challenging because most offenders will not be accustomed in using direct statements that expose them. Indirect language should be viewed by the counselor as a defense mechanism that is ultimately used to protect oneself from being rejected or harshly judged. During the process of communicating, offenders will often glaze over salient information regarding their life and who they are. In order to be effective, counselors must be alert to these subtleties in language and strategically and gently guide the offender back into the part of the offender’s life story that is most frightening or exposing in order to experience real and meaningful interaction. Real progress and healing will take place in sessions where the counselor is able to create an environment where an offender is able to explore real emotions and not be critically judged but instead accepted as a human being. Common Gestalt Techniques “Some of the most innovative counseling techniques ever developed are found in Gestalt Therapy” (Gladding, 1996, p. 227). The one precursor, however, essential to the application of Gestalt techniques is the authenticity of the counselor. As noted by Corey (2006), to mechanically apply therapeutic techniques does little to provide the foundation on which offenders are able to transform inauthentic living to that which is filled with feeling and the ability to express oneself wholly. Also, it is important to differentiate between two different concepts, exercises, and experiments, commonly used in Gestalt therapy. Exercises are ready-made techniques (Corey, 2006; Gladding, 1996) applied to certain circumstances in order to provoke a response from an offender or further exploration of feeling. Experiments are spontaneous and grow out of specific interactions taking place within the counseling relationship. For example, an offender filled with anger and rarely able to experience joy or playfulness may be asked to do something silly. He may be asked to lie on his back on the floor and flail his arms and legs. To the offender this may seem bizarre and completely void of any practical reasoning. The point, however, is to demonstrate that it is ok to be silly—it can be fun and invigorating even if control is set aside only for a short time. Experiments are vital to Gestalt therapy and provide the path for exploring stimuli responsible for much of the offender’s distress. Among the most poignant of Gestalt techniques is confrontation. It is critical that counselors be able to point out incongruencies in what offenders are doing and saying. The ability to effectively confront offenders requires counselors to be authentic and also brave enough to endure negative reactions as offenders struggle to maintain the “props” that have supported their egos and justified their actions. It is important to note that confrontation in contemporary Gestalt therapy is not meant to be harsh or delivered in the form of attacks. Modern Gestalt therapy has far advanced many of the techniques exhibited by its founder, Fritz Perls. As noted by Yontef (1993) it appears as though Perls, in many cases, was more interested in meeting his own needs than those of his clients. Confrontation is the attempt to gently transform an offender into a more real person by showing him or her acceptance for who he or she really is and that denying one’s responsibility is not capable of providing wholeness. Another technique common to Gestalt therapy is dialoguing with polarities. The polarities are commonly depicted as the “top dog” and “under dog.” The top dog is the part of our personality that is associated with governing our thoughts and actions. It is perfectionistic and overly demanding. The top dog is where “shoulds” originate. The underdog takes the opposite stance and usually relies on the perception of being powerless and is very capable of creating clever excuses for not acting or changing one’s behavior. Without intervention these two sides become embroiled in a bitter battle that deflates one’s energy and sense of wholeness. One of the most effective techniques in dealing with polarities is the empty chair. The offender is guided through a process where the use of an empty chair is used as a prop to illuminate the internal struggle caused by conflicting messages. The essence of the empty chair technique is to enhance awareness and reduce fragmentation. The offender is guided through the process of placing each polarity into the empty chair and then verbalizing its demands. Ultimately, the offender is able to internalize how each polarity is bombarding the authentic self with messages that are impossible to carry out, or place extreme demands on the authentic self that if carried out will greatly detract from one’s quality of life. Role-playing is a technique used to help offenders identify and adapt more functional responses to aversive stimuli. This can be a very beneficial exercise for offenders who feel “trapped” or “locked in” to certain responses that they feel must be carried out under certain circumstances. For example, the offender who feels he must respond with violence to any circumstances where there is the perception of being disrespected may begin to explore various alternatives by playing out different roles within the safety of the counseling process. Staying with feelings is the process through which counselors help offenders remain in the present with feelings that are frightening or shameful. Most human beings have a very difficult time remaining in the present with feelings that threaten our cognitive equilibrium. Humans are well served by arranging feelings and emotions in ways that reduce anxiety. The problem with this, however, is that it is impossible to reach the origins of dysfunction by attempting to alter or rearrange feelings on the surface. The consequence of not staying with feelings and investigating the origins is that the same defensive techniques will continue to be employed when presented with threatening stimuli. The counselor’s task is to encourage the offender to stay with feelings for as long as possible. The longer the offender is able to remain in the present with feelings the better the chances of uncovering the origins of the feelings which can then be processed and evaluated. Making the rounds is a Gestalt technique commonly employed in group settings. This can be a very powerful technique as offenders are encouraged and guided through the process of “checking out” their feelings with the members of the group. Corey (2005) provides a good example of how he has used this technique with clients having difficulty trusting others. Offenders are also likely to find it very difficult to trust most human beings because they would have often experienced rejection and neglect during their formative years. For those offenders having a difficult time taking the risk associated with sharing their feelings, making the rounds may prove very beneficial. An offender may be encouraged to address each member of the group and begin the dialogue with “What makes it hard for me to trust you is …” (Corey, 2005, p. 211). The goal is to help offenders begin the process of taking risks and understanding that not everyone will judge them with the harshness they have experienced in the past. Exaggeration is often used in Gestalt therapy to heighten awareness surrounding various messages the offender may be sending. Exaggeration is usually used in conjunction with behavior but can be adapted to cognitive processes as well. An example could include a counselor guiding an offender through the “worst case scenario” of some real or imagined stimuli. The ultimate goal is to reduce fear in relation to a circumstance or encounter the offender perceives as distressing. CASE VIGNETTE: An Example of Gestalt Therapy Used with an Offender Suffering from Substance Abuse Sandra is a 38-year-old African-American woman who has abused a number of substances, including cocaine, heroine, alcohol, and marijuana over the past 15 years. She left high school and was a prostitute for five years. Later she found a job as a sales clerk at a home furnishings store. Sandra had two children in her early 20s, a daughter who is now 15, and a son, aged 18. Because of her substance abuse problems, they live with other relatives who agreed to raise them. Sandra has been in treatment repeatedly and has remained substance-free for the last five years, with several minor relapses. She has been married for two years to Steve, a carpenter; he is substance-free and supports her attempts to stay away from substances. Last month she became symptomatic with AIDS. She has been HIV-positive for five years but had not developed any illnesses related to the disease. Sandra has practiced safe sex with her husband who knew of her HIV status. Recently, after learning from the physician at her clinic about her HIV symptoms, she began to “shoot up,” which led her back into treatment. Out of fear, she came to the treatment center and asked to see a counselor at the clinic one day after work. She is worried about her marriage and that her husband will be devastated by this news. She is afraid she is no longer strong enough to stay away from drugs since discovering the onset of AIDS. She is also concerned about her children and her job. Uncertain of how she will keep on living, she is also terrified of dying. Response to the case study The Gestalt therapist begins with Sandra’s current experience of the world, starting with awareness and attention. The therapist may simply help her become aware of basic sights, sounds, somatic reactions, feelings, and thoughts as well as what her attention drifts to. The immediate contact between therapist and client is a component of the “now” where these sensations are explored directly. The therapist might notice and ask about her style of eye contact, or her fidgeting body, or stream of thoughts (e.g., “What is it like to make eye contact now? What is the sensation in your body at this moment?”). Sandra may also identify certain issues such as substance abuse, relationship difficulties, and the threat of death from AIDS that seem to dominate her life. The therapist might invite her to name and explore the sensation that the thought of death, for example, brings; perhaps this involves a sense of a void, or feeling cold and dark, or a feeling of engulfment. She then may be asked to become these sensations—for example, the therapist may ask her to be “the void” and encourage her to speak as if she were that void. This may then open possibilities for a dialog with the void through acting out the opposite polarity: separateness and choice. This might involve using an empty chair technique in which the client would literally move into the chair of the “void,” speak as if she were that, and then move into an opposite chair and respond in a dialog. A therapist could also explore her introjection through questions such as, “How is this void different or the same as from the feeling of alcohol or in relationships with your children or husband?” She might also use this same technique to dialog with family members, or certain aspects of herself. Sandra seems to have a great deal of “unfinished business” that involves unexpressed feelings (e.g., anger, longing, hurt). Experimentation with these sensations may begin to free her to express and meet these feelings more directly. All of this work encourages Sandra’s experimentation with new ways of relating both during and outside of the session in order to move into the “here and now” and work toward the resolution of “unfinished business.” Source: Barry, K. L. (1999). Brief interventions and brief therapies for substance abuse. DHHS Publication No. (SMA) 99-3353. Substance Abuse and Mental Health Services Administration. Rockville, MD. SECTION SUMMARY Gestalt therapy is primarily aimed at helping offenders modify dysfunctional behavior through enhanced awareness of feeling and emotion. The essence of Gestalt therapy is wholeness. In other words, as long as one is fragmented and not functioning from a unified perspective there will be distress. Gestalt therapy is direct and firmly predicated on a strong alliance between the counselor and offender. Reality or “realness” is also a big part of Gestalt therapy. The work of the counselor is to help offenders identify troublesome behavior and begin to develop new ways of getting their needs met. Confrontation is the mainstay of Gestalt techniques. However, it is delivered gently and with empathy. LEARNING CHECK 1. Modern Gestalt therapy is still practiced in the same manner in which it was introduced by Fritz Perls. a. True b. False 2. Wholeness is important to Gestalt therapy but not as important as intellectualization. a. True b. False 3. The empty chair is a common technique used in Gestalt therapy. a. True b. False 4. In Gestalt therapy, counselors rarely confront offenders due to the fact that this may damage the therapeutic alliance. a. True b. False 5. In most cases the “top dog” will be correct and should be obeyed, especially in light of the fact that most “shoulds” have been ingrained through the interactions with care givers. a. True b. False CONCLUSION In this chapter various therapeutic modalities have been explored. Each modality consists of specific theoretical underpinnings that provide the foundation for techniques aimed at altering cognitions and behaviors. For example, some modalities believe it essential that past experiences be fully explored while others pay no attention to past experiences and concentrate solely on present feelings and actions. In the end, most modern therapeutic modalities have more in common than not. First, the therapeutic alliance is central to all. Without a strong alliance little progress should be expected. The counselor should lead this process and foster the alliance through respect and nonjudgmental modeling aimed at creating a comfortable and safe environment. Second, once the alliance has been established each modality begins the process of attempting to change behavior. Behavior therapy is concerned with altering dysfunctional behavior via the process of classical or operant conditioning. Reward and punishment are central to behavior therapy with little concern for underlying psychological issues that may be contributing to distress. Cognitive therapy and cognitive behavior therapy are most concerned with altering behavior via the alteration of cognition. Over the past several decades, cognitive modalities have received an abundance of support as being very effective in producing meaningful change. Reality and Gestalt therapy are both concerned with the “now” and strive to create wholeness through mending fractured parts of the self. They are also heavily focused on rationality and pay careful attention to what is realistic for an individual offender. Finally, we would like to aggressively assert that these modalities are a small sampling of a very rich field containing many more techniques all aimed at helping people realize more of their natural self. Over the last couple of decades there have been strong movements to integrate several different theories in order to capture more of the variance associated with distress. We encourage students to carefully explore the basic foundations of each therapeutic modality. Often the one that will fit best will be the one that is most aligned with an individual’s own preferred methods of learning. Effective counseling is really about the counselor and not the specific modality. The modalities provide direction, insight, and techniques all of which are very beneficial. The true worth of their application, however, will be decided by the quality of the counselor which is usually most correlated with the depth of one’s own self-exploration and understanding. Essay Questions 1. Explain why behavior therapy may be very successful in some circumstances. Also, identify several circumstances in which behavior therapy may not be successful. Why? 2. Discuss the basic tenets of cognitive therapy. Why, in your opinion, was much of Beck’s work concerned with depression? 3. Explain the basic premise of reality therapy. Discuss two of the techniques you think would be most effective with offenders. 4. Explain the basic premise of Gestalt therapy. Discuss the importance of the Impasse. 5. Explain, using your own words, why the therapeutic alliance is so important in confronting offenders. Treatment Planning Exercise During this exercise, the student should consider the case of Mike. Mike has Narcissistic personality disorder, which makes him very difficult to treat. Students should choose two theoretical approaches from behavioral, cognitive, reality, and/or Gestalt theoretical perspectives. The student should explain how they would provide counseling with Mike using their first chosen theoretical perspective and then they should do the same again with their second theoretical perspective. Once the students have done this, they should then compare and contrast both approaches noting how each would address Mike’s issues while also noting some limitations to any of the theoretical perspectives that were chosen. The Case of Mike Mike is a 20-year-old male who has just recently been released from jail. Mike is technically on probation for car theft, though he has been involved in crime to a much greater extent. Mike has been identified as a cocaine user and has been suspected, though not convicted, for dealing cocaine. Mike has been tested for drugs by his probation department and was found positive for cocaine. The county has mandated that Mike receive drug counseling but the drug counselor has referred Mike to your office because the drug counselor suspects that Mike has issues beyond simple drug addiction. In fact, the drug counselor’s notes suggest that Mike has Narcissistic personality disorder. Mike seems to have little regard for the feelings of others. Coupled with this is his complete sensitivity to the comments of others. In fact, his prior fiancé has broken off her relationship with him due to what she calls his “constant need for admiration and attention. He is completely self-centered.” After talking with Mike, you quickly find that he has no close friends. As he talks about people who have been close to him, he discounts them for one imperfection or another. These imperfections are all considered severe enough to warrant dismissing the person entirely. Mike makes a point of noting how many have betrayed their loyalty to him or have otherwise failed to give him the credit that he deserves. When asked about getting caught in the auto theft, he remarks that “well my dumb partner got me out of a hot situation by driving me out in a stolen get-a-way car.” (Word on the street has it that Mike was involved in a sour drug deal and was unlikely to have made it out alive if not for his partner.) Mike adds, “you know, I plan everything out perfectly, but you just cannot rely on anybody … if you want it done right, do it yourself.” Mike recently has been involved with another woman (unknown to his prior fiancé) who has become pregnant. When she told Mike he said “tough, you can go get an abortion or something, it isn’t like we were in love or something.” Then he laughed at her and told her to go find some other guy who would shack up with her. Incidentally, Mike is a very attractive man and he likes to point that out on occasion. “Yeah, I was going to be a male model in L. A., but my agent did not know what he was doing … could never get things settled out right … so I had to fire him.” Mike is very popular with women and has had a constant string of failed relationships due to what he calls “their inability to keep things exciting.” As Mike puts it “hey, I am too smart for this stuff. These people around me, they don’t deserve the good life cause they’re a bunch of dummies. But me, well I know how to run things and get over on people. And I am not about to let these dummies get in my way. I got it all figured out … see?” Bibliography Bartol, C. R., & Bartol, A. M. (2008). Criminal behavior: A psychosocial approach (8th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row. Beck, A. T. (1976). Cognitive therapy and emotional disorders. New York: International University Press. Beck, A. T. (1987). Cognitive therapy. In J. K. Zeig. (Ed.), The evolution of psychotherapy (pp. 149–178). New York: Brunner/Mazel. Beck, A. T. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press. Corey, G. (2005). Theory and practice of counseling and psychotherapy (7th ed.). Belmont, CA: Brooks/Cole. Cormier, S., & Nurius, P. S. (2003). Interviewing and change strategies for helpers: Fundamental skills and cognitive behavioral interventions (5th ed.). Pacific Grove, CA: Brooks/Cole. Gladding, S. T. (1996). Counseling: A comprehensive profession (3rd ed.). Englewood Cliffs, NJ: Prentice Hall. Glasser, W. (1965). Reality therapy. New York State Journal for Counseling and Development, 7(1), 5–13. Glasser, W. (1972). The identity society. New York: Harper & Row. Glasser, W. (1976). Positive addiction. New York: Harper & Row. Glasser, W. (1980). Reality therapy: An explanation of the steps of reality therapy. In W. Glasser (Ed.), What are you doing? How people are helped through reality therapy. New York: Harper & Row. Glasser, W. (2003). Warning: Psychiatry can be hazardous to your mental health. New York: Harper Collins. Glasser, W., & Zunin, L. M. (1979). Reality therapy. In R. Corsini (Ed.), Current psychotherapies (2nd ed., pp. 302–339). Itasca, IL: Peacock. Kazdin, A. E. (2001). Behavior modification in applied settings (6th ed.). Pacific Grove, CA: Brooks/Cole. Mahoney, M. J., & Lyddon, W. (1988). Recent developments in cognitive approaches to counseling and psychotherapy. Counseling Psychology, 16, 190–234. Meichenbaum, D. (1977). Cognitive behavior modification: An integrative approach. New York: Plenum. Miltenberger, R. G. (2004). Behavior modification. Principles and procedures (3rd ed.). Pacific Grove, CA: Brooks/Cole. Perls, F. (1969). In and out of the garbage pail. Moab, UT: Real People Press. Perls, F. (1970). Four lectures. In J. Fagan & I. L. Shepherd (Eds.), Gestalt therapy now (pp. 14–38). Palo Alto, CA: Science and Behavior Books. Polster, E., & Polster, M. (1973). Gestalt therapy integrated: Contours of theory and practice. New York: Brunner/Mazel. Spiegler, M. D., & Gueveremont, D. C. (2003). Contemporary behavior therapy (4th ed.). Pacific Grove, CA: Brooks/Cole. Wolpe, J. (1958). Psychotherapy by reciprocal inhibition building. Stanford, CA: Stanford University Press. Wolpe, J. (1990). The practice of behavior therapy (4th ed.). Elmsford, NY: Pergamon Press. Wubbolding, R. E. (1988). Using reality therapy. New York: Harper/Collins. Wubbolding, R. E. (1991). Understanding reality therapy. New York: Harper/Collins. Yontef, G. M. (1993). Awareness, dialogue and process: Essays on Gestalt therapy. Highland, NY: Gestalt Journal Press. Zinker, J. (1978). Creative process in Gestalt therapy. New York: Random House. 6 Family Systems Therapy and Counseling CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Know the basic principles of family systems therapy, including circular causality, cybernetics, homeostasis, and feedback loops. 2. Understand how correctional counselors can use family therapy and/or family counseling with the offender population. 3. Be aware of various techniques of family systems therapy that correctional counselors can utilize. 4. Be aware of cross-cultural considerations with family therapy. 5. Know the tenets to structural family therapy. 6. Know the theoretical aspects and techniques associated with Bowenian family systems therapy. 7. Know the theoretical aspects and techniques associated with behavioral family systems therapy. PART ONE: FAMILY SYSTEMS IN GENERAL Introduction Family systems therapy is perhaps one of the most unique forms of therapy that will be presented in this text. This is simply due to the fact that family therapy is based on a “systemic” approach that is different from other approaches that focus on the individual. While group counseling techniques tend to naturally focus on more than one person, the focus is not on interactions in the outside environment but is instead focused on the interactions among members within the group setting. Family systems therapy, on the other hand, focuses on the interactions of members in the session both inside and outside the therapeutic setting. Further, these members will have typically known each other for a number of years, will have some sort of shared history, and will usually be linked by a number of other extended family and friends that are mutually known. These dynamics provide therapeutic strengths and challenges for the correctional counselor because, on the one hand, the counselor can utilize family support to aid the offender in reforming, yet on the other hand, there is much more complexity to tracking the interactions, communication, and history of multiple members who share mutual knowledge—mutual knowledge that is unknown to the counselor until it is brought up in therapy. With the aforementioned in mind, it can probably be surmised that this type of therapy is somewhat difficult to deliver, requiring a great deal of skill and experience for those wishing to implement it into their repertoire of therapeutic options. In fact, a person wishing to conduct marriage and family therapy (as opposed to a single or brief set of family counseling sessions) must have separate, formal, and extensive training to qualify him or her to deliver such services. Further, this typically results in an entirely different set of qualifications so that the counselor can effectively be referred to as a licensed marriage and family therapist (LMFT). The licensed marriage and family therapist is a therapist who has completed additional coursework beyond that required of the traditional graduate-level counseling education. Additional clinical hours providing services to families are also required, and additional testing, supervision, and record keeping often coincide with these advanced clinical hours. Only such therapists who complete these and other requirements set by the counselor’s state ethics board may call themselves LMFT. Nevertheless, it is often the case that many non-LMFT counselors may engage in what is commonly referred to as family counseling. Family counseling consists of therapeutic sessions that include the client’s family members in the treatment plan. The use of these family members is typically short term and is not typically considered therapy for the entire family as much as it is considered therapy for the individual client, with the aid of other family members being solicited for additional individual client support. However, as we will see later in this chapter, some caution may need to be exercised for three reasons when using family systems approaches. First, the client’s welfare must be considered as paramount and, with that in mind, the counselor must be assured that the family system delivering support to the client is not itself a major causal factor in the client’s offending. Often, offenders are themselves enmeshed in dysfunctional family systems that may have generations of criminogenic patterns of behavior. Such families are not likely to be good candidates for therapeutic support since they are themselves in need of pro-social change. These families would require long-term family therapy and this would typically not occur unless the treatment program could gain their willingness to attend and this would then require the services of an LMFT. Second, the client who acts out in a family is often synonymous with what family therapists refer to as the identified patient. The identified patient is often referred to as the “symptom bearer” of the family; this individual is most likely to be the individual first sent for treatment and it is their disruptive behavior that serves as the social glue for the family, giving the family an issue to rally around. This is especially the case with adolescent members of the family, and correctional counselors who work with juvenile offenders need to keep this possibility in mind whenever they deal with delinquent youth who are referred by their own family. Third, counselors will need to ensure that they understand their bounds of competence if they are not licensed family therapists, because a failure to do such can result in a violation of state law and/or their code of ethics. As the student may now understand, the focus of family systems therapy is on the family and the individual’s dysfunctional behavior that stems from family interactions. Specific theoretical orientations and techniques exist within these approaches that can serve the correctional counselor in effectively addressing families in need of treatment. Further, this mode of treatment has been found to be very effective with the substance-abusing population (SAMHSA, 2005). Family therapy (particularly functional family therapy) has also been found to be particularly successful with the juvenile population (SAMHSA, 2005). Given that the majority of offenders in the correctional population have had some kind of substance-abuse issue and given that a large portion of the correctional system consists of young males, family systems therapy should be considered an important modality within the field of correctional counseling. In general, all family therapy approaches are built on the tenets of general systems theory. General systems theory holds the family as an entity that is maintained by the interactions of its members. This theory also contends that the best way to understand the individual is through the study of the context of his or her interactions. In addition, the family can be viewed as either an open or a closed system. An open family system continuously receives input from and discharges output to the environment. Closed family systems tend to be isolated and are considered stagnant. These systems are typically considered stagnant and it is within these systems that family secrets may exist (such as with childhood sexual abuse and/or other forms of aberrant behavior within the family system). As will be discussed in Chapter 14, these types of systems (as well as chaotic and/or conflicted systems) are common among those that encounter types of sexual abuse and/or family violence. Lastly, systems theory holds that families engage in behaviors and modes of communication that ensure homeostasis of the system. Homeostasis is a tendency of families to behave in a manner that maintains the systemic equilibrium or the status quo of the system. In essence, the pursuit of homeostasis is what keeps dysfunctional families in their zone of comfort and serves to defy the attempts of therapists to influence such systems toward more adaptive form of functioning. The student should understand that while family members may act in a manner that supports homeostasis, they are not necessarily consciously cognizant of the fact that their behavior achieves such a balance. Rather, they tend to instinctively react in this manner regardless of their level of deliberation or forethought. This does not mean that members do not deliberately attempt to maintain their family’s status quo but rather simply implies that members engage in such behaviors both deliberately and subconsciously. Communication and the Family System A primary area of focus for most family therapists is the communication processes within the family system. Much of this approach in family therapy is derived from the influence of cybernetics. When applied to the family communication process, cybernetics effectively incorporates that notion of feedback loops through which the family system processes information that it needs to maintain a steady and stable state of functioning. These feedback loops can be either negative or positive. Negative feedback loops reduce deviation from the norms and expectations of the family system and therefore increase equilibrium and stability within the system. Positive feedback loops serve to increase behavioral deviation and therefore disrupt that system. However, it should be understood that the results of a positive feedback system can initiate change that is healthy. Consider, for example, a family that is in equilibrium but the sense of stability in that system is maintained through abusive dynamics and/or uneven power structures between the primary adult couple. A break up in that sense of equilibrium may be effective in creating a more healthy family system. One other common notion of family systems therapy is that of circular causality. This is one of the hallmark distinctions between family therapy and other individual-based forms of therapy. Indeed, where other forms of therapy tend to describe pathology and/or life-course problems in a linear cause-and-effect fashion, family system’s notion of circular causality regards a symptomatic behavior as an actual part of the ongoing circular feedback loop. This is very important because family systems therapy will often address symptoms, in and of themselves. Most other forms of therapy tend to emphasize the need for addressing causal factors that are latent precursors to the symptomatic behaviors. However, family therapists will address symptoms and/or causal factors equally and independently since it is presumed that each ultimately “circles” back to being a causal factor of the other. This also is important when addressing issues between married couples and/or other family members because the emphasis often shifts any source of blame from one person or another and instead creates a schema where cause and effect are essentially the same. In essence, circular causality could be likened to a “cause-equals-effect-and-effect-equals-cause” perspective. This type of perspective is typically maintained in most types of therapy and in relation to most issues, except for those situations where abuse is encountered. In such situations, abuse is never considered appropriate behavior, though some cultural situations may modify the particular definition of what may or may not entail abusive behavior. In the previous comment, it should be noted that family therapy is often effective in addressing parenting issues within dysfunctional families. The correctional counselor may have offenders on their caseload who are court mandated for abusive behavior (on one extreme) or they may even have offenders who are processed due to negligence in parenting (the other extreme). In both cases, family therapy may be an appropriate intervention. Further, inappropriate types of parenting are often intertwined with adolescent misbehavior and acting out among juveniles. This again makes it likely that such interventions can be productive for the family system and the correctional counselor. Family therapists who focus on communication tend to operate from the perspective that all behavior is communicative, and thus people are always communicating, even when they seem not to be engaged in any overt or goal-directed behavior. Further, family rules are thought to set the structure of family communications. These rules are not necessarily officially stated but are mostly understood by family members. Covert rules between couples (i.e., she handles the domestic issues and he handles the bills) establish each partner’s role in the family and provide a sense of homeostasis, regardless of whether this homeostasis is the most healthy means of operating. Dysfunctional communication patterns that family therapists might look for would include: (1) blaming and criticizing; (2) the use of incomplete statements (i.e., stating “I am angry” but not explaining why); (3) overgeneralizing (you never listen to me); and (4) mindreading or acting as if the partner should know what is on the client’s mind. All of these patterns of interaction lead to breakdowns in communication. Family therapists seek to help “family members gain awareness of patterns of relationships that are not working well and create new ways of interacting to relieve their distress” (Corey, 1996, p. 467). When addressing dysfunctional interactions, family therapists tend to use both direct and indirect techniques of intervention. Direct techniques include the following: (1) pointing out to family members problematic interactions as they occur; (2) teaching effective forms of communication (such as using “I” statements rather than “you” statements); and (3) interpreting interactional patterns, including nonverbal intentions that are wittingly or unwittingly communicated. Before proceeding to indirect techniques, it should be clarified that “I” statements are those where the client accepts ownership for his or her own feelings (i.e., “I feel that you should not do that”) as opposed to statements that attribute blame to the other person (i.e., “you know that you should not do that”). Though seemingly minor, these differences in communication styles make all the difference in the outcome of communication interactions, and many clients and/or family systems are truly not aware of how damaging such negative communication patterns can be. Indirect techniques of communicative intervention might include the use of what are called double binds, which are interventions where the client is required to do something contradictory to his or her desired behavior. For example, the therapist might have instructed a male client who dislikes his mother-in-law to give her a present each time he has an argument with her. The idea is based on the notion provided by the well-known Jay Haley, who said “if one makes it more difficult for a person to have a symptom than to give it up, the person will give up the symptom” (Haley, 1984, p. 5). The use of paradoxical interventions may also be used, though these must be carefully chosen and are reserved for the skilled therapist. An example might be when a counselor, hearing that a couple cannot get along pleasantly, instructs the couple to argue for two hours every day as required homework during the following week. Naturally, this is built on the premise that we all become bored with those things that become a task. Overall, the intervention can have good outcomes, but the counselor must again be careful in the use of this intervention and must be assured that the couple are not domestically violent. Multigenerational Transmission of Dysfunction Murray Bowen was the leading theorist and founder of family therapy processes during their formative years. Goldenberg and Goldenberg (1996) note that his theory “represents the intellectual scaffolding upon which much of mainstream family therapy has been erected,” followed by the point that Bowen conceptualized “the family as an emotional unit, a network of interlocking relationships, best understood when analyzed within a multigenerational or historical framework” (p. 165). It is this multigenerational aspect of family systems theory that is of particular interest since this is often a dynamic that is relevant to the offender population. Indeed, many career offenders may belong to families that have a criminogenic history that spans generations. In fact, a criminal subculture may be part of the family culture. This can be evidenced by multiple generations of the same family that are processed through the criminal justice system and seen by many criminal justice practitioners within the correctional setting. Bowen (1978) proposed that the multigenerational transmission process accounts for severe dysfunction within families, this dysfunction being the result of the operation of the family’s emotional system over several generations. The nature of this familial emotional system is rooted in another concept attributed to Bowen’s work—differentiation of self. Differentiation of self occurs in an individual when the person is able to distinguish between the intellectual process and the feeling process that he or she is experiencing. According to Bowen, persons who are mostly mentally healthy are able to achieve a balance between logic and emotion, achieving rationality but not at the expense of losing their capacity for spontaneous emotional expression. This is not to assume that Bowenian family systems theory holds that emotions should necessarily be suppressed as much as it implies that individuals should not allow their life decisions to be driven by emotion. Papero (1990) summarizes the notion of differentiation best by stating: To the degree that one can thoughtfully guide personal behavior in accordance with well-defined principles in spite of intense anxiety in the family, he or she displays a level or degree of differentiation. (p. 48) The opposite extreme of differentiation is fusion. Fusion is when an individual has his or her logical decision making fused with his or her emotional framework, the two are thus inseparable. The more fused these two characteristics are, the worse that a given individual will function. Lastly, Bowen also introduced a related concept known as the undifferentiated family ego mass, which conveys the notion of a family that is emotionally “stuck together” in an unhealthy and counterproductive sense. For Bowen, maturity and self-actualization require that the individual become free of unresolved attachments to his or her family of origin. It is from this point that we again return to our original concept of multigenerational transmission of dysfunction. Families that have members who have their cognitive and emotional aspects fused are not sufficiently differentiated from the family system, and that are stuck together in maladaptive forms of closeness are those most likely to transmit their dysfunction from one generation to another. These types of dynamics are frequently seen within the offender population. This is particularly true in abusive families and those that have routine familial drug abuse. In such cases, it is obvious that these families are more detrimental to the offender’s reform than anything and this would mean that the entire family would be in need of therapeutic services. However, these types of families seldom make a collective and willing choice to mutually engage in treatment. In such cases, Bowen contends that therapists should focus the majority of their clinical attention on the highest functioning member that is present rather than the lowest. On the face of it, this seems to be opposite of what one might expect. But Bowen contends that lavishing clinical attention on the least functioning individual is more likely to lead to little or no outcome, particularly due to the negative influences of the rest of the family members. In fact, these persons will be the most susceptible to negative influences from the dysfunctional family. Rather, the highest functioning member is the most likely to weather the storm, so to speak, when the dysfunctional family is in conflict and/or crisis, and they are the most likely to have some sort of leadership impact on other family members. Further, Bowen observes that as that person becomes highest functioning member, there is an inherent tendency in other members to follow suit, thus increasing the overall functioning of the entire system. The specific applications for correctional counseling may be difficult to see. But in cases where correctional counselors have juvenile clientele, it is important for counselors to identify those families that have these dynamics. In such cases, the correctional counselor would want to identify the higher functioning (more differentiated) family members who can balance the emotional content of the family with reasonable decision making. Such individuals are likely to function more adaptively during times of crisis and will likely have more positive influence over those that are less able to cope without emotional turmoil ensuing. Further, the correctional counselor should keep in mind the possibility that it is sometimes the troubled teen who has been selected as the identified patient, not because they were initially the worst off, but simply because they may not “fit” within the family system. In low functioning families, the counselor may find that ironically, the “troubled” teen does not fit within the family system because he or she is, in fact, the highest functioning member. Their behavior may simply be a skillful manner of keeping the family together and centered on one common issue—the identified patient. However, the counselor must be careful with this progression in thought since such a client may actually suffer negative drawbacks from additional focus being provided to him or her. This may confirm in the family’s consciousness that this person is indeed the source of the family’s problems. This can have a negative effect on the family’s progress and on the individual client. Further, in some cases, the identified patient may have genuine psychological difficulties such as a mood or personality disorder, perhaps coupled with substance abuse. The correctional counselor would not want to dismiss the aspect in treatment considerations (obviously) but most family therapists are interestingly opposed to the use of clinical diagnoses. We do not subscribe to that view and consider clinical diagnoses useful and necessary in the correctional setting. Nevertheless, these disorders may have underlying causal factors that are family secrets. Consider, for example, an adolescent female being treated for acting out, substance abuse, and potential histrionic personality disorder. It may be that later, the counselor finds a history of childhood sexual abuse. In such a case, the client may actually be the highest functioning client (when left to her own devices) within the family system but is simply manifesting clinical reactions to the sexual abuse. As can be seen, correctional counselors must consider the approach and implementation of family interventions in a careful manner. Further, in the example just provided, the idea of circular causality might lead some therapists to the erroneous notion that the symptom and the abuse have circular causality. But keep in mind that, as was stated earlier in this chapter, there is no justification for victimization. Aggressive and exploitative behavior patterns are what correctional counselors are specifically tasked with addressing. However, the adolescent client’s symptoms of personality disorder and substance abuse do play a circular role of causation in being singled out as the identified patient and also serve to increase the negative attention given to that client. It is in such a case that the correctional counselor would want to safeguard the client from any psychological harm that may be occurring within the family to ensure that the client is able to heal. Addressing the symptoms, in such a case, would be important to reduce conflict that aggravates the client’s prognosis. However, the underlying trauma associated with sexual abuse would have to be addressed and would, in all likelihood, result in long-term therapy as the client addressed this victimization while learning healthy means of coping. Role of the Therapist and Common Techniques Family therapists tend to be a bit more directive than are therapists who operate from other perspectives. It should be pointed out that there are a number of theoretical perspectives within the family therapy literature, more than can possibly be discussed in this one chapter. Indeed, there are textbooks that entirely address nothing but family therapy approaches. The purpose of this chapter is simply to give the student an understanding of the more common tenets found in the mainstream field of family therapy and to explain how correctional counselors might utilize such approaches with their own correctional caseload. Aside from this, it is hoped that the student learns a few specific techniques when conducting counseling sessions; some of these techniques have already been presented and others will follow. Regardless of the theoretical perspective and regardless of the specific technique, family therapy is known for being a more directive form of therapeutic assistance, with the therapist acting as a coach or a teaching in many respects. The key to family therapy is getting clients to understand relationship effects and unhealthy patterns of interaction. Family therapists often give direct instruction and guidance to clients and their families. The therapy tends to be focused on the present point and time but does seek to have the client understand challenges in his or her own family of origin as a means of resolving issues in current relationships. As a means of doing this, family therapists have several techniques available that they will employ. These techniques are varied but they all tend to achieve one of three purposes: (1) to build rapport, (2) develop awareness within family members regarding their own family-of-origin issues, or (3) teach clients about healthy relationships. The first technique is one that is borrowed from a leading forerunner in family therapy, Salvador Minuchin. This technique is joining, which is the process of building and maintaining a therapeutic alliance. This is a critical first step in family therapy and resounds earlier discussions in Chapter 4, with all the methods of building rapport (i.e., attending behaviors, reflecting affect, genuineness, paraphrasing, and exhibiting empathy) being relevant to the process of joining. Basically, one could simply incorporate all the aspects of Chapter 4 into the joining process in family therapy. However, the counselor joins the family for the strict purpose of modifying the means by which it communicates and functions but the counselor does not solve the family’s problem. Rather, this is left to the family and requires that members develop their own means by which issues are resolved. While the counselor will aid in modeling effective communication, enlightening members about family dynamics, and guiding the process of interaction, it is the family that itself resolves disputes and/or problems that emerge. Corey (1996) notes that “in order for the therapist to become a part of the family system, it is critical that he or she establish rapport by being sensitive to each of the members” (p. 396). This is particularly important because family members will be sensitive to any biases that may emerge. Naturally, this can impair the therapist’s ability to build alliances with the group as a whole, so it is important that the correctional counselor keep this in mind, even when one of the members is the perpetrator of a crime against another family member. Obviously, the process of rapport building is much more challenging in the family setting than in the individual counseling setting because the therapist has to maintain a rapport with many different personalities that are enmeshed by common histories and experiences. The next technique of interest is the genogram. To a certain extent, the genogram can be likened to a method of assessment, as this tool provides the therapist with a baseline understanding of where the family is at in terms of relationships, important family events, and issues that have occurred in the family (Corey, 1996; McGoldrick, Gerson, & Shellenberger, 1999). Further, since the genogram is developed in a collaborative fashion (the counselor draws the genogram, asks questions of the client, and fills in details using a variety of symbols and other aids), a sense of rapport is often developed once the genogram is complete. Essentially, a genogram is a: A pictorial chart of the people involved in a three generational relationship system, marking marriages, divorces, births, geographical location, deaths, and illness. This is typically explained to the client during an initial session and developed as sessions progress, is used for discussion points, and is especially helpful when client and therapist reach a point of being “stuck” in the therapeutic process. Genograms can be used to help identify root causes of behaviors, loyalties, and issues of shame within a family. (SAMHSA, 2005, p. 42) The use of the genogram is fairly commonplace in family therapy and can serve as an excellent therapeutic tool. In fact, this tool can be used in a number of instances, even if the counselor does not intend to conduct family therapy or counseling. For families that have dysfunction that has been transmitted between generations, this can be a particularly useful tool. Another technique often used by structural family therapists is the use of family mapping. This technique was developed by Salvador Minuchin, the founder of structural family therapy, a type of family therapy that focuses on the structural organization of the family itself, examining subsystems within the family system, such as the parental subsystem (the mother and father figures), the child or sibling subsystem (consisting of one or more children), and the extended subsystem (such as grandparents). Each subsystem has a specified set of roles and expectations within the broader family system, with healthy boundaries that exist between each subsystem, allowing for multiple subsystem relationships to emerge at different levels and in different contexts. The process of family mapping helps to illustrate the familial norms and expectations between persons and between subsystems. Family mapping utilizes a method for mapping the structure of the family by illustrating boundaries that are overly rigid (i.e., a parent who believes children should be seen but not heard), diffuse (enmeshment, such as with an overprotective parent), or clear and functional (boundaries allow subsystems to operate appropriately but are permeable so as to allow communication throughout the family). The use of family mapping highlights the functioning of the family and its communication patterns, providing insight and awareness for improvement in family functioning. Another related concept, also developed by Minuchin, is the use of boundary setting. Boundaries are “the emotional barriers that protect and enhance the integrity of individuals, subsystems, and families” (Corey, 1996, p. 393). The demarcation of boundaries serves to maintain the amount of contact between family members. Healthy boundaries are necessary if families are to function adaptively within the home and especially in broader society. Family therapists often aid parents and other family members in setting boundaries, which simply consists of ensuring that appropriate relationships are maintained both in terms of closeness and distance, as is necessary for the effective day-to-day functioning of the family. Corey (1996) provides a clear illustration of the importance of subsystems and their corresponding boundaries as follows: When family members of another subsystem take over or intrude on one in which they do not belong, the result is usually some form of structural difficulty. For example, the sex life of the adults in the family belongs to the spousal subsystem; when children are allowed to witness, comment on, or investigate their parent’s sexual activity, they are inappropriately involved in the spousal subsystem. This extreme example may be easier to understand than noting that parents ought to allow their children to form their own relationships. This second example, however, is just as important; working out brother and sister relationships is a task for the sibling subsystem, not the parental subsystem. Parents have their own activities and functions to address. (p. 393) Another important technique used by many family therapists is reframe. Reframing is when the counselor provides an interpretation of family life events or circumstances that are different from those that are considered by the family itself. The use of reframes allow the counselor and the family to observe an issue from multiple angles, thereby providing additional means of addressing the problem that is at hand. Corey (1996) adds further clarity by noting that “through reframing it becomes possible to grasp the underlying family structure that is contributing to an individual’s problem. In this way, one member does not bear the full burden of blame for a problem or the total responsibility for solving it” (p. 397). Thus, the effective use of reframes allows the counselor and the family to define the problem through a number of means, providing more options for correcting the problem while also deferring the responsibility for the problem among the family as whole. Such an approach provides significant leverage for the counselor and can greatly empower the family. Benefits with Multicultural Counseling Family therapy has been noted to have particularly useful applications among various ethnic and/or racial groups. Indeed, family systems therapy in a multicultural framework has significant appeal for those groups that place value on the inclusion of extended family members. Corey (1996) notes that families have their own cultures among members and yet the family system is intertwined to the larger culture from which the members belong. Corey adds that culture and ethnicity are so interrelated with family that it is difficult to know whether issues are particular to the family system itself or to the broader culture that the members share. From the information presented in Chapter 2, it is clear that there is extensive research on cultural competence and family therapy. However, there is very little research that has examined specific effects of culture and ethnicity on the actual clinical processes of the therapy itself (Santisteban, Muir-Malcolm, Mitrani, & Szapocznik, 2002, p. 331). More extensive research is needed on the interplay between “ethnicity, family functioning, and family intervention” (Santisteban et al., 2002). It is important that counselors move beyond ethnic labels and consider a host of factors—values, beliefs, and behaviors—that are associated with ethnic identity (SAMHSA, 2005). In addition to the major life experiences that must be factored into treating families in a correctional counseling context is the complex challenge of determining how acculturation and ethnic identity influence the treatment process. Other influential elements that may need to be considered are the effects of immigration on family life and the circumstances that motivated emigration (migration due to war or famine is a far more stressful process than voluntary migration to pursue upward mobility), and the sociopolitical status of the ethnically distinct family, in particular how the host culture judges people of the family’s ethnicity (SAMHSA, 2005; Santisteban et al., 2002). Also, just as noted in Chapter 3, it is important to be aware of the various cultural factors associated with different client populations, but we must be careful when developing generalizations about barriers to treatment for racially and ethnically diverse men and women since characteristics are not identical among members within these groups. Still, some common cultural barriers to treatment, particularly among African-Americans and Hispanics/Latino-Americans, have been examined (SAMHSA, 2005). These include misperceptions in recognizing problematic behavior and/or the severity of that behavior (as with substance-abuse issues, for example, where there may be a cultural belief that one’s alcohol use is not a problem, or not a severe one, and that those affected can handle the problem on their own), costs associated with seeking treatment, as well as doubt about the efficacy of treatment (SAMHSA, 2005). Further, some issues such as with parenting and the use of discipline may be much different from mainstream society but well accepted within the client’s own cultural group. Other barriers to treatment for these groups include inherent mistrust of the therapeutic process and/or agencies that deliver such services (see Chapter 3). Though Chapter 3 does cover a wide range of cultural issues relevant to counseling in great detail, we think that it is important to again provide some points relevant to specific groups that are likely to be encountered in the correctional context. Though the relevance for specific correctional systems will vary depending on the area of the nation, it is expected that the four groups discussed in the following subsections will provide an effective integration of some of the material from Chapter 3 within a family therapy (as opposed to individual therapy) context. This is not duplicate material but instead expands on the points associated with cultural issues in both contexts of therapy, demonstrating the interlocking nature of the individual and their culture as well as their family system and the cultural factors that have shaped that system. Further, the next subsection brings to light some additional considerations that were perhaps unwieldy for Chapter 3 but are better included in this section of the text. It should be noted that the material in the next few subsections has been adapted from the SAMHSA government document titled Substance Abuse Treatment and Family Therapy. This document lends itself well for a correctional counseling context due to the fact that points are easily extrapolated to a plethora of problems that offenders encounter (beyond substance abuse) and due to the fact that the overwhelming majority of offenders do have substance abuse issue. This government document is considered public domain and parts have been reproduced or copied with such automatic permission. With this noted, we now turn our attention to the cultural groups that follow. AFRICAN-AMERICANS As with all individuals, African-American clients are sensitive to whether they are being treated with respect. Cultural information should be considered hypotheses rather than knowledge. Techniques shown to be effective with African-Americans will be rendered ineffective if the therapist assumes an attitude that is alienating to clients. People of African ancestry are widely divergent. Therapies effective for African-Americans may be inappropriate for immigrants from the Caribbean or Africa. The personal connection between family and therapist is the single most important element in working with African-American families. Without rapport, treatment techniques are worthless and the family will likely terminate therapy early (Wright, 2001). African-American families also are sensitive to a patronizing approach that Boyd-Franklin (1989) refers to as missionary racism. Therapists should be sensitive to the ways in which this message may be conveyed. Clinicians must be aware of any biases or attitudes regarding their African-American clients. To address this issue effectively, therapists may need assistance from supervisors or colleagues or training in cross-cultural situations (Wright, 2001). Santisteban et al. (1997) found that single-family therapy improved family relationships and reduced behavioral problems in African-American youngsters. African-Americans also function very successfully in multiple family therapy. For many African-American Christians, the Bible is a longstanding source of truth and solace that helps them make sense of life (Reid, 2000). Because of the church’s centrality to their lives, a Bible-related recovery program has been found to be effective for African-American Christian families (Reid, 2000). LATINO-AMERICANS Perhaps the most widely acknowledged common thread among Hispanics/Latinos is the importance placed on family unity, the family’s well-being, and the use of family as a support network. Familialism or familismo are terms that refer to a core construct among Hispanic and other ethnic-minority cultures. It has three components: (1) perceived obligations toward helping family members, (2) reliance on support from family members, and (3) the use of family members as behavioral and attitudinal referents (Marín & Marín, 1991). Generally, the typical nuclear family is embedded in an extended family with flexible and open boundaries. Hispanics/Latinos place a strong emphasis on extended family and clustering (Kaufman & Borders, 1988), and there tend to be fluid boundaries between family members such as cousins, aunts, uncles, and grandparents. “The family is usually an extended system that encompasses not only those related by blood and marriage, but also compadres (godparents) and hijos de crianza (adopted children, whose adoption is not necessarily legal)” (Garcia-Preto, 1996, p. 151). Extended family members perform parental duties and functions, providing the children with the adult attention that is hard to come by in a large family (Falicov, 1998). Relationships between siblings and cousins are strong and it is not uncommon to have few peer friendships outside the sibling subgroup. Godparents are practically an additional set of parents, acting as guardians or sponsors of the godchildren and maintaining a strong relationship with the natural parents (Falicov, 1998). Therapists who plan to work with Latino families who have migrated from Mexico should be familiar with spiritual healers, the curandero or curandera (i.e., folk healer). These healers can help resolve intrapsychic and interpersonal problems. Curanderismo, or the art of folk healing, is a particular treatment modality used primarily in Latino or Southwestern rural communities, although it is also prevalent in metropolitan areas with a large Latino population. Curanderos earn their trust from the community; the community validates their “practice.” This modality contains a mix of psychological, spiritual, and personal belief factors. Since the curanderos are considered to be holy, they invoke God’s and the saints’ blessings on people seeking their aid. ASIAN-AMERICANS Because extensive discussion was given to Asian-Americans in Chapter 2, this subsection will be a bit briefer than might otherwise occur. Correctional counselors should understand that due to the fact that Asian cultures are so intensively family centered, the responsibility of maintaining filial obligations is perhaps the dominant concern in the life of most Asians (McGoldrick, Giordano, & Pearce, 1996). Given the central importance of family in Asian cultures, it is critical to assess the family’s part when treating Asian-Americans with substance-use disorders. The psychological influence of the family, particularly the older members, is considerable even when key members are missing as a result of loss, nonmigration, or emotional estrangement (Chang, 2000). Family therapy with Asian-Americans is least likely to include older generations. The primary reason for this absence according to younger family members is that they hope to spare their elders any discomfort. Working delicately and tactfully with elders is of foremost importance. When treating unresolved issues among older generations, therapists must demonstrate respect, reveal genuine empathy, and, above all, avoid embarrassing older family members. Often family members will try to shield older family members from shame. Family therapists must be cognizant not to rush into exploration of sensitive areas. One method is to initially join with the family at a broad experiential level—sharing their salient traumatic incident—without prying for embarrassing or threatening details (Chang, 2000). Opinions vary on whether family therapy is an appropriate vehicle to counsel Asian-Americans with substance-use disorders. Paniagua (1998) states that family therapy is effective because the family is more important than the individual in Asian families and the act of withholding information from family members is unfamiliar to many Asians. May Lai (2001) urges therapists to work with the client’s family, but to use individual counseling rather than family therapy. Debates on the efficacy of involving Asian families often revolve around the presumed skill level of the therapist, not the fundamental importance of the client’s relationship to his or her family. Clearly, counseling Asian-American families requires skill, delicacy, and knowledge of cultural factors. NATIVE AMERICANS Many tribes do not make any distinction between the nuclear family and grandparents, uncles, aunts, and cousins (Brucker & Perry, 1998). Many tribes characterize great uncles, great aunts, and grandparents (Brucker & Perry, 1998). Sometimes the family includes medicine people and nonrelated people (Brucker & Perry, 1998). Within Indian culture, families work together to address problems. Family therapy’s emphasis on systems and relationships is in particular cultural harmony with American Indians (Sutton & Broken Nose, 1996). Sutton and Broken Nose (1996) emphasize the preferred use of culturally appropriate, nondirective approaches involving “storytelling, metaphor, and paradoxical interventions” (p. 33). Networking and ritual approaches are preferable to strategic or brief interventions (Sutton & Broken Nose, 1996). In certain cases a family member must go into inpatient treatment for substance abuse before family therapy can make any real impact. It is always possible, however, to continue to work with the family in preparation for the return of the family member to the home, with the goal of modifying family relations that may have contributed to the maintenance of the problem. The historical trauma experienced by American Indians combined with the usual considerations of codependency and enabling, for example, make family therapy for substance-abuse treatment a challenging endeavor (Duran & Duran, 1996). The model also must be congruent with the culture of the people that it intends to serve. For example, some parents from Asian cultures may be perplexed by the assumption that children have a “voice” in the family (e.g., children who take on adultlike responsibilities by interpreting for parents, but do not hold adultlike responsibilities in the family). The model selected must accommodate differences in family structure, hierarchies, and beliefs about what is appropriate and expected behavior. Additional Guidelines for Cross-Cultural Family Therapy McGoldrick et al. (1996) provide perhaps the single best text related to racial and ethnic issues associated with family therapy. Students who are particularly interested in cross-cultural counseling and/or family therapy are strongly recommended to refer to their text. However, there are eight specific recommendations that McGoldrick et al. (1996) provide for the would-be cross-cultural family therapist that are quite insightful, with five of them being highly relevant to correctional counselors. We include these five selected guidelines below since they tend to hold value for correctional counselors using family therapy perspectives, regardless of the specific cultural group being considered. These guidelines are as follows: 1. Assess the importance of ethnicity to clients and their families. Not all clients identify with their ethnicity or religious background identically and it is important for the counselor to determine the client’s own perceptions before making any generalizations or drawing inferences. 2. Validate and strengthen the client’s ethnic identity. McGoldrick et al. (1996) note that “under great stress an individual’s identity can easily become diffuse. It is important that the therapist foster the client’s connection to his or her cultural heritage” (p. 23). This is a particularly important point since such diffusion is undoubtedly likely to be relevant both to family dynamics (separation from others) and to cultural aspects of the client. See Exhibit 6.1 as an example of where a client (Darius) is diffused from his family, a family that apparently has had drug and alcohol problems that have been transmitted between multiple generations. EXHIBIT 6.1 Structural/Strategic Family Therapy in the Criminal Justice System Darius, a 21-year-old male from the San Juan pueblo in New Mexico, was referred to a clinic for court-mandated substance-abuse counseling. He had just received his third violation for driving under the influence (DUI). Darius had been on probation since age 13 for various charges, including burglary and domestic violence, and he had a long history of alcohol and drug abuse. He had been on his own for eight years and had no family involvement in his life. Darius had participated in several residential treatment programs, but he had been unable to maintain abstinence on his own. When Darius entered outpatient treatment, he was extremely angry at “the system” and refused initially to cooperate with the therapist or his treatment plan. The therapist was pleasantly surprised that he did show up for his weekly sessions. The following interventions seemed to help Darius: • The counselor suggested that one treatment goal might be for Darius to finally get off probation. At the time, he still had 18 months of probation remaining. • The counselor helped Darius see the relationship of alcohol and drugs to his involvement with the criminal justice system. • The counselor constructed a genogram depicting three generations of Darius’ family of origin. This portrayal illustrated a great deal of family disintegration linked to poverty, substance abuse, and his parents’ and grandparents’ boarding school experience. • The counselor initiated couples therapy to help Darius stabilize a significant relationship. • After conferring with the probation officer, the counselor decided that Darius would benefit from a six-month trial of Antabuse treatment. • The probation officer required that Darius find regular employment. During the course of treatment, Darius was able to stop drinking and reevaluate his belief system against the backdrop of his family and the larger judicial system in which he had been so chronically involved. He came to be able to express anger more appropriately and to recognize and process his many losses from family dysfunction. Although many of his family members continued to abuse alcohol, Darius reconnected with an uncle who was in recovery and who had taken a strong interest in Darius’ future. Eventually, Darius formed a plan to complete his GED and to begin a course of study at the local community college. The counselor helped Darius to examine how the behaviors and responsibilities he took on in his family shaped his substance use. Source: Substance Abuse and Mental Health Services Administration (SAMHSA). (2005). Substance abuse treatment and family therapy. Rockville, MD: Center for Substance Abuse Treatment. 3. Be aware of and use the client’s support systems. “Often support systems—extended family and friends; fraternal, social, and religious groups—are strained or unavailable. Learn to strengthen the client’s connections to family and community resources” (McGoldrick et al., 1996, p. 23). This is also relevant to the client case presented in Exhibit 6.1. 4. Do not feel as if you must know everything about other racial and/or ethnic groups. This is obviously an impossible task for anyone and counselors should not feel obligated to be an “expert” on all cultural groups. Counselors should be aware of their limitations, be honest about these limits (with the clients as well as with themselves), but should be “openheartedly curious” about the client’s cultural background (McGoldrick et al., 1996, p. 23). This creates learning potential, expresses genuine care and concern, and can be a very good rapport builder within the therapeutic relationship. Such an approach is likely to maximize the therapeutic alliance that should be formed. 5. Avoid dichotomous thinking (yes or no, black or white) and consciously allow for three or more possibilities or outcomes for any issue discussed. Avoid categorizing issues into this-or-that categories. This also includes consideration of racial/ethnic categories. For instance, if you are exploring African-American and Caucasian-American differences, consider how a Latino-American might perceive the situation (McGoldrick et al., 1996). As another example, issues related to male and female relations among the African-American population might emerge, amidst this, consider how an African-American lesbian might perceive the discussion (McGoldrick et al., 1996). All of these points demonstrate that polar extremes in perception are detrimental to cross-cultural forms of intervention. SECTION SUMMARY Family systems therapy is an orientation that is much different from the training given to the typical counselor. In fact, only family therapists are qualified to actually practice family therapy. Nonetheless, counselors find it useful to integrate many of the techniques and/or approaches that are common to family therapy. These approaches have been found to be particularly effective with the juvenile and/or drug-abusing population. Family therapy is much more directive than other forms of therapy. In most respects, the counselor will act as a family coach (when conducting therapy with the entire family) or will be directive in explaining how individuals may need to address interactions within their own family system (this is especially true if the family is more dysfunctional than the offender). There are numerous techniques that family therapists may employ, each of these are designed to address the interactive nature of families as a means of resolving conflict between members and issues that aggravate stress within the family system. The need to maintain equilibrium within families is presented as a primary reason for much of the behavior, whether functional or dysfunctional, in most family systems. Lastly, family therapy has been shown to be effective with diverse racial and/or ethnic groups. This provides another practical consideration for correctional counselors whose caseloads are drawn from a diverse offender population. LEARNING CHECK 1. ________________________ occurs in an individual when the person is able to distinguish between the intellectual process and the feeling process that he or she is experiencing. a. Differentiation of self b. Differentiation of emotions and cognitions c. Cognitive override d. None of the above e. All of the above 2. ________________________ is a tendency of families to behave in a manner that maintains the systemic equilibrium or the status quo of the system. a. Family balance b. Collateral emotional exchange c. Order maintenance d. Equilibrium maintenance e. Homeostasis 3. A genogram is a pictorial chart of the people involved in a three generational relationship system, marking marriages, divorces, births, geographical location, deaths, and illness. a. True b. False 4. The identified patient is often referred to as the “symptom bearer” of the family. a. True b. False 5. Family systems therapy is a well-suited approach for diverse racial, ethnic, and cultural groups. a. True b. False PART TWO: BOWENIAN SYSTEMS Bowenian Family Systems According to Bowenian family systems, all family dysfunctions (including, of course, criminal behaviors) come from ineffective management of the anxiety in a family system. More specifically, pathological behavior (i.e., sex offending, compulsive behaviors, substance abuse) is viewed as a means for both individuals and the family as a group to manage anxiety. Take for example a chronic drug addict within a family system, drug abuser is thought to do so in part as a means of reducing anxiety temporarily, and this also allows the entire family to focus on the individual who uses drugs as the problem, which then also allows all member to deflect attention from other sources of anxiety (SAMHSA, 2005). A major source of anxiety can be a family’s reactivity, or the intensity with which the family reacts emotionally to relationship issues instead of carefully thinking them through. Ideally, family members are able to strike a balance between emotional reactivity and reason and are aware of which is which. As noted earlier, this is referred to as differentiation and this is the hallmark of Bowenian family therapy. Family members who are adequately autonomous are neither fused with nor detached from others in the family. Bowen family systems therapy is also based on the premise that a change on the part of just one family member will affect the family system (Goldenberg & Goldenberg, 1996; SAMHSA, 2005). To reduce the family’s reactivity, for example, counselors coach the most motivated family members in ways to curb their reactivity and behave differently in their relationships. Such changes can decrease or even eliminate the problem that brought the family into treatment. The Bowenian approach to behavior change often works through one person, and its scope is highly systemic. For instance, Bowen attempts to reduce anxiety throughout the family by encouraging people to become more differentiated, more autonomous, and less enmeshed in the family emotional system. As noted earlier, Bowenian therapy seeks to focus on higher functioning members as a means of motivating the family system as a whole. However, this process requires that the therapist consider several interlocking elements that work hand in hand to enable dysfunctional processes. The correctional counselor must understand these processes since these are the social factors that will most likely offset any gains made during therapy once the client returns home. This is particularly true for juvenile offenders. One of the primary points to attend to is the development and maintenance of emotional triangles. Emotional triangles are when a two-person system such as the husband and wife experience conflict or instability and a third person is drawn into the relationship as a means of increasing the sense of stability. This third person is essentially “in the middle of the relationship” and may act as referee or confidant to each person in some cases. In other cases, the person may instead be brought into the relationship as a problem person that the couple can focus on, thereby resolving their own instability by focusing on the third person introduced. However, even the three-person relationship may not always be sufficient to contain tension that is experienced, and this results in distress that is spread to others. Further, as more people become involved, the family system may become a series of interlocking triangles (Goldenberg & Goldenberg, 1996). This can even heighten the initial problems and sources of tension that the original triangle relationships sought to resolve. Another aspect of family relationships that Bowenian family therapists tend to focus upon is called emotional cut-off. Emotional cut-off refers to the dysfunctional methods by which members use to distance themselves from their family. Often, relationships will be severed but they may simply be deliberately allowed to digress on their own. These members may try to place geographical distance between themselves and other members, they may use psychological barriers (i.e., ceasing to talk with family members), or they may engage in methods of self-deception, convincing themselves that no problem exists since no contact is maintained (Goldenberg & Goldenberg, 1996). However, the latent dysfunction, trauma, and anxiety reveal in many cases when the person is required to talk about their family history or worse yet when they must make intermittent contact with their family members. In such cases, persons that are emotionally cut-off have great difficulty with these activities. Bowenian family therapists will nearly always seek to engage in processes of de-triangulation where family members are educated on the process and the ineffective means that these processes have on the communication process. Further, these therapists also tend to require that clients address emotion cut-offs that exist, though this is of course counterbalanced with a dose of common sense. For example, a Bowenian family therapist would not be likely to require the victim in a domestically abusive case or a victim of child molestation to repair the cut-off that would likely exist between the victim and the perpetrator. However, Bowenian therapists might have the victim develop awareness and explore their cut-offs with other family members that occurred after the victimization was discovered in the criminal justice system (i.e., extended family that are sympathetic to the perpetrator or at least forgiving of the perpetrator). Such occurrence happens routinely within dysfunctional and criminogenic families. Thus Bowenian therapy will tend to address both emotional triangles and emotional cut-off (two opposite relational reactions) as a means of helping the client to become more differentiated. Incidentally, there are some occasions where Bowenian objectives of addressing emotional cut-off between a victim and perpetrator might occur, even with domestic abuse cases and/or cases of sexual assault. This is particularly true in cases where restorative justice approaches are used to process offenders. Restorative justice being a term for interventions that focus on restoring the health of the community, repairing the harm done, meeting victim’s needs, and emphasizing that the offender can and must contribute to those repairs. Restorative justice considers the victims, communities, and offenders (in that order) as participants in the justice process. In such cases, the victims willingly choose to engage in the restoration process and it would be likely that techniques of de-triangulation (encouraging direct communication of emotions) and the removal of cut-off (requiring that communication be undefensive, calm, and sincere) would be highly useful (Exhibit 6.2). EXHIBIT 6.2 Use of Bowen Family Systems Therapy with Immigrant Populations Although no demonstrated outcomes substantiate Bowenian therapy to address criminal offending, counselors have often used it to treat clients with criminogenic behavioral patterns (such as with substance-use disorders) who have immigrated to the United States. It is believed that this therapeutic approach is a good match for such clients because it emphasizes the intergenerational transmission of anxiety and the effects of trauma that are passed down through generations. The perspective that the “past is the present” provides a mechanism to understand the lowered self-esteem of a person who has lost everything of importance: language, homeland, culture, possessions, and often, a sense of cultural identity. For many the circumstances of migration are traumatic. Such losses are not only carried from the past, but continue to occur in the present as family members are subject to the indirect consequences of migration, such as unemployment or underemployment, marginal or overcrowded housing, untreated health problems, and poverty. In this situation, criminal behavior may be a viable alternative to compensate for the lack of opportunities that exist, alcohol and drugs can provide an expedient way to blot out pain and hopelessness, and youth may engage in delinquent acts as a symptom of the challenges of acculturation (essentially being caught between two worlds, that of their parental culture and the broader American culture). Healing cannot begin until both the counselor and the client understand the significance of the loss of past cultural identification in light of the problematic behaviors that resulted in the immigrant offender’s contact with the criminal justice system. Source: SAMHSA. (2005). Substance abuse treatment and family therapy. Rockville, MD: Center for Substance Abuse Treatment. This insert is a modified version of the material adapted from the source document. Characteristics of the Dysfunctional Family When identifying the dysfunctional family, there are numerous characteristics that most all persons, professional and layperson alike, will understand to be counterproductive. For instance, most everyone intuitively understands that drug addiction, abusive parenting, or failing to pay one’s bills would be considered dysfunctional. Though specific definitions of drug addiction, child abuse, or financial irresponsibility might have some variance from family to family, the general concept is not lost on most rational persons. For the most part, these are commonly accepted characteristics of dysfunction. However, Bowenian family therapists also look for other aspects of family functioning to determine whether its members are well adjusted and part of a healthy system or one that breeds anxiety and tension. As stated earlier, dysfunctional families will tend to have members that are poorly differentiated; triangulation among relationships; and high levels of tension, conflict, and anxiety. These are common indicators that Bowenian therapists will seek to identify. In addition, Bowenian family therapists will examine sibling birth order positions among children in the family as well as the past histories of the parents. While sibling birth order dynamics go beyond the scope of this chapter to explain in detail, researchers have noted a variety of sibling personality profiles (i.e., the ol brother, younger sister, older sister, younger brother, only child, middle child, twins, and so forth) that work together and against one another in a variety of dynamics, some being more harmonious than others (Corey 1996). This likewise affects marriages between adults, depending on their birth order position as children in their own families of origin. Bowenians will examine birth order characteristics to unravel problematic combinations (i.e., two firstborns are married) that provide guidance as to underlying sources of tension not overtly obvious. Another aspect of dysfunctional families that has not been discussed is that of the societal-emotional process. According to Bowenian family systems, societal-emotional process refers to emotional factors in society that affect the emotional functioning of the family. This particular aspect is not well worked within the theoretical construct but makes intuitive sense, particularly for families that exist in underprivileged communities. As noted before, much of the prison population is drawn from offenders that come from backgrounds of poverty, low education, and diminished opportunities. Given these factors, it is easy to see how community factors (and those of the broader society) can create stress and strain for the family. Indeed, this is not much different from the notions of the criminological theorists, Messner and Rosenfeld, whose theory of institutional anomie contends that an emphasis on economic factors has placed strain on families throughout America, devaluing informal institutions and activities within the family and perpetuating a drive for increased activity in those areas that generate income in a competitive capitalistic market. While the tenets of this theory go well beyond the intent of this chapter, it is clear that other theorists contend that family dysfunction is as much a product of broader sociological pushes and pulls (that focus on the pursuit of economic stability). These same contentions would dovetail well with the Bowenian notion of societal-emotional process. SECTION SUMMARY This section familiarizes the student with Bowenian systems family therapy processes. Bowenian family therapy laid the groundwork for many other types of family therapy that followed. Bowenian family therapy is known for its emphasis on differentiation and for other key concepts such as emotional cut-off, emotional triangles, and other means of classifying family dysfunction and dynamics. This type of therapy is versatile and has provided a number of techniques that have been adopted by therapists practicing both family and individual therapy. This type of therapy examines other issues such as sibling birth order, consisting of a variety of sibling personality profiles (i.e., the older brother, younger sister, older sister, younger brother, only child, middle child, twins, and so forth) that work together and against one another in a variety of dynamics, some being more harmonious than others. Other concepts, such as societal-emotional process refers to emotional factors in society that affect the emotional functioning of the family. Thus, at its base, Bowenian processes implement the basic feedback loop process between families and their broader social environment that affects them. LEARNING CHECK 1. Societal-emotional process refers to emotional factors in society that affect the emotional functioning of the family. a. True b. False 2. ________________________ refers to the dysfunctional methods by which members use to distance themselves from their family. a. Emotional distance b. Geographical denial c. Ineffectual denial d. Relational emotions e. Emotional cut-off 3. Bowenian family therapists will nearly always seek to engage in processes of de-triangulation where family members are educated on the process and the ineffective means that these processes have on the communication process. a. True b. False 4. Emotional triangles are when a two-person system such as the husband and wife experience conflict or instability and a third person is drawn into the relationship as a means of increasing the sense of stability. a. True b. False 5. In Bowenian systems therapy, most of the clinical focus is given to the higher functioning client, not the one that is the least functioning. a. True b. False PART THREE: BEHAVIORAL FAMILY THERAPY Behavioral Family Therapy Though we refer to this subsection as behavior family therapy, some elements of this type of therapy may occasionally include cognitive elements. The majority of this section will indeed focus on behavioral interventions, but when and where appropriate, aspects of cognitive behavioral therapy may be included. Behavioral therapy and cognitive behavioral therapy tend to be the modalities of choice in many criminal justice programs because they are clear, easy to measure, and straightforward in application. This often suits correctional systems that seek evidence-based outcomes with their treatment programs. Behavioral family therapy includes three subcomponents: behavioral marital therapy, behavioral parent training, and functional family therapy. Behavioral marital therapy is based on the notion that “the behavior of both partners in a marital relationship is shaped, strengthened, weakened, and modified by environmental events, especially those events involving the other spouse” (Holtzworth-Munroe & Jacobson, 1991, p. 97). In general, the techniques of behavioral marital therapy are intended to (1) increase the couple’s recognition, initiation, and acknowledgment of pleasing interactions; (2) decreasing the couple’s aversive interactions; (3) training the partners in the use of effective problem-solving communication skills; and (4) teaching them to use contingency contracting in order to negotiate the resolution of persistent problems. Behavioral parent training seeks to change parental responses to undesired behaviors from a child so as to ultimately produce a change (and expected improvement) in the child’s behavior. This type of therapy is particularly important for the offender population since many of those processed through the criminal justice system will not have the necessary parental skills to raise their children in a pro-social manner. Further, such therapy is particularly useful for female offenders because over 70% of all female offenders are the primary caretakers of their children. Thus, this form of therapy is useful for correctional counselors as it provides specific tools for offenders who are parents, helping them to shape the behavior of their children in a manner that hopefully will not translate to future criminality in the next generation. Tenets of Operant Conditioning The most commonly used mechanisms that underlie behavioral family therapy are those associated with operant conditioning, as created by B. F. Skinner (1953). The primary notion is that most behavior is controlled and maintained by the consequences that occur. Essentially, this type of behavior modification relies of four primary and well-known principles: positive reinforcement, negative reinforcement, positive punishment, and negative punishment. A brief overview of each of these concepts will be provided, but before doing so, it should be noted that all four mechanisms are designed to aid in the shaping of desired behavior. Shaping is when behaviors are taught by reinforcing successive approximations of a desired behavior until the behavior is fully learned by the client. All aspects of behavioral family therapy center around this primary objective as a means of altering family functioning and the performance of individual members. Reinforcement essentially refers to the use of consequences that immediately follow a behavior and are contingent upon that behavior in order to increase the likelihood of the behavior occurring again. In most all treatment regimens, positive reinforcement is used. Positive reinforcement occurs when a benefit or privilege desired by the client would be presented after the client engages in a behavior that is consistent with the treatment plan as a means of increasing the likelihood that the client will repeat the desired behavior. On the other hand, negative reinforcement, while seeking to increase the likelihood of the repetition of a behavior, does so by removing an unpleasant or aversive stimulus or event immediately after the desired behavior is completed. Negative reinforcement occurs when an event or stimulus that is unpleasant to the client is removed after the client engages in behavior that is consistent with the treatment plan as a means of increasing the likelihood that the client will repeat the desired behavior. While most therapists do tend to emphasize the use of reinforcement rather than punishment, behavior psychology and/or behavioral therapy do also integrate the use of punishments as well. Essentially, the use of punishment is intended to decrease a behavior, but it should be made clear that punishment has been found to be much less effective than is reinforcement of desired behavior. In fact, it is generally held that if one does not reinforce a behavior, it will eventually become extinct. Therefore, extinction is when a behavior ceases due to a lack of reinforcement. The use of extinction is generally preferred to the use of punishment, but nonetheless the use of punishment is widespread throughout society and is a definite reality in the criminal justice system. As such, it would be foolhardy to fail to include this in the current discussion on operant conditioning principles common to behavioral family systems. Positive punishment results from any stimulus that, when applied after an undesired behavior, it reduces the likelihood of that behavior being repeated. Thus, positive punishment occurs when an event or stimulus that is aversive to the client is presented after the client engages in a behavior that is not consistent with the treatment regimen as a means of decreasing the likelihood that the client will repeat the undesired behavior. On the other hand, negative punishment occurs when an event or stimulus that is desired by the client is removed after the client engages in a behavior that is not consistent with the treatment regimen as a means of decreasing the likelihood that the client will repeat the undesired behavior. These principles of operant condition, reinforcement (both positive and negative), extinction, and punishment (both positive and negative) lie at the heart of behavioral family systems and are the main structure upon which this therapy is built. Though perhaps simplistic in its approach, it is a preferred modality in many criminal justice systems because of its straightforward approach and because it lends outcomes that are easily measured. It is with these mechanisms in mind that we now turn our discussion to the characteristics of a functional family and system as well as those of a dysfunctional family system, applying these mechanisms to both versions of family functioning. Behavioral Assessment in Behavior Family Therapy Behavioral therapy, like much of the field of psychology (as opposed to counseling), is grounded in scientific precision and empiricism. Behaviorists seek to operationalize a problem and employ quantitative methods of measuring behavioral change. In essence, behavioral family therapy is, in and of itself, evidence based. As discussed in Chapters 1 and 14, behaviorists will continually revise their hypotheses through an examination of their intervention’s success and/or failure and they will conduct further observations to validate their results. At all times behaviorists use a quantifiable method of observations that allows for the testing of hypotheses (i.e., the intervention will reduce client anxiety during the next two-week period) so that the treatment regimen is refined as therapy progresses. Behaviorist tend to place important emphasis on the assessment process, which “might include an objective recording of discrete acts exchanged by family members, along with the behaviors of others that serve as antecedent stimuli, as well as the interactional consequences of the problematic behavior” (Goldenberg & Goldenberg, 1996). Put in other terms, “assessment focuses on what the behavior or problem is and on the events that might influence that behavior. Further, assessment begins by clarifying the goals of the intervention and it is the assessment that is central to identifying the extent and nature of the problem before the intervention begins” (Kazdin, 2001, p. 7). A thorough behavioral assessment lends itself to effective post-treatment evaluation, an issue that is important to behaviorists who seek to measure and quantify the effects of the therapeutic process. With behavioral interventions, “assessment of family functioning tends to occur at two different levels: (1) a problem analysis that seeks to pinpoint the specific behavioral deficits that underlie the problem areas, which, if modified, would lead to problem resolution; and (2) a functional analysis directed at uncovering the interrelationships between those behavioral deficits and the interpersonal environment in which they are functionally relevant” (Goldenberg & Goldenberg, 1996, pp. 254–255). Both the problem analysis and the functional analysis are peculiar to behavioral therapies but are instrumental in laying the groundwork for these types of interventions. It is the functional analysis that is most important for students to understand because it is the cornerstone to behavioral therapy. Functional analysis reflects a means of understanding behavior and using causal events to create effective interventions (Kazdin, 2001). The key elements of a functional analysis are the assessment, development, and evaluation of hypotheses regarding circumstances that control behavior and the intervention. As one can tell, the process involved with functional analyses (particularly in regard to the generation of hypotheses) has many similarities to points that were made in Chapter 1. Kazdin (2001) notes that assessment is designed to “identify the relations of antecedents and consequences to the behavior of interest and hence the purposes or functions of the behavior. This assessment is likely to suggest patterns of when the undesired behavior is performed” (p. 104). For instance, the behavior may occur more at certain locations (i.e., school or home), or during certain times of the day or night (late and/or when there is a lack of sleep), or when certain persons are in the vicinity. The functional analysis of behavior then identifies these factors as a means of determining the antecedents to problematic behaviors. From this point, these antecedents are targeted with the idea that should one change the antecedent, changes in the problematic behavior will soon follow. During the process of identifying these antecedents, hypotheses are generated as to factors that may be maintaining or controlling the behavior. Kazdin notes that “if at all possible, the hypotheses are tested directly by assessing the target behavior as various conditions are changed” (2001, p. 104). The primary means by which information is gathered to conduct the functional analysis is through the use of interviews of individuals who have contact with the client or clients that are the focus of the analysis. The interview focuses on the context in which the behavior appears to identify factors that can be systematically identified for modification. In the context of family therapy, there may be multiple family members who are involved in providing information, particularly if the focus is on a single offender (such as a substance-abusing offender whose family is consulted to aid in treatment). When the entire family is the focus of the therapy, multiple members might be interviewed in relation to the actions of the other members, resulting in multiple perspectives being individually shared by multiple family members and giving the correctional counselor a unique perspective when examining family behavioral dynamics. It is from the point of assessment that the behavioral therapist then identifies dysfunctional areas of family behavior that are in need of modification (Exhibit 6.3). EXHIBIT 6.3 The 10 Underlying Assumptions of Behavioral Therapy 1. All behavior, normal and abnormal, is acquired and maintained in identical ways (just as with any of the basic leaning principles). 2. Behavior disorders represent learned maladaptive patterns that need not presume some inferred underlying cause or unseen motive. 3. Maladaptive behavior, such as symptoms, is itself the disorder, rather than a manifestation of a more basic underlying disorder or disease process. 4. It is not essential to discover the exact situation or set of circumstances in which the disorder was learned; these circumstances are usually irretrievable anyway. Rather, the focus should be on assessing the current determinants that support and maintain the undesired behavior. 5. Maladaptive behavior, having been learned, can be extinguished (i.e., unlearned) and replaced by new learned behavior patterns. 6. Treatment involves the application of the experimental findings of scientific psychology, with an emphasis on developing a methodology that is precisely specified, objectively evaluated, and easily replicated. 7. Assessment is an ongoing part of treatment, as the effectiveness of treatment is continuously evaluated and specific intervention techniques are individually tailored to specific problems. 8. Behavioral therapy concentrates on the “here and now” problems, rather than uncovering or attempting to reconstruct the past. 9. Treatment outcomes are evaluated in terms of measurable change. 10. Research on specific therapeutic techniques is continuously carried out by behavioral therapists. Source: Adapted from Goldenberg, I., & Goldenberg, H. (1996). Family therapy: An overview (4th ed., p. 254). New York: Brooks/Cole. SECTION SUMMARY Behavioral family therapy contends that the behavior of persons in a family relationship is shaped, strengthened, weakened, and modified by environmental events, especially those events involving other family members. Behavioral family therapy utilizes many concepts that are familiar to psychologists and students of psychology, such as operant conditioning, social learning/modeling, and the use of functional analyses of behavior. It is important that the student understand the basic points and concepts to behavioral psychology and/or therapy since family therapy systems designed around this modality stay true to the ideas presented by those who established the behavioral school. Behavioral family therapy and cognitive behavioral interventions are the preferred methods of intervention in many criminal justice treatment programs. Likewise, this is a good basic form of intervention that is easy to understand, measure, and evaluate. This also has strong appeal within the criminal justice system. As has been emphasized throughout this text, the use of effective assessment is considered extremely important in this type of intervention, but behavioral psychology uses a unique approach called the functional analysis of behavior. This form of assessment also aids in the treatment planning process and lends itself well to the implementation of the various mechanisms of reinforcement and punishment that are akin to operant conditioning. LEARNING CHECK 1. ________________________ occurs when an event or stimulus that is desired by the client is removed after the client engages in a behavior that is not consistent with the treatment regimen as a means of decreasing the likelihood that the client will repeat the undesired behavior. a. Positive reinforcement b. Negative reinforcement c. Positive punishment d. Negative punishment 2. ________________________ occurs when an event or stimulus that is unpleasant to the client is removed after the client engages in behavior that is consistent with the treatment plan as a means of increasing the likelihood that the client will repeat the desired behavior. a. Positive reinforcement b. Negative reinforcement c. Positive punishment d. Negative punishment 3. Social learning occurs when one person observes another engage in operant learning conditions and when the observing person then, in turn, repeats the behaviors that were reinforced for the person that had been observed. a. True b. False 4. ________________________ occurs when a benefit or privilege desired by the client is presented after the client engages in a behavior that is consistent with the treatment plan as a means of increasing the likelihood that the client will repeat the desired behavior. a. Positive reinforcement b. Negative reinforcement c. Positive punishment d. Negative punishment 5. ________________________ occurs when an event or stimulus that is aversive to the client is presented after the client engages in a behavior that is not consistent with the treatment regimen as a means of decreasing the likelihood that the client will repeat the undesired behavior. a. Positive reinforcement b. Negative reinforcement c. Positive punishment d. Negative punishment Effective Family Functioning and Dysfunctional Family Functioning As just noted, for behaviorists, the notions of operant conditioning stand at the heart of determining whether a family is functional or dysfunctional. When examining family systems, one of the key determinants of a high-functioning family is whether maladaptive behavior is reinforced. Obviously, in a functional family, such behaviors would not be reinforced. Though there may be some question as to specific definitions of adaptive behavior (considering family variability, the effects of culture, and etc.), it is nonetheless the case that effective families will not reinforce behaviors that are generally considered inappropriate in the broader mainstream society and that the same family system will reinforce those that are considered desirable. Further, high-functioning families do not often have a need for the use of punishment, the presumption being that a satisfactory set of reinforcers and reinforcement schedules will typically elicit the desired behavior in lieu of behavior that is not desired. Further, in most all functional families, social learning will take place that further reinforces the impact of operant conditioning. Social learning occurs when one person observes another engage in operant learning conditions and when the observing person then, in turn, repeats the behaviors that were reinforced for the person that had been observed. In other words, the person learns vicariously as a product of another person’s learning experiences. For example, if an older sibling is given praise for completing chores around the house, it is likely that the younger children will observe this and also do their chores, in the hopes of also getting praise. In addition, parents that are effective will also engage in modeling. Modeling is when desired behavior is deliberately produced by one person knowing that it is being observed by another. Thus, children will tend to repeat the behavior that is modeled by their parents, this being a product of social learning. If the parents then reward the child, then the social learning is further reinforced with operant conditioning and social learning mechanisms working hand in hand in an interlocking fashion. This further strengthens the learning processes that take place. It is important that functional families ensure that the benefits of pro-social behavior outweigh the costs of engaging in that behavior. Otherwise, there is little likelihood of motivating family members into engaging in a desired behavior. In addition, it is important that a sense or reciprocity is maintained among families members, this resulting in the mutual reinforcement of desired behaviors between family members and this also serving to further add to the social learning that takes place as family members observe reciprocal behaviors that reinforce each other. In terms of behavioral family systems, all of these elements are part and parcel of any well-functioning family. Naturally, behavioral therapists must attend to these when they attempt to motivate families toward change and they will attempt to instill such methods of interaction, the ultimate goal being that the family members reinforce one another, one step at a time, into functional and healthy means of operating. Naturally, dysfunctional families will tend to lack many of these qualities. In such families, there are often haphazard approaches to reinforcement, with inconsistent rewards and punishment. Indeed, consistency is the key to effective forms of behavioral shaping. This is not to say that desired behaviors must be rewarded every time that they occur (in fact, there is substantial research that demonstrates that ratio forms of reinforcement are much more effective), but it does mean that the same types of behaviors should be reinforced and that the same types of behaviors should be punished. Effectively attending to this requires effort on the part of the parents who may see themselves as too busy or too tired to maintain such a state of vigilant parenting. However, this is specifically where the problems with dysfunction can emerge. In short, maintaining a functional family takes work and effort; parents who guide their families will need to be prepared to provide such effort. In criminogenic families it can be very challenging to gain the motivation necessary to achieve effective outcomes. Further, the parents (whether they are offenders or otherwise) will need to model pro-social and adaptive behaviors since social learning will occur within the environment as family members observe one another. Lastly, communication within many dysfunctional families will often tend to be impaired and will usually be laden with conflicted intent, sarcasm, and/or inappropriate content. This obviously will impact the likely reaction that other family members will have to such means of message delivery. Because behavioral family therapy is so focused on the measurable outcomes and content of the behavior itself, a word of advice should be given. Families in counseling should all be given instruction in appropriate forms of communication. The delivery of the content is just as important (in many cases) as is the content itself, at least if one expects to have his or her content heard. The correctional counselor will do well to attend to the processes involved in a family’s communication patterns and will be best off if they have family members model effective communication patterns (the use of “I” statements, use of active listening effective reflection) during therapeutic sessions and at home. This is important because many challenged families cannot implement higher functioning forms of operation due to the crippling effects of inappropriate or ineffective communication. Indeed, in many of these families, verbal abuse may be present and this along will impair the effectiveness of any treatment plan that can be implemented. Thus, correctional counselors are encouraged to make this a part of their intervention plan when using behavioral family system perspectives. CONCLUSION Family systems therapy offers a set of treatment options that are very different from those used in individual counseling. While it is not necessary that correctional counselors be actual family therapists, it is useful if they are aware of the basic dynamics associated with family therapy and family counseling. Often, family issues lie at the base of many offender problems, and family therapy offers an option of rectifying dysfunctional family influences. Additionally, family therapy offers a venue by which well-adjusted families can aid in the offender’s treatment and/or recovery. It is with substance abuse and juvenile offenders that family therapy has been used extensively. Among both populations, this type of intervention has proven to be quite successful. There are many types of family therapy, just as with individual therapy. Each type reflects a different orientation but all consider the interaction process to be important in determining dysfunction. Further, all methods of family intervention examine issues associated with the homeostasis of the family system as well as other aspects of family functioning. Whether the family issues are those rooted in the past or those that occur in the present, there are a number of interventions that can aid correctional counselors in addressing this element of an offender’s clinical circumstances. Because of this and because this type of therapy tends to work well with diverse populations, it is a method of clinical practice that should not be ignored. Rather, it is a method that should be specifically utilized whenever practical for the agency that delivers therapeutic services. Given the trauma that tends to plague the backgrounds of many offenders, this type of intervention perhaps holds a greater degree of utility than is associated with many other types of interventions. Essay Questions 1. Describe the basic principles of family systems therapy. In your description, be sure to define the concepts of circular causality, cybernetics, home-ostasis, and feedback loops. 2. Describe two techniques of family systems therapy that correctional counselors can utilize. Also, can you think of situations in which these techniques may not be useful? 3. Describe the essence of structural family therapy. Provide an example of when this type of therapy may be particularly useful and why. 4. What is Bowenian family systems therapy? What are the central tenets of this system of therapy? How is this system different from other family system therapies? 5. Why is it important to identify and use an offender’s support system within the counseling process? Describe some of the advantages of doing so. Are there times where this may not be a good idea? Why or why not? Treatment Planning Exercise The case scenario for this chapter was selected for several reasons that are beneficial to showcasing family systems interventions and are also likely to enhance student learning. This case provides the student with a scenario where they can read and observe how a family therapist would address problems presented by a client family. Further, this case scenario includes a family of minority status (Latino-American) and thus also illustrates the utility of family therapy with diverse cultural groups. As noted in this chapter, the ability to apply family therapy to diverse racial, ethnic, and/or cultural groups is one of the strong suites of this mode of intervention. For this exercise, the student will not be responsible for applying aspects of the chapter to the scenario; rather this assignment works in a backward fashion. In this case, the student must read the scenario and identify concepts, terms, and/or techniques from the chapter(s) identified and must then explain how that identified concept, term, or technique was used by the therapist. This is intended to integrate the material even further through diversified learning processes, allowing students to analyze the scenario from the perspective of their readings. Lastly, note that students will need to identify components from this chapter as well as Chapter 3 on cultural competence. This further integrates the material provided throughout this text. For this assignment, the student must do the following: 1. Students should list five concepts, terms, or techniques from Chapter 6 that were mentioned or utilized by the therapist in this scenario. For each, be sure to provide a specific explanation of how your example was used, the area from the chapter to which this example corresponds, and explain whether you believe that the therapist used the concept, term, or technique in an effective manner. 2. Identify at least three issues, concepts, or other considerations from Chapter 3 that were relevant to this case scenario. Also explain why you chose those three in particular and explain whether the therapist considered those issues, concepts, or considerations in an effective manner. The Case of the Hernandez Family Initial Presentation: The Hernandez family was referred to the clinic by the public defender at the time of Isabelita’s third arrest, this time for drug possession. Isabelita was 15 years old, and she lived with her mother, a single parent, and a 12-year-old brother. Because the mother only spoke Spanish, the case was assigned to a Hispanic BSFT counselor who called home and heard screaming and fighting in the background. The counselor spoke with the mother, who sounded overwhelmed. When the counselor explained that he was calling to set up a family session, Ms. Hernandez angrily told the counselor that she could never get Isabelita to attend. The counselor asked Ms. Hernandez for permission to come to her home when she and Isabelita were both likely to be home. Because Ms. Hernandez worked as a domestic during the day, the appointment was set for 7 o’clock the next evening. When the counselor arrived at the home, he found the mother alone with her 12-year-old son. Ms. Hernandez explained that Isabelita often stayed out with her friends, and she could not predict what time Isabelita would be home. The 12-year-old son was quick to confirm his mother’s story and added that Isabelita was always upsetting his mother and that he wished she would just go away. Establishing the Therapeutic System: The counselor began to join with Ms. Hernandez by listening to the story of her hardships in this country and with Isabelita. Ms. Hernandez said how overwhelmed she felt by Isabelita’s behavior and that she did not know what she could do. In fact, she said, “It is all in God’s hands now,” as if there was nothing else she could possibly do. It appeared from the story that Ms. Hernandez did not have well-established rules or consequences for Isabelita’s behavior. It also appeared that most of the communication that occurred between daughter and mother was angry, blaming, and fighting. Ms. Hernandez felt that they could argue for hours about the same thing and then have the same argument all over again the next day. It was about 8:15 P.M., when Isabelita arrived. It was obvious to the counselor that her gait was unsteady and her speech was slurred. Her eyes were red. She barged into the home and went straight to the kitchen. When Ms. Hernandez said to Isabelita, “Come here, there is someone here who has come to see you about your arrest,” Isabelita answered, “F–—k them, I am hungry.” Ms. Hernandez went to the kitchen to serve Isabelita her dinner, screaming at her “Your food is already cold. You are late again. We had dinner two hours ago.” The screaming between mother and daughter continued for another 10 minutes before the counselor came to the kitchen to attempt to introduce himself to Isabelita, as a way of extending the joining process. In this first encounter, the counselor listened and joined. Diagnosis: While the counselor listened and joined, he also observed the interaction between mother and daughter. Armed with these observations, the counselor understood the family’s interactions along the following diagnostic dimensions. Organization: There is a problem with this family’s hierarchy and leadership. The identified patient is in a powerful position, while the mother is powerless and feels overwhelmed. The mother has no control over the identified patient’s behavior. There is no sibling subsystem. The 12-year-old son triangulates between the mother and the identified patient. Resonance: The family is very enmeshed. The quality of the enmeshment between the mother and the identified patient is conflictive and hostile. Developmental Stage: All three members of this family appear to be functioning below what would be appropriate for their ages and roles. The identified patient’s demands on her mother are those of a younger child, and she does not help out at home. The mother is overwhelmed and does not know how to control the identified patient. The son is too attached to his mother and involved in supporting her, and he does not engage in age-appropriate social and play activities. Life Context: The family is new to the United States, and the mother is disconnected from her host society (e.g., she has no English skills). The identified patient spends most of her time with acculturated peers who participate in drug use and risky sex. Identified Patient: The identified patient is extremely rigid. The identified patient centralizes herself with her negative behavior. The relationships between the identified patient and other family members are characterized by intense negativity. This family has not identified other problems or persons as a concern. Conflict Resolution: The typical pattern of interacting in the family is continuous conflict emergence without resolution. General Discussion of the Diagnosis: In the Hernandez family, the mother is overwhelmed and is unable to manage her drug-abusing daughter’s behavior. The daughter, in turn, has distanced herself from the family and spends the majority of her time with sexually active and drug-using friends. When the daughter is home, she and her mother fight constantly, with the brother intervening to take the mother’s side against his sister. The brother’s triangulating maneuvers serve only to further isolate the identified patient from her family. Cultural issues also need to be taken into account in diagnosing the Hernandez family. Upon their arrival in the United States from Colombia three years earlier, the members of this family began to drift apart from one another. Isabelita began learning English and associating with Americanized peers, whereas her mother remained socially and culturally isolated. Ms. Hernandez had become increasingly uncomfortable with Isabelita’s acculturating behavior and choices of friends, but the widening chasm between mother and daughter discouraged Ms. Hernandez from addressing these issues with Isabelita. By the time Isabelita was referred to treatment, the family system had become completely dysfunctional, and Ms. Hernandez had ceded nearly all of her power and authority to her daughter. Planning Treatment Based on Diagnosis: A powerful identified patient is typically joined first in order to engage the family into treatment. In this case, however, Isabelita did not present an engagement problem. Although angry and rebellious in her behavior, she was present in therapy and willing to voice her complaints and feelings. The counselor thus starts by joining both the mother and the identified patient. It is important very early in the therapy to work to restructure the dysfunctional family hierarchy. By supporting the mother, the counselor needs to help her break the cycle of conflict between herself and her daughter so that the mother can begin to recapture some control. Essentially, the counselor needs to help move the mother into an appropriate parental role. The brother’s attempts at triangulation need to be blocked, allowing the mother and daughter to resolve their issues directly, between the two of them. This also would permit the brother to engage in more age-appropriate activities. Isabelita’s disobedient behavior needs to be reframed as a cry for help in order to change the affective tone of her relationship with her mother, and, thus, to permit them to interact more positively. The treatment plan that the counselor formulated for the Hernandez family addressed the following: • Organization: A dysfunctional hierarchy exists in which the daughter holds the power and the mother is powerless and overwhelmed. Power must be transferred back to the mother. • Organization: The son is triangulated into the relationship between the mother and the daughter. The son’s attempts to triangulate must be blocked. • Resonance: The mother and the daughter are enmeshed in a conflictive and explosive relationship; the daughter’s behavior must be reframed as a call for help to reduce the negativity. • Developmental Stage: The daughter’s behavior at home is immature and demanding, the son is playing a “mother’s partner” role, and the mother does not assume appropriate parenting leadership. The daughter must be shown how to express her feelings, the mother must be encouraged to elicit and validate the daughter’s feelings, and the son must be prompted to participate in age appropriate social activities. • Identified Patient: The daughter is designated as the source of the family’s problems. The problem must be framed in terms of the whole family and addressed by changing the family’s patterns of interaction. • Life Context: Acculturation differences compound normative parent– adolescent disagreements and exacerbate the distance between the mother and the daughter. The counselor must help the two of them “get on the same page” in their interactions. • Life Context: The daughter is associating with high-risk peers. As power is transferred back to the mother, peer selection must be brought up, and the mother needs to encourage the daughter to select different peers. • Life Context: The mother and the son are socially isolated. The mother needs to familiarize herself with the English language and with American culture, and the son needs to associate with friends his own age. • Conflict Resolution: The mother and the daughter tend to shout at and insult one another with no resolution. The family must be taught to stay on topic and resolve issues without leaving the room or resorting to personal attacks. Producing Change: One week later, the counselor came for the second session, and the same exact incident reoccurred, with Isabelita coming home late, clearly on drugs. The counselor had already established a therapeutic relationship with the whole family. While the counselor sat with Ms. Hernandez waiting for Isabelita to show up, he used the time to explain how Ms. Hernandez could respond differently to Isabelita when she arrived home late (i.e., a reversal). The counselor coached Ms. Hernandez to remain calm, not let Isabelita engage her in a screaming match, and not provide or help her with food. When Isabelita arrived, her portion of the family dinner had been placed in the freezer. Upon her arrival, Isabelita as usual bolted to the kitchen and demanded food. Encouraged by the counselor, Ms. Hernandez continued to sit in the living room, which, in their small home, was just next to the kitchen. Isabelita came into the living room and began shouting at her mother about the food. The mother yelled back to Isabelita, “You are a drug addict,” and this began anew the cycle of blaming and recrimination. The counselor stood up, walked up to Ms. Hernandez, and said, “You need to stay calm and not let her control you with her fighting.” After several such interventions, Ms. Hernandez finally looked at the counselor and said, “I am trying to do it, but it is very hard.” This statement represented Ms. Hernandez’s initial step in using the counselor to help her detach from the conflict with her daughter. Furthermore, when the son stepped in, the counselor encouraged the mother to hold him back as well. Isabelita continued to scream at her mother without getting a response for another 15 minutes before storming to her bedroom in a fury. Having been unsuccessful in engaging either her mother or brother in a fight, she was frustrated and gave up. After the counselor gave the mother ample support and praise for having controlled the situation and avoided a fight, the counselor moved the conversation to the next step. He discussed other ways in which Isabelita would “push her mother’s buttons,” and he gave Ms. Hernandez the task of using the newly learned skills on these other occasions. This was a great gain for a single session, and it was clear that the gains from this session needed to be followed up and extended as soon as possible. The counselor told Ms. Hernandez that “we can keep making things better if we meet again in a few days.” To Isabelita, the counselor said, “You see, these fights between you and your mom don’t have to happen. If you’ll agree to have me here again next week, we can keep working toward having peace in your life.” As a result, both Ms. Hernandez and Isabelita agreed to hold another session the following week. At the beginning of the next session, the counselor followed up on the previous week’s gains by reviewing how Ms. Hernandez and Isabelita had made progress around the issue of fighting. The counselor intervened to block the brother’s attempts to triangulate himself into interactions between Ms. Hernandez and Isabelita. Throughout the session, the counselor praised Ms. Hernandez whenever she avoided a fight, and empathized with her when she did not. (“I understand how hard it is, but I know you tried.”) The counselor also praised Isabelita amply for her ability to follow her mother’s lead in avoiding fights that are “so upsetting to you.” Hence, both the mother and Isabelita received credit and praise for accomplishing changes in their relationship. Having experienced a major accomplishment in placing the mother in control of the interactions, the counselor was now ready to move to the next level: negotiation of rules and consequences. The counselor also began to reinforce changes in Isabelita’s behavior, no matter how small, by showing empathy for “how difficult all of this must be for you.” The counselor also took an active role in helping Ms. Hernandez move into a more appropriate parental role by gradually praising each of the mother’s attempts to guide or set limits for her daughter. The counselor also consistently reframed Isabelita’s disrespectful behavior as a cry for help and as her way of expressing pain. Gradually, over time, Isabelita’s externalizing behavior and drug abuse decreased. Ms. Hernandez learned to befriend her daughter and to remain calm and not engage in conflict (i.e., a reversal) whenever Isabelita would throw a tantrum. Isabelita began to phrase her complaints in the form of respectful disagreements rather than hostile attacks. The brother, sensing that the tension between his sister and mother was decreasing, slowly backed away from the triangulated relationship with them and began to seek out his own social activities. Source: This case vignette was adapted from the government document written by José Szapocznik, Olga Hervis, and Seth Schwartz and published by the National Institute on Drug Abuse titled Brief Strategic Family Therapy for Adolescent Drug Abuse (2003). Bibliography Bennett, L. A. (1978). Counseling in correctional environments. New York: Human Science Press. Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson. Boyd-Franklin, N. (1989). Black families in therapy: A multisystems approach. New York: Guilford Press. Brown, D., & Srebalus, J. (2003). Introduction to the counseling profession (3rd ed.). Pearson Education, Inc: New York. Brucker, P. 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Latino families in therapy: A guide to multicultural Practice. New York: Guilford Press. Garcia-Preto, N. (1996). Latino families: An overview. In M. McGoldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy (pp. 141–154). New York: Guilford Press. Gladding, S. T. (1996). Counseling: A comprehensive profession (3rd ed.). Englewood Cliffs, NJ: Prentice Hall. Goldenberg, I., & Goldenberg, H. (1996). Family therapy: An overview (4th ed.). New York: Brooks/Cole. Haley, J. (1984). Ordeal therapy. San Francisco: Jossey Bass. Harper, F. D., & McFadden, J. (2003). Culture and counseling: New approaches. New York: Allyn & Bacon. Holtzworth-Munroe, A., & Jacobson, N. S. (1991). Behavioral marital therapy. In A. S. Gunman & D. P. Kniskern (Eds.), Handbook of family therapy (Vol. II, pp. 96–132). New York: Brunner/Mazel. Kaufman, E., & Borders, L. (1988). Ethnic family differences in adolescent substance use. In R. H. Coombs (Ed.), The family context of adolescent drug use (pp. 99–121). New York: Haworth Press. Kazdin, A. E. (2001). Behavior modification in applied settings (6th ed.). Belmont, CA: Wadsworth/Thomson Learning. Kratcoski, P. C. (1981). Correctional counseling and treatment. Monterey, CA: Duxbury Press. Lester, D. (1992). Correctional counseling (2nd ed.). Cincinnati, OH: Anderson Publishing. Marín, G., & Marín, B. V. (1991). Research with Hispanic populations. Newbury Park, CA: Sage Publications. May Lai, T. F. (2001). Ethnocultural background and substance abuse treatment of Chinese Americans. In S. L. A. Straussner (Ed.), Ethnocultural factors in substance abuse treatment (pp. 345–367). New York: Guilford Press. McGoldrick, M., Gerson, R., & Shellenberger, S. (1999). Genograms: Assessment and intervention. New York: W. W. Norton and Co., Inc. McGoldrick, M., Giordano, J., & Pearce, J. K. (1996). Ethnicity and family therapy (2nd ed.). New York: Guilford Press. Paniagua, F. A. (1998). Assessing and treating culturally diverse clients: A practical guide (2nd ed.). Thousand Oaks, CA: Sage Publications. Papero, D. (1990). Bowen family systems theory. Upper Saddle River, NJ: Allyn & Bacon. Reid, D. J. (2000). Addiction, African Americans, and a Christian recovery. In J. A. Krestan (Ed.), Bridges to recovery: Addiction, family therapy, and multicultural treatment (pp. 145–172). New York: The Free Press. Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Mitrani, V., Jean-Gilles, M., & Szapocznik, J. (1997). Brief structural/strategic family therapy with African American and Hispanic high-risk youth. Journal of Community Psychology, 25(5), 453–471. Santisteban, D. A., Muir-Malcolm, J. A., Mitrani, V. B., & Szapocznik, J. (2002). Integrating the study of ethnic culture and family psychology intervention science. In H. A. Liddle, D. A. Santisteban, R. F. Levant, & J. H. Bray (Eds.), Family psychology: Science-based interventions (pp. 331–351). Washington, DC: American Psychological Association. Skinner, B. F. (1953). Science and human behavior. New York: Macmillan. Sutton, C. T., & Broken Nose, M. A. (1996). American Indian families: An overview. In M. McGoldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy (2nd ed., pp. 31–44). New York: Guilford Press. Substance Abuse and Mental Health Services Administration. (2005). Substance abuse treatment and family therapy. Rockville, MD: Center for Substance Abuse Treatment. Wright, E. M. (2001). Substance abuse in African American communities. In S. L. A. Straussner (Ed.), Ethnocultural factors in substance abuse treatment (pp. 31–51). New York: Guilford Press. 10 Anger Management and Domestic Abuse Counseling CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Know the basic components and processes to anger management and domestic abuse group interventions. 2. Understand the underlying dynamics associated with domestic abuse. 3. Identify Groetsch’s three categories of domestic batterers. 4. Match the appropriate treatment process with each category of batterer. 5. Be aware of corollary treatment issues relevant to domestic batterers. PART ONE: PERSONS WITH ANGER PROBLEMS AND DOMESTIC BATTERERS Though domestic violence issues have been given substantial public attention during the past two to three decades, there is still substantial confusion among the mainstream populace regarding distinctions between individuals with personal anger problems and those who are domestic batterers. Further, the term “anger management” has become one that is a source of humor, thereby almost normalizing the concept. Further, with the identification of phenomenon such as road rage and other commonly accepted terms for explosive behavior, it would seem as if the concept has been almost normalized within American culture. However, issues regarding domestic violence have not received as much lighthearted fanfare, generating social intolerance for this type of crime. Despite differing public perceptions regarding anger management and domestic battering, it is very common to see batterers mandated to anger management counseling, in some cases, without simultaneously attending a batterer’s group. It is in this manner that one concept becomes equated with the other, but, among professionals, it is clear that anger management interventions are no substitute for a genuine domestic batterer treatment program. While persons who have problems with anger control and emotional modulation may be in need of interventions to regulate their emotions, these dynamics are typically grounded in a sense of hurt or being aggrieved. Though this does not excuse extreme emotional outbursts or justify violent actions, it tends to be the case that most persons who have difficulties controlling their anger perceive some sort of slight, insult, or attack that has been aimed against them. In other cases, the anger may arise due to frustrations related to various stressors and/or persons who thwart the offender’s ability to achieve some sort of goal or desired outcome. While the factors just noted may help to explain the etiology to anger and even anger management problems, these factors do not, in and of themselves, explain the basis behind why domestic batterers commit such crimes. In the case of domestic batterers, the basis for much of the partner abuse that may occur is due to feelings of entitlement, particularly between male and female couples. In fact, many researchers (Pence & Paymar, 1993; Russell, 1996) note that belief systems grounded in patriarchy and male dominance tend to generate the abusive behaviors seen between batterers and their victims. Further, domestic abuse is targeted at persons who reside with the offender and/or have some sort of relationship with the offender. This is in contrast with generalized anger control issues that may be sparked by any number of stimuli, including persons known to the offender as well as those who may be perfect strangers. This is an important point because many batterers may abuse their partners and/or children but they may not exhibit these behaviors when amongst others. Indeed, by all public appearances, they may seem to be very upright and even unassuming persons. But behind closed doors, they may be quite manipulative in how they psychologically and physically intimidate others. In this regard, domestic battering is often tied with the desire to control people and, in many cases, results in repetitive incidents between the perpetrator and the victim. On the other hand, simple anger control problems may manifest with much less calculation and may also have little or nothing to do with power and control within a family system. Anger Management Groups Anger management groups tend to use cognitive-behavioral techniques in intervention. In many groups, specific techniques are taught. For example, persons in anger management groups may be taught to take “time outs” when they feel twinges of anger are building. They may also be taught deep-breathing techniques as a means of maintaining their calm. Clients may be taught to use “I” statements as a means of taking responsibility for their emotions and behaviors and to avoid blaming others. In addition, clients may be given an exercise regimen to relieve stress and tension. It is also common for these groups to instruct clients to use anger logs or journals where clients are tasked with maintaining a record of what made them angry throughout the week. Naturally, clients are required to consider factors that trigger their anger. There are a number of other techniques that may be taught to clients who are in anger management groups. Typically, anger management groups last only for a few weeks. In many cases, they may last for eight weeks or less. This short length of time tends to be true for clients who appear voluntarily as well as those who are court mandated. Throughout the course of these sessions, clients are required to consider those antecedent events that may trigger their anger and are also required to consider various means by which they can adjust and modify their reactions. Many intervention programs will use familiar techniques of thought stopping, cognitive restructuring, and an examination of one’s self-talk. Regardless of the agency, group, or professional expert who creates the curriculum, most all anger management interventions consist of the components that have been discussed in this subsection. Though some experts, such as Newton Hightower, Anderson and Anderson, and others, may have developed their own curricula that are well acclaimed throughout the nation (and perhaps the world), they all have similar themes in the manner by which anger is processed and by which it is treated. All of these interventions suggest some sort of approach that is cognitive-behavioral in nature. Further, these programs have not necessarily been tested for effectiveness through rigorous evaluative data. In addition, the training that counselors might seek from these programs can be quite expensive. Thus, casual students who would like to view a specific curriculum for anger management group process may find themselves unable to obtain this information without purchasing products by these vendors. Because of this, we recommend that students examine the manual and associated workbook published by the Substance Abuse and Mental Health Services (SAMHSA) manual titled Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual, written by Reilly and Shopshire (2002a). Though this manual has been constructed for group sessions with clients who have both anger management problems and substance abuse problems, we still recommend this manual to anyone interested in exploring how anger management groups are actually conducted. We particularly recommend this manual for persons who may later aspire to be correctional counselors. The reasons for advocating for the work of Reilly and Shopshire (2002a) are many. First, this curriculum contains all of the more common ingredients that are found in other curricula. Second, as has been discussed in earlier chapters, the vast majority of the offender population has some sort of substance abuse issue, whether it be personal drug use or the association with other drug offenders. This means that most offenders who present to a correctional counselor will have both anger management problems coupled with substance abuse problems. Indeed, many of the explosive situations that lead to trouble with offenders also included the use of substances during the time of arrest. Third, this particular curriculum is designed to last 12 weeks in duration and is therefore a bit more extensive than some of the other types of anger management curricula that are used today. Fourth, because this manual is a publication of the federal government that falls within the realm of being public domain, it is absolutely free of charge to persons wishing to obtain copies. The associated workbook used by clients in the anger management group is likewise free. Both may be freely copied and utilized to as desired by treatment providers and they are available online. Lastly, it is the contention of this text’s authors that the various products provided by SAMHSA are high quality and ideally targeted for the offender population. Thus, persons wishing to have a step-by-step guide on conducting an anger management group in addition to materials available to the participants of an anger management group only need to see the referenced entries for Reilly and Shopshire (2002a) included at the end of this text to directly obtain the materials for themselves. An Overview of Domestic Battering Groups The batterer’s first contact with the program occurs when he arranges for an intake interview. At this time, the client signs release forms that give the program permission to contact his probation officer and his partner. The program then notifies the probation office that the client has chosen it for treatment. The first step of the intervention is the intake assessment, a process that can span one to eight weekly sessions. The initial session may be done as an individual interview or as part of a group orientation. Intake sessions serve several purposes: • To get the client to agree with the terms and conditions of treatment and to sign the program contract; • To begin to assess the nature and extent of the batterer’s abusive behavior; and • To screen for other problems such as substance abuse, mental illness, and illiteracy. Beyond obtaining information solely related to domestic violence, the assessment typically includes questions about the batterer’s family history, propensity for violence outside the family, and substance abuse. In many cases, this session will also be the start of a rapport that will be built between the therapist and the batterer, while also obtaining basic information necessary for further intervention. Approaches to assessment vary from program to program, but most all of them now provide at least a cursory exploration of potential mental health issues and substance abuse issues since these do tend to be common among this population. Throughout this process, some programs may screen for possible problems by using simple checklists and then referring the client for formal psychological evaluation if a substance abuse or mental health problem is suspected. Other programs may have the resources to run the entire gamut of assessments and evaluations, particularly if these programs have numerous mental health clinicians available to the agency. After the initial intake session, most programs have an orientation process where the clients will meet for one or even several sessions during which the reeducation process begins. While conducting these initial sessions, counselors may use this time to further appraise the batterer since these will likely be the first few face-to-face observations that they may have with the client. In addition, this is a novel first meeting for the batterer who, while in the process of experiencing and adapting to the intervention process, may provide the therapist with clinical impressions and clues that further enhance the earlier assessment at intake. This is particularly true if the client has substance abuse or other mental health considerations. The session then turns to the program goals and the rules for participating in the group. Some of the rules relate to attendance, punctuality, and payment of fees; others are related specifically to the group process, such as confidentiality, abstaining from alcohol and other drugs 24 hours before each group session, and participating constructively in group discussions (Healey, Smith, & O’Sullivan, 1999). Other rules may prohibit sexist or degrading language and insulting or intimidating counselors or other group members and require waiting in turn to speak. Finally, the program explicitly states the expectation that batterers will refrain from all violent, intimidating, or threatening behavior toward their partners. In addition to indoctrinating new members about program rules, orientation sessions are used to teach batterers the underlying assumptions of the program (Healey et al., 1999). When relaying these assumptions, therapists may do any of the following: • Establish a broad definition of abuse that includes psychological and sexual abuse. • Motivate batterers to change; counselors highlight the consequences of the batterer’s abusive behavior on his children—often the best motivation to change. • Counselors also begin to build empathy for their partners among batterers by discussing the consequences of abuse for the victim. • Depending on the treatment approach, these sessions may also cover societal beliefs and norms that support. The orientation sessions tend to be more like didactic classes than later sessions, which may take on a more therapeutic tone. One reason for the lecture-type format is to maintain order among new members who would sidetrack group discussions by turning attention away from their own behavior to complaints about their partner or the criminal justice system (Healey et al., 1999). Another, more subtle, reason for the structured format is to firmly establish norms for how to participate in group discussions before members graduate to more informal groups. The sessions also set a tone of active participation, making clear that clients will not be allowed to attend class without really participating in group discussions. Finally, the orientation phase—especially if it is extended over a number of weeks—can also serve as a screening device for the more therapeutic ongoing groups. Once the orientation process has been completed, the group process will then shift toward the completion of some sort of scheduled curriculum. In many cases, this curriculum may span several months in duration, being much more in-depth than anger management curricula. In most cases, the batterer group intervention will last anywhere from 26 to 52 weeks in duration (Healey et al., 1999). It is the group intervention that has emerged as the intervention of choice for several reasons, which include the following: • The group combats the implicit social approval of abusive behavior that many batterers perceive from family and friends. By sending consistent messages that do not condone any form of abuse and encourage nonviolent alternatives, the group serves as a healthy support system for batterers who wish to change. • Successful group members can serve as role models to batterers who are just beginning to confront their own violent behavior, helping to break through a new member’s minimization of his abuse. • By providing a new source of support, the group reduces the batterer’s excessive dependence on his partner to meet all his emotional needs. However, group leaders must be alert and ready to intervene when batterers try to commiserate with one another, forming unhealthy bonds that excuse abusive behavior. As one set of group leaders advised, some programs are strictly structured, such as those using the Duluth curriculum (described below), prescribing the order in which topics are to be addressed. Other programs give discretion to group leaders to choose from a range of program content, while confronting batterers’ behavior more directly. Program directors warned that some leaders may resort to a more flexible approach because they lack the skill to keep group discussions focused on the planned curriculum. It is important, therefore, to distinguish between a flexible curriculum and uncontrolled digressions from the set discussion schedule. Whatever the structure or treatment approach, each group session typically begins with a round-robin style check-in, followed by the selected topic or educational piece for the meeting, ending with goal setting and check-outs. Check-ins are a way to introduce new members to the group and reinforce the program’s focus on the batterer’s behavior (Healey et al., 1999). They can be brief (each person states his name and one of the rules of the group) or more lengthy (each member describes his most recent or severe abusive behavior). In more therapeutically oriented programs, the check-ins can lead to discussions that take up the bulk of the session (Healey et al., 1999). For more educational programs, the check-ins are followed by a more structured presentation from the curriculum. Regardless of emphasis, at the end of the session programs typically assign homework that is designed to encourage each client to apply the session’s topics directly to his life. Check-outs help participants summarize what they learned and clarify their behavioral goals for the coming week (Healey et al., 1999). Most batterers deny or avoid accepting responsibility for their actions—that is, they refuse to view battering as a choice (Healey et al., 1999). As a result, one of the main goals of all reputable batterer intervention programs is to get the batterer to become accountable for his abusive behavior. Program staff have divided the most common tactics batterers use to avoid accountability into three categories: • Denying, which is when the batterer denies that the abuse ever happened. For example, a batterer may claim “I didn’t lay a hand on her; she made the whole thing up,” despite the fact that a readily available police and/or hospital report clearly documents that the batterer is lying. • Minimizing the abuse, which is done by downplaying the violent acts or underestimating effects of the assault. For instance, the batterer may claim “it was only a light slap” or that “She bruises easily,” as a means of downplaying the seriousness of the assault. • Blaming, which occurs when batterers attempt to find some cause external to themselves to which they attribute their battering behavior. The abuse of the victim, drugs or alcohol, or other life circumstances. In these types of situations, the batterer may blame the victim by stating “she drove me to it and should have known better,” or he may claim that he was drunk and therefore the battering was beyond his control. It is also not uncommon for batterers to claim that life stressors (whether related to work or other circumstances) provided the causal explanation for their actions. Because these tactics are so common, group leaders tend to be specially trained to look for these tactics. In most all programs, the group leader will be highly attuned to these tactics and will be very quick to confront those batterers who use them. In fact, the challenging of these tactics is one of the hallmark characteristics of batterer intervention programs. Thus, correctional counselors who intend to work with this population will find it useful to develop a keen ear for statements that resemble any of these three tactics. As with anger management groups, domestic batterer groups also tend to be cognitive-behavioral in approach. The specific techniques that are used often aid the batterer in recognizing how he may fuel his own sense of rage through irrational “self-talk,” the internal dialogue that the batterer uses to build himself up to an abusive incident. Examining the thoughts and feelings that precede the abuse helps the batterer to realize that he did not just lose his sense of control. In many cases, when the partner of the batterer does something unplanned or does not meet the expectations of the batterer, he will tend to repeat a series of negative thoughts about his partner which tend to build up the sense of anger and also to provide them with a justification for their violent actions. As this process occurs, the batterer repeats these negative thoughts to himself until his partner becomes an object that failed to perform as expected, and so violence becomes justified in his own mind. Essentially, cognitive-behavioral techniques used in batterer group-work tend to target three basic elements: • What the batterer thinks about prior to an abusive incident; • How the batterer feels, physically and emotionally, as a result of these thoughts; • What the batterer does, such as yelling and throwing things, that builds up to acts of violence. The group helps members to recognize and interrupt these thought patterns and the anger associated with them. In the process, the batterer learns to identify negative thoughts and feelings as precursors to his explosiveness and violence. As a result, he is taught to identify these cues at an early stage and to intervene with contrary thought that will prevent his typical reactions. Through the use of cognitive restructuring and other behavioral techniques such as time-outs, the batterer can practice the process so as to better interrupt the internal dialogues that occur prior to his overreactions. Further, he is taught to substitute his maladaptive thought patterns with reality checks and positive coping statements, while also reducing his state of physiological arousal through relaxation techniques (e.g., deep-breathing exercises, biofeedback) or noncompetitive forms of physical exercise that can reduce tension. Lastly, most all states have a variety of guidelines that are required of batterer intervention programs, particularly those that receive funding (Hanser, 2007). One author of this text conducted a study of batterer intervention and prevention programs in the state of Texas and found that the various guidelines associated with that state’s use of batterer interventions were consistent with the guidelines in other states. The Battering Intervention and Prevention Project Guidelines in the state of Texas were published by the Texas Council on Family Violence in tandem with the Texas Department of Criminal Justice and the Community Justice Assistance Division. The collaboration between these different organizations emphasizes the point that correctional counseling of batterers consists of a strong fusion between the criminal justice system and treatment providers. According to these guidelines, batterers are a special category of violent offenders who require specialized intervention. This is important because battering, in and of itself, is a behavior, not a clinical disorder, unto itself. There is no diagnosis for domestic batterers in the DSM-IV-TR, yet they are a very specialized type of offender who is obviously in need of change. The Texas guidelines go on to note that intervention programs should focus on both ending the violence committed by the offender and their capacity for change. Thus, the priority is to eliminate violent behavior through internal cognitive change. The state of Texas guidelines, in outlining the benefits of group interventions, state that programs with groups with men who batter are more effective than individual counseling approaches because they • Provide a greater opportunity for confrontation and accountability than do individual counseling approaches, • Are more successful in decreasing the domestic batterer’s fear of isolation and his overdependence on his partner, and • Are more cost effective than individual approaches. These benefits are of course similar to other benefits noted in the group therapy literature. It is apparent that these benefits are especially applicable to the battering population and it is for that reason that this chapter later provides two examples of group therapy programs for domestic batterers. Among other guidelines, the state of Texas notes that during group sessions, correctional counselors will be specifically tasked with confronting any denying, blaming, minimizing, justifying, and/or rationalizing that is identified by the therapist. This again demonstrates the manipulative nature of the domestic batterer and highlights the three tactics of manipulation mentioned earlier in this population. In such cases, counselors are to provide such confrontation despite the existence of dysfunctional relationships, current stress factors, or previous trauma experienced by the offender; and counselors are guided to emphasize that the decision to engage in violent behavior is a choice made by the offender; it has not been imposed upon them and is not beyond their control. Other suggestions include the following: • A “check-in” at the beginning of each session in which members report on recent behavior, homework assignments, and problem areas. • Role-plays, group exercises, or written work promoting the participation of batterers and the application of program principles. • A wrap-up concluding each session providing closure to deescalate heightened emotions and affirm the focal points and/or program principles. • Assigned homework extending the application and practice of the session’s focal points and program principles. Some form of community service may be required as part of the homework. In addition, just as with most groups, it is recommended that domestic batterer groups should never exceed 15 clients and it is also recommended that coleaders be used, when and where possible. When using coleaders, the inclusion of counselors of both genders is the most effective strategy as this can allow the counselors to model equality in communications and in relationships. Lastly, group programs should also have some sort of follow-up system that also incorporates self-help and social support. These programs should be structured to reinforce the maintenance of nonviolence and address issues that go beyond their offending, such as parenting classes, stress management courses, and/or other forms of mental health intervention. SECTION SUMMARY The use of anger management groups has become a common intervention within the criminal justice system. Some correctional counselors may find themselves leading such groups. However, treatment for anger management is not identical to treatment for domestic abuse. While many of the techniques and methods of intervention are similar, there are substantial differences in the issues that lead to general anger-control problems and domestic abuse. Although, at times, these tend to overlap (i.e., most domestic batterers are angry at the time that they assault their partners), the two types of intervention should not be confused. Anger management programs typically last around eight weeks, with some lasting a few weeks longer and some being a couple of weeks less. Regardless, anger management groups are short-term groups. Groups for domestic battering are much more long-term in nature. Further, these groups address deeply entrenched belief systems that relate to the many in which offenders view themselves and their partners within a relationship. Issues related to feelings of entitlement, control and manipulation of one’s partner, the use of fear and intimidation, as well as societal influences are part of the treatment. Further, most programs last for nearly six months in duration. While anger control techniques are taught in batterer interventions, many more issues are addressed in these types of interventions, providing a more in-depth form of therapy designed to change the mindset of the batterer. LEARNING CHECK 1. Most persons who have problems with anger control have a history of feeling of hurt or being aggrieved. a. True b. False 2. According to the authors, substance abuse problems are very common among batterers. This is so true that most programs should consider simultaneous treatment for substance abuse to be a common practice when operating batterer’s groups. a. True b. False 3. Denying, minimizing, and blaming are common tactics used by batterers. a. True b. False 4. According to the authors, batterer group interventions typically last anywhere from 12 to 18 weeks in duration. a. True b. False 5. Generally speaking, group interventions are considered to be more effective than are individual sessions with domestic batterers. a. True b. False. PART TWO: THE BATTERER As was mentioned in the previous section, domestic batterers are offenders who are a unique class unto themselves. Though these offenders are violent, they are selective with who and how their violence will be utilized (Groetsch, 1996). This is also what separates them from offenders who have generalized problems with anger control. Offenders with anger control problems may manifest their anger in any number of circumstances that can be quite chaotic and unpredictable. However, the domestic batterer’s violence is more focused and is rooted in numerous faulty belief patterns pertaining to their role and sense of entitlement within close relationships. Further, the reasons for their use of violence usually involve control and manipulation of an emotionally based relationship with the victim. While much attention has been given to the issue of domestic violence, it is the domestic batterer who is frequently misunderstood among both the general population and the body of criminal justice practitioners (Hanser, 2007). One of these misunderstandings is the fact that not all batterers are the same, both in terms of the personal factors associated with their abusive behaviors and the lethality of their violence. In much of the early domestic violence literature, this distinction was minimized and a simple view of the domestic batterer was presented, one that simply purported that all batterers were in need of incarceration and punitive sanctions. It is our position that battering, like any other crime, is naturally an inappropriate behavior that warrants criminal justice consequence. However, this notion would be no different if the crime were some other form of assault, including simple or aggravated assault, as well as sexual assault. The simple point of the matter is that a crime of violence warrants a sanction. But yet, even with other types of offenders, there is recognition of distinctions between the types of offenders. Indeed, the justice system also considers a sundry array of mitigating and aggravating circumstances when trying cases. Thus, some variability between offenders should be recognized. With this in mind, it is our position that batterers should be envisioned as falling along a continuum (Groetsch, 1996). Along this continuum, three specific categories of domestic batterers can be identified. This idea of creating specific categories within the battering population has become more accepted in recent years, particularly in regard to the development of psychological typologies. However, we will refer to the work of Groetsch (1996) for a couple of reasons. First, Groetsch is one of the first-known authors to suggest that there are clear and categorical distinctions between different types of batterers. Second, we believe that Groetsch’s work is well suited for the correctional counselor, being readily easy to implement in actual treatment programs. Thus, throughout this chapter, we will refer to the three categories developed by Groetsch (1996), who based his categories on the potential dangerousness of the batterer himself. The use of categories is helpful in determining which batterers are treatable from those who are simply beyond the scope of successful rehabilitation. In general, category one batterers are the least dangerous and most treatable, while category three batterers are very dangerous and not likely to complete treatment (Groetsch, 1996). Category two batterers fall between these two groups with prognoses that are the least predictable. The readers should note that these categories are in fact artificial for the most part but are simply a method by which classification and identification of likely prevention and treatment outcomes can be identified. Category one batterers are often nonviolent in most circumstances, both in public and in private. These types of batterers are usually caught in abnormal circumstances that may be uniquely stressful to that person, such as child custody disputes, the loss of employment, or some other life-course difficulty. Their abuse tends to be situational and isolated with much of the cause for the incident being generated from what are referred to as “external” environmental factors rather than internal thoughts or belief system issues (Groetsch, 1996). These offenders will typically have no previous violent relationships with intimates and are the least likely to use weapons during their abuse. These offenders are also least likely to present with any mental health or life development issues. What is perhaps most important is that these offenders do actually feel and express remorse over their actions. It is this last characteristic that makes this group treatable and truly separates them from the other two groups categorized in this chapter. Category two batterers, on the other hand, often display several character defects, including substance abuse/addiction, non-domestic violent activity, and problems related to moral turpitude. Abuse by these batterers is not situational and it is not isolated (Groetsch, 1996). However, abuse by these batterers is likely to be unpredictable, sometimes with little or no apparent provocation. Interestingly, it is difficult to determine causal factors that weigh most in their abusiveness, with both external environmental and internal belief-system factors having near-equal effects and thus explaining, at least in part, their unpredictable use of violence (Groetsch, 1996). These batterers may have had previously violent relationships with other partners and may have inflicted premarital abuse upon their current partner (Groetsch, 1996). These abusers may use weapons, though they are not prone to lethal levels of weapon use. Instead, weapons are often used to threaten the victim rather than to inflict actual harm. Further, these offenders feel and express little remorse and are not necessarily amenable to treatment. This of course makes their treatment as unpredictable as the onset of their violence. Category three batterers are high risk and often possess true personality disorders. These batterers often present ongoing and chronic patterns of abuse. Abuse among this population is largely based on internal belief-system issues regarding the rights of men in relationships with women (Groetsch, 1996). For this group, most all previous relationships with partners have been violent. Further, these batterers are likely to have exhibited some form of premarital violence toward their current partner. These abusers are likely to present and use dangerous weapons (Groetsch, 1996). In addition, these batterers demonstrate no remorse for their actions and seem to lack a conscience. These batterers are generally not considered to be amenable to treatment. In fact, it is most likely that a program of selective incapacitation would be the most pragmatic “intervention” when considering their extremely poor prognosis. According to Groetsch (1996), these batterers frequently present with one or more personality disorders listed in the DSM-IV-TR, including Narcissistic, antisocial, borderline, histrionic, paranoid, and obsessive-compulsive personality disorders. Of course, these disorders may occur in conjunction with numerous other DSM-IV-TR disorders such as substance abuse or depression. Sadly, this group is that which is in the direst need for treatment yet the comorbid nature of disorders among this population make them the most difficult ones to treat. While it is true that many people who have one psychological disorder experience other disorders at the same time, this occurrence is particularly pronounced among the category three battering population. The simultaneous occurrence of disorders, or comorbidity (Davis & Palladino, 2002), increases the difficulty associated with making appropriate diagnoses and developing effective treatment plans for these batterers. Treatment Approaches with Category One Batterers Category one batterers very rarely appear in the criminal justice system. When they do, these types of batterers are likely to be receptive to both the punitive or deterrent effects of punishment and the treatment-related aspects of their criminal sanction (Groetsch, 1996). These batterers are often described as “family-only” abusers (Wexler, 2000). These abusers are often dependent on the affection from their significant other and they often express jealousy if it appears that this affection is not centered around them (i.e., if it is also given to the woman’s children). As a manner of coping, they tend to suppress emotions and withdraw, later erupting into violence only after long periods of unexpressed negative emotions (Groetsch, 1996; Wexler, 2000). The acts of abuse are generally less severe than those of batterers and they do not tend to be aggressive in other circumstances (Groetsch, 1996). Importantly, these batterers also frequently express remorse for their abusive actions and they often voluntarily join groups in search of treatment. Many times, the mere threat that their partner will leave can influence them to seek genuine change. Among court-mandated batterers, this group tends to be the least assaultive. Because these batterers are often genuinely remorseful, willingly seek change, and because they are not nearly as assaultive as other batterers, the notion of reconciliation between the batterer and the partner may be workable. Further, this group of batterers may not require group therapy but may be receptive to individual sessions, so long as the sessions are focused on accountability for the abuse and as long as the session is not focused on other issues corollary to the domestic abuse. Though other issues may be valid and may exist, those would be the topic of additional sessions which would not take the place of any intervention targeted at the offender’s abusive behavior. Nevertheless, this group of batterers can still gain greatly from the traditional batterer’s group intervention process, and correctional counselors are encouraged to use this approach with this group of batterers, when they feel it is appropriate. However, it may emerge that these offenders, due to their generally nonviolent history, may not fit well with a group of batterers whose abusiveness and offending history is much more serious and/or much more extensive in nature. In such cases, other group members may unduly challenge this type of batterer, thinking that this batterer may be minimizing his actions when, in fact, his actions are not near as severe as that found among other group members. This is not to say that category one batterers should be exonerated, but a failure to understand distinctions between these batterers can lead to serious clinical miscalculations throughout the treatment process. It can also create complications within the group dynamics where offenders are taught to challenge minimization and denial. According to Groetsch (1996), the following methods of intervention can be considered with category one batterers: Individual Counseling. As noted previously, this type of counseling should make a point to directly address the client’s abusive behavior, holding the client accountable for that behavior. However, in most cases, these batterers genuinely do come to terms with their responsibility for their actions and put forth the effort to change. With that in mind, other forms of one-on-one counseling may focus on the external issues that brought the offender’s aggression to the surface. Naturally, other issues such as grief, substance abuse, stress, or other precursors to the aggression can and should be addressed in these corollary sessions. Marriage Counseling. It should be noted that this type of intervention is typically NOT recommended for batterers. Such a recommendation is typically considered quite unorthodox, though it has been used in some instances in an effective manner that does not jeopardize the victim. However, it is important to remember that many category one batterers are voluntary participants who report for treatment to repair the damage that they have done in their relationship with their partner. Further, many victims of these abusers are likely to continue in the relationship with this type of batterer, particularly if the onset of physical assault is perceived by the victim to be generated by outside stressors. In addition, some partners may wish to engage in mutual therapy with the abuser, both to see if he is actually working on his issues in therapy and to also provide support in the relationship. Again, though this would not be an option with most battering offenders, category one batterers often self-report. Support Groups. One-on-one counseling and marriage counseling are very limited in the time that a client spends in therapy. Support groups that focus on the specific issues or trauma that caused his violence are excellent means of reducing isolation, giving him exposure to others who understand his trauma, and providing him with an opportunity to establish peer relationship and fellowship. Support groups that address issues of stress, grief, substance abuse, and so on, and that employ a twelve-step program modality are excellent resources for such clients. If alcoholism is a concern, then victims should be simultaneously referred to Al-Anon. Spiritual Needs. When applicable and when able, the correctional counselor should not refrain from incorporating the batterer’s spiritual orientation, especially if the batterer alludes to his religious or spiritual beliefs. In fact, if possible, these beliefs and sources of pro-social support should be integrated into the treatment process. This is also an important consideration for those offenders who identify with a religious belief system or are members of a cultural group that holds a given set of spiritual tenets. Treatment Approaches with Category Two Batterers Category two batterers are more severe in the type of violence they employ and the frequency with which they employ that violence when compared to category one batterers. Unlike category one batterers, this group is likely to be deceitful and cunning when engaging in their abusive behavior. They are also likely to be much more devious and methodical than are category three batterers. While category two batterers are not as lethal as category three batterers, they are much more effective at hiding their abuse and evading law enforcement detection. Thus, extreme caution must be taken in the case of category two batterer. To illustrate this point, consider that many experienced intervention providers report very low success rates with these individuals. According to Wexler (2000), this type of batterer is occasionally referred to as “emotionally volatile.” This group tends to be violent mostly within their family, but they are often more socially isolated and socially incompetent than category one batterers. They exhibit higher levels of anger, depression, and jealousy (Wexler, 2000). Further, they find ways of misinterpreting their partners and blaming their partners for their own mood states. Depression and feelings of inadequacy are prominent among abusers of this category (Groetsch, 1996; Holtzworth-Munroe & Stuart, 1994; Wexler, 2000). Further, this category may have borderline or other personality disorders, though personality disorders are much more prevalent among the category three abuser. This group of batterers will typically have a poor treatment prognosis. Since this batterer’s violence is based more on internal issues and defective character traits than external trauma, the treatment for a category two batterer should be of a different format than those of the category one batterer. Unless a holistic approach is taken with the category two abuser, there is little chance for a positive change. Groetsch (1996) discusses the basic approaches to counseling intervention, as presented below: Individual Counseling. Generally, this type of therapy should not be used with this group. If used, it should be an adjunct form of treatment that focuses on the many defective character traits and internal issues of the category two batterer. Again, this type of therapy should not be allowed as a substitute for the use of standard group interventions. Group Counseling. This type of counseling is the preferred modality because other batterers, who know and recognize manipulation from their cohorts, are able to assist in holding the batterer accountable for his behavior. This “group pressure” has been shown to be very effective with this population. However, it is not uncommon for members of such a group to get into behavioral collusion with one another whereby negative traits are actually reinforced. A trained therapist should be aware of such a possibility and should counter peer collusion appropriately. Educational Groups. Since much of the violence of the category two assailant is associated with learned behavior, an educational component to a group can be essential. This type of group will seek to modify elements of the batterer’s socialization and will reeducate the batterer on matters involving gender roles, control, and sexism. Support Groups. As with the category one batterer client, individual and group counseling time is very limited and expensive. While the therapist may spend one or two hours weekly with this client, the reality is that there are innumerable daily interactions throughout the week that can trigger relapse within this client. Support groups can serve as an excellent “back-up” to therapy and also can help to build rapport among other group members who are in the support group. These groups likewise can be more readily available at the time of crisis rather than during a rigidly scheduled point throughout the week. Spiritual Needs. Just as with category one batterers, this area of batterer development can be of huge benefit in motivating the batterer toward change. As noted with category one batterers, this is an important consideration for those offenders who identify with a religious belief system or are members of a cultural group that holds a given set of spiritual tenets. Treatment Approaches with Category Three Batterers It is important to understand that this group of batterers are not only lethal but are very manipulative as well, being able to escape the detection of even the most seasoned therapists. This type of batterer is generally antisocial and more likely to engage in instrumental violence. By instrumental, it is meant that this violence is designed to gain a specific end or material outcome. In this case, violence “works” more successfully for this batterer in getting what they want (Holtzworth-Munroe & Stuart, 1994). They are limited in their capacity for empathy and attachment, and they hold the most rigid and conservative attitudes about women (Groetsch, 1996; Holtzworth-Munroe & Stuart, 1994; Wexler, 2000). They tend to be violent across situations and across different victims. They are generally more belligerent, more likely to abuse substances, and more likely to have a criminal history. This group is also unlikely to show remorse (Groetsch, 1996; Holtzworth-Munroe & Stuart, 1994; Wexler, 2000). Within this category there is a certain population of battering men who could be best described as “vagal reactors” or “cobras” (Jacobson & Gottman, 1998) or, in a more general sense, psychopaths (Hare, 1993). Psycho-physiologically oriented studies have identified an unusual pattern among a subgroup of the most severe batterers (Gottman et al., 1998; Wexler, 2000). This group of batterers have actually shown reductions in measures of arousal during aggressive interactions with their partners—completely contrary to expectations and typical patterns during aggressive interactions (Gottman et al., 1998; Wexler, 2000). These batterers have been dubbed “vagal reactors” because their nervous system arousal is strangely disconnected from their behavior (Gottman et al., 1998; Wexler, 2000). These batterers deliberately and manipulatively control what goes on in the marital relationship (Wexler, 2000). Jacobson and Gottman (1998) call these men “cobras” because of their ability to become still and focused before striking their victim—this is in contrast to the more typical category two and three “pit bulls” who slowly burn in frustration and resentment before finally exploding (Wexler, 2000). Men who operate in this cold and calculating manner are not at all likely to be successfully treated (Groetsch, 1996; Wexler, 2000). In fact, the best intervention for this group is most likely simple incapacitation. They display many of the characteristics of classic psychopathic behavior—not necessarily typical of all category two and three abusers (Hare, 1993; Wexler, 2000). In short, these are the worst of the worst among the battering population. Obviously, a healthy degree of skepticism must be utilized with this specific group of batterers and with category three batterers in general. Category three assailants who enter treatment generally do so in an effort to avoid criminal prosecution or in an attempt to lure their victims back into relationships. With category three batterers, Groetsch (1996) recommends that treatment specialists follow the recommended guidelines: • Instead of promoting treatment for the category three batterer, promote boundaries such as court mandates, restraining orders, and restrictions that serve to protect the victim. • Recognize that the criminal justice system refers batterers to treatment programs indiscriminately. • Recognize that the chronic batterer has extensive levels of denial. This batterer will minimize, externalize, and rationalize all of his behaviors and violence. • If you do provide treatment to the chronic batterer, never allow him to portray himself as a victim. While in some cases it may be true that he had a terrible childhood, he is now the perpetrator and should be confronted as such. • Never consider the alcoholism or drug addiction of the category three batterer as the reason for his aggression. Substance abuse is not a direct causative factor for the violence. For chronic batterers, it is just one of the many symptoms of the personality disordered batterer. • Remember, it is very common that this group of batterers will often present with separate personality disorders that aggravate the battering personality. These other disorders must be treated as well. Additional Notes on Treatment Approaches For all batterers, it is important to address all substance abuse issues first before other treatments have any chance of success. Without such primary interventions being established, the therapist will simply be reaching the “chemical” rather than the batterer’s actual personality and belief system. This explains why it is common practice for batterers to continue drug counseling as an adjunct to their batterer’s group counseling. This tactic naturally helps to prevent drug-induced relapse of domestic abuse. This is important to keep in mind because substance abuse correlates very strongly with aggressive behavior among batterers. This correlation has been found to be especially true with alcohol, which overwhelmingly emerges as a primary predictor of marital violence (Hanson, Venturelli, & Fleckenstein, 2002). In fact, one study found that rates of domestic violence were as much as 15 times higher in households where the husband was described as “often” being drunk rather than “never” being drunk (Collins & Messerschmidt, 1993; Hanson et al., 2002). Research consistently shows that spouse abusers have numerous alcohol-related problems (Barnett, Miller-Perrin, & Perrin, 2004). Because drunkenness can precipitate domestic battering and can be used as an excuse, clinicians must address alcohol treatment and must not allow the batterer to evade responsibility by blaming the alcohol for the behavior. Further, treating alcohol or substance abuse problems alone is not thought to be sufficient, unto themselves, to rectify abusiveness among any category of batterer (Barnett et al., 2004; Healey et al., 1999). In fact, it could likely be the case that a batterer may be more prone to abusiveness when he stops drinking due to the stressful and unpleasant effects of withdrawal during their new-found sobriety (Barnett et al., 2004). On the other hand, treatments that combine behavioral marital therapy with treatment of alcoholism have been found to reduce abusiveness (Barnett et al., 2004; O’Farrell & Murphy, 1995). Findings such as these demonstrate the complexities involved in addressing the alcohol-violence correlation. Further, as discussed earlier in this chapter, substance abuse/addiction disorders tend to be comorbid with other disorders (i.e., depression and other mood disorders, emotional disorders, and the various personality disorders previously discussed in this chapter), providing a treatment picture that is convoluted at best. Regardless of corollary issues in treatment, it is important to remember that in distinguishing between the three categories of batterers the main difference lies in the degree of the violence, how often it occurs, and the level at which the violence is sustained. This is crucial from a community supervision standpoint, as frequency and lethality of violence should be the primary concern in public safety risk-prediction decisions. Remember that while the category one abuser’s violence is isolated, the category two batterer’s abuse is sporadic and reoccurring. The abuse of the category three offender, on the other hand, is always ongoing and chronic. Making matters even more complicated is the fact that batterers will not always exhibit a perfect profile of category one, two, and three types of offenders. They frequently may fall somewhere between categories, making the diagnosis and corresponding risk-prediction of these offenders very difficult. SECTION SUMMARY Despite beliefs to the contrary, all batterers are not identical in the nature of their offending. This is a controversial view within some treatment circles since many early domestic abuse intervention programs would, in the process of working with corollary mental health issues, almost exonerate the batterer. In contemporary times, it is clear that some batterers may have a host of mental health considerations, substance abuse dependencies, and other factors that aggravate reform. However, they can and should still be held accountable for their abusive behavior. Still, one abuser may be quite different from another. Indeed, some abusers engage in violence in a routine pattern whereas others may do so as an isolated incident. To consider each to be one and the same would be a serious error in the assessment of lethality and in the treatment planning process. This chapter provides the student with a process whereby batterers can be classified so that treatment programs can be better tailored for those in treatment. Category one, two, and three batterers are classified by level of dangerousness which then determines whether some treatment modalities are more appropriate than others. Further still, category three batterers are most likely to have corollary mental health issues and therefore have a more challenging prognosis. Lastly, research has consistently shown that drug and/or alcohol abuse is a common problem among the battering population. Thus, batterers should be in substance abuse treatment prior to beginning a domestic violence intervention. This is even true if no documented substance abuse problem is on record because it is likely that they have simply evaded detection. Substance abuse treatment should continue during the entire time the batterer participates in the batterer’s group intervention. LEARNING CHECK 1. Rather than emphasizing treatment for category three batterers, it is recommended that the setting of effective criminal justice boundaries be emphasized. a. True b. False 2. In many cases, category one batterers do express a sense of genuine remorse and are receptive to treatment. a. True b. False 3. “Vagal reactors” or “cobras” are likened to psychopaths. a. True b. False 4. Anger management can be an appropriate intervention for the various categories of batterers. a. True b. False 5. Given the prevalence of substance abuse problems among the battering population, it is recommended that all batterers be placed in some form of substance abuse treatment intervention, even if no documented substance abuse problem has been detected. a. True b. False PART THREE: SPECIFIC DOMESTIC BATTERER GROUP INTERVENTION MODELS The Duluth Model Perhaps the most widely known curriculum is the Duluth model, which was initially constructed by Ellen Pence and Michael Paymar (1993). This was perhaps one of the earliest curricula to be designed as a full-range set of sessions for battering clients. This curriculum is so popular that many batterer intervention programs either adhere to or borrow from this psychoeducational and skills-building curriculum. This curriculum addresses a range of controlling behaviors, with the “power and control wheel” illustrating these behaviors in a unique but well-known diagram. This wheel depicts how physical violence is connected to male power and control through a number of “spokes” or control tactics: minimizing, denying, blaming; using intimidation, emotional abuse, isolation, children, male privilege, economic abuse, and threats. According to the Duluth model, the batterer maintains control over his partner through constant acts of coercion, intimidation, and isolation punctuated by periodic acts of violence. The Duluth curriculum is taught in classes that emphasize the development of critical thinking skills centered around eight themes: (1) nonviolence, (2) nonthreatening behavior, (3) respect, (4) support and trust, (5) honesty and accountability, (6) sexual respect, (7) partnership, and (8) negotiation and fairness. Depending on the total length of the program, two or three sessions are devoted to each theme. Thus, the Duluth model of intervention is designed to last anywhere from 16 to 24 weeks in duration. The first session of each theme begins with a video vignette that demonstrates the controlling behavior from that portion of the wheel. Discussion revolves around the actions that the batterer in the story used to control his partner; the advantages he was trying to get out of the situation; the beliefs he expressed that supported his position; the feelings he was hiding through his behavior; and the means he used to minimize, deny, or blame the victim for his actions. At the close of each session, offenders are given homework: to identify these same elements in an incident when they exhibited similar controlling behaviors. During subsequent sessions devoted to the theme, each group member describes his own use of the controlling behavior, why he used it, and what its effects were. Alternative behaviors that can build a healthier, egalitarian relationship are then explored. One of the drawbacks to this model of intervention is that it requires considerable skill on the part of group leaders. The curriculum is a bit open ended in approach meaning that the effectiveness of the intervention will tend to be related to the effectiveness of the correctional counselor(s) who facilitate the intervention. This is compounded by the fact that, with all group interventions for domestic batterers, group leaders have to be vigilant against both the active and passive ways batterers avoid taking responsibility for their abuse, both inside and outside of group. Because we believe that it is important to leave the student with a clear understanding of how interventions are implemented, a brief synopsis of each of the eight themes will be provided. Note that all information has been adapted from the work by Pence and Paymar (1993). Each session is presented in the discussion that follows. Nonviolence. This is the primary theme during the first two or three group sessions. The first 15 minutes of the session consists of a check-in (discussed earlier in this chapter), where offenders report their progress on steps that they have agreed to take toward treatment. During the initial session (as well as others, if the counselor so desires) video vignettes may be used to illustrate the main theme for these sessions. The remainder of each of the three sessions will focus on addressing the offender’s view on the use of violence and will consist of exercises where participants answer questions, examine past experiences, and role-play conflict resolution without the use of controlling or abusive behavior. Other group participants observe the role-play and provide their own observations and feedback. Nonthreatening Behavior. During sessions four through six, nonthreatening behaviors are the primary theme or focus. As with all sessions, the first 15 minutes consists of a brief check-in. Afterwards, offenders are required to discuss and explore past acts of violence and intimidation that they have committed. Offenders are given specific exercises that identify the means by which violence, and the threat of violence, is used to control their relationship with their partner. Underlying payoffs for the use of intimidation are explored during these sessions. Respect. During the next two or three sessions, issues of mutual respect are addressed, with specific focus being on the offender’s use of emotional abuse as a weapon in the relationship. Indeed, Pence and Paymar (1993) contend that “emotional abuse is one of the most powerful weapons a batterer uses to control his partner. It provides the foundation for the use of almost all other abusive behaviors” against those he victimizes. Through the use of emotional abuse, the offender makes a psychological attack on his partner’s self-esteem. Trust and Support. This theme examines the tendency that batterers have to isolate their partners from external relationships and human contact. This sense of isolation may occur due to a lack of economic resources (with the batterer encouraging the partner to stay home and not work), a lack of transportation (there is only one car and the batterer uses it), or admonishment for associating with certain friends and/or family. The use of these isolation techniques makes their partner dependent upon them and this translates to power over their partner. It is important that correctional counselors are attuned to the various techniques that are used by batterers to control their victim. What might otherwise seem like a series of events that just “happened” then become part of a methodical process for the batterer to maintain power. These behaviors are identified and challenged by group members as well as the counselor. Honesty and Accountability. During the sessions that address this theme, batterers are made to address their victim-blaming thoughts and words. During the sessions that address this theme, a variety of worksheets, role-plays, and other activities that require batterers to assume accountability for their actions are encouraged. The weeks that carry this theme tend to be met with more resistance than any other theme within the curriculum. Sexual Respect. This theme addresses issues related to coerced sex in abusive relationships. In many instances, the partner may be manipulated, harassed, or made to feel guilty if she does not acquiesce to sexual demands. In many cases, offenders do not see these dynamics as problematic; rather this may be normalized by these offenders. This is largely due to beliefs that are egocentric where the offender views himself as having a right to sexual access. Further, many batterers may view their partner’s unwillingness as a form of control by withholding something that is desired by the batterer. Partnership. During the sessions that follow this theme, beliefs in strict gender roles are explored and challenged. Concepts such as male privilege and entitlement, economic abuse, and the balance of power in relationships are also specifically addressed. Inherent to this theme is that historic oppression and subjugation of women has occurred because men have defined most facets of society which has, in turn, led to a sexist belief system and the common acceptance of male privilege. Though this is naturally changing in the United States, many batterers still cling to the outdated notions that women should play subservient roles to men. Negotiation and Fairness. This theme addresses the lack of negotiation skills that tend to be a common deficit among domestic batterers. According to Pence and Paymar, “the goal of negotiation is to balance the needs of two parties and to reach a resolution that is mutually satisfactory” (1993, p. 154). The sessions during which this theme occurs will consist of role-plays among the group participants as well as homework assignments designed to get the batterer to consider his own forms of controlling behavior that obstruct genuine negotiation. Lastly, the most common approach in implementing the Duluth model is to have three weeks per theme. During the first week of each theme, there will usually be five activities that participants must complete. The group begins with a check-in, where the participants briefly discuss their progress toward their agreed-upon goals. This is followed by a brief discussion on the definition of the theme that is identified for that session. Then a three to five minute video or role-play is shown and the participants are required to take notes and incorporate the vignette into the session. The counselor ma hen provide lecture format information to participants followed by an assignment whereby participants record and analyze an abuse incident that is similar to the one discussed. During weeks two and three, the process begins with a check-in. For week two there are usually only two activities. The majority of the session is then focused on the group analyzing their individual participant logs that identifies a personal example that fits with the overall theme of the session. Week three typically includes three activities, but these activities tend to consist of role-plays among group members where noncontrolling alternatives to abusive incidents are practiced. These incidents are typically chosen from a participant’s control log, making the exercises even more relevant to the individuals in the group. The Domestic Abuse Project Model The origins of Domestic Abuse Project (DAP) date back to 1979 and it was developed during the same time period that the work by Pence and Paymar was developed. The DAP model begins with an orientation session that is followed by a cycle of at least 20 sessions. These sessions are arranged into two separate session tracks, with the first 10 sessions being educational in nature. After the educational sessions are completed, the client will attend an intake session, which ensures that the participant is fit for the process sessions that follow. The process sessions are the actual group therapy components, with the educational sessions providing baseline information to clients to ensure that they have the requisite understanding of power-and-control issues so as to be active participants during the group process sessions. The orientation session occurs after initial contact with the intervention program. The meeting between treatment staff and the client allows the client to assess his own willingness to commit to treatment. At the same time, the correctional counselor is able to asses the offender’s readiness to participate. The education sessions consist of the correctional counselor presenting information and materials in a lecture format to the entire group of offenders. During the course of the 10 education sessions, the group is assigned a new topic each week. Among these topics would be the costs and payoffs of abusive behavior, cultural violence, and the consequences of violence. A more detailed breakdown of the orientation session and the education sessions are provided as follows: Orientation. The orientation session is divided into two parts. During part one, the correctional counselor should keep in mind that offenders typically experience a high level of anxiety and shame when they first begin a domestic abuse treatment program. The correctional counselor should attempt to provide information clearly and in a nonthreatening manner. Often, the use of a video during the orientation can help to facilitate conversation. During the orientation, offenders are informed of the philosophy and structure of the program. At the base of the DAP philosophy is the idea that power and control lie at the root of the violent behavior. During the second part of the orientation, offenders are introduced to the self-control plan (SCP), which is the cornerstone of the treatment regimen. The SCP is a cognitive-behavioral plan that helps to identify “cues” or antecedents to abusive behavior. The SCP is designed to assist the offender in early identification of these cues to enable him to make a healthier choice in his behavior before he feels that his actions are beyond his own control. Education sessions. The education sessions are ongoing and open, meaning that as new participants join these groups, those who have completed the education series leave the group. Further, offenders must attend at least nine different sessions. If a participant misses more than one session, he must wait 10 weeks until the missed session comes up in the cycle again so that it can be attended. Session 1—Costs and Payoffs of Abusive Behavior and Effects of Violence on Children: “The purpose of this session is to help group members realize that their abusive behavior may have short-term payoffs but will have long-term, detrimental consequences. Offenders learn how they can control and change their abusive behavior and implement more healthy alternatives for conflict resolution” (Domestic Abuse Project, 1993, p. 53). Session 2—Responsibility versus Shame: “The purpose of this session is to define shame and understand how it prevents people from taking responsibility for and changing their abusive behavior. Offenders are taught to identify feelings associated with shame and the manner by which shame and guilt can generate defense mechanisms that prevent the offender from being accountable for their actions” (Domestic Abuse Project, 1993, p. 63). Session 3—ABC Model and Stopping Negative Self-Talk: “The purpose of this session is to make the connection between emotional and behavioral responses and our core beliefs, attitudes, and self-talk. Choosing abusive behavior is based on negative self-talk about power, control, and expectations. Feelings of powerlessness, anger, and rage are based on these negative beliefs and serve as the basis for violent actions” (Domestic Abuse Project, 1993, p. 75). This session explains the ABC model with A being the activating event, B being a set of faulty beliefs, and C being the consequences of inappropriate actions. Session 4—Responsible Assertive Communication Skills: “The purpose of this session is to define and recognize the four main styles of communication” (Domestic Abuse Project, 1993, p. 83). Special attention is given to assertive communications and active listening skills. Further, offenders are required to discuss how abuse impairs future communication skills. Session 5—Responsible Assertiveness Role-Playing: “The purpose of this session is to identify the payoffs of developing assertive communication skill and an assertive belief system” (Domestic Abuse Project, 1993, p. 93). Session 6—Culture of Origin I: “The purpose of this session is to examine how rigid stereotypes of gender roles perpetuate abuse, foster shame, encourage aggressive behavior, and keep men from experiencing intimacy in a relationship” (Domestic Abuse Project, 1993, p. 101). Session 7—Culture of Origin II: The purpose of this session is to demonstrate that violence against a partner is not an isolated incident but occurs within a cultural and historical context that enforces a sense of power and control over one’s partner (Domestic Abuse Project, 1993). This session explores violence used for oppression and issue related to ideas of male privilege and power derived from an unequal society. Session 8—Ending Threats and Controlling Behavior: This session defines the use of threats and controlling behavior as abuse. It further explores how threatening and controlling behavior may have a profound impact on trust, honesty, and intimacy in a relationship. Lastly, possibilities of rebuilding trust and intimacy in relationships is explored (Domestic Abuse Project, 1993). Session 9—Stress and Anger: This session is similar in theme and scope to the content included in many anger management programs. Offenders are taught to understand anger, hostility, and aggression. This session also explores various aspects of stress and the means of coping (Domestic Abuse Project, 1993). Session 10—Therapist Exchange: This session typically has a visiting victim’s advocate or therapist educate offenders on victim issues. Further, offenders are again taught that the domestic abuse is not the fault of their partner. Once the offender completes the 10 education sessions, an individualized session is conducted with the offender and the correctional counselor. During this time, the correctional counselor will assess the client to determine if they are ready to engage in genuine therapy to change their abusive behavior. If the client is not ready, they may be sent back to repeat the education sessions or they may be sent out of the program, depending on the circumstances. Lastly, the process sessions allow group members to work through their feelings, discuss their abusive behavior, and engage in the feedback process with other members of the group. Lastly, while engaging in the process sessions, each offender is required to complete a set of three individual presentations to the group. The personal presentations cover topics related to each individual’s own abusive behavior and the changes that have been or will be made. SECTION SUMMARY This section provides the reader with an overview of two different types of batterer group intervention programs. The Duluth model is probably the most widely recognized form of batterer group interventions throughout the United States. Many programs tend to either use the entire curriculum or borrow from that curriculum. The Duluth model has a psychoeducational and skills-building approach, with each session following a defined theme. This provides for a clear structure to the treatment process and allows the correctional counselor to address many specific and clearly defined issues that are related to domestic abuse. However, there are other programs, such as the DAP model, that are likewise well disseminated and have a long history of use. This program also has themes throughout its sessions but divides the sessions between educational and process sessions. This means that batterers are given the requisite psychoeducation that is needed before they begin the second phase of sessions that is related to the treatment process. This again provides for a solid structure in intervention approach and also ensures that clients are ready for the group counseling experience before they start the actual treatment process. If an offender misses a session or is not deemed ready for further intervention by the correctional counselor, then further educational sessions are required. Further, the DAP model covers a broad array of issues and has a strong cognitive-behavioral approach, making it well suited for the criminal justice system. LEARNING CHECK 1. The Duluth model of intervention is based around eight broad themes. a. True b. False 2. The Duluth model has two separate session tracks, one that is educational and one that is process oriented. a. True b. False 3. The DAP model has its basis in psychoanalytic forms of intervention and psychotherapy. a. True b. False 4. The DAP model addresses issues involving shame and guilt experienced by the offender. a. True b. False 5. One of the drawbacks to the Duluth model of intervention is that it requires considerable skill on the part of group leaders. a. True b. False CONCLUSION Issues related to anger management and domestic abuse are common to the offender population. In many cases, offenders have themselves come from abusive homes, and, when they are themselves perpetrators of family violence, they may be enacting a cycle that could extend across numerous generations throughout some family systems. While anger management and domestic abuse interventions may have many similar techniques, the two should not be confused as being one and the same. The factors that relate to each may be quite different, particularly since domestic abuse tends to be specific to others who are close to the batterer whereas episodes of anger from an offender may be generated by any number of persons, stressors, or sources of aggravation. There have been cases where courts have mandated domestic batterers to anger management rather than a domestic batterers group intervention; this should not occur. Domestic batterers require extensive intervention that goes beyond simply addressing anger control. Rather, issues of sexism, a sense of entitlement, views on relationships, and power and control must be addressed, among other things. In addition, it is important to be able to discern between different types of batterers. Not all domestic abusers are equally dangerous nor do they all have the same prognosis for recovery. Some batterers may have a low likelihood of recidivism whereas others may be nearly beyond reform. Understanding the distinctions between the various types of batterers is important for victim safety concerns and for treatment planning purposes. Further still, domestic abusers may often have substance abuse issues that must be addressed. This is a very common occurrence and it is highly recommended that these offenders be required to attend treatment for any substance abuse problems that may exist. A failure to do so will most likely ensure that the batterer intervention is not successful. Lastly, mental health issues may also complicate the intervention process for many batterers. Correctional counselors must ensure that domestic batterers are screened for diagnosable disorders and that they receive assistance with those disorders. Lastly, two model programs of group intervention were presented in this chapter, the Duluth model and the domestic abuse project model of group intervention. These two groups were chosen due to their longevity (they have both been in existence since the inception of the movement to recognize domestic violence) and due to their widespread use throughout the country. While many intervention programs may not use these models in their purest form, these models do tend to have many of the characteristics that are common to domestic group interventions around the nation. It is clear from the presentation of these models that domestic batterer groups emphasize the use of cognitive-behavioral approaches to intervention and the need for offender accountability for the crimes that they have committed. These two aspects of the intervention process are important since they tend to be the hallmark components of effective domestic batterer group interventions. Essay Questions 1. Explain why the use of check-ins may be so common within domestic batterer group interventions. Further, explain some of the techniques used in interventions to make batterers track their behavior throughout the week between group sessions. 2. Provide at least one example of a cognitive-behavioral approach used in group interventions. In your opinion, why would cognitive-behavioral approaches be the perspective used in most batterer intervention programs? What are some techniques from your previous readings in Chapter 5 that would be effective with domestic abusers, given what you now know about domestic abuse group interventions? 3. From your previous readings, how do domestic abuser groups compare with the general group process presented in Chapter 7 of this text? What are some techniques from your previous readings in Chapter 7 that would be effective with domestic abusers, given what you now know about domestic abuse group interventions? 4. Discuss Groetsch’s three categories of domestic batterers. Why is it important to classify batterers into different groups and how does this assist in the treatment planning process? Also, explain which different types of interventions are likely to be effective with each category of domestic batterer. 5. Discuss some of the mental disorders that might be prevalent among the battering population. Explain how this might impact the likely success of treatment with batterers. Further, discuss why substance abuse treatment is important when considering the batterer population. From your previous readings in Chapter 8, what might be useful to consider when addressing substance abuse issues among batterers? Lastly, how would co-occurring disorders, in addition to the substance abuse issues, further complicate the treatment of a domestic batterer? Treatment Planning Exercise During this exercise, the student must consider the case of Jimmy and must determine whether Jimmy is being manipulative or whether the reasons that he gives are sincere. You must explain how you would confront Jimmy and how that may affect your rapport with Jimmy. Further, you must also consider how any confrontation might impair his relationship with his other treatment providers. The Case of Jimmy Jimmy is a domestic batterer who is in your group for his domestic abuse that meets on Monday evenings at 6:30 P.M. He is also in an additional group for anger management that meets at 7:00 on Wednesday evenings. Lastly, he is in another group for substance abuse issues at 7:00 on Thursday evenings. On Tuesday and Thursday mornings, he visits a local educational agency for GED preparation. In addition, Jimmy completes roughly eight hours of community service a week, attends AA meetings on Tuesday evening, and is also required to meet his probation officer five times per week since he is on intensive supervised probation. Jimmy has signed releases of confidentiality between all agencies and treatment providers enabling all persons involved with Jimmy’s case to talk with one another without concern for confidentiality. One day, Jimmy’s addiction therapist calls you and explains that he is concerned. It seems that Jimmy is violating the bounds of confidentiality by leaking information regarding other members of his batterers’ group. During the substance abuse group meeting on Thursday evenings, he routinely refers to clients in his Monday evening batterers’ group by name and provides details regarding their relationships and their treatment progress. The therapist explains that he talked with Jimmy about this, and Jimmy got a bit angry. He was not volatile, but irritated and exclaimed, “Here I am trying to participate in the group session and you are downin’ me, man! What gives with this, dude?” When you ask Jimmy about this issue, he points out that he is so busy with therapy and meeting the conditions of his supervision that he cannot remember who is in what group and how to sort things out. He claims that he slips up by accident and that he just cannot keep up. You screen his records and notice that the GED preparation and testing agency conducted a number of tests of cognitive functioning. They found that Jimmy has fairly significant cognitive deficits that affect his concentration. Whether this is induced by substance abuse is not clear, but it has been noted in his record (though Jimmy does not seem to be aware of this). On the other hand, you are keenly aware that batterers are very clever (though not necessarily smart academically), manipulative, and tend to be passive-aggressive by nature. In short, you suspect that Jimmy is manipulating his various treatment challenges to sabotage the therapy so that he can get reassigned. Lastly, you have been told by another offender in your batterer’s group that Jimmy has stated many times that he does not like the therapist for his addiction group and has been wanting to leave that group for some time. It seems that Jimmy brings this up when the batterer’s group members are outside smoking before the group work begins. Bibliography American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: Text revision (4th ed.). Washington, DC: American Psychiatric Association. Barnett, O. 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