[Advice] Replicating & Relationships

I have a couple of questions, any advice would be much appreciated. Firstly: how effective are perpetrator programs, if the abuser wants to change? Secondly, I have been repeatedly abused and my parents relationship was awful; how do I figure out what on earth a healthy relationship even looks like? I don’t want to accidentally be abusive. Are there courses on that?

[Mod note: due to the implied content of this letter, I’m primarily looking at between-partner abuse]

I have so many thoughts! Unfortunately I committed to answering advice with other questions! So I’ll sub-divide this question into answers to the objective questions and questions you might ask yourself.

How effective are perpetrator programs, if the abuser wants to change?

This is a surprisingly complicated question!

A note on instrumental vs. expressive abuse:
We distinguish between two kinds of abuse, and consider instrumental abuse more dangerous.
Expressive abuse is the outlet, it’s the way to burn off feelings, it’s the person who punches the wall, who slaps their partner in the heat of an argument, or screams in their face. Expressive abuse is temporally close to the trigger. I usually think of it as naturally creating the cycle of violence.

Instrumental abuse is harm used to indicate power. I think about it as being much more manipulative. It’s the partner who shreds all of her boyfriends sports gear because he hung out with his friends to watch the game, or the man who hurts his partner’s pet and tells them it’s because they should know better than to make him mad.

 

Lundy Bancroft, author of the famous book Why Does He Do That? makes the strong claim that most abusive [men*] are not able to change. The Campbell Collaboration—functionally the Cochrane Collaboration, but for social science—agrees when it comes to court-mandated domestic violence, there is no visible effect. [pdf]

But of course, this isn’t your question, really. People who end up in court-mandated treatment are (1) likely to have a very clear cut, almost exclusively physical violence related case and are (2) mandated, and thus very unlikely to be motivated to change.

Fortunately, the Campbell Collaboration also assessed Cognitive Behavioral Therapy for men who [physically] abuse female partners. (Apologies for the heteronormativity here, I’m having a lot of trouble finding anything else). They…were not optimistic [pdf]:

This review included six randomized controlled trials from the USA involving a total of 2,343 participants.

Four of the studies compare a group of men who receive cognitive behavioural therapy with a control group who receive no treatment but are released on parole, carrying out community service or under supervision. The other two studies compare cognitive behavioural therapy with other forms of treatment (process-psychodynamic group treatment and facilitation group). Following the course of treatment (a period of up to 26 weeks and a follow-up period of 1-2 years) the level of repeated violence is measured.

The studies fail to provide a clear picture of the effect of cognitive behavioural therapy on physically abusive men, as they point in different directions. The individual circumstances surrounding each study can determine how the therapy is carried out and thereby the effect of the therapy. However, on the basis of the information available, it is not possible to determine which variations are decisive. As the studies point in different directions, the idea that certain variations of the therapy may have both a positive and negative outcome cannot be ruled out.

The review includes studies where enrollment in the CBT program is voluntarily as well as those where enrollment is compulsory. The findings of the review do not, however, show any clear correlation between voluntary participation and a positive outcome of the treatment or compulsory participation and a negative outcome of the treatment.

A different, less careful, meta-analysis by Babcock, et al [pdf] finds a minimal effect from treatment, though again they pool voluntary and compulsory attendance and look at arrested populations of men. As explained by Stith et al, 2012:

While there is some question about what these small effect sizes actually mean for women who have been assaulted by an intimate partner, Babcock et al. (2004) note that, using the most conservative result, the treatment effect based on partner report in experimental studies (d = .09), treatment is responsible for approximately one tenth of standard deviation improvement in recidivism. In other words, a man who is arrested, sanctioned by the court, and treated has a 40% chance of remaining nonviolent versus a 35% chance of remaining nonviolent for a man who is arrested and sanctioned but not treated

Stith et al (2012) which seems to currently not be available outside university libraries, also review a large number of other programs—all with very few studies—to suggest that sometimes they work. However, uniting variables in those seemed to be that the couples were planning to stay together and that abuse did not necessarily disappear, but significantly decreased.

In conclusion…I’m not sure if I’m answering your question, or if the research does. When people are arrested for abuse, they’re easy to measure, and for those people, treatment has a minimal impact, if any. But those are people who physically abused someone else (usually a partner). And someone of them (just over a third) seem to stop spontaneously.

But I think the thing, LW, the thing is that even if someone can get become a better person, you are not obligated to remain involved while they do. I can’t promise that the perpetrator you’re asking about will or won’t change, but I can promise that you don’t have to find out. 

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LW, when you ask about forming relationships in the context of past abuse and seeing dysfunctional models of relationships, I think about the Seeking Safety program, which is evidence-supported.

Seeking Safety consists of 25 topics that can be conducted in as many sessions as time allows, and in any order. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices.

There are frequently groups that work through the Seeking Safety model, and you’re likely to find one if you live near a large city. Alternatively, there’s a well-liked Seeking Safety book.

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And finally, the questions:

How comfortable are you at saying no? Have you practiced this?
Saying ‘no’ to people is a skill! If you have someone you can trust, you could set up this as a thing you practice with them; where you plan to decline their suggested plans or idea of where to eat, etc.

Dialectical Behavioral Therapy has some things to say about this. [Example here]

Who’s on your team?
Who are the people outside your head that you could ask about your relationship? You don’t necessarily have to do what they say, or agree, but if you weren’t sure if something that occurred in a relationship was safe, who would you ask? One of them might be a therapist, but they could be friends or mentors, etc. Most cities have a hotline for intimate partner violence/domestic violence. You could call them to ask if you weren’t comfortable talking to someone else.

What are your tripwires?
What things would tell you ‘this is abuse’? It’s perfectly fine if you don’t have an answer for this yet! You might want to read over other people’s thoughts about what their red flags are. You might enjoy reading about green flags (note the difference between “good signs” and “requirements”) and working backwards.

What are things that make you uncomfortable but aren’t necessarily ‘abuse’?
You make it sound as though you have been around some unhealthy relationships. Sometimes, this causes people to have triggers that aren’t necessarily signals of abuse, but are things they cannot tolerate. Some people are fine having conversations where voices are raised and shouting ensues, some feel like crawling into a corner with their hands of over their ears at the slightest raised voice.

It’s useful to know what these are. You might want to change them or you might want to just avoid relationships that include these things.

Do you have a fuck off fund?
This a more fun way to say a savings account, but I’m serious about it. People with all sorts of protective factors end up in bad relationships, or feeling trapped in not-great-but-not-awful relationships. It happens. Do you have the savings to get yourself out?

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*Bancroft talks almost exclusively about men as abusers, one of the major failings of the book.

[1] Lynette Feder, David B. Wilson: Court-mandated interventions for individuals convicted of domestic violence. Campbell Collaboration, 2008