In the wake of the NFL domestic violence scandal the media has exploded with questions about what we need to do governmentally, institutionally, and politically to better manage partner abuse. Some have called the current rash of stories a “national teaching moment”—an opportunity for us to wake up to the prevalence and horror of domestic violence and take effective action against this crime.

I couldn’t agree more. A new way forward is desperately needed.

The raw statistics are staggering. One in 4 women will experience domestic violence in their lifetime. One-third of all female homicide victims are killed by intimate partners. 1.3 million women are victims of domestic violence every year.1 These numbers actually don’t do justice to the prevalence of the problem. We know that domestic violence is grotesquely underreported. And statistics clearly can’t reveal the trauma, the horror, and the pain these women experience.

Unfortunately the current direction of our national conversation on this issue—which has focused almost entirely on criminalizing abuse and consciousness raising — will not alone produce real results.

The scrutiny the NFL Commissioner, Roger Goodell, has come under for his handling of the Ray Rice case and his overall management of domestic violence issues within the NFL is justified. The admission by former Chicago Bears general manager Jerry Angelo that the NFL hid hundreds of domestic violence cases over his three decades in pro football shocks anyone with a beating heart and thinking mind.

But the public discourse ends where it should begin. Both pundits and the public seem to believe that strong enforcement, social sanctions, and increased public attention – suspending players for more games, increasing fines, expelling them from the league altogether, encouraging prosecutors to bring charges, insisting on jail time, speaking out forcefully against the problem, and so on – will significantly reduce partner violence.

It is not true. None of these steps are enough to do that. Not nearly.

Consciousness raising is not enough. A recent World Health Organization report2 on partner violence concluded that public campaigns “can increase knowledge and awareness, influence perceptions and attitudes, and foster political will for action, [but] the link between public awareness campaigns and behaviour change is not at all well-established.”

Criminalization is not enough: That same report concluded, “There is little evidence regarding the deterrent effect of criminal justice system responses to intimate-partner violence” 

Even prevention is not enough, both because we simply do not yet know yet how to have a large impact on preventing partner violence in the first place, and because almost all of the existing programs that can be somewhat helpful are applicable in childhood. If we could muster the political will to implement them widely, which unfortunately is doubtful, the problem of partner violence will remain and any hoped for reduction of violence will be moderate and in the distant future.

In the last 30 years we have made dramatic strides in bringing public awareness to these issues, and we’re supporting victims better than we ever have before. Treatments for PTSD and that aftermath of abuse are getting stronger. Public attitudes are changing. Screening for domestic violence is increasing.

But something is missing.

Where is the perpetrator in this picture?!

Broadly speaking, the perpetrator is in the picture in only in the sense of being an object of shame and blame. Never mind that many if not most perpetrators were themselves once the victims of violence and abuse.

I worry that the public, or even the domestic violence community who should know better, thinks we have “solved” the issue as long as there are loud calls for strong action against perpetrators. We can all shout at the top of our lungs that we believe domestic violence is wrong, but until we as a society figure out how to reduce partner violence our shouts are nothing but wind. Worse in a way, we can walk very close to objectification in these conversations and if we cross that line and begin to dehumanize perpetrators, we are participating in the same process we despise. Objectification and dehumanization is psychologically abusive whenever it is applied to a human being.

The one place where perpetrators are clearly in view is in treatment. But here the news is similarly dismal. A meta-analysis of experimental studies on domestic violence reveals that, on average, men who are arrested, sanctioned, and complete current interventions programs are only about 5 percent less likely to perpetrate physical violence against a female partner in the future.3

We have to focus our minds on these shockingly poor outcomes. More of the same isn’t going to work any better. Something is wrong.

I believe that we need a new approach that puts the perpetrator back in the picture in a different way – as whole human beings.

Please save me from emails about how I want to coddle criminals. Bull. I agree that partner violence is a crime. But I want the bottom line to change, fast. Shame and blame does not do that. I want to create a more humane world for all. Shame and blame does not do that either. Let’s find something that does.

Most treatment given to perpetrators is either based on feminist theory, which views the problem as one of consciousness raising, or traditional cognitive behavior therapy, which views the problem as one of skills deficits and anger management difficulties linked to cognitive misattributions. These are the well-meaning programs that have been implemented across the country – but their objective positive benefits are still very limited.

We are only likely to make rapid strides in our battle against domestic abuse when we climb down from the self-congratulatory rigidity of righteousness and realize that both victims and perpetrators are damaged by this interaction (not equally, but both are), that both are whole human beings, and that we need to give both parties the tools they need to properly engage with their emotions, manage their behaviors, and make choices that support their real values. We’ve known for a long time that partner violence is at least in part a problem in how perpetrators relate to their own emotions. Why not treat it as such?

The good news is that one of the first large randomized controlled trial trying to do that was recently published in the Journal of Consulting and Clinical Psychology4one of the world’s premier clinical psychology publications—and the results are encouraging.

A Novel Approach to Domestic Violence Intervention

The idea that perpetrators of partner violence have a hard time dealing with emotions sounds self-evident on the surface, but exactly how this occurs and how this works inside relationships is more complex. Taken together these factors tell us why shaming perpetrators will have minimal positive effects on actually reducing violence.

In the new study, Aimee Zarling and her colleagues show that partner aggression may be due to experiential avoidance and related emotional skills deficits. By digging into the existing literature on the subject, they found there was compelling evidence to support this concept for a variety of reasons:

  1. Psychological disorders that are prevalent in abusive partners often contain an experiential avoidance component.
  2. Abusive partners tend to be less aware of their internal states, and have greater difficulty identifying emotions.
  3. People who perpetrate domestic violence tend to have a low tolerance for unpleasant, negative emotions. They also typically have deficits in emotional skills such as describing their emotions verbally, accepting emotional states, or in engaging in goal-oriented behavior when experiencing negative emotions.
  4. Partners who engage in violence often have poor empathy skills.
  5. Experiential avoidance has been directly linked to decreased relationship adjustment, greater use of physical aggression, and greater exposure to physical aggression.

Combine all of this with the fact that aggression tends to provide immediate, short-term relief from negative emotions and that this relief reinforces the aggressive behavior, and what you have is a pretty clear experiential avoidance model of partner abuse. Domestic violence may actually be the outcome of the perpetrators’ attempt to avoid unwanted thoughts, feelings, urges, memory, and physical sensations.

This helps explain why doling out shame is a bad idea. Shame is a combination of healthy guilt over bad actions, and an unhealthy attachment to “I’m bad” as a self-conceptualization. Directly challenging the perpetrators conceptualization of himself, as often seems to be the goal of conscious raising interventions, can easily contain the same shame-based message. Perpetrators are whole people, who are showing in relationships the cost of not being open to their own inner world, and of not having the emotional agility to adjust to what they find there.

Helping people to back out of their own self-concepts (their “ego” if you will), to open up to experience, and to focus on their values are all areas where acceptance and commitment therapy (ACT—pronounced all as one word) excels. ACT treats experiential avoidance by teaching people how to become mindfully aware of their thoughts and feelings, to distinguish themselves as whole persons from their mental chatter, and to make choices based on their deepest values while experiencing those emotions and thoughts.

Knowing this, the researchers hypothesized that ACT “…would lead to significantly greater reductions in psychologically and physically aggressive behaviors” than a control condition.

Does ACT Work for Domestic Violence?

To test this hypothesis the researchers took 100 people who had committed at least two instances of abuse in the last six months and were actively seeking treatment for their behaviors. Participants were randomly assigned to 12 weekly 2-hour group therapy sessions that included ACT exercises or one that didn’t.

The ACT group received training in topics like:

In the non-ACT group, participants received a lecture and then discussed, reflected, and expressed their feelings related to the topic at hand with the group.

Both groups were measured at intervals pretreatment, during treatment, post-treatment, and at 3- and 6-month follow up across a variety of scales that measure physical violence perpetration, psychological aggression, experiential avoidance, and emotional regulation.

The results are fascinating. By the end the of the 12-week trial perpetrators were a bit less than half as likely to commit an act of physical violence against their loved one. That’s a great start but what really matters most is that it continued to grow even after treatment stopped. Six months after treatment, perpetrators were 73% less likely to physically assault their partner and were 60% less likely to be psychologically aggressive. That is a large effect. That’s an effect that matters in the lives of perpetrators and survivors as well.

Results of Using ACT to Treat Domestic Violence

Just as important we know why this happened. ACT participants showed significantly reduced experiential avoidance and improved emotional regulation at the end of treatment. These changes mediated outcomes – that is, they were shown empirically to be at least in part responsible for the solid follow up results on physical and psychological aggression.

Yes, this is only one study, and we are going to need to replicate these results in a broader population to corroborate the data. The authors themselves admit that one of the weaknesses of the study is that the model needs to be tested on people who are not volunteering for domestic violence treatment services. Interestingly, I spoke with the lead author on the study just before this article went to print, and she is now testing this method with court adjudicated batterers and is seeing positive results. We shall see. But in a field where large effect sizes are few and far between, this study gives real hope that putting the perpetrator back into the picture as a whole person will pay dividends in reducing violence. I am aware of no other large and well-controlled study on a domestic violence treatment program with these kinds of outcomes six months after treatment has ended.

The Future of Domestic Violence Intervention

Physical aggression against a partner is a crime and should be treated as such. But even so, we need to recognize that many if not most perpetrators will not going to jail, and virtually all who do will be released soon enough. We need to look more deeply into the human problem domestic violence represents. Criminalizing domestic violence and consciousness raising are just reasonable first steps on a much longer journey. Shaming perpetrators is not helpful. In addition to legal and social action, we need to help people who commit violence to mindfully come into contact with their thoughts and feelings, learn the agility they need to choose behaviors that correlate with their true values instead of acting out as a mechanism of escape.

We can uphold our values and the law while still being concerned for the well-being of both parties involved. We can recognize partner violence as a crime while still caring about both people in the relationship.

Perpetrators are people too. We need to keep that in the conversation or this “national teaching moment” will not lead to real and rapid progress in reducing violence.

References

1 http://www.ncadv.org/files/DomesticViolenceFactSheet(National).pdf

2 http://www.who.int/violence_injury_prevention/publications/violence/IPV-...

3 Babcock, J. C., Green, C. E., & Robie, C. (2004). Does batterers’ treatment work? A meta-analytic review of domestic violence treatment outcome research. Clinical Psychology Review, 23, 1023–1053. doi:10.1016/j.cpr.2002.07.001

4 Zarling, A, Lawrence E, and Marchman, J. A randomized controlled trial of acceptance and commitment therapy for aggressive behavior. Journal of Consulting and Clinical Psychology. Online First Publication, September 29, 2014. http://dx.doi.org/10.1037/a0037946

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