Phone Counseling is Effective Therapy

In a recent study published by the Journal of the American Medical Association, Lynn Bufka, Assistant Executive Director, Practice Research and Policy at the American Psychological Association, suggests that phone and online, or Skype, counseling can be a useful strategy. Scientists in the study found that more people dropped out of treatment, usually in the first five weeks, when they went to see their therapist face-to-face instead of talking to their therapist over the phone.

My experience at the Men’s Resource Center has shown that men, in particular, can struggle with accessing counseling as it may go against their traditional beliefs about masculinity; beliefs that say “real men make it on their own and the ones who don’t are weak.” For such men, phone and online counseling can be a painless and confidential means of seeking help. Such counseling may also serve as a triage into in-person counseling for the anxious or reluctant client. A phone or online counselor can help provide initial crisis management while working to encourage in-person counseling for clients whose issues would be better addressed face-to-face.

Phone and online counseling also benefit those who live in rural communities whose access to experts is restricted by geography. With phone and online counseling services, they are only a mouse click or a speed-dial away from the professional help they need. They no longer have to plan for long drives and can schedule sessions from the comfort of their home or office at a time that is convenient to them. Some clients in busy urban areas may wish to schedule phone or online counseling sessions merely to save time by avoiding drives across town.

Reach More Clients with Phone Counseling

I’m not advocating one type of counseling over the other. I believe that in-person Talk Therapy cures and that phone and online counseling can as well. Just think, if phone and online counseling weren’t available, some people might never access counseling services or, if limited to in-person services, would drop out as the aforementioned research reveals. It doesn’t have to be relegated to a “if you have to” or “another sign of interpersonal decay in this age of depersonalized technology.” As the 12-step recovery program states, “It can be the next right step” for particular clients in certain situations. My advice – don’t just hang your shingle. Consider opening up your phone line, and turning your computer on to this 21st century form of Talk Therapy.

A couple things you probably don’t know about Drug Court to consider if you should enlarge your practice with Drug Court clients:

• Drug Court isn’t just about drugs. Sometimes also called Sobriety Court and a variety of other names, this program works with offenders convicted of drunk driving offenses, minor in possession citations, probation violations as well as drug use and possession convictions.
• Arrangements between treatment providers and Drug Courts are still quite informal. In other words, if a Drug Court is new, expanding services, or it’s dissatisfied with its present providers, you may be able to become a Drug Court Treatment Provider.

You can find out more about this great opportunity to open a new practice or expand your present services by visiting the National Drug Court Institute or ordering my book Restorative Treatment: Build Your Own Successful Practice Helping Court-Refereed Clients Reclaim Their Lives.

A connection with substance abusers

I had been picked up for drunk driving twice. At that time, thirty-five years ago, DUI was treated with significantly less seriousness, and after my second arrest, I was required to attend a two-hour seminar on drinking and driving.

It was a warm and sunny early spring Saturday afternoon and I found the new high school in Livonia, a suburb of Detroit, without trouble. Sitting amidst other offenders, one of whom was amazingly attending the meeting in an obviously intoxicated state, I found myself listening to a middle-aged and dumpy-looking guy, Bob, from Alcoholics Anonymous. His non-descript appearance was misleading, for I was quickly astounded by his clarity and forthrightness in describing his life of alcoholism and debauchery. I had never heard anybody speak with such remarkable candor, facing the reality his life then and now with accountability, and, at the same time, casting the past aside and forgiving himself with complete abandon. During the break, smoking cigarettes and shuffling around on the pavement of the parking lot, a few of us chatted with him: I asked him more about his life and A.A. I was deeply drawn to him: I knew his message was important for me.

I got home and told my roommate about the meeting, about this man who talked to us, and about the guy who was arrested for drunk driving and came to the meeting intoxicated. I said, “Can you imagine that, going a seminar on alcoholism, hammered?” Ted went to fridge, and turning around, asked, “You wanna a beer?” “Sure,” I said.

Gratitude for counseling mentors

I now know that I was no different from the guy who was drunk. It was a long time between that Saturday afternoon in Livonia and the Thursday in February of 1986 when I stopped drinking and started attending A.A., but Bob had left an unconscious but transformative impression. As I write this, I realize that Bob’s voice was a latent catalyst that eventually led me to sobriety and catapulted me into a graduate program in counseling psychology. He helped me to enter a similar role as a mentor and teacher, incorporating his values in my work with men: authenticity, candor, and compassion.

Gratitude is a frequent topic at A.A., and when it’s my turn, I sometimes speak of my appreciation for Bob’s words on a spring day, over four decades ago, when the new leaves were just beginning to appear. Now retired from daily clinical practice, I write to carry the message.

Topics for Substance Abuse Groups

• Relapse Risk Reduction
• Patterns of Use
• Attitudes and Substance Abuse
• Minimization, Denial, and Blame
• Consequences of Use
• Countering Disastrous Thinking
• Lifestyles that Lead to Abuse and Relapse
• Stages of Recovery

Whether you’re treating alcoholism or drug abuse or addiction, your job is always full of ambiguity and the need for balance. Like any other counseling, the rules are not cast in stone. What works for one client in one setting may not work for another. What works in individual counseling may not be appropriate for group work.

Especially as treatment providers for the courts, we often find individuals with very different substance abuse problems in the same group. We have adolescents who have been merely experimenting with alcohol or drugs sitting next to hard-core alcoholics of those with drug dependency. We need to address ourselves to the education of the mildly abusing drinker who got picked up and blew .10 as well as challenge the full-blown alcoholic who’s still in denial of his problem.

When you use worksheets as a part of your treatment process, you individualize the therapy because each client responds at their own type and level of substance use. When you process their responses in a go-round and each group member shares his or her own answer to questions, you can address their place on the substance use continuum. Everybody’s substance abuse problem is included; no one’s left out. In addition, you make a personal connection with each group member every time you use a worksheet.

If you haven’t tried using worksheets on substance abuse topics such as different types of use, consequences of abuse, minimization and denial, risk for relapse, lifestyles that lead to abuse and relapse, and relapse prevention, try them now!

After I started providing batterer intervention services, I was asked to give a presentation to the women in shelter programs on my groups for abusive men. I explained how I taught men about the dangers of power and control tactics, the importance of personal accountability, and the necessity of being in charge of our behavior no matter what our partner does. I told the women that the goal of batterer intervention was to stop physical violence.

To my surprise, the women told me that they saw emotional abuse— name-calling, put-downs, accusations, threats, yelling,—as more serious than physical abuse. The women said that physical injuries heal, but emotional harm lasts forever.

What I really learned from the brave women at the shelter was this: men are letting themselves off the hook when they say, “I yell at my wife, but at least I’m not a batterer.” They are minimizing the damage that their emotional abuse does to their partners. Men in batterer intervention groups need to be challenged just as strongly and frequently for their emotional abuse as their physical violence.

What you may not help them to understand is the damage that their domestic violence does to themselves.

I have run groups for both batterers and alcoholics, and I have found many parallels between domestic violence and excessive drinking.

People who drink too much live miserable lives—they know they shouldn’t drink, they are full of self-hate for their drunken sprees, they condemn themselves for how their drinking hurts their families, and often they try to stop drinking only to relapse again and again.

I believe that the behavior of batterers is similar. When an abusive man harms his partner—either physically or emotionally or both—he usually experiences great shame and guilt because he hates to hurt the women he loves. He commits to her and to himself to never again repeat his behavior, and yet he finds himself acting abusively again. Each time, he’s angry and disappointed in himself. He wants to change. But frequently, he doesn’t—like an addiction to alcohol, his abuse is a habit, and it’s hard to break. And the longer he does it, the easier it is to relapse, the harder to stop, and the more miserable he becomes about himself.

The worst of the batterer’s domestic abuse is of course the damage it does to his partner. But it hurts him too. We must help him see the cycle: everyone suffers, including himself. When he’s full of shame and self-recrimination, he’s all the more likely to abuse. This doesn’t mean that he shouldn’t feel guilt: he needs to, it’s part of the process of recovery from battering. But his recognition of the damage he does to himself may give him even more motivation to end battering: all the more reason to stop abusive behavior.

Let’s start by looking at what not to do. The big five:

• Don’t lecture. In treatment circles, it’s called Didactic. Whatever you call it, don’t do it. Nobody loves a lecture, and substance abusers hate to be told anything.
• Don’t run a therapy group. Through self-disclosure is good for the soul and can help people bond, it doesn’t give people the information they need to achieve and maintain sobriety.
• Don’t tell war stories. People new to abstinence, especially young people, enjoy talking about just how drunk they got and what crazy stuff happened. Substance groups are about how bad drinking is, not how fun or funny.
• Don’t run an AA meeting. That’s what AA is for.
• Don’t get in the faces about what bad drunks or druggies they are. Of course you need to challenge them, but, though tempting, it doesn’t work to beat them up.

Open up the next window to tell them the Do’s of running substance abuse groups. Now the Do’s of running groups.

• Do tell them your own story. Don’t make it too long, just enough for them to know you get it about alcohol and drugs.
• Do require them to talk openly and accurately about what they used, how much, and how long, and do it often.
• Do require them describe consequences of their use.
• Do have a check every session. Identify a topic each time such as the greatest threat to their sobriety, the biggest benefit of sobriety, what they’ve learned about themselves from AA or from this group. Do not let the check-ins take the whole time of the session. If they go too long, people get bored and your group loses its effectiveness. You may have to interrupt if someone gets too long-winded or prod others to talk.
• Do use worksheets in which every group member has to answer the questions. Then get them to talk about their responses. Worksheets work because everybody has to think, they compare answers, and you have on-topic discussions. There are many good sources of substance abuse worksheets including those on this website.

Good luck!

Facilitating groups for court-referred clients can be hard work: The truth is, of course, that they are criminals, an indication that they may have lousy attitudes and rebel against authority — not qualities that make them stellar group members. But running groups can be enjoyable and rewarding. Many clients get with the program and make significant change in their lives. They listen and learn: they stop drinking and find ways to avoid abuse and instead treat their partners with respect. Their changes don’t always stick; sometimes they relapse or fall back into power and control, but many of them maintain the changes and stay in recovery, continuing to become even better husbands and partners.

Here are four EXs that will make your groups easier for you and more effective for them.

Expand their consciousnesses. Many may have never really considered stopping drinking. Give them a picture of what life is like when you’re a drunk and what it’s like when you’re sober. Get them to brainstorm a list and put it on the board of characteristics of what a Saturday is like after a night of drinking. Then make a list of what a normal Saturday could be. For batterers, help them envision a disciplined life in which they are not abusive, in which their homes are loving and happy.

Explain to them how recovery works, that it’s one day at a time, that they can plan a successful recovery the same way they map out a vacation with the family: Make plans for what to do when they used drink, how to stay away from people who drink and places where drinking happens, for calling a sponsor or accountability partner at least three times a day, attending AA or some other support group. If they are batterers, explain that they can find mentors to talk to, that they won’t let go of their all abusive patterns today, but they catch themselves and avoid more serious abuse starting now.

Expose them, without shaming, to the seedy and dirty sides of their lives. Describe how it feels to live with an alcoholic or to be a battered woman. Startle them into seeing how much they drink: report the fact that the average American has two drinks per week, not a hundred beers. Urge them to think about their economic conditions compared to those who don’t drink. With batterers, lead a discussion of parenting in which they speak proudly of their love for their children and how much time they spend them, and then confront these men with the fact that if they abuse their partners, they are bad Dads. Explain that because children identify so closely with their mothers, if you abuse your partner, you are abusing them.

Extricate them from lives that encourage drinking and abusive behavior. Tell them that they need to engage in a full court press, to pull out all the stops, and that, to quote Bill W., half-measures will avail them nothing. Encourage them to establish make life-style changes: finishing school or getting a GED; attending AA or church or some other organization to provides support, spending more time with affirmative extended family members.

In your face counseling

These tactics — part of a style we call “in your face counseling” — will energize you and your clients. Take some risks. If they don’t work, you will have at least learned something. And remember, one of the advantages of court-referred clients is that they have to come back!

Find more great ways of running groups in Therapist-Outfitters publications:

• Substance Abuse Worksheets: Thinking to Stop Drinking. Cognitive-behavioral curricula and worksheets for outpatient treatment groups that intervene with alcohol and other substance abuse dependence.
• Interventions for Men who Abuse Women: Worksheets for Facilitating Domestic Abuse Groups
• Restorative Treatment for Drug Court and Domestic Violence Clients: Build your own successful practice helping court-referred clients to reclaim their lives.

The National Organization of Women has provided a great service to the women—and men—of the United States. But where is the similar organization of men?

I proposed an organization of men, called the National Alliance of Men for Integrity and Compassion (NAMIC, pronounced nam-ic). NAMIC would work to end toxic male socialization to our boys, to promote loving and respectful relationships among men, to create a compassionate world that supports men in familial and other relationships.

The article also lists specific tasks that only a national organization could accomplish.

I believe there are many liberated men who would support NAMIC in its mission to replace violence and hyper-masculinity with compassion, community, and integrity. If the creation of NAMIC excites you as it does me, please email me.

To help us respond to the needs of batterer intervention services, please complete this one-page survey.

Another Fork in the Road

My experience suggests a fourth path: Court-driven clients. Like the other three sources, these clients come with their own set of motivations, struggles, and potential. In the case of court-driven clients, therapists are actually termed treatment providers. Their job is to challenge errant behavior by identifying its impact on others (“It will do harm. There will be consequences.”), help clients to recognize their destructive thinking and teach them to make healthy choices, creating better relationships and a more accountable life.

Courts are a Source of Clients

Court-driven clients are most frequently referred for drunk driving and other alcohol-related offenses, domestic violence, other-than-partner assault, possession and delivery of illicit substances, sexual abuse, and shoplifting. How many of these clients are sent to therapists each year? Their numbers rival the other groups which Grodzki has identified. It’s hard to get firm figures because each of the many District and Circuit Courts in the United States is an entity unto itself, but we do know that there are almost 3000 Drug and other problem-solving courts across the country with an average of 100 clients each totaling 300,000. Add on the other offenders who get more traditional referrals, and I guess that there are between a million and two million court-driven clients referred to treatment.

Therapists do not often seek out court-driven clients. Why not? Because (1) most private practitioners do not understand the court system and nobody’s told them where to look for clients, (2) they fear them (they are criminals, after all,) and the court system itself with its labyrinthine and convoluted ways, and (3) they assume that clients who are mandated for counseling will not be motivated. In fact, my experience is that the elders in treatment groups quickly help new referrals adopt a positive attitude and get with the program. Most make genuine change and are grateful for the experience.

Make Court-Referred Clients Part of Your Successful Therapy Practice

Some therapists make the assumption that they need to be associated with a licensed/accredited agency in receive court-referred clients. At the present time, there is no commonly accepted requirement. If you haven’t looked into making court-driven clients a part of your practice, you owe it to yourself to make the conscious decision Lynn Grodzki advocates. Find out how your local Drug Courts works, and investigate the availability of clients in your community. If you don’t, you may be missing out on a steady flow of clients who are required to pay for your services. You’ll also pass up rewarding teamwork with the courts and the gratification of helping clients make dramatic change.

As a treatment provider I received training by the Federally-funded National Drug Court Institute. In the book Restorative Treatment for Drug Court and Domestic Violence Clients, I describe the drug court movement and other court-driven client programs. Restorative Treatment details how social workers and therapists can prepare themselves to enter the fastest growing specialty in counseling. It also shows how working with a clientele that may initially appear to be resistant to treatment can in fact be rewarding both personally and financially.

Although increasingly varied in their approach to working with abusive men, batterer intervention services (BIS) adhere to best practice that emphasizes (1) safety for women (2) accountability for abusive behavior and (3) the exclusion of protocols that might lead group facilitators to collude with batterers. BIS facilitators use instruction, worksheets, and self-report to educate abusive men but have disdained the concept of an alliance with batterers for change.

The Cornerstone of Traditional Therapy

While I believe that these values of safety for women, accountability for men, and avoidance of collision are always imperative to BIS, I also think that it can be instructive to look at traditional counseling as a model for batterer intervention, in particular at the therapeutic alliance. Originally developed in study of the psychodynamic relationship, the use of the therapeutic alliance has become a cornerstone of effective therapy. In fact, research suggests that the container of the therapist-client relationship is the marker of efficacious counseling rather than the effectiveness of a particular type of therapy. Green asserts that “No array of clever, change-oriented techniques is effective in the absence of a positive emotional connection between therapist and client.”* Transference, countertransference, and other aspects of the relationship have been explored in many ways, and research continues to validate the centrality of the alliance.

Liking Batterers

The intervention alliance is similar to the therapeutic alliance in its fundamental simplicity: If you want batterers to pay attention to you, to learn what you’re trying to teach them you, you’ve got to like them, and they need to know it. Over the many years that I ran treatment groups for abusive men, I liked and connected with virtually all of them. I affirmed their comments in group discussions, praised their self-disclosures of abusive behavior, and applauded their ability to sincerely and honestly critique other group member’s thoughts or actions. I did it because it was good practice, but also because I meant it.

I also learned not to judge new good members too quickly. When I was new to BIS, I verbally annihilated a guy who came into the group with a long loud attitude. After a couple years in the business, I realized that I was abusive of him. In my own dominance and intimidation, I validated his control and abuse of his partner. When he said, “I don’t belong here,” I learned to say, “Give it a few weeks, and then will talk about.” I needed to be a role model for openness and respect. My tolerance created a container for the intervention alliance in which the batterer eventually realizes he needs to intervene in himself. He needs to realize that he is part of the intervention alliance, with your support intervening with himself.

Clear, Solid, and Robust Boundaries

The intervention alliance doesn’t suggest that we shouldn’t have strong boundaries. We will adamantly refuse to tolerate demeaning comments about women. We will interrupt a man who blames her behavior for his abusive actions. We will challenge a man who seems to be coasting through the group. We will meet outside of the group with men who do not seem to be incorporating the concepts of respect and egalitarianism in their relationship, telling them that they must intervene more deeply with themselves if they are to continue in the program.

We will of course have clients who we don’t like. If we can’t use our heart to make an alliance, we will use our best practice, in fact the values that we are trying to inculcate: respect, openness, and compassion.

For many BIS facilitators, this discussion of the intervention alliance simply codifies what they do already. But it’s not something that we talk about. Like the proverbial ostrich that buries its head in the sand, the intervention alliance has been ignored in an attempt to create a wide swath that would annihilate anything that could result in BIS facilitator collusion with the batterer. The acknowledgment of the existence of an alliance is seen as an act that could put women at risk because some in the field of domestic violence believe that interventionists are not to be trusted and that their wayward practices could lead to further abuse and violence.

The Light of Day

I have taken a different point of view, positing that the failure to recognize, study, and make the alliance a part of the interventionist protocol actually leads to greater risk. The identification of both those aspects of the alliance that have the potential for collusion and those which may shower great benefits on the batterer and partner need to see the light of day. Openness to the existence of the alliance will help interventionists to be more wary of too cozy relationships with batterers, to be more aware of the complexities of the relationship, and increasingly able to adopt aspects which will improve their practice. I hope I have here deconstructed the alliance, identifying and scrutinizing its benefits as well as its dangers, contributing to an expanded best practice which can save the hearts and lives of women.

Alliance Risks

There is always a risk with batterer intervention. It is our job to ensure that our treatment is effective with the abusive man, but we also need to remember that safety of the victim is the highest value. For more information, see Interventions for Men who Abuse Women: Worksheets for Facilitating Domestic Abuse Groups, or contact Therapist Outfitters.

*Robert-Jay Green, PhD, Therapeutic Alliance, Focus, and Formulation: Thinking Beyond the Traditional Therapy Orientations.

Harm and Consequences of Domestic Violence

In batterer intervention groups, your most important and most difficult task is to get men to realize how much they hurt their partners and children when they’re emotionally and physically violent. Once they open themselves to look at the swath of destruction, they will see that they need to stop.

You can lecture them about the consequences of battering, but they will feel that you’re condescending and attacking. Lecturing is deadly, and most clients tune you out after a couple minutes. At the other end of the continuum, loose group discussions provide an opportunity for clients to rail against law enforcement and the criminal justice system, and worse, their partners who called the police. These discussions foster a group environment in which you allow and therefore condone their acting out, specifically, blaming others for their domestic violence. Worksheets provide a tactic that avoids both facilitator monopolization of the group on the one hand and participant mayhem on the other.

Two Key Benefits to using Worksheets in Batterer Intervention Groups

Worksheets typically consist of several items in which clients respond to questions or statements. In a typical group discussion, you ask a question on the topic at hand and a couple people may raise their hands and supply the answer. The other eight or ten in the group may have thought for a moment of an answer, but when somebody else gives an answer, they turn minds to things that interest them more — “What will I have for lunch? Is that attractive women in the office married? How many more weeks to do I have to sit here?” The first benefit of using worksheets is that they require all group members to think of and write down an answer before somebody gives an answer.

The second benefit is that worksheets provide a variety of activities. When I taught remedial English at a small community college, I quickly learned that I needed to plan a number of short class activities in order to keep the student’s interest. The same is true of groups of court-referred clients. Here’s what happens when you distribute a worksheet to a men’s domestic abuse group.

You explain the purpose of the worksheet and ask them to answer the first question (for example, what is the definition of “abuse”?)

They think
They write
They share
You comment
You put their comments on the white board
They discuss
You summarize
You move on to the next question.

If you use a worksheet with six questions, you employ as many as 42 distinct segments during the group session. It’s easier for you and more effective for them.

For more discussion and 22 worksheets to make your group work, see the downloadable Interventions for Men who Abuse Women: Worksheets for Facilitating Domestic Abuse Groups.

What are your insights on using worksheets for facilitating domestic abuse groups?

The question of structure vs. spontaneity in running groups is one of the most common issues that therapists face. On the one hand, we want to give batterers opportunities to talk because we know they learn best from one another. On the other hand, time is precious and we want to keep things focused. Worksheets for abusive men’s groups can combine the best of both worlds: they contain structured learning activities interspersed with relaxed conversation.

Advantages of using worksheets for abusive men’s groups:

1. Maintain focus on an exploration of a particular topic. Unstructured discussions can ramble from one topic to another.
2. Encourage individual thinking. If you pose a question to the group, the most active members will give you the answers. Less enthusiastic men will demur, not thinking much about the question or the answer. If you use worksheets for domestic violence intervention groups, everyone in the group is forced to write an answer.
3. Present opportunities for rewarding and validating. It can be helpful to write responses to questions on worksheets on the white board: “What I said was so important that the group leader put it on the board.”
4. Disclose and take responsibility for abusive behavior. When clients are required to identify and admit their acts of domestic abuse on a worksheet, they are more likely to inventory their behavior and be accountable than if they are simply responding to a question in a discussion.
5. Encourage personal inventory. Many abusive men do not analyze themselves in a constructive way. Worksheets in which they are asked to identify destructive thinking and abusive behavior provide a window for self-examination.
6. Make ideas concrete with writing. Writing a definition or explanation increases the likelihood that they client will remember and incorporate ideas in his life.
7. Increase participation. Clients are more likely to speak up if they have something that they’ve written in front of them. Worksheets can produce more lively discussions.
8. Provide records of client activities and progress. Collect worksheets. Your clients will take them more seriously if you do and you can file them in their records as tangible evidence of their participation and improvement in group.
9. Rivet their attention. Using a worksheet to accompany DVDs (such as the Jackson Katz’s Tough Guise or Tony Porter’s series, A Call to Men) propels them to pay attention, looking for answers to question as they watch. I often run through the questions before starting the DVD.

Take a look at the worksheets in my book, Interventions for Abusive Men: Worksheets for Facilitating Domestic Abuse Groups. They can make you a more effective treatment provider and make your life easier.

How have you found worksheets to be helpful in your therapy practice?

In the 1960s and 70s the women’s movement focused attention on the lack of resources available to battered women. They also identified the lack of sanctions against men who raped or battered their female partners as the most dramatic example of how women rights were violated in our society.

Organizations such as the YWCA in Grand Rapids and the Center for Women in Transition in Holland, Michigan began providing information, counseling, and housing for battered women.

Programs for Abusive Men

Intervention with male batterers developed as part of this larger movement addressing the rights and needs of battered women.

In 1977, eight men who were friends of women’s activists in the Boston area came together to form a men’s collective called Emerge. They began to provide services to batterers. Their creation of services for batterers responded to the frustration of shelter workers who noted that women were being beaten when they returned home, and to the observation that some men were moving from one violent relationship to another.

Emerge became one of the first organizations to offer group treatment for men who batter. The growth of services for batterers rapidly followed its establishment.

In 1981, a group of individuals in Duluth, Minnesota including Ellen Pense and Michael Paymar became increasingly concerned with the increases in domestic violence and the recidivism among perpetrators. They established the Domestic Abuse Intervention Project. They created a curriculum called the Duluth Model which has become the most commonly used approach to working with batterers. The primary mission is to promote safety for victims and accountability for batterers. The program includes eight modules on subjects such as accountability, respect, healthy sexuality, and honesty. Typically, in Duluth Model programs, men are required to attend 26 weekly group sessions; however, 40 and 52 week programs are becoming increasingly common.

During the same period that batterer programs were being established, the dramatic awareness of domestic disputes lead some practitioners to develop family treatment models resulted including couples counseling with men who abused their partners. The use of these models for intervention with batterers has created a great deal of controversy, primarily out of fear that they may put the victim at risk. As a result, family and couple treatment interventions constitute a small minority of interventions.

Court Referred Group Treatment

Since the mid 90s many criminal justice systems began to change their response to battering. Police began to arrest men who abuses in increasing numbers. In the State of Michigan and in many other parts of the country, police are mandated to make an arrest if there is a clear indication that a man has physically abused his partner.

Currently, a large number of batterers appearing in court are mandated to batterer treatment. In this context, batterers intervention is one component of a coordinated community response to battering, which includes the probation sanctions for men who do not attend groups as required criminal justice system response as well as services for battered women and their children. Community intervention projects (CIP) seek to coordinate the response of these systems to provide sanctions for men s violent behavior and to coordinate needed services for victims and their families.

Effectiveness of Batterer Intervention Programs

Most batterer intervention programs are quite effective. Although court-referred clients are often initially resistant, most are willing to take responsibility for their behavior. They adopt tools to avoid further abuse and work to create more egalitarian relationships. In a study with 58th District Court a few years ago, I found that less than 10% of those who completed recidivated.

Charlie Donaldson, MA LLP LPC CAAC, one of the original members of the Ottawa County (MI) Sobriety Drug court team, has written an exhaustive manual, Restorative Treatment for Drug Court and Domestic Violence Clients, for therapists who want to join this the revolution. Donaldson points out that while other sources of clients are declining, referrals from drug and other problem-solving courts are growing.

Donaldson has drawn on his fifteen years of personal experience to write a book that explains both the theory and practice of work with court-referred clients. Restorative Treatment covers every aspect of building a practice: How courts work, creating a business plan, setting your business plan in motion, marketing and networking, principles and practice of restorative treatment, and programs tailored for the court.

When I started my practice, I contacted the local newspaper, and they gave me what appeared to be a great deal. For the price of a three-inch ad, they gave me space to advertise my services and the opportunity to write a topical article about counseling. I wrote nice little pieces about depression, anxiety, addiction, abusive behavior, and other malaises. The advertisements appeared once a month, and I ran the ad and the articles for over a year. I received two clients from my efforts.

My colleague ran spots on the local radio station for a couple months. They were expensive, and her records suggest that she received not a single client.

This is my advice: avoid advertising and concentrate instead on defining and promoting a marketing niche. You may wish to be known as a one-stop agency, but you need to pick one service and find ways to mine that particular market.

You can find more information on marketing for counselors and therapists in my book, Restorative Treatment for Drug Court and Domestic Violence Clients.

I’d worked with men who’d been arrested for domestic violence on an individual basis here and there. I’d tried to help men to manage their anger and I thought they probably needed to stop drinking so much. As I look back up it, I realize that I had common misconceptions about abusive men and the cycle of domestic violence. Fortunately, I met a woman who told me more in two hours about treating abusive men than I’d learned in the last five years. Here’s my story.

Domestic violence treatment program for men

February 16, 1996 was damp and drizzly day in Grand Rapids. I took the day off from work to attend the meeting of organization I’d heard about – a group of people who were meeting to learn how to better work with guys who’d physically abused their partners. I’d met a woman, Becky, who worked at the YWCA, and she’d encouraged me to go to. At that time Becky was fifty, but with her hair in a pony tail she looked thirty-five, and she had a vitality and energy that made her seem even younger. She’d developed the domestic violence treatment program for men and had achieved a reputation across the state for her expertise and commitment to the batterer intervention.

I picked her up at her home, and we started off on the two hour trip north to Cadillac where the meeting was being held. In Michigan, a short distance can make a considerable difference in the weather, and no more than thirty miles outside of Grand Rapids we encountered snow and slick roads. I backed my speed down to 55 miles an hour, and we started talking about domestic violence.

I’d worked with one client in particular who seem to fit this mold: an ex-cop named Robert from Detroit who discovered his wife, Linda, was having an affair. After drinking a 12 pack of beer, he punched her repeatedly in the face, giving her a black eye and breaking her jaw.

As we passed Newago, I began telling Becky about Robert and about how I’d tried to teach him anger management so he wouldn’t hurt Linda again. I told Becky that he was a proud man and that it wasn’t surprising that he got so upset.

By now we’d seen cars in the ditch and I’d slowed down to forty-five. Becky said, “You said he was a proud man, and I wonder if he wasn’t really a pretty controlling man. I wonder if he didn’t work to keep her under thumb. I’ll bet he called the shots in their relationship, telling her what to do and not to do, and tried to keep her isolated from other people.”

“Well,” I said, “He did say that he didn’t like her going out much. He wanted her to stay home and take care of the kids. I think he was afraid she’d meet somebody else. And she did.”

“Charlie,” she said, “I wonder, was his father a cop too?”

“Yeah, he was. How’d you guess?”

“From the way you described him, it sounded like that he came from a family with a dominating father, and he’d carried on the tradition. You know, domestic violence isn’t really caused by anger. It happens when a man’s control of his partner is questioned—when she doesn’t do what he wants her to—when she gets outside of the box. Proud men are patriarchal men, and they gain their self-esteem by controlling others, and they’re insulted when others don’t do what they want.”

“I hadn’t thought of it that way,” I admitted.

“In fact, control is really kind of a high, especially if you don’t feel very good about yourself in the first place. I went to a workshop recently, and the facilitator asked us to stand up with another woman in front of us. She told us to reach out with both hands out and push the woman back by the shoulders, and to continue to push her until she backed into the wall. I was surprised at myself. I was surprised at how much I enjoyed doing this. I was surprised that pushing another person around was a high. It felt good to be so in control of another person.

“As we processed our experiences afterwards, we discussed how we had mixed feelings about our behavior. On the one hand we had to admit it felt good. On the other hand, the woman who was the “victims”—the one who was pushed—had quite a different experience. She spoke about how small and abused she felt. We recognized that feels good to control another person but it’s also very destructive.

Domestic violence is about control and power

“So,” Becky went on, “Domestic violence really isn’t so much anger or alcohol as it’s about power. They guys are raised in a society that tells boys that to be real men they should be in control. They should have power over the women in their lives.

“And what we as counselors need to teach these guys is that it doesn’t work to have power over other people. What works is to feel empowered and to share power. Your client, the cop, may have looked competent and strong, but behind that badge, he was a pretty insecure guy He thought that he could make himself feel better by calling the shots and he’d probably been control her for a long time. In fact, of course, in the long run, things only got worse. She had an affair. And she finally left, didn’t she?”

“Yeah,” I said. “She didn’t leave right away after the violence. He told me she said she wanted to give him another chance. But then one day, he said, a couple weeks later, he came home and she was gone. There was a note. It said, ‘I hope you’ll get some help.’”

There was silence in the car. I said, “Want a stick of gum?”

“Sure,” Becky said.

In Cadillac, the beginning of the north country in Michigan, it was snowing hard and there was a foot of snow on the ground. That day, at our meeting, we elected the first co-chairs of the Batterer Intervention Service Coalition. It was an important day for that organization. But what was important for me was that in that two hour car ride, I’d been given the gift of understanding the core of domestic violence. It’s about the use of abuse to get what you want.

The key to a successful mental health or substance abuse practice is marketing. What is marketing? Marketing is simply all the means by which a business attracts and retains customers. It includes:

Market research: Do people want the therapeutic services you wish to offer? Are there sufficient numbers of clients and can they pay? Are they being served by other agencies? Are the courts and other referring institutions looking for agencies? How do you get the information you need to make good business decisions?

Program development: What programs do you wish to offer? What do you want to be known for? What will be your flagship program? What treatment/counseling protocols drive your programs?

Promotion: How will you reach your prospective clients? Word-of-mouth? Flyers? Speaking engagements? Advertising? Free lectures to other therapists or the public? How do you convert interested people into committed clients?

Retaining clients: Are your facilities attractive and comfortable? Do you appear well organized and professional? Is your manner with new clients inviting and enthusiastic? Do you deliver the services you say you do? Do you give clients an opportunity to provide feedback about their counseling experience?

These are important questions. Do not blow them off. Whether you’re starting your own practice or you want to improve your agency, you need to plan with these questions in mind. Following the basic principles of business can make the difference between a failed and a successful practice.

• Don’t advertise. One shot advertising is seldom successful and long-term advertising is always expensive.
• Don’t spend big bucks on business cards and letterhead. People do not decide on getting therapy at your shop on the basis of your printed materials.
• Don’t buy expensive furniture.
• Don’t buy cheap furniture.
• Don’t promote long-term therapy.
• Don’t take sides in couples therapy.
• Don’t be afraid to call a probation officer if a court-referred client is acting out.
• Don’t refuse to negotiate a client fee.
• Don’t refuse to hire a receptionist. When you start out you may not be able to afford a receptionist, but you can double your revenues when you have a competent person answering the phone and greeting clients.
• Don’t decide not to call Therapist-Outfitters for help.