What Do Professionals Need to Know?

Mental Health

Overview of the Issue: What about treatment for abusers?

Mental health treatment is often seen as the intervention of choice for batterers, but:

• It has not proven to be effective in reducing violent behavior over the long term.

• Abusers who genuinely want to change their behavior can do so without treatment.  They readily change their behavior when necessary to avoid negative consequences, and are perfectly able to act differently toward people other than their partners. 

• It is an insufficient response to criminally abusive behavior.  Diverting an abuser out of the criminal justice system and into treatment may lead him to conclude that his behavior is not taken seriously.

• Mental health-related problems such as anger, substance abuse, personality disorders, intermittent explosive disorder and childhood trauma are not the cause of abusive behavior toward a partner and children.  These problems are correlated with domestic abuse and may influence the shape it takes in a particular case, but wanting to quit drinking or feel better emotionally is not the same thing as wanting to treat one’s partner better.  Abusive behavior pays off for the abuser, regardless of its cost to his partner and children, and treatment is unlikely to get him to stop it for their benefit. 

If abusiveness were the result of individual pathology, it would make sense to provide mental health treatment as a response to it.  Framing abuse as pathology in need of treatment goes something like this:

• He must be sick to act that way. That is, he wouldn’t be abusive if he didn’t have an underlying psychological problem (Intermittent Explosive Disorder, Antisocial Personality Disorder, substance abuse, insecurity, anger, trauma, etc.).

• If I treat his underlying disorder, he will quit being abusive.

This way of understanding abuse hands the abuser an excuse for his behavior.  The likely result is that he will begin to say, “It’s not my fault – my _____ made me do it.”  He begs or pressures his partner to hang in there with him while he works on his problem, and promises that things will get better.  Since that’s what she wants, she may agree to stay with him, deferring her own needs for safety and freedom. His therapist has unintentionally become his ally in continuing to control his partner. 

Therapy should not be the standard response to abusers generally, because whatleads to domestic violence is often not the sort of thing that treatment can address, including:

• Entitlement attitudes.  Most abusers believe that there is something that entitles them to control their partners.  In the case of men’s abuse of women, that something is often a belief in male dominance.  Some abusers choose to examine and change these attitudes during therapy, but treatment cannot be reliably used to change attitudes – especially ones that operate to the abuser’s benefit.

• Cultural and social support for entitlement attitudes. Social support is a powerful reinforcer that keeps abusive behavior going, and clinicians cannot stop abusers from receiving it.

• Tactics of control.  Abusive behavior is not random.  It often boils down to carefully chosen tactics, which are used intentionally to achieve the abuser’s goal of control. Co-occurring mental health or substance abuse problems do not make tactics into a sickness that can be cured.