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A Pre-CAT Issue: The Influence of Partner Safety on the Assessment of Men Who Batter

Bell, C., 1998. A Pre-CAT Issue: The Influence of Partner Safety on the Assessment of Men Who Batter. Reformulation, ACAT News Spring, p.x.

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INTRODUCTION

In the usual working experience of most therapists, clients/ patients who present a risk of death or serious injury to third parties are so rare that few clinicians ever encounter them. However, for those of us providing services for outpatients with known histories of abusiveness, I maintain that systematic risk assessment is essential, despite its particular legal, professional and ethical dilemmas, if we are to avoid service provision which is naive, collusive and potentially dangerous. My intention in this short paper is to explore the way in which this assessment of risk and the prioritisation of safety of female partners of prospective clients has a particular bearing on the delivery of CAT with the rather unique client population of heterosexual men who batter.

Here I shall advocate positioning CAT so as to recognise the unique circumstances in which the male perpetrator of violence continues to live with his female victim, by establishing procedures that prioritise protection of the survivor and the ending of her victimisation. Implications for service delivery are also discussed. Though recognising a strong case for the use of the term survivor when applied to battered women (Thorne-Finch 1992) and acknowledging that they are often simultaneously victimised and actively surviving (Hooper 1991), I have elected to use the word victim, often voiced by abused women themselves (Kirkwood 1993), not to imply any passivity or debilitation, but to emphasise the powerlessness that is the frequent consequence of their partner's procedures- of domination and control.

CURRENT TRENDS

Feminist and profeminist activists have urged therapists working with violent men to prioritise the protection of battered women over attempts to treat their abusers, arguing that the therapeutic needs of a man who batters should not outweigh the interests of his partner for safety. Moreover, services, it is maintained, should also be evaluated from the perspective of whether, in attempting to provide help for the instigators of the violence, they do more to enhance or to endanger the safety of battered partners (Hart 1988b). Some therapists even advocate that the victim of violence be seen as the primary client in this context albeit that it is the offender/patient who is the actual focus of clinical intervention.

Hart (1988a) alleges that few services have internal policies that address this issue as yet, though there does seem a discernible trend to embrace these concerns. For example, the substance of these values was adopted at the National Practitioners' Standing Conference held in May last year where delegates unanimously agreed to make women's need for safety the first item on its 'Statement of Principles' for working with perpetrators of domestic assault. This position has also been reflected in many recent documents (Pence 1988, Harris et al 1990, Fitch et al 1992, S. Yorks Probation Service 1994) from agencies sponsoring services for men who batter. The Position Statement on Domestic Violence approved by the National Council of the Association of Chief Officers of Probation in 1992 also not only recommends that Probation Committees adopt a policy on domestic violence that affirms the need to safeguard abused women (A.C.O.P. 1992) but also that the Courts and case managers alike strive to find out how a woman victim might most feel protected and to compile reports and licence conditions with the safety of victims in mind (A.C.O.P. 1992).

IMPACT OF SERVICE PROVISION

Since the declared objective of leading projects providing treatment for men who batter is to put an end to victimisation, recognition of the impact upon the partner's welfare of the very provision of therapy is essential. This is especially so since the batterer's attendance for therapy is likely to be the most significant factor in his partner's decision to remain with him or even to return where she has already managed to leave (Gondolf 1988). Hague and Malos (1993) claim that the effectiveness of intervention with men who batter is not yet fully established and some practitioners maintain that information gleaned from treatment actually enables offenders to enhance their regime of intimidation and control over battered women (Harris et al 1990). Suggestions have also been made that beneficial outcomes may only be short term (Hart 1988b) and that, if not done well, therapy is best not done at all (Horley 1990). Therefore, however well-intentioned, the mere provision of a service for the batterer may well result in exposure of his partner to risk that would have otherwise been avoided by her leaving or staying away. Moreover, the proclivity of many men who batter to procedures which dictate the discharge of stress through abuse to vulnerable members of their family, should not be overlooked and where such a man having a history of severe violence to, his partner is coerced or merely persuaded to participate in a therapy that he is quite likely to experience as challenging and therefore stressful, his potential for harmdoing must be considered high, especially as many men who batter hold their partners directly responsible for finding themselves there. Ironically too, the man's participation in non-custodial initiatives intended to abate victimisation can also result in a reduction in perceived seriousness with which he is viewed by other statutory or voluntary agencies (Horley 1990, Scottish Women's Aid 1991) precipitating a minimisation or withdrawal of support services for the victim.

CURRENT LITERATURE

As yet, despite a rapidly increasing volume of literature exploring the many facets of domestic violence (Hotaling and Sugarman 1986), references examining risk assessment issues are few (Goldsmith 1990). However, there are some authors who do recognise that a proportion of perpetrators may be too lethal to be treated on an outpatient basis (Stordeur and Stille 1989) or whilst not in custody (Hart 1988b) and some who advocate that therapists never make the assumption that a partner is safe. Others recommend that a man not be accepted for treatment before a reduction in what they claim to be high risk markers (Sonkin et al 1985). I believe there is, therefore, a strong enough case for CAT therapists to adopt this moral and potentially legal responsibility to victims if intervention is not to double as a confessional in which therapy inadvertently assists the maintenance of the man's violence rather than resolves it. More detailed accounts of perpetrator attributes and other factors associated with an increased probability of future dangerousness can be found in Hotaling and Sugarman (1986, 1989), McNeil (1987), Hart (1988a), Tolman and Bennett (1990) and Campbell (1986, 1995).

DILEMMAS

The assumption of this duty to predict responses to client engagement and to consider the safety of vulnerable others is not, however, without its dilemmas. Perrott (1994) describes how probation officers, for example, often face contradictory demands by a number of different groups: offenders, victims, the judiciary, government and society. In my own professional setting working partly in partnership with the criminal justice system, particularly under the last political administration where the Service was increasingly driven by expediency and selfjustification, further issues also arise because of differences in ideological and ethical perspectives. Before 1990 there were no probation projects dealing specifically with domestic violence, the Home Office having previously prioritised property-related offences. Indeed, it could be said that even now diversion from court (cautioning rather than prosecution), still the most likely outcome for a man arrested for assault on his partner, continues to relegate wife abuse to the level of minor crime such as shoplifting. Consequently, the legacy of a probation response which has traditionally sought to prevent the recurrence of crime by the supervision of an offender within his/her own community raises many tensions when a man who batters continues to live in the same house as the victim of his criminal assault. The Service, with its mantel of offence-focus, has been slow to acknowledge the unique circumstances of domestic violence and whilst the machinery of Risk Management Teams can theoretically be assembled, this timeconsuming and costly apparatus is rarely called upon to protect the interests Of women victims in their own homes. This ambivalence is of course compounded when the victim, invariably because of fear or economic dependence (or as in two of my cases recently where the perpetrator was the registered carer of his disabled, battered partner) is also unwilling to deny her attacker's return.

In the absence of any corporate risk assessment protocols in the context of my work, it is my responsibility to deliberate about the merit of imposing preconditions or restrictions on the delivery of a CAT therapy (surrender of weapons, use of personal alarms for the victim, requiring the perpetrator to sleep away from home the night after therapy, temporary separation, use of criminal justice or civil law sanctions etc.) or indeed, whether to offer a therapy at all. The minimal motivation levels of many of the men referred to me means that the insistence on contracting for partner safety easily repels a prospective client (though, as McNeil (1987) suggests, some clients who experience homicidal urges toward their partners often feel comforted in the knowledge that some external controls will be imposed to minimise the risk of their feelings being acted upon). Given the unlikelihood of custodial sentences and the minimal effect that criminal justice sanctions have with high-risk offenders anyway (Sherman 1992) and given the absence of any other service that addresses the man's violent behaviour, the decision to reject or delay a probation client because of his suspected or proven lethality is not always easily taken when this is the very offender most in need of help. To do otherwise, however, is to accept a 'batterer' into treatment in the hope of facilitating change but in the knowledge that to do so may well, in the short term at least, collude with the exposure of his victim to potentially life-threatening risk. Reflective management of this decision-making also means of course, continual scrutiny of oneself and of one's value-base, especially in personal therapy and in supervision: at what point are the rights and needs of the perpetrator subsumed by consideration for his victim? To what extent do my own biases based upon class or race, for example, play a part in arriving at judgements? How do I reconcile attempts to help an offender reduce his controlling behaviour despite a therapeutic context in which I may advocate measures to control him? How much is my confidence in my ability to bring about change contaminated by my own grandiosity? Is denial the sole prerogative of my client? Do I have a predisposition to overstate or understate a client's propensity for dangerousness?

FIRST STEPS

It may well be, as Hart (1988b) asserts, supported by Goldsmith's research (1990), that the person actually best placed to make a reliable assessment of dangerousness levels is the victim herself. Various studies (Monahan 1984, McNeil et al 1988, Blomhoff et al 1990) underpin the common assumption that the most reliable predictor of interpersonal violence is a history of previous violence: there can be no better assessor of a man's capacity for violation of his partner than the woman herself. She will more than likely be able to identify antecedents and cycles in her abuser's behaviour and may best know what measures to take to minimise her self-exposure. However, the victim can hardly be expected to be familiar with the process or content of the therapy her partner is about to undertake nor to anticipate his response to it. Feminists have long emphasised battered women's need to be furnished with adequate information about therapeutic intervention with their partners; the importance of practitioners not making over-zealous claims of success has also been stressed. Arming a victim with accurate information about working styles and CAT paradigms and about the uncertainty of success or even change, therefore, seems an essential first step in the fulfilment of any commitment to consider her safety.

Nevertheless, the product of what Ferraro and Johnson (1983) call the Process of Victimization for many battered women is the tendency to rationalise their partner's abusiveness especially in the absence of any institutional or cultural support. The denial of injury and of victimisation itself are also cited as consequences of subjection to long-term abuse which tends to leave the victim accepting responsibility for her partner's violence in the belief that her supposed provocation (Pagelow 1981) is synonymous with justification. The victim's interests may not therefore be best served by an ill-informed presumption that the provision of information in itself will necessarily empower the woman to act decisively to provide for her own safety, even assuming her access to appropriate resources.

PRACTICE TENSIONS

This elicits further dilemmas: do I assume that the partner is unable or unwilling to take some responsibility for her own welfare and, as it were, make decisions on her behalf (in true patriarchal fashion?) as to whether she will be at more or less risk by her batterer being offered therapy. Or, do I accede to her possible requests (that he remain with her in the matrimonial home, that he undertake the therapy etc.) in the knowledge that her comments may well have their origin in shame (Carden 1994), fear, denial, financial dependence or in hope that he will change this time? Does she harbour conscious or unconscious hopes that a decision to prioritise her safety will in fact be made for her, despite her best protestations, in order to avoid the violent recriminations that could follow her efforts at self-determination? The tendency of men who batter to under-report the frequency and severity of their violence is well established (Ganley 1981, Sonkin et al 1985, Stordeur and Stille 1989, Saunders 1992), as is clinicians' poor track record in predicting violence (Miller and Morris 1988, Gondolf et al 1990). Male practitioners' proneness to collude with abusive men's minimisation of their violence has also been alluded to (Hearn 1993).

One obvious resolution to the predicament of assessing dangerousness would therefore be to actually interview the partner herself to enhance judgements as to the degree of the perpetrator's lethality and to attempt to ascertain and to cater for her reasonable wishes. However, to initiate such direct contact has invariably been condemned by Women's Aid on the grounds that this approach in itself could well put the woman at risk. She may receive violent admonishments, prior to any meeting, as a reminder to censor her contributions or subsequent assaults as her batterer seeks to elicit evidence of any 'indiscretion'. Also, any unpopular decision ultimately arrived at, perceived by her partner as consequential to the meeting, risks sentencing her to further reprisals. Moreover, because of the inherent power discrepancies, the abused women may in any event defer to my judgement as a white, middle-class male professional 'expert'.

In addition to providing the partners of prospective clients with the appropriate information, it is my current practice therefore to invite participation from women's organisations in order to avoid direct contact with the battered woman myself. They seem best placed to help the victim assess what is actually. in her best interests and to communicate the product of their collective appraisal in a' way that minimises risk and informs the design of a safety plan. Moreover, the inclusion of another agency, especially when added to by the corroboration of other third parties, can greatly enhance the accuracy of predicting further violence in the face of measures to prevent it (Prins 1988, Werner, Rose and Yesavage 1990). Here, again, however, this domain is not without its tensions. I often find myself in receipt of sensitive material provided by women's advocates with the understandable request that it be treated confidentially. This frequently means arriving at a decision regarding service provision that is mainly informed by that privileged information but in such a way that the prospective client is unaware of its existence. Apart from reflecting on the obvious ethical issues involved, I do experience anxiety as to whether, despite my best endeavours, the client intuits its transmission either by my inadvertent disclosure or by the effect the possession of the information has counter-transferentially.

It is also worth noting here that the prioritisation of partner safety in the assessment phase of working with men who batter clearly has value beyond its immediate relevance to victims. It is perhaps tautological to say of male 'batterers" that they disregard interpersonal boundaries: but I do regard the emphasis on partner welfare as an educational measure in soliciting their maintenance. Modelling, after all, has been shown to be an essential component of efficacious intervention with offenders (Antonowica and Ross, 1994).

IMPLICATIONS FOR PRACTICE

Not all clients have contact with their partners during therapy, some may not be in a relationship at the time and not all have a high potential for dangerousness. However, I have attempted to build a case for identifying those clients who do or may present a risk to vulnerable others, before deciding whether to offer CAT. I shall now outline what I see as key prerequisites in a pre-CAT risk assessment to this end:

1. That the partner be contacted not only to provide details of relevant support services available to her but also to dispel any illusions she may harbour as to the likely success of therapy, to inform her that a risk assessment will be carried out and that she will be notified of the outcome, where appropriate.

2. Given the possible impediment of overempathy with the perpetrator (Hart 1988a), that risk assessment be SYSTEMATIC and that corroboration of the prospective client's dispositions be sought from partners and other third parties. That CAT be denied until contact has been made with the man's partner.

3. Where a significant risk is deemed to exist, that a SAFETY PLAN be established to minimise the risk of violence and to emphasise alternative choices of behaviour. Both situational and psychological steps to be taken in stressful circumstances should be identified (perhaps by a simple sequential diagram) after agreement is secured to pre-conditions to acceptance to therapy (limiting access to the victim; relinquishing weapons; acceding to civil or criminal injunctions; reducing high risk markers etc.).

4. That women's liaison workers be encouraged to develop a SAFETY PLAN confidential to the victim to be implemented at times of high risk (e.g. appendix 2 in Fieldhouse et al (1995)).

5. That mechanisms be introduced for PERIODIC RISK REVIEWS.

6. That a WRITTEN CONTRACT be agreed with each client which clearly identifies the TARGET PROBLEM and AIMS of the therapy, attendance requirements, the limitations of confidentiality (including a check-list of those who will have access to his attendance records) and safety initiative procedures.

7. That, in addition to establishing criteria for implementing a SAFETY INITIATIVE, strategies be discussed in supervision for dissuading/ preventing clients from fulfilling any subsequent violent intent, including consideration for 'sectioning' under the Mental Health Acts (see Owen 1993).

8. Given the role of Women's Refuges and Women's Aid, that key staff be invited to familiarise themselves with CAT practice paradigms to be better able to inform victims. It may be, given that many of these (we) men share common procedures (vulnerability dilemmas, comfort traps etc.) and reciprocal role repertoires (e.g. controlling/controlled), that a generalised S.D.R. could be put to good use here.

BIBLIOGRAPHY

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Calvin Bell

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