Thursday, June 01, 2006

Education vs Therapy

One question that was posed after the Partner Abuse intervention training in Springfield last week:

"You say that group interventions with men who batter should be educational groups rather than therapy groups. One distinction you make between the two is to say that education is directive, the facilitator takes the group in a pre-determined direction, whereas therapy 'meets the client where they are at'. Yet, then you talk about using Motivational Interviewing in Partner Abuse Intervention groups. Isn't 'meeting the client where they are at' a key principle of Motivational Interviewing and doesn't this contradict your distinction that these groups should be education rather than therapy?"

First, I appreciated that this question came up after the training because a similar question was asked during the training, essentially asking why we are advocating any therapy-based techniques if this is strictly education.

There are two points I think we need to keep in mind:

One is to make sure that we understand why we are making the distinction between therapy and education in working with men who batter. If we clearly identify why we focus on education rather than therapy it will help guide us in understanding when and why we bring in elements from the therapeutic realm. I believe that a main reason for this distinction is that philosophically, to say we are doing therapy with domestic batterers runs counter to the principles which founded this work. If you look at the history, batterer's intervention was born out of a hope to further provide safety to victims. Any healing (a word that may be associated with therapy) on the part of the perpetrator is secondary, if considered a goal at all. Perhaps a goal that many people are more comfortable with is change (cognitive and behavioral) rather than healing.

Some other reasons to lean away from calling this work therapy:

  • It might suggest mutual responsibility for the violence between perpetrator and victim.
  • Some therapy models might recommend rage-expression or anger management, approaches which may increase risk of violence or fundamentally misunderstand the beliefs that support domestic violence.
  • Other therapy models might see the violence as poor impulse control, rather than as an exertion of control over one's partner.
  • If a man becomes violent again, a therapy-based approach might see this as "relapse" behavior, which suggests his "affliction" got the best of him rather than seeing the behavior as a calculated choice on his part.

Understanding these basic principles, I think it is possible, if not necessary to bring in techniques from the realm of therapy without softening on these principles. In other words, we may borrow Irvin Yalom's idea of peer-modeling in group without using his concept of client-driven group goals. Perhaps where we borrow most from the therapy world is in cognitive-behavioral techniques, which focus on confronting thoughts and expecting behavior change. But again, I think we are borrowing techniques more than embracing theories.


My second point may be an extension of the first, and it relates directly to the phrase "meeting the client where he is at".
If therapy involves meeting the client where they are, and we are not doing therapy, why talk about Motivational Interviewing (MI) which largely seeks to meet the client where they are?
I think (my beliefs, here!) that there is a key difference in what we traditionally mean by this in therapy and what the MI model suggests. The Rogerian concept of self-actualization, or self-efficacy, which guides many therapists, really takes this idea of "meeting the client where they are at" seriously. It's a belief that the client will take you where they need to go. It's also a belief that the client has what they need to achieve self-actualization and the key role of the helping professional is to affirm and accurately empathize.

Motivational Interviewing is not exactly the same. If any thing, it's like Carl Rogers with a hidden motive. Here's a quote from the original MI book by Rollnick and Miller:

"...Motivational interviewing differs from the method described by Rogers as it is consciously directive. The terms "client-centered" and "non-directive" are sometimes used interchangeably, but they refer to different aspects of counseling style. Motivational interviewing is intentionally addressed to the resolution of ambivalence, often in a particular direction of change. The interviewer elicits and selectively reinforces change talk and then responds to resistance in a way that is intended to diminish it."

Motivation Interviewing, Miller, W., & Rollinck S. 2002, Guilford Press, NY p.25

I think that if motivational interviewing can help a facilitator effect behavioral change in a batterer's group participant, then it's worth looking at. I am constantly using MI skills in batterer's groups to elicit change-talk from the men with the goal of helping them move in a direction that I am very intentionally hoping they move toward.

I hope some of this helps to clarify. I also hope to hear your thoughts as you read this. Click on the word "comments" below this post if you'd like to leave a comment. As always, I am very open to other opinions, corrections, challenges, etc.