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.


Blogger Beachwriter said...

Very interesting. Good points and very informative. "Therapy" to me is important, but you made some great points about "Education."
I, too, agree that society, batterers, and even their victims should be "Educated" about abuse. They should "Educate" themselves as to why they are abusive as well as the victims of abuse should "Educate" themselves as to why they are in an abusive situation.
Therapy, to me, is to...find out the "reason" why we are the way we are, but therapy doesn't necessarily "Educate" us about abuse.

I feel that society needs to educate themselves about abuse and why its happening in our world, and what we can do to change it.

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Anonymous Anonymous said...

Your subconscious mind is a powerful force. It can be an un-defeatable ally or a dangerous foe! It is a powerful force of nature that can be harnessed and made to work for us or it can be a wild beast that runs riot with our lives.
How powerful is 'powerful'?

Take the first Atomic Bomb - it could lay waste to an entire city in seconds. Or the gravitational pull of the Sun which stops our tiny planet from hurtling into space. Imagine the power of a black hole - that region of spacetime from which nothing can escape not even light travelling at 186 thousand miles a second. The Universe is full of powerful forces. Yet, all these wondrous things pale into insignificance when compared to the power of the subconscious mind.

The subconscious part of your mind is that part which regulates your heartbeat, lungs, digestive system and everything else in your body. It directs the inner workings of your body and such things as (what biologists call) 'machines' - tiny living cells that are composed of motors, drive-shafts and propellers - seriously!!! There is mounting evidence that the cells in our bodies have memory and that our very DNA is coded with memories of our ancestors. As well as having full control of all these functions and more your subconscious also retains all the thoughts, experiences and emotions you have ever felt. It regulates the most complicated mechanism in the unknown Universe - your body - and it can calculate the trajectory of multiple moving objects while supplying you with the words necessary to debate an issue while controlling a complex task of activities such as driving a car!
These tasks alone show how powerful the subconscious mind is. But it is much more powerful than that!

The truth is: No-one knows the limits of the subconscious mind's power!

Tell yourself that you will wake up at 6 a.m. and chances are you will awake. Go to a crowed party and through a mass of voices you will hear someone at the other side of the room mention your name! Set a problem aside and miraculously, out of nowhere, the answer comes while you are involved in another task. It recreates situations in your life that correspond to your beliefs. Time and time again you find yourself in the same situations, with similar partners, in almost identical jobs. Like a wheel your subconscious mind creates situations that bring your life back to the same spot.
Likewise it can totally transform your life - even overnight! It can bring you new situations, life experiences, luxuries and even people.

However, it is like a na�ve child or a better analogy is that of a computer. It believes everything that you tell it. Your conscious mind is the gatekeeper. Anything you think with complete faith is immediately past to the subconscious mind - which it then takes as literal fact. There will be no arguments because it has no discriminating capabilities.
Although your subconscious mind is more powerful than you can possibly imagine it is a mere servant. It is at your disposal. YOU are in charge. It acts just like a computer and like every computer it needs software to run. So if you do not program it then someone else will! You are constantly being bombarded with software programs for the mind every minute of everyday. Buy this product and you will look slim, drive this car and you will seem sexy, drink this potion and you will feel more vibrant about life. You are told what to buy and when to buy it, when you are too young to do a thing and when you are too old. You are told what is possible and what is not. Snap out of it!
Take back your control over mind and body. You were born with the most powerful computer system known to man - a bio-computer that regulates a sophisticated, highly flexible, changeable, self repairing vehicle. You are amazing, a true miracle. If you bought a new top of the range diesel Mercedes would you let Joe or Sue down the road fill it up with petrol?
Begin to think for yourself. Who told you that you could not achieve your dreams? Do you believe it? Who told you that you were too fat, too skinny, too stupid, too smart, too young or too old?

Does it matter?

No! Because you are and always have been in total control. Change your thinking and you will change your subconscious beliefs. Change your subconscious beliefs and you will change your life.

8:08 AM  
Anonymous Wendi said...

A typical dictionary definition of hypnosis states that it is: a state that resembles sleep but that is induced by suggestion. However, anyone who has tried hypnosis (and any self respecting hypnotist) will tell you that this is a very simplistic view of the subject!
A much better description comes from the Free Online Dictionary which states that hypnosis is: an artificially induced state of consciousness, characterised by heightened suggestibility and receptivity to direction. So what does this mean and how can it be used to your advantage?

Well, the subject of hypnosis has been discussed and pondered since the late 1700s. Many explanations and theories have come and gone though science, however, has yet to supply a valid and well-established definition of how it actually happens. It's fairly unlikely that the scientific community will arrive at a definitive explanation for hypnosis in the near future either, as the untapped resources of our 'mostly' uncharted mind still remain something of a mystery.
However, the general characteristics of hypnosis are well documented. It is a trance state characterized by extreme suggestibility, deep relaxation and heightened imaginative functioning. It's not really like sleep at all, because the subject is alert the whole time. It is most often compared to daydreaming, or the feeling you get when you watch a movie or read a captivating book. You are fully conscious, but you tune out most of the outside world. Your focus is concentrated intensely on the mental processes you are experiencing - if movies didn't provide such disassociation with everyday life and put a person in a very receptive state then they would not be as popular (nor would TV advertising be as effective!). Have you ever stated that a film wasn't great because you just couldn't 'get into it'???
This works very simply; while daydream or watching a movie, an imaginary world becomes almost real to you because it fully engages your emotional responses. Such mental pursuits will on most occasions cause real emotional responses such as fear, sadness or happiness (have you ever cried at a sad movie, felt excited by a future event not yet taken place or shivered at the thought of your worst fear?).
It is widely accepted that these states are all forms of self-hypnosis. If you take this view you can easily see that you go into and out of mild hypnotic states on a daily basis - when driving home from work, washing the dishes, or even listening to a boring conversation. Although these situations produce a mental state that is very receptive to suggestion the most powerful time for self-change occurs in the trance state brought on by intentional relaxation and focusing exercises. This deep hypnosis is often compared to the relaxed mental state between wakefulness and sleep.
In this mental state, people feel uninhibited and relaxed and they release all worries and doubts that normally occupy their mind. A similar experience occurs while you are daydreaming or watching the TV. You become so involved in the onscreen antics

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