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Does Batterer Treatment Reduce Violence? A Synthesis of the Literature
Robert C. Davis
Bruce G. Taylor
Robert C. Davis, MS, and Bruce G. Taylor, PhD, Senior Research Associates, Victim Services Research, 346 Broadway, Suite 206, New York, NY 10013. The authors thank Joel Garner for making valuable comments on an earlier draft of this paper. The views expressed are the authors' own and are not meant to represent the official position of Victim Services, the U.S. Department of Justice, or the National Institute of Justice.
SUMMARY. This paper reviews three questions based upon the research literature on group treatment programs for batterers: (1) Does treatment reduce violence relative to the absence of treatment, (2) Do some forms of treatment work better than others, and (3) Does treatment work better for some batterers than for others? While there exist several dozen evaluations of batterer treatment programs, few have employed methodologies which are appropriate to addressing the issue of whether treatment is effective. However, among the handful of quasi and true experiments there is fairly consistent evidence that treatment works and that the effect of treatment is substantial. Regarding the second question, we have little evidence to date that one form of treatment is superior to another or that longer programs turn out less violent graduates than shorter ones. Regarding the last question, there are bases for hypothesizing that some batterers may fare better in treatment (or fare better in certain types of treatment) than others. However, empirical verification has been highly limited to date. The paper concludes with lessons drawn from the literature on designing future research.
[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected]] Over the past two decades, the law enforcement response to domestic violence has become increasingly tough. Pro-arrest police policies have been promoted by advocates and widely adopted by police departments across the country (Buzawa and Buzawa, 1996). Increasingly, prosecutors as well have removed discretion traditionally given victims of domestic violence and insisted that cases be pursued to conviction regardless of victim desires or willingness to cooperate (Rebovich, 1996; Hanna, 1996). These changes have meant that criminal courts have had to sanction an expanding pool of batterers, and they have increasingly come to rely upon group treatment programs as the sanction of choice.
There are compelling reasons why group treatment programs for batterers have become a popular mode of court sanction. Even in serious battering cases, many victims choose to stay with abusive partners (Taylor, 1995). Such victims are interested in sanctions which offer them safety from violence, not retribution or punishment that will jeopardize their partner's ability to earn a living. Alternative sanctions commonly used in other crimes have little face validity in abuse cases: There is little reason to believe that fines, community service or probation without special conditions will stop batterers from abusing their spouses.
In this paper, we review research studies on the effectiveness of batterer treatment programs in reducing violence. We begin by reviewing the variety of treatment programs available. In the second section, we review evidence on whether batterer treatment reduces violence. The third section discusses research which compares outcomes of different types of treatment programs. In the fourth section, we synthesize what we have learned from the literature. The final section makes recommendations for future research.
I. The Nature of Batterer Treatment
The first group programs for batterers were begun during the late 1970s. Feminists, victim advocates, and others realized that providing services to victims of abuse and then returning them to the same home environment did little to solve abuse problems (Healey, Smith, and O'Sullivan, 1997). Group treatment was believed to be more appropriate than individual counseling or marital therapy because it expanded the social networks of batterers to include peers who are supportive of being nonabusive (Crowell and Burgess, 1996). Groups also proved to be less expensive than one-on-one counseling sessions. The earliest batterer groups were educational groups which sought to promote an anti-sexist message (Gondolf, 1995). With the passage of time, they gradually incorporated cognitive/behavioral therapeutic techniques and skill-building exercises.
As states introduced pro-arrest statutes during the 1980s the number of batterers arrested and convicted increased, and group treatment became the treatment of choice for the courts (Healey et al., 1997). Court-mandated batterer treatment significantly increased and diversified the number of batterer programs nationally (Feazell, Mayers, & Deschner, 1984). A recent estimate places the proportion of court mandates in treatment programs at 80% (Healey et al., 1997).
Batterer treatment may be required by criminal courts as part of a pre-trial diversion program, may be ordered by judges as part of a sentence, or may be imposed by probation agencies empowered to set special conditions of probation (Hamberger & Hastings, 1993). In at least one major urban jurisdiction, the district attorney sometimes agrees not to file charges at all if a brief treatment program is completed (Davis and Smith, 1997). In some states (see Ganley, 1987), civil courts as well as criminal may mandate a batterer to treatment (e.g., as a condition related to child visitation). Many batterer programs are run by probation departments, while others are run by mental health clinics, family service organizations, and victim service organizations.
Modern batterer groups tend to mix different theoretical approaches to treatment (Healey et al., 1997), although most batterer programs are based upon the feminist model developed by the Domestic Abuse Intervention Project in Duluth, Minnesota. The Duluth model assumes that physical violence is part of a spectrum of male efforts to control women. But batterer programs also commonly deal with the need for anger control, stress management, and better communication skills.
Not only treatment approach, but treatment length varies from program to program. The duration or number of sessions may vary from as little as one day to 32 weeks (Feazel et al., 1984). Some in the field even have advocated long-term treatment from 1 to 5 years (Ewing, Lindsey, & Pomerantz, 1984). However, there also is substantial pressure to keep batterer treatment short in duration resulting from pressure from insurance companies' imposition of time limits for batterers seeking reimbursement (Edelson and Syers, 1990).
Current trends in treatment programs seem to be going in conflicting directions. Increasingly, states are developing guidelines to codify standards for treatment content and length among batterer treatment programs (Gondolf, 1995). But, on the other hand, there is increasing sentiment that a "one-size fits all" approach to batterer treatment fails to recognize the diversity of batterers that enter treatment (Healey et al., 1997). There is a trend for treatment programs to tailor interventions to different batterer types defined by personality, violence history, or substance abuse. Other programs have been specially designed to accommodate sociocultural differences among batterers such as poverty, ethnicity, or sexual orientation.
II. Does Batterer Treatment Work?
Over the last two decades there have been many empirical studies on batterer treatment programs. There are at least six published reviews of over 35 published single-site evaluations (Eisikovits & Edleson, 1989; Gondolf, 1991, 1995; Rosenfield, 1992; Saunders, 1996a; Tolman & Bennett, 1990) and eight book chapters reviewing this same research (e.g., Hamberger & Hastings, 1993; Crowell & Burgess, 1996; Dobash, Dobash, Cavanagh & Lewis, 1995; Dutton, 1988,1995; Rosenbaum & O'Leary, 1986; Saunders & Azar, 1989; Tolman & Edleson, 1995). Since these literature reviews a number of new studies have been conducted and published.
However, the volume of the literature is deceptive. In fact, there have been only a handful of investigations that can make any legitimate claims about differences between treated batterers and untreated batterers. The batterer treatment literature has gone through three generations of studies. Most recent have been investigations which have randomly assigned batterers to treatment conditions. These are the strongest designs. Quasi-experiments of varying quality appeared somewhat earlier in the literature. The oldest, and by far the largest, portion of the empirical literature consists of studies which examine only batterers assigned to treatment programs. Included in this set of studies (which are discussed later in the paper) are: (a) studies which assess violence or other individual outcomes only after batterer treatment, (b) studies which measure violence before and after treatment, and (c) studies which compare violence of batterers who complete treatment with batterers assigned to treatment, but do not attend. Although the methodologies of early studies do not tend to be strong, they are important because they laid the foundation upon which stronger designs could be developed.
Methodological Issues in the Literature
In order to intelligently evaluate treatment outcome studies, it is important to have in mind some of the methodological shortcomings common in this literature. This section outlines some of the major problems which are common to many studies. These methodological issues have already been reviewed extensively elsewhere (e.g., Hamberger & Hastings, 1993; Rosenfeld, 1992; Saunders, 1996). However, a brief overview is necessary since we will draw upon this understanding to evaluate particular investigations and groups of studies.
First, there has been a lack of consensus on how to measure program effects. Studies have measured program effects on violence using official data on arrests and complaints, victim surveys, and batterer surveys. Rosen feld's (1992) review makes the point in detail that official reports of violence and batterer surveys seriously underestimate actual violence committed in relationships. Moreover, some studies (e.g., Mauiro, Cahn, Vitaliano, and Zegree 1987) have not included any indicators of violence in their outcome measures. (Such studies are not included in our review.) Follow-up intervals have varied greatly, from several months to several years (Rosenfelds' 1992).
Studies differ widely in their statistical sophistication. While most have reported inferential statistics examining differences between means, a few have merely presented percentage differences (see Tables 1-3). Some studies which did use inferential statistics were conducted without sufficient statistical power to detect differences between treated and untreated participants (e.g., Chen et al., 1989). Some of the best quasi-experiments have incorporated multivariate analyses which attempt to control for the effects of extraneous variables when isolating effects (Harrell, 1991).
Studies have varied in terms of the populations they are investigating. Obviously, the samples in these studies are not going to be representative of all batterers in the United States, or even all batterers mandated to batterer treatment in the United States. Most researchers would probably be satisfied with demonstrating that batterer programs are effective for some well-defined group of batterers in a court system, in one city. Clearly, obvious sample selection biases should be avoided.
One such sample selection bias is that most of the batterer programs that have been evaluated exclude difficult batterers (e.g., recidivist batterers or those who have substance abuse problems) from their programs (see Rosenfeld, 1992 for a review). Elimination of potentially difficult subjects may overestimate the successfulness of treatment programs, were these ...
