Friday, July 4, 2014

Thinking Habits That Work Well

Two Wrongs Don't Equal One Right
I don't need to retaliate just because someone else says or does something wrong. Anything I say or do to get even will not resolve or fix anything. It will only result in feeling embarrassed and guilty. Dealing with another's inappropriate behavior by not retaliating is a sign of true strength and power. Coming out of a difficult situation with integrity and respect for my own maturity is far more important than protecting my pride and ego.

I Am Accountable For My Own Actions
There is nothing another person can say or do that can make me say or do something I know is wrong. I can feel mad or angry and still not say or do anything that I will regret or feel guilty about later. Even if some one else says or does something wrong that really upsets me, I am accountable for how I respond. I can rise to a higher, more mature level. I can choose to deal with any situation in a calm, adult manner.

I Am Responsible For My Day
I am responsible for how I feel and for what I do. Nobody can make me feel anything. If I have a rotten day, I am the one who allowed it to be that way. If I have a great day, I am the one who deserves credit for being positive. It is not the responsibility of other people to change so that I can feel better. I am the one who is in charge of my life.

I Don't Have To Control Things
I will survive if things are different than what I want them to be. I can accept things the way they are, accept people the way they are, and accept myself the way I am. There in no reason to get upset if I can't change things to fit my idea of how they ought to be. There is no reason why I should have to like everything. Even if I don't like it, I can live with it.

Everybody Doesn't Have To Love Me
Not everybody has to love me, or even like me. I don't necessarily like everybody I know, so why should everybody else like me? I enjoy being liked and being loved but if somebody doesn't like me, I will still be OK. and still feel like I am an OK. person. I can't "make" somebody like me any more than someone can get me to like them. I don't need approval all the time. If someone does not approve of me, I will still be OK.

It Is OK To Make Mistakes
It is OK. to make a mistake. Making mistakes is something we all do, and I am still a fine and worthwhile person when I make a mistake. There is no reason for me to get upset when I make a mistake. I am trying and if I make a mistake, I am going to continue trying. I can handle making a mistake. It is OK. for others to make mistakes too. I will accept mistakes in myself and also mistakes that others make.

Other People Are OK And I Am OK
People who do things I don't like are not necessarily bad people. They should not necessarily be punished just because I don't like what they do or did. There is no reason why another person should be the way I want them to be; and there is no reason why I should be the way somebody else wants me to be. People will be whatever they want to be, and I will be whatever I want to be. I cannot control other people, or change them. They are who they are; we all deserve basic respect and reasonable treatment.

I Can Handle It When Things Go Wrong
I don't need to watch out for things to go wrong. Things usually go just fine and when they don't, I can handle it. I don't have to waste my energy worrying. The sky won't fall in; things will be OK.

It Is Important To Try
I can. Even though I may be faced with difficult tasks, it is better to try than to avoid them. Avoiding a task does not give me any opportunities for success or joy, but trying does. Things worth having are worth the effort. I might not be able to do everything, but I can do something.

I Am Capable
I don't need someone else to take care of my problems. I am capable. I can take care of myself. I can make decisions for myself. I can think for myself. I don't have to depend on somebody else to take care of me.

I Can Change
I can change. I don't have to be a certain way because of what has happened in the past. Everyday is a new day. It's silly to think I can't help being the way I am. Of course I can.

Other People Are Capable
I can't solve other people's problems for them. I don't have to take on other people's problems as if they were my own. I don't need to change other people, or fix up their lives. They are capable and can take care of themselves, and can solve their own problems. I can care and be of some help, but I can't do everything for them.

I Can Be Flexible
There is more than one way to do something. More than one person has good ideas that will work. There is no one and only best way. Everybody has ideas that are worthwhile. Some may make more sense to me than others but everyone's ideas are worthwhile, and everyone has something worthwhile to contribute.

To Family and Friends of Batterers Intervention Program Participants

It is extremely important for you to be realistic in your expectations of what will be accomplished in a batterers intervention program. Often times participants that enroll in a program on their own, without being court ordered, drop out prior to completing the entire program. Participants mandated to programs by courts are also sometimes (due to circumstances beyond the agency's control) not required to complete the entire program successfully.

Be aware, studies at my programs have shown that 88% of people who drop out of the program (whether court ordered or self referred) without completing are soon arrested. If your partner quits attending before they complete the WHOLE program there is a very high possibility you and your family are in danger of being abused.

I strongly encourage you to contact the domestic violence hotline at 1-800-322-7385 and get connected to a local advocate to help you develop a safety plan. Please do not accept your partner's reasons/excuses/justifications for dropping out of a batterers intervention program to convince yourself not to plan for the safety of you and your family.

My program is specifically designed with the intent and purpose of ending abuse and violence in all forms. We attempt to address all levels of violence including verbal abuse, emotional abuse, sexual abuse, and physical abuse. However, our experience has shown that sometimes participants have taken information presented in our program, twisted it's meaning, and subsequently attempted to use the information as a manipulation tactic. I want you to be aware that if something one of our clients brings home doesn't quite sound right, this is likely what is happening.

My first priority in my program is your welfare and safety. In this regard, please take this notice as an invitation to contact me in any event that you have a question about anything that was said, taught, or talked about in one of our classes. Any conversation I or my staff have with you will be held in the strictest confidence and we will not tell our program participant that we even spoke with you unless you specifically request that we do so. Our studies have shown that less than ten percent of individuals who COMPLETE our entire program are arrested again for any crime. However, please understand, it is safest to assume your partner will be the one in ten that continues to be abusive. So do not assume you and your family are safe just because your partner attends or completes our program.

If you wish to learn how to accurately determine if your partner is improving, come and visit our program yourself for free and learn what we teach.

Wednesday, July 2, 2014

Mental Health Treatment for Domestic Violence; Medicalization of Criminal Behavior

Mental Health Counseling or Treatment is not an appropriate strategy to address abusive behavior; especially domestic violence. A Certified Batterers Intervention Program (BIP) is the appropriate intervention.
Anger management providers are usually licensed clinicians. They will often diagnose, or label, abusive behavior as a “medical condition” or “mental health problem”. They will assign a DSM label such as “Impulse Control Disorder” and will then draft an individualized treatment plan to treat the disorder. This labeling serves to provide abusers with more justifications and excuses for their behavior such as, “I couldn’t help it; I have a problem. I am sick.”

The two most common diagnoses used with abusive men are Intermittent Explosive Disorder and Impulse Control Disorder Not Otherwise Specified. These disorders frame the client as a victim of neurological misfiring, and assert that the client, who is now a victim, has no control over their behavior.

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:

  1. 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.).
  2. If I treat his underlying disorder, he will quit being abusive.

This way of understanding abuse hands the abusive person an excuse for their behavior. The likely result is that they will begin to say, “It’s not my fault; my (fill in the blank mental health disorder) made me do it.” They beg or pressure their partner to hang in there with them while they work on their problem, and promise that things will get better. Because that’s what their victim wants, they may agree to stay in the relationship, deferring their own need for safety and freedom. The therapist has unintentionally become the abuser’s ally in continuing to control their partner.

To avoid feeling guilty and accepting personal responsibility for their behavior, abusers will (consciously or subconsciously) blame anyone or anything they can. In addition to blaming the victim for provoking them, they will blame alcohol, drugs, stress, etc. Regardless of whether these factors contribute to abuse, abusers need to accept full responsibility for their behavior in order to begin the process of personal change. Mislabeling abusive behavior as a medical condition or mental health problem exacerbates the real problem of the abusive person accepting personal responsibility to end their self-delusional beliefs that excuse, justify, minimize, and enable their abuse.

Therapy should not be the standard response to abusers generally, because those attitudes that lead to domestic violence are often not specifically addressed in treatment, including:

  1. 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 abusive person’s benefit.
  2. Cultural and social support for entitlement attitudes. Social support is a powerful reinforcement that keeps abusive behavior going, and clinicians cannot stop abusers from receiving it.
  3. Tactics of control. Abusive behavior is not random. It often boils down to carefully chosen tactics, which are used intentionally to achieve the abusive person’s goal of control. Co-occurring mental health or substance abuse problems do not make tactics into a sickness that can be cured.
As I previously stated, probably the most common diagnoses used with abusive men are Intermittent Explosive Disorder and Impulse Control Disorder Not Otherwise Specified. These disorders frame the client as a victim of neurological misfiring, and assert that the client, who is now a victim, has no control over their behavior. Yet abusers often perpetuate abuse in a premeditated systematic manner using tactics of power and control. Abusers themselves will often claim to be “triggered” to become abusive.

Thus neither of these diagnoses applies, and to use them in order to seek third party reimbursement is at minimum unethical and more likely illegal. The client is then left with an inaccurate diagnosis as part of their medical record, which may be problematic for the client in the future. This also could be harmful for the reputation of the clinician.

Let’s say for a moment, upon the recommendation of their physician, a person wants to quit smoking to avoid a potential medical problem. They enroll in a class to learn techniques to successfully change their behavior and quit smoking. If the facilitator of the class is a Licensed Mental Health Counselor (LMHC) is it ethical and appropriate for them to diagnose the client with an anxiety disorder in order to get health insurance to pay for cost of providing the class? Suppose the client revealed to the counselor that they’ve been smoking for a real long time and they feel a little anxious about “giving it up?” Is it appropriate now for the counselor to diagnose the client to seek reimbursement to fund the class?

An ICADV-Certified Batter Intervention Program (BIP) does not call what it does “treatment.” Treatment is a term for service provided to address a “medical condition” or “mental health” problem. BIPs advocate against viewing abuse as anything other than immoral, inappropriate (often criminal) behavior. Labeling abuse as a “medical condition” or “mental health problem” provides an excuse, “I couldn’t help it, I have a problem.” Thus abusers avoid accepting personal responsibility for their behavior.

Mental health-related problems such as anxiety, depression, anger, substance abuse, personality disorders, intermittent explosive disorder, and childhood trauma are not the cause of abusive behavior toward a partner and/or children. These problems are often 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 or children better. Abusive behavior pays off for the abusive person, regardless of its cost to his partner and children, and treatment is unlikely to get him to stop it for their benefit.

If an abusive person is found to have concurrent mental health disorders along with their violent or abusive behavior, they should be referred for appropriate treatment to address those concerns prerequisite to attending a certified BIP. However, the mental health treatment should never be allowed to substitute for attending a certified batterer intervention program.

Terry A. Moore, LCAC
ICADV Certified Senior BIP Facilitator