Key Components of the Batterer Intervention Program Process: An Analysis of Observational Data From Two Community-Based BIPs

Abstract

Qualitative research on batterer intervention programs (BIPs) has primarily consisted of interview-based studies of clients and facilitators. To date, no research has utilized observational data to understand how BIPs “work,” or the processes occurring in BIPs that promote prosocial behavioral change. Forty-four observations of BIP group sessions were conducted. Two key processes were found: “facilitator processes” (e.g., managing group dynamics and engaging clients in learning) and “client processes” (e.g., mutual aid, help-seeking, and support). More observational research on BIPs is needed to uncover the full range of processes occurring during BIPs and that can link group processes to client outcomes.

Keywords

intimate partner violence perpetrators batterer intervention

Introduction

Intimate partner violence (IPV) is recognized as a serious public health threat which can have a number of adverse health consequences for victims, including physical injuries, reproductive health issues, mental health problems, and gastrointestinal disorders, among others (Sugg, 2015). Efforts to reduce IPV and its associated health costs have primarily focused on victims (Sugg, 2015); however, there has been the growing recognition that programs that provide intervention to perpetrators and can stop abusive behaviors at the source are needed. In response to this, the United States has seen an increase in the implementation of group intervention mechanisms designed for perpetrators (Barner & Carney, 2011), otherwise known as batterer intervention programs (BIPs; Barner & Carney, 2011; Bennett & Williams, 2001). Today, an estimated 1,500-2,500 BIPs exist in North America (Cannon et al., 2016; Carter, 2010; Price & Rosenbaum, 2009), and similar programs can be found throughout Europe, Australia, and other parts of the world (Chung et al., 2003; Enosh et al., 2013; Hamilton et al., 2013; Rothman et al., 2003).

Although different theoretical orientations for BIPs exist, a recent survey by Cannon et al. (2016) found that the Duluth model (Pence & Paymar, 1993), a feminist psychoeducational method, and cognitive behavioral therapy (or some combination of the two) continue to be the most commonly reported programmatic approaches. The goal of BIPs is to encourage men who perpetrate violence to take responsibility for their abuse, and ultimately, cease their violent behaviors (Bennett & Williams, 2001; Mederos, 1999; Saunders, 2008). However, research on BIPs remains inconclusive as to their ability to reduce perpetration (Eckhardt et al., 2013). Furthermore, the underlying mechanisms that may elicit behavioral change during the BIP process remain unclear (Gondolf, 2012; Velonis et al., 2020). Nonetheless, BIPs remain the number one programmatic effort to address perpetration (Cannon et al., 2016; Carter, 2010), and their importance as a component of coordinated community responses to IPV cannot be minimized. Thus, continuing research on BIPs, and in particular, on how BIPs work to promote positive behavioral change among perpetrators, is warranted.

Research on BIPs

Much of the scholarly work on BIPs has focused on determining program effect, or rather BIPs’ ability to reduce IPV behaviors among their clients and/or if one BIP model is more effective than another (Eckhardt et al., 2013; Ferraro, 2017). Most of these studies have used experimental, quasi-experimental, or meta-analytical methodologies to determine BIPs’ impact on recidivism or reassault rates (Eckhardt et al., 2013). Although some have shown promise (Boots et al., 2016; Crane & Eckhardt, 2013; Kelly & Westmarland, 2015; Lila et al., 2018; Mills et al., 2012; Zarling et al., 2015), most have shown little to no program effect (Babcock et al., 2004; Dunford, 2000; Easton et al., 2007; Feder & Dugan, 2002; Feder & Wilson, 2005; Gordon & Moriarty, 2003; Haggård et al., 2017; Labriola et al., 2008; Miller et al., 2013; Tutty & Babins-Wagner, 2019). Thus, there is still no conclusive evidence that one BIP model is more effective than another or that BIPs are able to consistently and significantly reduce IPV perpetration behaviors (Eckhardt et al., 2013). Furthermore, methodological issues (e.g., loss to follow-up, heterogeneity of programs, lack of ability to randomize) make it difficult to conclusively say what impact programs have on perpetration behaviors (Gondolf, 2001). Finally, as some have argued, although quantitative studies of BIP efficacy are important, they also are limited in that they provide little descriptive information on the contexts and processes associated with change during treatment (Sheehan et al., 2012).

Qualitative research, however, may be better suited to explore the contexts and processes of change associated with BIPs (Sheehan et al., 2012). Such studies can shed light on the experiences of treatment, the circumstances in which change may or may not occur, and more importantly, the mechanisms of BIPs that are effective for promoting behavioral change among perpetrators (Carter, 2010; Sheehan et al., 2012). Qualitative research on BIPs, therefore, has sought to understand the factors that enable or impede change among men who perpetrate violence (Aguirre et al., 2011; Enosh et al., 2013; McGinn et al., 2020; Morrison, Hawker, et al., 2021; Parra-Cardona et al., 2013) as well as the behavioral and/or psychoeducational gains (e.g., anger-management skills, increased knowledge of IPV) that can be made from BIPs (Holtrop et al., 2017; Kelly & Westmarland, 2015; Kilgore et al., 2019; Morrison, Burke, et al., 2018; Pandya & Gingerich, 2002; Rosenberg, 2003; Scott & Wolfe, 2000; Sheehan et al., 2012). Other studies have looked at BIP group dynamics (e.g., therapeutic alliance, peer support and discussion) and how the interpersonal interactions that occur during group work might contribute to change (Boira et al., 2013; Chovanec, 2012, 2014; Gray et al., 2014; Holtrop et al., 2017; Morrison, George, et al., 2019; Parra-Cardona et al., 2013; Rosenberg, 2003; Shamai & Buchbinder, 2010; Silvergleid & Mankowski, 2006). Thus, this body of research has been particularly salient in helping to describe some barriers and facilitators to change, how change is understood by those engaged in BIP work, and some of the components of BIPs that perpetrators and facilitators find useful.

To date, however, almost all of the qualitative research on BIPs has been conducted using interviewing methods of data collection (McGinn et al., 2020). Interview-based studies, although important, are nonetheless limited in that participants engaging in interviews may be unwilling or unable to share certain things, may not remember all aspects of an experience and/or may recall experiences incorrectly, or may perceive events to be irrelevant and not report them (Green & Thorogood, 2018; Pope & Mays, 2006). Thus, interview studies alone may be incomplete in what they tell us about how BIPs work and the contexts and processes that support change during this process. Studies that use direct observation of BIPs, and systematically observe and record how BIP clients and facilitators relate to and behave within the BIP environment are therefore needed. Very few observational studies of BIPs exist, however (Santirso et al., 2018; Semiatin et al., 2013); those that do use quantitative measures to rate client/facilitator working alliance (Santirso et al., 2018; Semiatin et al., 2013) and/or the relationship of pro-therapeutic behaviors in group to recidivism/reassault rates (Semiatin et al., 2013).

To our knowledge, there appears to be no studies that have sought to utilize qualitative observational methods to analyze BIPs and systematically document and record the BIP group processes as they are occurring. This study seeks to fill this much-needed gap by presenting findings from direct observations with two participating community-based BIPs. Such studies can provide insights into the BIP group process that may not be readily forthcoming from interviewing alone, capture behaviors or other interactions that BIP participants may not realize are happening, and provide insights into the interpersonal interactions between individuals and the group (Pope & Mays, 2006). In addition, such studies can assist in our understanding of what “works” for BIPs, or rather the specific processes and mechanisms that are most effective for engaging perpetrators in intervention and reducing abusive behaviors.

Method

Parent Study

Between 2013 and 2015, we conducted a 2-year ethnographic study of two community-based BIPs in an urban setting in the United States. The parent study employed both semi-structured interviews and direct observations of BIP groups to address two primary aims. First, we sought to understand the BIP experience from the perspective of BIP clients, facilitators, administrators, and other professionals whose work brings them in close contact with BIPs and/or IPV. Second, we collected observational data to document and describe how BIPs “work.”

Current Analysis

As part of the parent study, we performed direct observations of BIP group sessions. Observations sought to answer two key questions about BIPs. First, we wanted to capture BIP group content including what topics or subjects were addressed within groups and how information was delivered or brought to the group (e.g., psychoeducational activities). Second, we wanted to understand the BIP group processes, or rather the interpersonal interactions between facilitators and clients that occurred in groups that may precipitate change, including how facilitators managed group dynamics, how facilitators and clients interacted, and how clients interacted with one another. The current analysis draws on these observations to highlight the process components of BIPs.

Setting

We collected data from two community-based BIPs operating in an urban area in the United States. At the time, the BIPs were two of the largest, longest operating programs of their kind in the area. Each program had at least 10 years of experience providing BIPs, had at least five locations in the area where they provided services, and served more than 100 male clients per year, most of whom were court-mandated to attend. Both programs also had open or rolling enrollment, meaning that new clients could join the group at any time. One program was stand-alone, meaning it was not attached to another service agency; the other was administered by a local women’s shelter. The main difference between the two programs was that one utilized a 16-week format and an adaptation of the Duluth model; the other utilized a 24-week format and an adaptation of Emerge.

Data Collection

In total, we conducted 44 observations of BIP group sessions; 18 observations were conducted at the 16-week Duluth-based BIP, and 26 were conducted at the 24-week Emerge-based BIP. Program administrators informed facilitators within each agency about the study and the dates and locations for planned observations. In total, we observed 11 facilitators (four at the Duluth-based program, seven at the Emerge-based program) at eight locations (four locations per BIP). As the goal of our study was to observe the BIP group process and not to track individual clients’ progress through the group, at the suggestion of our IRB, we did not keep track of which clients were present at each group session. Thus, we cannot report on the total number of clients observed throughout the data collection as some clients may be represented more than once in the data set. Instead, we can only report on the average number of clients present at each observed BIP session. Over the course of all 44 observations, the average number of clients present per session was 10, with between 8 and 15 clients present at any given group meeting. To reduce the burden on facilitators and clients of having an observer present, we rotated observations every week to a different location; thus, each week for a period of 26 weeks we attended a BIP group session at one location at each agency until observations were complete. The number of group session observations performed in each BIP were chosen based on the number of required sessions for the usual client in each BIP; we mimicked the number of sessions a typical BIP client would attend for that specific BIP with two additional session observations to ensure that we had attained saturation regarding observations. This strategy allowed us to gain a broader insight into the variations that exist within BIP groups due to factors such as changing clients (i.e., clients entering or leaving the program), service location (i.e., the demographics and make-up of clients), and differences in facilitators’ style and/or ways of working together during the group.

To ensure accuracy, validity, and quality of observational data, we utilized a multistep process. First, two PhDs trained in ethnographic research attended each BIP group session together and took detailed notes. Second, immediately following BIP sessions, the researchers conducted a debriefing session with the BIP facilitators in attendance to review notes, reconcile differences in observations, solicit facilitator feedback and insight, and clarify any issues that might have arisen during the observation process. Third, the two researchers then met independently of BIP facilitators to review notes once more, reconcile any remaining differences, and consolidate notes into a master file for analysis. Any program materials that were used during group sessions (e.g., handouts, lesson plans) were also inserted into the notes and included in the master file.

A note on the ethical implications of group observation: During the BIP intake process, clients are informed of the possibility of having an outside observer in the group and sign a contract acknowledging this and other program rules before beginning regular sessions. Observers, therefore, constitute a part of the programs’ normal operating procedures, and clients are accustomed to occasionally having observers present. Nonetheless, we understood that clients could become uncomfortable with our presence and that this, in turn, could lead to clients feeling resistant and/or unwilling to open up during group, thus impeding the work the BIPs were trying to accomplish. To minimize such occurrences, and in consultation with the BIPs and our IRB, we took the following steps to reduce discomfort. At the start of the BIP session, one of the researchers read an introductory script providing a general overview and description of the study. The researcher emphasized that although she and her colleague were taking notes throughout the duration of the group session, no identifying information would be collected (e.g., name, race, age) and that the focus of the observation was strictly on the group content, processes, dynamics, and interaction styles. The researcher also reviewed with the clients the steps taken to protect their anonymity and safety during the conduct of the study. The researcher then gave the clients time to ask questions or seek clarification.

All observation notes were typed up. We used Atlas.ti (Muhr, 2004), a qualitative data management software program, to organize and store our data and data analysis. Our analysis was guided by the two research questions: (a) What is the content addressed in the BIP sessions? and (b) What are the processes of BIPs? Because of the complexity of the observational data, we chose to perform two independent analyses—one which focused on identifying thematic codes related to BIP content, and the other focused on identifying thematic codes in BIP processes. Given the scope of the research and the breadth of information gathered during the study, only the process codes are presented in this article. For this analysis, we performed a three-coder iterative approach, with an emphasis on identifying broad thematic codes and subcategories (Crabtree et al., 1999). In the first step, the first and third authors and a qualitatively trained research assistant each independently conducted open coding of the observation notes. Each coder reviewed the text line by line and made note of initial thematic categories and codes. Next, the coders met to review the coding and to begin to develop a draft codebook of themes and subthemes and definitions for each. The codebook was then given to other members of the research team, including participant stakeholders, for feedback. That feedback was incorporated into the codebook for further refinement. The coders then recoded the notes using the codebook. All coders met an additional time to compare coding and reconcile any discrepancies if needed.

Results

Our analysis yielded two categories of process codes present in the observational data. First, “facilitator processes” are interactions in which facilitators sought to manage group dynamics or engage clients in the learning process, including establishing ground rules, refocusing clients, empowering clients to see they have choices, challenging clients on their behavior, soliciting client input, and providing positive feedback. Second, “client processes” are interactions driven by clients, including asking for help from the group, offering each other advice, challenging other clients, providing support, and showing resistance.

A note on data presentation: Group processes are dynamic, and arguably, such interactions are defined by the actions and reactions of group participants, the participants present, and the content of group discussions. However, for sake of clarification and ease of presentation, we have divided these processes into the thematic categories described above to provide an overview of the kinds of interactions typical of clients and facilitators during batterer intervention group sessions.

Facilitator Processes¹

Establishing ground rules

Table 1 presents themes and examples from the facilitator-driven processes. One of the most common facilitator processes were those that established “ground rules.” Clients typically arrive at BIP group sessions having had an intake that informs them of group policies and procedures. However, they often needed a reminder of what was expected of them. Thus, sometimes “ground rules” included reinforcing policies related to issues such as attendance. For example, when clients arrived late to group, facilitators might use this as an opportunity to remind clients to be on time to group sessions or other attendance policies (Quote 1).

Table 1.

Facilitator-Driven Processes.

Theme	Quotes
Establishing ground rules	1. M11 enters in late. F11 tells him he cannot be there. M11 doesn’t argue and leaves. M12 comes in 15-min late; he is asked to leave. F11 says that it is perfect opportunity to remind the clients that they must be on time. It is a rule of the program not to allow late clients to enter unless they have notified ahead of time.
	2. M2 starts to speak, M4 interrupts again (he has done this twice now) and starts talking over M2. F2 asks M4 to please stop interrupting. She says that M4 needs to allow the other clients in group to talk. F2 says this goes for the rest of the group as well, they need to respect each other and take turns talking.
	3. M7 says that he and his “woman” got into a fight, he was charged with simple assault. F10 says that M7 needs to refer to his partner by her first name, or simply partner. M7 says his partner irks him and doesn’t get why he has to. F10 says that it’s simple, a matter of respect. She says that M7 doesn’t have to use her name, but phrases like “my woman” objectify women, and they are not going to be disrespectful to women in the group. F2 agrees and says that no matter how they feel about their partners, the men still have to be respectful.
Refocusing	4. F2 says he wants to talk about self-care. He asks the men what they do to relax. M7 says he watches TV. M8 agrees but says that wasn’t so relaxing this week. He says didn’t like the Super Bowl. (The discussion digresses into a conversation about the Super Bowl.) M1 agrees and says he hated the Super Bowl. M5, M6, and M3 weigh in on the game. F2 stops the men and says (with a laugh) he’s not happy about the outcome of the game either, but that they need to get back on track. He reminds the men that they are there to learn, they really need to focus on the topic at hand. He asks again, what do the men do to relax?
Refocusing	5. M2 says he did not do anything wrong, he’s the victim. His partner started the argument. F2 says that this isn’t about attacking M2 or placing blame. Rather, they want him to learn some tools that will keep him from coming back. F2 addresses the group and says, the group is not about who’s right or wrong. It’s about helping the men, including M2, to learn about themselves. Thus, they are interested in M2, not his partner. F9 adds that the group is an opportunity for M2 to learn something and make some changes, but he has to focus on himself.
Soliciting client input	6. M1 says his partner yells at him when he comes home; he doesn’t know how to respond to it. He keeps his mouth shut, just sits there, and watches TV. F2 says to the group, “Help him out. What coping skills does M1 have so that he doesn’t have to walk away or chose to fight?” M7 says that he should give his partner his full attention, M1’s partner just needs to get stuff off her chest, M1 should keep the lines of communication open. M4 thinks M1 and his partner need to have a mutual agreement for a time to talk, turning the TV on signifies that M1 is ignoring his partner. M8 agrees, M1 should turn off the TV. M5 agrees M1 should turn off the TV and talk about the situation with his partner when things are calm. M8 says do not offer your partner suggestions, guys try to fix things all the time, sometimes women just want their partners to listen. M5 agrees and says that sometimes people just want to vent and want their partner to listen.
Emphasizing choices	7. M2 says that he doesn’t belong in group and is “forced” to be there. F12 asks M2 whether the judge gave him a choice. M2 says yes, these classes or jail. F12 asks M2, so you chose the classes? M2 says yes. F12 if he does not want to be there, he does not have to be. He is free to leave—but that is his choice. She adds if he chooses to stay, he can also choose what he wants to get out of group. She says he’s paying to be there, so why not get something from it?
	8. M4 saw texts from another man on his partner’s phone. His partner was drunk and asleep, he woke her up to confront her. F4 says that if he knew his partner was drunk and asleep, it’s no wonder it didn’t go well. She asks M4 what he would do differently now. M4 says nothing. He had no choice. He can’t not have those emotions when he finds texts like the ones he found. F4 asks if M4 can reframe the situation so that he could get himself through to the next morning; she says what she’s hearing is that if the situation happened again, M4 would do the same thing. M4 insists that he could not have done anything differently; he can’t not respond when he is angry. F3 says that the point is that M4 has choices. He did not “have” to do anything. He chose to, and if a chose to, he could choose not to, or to react a different way.
	9. M1 says that his partner “pushed his buttons.” He just snapped. M3 agrees with him and says that’s what happened to him. F3 says, if we’re responsible for how we react, what exactly does it mean when someone “pushes your buttons”? M2 says we all have buttons; we all have limits to what irritates us. F3 agrees, we all have things that irritate us. However, we have a choice how to respond. Someone can only push your buttons if you let them. M3 says what do you do then, do you just not get upset? F3 says you have to make the decision to not act the same way to something that irritates you. No one has the power or the authority to make us do anything unless we give it to them. It is your choice to respond a certain way.
Confronting clients	10. M5 and his partner got into a fight. Afterward, his partner, who is 3 months pregnant, was having stomach pains, so he took her to the hospital where he was arrested. F3 says that his story does not make sense, why was he arrested? M5 says he doesn’t know. F3 asks if he punched her in her stomach. M5 says he did not, but she had a bruise on her stomach. F3 asks how she got the bruise on her stomach. She says she’s going to ask him again; did he punch her? M5 finally admits he pushed her. He insists he did not punch her, he only pushed her.
Confronting clients	11. F1 says “let’s break it down.” She says, what if the men are out with their partners at a club and someone asks her to dance, what’s the response? Whose choice is it if she wants to dance with someone? M5 says “She gets to choose if she wants to dance with someone?” M6 agrees and says, she’s my wife, since the beginning of time men fought to protect their partners. M2 says you have to protect what’s yours, that’s part of being a man. F1 says she’s bothered by the men’s attitude, such thinking objectifies women, it gives men permission to try to control their partners. She uses the example of a pen and says “this is my pen; it’s mine. I can do with it what I please. I can toss it in the trash, break it, throw it on the ground.” She says the point is that this thinking allows the men to be controlling, they need to think about how this thinking gives them permission to be abusive.
Demonstrating support and feedback	12. F1 asks M1 to clarify something. Earlier he said that his PT “pushed his buttons” but he didn’t respond to her. F1 wants to know what M1 meant by that. M1 says normally he would have lost his temper at his PT, but he didn’t this time, he just took a time out. F1 says that’s progress, he didn’t let it escalate or do something worse. She asks M1 how that makes him feel. M1 says that it makes him feel good; he is trying to do what the group says. F1 says that M1 should be proud of himself that he responded appropriately and adds “good work.”

Other “ground rules” included behavioral norms or expectations for how clients should act during group. For example, clients sometimes could be disruptive or disrespectful to the group. In those instances, facilitators would intercede and remind clients that such behavior would not be tolerated. Quote 2 demonstrates what happens when a client continues to talk over other clients in the group and the facilitator intervenes. Other examples included instances such as clients’ cell phones ringing, clients not paying attention, talking over one another or the facilitator, falling asleep, or engaging in distracting behaviors (e.g., looking at cell phones, texting).

One of the most common “ground rules,” however, was the expectation that clients would exhibit respect toward women. Many BIPs ask clients to avoid language that is derogatory toward women (e.g., “girl”), and thus, a common practice in groups is that clients are expected to use their partners’ name or the term “partner” when discussing their victim (Quote 3). “Ground rules,” therefore, served to establish basic operating procedures within groups. By conveying a range of behavioral norms that clients were expected to adhere to, facilitators helped to minimize behaviors that disrupted the group or were disrespectful to group members, partners, or women more generally. In this way, ground rules were useful not only in helping facilitators to manage the group process, but they also provided an opportunity to model behaviors that were goals of the BIP itself.

Refocusing

Another common facilitator process was refocusing clients or helping clients stay on topic or focused during group. For example, clients sometimes would discuss topics that were irrelevant to the group (e.g., sports) and the facilitator would have to refocus their attention back to the discussion at hand (Quote 4). Not infrequently, clients also would try to avoid assuming accountability for their actions by attributing blame to the victim. In these instances, facilitators would gently remind clients that the intent of the group was to help them learn, but to do so, the men needed to focus on themselves (Quote 5) and on their own behaviors and responses. Facilitators, therefore, often had to remind clients of the intent of group and their desire for clients to learn something to keep clients focused and on topic. In this way, facilitators also were able to redirect clients when they began to avoid accountability or engage in negative discourse regarding their partners. Again, this served the dual purpose of keeping the group focused as well as reinforcing the message that participants need to take responsibility for their abusive behaviors.

Soliciting client input

Facilitator processes also included instances where facilitators solicited the input of the group. This kind of interaction occurred when clients brought issues to the group, asked a question or for advice, or expressed uncertainty about how to deal with a problem or situation. Rather than providing the answer themselves, facilitators would turn the problem back to the group and ask for their input and suggestions (Quote 6). In this manner, facilitators often encouraged clients to talk through problems with one another and provide feedback to each other. By placing issues in the hands of the group, facilitators promoted participation and engagement in the group as well as collective problem-solving. This too helped to enhance the group process as well as demonstrate useful relationship skills for participants.

Emphasizing choices

Another facilitator process was that of framing clients’ actions and behaviors as a choice. This process often occurred when clients demonstrated resistance, either to the program or to accepting responsibility for their actions. For example, it is a common occurrence for clients new to the BIP program to argue that they did not need to be in group and that they felt it was unfair that they were forced to attend the program. Facilitators often met this initial opposition to the program by framing participation as a choice (Quote 7). Clients also sometimes stated, because of their anger or other emotions, that they had no “choice” but to behave in certain ways (i.e., abusively; Quote 8). Similarly, clients also often insisted that their behaviors were justified because of the actions of their partners. Thus, facilitators often had to counter the common refrain among clients that their partner had “pushed their buttons” (Quote 9). Emphasizing choices, therefore, served to counter client resistance and underscore for clients that their actions and behaviors are a choice, and as such, they can choose how they wish to respond in any given situation.

Confronting clients

Facilitator processes also included interactions whereby facilitators confronted clients in the group. Facilitators intentionally and directly challenged both individual clients and the group when facilitators felt clients were either engaging in denial or otherwise trying to rationalize their behaviors. In this first example, the client refuses to admit that he in some way physically harmed his partner (Quote 10). In the next example, the facilitator confronts the whole group regarding their attitudes toward their partners as objects and how this thinking allowed them to rationalize or justify their abuse (Quote 11). Using direct confrontation, facilitators could simultaneously prevent the group from going off track and emphasize the behavior change expected of the participants.

Demonstrating support and positive feedback

Finally, facilitators also provided positive feedback and support to clients. This process included instances where facilitators would acknowledge clients’ progress or change and provide the client with encouragement, while simultaneously reinforcing the tools, skills, or other lessons being taught in group (Quote 12). Positive reinforcement, therefore, was often used to encourage clients’ continued efforts toward making prosocial behavioral changes.

Support in the groups, however, extended beyond positive reinforcement; it also included instances where facilitators demonstrated kindness and empathy to clients who were struggling with issues outside the scope of the group (e.g., death or sickness in the family, loss of employment). Rather than shutting clients down when they shared such issues, facilitators would give clients some time to express their feelings and then ask whether there was anything they needed from the facilitators, or the group, that night. Facilitators also often offered additional support (e.g., willingness to speak to clients outside of the group, referral services). Thus, facilitators created space for clients to share, and receive support for, what was going on in their lives.

Client Processes

Asking for advice

Table 2 presents themes and examples from the client-driven processes. Client processes included interactions where individual members of the group, without facilitator intervention or prompting, would solicit advice from the other clients by presenting a problem to the group and asking for their input and feedback. Examples include asking the group to weigh in on whether a behavior is abusive (Quote 1) and asking for help with a partner whom a client fears is jeopardizing his job (Quote 2). In both cases, the client presents a problem to the group and asks for help from the other clients and the facilitators. This process allowed clients to receive input and advice regarding the issues they are struggling with and, more importantly, often provided critical feedback to clients on their behavior.

Table 2.

Client-Driven Processes.

Theme	Excerpt
Asking for advice	1. M8 has a question for the group. He wants to know whether it’s power and control when he asks his partner what she wants and she says “whatever” and so he makes the decision. M5 says that everyone’s relationship is different and that M8 has to find what works for him and his partner. M8 says that he’s trying not to control or abuse his partner, but she never answers him when he asks her what she wants, and after a while he stops trying to ask. M5 says that it can only be abuse if he’s trying to control his partner. M2 asks M8 whether that’s what he’s trying to do. M8 says he doesn’t think so. M2 says that maybe M8 should look at the situation a little deeper and reflect on what is really going on, maybe she doesn’t respond because when she does, you don’t take her opinion into consideration and do what you want anyways. M8 says that may very well be true.
Asking for advice	2. M10 has a question. His partner is calling, texting, and even showing up at his job. What can he do in that situation? M2 asks him what he thinks should do. M10 says he doesn’t know. M4 asks M10 why he thinks his partner is doing this. M10 says he doesn’t know, maybe his partner needs more attention. M3 says he thinks there is more going on that M10 is admitting, but the first thing M10 should do is solve the problems he is having at home so they wouldn’t spill over into his workplace. M2 agrees and says that he has to handle his relationship on the front end so that it doesn’t affect the rest of his life. M10 admits that he hasn’t been doing that. He’s been avoiding his partner.
Giving advice	3. M3 says he checked his partner’s texts because he suspected she was cheating. She caught him, and they got “into a fight.” He pushed her and now he is here. M2 says that he wants to say something to M3 about looking at his partner’s texts. M2 says that the text thing is “tricky.” M3 responds that it is only “tricky” when you find something. M2 says that he’s done the same thing before and wishes he didn’t; furthermore, he thinks M3 shouldn’t even think “I should look through the phone.” He’s learned that if that is what he is thinking then perhaps that is not a relationship he should be in. He thinks that M3 should talk to his partner about his concerns, and if he can’t, perhaps he should rethink the relationship.
Confronting each other	4. M1 says his partner does not handle the children the way that he thinks she should. M4 jumps in and says M1 doesn’t live there, so really he can’t say anything. What he hears is that M1 is a visitor in the house. He says that visitors can’t come in and start barking orders. He then asks M1 whether his parnter is his “friend.” M1 agrees that yes, she is. M4 says well, “then help her clean up, that’s what friends do for each other.” He says if M1 isn’t willing to live there with his partner full time, he needs to be respectful like a visitor and not make demands. M6 agrees and says that M1 needs to make his presence known and not his attitude. M1 says she asks him to help clean up and he doesn’t feel that he should have to clean up. M4 interjects and says from the outside looking in that M1 should give his partner a hand and that the real solution is that M1 needs to makeup his mind as to whether or not he’s going to be with his partner. He hears M1 pointing the finger at his partner and really what M1 should be doing is pointing his finger at himself.
	5. M9 says that he is frustrated with his partner that she still does not trust him. He wants his relationship to be where his partner trusts him and that he can drink and not act out. M7 says that he thinks M9 is being selfish and that M9 wants her to trust him for him, so that he can drink, not his partner. He says that in order for it to be selfless, M9 should want to better himself for the sake of his partner and her safety. M9 says he does, but he also wants to move forward. M3 agrees and says that M9 should think about why it’s so important to him that his partner trust him when he drinks. He thinks it’s because M9 wants to drink and not because he wants to do what he should to take care of his relationship.
Providing support	6. M2 says that he id’ed a few of his triggers over the weekend, at work he got into a problem with one of his coworkers. He says that he felt his face getting hot and flushed and felt his body getting heated so he walked away and then came back and talked calmly with her. M9 asks him how the conversation resolved. M2 says that he told his coworker he felt misunderstood and blamed. He was confused why she was upset. After talking, he understood better what had happened and how he had contributed to the situation. M9 says it was good M9 was able to remain calm, identify his feelings, and control his behavior.
Resistance	7. M13 says he restrained his partner, she got scared and called the cops on him. FD2 asks him whether they are still in a relationship and live together. M13 says yes. F14 asks him what he has been doing since to keep this from happening again. M13 says nothing. There’s no need to do anything. He and his partner are fine. M11 asks M13 what he will do if it does happen again and M13 says “get rid of her.” M9 says M13 needs to think about what he did to cause the situation. M13 says that his partner initiated it, he still doesn’t see how he is responsible. F14 says they are both accountable for their own actions, regardless of who initiates it. M13 says he still does not see how what he did was enough for his PT to call the cops; he does not think he needs to be in this group. He is not “abusive.” M8 says he restrained his PT. If he hadn’t reacted the way he did, he wouldn’t have to be dealing with the consequences of his actions. M13 protests, he restates that his partner initiated it, so how is he responsible, holding her down was not enough to call the cops. F14 says “wait a minute.” We assume that others know our intentions. He’s a big guy and perhaps he doesn’t realize how intimidating he can be—especially when he’s angry. She says that most people don’t realize how they look when they are angry. M13 says his partner should know him “better than that.”

Giving advice

Client processes also included interactions in group in which clients gave unsolicited advice to each other, again without prompting from the facilitators. In these instances, clients offered up their own experiences and insights to help each other. This type of advice was usually framed by clients within the context of having been in the same situation in the past and/or when one client in group identified with another’s experiences (Quote 3). By sharing an experience and what had been learned from that experience, clients were able to provide feedback to others in the group about how to handle problems in their relationships differently.

Confronting each other

Another client process included instances where clients would confront one another about their behavior. Modeling the confronting behaviors of facilitators, clients would also confront other clients for not taking responsibility for their behaviors. In Quote 4, a client, who is upset at the mother of his children, is confronted about his behavior by the other clients in group. Another example (Quote 6) occurred when clients confronted another member of the group who is upset that his partner continues to not trust him because of his behavior. In both examples, the group confronts another client about his behaviors and the motives underlying those behaviors. By doing so, clients often served as a kind of “checks and balances” for one another, holding each other responsible for their behavior.

Providing support

In addition, clients modeled the supportive behaviors of facilitators. When other group members demonstrated positive changes, clients noticed and would often comment on what they believed was genuine progress (Quote 6). Clients also provided support to members of the group who were dealing with difficult issues outside of the context of abuse, such as health concerns, deaths in the family, or joblessness, among other issues. Thus, client processes included those instances where group members acted as a kind of support network for one another. By providing positive feedback and demonstrating empathy, clients helped to encourage each other toward change. Such instances also served to build group comradery and exemplify the impact of the group in supporting improvement and change among its members.

Demonstrating resistance

Finally, client processes also included instances in which clients actively resisted the group. For example, one client, who has been in group for several weeks, continued to resist feedback from both the facilitator and the other group members (Quote 8). In this instance, despite both the facilitator and other clients challenging him and encouraging him to think about his behavior and the choices he made, the client continued to show resistance and deny that he is abusive. Although such resistance is unfortunate, this example nonetheless also helps to highlight how clients work together as a group to try to challenge each other and hold one another accountable for abusive behaviors.

Discussion

Our 2-year ethnographic study of BIPs used direct observation to capture some of the processes, or interpersonal interactions, that may be occurring in such programs. We found facilitator-driven processes helped to manage group dynamics and enabled learning both at the individual and group levels. Clients, interestingly, also engaged in processes that mirrored those of facilitators and helped to meet their own needs or those of a fellow group member. Our findings not only support much of the qualitative literature on the BIP group experience, as reported by facilitators and clients, but also shed light on processes that may not be evident in interview-based research. Our findings are therefore important for demonstrating firsthand how BIPs work in “real time” and have significance for thinking about how to improve our understanding of BIP efficacy.

Although our identified facilitator processes of establishing “ground rules” and “refocusing” have not been identified in the interview-based qualitative literature on BIPs, there is some indication that these processes are evident in other BIP studies. For example, clients in Holtrop et al. (2017) viewed facilitators as “holding the group together” or keeping the group on the right course, whereas those in Parra-Cardona et al. (2013) saw facilitators as “in charge of the orchestra.” Likewise, clients in Brownlee and Chlebovec (2004) and Chovanec (2012) reported that facilitators helped them to stay focused on themselves during group. Although it is unclear whether the findings from these studies are the result of the exact processes found in our analysis, our study nonetheless suggests that facilitators engage in processes designed to manage across individual and group dynamics, such that interruptions and digressions are minimized. Furthermore, our study suggests that these processes may not always be readily apparent to clients and, as such, may be underreported in interview-based research with perpetrators. Such processes, however, are important for thinking about how facilitators manage BIPs and suggest that facilitators’ ability to keep clients on track and focused is important for maintaining group integrity.

In contrast, BIP facilitators’ use of confrontation is well-documented in the BIP literature (Boira et al., 2013; Chovanec, 2012, 2014; Gray et al., 2014; Holtrop et al., 2017; Kelly & Westmarland, 2015; Morrison et al., 2017; Morrison, George, et al., 2019; Parra-Cardona et al., 2013; Silvergleid & Mankowski, 2006) and thus that we found this type of interaction in our analysis is not surprising. Our research, therefore, helps to provide “real-time” examples of how confrontation works and more importantly how it is used by both facilitators and clients alike. However, confrontation within BIPs is not without controversy. Confrontation is typically a key strategy used in the Duluth model (Pence & Paymar, 1993). Critics of confrontation and the Duluth model have suggested that this kind of interaction may increase resistance by shaming clients (Dutton & Corvo, 2006, 2007; Mankowski et al., 2002; C. M. Murphy & Baxter, 1997; Musser et al., 2008). Although we cannot be certain, our findings do not seem to indicate that confrontation necessarily involved shame nor had any adverse implications in the groups. Furthermore, we found that although facilitators and clients confronted other group members, they also provided support and positive feedback to group members when needed. Research has shown that support is an important counterpoint to confrontation in the BIP context—that is, clients have regularly reported that having a balance between confrontation and feeling cared for during group is important for motivation and engagement (Boira et al., 2013; Chovanec, 2009, 2012; Shamai & Buchbinder, 2010; Silvergleid & Mankowski, 2006). That both facilitators and clients engaged in supportive interactions with other clients is important, then, and shows that BIPs can create a balance between a positive, caring environment, and one that confronts perpetrators and holds them accountable for their behaviors. Facilitators working in BIPs may wish to consider how to appropriately balance confrontation and support during group. A better understanding, however, of how these two processes work in tandem and are related to BIP outcomes is needed.

We also found that facilitators used processes such as emphasizing choices to counter client resistance. Like confrontation, emphasizing choices served to help promote accountability by placing responsibility for their decision-making on the clients. The notion of emphasizing choices is also not a theme that has been identified in the qualitative research on BIPs. However, both Holtrop et al. (2017) and Silvergleid and Mankowski (2006) found that clients in their studies reported gaining the knowledge that they could make different choices when confronted with anger. Again, it is unclear whether these findings reflect the process of emphasizing choices we found in our analysis; nonetheless, our study suggests that there may be more subtle, less obvious processes (than confrontation) occurring in BIPs that minimize resistance and promote accountability. At the same time, we also found some clients, despite the efforts of facilitators and other clients, continued to exhibit resistance to the program. Resistance and denial are common in BIPs (Boira et al., 2013; Gray et al., 2014; Morrison, George, et al., 2019; Morrison, Hawker, et al., 2021), and thus, it is not surprising that we observed this in our data. However, when our findings are considered together, what emerges is a complex set of processes, whereby clients receive direct and indirect feedback from both facilitators and clients, each of which is negotiated in the moment or renegotiated across time as clients make progress and/or experience setbacks. Our study, therefore, suggests that more observational research is needed not only to continue to uncover the full range of processes occurring in BIPs, but that can also link those processes back to client progress or stages of change. One of the main conclusions from this work then is that qualitative research on BIPs may need to utilize more multimethod designs, such as observational studies combined with immediate postgroup interview or surveys that can capture real-time responses to BIP group processes. Such studies would allow us to better understand which group processes are the most beneficial for promoting behavioral change among perpetrators and to begin to link those processes to desired outcomes, thus helping to clarify the question of not only BIP efficacy but also that of best practices.

In addition, we found that facilitators and clients both encouraged participation in and ownership of the group. Facilitators solicited input from the entire group when clients presented an issue or problem. Clients similarly mirrored this process by independently posing questions to the group and asking for advice from their fellow groupmates. Both of these processes engendered participation by engaging the group in a form of collective problem-solving. The processes also allowed clients to take some ownership of the group, by giving them the opportunity to learn from one another and by allowing them to devise their own solutions to their problems, rather than relying on facilitators to provide them with answers. Consistently, research has shown that men engaged in BIPs highly value sharing stories and learning from one another as a part of the BIP process (Chovanec, 2014; Gray et al., 2014; Holtrop et al., 2017; Kelly & Westmarland, 2015; Morrison, George, et al., 2019; Shamai & Buchbinder, 2010; Silvergleid & Mankowski, 2006), and there is evidence to suggest that such peer discussions help engage clients in the change process (Chovanec, 2014; Morrison, George, et al., 2019). Studies have also found group leadership to be an important component of BIPs, and clients who are further along in the process often serve as role models or mentors to newer or more resistant clients (Chovanec, 2009, 2012; Morrison, George, et al., 2019; Silvergleid & Mankowski, 2006). Our study, therefore, lends support to the existing literature on peer discussions in BIPs and helps to show how BIP facilitators engage group members and promote critical thinking and problem-solving skills. More importantly, however, it also shows that BIP facilitators are willing to and often do share power with clients in the group context; or rather, they give clients the freedom to interact and engage with one another in ways that permit clients to take responsibility both for their individual progress and for that of the group. Thus, our study suggests that, in some ways, BIPs are exemplifying the potential of the empowerment process in group intervention, a point to which we will now turn.

Although a thorough examination of group work practice models is not within the scope of this article, it is nonetheless important to place our findings in the context of some of the underlying mechanisms that form the basis of group work and, in particular, of those processes associated with mutual aid (Gitterman, 2004). Mutual aid, unlike psychoeducational models which traditionally take an educational stance whereby service providers deliver knowledge, is predicated on developing an alliance among group members, which allows them to use their own knowledge and expertise to solve their problems, often with minimal professional intervention (Gitterman, 2004). As stated in the introduction, psychoeducation has been one of the primary models used in BIP work (e.g., Duluth); mutual aid models, however, have not been applied to groups that work with men who perpetrate IPV (Chovanec, 2009). This is perhaps due to in part to belief that traditional forms of psychotherapy are inappropriate for BIPs and do not adequately confront perpetrators’ rationalizations and denial (Maiuro & Eberle, 2008). Yet, undeniably some of the processes uncovered in our analysis are similar to processes that have been identified in mutual aid groups—namely, the processes of giving advice, support, confrontation and soliciting client input, mirroring the processes of sharing data, emotional support, mutual demand, and helping with specific problems that are characteristic of mutual aid groups (Gitterman & Schulman, 2005). In addition, the processes of soliciting client input, asking for and giving advice, promoted a kind of shared power between clients and facilitators in the group, another hallmark of mutual aid (Gitterman, 2004). This similarity between BIP processes and that of mutual aid has been observed elsewhere; Chovanec (2009), for example, found that confrontation and support by group members was important for the change process among clients just entering the group. Chovanec concludes that mutual aid was active in the BIP in his study and that a “greater intentional application of the mutual aid concept in domestic abuse groups is indicated” (p. 136). This is not to say that psychoeducational components are not present in the content of the BIPs or not apparent in some of the processes we uncovered; it is just to say that although BIPs may adopt psychoeducational models (e.g., Duluth), there may be ways in which BIPs operate “on the ground” that are reflective of other principles or mechanisms of group work (Cannon et al., 2016).

Furthermore, mutual aid as a group work principle is not distinct from empowerment practice. Although it might seem counterintuitive to consider the empowerment of perpetrators of violence, there is evidence that feelings of powerlessness are at times related to men’s violence (Baugher & Gazmararian, 2015). Thus, creating a group setting where clients experience empowerment as a process and outcome has potential for preventing future violence. There are many ways in which the processes we observed in the BIPs represent empowerment practice. Specifically, empowerment practice involves consciousness raising, an understanding of shared challenges, and collective responses to oppressive conditions. The mutual aid and support that clients offer each other in these BIPs can thus be understood as a form of empowerment that some believe will be effective in helping men avoid perpetrating additional abuse (Decker, 2018). Notably, critiques of “empowering” women to avoid abuse as a means by which women are indirectly blamed for their victimization (e.g., Aiken & Goldwasser, 2010) are addressed by approaches which empower perpetrators to take responsibility for themselves and for the patriarchal culture that perpetuates these patterns. As Carr (2003) notes, “long-term, intensive, small-group work is a highly efficacious means of empowerment practice” (p. 18). Thus, our research suggests that “empowerment” as a principle may need to be considered in greater depth in context to BIPs’ goals and curricula, and in particular, BIPs may wish to consider how to utilize mutual aid or other group therapeutic strategies to empower perpetrators to be accountable for abuse and take ownership over their change process.

Limitations

This study has several limitations. First, we did not collect any identifying information (e.g., age, race) as a part of the study. This was done to ensure the safety and anonymity of clients attending the BIP group sessions. As such, however, we are unable to provide any demographic information on the makeup of the group sessions we observed. However, data from the participating BIPs suggest that the makeup of their client population is representative of the region in which the study was conducted. Second, the BIPs from which these participants were recruited focused primarily on adult male perpetrators of IPV against female partners. Thus, our findings may not be generalizable to other populations of perpetrators/BIPs (e.g., groups for women or LGBTQ persons). However, in discussing these findings with BIP/IPV experts and community stakeholders, both from our region and from other parts of the United States, we have noted expressed corroboration with our findings in regards to groups for male perpetrators. Third, our presence in the group may have altered the way in which facilitators and clients interacted, and it is possible that both unknowingly interacted in ways that they perceived would be viewed favorably. However, our use of “member checks,” both during the observations (i.e., the debriefing sessions with facilitators) and analysis, is a known tool for improving the reliability of qualitative data (Creswell & Miller, 2000; E. A. Murphy & Dingwall, 2003), thus helping to minimize potential for social desirability bias and misinterpretation on the part of the data collection team. Finally, as we were interested in the group processes and not necessarily interested in individual clients, we did not track individual clients from one observation to the next. Consequently, we are unable to report on the total number of clients observed and instead can only report on the average number of clients observed per BIP session. Thus, it is unclear to what extent clients progressed from one week to the next in the process, nor are we able to link aspects of this process to outcomes.

Conclusion

As part of our 2-year ethnographic study, we collected observational data from group sessions with two community-based BIPs to understand what processes, or interpersonal interactions, were occurring in groups. We found that facilitators and clients both engaged in various processes that served to meet the needs of individual group members and the group as a whole and promoted abuse awareness, accountability, critical thinking, and problem-solving skills. We also found that facilitators may engage in processes to manage the group and decrease resistance to the programs that are subtle and may not be readily apparent to clients, and thus, may be underrepresented in interview-based research with perpetrators. We also found that although BIPs may adopt psychoeducational or cognitive behavioral therapy models, other principles of group work–namely, those of mutual aid and empowerment–may be at work during groups. Our study suggests the need for more observational research on BIP group sessions to uncover the full range of processes that may be occurring during these programs and that can assist in helping to understand what processes or mechanisms might be associated with client outcomes. Future studies should seek to further explore BIP processes observationally and to link those processes to desired programmatic outcomes.

Footnotes

Acknowledgements

The authors would like to thank the Pennsylvania Coalition against Domestic Violence and the Women’s Center and Shelter of Greater Pittsburgh for their support.

Authors’ Note

Study conception and design: all authors; acquisition of data: Penelope Morrison; analysis and interpretation of data: Penelope Morrison, Judy Chang, and Cynthia Holland; drafting of manuscript: Penelope Morrison, Judy Chang, Cynthia Holland, Sara Goodkind, and Patricia Cluss; critical revision: all authors.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support for this work was made possible by grant funding from the Pennsylvania Commission on Crime and Delinquency.

ORCID iD

Penelope K. Morrison

Notes

Author Biographies

Penelope K. Morrison, PhD, MPH, is an assistant professor of biobehavioral health at Penn State New Kensington. Her research interests focus on addressing health disparities for underserved populations of women and children and, in particular, addressing the impact of IPV on families. She also has served as a qualitative methodological expert on projects related to veterans’ health, maternal to child health, adolescent risk taking, telemedicine, and patient-provider substance use communication.

Sara Goodkind, PhD, is an associate professor in the School of Social Work, Department of Sociology, and the Gender, Sexuality, and Women’s Studies Program at the University of Pittsburgh. Her research and scholarship focus is on marginalized youth and the inequities they experience. Much of her work examines social service programs and systems that work with young people, concentrating on young people’s experiences in educational, child welfare, and juvenile justice systems, and how these systems both construct and meet the needs of the young people they serve.

Cynthia L. Holland, MPH, has over 24 years of experience in research in multiple areas including substance use, substance use in pregnancy, intimate partner violence and concussion. She has been a clinical research coordinator for the past 20 years and is currently the UPMC/University of Pittsburgh Concussion Research Lab Manager and coordinates the program’s extensive research portfolio. She has been with the program for 5 years.

Patricia A. Cluss, PhD, is a licensed psychologist with expertise in working with women on health, mental health, relationship and transition concerns. She recently retired from the Psychiatry faculty of the University of Pittsburgh School of Medicine where she was a researcher and program developer.

Elizabeth Miller, MD, PhD, is the Director of the Division of Adolescent and Young Adult Medicine. She maintains an active research program focused on reducing gender-based violence to improve adolescent health with funding from the National Institutes of Health (NIH), the CDC, Office on Women’s Health, and foundations. Dr. Miller also serves as research consultant to Futures Without Violence, a national nonprofit organization providing resources to health care providers in their efforts to prevent domestic violence and sexual assault.

Donna George, MS, is an AOD Program Director for the Pennsylvania System of Higher Education at California University of Pennsylvania. She has over 20 years of experience as an advocate and facilitator, working with both men and women in the area of intimate partner violence.

Rhonda Fleming, MSOL, is the Education & MEN/S Program Director at Women’s Center & Shelter of Greater Pittsburgh. She has more than 20 years of experience training others, both nationally and internationally, in the area of intimate partner violence. Her expertise includes identifying warning signs of abuse, safety planning, teen dating violence, effects on children, and understanding the batterer’s perspective.

Judy C. Chang, MD, MPH, is an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Medicine, University of Pittsburgh. Her work has been primarily focused on violence against women, specifically on issues regarding health care screening and interventions for intimate partner violence. She has participated in multiple collaborative groups exploring various topics in women’s health services and outcomes, and is currently expanding her research to examine patient–provider communication in women’s health and obstetrics/gynecology.

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Key Components of the Batterer Intervention Program Process: An Analysis of Observational Data From Two Community-Based BIPs

Abstract

Keywords

Introduction

Research on BIPs

Method

Parent Study

Current Analysis

Setting

Data Collection

Results

Facilitator Processes 1

Establishing ground rules

Refocusing

Soliciting client input

Emphasizing choices

Confronting clients

Demonstrating support and positive feedback

Client Processes

Asking for advice

Giving advice

Confronting each other

Providing support

Demonstrating resistance

Discussion

Limitations

Conclusion

Footnotes

Acknowledgements

Authors’ Note

Declaration of Conflicting Interests

Funding

ORCID iD

Notes

Author Biographies

References

Facilitator Processes¹