Late last year, responders at Western Massachusetts’s A Call for Change Helpline heard from a disparate group of callers: A wealthy man who regretted dropping thousands of dollars on self-help resources. A woman miserable because her partner flirts with other women. A serial abuser with years of incarceration behind him, staring down a long new prison sentence.
What all of these people had in common was that they were controlling and violent toward their romantic partners and unhappy with their own behavior. The job of the trained responders at A Call for Change is to take that nascent sense that something is wrong and turn it into full-blown accountability and, ideally, personal transformation. The helpline is currently the only one in the nation designed for people who behave abusively to call in anonymously and confidentially; traditionally, the only treatment available for people who are abusive has been linked to the criminal justice system or mandated social services, and research suggests these programs aren’t very effective.
The baggage around these programs is so entrenched, in fact, that when JAC Patrissi, MSW, one of the founders of A Call for Change, first suggested the helpline, people told her that no one would ever call, and if they did, they’d only be seeking absolution to continue the abusive behavior. The result has been the opposite, Patrissi said: In the first year after the line’s 2021 launch, 250 people called, and the numbers are still growing. What’s more, more than two-thirds of callers call back, often with reports about how they’d tried new, safer relationship strategies they’d learned from the helpline.
“When you mandate people, they’re having a completely different orientation and experience toward you,” Patrissi said. “It’s the ‘minimize, deny, blame, shift, attack the identity of the victim’ stage. But if you self-refer and you get no external reward, if you’re going to call, it’s for your own goals.”
The helpline is part of a small but growing movement developing new ways of treating people who perpetrate intimate partner abuse. Psychologists and other mental health advocates are hopeful that these new programs, combined with more broadly targeted efforts to educate young people about relationship skills, will budge the needle on repeat abuse and become more than a poorly funded sidenote in the criminal justice system.
“When we try to think about what is going to help someone recover and stop perpetrating violence, usually punishment is not going to be the solution,” said Carla Stover, PhD, a clinical psychologist and associate professor at the Yale University School of Medicine’s Child Study Center who studies the impact of family violence. “If we simply shame people for their use of violence, and we don’t design programs that will help them understand what is causing their use of violence, how can we expect them to stop those behaviors without appropriate support?”
Historical challenges
The idea of reforming abusers first came up in the 1970s, as intimate partner violence (IPV) was being criminalized. Feminists and their allies began developing what are sometimes still called “batterer intervention programs,” focused on unteaching men patriarchal values. In 1984, when the U.S. Attorney General’s Task Force on Family Violence recommended mandating counseling for abusers, these programs were the model. By the early 2000s, there were at least 2,500 batterer intervention programs, sometimes known as relationship violence intervention programs, around the country (in Murphy, C. M., et al., Handbook of Interpersonal Violence and Abuse Across the Lifespan, Springer Reference, 2019opens in new window).
The vast majority of states now mandate these programs for people convicted of IPV, most of whom are not incarcerated. The most common curriculum is the Domestic Abuse Intervention Project, better known as the Duluth Model, which posits that beliefs about male superiority are at the root of male-to-female violence. (Duluth was designed with male abusers and female victims in mind, based on research finding that male-to-female violence is the most severe and damaging, but its use is necessarily limited when it comes to people in nonheterosexual relationships or in relationships with transgender or nonbinary partners.)
The problem is that decades of research show these programs to be minimally effective. “If you took one man who is convicted of domestic violence and completes a full program, which is usually about 24 to 36 hours total, and another who never completes a day, it reduces recidivism about 5%,” said Erika Lawrence, PhD, a clinical psychologist at Northwestern University who studies domestic violence intervention programs (Babcock, J. C., et al., Clinical Psychology Review, Vol. 23, No. 8, 2004opens in new window).
Discouragingly, alternative programs that take a cognitive behavioral therapy (CBT) focus have not proven more effective than the Duluth model. One challenge to comparing programs head-to-head in the real world, though, is that people in the court system often receive a hodgepodge approach to treatment, with programming that may mix CBT, Duluth, and other strategies. Without testing each of these homegrown programs individually, it’s difficult to know which are effective and which aren’t, said Christopher Murphy, PhD, a clinical psychologist at the University of Maryland, Baltimore County who researches relationship violence interventions. And the resources for that research just aren’t there, in most cases.
“What I’ve learned is that I try to do a lot of skill building and teach clients skills to manage their emotions as well as alternatives to aggression and violence,” said Philip A. Kerne IV, PhD, a psychologist and the director of psychology services for Fort Bend County Juvenile Probation in Richmond, Texas, who contracts with the Texas nonprofit Aid to Victims of Domestic Abuse (AVDA) to offer the organization’s Battering Intervention and Prevention Program. Kerne originally trained on the Duluth model but now uses an approach built around CBT and decades of professional experience.
However, AVDA has few opportunities to track program participants over time. The organization keeps tabs on program completion but has little access to data on later offenses. AVDA does send surveys to participants and their partners after the program, but “we do not get very large response,” said AVDA CEO Maisha Colter.
It’s a difficult area to research, in part because no outcome measure fully captures the scope of participants’ behavior. Even when participants and partners respond to surveys, answers can be skewed, particularly if participants are afraid honesty may land them back in legal trouble. Arrests, charges, and conviction records capture only the small slice of abuse that gets reported to authorities. These records are also skewed by the disproportionate likelihood that a man of color will be arrested, charged, and convicted of a crime like IPV compared with a White man, said Amie Zarling, PhD, a clinical psychologist at Iowa State University who studies IPV treatment and prevention.
Research methodology challenges also abound. Randomization may be impossible within the mandates of the criminal justice system. State law may require certain types of programs. Resources for staff training are often limited.
“People are really quick to impugn these programs or say they don’t work, but I would argue there are just a lot of challenges and barriers in being able to document efficacy,” Murphy said. “It’s a very complicated evaluation and research problem.”
New approaches
The discouraging findings so far have sometimes led to disenchantment with these programs, Murphy said. But some researchers are pushing back against giving up on treatment. Both Zarling and Lawrence are conducting randomized clinical trials of an acceptance and commitment therapy (ACT)–based approach called Achieving Change Through Values-Based Behavior (ACTV), which they cocreated.
Unlike the Duluth and CBT models, ACTV doesn’t aim to change underlying thoughts about women and power but focuses on changing abusive behaviors. “We talk about power and control; we talk about thoughts and feelings; we also talk about alcohol and drugs, we talk about family of origin—all of the factors that have been shown to contribute [to abuse],” Lawrence said.
A focus on behavior over belief helps avoid getting into fruitless arguments with participants who can be resistant to the idea that they are in the wrong, Zarling said. “You’re never going to be able to argue someone out of their perspective,” she said. “From an ACTV perspective, we validate the emotion and take a functional perspective to it: ‘Okay, you just said your wife is a b****. How does that impact your relationship with her when you buy into that thought? What do you do?’”
In a trial of 338 men randomized to ACTV versus Duluth in Iowa, Zarling found that survivors of ACTV participants’ violence reported significantly less controlling behavior, fewer physical assaults, and fewer instances of stalking than survivors of Duluth participants’ violence a year after the program (Journal of Consulting and Clinical Psychology, Vol. 90, No. 4, 2022opens in new window). ACTV participants also had half the number of new violent charges as Duluth program participants and fewer nonviolent charges. There was no statistically significant difference in new IPV charges, but the study ended early because of the Covid-19 pandemic and was thus underpowered for examining that outcome, Zarling said.
In a trial led by Lawrence in Minnesota, men convicted of domestic assault were less likely to be convicted again of any crime, including nonviolent crimes, violent crimes, and domestic assault, in the five years after participating in ACTV versus a Duluth or CBT-based model (Journal of Consulting and Clinical Psychology, Vol. 89, No. 5, 2021opens in new window). “We are reducing outcomes anywhere from one-third to one-half compared to the standard,” said Lawrence, who is currently running another trial of ACTV in Minnesota, funded by the Department of Justice’s Office on Violence Against Women.
Another promising program is Strength at Homeopens in new window, a trauma-informed approach developed by Casey Taft, PhD, a clinical psychologist at the Boston University School of Medicine. Now available at more than 50 Department of Veterans Affairs (VA) hospitals, Strength at Home is a CBT-based program that takes into account how a person’s own traumatic experiences can lead them to crave control in relationships. “Trauma is really common in most all of these populations,” said Murphy, who collaborated on the development of the program.
A randomized controlled trial in veterans found that Strength at Home reduced both physical and psychological IPV (Journal of Clinical Psychiatry, Vol. 77, No. 9, 2016). A small follow-up suggests the program may be effective for civilians, too (Journal of Family Psychology, Vol. 35, No. 6, 2021opens in new window).
While many of the participants in the Strength at Home program are still referred via Veterans Treatment courts, there is a big effort within the VA to build more entry points through mental health care, primary health care, and addiction services, Murphy said. Relying solely on the courts as an entry to treatment leads to racial disparities and ties help-seeking inexorably to punishment.
“There’s a huge need out there to build better connections, better systems, and to just destigmatize the process of getting help,” said Murphy.
Often, families do ask for help for the abusive individuals in their lives, said Yale’s Stover. And often, there is nowhere to turn. Fathers for Change, a program Stover developed, is an attempt to correct that. The program tackles IPV, substance misuse, and child maltreatment, because families often experience all three at once. It is difficult, Stover said, for parents to keep up with all the programs they’re mandated to complete by child and family services if these issues are addressed separately.
Fathers for Change is a one-on-one approach with the optional inclusion of the mother and children. It uses motivational interviewing and promotes emotional regulation and reflective functioning, or understanding one’s own and others’ mental states, goals, and attitudes. The program has now been implemented at six sites across Connecticut, with mothers reporting declines in IPV and children’s witnessing of violence, and fathers reporting improvements in regulating emotions, anger, and hostility (Journal of Family Violence, Vol. 37, 2020opens in new window).
Updated understanding
At A Call for Change, responders hear from a diverse set of callers, including some who have been incarcerated many times for abuse and others who may never face a charge. For many people of color and LGBTQ+ individuals, criminalization is a double-edged sword.
“We got the overwhelming feedback that the people who were not being served now by our general interventions would not call a line like ours unless it was anonymous and confidential,” Patrissi said. “Some responses we got were, ‘Well, if the police are coming to my house, they’ll kill us both.’”
A Call for Change operators do have a legal duty to report callers who share personal information and a location and admit to being in the act of harming their partners or putting them in imminent harm. Operators are trained in deescalation in the event that a person calls and says they want to hurt their partner or are doing so. But calls are far more likely to happen when the abusive person is alone and can speak privately. One man diagnosed with narcissistic personality disorder will call to say he’s just run a mundane errand for his wife and knows he shouldn’t go home and angrily demand gratitude; the A Call for Change responder will give him sympathy for his feelings of need and praise for recognizing that he can’t treat his wife poorly because of it.
One man will call from his car before going home to his partner in order to practice his mantra that she is a separate person from himself who is just as valuable as he is—a reminder of how fundamental the lessons abusive people need to learn are, Patrissi said.
The organization advertises through billboards, YouTube, TikTok, and flyers handed out by service providers. The messages in these outreach efforts appeal to people’s sense that something is wrong about their behavior; for example, one TikTok clip asks, “What if someone was putting hands on your mama or your sister or your daughter? Do you want to be that guy?” Others emphasize that hurting others is a decision and that change is always possible. Google is the main way people find A Call for Change’s website, Patrissi said, and billboards are also surprisingly effective. “People pull over, calling us, saying, ‘I think this line is for me.’”
A Call for Change’s method uses a gender-agnostic approach of identifying abusive values and nudging callers to reevaluate them. Key abusive values include the idea that it’s okay to use power and control to avoid one’s own discomfort. Another is a lack of mutual accountability, such that the abuser feels they can tear down their partner but can never be questioned themselves. While callers are often men, some are women, some are not cisgender, and many are not in heterosexual relationships. The approach is more expansive than older conceptions based on male-to-female violence, while still acknowledging the role of patriarchy, White supremacy, cis supremacy, ableism, and other societal hierarchies in power and control, Patrissi said.
[Related: Building more inclusive IPV prevention]
A Call for Change is working with a team from the organization Collective Capacity, which conducts evaluations to ensure that callers get responses consistent with A Call for Change’s principles and goals. Several other helplines for harm-doers have popped up globally in the past five years, including in Colombia, Nova Scotia, and Sweden. Australia and the United Kingdom have had similar helplines for longer. Patrissi and other board members have heard interest from more than a half dozen states about launching lines of their own; Vermont and Wisconsin are closest to getting lines up and running. Meanwhile, in Maryland, Murphy is working with the IPV organization House of Ruth to test whether providing abusive individuals low-barrier, low-cost employment support, mental health support, and parenting support reduces later violence. Basic services can be powerful: Previous work has shown that a no-barrier housing-first model for survivors improves their safety and stability (Sullivan, C. M., et al., Journal of Family Violence, Vol. 38, 2023opens in new window).
Both hotlines and new programs have to face the reality that funds are limited. The scarcity of resources pits programs for survivors against programs aimed at abusers.
“People are having to prioritize where resources go,” said Oyesola Oluwafunmilayo Ayeni, PhD, an ecological/community psychologist and the director of research and evaluation at the National Resource Center on Domestic Violence, which provides organizations around the country with training, resources, and assistance in preventing and treating IPV. “There needs to be a more concerted effort to increase the resources that are available for intimate partner violence across the board, so we can not only support survivors but also create additional programs for harm-doers.”
Funding cuts are a frequent reality in the field, agreed Fort Bend’s Kerne. “[Prevention] is not always a priority,” he said. “But you do hear about it on the news when something tragic happens.”
