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    Emma Mawson-Johnson reflects upon the role Motivational Interviewing might play with domestic violence offenders


    Within this article, a critical evaluation of the role of brief approaches through counselling and helping will be conducted. This will be in conjunction with analysing Motivational Interviewing with its effectiveness towards helping Domestic abusers or Intimate Partner Violent Offenders. Furthermore, implications of practise will be drawn out and discussed through a review of recent case studies within this chosen field. In particular, Crane & Eckhardt’s (2013) study on the ‘Evaluation of single-session Brief Motivational Enhancement Intervention for Partner Abusive Men.’

    The term Intimate Partner Violence (IPV) is mentioned throughout significant literature in relation to both physical, psychological, sexual violence as well as stalking by a past or present intimate partner and is described as severe, preventable public concern (, 2016). Carden & Farrell (2013) discuss that IPV offenders often ‘know better’ although something internally prevents them from ‘acting better’. They continue, defining IPV and abused as a highly complex behavioural pattern with multiple determinants and dimensions (p.352). Lombard & McMillan (2013) discuss men’s violence against women as often viewed as displays of male power that is repeated and validated through personal experiences and broad structural inequalities. However, Gilchrist (2013) claim there are multiple reasons or ideologies for IPV; including patriarchal cultures; problems within the family dynamics such as stress or difficulties with relationship interactions. Another notion is that violence against a partner is learned through modelling from possible past experience as a child whereby the behaviour is reinforced.  Psychopathology is a leading theory for (IPV) which involves jealousy, dependency and attachment issues, a self-esteem model and finally attitudinal and cognitive attributes or deficits.  In IPV Offenders, the level victim blame is often higher than other types of other offenders in addition to unstable attributes as to the reason behind the violence e.g. blaming alcohol (Gilchrist, 2013). Working with IPV offenders is complex and multi-faceted due to their characteristics, background, past experiences and often substance abuse combined. Lombard & McMillan (2013) add that in order to create any form of positive outcomes, it is essential to understand the characteristics of these offenders.

    Brief approaches in relation to counselling therapy uses short-term intervention sessions, which focus on helping a client to overcome or effectively handle a specific problem, challenge, or to create a desired change. Due to these aspects, the therapy is typically goal-oriented, and sessions tend to focus with present and future aspects of the issue as opposed to delving into the past. Establishing a set goal, as a therapist, is the hallmark of brief approaches, with a more active and directive strategy towards the client (Corey & Corey, 2014). Cade & O’Hanlon (1993) state that the origins of brief approaches aimed to innovate and improvise techniques to bring change and through this, an obvious factor of effective shorter therapy prevailed to practitioners rather than the longer, traditional approaches. Therapists preferred the refreshing pragmatic view, creativity and optimistic elements interjected into the brief therapy. Moreover, the short but effective methods are popular due to to funding sources including the NHS, insurance companies, local authorities and other helping agencies, especially in the UK (Feltham & Dryden, 2006).

    One popular brief approach is Motivational Interviewing (MI); known for its influence with changing habits and behaviour. This and many other constituents, which will be discussed, are a basis for its particular positive effects in working with IPV offenders. “MI is a collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Miller & Rollnick, 2013, p.12). Due to his keen interest in attempting to help clients increase their motivation through discussions of goals through change, William Miller began developing this concept in the 70’s, although people often associate it as being a recent technique (Hohman, 2012). MI uses a combination of both human and behavioural approaches derived from Miller’s background as a psychologist and Carl Roger’s client centred approach. It has developed using, goal-orientated attention through the client’s perspective rather than framing issues from a professional viewpoint acting as an expert. Therapists avoid directing clients toward specific solutions which may elicit resistance from the client; instead they evoke client’s own interests in change and steer commitment to certain actions that lead client’s to their goals of change using four main processes of engaging, focusing, evoking and planning to achieve these aims. With the behavioural side, the individual’s thoughts and behaviours are recognised to assess and influence positive and beneficial patterns. Thus maintaining the fruitful and efficient habits towards a clear-minded future (Wagner & Ingersoll, 2013, p. 4-5). In using this combination, MI uses a medium between directive (giving advice) and following (listening) approaches through a guiding style( providing advice when necessary and listening when needed), (Miller & Rollnick, 2013).

    Wagner & Ingersoll (2013) discuss the unique Spirit of MI focusing on evocation, compassion, collaboration and acceptance and it calls upon the individual’s inner strengths and motivations to evoke change. “MI is about evoking what is already present, not installing what is missing” (p.24); collaboration involves working and cooperating together in a respectful manner; compassion is a keen endorsement into the other’s wellbeing, by viewing and accepting the other’s needs as highly significant. Finalising, with acceptance which consists of four main aspects including: Absolute worth – seeing the worth and potential in every individual; Autonomy- allowing the client’s capability and right for self-direction; Affirmation – to search and draw out the strengths of the person and Accurate empathy – effort to comprehend the person’s internal outlooks of life. The key belief here is that ‘acceptance facilitates change’ (Wagner & Ingersoll, 2013, p.37). Carden & Farrall (2013) add the benefit of the spirit of MI with IPV offenders in that “An emphasis on competencies rather than deficits, an empathetic, non-judgemental, collaborative stance and respect for autonomy (essential elements of MI) may be more effective at reducing relationship violence than education or punishment” (p.352).

    In accordance with the spirit of MI, Miller & Rollnick (2013) state that there are four main principles and five main strategies. The principles include; developing discrepancy – deliberating a difference between two things and using this code to discuss and discover what is getting in the way between the person’s current situations to their desired destination; rolling with resistance – expecting a resistance and embracing it as a pathway to change rather than an obstacle. It is essential to understand and respond in a manner that advances the resistance into openness of change (Downey & Johnson, 2013); expressing empathy – putting yourself in their shoes and understanding views from their perspective; finally, supporting self-efficacy – the belief that you can accomplish the goals you set for yourself (Miller & Rollnick, 2013).  Within the line of these principles, five main strategies to interlink and embrace these principles emerge known as OARS; Open questions, Affirmations, Reflections, and Summaries where the therapist finalises the session with any concerns, self-motivational statements and identifying client’s priorities. Eliciting this ‘change talk’ is the foundation of communicative form (Wagner & Ingersoll, 2013). This is where the counsellor might introduce change and sustain talk using the acronym; DARNCATS, which is the Desire to change, Ability to change, Reasons for change, Need for change, Commitment to change, Activation and Taking steps. These are vital parts of delivering MI (Wagner and Ingersoll, 2013).

    By helping the client understand what motivation is and understanding the stages of change, the counsellor can help guide the client to a stage where they want to move forward, sometimes made easier for those obligated to attend, like IPV offenders (Wagner & Ingersoll, 2013).  Prochaska & DiClemente, (1992) assert that change occurs naturally predominantly through the encouragements of interpersonal interactions. Furthermore, they discuss a diagram of the Wheel of Change, which includes stages of change, where the the therapist can assess the individual’s present point of change and signs of progression or often regression too. Crane & Eckhardt (2013) discuss the vast empirical evidence of seeking the clients ‘readiness of change’ and describe this as a crucial element for the client to progress where an evaluation of the client’s willingness to move forward and change is made through five key stages. Miller & Rollnick (2013) begin with Pre-Contemplation – A client may be mandated to attend and have thoughts such as ‘I don’t want to be here’ including elements of denial. Thus MI is a predominant choice when working with ‘court mandated’ or referred offenders. Following this, the individual may move to the Contemplation stage where they acquire some awareness of their problem and start to consider change but may reject them with other excuses. With this stage, there is a strong sense of ambivalence, weighing out the pros and cons that the therapist embraces, as a natural aspect within the client. Ambivalence in regards to violent partners relates to conflicting motivation to discontinue violent behaviour, whilst continuing to justify abuse or remain uncertain about one’s ability to remain non-violent (Murphy and Eckhardt, 2005). Accepting Ambivalence is a key factor in the MI approach and achieved through developing the client’s self-motivation through change talk, exploring the best, and the worst things from that change. Looking forward – where do you see yourself? “The therapist’s objective is to help the client resolve ambivalence in a manner that promotes therapeutic change in a non-demanding, non-judgemental manner’” (Crane & Eckhardt, 2013, p.181). Moving onto the Determination stage, there becomes a need for change and a readiness to progress; with the individual’s feelings that “I can’t go on like this, what can I do?” When the client arrives at the Action stage, a change has taken place and progression is procured. The therapist will then facilitate with strategies into help obtain change with advice and guidance; leading onto the stage of Maintenance, where they would encourage and embrace morale for client especially if a plan does not go as expected. In the last stage upon the wheel of change, Prochaska & DiClemente (1992) discuss the possible and often inevitable Relapse in which the individual regresses back to the old ways, sometimes due to a failed attempt or plan of change, where they revert to old behaviour. The therapist prepares for this and assists with critical support with a focus to avoid the demoralisation of the client with the hope and aim in leading them back to the determination stage. Thus, there is often an ongoing cycle.








    The counsellor is prepared for reluctance and the Pre-contemplation stage and uses this to draw upon the client’s own notions along with the unique principles of MI, they will work on creating a firm commitment derived from the client’s inner views and ideas and use this to achieve their desired outcomes and goals (Miller & Rollnick, 2013).

    A strength of MI is that it can be used both one to one, through telephone or web chat, with families and through Groups. In particular, Carden & Farrall (2013) focus on group work with IPV offenders as it suggestively fits well in providing a supportive environment for the client who may be feeling isolated from society. Moreover, it can help the client listen to others who are in the same situation. “Supporting Self efficacy is easier during group-work than an individual session, by virtue of going through it together,” (Wagner & Ingersoll, 2013, p.63.) However, a limitation is that individuals may choose a same goal as another in the group rather than eliciting their own self-growth. When overcoming this barrier, the therapist may reiterate that goals are individual, unique and different to each person. (Wagner & Ingersoll, 2013). Gilchrist (2013) supports this, stating that group work with IPV offenders seems to be the most effective strategy, when matched with ‘readiness of change’. The use of OARs in-group work focuses mainly on the open questions to bring out relatable themes in the group and summarising to bring forth previous mentioned discussions and content and using it as a springboard to focus on forward thinking and potential. (Wagner & Ingersoll, 2013). Due to MI and its effects towards creating change, the approach is deemed to work successfully with offenders of domestic violence.

    MI is viewed as an innovative new approach when encouraging change due to the client centred techniques of empowering the autonomy of client using non-confrontational tactics with respect, learning what matters from them and using this to create evocation – drawing out ideas whilst not imposing those (Carden & Farrall, 2013). In this sense, Miller and Rollnick (2009) suggest that it can be highly effective as a treatment, creating meaningful and enduring change with offenders; predominantly those who are forced to attend interventions when other approaches may use a confrontational side, which may cause the client to regress through justifying, blaming or denying their violence. Due to unpleasant experiences with authoritative figures and family members, offenders often expect a continuous disrespect. In turn, this can cause resentment, and they engage with treatment because of the external consequences, rather than internal motivation (Carden & Farrall 2013). Kistenmacher & Weiss (2008) assert that, “Given that lack of motivation is the greatest obstacle to treating battering men, combined with documented success rates of MI, the application of it towards batterers’ treatment is a logical next step,’ p. 559). Furthermore, they discuss MI’s principle of developing discrepancy with the client by addressing their pre-contemplative state of denial between what they want or believe with how they actually behave. Thus an altered confrontational method, which draws upon the client’s thoughts rather than a directional expertise. Rollnick & Miller (2013) add that MI has taken root for some of the most neglected and rejected members of society.

    A challenge for therapists using MI in this area is that the client must always receive, Rogers’s Person Centred conditions including; compassion, being valued and empathised; which, as a therapist, may be difficult to put aside prejudice thoughts and feelings towards domestic violent abusers. “No matter how violently a participant may have behaved, we approach them with attitudes that define MI spirit,” Carden& Farrall, 2013, p.352). In relation to compassion “MI should never be used against client’s best interest, even if there are occasions when we may choose not to help them pursue potentially damaging self-interests due to ethical concerns, (Wagner & Ingersoll, 2013, p.37). This suggests that although the client may speak negatively about harming their partner, you must still priorities their wellbeing and thoughts. Gilchrist (2013) debates that, with this, ‘a concern has been raised of the possibility of the therapist colluding with an abuser or inadvertently supporting the abuse (P.169). Another constraint or drawback is that counselling may be required or provided to the actual therapist, in some organisations. This can be defined as supervision and allows an opportunity for the practitioner to explore all dilemmas including possible undesirable prejudice towards the IPV offenders (Dunnet et al, 2013).

    The most recent study on using MI with IPV offenders appears to have been from 2013, within the USA “Evaluation of a single-session Brief Motivational Enhancement Intervention for Partner Abusive men” by Cory Crane & Christopher Eckhardt (2013). This can already be seen as a limitation as there is a four-year gap where further research could have been developed. Furthermore, there seems a lack of research taken in the UK, which although both are westernised, demographically may have differed due to cultural differences (Tsui & Gutek, 1999).Within the study, eighty two participants were involved which identifies this as a small-scale study; however, it still works with a good effective number to discover as relevant result (Clough & Nutbrown, 2012). A strength and effective element of the study is that it has a combination of secondary research used from four other effective and influential studies spanning from one in 2001, two in 2008 and one in 2010 (Crane & Eckhardt, 2013). When analysing a research study, it is important to consider any bias from those conducting it when it is a self-report, including their agenda for conducting the study. There does not seem any obvious bias, as both appear to have had extensive experience with psychology and using Motivational Interviewing to conduct a number of studies from as far back as the 90’s. Moreover, Crane & Eckhardt’s acknowledgement of limitations and improvements for further research show a non-bias sense (Crane & Eckhardt, 2013). However, the fact that they are only using one session of MI suggests a funding or money saving agenda. “The current study sought to investigate the value of a cost and time efficient single Brief Motivational Enhancement (BME) session; that can be involved before treatment” (Crane & Eckhardt, 2013, p.181). It focused on the efficacy of a single-session of MI in further treatment attendance and the reduction of recidivism rates (the likeliness of an offender to re-commit a crime) (Kistenmacher & Weiss, 2008). Crane & Eckhardt (2013) describe their study as unique due to their brevity of one session. One could deliberate whether one session could truly be enough to motivate a client, although evidence suggests, “a single session of MI may be sufficient to particularly resolve a client’s ambivalence towards harmful behaviours” (Musser et al, 2008, p.539). This in turn could take the offenders onto the next stage of change. Moreover, Miller & Rollnick (2013) state that ‘adding a single prefatory session with an MI therapist, has been found to double favourable outcomes’’ (p.381)

    The intervention to follow this pre-treatment approach is a mandatory twenty-six weeks, where MI was delivered as a motivational assistance into the attendance and willingness of this long-term intervention. This suggests that the application of MI can be applied, both as an individual effective brief therapy and in conjunction towards a long-term therapy. Specifically, in this study, the Mandatory Batterer Intervention Programme (BIP) uses a combination of psychoeducational methods, cognitive change strategies and skills training (Crane & Eckhardt, 2013). A key influence of this study was to increase or encourage the stage of change process in the client’s motivation, which is often conflicted or destroyed in these type of interventions due to ‘‘didactic group treatment through confronting perpetrator’s misogynistic attitudes, identifying belief related to male power or control’’(Pence & Paymar, 1993 – cited in Crane & Eckhardt, 2013, p.181). Using MI as a new and effective approach seems to suit well with clients due to its stark contrast to the confronting interventions, where the men are more likely to regress or remain in in the pre-contemplation stage of change; often feeling the need to justify and defend their past actions. Daly & Pelowski (2001) claim that the significant percentage of failure in attendance and high attruition following the first mandatory sessions, highlight the necessity of MI techniques either during or prior to the first session of intervention.

    MI works predominantly well with clients who are angry at having to attend, apprehensive of what will happen, in denial or reluctant to examine behaviour or accept responsibility, helping people make decisions on change. The MI therapist achieves this by; avoiding closed questions, confrontation of the denial, acting like the expert and labelling. Becker’s (1963) labelling theory uses the idea that negative labels and names define a person and view them in an adverse manner (Giddens, 2009). As MI is humanistic, it draws out and embraces the positives of the person, thus negative labelling of the offender – such as batterer or perpetrator, often used in other interventions - is strongly avoided. With the predominant reason, being that is can feedback negative assumptions and may cause the client to regress or repress (Carden & Farrall, 2013).Which often, are viewed as key problems in certain interventions, such as the aforementioned research study, which is why it can be seen as a new positive alternative to other interventions with IPV abusers.

    A strength of the study is that the researchers considered using female IPV offenders, which supports an equal gender bias; however, Crane & Eckhardt, (2013) discuss how the females intended were too irregularly charged, to be referred into a mandatory intervention. However, a limitation of the study is that the practitioners involved had no previous experience of MI and only received two weeks training of the strategies adhering to the MI code of standards (Crane & Eckhardt, 2013). Some would judge this as insufficient experience of practice to conduct a session. This is a popular concern for the future of training with therapists, as it questions how effective their delivery of MI truly can be from quick training and little experience.

    When reviewing studies of using Motivational Interviewing with IPV men, a few elements appear common within them including self-assessment reports upon discovering their perceptions and previous actions of their violence and relationships. This further creates an understanding of their stage or readiness of change. Crane & Eckardt (2013) use a Revised Tactic Conflict Scale (CTS2) (Straus, 1996) as at the time, it was the most ‘widely used domestic violence assessment instrument and had strong reliability and strong construct validity’ (p.182).  The assessment has suggested that it is vital to understand where the men are on their path to overcome these issues and appears to relate specifically towards their future levels of change when reviewing results and positive outcomes in combinations to other interventions or recidivism. Mcconnaughy, Prochaska & Velicer (1983) utilised a Stages of Change Questionnaire (SOCQ), which is often used in MI treatments and can be altered to a specific area e.g. revised to specify in violence. It also assists with therapist and client sessions as they can refer back to their results of readiness of change, (Kistenmacher & Weiss, 2008).   Another commonality is that Motivational interviewing as a brief approach, seems to work most effectively as a pre-treatment or preparation towards another counselling approach such as CBT, Mindfulness or interventions using a combination of approaches and skills. Miller & Rollnick (2013) support this, asserting that MI integrates successfully with a range of active interventions or treatments, with the potential of enhancing the efficacy of both. After several reviews of studies on motivational interviewing with violent partners, it seems evident that the outcomes depend on what stage of readiness the participant/client was at, although positive as a whole. This was a vital indication in Crane & Eckhardt’s study ‘’treatment outcomes may be improved through efforts that consider individual differences, such as one’s stage in the change process in planning interventions’’ (2013, p.187). Another point to make is overall, although the MI session increased the likelihood of attending interventions as a mean of change, the effect was likely to decay following the 26-week intervention, (Crane & Eckhardt, 2013). Feltham & Dryden (2006) supports this intention of short interventions by stating that brief approaches should ideally be used on clients functioning reasonably well and be able to benefit from the therapeutic method that will last week’s rather than years. Almost all of the studies were conducted in the US and seem to work either as a pre-treatment combined or before other interventions such as CBT.

    Which leads to the comparison of the effects of long-term therapy against brief approaches. “Length of treatment has been a contentious issue since the time of Freud,’’ (Feltham & Dryden, 2006, p.4.)  Long term counselling is identified when there are 25 sessions and more (Shipton & Smith, 1998). “Private long term therapy, particularly psychoanalytical, is very expensive and inaccessible to the majority of people” (Feltham & Dryden, 2006, p.5.) Cognitive Behavioural Therapy derived from a psychoanalytical framework, which was originally a long-term approach. However, over time it has been adjusted and altered into a creating a shorter and more cost effective treatment, becoming popular in the 80’s. One interesting point of evidence to make in the study in reference to the effects of MI and CBT is that by Rosenblum et al, (2005); who reported that CBT was more effective than MI with anti-social individuals – a possible link to IPV offenders. This hypothesis was established due to an assumption of anti-social individuals struggling to form therapeutic relationships essential in MI, which in turn conflicted with the treatment (Rosenblum et al, 2005). Notwithstanding, due to extensive and lengthy researched evidence between brief and long-term approaches, it appears that both are as effective in different ways. This has allowed many practitioners to design their approaches in accordance to the client’s needs. (Carter, 2005).

    Suggestions for further research in the field of MI and IPV offenders include; integrating female offenders to understand a gender variable; considering the influence of a location, such as a clinical setting, upon the MI effects. Another consideration is to extend the follow up period after the study to understand if the client is still in a positive change mind-set from previous treatment. Moreover, deliberating the level of effect and influence MI has towards an IPV offender depending on the extent and level of abuse and violence by the partner (Crane & Eckhardt, 2013).

    Overall, the main assets of MI can be derived from a medium of giving advice, listening, extracting the strengths from an individual by using their self-motivation and relaying back a respectful, collaborative and non-judgemental impression. Moreover, the benefit of understanding and pinpointing a client’s stage of change can influence their motivation for moving forward through evocation and using change and sustain talk. Because of the unique alternative, autonomous approach towards IPV offenders, it seems more effective in encouraging the change in their behaviour. Miller & Rollnick (2013) continue to adapt and improve their therapy through reviewing these studies focusing on what seem to be the key strong factors in effectively treating clients. Overall they claim ‘we think it fair to say after 200 clinical trials, that something seems to be happening with the practice of MI that is often associated with beneficial outcomes when compared to no intervention or brief advice, or when added to other active treatment,’ (p.379).


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