Graduation and Termination Issues

There are a number of behaviors that may result in the client’s termination from the program. If court-mandated, a final Progress/Enrollment/Termination Report(see Forms) is immediately faxed to the supervising probation officer indicating the fact that the client has been terminated and the reasons for such an action. If the client is self-referred or court mandated, the clinician is to notify the client’s partner that the client has been terminated from the program. The clinician may discuss safety planning with the partner. The clinician is to notify the program coordinator immediately when any termination conditions occur. Below is a list of each basis upon which a client may be terminated and examples of each.

Causes for termination (and examples)

1.  Lack of motivation
   1. Client continues to commit violence or makes a threat of violence towards partner or others
   2. Client continues to express lack of remorse and responsibility for re-offenses and/or original offense, after appropriate therapeutic intervention
   3. Client misses group meetings (beyond maximum)
   4. Client refuses to complete required homework
   5. Client does not participate in group sessions
2. Lack of treatment progress
   1. Client continues to commit violence or makes a threat of violence towards partner or others
   2.  Client continues to express lack of remorse and responsibility for re-offenses and/or original offense, after appropriate therapeutic intervention
3.  Violation of program rules
   1.  Nonpayment of fees or failure to follow-through with payment contract
   2. Client commits violence or makes a threat of violence towards group members, agency staff, or other client. c. Violation of confidentiality
   3. Client misses group meetings (beyond maximum)
   4. Client commits violence or makes a threat of violence towards partner (regarding follow-up procedures)
   5. Client brings weapon into agency or group.
4. Unsuitable for treatment program
   1. Client needing inpatient or primary alcohol or drug treatment
   2. Client needs inpatient psychiatric
   3. Other situational factors (work schedule, learning disabilities, etc.) prevent client from participating in program.

Mandatory Termination

Some programs/clinicians may decide that any one or a number of the above reasons for termination may be grounds for immediate and mandatory termination. For example, clients who violate confidentiality, threaten or act violent towards members of the group or therapists, bring weapons to the group, or threaten their partner not to cooperate with the partner follow-up procedures may be immediately terminated without offering the client a second chance.

What is Successful Completion of Treatment?

The primary goal of treatment is to insure family safety by helping clients learn alternatives to using violence to cope with life’s problems. Yet, how long should this treatment last? How do we know when we have achieved the goal of stopping the violence? These are difficult questions to answer. We know that many clients stop their violence for fear of being arrested or going to jail for violating probation. We know from the research that approximately 40-50% of clients re-offend within two years post treatment.We also know that only approximately 7% of clients completely desist from violence after two years post treatment. We also know that the vast majority of clients continue to use psychological violence, even if they stop the physical violence. Although the state mandates 52 weeks of treatment, or rather education, how do we know that this is sufficient for the majority of clients? The answer is, we don’t! Therefore until we develop a better knowledge of how to “cure” violence, we must be very careful in our measures of client evaluation and we must be tentative about client prognosis.

It is unrealistic to believe that a 52-week education or therapy program will be sufficient intervention to bring about a change in all individuals, some of whom have established patterns of violence for many years. For those individuals who have only acted violently once or twice and genuinely feel remorse for their actions, a short-term program may be most effective. However, the majority of batterers referred for counseling have a long history of violent behavior that is well entrenched in their repertoire of responses to stress, conflict, and emotional strife. Therefore, for a large segment of the population of batterers, longer-term interventions will be necessary to assure comprehensive recovery.

Unfortunately, no psychometric tool has been developed that assesses a person’s risk for future violence. Therefore the counselor must rely on partner reports and on self- and peer-evaluations. These can be therapeutically valuable as well as assist in treatment-planning decisions.

At some point in the process, either the client will want to stop or will ask if he/she is ready (if self referred); or the probation officer is going to want a 52-week final disposition. What should the counselor do?

The counselor should first review the client chart before making a final evaluation on the client. The client who is approaching their fifty-second week of treatment should have at least three Progress/Enrollment/Termination Reports(see Forms) in the chart. Additionally, there should be at least 11 Victim Contact Forms(see Forms in the chart and approximately 50 client check-in entries in the Client Group Notes(see Forms).These sources should give the therapist, as well as any objective evaluator, a good idea of how the client has progressed in the program.

The most important question in determining whether or not to graduate a client is to determine how well the client has achieved the three primary therapeutic goals: increased ability for affect regulation (stopping physical, sexual and psychological violence); increased knowledge of domestic violence; and increased social problem solving skills.The following behaviors are indicative of a client’s progress in these four areas. These goals should be corroborated by the client’s partner (if appropriate).

• Client is taking real and practice Time-Outs on a weekly basis.
• Client completes anger journal on a weekly basis.
• Client demonstrates ability to identify physical and behavioral signs of anger.
• Client demonstrates positive communication of anger as well as other feelings.
• Client demonstrates positive social problem solving skills.
• Client has completed all additional homework assignments.
• Client can recognize negative self-talk and transform it to positive self-talk.
• Client is able to teach other clients behavioral skills and education concepts.
• Client is able to recognize minimize, denial and blaming in self and others.
• Client has not perpetrated violence for at least six months.
• Client can recognize and address volatile situations with self and others.
• Client has attended the minimum number of group sessions.
• Client has paid all outstanding balances.
• Client participates in-group sessions.
• Client acknowledges complete responsibility for his/her violence.
• Client evidences control over psychoactive substances.
• Client can recognize power and control behaviors
• Client utilizes the equality wheel behaviors to solve domestic conflict.

Has This Person Changed?

Clearly, if clients were able to change on their own, they would not need to be in therapy.If it were only a matter of self-control, probation alone would be sufficient to help clients maintain a non-violent lifestyle. Therefore, for most clients, change will come slowly and will probably include additional acts of violence, volatile situations and resistance to completing homework and implementing behavioral interventions. These, as well as behavioral successes, are all a part of the change process.

In 1983, James Prochaska, Ph.D., and C.C. DiClemente introduced the Stages-of-Change Model (also called the Transtheoretical Model) for predicting health-related behavior change.Their theory suggests that individuals who trying to overcome problems such as smoking, sedentary living or being overweight move through a series of stages. Additionally, this is not a linear model, but rather a spiral one, in which people may move from one stage to another without passing through an intermediate one. The stages are precontemplation, contemplation, preparation, action, maintenance and termination. People must move through early stages in which motivation and commitment are formalized before taking action and changing their behavior. Prochaska and colleagues have been studying this model for 16 years, and found it applies to a wide range of health behaviors, including alcohol and drug addition.Don Dutton suggests that this model can be applied to working with perpetrators of domestic violence as well. Prochaska and colleagues demonstrated that the amount of progress people made in a program was directly related to the match between the client’s stage of change and the types of interventions utilized with the clients. For example, in one study they evaluated a worksite weight loss program that had an 80% dropout rate. They found participants who were not in the preparation or action stages early in the program were likely to drop out or fail to progress because the interventions offered were geared toward participants in the later stages of change. There was a mismatch between the type of program offered (action-oriented) and the condition of the population (precontemplators).Below is a brief overview of the Prochaska and DiClemente model as it may apply to perpetrators of domestic violence.

In the first stage, precontemplation, individuals with violent behaviors have no intention of changing within six months. People may be in this stage because they are uninformed about the consequences of their behavior, or demoralized about their ability to change because they have unsuccessfully tried a number of times, or actually believe that there is nothing wrong with violence between intimates. In general, these individuals tend to be defensive about their violent behavior and do not want to read, talk or think about it. They may feel a situation is hopeless (perhaps because they’ve tried to change before without success), and they use denial, defensiveness and externalization to keep from taking responsibility for their behaviors. For some perpetrators, they feel "safe" in precontemplation because they can't "fail" there. For others, precontemplation results from protecting themselves from feeling the emotional vulnerability associated with looking at psychological problems.

Some clients may consciously evaluate the disadvantages of changing their behavior as greater than the advantages. For example, an individual may perceive the sacrifices and feelings associated with stopping violence (such as feeling less in control of their life or not wanting to be viewed as being emasculated in their relationship to their partner) cannot be justified by the benefits of a non-violent lifestyle. Some perpetrators may be misinformed of what it takes to change (like trying to avoid feelings altogether).Some perpetrators may be unaware of all the advantages of changing. These clients are often characterized as unmotivated or not ready for domestic violence program.

The most effective strategy with individuals in this stage is help from others (particularly those with similar problems), perhaps in the form of simple observations or confrontation. Such help allows precontemplators to see themselves as others do. Consciousness-raising is important, too. Sometimes it comes from the therapist, a book or peers. For some clients a stirring life event, such as a separation or divorce or a movie, such as the Burning Bed can trigger an emotional or cognitive epiphany.In this early stage of change, talking about their violence may trigger feelings of shame and these feelings could ultimately help to facilitate the change process.

Strategies that are effective in this stage are consciousness-raising, for example, by reading up on domestic violence. Reading and watching movies allows clients to focus on the negatives aspects of their violence.It also helps the client to imagine additional consequences down the line if they don't do things differently. Emotional arousal, sometimes accomplished by discussing childhood abuse, also helps. In addition, "social liberation" can play a big role.Some individuals who get involved in social causes and indicate that they are in violence recovery often receive strong social reinforcement for not only acknowledging their problem and getting help, but also for spreading the gospel, as it were.However, as mentioned above, this can become a distraction for the client in that he/she can focus on the world and avoid dealing with his or her own home.The client may need to be reminded that “world peace, begins in the heart.”

Individuals who are in the preparation stage are planning to take action within a month. They think more about the future than about the past, more about the pros of being non-violent than about the cons. In other words, they pull themselves in a new direction more than they pull themselves away from an old one. This is the decision-making stage. Individuals have made a commitment to take action and are already making small behavioral changes, such as taking time-outs or working in their anger journal on a regular basis. Individuals in this stage also are willing to talk about the problems they are having at home, rather than continually reporting that everything is all right. These are the people you want to have in your group in sufficient numbers to influence people in the earlier stages.

Like the precontemplators, many preparers may motivate themselves by making their intended change public rather than keeping it to themselves. Social liberation continues to play a role, as does self-reevaluation.

is when the client is overtly expressing a genuine belief that violence is unacceptable and is actively utilizing the therapeutic interventions to change him/herself and the relationship. This state is the busiest stage of change. It’s also the stage most visible to others. In this stage, individuals make notable efforts to change. They are classified in the action stage only if they have modified their behavior to an acceptable criterion. With violence, for example, it does not count if they take an occasional time-out or writes in the anger journal once a month. Although this may be a good start, research tells us regular behavioral change is necessary to decrease the risks associated with violence. Clients in this stage are likely to report taking time-outs or writing in their anger journal on a regular basis.They are actively working on improving communication with their partner. They are asking the group and the therapist for help with their problems.They view the group as a resource rather than a “have-to.”

People in the action stage need to apply their sense of commitment to the change. They might give themselves rewards for their hard work. "Countering" is extremely important at this stage--taking time-outs instead of needing to be “right” with their partner, for instance. Making the environment more change-friendly--leaving “Do you need to take a time-out” notes around the house--is crucial, too.Having relationships with peers who support the client’s goals and who applaud his/her efforts provides more motivation for change.Clients in this stage are not only working on their relationship with their partner, but are beginning to question other relationships as well, such as friends, family and co-workers.

, often far more difficult to achieve than action, can last a lifetime. Domestic violence treatment programs that promise easy change usually fail to acknowledge that maintenance is a long, ongoing process. Three common internal challenges to maintenance are overconfidence, daily temptation, and self-blame for lapses.

People in maintenance should apply the same strategies as those in the action stage: commitment, reward, countering, modification of the environment, and helping relationships.However, continued support from peers can be the most helpful source of maintaining a violence-free lifestyle. Some individuals describe a termination phase of this process in which the client is no longer tempted to become violent. At this point, the cycle of change is exited. However, I would say termination never occurs; only that maintenance becomes less vigilant over time.

Using the above model, one would not consider concluding treatment until the client is in the maintenance phase.In other words, they have already taken action; made significant changes in the ways they cope with their emotions, conflict and stress and have had some period of time to securely establish these new patterns of behavior.The time it takes for this process to occur will differ for each client.Length of treatment will depend on multiple variables including, age, education, socioeconomic status, history of violence, diagnosis, neurological functioning, substance abuse history, child abuse history, to name a few.

Concluding Treatment

If the client has been approved for graduation, the therapist should complete a final evaluation form and send it to probation and schedule an exit interview with the client. The client receives a certificate of completion from the program.Following participation in 52 group meetings, an exit interview is conducted by group leaders, as required by California State law for the purpose of summarizing the group participant's progress in the program, as well as areas still needing attention.A final Progress/Enrollment/Termination Report(see Forms) is sent to the supervising probation officer or the domestic violence court indicating that the client has completed the program. Ultimately, clients, victims, and law-enforcement personnel need to be educated that there are no guarantees regarding violence potential for the future.

If graduation is denied, then the therapist must explain the reasons for the denial and recommendations to the client and probation.If the client is to stay in the program, a Progress/Enrollment/Termination Report (see Forms) is to be completed designating the length of the extension and the specific treatment goals that the client must achieve in order to graduate.If the client needs a different or additional treatment, the therapist should include this information in the probation report as well.

Termination Ritual

Developing a graduation ritual can be an effective way of facilitating group members to explore their personal feelings and life experiences with endings, transitions, loss and grief.Participants should be reminded that this is not the end of their growth journey but a transition to another phase.Recovery is a life long process of change and personal growth.In my book, Wounded Boys/Heroic Men I explain the hero’s journey at a metaphor for the process of recovering from childhood abuse.

The late Joseph Campbell’s description of the hero’s journey is much like healing from childhood abuse as well as the process of learning to live without violence.Each of us who embarks on a dangerous endeavor is a hero. It takes a great deal of courage to face our inner wounds and our darkest impulses and behaviors. By facing our inner demons, and coming to terms with our vulnerabilities we re-emerge a changed person -- transformed by the process.Every hero’s healing journey involves: a calling, the leaving, the spirit guide, the courageous act and the returning.

.The hero's journey begins with a calling; a message sent to him or her from far away. He may experience the message as an inner uneasiness, discomfort, or a feeling that something is just not right. The message may also come from outside the hero in form of someone else telling him he needs to change.The calling may come in the form of court-mandated treatment.No matter how the message appears, at some point the hero must decide to respond.He is then faced with the next task in his journey, the leaving.

The Leaving.Now the hero must depart from a safe place and venture into uncharted territory.Through the process of therapy, the hero explores his/her inner emotional world - a dark and unfamiliar place.This begins with breaking the denial that has kept the hero safe all these years and talking about long-ignored feelings, thoughts and memories may be the first step on the journey.

Embarking on the healing journey can be frightening and unnerving. The hero is out of his/her daily routine, which removes a sense of predictability and security. The healing process can be like a roller coaster; sometimes one will feel frightened, angry, and depressed and other times the hero will feel energized, excited, and hopeful. Most important, the leaving means the hero must come face to face with different parts of the self, both positive and negative.

The Spirit Guide.Every hero has the assistance of a spirit guide or mentor; someone who has also taken the journey and who will assist him/her in the change process. In the movie Star Wars, Ben Kenobi helped Luke Skywalker across the threshold from earth to space and taught him the importance of getting in touch with his own inner force - the feelings.Your spirit guide may take the form of a therapist, another person who has already embarked on a personal healing journey.This mentor may also be an AA sponsor, a close friend, an elder or another person in the group. The guide can be just about anyone the hero respects and trusts and who has taken a similar journey. Ultimately this spirit guide will help the hero prepare for the most challenging part of the journey, the courageous act.

The Courageous Act.At some point in the journey the hero is faced with a challenge of enormous proportions. He/she may have to do battle with a frightening creature or another person. The hero may have to reclaim a treasure that was taken away or save the life of another person. Usually the hero has to use not only physical strength but also other resources, such as feeling, intelligence, intuition, or sensitivity. The hero has to put aside the ego, become humble, and do what is necessary to complete the task.

Clients will find many challenges in healing from domestic violence and childhood abuse. Perhaps they will have to do battle with their inner abuser or reclaim the lost inner child or rescue their own inner feminine/feeling side. Clients will have to do battle with their inner abuser's tendency to blame themselves for their abuse - both as a child and as an adult. Combating low self-esteem is another challenge of the healing process. Learning to get in touch with feelings may be the greatest challenge of all. Facing other inner challenges, such as acknowledging weaknesses, admitting that one can't do it alone, being willing to make and learn from mistakes, and learning to ask for help. This will require courage and persistence, but when the hero returns he/she will discover that they have changed in a fundamental way.

When the hero returns from the journey there is something different about him/her. The courageous act has brought about an inner change that others notice immediately. A partner, friends, or coworkers may tell the person that they seem different. The client may even notice the difference him/herself, feeling more centered, an inner peace or happier with life. The hero may not feel noticeably different from the way he/she felt last week, but the hero may feel radically different than he/she did six months or a year ago.

An important part of the hero's return is talking about what he/she has learned on the journey. This doesn't mean bragging about his heroism but spreading an important message that captures the essence of the journey. For you this may involve encouraging other people to embark on a similar healing journey. It may also simply be encouraging others to talk about their feelings rather than hide them. The client may find that the message will go to his/her children in the way that he/she chooses to raise them differently from the way they were raised. It may be helping a friend in crisis or supporting a partner in a different way than he/she has in the past. Some heroes have written about their experiences in the hope that other men and women could find courage in hearing another person’s story.

Leaving and Returning.Heroes usually don't go on only one journey; adventure is a way of life for them. There is a continual leaving and returning, coming and going, facing new challenges and reaching new heights of awareness and change. The healing journey will consist of a similar process of leaving a safe and comfortable place, facing and meeting a challenge, and returning with a new attitude or other change. After a while the hero will venture out again to face new hurdles and overcome new barriers to finding peace of mind. But with each journey the hero will develop new skills to make the next one easier.

Facing the intense pain of domestic violence and childhood abuse takes courage of heroic proportions. One is a hero for answering the call no matter in what form it came. One is a hero for asking for help and taking deliberate steps in healing the inner wounds. One is a hero for facing inner demons and reclaiming one’s lost self. One is a hero for coming back a changed person and passing on the knowledge to others. One is a hero for continuing to struggle with inner wounds and making peace with oneself and others. Through your healing journey the hero will discover their own heroism and learn to appreciate the heroism in others.

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