Knowledge Sharing Forum
Lethbridge, AB
March 23, 2011
Outline
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Learning Objectives
AFC History
Program Philosophy
Program structure
Flow of treatment
Topics
Group Outline
Interventions (Theoretical Framework)
Program Outcomes
Learning Objectives
1. Participants will be able to describe the basic assumptions of the
Accountability for Change treatment model.
2. Participants will learn about specific interventions for working with
intimate partner violence offender populations.
3. Participants will be able to identify ways to measure treatment
outcomes in providing group therapy treatment in the field of intimate
partner violence.
4. Participants will learn how to apply methods from the Accountability
for Change model into their own practice.
The Accountability for Change
Project (AFC)
 The Accountability for Change Project (AFC) has been
in place for nearly 5 years at Lethbridge Family
Services. Since that time, we have seen over 250 group
participants go through our program. In this
presentation, we will share some of our experiences,
some program statistics and successes, and what we
have found works in terms of effective treatment for
IPV offenders.
Program Philosophy
The belief of the program is that it is important to be
respectful of participants and engage them in the process
of their own change. This means that it is important to
assist participants in exploring their own view of their
relationships and how their emotions, attitudes, beliefs
and behaviours affect both them and their partner. This
“invitational” and respectful approach results in more
real and lasting change than a more punitive or shaming
stance. Participants feel heard and understood and this
environment allows them to really begin the work of
change.
We do not do anger management!
 It is common misconception that anger is what
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drives people to violence and as such it is the anger
that needs to be controlled.
The anger itself is not the problem, it is simply an
emotion, like any other.
All human beings have the capacity to feel anger.
All human beings have the capacity to express this
anger in healthy or unhealthy ways.
The issue lies in how one CHOOSES to express that
anger – the behaviour (violence) that they choose.
So we do not modify the feeling, we help modify the
behaviour.
Program Structure
 The program runs for 12 weeks for 2.5 hours each
session (30 hours in total).
 It is primarily process in that a small amount of
psycho educational content is introduced each
session but most of the group is discussion and
processing the material.
 We come from a strength based perspective in that
we believe that participants already know much of
what they need to know in many ways, we just give
them the words, the tools and a new way of thinking
about it (Thumb Switch ).
Co-Ed Groups
 Since March of 2008, we have began accepting both
men and women participants in our program.
 This originally ran as a pilot in March of 2008 when
our first two women participated (and completed)
group alongside 8 men.
 Due to the success of this first group, the decision
was made to continue.
 Both Probation and Lethbridge Family Violence
Treatment Services have been supportive of this
initiative.
Remember...
 We are not the ones who charge people with DV
related offences.
 We are treatment providers, we are NOT the
punishment phase for the person who has been
charged.
 Each person has a choice of whether or not to attend
and complete group.
 Not all people who are referred from probation
participate in group, this is decided on a case by case
basis.
Expectations
 Participants are expected to attend weekly sessions
and are allowed no more than one missed session.
 They are also expected to complete a number of
written homework assignments.
 Their active participation within group is a
requirement for their successful completion.
Group Format
 All groups begin with a welcome and a check in – a
time to go around and have each person (participants
and facilitators) share about how their week went and
anything else they feel like they want to say as we start
the group.
 Ground rules need to be established for the check-in
(and check-out) ahead of time: one person at a time,
no interrupting or cross talk and whoever starts gets to
pick the order.
Format
 Each group ends with a checkout – a time where
participants and facilitators share how they feel
leaving group, anything that stood out for them etc.
Facilitators may ask something specific at check-out
(i.e. one thing you are going to do for yourself over
the next week, or one thing you are going to do to
work on your goal over the next week).
 We always take a break at about the halfway point for
about 10 minutes.
Format continued…
 We do not have “confession” at the beginning of group,
where each participant shares what brought them to
group. We have found there is no value in doing this
and also find that it just fuels further resistance and
defensiveness in participants.
Flow of Treatment
 We do not have set topics each week but rather prefer
to follow the natural unfolding of the group as it
progresses.
 There are key areas that are covered though at some
point within the group…
Process
 Process-based means that the participants do the
majority of the talking. Psycho-education is valuable
and works to offer information and create a context for
discussion, but the goal is for the participants to carry
the majority of the group, while facilitators simply
(and non-intrusively) guide the process.
 Process based work focuses on the here and now –
everything that happens is discussed in group at the
time it is happening.
Topics
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Emotions and basic needs
Anger and healthy responses to it
Goals
Parenting
Communication
Defining Abuse
Healthy Relationships
Boundaries
Existential Positions
Attachment issues & the impact of family of origin
hurts
Empathy
Impacts of abuse on partner, children and self
Gender issues
Stress, resiliency and coping
Sample Group Outline
Week One
 Welcome and a thank you for coming (lots of people were supposed to
be here, but not all of them are here, so congrats etc.)
 Information about the program (very brief)
 Explanation of check-in
 Check-in
 Establishing group rules – do as a brainstorm – what do they need to
have this be a positive experience? Remind them of the program’s rules.
 Brainstorm: Hopes & Fears
 Psycho-ed. component: The Needs Wheel
 Processing The Needs Wheel
 Processing expectations: what did you think this would be? What did
you think the facilitators would be etc.?
 Check-out
Sample Group Outline
Week Two
 Welcome participants back
 Check-in
 How are they feeling after last week? Any questions etc.?
 Psycho-ed. component: Anger (including the Manipulation Triangle)
 Process psycho-ed. material – thoughts, impressions, ideas,
normalizing feeling victimized (by the cops, their partner etc.) – Be
careful here though not to let it get into a system blaming discussion –
normalize it, but then focus on who’s here – they are, the cops aren’t, so
lets focus on what they can do with this now
 Make sure to bust the myth of “anger management”
 Thumb switch
 Information on goal setting as a primer for next week (ask them what
makes a good goal…)
 Check-out
Collaborative Approach
 Works from a position of curiosity and not knowing –
therapist not in the expert role but rather a
collaborative partner in the process.
 Strength based – not shaming and punitive but
respectful and supportive.
 We work to highlight group participant’s strengths.
 We help them to reframe their issues and concerns
(i.e. controlling my temper becomes responding to
and expressing my anger in a healthy way).
A Strength Based Approach
 We believe that participants have the resources and
skills necessary for successfully coping and growing
but they often are not using them.
 Out focus in on assisting participants in identifying
their own strengths and competencies within their
own environment.
 Consistent with this, it is not our job to teach them a
bunch of things they already know – more so, we want
to work with them on how to apply and use these
resources and skills in their lives.
A Blended Approach
 As no one theory has been shown to adequately
address the issue of domestic violence, we have taken
the best of several theories and have shed many of the
limitations that these theories may have all on their
own.
 We propose a blended approach of a number of
perspectives in an effort to best serve our clients and
assist them in leading violence-free lives.
Theoretical Framework
The Accountability for Change Project is a process
orientated, strength based program that draws from
a number of theoretical orientations including:
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Solution Focused
Person Centered
Attachment Theory
Transactional Analysis
Feminist Theory
Social Learning Theory
Cognitive-Behavioural Therapy
Solution Focused Therapy
 Works from a position of curiosity and not knowing –
therapist not in the expert role but rather a
collaborative partner in the process.
 Goal directed with a strong emphasis on the
participants themselves identifying what they need to
change.
 Strength based – not shaming and punitive but
respectful and supportive.
 Strongly focused on the participant’s themselves
identifying and working on a goal for themselves
throughout the treatment process.
Person Centered Therapy
 Respectful interaction within the group towards all
participants.
 Genuine support, care and concern for all participants.
 The belief that participants are their own best expert in
determining what they need to do, we simply support them
in this process.
 The capacity for change lies within the client and most of
what they need to know, they already know. We are not the
experts in their lives, they are.
Attachment Theory
 Insecure attachment has been linked very strongly to
difficulties in relationships when the child becomes an
adult (Dutton et al. as cited in Diefenbeck, 2003).
 Because treatment is so process oriented, it differs
greatly from approaches such as CBT, because it
involves little in the way of teaching skills and offering
new perspectives.
 Group treatment is very fluid and very much process
oriented, and attempts to create a safe and supportive
environment in which to deal with attachment issues.
Interventions
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Needs Wheel
Manipulation/Drama Triangle (Transactional Analysis)
Brainstorms and group discussions on a variety of topics
Goal formulation and regular monitoring of goal attainment
CBT (time-out’s, reframing, guided imagery, relaxation/deep breathing
techniques, PMR)
Be a Man box/Be a Lady Flower
Video: The Trouble with Evan
Role plays (i.e. communication, proximity exercises, existential
positions)
Drawing their snowmen (Transactional Analysis)
Homework assignments (Small Things that Make a Relationship
work/Reflections of my Group Experience)
Process based skills
Goal Formulation
 We have a strong emphasis on goals and all
participants must have a goal formulated by session 3.
 Goals must be attainable, observable and measurable
and in relation to another person.
 Each session thereafter, participants reflect on how
they feel they are doing in meeting their goal and what
steps they have taken to get there. Progress on their
goal is indicated using scaling questions.
 It is really critical that the goal come from the
participants themselves in order to make their
experience a meaningful one for them.
Outcome Measurements
We use a variety of outcome measurement tools and
interventions to measure success in our participants.
These include:
- OQ-45.2
- URICA DV
- Your Behaviour scale
- Weekly Evaluations (client self report)
- Final group evaluation (client self report)
- Check-in’s and check-out’s
- Homework
Program Outcomes
 Since April 1, 2006 – 257 intakes have been processed for
group. Of those 257 intakes 23 are currently in group or
waiting to start group in January.
 Since April 2006 only 18 clients (7%) have been processed
to attend group more than once in our program.
 Also, there have been 32 women processed for group
(three were repeat customers). About 13.5% of group
intakes are women.
 Our program has 77.5% completion rate so far this year.
Traditional Treatment Effectiveness
 The outcomes of the majority of treatment programs
for male perpetrators of violence appear not very
promising given high recidivism rates post-treatment
(Pugh, 2003).
 Treatment programs face a high incidence of dropouts,
ranging anywhere from 30 to 60% (Daly & Pelowski as
cited in Scott & Wolfe, 2003).
Comments from the Participants
Things they liked…
 Comforting to know I’m not alone
 Everyone was very involved and open with their thoughts
 Making and discussing our goals
 Learning that during most arguments, people want to talk
about how they feel about something
 Just all the talking, makes me feel better
 Very insightful and it was very familiar
 Everything. Absolutely everything
 Got to open up and talk about my childhood
 Open discussion – relaxed atmosphere
More Comments
Things they didn’t like…
 Realizing that I repress my feelings of anger to a huge
extent. I will try to express them more often in healthy
way before next group
 Paperwork
 Talking about my feelings (ha ha!)
 There actually wasn’t anything I didn’t like about
tonight’s group…honest!!
 It’s the last one 
Comments
Final Comments…
 I really enjoy this group and look forward to the rest of
the weeks .
 Thanks for listening again! I think this is really going
to work!
 Excellent getting points across. Instructors make
everyone feel comfortable and accepted.
 I’ve learned so much. I love being here.
 I feel good about myself with the changes I’ve made
and will make in the future.
Best Practices
 We continue to consult and network with other
treatment agencies both in Canada and the U.S
 Research is ongoing within our agency in an effort to
ensure that the treatment provided meets the highest
ethical standards, and is within the best interests of
our clients.
Bottom Line...if it doesn’t work or isn’t in the best
interest of each person we work with, we don’t do
it.
New Initiatives
 Starting in February 2011, we began offering a Part II to
the AFC group.
 All participants who complete group and who have
children under the age of 16 are invited to come back
for a 4 week Parenting Group.
 Partners are also invited and child care is provided.
 The second Parenting group will be offered in April
2011.
Suggested Readings
 For more information on domestic violence treatment,
check out:
Solution-Focused Treatment of Domestic Violence Offenders – Accountability for
Change (Lee, Sebold, Uken)
Family Interventions in Domestic Violence (Hamel & Nicholls, Eds.)
Gender Inclusive Treatment of Intimate Partner Abuse: A Comprehensive
Approach (Hamel)
Accountability for Change: Solution-Focused Treatment with Domestic Violence
Offenders (Lee, Uken, Sebold)
Wounded Boys, Heroic Men: A Man’s Guide to Recovering from Child Abuse
(Sonkin)
Current Controversies on Family Violence, 2nd ed. (Loseke, Gelles & Cavanaugh)
The Abusive Personality (Dutton)
Questions??
Contact Us
Contact Dave Shirley, AFC Coordinator at 403-327-5724
or at dshirley@lfsfamily.ca
Website
www.lfsfamily.ca