The Compassion Program

A brief, intensive and effective program for mending (healing) abusive relationships through the self-regulation of anger and anxiety.

The Compassion Program is a diciplined, intensive, didactic, skill-building instruction in basic self-regulation skills that reduce  the motivation to abuse.  The format of the program is a 12-session, 2-hours per session domestic violence treatment program with demonstrated effectiveness.  Pioneered by Dr Steven Stosny, the program has been conducted successfully in several States of America and in other countries of the world.  Research to date has shown offenders are 87% violence-free and 71% verbal aggression-free based on victim reports.  Additionally, of those ordered into the program, 74% complete (http://compassionpower.com/statistics.php).

The major skills and concepts imparted in the program include:

• Sensitivity to internal experience of self and loved ones
• Internal causes of abusive behaviour
• Self-regulation as the only route to personal power
• Well being and self-esteem depend on compassionate behaviour
• Perspective-taking in disputes (Value while disagreeing).

This innovative treatment uses compassion for self and loved ones as an incompatible response to the motivation to control and abuse.  The treatment, its theoretical and empirical foundations, and research evaluation are presented in the book "Treating Attachment Abuse" by Dr. Steven Stosny (Stosny, 1995).

The program, with its focus on engagement of the offender, is well placed to meet the selection criteria of the "What Works" literature (http://www.surreyprobation.org.uk/wworks.pdf).  According to the "What Works" Literature, effective programs:

• Are supported by research evidence
• Use a variety of interventions methods linked to criminogenic needs
• Reduce recidivism
• Match risk levels with intensity and duration of the program
• Have acceptance in professional literature
• Have demonstrated treatment effect in well-controlled evaluation studies.

Research Evidence

1.1 Attachment Theory

The ethological theory of attachment is a theory formulated by John Bowlby, which views the infant's emotional tie to the familiar caregiver as an evolved response that promotes survival.  This is the most accepted view of the infant's emotional tie to the caregiver (Beck, 1997).  According to Bowlby (1980), development of attachment occurs in four phases: pre-attachment, attachment-in-the-making, clear-cut attachment, and formation of a reciprocal relationship.

Depending on their experiences during these four phases, children develop a lasting affectional tie with the caregiver, which allows  them to use the attachment figure as a secure base across distance and time.  This inner representation of the parent-child bond becomes a critical part of personality, which serves as a set of expectations about the availability of attachment figures.  This image becomes the guide or model for all future close relationships.

Parker (2002) says that from our earliest childhood what we learn about ourselves and others is dependent on what is experienced within the context of significant relationships.  Further, adult attachment behaviours become working models of how we  view ourselves and others that are usually unconscious and mostly stable.  Attachment theory helps us understand the thoughts and feelings of people who are experiencing a range of symptoms that do not make sense to them.  This framework of understanding disperate feelings gives psychological meaning to real experiences, which helps to neutralise feelings and encourages self-reflection.  It allows for explaination without blaming the client.  Additionally, Parker (2002) suggests that attachment theory allows focus on the regulation of affect.

1.2 Violent Behaviour and Attachment Theory

Umberson, Williams, and Anderson (2002) argue that violent behaviour is an expression of emotional upset, particularly amoung certain groups (e.g., men).  This they say is not to provide justification for violence, but is intended to provide another perspective of looking at emotional uspet and violence.  Further, Umberson et al.  (2002) argue that just because people repress emotions and feelings, it does not mean that they are free of distress.  They emphasise that violent behaviour is an external expression of emotional upset in society, which conveys the message that emotions and feelings are to be repressed and that the use of violent behaviour is a suitable way to respond to frustrations and stress.  In contemporary society, violent behaviour is a serious social problem and social norms advance and support this way of expression.  The rate of violence in our society suggests that this is not an unusual way of expressing upset.

1.3 Violent Emotions

 Retzinger's (1991) review on conflict contends that alienation plays an important part in the theory of conflict, as well as the role of face saving in escalating conflict.  Characteristic behaviours such as increased threat, demeaning criticism, contempt, disgust, blame, perceived injustices, rebuff, and feeling of being devalued, have strong emotional connotations.  Studies cited in Retzinger (1991) suggest that emotions are central to marital conflict.  Conflict escalation needs to be understood in terms of bonding systems, alienation, and emotional process.  Intact bonds are flexible adn are characterised by, pride, joy, and happiness.  When bonds are damaged or threatened they are marked by insecurity, sadness, anger, and shame.

Further Retzinger (1991) asserts that emotions are culturally shaped and biologically given, since no newborn baby has to learn to smile or cry.  McDougall (1908) cited in Retzinger (1991) states that shame appears to be the most social of all human emotions, which is second to none in its significance in human relationships.  Shame is different to other families of emotion in that its main characteristic is that it involves the self its relationship to other persons; it is the only emotion characterised by "self-other process".  Shame is about preservation of solidarity, it is not concerned with the organism as an isolated entity, but with relationships between people.  Shame always occurs in response to other human beings.

The notion of individualism is a myth, which Retzinger (1991) argues, denies the inherent bond with others, as well as the emotional system that helps preserve the bond.  Shame has been deemed unimportant in this day and age and instead the focus has been on guilt.  The powerful mechanism of shame is a normal and necessary part of a well-functioning society.  Shame is the human mechanism used to monitor the self in social context.  Shame affects the whole self.  When experienced, there is a sudden exposure of deficience in one's own eyes as well as the eyes of the other.  In the experience of shame, the self feels helpless, not in control, and the reaction to shame is to hide.  In contrast, guilt is about behaviours done or not done adn the self feels in control and intact.  The reaction to guilt is to make restitution.

For shame to occur we must care about the other.  The relationship is open to distruction if one refuses to acknowledge threats or damage to bonds.  Often, events that appeartrivial can elicit shame.  Once shame is experienced, one wants to aviod the experience so as not to feel the pain of rejection.  This unacknowledged shame can play havoc in relationships.  It is unusual to find protracted anger without shame being present and visa versa.  In partner abuse, the aggressor usually feels shamed by the victim's maner.  From this perspective, the violence can be seen as a form of self-defence against a perceived or imagined attack on the self, which is overly dependent.  Unacknowledged shame acts as both a generator and an inhibitor of anger, rendering the undividual impotent to express anger towards teh other, while simultaneously generating further anger, which can lead to demeaning or hostile criticism, blame, insult, withdrawal, or worse (Retzinger, 1991).

Rage is quick to follow if intense shame is unacknowledged.  Each emotin serves as a stimulus for the other, and when shame is unacknowledged, one partner is likely to project the problem onto the other, which brings into consciousness the damaged state of the bond.  When this occurs, the tendency is to perceive the self as victim and the partner as the problem, instead of acknowledging feelings, and joint involvement in the problem, and the need for love, care and connection.  This shame experience is followed by denial or hiding of vulnerable feelings or one's own responsibility, followed by projection of blame onto the other.  Shame helps to clarify why it is so easy to blame or criticise the other, and how it is that some quarrels never end (Retzinger, 1991).

The main ingredients from the above review in protracted conflict are as follows:

1. The social bond, with its many parts is threatened; this threat often involves disrespect.
2. Shame signals damage to the bonding system.
3. Shame is denied; the self feels estranged and experiences the other as the source of the attack.
4. Anger follows, further signalling threat to the self and bond, and may be a protest against the threat.  When the bond is ignored, anger serves as a mechanism for saving face.

People kill for social reasons such as lost honour, lost affection, or other highly moral reasons, so this formula should not be taken lightly.

Stosny (1995) asserts that important ethical questions are raised when treating attachment abusers in regard to how clinicians go about helping clients behavee morally.  To aviod the risk of using power and authority to impose the majority's familial values on a minority, treatment needs to avoid the temptation to advocate particular values and endeavour, instead to help clients build skills to make moral judgements and to act on them with integrity (Stosny, 1995).  Stosny (1995) argues that a powerful sense of self, reinforced by the internal reward of compassionate constructions of self and others will produce moral agency.  Berkowitz (1990) cited in Stosny (1995) asserts that a person who already feels bad about himself is more inclined to convert the inappropriate feelings into anger, and thus, become less inclined to adhere to morally guided behaviour and become more impulsive.

According to Broucek (1991) ours is a shaming culture.  Stosny (1995) suggests that there is increasing understanding that the cause of escalating violence and the tendency towards narcissistic behaviours being observed in modern society involves the trivialisation of prosocial motivations such as compassion and forgiveness.  This could well be the cause, instead of the result of the culture of violence.

1.4 Compassion Approach

Supporting evidence for the Compassion Program is presented in the publication "Treating Attachment Abuse: A Compassionate Approach" by Steven Stosny, published by Springer Publishing Company (Stosny 1995).  Whilst sample size in this pilot evaluation was relatively small, results are very encouraging.  Further studies are in progress, e.g., "Change in Self-esteem and Physical Aggression During Treatment of Partner Violent Men", Murphy, C. M., Morrell T.M., and Stosny, S.  (In press).

It should be noted that research evidence for the effectiveness of the current dominant program, the Duluth Domestic Violence Perpetrator Program, is lacking to date, and in fact this program had no impact on recividism after 5 years (Vincent & Jouriles, 2000).  The Compassion Program differes in approach to the Duluth program.  The Compassion Program is a cognitive-behavioural intervention based on attachment theory, unlike the psycho educational approach of the Duluth program.  The Compassion Program focuses on engagement of participants through the viewing of a purpose-made video, "Shadows of the Heart" (Stosny 1994).  From here, participants are given skills to enable behavioural changes to occur.

Intervention Methods

The Compassion Program uses a workshop presentation with a variety of interventional methods, including:

• Didactic presentation supplemented with video and overhead presentations.
• Each session has "homework" which is required to be completed before the next session.
• Limited group discussion (because of the many narcissists among abusers) as the group develops self-regulation skills.
• An official manual supplemented with extra relevant handout material (which may vary to address specific needs) is used to enhance understanding of concepts discussed in sessions.
• Contact details are given to  participants to give assistance with homework (e.g. lach of literacy skills) and with understanding issues such as personal conflict.  Help is available through telephone counselling in crisis situations.
• A "one-on-one" focussed session is given to any participant genuinely unable to attend a session.

Criminogenic Risk Factors

Criminogenic risk factors associated with attachment abuse and recidivism are adequately addressed in the Compassion Program.  The risk factors addressed include:

• Particular temperament and behavioural characteristics such as egocentrism.
• Negative family factors such as abuse.
• Unstructured and undisciplined environment.
• Unregulated guilt, shame, and abandonment or engulfment anxiety.
• Poor social skills.
• Poor parenting skills.
• Poor bonding skills with the significant others in offenders lives.
• Poor intimacy skills.

Reduction in Recidivism

Ongoing evaluation of The Compassion Program is obtained by administering the conflict tactic scale, Straus (1996) to partners one year after completing the program.  Of those ordered into the program 74% complete.  Results to date show 86% violence free after one year based on victim report, 71% verbal aggression-free after one year, and 92% free of serious violence after one year, again based on victim report.

Matching of Risk Levels with Intensity and Duration of Program

Engagement of the participant is paramount to the successful outcome of any program.  The Compassion Program focuses on establishing engagement through viewing and post-viewing procession of the video "Shadows of the Heart".  Participants are reminded after the video that they have choices in how they respond in any situation, and that personal power is about choices and options.

The program emphasises that you don’t always have a choice in what you do, but you always have a choice about what something means to you.  It than asks, “Is this program going to be a benefit to you?”  “Can you turn it into something positive for yourself?”  “Or are you going to make it a waste of your time?”  It then explains that real personal power is deciding what your experience is going to mean to you, and that you always have a choice. 

 Participants may be ordered by the court to attend programs, but no one can make participants learn or change. This is a choice that each participant must make. The program is able to demonstrate engagement through satisfactory completion of homework assignments, and demonstration of improvement in emotional regulation skills. A completion certificate is not given unless these criteria are strictly met. This is made clear to participants in the first session of the program.

Acceptance in professional Literature

The Compassion Program approach to domestic violence demonstrates professional acceptance through inclusion in the publications (Stosny, 2002) “Treating attachment abuse” in “Programs for Men who Batter: Intervention and Prevention Strategies in a Diverse Society”.  As well as professional acceptance, the work of Dr Steven Stosny is acquiring increasing lay acceptance as the effectiveness of his program gains media recognition.  Dr. Stosny recently appeared as expert consultant on the Oprah show, a summary of which was published in Oprah magazine (Oprah Winfrey Show October, 2003).   

Demonstrated Treatment Effect

See figures quoted above.  In addition, as consideration of safety for partners and children is paramount, The Compassion Program focuses on partner safety.  To address this issue (for mandated clients) a letter is sent to the partner of participants informing them of their partner’s participation and times of sessions.  Partners are invited to attend the program also, although attending different sessions to their partner is recommended.  Partners are warned that treatment is not effective in stopping abusive behaviour in everyone, and that their focus must be on their own safety and recovery as well as that of their children.  Partners are cautioned not to resume their relationship unless their safety can be completely and unconditionally guaranteed.  If continued abuse occurs partners are advised to phone the workshop facilitator or the police. Additionally, a safety plan is included for the partner.

A Brief Overview of The Compassion Program  - A 12-session program. 
Module One:

Session 1: Focuses on engagement of the participant as well as giving an overview of the program, and expectations for satisfactory completion of the workshop.

Session 2: Understanding the process of anger physically, cognitively and behaviourally.

Session 3: “HEALS” – a five-step healing technique to process hurt, and change motivation from attack/avoid motivations to approach motivations, which are to heal, improve and correct.               
     
This technique is then individually practiced in front of the group during the remainder of session 3 and part of session 4. An audio version of the steps of the HEALS process is supplied to each participant.  Participants are required to listen to the tape 12 times a day for 4 to 6 weeks to generate automatic healing response to anger.

Session 4: A consolidation session to reinforce the concepts taught to date and to make sure participants clearly understand the subject matter, as this is the foundation of the remainder of the program.

Module Two:

Session 5: The functions of compassion and how that relates to unwise trust and disagreement are explained.  The abuse cycle is discussed and finally a discussion about normal feeling and how our thinking changes them into symptoms and defences.

Module Three:

Session 6: Video version of “HEALS” showing a role-play of the use of the HEALS process under stressful circumstances.  A quiz to highlight how socialisation of the “macho” image is not in the participant’s best interest is presented to the group.  Self-esteem, blame and responsibility and building immunity to core hurts is covered.

Module Four:

Session 7: Empowering loved ones, avoiding power struggles and parenting skills.

Module Five:

Sessions 8: Empowering children (continued), family empowerment agreement, family solution finding guide and how to disagree are taught.

Session 9: Family problems are discussed, the different worlds of work and family, enriching attachment relationships, post traumatic stress, the great threats of intimacy (fear of abandonment and engulfment) and how to regulate these are discussed.

Session 10: This session covers resentment and how to prevent it, the requirements of intimacy and protecting the attachment bonds.

Module Six:

Session 11: Consolidating gains and relapse prevention are the key topics of this session and everyone recites the gains they have made from the program in front of the group.

Session 12: Processing a “Letter of Compassion” written by the participant to the person hurt. This is a way of formally drawing a line between the past, controlled by anger and hurt, and the present, in control of self, competent, growth-oriented, compassionate, and healing.

A completion certificate is issued to participants who fulfil all requirements for the program. Any participants who do not fulfil requirements are invited to complete in a repeat of the program.

Facilitation of  “The Compassion Program”

The Compassion Program is personally facilitated by Mr Denis Hay.  Denis has a great passion for this work and an affinity with the offenders.  He has received training under Dr Steven Stosny in CompassionPower programs, has a partnership and copyright agreement authorising Denis to run his programs and reproduce his materials. As the program gains acceptance and popularity Denis will recruit and train other suitably qualified and dedicated facilitators to assist.

Denis has worked as a Lifeline telephone counsellor for approximately 8 years.  During that time he became a group leader and training facilitator.  Additionally, Denis has worked with men in industry as a tradesperson for 40 years and for the last 6 years in a face-to-face counselling role.  He has completed a Men’s Group Facilitators Training Course conducted by Yaro Starak who is co-director of the Brisbane Gestalt Institute.  Qualification include Masters of Counselling degree and a Bachelor of Social Science (Psych) degree and as well as a Cert VI in Assessment and Workplace Training.

Denis is a clinical member of the Queensland Counsellors Association and a member of the Men’s Health and Wellbeing Association (Qld) and has been a member of both organisations management committee.  He is registered on the Psychotherapy & Counselling Federation of Australia (PACFA) national register, which has high eligibility criteria for inclusion.

Cost Effectiveness of the Program

This program achieves greatly reduced recidivism, provides monthly statistical reports of treatment effectiveness and dropouts, and tracks clients for one year following treatment.  The program engages clients, reducing the need for courts to enforce attendance.  Compassionate child-rearing techniques are taught to break the cycle of violence.  Linkages with the Court and probation authorities will be maintained, promptly reporting completion, dropouts, and no shows.

The safety of victims is paramount and participants and their partners are provided with free lifetime group membership, which means they can phone to discuss issues or attend part or the entire workshop again.     

Program cost varies depending on the number of participants (partner free of charges except for the cost of new workbook and materials).

Summary

The Compassion Program is different to other programs currently used.  It is a cognitive-behavioural intervention based on attachment theory.  The model locates the origin of abusive behaviour in the abuser’s use of anger to avoid feeling the painful emotions of shame and distress, which can be experienced as being disregarded, devalued, rejected, powerless, unimportant, accused, guilty, or unlovable.  These painful labels are called “Core Hurts”.  The healing technique called HEALS cognitively restructures these hurts by improving the offenders’ capacity to regulate their own emotions and to engender compassion and empathy using cognitive-behavioural techniques designed to disrupt the offenders’ violent emotional response to guilt, shame and fear of abandonment.

The treatment is non-blaming and non-shaming.  The program is designed to significantly increase participants emotional intelligence and in turn to regulate their vulnerable emotions in ways that are in their long-term best interest and the long-term best interest of their loved ones.

Research data supports this cognitive-behavioural based program.  Additionally, professional literature reinforces the approach to domestic violence that the Compassion Program uses.  The program is well received by participants, even those who are mandated to attend by the courts.

Cost effectiveness is addressed by the benefits this package offers to the courts and the criminal justice system.  For example: Greatly reduced recidivism, monthly statistical reports of treatment effectiveness and dropouts and the tracking of the clients for one year following treatment.

The Compassion Program teaches compassionate child-rearing techniques to break the cycle of violence.  Program completion, drop-outs and no shows are promptly reported to the courts or probation authorities.  Safety of victims is paramount and finally all participants in the program and their partners are offered a free lifetime support group membership.

The Compassion Program as offered here represents excellent value for a program with demonstrated and proven effectiveness and reproducible results.

 
References

     Abuse Data (recidivism based on report of victims).  Retrieved August 24, 2002 from the World Wide Web: http://compassionpower.com/statistics.php     
     Bowlby, J.  (1980).  Attachment and loss: Vol3.  Loss.  New York: Basic Books.
    
     Broucek, F. J.  (1991).  Shame and the self.  New York: Gilford Press.
    
     Jouriles, E. N., & Vincent, J. P.  (2000).  Domestic violence: Guidelines for research-informed practice.  London, PA: Jessica Kingsley Publishers.
    
     Murphy, C. M., Morrell, T. M., & Stosny, S.  (in press).  Change in self-esteem and physical aggression during treatment for partner violent men.  Journal of Family Violence.
    
     Oprah, W.  (2003).  Oprah Winfrey Show. October, 2003.
    
     Parker, J.  (2002).  Attachment and adult psychology.  Clinical Social Work Journal, 30(1), 113-116.
    
     Retzinger, S. M.  (1991).  Violent emotions: Shame and rage in marital quarrels.  Newbury Park, CA: Sage Publications. Inc.
    
     Stosny, S.  (1994).  Shadows of the heart: A dramatic video for the treatment resistance of spouse abusers.  Social Work, 39 (6).
     
     Stosny, S.  (1995).  Treating attachment abuse: A compassionate approach.  New York: Springer Publishing Company.
    
     Stosny, S.  (2002).  Treating attachment abuse: The compassion workshop.  In E. Aldarondo, F.  (Eds.), Programs for men who batter; Intervention and prevention strategies in a diverse society.  Kingston, NJ: Civic Research Institute.
    
     Straus, M. A., & Hamby, S. L.  (1996).  The revised conflict tactics scale (CTS2): Development and preliminary psychometric data.  Journal of Family Issues, 17 (3), 283-316.  
    
     Umberson, D., Williams, K., & Anderson, K.  (2002).  Violent behaviour: A measure of emotional upset.  Journal of Health and Social Behaviour, 43(2), 189-206.
    
     Vincent, J. P., & Jouriles, E. N.  (Eds.).  (2000).  Domestic violence: Guidelines for research-informed practice.  London; PA: Jessica Kingsley Publishers.
   
      What Works reducing re-offending: Evidence-based practice.  Retrieved October 13, 2003 from the World Wide Web: http://www.surreyprobation.org.uk/wworks.pdf