Domestic Violence Batterer’s Treatment: MRT and the New DSHS Regulations

What is the Difference Between Anger Control and Batterer’s Treatment?

For anyone charged with domestic violence, it is very important to be aware of something as an initial matter: Domestic Violence Batterer’s Treatment is not Anger Management or Anger Control. How different probably depends on who you ask. But all professionals in the field would probably agree that there are a number of differences that are critical and generally true:

• anger management is not aimed at a relationship with a particular victim; on the other hand, Domestic Violence Batterer’s Treatment deals with a relationship with a particular intimate partner or family member and usually involves that person’s input in the treatment;
• anger management classes are short term (2 to 16 hours) versus batter’s treatment which is long term (6 months to a year or longer)
• anger control is far cheaper: For anger management, prices of $100 or $200 are typical. Domestic Violence Batter’s Treatment is far more expensive. One local agency advertises that it charges $40 per session. So, just the first six months would cost $1,040, not including the cost of the evaluation (for which prices of $300 or more are typical). Most agencies do not list their prices.
• anger control views anger as the problem versus batter’s treatment which has generally viewed the offenders wish to exert power and control over specific victims as the entire problem, or a big part of the problem.

What is MRT?

Moral Reconation Therapy® or MRT is a copyrighted model of mental health therapy used to treat domestic violence abuse and other mental health issues. It is a model of therapy that is being incorporated into domestic violence treatment to an increasing degree around the country instead of, or in addition to, the “Duluth Model” which has been the prevailing model.

The therapeutic approach that eventually became MRT was first developed in the late 1970’s and early 1980’s by a Dr. Greg Little and Dr. Ken Robinson at the Federal Correctional Institute in Memphis. The early program was used to treat drug addiction in male inmates at that prison. In the mid-1980’s, those doctors and others in the field worked on the early program to develop the written materials that were the first MRT workbooks. MRT is now used to treat domestic violence, drug addiction and other mental health issues all over the United States and in a number of foreign countries.

Understanding a bit of the history of MRT is useful in order to understand that MRT is not a specific mental health treatment program. Although the MRT approach being used by domestic violence treatment agencies around the country, it should be kept in mind that MRT is a therapeutic approach, not a specific program. One consequences of this – a consequence discussed in the literature – is that what actually happens in treatment programs truthfully advertised as MRT treatment may vary from agency to agency, and even from one counselor to another at the same agency.

MRT is a cognitive-therapy based approach, in the words of its advocates, that attempts to lead to enhanced moral reasoning, and encourage better decision making and morally appropriate behavior. The MRT website explains that a basic idea of MRT is that the problem being addressed – domestic violence, drug addiction, etc. – is the result of cognition: that is to say, of thought processes that are defective and wrong. “Thoughts, beliefs and attitudes” is a phrase frequently used in MRT literature. The MRT website (www.moral-reconation-therapy.com) explains that “moral” refers to moral reasoning. The term “conation” comes from the psychological term “conation” which refers to conscious decision making. MRT is intended to lead to enhanced moral reasoning, better decision making and more appropriate behavior.

MRT is sometimes referred to as the second wave of mental health therapy. The “First Wave” was the first generation of psychotherapy developed in the late 19th century. It is “behavioral” in that it assumes that a person’s behavior is a reflex produced by a response to stimuli in the environment, or a consequence of that individual’s history. First wave psychotherapy tends to focuses on the past, on traumatic experiences and is heavily therapist guided. The second wave, as discussed, is cognitive therapy which it’s supporters emphasize is evidenced based – that is, like some other schools of therapy, it is based on research as to what actually works with actual patients. A third wave of psychotherapy is an emerging approach that develops and expands on the first and second waves. A core idea of the third wave is that the first and second waves focused on internal thought processes and emotions; but, the third wave expands the focus to developing skills for coping with one’s external situation. The third wave addresses a criticism of the Duluth Model approach (discussed below), ie, that it can tend to ignore real life problems that are actually a big part of the domestic violence problem, i.e., economic pressures, alcohol and drug addiction, etc.

How is MRT Different than the Previous Prevailing School of Domestic Violence Treatment?

The Duluth Model has been the prevailing model of domestic violence treatment for a number of years. The Duluth Model’s name comes from the city of Duluth, Minnesota where the program was developed in the early 1980’s. It was developed by battered womens’ advocates with the aims, in the programs words, of keeping victims safe, holding batterers acountable, and shifting the responsibility for victim safety to the community and law enforcement.

The Duluth Model views domestic violence as a result of men’s use of battering to exert power and control over women and is the result of the power imbalance between men and women in a society that is still patriarchal. The Duluth Model’s emphasis is sometimes described in several bullet-points that are probably familiar to anyone involved in domestic violence treatment – whether as a patient or a provider – in the past 20 years. This is an excerpt from the Duluth Model’s website summarizing the approach:

A community using the Duluth Model approach:

• Has taken the blame off the victim and placed the accountability for abuse on the offender.
• Has shared policies and procedures for holding offenders accountable and keeping victims safe across all agencies in the criminal and civil justice systems from 911 to the courts.
• Prioritizes the voices and experiences of women who experience battering in the creation of those policies and procedures.
• Believes that battering is a pattern of actions used to intentionally control or dominate an intimate partner and actively works to change societal conditions that support men’s use of tactics of power and control over women.
• Offers change opportunities for offenders through court-ordered educational groups for batterers.
• Has ongoing discussions between criminal and civil justice agencies, community members and victims to close gaps and improve the community’s response to battering.

Under the Washington State DSHS regulations, the basic requirements of the Duluth Model – for example, that the primary focus of a program must be victim safety and offenders must be held accountable – must be included in every domestic violence batterer’s program. So there is a certain blurring of the differences between the various approaches to domestic violence treatment. However, both the old regulations and the new revised regulations do not require any particular approach. The new regulations expressly allow different approaches, including cognitive-behaviour approaches, ie, MRT.

What are the Regulations Governing Domestic Violence Treatment in Washington State?

In Washington, any program that advertises that it provides domestic violence “perpetrator” treatment or that holds itself out as satisfying court ordered domestic violence treatment is regulated by the Washington State Department of Social and Health Services or DSHS. The DSHS regulations governing domestic violence treatment have just been revised and overhauled. The new regulations went into effect on June 21, 2018. The older regulations have been repealed and the new regulations are at WAC 388.60A.

A DSHS information sheet accompanying the new regulations explains that the regulations governing domestic violence treatment had not been updated since 2001. DSHS states that the new regulations are an extensive overhaul of the regulations and are intended to update the regulations so as to increase the effectiveness of treatment, standardize that treatment throughout the state and increase the safety of victims and their families.

The new regulations are voluminous and address many areas of domestic violence treatment. Key changes include:

• a more intense interview, intake and assessment process that will be used to develop individualized treatment plans. DSHS explains that this section of the regulations has been completely overhauled to provide a more robust intake process and is intended to help determine the correct level of treatment for each participant and to help standardize treatment statewide
• all programs, whatever school is followed, must use evidence based or promising practices; (as discussed, evidence based means a treatment approach is based on research that the treatment approach actually works; promising practices is a term of art meaning preliminary research and evidence shows that the approach may become an evidence based approach)
• 4 levels of treatment are created and each level has a different minimum length of treatment. The old regulation providing that treatment had to be at least 24 weekly same sex sessions of group therapy with another 6 months of follow-up treatment. The new regulations create 4 levels level treatment. The minimum treatment period for all programs is the period required to meet all the requirements of the treatment program and must include at least:
  • level 1 – a minimum of 6 months of weekly group sessions
  • level 2 – a minimum of 9 months of weekly group sessions
  • level 3 – a minimum of 12 months of individual sessions, or a combination of weekly and group
  • level 4 – a minimum of 18 months of weekly individual sessions, or a combination of weekly and group (WAC 388.60A.0420)
• at all levels of treatment, group sessions must be same-sex, weekly and at least 60 or 90 minutes depending on the number of participant;

Like the old regulations, the new regulations do not mandate that treatment follow one of the various schools of psychiatric approaches. Articles on the old regulations sometimes incorrectly stated that the old regulation mandated the Duluth approach. It was and is true that the regulations require all treatment programs to incorporate some of the basic requirements of the Duluth method. For example, the new regulations require that any treatment program must document that the program’s primary focus is on victim safety and holding the offender accountable as noted above, and require that whatever philosophy is used, treatment cannot blame the victim or suggest that a victim shares responsibility for the abuse. However, the new regulations expressly note that cognitive approaches such as MRT are permitted by including cognitive approaches in a non-exclusive list of permitted practices. (WAC 388.60A.0310).