Over the past thirty years since the 1970s, the treatment of choice for perpetrators of domestic violence has not evolved much. Most programs consist of either cognitive-behavioral therapy (e.g., Dutton 1998; Sonkin 2003), feminist-based reeducation (Pense and Paymar 1993), or a combination of the two. Other models, such as those of family systems and psychodynamics (Dutton and Sonkin 2003), have been described but are less common in practice. The reason for this is that state laws that have been advocated by activists generally mandate the type of interventions providers must include in their programs, and these requirements usually are based on the feminist reeducation model, such as that offered by the Domestic Abuse Intervention Project, which has come to be known as the Duluth Model. Although some scholars and practitioners are attempting to challenge these traditional ways of approaching perpetrator treatment (see, e.g., Dutton and Nichols 2005), domestic violence intervention has experienced little change in recent decades.
Many states have mandated the Duluth Model into the law, even though numerous evaluations of this model have found that program participation had no impact on recidivism (Davis, Taylor, and Maxwell 1998; Feder and Forde 1999; Levesque 1998; Shepard 1987, 1992). One outcome of having legislated a particular form of intervention is that there has been a stagnancy in the field, resulting in minimal innovation and change over the last decades of the twentieth century. What is most disturbing is that this stagnancy continues despite research suggesting that the current intervention models are having only a moderate effect on treatment outcome (Babcock, Green, and Robie 2004).
The purpose of this research paper is to propose an expansion of the common conceptualization of domestic violence from a primarily behavioral-social/political perspective to a model that considers recent findings in developmental and social psychology as well as neuropsychology. While this research paper will focus primarily on male perpetrators, many of the principles of attachment theory and neurobiology presented here can be applied to women perpetrators (Babcock, Miller, and Siard 2003; Leisring, Dowd, and Rosenbaum 2003) and victims (Henderson, Bartholomew, and Dutton 1997; Morgan and Shaver 1999).
I. Attachment Theory Overview
II. Adult Attachment
III. The Neurobiology of Attachment
IV. Attachment Theory and Domestic Violence
V. Developing the Therapeutic Alliance with Batterers
Affect Regulation in the Treatment of Perpetrators
VII. Left Brain/Right Brain
Attachment Theory Overview
In his landmark trilogy Attachment and Loss, the British psychiatrist John Bowlby (1969, 1973, 1980) posited a theory of development that contradicted the prevailing psychoanalytic theories of the time and proved to be a revolutionary way of understanding the nature of the attachment bonds between infants and their caregivers (Bretherton 1992). In his observations of infants separated from their mothers and fathers during hospitalizations, he saw the dire effects of separation distress on the emotional state of the child. According to the theory, attachment is governed by a number of important principles. First, alarm of any kind, stemming from an internal (such as physical pain) or external source (such as a loss of contact with a caregiver), will activate what Bowlby called the ‘‘attachment behavioral system.’’ Bowlby believed that this system was one of four behavioral systems that are innate and evolutionarily function to ensure survival of the species. The distress produced by the stimulus directs and motivates infants to seek out soothing physical contact with the attachment figure. Once activated, only physical attachment with the attachment figure will terminate the attachment behavioral system. As Cassidy (1999) describes, the infant is like a heat-seeking missile, looking for an attachment figure that is sufficiently near, available, and responsive. When this attempt for protection is met with success, the attachment system deactivates, the anxiety is reduced, the infant is soothed, and play and exploration can resume. When these needs are not met, the infant experiences extreme arousal and terror. When the system has been activated for a long time without soothing and termination, the system can then become suppressed. If the system is activated and inconsistently soothed, it can become exquisitely sensitive and reactive. Bowlby reported observations he made of 15- to 30-month-old children separated for the first time from their mothers. He witnessed a three-phase behavioral display: protest, despair, and detachment. He concluded from these observations that the primary function of protest was to generate displays that would lead to the return of the absent parent. This expression of negative emotion may be viewed as an attempt to recapture the attachment figure that can soothe tension and anxiety at a developmental stage where the child cannot yet self-soothe. Through this signaling, the attachment figure is told that she is wanted and/or needed. When the attachment figure is sufficiently unresponsive to the infant’s call for help, insecure patterns of attachment develop that may set the stage for interpersonal problems later in life.
Mary Ainsworth was the American psychologist who brought Bowlby’s theory to the United States and developed a method, the Strange Situation, of assessing infant attachment (Ainsworth, Blehar, Waters, and Wall 1978). Originally three patterns were observed—secure, anxious-avoidant, and anxious-ambivalent—but later on a fourth category, disorganized, was described. Since Ainsworth’s original studies, it has been found that attachment pattern rates are fairly consistent across cultures— approximately 65 percent secure and 35 percent insecure (van IJzendoorn and Sagi 1999). The Strange Situation is a laboratory procedure used to assess infant attachment status. The procedure consists of eight episodes of separation and reunion. The infant’s behavior upon the parent’s return is the basis for classifying the infant into one of three attachment categories. The secure infants experienced distress at the separation and were unable to resume exploration and play. When the parent returned, the infant showed distress but was able to quickly settle down and return to exploration. Another group of infants showed distress at neither separation nor reunion. These infants were termed anxious-avoidant. Although they seemed unaffected by the separation and reunion process, their results on physiological measures showed that they were clearly in distress. A third category of infants were extremely distressed at separation and at reunion. However, these infants were not able to return to play and exploration, like the secure infants, when their parents tried to soothe them. They clung to their parents and often demonstrated anger and aggression. These infants were termed anxious-resistant.
Originally researchers described three categories (secure, anxious-avoidant, and anxious-resistant), though some infants studied were termed ‘‘cannot classify.’’ Main and Solomon (1986) looked more closely at these unclassifiable infants and found that some children were particularly ambivalent upon reunion with their attachment figure, both approaching and avoiding contact. These infants appeared to demonstrate a collapse in behavioral and attentional strategies for managing attachment distress (Hesse and Main 2000). They didn’t display an organized strategy for coping with attachment distress, so these infants were termed disorganized. When researchers asked why these children were both seeking protection from their caregivers while at the same time pulling away, they discovered that a large percentage of these infants were experiencing abuse by their caregiver. Main and Hesse (1990) wrote that these infants were experiencing ‘‘fear without solution.’’ Another subgroup of disorganized infants, however, were not experiencing abuse by their caregivers, which the researchers found to be a curious anomaly. It was discovered that these caregivers had experienced abuse by their parents, but that abuse was still unresolved (Hesse, Main, Yost-Abrams, and Rifkin 2003). Upon close examination, it was discovered that when the infant was in need of protection, the caregiver became frightened (as evidenced by his or her turning away or making subtle frightening faces at the infant). It is believed that attachment disorganization occurs when a parent acts either frightening or frightened in response to the infant’s need for protection.
In the 1980s, the field of adult attachment began to evolve. This occurred for several reasons. First, many attachment labs were conducting research on the continuity of attachment status over time. Researchers were also becoming interested in the long-term effects of secure and insecure attachment on interpersonal functioning. As the research in child, adolescent, and adult attachment evolved, new methods of assessing attachment status were needed. Main and Goldwyn (1993), at the University of California, Berkeley, developed the Adult Attachment Interview (AAI). The interview has been utilized in hundreds of studies worldwide to assess adult attachment states of mind.
In longitudinal studies, 80 percent of children assessed in the Strange Situation as infants were given the same AAI classification as young adults (Fraley 2002; Waters, Hamilton, and Weinfield 2000). In approximately 20 percent of the cases, the attachment status changes over time (usually from insecure to secure, but sometimes the other way). The term ‘‘earned security’’ is used for those individuals who were assessed as insecure as infants but assessed as secure as adults (Roisman, Padron, Sroufe, and Egeland 2002). When a child changes from insecure to secure, it is most likely as a result of a relationship. This makes sense because insecurity grows out of relationships, so one would expect ‘‘earned security’’ to grow out of relationships. The AAI data have also been utilized to examine the relationship between the parent’s attachment status and the attachment relationship between that parent and her/his infant (Main and Goldwyn 1993). The most robust predictor of the attachment pattern between the infant and her/his parent is the attachment status of the parent—as high as 80 percent predictability.
Social psychologists have studied attachment in adult relationships and its relationship to interpersonal (Fraley and Shaver 2000) and group processes (Rom and Mikulincer 2003). Out of this track came a large body of social-psychological research on attachment style (rather than attachment status, the term used by developmental psychologists) and interpersonal functioning. Self-report measures have been developed that could be quickly administered to a larger group of subjects and scored relatively easily. Attachment is deconstructed differently, depending on the measure. For example, the Experiences in Close Relationships Scale measures attachment patterns based on two continuums, anxiety and avoidance (Brennan, Clark, and Shaver 1998). The Relationship Status Questionnaire, developed by Bartholomew and Horowitz (1991), measures attachment in a way that is more in line with Bowlby’s initial conceptualization: internal working models of self and others. Although there was some initial conflict between the consistency between self-report measures and interview methods, recent studies have suggested that these different assessment tools may have more consistency than originally thought (Shaver, Belsky, and Brennan 2000).
A number of important findings have emerged from the research on attachment. Attachment is a form of dyadic emotion regulation (Mikulincer, Shaver, and Pereg 2003; Sroufe 1995). Infants are not capable of regulating their own emotions and arousal and therefore require the assistance of their caregiver in this process. How the infant ultimately learns how to regulate his/her emotions will depend heavily on how the caregiver regulates his/her own emotions and displays sensitivity or attunement to the infant’s emotional state (Fonagy, Target, Gergely, and Jurist 2002; Stern 1985). Another important finding was that attachment is not a one-way street. As the caregiver affects the infant, the infant also affects the caregiver. This process is referred to as ‘‘mutual regulation’’ (Tronick 1989). The caregiver is not only aware through observation of the infant’s emotional state, but also feels the infant’s emotions, which allows for even greater sensitivity.
The Neurobiology of Attachment
Bowlby believed that attachment was a biologically based behavioral system (Bowlby 1988). However, it wasn’t until the 1990s, the decade of the brain, with the development of sophisticated scanning techniques, that we were able to literally look into the brain and better understand how this behavioral system actually functioned. Magnetic resonance imaging (MRI) studies of infants have indicated that a rapid and significant brain growth spurt occurs from the last trimester of pregnancy through the second year. The volume of the brain, particularly the right brain, increases rapidly during the first two years (Schore 1994). The right brain has been linked with self-regulation, the enhancement of self/other emotion regulation, and the implicit self, all of which are shaped by these attachment experiences (Fonagy 2001; Schore 1994). During this time, the infant is developing important neural capacities that critically affect interpersonal functioning. Certainly these first two years are both a time of opportunity and a time of vulnerability (Siegel 1999).
What are the mental capacities that are developing in the infant’s right brain during this critical period? Siegel (1999) states that early childhood experiences with caretakers allow the brain (the right prefrontal cortex in particular) to organize in specific ways, which forms the basis for later interpersonal functioning. The immature infant brain uses the mature functions of the caregiver’s brain to develop these important neural capacities, which include: body mapping, reflective function, empathy, response flexibility, social cognition, autobiographical memory, and emotion regulation. Given this list, a well-developed right prefrontal cortex is critical to experiencing healthy interpersonal relationships. It may also be the biological basis of the attachment behavioral system. The lack of development of this part of the brain and the need for parental interaction explains why there would be such a high correlation between a parent’s attachment status and the infant’s attachment status.
Because the vast majority of perpetrators of domestic violence have insecure attachment (Dutton 1998), it is important for clinicians to understand what specific neural capacities may be lacking in their clients and to develop interventions that specifically address those deficits. In addition, if secure attachment in parents is most likely going to imbue secure attachment in children (good affect regulation capacities), then the same may be true about psychotherapy. The better therapists are at regulating their and their client’s affect, the more likely their clients will become ‘‘earned secure.’’
The neurobiology findings suggest that the techniques typically utilized to effect change in treatment, such as interpretation, education, and skill building, may not be sufficient to bring about lasting (one may even say neurobiological) change in psychotherapy clients. Schore (2003a, 2003b) suggests that the right-brain to right-brain attunement that occurs between a parent and an infant is primarily a nonverbal, nonintellectual process. He suggests that psychotherapists appreciate this fact if they want to make an impact on the neural capacities of the right brain. The right hemisphere processes information quite differently from the left hemisphere (Trevarthen 1996). The right-hemisphere specialization in affective awareness, expression, and perception is critical to clinicians who are helping people learn to regulate affect more adaptively. However, the language of the right hemisphere is different from the left. As opposed to the left hemisphere, whose linguistic processing and use of syllogistic reasoning looks for logical, linear cause-effect relationships, the language of the right hemisphere is nonverbal and body oriented (Siegel 2001). It would follow that changing these capacities of right-prefrontal functioning will necessarily involve a nonverbal and body-awareness component.
Attachment Theory and Domestic Violence
Don Dutton’s (1988, 1994) groundbreaking studies on batterer typology and intervention found that there were different types of batterers needing different types of interventions. Other domestic violence researchers (Babcock, Jacobson, Gottman, and Yerington 2000; Hastings and Hamberger 1988; Holtzworth-Munroe, Smart, and Hutchinson 1997; Saunders 1987) have found the same differences. As Dutton (1994) began to incorporate attachment measures into his interview protocol, it became clear that different patterns of attachment also began to emerge. Approximately 40 percent had dismissing attachment (as compared with 25 percent in the nonclinical population), 30 percent preoccupied attachment (as compared with 10 percent in the nonclinical population), and 30 percent disorganized attachment (as compared with 5 percent in the nonclinical population). Dutton utilized a self-report measure developed by Kim Bartholomew, the Relationship Scales Questionnaire (RSQ) (Bartholomew and Shaver 1998). These findings were corroborated by the research conducted by Holtzworth-Munroe et al. (1997), who utilized both the RSQ and AAI in their research with perpetrators and found similar results with both measures. What these data suggest is that domestic violence perpetrators have higher rates of attachment insecurity than the general population and that incorporating attachment theory into treatment may ultimately help increase outcome data and facilitate the process of clients developing ‘‘earned security.’’
These data also prove that batterers represent a heterogeneous population and that different interventions may be necessary for different clients depending on how they regulate attachment distress. For example, batterers with a dismissing attachment status downregulate affect, so interventions need to focus on helping these individuals identify disavowed affect and learn constructive ways of expressing feelings and needs in a relationship context. Conversely, preoccupied clients, who have learned to upregulate attachment distress, need to learn how to self-soothe when activated and not depend solely on their attachment figures to soothe them via proximity maintenance.
Disorganized batterers have learned that interpersonal relationships are dangerous. They have learned to regulate attachment distress through approach and avoidance. When these forces are strongest, it can result in a breakdown in cognition and affect, resulting in uncontrollable rage and dissociation. These individuals need to address previous traumas and losses in order to break the disorganized processes that contribute to aggression and violence. One study found increased success (Saunders 1996) when batterers who have experienced childhood abuse were given psychodynamic treatment models that emphasize resolution of childhood abuse dynamics. Although the goal of domestic violence treatment for each of these attachment categories is similar—cessation of violence— how that goal is achieved will differ depending on how each client typically regulates attachment distress.
Developing the Therapeutic Alliance with Batterers
The most robust predictor of change in psychotherapy is not the techniques or even the brilliant interpretations that therapists devise, but the relationship between the client and the therapist (Horvath and Greenberg 1989; Luborsky 1994; Stern 2004). Bowlby (1969) believed that intimate attachments to other human beings are the hub around which a person’s life revolves. From these intimate attachments, a person draws strength and enjoyment of life. Bowlby also believed that one such attachment might be a person’s therapist. Bowlby (1988) described the five tasks of attachment-informed psychotherapy. One of those tasks is to explore the relationship with a psychotherapist as an attachment figure. Bowlby believed that the therapist would be viewed as an attachment figure regardless of whether or not the client was aware of this fact. And like the patterns of attachment that emerged in the stressful Strange Situation procedure, the natural ruptures and reunions that occur in psychotherapy that are likely to activate the attachment behavioral system of the client will become grist for the therapeutic mill.
Because more perpetrators of domestic violence have had particularly negative experiences in their family-of-origin attachment relationships, simply walking into the therapist’s office is likely to cause some degree of anxiety. In this unusual type of relationship, clients have the opportunity to have these reactions and patterns of attachment brought to their attention, to reappraise their functionality and learn new methods of regulating attachment distress.
How does one facilitate the process of attachment in psychotherapy? Therapists are trained to focus primarily on verbal communication in the therapeutic encounter, but just as the expression of infant distress is largely nonverbal, so, too, much of the communication between client and therapist occurs on the nonverbal level. The more therapists are able to adaptively regulate their own emotional reactions to clients, the better they will be able to attend and respond to their clients’ signals. Therefore, it is critical that therapists working with perpetrators are able to read nonverbal signals, interpret them correctly, respond quickly and appropriately, and help slowly and gently bring these emotions to awareness so that perpetrators can learn adaptive ways of regulating them. Contingent communication begins when the client sends a signal to the therapist. These signals are both verbal and nonverbal (facial expressions, body movements/gestures, tone of voice, timing and intensity of response, etc.). The therapist needs to recognize the signal, interpret it correctly, and send back a message to the client that these signals have been seen. This response is not simply a mirror of what was received (e.g., I see that you are angry); the therapist must send a message that not only was the original signal received and interpreted and is being responded to, but that a part of the therapist has been communicated to—that part, of course, which is the therapist’s caring, concern, or empathy. When this contingent communication occurs, the client not only feels understood but feels connected to another person, and the process continues. Trevarthen (1993) contends that contingent communication is the basis of healthy, collaborative communication and facilitates positive attachments.
This seems so elementary, yet what these scholars and practitioners suggest is that the ability to read and interpret these nonverbal signals is more than a therapeutic trick the therapist occasionally pulls out of his or her bag. It is the basis of developing the therapeutic alliance, which in turn is the key to positive therapy outcome. Many perpetrators of domestic violence enter into therapy under duress and emotionally difficult situations (such as a separation or divorce). It is critical that therapists listen closely as well as look for nonverbal signals and respond starting with the first contact in a sensitive and caring fashion. So much of domestic violence literature emphasizes confrontation of minimization and denial, and though it is important to address these issues, it is probably more important to attend to the client’s emotional state and respond in an empathic and helpful way. Just walking into the therapist’s office is going to trigger attachment distress for most clients. Add to this the fact that the client is being forced to attend therapy and that he may be anxious about losing his family. Attending to the therapeutic alliance is going to give the therapist more leverage later on to deal with the other issues in therapy, such as denial, minimization, and inspiring commitment to behavior change.
Observation of the client is key to noticing these changes in states of mind. But because much of interpersonal communication goes on below the radar or outside of one’s consciousness, there will be many instances when recognition of signals is not sufficient. As mentioned earlier, Tronick (1989) states that affect in the attachment relationship is a two-way street: The infant is affected by the parent and the parent is affected by the infant. In other words, the parent feels what the infant is feeling. There is research suggesting that a particular part of the prefrontal cortex, called the mirror neuron system, is responsible for this phenomenon (Iacoboni, Woods, Brass, Bekkering, Mazziotta, and Rizzolatti 1999). The mirror neuron system is hypothesized to be the biological basis of our ability to experience empathy (Preston and de Waal 2002). This system allows the brain to simulate an emotional response observed in others, and this process does not have to be conscious. In other words, one can feel what others feel simply by observing their signals, and this process occurs whether we are conscious of it or not. Therefore, another way therapists can learn to be sensitive to a client’s emotional state is by being attuned to their own emotional state when in a client’s presence. To complicate matters, changes in the therapist’s state of mind will be picked up by the client’s mirror neuron system and will either exacerbate or reduce their anxiety. This close attention to the process of contingency is critical not only to the development of the therapeutic relationship, but to helping the client learn more adaptive affective regulation skills as well. When a patient feels empathized with by the other, he experiences a deep sense of being understood, which contributes to positive feelings associated with close relationships. When the therapist is regulating his or her affect in a constructive manner, the client will learn how to do the same, whether it’s made explicit or not.
Affect Regulation in the Treatment of Perpetrators
Over the past fifteen years, the affective neurosciences have evolved primarily because of improved imaging techniques that have also allowed us to better understand how emotion and cognition work together to create the experience of feeling (Damasio 1999; Panksepp 1998). Additionally, these imaging techniques have elucidated how the two hemispheres of the brain may operate very differently in important domains of psychological functioning such as memory (Kandel 1999; Tulving 1993) and emotion (Davidson 2003). Although most batterer intervention programs consider improved affect regulation abilities to be paramount in their treatment goals, many clinicians utilize interventions that reflect obsolete notions of emotion and its regulation.
What are emotions? Emotions are packages of solutions handed down by evolution to assist organisms to solve problems or endorse opportunities (Damasio 1999). All emotions are involved either directly or indirectly in the organism’s management of life. The purpose of emotions is to promote survival, with the net result being to achieve a state of well-being (Ryff, Singer, and Love 2004), versus some state of neutrality. Emotions can be broken down into three categories: primary, background, and social (Damasio 1999, 2003; Siegel 1999). The primary emotions were those originally described by Darwin (1872/1965): anger, sadness, happiness, surprise, disgust, fear. These emotions are characterized by a quick onset, burst, and rapid decay. This is not to say that these primary emotions can’t last for a long period of time; for example, they could be constantly stimulated by an ongoing emotionally ‘‘competent stimulus’’ (a term Damasio uses to refer to the external or internal stimulus that evokes the emotional response). ‘‘Background emotions’’ are those one experiences when one arises in the morning and feels a strong sense of possibility for the day (or the opposite), or when someone is asked how she is feeling and the response is simply ‘‘good’’ or ‘‘bad.’’ They are often thought of in simple ways— you feel good or not good. These emotions are present in the background and may exert their influence on us throughout the day, though we may not necessarily be aware of them. Background emotions may set a certain emotional temperature, which may in turn affect how one experiences a primary emotion. Social emotions are extremely complex— they may be an amalgam of primary emotions but are triggered during a social interaction. Emotions such as compassion, shame, contempt, resentment, awe, jealousy, or altruism may be thought of as combinations of primary emotions or ones that have their own unique configuration and purpose. Like the primary and background emotions, these emotions may also become activated without conscious awareness, and will exert their influence on the person’s behaviors and cognitions.
Another important characteristic of emotions is that they generally occur in the body first, not just the muscles or specific organs, but the viscera and the internal chemistry of the body. Damasio (1999) has demonstrated that there is a dedicated system within the spinal cord for transmitting information about emotion from the body to the brain. There are particular trigger points in the brain for specific types of emotions (such as the amygdala for fear, or the ventral medial prefrontal cortex for certain social emotions), and these structures can activate behavioral solutions without the mind knowing it’s experiencing an emotion at all. This means that there are times when we are in the process of emoting in a rather ‘‘thoughtless’’ manner. This fact helps us to understand how emotions get communicated nonverbally without our awareness.
Feeling occurs when a person becomes consciously aware of the fact that he is in the process of experiencing emotion (Damasio 1999, 2003). Feeling occurs in the prefrontal cortex, which has a region specifically dedicated to recognizing changes in the body. The orbital prefrontal cortex is thought to be involved in this body mapping process, which would allow for the sensing of emotion. Damasio considers the feeling of emotion similar to a sense—not unlike smell, hearing, sight, touch, and taste. Feelings reveal to us the state of the organism at any particular point in time. Feelings allow us to make decisions about how to respond to emotions; they allow us the opportunity to make a choice. The process of emoting does not end in a neutral state, but the goal of the process of emoting is to end in a state of wellbeing (Damasio 2003; Urry et al. 2004).
The affect regulation strategies that batterers learned in childhood don’t ultimately result in feelings of well-being, but in more frustration and distress, particularly when those strategies are placed in the relationship context. For example, a preoccupied client’s dependency on his partner to soothe his fears of loss and neediness through clinging or preoccupied anger ultimately drives the partner away, producing even greater feelings of loss and anxiety. Likewise, a dismissing client’s overreliance on independence and apparent devaluation of attachment to deal with his fears of closeness only leads to greater feelings of loneliness when others perceive him as not needing intimacy.
In treating perpetrators of violence, therapists need to help them become more aware of their different types of emotions (the process of feeling) and how those emotions interact with each other, by strengthening their body-mapping capacities of the prefrontal cortex. In addition, by identifying the competent stimuli that trigger the different emotions in the first place, they can better predict when an emotion is likely to be triggered. Of course, these stimuli can be external to the person (such as criticism from a spouse or defiance by a child), but it can also be internal (such as a memory from childhood that is triggered by a criticism by a spouse). By appreciating the range of their emotions, clients can benefit from therapy by learning a new emotional vocabulary, so as to better know themselves and communicate more effectively with others. More adaptive regulation strategies will lead to feelings of well-being, which will ultimately reinforce these strategies. By making clients more aware of their emotional processes, therapists give them the opportunity to make better decisions about how to cope with their emotional responses (Bechara, Damasio, and Damasio 2000).
Because emotions often occur without the person knowing (having a feeling), the therapist is at a disadvantage without the assistance of a brain scanner that would indicate that a client is in the process of emoting. However, because the body is so directly involved with the emotional process, and usually responds before the emotion is felt, the bodily changes that occur could be recognized by the therapist, who can in turn bring this awareness to the client. The typical signs that an emotion is occurring include changes in facial expression (Ekman and Friesen 1978), eye gaze, tone of voice, bodily motion, and timing of response (Siegel 1999). Therefore, therapists would need to pay careful attention to these nonverbal cues in their clients and carefully bring this to their client’s attention. Likewise, as described earlier, therapists can make use of their own emotional reactions (those activated by the mirror neuron system) to better understand their clients’ states of mind. Confrontation, though it can at times be useful, is generally not helpful when a person is unaware of his emotional state. A gentle and supportive approach can help to raise the client’s awareness of his emotional state, whether in the context of group, individual, or couples psychotherapy. Because of their history of deactivating or hyperactivating attachment distress (or a combination of both in cases of disorganized attachment), these clients will need consistent and sensitive attunement by the therapist to learn to recognize and tolerate all of their emotional states and develop new strategies for regulating them.
Left Brain/Right Brain
Another exciting concept in the affective neurosciences is the notion that different parts of the brain specialize in different capacities. Neuroimaging technology has made it increasingly clear that the different hemispheres of the brain (right and left), even of the same neurostructures, may have different functions. Richard Davidson (2004) has found differences in the patterns of activation of the prefrontal cortex with regard to approach and avoidance emotions. His studies have included brain scans of monks who have studied with the Dalai Lama (Davidson 2000). He found that these individuals had particularly positive outlooks on life, and this was reflected by difference in the activation of their right and left prefrontal cortexes. Individuals who have an overall positive outlook on life are more likely to have higher left-to-right prefrontal activation in response to problem solving, as compared with individuals who have a more negativistic outlook on life (who have a lower left-to-right ratio of activation). In other words, some people do really see the glass as half full and others really see it as half empty. What is most interesting about Davidson’s work is that the pattern of activation can be changed through mindfulness techniques. Individuals with secure attachment are likely to have this more positive outlook, whereas individuals with insecure attachment are more likely to possess a negative outlook. These data suggest that an important part of psychotherapy with perpetrators may include teaching certain clients mindfulness techniques in the service of developing more effective affect regulation strategies. If emotion begins in the body, then training the mind (the prefrontal cortex in particular) to be more mindful of the body and its changes will help a person become more aware of their emotions. Perpetrators with moderate to severe affective disorders who participate in meditation and other, similar practices report that these activities dramatically increase feelings of well-being and, when practiced consistently, can have a long-lasting effect.
Attachment theory is a useful lens through which to understand perpetrator behavior. It explains how early childhood experiences have led to a particular way of experiencing close relationships. It also helps therapists to see how, depending on the attachment status of the client, interventions will need to be developed to address their specific needs and that cookie cutter approaches will not advance the profession. The attachment findings make it clear that domestic violence is not just a result of social conditioning; if anything, it is at least the interaction between psychological conditioning and the social context. Therefore, while social changes are necessary, violence will never stop as long as the psychological and biological factors are minimized or altogether ignored.
What neurobiology findings suggest is that the regulation of affect, particularly with individuals with insecure attachment, is much more complex than early theories of intervention have suggested. Developing skills in adaptive regulation of both negative and positive emotional states involves learning to recognize an emotionally competent stimulus—identifying the different types of emotions that are activated in the body—and how consciousness is necessary to allow the individual to feel the emotion and finally make adaptive choices with regard to responding to the emotional stimulus. Most importantly, the notion that the final goal of this complex process is to achieve a state of well-being, rather than simply neutrality or some resting state of quiescence, is one of the rewards of the change in the strategies.
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