Chuka Nestor Emezue // In 1985, Dr. Giuseppe Costantino and his colleagues, Drs. Robert G. Malgady, and Lloyd Henry Rogler, drafted their foremost paperback: “Cuento Therapy: folktales as a culturally sensitive psychotherapy for Puerto Rican children.” Their work provided instruction in Cuento Therapy, as well as its hopeful application to the field of child psychotherapy and narrative psychology — specifically, as a culturally-sensitive answer to mental health care disparities among Hispanic ethnic minorities (Costantino, et al. 155-165).
Cuento Therapy: Giving a Voice to Victims
Cuento therapy (CT) – involves the creative use of cuentos or Spanish-language mythological folktales to re-tell old stories to a new generation of fascinated listeners (usually children or troubled adolescents) trying to make sense of an adverse condition or a traumatic episodic event, such as a history of sexual assault or domestic violence. In some cases, the mother serves as the storyteller-therapist, an agent of socialization in this bidirectional process of healing through narrative interaction. By so doing, the attending clinical therapist – who facilitates this process – is primed to access a client’s traumatized emotional make-up, prompting a required response by broaching cognitive jurisdictions once considered unreachable using conventional means. CT was an innovative amalgamation of western tenets of social cognitive and clinical psychology with folkloric literature to cater to children in troubled families (Costantino, et al. 155-165).
Cuento therapy offered Dr. Costantino’s clients — especially those who had been exposed to adverse childhood experiences — a way to cope, to remain resilient, to contemplate and participate in treatment. These possibilities were especially suited to Hispanic immigrants who felt misplaced and overwhelmed in their new host communities as they contended with multiple forms of immigrant-specific vulnerabilities (Capaldi, et al. 231-280). In a seven-year project, Costantino and colleagues demonstrated some benefits of CT, including child anxiety reduction, increase in scores on the Wechsler Intelligence Scale for Children, increase in self-esteem and self-disclosure, decreased psychological anxiety, and a reduction in aggression (Costantino, et al. 155-165). Today, cuento therapy remains an evidence-based, culturally congruent rehabilitation modality for Latino youths (Costantino, et al. 155-165).
Storytelling and metaphors in psychotherapy and psychoanalysis are not novel therapeutic devices (Augusta-Scott and Dankwort 783-805; Witztum, et al. 270-290). These procedures have been used to stimulate therapeutic involvement and engagement with hard-to-reach patients. Many patients, especially child victims of domestic and sexual abuse, lack well-defined terminologies and vocabularies to express particular emotional vignettes. And yet, storytelling and metaphor are not only used to treat victims, but also perpetrators. Narrative therapy has been proposed as a viable method of treating perpetrators of intimate partner violence, including perpetrators of violently physical, verbal, emotional, financial, and sexual abuse.*
Batterer Intervention Programs: Transforming Perpetrators
The standard treatment for intimate partner violence (IPV) is a Batterer Intervention Program (BIP). Over time, the term ‘treatment’ has been replaced in the IPV literature with ‘intervention’. For that reason, intimate partner violence (IPV) interventionists modified their classic categorizations of male batterer typologies from the ‘psychotic’ to ‘psychosocial’ provinces [see Holtzworth-Munroe & Stuart 87-103]. Anger is no longer an excuse. Where once, IPV was considered a direct result of a psychosomatic deficit (i.e. violence as a form of uncontrollable anger, prior trauma, and psychosis), newer treatment modalities have approached the problem as a product of cognitive behavioral proclivities, such as negative, long-standing gender norms and sociocultural stimuli. Violence, that is, is seen as a learned and intentional manifestation of cohesive power and control behavior, guided by hegemonic masculinities and social factors.
This new understanding of the nature of violence gave rise to BIPs, which derived relevance from a new awareness of the rising epidemic of violence against women, underscored by pro-feminist and gender equality movements of the 1970s. This era informed public angst, governmental policies, and batterer treatment modalities, such as BIPs, geared towards eliminating (or at least reducing) domestic violence (Augusta-Scott and Dankwort 783-805; Waller 42-49). Incarceration and/or sentencing to mandatory BIPs had been the ineffective modus operandi in curbing IPV perpetration and holding abusers accountable (Babcock, et al. 1023-1053).
But it wasn’t clear that BIPs worked. There were foundational challenges that diminished the effectiveness of evidence-backed treatment modalities for IPV perpetrators (for a comprehensive risk factor analysis of IPV, see Capaldi, et al. 231-280). BIPs were having little to no treatment effect on abusers, for two principal reasons (Babcock, et al. 1023-1053). First, the anchoring of IPV on solely sociocultural and feminist descriptions without counting in structural and systemic influences proved to be reductionist in theory and in treatment, and was therefore implicated as a reason for the tempered effectiveness of well-intentioned BIPs (Waller 42-49). Second, a Westernized theoretic designed for non-Hispanic, middle-class batterers failed to convert their underprivileged counterparts (especially those from minority ethnoracial groups, including immigrant batterers) from a life of partner violence. Batterers were resistant to behavior change in general, but minority group batterers were resistant to discriminatory racist sentencing mandating them to BIPs that discounted their socioeconomic realities in designing treatment, sometimes even reproducing the same systemic racism and classism of larger society that exacerbated their violent ways (Waller 42-49).
Consequently, police- and victim-reports of IPV recidivism and re-abuse rates remain inexcusably staggering – even with standardized BIPs. In fact, a multi-country WHO study revealed that between one in ten to seven in ten women report physical and/or sexual abuse; while 15% to 75% report psychological and emotional abuse (Garcia-Moreno et al., 1260-1269).
To address some of these impediments to program efficacy, newer models of standard BIPs use overlapping applications of Cognitive Behavioral Therapy (CBT), patriarchal-feminist models, and psychodynamic-psychotherapeutic models to create treatment modalities that cater to their client diversities and universalities. For example, culturally adapted BIP treatment curricula have become more user-friendly, as they derive from native languages (mostly Spanish). Bilingual coordinators incorporate cultural philosophies of negotiated masculinity and femininity (for example, incorporating machismo and marianismo in narrative discourse with Hispanic clients).
Other sociocultural and sociopolitical factors that sustain interpersonal and extrapersonal violence are also taken into consideration. BIP delivery styles employ a mix of strategies including role-playing, group discussion, individual interviews, and educational programs. Most programs leverage the abusers’ values system, including personal responsibility, willingness to change, family preservation, and gendered domestic violence norms. In some ways, the traditional feminist-centric view of power and control is complemented by a socioecological refocusing on family violence. By so doing, experimental (and even controversial) modalities for perpetrator treatment have been proposed (see Öst 296-321).
Narrative Therapy: A Way Forward?
Significantly, narrative therapy has begun gaining prominence as a non-empirical, interdisciplinary response to the systematic imperfections of typical BIPs (Augusta-Scott and Dankwort 783-805) as it finds utility with psychotherapists, researchers, program designers, and psychologists, as well as in ‘curing’ other conditions such as depression (Muntigl 577-596), and as a palliative measure in curative storytelling for female victims of abuse (Polletta 1490-1509). However, the benefits of narrative therapy remain anecdotal in IPV treatment for men who abuse women, even as its merits lie in its ability to involve the abuser in his/her own rehabilitation. That is, through the linguistic and self-recounted construction of narrative discourse that assists the abuser’s elucidation of their (often idiosyncratic) violence-promoting rationale, their cognitive processes, and an unforced self-assessment of their culpability.
Thus, narrative therapy provides an entry point to applicable therapeutic activities, as the therapist and client broach a point of mutuality, identification, and (believe it or not) empathy (as opposed to the defunct practice of shaming), so that remediation can commence where imprecisions in cognition and value systems are non-judgmentally addressed. Even more important is the construction and intentionality of narratives — that is, the choice of verbiage and lexis the client (or abuser) decides to use in the disclosure of a violent experience. This intentionality is vital and contributes to the diagnosis of his/her care needs and motivations, serving as a facilitative conduit for the therapist’s ingress to the client’s emotional and psychological landscape.
Third wave cognitive behavioral therapists – especially those dealing with violent abusers – can arguably be criticized for ‘cuddling’ these violent men (or women) with a history of domestic violence, many of whom are considered undeserving of that level of empathy. (After all, recent findings by the Centers for Disease Control and Prevention (CDC) put prevalence at 1 in 3 women and 1 in 6 men for lifetime sexual violence in the United States. In general, more than 27% of US women and 11% of US men have experienced contact sexual violence, physical violence, and/or stalking (1 in 6 women and 1 in 19 men) by an intimate partner in their lifetime (CDC, 2014).) However, it would seem that little else works.
Notably, critiques of the third wave CBT decry its lack of evidential support in treating certain conditions. Other disputes stem from the relevancy of the program curricula, the level of reproducibility, case-study fallacies, the presumed expertise of group facilitators, the execution of program mandates, and procedurally fallacious deductions of what works best, for whom, when, and where (see Corrigan (2001) in Öst 296-321). The lingering question remains: in view of previous inefficacious BIP care itineraries, does narrative therapy — along with the potential for cultural sensitivity and specificity modeled by the related practice of Cuento Therapy — offer potential in accounting for the sociocultural and psychosocial mediating and moderating contributors to dyadic intimate violence? This remains to be seen.
Augusta-Scott, Tod, and Juergen Dankwort. “Partner Abuse Group Intervention.” Journal of Interpersonal Violence, vol. 17, no. 7, 2002, pp. 783-805.
Babcock, Julia C., et al. “Does batterers’ treatment work? A meta-analytic review of domestic violence treatment.” Clinical Psychology Review, vol. 23, no. 8, 2004, pp. 1023-1053.
Capaldi, Deborah M., et al. “A Systematic Review of Risk Factors for Intimate Partner Violence.” Partner Abuse, vol. 3, no. 2, 2012, pp. 231-280.
Costantino, G., Malgady, R. G., & Rogler, L. H. (1986). Cuento therapy: A culturally sensitive modality for Puerto Rican children. Journal of Consulting and Clinical Psychology, 54(5), 639-645. http://dx.doi.org/10.1037/0022-006X.54.5.639
Costantino, Giuseppe, et al. “Cuento Therapy.” Encyclopedia of Cross-Cultural School Psychology, 11 Mar. 2015, pp. 298-300, link.springer.com/referenceworkentry/10.1007%2F978-0-387-71799-9_107.
Costantino, Giuseppe, et al. “Folk hero modeling therapy for Puerto Rican adolescents.” Journal of Adolescence, vol. 11, no. 2, 1988, pp. 155-165.
Holtzworth-Munroe, Amy, and Gregory L. Stuart. “The relationship standards and assumptions of violent versus nonviolent husbands.” Cognitive Therapy and Research, vol. 18, no. 2, 1994, pp. 87-103.
Garcia-Moreno, Claudia, et al. “Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence.” The Lancet, vol. 368, no. 9543, 2006, pp. 1260-1269.
Muntigl, Peter. “Storytelling, Depression, and Psychotherapy.” The Palgrave Handbook of Adult Mental Health, 2016, pp. 577-596.
Polletta, Francesca. “How to Tell a New Story About Battering.” Violence Against Women, vol. 15, no. 12, 2009, pp. 1490-1508.
Waller, Bernadine. “Broken fixes: A systematic analysis of the effectiveness of modern and postmodern interventions utilized to decrease IPV perpetration among Black males remanded to treatment.” Aggression and Violent Behavior, vol. 27, 2016, pp. 42-49.
Witztum, Eliezer, et al. “The use of metaphors in psychotherapy.” Journal of Contemporary Psychotherapy, vol. 18, no. 4, 1988, pp. 270-290.
Öst, Lars-Göran. “Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis.” Behaviour Research and Therapy, vol. 46, no. 3, 2008, pp. 296-321.
*See Augusta-Scott and Dankwort 783-805. Notably, this article focuses on heterosexual, male-to-female IPV intervention efforts.