Chuka Nestor Emezue // In 1985, Dr. Giuseppe Costantino and his colleagues, Drs. Robert G. Malgady, and Lloyd Henry Rogler, drafted their popular paperback: “Cuento Therapy: folktales as a culturally sensitive psychotherapy for Puerto Rican children.” Their work positioned ‘Cuento Therapy,’ as a hopeful form of narrative therapy in the field of child psychotherapy and narrative psychology. Specifically, as a culturally-sensitive answer to the many mental health care disparities faced by Hispanic American ethnic minorities who were systematically underserved by traditional psychotherapeutic services (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). The goal is to make sense of an adverse psychological condition or a traumatic event, such as rape, sexual assault, and witnessing domestic violence. In some cases, the mother served as the de facto storyteller-therapist. Mothers formed trusting therapeutic alliances as agents of socialization in this bidirectional process of healing through narrative interaction. In the process, a trained attending clinical therapist – who quietly facilitated this process – was primed to access a client’s traumatized emotional make-up, prompting a required response by broaching cognitive jurisdictions once considered unreachable using conventional means of child psychotherapy. Cuento therapy 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).
In testing the efficacy of Cuento therapy, Dr. Costantino et al. reported on a 1986 randomized control trial conducted in Brooklyn, New York, with “high risk Puerto Rican children from kindergarten through third grade, N=210, and their mothers.” High-risk children in this study were those from low-income single-parent households, exposed to adverse childhood experiences, and exhibiting maladaptive behaviors in school and at home. Noting the lack of ‘culture congruent’ therapy modalities for Hispanic children at high risk for mental and psychological stressors, Dr. Costantino’s goal was to offer this impacted families a way to cope, to remain resilient, to contemplate healing while participating in adapted culture-sensitive therapy modalities. These possibilities were uniquely suited to Puerto Rican 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 this RCT, Costantino and colleagues demonstrated noted benefits of using cuento therapy, including child anxiety reduction, increased scores on the Wechsler Intelligence Scale for Children, increase in self-esteem and self-disclosure, decreased psychological anxiety, and a reduction in aggressive behaviors (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, familiar folktales, 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 stimulated the therapeutic engagement of hard-to-reach patients. Many hard-to-reach patients, especially child victims of sexual abuse, lack well-defined terminologies and vocabularies to express particular emotional vignettes, not to mention issues with recalling traumatic memories. However considering the diverse origins that domestic violence researchers cite for partner violence (i.e., from micro-level personality-trait perspectives of abusive behaviors to macro-level background-situational model of partner violence), it begs to think that storytelling and metaphor may not only be useful to heal and rehabilitate victims of violence but their perpetrators as well. Thus, narrative therapy is 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 male-facing response for intimate partner violence (IPV) is a Batterer Intervention Program (BIP) – among other forms of penance and law enforcement. Over time, the term ‘treatment‘ has been replaced in the IPV literature with ‘intervention.’ For that reason, IPV interventionists have gradually modified their classic categorizations of male batterer typologies from the classic ‘psychotic‘ to new-school ‘psychosocial’ provinces [see Holtzworth-Munroe & Stuart 87-103]. Anger alone is no longer an excuse for wife-beating. Instead, other factors are considered, including socio-ecological stressors. 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 of partner violence as a product of socio-cognitive behavioral proclivities, such as rigid gender norms as gendered stimuli on how to be a man (or how to treat women and girls). Therefore, partner violence is construed as a learned and intentional manifestation of cohesive power and control behaviors, guided by hegemonic masculinities and predominant social factors.
This understanding of the nature of violence is not entirely novel but has given rise to third-wave batterer programs that emphasize accountability, mindfulness, acceptance of guilt, and even restorative justice. Batterer programs have found relevance from a classic awareness of the rising epidemic of violence against women, underscored by pro-feminist and gender equality movements of the 1970s, and newer intersectional models that emphasize the intersectionality of partner violence. This new era has informed public angst, governmental policies, and batterer treatment modalities geared towards eliminating (or at least reducing) domestic violence (Augusta-Scott and Dankwort 783-805; Waller 42-49). Incarceration and sentencing to mandatory BIPs had become an ineffective modus operandi in curbing IPV perpetration and holding abusers accountable (Babcock, et al. 1023-1053).
It is no longer news that BIPs offer marginal success in reforming male abusers. There were foundational issues that diminish the effectiveness of evidence-based treatment modalities for IPV perpetrators (for a comprehensive risk factor analysis of IPV, see Capaldi, et al. 231-280). Two main foundational issues are cited (Babcock, et al. 1023-1053). First, the anchoring of partner violence solely on sociocultural and feminist issues without counting in structural and systemic influences proved to be reductionist (in theory and treatment), therefore tempering the effectiveness of well-intentioned BIPs (Waller 42-49). Second, a Westernized theoretic designed for white non-minority, middle-class, and heterosexual batterers failed to convert their underprivileged counterparts (especially those from minority ethnoracial groups, including immigrant batterers) from a life of partner violence. Batterers remain resistant to behavior change in general, and minority group batterers are 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 the high prevalence of partner violence. A multi-country WHO study revealed that between one in ten to seven in ten women report physical and sexual abuse, while 15% to 75% report psychological and emotional abuse (Garcia-Moreno et al., 1260-1269). Recent findings by the Centers for Disease Control and Prevention (CDC) puts the prevalence at 1 in 6 men for lifetime rape and sexual violence in the United States. In general, more than 27% of US women and 11% of US men have experienced combined 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).)
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 program facilitators 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 socio-ecological 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 is gaining prominence as an interdisciplinary response to the systematic imperfections of typical BIPs (Augusta-Scott and Dankwort 783-805) as it finds utility with psychotherapists, researchers, and program designers, in ‘curing’ mental health 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 rehabilitation. That is, through the cognitive and self-directed construction of narrative discourse to aid the abuser’s description of their rationale for using violence, their cognitive processes, and an unforced self-assessment of their culpability (and possible readiness to change).
Thus, narrative therapy provides an entry point to therapeutic activities, as the therapist and client broach a position of mutuality, identification, and (believe it or not) empathy. Narrative therapy is an antithesis to the defunct practice of shaming (a counterproductive tactic), thus permitting space for fruitful remediation, where imprecisions in cognition and value systems are addressed (using Socratic non-judgmental approaches). Even more critical in this space of therapy is the construction and intentionality of abuser narratives. That is, the choice of verbiage and language the client (or abuser) chooses to use in the disclosure of a violent experience and their use of violence. This intentionality is vital and contributes to the diagnosis of his/her motivations and care needs, serving as a facilitative conduit for the therapist’s ingress to the client’s emotional and psychological landscape.
Arguably, third-wave novel approaches (such as narrative therapies) can be criticized for their experimentalism, still-emergent evidence of efficacy, and for ‘cuddling’ these violent men (or women) with a brutal histories of perpetrating partner and domestic violence, many of whom are considered undeserving of any therapeutic empathy. However, several meta-analyses of empirical treatment programs show that little else works, making a case for alternative modalities for fully rehabilitating abusive men and preventing subsequent partner abuse recidivism.
Notably, other critiques of these third-wave approaches stem from the relevancy of their program curricula, their level of reproducibility, the presumed expertise of program facilitators, the execution of program mandates, and 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 show potential in accounting for the sociocultural and psychosocial mediating and moderating contributors to 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.
Photo credit: Tim Mossholder @timmossholder
*See Augusta-Scott and Dankwort 783-805. This article focuses on heterosexual, male-to-female IPV intervention efforts.