Professional understandings of men’s violence against women

ABSTRACT

In Sweden, the social services have recently been given legal responsibility to act so that men who are violent against women in intimate relationships change their behaviour. However, research on how professionals in the social services understand intimate partner violence and the violent acts of men is still scarce. By drawing on interviews with 16 social workers who are practicing treatment for male perpetrators of violence, this article aims to explore the professionals’ understandings of the roots of men’s violence against women, what they perceive as the most effective way to help their clients to change their behaviour and what the end goal of the treatment is. The social workers describe the causes of their client’s violence as based in childhood trauma and that the men have severe problems regulating their emotions. It is believed that these difficulties are best treated through the establishment of a therapeutic alliance, allowing for an enhancement of their ability for empathy. Using professional theory, we interpret these results as an expression of a psychotherapeutic knowledge system. Finally, we discuss how a psychotherapeutic understanding has come to dominate work with men’s violence and what the consequences of this understanding are.

ABSTRAKT

Tidigare svensk forskning om personal som arbetar inom socialtjänsten med våldsutsatta har visat att psykoterapeutiska förklaringsmodeller kommit att betraktas som mer professionella än feministiska perspektiv på mäns våld. Flera argumenterar för att det kan leda till ett förlorat fokus på den maktobalans som råder mellan våldsutövare och våldsutsatt. Till skillnad från tidigare forskning undersöker den här artikeln socialarbetare som arbetar med behandling för våldsutövare, hur de förstår mäns våld, hur de försöker att förändra sina klienter och vad de betraktar som målet med behandlingen. Intervjuer genomfördes med 16 socialarbetare. De beskriver mäns våld som en konsekvens av ett trauma grundlagt i barndomen vilket gör att männen har svårigheter med att härbärgera sina känslor. Det försöker socialarbetarna förändra genom att bygga en terapeutisk allians och stärka männens empatiska förmåga. Den här psykoterapeutiska förståelsen tolkar vi som ett uttryck för vilken profession och organisation som kommit att äga problemet. I förlängningen innebär det att till vilken organisation man förlägger ett socialt problem kommer att få konsekvenser för det praktiska arbetet som kan bedrivas. På så sätt blir det viktigt för framtida forskning att undersöka hur frågan om behandling för män som utövar våld mot kvinnor kom att anses som hemmahörande inom socialtjänsten.

KEYWORDS:

• Professionalism
• Treatment for men’s violence
• Social work

KEYWORDS:

• Professionalism
• Behandling för män som utövar våld mot kvinnor
• Socialt arbete

Introduction

Men’s violence against women in close relationships (hereafter men’s violence) is a global and severe problem that threatens the lives of many women and children (Garcia-Moreno et al., 2006). In recent decades it has increasingly been recognised as a problem that public authorities need to respond to. In Sweden, the social services have been assigned legal responsibility for the victims of men’s violence since the 1990s (Ljungwald, 2011) and more recently also for the perpetrators of violence (prop. 2020/21:163).

Initiatives to end men’s violence have historically been a part of the women’s movement’s struggle for equality, but in recent decades it has increasingly been recognised as a public concern and the responsibility to act on the problem has been formally placed within the personal social services (PSS). As a result, professional social workers, often with an advanced training in psychotherapy, are now working with the problem. Professionalisation is here understood as a process whereby a professional group working on the basis of its own academic knowledge base (not necessarily objective or non-ideological) become responsible for a task (Brante et al., 2019). As will be shown, this professionalisation of work with violent men has led to shifts in the perception of the problem and how it is best dealt with, ultimately affecting practice.

The placement of the formal responsibility for working with men’s violence with the social services makes the understandings of the local professionals in charge of handling the problem of particular interest. How do these professionals understand men’s violence and what measures do they think should be taken to change their violent behaviour? Proceeding from interviews with Swedish professionals who work with treatment of perpetrators within the PSS, this study explores professional understandings of the roots of men’s violence, what they perceive as the most successful way to help their clients to change their behaviour and what the end goal of the treatment is. The finding unfolds that these understandings are based on a psychotherapeutic knowledge base. We discuss how a psychotherapeutic understanding of men’s violence has come to dominate social work in this area and we discuss the potentially harmful consequences of them from the perspectives of the victims.

Background

Previous research on treatment for violent men

Treatments for men who are violent in their intimate relationships have attracted much attention in international research. Some of this research has focused on the assumptions underpinning these programmes, while other research has been investigating the evidence for different programmes.

Gondolf (2001) makes an often-quoted distinction between three kinds of programmes for violent men with different ontological assumptions regarding the roots of the violence and how to best approach it. Cognitive–behavioral approaches work by identifying and restructuring thought patterns that justify aggressive behaviour, and replace problem behaviours with more acceptable behaviours. This perspective has been critiqued for neglecting men’s power over women. Psychodynamic approaches focus on the emotions and personality of the violent individual. It views violence as a product of emotional pain and attachment issues related to childhood trauma and advocates therapy to allow the men to better understand and connect with their feelings. This perspective has been critiqued for creating sympathy for the perpetrator rather than instilling a sense of responsibility. Finally, feminist programmes, such as the Duluth model, which sees men’s violence as a way to control and exert power over women which is an expression of patriarchal society. Feminist programmes try to teach violent men other, more equal, ways to relate to women. These programmes have been critiqued for being confrontational, possibly making men more defensive and less open to reform.

Although the research debate has focused mainly on the feminist and psychological approaches to men’s violence, there are also sociological perspectives that highlight men’s violence as a consequence of situational factors such as unemployment, lack of housing, misuse of drugs or alcohol, or poverty (Loseke, 2005).

In practical terms more than one of these paradigms are often included in the same treatment programme. Indeed, Hamilton et al. (2012) finds that a majority of batterer programmes in the European countries are based on more than one paradigm. In Sweden, the most common programme, Alternative to violence (ATV), combines two perspectives on the origins of violence: the feminist sociocultural understanding and the individual psychological understanding. In the model the violence is seen as an expression of asymmetric gender/power relations, however the model also places great importance on trauma and early parent–child attachment for the understanding and treatment of violent men (Askeland and Råkil, 2017).

Quite a few meta-analyses have been conducted to determine the efficiency of batterer programmes (Akoensi et al., 2012; Arce et al., 2020; Babcock et al., 2004; Babcock et al., 2016; Berg Nesset et al., 2019; Gondolf, 2001, 2004, 2011; Hamilton et al., 2012; Smith Stover et al., 2009). Most of these studies find small but significant reductions in violence as a consequence of programme participation. Arce et al. (2020) puts it somewhere between 5 and 20 percent depending on the study. However, results are not generalisable to all programme types, neither are they consistent between studies. Some studies even report negative results.

In short, it is still debatable what exact programmes and techniques provide the best effects. However, practice is not only determined by evidence, but is rooted in factors such as policies, traditions and professional knowledges, which point to the importance of investigating the practitioner perspective on treatment. However, such research is comparatively scarce.

Swedish research on treatment for violent men is still lacking. Research has primarily focused on work with the victims of men’s violence while research looking at work with the violent men is still lacking. In this study we focus this work by investigating the understandings of the practitioners who give treatment to the violent men.

Swedish social work with men’s violence in intimate relationships

Today, political initiatives against men’s violence are part of the agenda of the UN, the EU and also the Swedish national government (Lundberg & Stranz, 2019). In Sweden, the idea that something had to be done about male perpetrators of violence was mentioned in a government bill already in 1997 (Prop., 1997/98:55) and recurrently suggested in official reports and government bills during the early 2000s (SOU, 2004, p. 121; SOU 2006, p. 65; prop, 2005/06:155; prop., 2006/07:38). In this context, treatment for perpetrators was launched as one way to deal with the problem of men’s violence but it was not clear what kind of treatment should be implemented and by which actors or organisations.

Support initiatives for victims and offenders respectively have different backgrounds. Many support initiatives for female victims of men’s violence, such as those offered by The women’s shelter movement, were clearly influenced by a feminist understanding of men’s violence (Helmersson, 2017). However, treatments for violent men have not developed out of feminist theory. In the first national survey of support initiatives for violent men, Eriksson et al. (2006) writes that work with perpetrators mainly emerged from 1996 and onwards. Early initiatives came from non-governmental organisations that worked with men in crisis, for example following divorce or custody disputes. The theoretical base for this work was unclear. While some treatments integrated an understanding of how power and gender relates to violence, others were more sceptical to adopting such a perspective. The 2005/2006 government bill was also hesitant to give a monopoly to the gender perspective. A passage in the bill states that men’s violence is an expression of unequal gender power relations but that treatment should not exclude consideration of individual factors (s. 67; prop., 2005/06:155).

A change in the Social Services Act, 2021 formally gave the Swedish social services the responsibility to work with men who are violent towards their female partners (Social Services Act, 2001, p. 453, chapter 5, §11a). The legal changes can be understood as a direct consequence of the Istanbul Convention, signed by Sweden, which calls on the signing states to ‘take the necessary legislative or other measures to set up or support programmes aimed at teaching perpetrators of domestic violence to adopt non-violent behaviour in interpersonal relationships with a view to preventing further violence and changing violent behavioural patterns’ (article 16 p. 1).

Professionalism in the Swedish personal social services

The increased legal responsibility of the social services has meant that the handling of men’s violence has gradually been incorporated into the organisation of the Personal Social Services (PSS). The PSS are municipality-based, administrative, bureaucratic organisations (Bergmark & Lundström, 2008). In contrast to the non-governmental sector, which can highlight power differences between men and women as part of their political struggle for equal rights, the public sector needs the legitimacy and assumed objectivity offered by professional knowledge in its work with men’s violence (Lehrner & Allen, 2009; Mehrotra et al., 2016; Stranz et al., 2016). As a consequence, researchers have argued, feminist understandings of men’s violence have been replaced by the values guiding the PSS, subject to its organisational conditions and the resources available for social workers (Lundberg & Stranz, 2019).

Sjögren (2018) argues that the main tool that the professional social workers possess in their work is their ability to build trustful relationships with their clients. Working in the PSS, with people in difficult life situations, demands a good ability to communicate, and several of the goals set by the government for the education of social workers include communicative skills and an ability to show empathy towards the people you meet (HF, 1993, p. 100).

But are professional communicative skills and the ability to build good relationships exclusive to the social work profession? Hardly. It can be argued, in line with Brante et al. (2019), that social work as a profession draws on knowledge that is considered less unique and legitimate than that of classical professions such as medical doctors or engineers. Where medical doctors in their work can draw from an exclusive arsenal of competences and technologies, ranging from surgery to pharmaceuticals, social workers primarily draw on their ability to communicate. Where does this leave social workers when assigned responsibility for violent male offenders?

Sjögren (2018) argues that social workers practising individual treatment would probably draw upon a more established psychotherapeutic knowledge system to legitimize their work. To be allowed to practice psychotherapeutic treatment in Sweden, social workers need additional advanced training in psychotherapy. In comparison to social work, psychotherapy is a more established field of knowledge, an expert system, exclusive to certified psychotherapists.

An implication of the professionalisation of work with men’s violence is thus a change in the knowledge base guiding the work. As men’s violence has been included in the responsibilities of the social services, the political understandings of the problem (i.e. as expressed by the feminist social movement) have diminished (Barret et al., 2016; Lehrner & Allen, 2009; Lundberg & Stranz, 2019). At the same time, individual-based perspectives have gained importance and non-governmental actors such as the Women’s Shelter Movement (which is still a central provider of IPV services in Sweden) has increasingly moved towards collaboration with the social services and towards professional legitimacy (Barret et al., 2016; Lundberg & Stranz, 2019; Mehrotra et al., 2016; Wies, 2008).

In previous research the coexistence of multiple perspectives in professional understandings of men’s violence is clear. Mattsson (2013) studied an integrated service unit for the handling of IPV within the PSS. She could identify two different understandings in the studied team of professionals. Some of the professionals, primarily women, expressed a structural understanding of the violence as based in unequal gender relations. Others, primarily men who were also educated psychotherapists, relied on a relational understanding of IPV, interpreting it in terms of a conflict between two persons. Furthermore, the male therapists pointed to the men’s vulnerability by emphasising that they had experienced violence in their original families and that this understanding was essential to help them change their behaviour. Mattsson highlights the supposedly neutral position of professionals as carriers of an exclusive knowledge, but warns that without a structural perspective on the violence, women’s higher risk of exposure to violence can become invisible. Mattsson concludes, in conformity with Hearn (1998), that it is vital not to let the attention towards the men diminish the experiences and vulnerability of the women.

In a different study of professionals working with female victims at specialised departments within the municipal social services, Helmersson (2017) similarly identifies a psychological understanding of IPV. She finds that the social workers perceive an individual-focused treatment, such as teaching women how to avoid risks of violence, as the accurate thing to offer the female victims.

Swedish research on the understandings of those practising professional work with male offenders is still scarce. The point of departure of this project is that previous findings of research on professionals practising social work with men’s violence in family treatment units or in units working with female victims needs to be advanced through an exploration of the perspectives of those who work with treatment for men, because ultimately their understandings of the problem will have practical consequences for their social work practice and the political mission to change perpetrators. Drawing on interviews with social workers working with treatment for violent men, this study explores professional understandings of the roots of men’s violence, what they perceive as the most successful way to help their clients to change their behaviour and what the end goal of the treatment is.

Theoretical framework

In the discussion of our empirical findings we build on a profession’s perspective (Abbot, 1988; Brante, 2011; Brante et al., 2019). Abbot states that professions base themselves on knowledge systems that legitimize their exclusive right to treat and reason about conditions within their jurisdiction. Following Abbot, Brante (2011) defines a profession as occupational services based on academic knowledge, acquired through formal education: ‘Professions constitute asset points to what is seen as the most profound (better, more reliable, recognised) theoretical principles that can be put into practical use’ (s 9–10). More precisely, Brante (2011) argues that it is a particular ontological model, that may include observable surface facts but also (more importantly) assumed underlying ontological elements, relations and causal mechanisms, that constitute this academic knowledge base. The ontological model guides perceptions and allows a certain style of thinking, both in research and in practice. A profession is thus a community of professionals that use the same ontological model to reason about problems and suggest interventions based on it.

Moving from one ontological model to another implies a change in style of thinking. Psychoanalysis may for example view action (such as violence) in terms of unconscious drives (causal mechanism) and suggest talking therapies (intervention) to make these unconscious drives conscious. Sociology may instead view action in terms of e.g. class, roles and power structures and suggest contextual interventions to change behaviour. Biology may instead direct the gaze to genetics and biochemistry to chemical reactions in the brain in order to explain action and suggest interventions.

By taking their point of departure in Bourdieu’s (1992) concept of a field, Brante et al. (2019) show how professions compete for, claim, provide and use expertise within a professional field in which they strive for occupational and theoretical monopoly. Social work is a profession that Brante et al. (2019) classifies as a welfare profession. Compared to what Brante et al. (2019) describe as classic professions, such as doctors or engineers, the ontological models of the welfare professions are less established and may be said to command less authority than older professions. For example, the welfare state has never entrusted social work with full jurisdiction within their field, and the profession remains highly restricted by organisational conditions and the social services legislation (Brante et al., 2019). However, in this project the interviewees are social workers with further education as psychotherapists – a more established field of knowledge. How does this affect their jurisdiction? Brante helps us discuss how certain ontological models and associated interventions are deemed as more authoritative and professional than others in social work with men’s violence.

Method

This study is part of an ethnographic project that studies treatment for men’s violence within the Swedish PSS (for further clarification see Sörmark, 2020). Ethnographies favour an open, explorative, approach to social investigation (Hammersley & Atkinson, 2007). Research questions and data collection develop dynamically during the project, as new insights give rise to new questions. The aim of this particular study emerged after ethnographic observations of group therapy sessions for men who had been violent to their female partners (reported elsewhere, XXX). During the observations, assumptions emerged about the causes of the violence, how to change violent behaviour, and intimate relationships ideals. Since these assumptions will ultimately affect practice, the sessions prompted further exploration into the understandings of the professionals through qualitative interviews.

Empirical material and procedures

To investigate the professionals’ ideas, semi-structured interviews were conducted with 16 social workers, from 7 different establishments, who provide treatment for men who have been violent towards their female partners. As interview participants we sought trained and experienced professionals who could contribute insights into the ideas behind the treatment. Almost all of these social workers had further education in psychotherapy. Thus, the sample can be described as purposeful, a sampling method commonly applied in ethnographic explorations (Hammersley & Atkinson, 2007; Lincoln & Guba, 1985).

In order to recruit participants, managers of social service divisions specialised on treatment for violent men in one of Sweden’s larger city areas were sent an e-mail with information about the project. To assure a width in the collected data, two divisions located in smaller cities were also contacted. The managers were asked to inform their employees about the project and our request for participants. Those who were interested in participating in the interviews contacted the first author through mail and a time was scheduled.

The final sample included seven women and nine men, primarily consisting of social workers with advanced training as psychotherapists. They had an average of ten years of experience of working with perpetrators.

The interviews were conducted between autumn 2020 and early spring 2021 and took place at the workplaces of the social workers. They lasted between 45 and 60 minutes. Due to the Corona pandemic, the last four interviews were conducted digitally through Zoom. However, the answers given by these interviewees and those in the first interviews did not differ in any noteworthy sense.

The interviews can be characterised as thematic, exploring themes and questions that were raised by the previous observations. The interview guide was structured around two themes which emerged as central for the understanding of the studied context in the previous observations: (1) treatment/change, and (2) intimate relationships. The guide included questions such as ‘When does treatment work?’, ‘If you imagine an ideal situation with unlimited resources then what is the best way of working with men’s violence against women?’, ‘What is a good partner like?’, ‘What is a constructive way of handling conflicts in an intimate relationship?’ and ‘Why is it important to be able to have intimate relationships?’. All interviews were recorded and transcribed.

All interviews were performed by the first author. In her experience the interviews were characterised by great enthusiasm for the project, from both the managers and the interviewed social workers. The interviews are also characterised by a high level of correspondence between the answers of individual social workers.

The alternative to violence treatment model

The treatment sessions, observed in previous ethnographic explorations of the project, were influenced by the Alternative to Violence treatment model (ATV), which is the most common intervention used in the Nordic countries for treating men with a history of perpetrating violence (Räsänen, 2013). ATV claims to combine two antagonistic perspectives on the origins of violence: The feminist/structural and the psychological. On one hand, violence is seen as an expression of asymmetric gender/power relations. However, in comparison to traditional social work, the model also places great importance on trauma. This was reflecting in the interviewees answers which we have derived to a more psychotherapeutic ontological model.

Analysis

According to Rennstam and Wästerfors (2018) all analyses of qualitative data, regardless of methodological tradition, contain three steps: sorting the material, reducing it and finally highlighting and argumentation. Early in our process of reading and re-reading transcripts, sorting and reducing the data, we identified a central theme running through the interviews that consisted of professionals talking about a problem and using their expert knowledge to conceptualise the problem and its solution. These early insights were used to refine and develop the research questions, in line with the explorative character of ethnographic methods (Lincoln & Guba, 1985). The emerging theoretical theme concerned the importance of professional identity and organisational context for the social workers’ understanding of men’s violence. In the search for perspectives that would allow a better understanding of the interviews, we turned to Abbot’s (1988) and Brante et al. (2019) theories of professions and their knowledge systems, perspectives that allowed us to further discuss our empirical findings.

Ethical considerations and approval

The project has undergone ethical review and has been approved by the Swedish Ethical Review Authority (Dnr 2020–01361). All interviewees received information about the project’s aims and their rights as research participants to freely chose to participate in the study. All participants were also offered to read the interview transcripts.

Results

What causes the problem?

In this section the social workers’ assumptions about the underlying causes for men’s violence are investigated. In short, the social workers believe that the cause of the male violence is that the men have severe problems handling their emotions, problems perceived to be stemming from childhood traumas. According to the interviewees, their clients cannot identify, understand or reflect on their emotions, nor can they verbally communicate them to their partners. Often they only feel an intensified aggression. As a consequence, they misinterpret their partner’s behaviour as hostile and experience everyday arguments as potential threats to their lives, manageable only through the exercise of violence. Thus, the perpetration of violence becomes a way to convey a vulnerability that they can neither put into words nor communicate to their partner. This problematisation is apparent when Susanne, Nilofar, Marcus and Ali talk about their clients:

Nilofar:

The real challenge for them is not to desist using violence but to accept their emotions instead of blaming their partners. It is not to stop being sad or angry, but to be able to be sad and angry! To handle these feelings. In the way that we all have feelings of anger, sadness and fear, but are able to distinguish between them and cope with them. [/ … /] These feelings are not dangerous and do not need to be blocked out.

Susanne:

The most common problem I encounter is that they have no contact with their emotions. They can’t identify them, they can’t detect nuances between them. So, we have to start by getting them in touch with their feelings so that they can understand what is happening in these situations.

Marcus:

It is not enough that they decide to change, they need to acquire skills that help them achieve this change. They have [/ … /] problems regulating emotions, they need to learn how to face and accept their emotions.

Ali:

Often, these men feel anger. However, this can be secondary. Basically, they may be sad or scared at first, but these feelings are way too hard for them to handle.

Susanne, Nilofar, Marcus and Ali all describe that their clients cannot manage or understand their emotions and are experiencing a hard time even identifying and differentiating between emotions such as anger, sadness or fear. This inability is thought to be linked to aggression and violence. The problem could be described by using the metaphor of a pressure-cooker: in the absence of an ability to harbour and verbally communicate unpleasant emotions such as anxiety, fear or sadness, these feelings are suppressed, causing a pressure which explodes into overreactions and violence.

According to the interviewees, these emotional difficulties can be traced back to traumatic childhood experiences that negatively affect parent–child attachment. Violence in the family of origin, abuse, neglect and rejection are frequently mentioned traumatic experiences, that are assumed to contribute to an inability to handle emotions and, in extension, possibly violent behaviour. Ingemar estimates that at least 95% of his clients have experienced violence as children. One interviewee, Johan, describes the inability to deal with emotions as a kind of family legacy:

Johan:

If the parents are good at mentalisation [the ability to reflect on the thoughts and feelings of self and others], the child will also develop this ability. Thereby, a secure parent–child attachment is established that can be passed on to the next generation. Unfortunately, the same goes for trauma. If you don’t work on your trauma you will pass that on to your children too.

Traumatic experiences of the kind mentioned above are interpreted as hindering the development of a parent–child attachment and the child’s ability of handling emotions.

How can the problem be solved?

As described above, the interviewees explain men’s violence in terms of a lack of emotional competence. Therefore, a central aim of the treatment is to teach the men to cope with their feelings. The solution to the problem is thus found in emotional and relationship training. For example, Anders states that his job is to work with his clients’ emotions, and Adam explains that the aim of the treatment is to teach the men to show themselves vulnerable – to accept and host negative feelings but also to communicate them.

According to the interviewees, the men long for a well-functioning relationship with partners and children, but are unable to achieve this. A consequence of the men’s inability to accept and harbour their emotions is the projection of blame for their own violent actions onto their partners/ex-partners. Thus, the professionals will try to enhance the men’s emphatic ability by practicing how to recognise and (re)interpret their emotional reactions. This will allow them to also change their violent behaviour. For example, Margareta says that the men learn to handle these situations in other ways because they can handle their emotions.

However, treatment is not limited to emotional self-awareness. The interviewees connect the ability to understand and express own emotions with the ability to also understand the perspectives of partners and children. This is reflected in their frequent use of the term mentalization – the ability to reflect on one’s own emotions as well as those of others. For example, Marcus describes how the capability for introspection is related to the understanding of the emotional worlds of others:

The first phase of the treatment consists of listening more to yourself – to understand your own feelings. However, later phases of the treatment also emphasize the ability to take in other people's feelings and perspectives [/ … /] As a partner you need to be able to mentalize and be curious about how the other thinks, rather than immediately trying to interpret their intentions.

By working on the men’s emotional skills – teaching them to identify, listen and reflect upon their inner feelings, it is assumed that their abilities to empathise with partners and children will also grow, which in turn will stop them from using violence. This association goes both ways. When you lack knowledge of your own reactions and feelings, you will misinterpret the reactions and feelings of others as well. This relationship is explained by Nilofar when she describes what abilities her clients must develop to achieve change:

Nilofar:

Self-awareness, empathy. Coping with their own feelings, coping with their own shortcomings. Because when you can't do that, that's when you start to blame it on others in a negative way … when you cannot distinguish between yourself and the other, it is one thing I see that commonly becomes destructive.

When asked how the treatment works the professionals state that effective outcomes are dependent on the relationship between the client and his therapist, in particular the establishment of a therapeutic alliance (Wampold, 2013). This is highlighted by Ingemar:

Ingemar:

We try to form an alliance with the men because that is what it all comes down to. If there is an established alliance, then I can question their behaviour and help them think differently. So that is the most important thing.

Enhancement of the men’s emotional vulnerability can be achieved only when there is a trustful therapeutic alliance. The alliance allows the therapist to help the client to understand and interpret his feelings in new ways. Marcus says that words like listening, respect and empathy guide him in his work. In a sense then, ‘the medium is the message’: The way that a good therapy conversation works is also how the therapists imagine a good relationship. We will return to this under the next section.

What is the end goal of the treatment?

A central theme in the interviews regarded what the treatment aspires to achieve and what the therapists see as a good relationship. For example, Anders and Susanne talked about what constitutes a good intimate relationship:

Anders:

To be open about your feelings, to communicate how you feel and be sensitive to what your partner feels and wants. So, it’s about emotions and communication, trying to understand the other.

Susanne:

[A good relationship] is based on reciprocity. You want the best for each other. You can quarrel and hurt each other but you can repair. It is not built on power differences. An equal and reciprocal relationship.

Ingemar stresses the importance of arguing on equal terms, of being able to compromise and to show oneself vulnerable during conflicts. The interviewees all talk about ideal relationships in very similar ways. All of the research participant’s state that equality constitutes the ideal way of being intimate partners. Equality is presented as the opposite of and the remedy for violence. They emphasize the importance of partners being able to listen and seek to understand each other’s feelings, to verbally communicate their own feelings, and to negotiate and compromise with each other. At the end of one interview, Daniel tells a joke to illustrate his view on what is important in an intimate relationship:

Daniel:

It is kind of a compromise. Like now that we are looking for a boat, me and my partner, we have to compromise. Should it be a sailing boat, like she had growing up and she likes, or should it be a motorboat, like I had growing up and I want? We have to compromise, dealing back and forth, and that is quite exciting, almost like foreplay. It is fun, that dialogue and that journey that you do together.

The anecdote is illustrative of how the interviewees see the ability to negotiate and compromise as central for an intimate, non-violent, relationship. In an earlier article published in this project, based on observations of group treatment within the PSS for men (Sörmark, 2020), the first author has argued that this ideal corresponds closely to Giddens (1992) ideal type of the pure relationship.

Other understandings?

To recapitulate, the interviewees frame men’s violence as an individual problem caused by an inability to harbour and handle emotions, and this inability is traced back to childhood trauma. The solution is to teach the men to mentalize and accept their emotions, and also, in extension, accept their partner’s feelings and to be able to feel empathy for them. It is believed that mentalizing will allow them to have non-violent, equal and reciprocal relationships. Important for achieving this goal is the establishment of a trustful therapeutic alliance that allows the social worker to help the client to work with his feelings.

The professionals seemed to primarily draw on their knowledge of psychotherapy to explain what causes the violence and what the goal of treatment is. Are alternative understandings visible in their talk? When asked to imagine an ideal way of working with men’s violence with unlimited resources, none of the professionals mention factors such as poverty, crowded housing or substance abuse to be related to violence. Feminist perspectives on men’s violence are also noticeably absent in the interviews. There were elements during the interviews that can be understood as an appreciation of feminist perspectives, such as the importance they give to equality as an overarching value in good intimate relationships and the great importance placed on the men to take full responsibility for their violence. Nevertheless, even if there were examples of what could be interpreted as alternative understandings of men’s violence, the psychotherapeutic explanations clearly dominated. In the final section below, we discuss the consequences of a psychotherapeutic understanding of men’s violence and how it has come to dominate work with men’s violence.

Discussion

The purpose of this study was to explore professionals’ subjective understandings of the roots of men’s violence against women, what they perceive as the most successful way to help their clients to change their behaviour and what the end goal of the treatment is. Our interviewees are all psychotherapists working with individual treatment of violent men within the social services in Sweden. According to Abbot (1988) professions are based on systems of knowledge that give them authority to legitimately manage matters within their respective domains of expertise and ownership. According to Brante (2011) this knowledge system is at its core an ontological model that produces a certain style of thinking around problems and interventions. As shown above, our interviewees use a coherent vocabulary when discussing the roots of men’s violence and the goal of the treatment. Central concepts used are childhood traumas and difficulties in recognising and hosting strong emotions. In terms of interventions, male offenders are thought to need to develop an ability to mentalize about their own and others’ feelings, and this is achieved through the establishment of a therapeutic alliance with the professional.

It is clear that the professionals draw on a psychotherapeutic ontological model (Wampold, 2013) that produces a particular understanding of men’s violence with implications for treatment. Although the interviewed professionals have a basic training as social workers, social factors such as poverty, overcrowded housing, unemployment or substance abuse – all of which may be related to violence (Loseke, 2005) – are not mentioned. And although the professionals are explicitly basing their work on the ATV treatment model, the gender power perspective is at most mentioned as a motivation for their work, but refuted as a point of departure for the treatment. The problem remains individual, rather than social or political.

Although psychotherapy and social work share some assumptions, such as the importance of a therapeutic alliance for achieving behavioural change, there are substantial differences. The social worker is often characterised as a generalist. Their expert knowledge is directed towards a holistic understanding of the individual within a wider social system (see e.g. Panican & Björklund, 2019). Their ontological model of violence will include structural and contextual factors such as gender relations and power differences. In contrast psychotherapists are specialists with an advanced training in psychotherapy. While the social worker is trained to problematise the social context the psychotherapist focuses individual problems. A consequence of giving ownership of the problem of men’s violence to psychotherapists is thus a loss of the problem’s social dimensions, at least within the treatment context. Several researchers have argued that this can result in neglect of the asymmetric power balance between the victim and the offender that may lead to misjudgments concerning the safety of women and children (Helmersson, 2017; Mattsson, 2013). An option could be to work preventively with men’s violence within the framework of a social worker’s professional knowledge, for example through community work focusing on gender roles.

As Brante (2011) argues different professions contribute different ontological models to the understanding of problems and different tools for intervention. Placing responsibility for handling men’s violence with the social services underlines an understanding of male violence as a social problem. In contrast, placing the responsibility within the health care system would signal that men’s violence is a question of e.g. chemical imbalance or mental ill-health. But if the problem is perceived of as social, why has it been placed with the psychotherapists? The psychotherapeutic treatment offered by the social services treats the violence as an individual rather than a social defect, not entirely dissimilar to the way it would be treated by the medical community.

Organisational ownership of the problem

One way to understand the placement of the problem in the hands of psychotherapists within the social services is as a way of living up to the letter of the law. Through the amendment to the Social Services Act in 2021 the social services gained responsibility for working with men who are violent against their partners (and children) and to ‘act so that whoever subjects or has subjected a close relation to violence or abuse changes their behaviour’ (2001, p. 453, chapter 5, §11a). The emphasis (also in the underlying government bill, prop, 2020/21:163) on acting towards a change in behaviour seems to imply individual treatment. However, this is not normally a task for the social services. The amendment thus effectively created a task for the social services for which regular social workers are not equipped, and this demanded a special organisational solution.

The treatment units in which our interviewees work can be described as specialised spaces within the wider organisational context of the social services, with the task of making violent men change their behaviour. In these units, only social workers with an advanced training in psychotherapy are allowed to work. Even if these psychotherapists are hired by the social services and are working on their premises, they are not performing social work. Creating a special space for psychotherapists is thus a way to fulfil the legal responsibility of offering treatment to violent men while at the same time following the established practice of not letting social workers provide individual psychotherapeutic treatment.

To some extent this amendment to the Social Services act may be viewed as a formalisation of a practice that was already established within the social services in some parts of the country, as part of a family centred approach to partner violence. But how exactly this solution to the perceived problem became regulated in law remains a question for further research.

It should be noted that the social services do not have sole responsibility for the problem of men’s violence. For example, on a pedagogical level the issue is approached through work on gender roles in schools. Men’s violence, in as far as it constitutes criminal behaviour, is also handled by the law enforcement agencies. But since far from all men that use violence against their female partners are prosecuted, it leaves tasks and initiatives for other actors who can contribute to the elimination of men’s violence. This is where social work is afforded a central role.

Conclusion

A core contribution of the article is that organisational and professional ownership of the treatment of male offenders has implications for practice since different professions draw upon different understandings and organisational resources. Feminist researchers have highlighted the limits of individual-centred and psychotherapeutic understandings of men’s violence and how the loss of concepts of gender, power and social context can lead to misjudgement in practices and ultimately endanger the safety of women and children. The traditional holistic perspective of social work remains an important contribution to work with perpetrators of male violence.

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No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Mira Sörmark

Mira Sörmark is a social worker and a PhD student at the Department of Social Work at Stockholm University. Her PhD project is an ethnographic exploration of treatment within the Swedish Personal Social Services for men who have been violent towards a female partner.

Torbjörn Bildtgård

Torbjörn Bildtgård is associate professor in Sociology and lecturer in Social work at Stockholm university. For the last 15 years his research has mainly focused the family relationships of older people in late modern society, including grey divorce, new intimate relationships in later life, ageing stepfamilies, ageing without a family and more. He is currently associate editor of the International Journal of Ageing and Later Life.

Lena Hübner

Lena Hübner is associate professor and senior lecturer in Social Work at Stockholm University. Her research interests are primarily connected to drug and alcohol misuse; she has done research on Swedish and Nordic alcohol and drug policies and on social work with drug and alcohol misusers. She has also written about evidence-based social work, on social work and its terminology and of the Swedish education of social workers.