Eight weeks of therapy, plus a little money, can change the lives of violent men

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I work with violent young men, from Africa to the Americas – guys so far into the life of crime that a natural reaction is desperation. If 10 years ago you had told me that eight weeks of therapy plus a little money could turn a significant proportion of them away from this life, I would have scoffed. But it’s true, as three colleagues and I have demonstrated in a new working paper. What we learned in Monrovia, Liberia has the potential to change the way America deals with its own epidemics of crime and murder.

Cognitive-behavioral therapy, or CBT, is a set of simple techniques to recognize your “automatic” problem behaviors and train you to act differently. For example, when an emotion like anger rises, CBT helps you recognize how it may be distorting your thinking. You can practice habits that put your rational brain back in control, like breathing slowly, counting to 10, or walking away.

Research has shown that CBT can be effective in treating a range of disorders, including depression and anxiety, and CBT techniques have also long been used to combat aggression and criminal behavior. Juvenile prisons use it regularly, for example, although its long-term effectiveness remains a subject of study. In 2009, my colleagues and I, working with a program called Sustainable Youth Transformation in Liberia, decided to explore, using a randomized trial, the difference CBT could make for men deeply immersed in everyday crime and violence. STYL has recruited 1,000 men who fit this description. Half were offered therapy via a lottery: for two months they were counseled in groups three times a week, four hours at a time, supplemented by individual sessions. Then, after therapy ended, we held a second raffle to determine who received $200 cash. (We hypothesized that money alone could make a difference in men’s lives.) This made four groups – therapy only, money only, both therapy and money, and a control group that did not received neither.

We looked at the effects one month after the program, then a year later, and most recently after 10 years. In a previous article, we showed that therapy plus money had promising results after one year. Other research on CBT and violence prevention suggests that the effects of therapy diminish after that, and Liberia was no different – ​​the effects of therapy alone began to fade within the first year.

We expected therapy plus money to suffer the same fate over time (like most of the experts we interviewed). But a decade later, after tracking down and interviewing as many men from the original study as we could find (about 830, 93% of those still alive), we learned that the large effects in the therapy group more money were backed.

After 10 years, for example, 5% of men who received both treatments (money and therapy) reported selling drugs, compared to 10% for the control group. Additionally, each person who received therapy and cash committed half the theft, on average, as the men in the control group—similar results to our one-year study. We don’t have data for every year in between, but the surveys we do have suggest about 30 fewer robberies and assaults per person, per year, for a decade. Since money and therapy together cost $530 per person, the expense was less than $2 for each robbery averted (disregarding the drop in drug sales and interpersonal violence).

An unintended consequence of mindfulness

As for therapy alone, after a decade there were detectable signs of improvement, but they were significantly weaker than therapy plus money, and not as statistically accurate. We believe the difference is because even modest financial support gave the men enough stability in their lives to practice the behaviors they learned during therapy. The men who received the money generally used the money cautiously, we found, starting small businesses like shoe shiners. But these businesses were short-lived, and within months their assets were stolen or the businesses simply collapsed. So therapy plus money didn’t mean they were making more money a year or 10 years later.

As with any study, there are weaknesses. Impoverished Liberia does not have crime statistics or arrest records, so our data on male behavior was self-reported. (We asked the men about dozens of antisocial and illegal behaviors, including drug dealing, stealing, fighting, arrests, carrying weapons, and domestic violence.) We did what we could to validate this information, by sending qualitative researchers to observe 100 of the men. for four days; their impressions matched the survey data. We also measured outcomes like patience with real-money games, and still saw impacts there.

Addressing gun violence means considering alternatives to the police

This 10-year research odyssey grew out of my relationship with Johnson Borh. He still leads STYL, as he did when we first met in 2008, when he was a smiling, plump man in his thirties who moved easily among the underclass of Monrovia. He introduced me to men huddled in the thatched huts that served as drug dens, or standing with empty wheelbarrows, ready to transport goods for hire (but making most of their money from theft).

Borh had been offering a version of STYL for a decade. I started attending the meetings that he and his self-taught social workers led. We rested on plastic chairs in an abandoned building. The men rehearsed how to handle raw emotions and peacefully negotiate their way through threatening situations. Advisers have also urged them to try out a new social identity for height – swapping shorts and sandals for slacks and dress shoes, for example, and practicing going to banks and supermarkets.

Borh had pieced together the program from online documents, but it was clear that it was a cognitive-behavioral program except for the name (indeed, many of the textbooks he downloaded were based on CBT ). To see if it worked, Bohr and I teamed up with behavioral economist Julian Jamison; a clinical psychologist, Margaret Sheridan; and a master of randomized trials, Sebastian Chaskel.

Beyond the large and persistent impacts of therapy and economic aid, our results offer other good news. Even among the control group, half returned to a more traditional, non-violent life within a year. This suggests that even the young Liberian men who seem the most lost average out over time. We also found that the impacts of STYL on crime and violence were concentrated among men who initially reported the most antisocial behaviors. This suggests that cities can make significant progress on violence with targeted interventions for the small number of people most at risk.

This is just one of many studies that show the promise of CBT in the fight against violence. At the same time that we are studying STYL, a group of Chicago economists and psychologists evaluated two versions of Becoming a Man – a CBT-based program for troubled teens in high schools most plagued by violence in the town. Their research found that CBT alone – no economic aid, in this case – resulted in a 45-50% reduction in violent crime arrests over the next two years. And even though the effects of the therapy alone waned somewhat over a longer period, the authors demonstrated that the benefits of BAM were significant enough to more than justify the cost of the program. The researchers also studied a BAM-like program in juvenile detention, in the same article, and came to similar conclusions.

American cities need solutions to the problems of gun violence, especially those that do not involve harassing and imprisoning members of minority groups. CBT, in concert with economic assistance, offers a promising alternative, which avoids communal violence rather than punishing and imprisoning offenders after it has occurred. President Biden has advocated putting more money into “community violence interruption” programs like Becoming a Man.

Controlling anger is a habit we all need to practice, as is managing conflicting relationships, acknowledging biases, and seeing arguments from another perspective. Decades of social science show us that peaceful societies saturate the lives of citizens with these lessons, fortifying them with laws and norms. They socialize their young people to non-violence, in what the sociologist Norbert Elias has called “the process of civilization”.

In America, we start early, with “Sesame Street,” “Mr. Rogers,” and other TV shows deliberately designed to convey these behaviors. And most schools teach the same social-emotional skills that programs like STYL impart. But some young people don’t. They don’t follow these lessons in class or at home – or they just need a little extra help learning them. This includes disgruntled young men in Chicago and street youth in Monrovia – but in principle the approach could work with anyone engaged in sustained and regular activity. violence. We don’t yet know the full range of its benefits and limitations. But like Johnson Borh, we have to try things, tinker, and find out what works. He showed us something deeply hopeful: that we can make societies less violent, not by using force, but by forging a path to a different life.


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