Avaliação da efetividade do protocolo de psicoterapia para mulheres com histórico de violência por parceiro íntimo em follow-up

Abstract

The development of psychological interventions with follow-up assessments for women victims of violence are essential to verify the effectiveness of treatment with this population. This dissertation consists of two studies: Scope review (I) and empirical study (II). The objective of Study I was to investigate the methodological aspects, main results and limitations of the follow-up evaluations of interventions for women with a history of intimate partner violence (VPI). A search was carried out in the Scielo, Scopus, PsycInfo and Web of Science databases, with the descriptors: (“clinical trial” OR “therapy” OR “psychotherapy” OR “psychological treatment”) AND (“violence” OR “mistreatment” OR “intimate partner violence” OR “domestic violence” OR “conjugal violence”) AND (“women”). 1,480 articles were found and after applying the inclusion and exclusion criteria, 11 articles made up the final sample. A descriptive synthesis of the selected studies was carried out. The analysis and extraction were conducted by two independent judges. A Bardin content analysis was also carried out. Most of the follow-up assessments were carried out through the reapplication of the basic instruments, with the period of 3 months post-intervention being most used. Sample losses were identified in all studies analyzed. The limitations and difficulties were associated with the complexity of the target population. It was verified the importance and the need to adapt the follow-up evaluations to ensure the effectiveness of the interventions, in order to reach a larger number of women, strengthen protective aspects and prevent victimization. The purpose of Study II was to evaluate the therapeutic effects of the cognitive-behavioral psychotherapy protocol by means of psychopathology indicators 6 months after the end of the intervention. Fifteen women (M = 36.67 years) who had completed psychotherapy participated in the study. The collection was carried out in person with seven participants, and in the online format with eight participants. Instruments were applied to assess levels of self-esteem, life satisfaction, anxiety, depression, post-traumatic stress disorder (PTSD), post-traumatic beliefs and complex trauma. These instruments were applied in the three moments of evaluation. A structured interview was applied only at the follow-up. All interviews were audio recorded and transcribed. Descriptive analyzes of frequencies were carried out, Friedman's test to verify differences between the evaluation times, analysis with JT method to evaluate individual differences and clinical significance. Content analysis was also carried out from the interviews. The results indicated that the intervention was effective in reducing symptoms of depression and PTSD and that the effects were maintained at follow-up. It was observed that the improvement was also associated with the current living conditions of women. Therefore, the importance of understanding for whom the intervention is being offered and how it can work is discussed. In the interview, most participants reported that breathing, psychoeducation and cognitive restructuring techniques were the most positive of psychotherapy. It appears that psychotherapy is a tool that can mitigate negative outcomes in mental health resulting from violent experiences in the relationship. In addition, it enables the construction of a secure bond, strengthening protective aspects and the autonomy of women.