Uma revisão das práticas atuais na intervenção com agressores conjugais

Cunha, Olga; Gonçalves, Rui Abrunhosa

doi:10.1590/0101-60830000000008

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Sumário

Review Articles • Rev. psiquiatr. clín. 41 (2) • mar-apr 2014 • https://doi.org/10.1590/0101-60830000000008 copiar

Uma revisão das práticas atuais na intervenção com agressores conjugais

Autoria SCIMAGO INSTITUTIONS RANKINGS

Contexto

Desde os anos 1970, assiste-se a uma proliferação dos programas de intervenção para agressores conjugais, no entanto os resultados mantêm-se controversos.

Objetivos

Este estudo visa analisar a literatura publicada entre os anos de 2000 e 2013 acerca da eficácia da intervenção com agressores conjugais.

Métodos

Para o efeito, realizou-se uma revisão de artigos publicados durante esse período (2000-2013) a respeito da intervenção com agressores conjugais. Foram consultadas bases de dados de referência na área das ciências sociais. Excluíram-se da análise artigos que versavam sobre programas destinados a um público-alvo ou com um foco de intervenção demasiadamente amplo, agressoras do sexo feminino e agressores homossexuais.

Resultados

Trinta e seis estudos que descreviam 37 programas de intervenção dirigidos a agressores conjugais preencheram os critérios de inclusão definidos. Na generalidade, os programas analisados adotaram um formato grupal (70.3%) e um modelo de intervenção cognitivo-comportamental (56,8%) e/ou psicoeducativo (18,9%), e uma parte se assumiu como assente no modelo Duluth (32,4%). No que diz respeito à eficácia da intervenção, os resultados dos diferentes estudos revelaram-se ambíguos, com taxas de sucesso entre os 39,4% e os 97%, taxas de abandono entre os 10% e os 58% e taxas de reincidência entre os 0% e os 65,9%.

Conclusão

Em suma, a eficácia da intervenção com agressores conjugais mantém-se controversa, o que parece relacionar-se essencialmente com as diferentes metodologias utilizadas nos estudos. Não obstante tais inconsistências, os programas para agressores revelam-se uma importante medida na redução da reincidência na violência doméstica.

Violência em relações de intimidade; agressores conjugais; programas de intervenção, eficácia da intervenção

Passive-aggressive responses*** (-)Authors	Research design	Results

Bowen²⁷ ⁽¹⁾ (Domestic Violence Perpetrator Program – DVPP)	Quasi-experimental	Group cohesion (+); Leaders support (+)
	(pre-test, post-test and 5 months follow-up)	Expressiveness: G1** (+)
	G1 = 2 hours	Anger and aggression: G1** (+)
	G2 = 2.5 hours	Order and organization: G2* (+)
		Leader control: G2* (+); Innovation: G1 (+)

Bowen et al.^{20 (1)} (Domestic Violence Perpetrator Program – DVPP)	Quasi-experimental	Dropout = 33%
	(pre-test, post-test and 11 months follow-up)	Re-offending = 21%
	G1 = completers	Demographic characteristics: G1 x G2: ns
	G2 = dropout	Psychological characteristics: G1 x G2: ns
		Criminal history characteristics: G1 x G2** (+)

Bowen et al.^{28 (1)} (Domestic Violence Perpetrator Program – DVPP)	Quasi-experimental	Re-offending = 10.8%
	(pre-test, post-test and 5 month follow-up)	Cognitive domain, arousal domain, behavioural domain, sympathy for the battered women, chance locus of control: GN x GO: ns
	GN = non-offenders
	GO = offenders

Buttell²⁹	Quasi-experimental	Moral reasoning: ns
	(pre-test and post-test)

Buttell and Carney^{30 (2)}	Quasi-experimental	Spouse-specific behaviour, controlling behaviour and propensity for abuse: ns
	(pre-test and post-test)

Buttell and Carney^{31 (3)}	Quasi-experimental	Passive-aggressive responses*** (-)
	(pre-test and post-test)	Assertiveness, controlling behaviour, propensity for abuse: ns
	G1 = African American	G1 x G2: ns
	G2 = Caucasian

Buttell and Carney^{32 (2)}	Quasi-experimental	G1 = Self-deception*** (+)
	(pre-test and post-test)	G2 = Propensity for abusiveness*** (+)
	G1 = African American	Total sample
	G2 = Caucasian	Passive-aggressive responses* (-); controlling behaviour* (-); propensity for abusiveness** (-)

Buttell and Pike³³	Quasi-experimental	Success = 72.5%
	(pre-test, post-test and 12 months follow-up)	Alcohol (-); Drug (-); Violence*** (-)
		Control (-); Stress-coping (-)

Carney and Buttell^{34 (3)}	Quasi-experimental	Dropout = 58
	(pre-test and post-test)	Interpersonal dependency: ns

Chan³⁵	Quasi-experimental	Physical assault* (-)
	(pre-test and post-test)	Psychological aggression* (-)

Cissner and Puffett³⁶	1 year follow-up	Success = 68%
(The Domestic Violence Accountability Program)		Recidivism: in-program arrest = 27%; 1 year post sentence arrest = 27%; 1 year post-program arrest = 18%
		Criminal contempt arrest = 7%
		Violent arrest = 12%

Cissner and Puffett³⁶	1 year follow-up	Success = 77%
(Interborough Developmental Consultation Centre – IDCC)		Recidivism: in program arrest = 29%; 1 year post sentence arrest = 36%;
		1 year post program arrest = 14%
		Criminal contempt arrest = 14%
		Violent arrest = 16%

Connors et al.³⁷ (The Moderate Intensity Family Violence Prevention Program)	Quasi-experimental	Interpersonal relationship (jealousy)* (+); Aggression* (+)
	(pre-test and post-test)	Violence* (-); Empathy for the victims* (+)
	G1 = Ready to change	Acceptance of responsibility*** (+)
	G2 = Not ready	Acknowledges the use of power and control*** (+)
		Recognizes cognitive distortions*** (+)
		Understands the abusive patterns***(+)
		Motivation to change* (+); Participation in program and performance* (+);
		Responses to potential risk situations* (+); Readiness to change* (+)
		G1*** x G2

Connors et al.³⁸ (The High Intensity Family Violence Prevention Program)	Quasi-experimental (pre-test and post-test)	Interpersonal relationship (jealousy)* (-); Aggression* (-); Violence*** (-)
		Acceptance of responsibility*** (+)
		Acknowledges the use of power and control*** (+)
		Empathy to the victims* (+); Recognizes cognitive distortions* (+); Understands the abusive patterns* (+); Motivation to change* (+); Responses to potential risk situations (interpretation) (+); Readiness to change* (+)

Echeburúa and Fernández-Montalvo^{39 (4)}	Quasi-experimental	Success: 68.2%
	Pre-test	Cognitive bias about women (-); Cognitive bias about use of violence (-);
	Post-test	Empathy: ns; Trait-anger: ns; Anger expression (-); Impulsivity (-); Self-esteem (+); Symptomatology* (-)

Echeburúa et al.^{40 (4)}	Quasi-experimental	Success = 92%
	(pre-test and post-test)	Cognitive bias about women (-); Cognitive bias about use of violence (-);
	G1 = Completers	Empathy: ns; Symptomatology* (-); Hostility* (-); State-anger* (-); Impulsivity: ns;
	G2 = Dropout	Self-esteem: ns; Inadaptation: ns; Motivation to change (G1* (+) x G2)

Echeburúa et al.⁴¹	Experimental (pre-test, post-test and 1, 3, 6 and 12 months follow-up)	Success: 87.96% Cognitive bias about women* (-); Cognitive bias about the use of violence* (-); Empathy* (+); Trait-anxiety* (-); Trait-anger* (-); Depression* (-); Self-esteem* (+); Inadaptation* (-)

Authors	Research design	Results

Feder and Dugan⁴² (The Broward experiment)	Experimental	Success = 97%
	(pre-test and post-test)	Self-reports of abuse: ns; Victim reports of abuse: ns
	G1 = Experimental group	Recidivism (official reports): ns
	G2 = Control	Beliefs about wife beating, attitudes toward women, treats domestic violence as a crime, responsibility, likelihood for repeated abuse: ns

Lawson et al.⁴³	Quasi-experimental	Secure attachment* (+); Anxiety and avoidance attachment: ns;
	(pre-test and post-test)	Comfort with closeness and depending of others = G1** (+) x G2 x G3
	G1 = Secure-changed	Avoidance and closeness with others = G1 x G2* (+) x G3* (+); Depression and anxiety* (-) G1* (-) x G2 x G3
	G2 = Secure-unchanged	Functioning*** (+) G1 x G2 x G3: ns
	G3 = Insecure	Partner violence* (-) G1 x G2 x G3: ns

Lila et al.⁴⁴	Pre-test and post-test	Perceived severity* (+)
		Responsibility assumption* (+)
		Risk of recidivism* (-)

Lin et al.⁴⁵	Quasi-experimental	Overall violence: GE* (58.6%) x GC (41.4%) (3 months follow-up)
	(3, 6 and 9 months follow-up)	Physical violence: GE (20%) x GC (13.4%): ns
	GC = Control	Verbal violence: GE* (58.6%) x GC (43.7%) (3 months follow-up)

Novo et al.²⁶ (Galicia Reeducation Program for Gender Violence Offenders)	Quasi-experimental	Psychological symptoms*** (-)
	(pre-test and post-test)	Obsessive-compulsion** (-)
		Interpersonal sensitivity*** (-)
		Depression* (-); Anxiety (-)
		Hostility*** (-)
		Phobic anxiety** (-)
		Paranoid ideation* (-); Psychoticism* (-)


Pascual-Leone et al.²⁵ (Relating Without Violence)	Quasi-experimental	Dropout = 10%
	(7, 8 and 9 month, 1, 2 and 3 years follow-up)	Recidivism (3 years follow-up) = 15.6%
	GE = Intervention	GE* (-) x GC (7 and 8 months follow-up)
	GC = Control	GE x GC: ns (9 months, 1, 2 and 3 years follow-up)

Ramírez et al.⁴⁶	Quasi-experimental	Aggression: ns (hostility** (-) (GE x GC: ns)
	(pre-test and post-test)	Benevolent sexism*** (-) (GE* x GC); Hostile sexism* (-) (GE x GC)
	GE = Treatment	Jealousy* (-) (GE x GC: ns); Marital satisfaction* (+) (GE* x GC)
	GC = Control	Conflict tactics** (-) (GE x GC: ns)
		Responsibility* (+) (GE* x GC); Responsibility minimization*** (-) (GE x GC: ns)
		Emotional abuse** (-) (GE x GC: ns)
		Personality (NEO-PI): ns (openness to experience (+); kindness(+) (GE x GC: ns)
		Personality (I-7):Impulsiveness**(-) (GE x GC); empathy(+) (GE x GC: ns); venturesomeness(-) (GE x GC: ns)
		Anger (anger trait* (-); external anger expression*** (-); internal anger expression* (-); internal anger control* (+); anger expression and control* (-) (GE x GC: ns)

Rosenbaum et al.⁴⁷ (Mens’ Educational Workshop – MEW)	Quasi-experimental	Success
	(post-test and 20 months follow-up)	G1 (56.5%) x G2*** (79.5%)
	G1 = Self-referred	G1 (39.4%) x G2* (75.2%) (20 sessions)
	G2 = Court-referred	Recidivism
	G3 = Completers	G1 (13.4%) x G2** (4.9%)
	G4 = Non-completers	G3* (-) x G4
	7, 10 e 20 sessions	10 and 20 sessions = > recidivism

Sarto and Esteban⁴⁸	Post-facto	Dropout = 55.1%
	(3, 6 and 12 months follow-up)

Schmidt et al.⁴⁹	Quasi-experimental	Success = 52%
	(pre-test and post-test)	Statements that support abusive behaviour (-); Statements that support a nonviolent relationship (+); Motivating factors for behaviour change** (+)

Stith et al.⁵⁰ (Domestic Violence Focused Couples Treatment)	Quasi-experimental	Success
	(pre-test and 6 month and 2 years follow-up)	T1 (70%) x T2 (73%): ns
	T1 = Multi-couple group	Beliefs about wife beating: T1(-) x T2 x T3 (M(-) x W)
	T2 = Individual couple	Marital satisfaction: T1** (+) x T2 x T3
	T3 = Comparison	Acceptance of marital aggression: T1*** (-) x T2 x T3
		Recidivism
		6 months: T1(25%)* x T2(45%) x T3(67%)
		2 years: T2*(0%) x T3 (50%); T1⁺(13%) x T3; T1 x T2⁺

Taylor et al.⁵¹ (Victim Services’ Alternatives to Violence) (The Brooklyn Experiment)	Experimental	Recidivism
	(6 and 12 months follow-up)	Officially recorded incidents: GE** (-) x GC
	GE = Intervention	Victim-reported incidents: GE (-) x GC: ns
	GC = Control	Treatment = < recidivism
Taylor and Maxwell⁵² (Sacramento Jail Batterer Intervention Program)	Randomized experimental	Batterers
	(6 and 12 months follow-up)	Psychological abuse: GE x GC: ns;
	GE = Treatment	Threats of physical abuse: GE x GC: ns;
	GC = Control	Physical abuse: GE x GC: ns;
		Controlling behaviours: GE** (-) x GC
		Victims: GE x GC: ns
		Oficial data: GE (65.9%) x GC (65.7%): ns

Authors	Research design	Results
Alexander⁵³ (Stages of change – SOC; Cognitive-behavioural gender-re-education format – CBTGR)	Quasi-experimental	Physical and psychological aggression (post-test): ns
	(pre-test, post-test and 6 and 12 months follow-up)	Physical aggression (follow-up) (-) (G1* x G2)
	G1 = SOC	Psychological aggression (follow-up) (-) (G1 x G2: ns)
	G2 = CBTGR	Assumption of responsibility, attendance, treatment completion, working alliance, group cohesion: ns

Dunford⁵⁴	Randomized experimental (post-test and 1 year follow-up)	Success = 71%
(San Diego Navy Experiment)	T1 = Men’s group	Frequency of victimization: T1 x T2 x T3 x T4: ns
	T2 – Conjoint group	Official data: T1 x T2 x T3 x T4: ns
	T3 = Rigorous monitoring group	Prevalence and frequency of violence* (-)
	T4 = Control group

Hendricks et al.²⁴ (Stopping Abuse for Everyone – SAFE; Reasoning and Rehabilitation – R&R)	Quasi-experimental (6, 12 and 18 months follow-up)	Recidivism = 17.5%
	G1 = SAFE	(6-12 months follow-up = 23%; 12-18 months follow-up = 17%); G1* (14.4%) x G2 (32.4%); G3*** (10.6%) x G4 (38.8%)
	G2 = R&R + SAFE	Risk: G3 * (-) x G4; G1 x G2*** (+)
	G3 = Completed SAFE	Discharged score: G1 x G2** (+); G3 x G4* (+)
	G4 = Incomplete SAFE


Morrell et al.⁵⁵	Quasi-experimental (pre-test, post-test and 6 month follow-up)	Success = 86%
	T1 = Cognitive-behavioural group therapy	Recidivism: ns
	T2 = Supportive group therapy	Physical assault*(-); psychological aggression(-), injuries**(-), sexual coercion(-): T1 x T2: ns
		Readiness to change: ns (T1 x T2: ns)
		Self-esteem** (+) (T1 x T2: ns)
		Self-efficacy*** (+) (T1 x T2*)

Murphy et al.⁵⁶	Quasi-experimental (pre-test and post-test)	Self-esteem: T1* (+) x T2*** (+)
	T1 = Cognitive-behavioural	Physical aggression: T1* (-) x T2** (-)
	T2 = Compassion workshop

Scott et al.⁵⁷	Quasi-experimental (pre-test and post-test)	Dropout
	T1 = Standard program	T1 = 53.5% (46.5% completed the treatment); T2 = 15.8% (84.2% completed the treatment)***
	T2 = MET (motivational enhancing treatment) + standard program	Accountability: T1 = 2.34; T2 = 2.54
		Active engagement: T1 = 2.78; T2 = 2.72

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[1] Address correspondence to: Olga Cunha. School of Psychology, University of Minho, Campus de Gualtar – 4710-057 – Braga, Portugal. E-mail: olgacunha27@hotmail.com