Psychotherapy with women who have been abused by their Psychotherapy with women who have been abused by their partners: Characteristics and interruption of treatmentpartners: Characteristics and interruption of treatment

Davins-Pujols, M., Pérez-Testor, C., Castillo, J.A. & Salamero, M.Davins-Pujols, M., Pérez-Testor, C., Castillo, J.A. & Salamero, M.montserratdp1@blanquerna.url.edu

Unitat d’Atenció Especialitzada per a Dones Maltractades (UNADOM, Unit of Specialised Care of Abused Women)

Vidal i Barraquer University Institue for Mental Health (URL)

INTRODUCTIONINTRODUCTIONThe interruption of treatment based on a unilateral decision by the patient, counter to the opinion of the professional, occurs often in clinical practice. In a classic meta-analysis of the topic, Wierzbicki and Pekarik (1993) found an average drop-out rate of 46.86% in the 125 studies they surveyed. In the case of women who have been abused by their partners, the repercussions of this abandonment might be especially serious in that it might mean that they continue to suffer from abuse or fail to treat its symptoms and personality consequences (Pérez-Testor, Castillo, Davins, Salamero & San Martino, 2007).

Even though the abandonment of psychological treatment may also be associated with characteristics of the therapist and difficulties in the therapeutic relationship (Castillo, Pérez-Testor & Aubareda, 1996), in this study we have focused on the patient variables.

METHODMETHODSampleUNADOM has cared for 50 abused woman; 19 of them finished the treatment, 19 abandoned itand 12 are still undergoing treatment. In this study, we did not include this last group. Withregard to the number of sessions, the women that abandoned the psychotherapy had anaverage of 5.21 sessions (sd=7.22), while those that finished it had an average of 30.15sessions (sd=10.43; t=8.57, p<0.001).

Instruments1) Adaptation of the Semi-structured Interview on Domestic Abuse (Echeburúa, Corral, Sarasua,Zubizarreta & Sauca, 1994), which evaluates different aspects of the abused woman and theabuse she has suffered from: socio-demographic characteristics and type, duration andfrequency of the abuse.

2) Millon Clinical Multiaxial Inventory-II (MCMI-II, Millon, 1987).

InterventionUNADOM’s current action programme is targeted at abused women who need outpatientpsychological help. This service is public and free-of-charge. After holding several exploratoryinterviews and administering the questionnaires, focal, brief psychoanalytical psychotherapy isbegun (when indicated). The frequency of the sessions is weekly, and each session lasts 30minutes. The duration of the treatment can range from between approximately three monthsand one year.

GOALSGOALS1. To evaluate the socio-demographic

characteristics and circumstances of the abuse suffered by women cared for in a unit specialising in the psychological treatment of abused women (UNADOM), according to whether they finished or abandoned the treatment.

2. To examine whether there are differences in personality style and type of abuse between women who finished the psychotherapy and those who abandoned it.

REFERENCESBados, A., Balaguer, G. y Saldaña, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63(6), 585-592.Castillo, J.A., Pérez-Testor, S. y Aubareda, M. (1996). El abandono de los tratamientos psicoterapéuticos. Clínica y Salud, 7(3), 271-292.Daughters, S.B., Lejuez, C.W., Bornovalova, M.A., Kahler, C.W., Strong, D.R. & Brown, R.A. (2005). Distress tolerance as a predictor of early treatment dropout in aresidential substance abuse treatment facility. Journal of Abnormal Psychology, 114(4), 729-734.Davis, S., Hooke, G.R. & Page, A.C. (2006). Identifying and targeting predictors of drop-out from group cognitive behaviour therapy. Australian Journal of Psychology,58(1), 48-56.Echeburúa, E. (1994). Personalidades violentas. Madrid: Pirámide.Harris, R., Savage, S., Jones, T. & Brooke, W. (1998). A comparison of treatments for abusive men and their partners within a family-service agency. Canadian Journal ofCommunity Mental Health, 7(2), 147-155.Hopwood, C., Ambwani, S. & Morey, L. (2007). Predicting nonmutual therapy termination with the Personality Assessment Inventory. Psychotherapy Research, 17(6),706-712.Leblond, J., Ladounceur, R. & Blaszczynski, A. (2003). Which pathological gamblers will complete treatment? British Journal of Clinical Psychology, 42(2), 205-209. Millon, T. (1987). Millon Clinical Multiaxial Inventory manual II. Minneapolis: National Computer Systems.Pérez-Testor, C., Castillo, J.A., Davins, M., Salamero, M. & San Martino, M. (2007). Personality profiles in a group of battered women: Clinical and care implications.Journal of Family Violence, 22(2), 73-80.Rinfret-Raynor, M., Paquet-Deehy, A., Larouche, G. & Cantin, S. (1992). Intervening with battered women: Evaluating the effectiveness of a feminist model. Quebec: TheNational Clearinghouse on Family Violence of Health and Welfare Canada.Schlee, K.A., Heyman, R.E. & O’Leary, K.D. (1998). Group treatment for spouse abuse: Are women with PTSD appropiate participants? Journal of Family Violence, 13(1),1-20.Tehrani, E., Krussel, J., Borg, L. & Munk-Jorgensen, P. (1996). Dropping out of psychiatric treatment: A prospective study of a first-admission cohort. Acta PsychiatricaScandinavica, 94(4), 266-271.Thormählen, B., Weinryb, R.M., Norén, K., Vinnars, b., Bagedahl-Strindlund, M. & Barber, J.P. (2003). Patient factors predicting dropout from supportive-expressivepschotherapy for patients with personality disorders. Psychotherapy Research, 13(4), 493-509.Watson, H. (2005). Female survivors of domestic violence: Correlates of treatment-related variables in women in an outpatient treatment program. Dissertation AbstractsInternational: Section B: The Sciences and Engineering, 66(2-B), 1189.Wierzbicki, M. & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190-195.Wishnick, H.M. (2001). Demographic and psychosocial correlates of entry into the public sector mental health system. Dissertation Abstracts International: Section B: TheSciences and Engineering, 62(5-B), 2509.

DISCUSSIONDISCUSSIONThere is little information on the drop-out rate of psychological treatment in abused women. Therange of drop-out rates in the studies surveyed is broad, between 22.1% (Rinfret-Raynor,Paquet-Deehy, Larouche & Cantin, 1992) and 45.7% (Harris, Savae, Jones & Brooke, 1988). Inour sample, the interruption rate was 38%.

With regard to the circumstances of the abuse, our results coincide with those that point to ahigher risk of interruption among younger people (Tehrani et al., 1996; Thormählen et al.,2003). Having suffered from other psychopathological disorders, plus childhood abuse and abusefrom previous partners tend to make interruption more frequent among abused women, which isalso coherent with other studies (Hopwood et al., 2007; Watson, 2005). No differences wereobserved based on the type and duration of the abuse.

Nevertheless, in our sample, anxiety is more pronounced in those who finished the treatment.The women who were abused from their partners use a variety of strategies to handle theirsuffering, involving both emotional deactivation and hyperactivation (Pérez-Testor et al., 2007).The presence of anxiety make the abused woman experience the suffering in a more obviousway, and therefore they might serve as a motivator for continuing the treatment.

Even though no quantitative differences were noticed in the personality styles of both sub-groups, the dependent personality style was more common in the women who finished thetherapy: perhaps the dependent trait nurtures the patient-therapist bond.

Having suffered from abuse in childhood and with different partners are variables associatedwith abandonment. Might they be indicators of a greater lack of trust, of more difficulties inestablishing an appropriate therapeutic alliance? This question merits further study.

RESULTSRESULTS

Table 1. Age and children

Drop-outs (n=19) Finished (n=19)

Mean (SD) Mean (SD) t p

Current age 35.79 (10.26) 44.32 (15.21) 2.03 0.05

Age when the couple relationship started 23.95 (10.07) 23.47 (5.76) 0.18 0.86

Number of children 1.26 (1.49) 2.11 (1.60) 1.68 0.84

Table 2. Type and duration of abuse

Drop-outs Finished 2 p

N (%) N (%)

Type of abuse 0.14 0.93

Psychological 5 (26.3) 6 (31.6)

Physical and psychological 11 (57.9) 10 (52.6)

Physical, psychological and sexual 3 (15.8) 3 (15.8)

Duration 0 1

From 0 to 2 years 7 (36.8) 7 (36.8)

More than 2 years 12 (63.2) 12 (63.2)

Table 3. Other circumstances of domestic abuse

Drop-outs Finished

N (%) N (%)

Psychological disorder prior to the experience of abuse* 17 (89.5) 12 (63.2)

Experiences of abuse with previous partners* 7 (36.8) 2 (10.5)

Experiences of abuse in the birth family 10 (52.6) 5 (26.3)

Experiences of abuse in childhood* * 10 (52.6) 4 (21.1)

Physical and/or psychological abuse of the children 5 (26.3) 7 (36.8)

Family support 8 (42.1) 12 (63.2)

* 2=3.64, p=0.06; * * 2=4.07, p=0.04

Table 4. Personality styles and moderate clinical syndromes

Drop-outs Finished

Mean (SD) Mean (SD) t P

Schizoid (1) 66.9 (11.4) 68.9 (16.0) 0.44 0.66

Avoidant 73.2 (16.0) 76.5 (13.7) 0.68 0.50

Dependent (3) 71.8 (31.6) 80.0 (19.2) 0.99 0.34

Histrionic (4) 70.1 (18.3) 65.5 (20.0) 0.73 0.47

Narcissistic (5) 66.3 (27.8) 64.7 (17.6) 0.11 0.86

Antisocial (6A) 59.6 (22.4) 59.3 (6.6) 0.06 0.95

Aggressive-sadistic (6B) 62.8 (22.9) 62.9 (14.2) 0.02 0.99

Compulsive (7) 71.5 (18.8) 76.4 (18.8) 0.79 0.43

Passive-aggressive (8A) 69.2 (29.0) 68.6 (15.8) 0.08 0.94

Self-defeating (8B) 75.5 (22.6) 76.7 (12.6) 0.20 0.84

Anxiety (A) 64.3 (30.1) 80.4 (23.0) 1.85 0.07

Somatoform (H) 65.1 (10.4) 69.7 (9.7) 1.42 0.17

Manic disorder (N) 55.6 (15.1) 54.0 (16.3) 0.32 0.75

Dysthimic disorder (D) 62.8 (31.0) 72.6 (27.6) 1.03 0.31

Alcohol dependence (B) 49.6 (16.8) 52.3 (10.82) 0.58 0.57

Drug dependence (T) 54.0 (18.3) 53.7 (13.10) 0.24 0.82