Overcoming Gender Based Violence: which psychotherapeutic approach?


Gender-based violence (GBV) is a widespread public health issue. It was demonstrated that GBV has a profound impact on society, in general, and on mental health, in particular, and represents a global challange to reach equality, equity and freedom. The World Health Organisation (WHO) reports that, on average, one in three women worldwide is subjected to physical or sexual violence throughout their lives, in most cases by the partner (Intimate Partner Violence, IPV) or by other people (1). Data in Italy show that  31.5% of women aged 16-70 have been subjected to GBV; in particular 20.2% have been subjected to physical violence, 21% to sexual violence, 5.4% to rapese and attempted rapes (2). In the year 2020, 116 women were victims of voluntary murder in Italy. Homicide rates by gender show that men have been less involved over 26 years (1992-2018), while women victims of murder have remained stable overall (3). In most cases, the perpetrator of the abuse is someone known to the woman, such as the current or former partner, or other family members (4). In recent years, with greater impact during the Covid-19 pandemic, the number of GBVepisodes has increased. This figure was reported in a survey published in July 2020 by the United Nations, which called this phenomenon “shadow pandemic” (5). In this context, even in Italy the explosion of cases of violence was substantial (3).

Italy is committed to fight gender-based violence as one of the countries that signed the Istanbul Convention in 2011, of which the main novelty was to recognise violence against women as a form of violation of human rights and discrimination (6), as to underline the universality of the phenomenon. Various risk factors have been identified which expose women to situations of violence. Indeed, 73% of the victims of violence were in socio-economic difficulties (7). In addition, a multinational WHO study found that GBV is more common in low- and middle-income countries than in high-income countries. However, this report probably focuses its attention on episodes of physical or sexual violence, more clearly objection able since physical signs are visible. It should be considered that in high-income countries GBV can manifest itself more intensely in terms of invisible violence, given its psychological nature.

Studied report that mental health problems for GBV survivors most occur in sociocultural context of inequality, dehumanization, and stigma (8). Therefore, if the victims of violence are not recognized and do not receive adequate treatment, the risk of developing mental illness increases. And viceversa, mental disorders increase the risk of being a victim of GBV. Women victims of GBV may beexposed to increased morbidity and mortality, as well as to a risk of recurrence of the violence itself, particularly for those living IPV (9).

In the literature, mental health intervention modalities that can reduce the impact of violence by the partner and improve the outcome of survivors are studied. Psychological interventions such as cognitive behavioral therapy (CBT), eye movements desensitization and reworking (EMDR) and interpersonal psychotherapy (IPT) reported positive outcomes for women victims of sexual violence perpetrated by unknown person. In these approaches, clinical improvement is linked to the fact that violence has already ceased. In cases where victims still live in the context of violence, the effectiveness of these psychotherapeutic interventions is limited (9). Noteworthy, there is a growing amount of evidence suggesting that interventions, conducted by paraprofessionals specialised by short training, may be effective for common mental disorders in these contexts (10). Among trainee therapists, non-specific skills (e.g. interest, collaboration, empathy and human warmth) contribute as an independent factor to patients’ clinical outcomes (11), particularly for short-term treatments(12). In other studies it is reported that addressing men’s mental health, in terms of exposure to environmental stressors, general mental distress and sociocultural issues, can reduce the risk of violence being perpetrated (8).

This analysis responds to the growing need to recognize that GBV, especially psychological violence, associated with personal and identity deficiencies, can remain hidden, invisible, without ever becoming physical, unless you get the skills to recognize it in the profound relationship dynamics (13). The purpose of this review is therefore to examine which psychotherapeutic interventions are applied in the broad field of GBV. Research has shown that few authors have studied evidence of the effectiveness of individual and especially group dynamic psychotherapy. Overall, the outcomes of mental health interventions are partial in preventing and addressing psychological violence, as well as allowing women to emerge from the spiral of invisible violence that is necessary to make free personal choices and seek and create creative and healthy relationships. In conclusion, although some interventions for GBV survivors have shown evidence of efficacy in short-term resolution of symptoms of related mental disorders, further research on individual and group dynamic psychotherapy interventions is needed, focusing on the care of the unconscious dynamics of relationship of active and passive victims involved in the spiral of gender violence.



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