FEELI N G POW ERLESS: A FEELI N G EXPRESSED BY CAREGI VERS OF
SEXUAL VI OLEN CE VI CTI MS
1Mar ia Edu ar da Cav adin h a Cor r ea2 Liliana Mar ia Labr onici3 Tat ian e Her r eir a Tr igu eir o4
Correa MEC, Labronici LM, Tr igueir o TH. Feeling pow er less: a feeling expr essed by car egiver s of sexual violence v ict im s. Rev Lat ino- am Enfer m agem 2 0 0 9 m aio- j unho; 1 7 ( 3 ) : 2 8 9 - 2 9 4 .
This phenom enological st udy aim ed t o r ev eal t he m eaning of pr ov iding car e t o v ict im s of sex ual v iolence. The st udy w as car r ied out fr om Decem ber 2006 t o Mar ch 2007 w it h 12 healt h pr ofessionals. Dat a w er e collect ed t h r ou gh t ape- r ecor ded sem i- st r u ct u r ed in t er v iew s, w h ose an aly sis follow ed t h e ph en om en ological t r aj ect or y . The follow ing t hem e em er ged: Feeling pow er less, a feeling ex pr essed by car egiv er s of sex ual v iolence v ict im s. The feeling of pow er lessness is cont inuously fed by healt h pr ofessionals’ daily r out ines, giv en t he im possibilit y of solving sit uat ions of violence, of pr oblem s t hat em er ge fr om t he ot her ’s subj ect ivit y, as w ell as social issues, b ecau se t h ese p r of ession als w er e n ot t r ain ed f or t h at . Th u s, it is essen t ial t o ad d r ess t h e issu e b ot h in u n d er g r ad u at e an d g r ad u at e p r og r am s in h ealt h an d h u m an ar eas. I n st it u t ion s sh ou ld p r om ot e con t in u in g educat ion so t hat t hese pr ofessionals can act pr oper ly .
DESCRI PTORS: sex u al v iolen ce; pr ofession al pr act ice; h ealt h per son n el; pr ofession al- pat ien t r elat ion s
SENTI RSE I MPOTENTE: UN SENTI MI ENTO EXPRESADO POR CUI DADORES
DE VÍ CTI MAS DE VI OLEN CI A SEXUAL
Se t r at a de una inv est igación fenom enológica que t uv o com o obj et iv o desv elar el significado de la v iv encia de cuidar de víct im as de violencia sexual; fue r ealizada de diciem br e de 2006 a m ar zo de 2007, con 12 pr ofesionales de la salud. La r ecolección de los discur sos ocur r ió m ediant e ent r evist a sem iest r uct ur ada gr abada, y el análisis se r ealizó p or la d escr ip ción , r ed u cción y com p r en sión d el f en óm en o; d e est e, em er g ió el t em a: sen t ir se im p ot en t e, u n sen t im ien t o ex p r esad o p or el cu er p o d e las cu id ad or as d e v íct im as d e v iolen cia sex u al. El sen t im ien t o de im pot en cia es alim en t ado cont inuam ent e en lo cot idiano de los pr ofesion ales - delant e de la im posibilidad de r esolv er la sit uación de la v iolencia, de solucionar pr oblem as que em er gen de la subj et iv idad del ot r o y de cuest iones sociales - por que no fuer on pr epar ados par a esas sit uaciones. Así, es im pr escindible que el t em a sea abor dado t ant o en la gr aduación com o en la posgr aduación de los cur sos de las ár eas de la salu d y h u m an as, a f in d e q u e esos p r of esion ales p u ed an act u ar ad ecu ad am en t e, y q u e las in st it u cion es p r om u ev an cap acit ación p er m an en t e.
DESCRI PTORES: v iolen cia sex u al; pr áct ica pr ofesion al; per son al de salu d; r elacion es pr ofesion al- pacien t e
SENTI R- SE I MPOTENTE: UM SENTI MENTO EXPRESSO POR CUI DADORES DE
VÍ TI MAS DE VI OLÊNCI A SEXUAL
Tr at a- se de pesquisa fenom enológica que t ev e com o obj et iv o desv elar o significado da v iv ência no cuidar de v ít im as de v iolên cia sex u al. Foi r ealizada de dezem br o de 2 0 0 6 a m ar ço de 2 0 0 7 , com 1 2 pr of ission ais de saúde. A colet a dos discur sos ocor r eu m ediant e ent r ev ist a sem iest r ut ur ada gr av ada, e a análise se deu pela descr ição, r edução e com pr eensão do fenôm eno. Dessa, em er giu o t em a: sent ir - se im pot ent e, um sent im ent o expr esso por cor por eidades cuidador as de vít im as de violência sexual. O sent im ent o de im pot ência é alim ent ado cont inuam ent e no cot idiano dos pr ofissionais, diant e da im possibilidade de r esolv er a sit uação da v iolência, de pr oblem as que em er gem da subj et ividade do out r o, bem com o de quest ões sociais, por que não for am pr epar ados par a isso. Assim , é im pr escindív el que o t em a sej a abor dado t ant o na gr aduação com o na pós- gr aduação dos cur sos da ár ea da saúde e hum anas, a fim de que esses pr ofissionais possam at uar adequadam ent e, e que as in st it u ições pr om ov am capacit ação per m an en t e.
DESCRI TORES: v iolên cia sex u al; pr át ica pr ofission al; pessoal de saú de; r elações pr ofission al- pacien t e
1
Pap er ex t r act ed f r o m Mast er ’ s Th esi s; 2RN, D o ct o r al St u d en t , Facu l d ad e d e Saú d e Pú b l i ca d a Un i v er si d ad e d e São Pau l o , Br azi l , e- m ai l : ecavadinha@gm ail.com .br ; 3RN, Ph.D. in Nur sing, Full Pr ofessor, Univer sidade Federal do Paraná, Brazil, e- m ail: lililabr onici@yahoo.com .br ; 4Under graduat e st udent in Nur sing, Univer sidade Feder al do Par aná, Br azil, e- m ail: t at iher r eir a@hot m ail.com .
I NTRODUCTI ON
V
i o l e n c e i s a c o m p l e x a n d g l o b a l phenom enon w it h m ult iple for m s of ex pr ession in allsociet ies and in div er se scenar ios. I t is cur r ent ly t he
k ey n ot e of daily lif e( 1 ) an d is u n dou bt edly t h e m ain pr oblem faced, as it is no longer a fact ex clusiv e t o
t he police. I nst ead, it has becom e a social problem( 2) t hat affect s t he populat ion in general in different age
ranges, regardless of social class and econom ic st at us.
Th er e h as n ev er b een m or e d iscu ssion on
v i o l en ce an d h o w t o f i g h t i t an d y et , a f eel i n g o f
p o w e r l e s s n e s s h a s i n c r e a s e d( 1 ). A f a c t o r t h a t cont ribut es t o pow erlessness is it s m orbidit y, w hich is
difficult t o m easur e, be it due t o t he scar cit y of dat a
or im p r ecise in f or m at ion g en er at ed t h r ou g h p olice
occur r ence r epor t s or by t he lit t le v isibilit y of cer t ain
t ypes of inj uries and t he m ult iplicit y of fact ors involving
v iolent act s( 3).
Reg ar d in g sex u al v iolen ce ag ain st w om en ,
t he Minist r y of Healt h r ecom m ends t hat t hey should
be at t ended by an int er disciplinar y t eam , com posed
o f p h y s i c i a n s , p s y c h o l o g i s t s , n u r s e s a n d s o c i a l
w orkers, each w it h a specific role. For t hat t o happen,
all should be sensit ized t o violence issues and be able
t o w elcom e and offer suppor t t o t he m ain dem ands( 4). The Municipal Secret ary in Curit iba, PR, Brazil
has dev eloped, t hr ough t he Mulher de Ver dade [ Real
Wom en] , a prot ocol t o at t end wom en vict im s of violence
in t he at t em pt t o offer healt h professionals m et hods t o
det ect signs and sym pt om s of aggression, approaching
an d w elcom in g st r at egies, an d in for m at ion t o or ien t
wom en who seek help in healt h unit s.
When health professionals develop this protocol,
t hey are exposed not only t o signs det ect able t hrough
sophist icat ed equipm ent s for clinical diagnosis t hat are
conducive to the expression of com plains and sym ptom s
revealing evident healt h problem s, but t hey also share
the suffering, pain, fear and sorrow triggered by violence
and st ore t he experiences of sexual violence vict im s in
their bodies, which can also affect them .
Based on t h e ab ov e, t h is st u d y aim ed t o:
r eveal t he m eaning of t he exper ience of car e deliver y
t o v ict im s of sex ual v iolence.
METHOD
Th is is a ph en om en ological st u dy based on
c o n c e p t s o f b o d y, c o r p o r a l i t y a n d p e r c e p t i o n( 5 ).
Phenom enology w as chosen because it per m it s going
b ey o n d t h e w o r l d o f a p p ea r a n ces a n d t h eo r et i ca l
k n ow led g e. Th e in v est ig at ion seek s t o ap p r ox im at e
t h e h u m an ex p er ien ce u n d er a n ew p er sp ect iv e so
as t o under st and it based on it s ex ist ence.
The phenom enological pr oposal is t o dir ect ly
in v est igat e h u m an ex per ien ces t o u n der st an d t h em
w i t h o u t g e t t i n g t i e d t o ca u sa l e x p l a n a t i o n s o r t o
gen er alizat ion s an d aim s f or dir ect obser v at ion an d
d e scr i p t i o n o f p h e n o m e n a , w h i ch a r e se n se d b y
consciousness( 6). For t hat , t he r esear cher has t o giv e u p assu m p t ion s, h y p ot h eses or ex p licat iv e t h eor ies
t o r each t he “ go- t o- t he- t hing- it self ”, t hat is, t o seek
t h e i n d i v i d u a l ’ s u n i q u e a n d p e r s o n a l c o n s c i o u s
exper ience, cont ained in t he subj ect ive w or ld of each
per son and w hich can be acknow ledged t hr ough w hat
is r ev ealed( 7 ).
The exper ience happens in t he body, t he fir st
a n d o n l y p l a ce o f h u m a n e x p e r i e n ce( 8 ), i t i s t h e e x p r e ssi v e sp a ce , se t o f e x p e r i e n ce d m e a n i n g s,
vehicle of t he being in t he w orld, w hich is capable of
seeing, suffer ing, t hink ing and ex pr essing. Thus, t he
body is concr et e of hum an exist ence and it s m ult iple
f or m s of ex pr ession ar e r ev ealed in t h e cor por alit y.
I t is w hat per m it s, by per cept ion, access t o t he w or ld,
t o k n o w l ed g e. Per cep t i o n i s t h e en co u n t er o f t h e
subj ect w it h t he w or ld and is pr esent ed as a m osaic
of “ a set of different obj ect s”, due t o t he “ recollect ion
of past ex per iences”( 5).
Th i s st u d y w as set i n h osp i t al s, r ef er en ce
cent ers t hat at t end sexual violence vict im s in Curit iba,
PR, Br azil. Dat a w er e collect ed b et w een Decem b er
2006 and Mar ch 2007, involving 12 healt h pr ofessionals
w it h a bachelor ’s degr ee w ho at t ended sexual violence
v i c t i m s : f o u r n u r s e s , t h r e e p h y s i c i a n s , t w o
psy ch ologist s an d t h r ee social w or k er s.
Re g a r d i n g e t h i c a l a s p e c t s , t h e r e s e a r c h
p r oj ect w as ev alu at ed an d ap p r ov ed b y t h e Et h ics
Co m m i t t e e ( CAAE No 0 0 4 9 . 0 . 0 9 1 . 0 0 - 0 6 ) , w h o se
r epor t w as for w ar ded t o t he et hics com m it t ees of t he
inst it ut ions involved in t he st udy for t heir inform at ion.
Aim in g t o assu r e an on y m it y of par t icipan t s,
Ar abic num ber s fr om 1 t o 1 2 follow ing t he or der of
i n t e r v i e w s w e r e u s e d t o i d e n t i f y t h e o b t a i n e d
st at em en t s.
Dat a w er e collect ed t hr ough sem i- st r uct ur ed
in t er v iew s, t ap e- r ecor d ed an d f u lly t r an scr ib ed , t o
seek t h e ex pr ession of ex per ien ces, con sider in g t h e
follow ing quest ion: t ell m e about y our ex per ience in
Som e d if f icu lt ies w er e f aced t o ob t ain t h e
st at em en t s: r ed u ced n u m b er of p r of ession als w h o
w o r k w i t h v i o l e n ce v i ct i m s i n r e f e r e n ce ce n t e r s,
r e f u sa l o f t w o p r o f e ssi o n a l s t o p a r t i ci p a t e i n t h e
s t u d y, p a r t i c i p a n t s d i d n o t h a v e m u c h t i m e t o
at t en d t h e in t er v iew s an d im p ossib ilit y t o ar r an g e
an ot h er t im e, ou t of t h e w or k en v ir on m en t , t o car r y
o u t i n t er v i ew s.
D i sco u r se a n a l y si s f o l l o w e d t h e f o l l o w i n g
st ep s: d escr ip t ion , r ed u ct ion an d p h en om en olog ical
under st anding( 9). Phenom enological descr ipt ion is t he ex posu r e of a ph en om en on in a con t ex t u alized w ay
t h a t a i m s t o se e k t h e e sse n ce o f t r a n sce n d e n ce
t h r o u g h i t s a n a l y s i s , i n t e r p r e t a t i o n a n d
u n d er st an d in g( 1 0 ). I t is an in v est ig at ion of w h at is show ed and can be discover ed, t hough it is not alw ays
seen . I t h ap p en s t h r o u g h t h e i n t er v i ew ee’ s n aïv e
d iscou r se, as f r om h is( er ) liv ed ex p er ien ce, w h ich
i n d i c a t e s h o w t h e i n d i v i d u a l p e r c e i v e s a g i v e n
p h en om en on , it is “ t h e in d iv id u al’s p osit ion in t h e
w or ld of his( er ) m eanings”( 5).
Th e r ed u ct ion st ep con sist s in r et u r n in g t o
t he descr ipt ion t o quest ion it , and aim s t o det er m ine
and select w hich par t s of descr ipt ion ar e consider ed
essent ial from t hose t hat are not . What one w ishes is
t o find exact ly w hich part s of t he exper ience ar e t r uly
part s of consciousness, select ing t hem fr om t hose t hat
ar e sim ply supposed( 9). I t is at t his m om ent t hat t he p a r t i ci p a n t ’ s e x p r e ssi o n s a r e t r a n sf o r m e d i n t h e
r esear ch er ’s lan g u ag e, cr eat in g , t h er ef or e, u n it s of
m e a n i n g i n t h e a t t e m p t t o u n d e r s t a n d t h e
phenom enon. When t he r esear cher assum es t he r esult
of r educt ion as a set of unit s of m eanings t hat show
t h e in d iv id u al’s con sciou sn ess of t h e p h en om en on ,
t h e t h i r d m o m e n t e m e r g e s : p h e n o m e n o l o g i c a l
u n d er st an d in g .
Ph e n o m e n o l o g i c a l u n d e r s t a n d i n g i s t h e
m o m e n t w h e n u n i t s o f m e a n i n g s a r e su m m a r i ze d
a n d t h e i n d i v i d u a l ’ s co n sci o u sn e ss r e g a r d i n g t h e
p h e n o m e n o n i s u n v e i l e d t h r o u g h t h e
i n t e r p r e t a t i o n o f h i s ( e r ) d i s c o u r s e , i n l a n g u a g e
t h a t s u p p o r t s w h a t t h e r e s e a r c h e r i s l o o k i n g
f o r( 1 0 ). T h e r e f o r e , i t i s n o t h i n g m o r e t h a n a n e x e r c i s e o f i n t e r - s u b j e c t i v i t y a n d h e r m e n e u t i c s
t h a t p e r m i t s c a p t u r i n g t h e s u b j e c t i v e l y l i v e d
e x p e r i e n c e w i t h o u t e x p l a n a t i o n s .
At t h e e n d o f t h i s t r a j e ct o r y, t h e f o l l o w i n g
t h e m e e m e r g e d : f e e l i n g p o w e r l e s s – a f e e l i n g
e x p r e s s e d b y c a r e g i v e r s o f s e x u a l v i o l e n c e
v i c t i m s .
RESULTS
N o t h i n g c a n h a p p e n o u t o f o n e ’ s b o d y
becau se it is w h at is con cr et e in ou r ex ist en ce an d
t he place w here all experiences are st ored during our
e x i st e n t i a l t r a j e ct o r y i n t h e p e r so n a l , so ci a l a n d
p r o f e s s i o n a l d i m e n s i o n s . I t i s t h e s p a c e w h e r e
“ ever yt hing r em ains; of m aking one see and t alk and
w her e ev er y t hing is show ed”( 5).
H e a l t h p r o f e s s i o n a l s w h o a t t e n d s e x u a l
violence vict im s frequent ly deal w it h t heir ow n anguish
in v iew of h u m an lim it at ion s an d also w it h h ealt h
sy st e m l i m i t a t i o n s b e ca u se , so m e h o w , e v e r y o n e
needs t o be ex posed. This ex posur e im plies show ing
fr agilit ies, v ulner abilit ies and lim it at ions, and can be
illust r at ed by t he follow ing discour se ex cer pt :
I guess t hat t he lim it at ion is r eally t his t hing of I ’m
going t o sit w it h you and cr y t oget her , you know , it ’s difficult t o
keep up w it h t he r epor t s. You feel like cr ying, scr eam ing. You
lear n about your lim it at ions dur ing car e. At t ending t hese w om en
m eddles w it h your lim it at ions, you know . How far can I go, t o
w hat ext ent am I being pr ofessional, t o w hat ext ent am I let t ing
t he pr ofessional aside, am I going t o get angr y or cr y w it h t his
w om an? ( I nt er view ee 7) .
Being w it h t he ot her so ( s) he can show his( er )
w or ld, t he ex per ience liv ed, so t hat t he pr ofessional
can capt ur e it , is done by per cept ion. I t is const r uct ed
w it h st at es of con sciou sn ess, based on per cept ion s,
r eason for w hich it is consider ed a hum an act .
Per cept ion is t he sense t hat inaugur at es t he
opening t o t he w or ld as t he out w ar d pr oj ect ion of a
being. When t he hum an being is faced w it h som et hing
t hat is pr esent ed t o his( er ) consciousness, s( he) fir st
not es it and perceives it in t ot al harm ony w it h it s form ,
as fr om h is( er ) per cept iv e con sciou sn ess. Aim in g t o
p er ceiv e it , t h e h u m an b ein g f eels it , im ag in es it s
fullness and is able t o describe w hat it really is. This
w a y, k n o w l e d g e r e g a r d i n g t h e p h e n o m e n o n i s
gener at ed ar ound t he phenom enon it self. Thus, “ any
consciousness is percept ive, even consciousness about
ourselves”( 5), t hat is, consciousness t hat w e ar e body. The body is unique and m ediat es t he hum an
relat ionship wit h t he world, being in t he world, and t he
h u m an bein g r elat es w it h t h is an d t h e ot h er by it s
corporealit y, t hat is, his( er) form of expression. Thus,
at t endance t o sex ually v iolat ed bodies is car r ied out
by living bodies, and it consist s in corporealit y and by
cor p or ealit y, w h er e p r of ession als con sid er t h e car e
delivered t o hum an beings as t heir exist ent ial proj ect .
“being” involved with bodies that need care, because they
experience a m om ent of exist ent ial fragilit y, generat ed
by violence, which they share during care delivery.
Violen ce is a com p lex p r ob lem w it h sev er e
co n se q u e n ce s b e ca u se i t a f f e ct s t h e i n d i v i d u a l ’ s
m uldim ensionalit y. Healt h professionals are concerned
w it h t he use of t he prot ocol t o t r eat vict im s because it
d o es n o t co n si d er i ssu es t h a t i n v o l v e t h e o t h er ’ s
su b j ect iv it y an d social p r ob lem s. Th is r u sh in car e
d el i v er y can p r o d u ce a r esu l t o p p o sed t o w h at i s
expect ed, t hat is, ot her violence, since it can disrespect
t he v ict im ’s t r aj ect or y and lead t o fr ust r at ion. Thus,
t h ey m i g h t f eel t h ey h a v e l i t t l e “ p r o b l em - so l v i n g
c a p a c i t y ” i n r e s o l v i n g t h e p r o b l e m( 1 1 ), a n d professionals feel t his lit t le “ problem - solving capacit y”
as ex pr essed in t he follow ing discour se.
Ther e ar e sever al kinds of violence, such as chr onic
violence [ …] com m it t ed by t he par t ner or husband, it is a pr ofile
in w hich I t hink t hat m y int er fer ence, m y par t icipat ion is sm all,
because it involves ot her t hings in t he pat ient ’s social and fam ily
con t ex t abou t w h ich w e don ’t h av e m u ch “ pr oblem solv in g
capacit y” ( I nt er v iew ee 2) .
Pat ient s w ho suffer chr onic violence ( ...) I feel t hat
t hey ar e for ced t o com e her e; but , like, I feel t hat it ’s som et hing
t hat w ill not be quickly r esolved because t hat is a cont inuum ,
you know . But , like, t hese ar e t hings t hat ar e out of m y league.
And t hen I see t here is no resolut ion. I t ’s why people get anxious,
including m y self ( I nt er v iew ee 3) .
The feeling of not solv ing t hings can lead t o
t h e f eelin g of p ow er lessn ess, w h ich m an y t im es is
inst alled in t he w ork environm ent and can occur w hen
professionals confound t heir obj ect ives and lim it at ions
w it h t hose of t he ot her corporealit y, t he one w ho asks
for help( 12). This feeling w as const ant ly pr esent in t he discour se of t he int er view ed pr ofessionals, w hich w as
u n v eiled as on e of t h e f eelin gs t h at af f ect t h em as
p r of ession als.
I t hink t hat oft ent im es t he feeling of pow er lessness
m akes you anxious, you look t o t he per son and t hink: ‘w hat am I
going t o do?’. Many t im es I feel pow er less. Many t im es I w ant t o
d o s o m e t h i n g ( …) . So t h e r e ’ r e t h i n g s t h a t b o t h e r m e ,
pow er lessness and also t he fact t hat t he w om an w ho is t her e
r epr esent s violence ( I nt er view ee 7) .
Th e f eelin g of p ow er lessn ess also em er g es
w hen pr ofessionals ar e clinically at t ending a child or
an adolescent and ar e obliged t o dischar ge t hem and
get t hem back t o t heir legally r esponsible adult s. Thus,
t h ey h av e t o ign or e w h at t h e fu t u r e m igh t br in g t o
t h ese clien t s( 1 3 ). Th is sit u at ion w as per ceiv ed in t h e ex cer pt of t he follow ing discour se:
The m ost difficult t hing for m e is childr en and chr onic
( sexual) violence. Because t hey’re unprot ect ed, because children
don’t have experience or condit ions t o get out of t he sit uat ion; we
can even see t he social im posit ion of values t hat ar e ver y st r ong.
I feel so pow er less ( I nt er v iew ee 2) .
W h a t a p e r s o n ( p h e n o m e n o n ) p e r c e i v e s
occur s in an ar ea w hich ( s) he is par t of. The ident it y
o f t h e p er cei v ed w o r l d o ccu r s t h r o u g h o n e’ s o w n
p er sp ect i v es a n d i s co n st r u ct ed i n m o v em en t s o f
r esum pt ion of t he past and opening t o t he fut ur e, and
new per spect iv es ar e alw ay s possible( 5). Pr ofessionals ar e m ar ked by t hese exper iences, r ecall each of t hem
in det ail, even w hen t hey happened in a dist ant past .
They do not m ake it explicit , but feel t hey have caused
an ev il, feel co- r esponsible for not being able t o act
out of t heir scope of w or k , because ev en w hen t hey
do, not hing r esult s( 13). I n t hese cases, pow er lessness causes per cept ible t ension in t he int er v iew ees, w hich
is accom panied by anguish and sor r ow , st or ed in t heir
bodies, as ex plained in t he follow ing:
Ther e w as a case I w ant ed t o adopt t w o gir ls w ho w er e
( sexually) violat ed by t heir parent s, t hey were even t he sam e age
of m y daught ers, but we have t o work on t his t oo. I got devast at ed,
even got sick and t hen you get t hat feeling of pow er lessness
( in t er v iew ee 1 1 ).
Th e f e e l i n g o f p o w e r l e ssn e ss, so m e t i m e s
“ u selessn ess”, ot h er t im es of v iolen ce or in capacit y
t o r e l i e v e a l l o f t h e p a t i e n t ’ s p a i n a t t h a t g i v e n
m om en t , ap p ear s t o b e r em n an t of ou r b iom ed ical
t raining. I t is not about pain as t he fift h vit al sign but
t h e pain t h at t r an scen ds t h e ph y sical an d seem s t o
r em ain in t he body’s essence. I t com es t o light w hen
o n e sh a r e s t h e b e i n g a n d b e i n g i n t h e w o r l d a s
cor por ealit y, t h at is, w h en t h e inv isible is u n v eiled.
The invisible becom es visible w hen one exposes his( er)
o w n su b j ect i v i t y t o t h e o t h er w h o ca p t u r es i t b y
percept ion, since t his is t he w ay t o access t he w orld( 5). The biom edical m odel does not addr ess t he know ledge
of t he ot her ’s subj ect ivit y; t his kind of t r aining m akes
t h e pr of ession al v alu e pr act ical r esu lt s in t h e sh or t
t er m . Thus, w hen it does not occur, t her e is a false
feeling t hat not m uch is being done for t he client , as
v er ified in t he follow ing.
Many t im es t her e’s t hat feeling of pow er lessness, t hat
you’r e doing not hing, you know ! I can’t give you an aspir in t o
alleviat e pain, t her e isn’t a r em edy you can give and say it ’ll go
aw ay. You can’t put a ser um , give an inj ect ion and ever yt hing is
gone. I t ’s differ ent , it w on’t pass, it w on’t . I t ’s a life m yst er y.
I t ’s like t he pain of loss, pain of deat h, of passion. But I t hink
Healt h p r of ession als w h o at t en d v ict im s of
sex ual v iolence shar e t he ex per ience t hat gener at es
t h e f e e l i n g o f p o w e r l e ssn e ss, w h i ch m a k e s t h e m
underest im at e t heir ow n abilit ies and know ledge, and
do not per ceiv e client s’ r esour ces and possibilit ies.
I t is im por t an t t h at sex u al v iolen ce v ict im s
ar e able t o shar e t heir exper ience w it h pr ofessionals,
because t his is a possibilit y, a pre- condit ion t o rest it ut e
a w or ld w it h m eaning. Helping t hem t o found a new
m e a n i n g i n t h e i r e x i s t e n c e m e a n s e n t e r i n g
subj ect ivit y. I n t his perspect ive, t he need of t he healt h
t eam t o get in cont act w it h t heir suffer ing and r ealit y
is evident , helping t hem t o r econst r uct a m or e r eliable
and less t hr eat ening inner w or ld( 14).
At t he m om ent t he car egiver ’s bodies assum e
t he car e of sexually violat ed bodies, t hey st ar t t o
be-w i t h - t h e - o t h e r a n d t h i s r e l a t i o n sh i p a f f e ct s t h e i r
ex ist ence. Appar ent ly, pr ofessionals ar e not pr epar ed
or do not hav e pr oper t ools t o deal w it h feelings of
p ow er lessn ess, an g er an d an g u ish , am on g ot h er s.
Dealin g w it h t h ese f eelin g s w ill f av or an d f acilit at e
t heir w or k. For t hat t o occur, how ever, get t ing in t ouch
w i t h t h e i r o w n p r e co n ce p t i o n s, m o r a l v a l u e s a n d
feelings in relat ion t o sexual violence vict im s is needed,
br inging t hese issues t o t he “ consciousness” so t hat
t h e y a r e b e t t e r e l a b o r a t e d , a v o i d i n g n e g a t i v e
int erference in t heir professional life. Thus, one should
co n si d er t h a t ev er y t h i n g p r esen t ed b y a cl i en t i s
p er t in en t an d ap p r op r iat e, w h o can n ot b e ch ar g ed
f or r ev iv in g t h e pr of ession als’ issu es or em ot ion ally
“ t ouch” t hem .
FI NAL CONSI DERATI ONS
I t is im por t ant t o const ant ly pay at t ent ion t o
t h e b od y so as t o p er ceiv e it s sig n s, ack n ow led g e
and under st and it bet t er and oneself. Self- k now ledge
is essent ial t o grasp t he ot her w ho needs car e dur ing
con su lt at ion .
U n d e r s t a n d i n g t h e o t h e r i n h i s ( e r )
m ult idim ensionalit y m eans perceiving t he ot her. When
it occur s, one is faced w it h t he possibilit y of helping
t h e o t h er t o r eco n st i t u t e h i s( er ) sel f i m a g e, sel f
-est eem , t r an scen d in g h is( er ) h er e an d n ow , w h ich
em er g ed f r om a p ast in w h ich sex u al v iolen ce lef t
v isib le an d in v isib le scar s in on e’s b od y an d m ad e
him ( er ) t o ex per ience an ex ist ent ial v ulner abilit y.
Healt h pr ofessionals not only see t o a body
t h a t p r e s e n t s s i g n s a n d s y m p t o m s a n d n e e d s
t r eat m ent t hat can be found in t he car e pr ot ocol. Many
t im es, t hey face social pr oblem s, w hich t hey ar e not
prepared for, because em ot ions, feelings and suffering
em er g e d u r in g car e d eliv er y. Discou r se or r ep or t s
v ict im s of sex u al v iolen ce br in g t o t h e con su lt at ion
ar e d en se an d p u t p r of ession als in a d elicat e an d
f r ag ile p osit ion in t h e f ace of t h eir im p ossib ilit y t o
r esolv e t he pr oblem because it is out of t heir scope
of com p et en ce, w h ich can g en er at e t h e f eelin g of
pow er lessn ess in t h ese pr of ession als.
Th e f eelin g of p ow er lessn ess is con t in u ally
fed in t hese pr ofessionals’ daily life and is st or ed in
t h e i r b o d i e s i n t h e sa m e w a y t h e v i ct i m s’ d e n se
r ep o r t s a r e, w h i ch a l so a f f ect t h em . Th a t i s w h y
st r at eg ies n eed t o b e d ev ised an d im p lem en t ed in
t he ser v ices so as t o pr ov ide for and guar ant ee t he
healt h of w or k er s as w ell, since t hey do not r eceiv e
pr oper t r ain in g t o deal w it h issu es t h at in v olv e t h e
sex u al v iolen ce p h en om en on .
The inst it ut ion needs t o const r uct and assur e
a w elcom ing and safe rout ine for healt h professionals,
since t hey t ake car e of t he ot her, but not always t ake
care of t hem selves properly. The care of professionals
is r elat ed t o t he cr eat ion of em ot ional condit ions t o
h elp t h em d eal w it h t h eir p r ob lem s. Th is w ay, t h e
m en t a l su f f er i n g i n h er en t i n t h ei r a ct i v i t y ca n b e
t r ansfor m ed in per sonal developm ent and const r uct ion
of k now ledge, if daily under st ood and elabor at ed by
it s act or s.
Th er ef or e, it is essen t ial t h at t h is issu e b e
addr essed in u n der gr adu at e an d gr adu at e pr ogr am s
in t he healt h and hum an ar eas, so as t o t r ain fut ur e
pr ofessionals t o t ak e car e of sex ual v iolence v ict im s.
I n s t i t u t i o n s a l s o n e e d t o i m p l e m e n t c o n t i n u i n g
t r a i n i n g , c r e a t e g r o u p s g u i d e d b y s p e c i a l i z e d
pr ofessionals so t hat healt h pr ofessionals w ho deliver
care t o t hese vict im s can address not only t heir feeling
of p ow er lessn ess b u t also accu m u lat e ex p er ien ces
an d su ffer in g t h at ar e sh ar ed by t h e v ict im s, w h ich
ca n a f f e ct t h e m i n t h e i r m u l t i p l e d i m e n si o n s. I n
ad d i t i o n , an i n st i t u t i o n al et h i cs p o l i cy t h at v al u es
w or k er s’ healt h is needed.
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