Using a Holistic Approach to Foster Recovery in Women Survivors of Intimate Partner Violence
Updated: Sep 21
by Bonnie Koehn
*This post is a condensed, informal version of my graduate studies capstone research project. Please contact me if you're interested in reading the full academic project.
Defining woman/women: these terms are used to include cisgender women, transgender women, and others who identify as women.
Defining Intimate Partner Violence (IPV): IPV is defined by the World Health Organization (2021) as “behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours” (para. 2). Coercive control has recently been added to most definitions of IPV. It is described by Chambers et al. (2018) as “interweaving repeated physical abuse with three equally important tactics: intimidation, isolation, and control" (p. 671).
Understanding the All-encompassing Effects of IPV on Women
In order to best support women survivors of IPV, it is imperative to have an understanding that this kind of trauma leaves no part of a woman's life untouched. As Anderson et al. (2012) asserted, “practically every aspect of a domestic abuser survivor’s life is altered in the aftermath of domestic violence. Leaving an abusive relationship involves transitioning from being controlled to being in control while coping with the costs of a domestic life filled with fear, terror, and devastation” (p. 1279).
Anderson et al. (2012) spoke to the fact that this process requires an incredible level of strength and energy. However, these resources can be difficult to access for women during post-IPV trauma. They may experience PTSD, anxiety, or depression, all while going through the required motions of work, parenting, rebuilding social connections, and managing responsibilities.
One of the deepest wounds of IPV is the damage it can do to a woman’s sense of trust in her own judgement. There can be a loss of identity, as focusing on trying to create external safety in an abusive home can require a complete loss of focus on the self. The abuser may have isolated a woman from friends and family, and limited her ability to participate in the work or leisure activities she enjoyed prior to the relationship. This multifaceted loss of trust, identity, and social connection results in a need to rebuild the self in recovery: a self that can integrate with the former identity in a compassionate way. In this article, I offer suggestions for a holistic and social justice approach to nurturing recovery in women after IPV.
Where to Start? Understanding the Post-IPV Ecosystems of Women
There should be no assumption that once a woman leaves her abuser, she is free.
Whether she has children with her abuser or not, they may continue to seek control over her home, her finances, her health care, her vehicle, or her social connections. They may stalk or harass her, monitor her personal and professional life, or intimidate her friends and family. If they share children, the abuser may use visitation as an access point for harmful communications and coercive control. They may also use parenting time to sabotage a woman’s work, education, and relationships by being unreliable or absent for parenting commitments, or they may avoid financial responsibility for the children in order to punish her for leaving.
These post-separation behaviours can slow the pace of recovery for women survivors. As such, supporting survivors’ recovery means having an awareness of the lengthy process of disentanglement, and knowing that in some cases women may be working hard to heal despite involuntary prolonged exposure to post-separation abuse and control.
For some, leaving is only the beginning of an extended journey to safety and wellness.
In addition to the mental, physical, and financial consequences of IPV for women, there is often stigma attached to IPV. Survivors are often judged as having made bad choices, or having stayed with an abuser, when they most often did not have the freedom or privilege to leave. Assumptions of choice are inaccurate and deeply infused with shame, and freedom from shame is the real root of any meaningful healing. Therapists should have sincere empathy for clients who have suffered with IPV, and the ability to create a safe and non-judgemental space for curiosity, connection, and healing.
A Closer Look at Resilience and Posttraumatic Growth After IPV
Graham (2013) defined resilience as “the capacity to respond to pressures and tragedies quickly, adaptively, and effectively” (p. xxv). They asserted that resilience is developed in the presence of early experiences of neurobiological safety and secure attachment to caregivers. If we subsequently experience the modeling of resilience by family and loved ones, we solidify our ability to cope with challenges and stressors, and we develop a functional level of innate resilience that can last through the lifespan.
Posttraumatic Growth, or PTG, is different from resilience. According to Tedeschi et al. (2020), those who experience PTG have realized that struggle is not permanent, nor will it be entirely absent. Unlike resilience, PTG is not an ability to withstand struggle in the moment it occurs. Rather, it is a process of moving forward and building a more positive world for oneself after a traumatic experience.
This does not mean that the new path is free of problems, but that it can be walked with the knowledge that there is meaning in struggle. Those who experience PTG understand that they can have positive and valuable connections and lives, even amid difficulty. There is an internal grounding that allows for graceful acceptance of challenges, and continued perseverance.
Rethinking the Concept of Resilience
Many definitions of resilience summarize a common assumption: that while the development and maintenance of resilience can be supported by external resources, it is an internal characteristic, and a measure of one’s success and value relative to experiences of adversity. A similar assumption underlies the concept of PTG. However, these assumptions may be contributing to problematic assessments of resilience or brokenness in IPV survivors.
The word resilient is so often used to describe those who have had to rely on themselves in order to overcome social, emotional, psychological, financial, and other types of adversity in the absence of protective factors and supports. However, being named resilient can be a point of frustration for survivors who may have had no other option. Being deemed a relative success or failure at survival, healing, and recovery from IPV can create further burden and pain for those who have faced severe difficulty without adequate support.
How, then, can counsellors help to relieve IPV survivors of this judgement? We can work toward redistributing some responsibility onto the systems (such as social, familial, community, socioeconomic, and legal) that often abandon survivors to what I call ‘forced resilience’.
Mental health professionals can begin to reconsider how we tend to look at resilience and PTG as trophies of trauma, and instead recognize these as forced states of being that may be exhausting, overwhelming, or even resented by those who have carried the burden of the trauma and disadvantages that IPV delivers.
I do not suggest that we cease using the term resilient, but that we take thoughtful care to first consider the environmental and systemic factors that each individual client has worked with or without.
How Can Counsellors Best Support Survivors’ Healing?
A holistic approach can effectively support women survivors on their paths to recovery. My proposed approach suggests using Polyvagal theory, and a combination of narrative and compassion-focused individual counselling, combined with group therapy, somatic healing, and social connection. This framework must be firmly grounded in a social justice approach. When practitioners compassionately acknowledge the many disadvantages that this population faces, they can foster a deeper recovery and thriving process for clients. Below are some specific considerations for a holistic social justice approach:
The Importance of Good-fit Therapy
It is imperative that survivors of IPV have access to a counsellor to whom they can relate. Tutty et al. (2021) described how advocates and counsellors may incorrectly assume that IPV clients “necessarily suffer from mental health problems” (p. 1139). I have observed that women survivors may present as clinically depressed or having an anxiety disorder when in fact they are having a very normal, healthy reaction to being oppressed by the consequences of IPV and the inadequacies of the systems that are meant to support them. Women survivors of IPV are in fact some of the most resourceful and hopeful clients I have seen, and they often surpass their own expectations for recovery.
While therapists do not need to have a personal history of IPV to be authentically empathic, compassionate, and supportive, it can be beneficial to have lived experience in this area. A counsellor need not disclose specific information about their own experiences. Their ability to hear, see, and understand from a place of experiential understanding can be deeply healing for clients. In such a therapeutic environment, and in the knowledge of shared experience, there is authentic empathy that can allow the client to feel safe to release and externalize their pain without fear of judgement.
Most importantly, therapists can understand and acknowledge that resilience is not a gift survivors ask for, and that their ability to experience PTG is a reward that does not come easily.
A non-judgmental stance and steady respect can build a secure base that allows IPV clients to keep reaching toward growth, hope, and forward motion. It can anchor survivors in a sense of safety that frees them to take the steps needed to push through and out of trauma.
Some Effective Therapeutic Approaches for Women IPV Survivors
My approach to individual counselling for women IPV survivors is holistic, using a combination of narrative and compassion-focused therapies, and Polyvagal theory, through a social justice lens. This population requires approaches that consider their past, present, and hopes for the future, as well as an awareness of what systems are either supporting or oppressing them. These approaches provide ample space for these perspectives.
Narrative approach. Narrative therapy provides opportunity for survivors to externalize the pain, shame, stigma, and destruction that IPV brings to their lives. It offers the freedom and space for survivors to share the story of the abuse in their own unfiltered words and to be heard by a compassionate and non-judgmental listener. This can provide tremendous relief, especially if a woman has been silenced by her abuser or by the patriarchal systems that contribute to the oppression of women.
The narrative therapy processes of noticing strengths, identifying values, and re-storying are empowering for survivors, and can help them to take back ownership of their lives and selves. Noticing their own strengths and acts of courage within their own stories can help clients to build the groundwork for resilience and PTG. In doing this, they learn to focus on internal resources that can be accessed well beyond the therapeutic environment.
There is power in collaboratively identifying and naming the acts of resistance in a woman’s narrative. As Delker et al. (2020) asserted, “in a cultural climate that tends to silence survivors from speaking out about interpersonal violence, even naming one’s experiences can represent a form of resistance” (p. 7).
In naming her acts of resistance, a woman can begin to understand herself as someone who fought back, left the abuse, and survived. She can centre herself as the heroine in her life as she begins to look toward a better future.
Polyvagal approach. Porges’ (2017) Polyvagal Theory explains that our nervous systems are always scanning for safety, and that when we feel safe, we can relax and rest in a physiological state that supports healing and positive social engagement. Porges asserts that in this safe state, therapeutic relationships become stronger, neural pathways related to attachment and relational safety are repaired or formed, and the therapeutic process can be productive (p. 179).
Polyvagal theory provides a useful theoretical groundwork when working with IPV survivors because safety and nervous system regulation are essential to their ability to relax, connect, and engage in productive emotional work. The social engagement system becomes confused and can go offline during and after IPV. When a therapist can effectively bring it back online, they support the client’s optimal healing potential.
Therapy can provide a safe home base from which a survivor can access resilience and explore healing and PTG. The safety of the therapeutic relationship itself can become a catalyst for recovery.
A Compassion-focused approach. Compassion and self-compassion are powerful tools for the healing of IPV and the fostering of resilience and PTG. Lander (2019) explained how receiving and observing compassion helps clients to develop self-compassion. IPV can cause feelings of shame, guilt, and self-criticism, as survivors may have internalized the abuser’s views, along with the stigma and judgements received from those who may not understand their experiences.
Counsellors can model compassionate behaviours in their reactions to clients’ upsetting situations, and this guides clients in learning to offer themselves similar understanding and compassion. For clients who have never learned to respond compassionately to their own fear and distress, or have been forced to unlearn self-compassion in order to survive IPV, this therapy can help them learn or rediscover how to react mindfully and compassionately to distress, and to find feelings of safety in self-soothing thoughts and behaviours.
An intervention that works well for women IPV survivors is compassionate imagery. One way to do this, as described by Gilbert and Procter (2016) is to ask clients to imagine their “perfect nurturer” (p. 12). This can be a real or imagined person or creature who has capacity to express care and compassion. Survivors can call this perfect nurturer forward mentally in times of distress in order to soothe fear or internal criticism. The feeling of receiving compassion from an imagined internal nurturer can help clients to develop the ability to lean into self-compassion.
Beyond Individual Therapy: Group Support as an Essential Tool for IPV Recovery
Since social connection is a key part of IPV healing, support groups are an effective way to combine therapeutic interventions with safe connections. A group environment where participants feel safe to discuss shared experiences of IPV can be a powerful vehicle for building emotional, social, and neurological resources. Group facilitators can create a nurturing and judgement-free environment where women feel free to participate to their own comfort levels. This allows the nervous system to relax, which supports positive emotional engagement.
Additionally, group therapy provides opportunities for mentorship. The mentorship women receive in support groups can be life-altering. In addition to the emotional care and guidance they can offer, mentors have a wealth of knowledge about the practical resources that may be available to support re-stabilizing of the survivor’s external environment. When clients eventually reach a point where they can mentor others, the role provides a full-circle healing experience.
Helping to Foster Community and Social Supports for Clients
Žukauskienė et al. (2021) identified that “for 40% of women who disclosed that they were abused by an intimate partner, no one in their social network tried to help them” (p. 7605).
This is an alarming statistic that illustrates the isolation that women survivors can feel during and after IPV. The reasons for this lack of support are varied (for example, isolation, shame, or fear of making things worse), but in all cases, rebuilding the social circles of survivors is imperative to their recovery.
Social connection can build webs of support infused with friendship, shared experience, networking possibilities, nervous system regulation, access to advice or guidance, skills building, and simple human functions like laughter, storytelling, sharing food, and the enjoyment of time. When children are included in such activities, it provides them with opportunities to build their own social-emotional skills and to observe their mothers in environments of friendship, positivity, and care. It can provide relief to children who have observed their mothers in fear, stress, or danger at home with an abuser to see them surrounded by support, nurturing, and positive social behaviours.
In addition to encouraging IPV clients to connect with social supports, counsellors can refer them to community organizations, government agencies, and non-profits that specialize in supporting this population. Speaking with clients about needed supports, and/or providing resource guides, can help build these connections. Counsellors can also advocate by making initial contact on a client’s behalf if this is a barrier.
The Benefits of Somatic and Physical Healing Practices
Now that we have considered the benefits of individual therapies and group/community supports, we will focus on the healing effects of somatic practices. IPV can cause women to experience lasting physical pain or body memory, or there may be a resistance to connecting with the body at all. Somatic healing can be integrated with therapy or accessed between sessions, depending on clients’ needs.
Whether it is trauma-sensitive yoga (TSY), massage therapy, energy healing, sound baths, osteopathy, acupuncture, or other healing modalities, IPV survivors benefit from healing touch and movement when they feel safe to explore these.
TSY is an effective healing practice for IPV clients, since it meets needs for movement, physical release, safe sharing of space with others, energetic connection, and spiritual guidance. TSY can provide a low-stakes safe space with a group of people who are present for an exchange of positive connection and the movement and release of physiological energy. For women emerging from a state of trauma, this can be reassuring and healing.
According to Ong (2021), one of the elements of TSY that differentiates it from more commonly practiced forms of yoga is that the focus is on safe and positive connections with the body. Instructors encourage students to work within their physical limits and not to push past pain or discomfort, but to honour their inner knowledge of what feels safe and good for them. This allows students to lean into a compassionate and loving relationship with their physical selves. It also provides them with a sense of choice and bodily autonomy. These practices can restore feelings of control and safety within survivors that remain beyond the yoga studio.
Ong (2021) noted that the same principles and signals of safety used in TSY (safe environment, non-judgement, gentle tone, careful wording, choice, compassion) can be used in the counselling environment. Somatic exercises like mindful breathing, sensory connection (aromatherapy, holding stones or other natural objects) can also bring TSY principles into therapy. The underlying TSY themes of safety, autonomy, gentleness, and honouring each person’s limits, are easily transferable to the counselling environment.
The Need for Parenting and Coparenting Support After IPV
In addition to therapeutic, social, and somatic healing processes, women who have been victims of IPV where children are involved require an additional level of support. These women are often supporting their children’s well-being while trying to facilitate a safe relationship between the children and the ex-partner. Coparenting with an abusive ex-partner, particularly if they continue to abuse post-separation (for example, through harm to the children, intimidation, financial control, coercive control via parenting, stalking, harassment, or legal abuse), can be a minefield of setbacks to recovery.
There is a need for more counsellors who have in-depth training regarding survivors’ experiences of coparenting with abusive ex-partners. Many of the current models are reactive as opposed to preventive in terms of providing parenting and coparenting support for women survivors. A separate, safe, strengths-based, nurturing, and compassionate space for this population of mothers to share the challenges of parenting and coparenting after IPV can go a long way in reinforcing the mother-child bond and building confidence in a mother’s abilities to navigate her child’s recovery alongside her own. A focus on secure attachment, safety, positive parenting skills, and self-care in difficult parenting moments can help to ground mothers and allow them to rebuild their unique identities as parents.
The Pervasive Problem of Post-IPV Legal Conflict
A growing body of research is beginning to reflect the damage done when women are taken to family court by an abusive ex-partner. In these cases, victims are subjected to the ex-partner’s continued emotional and financial grip on their lives via the family law system, sometimes for many years. The problem of post-IPV legal conflict is pervasive, and is often either minimized, or only peripherally addressed, by the systems that are meant to support the recovery of women and children from IPV.
Forced entanglement in legal conflict takes a serious toll on every area of a woman’s life. In addition to the above barriers to healing and recovery, abusive litigation has the power to worsen and extend the trauma by repeatedly revictimizing, keeping the survivor under chronic toxic stress, and causing long-term financial instability.
It does not take two willing participants to create legal conflict, and both women and children suffer long-term negative effects due to the destabilizing, harmful, and costly nature of this this type of abuse.
Davina and Holt (2021) wrote a report on post-separation contact and domestic violence that examines the problems described above. According to the authors, abusers often use coparenting and court proceedings as ways to maintain control and harass their ex-partners. Legal conflict, especially for the purposes of maintaining control or abuse, detracts significantly from mothers’ abilities to be fully responsive, functional, and forward-focused at a critical time in her, and her children’s, recovery processes.
A report by Rise Women’s Legal Clinic (Hrymak & Hawkins, 2021) also detailed the difficulties and serious safety risks that custody litigation can create. This report should be read by every judge, lawyer, mental health professional, and social service provider who works with this population. With increased research and advocacy efforts, some courts are beginning to take notice and limit legal action by perpetrators of IPV when abuse of the legal system is detected. However, there is much work to be done in this area.
Social services and counselling professionals have an ethical responsibility to acknowledge the major mental health consequences of legal conflict, and to advocate for systemic change that protects the well-being and stabilization of women survivors and their children. Ongoing legal conflict can result in worsened anxiety, complex posttraumatic stress disorder (C-PTSD), sleeplessness, chronic stress, and other conditions. In such cases, practitioners should be prepared to offer a social justice approach to therapy, as well as referrals to community and legal supports, where these exist.
Supporting IPV Recovery Through a Social Justice Lens
The need for a social justice approach to IPV recovery for women is clear when we consider the many disadvantages abuse can create for this population. I have weaved these throughout this article in order to keep them at the forefront. However, here I will highlight some specific areas of disadvantage about which counsellors can and should advocate for IPV clients whenever possible.
Financial Need. Howell et al. (2018) explained that “higher income levels tend to be associated with increased access to resources, more perceived control, and higher levels of resilience”, as opposed to lower income, which “is associated with an insecure sense of the future, passive coping, heightened stress, and poor health” (p. 6). Despite this knowledge, counselling remains out of financial range for some IPV survivors. To ensure that this population receives quality good-fit therapy, counsellors can consider offering sliding scale or pro bono services.
Safety at Home. Schaefer et al. (2021) explained that for IPV survivors, physical safety is “a precondition for coping” and successful engagement in therapy (p. 14). Practitioners should check in with clients to assess whether they are safe and secure at home, and whether they are adequately housed.
Resources. Counsellors can stay apprised of legal, educational, employment, housing, community supports, and other resources for women survivors of IPV. It can be useful to create a resource document that can be easily updated and shared with clients.
Ethical Considerations for Disadvantaged Women. Some populations of women experience gendered violence and intimate partner violence more often than others. I refer specifically to: transgender women; Black, Indigenous, and other people of colour (BIPOC); women immigrants; and women with disabilities. These women face complex layers of difficulty in recovery from IPV (Delker et al., 2020; West, 2021; Winiker et al., 2022). Treatment should recognize this population’s specific challenges, strengths, and unique pathways to recovery.
There are overlapping complexities in the lives of women affected by IPV, and so many aspects of healing and recovery that are impacted by the disadvantages IPV causes. This article was informed by reflecting on the process of my own journey of recovery from IPV, my own experiences of resilience and PTG, and the stories that courageous and empowered women have shared with me in support groups, sharing circles, and therapy sessions. In all of these narratives, good-fit therapy, a holistic approach, somatic release of trauma, social support, and a social justice framework were core aspects of healing.
It is deeply rewarding and moving to walk alongside clients as they work through the scars of this trauma and begin to see themselves as whole women again.
Counsellors can lead clients toward a holistic path to healing, where they feel seen and heard, where they can see their own value and strengths, where they can feel safe in their bodies and in the world again, and where they can find a lasting sense of support and community that bolsters their ability to bounce back, and to continue growing and thriving beyond trauma.
A Final Word on Resilience
If mental health professionals and service providers could begin to reconsider the ways in which they measure and think about resilience, and how they convey this term or bestow it upon those who have moved through the trauma of IPV, they would be of greater service. While it is admirable to overcome the adversity of IPV and to thrive in social, emotional, interpersonal, career, or other endeavours, we cannot overlook the weight that this journey places on those who are less supported, less protected, fall through systemic cracks, and are forced to forge their own path to a healthier life and mental state.
Resilience and PTG are not end points after IPV trauma. They are only the survival mechanisms and starting places for healing the wounds incurred by carrying such heavy things. They are places where we can sit in respectful compassion with clients, to assess, and ideally, to help repair, the failings of systems that are meant to protect and guide those who have been harmed by an intimate partner.
Anderson et al. (2012) asserted that “the goal of the helping process should not be for professionals to impose a resiliency framework onto survivors’ life experiences” (p. 1295). Rather, the true goal of the helping process with women survivors of IPV is to provide women with a safe and compassionate space where they can, at their own pace and in their own unique ways, reclaim ownership of their bodies, minds, lives, and identities.
Photo by Ester Marie Doysabas on Unsplash
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