Supporting Clients Experiencing Intimate Partner Violence (IPV): A Guide for Therapists

Intimate Partner Violence (IPV) can affect anyone, regardless of gender, sexual orientation, socioeconomic status, or background. As a therapist, you may be one of the few safe and confidential spaces a client has to process their experiences and plan for safety. This article offers guidance rooted in evidence-based practice to help you navigate these conversations with warmth, attunement, and clinical skill.

Recognizing the Signs of IPV

IPV includes physical violence, sexual violence, stalking, and psychological aggression by a current or former partner. It may present in obvious or subtle ways. Research shows many survivors may not name their experience as abuse, especially when coercion and control are psychological or financial (CDC, 2023).

Behavioral and Emotional Signs

  • Expresses fear, anxiety, or hypervigilance when discussing their partner or relationship
  • Frequently defends or minimizes their partner’s behavior (“It’s not that bad” / “I just make them mad sometimes”)
  • Appears anxious or distracted during sessions, particularly when the phone rings or if asked about their partner
  • Exhibits symptoms of depression, PTSD, panic, or substance use that seem linked to the relationship
  • Displays excessive guilt or responsibility for the partner’s emotions or behavior
  • Shows sudden changes in affect or demeanor when certain topics are brought up (e.g., flinching, shutting down)
  • Difficulty making decisions or expressing preferences (may be conditioned by coercive control)

Physical and Environmental Signs

  • Reports or shows signs of unexplained injuries or frequent accidents
  • Delays seeking care for injuries or avoids medical appointments
  • Appears to be under surveillance (e.g., monitoring phone, partner frequently “dropping in” or calling during sessions)
  • Mentions that their partner controls access to finances, transportation, medications, or health care
  • Reports partner insisting on attending or controlling therapy sessions (or canceling on their behalf)
  • Describes being prevented from working, studying, or maintaining outside relationships
  • Sudden relocation or frequent moves with vague explanations

Relational and Narrative Cues

  • Describes patterns of jealousy, possessiveness, or accusations from the partner
  • Reports being frequently “punished” emotionally or physically for asserting needs or independence
  • Has difficulty identifying safe, trusting relationships outside of the partnership
  • Recounts relationship experiences that follow the Cycle of Abuse (tension → explosion → honeymoon phase → tension again)
  • Mentions “walking on eggshells,” needing to “keep the peace,” or fear of partner’s reactions
  • Expresses confusion or doubt about what is normal or acceptable in relationships
  • Describes sexual encounters that involved pressure, coercion, or discomfort, even if they don’t label it as assault

Contextual and Identity-Based Considerations

  • Is part of a marginalized identity group and expresses fear of system involvement (e.g., LGBTQ+ clients, undocumented immigrants, survivors of racial trauma)
  • Reports fear of not being believed or fear of losing children if they speak up
  • Mentions spiritual, cultural, or familial pressures to stay in the relationship
  • For LGBTQ+ clients: may describe threats to “out” them or invalidate their identity
  • May express confusion about whether what they’re experiencing “counts” as abuse, especially if it is non-physical (e.g., emotional or financial abuse)

Many survivors may not disclose IPV directly, especially early in treatment. Building safety, asking gentle but clear questions, and using nonjudgmental language can help open the door over time.

Creating a Safe, Empowering Therapeutic Space

Building Trust, Understanding Their Experience, and Supporting Autonomy

Trust is the cornerstone of therapeutic work with IPV survivors. Many clients feel isolated, ashamed, or unsure of how to name what they’re experiencing. Your role is to gently open space for exploration without pressure or judgment.

Use open-ended, validating questions like:

  • “I know things can be really complicated in relationships. How have things been feeling for you lately?”
  • “What are some things that help you feel safe or grounded when things get tough?”
  • “What are the things you love about your relationship? And what are the things that feel harder to manage?”

This approach helps clients feel seen and respected- an essential step toward healing and safety. Research consistently shows that survivors fare better when they feel in control of decisions (Warshaw et al., 2009).

Gently Exploring Readiness & Safety Concerns

IPV work is never about telling someone what to do. Instead, we meet them where they are, honor their ambivalence, and co-create clarity.

Support reflective conversation with questions like:

  • “Have there been times when you’ve felt unsafe or uneasy? What did you do in those moments?”
  • “If there was ever a time you needed to get space, what would that look like for you?”
  • “What do you think would need to change for you to feel completely safe in this relationship?”

These questions promote insight and help the client think ahead without demanding decisions.

Assessment Tools: When and How to Use Them

Use clinical screening tools with care. Avoid using them too early or without context.

HITS Screening Tool (Hurt, Insult, Threaten, Scream): A 4-item scale that can be useful in identifying IPV

  • Four Questions: The HITS tool asks the following four questions:

    • How often does your partner physically hurt you?
    • How often does your partner insult you or talk down to you?
    • How often does your partner threaten you with harm?
    • How often does your partner scream or curse at you? 

  • Scoring:

    • Each question is answered on a 5-point scale, with responses ranging from "Never" to "Frequently". The total score is calculated by summing the responses to all four questions. 

  • Interpretation:

    • A score of 10 or higher is generally considered suggestive of IPV, indicating that the individual may be experiencing IPV. 

CUES Model (Confidentiality, Universal Education, Empowerment, Support) 

  • Developed by Futures Without Violence, this approach offers universal education about healthy relationships and connects clients with support,without requiring disclosure.

Supporting Safety Without Mandating Action

It is not a therapist’s role to direct clients to leave or stay. Research consistently shows that survivors fare better when they feel in control of decisions (Warshaw et al., 2009). 

Instead, focus on increasing safety and reducing isolation. Evidence-based practices include:

1. Safety Planning

Safety planning is most effective when it’s collaborative, specific, and trauma-informed.

Introduce it gently with normalizing language:

  • “If things ever felt too overwhelming, who would be the person you’d trust most to talk to?”
  • “Would it be helpful to think through small ways to feel more secure day to day?”
  • “Some people find it reassuring to have a backup plan, just in case. If you ever needed to get somewhere safe quickly, do you have a place you’d feel comfortable going?”
  • “Would it feel okay to put together a list of important things (like documents or contacts) that you’d want to have in one place, just for peace of mind?”

Create a plan tailored to the client's current circumstances and readiness. Components may include:

  • Safe places to go in an emergency
  • Important phone numbers (DV shelters, trusted friends)
  • Hiding a go-bag with essentials
  • Safe words or signals to indicate danger

National Domestic Violence Hotline (1-800-799-7233) offers 24/7 safety planning help via text or chat. They also offer a thorough IPV safety plan template you can use with clients. 

2. Psychoeducation

Normalize trauma responses like confusion, loyalty, or shame. Discuss:

  • The cycle of abuse
  • Gaslighting and coercive control
  • Impact of trauma on memory, decision-making, and attachment

3. Empowerment-Focused Therapy

Trauma-informed modalities such as Cognitive Processing Therapy (CPT), EMDR, and Narrative Therapy can help survivors regain a sense of agency. Begin these after safety has stabilized.

Collaborating with Community Resources

Survivors often benefit from wraparound support. With the client’s consent:

  • Refer to local IPV shelters or advocacy programs. Therapists provide emotional and psychological support, while IPV advocates are often better equipped to assist with logistics like shelter or court accompaniment.
  • Connect them to legal aid if custody, restraining orders, or immigration status are concerns
  • Encourage group therapy or peer support when appropriate

Documentation Considerations

Remember: for any client, it is important to only disclose data in documentation that meets medical necessity and supports a record for the service- but this is particularly true for those who are at risk of IPV. Ensure that your documentation does not put the client at risk (e.g., avoid labeling notes “domestic violence” if the client’s partner has access to records). 

Working with clients experiencing IPV is complex and emotionally demanding, but your presence, attunement, and skill can be lifesaving. Even if a client isn’t ready to leave or disclose, you are planting seeds of empowerment and offering the radical act of listening.

Helpful Resources for Therapists

If you need help applying this guidance to a specific case, reach out to Rula’s Patient Safety Team! We know this is incredibly challenging and complex work- Patient Safety can also help to support you as you work with this client.

 

Updated

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