It seems fitting that I am writing this response to Hilary Abraham’s article on domestic abuse (‘It’s safe here’, therapy today, November 2008) on White Ribbon Day – the international day for the elimination of violence against women.
As a counsellor with Women’s Aid in Scotland for many years, I welcomed Hilary’s piece and much in it resonated with my own practice, notably the prioritising of the basic need to feel safe and free from harm, acknowledgement of the equal damage caused by emotional and psychological abuse, and the importance of offering a range of support options, which are so effectively provided by Women’s Aid groups nationwide. I would agree that women leaving abusive relationships are usually struggling with a process ‘very similar to that following bereavement – an intense impact, followed by a period of adjustment and finally the long transition to a new way of life’. Offering such an analogy and framework for recovery to my own clients has often helped them make sense of their maelstrom of emotions and eased the pressure they feel to ‘get over it’, allowing them space and time to rebuild what Hilary terms ‘the greatest loss of all’: personal integrity.
However, where I would take issue with the article is the section discussing PTSD, which Hilary describes as a potentially stigmatising label, although acknowledging that as a ‘diagnosis’ it can enable ‘the minority of women who need professional mental health services to get help without feeling they are personally inadequate or to blame’. As a person-centred counsellor (and therefore also a professional mental health worker – though I would never seek to ‘diagnose’ anyone), I pay close attention to the words and images my clients use to express their feelings. Frequently these reflect the impact of severe and enduring trauma, including repeated acts of sexual violence such as rape, calculated to punish, control and degrade. Survivors are left with a legacy of flashbacks, nightmares, panic attacks, disassociation, and a familiarity with the adrenalised state of being perpetually in ‘fight, flight or freeze’ mode, which living with a controlling, unpredictable and violent partner evokes.
Like Hilary I hear the ‘same words and phrases’ being used to describe the effects of abuse and I am struck by how often women will refer to these relationships as ‘battlegrounds’ or ‘unwinnable fights’, where they have to employ learned strategies and tactics in order to simply survive and protect themselves and their children. Several of my clients have described the different reality into which they emerge after leaving as a ‘no man’s land’ (and what many powerful resonances that carries!), where they feel stripped of identity, dazed, numb and in limbo. Another client voiced the sense she had of ‘coming out of a cult’, which summed up for her the experience of living an isolated, altered reality, vulnerable and ‘crazy’ in the confines of her own home.
Recognisable symptoms of PTSD, I would argue, are sadly common for many who contact Women’s Aid, whether or not they choose counselling as a means of support. Indeed this is why multi-agency awareness training run by Women’s Aid groups frequently uses exercises that highlight the similarities in experience between the relationship of prisoners of war and their captors and those of women in abusive partnerships. In responding to and validating survivors’ experiences, I feel it is important to acknowledge and name the effects of trauma before the loss and grief work, so sensitively described in Hilary’s article, can be done. In my experience, clients are relieved to be able to recognise that their intense feelings and responses both within the abusive relationship and after they have left, are natural reactions to trauma and it is helpful to clarify this without fear of ‘labelling’ them in any way.
Despite growing public awareness and greater understanding, domestic abuse is still in itself stigmatising and shameful for women; if we shy away from, or minimise, their experiences, aren’t we in danger of perpetuating the feelings of shame and guilt survivors carry with them so long? I wonder if we really need to ‘reframe’ the effects of domestic violence or simply listen to and accept the (often shocking) reality of each woman’s experience, provide the support she needs, and all of us take responsibility for working towards a society where women and girls can feel safe and free from fear?

MBACP (Accred)