intimate partner violence (ipv) - wordpress.com · intimate partner violence & grief 2 abstract...

Intimate Partner Violence & Grief 1

In press at Child & Family Social Work, do not cite without permission of author.

Intimate Partner Violence and Women’s Experiences of Grief

Jill Theresa Messing, MSW, PhD

Assistant Professor, School of Social Work

Arizona State University

Rebeca Mohr, MSW

Research Assistant, School of Social Work


Alesha Durfee, PhD

Associate Professor, School of Social Transformation


Acknowledgements: We wish to thank the survivors who so generously shared their stories.


ABSTRACT

A greater understanding of women's emotional and behavioral responses to intimate partner

violence (IPV) may be aided by an examination of the grief course. Women going through the

process of leaving their abusers, like women leaving non-violent partners, experience grief

during and at the termination of their relationship, even if they feel relief at the cessation of

violence. Through qualitative interviews with 14 female survivors of IPV, we critically examine

the utility of Kubler-Ross’ grief model to understand how women come to terms with their

experiences of violence and the end of their violent relationships. Results suggest that Kubler-

Ross’ model helps explain the emotional reactions and decision-making of IPV survivors in

regard to staying, leaving, and returning to their partners. While a model developed to explain

grief due to death may not entirely explain the reactions of IPV survivors going through the

process of leaving abusive partners, and does not account for psychological reactions to trauma,

social workers and mental health professionals can use this grief model as a framework to better

tailor services to survivors of IPV.


Social workers in all areas of practice are frequently in contact with clients whose lives

are affected by intimate partner violence (IPV) (Danis, 2003). Lifetime prevalence of physical

and/or sexual IPV across 15 countries ranges from 15-71% (Garcia-Moreno, Jansen, Ellsberg,

Heise & Watts, 2006), and between 25-35% of U.S. women experience IPV in their lifetime

(Black et al., 2011; Breiding, Black, & Ryan, 2005). Women who experience IPV suffer poorer

health and require more medical care than those who have not been abused (Hazen, Connelly,

Soriano & Landsverk, 2008). Psychological consequences of IPV include anxiety, depression,

suicide, posttraumatic stress disorder, self-injury, psychosomatic complaints, substance misuse,

and decreased self-esteem (Bacchus, Mezey & Bewley, 2003; Coker et al., 2002; Golding,

1999).

IPV is a significant predictor of a woman’s decision to separate from her intimate partner

(Hardesty, 2002; Maxwell, 1999; Newmark, Harrell, & Salem, 1995; Walker, Logan, Jordan &

Campbell, 2004), despite the increased risk for homicide that separation poses (Campbell et al.,

2003). Readiness to leave is developed over time, and begins with emotional and cognitive shifts

that occur prior to the physical dissolution of the relationship; the emotional separation that

occurs prior to physical separation can be as difficult and painful as the physical separation

(Anderson & Saunders, 2003; Few & Rosen, 2005; Rosen & Stith, 1997; Walker et al., 2004).

Like women leaving non-violent partners, women going through the process of leaving an

abusive relationship experience loss in several areas of their lives, including financial, material,

psychological and social losses, and legal disadvantages (Amanor-Boadu et al., 2012; Campbell,

1989; Hamby, 2008; Turner & Shapiro, 1986; Varvaro, 1991). Exacerbating the difficulty of

severing emotional ties prior to, during and after physical separation, abused women may feel

pressure to remain in their relationship in order to maintain their sense of self and may perceive


the dissolution of an intimate relationship as a failure (Campbell, 1989; Goodman & Epstein,

2009; Turner & Shapiro, 1986).

A greater understanding of women's emotional, psychological, and behavioral responses

to IPV and the leaving process may be aided by an examination of the grief course, yet the

mourning of IPV survivors is not clearly acknowledged or understood within research and

practice. Previous reports on the experiences of grief among women going through the process of

leaving an abusive relationship are dated (Campbell, 1989; Flynn & Whitcomb, 1981;

Silverman, 1981; Turner & Shapiro, 1986; Varvaro, 1991; Weingourt, 1979) and much of this

work is not empirical (Flynn & Whitcomb, 1981; Turner & Shapiro, 1986; Varvaro, 1991;

Weingourt, 1979). Grief is perhaps the most suppressed emotion among survivors of IPV

(Silverman, 1981) and some IPV experts have reported that women’s experiences of grief upon

separating from an abusive partner are often condemned by the general public as pathological

(Campbell, 1989). Without understanding and validation, survivors will not be able to mourn

openly and manage their grief symptoms (Flynn & Whitcomb, 1981; Silverman, 1981).

Presently, there are a variety of theories and frameworks that attempt to explain the wide

range of grief responses (Allumbaugh & Hoyt, 1999; DeSpelder & Strickland, 2011; Kato &

Mann, 1999; Servaty-Seib, 2004). This research assesses the applicability of one of the most

influential stages of grief theories – the Kubler-Ross (1969) grief model – on the emotional

experiences of IPV survivors going through the process of leaving an abusive partner. This

model was chosen as it has been previously theorized as an appropriate model for understanding

the experiences of women who leave abusive relationships (Flynn & Whitcomb, 1981; Turner &

Shapiro, 1986). It is important to note, however, that other models of grief may also be

applicable. Worden (2009), for example, proposes four tasks of mourning after the death of a


loved one and some of these tasks may also fit with the experiences of IPV survivors (e.g.,

adjusting to the environment, moving on with life). Similarly, Bowlby and Parkes (1970) provide

four main stages of the grieving process: numbness, yearning, disorganization/despair, and

reorganization. The final stage may be particularly applicable to women going through the

process of leaving an abusive relationship. Many theories of grief – particularly stage theories –

have overlapping features; each begins by suggesting that the survivor is traumatized by their

loss, goes onto assert that the person works through emotions such as sadness and anger, and

ends with the idea that the experience can be incorporated into the sense of self and the pain

transformed into strength. Of course, every grief experience is unique, idiosyncratic, and varies

according to personal characteristics, cultural background, circumstances of the loss, presence of

other stressors, and social support (DeSpelder & Strickland, 2011; Servaty-Seib, 2004).

The Kubler-Ross Grief Model

The Kubler-Ross model encompasses five stages – denial and isolation, anger,

bargaining, depression, and acceptance. Each grief process is unique; the five stages are not

meant to be rigid, orderly, or linear, nor are they all experienced by every individual (Kubler-

Ross & Kessler, 2005). Leaving is a process, and women in abusive relationships may leave

many times before finally extricating themselves; as such, the stages of grief may be cyclical

(Flynn & Whitcomb, 1981; Silverman, 1981; Turner & Shapiro, 1986; Varvaro, 1991).

Kubler-Ross (1969) states that the grief process initiates with feelings of denial and

isolation that are a temporary reaction to the grieving individual’s state of shock. During this

phase, IPV survivors may experience feelings of disassociation, deny that violence exists,

rationalize abuse by taking blame for the violence, and hope the abuse will stop on its own

(Flynn & Whitcomb, 1981; Silverman, 1981; Turner & Shapiro, 1986). It is hypothesized that


denial occurs because of shame, fear of retaliation, self-blame, and low self-esteem (Flynn &

Whitcomb, 1981; Turner & Shapiro, 1986). Support is rarely sought out during this phase

(Turner & Shapiro, 1986).

In the anger stage, individuals start to recognize their misfortune, evoking feelings of

anger (Kubler-Ross, 1969). This anger can be directed at others or at the self in the form of guilt,

and is associated with the idea that the misfortune could have been prevented if the individual

had responded to the situation differently (Kubler-Ross & Kessler, 2005). Women may not

express anger openly for fear of retaliation (Flynn & Whitcomb, 1981), but it has been theorized

that women are more likely to seek help and are motivated to change during this phase (Turner &

Shapiro, 1986). The anger phase has been described as the most socially acceptable stage for

women going through the process of leaving an abusive relationship (Turner & Shapiro, 1986).

Following the anger stage is bargaining, which is an attempt by the mourning individual

to postpone loss (Kubler-Ross, 1969). The bargaining phase may be marked by attempts to

reconcile, and could be exacerbated when the abusive partner is loving and remorseful after

violent incidents (Flynn & Whitcomb, 1981; Turner & Shapiro, 1986).

The next phase, depression, is marked by a sense of great loss; the individual should be

allowed to express their sorrow to attain acceptance (Kubler-Ross, 1969). This phase is

characterized by loss of self-esteem, a sense of futility, and despair (Flynn & Whitcomb, 1981).

The depression stage can occur both before and after separation, and may lead to reconciliation.

This stage also may not be accepted and discussed openly among IPV survivors as they are

expected to feel relieved and angry – as opposed to mournful – during the process of leaving a

violent relationship (Turner & Shapiro, 1986).


The final stage, acceptance, is reached when women can fully accept their situation and

gain control over their lives (Turner & Shapiro, 1986). IPV survivors who are unable to reach

this phase may experience chronic grief (Flynn & Whitcomb, 1981). In order to test the theory

that the Kubler-Ross model of grief can be applied to women leaving abusive relationships

(Flynn & Whitcomb, 1981; Turner & Shapiro, 1986), this research applies the Kubler-Ross

model to female survivor’s descriptions of their grief experience.

Methods

Open-ended, semi-structured interviews were utilized to gather data from 14 women

recruited from a domestic violence shelter (n=8) and a non-residential program serving domestic

violence survivors (n=6). Recruitment was conducted during support groups at both locations;

survivors were asked to contact researchers if they were interested in participating in an

interview about their experiences of grief and sadness as they went through the process of

leaving their intimate partner. The Institutional Review Board of Arizona State University

approved the research procedures. Interviews lasted approximately 60 minutes and were audio

taped and transcribed. The Grief Response Assessment Questionnaire (Varvaro, 1991) was

employed to support the development of the interview questions which focused on participants’

emotional and cognitive reactions during the process of leaving their violent relationships.

All interviews were coded in ATLAS.ti (2010) using a deductive template approach to

theoretical coding (Crabtree & Miller, 1999). The template/codebook was developed a priori,

was based on the Kubler-Ross theoretical framework and initially included only the five stages

of grief (denial/isolation, anger, bargaining, depression, and acceptance). Our use of this

template was interactive and reflexive, allowing these original themes to change and additional

themes to emerge through a process of open coding. Several examples follow: “Bargaining” was


not apparent in women’s accounts of their grief process and, after further coding and analysis,

we changed this theme to “indecision”; we expanded on the codebook by adding the codes

“sadness” and “suicidal ideation” to the existing “depression” code as the data indicated that it

was important to delineate between these emotions; we added codes referring to women’s

process of leaving as this emerged as an important theme throughout the analysis process. All

changes to the template were recorded and the first and second authors utilized a debriefing

process to reach consensus throughout the analysis.

Results

Participant Characteristics

Women’s ages ranged from 19-62 years (M=39.4, SD=15.8). All women had ended their

abusive relationship prior to participating in the study, and six participants were divorced.

Relationship length ranged from less than a year to 29 years (M=10.9, SD=8.8), and women

reported physically leaving their abusive relationship 1-9 times (M=3.3, SD=2.5). On average,

women who went to shelter (n=8) had more cycles of leaving and returning (M=3.9, SD=2.7)

than participants who never utilized shelter services (M=1.7, SD=1.9). All women (n=14) had

experienced verbal and psychological abuse. Three women reported sexual abuse only, 9

participants reported physical abuse only, and 2 women experienced physical and sexual abuse

concomitantly.

Leaving as a process

While some participants (n=5) reported that they left only once, most (n=9) reported

leaving their abusive partners multiple (2-9) times before making the final decision to end the

relationship. Lack of economic and social support (n=6; “I left… but because [I didn’t] have any

money and my family wouldn’t take me in, I had to go back,” “I had… no friends, no support…


I was alone”), feelings of love and attachment (n=6; “He left a message and he was just sobbing

and it broke my heart because I still love[d] him,” “[It] took me seven years… to stop loving

him”) and a desire to maintain their family (n=4; “I have left plenty of other times and you, you

leave, then you think: ‘Oh, I can go back and work it out for the sake of the kids’”) were the

main reasons that women reconciled with abusive partners. These reasons are not mutually

exclusive and women reported different reasons for returning at different times (“There were

times that I loved him… I went back. There were times that I left him and I only went back

because I had nowhere else to go”) or returning for a combination of reasons (“Financially it’s

easier [to return] and… being a single parent… sucks, so that’s like another reason”). For

participants in this study, leaving was an emotional process, not a single, finite act. Women

reported returning to their partners primarily during the denial, depression, and

bargaining/indecision stages of the Kubler-Ross model.

The Kubler-Ross Model

Denial and Isolation. For many women in abusive relationships, denial is the first

response to the loss of their idealized relationship (Turner & Shapiro, 1986). During this stage,

feelings of shock are often present and women generally do not acknowledge the existence of

IPV (Turner & Shapiro, 1986). Eleven participants identified experiences of denial: “I couldn’t

believe it had gotten that bad. I was in such denial.” and “It slowly graduated… first… an

argument… I ignored that. Then… a slap in the face. I ignored that.” The reasons for denial

varied and included self-blame (“What did I do to push him into that mode?... I felt guilty… Did

I make you do this?”) and psychological defenses (“I think I always try to numb out my

feelings… I would be crying, but I’d do anything not to feel.”).


Twelve of the 14 participants reported feelings of shock and fear consistent with the

denial stage of the Kubller-Ross model: “I was in shock. I kept thinking to myself things were

going to get better and they never did.” In this stage, women did not physically leave or they left

and returned to their intimate partners because they did not recognize that the abuse would

continue and escalate. As one woman stated, “After he got through being mad and I got through

being afraid, that is when… I went back and… repeated the cycle.” Women reported that they

were afraid – some afraid of their partner (“Scared. I thought he would get really mad and he

did,” “[I was] so afraid [of him] that I would end up going back”) and others afraid of being

alone (“I felt that insecurity and I couldn’t think about being by myself. I was too afraid to be on

my own”). Shock, fear, and love combined in this stage to keep women in their abusive

relationships, and to encourage them to return to abusive partners if they left: “I guess a little bit

of love is worth a bunch of misery.”

Anger. All participants reported feelings of anger and/or guilt; both of these feelings were

strongly connected to their children’s wellbeing. Some women felt that they could have stopped

the abuse earlier: “It just breaks my heart because if I could have maybe done something when

[my children] were younger… maybe this pattern wouldn’t be continuing.” Another participant

stated, “I felt guilty. I really felt guilty because I felt like ‘What am I putting myself through,

what am I putting my kids through?’” Some participants reported feeling angry at themselves for

staying in the relationship, or for not physically leaving earlier. One woman said, “I was mad

because of everything he put me through... it was stupid of me to be there that long…I was mad

because I was the one being abused and I was still there.”

Other women were angry at their partners: “He has wronged me and my children in too

many ways… for me to ever forgive him.” Another woman said “I am to the point right now


where I would probably get a gun and kill him. That is not the type of person I am but when he

starts hurting your children and treating them disrespectfully…” Anger toward partners given

the time and effort the women had invested in their relationships was also a common theme. One

participant stated, “I got so angry—how dare he take all those years of my life… do that in front

of my children… how dare he?”

Bargaining. The bargaining phase has been described as the irresolute stage that IPV

survivors experience after physically leaving an abusive partner (Flynn & Whitcomb, 1981;

Turner & Shapiro, 1986). We recoded this stage as indecision, as the participants vacillated

internally between continuing their separation and returning to their partner (rather than

bargaining with an outside source): “My mind fluctuates from ‘Oh, my God. This is so over’ to

‘Oh, but it might be okay.’” Among the women, this phase was associated with a variety of

emotions ranging from powerlessness (“I … remember having nowhere to go. I did not think I

had any options at all”) to hope. Feelings of hope were similarly mercurial; women reported

feeling hopeful that they could obtain independence from their partner (“I was hoping… I never

had to go back to him”) coupled with hope that their partner would change and they could

reconcile (“I was being hopeful…We have a family and he would feel bad and … have his

[conscience] kicking in and telling him that it’s wrong”). Twelve women reported these feelings

ambivalence about their relationships and their partner after physically leaving. As one

participant described:

The whole thing is an emotional rollercoaster. “He’s an idiot.” “I miss him.” “I need him.” “I don’t need him.” “I don’t want to talk to him again.” “Why isn't he calling?” “What’s he doing?” “Who cares?” It’s worse at night when … [I’m] alone.


The most reported reason for women to reconcile or stay in their relationship was a lack of

economic and social support, leading to feelings of powerlessness. As one woman stated, “I just

remember feeling helpless… I [had] nowhere to go. I didn’t think I had any options.”

Indecision was also strongly linked to women’s perceptions of what was best for their

children. Some women reconciled with their partners because they were not able to care for their

children alone: “I got a job but then day care was so expensive, I couldn't afford [it].” A number

of participants considered the maintenance of the relationship to be in the best interest of the

children: “I … tried to make [the relationship] work for the sake of my kids.”

Depression. The depression phase has been described as marked by physical symptoms,

feelings of hopelessness, and a loss of self-efficacy and self-esteem (Flynn & Whitcomb, 1981).

Feelings of sadness were commonly reported by the women in this study, and were recognized as

a normal response to the process of leaving. Seven participants reported feelings of sadness, but

they did not define this as depression and did not report suicidal ideation: “I didn't go into severe

depression, but I had times when I felt low” and “I was sad and I grieved because I really loved

him.” An additional four women reported clinical depression and three of these reported suicidal

ideation: “I thought that dying was the solution” and “there were times… when I just wanted to

kill myself. I thought that was my only way out.”

The sadness experienced by women was often connected to the loss of their intimate

relationship (“I miss the way he smells and the way he feels”) as well as the loss of a father

figure for their children or an intact family: “I didn't want my son to … have a split up

relationship. So I was sad.” Because their sadness was tied to the dissolution of their relationship

(“I was sad because I had left,” “After I left… I mourned it like a death”), many women reported

returning to their intimate partner in order to alleviate these feelings of depression (“I thought I


couldn’t breathe without him. I thought I couldn’t live without him… I just needed to get back to

where he was”). Some women worked through their depression after they left their relationship,

and some reported that they were still working through these feelings: “I go through days where I

am happy… but yet there are days where I am like ‘God, is this ever going to end?’” Other

women reported that they needed to overcome their sadness before they were able to physically

leave their partner permanently:

I didn’t care anymore. Usually when I did leave, I would cry. I would cry – pack my stuff and cry and I cried a lot. But this last time, I just woke up one day and I said “I’m done. I am so done with this.” And I just packed my stuff and I left. I didn’t cry. I didn’t care about going back. I said “I am never coming back.” In addition to sadness about the dissolution of their relationship, 3 participants reported

feelings of despair and hopelessness about their current circumstances. These feelings were

marked by an inability to see a way to move forward, particularly in relation to permanent

damage caused by their abusive relationship. One participant reported feeling discouraged about

finding a non-abusive intimate partner: “I don’t think there is a chance for me to have that person

with me. I think that it’s over for me. I would rather be single.” Another participant considered it

impossible to overcome the damage caused by abuse: “Once you have been abused you never get

over it.”

Acceptance. The acceptance stage is marked by willingness to start a new life and

acknowledgement of the losses faced (Turner & Shapiro, 1986; Flynn and Whitcomb, 1981).

Most of the women (n=13) reported some emotions associated with acceptance, including relief,

hope, and empowerment. Ten participants reported feelings of lightening, “I can breathe again

[because] I will never have to actually be with him.” Nine participants stated that they felt

hopeful about their future: “[My future is going to be] successful because I’m not going to be


getting abused anymore.” Three women reported that they overcame the grief process through

their desire to be healthy for their children: “I got myself together, not just for me but for my

son.” Five women also reported feeling optimistic about the future for their children: “I feel

hopeful about finding a good future for my children.”

Eight women reported that they felt empowered once reaching this stage, “I don't belong

to nobody but myself… and now I have more power over myself.” These feelings of

empowerment came from knowledge that they had overcome a difficult situation (“I got through

it… I’m going to be okay”), that they had learned from their relationship (“I learned from it. I

learned to survive. I learned to be a survivor”) and that they had done this through reliance on

themselves (“Now I can say that I made it, and I did it by myself”); women were clearly proud of

these accomplishments (“I am proud of myself,” “My self-esteem is up”). Women talked about

“recreating” and “reforming” themselves, being “free,” feeling “good… relieved… safe.”

Through acceptance, women transformed their experiences of victimization into empowerment;

as one woman said, “I want to be amazing, period.”

Discussion

Though there is not one set trajectory for mourning the dissolution of a relationship,

women going through the process of leaving an abusive partner appear to engage in a grief

course that includes the five stages of grief described by Kubler-Ross. Study data supported

previous suppositions that grieving individuals may vacillate between stages of grief (Flynn &

Whitcomb, 1981; Silverman, 1981; Turner & Shapiro, 1986; Varvaro, 1991). Violent

revictimization by their intimate partner, generally after reconciliation, and other negative life

circumstances caused participants to re-experience stages of grief that they had previously

undergone. Women also reported experiencing emotions associated with more than one stage


simultaneously. Consistent with previous research, participants reported grieving over the loss of

material and emotional aspects of their lives with their partners, both prior to and after the

physical separation (Amanor-Boadu et al., in press; Anderson & Saunders, 2003; Turner &

Shapiro, 1986; Varvaro, 1991).

Specific feelings and emotions – as well as the intensity, onset, and length of each grief

stage – varied by participant. Most participants reported feelings and emotions associated with

the first stage of grief – denial and isolation – while still in their relationship. Denial was often

accompanied by fear of their partner and fear of being alone. Women who did not go to a shelter

appeared to be further along in their grief process when they left their partner and therefore did

not return as many times. This finding deserves further study, but may be because these women

stayed in their relationships longer, or had more financial resources and/or social support. The

duration of the grief process also differed by participant. Feelings associated with acceptance

occurred from several months to years after the separation, and, at the time of this study, not all

participants had reached the acceptance stage.

Demographic and relationship characteristics – such as age, length of the relationship,

social support, and marital status – influenced the grief process. Previous research has examined

the influence of children on the decision to leave a violent relationship (e.g., Moe, 2009) and it is

important to note that the women in this study who had children living with them (n=12)

reported that their children were often the driving force behind the choice to remain in, leave, or

return to the relationship. Women who had longer relationships appeared to have a more

prolonged grief process and reported less acceptance than women with shorter relationships. This

may be related to the bond that women form with their partner over many years. Similarly, older

women, women with fewer resources and women who had been married to their partners


reported a more difficult grief process and less frequent acceptance. Of course, a woman’s

agency may supersede all of these factors. While the women in this study talked about ways in

which the abuse that they experienced constrained their self-determination, they also shared their

experiences of empowerment and demonstrated great strength, resilience and an ability to take

positive action both during and after their abusive relationships.

Strengths & Limitations

All participants in this study were recruited in a single city in the Southwest United

States. Participants were recruited from both a residential and a non-residential domestic

violence service provider; however, all women were participating in a support group, had been in

heterosexual relationships, and had chosen to terminate their violent relationship. Participants

self-selected to participate in an interview regarding their experiences of grief throughout the

process of leaving their intimate relationship and, therefore, may be different than women who

chose not to participate in the interview. Further, participants were all seeking formal services

and may be different than women who do not attend support groups or seek services for IPV.

Although participants were characterized by diverse economic, social, and ethnic origins, they

represent a very small proportion of help-seeking survivors and, as such, results are not

generalizeable.

For some participants, it had been several years since they had separated from their

partner and time may have changed their recollections about the relationship. However, the

length of time since separation may have also allowed the women to move through each of the

stages of grief; more recent survivors may not have had the time or distance to progress through

the five Kubler-Ross stages. The study relied exclusively on self-report, which is often


problematic; for this study, self-report is considered a strength, as the only reliable way to assess

the grief processes of these survivors is the women themselves.

A limitation of the Kubler-Ross framework is that the process of leaving an abusive

relationship is not the same as loss through death; the partner is alive and may remain a part of

the survivors’ life, particularly when they have children in common. While the Kubler-Ross

framework assists in furthering our understanding of the experiences of grief among IPV

survivors, the application of the Kubler-Ross model to the grief process of IPV survivors is not

an exact fit. The Kubler-Ross model has the most theoretical and practice-based support within

the literature, but future research should continue to examine other models of grief that may be

applicable to IPV survivors. It may also be that no model of grief developed to explain loss

through death is entirely relevant to the experiences of grief for women who go through the

process of leaving an abusive relationship.

Participants also described experiences that can be explained without reference to models

of grief. Women’s descriptions of denial and isolation and bargaining/ indecision, for example,

may also be understood through the stages of change framework (Prochaska & DiClemente,

1982). Similarly, Judith Herman’s (1997) work on trauma and recovery has been used

extensively to describe survivor’s reactions to and recovery from abuse, and is applicable to the

experience of the women in this study. It is important that we understand women’s grief

responses in the context of their experiences of trauma. This paper was unable to disentangle

grief reactions from trauma responses, but future research should examine the relationship

between violence, trauma, and grief in order to better tailor interventions for survivors of IPV.

Despite these limitations, this study presents a comprehensive account of the grief

experienced by 14 women who left abusive relationships, and is the first research study to apply


Kubler-Ross’ stages of grief model to women going through the process of leaving an abusive

relationship. This study is theoretically based, and presents survivors’ voices to elucidate

women’s experiences of grief. By examining a topic that has been often overlooked in studies of

separation from an abusive partner, this research may encourage future examination of the

applicability of grief models to survivors’ experiences. Finally, recognition and understanding of

the grief course by practitioners may assist them in understanding women’s feelings, motivations

and decisions, thereby assisting them in their work with survivors of IPV.

Implications for social work practice

Grief work has been described as active, ongoing and effortful (Stroebe & Schut, 1999),

and a survivor’s processing of emotions related to the termination of her abusive relationship is

no less taxing. It may be helpful for social workers to understand that survivors appear to

experience the stages of grief described by Kubler-Ross. Understanding some of the affective

reactions to IPV as grief responses may help social workers increase their patience and empathy,

as well as provide a framework for encouraging a survivor to move through the stages of grief

toward acceptance, a stage which encompasses autonomy, empowerment, and self-

determination. Normalization of the survivor’s grief experience can occur within an individual

or group setting through education about the stages of grief and reflection on experiences of the

emotional reactions associated with the Kubler-Ross model. Throughout the grief process, it is

important to provide a survivor with a safe environment in which she can process her grief and

other competing emotions about the end of her relationship. Encouraging adaptive coping

strategies and providing survivors with skills to assist them with managing their feelings of grief

is also important.


Among the participants in this research study, the denial stage of the grief process was

accompanied by feelings of shock, self-blame, fear, and numbing. Post-traumatic stress disorder

is common among IPV survivors (Golding, 1999) and appropriate therapeutic responses to

trauma should also be employed. Practitioners who come into contact with women

demonstrating denial should not blame survivors for their reactions, but understand that this may

be part of the grief process. It is important to empathize with the survivor’s feelings, educate her

about the cycle of violence and risk factors for homicide, and express non-judgmental acceptance

of the survivor’s decisions. Stating that abuse is never the survivor’s fault and emphasizing that

no one deserves to be abused may assuage feelings of self-blame that are evident during this

stage.

Practitioners can work with IPV survivors to allow them to express both feelings of guilt

and anger. Assisting women in expressing and overcoming these feelings may be an important

part of moving towards acceptance. Though it may be easier with feelings of anger, it is

important that practitioners understand and validate women’s experiences of guilt as well, and

reframe these emotions using a strengths-based perspective; for example, by praising the

woman’s strength in seeking help.

The indecision phase may be the most difficult for social work practitioners, particularly

if the survivor is considering returning to an abusive partner. The dual process model of coping

with bereavement postulates that a grieving person oscillates between loss-oriented and

restoration-oriented grief (Stroebe & Schut, 1999). This oscillation may hinder the survivor’s

ability to access practical and emotional assistance, and erratic and extreme emotions can be

stressful and demanding for practitioners (Abrahams, 2007). In addition to building self-

awareness through considering their own biases and reactions, an understanding of the grief


process may assist social work practitioners in understanding the factors that lead to indecision.

Given the increased risk for homicide after separation, it is important also to recognize that some

IPV survivors return to their partners for their own safety (Campbell, 2004). Even if safety is not

the most pressing concern, many women physically leave their relationship numerous times

before a final separation; feelings of love, commitment, and ties to family are strengths that

would not be doubted in other contexts, and returning to an abusive partner is not a failure. Danis

and Black (2011) have suggested a re-conceptualization of shelter services as respite care for

IPV survivors in order to reduce feelings of blame associated with returning to a violent partner.

Expressing non-judgmental acceptance of a woman’s decision ensures that she will feel

comfortable seeking help again. If a woman decides to return to her abusive partner, a

practitioner should provide her with information on risk factors, safety planning and community

resources.

Several women in this study reported feeling sadness, depression and suicidal ideation.

Suicide threats/attempts are common among survivors of IPV; women who have experienced

more severe and potentially lethal abuse, are younger, or have a chronic/disabling condition are

more likely to experience suicidal ideation (Cavanaugh et al., 2011). Practitioners need to be

aware of this potential, assess for depression and suicidal ideation, and provide women with

appropriate mental health interventions. Social workers may consider these feelings a normal

part of the grief process and help women to understand that it is normal to experience sadness

and depression throughout the process of leaving. Some women in this study had feelings of

persistent hopelessness and believed that they would never be able to live a normal life or have a

non-abusive relationship. Introducing women to survivors who have gone on to have fulfilling


lives may assist with these feelings, though it is important to be aware that feelings of

hopelessness are often tied to depression and may need additional clinical intervention.

Not all survivors of violence reach a stage of acceptance; for others it may take time.

Women who experience acceptance may feel hopeful about the future for both themselves and

their children, and are unlikely to return to their abuser. For women in this study, acceptance was

a process of incorporation, wherein a survivor’s identity is fundamentally changed through the

integration of her relationship, abuse and separation experience (Evans & Lindsay, 2008). Like

other experiences of grief, the resolution of the grief process for these survivors was not to leave

positive and negative experiences behind, but to allow those experiences to educate and

empower, leading to healing and growth. Interactions with others – including practitioners – may

affect the grief process and a survivor’s ability to adjust to the dissolution of her relationship

(Stroebe & Schut, 1999). Care that is client-centered, mindful and empathic may assist women

with healing (Cacciatore, 2010). Understanding survivor’s experiences of grief may help

practitioners to empathize with IPV survivors and better attend to their material and

psychological needs.


References

Abrahams, H. (2007). Supporting women after domestic violence. Philadelphia, PA: Jessica

Kingsley Publishers.

Allumbaugh, D.L., & Hoyt, W.T. (1999). Effectiveness of grief therapy: A meta-analysis.

Journal of Counseling Psychology, 46,370−380.

Amanor-Boadu, Y., Messing, J.T., Stith, S., Anderson, J.R., O’Sullivan, C., Campbell, J.C.

(2012). Immigrant women and non-immigrant women: Factors that predict leaving an

abusive relationship. Violence Against Women, 18(5), 611-633.

Anderson, D.K. & Saunders, D.G. (2003). Leaving an abusive partner: An empirical review of

predictors, the process of leaving, and psychological well-being. Trauma, Violence, &

Abuse, 4,163-191.

ATLAS.ti (Version 6.2) [Computer software] (2010) Berlin, Scientific Software Development.

Bacchus, L., Mezey, G., & Bewley, S. (2003). Experiences of seeking help from health

professionals in a sample of women who experienced domestic violence. Health and

Social Care in the Community, 11,10-18.

Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J. &

Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey: 2010

Summary Report. Atlanta GA: Centers for Disease Control and Prevention.

Bowlby, J., & Parkes, C.M . (1970). Separation and loss within the family. In E.J. Anthony &

C.M. Koupemik (Eds.). The child in his family. New York: Wiley

Breiding, M., Black, M.C. & Ryan, G.W. (2005). Prevalence and risk factors of intimate partner

violence in eighteen U.S. States/Territories. Am J Prev Med,34(2),112-118.


Cacciatore, J. (2010). Stillbirth: Patient-centered Psychosocial Care. Clinical Obstetrics &

Gynecology,53(3),691-699.

Campbell, J. (1989). A test of two explanatory models of women’s responses to battering.

Nursing Research, 38(1),18-24.

Campbell, J. (2004). Helping women understand their risk in situations of intimate partner

violence. Journal of Interpersonal Violence, 19(12),1464–1477.

Campbell, J.C., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, M.A. et al.

(2003). Risk factors for femicide in abusive relationships: Results from a multisite case

control study. AmJ Public Health, 93(7), 1089-1097.

Cavanaugh, C.E., Messing, J.T., Del-Colle, M., O’Sullivan, C. & Campbell, J.C. (2011).

Prevalence and correlates of suicidal behavior among adult female victims of intimate

partner violence. Suicide & Life-Threatening Behavior, 41(4),372-383.

Coker, A.L., Davis, K.E., Arias, I.A., Desai, S., Sanderson, M., & Brandt, H.M. et al.(2002).

Physical and mental health effects of intimate partner violence for men and women.

American Journal of Preventive Medicine, 23,260–268.

Crabtree, B., & Miller, W. (1999). Doing qualitative research. Newbury Park, CA: Sage.

Danis, F.S. (2003). Social work response to domestic violence: Encouraging news from a new

look. Affilia: Journal of Women and Social Work, 18 (2), 177-191.

Danis, F.S. & Black, B. (May 2011). Reclaiming Feminist Social Work Practice In Domestic

Violence Shelter Services, Presentation at the Unsettling Feminisms Conference,

Chicago, IL.

Deaton, W., Hertica, M.(2001). A therapist guide to growing free: A manual for survivors of

domestic violence. Binghamton, NY; The Haworth Maltreatment and Trauma Press.


DeSpelder, L.A., & Strickland, A.L. (2011). The Last Dance. McGraw Hill

Evans, I. & Lindsay, J. (2008). Incorporation rather than recovery: Living with the legacy of

domestic violence. Women’s Studies International Forum,31,355-362.

Flynn, J., &Whitcomb, J. (1981). Unresolved grief in battered women. Journal of Emergency

Nursing, 78(8),250-254.

Few, A., & Rosen, K. (2005). Victims of chronic dating violence: How women’s vulnerabilities

link to their decisions to stay. Family Relations, 54,265-279.

Garcia-Moreno, C., Jansen, H., Ellsberg, M., Heise, L., Watts, C.(2006). Findings from the

WHO multi-county study on women’s health and domestic violence,.Lancet, 368(9542),

1260–1269.

Golding J.M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-

analysis. Journal of Family Violence,14(2),99-132.

Goodman, L.A. & Epstein, D. (2009).Listening to battered women. Washington DC: APA.

Hamby, S. (2008, September). A holistic approach to understanding the coping strategies of

victims. Presented at the 13th International Conference on Violence, Abuse, & Trauma,

San Diego, CA.

Hardesty, J.L. (2002). Separation assault in the context of postdivorce parenting: An integrative

review of the literature. Violence against Women, 8,597–625.

Hazen, A., Connelly, C., Soriano, F., Landsverk, J.(2008). Intimate partner violence and

psychological functioning in Latina women. Health Care for Women International,

29,282–299.

Herman, J. (1997). Trauma and Recovery. Basic Books.


Kato, P., Mann, T.(1999). A synthesis of psychological interventions for the bereaved. Clinical

Psychology Review, 19(3),275-296.

Kubler-Ross, E., & Kessler, D. (2005) On grief and grieving: Finding the meaning of grief

through five stages of loss. New York, NY: Scribner.

Kubler-Ross, E. (1969). On death and dying. New York, NY: Macmillan.

Macy, R.J., Giattina, M., Sangster, T.H., Crosby, C., Montijo, N.J. (2009). Domestic violence

and sexual assault services: Inside the black box. Aggression & Violent Behavior, 14,359-

373.

Maxwell, J.P. (1999). Mandatory mediation in the face of DV: Suggestions for courts and

mediators. Family and Conciliation Courts Review 37,335–355.

Moe, A.M.(2009). Battered women, children, and the end of abusive relationships. Affilia,24(3),

244-256.

Newmark, L., Harrell, A., & Salem, P. (1995). Domestic violence and empowerment in custody

and visitation cases. Family and Conciliation Courts Review, 33 60-62.

Prochaska, J.O., DiClemente, C.C. (1982). Thranstheoretical therapy: Toward a more integrative

model of change. Psychotherapy, 19(3), 276-288.

Rosen, K., Stith, S.(1997). Surviving abusive dating relationships: Processes of leaving, healing

and moving on (pp.170-182). Out of the Darkness. G. Kantor & J. Jasinski (Eds.). CA:

Sage.

Silverman, P.R. (1981). Helping women cope with grief. CA: Sage.

Servaty-Seib, H.(2004). Connections between counseling theories and current theories of grief

and mourning. Journal of Mental Health Counseling, 26(2), 125-145.


Stroebe, M., Schut, H. (1999). The dual process model of coping with bereavement: Rationale

and description. Death Studies, 23, 197-224.

Turner, S., Shapiro, C. (1986). Battered women: Mourning the death of a relationship. Social

Work, 31,372-376.

Varvaro, E. (1991). Using a grief response assessment questionnaire in a support group to assist

battered women in their recovery. Response, 13(4),17-20.

Walker, R., Logan, T.K., Jordan, C.E., & Campbell, J.C.(2004). An integrative review of

separation in the context of victimization: Consequences and implications for women.

TVA, 5(2), 143-193.

Weingourt, R. (1979). Battered women: The grieving process. Journal of Psychiatric Nursing

and Mental Health Services. 17(4),40-47.

Worden, J.W. (2009). Grief counseling and grief therapy (4th Edition). NY: Springer.

intimate partner violence (ipv) - wordpress.com · intimate partner violence & grief 2 abstract...

Documents