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Domestic abuse (DA) is widespread: there were 2.1 million cases recorded in England and Wales in 2023, and it will affect one in five adults in their lifetime.¹ DA is also one of the most persistent and complex challenges faced by mental health professionals.²

DA does not always end when the abusive relationship ends. Survivors often remain vulnerable to post-separation abuse, such as coercion, legal disputes, financial control and parental alienation, which sustains psychological distress. DA is therefore a chronic rather than a single-event trauma.³ Survivors might not even recognise their past or current situation as abuse.^4,5 They might also develop survival-based adaptations,⁶ such as hypervigilance, avoidance and dissociation.Ìý

Most counselling and psychotherapy training lacks specialist education on DA,⁷ leaving practitioners without the tools to navigate not only its psychological impact but also its relational and systemic implications. In addition, standard trauma models do not always consider the complexities of DA, potentially leading to interventions that fail to recognise ongoing risk, misattribute symptoms or reinforce self-blame.^7-9Ìý

In my opinion, a structured framework is needed to ensure that counsellors do not approach DA as a past event with a linear healing trajectory, but instead align their interventions with the survivor’s stage of recovery and external realities. Without a tailored approach, there is a risk that therapists will:

• misinterpret trauma responses as pathology, by failing to recognise survival-based adaptations as rational responses to ongoing threat⁸
• apply interventions that do not account for ongoing risk,^5,10 leading to misplaced therapeutic goals, such as premature trauma processing or reconciliation with an abuser¹¹
• overlook systemic and cultural barriers that affect a survivor’s access to safety and support, such as financial dependence, immigration status, religious pressures or community stigma
• reinforce intersectional disadvantages, by failing to recognise how gender, race, disability, sexuality and socio-economic status shape survivors’ experiences and recovery pathways.¹² Survivors from marginalised backgrounds might face additional barriers in disclosing abuse, accessing support or being believed
• lack awareness of legal and procedural coercion, including how family courts, parental alienation and financial control can be used to sustain abuse, post-separation.^13,14Ìý

I would like to put forward a therapy model and a stage-based recovery framework to guide DA counselling. I first introduced the narrative regulation therapy (NRT) model in 2023, as an applied self-help model to support relationship trauma following domestic abuse.¹⁵ The model integrates trauma-focused intervention theory with relational and systemic dynamics. It helps to assess and support survivors’ psychological adaptations, relational narratives and ongoing risks.Ìý

The five-stage recovery framework ensures interventions align with the client’s recovery stage and safety needs. Together, the model and the recovery framework support timely, risk-aware interventions, helping counsellors to assess needs, avoid reinforcing coercion and apply appropriate competencies at each stage.Ìý

A core feature of NRT is its recognition of DA as an attachment injury. Disrupted attachment is often linked to childhood experiences, but it can also emerge in abusive relationships,^16,17 where repeated violations of trust lead to self-blame,^€ confused self-development and emotional dysregulation.¹⁹ Survivors frequently internalise responsibility for the abuse,¹⁸ resulting in fear, obligation, guilt and shame (FOGS), which reinforce entrapment.

By mapping these dynamics, NRT helps survivors and counsellors collaboratively formulate how abuse developed, is maintained and continues to shape survivorship. It serves both as a therapeutic intervention and as a guide for timing appropriate interventions, ensuring that survivors do not begin to process trauma while external threats remain.Ìý

NRT proposes that the psychological impact of DA is shaped by a multi-system attachment dynamic, where the victim, abuser and societal influences interact to reshape the victim’s sense of self, reality and relationships. Victims enter abusive relationships with an existing attachment style, often insecure or disorganised, which makes them susceptible to seeking validation and worth within relationships, even in the presence of harm.^16,20Ìý

Alternatively, their insecurity develops as a consequence of prolonged abuse.¹⁶ Initially, the victim might hold beliefs such as: ‘I am loved. I am valued.’ However, through sustained manipulation and control, this narrative shifts into: ‘I am to blame. I am worthless. My partner’s needs come first’.²¹ The victim comes to look at the relationship through a particular lens, reflecting their current relationship narrative.Ìý

The shift in the victim’s relationship narrative is shaped by three overlapping narratives that influence the victim’s perception of reality: 

• external relationship narrative: messages from society, family, friends and culture about love, commitment and endurance can reinforce perseverance in relationships, even at great personal cost. Some societies, families or cultures might, for example, disapprove of divorce or believe that parents should stay together for the sake of the children 
• the abuser’s relational narrative: the abuser dictates expectations, obligations and rules, which evolve over time into rigid, punishing demands. These expectations are sometimes interwoven with moments of affection, reinforcing the victim’s hope for change
• the forced narrative: the abuser’s narrative is not simply communicated; it is imposed through grooming, gaslighting, threat, violence, denigration and blame, creating a disorienting psychological climate where the victim feels responsible for the abuse.Ìý

Instead of recognising the escalating harm, victims often internalise the abuser’s perspective, leading to self-blame and self-sacrifice. Psychological adaptations emerge to help them survive the situation, but these also distort reality and prevent escape. Adaptations include: 

• dissociation: detachment from emotions or reality to cope with overwhelming abuse 
• learned helplessness: repeated failures to stop the abuse can lead to passive acceptance of control
• cognitive dissonance: conflicting beliefs (they love me and they hurt me) cause mental distress, which is resolved by rationalising the abuse
• addiction to cycles of drama: the highs and lows of the relationship create an emotional dependency, reinforcing the bond
• emotional dysregulation: the victim’s emotional state becomes dependent on the abuser’s mood, making them hypervigilant to cues of danger or approval 
• FOGS: a reactive over-reliance on limited emotions that binds the victim to the abuser, reinforcing compliance and hampering recovery after escape.Ìý

The complex web of psychological responses results in a dysfunctional yet adaptive survival strategy. Victims develop safety behaviours and cognitive distortions that make escape feel impossible or even dangerous.²² They lose any connection with their own needs and autonomy, so a future beyond survival becomes obscured, reinforcing the cycle.²³ They become trapped in an abusive unreality.Ìý

The NRT model functions as both a formulation tool and a therapeutic intervention. The structured approach supports: 

• attachment injury repair: externalising and normalising blame and addressing shame, guilt and trust violations
• cognitive reframing of negative self-perceptions: shifting from self-blame to an understanding of coercive dynamics
• a coherent survivor narrative: helping to process abuse-related experiences into an organised, understandable narrative account of the experience.Ìý

Effective DA counselling requires counsellors to recognise where a survivor is in their recovery journey, which psychological processes are reinforcing cycles of abuse (both before and after escape) and how specific interventions can target these mechanisms.^7Ìý

Of course, each client will have a different experience. Some might have early attachment wounds that heighten vulnerability to abuse. Others might have cultural beliefs or context that intensify external narratives about commitment and blame. But I believe this formulation provides therapists with a comprehensive framework to navigate recovery.Ìý

The NRT model incorporates the ongoing influence of the abuser and wider societal narratives, emphasising how post-relational abuse and external reinforcement of the abuse dynamic affect a survivor’s psychological trajectory. For example, legal and social systems, such as family courts and shared finances, can sustain coercive control. Clients can also experience post-separation harassment and manipulation, including stalking, legal threats, child alienation and false accusations. Societal and cultural narratives can further reinforce the abuse dynamic, perhaps by suggesting that forgiveness is healing or that marriage is sacred.Ìý

The model does not position recovery solely as an internal psychological process but recognises that healing is directly influenced by the survivor’s level of freedom from the abuser’s control and the social context they occupy (situational interference). Therefore, a survivor’s psychological adaptations are not just internal defence mechanisms but often active responses to ongoing external realities.Ìý

Therapy that fails to recognise the external influences risks misattributing justifiable distress to internal trauma, leading to interventions that could reinforce, rather than challenge, the abuser’s lingering control, victim blame or pathologise safety behaviours.Ìý

Stages of recovery 

There are five stages to the proposed recovery framework – and recovery is not just about physical escape. Clients are unlikely to progress through the stages in order. For example, many survivors return to abuse or experience abuse after escape, even years later. The recovery will also be influenced by any ongoing abuser involvement, systemic pressures and psychological entrapment. The five stages are: 

• stage one: escaping domestic abuse. The victim remains in the relationship, with growing awareness of abuse but no clear escape plan. Psychological entrapment is at its peak, so intervention must focus on risk management, safety planning and initial disruption of the abuser’s control
• stage two: escaping victimhood. The survivor has physically left the relationship but remains at high risk of return/ongoing abuse, due to ongoing post-relational abuse, coercion and attachment wounds. Psychological interventions must prioritise risk management, skills development and validation over trauma recovery, preventing re-exposure to abuse and reinforcing boundaries
• stage three: resolving victimhood. The survivor is unlikely to return but negative contact with the abuser continues (legal battles, co-parenting, financial entanglements). Psychological recovery must integrate emotional boundary setting and risk awareness, ensuring that post-relational abuse does not sustain self-blame and FOGS
• stage four: resolving survivorship. The abuser’s influence has significantly reduced or ceased but the survivor experiences persistent psychological impacts. Trauma-informed interventions, such as trauma-focused cognitive behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing (EMDR), emotional processing and relational repair work, become appropriate at this stage 
• stage five: resolved survivorship. The relational wound has been processed or functionally managed and ongoing abuser interference is absent. The survivor might seek therapeutic support for broader mental health concerns, unrelated to DA.Ìý

As survivors do not always progress through the stages in a linear way, counsellors must carry out regular risk assessments. They must be aware that abuser interference can resurface at any time, reactivating trauma responses and re-introducing narrative distortions that sustain entrapment. Many survivors also enter into new abusive relationships as they progress through recovery, or halt at a particular stage due to a lack of support.Ìý

Counsellors should maintain a dynamic assessment of key elements within the NRT model, including the survivor’s adapted relational lens (core schemas, self-blame, attachment beliefs), patterns of emotional dysregulation, physiological or compulsive pull towards the abuser (emotionally disrupted attachments, addiction to conflict cycles) and the presence of FOGS or cognitive dissonance. Careful attention should also be given to whether these dynamics are internally maintained or externally reinforced through ongoing coercive control or systemic factors.

Counsellors should also question whether the survivor’s distress is related to past trauma or current coercion, whether the client has the necessary psychological (and physical) safety to engage in recovery work, whether life circumstances are likely to interfere with therapy and how ongoing threats shape the survivor’s capacity for emotional regulation. Without this awareness, some therapeutic approaches could inadvertently desensitise survivors to danger, leading them to rationalise ongoing abuse or accept covert control as ‘normal’.Ìý

A client came to therapy 10 years after leaving her husband, indicating that the ‘scars are still raw’. A full exploration using the NRT model revealed that she was under pressure from her former husband and family to present a united front as grandparents at family occasions, for the benefit of the grandchildren. She was therefore in regular close contact with her previous abuser and there was a resurgence of abusive behaviours. The client felt that she was to blame, because she was struggling to meet everybody’s expectations. In reality, she had moved from stage five to stage three due to external influences – indicating the need for new boundary skills alongside therapy support.Ìý

The competency framework above details the skills necessary for working with survivors, ensuring that interventions are contextually informed, risk-aware and aligned with the survivor’s stage of recovery.Ìý

In stages one to three, survivors require specialist intervention to manage immediate safety risks, prevent re-engagement with the abuser and disrupt trauma bonding. In stages four to five, the focus shifts to processing trauma, rebuilding identity and supporting long-term recovery.Ìý

Ideally, a counsellor would not work with high-risk clients at stages one or two, when escape from domestic abuse and/or management of ongoing threat and coercion are ongoing, without co-ordinating with specialist services. It’s important to know that most DA-related homicides occur after separation, and previous violence is often not a present risk factor.^24Ìý

Clients can be resistant to engage other services, so counsellors need to ensure they are working within their competencies, accessing relevant supervision and breaching confidentiality when risk merits the involvement of emergency services. Professional involvement (including the involvement of mental health professionals) without adequate skill has been recognised as a contributing factor in DA victim suicides and homicides.^25,26Ìý

The NRT model and five-stage recovery framework provide a structured, context-sensitive approach for working with DA survivors. The NRT model functions as a formulation and narrative intervention tool, helping counsellors and clients to formulate how abuse has shaped a survivor’s relational framework, cognitive distortions and emotional regulation, while also identifying ongoing external influences that sustain trauma responses.Ìý

The five-stage framework ensures interventions align with the survivor’s stage of recovery. It differentiates between those still experiencing coercion and risk (stages one to three) and those in post-abuse psychological recovery (stages four to five), ensuring that non-adapted trauma processing interventions are not introduced prematurely when external threats remain.Ìý

Together, these models provide a structured, risk-aware approach to DA counselling, ensuring that interventions are timed appropriately, aligned with survivors’ real-world risks and adapted for cultural and systemic barriers. By moving beyond traditional trauma models, NRT and the five-stage recovery framework help prevent potential mis-steps in DA therapy, reducing the risk of re-engagement, re-traumatisation or reinforcing coercive narratives.Ìý