Introduction
Domestic violence (DV) against women remains an enduring worldwide concern that perpetuates a cycle of harm and trauma, impacting individuals, families, and societies (Hardesty & Ogolsky, 2020). This issue traverses geographical and cultural boundaries, impacting individuals across diverse demographics, including age, race, socioeconomic status, education, and religion (WHO, 2018). DV encompasses coercive control and physical, psychological, sexual, and/or economic abuse(s) within familial or romantic relationships (Ogbe et al., 2020). Definitions of each abuse category may differ across empirical literature and global jurisdictions; however, they are typically understood to include the following (Lagdon et al., 2014). Coercive control describes a strategic pattern of behavior designed to establish dominance and submission, including tactics such as isolation, intimidation, and manipulation (Myhill, 2015). Physical abuse involves the intentional use of physical force with the potential for causing harm, injury, disability, or death. This includes acts such as hitting, slapping, punching, choking, and using weapons, as well as physical aggression to property/objects which threatens or distresses the victim (Safe Ireland, 2022). Psychological abuse refers to mental and emotional harm caused by threats, insults, humiliation and manipulation (Hardesty & Ogolsky, 2020). Sexual abuse defines any non-consensual sexual acts towards a victim (Laskey et al., 2019), while economic abuse includes controlling their access to financial resources, thus limiting their independence (Stylianou, 2018).
Historically, the use of the term ‘violence’ reflected an empirical and legal focus on physical acts at the expense of non-physical ‘abuse(s)’ (Lagdon et al., 2014). However ‘domestic violence’ is now often utilized as an umbrella-term for any and all categories individuals experience (Laskey et al., 2019). Therefore, for the purpose of this study, the terms ‘violence’ and ‘abuse’ will be used interchangeably. Whilst there is increasing acknowledgement of men experiencing DV (Laskey et al., 2019)– as well as its occurrence in same-gender and gender-diverse relationships (Laskey et al., 2019)– it remains consistently reported that women disproportionately experience DV perpetrated by men (WHO, 2018; Laskey et al., 2019). Prevalence rates of DV against women are estimated at 20%-30% globally (WHO, 2018) and in Ireland (Women’s Aid, 2020), with intimate partner violence (IPV) - abuse by a current or former male romantic partner– emerging as the most prevalent form (WHO, 2018; Women’s Aid, 2023). Thus, the current study will focus on DV perpetrated against women solely. Furthermore, it is important to note that women who have experience of DV may identify with the term ‘victim’ or ‘survivor,’ or may prefer not to be labeled at all. Henceforth, ‘victims’, ‘survivors’ and ‘women who’ve experienced DV’ will also be used interchangeably.
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In the Republic of Ireland (Ireland hereafter), psychosocial supports for women who experience DV are typically provided by specialized Domestic Violence Services (DVSs) (Safe Ireland, 2022). Such organizations provide emotional support, safety planning and DV psychoeducation, emergency and transitional accommodation, court accompaniment and advocacy as well as key-working and referral to external services (Sullivan, 2018; Safe Ireland, 2022). Ireland has a history deeply rooted in traditional– conservative Catholic– values which has ecologically shaped outcomes for women experiencing gender-based violence (O’Sullivan, 2023). The removal of “marital exemption” for rape as well as the legalization of divorce in the 1990’s, same-gender marriage in 2015 and abortion in 2018 reflect some of the legislative changes that impact women who experience IPV in the last 30 years. However, the constitutional prioritization of married couples and the ‘nuclear family’ means victims of DV may still experience different challenges regarding legal, financial, housing and child custodial rights if they are married or not (O’Sullivan, 2023). The Irish Domestic Violence Act (2018) represents a significant modern legislative effort to address DV in Ireland, including the recent addition of coercive control as a criminal offence (Thompson et al., 2022). Still, it has been critiqued for its limitations and gaps; particularly in creating a ‘hierarchy of victims’ with varying experiences of protection and support (O’Sullivan, 2023; Thompson et al., 2022). Furthermore, Ireland has experienced significant social justice and economic changes, becoming increasingly diverse and multicultural (O’Sullivan, 2023). Thus, understanding the psychosocial needs of women who experience DV in Ireland requires examining the interplay of individual, relational, and societal factors within this distinct context.
DVSs are also the primary drivers of research into the prevalence and psychosocial impacts of DV in Ireland, with a significant lack of modern empirical literature produced outside of these services. The European Fundamental Rights Agency’s (2014) EU-wide study of gender-based violence remains the last non-DVS study of DV prevalence in Ireland, with 1 in 3 of the sample (n = 1400) experiencing intimate partner violence. At present, DV incidence rates in Ireland are not recorded by State agencies beyond the inference from crime statistics; where the relationship between the victim and accused in sexual or physical assaults has been recorded since 2021 (Central Statistics Office, 2023). In the most recent year available– 2022–4,968 women reported sexual and physical violence offences, of which 41% (n = 1987) accused current/former intimate partners and 24% (n = 1192) accused blood relatives, demonstrating the high prevalence of DV in gender-based crimes reported by women in Ireland. However, such stats only represent victims that report– and only include physical and sexual assaults - thus they are likely underestimations. The most recent figures of women experiencing DV supported annually by Safe Ireland DVSs (2022)– over 11,000 - and Women’s Aid (2023)– over 28,500– highlight the high numbers of survivors supported by Irish DVSs and thus the optimal positioning of these organizations as sources of information on the psychosocial needs among this population.
Psychosocial Consequences of DV
There is a strong establishment of DV victimization as a risk factor for clinical levels of depression, anxiety, Post-Traumatic Stress Disorder (PTSD) and Complex-PTSD, even in the months and years after exiting an abusive relationship (Lagdon et al., 2014; Pill et al., 2017; Fernández-Fillol et al., 2021). However, the focus on clinical classifications of mental ill-health stemming from DV dominant in psychological literature presents a concerning framing of survivors’ responses– such as hypervigilance, emotional and mood fluxes, difficulty trusting others, and interpersonal issues– as symptomatology arising from a condition rather than natural reactions to distressing events (Pill et al., 2017). Applying a mental-illness paradigm to defining trauma and recovery for women who’ve experienced DV not only risks pathologizing them, but also prioritizing symptom reduction and minimizing their wider-reaching needs (Pill et al., 2017; Hameed et al., 2020). A wealth of empirical studies and reviews exist inferring post-intervention increases in ‘wellbeing’ as indexed by decreases in scores on standardized depression, anxiety and PTSD measurements (Hameed et al., 2020). Literature on non-psychological psychosocial needs and interventions are less available (Wessells & Kostelny, 2022). Defining wellbeing, trauma and recovery solely based on symptom-reduction has also been criticized for excluding post-traumatic growth; the positive psychological changes that can occur– often alongside symptomology - in DV survivors (Bryngeirsdottir et al., 2022). Furthermore, diagnostic-centric approaches fail to consider the emotional complexities involved in DV; ranging from the intensive fear and shame commonly reported by survivors that prevents help-seeking (Lelaurain et al., 2017), to the impact of betrayal trauma and conflicting feelings expressed in response to being abused by a loved one (St. Vil et al., 2018). Such unique emotional wounds stemming from DV experiences can hinder survivors engaging with the professional supports they often need to address such complexities of needs (Lelaurain et al., 2017). In addition, survivors are at risk of revictimization via future abusive relationships if contributing vulnerabilities are not addressed (Ørke et al., 2018), highlighting the need for comprehensive supports that facilitate recovery from DV via a holistic, needs-based framework to break the cycles of trauma stemming directly and indirectly from experiencing DV.
Experiencing DV often leads to a complexity of needs beyond psychological/emotional domains, requiring specialized and multi-disciplinary responses (Hameed et al., 2020). In addition to physical injuries, the impact of prolonged DV-related stress has been associated with risk of chronic disease development, as well as health-harming behaviors such as drug and alcohol misuse (Stubbs & Szoeke, 2022). Complicating outcomes further for survivors, they typically face significant losses in social supports, a key facilitator of wellbeing both during and post-DV (Sullivan, 2018; Ogbe et al., 2020). Isolation of victims is a common tactic utilized by perpetrators of DV, often damaging relationships with non-abusing family/friends (Myhill, 2015; Herman, 2019). Furthermore, in their review of the last decade of IPV-related research, Hardesty and Ogolsky (2020) note that most studies focus on individual and relational factors and consequences for victims, with a dearth of investigations of the broader social, environmental and societal/structural aspects. Both current and prior experiences of DV pose a significant threat to the financial and housing security of women. DV represents a leading cause of homelessness amongst women internationally (Yakubovich et al., 2021) and in Ireland (Mayock et al., 2016), as well as a significant contributor to income/employment loss, debt and poverty for survivors (Stylianou, 2018; Safe Ireland, 2021). Such resource losses can increase dependencies on abusers as well as present barriers to escaping abusive relationships, whilst also threatening post-separation recovery and wellbeing (Katz et al., 2020; Paphitis et al., 2022). Hence, research of DV consequences must go beyond psychological/mental health and include broader socioenvironmental barriers and facilitators of recovery to adequately identify, investigate and positively intervene in outcome trajectories for survivors.
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The use of conceptual models to illustrate the psychosocial needs of DV victims/survivors more holistically to supporting professionals is well established in the literature (Carlson, 1984; Hardesty & Ogosky, 2020). The Barriers Model (Grigsby & Hartman, 1997) instructs therapists working with DV survivors to approach recovery through four hierarchical stages; namely basic needs/safety, social support, processing psychological consequences of DV victimization and finally, childhood abuse. By emphasizing these interrelated barriers, the model advocates that basic and psychosocial needs must be met before deeper psychological and trauma-focused work can safely and effectively commence (Grigsby & Hartman, 1997). Sullivan’s (2018) Social and Emotional Wellbeing Framework outlines the moderating influence of professional DVS supports on the effects of traumatic loss; conserving or replenishing the emotional, mental and social resources of women engaged with their services. Furthermore, the ‘Thrivership’ Model (Heywood et al., 2019) notes how identifying with the labels of ‘victim’, ‘survivor’ or ‘thriver’ is heavily impacted by individual, community and societal barriers and facilitators. As such, women who’ve experienced DV may oscillate between identities as their recovery is nurtured or hindered by external influences (Heywood et al., 2019). It also highlights the impacts of DVS education and advocacy at the individual, community, and society levels (Heywood et al., 2019). Thus, studies of the particular and multifaceted psychosocial needs of DV survivors are critical to identify the array of stakeholders needed to facilitate their recovery.
The Current Study
The overall aim of our research is to address this gap in knowledge regarding the psychosocial needs of DV survivors within the Irish context. Understanding the current needs of this population is not only necessary for the development of trauma-informed recommendations and interventions, but also in identifying appropriate services and scaling these to meet demand. However, it is imperative to note that utilizing secondary sources in DV research is a debated issue. In both their review of the literature and present study analysis, Dragiewicz and colleagues (2023) posit that survivors of gender-based violence typically report positive experiences when engaging in research, such as reflection on their strengths and feeling they are contributing to prevention/intervention efforts for other women. However, potential re-traumatization of participants is a key concern of researchers, with the ‘timing’ of research participation regarded by some survivors as a critical factor (Heywood et al., 2019; Dragiewicz et al., 2023). We acknowledge the importance of directly incorporating the voices of survivors in research to ensure their agency in speaking of their experiences. However, we also recognize that survivors who are actively engaged with DV services are often in a state of crisis (Heywood et al., 2019; Safe Ireland, 2022). Engaging them in research during such vulnerable times may pose significant ethical and practical data collection challenges (Dragiewicz et al., 2023). As the current research intends to assess a highly broad scope of psychosocial needs, DVS frontline staff are optimal commentators as they will likely draw their opinion from experiences involving multiple clients and may identify patterns in presenting issues. Furthermore, as key professional supports for survivors, DVS staff are well-positioned to provide valuable insights into the psychosocial needs of survivors based on their extensive experience and close interactions with women who’ve experienced DV, as well as advocacy-driven organizations (Heywood et al., 2019; Safe Ireland, 2022). Thus, this approach allows us to gather comprehensive data while respecting the immediate needs and circumstances of the women who are availing of DVS supports.
Methods
Due to the aforementioned lack of research within the Irish context, an explanatory sequential mixed-methods (McCrudden et al., 2019) design was selected. The intent was to glean information on DVS staff’s views using a survey, which would inform the qualitative interview questions and maximizing our potential to gather data on the professional experiences of individuals working with women experiencing DV in Ireland. This approach was chosen to establish a working understanding of the most frequently observed psychosocial needs of women engaged with DVSs, before delving deeper into the underlying reasons and contextual factors of the most prevalent needs identified in the survey. As per Proudfoot (2022), an inductive/deductive hybrid approach to data collection and analysis was utilized. Participants were invited to complete an online, anonymous survey of psychosocial need frequencies amongst their clients, with the aim of covering a wide breath of potential needs and identifying those which DVS staff observe regularly. Participants could also opt in for a one-to-one interview if they wished to at the end of the survey. The purpose of this interview was to explore the preliminary findings of the survey in further detail, as well as investigate their professional opinions of the barriers and facilitators of DV recovery in different psychosocial domains.
Participants’ Profile
According to Safe Ireland (2022), there are approximately 300 full-time and 200 part-time DVS staff working in the Republic of Ireland; however, this number may include non-frontline professionals (e.g., administrative staff). With such a small sample pool– and a wide geographical spread– recruitment was conducted electronically via the 39 DVSs (Safe Ireland, 2023) in operation in Ireland. Recruitment and data collection began in February 2023, with plain language statements, promotional materials - including an electronic link to the online survey- and a request to distribute these amongst staff emailed to each service, as well as contact information for the research team. Participants were eligible for the study if they were (a) aged 18 or over, (b) worked in a DVS in Ireland and (c) in a client-facing role for 6 months or longer. Client-facing roles were defined as positions working directly with women in refuges or in the community and supporting them with their care needs. Categories of roles were provided to distinguish between professionals including Refuge Workers, Outreach Workers, Court Support Workers, Child Support Workers and Other (allowing participants to define their own role if they did not perceive the former titles as relevant). Participants were asked for their length of time in this role in order to exclude those working less than 6 months– due to potential limited experience in the role– however all respondents exceeded this threshold. Participants were also asked for the county (province) in which they work to analyze potential diverging trends based on location. As shown in Table 1, a total of 40 DVS frontline staff completed the quantitative component of this study in full; nine partial responses were recorded but excluded from analysis. Of the participants that completed the survey, eight provided contact details for further interviewing. Following contact, two participants withdrew due to time constraints, leaving six individuals participating. Interviewees included three ‘Refuge Workers’ (P1, P2 and P4), two ‘Outreach Workers’ (P3 and P6) and one ‘Court Support Worker’ (P5) from across four counties in Ireland.
Ethics
This study was ethically approved by the Dublin City University Psychology Ethics Committee (Reference code: DCU_PEC_2023_138). The importance of confidentiality for participants was pre-acknowledged by the research team due to the highly sensitive nature of their work, as well as the aforementioned small population of DVS staff in Ireland. As such, the online survey was designed to collect minimal demographic and personal data, instead focusing primarily on extracting the professional opinions of participants. Two participants selected the ‘Other’ option when asked their job role and provided their individualized titles; in order to protect anonymity, they were amalgamated into a similar job role group from the list provided. Furthermore, participants were informed of the potential limitations of confidentiality regarding the qualitative interviews and data analysis segments of this project prior to participation and welcomed to complete the anonymous survey without engaging with the qualitative component. Participants who engaged with the interview process were informed that their names would not be used in the write up of this study, but instead quotes would be ascribed to their participant number. Regarding protecting the confidentiality of DVS clients, participants were asked not to disclose identifying information or discuss individual cases of their clients at the start of the survey and (if applicable) at the start of interviews.
Quantitative Measures and Procedures
An online survey was developed by the research team via Qualtrics and was designed to include a broad, comprehensive variety of needs that DVS professionals may encounter. Items were generated following a review of systematic reviews and theoretical models of DV survivors and the psychosocial and basic needs that impacted their recovery, with the research team selecting commonly reported relevant constructs to include as items. A total of 112 items were included, encompassing nine theoretically and empirically supported sections; Physical Health (Stubbs & Szoeke, 2022), Mental Health (Lagdon et al., 2014; Micklitz et al., 2023), Emotional Health (Sullivan, 2018), Social/Relational Health (Sullivan, 2018; Micklitz et al., 2023), Cultural Health (Pokharel et al., 2023), Parenting Needs (Austin et al., 2019), Education and Employment (Showalter; Weitzman, 2018), Income and Housing (Stylianou, 2018; Yakubovich et al., 2021) as well as Access to Services (Femi-Ajao et al., 2020); see Online Resources 1 for full survey. 96 items were presented with Likert scales ranging from 1 “Never” to 5 “Always”, asking participants to score how often they observed each issue. A sixth answer option “Cannot Estimate” was included so that participants could continue past questions that were not relevant to their work. At the end of each section, participants were asked two free-text open-ended questions; (1) to state the most common needs they observed (e.g. physical health needs in the Physical Health section) and (2) to state barriers their clients faced to meeting these needs. Each section followed this format, with exception to Income and Housing which included a question asking participants to score from 1 (most common) to 5 (least common) the accommodation type women left refuge to. The Access to Services section listed a range of external services (e.g. Doctor, Social Welfare, Addiction Services, etc.) and asked how often clients had access to these if needed. The two free-text open-ended questions asked participants to list (1) services they found helpful/understanding of DV and (2) services they found unhelpful/not understanding of DV.
Quantitative Data Analysis
Prior to commencing interviews, a preliminary analysis of the survey responses was completed via SPSS v28 software. Frequency statistics and median scores were utilized to identify items that participants indicated they commonly encountered; see Results section for further detail. To identify areas of note for further investigation via qualitative interviewing, a threshold of ≥ 3.5 was applied to median scores to highlight items in which respondents predominantly scored as occurring “Most of the time” or “Always”; or in the case of reverse scored items, as “Rarely” or “Never” occurring; see Online Resource 1 for survey items and scoring details. This helped to identify ‘hot topic’ areas of interest and these items were selected for inclusion within the interview questions. Items included in interview questions were pooled under the same section headings as the survey. Answers provided to the open-ended questions of the survey were also preliminarily assessed, however as per O’Cathain and Thomas (2004), such answers merely restated or slightly elaborated on closed-question items and thus, were not analyzed further. We have provided the survey items with scoring details (Online Resource 1), and anonymized survey data (Online Resource 2); topic guides are available on request.
Qualitative Measures and Procedures
Following the preliminary analysis of survey responses, a topic guide was developed using a deductive descriptive approach (McCrudden et al., 2019). Questions addressed the most prominent issues highlighted by the survey as well as asked interviewees how these issues impact recovery from DV for their clients, and what supports they currently see/wish to see in Ireland. The following sections were covered by the developed topic guide; ‘Mental Health’, ‘Emotional Health’, ‘Social/Relational and Cultural Health’, ‘Parenting Needs’, and ‘Employment, Income & Housing’. Six semi-structured interviews were conducted one-to-one over Zoom between May and June 2023, ranging from 30 to 45 min each. Before completing the interview, participants were reminded of the purpose of the study and their right to withdraw, the limits of confidentiality were readdressed as well as the purpose of recording the interview for transcription; their consent was then reconfirmed. Before concluding the interview, participants were also invited to share any points they felt were not addressed or wished to further expand on.
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Qualitative Data Analysis
Using the six-phase analysis method and 15-point checklist proposed by Braun and Clarke (2006, 2019) we performed an inductive thematic analysis on the interview transcripts. The interviews were transcribed verbatim following each interview and later checked against the audio for accuracy. Once this was complete, an initial review of the transcripts was conducted, to become familiarized with the data. This process involved line-by-line coding to generate the initial codes. Once completed, we systematically searched for themes within the data and reviewed them to ensure accurate and in-depth capturing of the participants’ responses by re-reading the transcripts. These identified themes were then defined and feature in the Results section below. Throughout the data collection and analysis process, the researcher embraced reflexivity by adopting reflective journaling methods suggested by Braun and Clarke (2019).
Results
Survey Findings
Of the 96 survey items relating to frequency of issues, 37 reached our minimum threshold for inclusion; a median score of ≥ 3.5; reflecting that a majority of respondents selected higher frequencies than “Half” of the time (see Table 2 for items reaching this threshold). 32 items received a median score of 4. One item ‘feel fear towards their abuser(s)’ received a median score of 4.5 whilst three items– ‘worry about the impact of DV on their children’, ‘have enough income to save money’ (reverse scored item) and ‘report stress/worry about their finances’ - received a median score of 5. Median scores of 2– “Rarely” observed issues– were recorded for 16 items; one of the six Physical Health items, five of the nine Mental Health items, one of the 12 Social Health items, three of the 11 Cultural Health items, five of the 12 Education & Employment items and one of the 10 Income & Housing items; please see Online Resource 2 for full details. Of the Access to Services items (n = 11), eight items earned a median score of 3 or 4, indicating that most participants felt their clients had access to the named services “Half” or “Most” of the time. Three services earned a score of 2, namely “Community Mental Health/Psychiatrist” (M = 3.75, SD =.89), “Disability Services” (M = 2.93, SD = 1.62) and “Education/Employment Services” (M = 3.7, SD = 1.16). However, it is unclear whether this represents participant views’ of these services as rarely accessible, or rarely in request from their clients. Interestingly, the items asking participants how often their clients report feeling other services are helpful/understanding (M = 3.05, SD = 1.06) and are not helpful/understanding (M = 2.98, SD = 1.12) of DV both earned median scores of 3, and similar mean and standard deviation scores. Whilst access to other services does not present as a pressing issue from the survey analysis– in comparison to other items– the perceived experiences of their clients engaging with external services appears to be mixed amongst the sample. Potential trend analysis based on urban/rural location of participants was not possible due to the highly skewed representation of participants in predominately urban settings; see Table 1.
A significant proportion of respondents reported that their clients frequently experienced depression (M = 3.9, SD = 0.67), anxiety (M = 4.25, SD = 0.63) and sleep disturbances (M = 4.25, SD =.81) as well as a high number of Emotional Health needs (see Table 2). Social Health, Parental Needs and Income & Housing sections also had several items with median scores ≥ 3.5, with only one item from the Cultural Health and the Education & Employment sections exceeding this threshold. The median scores– ranging from 3.5 to 5– and narrow interquartile ranges suggest a consistent pattern of reporting among respondents, indicating that most assessed these needs as occurring “Most of the time” or “Always”. Furthermore, when asked to rank the accommodation clients in refuge exited to (1 = most common, 5 = least common), 67.5% of participants (n = 27) ranked ‘Homeless Services/Accommodation’ as the most common. ‘Return Home Without Abuser(s) Present’ received a score of 4 or 5 by 77.5% of the sample (n = 31), indicating it as the least observed outcome for women post-refuge, according to our sample.
Table 1
Survey sample demographics
County of work | n | % of sample | Job role* | n | % of sample | ||
|---|---|---|---|---|---|---|---|
Dublin | 26 | 65.0 | Refuge Worker | 25 | 62.5 | ||
Cork | 4 | 10.0 | Outreach Worker | 10 | 25.0 | ||
Galway | 3 | 7.5 | Court Support Worker | 4 | 10.0 | ||
Wexford | 2 | 5.0 | Child Support Worker | 1 | 2.5 | ||
Kerry | 2 | 5.0 | |||||
Limerick | 2 | 5.0 | |||||
Wicklow | 1 | 2.5 | |||||
Mean score | SD | Median | Range | Min | Max | ||
Years working in DVSs | 3.73 | 5.5 2.08 | 29.5 | 0.5 | 30 | ||
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Table 2
Survey results of interest
Survey Item | Survey Answer Frequencies % (n) | Measures of Central Tendencies and Dispersion | |||||||
|---|---|---|---|---|---|---|---|---|---|
A* | M* | H* | R* | N* | Mean | SD | Median | IQR | |
Section: Mental Health | |||||||||
Experience depression | 12.5 (5) | 70 (28) | 12.5 (5) | 5 (2) | 0 (0) | 3.9 | 0.672 | 4 | 0 |
Experience anxiety | 35 (14) | 55 (22) | 10 (4) | 0 (0) | 0 (0) | 4.25 | 0.63 | 4 | 1 |
Experience sleep disturbances | 42.5 (17) | 45 (18) | 7.5 (3) | 5 (2) | 0 (0) | 4.25 | 0.809 | 4 | 1 |
Fatigue/tiredness even after sleep | 22.5 (9) | 62.5 (25) | 12.5 (5) | 2.5 (1) | 0 (0) | 4.05 | 0.677 | 4 | 0 |
Section: Emotional Health | |||||||||
Feel hopeless | 20 (8) | 55 (22) | 15 (6) | 10 (4) | 0 (0) | 3.85 | 0.864 | 4 | 0.75 |
Feel lonely | 17.5 (7) | 47.5 (19) | 27.5 (11) | 7.5 (3) | 0 (0) | 3.75 | 0.84 | 4 | 1 |
Feel grief | 27.5 (11) | 42.5 (17) | 25 (10) | 5 (2) | 0 (0) | 3.93 | 0.859 | 4 | 2 |
Feel isolated emotionally | 7.5 (3) | 60 (24) | 25 (10) | 7.5 (3) | 0 (0) | 3.68 | 0.73 | 4 | 1 |
Feel fear relating to their abuser(s) | 50 (20) | 47.5 (19) | 2.5 (1) | 0 (0) | 0 (0) | 4.47 | 0.554 | 4.5 | 1 |
Feel overwhelmed by their emotions | 20 (8) | 55 (22) | 22.5 (9) | 2.5 (1) | 0 (0) | 3.93 | 0.73 | 4 | 0.75 |
Feel happy, joyful or positive emotions | 2.5 (1) | 10 (4) | 10 (4) | 65 (26) | 12.5 (5) | 3.73 | 0.987 | 4 | 0 |
Feel emotionally supported | 2.5 (1) | 17.5 (7) | 27.5 (11) | 52.5 (21) | 0 (0) | 3.28 | 0.993 | 4 | 1 |
Section: Social/Relational Health | |||||||||
Have friends or family they can turn to | 0 (0) | 7.5 (3) | 27.5 (11) | 65 (26) | 0 (0) | 3.58 | 0.636 | 4 | 2 |
Positive relationship with family of origin | 0 (0) | 0 (0) | 45 (18) | 55 (22) | 0 (0) | 3.55 | 0.504 | 4 | 1 |
DV from past/current romantic partner(s) | 35 (14) | 50 (20) | 2.5 (1) | 12.5 (5) | 0 (0) | 4.08 | 0.944 | 4 | 1 |
Connection to their community/local area | 0 (0) | 5 (2) | 20 (8) | 62.5 (25) | 12.5 (5) | 3.83 | 0.712 | 4 | 0.75 |
Have good supports in their community | 5 (2) | 0 (0) | 10 (4) | 72.5 (29) | 12.5 (5) | 3.83 | 1.01 | 4 | 0 |
Have a hobby/activity | 0 (0) | 0 (0) | 0 (0) | 70 (28) | 30 (12) | 4.3 | 0.464 | 4 | 1 |
Experience social isolation | 2.5 (1) | 57.5 (23) | 12.5 (5) | 27.5 (11) | 0 (0) | 3.35 | 0.921 | 4 | 2 |
Section: Cultural Health | |||||||||
Support from others of similar culture | 0 (0) | 0 (0) | 15 (6) | 72.5 (29) | 12.5 (5) | 3.98 | 0.53 | 4 | 0 |
Section: Parental Needs | |||||||||
Trusted person to mind their child(ren) | 0 (0) | 22.5 (9) | 15 (6) | 62.5 (25) | 0 (0) | 3.4 | 0.841 | 4 | 1 |
Have someone to teach parenting skills | 2.5 (1) | 12.5 (5) | 10 (4) | 57.5 (23) | 17.5 (7) | 3.73 | 1.06 | 4 | 0.75 |
Have someone to provide reassurance | 2.5 (1) | 7.5 (3) | 12.5 (5) | 62.5 (25) | 15 (6) | 3.78 | 0.974 | 4 | 0 |
Feel overwhelmed trying to parent | 5 (2) | 52.5 (21) | 30 (12) | 12.5 (5) | 0 (0) | 3.5 | 0.784 | 4 | 1 |
Have time to look after their own needs | 0 (0) | 10 (4) | 7.5 (3) | 52.5 (21) | 30 (12) | 4.03 | 0.891 | 4 | 1 |
Worry about impact of DV on children | 60 (24) | 22.5 (9) | 17.5 (7) | 0 (0) | 0 (0) | 4.43 | 0.781 | 5 | 1 |
Section: Education and Employment: | |||||||||
DV impacted their work performance | 15 (6) | 37.5 (15) | 30 (12) | 17.5 (7) | 0(0) | 3.5 | 0.961 | 4 | 1 |
Section: Income and Housing: | |||||||||
Have own bank account and safe access | 0 (0) | 10 (4) | 40 (16) | 50 (20) | 0 (0) | 3.4 | 0.672 | 3.5 | 1 |
Have their own income | 0 (0) | 15 (6) | 32.5 (13) | 52.5 (21) | 0 (0) | 3.38 | 0.74 | 4 | 1 |
Have enough income to manage their bills | 0 (0) | 10 (4) | 30 (12) | 50 (20) | 10 (4) | 3.6 | 0.81 | 4 | 1 |
Have enough income to save money | 0 (0) | 0 (0) | 0 (0) | 47.5 (19) | 52.5 (21) | 4.53 | 0.506 | 5 | 1 |
Report stress/worry about their finances | 62.5 (25) | 17.5 (7) | 15 (6) | 5 (2) | 0 (0) | 4.38 | 0.925 | 5 | 1 |
Can return home after legal interventions | 0 (0) | 30 (12) | 15 (6) | 47.5 (19) | 7.5 (3) | 3.33 | 0.997 | 4 | 2 |
Need to seek new housing to escape DV | 10 (4) | 62.5 (25) | 2.5 (1) | 25 (10) | 0 (0) | 3.58 | 0.984 | 4 | 1.75 |
Stayed in DV due to no housing options | 32.5 (13) | 30 (12) | 27.5 (11) | 10 (4) | 0 (0) | 3.85 | 1.01 | 4 | 2 |
For clients in refuge please rank from 1 (most common) to 5 (least common) the type of accommodation they exit to | Survey Answer Frequencies % (n) | ||||||||
1 | 2 | 3 | 4 | 5 | Mean | SD | Median | IQR | |
Homeless Services/Accommodation | 67.5 (27) | 17.5 (7) | 0 (0) | 5 (2) | 10 (4) | 4.25 | 1.39 | 5 | 1 |
Return Home without Abuser(s) Present | 0 (0) | 15 (6) | 7.5 (3) | 52.5 (21) | 25 (10) | 2.03 | 1.15 | 4 | 0.75 |
Interview Findings
Based on the descriptions of their role that each individual provided, it was evident that all participants work with women across DV situations; from those currently in an abusive relationship and those attempting to escape, to those who have exited the relationship but are still dealing with the negative repercussions and requiring support. A thematic analysis (Braun & Clarke, 2006) was conducted, with five themes each with three subthemes generated. During reflection on theme generation, we observed categorizations aligning with an Ecological Systems framework (Carlson, 1984); spanning individual, relational, social-structural and societal levels. The following themes are therefore posited under these domains as followed; (1) Institutional Responses (societal), (2) Structural Entrapments (social-structural), (3) Social Connections (relational) and (4) Emotional and Mental Experiences (individual); See Fig. 1. for thematic map. Furthermore, whilst the chronological level in ecological models typically represents the changing of environments or culture over time, here we posit the theme of (5) ‘Trauma Longevity’ as an ongoing factor in flux; both influencing and being influenced by the aforementioned domains.
Theme 1: Institutional Responses
Whilst participants noted a number of professionals who survivors may come into contact with, three core services– and their impacts on victim/survivor wellbeing– emerged; the courts systems, the police, and DVS refuges. These form two of the subthemes; (1) The Legal System and (2) “Refuge but….”. The third subtheme captures what interviewees perceive as missing from non-DVSs; (3) Professional DV Education.
Participants expressed that engagement with the Irish courts and an Garda Síochána (Irish police force) can have detrimental influences on their clients; the majority stated the view that both institutions are not aware of the effects of trauma on survivors’ abilities and behaviors, and thus can disregard or misinterpret these in ways that impact survivors negatively;
“The trouble with PTSD is their memory is fragmented, so they might not remember everything in one order….so it really does impact on their ability when they attend court. Their senses get overwhelmed, they completely shut down. I’d a lady last week, she just lost what she was saying on the stand, couldn’t remember anything, so she looked like a really bad witness. Like she was telling the truth, but it’s just that her post traumatic stress is shutting her brain down.” - P5.“We’d offer to sit in with the ladies when they’re giving a statement [to police], and I’ve had to jump in on a good few, asking the [police officer] to stop interrupting her, to give her a few seconds to answer, let her get a tissue cause she’s sobbing her eyes out telling you the most horrific experiences of her life and you’re shouting at her; it’s why it’s our practice to offer to sit in, cause I wish I could tell you that was a rare occurrence.” - P2.
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In relation to women who have children with the abuser, participants commented that access cases– court-ordered periods children are with their father– do not adequately consider the role of previous DV on mothers and their children, perpetuating further harm to women worrying about the safety and wellbeing of their children.
“The worst damage I see to my clients in relation to their children is what the court system does. The court system’s inability to put the children’s interest first, but unfortunately, they don’t. They put fathers’ interest first…. what [clients] are not able for is the court system ripping the children out and sending them to the abuser when the children don’t want to go on overnight access.” - P5.“I can’t remember the figures, but I think something like 80% of the courts in district court are to do with domestic violence cases. So even if they’re turning up just for access or whatever, there’s often been abuse in the past. I think there’s a huge fear in how it’s impacting the children, how it has impacted. And then that continued exposure. Again, ‘How do I mitigate against that?’.” - P6.
The role and responses of refuges– crisis accommodation provided by DVSs– was highlighted by participants as crucial; both in offering safe shelter to escape DV victimization and be connected with supports, but also in how being out of the immediate threat allows women space to process their experiences and make decisions;
“You can’t be questioning the meaning of life when you’re worried that you’re going to get beaten tonight, you just don’t have that space. And so, I think with refuge, you have that distance.” - P1.“We can sometimes see the same women back more than once, be it she went back to the same abuser, or he came after her, he’s disregarding the order, or it’s a new DV relationship; but the fact that she knows we’re here if she needs us, however many times she needs us; sometimes people aren’t ready to do the deep trauma work the first time, but maybe on the second they will, they know here is safe and they’ll be supported.”, - P2.
However, interviewees noted that these benefits of refuge are often obstructed by the lack of additional or alternative accommodations to exit to, creating anxiety for women about their immediate futures. Although some transitional houses– DVS supported medium-term housing– exist, these were noted to be in stark short supply by three participants, who advocated that more are needed around the country;
“And realistically, ‘we have nowhere else to put you after the refuge other than to refer you to homeless.’ Like again, how could you not continue to feel anxious? Continue to worry what the future looks like for you and your children and continue to not feel able to relax?…. I think just even the next step from refuge being so up in the air, that wouldn’t help.” - P1.“I definitely think I’d like to see more transitional housing, so moving away from- I think refuges will always have a place in need- but more transitional houses because it allows them a space to decompress, to stabilize. I think that aids their recovery.” - P6.
The importance of specialized DV education for service providers was regarded by the majority of interviewees, both through commenting on the impact of its absence amongst professionals involved in court proceedings, as well as improved but inconsistent interactions of their clients over time with an Garda Síochána;
“I would like to see court report experts, the psychologists and social workers that write these reports. They need to be trained, and it needs to be accredited. At the minute they’re absolutely not. Training is absent from a domestic violence professional. It’s absolutely crucial…. Anyone that comes in contact, because they’re missing the abuse, they might say that “she has a drink problem”, but they are missing the abuse.” - P5.“Like, thankfully, there’s now decent [police officers] and you’re hearing better stories. But you’re still hearing some atrocious stories of [police officers] giving women wrong information, sending them back to situations that are dangerous and not being believed. Because you kind of think, ‘God, well done for going’ and then sure ‘Jesus, she won’t be going there again!’ you know? And it’s just a missed opportunity.” - P1.
Theme 2: Structural Entrapments
In addition to the risk of poverty and homelessness their clients face when escaping abusive relationships, interviewees described systemic barriers regarding accessing government financial and housing supports. These issues and their impacts form the first two subthemes (1) Poverty or Penalization and (2) Homeless Impact, whilst the third subtheme addresses what participants view as necessary to address them; (3) Reform and DV Prioritization.
Interviewees addressed the double-edged “costs to freedom” for their clients, who face both a reduction in income and resources, as well as additional financial costs in terms of lone parenting their children, and legal interventions such as divorce and access proceedings;
“When a woman leaves her abuse, she’s also missing another piece of income there to support her children. So that’s gone. And then she’s trying to manage everything on her own. Financial pressure is such a stressful thing for the women. Having to constantly look at the price of things and go for something cheaper, say no to your kids. You know, it has a knock-on effect, which equally destroys your mental health as well.” - P4.“What I do see with a lot of our clients is that they’re working in low paid jobs, part time, to make ends meet, and they’re on social welfare, which then puts them over the limit for legal aid. So then, when they’re going to a divorce case, they’re having to pay their lawyers. And then if they get brought back to court 20 times, all their money is gone. This is financial abuse through the legal system.” - P5.
Furthermore, interviewees also stated that such dilemmas force women to exit employment as earned income puts them above designated thresholds for legal and housing supports, but entraps them in poverty;
“So, to have the immediate foundation needs met; housing and finance. The vast majority of women are having to enter poverty, and that is a huge, huge cost.” - P6.“That’s trapping women in poverty. That’s making them go back into the social welfare system rather than working. We have managed to get, through the HAP 1scheme, some into housing. But their rents are way above the housing limits for HAP and so they’re having to pay the extra money out themselves. So again, it’s another poverty trap.” - P5
Regarding social housing supports, participants described a lack of entitlements for clients who co-own their property with the abuser, and penalization of both those who flee their owned homes and those who flee or surrender social housing tenancies;
“I’ve been here six years. There isn’t a client that housing and finance are not at the absolute forefront in terms of their plan to try and get away from their abuse.” - P6.“’e might be able to give you HAP, but you’re going to have to wait for 12 months, to go on the Council housing list again because you’re making yourself homeless.’ Yeah. They’re ‘making themselves homeless’ by leaving a DV situation. They’re penalized for 12 months for that.” - P1.“They have to present to the County Council, and if they’re not entitled to housing supports because their name is on a house, then they’re told ‘your option is to get a safety order and go home’.” - P3.
All six participants spoke of the impact of facing or experiencing homelessness on their clients’ wellbeing, and also decision-making. For the latter, interviewees cited fear of homeless services and losing custody of their children as leading women to return to or remain in households with domestic violence;
“It’s a brutal situation where you are saying to somebody ‘your options are going home - hopefully, maybe - with an order or going to homeless accommodation’ because, honestly, there is so little options. Why would you not go home to the abuse that you know, rather than walk into that?” - P1.“So again, it’s another poverty trap. But if they don’t do that, they have nowhere for their kids to stay. Then they lose custody……. I have clients that should have custody of their children. The children are living with the abuser because she has nowhere to take the children.” - P5.“Very difficult because a lot of women tend to return for that reason, feeling like they can’t cope, they can’t do it on their own, and a lot of them tend to go back….We can’t get them housed, so unfortunately, they’re going back to the abuse because they want to keep their kids safe. And although we know it’s not safe, but they’re thinking safety, as in basic needs of housing, water, food.” - P4.
Two interviewees also made comparisons of housing security vs. homelessness on the recovery trajectories of their clients; one participant contrasted clients from years ago to those now and the role of an accelerating national housing crisis, whilst another described clients in crisis accommodation who either found housing or exited into homelessness;
“…Like there was options. There was, you know, you got your HAP and you searched and searched, and you got a private rental. And there was ways out, and it was great as staff even, as well as obviously the ladies, because it was like, ‘Oh, great. It only took 129 days for her to change her life. 129 days in refuge for her to move away from the abuse and not have to go back’.” - P1.“Some of them got moved into social housing, into new houses and they were doing so much better than the women who ended up still homeless after that, or back with families, living on couches and sharing rooms. You can just see with a woman, what safety and security does.” - P3.
Participants consistently called for systemic reforms that prioritize the safety and well-being of survivors. The lack of - or delayed - response by State services was posited by participants as a result of low awareness of the urgent needs of their clients. To address this, interviewees collectively suggested structural prioritization of DV survivors, from designated DV liaison workers and policy change to more rapid responses of existing DV housing supports;
“County Council wise, I think there maybe should be a specialized domestic abuse liaison officer that deals with us, any of the housing queries that relate to DV, that prioritization is actually given, that if there’s a need for transfers, that is completed, because that’s such a major issue we have.” - P6.“DV rent supplement, which is an emergency payment for three months; it all sounds well and good. But I tried to refer a woman, and she did find a place to live and she’s 67 weeks now into an apartment; that payment still hasn’t come through. And this is meant to be an emergency payment.” - P3.“It is so frustrating when you have a woman, possibly children too, going to a homeless service, their lives turned upside down, and a perpetrator is living in a 3-bedroom house on his own…you’re seeing County Councils not evicting or barring convicted abusers, and then having the gall to penalize women who surrender or take their name off of a social house…It needs to change.” - P2.
Theme 3: Social Connections
The noticeable difference social support– or lack, thereof– makes for women recovering from DV was commented on by the majority of participants, as well as the exacerbated need for and difficulty providing this for migrant survivors, and the facilitating role of peer support groups in addressing support deficits. This is represented via three subthemes; (1) Isolation vs. Support, (2) Lost In Translation and (3) Peer Support Groups.
Participants acknowledged the internal and external impacts of DV victimization on their clients’ isolation; encompassing that negative self-views may prevent women engaging with social supports as well as the isolating tactic abusers utilize to exert further control;
“If they’ve been isolated in their abuse, the majority of their life, they know no difference. So, it’s hard to then just turn into a social butterfly, it takes time, and it’s a journey.” - P4.“There can be shame keeping them from telling their family or friends. But it can also be another survival strategy….sometimes the woman is so afraid and is just trying to live minute-to-minute, she’s not thinking of the love or help her friends can offer.” - P2.“So many women’s worlds can become very small, often not allowed to talk to friends for years. This lack of social connections makes their world so small, lonely; they’ve no support around them.” - P1.
Support from the families of survivors was noted to potentially play a protective role, helping clients mitigate post-separation challenges, or exacerbating hurt by invalidating their experiences;
“Families can really go both ways, to the extreme. You’ve families where there was– or still is– DV, or even that don’t but encourage women to go back, in the name of ‘keeping the family together’. But I’ve also seen families be phenomenal supports for the women, you can see the difference.” - P2.“That’s very often the deciding factor between who becomes a [refuge] resident, or ends up in homeless services, and who stays as a long-term client, is the family support, that is a very determining factor.” - P3.
The heightened risk of isolation for migrant survivors in Ireland was highlighted by several participants; noting language barriers and a lack of awareness of DV laws and services can lead migrant women to believe there is no alternative than to remain in the abusive relationship;
“There are so many women who are literally on their own in the country…for people who are coming in, who have nobody, have no clue, don’t have the language, don’t have any access to money, who are absolutely terrified. They’ve been told ‘you won’t survive without me’. Like they can really believe it because they have nobody else. They don’t know that all these supports are out there.” - P1.“Especially with my non-national clients. They cannot communicate, so they’re afraid of their own solicitors. They don’t understand what’s happening…. She often doesn’t know what’s going on. She’s just terrified and so that produces really bad outcomes for these women and their children.” - P5.
Interviewees also commented on the impact of language barriers limiting the support they can offer some clients, thus continuing a sense of isolation, particularly in relation to processing trauma or experiencing intensive emotional responses;
“If you’ve got trauma and then you’ve got somebody who can’t speak English, it’s nearly like it’s trapped…Again, just even language, it’s so hard when you see somebody, and they’re upset and you can’t comfort them. You can comfort them a little bit, but not the same way as properly connecting, communicating the hurt that they’re feeling.” - P1.“My heart goes out to the ladies who can’t speak English, or who can a bit but trauma or emotions just shuts down that ability. You see that raw pain, emotions are a universal language…I think the gist of it gets across, but you’re never 100% connected; and that connection is so important when you’re working with trauma.”- P2.
All six participants expressed the view that peer support groups were key to the social– and overall– recovery of their clients. Interviewees described these as reducing isolation and promoting feelings of acceptance and solidarity, but noted groups are in short supply and not prioritized due to resource constraints;
“I would like to see - and that we don’t have - is support groups for the women. I do a lot of 1-to-1 work, but I actually really think we need more support groups for them to say, ‘It’s not just me’.” - P3.“They do need more peer support. They need more opportunities to mix with each other and meet, meet with each other. It’s just that everything is so pressed; time, money, everything. That these sorts of programs kind of get pushed sideways.” - P5.
Theme 4: Emotional and Mental Experiences
Throughout interviews, participants highlighted the toll experiencing DV– and the aforementioned consequential hardships clients face– takes on their emotional health, as well as mental health difficulties that may arise. The following subthemes address (1) Complex Emotions, described as unique to DV survivors, (2) Mental Health of Mothers, the often-deprioritized need by clients and weaponized need by abusers, and (3) Holistic Mental Health Care, called on for by DVS professionals for medical doctors to take a trauma-informed approach and address the current medication-focused response to survivors;
Speaking of the range of emotions their clients experience, participants noted trends of sadness, hopelessness, anger, grief, and fear. Furthermore, they also described how these can co-occur, particularly in relation to the ending of their relationship with the abuser;
“You’ve not just gone through abuse. You’ve also lost- I think what people seem to forget is you’ve lost your husband or your partner who you actually love very much. So, you’re trying to deal with the actual heartbreak of losing somebody.” - P4.“Sometimes you get a lot of grief as well as another emotion that I deal with, even if they come out with a divorce they wanted. And they got everything they wanted. There’s a loss, a sense of grief and that their life hasn’t worked as they wanted, or the children are affected. Or I see a lot of that kind of guilt and grief, especially around the children.” - P5.
For their clients who are mothers, interviewees noted particular barriers to attending to the emotional and mental health difficulties stemming from DV victimization. Prioritization of their children’s needs, lacking childcare or time apart from the children to attend therapeutic supports and ongoing contact with abusers regarding parenting were cited as preventing women from processing their emerging emotional responses to their abuse;
“She has to be the mammy, she’s got to put the face on, to make the dinner. She’s got to do everything you have to do, and so she’s only able to fall apart when the kids go to sleep.” - P1.“Yeah, the mam guilt is definitely there. You know, sometimes they look at the kids and they just break down because they feel awful. And that’s them being so hard on themselves, as the mothers do.” - P4.“There is a difference for women with kids; when it’s just them and they leave [the relationship], they can look at processing trauma, they can look at releasing everything that was held in while they were in survival mode. But when kids are involved, she will always be connected to him, so instead of releasing those emotions, they can be triggered every time she’s contacted by him.” - P2.
In addition to these barriers, several interviewees reported their clients worry that receiving formal mental health supports may be utilized against them by abusers with regards to custody of their children, noting this as a common form of coercive control mothers face;
“One of the barriers that a lot of my clients have faced is that it is used against them in the legal system. That it is used as an excuse for that woman, maybe to be labelled as an unfit mother. It can be used very often as a defense against domestic violence…many occasions where a woman’s mental health history has been brought to the court to use in access and safety order hearings.” - P3.“The biggest threat that you can ever say to a mammy is ‘I’ll ring [Child Protection Services]. I’ll get custody of him. He’ll be taken off you. You’re mad. You’re on antidepressants. Nobody’s gonna believe you’.” - P1.“A lot of my clients as well are worried if they speak to a GP that it will be used against them in court that, if they seek help, because a very common form of threat and coercion, I’d say in most of my cases, would be around saying that the mam is mentally unwell.” - P5.
Regarding current mental healthcare for their clients, five interviewees described rapid provision of anti-depressant and hypnotic medications when women present with mood or sleep disturbances. Some participants shared appreciation for the potential contribution of medication to their clients’ wellbeing, but all expressed that holistic supports are needed;
“We see this issue, where you go to a doctor and the first thing is ‘We’ll give you pills.” - P5
“The doctors will just throw the tablets, some anti-depressants. I feel like interventions is what’s needed. More groups, more supports for women, more active supports.”- P4.“Well, I’m not a big, huge believer in medication, but I sometimes think it does have its place. If a woman is really, really struggling to function, I think it does have its place sometimes, medication. But it should always be done alongside that talking therapy as well.” - P1.
However, one participant expressed concern that the use of medication reduced the women’s trauma to clinical symptoms, whilst another two posited mental health difficulties– including substance misuse– as stemming from post-traumatic stress;
“I’m not against medication, but I do see this as a way of misdiagnosing the ladies; only looking at the depression and ignoring all the impacts of trauma on her mind and body; labelling her based on the medication she’s being prescribed and not what’s actually going on for her.” - P2.“You get the anxiety, you get depression, substance abuse. So that would be the main thing when I see a client, it’s all post-traumatic stress.” - P5.“Their mind has gone through a severe amount of trauma. To the point that sometimes women make unhealthy choices and go down on the wrong road. Sometimes they turn to substance abuse.” - P4.
Theme 5: Trauma Longevity
All six participants highlighted the traumatic impact of DV victimization on their clients. This was expressed both directly as a result of experiencing prolonged abuse, and indirectly via interactions with trauma-inducing systems. Three subthemes were developed to capture the dynamic impacts of trauma participants observe their clients going through; (1) Chronic Traumatization, (2) Re-Traumatization, and (3) Non-Linear Recovery.
All participants endorsed the view that DV victimization typically led to long-term, trauma-based impacts for their clients, with several referring to PTSD. In addition to the aforementioned social, emotional, and mental outcomes for survivors, interviewees also spoke of the abuser’s influence remaining regarding the women’s relationships with themselves and their children even post-separation;
“Where just because they’ve left the abuser, the abuser hasn’t left their head, so very often they will still continue to hear exactly what he would say.” - P1.“That longitudinal experience of domestic abuse, it never ends it, it affects in different ways. It has residual impacts both on mam and the kids, and then dynamics within the family then as a unit.” - P6.
Furthermore, the majority of participants referred to clients being in “survival mode”; both whilst in the abusive relationship and continuing after separation as they face traumatic losses, such as facing homelessness;
“It’s like taking two steps forward and 55,000 steps back because they come in and we give them hope. We help them flee their domestic abuse, help them get on the right track. And then, unfortunately, with the housing crisis the way it is at the moment we have no options sometimes, and their only option is to move them to homeless. And it’s just such an anti-climax and devastation to a woman and to a mother, to have to go into homeless.” - P4.“You’re telling someone who’s already lost themselves in an abusive relationship, to give up everything else they have. Give up your home, your possessions, say goodbye to everything you knew, any scrap of social support you had….the losses they experience are never ending.” - P2.
Distinct from the prolonging of “survival mode”, interviewees also described re-traumatization– reactivation of trauma-based responses - of their clients; primarily via interactions with services and institutions;
“But it’s when they come out of survival mode and they’re in the court system and their children are being sent off to access that is unsafe, you know? It’s absolutely terrifying. Yeah, I think that’s more the impact on mothering, as a direct result of insensitive and untrained court system.”> - P5.“And then there’s drug abuse and alcohol abuse, and also domestic violence in homeless services as well. So, it’s really triggering for the woman, she’s re-traumatized.” - P4.“It can take so much to build a woman back up such effort from her, from her supports; and one bad interaction with a [police officer] or judge can send her miles backwards. She feels she’s back in it.”– P2.
In describing the impacts of trauma– and mechanisms of recovery– all participants endorsed the view that their clients go through a non-linear progression through stages of experiencing trauma, processing it, re-traumatization and re-engagement with life; often managing these experiences alongside the benefits and sacrifices made to escape DV victimization;
“It’s not a straight road. It’s up and down. And it takes a long, long time to get to an even keel, because a woman is trying to deal with everything.” - P4.“You can’t think about your recovery if your housing is not secure, you can’t think of anything else. You’re in fight or flight mode at all times, haven’t got your basic needs met, can’t think about healing from the past.” - P3.
In recognition of the longitudinal– and sometimes unpredictable– nature of DV victimization and recovery, most participants referred to the ongoing support DVSs offer to clients, particularly noting the importance of psychoeducation in facilitating autonomy;
“I tell clients; ‘you have to fight to hold on and fight to let go. And it’s not a race or a sprint. It will be a marathon, but we’ll be with you along the way’.” - P6.“It’s really about meeting the woman where she is at in her journey; you can’t force someone to process emotions, and you can’t do it for them. It’s a mixture of having the right external resources, the housing, the safety, the security, the physical needs, and also the internal resources, her inner emotional world, her inner strength; a lot of things need investment for her recovery.” - P2.“I think our work, particularly post separation, is contextualizing their experience of domestic abuse in terms of the survival strategies they’ve used, and whether they’re still serving them as much anymore, introducing the idea of choice and control that they didn’t have before.” - P6.
Fig. 1
Thematic map
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Subtheme Linkages
Individually and collectively, the participants illustrated how the psychosocial needs of their clients are often interdependent; beyond the expected impact of positive/negative external events on internal emotional states. Interviewees noted several examples of wider structural and institutional bodies upholding or contributing to the power imbalances women who’ve experienced DV are attempting to escape. The most commonly addressed interactions are captured as inter-related subthemes (see Fig. 1), with a brief description of the relationship between subthemes provided below. Interviewees expressed that engagement with the courts (Legal System) often results in financial penalties that leave survivors in precarious economic situations, deterring employment and/or depleting income via multiple court dates and low free legal aid thresholds (Poverty or Penalization). Furthermore, the disclosed accounts of women who are mothers having their mental health histories weaponized in courtrooms– and the resulting fear of seeking mental health care– reflects the impact of legal system powers of survivor’s decision-making (Mental Health of Mothers). Regarding these barriers, participants noted that the current legal framework may contribute to ongoing trauma and inadequate protection of DV victims, noting critical change is needed to effectively meet the needs of women who experience DV in Ireland (Reform & Prioritization). Significant system change was also called for with regards to accommodation supports for survivors post-crisis (“Refuge but…”); while refuges were regarded as providing essential services, their long-term support limitations– and lack of alternative accommodation– leave victims vulnerable to homelessness, thus entrapping them in further cycles of instability and risk (Homeless Impact).
Discussion
The aim of this study was to identify, via frontline DVS staff, the breath of psychosocial needs of women engaged with Irish DVSs, to assess their most frequently presenting issues, as well as the impacts of these on their recovery from DV victimization. Through the survey data of DVS staff, it is apparent that the women they support face an array of difficulties stemming from DV victimization, with the majority of respondents stating issues around mental, emotional, and social health are present for their clients. Furthermore, participants’ answers to the survey reveal that deficits in financial and housing security are prominent, indicating that women engaging with their services typically have unmet basic needs in addition to the psychosocial consequences of DV victimization. Via in-depth individual interviews, frontline DVS staff elaborated on this snapshot of needs. Speaking to the lived experience of their clients managing the psychosocial impacts of DV victimization, interviewees noted the interactions and influences of needs with and on one another, as well as the effects of wider social and societal factors on their clients’ recovery. We posit the findings of our thematic analysis as multifaceted and dynamic components of an ecological systems framework of DV survivors’ psychosocial needs, reflecting the longstanding use of such frameworks in this area (Carlson, 1984; Hardesty & Ogosky, 2020). Our positing of trauma at the chronological level is also backed by prior literature (Hardesty & Ogosky, 2020). Unlike isolated events, chronic trauma, re-traumatization, and non-linear recovery represent cumulative experiences which influence, and are influenced by survivors’ relational, social-structural, and societal environments, highlighting that trauma recovery is uniquely fluid within the chronological level. Re-traumatization should be viewed as a temporally embedded risk, one that arises not merely from past trauma but is reactivated by external factors, often within systemic and relational contexts (Carman et al., 2022). This complexity underscores that the trauma recovery process cannot be strictly linear, as each setback is embedded within an overarching, time-bound process that differentiates the chronological level from the more static aspects of our findings (Bryngeirsdottir et al., 2022).
The results of this study underscore the critical challenges of poverty and lack of housing as primary barriers to recovery for women experiencing domestic violence. In addition to the risk of women returning to abusive relationships (Yakubovich et al., 2021), the damaging mental, emotional, and social impacts of homelessness for DV survivors is well documented (Mayock et al., 2016). As outlined by The Barriers Model (Grigsby & Hartman, 1997), safety, stability and meeting the basic needs of DV survivors forms the basis of their recovery, thus deficits at this level may prolong and compound their traumatic experiences, as well as delay their healing. Of particular concern to the participants of this study were a cohort of clients deemed ineligible for social housing supports by Irish State housing agencies due to legal ownership of property, or an existing social housing tenancy. In either circumstance, interviewees stated penalization– via blacklisting from housing supports for one year– occurs, as clients are classed as “making themselves homeless” by vacating the property, despite doing so to escape an abusive household. This depicts a troubling gap in current Irish policy regarding housing. Whilst these women endure the psychosocial impacts of homelessness, they are not offered the typical social-structural supports; prolonging their recovery from DV and presenting a heightened cost-benefit disparity to leaving their abuser. In contrast, this study’s findings reconfirm the essential role refuges play– according to DV professionals - in supporting women affected by DV, both as an immediate crisis intervention, and in providing a foundation for ongoing recovery. The moderating effect of refuge support and availability on current experiences of abuse (Jonker et al., 2015) as well as nurturing trauma recovery trajectories and leading to long-term positive psychosocial outcomes (Tutty et al., 2021) is well established. Refuges and their associated benefits have been the subject of extensive prior scientific evaluation, leading to developments such as the aforementioned Social and Emotional Wellbeing Framework (Sullivan, 2018), which in turn is utilized by Irish DVSs to guide their service provision (Safe Ireland, 2022). This theory-to-practice pipeline both demonstrates the importance of research and evidence-based models on the psychosocial needs of DV survivors, but also the potential for such work to make real-world– and potentially large scale - positive differences for the survivors at the societal level. However, as noted by participants in both the quantitative and qualitative components of this study, many women face homelessness following their stay in refuge, presenting a potential mediating factor on these benefits.
Complicating the opportunities DV survivors have to secure housing is the negative relationship between DV and income. The financial costs of DV victimization - for the individual woman and the Irish State– were recently highlighted in research by Safe Ireland (2021); with an estimated cost of 113,475€ per woman spanning the abusive relationship as well as post-separation relocation and recovery. Loss of income and productivity were noted as the top contributors (Safe Ireland, 2021), a sentiment endorsed by the participants of our interviews. Court-related costs were particularly noted by interviewees to induce poverty amongst DV survivors, both by reducing the availability clients have to hold down employment, and the low-income thresholds for free legal aid deterring clients from working or draining the financial resources of those who do. Such impacts of multiple court dates– and the ongoing nature of these cases– as well as difficulties securing childcare have been recorded as key barriers for DV survivors gaining and maintaining employment (Showalter, 2016). In addition to the protective role of employment and financial security on recovery from DV victimization (Showalter, 2016; Stylianou, 2018), facilitating DV survivors to access employment and reduce social welfare usage presents an overlooked cost-saving measure by the Irish State. This strategy would require both investment in supports, and removal of social-structural barriers currently experienced by DV survivors.
In addition to financial capital, relational capital has a significant standing in the literature as a key determinant of DV survivors’ recovery trajectories. The importance of social support in aiding the recovery process for DV survivors has been underscored as a pivotal factor in enhancing outcomes (Ogbe et al., 2020). Furthermore, social supports serve as a preventative factor for returning to abusive relationships (Herman, 2019), as well as a moderating factor over the cumulative and chronic stressors faced by DV survivors during their recovery (Ogbe et al., 2020). In the current study, survey respondents endorsed observing several deficits in social support; more than half of the sample stating their clients experience social isolation ‘Most of the time’. Interviewees also highlighted the typically unique vulnerability of migrant women experiencing DV victimization and isolation, noting that this cohort may be both unaware of DVSs and in heightened need of their services. With said lack of knowledge regarding interventions for DV and language barriers preventing them– and the professionals around them– from efficiently and effectively addressing their psychosocial needs, migrant women potentially face prolonged periods within abusive relationships (Femi-Ajao et al., 2020). Acknowledging the importance of social support, as well as facilitating opportunities to foster it amongst their clients, all six of the interviewees in the current study advocated for peer support groups. These groups provide a unique and invaluable space where survivors can network with others who have navigated similar challenges, creating a sense of shared understanding and empathy (Ogbe et al., 2020). Such experiences amongst DV survivors in peer support forums are noted in the ‘Thrivership’ Model (Heywood et al., 2019) to both accelerate and stabilize the progression of women identifying with ‘survivors’ and ‘thrivers’, underpinning peer support groups as a key relational level recovery aid. As such, this finding of our study– the endorsement of peer support groups by DVS professionals, and their observed short supply in Ireland - may greatly interest DVS providers as well as community-based organizations. Whilst the aforementioned societal and social-structural influencers of DV survivors’ recovery require larger-scale reform to adapt, peer support groups present an easily and quickly implemented, low-cost intervention with demonstrated positive psychosocial outcomes (Heywood et al., 2019; Ogbe et al., 2020).
At the societal level, the Irish courts system was regarded by participants as having a severe and multilayered impact on DV survivors; primarily due to a lack of trauma-informed practitioners and legal frameworks. This criticism of the courts is echoed by DVS staff and DV survivors across numerous studies, as evident by reviews available in the literature (Hardesty & Ogosky, 2020; Katz et al., 2020), representing an issue that is not unique to the Irish context. However, with Ireland as one of few countries internationally with specific law regarding coercive control (Gill & Aspinall, 2020), this finding– the commonly reported lack of consideration of abuse impacts on survivors by the judicial system– may seem incongruent with such progressive legislation. Globally, researchers have reported on the use of legal systems by abusers– particularly regarding child access - to conduct post-separation abuse (Katz et al., 2020). Furthermore, accusations of parental alienation are typically made regarding survivors’ attempts to shield themselves and their children (Stark et al., 2019), positioning them in opposition to legal systems that prioritize mediated resolutions and co-parenting arrangements (Laing, 2017; Stark et al., 2019). This facilitation of post-separation abuse can not only prolong chronic traumatization by abusers, but it also risks re-traumatizing them as the court’s treatment of women may mirror the power dynamics of DV they have– or continually– experience with their abusers (Laing, 2017). These findings highlight a critical gap between Ireland’s progressive legal framework on DV and the practical application within judicial systems. While the law recognizes coercive control, the burden often falls on support services to provide the nuanced understanding and support of survivors impacted by coercive abuse. This places additional pressures on DVSs, underscoring the need for resources that address the unique psychological and emotional sequelae of coercive control and support non-linear, trauma-informed recovery.
Despite the wide availability of studies capturing this negative relationship of courts and DV survivors’ recovery (e.g., Hardesty & Ogosky, 2020; Stark et al., 2019), there are fewer examples of strategies to address or reduce it. As called for by the participants of the current study, there are examples of national judicial educational programs in the literature leading to increased knowledge and subjective awareness of DV presentations in family court cases (Jaffe et al., 2018) as well as an inference that it leads to more positive outcomes for DV survivors (Stark et al., 2019). Although marked with inconsistencies, participants of the current study noted improvements in their clients’ interactions with Gardai/Irish police citing the role of DV education, aligning with wider-scale studies of this topic amongst Irish DVSs (Thompson et al., 2022). With recent proposals by the Irish government to implement specialized DV training of judges (Egan & O’Malley-Dunlop, 2023), future researchers can utilize this opportunity to robustly investigate if such education-based interventions can lead to meaningful changes for DV survivors within the Irish court system.
For DV survivors who have children with their abusers, there was a concerning finding regarding the portrayal of their mental health needs in Irish courts. The interviewees noted several instances of clients expressing fear that their mental health histories and formal treatments may be weaponized in DV and child access cases, with some participants stating they have directly observed this occur in court proceedings. Whilst the occurrence of this issue is reported in the literature (Gutowski et al., 2023), the accounts provided by participants highlight an under-addressed use of the courts to perpetrate further harm to DV survivors. Additionally, the participants also described significant shortages in robust, holistic mental health care available to clients; with several interviewees illustrating an immediate medication response by Irish doctors to DV survivors presenting with difficulties. There is a wealth of research examining the risk of DV victimization leading to clinical levels of depression, anxiety, PTSD and Complex-PTSD, and the need for professionally provided psychosocial interventions (Paphitis et al., 2022). Furthermore, the lack of non-pharmaceutical treatments for DV survivors goes against established best practices regarding the mental health care of individuals at risk of PTSD or Complex-PTSD (Pill et al., 2017). This issue presents a double-edged barrier for DV survivors who have children with their abusers; the threat of utilizing clinical mental health supports in court may prevent them seeking it, whilst the lack of alternatives risks them not addressing the emotional and mental impacts of DV victimization. Without adequate support, this cohort are at risk of their experiences of chronic traumatization being prolonged, whilst also facing heightened risk of re-traumatization and more unstable recovery trajectories (Fernández-Fillol et al., 2021; Pill et al., 2017).
At the individual level of the DV experience is an array of complex and dynamic emotional and mental processes; both arising from the chronic traumatization of DV survivors by their abusers (Fernández-Fillol et al., 2021), and in response to instances of re-traumatization and ongoing hardship occurring across individual recoveries (Ogbe et al., 2020). As endorsed by the participants of both the survey and interview components of this study, studies of the emotional and mental health impacts of experiencing DV highlight the presence of fluctuating and ranging emotional responses, as well as disturbances in mood and sleep, and heightened anxiety levels (Fernández-Fillol et al., 2021; Ogbe et al., 2020; Paphitis et al., 2022). However, the role of complex grief for survivors– pertaining to their abuser and feelings regarding the end of the relationship– is less investigated than the more clinically-aligned states. Defining this as ‘disenfranchised grief’, Woodlock and colleagues (2023) recently posited that there is a lack of social acceptance for women to share such feelings and still be viewed as valid victims of abuse. Furthermore, as per Messing and colleagues (2015), mental health and social work professionals who apply an adapted grief model to the emotions and behaviors of DV survivors may be better positioned to offer effective mental and emotional health care. However, there is a significant lack of research– particularly non-qualitative studies with DV survivors– investigating this phenomenon to conclude what such interventions should look like, presenting a gap warranting further investigation.
In addition to research findings, non-findings often harbor invaluable insights into the intricacies of the phenomenon under investigation. In the realm of understanding the psychosocial needs of women accessing DVSs in Ireland, the discrepancy between survey data and prevalent literature regarding substance use rates among this demographic presents an intriguing divergence. While the survey median score of 2 indicates participants “rarely” observe this amongst their clients, this may seem contrary to the prevailing narrative of substance use rates among this demographic (Banka et al., 2022; Morton et al., 2023). The unprompted mentions of substance use by three out of six interview participants sheds light on a potential underlying issue. This disparity could indicate a systemic barrier to accessing services for DV survivors who use substances. According to a recent prevalence study (Banka et al., 2022), it is estimated that a minimum of 11,000 women who use substances in Ireland each year experience DV victimization. In a qualitative study amongst this population in England, Fox (2020) recorded a perceived disconnect between women’s DV and addiction services amongst participants, which often forced them to choose between which issue to seek support for. Commenting on the lack of services addressing intersectional needs for women in Ireland, Morton and colleagues (2023) noted that such barriers can reduce the individual’s help-seeking or encourage them to hide needs that may prevent them access. The wider literature available suggests that the reported rarity of observing substance use in the survey might not accurately reflect the reality faced by many women accessing DVSs in Ireland. Consequently, this might signify a sub-population amongst DV survivors that remains underserved or overlooked within the current support framework (Morton et al., 2023).
Limitations and Future Directions
The current study presents several limitations regarding the knowledge we could generate. 35 items had a median score of 3, indicating issues reportedly seen “half of the time” but were beyond the study’s scope. Additionally, lower endorsement of specific needs, like addiction, disabilities, or minority group identification, may reflect challenges in frequency surveying rather than indicating these needs are “rare.” Survivors may not always disclose such information– and DVSs may not seek it - due to various factors, including privacy concerns or the focus on more immediate survival needs. Such needs, even if infrequent, often intersect with broader psychosocial challenges (Wessells & Kostelny, 2022) and warrant comprehensive and equitable support. While the full survey results are available (Online Resource 2) for further research, our DVS staff sample represents only one group and includes just six individuals for qualitative data, limiting the study’s generalizability. Survivor perspectives might differ significantly from those of DVS professionals regarding key needs (Dragiewicz et al., 2023). Although our approach primarily focuses on unmet needs, we recognize the importance of a strengths-based perspective highlighting survivors’ resilience (Heywood et al., 2019). However, identifying unmet needs remains vital to reveal gaps in support and inform multi-stakeholder interventions. This approach allows for the identification of gaps in support systems and the responsibilities of broader society to provide adequate resources and interventions.
Conclusion
As highlighted by our findings, the psychosocial needs of DV survivors in Ireland span multiple domains, illustrating the far-reaching consequences of DV victimization, as well as the multifaceted factors involved in recovery. The mixed methods design of our study has allowed for both a broad snapshot of needs to be captured, as well as in-depth exploration of the lived experience of DV recovery for women in Ireland, as told by the DVS staff who support them. Our analysis concludes that DVS frontline staff posit the current needs of their clients as spanning beyond the typical psychosocial domains to include complex interactions with societal services; with significant influences of State actors on the trauma recovery trajectories. Furthermore, the ecological conceptualization of our findings presents a preliminary analysis of the factors influencing recovery at the individual, relational, social-structural, and societal levels, as well as the interweaving effect of trauma on survivors’ engagement and treatment at each level. However, development of a model is hindered due to the need for further research. As such, the approach we’ve taken may act as an evidence-based guide for future researchers aiming to further define and describe the psychosocial needs of DV survivors. This presents as an important first step in addressing the significant gap in research within the Irish context, as well as facilitating the development of empirically supported interventions and models to guide practitioners supporting DV survivors and reducing the prolonging of trauma and/or re-traumatization of women with experience of DV.
Acknowledgements
This research project would not have been possible without the time and insights generously offered by participants, and we wish each of them our sincerest thanks and well wishes. As professionals working with victims and survivors of domestic violence, the time taken from their important and demanding work to contribute to this study is greatly appreciated. Furthermore, it was evident from interviews that participants were passionate about the care of their clients, working as advocates for them across a number of domains. The often-unseen work they do to support women to escape and recover from domestic violence is inspiring.
Declarations
Ethical Approval
This study was approved by the Dublin City University School of Psychology Ethics Committee (Reference code: DCUPEC_2023_138). The procedures used in this study adhere to the ethical standards of the Psychology Ethics Committee and the tenets of the 1964 Declaration of Helsinki.
Consent
All participants provided freely given, informed consent for participation, data collection and publication of this data. Interview participants were made aware of the limits of confidentiality specific to interview data (e.g. quotes used in publication) prior to collection and consent reaffirmed.
Competing Interests
The authors have no competing interests to declare that are relevant to the content of this article. Author MK is employed by a domestic violence refuge, however neither he nor the employer/service stand to gain financially or otherwise unethically by the completion or publication of this study.
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