When a client describes intimidation, threats, or coercion by an intimate partner, a common reaction is: “Why don’t they leave?” The question may come from genuine concern, but it assumes that leaving is simple, available, and immediately safe. For someone experiencing intimate partner violence (IPV), each of those assumptions may be wrong.
A more useful clinical question is: “What makes safety possible for this client right now?” That shift invites us to understand the person's circumstances without making their willingness to leave the measure of progress.
Understand the barriers before suggesting a solution
IPV can involve physical violence, sexual violence, stalking, psychological aggression, and patterns of coercive control. A partner may restrict access to money, transportation, housing, health care, friends, or information. Threats involving children, pets, immigration status, or private images can make the consequences of leaving feel overwhelming. Love, hope, religious commitments, family pressure, and fear can coexist. None of these realities makes the abuse acceptable; they help explain the decisions a survivor must navigate. The National Domestic Violence Hotline describes both the practical and emotional barriers that can make leaving difficult.
Separation may also bring new danger. Some people know their partner's patterns better than anyone else and have good reason to fear retaliation. Others have attempted to leave and encountered increased monitoring or threats. When we treat departure as the only valid goal, we risk overlooking the client's own assessment of danger and the resources they need to stay safer.
Consider asking: “What concerns you most about making a change?” “What has helped you stay safe so far?” “Who, if anyone, can you contact safely?” These questions provide information for care while respecting the client's expertise in their own life.
Build trust without taking over
Many survivors have been told what to do, doubted, or blamed. A directive response in therapy can echo that loss of control, even when the clinician means well. Start by listening, naming what you hear, and affirming that responsibility for abuse rests with the person choosing to use it.
You might say: “I'm glad you told me. You do not deserve to be threatened. We can think together about what support would feel useful to you.” Avoid demanding details that are unnecessary for care, promising absolute confidentiality, or announcing a plan before discussing the client's priorities. Explain the applicable limits of confidentiality and any reporting obligations accurately, according to your setting and jurisdiction.
Trust also requires attention to identity and context. A Black survivor may have concerns about how systems respond to their family. A client with a disability may rely on their partner for daily assistance. An LGBTQ+ client may worry about being outed; an undocumented client may fear threats involving immigration. Ask about these concerns rather than assuming them. A culturally responsive approach recognizes how racism, stigma, access to resources, and previous experiences with institutions may shape the safest available options.
Assess safety collaboratively
Support does not mean avoiding risk assessment. Ask about immediate safety, threats, escalating behavior, stalking, access to weapons, and concerns for children or others when clinically relevant. Follow your organization's protocols and seek appropriate consultation for acute risk. Make sure it is safe to ask: a partner may be nearby, monitor messages, or access a shared patient portal.
A safety plan is more than a suggestion to leave. It can address what the client might do while staying, when preparing to leave, or after separation. Depending on the situation, planning may include safe contacts, a code word, an emergency destination, access to documents or medication, and ways to communicate privately. Discuss the risks of keeping written plans or resource information where a partner could find them. The Hotline's safety-planning guidance offers ideas that can be adapted with the survivor, not imposed on them.
Before offering a hotline number, shelter referral, or follow-up message, ask whether receiving or storing that information is safe. Never assume that a voicemail, email, or handout is private. If the client wants specialized support, collaborate on a referral to a domestic violence advocate. Advocacy can help with safety planning and practical needs beyond the therapy room.
Keep therapy connected to the client's goals
IPV may affect sleep, concentration, mood, relationships, and a person's sense of self. These concerns deserve care, but symptom treatment alone cannot remove an ongoing threat. Work with the client to identify what they want from therapy now: emotional grounding, clarity about coercive behavior, stronger social support, help navigating resources, or space to consider options.
Revisit the plan over time. Circumstances change, and a client who declines a referral today may want it later. Document clinically relevant disclosures, assessments, consultation, resources offered, and the client's stated preferences in line with professional standards and your organization's policies. Be thoughtful about what appears in records or portals that another person might access.
Progress may look like naming a pattern of control, identifying one trusted person, or recognizing that a threat is not their fault. These steps matter even if the relationship has not ended. Trauma-informed care protects the therapeutic alliance while making room for honest discussion of danger.
Continue building your clinical skills
RS Courses offers several learning opportunities relevant to this work:
- Working with Clients Who Use Intimate Partner Violence: Clinical Assessment and Intervention Strategies addresses assessment and intervention when a client is the person using harm. That work requires a distinct approach from survivor support.
- Trauma-Informed Clinical Practice: Assessment & Intervention Strategies strengthens the foundation for responsive assessment and care.
- From Mistrust to Engagement: Building Therapeutic Trust with Marginalized Clients explores the relationships and cultural responsiveness that can help clients stay engaged in treatment.
The question “Why don't they leave?” directs attention toward a survivor's decision. Better questions direct attention toward the harm, the barriers around the client, and the choices we can help them access. Our task is to listen carefully, assess risk, offer resources safely, and remain a steady clinical partner as the client determines their next steps.
If you or someone you know needs support: The National Domestic Violence Hotline offers confidential support and safety-planning resources. If you are in immediate danger, call emergency services when it is safe to do so.