Annie Mortimer (not her real name), a graduate student in her late 20s, came to the Safe Horizon Community Program after her therapist of six months had terminated services with her.

Annie had initially gone to this therapist for depressive symptoms, and to deal with longstanding family issues. About four months into treatment, she disclosed that her boyfriend was abusive. A short while later, her therapist told her that she could not continue to work with her unless she broke up with her boyfriend. While Annie understood her therapist’s concerns for her safety, she nonetheless did not want to leave her boyfriend.

When Annie declined to do so, she was referred to Safe Horizon. Safe Horizon is a New York City-based victim services agency that provides victims of domestic violence, child abuse, human trafficking, rape and sexual assault, as well as homeless youth and families of homicide victims, with a wide range of comprehensive support.

Here, she was assigned an “advocate” and Annie told her that she felt abandoned by her prior therapist. Advocates have a wide range of responsibilities, including advocacy, intensive case management, and supportive counseling, but are not trained psychotherapists. While some advocates may have advanced degrees in social work or counseling, others may hold bachelor’s degrees.

Intimate violence programs like ours often receive referrals from clinicians who request that we help a client end an abusive relationship. However, we rarely do so, since our goal is to support clients’ self-determination by providing them with the information and support they need to decide—for themselves—what steps they wish to take. When therapists see clients in abusive relationships, they often (with the best of intentions) dismiss their priorities unless they include either ending the relationship or getting the police involved. But research has shown that this approach can backfire, and may paradoxically discourage the victim from seeking help, placing him or her at increased risk (Davies J et al, Safety planning with battered women: Complex lives, difficult choices. Thousand Oaks, CA: Sage Publications;1998). In addition, overvaluing the therapist’s opinion can recreate the power dynamic of an abusive relationship.

During sessions with her advocate, Annie described a volatile relationship that would at times culminate in her boyfriend throwing things at her, breaking things, and pushing or grabbing her. He was also verbally abusive, frequently calling her names and belittling her. Surprisingly, however, Annie said that that she was not afraid of him, and that she was usually able to calm him down before a fight got out of hand. If her de-escalation attempts did not work, she would leave the apartment for a while.

The advocate reviewed and explored Annie’s strategies in managing her safety. Annie shared that she had never thought about appeasing her boyfriend as a safety strategy, and, in fact, had generally considered it a sign of weakness.

Over the next three months, a complex picture of Annie’s relationship emerged. Annie, who considered herself a bit of a loner, had met her boyfriend through school, and he had moved in with her about a month into their courtship. She talked fondly of him being the first person to accept her the way she was. He could be very caring and warm but also cold and rejecting. Although he could at times become violent, the risk that was most threatening to Annie was that of her boyfriend leaving her. The couple had broken up a few times, and each time he had left her. While Annie relayed her story, her advocate listened non-judgmentally, used neutral language (eg, referring to the boyfriend by his name instead of as the “abuser”), and respected Annie’s priorities while assessing possible changes in Annie’s safety.

The turning point came when one day Annie reported feeling afraid of her boyfriend for the first time. She said that he had held a chef’s knife in his hand and talked of stabbing her. There was something about his look that had shaken her, though he insisted he was “only kidding.” The same day, he had put his hands loosely around her throat and had observed how easy it would be for him to strangle her. Again, he laughed it off, maintaining that it was only a joke.

After an argument, he left the apartment the next day. Though Annie didn’t think he would come back for at least a week, she decided to ask a friend to stay with her for a couple of nights. Annie’s advocate talked her through possible scenarios of him contacting her or coming home and they discussed how she would respond. She decided not to change locks, or report the threats to the police, as she believed that this would make matters worse. Studies have shown that for every intervention, including the involvement of the criminal justice system, that has helped a survivor, it can make the situation worse for others (Goodkind JR, Violence Against Women 2004;10(5):514–533).

Annie and her boyfriend reconciled a few weeks later. Annie’s advocate maintained her non-judgmental stance, and continued to work with her to make adjustments to her safety plan. Maintaining a non-judgmental stance is not always easy and requires practice, training, and supervision. The advocate may in certain situations express concern regarding a client’s safety, but unless it is a mandated reporting issue, will not take action against a client’s will. Annie’s safety plan included choosing to disclose the abuse to a handful of friends, thus creating a wider network of support. Annie stated that she knew that the relationship was not what she wanted, but that she was not ready to go through the turmoil of a break-up. She needed to finish her master’s thesis and a big presentation that was required for her to graduate.

Annie terminated services after successfully completing her thesis and presentation. She had not broken up with her boyfriend, but they had started to have conversations about ending things. These conversations had not led to violence; he had started to spend more time away from Annie, with his family and friends. Annie said that when he wasn’t there, she still felt the urge to call him, and tell him to come back, but was now able to resist acting on these feelings. Annie and her advocate agreed that they could resume sessions in case she needed help in the future.

Annie’s story defies commonly held views about relationships involving abuse, including the idea that the abusive partner always forces the victim to stay. Not stigmatizing her relationship, and honoring Annie’s voice and decisions, allowed her advocate to work collaboratively with Annie. The advocate respected Annie’s priorities and understood that she was managing multiple risks and juggling competing interests, such as the risk of abuse versus her need to finish school. Having a safe space where she could explore her ambivalence without being pushed into interventions that were not realistic or safe for her ultimately helped Annie resolve a difficult relationship.