Assessing the Physical Dangers of Emotional Abuse

As mental health professionals, we’re trained to recognize the obvious signs of physical and sexual domestic violence—bruises, broken bones, long sleeves or turtlenecks in warm weather, frequent absences from work—and bring up safety planning right away. But our training rarely captures the complexities of a form of psychological abuse now widely known as coercive control. A pattern of behaviors that creates an unequal power dynamic in a relationship, coercive control involves emotional neglect, intimidation, humiliation, and gaslighting. Because it tends to be more psychological than physical, clinicians may assume coercive control isn’t actually physically dangerous.

For more than 25 years, I’ve been an advocate for people experiencing intimate violence—people of all genders, sexual orientations, races, and ethnicities—and I’ve accepted client referrals from many colleagues. In the process, I’ve learned that well-meaning therapists unwittingly overlook the seriousness of coercive control in relationships with no history of physical violence. But just because aggression isn’t physical doesn’t mean it isn’t dangerous. It also doesn’t mean that it won’t turn dangerous. Am I an alarmist? Does someone who feels bullied, scrutinized, emotionally unsafe, and devalued in a relationship merit the safety plans we’d diligently create if they were physically unsafe?

Statistics show that coercion and controlling behaviors alone—not necessarily physical violence—are a precursor to the worst-case scenario type of aggression that can occur: partner homicide. That’s why I always introduce a danger-assessment instrument created by Jacquelyn Campbell, associate dean at Johns Hopkins University School of Nursing, to help clients identify hidden risk factors in their relationship. Many clients are astonished when they learn that behaviors they labeled as “childish” or “narcissistic” are elements of coercive control. One man was convinced his husband’s abuse was caused by his OCD until I asked him, “He’s a teacher, right? Does he yell at his students and call them names when they leave their trash on the floor like he does with you?” That was a moment of clarity, and my client began planning for an exit.

Of course, there are many reasons why someone may not be able to leave an abusive relationship. These include children’s well-being, religious beliefs, past and present access to education and professional opportunities, finances, and immigration status. I work with many clients who can’t leave, and even when they insist they’re not in any physical danger, it’s important to establish a safety plan.

My client Briana had initially contacted me for couples therapy, but when her husband refused to come, we began individual sessions. She was a manager at a Fortune 500 company. Her husband, Frank, had been an attorney at an international law firm—until he unilaterally decided to quit his job during the pandemic, leaving her to be the sole breadwinner. Although it was meant to be a temporary arrangement, in the four years that had passed since he stopped working, he’d barely attempted to look for new employment.

Briana reported that at the beginning of their 14-year marriage, she and Frank had a “good life.” They loved to travel and had even ended up living in Italy for Frank’s job. When their daughter, Sylvie, was born, they’d agreed it would be easier to raise her near family, but as soon as they’d returned to the States, Frank had begun drinking and blaming Briana for “making” him leave a job he’d loved. He was verbally aggressive with her and often told her she was being needy, sensitive, and ridiculous, especially whenever she tried to talk about how they might work on their relationship.

“He’s a great father,” she said. “Sylvie loves playing with him. But I hate that she witnesses the way he treats me. One time, when I told him I wanted to move out because of it, he threatened to kill himself if I left.”

I raised my eyebrows. “Has he ever threatened you or Sylvie directly?”

“No,” Briana insisted, “he’s not violent like that.”

Then, one night, he’d come home drunk after going to a baseball game with friends and declared he’d missed Sylvie and wanted to give her a hug. When Briana told him not to wake her up, he exploded in anger and accused her of keeping his daughter from him. He burst into Sylvie’s room, flicked on the light, and planted himself on her bed. Tired and confused, Sylvie started whimpering, but Frank had continued to sit there, stubbornly saying that he wouldn’t let his daughter be “co-opted by a controlling mother.” When Sylvie’s whimpers escalated to wails, he’d physically blocked the way so Briana couldn’t comfort her. This struggle went on for over 15 minutes, until he’d finally declared Briana a “raging bitch” and stormed out of the room.

Briana had stayed in Sylvie’s bed for the rest of night, shaking with anger and fear, trying to mentally prepare herself to gather some essentials in the morning and find a hotel where she and Sylvie could stay for a while. But how would Sylvie get to school? What about packing her lunch—how do you do that from a hotel? What if Frank got upset and destroyed the things he knew meant something to her, like her father’s stamp collection? Should she take that with her? Next week was the parent-teacher conference—how would they handle that together? What about plans they’d made with old friends to visit Italy over the holidays? Sylvie had been looking forward to that for months. If they shared custody, how would their daughter endure being shuttled back and forth between two houses with different rules? How could they ever reach a custody agreement that would accommodate her rigorous work schedule?

In the morning, sleepless and paralyzed with fear, Briana entered the dining room—and found Frank sipping coffee and scrolling through emails on his phone, calm, collected—and seemingly loving. He didn’t apologize, but he stood up and gave Briana a hug. Then, he made breakfast and told Sylvie that “Mommy and Daddy” would never let what happened last night happen again because it must’ve been really scary for her. Relieved that Sylvie seemed chipper and unphased by what she’d witnessed, and that they wouldn’t have to figure out a cascade of logistics with huge implications for Sylvie’s childhood, Briana had gone to work and pretended to move on.

Hearing about this incident in our session that week alarmed me so much that I asked outright if she’d considered applying for a protective order. She said she was concerned that a court order would make it harder for Frank to find a job, and she said she couldn’t stop thinking about the last time she’d wanted to leave and Frank had threatened suicide. I told her that I was afraid for her safety and that she couldn’t be the one to help him if he was suicidal. “If you stay,” I warned, “he might hurt you or Sylvie. At least, you should speak with an attorney, so you understand your legal position.”

I was certain the attorney would echo my sentiments: that she should consider applying for a protective order and get out as soon as possible. I was even prepared to discuss the necessary logistics and help with checklists and documentation. But when she came to our next session, she announced, “The lawyer told me that since there’s no physical violence, I could lose everything if I left now, including my daughter!”

Why? Frank was presumed to be a full-time parent because he didn’t work. He also cared for Sylvie when Briana traveled for work. Even though Sylvie was in school most of the day, and Briana took care of putting her to bed, he was nevertheless likely to be considered the primary caregiver. There was no proof that Frank was anything but a doting father. If she took him to court, he might be awarded primary custody of Sylvie, and Briana would be ordered to pay child support and alimony as the family’s sole wage earner. The attorney suggested that Briana remain in the relationship for another year. During that time, she should reduce her work hours, stop traveling for work, increase her parenting time with Sylvie, and document each incidence of Frank’s verbal aggression.

While I frequently refer clients to attorneys to avoid the appearance of giving legal advice, I’d never considered that Briana’s job and financial resources could be used to block her path to safety. I was stunned, sad, and scared for her. But since she was going to stay in the house with Frank, I worked with her to create a personalized safety plan to reduce the risk of serious harm to herself and Sylvie.

First, I suggested that she open a bank account in her name only, so that if she had to make a quick exit and needed access to funds, she wouldn’t have to worry about Frank withdrawing all the money out of their joint accounts and closing their credit cards. As an added security measure, we role-played what Briana could tell Frank about why she’d opened this separate account if he ever discovered its existence. Next, she made multiple copies of her keys and of her and Sylvie’s passports, birth certificates, and social security cards. She placed these items in an envelope with emergency cash and gave them to her sister for safekeeping. She also stashed a small “go bag” in Sylvie’s closet so they could have a change of clothes and some essentials if they ended up at a hotel. We took time to acknowledge her mixed feelings, including grief, about taking these precautions because the man she’d once trusted was now a source of anxiety for her.

Briana knew the safety plan wouldn’t solve her problems, but as she checked each of these items off her list, she felt more empowered to face her challenges and fortify herself in other ways. She didn’t know what would happen to her marriage in the months and years to come or what would unfold for her professionally, but she soon felt secure enough to take what was for her a big step: suggesting to Frank that he see a therapist of his own. “If our conversation takes a turn for the worse,” she told me. “At least I have a safety plan.”

This type of planning might have seemed extreme to some, but it kept her from feeling paralyzed and helpless.