When Abuse Doesn’t End: Working with the Internal Aftermath of Harm
Content note: This article contains discussion of abuse, trauma, and their psychological effects. The material is reflective and non-graphic but may still be distressing for some readers.
With thanks to our member, Tina Stockwell, for this blog.
Abuse is often understood as something that happens in relationship with another person. An event, a pattern, a history. In therapy, however, it quickly becomes clear that for many survivors, abuse does not end when the relationship ends, the perpetrator leaves, or the disclosure is finally spoken aloud. It continues internally, shaping how the person relates to themselves, others, and the world.
Much of my work sits with this quieter, less visible aftermath. Clients may arrive years after the abuse has “stopped”, often unsure why they still feel unsafe, ashamed, hyper-vigilant, disconnected, or critical of themselves. They frequently describe a sense of being stuck, frustrated that insight alone has not brought relief. From the outside, life may appear stable. Internally, the threat remains.
One of the most consistent patterns I see is the way abuse becomes internalised. Survivors often carry the perpetrator’s voice inside them: a running commentary of blame, minimisation, disbelief, or contempt. This internal voice can feel indistinguishable from their own thoughts. Clients may say, “I know logically it wasn’t my fault, but it still feels like it was”, or “I don’t know where their voice ends and mine begins”. In these moments, therapy is less about uncovering new information and more about gently disentangling what was learned for survival from what is actually true.
Pacing is crucial here. Abuse involves a profound loss of control, so therapeutic work that moves too quickly, seeks catharsis, or prioritises “progress” can unintentionally echo the original harm. I am often attentive to how easily good intentions can slip into subtle pressure: to forgive, to process, to confront, to move on. For many survivors, safety is not built through intensity but through consistency, choice, and predictability.
Language matters deeply in this work. Survivors are used to being told what happened to them, what it meant, and how they should feel about it. I try to hold descriptions lightly, offering possibilities rather than conclusions, and allowing clients to accept, reject, or reshape what is offered. This approach respects autonomy and helps rebuild a sense of authorship over their own story. It also reduces the risk of therapy becoming another place where power is unevenly held.
Another common feature of abuse recovery is ambivalence. Clients may miss their abuser, feel loyalty towards them, or grieve what they hoped the relationship could have been. These feelings are often accompanied by deep shame and self-judgement. Creating space where such contradictions are allowed — without rushing to correct them — can be profoundly reparative. Survivors do not need their feelings to be fixed; they need them to be survivable.
Working with abuse also requires ongoing attention to the therapist’s internal world. Sitting alongside accounts of harm, injustice, and betrayal inevitably stirs emotional responses. Over time, there can be a pull towards rescuing, over-protecting, or working harder than the client. Equally, there can be moments of frustration, helplessness, or fatigue. For me, regular supervision, clear boundaries, and honest self-reflection are essential safeguards — not only against burnout, but against inadvertently re-enacting dynamics of control or collapse.
Self-care in this context is not just about rest or recovery between sessions. It is also about maintaining clarity: knowing when something belongs to the client, when it belongs to the work, and when it belongs to my own history or values. Abuse work demands humility. It asks us to tolerate not knowing, to sit with slow change, and to trust that safety built gradually is more enduring than insight gained quickly.
Abuse is often spoken about in extremes: crisis or recovery, victim or survivor, harm or healing. In practice, it is far messier. Progress may look like a client noticing an internal voice and pausing before obeying it. It may look like choosing rest over self-punishment, or naming discomfort instead of dissociating from it. These shifts are easy to overlook, yet they represent meaningful reclamations of agency.
As counsellors, we are privileged to witness these moments. Bringing abuse into the foreground of our professional conversations is not about re-traumatisation or exposure; it is about accuracy. Abuse is not rare, and its effects are not confined to the past. By attending carefully to how harm lives on internally, and by working in ways that prioritise safety, choice, and respect, we can support survivors not just to understand what happened to them, but to relate to themselves differently in its wake.
