Introduction

IPV in Couple Therapy Context

Intimate partner violence (IPV) remains a significant public health and clinical issue, with wide-ranging implications for individuals, families, and therapy practices (Black, 2011; WHO, 2021). Prevalence surveys in Norway and worldwide show that 14–30% of respondents in community samples report having experienced partner violence at some point in their lives (Andersson et al., 2015; Dale, 2023; Smith et al., 2017). In clinical populations, the rate of partner violence is even higher. Couples who seek therapy for relationship problems are two to three times more likely to have experienced physical IPV than couples in the general population (Heyman et al., 2023), with studies indicating that over half of such couples report having engaged in physical violence within the past year (Jose & O’Leary, 2009). Despite this high prevalence in research studies, such experiences are often not disclosed by the couple when entering couple therapy and may only gradually emerge during the therapeutic process.

Delayed recognition of IPV in therapy presents clinical and ethical challenges. Disclosures tend to emerge gradually, during treatment rather than at initial assessment (Keilholtz & Spencer, 2022). Victims’ fear of negative consequences often shapes delayed disclosures in health care services. This may include fear of their abusive partner, concern for their children, or worry about being judged by professionals or their social environment (Heron & Eisma, 2021). In the context of couple therapy, disclosure may also be delayed because clients do not initially frame the violence as abuse, but rather as conflict, mutual aggression, or situational tension (Simpson et al., 2007). Furthermore, some evidence suggests that couples seeking therapy with a history of violence do not perceive violence as a serious issue or problem in their relationship (Doss et al., 2003; Ehrensaft & Vivian, 1996). Couple therapists, in turn, may underestimate the presence or severity of IPV when clients present with more surface-level relational concerns (Dudley et al., 2008).

Although clinical guidelines recommend early detection methods, such as routine IPV screening and separate initial interviews (Bograd & Mederos, 1999; Keilholtz & Spencer, 2022), these approaches may not fully capture the complexity of clients’ relational realities; rather, IPV can remain undisclosed for multiple reasons until therapy is underway. When violence is disclosed or emerges as an issue during couple therapy, it creates complex ethical and clinical challenges (Keilholtz & Spencer, 2022; Snellingen et al., 2024), potentially disrupting the process and prompting reassessment of goals and safety considerations, as well as difficult decisions about whether continuing couple therapy is appropriate (Johnson, 2008; Karakurt et al., 2016; Keilholtz & Spencer, 2022; Snellingen et al., 2024; Stith et al., 2012).

These challenges are closely linked to the broader debate about the use of conjoint therapy in IPV cases, where the possible benefits must be carefully weighed against potential risks (Karakurt et al., 2016). Critics of conjoint therapy in the context of IPV argue that meeting partners together when violence is present can inadvertently reinforce harmful relational dynamics. For example, joint sessions may allow controlling behaviors to continue unchecked, encourage the minimization or denial of violent incidents, silence or intimidate the partner who has been subjected to violence, or risk re-traumatization if the violence is ongoing (Johnson, 2008; Kelly & Johnson, 2008). These concerns are especially pronounced in situations of coercive controlling violence, where fear and power asymmetries undermine any possibility of safety and equitable dialogue. In such cases, conjoint therapy is generally contraindicated because standard therapeutic processes could be co-opted to maintain control or could further endanger the partner exposed to violence (Johnson, 2008; Karakurt et al., 2016).

Still, a growing body of research and clinical literature suggests that couple therapy in the context of IPV can be effective in certain situations if thorough assessment and clinical safeguards are in place (Hurless & Cottone, 2018; Karakurt et al., 2016; Littlechild et al., 2024; Slootmaeckers & Migerode, 2018; Visser et al., 2020). Multiple studies have shown that carefully implemented conjoint approaches do not necessarily increase the risk of harm to victims and may even help reduce violent behaviors while improving communication, problem-solving, overall relationship satisfaction, and enhanced co-parenting collaboration (Hurless & Cottone, 2018; Karakurt et al., 2016; McCollum & Stith, 2008; Stith et al., 2012). Various conceptual frameworks emphasize the need for nuanced assessment approaches that consider not only individual risk factors but also relational dynamics and broader contextual influences (Alexander & Johnson, 2023; Carlson & Dayle Jones, 2010; Stith & Spencer, 2024). This reflects the multidimensional nature of IPV, which may vary in frequency, severity, coercive control, power dynamics, gender expectations, and subjective experience, underscoring that conjoint approaches cannot be applied as a “one size fits all” solution in cases of intimate partner violence. Instead, clinical decision-making requires careful differentiation between types of violence, continuous risk assessment, and flexible therapeutic responses that prioritize safety while remaining open to potential benefits where conditions allow (Snellingen et al., 2024).

The Help-Seeking Journey Leading Up To Couple Therapy

Research shows that couples often wait an average of six years after recognizing relationship issues before seeking professional help, which can cause problems to become deeply entrenched and lead to destructive patterns (Jarnecke et al., 2020).

Personal, relational, and contextual factors shape and postpone clients’ help-seeking experiences and pathways before they enter couple therapy. This delay may be caused by stigma, beliefs in self-reliance, and discomfort with sharing private issues with outsiders (Hubbard & Anderson, 2021; Stewart et al., 2016). Barriers to seeking help also include practical factors such as cost, limited access, and uncertainty about where to find suitable services (Hubbard & Anderson, 2022; Williamson et al., 2019). Emotional and interpersonal obstacles, such as fear of judgment, feelings of shame or failure, and concerns about a partner’s willingness to participate, may delay help-seeking (Doss et al., 2004; Hubbard & Anderson, 2022). Furthermore, in heterosexual relationships, traditional masculine gender norms can pose challenges, as male partners may be reluctant to seek help for relationship problems (Parnell & Hammer, 2018). Clients’ prior experiences with help services and their expectations beforehand often shape their motivation and engagement when starting therapy (Hubbard & Anderson, 2022; Tambling et al., 2014; Vogel et al., 2005). Cultural and structural factors also play a role; clients may face language barriers, lack access to culturally competent services, and experience discrimination (Lelaurain et al., 2017; Satyen et al., 2019). On the other hand, concerns for children’s well-being are frequently a primary motivator for couples to initiate therapy (Darwiche et al., 2022; Doss et al., 2004), particularly for mothers (Cravens et al., 2015).

Despite growing research on IPV in couple therapy and broader insights into help-seeking behaviors, there is limited research on the help-seeking journey that leads to violence-focused couple therapy, especially in cases where violence was not initially disclosed but gradually became the primary focus of therapy. Understanding the help-seeking patterns of different groups and their specific needs can help professionals better understand attendees’ behaviors and tailor their interventions accordingly (Stewart et al., 2016). Therefore, developing a deeper understanding of how both clients and therapists experience and navigate this process is essential for building knowledge to enhance early detection, individualizing interventions, and safeguarding the therapeutic process in couple therapy.

Aim and Research Question

Despite the high prevalence of IPV among couples who seek therapy, such violence is often not disclosed at intake. Instead, it tends to emerge gradually and only later becomes a central concern in the context of couple therapy. This qualitative study explores the trajectory from problem recognition to the point where previously unspoken or unnamed IPV becomes the focal point of clinical work. Gaining insight into this progression requires attention to both the lived experiences that precede therapy and the relational and therapeutic processes that unfold within it.

The Guiding Research Question Is

How do partners and their therapists experience and make sense of the process that leads to violence-focused couple therapy?

Method

The present study adopts a qualitative design grounded in a multiperspective Interpretative Phenomenological Analysis (IPA) framework (Larkin et al., 2019). It is situated within the Norwegian Family Counselling Services (NFCS), a publicly funded, low-threshold service offering free systemic and relationally oriented couple and family therapy. The NFCS comprises 42 offices and approximately 500 therapists, including social workers, psychologists, and family therapists. In 2022, the service met approximately 55,000 families (Snellingen et al., 2024). As part of its mandate, the NFCS addresses and prevents family violence, recognizing that couples seeking therapy may present risks of relational aggression. A recent survey (Carlin, Snellingen, Nordvik & Axberg, 2025) reported that therapists in the NFCS identified violence as a concern in 21% of all couple therapy cases.

Participants

The study included four heterosexual couples and their therapists. In one case, a couple was seen by two co-therapists, bringing the total to five therapists in the overall study. Descriptive statistics are provided in Tables 1 and 2. To protect both internal confidentiality (participants within the same therapy case) and external confidentiality, identifying details were handled with care by grouping demographic variables into broader categories to reduce the risk of recognition, and therapists were not linked to the specific couples they worked with.

The four couples had a total of nine children living at home, and their relationships had lasted for an average of over 10 years. All couples reported incidents of less severe physical violence within the previous year, such as pinching, holding, or pushing. In three cases, participants described episodes considered more severe, occurring at various times, ranging from up to ten years ago to one more recent event. However, we assessed that none of these situations met the threshold for initiating safety protocols or mandatory reporting under Sect. 196 of the Norwegian Penal Code (2005), which requires all adults “to report or seek to avert by other means a criminal act or the consequences thereof at a time when this is still possible and it appears certain or most likely that the act has been or will be committed.” Likewise, Sects. 13 − 2 of the Norwegian Child Welfare Act (2021) was not activated, as there were no indications of child maltreatment, neglect, or risk to life or health. All therapists had substantial experience within the NFCS and had completed multiple courses on addressing violence in couple therapy.

Procedure

The recruitment was carried out through purposive sampling because the participants could offer insights into the specific phenomenon of interest within a relevant context. In line with IPA’s idiographic commitment, the focus is on achieving depth of analysis rather than breadth of representation (Smith et al., 2021; Smith & Nizza, 2022). Therefore, IPA studies typically employ small, carefully selected samples to allow for a detailed, case-by-case examination before moving to more general claims (Eatough & Smith, 2017). The inclusion of four couples and their five therapists provided multiple, interwoven perspectives on the same relational process, aligning with IPA’s emphasis on idiography and adding analytic depth through triangulation of viewpoints (Larkin et al., 2019). This design allows for a nuanced exploration of how participants within the same case make sense of their lived experiences.

Participants were recruited from therapeutic cases within the NFCS where violence emerged as a topic after therapy had begun. The process began by contacting the selected offices through their leadership, then sending direct invitations to individual therapists. Upon obtaining consent, therapists participated in multiple video meetings with the researchers to discuss client recruitment, address safety concerns, and clarify procedures. Then, the participating therapists first informed relevant clients about the study and asked if they were interested in participating. Clients who showed interest were asked for initial consent, allowing the researchers to contact them, provide further details, and, if both partners agreed, schedule an interview.

All therapists who were invited to participate agreed to take part, whereas recruiting clients proved more challenging. Therapists noted two main issues. First, several couples were in early and uncertain stages of therapy, making research participation difficult. Severe violence also prevented approaching clients in some cases. A second difficulty concerned informed consent from all involved in the therapeutic system. Therapists observed that individuals who had experienced and were victims of violence tended to be more willing to participate. In contrast, those who had used violence were more reluctant or declined altogether. These dynamics shaped the sample that ultimately participated in the study.

Once violence became a relevant issue in therapy, therapists introduced the study to eligible clients. Clients who gave initial consent were offered the chance to talk with the researchers by phone to discuss the study and ask questions before the interview. On the day of the interview, informed consent was reaffirmed and signed again. Participant selection was based on three criteria: (1) There were no information about violence at intake or in referrals, which is relevant for NFCS practice, since intake details are often limited and seldom include sensitive case details, (2) all parties acknowledged violence as a central focus in the therapy process, and (3) both partners in the couple and their therapist gave informed consent to participate in the study.

A semi-structured interview guide was developed, and individual in-person interviews were conducted with each client and their therapist. To ensure consistency, all interviews were conducted by the first (J.F.S.) and second (P.E.C.) authors. The guide covered topics such as the decision to pursue couple therapy, therapeutic dynamics, the emergence and management of violence, safety concerns, and relational challenges. Interviews lasted between 1.5 and 2.5 h, were audio-recorded with consent. As an example, participants were asked questions such as: “Which of you contacted the NFCS?”, “At the beginning of therapy,did you think of what happened between you as violence?”, “Can you remember when violence first became an issue in the therapy conversations?","What words were used?","What made it possible to talk about it?”, and “How was it for you when violence became a concern in therapy?” These examples illustrate the semi-structured format of the interviews, designed to invite detailed reflections while allowing participants to shape the direction of the dialogue. The participants were also asked individually about the types of violence relevant to their current relationships and how these concerns were discussed in their therapy.

To protect confidentiality and honor each participant’s autonomy, no information shared in one interview was disclosed or referred to in subsequent interviews, even though the study followed a sequential design involving both partners and their therapist. At the same time, participants were informed of the procedures to be followed if the researchers became aware of any information indicating a severe and imminent risk to someone’s well-being or life. All interviews were audio-recorded and transcribed verbatim to ensure accuracy and reliability. During transcription, participants were pseudonymized; in the results section, fictitious names are used and specific details removed to safeguard both internal and external anonymity. None of the participants received payment or any other form of compensation for their participation.

Data Analysis

Data analysis was guided by the principles of Interpretative Phenomenological Analysis (IPA) (Smith et al., 2021), adapted to a multiperspective framework (Larkin et al., 2019), and applied flexibly to fit the study’s aims and context (J. A. Smith & Nizza, 2022). The core of IPA involves moving from a detailed descriptive account of each participant’s experience to a more interpretative understanding of its meaning within context. This process was informed by the double hermeneutic central to IPA, where researchers seek to make sense of participants who are themselves making sense of their lived experiences (Smith et al., 2021). Through this iterative dialogue, we moved within the hermeneutic circle between part and whole, developing an increasingly nuanced understanding of how meaning was co-constructed during analysis.

IPA’s theoretical foundations are rooted in phenomenology (focused on subjective lived experience) and hermeneutics (the recognition of interpretation). It is idiographic, emphasizing detailed case-by-case analysis before identifying broader patterns (Smith et al., 2021). The analysis in this study prioritized clients’ perspectives on their journey toward couple therapy, with IPV as the focus. Therapists’ perspectives were selectively integrated to enrich the analysis, highlighting contrasts, validating clients’ accounts, and adding contextual or relational depth. This approach allowed for a nuanced exploration of relational and systemic dynamics, capturing both individual and intersubjective aspects. By combining these perspectives, the analysis offered a layered understanding of the help-seeking journey that leads to violence-focused couple therapy in cases where violence was not initially disclosed but gradually emerged as the central focus of the therapeutic process.

We viewed bracketing as a cyclical and reflective process rather than an act of setting aside preconceptions (Smith et al., 2021). Recognizing that suspending assumptions entirely is impossible, we employed reflexive diaries, analytic memos, and peer discussions to explore how our professional backgrounds influenced our interpretations. This approach to bracketing enhanced reflexivity by striving for both closeness and openness to participants’ sense-making, while maintaining critical awareness of our own interpretative influence.

All interviews were conducted in Norwegian, except one in English. Translation was treated not as a neutral transfer of meaning but as an interpretative and reflexive act shaping the analytical process. To address this, the research team engaged in repeated collaborative translation reviews, discussing wording choices and cultural nuances affecting the phenomenological interpretation of participants’ experiences. All co-authors, fluent in both Norwegian and English, focused on preserving tone, emotion, and contextual meaning rather than literal equivalence. A native English-speaking member of the supervisory team contributed linguistic and cultural insight. These discussions became an integral part of the interpretative process, helping to ensure that the translated text remained faithful to participants’ voices while also being attentive to the researchers’ interpretative involvement.

The analysis began with an idiographic focus, examining each transcript individually before identifying patterns across the dataset. Combining traditional IPA’s case-by-case approach with a relational, comparative lens, the process was iterative and multilayered, comprising the following stages: (1) Researcher Reflexivity- initial reflections on potential biases were documented through diaries and peer discussions, (2) Immersion and Exploratory Noting - transcripts were read multiple times, with detailed exploratory notes made at each pass, (3) Multiple Readings - descriptive, linguistic, and interpretative readings captured nuances beyond surface content, (4) Experiential Statement Development - key quotes were thematically grouped and transformed into experiential statements for each interview, (5) Case-Level Analysis - within each therapeutic case, clients’ and therapists’ experiential statements were compared to explore relational dynamics, (6) Cross-Case Group Synthesis - themes were synthesized across participants, comparing experiences of those subjected to violence, those who had used violence, and therapists, (7) Linking to Research Question - overarching themes were constructed to reflect shared and divergent experiences most relevant to the study’s aims, (8) Thematic Refinement in Write-Up - themes were further developed during writing; some were nuanced or excluded if insufficiently grounded in the data, (9) Consolidation - transcripts were revisited to ensure that themes accurately reflected the depth and breadth of the material.

The first author (J.F.S.) led the analysis, with ongoing critical input from the second (P.E.C.) and third (U.A.) authors to ensure rigour and trustworthiness.

Researcher Reflexivity, Positionality, and Trustworthiness

Maintaining a reflective and transparent stance is a foundational principle in qualitative research, especially within interpretative phenomenological analysis, where the researcher’s perspective is acknowledged as an integral part of the interpretative process (Dallos & Vetere, 2005; Smith et al., 2021). The first and second authors are employed within the Norwegian Family Counselling Services, where the study was conducted. In contrast, the third author is a university-based researcher with long-standing expertise in family therapy and violence studies. This positioning offered close access to clinical realities but also demanded sustained reflexivity to manage potential role conflicts. To address this, the team engaged in continuous supervision, reflexive dialogue, and maintained reflexive journals throughout all stages of the project. All decisions regarding design, data collection, analysis, and publication were made independently of the organization and funder.

We recognize that our “horizons of understanding,” shaped by experience, language, and professional context, both enable and constrain our interpretation (Gadamer, 1998). Throughout the research process, we have sought to strike a balance between an insider’s familiarity with the field and a critical awareness of the assumptions that such proximity can introduce. The authors share a systemic and relational perspective on intimate partner violence, one that emphasizes context, interaction, and meaning-making while upholding individual safety and accountability as non-negotiable priorities. This position does not imply that conjoint therapy is always appropriate in IPV cases; instead, we regard violence as a multifaceted phenomenon that requires differentiated responses, both in research and in clinical practice.

To strengthen the study’s trustworthiness, we applied strategies aligned with qualitative criteria for credibility, dependability, confirmability, and transferability (Creswell & Poth, 2018; Lincoln & Guba, 1985; Smith et al., 2021). Credibility was enhanced through triangulation of perspectives (clients and therapists), iterative engagement with the data, and ongoing reflexive dialogue within the research team. Dependability and confirmability were supported by maintaining analytic logs, reflexive journals, and peer debriefing. We also prioritized “thick descriptions” of the results, context, and participants to enable readers to assess transferability (Lincoln & Guba, 1985). Transparency was supported by clearly describing all analytic steps from transcription to theme development, allowing readers to trace the interpretative logic. Consistent with interpretative approaches to validation, our aim was not a singular “right” account but a transparent, well-evidenced rendering that invites critical engagement (Creswell & Poth, 2018). An audit conducted by a member of the supervisory team (not among the authors) further evaluated the consistency between raw data and final interpretations, emphasizing methodological rigor (Smith et al., 2021). Collectively, these practices grounded the analysis in participants’ lived experiences while making the researchers’ interpretative role more explicit.

Ethics

Guillemin and Gillam (2004) distinguish between procedural ethics, which involves the formal approvals and protocols preceding research, and ethics in practice, which entails navigating ethically important moments that emerge during the research process. Procedural ethics provides foundational safeguards, such as informed consent and committee approval. In contrast, ethics in practice requires ongoing reflexivity and the ability to recognize and respond to ethically important moments and branching points as they arise (Guillemin & Gillam, 2004; Snellingen et al., 2025).

Procedural Ethics

This study adhered to the Declaration of Helsinki and was reviewed by the Regional Committee for Medical and Health Research Ethics, South-East Norway, under the Norwegian Research Ethics Act (2017). It was deemed outside the scope of the 2008 Act on Medical and Health Research (ref. 192736) and thus did not require formal approval. The study also complied with the Norwegian Centre for Research Data guidelines (ref. 999687).

Ethics in Practice

Conducting a qualitative, multiperspective study involving both partners and their therapist in ongoing couple therapy, particularly where violence is a central concern, presented ethical dilemmas and complexities. Core considerations included participant safety, confidentiality, and obtaining informed and voluntary consent. To mitigate these issues, we established four distinct points at which information, questions, and consent were revisited and reviewed. (1) Once the inclusion criteria were met, therapists introduced and informed the clients about the study. They were invited to provide their initial consent, thereby allowing the researcher to contact them. (2) Clients were then offered a telephone consultation in which they could raise questions or concerns before deciding whether to participate in the interview. (3) On the interview day, the study was reintroduced, participants were given the opportunity to ask further questions, and written consent was obtained for a second time. (4) Finally, at the conclusion of each interview, participants were asked about their experience, invited to share any remaining concerns, and given a renewed opportunity to confirm or withdraw their consent for the use of the data.

To protect identities, all participants were pseudonymised and described in general terms to prevent linkage between individuals, couples, or therapists. For a comprehensive discussion, see Snellingen et al. (2025).

Results

Our multiperspective Interpretative Phenomenological Analysis led to two main group experiential themes: the Pre-therapy Journey and the In-therapy Journey. Together, they form what we have here termed the dual journey, characterizing the long and multifaceted process by which violence becomes the central issue in couple therapy. This dual journey comprises two stages that are chronological yet iterative.

In our results, the pre-therapy journey includes four sub-themes that mainly relate to aspects of the help-seeking process before starting the current couple therapy: (1) Women’s Agency in Initiating Change, (2) Children as Catalysts for Change, (3) Critical Threshold: Reaching “Enough is Enough,” and (4) The History and Impact of Unsuccessful Help-Seeking Attempts.

The in-therapy journey consists of two sub-themes that unfold within the therapy context: (5) Is It Violence? Internal and Relational Negotiations and (6) Beyond “Repair”? Relational and Therapeutic Consequences of Long-term Patterns of IPV. An overview of the main experiential themes and corresponding subthemes is presented in Fig. 1.

Having provided an initial, overarching description of the dual journey, comprising the two main group experiential themes, Pre-therapy Journey and In-therapy Journey, and their six associated sub-themes, we now turn to a more detailed presentation of each sub-theme. This will be followed by a discussion exploring their clinical relevance, particularly their implications for therapeutic practice, as well as broader organizational and policy-level considerations. Furthermore, we introduce the Dual Journey Model as a conceptual tool for understanding how clients’ pre-therapy experiences and in-therapy processes mutually inform and shape one another.

Pre-therapy Journey

1. Women’s Agency in Initiating Change

The results show that, from clients’ perspectives, help-seeking for IPV was a gradual process, shaped by growing recognition of the problem’s severity and efforts to overcome both personal and relational barriers to accessing support. In all cases in this study, it was the woman, regardless of who was the primary aggressor in the relationship, who initiated contact with the counselling services and scheduled the first appointment. Entering couple therapy was never immediate; it followed a prolonged period of emotional strain. As Maria reflected, “It’s been four years since I first mentioned we should go to therapy,so I’ve spent a long time being able to get him on board.” The women expressed a strong sense of responsibility for initiating change for the deteriorating relationship and the escalating distress within the family. As Anna put it:

It has always been me who has taken the initiative, and I guess it was both of us who felt that the relationship just didn’t feel right. It feels difficult, and there’s a lot of arguing, so the main focus was for the family’s sake.

The male partners were often hesitant, expressing initial resistance or a belief that the issues could be resolved independently. Olav illustrated this dynamic in the following dialogue, describing how the initiative was taken and how couple counselling eventually materialized:

Olav: What I experienced was that I first wanted to try to resolve the situation with my wife and me on my own.

Interviewer: Okay. What made you contact the Family Counselling Service?

Olav: It wasn’t me; it was my wife.

Interviewer: Hadn’t she talked to you about it before she took that call?

Olav: Yeah, she had, but I didn’t want to. She talked about it for a long time. I just didn’t trust it (therapy).

In several cases, the male partners, typically those who had engaged in violent behavior, agreed to attend therapy only after their female partners issued a firm ultimatum or signaled a serious intent to leave the relationship. As Sofia explained:

He knows that if he doesn’t continue here, there will be nothing more between him and me, so he will be in a very pressured situation. So, it is like an ultimatum. But it’s also important to me that he does it because he feels it is necessary.

All the therapists noted that the women initiated contact and assumed responsibility for seeking support. These dynamics often persisted into therapy, where women typically initiated and framed the issues and articulated the destructive patterns, including violence, eventually. One therapist observed: “They’re really different. She’s talkative,very active,and seems to have everything clear in her head,while he needs much more time to process,both what she’s saying and what’s going on between them in the conversation.” Another therapist reflected on how the woman’s clarity compelled an immediate therapeutic response: “In this case,the violence was addressed out of the blue. It became impossible not to acknowledge it in the very first session because she was so explicit,I felt I had to name it.” While these initiatives placed much responsibility on the women, therapists also described it as a “gift,” enabling early focus on safety and core relational issues.

2. Children as Catalysts for Change.

All couples had children living at home, and concern for the children emerged in the interviews as a central motivator for seeking couple therapy. Most clients, both women and men, expressed growing concern within the pre-therapy journey about how exposure to conflict and violence might affect the children over time. The desire to shield children from witnessing harmful interactions, reduce emotional tension at home, and ensure a healthier developmental environment often prompts help-seeking. Several participants noted that while they could endure distress themselves, the thought of its potential impact on their children compelled them to act. As Hilde explained:

I’ve told him all these years that his aggression is a big problem, and I’m scared, anxious, and nervous. That, eh, I am terrified that my children will grow up seeing, or hearing, or understanding any of it. I can be patient and “stepped on” and things like that for a certain amount of time, but there is a boundary: if it affects them (the children), there is nothing more to talk about.

Both women and men described experiencing a form of constructive distress when they became aware of the actual or potential impact of the situation on their children. This awareness often acted as a catalyst for change, motivating them to seek help and invest in reducing harmful interactions and fostering healthier relational patterns. Aksel articulated how concern for his children compelled him, albeit reluctantly, to engage in therapy:

It’s a recurring theme that the children suffer from our arguments and conflicts. That’s a huge motivator. It’s incredibly painful to see them compensate…I grew up with parents who argued. I know what that did to me. It affects you. You feel unsafe at home, insecure. I really want them to avoid having that same experience.

While children were often the primary motivators for seeking help, they could also serve as a counterforce, as some parents hesitated to engage with services due to fears about the potential consequences of seeking external help. Anne, a woman who had been the primary aggressor in her relationship, described the ambivalence she experienced after initiating contact with the NFCS:

I was very much in favor of it right away. But after a while, I began to wonder what I had exposed us to. Family counselling services, are they a risk to us and our children? I’ve been thinking, if I’m completely honest, will it be blown out of proportion? But this is also important. I’ve thought a lot about how hard it is to talk about violence lately. Where do you turn for help? You’re afraid of being judged. Will you lose your child?

All therapists emphasized that children’s experiences were a central focus of the couple therapy, serving both as a lens for assessing their well-being and help needs, and as a key entry point for emotionally engaging the parents. The child’s situation often served as a powerful therapeutic entry point, inspiring and deepening reflection and highlighting the need for change during sessions. One therapist explained how directly addressing the impact on children could evoke constructive shame in the parent who had used violence, helping to bypass defensiveness and encourage accountability.

What really matters to me is the children. I try to highlight their experience, their feelings, what’s going on for them, and what might actually make a difference. That helps make the situation more serious. I think that seriousness, that shame that comes up, is important. It’s a therapeutic tool. When the one who used violence gets sad or even cries, I say: ‘Good, that means this matters to you. You don’t want to be this person.’ Shame can be a powerful driver for change.

3. Critical Threshold: Reaching “Enough is Enough”.

Many clients described a paradigm shift, a critical turning point in their understanding of the situation, that marked the moment they realized the relationship could not continue without external help. These thresholds were often accompanied by intense emotions such as anger, fear, desperation, and uncertainty, as well as a renewed sense of determination and, sometimes, hope. At this point, one or both partners became resolute in the need for change. In our study, both women and men reported reaching such limits. For women in particular, this shift was triggered by a severe or frightening incident, or by the cumulative toll of repeated destructive behaviors. These “enough is enough” moments marked a turning point from tolerating and adapting to the situation to taking action and, especially for the women in this study, seeking help. As one woman recalled after a particularly intense episode:

We’re completely done, and I’ve had enough…and then I started to think that I can’t live with this anymore, and I left him temporarily…he was so sorry that I had left him, and we had different opinions, and he just wanted to die, yes, he was terribly dramatic. And then I contacted the family counselling office, maybe a week after that.

The men often described a parallel realization, marked by fear of “losing everything,” that catalyzed their acceptance of the need for help. This fear of relational collapse prompted a shift toward change. As Thomas reflected, the relationship itself had to transform: We very much want to make our relationship work better,obviously…You know,maybe the counselling leads to,like,separating,or,whereas it feels like that’s a more unlikely outcome,you know,now when we talk about things.

4. The History and Impact of Unsuccessful Help-Seeking Attempts.

For all couples, entry into couple therapy had been preceded by prior help-seeking, individually or as a couple. While some of these efforts offered partial support, they were often accompanied by disappointment, frustration, or a sense of futility. The recurring sentiment, “we tried before,but it didn’t help,” reflected both the persistence of their struggles and the complexity of their help-seeking trajectories. Several individuals had previously engaged with various services to cope with or to address their problems, including counselling, physiotherapy, clergy, and anger management, often without involving their partner. These efforts rarely addressed the relational dynamics at the core of their struggles. Hilde reflected on what motivated her to pursue couple therapy at the NFCS.

I had some sessions with a psychologist, but personally, I don’t think it helped. Not if I’m just sitting there talking to a psychologist on my own, what really matters is talking together. If the man I’m married to has his own issues and is at home, with his stuff, then it just gets frustrating coming back to him, because he hasn’t changed at all. That’s why it’s so important.

Aksel, from another couple, echoed this experience, explaining his motivation to pursue couple therapy, “I don’t think it would help if one of us went to one place and the other was somewhere else,talking to someone…Now,it’s like we’re in the same boat,in a way.”

Some couples had previously tried couple therapy, but it often ended prematurely because one or both partners withdrew from the therapy. A recurring theme was a perceived mismatch between the therapeutic approach, personal chemistry with the therapist, or the couple’s specific needs. Anne and her partner had engaged with the NFCS before, but at that time, violence was not addressed as an issue in the therapy:

We have contacted the Family Counselling Office, I think, for the third time. Yes, the third time... But this time, it has felt very good for all of us, or for both of us, at least. The other times, it kind of didn’t happen, just a couple of conversations, maybe.

Several participants had a history of unsuccessful help-seeking, fostering ambivalence toward entering therapy and shaping their emotional and temporal investment in the early sessions. As one therapist observed: “They’d had several contacts here before,so I already knew he was sceptical,she mentioned that in the very first conversation.” Prior therapeutic experiences thus functioned not merely as background, but as active influences on expectations and engagement in the current process.

When violence emerged as an issue, the therapists often questioned not only whether the couple shared a goal of preserving the relationship, but also whether conjoint therapy, and the NFCS specifically, was the appropriate setting. As one therapist reflected:

For me, it’s also about getting some clarification, like, at least in my own mind, around whether it’s a yes or no to continuing the relationship, or whether it’s more about figuring out if it’s actually helpful for them to be in the same room talking together. Those are two very different questions. It’s more like: what’s the most useful way to talk with people who are clearly in crisis? That’s a very different question than, ‘Are these two still going to be a couple in five years?’ Or even next year, you know?

Several therapists emphasized the importance of maintaining a flexible stance, particularly when it became unclear whether the couple still shared a desire to continue the relationship. In such cases, some therapists described a shift from structured couple therapy toward exploratory or clarification-oriented sessions, where the aim was to assess not only relational viability but also whether continued joint sessions were therapeutically meaningful or safe. This clinical pivot often involved holding space for relational ambivalence while simultaneously evaluating whether alternative formats, such as individual sessions, parallel work, or referrals to specialized services, were more appropriate.

In-therapy Journey

5. Is It Violence? Internal and Relational Negotiations.

Although many participants described enduring patterns of aggression and relational harm, few initially identified their experiences as violence when entering therapy. For some, the realization emerged during early sessions; for others, it surfaced later in the therapeutic process. Hilde, for instance, did not associate her experiences with terms like “violence” prior to contacting the NFCS:

Interviewer: Did you think of it as violence before you came to the Family Counselling Office?

Hilde: No.

Interviewer: So, what did you think it was if it wasn’t violence?

Hilde: I thought it was a horrible situation. I just thought it was anger. But I didn’t think it was violence. Not really.

This excerpt illustrates how clients often framed their experiences through more familiar or less stigmatized terms such as “anger,” “conflict,” or “a difficult situation.” Labeling something as “violence” entails more than semantics; it invokes moral, legal, and emotional implications. Gender differences also appeared salient: women tended to adopt a broader understanding of violence, while some men equated it solely with physical acts. Olav, for example, did not recognize his behavior as violent until engaging with the NFCS.:

Olav: I didn’t know it was violence, because I hadn’t hit anyone, it wasn’t physical.

Interviewer: So, for you, violence only means something physical?

Olav: That’s what I thought.

Many participants expressed ambivalence toward the term “violence,” engaging in internal and relational negotiations over its appropriateness or fairness. Einar’s reflection highlights the relational and contextual dynamics of naming and using the term ‘violence’. His reluctance to use the term stemmed not from denial but from a nuanced consideration of intent, emotional tone, and situational context.

Interviewer: Could you say a bit more about that? It’s really interesting. She hit you once, and earlier, and you said, “I didn’t really think of it as violence.” Can you elaborate on that?

Einar: I just saw it as a reaction in the moment, not that she wanted to hurt me or anything. I mean, you could call it violence, sure, but to me it wasn’t like that. It didn’t bring up any thoughts of revenge or anything like that. However, in this context now, I suppose it gets interpreted as violence.

For Einar, the term “violence” felt overly severe, too definitive for what he perceived as a brief loss of control, absent of malicious intent. His remark, “in this context now,” highlights how the therapeutic setting can reframe perceptions and introduce alternative interpretative lenses.

Both women and men engaged in internal and interpersonal negotiations over how to define their relational dynamics, particularly when behaviors deviated from more stereotypical notions of violence. These negotiations often unfolded explicitly in therapy. Sofia noted that it was the therapist who introduced the term “violence” into their conversation, as it had not been part of the couple’s initial framing. For her, this intervention offered long-awaited recognition:

In a way, it’s good to hear. No, I guess it was like, I don’t know if it’s right, but he has to understand that it’s serious. That it is, or he probably understands that it’s serious, but … It may sound horrible, but I think it was good that she said physical and psychological violence and that he heard it; it’s a kind of confirmation that it’s real,

For Sofia, the therapist’s intervention provided the recognition she lacked; it “confirmed” her reality.

The therapists demonstrated a conscious and reflective approach to the term violence, often seeking to name and frame clients’ destructive behaviors as violence early in the therapeutic process. One therapist described herself as both persistent and adaptable, emphasizing a willingness to engage in “negotiation”:

When we introduce the word ‘violence,’ it’s important that we use it enough times for it to really land with the people we’re talking to. So, if he says ‘angry,’ I might say ‘violent.’ And like I mentioned earlier, what really matters is how it affects the person he’s angry at; that’s why I call it violence. It’s not just about him, but about how it affects the other in the room, and also because that’s how I understand it. It’s important that we’re on the same page when we talk about these things, and in this case, that worked well. But in other cases, it might not land the same way. Then I stay flexible, I still want to name it, but I might use the word ‘aggression’ instead. Just as important, though, is highlighting the impact it has on others, and that it’s harmful and destructive to their relationship.

For some therapists, consistent use of the term “violence” was crucial, repeating it until it resonated with clients and was accepted as central to the therapeutic work. Others placed less emphasis on the term once a shared understanding had been established, focusing instead on the couple’s recognition of the problem, their engagement with its impact, and their willingness to take responsibility for it. As one of the therapists noted:

It’s not like I’m super focused on the word violence; I’m not at all concerned with hammering that word in, really. What I do care about is defining what’s happening in a way that both partners can recognize themselves in and feel seen.

Differences in therapists’ years of experience did not appear to influence how or when they introduced the term violence. Instead, what seemed to shape their approach was each therapist’s underlying clinical stance on whether explicitly naming violence was necessary to engage with the couple’s destructive interactional patterns meaningfully and to support therapeutic progress. The ongoing internal and relational negotiations about whether and how to define the problem were not merely semantic; the chosen framing tended not only to shape the therapeutic dialogue but also to influence the structure, content, and direction of the therapeutic process. One therapist reflected:

Therapist: Yeah, up until now I’ve really thought of this more as an anger issue. I’ve been a bit unsure; I don’t think I’ve really seen it as a “violence case” from the start.

Interviewer: What would you have done differently, then?

Therapist: Then I probably would’ve treated it more like a violence case; I would’ve thought, okay, I need to map out the frequency, the severity, the power dynamics, I would’ve used more of that “Life in the Family” (assessment form used in the NFCS) assessment approach. Like, I need to know what’s actually going on here before we even begin.

6. Beyond “repair”? Relational and Therapeutic Consequences of Long-term Patterns of IPV.

Many clients carried into therapy a long history of violence, conflict, and uncertainty. For most couples in this study, destructive patterns had emerged early in the relationship and gradually intensified. When asked how long things had been difficult, Hilde reflected: “It’s been like that all these years,really… I thought it would get better,but it didn’t.” By the time they sought professional help, most couples were entrenched in cycles of psychological and material violence, with occasional physical aggression (e.g., pinching, holding, shoving). These patterns were not isolated incidents; for some, they were part of an ongoing dynamic characterized by recurring tension and relational strain. Maria described this phase as “a constant walking-on-eggshells atmosphere,” where even “neutral behaviours”, tone of voice, gestures, or facial expressions could trigger tension due to accumulated experiences of distress. Hilde further reflected on how, over time, living in this situation had come to affect nearly every aspect of her life:

It has affected my whole life because I get nervous, you lose your joy, you lose your energy, and you get a lot of ‘cracks’. You just become destroyed by it. Your psyche is destroyed, your concentration is destroyed, you are unable to achieve anything. It’s absolutely horrible.

The cumulative impact was significant. Participants described mental and physical strain, including low mood, fatigue, disrupted sleep, and somatic tension such as headaches and muscle pain. One participant reported trauma-related symptoms, including intrusive memories. Three clients had taken sick leave or temporarily left the workforce. Relationally, trust was eroded, communication was strained, and many lived with ongoing uncertainty about the future of the relationship. Although seeking therapy was motivated by a wish to improve an increasingly difficult situation, it was often accompanied by ambivalence about whether the relationship could or should continue. As Maria expressed:

It’s my life, you know… I really have to ask myself, what am I doing? And whether I want to leave. But I’ve chosen to stay. Still, you’re never completely sure, am I doing the right thing? It’s hard. That’s why I’m doing this, because you need advice and guidance in situations like this.

From the therapists’ perspective, questions about the couple’s capacity to rebuild were often central. Several reflected on how the cumulative effects of fear, emotional distance, and repeated rejection challenged the very premise of relational repair. As one therapist noted:

Deep down, I’m not sure whether these two people can actually create something good together again, or whether they’re beyond the point of ‘repair’. There’s such obvious distance, no physical intimacy, and so much rejection. And a lot of fear, at least from her side. It makes me wonder: is it even possible to rebuild something safe, close, and trusting?

Such reflections introduced a deeper layer of complexity: whether the violence and its aftermath had fractured the couple’s bond to the extent that a shared therapeutic project was no longer viable. When emotional and relational injuries were deep and longstanding, the therapeutic window could narrow, making it difficult, or at times impossible, to address the violence constructively. One therapist described:

If I go straight into the violence, it can escalate things. The whole focus becomes so negative for people who are already completely worn out. I feel like I lose the chance to help them just float a little above water, to breathe. Instead, it can feel like I’m pulling them further down.

This delicate balancing act, between naming the violence and preserving the couple’s capacity to “have their head above the water,” was a core therapeutic challenge. The consequences of violence were not only personal and relational but also shaped the therapeutic process itself. Therapists had to navigate a delicate balance of timing, acknowledgment, and emotional readiness, while also managing the ongoing uncertainty about the well-being and safety of everyone involved, and continuously assessing whether conjoint therapy remained an appropriate and safe format for the couple.

Discussion

Introducing a Dual Journey Model

This study illuminates the complex, multilayered help-seeking processes of couples entering couple therapy, where IPV only becomes an issue after therapy has begun. Based on our results, we propose a Dual Journey Model, which captures both the Pre-therapy Journey (themes 1–4) and the In-therapy Journey (themes 5 & 6), two stages that are chronological yet iterative, reflecting how past experiences continuously shape in-session dynamics and vice versa, visualized in Fig. 2 below:

The pre-therapy journey refers to the often long and complex process that precedes therapy. It includes living with the effects of violence, acknowledging the problem, navigating formal and informal support systems, and reaching a state of readiness to seek help. This process is often marked by ambivalence, fear, previous unsuccessful attempts at help-seeking, and concerns about the children. In our study, these challenges typically unfolded over months or years, leaving behind a layered history of emotional distress and relational disruption that culminated in a critical threshold, often described as a point where “enough is enough.” These lived experiences are not left at the door when entering therapy; instead, clients bring them into the process, influencing their expectations, engagement, and interactions among participants during the in-therapy journey.

The in-therapy journey occurs within the therapeutic relationship and the couple therapy setting itself. In this study, it encompasses efforts to establish safety, build a working alliance, and identify and make sense of the violence as it is experienced and expressed. Importantly, it also involves fostering a shared and negotiated commitment to change, where violence is not seen as a peripheral concern but acknowledged as central to the therapeutic process. In this sense, if the in-therapy journey is to lead to violence-focused couple therapy in practice, it must involve collaborative negotiation and the co-creation of new relational meaning, supporting the emergence of a sufficiently shared understanding of the violence, its consequences, and a unified goal for the therapeutic project.

Drawing on Gadamer’s hermeneutic-phenomenological philosophy (Gadamer, 1998), the Dual Journey Model rests on the idea that our understanding is always shaped by our situated horizon of understanding that integrates past, present, and anticipated future. Within this setting, it means that clients and therapists make sense of what emerges not in isolation, but in connection with what has already been lived and what may yet become possible. For instance, when the therapeutic dialogue contributes to internal and relational negotiation of naming and framing violence, this does not simply state what has happened. Instead, it may reshape how past actions and situations are interpreted. What was once described as “he just hit the wall” or “anger” may be understood as a single act of material violence, or as part of a broader pattern of coercive or psychological abuse.

This retrospective re-interpretation, enabled by new language and understanding through dialogue and reflection, can reshape how clients understand their history, recalibrate their experience of the present, and expand and influence their sense of future possibilities, including critical decisions about staying in or leaving the relationship.

At the same time, pre-therapy experiences, such as mistrust, concern for the children, or doubt about the continuation of the relationship, can resurface in-session in either their original form or nuanced variations, shaping clients’ expectations, therapeutic dynamics, and possibilities during the in-therapy journey. The in-therapy journey may provide new language and a relational context through which earlier experiences can be re-evaluated. Thus, the pre- and in-therapy journeys are in this sense not merely sequential stages, but co-constitutive movements that continuously inform and reshape one another as therapy unfolds.

This Dual Journey Model is not merely descriptive; it serves both analytic and practical functions. For therapists, it offers a structured yet flexible tool for case conceptualization, enabling greater attunement to the evolving interplay between prior experience and current therapeutic dynamics. For service developers and policymakers, the model provides a scaffold for designing services that are responsive to the relational complexity and needs of couples who experience IPV, particularly those who do not disclose violence at intake for various reasons. In the following section, we outline some clinical implications for therapists, along with broader organizational and policy considerations.

Clinical Implications for Therapists

Our results point to several clinical implications for therapists working with couple therapy in the context of IPV. While therapists are well aware that clients bring a lived history into therapy, the Dual Journey Model calls for more active and deliberate attention to how this history shapes and is in turn shaped by the therapeutic process. Rather than treating the past merely as background information, therapists are encouraged to remain attuned to how each partner’s pre-therapy experiences continue to influence their engagement, sense of safety, capacity to speak about violence, and possibilities for change. Attending closely to how these experiences and relational patterns unfold within therapy may foster a more grounded and responsive approach to addressing IPV in couple therapy.

Revisit the Pre-therapy Journey Early on

This study’s results remind us that therapy does not begin as a blank slate. Couples carry various experiences from the pre-therapy journey, such as prior help-seeking attempts, which shape their expectations and engagement (Tambling et al., 2014). In low-threshold services like NFCS, where intake information is limited, therapists might more effectively engage with clients by revisiting their pre-therapy journey experiences and acknowledging and incorporating them into the in-therapy journey. By addressing themes such as failed interventions, ambivalence about staying together, and concerns for the children, therapists can help co-construct a shared understanding of why the couple is in therapy and what is at stake. This early attention to pre-therapy dynamics may lay the groundwork for safety and openness, while ensuring that the issues addressed in the in-therapy journey are meaningful and relevant to the couple.

Address Gendered Asymmetries in Engagement and Responsibility

In line with previous research, our data show that women most often initiated help-seeking, highlighting persistent gendered dynamics in who carries the responsibility for relational repair (Addis & Mahalik, 2003; Trillingsgaard et al., 2019). Such patterns illustrate how individual behaviors are embedded in broader gendered power structures (Dobash & Dobash, 2017; Kimmel, 2002), underscoring the need for therapeutic approaches that critically address asymmetrical structures. Feminist scholarship has long shown that women’s disproportionate assumption of emotional responsibility reflects broader cultural scripts of gendered care work, as for example conceptualized by Hochschild (2022) as emotion work, which can perpetuate inequities in both intimate relationships and therapeutic settings. Recognizing this dynamic is therefore essential to avoid unreflective reproducing structural asymmetries in the therapeutic process. If left unexamined, such asymmetries may reinforce unequal emotional labor and accountability within the therapeutic process, especially when one partner has used violence. Therapists may benefit from remaining attentive to how gendered relational scripts shape the dynamics of the in-therapy journey, particularly in terms of engagement and responsibility-taking, and implement interventions that redistribute the emotional and relational burden and responsibility (Knudson-Martin, 2013; Vall et al., 2018). At the same time, the gendered and relational patterns observed in this study must be understood within a broader Norwegian and Nordic cultural context characterized by ideals of equality, shared parenting, and mutual responsibility. While such egalitarian ideals can foster openness and collaboration in therapy, they may also obscure ongoing power imbalances and subtle forms of coercion that persist beneath discourses of equality (Wemrell et al., 2022). Therapists must therefore remain attentive to how these local cultural narratives around gender, conflict, and responsibility shape how clients describe, interpret, and respond to violence in their relationships.

Focus on the Children

Children often act as both motivators for help-seeking and as therapeutic resources. In our study, awareness of and acknowledgment of the impact on their children frequently triggered “constructive distress,” encouraging parents to participate and seek help (Darwiche et al., 2022). Similarly, Merchant and Whiting (2018) found that many couples identified a “turning point” related to their children, such as witnessing a violent episode or reflecting on intergenerational transmission of violence, which served as a wake-up call to reconsider “where the relationship was headed.” In their grounded theory of desistance, moments when children observed violence or when parents saw its impact on them often triggered reflection, remorse, and a deliberate choice to change. At the same time, our study also indicated that uncertainty and fear of triggering child protection services led some individuals to withhold or soften their disclosures. This underscores the importance of a transparent and child-sensitive approach. Therapists should communicate clearly about their role, the limits of confidentiality, and the possible implications of disclosure, while also acknowledging the potential value of integrating a child-focused perspective in therapy or, in some cases, involving children directly when it can be done safely and meaningfully. Including children’s perspectives may deepen understanding of their situation (Holt et al., 2008) and strengthen motivation for change (Cravens et al., 2015; Merchant & Whiting, 2018). However, such involvement requires careful ethical consideration and clear information for all parties involved to ensure that participation fosters safety, trust, and therapeutic engagement.

Adjust the Pacing of Naming and Framing the Violence

Naming and framing the main issue as violence was a negotiated process, both internally and relationally. Especially among men, there was a tendency both in the pre- and in-therapy journey to reserve labeling behaviors as violent, for overt physical acts. This finding aligns with earlier research on differences between clients and therapists in recognizing IPV (Dudley et al., 2008; Simpson et al., 2007). Therapists responded with dialogical flexibility, introducing language aligned with clients’ experiences and guiding them toward recognition and a shared vocabulary. This approach resonates with practice recommendations emphasizing careful pacing, screening, and sensitivity to escalation risk during conjoint sessions in IPV couple therapy (Keilholtz & Spencer, 2022; McCollum & Stith, 2008). Within the in-therapy journey, calibrated pacing is often essential when naming and framing the violence, striking a balance between the need for clarity and accountability, on the one hand, and fostering therapeutic engagement and a shared project for change, on the other. However, this process should not compromise the safety of those involved. At the same time, it is essential to recognize that naming violence may carry some risks. As Hearn (2013) has argued, naming violence can sometimes produce paradoxical effects, such as leading to minimization, justification, or a defensive reframing of responsibility, particularly when it threatens established gendered power positions or challenges dominant narratives of control. In this sense, therapists must remain critically attuned to how the timing, tone, and context of naming and framing violence can either open space for accountability and enhanced safety or, conversely, hinder it. Through ongoing, reflexive internal and external negotiations that remain sensitive to power, language, and lived experience, therapists can help transform the act of naming and framing violence as the core issue from a potentially polarizing intervention into a shared process that deepens understanding and supports safe, constructive change.

Long-term Violence and Emotional Exhaustion Can Limit the Potential for Relational Repair and Healing Processes

In such cases, reassessing the suitability of couple therapy becomes both ethically and clinically necessary (Snellingen et al., 2024). Within the broader literature, two dominant positions shape the discourse around how to approach IPV in couple therapy. The first position cautions against or rejects conjoint therapy when violence is present, citing concerns about safety, power imbalances, and the potential re-traumatization of victims. This position has been widely discussed and challenged in the literature (Armenti & Babcock, 2016; Hurless & Cottone, 2018; Stith & McCollum, 2011). The second position advocates for more differentiated clinical judgment, often guided by IPV typologies, particularly the distinction between coercive controlling violence and situational couple violence, as a basis for deciding whether conjoint therapy may be appropriate (Holtzworth-Munroe & Stuart, 1994; Johnson, 2008). Yet, others argue that such typologies, while clinically helpful, are often empirically inconsistent or overly rigid to fully capture the dynamic and evolving nature of couples’ lived experiences in therapy (Alexander & Johnson, 2023). Our results support this view; typologies may serve as heuristics but must be complemented by clinical judgment attuned to evolving relational dynamics. Therapists should continuously assess whether the couple is committed to a shared, regenerative process and whether conditions are safe enough for conjoint work (Snellingen et al., 2024). This involves ongoing monitoring of how the pre-therapy journey influences and integrates with the in-therapy journey, as well as critically evaluating how the in-therapy process is unfolding, shaping not only what is addressed in therapy but also how safety, trust, and change are made possible.

Organizational and Policy Implications

In low-threshold, generalist services such as NFCS, where therapists begin with limited information, this study highlights several key implications for organizational and policy development. While the discussion draws on the Norwegian NFCS context, the implications are relevant to other service systems aiming to integrate violence-sensitive couple therapy, including those operating with different mandates, thresholds, or resource levels. These implications align closely with the results and emphasize the interdependence of clients’ pre-therapy experiences and the in-therapy process.

Facilitate Early Access To pre-therapy Journey Experiences

Services should not rely solely on client self-disclosure of violence during early sessions. While some couples may feel ready and able to share their experiences early, many do not. To better support the in-therapy journey, organizations would benefit from proactively creating conditions for disclosure that are relevant for the specific service and that support and supplement the therapist’s clinical judgement. This may include some routine inquiries, structured intake protocols, and separate initial interviews, practices that enhance risk detection and support safer entry into therapy (Bograd & Mederos, 1999; Bradford, 2010; Schacht et al., 2009; Zahl-Olsen et al., 2019).

Systematically Develop and Continually Cultivate Therapists’ Capacity To Address IPV

Services should support therapists in building capacity to address and manage IPV in couple therapy. Even with routine inquiry and screening in place, as our results indicate, many clients might not initially recognize their behavior as violent or be ready to disclose. Couple therapists need training that goes beyond generic knowledge and typology labels, providing them with skills to sensitively introduce, reframe, and revisit issues related to IPV in couple therapy, as it may emerge gradually, ambiguously, or in fragmented form. These capacities can be strengthened through ongoing supervision, specialized training, and an organizational culture that scaffolds reflective and ethically grounded practice (Sammut Scerri et al., 2017; Snellingen et al., 2024). For therapists and organizations that choose to continue working conjointly after violence has been disclosed, a range of models and frameworks have been developed to support safe and differentiated clinical practice (Cooper & Vetere, 2008; Keilholtz & Spencer, 2022; Sammut Scerri et al., 2017; Slootmaeckers & Migerode, 2018, 2020; Stith et al., 2012; Vall et al., 2018). These approaches emphasize careful assessment of the type of violence, power dynamics, and motivation for change, alongside continuous monitoring of risk and safety throughout the therapeutic process. However, such competence cannot be assumed after short-term implementations; it must be continually cultivated, systematically supported, and embedded within both clinical routines and ongoing professional development structures if this work is to remain safe, effective, and sustainable over time (Husso et al., 2021).

Develop Dynamic Service Models that Evolve with the Journey

Clients who enter therapy with complex pre-therapy histories, such as long-term IPV, negotiations about naming and framing the violence, ambivalence regarding continuing the relationship, concerns about children, or fragmented help-seeking, often require integrated and adaptable formats within the in-therapy journey. Services like NFCS would enhance their capacity to meet the needs of the clients by supporting transitions between individual, couple, and family modalities based on ongoing assessment. Flexibility across the therapeutic timeline, especially at key transitions and changes, can enhance safety, therapeutic relevance, and continuity (Littlechild et al., 2024; Stith & Spencer, 2024; Visser et al., 2020).

Prioritize Continuity of Care

Repeated unsuccessful help-seeking can erode trust and diminish hope in therapy and services. Several participants described prior experiences of being misunderstood or offered services that did not fit their needs. These findings echo research linking past negative experiences with professionals to delayed help-seeking and guardedness (Tambling et al., 2014; Vogel et al., 2005). Especially in low-threshold services, maintaining continuity of care through clear routines, trauma-informed approaches, and transparent communication is essential. Services should outline structures and routines to ensure that clients are informed about what happens when violence is disclosed, including implications for safety, confidentiality, and follow-up. If couple therapy becomes unsafe or insufficient, services should be prepared to adapt, whether through format shifts, clarification sessions, or timely referrals. This “meeting clients where they are” approach strengthens ethical and safe support and responses, whether within the service or with corresponding help systems (Messing et al., 2015).

Strengths, Limitations, and Future Research

The results above should be interpreted as situated and illustrative rather than representative. In line with the epistemological underpinnings of IPA, the aim is not generalization but rather to provide a rich, idiographic account that can deepen understanding of how particular individuals make sense of their lived experiences (Smith et al., 2021). By attending closely to the meaning-making of participants within their relational and therapeutic contexts, the study provides insights that may resonate beyond the immediate sample through a form of “theoretical transferability” (J. A. Smith & Nizza, 2022). In this sense, the findings should be viewed as opening up possibilities for understanding rather than as definitive claims about all couples experiencing IPV in therapy.

A prime strength of this study lies in its multiperspective approach, which allows us to explore rich, relational nuances by examining therapist and couple perspectives simultaneously. Conducting interviews during ongoing therapy adds immediacy, allowing us to explore participants’ experiences as they unfold or in the near present. This enables us to examine multiple perspectives of both the past, present, and anticipated future from the vantage point of ongoing couple therapy, as well as the relationship between them. Our insider position within the NFCS seemed to facilitate trust and openness, encouraging deeper exploration.

However, this study was conducted within a Norwegian public couple and family therapy service, which offers low-threshold, accessible, and free couple therapy. The specific service context, combined with a small clinical sample and the highly experienced therapists included in this study, may limit the transferability of the findings to other settings. Adaptation may be needed in services with different structures, referral pathways, or levels of therapist capacity to address IPV. Our dual role as researchers and our work within the same organization may have influenced responses, despite participants reporting this as a sense of safety.

In addition, the recruitment process introduced certain limitations. Therapists observed that partners who had experienced or been subjected to violence were generally more willing to participate, whereas those who had used violence were more likely to decline. This imbalance may have influenced the diversity of couples represented in the data, as inclusion required consent from both partners and their therapist. Future research could therefore explore recruitment strategies or study designs that better capture a broader spectrum of couples affected by IPV.

Furthermore, the findings should be read in light of the Scandinavian sociocultural context, characterized by strong welfare-state and gender equality ideals that shape public understandings of family life and violence (Wemrell et al., 2022). Future studies could explore how cultural norms around emotional expression and gender intersect with help-seeking and disclosure processes more specifically in other cultural settings, where understandings of violence and responsibility may differ.

Future research could also extend to diverse services and clinical contexts to explore how both clients and therapists experience and make sense of the Dual Journey Model. Including couples dealing with varying forms of violence or relational challenges, as well as therapists with different levels of experience, may help assess the model’s adaptability and relevance across settings. Additionally, incorporating children’s perspectives could provide valuable insights into the broader relational dynamics and contribute to more ethically attuned practices in couple therapy.

Conclusion

This study highlights the long and dual journey toward violence-focused couple therapy as involving not only a pre-therapy journey, but also a vital in-therapy journey where IPV becomes increasingly central to the therapeutic work. The Dual Journey Model distinguishes these two phases while emphasizing their deep interconnection. The pre-therapy journey, as characterized in this study, involves women initiating change, clients experiencing ambivalence and emotional uncertainty, repeated failed help-seeking efforts, and concerns for their children. This phase reaches a critical threshold, a point where “enough is enough,” which prompts the couple to seek help. Within the in-therapy journey, these histories are not left behind; they resurface and can take on new meaning and shape as the in-therapy journey unfolds. Through internal and relational negotiation, clients and therapists engage in the process of naming and framing the violence towards potentially recognizing IPV as the core issue.

The Dual Journey Model reminds us that safety, relevance, and change are encouraged when therapists attune to both journeys and the chronological yet iterative movement of these in ongoing therapy. Recognizing how pre-therapy experiences continue to inform in-therapy dynamics, and how new insights in therapy may reconfigure the past. By honoring clients’ interpretative horizons and integrating this temporal complexity into clinical reasoning, the model supports a context-sensitive, ethically grounded, and responsive therapeutic process that prioritizes client safety and well-being at its core, while creating space for potential new relational futures to emerge.