One in 16 men (six per cent) and one in six women (17 per cent) have experienced physical or sexual violence at the hands of a current or previous cohabiting partner (ABS 2016), while 23 per cent of women and 16 per cent of adult men have experienced emotional abuse by a partner at some point since the age of 15 (ABS 2022).

Worldwide, 27 per cent of women will have experienced domestic or dating violence in their lifetime (WHO 2021).

I am one of those people.

I am one of your colleagues.

Before I became a statistic, it never crossed my mind that the people with whom I spent a large part of my time could have this happening in their lives.

As both an undergraduate and a postgraduate physiotherapy student, I found that the curriculum contained no education about physical, emotional or psychological abuse or about the impact that abuse of any kind has on the physical health of our patients.

At the time of writing, there is no professional development offered by the APA in these areas, either.

However, the world is waking up, as evidenced by the introduction of domestic violence (DV) leave and coercive control laws.

As a profession, we should be educating ourselves.

The United Nations defines DV as ‘a pattern of behaviour in any relationship that is used to gain or maintain power and control over an intimate partner’.

It encompasses all ‘physical, sexual, emotional, economic or psychological actions or threats of actions that influence another person’ (The UN n.d.).

It is reasonable to assume, on any given day at work, that a number of the adult Australians with whom you come into contact are victims of DV.

Yet we receive no training in this area.

Our education is dominated by the medical model, which fails to accommodate mind–body interactions.

The emotional trauma that underpins DV is therefore frequently misunderstood or overlooked.

Despite the biopsychosocial model being accepted as an optimal way to practise healthcare, the absence of training in how emotional trauma expresses itself physically means that our diagnostic skills revert to the medical model when we can’t explain what we see.

From neck pain that started after strangulation to pelvic pain after rape or back pain after a stressful life event, the source of the pain is often unnecessarily medicalised.

If our training teaches us that physical pain is underpinned by a ‘medical issue’, how do we learn to see the emotional issues affecting our patients and our colleagues?

While the statistics tell me I am not alone in experiencing domestic violence, I have been very alone as a professional navigating a career with the cloud of domestic violence over my head.

Initially, I wasn’t even aware of what it was I was experiencing.

I had no language to articulate the patterns of behaviour I was subjected to; all I knew was that it didn’t feel great.

My innate survival mechanisms unfortunately contributed to that lack of awareness.

If I stopped to feel too much, there was no one there to support me.

If I started to speak up against the perpetrator, the abuse intensified.

Silencing is a powerful tool used by perpetrators of abuse, along with shaming, blaming, criticising, verbal abuse, manipulation, control and abdication of responsibility.

All together, they cause devastation for the individual on the receiving end.

Once I realised what was happening, I found that there was no one in my professional circle who understood.

After all, my colleagues had mostly met the perpetrator and their experience was very contradictory to what I was describing.

Such dissonance, I observed, was hard for most to reconcile and any attempts to explain my experience were dismissed, trivialised or diminished.

This failure to hear you and believe you deepens the injustice of DV.

I get it.

I get that an educated perpetrator is very skilled at making others think they are a great person.

I understand that colleagues have been fortunate enough to avoid exposure to psychological and emotional abuse, so they can’t know the nuances.

They can’t see what they don’t know.

What I observed in many of my colleagues was an inability to sit with the discomfort elicited by my story.

The way they responded highlighted how deficient our training is in teaching us to be comfortable exploring the uncomfortable.

When discomfort arises in us as clinicians, due to interactions with patients or colleagues, we need the skills to support people rather than diminishing and dismissing those feelings of discomfort as quickly as we can, inadvertently silencing those whose stories don’t align with our own tolerances.

Recent changes to industrial law include the right to domestic violence leave.

However, I am concerned that when availing themselves of that leave, victims may not actually be supported in the manner for which the leave was intended.

How do I go to an employer who has diminished my attempts to communicate that I am a victim of DV and ask for DV leave?

The fact that staff don’t ask for this leave does not guarantee that staff aren’t victims—it may mean that our working environment is not emotionally safe enough to disclose DV or request leave.

Emotional safety training requires far more than the ‘rapport’ skills taught and gained over our careers.

While most of us think of ourselves as trustworthy, there are occasions when our behaviour might not convey that to patients or other professionals.

As a victim of DV, my trust was violated by someone who should have been trustworthy.

I was blatantly lied to, gaslit, manipulated into believing things that I later discovered were not true and promised things that never eventuated.

Personal information was shared publicly, with an aim to humiliate or degrade.

Boundaries were not respected and the perpetrator refused to take responsibility for their behaviour.

This lack of responsibility looks like blame, accusation, deflection away from the perpetrator’s behaviour and the creation of a new focus on your behaviour.

By setting a boundary, you become the unreasonable one and the perpetrator’s persistent violation of boundaries continues until you give in.

Consequently, I am hypervigilant about the absence of trustworthy behaviour.

As a clinician or colleague, we have an implied ethical obligation to create emotional safety.

I suspect this is something that most of us have not analysed, but rather assumed we are doing.

At the same time, we rarely stop to assess the unease we feel after an interaction with an unsafe person.

The more frequently this occurs, the more we run the risk of it becoming the norm.

As a society, we have been trained to dismiss that feeling and as a profession, we are not educated about the requirement to be emotionally safe nor about how to protect ourselves or others from those who are unsafe.

Our lack of emotional hygiene as professionals leads to burnout.

Our profession is full of empathetic, giving people.

However, this opens us up to exploitation.

Perpetrators do not respect boundaries.

They do not allow others to prioritise themselves—only their needs matter.

They punish you if you don’t comply.

If you please them and behave as they wish you to, they reward you or cease punishing.

If you speak up, they get rid of you or silence you.

They are unable to tolerate differing opinions.

Such behaviours are consistent with the absence of emotional safety.

In my career I have observed that as a profession, we are not immune to exhibiting these behaviours in the workplace.

As physiotherapists, we need to be cognisant of not creating and not exploiting power imbalances.

Each of us who remains silent or colludes with these behaviours is complicit.

Emotional safety is underpinned by trust.

As professionals, if we assess our own and others’ behaviour according to Brené Brown’s BRAVING acronym, which summarises the anatomy of trustworthy behaviour (Brown 2022), we will go a long way towards creating emotional safety in the workplace for both colleagues and patients.

If you don’t have the skills to recognise and respond to DV, gaining a base understanding of trauma-informed care and the anatomy of trustworthy behaviour is a good start.

In addition to physical safety in working environments, emotionally safe conditions are essential and should be a given.

Imagine if we all spoke out against emotionally unsafe behaviour—if there were signs in workplaces saying ‘The silent treatment is not tolerated’ or ‘Undermining, collusion, special treatment and private meetings are not tolerated’.

If we had truly safe workplaces, I believe there would be less illness and burnout in our profession.

I would like to see physiotherapy training and professional development encompass trauma-informed care and education about DV and about the impact such social issues have on our physical health.

A thorough understanding of DV will help us to support colleagues and patients who may be experiencing it and to be leaders on this issue in the health profession.

>> Author name withheld upon request. Email inmotion@australian.physio if you want to liaise with the author about this article.

References

Australian Bureau of Statistics, ‘Personal Safety, Australia,’ 2016. https://www.abs.gov.au/statistics/people/crime-and-justice/personal-safety-australia/latest-release
Australian Bureau of Statistics, ‘Domestic Violence: Experiences of Partner Emotional Abuse,’ 2022. https://www.abs.gov.au/articles/domestic-violence-experiences-partner-emotional-abuse
World Health Organization, ‘Violence against women,’ 2021. https://www.who.int/news-room/fact-sheets/detail/violence-against-women
The United Nations, ‘What Is Domestic Abuse?’ n.d. https://www.un.org/en/coronavirus/what-is-domestic-abuse
Brené Brown, ‘Dare to Lead: The BRAVING Inventory,’ 2022. https://brenebrown.com/resources/the-braving-inventory