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How to write treatment plans for survivors of domestic violence

Learn how to create a trauma-informed treatment plan for survivors of domestic violence, including safety planning, therapy approaches, and recovery support.

October 10, 2025 • Updated on September 4, 2026

By Ryan DeCook, LCSW • Clinically reviewed by Maddie Tong, LCSW

8 min read

By Ryan DeCook, LCSW • Clinically reviewed by Maddie Tong, LCSW

According to the National Intimate Partner and Sexual Violence Survey, 36% of women and 33% of men in the United States report experiencing intimate partner violence or stalking at some point in their life. After the shock of those numbers sinks in, we must accept the reality that, as therapists, we will very likely encounter a client experiencing domestic violence at some point in our career. When that moment comes, we need to be prepared. While receiving formal training in this area should be a top priority, this article can also provide some helpful things to consider.

Treatment approaches for survivors of domestic violence

It's essential to note that the clinical approach to supporting survivors is dependent on their current safety status. Treatment will look fundamentally different for an individual in an active domestic violence scenario (where the focus must remain on safety planning and risk assessment as the first priority) versus someone who is experiencing distress or PTSD in the aftermath of domestic violence (where trauma processing and other therapeutic approaches become the primary focus). With that in mind, safety and risk assessment are always paramount before beginning more in-depth work.

Let’s take a look at what treatment interventions may be useful when working with survivors of domestic violence. Knowing the effective routes you can take with a client can inform your planning and treatment implementation.

Safety planning and risk assessment 

Risk assessment involves first evaluating imminent safety concern or level of risk. If active risk is identified, steps must be taken to protect the patient. If imminent risk is ruled out, risk assessment refers to evaluating the lethality and likelihood of further harm, violence, homicide, or suicide. Client reports are factored in giving weight to the survivor's subjective perception of risk. Building trust is essential to creating space where the patient can respond honestly. Empirical risk factors should be assessed, such as past violence/lethality history, violence and suicide history, current threats, escalation, hopelessness, access to weapons, and recent or pending separation status of the relationship. Assessments such as the Danger Assessment have been validated and can provide useful information, though providers should seek proper training before enacting these types of assessments.

Safety planning follows risk assessment and is a dynamic, collaborative, and personalized strategy intended to increase safety for clients and prepare them for potential crisis situations. Working out a unique plan with a client might include identifying warning signs that a crisis may be occurring, distress tolerance and emotional regulation skills (coping skills), crisis resources to contact, having a packed bag, pre-identified safe routes/locations, having safe people to call with code words, securing important belongings in advance, having a plan for children and pet care, and having a safe place to go. The Domestic Violence Crisis Center website has a helpful guide to safety planning.

Trauma-informed talk therapy 

Trauma-informed therapy should be infused in any care provided to survivors of domestic violence. This therapy approach is continually mindful of the significant impact of the trauma that domestic violence can cause for survivors. Therapists should emphasize safety, empowerment, collaboration, and avoiding re-traumatizing the client throughout treatment. Coping skills and resilience are often focuses of the therapy. Research has shown trauma-focused cognitive behavioral therapy (TF-CBT) and narrative exposure therapy as two talk-based therapies that have results on the mental health impacts of domestic violence.

Crisis intervention resources 

Part of a good safety plan must include crisis resources. You can supply these for clients who are not already aware of them. These are services that can provide immediate support, shelter, safety, and counsel in emergency situations. Some good places to start include:

  • National Domestic Violence Hotline (1-800-799-SAFE): Provides free and confidential crisis intervention, support, education, and referrals to local services
  • Sexual Assault Hotline (1-800-656-HOPE): Offers support and resources to survivors of sexual assault including crisis counseling, and referrals
  • Domesticshelters.org: A website to find local DV shelters, programs, hotlines, and education on how to escape and find recovery
  • Advocacy services that can be found by contacting hotlines, state or county services, or local community organizations

Support groups for survivors 

Group interventions for domestic violence survivors have been proven through research to have a strong impact on symptom reduction and reduced isolation. Particularly CBT group-based interventions have proven to be as effective as individual therapy. It is important to note that psychological interventions for domestic violence survivors, both individual and group, have proven to improve mental health symptoms but do not necessarily reduce the client’s participation in relationships containing domestic violence. 

Psychoeducation on abuse and trauma cycles

Normalizing the effects of trauma for clients and educating them on the patterns of abuse can be helpful once safety is established. The cycle of abuse is an educational tool promoted by domestic violence educators and support providers. Use clinical judgment to determine when a client is ready to receive psychoeducation based on their ability to tolerate distress, receive new information, and exhibit cognitive flexibility. 

Addressing PTSD, anxiety, and depression

For insurance purposes, there are T-codes that capture domestic violence. But these codes should almost always be used in acute-care settings, not by outpatient providers. 

Often, it may be favorable for outpatient providers to bill for the mental health challenges related to domestic violence, such as PTSD, anxiety, or depression.

When these mental health symptoms are present and related to domestic violence, they should be addressed in the treatment plan. Research has proven that multiple interventions, including EMDR and CBT, are effective in reducing symptoms for survivors of domestic violence. In addition to these, the American Psychiatric Association (APA) recommends skills training in affect and interpersonal regulation (STAIR), interpersonal therapy (IPT), and cognitive processing therapy (CPT). 

Empowerment and self-esteem building 

Survivors of domestic violence often are stripped of choice and control, which can erode self-esteem over time. Empowerment and self-esteem oriented therapy focuses on giving control and choice back to survivors through every aspect of treatment. Support in decision making — as well as skill building in communication, boundary-setting, and emotional regulation — can also be part of empowerment and self-esteem building. It’s important to address conversation around leaving a partner sensitively. When approaching the topic of separation, clinicians must prioritize client autonomy and safety. Pushing or suggesting that a client leave an abusive partner is clinically inappropriate, as it risks shattering the therapeutic alliance and causing them to shut down. Crucially, the period surrounding separation is statistically the highest-risk time for violence, including lethality, meaning any discussion must be immediately framed around enhanced, client-driven safety planning. This runs the risk of breaking trust with the client or causing them to shut you out. Focusing on motivational interviewing and building resources can further empower survivors.

Individual or group CBT, acceptance and commitment therapy, support groups, and schema therapy are interventions that are proven to boost self-esteem and resourcefulness. The APA recommends HOPE (helping to overcome PTSD through empowerment) and RPRS (relapse prevention and relationship safety) as some interventions focused on safety and empowerment. 

Legal advocacy and case coordination

In navigating the complexities of domestic violence, other supports are often involved beyond just therapy. This might include legal advocacy. Referrals can be made when survivors need help to navigate protective orders, custody hearings, or divorce proceedings. Therapists can only share as much with a legal advocate as the client wants them to share. Other care might be offered through case managers, doctors, or shelter staff, for example. It should be determined with the client and other support team members what makes sense for the cadence and depth of coordination. Appropriate coordination of holistic care through a multidisciplinary team improves outcomes for DV survivors.  

Note on legal and ethical duties: Providers should document any safety concerns discussed with a patient, particularly when domestic violence is mentioned or when the patient remains in contact with the perpetrator. Careful documentation supports continuity of care, facilitates appropriate follow-up, and ensures compliance with reporting obligations.

Involving trusted support systems 

Defining who a survivor can trust as part of their social support team is an effective intervention. Family members, close friends, neighbors, faith leaders, or professionals are all possibilities to fill the role of support team. Directing the client towards this support team can enhance emotional safety, physical safety, support for practical needs, and empowerment. Where appropriate, signed consent can be obtained from the client to give permission for these support people to join certain sessions of therapy or safety planning. If collaborating with these support people, it is critical to determine their role and purpose as part of treatment. Boundaries, consent, and confidentiality should be discussed with the client about anyone involved in this way. 

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What to consider when creating a domestic violence treatment plan

With an understanding of domestic violence interventions, you can now start considering the treatment plan. There are some key components to keep in mind. 

Initial screening and safety assessment 

The screening and assessment done at the onset of treatment will determine much of the treatment plan direction. Screening best practices include client reports, direct observation, and validated assessment tools such as the HARK, HITS, PVS, or WAST. Each of these briefly measures aspects of domestic violence in some manner and scoring guides can be found online. Use clinical judgment to complete your conceptualization and determine if more than one assessment tool is needed. Keep in mind that these assessment tools are primarily validated for younger women. Screening for men may need to rely more on client reports and observation. 

The APA recommends assessments be conducted in private, confidential settings and that questions be framed in nonjudgmental ways. Strengths-based and empowering language should be utilized, and trauma history should not be discussed too quickly to avoid emotion dysregulation or dissociation.

It is essential to be aware of state and local mandatory reporting laws, especially if minors or elders have been exposed to any of the abuse. See the section above for risk assessment and safety planning. 

Understanding the survivor’s priorities and setting trauma-informed goals 

All treatment of domestic violence should be empowering, trauma-informed, and survivor-centered, including client goals and priorities. It can take time to build trust, but this is a necessary step for truly understanding the survivors goals. Survivors report the best experience of therapy when clinicians provide relationship-building, respect, and autonomy for decision making. As a therapist, be sure to monitor your own biases when developing goals, as intimate partner violence can be triggering for even the most seasoned providers.

As clients share more of their priorities, clinicians can come alongside the clients to shape their desires into goals that are actionable and measurable (SMART goals). These goals may include securing housing or other short term needs, establishing safety, stabilization of mental health symptoms, healing from trauma, rebuilding trust and autonomy, and restoring connections and support. The prioritization of empowerment and autonomy should be maintained throughout the goal setting and action stages of the treatment plan because choice is a powerful intervention for clients. 

Multidisciplinary collaboration and referrals 

Multidisciplinary teams (MDT) and a holistic approach can improve outcomes for domestic violence survivors. Part of the screening phase is to determine the needs and goals of the client, as well as their existing supports. An MDT may include healthcare providers, legal experts, mental health professionals, advocates, and social service providers. If a client already has these supports in place, gaining written consent to collaborate can be a good first step. If the client does not have these supports in place and wants support, work with them to determine what referrals are needed and steps needed to secure those supports. The MDT can work best when roles and cadence of communication are clearly defined.

Monitoring emotional safety and progress 

As the treatment plan unfolds, it is useful to monitor the client and track progress. The initial screening tools already mentioned (e.g. danger assessment, HITS) can be applied at various intervals throughout treatment to assess for safety. Initial mental health questionnaires such as the PCL-5 for trauma, PHQ-9 for depression, or GAD-7 for anxiety can also be applied initially and on a recurring basis. Ongoing discussion and qualitative reports from the client can be useful for monitoring progress and the quality of the therapeutic relationship. There is no standard frequency for these follow up assessments, but it may be beneficial to consider follow up every one to three months. 

Supporting recovery from complex trauma 

Domestic violence and trauma are synonymous for many clients. The impact of the abuse, which is often chronic, can have far-reaching effects. Complex trauma refers to a pattern of repeated, prolonged, and severe traumatic experiences that occur in the context of a significant interpersonal relationship, such as with a caregiver, partner, or community. Providing care for these clients through an empowered, trauma-informed way is imperative. Ensuring safety and helping clients to stabilize their mental health symptoms is often the best approach before approaching any work on trauma reprocessing. STAIR and DBT can be effective, as can skills-based approaches for these early stages. 

The APA recommends that EMDR, CPT, and trauma-focused CBT can be effective for processing traumatic experiences and reducing symptoms. A combination of therapies may be useful to help clients move through different phases of their treatment. Helping clients to rebuild connections with their self-esteem, other people, and other important aspects of their life are also part of supporting recovery from trauma. For complex cases with domestic violence and trauma, make sure to seek consultation or continuing education.

Domestic violence treatment plan example

The following is a treatment plan sample for domestic violence. It assumes treatment for PTSD as that is what insurance will be billed for, but the objectives relate directly to the domestic violence experienced. This treatment plan is for educational purposes only and is not to be used as prescriptive for treatment. 

Client Name: Jane Client

DOB: 2/11/94

Therapist Name: John Therapist

Date: 9/1/25


Initial Treatment Plan


Diagnosis Code/Name: F43.10 Post-Traumatic Stress Disorder (PTSD)

Main Presenting Symptoms and Challenges: Intrusive memories, nightmares of domestic violence experiences, avoidance behaviors, hypervigilance, startle response, difficulty sleeping, anxiety, ongoing fear for safety, lack of housing stability. 

Modality Planned: Individual Trauma-Focused CBT, EMDR, DBT, STAIR, care coordination with legal advocate and case manager.

Frequency and Duration of Sessions: Weekly 60 minute sessions

Estimated Length of Treatment: 6 months

Treatment Goals and Objectives:


Long-Term Goal #1: Increase sense of safety and stability by establishing a safety plan and by securing safe housing. 

Estimated Goal Completion Date: 3/1/26

  • Objective #1: By 12/1/25 Client will complete and review a personalized safety plan that addresses current risks. This will be reviewed with therapist every 4 weeks ongoing. 
  • Objective #2: By 2/1/26 Client will secure and move into safe housing, to reduce risk of ongoing domestic violence. This will be verified with case manager. 

Long-Term Goal #2: Improve emotion regulation and reduce PTSD symptoms through evidence-based trauma therapies. 

Estimated Goal Completion Date: 3/1/26

  • Objective #1: Client will demonstrate reduction in PTSD through a reduction of PCL-5 by at least 10 points from baseline assessment to assessment completed on 3/1/26. Assessments will be measured bi-weekly. 

Objective #2: By 2/1/26 Client will master and apply 3 coping skills to help manage hypervigilance and startle responses. This will be assessed by self-report and therapist observation.

How ICD-10 codes fit into your domestic violence treatment plan for adults

Domestic violence is not, itself, a diagnosable mental health condition. That said, many survivors experience conditions including PTSD, depression, and anxiety. Therapists often choose to use ICD-10 codes for these conditions when creating treatment plans and billing insurance.

You may also choose to use an ICD-10 Z code. A Z code typically can’t be the primary code used when billing insurance, but it can be included when other ICD-10 codes don’t fully capture the reasons someone sought care. Code Z63.0, problems in relationship with spouse or partner, may be relevant in this case.

There are also ICD-10 T codes related to domestic violence, but they are rarely used in outpatient care.

Domestic violence treatment plan FAQs

When is the highest-risk period for a domestic violence survivor?

The end of a relationship is, statistically, the riskiest time for domestic violence to occur. If your client is planning to leave a violent partner, it’s crucial to focus on safety planning.

What's the difference between TF-CBT and narrative exposure therapy for domestic violence survivors?

TF-CBT and narrative exposure therapy are both evidence-backed treatments for domestic violence survivors, but they take different approaches. CBT is all about identifying and disrupting harmful thought patterns related to trauma, while narrative exposure therapy uses storytelling to make traumatic memories less powerful.

How do I build trust with a client who may not disclose the full extent of abuse?

Pressuring a trauma survivor to disclose details too quickly can be harmful, both to your client and your therapeutic relationship with them. Let your client set the pace and steer treatment, and be sure to use empowering and non-judgmental language. Survivors say the best therapeutic experiences happen when clinicians are respectful, take time to build relationships, and allow their clients to take the lead.

Do I need specialized training to treat domestic violence survivors?

Some, but not all, states require some domestic violence training for general therapy licensure. But if you plan to focus on this population, additional specialized training is strongly recommended. You may wish to pursue TF-CBT certification, training on administering specialized assessments, and more.

What role do support groups play in domestic violence recovery?

Research shows that support groups — particularly those utilizing CBT approaches — can effectively reduce mental health symptoms among domestic violence survivors. If you’re interested in running a support or therapy group, consult our group therapy activity ideas.

How common is domestic violence among therapy clients?

Data suggest 36% of women and 33% of men in the U.S. will experience intimate partner violence or stalking at some point. Those unfortunate statistics mean you will likely encounter this issue at some point in your therapeutic career — if not multiple times.

What if my client doesn't identify their relationship as abusive?

If you believe your client is at imminent risk of serious harm, you may need to take steps to protect them. In general, however, you should give weight to your client’s subjective reports about risk and safety. Remember, it can take time to build the trust required for a client to fully confide in you, so avoid pushing too hard before you’ve laid a strong foundation.

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Build your best practice with Headway

With the high prevalence of domestic violence, you will likely need to treat it at some point in your career. Empowering clients with a trauma-informed approach and evidence-based practices can make a significant difference in the lives of domestic violence survivors.

Headway is a practice management software that can support your care for clients. By offering assessment tools such as the PCL-5, insurance billing, and documentation tools, Headway can help you to spend less of your time burdened by administration and more time supporting change in your clients.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

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