The Association Between Social Support and Stages of Change in Survivors of Intimate Partner Violence

Abstract

For survivors of intimate partner violence (IPV), it is often difficult to take steps to establish safety and obtain a violence free life. Researchers have applied stage of change theory to aid in understanding the experience of survivors, as well as, the factors that can help women who desire to make changes in or break free from a violent relationship. Social support is one factor that can be helpful to IPV survivors who are attempting to make changes in their relationship. The purpose of the current study was to examine the differences in social support experienced by women who are at varying points in the process of change. Shelter residents (N = 191) participated in this cross-sectional non-experimental study. Analyses demonstrated five distinct clusters or profiles of change among study participants and were labeled by the authors as follows: preparticipation, decision making, engagement, ambivalent, and action. All forms of social support (i.e., structural, functional, and satisfaction) were generally higher for individuals more engaged in the process of change. More specifically, differences were noted between the action and decision-making clusters and the engagement and decision-making clusters. These findings suggest that it is vital that clinicians working with survivors of IPV not only assess but also tailor interventions to meet survivors where they are in the process of change. Further, interventions that foster survivors’ abilities to develop reliable and satisfying social support networks will be beneficial for survivors of IPV.

Keywords

intimate partner violence domestic violence stages of change social support

Intimate partner violence (IPV) is an extremely serious and prevalent problem in our society. According to the Centers for Disease Control and Prevention (CDC; Black et al., 2011), in the United States each year, women experience about 4.3 million intimate partner–related physical assaults and 16.6 million intimate partner–related psychological attacks. Further, in 2010, IPV resulted in 1,336 deaths in the United States (Black et al., 2011). The National Center for Injury Prevention and Control (2003) estimated that IPV against women costs over $5.8 billion per year.

Given the high prevalence and costs of IPV, research on IPV victims’ decisions to stay with or leave an abuser has proliferated, indicating that leaving an abuser is not always what the survivor may want, is not always feasible (e.g., financially, protection of children), and does not guarantee that the abuse will cease. Further, leaving the relationship can lead to increased risk of harm from the abuser, and yet many still expect the survivor to leave a violent relationship or question why she may stay (D. K. Anderson & Saunders, 2003; Thapar-Björkert & Morgan, 2010).

It is imperative that IPV interventions place the burden of change and focus on those who perpetrate violence, not those victimized by it. However, of equal importance are the numerous agencies that help women and their children find safety from the abuse and are effective along several domains including reducing revictimization rates (Bennett, Riger, Schewe, Howard, & Wasco, 2004; Sullivan & Bybee, 1999). For example, an intervention that used empowerment to help sheltered women identify threats to their physical or emotional safety that were within their control was effective in reducing reabuse (D. M. Johnson & Zlotnick, 2009; D. M. Johnson, Zlotnick, & Perez, 2011). Thus, understanding factors that may be related to the survivors’ process of attempting to establish safety can provide important targets for intervention for individuals working with survivors of violence (e.g., advocates, shelter workers).

In the past decade, researchers have begun to understand that abused women’s process of seeking safety from violence is complex and may take months or even years. Some have applied stage of change theory to understand the survivor’s perspective (Alexander, Tracy, Radek, & Koverola, 2009; Brown, 1997; Burman, 2003). Although there is a dearth of knowledge about the process of change in IPV survivors, research has established various factors that impact attempts to establish safety. One such factor that serves a protective function for survivors of IPV is social support (Coker, Watkins, Smith, & Brandt, 2003). Examining the relationship between the process of change and social support in IPV survivors will provide valuable information regarding how best to tailor interventions to survivors’ needs. Thus, this study aims to examine the differences in social support experienced by women who are at varying points in the process of change.

The Process of Change in Survivors of IPV

Understanding the slow and incremental process of change in survivors of IPV goes beyond the discrete decision to stay with or leave an abuser (Brown, 1997). Women are likely to return to an abuser multiple times before finally ending an abusive relationship, and while the survivor may appear inactive during this time of leaving and returning, she is likely taking critical steps toward ending the violence in her life (Bell, Goodman, & Dutton, 2007; Brown, 1997). Solely examining a woman’s decision to stay in or leave an abusive relationship does not capture the cognitive shifts regarding herself, her relationship, and her abuser that can be more accurately understood by examining the process of change. Identifying barriers or facilitators to this process of change will aid advocates and clinicians in tailoring interventions to better meet the needs of IPV survivors.

The transtheoretical model of behavior change (TTM; Prochaska & DiClemente, 1982), also known as the stages of change (SOC) model, includes five distinct stages that are cyclical, acknowledging the probability of setbacks during the process of behavior change. The different stages that reflect an individual’s readiness to change include precontemplation, contempla-tion, preparation, action, and maintenance (Prochaska & DiClemente, 1982). Prochaska and DiClemente (1982) postulate that an individual must cycle through these stages before they can enact any long-lasting changes.

Acknowledging the unique pressures and complex process of change experienced by IPV survivors, Brown (1997) adapted the SOC model to more appropriately describe the various stages in the process of a survivor attempting to obtain a violence free life. Importantly, this model does not explain a woman’s decision to stay in or leave a relationship, but rather it describes the cognitive shifts survivors experience regarding themselves, their relationships, and their partners (Brown, 1998). Precontemplation is characterized by a denial of the problem and a refusal to perceive the perpetrator in a realistic light (Brown, 1997). Women in this stage may believe that trying harder to please their partner will end the abuse and may appear defensive or resistant when other perspectives are offered (Burman, 2003). In the stage of contemplation, IPV survivors recognize a problem exists, may consider the pros and cons of shifting their views, but have yet to commit to making such shifts (Brown, 1997). Preparation is characterized by planning the manner in which safety will be sought out within a specific time frame (e.g., within the next month; Brown, 1997). During Letting Go of the Hope He Will Change, specific to Browns’ (1997) model, IPV survivors release hope that their partner will change. In Action, survivors carry out the strategy to overtly obtain safety (e.g., going to a shelter or obtaining a restraining order; Burman, 2003). The final stage of Autonomy/Separate Self is when a woman feels confident in the realistic view she has developed of herself and the decision she made to seek safety (Brown, 1997).

Although some have found the SOC model appropriate for survivors of IPV, others question the utility for this population (C. Anderson, 2003; Chang et al., 2006; Cluss et al., 2006). Many researchers cite that applying this model to IPV survivors implies that their behavior is dysfunctional and places the burden of change on the survivors (Chang et al., 2006). Further, a qualitative study concluded that the SOC model is not useful for survivors of IPV, as the process of change was non-linear in survivors, with women sometimes skipping stages and moving quickly into later stages (Chang et al., 2006). Others believe that the SOC model does not blame the survivor, but rather provides a more holistic template for understanding the complex process and factors involved in seeking safety from a violent relationship (Reisenhofer & Taft, 2013; Shorey, Tirone, Nathanson, Handsel, & Rhatigan, 2013). Further, survivors transition in and out of their abusive relationships (Bell et al., 2007), thus momentary relationship status does not accurately depict their experience. A more accurate conceptualization of the survivors’ complex experiences may be afforded by the SOC theory, as it considers how they think and feel about themselves, their partner, and their relationship.

To date, few empirical studies have investigated the SOC model with IPV survivors. Survivors of higher education, income, and age have been found to be in later SOC (Alexander et al., 2009; Shurman & Rodriguez, 2006). In addition, African American women compared with women of other races have been found to be at later SOC (Alexander et al., 2009). In addition to demographics, higher levels of psychopathology, distress, self-esteem, spiritual well-being, and social support have been found to contribute to a woman’s readiness to change (Bliss, Ogley-Oliver, Jackson, Harp, & Kaslow, 2008; N. L. Johnson & Johnson, 2013; Shurman & Rodriguez, 2006). Finally, higher levels of relationship commitment and others’ approval of the relationship were associated with earlier SOC in IPV survivors (Shorey et al., 2013). In sum, the literature on factors that impact SOC in survivors requires further inquiry to determine the relevance of the SOC model to IPV survivors.

Social Support and the Process of Change

Given that abusive relationships tend to negatively affect women’s level of social support (Katerndahl, Burge, Ferrer, Becho, & Wood, 2013), and the significant role social support plays in abused women’s efforts to establish safety (Beeble, Bybee, Sullivan, & Adams, 2009), examining the relationship between social support and survivors’ process of change may inform both policy and interventions. Social support includes connections to and supportive actions taken by significant others in one’s life (Barrera, 1986), and has been shown to have considerable physical and mental health benefits (Cohen, 2004; Cohen & Janicki-Deverts, 2009). The literature demonstrates both positive and negative roles regarding social support among survivors of IPV, thus highlighting the importance of social support research for this specific population (Beeble et al., 2009). Abusers often isolate women by separating them from friends and family. Even when offered support, survivors may feel ashamed and humiliated by the abuse and decline such support (Barnett, 2001). Further, research has shown that supportive reactions (e.g., validating the experience of a survivor) are most helpful to those who have experienced IPV, whereas negative reactions (e.g., disbelief of a survivor’s experience) have been linked to poorer mental health outcomes (Sylaska & Edwards, 2014). Unfortunately, compared with those who have not been victimized, survivors of IPV often have less social support from friends and family (Katerndahl et al., 2013). Such a limited support network is likely to increase barriers for women who desire change (Petersen, Moracco, Goldstein, & Clark, 2005).

To date, the scant research regarding the impact of social support on the process of change in survivors of IPV has yielded mixed results. The manner in which researchers have measured social support may be one contributing factor to the mixed results. For example, structural support, defined as the size of an individual’s support network (Procidano & Heller, 1983), has been found to be both unrelated (Alexander et al., 2009) and positively associated with readiness to change (N. L. Johnson & Johnson, 2013). Qualitative and quantitative research have demonstrated that functional support, defined as emotional and practical aid received by a social support network, is an important contributor to seeking safety and obtaining a violence free life and maintaining such a change (Levendosky et al., 2004; Short et al., 2000). In contrast, Bliss and colleagues (2008) found a negative relationship between perceived social support and the contemplation and maintenance stages. Finally, an additional aspect of social support, the amount of satisfaction an individual feels toward her network, has been found to facilitate the process of leaving an abusive relationship (Alexander et al., 2009; D. K. Anderson & Saunders, 2003; Estrellado & Loh, 2014).

In sum, the literature generally consists of mixed findings regarding the relationships of various types of social support with the process of change among women in abusive relationships. Further research is needed to elucidate the relationship between social support and the process of change in survivors of IPV with the hope that interventions can be tailored to meet the needs of survivors more effectively. Yet, to our knowledge, no studies have delineated the relations of each of these types of social support (i.e., structural, functional, and satisfaction) with the process of change in survivors of IPV, a necessary step to understand what social support type may be relevant to interventions for this population.

The Current Study

The current study sought to address gaps in the literature by examining the relationship between clearly defined aspects of social support (i.e., structural, functional, and satisfaction) and the SOC in IPV survivors. Prior research has found that IPV survivors report social support as an important factor when considering seeking safety from violence (D. K. Anderson & Saunders, 2003; Choice & Lamke, 1999; Estrellado & Loh, 2014); thus, we hypothesize that

Hypothesis 1: Structural support will be higher for individuals more engaged in the process of change.

Hypothesis 2: Functional support will also be higher for individuals more engaged in the process of change.

Hypothesis 3: Satisfaction with one’s social support will be greater among individuals more engaged in the process of change.

Method

Participants

A total of 191 current residents of local area battered women’s shelters that serve a mid-sized mid-western city and the surrounding area participated in the current study. Mean age of participants was 34 (SD = 10.03). Of the women, 58.4% reported their relationship status as single, 15.8% reported being separated from their partner, 13.2% reported being married, and 11.1% reported their status as divorced. In regard to race/ethnicity, 50.3% of participants identified themselves as Caucasian, 40.8% identified as African American, 4.7% identified as “Other,” 2.6% identified as Hispanic, and 1.6% identified as Asian. The majority of participants (74.9%) indicated a salary less than $10,000 a year. Of the participants, 76.8% indicated being unemployed and 85% reported receiving government aid.

On average, participants reported that in the 6 months prior to the study, they experienced occasional physical violence and frequent psychological aggression by their intimate partners. Almost the entire sample reported experiencing at least one act of physical violence (96.9%), and the entire sample reported experiencing at least one act of psychological aggression (100%).

Measures

SOC

The Process of Change in Abused Women Scale (PROCAWS; Brown, 1998) is a 51-item self-report measure containing nine subscales that assess participants’ SOC (25 items; Precontemplation, Contemplation, Letting Go of the Hope He Will Change, Action, and Autonomy/Separate Self), decisional balance (12 items; Pros and Cons of Change), and self-efficacy (14 items; Temptations and Confidence About Change). For this study, only the SOC subscales were used. The PROCAWS is limited in that it does not assess the stage of preparation, an important part of SOC theory. However, a notable strength of this measure is that it assesses the survivor’s overall readiness to address the violence as they experience cognitive shifts and begin to see themselves, their relationship, and their partners differently, rather than the readiness of survivors to make changes in their own behavior as most other SOC measures typically assess. In a sample of women primarily from battered women’s shelters and advocacy programs, each SOC subscale demonstrated moderate to high reliability (αs = .70-.93) and high construct validity (Brown, 1998). The reliability coefficients for each subscale in the current study ranged from moderate to high and are reported below.

The five SOC that can be used to characterize women in the process of change after experiencing significant violence from a partner were assessed using 25 items comprising the following five-item subscales: Precon-templation, Contemplation, Letting Go of the Hope He Will Change, Action, and Autonomy/Separate Self. Participants were asked to rate each item on a 5-point Likert-type scale from 1 (strongly disagree) to 5 (strongly agree). Each participant received a separate mean score for each of the five stages with higher scores indicating greater engagement in that stage. Internal consistency values for the SOC in the present study were .77 for Precon-templation, .76 for Contemplation, .71 for Letting Go of the Hope He Will Change, .78 for Action, and .85 for Autonomy/Separate Self.

Structural support and satisfaction

The Social Support Questionnaire (SSQ; Sarason, Levine, Basham, & Sarason, 1983) is a 12-item self-report measure used to assess the number of people on whom the participant could rely in various situations (six items) and the amount of satisfaction with these social supports (six items). Participants were able to list up to nine people per situation and satisfaction was rated on a 6-point Likert-type scale from 1 (very dissatisfied) to 6 (very satisfied). The total number of supports was obtained by summing the total number listed for each question and taking the mean of all six questions with higher scores indicating a larger support network. Satisfaction was determined by taking the average of the six satisfaction questions with higher scores indicating more satisfaction. Internal consistencies for the measure have been demonstrated to be very high, ranging from .90 to .93 for both number of supports and satisfaction (Sarason, Sarason, Shearin, & Pierce, 1987). Internal consistencies for total number of supports and overall satisfaction in the present study were .92 and .91, respectively. Convergent and discriminant validity were established, and the test–retest reliability for the current measure was shown to be high (Sarason et al., 1987). Regarding convergent validity, the SSQ was moderately correlated with an established measure of perceived social support (r = .44 for number of supports and r = .52 for satisfaction), and discriminant validity was established through negative correlations with a measure of social anxiety (r = −.31 for number of supports and r = −.25 for satisfaction; Sarason et al., 1987).

Functional support

The Interpersonal Evaluation List (ISEL; Cohen, Mermelstein, Kamarck, & Hoberman, 1985), a 40-item self-report measure containing four subscales (10 items each), was used to measure the overall perceived availability of social resources. The four subscales assessed the following types of support: Tangible (the availability of material aid), Appraisal (the availability of someone to talk with about problems), Self-Esteem (the availability of a positive comparison when comparing one’s self to others), and Belonging (the availability of people one can do things with). Participants rated each item on a 4-point Likert-type scale from 0 (definitely false) to 3 (definitely true), with higher scores indicating higher perceived availability of social resources. Each subscale is scored by summing each of the items on that scale, and the total score is obtained by summing all the items. Adequate psychometric properties have been demonstrated for the entire measure including test–retest reliability ranging from .70 to .87 and internal consistencies ranging from .60 to .86 (Cohen et al., 1985). For this study, the internal consistency was .93 for the Total Scale, .84 for the Tangible subscale, .85 for the Appraisal subscale, .73 for the Self-Esteem subscale, and .81 for the Belonging subscale. Adequate convergent (r = .46 with number of close friends and r = .42 with number of close relatives) and discriminant validity (no correlation found with social desirability) has been demonstrated (Cohen et al., 1985).

Procedures

The study was advertised through flyers located at battered women’s shelters. Current residents were able to contact a confidential research line and set up an appointment to complete the questionnaires. Research staff also attended shelter meetings to approach current residents about participating in the study. Participants provided informed consent, completed the questionnaires, and upon completion were compensated $20 for their time. All research procedures were approved by the Institutional Review Board.

Data Analyses

Across all variables, approximately 0.4% of data were missing, with the percentage of missing values for each variable ranging from 0% to 1.6%. Given the minimal amount of missing data and operating under the assumption that data were missing completely at random, we used pairwise deletion when running analyses.

First, to create cluster profiles for the SOC, we conducted a hierarchical cluster analysis using the SOC subscales. Cluster analysis provides a more comprehensive and realistic understanding of the process of change by examining the pattern of survivors’ scores on each stage of change, retaining information that is lost when survivors are assigned to only one specific stage (Brown, 1998). Each individual was initially an individual cluster, then the Euclidean distance between each individual cluster was calculated, and those that had the smallest difference were combined to form larger, specific clusters (Ward, 1963). As such, individuals with similar patterns across the various SOC as measured by the PROCAWS were grouped together. Using Ward’s Method, a five-cluster solution was chosen that best represented the associations in the SOC. After individuals were assigned to a specific cluster, multivariate analysis of variance (MANOVA) was conducted to examine cluster differences in functional, structural, and satisfaction with social support. Then, univariate effects were tested using analysis of variance (ANOVA), with Tukey’s Honestly Significant Difference (HSD) post hoc analyses to examine where the differences lie.

Results

The cluster analysis revealed five clusters. Based on cluster characteristics (see Table 1), each cluster was named. Clusters included preparticipation, characterized by low scores on all SOC; decision making, characterized by low scores on Precontemplation and average scores on all other SOC; engagement, characterized by very low scores on Precontemplation and high scores on all other SOC; ambivalent, characterized by average scores on Precontemplation and high scores on all other SOC; and action, characterized by very low scores on Precontemplation, low scores on Letting Go of the Hope He Will Change, average scores on Contemplation, and high scores on Action and Autonomy/Separate Self.

Table 1.

Cluster Characteristics.

	Cluster 1	Cluster 2	Cluster 3	Cluster 4	Cluster 5
	Preparticipation	Decision Making	Engagement	Ambivalent	Action
Sample size	16	45	87	15	28
SOC as measured by PROCAWS
Precontemplation	2.71	2.67	1.30	3.29	1.67
Contemplation	2.39	3.73	4.13	4.64	3.73
Letting go of the Hope He Will Change	2.63	3.86	4.66	4.10	2.96
Action	2.29	3.79	4.68	4.69	4.46
Autonomy/Separate Self	2.42	3.23	4.49	4.63	4.58

Note. Values in table represent means of respective stages for each cluster. SOC = Stages of Change; PROCAWS = Process of Change in Abused Women Scale.

The MANOVA was conducted with cluster membership as the independent variable and structural, functional, and satisfaction with support as the dependent variables. The omnibus test was significant (Pillai’s Trace = .23), F(24, 716) = 1.84, p < .01, $η_{p}^{2}$ = .058). ANOVAs and post hoc analyses for each dependent variable are outlined below and displayed in Table 2.

Table 2.

Differences Between Clusters on Self-Efficacy, Decisional Balance, Structural, and Functional Support.

	Cluster 1	Cluster 2	Cluster 3	Cluster 4	Cluster 5		Effect Size
	Preparticipation	Decision Making	Engagement	Ambivalent	Action	F, p	η²
Cell size	16	45	87	15	28
Structural
Number of supports	1.08 (0.98)	1.04 (1.16)^a	1.83 (1.75) ^a	1.66 (1.57)	1.47 (1.20)	2.46, .047	.05
Satisfaction	3.88 (1.87)	3.49 (1.78)^a,b	4.68 (1.51)^a	4.44 (1.61)	4.76 (1.24)^b	5.07, .001	.10
Functional
Total	57.25 (24.43)	49.36 (20.39)^a	63.84 (25.85)^a	55.07 (13.84)	63.36 (20.21)	3.30, .012	.07
Appraisal	13.81 (6.72)	12.47 (6.59)^a	16.91 (7.93) ^a	13.29 (4.53)	15.61 (6.95)	3.27, .013	.07
Tangible	13.19 (7.02)	10.84 (6.88)^a	15.16 (7.35)^a	11.71 (5.82)	14.25 (6.81)	3.11, .017	.06
Self-Esteem	14.56 (6.28)	13.60 (4.87)^a	16.00 (5.83)	15.71 (4.16)	18.04 (4.64)^a	3.25, .013	.07
Belongingness	15.69 (6.86)	12.44 (6.10)^a	16.31 (7.19) ^a	14.36 (5.29)	15.46 (5.72)	2.66, .034	.05

Note. N = 191. Superscripts of the same letter represent significant changes between those clusters.

There were significant effects of cluster for structural support, specifically, the total number of supports (see Table 2). As revealed by Tukey’s HSD test, those in Cluster 3 (engagement) reported more supports than those in the Cluster 2 (decision making).

There were significant effects of cluster for satisfaction with support. As revealed by Tukey’s HSD test, those in Clusters 3 (engagement) and 5 (action) reported more satisfaction with supports than those in Cluster 2 (decision-making cluster).

There were significant effects of cluster for functional support including overall functional support, appraisal, tangible, self-esteem, and belonging. Those in Cluster 3 (engagement) reported more overall functional support, appraisal, tangible support, and belonging, than those in Cluster 2 (decision making). Further, Tukey’s HSD test revealed that those in Cluster 5 (action) reported greater self-esteem than those in Cluster 2 (decision making).

Discussion

The current study is, to our knowledge, the first to examine the relationship between clearly defined types of social support (i.e., structural, functional, and satisfaction) and the process of change in IPV survivors. A notable strength of this study is the use of cluster analysis, which considers individuals’ responses to the different SOC and creates a more comprehensive profile of where individuals fall in the process of change, thus grouping individuals with similar change profiles, not placing them in a discrete stage of change. Results demonstrated five distinct profiles, or clusters, of change among study participants, with each profile indicating individuals at different points in the process of change. The patterns found within the clusters were mostly consistent with change patterns found in a study of abused women (Brown, 1998), as well as, research on individuals seeking outpatient, pain management, and drug and alcohol dependence psychotherapy (Li, Ding, Lai, Lin, & Luo, 2011; McConnaughy, DiClemente, Prochaska, & Velicer, 1989; Norcross, Krebs, & Prochaska, 2011).

Interestingly, no clusters emerged in this sample that were similar or related to precontemplation, the stage during which individuals are unaware of an existing problem. All participants were seeking or had already sought shelter from IPV, a significant step in acknowledging the violence experienced, and therefore were at least partially engaged in the process of change. The cluster found in the current study involving the earlier processes of change, preparticipation, has been found in several samples of psychotherapy patients and those with substance dependence (Li et al., 2011; McConnaughy et al., 1989). Individuals in this cluster appear to be slightly engaged in the process of change, but have yet to fully participate and take action in making a change within their life. Similarly, those in the ambivalent cluster are high on all SOC and are likely experiencing mixed feelings regarding making changes within their life. It is likely that individuals in this cluster experience positive and negative feelings regarding both changing and not changing.

The decision-making, engagement, and action clusters were all similar to those found by Brown (1998) in a sample of shelter residents. The decision-making cluster, which some researchers have termed preparation (Keefe et al., 2003), reflects a transition point from preparticipation into the later stages of engagement and action. This profile is characterized by similar scores on the Contemplation and Action subscales. While the engagement cluster has been found in various research areas and is depicted by engagement in later SOC, individuals in this cluster also appear to be high on contemplation suggesting that while pursuing change, some questions about and hesitancy related to making a change may still be present. The action cluster appears to be somewhat specific to survivors of violence, as it has been rarely found in the research, despite being a theoretically vital piece of the process of change. This profile includes individuals who are highly engaged in later SOC and less engaged in the earlier stages, indicating individuals who are further along in the process of change.

Despite the fact that all participants had already taken a significant step in acknowledging the violence they experienced by seeking shelter from IPV, our sample of current residents showed a number of diverse SOC. This suggests that despite the similarity of seeking shelter, the women in the current sample are at varying places in the decision process of maintaining a violence free life. Consistent with prior research findings (e.g., D. K. Anderson & Saunders, 2003; Brown, 1997), the diverse SOC found in this sample suggest that establishing safety and obtaining a violence free life is not a discrete, simple decision. Even though our sample consisted of women who were currently in shelter, the women in our sample displayed much variation in their process of change. This finding highlights the importance of assessing for and targeting interventions to IPV survivors’ SOC.

Our hypothesis that all forms of social support would be higher for individuals more engaged in the process of change was generally supported. Participants in the action cluster reported greater functional supports and were more satisfied with such support than those in the decision-making cluster. Further, individuals in the engagement cluster reported more structural and functional support and greater satisfaction with their support than individuals in the decision-making cluster. Consistent with past research (Beeble et al., 2009), these findings suggest that social support is instrumental and beneficial to survivors of IPV. These results extend the current literature by demonstrating that there are distinct differences in social support depending on where in the process of change an individual falls. Individuals more engaged in the process of change report more social support than those less engaged in the process, suggesting a positive relationship between structural, functional, and satisfaction with support and the process of change. The isolation often experienced by survivors of IPV, coupled with survivors’ shame, and disbelief or denial among family and friends may explain the differences noted in social support across the clusters of change.

Our results indicated that all forms of social support increased between the decision-making and engagement clusters, suggesting that significant changes in all types of social support are made as survivors experience a shift in their views about themselves and their relationship, and are thus more engaged in making changes in their relationship. While it is important to consider the unique roles of these forms of social support, it is likely that each influences the other such that unique influences are difficult to identify. Interestingly, however, the only differences that emerged between the decision-making cluster and the more engaged cluster of action were in functional support and satisfaction, not the number of supports. One potential explanation for such differences may be that when survivors are making the shift from decision making to action, it is vital that they have practical and emotional support on which they can rely. Thus, if a survivor is adequately satisfied with the practical support she is receiving, she may be more able to make a change in her life despite the total number of supports in her network. These results suggest that it may be most important to provide survivors with satisfactory emotional and practical aid to make the changes they are seeking. However, it is important to note that an increase in the total number of supports did emerge between the decision-making and engagement clusters, which may suggest that, in addition to emotional and practical aid, a greater quantity of social supports can provide survivors with a greater sense of security in navigating a challenging period in life.

In summary, the results of this study suggest that the greatest differences in social support for survivors of IPV exist between the decision-making and engagement clusters and the decision-making and action clusters. Given that the decision-making cluster is considered a transitional period between the earlier and later SOC, increases in social support may facilitate the transition to later SOC was supported. These results support the hypothesis that serious changes are made between stages. Specifically, women in later SOC reported more social support than women in earlier SOC. Although the cross-sectional nature of this study does not allow for temporal or causal inferences, future longitudinal research should consider the temporal relationships between social support and process of change.

Limitations

The current results should be considered with several limitations in mind. First, the sample for this study included a select group of shelter residents. Entering a shelter and moving away from one’s abusive partner suggest that significant changes have already been made, and thus, the sample of this study is likely more representative of women who were at more engaged in the process of change. Although it is suggested that the stages are cyclical, future research examining a sample that captures more women in earlier stages would be beneficial in increasing the generalizability of the results. Further, a large number of the sample was captured by the engagement cluster and could potentially preclude our ability to detect differences between the various clusters. Future research with a larger sample with more equal distributions between clusters would increase the power to detect difference across clusters. In addition, the utilization of self-report measures may not holistically capture the complex process of change in survivors of IPV. Although the use of cluster analysis attempts to more accurately account for the variations in SOC, the use of self-report measures only captures one point in time, precluding the ability to examine non-linear patterns of change. Further, the cross-sectional nature of this study precludes inferences about temporality and causality. Thus it is unclear whether increased social support creates changes in SOC or if changes in the SOC facilitate changes in social support. Further, the predictive validity of the SOC measure, the PROCAWS, used in this study is unknown. Finally, this study focused on social support received from family and friends and thus fails to capture other potential sources of support (e.g., physicians, nurse, etc.) that have been shown to be instrumental in connecting survivors of IPV to needed resources (Zink, Elder, Jacobson, & Klostermann, 2004).

Research Implications

In addition to addressing the limitations of the current study, more empirical research is needed to understand the complex experience of survivors of IPV. Future research that uses additional means to assess the process of change, such as qualitative interviews, may be helpful. Specifically, interviews that allow women to provide context for their desire for change or barriers that may inhibit changing could provide a better understanding of the applicability of this model to survivors of IPV. Further, as advances in technology have increased means for communicating and connecting among individuals, social support that occurs across such means (e.g., in person, over the internet, etc.) should be examined to gain a better understanding of an individual’s social network and the implications and potential benefits of said network. Further, future research should consider using longitudinal designs to better conceptualize the relationship between social support and the process of change over time.

Clinical and Policy Implications

These findings have important clinical and policy implications for working with survivors of IPV. First, as previous research has shown a significant association and moderate effect size between stage of change and psychotherapy outcomes (Norcross et al., 2011), it is vital that clinicians working with survivors of IPV assess and tailor interventions to meet clients at their stage of change. Further, with greater understanding of the relationship between social support and the process of change, clinicians can refine and develop interventions to foster survivors’ abilities to develop the social support they need. Specifically, interventions for all survivors of IPV should develop components that help educate and provide women with tools to build satisfying and supportive relationships that will help lead to their long-term safety. Further, the knowledge that social support is often lower earlier in the process of change suggests that interventions for those in the earlier SOC should help women develop more satisfying relationships in hopes of helping them to remain safe in the future. Finally, policymakers should advocate for increased funding for supportive services for shelters and other domestic violence agencies providing assistance to women in the early stages of attaining violence free life. Increased funding for these agencies will advance efforts to increase both tangible and social support to aid women seeking shelter and safety from IPV.

Conclusion

In summary, the current study contributes to and extends research on the complex process of change in survivors of IPV. Taken together, the results of this study suggest that there are distinct change profiles for survivors of IPV who differ in the amount of functional and structural support, as well as satisfaction with their social support. These results highlight the theoretical and clinical importance of social support and its relationship to the process of change in survivors of IPV.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Heather Zapor, MA, is a doctoral student in clinical psychology at the University of Tennessee. She received her MA from the University of Tennessee and her BA from the University of Akron. Her research interests include risk and resilience factors for intimate partner violence.

Caitlin Wolford-Clevenger, MS, is pursuing her PhD in clinical psychology at the University of Tennessee–Knoxville. She received her BA and MS in psychology at the University of South Alabama. Her research interests focus on understanding and preventing the development of self- and other-directed aggression.

Dawn M. Johnson, PhD, is an associate professor in the Department of Psychology at the University of Akron. Her research has focused broadly on violence against women, with a focus on intimate partner violence. To date, a majority of her research has focused on developing and evaluating interventions for survivors of intimate partner violence who seek shelter.

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