"Lost & Found: Reclaiming your Sense-of-Self with OT after divorce"
For many, navigating the aftermath of relationship abuse is a journey that reshapes not only their view of the world but also their inner sense of identity, control, and worth. Abuse can create lasting impacts on a person’s sense of self, mental health, and daily functioning, making it difficult to feel grounded, safe, or whole. Occupational Therapy (OT) offers valuable insights and strategies for those affected by abuse, helping them rediscover their identity and build resilience. By examining abuse through the lens of the Model of Human Occupation (MOHO) and Sensory Integration (SI) theory, OT practitioners can guide survivors toward healing and reclaiming their lives.
The Bio-Psycho-Social Impact of Abuse
Chronic relationship abuse affects the biological, psychological, and social dimensions of a person’s life in profound ways. Abuse survivors often experience heightened stress responses, an altered view of themselves, and a disrupted ability to engage in meaningful activities and roles.
Biologically: Abuse-induced stress can create persistent physical responses, including hypervigilance, disrupted sleep, chronic pain, and other symptoms related to the “fight or flight” response. In fact, research shows that chronic stress can lead to long-term health issues, such as gastrointestinal distress, immune dysfunction, and cardiovascular complications (Ross & Wynne, 2021).
Psychologically: Emotional abuse impacts mental health, often leading to depression, anxiety, and diminished self-esteem. Survivors may experience confusion about their self-worth, as continuous manipulation erodes a person’s confidence and trust in their judgment. According to MOHO, the impact on volition—the internal drive and motivation that directs one’s actions—is one of the most significant shifts (Kielhofner, 2008).
Socially: Abuse can also isolate individuals from family, friends, and support networks. This isolation makes it difficult for survivors to maintain social roles, often diminishing their identity and sense of connection with others. Rebuilding these roles is central to occupational engagement, as meaningful relationships are key components of one’s well-being and self-image.
MOHO: The Model of Human Occupation and Abuse
The Model of Human Occupation (MOHO) provides a framework for understanding the ways abuse can disrupt a person’s routines, roles, and self-identity. MOHO emphasizes three key components: volition (motivation and values), habituation (daily routines and roles), and performance capacity (physical and mental skills required to engage in activities). Abuse impacts each of these components uniquely:
Volition and Identity Erosion: Abuse often causes survivors to doubt their worth, affecting their sense of volition. The consistent criticism, control, and manipulation inherent in abusive relationships can lead to “learned helplessness,” where the survivor feels powerless to make decisions or direct their life. Their self-concept becomes compromised, making it difficult to reconnect with personal interests or set meaningful goals (Kielhofner, 2008).
Disrupted Routines and Habituation: In abusive relationships, routines and roles can be highly controlled by the abusive partner, creating a disrupted or rigid daily structure. Survivors may adapt by neglecting their own needs, focusing instead on appeasing their partner to maintain peace. This can lead to a loss of self-care routines, difficulty setting boundaries, and a diminished ability to engage in daily roles that once provided purpose and satisfaction.
Performance Capacity: The mental and physical toll of chronic stress impacts one’s performance capacity, which can make even routine activities feel overwhelming. Abuse may affect cognition, causing survivors to doubt their memory, perceptions, and decision-making abilities. Physically, survivors may feel fatigued or worn down, as the body’s stress responses deplete their physical reserves, making it difficult to engage in activities they once enjoyed.
Sensory Integration Theory and the Impact of Abuse
Sensory Integration (SI) theory offers additional insights into the physical and sensory effects of abuse. Originally used to understand sensory processing difficulties, SI theory applies here by recognizing that chronic abuse may heighten one’s sensory responses, leading to a hypersensitive or hypervigilant state.
Sensory Overwhelm: Abuse often causes survivors to become hyper-attuned to their environment, particularly to potential threats. This heightened state of awareness can lead to sensory overload, where common stimuli (like loud sounds, certain textures, or physical touch) trigger intense, sometimes uncontrollable reactions. Survivors may startle easily, experience anxiety in crowded spaces, or avoid certain sensory triggers altogether to minimize distress (Wilbarger, 2007).
Body Awareness and Boundaries: Abusive relationships can blur personal boundaries, both physically and emotionally. Survivors may lose a clear sense of bodily autonomy or comfort in their own skin, often feeling disconnected from their own sensory preferences. SI-informed OT can be beneficial in helping survivors reconnect with their physical sensations, re-establish personal boundaries, and regain a sense of bodily control (Ayres, 2005).
OT Strategies to Support Self-Identity and Healing
Occupational therapists use a variety of approaches to support survivors in regaining a sense of control, safety, and self-identity. These strategies are designed to address disrupted routines, sensory sensitivities, and the damaged sense of self that often results from abuse.
1. Reconnect with Volition through Personal Goals
Creating personal, meaningful goals can help rebuild volition. OT practitioners may guide clients in identifying small, achievable goals related to their interests and values. These can include simple self-care routines, rediscovering hobbies, or trying new activities in a supportive setting. Small successes reinforce confidence, helping survivors reclaim their autonomy and rebuild motivation (Kielhofner, 2008).
2. Establish Routine as a Form of Empowerment
Routine-building helps survivors regain stability and predictability in their lives. An OT practitioner may support clients in developing routines that incorporate self-care, relaxation, and positive social interactions. Establishing these routines can offer a sense of control, promoting habituation in ways that are nurturing rather than controlled by an external party (Christiansen & Baum, 2005).
3. Sensory Grounding Techniques for Emotional Regulation
Sensory grounding exercises can help reduce hypervigilance and bring the individual back to the present moment. Techniques such as deep breathing, progressive muscle relaxation, and sensory-based grounding (like holding a warm cup, focusing on tactile sensations, or mindful stretching) can help individuals feel more connected to their bodies and emotions (Wilbarger, 2007).
4. Rebuild Social Roles and Community Connections
Occupational therapists can work with clients to identify and strengthen healthy social roles and relationships. Rebuilding a supportive social network can counteract the isolation experienced in abusive relationships, helping survivors reconnect with people and activities that promote a positive sense of identity and belonging (Christiansen & Townsend, 2011).
5. Work with a Therapist to Process Trauma and Reclaim Identity
For those recovering from abuse, an OT or mental health professional skilled in trauma-informed care can provide invaluable guidance. Through therapy, survivors can work to understand their experiences, rebuild self-esteem, and develop coping mechanisms. Therapy can include cognitive reframing, role-playing exercises to practice assertiveness, and activities focused on self-discovery and empowerment.
Moving Forward with Resilience and Support
Recovering from relationship abuse is a deeply personal journey, one that may feel overwhelming but is ultimately transformative. From an OT perspective, the process of healing involves redefining one’s sense of self, re-establishing control over daily activities, and learning to trust in one’s abilities and choices. By addressing the bio-psycho-social impact of abuse, and supporting survivors with targeted strategies grounded in MOHO and SI theory, occupational therapists can play an essential role in empowering individuals to reclaim their lives and reimagine their futures.
References
Kielhofner, G. (2008). A Model of Human Occupation: Theory and Application. Lippincott Williams & Wilkins.
Christiansen, C., & Baum, C. M. (2005). Occupational Therapy: Performance, Participation, and Well-being. SLACK Incorporated.
Ayres, A. J. (2005). Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Western Psychological Services.
Wilbarger, P. (2007). "Sensory Defensiveness in Children Aged 2–12 Years." American Journal of Occupational Therapy, 61(2), 190-197.
Christiansen, C., & Townsend, E. (2011). Introduction to Occupation: The Art and Science of Living. Prentice Hall.
Ross, R., & Wynne, A. (2021). "Chronic Stress and Health Implications for Domestic Abuse Survivors." Journal of Applied Psychology, 112(3), 421-432.
