Subtle abuse of women of high educational and socio-economic status in intimate heterosexual relationships: An exploration of the phenomenon to aid therapist recognition

Parkinson, Rosemary (2024) Subtle abuse of women of high educational and socio-economic status in intimate heterosexual relationships: An exploration of the phenomenon to aid therapist recognition. Doctoral thesis, University of East Anglia.

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Abstract

This thesis examines the subtle abuse of heterosexual women of high educational and socio-economic status in intimate partner relationships (‘HESES victims’). Therapist observation suggests such abuse can occur on a subtle level throughout a relationship causing short- and long-term mental and physical health impacts. Currently a conceptualisation of subtle abuse is absent, resulting in a lack of recognition by therapists and victims. This thesis aimed to understand the perpetration and impact of subtle abuse of HESES victims and improve therapist recognition.

A definition of subtle abuse was constructed following a scoping review of existing literature. A subsequent ethically approved patient and public involvement study was conducted to thoughtfully inform an empirical study of the experience of subtle abuse among HESES victims. The author’s therapeutic approach of cognitive analytic therapy (CAT) informed both study design and the interpretation of findings.

Following a novel recruitment strategy using vignettes of subtle abuse, semi-structured interviews were conducted with 11 victims and four therapists. Interviews were analysed using reflexive thematic analysis. Findings include: HESES victims can suffer subtle abuse on an ongoing basis without the presence of more overt abuse; subtle abuse is underpinned by a self-centred perpetrator attitude; this creates an incongruence in victims leading them to disconnect from themselves and others and focus on keeping the perpetrator ‘happy’. The mechanism of perpetration and victim impact prevents victim and therapist recognition and can be understood through the CAT concept of reciprocal roles.

The thesis conceptualises the experience of victims of subtle abuse for the first time. Key learnings include that HESES victims are impacted in potentially unique ways and awareness of countertransference is central to subtle abuse recognition in therapy. Tools to aid therapist recognition are proposed, including a cycle of subtle abuse and a novel diagram of subtle abuse underpinned by CAT.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User:	Chris White
Date Deposited:	11 Feb 2025 08:31
Last Modified:	11 Feb 2025 08:31
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98420
DOI:

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