What Survivors of Family Violence Can Expect During an OT Assessment
Survivors of family violence have often been through physical and emotional hell. Facing any kind of assessment or evaluation after such trauma can be intimidating – the survivor might worry about being judged, not being believed, or having to relive painful experiences. As an occupational therapist who conducts assessments in a family violence context, I want to demystify this process and put some of those worries at ease. This article is written for survivors (and the lawyers or advocates working with them) to explain exactly what happens during an OT assessment for someone who has lived through domestic abuse. The bottom line: an OT assessment is not an interrogation or a test you pass/fail. It’s a collaborative, compassionate evaluation aimed at understanding what you need to live a safer, easier, and more fulfilling life after the abuse. Here’s what you can expect.
A Safe and Supportive Environment:
First and foremost, the assessment will be conducted in a safe, confidential space. This might be a quiet clinic room, your own home (if that’s safe and you’re comfortable there), or even via a secure video call if in-person isn’t possible. My priority as an OT is to help you feel as at ease as possible. I might start by explaining privacy: everything we discuss is confidential and will only be shared with others (like your doctor or lawyer) with your consent and for the purposes you agree to.
We also follow a trauma-informed approach. In practical terms, that means I acknowledge upfront that talking about or demonstrating difficulties related to the abuse might be hard. I’ll often say something like, “If at any point you feel uncomfortable or need a break, please let me know. We can pause anytime.” You are in control of the pace. If certain topics are triggering, we can skip them or approach them gently. And I’ll do my best to avoid any triggering language – for example, instead of probing into details of the abuse events, I might ask about your current symptoms or difficulties in daily life that could stem from those events, without making you recount them unless you choose to.
The atmosphere is meant to be conversational and respectful. Many survivors come in bracing for skepticism, especially if they’ve encountered people who didn’t believe them in the past. You won’t get that from an OT. My role is not to question if something happened; I operate on the understanding that you have survived trauma, and my job is to understand its effects and help from here forward. You can expect empathy, active listening, and zero judgment.
The Interview: Telling Your Daily Life Story
Every OT assessment includes an interview portion. Given your experience, I will tailor my questions sensitively. We’ll likely start with some general background: “Can you tell me a bit about yourself? For instance, who lives with you, or what kinds of things you do on a typical day?” This helps me understand your context – whether you have kids, whether you’re working or in school, etc.
Then we’ll get into specific daily activities:
Self-Care: I might ask how you’re managing personal care tasks. “Do you have any trouble with things like showering, dressing, or grooming?” If you do, I’ll gently ask what makes it hard. For example, some survivors share that they feel unsafe closing their eyes to wash their hair (a PTSD-related hypervigilance), or that joint pains from past injuries make dressing difficult. Even sleep is a self-care activity – I’ll likely ask, “How are you sleeping lately?” Many survivors have insomnia or nightmares; it’s important I know that.
Household Tasks: “How is it going with tasks around the house, like cooking, cleaning, shopping for groceries?” If you’re having trouble, we’ll discuss why. Maybe anxiety stops you from going to the store, or maybe a shoulder injury makes lifting pots painful, or perhaps concentration issues mean you often forget something on the stove. OTs delve into these nitty-gritty details not to overwhelm you, but to identify where you struggle so we can find ways to help.
Work/School: “Are you currently working or studying? If yes, what’s your experience been like? If not, is that something you’re aiming for?” If you are employed or in school, I’ll ask if any parts of those roles are challenging now. Survivors sometimes mention memory issues (like forgetting deadlines), difficulty focusing, or anxiety around coworkers. If you’re not working due to the aftermath of abuse, that’s okay – I just want to know what your day looks like and if return to work is a goal. We can discuss any volunteer work or hobbies in a similar vein.
Leisure and Social Life: “How do you spend your free time? Are there activities you enjoy or used to enjoy?” This can be a sensitive area because abuse often isolates people or steals away their free time joys. If you say, “I used to love painting but I haven’t had the energy,” that tells me about your emotional state. If you’ve withdrawn from friends, that could be due to trust issues or depression. These are things we can work on gradually, and noting them is important.
Specific Symptoms Check-In: Based on earlier answers or what I know from your referral, I might ask targeted questions. For example, if I know you sustained a concussion during the abuse, I’ll ask about headaches, dizziness, or vision problems. If there’s known PTSD, I might carefully ask about how you handle stress or if you have flashbacks in day-to-day life. If depression is noted, I might ask about your motivation levels or if you’re able to get out of bed for basic tasks.
Throughout the interview, I’m taking notes – not furiously like a detective, but I will jot down key points. I might even use some checklists or standardized questionnaires if appropriate. For example, I might administer a short PTSD symptom checklist or a depression inventory. I’ll always explain what I’m doing: “This form has a list of symptoms; let’s see which ones you’ve been experiencing and how often.” You have every right to decline any question or tool, but most survivors actually appreciate that these tools exist – it often validates that what they’re feeling is recognized as part of a known condition.
Remember, this interview portion can stir emotions. It’s not uncommon if you feel sad or even tearful discussing these challenges. That is absolutely okay. I might pause and ask, “How are you feeling talking about this? Do you need a break or shall we continue?” It’s perfectly fine to take a moment, have some water, or even continue through a few tears if you’re comfortable – I’ll have tissues handy and a supportive demeanor. My goal is that by the end of this interview, you feel heard. Many survivors tell me that it was therapeutic to have someone truly listen to how hard things have been.
Functional Assessment: Gentle Activities to Gauge Abilities
After or interwoven with the interview, there will usually be some functional tasks. This isn’t like a school test; think of it more as trying a few activities together to see where strengths and limitations lie. I always tailor activities to each person, but here are examples of what might happen:
Range of Motion and Strength (Physical Check): If you have any physical injuries or pain, I’ll likely do a brief exam. I might ask you to reach your arms overhead, bend your knees, or grip my hand – basic movements to see if any joints are stiff or weak. If you mentioned a painful shoulder, I’ll be very gentle in checking its movement, and I’ll stop as soon as you report pain. I’ll also note if you have scars or swelling from injuries (for documentation, not to scrutinize). This part is somewhat clinical, but I keep it as quick and comfortable as possible.
Balance and Coordination: If relevant (for instance, if you’ve had falls or dizziness), I might ask you to do a simple balance test like standing on one foot or walking a short line heel-to-toe, with me spotting you for safety. Or I may ask you to pick up small objects (like coins or pegs) to see if hand tremors or coordination issues from anxiety or injury are present.
Cognitive Tasks: Many survivors have cognitive fatigue or memory issues. I might do a few short tasks to assess this. Commonly, I might ask you to remember a short list of words and repeat them after a few minutes, or do a simple mental exercise like “count backwards from 100 by sevens” (don’t worry if you can’t do that – it’s just a screening tool many of us struggle with!). If concentration is an issue, I might have you read a short paragraph and tell me about it, or follow a multi-step instruction to see if any steps are missed. These tasks are not about IQ; they’re about figuring out if trauma has impacted cognitive processes. I’ll clarify that I’m not testing your intelligence – only checking if the abuse might have caused things like memory gaps or slowed thinking.
Daily Task Simulation: Depending on time and what you’re comfortable with, I sometimes simulate a relevant task. If a survivor is okay with it, I might say, “Let’s pretend it’s morning and you’re making a simple breakfast. Walk me through what you’d do.” We might even go to a kitchen area if available, or just talk it through in detail. Or if a survivor has trouble driving (very common if trauma occurred in or around cars, or due to anxiety), I might ask them to show me how they’d get into a car and adjust mirrors, etc., without actually driving. The idea is to spot any functional difficulties – maybe they hesitate at a step due to fear, or their hand strength isn’t enough to open a jar. These simulations often reveal things that wouldn’t come up in conversation.
Sensory and Emotional Responses: I also observe how you respond to the environment. If a door slams in the hallway and you jump, I take note of that startle response as a PTSD symptom. If having me stand behind you makes you tense, I’ll notice and maybe adjust how I interact (and note that hypervigilance). None of these observations are to judge; they’re to fully capture what stimuli affect you adversely so we consider those in any recommendations.
Everything we do in this functional portion, I explain first and get your consent. If you ever say “I’m not comfortable doing that,” we skip it. There’s no absolute required task. If an evaluation is for legal documentation, I might encourage trying at least a bit of each category so we have data, but I will never force something that causes distress. Your wellbeing during the assessment is more important than checking every box.
No Judgment – It’s About Understanding and Problem-Solving:
I want to reiterate strongly: there is no judgment in an OT assessment. If you struggle with a task, I don’t think “oh, you failed.” I think “okay, here’s an area we need to address.” If anything, seeing a difficulty gives me a chance to brainstorm solutions. For instance, if you couldn’t lift your arm above shoulder height due to an old injury, I might already start suggesting, “Maybe we can store your dishes on a lower shelf to make kitchen tasks easier – just an idea we can try.” If you become anxious and can’t finish a memory exercise, I might say, “That’s fine; we can stop here. One thing that sometimes helps is writing down tasks – do you use a notebook or app for reminders?” I sprinkle these little problem-solving tips throughout the assessment to gauge what might assist you, and also to reassure you that difficulties can often be worked around.
It’s also worth noting: you won’t be blamed or pressured for what happened to you. If your partner broke your wrist and now it doesn’t move well, I’m not going to ask “Why didn’t you get better treatment?” or any such accusatory question. I focus on the present: “Given your wrist is stiff, how can we make daily tasks easier on you?” If you haven’t been able to do something like exercise because of depression, I won’t scold “you should really exercise.” Instead, I might say, “Energy is tough when you’re depressed. Let’s see if there’s a small activity you enjoy that we can work into the day to boost your mood.”
By the end of the assessment, many survivors express relief. Typical comments I hear are, “This felt more like a conversation than a test,” or “I was nervous at first, but I actually feel good that we talked about these things.” Remember, the purpose of this assessment is not to find flaws in you – it’s to identify challenges caused by the abuse so that we can plan to overcome them or get you support.
What Happens After: The Report and Next Steps
Once the assessment is done, I will compile everything into a report. Depending on why the assessment was ordered, this report might go to your lawyer, a doctor, or a caseworker. It will detail all the areas we covered: what difficulties you have, what strengths you have (yes, I also highlight positives – like strong motivation to improve, or good family support, etc., because those matter in recovery), and any recommendations I have.
I usually end the in-person session by summarizing to you what I observed: “From what I’ve seen today, it looks like you have a lot of issues with anxiety and concentration that are affecting your daily tasks, and physically your main limitations are your shoulder and wrist. I’m going to recommend a few things: possibly a follow-up with a neurologist for your headaches, regular therapy for the PTSD if you’re not already in it, and some occupational therapy sessions focusing on pain management strategies and memory techniques. I’ll also recommend some immediate fixes like a shower chair to help with fatigue when you wash up.” I check if that sounds right to you – this is a good time for you to correct me if I got anything wrong or add something if we missed it.
For many survivors, the recommendations are the most valuable part. You walk away not just assessed, but with a game plan (or at least the start of one). This could include:
Medical follow-ups (e.g., see a specialist about that knee that never healed right).
Therapeutic interventions (e.g., start or continue counseling, or OT sessions to work on certain goals).
Community resources (e.g., contact a local domestic violence organization for support group or vocational training programs if you’re trying to get back to work).
Adaptive strategies (e.g., use a pill organizer if you have trouble remembering medications, use phone reminders for appointments, practice a grounding technique when panic hits).
Environmental modifications (e.g., better lighting at home if you have vision issues, an ergonomic pillow if neck pain is an issue).
If the assessment is for legal purposes, the report will go to your legal team to support your case (for instance, in an injury claim or for a disability benefit application). If you’re curious or wish to see it, you can request a copy or have it shared with you – after all, it’s information about you.
Finally, I always reassure the survivor that the assessment is not the end. It’s the start of the next phase – whether it’s starting therapy, beginning OT sessions, or simply having documentation now that validates what you’ve been through. If I’ll be continuing to work with you as your OT, we’ll then set some goals together based on everything we found. If my role was just the one-time evaluation, I’ll make sure you have referrals to those who will carry on the care. Either way, you’re not being left hanging.
Undergoing an OT assessment as a survivor of family violence might seem daunting, but it should ultimately be an empowering experience. It’s a chance to have all aspects of your well-being looked at – not just the obvious injuries, but the subtle, everyday struggles that deserve attention. A good occupational therapist will make the process collaborative and respectful. By understanding what to expect, hopefully you can walk into the assessment with a little less anxiety. Remember: this assessment is about helping you. It’s about putting together pieces of a puzzle – your physical health, mental health, and daily life – so that a clear picture emerges of what you need to move forward. And moving forward, beyond merely surviving each day, towards a life where you can thrive and feel safe, is the ultimate goal. You are not alone in that journey; an OT, among others, can be a helpful guide along the way.