Understanding Social Workers and Health Professionals’ Public Stigma against Women who Experience Intimate Partner Violence in Spain

ORIGINAL ARTICLE Journal of Family Violence https://doi.org/10.1007/s10896-024-00714-y Currently, there is little data on IPVAW experienced by women aged 50 years and older (WHO, 2021). In Spain, the country where we conducted this study, 14.2% of women older than 15 years have experienced some form of physical and/or sexual violence at least once in their lifetime. In the case of psychological violence, this figure rises to 31.9% (Government Office against Gender-Based Violence, 2019). We conducted this research from a feminist perspective that understands IPVAW as a public global problem that results from and enforces a patriarchal system that oppresses women, maintains cisgender men’s control of life opportunities and resources, therefore creating a system where women are victims (Barnett et al., 2016; Dobash & Dobash, 1979). From this perspective, the agency of survivors is also recognized, particularly their power to act and make decisions (Black et al., 2020; Gondolf & Fisher, 1988) since women face individual challenges and act accordingly in a unique way (Barrios et al., 2021). As defined by the World Health Organization [WHO] (2021), intimate partner violence against women (IPVAW) describes physical aggression, sexual coercion, coercive control, and/or psychological abuse by an intimate (ex) partner, and is the most frequent form of violence against women. This violence constitutes a human rights violation that remains a public health problem with serious consequences for survivors and their children. Global data indicate that 27% of women aged 15–49 have experienced physical and/or sexual IPVAW at least once in their lifetime. Lara Murvartian [email protected] 1 Department of Experimental Psychology, University of Seville, Camilo José Cela, s/n, Seville 41018, Spain 2 Department of Interdisciplinary Professions, East Carolina University, Greenville, NC 27858, USA Abstract Purpose Social workers and health professionals play a relevant role in the detection and intervention of intimate partner violence against women (IPVAW). However, these professionals may exert public stigma against IPVAW survivors, which prevents disclosure, help seeking and affects women’s health. There are no comprehensive models that explain stigma functioning in Spain. Our aim was to explore the functioning of such stigma that may be exercised by social workers and health professionals in Spain. Their perceived impact of stigma on survivors was also studied. Methods Interviews with 18 providers were conducted and analyzed through template analysis. Results The findings confirmed the presence of stigma and revealed that it was often unintentional. Factors about the Roots of stigma were identified (e.g., Privileged social identities or Symptom-focused role of psychology), which triggered several Myths about IPVAW and survivors (e.g., Broken toy or Survivor-profile) and Stigmatizing responses (e.g., Being paternalistic or Judging) when offering professional help. Several consequences of these myths and responses showed the perceived high Cost of stigma for survivors (e.g., Leaving support services or Internalizing stigma). Conclusions The results confirmed the importance of effective professional training to prevent stigmatizing myths and responses. Training should reduce professionals’ patriarchal values, increase their knowledge about IPVAW, self-reflection on how personal experiences and social identity influence their practice, and self-reflection on their own practice in general. Such training should also promote an intersectional perspective on recovery, a view of survivors as agents, a contextual approach, active listening, close contact with survivors, and informed care. Keywords Stigma · Intimate partner violence against women · Social work · Healthcare · Professionals · Qualitative Accepted: 2 July 2024 © The Author(s) 2024 Understanding Social Workers and Health Professionals’ Public Stigma against Women who Experience Intimate Partner Violence in Spain LaraMurvartian1· Francisco JavierSaavedra-Macías1· Manuel Luisde la Mata1· AllisonCrowe2 1 3 Journal of Family Violence Because IPVAW has serious health, financial and social costs for survivors and their children, WHO (2020) has declared the provision of survivor centered, nonjudgmental support services essential. Spain is a country where there has been an increase in the number of support services for survivors and training of professionals since the approval of Organic Law 1/2004 of 28 December, on Integral Protection Measures against Gender-Based Violence (Gracia et al., 2020). However, research has revealed that access to support resources, as well as the decision to disclose abuse and seek help is hindered by a series of barriers that are present and interact in unique ways for each survivor (Barrios et al., 2021; Pokharel et al., 2020). These barriers include public stigma towards survivors (WHO, 2021), a complex phenomenon that will be further describe below including negative beliefs, prejudice, and discrimination from others toward the stigmatized (Link & Phelan, 2001; Pescosólido & Martin, 2015). Public stigma has been studied in the last decade in the field of IPVAW due to the difficulties it poses to the process of recovery from violence (Bellia et al., 2019; Murray et al., 2016, 2018). Recent international literature has reported that this stigma is also exercised by professional helpers. Sometimes, when survivors reveal abuse, professionals do not listen to their stories or judge them (Barrios et al., 2021; Crowe & Murray, 2015; Kennedy & Prock, 2018; Pokharel et al., 2020). On the other hand, anticipation of these responses holds women back from seeking formal help causing them to deny the abuse when professionals have suspicions and ask about abuse directly (Barrios et al., 2021). Women face several micro (e.g., economic dependence) and macro challenges (e.g., patriarchal gender roles) before revealing abuse to a professional (Pokharel et al., 2020). As such, once they take this difficult step, it can be devastating to meet with professionals who stigmatize them. In the current study, we focus on professionals in the health system, since the consequences of IPVAW on health lead survivors to make greater use of these services than the general population (Woods, 2010), and because either through direct disclosure of the survivor or through the professional’s suspicion of IPVAW signs, health providers play a key role in the detection and intervention in IPV. Similarly, we focus on social workers, given their relevant contribution to women’s health and safety (Rizkalla et al., 2020; WHO, 2021). The Spanish Ministry of Health, Social Services and Equality (2012) promotes a nonjudgemental, multidisciplinary approach toward IPVAW cases, highlighting the importance of professionals from the social and health sector for an integrated system of care. However, after a comprehensive review of the literature, we found a few studies that detected the presence of myths and negative attitudes related to IPVAW and survivors among previous professionals in Spain that prevented survivors from seeking formal help. Durán-Martin et al. (2022) detected negative attitudes (e.g., minimizing the abuse or blaming survivors) that were a barrier to seeking formal help. It is worrying that these attitudes are even higher for vulnerable groups such as young women, immigrants, women with disabilities (Durán-Martin et al., 2022) and Roma women (Briones-Vozmediano et al., 2018; Durán-Martin et al., 2022). This is related to the intersectionality of other socially stigmatized identities (Murray et al., 2016), something that will be discussed at the end of the following section. On the other hand, Martínez-García et al. (2021) found a relationship between the absence of myths about survivors and IPVAW in emergency health care physicians and nurses and a greater probability of IPVAW case detection. However, although social beliefs are an important part of public stigma, the above-mentioned studies leave behavioral components aside (Barnett et al., 2016), in other words, we did not find any research that comprehensively analyzed IPVAW public stigma in Spain. Therefore, understanding how stigma, with all its elements, is generated and maintained is essential to designing and implementing strategies to prevent it in professionals. Stigma towards IPVAW Survivors Stigma has been defined as a process that originates in social interactions (Goffman, 1963) in which there is a power difference between the person who stigmatizes and the stigmatized. Namely, an attribute of the person stigmatized is associated with a series of negative social beliefs that lead to prejudice and discrimination from others (Link & Phelan, 2001). Pescosólido and Martin (2015) highlight the complexity of this process, in which characteristics of the person who stigmatizes, the stigmatized, and the community interact and maintain the stigma. They also add how prejudice and discrimination reinforce negative beliefs. Public stigma specifically refers to stereotypes, prejudices, and discriminatory behavior endorsed by the general public (Pescosólido & Martin, 2015). Public stigma towards survivors of IPVAW started to be analyzed only ten years ago when Overstreet and Quinn (2013) noted that the label of “IPVAW survivor” was associated with the stereotype of women as passive, weak, responsible for the abuse, leading to judgmental, isolating and blaming behaviors from others. According to Barnett et al. (2016), this stigma reinforces gender inequalities in the context in which it arises, acting as a mechanism of social control. Some factors involved in IPVAW public stigma have been identified by relevant literature on the topic. First, there are those that underlie or drive discriminatory beliefs 1 3 Journal of Family Violence and behaviors, which reflect our patriarchal culture, laws, and media (e.g., cultural norms, lack of education on the topic, Bellia et al., 2019; Murray et al., 2016), of which professionals would not be exempt. In this regard, Spain has experienced a great improvement in gender equality since 2010, with the greatest progress achieved in the areas of economic and social power (European Institute for Gender Equality, 2022). With respect to IPVAW, social awareness, services for attention to survivors, and professional training have increased since the approval of Organic Law 1/2004, considered one of the most advanced laws on IPVAW protection in Europe (Gracia et al., 2020). This is of great relevance, since insensitive legislation on IPVAW creates a context of legitimization (Barnett et al., 2016). Nevertheless, sexism is still present (Gracia et al., 2020), and forces against these advances in equality can be observed. For example, in the emergence of extreme right-wing political discourses that question the previously mentioned law for discriminating against men, something that has been criticized by feminist research for minimizing the severity of IPVAW (Varela-Guinot, 2021). In addition to factors that sustain stigma, the literature has identified some components of stigma. First, a set of cognitive components, in other words, of false and stereotypical beliefs about IPVAW, (e.g., considering it a private matter, Murvartian et al., 2023b) and about survivors (e.g., believing they are uneducated, Murray et al., 2016). These have been internalized by the general public, professionals included (Briones-Vozmediano et al., 2018; Durán-Martín et al., 2022; Martínez -García et al., 2021), and contribute to minimize, deny, or justify IPVAW (Murvartian et al., 2023a). Spain is one of the countries within the European Union that stands out for its research and actions aimed at deconstructing these false beliefs (Gracia et al., 2020), however, they are still present (Ferrer-Pérez et al., 2019; Megías et al., 2018; Sánchez-Prada et al., 2020, 2021). In this regard, the Organic Law 1/2004 has been criticized for being applied by professionals without considering the situation of each woman and without their voices being heard, constructing the subjectivity of the “woman survivor” according to social stereotypes (Cubells & Calsamiglia, 2018). Related to this, Bosch-Fiol and Ferrer-Pérez (2012), who listed various existing myths in Spain (e.g., survivorblaming), highlighted that patriarchal forces that go against the feminist movement are generating subtler expressions of sexism, giving rise to neo-myths (e.g., the aforementioned erroneous belief that the law discriminates against men) on which to increase the focus. Second, a number of behavioral components of IPVAW public stigma have been identified. Specifically, Murray et al. (2018) listed a number of stigmatizing behaviors (e.g., isolating the survivor, blaming her for the abuse, etc.) that Crowe and Murray (2015) found were also exercised by professional helpers when dealing with survivors. Blaming women for abuse and not taking them seriously was most common among providers. In line with this, a recent qualitative study has been conducted on the nature of stigma by law enforcement and legal professionals in Spain which identified a variability of stigma behavioral components in that field (Murvartian et al., 2023b). However, it is noteworthy that, to our knowledge, no studies have been conducted on the behavioral components of stigma that may be exerted by professionals from the social work and health sectors in Spain. There is, however, international (e.g., Rivera et al., 2012) and Spanish literature (e.g., García-Jiménez et al., 2019) that analyzes “secondary victimization”. This is a concept closely related to this behavioral component which refers to insensitive and negative practices by professionals that add to the harm and violation of rights that women have already suffered due to abuse, but in this case by those who should be helping them (García-Jiménez et al., 2019; Rivera et al., 2012). However, public stigma is a broader concept than secondary victimization. These three factors described so far are interconnected. Erroneous beliefs reflect the patriarchal sociocultural context that dictates what is or not acceptable regarding the use of violence against women in an intimate relationship. These myths also reinforce the sociocultural context where IPVAW takes place and contributes to public stigmatizing behaviors towards survivors (Gracia et al., 2020; Overstreet & Quinn, 2013). Moreover, those stigmatizing behaviors may reinforce myths and stereotypes (Pescosólido and Martin, 2015). The literature has also highlighted that stigma results in negative consequences for the recovery from violence and wellbeing of survivors. Some examples are not disclosing abuse or seeking help (Bellia et al., 2019; Murray et al., 2016), or suffering from mental health problems (e.g., PTSD, Kennedy & Prock, 2018). Taccini and Mannarini (2023) recently made a first attempt to define public stigma towards survivors of IPVAW. First, the authors emphasized that greater acceptance of sexist, conservative or patriarchal attitudes is associated with greater public stigma. Likewise, stigma includes a series of myths about IPVAW that contribute to minimize the abuse, blame survivors and exonerate aggressors, and reduce this violence only to physical abuse. The authors also explain that stigma carries with it prejudices or generalized social attitudes by which women were blamed, discredited, and made feel ashamed. As for the discriminatory behaviors that emerged in women’s social interactions, the authors identified a series of behaviors from professionals working in different settings (secondary victimization) that alienated, blamed and discredited survivors, and made women feel ashamed. In this first attempt to conceptualize stigma, they 1 3 Journal of Family Violence social services by adopting a ‘turn to language’ approach, since language reflects and reinforces the oppressive reality of public stigmatization. Participants and Recruitment We used a purposive sampling technique to recruit professionals from the health and social care system who provided services to IPVAW survivors. We recruited participants by distributing a flyer calling for volunteers through national professional networks and by referrals of eligible participants from known professionals who work with survivors. The practitioners did not receive incentives for their participation. The number of participants was determined by data saturation. The data saturation procedure employed consisted in increasing the number of participants as the data were analyzed until no new relevant information emerged from the interviews, that is, no new categories, relationships between categories, or perspectives. For example, three of the four participants initially interviewed had been in practice for more than 25 years. According to preliminary analysis, this fact may have influenced the participants’ conceptualization of stigma. Therefore, the research team decided to target professionals with less work experience in the next round. Data saturation was reached with a total of 18 participants, which is consistent with recommendations from Hennink and Kaiser (2022). Participants worked in different regions of Spain, six of them for the public health sector, three in private health facilities, and nine in social services and/or associations. Seven were regional/national experts in IPVAW, assisting IPVAW survivors in their workplace daily. The rest of the professionals assisted survivors occasionally. All participants, except a nurse and a psychologist, had received IPVAW training. The age of the participants ranged from 24 to 65 years (M = 43.94; DT = 13.58). Gender balance and diversity in terms of years of professional practice (between 2 and 41 years) was achieved. Demographic data can be found in Table 1. We have used fictitious names to protect the anonymity of the participants. Data Collection We used a semi-structured, in-depth interview protocol (see Appendix A) audited by IPVAW experts and successfully piloted with three professionals. It consisted of open-ended and flexible questions that encouraged the interviewee to speak freely about a series of topics which the researcher could further investigate with follow-up questions (Scanlan, 2020). Before starting the interview, informed consent was obtained. The interview followed a structure with questions moving from general to more specific. The interview also emphasized how public stigma becomes internalized, which in turn reinforces public stigma. Additionally, they found that internalized stigma increases with secondary victimization. There are also two aspects that should be highlighted in relation to IPVAW public stigma. First, the oftentimes implicit nature of stigma, which has been found when analyzing IPVAW myths (Ferrer-Pérez et al., 2020) and outlined as one of the challenges of any stigma (Pescosólido & Martin, 2015). And second, that every experience of stigma is unique, as public stigma associated with being a survivor of IPVAW is intensified with the intersectionality of other socially stigmatized identities (e.g., ethnicity, social class, etc.), increasing the barriers that IPVAW stigma entails, such as for help-seeking (Murray et al., 2016). In the patriarchal system the mere fact of being a woman expressing anger carries with it the public stigma of being “irrational” or “hysterical” (Slater et al., 2003). Therefore, for a woman to fight against abuse would always imply a double stigma, as a woman, and as someone who has experienced IPVAW. The Present Study Considering the above and given that the nature of stigma varies according to the geographical and historical context in which it arises (Goffman, 1963; Pescosólido & Martin, 2015) the general objective of the present study was to analyze the functioning of public stigma towards IPVAW survivors in professionals working in healthcare and social services in Spain. Specifically, the purpose was to identify the factors involved in such stigmatization, the relationships between them, and the effect of stigma on survivors. We used a qualitative approach given the suggestions to deepen the understanding of stigma by directly asking practitioners (Crowe & Murray, 2015). Method Study Design This research received ethics approval from the XXX Research Ethics Committee (approval number: XXX). Epistemologically, the study falls within a critical feminist social constructivist approach, from which there would not be a single interpretation of the phenomenon and would depend on our position as researchers and the sociocultural and historical context in which the study took place (Wigginton & Lafrance, 2019). For this reason, to answer our research aim, we used the testimonies from semi-structured in-depth interviews with professionals in healthcare and 1 3 Journal of Family Violence appears in Table 1. Questions were open-ended, in other words, we did not set pre-stablished options or categories. Data Analysis Three researchers participated in the data analysis and no software was utilized for this purpose. We followed a template analysis procedure (Brooks et al., 2015). The RL maintained a reflective attitude and discussed the dilemmas she found with the rest of the team. In addition, a subset of six interviews were independently analyzed by the RL and the rest of the team, and they met afterwards to discuss the dilemmas encountered, not to reach a consensus, but to obtain a more complete view of the interpretations that would contribute with a novel perspective on the topic of study (Madill et al., 2000). Analyzing a subset of interviews at the beginning is common in template analysis to get an initial solid template of themes and subthemes (Brooks et al., 2015). This was done independently by each team member to ensure that it was not just agreed upon by one person, but by the entire research team; in other words, to add solidity to this initial template. The rest of the interviews were analyzed by the RL, who then met with the rest of the team to discuss the dilemmas that arose. In addition, cross-anal- ysis of a set of interviews by other researchers is a common practice in qualitative research to strengthen the reliability of findings. Typically, this cross-analysis is done on only a portion of the total interviews. Twenty to thirty% of the data is considered a very appropriate percentage (Barbour, 2001). began by surveying the personal experiences of the professionals with the survivor care and their general opinion of what this work entails. Then the Research Leader (RL) explored whether he knew what the word “stigma” meant and was given a brief definition of this concept according to the literature, so that, from that moment on, all interviewees understood the concept of stigma and the questions related to this concept in the same way. Then, they were explicitly asked if they believed that there was public stigma towards IPVAW survivors. If professionals did not believe that public stigma existed, the interview ended by collecting their opinion in this regard. If they answered affirmatively, the origin of stigma, its nature/manifestations, and impact on survivors were examined in depth. Furthermore, if they answered affirmatively, the RL asked whether stigma also existed among professionals in their field and if so, if there were differences between this type of stigma and stigma in society, in general. The interview ended with an exploration of the stigma that professionals themselves may have exercised in their practice (see Appendix A). We assumed that professionals could exercise stigma and not be aware of it (Ferrer-Pérez et al., 2020), possibly making it easier for them to identify stigma in others. The interview structure and open-ended questions allowed us to explore the participant’s implicit stigma that arose in the interview, in addition to the stigma that interviewees openly said they and other professionals had at some point exerted. All interviews were audio-recorded and lasted between 45 and 90 min. Sociodemographic questionnaires were completed at the end. The information collected was the one that Table 1 Characteristics of the participants Name Age Gender Profession Sector Years in practice Experts in IPVAW Training in IPVAW Ana 63 W Physician Public health sector 35 No Yes Alex 30 M Physician Public health sector 3No Yes Romeo 57 M Nurse Public health sector 30 No No Emma 49 W Nurse Public health sector 26 Yes Yes Bianca 24 W Nurse Public health sector 2 No Yes Óscar 56 M Paramedic Public health sector 26 Yes Yes Javier 30 M Psychologist Private healthcare facility 2 No No Roberto 44 M Psychologist Private healthcare facility 2 No Yes Eva 28 W Psychologist Private healthcare facility 2 No Yes Mia 56 W Psychologist Social services 28 Yes Yes Valentina 51 W Psychologist Social services 26 No Yes Marco 58 M Psychologist Social services 25 Yes Yes Laura 65 W Social worker Social services 41 Yes Yes Nicolás 49 M Social worker Association and social services 15 Yes Yes Erick 37 M Social worker Association 13 No Yes Elena 31 W Social worker Social services 11 No Yes Félix 30 M Social worker Association and social services 6 Yes Yes Isabella 33 W Social worker Social services 2 No Yes Note: M, Man; W, Woman 1 3 Journal of Family Violence that are closest to the statements made by the participants. Codes were grouped into subthemes and subthemes were grouped into themes. For example, the code “The sexism we grew up with at home” is part of the subtheme Patriarchy, and this subtheme is included in the theme Roots of stigma. Similarly, the code “Survivors find themselves without sources of support” is part of the subtheme Feeling unprotected, and this subtheme is embedded in the theme Cost of stigma for survivors. This iterative process of repeatedly reading the data and refining (eliminating, merging, adding, and redefining) the themes and subthemes continued until we obtained a template that allowed for a detailed and organized summary of all relevant data for this research (Brooks et al., 2015). The final template can be seen in Fig. 1 and will be explained in detail in the Results and Discussion section. As mentioned above, we followed a template analysis procedure (Brooks et al., 2015), a flexible technique that allowed us to begin considering a few broad a priori themes which, according to recent literature (e.g., Murray et al., 2016), are central to explaining how stigma works. These themes were: The roots of stigma (i.e., factors that drive/ underly stigma), False beliefs regarding IPVAW and the survivors, Stigmatizing responses towards them (i.e., stigmatizing behaviors when dealing with survivors), and The cost of stigma on the stigmatized (see the Introduction for more detail). We applied these initial themes to the data, and when new data did not fit, we modified them or added new ones. We organized themes in a hierarchical structure so that various themes were grouped into broader themes. That is, all of the interviews were analyzed using codes, which are the units Fig. 1 Final template with themes and subthemes on the functioning of public stigma towards women who experience IPVAW from social work and health professionals. Note. The four broad themes are written in bold inside the boxes, and the subthemes are listed below each theme. The two themes that refer to factors that increase the stigmatization process are inside the dashed boxes. Arrows show the associations between themes 1 3 Journal of Family Violence in the interview, he demonstrated awareness, but, paradoxically, still did not believe that a professional could exercise stigma. This conflict showed up in his discourse. As another example, one of the psychologists concluded the interview asking if she herself could also have exercised the stigma she identified in her colleagues. The participant explained how it had been easy for her to identify the stigma that others exerted and that, if she stopped to think about it, she herself could have acted in that way. This could be another example where the professional is half aware of stigma, in this case the stigma of others, and began to question her own. It should also be noted that twelve participants felt that the public stigma among professionals was very similar to that of the rest of society, as they were part of the patriarchal culture. They agreed that it was more harmful for survivors to encounter stigma from a professional, since they are in a helping role. Next, we describe and discuss the themes and subthemes of stigma functioning (see Fig. 1). Stigma Functioning Figure 1 shows the final template resulting from the analysis conducted. As can be seen, the four themes that guided the start of the analysis -Roots of stigma, Stigmatizing myths about IPVAW and survivors, Stigmatizing responses and The cost of stigma for survivors - were maintained and comprised a series of sub-themes. Furthermore, two new themes emerged in addition to these four: Intersection of other stigmatized attributes and Stigmatization in rural areas (vs. urban). The functioning of stigma is therefore explained by a total of six broad themes. The Roots of stigma referred to the factors that participants considered to be the origin of both Stigmatizing myths about IPVAW and survivors held by professionals, and the Stigmatizing responses from practitioners when they attended a survivor. Myths were frequently identified by professionals as the basis for stigmatizing responses, and both myths and responses led to a series of perceived negative consequences for survivors (The cost of stigma for survivors), as understood by participants. Each of these four broad themes was composed of various, specific subthemes. Additionally, some participants indicated two factors that modulated the stigmatization process by increasing it, corresponding to the themes Intersection of other stigmatized attributes of the survivor and Stigmatization in rural areas (vs. urban). In the following sections, we expand on all themes and subthemes in detail, accompanied by quotes from the participants. The Roots of Stigma One of the root causes of stigma was, according to more than half of the interviewees, Patriarchy. The stigma was The position of the RL in this study was based on the understanding that public stigma is a complex process influenced by specific geographical and historical contexts (Goffman, 1963; Pescosólido & Martin, 2015; Wigginton & Lafrance, 2019). Moreover, she assumed that every experience of stigma would be unique and intensified by other intersecting socially stigmatized identities (Murray et al., 2016). She also viewed IPVAW as a public problem that results from and enforces a patriarchal system that oppresses women (Barnett et al., 2016) and survivors as active agents of IPVAW recovery (Black et al., 2020; Gondolf & Fisher, 1988). Furthermore, she understood recovery from an intersectional framework, which assumes that IPVAW resistance and liberation strategies are diverse and unique according to women’s circumstances and social identities (Barrios et al., 2021). We will now present and discuss the findings of this study. Results and Discussion First, it should be noted that none of the participants knew the concept of public stigma completely. However, in the interview, after receiving the definition, seventeen participants believed that there was a public stigma from society toward IPVAW survivors and that this was also exerted by professionals, confirming previous findings (e.g., Crowe & Murray, 2015). Before describing the categories in Fig. 1, it is essential to present some overarching characteristics of stigma that were identified from the participants’ testimonies. Something we consider of great relevance, as mentioned in the Method section, is that stigma can be exerted implicitly (Ferrer-Pérez et al., 2020). In fact, eight professionals indicated that stigma was often exercised unintentionally. Furthermore, some contradictions observed in the interviews showed that there were different levels of awareness in the exercise of stigma. For example, of the only three participants who denied that they had exerted stigma, we found stigma in two of them that they were not aware of. One of them expressed that stigma existed, but not exercised by physicians, since they were experts on “reading people” and would easily recognize if women were pretending to be survivors of IPVAW. However, in another part of the interview, he said that there were physicians who stigmatize because they were not trained in IPV, or due to their political ideology. In other words, there was a moment in which he denied that there might be stigma from professionals, yet at another point, he acknowledged the opposite. To conclude that this participant was aware of stigma or that he was not aware of it could be simplistic. As expressed, the perception of professional stigma seems to be a continuum. At times 1 3 Journal of Family Violence is not a synonym of the abuse ending, and that recovering from violence involves many other aspects once the relationship ends, such as regaining social networks that were lost as a consequence of the isolation to which the aggressor subjected them, or listening and loving themselves again (Hamilton, 2010). Added to the above-mentioned factors, the Personal experiences of the professionals seemed to influence the attention given to the survivors too. For example, if the professional knew the abuser personally and he had always been outwardly friendly, they doubted the survivor’s testimony. Also, the professional’s own experiences related to abuse, partners, etc., influenced their professional care. In this sense, Romeo (nurse) confessed having doubted the testimony of survivors: My analysis of reality is greatly influenced by my personal experiences. If I feel that I’m dealing with a manipulative person, I’m very sorry but I cannot act against the way I truly feel. So, have I ever been wrong? Maybe when it comes to manipulation, because I’ve dealt with a couple of cases, relatively close to me, of parental alienation, a syndrome which I’m not sure is officially recognized. What I accused those women of [from the aforementioned cases] is that both of them were being manipulative. Romeo suggested that his personal experience legitimized his interpretations of reality. He did not question whether what he felt was correct; whether he should try to be more impartial and not let his personal experiences influence him. He apparently acknowledged that he may have been mistaken at times in thinking that the survivors were manipulative. However, he explained that this was because he had dealt with two cases close to him of parental alienation. Parental Alienation Syndrome (PAS) is a controversial concept and is not recognized as a medical or psychiatric disorder in official diagnostic manuals. It refers to a situation in which a parent, often during a custody dispute, manipulates a child to develop a negative attitude toward the other parent, thereby undermining the relationship between the child and that parent (Escudero et al., 2010). The PAS is a concept that is often used to attack women, portraying them as manipulative who turn their children against their fathers. This is currently considered one of the neo-myths about IPVAW in Spain (Bosch-Fiol & Ferrer-Pérez, 2012; Escudero et al., 2010). The research group on PAS formed by Escudero et al. (2010) and created by agreement of the State Observatory on Violence against Women of the Ministry of Equality concluded that: not only associated with suffering IPVAW, but with being a woman (Slater et al., 2003). Participants expressed that the patriarchal values in which they had all been socialized were still deeply rooted and that deconstruction was difficult. This suggests that it is not enough to receive theoretical training on IPVAW and gender equality, but everyone would have to review their own sexist attitudes (Jiménez García- Bóveda et al., 2021). In line with this, Mia (psychologist - expert in IPVAW) expressed: We can have training in gender equality, and in IPVAW. If there’s no ‘patriarchy cleansing’, in the end, we professionals who work with gender-based violence are going to project our sexist attitudes onto women. Many of the interviewees also agreed that the Lack of training regarding the functioning of the IPVAW and the recovery process was responsible for stigma. In fact, recent studies carried out in Spain have shown that professionals’ lack of preparation was the main reason for lower violence detection and use of protocols for addressing IPVAW in health services (Portela-Romero et al., 2020). Participants expressed that there were still many untrained professionals, even in domestic violence support services. On one hand, this lack of knowledge made it difficult to detect cases of IPVAW, since, as Alex (physician) indicated: “You only look for what you know”. On the other hand, even if IPVAW was detected, being untrained made it difficult to understand some of the survivors’ actions and decisions (e.g., not recognizing themselves as someone suffering IPVAW, withdrawing the complaint, etc.). An example was found in Ana’s (physician) testimony. You say ‘this lady is financially covered, she has an apartment, and now you go back [to the aggressor], after 2 years? My God, why?!’ It is difficult for you to understand. There are no more excuses. Ana implicitly stigmatized the survivor by considering she had “no more excuses” to go back with the abuser, while, at the same time, Ana was starting to realize that the problem could be that she had difficulties understanding the survivor. This is a clear example of how the agency of women who experience IPVAW has traditionally been defined as the ability to end the abusive relationship and not return with the abuser (Mackenzie et al., 2020). This is why the training of professionals should not only focus on the signs that allow violence to be detected and the protocols to be applied, but also on the consideration of recovery from violence as a more complex process that may include leaving and going back to the abuser several times. Moreover, professionals should understand that ending the relationship 1 3 Journal of Family Violence Secondly, participants felt that certain Privileged social identities could facilitate stigmatization. According to Javier (psychologist), when explaining why he had exercised stigma: Yes. I know that at some point [I have exercised stigma], more in my youth, because of the sexist education I was given at home. Unfortunately, I wasn’t born in a society where sexism didn’t exist. But, on top of that, I’m a man, white, heterosexual, with three brothers, also white and heterosexual men. So, we’ve lived in a home where sexism was even more present. In fact, there are still certain sexist attitudes in me that I must reflect on carefully in order to avoid. Javier attributed having exercised stigma to the patriarchal values in which he was raised, as was captured in the aforementioned Patriarchy subcategory. And he referred to how within a patriarchal society, privileged social identities such as “men”, “white”, “heterosexual” further increased the presence of such values. In this regard, there is much evidence indicating that negative attitudes toward IPVAW and survivors are more frequent in men than in women (Gracia et al., 2020; Jiménez García-Bóveda et al., 2021). However, even though Javier had exercised stigma, he was aware of his social position and the added reflective work he still needed to avoid the influence of those internalized sexist values. From all the above, we would like to highlight that, although an increasing number of professionals in Spain have received training in IPVAW (Gracia et al., 2020), this number is still low, as expressed by the participants. Moreover, patriarchal values, certain personal experiences (or lack of them) and privileged social positions also influence stigma, regardless of professional or advanced-level training in IPVAW. In this sense, we conclude something that has been widely proven for mental health public stigma: training based on theory and concepts alone is not enough for preventing stigma (Gaebel et al., 2017). And finally, the participants highlighted two other factors that obviate the context of survivors and contribute to public stigmatization. First, thinking ‘we live in a free society’, where everyone acts voluntarily, led to blame the survivors for their situation. Nicolás (social worker - expert in IPVAW) explained: “It’s like, ‘If you were in a free society, why didn’t you get out of there?’ [imitating others] It’s like… if she’s there, it’s because she wanted to be there, you know?‘. The notion that ‘we live in a free society’ correlates with a false idea that gender equality has already been achieved, which Valcárcel (2008), a renowned Spanish feminist philosopher, called ‘the mirage of equality’. This idea ignores the patriarchal system that oppresses women The alleged Parental Alienation Syndrome is a legal strategy employed by attorneys to extricate their male clients when accused of abuse, sexual misconduct, negligence in parenting, or simply when, after perpetrating IPVAW against their wife, they refuse the divorce request. This concept, formulated by Richard A. Gardner, is primarily rooted in his misogynistic belief, prevalent among various professionals from different disciplines, asserting that women lie and act vengefully by brainwashing their children against the father. Consequently, evidence of abuse or misconduct, including medical evidence and expert testimonies, is dismissed as it is deemed to stem from the mother’s alleged vengeful denigration campaign against the father, rather than being seen as the responsible actions of a mother attempting to protect her children from violence. Romeo’s testimony was an example of how personal experiences -the two women he knewcan be interpreted under the lens of patriarchy -under the above-mentioned neo-myth- and influence professional care. Some authors (Murvartian et al., 2023a) have suggested that not knowing survivors may be related to the exercise of greater stigma. However, as we can see here, not all close experiences prevent the exercise of stigma but may even increase it. Perhaps only close experiences that challenge the stereotype and prejudice associated with the stigmatized could contribute to reducing public stigma. This could be the reason that some studies (e.g., Gracia et al., 2020) found contradictory results about knowing a survivor or not and its correlation with stigmatizing attitudes. Apart from the three factors presented, there were others mentioned less frequently. First, there was the Distorted media image of IPVAW and survivors that reinforced some stigmatizing myths. An example of this was the false image given in the news about the ease with which men can be arrested for abuse allegations. Additionally, Félix (social worker - expert in IPVAW) explained how the public image portrayed in IPVAW awareness campaigns about survivors (e.g., women with a black eye or a sad face) was far from reality and stigmatized them. 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