Working with Bullying: Supporting Victims

This article offers a clinical guide to definitions, risk and protective factors, and therapeutic strategies for working with bullying victims, both children & adults.

Introduction

Bullying is a pervasive interpersonal phenomenon with significant mental health sequelae. Mental health professionals often see clients who have been bullied in childhood, adolescence, or adulthood — sometimes decades later — and struggle with its psychological legacy. For clinicians, it is not enough to treat symptoms; a trauma-informed, developmental, contextually informed approach is required.

In this article we (1) define bullying and situate it conceptually; (2) review forms, functions, prevalence, risk and protective factors; (3) examine developmental and life-course implications; and (4) propose clinical strategies, tools, and techniques for supporting victims — divided by child/adolescent work and adult work.

Defining bullying, context, form and function

Definition

Bullying is typically defined as aggressive, unwanted behaviour by an individual or group, repeated over time, in which the victim is unable or unwilling to defend themselves, and where there is an imbalance of power (Ferraz de Camargo et al, 2023).

Key elements in most definitions:

1. Intentional harm — not accidental or mutual conflict.
2. Repetition or persistence — not a single event.
3. Power imbalance — may be physical, social, psychological, or organisational.

Some expand it to include emotional, relational, and digital/online forms (Rettew & Pawlowski, 2022). The Anti-Bullying Alliance (UK) adds: “repetitive, intentional hurting … relationship involves an imbalance of power” (Cullinan & Omijeh, 2025).  Some authors conceptualise chronic bullying as a developmental trauma, especially when exposure is prolonged and pervasive (Ferraz de Camargo et al, 2023). From a systems lens, bullying often depends on enabling environments (peers, institutions, culture) (Carney & Hazler, 2015).

Context and distinctness from conflict

• Bullying is distinct from peer conflict or aggression between equals. In the latter, power imbalance and repetition may be absent.
• It is relational and systemic: bullies typically manipulate context, recruit bystanders, and exploit silence or institutional inaction (Carney & Hazler, 2015).
• In workplaces, the term “mobbing” is often used to describe group-targeted hostile behaviour (Wikipedia, 2025a).

Forms of bullying

A surprising number of forms of bullying exist.

Overt / direct bullying

• Physical (hitting, pushing, damaging property)
• Verbal (name-calling, threats, insults)

Relational / social / covert bullying

• Social exclusion, rumour spreading, manipulation of friendships
• Silent treatment, ostracism
• Subtle undermining or humiliation (Wikipedia, 2025b)

Cyberbullying / online aggression

• Harassing messages, posts, images, defamation, impersonation, exclusion
• Can magnify reach, anonymity, permanence, diffusion across contexts (Kallman, Han, & Vanderbilt, 2021).

Sexual/sexist bullying

• Sexual remarks, harassment, spreading sexual rumours
• Gender-based humiliation or shaming

Workplace bullying / organisational bullying

• Insults, gaslighting, sabotage, social isolation, micromanagement
• More subtle relational aggression, power abuses, performance critique with malice

Intersectional or identity-based bullying

• Targeting based on race, gender identity, disability, sexuality, religion
• Can intersect with minority stress frameworks

Functions, motives, and dynamics

Bullying often serves functional and social psychological purposes for perpetrators or groups:

• Dominance and control: establishing hierarchy or power.
• Social status: enhancing group cohesion, excluding outsiders, reinforcing in-group norms.
• Emotional regulation: projecting frustration, displacement of aggression.
• Revenge or “retaliation”: responding to perceived slights.
• Modelling or imitation: cultural or institutional norms that tolerate aggression.
• Instrumental gain: in workplaces, gaining advantage, suppressing competition, maintaining control.

From the victim’s standpoint, bullying often involves isolation, learned helplessness, shame, internalisation, self-blame, and hypervigilance (Carney & Hazler, 2015).

Bystander behaviour is critical: reinforcement, passive witnessing, or defending can shift dynamics (Marsh, 2018).

Prevalence, risk and protective factors

Prevalence

The prevalence of bullying victimisation may be higher than typically realised.

• Meta-analyses and large-scale surveys suggest that about one in three children or adolescents (approximately 30–35 %) experience bullying (in any form) at some point (Ferraz de Camargo et al, 2023).

• Cyberbullying prevalence varies; many victims are also bullied offline (Eyuboglu et al, 2021).
• Among U.S. adolescents, some studies estimate that about 5 % report repeated bullying (more than 2–3 times) in recent months (Low et al, 2025).
• Workplace bullying is also common; estimates vary by sector, but many employees report experiencing hostile work behaviour — though formal prevalence data is heterogeneous.

Longitudinal data show some children are victimised only in early childhood, some in adolescence, and a subgroup experiences chronic victimisation (Chow et al, 2023).

Risk factors for victimisation

Risk factors can be grouped by individual, relational / peer, and contextual / institutional levels. This table summarises the risk indicators for each domain.

Domain	Risk indicators
Individual	Low self-esteem, social skill deficits, internalising symptoms, anxiety, depressive symptoms, poor assertion skills, perceived difference or “otherness” (e.g. disability, obesity, minority identity) (Sanders, 2022)
Family / Early environment	Family conflict, low parental support, maltreatment, harsh discipline, insecure attachment, and poor supervision (Low et al, 2025)
Peer / relational	Social exclusion, peer rejection, few friends, loneliness, low peer support, victim of prior aggression (Low et al, 2025).
School / organisational climate	Permissive discipline policy, weak leadership, poor supervision, normative aggression, intolerance of diversity, weak anti-bullying policies (Marsh, 2018).
Contextual / systemic	High inequality, discrimination, institutional power hierarchies, culture of silence (Carney & Hazler, 2015).

Not all victims have all risk factors; risk is probabilistic and interacts across levels. Recent machine-learning modelling (using SHAP) in adolescent samples identifies family dysfunction, feelings of social exclusion, and school dislike among top predictors of victimisation (Low et al, 2025). We also note here that subpopulations such as neurodivergent people (e.g., those with autism) or psychiatric vulnerability are at significantly increased risk (Abrego-Crespo & Renzo, 2025).

Protective factors and resilience

Key protective or resilience factors include:

• Strong peer support / friendships
• Adult support (teacher, mentor, family)
• Emotional regulation skills, assertiveness
• Self-efficacy and coping flexibility
• School climates that promote respect and inclusion
• Clear institutional anti-bullying policies with enforcement
• Bystander intervention norms

Intervening to strengthen protective factors is central to prevention and support.

Clinical impacts and lifespan considerations

Sadly for victims of bullying, its effects are not overcome with removal of the bully from the victim’s life. There are both short-term and long-term consequences.

Immediate & short-term outcomes

Victims may present with:

• Anxiety, depression, social withdrawal, and/or low self-esteem
• Somatic symptoms (headaches, sleep disturbance)
• Suicidal ideation or self-harm
• Posttraumatic stress symptoms (hypervigilance, intrusive thoughts)
• Academic decline, school avoidance, absenteeism
• Interpersonal distrust, hostility

These effects are documented in both child/adolescent and adult populations (Rettew & Pawlowski, 2022).

Long-term and adult sequelae

The tentacles of bullying reach far into a child’s future as an adult. Victimisation in childhood predicts:

• Adult psychopathology including depression, anxiety, PTSD, substance misuse, and suicidality (Sanders, 2022).
• Poorer social and occupational functioning
• Elevated risk of revictimisation in adult interpersonal contexts
• Physiological effects: chronic stress, dysregulated HPA axis, inflammatory markers (in some studies)
• Identity, shame, latent trauma, and relational difficulties

For clinicians, working with adult clients who were bullied years earlier often requires trauma-informed and developmental reconceptualisation of symptoms, rather than treating them as isolated clinical disorders.

Clinical strategies, tools, and techniques for victims

Below we separate clinical strategies by developmental level (children/adolescents vs adults). Many principles overlap.

Overarching Principles

• Trauma-informed approach: It is crucial to validate client experiences, recognise betrayal and powerlessness, and avoid revictimisation.
• Developmental sensitivity: Practitioners must tailor interventions to client age, cognitive capacities, and family context.
• Ecological perspective: Attending to the individual and not to the systems in which they are embedded will not work. Mental health professionals must also pay attention to the systems (i.e., family, peers, school, and workplace).
• Strengths-based framing: Our task is to build resilience and restore agency.
• Psychoeducation and normalisation: A foundational peg is to help clients understand that bullying dynamics are not their fault.
• Parallel work with contexts: Where possible, professionals must collaborate with schools, employers, and organisational systems to help those in the systems understand the nature of the bullying occurring and to offer strategies for protection and prevention.
• Ethical vigilance: While we observe confidentiality, we also must note mandated reporting (for children); safety planning for all is imperative.

For children and adolescents (and their families)

Assessment and formulation

Bullying, more than many client presentations, must be viewed through an ecological lens. Thus, mental health professionals gather history not only related to the types of bullying and its frequency and duration, but also its context, such as who the perpetrators and also the bystanders are. We must assess psychological symptoms, trauma responses, and coping strategies. Meanwhile we map the relevant relational systems: family, peer, school environment. With all of this data, we identify strengths and supports already available or potentially accessible to clients.

Finally here, we formulate bullying impact as a relational-trauma overlay rather than only a discrete “bullying disorder.”

Psychoeducation and normalisation

This category of interventions helps the victim-client to understand what bullying is, how the power dynamics work, and what the functions of bullying are. As part of normalisation, practitioners can help the child recognise internalised self-blame and shift responsibility to the perpetrator or context. With caregivers and teachers, our role as clinicians is not only to provide the psychoeducation on how bullying works but also to show how to work with bystander roles and intervention.

Cognitive restructuring / CBT approaches

Because of the self-blaming and internalising of hostility that occurs with bullying, CBT-style approaches continue to be an essential component of treatment. Here, we:

• Target self-blaming cognitions (“I deserve this,” “I’m weak”) and replace with balanced, realistic appraisals.
• Address anticipatory anxiety and catastrophic thinking, e.g. “They will always attack me.”
• Use behavioural experiments: safe exposure and assertive statements.
• Incorporate developmentally appropriate materials, such as stories and metaphors.

(In bullying-specific CBT, or BV-CBT), we include modules for emotion regulation, cognitive flexibility, and safety planning (Ferraz de Camargo et al, 2023).

Emotional regulation and coping skills

Bullying issues may not be resolved immediately. While counselling and/or advocacy with the client’s systems is ongoing, it will be helpful to incorporate skills to help the client self-regulate and cope. Thus, interventions in this category consist of:

• Teaching distress tolerance (e.g. grounding, breathing)
• Teaching emotional awareness:  naming and labelling of emotions
• Using expressive activities (e.g., drawing, journalling)
• Developing coping flexibility, so enhancing problem-solving and cognitive reappraisal

Social skills and assertiveness training

Those with dysfunctional families and those who feel socially excluded are more likely to be bullied. Those same individuals are also more likely to have lower levels of social skills, including not knowing how to assert themselves. Countermeasures thus include:

• Role-playing assertive responses (verbal scripts, body language)
• Teaching “buddy systems,” peer support strategies
• Coaching in safe disclosure: when and to whom to talk

Safety and relational strategies

As noted above, bullying is not merely the “hits” of psychological or online abuse; sometimes it is physical. Thus, interventions to increase safety include and go beyond plans for safety, encompassing interpersonal strategies to increase it:

• Developing a safety plan (where to go, how to exit, trusted adults)
• Encouraging documentation (journals, screenshots)
• Engaging with school: support advocacy, accommodations, anti-bullying policies
• Undertaking bystander training: empowering peers to intervene

Family and caregiver involvement

Treating a child-victim of bullying involves more than working with the child. Interventions with family and caregivers include working with parents to validate, buffer, supervise, and liaise with school. Many parents will not know how to liaise with the school, nor how to advocate (assertively and not aggressively) for their child; thus, parent coaching in advocacy skills is important, along with supporting parents through (understandable) emotional responses, such as anger and/or guilt.

Group / peer-based interventions

Bullying typically is an isolating experience (“Why are they picking on me?”), so support groups can help client-victims reduce their sense of isolation. The groups can/should include psychoeducation on social and coping skills and how to build resilience. A caveat is that such groups should be carefully managed to avoid group re-traumatisation.

Trauma-focused techniques (if needed)

You can use trauma-processing (EMDR, TF-CBT, narrative exposure) for entrenched PTSD symptoms; you need to incorporate principles of safety, stabilisation, and pacing. Premature, forced exposure could result in dissociation, so practitioners must monitor for that.

Booster and maintenance work

Some children or adolescents, after engaging counselling, may present as hardy and fully able to deal with any ongoing bullying. Nevertheless, periodic check-ins are important, both to check for any ongoing bullying and also to reinforce the client’s resilience and prevent relapse. On occasion, a “geographical cure” may be necessary – that is, having the client change schools – in which case support for the transition will be helpful.

For adults (victims of bullying, past or present)

Many principles overlap with child/adolescent work, but adults bring added complexity: longer histories, identity formation, and sometimes institutional constraints.

Assessment and narrative mapping

Get curious about how bullying has unfolded for the adult client. You can ask:

• What is their bullying history (in childhood, adolescence, and adulthood)? What is/has been the frequency of the bullying? In which context(s) does it occur?
• Can you – collaboratively with the client – chart the symptom timeline? What have been the relational consequences of the bullying and its symptoms?
• Can the client identify (with your help) their core beliefs about self, shame, and mistrust? What relational schemas are they exhibiting?
• What comorbidities, such as depression, anxiety, or PTSD, do you observe?

Psychoeducation and reframing

As with children and adolescents, there is much potential for healing with appropriate psychoeducation. Here, the work is to:

• Situate bullying in relational, power dynamics, and systemic contexts
• Validate long-term impact and dismantle internalised shame
• Help the client reframe as a survivor rather than a “weak target”

Cognitive and schema interventions

As with younger client-victims, restructuring of some cognitions will be helpful. With adults, there can also be the deeper work of looking into schemas:

• Cognitive restructuring: challenging global negative self-beliefs rooted in bullying
• Schema therapy: working through maladaptive schemas (defectiveness, mistrust, abandonment)
• Imagery rescripting / limited reparenting (where appropriate)

Trauma-focused approaches

If PTSD symptoms are present, use trauma-informed modalities (TF-CBT, EMDR, CPT). You are likely to eventually do exposure work; in this, you must carefully manage boundaries, pacing, and resources for the client. Psychoeducation is, again, useful, as you help the client learn about hypervigilance and trauma responses.

Emotional processing and self-compassion

Emotions as well as cognitions need to be dealt with in the case of adult bullying. This category of intervention has three chief components:

• Facilitating emotional expression (anger, grief, shame)
• Helping the client to use self-compassion, mindfulness, and acceptance-based approaches
• Distinguishing between emotional pain (which is legitimate) and rumination, which is typically unhealthy.

Assertiveness, boundary setting and relational repair

Does the client know how to assert themselves? How intact are their boundaries? You can role-play assertive communication in adult contexts and teach boundary skills in workplace or interpersonal settings. Ultimately, the client may need to decide whether to confront the bully, seek restitution, or reframe closure. You can support them in this.

Organisational and contextual navigation

With adults, ongoing bullying in either their workplace or other institutions may mean that they need to decide whether to report it or take legal or human resource steps. Your role here may be to assist in a risk/benefit analysis. Beyond that, you may be called upon to collaborate with occupational or legal professionals. And the client may wish to have your help in mapping allies, support networks, and institutional levers.

Identity, meaning, and growth work

The deeper work with bullied adults goes beyond ensuring safety and deciding whether to complain or sue. There is much growth possible from the experience. You can:

• Explore how bullying experience shaped their identity; reconstruct their narrative as “survivor”, not “victim”.
• Explore post-traumatic growth: what new values emerge? How do they see their resilience now? How are they making meaning of the bullying?
• Use acceptance, existential or narrative therapy elements.

Maintenance and monitoring

Similarly to younger clients, adults should be monitored for revictimisation in their adult relationships. Relapse prevention interventions can be offered to ensure that clients do not relapse into being victimised, either in their work or when they are experiencing relational stress. As with children and adolescents, periodic check-ins or “refresher” sessions can help keep at bay any regression into learned helplessness or other victim behaviours.

Sample clinical workflow (for victim client)

The following sequence of treatment steps is not meant to be a linear progression from Steps 1 to 8. Rather, it is a somewhat iterative general progression, in that a given step may be undertaken, client and clinician may move on to the next step in the sequence, but later they may circle back to revisit an earlier step. Some steps may be taken simultaneously.

1. Intake & assessment
2. Psychoeducation & formulation
3. Safety planning & coping stabilisation
4. Cognitive/emotional work (CBT, schema, trauma)
5. Interpersonal skills, assertiveness, boundary setting
6. Contextual intervention (school, workplace liaison)
7. Closure, relapse prevention, post-trauma growth
8. Long-term monitoring

Clinical “tools” and worksheets (an illustrative selection)

Given the interventions that we have suggested above, which tools and worksheets will be helpful to client-victims in combating bullying? The scope of our article here does not permit explanation of these listed below, but they are easily found online if you are unclear on what is meant:

• Bullying history map: timeline, types, actors, impacts
• Cognition diary: link events to thoughts, feelings, behaviours
• Assertive script library: templates for “I statements”
• Safety plan sheet
• Imagery rescripting template
• Relational boundaries worksheet
• Self-compassion exercise (e.g. letter from compassionate self)
• Relapse prevention / booster plan

You may embed these into your modality (individual, group, school, workplace) as client- or context-appropriate.

Clinical challenges and ethical considerations

Bullying can be a complex issue to treat due to the multiple parties involved. Here are some of the challenges and considerations you will confront.

• Underreporting and secrecy: many victims minimise or hide due to shame or fear.
• Resistance from systems: schools and workplaces may resist acknowledging bullying.
• Dual roles and conflict: as clinician you may liaise with institutions; you still need to maintain therapeutic boundaries.
• Safety and escalation: assess for risk of harm or retaliation.
• Intersectional vulnerabilities: clients from marginalised groups may face compounded risk and stigma.
• Client readiness and pacing: some will not be ready for trauma exposure; prioritise stabilisation.
• Secondary trauma / vicarious exposure: clinicians must self-monitor for burnout.

Case Vignette (Child / Adolescent)

Case vignette
“Maria,” age 14, is referred for low mood and social withdrawal. In sessions she reveals that since Year 8 she has been the target of repeated exclusion, rumour-spreading, and online harassment by a peer clique. The relationship dynamics evolved gradually; school staff intervened but inconsistently. Maria blames herself and says, “I should just disappear.” She avoids school, relationships, and social media.

What is your most effective professional response? We summarise a treatment plan which encompasses the discussion in this article.

Therapeutic approach sketch

• Start with validation and psychoeducation: bullying is relational and systemic, not her fault.
• Build safety and coping skills (breathing, grounding).
• Use a cognition diary to catch self-blame thoughts (“I am worthless”) and reframe them.
• Role-play assertive but safe responses (e.g. “I won’t engage with rumours”).
• Liaise with school to reinforce anti-bullying measures and safe spaces; develop bystander protocols.
• Gradually expose Maria to social interactions in a supportive way.
• Monitor her for trauma symptoms; if present, use trauma-processing (narrative exposures).
• Empower Maria to build support (trusted peers, mentors) and strengthen resilience.

Conclusion and clinical next steps

Working with victims of bullying demands more than symptom-focused therapy. Clinicians must adopt a relational and ecological lens, validate the power dynamics, rebuild agency, and – where possible – influence the environments that sustain bullying. Through careful assessment, psychoeducation, trauma-sensitive cognitive/emotional work, assertiveness training, and system-level liaison, we can help victims move from a posture of helplessness to one of resilience, reparation, and growth.

Key takeaways

• Bullying is intentional, repeated aggression with power imbalance; it is not mere conflict.
• Multiple forms exist: physical, relational, cyber, sexual, workplace.
• Risk is multifactorial (individual, familial, peer, institutional).
• Many victims manifest trauma, internalisation, and long-term suffering.
• Treatment must be trauma-informed, agency-restoring, and systems-aware.
• Child/adolescent interventions emphasise safety, cognitive restructuring, social skills, and school liaison.
• Adult interventions often require deeper narrative work, schema repair, boundary-setting, and sometimes organisational advocacy.
• Clinicians should maintain ethical clarity, attend to system resistance, and prevent re-traumatisation.

Questions therapists often ask

Q: How should we define “bullying” when assessing clients — what distinguishes it from ordinary peer conflict?

A: Use a definition that emphasises three core criteria: (1) intentional harmful behaviour (not accidental or mutual conflict), (2) repeated over time (not a single incident), and (3) a power imbalance (physical, social, psychological or institutional).

Q: What sorts of risk and protective factors should we consider when working with someone who has been bullied?

A: Risk factors span individual (e.g. low self-esteem, social-skill deficits, internalising symptoms, perceived “otherness”), family (e.g. poor supervision, insecure attachment), peer/contextual (social exclusion, few friends), and institutional (weak anti-bullying policy, tolerant culture). Protective factors include strong peer or adult support, emotional regulation and assertiveness skills, inclusive institutional climate, and bystander intervention norms.

Q: What kinds of psychological or physical symptoms might suggest long-term consequences of bullying — even years later?

A: Survivors may show persistent anxiety, depression, low self-esteem, somatic symptoms (sleep problems, headaches), post-traumatic stress symptoms, relational distrust, social withdrawal, and difficulties in occupational or interpersonal functioning. Bullying in childhood or adolescence can predict adult psychopathology, revictimisation, chronic stress-related physiological effects, and identity or relational difficulties.

Q: What therapeutic approach and strategies tend to work best when supporting child or adolescent victims of bullying?

A: Combine a trauma-informed, ecological framework with: assessment of relational systems (family, peers, school); psychoeducation and normalisation; cognitive restructuring (challenging self-blame and catastrophic thinking); emotion regulation and coping skills; social skills/assertiveness training; safety planning; caregiver and school-system liaison; and, where appropriate, peer group or support-group work.

Q: How should treatment differ when working with adult clients whose mental health issues stem from past bullying?

A: For adults, begin with narrative mapping of their bullying history and timeline of symptoms; offer psychoeducation and reframing to dismantle internalised shame; use cognitive and schema-focused therapy (including schema therapy, imagery rescripting, self-compassion); trauma-focused work if needed (e.g. EMDR, trauma-informed CBT), plus assertiveness, boundary-setting, relational repair, organisational advocacy (if workplace bullying), identity and meaning reconstruction (survivor narrative), and long-term relapse prevention and monitoring.

References

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• Kallman, J. Han, J., & Vanderbilt, D.L. (2021). What is bullying? Clinics in Integrated Care, Vol. 5, April 2021, ISSN = {2666-8696}, doi = {https://doi.org/10.1016/j.intcar.2021.100046}. Retrieved on 13 October 2025 from: https://www.sciencedirect.com/science/article/abs/pii/S2666869621000129
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