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Serving Transgender Victims of Sexual Assault
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Transgender 101Sexual Assault in the Transgender CommunityTips For Those Who Serve Victims
June 2014
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Victim Issues

Internalized Transphobia and Shame

The cumulative effects of enduring ongoing prejudice may have an impact on transgender victims of sexual assault. It is not uncommon for transgender people to experience parental disapproval, bullying at school, harassment socially or at work, and intimate partners who engage in power-and-control tactics. Some transgender people have been conditioned to believe that abusive behavior is normal; therefore, they may not recognize that an interaction was abusive or sexually violent.

Many transgender people, particularly those who declared or displayed their gender non-conformity when young, have been subjected to years of messages that something is wrong with them, that they are unlovable, and that their gender identity will bring them lifelong pain and hatred. Not surprisingly, some of these individuals grow up believing that any relationship is better than no relationship at all, and therefore they stay in unhealthy relationships.

Both intimate partner violence and hate violence by strangers may include anti-transgender slurs, insults about the person's body, or commentary on the person's appearance. Some victims may well believe that they deserve and are at fault for violence or sexual assault. In FORGE's 2005 research, many respondents reported not recognizing assault as abuse when it was happening, feeling overwhelmed with shame related to being transgender and assaulted, or thinking they were responsible for the abuse because they were transgender. According to many respondents, shame played a large and varied role in the aftermath of sexual assault1:

By me putting up with [the sexual violence], I thought it would help me to be "normal," not transgendered or lesbian.

***

Fear, not thinking anyone would understand (especially around trans issues), shame about having put up with [the abuse] for so long [reasons for not reporting sexual violence].

***

I was ashamed of myself, my identity, my desires, my inner person. They crucify people like me. It would have been nice to know that I wasn't a freak and that there were others like me. But when they asked me what was my problem in school they always assumed I was just a bad kid. Little did they realize I couldn't stand myself. And hated what I was. I felt I needed to be bad to be respected and left alone.

***

At age 12 my neighbor cornered me in the chicken coop behind my parents' house. He knocked out my tooth with a baseball bat. But [he] was too intoxicated to maintain an erection, so he used a screwdriver instead. Until he passed out. My mother felt that the incident was my fault and a normal response to my cross-dressing, and drove me to town to purchase feminine napkins for the anal bleeding. Mother didn't want the town to know I'd been raped for cross-dressing.

One author described the difference between shame and guilt this way: "[S]hame is a feeling of pervasive defectiveness, whereas guilt feelings stem from specific actions that are hurtful to others."2 Four strategies people use to escape shame are—

  1. withdrawal (isolation),
  2. avoidance (drug/alcohol use or creating a false, arrogant self-image),
  3. self-attack, and
  4. attacking others.3

This author also discusses the shame-rage spiral: "Exploding in rage leads to a feeling of being out of control, which itself is humiliating, fueling further shame and rage, a volatile mix that often ignites physical abuse and battering."4

Implications and Actions for ...

Health Care Providers

Transgender individuals may believe that they are not entitled to respectful medical care or that only some parts of their body deserve to be treated. Because of past discrimination in health care settings, they may feel that discussing their body is risky and makes them vulnerable. Embarrassment, shame, and apprehension may prevent transgender victims of sexual assault from revealing the extent of their injuries or lead them to refuse treatment. This may include being unwilling to have forensic evidence collected directly after an assault.

Internalized transphobia may also deter victims from seeking care because they fear disrobing for physical examinations. Remind these patients that they can undress to the level of their comfort and that they can wear gowns or be draped to feel less exposed and vulnerable, which will encourage them to return for additional care if needed. Also consider asking patients if they would like a nurse, certified nursing assistant, friend, partner, or another ally present during the exam (but see Companions as Abusers in this e-pub).

Treat transgender patients with the utmost respect and dignity, without commenting on or visibly reacting to the person's gender identity or body. As you would with any sexual assault victim, be gentle, respectful, patient, and dignified. No disgust or judgment should be shown, as patients are likely to internalize those responses as being about their gender identity, appearance, or behavior. Responsibility for the assault should be fully assigned to perpetrators, even if victims' behavior may have placed them in dangerous or risky situations.

If you treat transgender patients as part of their routine health care, be aware that transgender victims of sexual assault may forgo routine care or care of specific medical conditions after being assaulted. For example, it is common for people on the female-to-male spectrum to delay or avoid routine gynecologic care. If they have been sexually assaulted, they may avoid this form of medical care even more due to shame stemming from the assault. You may want to schedule longer appointment times for these patients to allow ample room for discussion, and proceed through the exam more slowly. Make sure not to "scold" patients or make them feel guilty if they are unwilling or unable to receive medically suggested treatment, testing, or care.

Patience and relationship building will increase trust and may gradually lead to patients who are more willing and able to receive more comprehensive care.

Emergency Medical Personnel

Treat transgender patients with the utmost respect and dignity, without commenting on or visibly reacting to the person’s identity or body. Because certain aspects of a sexual assault may feel more shaming than others, patients may well try to avoid discussing these components and may also resist care. As you would with any sexual assault victim, be gentle, respectful, patient, and dignified. No disgust or judgment should be shown, as patients are likely to internalize those responses as being about their gender identity, appearance, or behavior.

Internalized transphobia may result in transgender individuals resisting medical care, even if injuries are significant. They may also minimize the injuries they sustained. If this is the case, consider stressing that everyone deserves quality health care and the opportunity to pursue criminal justice options. Victims of sexual assault may be unaware of their options; you can help them understand the importance of receiving timely medical care.

Transgender individuals may believe that the sexual assault was their fault and may be hesitant or elusive or make statements that do not align with professional observations or experience. This reticence to share or the focus on other aspects of the assault are not necessarily signs of deception. For example, it may be clear that a victim has sustained an injury caused by another person, yet the transgender victim focuses on how they were at fault for wearing makeup or for walking down a specific street instead of describing the perpetrator or what happened. Although this line of thought is common in a wide range of sexual assault survivors, it may be more prevalent for transgender survivors.

Law Enforcement

Treat transgender victims with the utmost respect and dignity, without commenting on or visibly reacting to the person's identity or body. Because certain aspects of a sexual assault may feel more shaming than others, victims may well try to avoid discussing these components and may also be reluctant to file a police report or pursue evidence collection. As you would with any sexual assault victim, be gentle, respectful, patient, and dignified. No disgust or judgment should be shown, as victims are likely to internalize those responses as being about their gender identity, appearance, or behavior.

Internalized transphobia may result in transgender individuals resisting medical treatment, even if injuries are significant. They may also minimize the crime that occurred and be less willing to make a formal report to law enforcement. If a victim resists or hesitates to access medical care or a forensic examination, consider stressing that everyone deserves quality health care and the opportunity to pursue criminal justice options. Victims of sexual assault may be unaware of their options, so it is important for law enforcement officers to fully explain possible courses of action, including forensic examination, detailed reporting, access to sexual assault advocates, and other resources within the community. One of your overarching goals is to help victims regain control over what happens to them; respect and affirm their decisions of whether or not to seek care. You may encourage victims to pursue evidence collection and reporting, as long as you do so in a respectful way that does not pressure the victim.

Transgender individuals may believe that the sexual assault was their fault and may be hesitant or elusive or make statements that do not align with professional observations or experience. This reticence to share or the focus on other aspects of the assault are not necessarily signs of deception. For example, it may be clear that a victim has sustained an injury caused by another person, yet the transgender victim focuses on how they were at fault for wearing makeup or for walking down a specific street instead of describing the perpetrator or what happened. This line of thought is common in a wide range of survivors of sexual assault, but it may be more prevalent for transgender survivors.

Responsibility for the assault should be fully assigned to the perpetrator, regardless of the situation, location, or circumstances. Sexual assault is never the victim's fault; it was the perpetrator's choice to assault the victim. In the words of one transgender victim of sexual assault, initial responders could have helped the victim "to have realized that I was not to blame, and that I didn't 'ask for it' by being trans."1

By modeling respect and compassion, you can help victims understand that they are not at fault and that they deserve respectful treatment.

1. FORGE, 2005. Sexual Violence in the Transgender Community survey, quotation from narrative response.

Advocates

Because certain aspects of a sexual assault may feel more shaming than others, victims may well try to avoid discussing these components and may also resist medical care. As you would with any sexual assault victim, be gentle, respectful, patient, and dignified.

If a victim resists medical care or hesitates to receive that care or a forensic examination, consider stressing that everyone deserves good health care, and offer to accompany the victim to the medical exam. Concurrently, one of your overarching goals is to help victims regain control over what happens to them, so it is also important to affirm their decisions of whether or not to seek care. (Do consider reminding them, however, that evidence collection is time-sensitive.)

Therapists

As a result of internalized transphobia and shame, some transgender individuals are reticent to share information about their bodies, identities, or experiences, including sexual assault. You may need to address these layers of transgender-specific shame and self-blame before you can help clients begin healing from the assault; the healing process may be more prolonged as a result. Acknowledging clients’ small steps toward self-understanding and self-acceptance is key. Overall—

  • Be patient. Do not “scold” transgender clients or make them feel guilty about the pace or progress of their therapeutic process.
  • Reassure them that they are normal.
  • Help them realize that what happened to them is not their fault.
  • Remind them that other survivors feel the same types of emotions and have the same types of responses.

Shame is common in most sexual assault clients, regardless of their gender history. With transgender individuals, it may be difficult to determine the exact root of their shame. Understanding the complex relationship between shame and transgender identity is essential, but it is more important to listen carefully and empathically, reflect language and concepts, and assist transgender clients in lessening their feelings of shame and guilt. According to one FORGE survey respondent who was sexually abused by their therapist:

Shame has kept me silent all these years. This survey is one of the few times that I have discussed these events. No one wants to hear about this, because therapists are supposed to be God and cannot do any wrong.1

If clients begin to blame themselves, remind them that they did not cause the assault. This may be especially difficult for transgender clients to believe. Many perpetrators frequently claim the client’s gender identity, expression, or non-congruence “caused” the assault. This can enhance clients’ preexisting anxieties and contribute to a heightened belief that the assault was their fault.

If possible, encourage clients to join transgender support groups or participate in organized transgender events, which can help them create a more positive self-image. That said, it is important to keep in mind that the transgender community is small and tightly knit, which may make them feel too exposed (everyone knows everyone) or may put clients in contact with their perpetrators within the transgender community. Assess clients’ comfort with their peers before steering them toward these options.

For more information on shame and its treatment, read Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life, by Marylene Cloitre, Lisa R. Cohen, and Karestan C. Koenen. One of their main recommendations is that therapists wait until late in treatment to tackle shame, after much relationship building and previous therapeutic work has already taken place.

1. FORGE, 2005, “Transgender Sexual Violence Project: Summary of Wisconsin Data," accessed Feb. 13, 2003.

Support Group Facilitators

Some transgender survivors may need individual therapy to work on internalized transphobia or shame before they are ready to enter a support group.

Because shame tends to be a common emotion for many survivors, it will likely emerge within support group settings. With transgender clients, it may be difficult to determine the exact root of their shame. Understanding the complex relationship between shame and transgender identity is essential, but it is more important to listen carefully and empathically, reflect language and concepts, and assist transgender individuals in lessening their feelings of shame and guilt. According to one FORGE survey respondent who was sexually abused by their therapist:

Shame has kept me silent all these years. This survey is one of the few times that I have discussed these events. No one wants to hear about this, because therapists are supposed to be God and cannot do any wrong.1

If clients begin to blame themselves, remind them that they did not cause abuse. This may be especially difficult for transgender clients to believe because so many assaults of transgender survivors are reported as being related to transgender identity or expression. Many perpetrators target transgender people because of their transgender status, which can create a heightened belief that survivors are at fault.

Make sure not to "scold" clients or make them feel guilty if shame is overriding their ability to address other therapeutic issues. These clients may need additional time and tools to help them feel less shame, or they may need to work individually with a therapist to become ready to participate in a support group.

For more information on shame and its treatment, read Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life, by Marylene Cloitre, Lisa R. Cohen, and Karestan C. Koenen. One of their main recommendations is waiting until late in treatment to tackle shame, after much relationship building and previous therapeutic work has already taken place.

1. FORGE, 2005, “Transgender Sexual Violence Project: Summary of Wisconsin Data," accessed Feb. 13, 2003.