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Victim Issues
Preferred Language
Victims are always experts in their own experience, identity, and language preferences. Listen carefully to the language that victims use to describe themselves and their bodies and reflect those words back to them.
Using a person's preferred name is validating and comforting, even more so when someone has recently experienced trauma and violence. Ask what the victim would like to be called, and if appropriate (or in doubt), which pronoun they prefer. Following their lead will encourage their continued interaction with you and ultimately will result in better professional care.
Transgender people are especially likely to pay increased attention to the language that you use as a way of assessing whether they are safe and will receive sensitive, culturally competent care. For example, if a transgender victim introduces himself as Gabriel, he will likely be paying attention to your comfort and willingness to call him Gabriel. Refer to transgender victims by their preferred names whenever possible. (In some cases, you may need to use a person's legal name. For example, the transgender person may not be out to loved ones who are present at the time.)
In addition to preferred names, pronouns are an especially important indicator of your cultural competence. It is critical to listen for, ask about, and accurately and consistently mirror a person's pronoun preference, even when the victim can't overhear you speaking with a colleague. If a victim's appearance and stated name are clearly feminine or clearly masculine, it is generally safe to use "she" or "he," respectively, when speaking about them. If name and gender presentation don't seem to match, the victim appears uncomfortable when a particular pronoun is used, or you are unsure which pronoun is preferred, ask. These questions acknowledge the victim's identity and establish your desire to serve the victim respectfully. Correctly identifying a person's gender and referring to that person with congruent pronouns increases rapport between victim and professional. That being said, don't let a mistake derail you; even long-time transgender activists occasionally mis-gender someone.
When at all possible, avoid gendered honorifics such as "Ms." or "Sir," unless a person has expressed a preference for them. Hearing the wrong gendered honorific can be especially distressing for transgender victims. In some cases, victims may discontinue care, unable or unwilling to hear incorrectly gendered references about them.
Transgender people use various terms differently and to mean different things. If a person uses a specific identity word, echo that language. For example, if a victim states, "I identify as a transgender woman," use the phrase "transgender woman" moving forward. If you are not sure what a particular term means, it is okay to ask.
All professionals should focus only on the information they need to provide quality and respectful services.
Implications and Actions for ...
Health Care Providers
Use patients' preferred names and pronouns consistently—directly with them and with others, whether or not they are within earshot. If you work in an office with other staff, make sure that they also mirror the patient's preferences. If you make a mistake and use the wrong pronoun or name, sincerely yet briefly apologize. A prolonged explanation may make the situation more awkward and uncomfortable.
Medical billing and charting issues may require that more than one name is on a patient's chart or records. Medical billing staff should work directly with patients to ensure their correct name and sex are assigned for insurance billing purposes. Even if billing records are in one name, make sure you still address patients by their preferred names and pronouns at all times. When providing information and making referrals to other providers, ask the patient which name and pronoun to use.
Allow patients to describe the assault using the words that are most comfortable to them. If you need more specific details, ask questions in ways that do not introduce gendered words or concepts. For example, ask if they were "penetrated" instead of "vaginally penetrated" or ask them to point to the anatomy on a body map.
If you have to directly refer to a person's anatomy, listen carefully for and echo the language that the person uses. Some transgender people use what some might consider slang or nontraditional language to describe specific parts of their bodies, particularly their genitals and chest/breast area. For example, a transgender person who identifies as male may have what most people consider to be breasts; if he refers to his "chest" during a medical exam, reflect his language rather than using medical or female-specific terms. Keep in mind that some transgender people have complicated relationships with their bodies, and that others have been subjected to providers who ask inappropriate questions or use offensive language. When unsure of patients' preferred language, use non-gendered terms (e.g., genitals) or ask for their preference: "Are there any terms that you prefer I use when referring to parts of your body?"
It might be challenging both to mirror the patient's preferred terminology and to use medically accurate language in charting and documentation. Focus on the interactions with the patient in the moment, take notes in a way that is congruent with the patient's preferences, and write official documentation at a later time. This helps ensure that the official records are correct, that the patient feels respected, and that you can focus on providing successful and comfortable medical care.
Emergency Medical Personnel
Use patients’ preferred names and pronouns consistently—directly with them and with others, whether or not they are within earshot. If you make a mistake and use the wrong pronoun or name, sincerely yet briefly apologize. A prolonged explanation may make the situation more awkward.
As emergency medical personnel, you will generally ask conscious patients to describe how they are injured. Allow patients to describe their injuries using the words that are most comfortable to them. If you need more specific details, ask questions in ways that do not introduce gendered words or concepts. Using generic wording (e.g., “Can you show me or tell me where it hurts?”) allows patients to choose how to convey what occurred in words that are in line with how they view their bodies.
Some transgender people use what some might consider slang or nontraditional language to describe specific parts of their bodies, particularly their genitals and chest/breast area. If a patient is describing where they are injured and you are unsure what they mean, ask more detailed questions. Once an individual has named a body part, ask if that is their preferred term and then use it.
Similarly, you may want to inform patients you are treating that you may use medical language but can use different words if they prefer. Telling people why something is being done (such as using clinical language) is a best practice that encourages cooperation. Being open to hearing and then using the patient’s terms is an even better practice.
Law Enforcement
Use victims' preferred names and pronouns consistently—directly with them and with others, whether or not they are within earshot. If you make a mistake and use the wrong pronoun or name, sincerely yet briefly apologize. A prolonged explanation may make the situation more awkward.
In some cases, using a victim's preferred language can be problematic. For example, a victim's family may be uncomfortable with the person's identity. If the family uses the victim's old name and pronoun, you may find yourself in a conversation with victim and family in which you're both referring to the same person by different names and pronouns. If the victim's family objects to this, you may want to switch to the old name and pronoun when you're talking with them; however, it's not your role to intervene in this kind of family matter. Another example would be if the victim disclosed to you but does not want to disclose to others; in this case, only use the victim's preferred language when you are alone with the victim.
Allow victims to describe the assault using the words that are most comfortable to them. If you need more specific details, ask questions in ways that do not introduce gendered words or concepts. For example, ask if they were "penetrated" instead of "vaginally penetrated" or ask them to point to the anatomy on a body map.
Some transgender people use what some might consider slang or nontraditional language to describe specific parts of their bodies, particularly their genitals and chest/breast area. If a victim is describing what happened during the crime or where they were injured and you are unsure what they mean, ask more detailed questions. Once an individual has named a body part, ask if that is their preferred term and then use it.
Advocates
Use victims' preferred names and pronouns consistently—directly with them and with others, whether or not they are within earshot. If you make a mistake and use the wrong pronoun or name, sincerely yet briefly apologize. A prolonged explanation may make the situation more awkward and uncomfortable.
In some cases, using a victim's preferred language can be problematic. For example, a victim's family may be uncomfortable with the person's identity. If the family uses the victim's old name and pronoun, you may find yourself in a conversation with victim and family in which you're both referring to the same person by different names and pronouns. If the victim's family objects to this, you may want to switch to the old name and pronoun when you're talking with them; however, it's not your role to intervene in this kind of family matter. Another example would be if the victim disclosed to you but does not want to disclose to others; in this case, only use the victim's preferred language when you are alone with the victim.
Allow victims to describe the assault using the words that are most comfortable to them. If you need more specific details, ask questions in ways that do not introduce gendered words or concepts. For example, ask if they were "penetrated" instead of "vaginally penetrated" or ask them to point to the anatomy on a body map.
If accompanying a victim to services provided by another professional (e.g., health care provider), you may need to advocate for the use of the victim's preferred language. If necessary, explain how the professional can document the visit in a way that reflects the victim's preferred language, along with supporting narrative that describes and clarifies for other readers. For example, if a transgender victim refers to his torso as his "chest," support the victim by verbally using and repeating his language and support providers by encouraging them to document injuries using the victim's language and also using medical language, so that both are recorded and described.
Therapists
Use clients’ preferred names and pronouns consistently—directly with them and with others, whether or not they are within earshot. If you work in an office with other staff, make sure that they also mirror the clients’ preferences. If you make a mistake and use the wrong pronoun or name, sincerely yet briefly apologize. A prolonged explanation may make the situation more awkward and uncomfortable.
Medical billing and charting issues may require that more than one name is on a client’s chart or records. Medical billing staff should work directly with clients to ensure their correct name and sex are assigned for insurance billing purposes. Even if billing records are in one name, make sure you still address clients by their preferred names and pronouns at all times.
Allow clients to describe the assault using the words that are most comfortable to them. If you need more specific details, ask questions in ways that do not introduce gendered words or concepts. For example, ask if they were “penetrated” instead of “vaginally penetrated” or ask them to point to the anatomy on a body map.
It is also critical to determine and reflect the terms that clients use to refer to their bodies and identities. One respondent to FORGE’s 2005 survey said about his therapist, “Had he and I needed to explore it, some discussion or emphasis on how vaginal penetration uniquely emasculates a male-identified biogirl would’ve possibly been useful.”1 When serving this client, the therapist would need to inquire as to whether “vaginal penetration,” “male-identified,” and “biogirl” are that client’s preferred terms and then to respect and consistently use those terms.
Language goes far beyond body and identity. If the sexual assault occurred when the transgender person was reflecting another (outward) gender, the client may want to talk about the assault while using a different name and/or pronoun. In contrast, some clients rewrite their life's history to align with their current gender identity. Being understanding about the “conflicting” language a transgender client uses, and reflecting the client’s own language as often as possible, validates the client’s experience and shows that you understand the complexity of how gender and trauma may interrelate.
1. FORGE, 2005, "Implications," quotation from narrative response to the Sexual Violence in the Transgender Community Survey, accessed Feb. 13, 2013.
Support Group Facilitators
Use clients' preferred names and pronouns consistently—directly with them and with others, whether or not they are within earshot. Front desk staff, billing specialists, and everyone in your office who has contact with transgender clients should be trained on how to appropriately interact with them. A client who is repeatedly greeted by front desk staff with the wrong name or pronoun will feel immediately uncomfortable, which detracts from the healing environment. Many clients will not return for services at all if they are addressed incorrectly. If you or someone in your office makes a mistake and uses the wrong pronoun or name, sincerely yet briefly apologize. A prolonged explanation may make the situation more awkward and uncomfortable.
Medical billing and charting issues may require that more than one name is on a client's chart or records. Billing staff should work directly with clients to ensure their correct name and sex are assigned for insurance billing purposes. Even if billing records are in one name, make sure you still address clients by their preferred names and pronouns at all times.
In the support group setting, model the use of transgender clients' preferred names and pronouns in front of other group members. If you encounter resistance within the group, discuss why it is important to create a nonbiased, respectful environment, which includes addressing individuals as they would prefer to be addressed. Post ground rules that contain group agreements and refer to and remind participants of ground rules if they are violated.
It is also critical to determine and reflect the terms that clients use to refer to their bodies and identities. One respondent to FORGE's 2005 survey said about his therapist, "Had he and I needed to explore it, some discussion or emphasis on how vaginal penetration uniquely emasculates a male-identified biogirl would've possibly been useful."1
Language goes far beyond body and identity. If the sexual assault occurred when the transgender person was reflecting another (outward) gender, the client may want to talk about the assault while using a different name and pronoun. In contrast, some clients rewrite their life's history to align with their current gender identity. Being understanding about the "conflicting" language a transgender client uses, and reflecting the client's own language as often as possible, validates the client's experience and shows that you understand the complexity of how gender and trauma may interrelate.
1. FORGE, 2005, "Implications," quotation from narrative response to the Sexual Violence in the Transgender Community Survey, accessed Feb. 13, 2013.
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