Serving Transgender Victims of Sexual Assault

June 2014

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Tips for Those Who Serve Victims

Victim Issues

Perpetrator Issues

Standard Practices

Notes

Victim Issues

Relationships

Sexual assault affects every relationship in a victim's life—casual friendships, coworker relationships, interactions with family members, and dynamics with an intimate partner. According to one FORGE survey respondent:

The abuse that [occurred] now plays a part in physical aspects of my relationship with my current partner. There are many things that trigger panic attacks, and there is always caution to avoid these triggers.⁸

Being assaulted, particularly by someone you know or love (and who presumably loves you), has many unique short- and long-term ramifications. The ability to trust is often damaged and other relationships may suffer, as these FORGE survey respondents' answers suggest⁹:

My ability to trust people has been severely impacted by these traumas.

***

I broke up with an abusive partner; otherwise there has been tension in intimate relationships.

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I can't hold a relationship.

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[I] was too young [at the time of the assault to be partnered], but have serious problems with relationships/trust [now].

***

[T]he effects of sexual violence are woven into the fabric of my being, always have and still do affect every way I sit, walk, talk, stand, breathe, feel, think, all affects relationship[s].

If the abuse took place in childhood—particularly if it went on for many years or there were multiple abusers—the victim may not have mastered typical developmental tasks or have learned sufficient social skills. One respondent said that they would like to access services providing—

Social support and therapy to help me develop the missing social skills that are a consequence of my childhood abuse, and my years and years of cognitive dissociation.¹⁰

Although providers may inquire about partnership status, what they may actually need to know is very specific information about health insurance benefits, emotional support at home, economic stability or eligibility, or assessment of legal rights. For example, a common intake question is "are you married?" Given the variability of state and federal recognition of same-sex domestic partnerships, civil unions, and marriages, this question is not particularly useful.

Instead, consider asking one of the following questions, depending on the information you seek:

In this e-pub*—

Transgender 101: Relationships
Tips for Those Who Serve Victims: Sexuality, Companions as Abusers

*Clicking these links will take you to other sections in this e-pub. To return, hit your browser's "back" button.

Do you live alone? If not, how many people live in your home?
Are you sexually active?
Who provides emotional support?
Is there someone to care for you following medical treatment?
What is your sexual orientation? (This question may be relevant, for example, if you need to place a transgender victim in a support group for LGBTQ victims.)
Is there someone you want us to notify in an emergency?
Are you pursuing a relationship? (This could be an appropriate question for mental health care providers, because sexuality and relationships can be affected by assault.)
What pronoun should I use to refer to your partner?
If you were hospitalized, might anyone challenge your partner's right to visit?
For income eligibility purposes, do we count your partner's income?
Are your legal affairs in order (e.g., durable power of attorney, will)?
If you were widowed, would you be eligible for survivor's benefits?

Professionals who help victims of sexual assault should be aware of the information they are seeking, tell the victim why the question is being asked, and then ask the accurate question rather than relying on questions that may be both misleading and alienating.

Implications and Actions for ...

Health Care Providers

Because many transgender survivors of sexual assault have experienced previous traumas, they may already have trouble interacting with anyone new, including health care providers.¹ Patience and persistence are key to effectively serving sexual assault survivors of any gender identity or history.

Transgender patients who have been sexually assaulted often bring companions or family members to support and advocate for them when dealing with known and unknown professionals, especially if those professionals may expect them to disrobe. Some transgender people may not have family or partners to accompany them, but they may have developed strong social networks whose members have become family to them. Honoring these relationships as equally valid to legal family is another way to honor transgender peoples' lives and experiences. Treat transgender individuals' partners in the same manner as non-transgender patients' partners. Make sure, however, to screen companions first to ensure that they are not the perpetrators (see Companions as Abusers in this e-pub).

If the companion is not or may not be the perpetrator/abuser, encourage the patient to bring the companion, when medically feasible. If the companion is the abuser, speak with the patient privately to discuss the patient's immediate options and contact the local victim service provider or sexual assault victim advocate to help the patient with safety planning. (Safety planning is discussed in more detail in the Companions as Abusers: Implications and Actions for Advocates section.)

1. According to unpublished survey data, for example, 72 percent of adult sexual assault victims who are transgender and 64 percent of those who were sexually abused as children have experienced at least one other form of victimization in their lives. FORGE, 2011, Transgender Individuals’ Knowledge of and Willingness to Use Sexual Assault Programs, unpublished survey data, Morehouse School of Medicine’s Institutional Review Board.

Emergency Medical Personnel

Because many transgender survivors of sexual assault have experienced previous traumas, they may already have trouble interacting with anyone new, including emergency medical personnel.¹ Patience and persistence are key to effectively serving sexual assault survivors of any gender identity or history.

Transgender patients may prefer to have a partner, family member, or friend present during medical exams or assessments. This may not be feasible in emergency care settings in which you have to quickly stabilize patients who are acutely injured or may need ample space to appropriately assess and treat patients.

When possible, allow patients to identify support people (e.g., family members, loved ones) who might be at the scene. If it is common practice to allow family members and loved ones of non-transgender patients to ride along in the ambulance, allow loved ones of transgender patients to do so as well (but see Companions as Abusers, in this e-pub). Similarly, if it is common practice to hand paperwork or resource brochures or other information to a loved one, follow identical practices when serving a transgender patient who has a loved one present.

Some transgender people may not have family or partners, but they may have developed strong social networks whose members have become family to them. Honoring these relationships as equally valid to legal family is another way to honor transgender peoples' lives and experiences.

Law Enforcement

Because many transgender survivors of sexual assault have experienced previous traumas, they may already have trouble interacting with anyone new, including law enforcement officers.¹Patience and persistence are key to effectively serving sexual assault survivors of any gender identity or history.

Transgender survivors may prefer to have a partner, family member, or friend present during medical exams, discussions about the crime, or law enforcement interactions. Some transgender people may not have family or partners, but they may have developed strong social networks whose members have become family to them. Honoring these relationships as equally valid to legal family is another way to honor transgender peoples' lives and experiences.

It is critical to determine that the individual with the transgender person is not the perpetrator. Screening the victim and companion separately is essential to ensuring that appropriate boundaries are set and maintained. (See Companions as Abusers in this e-pub.)

Some jurisdictions do not allow friends or relatives to be present during questioning. In these cases, if the transgender person still would like accompaniment, arrange for questioning to occur after the transgender victim has been connected with an advocate, who can be present during questioning.

Advocates

Because many transgender survivors of sexual assault have experienced previous traumas, they may already have trouble interacting with anyone new, including advocates.¹ Patience and persistence are key to effectively serving sexual assault survivors of any gender identity or history.

Transgender survivors may prefer to have a partner, family member, or friend present during meetings with you or with other professionals. Some transgender people may not have family or partners to accompany them, but they may have developed strong social networks whose members have become family to them. Honoring these relationships as equally valid to legal family is another way to honor transgender peoples' lives and experiences. Treat transgender individuals' partners in the same manner as non-transgender patients' partners. Make sure, however, to screen companions first to ensure that they are not the perpetrators (see Companions as Abusers in this e-pub).

Therapists

Transgender people who are in an intimate relationship may be with a non-transgender or transgender partner. Given that one in two transgender people have been sexually assaulted at some point in their lives, 75 percent of relationships with two transgender partners will include at least one survivor; in 25 percent of these relationships, both will be survivors.¹ To best serve transgender survivors, you must be up to date on the literature about the impact of trauma histories on intimate relationships.

In general, therapy is frequently about relationships with parents, coworkers, children, spouses, friends, chosen family, neighbors, or strangers. Therapists are well-versed in helping people resolve conflicts within relationships, understand relationship dynamics, and strengthen relationships that may have been fractured or weakened. Many transgender people use therapy to process relationships that are already complicated by gender identity. Sexual assault may increase tension in these relationships, undermine effective communication, or have a negative impact on trust. Recognizing how previous relationship challenges are affected by sexual assault can help increase transgender clients’ sense of being understood and their ability to successfully engage in therapy.

1. FORGE, 2005, Sexual Violence in the Transgender Community Survey, unpublished data; G. Kenagy, 2005, “The Health and Social Service Needs of Transgender People in Philadelphia,” International Journal of Transgenderism 8(2/3):49–56; G. Kenagy and W. Bostwick, 2005, “Health and Social Service Needs of Transgender People in Chicago,” International Journal of Transgenderism 8(2/3):57–66.

Support Group Facilitators

Many books are available about working with couples in which one or both partners have a trauma history. Given that one in two transgender people have been sexually assaulted at some point in their lives, 75 percent of relationships with two transgender partners will include at least one survivor; in 25 percent of these relationships, both will be survivors.¹ To best serve transgender survivors, you must be up to date on the literature about the impact of trauma histories on intimate relationships, and you should invite clients to discuss trauma histories if they exist. In addition, encourage transgender survivors to engage their partners in therapy, support groups, or other forms of direct support.