Critical and Radical Social Work Supporting trans* survivors of sexual violence: learning from users' experiences --Manuscript Draft-Manuscript Number:
CRSW-D-14-00049R1
Article Type:
Voices from the front line article
Full Title:
Supporting trans* survivors of sexual violence: learning from users' experiences
First Author:
Sally Rymer
Corresponding Author:
Valentina Cartei, Ph.D. Survivors'Network Brighton, East Sussex UNITED KINGDOM
Corresponding Author Secondary Information: Corresponding Author E-Mail:
[email protected]
Other Authors:
Sally Rymer
Order of Authors Secondary Information: Keywords:
sexual violence; transgender; rape; access; gender identity
Additional Information: Question
Response
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ABSTRACT
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Transgender individuals are particularly vulnerable to sexual violence, yet many do not seek, nor
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receive, adequate support following unwanted sexual experiences. Our study explores the needs
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and experiences of transgender survivors when accessing sexual violence support services. The
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study examines the barriers that trans* survivors may face in accessing services and ways that
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organisations can reduce these barriers. Our findings provide valuable insights for sexual
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violence agencies and other providers about how to engage meaningfully with transgender
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survivors.
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INTRODUCTION
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Over the past 20 years, research on sexual violence has shown the severity, extent and wide-
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spread prevalence of this crime (Basile, et al., 2007). Whilst there are many kinds of sexual
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violence (including, but not limited to, sexual harassment, unwanted sexual touching, rape and
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sexual assault), they all share at their basis the abuse of power, control and trust by those who
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perpetrate these acts (Jewkes et al., 2002). As a consequence, although everyone can experience
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sexual violence, members of marginalised groups are often the most targeted because negative
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attitudes, isolation and social exclusion make them more vulnerable to perpetrators (Stozer,
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2009).
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This paper will explore the experiences of a particular marginalised group: transgender
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individuals. Transgender (hereafter trans*) people are those who feel that the gender assigned to
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them at birth does not correspond with their gender identity or expression (whereas ‘cisgender
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individuals’ refers to people who experience a match between the gender they were assigned at
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birth, their bodies and their personal identity (Human Rights Campaign, 2015)). Trans *
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individuals may identify between, beyond or outside of this binary way (male/female) in which
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society describes gender. Some may also make changes to their outward identity expression (e.g.
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changing name/pronouns) or pursue medical interventions (Human Rights Campaign, 2015).
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Trans* individuals are often marginalised and face significant levels of abuse, harassment and
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violence, including sexual violence (Hill & Willoughby, 2005). More specifically, US research
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has shown that approximately 50% of trans* people experience sexual violence at some point in
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their lifetime (Stotzer, 2009), compared to 20% of cisgender individuals (Black et al., 2011).
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Moreover, the “Trans Mental Health Survey” (McNeil et al., 2012), the largest UK questionnaire
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of the trans* population to date, shows that between 40-60% of trans* people know someone in
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their trans* community who has experienced sexual violence.
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While trans* people appear to be at particularly high risk of sexual violence, they may also find
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it more difficult to access services that would be able and willing to support them in their
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recovery. Recent research in a variety of social care settings, including mental health (McNeil et
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al., 2012), crime protection (Moran, & Sharpe, 2004) and domestic violence (Bornstein et al.,
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2006; Miles-Johnson, 2013; Roch et al., 2010), has highlighted that trans* people face significant
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barriers in accessing support and are discriminated against in relation to the quality of care
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received. However, there is little literature (Balzer & Hutta, 2012; Stotzer, 2009; Rothman et al.,
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2011) which specifically addresses equitable access to support services for trans* survivors of
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sexual violence.
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The present study begins to address this gap in the literature by exploring the experiences of
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support received by trans* survivors of sexual violence in the South-East of England. The
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study’s aims were two-fold: to reveal barriers that trans* survivors may face in accessing
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services as well as to identify interventions for overcoming these barriers. Survivors were asked
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about their experiences accessing specialist support. Reflecting the UK landscape of service
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provision, options included reporting to the police, accessing Sexual Assault Referral Centre
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where forensic exams are undertaken, seeking out healthcare related to their experience of sexual
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assault (ex STI or pregnancy testing, emergency contraception) and accessing support provided
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by charitable or private organisations such as telephone helplines, drop-ins and advocacy or
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counselling services.
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METHODS
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Procedures
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The present research was funded by Survivors’ Network, the Rape Crisis Centre for Sussex.
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Forty-two trans*survivors, aged 18-65, answered closed and open-ended questions about barriers
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to accessing services and suggestions to improve service accessibility through a web-based
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questionnaire (June to September 2013). Participants were recruited through a link posted on
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Survivors’ Network website, Facebook and Twitter pages. The link was also distributed via
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email to Sussex-based LGBT, domestic and sexual violence services. Flyers were distributed in
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LGBT pubs and clubs across Brighton & Hove, at Sussex and Brighton Universities and at
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Brighton-based Trans* Pride 2013. Word of mouth was also an important way of publicising the
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questionnaire.
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Additionally, six participants were interviewed in semi-structured interviews to gain a more in-
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depth understanding of their experiences (Morgan & Krueger, 1998). Three of the six
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interviewees were trans* survivors of sexual violence and three were professionals who work
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with trans* survivors. All participants gave their informed consent. The study received ethics
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approval by the Social Care Research Ethics Committee (code: 13/IEC08/0023).
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Data Analysis
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All quantitative data (e.g. percentages) reported in the study were calculated from individual
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questionnaire responses using Google Analytics (for some questions, respondents were allowed
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to choose multiple answers, and thus the total percentages add up to greater than 100%). In
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addition, the two authors independently analysed open questions from the questionnaire and
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interview transcripts via thematic analysis and crosschecked their individual results to avoid lone
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researcher bias (Burnard et al., 2008). Consistent with this approach, coding categories were not
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prescribed, but emerged from coding the data iteratively (Starks & Trinidad, 2007).
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FINDINGS
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Levels of Access
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Seventy-eight per cent of the respondents disclosed that they did not access support, including
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statutory (e.g. police, healthcare) or specialist (e. g. Rape Crisis Centre) services for survivors of
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sexual violence. Of those, 40% did not access services for fear of being discriminated against
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because of their gender identity, while a further 20% reported being unaware of services
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available to them. Almost a third of participants also reported that feeling ashamed (21%) or not
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ready (19%) prevented them from seeking help.
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Of those participants who accessed services (22%), the majority accessed a counsellor (60%) or
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health professional (57%), while 34% accessed a helpline. Twenty-eight per cent also reported to
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the police. Almost all (92%) participants who accessed services following an experience of
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sexual violence reported that their gender identity influenced their experience of support.
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Barriers to accessing services
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Data were also analysed for information about what specifically stopped trans* individuals from
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accessing services. We found that overall, trans* individuals did not access services due to fear
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of, or direct experience of: trans*phobia, outing, ignorance about trans* experiences, and a
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general mistrust of services.
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Trans*phobia
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Both respondents who ultimately accessed services and those who did not were asked about
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potential barriers when considering accessing services. Almost all respondents reported being
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afraid of discrimination from workers (98%) or other service users (87%). Many were concerned
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they would be refused access to the service or be mis-gendered while using the service.
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As one respondent put it:
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“I was concerned they would hear my voice on the phone and think I am a man pretending to be
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a woman. Worried I'd be turned away without any help.”
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Fifty-eight per cent of the respondents expressed concerns about the language used by workers or
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other service users, such as using the wrong pronouns to describe a trans* person:
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“I didn't have the resources to explain my gender on top of talking about my experiences
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of rape […] (the) rape counsellor […] kept referring to me as a woman and I'm not.”
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Over half (58%) of respondents were also worried about being expected to use language they
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were not comfortable with to describe their assault or having others use language to describe
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their anatomy or gender identity which felt incorrect or offensive to the trans* person. One
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participant who was assaulted before they transitioned commented:
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“It is really daunting to talk about sexual abuse that happened when you were presenting as your
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birth gender after you have transitioned. I was not ready to talk about it for a long time after it
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had happened. However, when I was ready to disclose, I was presenting as a man and then I
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encountered two problems; one) I didn't want to remember when I was a girl and two) men are
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perceived as not having experienced sexual abuse so I wasn't sure how I would be received.”
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Another participant reported that having such conversations would increase feelings of
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dysphoria:
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“As a trans man, I would have to use terminology for my genitals that is incredibly painful and
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dysphoria-inducing in order to explain what he did to me.”
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Outing
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Seventy-eight per cent of respondents expressed a concern about the wider repercussions
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(including personal safety, loss of job and personal relationships), of coming out as trans* while
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using support services if their gender identity was disclosed outside the service. As one
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participant commented:
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“I was fearful that exposure in the national press would have resulted in my losing my job and
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everything that I had worked to achieve.”
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Lack of understanding of the complexities around sexual violence and gender identity
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Ten out of the 12 respondents who gave additional comments and all interviewees also voiced
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fears about a lack of understanding of how trans* identity and sexual violence can interrelate.
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“People would tell me that I shouldn't have been "out" about being trans or that I shouldn't have
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transitioned because this would happen to me.”
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Moreover, while the reality of how trans* people experience their bodies and their sexual assault
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is varied and highly individual, many felt that services did not provide a safe space in which they
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could explore this complex relationship. An interview participant noted that a major problem he
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faced was:
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“Staff making expectations or policing how people relate to their body emotionally or
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physically.”
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Mistrust towards services
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Finally, participants revealed mistrust towards services due to negative past experiences of
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accessing services. Participants reported that they had been failed by services many times over
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and had experienced a great deal of discrimination. As a professional commented:
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“People are not coming forward because they have a very strong learnt experience of being
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excluded…You have to take a long-term, slow trust building approach. It has to become an
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integral part of what you do, not a 6-months project. A lot of trans people have a really good
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bullshit raydar. They know when an organisation is being tokanistic, and when genuine.”
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In order to overcome this learned mistrust, organisations must invest in long-term capacity
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building and training in order to become trans* inclusive organisations. As the above quote
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evidences, piecemeal changes will not create genuinely safe, trans*-inclusive organisations.
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Recommendations for specific changes that will increase the inclusivity of an organisation will
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be discussed in the following section.
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What would a good service look like?
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After discussing their own difficulties in accessing services, participants were asked questions
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about what would make a sexual violence recovery service welcoming and accessible to trans*
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survivors.
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Gender as a continuum
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The vast majority (83%) of respondents reported that they would feel uncomfortable accessing a
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service that advertises itself simply as ‘for men’ or ‘for women’. The language used to describe
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services can play an important role in signalling to trans* people that a service is trans*-
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inclusive:
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“I get read as a cis woman while identifying as a non-binary femme, and the services I used were
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"for women" which made me feel alienated and erased.”
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Challenging Transphobia
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Another marker of an inclusive service is that the organisation actively challenges transphobia as
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it would any other form of discrimination. It was important to participants that organisations
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offered their staff the necessary training to equip them to address transphobia whenever it occurs:
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“If I go to the toilets and get challenged and report it, that the organisation doesn’t say to me you
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better use the accessible toilets.”
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A professional said that inclusive organisations must:
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“Ensure all employees from a front desk to senior levels are educated in human rights and that an
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''equal opportunities '' policy does not simply '' exist '' to gloss the image of that organisation but
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is a constant reminder that should you meet people with a protected characteristic they must be
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treated with respect and dignity.”
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Understanding specific issues in relation to trans* identity and sexual violence
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Training should also equip staff with a detailed understanding of the struggles commonly faced
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by trans* and non-binary survivors. As one participant put it:
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“There needs to be full understanding of the unique issues that trans* and non-binary people
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face, and compassion for the gender dysphoria that often comes when trans and NB (non-binary)
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people discuss their bodies.”
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Such training should equip staff to discuss the service user’s assault using language that feels
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comfortable to the survivor. An interview participant described a positive experience with a
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support service by saying:
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“They were brilliant. They asked me what language I wanted to use to refer to my body, what
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language I was comfortable with, and then just stuck to using that language… They made sure
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my body was referred to in ways I felt comfortable with.”
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Service promotion
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Interviews with professionals who successfully engaged with users highlighted the importance of
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ensuring that services are known and trusted within the trans* community by including this as a
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long-term priority in the organisation’s publicity strategy. Successful examples included building
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relationships with existent service providers who are well-known and trusted in the
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community— for example by offering regular training swaps, and by providing outreach services
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in their premises. They also highlighted the importance of using trans* inclusive language (terms
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such as ‘self-identifying women’ or ‘all genders’ rather than male and female) in all publicity
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material and organising regular awareness events not only to promote one’s service, but also as a
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tool to gather the opinions of trans* people about proposed new services for them.
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Type of organisation and services
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The majority (70%) of respondents said they would feel comfortable accessing a service that
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worked with the LGBT community, even if the organisation itself did not only serve LGBT
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individuals. This was echoed by the reported level of success experienced by all three
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professionals, despite the fact that two of them were working for organisations that were not
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LGBT-specific. Over half (56%) of survivors said that it was also important or very important
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that the staff/volunteers at the service also be trans* or non-binary, while 64% said that it would
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be important or very important that they not be the only trans* or non-binary person using the
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service. Almost all respondents reported that they would find face-to-face support would be
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useful and 94% also reported on the importance of having access to a helpline.
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DISCUSSION
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The present study explored the accessibility of services offering support to survivors of sexual
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violence as it is experienced by individuals who identify as trans* as well as their
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recommendations to increase access. Survivors’ views were complemented with those of
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professionals who support them.
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Our research showed that feeling ashamed or guilty to talk about their experience often prevents
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trans* survivors from seeking professional help. These barriers are shared by cisgender
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individuals (Mahoney, 1999) and are in line with societal beliefs that survivors of sexual
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violence have somehow invited the violence they have suffered (McKimmie et al., 2014;
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O’Hara, 2012). In case of trans*survivors, myths about sexual assault may be further
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complicated by transphobia (Ullman, 2006). For example, participants in this study expressed
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concerns their experience of sexual violence could be viewed as a result of their gender identity
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and therefore their experience would both be discounted and blamed on them rather than on the
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perpetrator. Support services therefore not only need to ensure survivors are listened and
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believed (Ullman, 2006), but they must also be aware of such myths and be careful not to collude
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with them.
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The present study also highlighted that further specific barriers for trans* individuals are often
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grounded in the fears of experiencing direct discrimination from service providers and other
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users accessing services because of their gender identity. These fears were at least partly
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informed by survivors’ past experiences of inequality and discrimination in accessing services
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generally. Indeed, one Brighton & Hove questionnaire found that 47% of trans* individuals felt
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discriminated against on account of their gender identity by public and private sector
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organisations in relation to health, housing, recreation and employment (Browne and Lim, 2008).
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These experiences also reflect national statistics on the alarming levels of transphobia amongst
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service providers (Whittle et al., 2007) and society in general, including hate speech, harassment
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and bullying (Turner et al., 2009). Discrimination faced in accessing services can have severe
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consequences on the survivor’s journey to recovery from sexual violence, including re-
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traumatisation, and may lead the individual to stop seeking support (Ard & Makadon, 2011).
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Indeed, national and international research in a variety of fields, including domestic violence
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(Ard & Makadon, 2011) and mental health (Grant et al., 2010) demonstrated that perceived past
279
discrimination deters LGBT individuals from seeking further help and negatively impacts
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individuals’ health and well-being.
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In order to address these fears, our findings suggest that services should be explicit about what
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has been put in place to protect trans* service users, for example by developing (and making
283
public) clear guidelines about how staff and volunteers will handle any instances of
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discrimination against trans* service users. Clear confidentiality policies are also necessary for
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service users who are concerned about being outed while using the service. Furthermore, such
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policies should be consistently adhered to throughout the organisation and training provided to
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all staff and volunteers so that they feel equipped in putting them into practice. These steps echo
288
recommendations on trans*inclusion that have been recently developed by GALOP, a London-
289
based, LGBT, anti-violence and abuse charity (Gooch, 2011).
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Even when services did not directly discriminate against trans* individuals, survivors feared that
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providers may having little understanding of transgender issues, particularly in relation to sexual
292
violence— for example by framing sexual violence as the cause of their gender identity, or by
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forcing them to talk about their bodies using terms that are incorrect or uncomfortable. Indeed,
294
research suggests widespread ignorance about gender expression and identity of trans* people.
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Two studies of transgender healthcare in Scotland found that many health professionals confused
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transgender issues with issues of sexual orientation (Scottish Needs Assessment Programme,
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2001; Inclusion Project, 2003). Our research indicates that trans* awareness training for staff is
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required so that front-line workers can provide services which are safe and supportive
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environments in which trans* individuals can have difficult and nuanced discussion about their
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experiences of sexual violence.
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The present study also revealed that one fifth of respondents were not aware of what services
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were available to them. While more research is needed to determine the true extent of service
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provision for trans*survivors of sexual violence at both local and national levels, this may also
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indicate that existing trans*inclusive services are not reaching those they aim to serve. Indeed
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service providers themselves often acknowledge a lack of outreach to LGBT victims (Ciarlante
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& Fountain, 2010). Because the trans* community appears to be relatively small and
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geographically widely spread (though a comprehensive picture is lacking - Reed et al., 2009),
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potential clients might know service providers only through shared networks. Our findings
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indicate that to successfully raise their profile (and gain trust) within such networks, providers
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need to build up relationships with organisations and individuals who already successfully
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engage with the trans* community, and take a wider interest in challenging LGBT discrimination
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both within and outside of their own organisation. Our findings also suggest that promotional
313
material and support resources should be revised to show that the organisation has an
314
understanding of the complexity of gender identity and has thought about how to make their
315
services more inclusive of trans* people, for example by reflecting the burden of violence in the
316
LGBT community in their content (e.g. through stats) and by using trans*inclusive wording (for
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example by advertising services as open to all ‘self-identifying women’ rather than as ‘open to
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females’, Gooch, 2011).
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While it is important that existing services become more inclusive of trans* people, the research
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also demonstrated a clear need for specialist services for trans* survivors of sexual violence.
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Since their experience of sexual violence and their support needs are often affected by their
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gender identity, specialist services could offer more supportive and clearly targeted services. For
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some of the participants in this study, it was important to them that they not be the only trans*
324
person using a service; specialist services would also provide spaces where trans* people do not
325
feel like a minority within the service. Importantly, specialist services would also offer support
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for non-binary people who are unable to access women-only or men-only services.
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Conclusions
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The present study offered preliminary insights into the problems which currently exist in the
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accessibility of sexual violence recovery services for trans* service users, and identified possible
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solutions. Service providers and policy makers need to continue highlighting the gendered nature
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of sexual violence (Reed et al., 2010), but they must do so in ways that do not exclude those who
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do not conform to the male/female gender binary. In particular, while research (Sullivan, 2011;
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Women’s Resource Centre, 2007) clearly demonstrates the importance of single-gender spaces in
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the healing process of many survivors, it is difficult to determine which individuals should have
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access to such spaces, given the variety of gender identities and presentations among survivors,
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and to what extent such spaces match the needs of an increasingly gender-diverse population
337
(Gottschalk, 2009). Whilst our findings are limited in sample size and geographical reach, they
338
nevertheless indicate trans* people are willing to be actively involved in articulating their needs
339
and shaping services and therefore can and should play a key role in this debate.
340 341
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Press For Change, http://www.ucu.org.uk/media/pdf/r/6/transphobic_hate_crime_in_eu.pdf
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Ullman, S, 2006, Social Reaction, Coping Strategies, and Self-blame Attributions In Adjustment
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To Sexual Assault, Psychology of Women Quarterly, 20, 505–526
416
Whittle, S, Turner, L and Al-Alami, M, 2007, Engendered Penalties:
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Transgender and Transsexual People’s Experiences of Inequality and Discrimination, The
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Equalities Review, http://www.pfc.org.uk/pdf/EngenderedPenalties.pdf
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Women’s Resource Centre, 2007, Why Women Only?, Women’s Resource Centre,
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Final manuscript (NOT anonymised)
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Supporting trans* survivors of sexual violence: learning from users' experiences
2
Sally Rymer1, Valentina Cartei2
3
1,2
4
2
Survivors’Network, Rape Crisis Centre for Sussex
corresponding author:
[email protected]
5 6
ABSTRACT
7
Transgender individuals are particularly vulnerable to sexual violence, yet many do not seek, nor
8
receive, adequate support following unwanted sexual experiences. Our study explores the needs
9
and experiences of transgender survivors when accessing sexual violence support services. The
10
study examines the barriers that trans* survivors may face in accessing services and ways that
11
organisations can reduce these barriers. Our findings provide valuable insights for sexual
12
violence agencies and other providers about how to engage meaningfully with transgender
13
survivors.
14 15
INTRODUCTION
16
Over the past 20 years, research on sexual violence has shown the severity, extent and wide-
17
spread prevalence of this crime (Basile, et al., 2007). Whilst there are many kinds of sexual
18
violence (including, but not limited to, sexual harassment, unwanted sexual touching, rape and
19
sexual assault), they all share at their basis the abuse of power, control and trust by those who
20
perpetrate these acts (Jewkes et al., 2002). As a consequence, although everyone can experience
21
sexual violence, members of marginalised groups are often the most targeted because negative
22
attitudes, isolation and social exclusion make them more vulnerable to perpetrators (Stozer,
23
2009).
24 25
This paper will explore the experiences of a particular marginalised group: transgender
26
individuals. Transgender (hereafter trans*) people are those who feel that the gender assigned to
27
them at birth does not correspond with their gender identity or expression (whereas ‘cisgender
28
individuals’ refers to people who experience a match between the gender they were assigned at
29
birth, their bodies and their personal identity (Human Rights Campaign, 2015)). Trans *
30
individuals may identify between, beyond or outside of this binary way (male/female) in which
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31
society describes gender. Some may also make changes to their outward identity expression (e.g.
32
changing name/pronouns) or pursue medical interventions (Human Rights Campaign, 2015).
33 34
Trans* individuals are often marginalised and face significant levels of abuse, harassment and
35
violence, including sexual violence (Hill & Willoughby, 2005). More specifically, US research
36
has shown that approximately 50% of trans* people experience sexual violence at some point in
37
their lifetime (Stotzer, 2009), compared to 20% of cisgender individuals (Black et al., 2011).
38
Moreover, the “Trans Mental Health Survey” (McNeil et al., 2012), the largest UK questionnaire
39
of the trans* population to date, shows that between 40-60% of trans* people know someone in
40
their trans* community who has experienced sexual violence.
41 42
While trans* people appear to be at particularly high risk of sexual violence, they may also find
43
it more difficult to access services that would be able and willing to support them in their
44
recovery. Recent research in a variety of social care settings, including mental health (McNeil et
45
al., 2012), crime protection (Moran, & Sharpe, 2004) and domestic violence (Bornstein et al.,
46
2006; Miles-Johnson, 2013; Roch et al., 2010), has highlighted that trans* people face significant
47
barriers in accessing support and are discriminated against in relation to the quality of care
48
received. However, there is little literature (Balzer & Hutta, 2012; Stotzer, 2009; Rothman et al.,
49
2011) which specifically addresses equitable access to support services for trans* survivors of
50
sexual violence.
51 52
The present study begins to address this gap in the literature by exploring the experiences of
53
support received by trans* survivors of sexual violence in the South-East of England. The
54
study’s aims were two-fold: to reveal barriers that trans* survivors may face in accessing
55
services as well as to identify interventions for overcoming these barriers. Survivors were asked
56
about their experiences accessing specialist support. Reflecting the UK landscape of service
57
provision, options included reporting to the police, accessing Sexual Assault Referral Centre
58
where forensic exams are undertaken, seeking out healthcare related to their experience of sexual
59
assault (ex STI or pregnancy testing, emergency contraception) and accessing support provided
60
by charitable or private organisations such as telephone helplines, drop-ins and advocacy or
61
counselling services.
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62 63
METHODS
64
Procedures
65
The present research was funded by Survivors’ Network, the Rape Crisis Centre for Sussex.
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Forty-two trans*survivors, aged 18-65, answered closed and open-ended questions about barriers
67
to accessing services and suggestions to improve service accessibility through a web-based
68
questionnaire (June to September 2013). Participants were recruited through a link posted on
69
Survivors’ Network website, Facebook and Twitter pages. The link was also distributed via
70
email to Sussex-based LGBT, domestic and sexual violence services. Flyers were distributed in
71
LGBT pubs and clubs across Brighton & Hove, at Sussex and Brighton Universities and at
72
Brighton-based Trans* Pride 2013. Word of mouth was also an important way of publicising the
73
questionnaire.
74 75
Additionally, six participants were interviewed in semi-structured interviews to gain a more in-
76
depth understanding of their experiences (Morgan & Krueger, 1998). Three of the six
77
interviewees were trans* survivors of sexual violence and three were professionals who work
78
with trans* survivors. All participants gave their informed consent. The study received ethics
79
approval by the Social Care Research Ethics Committee (code: 13/IEC08/0023).
80 81
Data Analysis
82
All quantitative data (e.g. percentages) reported in the study were calculated from individual
83
questionnaire responses using Google Analytics (for some questions, respondents were allowed
84
to choose multiple answers, and thus the total percentages add up to greater than 100%). In
85
addition, the two authors independently analysed open questions from the questionnaire and
86
interview transcripts via thematic analysis and crosschecked their individual results to avoid lone
87
researcher bias (Burnard et al., 2008). Consistent with this approach, coding categories were not
88
prescribed, but emerged from coding the data iteratively (Starks & Trinidad, 2007).
89 90
FINDINGS
91
Levels of Access
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92
Seventy-eight per cent of the respondents disclosed that they did not access support, including
93
statutory (e.g. police, healthcare) or specialist (e. g. Rape Crisis Centre) services for survivors of
94
sexual violence. Of those, 40% did not access services for fear of being discriminated against
95
because of their gender identity, while a further 20% reported being unaware of services
96
available to them. Almost a third of participants also reported that feeling ashamed (21%) or not
97
ready (19%) prevented them from seeking help.
98 99
Of those participants who accessed services (22%), the majority accessed a counsellor (60%) or
100
health professional (57%), while 34% accessed a helpline. Twenty-eight per cent also reported to
101
the police. Almost all (92%) participants who accessed services following an experience of
102
sexual violence reported that their gender identity influenced their experience of support.
103 104
Barriers to accessing services
105
Data were also analysed for information about what specifically stopped trans* individuals from
106
accessing services. We found that overall, trans* individuals did not access services due to fear
107
of, or direct experience of: trans*phobia, outing, ignorance about trans* experiences, and a
108
general mistrust of services.
109 110
Trans*phobia
111
Both respondents who ultimately accessed services and those who did not were asked about
112
potential barriers when considering accessing services. Almost all respondents reported being
113
afraid of discrimination from workers (98%) or other service users (87%). Many were concerned
114
they would be refused access to the service or be mis-gendered while using the service.
115 116
As one respondent put it:
117 118
“I was concerned they would hear my voice on the phone and think I am a man pretending to be
119
a woman. Worried I'd be turned away without any help.”
120 121
Fifty-eight per cent of the respondents expressed concerns about the language used by workers or
122
other service users, such as using the wrong pronouns to describe a trans* person:
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123 124
“I didn't have the resources to explain my gender on top of talking about my experiences
125
of rape […] (the) rape counsellor […] kept referring to me as a woman and I'm not.”
126 127
Over half (58%) of respondents were also worried about being expected to use language they
128
were not comfortable with to describe their assault or having others use language to describe
129
their anatomy or gender identity which felt incorrect or offensive to the trans* person. One
130
participant who was assaulted before they transitioned commented:
131 132
“It is really daunting to talk about sexual abuse that happened when you were presenting as your
133
birth gender after you have transitioned. I was not ready to talk about it for a long time after it
134
had happened. However, when I was ready to disclose, I was presenting as a man and then I
135
encountered two problems; one) I didn't want to remember when I was a girl and two) men are
136
perceived as not having experienced sexual abuse so I wasn't sure how I would be received.”
137 138
Another participant reported that having such conversations would increase feelings of
139
dysphoria:
140 141
“As a trans man, I would have to use terminology for my genitals that is incredibly painful and
142
dysphoria-inducing in order to explain what he did to me.”
143 144
Outing
145
Seventy-eight per cent of respondents expressed a concern about the wider repercussions
146
(including personal safety, loss of job and personal relationships), of coming out as trans* while
147
using support services if their gender identity was disclosed outside the service. As one
148
participant commented:
149 150
“I was fearful that exposure in the national press would have resulted in my losing my job and
151
everything that I had worked to achieve.”
152 153
Lack of understanding of the complexities around sexual violence and gender identity
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Ten out of the 12 respondents who gave additional comments and all interviewees also voiced
155
fears about a lack of understanding of how trans* identity and sexual violence can interrelate.
156 157
“People would tell me that I shouldn't have been "out" about being trans or that I shouldn't have
158
transitioned because this would happen to me.”
159 160
Moreover, while the reality of how trans* people experience their bodies and their sexual assault
161
is varied and highly individual, many felt that services did not provide a safe space in which they
162
could explore this complex relationship. An interview participant noted that a major problem he
163
faced was:
164 165
“Staff making expectations or policing how people relate to their body emotionally or
166
physically.”
167 168
Mistrust towards services
169
Finally, participants revealed mistrust towards services due to negative past experiences of
170
accessing services. Participants reported that they had been failed by services many times over
171
and had experienced a great deal of discrimination. As a professional commented:
172 173
“People are not coming forward because they have a very strong learnt experience of being
174
excluded…You have to take a long-term, slow trust building approach. It has to become an
175
integral part of what you do, not a 6-months project. A lot of trans people have a really good
176
bullshit raydar. They know when an organisation is being tokanistic, and when genuine.”
177 178
In order to overcome this learned mistrust, organisations must invest in long-term capacity
179
building and training in order to become trans* inclusive organisations. As the above quote
180
evidences, piecemeal changes will not create genuinely safe, trans*-inclusive organisations.
181
Recommendations for specific changes that will increase the inclusivity of an organisation will
182
be discussed in the following section.
183 184
What would a good service look like?
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After discussing their own difficulties in accessing services, participants were asked questions
186
about what would make a sexual violence recovery service welcoming and accessible to trans*
187
survivors.
188 189
Gender as a continuum
190
The vast majority (83%) of respondents reported that they would feel uncomfortable accessing a
191
service that advertises itself simply as ‘for men’ or ‘for women’. The language used to describe
192
services can play an important role in signalling to trans* people that a service is trans*-
193
inclusive:
194
“I get read as a cis woman while identifying as a non-binary femme, and the services I used were
195
"for women" which made me feel alienated and erased.”
196 197
Challenging Transphobia
198
Another marker of an inclusive service is that the organisation actively challenges transphobia as
199
it would any other form of discrimination. It was important to participants that organisations
200
offered their staff the necessary training to equip them to address transphobia whenever it occurs:
201 202
“If I go to the toilets and get challenged and report it, that the organisation doesn’t say to me you
203
better use the accessible toilets.”
204 205
A professional said that inclusive organisations must:
206 207
“Ensure all employees from a front desk to senior levels are educated in human rights and that an
208
''equal opportunities '' policy does not simply '' exist '' to gloss the image of that organisation but
209
is a constant reminder that should you meet people with a protected characteristic they must be
210
treated with respect and dignity.”
211 212
Understanding specific issues in relation to trans* identity and sexual violence
213
Training should also equip staff with a detailed understanding of the struggles commonly faced
214
by trans* and non-binary survivors. As one participant put it:
215
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“There needs to be full understanding of the unique issues that trans* and non-binary people
217
face, and compassion for the gender dysphoria that often comes when trans and NB (non-binary)
218
people discuss their bodies.”
219 220
Such training should equip staff to discuss the service user’s assault using language that feels
221
comfortable to the survivor. An interview participant described a positive experience with a
222
support service by saying:
223 224
“They were brilliant. They asked me what language I wanted to use to refer to my body, what
225
language I was comfortable with, and then just stuck to using that language… They made sure
226
my body was referred to in ways I felt comfortable with.”
227 228
Service promotion
229
Interviews with professionals who successfully engaged with users highlighted the importance of
230
ensuring that services are known and trusted within the trans* community by including this as a
231
long-term priority in the organisation’s publicity strategy. Successful examples included building
232
relationships with existent service providers who are well-known and trusted in the
233
community— for example by offering regular training swaps, and by providing outreach services
234
in their premises. They also highlighted the importance of using trans* inclusive language (terms
235
such as ‘self-identifying women’ or ‘all genders’ rather than male and female) in all publicity
236
material and organising regular awareness events not only to promote one’s service, but also as a
237
tool to gather the opinions of trans* people about proposed new services for them.
238 239
Type of organisation and services
240
The majority (70%) of respondents said they would feel comfortable accessing a service that
241
worked with the LGBT community, even if the organisation itself did not only serve LGBT
242
individuals. This was echoed by the reported level of success experienced by all three
243
professionals, despite the fact that two of them were working for organisations that were not
244
LGBT-specific. Over half (56%) of survivors said that it was also important or very important
245
that the staff/volunteers at the service also be trans* or non-binary, while 64% said that it would
246
be important or very important that they not be the only trans* or non-binary person using the
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service. Almost all respondents reported that they would find face-to-face support would be
248
useful and 94% also reported on the importance of having access to a helpline.
249 250
DISCUSSION
251
The present study explored the accessibility of services offering support to survivors of sexual
252
violence as it is experienced by individuals who identify as trans* as well as their
253
recommendations to increase access. Survivors’ views were complemented with those of
254
professionals who support them.
255 256
Our research showed that feeling ashamed or guilty to talk about their experience often prevents
257
trans* survivors from seeking professional help. These barriers are shared by cisgender
258
individuals (Mahoney, 1999) and are in line with societal beliefs that survivors of sexual
259
violence have somehow invited the violence they have suffered (McKimmie et al., 2014;
260
O’Hara, 2012). In case of trans*survivors, myths about sexual assault may be further
261
complicated by transphobia (Ullman, 2006). For example, participants in this study expressed
262
concerns their experience of sexual violence could be viewed as a result of their gender identity
263
and therefore their experience would both be discounted and blamed on them rather than on the
264
perpetrator. Support services therefore not only need to ensure survivors are listened and
265
believed (Ullman, 2006), but they must also be aware of such myths and be careful not to collude
266
with them.
267 268
The present study also highlighted that further specific barriers for trans* individuals are often
269
grounded in the fears of experiencing direct discrimination from service providers and other
270
users accessing services because of their gender identity. These fears were at least partly
271
informed by survivors’ past experiences of inequality and discrimination in accessing services
272
generally. Indeed, one Brighton & Hove questionnaire found that 47% of trans* individuals felt
273
discriminated against on account of their gender identity by public and private sector
274
organisations in relation to health, housing, recreation and employment (Browne and Lim, 2008).
275
These experiences also reflect national statistics on the alarming levels of transphobia amongst
276
service providers (Whittle et al., 2007) and society in general, including hate speech, harassment
277
and bullying (Turner et al., 2009). Discrimination faced in accessing services can have severe
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278
consequences on the survivor’s journey to recovery from sexual violence, including re-
279
traumatisation, and may lead the individual to stop seeking support (Ard & Makadon, 2011).
280
Indeed, national and international research in a variety of fields, including domestic violence
281
(Ard & Makadon, 2011) and mental health (Grant et al., 2010) demonstrated that perceived past
282
discrimination deters LGBT individuals from seeking further help and negatively impacts
283
individuals’ health and well-being.
284
In order to address these fears, our findings suggest that services should be explicit about what
285
has been put in place to protect trans* service users, for example by developing (and making
286
public) clear guidelines about how staff and volunteers will handle any instances of
287
discrimination against trans* service users. Clear confidentiality policies are also necessary for
288
service users who are concerned about being outed while using the service. Furthermore, such
289
policies should be consistently adhered to throughout the organisation and training provided to
290
all staff and volunteers so that they feel equipped in putting them into practice. These steps echo
291
recommendations on trans*inclusion that have been recently developed by GALOP, a London-
292
based, LGBT, anti-violence and abuse charity (Gooch, 2011).
293
Even when services did not directly discriminate against trans* individuals, survivors feared that
294
providers may having little understanding of transgender issues, particularly in relation to sexual
295
violence— for example by framing sexual violence as the cause of their gender identity, or by
296
forcing them to talk about their bodies using terms that are incorrect or uncomfortable. Indeed,
297
research suggests widespread ignorance about gender expression and identity of trans* people.
298
Two studies of transgender healthcare in Scotland found that many health professionals confused
299
transgender issues with issues of sexual orientation (Scottish Needs Assessment Programme,
300
2001; Inclusion Project, 2003). Our research indicates that trans* awareness training for staff is
301
required so that front-line workers can provide services which are safe and supportive
302
environments in which trans* individuals can have difficult and nuanced discussion about their
303
experiences of sexual violence.
304
The present study also revealed that one fifth of respondents were not aware of what services
305
were available to them. While more research is needed to determine the true extent of service
306
provision for trans*survivors of sexual violence at both local and national levels, this may also
307
indicate that existing trans*inclusive services are not reaching those they aim to serve. Indeed
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308
service providers themselves often acknowledge a lack of outreach to LGBT victims (Ciarlante
309
& Fountain, 2010). Because the trans* community appears to be relatively small and
310
geographically widely spread (though a comprehensive picture is lacking - Reed et al., 2009),
311
potential clients might know service providers only through shared networks. Our findings
312
indicate that to successfully raise their profile (and gain trust) within such networks, providers
313
need to build up relationships with organisations and individuals who already successfully
314
engage with the trans* community, and take a wider interest in challenging LGBT discrimination
315
both within and outside of their own organisation. Our findings also suggest that promotional
316
material and support resources should be revised to show that the organisation has an
317
understanding of the complexity of gender identity and has thought about how to make their
318
services more inclusive of trans* people, for example by reflecting the burden of violence in the
319
LGBT community in their content (e.g. through stats) and by using trans*inclusive wording (for
320
example by advertising services as open to all ‘self-identifying women’ rather than as ‘open to
321
females’, Gooch, 2011).
322
While it is important that existing services become more inclusive of trans* people, the research
323
also demonstrated a clear need for specialist services for trans* survivors of sexual violence.
324
Since their experience of sexual violence and their support needs are often affected by their
325
gender identity, specialist services could offer more supportive and clearly targeted services. For
326
some of the participants in this study, it was important to them that they not be the only trans*
327
person using a service; specialist services would also provide spaces where trans* people do not
328
feel like a minority within the service. Importantly, specialist services would also offer support
329
for non-binary people who are unable to access women-only or men-only services.
330
Conclusions
331
The present study offered preliminary insights into the problems which currently exist in the
332
accessibility of sexual violence recovery services for trans* service users, and identified possible
333
solutions. Service providers and policy makers need to continue highlighting the gendered nature
334
of sexual violence (Reed et al., 2010), but they must do so in ways that do not exclude those who
335
do not conform to the male/female gender binary. In particular, while research (Sullivan, 2011;
336
Women’s Resource Centre, 2007) clearly demonstrates the importance of single-gender spaces in
337
the healing process of many survivors, it is difficult to determine which individuals should have
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338
access to such spaces, given the variety of gender identities and presentations among survivors,
339
and to what extent such spaces match the needs of an increasingly gender-diverse population
340
(Gottschalk, 2009). Whilst our findings are limited in sample size and geographical reach, they
341
nevertheless indicate trans* people are willing to be actively involved in articulating their needs
342
and shaping services and therefore can and should play a key role in this debate.
343 344
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