International Journal of Coercion, Abuse, and Manipulation Volume 9 2026 6
the SAIGE Counseling Competencies and WPATH
Standards of Care into their practice, both of which
emphasize cultural humility, informed consent, and
identity-affirming approaches. Trauma-informed
care for TGD survivors must explicitly name and
counteract stigma at every level—through inclusive
language, visible affirmation, systemic advocacy,
and collaborative treatment planning. By doing so,
clinicians not only reduce the risk of malpractice but
also create therapeutic spaces where survivors can
reclaim agency, dignity, and relational safety.
Gaps in the Literature
Research often overlooks how trans women of color
and bisexual trans women face higher risks of sexual
and physical violence, focusing instead on White,
heterosexual TGD individuals (King et al., 2021
Messinger &Guadalupe-Diaz, 2021 NCAVP, 2016).
To obtain accurate data, studies need to include more
representative populations and address factors like
sexuality, socioeconomic status, and race to better
support T-IPV survivors.
Moreover, due to the evolving nature of gender identity,
many studies struggle to define TGD populations
operationally, which results in varied samples that
may exclude non-binary individuals and other gender-
nonconforming groups (de Vries, 2014 Marrow
et al., 2024). Additionally, the tendency towards
underreporting within the TGD community further
limits the availability of data for researchers. Studies
have shown that formal victim assistance services
and help-giving resources—such as police, healthcare
professionals, hotlines, and community shelters—are
significantly underutilized by T-IPV survivors, leaving
researchers with minimal data from these sources
(Kurdyla et al., 2021).
A Relational Framework
Given that IPV is an inherently violating and relationally
wounding experience, the counseling process and
counseling relationship should center on relational
safety and emotional security. Survivors, particularly
in the TGD community, often experience not only
the betrayal and harm from their partner but also
compounded disconnection from family, community,
and institutions that may already marginalize them
(Henry et al., 2021 Rogers, 2016 Singh &Moss,
2016). Many T-IPV survivors report feeling invisible
or disbelieved by service providers, law enforcement,
or even victim support spaces that center cisgender
narratives, which only serves to reify relational
alienation and internalized shame (Marrow et al., 2024
Beyer et al., 2022 Kussin-Shoptaw et al., 2017). For
these reasons, connection, care, and relational stability
must be centered when working with TGD survivors of
IPV (Bowling et al., 2020).
Mental health professionals are afforded the
distinct opportunity—and charged with the ethical
responsibility—to act as agents of change and
promote meaningful individual and social growth.
They are uniquely positioned to catalyze fundamental
systemic change and make meaningful contributions
to individual and public wellness. To meet these
standards and deliver effective services, clinicians
must actively advocate for their clients, both during
and outside the traditional 50-minute therapy hour. To
support counselors in this mission, the authors suggest
a seven-element relational model for working with
TGD survivors of violence and enhancing professional
competency.
This model provides a non-linear framework of
treatment elements for clinicians to consider, which
can be adapted to individual needs and treatment goals.
These treatment recommendations can be remembered
using the acronym SINCERE: signs, information,
nuance, continuing education and advocacy,
resources, and establishing. At its core, SINCERE is
a trauma-informed framework that centers relational
safety (the intentional creation of emotionally secure,
identity-affirming, and socially embedded therapeutic
relationships) as the foundation for effective counseling
with survivors of T-IPV.
Signs
Clinicians must recognize the indicators of T-IPV
and remain vigilant about factors that could heighten
a client’s risk of exposure to violence. Signs of T-IPV
typically fall under five main categories: emotional
and psychological abuse, physical abuse, sexual abuse,
financial abuse, and gender-based abuse or exploitation
(King et al., 2021 Marrow et al., 2024). Someone
experiencing one or a combination of these five forms

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Ruby Cramer and Sarah Stillwell |SINCERE: A Relational Safety Model for Counselors
of abuse unique to TGD individuals may display
emotional distress, social disinterest or withdrawal,
constant fear or paranoia, fear of expressing identity,
negative self-talk, sudden changes in behavior,
unexplained physical injuries or marks, low self-
esteem, unexplained agitation, becoming non-verbal
or non-responsive, self-reports of sudden financial
changes or issues, and a spectrum of other material
and mental health indicators (Bowling et al., 2020
Howard et al., 2020 NSVRC, 2019 Scheer &Poteat,
2021). Above all, the most notable sign that violence is
occurring or has occurred is an individual’s self-report
of explicit or suspected abuse.
Identifying the signs of abuse is equally important as
recognizing factors that often heighten an individual’s
risk of exposure or re-exposure to coercion and abuse.
For example, incarceration, sex work, immigrant
status, houselessness, disability, substance abuse, age,
race, ethnicity, and sexual orientation are significant
contributors to marginalization and thus can increase
the risk of T-IPV (James et al., 2016 King et al., 2021
Seelman, 2015). This is illustrated by the fact that in
2019 alone, a staggering 77% of TGD sex workers
reported experiencing IPV, and of that population,
Black TGD women were at the highest risk of exposure
to violence (NSVRC, 2019).
By exercising mindfulness of clients’ socioeconomic
locations, clinicians can more effectively identify any
precipitating elements of T-IPV or factors that elevate
risk and consequently facilitate access to necessary
help or resources. Furthermore, understanding the
tactics of abuse and violence perpetrated against TGD
survivors at both individual and institutional levels is
fundamental to providing quality mental health services
and effectively responding to a survivor’s circumstances
(Dolan &Conroy, 2021). Providers must consider
that structural discrimination not only increases risk
of exposure and re-exposure to T-IPV but that it may
also be leveraged against survivors by abusers to keep
them in more exploitable and controllable positions
(Marrow et al., 2024 James et al., 2016).
According to coercive control theory, signs of IPV extend
beyond physical or emotional abuse to include patterns
of restriction of autonomy and agency (Tolmie, Smith,
&Wilson, 2024). For TGD survivors, coercive control
may manifest as abusers monitoring daily routines,
isolating survivors from affirming communities,
controlling or blocking access to gender-affirming
care, threatening to out the survivor, withholding
medications, or leveraging systemic discrimination
to entrap them. Furthermore, the coercive control
theory framework underscores the importance of
understanding IPV as a liberty crime (Tolmie, Smith,
&Wilson, 2024). Counselors must therefore exercise
understanding and awareness of not only overt acts
of violence but also subtle, ongoing tactics of control
that erode autonomy. For the TGD population, this
might include abusers exploiting legal vulnerabilities,
immigration status, or healthcare access to maintain
dominance. Understanding these varied, intricate
ways in which signs of T-IPV uniquely manifest will
enable counselors in effective prevention, intervention,
and safety planning. Furthermore, having the ability
to actively recognize signs of T-IPV and systemic risk
factors allows clinicians to validate survivors’ realities
and intervene early. This ultimately communicates
attunement to the individual’s lived experience and
contributes to building relational safety between client
and clinician.
Information
Counselors require a comprehensive, well-rounded
foundation of knowledge to practice competently.
To work with this population, one must be familiar
with the current federal and state laws surrounding
IPV to understand any legal or material roadblocks
that clients might encounter. Clinicians must be
knowledgeable about the specific forms, treatment
barriers, intervention models, statistics, legal statutes,
and features of T-IPV. Accruing information on these
key elements will help mental health professionals
to avoid making errors that commonly occur when
working with this population, such as incorrect shelter
placement, inappropriate referrals, and faulty safety
planning (Kattari et al., 2020).
For clinicians aiming to enhance their proficiency in
working with the TGD community, a valuable starting
point is to familiarize themselves with the latest
standards of care (SOC) put forth by the WPATH, a
leading voice on working with TGD clients in clinical
and medical settings (Coleman et al., 2022). Clinicians
working with survivors of T-IPV may also consider
exploring research studies, local organizations and