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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
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
