Addressing intimate partner violence with LGBTQ+ clients

By Lisa R. Rhodes

June 2023

It has been a long-held belief that intimate partner violence (IPV) happens primarily in heterosexual relationships and that straight, cisgender women are most likely to be the victims of abuse. “Domestic violence theories have historically been gender based,” says Susan Holt, a licensed marriage and family therapist (LMFT) and an associate director of the Mental Health Department at the Los Angeles LGBT Center. Domestic violence or outreach materials, research and media often talk about IPV from this heteronormative perspective and refer to victims of IPV using the pronoun “she” and perpetrators of IPV as “he,” Holt notes. And domestic violence shelters and support groups are often designed for and cater to straight, cisgender women. This belief that IPV happens only or mainly to straight, cisgender women prevents many LGBTQ+ people from recognizing that they may be in an abusive relationship and that they have the right to seek protection from their abuser. “LGBTQ+ intimate partner violence has been relatively invisible to not only members of the LGBTQ+ community but our society in general,” Holt says.

The pervasiveness of abuse

IPV in the LGBTQ+ community is more prevalent than commonly believed. The Centers for Disease Control and Prevention’s report National Intimate Partner and Sexual Violence Survey: 2010 Findings on Victimization by Sexual Orientation found that domestic violence occurs in LGBTQ+ relationships at rates similar to or higher than those in the general population. According to the 2020 report Finding Safety: A Report About LGBTQ+ Domestic Violence and Sexual Assault, published by the Los Angeles LGBT Center, 4.1 million LGBTQ+ people in the United States have experienced physical IPV, partner rape or partner stalking in their lifetimes. When LGBTQ+ people do reach out for help in an abusive relationship, they are often mistreated and disrespected. The Finding Safety report notes that 70% of the LGBTQ+ individuals surveyed said that when they sought assistance from service providers, which included mental health counselors and physicians, they experienced “prejudice and/or negative responses to their gender or sexuality” and were often dismissed and shamed. They also reported homophobic, transphobic and sexist treatment, as well as violence, when they attempted to report the abuse to the police. According to the report Intimate Partner Violence and Sexual Abuse Among LGBT People: A Review of Existing Research, published by the Williams Institute in 2015, studies suggest that “transgender people may confront similar levels, if not higher levels, of IPV as compared to sexual minority men and women and cisgender people,” with findings of lifetime IPV among transgender people ranging from 31% to 50%. “The LGBTQ+ population has not been commonly studied. This is especially true when it comes to domestic violence and intimate partner violence,” says Holt, founder and director of the STOP Violence Program at the Los Angeles LGBT Center. “Rather, information that applies to other populations without the unique, and often complex, aspects of the LGBTQ+ population [is] extrapolated and applied to the community.” Holt says that both historically and currently, bisexual female survivors of IPV have been overlooked or misclassified as either heterosexual or lesbian based on their partner, and they report higher levels of severe violence, such as choking, than do lesbians or heterosexual women. “Bisexual females are often believed erroneously to be hypersexual and depicted as sexual objects, or more sexual than others, and hence subject to objectification and violence,” she continues. “They are also more often controlled by their partners because the partner fears that they cannot be trusted [and] are prone to affairs and infidelity.” Unlike male survivors of IPV, Holt says bisexual and heterosexual women tend to be more willing to disclose the abuse they have experienced and are open to seeking assistance, which may account for their higher numbers in studies.

Patriarchal and systemic oppression

Patriarchal norms and systemic oppression make LGBTQ+ people more susceptible to IPV. Tristyn Ariyan, a licensed professional counselor (LPC) in Texas who specializes in trauma and relationship issues and violence-informed care for the LGBTQ+ population, says society’s patriarchal view that only men are entitled to exercise power and control “complicates the understanding and recognition of sexual minority or intimate partner violence.” Ariyan says the patriarchal assumption that men are perpetrators of abuse comes from the idea that sex assignment plays an integral part of social and intimate power dynamics: People assume that men inherently have a right to power and will therefore be socialized to be aggressive and strong, whereas women are raised to be compliant and docile. “This patriarchal perspective skews the view of same-sex and transgender relationships with both societal and internalized beliefs such as men cannot be victims, women are not violent, and LGBTQ+ and intimate partner violence [are] reciprocal, which often prevents reporting and intervention,” she adds. Society’s patriarchal construct creates myths and expectations about LGBTQ+ relationships so that a partner’s role in the relationship is decided by factors such as their gender expression (based on societal constructs), says Eric Sullivan, an LPC and LMFT who specializes in working with the LGBTQ+ community. “For example, if you’re in a gay male relationship, there’s this myth that if you’re the ‘top’ [the one who gives penetration] in the relationship, then you’re supposed to be more in control, more dominant, more ‘masculine,’” Sullivan says. Myths such as this perpetuate “constructs of gender norms that aren’t true ... even in heterosexual man [and] woman relationships,” he explains. How a person decides to exert power or control over another person “isn’t connected to a person’s gender or sexuality,” says Ariyan, owner of Luna Therapy Solutions in San Antonio, and “doesn’t line up” with stereotypical notions of masculinity. Moshe Rozdzial, an LPC and owner of Glow Counseling in Denver, says another harmful consequence of patriarchy is the concept of ownership and that men have the right to “own” or control their partner and children. No one, including LGBTQ+ people, is immune from having been indoctrinated by this social construct, he stresses. “The dynamics of power and position in LGBTQ+ relationships are not outside of patriarchy,” says Rozdzial, a certified sex therapist and national co-chair of the National Organization for Men Against Sexism. This is why some gay men and lesbian women believe they have the right to control their partner, he says. “No relationship is purely equal. Someone in the relationship has rank, position or power based on financial standing, education or social status,” he adds. “No relationship is free of power dynamics.” How these power dynamics play out between two people is what differentiates an abusive relationship from an egalitarian relationship, Rozdzial notes. This reality is not unique to LGBTQ+ relationships; it is a broader understanding of IPV, he says. Not only is patriarchy an adverse influence in LGBTQ+ relationships, but the systemic oppression against LGBTQ+ people can be detrimental to their sense of self. “We have unique forms of discrimination and prejudice that we experience in the world that are added pressures and stressors in relationships,” says Sullivan, who is part of the LGBTQ+ community and owner of a virtual private practice, Proud Counseling. LGBQT+ people often internalize a lot of the oppression they experience, which is a form of complex trauma that can show up in relationships and other areas of their lives, Sullivan notes. Individuals who identify as LGBTQ+ grow up hearing negative social messages that their existence is wrong, sinful or perverted, and these messages are pervasive throughout society’s institutions, such as the media, schools, the workplace, religious institutions and even family systems, says Rozdzial who has been counseling LGBTQ+ people for more than 20 years. “People hear those messages and come to feel they are damaged or broken or worthy of abuse, punishment or shame, rather than seeing [the messages] as tools of systemic oppression and ‘othering’ that are inherently outside of themselves,” he says. Sullivan says these negative messages lead some LGBTQ+ people to feel that their personal relationships are judged by others. This often makes them uncomfortable to tell others they are in an LGBTQ+ relationship. It’s already hard to navigate a personal relationship but being a queer couple “makes it that much harder,” Sullivan says. And fear of judgment for being LGBTQ+ can make it more difficult for someone to report IPV, he adds. Rozdzial uses psychoeducation to educate his clients about the harmful impact of internalizing these oppressive messages. “I want my clients to understand that what they are experiencing [in regard to abuse] is not their fault,” he explains, noting that heterosexuality and society’s assumptions about its inherent superiority means that LGBTQ+ people are often seen as “outsiders.” He also works to reinforce clients’ strengths and self-determination. Rozdzial says he helps clients develop affirmative statements such as “This is not about me,” “I am not shame worthy” and “This is not my doing,” which help them externalize systemic oppression. “I want them to realize that they deserve a life free of fear and discrimination, both at home and in society,” he says. Rozdzial advises clinicians who work with LGBTQ+ survivors of domestic abuse to invest time in unearthing any biases and assumptions they may have about the LGBTQ+ community before developing the therapeutic relationship. “The therapist is in a power position that can be used against the client if they are not aware of systemic oppression,” he says. “Counselors can harm the client in the clinical setting if they unknowingly align themselves with patriarchal constructs or heterosexist, anti-gay beliefs.” Holt says it is critically important for counselors to be properly trained to treat LGBTQ+ survivors of IPV. “Because domestic violence and intimate partner violence can cause emotional trauma [and] physical injuries and is potentially lethal, it is imperative that counselors, when faced with a domestic violence case, make sure they have been sufficiently trained to intervene safely and effectively,” she stresses.

Assessing for domestic abuse

Because LGBTQ+ clients may not be aware that they are in an abusive relationship, clinicians must be diligent to correctly assess for IPV. The counselors interviewed for this article recommend that clinicians who are working with couples assess one client at a time and in private. That way, if abuse is present, then the client who is being mistreated might feel more comfortable giving honest answers during the intake. Ariyan uses the Danger Assessment-Revised questionnaire to screen clients for trauma as part of the intake process. Although the questionnaire was designed to assess abuse in female same-sex relationships, she says that counselors can revise the questions to use gender-neutral language in session with LGBTQ+ clients. The questionnaire includes questions such as:

• Is she [your partner] constantly jealous and/or possessive of you?
• Does she [your partner] try to isolate you socially?
• Does she [your partner] constantly blame you and/or put you down?

To better assess for IPV, Sullivan also suggests counselors ask the following questions during intake:

• In general, how does your partner treat you?
• Do you feel safe and comfortable in your living environment?
• Are there times when you fear your partner?
• Has your partner ever called you a disparaging name?
• Has your partner ever threatened you or struck you?
• Has your partner ever forced you to have sex when you didn’t want to?

Sometimes clients may be hesitant to answer these questions out of concern for how the information will be used. If this happens, Sullivan recommends clinicians normalize the intake process by saying something such as, “It seems like you are hesitant to answer some of these questions. That’s perfectly normal. I’m here to help. You can share only what is comfortable for you. The information that you share can be helpful to you and for me, so that I know what’s going on, and so we can decide what we will work on together in therapy.” Sullivan, who consults with businesses to help them become LGBTQ+ inclusive, also suggests counselors let clients know during the intake process if they are a member of the LGBTQ+ community or if they identify as an ally of the community. This is important, he says, because clients may be concerned that the clinician has a judgment or bias against LGBTQ+ people or same-sex couples.

Abusive tactics

In addition to the common manifestations of IPV, which include physical, sexual, emotional and economic maltreatment, abusers in LGBTQ+ relationships may use harmful psychological tactics that target their partner’s gender identity or sexuality to degrade and humiliate them. Because LGBTQ+ people and survivors of IPV internalize being abused, there is often an expectation that being abused “is their lot in life,” Rozdzial says. Therefore, they may not recognize these destructive LGBTQ+ specific tactics, which include the following:

• Threatening to “out” a partner to their family, friends, employer or other social connections. Ariyan says outing a person in the LGBTQ+ community who is not ready or willing to do so themselves can cause them to lose their job, housing or place of religious worship or create a rift in their family and other support systems that may be difficult to heal.
• Using derogatory slurs. Sullivan says an abuser may use name calling or mockery that’s related to a partner’s queer identity to shame them.
• Exploiting a partner’s insecurities around their gender identity or sexuality. Abusers may use a partner’s emotional vulnerabilities against them. For example, Sullivan says that an abuser may tell a transgender woman in transition, “You’ll never be a ‘real woman,’ and you are lucky that I’m with you because nobody else is going to want to date you.”
• Limiting a partner’s support system by isolating them from family, friends or other social connections. Sullivan says an abuser may try to elevate their position in the partner’s life over all other people. For example, an abuser may tell their partner, “Your friends don’t support you. Your family doesn’t support you, but I accepted you right away.”

The nature of generalized or LGBTQ+ specific abusive tactics in a relationship “may provide insight into [the] overall dynamics of monitoring and controlling behaviors by one partner over another, even as sex, gender identity or gender expression may not be defined through a traditional heteronormative lens,” Rozdzial says.

Healing trauma and affirming the self

The counselors interviewed for this article agree that LGBTQ+ survivors of IPV often struggle with anxiety, depression, posttraumatic stress disorder and suicidal ideation. Therapeutic modalities such as skills training in affective and interpersonal regulation (STAIR), somatic experiencing, mindfulness and LGBTQ+ affirmative identity therapy can help clients process trauma, reframe their thoughts, heal their emotions and repair their sense of self-esteem. It’s important for clinicians to help clients experiencing IPV feel safe so they can share their experiences without fear of being judged or shamed for who they are. A critical part of therapy with LGBTQ+ people, Rozdzial says, is to “name and acknowledge the level of abuse they are experiencing” and help them to understand that the negative behavior is a result of external systemic factors, rather than as “a personal or individual internalized expression of self.” Ariyan says she honors the client as “the expert of their own experience” and “allows them to lead the discussion [to] increase their self-agency.” She says that because survivors have often received mixed messages from their abusers, they learn to assign meaning to nonverbal behaviors to help them receive information beyond what is being spoken or told to them. Because of this, “many survivors are highly adept at reading nonverbal cues, so clinicians must work to be genuine, congruent and explicit,” she notes. Ariyan uses STAIR to help survivors process trauma. STAIR, which was originally developed to help people who have experienced childhood abuse and have a history of posttraumatic stress disorder, is a skills-based approach that “can be modified for use with clients that have a history of intimate partner violence,” she notes. “The primary focus of STAIR is reframing cognitions that are impacted by traumatic experiences, allowing individuals to develop and practice adaptive emotion regulation and increase interpersonal functioning,” Ariyan says. “STAIR facilitates meaningful change with clients as they become aware of the impact of interpersonal violence schemas and how it can influence their emotional and social functioning, while also increasing their resiliency through somatic awareness strategies and cognitive restructuring.” Processing and discussing traumatic events can be stressful, so counselors should ensure that clients have the coping skills needed to address any potential emotional dysregulation that comes up. Ariyan finds somatic experiencing helpful when working with survivors of IPV because it helps clients address physiological dysregulation of traumatic experiences. “By learning to reconnect body sensations with the mind, clients are able to communicate to their nervous system that the perceived threat is over, facilitating a sense of safety and increasing their window of tolerance, or functional range, when activated by stressors,” she explains. One somatic experiencing self-soothing intervention that Ariyan suggests counselors use is resourcing (i.e., the practice of having the mind/body attuned to sensations of safety). Counselors, for example, could ask the client to imagine a place they find beautiful or comforting and think about the details of the places — the sights, smells and sensations — they are noticing. Counselors can then ask about the emotions (e.g., happy, relaxed) and body sensations (e.g., warmth) they are experiencing and where in their body they feel these sensations. “If a client begins to experience distress during a session, it can be useful to pause for a moment, bring awareness to a positive and calm resource, then proceed once they have returned to a safe state,” Ariyan says. Clients can also use this exercise of concentrating on a calming location and the pleasant sensations associated with it outside of session whenever they feel the need to create safety and calm within their environment, she adds. Sullivan uses mindfulness and grounding exercises such as deep breathing and body scanning to help clients develop the coping skills they need to manage the stress that may result from exploring their traumatic experiences. He also uses LGBTQ+ affirmative therapy to foster empowerment and acceptance of a client’s queer identity, which amplifies their confidence and sense of self and counters negative messages they may have heard from an abusive partner. Sullivan notes that it’s important for counselors to provide psychoeducation about heterosexism, homophobia, transphobia and other biases to help clients understand that systemic oppression is a form of complex trauma that needs to be processed and that the abuse they have suffered is not their fault. Even if LGBTQ+ people have experienced a complex level of trauma, they are not “damaged,” Sullivan stresses. Instead, he says clinicians can help these clients recognize the strengths and resiliency they have developed from their experiences and use these qualities to rebuild their self-esteem and live an empowered life.

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Resources for LGBTQ+ domestic violence survivors

• Battered Women’s Movement
• Los Angeles LGBT Center’s STOP Violence Program
• National LGBTQ Institute on Intimate Partner Violence

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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