Client-centred practice dictates that clients needs with regard to service provider gender must predominate over other service delivery matters whenever possible

This refers to offering: Gender choice

And being aware of: Gender matching

Long term psychological harm from sexual violence is mitigated by the speed and consistency of the return to normal levels of arousal of the survivor’s nervous system.  In this context, it would be ideal for  all survivors, regardless of sex, gender identity [link to gender identity heading in Doing our best for lgbtqi survivors report] or sexual orientation to be asked if they have a preferred gender of those who will support them.

If this level of flexibility is not available, then gender matching for cis straight women is likely to be the safest default if these women have been assaulted by a male.  Factors supporting this position include:

• Women generally feel more able to talk about sexual matters with other women than with other men (excepting partner).
• Following sexual assault by a male, many women are scared of men and therefore find it difficult to engage with male providers. They can become distressed or frightened in response to male secondary sexual characteristics (such as smell or depth of voice) without necessarily even being aware of the source of their distress.
• In research looking at post-rape medical examinations, 82% of survivor/respondents said that it made a difference to them that the crisis support worker was female. This included the 1 male survivor/respondent involved in this part of the research. [1]
• Preferences for gender of staff providing forensic medical examinations and care has been investigated. Nearly 80% of respondents indicated that they would prefer a female to examine them and nearly ½ of the females and ¼ of the males indicated that they would not go ahead with the examination if there was no choice but to have a male examiner. [2]
• In an Australian study, while some survivors said that they wanted choice of the gender of staff, when choice was available, most chose a female provider[3]. In Jordan’s NZ research, victims/survivors reported having a “woman present” made it easier for women to report rape and sexual assault [4]
• There can be an immediate rapport between women about rape, whereby the woman who has been raped expects understanding (and therefore emotional safety) from another woman in a way that she doesn’t expect it from a man. This is both about the nature of rape and its perpetrators, but also that in our society women are generally expected to be those most able to respond to our emotional experience.
• However, if the offender was not male, and there is no choice available, then acknowledging the lack of choice and talking through with the survivor what her personal safety needs are in the process will be important.

For some cultures, it is not acceptable for cross gender talk about sexual matters, so gender matching for men would also be expected.  However, in general for cis straight men, gender matching is less straightforward.  While men need the same things that women do to be able to expect the emotional safety which comes from understanding and compassion, a number of studies have highlighted the significance of peer and group support as an effective therapeutic intervention for male victims/survivors[5].  One study highlighted the need for frontline services to have access to such supports, available following initial disclosure made by male victims/survivors.[6]

• Some men feel safer working with women, especially in the context of emotional repression and relationship struggles.
• Others need the opportunity to explore issues of sexuality, masculinity/vulnerability and sexual behaviour with men (some term this the ”nuts ’n bolts” of the abuse experience). Many men have a number of therapists over time for different stages of their recovery.

Around 12% of New Zealand’s population may identify under diverse sex, sexuality and gender umbrellas.[7]  Research tells us that people of the LGBTIQ+ communities can face high rates of sexual violence.[8]  Gender choice is significant for these survivors as diverse sex, gender identity, and sexual orientation can heighten vulnerability following sexual assault.  For example, if a gay identified male person was supported by a straight woman, he may experience high stress from not expecting to be understood by someone of an opposite gender AND sexuality to himself.  A trans person will often be outed in the process and may anticipate negative reactions from others if genital examination is required in a medical process.  If no choice is available, acknowledge the lack of choice and talk through with the survivor what their personal safety needs are in the process.

The house seemed full of huge men (police officers). Among them, as they crowded in the doorway from the hall to the dining room, I could see a woman’s face. I held on to her eyes and she on to mine. Someone asked if i was happy to talk to a male officer, and I said yes, assuming that the female officer would stay. She didn’t; I felt sad and confused about that.
– Leefman, 2005 p. 25-26)

1.  Kelly, L., & Regan, L. (2003). Good practice in medical responses to recently reported rape, especially forensic examinations. Glasgow: Rape Crisis Network Europe.  Lovett,J., Regan, L., & Kelly, L. (2004). Sexual Assault Referral Centres: Developing good practice and maximising potentials. (Home Office Research Study 285). UK: Home Office Research, Development and Statistics Directorate.
2. Chowdhury-Hawkins, R., Mclean, I., Winterholler, M., & Welch, J (2008). Preferred choice of gender of staff providing care to victims of sexual assault in Sexual Assault Referral Centres (SARCS). Journal of Forensic and Legal Medicine, 15, 363-367.
3. Quixley, S. (2010). The right to choose: Enhancing best practice in responding to sexual assault in Queensland. Queensland Sexual Assault Services. Retrieved from: http://apo.org.au/node/22924  
4. Jordan, J. (1998). Reporting rape: Women’s experiences with the police, doctors and support agencies. Wellington: Institute of Criminology, p.30.
5. Fisher, A., Goodwin, R., & Patton, M. (2008). Men and healing: Theory, research and practice in working with male survivors. Toronto, Canada: Cornwall Public Enquiry.
6. Davis, M, (2002). Male sexual assault victims: A selective review of the literature and implications for support services. Aggression and Violence Behaviour 7 (3), 203-214.
7. Clark, T. C., Lucassen, M. F.G., Bullen, P., Denny, S. J., Fleming, T. M., Robinson, E. M., & Rossen, F. V. (2014). The health and well-being of transgender high school students: results from the New Zealand Adolescent Health Survey (Youth’12). Journal of Adolescent Health, 55(1), 93-99.
   Lucassen, M. F. G., Clark, T. C., Moselen, E., Robinson, E. M., & Adolescent Health Research Group. (2014). Youth’12 the health and wellbeing of secondary school students in New Zealand: Results for young people attracted to the same sex or both sexes.  Auckland: The University of Auckland.
8. Le Brun, C., Robinson, E., Warren, H. and Watson, P., (2005), Non-heterosexual Youth: A Profile of Their Health and Wellbeing; Data from Youth2000, The University of Auckland.

PRACTICE EXAMPLES

• Currently services in NZ mostly recruit women to support female survivors.  The Human Rights Act 1993 (as at June 2016) makes provision for allowing employment which might otherwise be seen to be discriminatory, where it is for “a counsellor on highly personal matters such as sexual matters or the prevention of violence” Part 4, Section 27.
• In a situation where a number of boys and young men were identified as survivors by police following investigation of a man who had been abusing multiple boys over some years, the local crisis support service offered meetings for groups of survivors and their parents to meet local service providers, including male counsellors who worked with survivors.
• While Wellington HELP is not able to provide gender choice to males at point of contact, every man that contacts HELP is given info about MSSAT (Male Survivors of Sexual Abuse Trust) and Livingwell.
• Male Survivors of Sexual Abuse Trust is establishing itself as a national organisation so will be able to provide support for many more male survivors.
• If you are able to provide a practice example offering gender choice to survivors from LGBTIQ communities, please let us know so we can include it here:   toahnnestgoodpractice@gmail.com