J enna Hershberger, a licensed professional counselor, was working on a crisis response team for a regional human service center in North Dakota when she received a call from a young woman reporting physical abuse. The woman commented on her medical complaints, but not on her mental and emotional health. Hershberger knew there was more to the woman's story, so she asked to meet her in real life to discuss things further. The woman agreed.
During their face-to-face meeting, Hershberger, a therapist at the Village Family Service Center in Fargo, North Dakota, noticed signs of a possible sex trafficking. “Your presentation was really worrying. She was very tearful, ”recalls Hershberger. The woman also kept mentioning how her "friends" forced her to do things while under the influence of drugs. The more the woman shared, the more convinced Hershberger was that the people addressed were human traffickers and not friends. When Hershberger asked where the woman was, she revealed that she was currently homeless.
After a while, the woman finally admitted that she had been forced into sex trafficking and that she wanted to get out. She was scared and didn't know what to do. Fortunately, Hershberger did. She found safe shelter for the woman for the night and helped her find mental and physical health services.
"I'm in North Dakota … [where] Prevalence rates [of human trafficking] are lower, but it still happens," says Hershberger, a member of the American Counseling Association. "The tragedy of where I am, and in rural areas of the Midwest, is that people just seem to be saying, 'Well, that doesn't happen here.'"
Jared Rose, a licensed professional clinical advisor and supervisor with a private practice, Moose Counseling and Consulting LLC, in Toledo, Ohio, has also encountered a "non-my community" mentality regarding human trafficking. . He began working in the fight against human trafficking about 15 years ago when someone working for an anti-trafficking organization in Toledo approached him about his work with the LGBTQ + community and with people infected, affected or at risk with HIV , both often cross with human trafficking. While giving training courses in rural Ohio counties, Rose heard police say, "This is not happening here." This statement makes Rose shudder because he knows firsthand that this is happening from his work with people who have been victims of human trafficking.
Human trafficking is actually more common than we think. The International Labor Organization reported that around 40.3 million people worldwide were living in modern slavery in 2016. Sometimes people wrongly assume that human trafficking is only a problem in developing countries, but the National Human Trafficking Hotline identified 63,380 human trafficking survivors in the United States from 2007-2019.
Rose, an ACA member who wrote an ACA trafficking awareness factsheet for school counselors in 2019, notes that too many counseling clinics are ignorant of the definition and signs of human trafficking. “You could have the epitome of the suitcase in front of you,” says Rose. "And if you don't even know what human trafficking is, you will miss it."
Recognize the characters
The US Department of Homeland Security defines human trafficking as the use of force, fraud, or coercion to obtain any type of labor or commercial sexual act. Rose, assistant professor of counseling at Bowling Green State University, advises counselors to stay vigilant for signs of violence, fraud, or coercion with clients. "Pay attention to who you are with and where the power and control are," he says. For example, does someone else benefit – often financially – from the customer's actions? Does someone else seem to be responsible or to make all of the customer's decisions for them?
Hershberger, a graduate student in the counselor training and supervision program at North Dakota State University, also looks for visual signs such as bruises, scars, or burn marks. People who are or have become victims of human trafficking are often branded with “property” tattoos with the name of their trafficker or with symbols such as a star or a cowboy hat. Because sexual acts are extremely stressful to the body, survivors often discuss medical conditions such as dental problems, migraines or urinary tract infections, she adds.
Customers who have been trafficked “can appear overly indulgent and submissive, or they can appear very aggressive and abrupt,” emphasizes Hershberger. Consultants need to recognize "that these strategies used to be adaptive, but are no longer."
Regarding human trafficking, Rose notes that risk factor # 1 for children is not accommodated. He explains that he prefers the term “unhoused” to outliers because children are often abandoned or “thrown out” by their families. "Within two to three days of leaving the house, children are approached [by traffickers] and a third of those [unhoused] children are trafficked," he says. "So, this piece of not being housed – couch surfing, staying in an animal shelter, living on the street, or whatever the case may be – puts them at a much higher risk." Children who are already vulnerable can easily be one Adults fall victim to who pays them attention or what they initially perceive as support, he adds.
Other risk factors are lower socio-economic status, past trauma (sexual, physical, emotional, verbal or spiritual), different skills, substance use and belonging to a racial or sexual minority group, says Hershberger. Given the complex trauma these individuals experience, they often present with comorbid disorders such as substance use, bipolar, and major depression, she notes.
Counselors can miss or miss signs of human trafficking when taking the client's circumstances at face value or taking problems at face value, notes Paige Dunlap, associate professor of counseling at North Carolina Agricultural and Technical State University. For example, if a client is homeless or unidentified, counselors can begin to talk about the client's emotions, behaviors, and social systems related to the client's chronic homelessness and help them develop a plan to find a more stable environment. However, clinicians may miss the bigger picture, says Dunlap, a licensed clinical mental health advisor with a private practice in Greensboro, North Carolina. Perhaps the client was forced into sex trafficking after being taken from his home or after escaping from an unsafe environment.
“There are many different risk factors. There are many different things to look for. There are a number of populations that we are particularly concerned about, but it all boils down to vulnerability, ”says Rose. For this reason, he emphasizes that consultants must be aware of these weaknesses in connection with their clients.
Sometimes counselors fear they won't be able to spot the signs of human trafficking, says Rose, but he assures them that they know how to read interpersonal responses. You know when someone is looking for answers. They notice when people's stories don't match.
Counselors also need to consider what a human trafficking survivor might look like in their particular clinical setting, says Hershberger. For example, if a counselor is doing crisis work, they might have someone who denies trafficking or is faced with what looks like domestic violence.
The office environment can determine the likelihood a practitioner will encounter someone who is currently a victim of human trafficking or who has dropped out. Counselors who work in public health facilities or hospitals are more likely to see people currently being harassed when they come to us for a medical problem like a sexually transmitted disease test or abuse injury, says Rose fixed. Counselors who work in a private practice or with a community agency will typically see these clients after their release, he says.
Establish trust and security
People who have been trafficked may have difficulty trusting others. Before considering clinical treatment plans, counselors need to develop a sense of security and healthy therapeutic relationships with these clients, Hershberger emphasizes. These individuals have “had a complex trauma in the sense that it is repetitive over a long period of time and often comes from people who should be caregivers,” she explains, “so it is really difficult for trafficked survivors to trust us. We really have to be authentic, because survivors will notice if [we’re] not [we’re]. "
Hershberger, president of the North Dakota Association for Counselor Education and Supervision, advises clinicians to maintain an open door policy on trafficking survivors, especially when working on working with the client. People dealing with significant trauma may be more prone to canceling sessions, so sticking to a policy of canceling after two missed sessions won't help build engagement and relationship with these clients, she warns.
Counselors' innate desire to help clients heal can sometimes be an obstacle to building this relationship. Rose sees counselors who want to dive straight into trauma work before first building strong therapeutic and strategic foundations, which can take a long time. "The moment we try to exert too much pressure – even when our best intentions are there – someone [a negative] can react" and feel that the counselor is forcing him to do something he does not want or does is not yet ready to do so, he says.
Rose also experienced the opposite: Clients who are frustrated when counselors do not go straight into trauma work. In this case, he explains to customers that while they feel ready, their entire system may not. To further illustrate, he compares trauma work to a physical wound: “If I'm poking around at a wound and you don't trust me yet, or your entire system isn't ready to let it happen, you will pull back immediately and you won't want me in I'm close, ”he tells his customers. “And the same thing [thing] happens cognitively and emotionally with trauma. If we start to rummage around and you are not ready, then it will break on us. "
The need for clinical trauma care
Rose claims that counselors are in a prime position to provide clinical psychotherapy and trauma-focused work. Rose is an executive member of the Lucas County Human Trafficking Coalition and was awarded the 2017 Social Justice Leader Award by the Human Trafficking and Social Justice Institute.
Mental health services targeting human trafficking survivors are great at managing client symptoms through art or expression therapy or group work, but Rose finds that this is where her treatment often ends. “It has to be more. It has to be evidence-based trauma work, ”he emphasizes. “We can't just treat symptoms. We have to treat the whole person and we have to treat the trauma. ”
“Folx trafficked into the labor trade have all sorts of layers of trauma damage. … Victims of sexual intercourse all have symptoms of domestic violence, emotional abuse, physical abuse, sexual abuse – all in one very uncomfortable package, ”he continues. “And expressive therapy won't treat that trauma; it will treat the symptoms. If we really want to help Folx, we have to go deeper, and that's where advisors really have to come into play. ”
Rose, a Certified Eye Movement Desensitization and Recovery (EMDR) therapist, recommends counselors use evidence-based trauma treatment that follows a triphasic approach that a) creates a foundation, b) prepares and works through the trauma, and c) plans for the future. Rose often uses EMDR when working with this population because he finds it helpful in treating the cause of the trauma. He also recommends trauma-focused cognitive behavior therapy, especially when working with children and adolescents.
Use the relational approach
Hershberger points out that traffickers differ from other sex offenders (who are often described as socially awkward and want a sense of belonging) in that they are often socially intelligent, charismatic, and good at building relationships. You gain the trust of vulnerable people by first meeting their need for love, connection, and belonging, she explains. For example, the trafficker could be the first person in the person's life to recognize and celebrate their birthday, or to give them special attention, e.g. B. for a manicure.
These acts can lead some survivors to forge links with and defend their traffickers – a condition often referred to as Stockholm Syndrome. Hershberger and Dunlap point out that something similar sometimes happens with individuals exposed to domestic violence. “Survivors often defend their traffickers because they didn't have that sense of belonging or because this family grew up. This is the first time that they are experiencing this – along with terrible trauma – but it is difficult for them to distinguish, ”explains Hershberger.
According to Hershberger, these trauma ties illustrate the survivors' desire for human connection. Human traffickers thwart this connection by taking advantage of this wish for their own benefit.
“Human trafficking is the ultimate anti-relationship,” argues Hershberger, who recently gave a lecture on the subject at the ACA's Virtual Conference Experience. Sex trafficking survivors have been forced to “exist in a world without authentic, growth-friendly relationships,” she explains. Therefore, she recommends counselors use a relational-cultural approach with this client population in order to foster an authentic growth-promoting connection.
To explain this approach, Hershberger introduces Marie, a fictional client: When she was 14 years old, Marie lived in an abusive home where her mother's boyfriend molested her. So Marie was excited when Jake, a 24-year-old man, came up to her and promised her a better life than his "girlfriend". He bought her nice things and told her she was "amazing in bed". One day he told Marie that some money hadn't come at work and asked if she would help him by having sex with a couple of men. When she struggled, he beat her until she obeyed. He forced her into sex trafficking and she had sex with up to 10-15 men a night. (See Hershberger's 2020 article, “A Relational-Cultural Theory Approach to Working with Sex Trafficking Survivors,” published in the Journal of Creativity in Mental Health, for a more detailed discussion of this case study.)
Following a relational-cultural framework, Marie's advisor initially creates a feeling of security and trust, and they are authentic, empathetic and consistent in their interpersonal interactions, says Hershberger. So if the counselor makes a mistake by showing up late for the meeting, he acknowledges the mistake, apologizes and asks Marie how he can make amends.
Marie may have internalized negative beliefs or self-reproaches, such as “I am only good for my body and the benefit of others” or “I am not worthy to be loved”. The counselor can help Marie identify and name these beliefs first, and then they can work together to challenge these negative beliefs. The therapeutic relationship further challenges Marie's distorted thinking about herself and relationships, notes Hershberger, and models what a healthy relationship entails.
To question Marie's beliefs, the counselor could use self-assessment and tell Marie: "I experience you as a creative, confident person who is worth loving." Hershberger recommends counselors to use the to use the client's own words to help the client to recognize and recognize his strengths.
As Hershberger points out, human traffickers try to keep victims in a constant state of uncertainty about their surroundings, security or identity. The role of the counselor is to identify unclear moments or thoughts, such as Marie's negative perception of her self-worth, and to help her to create clarity.
Hershberger names bibliotherapy and narrative therapy as useful approaches to empower survivors of human trafficking and to help them find their own voice. For example, the counselor could ask Marie what name her human trafficker gave and what name she would like to use in the future. Then Marie could write a diary about this new identity and the qualities associated with it.
The consultant could also add creative techniques such as collages or relational images. For example, Hershberger once had a client who identified with the image of a wounded deer because he too had been injured and abandoned. The wound corresponded to their own trauma related to the physical abuse they had experienced while being trafficked. Hershberger later used this image to help the client reflect on their future identity and create a collage of their strengths.
The therapeutic relationship becomes a healthy one – one that is safe, reliable, and empowering, and counteracts the separation and insecurity that survivors experienced when they were trafficked, says Hershberger.
Preparation for working with this population group
The best way to understand what is going on with human trafficking in a given area is to get involved and volunteer in the community, says Rose. A starting point is attending or participating in meetings of local, regional or state coalitions and task forces on human trafficking. “You can find out more about which agencies are offering services to this population,” he says. "You need to know where mental health providers are and you need to know where additional services for survivors are."
Rose advises counselors to approach these partnerships with a learning and helping attitude. Communities don't respond well to people who think they know what's best or have the right answers, he says. Instead, educate these organizations about the critical skills they may be lacking. The consultants have "the clinical piece that many of these places need and seek," notes Rose. "There are many social workers, nurses and other helping professionals, but clinical mental health treatment may not be what they have."
In addition to attending monthly sessions of the North Dakota Human Trafficking Task Force, Hershberger prepared to work with this population by reading case studies and familiarizing herself with these difficult stories. She also reached out to other clinicians in the field to hear about her experiences. She emphasizes: "It is one thing to hear terminology, but another thing to hear someone's story."
Rose and Dunlap recommend counselors to limit their case numbers (if they can) when working with this population. "You can't hear the nightmares three, four, or eight hours a day and expect it to be okay by 6 or 7 a.m.," says Rose. Both he and Dunlap, an ACA member who researches and works with youth with disabilities, trafficking survivors, and criminal populations, had to learn to better align their clinical schedule. They purposely leave time between these difficult sessions so that they can reflect, re-energize, and regroup before seeing their next client.
Counselors also need to remember that not every client-counselor relationship is the right one, says Rose. For example, someone may refer a female sex trafficking survivor to him for his expertise in EMDR, but if she has been molested by men her entire life, she may not want to work with Rose, regardless of his qualifications and reputation as a consultant.
"These clients have been treated very badly all their lives," he emphasizes. “Part of that therapeutic relationship is realizing that I may not be the best counselor for every person I want to help, and that's fine. Only giving this freedom and autonomy [clients] will help them on their way. You don't have to work with me to fix the problem. ”
Rose reminds counselors that there are other ways to help this population without working directly with clients. Advisors can get involved in local agencies that deal with human trafficking, offer training and further education or deal with prevention, he says.
Hershberger understands how difficult it can be when advisors have to refer a client. Since she was part of a crisis response team when she met the woman who survived the human trafficking, she was unable to continue working with her. The woman was referred to another clinician who worked for the Human Service Center. “That was tough,” she recalls. "I couldn't stay with her, and this continuity of care would have been nice."
Hershberger had the opportunity to meet the woman a few months later. With the help of her new advisors, she made progress towards healthier relationships.
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Working with perpetrators of human trafficking
P aige Dunlap, a licensed clinical mental health advisor based in Greensboro, North Carolina, once worked with an agency in Detroit that assisted people who stopped participating in gang activities. By sharing their stories, some of the group members announced that they were directly or indirectly involved in human trafficking. After recovering from the initial shock, Dunlap began to think about it and to find out how advisers could help traffickers.
"We as consultants don't really talk about this hidden culprit population," she says. "We don't know much about them."
Often people's prejudices can cloud their judgment about these people. The more Jenna Hershberger, a licensed Associate Professional Counselor in Fargo, North Dakota, researched and worked with cases of sex trafficking, the more she discovered the dichotomous thinking involved: people view traffickers as "bad" and survivors as "good." . "But it's more complicated, she says.
"In the literature we see that traffickers and survivors experience the same childhood trauma as sexual, emotional, physical and spiritual abuse," she explains. But for people who become traffickers, "there is a bias in the way they respond to the trauma". Hershberger, a graduate student in the Counselor Education and Supervision Program at North Dakota State University, admits this is an area of research that mental health professionals do not yet fully understand. However, initial clinical findings as well as Hershberger's own professional experience indicate that human traffickers often show a lack of empathy and support human trafficking myths such as “people like this way of life”.
Dunlap, Associate Professor of Counseling at North Carolina Agricultural and Technical State University, says that traffickers and victims of human trafficking are often entangled in this world for similar reasons. “There is a need to belong in all of these people,” she says. Both groups often lack support systems, have limited job opportunities and are tempted by promising a “better” life, she explains.
Once people are involved in human trafficking, it becomes difficult for them to leave the country, emphasizes Dunlap. “For them, too, it is almost becoming an institutionalization. … They don't know how to function outside of it. "
"It's getting really difficult to get these people into your office to do this hard work," she admits. "If you are a counselor and you happen to have these clients, the last thing they need is that your own prejudices keep them from getting help because it is good for them to just be there."
Hershberger hopes the counselors will continue to find ways to better serve both survivors and traffickers. In doing so, she encourages counselors to address a larger question: How do we as a society create spaces in which people do not know what a healthy relationship looks like, so that they search this subculture for a sense of belonging?
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Lindsey Phillips is the Senior Editor of Counseling Today. Contact them at [email protected].
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Opinions and statements in articles appearing on CT Online should not be construed as the opinions of the editors or guidelines of the American Counseling Association.
