Amanda Gopal, LCSW. At A Glance. Clinical Considerations and Interventions for Survivors of Sex Trafficking

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1 Clinical Considerations and Interventions for Survivors of Sex Trafficking September 13, th Annual Children s Cove Conference Amanda Gopal, LCSW agopal421@gmail.com Amanda Gopal, LCSW Therapist, The Healing Place, Hendersonville, NC The Hope House DMST program The Hundred Movement At A Glance Definitions and scope of sex trafficking Characteristics of sex trafficking victims: mindset, common mental health diagnoses Cultural considerations Treatment Interventions EMDR TFCBT IFS

2 Trafficking in Persons Article 3 of U.N. Protocol to Prevent, Suppress and Punish Trafficking in Persons: Trafficking in persons shall mean the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs; Sex Trafficking Trafficking Victim s Protection Act (TVPA) of 2000 defines sex trafficking as the recruitment, harboring, transportation, provision, or obtaining of a person for a commercial sex act. Commercial sex act means any sex act on account of which anything of value is given to or received by any person. Severe form of trafficking: sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age. Note: Force, fraud, or coercion is not needed if the victim is under age 18 How It Happens Kidnapping or Detaining Boyfriend Pimp Gangs or Drug Cartels Recruitment From Peers Extortion or Blackmail Internet False advertising for modeling, acting, dancing jobs

3 Scope of Sex Trafficking International Labor Organization Global Estimate of Forced Labour, million people subject to forced labor, including labor and sex trafficking 4.5 million (22%) are victims of forced sexual exploitation 98% of sex trafficking victims are female 21% of sex trafficking victims are under 18 74% are trafficked across international borders 19% are trafficked/moved within their own country 7% are trafficked where their usually reside Common Trauma Reactions in Sex Trafficking Victims Depression Anxiety or Panic disorders Substance abuse Eating disorders Suicidal thoughts or behaviors Irritability and Anger Hypervigilance Difficulty sleeping Flashbacks Hallucinations or Delusions Difficulty establishing trust Nightmares/Night Terrors Trauma bonds Avoidance Memory loss Intrusive Thoughts Shame Self-Blame Dissociation *PTSD *Dissociative disorders *Complex trauma *Anxiety Disorders *Substance Abuse Disorders

4 7 Domains of Impairment in Complex Trauma Attachment Biology Affect or emotional regulation Dissociation Behavioral control Cognition Self-concept Cook, A.,, Blaustein, M., Spinnazzola, J., van der Kolk, B. (Eds.). (2003). Complex trauma in children and adolescents. National Child Traumatic Stress Network. What Makes The Sex Trafficking Victim Unique Extended rapport building phase Deeply seated defenses Don t recognize the victimization as easily Difficulty with trust More focus on safety Lack of support system Difficulty gathering history Move to rescue home Family involvement in abuse Often not good self-reporters Intense trauma bonds Things That Don t Work Framing their experience for them Assuming that the sex trafficking was the worst experience Engaging in the power struggle Trying to do it all myself

5 Other Considerations Don t expect a neat package Don t take lies personally Mirror the language they use Give them choices Appearance and material things can be important Cultural Considerations Counseling is predominately a western practice Conceptualization of mental illness Family culture of keeping problems to yourself Work within context of family (not individual) Knowledge of immigration remedies and resources Role of culture in Marshall Islands it is acceptable to be a prostitute Gang culture; trafficking culture; street terms Language barriers National Human Trafficking Resource Center Trauma Informed Services Trauma Sensitive Services Trauma Focused Services Johnson, B.C. (2012). Aftercare for survivors of human trafficking. Social Work and Christianity, 39 (4),

6 Assessments Trauma Symptom Inventory (ages 18+) John Briere, Ph.D. Trauma Symptom Checklist for Children (ages 8-16) John Briere, Ph.D. Juvenile Victimization Questionnaire, David Finklehor et al. Strengths and Difficulties Questionnaire, Robert Goodman Dissociative Experiences Scale, Eve Bernstein Carlson, Ph.D. and Frank Putnam, M.D. UCLA PTSD Scale, Pynoos et al. Eye Movement Desensitization and Reprocessing (EMDR) Developed by Dr. Francine Shapiro Evidenced-Based Treatment for treating trauma Based on Adaptive Information Processing (AIP) model 3 pronged approach: Past experiences, current triggers, future challenges Dual focus and bilateral stimulation Results in alleviation of presenting symptoms, a decrease or elimination of distress from the disturbing memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers. (EMDRIA.org) EMDR with Sex Trafficking Survivors Extended preparation phase Extended resource installation Reverse Protocol Future-Present-Past Because trauma clients typically function in survival mode, where the client lives moment to moment with no thought of the future, establishing hope for the future is imperative for successful outcomes in therapy. Adler-Tapia, R. (2012). Child Psychotherapy: Integrating Developmental Theory into Clinical Practice. New York, NY: Springer Publishing Company, LLC

7 Internal Family Systems Richard Schwartz, Ph.D. Combines multiplicity of the mind and systems theory Goal is to achieve balance and harmony in the internal system and to differentiate the Self as the leader of the system Common internal parts: exiles, managers, firefighters, protectors, inner critic Parts Work: An Illustrated Guide to Your Inner Life by Tom Holmes Internal Family Systems Assessment Education and introduction of language Parts inventory Establish Self as leader of the system Work to ease fears and actions of protective parts Unburdening exiles Trauma Focused Cognitive Behavioral Therapy (TFCBT) Developed by Judith Cohen, Anthony Mannarino, and Esther Deblinger Evidenced-based practice for treating PTSD in children sessions Individual child and parent sessions Joint parent-child sessions Free 10-hour training

8 Trauma Focused Cognitive Behavioral Therapy (TFCBT) Assessment and Psychoeducation Relaxation and coping skills Affective expression and regulation Cognitive coping Trauma narrative In-vivo exposure (if needed) Healthy relationships Personal safety Adapted TFCBT for Sex Trafficking Victims Becca Johnson, Ph.D user-friendly language Gathering, Learning, Helping, Relaxing, Feeling, Thinking, Sharing, Evaluating, Sharing 2, Living Free, Safe and Well Residential staff or house parents are provided with parent information and taught TFCBT stages Trauma narrative piece about what victims had to do to others Possible TFCBT Stages with Sex Trafficking Survivors Rapport building Personal Safety Relaxation and coping skills Affective expression and regulation Cognitive coping Trauma narrative Healthy relationships Personal safety Preparing for the future

9 Possible TFCBT Stages with Sex Trafficking Survivors Rapport building Safety Relaxation and coping skills Affective expression and regulation Cognitive coping Trauma narrative Healthy relationships Personal safety Preparing for the future Rapport and Assessment EMDR Preparation phase Safety Psychoeducation IFS parts work Relaxation and Coping Sample Order Of Stages Affective Expression and Regulation Cognitive Coping IFS parts work EMDR future protocol Psychoeducation Trauma Narrative IFS parts work EMDR present and past protocol Healthy relationships Preparing for the future Amanda Gopal, LCSW