Human Trafficking in Mental Health

Human Trafficking in Mental Health (by me for Minded Institute) What is a human trafficking? Is it the sexual slavery, the domestic violence or the labor slavery? It’s not easy to distinguish the real meaning of it. All those factors are related to each other and definitely can be linked to human trafficking. However my main focus is in a global sexual slavery. Almost 1milion population including children, women and men are en–slaved and tortured each year in demand for their bodies (UN 2007). There are certain organizations, which globally are engaged in the battle against human trafficking such as the United Nations (UN), International Organization of Migration (IOM), International Labor Organization (ILO) and UNICEF. To increase the awareness of this phenomenon on national and international level all kind of medias such as New York Times, National Geographic, film productions ‘Dirty Pretty Things’, ‘Holly’ and performing arts are involved in either tracking the most affected locations, population or providing with the preventions such as counseling, psychotherapy, creative therapy, neurotherapy (neurofeeback). The main cause of human trafficking is a migration and labor slavery of trafficked population due to the underdeveloped economically countries and other mental disorders of traffickers. According to Omelaniuk (2005), IOM data show that nearly 80% of those trafficked are women, and 75% are 25 years old or younger. Seelke and Siskin (2008) highlight that trafficking can occur in multiple ways: individuals could be kidnapped as well as lured or enticed with false promises of paying jobs. Hughes and Denisova (2002) also report that individuals may be drawn into trafficking through such sophisticated methods as apparently legal “modeling” schools, tourist agencies, or seemingly reputable sources for international jobs. Women and children trafficked for sexual exploitation typically are sexually tortured, raped, starved, confined, secluded and forced to have unprotected sex with multiple sexual partners (Monzini 2005; Omelaniuk 2005; Seelke and Siskin 2008). Many are also forcibly made to use drugs (Monzini 2005; Seelke and Siskin 2008). Those trafficked for purposes of forced labor can be similarly physically and mentally abused as well as confined, secluded and made to work in brutal conditions and for long hours (Seelke and Siskin 2008). Those individuals who are found and returned to their home communities often face additional difficulties. Many countries have no or inconsistent laws and regulations regarding the identification and treatment of trafficked individuals (Omelaniuk 2005). When returned, individuals may be spurned by their home communities and their families, especially in the case of sexual trafficking, forcing individuals into conditions that make them again vulnerable to being trafficked (Hughes and Denisova 2002; Monzini 2005). For example, studies in Ukraine show that 75% of families would shun a child who was known to be involved in prostitution, even if involuntary (Hughes and Denisova 2002). In addition to these difficulties being increasingly addressed by non-governmental organizations and international human rights organizations in trafficked individuals’ home communities, much can be done by those countries considered to be receiving communities, such as the U.S. or the countries of the European Union. The victims of such a terrible traumatic experience can search help in mental health professionals and their organizations in attending to issues related to trafficking, such as rehabilitation of victims, prevention of trafficking and becoming involved in local, national and international efforts to stop these violations of human rights. Severe psychological and physical abuse, as well as struggling to survive under extreme and at times life-threatening conditions, marks the typical context of trafficking (Hughes and Denisova 2002; IOM 2002; Monzini 2005; UN 2007). IOM (2002) reports show that typical victims of trafficking experience many symptoms reported by those who have experienced torture, such as psychosomatic reactions, psychological reactions, psychoactive substance abuse and dependence, social reactions and psychophysical consequences of PTSD or injuries. A study by Bezpalcha (2003) identified the following range of reactions: fear, guilt, rage, sense of betrayal, distrust, helplessness, shock, suspicion and feeling lost. An IOM (2003) study involving trafficked women in Kosovo showed that individuals also may experience a sense of apathy/resignation, extreme forms of submissiveness to any authority, maladaptation in all social situations, and loss of personal initiative or autonomy. This study also showed that such individuals tended to turn to self-medication through substances as well as being much more likely to inflict self-harm or to commit suicide. However, this study also highlighted that victims of trafficking often possessed resilience and a quest for meaning that facilitated their healing and adaptation. Even if the psychological assistance is highly required to help the victims to deal with their trauma, however existing guidelines appear to focus primarily on actions by law enforcement personnel, humanitarian and social agencies seeking to provide victims with basic needs, such as safety and shelter, as well as more fundamental legal and economic resources. Focus on repatriation to their home community is often primary. Thus, although psychological rehabilitation is frequently highlighted as being vital to victims’ healing and integration, it seems to receive only minimal attention and resources. Aron et al (2006) reported that victims often indicated that they wished to receive some type of counseling treatment, especially after their sense of safety and normalcy was re-established. In their study, those who received counseling reported “many positive outcomes, including a stronger sense of self and a feeling that that they have grown stronger from having survived the trafficking experience and coped with its aftermath”. Mental health practitioners are trained to provide with appropriate service to the victims of physical and mental abuse. Also they collaborate with social agencies that can provide such clients with access to legal, economic, vocational, and other vital life resources. The clinical work with victims of trafficking is most likely to include cross-cultural encounters; counselors should seek training in how to work through interpreters. Therapists cultural awareness should encompass an understanding of the diversity of worldviews, family/community/social processes, and ethnic identity. A mental health education, psychotherapy, cultural empowerment, and integration of Western and indigenous healing methods are a key point in efficiency of helping the victims of Human trafficking. In prevention of human trafficking a various organizations are involved as specified above. The integrity of therapists and the international organizations can improve the chance of help and save life’s of human trafficking victims. As I’ve already mentioned about the common mental damage due to a sexual abuse, its causes and preventions, now I would like to relate to the alternative therapy techniques, which are as powerful and useful in posttraumatic recovery form the even as traditional therapy. Human trafficking victims usually have symptoms of PTSD and the most common ways of healing are through the breath, body movement and meditation. As much as I’m interested in creative arts form of therapy, however on this occasion I would like to elaborate a theme of yoga therapy in this particular population. YFTM is one of the yoga therapy forms, which consists of psychotherapy, neuroscience, yoga and meditation aspect in healing of people with mental health issues including PTSD. In this case I would like to draw attention to PTSD aspect in relationship to YFTM based on neuroscience. In PTSD there is an imbalance in the brain functioning between the left and right hemisphere. Repetitive recall of traumatic memories and chronic intermittent hyperarousal are characteristic of posttraumatic stress disorder (PTSD). Hyperarousal and memory dysfunction implicates “limbic” brain regions, including the amygdaloid complex, hippocampal formation, and limbic cortex, such as the orbitofrontal and anterior cingulate areas. Activation for PTSD population occures in the anterior cingulate/middle prefrontal cortex - in the region of the left amygdala. The neurotherapy/neurofeedback is another very sufficient form of therapy to treat the PTSD patients and in this case victims of human trafficking. It involves helping a person learn how to modify his or her brainwave activity to improve attention, reduce impulsivity, and to control hyperactive behaviors. It is a painless, non-invasive treatment approach that allows the individual to gain information about his or her brainwave activity and use that information to produce changes in brainwave activity. Available research indicates that individuals with PTSD have too little of certain types of brainwave activity in some areas of the brain and/or too much of certain other brainwave activity in comparison to those without the disorder. In Neurotherapy individuals are trained through the use of computerized biofeedback equipment to change their brainwave activity. Clinicians and researchers who have provided Neurotherapy training report that when brainwave activity is changed, or when the brain is trained to work in certain ways in the process of Neurotherapy, symptoms of PTSD are usually reduced. YFTM is one of the most efficient methods to treat the PTSD in a very complex way. By fusing various techniques such as: breath, yoga practice, meditation/relaxation we centre the body, breath and mind. By merging them with psychotherapy and neuroscience’s principles we prevent from the memories arousals, traumatic experience flashbacks. As PTSD population is tent to be dissociated from themselves, YFTM helps this population to be aware of body, breath and by being with whatever sensation arises, brings mind to the present moment. Ocean sound breath in first place draws attention to the breath and calms down the triggered mind. Followed by a very intelligently structured simple yoga sequence, brings awareness to the body and movement. The meditation at the end of the therapy session allows to rest the body, breath and mind. To stay still in lying or seating position requires focused and centered mind. All those elements enriched by psycho and neuro education are grounding, helpful in stilling the mind and preventing from repetitive thoughts arousals. The closing at the end of therapy session integrates the participants if it’s a group sharing and allows to express ones feelings on the surface of not engaging topics. In addition to such a set up practice after yoga sequence or instead of it, depending on time I would consider adding the flow/free/improvised meditative movement starting from the floor and gradually rising up, using different levels in different space and dynamic. In this case I would play a soft music that would inspire one to move within his/her range of movement. This would aspire the participant to be creative and feel safe in the environment created by his/her awareness while moving. Followed by ocean sound breath and relaxation in corps pose would settle up once breath and mind in a present moment. I would like to elaborate a little bit more border the topic of trauma and PTSD in relationship to survivors of human trafficking. Beside all the factors, causes and ways of dealing with PTSD I’m going to give an outlook on the traumatic events in general and in relationship to trafficked population. Trauma is a noun- meaning wound. It’s defined as: a psychologically wounding experience which “includes physical, sexual and institutional abuse, neglect, intergenerational trauma and disasters that induce powerlessness, fear, recurrent hopelessness and a constant state of alert” (National Center on Trauma-Informed Care). A traumatic experience usually includes the overwhelming experiences beyond one’s normal ability to cope, threat to one’s physical and/or mental well-being, extreme vulnerability or a complete loss of control, feeling chronically helpless and fearful, profoundly disrupts one’s relationships and one’s basic belief systems (J. Herman, 1992). PTSD can develop in people who have experienced: childhood physical, emotional, or sexual abuse, a serious accident, medical complications, violent physical assaults including torture, sexual assault or rape, violent, life threatening, natural disasters, incarceration, human trafficking-labor and/or sex. Severe trauma destroys one’s belief in a safe world. One loses his or her ability to control or predict their world. All survivors search for meaning in what has happened to them. Finding some meaning is critical to ultimate healing. Culture plays a significant role in how trauma is identified, explained and resolved. How does our culture view a prostituted teenage, criminal, drug addict, willing participant, or victim? All these labels affect how the teenager views him or herself and how quickly they see their own vulnerability and victimization. The same level of PTSD is in prostituted persons as in combat veterans. Trafficked persons often don’t know if they will live or die, moment to moment. Over 90% of prostituted persons want out, but cope with continuing in prostitution-by dissociation and numbing out (Melisa Farley, Ph.D.) Trauma occurs on a continuum of complexity, from less complex single events adult onset (an auto accident), to the repeated and intrusive trauma, frequently of an interpersonal nature (the serial commercial rape of sex trafficking). The more the violation of relationship, trust, body integrity, violence, the more prolonged the deepening of trauma. Complex trauma Involves multiple or prolonged traumatic events. It results in emotional deregulation, loss of safety, direction, and the ability to detect or respond to danger cues. Often ‘miss’-diagnosed as ADD/ADHD, OCD, Schizoaffective, etc (J. Herman, 1992). Intergenerational trauma consists of traumatic events that took place in previous generations and impact current behaviors and beliefs (colonization, Holocaust survivors, earthquake and hurricane survivors, domestic violence, sexual abuse, trafficking (Ally Jamieson, MSW). Prevalence estimates of lifetime exposure to traumatic events from the National Comorbidity Survey were as high as 61% of men and 51% of women (Kessler et al, 1995). 29% of all forcible rapes happen before the age of 11. In 1994, 62% of nearly 3 million attacks on American women were perpetrated by someone they knew, 63% of nearly 4 million attacks on men were perpetrated by someone they didn’t know, strangers (van der Kolk, 2000). Children are abused at a rate1500% higher than the national average (National Victim Center, 1993) Traumatic responses are that person’s best attempt to cope with the overwhelming experience of trauma. Each person responds differently to the same potentially traumatic events depending on one’s personal history with trauma, social and familial supports, and natural coping skills (J. Herman, 1992). Victims who experienced early violence - prolonged, intrusive, and life threatening situations can be expected to manifest severe trauma symptoms and without specialized treatment their traumas will likely leave permanent emotional scars. Even with therapy forty percentage of complex trauma survivor fail to achieve full symptom relief (L. Schupp, 2004). “For many sexual assault precedes their entry into sex trafficking; the trauma they have sustained renders them vulnerable to their traffickers, facilitates the traffickers’ control, and is exacerbated by ongoing serial commercial rapes, terroristic control tactics, trauma bonding, confinement and isolation”(D. Leidhodt, 1994).“Fear is also increased by inconsistent and unpredictable outbursts of violence and by capricious enforcement of petty rules. The ultimate effect of these techniques is to convince the victim that the perpetrator is omnipotent, that resistance is futile, and that her/his life depends upon winning her/his indulgence through absolute compliance” (In Trauma & Recovery, Judith Herman, 1993). In situations of captivity, like human trafficking, the perpetrator becomes the most powerful person in the life of the victim, and the psychology of the victim is shaped by the actions and beliefs of the perpetrator (In Trauma & Recovery, Judith Herman, 1993). Let’s imagine a 13 year old victim constantly having to lie about the age, all the identification is taken away, having to change the name, addictively following the abuser, being kidnapped, raped repeatedly, beaten for not making enough money, having threats made against victim’s family, changing the appearance, being constantly threatened with violence, living with a group of people called “family”, feeling trapped in an abusive and violent situation, not being allowed any contact with the world outside abusive situation, having sex with strangers every night, getting arrested again and again, having to trade sex with a police officer in exchange for not getting arrested,….(CSEC curriculum, Lloyd and Polaris Project). How possibly any human being could cope with such a situation and have no mental issue as a result? What’s the possibility of being able to recover after the mental, physical and brain damage has been done? Let’s have a look at the brain’s structure to recognize the brain changes and its dysfunction due to the behavioral changes based on the abuse. How power game between a victim and abuser can damage someone’s perception of safety and well-being. How possibly someone drawn into the prostitution can accept it without willing to escape. How manipulative must be oppressors, so victims obey every violation of their rights. How does our brain function to allow such a mental conditions to take place and create such a fear around traumatic event, so the victim is lost in self-evaluation and is not able to rebuild the trust. All these wouldn’t be explicable if the neuroscience wasn’t so advanced to prove the neuroplasticity and neurogenesis, that brain can change, the new neurons can be re-built and fired/wired between themselves. By relearning new thinking and behavioral patterns we create in the brain new neuro-patterns, which make remarkable changes in a life of someone who has been exposed to events which made his/her life unbearable and dissociated from it. In the structure of the brain we’ve got three major sections all related with each other: limbic system responsible for emotional regulations; brain stem for a heart rate, breathing, blood pressure, appetite, temperature, integrates with emotions and thoughts to adjust internal responses, can make some internal states “conscious” (hunger, pain, fatigue, etc.) and prefrontal cortex responsible for executive thinking like thoughts, problem solving, planning, organizing, time management. How do threats to safety impact the brain? Our body is designed to keep us out of danger. In other words, when trafficking surivers are unable to fight or flee, the entrapment instills a constant state of frozen hopelessness and hyper vigilance. We have one set of chemicals that revs us up, another that calms us down, and a third set that helps regulate the other two (Homelessness and Traumatic Stress Training Package The National Center on Family Homelessness). ““PTSD develops following exposure to events that overwhelm the individual’s capacity to re-establish homeostasis. Instead of returning to baseline, there is a progressive kindling of the individual’s stress response...even minor reminders of the trauma may precipitate a full-blown neuroendocrine stress reaction”(Van Der Kolk, 2003). Neurotransmitters are the chemicals that tell the brain what to think, feel, and do such as: Serotonin, Dopamine, Epinephrine, Norepinephrine, Oxytocin, Vasopressin. Environmental and emotional triggers inform how do neurotransmitters interact to regulate our moods and functioning. This is the classic “fight” or “flight” or “freeze” response in dangerous situations. Triggers activate the alarm system. When someone is triggered they may feel and act as though they are back in the time of danger, even though they are not (J. Herman, 1992). “Cells that fire together, wire together”. “Within this zone, a person can contain and experience affects, sensations, and thoughts and can process information effectively ...without disrupting the functioning of the system.” Ogden & Minton (1999).“Poor tolerance for arousal is characteristic of traumatized individuals” (Van der Kolk, 1987). Cortisol (stress hormone) protects the body by proper glucose metabolism, regulation of blood pressure, insulin release for blood sugar maintenance immune function, inflammatory response. With extreme and consistently high stress levels, the body experiences impaired memory and thought processes, widespread cell death, decreased developmental capacity, physical ailments such as: suppressed thyroid function, blood sugar imbalances, higher blood pressure and lowered immunity. In explicit memory is a need for conscious recollection in order to recall something. Implicit memory is characterized by a lack of conscious awareness in the act of recollection. Traumatic memories are stored in the implicit memories. The strongest memory is smell. The amygdala houses all unconscious traumatic memories and is where “fight/flight/freeze” is decided. The amygdala signals the rest of the body to respond through high levels of cortisol and other neurotransmitters/neurohormones. Trauma or sustained high stress in childhood damages the corpus callosum, which connects the left brain from the right brain. Disconnection can result in unknown and reactionary emotional states, depression and anxiety disorders, and memory limitations. What things might “trigger” a trafficking victim in a Salvation Army shelter? Certain smells, the presence of men in a female area, forced to stay in the shelter-confinement, lack of cultural sensitive activities or food, having no voice in case planning/decisions. Hebb’s hypothesis about “neurons that fire together wire together” means that the more we use neurons (thoughts, feelings) the stronger their connections become. The negative cycle of thinking processes stops from further prevention of expansion of self capacities, create overwhelming feelings associated with trauma/abuse, dissociate and use avoidance as coping skill (Briere, 2002). Psychological challenges for trauma survivors affect dysregulation, aggression against self and/or others, amnesia, dissociation, depression, distrust, shame, self-hatred. Traumatized sexual slavery victims experience flashbacks and repeated reliving of traumatic experience, avoid reminders, are hyper vigilant, have got concentration difficulties, unconsciously search for similarities between present experiences and past trauma (van der Kolk, 2003). Extreme stress disorders in PTSD complex event like human trafficking characterize victims with difficulty regulating anger or self- destruction, amnesias, dissociative and depersonalization episodes, chronic guilt, shame, and sense of responsibility, inability to trust or feel intimate with others. Common victims of human trafficking are children and as a result of developed trauma they respond in certain way to protect themselves, such as: fear and anxiety, difficulty in regulating emotions, memory and attention difficulties, learning challenges, psychotic-like symptoms , avoidance, sexualized behaviors, aggression, difficulty relating to others (Adapted from National Crime Victims Research and Treatment Center, Medical University of South Carolina). There are a positive feelings (Stockholm Syndrome) by the victim towards the abuser/controller and negative feelings by the victim towards family, friends, or authorities trying to rescue/support them or win their release. They support the abuser's reasons and behaviors, the abuser towards the victim has got positive feelings, supportive behaviors by the victim, at times helping the abuser, inability to engage in behaviors that may assist in their release or detachment (CSEC Curriculum, Lloyd and Polaris Project). In terms of trauma bonds victims are grateful for small kindness, deny violence when violence and threats of violence are actually occurring, rationalize violence, deny anger at exploiter to others and to self, believe they have some control over abuse. They believe if they control situation it lessens pimps/customers/traffickers control and abuse, self-blame for situation and abuse (CSEC Curriculum, Lloyd and Polaris Project). For Stockholm Syndrome to occur needs to be the presence of a perceived threat to one's physical or psychological survival and the belief that the abuser would carry out the threat, the presence of a perceived small kindness from the abuser to the victim, isolation from perspectives other than those of the abuser, the perceived inability to escape the situation (CSEC Curriculum, Lloyd and Polaris Project). Unfortunately, many victims return to abusive situations. Breaking trauma bonds takes the following: time, being genuine and caring about their welfare, building a trusting relationship, involving survivors in a program, providing practical assistance, and offering hope for positive change over time (move from victim to survivor identification). There is a vast amount of trauma specific therapies used in human trafficking victims cases which I’ve mentioned about earlier and I would like to extend it to: Cognitive-Behavioral (CBT) - to address faulty beliefs, peer support group therapy, intensive grief counseling Rapid Eye Movement, tapping, other physical techniques to break the connection between sensations and memories, journaling, writing, poetry, art, dance, yoga, breath work, life skills training, exposure and other behavioral therapies, spiritual approaches such as mediation, mindfulness, Acceptance and Commitment Therapy (ACT) (Ally Jamieson, MSW). Additionally, developing alternative to traditional “talk” therapies is seen as an important adjunct in the long term healing of trauma, especially therapies that build self esteem, empowerment and re-connection with self, such as: art therapy, journaling, poetry and song writing, yoga, body work, drama and outdoor physical activities, like gardening and pet therapy. To intervene existing situations there is a need of particular strategies such as: exploration vs. consolidation – finding the balance, intensity control and the goal sequence – self before trauma. The most important for survivors is to develop a relationship with self. It can be achieved by safety, support, facilitation of self-awareness and positive identity, self/other entitlement, affects modulation/tolerance and interpersonal relationship challenges (Ally Jameison, MSW). The therapeutic processes are facilitated in order to increase survivors awareness of triggers, reduce influence of memories when triggered, reduce cognitive/emotional activation over time (Briere, 2002). In order to be most helpful, Salvation Army line staff should be trained in basic calming techniques and coordinate efforts with the treating specialized clinical therapist, and the victim/survivor him or herself. 􏰀 Safety, anxiety management, emotional processing are the most critical steps in treating PTSD (van der Kolk, 2003). Trauma informed practice suggests the staff are aware (as much as possible) of potential triggers and reactions to triggers for the survivors under their care, and that staff will have planned a strategy to assist survivors to calm themselves when they are triggered with non- life threatening environmental stimuli. The informed program is designed of 6 Components for Trauma: setting the stage, conducting and understanding the self-assessment results, develop a strategic plan, implement trauma-Informed changes, sustain change/adapt to new challenges. The principles of Trauma-Informed Care are to understand trauma and its impact, promote safety, ensuring cultural humility, supporting survivor’s control, choice and autonomy, sharing power and governance, integrated & holistic system of care, caring and supportive relationships, on-going healthy boundary analysis and belief that recovery is possible (Headington Institute, 2010). Trauma-Informed Organizations are living systems themselves. Like individuals, organizations are vulnerable to the impact of repetitive and/or chronic stress conditions. It’s essential to ask ourselves question what kinds of people trigger us? Awareness is critical...When we are listening to someone’s story of something that triggers us, we are hit twice as hard psychologically and biologically. The “body memories” are triggered and are not necessarily in our control (Ally Jamieson, MSW) I would like to refer to a Vicarious Trauma. It’s a transformation in the self of a trauma worker or helper that results from empathic engagement with traumatized clients. Its physical and psychological signs manifest in hyper-arousal, invasive thoughts or images regarding traumatic events (particularly when trying not to think about it), feeling numb, feeling unable to tolerate strong emotions, increased sensitivity to violence, cynicism, generalized despair, hopelessness, loss of idealism, guilt regarding our own survival and/or pleasure, anger, disgust, fear (Headington Institute, 2010) Vicarious Trauma is characterized by various behavior and relationship signs, such as: difficulty setting boundaries, feeling like we never have time or energy for ourselves, feeling disconnected from love, general social withdrawal, difficulties paying attention to other’s distressing stories, decreased interest in activities that used to bring enjoyment or relaxation, irritable, intolerant, agitated, impatient, needy, and/or moody, increased dependencies or addictions involving nicotine, alcohol, food, sex, shopping , internet, and/or other substances, sexual difficulties, impulsivity (Headington Institute, 2010) Transference can happen in every healthy relationship. To be able to bring traumatized person back to its own values and self-confidence the awareness, balance and connections are essential. Very important are self care strategies such as sleep, eat well, exercise, walk, jog, dance, do yoga, read for pleasure, say ‘no’, smile, see friends, cry, laugh, meditate, boundaries. “Personal boundaries are guidelines, rules or limits that a person creates to identify for themselves what are reasonable, safe and permissible ways for other people to behave around them and how they will respond when someone steps outside those limits.” Source: (ChildTraumaAcademy,2002) In what ways can language “creep into” our perceptual world and influence or change how we view a situation? If it’s manipulative, bossy, paranoid it can hurt and affect the recovery of the victim. If it’s gentle, sensitive, in the same time indicating the rules and boundaries for example instead of ‘Rule-no watching TV after 10pm’ can be rephrased ‘Community Living Agreement -You can watch TV until 10pm’. In communication of rules is significant to include what you can do, not simply what you can’t do. To create the safety environment around the therapy delivered to the victim of human trafficking and PTSD, remarkable is the awareness of other services involved in the therapeutic methodology, staff training trauma, impact on development, symptoms, triggers, attachment theory, cultural differences in trauma meaning, impact of working with survivors on staff, de-escalation strategies, maintaining healthy professional boundaries. To monitor the changes and process of victims healing is on going staff supervision and self care, establishing a safe physical environment, cultural competency, privacy and confidentiality. To prevent client from flashbacks and self-harming is to set up the safety planning and crisis prevention, open and respectful communication, developing empowering goals and plans. The reason I chose to elaborate the human trafficking topic in mental health is to picture one’s difficulties to engage in the society, forgive him/herself and others; encourage one to appreciate the given opportunity to live and make changes within the community or just take a different path in his/her life. We are only human beings and the mind is there to remind us of the past and future, however we are in charge of our own destiny. By using different forms of therapy partly listed above, we can make changes in our life as an individual and as a society. Being judgmental and full of guilt will not make any difference in one’s self-evaluation. By being aware of the weaknesses and accepting the disadvantages we can move forward and make progress. As the trafficking of human beings is epidemic, the mental health providers and government institution are responsible for ending such an exploitation and violence. Such a vast number of almost 1 million sexually abused, traded children, women and men brings a need of the psychotherapy topic to be explored in order to find the most efficient preventive ways for the most affected people to carry on with their lives. These individuals may find their way to recover mentally by receiving an appropriate professional therapist’s assistance. Us as a society being aware of the credulity and terror expanded over the world in field of sexual slavery and labor, we can fight for human rights and diminish the suffering of the trafficked population or prevent it from happening. Bibliography: Anti-Slavery International. (2005). Protocol for identification and assistance to trafficked persons and training kit. London: Anti-Slavery International. Aron, L. Y., Zweig, J. M., & Newmark, L. S. (2006). Comprehensive services for survivors of human trafficking: Findings from clients in three communities. Washington, D.C.: Urban Institute. Bales, K. (2005). Understanding global slavery. Berkeley: University of California Press. Bessel A. van der Kolk 2003. Posttraumatic Stress Disorder and The Nature of Trauma. Biol Psychiatry 1999;45:817–826 (1999) Society of Biological Psychiatry. PsychiatryDraguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (2nd ed.), pp. 209–232. Thou- sand Oaks: Sage. Bloom, S. (2006). Organizational Stress as a Barrier to Trauma-Sensitive Change and System Transformation. Community Works, Philadelphia, PA. European Commission. (2004). Report of the experts group on trafficking in human beings. Brussels: European Commission. Feingold, D. A. (2005). Human trafficking. Foreign Policy, 150, 26–32. Headington Institute, 2010, www.headington-institute.org Hughes, D. M., & Denisova, T. (2002). Trafficking in Women from Ukraine. Final report to the National Insti- tute of Justice, 2002, NCJ 203275. ILO (International Labor Organization) (2005). Tools for prevention — participatory monitoring: Guidelines for practitioners in the fight against human trafficking. Bangkok: ILO. IOM (International Organization for Migration) (2002). Report of the counter-trafficking unit: Return and re- integration project. Brussels: International Organization for Migration. Kelly, L., & Regan, L. (2000). Stopping traffic: Exploring the extent of, and responses to, trafficking in women for sexual exploitation in the UK. Police Research Series, Paper 125, Home Office, London. Loiselle, M., MacDonnell, M., Duncan, J., & Dougherty, M. E. (2006). Care for trafficked children. Washing- ton, DC: United States Conference of Catholic Bishops. Monzini, P. (2005). Sex traffic: Prostitution, crime and exploitation. New York: Zed. Omelaniuk, I. (2005). Trafficking in human beings. New York: The United Nations Expert Group Meeting on International Migration and Development, UN/POP/MIG/2005/15. Poulin, R. (2004). Globalization and the sex trade: Trafficking and commodification of women and children. Canadian Women’s Studies, 22, 38–43. Trauma Informed Practice to Victims of Human Trafficking Michael A. Smith, Ph.D., LCSW Cascade Division Social Services Consultant The Salvation Army Portland. United Nations. (2002). Prevention of human trafficking. New York: United Nations. Vayrynen, R. (2003). Illegal immigration, human trafficking, and organized crime. Discussion paper no. 2003/72. Helsinki, Finland: United National University/Wider.