Introducing «Here & Now - A self-help guide for survivors of human trafficking»

Through her work with survivors of human trafficking in Norway and abroad, clinical psychologist Benedicte Ekman saw that many survivors have serious post-traumatic reactions, but for many reasons few received professional treatment and other medications. In an effort to meet this need Ekman in cooperation with colleagues in For Freedom developed self-help manual “Here & Now” to reach more survivors with evidence based psychological knowledge and support to help them. 

The manual was released August 22nd 2019 at “Litteraturhuset” in Bergen, Norway where Ekman introduced the work and presented the content of the manual.   Written by: Thea Myhr

The manual was released August 22nd 2019 at “Litteraturhuset” in Bergen, Norway where Ekman introduced the work and presented the content of the manual.

Written by: Thea Myhr

Trauma experiences in human trafficking

Modern slavery or human trafficking is defined by UN’s International Labour Organization as “situations of exploitation that a person cannot refuse or leave because of threats, violence, coercion, deception, and/or abuse of power” (International Labour Organization, 2018) .

Many survivors of human trafficking develop severe psychological reactions after the traumatic events they are exposed to in the trafficking and slavery situation (Banovic & Bjelajac, 2012; Greenbaum, 2014; Ostrovschi, 2011). Sexual abuse, violence, threats of violence toward the victims´ family, drug addiction and isolation are common control tactics traffickers use towards victims (Abas et al., 2013; Banovic & Bjelajac, 2012; Muftic, & Finn, 2013; Raphael, Reichert, & Powers, 2010), and living in these conditions for shorter or longer periods of time can cause severe post-traumatic reactions (Abas et al., 2013; Hossain et al., 2010).

Human trafficking include the use of threats and punishment in order to control and keep the victim in the situation. Threats like «If you don't do this, …. will happen to you or your family» are often legit and demonstrated. The control, deprivation of freedom, physical violence, sexual abuse, economic limitations or forced prostitution are common traumatic experiences in human trafficking (Estes & Weiner, 2002; Hossain et al., 2010; Raphael, Reichert, & Powers, 2010; Syamsuddin & Azlinda Azman, 2015; Muftic, & Finn, 2013; Raymond et al., 2002; Zimmerman et al., 2008). Victims are often in the trafficking situation for a longer period of time, which enhances the psychological pressure on the person. 


Normal reactions to abnormal events

Post-traumatic stress disorder (PTSD) is a common disorder for survivors of human trafficking (Banovic & Bjelajac, 2012; Hossain et al., 2010). Flashbacks, nightmares, anxiety, avoidance, dissociation and depression are common features of PTSD. The risk of developing PTSD increases with the severity and complexity of the traumatic events the survivors have been exposed to. The core of PTSD is that the victim lose their natural trust in other people and the basic belief that the world is a safe place. This hinders the victim´s ability to relax and engage with other people, sometimes even with their loved ones, often resulting in avoidance, isolation, loneliness, and depression. In addition the prevalence of other anxiety disorders, self harm and psychosomatic illnesses are high in this group (Greenbaum, 2014; Ostrovschi et al., 2011; Zimmerman et al., 2008), this can lead to self-medication and addiction. 

Some survivors become emotionally connected to their trafficker because many traffickers pose as boyfriends or they are in fact family members. The trafficker is often the one providing you some food, clothes and other necessities, but they are also the one using threat and violence to force them to work or perform services. The emotional mix of love, manipulation and violence in their relationship with their trafficker confuses many survivors and it can cause grief and shame when they work to process their experiences. 

In addition to psychological reactions and physiological injuries and illnesses, survivors often struggle with interpersonal difficulties like trust issues and emotional dysregulation (Ijadi-Maghsoodi, Cook, Barnert, Gaboian, & Bath, 2016). This can also cause survivors to distrust helpers and help in general. For Ekman it was important to develop a helpful tool that would be easy for survivors to receive, trust and try out. Therefore the manual is free and available on For Freedom´s home page, forfreedom.no. 
The reactions and difficulties observed in survivors of human trafficking are normal reactions to abnormal events. This however, is something many victims do not know until they are told so. Thoughts like «What is wrong with me?» or «Am I going crazy?» are not uncommon in trauma survivors who have not received help. Some survival reactions, like “fight-or-flight” were helpful for survival when exposed to trauma, but post-trauma they cause the survivor to react in inappropriate or confusing ways. The self-help manual explain why these reactions are common human reactions to trauma, how to understand them and how the reader can learn to stop them.

A labour of love

Ever since I studied psychology I have had an academic interest in trauma psychology and how certain events can affect a person's psychological functioning or harm their personal development. At the same time I have a passion to fight modern slavery. When I started working with survivors I quickly realized that my academic interest was very relevant to my work in the modern slavery field. This manual has been a labour of love for both the academic and the activist in me”, Benedicte Ekman, author of “Here & now”, says. 


The content of the self-help manual is based on principles from trauma psychology, which can be helpful for different types of clients. However, this manual is written for people who have survived a human trafficking or modern slavery situation where threat, violence and manipulation have been used to control and force the victim to work or perform services. The manual is written in English, mainly for adults, but the language is simple and the use of metaphors makes the content easy to understand. The purpose of the manual is to help survivors help themselves, but it can also be used in guided self-help or as a guide for helpers and therapists in their treatment of a client. 

The inviting design and illustrations, combined with the easy language, makes the manual available for most to comprehend. Each chapter covers a different topic starting with an introduction to educate the reader on the problem and helping them to recognize and understand the challenge in their own life. Each chapter ends with a guide to how the reader can master the challenge with tools or exercises. 

“The Norwegian health care system has many excellent clinical psychologists who understand the physical, sexual and psychological stresses that trauma survivors experience. The help exists and is both sufficient and available, but even so, the problem with human trafficking is new and unfamiliar for the helpers and therapists in the health care system. Part of the problem is also that many survivors struggle with trust and sharing their experiences with helpers. In addition many survivors return home before they can receive help. I hope the self-help manual can meet the need for knowledge and understanding that survivors and helpers have”, Ekman adds.  

Why self-help is necessary

“I would always recommend a survivor to seek professional health care and therapy if that is an option. However, many survivors do not have that option”, Ekman says. 


Victims of human trafficking may face several difficulties in their attempt to seek appropriate help for their post-traumatic difficulties. Lack of residence permit which hinders access to healthcare in the host country, or lack of proper health care in their home country, may leave many alone and struggling. Receiving the “Here & Now” manuel may therefore be a crucial and welcoming help for some of them.

“Here & now - A self-help manual for survivors of human trafficking” is now available to read on forfreedom.no.

References

Abas, M., Ostrovschi, N. V., Prince, M., Gorceag, V. I., Trigub, C., & Oram, S. (2013). Risk factors for mental disorders in women survivors of human trafficking: A historical cohort study. BMC Psychiatry, 13(204). https://doi.org/10.1186/1471-244X-13-204

Banovic, B., & Bjelajac, Z. (2012). Traumatic experiences, psychophysical consequences and needs of human trafficking victims. Vojnosanitetski Pregled, 69(1), 94–97. https://doi.org/10.2298/VSP1201094B

Estes, R. J., & Weiner, N. A. (2001). The commercial sexual exploitation of children in the US, Canada and Mexico. University of Pennsylvania, School of Social Work, Center for the Study of Youth Policy.

Greenbaum, V. J. (2014). Commercial sexual exploitation and sex trafficking of children in the United States. Current problems in pediatric and adolescent health care, 44(9), 245-269.

Hossain, M., Zimmerman, C., Abas, M., Light, M., & Watts, C. (2010). The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women. American Journal of Public Health, 100(12), 2442–2449. https://doi.org/10.2105/AJPH.2009.173229

Ijadi-Maghsoodi, R., Cook, M., Barnert, E. S., Gaboian, S., & Bath, E. (2016). Understanding and Responding to the Needs of Commercially Sexually Exploited Youth: Recommendations for the Mental Health Provider. Child & Adolescent Psychiatric Clinics of North America, 25(1), 107–122. https://doi.org/10.1016/j.chc.2015.08.007.

Muftic, L. & Finn, M. (2013). Health outcomes among women trafficked for sex in the United States: a closer look. Journal for Interpersonal Violence;28(9):1859–85.

Ostrovschi, N. V., Prince, M. J., Zimmerman, C., Hotineanu, M. A., Gorceag, L. T., Gorceag, V. I., ... Abas, M. A. (2011). Women in post-trafficking services in moldova: Diagnostic interviews over two time periods to assess returning women’s mental health. BMC Public Health, 11(232). https://doi.org/10.1186/1471-2458-11-232

Raphael, J., Reichert, J. A., & Powers, M. (2010). Pimp control and violence: Domestic sex trafficking of Chicago women and girls. Women & Criminal Justice, 20(1-2), 89-104.

Raymond, J. G., D´Cunha, J., Dzuhayatin, S. R., Hynes, H. P., & Rodriguez, R. (2002). A comparative study of women trafficked in the migration process. Patterns profiles and health consequences of sexual exploitation in five countries (Indonesia the Philippines Thailand Venezuela and the United States).

Syamsuddin, S. S. T., & Azman, A. (2015). “Door to door cleaner”: A new variant of human trafficking in domestic sector. Procedia-Social and Behavioral Sciences, 172, 405-410.

Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M., ... Watts, C. (2008). The health of trafficked women: A survey of women entering posttrafficking services in Europe. American Journal of Public Health, 98(1), 55–59. https://doi.org/10.2105/AJPH.2006.108357




Thea Myhr