Just released from prison at age 38, Norma Hotaling was determined to leave behind her past life of prostitution, homelessness and heroin addiction--at least 20 years of it.

"I was struggling for my life," she told an audience at a presidential-track address at APA's 2004 Annual Convention in Honolulu. "I was at a point that if I stayed on the street, I knew I was going to die....If you would have asked me what I thought about myself, I would have said 'I'm a bad person, I'm a criminal and I'm a horror.' You can only imagine what my life was like to develop that type of identity."

However, with therapy from a psychologist, Hotaling was able to make sense of how her life had spun out of control--tracing it back to the abuse she suffered in childhood and her resulting anger. And, through that insight, she's been able to turn herself around: Now, she's helping others like her escape prostitution and overcome the trauma and abuse from sexual exploitation.

In 1993, she founded Standing Against Global Exploitation (SAGE), a San Francisco-based holistic rehabilitation center that offers prostitutes mental health counseling and drug rehabilitation services to help them leave prostitution, heal from the trauma of sexual exploitation and begin new careers.

To feminist psychologist Janet Shibley Hyde, PhD, of the University of Wisconsin­Madison, Hotaling exemplifies the power of psychotherapy in helping people overcome trauma.

"Rarely have I seen such a personification of human resilience," Hyde told the audience during the session.

Prostitution trauma

But the road wasn't easy. Hotaling described herself as a casualty of numerous systems--judicial, medical and educational--that turned their backs on helping her. She attributed this to a prevailing societal view that prostitution is a victimless crime.

Countering that view, Hotaling said many women in prostitution suffer from post-traumatic stress disorder (PTSD) and self-medicate with drugs. What's more--and particularly disturbing--Hotaling said the average age of entry into prostitution is 14, and the term "child prostitutes," she said, places the crime on the child when it's really rape and sexual assault of a minor.

In Hotaling's own life, a psychologist helped her understand the psychological connections of her past--sexual abuse, molestation, drug use, criminal behavior and child exploitation through prostitution. "Can you imagine what it is like going from an identity of a bad person...to starting to connect all of the dots?" Hotaling said.

Changing lives

Hotaling credits the work with her psychologist for inspiring her SAGE programs. At SAGE, peer counselors--also former prostitutes--work with women and men who have faced rape, sexual assault, molestation and violence. SAGE also offers interventions to prostitutes and those exiting prostitution--such as assessments, referrals, peer support, vocational training, counseling, mentoring and rehabilitation. By making former prostitutes peer counselors at the center, Hotaling said the women become empowered and stay off the streets.

Psychologists can help too. Currently, SAGE programs are being replicated in North Carolina, New York, Kansas City, Atlanta, Denver, Seattle and St. Paul, Minn. Psychologists located in those places can help train peer educators--who are former prostitutes themselves--and provide them with support and training to work with other prostitutes.

Beyond SAGE involvement, Hotaling also encouraged psychologists to contact their district attorney's office and offer to help rehabilitate children exploited by prostitution. She also suggested contacting police departments to offer therapy to "johns" who are charged.

Hotaling hopes her SAGE outreach programs on the streets and in prisons raise awareness about the implications of sexual exploitation and prostitution that can lead to addiction and PTSD.

"I was able to...turn my life around," Hotaling said. "I believe it is also possible for [others]."

Further Reading

For more information on SAGE activities, visit www.sageprojectinc.org.