Treating survivors of human trafficking

At age 14, Marjorie Saylor ran away from a home plagued by sexual abuse and domestic violence only to fall prey to an even darker world. Raised in a strict religious environment that valued female subservience, Saylor internalized a toxic message. “Violence equals love. Sex equals love. That was the narrative that I believed as a child going into adulthood and early relationships,” Saylor said. “I didn’t understand what healthy relationships or boundaries looked like at all.”

For 17 agonizing years, Saylor endured both sex and labor trafficking before finally breaking free of her trafficker. Her story echoes the experiences of millions worldwide, highlighting how poverty, abuse, and violence create fertile ground for human trafficking. Now the director of human trafficking services and awareness for San Diego County, Saylor stressed the importance of understanding the recruitment tactics, physical and behavioral indicators (PDF, 874KB)opens in new window, and risk factors of human trafficking. “Those who are fully educated on what human trafficking looks like in all its forms can identify exploitation even if their client is not directly stating it.”

Nancy Sidun, PsyD, ABPP, cochair of the former APA Task Force on Trafficking of Women and Girls, highlighted the role psychologists play in providing appropriate and effective care for survivors. “Being trauma informed is critical, especially around complex trauma. Those who are at higher risk of being trafficked are more vulnerable people who have greater adverse childhood experiences,” she said.

Human trafficking is an estimated $236 billion global industry that exploits men, women, and children from all walks of life. The U.S. Department of Justiceopens in new window defines it as “the use of force, fraud, or coercion to obtain some type of labor or services, or to engage in commercial sex acts.” Estimating the scope of domestic human traffickingopens in new window is challenging due to the crime’s clandestine nature coupled with victims’ fear and isolation. In 2021, the National Human Trafficking Hotlineopens in new window identified 16,554 likely victims (PDF, 726KB)opens in new window—and experts believe these numbers only scratch the surface. Countless victims are likely hidden in plain sight.

The dramatic abduction scenarios portrayed in movies like Takenopens in new window are far from the norm. Contrary to popular belief, human trafficking is as much a domestic issue as it is an international one. It occurs in every community, affecting victims of all ages, genders, races, sexualities, and socioeconomic levels. Traffickers are often known to their victims—they can be family members, romantic partners, peers, or trusted community figures.

Traffickers exploit their victims by taking advantage of personal vulnerabilities, power imbalances, and opportunities for profit. Factors such as poverty, housing instability, mental health concerns, substance use, and other adverse childhood experiences place potential victims at disproportionate risk. These groups include communities of coloropens in new window, people living with disabilities, and those who identify as LGBTQ+. Members of those groups may be rendered vulnerable because of systemic inequalities, social marginalization, and reduced access to support systems. However, anyone with exploitable vulnerabilities can become a target.

While women and girls are disproportionately targeted, men and boys are also victims, though their experiences are often underreported. “Research says that 7 in 10 victims are women and girls. However, boys are the fastest growing group in both sexual and labor exploitation,” Sidun said.

Not all human trafficking is sex trafficking. Labor trafficking is also prevalent, but it is frequently overlooked because it can masquerade as legitimate employment. Laura Dryjanska, PhD, a researcher and professor of psychology who directs the minor on human trafficking studies at Asbury University in Wilmore, Kentucky, emphasized the need for more data on the diversity of victims. Traffickers often lure in vulnerable individuals by exploiting their victims’ aspirations.

For example, Dryjanska is currently researching young male Venezuelan survivors who were promised baseball scholarships but were ensnared into trafficking schemes instead. They entered the United States on student visas, but their traffickers seized their documentation upon arrival and forced them into construction and other labor. Meanwhile, the sponsoring institutions had to revoke their visas when they did not show up to play, essentially making them undocumented and even more vulnerable to their traffickers’ manipulations.

“That human quest we appreciate so much in psychology and willingness to take risks is completely crushed and misused by traffickers. They often take high-achieving and brave individuals who want to better themselves and provide for their families and crush their dreams. I’m especially sensitive to those types of stories being overlooked,” Dryjanska said.

She added that many individuals subjected to labor trafficking may not self-identify as victims, having normalized or internalized deep shame about their exploitation. Others fear the consequences of seeking help. Traffickers exploit this reluctance, using threats of legal action or deportation as tools of control.

Research shows that survivors often endure severe psychological symptoms. Depression is common and often coupled with symptoms like sleep disturbances, feelings of worthlessness, and suicidal ideation. Many survivors suffer from posttraumatic stress disorder (PTSD), experiencing intrusive thoughts, nightmares, and hypervigilance. Complex PTSD (CPTSD), which results from prolonged exposure to early trauma like child sexual abuse, may also create difficulty in self-perception and emotional dysregulation among survivors.

One study of 131 sex and labor trafficking survivors found that 71% suffered from depression and 61% from PTSD, with two-thirds of those people also meeting criteria for CPTSD (Hopper, E. K., & Gonzalez, L. D., Behavioral Medicine, Vol. 44, No. 3, 2018opens in new window). Additional research among homeless youth in Kentucky and Indiana found participants who had experienced sex trafficking were almost four times more likely to report suicidal ideation than those who had not (Frey, L. M., et al., Crisis: The Journal of Crisis Intervention and Suicide Prevention, Vol. 40, No. 4, 2019opens in new window).

A systematic review indicated a median PTSD prevalence of one-third of adult and child survivors of trafficking, with higher rates among survivors of commercial sexual exploitation (41.6%) than survivors of labor trafficking (30.67%) (Newberry, G. C., Modern Psychological Studies, Vol. 30, No. 1, 2024opens in new window). Another review found that 41% of survivors of human trafficking had CPTSD (Evans, H., et al., The European Journal of Psychiatry, Vol. 36, No. 2, 2022opens in new window).

Children who have been subjected to child sex trafficking are more likely to develop dissociative responses. In a study of confirmed and at-risk victims of commercial sexual exploitation, 20% of the confirmed victims met criteria for dissociation, while only 7.7% of the at-risk victims did (Kenny, M. C., et al., Child Abuse and Neglect, Vol. 100, 2020opens in new window). Richard LaBrie, PsyD, a clinical psychologist and trauma specialist based in Pasadena, California, explained that dissociation can serve as a protective mechanism for victims who have faced repeated trauma. “People with dissociative identity disorder often don’t get a proper diagnosis for years because they encounter therapists who don’t understand or can’t test for it appropriately,” LaBrie said. Only when paired with a trained and trustworthy therapist do they reveal their symptoms.

Creating a safe environment for victims and survivors is essential, as betrayals of trust and violations of their personal boundaries are commonplace. Elizabeth Hopper, PhD, codirector of the National Center on Child Traffickingopens in new window at Georgia State University, stated that for many, the process of engaging with providers can leave them feeling exposed, reminding them of the ways that their vulnerabilities were exploited by traffickers. Hopper urges psychologists to prioritize building a sense of safety to assist survivors’ recovery, combating the depersonalization, devaluation, and mistrust that occur when traffickers convey to survivors, “You’re an object. You’re here for my benefit.”

Hopper recommends working with survivors to help them recognize their strengths and support them in their own process of recovery and self-determination. “The level of disempowerment is so huge that our role as providers for this population is really around recognizing and elevating,” she said. Some strategies to build that sense of safety include flexibility in service process, or inviting “warm handoffs” from trusted mentors or health care providers whom they already trust. Psychologists should also invest in understanding survivors’ individual cultural beliefs and perspectives on healing.

Cassandra Ma, PsyD, is the executive director of Reclaim13, a nonprofit supporting child and adolescent survivors of sexual abuse and exploitation, including sex trafficking. A central aspect of Reclaim13’s approach is teaching survivors what healthy relationships look like, contrasting the exploitative dynamics they experienced with traffickers. Many young victims develop trauma bonds with their traffickers because of their developmental need for an adult caregiver, even if that caregiver is also a perpetrator. Ma and her team respond to survivors in nurturing and nonjudgmental ways as a direct repudiation of the tactics traffickers use to shame and manipulate their victims.

“Our first goal is always helping them to feel safe. The way that we react to them tells them a whole lot about how other people might react and challenges their paradigms about adult-child relationships. We gradually create that safety and build healthy attachment,” she said. Ma and her team provide therapy and support services that address the layers of complex trauma the children have experienced and model supportive and loving interactions that demonstrate healthy relationships are not transactional. She added that children exposed to trafficking may internalize their perpetrators’ distorted view that human interactions are not prosocial. “We help them to understand a different mindset. We show our kids that human relationships are not a means to an end,” Ma explained.

Ellen Lacter, PhD, a licensed clinical psychologist based in San Diego, works directly with adult victims of child sex trafficking. These victims have been violated by those closest to them at much younger ages than the typical adolescent victim portrayed in the media. Perpetrators include parents, neighbors, and institutions with access to children. “Psychotherapists, like myself, have a window into the nature of child sex trafficking that paints a more gruesome picture than is usually represented in summary reports by federal agencies or in psychological research,” Lacter said. Her clients experience CPTSD and dissociative identity disorder. In her work, she provides an empathetic and nonjudgmental environment that allows victims to explore their feelings, memories, and dissociated parts of self within their window of tolerance.

To overcome barriers to escaping commercial sexual exploitation, Abigail Judge, PhD, takes her services outside the office. Judge, a clinical psychologist and codirector of the Boston Human Exploitation Advocacy Team (HEAT)opens in new window leads a community-based program for women dealing with opioid use disorder who are currently experiencing sex trafficking. “We quickly learned the limits of traditional psychological models for a population constantly in survival mode. This population tends not to seek help in traditional ways,” Judge explained.

Boston HEAT meets women in various locations, including streets, emergency rooms, and detention centers, building person-centered therapeutic relationships over time. They receive referrals from hospitals and the Boston Police Department. Initially, they focus on addressing basic needs like food, clothing, and providing safe spaces for rest and hygiene. Through consistent engagement, they foster trust and offer psychological support throughout the women’s recovery journeys. Judge urges psychologists to avoid “saviorism” and lead with humility as they work with victims and survivors. Humility requires valuing the women’s knowledge based on their lived experience and partnering with them in good faith to find solutions for their struggles. This can help psychologists understand the barriers to treatment from the women’s perspective and adapt services accordingly. Research indicates that such approaches can enhance trust, address safety concerns, and foster agency among survivors of sex trafficking (Mumey, A., et al., Psychological Trauma: Theory, Research, Practice, and Policy, Vol. 13, No. 2, 2021opens in new window).

Kalyani Gopal, PhD, leads the Sex-Trafficking Awareness, Freedom, and Empowerment Coalition for Human Rights (SAFECHR) in Munster, Indiana. SAFECHR has developed a Human Trafficking Credentialing Training Curriculum and operates a therapeutic residence for female trafficking survivors and their children, employing an innovative approach to healing. Traffickers often become a victim’s entire world, fulfilling all roles typically provided by family or support systems. Many of Gopal’s patients endured extensive abuse by traffickers who created deep trauma bonds with them. They exploited their desire to be loved and cared for, especially if they came from unstable or abusive backgrounds. Since 2020, 56 women have graduated from her program, representing 87% completion for women coming into the residence. Statistics from the housing program show comorbid substance use disorders (40%), foster care placement (50%), childhood histories of sexual abuse (70%), and mental illness diagnoses (91%) among residents.

Recognizing the limitations of traditional therapies like cognitive behavioral therapy (CBT) for trafficking survivors, Gopal and her team employ “ACES-based shadow work,” which addresses the root causes of complex trauma through writing, drawing, reflecting, and group discussions. Gopal advises psychologists to go directly into community settings to engage with victims and survivors. This firsthand experience can help them understand the complex cultural, political, and economic factors shaping the lives of people who have been trafficked. “Macro, micro, and mesosystems are impacted by human trafficking. Seeing them in a clinic alone doesn’t cut it, ” Gopal noted.

Phuong Nguyen, PhD, a clinical psychologist in Houston, leads the Anti-Human Trafficking Programopens in new window at Baylor College of Medicine. He and his team reach victims via the medical center’s emergency department. “This setting grants confidentiality and safety, which a lot of our patients don’t have when they encounter law enforcement,” Nguyen said. His program is the first of its kind to offer a postdoctoral fellowship that specializes in working with human trafficking victims, particularly within an integrated health care system.

His team provides trauma-informed care for victims who present with mental health issues, including PTSD, suicidal ideation, and depression. The program also collaborates with city officials to create a health care response that complements law enforcement efforts. Since its inception in 2017, the program has screened more than 700 victims and aims to serve as a model for other hospital systems. Nguyen’s program has also trained thousands of health care providers to recognize and respond to signs of human trafficking.

Krista Fritson, PsyD, a licensed clinical psychologist and professor at the University of Nebraska at Kearney, works with law enforcement to recognize and better respond to human trafficking. Kearney is a small town of slightly more than 30,000, but it is a potential hub for human trafficking because of its location on Interstate-80, which cuts across the country. In collaboration with Kearney’s SAFE Center, Region 3opens in new window, and other agencies, Fritson trains officers to adopt trauma-informed techniques during their interactions with victims.

Fritson and other mental health professionals lead role-playing scenarios to help officers practice using open body language, managing tone of voice, and avoiding interrogation-style questioning to allay fear when they encounter victims. This approach is crucial because many fear being charged with a crime if they interact with law enforcement. “We have seen officers start to engage differently and behave in a different, more empathic way versus how they are trained to be adjudicators in law enforcement,” Fritson said. As a result, victims are more willing to access services such as medical care or housing rather than feeling intimidated.