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FMR 64 Trafficking and smuggling 43

June 2020 www.fmreview.org/issue64

then subsequently guiding treatment falls education about the effects of sexual
short of capturing the long-term effects of violence – particularly the strategies that
such debilitating trauma. Instead, ‘complex perpetrators deploy to create isolation
PTSD’ was developed as a framework for and decrease victims’ sense of self-worth
understanding the effects of complex trauma – can be interwoven into programming.
– trauma that is prolonged, repeated and Also consider incorporating Interpersonal
interpersonal in nature, and from which Psychotherapy (IPT), an evidence-based
escape is not possible due to physical, treatment focused on linking life events –
psychological, maturational, environmental grief, interpersonal conflict, role transitions
or social constraints. Well-accepted examples and/or social isolation – with symptoms of
of complex trauma include child abuse, distress. IPT helps individuals build skills
domestic violence, sex trafficking and other that fight helplessness and hopelessness
forms of modern slavery, situations of even in situations of extreme adversity. The
4
genocide or organised torture campaigns. treatment is recommended in the World
Complex PTSD includes the core defining Health Organization/UNHCR mhGAP
symptoms of PTSD (re-experiencing, Humanitarian Intervention Guide as an effective
avoidance or numbing, and hyper-arousal) first-line treatment for depression that can
as well as disturbances to the regulation be delivered by trained and supervised
of emotion, interpersonal relationships, non-mental health community workers
conception of self, consciousness and in low- and middle- income countries. 5
systems of meaning. Complex PTSD
2
has been suggested as the most accurate Develop awareness of triggering
way to describe the deep disruptions interactions and incorporate opportunities
to psychological functioning that are for choice and autonomy: A relationship
experienced by survivors of sex trafficking. 3 might become fraught when a well-
intentioned clinical provider introduces a
Incorporating a complex-trauma informed legal or programmatic framework that is
approach perceived as controlling or disenfranchising.
By incorporating an understanding of For example, conversations about safe,
complex trauma into their approach, effective parenting may backfire if they
clinicians and humanitarian aid workers are undertaken with a punitive or overly
can build their capacities to bridge the authoritative tone. Similarly, interventions
divide between need and engagement. addressing ‘harm to self’ or ‘harm to
Several steps could help in doing this: others’ can be especially difficult. A trusted
relationship can suddenly collapse if a
Recognise that providing for a survivor’s service provider triggers memories of
unmet needs sets the stage for their a trafficker by restricting freedom and
recovery: Attending to physical safety, autonomy. In these circumstances, providers
nutrition and general health-care needs should remember that loss of will and
sets the stage for psychological healing. the ensuing feelings of fear may trigger
anxiety and even dissociation in survivors,
Incorporate elements of evidence-based because in the past similar situations have
treatment: Integrating ideas from the signalled impending harm or assault.
cognitive model of PTSD may enhance
service delivery. This approach is anchored Realise that rejecting treatment may be a
in the idea that appraisals of self and one’s way of communicating distress: Moments
place in the world play important roles in in which we, as providers, feel ineffective,
the maintenance or remission of trauma or in which a survivor disengages or rejects
symptoms. For example, attributing blame agreed-upon goals or work, are the very
to oneself for negative life events has moments when we need to pause and
been shown to impede recovery. Psycho- reflect on what is happening. Ask yourself