The United States prides itself as the “land of the free.” However, with human trafficking now being a multi-dollar billion industry and cases increasingly increasing in the US, slavery is still alive. Human slavery qualifies as a modern form of slavery. Traffickers subject victims to various conditions of modern-day slavery, including sex trade, forced labor, or debt peonage. Therefore, human trafficking is an extreme form of labor exploitation whereby men, women, and children are obtained or recruited to be forced to labor against their will through coercion, force, or fraud. While some victims of trafficking are forced to work in the prostitution trade, many others are forced to perform other forms of labor such as factory work, domestic servitude, or agriculture work. Notably, trafficking victims often experience physical and psychological abuse, which renders human trafficking a significant public health concern. Therefore, human trafficking survivors need therapeutic interventions to treat their complex layers of multiple traumas resulting from the experienced ordeal.
Description of the Crisis – Human Trafficking in the USA
In the US, victims of human trafficking are almost exclusively immigrants, whereby most of them are women and children. According to Salami, Gordon, Coverdale, and Nguyen (2018), immigrant women and children are the most vulnerable to the coercive and deceptive tactics of traffickers due to their considerably lower levels of education, their immigrant status, language barrier, and lack of unfamiliarity with the US employment protections. Recruiters or employers usually compel their victims to perform a job using various forms of deception, coercion, or physical abuse. As such, they deprive the victims of their right to consent (Marburger & Pickover, 2020). Notably, the use of physical force or psychological, economic, or legal coercion by the traffickers or employers force the victims into labor situations that they cannot freely escape.
In some extreme situations, the victims are not lured or forced into an employment relationship but are sold by their family members or abducted or kidnapped by human traffickers. However, the common tactic used by the traffickers is luring victims into exploitive employment relationships by making false promises regarding the nature and condition of the promised jobs (Fukushima, 2019). For instance, a trafficker may promise a young woman a job in the US as a nanny earning minimum wage, but when she arrives, she is instead coerced to work as a sex worker where her wages are withheld, and is not allowed to leave the premises.
Studies focusing on the survivors of human trafficking have unearthed that victims undergo physical and psychological abuses under their employers or the traffickers. The ordeals include psychological abuse, whereby traffickers often subject the victims to psychological abuse through isolation, threats, and deprivation. Traffickers commonly threaten to harm or kill victims or their family members if they defy them or try to escape (Fukushima, 2019). Fukushima further explains that the victims are also deprived of their freedom of movement. They are isolated in their place of work and cut their contact with the outside world. The traffickers also subject their victims to patterns of abuse to cause fear and disorientation. Winterdyk (2020) elucidate that traffickers often use severe verbal abuse and insult to exacerbate feelings of isolation, betrayal, and shame that the victims experience. Moreover, the traffickers and employers subject the victims to physical abuse by often beating and brutalizing them. The victims are also raped and sexually abused, and frequently deprived of adequate sleep, food, and shelter. Consequently, trafficking inflicts complex layers of trauma on the victims.
The physical and psychological abuses suffered by victims of trafficking can cause many short and long-term adverse psychological effects. The impacts may lead to mental health concerns, maladaptive behaviors, and substance abuse. According to Marburger and Pickover (2020), possible psychological effects of human trafficking include anxiety disorders, depression, post-traumatic stress disorder (PTSD), shame and guilt, substance use and disorders, identity disturbance/confusion, and suicidal ideation. The traumatic events that human trafficking victims experience renders the crisis a public health concern and points out the urgent need to prioritize treatment strategies aimed to improve the psychological well-being of trafficking victims.
Historical Context of Human Trafficking in the US
In the past five years, the ‘informal economy’ – that is, remunerative work that is not recognized, protected, or regulated by the government – has significantly grown, and so has the occurrence of trafficking or forced labor. According to Winterdyk (2020), in the recent past, trafficking in the US has been most pervasive in agriculture, domestic service, sex industry, sweatshop and factory work, and restaurant and hotel work. Majority of the trafficking cases in the US have been reported in California, New York, and Florida. Notably, these are states with a high concentration of immigrants. Winterdyk explains that human trafficking is driven by the increasing demand for cheap, unskilled, and exploitable labor. In the past five years, trafficking in person has stood out as the second-largest criminal industry in the US, and drug trafficking (“Human Trafficking: Modern Enslavement of Immigrant Women in the United States”, 2019). Another alarming trend is that human trafficking is the fastest-growing criminal industry in the US. According to the US Department of State, various factors contribute to the increased supply of trafficking victims. Among the factors include poverty, organized crime, the attraction of the perceived higher standards of living in the US, lack of employment opportunities in the home country of the victims, violence against women and children, government corruption, political instability, and armed conflict in victims home country, and discrimination against women (Fukushima, 2019). These factors make it relatively easier for traffickers to lure or force their victims into forced labor.
Trafficking in Person Prevalence
In the recent five years, the prevalence of trafficking in person has steadily increased. It is difficult to precisely determine the scope of human trafficking since it is a covert practice. However, the US Department of State estimates that about 14,400 to 17,500 people are trafficked into the US each year (“Human Trafficking: Modern Enslavement of Immigrant Women in the United States”, 2019). Notably, these numbers do not encompass the many individuals trafficked within the United States borders. According to recent statistics by the US National Human Trafficking Hotline, trafficking in person continues to rise despite the government’s efforts to combat the crisis (“2019 Data Report: The US National Human Trafficking Hotline”, 2020). The table below shows human trafficking situations identified in the years 2015 through 2019.
Figure 1: Human Trafficking Situations Identified
Retrieved from “2019 Data Report: The US National Human Trafficking Hotline” (2020)
The report by the US National Human Trafficking Hotline also ranks human trafficking by type of trafficking. The top three identified sex trafficking types include escort services, pornography, illicit massage, and health and beauty. On the other hand, the top three identified labor trafficking types include domestic work, traveling sales crew, and agriculture and husbandry (“2019 Data Report: The US National Human Trafficking Hotline”, 2020). As per Winterdyk (2020), apart from the above-mentioned factors, the internet has also contributed to the prevalence through increasing convenience and reducing the risk associated with the trade.
A major concern related to human trafficking is the impact the above-described experiences have on the victims’ and survivors’ mental health. Trafficking poses a significant risk to the victims’ long-term mental health due to the complex layers of the multiple traumas suffered. Therefore, trauma-informed care is fundamental and should include a commitment by public health to empowerment and recognition of the impact of the many traumatic events on the trafficking survivors across their life course (Salami, Gordon, Coverdale, & Nguyen, 2018). For victims suffering from multiple traumas, the therapist and patient should work together to determine the most traumatic experience. Since victims may not identify trafficking as their most traumatic event, Marburger and Pickover (2020) proposes a flexible therapeutical intervention. Focusing on the most traumatic event allows human trafficking survivors to learn coping skills to decrease trauma symptoms. It also helps the victims practice and learn to manage trauma symptoms related to other traumas’ memories (Altun et al., 2017). Since inpatient settings emphasize screening, psycho-education, and stabilization, it is also essential to employ supportive interventions in the said settings to help the patients feel safe. This should include follow up appointments in outpatient services to ensure patients receive effective trauma treatment.
Two therapeutic interventions that can help treat human trafficking survivors’ trauma symptoms include cognitive processing therapy (CPT) and prolonged exposure therapy (PE). According to Altun et al. (2017), CPT and PE are the primary interventions that can be used to treat trafficking victims in outpatient settings. The International Society supports the two interventions for Traumatic Stress Studies as evidence-based therapies for PTSD. Although the two interventions have been proved to meliorate trauma symptoms, they differ in terms of primary mechanisms of action. For CPT, the recommended mechanism is the cognitive reconstructing technique to change maladaptive hopelessness cognitions about oneself and the world that develop due to the traumatizing experiences. On the other hand, PE mitigates distress through a habituation process. A therapist repeatedly exposes victims of human trafficking trauma to both internal and external stimuli that remind them of the traumatizing events they experienced (Salami, Gordon, Coverdale, & Nguyen, 2018). According to Marburger and Pickover (2020), learned avoidance only serves to aggravate post-traumatic stress symptoms since victims never fully process their trauma experiences.
Although the pathways to effect change differ in CPT and PE, the desired outcome occurs at both the cognitive and habituation level with both interventions. Regarding CPT, changing a victim’s maladaptive perception about him/herself and the world allows changes in general activity level and decreases apathy and anhedonia for various activities (Salami, Gordon, Coverdale, & Nguyen, 2018). Hence, habituation serves as a natural consequence for restructuring negative cognition owing to reduced fear as the victims approach various activities. Studies evaluating the two interventions have shown comparable levels of treatment effectiveness for treatment completers.
It is also worth noting that survivors of human trafficking are likely to develop substance-related conditions to cope with their trauma. For those with symptoms of substance use symptoms, cognitive interventions such as cognitive processing therapy – cognitive therapy only (CPT-C) coupled with other treatment such as CPT or PE to reduce both trauma and substance use symptoms (Salami, Gordon, Coverdale, & Nguyen, 2018). In some cases, CPT-C may not succeed in achieving full remission. In such instances, a professional can use additional evidence-based psychotherapeutic interventions that specifically focus on substance use, such as the 12-step program or motivational enhancement therapy (Marburger & Pickover, 2020).
Other therapeutic interventions include cognitive behavior therapy (CBT) and interpersonal therapy (IPT). These are effective for treating anxiety and depression as they decrease psychological distress by strengthening and creating new interpersonal relationships (Marburger & Pickover, 2020). Whereas all the alternatives discussed in this paper have been proven effective, therapists should carefully assess a patient’s trauma and characteristics to establish the most appropriate treatment progression. Caregivers have a wide range of therapeutic interventions, some of which have not been discussed in this paper, such as exposure-based interventions and relaxation training, sleep hygiene techniques, nightmare exposure, and rescripting therapy to improve long-term patient outcomes. However, a therapist must decide based on the patient’s unique needs (Altun et al., 2017). Altun et al. advise that the best intervention is one that is tailor-made to suit the specific needs of an individual patient as opposed to a one-for-all approach.
Critical Analysis of Human Trafficking in the USA(Pros and Cons)
There is no single advantage associated with human trafficking to the United States society. Human trafficking is lucrative for the perpetrators, but they prey on victims’ weaknesses, unfamiliarity, unfortunate circumstances, and inexperience to subject them to an ordeal that inflicts complex layers of multiple traumas on both the victims and the survivors. Thus, human trafficking is a crime – one that is only associated with negative impacts on society. The cons related to human trafficking include sexual exploitation, forced labor, child labor, and many other inhumane treatments that strip the victims of their dignity. Trafficking in person has also separated many individuals from their families and isolated them from the world by confining them to their workplaces like slaves. Also, as above-discussed human trafficking causes both the victims and survivors physical and mental harm by subjecting them to physical and psychological abuse. Moreover, it abuses the legal process as traffickers sometimes use legal mechanisms to enforce their control over the victims (Winterdyk, 2020). For instance, traffickers often deprive their victims of their identification documents and passports or threaten the victims with deportation or arrest if they do not cooperate. Therefore, human trafficking is a vile crisis with adverse impacts on the victims and their families as well as the entire United States.
To sum up, human trafficking is an economically lucrative trade that continues to enslave millions of victims for coerced service and labor. Traffickers subject the victims to traumatizing events that have adverse psychological consequences. Whereas it is up to the government through its various intelligence and security bodies to eradicate human trafficking, public health providers have an obligation to help the survivors heal from the complex layers of multiple traumas that they experience. There exist several therapeutic interventions that therapists can use to treat human trafficking survivors. Some of these interventions include cognitive processing therapy, prolonged exposure therapy, cognitive processing therapy –cognitive only, cognitive behavior therapy, and interpersonal therapy. Other interventions include relaxation training, sleep hygiene techniques, nightmare exposure, and rescripting therapy. Notably, a therapist should thoroughly assess a human trafficking survivor to determine a therapeutic intervention or a combination of various treatments that is most suitable to a specific case.
Marburger, K., & Pickover, S. (2020). A Comprehensive Perspective on Treating Victims of Human Trafficking. Professional Counselor, 10(1), 13-24.
Salami, T., Gordon, M., Coverdale, J., & Nguyen, P. T. (2018). What therapies are favored in the treatment of the psychological sequelae of trauma in human trafficking victims?. Journal of Psychiatric Practice®, 24(2), 87-96.
Winterdyk, J. (2020). Explaining Human Trafficking: Modern Day-Slavery. The Palgrave international handbook of human trafficking, 1257-1274.