9.5 Working with Psychological Conditioning, Traumatic Re-enactment and Traumatic Bonding An Eastern European man trafficked for forced labour Psychological conditioning “An important aspect of therapy for sexual abuse survivors is to help them learn to protect themselves and to make conscious choices about not engaging in relationships or behaviours that are harmful.” Dr. Bessel van der Kolk114 There is consistent research evidence that victims of repeated sexual abuse and other forms of interpersonal violence are at greater risk of re-victimisation compared to those who have not been abused115. This is a problem which has been frequently observed by HBF clinicians in the course of their work with victims of trafficking. Predictors of re-victimisation include childhood sexual abuse, physical abuse or multiple traumas.116 Clinical notes on an East Asian woman exploited since childhood and trafficked for sexual exploitation Yoon has been conditioned throughout her life to exploitation and subservience in brothels. Her extreme youth, isolation, and lack of supportive networks, increased her vulnerability to such an extent that it was relatively easy for the trafficker to establish and maintain a level of control that resulted in her having no autonomy whatsoever in any aspect of her life. She only socialized with other women who were similarly exploited in brothels in which she worked. People who have suffered interpersonal violence in trafficking for various forms of exploitation may display passivity and an inability to control their own destiny, as well as an underlying inability to form normal emotional attachments. This can be the result of their habituation to systems of subjugation and brutality which have repeatedly shown them that self-preserving responses and reactions are futile. It is a reason why they may feel unable to try and initiate escape even after the physical constraints of their captivity have been relaxed, remaining psychologically rather than physically controlled by their traffickers. Psychiatric 114 Clinics of North America, - Jon is used to carrying out orders and instructions. He has worked at various restaurants for years without receiving any payment other than occasional handouts of £10 or £20. It seems that he believes in each case that he will be eventually paid for his work, and the discovery that he will not has not deterred him from this pattern. He is motivated by his need of a place to stay and problems in his country of origin. However, clinicians have noticed that he has learning difficulties and is highly “suggestible”. He has become conditioned to a certain way of life and lacks the autonomy necessary to take any initiative to help his case, including accessing health services. He is not used to directing his own actions and this puts him in a high risk group for further harm/exploitation. Over a prolonged period of time, a culture of blame and the internalization of shame can have a long term and damaging effect on the outlook of the victim. Experiencing a traumatic event in the form of threat to life, physical, or psychological integrity may overwhelm ordinary human adaptation to life, resulting in intense fear, loss of control, threat of annihilation, and when action is of no avail, helplessness and terror. Helplessness (to take action to change the outcome) appears to be a major factor in defining the experience of trauma. The traumatic reaction emerges from the disorganized system of self defence (fight, flight, freeze), and from the dissociation of sensations and emotions related to the experience. These reactions may affect normally integrated functioning, increasing physiological arousal and emotional dysregulation, and causing changes in cognition and memory.117 In cases where clients struggle to take initiative or to assert themselves even in minor ways, clinicians should explore this carefully through therapeutic work. It is important that they can recognize psychological conditioning in victims of trafficking, but can also distinguish it from other factors that may give rise to similar responses and behaviour: – The significance of cultural differences for some people who have been trafficked should not be underestimated. Sometimes they may not act in ways that are “expected” because they are not sure of what is required from them, or their understanding of a situation differs greatly from how it is perceived by others. Lack of confidence in ”, Trauma, Violence, & Abuse, What’s New in the Study and Treatment of Interpersonal Trauma 107