Within the trafficking situation, victims will have been prohibited from demonstrating any “hate” that they feel towards their trafficker due to the fear of physical and/or psychological punishment. They may therefore turn this hatred against themselves in order to find a release for it. sciously realized or understood. It is useful to emphasize positive actions, to focus on the “here and now” and to take different routes around the discussion. This helps to avoid depressing or distressing the client by re-playing their traumatic experiences in the same chronological order. Through long term therapy, victims can come to consciously recognize their “traumatic bonding” with a trafficker. With careful assistance from their clinician, they can very gradually dis-engage from it. HBF’s clinicians have to bear in mind the risk of suicide with clients who have been trafficked, especially during periods of difficulty or crisis. This means that they may ask them direct questions about self-harm or respond to comments by the client that may give rise to concern. For example, if clients express the wish to harm themselves or raise fears about their own behaviour which is placing them at risk or harming their health, the clinician may explore this by asking how they feel when they do this, as opposed to “why” they do this. If a client says that they “don’t want to wake up in the morning” the clinician may ask if they have ever thought of doing something to make this happen. “Some clients want to openly express feelings in therapy that they could never have revealed to their trafficker because they were too afraid to do so. In a safe environment where they are free of any physical or psychological threat, they can work through feelings of anger, shame, ‘love’ and loss that will help them to loosen the bonds of the victim-trafficker relationship. “Some victims of trafficking for sexual exploitation who have been forced to adopt a ‘pleasing’ prostitute persona find this honest ‘confrontation’ in the therapeutic setting particularly helpful. The coerced ‘acting out’ of pleasure and the desire to please in forced prostitution, masks the harsh reality of their lives and circumstances. It is highly damaging to their sense of self, and can result in vulnerability to self-harming behaviour. “A trusting therapeutic relationship can help to contain and support feelings that have previously been unrecognized and therefore are harmful for the client. Through therapy, people who have been subjugated by others can eventually come to internalize positive, caring and trusting attributes which replace the negative love/hate dynamic.” Julie Goldstein, HBF Psychologistand Gestalt Therapist 9.6 Working with Victims of Trafficking who Engage in Self-Harming Behaviours People who have been trafficked may have ongoing problems of engaging in self-harming behaviours and suicidal ideation as well as substance abuse or eating disorders. These are complex issues in all cases. Disengagement from self-harming behaviours can be achieved gradually through a process of listening and gentle questioning in response to a person’s statements about themselves. In this way they can be assisted to gain some perspective on their actions/behaviour in relation to their safety and well-being. In many cases this has not been con- Use of open questions (those that do not simply require a “yes/no” answer) assists clients to make psychological links for themselves, by widening a difficult subject out into other realms of their thoughts and imagination. This can provide them with the opportunity to think and act differently if they choose to do so. The conscious and shared acknowledgement of self-harming behaviour, within a safe and supportive environment, is key to recovery. Taking the time necessary to work through feelings of shame and low self-esteem within therapy sessions is of paramount importance. These feelings can trigger self-harming behaviours, but they also result from selfharming behaviours, which can put victims of trafficking at risk because they are too afraid to ask for help. It therefore becomes a cycle: people who engage in self harm often fear that they will be perceived as being mentally ill if they tell anyone, and so this behaviour is carried out in secret. 9.7 The Gateway to Positive Relationships and Integration Provision of a “gateway” to positive relationships and integration into the wider community is an essential part of the therapeutic process. Over time, victims of trafficking are helped to create a more fulfilling life for themselves and to find support from people and in places they had not previously known about or considered. This stage is reached at different times for different people, at their own pace and in accordance with their individual needs and circumstances. Group therapy does not provide a substitute for individual therapy but can be introduced either in parallel, or as a therapeutic progression, in cases where it is appropriate and 109