10 Understanding the Process of Recovery for Victims of Human Trafficking The psychological recovery of survivors of interpersonal violence is a long term and ongoing process. Its duration cannot be estimated from a clinical “snapshot” of a client’s recovery progress taken at any particular point in time. In HBF’s clinical experience, the psychological recovery of people who have suffered interpersonal violence from trafficking cannot be plotted on a graph that predictably travels gradually or steeply upwards over time. If set out on a graph, many cases would show steep highs, deep lows and long-term plateaus of stasis in no set or predictable order. The “recovery progress pattern” of victims of trafficking undulates between positive steps forward and setbacks which can range from moderate to extreme. These undulations, caused for example by negative legal outcomes, practical problems, emotional difficulties and re-traumatization triggers are potentially dangerous for victims. “Deep lows” (e.g withdrawal, loss of contact with support services, self-harming behaviours or suicide attempts) can occur months or years into, or beyond, their therapeutic care and after positive progress has been made. Critical developments (for example practical, legal, welfare, relationship issues) can also weigh upon victims of trafficking over time and they may become increasingly disturbed or depressed despite efforts to relieve this. Therefore, rather than focusing upon whether a client has or has not recovered from their experiences of trafficking, HBF consistently monitors their individual recovery progress. Our intention is to ensure that they can cope with specific tasks and challenges that they are currently facing in their lives at any stage after trafficking, and to identify any requirements they may have for appropriate support and assistance. that can cause setbacks, for example patterns of self-harm, suicide attempts, lost contact with support services, withdrawal and depression, eating and sleeping disorders and relapses into substance dependency. Over time the therapeutic response to setbacks becomes more straightforward and a client who suffers repeated setbacks will come to recognize steps that are taken as known and familiar. A detailed understanding of the client’s individual background can also enable clinicians to identify the resilient aspects of their character which helped them to survive trafficking. They can then be encouraged to recognize and draw upon these in order to help and protect themselves. 10.1 HBF’s Approach to Cases in which Significant Recovery Progress is Observed at an Early Stage Clinicians find that some victims of trafficking make swift progress during their first months of contact with HBF. The stabilization provided for them through co-ordination of their medical care and practical/welfare/legal needs can greatly improve their sense of safety, health and well-being. Clinical notes on the initial recovery progress of an East Asian man trafficked for forced labour in construction work June 2011: Han cannot sleep. He is suffering flashbacks and auditory hallucinations and he is scared to go outside. His mood is low and he is quick to anger. He is afraid of his own anger and this is a reason why he does not go outside. He has a persistent cough. He insists on sitting with his back to the wall and the blinds drawn as he says he feels more secure this way. He suffers suicidal ideation. Clinicians learn the most about the challenges of victims’ recovery from clients who have long ago finished their treatment at HBF, but remain in contact with HBF staff and clinicians and return periodically for therapeutic assistance and support. Action: Han has been referred to his local Community Mental Health Team. We informed his GP (UK doctor) of his trafficking history and his health concerns and he has been prescribed anti-depressants by the GP. He will have regular follow up appointments at HBF to monitor his progress. A clinician’s knowledge of their client builds through the long term therapeutic relationship and lends them an increased understanding of the particular individual “triggers” September 2011: Han has attended several appointments which he says have made him feel less isolated, and he now feels he has support from other people. He is hearing voices 111