less than before, and mainly at night, but he is sleeping better. His mood is better, he is no longer suicidal, his anger is better managed and he feels in control of himself. He is able to maintain eye contact, and is no longer insisting upon sitting tightly against the wall. He has received good medical test results which have made him feel more confident. Interaction with concerned professionals may improve a person’s overall well-being and prevent them from feeling isolated or unable to cope. However it is essential to maintain momentum at this stage and to ensure that the client is not suddenly left without any contact, which could lead to the re-emergence of isolation, distress and depression. In some cases where there is apparent, marked progress at the initial stages of contact, this may be a reflection of the victim’s circumstances in the trafficking situation having been so extreme. In such cases our clinicians do not simply accept such improvements at face value but continue to provide clients with on-going monitoring and support. It is often found that a client was unable to fully disclose the details of a history of prolonged abuse and neglect until much later on in treatment, and that this marked initial progress may suffer significant setbacks over time. 10.2 HBF’s Approach to Cases which Lack Visible Signs of Recovery Progress To return to the graph analogy, there are also cases in which the “recovery progress pattern” may continue in a straight, often “low” line without change and for what seems to be a long time. The client may return to therapy sessions repeatedly without making any apparent progress. However, maintaining their engagement with support services and attending therapy on regular basis demonstrates that they are working to remain safe from harm. The prognosis in such cases is positive, and better than a sudden decline, or even, in some cases, a sudden upturn, both of which may be de-stabilizing. Continuity of connection to therapeutic care is a positive sign, and recovery from severe traumatic experiences takes considerable time. 10.3 Working with Clients Under Pressure: the Effects Upon Therapeutic Work of Legal Procedures, Decisions and Outcomes The majority of victims of trafficking in the care of HBF suffer problems relating to their risk of re-trafficking/harm or exploitation, medical issues, legal procedures/decisions as well as destitution, and issues with housing and poverty. 112 These issues frequently become an overwhelming pre-occupation and can cause anxiety which exacerbates existing trauma. A victim of trafficking at his asylum interview “I have no family. This is what has happened in my life. I am not saying this just because I want a stamp to stay in this country, I’m saying this because this is what happened to my life. I can’t eat or sleep. Let them feel this for me, I’m in pain. Don’t compare me to other cases, everyone is a different man.” HBF focuses upon the changing needs of clients so that they can be referred as quickly as possible to appropriate organizations which can offer targeted assistance. It is essential for people who have been trafficked to be represented and advised by lawyers who are trained and are committed to developing long-term experience of working with victims of trafficking.124 HBF refers clients for legal advice and representation; to the police where appropriate, and to housing, welfare and support services. Clinicians are often asked to provide medico-legal evidence for legal representatives, courts and decision-making bodies. Therapeutic work also has to remain flexible as it is adjusted in accordance with individual needs. Issues that may seem minor to others can also become serious obstacles to long term recovery if therapeutic support is not provided. Victims of trafficking need assistance to develop coping strategies and skills which enable them to meet the challenges of their daily lives. In some cases victims suffer severe trauma responses to negative legal decisions and outcomes. This may result in their losing contact with essential support services and suffering increased vulnerability to exploitation, acts of selfharm and/or attempting suicide. It can happen months or years into their legal case, even after a significant degree of recovery and stability has been reached, and a therapeutic relationship of trust has been established. In all such cases this is undoubtedly an important and disappointing setback. However in HBF’s clinical experience, in cases where there are strong foundations of therapeutic work and multi-agency co-operation, individuals are far -