Lidia GORCEAG,
Psychologist, Center of Rehabilitation (IOM)

The work experience enabled the employees of the Center for rehabilitation of the victims of trafficking in human beings reveal the psychological and social problems the women face during the crisis.

Identified Issues

The returned trafficked women exhibit serious psychopathic disorders, which are affecting their personal life and professional activity and it would not be enough to apply one rehabilitation/treatment method for their full recovery. Usually they encounter:

• difficulties in regaining control of their own life;
• personal integrity crisis;
• impossibility to identify their own feelings/difficulties in de-briefing (they feel scared, guilty, offended, shamed, betrayed, helpless/despaired, shocked, doubting, lost, unconfident, etc.);
• increased risk to repeated situational crisis and retrospective experiences;
• alteration of personal values and behavior (lost the basic living skills, child abandoning, suicide tendencies, accentuated sexual instinct, etc.);
• victim’s failure to integrate into society;
• slow rehabilitation process;
• repeated manifestations of the post-traumatic stress (PS) after therapy.

The Center of Rehabilitation still has on its agenda the following problems revealed after its personnel work with the victims:

• deep traumas;
• special status (mental retards, schizophrenia, deep depression, alcohol dependence, drugs);
• special groups (minors, socially-vulnerable families, previously raped victims, incest victims).

All these problems make it impossible for the victim to integrate both in family (high divorce risk, high pressure in family, not accepted by the family members, etc.), and in society (unemployment, deterioration of culture/family institution, traditions and customs, etc.). That is why it is essential to offer appropriate help to these people during the crisis.

The key characteristics of the post-traumatic stress are as follow:

• PS is a stress which is caused by the human psychic itself;
  
• During the PS one could feel both neuropsychic and stomach disorders;
• PS resides in psycho-behavioral and somatic disorders, intensified and exceeding the acceptable limits, rather conventional, as one being appropriate to a simple adjustment;
• Depending on the result of confrontation between the stress agents and the mental and physical reaction of human organism to this (PS itself), we can see the following phenomena: a) apparent or real re-installation of the same psycho-behavioral pattern, just like before the action of stress agents; b) aggravation, during the PS, and particularly after the incubation period, of some stable psycho-somatic disorders or even some mental or somatic diseases. In cases when the situations associated with trauma represent a strong emotional bottleneck, it leads to the total arrest or dissociation, as if the trauma appeared just now. Thus, it can turn into a vicious circle.

Solutions

Crisis intervention

This process cannot be expressed in just a few sentences. It is aimed at stimulating, regaining by the woman of her autonomy,
thinking through emotions to see herself as an integral person and to start living as a free person.

The experience shows these problems require long-term assistance with involvement of a larger group of different experts.

Long-term rehabilitation

The psycho-therapeutic treatment may include the following:

• debriefing (crisis intervention);
  
• cognitive-behavioral therapy;
  
• group therapy;
  
• psychodynamic psychotherapy;
  
• desensitization and re-processing;
  
• hypnotherapy.

Methodology

The post-traumatic stress treatment usually starts with a detailed evaluation and determination of the treatment plan which meets the victim’s needs. Generally, the post-traumatic stress treatment starts only when the victim is in a safe place and the crisis is over. For example, in case of current exposure to trauma (like family violence, abuse, recent recovery from trafficking) the person undergoes depression or is thinking about suicide, is in panic or needs a detoxication treatment from alcohol or drugs, which is the first step of Phase I treatment.

The treatment phases would have the following intervention principles:

• studying the causes of the post-traumatic stress by the trauma survivors and her family members; the way in which these dysfunctions influence the victim and her family; other problems specific to the post-traumatic stress symptoms; comprehending that the post-traumatic stress is an anxious dysfunction acknowledged by doctors, is important for an efficient treatment;
• examination and work on strong feelings such as fear, shame or guilt specific to all survivors of all trauma situations;
• teach the survivor to get rid of trauma memories, reactions and abhorrence without being overwhelmed or emotionally blocked;
• the trauma memories usually do not disappear completely after therapy however, these could be controlled by new coping skills.

Stages of intervention during the crisis

Objective 1. Set emotional contact

Description. At this moment (when offered assistance immediately after return) the person is receptive to the smallest signs of attention; can appreciate any support (capacity to listen to her, offer shelter, be by her only). The beneficiary’s placement with the Center of Rehabilitation, communication with the environment, helps her expand the horizons of the adoptive reactions; she is offered personal space, time to make decisions; it is essential not to ruin the trust for those who surround her.

Result. The emotional contact develops the capacity to recognize the lived through emotions and feelings.

Objective 2. Accept and live through emotions and own feelings

Description. Immediately after placement with the Center of Rehabilitation, the person is receptive to the smallest signs of attention; can appreciate any support (capacity to listen to her, offer shelter, be by her only).

Result. The placement of beneficiary with the Center of Rehabilitation, communication with the environment helps her expand the horizons of the adoptive reactions; she re-finds her personal space, time to make some decisions and re-gains trust for the people surrounding her.

Objective 3. Identify the problem

Description. The social assistant or psychologist helps the beneficiary analyze the current situation, studies the problem which provokes most of the emotions at this moment, then thoroughly studies the recent experiences. Together, they try to find the reasons that caused the crisis, analyze the said by the beneficiary and will reach a consensus on the main problem. It is important to keep focused on the part of the problem under study. (“Have you had similar situations before? How did you overcome them? What happens if we resolve this problem? What’s the main obstacle in getting there? Any alternatives, what’s the price you have to pay to get the problem resolved?”).

Result. Capacity to formulate the problems and prioritize them.

Objective 4. Work with the beneficiary’s problem “here and now”

Description. The Psychologist and the social assistant work with the beneficiary to restore the self-confidence; helps her reveal her fortes, be confident, re-gain control of her life. The re-do plan needs to be prepared jointly with the beneficiary. The consent of the assisted person and respect for her wish to the extent possible are indispensable for the success of her rehabilitation and re-integration. The beneficiaries often have problems setting priorities and may make hasty decisions.

Result. Set the „wish and must” balance expressed by the beneficiary, likewise the immediate needs/priorities identified by the psychologist or the social assistant.

Recommendations

The methods used for therapy in case of crisis might vary. The mostly applied ones proved to be the following:

• rational elements of psycho-therapy, based on logical analysis of the beneficiary’s condition, explanation of reasons, forecast. The application of this therapy minimizes the anxiety, offers self-confidence.
• Cognitive therapy aims at changing the inadequate cognitions (changing the thoughts) which cause the emotional experience to have led to crisis.
• Gestalt-therapy, used to correct the perception processes, processing and updating the information of the beneficiary in crisis. This therapy helps update the internal personal conflicts and may cause a positive chance in the personality,new explorations.
• Method of muscular relaxation, Autogenic trainings, which helps the beneficiary overcome the crisis, use it later while in stress situation.
• Therapy of the thinking field, which is a punctuate massage, having a certain algorithm, rhythm, consequence. This method may be applied later but the patient herself to help herself or the environment.