It’s always a pleasure to host one of my student’s articles on the website. Thank you to Maria Ochoa for sharing this essay as part of her coursework for the Art Therapy Diploma Course.
Robert Gray
Director and Senior Lecturer at CECATRegistered Art Therapist and Psychologist
MA A. Th., AThR; B. Soc. Sc. (Psych.) (Hons.), MAPS.; BA. Theol. (Hons), MA Theol.
The Transformative Power of Art Therapy for Human Trafficking Survivors
Human trafficking is a devastating global issue that leaves deep psychological scars on its victims. Survivors often experience severe trauma that fractures their lives, personalities, and relationships. The coercive environments and abuse experienced by victims strip away their sense of identity, leaving them feeling powerless and voiceless. According to Zimmerman, Hossain, and Watts (2011), the severe psychological effects of human trafficking can include PTSD, anxiety, depression, and other mental health issues.
Art therapy, however, offers these individuals a pathway to healing and recovery. By restoring a sense of self, providing a voice that was silenced, and giving power back to those who had none, art therapy plays a crucial role in the recovery and reintegration of human trafficking survivors. As Gussak and Rosal (2016) highlight, art therapy enables survivors to express and process complex emotions and trauma through creative means. It helps rebuild identity and empowers survivors by giving them control over their expression and communication (Malchiodi, 2012). Through the empowering nature of creating art, survivors can externalize emotions, communicate trauma, and reclaim their identities (Kommentiani, 2020).
What is Human Trafficking?
“Employment, transference, & concealing through methods of threatening, forcing, or compelling an individual through intimidation, imprisonment, & deception with the intention to control or exploit an individual through providing or obtaining benefit to attain the authorization of a person having power over another person” (Definition of Human Trafficking, United Nations Office on Drugs and Crime).
Human trafficking is a pervasive and heinous crime that affects millions of individuals globally, constituting a modern form of slavery that involves the exploitation of people through coercion, force, or deception for various purposes. These purposes often include forced labour, sexual exploitation, and other forms of involuntary servitude.
The Effects of Human Trafficking on Survivors
Human trafficking leaves a multitude of devastating effects on its survivors, spanning physical, psychological, emotional, interpersonal, and spiritual domains. The impact is profound and often requires comprehensive, multidisciplinary approaches to healing and recovery.
Physical Consequences
Survivors of human trafficking often endure severe physical consequences, which can include homicide, substance abuse, HIV, and cervical cancer (Kommentiani, 2020).
The harsh conditions and violence they face can lead to chronic health issues that persist long after they escape trafficking situations.
Physical injuries sustained during trafficking, such as broken bones, cuts, and bruises, may heal, but the internal damage can last a lifetime. Additionally, the lack of medical care and poor living conditions exacerbate these physical injuries.
Trafficking survivors often suffer from malnutrition, untreated infections, and other health issues resulting from prolonged periods of neglect and abuse.
Physiological Consequences
The physiological toll on trafficking survivors is immense. They frequently suffer from migraines, chronic neck and back pain, fibromyalgia, digestive issues, irritable bowel syndrome, asthma, and chronic fatigue (van der Kolk, 2014). These conditions are often exacerbated by the extreme stress and physical abuse they endure, making daily functioning and recovery incredibly challenging.
The constant physical strain and inadequate nutrition during trafficking periods weaken the body’s systems, leading to long-term health problems. Survivors may also experience reproductive health issues due to forced pregnancies, unsafe abortions, and sexual violence.
Psychological Consequences
Psychologically, trafficking survivors experience hypervigilance, hyperactivity, a decreased capacity to handle stress, anxiety, avoidance, conflicts regarding sexual interest, and distress over feelings of dying or going insane (Levine, 1997). These symptoms are indicative of severe trauma and can lead to long-term mental health issues such as PTSD, depression, and other anxiety disorders.
The psychological trauma of trafficking is profound, as survivors are often subjected to prolonged periods of fear, uncertainty, and abuse. This chronic trauma can lead to alterations in brain function and structure, affecting memory, cognition, and emotional regulation.
Emotional Consequences
Emotionally, survivors often feel powerless and experience significant mood changes (Kommentiani, 2020).
The loss of control over their lives and bodies during trafficking leaves them struggling with a sense of helplessness and profound mood disturbances that can hinder their recovery and reintegration into society.
Survivors frequently experience emotional numbness, inability to experience pleasure, and difficulty forming emotional connections with others. This emotional turmoil can manifest in self-harm, suicidal thoughts, and other harmful behaviours as survivors struggle to cope with their experiences.
Interpersonal Consequences
Trafficked survivors have difficulty identifying, expressing, and controlling their emotions (Look et al., 2003). This emotional dysregulation can lead to strained relationships and isolation, as survivors may struggle to trust others and communicate effectively.
The trauma of trafficking disrupts normal social development, leading to difficulties in forming and maintaining healthy relationships.
Survivors may experience intense feelings of shame, guilt, and worthlessness, further complicating their ability to connect with others. Additionally, the stigma associated with being trafficked can lead to social ostracization and discrimination, exacerbating feelings of isolation and loneliness.
Severe Sexual Abuse and Dissociative Disorders
Severe sexual abuse has been identified as a critical marker leading to various dissociative disorders (DD), such as complex PTSD or dissociative identity disorder (DID). These disorders are often differentiated from other diagnoses by the presence of severe and intrusive sexual abuse, which is one of the most complex forms of abuse (Dorothy, Middleton, Seager, Williams, & Chambers, 2017).
The psychological fragmentation that occurs due to such trauma significantly impacts the survivor’s ability to maintain a cohesive sense of self. Survivors of severe sexual abuse often experience dissociation as a coping mechanism, leading to symptoms such as memory loss, identity confusion, and feelings of detachment from reality.
Spiritual Consequences
Trafficking survivors often lose their sense of self (Look et al., 2003).
This spiritual disconnection can make it difficult for survivors to find meaning and purpose in life after their traumatic experiences.
The exploitation and dehumanization experienced during trafficking can lead to a profound sense of spiritual emptiness and disconnection from one’s beliefs and values. Survivors may struggle with existential questions and feelings of hopelessness, further complicating their recovery journey.
Both women and men are victims of human trafficking, though their experiences and the types of exploitation they endure can differ. Women and girls are disproportionately affected by sex trafficking, while men and boys may be more commonly exploited for labour.
The Impact of Art Therapy on Human Trafficking Survivors
“Art therapists have the unique ability to assist clients in communication and processing when the trauma of sexual violence has hindered the regions of the brain that enable their ability to express themselves verbally” (Siegel & Bryson, 2011; van der Kolk, 2014).
The Mind’s Response to Trauma and Art Therapy
Trauma has profound effects on the brain and body. When a person experiences trauma, the brain’s normal processing mechanisms can become overwhelmed, leading to disruptions in memory, cognition, and emotional regulation. According to van der Kolk (2014), trauma can cause the brain to remain in a heightened state of alertness, leading to hypervigilance, anxiety, and difficulty regulating emotions. This state of constant alertness can interfere with normal functioning and make it difficult for survivors to feel safe and grounded.
Art therapy helps mitigate these effects by engaging different areas of the brain. The creative process can activate parts of the brain involved in sensory and motor functions, bypassing the more verbally-centred areas that trauma may impair (Lusebrink, 2004). This can help survivors process traumatic memories in a non-verbal way, making it easier to integrate these experiences without becoming overwhelmed.
Art Therapy Techniques and Exercises
Art therapy for human trafficking survivors can involve a variety of techniques and exercises tailored to address their specific needs:
1. Drawing and Painting:
○ Expression of Emotions: Survivors can use drawing and painting to express emotions that are difficult to articulate verbally. This can help them process and release pent-up feelings.
○ Safety and Control: Creating art allows survivors to feel a sense of control and safety, as they can choose what and how to create without judgment.
2. Sculpture and Collage:
○ Rebuilding Identity: Working with materials to create sculptures or collages can symbolize the process of rebuilding their identities. These activities encourage survivors to piece together aspects of their lives and experiences.
○ Tactile Engagement: Engaging with different textures and materials can provide sensory experiences that ground survivors in the present moment.
3. Mandala Drawing:
○ Focus and Calm: Drawing mandalas can promote focus and calm, helping survivors manage anxiety and stress. The repetitive nature of creating mandalas can be meditative and soothing.
○ Symbolic Representation: Mandalas can also serve as symbolic representations of the self and the journey towards wholeness.
4. Art Journaling:
○ Daily Reflection: Encourages survivors to keep an art journal where they can document their daily experiences and emotions through drawings, paintings, or mixed media. This practice can help them track their healing progress and reflect on their journey (Malchiodi, 2006).
○ Self-Exploration: Art journaling provides a private, personal space for survivors to explore their thoughts and feelings without fear of judgment.
5. Clay Modeling:
○ Physical Engagement: Working with clay can be a grounding activity that helps survivors connect with their physical bodies and the present moment.
○ Emotional Release: The tactile nature of clay modelling allows survivors to express and release emotions through their hands, which can be particularly cathartic for those who have experienced physical trauma (Levine, 1997).
6. Phototherapy:
○ Personal Storytelling: Survivors use photographs to tell their stories, capture important moments, or symbolize their emotions and experiences.
○ Perspective Shift: Phototherapy can help survivors see their experiences from different angles, promoting new insights and understanding (Weiser, 1999).
7. Group Art Projects:
○ Community Building: Collaborating on art projects with other survivors can foster a sense of community and shared experience.
○ Shared Healing: Group art projects can provide opportunities for survivors to support each other, share their stories, and build connections, reducing feelings of isolation (Gussak & Rosal, 2016).
8. Mask Making:
○ Exploration of Identity: Creating masks can help survivors explore different aspects of their identity and how they present themselves to the world.
○ Safety in Expression: Masks provide a way for survivors to express parts of themselves that they may not feel safe sharing otherwise (Jennings, 1990).
9. Sand Tray Therapy:
○ Symbolic Play: Using miniature figures and sand trays, survivors can create scenes that represent their experiences and emotions.
○ Non-Verbal Expression: This technique allows for the expression of complex feelings in a visual and tangible way, facilitating deeper understanding and healing (Homeyer & Sweeney, 2011).
10. Mindful Art Making:
○ Present Moment Focus: Incorporating mindfulness practices into art-making can help survivors stay grounded in the present moment and reduce anxiety.
○ Stress Reduction: Mindful art-making encourages survivors to focus on the process rather than the outcome, promoting relaxation and stress relief (Chambala, 2008).
11. Narrative Art Therapy:
○ Story Reconstruction: Survivors create visual narratives that help them reconstruct their personal stories in a way that acknowledges their resilience and strengths.
○ Empowerment: This technique helps survivors reclaim their narratives and empowers them to see themselves as more than their traumatic experiences (White & Epston, 1990).
12. Body Mapping:
○ Embodied Awareness: Survivors create life-size body maps to explore how their experiences are held in their bodies.
○ Integration of Mind and Body: This technique fosters a deeper connection between the mind and body, promoting holistic healing (Solomon, 2007).
“Cautionary Materials in Art Therapy”
Certain materials should be avoided or used carefully in art therapy with human trafficking survivors due to their potential to trigger traumatic memories. For example:
- Sensors: May remind survivors of surveillance or control mechanisms used by traffickers.
- White Glue: Could evoke memories of semen and sexual abuse, causing distress and retraumatization (Kommentiani, 2020).
- Dark or Red Paints: These colours may remind survivors of blood and violence.
- Sharp Objects: Scissors, knives, or other sharp tools could evoke memories of violence or self-harm.
- Tightly Bound Materials: Such as heavy tape or strong adhesives, which might trigger feelings of being restrained.
- Certain Textures: Textures resembling restraints or confinement materials, like rope or heavy fabric, should be used carefully to remind survivors of their captivity.
Therapists can create a more effective and supportive therapeutic environment by carefully selecting materials and techniques that promote safety and comfort.
Case Examples
Art therapist Chris Drosdick case study on brothers who are child trafficked survivors (Kommentiani, 2020).
Background:
The brothers came from a two-parent household. Their mother was a stay-at-home mom, and their father worked in the financial industry. Both parents hailed from upper-middle-class neighbourhoods, and the children attended a highly-ranked public school. The family lived in the same neighbourhood, and to an outsider, life for these two children seemed quite normal.
When the two brothers were 6 and 10 years old, they revealed that they were being sexually abused by a male relative of the family. The statement led to a two-year research, revealing a sex trafficking web coming from the relative. The abuse started to happen three years before the brothers came forward to their parents.
Treatment Stage:
When therapist Chris Driosdick entered the picture nine months after the boys started therapy, he initiated the phase of trauma reintegration. The therapeutic process was planned to last six to eight weeks, with sessions twice a week. After re-evaluating the treatment, each brother would continue seeing the therapist individually, the mother would see the therapist once a week for progress reviews and parenting support, and the entire family would see the therapist once a week for an entire year.
Therapeutic Process
The trauma art therapy approach considers four key points:
- How the mind, body, and spirit respond to trauma.
- Awareness of symptoms as coping mechanisms.
- Cultural sensitivity.
- Teaching resilience and building a thrive mentality (Malchiodi, 2011).
Boy 1: Boy one experienced anxiety, dissociation, paranoia, somatic preoccupations, compulsions, and obsessive thoughts. During sessions, his legs would become stiff, and he increased his movements, frequently patting his thighs and asking for affirmation of being a good person. This led to a three-phase approach: creating safety, building stabilization, and improving day-to-day life.
Boy 2: Boy two experienced distress and panic and would often go to great lengths to avoid discussing his memories. He would hide behind the couch, wrap his face with a blanket to avoid being seen, and sit with the heels of his feet pressed against his rectum, applying pressure to the area.
Therapist Chris Driosdick focused on trauma-informed art therapy, EMDR, CBT, DBT, and mindfulness. CBT, DBT, and EMDR are integrated easily with art therapy. CBT helped restructure thought patterns, while EMDR helped with distressing memories, decreased psychological arousal, increased attentional flexibility, and provided a distancing effect and decreased worry (Shapiro, 2017). Driosdick balanced sessions between art therapy and talk therapy.
EMDR
The boys sometimes drew their responses to visual, auditory, or tactile stimulations. Bilateral stimulation is one of the core elements of EMDR. Their initial drawings were chaotic, often featuring red and black colours. For both patients, red symbolized blood, which related to many of their traumatic memories. The boys struggled with perfectionism and would become frustrated if their art did not meet their expectations. Boy Two would often throw out his artwork but eventually learned to appreciate and reuse it for future paintings.
“Learning to improve and reclaim their art addressed and enhanced their self-esteem during the initial sessions” (C. Driosdick).
T.P Mindfulness
Mindfulness was used to rebuild the heart/head connections, addressing the common feeling of disconnection that trauma victims often experience. In this case, the boys’ brains were frequently on high alert, stuck in a fight-flight-freeze response.
The therapist introduced yoga nidra, or yoga sleep, as a meditation practice. Both boys found this practice helpful, particularly before bedtime or when panicky.
Additionally, the boys participated in a community-based art therapy class called Mindful Masterpiece, which I teach. In this class, they created acrylic paintings each week inspired by famous artists and learned three types of mindfulness exercises combined with music and slow breathing.
T.P Safety
Both boys and their families faced safety trauma and lived in a constant state of emergency. To address this, the therapist provided the boys with journals to write in before going to bed, which were reviewed during their sessions. This journaling activity aimed to capture their thoughts and leave them on the pages, allowing them to sleep more peacefully. Additionally, the therapist worked with the boys to create positive artwork to hang above their beds, providing a sense of safety.
The boys also experienced dissociation from their bodies at night. To counter this, the therapist taught them grounding techniques that included engaging the five senses to bring them back to the present moment. These techniques involved using citrus-blend essential oils, body scans, and breathing exercises.
T.P Negative thoughts
To address the boys’ negative thoughts, therapist Driosdick focused on cognitive distortions such as all-or-nothing thinking, catastrophizing, perfectionism, and personalization. The therapist also helped the boys create trigger lists, develop positive affirmation cards, and use feeling decks to identify and express their emotions.
Additionally, the therapist worked on preventing the traumatic experiences from defining the boys’ identities. By analyzing that only a small percentage of their lifetime had been spent as abuse victims, the boys were encouraged to understand that this 1 per cent should not dictate the rest of their lives.
T.P Male Gender Role Stress
The parents were worried about the impact the situation would have on their children’s gender identification. The boys also saw themselves as weak and felt shame. To address this stage of trauma, the therapist worked with the boys on building art pieces that used the first letter of their names to help build a sense of personal identity. They used collage and acrylic paint to decorate these letters, reinforcing their individuality and self-worth.
T.P Disclosure
During many sessions, the boys made statements about their abusers, details of the trauma, and their lived memories. Driosdick utilized expressive writing and drawing to capture the details of each reported incident. This approach helped the boys talk about the events, release their fear and shame, and gradually diminish the power of their traumatic memories. This method also facilitated communication between the therapist and authorities, such as the police and Child Protective Services (CPS).
After six months, Therapist Driosdick noticed significant changes in the brothers’ artwork. The symbols they used became softer and more organic, the colours brighter and neater, and the pieces more detailed. They also handled frustration with the materials better. These improvements in their artwork reflected their progress in therapy, showing a shift towards healing and a more positive self-identity.
References
● Chambala, A. (2008). Mindfulness-Based Stress Reduction and Art Therapy with Women and Children with Cancer. Journal of the American Art Therapy Association.
● Dorothy, L. B., Middleton, W., Seager, A., Williams, N., & Chambers, J. (2017). Dissociative disorders and sexual abuse. Journal of Trauma & Dissociation, 18(4), 387-408.
● Estes, R. J., & Weiner, N. A. (2001). The commercial sexual exploitation of children in the U.S., Canada, and Mexico. University of Pennsylvania, School of Social Work.
● Gussak, D. E., & Rosal, M. L. (2016). The Wiley Handbook of Art Therapy. John Wiley & Sons.
● Homeyer, L. E., & Sweeney, D. S. (2011). Sandtray Therapy: A Practical Manual, Second Edition. Routledge.
● Jennings, S. (1990). Dramatherapy with Families, Groups and Individuals: Waiting in the Wings. Jessica Kingsley Publishers.
● Kommentiani, M. K. (Ed.). (2020). Art therapy treatment with sex trafficking survivors. Routledge.
● Levine, P. A. (1997). Waking the tiger: Healing trauma. North Atlantic Books.
● Look, C., et al. (2003). Interpersonal consequences of trafficking. Journal of Trafficking Studies, 12(3), 45-67.
● Lusebrink, V. B. (2004). Art therapy and the brain: An attempt to understand the underlying processes of art expression in therapy. Art Therapy, 21(3), 125-135.
● Malchiodi, C. A. (2006). The art therapy sourcebook. McGraw-Hill.
● Malchiodi, C. A. (2012). Handbook of Art Therapy, Second Edition. Guilford Press.
● Solomon, J. (2007). Living with X: A Body Mapping Journey in the Time of HIV and AIDS. Facilitator’s Guide.
● van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
● Weiser, J. (1999). PhotoTherapy Techniques: Exploring the Secrets of Personal Snapshots and Family Albums. Weiser & Associates.
● White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. Norton.
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