3 Trauma Informed Strategies for When, Not If, You Work with a Patient Experiencing Commercial Sexual Exploitation

 It is estimated that 6.3 million people are being commercially sexually exploited globally at any given time based on the most recent 2021 report by the International Labour Organization and the Walk Free Foundation. Over 25% of these people are under the age of 18 and nearly 80% are women or girls. The number of people overall in forced labor (either sex or labor exploitation) increased over 10% between 2016 and 2021. In the United States, 16,721 victims of human trafficking were identified by calls made to the National Human Trafficking Hotline in their most recent 2021 report. As with any form of abuse, statistics such as these are an underrepresentation of the actual occurrences due to the many factors that interfere with survivors reporting such abuse. As an OT/OTA it’s not if you’ll work with a client who has experienced or is at risk for commercial sexual exploitation (CSE), it’s when. 

CSE is defined as the use of force, fraud, or coercion to compel a person into a commercial sex act against their will. If the person performing the commercial sex act is a minor, there legally does not have to be force, fraud, or coercion for this crime to be considered CSE. A commercial sex act is the exchange of something of value (money, drugs, shelter, etc.) for some kind of sexual act or material (sexual abuse, pornography, etc.). 

Separate from CSE, sex work involves an adult receiving money or goods in exchange for consensual sexual services with another adult. It’s important to note that many sex workers report high levels of violence and harassment within the context of their work from clients, managers, and police. Criminalization of sex work makes it even more difficult for these individuals to report this treatment and establish a clear understanding of the difference between sex work and CSE. Despite some similarities, CSE and sex work are not the same thing. 

Examples of CSE include:

• a 40 year old being forced through intimidation and physical abuse to provide sexual content on OnlyFans and the profit is being taken by their partner
• a 20 year old exchanging nudes online with another person who posts them on a pornography website for profit and without the 20 year old’s consent
• a 15 year old in a sexual relationship with a 19 year old when the given state’s age differential is 4 years. 
• a parent receiving drugs in exchange for people having sexual contact with their 10 year old 
• a 17 year old is kicked out of their home when they inform their parents they are gay, after a few nights on the street they trade sex for a place to stay with an older adult who promises to care for them 

It’s necessary to ask OT clients about their trauma history and current safety needs in order to create a trauma-informed environment to receive your client’s disclosure of past or current abuse. The abuse may be impacting their treatment without you, or even them, knowing. 

Below are 3 strategies for being trauma-informed when working with people with a history of CSE. These strategies are also good for clients who are experiencing or have experienced other forms of abuse.  

1. Resist asking why someone has not exited an unsafe relationship/situation or notified law enforcement. Instead listen to them and guide them in the problem solving process to help them identify what they need to be safe and stable. Exiting is not always possible right away or may not be the preferred next step for someone. 
2. Be aware of the risk factors and red flags associated with CSE. Ask your clients if they are safe, if they are having to do anything they don’t want to do, and how their needs are getting met. This awareness can be the starting point to them opening up to you.  Worried about “opening a can of worms”? The suggestion is to consider how your OT interventions could even be effective if the person is returning to an unsafe environment? The unsafe environment and situation is now the primary intervention focus.  
3. Be open to incorporating interventions related to healthy relationships, online safety, sexual health, self-image, and trauma responses (just to name a few!) as you see fit in order to address a variety of needs for your clients. These topics are important for everyone and could be a more non-intimidating entrance for important conversations with survivors of CSE. 

Representations of both sex workers and survivors of CSE are typically female and hetero-centric meaning females are portrayed as the victims and males are portrayed as the consumers (sex work) or perpetrators (CSE). It’s important to know that any person of any gender or sexual orientation can be the victim or perpetrator.

It is helpful to familiarize yourself with local anti-trafficking, domestic and sexual violence, and social service agencies to further assist your clients who have experienced CSE or may be at risk for CSE through their involvement in the sex industry. Additional resources can be found at:

• https://polarisproject.org
• https://www.missingkids.org/home
• https://humantraffickinghotline.org/en
• https://thelifestory.org

 Blog written in collaboration with Arielle Posadas, LOTR, QMHP. If you want to continue the conversation with Arielle, here's her email: [email protected]