Post-Trauma Growth Experiences Among Sex Trafficking Survivors in the United States: A Transcendental Phenomenological Exploration

Apr 1, 2026 | Volume 16 - Issue 1

Priscilla Rose Prasath, Devon E. Romero, Claudia G. Interiano-Shiverdecker, John J. S. Harrichand, Leslie Citlalli Garza Mendoza

This study explores the phenomenon of post-traumatic growth (PTG) among survivors of sex trafficking in the United States using a transcendental phenomenological approach. Through in-depth interviews with 10 survivors, the study illuminates the essence of PTG as experienced by participants, emphasizing personal and contextual factors that supported their change. Bracketing was used to reduce researcher bias, allowing the voices and meanings of participants to guide the analysis. Findings highlight two broad themes: internal agency driving change and external factors promoting change. The study offers implications for trauma-informed support and survivor-centered counseling interventions.

Keywords: post-traumatic growth, sex trafficking, internal agency, trauma-informed support, counseling interventions

     Post-traumatic growth (PTG) is the positive psychological change following the struggle with traumatic or highly challenging life circumstances (Tedeschi et al., 2018). Tedeschi and Calhoun (2004) argued that trauma is defined not by the event itself but by its effect on an individual’s core schemas or worldview, which may require reconstruction in order to integrate the traumatic experience. PTG’s framework allows us to understand the growth individuals may undergo after trauma (Tedeschi & Calhoun, 1995). This change results in new ways of thinking, feeling, and behaving that move beyond the trauma rather than returning to baseline functioning (Tedeschi & Calhoun, 1995). These long-term changes often emerge through deliberate reflection, not immediate reactions (Tedeschi et al., 2018). PTG is seen as an “ongoing process” rather than a “static outcome” (Tedeschi & Calhoun, 2004, p. 1).

Domains and Factors that Promote PTG
     Researchers have identified five domains of PTG: personal strength, close relationships, new possibilities, greater appreciation of life, and spiritual development (Tedeschi & Calhoun, 1995). These domains reflect positive changes following trauma. Personal strength includes enhanced self-reliance, increased fortitude, and a shift from seeing oneself as a “victim” to a “survivor” (Tedeschi et al., 2018, p. 27). Close relationships involve greater compassion, openness to help, and deeper connections (Tedeschi & Calhoun, 2004). New possibilities refer to recognizing new life opportunities, such as changes in interests or careers. Greater appreciation of life includes valuing things once taken for granted. Spiritual development entails changes in beliefs and reflections on life’s meaning (Tedeschi et al., 2018).

PTG may arise after major life crises, often following struggles to cope, though not always immediately (Tedeschi & Calhoun, 1995, 2004). It is important to note that PTG is not an automatic or inevitable outcome of trauma. Tedeschi and Calhoun (2004) emphasized that PTG involves an additional cognitive and emotional burden placed on survivors, who must grapple with the disruption of core schemas in order to reconstruct meaning. In other words, although trauma may create the potential for growth, survivors must actively engage in processes of reflection, sense-making, and struggle for PTG to occur (Tedeschi et al., 2018). Clarifying this distinction helps underscore that PTG requires effortful engagement beyond merely surviving or adapting. Although unplanned and unexpected, certain interventions can support PTG (Tedeschi et al., 2018). Contributing factors include cognitive processing, positive reappraisal, personality traits, trauma characteristics, individual differences, and social support (Henson et al., 2021). Coping strategies such as problem-solving, emotion regulation, forgiveness, religiosity, and spirituality have also been linked to PTG (Park, 2010; Schultz et al., 2020).

PTG in Individuals With Experiences of Sex Trafficking
     Sex trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act” (Victims of Trafficking and Violence Protection Act of 2000, § 103). Survivors often experience trauma and symptoms of post-traumatic stress disorder. PTG may begin when individuals gain the strength to leave trafficking situations and reclaim control of their lives. Current peer-reviewed literature on PTG among sex trafficking survivors remains limited. Schultz et al. (2020) examined PTG and religious coping, finding that education and faith contributed to hope and resilience. However, their focus on scales and structured reflections did not capture the phenomenological essence of survivor-defined growth. Our study extends this work using a transcendental phenomenological approach, centering survivors’ voices and allowing meaning to emerge from their narratives of change, agency, and empowerment.

Highlighting survivor-defined PTG is important for the counseling profession because it provides a more authentic and nuanced understanding of how growth is experienced by individuals who have endured extreme trauma. Much of the existing counseling literature has conceptualized PTG through researcher-defined domains or standardized measures, which risks overlooking survivor-specific meanings and contexts (Zoellner & Maercker, 2006). By privileging survivor voices, counselors can gain insight into culturally and contextually grounded processes of growth, which informs more effective trauma-informed and strengths-based interventions (Hays & Singh, 2023). This perspective also contributes to the counseling profession’s ethical responsibility to amplify marginalized voices and to design interventions that align with survivors’ lived realities, rather than imposing externally constructed frameworks (Herman, 1997).

In extending this focus, we emphasize survivor-constructed understanding and the process of becoming, rather than solely coping or recovery, filling a gap in the literature. We also distinguish PTG from resilience, defined as the capacity to bounce back to pre-trauma functioning, and from healing, defined as the restoration of well-being, by focusing on psychological and existential growth beyond pre-trauma functioning (Tedeschi & Calhoun, 2004). Although resilience emphasizes adaptation and returning to prior levels of functioning after adversity, and healing involves the restoration of well-being, PTG reflects growth that surpasses baseline functioning (Zoellner & Maercker, 2006). In this study, instances in which growth was described as moving beyond survival or recovery into a redefined sense of identity and purpose were notated as PTG experiences. This framing underscores that PTG is not synonymous with resilience or healing but represents a qualitatively distinct process of change. This survivor-centered perspective contributes to the PTG and sex trafficking discourse, capturing survivor-defined growth that emerges not only from overcoming adversity but also from redefining oneself after exploitation.

Purpose of the Study and Research Question
     This study explores the lived experiences of PTG among survivors of sex trafficking in the United States using a transcendental phenomenological approach. By centering survivor voices, it seeks to understand how individuals make meaning of growth after exiting trafficking. This inquiry contributes to academic understanding and offers practical implications for trauma-informed, strengths-based interventions. The guiding research question was: How do survivors of sex trafficking in the United States describe their experiences of PTG?

Methods

Research Design
     This study employed transcendental phenomenology to explore how survivors of sex trafficking make sense of their PTG (Moustakas, 1994). Transcendental phenomenology focuses on describing the essence of a phenomenon as experienced by individuals, by setting aside or bracketing the researchers’ own assumptions and biases. Through systematic reduction and imaginative variation, we aimed to identify the core meanings of PTG within participants’ lived experiences. This approach was chosen to allow rich, first-person accounts of healing and growth to emerge, with the research team taking deliberate steps to bracket preconceptions.

Transcendental phenomenology was selected because it emphasizes the description of the universal essence of a phenomenon through the lived experiences of individuals while intentionally setting aside researcher assumptions (Moustakas, 1994). This design aligns with our purpose of privileging survivors’ voices and minimizing interpretive bias, which is particularly important in research involving historically marginalized populations (Hays & Singh, 2023). Compared to interpretive phenomenology, which centers the researcher’s interpretation, transcendental phenomenology places greater weight on participants’ meaning-making, making it well-suited for capturing survivor-defined PTG. This methodology also aligns with the counseling profession’s emphasis on client-centered and strengths-based approaches.

Researcher Positionality
     While transcendental phenomenology requires the bracketing of researcher assumptions, we also provide positionality statements to enhance transparency. We engaged in ongoing reflexivity, journaling, and bracketing discussions throughout data collection and analysis. These efforts helped us remain attuned to participants’ meanings and reduce potential bias. Hays and Singh (2023) considered subjectivity statements crucial to inform readers about the context and process of qualitative research. Priscilla Rose Prasath (cisgender female, Asian Indian), Devon E. Romero (cisgender female, biracial), Claudia G. Interiano-Shiverdecker (cisgender female, Latina), and John J. S. Harrichand (cisgender male, biracial/Asian) are current university counselor educators with numerous publications, presentations, and training given to counselors-in-training and professional counselors on sex trafficking. Prasath primarily studies positive psychological constructs such as PTG from a strengths-based perspective. Prasath, Romero, Interiano-Shiverdecker, and Harrichand all hold a license as a Licensed Professional Counselor (LPC); Harrichand also holds an LPC-S. They have a combined 20+ years of clinical experience working with diverse clientele and in a variety of settings.  Leslie Citlalli Garza Mendoza (cisgender female, Latina) is currently enrolled as a doctoral student at the same university as Prasath, Romero, and Interiano-Shiverdecker. Having conducted prior research on sex trafficking experiences, we approached this study with certain preconceptions. We anticipated that the findings would align with those of other trauma victims in the existing literature. However, our previous work led us to consider the possibility that PTG may manifest in more areas than the traditionally recognized five PTG domains.

Participants and Sampling
     Ten participants were selected using purposive sampling, having lived experience of post-trauma growth following sex trafficking, consistent with phenomenological methods (Moustakas, 1994). PTG was intentionally not an explicit inclusion criterion because one of the central aims of this study was to explore how survivors themselves describe growth following trauma without imposing a predetermined definition of PTG. By not requiring participants to self-identify with the concept of PTG, we were able to capture survivor-constructed understandings of growth, which is consistent with transcendental phenomenology’s emphasis on allowing meaning to emerge from participants’ voices (Moustakas, 1994). Survivors were invited to share their experiences of positive changes and post-trafficking healing, and PTG was identified through analysis when participants described growth beyond baseline functioning. This approach aligns with calls in the literature to privilege survivor perspectives and to avoid constraining data collection to researcher-driven constructs (Hays & Singh, 2023).

With regard to participants’ characteristics, ages ranged from 30 to 42 (M = 36.7, Mdn = 38.5, SD = 5.1). Most participants were White (n = 8), with one American Indian or Alaskan Native participant and one Black participant. Nine were U.S.-born; one was an immigrant residing in the United States for 4 years. Educational attainment ranged from secondary school to graduate school. Marital status included single (n = 3), married (n = 1), separated (n = 2), and divorced (n = 4). To provide additional context, participant demographic information is summarized in Table 1.

Table 1

Survivor Demographics

Survivor Age Gender Race / Ethnicity Marital Status Education
Annabel 37 Female White Divorced Graduate School
Betty 30 Female White Single Graduate School
Cassie 41 Female White Divorced College
Crystal 42 Female American Indian or

Alaskan Native

 Separated Some College
Gretchen 30 Female White Divorced Some Graduate School
Jennifer 32 Female White Separated College
Jes 42 Female White Married 10th Grade; GED
Mia 41 Female White Single Secondary School
Monica 32 Female White Divorced College
Niki 40 Female Black Single Graduate School

Note. GED = General Educational Development; age in years.

Data Collection Procedures
     After receiving IRB approval from the university, we sought participants through purposeful sampling. Interview questions were developed following Moustakas’ (1994) recommendations for phenomenological research, using open-ended, broad questions that allowed participants to reflect deeply on their lived experiences. To minimize bias, Prasath conducted bracketing activities before and throughout the data collection. Interviews were audio-recorded, transcribed, and reviewed for accuracy.

Inclusion and Recruitment
     Participants were required to be sex trafficking survivors over the age of 18. Recruitment began in early 2022. Initially, we reached out to professional networks and advocacy contacts known to members of the research team, including colleagues who had previously collaborated with survivor leaders or anti-trafficking initiatives. This initially yielded one volunteer, but after 2 months, additional participants could not be reached through these connections.

Consequently, we broadened recruitment to additional purposeful sampling strategies. Rather than working exclusively through organizations or mental health professionals, which may have limited access to survivors who publicly self-identify, we directly contacted individuals who had already chosen to share their survivorship openly via social media platforms such as TikTok, Instagram, and Twitter. This strategy aligned with our goal of centering survivor-defined PTG and ensured we recruited participants who were willing to narrate their experiences in their own terms. Through these efforts, nine more individuals volunteered within 2 months. Interested participants completed consent forms, a demographic form, and a one-time Zoom interview. To protect confidentiality, all references to organizations, programs, or initiatives were generalized, and identifying details were removed. Any names used in reporting were pseudonyms chosen by the research team to further protect anonymity. Participants received a $20 gift card for their involvement. Data collection concluded in May 2022.

Interview Protocol Development
     The interview questions were developed through an iterative process informed by both the research design and existing scholarship on PTG. We reviewed foundational literature on PTG domains (Tedeschi & Calhoun, 2004) as well as recent studies examining growth among trauma-affected populations (e.g., Schultz et al., 2020). This ensured our protocol included questions that tapped into constructs previously studied, such as changes in relationships, new possibilities, personal strength, and spirituality, while also leaving space for survivor-defined meanings to emerge. Additionally, members of the research team drew on our clinical expertise counseling individuals with trauma histories to ensure that the questions were phrased sensitively and reduced the risk of retraumatization. The resulting semi-structured protocol balanced theoretical grounding with clinical appropriateness, consistent with Smith et al.’s (2009) recommendations for qualitative interviewing.

Interview Content and Process
     Harrichand, a counselor educator with expertise in qualitative inquiry and a Certified Clinical Trauma Professional, conducted the interviews. The semi-structured format began with broad, non-threatening prompts (e.g., “Please tell me a little about yourself and your background”) before progressing to more specific questions about change, coping, and growth after trafficking. Questions included: “What do you think are the most common challenges that survivors experience after their sex trafficking experience?”; “Tell me about the person you are today—how does this person compare to who you were before?”; “What helped you overcome the impact of sex trafficking?”; “Were there services or resources that were helpful to you?”; “What is important for counselors to know when working with sex trafficking survivors?”; and “What is important about your experience that I haven’t asked you and you haven’t had the chance to tell me?” This progression followed Smith et al.’s (2009) emphasis on beginning with general questions before moving to potentially sensitive areas. Interviews were conducted with sensitivity and empathy, using counseling skills such as reflections, minimal encouragers, and attending behaviors to facilitate conversation. Interviews ranged from 41 to 145 minutes (M = 80.9), allowing for in-depth exploration of each participant’s lived experience.

Data Analysis
     Data analysis followed Moustakas’ (1994) transcendental phenomenological method. We began with epoché, or bracketing, to set aside preconceptions related to trauma and PTG. Prasath and Mendoza independently immersed themselves in the data by reading and re-reading interview transcripts. We conducted horizontalization by first treating all statements as equally valuable. From this pool, we then identified significant statements, defined as those that directly illuminated participants’ experiences of PTG, for further clustering into meaning units. Weekly meetings were held over a semester to review notes and merge coding. Mendoza conducted initial coding, followed by Prasath’s independent coding.

The coding process focused solely on identifying PTG, defined as growth beyond baseline functioning and recovery. Statements that reflected only symptom relief or a return to prior levels of functioning were not coded as PTG. In contrast, when participants described new perspectives, redefined identity, or discovery of new possibilities, these were categorized as PTG. Ambiguous expressions, such as “I am happy,” were coded as PTG only when participants explicitly tied such expressions to broader meaning-making or identity shifts. Coding judgments were discussed in team debriefings to ensure consistency and credibility.

Through imaginative variation, we then explored how context shaped meaning. Textural descriptions (what was experienced) and structural descriptions (how it was experienced) were synthesized into a composite narrative. For example, even when not directly prompted, participants’ accounts revealed structural descriptions of PTG as integral to their lived experiences.

Strategies of Trustworthiness
     To ensure rigor, we followed Moustakas’ (1994) guidelines and qualitative research best practices (Hays & Singh, 2023). Prasath and Mendoza maintained bracketing journals and engaged in regular reflexive dialogues to manage assumptions. Researcher triangulation was achieved through independent coding by team members from varied professional backgrounds, followed by collaborative debriefings to reach consensus. To strengthen credibility, we conducted peer debriefings and obtained an external audit by a qualitative research expert. Member checking was limited to transcript verification to remain consistent with phenomenological principles. An audit trail was maintained, and thick, descriptive narratives supported by direct quotations enhanced transferability and confirmability.

Results

We categorized the experiences of participants into two broad themes: Internal Agency Driving Change and External Factors Promoting Change (see Table 2).

Table 2

Themes and Subthemes

Experiences of PTG Themes Subthemes
Internal Agency
Driving Change		 Personal Strengths Resources ·         Warrior and survivor mindset

·         Self-awareness

·         Confidence

·         Forgiveness
Finding Meaning in the Everyday ·         Acceptance and gratitude

·         Positive reframed perspective toward life and self
Creating Paths Forward ·         Pursuing new career path as an advocacy agent

·         Entrepreneurial mindset

·         Educating and training others

·         Empowering other survivors
Spiritual Grounding and Rediscovery ·         Meaning-making of experiences

·         Faith as a healing pathway

·         Transition to spirituality or redefining spiritual identity
Past Survival Mechanisms Evolving Into Coping Strategies ·         Acceptance coping

·         Skilled crisis management

·         Dissociation

·         Substance coping

·         Avoidance coping
External Factors
Promoting Change		 Close Relationships ·         Navigating trust and vulnerability

·         Balancing isolation and connection

·         Survivor-led peer support
Supportive Resources
and Services		 ·         Access to basic needs

·         Trauma-informed resources and programs

·         Survivor-led initiatives

·         Barriers to access
Counseling Experiences and Alternative Paths to Healing ·         Counselor characteristics—knowledge, skills, dispositions, and practices

·         Importance of tailored counseling approaches

·         Multidisciplinary trauma-informed teams

·         Alternative therapeutic modalities

·         Support groups

 

Internal Agency Driving Change

     Within the theme Internal Agency Driving Change, most participants identified the following five areas: Personal Strengths Resources, Finding Meaning in the Everyday, Creating Paths Forward, Spiritual Grounding and Rediscovery, and Past Survival Mechanisms Evolving Into Coping Strategies. To illustrate how they manifested in survivors of sex trafficking, we coupled each subtheme with representative quotes.

Personal Strengths Resources—“A Warrior and Survivor Mindset”
     All 10 participants shared the subtheme of Personal Strengths Resources, including confidence, forgiveness, self-awareness, and developing a warrior and survivor mindset. Many described reclaiming their confidence, learning self-forgiveness, enhancing their intuition for protection, and embracing a resilient mindset, with Monica summing up this subtheme by expressing, “I’m a survivor and a warrior first.” Niki shared the process of relearning that she “cannot control the actions of other[s] . . . but I can control what I can do to make myself safe to move on with my life . . . I can act—advocate for myself . . . giv[e] myself that space.” Six participants expressed confidence in their narratives—which was taken from them while being trafficked. Participants shared, “I like myself now,” “I’m happy,” and “I’m way more confident.”

Four of the participants described their capacity to participate in forgiveness of self and others even after their experiences of sex trafficking. Annabel shared, “I guess my capacity to empathize with people who were like <laughing> doing awful stuff to me . . . I guess is endearing . . . an internal quality.” Monica noted that her healing journey involved forgiveness and “being compassionate again.” She explained, “The hardest action we have to take for ourselves and our mental state is forgiving those who trafficked us. . . . only then I feel like we can actually start forgiving ourselves and that’s been a really difficult piece.” She added, “I have forgiven myself.”

Like intuition, nine participants expressed increased self-awareness following their life of sex trafficking. Cassie reflected, “I’ve had to really kind of figure things out on my own.” She noted that self-awareness allows her to be present in the life she is living today. While Monica expressed that she is “finding her identity . . . doing everything for me authentically. . . . it’s releasing all that, it’s fully taking down that mask and being authentic . . . feeling emotion again.” Seven participants highlighted traits such as intelligence and resilience. Mia also emphasized the importance of stubbornness in her journey to healing, stating, “When I started the journey to healing, it was ‘I want healing at any cost.’” She further elaborated, “That’s why I was created so stubborn . . . digging my heels into the sand, being like, I’m not going to let them win. I’m not. And if it takes me 40 years, I’m not gonna let them.”

The final quality that was noted as a personal strength by all 10 participants was having both a warrior and survivor mindset. Crystal expressed this mindset by saying, “I refuse to let them [sex traffickers] win. . . . it took a lot of work to come back. . . . They tried to take my voice, but they didn’t. . . . I started voice therapy . . . and it’s already a little bit better.” Gretchen shared that feeling “powerful again . . . I am you know, like f*ck it. F*ck all of you, like, I’ll just do whatever . . . instead of feeling those true, awful, sad emotions . . . like, what happened to me wasn’t my choice.” Mia ascribed such a strength to her willingness to take risk, while Monica summarized it as, “I’m a warrior, I have superpowers, and I’m a superwoman.”

Finding Meaning in the Everyday—“I Have Joy”
     All 10 participants highlighted Finding Meaning in the Everyday despite their traumatic experiences from sex trafficking, with many expressing acceptance, gratitude, and self-empowerment as they reclaimed their lives and healed, exemplified through narratives of finding their voice, embracing happiness, reconciling with their bodies, drawing strength from their faith, and engaging in acts to make a new beginning. Annabel’s story captured this subtheme when she acknowledged the struggle of getting “comfortable exercising those new muscles” of learning to “value” oneself, to do “something healthy,” and doing things that make one “happy.”

Participants expressed a sense of acceptance and gratitude for where they are today. Niki expressed, “I’m <pause> having to accept that I am not the same person. . . . I’m just doing my best in that moment and being okay with that, instead of, like, trying to beat myself up.” Betty shared that her life could have been worse: “I’m pretty fortunate that I didn’t have any other long-term . . . like, I don’t have HIV, or Hep-C, or I didn’t have kids.” Monica noted that acceptance involved permitting herself to be happy: “I was truly in this push and pull of, like, is happiness real? . . . It’s okay to be happy. . . . It’s okay to feel fulfilled, it’s okay to feel abundance.” Cassie captured the magnitude of time it has taken her to heal and accept her body: “I have spent the last probably 15 years coming back into my body.”

Most participants reframed their perspective toward life and self-identity. Some of them, like Crystal, experienced this reframe because of their faith: “I have joy, which is like that inner contentment, that peace . . . that surpasses all understanding.” She went on to say, “The Crystal that I am now is who God intended me to be; the person that I was before is who my family made me think that I was.” Others, like Mia, reframed the way they viewed life after sex trafficking, emphasizing the potential for the experience to change and empower oneself.

Creating Paths Forward—“I Just Want to Get Out There and Do My Part”
     While five participants identified education as key to their story, all 10 participants shared about Creating Paths Forward after their life of sex trafficking. This involved pursuing a new career path, having an entrepreneurial mindset, desiring to educate and train other professionals, and having the drive to empower other survivors. All participants were pursuing a new career path focused on mental health, nursing, shelter coordination, or advocacy work. Participants discussed how education and work helped them find a new sense of purpose. Jennifer emphasized, “Education is key. That was probably one big part of my story.” Betty similarly noted that “finding something to give yourself purpose . . . finding purpose helps you overcome everything.” For Cassie, securing student loans was a step toward this new purpose. Crystal expressed a deep love for learning, while Betty pursued her goal of going to nursing school. Jes found that engaging in sales jobs when she left sex trafficking was “powerful for deep inner healing,” understanding how these avenues contributed to a sense of empowerment and recovery.

These professional roles highlighted how survivors’ traumas led them to engage in trauma-informed care, helping others navigate similar difficult experiences while healing from their past traumas. For example, Betty shared, “I am a nurse now. I’m a nurse educator,” and one of her main goals “is to integrate sex trafficking education for nursing staff.” Cassie commented on becoming a shelter coordinator for a “domestic violence and sexual prevention program,” and that she loves what she does: “I love helping other people—I don’t care how I’m helping them, what capacity, as long as I’m helping, I am happy.”

Participants shared how they developed an entrepreneurial mindset, starting nonprofits or other organizations to bridge gaps in services, such as emergency response and long-term support programs. Crystal expressed the desire to open a nonprofit organization to help women escape sex trafficking: “I’m trying to bridge that gap. . . . I’m not gonna wait and say, ‘Oh you have to call me back so we can do an intake process to see if you’re good fit or not [to get help].’” Similarly, Monica’s platform is focused on “bring[ing] awareness that survivors are not a threat or they’re not a victim . . . they need to be treated with such respect as an identity, like a superpower.”

Participants also expressed the desire to educate and train other professionals, helping others and making systemic changes, particularly in health care, law enforcement, and legal systems. For example, Mia has visited “14 countries on four continents doing missions work and working with non-government organizations doing humanitarian work” in which she focuses on helping lawmakers or government agencies specifically around child trafficking. She is using her story of sex trafficking “to help police departments and DAs and lawmakers . . . see [sex trafficking]. . . . I want to be able to equip, you know, whether it be therapists or cops, or law enforcement, or you know, the legal system.

A final dimension of this subtheme highlighted by all 10 participants was the desire to empower other survivors, shifting the narrative from victimhood to empowerment. Their stories also revealed the challenges faced in overcoming criminal records, trauma, and societal stigma, inspiring them to advocate for more respect and understanding of survivors’ journeys. Crystal shared, “I’m trying to save people’s lives. People saved my life . . . I intend to use [it] to help other women . . . I just want to get out there and do my part.” Jennifer described working as the shelter coordinator and also serving as “a part-time deputy” to help other survivors. And Monica is using her education as a life coach to help survivors with their “trauma response and transformation. . . . I really work hard on helping survivors heal . . . [to] stop placing themselves as victims and start thriving as survivors and leaders.” Collectively, these narratives underline the resilience of survivors and their dedication to using their experiences to educate, advocate, and support others within and beyond their communities.

Spiritual Grounding and Rediscovery—“Untangling the Mess”
     Seven participants reported relying on religion to cope with the aftermath of their sex trafficking experiences and to search for deeper meaning. Crystal stated, “That’s been the best thing out of all this, like kind of makes it all worth it, because the relationship I have with God now, yeah. It was worth going through everything I went through.” The discovery of purpose and strength through religion and spiritual practices was commonly reported among participants. Crystal emphasized the importance of her faith, stating, “Obedience to God is the only thing that kept me here.” Jes added, “I just started searching for answers,” reflecting a journey of meaning-making that helped anchor her during her healing.

They found comfort in their faith as they navigated the healing process, valuing the relationship and sense of meaning that emerged from their sex trafficking experiences. Six participants reported continuing to practice religion and finding a silver lining in their experiences. Gretchen reported, “Hopefully, God willing, I will be able to move away from here someday, but I think, you know, I have, like, really big faith and, like, God put me here for a reason.” For others, spirituality became a path for self-discovery and identity formation. Mia described being on a journey to understand who she truly was, while Monica highlighted the role of spiritual beliefs in helping her recognize and embrace her identity as a survivor. Of them, three participants described reframing their view of religion, recognizing that individuals have some control over their divine life, destiny, and purpose. For example, Mia and Monica spoke about their journeys of self-discovery and finding their identity through spiritual exploration. In contrast, two participants expressed redefining their spiritual identity as neither religious nor spiritual. Betty shared her journey: “I absolutely decided like I’m not Christian. For a long time, I considered myself an atheist, I don’t believe in anything, but over time I have really connected with my spiritual self . . . I would consider myself a Pagan now.”

Past Survival Mechanisms Evolving Into Coping Strategies
     All 10 participants identified past survival mechanisms that once shielded them from immediate psychological harm but have since evolved into coping strategies, facilitating PTG. These mechanisms, such as acceptance, handling crisis situations, substance coping, and avoidance coping, highlight the participants’ resilience and ability to navigate challenging environments while seeking healing
and growth.

Acceptance coping emerged as a pivotal process for participants, marked by an eventual awareness of their trauma and a willingness to confront it. Many described the delayed realization of their experiences, often occurring long after the traumatic events. Jennifer shared how she initially failed to recognize her reality, noting that when she was in the midst of it, she “didn’t even realize that’s what it was.” Similarly, Annabel reflected on how she spent years believing her experiences were normal or expected, only to later understand the severity of her situation. She recalled a conversation with a friend who said, “I can’t believe I know a victim of trafficking,” to which Annabel responded, laughing, “Who?” Her friend’s reply, “You,” was a startling revelation. As participants moved toward acceptance, many began dismantling survival personas they had developed to protect themselves. Monica explained how she had “played roles and characters” during her trauma, but healing required her to “take down that mask” and embrace her authentic self. For her, the journey to authenticity involved intense healing and self-discovery, which she described as both liberating and transformative.

Participants also demonstrated exceptional crisis management skills, or a sense of keen intuition, often rooted in their need to survive. Jes shared needing to “read body language and understand how to perceive people,” a skill that became second nature over time. Mia further commented that “trafficking survivors have been taught to read their audience. . . . they’re gonna be able to see it on your face because that’s what they’ve been trained to do. . . . I still to this day can read people really well.” Dissociation also played a significant role, allowing participants to detach from their immediate realities. Cassie explained how she “detached from [herself]” as a survival mechanism, while Betty noted that dissociation led to “huge blocks of memories that are gone,” which helped protect her from the overwhelming trauma. For Annabel, dissociation was both a liability and a tool that allowed her to function. She reflected on how it helped her succeed in academic and workplace settings, as it gave the impression that she was “much more functional.” While acknowledging its downsides, she described her dissociation as more “managed” now, highlighting its adaptive value.

Substance use was identified as another critical survival mechanism, providing temporary relief from the pain and chaos participants endured. For Annabel, drug use was a means of survival, as she admitted that “a good stint of drug use” likely saved her life. She described how substances helped her tolerate what she was experiencing, echoing sentiments shared by Betty and Cassie, who also turned to drugs as a way of coping with their trauma. Although harmful in the long term, substance use offered an escape during moments of extreme distress. As participants transitioned into recovery, some replaced illicit substances with prescribed medications to manage ongoing challenges. Gretchen, for example, explained how she now uses medication to address high blood pressure and anxiety, demonstrating a shift toward healthier coping strategies.

Finally, avoidance strategies, including running away and emotional distancing, were essential survival tools for many participants. Crystal shared how physical avoidance, or running, was a literal means of staying alive for her. Emotional avoidance also played a role, with Betty describing herself as “very distrustful” of others as a way to protect herself. Although these strategies sometimes prevented participants from fully engaging with their trauma, they were vital in enabling them to navigate and survive their immediate environments.

Together, these diverse coping mechanisms, whether acceptance, dissociation, substance use, spirituality, or avoidance, illustrate the complex, adaptive ways in which survivors of trafficking have navigated their pasts. Over time, these mechanisms have evolved, allowing participants to pursue growth and healing while continuing to adapt to the challenges of their unique journeys.

External Factors Promoting Change
     All participants highlighted various external contextual factors that supported their growth and healing, ranging from supportive resources and services to meaningful social support systems, including the role of counselors. We organized these insights into three subthemes: Close Relationships,  Supportive Resources and Services, and Counseling Experiences and Alternative Paths to Healing.

Close Relationships—“I Needed Somewhere to Go”
     This subtheme was endorsed by all 10 participants, reflecting the significant challenges and complexities survivors of sex trafficking face in their relationships, trust, and healing. Participant narratives revealed the profound challenges of forming and maintaining close relationships, alongside the critical role of family, community, and pivotal interventions in their healing. Although many survivors continue to grapple with distrust and self-protection, the presence of supportive networks and key turning points fosters resilience and PTG, enabling them to navigate their journeys toward recovery.

Firstly, all participants described how trust and vulnerability became extremely difficult after their trafficking experiences. Monica, for example, explained how it takes time to feel safe opening up to loved ones, contrasting it with the transactional nature of sex trafficking. Despite being 7 years removed from her trafficking experience, Monica noted she is “still working on trust issues,” particularly in the context of her small, close-knit community. Additionally, Betty and Annabel highlighted how survival mechanisms during trafficking carried over into their post-trafficking lives. Betty described herself as “distrustful” and admitted to avoiding romantic relationships entirely, saying, “I don’t really bond with men. . . . Like, I could see myself being single forever.” Though initially difficult, she shared that she has come to terms with this choice, adding, “I am finally at a point now where I am okay with being alone.” Annabel, on the other hand, described how she learned to maintain superficial relationships as a way to stay safe, stating that she became “really good at superficial relationships” and intentionally shares “just enough personal details so that people think they have some understanding of me.”

The lasting effects of trauma created further barriers to forming close relationships. Crystal spoke about the overwhelming impact of triggers, explaining that “the nightmares, the flashbacks . . . smells, areas” make it difficult to rebuild trust. She poignantly concluded, “You can’t teach somebody how to trust again. You just can’t.” Secondly, despite these challenges, five participants described how community support played a crucial role in their healing process. Niki emphasized the normalizing and validating effect of being in a survivor community, noting that connecting with others who had similar experiences made her feel less isolated and helped her develop compassion for herself and others. She reflected, “It’s given me a new level of grace for . . . people’s brokenness.” Mia encapsulated the importance of collective care in her statement that “it takes a village to have a human trafficking survivor recover and live a meaningful life.” Thirdly, support from family members emerged as a critical factor for most participants. Monica expressed deep gratitude toward her daughter, who encouraged her to seek help and begin her recovery journey. Similarly, Betty described the unwavering support of her parents, who were aware of what she had endured but never judged or mistreated her. Betty also described how her family helped her escape, recalling, “They packed up my apartment and moved me to an undisclosed location. And that’s kind of how I actually found my freedom.” Jennifer noted that her mother played an essential role in her recovery, sharing that “she was always there for everything, if I needed to talk, if I needed somewhere to go.” Gretchen echoed this sentiment, reflecting on how her family stepped in to help her, saying, “Luckily, I had family that would help me.” Other participants recalled individuals who helped them envision a different future. Betty shared how a preceptor during her training encouraged her to pursue nursing, saying, “She’s like, ‘You shouldn’t be a medical assistant; you need to be a nurse and go back to school.’”

Next, several participants highlighted how their upbringing and privilege laid a foundation for resilience. Betty reflected on her stable background, saying, “I had a great family . . . a wonderful upbringing. I was a middle-class White female from a very conservative military family.” Gretchen similarly described her childhood as “pretty normal,” emphasizing the stability of having “both my parents together” and a mother who had a successful career. Finally, Jes added that she consciously uses her privilege to make a difference, stating, “I use my privilege to kick open the door.”

Supportive Resources and Services
     All 10 participants described the availability and access to various services as crucial factors in promoting their PTG experience. Frequently mentioned were access to education, housing, mental health services, substance abuse recovery centers, and advocacy agencies. For example, Crystal emphasized the importance of “resources for education and housing,” while Cassie underscored the value of “having survivor leaders in those types of programs” to foster a deeper sense of understanding and connection. Similarly, Annabel highlighted the importance of mental health deputies who are “trained to respond to her unique needs,” explaining how they could “use the powers of law enforcement to quickly get to me, before I get too far.”

Participants also shared names of specific organizations and programs that played influential roles in their recovery journeys. Some of them were nonprofit organizations, or a community-based advocacy initiative, or a faith-based program. Additionally, many found the scholarship support that some of the school programs offered to be incredibly helpful. Many also emphasized the role of programs that offered vocational training and legal assistance to be extremely instrumental in regaining stability.

Participants experienced interventions or moments that prompted lasting change. Health care providers, educators, family members, and peers often served as catalysts for PTG. Betty credited her primary care doctor for recommending her first counselor after learning about her trauma during a routine clinical exam. She explained, “I wouldn’t have seen that first counselor at Kaiser if it wasn’t recommended by my primary care doctor.” For Mia, safe spaces at school—like time spent with the librarian—provided much-needed respite: “I could escape for half an hour, 45 minutes.” These supports were often intertwined with personal growth and self-discovery. Jes highlighted how sales training helped her “establish better boundaries and figure out who I was and how I wanted to help people,” while Gretchen shared how bodybuilding boosted her confidence and strengthened her faith.
Niki credited exercise for rebuilding trust in herself and staying physically present: “It was really helpful for me because I was checking out all the time.”

Spirituality and faith were also recurring themes. Many participants found strength through religious programs, community resources, or personal faith. Gretchen described how faith and bodybuilding were interwoven in her journey to healing. Finally, advocacy agencies and survivor-led programs emerged as critical enablers of recovery. Cassie stressed the importance of survivor leaders, noting, “It takes someone who is a survivor who is really going to be able to understand how to respond.” Similarly, Gretchen noted the value of advocacy agencies and peer support groups, while Annabel highlighted the role of trauma-informed law enforcement and ritual abuse trafficking supports.

Counseling Experiences and Alternative Paths to Healing
     All participants described varied experiences with mental health services, which were pivotal in their journeys toward PTG. Key themes included the importance of counseling, support groups, and alternative healing methods. Critical factors were counselor characteristics, multidisciplinary support, and access to alternative therapies.

For many, counseling played a central role in healing. Cassie shared attending therapy “off and on, pretty much [her] whole life,” while Gretchen found it consistently helpful. Monica said, “Because of therapy, I got in touch with my first nonprofit,” which led to public speaking and professional growth. Therapy addressed trauma and empowered participants to explore their potential. Mia found strength in her therapist’s gentle honesty, and Monica credited therapy with healing from sex addiction. Jes emphasized that having the “right therapist” was essential.

Participants identified key counselor traits in four areas: knowledge, skills, disposition, and practices. Annabel emphasized the importance of understanding trafficking-specific dynamics. Creativity was a valued skill. Jes appreciated a “tender heart” balanced with desensitization, while Mia praised “gentle reality checks with massive doses of compassion.” Patience and honesty were highlighted repeatedly as essential for building trust. Monica and Annabel emphasized the importance of safety and collaboration, while Annabel also recommended involving survivor mentors.

Participants also turned to alternative healing approaches. Betty credited her dog for saving her life and praised animal therapy. Niki found yoga and dance helped release trauma: “Trauma can get locked in your body . . . doing certain movements helps.” Somatic therapies such as massage, float therapy, and trauma touch therapy were described as deeply calming. Mia appreciated trauma touch therapy because “you don’t have to say a word . . . it simply lets your body release the trauma.” Reiki, bodybuilding, retreats, and art therapy also provided outlets for recovery. One participant described reiki as emotionally freeing, while another found smashing objects helped release rage.

Support groups were vital, especially when individual counseling wasn’t accessible. One participant noted that support from peers “made a big difference,” while another participant saw survivor groups as protective against re-trafficking. Another participant stated that she gained confidence speaking in group settings, while one other participant stressed the importance of a coordinated trauma response and informed professionals who could meet survivors where they were in their healing.

Discussion

This study examined the lived experiences of PTG among sex trafficking survivors using a transcendental phenomenological approach. By bracketing assumptions and centering participant voices, we identified themes reflecting both internal agency and external influences. Rather than imposing a framework, we allowed themes to emerge from survivor narratives and later contextualized them through PTG scholarship. Findings highlight the complex nature of growth and the dynamic interplay between survival mechanisms, personal development, and supportive environments.

Internal Agency Driving Change
     Participants’ narratives revealed that PTG was not linear but a dynamic process rooted in reclaiming power, identity, and meaning. Survivors drew on personal strengths such as resilience, confidence, forgiveness, and self-awareness. Developing a “warrior” and “survivor” mindset marked a shift from victimhood to agency as participants redefined their self-concept and resisted being reduced to their past. These accounts align with the PTG domain of personal strength (Tedeschi & Calhoun, 2004), though the framing came from survivors’ voices. Resilience was seen as both empowering and protective, reflecting a nuanced understanding of strength (Luthans et al., 2006). Survivors acknowledged vulnerability not as weakness but as a space for growth. Healing required confronting fear and suffering while reclaiming agency—consistent with trauma-informed resilience, which emphasizes growth through engagement with pain (Courtois & Ford, 2013).

Survivors also cultivated joy, gratitude, and acceptance through reflection and reframing. This shift supported a more empowered relationship with self and others. These experiences mirror findings on the role of gratitude in fostering growth (Fredrickson et al., 2003; Park & Ai, 2006). Redefining purpose through advocacy and education emerged as another form of internal agency. Survivors pursued careers and roles that allowed them to “do their part,” transforming past suffering into purposeful action. Advocacy became a way to reclaim power, support others, and create change. These findings align with research linking prosocial behavior to PTG (Linley & Joseph, 2004) and reflect both personal and relational redefinition (Park & Ai, 2006; Tedeschi et al., 2018). Spiritual grounding also contributed to identity reconstruction, with survivors finding meaning through faith or redefining their beliefs. This spiritual growth reflected personal framing and aligned with broader PTG literature (Park & Ai, 2006).

A novel insight was the recontextualization of survival mechanisms such as dissociation, substance use, and hypervigilance, which were described as adaptive tools that later evolved into coping strategies. Survivors did not view these as inherently maladaptive but as necessary for survival. Over time, they became integrated into intentional healing. This perspective affirms trauma-informed models that recognize these behaviors as adaptive (van der Kolk, 2014). For example, hypervigilance was reframed as intuition, and dissociation transitioned into mindful awareness, demonstrating survivors’ capacity to extract meaning from adversity (Luthans et al., 2006).

External Factors Promoting Change
     External support systems played a vital role in participants’ growth. Survivors emphasized the value of close relationships with family, mentors, or peers, while also naming the difficulty of rebuilding trust. Survivor-led networks helped them connect without fear of judgment, underscoring the importance of relational safety in trauma recovery. Though many initially struggled with vulnerability, forming safe connections brought healing benefits, even amid ongoing trust issues. This finding aligns with attachment-based trauma recovery models, which highlight the reparative potential of secure relationships (Courtois & Ford, 2013; Herman, 1997).

Access to counseling and trauma-informed relationships was also pivotal in supporting participants’ growth. Participants valued counselors who showed patience, honesty, warmth, and structure. These were reported as some qualities that foster trust and reflection. These traits reflect trauma-informed principles (Hays & Singh, 2023; Herman, 1997). Support groups further offered validation and community, reinforcing survivor networks as protective against re-trafficking. Survivors also engaged in non-traditional healing approaches, including movement-based therapy, spiritual practices, creative arts, retreats, and animal-assisted interventions. These practices enabled emotional release, reconnection with the body, and creativity, affirming the need for individualized, culturally relevant care.

Implications for Practice
     This study underscores the complexity of PTG among sex trafficking survivors, demonstrating that growth involves both internal processes and external sources of support. By centering participants’ voices, we uncovered themes that reflect established PTG domains (Tedeschi & Calhoun, 2004) while expanding the framework to include survival mechanisms as foundations for growth.

The findings offer insights for enhancing trauma-informed care and guiding counselors, researchers, and policymakers. Key implications include integrating strengths-based, individualized interventions that emphasize support networks, empowerment, and community engagement. Counselors should view survival mechanisms like dissociation or substance use as adaptive responses and help survivors reconceptualize them into healing tools. Creativity, patience, and honesty were identified as essential counseling traits. Therapies such as somatic work, art, and movement-based interventions should be considered. Involving survivors in treatment planning helps tailor care to their unique goals.

Support groups and survivor-led programs are vital for fostering PTG and preventing re-trafficking. Counselors should collaborate with nonprofits and survivor communities to build peer support models that offer connection and validation. A multidisciplinary approach is essential, requiring collaboration among mental health professionals, social workers, medical providers, and legal advocates. Training in trauma-specific competencies such as recognizing trafficking indicators and addressing ritualistic abuse is critical. Survivors also emphasized rediscovering identity and agency. Counselors can support this by creating leadership opportunities including mentoring, advocacy, writing, or speaking. Incorporating survivor voices into policies and services can strengthen the effectiveness of survivor-centered care.

Finally, consistent with the counseling profession’s emphasis on strengths-based approaches, our findings underscore the importance of recognizing and building upon survivors’ existing resources, including resilience, agency, and the warrior mindset described in their narratives. Counselors can integrate trauma-informed best practices with these strengths to promote empowerment, identity reconstruction, and long-term well-being (Courtois & Ford, 2013; Hays & Singh, 2023).

Limitations and Recommendations for Future Research
     Although this study offers valuable insights into PTG among sex trafficking survivors, several limitations should be noted. Participants were recruited primarily through advocacy networks and social media, which likely attracted individuals already engaged in healing or public advocacy. This self-selection may reflect those already experiencing PTG and may have excluded individuals in earlier or more complex stages of recovery. Future research should include more diverse survivor experiences, especially those in the immediate aftermath of trauma, to capture a broader range of recovery trajectories.

The study’s limited cultural and racial diversity also affects generalizability, underscoring the need to explore how cultural factors influence PTG and intervention effectiveness. The cross-sectional design offered only a snapshot of PTG. Longitudinal research could better illuminate how survival mechanisms like dissociation evolve into adaptive strategies. Further research is needed to examine the role of alternative practices such as somatic approaches, yoga, or animal-assisted activities, which some survivors found meaningful, though their effectiveness in addressing mental health concerns remains under investigation. Finally, engaging survivors as co-researchers can ensure their lived experiences meaningfully shape future research and advocacy.

Given these limitations in generalizability, future research should also focus on refining theory related to survivor-defined PTG. Clearer theoretical frameworks are needed to distinguish PTG from related constructs such as resilience and healing, and to guide counseling interventions that are both evidence-based and survivor-centered.

Conclusion
     This study examined survivor-defined PTG among sex trafficking survivors, highlighting resilience, identity shifts, and renewed purpose. Survivors described PTG as more than recovery, involving meaning-making, agency, and hope. These findings support strengths-based, trauma-informed counseling that amplifies survivor voices and fosters growth beyond symptom relief. Training programs should prepare counselors to recognize and support PTG, while future research can expand survivor-centered definitions across diverse contexts and evaluate interventions that intentionally promote growth.

 

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript. 

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She’s Just a Prostitute: The Effects of Labels on Counselor Attitudes, Empathy, and Rape Myth Acceptance

Nov 10, 2019 | Volume 9 - Issue 4

Stacey Diane Aranez Litam

 

This study examined whether attitudes based on labels and counselor demographics predicted empathy and rape myth acceptance in counselors. A difference in attitudes based on the labels of either “prostitute” or “sex trafficking” was found. Attitudes based on labels and counselor demographics additionally predicted scores of empathy and rape myth acceptance. The importance of obtaining training on human sex trafficking was identified. The implications of these findings are discussed within the areas of counseling, counselor education, and counselor supervision, including challenging stigmatizing beliefs about individuals who have experienced commercial sexual exploitation, incorporating discussions about human sex trafficking into counselor education courses, and learning about resources and trauma-informed techniques that empower trafficked clients and support counseling supervisees.

 

Keywords: sex trafficking, human trafficking, prostitutes, rape myth, labels

 

 

Exploitation of humans through the use of force, fraud, and coercion is not a new phenomenon. Despite increased awareness to the social injustice of human trafficking and modern-day slavery, trading in human beings represents a current business enterprise well established prior to the colonization of North America (Johnson, 1997). Although the prevalence of human trafficking remains unknown (Andretta, Woodland, Watkins, & Barnes, 2016; Fedina, 2015), it occurs within the United States and across the globe, affecting all regions of the world (Davy, 2016; United Nations Office on Drugs and Crime, 2014). With an estimated 32 billion dollars accrued annually through the sexual exploitation of women, children, and men (Thompson & Haley, 2018), the United Nations identified human trafficking as the third largest criminal enterprise globally, just behind those involving drugs and weapons (Thompson & Haley, 2018).

 

Human trafficking encompasses both labor trafficking and sex trafficking. The Trafficking Victim Protection Act was passed by the U.S. Congress in 2000 to address the needs of trafficked survivors. This act, which applies to instances of sex and labor trafficking, defines human trafficking as the recruiting, harboring, transporting, supplying, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of involuntary servitude or slavery (U.S. Department of State, 2016). Sex trafficking is a specific type of human trafficking characterized by scenarios in which commercial sex acts are induced by force, fraud, or coercion, and/or in which the person induced to perform sex acts is under 18 years of age (U.S. Department of State, 2016). The International Labour Organization (2012) reported 4.5 million people were victims of sex trafficking worldwide. In 2008, the National Human Trafficking Resource Center established a hotline service that provides information related to labor and sex trafficking cases reported in the United States (Gerassi, 2015). Since 2008, reports of trafficking through the hotline have increased at the rate of 259% per year, resulting in a total of 20,400 cases involving elements of trafficking and exploitation (Gerassi, 2015). Given these estimates, it is likely that counselors will work with sex trafficking survivors at some point during their career.

 

Whereas sex trafficking is characterized by commercial sex acts induced by force, fraud, and coercion (U.S. Department of State, 2016), sex work refers to the voluntary exchange of sexual services, performances, or products, provided without coercion, control, or force (Gerassi, 2015). Individuals who self-identify as sex workers consent to provide sex acts (Bettio, Della Giusta, & Di Tommaso, 2017; Gerassi, 2015). Conversely, sexual assault occurs when unwanted sexual behaviors are attempted or completed against a person’s will (National Institute of Justice, 2017). Yet, individuals participating in sex work are at increased risk for becoming victims of human sex trafficking and experiencing other types of abuse (Cole & Sprang, 2014). One study that examined the types of abuse experienced by sex trafficking victims found trafficked individuals experienced physical violence (88.9%), sexual violence (83.3%), and psychological violence (100%; Muftic & Finn, 2013). Although overlap exists, not all sex workers are trafficked, although all sex trafficked individuals are forced to perform sex work. Research suggests that the majority of sex trafficked individuals also experience some form of sexual assault.

 

Most narratives about sex workers and prostitutes do not adequately examine the influence of structural factors, such as poor economic and social conditions, which may perpetuate the choice to become sex workers (Schwarz, Kennedy, & Britton, 2017). Instead, existing studies focus on aspects of morality attributed to sex workers (Alvarez & Alessi, 2012). For example, a Nepalese-based study found prostitutes were viewed as immoral and were ostracized because of fear of HIV contagion (Alvarez & Alessi, 2012). Continuing to focus on labels based on the perception of individuals’ consent, agency, and choice perpetuates the presence of stigma (Bettio et al., 2017).

 

The presence of stigma is well-documented in sexual commerce research. The terms sex worker and prostitute are often used interchangeably in reference to individuals exchanging sex acts for compensation, and stigma exists based on which term is used (Alvarez & Alessi, 2012; Bettio et al., 2017; Gerassi, 2015; Schwarz et al., 2017). Specifically, rates of stigma are highest when applied to street prostitution compared to commercial stripping, pornography, and other sex acts (Schwarz et al., 2017; Weitzer, 2018). The effects of stigma based on labels negatively influence overall wellness. Sex workers who had been labeled prostitute reported lower levels of well-being (Bradley, 2007) and struggled with feelings of anger, confusion, frustration, and being misunderstood (Tomura, 2009).

 

Regardless of how people, including counselors, characterize the construct of human sex trafficking, the stigma associated with labeling clients as prostitutes negatively impacts sex trafficked survivors’ overall wellness. Misconceptions and stigma related to sex work negatively influence therapists’ abilities to successfully provide mental health services (Wolf, 2019). Many trafficked survivors feel shame and therefore avoid seeking help (Baldwin, Fehrenbacher, & Eisenman, 2015).

 

Barriers to Counseling Sex Trafficking Survivors

 

Counselors and mental health professionals often lack adequate knowledge and skills for counseling sex trafficking survivors (Domoney, Howard, Abas, Broadbent, & Oram, 2015). To provide successful mental health services, counselors should maintain appropriate attitudes and levels of empathy and have an understanding of rape myths.

 

Attitudes Based on Labels

Within the counseling setting, it is essential that counselors demonstrate empathy and unconditional positive regard and develop a strong therapeutic relationship with sex trafficking survivors. The language and labels used to describe clients can impact these necessary elements (Litam, 2017). According to the principle of linguistic relativity, language shapes perceptions of our world and significantly influences cognitive processes (Wolff & Holmes, 2011). Attitudes and perceptions toward groups of people vary depending on the labels ascribed to them (Szeto, Luong, & Dobson, 2013). For example, negative attitudes and perceptions exist when describing groups of people as “homeless” (Phelan, Link, Moore, & Stueve, 1997) and “fat” (Brochu & Esses, 2011) compared to “poor person” and “overweight,” respectively. Attitudes based on labels also influence rates of stigma for individuals receiving mental health services. Terms like “psycho,” “nuts,” and “crazy” may evoke feelings of danger and unpredictability about individuals with mental illness, ultimately contributing to increased rates of stigma (Szeto et al., 2013).

 

The use of labels to define people has been found to increase attitudes and stigma in the medical, legal, counseling, and social professions (McCoy & DeCecco, 2011; McLindon & Harms, 2011; Russell, Mammen, & Russell, 2005). To avoid marginalizing clients by referring to them by their diagnoses (e.g., schizophrenics, borderlines, autistics), person-first language was developed to separate an individual’s identity from their clinical diagnosis, disability, or chronic condition (Granello & Gibbs, 2016). Person-first language asserts that a person diagnosed with autism should be identified as a “person with autism” rather than “an autistic.” Thus, counselors must avoid labels to minimize the stigmatization of clients, especially when those labels are perceived as pejorative (American Psychological Association, 2010).

 

     A study conducted by Granello and Gibbs (2016) sought to examine the influence of person-first language on attitudes of tolerance for people with mental illness. Undergraduate students (n = 221), adults from a community sample (n = 211), and professional counselors and counselors-in-training (n = 269) were each given a measurement of tolerance. Tolerance was measured using the Community Attitudes Toward the Mentally Ill scale (Dear & Taylor, 1979), which measured four subscales of tolerance: Authoritarianism, Benevolence, Social Restrictiveness, and Community Mental Health Ideology (Dear & Taylor, 1979). These subscales respectively referred to participants’ views that people with mental illnesses need to be hospitalized; the belief that society should be sympathetic and kind to people with mental illnesses; the belief that people with mental illness are dangerous; and the belief that community-based mental health care is more beneficial than treatment in residential mental health care facilities (Dear & Taylor, 1979). Within each group, half of the participants received a tolerance measure that used the phrase “the mentally ill,” while the other half completed the same tolerance measure with the person-first language “people with mental illness.” The results of this study indicated that across all three groups, the measurement using “the mentally ill” yielded lower levels of the attitude of tolerance (Granello & Gibbs, 2016). These results indicate how attitudes are related to labels.

 

Empathy Within the Counseling Setting

In a meta-analysis of 224 studies examining empathy and outcomes in 3,599 clients, empathy was found to account for more outcome variance than specific treatment methods (Elliott, Bohart, Watson, & Greenberg, 2011). The results further indicated empathy was a medium-sized predictor of psychotherapy outcome across therapists’ theoretical orientation, treatment format, and severity of clients’ presenting concerns (Elliot et al., 2011). The results of these studies identified client-perceived therapist empathy as the strongest predictor of therapeutic outcomes.

 

Clients, including sex trafficking survivors, who experience a therapeutic environment characterized by counselor empathy feel more deeply understood (Clark, 2010), which promotes treatment satisfaction, likelihood of compliance, and involvement in the treatment process (Bohart, Elliott, Greenberg, & Watson, 2002). These findings provide evidence for the significant role of empathy as a catalyst for client change regardless of a counselor’s theoretical orientation, treatment format, or severity of client issues (Bohart et al., 2002; Elliot et al., 2011; Imel, Wampold, Miller, & Fleming, 2008; Moyers & Miller, 2013; Watson, Steckley, & McMullen, 2014). Based on the complex, multi-systemic, and unique needs of sex trafficking survivors, it is imperative that counselors working with this population demonstrate empathy to promote client compliance and treatment involvement (Litam, 2017). Counselors who work with sex trafficking survivors must obtain a deeper understanding of how the presence of rape myths may negatively impact their abilities to demonstrate empathy within the therapeutic setting.

 

Rape Myth Acceptance

The ways in which counselors conceptualize sexual violence may be a result of the acceptance of rape myths. Rape myths are complex sets of cultural beliefs, stereotypes, or prejudices about rape, victims of rape, or perpetrators of rape that support and perpetuate male violence against women (Burt, 1980). Common rape myths toward women include the prejudiced beliefs that victims are lying, a rape did not occur, the perpetrator was provoked by the victim, and that the victim deserved the rape in some way based on appearance, behavior, or style of dress (Edwards, Turchik, Dardis, Reynolds, & Gidycz, 2011; Wilson, Newins, & White, 2017). Additionally, the presence of benevolent sexism, or the set of beliefs that women should be protected by men, possess domestic qualities, and fulfill men’s romantic needs (Barreto & Ellemers, 2005), has been associated with rape myth acceptance (Chapleau, Oswald, & Russell, 2007). The concept of benevolent sexism explains why women who violate this stereotype by using drugs or alcohol, dressing “provocatively,” or trusting strangers are perceived as partially responsible for their rape because they are expected to be aware of risks and avoid precarious situations (Chapleau et al., 2007; Smette, Stefansen, & Mossige, 2009).

 

The extent to which rape victims are blamed for their own victimization has been associated with various factors, including the presence of traditional gender roles (Burt, 1980; Schechory & Idisis, 2006), sexual conservatism, and a tolerance for interpersonal violence (Burt, 1980). Additionally, society continues to hold prejudiced attitudes about “real” rape victims (Hockett, Smith, Klausing, & Saucier, 2016). According to Maier (2008) and Williams (1984), a “real” rape victim is characterized by a non-intoxicated woman who was unexpectedly and violently raped by a stranger in a deserted place, sustained obvious physical injuries, struggled with apparent emotional distress, and quickly reported the crime to law enforcement. In reality, few reported cases meet these criteria for the “real” rape victim stereotype (Hockett et al., 2016). Survivors of rape who do not meet the real victim stereotype are more likely to be blamed or perceived as responsible in some way for their attack (Lonsway & Fitzgerald, 1994). Survivors of human sex trafficking are raped by traffickers during their initiation into sex work and are continually raped by buyers during their captivity (Cianciarulo, 2008). Sex trafficking survivors are often misidentified as “prostitutes” and “sex workers” and are therefore not perceived to be “real” rape victims because of the presence of rape myths (Cianciarulo, 2008; Hockett et al., 2016).

 

Rape myth acceptance negatively influences the treatment modalities used by counselors and other mental health professionals. In a study conducted by Dye and Roth (1990), psychologists, social workers, and psychiatrists who held more prejudiced beliefs toward sexual assault victims were significantly more likely to use victim blaming interventions. A study conducted by McLindon and Harms (2011) indicated counselors who used biased or judgmental speech when conceptualizing clients who had been raped were more likely to adhere to rape myths. Counselors must understand the relationship between language/labels, empathy, and rape myth acceptance when supporting survivors of sexual trauma, including sex trafficking survivors.

 

When counselors accepted rape myths, sexual assault survivors were more likely to experience poor post-trauma outcomes (Wilson et al., 2017). Counselors who adhere to rape and human trafficking myths, or who engage in behaviors that reduce the amount of empathy afforded to clients, may lead to client re-traumatization, intensified feelings of client shame, and increased rates of early termination. Counselors must therefore understand how barriers to counseling sex trafficking survivors may negatively influence the success of client treatment (Wilson et al., 2017).

 

Human Trafficking Myths

Human trafficking myths are false beliefs about human trafficking and trafficking survivors that blame the victim, excuse the perpetrator, and deny or justify the sale or trade of human beings (Cunningham & Cromer, 2016). For example, human trafficking victims in the media are portrayed as young, innocent, and vulnerable children, when in reality, victims of all ages are trafficked (U.S. Department of State, 2001). Another misconception is the belief that victims are kidnapped and then trafficked, when more often than not they are exploited by a loved one such as a family member or an intimate partner (Gerassi, 2015). A study conducted by Cunningham and Cromer (2016) was the first to identify the presence of human trafficking myths in an undergraduate sample. The results of the study found human trafficking myths in 36.5% of the participants with 31% attributing blame to the victim. Men who perceived the vignette as an instance of sex trafficking were more likely to engage in victim blaming and were more accepting of human trafficking myths than their female counterparts (Cunningham & Cromer, 2016).

 

Purpose of the Study and Research Hypothesis

 

The present study sought to examine whether counselors’ attitudes differed based on labels
(i.e., prostitute and prostitution vs. sex trafficked women and sex trafficking). Additionally, the study explored whether attitudes based on labels and counselor demographics predicted levels of empathy and rape myth acceptance in counselors. Three research questions were identified: (1) Does a significant difference exist between Attitudes Toward Prostitutes and Prostitution Scale (APPS) and Attitudes Toward Trafficked Women and Sex Trafficking Scale (ATTS) scores? (2) Do APPS and ATTS scores and counselor attributes predict empathy scores on the Empathy Assessment Index (EAI)? and (3) Do APPS and ATTS scores and counselor attributes predict rape myth acceptance scores on the Illinois Rape Myth Acceptance Short Form (IRMA-SF)?

 

Method

 

Participants

Participants were licensed professional counselors and clinical counselors (N = 396) in Ohio. The mean age was 42.1 years (SD = 13.51). Participants self-identified as Caucasian/White (n = 364, 91.9%), African American/Black (n = 22, 5.6%), Hispanic/Latino(a) (n = 6, 1.5%), American Indian/Alaskan Native (n = 3, 0.8%), Asian American/Asian (n = 3, 0.8%), Arab American (n = 1, 0.3%), and Other (n = 1, 0.3%). The participant who selected Other self-identified as European American; some participants selected multiple items. Of the total 396 participants, there were more females (n = 341, 86.1%) than males (n = 53, 13.4%). Two participants (0.5%) identified as transgender. Years of counseling experience spanned from less than 1 year to 46 years with a mean of 11.1 years (SD = 10.43). The majority of participants had earned a master’s degree in counseling (n = 354, 89.4%). A smaller percentage of individuals sampled had earned a doctoral degree (n = 42, 10.6%). One participant indicated she or he had earned a master’s degree and an EdS degree (n = 1, 0.3%).

 

Instruments

Demographics/background form. A demographics/background form was used to collect respondents’ age, race, ethnicity, gender, work experience, and level of education. The form also collected whether participants had previously received training on human trafficking and prostitution. Following the demographics document, participants completed either the APPS or the ATTS. Once the appropriate scale was completed, all participants completed the IRMAS-SF, the EAI, and the Marlowe-Crowne Social Desirability Scale (MC-SDS) – Form A.

 

Attitudes Toward Prostitutes and Prostitution Scale (APPS). The APPS (Levin & Peled, 2011) is a 29-item instrument that uses a 5-point Likert scale ranging from 1 (fully disagree) to 5 (fully agree) and measures the degree to which participants agree with statements about prostitutes and prostitution. Specifically, the APPS measures Sexual Domination Discourse (SDD; Outshoorn, 2005) attitude, which views prostitution as a form of oppression (Barry, 1979). Individuals with high SDD attitudes believe women do not choose to engage in prostitution and are instead forced to participate in the sex industry as the result of early traumatic experiences (Hunt, 2013; Outshoorn, 2005). The theoretical background for the APPS emerged after an analysis of the existing literature found that views about prostitutes and prostitution could be roughly divided into normative and problem-oriented attitudes (Levin & Peled, 2011). According to Levin and Peled (2011), the normative attitude refers to the belief that prostitutes and prostitution are inherent and functional aspects of a normative society in which commercial sex work is an independent choice. Conversely, the problem-oriented attitude refers to the belief that prostitutes and prostitution are socially deviant in nature (Levin & Peled, 2011). Responses about prostitutes and prostitution are measured on two axes (“normative/deviant” and “choosing/victimized”) that can be further categorized into four subscales (Levin & Peled, 2011).

 

Two subscales assess the participants’ perception of prostitutes as people. Scores on the Prostitutes as Choosing/Victimized (PSCV) subscale measure whether respondents believe prostitutes choose to engage in prostitution (“Prostitutes enjoy the controlling of men”) or are victimized into the act of prostitution (“Prostitutes are unable to get out of the situation they are in”). The PSCV subscale has seven items. The Prostitutes as Normative/Deviant (PSND) subscale measures the extent to which respondents believe prostitutes, as people, are either normative (“Women become prostitutes because they were not properly educated”) or deviant (“Most prostitutes are drug addicts”). The PSND subscale has eight items.

 

Two additional subscales measure the act of prostitution itself. The Prostitution as Normative/ Deviant (PNND) subscale measures whether respondents perceive the act of prostitution to represent either social normativeness (“Prostitution provides men with stress relief”) or social deviance (“Prostitution harms the institution of marriage”). The PNND subscale has seven items. Finally, the Prostitution as Choosing/Victimized (PNCV) subscale measures whether respondents perceive prostitution represents either women’s choice (“Prostitution is a way for some women to gain power and control”) or the victimization of women (“Prostitution is a form of rape in which the victim gets paid”). The PNCV has seven items (Levin & Peled, 2011). Higher scores on the APPS reflect stronger adherence to the SDD attitude, which asserts that women engaged in sex work do not choose prostitution out of their own free will and prostitution is a deviant act that victimizes women (Farley et al., 2003; Hunt, 2013).

 

The APPS demonstrates sound psychometric properties for the measurement as a whole, across measures both about prostitutes and prostitution, and across all four subscales. The instrument was developed over two pilot studies using 392 male and female undergraduate and graduate students. As reported by Levin and Peled (2011), Cronbach’s alpha rendered an internal consistency for the entire scale (α = .81), on both subscales (α = .73; α = .73), and across all four subscales (α = .88; α = .81; α = .86; α = .83). The results of these analyses suggest satisfactory construct validity for a two- and four-dimensional model of the APPS (Levin & Peled, 2011). The APPS provides an overall score of attitudes about prostitutes and prostitution, scores related to attitudes about prostitutes and prostitution, and scores within each of the four subscales.

 

Attitudes Toward Trafficked Women and Sex Trafficking Scale (ATTS). The first author collaborated with the developers of the APPS (Levin & Peled, 2011) to alter the APPS wording to better reflect person-first language (e.g., “human trafficking survivor” and “sex trafficking”). The updated form was named the Attitudes Toward Trafficked Women and Sex Trafficking Scale (ATTS). Suggestions provided by the instrument’s original developers were followed to minimize the possibility that updating the APPS would interfere with its sound psychometric properties. The four subscales measured by the ATTS are the same as for the APPS. The reliability and validity information pertaining to the ATTS is unknown as this study was the first to use it, and we are in the process of measuring its psychometrics.

 

Illinois Rape Myth Acceptance Scale – Short Form (IRMA-SF). The 22-item Illinois Rape Myth Acceptance Scale – Short Form (IRMA-SF) was developed to allow brief assessment for the general factor of rape myth acceptance (Payne, Lonsway, & Fitzgerald, 1999). To examine the construct validity of the IRMA-SF, t-tests were conducted that compared participants’ gender on the IRMA-SF in relation to other variables with theoretical and/or empirically demonstrated relationships to rape myth acceptance; the other variables included sex-role stereotyping, adversarial sexual beliefs, hostility toward women, and attitudes toward violence. The results indicated men had higher means on these scales than women—IRMA: t (1174) = 6.23, p < .001 and IRMA-SF: t (174) = 6.09, p < .001 (Payne et al., 1999). Additionally, the previously mentioned variables (e.g., sex-role stereotyping) ranged from r (174) = .47, p < .001, to r (174) = .74, p < .001 (Payne et al., 1999). These results confirmed the construct validity of the IRMA-SF (Payne et al., 1999). The IRMA-SF possesses adequate construct validity, internal consistency, and reliability and allows for a quicker assessment for the general factor of rape myth acceptance (Payne et al., 1999). The 22-item IRMA-SF was selected for the study to limit the cognitive fatigue associated with lengthy questionnaire forms and to minimize the rate of non-response error for long surveys with many items (Groves, 1989). The IRMA-SF is a publicly available instrument, so no permission was needed to use it in the study. The IRMA-SF is scored by totaling the cumulative score, with higher scores indicating greater rejection of rape myths.

 

Empathy Assessment Index (EAI). The EAI was developed by Gerdes, Geiger, Lietz, Wagaman, and Segal (2012). The EAI incorporates both emotional and cognitive components of empathy and was developed over a 4-year period with eight different administrations to more than 3,500 participants (Gerdes & Segal, 2011; Gerdes, Segal, & Lietz, 2012). The EAI is a 22-item instrument that measures five subscales of neurologically identified components of empathy: (a) Affective Response (e.g., “When I see someone receive a gift that makes them happy, I feel happy”), (b) Self–Other Awareness (e.g., “I can tell the difference between someone else’s feelings and my own”), (c) Perspective Taking (e.g., “I can imagine what the character is feeling in a good movie”), (d) Emotion Regulation (e.g., “When I am upset or unhappy, I get over it quickly”), and (e) Affective Mentalizing (e.g., “When I see a person experiencing a strong emotion, I can describe what the person is feeling to someone else”). To control for social desirability and hide the link to empathy, the EAI is titled the “Human Relations Survey.” The typical time to complete the EAI is 5–10 minutes. The EAI is a publicly available instrument, so no permission was needed to include it in the study.

 

Marlowe-Crowne Social Desirability Scale (MC-SDS) – Form A. The Marlowe-Crowne Social Desirability Scale (MC-SDS) – Form A consists of 11 items and uses a true/false format to measure whether participants respond to survey items in a socially desirable way. The items on the MC-SDS –
Form A describe culturally approved behaviors with minimal implication of psychopathology (Crowne & Marlowe, 1960). The MC-SDS – Form A is used in conjunction with other self-report measures to assess the impact of social desirability on participants’ responses (Reynolds, 1982). The MC-SDS – Form A yielded .74 using the Kuder-Richardson Formula 20 for reliability with a significant correlation coefficient (r = .91; p < .001) and coefficient of determination (r2 = .83). Thus, the MC-SDS – Form A represents a reliable and valid form to assess social desirability (Reynolds, 1982).

 

Procedures

After receiving IRB approval, the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board provided the email addresses of all licensed counselors in Ohio. As an incentive to participate in the study, three participants were randomly selected to receive one of three $75 Amazon gift cards. Email addresses were alphabetized and were sorted into two equal groups. The people in the first half (17,814), those whose names were toward the start of the alphabet, received a recruitment email with a link to the APPS. Those in the second half (17,814) received a recruitment email with a link to the ATTS.

 

Participants who received the APPS were presented with “prostitute” labels in the recruitment email and in the consent form. The APPS group was not exposed to “sex trafficking” labels. Conversely, the ATTS group was presented with “sex trafficking” labels in the recruitment email and in the consent form. The ATTS group was not exposed to “prostitute” language. After completing the demographics form, both groups completed either the APPS or ATTS surveys before moving on to the EAI, IRMA-SF, and MC-SDS – Form A. Statistical analysis indicated there were no significant differences between groups in their demographics.

 

Statistical Analysis

An alpha level of .05 and a medium effect size of .15 were maintained for all statistical procedures (Cohen, 1988). The .05 alpha level was maintained to mitigate the potential of a Type I error (Cowles & Davis, 1982). With a power of .80, a set beta of .20 was obtained, which was an acceptable mitigation of Type II errors (Lenth, 2001). A power analysis using G*Power was conducted for an independent samples t-test, which yielded a sample of 128. The study sample size was 396 participants. A total of 193 participants completed the APPS and 203 participants completed the ATTS.

 

Descriptive statistics of the criterion variables for the APPS and ATTS with the IRMA-SF, EAI, and MC-SDS – Form A were obtained and can be found in Tables 1 and 2. A series of t-tests were used to assess whether a significant difference existed between APPS and ATTS scores. To test for normality, univariate outliers were assessed and a Kolmogorov-Smirnov test was conducted. The assumption of independence was met from the random assignment of respondents and their lack of interaction within the study. The result of Levene’s test was not significant; thus, the assumption of homogeneity of variance was not violated.

 

To test the second research question, two hierarchical regressions were conducted to examine whether APPS and ATTS scores and counselor demographics predicted empathy scores on the EAI. To test the third research question, two hierarchical regressions were conducted to examine whether APPS and ATTS scores and counselor demographics predicted scores of rape myth acceptance on the IRMA-SF. For each of the two hierarchical regressions, counselor attributes were added in order of anticipated strength. After consulting research that examined the effects of variables on rape myth acceptance, the predictor variables were added in the following order: gender (Aosved & Long, 2006; Jimenez & Abreu, 2003; Suarez & Gadalla, 2010), race/ethnicity (Giacopassi & Dull, 1986; Lefley, Scott, Llabre, & Hicks, 1993; Suarez & Gadalla, 2010), level of education, years of experience, and age (Suarez & Gadalla, 2010). Each hierarchical regression analysis was conducted with an alpha level of .05 and power of .80. The assumption of independence was met from the random sorting of respondents and their lack of interaction within the study. The assumption for normality was tested by examining the distribution of the EAI and IRMA-SF scores. Observations more than two standard errors from the mean were removed. An analysis of EAI and IRMA-SF scores was plotted and demonstrated a normal shape. Residual plots from SPSS were examined to test for linearity. The variance inflation factor (VIF) was referenced within the multiple regressions with a heuristic value of four set as the upper bound for acceptable multicollinearity. The residuals appeared scattered around the zero horizontal line which indicated the assumption of homoscedasticity was not violated. Thus, none of the assumptions for conducting a multiple regression were violated.

 

 

Table 1

 

Descriptive Statistics of the Criterion Variables for the APPS

Variable          Mean             SD            Minimum           Maximum         Range

 

EAI                  4.73           0.428               3.59                    5.68                  2.09

AM                4.77           0.555               3.00                    6.00                  3.00

AR                 4.82           0.639               3.20                    6.00                 2.80

ER                  4.41           0.594                2.30                    6.00                  3.75

PT                  4.83           0.529               3.20                    6.00                  2.80

SOA               4.80           0.576               2.75                    6.00                 3.25

IRMA-SF         1.47           0.462               1.00                    2.73                  1.73

MC-SDS          5.17           2.490               0                       11.00                11.00


Note. EAI = Empathy Assessment Index, AM = Affective Mentalizing, AR = Affective Response,
ER = Emotion Regulation, PT = Perspective Taking, SOA = Self-Other Awareness,
IRMA-SF = Illinois Rape Myth Acceptance Short Form, MC-SDS = Marlowe-Crowne Social Desirability Scale.

 

 

 

Table 2

 

Descriptive Statistics of the Criterion Variables for the ATTS

Variable           Mean            SD           Minimum           Maximum        Range

 

EAI                  4.76            0.426               3.86                     5.86              2.00

AM               4.80            0.610               3.20                   6.00              2.75

AR                4.75            0.632               3.20                   6.00              2.80

ER                 4.46            0.483               3.00                   5.50              2.50

PT                 4.88            0.540               3.20                   6.00               2.80

SOA              4.87            0.540               2.75                     6.00              3.25

IRMA-SF         1.38            0.380               1.00                   2.50              1.50

MC-SDS          5.24            2.480               0                      11.00             11.00

 

Note. EAI = Empathy Assessment Index, AM = Affective Mentalizing, AR = Affective Response,
ER = Emotion Regulation, PT = Perspective Taking, SOA = Self-Other Awareness,
IRMA-SF = Illinois Rape Myth Acceptance Short Form, MC-SDS = Marlowe-Crowne Social Desirability Scale.

 

 

Results

 

Analysis of the Marlowe-Crowne Social Desirability Scale – Form A

Prior to analyzing the data, results from the MC-SDS – Form A were examined. The means for both groups were similar although the ATTS group (M = 5.24, SD = 2.48) scored slightly higher than the APPS group (M = 5.17, SD = 2.49). Based on these results, the responses provided by the study sample likely were trustworthy, indicated acceptable rates of social desirability, and likely reflect participants’ true attitudes based on labels.

 

Bivariate Results

Correlations were used to examine the strength of relationships between variables. The following section outlines significant correlations between counselor demographics and scales, subscales, and survey items on the APPS or ATTS, EAI, and IRMA-SF.

 

     Significant correlations between age and survey items. Bivariate correlational analyses were conducted to examine whether significant relationships existed between counselor age and the APPS/ATTS, EAI, and IRMA-SF. Age and PSCV were significantly correlated (r = .128, p < .05). Thus, as participants’ age increases, the belief that prostitutes are victimized also increases. Age was significantly correlated with the IRMA-SF (r = .101, p < .05) in addition to 11 items on the IRMA-SF. The results from the correlation analysis indicated as participant age increases, so too does acceptance of most rape myths. Thus, younger participants were less likely to accept rape myths than older participants. Age was significantly correlated with the Emotion Regulation (r = .200, p < .01) and Affective Mentalizing (r = -.137, p < .01) subscales on the EAI. The results from the bivariate correlational analysis indicated older participants were reportedly better able to regulate their emotions, whereas younger participants reported greater success in cognitively evaluating another person’s emotional state compared to their older counterparts.

 

     Significant correlations with gender. Bivariate correlational analyses were conducted to examine whether significant relationships existed between counselor gender and the APPS/ATTS, EAI, and IRMA-SF. Gender and previous training on prostitution and/or human trafficking were significantly correlated (r = -.112, p < .05). Based on the results of the correlation coefficient, males in the study were less likely to have received training on prostitution and human trafficking compared to females. Gender and years of counseling experience were significantly correlated (r = -.110, p < .05). Based on the results of the correlation coefficient, males reported more counseling experience than females.

 

Regarding the APPS/ATTS surveys, gender was significantly correlated to the PSCV subscale
(r = .102, p < .05), and the PNCV subscale (r = .102, p < .05). Thus, female counselors were more likely
than their male counterparts to perceive prostitutes as victims and were more likely to hold the attitude that prostitution occurred as the result of victimization. Gender and the IRMA-SF were significantly correlated (r = -.269, p < 01), with counselor gender significantly correlating with 19 out of 22 items (86%) on the IRMA-SF. Based on these results, male counselors were more likely to accept rape myths compared to female counselors.

 

On the EAI, gender was significantly correlated to the Perspective Taking (r = .161, p = < .01) and Affective Response (r = .142, p < .01) subscales, in addition to the overall EAI measure (r = .112, p < .05). Thus, female counselors reported greater success with imagining the experiences of others and were more likely to experience automatic reactions when observing the emotions of others. Compared to their male counterparts, females reported higher scores of empathy overall.

 

     Significant correlations with years of counseling experience. Bivariate correlational analyses were conducted to examine whether significant relationships existed between years of counselor experience and the APPS/ATTS, EAI, and IRMA-SF. Years of counseling experience and previous training on prostitution and/or human trafficking were significantly correlated (r = -.142, p < .01). The longer counselors had practiced, the less likely they were to have received training on prostitution and human trafficking. Years of counseling experience was also significantly correlated with the APPS/ATTS item, “Prostitutes/trafficked women earn a lot of money” (r = .153, p < .01). Thus, the longer counselors had practiced, the more they believed engaging in prostitution or being trafficked was a lucrative endeavor. Years of counseling experience were not significantly correlated with overall APPS/ATTS scores (r = .030, p > .05), overall IRMA-SF scores (r = .055, p > .05), or overall EAI scores (r = .025, p > .05).

 

     Significant correlations with training on prostitution and/or human trafficking. Bivariate correlational analyses were conducted to examine whether significant relationships existed between previous training on prostitution/human sex trafficking and the APPS/ATTS, EAI, and IRMA-SF. An examination between training and survey items revealed a significant relationship between previous training and the APPS/ATTS items “Most prostitutes/trafficked women are morally corrupt” (r = .157, p < .01), “Most prostitutes/trafficked women are ugly” (r = .150, p < .01), “Prostitutes/trafficked women spread AIDS” (r = .122, p < .05), Prostitutes/trafficked women enjoy the controlling of men” (r = -.125, p < .05), “Prostitution/sex trafficking is a way for some women to gain power and control” (r = -.113, p < .01), and “Prostitution/sex trafficking harms the institution of marriage” (r = .108, p < .05). Based on the bivariate correlations, participants who had not received training on prostitution/sex trafficking were more likely to believe prostitutes/trafficked women were morally corrupt, ugly, spread AIDS, and harmed the institution of marriage. Counselors who had not received training on prostitution/sex trafficking were less likely to believe that prostitutes/trafficked women engaged in sex acts to gain power and control and enjoyed the controlling of men.

 

Previous training was significantly correlated with the overall IRMA-SF scale (r = .127, p < .05) and the Self–Other Awareness subscale. Thus, counselors with no previous training on prostitution/sex trafficking were more likely to accept rape myths and less likely to successfully engage in the empathy construct of perspective taking.

 

     Significant correlations between survey items. Bivariate correlational analyses were conducted to examine whether significant relationships existed between items on the APPS/ATTS, EAI, and IRMA-SF. The APPS/ATTS survey item “Most prostitutes/trafficked women are ugly” was significantly correlated with 22 items (76%). The results revealed counselors’ perception that the “uglier” prostitutes/trafficked women were, the more likely they were to harm the institution of marriage, increase the rate of sexually transmitted diseases, spread AIDS, damage society’s morals, be morally corrupt, and have drug addictions. This APPS/ATTS item was of interest because of the presence of the label “ugly.”

 

The overall IRMA-SF scale was significantly correlated to 23 items on the APPS/ATTS (79%) and the overall mean score for SDD attitudes (r = -.132, p < .01). Thus, a relationship existed between higher scores of items indicating agreement with SDD and lower levels of rape myth acceptance. The more counselors in this study perceived prostitutes to be victims and prostitution as the result of victimization, the less likely they were to accept rape myths. The IRMA-SF scale was significantly correlated with the EAI subscales of Affective Response (r = -.169, p < .01) and Perspective Taking (r = -.181, p < .01). Counselors with lower levels of rape myth acceptance were better able to imagine and react to the emotions of others. Counselors who believed they were better able to imagine and subsequently experience themselves in other people’s shoes were less likely to accept rape myths.

 

Finally, a significant correlation was found between the APPS/ATTS item “Prostitutes/trafficked women are unable to get out of the situation they are in” and the overall mean score for SDD (r = .494, p < .01). Therefore, counselors who perceived that women who engaged in sex acts were victimized were more likely to believe that women in sex work did not choose it.

 

Research Question 1

A series of t-tests were conducted to examine whether differences existed between APPS and ATTS groups. The overall mean scores between APPS (M = 3.56, SD = .427) and ATTS groups (M = 3.80,
SD = .255), t (394) = -6.952, p < .01, were significantly different. The results of the t-test indicated participants who received “trafficking” labels were significantly more likely to perceive trafficked women as victims and sex trafficking as a form of victimization. Four additional t-tests determined significant differences existed between each of the APPS and ATTS subscales. The results of these t-tests can be found in Table 3 and are presented below.

 

 

Table 3

 

Independent t-Test Between APPS, ATTS, and Subscales

APPS                                  ATTS

M         SD        n                M       SD         n                 t            Sig (p < .01) 

 

Overall   3.56     0.427    193           3.80    0.255     203           -6.950          .000

PNCV     3.80    0.707    193           4.13    0.405     203           -5.830           .000

PNND     3.76    0.553    193           4.12    0.468     203           -6.905           .009

PSCV      3.80    0.575    193           4.33    0.390     203         -10.697           .000

PSND      2.95    0.410    193           2.79    0.276     203            4.500           .000

 

Note. PNCV = Prostitution as Choosing/Victimized, PNND = Prostitution as Normative/Deviant,
PSCV = Prostitutes as Choosing/Victimized, PSND = Prostitutes as Normative/Deviant.

 

 

 

     PNCV. An independent samples t-test was conducted between groups to examine if a significant difference existed on the PNCV subscale. The mean scores between APPS (M = 3.80 SD = .707) and ATTS groups (M = 4.13, SD = .405), t (394) = -5.830, p < .01, were significantly different. Based on the results, participants who received surveys with “trafficking” labels indicated significantly stronger beliefs that sex trafficking was an act of victimization.

 

PNND. An independent samples t-test was conducted between groups to examine if a significant difference existed on the PNND subscale. The mean scores between APPS (M = 3.76, SD = .553) and ATTS group, (M = 4.12, SD = .468), t (394) = -6.905, p < .01, were significantly different. Based on these results, participants who received the survey with “trafficking” labels indicated significantly stronger beliefs that sex trafficking represented a deviant rather than normative act.

 

PSCV. An independent samples t-test was conducted between groups to examine if a significant difference existed on the PSCV subscale. The mean scores between APPS (M = 3.80 SD = .575) and ATTS groups (M = 4.33 SD = .390), t (394) = -10.697, p < .01, were significantly different. Based on these results, participants who received the survey with “trafficking” labels indicated significantly stronger beliefs that trafficked women were victimized and did not choose to engage in sex acts.

 

PSND. An independent samples t-test was conducted between groups to examine if a significant difference existed on the PSND subscale. The mean scores between APPS (M = 2.95, SD = .410) and ATTS groups (M = 2.79, SD = .276), t (394) = 4.50 p < .01, were significantly different. Based on these results, participants who received the survey with “trafficking” labels indicated significantly stronger beliefs that trafficked women who engaged in sex acts were engaging in deviant rather than normative acts.

 

Research Question 2

A regression analysis for the APPS and ATTS was conducted to examine whether the linear combination of APPS or ATTS scores and counselor age, race/ethnicity, gender, work experience, and education significantly predicted participants’ overall scores of empathy on the EAI. Table A1 (see Appendix) outlines the regression analyses for the EAI overall and for each of the five subscales. The results of the regression overall indicated that race was a significant predictor of empathy (R2 = .07, F(6,186) = 2.357, p < .01) and explained 7% of the variance for empathy within the APPS group. The results of the regression were not significant (R2 = .05, F(6,194) = 1.829, p > .05) for the ATTS group.

 

APPS scores and counselor demographics did not predict scores of Affective Mentalizing on the EAI (R2 = .05, F(6,186)=1.952, p > .05). Within the ATTS group, age and attitude were significant predictors of Affective Mentalizing (R2 = .071) and explained 7% of the variance. APPS scores and counselor demographics did not predict scores of Affective Response on the EAI (R2 = .05, F(6,186) = 1.802, p > .05). Within the ATTS group, gender and attitude were significant predictors of Affective Response (R2 = .089) and explained 9% of the variance. When examining the linear combination of APPS scores and counselor demographics, the results of the regression were significant (R2 = .086) although there were no individually significant predictors for Emotion Regulation on the EAI. ATTS scores and counselor demographics did not predict scores on the Emotion Regulation subscale of the EAI (R2 = .089, F(6,194) = 3.14, p > .05). Within the APPS group, race and gender significantly predicted the empathy construct of Perspective Taking (R2 = .105) and explained 10% of the variance. ATTS scores and counselor demographics did not predict scores on the Perspective Taking subscale of empathy (R2 = .044, F(6,195) = 1.494, p > .05). Neither linear combinations of APPS scores and counselor demographics (R2 = .043, F(6,186)=1.401, p > .05) nor ATTS scores and counselor demographics
(R2 = .045, F(6,194) = 1.532, p > .05) predicted scores of Self–Other Awareness on the EAI.

 

Research Question 3

Two hierarchical regressions were conducted to test whether the linear combination of APPS or ATTS scores and counselor age, race/ethnicity, gender, work experience, and education significantly predicted participants’ overall scores of rape myth acceptance on the IRMA-SF. Table 4 outlines the regression analyses for the IRMA-SF. The results of the regression were significant within the APPS group (R2 = 156, F(6,186) = 5.717, p < .05). Gender significantly predicted rape myth acceptance (b = .272, p < .05), as did age (b = .236, p < .05) and attitude (b = -.175, p < .05). Based on these results, male counselors and participants exposed to prostitute labels were more likely to accept rape myths. The results also indicated that the older counselors were, the more likely they were to accept rape myths. Gender, age, and SDD attitudes explained 16% of the variance within the APPS group. The results of the regression were significant within the ATTS group (R2 = .065, F(6,194) = 2.231, p < .05). Gender significantly predicted rape myth acceptance (b = .178, p < .05) and explained 7% of the variance within the ATTS group. Within both groups, male counselors were more likely to accept rape myths compared to female counselors.

 

 

Table 4

Multiple Regression Analysis for APPS (N = 193) and ATTS (N = 203) With IRMA-SF

 

APPS

  

ATTS
Variable B SE B b t Sig. (p) B SE B b t Sig.(p)

 
IRMA-SF

   Constant

   Gender

   Race

   Education

   Age

   Experience

   Attitudes

  

1.807

.347

-.026

.013

.008

-.003

-.190

  

.290

.087

.104

.115

.003

.004

.074

  

 

.272

-.017

.008

.236

-.063

-.175

  

6.236

3.975

-.250

.116

2.358

-.630

-2.561

  

.000

.000**

.803

.908

.019*

.530

.011*

  

1.146

.212

-.184

.055

-.001

-.001

.119

  

.402

.087

.106

.085

.003

.004

.106

  

 

.178

-.128

.049

-.050

-.033

.080

  

2.850

2.444

-1.745

.645

-.435

-.291

1.119

  

.005

.015*

.083

.520

.664

.771

.265

 

Note. *p < .05. **p < .01.

 

 

 

Discussion

 

Based on the results from this study, exposure to “prostitute” and “sex trafficking” labels influenced a significant difference between attitudes in counselors. The combination of attitudes and counselor demographics additionally predicted scores of empathy and rape myth acceptance. Lack of training on sex trafficking was also linked to higher acceptance of rape myth acceptance. The results from this study are consistent with research that identified the stigmatizing effects of the prostitute label (Bradley, 2007; Tomura, 2009), but represent new findings as this study was the first to identify how sex trafficking labels influence empathy and rape myth acceptance in counselors. This study also is the first to illuminate how a lack of training on sex trafficking influences greater rates of rape myth acceptance.

 

Female counselors who completed surveys with sex trafficking labels scored higher on empathy compared to male counselors. This finding is consistent with a study conducted by Mestre, Samper, Frias, and Tur (2009), who confirmed women have a greater proclivity for empathic responses compared to men. According to the present study, male counselors in both groups were more likely to accept rape myths compared to female counselors. This finding is consistent with existing studies that identified greater rates of rape myth acceptance in males compared to females (Aosved & Long, 2006; Cunningham & Cromer, 2016; Suarez & Gadalla, 2010). Counselors exposed to prostitute labels scored significantly higher on Emotion Regulation compared to counselors who received sex trafficking labels. This may be explained by counselors’ need to mitigate the emotional responses required to understand the experiences of sexual violence and physical abuse that characterize prostitution. When counselors completed surveys with prostitute labels, race and gender predicted perspective taking. According to Seward (2014), people of color may demonstrate higher rates of empathy and racial acuity compared to their White counterparts. The effect of membership in a non-majority racial/ethnic group may have increased participant empathy for other marginalized groups. Compared to their male counterparts, women are also members of a disempowered group. Thus, a female gender identity may have influenced participants’ abilities to take perspective when imagining the experiences of others.

 

Implications for the Counseling Profession

The present study illuminates the importance for counselors to recognize that language matters; using “sex trafficked survivor” instead of “prostitute” in client conceptualization and within the therapeutic setting influences attitudes and several independent constructs of empathy and the presence of rape myth acceptance. Using a more strength-based term, such as sex trafficking survivor, may be more appropriate. Avoiding other stigmatizing labels, such as “ugly,” is also important within the counseling setting. As evidenced within this study, counselors perceived “uglier” prostitutes/trafficked women as more likely to harm the institution of marriage, increase the rate of sexually transmitted diseases, spread AIDS, damage society’s morals, be morally corrupt, and have drug addictions.

 

In a study conducted by Kushmider, Beebe, and Black (2015), counselors-in-training described feelings of professional helplessness and a desire for specialized coursework to learn how to better support clients who have survived all types of sexual assault. Obtaining training on sex trafficking represents an essential component of best practices when counseling sex trafficking survivors. As evidenced within this study, counselor educators may better support students by incorporating discussions about human sex trafficking as part of the Council for Accreditation of Counseling and Related Educational Programs (2015) required trauma curriculum. For example, social and cultural foundations courses can include a conversation about sex trafficking as part of a discussion on gender, gender equity, and working with refugee populations.

 

Counselors, counseling supervisors, and counseling students may benefit from receiving training on topics related to human trafficking and sex trafficking. Within this study, counselors in Ohio who had not received training on prostitution/sex trafficking were more likely to believe prostitutes/trafficked women were morally corrupt, were ugly, spread AIDS, and harmed the institution of marriage. Counselors with no previous training on prostitution/sex trafficking were also more likely to accept rape myths and were less likely to successfully engage in the empathy construct of perspective taking. Based on the results of this study, male counselors were less likely to have received previous training compared to females.

 

Counseling supervisors must become knowledgeable about resources, promote awareness, and recognize trauma-informed techniques that support their supervisee and empower the trafficked client. Counseling supervisors may normalize the stress, anxiety, and feelings of helplessness that many counselors experience when working with sex trafficked survivors. Engaging in healthy self-care practices is essential for counselors, counselor educators, and counseling supervisors who work with this challenging population.

 

Limitations and Future Research

Future studies may benefit from using a qualitative or mixed methods approach to explore the relationship between counselor beliefs and human trafficking myths. A detailed analysis of the influence of labels on attitudes across more diverse counselor demographics were not obtained because of an overrepresentation of White females in the study. Future areas of study may benefit from using a stratified sample. Obtaining a deeper understanding of the most common human trafficking myths that exist within the fields of counseling, counselor education, and counselor supervision may be helpful. Researchers could facilitate focus groups at various locations—including university settings, community mental health centers, agencies, and schools—to identify common human trafficking myths. A deeper understanding of trafficking myths is needed to develop effective training programs.

 

The development of competencies for human trafficking is needed. Presently, competencies for working with sex trafficking survivors have not yet been established. Experts on the topic of human trafficking may collaborate and document ways to identify trafficked survivors across school, clinical, and community settings. Evidence-based treatment for counseling sex trafficking survivors and trauma-informed techniques for supervising counselors working with sex trafficking survivors could be identified.

 

Conclusion

 

The results of this study illuminate the effect of labels on attitudes and how those attitudes predict empathy and rape myth acceptance in counselors. The presence of prostitute and sex trafficking labels influenced attitudes and predicted levels of empathy and rape myth acceptance in counselors. The importance of obtaining training on the topic of sex trafficking was also identified. The implications of this study related to the counseling profession were outlined and the study limitations were presented. Counselors must reflect on whether they hold stigmatizing beliefs about individuals who have engaged in commercial sex work or who have survived forced sexual exploitation. Additionally, counselors working with sex trafficking survivors may avoid using the prostitute label as this was linked to greater rates of rape myth acceptance and decreased rates of empathy. Future research areas may identify prevalent human trafficking myths and develop human trafficking competencies. The motivating factors and barriers to receiving training on human sex trafficking may also be explored.

 

 

Conflict of Interest and Funding Disclosure

Data collected in this study was part of a dissertation study.
The dissertation was awarded the 2019 Dissertation Excellence Award
by the National Board for Certified Counselors.

 

 

 

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Appendix

Table A1

 

Multiple Regression Analysis for APPS (N = 193) and ATTS (N = 203) With EAI
                                                            APPS                                                                                             ATTS

Variable B SE B b t Sig. (p) B SE B    b t Sig. (p)
EAI

   Constant

   Gender

   Race

   Education

   Age

   Experience

   Attitudes

  

4.169

-.150

.268

.060

.001

9.389

.085

  

.282

.085

.101

.112

.003

.004

.072

  

 

-.127

.039

.039

.033

.002

.085

  

14.801

-1.763

.2651

.533

.313

.022

1.186

  

.000

.080

.009**

.594

.594

.983

.237

  

4.169

-.193

-.098

-.069

-.005

.007

.227

  

.450

.097

.118

.096

.004

.005

.119

  

 

-.146

-.061

-.055

-.168

.175

.137

  

9.257

-1.993

-.830

-.718

-1.462

1.526

1.906

  

.000

.048

.408

.474

.145

.129

.058
EAI (AM)

   Constant

   Gender

   Race

   Education

   Age

   Experience

   Attitudes

  

4.629

-.132

.269

.271

-.005

.000

.032

  

.367

.111

.132

.146

.004

.006

.094

  

 

-.086

.148

.135

-.125

-.007

.024

  

12.611

-1.191

2.041

1.850

-1.184

-.066

.338

  

.000

.235

.043

.066

.238

.948

.736

  

3.849

-.209

.019

.081

-.013

.008

.371

  

.639

.138

.168

.136

.005

.007

.169

  

 

-.110

.008

.045

-.283

.135

.156

  

6.025

-1.519

.110

.600

-2.483

1.189

2.197

  

.000

.130

.912

.549

.014*

.236

.129*
EAI (AR)

   Constant

   Gender

   Race

   Education

   Age

   Experience

   Attitudes

  

4.082

-.252

.231

-.091

.000

.002

.163

  

.424

.128

.152

.169

.005

.006

.108

  

 

-.144

.111

-.039

-.007

.025

.109

  

9.630

-1.976

1.520

-.536

-.069

.235

1.509

  

.000

.050

.130

.593

.945

.815

.133

  

3.864

-.335

-.232

-.233

-.008

.006

.378

  

.663

.143

.174

.141

.005

.007

.175

  

 

-.169

-.097

-.124

-.166

.102

.152

  

5.832

-2.350

-1.336

-1.656

-1.475

.904

2.162

  

.000

.020*

.183

.099

.142

.367

.032*
EAI (ER)
Constant   Gender   Race   Education   Age

   Experience

   Attitudes

  

3.353          .387                           8.658        .000            4.623           .512                          9.031            .000

.119          .117         .073          1.017        .311              .078           .110             .052        .710            .478

.202          .139         .104          1.454        .148             -.173           .134            -.095     -1.285           .200

-.068          .154        -.032          -.443         .148             -.179           .109           -.125      -1.643           .102

.008          .004         .191          1.831        .069               .003         .004             .086         .744            .458

.003          .006         .049             .469        .639               .005         .005             .112         .975            .331

.139          .099         .100          1.403        .162              -.045         .135            -.024       -.332            .740
EAI (PT)

   Constant

   Gender

   Race

   Education

   Age

   Experience

   Attitudes

  

4.442          .341                        12.024        .000              4.012         .575                           6.980            .000

-.273          .103       -.188         -2.654         .009*            -.239           .124           -.142     -1.935            .054

.412          .123        .238           3.361        .001*            -.093           .151           -.046       -.619             .537

.012          .136        .007             .091        .927               .016           .122            .010          .132            .895

-.002          .004       -.040           -.389         .698              -.005           .005           -.130     -1.128            .261

-.001          .005       -.102           -.117         .907               .005           .006             .096          .834            .406

.038          .087        .031             .435        .664               .302           .152             .143        1.990            .048
EAI (SOA)

   Constant

   Gender

   Race

   Education

   Age

   Experience

   Attitudes

  

4.292

-.153

.200

.225

.005

-.003

.047

  

.385

.116

.138

.153

.004

.006

.098

  

 

-.097

.106

.108

.114

-.055

.035

  

11.159

-1.323

1.448

1.465

1.074

-.516

.480

  

.000

.188*

.149

.145

.284

.607

.632

  

4.610

-.214

.022

-.009

-.003

.012

.070

  

.570

.123

.150

.121

.005

.006

.151

  

 

-.128

.011

-.006

-.078

.237

.034

  

8.082

-1.741

.147

-.075

-.672

2.057

.466

  

.000

.083

.883

.940

.503

.041

.642

Note. AM = Affective Mentalizing, AR = Affective Response, ER = Emotion Regulation, PT = Perspective Taking,
SOA = Self–Other Awareness, Attitudes = Mean Score on APPS or ATTS.
*p < .05. **p < .01.

Stacey Diane Aranez Litam is an assistant professor at Cleveland State University. Correspondence can be addressed to Stacey Litam, 2121 Euclid Avenue, Julka Hall 272, Cleveland, Ohio 44115, s.litam@csuohio.edu.